Miguel Xavier

University of Lisbon

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José Miguel Caldas‐de‐Almeida

Universidade Nova de Lisboa

Oye Gureje

University of Ibadan

Ronald C. Kessler

Harvard University Press

Jordi Alonso

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública

Giovanni de Girolamo

Centro San Giovanni di Dio Fatebenefratelli

Amit Malik

University of Al-Qadisiyah

Josep María Haro

Parc Sanitari Sant Joan de Déu

Silvia Florescu

National School of Public Health, Management and Professional Development

Ronny Bruffaerts

KU Leuven

Kate M. Scott

University of Otago

Cooperative Institutions

Harvard University

Universidade Federal de Viçosa

University of Lisbon

Universidade Nova de Lisboa

UNSW Sydney

Columbia University

University College London

Queensland Centre for Mental Health Research

University of Washington

University of Michigan–Ann Arbor

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The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative

BMC Medicine (2017)

Dan J. Stein Carmen Lim Annelieke M. Roest Peter de Jonge Sergio Aguilar‐Gaxiola

There is evidence that social anxiety disorder (SAD) is a prevalent and disabling disorder. However, most of the available data on the epidemiology of this condition originate from high income countries in the West. The World Mental Health (WMH) Survey Initiative provides an opportunity to investigate the prevalence, course, impairment, socio-demographic correlates, comorbidity, and treatment of this condition across a range of high, middle, and low income countries in different geographic regions of the world, and to address the question of whether differences in SAD merely reflect differences in threshold for diagnosis.Data from 28 community surveys in the WMH Survey Initiative, with 142,405 respondents, were analyzed. We assessed the 30-day, 12-month, and lifetime prevalence of SAD, age of onset, and severity of role impairment associated with SAD, across countries. In addition, we investigated socio-demographic correlates of SAD, comorbidity of SAD with other mental disorders, and treatment of SAD in the combined sample. Cross-tabulations were used to calculate prevalence, impairment, comorbidity, and treatment. Survival analysis was used to estimate age of onset, and logistic regression and survival analyses were used to examine socio-demographic correlates.SAD 30-day, 12-month, and lifetime prevalence estimates are 1.3, 2.4, and 4.0% across all countries. SAD prevalence rates are lowest in low/lower-middle income countries and in the African and Eastern Mediterranean regions, and highest in high income countries and in the Americas and the Western Pacific regions. Age of onset is early across the globe, and persistence is highest in upper-middle income countries, Africa, and the Eastern Mediterranean. There are some differences in domains of severe role impairment by country income level and geographic region, but there are no significant differences across different income level and geographic region in the proportion of respondents with any severe role impairment. Also, across countries SAD is associated with specific socio-demographic features (younger age, female gender, unmarried status, lower education, and lower income) and with similar patterns of comorbidity. Treatment rates for those with any impairment are lowest in low/lower-middle income countries and highest in high income countries.While differences in SAD prevalence across countries are apparent, we found a number of consistent patterns across the globe, including early age of onset, persistence, impairment in multiple domains, as well as characteristic socio-demographic correlates and associated psychiatric comorbidities. In addition, while there are some differences in the patterns of impairment associated with SAD across the globe, key similarities suggest that the threshold for diagnosis is similar regardless of country income levels or geographic location. Taken together, these cross-national data emphasize the international clinical and public health significance of SAD.

10.1186/s12916-017-0889-2

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Obsessive‐compulsive symptoms in primary focal dystonia: A controlled study

Movement Disorders (2011)

J. Bernardo Barahona‐Corrêa Paulo Bugalho João Tiago Guimarães Miguel Xavier

Abstract Primary focal dystonia is an idiopathic neurological disorder causing involuntary muscle contraction. Its pathophysiology probably involves the basal ganglia and cortical‐basal pathways. Primary dystonia appears to be associated with significant obsessive‐compulsive symptoms, but evidence remains scarce and contradictory. We addressed the following research questions: (1) Do primary dystonia patients have high obsessive‐compulsive symptom scores? (2) Are these symptoms more severe in dystonia than in controls with equivalent peripheral neurological disorders? and (3) Is psychopathology different in botulinum toxin‐treated and ‐untreated dystonia patients? This work was a cross‐sectional, descriptive, controlled study comprising 45 consecutive patients with primary focal dystonia (i.e., blepharospasm, spasmodic torticollis, or writer's cramp) 46 consecutive patients with hemifacial spasm, cervical spondylarthropathy, or carpal tunnel syndrome, and 30 healthy volunteers. Assessment included the DSM‐IV based psychiatric interview, Symptom Checklist 90R, Yale‐Brown Obsessive‐Compulsive Scale and Checklist, and the Unified Dystonia Rating Scale. Dystonia patients had higher Yale‐Brown Obsessive‐Compulsive Symptom scores than both control groups. Dystonia patients with obsessive‐compulsive symptom scores above cut‐off for clinical significance predominantly developed hygiene‐related symptoms. Major depression and generalized anxiety disorder were the most frequent psychiatric diagnoses in primary focal dystonia. Obsessive‐compulsive disorder frequency was 6.7%. Primary focal dystonia patients have higher obsessive‐compulsive symptom scores than individuals with similar functional disabilities resulting from other neurological disorders, suggesting that obsessive‐compulsive symptoms in dystonia are not reactive to chronic disability. Dystonic muscle contractions and obsessive‐compulsive symptoms may share a common neurobiological basis related to cortical‐basal dysfunction. Psychopathology, especially obsessive‐compulsive symptoms, should be actively explored and treated in primary focal dystonia. © 2011 Movement Disorder Society

Focal dystonia

Blepharospasm

Spasmodic Torticollis

Cervical dystonia

Movement Disorders

Trihexyphenidyl

10.1002/mds.23906

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Needs Assessment Framework for Mental Health Policy in Treating Persons With Serious Mental Illness in Azerbaijan

Psychiatric Services (2019)

Jamila Ismayilova Miguel Xavier Kerim Münir

Persons with serious mental illness and their families in low- and middle-income households continue to face important challenges and barriers to care. In Azerbaijan, the needs of individuals with serious mental illness have been studied to gain insight for improvement of mental health policy and research. This column describes needs assessment work by the National Mental Health Center, located in Baku, as well as lessons learned and further recommendations regarding better targeted, culturally informed, and person-centered care. In particular, the authors emphasize the importance of gender and socioeconomic disparities in care provision, disparities that have a significant parallel in other post-Soviet Eastern European and Central Asian countries.

Mental Health Care

10.1176/appi.ps.201700474

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Disability Mediates the Impact of Common Conditions on Perceived Health

PLoS ONE (2013)

Jordi Alonso Gemma Vilagut Núria D. Adroher Somnath Chatterji Yanling He

Background We examined the extent to which disability mediates the observed associations of common mental and physical conditions with perceived health. Methods and Findings WHO World Mental Health (WMH) Surveys carried out in 22 countries worldwide (n = 51,344 respondents, 72.0% response rate). We assessed nine common mental conditions with the WHO Composite International Diagnostic Interview (CIDI), and ten chronic physical with a checklist. A visual analog scale (VAS) score (0, worst to 100, best) measured perceived health in the previous 30 days. Disability was assessed using a modified WHO Disability Assessment Schedule (WHODAS), including: cognition, mobility, self-care, getting along, role functioning (life activities), family burden, stigma, and discrimination. Path analysis was used to estimate total effects of conditions on perceived health VAS and their separate direct and indirect (through the WHODAS dimensions) effects. Twelve-month prevalence was 14.4% for any mental and 51.4% for any physical condition. 31.7% of respondents reported difficulties in role functioning, 11.4% in mobility, 8.3% in stigma, 8.1% in family burden and 6.9% in cognition. Other difficulties were much less common. Mean VAS score was 81.0 (SD = 0.1). Decrements in VAS scores were highest for neurological conditions (9.8), depression (8.2) and bipolar disorder (8.1). Across conditions, 36.8% (IQR: 31.2–51.5%) of the total decrement in perceived health associated with the condition were mediated by WHODAS disabilities (significant for 17 of 19 conditions). Role functioning was the dominant mediator for both mental and physical conditions. Stigma and family burden were also important mediators for mental conditions, and mobility for physical conditions. Conclusions More than a third of the decrement in perceived health associated with common conditions is mediated by disability. Although the decrement is similar for physical and mental conditions, the pattern of mediation is different. Research is needed on the benefits for perceived health of targeted interventions aimed at particular disability dimensions.

CIDI

Depression

10.1371/journal.pone.0065858

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La constitucionalización cosmopolíta del Derecho Internacional: una reconstrucción crítica de la propuesta de Jürgen Habermas

Arteta Arilla Miguel Xavier

En este trabajo hemos pretendido demostrar que, aunque otorga excesivo peso a los Estados y no cierra definitivamente todas las aporias del cosmopolitismo, la fundamentacion discursiva de una teoria juridico-politica que se mueve entre la facticidad y la validez, permite a Habermas afrontar los puntos debiles de la tradicion kantiana, en la que se inscribe, y apuntalar una propuesta de constitucionalizacion cosmopolita del Derecho internacional suficientemente solvente como para arrostrar los retos que se le van presentando. Pondremos a prueba esta hipotesis, a su vez, con cuatro sub-hipotesis que, no por casualidad, coinciden con las cuatro partes que componen este trabajo. Y trataremos de responder y confirmar esas cuatro sub-hipotesis asumiendo para cada una dos o tres objetivos; tampoco por casualidad, cada uno responde a un capitulo distinto. Primera sub-hipotesis: La base discursiva de su teoria de dos niveles es optima para superar las aporias kantianas senaladas por Hegel y permite combatir muchas de las teorias mas conservadoras que legaron a Hegel a costa de disolver al individuo, restandole su autonomia. Habermas consigue unir satisfactoriamente eticidad y moralidad. Para corroborarlo trataremos de demostrar que buena parte del legado hegeliano anula la autonomia del individuo y astilla la razon universal presupuesta por la Ilustracion dando pie a un mosaico de racionalidades que impide trascender el mundo que somos y cortocircuita cualquier idea de razon que desee tender hacia la unidad, aun cuando pretenda hacerlo “desde una pluralidad de voces”. Frente al astillamiento de la razon, que disuelve la autonomia y cortocircuita la razon, impidiendonos aprender de la historia e imposibilitando la evolucion social, mostraremos como Habermas introduce al pensamiento kantiano en la intersubjetividad, gracias al legado de G. H. Mead, y rescata lo mejor de Kant y de Hegel, conservando la autonomia del sujeto en forma de razon comunicativa del interlocutor valido. La evolucion social es posible. La teoria comunicativa (reproduccion simbolica de la sociedad) junto con la teoria de sistemas (reproduccion material de la sociedad) permiten, unidas, captar mucho mejor la complejidad del mundo social, abriendo un espacio inmenso para la critica sin perder de vista la facticidad. Se dara asi cuenta de como pueden desarrollarse/reproducirse legitimamente la personalidad, la cultura y la sociedad. El Derecho constituira el factor clave, debido a su papel de bisagra entre reproduccion simbolica y reproduccion material de la sociedad. Segunda sub-hipotesis: Volcado en el Derecho, y gracias a su formulacion del principio democratico, junto con la perspectiva que le brinda su teoria de dos niveles, Habermas puede perfeccionar el analisis kantiano de la soberania popular y proponer un proceso de constitucionalizacion que gira en torno al medio que es el derecho, el poder y la solidaridad. Podra, ademas, justificar la necesidad (y avalar con cierta empiria la posibilidad) de extenderla en forma de constitucionalizacion cosmopolita del Derecho internacional. Trataremos de confirmar esto mostrando como el Derecho, el poder y la solidaridad conforman, en la teoria habermasiana, tres elementos caracteristicos de un buen proceso de constitucionalizacion porque, bien imbricados, controlan la temida diferenciacion sistemica y conforman una democracia con dimension epistemica. Con ellos se reconstruye intersubjetivamente el concepto republicano de autonomia, revisado en terminos de Teoria del discurso. En segundo lugar, trataremos de mostrar que Habermas es convincente cuando afirma que hoy es necesario extender ese proceso de constitucionalizacion mas alla de las fronteras nacionales. Tercera sub-hipotesis: Al detectar algunos presupuestos erroneos que forzaron a Kant a escoger entre Republica mundial y asociacion de naciones, Habermas abre una via nueva, fructifera y, en cierto modo, incluso avalada empiricamente para que podamos caminar hacia la constitucionalizacion cosmopolita del Derecho internacional. La corroboracion de esto pasa por demostrar que los ajustes teoricos (entre los cuales destaca una soberania dividida “en el origen” de la comunidad que va a crearse) permiten a Habermas continuar convincentemente con el legado kantiano, despegandose de las criticas enemigas y sin necesidad de una teleologia historica. Y no podremos dejar de ahondar, si queremos dar cuenta de la verosimilitud de todo esto, en su propuesta cosmopolita. Como veremos, coincide en mucho con lo que ya hay y con lo que la conciencia social espera. Cuarta sub-hipotesis: Aun siendo la de Habermas una propuesta juridico-politica increiblemente exhaustiva, razonada y razonable es dificil que escape por completo a los clasicos puntos debiles de toda propuesta cosmopolita, en general, y deliberativa, en particular.

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[Family interventions in schizophrenia. From theory to the real world in Portugal today].

PubMed (2006)

Manuel Gonçalves‐Pereira Miguel Xavier António Neves J. Bernardo Barahona‐Corrêa Gráinne Fadden

In the field of pychoeducational interventions in schizophrenia, terminology is sometimes misleading and further efforts are needed to specify and operationalise terms such as psychoeducation or family intervention, especially wherever they are adapted, for example, for use in non-English speaking countries. On the other hand, in spite of growing evidence of their clinical effectiveness, family interventions for schizophrenia are still not routinely implemented in real life clinical settings. Furthermore, the current poverty of original literature or replication studies in Portugal in the field of family interventions is astonishing. Several high-quality review papers have been published in the last two decades, summarising or meta-analysing data concerning efficacy, effectiveness and efficiency of these family interventions worldwide, but mostly in Anglo-Saxon literature. These findings were indeed incorporated in several clinical guidelines, namely in the United Kingdom. But there seems to exist, in a considerable number of settings, a lack of will to implement scientific findings established for more than twenty years. In developed countries, this should be addressed as a true paradox.

Psychoeducation

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P-308 - Restructuring child and adolescent mental health services in portugal

European Psychiatry (2012)

C. Marques Marco Torrado Miguel Xavier P. Mateus Á. Carvalho

According to WHO, 2 million young people in Europe suffer from mental disorders, sometimes receiving no care. In 2007, the Portuguese Government set a new Mental Health Plan (MHP), which included guidelines for Child and Adolescent Mental Health Services (CAMHS) development. Although positive aspects have been achieved, CAMHS evaluation identified significant deficiencies (accessibility, equity and quality of care). In what concerns children and adolescents, the MHP aims: To program new CAMHS in every central and district hospital, in order to cover the entire country. To ensure equity and promote human rights. To decentralise and integrate mental health in the general health system (including primary care) in order to increase access and reduce stigma; A National Coordination Body for Mental Health has been empowered to assure the implementation of the MHP, with external monitoring from WHO. This Coordinating Body includes a team of child and adolescent mental health experts. There have been significant improvements in several key areas: diagnosis of current situation (structures, human resources), creation of new CAMHS, reshaping financing model proposals, planning of residential and day unit facilities for adolescents with double diagnosis, mental health promotion and domestic violence prevention programmes, advocacy and stigma. The MHP can help to overcome some of the problems present in MHS in Portugal. Special attention should be given to CAMHS, namely through the increase of new services and new teams. Nevertheless, given the present crisis context, broad policies can negatively influence and restraint the mental health plan implementation.

Restructuring

Equity

10.1016/s0924-9338(12)74475-9

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National Mental Health Plan: An Opportunity to Implement Psychoeducation in Portugal?

European Psychiatry (2009)

Miguel Xavier Manuel Gonçalves‐Pereira José Miguel Caldas‐de‐Almeida

It is well known that due to deinstitutionalization, faster discharge from wards and insufficient community resources, direct contact of the severe mentally ill patients with their families has increased a lot in the last years. In the last two decades, mental health services across Europe developed a diversified offer of programmes, including psychoeducation and family interventions, in order to ensure an effective response to the different care needs. In Portugal, the lack of planning and consistent support in the improvement of mental health services means that the country is lagging behind significantly in this field in relation to other European countries. Concerning the specific subject of psychoeducation and family interventions for psychotic patients and their families, its true that treatment in Portugal seldom comport with the best scientific evidence, but so far there has been no pressure on the services to change this oddly situation. The new National Mental Health Plan, launched in 2008, sets that i. People with mental disorders should be involved and participate in the planning and development of the services they benefit from, and that ii. Family members of the mentally ill should be considered as important partners in care provision, and encouraged to participate in this provision and to receive the necessary training and education. Based on these principles, the Mental Health Plan may be a critical opportunity to implement psychoeducation and family interventions in Portugal. The authors address this issue, discussing also the potential role of new models of contracting, financing, accounting and monitoring.

Psychoeducation

10.1016/s0924-9338(09)70466-3

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EPA-0485 - Evaluating the somatic impairments in the elderly: preliminary results of the 10/66-dementia research group prevalence study in Portugal

European Psychiatry (2014)

Miguel Xavier A.M. Cardoso Cátia Raminhos Joaquim Alves da Silva Ana Verdelho

Background Somatic comorbidities are common among elderly patients with mental health problems, namely dementia and depression. Quite often, somatic problems are associated with a substantial impairment in daily routines, as well as to a worse outcome of the neuropsychiatric condition. Objectives to investigate the level of impairment due to comorbid somatic problems in the elderly, as part of the implementation of the 10/66- Dementia Research Group Population-based Research Protocol in Portuguese settings. Methods A cross-sectional survey was implemented of all residents aged 65 in a semi-rural area in Southern Portugal. Evaluation included a cognitive module and the Geriatric Mental State-AGECAT (GDS). Training of the field researchers was conducted with the supervision of the 10/66-DRG coordinators (CF, MP). Results 703 elderly participants were evaluated. Interference with daily activities was present in every area assessed, with moderate to severe impact in the following areas: Arthritis or rheumatism (36,9%), eyesight problems (19,8%), hypertension (10,5%) and gastro-intestinal conditions (10,4%). 48,9% of the participants had at least one contact with a primary care health centre in the last three months, and 22,5% had at least one contact with a doctor in a general hospital. Conclusions Results showed a relevant degree of impairment due to somatic conditions, and a high use of services, namely at primary care level. The significant prevalence of comorbid somatic conditions should be taken into account regarding the organization of services directed to older patients with mental health problems, that has been considered a priority in the Portuguese Mental Health Plan 2007–2016.

10.1016/s0924-9338(14)77892-7

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P-613 - Implementation science: a new paradigm in organizing mental health services

European Psychiatry (2012)

P. Mateus José Miguel Caldas‐de‐Almeida Á. Carvalho Miguel Xavier

Implementation science evaluates the processes that move evidence-based treatments into routine use. In Portugal, a new National Mental Health Plan with a community model has been launched in 2007. In order to change the operational model for mental health teams, a case-management (CM) training program has been prepared by the Ministry of Health. To evaluate the effectiveness of the "implementation process" according to: a) profile of mental health services, b) organisational culture, c) barriers, d) degree of implementation. 30 mental health services were assessed. The "implementation process" included a CM course (SAMHSA procedures). Implementation effectiveness and barriers were assessed by: Barriers and Facilitators Assessment Instrument (MAJ Peters, 2001) and Illness Management Fidelity Scale - IMR (Mueser, 2009). Assessment of services showed: liaison with primary health care (50%), routine use of guidelines (57%), single clinical records (50%), training and continuous education plan (85%), research practice (21%). Regarding the professionals, 70% reported previous case management practice, but only 20% had a formal training in CM. The CM approach was fully implemented in 36,3% of the services, fairly implemented in 45,4%, but still not enough implemented in 18,3%. Main barriers identified were related with availability of time (61%), lack of dedicated facilities (61%), low motivation (38%) and absence of financial incentives (38%). In Portugal several barriers still undermine the full implementation of CM. Implementation science may contribute to improve the delivery of evidence-based care.

Christian ministry

Implementation research

10.1016/s0924-9338(12)74780-6

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