The World Health Organization (WHO) today released the third edition of Mental Health Gap Action Program (mhGAP) Guideline which includes important new and updated recommendations for the treatment and care of mental, neurological, and substance use disorders (MNS).
MNS disorders contribute significantly to morbidity and premature mortality in all regions of the world. Yet it is estimated that more than 75% of people with MNS disorders cannot access the treatment or care they need.
The mhGAP guideline helps countries strengthen their capacity to address the growing burden of these conditions. It is intended for use by doctors, nurses, other health workers working in non-specialist settings at the primary health care level, as well as health planners and managers.
“For 15 years, mhGAP has played a critical role in improving access to evidence-based psychological interventions and medications for the treatment and care of people with mental, neurological, and dementia-related disorders. substance use. Given the growing importance of mental health, this evidence-based guide is more important than ever to help primary health care workers treat people with MNS disorders,” said Dévora Kestel, director of WHO for mental health and substance use.
The 2023 guideline update includes 30 updated and 18 new recommendations related to MNS conditions, as well as 90 pre-existing recommendations.
New recommendations on anxiety disorders
The guidelines contain a new module on anxiety, reflecting the growing number of people suffering from anxiety disorders, which are among the most common mental disorders worldwide. The module includes the following recommendations:
- Psychological interventions based on cognitive-behavioral therapy (CBT) should be offered to adults suffering from generalized anxiety disorder and/or panic disorder. These interventions can be delivered in a variety of formats, including online, in-person, group, or self-guided.
- Stress management techniques should be considered for adults with generalized anxiety and/or panic disorder.
- Selective serotonin reuptake inhibitors (SSRIs) should be considered for treating adults with generalized anxiety and/or panic disorder.
Psychological and psychosocial interventions
The guidelines emphasize the continued importance of psychological treatments for a range of MNS conditions.
The mhGAP guideline contains new recommendations on psychosocial interventions for caregivers of people with psychosis or bipolar disorder as well as new recommendations on psychosocial interventions for psychosis, alcohol dependence, substance use, dementia and children and adolescents with neurodevelopmental disorders, including autism, ADHD and brain disorders. paralysis.
Women and girls who want to or might become pregnant should not use valproic acid (sodium valproate).
The guideline contains an updated recommendation that advises against the use of valproic acid (sodium valproate), a medication for the treatment of epilepsy and bipolar disorder, due to the risk of birth defects if used. taken during pregnancy.
The guideline recommends the following:
- Valproic acid (sodium valproate) should not be prescribed to women and girls who wish to become pregnant or may become pregnant due to the high risk of birth defects and developmental disorders in children exposed to valproic acid in the womb.
- For women and girls currently receiving valproic acid (sodium valproate), counseling should be provided on the use of effective contraception.
- It is important that women and girls do not stop taking valproic acid (sodium valproate) without first discussing it with their doctor.
- Women should be advised to consult their doctor as soon as they plan to become pregnant and to consult their doctor urgently if they become pregnant. Every effort should be made to transition to appropriate alternative treatment before conception.
- A specialist should periodically check whether valproic acid (sodium valproate) is the most appropriate treatment for the person.
The guideline reflects the WHO safety statement issued in May 2023 on the use of valproic acid (sodium valproate) for the treatment of epilepsy and bipolar disorder in women and girls of childbearing age. This topic was discussed at the WHO Advisory Committee on Safety of Medicines (ACSoMP) meeting (December 2022 ACSoMP Recommendations). A safety declaration has also been added to the Essential Medicines List (EML).
Other recommendations:
- The psychological and psychosocial interventions delivered digitally are divided into several modules: alcohol use disorders, anxiety, stress-related conditions, drug use disorders, self-harm and suicide.
- Recommendations for non-pharmacological interventions to improve outcomes for people with dementia have been updated to include exercise, CBT, cognitive stimulation therapy and cognitive training.
- The antipsychotic medications quetiapine, aripiprazole, olanzapine, paliperidone, and the long-acting antipsychotics haloperidol and zuclopenthixol are included for the treatment of psychosis and bipolar disorder. Levetiracetam and lamotrigine are included for the treatment of epilepsy.
Notes to editors:
- First published in 2010 and last updated in 2015, the mhGAP Guidelines and their associated products, including the mhGAP Intervention Guide, are now used in more than 100 countries and available in more than 20 languages .
- The mhGAP guidelines have been updated in accordance with the WHO guideline development manual and meet international standards for evidence-based guidelines. In collaboration with the Guideline Development Group (GDG), Thematic Expert Groups (TEG) and the Guideline Methodologist, the WHO Steering Group identified priority questions and outcomes to determine those that were essential to updating the mhGAP guidelines. Systematic reviews of the evidence were used to develop the Evidence for Decision and Summary of Findings tables, using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) approach. The GDG has developed recommendations which take into account a range of elements, namely: the certainty of the evidence; the balance between desirable and undesirable effects; values and preferences of the intended users of the intervention; resource requirements and profitability; health equity, equality and non-discrimination; feasibility; human rights and sociocultural acceptability.
