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KS1 - Keynote Speech
Chairs: Sam Tyano, Israel
Dongfeng Zhou, Chinese Mainland
KS1-1
全球化和以人 为本的精 神病学 - Globalization and Psychiatry for the Person
Juan E. Mezzich 1
1 International Center for Mental Health, Mount Sinal School of Medicing, New York University, New York, United States
当今世界全球化浪潮的推 进提供了许多重要的机会诸如与精神卫生和精神病学相关的信息也日益增多。与此同时，也存在着众多诸如潜在的去人性化趋势以社会 不公正以及排斥 为特点的障碍。为了面对这些重要的挑战，世界精神病学协会开始尝试构建以人为本的精神病学。它的核心要素是由那些临床医生（不只是抽象意义上的掌握治疗技术者而是将其扩展至完整的人）在其他人（包括值得尊敬的咨询者）的协助下，为那些寻找帮助自己履行人生计划者提供以人为本的全面的精神病学（包括全部坏的和好的健康）。这种初步的尝试是目前 WPA 活 动中最为核心的内容 ， 也是其它主要国际健康组织所感兴趣的内容。
The ongoing processes of globalization in today′s world offers a number of important opportunities such as increasing access to information pertinent to psychiatry and mental health. At the same time, it has a number of drawbacks such as the potential for dehumanization as well for social disparities and exclusion. In response to these important challenges, the World Psychiatric Association has established an initiative on Psychiatry for the Person. Its key elements are the promotion of a psychiatry of the totality of the person (including both ill and positive health), by the person (with clinicians extending themselves as full human beings rather than abstract healing technicians), for the person (seeking to assist the fulfillment of the person′s life project), and with the person (in respectful collaboration with the person who consults). This initiative is informing most key current activities of WPA and its components and is attracting interest as well from major international health organizations.
KS1-2
全球化 对中国精神卫生的影响 - Globalization and its Impact on Mental Health in China
Zhang Mingyuan 1
1 Shanghai Mental Health Center , Shanghai , Chinese Mainland
随着 1979 年以来的改革 开放 ， 中国已经进入高速全球化的进程。过去的三十年已经见证了这一革命性的变化。
全球化在中国的 积极影响是显著的，包括国家经济的快速发展，人民生活水平的不断提高，以及精神卫生事业的的高速发展。到 2006 年，中国精神科医 师的数量已经达到 19130 名，分 别超过 1957 年 400 名的 47 倍和 1985 年 5500 名的 3.5 倍。精神病院的床位数达到 145570 张，分别超过 1957 年 11000 张的 13 倍和 1985 年 64000 张的 2.3 倍。中国政府已 经加强对精神卫生的重视，包括精神卫生规划和政策的制定，开始关于精神卫生的部门间联席会议，建立精神卫生管理办公室，并增加对精神卫生服务和研究的投入。精神卫生立法已经在一些大城市开展，如上海、北京、宁波和杭州。我们期待精神卫生事业发展的步伐将会在中国越走越快。 中国的全球化 进程也给精神卫生事业带来新的挑战。中国社会经济发展的不平衡，中西部地区发展相对较慢，尤其是农村， 那里的人 们仍生活在贫困中。工业化和城市化进程使得数十亿移民从农村迁徙到城市。家庭的结构经历了巨大的变化，传统上的大家庭逐渐减少，取而代之的是现代的小家庭。老龄化的速度逐渐加快，带来的精神卫生问题和对老年人的照顾问题变的日益明显。不健康的行为对精神卫生的影响也日益明显。爱滋病、梅毒和其他性传播疾病的发病率快速升高。因酒精中毒和药物滥用引起 的精神障碍的 发病率也在升高。青少年过度使用网络。
总之，中国仍是一个以精神疾病低治疗率为特点的精神卫生资源匮乏的发展中国家：精神分裂症和其他精神病性障碍的治疗率不足 50% ，而一般精神障碍的治 疗率不足 10% ，如情感障碍、焦 虑障碍和物质滥用。作为中国 2002-2010 年精神 卫生规划中明确的目标，提高治疗率具有相当的实用性和现实性。
全球化也是中国精神 卫生事业的机遇。中国可以并应该学习其他国家精神卫生事业发展的经验教训，并综合地区的实际情况制定策略。这将避免走弯路。从这一点来看 ， 中国应该感谢全世界精神卫生事业的老师们。
With the implementation of reform and open policy since 1979, China has been joining the march of globalization worldwide, at full speed. The past three decades has witnessed a revolutionary and immense change.
The positive impact of globalization in China is obvious, including rapid development of national economy, incessant enhancement of living standard of people, as well as rapid evolution of mental health sector. By year 2006, the number of psychiatrists reached 19130 nationwide, 47 and 3.5 times more compared to 400 in 1957 and 5500 in 1985, respectively. The number of psychiatric hospital beds reached 145570, 13 and 2.3 times more compared to 11000 in 1957 and 64000 in 1985, respectively. The government has strengthened its work emphasizing on mental health, including mental health planning and policy-making, initiation of inter-ministry joint meeting on mental health, establishment of administration office of mental health, and increase of investment in mental health service and research. Mental health acts were issued in several large cities, such as Shanghai , Beijing , Ningbo and Hangzhou . It is expected that the pace of development of mental health in China will further accelerate.
The progress of globalization in China imposed new challenge on mental health as well. The socio-economic development of China is not balanced in that many middle and west areas developed relatively slow, particularly in rural areas. And many people there still live in poverty. The progress of industrialization and urbanization brings about billions of migrants into cities from rural areas. The structure of family undergoes significant change, with increasing reduction of traditional expanded family, replaced by modern small-size core family instead. The speed of ageing increases, with problems in mental health and care of elder becoming increasingly prominent. The impact of unhealthy behaviors on mental health becomes increasingly evident. The incidence of AIDS, syphilis, and other sexually-transmitted diseases rapidly increases. The incidence of mental disorders caused by alcoholism and drug abuse also increases. Over-use of internet prevails in adolescents.
Overall, China remains a developing country with insufficient mental health resources, characterized by a very low treatment rate in mental illed: less than 50% for schizophrenia and other psychotic disorders, as well as less than 10% for common mental disorders, for example, affective disorders, anxiety disorders and substance abuse. China 's mental health planning for 2002-2010 listed the enhancement of treatment rate as its specific objective, which is regarded as relatively practical and realistic.
Globalization is also an opportunity for mental health in China . China may and should learn from the experience and lessons of other countries in developing mental health and formulate its own strategy with the integration of local situation. This would avoid detours. From this perspective, China should extend its gratitude to global mental health teachers.
KS1-3
移民和文化适 应对于精神卫生的影响 - The Impact of Migration and Acculturation on Mental Health
Pedro Ruiz 1
1 University of Texas Health Science Center Houston , Psychiatry, Houston , United States
自从二次世界大 战以后 ， 移民入美国的比例稳步上升。此外，近二十年来全球化进程快速推动了指向发达地区或工业化国家的移民浪潮。伴随着这种情形同时到来的是这些移民原有的传统，文化和语言。结果是文化适应对于这类移民群体的巨大冲击。 与此同 时，这种文化适应应激所带来的后果从精神卫生的眼光来看是带有相当的病理学意义的。从另一方面而言，移民们有能 力去克服，适 应和调整在这种冲击下的主导文化。在此所要阐述的是对于文化适应应激的后果范式。此外，也会提到如何来检验各种因素在这一文化适应进程中所起的作用。最后，这些因素所导致的病理性表象将会被提出及讨论。
EDUCATIONAL OBJECTIVES:
4. 理解两 种文化冲击下文化适应应激在精神卫生和精神疾病方面所起的作用。
5. 认识社会人口统计学变量对于文化适应进程的影响。
6. 从移民 进程中了解它的行为后果。
REFERENCES:
4. Ruiz P, Venegas-Samuels K, Alarcon RD : The Economics of Pain: Mental Health Care Costs Among Minorities. Psychiatric Clinics of North America , 8: 659-670, 1995.
5. Ruiz P, Alarcon RD : How Culture and Poverty Exclude People from Care. American Journal of Forensic Psychiatry, 17: 61-73, 1996.
6. Ruiz P: New Clinical Perspectives in Cultural Psychiatry. Journal of Practical Psychiatry and Behavioral Health, 4: 150-156, 1998.
Since World War II, the rate of immigration to the United States has steadily increased. Additionally, during the last two decades the globalization process has rapidly expanded the migratory trends from developing regions to industrialized nations or regions. Together with this migration pattern, migrants have brought with them their heritage, culture and language. As a result of this process, acculturative stress has greatly impacted all of these migrant groups. At times, the outcome of the acculturative stress has been quite pathological from a mental health point of view. At other times, migrants were able to cope, adapt and adjust vis-à-vis the majority culture. In this presentation, a description of the outcome pattern of acculturative stress will be addressed; additionally, an examination of all of the factors that play a role in this acculturation process will also be addressed. Finally, the factors that lead to pathological manifestations will be presented and discussed.
Educational objectives:
1. To understand the role of acculturative stress vis-à-vis mental health and mental illness.
2. To recognize the sociodemographic variables that impact on the acculturation process.
3. To learn the behavioral outcomes that derive from the migration process.
References:
1. Ruiz P, Venegas-Samuels K, Alarcon RD : The Economics of Pain: Mental Health Care Costs Among Minorities. Psychiatric Clinics of North America , 8: 659-670, 1995.
2. Ruiz P, Alarcon RD : How Culture and Poverty Exclude People from Care. American Journal of Forensic Psychiatry, 17: 61-73, 1996.
3. Ruiz P: New Clinical Perspectives in Cultural Psychiatry. Journal of Practical Psychiatry and Behavioral Health, 4: 150-156, 1998.
KS1-4
抑郁症的治 疗与精神病学进展 - Advances in Psychiatry and Treatment of Depression
Jerrold Rosenbaum 1
1 Massachusetts General Hospital , Psychiatry, Boston , United States
在 过去的几十年间 ， 精神医学取得了许多重要进展 ， 一些严重精神疾病 （ 包括抑郁症 ） 的诊断准确性与治疗的效果也因此得以改善。抑郁症的患病率高，致残率高。本文将综述抑郁症的诊断与治疗新进展，并阐述今后十年抑郁症研究进展的可能方向与目前争议的问题，如自杀、新药研发和大型研究的阴性结果，等等。
There have been multiple important advances in psychiatry in the past decade. Such advances have improved diagnostic accuracy and treatment effectiveness in several psychiatric disorders, including depression. Given the high prevalence and substantial disability associated with depression, practitioners would benefit from a review of recent developments in depression diagnosis and treatment, as well as a description of likely advances in the next decade of depression research, and current controversies, like suicide, new drug development, the negative findings from the large trials, etc.
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