Mind, Brain, and Behavior

Unit 8

This unit challenges learners to gain an understanding of neuroanatomy, neurophysiology, and related therapeutics, and to apply this knowledge in the care of the mind, body, and spirit of patients with neurological and psychiatric conditions. Learners study the structure and function of the brain and spinal cord and how alterations of these systems may affect the person’s physical and mental health. Using case-based learning in small and large group sessions, learners analyze central nervous system diseases and disorders and recognize common neurological and mental health issues. Cases include concepts of neurological processes, human development, psychopathology, and substance use. As part of their ongoing professional development as osteopathic physicians, learners examine the physical and behavioral complexities of caring for patients with neurological and psychiatric conditions. Stigma of chronic mental illness, social determinants of health, and relevant bioethical topics are also explored.

Rationale

One might argue that the brain is the essence of our being - our curiosity, our personality, our humanity. The study of the brain and the mind is critically important to understanding not only the health and disease of the central nervous system, but also the physical health of all of the other body systems. An understanding of the interconnectedness of the mind and body, including the neuro-endocrine-immune system, provides the underpinnings for the powerful role of integrative care.¹ This perspective serves as a framework by which learners will incorporate osteopathic principles into clinical skills.

Neurologic disease affects people across the lifespan, and concomitantly, the cost of nine of the most common neurological diseases currently exceeds $800 billion per year in the United States; the burgeoning geriatric population in this country is expected to further increase that figure.² Stroke is ranked as the fifth and Alzheimer’s disease as the sixth leading cause of death in the United States.³ Increasing neurologic disease burden is not just limited to this developed nation: well over half of people affected by dementia worldwide currently live in low and middle income countries, and this proportion is expected to rise to over 70% by 2050.⁴ Other disorders of the brain and nervous system, including additional neurodegenerative diseases, malignancies, epilepsy, multiple sclerosis, amyotrophic lateral sclerosis, and headaches are also significant causes of morbidity and mortality.

Every physician, regardless of specialty, will provide care for patients with mental illness, and the ability to identify and recognize a need for mental health treatment is at the core of caring for the whole person. According to the World Health Organization (WHO), depression is currently the leading cause of disability worldwide.⁵ The WHO has described an urgent need for increased investment in support for people with mental health disorders; almost 50% of people with depression do not receive treatment, even in high-income countries. Depression is associated with increased risk for medical illness, including diabetes and heart disease,⁶ and individuals with mental illness are at increased risk for delayed diagnosis of medical conditions.⁷ Those with chronic illness are also at higher risk for depression compared with the general population: as many as one in four people with diabetes have a mood disorder.⁷ Survivors of trauma are also at increased risk for chronic health problems,⁸ as well as mental illness, substance abuse, and overall healthcare utilization.⁹ Trauma is unfortunately common: between 15-25% of women experience sexual abuse at some point in their lifetime,⁹ and as many as one in five service members returning from military deployments report symptoms consistent with post-traumatic stress disorder.¹⁰ Anxiety disorders, which are the most common class of mental disorders in the general population, carry an estimated lifetime prevalence of over 15%.¹¹

Mental illness and substance abuse affect people of all backgrounds, yet tremendous ignorance, prejudice, and discrimination continue to surround and add to the burden of individuals with mental illness.¹² Some of the most vulnerable populations are disproportionally affected by mental illness. Among individuals who are chronically homeless, approximately 30% have a serious mental illness and two thirds have a primary substance use disorder.¹³

Care of patients with the chronic illnesses and progressive diseases explored in this unit may elicit strong feelings for clinicians.⁷ Recognition of these responses and attending to one’s own emotional and spiritual needs is critical to self-care and key to preventing a central cause of physician burnout.¹⁴ Attending to the patients’ mental health as well as difficult but important thoughts and emotions arising in reaction to the experience of severe and chronic illness helps to promote healthy coping for the patient,⁷ which results in truly caring for a person’s mind, body, and spirit.

References 

¹ Davidson R, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli S, Urbanowski F, Jarrington A, Bonus K, Sheridan J.; Alterations in Brain and Immune Function Produced by Mindfulness Meditation, Psychosom Med. 2003 Jul-Aug;65(4):564-70.

² Gooch CL, Pracht E, Borenstein AR. The Burden of Neurological Disease in the United States: A Summary Report and Call to Action. Annals of Neurology. 2017;Accepted Author Manuscript.

³ National Center for Health Statistics.  (2017, May 3). Deaths and Mortality. Retrieved June 30, 2017, from http://www.cdc.gov/nchs/fastats/deaths.htm

⁴ World Health Organization. (2017, April). 10 facts on dementia.  Retrieved June 30, 2017

⁵ World Health Organization. (2017, March 30). "Depression: let's talk" says WHO, as depression tops list of causes of ill health. Retrieved June 30, 2017, from http://www.who.int/mediacentre/news/releases/2017/world-health-day/en/

⁶ American Heart Association. (2017, May 2). Depression After A Cardiac Event or Diagnosis. Retrieved June 30, 2017, from http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Depression-and-Heart-Health_UCM_440444_Article.jsp#.WRYLMVKZNTY

⁷ Turner J, Kelly B. Emotional dimensions of chronic disease. West J Med. 2000 Feb;172(2):124-28.

⁸ Rosenberg HJ, Rosenberg SD, Wolford GL 2nd, Manganiello PD, Brunette MF, Boynton RA. The Relationship between Trauma, PTSD, and Medical Utilization in Three High Risk Medical Populations. Int J Psychiatry Med. 2000;30(3):247-59.

⁹ Substance Abuse and Mental Health Services Administration. (2017, September 15). Trauma and Violence. Retrieved October 9, 2017, from https://www.samhsa.gov/trauma-violence

¹⁰ U.S. Department of Veterans Affairs. (2017, October 3). PTSD: National Center for PTSD. Retrieved October 9, 2017, from https://www.ptsd.va.gov/public/ptsd-overview/basics/how-common-is-ptsd.asp

¹¹ Centers for Disease Control and Prevention. (2013, October 4). Burden of Mental Illness. Retrieved June 30, 2017, from Thornicroft G, Brohan E, Kassam A, Lewis-Holmes E. Reducing stigma and discrimination: Candidate interventions. Int J Ment Health Syst. 2008;2:3.

¹² Substance Abuse and Mental Health Services Administration. (2017, September 15). Homelessness and Housing. Retrieved October 9, 2017, from https://www.samhsa.gov/homelessness-housing

¹³ Drummond D. Physician Burnout: Its Origin, Symptoms, and Five Main Causes. Fam Pract Manag. 2015 Sept-Oct;22(5):42-47.