Dr.

Dalia El-Shafei
Lecturer, Community Medicine Department, Zagazig
University
 • State of well-being in which the individual:
• Realizes his own abilities,
• Cope with normal stresses of life,
Mental • Can work productively
• Able to make a contribution to community.
Health:

• Any disease or conditions that affect way a person

• Thinks,
• Feels,
Mental • Behaves
• Ability to relate to others & to surroundings
Illness:
1) Emotional balance.

2) Social adjustment.

3) Perceiving things the way they are.

4) Achievements consistent with individual's

abilities & opportunities.
1. WHO suggests that half the world's populations are
affected by mental illness with an impact on:
 their self-esteem,
 relationships and
 ability to function in everyday life.

2. Good mental health can improve one’s life,

poor mental health can prevent someone from living a
normal life.
1. Genetic predisposition: vulnerability
to most major psychiatric disorders
2. Age: High prevalence in old ages e.g.
Alzheimer's disease
3. Sex:
Anxiety & depression are more common
among women,
substance abuse is more common
among men.
4. Infections: Parasites such as malaria & encephalitis
→epilepsy - meningitis.

5. Toxic substances: alcohol and opiates.

6. Environmental exposure: lead in children → MR or ↓

intelligence.

7. Homeless people: schizophrenia or substance abuse.

8. Malnutrition: deficiency in vit. B & protein deficiency in

Kwashiorkor

9. Living in high floors housing, loneliness.

 Physical causes Mental disease
Mental diseases Physical illness

↓ iodine during pregnancy & oxygen at birth, injuries

& early childhood brain infections →MR.
Nutritional deficiencies such as PEM →MR.
Depression interacts with cardiovascular illnesses &vice
versa.
Anxiety, depression & substance abuse can also
complicate existing physical disorders.
 Psychopathic Impaired
disorders: intelligence
aggressive
antisocial acts

Behavioral
disorders as
Schizophrenia
maladjustment
& absenteeism.

Psychosis &
depression
 Mental illness & poor mental health are public problems
 Great impact on:
 • Distressing symptoms.
• Unable to participate in work & leisure.
Individuals • Quality of life continues to be poor: stigma & discrimination.

• Economic burden
• Disruption of house hold routine & restricted social activities.
• Lost opportunities prevent them from achieving their full
Family potential in work & social relations.

• Cost of providing care.

• Loss of productivity.
Community • Legal problems including violence.
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1. Mental health promotion:

improving ability of people to
deal more effectively with
everyday life stresses.

Mental health education to

improve mental abilities
through Mind's education with
special programs directed to
vulnerable groups; children,
adolescents, youth & elderly.
2. Genetic counseling, antenatal care: normal fetal
development, no exposure to X ray & no self intake of
drugs.
Natal care to prevent birth trauma can reduce occurrence
of mental disorders (Down syndrome).

3. Education,
employment,
social well-being, Important role in preventing
availability of food, mental disorders & promoting
housing mental health.
4.Raising public awareness about mental health
disorders.
Patients need ttt & kind care rather than punishment.
5. Awareness of psychological development: development
of human being's cognitive, emotional, intellectual, &
social capabilities is functioning over course of life span
from infancy through old age.

6. Life skills education:

 Interpersonal communication skills,
 Cooperation & teamwork.
 Decision-making
 Critical thinking skills.
 Skills for managing feelings.
 Skills for managing stress.
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It refers to intervention undertaken to reduce complications

& all specific treatment-related strategies.

1- Detection of mental disorders/illness in PHC:

Screening: for early detection of developmental delay at nursery,
school, university, military and work.
Early diagnosis: progression from asymptomatic to symptomatic
mental health disorder is subtle.
Mental disorder may exist for longer periods till recognized. Early
diagnosis needs capacity building of lay person, other professionals &
general practitioners.
2- Proper management and/or referral to psychiatrist:

Complete psychiatric assessment.

Detailed personal history &diagnosis.

Counseling, psychotherapy & medical ttt.

Admission to psychiatric word/hospital.

 3- Crisis intervention: 2ry

In wars,
disasters Mental health problems increase
crisis
Need immediate intervention
situation

Course of disease
Social support ↓ Duration intensity
Recovery
 3ry

Interventions that reduce disability & all forms of rehabilitation as

well as prevention of relapses of illness. The integration of needy
groups in the society is needed.

It can be achieved by:

1. Increasing society understanding of causes of disabilities &
abilities of needy/disabled group.
2. Attempting to reverse peoples & children negative attitudes.
3. Improving health-workers approach toward needy/disabled
groups.
4. Improving self-esteem & confidence of needy/disabled groups.
5. Showing needy/disabled groups can take care of others, not just
themselves.

6. Increasing opportunities for physical & socio-economic

integration of needy/disabled groups in daily activities.

7. Presenting abilities of needy/disabled groups through public

information campaigns to reduce stigmatization of mental
problems.

8. Training health workers about the needs of special groups.

9. Providing facilities/ services-day care centers & counseling sites

to families of needy/disabled.
10. Orientation of children about disabilities in schools, helping
regular schools integrates disabled children & promotes inclusive
education.

11. Communicate to parents about disabilities of their disabled

children.

12. Improve physical accessibility to public places, like mosques,

governmental offices and schools.

13. Create incentives for employers to hire disabled people

In Egypt the national mental health program focuses on:
1. Decentralization of mental health care & community care in
different governorates.
2. Inclusion of mental health in PHC.
3. Training of family doctors to deal with main mental disorders.
4. Awareness-raising among public regarding recognition of mental
disorders & methods of referral.
The new policy of deinstitutionalization & provision of community
care may reduce number of psychiatric inpatients but will not solve
problem.
After-care services in Egypt are still limited because of poor
understanding of most people is in need for follow up care after
initial improvement.
 Substance abuse = Drug abuse: any use of non prescribed, non
controlled substances or drugs without medical reason.

Drug Misuse: prescription medications with clinical efficacy but

abuse potential & known adverse effects linked to improper use as:
psychiatric medications with sedative, anxiolytic, analgesic, or
stimulant properties.

 Drug Dependence: state of psychic or physical dependence on a

drug occurring after periodic or continuous administration of that
drug.
*Addicted Person: person who is unable to free himself from a
harmful habit or he is unable to stop that habit.

*Psycho Active Drugs: exogenous substances that affect CNS for

calming, energizing or pleasurable. Excessive use of these drugs
leads to tolerance.

*Tolerance: need for increasing dose of a drug to reach original effect

of it.
 Drug users in Egypt range from 1-6 million people, with
most drug users being in the 15-25 age groups.

 Accurate statistics are difficult to obtain nature of drug

abuse & the stigma associated with being an addict.
 Narcotics:
Morphine,
Heroin &
Codeine

Cannabis: Depressant:
Hashish & Alcohol &
Marijuana Barbiturates

Hallucinogens:
Stimulants:
(LSD) Amphetamin
e & Cocaine.
1- Drug pharmacological effects, its ability to form psychic
dependence & tolerance.
2- Availability & easy accessibility of drugs.
3- Immature aggressive persons & sociopathic personality.
4- Psychic & neurological illness.
5- Parents or friends are addicts.
6- Rapid socioeconomic changes & deterioration of family & social
life.
7- Work problems.
8- Youth & adolescents use drugs to escape from a problem, to have
new experience & to express independence.
1-Adverse physical, mental, social & economic
consequences.
2- Alters neuromuscular coordination, reaction time &
judgment &↑ accidents.
3- ↑ Money expenditure for ttt of abusers.
4- ↑ Morbidity, withdrawal symptoms & premature death
due to over dose intake.
5- ↑ Absenteeism from work.
6- ↓ Quality & Quantity of work products.
7- ↑ Crime & violence.
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 Eliminate illegal drug use.

Empower laws & legislations that prevent cultivation, importation

& selling these drugs.

Health education for adolescents, students & workers for hazards

of drug abuse & their sequences.

Encourage youth for physical exercise & safe recreation activities.

Control family & social problems.

Parental supervision & control influence of bad peers.

 Early diagnosis of cases & continuous supervision.

Hospitalization of severe cases.

Hot line service for rapid management & confidential

service.

Follow up of recovered cases.

Rehabilitation of addicts, find suitable jobs & no
community stigma
It is unexpected, unplanned event that produces injury,
death, property loss or damage.
Increasing problem in developed & developing countries.

Types of accidents:
1- Road accidents 2- Home accidents
3- Occupational accident 4- Natural disaster
5- Birth injuries 6- Sport injuries
7- War
Causing laceration, contusions, bleeding, paralysis, fractures,
amputation, death etc.
 Road defects (Enviroment):
Narrow ,
Crowded,
Inadequate lightening,
Lack of traffic signs.
Pedestrian (Host):
Extreme of age,
Impaired alertness,
Negligence of traffic signals
Obesity.

Risk factors

Driver (Host):
Impaired alertness due to fatigue, Vehicle defects (Agent):
Drug abuse, Old models,
Worry, Bad maintenance,
Inadequate training, Variability in size.
Psychic upset.
 Road:
Town planning, Vehicle:
Clean & wide roads, Period inspection
Good lightening & traffic repair of vehicles.
signals.

Prevention

Driver:
Health appraisal before license,
Rules for maximal speed. Training,
Use of seat belt,
Health education of pedestrians.
  Animal bites
 Burns: matches, boiling fluids, fire
 Chemical poisoning: drugs
 Collapse of old building.
 Electric shock: neglected maintenance,
exposed wire.
 Fall on stairs, striking against furniture,
slippery floor
 Wounds by sharp knives, pointed
articles.
 Extreme of age.

 Epilepsy, fainting, loss of consciousness

 Over confidence in repairing electric appliance.

 Bad illumination,

 Slippery floor or stairs, derangement of furniture,

 Presence of drugs at reach of children.

 Storage of medications & toxic substance (caustic soda,
-
pesticides) in high places, closed, & away from children hands.

- Close windows, balcony guard.

- Matches, sharp knives should be put in hidden place.

- Children should not stay with mothers in kitchens during

cooking.

- Use special adhesives to cover electric opening in wall.

- 1st aid must be present in every house to help in emergency.

Definition: accidents occurring
during work.

Examples: Falls, fractures,

amputation, electric shock,
burning, explosion, & chemical
toxicity.
Personal causes
• Age: Extreme of age.
•Poor physical health “fever,
epilepsy, hypoglycemia,
defective hearing or vision, low
intelligence”
• Psychological upset, stress,
fears.
• Negligence of wearing PPE
• not follow instructions of
machines.
Environmental causes
• Bad environmental sanitation:
bad ventilation, bad
illumination, low or high
temp., noise, crowded places.
• Unsafe machines: exposed
electricity, bad maintenance,
lack of safety measures.
Impact of accidents on workers & industry:

 Impaired health, disability and handicapping.

 Increased expenses on medical care, rehabilitation &

compensation.
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 Primary prevention of accidents:

 Sanitary environment.

 Good machinery design, safety & good maintenance.

 Health education of workers, good training before work,

 Prevention of fatigue, solving psychological troubles.

 ttt of any illness, good nutrition.

 • 1st aid & emergency services for proper
management of injuries at all work places
2ry
prevention

• Placement in another job, training

• Artificial limb in amputation, special aids
3ry for handicapped persons.
prevention