“brains—even small ones—are dauntingly complex”

22 09 2013

Here is a great article by Gary Marcus that was recently published at the New-Yorker. Enjoy!

 

A MAP FOR THE FUTURE OF NEUROSCIENCE

Gary Marcus

On Monday, the National Institutes of Health released a fifty-eight-page report on the future of neuroscience—the first substantive step in developing President Obama’s BRAIN Initiative, which seeks to “revolutionize our understanding of the human mind and uncover new ways to treat, prevent, and cure brain disorders like Alzheimer’s, schizophrenia, autism, epilepsy, and traumatic brain injury.” Assembled by an advisory panel of fifteen scientists led by Cori Bargmann, of Rockefeller University, and William Newsome, of Stanford, the report assesses the state of neuroscience and offers a vision for the field’s future.

The core challenge, as the report puts it, is simply that “brains—even small ones—are dauntingly complex”:

Information flows in parallel through many different circuits at once; different components of a single functional circuit may be distributed across many brain structures and be spatially intermixed with the components of other circuits; feedback signals from higher levels constantly modulate the activity within any given circuit; and neuromodulatory chemicals can rapidly alter the effective wiring of any circuit.

To tackle the brain’s immense complexity, the report outlines nine goals for the initiative. No effort to study the brain is likely to succeed without devoting serious attention to all nine, which range from creating structural maps of its static, physical connections to developing new ways of recording continuous, dynamic activity as it perceives the world and directs action. A less flashy, equally critical goal is to create a “census” of the brain’s basic cell types, which neuroscientists haven’t yet established. (The committee also devotes attention to ethical questions that could arise, such as what should happen if neural enhancement—the use of engineering to alter the brain—becomes a realistic possibility.)

The most important goal, in my view, is buried in the middle of the list at No. 5, which seeks to link human behavior with the activity of neurons. This is more daunting than it seems: scientists have yet to even figure out how the relatively simple, three-hundred-and-two-neuron circuitry of the C. Elegans worm works, in part because there are so many possible interactions that can take place between sets of neurons. A human brain, by contrast, contains approximately eighty-six billion neurons.

To progress, we need to learn how to combine the insights of molecular biochemistry, which has come to dominate the lowest reaches of neuroscience, with the study of computation and cognition, which have moved to the forefront of fields such as cognitive psychology. (Though some dream of eliminating psychology from the discussion altogether, no neuroscientist has ever shown that we can understand the mind without psychology and cognitive science.) The key, emphasized in the report, is interdisciplinary work shared as openly as possible: “The most exciting approaches will bridge fields, linking experiment to theory, biology to engineering, tool development to experimental application, human neuroscience to non-human models, and more.”

Perhaps the least compelling aspect of the report is one of its justifications for why we should invest in neuroscience in the first place: “The BRAIN Initiative is likely to have practical economic benefits in the areas of artificial intelligence and ‘smart’ machines.” This seems unrealistic in the short- and perhaps even medium-term: we still know too little about the brain’s logical processes to mine them for intelligent machines. At least for now, advances in artificial intelligence tend to come from computer science (driven by its longstanding interest in practical tools for efficient information processing), and occasionally from psychology and linguistics (for their insights into the dynamics of thought and language). Only rarely do advances come from neuroscience. That may change someday, but it could take decades.

It would have been useful for the report to include more discussion of the Allen Institute for Brain Science, which has its own half-billion-dollar budget for neuroscience, provided by its founder, Paul Allen. Whereas the BRAIN Initiative is still only a proposal, the A.I.B.S. has, for the past decade, been building brain maps and sharing them freely. Because its recent proposal for a series of “brain observatories,” described last year in Nature, presaged Obama’s BRAINInitiative in many ways, it arguably deserves more comment and analysis. (Full disclosure: I’m speaking at the Institute next week.)

But these are quibbles. There are plenty of reasons to invest in basic neuroscience, even if it takes decades for the field to produce significant advances in artificial intelligence. If the projects outlined in the new report deliver half of what they intend, they will revolutionize both science and medicine by giving us the first clear understanding of the circuits that underlie brain function. With those discoveries, we may see the first major advances in decades in the treatment of mental illnesses and brain injuries. More than that, we stand an excellent chance of gaining a significantly richer understanding of ourselves.

 





Mental health knowledge and attitudes of general practitioners and pediatricians toward persons with psychiatric disorders prior to the integration of mental health into primary care – A research proposal

19 09 2013

Below please find is a research proposal entitled ‘mental health knowledge and attitudes of general practitioners and pediatricians toward persons with psychiatric disorders prior to the integration of mental health into primary care’. Since I think that this issue is very important and relevant to the Israeli health system and due to the fact that I do not have the time to promote it, I encourage you to use it and to study this highly important issue. Good luck!

 

Title

Mental health knowledge and attitudes of general practitioners and pediatricians toward persons with psychiatric disorders prior to the integration of mental health into primary care

Abstract

Scientific Background: Israel is currently promoting a reform aimed to improving the accessibility, availability, and efficiency of mental health services. As part of this reform, mental health integration into primary care will take place over the next couple of years.

Objectives: the main objective is to investigate whether, and to what extent, general practitioners and pediatricians, have the adequate knowledge and attitudes that are required to effectively assess, diagnose, treat, support and refer people with psychiatric disorders.  The findings of this proposed study may provide valuable information for policy makers concerning the current knowledge and attitudes of GPs and pediatricians in the mental health field while indicating whether there is a need to promote mental health training among these populations.

Working hypotheses: Overall, general practitioners and pediatricians do not have the adequate knowledge and attitudes to provide evidence based health services to children and adults with psychiatric disorders. Pre-service education and training in mental health, years of practice, participant’s country of origin country of medical studies and post graduate training, current workplace, familiarity with persons with psychiatric disorders, geographic location of the clinic and gender will impact the participant’s mental health knowledge and attitudes.

Methods of Data Collections: a cross-sectional quantitative research of general practitioner and pediatricians using case vignette questionnaires, demographic questionnaire and Level of Contact questionnaire

Methods of Data Analysis: Differences in socio-demographic characteristics across vignette groups will be analyzed using chi-square tests and one-way analysis of variance (ANOVA). The responses the questionnaires will be examined using one-way ANOVA tests, followed by posthoc Mann–Whitney U-tests for overall significance at the P < 0.05 level. ANOVAs followed by confirmatory ordinal logistic regressions will be used for interactions between the moderating variables and participants’ knowledge and attitudes towards the patients in the four vignettes.

 

  1. Scientific background:

About 450 million of people worldwide are affected by psychiatric disorders. The World Health Organization (WHO) estimates that 154 million people are affected by depression and 25 million people from schizophrenia; 91 million people are affected by alcohol use disorders and 15 million by drug use disorders (WHO, 2004, 2006). With regard to children, the literature indicates that approximately one in five children have a psychiatric disorder (WHO, 2005). Disorders regularly seen within this population include attention-deficit/hyperactivity disorder, conduct disorder, generalized anxiety disorder, depressive disorders, post traumatic stress disorder, and separation anxiety disorders (WHO, 2006; Korczak & Goldstein, 2009; Polanczyk, de Lima, Horta, Biederman and Rohde, 2007).

 

Psychiatric disorders are both prevalent and highly disabling conditions. Measured by years lived with disability and by premature death (DALYs), psychiatric and neurological conditions accounted for over 13% of the global disease burden in the year 2001 need more recent  (WHO, 2004). Among individuals age 15–44, unipolar depression is the second leading contributor of DALYs, with alcohol-related disorders, schizophrenia, and bipolar disorder among the top 10 disorders. Approximately, 33% of all years lived with disability (YLD) are imputed to psychiatric conditions. Of the 10 leading causes of YLD in the world among individuals of all ages, four are psychiatric conditions, with unipolar depression being the leading cause. These figures are rising. By 2030, in high-income countries, depression will become the single highest contributor to the overall disease burden (Mathers CD, Loncar, 2006). Psychiatric disorders also affect, and are affected by, chronic diseases such as cancer, cardiovascular diseases, diabetes and HIV/AIDS. Hence, when untreated, psychiatric disorders can contribute to unhealthy behavior, non-adherence to prescribed medical regimens, diminished immune functioning, poor prognosis and early dead (Miller, Paschall and Svendsen, 2006; Nakash, Shemesh, Nagar and Levav, 2012).

 

Despite the potential to successfully moderate the effect of psychiatric disorders, only a small minority of those in need receive adequate mental health care (World Health Organization and World Organization of Family Doctors (Wonca), 2008). The report of the US Surgeon General emphasized the critical role of stigma on the public’s willingness to seek help and to receiving mental health services (U.S. Department of Health and Human Services, 1999). Furthermore, it highlighted the fact that the separation of treatment care systems (i.e. mental health system – physical health system) increases the stigma of mental health disorders and care and decrease the accessibility to treatment, while maintaining the wide treatment gap.  As a result, many countries have recently sought to integrating mental health services into primary care to reduce the treatment gap while enhancing the access of mental health services (WHO & Wonca, 2008). In this process, those countries tried to assure that primary care workers hold the knowledge, which is required to effectively assess, diagnose, treat, support and refer to the specialized services people with mental disorders. Nonetheless, the professional literature indicates that in many parts of the world, primary care workers fail to detect psychiatric disorders, and for a range of reasons they also fail to provide evidence-based treatment to persons they do identify in need of care (Üstün & Sartorius, 1995).  While there are many reasons why psychiatric disorders are under-detected and undertreated in primary care (e.g., patient factors, health system factors, and societal and environmental factors) (WHO & Wonca, 2008), the role of the health care workers is crucial. Research suggests that many health workers do not receive adequate training on mental health issues or developed frank stigmatic attitudes. In most countries, primary care worker training ranges from a few hours to a maximum of one or two weeks. Misunderstandings about the nature of mental health problems, prejudice against people with mental disorders, and inadequate time to evaluate and treat psychiatric disorders in clinical settings are other contributing factors. For example, a recent study indicates that 98.5% general practitioners providing mental health services care in a primary care setting feel the need to be properly trained and oriented in the management of patients with psychiatric disorders to improve the overall quality of health care (Chaundhary & Mishra, 2012).  Furthermore, 79% of the primary care providers in their sample did not know any psychiatric illness diagnosis criteria neither have they any exposure to training to deal with psychiatric conditions. Hence, they treat their patients based on their “own intuitions” (Chaundhary & Mishra, 2012, p. 23).

 

While formal education in the mental health field can lead to better evidence based practice it may lead to positive attitudes toward persons with psychiatric illness. Research on health-related attitudes largely indicates that overall, one’s professional knowledge about psychiatric illness and disability, as well as one’s positive contacts and interactions with people who psychiatric disorders, positively affect the individual’s attitudes toward them, both in an absolute sense and in comparison to the views of the general public (Penny, Kasar, & Sinay, 2001; Whal & Aroesty-Cohen, 2010; Yamauchi Semba, Sudo, Takahashi, Nakamura, Yoshimura, Koyama et al, 2011). For example, in their recent review of the literature, Whal and Aroesty-Cohen (2010) found that 14 of the 19 studies investigated (published between the years 2004-2009) reported general positive attitudes among mental health professionals toward people with psychiatric illness, whereas only five showed predominantly negative attitudes. Nevertheless, students and professionals in the health field are not immune to the influence of negative attitudes and discrimination (e.g., Nordt, Rossler, & Lauber, 2006; Tervo & Palmer, 2004). In fact, the professional literature suggests that negative attitudes on the part of health professionals is most toxic, since their attitudes related to the prognosis, recovery and social inclusion of people with illnesses may have a crucial impact on the lives of their patients (Corrigan, 2007; Li, Comulada, Wu, Ding, & Zhu, 2011). For example, in a survey of 1073 mental health professionals and 1737 members of the general public, researchers found that psychiatrists held more negative attitudes toward people with psychiatric illness than the general public. Moreover, mental health professionals of all types were three times more likely to support restrictions for people with psychiatric illness than the general public (Nordt, Rossler, & Lauber, 2006). Another study found that general practitioners were less happy to have a patient with schizophrenia on their practice list and reported that patients with schizophrenia are more likely to be violent than most patients (Lawrie, Martin, McNeill, et al, 1998).

Israel is currently promoting a reform in its mental health system aimed to integrating mental health services into primary care settings. The main purposes of this reform are to (1) improving the link between mental and physical care by enhancing primary care physicians’ capacity to diagnose and treat psychiatric disorders; (2) strengthening the consultation and referral relationships between the primary care providers and mental health specialists; (3) and to improving availability and access of mental health services (Rosen,Nirel, Gross, Bramali and Ecker, 2008). Furthermore, the implementation of this reform is expected to facilitate help-seeking strategies, and improve early detection and intervention that that may increase the chances of quicker recovery and better long-term outcomes. Following the experiences of other countries (WHO and WONCA, 2008), one of the main factors that may determine the success of this reform is the degree to which primary care providers would have adequate knowledge and positive attitudes that would improve their practice, including their willingness to consult and be supervised by mental health experts. Hence, as will be elaborated in the next section, the main goal of this proposed research is to investigate the current diagnostic and treatment knowledge, attitudes and practices among general practitioners (GPs) and pediatricians.

 

  1. Objectives

General objective:

  1. To investigate mental health knowledge and attitudes of general practitioners and pediatricians (heretofore: participants), in primary care settings, in the pre integration era.
  2. To investigate mental health attitudes in general and attitudes toward persons with psychiatric disorders in particular among study participants.
  3. To investigate the association of participants’ age, gender,  country of origin, personal familiarity with persons with psychiatric disorders, country of medical studies and post graduate training,  current workplace (the health plan that the participate work with), mental health pre-service education; years of practice, geographic location of the site of current practice and, on mental health knowledge and attitudes.

 

  1. Working Hypotheses

Base on past research, we expect the following:

  • Overall, general practitioners and pediatricians do not have the adequate knowledge and attitudes to provide evidence based health services to children and adults with psychiatric disorders.
  • Pre-service education and training in mental health, years of practice, participant’s country of origin country of medical studies and post graduate training, current workplace, familiarity with persons with psychiatric disorders, geographic location of the clinic and gender will impact the participant’s mental health knowledge and attitudes. 

 

  1. Comprehensive description of study design and methodology:

This is a cross-sectional research of general practitioners and pediatricians using a case vignette questionnaire aimed to investigate 1) the degree to which the participants have the adequate knowledge on psychiatric diagnosis and treatments; 2) to explore the participants’ attitudes toward psychiatric disorders and patients with psychiatric disorders. Furthermore, the impact of pre-service education and training, country of medical studies and post graduate training, participants’ country of origin, years of practice, gender, geographic location of their clinic and personal familiarity with persons with psychiatric disorders, on their mental health knowledge and attitudes will be ascertained as well.

Participants: A convenient sample of 500 general practitioners and 200 pediatricians will be recruited for the present study. These figures were selected following a power analysis that was conducted using the G*Power 3 program (Faul, Erdfelder, Lang, & Buchner, 2007) to determine the sample size. With alpha set at 0.05 and power at 0.80 that a minimum sample of 180 participants was needed to detect a significant medium effect (f = 0.25) using one-way ANOVA with four [vignettes] groups.

Recruitment. This proposed research will approach all the registered GPs (around 5000) and pediatricians (around 2000) via an email message that will include a cover letter with the purposes and importance of the study followed by the research questionnaires. Furthermore, we will collaborate with the four Israeli health plans and will seek to promote collaborations with the Israel Ambulatory Pediatric Association and with the Israel Association of Family Physicians in order to increase participation.  The cover letter and questionnaires will also be published in websites and social media that are aimed for general practitioners and pediatricians. Finally, the research assistances will attend professional conferences where they will encourage GPs and pediatricians to fill the questionnaires on site.

Research tools:

The present research will be based on case vignettes that will be followed by mental health knowledge questionnaire concerning psychiatric diagnosis and treatment and attitudes measurements. The case vignettes that will be developed for GPs will include a description of adults who experience symptoms of schizophrenia, unipolar depression, diabetes or no illness (i.e. good health). The case vignettes that will be developed for pediatricians will include a description of children who experience symptoms of Attention deficit-hyperactivity disorder (ADHD), separation anxiety, Asthma or no illness.

These vignettes will be followed by a questionnaire that will be developed for this research aimed to assess the participants’ knowledge ability to diagnose and tailor a treatment (including referring the potential patient to a mental health expert) for the person described in the vignette. In addition, based on the study of Lawrie et al. (1998), which measured mental health attitudes among primary care providers, participants will be asked to report their level of agreement with 13 statements based on the vignette using a 7-point Likert scale (e.g., you would be happy to have this patient on your list, this person is likely to take up a lot of time, this patient is more likely to be violent than most patients, and this patient is unlikely to comply with advice or treatment given). In addition, a socio-demographic questionnaire will be distributed. In this questionnaire, participants will be also asked to report with what health plan they are working. Moreover, participants will be asked to answer a modified Level of Contact questionnaire (Holmes, Corrigan, Williams, et al, 1999) that include a lists 12 situations of varying degrees of intimacy that involve persons who have psychiatric illness and diabetes. The reason for asking of previous contact between the participants and persons with psychiatric illness and diabetes is based on the contact hypothesis (Allport, 1954) which demonstrated that contact under certain conditions is highly effective in alleviating negative attitudes and prejudice directed toward out-group members, including persons with psychiatric illness and other health conditions (Corrigan, Roe and Tsang, 2011; Wright, 2009). Finally, a questionnaire regarding the participants’ pre-service education will be developed. The aim of this questionnaire is to investigate to what extent, medical school, internship and residency programs impact the mental health knowledge, attitudes and practice of the participants.

 

Analysis

Analyses will conduct using the Predictive Analytics SoftWare (PASW, Version 18.0). All data will be dual entered. Differences in socio-demographic characteristics across vignette groups will be analyzed using chi-square tests and one-way analysis of variance (ANOVA). The responses to the mental health knowledge and attitudes across the four groups will be examined using Kruskal–Wallis one-way ANOVA tests, followed by posthoc Mann–Whitney U-tests for overall significance at the P < 0.05 level. ANOVAs followed by confirmatory ordinal logistic regressions will be used for interactions between the following variables and participants’ knowledge, skills and attitudes towards the patients in the four vignettes:

1. Preserves medical education and training in the mental health field

2. Workplace (i.e. the health plan that the participant work with).

3. Years of practice

4. Country of origin and country of medical studies and post graduate training

5. Contact with persons with psychiatric disorders

6. Gender

7. Geographic location of the clinic

 

Procedure:

At the first stage the vignettes and questionnaires developed for this study will be reviewed by a panel of experts. The questionnaire will be distributed among 10 GP experts and 10 pediatric experts. They will be asked to provide feedback concerning the validity and clarity of the vignettes and the questions and their relevance to the research objectives. The panelists will not serve as study participates. After the validation phase, vignettes and the questionnaires will be uploaded to a research website. Then, study participant will be recruited by the research assistances (see the recruitment section). The vignettes will be then randomly allocated and a cover letter which describe the aim of the research and that states that all responses would be anonymous,  with a link to the website will then be sent to study participates. Moreover, they will be informed that their participation is entirely voluntary. A follow up reminder will be sent to participants will be sent a month after.

 

Possible biases and research limitations

The qualifications of the study are those characteristics of the design or methodology that set parameters on the application or interpretation of the results of the study, that is, the constraints on the generalizability and utility of the findings established by internal and external validity. With regard to external validity, the proposed research needs to be examined in light of several limitations. First, the fact that the proposed research relies on a convenience sample, rather than a representative sample, reduces the ability to draw inferential conclusions from the sample data about the general population. However, the findings of this proposed research may provide important information can lead to further research among a representative sample of GPs and pediatricians in Israel. A second limitation relates to response rates. In this project, the main problem is the difficulty to reach the participants who may be loaded with their daily work and not see the importance of filling in a questionnaire for research purposes. Therefore, multiple recruitment strategies will be employed in order to assure that most participants will indeed answer the questionnaires. Finally, social desirability is treated as a factor that can contaminate commonly used self-report measures and thus lower reliability and validity of the results. This is mostly relevant to attitudes questionnaires. The proposed study will be anonymous and that may significantly reduce the social desirability bias.

5. Significance of the Proposal:

Over the past two decades, the State of Israel is preparing to transfer legal responsibility for mental health care from the government to the country’s four, competing, non-profit health plans. This reform seeks to improve the health and well-being of the persons with psychiatric disorders by establishing a legal right to care, increasing the level of government funding for mental health care, and improving the accessibility, availability, and efficiency of services. Nowadays, where the mental health integration into primary care is about to come to realization, there is a need to assess whether primary care providers, which will serve as the main gatekeepers for mental health conditions, have the adequate mental health knowledge and attitudes. Learning from the experience of countries that conducted similar mental health reforms without ensuring that the primary care providers have the needed mental health knowledge and attitudes to provide adequate mental health services (WHO and Wonca, 2008), the present study seeks to provide information about the current mental health knowledge and attitudes of primary care providers; information that may assist to better implement this important reform.

 

References

 

Allport, G. W. (1954). The nature of prejudice. Cambridge, MA: Perseus Books.

 

Corrigan. P.W., (2007). How Clinical Diagnosis Might Exacerbate the Stigma of Mental Illness. Social Work, 52 (1), pp. 31-39.

 

Faul, F., Erdfelder, E., Lang, A.G., and Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social ,behavioral, and biomedical sciences. Behavior Research Methods, 39, 175-191.

 

Lawrie, S. M., Martin, K.,  McNel, G. J., Drife, J. Chrystie, P., Reid, A.,  P. Wu, P., nammary, S., and J. Ball (1998). General practitioners’ attitudes to psychiatric and medical illness. Psychological Medicine, 28, pp 1463-1467.

 

Li, L., Comulada WS, Wu Z, Ding Y, Zhu W. (2011). Providers’ HIV-related avoidance attitude and patient satisfaction. Health Expectations. doi: 10.1111/j.1369-7625.2011.00705.x.

 

Mathers C.D., Loncar D. (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLos Medicine, 3:2011–2030.

 

Miller B.J., Paschall C.B., 3rd, Svendsen D.P., (2006). Mortality and medical comorbidity among patients with serious mental illness. Psychiatric Services;57(10):1482-7.

 

Nakash, O., Shemesh, A., Nagar, M., and Levav, I., (2012).  Cancer and common mental disorders in the community: Results of the Israel-World Mental Health Survey. European Journal of Psychiatry; 26 (3), 174-184.

 

Nordt, C., Rossler, W., and Lauber, C. (2006). Attitudes of Mental Health Professionals Toward People With Schizophrenia and Major Depression. Schizophrenia Bulletin. 32 (4): 709–714.

 

Penny, N.H.,  Kasar, J. and  Sinay, T (2001). Student Attitudes Toward Persons With Mental Illness: The Influence of Course Work and Level of Fieldwork. The American Journal of Occupational Therapy, 55 (2), 217-220.

 

Polanczyk G., de Lima M.S., Horta B.L, Biederman J, and Rohde L.A., (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis”. The American Journal of Psychiatry 164.

 

Rosen, B., Nirel, N., Gross,R.,  Bramali, S., and Ecker, N., (2008). The Israeli Mental Health Insurance Reform. The Journal of Mental Health Policy and Economics, 11, 201-208.

 

Tervo, R.C. & Palmer, G. (2004). Health professional student attitudes towards people with disability. Clinical Rehabilitation; 18(8), 908-915.

 

U.S. Department of Health and Human Services. (1999). Mental Health: A report of the Surgeon General. Rockville, MD: Author.

 

Üstün T.B., Sartorius N., (eds.) (1995). Mental illness in general health care: an international study. Chichester, Wiley.

 

Wahl, O.F. & Aroesty-Cohen, E. (2010). Professional Attitudes about Mental Illness: A Review of the Recent Literature. Journal of Community Psychology, 38 (1) 49–62.

 

World Health Organization (2004). Revised Global Burden of Disease (GBD) 2002 estimates. Geneva, World Health Organization. Can be retrieved at: http://www.who.int/healthinfo/bodgbd2002revised/en/index.html, accessed 31 March 2008 (

 

World Health Organization (2005). Child and adolescent mental health policies and plans. Geneva, World Health Organization.

 

World Health Organization (2006). Neurological disorders: public health challenges. Geneva, World Health Organization.

 

World Health Organisation, (2008). The Global Burden of Disease: 2004 Update. WHO, Geneva, Switzerland.

 

World Health Organization and World Organization of Family Doctors (Wonca) 2008. Integrating mental health into primary care: A global perspective. ISBN 978 92 4 156368 0; 206 pages. Available at: http://www.who.int/mental_health/policy/Integratingmhintoprimarycare2008_lastversion.pdf

 

Yamauchi T., Semba T., Sudo A., Takahashi N., Nakamura H., Yoshimura K., Koyama H., Ishigami S., and Takeshima T., (2011). Effects of psychiatric training on nursing students’ attitudes towards people with mental illness in Japan. International Journal of Social Psychiatry,  57 (6), 574-579.

 

 

 

 

 

 

 





The Neuroscience of Sleep

2 09 2013

This time I want to offer you an opportunity to hear a great lecture by Russell Foster about the The Neuroscience of Sleep. To see his speech click HERE. Enjoy!