SWITZERLAND —The World Health Organization (WHO) has released the third edition of the Mental Health Gap Action Programme (mhGAP) guideline, ushering in vital new and updated recommendations for the treatment and care of mental, neurological, and substance use (MNS) disorders.

These conditions significantly contribute to global morbidity and premature mortality, yet over 75% of affected individuals struggle to access the necessary treatment.

The mhGAP guideline serves as a crucial tool for countries aiming to bolster their capacity to address the escalating burden of MNS disorders.

Tailored for use by healthcare professionals in non-specialist primary care settings, as well as health planners and managers, it plays a pivotal role in advancing evidence-based psychological interventions and medications.

Dévora Kestel, WHO Director for Mental Health and Substance Use, emphasized the enduring importance of mhGAP, stating, “Considering the growing relevance of mental health, this evidence-based guide is more important than ever in supporting primary health care workers to treat people with MNS disorders.”

The 2023 guideline update features 30 updated and 18 new recommendations related to MNS conditions, alongside 90 existing recommendations.

Notably, it introduces a new module on anxiety, addressing one of the world’s most common mental disorders.

Recommendations within this module encompass psychological interventions based on cognitive-behavioral therapy (CBT), stress management techniques, and the consideration of Selective Serotonin Reuptake Inhibitors (SSRIs) for treating adults with generalized anxiety and/or panic disorder.

Furthermore, the guideline underscores the ongoing significance of psychological treatments for various MNS conditions.

It introduces new recommendations on psychosocial interventions for carers of individuals with psychosis or bipolar disorder and extends guidance on psychosocial interventions for psychosis, alcohol dependence, substance use, dementia, and neurodevelopmental disorders in children and adolescents.

A notable update pertains to the use of valproic acid (sodium valproate), a medication for epilepsy and bipolar disorder.

Due to the heightened risk of birth defects if taken during pregnancy, the guideline advises against its prescription for women and girls planning pregnancy or who may become pregnant.

For those currently prescribed valproic acid, effective contraception is recommended, emphasizing the importance of consulting a physician before discontinuing the medication.

The release incorporates digitally-delivered psychological and psychosocial interventions across various modules, addressing alcohol use disorders, anxiety, stress-related conditions, drug use disorders, self-harm, and suicide.

Notable updates include recommendations for non-pharmacological interventions for dementia, such as physical exercise, CBT, cognitive stimulation therapy, and cognitive training.

Antipsychotic medicines such as quetiapine, aripiprazole, olanzapine, paliperidone, and long-acting antipsychotics like haloperidol and zuclopenthixol are included for the treatment of psychosis and bipolar disorder.

Levetiracetam and lamotrigine are recommended for the treatment of epilepsy, reflecting the guideline’s comprehensive approach to mental health care.

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