Hello. My name is Emiliano Albanese, and we're going to be talking about neuropsychiatric conditions and disorders from a public health perspective. We'll start from the definition of health that comes from the Constitution of the World Health Organization therefore, dates back to 1948. And in this definition of health, you see that the physical component is actually accompanied by the mental and the social part of well-being, in the well known, not merely absence of disease. So, the mental and social acception of well-being in the original definition of health, were definitely present and somewhat should have been used, as a guidance in general in public health to be concerned with these aspects, to pursue the health for populations in the world. However, it must be recognized that these have been largely neglected. And although this is an integral part of health, there are some obvious reasons. The first one is the fact that, in general, the criticism to the field of public mental health and in general of psychiatry, is that they have not produced convincing, valid, and reliable measures of the distribution, that is the prevalence of diseases, and their impact in the general population. Having not numbers is clearly problematic when you try and pursue the case of any argument. But in the second place is the fact, it was believed, up until a few decades ago that, in any case for mental health, for psychiatric disorders, there was not much that could be done in terms of prevention and in terms of treatment, whether this was drugs and therefore pharmaceutical, or other types of intervention, more psychotherapeutic based. Now, the other major component that impeded the integration of mental and social well-being in public health in general, is the fact that mental disorders are still highly stigmatized. This stigmatization leads, in most cases, to a discrimination of patients. A discrimination by their peers, in their communities, by society at large. But also by health specialists, who essentially are less prone to attend to the aspects of physical health or health in general of these people, because of the great difficulties in the relationship which is part of the disease itself. So these aspects are just two major examples, that we believe may apply on a global scale. But you see that there is a third point here in the list. And actually they may be many others, because depending on the context, we believe that there are many other barriers that essentially prevented mental and social well-being to be proactively integrated in public health in the world. So, what is mental health? This is one definition, so it's of course, a state of well-being. And the idea is that, the person should be able to realize their own potential, but also to respond effectively or cope with the normal strains or difficulties of life, which is just normal component and things that happen, life events of all sorts. The idea of being resilient and respond to these is something that we apprehend and that we learn because, we want to restore to a state in which essentially we are able to contribute to society, just following what personal inclinations are. So as you can see, this definition of mental health is somewhat elusive if it is compared to a definition of physical health and it's not just because of the mere absence of disease. And, the fact that it's a elusive definition of mental health, has been officially recognized by the World Health Organization back in 2001. And there are a number of these scores of the philosophical kind in most respects, to try and address why it is hard to define mental health and not just public mental health. The idea behind psychiatry in general is that, in most respect, mental disorder and neuropsychiatric disorders have an important ideological component in their definitions. So they're strongly bound to the cultures. And that's because the impact of the disease, the dysfunction, and the maladaptive behaviors of those affected, are important component to come to a diagnosis. And when we say diagnosis, we believe it is important to remind that a diagnosis, so labeling somebody with a disease or another, has some classification purposes of utility. Because we make a distinction with other diseases and because we make a distinction of what is the norm or what we call sometimes normality, which clearly changes across culture. So essentially, the two approaches that we have, that we use comes at the same time, a culturally bound approach, because we want to analyze and determine what happens where the person affected lives. But also, another approach which is totally trans-cultural and recognizes the generalizability and the common aspects and components, including an implied underpinning neuropathology and neurobiology of mental disorders, that is totally independent of the culture. We named these two emic and the etic approach, and they come from the phonemic and the phonetic, the Latin words. The definition of public mental health would follow and is essentially the large discipline that it is concerned with the reduction of the incidence and the prevalence of mental disorders, but also of their impact in the general population. What is probably missing in this definition is the idea that public mental health is also primarily concerned with the promotion of mental health. Because, if its definition is the concept of well-being, we want to promote and improve the level of well-being in population at its maximum. So, as you can see, it's a really rich and wealthy composite field in public health because, it encompasses all dimension of prevention, diagnosis, treatment but also health promotion in the general population. Now of course, the cornerstone of public mental health would be psychiatric epidemiology, as epidemiology is the cornerstone for public mental health. And psychiatric epidemiology has an inherent difficulty to face in the first place. And it's probably something that we can sum up with the idea, that the medical assumption, that a disorder exists in the population in the first place, before we go out and attempt to measure it, is with mental disorder somewhat more tenuous and this is because we are unable to locate why the disease is, for instance, and because these is less linked to the underlying physiopathology. Now, psychiatric epidemiology made important improvements in the past decades. And so,,we came from an attitude and a way to make diagnosis that was limited to specialist and psychiatrist. So, the experts point of view, which is the totally unstructured approach to a diagnosis. And as you can imagine, this is not exactly comparable with an epidemiological approach, because the experts cannot assess too many people, large samples, as we need to know the epidemiology, but also because replication and reliability of these diagnostic assessments cannot be guaranteed in large samples and population based studies. So we moved to a second phase, which is the self-reported symptoms because we wanted to elicit what the actual, in that actual moment people were perceiving in terms of symptomatology or what we could see in terms of signs as the expression of the mental disorder. And then, ultimately this is still the era of the highly fully structured approach, where algorithms are used to define diagnostic entities. You can see that the three phase clearly overlapped historically and is still at present. This is simply an example, this slide of what happened in terms of actual epidemiologic psychiatric surveys in the general population. Let me just focus on the first one, which is the international pilot studies on schizophrenia, because this was revolutionary in the sense, that change, the viewpoint that schizophrenia was a disease only of Western countries and most developed cultures. And that there was potential, cultural and medical colonialism in trying to label people with schizophrenia in the low and middle income countries. And that was the consequence of the idea, that most of the symptoms and signs that wouldn't need to be present to make a diagnosis, are somewhere, somehow part of the cultures, somewhere else, not in Western countries. Thank you very much.
