Neurological, Psychiatric, and Developmental Disorders:: Meeting the Challenge in the Developing World

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National Academies Press, Jan 1, 2001 - Medical - 458 pages
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Brain disorders-neurological, psychiatric, and developmental-now affect at least 250 million people in the developing world, and this number is expected to rise as life expectancy increases. Yet public and private health systems in developing countries have paid relatively little attention to brain disorders. The negative attitudes, prejudice, and stigma that often surround many of these disorders have contributed to this neglect.

Lacking proper diagnosis and treatment, millions of individual lives are lost to disability and death. Such conditions exact both personal and economic costs on families, communities, and nations. The report describes the causes and risk factors associated with brain disorders. It focuses on six representative brain disorders that are prevalent in developing countries: developmental disabilities, epilepsy, schizophrenia, bipolar disorder, depression, and stroke.

The report makes detailed recommendations of ways to reduce the toll exacted by these six disorders. In broader strokes, the report also proposes six major strategies toward reducing the overall burden of brain disorders in the developing world.

  

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Contents

Introduction
13
NEUROLOGICAL PSYCHIATRIC AND DEVELOPMENTAL DISORDERS
14
CHALLENGES FOR THE CARE OF BRAIN DISORDERS
15
GOALS OF THE STUDY
16
STUDY APPROACH
17
ORGANIZATION OF THE REPORT
18
The Magnitude of the Problem
21
EFFECTS ON COMMUNITIES AND NATIONS The Disease Burden
22
Research
198
Neurocysticercosis
201
EPIDEMIOLOGY
202
PREVENTION
204
Schizophrenia
217
SCOPE OF THE PROBLEM
221
Social and Economic Costs
222
PREVALENCE AND INCIDENCE
225

EFFECTS ON INDIVIDUALS AND FAMILIES Lost Productivity
33
THE ROLES OF POVERTY AND GENDER INEQUALITY
34
PovertyAssociated Risk Factors for Brain Disorders
35
The Role of Gender Inequality
37
CAPACITY TO ADDRESS BRAIN DISORDERS
41
Integrating Care of Brain Disorders into Health Care Systems
57
DEVELOPING A SYSTEM OF CARE Primary Care
61
The Role of Secondary and Tertiary Care
64
BUILDING CAPACITY THROUGH TRAINING
65
COLLABORATION WITH OTHER HEALTH AND NONHEALTH SECTORS
67
Schools and Educators
68
Community Organizations
70
THE COST OF INTEGRATING SERVICES
71
BUILDING RESEARCH CAPACITY THROUGH COLLABORATION
73
POLICY IMPLICATIONS
75
Local Policy
78
INTERNATIONAL SUPPORT FOR SYSTEMS OF PRIMARY CARE
79
The Role of Professional Societies and International Organizations
80
Provision of Essential Drugs
83
NATIONAL CENTERS FOR TRAINING AND RESEARCH
85
Findings and Future Strategies
97
REDUCING THE DISEASE BURDEN NOW Increasing Awareness
98
Utilizing Existing Health Systems
99
Expanding Use of CostEffective Interventions
100
CREATING OPTIONS FOR THE FUTURE
103
The Role of International Aid
106
Developmental Disabilities
113
Cognitive Disabilities
114
Motor Disabilities
115
Behavioral Disorders
116
PREVALENCE AND INCIDENCE
118
Prevalence of Cognitive Disabilities
119
Prevalence of Motor Disabilities
121
Prevalence of Behavioral Disabilities
124
RISK FACTORS
125
Nutritional Deficiencies
126
Infection
129
Environmental Toxins
131
Perinatal and Neonatal
132
Poverty and Trauma
133
Rehabilitation
141
Cost Analysis
153
CAPACITY
154
Epilepsy
179
SCOPE OF THE PROBLEM
181
Treatment Cap
182
Infectious Diseases
183
Mortality Rates
186
Genetic
187
Parasitic Infections
188
Bacterial Infections
189
Febrile Seizures
190
Treatment
191
CAPACITY
195
Incidence
226
RISK FACTORS
227
Brain Pathology
230
Functional Neuroimaging and Cognitive Deficits
231
Substance Abuse Comorbidity
233
INTERVENTIONS
235
Prevention
236
CAPACITY
243
Bipolar Disorder
257
SCOPE OF THE PROBLEM
258
PREVALENCE AND INCIDENCE
261
RISK FACTORS
263
Environmental
264
INTERVENTIONS
266
CAPACITY
272
Depression
283
SCOPE OF THE PROBLEM
286
Mortality
287
Social and Economic Costs
289
PREVALENCE AND INCIDENCE
291
RISK FACTORS
294
Environmental
295
Genetic
296
Gender and Reproductive Health
297
Neuroendocrine
298
Factors Affecting Course and Outcome
299
INTERVENTIONS
300
Preventing Suicide
305
Treatment
306
Cost Analysis
310
CAPACITY
311
Training
312
Research
314
Stroke
339
SCOPE OF THE PROBLEM
340
PREVALENCE AND INCIDENCE
344
Prevalence
345
Incidence
346
RISK FACTORS
349
Risk Factors for Stroke in Children
353
Factors Affecting Course and Outcome
355
INTERVENTIONS
357
Treatment
361
Cost Analysis
362
CAPACITY
363
Epilogue
377
The Study Approach
383
Measurement Issues in Calculating the Global Burden of Disease
391
Workshop Agenda
393
Economic Analysis
397
Committee and Staff Biographies
419
Glossary
425
Acronyms
431
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