Do You Mind? Campaign

Mental and neurological disorders affect millions of people around the globe.

Let’s take a journey to find out how we can solve this health puzzle.

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Policy-Makers

My name is Alison. I'm a government Health Minister and I have to constantly make tough decisions that impact people's lives. Mental and neurological disorders are a particularly challenging area. I have to think about how much of a public health issue it is compared to other diseases, so that any budget allocated to policies is effective. It's tough to put it that way, but we have to think about taxpayers money being put to best use. I believe my role as a politician is to also think of the wider impact of mental and neurological disorders on society. Follow me to get a glimpse of factors I take into account so that my country has a coherent set of policies for mental health.

I remember when the Norwegian Prime Minister Kjell Bondevik admitted publically that he suffered from depression. It was a real wake up call that nobody is immune to mental and neurological disorders.

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How many cases of mental and neurological disease are reported globally every year?

More than 700 million cases are reported, which is more than the entire population of the US, Brazil, Nigeria and Cambodia put together! Believe it or not, MNDs are responsible for 13% of the global disease burden. With these figures, the World Health Organisation estimates that mental and neurological disorders are the leading cause of ill health and disability globally.

700

Million

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13%

of total global disease burden

There are many other priorities on the political agenda such as non-communicable diseases and HIV/AIDS, TB and Malaria. An increasing consideration in public health is how one disease might impact or relate to others.

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Do mental and neurological diseases impact other disease policy areas?

Yes. Individuals who are undiagnosed or untreated are at a higher risk of engaging in substance abuse, smoking, and being overweight. All risk factors for developing other non-communicable diseases, which place additional burdens on the public purse.

It's not just about how one disease might impact individuals, it's also a question of how public health policy might impact other government policies. Like many other governments, we are struggling to get as many people in work as possible. Mental and neurological diseases have a direct impact on employment, not only for those suffering but also those who may have to care for them and their employers.

The size of this problem is clearly too big to ignore, and as a policy-maker I need to act early to stave off the costs of managing complex mental disorders that have been allowed to worsen. In politics, it's always a question of ministers defending their budgets, and increasingly I have to be able to show how the public health policies contribute positively to the economy or else it will not make it through the budgetary committee.

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In a 2011 report, the World Economic Forum reported MNDs account for 37% of healthy life years lost from NCDs. Depression, alcohol use disorders, and schizophrenia constitute the greatest global burden in terms of disabilty.

37%

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Can you quantify the global impact MNDs have on the public purse?

US$2.5 trillion
US$2.5 trillion. The World Economic Forum estimates that the global cost of MNDs was US$2.5 trillion in 2010. In the next 20 years, the global costs of MNDs are predicted to increase to US$6 trillion. US$6trillion is enough to create 30 million jobs in the United States.

Drilling down to understand which government budgets are most affected by the impact of MNDs is also a challenge.

Where can the costs of MNDs be seen?

Mostly from indirect costs, those not coming directly from the provision of healthcare services, such as lost productivity, sick leave, and early retirement.

About two-thirds of this cost comes from indirect costs, such as lost productivity, sick leave, and early retirement. The remaining third are costs directly related to the provision of healthcare services. First and foremost, MNDs impose a significant cost on individuals; but they also have a considerable impact on society and economies. In the European Union, for example, mental disorders account for 3-4% of GDP, the majority of which is attributed to indirect costs.

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Balancing the social, economic and health aspects of MNDs into one policy has to involve other government departments

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But which ones?

  • Finance Minister
  • Education
  • Work & Pensions
  • Science and Technology

Ministers working in Finance, Education, Work & Pensions and Science should be part of these discussions. The problems we face today – and the growing burden MNDs will pose in the future – demand the expertise and input of a number of public policy areas ranging from health and social services to urban planning, education and housing. For governments, tackling the societal challenges presented by mental and neurological disorders requires an end to silo-based thinking and a more open, collaborative spirit.

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Am I right to be focusing on diagnosis and treatment?

Yes

We can start by delivering mental and neurological services at the primary health care level, which are the most accessible, affordable and acceptable to local populations. By integrating mental health into these services, access is improved, detection is increased and effective treatment is more likely. Primary care services for mental health are less expensive than psychiatric hospitals and positive outcomes are achievable.

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Patient - Schizophrenia

Hi I'm David. I was 18 when I experienced my first psychotic episode. I had quite vivid hallucinations and my family and friends, who were around at the time, were as scared about it as l was. None of us knew what was happening to me. Schizophrenia was something that "mad people" had – not "normal people" like me.

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Do you think you know what Schizophrenia is?

The defining feature of schizophrenia is psychosis, being out of touch with reality. At times, it makes it hard to tell the difference between what is real and not real, think clearly, have normal emotional responses and act normally in social situations. Sufferers may also have disorganized speech, disorganized behavior, physically rigid or lax behavior (catatonia), significantly decreased behaviors or feelings, as well as delusions, which are ideas about themselves or others that have no basis in reality.

Since my first episodes began in my first year at University, I had to take a lot of time off and ended up dropping out. Since the symptoms of Schizophrenia, such as hallucinations and delusions, tend to start between the ages of 16 and 30, this illness affects you in the prime of life. When I was eventually diagnosed with schizophrenia, I was terrified of what people would think.

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What are the most common misconceptions about people with a mental disorder?

Almost one in four people will experience a mental disorder at some point in their lives, with 25 million people - more than the entire population of Mozambique - suffering from Schizophrenia alone. Despite these facts, social stigma of many mental and neurological diseases remains.

  • Mental disorders are untreatable
  • People with mental disorders are violent and dangerous
  • Mental disorders are not real medical conditions
25 MILLION people
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What causes Schizophrenia?

  • Character flaw
  • Genetics
  • Alcohol use disorders
  • Brain Chemistry / Structure

Schizophrenia is not caused by a character flaw or alcohol misuse. Genetics, brain chemistry/structure and even our environment can cause Schizophrenia. While schizophrenia occurs in 1% of the general population, the odds increase to 10% when a parent or sibling has the disorder. Scientists believe several genes are associated with an increased risk of schizophrenia, but that no gene causes the disease by itself. Many environmental factors may also be involved, such as exposure to viruses or malnutrition before birth, problems during birth, and other psychosocial factors.

I felt stigmatised. People tend not to talk about mental disorders in the same way they talk about other illnesses. This makes schizophrenia difficult to understand. In fact, like physical illnesses, schizophrenia has causes, symptoms and effective treatments but most people would not know that. Would you?

Today, 20 years on from my first episode, I am coping much better with my Schizophrenia. Although, learning to manage my condition has not been easy and just as other people with a brain disorder, I have needed a lot of help and support from family and friends, who have kindly given up a lot of their time to help me.

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I know that I am among the lucky ones. Others schizophrenia sufferers might have difficulties receiving support.

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Can you quantify the global impact MNDs have on the public purse?

US$2.5 trillion
US$2.5 trillion. The World Economic Forum estimates that the global cost of MNDs was US$2.5 trillion in 2010. In the next 20 years, the global costs of MNDs are predicted to increase to US$6 trillion. US$6trillion is enough to create 30 million jobs in the United States.
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Who can provide the most effective help for people suffering from schizophrenia?

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  • Primary Care, e.g Local GP’s office, Nurse/Public Health worker
  • Specialist
  • Family and Friends
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A specialist

A specialist such as a psychologist is the most important as they provide psychotherapy and psychopharmacology help which is essential; but they are closely followed by services delivered at primary health care level, which are very important as they are the most accessible, affordable and acceptable to local populations. Last but definitely not least, family and friends provide great emotional support for many suffering from Schizophrenia.

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I currently manage my Schizophrenia with therapy, taking my medicines and leading a healthy lifestyle. As they say: “a healthy body is a healthy mind”!

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However, in the future, I do hope to see more investment in brain research education and awareness raising to reduce stigma.
  • education
  • +
  • awareness
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Patient - Depression

My name is Alisha; I am a wife and a mother of four great children. We live in Mumbai, India. Since having my first child, I started feeling down, depressed, and had very little interest or pleasure in doing things I usually found rewarding. I felt like this for five years.

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Does this sound like depression to you?

Yes

Depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer. Other symptoms of depression can include: frequent thoughts of death, dying or suicide, crying spells for no apparent reason, unexplained physical problems, such as back pain or headaches, fatigue, tiredness and loss of energy and cognitive dysfunction-concentration difficulties, indecisiveness and forgetfulness among others.

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I very often felt isolated and alone...

Especially because I feared the stigmatisation that mental disorders carry among my family and the broader community. In the local newspaper, I read that people had complained about patients suffering from mental disorders at a nearby hospital because they may be spreading germs. My mother in law, on the other hand, thinks that I just like to pity myself and am lazy. She cannot believe that depression is a real brain disorder.

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Is depression a REAL brain disorder?

Yes. Depressive illnesses are disorders of the brain.

Longstanding theories about depression suggest that important neurotransmitters—chemicals that brain cells use to communicate—are out of balance in the case of depression. However, it has been difficult to prove this. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different from those people without depression. The parts of the brain involved in mood, thinking, sleep, appetite, and behavior appear different.

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To make matters worse, I also suffered from hypertension because of my depression. I was constantly anxious and was trying to deal with all the stress and strains of being a new mother.

Living with depression can be very lonely and give you the feeling that nobody else knows how it feels. However, I was surprised to learn that there are millions of people suffering from depression all over the world.

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Do you have an idea how many depression sufferers there are?

350 million
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350 million according to the WHO. This is 50% of the 700 million cases of mental and neurological disorders reported globally. The problem is also very common in India.

50%
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Despite the large number of sufferers, it was still very difficult for me to get the right kind of help.

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Can you imagine why?

  • I did not realize my general doctor could help me
  • I felt ashamed to admit what was happening to me
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For many people in Alisha’s position, the main problem is that she did not realize her local doctor was trained to deal with mental disorders. Even if she knew, she would have been ashamed to admit she had a problem as depression is really stigmatizing in many parts of the world.

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Alzheimer carer

My name is Maria and I’m Brazilian. I remember the day when Alzheimer disease came into our lives very clearly. I asked my mom to prepare her specialty dish for my kids and she did not know how to make it anymore. I guess I subconsciously felt something was wrong but I did not want to admit it to myself. At first, I was in denial. It was only when the situation got worse that I realized I needed to understand what was the reason for my mom’s symptoms.

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Do you know what is the most common type of dementia?

  • Vascular dementia
  • Frontotemporal dementia
  • Alzheimer's disease
  • Dementia with Lewy bodies

Dementia is a syndrome that can be caused by a number of progressive disorders but Alzheimer’s disease is the most common, accounting for 50 to 80% of dementia cases. It is estimated that there are 38 million people living with dementia worldwide, the number which will increase to 115 million by 2050. Nearly two-thirds live in low and middle income countries.

38 MIllion living with dementia worldwide
Up to 80% Suffer from Alzheimer's disease
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Do you know which symptoms are most likely in the early stages of the disease?

Memory loss, thinking, behavior problems as well as limited ability to perform everyday activities.

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With the passing of time it became evident to me that my mom would no longer be able to live independently. Her disease changed the lives of all of us. Before we were a typical Brazilian family and my mom was helping out with the kids. Suddenly the roles reversed completely, we had no choice but to organize ourselves to take care of her 24/7. I had to give up my full time job. I now work part time and we’re using our savings to pay for a nurse to help us when I’m at work.

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What do you think is the global economic burden of dementia?

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$600 Billion

The cost of social care, unpaid care by relatives and the medical bills for treating dementia was examined by the experts from the Karolinska Institute in Stockholm and King's College London who found that, if Alzheimer’s was a country, it would be the world's 18th biggest economy. If it was a company, it would be the world's biggest by annual revenue.

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But hard as it was to see our savings and hopes for our future slip between our fingers,
what I found really difficult were the changes in my mom’s mood and personality. She was confused and got upset very quickly whenever she was out of her comfort zone. One day she did not recognize who I was and this is when I really broke down.

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Do you know what the burden of taking care of a family member with Alzheimer’s can potentially be?

Depression is present in up to

55%

of the caregiving population

Caregivers of people with dementia have been shown to experience depression, anger, anxiety and guilt. Depressive symptoms among caregivers of persons with dementia are reported to range from 28% to 55% of the caregiving population. Carers also sometimes report negative attitudes toward the patient and other family members. The negative effects can lead even to physical health deterioration.

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"Maybe it would be easier to cope with this situation if..."

I could talk openly about it so somebody could give us a hand. But I'm afraid of what people might think. I feel I missed on an opportunity to diagnose my mom earlier and to better prepare myself for what's coming. Maybe I should not have waited so long before going to a specialist, maybe our primary doctors should be better trained to recognize such symptoms...

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Do you think that primary care, physicians and nurses can make a dementia diagnosis?

Yes

Evidence from high-income countries suggests that primary care physicians and nurses can, if specifically prompted to do so, make a dementia diagnosis with reasonable accuracy, using their knowledge of the patient, available case note information, and their own routine assessments. In Brazil and in other countries, community healthcare workers could, with a few hours training, identify dementia in the community, based solely upon their prior knowledge of older people from their routine outreach work.

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Employer & Employee

My name is Mark and I guess I’m what they call an entrepreneur. I grew my company in South Africa from a very small operation to a network of four offices employing 250 people. When I started my business, I did not know what it really meant to manage people. I guess we all learn by doing. And I was not aware how important the mental health of my employees is to the success of my business. The reality hit me when one of my employees had an epilepsy seizure. At the time I did not even know it was a neurological disorder

We tend to think that mental and neurological disorders are quite rare.
Are they? You might be surprised to know:

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How many people of working age are currently suffering from a mental disorder?

1 in 5

According to OECD one in five people of working age is currently suffering from a mental disorder. The lifetime prevalence is even twice as high.

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Given these numbers, I will probably have around 50 people with a mental and or neurological disorder in my company. As a businessman I guess one wonders if these employees are less efficient? Should I still employ them? Concretely, what should I do with an employee who is suffering from depression, which is apparently the most predominant mental disorder among working-age patients?

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What is the impact of the depression on employers?

Lost work productivity due to:

  • Concentration difficulties
  • Indecisiveness
  • Forgetfulness
  • Increased sick-leave use.
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Depression itself costs employers $44 million in a year in lost productive time. Workers with a mental disorder are absent from work for health reasons more often than other workers (32% versus 19%). They are also away for longer (6 versus 4.8 days of absence). Many do not take sick leave but instead may be underperforming in their jobs: 74% of all workers with a mental disorder report reduced productivity at work in a four week period.

$44 MILLION
in a year lost productive time

74%
reduced productivity at work

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We cannot neglect these numbers. I can’t even imagine the impact on the whole economy and that is something policymakers must surely consider daily. And no wonder many employees prefer to avoid talking about it. It takes an effort and courage to understand the challenge depression sufferers are facing every day and not to discriminate them while employing. I understood it when my sister, who suffers from depression, started looking for a job.

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Do you know how much more often people with a mental disorder are typically likely to be unemployed compared to people with no such disorder?

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Twice

The truth is that many people with a mental or a neurological disorder want to work but cannot find jobs. People with an MND are typically twice as likely to be unemployed. Moreover, there is a high share of long-term unemployment for people with severe mental disorders, leading to a high risk of discouragement and labor market withdrawal. People with common mental disorders, on the other hand, do not face higher long-term unemployment shares than the general population but they will often lose their job again quickly.

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And what happens next?

This is equally interesting from an employer perspective and from a broader societal context as jobless people with a mental disorder receive and depend on a range of working-age benefits. But from my perspective it’s more important to understand what needs to be done to make sure that the employees with mental disorders feel well at work and consequently that they work efficiently.

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What do you think are major factors helping people with mental disorders to stay at work?

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  • Good disease management
  • Proper medical care
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Good disease management and proper medical care.

The key workplace variable that can contribute to prevent worsening of mental disorders is good management, i.e. a line manager who supports the worker, gives adequate feedback and recognizes the work effort.

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Doctor

My name is Supun. I am a doctor in Sri Lanka and I really believe that there is a strong link between mental and physical health. We need to look at a patient holistically, which unfortunately and for different reasons, is not always the case in daily practice. It is important for the patient—and also carries benefits for society overall.

It might sound obvious that physical and mental health is equally important. But let’s see how mental health influences our physical health.

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People with severe mental disorders are more likely to be overweight, smoke and have a range of physical health problems.

50%

Depression patients have a 50% greater risk of cardiovascular disease

People living with mental illness such as depression and anxiety disorders, bipolar disorder and schizophrenia have worse levels of physical health and reduced life expectancy compared to the general population.

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But also patients suffering from chronic diseases—such as cancer, diabetes, and cardiovascular disease—are also more prone to developing a mental disorder.

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Which of the statements below seem true to you?

Obese people are between 20% and 50% more likely to experience depression or anxiety-related, bipolar or panic disorders

50%

People with cardiovascular disease are 70% more likely to have a depression or anxiety disorders

70%

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As I am a local doctor I’m also the first point of contact for my patients and in a sense I know them best and should be able to detect if something wrong is happening with their mental health. For a long time I felt I was not prepared to deal with such cases because I’m not a specialist.

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Do you think that primary care healthcare workers could provide basic mental healthcare?

60-80%

Yes, According to the World Health Organisation much of the mental health care, at least on the basic level, can be delivered by non-specialized healthcare providers (general doctors, nurses, healthcare workers and volunteers). It is estimated that between 60-80% of people with mental disorders can be provided help by these workers with some assistance from specialist.

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Easier said than done:

in my country, there are very few psychiatrists and they are mainly concentrated in the capital city. But I was lucky to be able to take part in a training organized by our government for primary care doctors. It helped me to learn how to screen, identify, diagnose and treat the majority of patients who come to me with a mental disorder.

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70%

It works for everybody. My patients often do not need to travel long distances to get treated. Also, I’m better equipped to help them with their physical conditions. It’s also good for our healthcare system - at a recent conference I’ve learned that system costs for people who live with depression and physical illness at the same time may be increased by as much as 70%. Politicians ought to look at this aspect more closely as well. For me the most important thing is how to prevent and treat such conditions.

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Let’s focus on prevention for a moment

- a key thing to fight one of the biggest health challenges we face at the moment – non-communicable diseases.

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Do you think there is a direct link between the prevention of NCDs and the mental health?

Yes, There Is

People with schizophrenia are twice as likely to smoke as the general population, and may do less exercise and have poorer nutritional habits. We should then take an integrated approach across prevention, treatment, and recovery.

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Scientist

I'm Megan and I'm an American scientist. I've always been into science but I couldn't decide what to specialize in. My grandmother helped me to decide. Or I should rather say her bipolar disorder helped me. I wanted to know what happens inside her brain and how I can cure her. Well, dreams can be more difficult to fulfill than expected. But I'm not giving up and I'm now working in the fascinating area of the brain – an organ of surreal complexity – and its disorders.

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Guess how many neurons, how many connections our brain has?

100 billion neurons in the cortex & 100 trillion synapses

that make up the connections inside our brains. We know a lot more about the brain than we used to and a lot less than we need to. Imagine the challenge: there are about as many cells in the brain as there are stars in the Milky Way galaxy.

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But how are they connected, how do they function? We are just starting to understand how the circuitry of the brain operates in relation to various brain disorders and we are starting to see the patterns for different disorders.

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See if you can imagine in this slightly simplistic way what happens to the brain in case of different illnesses?

Parts of the brain cortex are “bombed out”? Connectional differences – “traffic jams” or “detours” in your brain?
Huntington’s Depression
Parkinson’s OCD
Alzheimer's Post Traumatic Stress Disorder
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But there are still so many things we don’t know - for example why is the brain so vulnerable? The brain is a uniquely complex organ and research in this area is very difficult – both in terms of prevention and treatment. Let’s look at this for a moment.

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Do you think developing treatments for mental disorders takes more time than in case of physical diseases?

  • There is no difference
  • It takes less time
  • It takes more time

35%

Scientific innovation in the area of neuroscience is extremely challenging, with therapies requiring on average 35% more time to obtain regulatory approval compared with medicines for treating other disease areas. We have to also remember that the treatment is never just about the medicines.

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Even when we think we’ve made a breakthrough, we think we have a tougher time than other scientists

Do you know why?

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It's very difficult to find suitable patients for clinical trials

It's very difficult to find suitable patients for clinical trials as they do not address the problem of co-morbidities. Patients who suffer from multiple disorders are excluded from these studies due to control conditions, which makes it difficult for us to understand how to assess how people with more than one condition will react to one medicine.

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Still, we are really excited because we can now show that patients with bipolar disorder display different genetic markers than those with major depressive disorder. Today, these two conditions are often treated with the same medicines. Well, I still have a dream so we keep working...

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Can you guess what the scientists are currently working on?

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We think we have some ideas how we are going to stop diseases for progressing – or even preventing the illness altogether. We might be getting close to understanding how we might prevent mental disorders with vaccines and cognitive protective approaches. Imagine the day when doctors would have the tools to treat psychological disorders almost as effectively as they treat a heart condition!

These are all correct! But we can’t do it alone: Policymakers can play a key role in supporting better understanding on how our brain works by allocating appropriate budgets to brain research, which will help us to prevent and treat mental and neurological disorders.

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