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The Surgeon General's Report on Mental Health

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Table of Contents

Chapter 1
Introduction and Themes

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Overarching Themes

The Science Base of the Report

Overview of the Report’s Chapters

Chapter Conclusions

Preparation of the Report

References


Chapter 2
The Fundamentals of Mental Health
and Mental Illness

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The Neuroscience of Mental Health

Overview of Mental Illness

Overview of Etiology

Overview of Development, Temperament, and Risk Factors

Overview of Prevention

Overview of Treatment

Overview of Mental Health Services

Overview of Cultural Diversity and Mental Health Services

Overview of Consumer and Family Movements

Overview of Recovery

Conclusions

References

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Chapter 3
Children and Mental Health

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Normal Development

Overview of Risk Factors and Prevention

  • Risk Factors
    • Biological Influences on Mental Disorders
    • Psychosocial Risk Factors
    • Family and Genetic Risk Factors
    • Effects of Parental Depression
    • Stressful Life Events
    • Childhood Maltreatment
    • Peer and Sibling Influences
    • Correlations and Interactions Among Risk Factors
  • Prevention
    • Project Head Start
    • Carolina Abecedarian Project
    • Infant Health and Development Program
    • Elmira Prenatal/Early Infancy Project
    • Primary Mental Health Project
    • Other Prevention Programs and Strategies

Overview of Mental Disorders in Children

Attention-Deficit/Hyperactivity Disorder

    • Prevalence
    • Causes
  • Treatment
    • Pharmacological Treatment
      • Psychostimulants
      • Dosing
      • Side Effects
      • Other Medications
    • Psychosocial Treatment
      • Behavioral Approaches
      • Cognitive-Behavioral Therapy
      • Psychoeducation
    • Multimodal Treatments
    • Treatment Controversies
      • Overprescription of Stimulants
      • Safety of Long-Term Stimulant Use

Depression and Suicide in Children and Adolescents

  • Conditions Associated With Depression
  • Prevalence
    • Major Depression
    • Dysthymic Disorder
    • Suicide
  • Course and Natural History
  • Causes
    • Family and Genetic Factors
    • Gender Differences
    • Biological Factors
    • Cognitive Factors
    • Risk Factors for Suicide and Suicidal Behavior
  • Consequences
  • Treatment
    • Depression
      • Psychosocial Interventions
      • Pharmacological Treatment
    • Bipolar Disorder
      • Pharmacological Treatment
    • Suicide
      • Psychotherapeutic Treatments
      • Psychopharmacological Treatments
      • Intervention After a Suicidal Death of a Relative, Friend, or Acquaintance
      • Community-Based Suicide Prevention
      • Crisis Hotlines
      • Method Restriction
      • Media Counseling
      • Indirect Case-Finding Through Education
      • Direct Case-Finding
      • Aggressive Treatment of Mood Disorders
      • Air Force Suicide Prevention Program—A Community Approach

Other Mental Disorders in Children and Adolescents

Services Interventions

  • Treatment Interventions
    • Outpatient Treatment
    • Partial Hospitalization/Day Treatment
    • Residential Treatment Centers
    • Inpatient Treatment
  • Newer Community-Based Interventions
    • Case Management
      • Team Approaches to Case Management
    • Home-Based Services
      • Family Preservation Programs Under the Child Welfare System
      • Multisystemic Therapy
    • Therapeutic Foster Care
    • Therapeutic Group Homes
  • Crisis Services

Service Delivery

Conclusions

References


Chapter 4
Adults and Mental Health

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Chapter Overview

Anxiety Disorders

  • Types of Anxiety Disorders
    • Panic Attacks and Panic Disorder
    • Agoraphobia
    • Specific Phobias
    • Social Phobia
    • Generalized Anxiety Disorder
    • Obsessive-Compulsive Disorder
    • Acute and Post-Traumatic Stress Disorders
  • Etiology of Anxiety Disorders
    • Acute Stress Response
    • New Views About the Anatomical and Biochemical Basis of Anxiety
    • Neurotransmitter Alterations
    • Psychological Views of Anxiety
  • Treatment of Anxiety Disorders
    • Counseling and Psychotherapy
    • Pharmacotherapy
      • Benzodiazepines
      • Antidepressants
      • Buspirone
    • Combinations of Psychotherapy and Pharmacotherapy

Mood Disorders

  • Complications and Comorbidities
    • Clinical Depression Versus Normal Sadness
  • Assessment: Diagnosis and Syndrome Severity
    • Major Depressive Disorder
    • Dysthymia
    • Bipolar Disorder
    • Cyclothymia
    • Differential Diagnosis
  • Etiology of Mood Disorders
    • Biologic Factors in Depression Monoamine Hypothesis
    • Evolving Views of Depression
    • Anxiety and Depression
    • Psychosocial and Genetic Factors in Depression
    • Stressful Life Events
    • Cognitive Factors
    • Temperament and Personality
    • Gender
    • Genetic Factors in Depression and Bipolar Disorder
  • Treatment of Mood Disorders
    • Stages of Therapy
      • Acute Phase Therapy
      • Continuation Phase Therapy
      • Maintenance Phase Therapies
  • Specific Treatments for Episodes of Depression and Mania
    • Treatment of Major Depressive Episodes
      • Pharmacotherapies
      • Alternate Pharmacotherapies
      • Augmentation Strategies
      • Psychotherapy and Counseling
      • Bipolar Depression
      • Pharmacotherapy, Psychosocial Therapy, and Multimodal Therapy
      • Preventing Relapse of Major Depressive Episodes
    • Treatment of Mania
      • Acute Phase Efficacy
      • Maintenance Treatment to Prevent Recurrences of Mania
    • Service Delivery for Mood Disorders

Schizophrenia

  • Overview
    • Cognitive Dysfunction
    • Functional Impairment
    • Cultural Variation
    • Prevalence
      • Prevalence of Comorbid Medical Illness
  • Course and Recovery
    • Gender and Age at Onset
  • Etiology of Schizophrenia
  • Interventions
    • Pharmacotherapy
    • Ethnopsychopharmacology
    • Psychosocial Treatments
      • Psychotherapy
      • Family Interventions
      • Psychosocial Rehabilitation and Skills Development
      • Coping and Self-Monitoring
      • Vocational Rehabilitation

Service Delivery

Other Services And Supports

Conclusions

References


Chapter 5
Older Adults and Mental Health

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Chapter Overview

Overview of Mental Disorders in Older Adults

  • Assessment and Diagnosis
  • Overview of Prevention
    • Primary Prevention
    • Prevention of Depression and Suicide
    • Treatment-Related Prevention
    • Prevention of Excess Disability
    • Prevention of Premature Institutionalization
  • Overview of Treatment
    • Pharmacological Treatment
      • Increased Risk of Side Effects
      • Polypharmacy
    • Treatment Compliance
    • Psychosocial Interventions
    • Gap Between Efficacy and Effectiveness

Depression in Older Adults

Alzheimer’s Disease

Other Mental Disorders in Older Adults

Service Delivery

Other Services and Supports

Conclusions

References


Chapter 6
Organizing and Financing
Mental Health Services

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Overview of the Current Service System

The Costs of Mental Illness

Financing and Managing Mental Health Care

Toward Parity in Coverage of Mental Health Care

Conclusions

Appendix 6-A: Quality and Consumers’ Rights

References


Chapter 7
Confidentiality of Mental
Health Information: Ethical, Legal,
and Policy Issues

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Chapter Overview

Ethical Issues About Confidentiality

Values Underlying Confidentiality

Research on Confidentiality and Mental Health Treatment

Current State of Confidentiality Law

  • Overview of State Confidentiality Laws
  • Exceptions to Confidentiality
    • Consent by the Person in Treatment
    • Disclosure to the Client
    • Disclosure to Other Providers
    • Disclosure to Payers
    • Disclosure of Information to Families
    • Oversight and Public Health Reporting
    • Research
    • Disclosure to Law Enforcement Agencies
    • Disclosure to Protect Third Parties

Federal Confidentiality Laws

Potential Problems With the Current Legal Framework

Summary

Conclusions

References


Chapter 8
A Vision for the Future

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Continue To Build the Science Base

Overcome Stigma

Improve Public Awareness of Effective Treatment

Ensure the Supply of Mental Health Services and Providers

Ensure Delivery of State-of-the-Art Treatments

Tailor Treatment to Age, Gender, Race, and Culture

Facilitate Entry Into Treatment

Reduce Financial Barriers to Treatment

Conclusion

References


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