Clinical Review Recent advances


BMJ 2001; 323 doi: (Published 24 November 2001) Cite this as: BMJ 2001;323:1228
  1. Declan Lyons, specialist registrara,
  2. Declan M McLoughlin (, senior lecturerbb
  1. a Maudsley Hospital, London SE5 8AZ
  2. b Section of Old Age Psychiatry, Institute of Psychiatry, London SE5 8AF
  1. Correspondence to: D M McLoughlin

    The recent recognition of the global importance of mental disorders has put psychiatry firmly on the international health agenda. The World Health Organization has estimated that neuropsychiatric disorders and suicide account for 12.7% of the global burden of disease.1 Major depression, schizophrenia, bipolar affective disorder, alcohol misuse, and obsessive compulsive disorder account for five of the 10 leading causes of disability in low and middle income countries. In high income countries, dementia is the third most common neuropsychiatric disorder. We examine social, therapeutic, and aetiological developments in the specialty and discuss how they are influencing clinical practice.


    The recent advances selected are based on our clinical and academic interests. We identified the information presented from mainstream and specialist journals.

    Combating the stigma of mental illness

    Psychiatric stigmatisation is the inappropriate and erroneous association of mental illness with something disgraceful or shameful. Stigma generates a hidden burden and results in barriers to mental health care, reluctance to seek appropriate care, delay in return to wellbeing, and discrimination in allocation of resources.2 Stigmatising attitudes are found universally and can be deeply entrenched. For example, in some African countries traditional supernatural belief systems may lead to negative and hazardous responses to mental illness.3

    Two factors are important in reducing the burden of stigma: personal awareness of mental illness and availability of effective treatments. Now that we have effective treatments for the major psychiatric disorders, the key to changing attitudes is education. Before embarking on large scale public campaigns, it is essential to establish baseline attitudes and knowledge to determine what exactly needs to be changed and how this can be most effectively achieved and monitored. For example, the Royal College of Psychiatrists conducted a baseline survey of UK public attitudes as part of its campaign to combat stigmatisation, Changing Minds: Every Family in the Land. The …

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