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I. Pelc – BCNBP 2005

Belgian College of Neuropsychopharmacology and Biological Psychiatry - Brussels December 8th 2005. The Challenge of a Competitive Belgium Research in Mental Health. Prof. I. Pelc Belgium Scientific Counterpart to WHO Mental Health Europe. I. Pelc – BCNBP 2005.

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I. Pelc – BCNBP 2005

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  1. Belgian College of Neuropsychopharmacology and Biological Psychiatry - BrusselsDecember 8th 2005 The Challenge of a Competitive Belgium Research in Mental Health Prof. I. PelcBelgium Scientific Counterpart to WHO Mental Health Europe I. Pelc – BCNBP 2005

  2. WHO European Ministerial Conference on Mental Health Helsinki, January 2005 Mental Health : Facing the Challenges, building solutionsAction Plan • Promote mental well-being for all • Demonstrate the centrality of mental health • Tackle stigma and discrimination • Promote activities sensitive to vulnerable life stages • Prevent mental health problems and suicide • Ensure access to good primary care for mental health problems • Offer effective care in community-based services for people with severe mental health problems • Establish partnerships across sectors • Create a sufficient and competent workforce • Establish good mental health information • Provide fair and adequate funding • Evaluate effectiveness and generate new evidence I. Pelc – BCNBP 2005

  3. I. Pelc – BCNBP 2005

  4. THE EUROPEAN GOVERNMENTS SHOULD : • Support national research strategy at a coordinated and national level • Bridge the knowledge gap between research and practice • Insure that research program include long-term evaluation • Invest in training in mental health research I. Pelc – BCNBP 2005

  5. I. Pelc – BCNBP 2005

  6. ECNP TASK FORCE (2005) Estimated number of subjects in the general EU population (age 18-65) affected by mental disorders within past 12 months Source : Hans-Ulrich Wittchen, Frank Jacobi (2005). Size and burden of mental disorders in Europe : a critical review and appraisal of 27 studies. European Neuropsychopharmacology, Volume 15, Number 4, pp. 357-376. 12-months values rounded by Commission.Percentage values based on Commission’s own calculations. I. Pelc – BCNBP 2005

  7. ECNP TASK FORCE (2005) With little variation of country, only 26 % of all mental disorders receive any or even fewer adequate treatment I. Pelc – BCNBP 2005

  8. Mental Health Problems in EuropeSize and BurdenEconomic CostsECNP Task Force • Total health economic costs/year = 300 Billions Euros • Most important part is related to indirect costs : 132 Billions Euros • Drug Treatment Costs : 4 % of total costs I. Pelc – BCNBP 2005

  9. Total Expenditure on Health as a % of GDP (Europe 2002) Austria 7.7Belgium 9.1Denmark 8.8Finland 7.3France 9.7Germany 10.9Greece 9.5Iceland 9.9Ireland 7.3Italy 8.5Luxembourg 6.2Netherlands 9.1Norway 9.1Portugal 9.3Spain 7.6Sweden 9.2United Kingdom 7.7 Source : OECD 2004 I. Pelc – BCNBP 2005

  10. Estimates of mental health expenditure as a proportion of total expenditure on health % of health budget Austria N/ABelgium 6Denmark 8Finland N/AFrance 5Germany 10Greece N/AIceland 6.3Ireland 6.8Italy 5Luxembourg 13.4Netherlands 8Norway N/APortugal 5Spain 4.6 – 5.3Sweden 11United Kingdom 12 Source : WHO Atlas on Mental Health 2001 I. Pelc – BCNBP 2005

  11. But… Contributions of mental health problems to overall burden of ill health in Europe is estimated to be 20 % of Disability Adjusted Life Years (DALYs) (WHO 2004) I. Pelc – BCNBP 2005

  12. Belgian expenditures on drug addiction in 2002 in million EUR Source : De Ruyver, B. – Pelc, I. – Casselman, J. et al Drugbeleid in cijfers. Gent, Academia Press, 2004. I. Pelc – BCNBP 2005

  13. Research and Developmentinvestment by sectorsBelgium 2003 I. Pelc – BCNBP 2005

  14. Journals Publishing High Impact Research in Neuroscience, 1989-98 Source : ISI’s High-Impact Papers, 1989-1998 I. Pelc – BCNBP 2005

  15. BRAIN DECADE (1990-2000)Neurobiology of Emotions (2004)Brazilian Society of Neuroscience and Behaviour • What are the most critical issues/questions in the neurobiology of emotion ? • What do we know for certain about brain processes involved in emotion and what is controversial ? • What kinds of research are needed to resolve these controversial issues ? • What is the relationship between learning, memory and emotions ? I. Pelc – BCNBP 2005

  16. MINISTRY OF HEALTH – BELGIUMHigher Council of Health Working Group (2005 - ) : Mental Health Research and Developments, Inventory, Critical Analysis, Recommandations, Impact on Public Health I. Pelc – BCNBP 2005

  17. Evidence Based MedecineWhat is EBM ? Sackett (2000) : The conscientious explicite and judicious use of the current based-evidence in making decisions about the care of individual patients Adapted from G. Pieters Higher Council of Health Belgium. I. Pelc – BCNBP 2005

  18. Evidence Based Practice Elements for clinical decision Clinical Experience Patient’s(and therapist’s ?) preference Research data Adapted from G. Pieters Higher Council of Health Belgium. I. Pelc – BCNBP 2005

  19. Evidence Based Practice Clinical Problem Evaluation of the results Formulation of a specific question « Adapted Evidence » Relevant for a specific patient Patient’s choice « Values » Looking for evidences Critical evaluation of the evidences Adapted from G. Pieters Higher Council of Health Belgium. I. Pelc – BCNBP 2005

  20. Value Based Medecine (Fulford) • Evidence Based Medicine : to consider the complexity of relevant research data • Value Based Medecine : to consider the complexity of relevant values and/or individual choices Adapted from G. Pieters Higher Council of Health Belgium. I. Pelc – BCNBP 2005

  21. Evolution of treatment’s targets Psychotic Disorders (1)1930 - 2005 From Shock Therapy to : Conventional antipsychotics Dopaminergic receptors Broaders receptors sites D2 partial agonist (and atypical neuroleptics) Identification of specific receptor Identification of specific signal transduction Preclinical and clinical Improvement of Positive Symptoms Negative Symptoms Cognitive Performance Reduction of EPS Efficacy and effectiveness Study Protocols, RCT, Real Life Conditions, Compliance, Tolerability, Safety, Quality of Life, Access to Treatment, Continuity of Care, Care Costs, Patient’s and Therapist’s Judgment, Prospective Evaluation Adaptation of a personal communication from Prof. D. Lecompte I. Pelc – BCNBP 2005

  22. Evolution of treatment’s targets Psychotic Disorders (2)1930 - 2005 Stabilisation, Remission, Recovery Stabilisation : less external impact of positive symptoms Remission : mild detected levels of positive and other symptoms for at least 3 months Recovery : absence of any positive symptoms and mild other symptoms for at least 1 year (40 % of patients if followed up during 15 years !!!) Adaptation of a personal communication from Prof. D. Lecompte I. Pelc – BCNBP 2005

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