Transcript Which of these three has an alcohol problem?

Why Mental Health?
Professor Anne Lingford-Hughes
Professor of Addiction Biology, Imperial College London
Consultant Psychiatrist
CNWL NHS Foundation Trust
Dr Ed Beveridge
Consultant Psychiatrist
CNWL NHS Foundation Trust
This session…
• A little about us
• Mental health – True or False?
• Addiction – as an example of where science
meets mental health
• Questions (make a note as you go…)
Career path: Anne
• At school in Shrewsbury, interested in biology,
chemistry
– Liked doing projects more than exams
– Struggled at maths
• Applied to medical school – although not sure
about being a Dr
– 5 rejections
• (Finally) Got in to Oxford medical school after reapplying
Next ……
• Still ambivalent about being a Dr
– Did a PhD (so became other kind of Dr)
– Went to work in the US for 2 yrs
• Looking at chemical changes in the brain
• Completed my training to become a Dr (Dr)
– Trained in psychiatry in London
• Since then
– Research: how alcohol/drugs affect the brain
– Clinic: Treat people with alcohol/drug problems
– Teaching: undergraduate, Masters courses, supervise
research students; & Doctors
Travel.
Career Path: Ed
• School in NE London
• Sciences (and French) at A-Level
• Medical School in Cambridge & Oxford, trained in
Psychiatry in North London
• Consultant Psychiatrist, teacher and trainer
• Blog, tweet, travel, TV, music
Travel
“Mental Health”
True or False?
• “Mental health problems are
common”
Mental health problems are common
1 in 4 people in the UK will experience a mental
health problem per year
Bipolar Affective disorder (Manic Depression)
affects 1-3 in 100 people within their lifetime
Mental ill health costs the UK £70 bn per year
True or False?
• “Mental illnesses rarely get better,
whereas physical health problems
usually do”.
Mental illnesses rarely get better, whereas
physical health problems usually do.
Diabetes and high blood pressure are incurable
1/3 of people with psychosis recover fully
There is evidence for treatment for mental health
problems in the same way as there is for physical
illness.
True or False?
• “Mentally ill people can be
dangerous”.
Mentally ill people can be dangerous.
10% of homicide offenders have Schizophrenia
…but if you have Schizophrenia your risk of
committing homicide is 1 in 10 000 each year
Every homicide gets reported and this feeds stigma
If you have Mental Illness your risk of being
murdered if 5 times higher
True or False
• “Psychiatrists mainly give people medication”.
Working in mental health
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Psychiatrist
Clinical Psychologist
General Practitioner
Educational Psychologist
Psychiatric Nurse
Social Worker
Occupational Therapist
Pharmacist
Research Scientist
Support Worker
Peer Support Worker
Psychotherapist
Play Therapist
Drama Therapist
Music therapist
Art Psychotherapist
Counsellor
Psychoanalyst
True or False?
• There is a lot of scientific evidence about
mental illness.
Drugs and alcohol:
what do they do to the brain?
Anne Lingford-Hughes
Anne Lingford-Hughes
Professor of Addiction Biology,
Imperial College, London
Consultant Psychiatrist,
CNWL NHS Foundation Trust
Drug misuse is caused by ‘lack of
willpower’ and is not a disease
like diabetes or cancer?
What do people get from using drugs or
psychoactive substances?
• To feel good
–
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pleasure / escape
energy
tranquillity
understanding/insights/meaning
• To feel better
– sleep
– overcome feelings of anxiety or depression /
hopelessness eg for social interactions
Experimental Use
(large numbers use drugs
with no or little problems)
‘harmful use’- either to physical
or mental health
Addiction or Dependence :
“lack of control”
Addiction – 3 elements
Social factors
Drug
factors
Addiction
and its treatment
Brain mechanisms
Personal
biological
factors
Your Brain on Drugs?
TO: defining which regions of brain and which chemical
systems are important in different stages of
drug use, misuse and addiction:
help with prevention and treatment.
Addiction is a brain disease
which means you cannot do
anything about it?
Imaging the brain and its
function
Dopamine is released and taken
back up by transporter.
Drugs of abuse increase dopamine levels by
 blocking the transporter
 increasing firing rate of dopamine neuron
There is evidence that
baseline activity in the
dopamine system is
involved in ‘liking’
stimulants.
higher levels of dopamine
activity: unpleasant
lower levels of dopamine
activity: pleasant
This relationship also appears to apply to
cognitive performance
Increasing
pleasure, reward
Increasing anxiety,
paranoia
Dopamine activity
Also modifiable by stress, childhood experiences etc
This relationship also appears to apply to
cognitive performance
Increasing
pleasure, reward
Increasing anxiety,
paranoia
So one strategy for
prevention & treatment
would be to modulate
dopamine activity so it is
around ‘optimal’ – not to
block or boost everyone.
Dopamine activity
Also modifiable by stress, childhood experiences etc
Cannabis is the most harmful
drug in adolescence?
Alcohol main cause of global disability in
15-24 yr olds
Males
Females
Development of ‘risky’ behaviour vs
‘impulse control’ during adolescence
and early adulthood: the norm
Brain areas where volumes
are smaller in young adults
than adolescents
Brain changes during
development – ‘reward
drive’ areas mature early
and ‘impulse controlling’
frontal lobes are last to
finish maturing.
Impact of drugs of abuse
on developing brain:
concern is that may be
increasing future
vulnerability to continuing
drug misuse.
Sowell, E.R. et al., 1999
Model showing network of four brain circuits
involved in drug liking and addiction:
reward, motivation/drive, memory, control
Adult
Adolescence
Thank you.
Any questions?