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Classical definitions of motivation typically involve two main components: direction and activation. Motivated behavior is directed toward or away from particular stimuli (i.e., appetitive and aversive motivation). Furthermore, activational aspects of motivation refer to the observation that motivated behavior is characterized by substantial activity, vigor, persistence, and exertion of effort in both the initiation and maintenance of behavior. Although separate neural systems direct organisms toward distinct motivational stimuli (e.g., food, water, sex), there appears to be a common circuitry regulating behavioral activation and the exertion of effort. Mesolimbic dopamine is one of the brain systems mediating activational aspects of motivation and exertion of effort. This system integrates aspects of motivation and motor control functions involved in the instigation of action. Research on the neurobiology of effort has contributed to our understanding of the pathophysiology of neurological and psychiatric disorders that are characterized by motivational dysfunction.

The management of individuals with autism spectrum disorders (ASDs) requires a multimodal approach of behavioural, educational and pharmacological treatments. At present, there are no available drugs to treat the core symptoms of ASDs and therefore a wide range of psychotropic medications are used in the management of problems behaviours, co-occurring psychiatric disorders and other associated features. The purpose of this paper is to map the literature on pharmacological treatment in persons with ASD in order to identify those most commonly used, choice criteria, and safety.

A systematic mapping of the recent literature was undertaken on the basis of the following questions: What are the most frequently used psychoactive compounds in ASD? What are the criteria guiding the choice of a specific compound? How effective and safe is every psychoactive drug used in ASD? The literature search was conducted through search engines available on Medline, Medmatrix, NHS Evidence, Web of Science and the Cochrane Library.

Many psychotropic medications have been studied in ASDs, but few have strong evidence to support their use. Most commonly prescribed medications, in order of frequency, are antipsychotics, antidepressants, anticonvulsants and stimulants, many of them without definitive studies guiding their usage. Recent animal studies can be useful models for understanding the common pathogenic pathways leading to ASDs, and have the potential to offer new biologically focused treatment options.

This is a practice review paper applying recent evidence from the literature.

A high proportion of people with learning disabilities receive psychotropic medications such as antipsychotics, antidepressants, antianxiety drugs including benzodiazepines, buspirone and beta blockers, mood stabilisers such as lithium and some antiepileptic medications, psychostimulants, opioid antagonists and also vitamins and diets. Many receive these for behaviour problems for which these medications have not been indicated. Apart from a few exceptions of recent good quality randomised controlled trials (RCTs) of risperidone on the management of behaviour problems among children and adults with learning disabilities with and without autism, most of the evidence for the effectiveness of medication for the management of behaviour problems comes from non‐controlled or non‐randomised observational studies. The lack of evidence does not automatically mean that there is evidence that these medications are not effective. Current guidelines suggest that a thorough assessment of the cause and effect of the behaviour problems should be carried out before prescribing medications. A formulation should document the assessment and rationale for use of medications. Non‐medication based interventions should always be considered along with medication and where appropriate behavioural and psychological interventions should be employed either instead of or along with the medication. People with learning disabilities and their carers should be involved in the decision‐making process all along. Where necessary other relevant professionals should also be involved. At the outset the time, method and people involved with the follow‐up assessment should be determined. Follow up should involve an objective assessment of target behaviours but, more importantly, an assessment of the quality of life of the person and their carers. At each follow up a reformulation should be carried out along with consideration of non‐medication based management and the possibility of withdrawing medication. Important issues such as capacity, consent and legal issues should always be borne in mind. Medications should be used with some caution because of their adverse effects.

This chapter uses Goffman’s concept of total institutions in a comparative case study approach to explore the role of psychotropic drugs in the process of transinstitutionalization.

This chapter interprets psychotropic drug use across four institutionalized contexts in the United States: the active-duty U.S. military, nursing homes and long-term care facilities, state and federal prisons, and the child welfare system.

This chapter documents a major unintended consequence of transinstitutionalization – the questionable distribution of psychotropics among vulnerable populations. The patterns of psychotropic use we synthesize suggest that total institutions are engaging in ethically and medically questionable practices and that psychotropics are being used to serve the bureaucratic imperatives for social control in the era of transinstitutionalization.

Psychotropic prescribing practices require close surveillance and increased scrutiny in institutional settings in the United States. The flows of mentally ill people through a vast network of total institutions raises questions about the wisdom and unintended consequences of psychotropic distribution to vulnerable populations, despite health policy makers’ efforts regulating their distribution. Medical sociologists must examine trans-institutional power arrangements that converge around the mental health of vulnerable groups.

This is the first synthesis and interpretive review of psychotropic use patterns across institutional systems in the United States. This chapter will be of value to medical sociologists, mental health professionals and administrators, pharmacologists, health system pharmacists, and sociological theorists.

The ways in which the brain, as mapped by bioscience, has become popularly understood as the locus and determinant of the self is a topic of increasing importance within medical sociology. Nikolas Rose has influentially chronicled the emergence of a “neurochemical self,” determined by brain chemistry and thus fluid, malleable, and open to improvement via increasingly fine-tuned psychopharmacology. This chapter argues for the contemporaneous emergence of a neurostructural self, intrinsic to the growing neurodiversity movement. Drawing on trends in contemporary neuroscience and biological psychiatry, this model of “brainhood” conceptualizes the brain-as-self as a material system: governed by physical laws, and thus both morally innocent and robustly predictable. Rather than being infinitely open to intervention and optimization, however, the neurostructural self is imagined as fixed and immutable, resistant to the medical intervention and presumption of infinite flexibility inherent within neurochemical selfhood. This chapter draws on a two-year ethnographic study of autism spectrum disorders in North America, investigating the ways in which circulating discourses about medicine, culture, and identity are shaping the emergence, development and use of autism spectrum diagnoses in contexts of daily practice. In this chapter, I explore why individuals with the autism spectrum disorder known as Asperger's syndrome are particularly effective examplars, consumers, and producers of this neurostructural selfhood.

Depressive disorder has been defined by increasingly specific neurophysiological mechanisms and features during the past two decades. At the same time, depression has grown into an epidemic proportion and become a major public health problem. Consequently, the scope of depressive experience and conduct has also widened and the meaning of depression has multiplied and become equivocal. This chapter analyses how this tension is handled in current Western mental health care. The focus of the study is the role of neuroscientific views in mental health reasoning and practice. The empirical case is the mental health discussion in Finland from the late 1980s to the present day. The analysis of the historical change in understandings of depression in Finnish psychiatry and mental health care provides a view of the relevance of neuroscientific models in defining depressive illness and outlining diagnostic and treatment practices. Moreover, the analysis brings forth the relationship of neuroscientific concepts to other ways of defining depression – epidemiology, diagnostic classification, psychodynamic and other psychological theories – within clinical reasoning. A conclusion to be drawn from the analysis of the Finnish case is that neurobiological concepts of depression have only limited influence on the ways in which the disorder is conceived within the practical context of mental health care. It seems that the idea of depression as a multi-factorial disorder remains a good enough conceptual framework for clinical practice. Even the influence of neurosciences on treatment is still somewhat marginal. Within current practices of depression management, it is not the brain that is treated but risks, symptoms, and persons.

The purpose of this paper is to provide a summary of main outcomes of the 10th EAMHID International Congress and a critical overview of some key contributions.

A discussion on the impact of the neurodevelopmental perspective on mental health care achievements and failures in the field of intellectual disability (ID) and autism spectrum disorders (ASD).

The considerable progress in the field of mental health care for people with ID that has been made in the last 30 years and that is reflected through the 350 papers presented in this Congress represents the continuation of the work of great pioneers, such as Frank Menolascino, Felix Platter or William I. Gardner, who have been honoured by the EAMHID in the naming of the congress rooms, and the dedication of the poster award. The neurodevelopmental perspective was confirmed to be the current most valued conceptual framework to explain relations across systems and to support multi-level, transnosographic, life-long, interdisciplinary approaches in the production of aetiological insight and good-quality intervention for mental health problems; on the other hand it might determine a premature abandonment of the traditional nosology and the appearance of very broad spectrum conditions covering the full range of psychopathology. Also psychopharmacology was extensively considered, with the explicit aim to raise the attention of researchers and clinicians on this neglected topic. Unfortunately, adults with ID/ASD are still deprived of the right to receive treatments that are based on strong evidence, as it is for the general population.

This editorial outlines the second part of a special issue that offers a comprehensive and varied collection of papers from the contributions to the 10th International Congress of the EAMHID.