1. 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

2. 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…)

3. 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

4. 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

5. Travel.

6. 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

7. Travel

9. “Mental Health”

15. True or False? “ Mental health problems are common”

16. 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

17. True or False? “Mental illnesses rarely get better, whereas physical health problems usually do”.

18. 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.

19. True or False? “Mentally ill people can be dangerous”.

20. 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

21. True or False “Psychiatrists mainly give people medication”.

23. Working in mental health 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

24. True or False? There is a lot of scientific evidence about mental illness.

25. Drugs and alcohol: what do they do to the brain? Anne Lingford-Hughes Professor of Addiction Biology, Imperial College, London Consultant Psychiatrist, CNWL NHS Foundation Trust

26. Drug misuse is caused by ‘lack of willpower’ and is not a disease like diabetes or cancer?

27. What do people get from using drugs or psychoactive substances? To feel good –pleasure / escape –energy –tranquillity –understanding/insights/meaning To feel better –sleep –overcome feelings of anxiety or depression / hopelessness eg for social interactions

28. 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”

31. Addiction – 3 elements Social factors Personal biological factors Drug factors Addiction and its treatment Brain mechanisms

32. Your Brain on Drugs?

33. 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.

34. Addiction is a brain disease which means you cannot do anything about it?

35. Imaging the brain and its function

36. 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

37. 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

38. Dopamine activity Increasing pleasure, reward Increasing anxiety, paranoia This relationship also appears to apply to cognitive performance Also modifiable by stress, childhood experiences etc

39. Dopamine activity Increasing anxiety, paranoia This relationship also appears to apply to cognitive performance Also modifiable by stress, childhood experiences etc So one strategy for prevention & treatment would be to modulate dopamine activity so it is around ‘optimal’ – not to block or boost everyone. Increasing pleasure, reward

40. Cannabis is the most harmful drug in adolescence?

41. Alcohol main cause of global disability in 15-24 yr olds Males Females

42. Development of ‘risky’ behaviour vs ‘impulse control’ during adolescence and early adulthood: the norm

44. Brain areas where volumes are smaller in young adults than adolescents Sowell, E.R. et al., 1999 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.

45. AdultAdolescence Model showing network of four brain circuits involved in drug liking and addiction: reward, motivation/drive, memory, control

46. Thank you. Any questions?