This review summarizes the published work on the prevalence and incidence rates of autism spectrum disorder (ASD) in Chinese populations. The authors searched MEDLINE, Web of Science and the PsycINFO database and identified seven studies that were published in the English language. In mainland China, Li and colleagues reported an autism prevalence rate of 2.38/10,000 but admitted the possibility of underestimation. A higher prevalence of 11/10,000 was reported by Zhang and Ji based on a survey that was conducted in Tianjin, China. In Taiwan, Chien and colleagues reported that the cumulative prevalence of ASD increased from 1.79 to 28.72/10,000 from 1996 to 2005 and the annual incidence rate increased from 0.91 to 4.41/10,000 per year from 1997 to 2005. Another study based on the Taiwan national health insurance database reported a high prevalence rate of 122.8/10,000 for the year 2007. Two studies based on the Taiwan national disability registry data reported an increasing trend of ASD for the period 2000–2007 and 2004–2010, respectively. In Hong Kong, Wong and colleagues estimated that the incidence of ASD was 5.49/10,000 and the average prevalence over the 1986–2005 period was 16.1/10,000. We identified 12 studies through the searching of Chinese databases. The prevalences among these studies varied from 2.8 to 29.5/10,000. While existing data appear to suggest, it remains unclear whether there is a true rise in the prevalence of ASD in ethnic Chinese population across geographic sites. More collaborative research on this topic should be conducted in the future.
Copper takes part in a variety of biological reduction–oxidation (redox) processes, and is an important cofactor of many redox enzymes. Ceruloplasmin, the copper-transporting protein, also possesses an important redox capacity.
We assessed serum copper, ceruloplasmin and free-copper levels in 89 patients with Alzheimer's disease (AD) (mean age, 77.83 years; 41 men, 48 women) and in 118 healthy individuals (mean age, 69.93 years; 50 men, 68 women). High (≥75th percentile), medium, and low (≤25th percentile) copper, ceruloplasmin and free-copper groups were classified according to their serum level.
Serum copper (P = 0.026) and ceruloplasmin (P = 0.001) levels were significantly higher in the AD group than in the control group. There was no significant difference in serum free-copper levels between AD and healthy elderly groups (P = 0.975). After adjusting for age differences, serum copper (P = 0.049) was still significantly higher in the AD group. Furthermore, serum copper levels correlated with scores on the Boston naming test (r = −0.151, P = 0.037), indicating a close relationship between copper levels and cognitive abilities.
The significant association between the copper concentration in peripheral serum and AD with elevated copper levels found in patients with AD is likely linked to the evolution of AD. Serum copper levels were significantly negatively correlated with scores on cognitive test subscores. AD patients may have significantly more “defective” ceruloplasmin, that is, apo-ceruloplasmin lacking its copper, than in healthy controls.
The Chinese government and provincial authorities built a large number of temporary communities to shelter survivors after the May 2008 Wenchuan earthquake. Most residents left within a few months but others remained. This study describes the characteristics and psychological status of those victims who remained in a government-supported transitional community 12 months post-earthquake compared to residents who departed prior to that time.
Two groups of survivors of Wenchuan earthquake who resided in a transitional community were enrolled: 86 in December 2008 and 151 in February 2009. We assessed their mental distress, symptoms of depression and post-traumatic stress disorder and suicide risk. Forty-three and 46 members of the two groups, respectively, had departed the transitional community at 1 year post-earthquake.
In both groups, most of the survivors who remained in the community 1 year post-earthquake were older, female, with a lower education level and more serious personal losses. They had scored higher on self-report measures reflecting distressing symptoms and impairment as compared with their departed neighbors, and had a higher prevalence of depression and suicide risk at the time of enrollment.
Survivors who come to live in a transitional community following a disaster are heterogeneous. Remaining survivors were apparently more vulnerable and had a lower capacity to seek work and return to a more self-sustaining life outside the transitional community. Such vulnerable survivors require distinctive strategies for making a successful return to independent living.
The aim of this study was to investigate the psychological state of women and its associated factors in the third trimester of pregnancy and at 8 weeks postpartum and to explore the changes in psychological state between these two time points.
This survey study was carried out on 358 pregnant women visiting urban health centers in Shahroud, northeast Iran, in 2011. The women were followed at 8 weeks postpartum. In the third trimester of pregnancy, the participants completed the 28-item General Health Questionnaire (GHQ-28) and two other questionnaires on sociodemographic characteristics and frequent psychosocial stressors. They also completed the GHQ-28 and an obstetric information form at 8 weeks postpartum. The cutoff score for GHQ-28 in Iran has been calculated as 24, which denotes probable psychological health problems.
The mean total GHQ score decreased from 23.7 in the third trimester of pregnancy to 18.8 postpartum (P < 0.001). The proportion of women with a GHQ-28 score of 24 or higher in the third trimester of pregnancy and postpartum were 42% and 26%, respectively. Multiparity, caring for other family members, financial problems, and anxiety about personal and fetal health were the predictors of psychological health problems in the third trimester of pregnancy. The two predictors for postpartum psychological health problems were psychological health problems in the third trimester of pregnancy and the method of infant feeding at 8 weeks postpartum.
The prevalence of psychological symptoms was high among women in the third trimester of pregnancy. Psychological state of women improved after childbirth.
This survey aimed to probe the associations between altruism, social support and subjective health among incoming students with low level of social desirability.
Totally, 5,634 incoming university students were assessed and 2,472 students with a low tendency toward social desirability were recruited for analysis.
The results indicated that altruism and perceived social support were correlated and both could predict subjective health simultaneously. Path analysis indicated that altruism may promote health directly and indirectly by social support.
Developing curriculums to enhance altruism and social support could be an important issue for university students.
The Feasibility Study of the Korean Medication Algorithm Project for Bipolar Disorder 2002 (KMAP-BP 2002) revealed its clinical usefulness in 2005. Since much more data had become available since 2002, it was revised in 2006 as KMAP-BP 2006. For the same reason, revision of KMAP-BP 2006 is now necessary.
The questionnaire, amended on the basis of KMAP-BP 2006 and new data, was sent to 94 experts, 65 of whom replied.
In an acute manic episode, a combination of a mood stabilizer (MS) with an atypical antipsychotic (AAP) is recommended as first-line strategy. Monotherapy with MS is first-line in a hypomanic episode. Triple combination of a MS, an AAP, and an antidepressant (AD), is the first-line strategy in non-psychotic severe depression. Also MS+AAP and MS+AD are recommended as first-line. In psychotic bipolar depression, MS+AAP+AD, MS+AAP and AAP+AD are first-line strategies. In bipolar depression, lithium, lamotrigine and valproic acid are selected as first-line MS and quetiapine, olanzapine and aripiprazole are preferred antipsychotics. In maintenance treatment, a combination of MS with AAP and monotherapy of MS are recommended as first-line.
In treating bipolar disorder, even the first step of treatment, the expert consensus has changed from our studies in 2002 and 2006.
The aim of this study was to examine the reliability and validity of the nine-item Patient Health Questionnaire (PHQ-9) for screening depression in Chinese primary care settings.
In 100 randomly selected primary care clinics (PCC) of Hangzhou city, we recruited 2,639 patients (aged ≥18 years) and applied the PHQ-9 to screen for depression. Then, 280 of them were further interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual Disorders (SCID) for the diagnosis of major depression. Statistical analysis of the demographic data, reliability, validity and receiver–operator curve were performed.
The mean administration time was 7 minutes, and the Cronbach's α was 0.89. The optimal cutoff score of 10 on the PHQ-9 revealed a sensitivity of 0.87, specificity of 0.81, and positive likelihood ratio of 5.04. The area under the receiver–operator curve in this study was 0.91 (95% confidence interval, 0.87–0.94).
The PHQ-9 performs well and has acceptable psychometric properties for screening of patients with depression in a Chinese primary care population.
The present study aims to detect the specific and common impairment index relative to evoked brain potentials (EBPS) in deficit schizophrenia (DS) and nondeficit schizophrenia (NDS), and investigates the relationship between EBPs and clinical variables.
The study used EBPs in 21 patients with DS, 38 patients with NDS, and 50 healthy controls (HCs) to investigate P300 waves, mismatch negative (MMN), sensory gating (SG) P50 and contingent negative variation (CNV). A comparison of three groups and the relationship between EBPs and clinical variables were performed using general linear model analyses and partial correlation, respectively.
Compared with HCs, both groups of patients showed delayed N1, N2, and P3a latency, and reduced N1 and N2 amplitude. The MMN showed delayed latency. The P50 ratios and the inhibited ratios were impaired, whereas SG loss ratios increased. CNV amplitude was reduced. Compared with HCs, NDS showed delayed latency of S2′-C in CNV, whereas DS showed shortened latency. Only NDS, when compared with HCs, showed delayed latency of P3b, Also, only DS, when compared with HCs, showed delayed latency of point A in CNV. Latency of point A in CNV of DS, correlated with a poorer Global Assessment of Functioning Scale (6 weeks) and was independent of clinical characteristics.
Schizophrenia represents a clinical syndrome with shared impairments in brain function, whereas DS is a relatively homogeneous subgroup of schizophrenia with unique pathophysiological changes.
Continent-based regional reviews of mental health may not fully describe the status of ethnocultural groups that are widely dispersed across multiple continents or traditional world regions. Our aim was to describe the Austronesians, an ethno-linguistic group living primarily in islands and coastal areas in the Pacific and Indian Oceans and Southeast Asia.
Consulting lay databases, we created matrices to describe the demographic, political, and socioeconomic profiles of nations with majority and minority indigenous Austronesian language-speaking populations. We then accessed the scientific literature to describe examples of mental health disparities and/or challenges in mental health care delivery.
Many Austronesian-speaking people have experienced recent or current foreign occupation, lack of recognized sovereignty, poverty and low socioeconomic status, and low availability of psychiatric resources and providers. An analysis of the biological, psychological/psychocultural, and social and environmental impacts (risk or protective) on either the prevalence/presentation of mental illness, help-seeking behavior or access to mental health care, or management of mental illness suggested that there may be relatively unique stressors (e.g. loss of homeland from either global warming or nuclear contamination) affecting people in this region and certain biological profiles (e.g. susceptibility to obesity and metabolic syndrome) that may impact psychiatric treatment.
Solutions to mental health challenges in this world region may include culturally relevant and integrative mental healthcare delivery models; resource preserving, prevention-focused universal mental healthcare; and technology to improve connectivity and increase access to either direct services or workforce-building education and training.
This study explores barriers to seeking help for children with attention deficit hyperactivity disorder (ADHD) in Taiwan.
The caregivers (mainly mothers) of 104 children with ADHD were evaluated on an outpatient basis. The mean age of the ADHD children was 9.47 ± 1.97 years. Sociodemographic data and barriers related to seeking help were collected, including age, sex, multiple medical care seeking and parents' attitude toward the use of stimulants. The intensity of the barriers to seeking help was compared between good and/or poor compliance groups.
Those who took methylphenidate (MPH) regularly are less likely engage in multiple medical care seeking (P < 0.05) and are more likely to choose to seek help from a child psychiatrist as a first response to symptoms (P < 0.05). Boys with ADHD favored medical MPH treatment when seeking help. ADHD children of mothers with a higher education were more likely to refuse psychiatric treatment in the initial stage and seek alternative treatment such as sensory integration training.
There is a need to clarify how the misdiagnosis of ADHD as sensory integration dysfunction may impede seeking effective mental health care. Policy makers should enhance the understanding of parents with children with ADHD to increase treatment effectiveness and adherence.
Cardiac autonomic dysregulation has been proposed in panic disorder (PD), but the results are mixed. Analyses with larger sample sizes and better methodology are needed.
Forty-eight drug-naïve individuals with PD and 202 healthy volunteers were recruited for a case-control analysis. We used the Hamilton Anxiety Rating Scale and the Beck Anxiety Inventory to assess anxiety severity. Cardiac autonomic function was evaluated by measuring heart rate variability (HRV) parameters. Frequency-domain indices of HRV were obtained. The obtained results were evaluated in association with personality traits assessed by the Tridimensional Personality Questionnaire.
Patients exhibited reduced mean RR interval (816.94 ± 135.92 versus 873.47 ± 143.36 ms, P = 0.014) and HRV levels (Var 6.37 ± 1.32 versus 7.38 ± 0.95, LF 4.90 ± 1.63 versus5.82 ± 1.11 and HF 4.57 ± 1.53 versus 5.62 ± 1.24 [ln(ms2)], all P < 0.001) as compared to controls, which mainly suggested a reduction in cardiac vagal control in PD. The anxiety severity was negatively correlated with HRV levels (r = −0.29 for Var, r = −0.22 for LF and r = −0.28 for HF, all P < 0.001). The harm avoidance score (which has been suggested to be associated with serotonergic activity) was associated with decreased HRV levels (r = −0.22 for Var, P < 0.01, r = −0.14 for LF, P < 0.05 and r = −0.17 for HF, P < 0.01).
This study demonstrates that PD is associated with cardiac autonomic dysregulation, highlighting the importance of assessing HRV in PD patients.
With the modernization of Chinese society and increased general levels of education, the stigmatization of mental illness may have declined, especially among advanced students. However, misunderstandings about mental illness may remain and adversely affect service delivery to this population. Educational initiatives in psychiatry may support a more accepting and scientific understanding of these illnesses among college students.
Attitudes towards mental illness were compared between 161 medical students who received a basic 48-hour introductory course in psychiatry and 170 college students who had not received such a course using a 43-item questionnaire. Previous factor analysis had shown this questionnaire to address four factors: 1. Personal willingness to socialize with people with mental illness; 2. Support for normalizing relationships and activities of people with mental illness; 3. Rejecting supernatural explanations of mental illness; and 4. Agreeing with a biopsychosocial view of the etiology of mental illness. Analysis of Co-Variance was used to compare the groups on these factors with adjustment for significant differences in age and years of education.
The two groups of students scored similarly on the socializing factor (P = 0.252), the rejection of supernatural causes factor (P = 0.248) and the normalizing factor (P = 0.362), but students who had the didactic psychiatry course scored more positively on the biopsychosocial factor (percent difference = 15.06%, P = 0.001).
A single formal psychiatry course may improve understanding of the biopsychosocial causes of mental illness but did not affect other attitudinal domains among Chinese college students.
Singapore is a geographically small nation-state that has transformed itself from a third-world country to a developed nation after attaining political independence 46 years ago. The pace of change has been tremendous and mental health care is no exception. This paper provides an overview of mental health care and a review of key mental health legislation, including a National Mental Health Blueprint that was rolled out in 2007. On this background, the paper focuses on a description of forensic psychiatric services in Singapore. The role of the Department of Forensic Psychiatry at the Institute of Mental Health, which is the only forensic psychiatry department in the country, will be highlighted. Civil commitment and the treatment of unfit accused persons and insanity acquittees is reviewed. The role of forensic psychiatric assessments in the Singapore courts is examined. The application of the insanity and diminished responsibility defenses are reviewed. A trend is identified in the Singapore courts towards a more rehabilitation-focused sentencing approach and the role that forensic psychiatric assessments play in cases involving mentally disordered offenders is highlighted.
The objective of this study was to evaluate the effect of mirtazapine on sleep quality in real-world outpatients with major depressive disorder (MDD).
Demographic characteristics of MDD outpatients were collected and the Pittsburgh Sleep Quality Index (PSQI) was assessed before and after treatment.
In 3,924 MDD outpatients after treatment, sleep efficiency was significantly higher (P < 0.001), global PSQI score was significantly lower (P < 0.01), the reduction rates of sleep latency (P < 0.01) and global PSQI score (P < 0.001) were notably higher, and the proportion of using sleep medications (P < 0.05) was significantly lower in the mirtazapine group. In 3,455 MDD outpatients with insomnia after treatment, the reduction of sleep latency (P < 0.001), the prolongation of sleep duration (P < 0.001), and the increase in habitual sleep efficiency (P < 0.001) were more obvious, the reduction rates of sleep latency (P < 0.05) and global PSQI score (P < 0.001) were significantly higher, and the proportion of using sleep medications (P < 0.001) was significantly lower in the mirtazapine group. In 469 MDD outpatients without insomnia after treatment, the reduction of sleep latency (P < 0.05), the increase in sleep duration (P < 0.001) and habitual sleep efficiency (P < 0.001), and the reduction rate of global PSQI score (P < 0.05) were significantly greater in the mirtazapine group.
This real-world study suggests that mirtazapine improves sleep quality of MDD outpatients, and decreases the concomitant use of sleep medications.
Patients suffering from major depressive disorder (MDD) have been reported to have substantial long-lasting limitations in multiple domains of health-related quality of life (HRQoL). The thoughtful assessment of HRQoL and the impact of treatment response on HRQoL are emerging as important issues in the care of patients with major depressive disorder.
One hundred and three patients meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for MDD took fluoxetine (20 mg/d) for 6 weeks and were assessed by the Short Form 36 Health Survey (SF-36), the 17-item Hamilton Depression Rating (HAMD-17) and the Clinical Global Impression (CGI) scales. Relationships between SF-36 scores and depressive symptom severity and early change of these symptoms were tested.
SF-36 component scores at week 6 were higher than those at baseline (all P ≤ 0.0058). Scores for general health were significantly higher in responders than non-responders (P = 0.0009). The overall HAMD-17 and CGI scores at 2- and 6-week follow-up were significantly lower than those at baseline (P ≤ 0.0001). Higher scores for anxiety/somatization were significantly associated with poorer SF-36 scores at baseline (P = 0.0001); role-physical scores at week 6 were positively correlated with reduction rate of anxiety/somatization in 2-week follow-up (P = 0.0002).
Depressive symptom severity was associated with HRQoL in patients with MDD. HRQoL may vary with severity of depression and/or anxiety-somatization at baseline.
South Korea's low birth rate, aging society, and female migration to urban areas due to industrialization have caused an accelerated inflow of Asian female immigrants into Korea to marry Korean men, especially in rural areas. This study was performed to determine how family function of multicultural families changes over time and what factors affect the changes in family function of multicultural families.
The study subjects were 62 Asian immigrant women married to South Korean men living in South Korea. In a 1st wave study in August 2008, the socioeconomic factors and Family Adaptability and Cohesion Scale III (FACES III) scores were measured. A 3-year follow-up study was then conducted in August 2011, and the results were compared with the 1st wave study results.
The mean family adaptability score was 24.6 in the 1st wave study and 26.1 at the 3-year follow-up. The average family cohesion score was 31.0 in the 1st wave study and 36.7 at the 3-year follow-up. There was a statistically significant increase in family cohesion after 3 years (P < 0.001). In multiple regression analysis, age difference between husband and wife (P = 0.019) and subjective SES (P < 0.001) were found to be significantly correlated with positive changes of cohesion scores.
Family adaptability did not change over time; however, conversely, family cohesion increased. The age difference between husband and wife and the subjective SES had a positive association with the changes in family cohesion.
The purpose of this study was to assess the usefulness of the Korean version of the Mood Disorder Questionnaire (K-MDQ) as a screening tool for the identification of bipolar spectrum disorder (BSD) among Korean college students.
The sample of 1,020 college students was stratified to reflect geographical differences among the students. The K-MDQ and an epidemiological survey were administered between November 2006 and February 2007. To validate the K-MDQ as a screening tool for BSD, the Korean version of the Bipolar Spectrum Diagnostic Scale (K-BSDS) and the Structured Clinical Interview for DSM-IV (SCID) were also administered.
The rates satisfying MDQ criterion 1, and all three MDQ criteria, were 55.5% and 2.3%, respectively. According to the K-BSDS, 59.9% of the sample met the criteria for BSD using a threshold of 10, while no statistical differences were observed among subgroups. When we examined the diagnostic agreement between K-MDQ and K-BSDS, 79.5% of students who met MDQ criterion 1 were also positive on the BSDS. Sixteen (21.6%) of the 74 students who participated in the SCID interview were diagnosed with BSD.
Although the K-MDQ is a useful tool to assess BSD among inpatients and outpatients, it does not appear useful as a screening tool to detect BSD among college students.
This study investigated the effects of religiosity and spirituality on quality of life and depression among older people.
Two hundred and seventy-four solitary elderly people aged over 65 years living in Chuncheon city, South Korea were selected. Symptoms of depression were evaluated using the Short Geriatric Depression Scale-Korean version (SGDS-K) and quality of life was measured using Geriatric Quality of Life-Dementia (GQOL-D). We used the Duke Religion Index (DUREL) to assess religiosity and spirituality.
There was a significant correlation between scales of depression (SGDS-K), quality of life (GQOL-D), and scale of religiosity/spirituality (DUREL) in older people. Depressed people had a lower score GQOL-D than non-depressed people. Among the depressed, those believing in a religion had a higher GQOL-D score than the non-religious. Multiple regression analysis revealed that religiosity and spirituality had significant effects on depression and quality of life among the elderly. Interestingly, religiosity and spirituality were not related to depression and quality of life amongst Buddhists, but were related amongst Protestants and Catholics.
Religiosity and spirituality had significant effects on depression and on quality of life among the Korean elderly. However, there are different relationships between depression and religiosity, quality of life, and religiosity based on different religions. More research is needed to elucidate these findings.
The aims of the study were to examine the prevalence of premenstrual dysphoric disorder (PMDD), subthreshold PMDD and premenstrual syndrome (PMS) among adolescents, and to assess the nature of symptoms and the impact on daily life functions, especially for PMDD and subthreshold PMDD.
A cross-sectional survey was conducted among adolescents from an urban area. Participants included 984 girls divided into the following four groups, using a premenstrual symptoms screening tool: PMDD, subthreshold PMDD, moderate/severe PMS and no/mild PMS. An Adolescent Mental Problem Questionnaire, Center for Epidemiological Studies-Depression Scale, revised Children's Manifest Anxiety Scale, and a menstrual information questionnaire were also used.
Sixty-three (6.76%) of the subjects met the criteria for PMDD and 58 (6.2%) were subthreshold PMDD. The subthreshold PMDD group included 79.3% who met the symptom criteria for PMDD, but their impairment was moderate, and 21.7% who were falling short by the number of symptoms for PMDD diagnosis, though reporting severe impairment. The symptom intensity and frequency of the subthreshold PMDD subjects were similar to those in subjects with PMDD. In these two groups, 69% had moderate to severe physical symptoms. Psychiatric problems, including depression and anxiety, were higher in the PMDD and subthreshold PMDD groups than in the moderate/severe PMS and no/mild PMS group.
In total, 20% of adolescents reported suffering from distressing premenstrual symptoms, and girls with PMDD and subthreshold PMDD were very similar in their symptom severity and characteristics. Prospective daily charting is needed to confirm the accurate diagnosis and management of PMDD.
This systematic review investigated drug utilization for depression and assessed trends in prescriptions in China. Major Western and Chinese electronic databases were searched without language restriction for studies reporting defined daily doses. A total of 76 studies published between 2000 and 2010 reporting data on prescriptions for depression in China between 1996 and 2008 were included. All studies were published in Chinese. Most trials were conducted in urban areas in south and east China. Twenty-nine drugs were reported as antidepressants. On the basis of defined daily doses, melitracen/flupentixol combination, fluoxetine, and paroxetine were the most frequently prescribed compounds. According to published evidence, selective serotonin reuptake inhibitors have become the most commonly prescribed class of antidepressant drugs in China.
The aim of this study was to determine the personality characteristics of obese and morbidly obese individuals with no psychiatric disorder and the correlation between these characteristics and body image and self-esteem.
Sixty-nine obese individuals and 69 healthy controls, matched in age, sex and marital status, were included in the study. Psychiatric disorders were excluded for all participants using SCID-I and II. Obese and healthy volunteers were compared in terms of body image, self-esteem and personality characteristics.
TCI harm avoidance scores were higher in obese individuals compared to healthy controls. Harm avoidance scores were also higher in individuals with morbid obesity compared to non-morbid individuals, while self-directedness and persistence scores were lower. Body image dissatisfaction was higher in obese individuals. There was a negative correlation in obese individuals between body image and self-esteem scale scores and harm avoidance scores, and a positive correlation with self-directedness scores.
An elevated harm avoidance temperament characteristic may be correlated with obesity. Furthermore, high harm avoidance, low self-directedness and low persistence may be significant personality characteristics in a process leading to morbid obesity. In addition, harm avoidance temperament and self-directedness personality characteristics may be correlated with body image dissatisfaction and self-esteem in obese individuals.
Exposure to natural and human-made disasters is associated with long-term health consequences, including for mental health. Parents who have lost children, particularly their only children, in any circumstances are also at increased risk of developing mental health problems. The aim of this study was to review the available evidence about the psychological and social consequences for parents who had faced these circumstances simultaneously through losing children in a disaster. Systematic searching of the English and Chinese language literatures about the psychological and social functioning of bereaved parents after disasters revealed that a small number of studies met inclusion criteria. The results showed that bereaved parents had more mental health problems than bereaved spouses and non-bereaved parents, and mothers appeared to be more vulnerable to mental health problems than fathers. Potential protective factors for bereaved parents' mental health included having psychological interventions, having adequate social support, seeing their children's bodies and having a subsequent baby. Although the literature was modest and methodologically diverse, there was a consistent finding that parents who have lost children in disasters were at high risk of suffering mental health problems, especially bereaved mothers. As there was little evidence, further studies are needed to understand the best advice and interventions to offer bereaved parents and provide enhanced mental health care of such bereaved populations after disasters.
Pastoral Care (PC) practitioners respond to the spiritual needs of patients and families of all spiritual orientations. The integrated PC service in an acute psychogeriatric inpatient ward at St Vincent's Aged Mental Health Service, Melbourne, Australia, was examined to investigate how PC was being accessed by inpatients.
A retrospective medical record file audit was undertaken of patients admitted over a 16-month period from 1 February 2009 to 30 June 30 2010 (n = 202).
Sixty-eight percent were seen by PC practitioners during their admission. Sixty-six percent received PC assessments, 32% received PC ministry, and 10% received PC ritual or worship interventions. Other interventions (counseling/education, crisis situation, grief/ bereavement counseling) occurred infrequently. Seventy-five percent of Roman Catholic patients received PC compared to 57% of those patients with no religious affiliation. However, the overall association between religious grouping and receiving PC was not significant. Gender, religion, marital status, legal status, country of birth, language spoken, living situation, carer needs, or educational level were not related to PC contact. Whether or not an inpatient received PC assessment was unrelated to diagnostic category. Patients seen by PC were significantly more likely to engage in religious practice, have longer length of stay, and have neuropsychological, social work and occupational therapy assessments.
Results suggest that PC practitioners can help optimize the clinical care of patients by developing a comprehensive understanding of their spiritual and religious needs and providing a more holistic service.
Urinary incontinence (UI) and Alzheimer's disease (AD) are common in the elderly population and have increased rapidly in recent decades. This study aimed to evaluate the prevalence of UI and determine the neuropsychological characteristics of patients with AD and UI.
A total of 464 patients with probable AD were recruited, and the prevalence and type of UI were evaluated. Neuropsychological evaluation was assessed using the Mini-Mental Status Examination, Clinical Dementia Rating, Clinical Dementia Rating-Sum of Boxes, Global Deterioration Scale, Barthel Activities of Daily Living and Instrumental Activities of Daily Living.
The prevalence of UI in patients with AD was 24.8% (men 29.6%, women 23.0%). The two most common types of UI were urge incontinence (44.3%) and functional incontinence (25.3%). UI in patients with Alzheimer's disease was statistically significantly associated with Clinical Dementia Rating-Sum of Boxes (OR 1.56, 95% CI 1.21–2.01) and Barthel Activities of Daily Living (OR 1.34, 95%CI 1.22–1.47) after adjustment for different covariates.
UI commonly occurred in patients with AD. The Clinical Dementia Rating-Sum of Boxes and Barthel Activities of Daily Living could be potential predictors for UI in patients with AD.
Dysfunctional Attitude Scale is one of the most common instruments used to assess cognitive vulnerability. This study aimed to develop and validate a short form of Dysfunctional Attitude Scale appropriate for an Iranian clinical population.
Participants were 160 psychiatric patients from medical centers affiliated with Isfahan Medical University, as well as 160 non-patients. Research instruments were clinical interviews based on the Diagnostic and Statistical Manual-IV-TR, Dysfunctional Attitude Scale and General Heath Questionnaire (GHQ-28). Data was analyzed using multicorrelation calculations and factor analysis.
Based on the results of factor analysis and item-total correlation, 14 items were judged candidates for omission. Analysis of the 26-item Dysfunctional Attitude Scale (DAS-26) revealed a Cronbach's alpha of 0.92. Evidence for the concurrent criterion validity was obtained through calculating the correlation between the Dysfunctional Attitude Scale and psychiatric diagnosis (r = 0.55), GHQ −28 (r = 0.56) and somatization, anxiety, social dysfunction, and depression subscales (0.45,0.53,0.48, and 0.57, respectively). Factor analysis deemed a four-factor structure the best. The factors were labeled as success-perfectionism, need for approval, need for satisfying others, and vulnerability-performance evaluation.
The results showed that the Iranian version of the Dysfunctional Attitude Scale (DAS-26) bears satisfactory psychometric properties suggesting that this cognitive instrument is appropriate for use in an Iranian cultural context.
Cultural differences in the combined effects of Type D personality and other mediating factors in the Asian population have not been reported. We examined the influence of the Type D personality in relation to the presence of a partner by measuring symptoms of anxiety and depression, quality of life, self-perception of health status in coronary heart disease (CHD) patients and normal controls.
Normal controls (n = 541) and patients with CHD (n = 110) were included. All participants completed self-report measures on Type D personality, questionnaires on socio-demographic factors, the Spielberger State and Trait Anxiety Inventory-State (STAI-S), and the Center for Epidemiologic Studies Depression Scale (CES-D). By stratifying participant group, personality type, and partner status, eight groups were constructed.
The subjects with Type D personality showed higher mean scores on the STAI-S and CES-D as well as perception of their health. In cases of depression, CHD patients with Type D personality and without partner showed about a 50-fold increase in odds ratio when compared with non-Type D normal controls with partners. Odds ratio for depression changed from 31.44 to 48.72 in CHD patients with Type D personality based on the existence of a partner.
Having a partner significantly predicted the risk of depression. It is important to identify social support systems in CHD patients with Type D personality.
Prospective memory refers to the ability to remember to do something in the future. To date, little is known about prospective memory deficits in bipolar disorder (BD) in remission (euthymia). This study examined the nature and correlates of prospective memory in these patients.
Forty-seven euthymic BD patients and 47 matched healthy controls formed the study sample. Socio-demographic and basic clinical characteristics, prospective memory (Cambridge Prospective Memory Test [CAMPROMPT]), retrospective memory (immediate Logical Memory subtests of the Wechsler Memory Scales-Revised [WMS-R]), IQ (Raven's Progressive Matrices) and executive functioning (Wisconsin Card Sorting Test) were measured in all participants; patients' symptoms were rated with the 17-item Hamilton Depression Rating Scale and the 11-item Young Mania Rating Scale.
Patients performed significantly worse on time-based prospective memory compared to controls. Multivariate analyses revealed that patients' lower score on Raven's Progressive Matrices significantly contributed to poor performance on time-based prospective memory, whereas lower scores on WMS-R Logical Memory subtest contributed to poor performance on event-based prospective memory; in controls, lower education level and older age significantly contributed to poor performance on time-based and event-based prospective memory, respectively.
Prospective memory deficits persist in remitted BD patients suggesting that prospective memory impairment constitutes a trait deficit in BD.
There is increasing evidence to support the benefits of physical activity on cognition in older adults. This paper describes (i) the attitudes, beliefs and barriers towards physical activity of older adults with and without cognitive impairment and (ii) their opinion of the attributes of the ideal physical activity program.
Thematic analysis of focus groups and individual interviews with 50 older adults with no cognitive impairment, subjective memory complaints, mild cognitive impairment and Alzheimer's disease was performed.
Consistent with previous research in cognitively intact older adults, most participants, irrespective of cognitive status, had a positive attitude towards physical activity and believed it was beneficial both generally and for cognition. There was a preference for physical activity programs to be suggested by advertising and general practitioners (GPs), undertaken in a group setting, and beliefs that they should be tailored to individual's needs and preferences, and should be affordable according to their income. Participants with cognitive impairment cited specific barriers including “memory” and “lack of companion” as well as preferring “accessible” settings and “simple/light/safe” activities.
These findings provide useful data, particularly from participants with cognitive impairment, with whom there has been little research to date. This could contribute to efforts to translate the growing research evidence of the benefits of physical activity for brain health into effective community programs.
The aim of this study is to examine the association between suicidal behavior and mental health status of south Chinese people, and explore the mediating effect of help-seeking behaviors.
The study participants were 10,757 persons aged 18 years and older from the mental health survey of Xiamen city. Data on suicidal behavior and help-seeking behavior were collected by trained psychiatric nurses through face-to-face interviews. Mental health status was assessed using the 12-item General Health Questionnaire (GHQ-12). Multiple logistic regression and general linear model were used in statistical analysis.
In the entire study sample, 236 study participants reported suicide ideation (2.19%, 95% CI: 1.92–2.47%), and 59 reported at least one suicide attempt (0.55%, 95% CI: 0.41–0.69%). Individuals with suicide attempt and suicide ideation had higher GHQ scores than those without suicidal behavior. The majority of study participants with suicide ideation or suicide attempt did not seek any help (77.5% and 79.7%, respectively). Among participants with suicidal behavior, seeking help from mental health professional was associated with a better mental health status (OR = 4.04, 95%CI: 1.17–10.16).
Only a small proportion of individuals with suicide behavior in south China had ever sought help. Seeking help was associated with a better mental health status.
This study aimed to validate and culturally adapt the Perception of Care (PoC) for patients receiving acute psychiatric inpatient services in Hong Kong.
The PoC was translated and culturally adapted into a written Chinese version (C-PoC). Subjects completed C-PoC, Chinese version of Admission Experience Survey (C-AES) and World Health Organization Quality of Life Measure (WHOQOL-BREF). They were then rated by assessors with Brief Psychiatric Rating Scale (BPRS), Hamilton Rating Scale for Depression, Hamilton Rating Scale for Anxiety and Extrapyramidal Symptom Rating Scale. Explorative factor analysis and correlation between C-PoC, WHOQOL-BREF and C-AES served as the theoretical basis of construct validity. Multivariate analysis was used to identify predictors of satisfaction.
The C-PoC has a four-factor structure that resembles the original scale with demonstrating satisfactory construct validity and test-re-test reliability. Psychiatric symptom ratings did not predict any satisfaction ratings. Extrapyramidal symptoms predicted poorer satisfaction. Younger patients with affective diagnoses had better satisfaction.
The C-PoC is a psychometrically sound translation of the original scale. The current study paves the way for further studies among Chinese-speaking communities on the determinants and implications of patients' satisfaction by offering a psychometrically sound and yet concise instrument.
Sensitive, valid measures to assess the quality of the intimate partner relationship are necessary for both clinical practice and research. The aim of this study was to examine the validity of the Intimate Bonds Measure (IBM) in women who were pregnant or had recently given birth in Vietnam.
The IBM was translated and culturally verified in a step-by-step process with Vietnamese health workers, researchers and community members. The validation study was nested within two larger community-based cross-sectional investigations: the first in 2006, which recruited 199 pregnant women and 165 mothers of newborns, and the second in 2010, which recruited 419 pregnant women. Internal structure was assessed by factor analysis and Cronbach's alpha and construct validity by comparison with relevant factors.
Exploratory factor analyses revealed an identical factor structure to the one reported by the measure's developers in an Anglophone Australian population more than 20 years ago. The two factors replicate exactly the Care and Control subscales and Cronbach's alpha (from 0.68 to 0.83) indicates high internal consistency in both sub-scales. Mean scores of the Care-V and Control-V sub-scales were associated significantly and in expected directions with whether a woman could confide in, felt supported by or was frightened of her partner, or had experienced intimate partner violence and measures of mental health status.
The Vietnamese version of the IBM (IBM-V) is comprehensible, meaningful and appears to be a valid measure the construct of quality of relationship with an intimate partner among women in this setting.
Although several studies have explored craving for certain drugs, there is limited data describing the relationship between alcohol and nicotine craving from a multidimensional perspective among individuals with comorbid nicotine dependence (ND) and alcohol dependence (AD).
We compared a group of male patients diagnosed with ND and AD (n = 160) to a group of male patients diagnosed with ND only (n = 235). Smoking- and drinking-related clinical features were measured, including craving levels and the Nicotine Dependence Syndrome Scale (NDSS), which is a multidimensional questionnaire measuring ND. Subsequently, we studied factors that influenced smoking and alcohol craving in the ND and AD group.
Regarding the NDSS, the sum, priority and tolerance scores were significantly higher in the ND and AD group compared with the ND only group (P < 0.000, P < 0.000 and P = 0.001, respectively). In the comorbid group, regression analyses revealed that alcohol craving and Fagerstrom Test for Nicotine Dependence (FTND) scores contributed to nicotine craving (beta coefficient = 0.37, P = 0.005 and beta coefficient = 0.35, P = 0.026, respectively) and these two factors explained 36% of the variance). Nicotine craving appeared to be the only factor that contributed to alcohol craving (beta coefficient = 0.35, P = 0.002), and nicotine craving explained 16% of the variance.
This study may help clarify the clinical relationship between comorbid alcohol and nicotine dependence and help guide the development of effective treatment strategies for ND and AD patients.
The goals of the present study were to: (i) examine similarities and differences in behavioral/emotional problems manifested by children with autism spectrum disorder (ASD) and those with anxiety disorder (ANX); (ii) test the ability of each of the eight child behavioral checklist (CBCL) and teacher report form (TRF) syndrome scales to differentiate the ASD group from the ANX group; and (iii) test the ability of an ASD scale derived by Ooi et al. to differentiate the ASD group from the ANX group.
Archival CBCL and TRF data from 180 children between 4 and 18 years of age (119 males, 61 females) diagnosed with ASD (n = 86) or ANX (n = 94) at an outpatient child psychiatric clinic in Singapore were analyzed.
The ASD group scored significantly higher on Social Problems and Attention Problems but significantly lower on Anxious/Depressed and Somatic Complaints than the ANX group. The groups did not show significant differences on Withdrawn/Depressed and Thought Problems. Both the CBCL and TRF ASD scales were significant predictors of the ASD group, with moderate to high sensitivity and specificity.
Our findings for an Asian sample support the diagnostic overlap between ASD and ANX reported for Western samples and underscore the importance of treating ASD as both a unitary disease and as a web of overlapping configurations of underlying problem dimensions.
The National Suicide Registry Malaysia (NSRM) is a nationwide system that captures data on completed suicides in Malaysia from all forensic departments under the purview of the Ministry of Health Malaysia.
This paper examines all suicidal deaths reported to the NSRM from 1 January 2009 to 31 December 2009. The relevant variables were recorded in the paper-based Case Report Form (CRF) and then entered into the online reporting system for analysis.
The overall suicide rate for 2009 was 1.18 per 100,000 population (n = 328). The age range was 14–94 years, with a median of 37 (IQR 24) years. There were more men than women, the gender ratio being 2.9:1 (males : females), and the majority (89% or 293/328) were Malaysian citizens. Ethnicity-wise, Indians had the highest suicide rate of 3.67 per 100,000. The Malays and Bumiputera of Sabah and Sarawak had lower rates of 0.32 to 0.37 per 100,000.
Mental illness was reported in 22% (72/328) of the cases and physical illnesses in 20.4% (67/328). Previous suicide attempts were reported in 15.5% (51/328) of cases. History of substance abuse was present in 28.7% (83/328). Life events were positive in 41.2% (135/328) of cases.
Malaysia is able to generate statistics on suicide by enhancing the collaboration between forensic, psychiatry and clinical research agencies. These trends should be monitored to gain a better understanding of suicide trends.
Blonanserin is a relatively new atypical antipsychotic drug, and has been used in Korea and Japan for 1 and 3 years, respectively. Therefore, the clinical characteristics of blonanserin remain unclear. In this study, to clarify the features of blonanserin, we performed prospective and long-term comparative investigations of patients treated with blonanserin.
We followed 10 psychiatric patients who were switched to blonanserin from other antipsychotics for 1 year (schizophrenia: 8; mental retardation: 2). In the light of quality of life, we focused on adverse effects of patients during the follow-up.
In the long-term follow-up, (i) hyperprolactinemia is more frequently in risperidone than in blonanserin; however, it is more often in blonanserin than in olanzapine; and (ii) weight gain is more common in olanzapine than in blonanserin.
We switched to blonanserin from other antipsychotic drugs within the same case, and then followed the case for 1 year. We consider that long-term observations within the same case lead to obvious comparisons among drugs. On the basis of our findings, we conclude that blonanserin may be useful for the maintenance treatment of schizophrenia without inducing hyperprolactinemia and weight gain.
Several studies have suggested the presence of a theory of mind (ToM) deficit in schizophrenic disorders. This study examined the relationship of emotion recognition, theory of mind, and ward behavior in patients with schizophrenia.
Fifty-five patients with chronic schizophrenia completed measures of emotion recognition, ToM, intelligence, Positive and Negative Syndrome Scale (PANSS) and Nurse's Observation Scale for Inpatient Evaluation (NOSIE).
Theory of mind sum score correlated significantly with IQ, emotion recognition, and ward behavior. Ward behavior was linked to the duration of the illness, and even more so to theory of mind deficits. Theory of mind contributed a significant proportion of the amount of variance to explain social behavior on the ward.
Considering our study results, impaired theory of mind contributes significantly to the understanding of social competence in patients with schizophrenia.
Little is known about the prescription patterns of adjunctive antidepressants in Asian schizophrenia patients. This study aimed to examine trends in the use of antidepressants and their demographic and clinical correlates in the treatment of schizophrenia in Asia between 2001 and 2009.
A total of 6,761 hospitalized schizophrenia patients in nine Asian countries and territories were examined: 2,399 in 2001, 2,136 in 2004 and 2,226 in 2009. Patients' socio-demographic and clinical characteristics and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure.
The proportion of antidepressant prescription was 6.8% in the whole sample; 5.3% in 2001, 6.5% in 2004 and 8.7% in 2009. There were wide inter-country variations at each survey ranging from 0.9% in Hong Kong to 15.3% in Singapore in 2001; from 1.9% in Korea to 15.4% in Singapore in 2004; and from 2.7% in Japan to 22.0% in Singapore in 2009. Multiple logistic regression analysis of the whole sample revealed that patients on antidepressants were younger, more likely to receive benzodiazepines and have significant extrapyramidal side-effects and less likely to have significant positive symptoms.
Unlike findings in Western countries, adjunctive antidepressant prescription for schizophrenia was not common in Asia. The frequency of antidepressant prescription varied among countries and territories, suggesting that a host of clinical and socio-cultural factors played a role in determining antidepressant use in Asia.
Attention deficit hyperactivity disorder (ADHD) is a chronic debilitating illness with onset in early childhood. The objective of this study was to look at the impact of children with ADHD on their parents.
All parents with children diagnosed as having ADHD attending the Psychiatry Adolescent and Child Unit, University Malaya were included in this study. Their parenting stress was assessed using the Parent Stress Index.
A total of 95 parents participated in the study. The proportion of parents who reported significant stress in this study was much higher than in most studies (n = 69, 73%). Significant correlation was found between the severity of the child's disorder (Children's Global Assessment Scale [CGAS] score) and the parents' stress level (OR 0.16, 95% CI 0.05–0.51). Mothers were significantly more stressed than fathers (OR 0.16, 95% CI 0.05–0.51) and non-Malay parents more stressed than the Malay parents (OR 3.92, 95% CI 1.29–11.94). Parents with children older than 12 years of age were six times more stressed than parents with children younger than 12 years old (OR 6.47, 95% CI 1.55–27.01). Stressed parents acknowledged that having a child with ADHD was their biggest worry.
Stress has marked consequences on any person and has important bearings on their mental health. Stress among parents needs be looked into when treating children with ADHD.
Attention Deficit Hyperactivity Disorder (ADHD)-like symptoms are common among children and adolescents with Pervasive Developmental Disorders (PDD). The purpose of this study was to assess the impact of ADHD-like symptoms on the clinical features of adolescents with PDD.
A total of 72 subjects (between the ages of 12 and 17) diagnosed as having PDD were split into higher (ADHD+) and lower (ADHD-) groups according to the presence of ADHD-like symptoms as assessed with the Japanese version of the ADHD Rating Scale-IV (ADHD-RS-IV-J). Group differences in coexisting psychopathology, as assessed by the eight subscales of the Japanese version of the Child Behavior Checklist for Ages 4–18 (CBCL/4–18-J) and autistic core features, as assessed by the adolescent part of the PDD-Autism Society of Japan Rating Scale (PARS), were examined.
The ADHD + subjects showed a significantly higher degree of general psychopathology, including both externalizing and internalizing symptoms, as compared to subjects in the ADHD- subgroup. Additionally, the ADHD + subgroup showed greater impairment according to PARS scores.
These results indicate an important role of ADHD-like symptoms in PDD. Therefore, parents/caregivers may find it useful to know to what extent their child's ADHD-like symptoms deviate from the norm for PDD adolescents and the implications of these symptoms for long-term care. In addition, clinicians would be well advised to consider further systematic assessment of ADHD-like symptoms.
Although cognitive impairment is widely accepted as a leading indicator of dementia, influences of cognitive status on incident dementia and mortality remain unclear. The present study investigated the morbidity hazard associated with cognitive impairment and the mortality hazard associated with dementia in comparison to cognitively intact seniors.
A population-based sample of 2914 seniors with clinically diagnosed cognitive status at Wave I (1991–1992) of the Canadian Study of Health and Aging (CSHA) were followed-up 5 years later (1996–1997). At Wave I, there were 921 cognitively intact, 861 cognitively impaired but not demented (CIND), and 1132 seniors with dementia, respectively. The primary outcome measures 5 years later were being cognitively intact, CIND, dementia and death. Kaplan–Meier estimates, log-rank tests, and Cox's proportional models were used in the analyses.
Respondents with CIND at Wave I were 2.191 times (95%CI 1.706–2.814) more likely to have dementia 5 years later than cognitively intact seniors. After adjusting for confounding socio-demographic and health status factors, the odds ratio was reduced to 2.147 times (95%CI 1.662–2.774), but remained significant. Respondents with CIND had a mortality rate 1.869 times (95%CI 1.602-2.179) and seniors with dementia 3.362 times greater (95%CI 2.929–3.860) than that of seniors who were cognitively intact. After controlling the confounders, the odds remained significant at 1.576 (95%CI 1.348–1.843) for CIND respondents and 2.415 (95%CI 2.083–2.800) for seniors with dementia.
CIND increases both the risk of dementia and mortality. Early intervention with CIND is warranted to reduce both dementia incidence and mortality.
Peer support in mental health service delivery is a relatively new development in Western Australia, occurring only in the last decade. Consequently, what is known about peer support in mental health has been largely drawn from the overseas literature. The purpose of the present study was to identify how consumers of mental health services in Western Australia viewed the impact that peer support workers had on their life.
The nominal group technique was the method used to collect and analyze the data from nine participants living in the community who were supported by a peer support worker; the role of the peer support worker was to encourage healthy lifestyle behaviors.
The results indicate that the main influences of a peer worker for consumers were motivation, increased social interaction, living a healthier lifestyle, positive mental attitude and building confidence.
It was concluded that participants viewed the support they received as a positive experience, which contributed to building confidence and enabled participants to make lifestyle changes. However, the results need to be viewed with caution, not only because of the small sample size, but also because the peer workers and the participants were all male. Results may well be different where the role and gender of the support worker and consumer are different.
Data on the psychometric assessment of prospective memory (PM) are limited. The Cambridge Prospective Memory Test (CAMPROMPT) and its Chinese version (CAMPROMPT-C) have been applied to a variety of clinical conditions except for chronic schizophrenia. This controlled study explored the clinical utility of the CAMPROMPT-C in patients with schizophrenia by comparing their PM performance with that of normal controls.
Forty-four schizophrenia patients and 44 normal controls formed the study sample. Sociodemographic characteristics, PM, retrospective memory, and intelligence were measured in all subjects. Patients' psychopathology was rated with a standardized instrument.
Patients performed worse than normal controls on both the sum and subscale scores of the CAMPROMPT-C. Patients had comparable performances in PM subtypes. Bivariate analyses revealed that education level, intelligence, and retrospective memory were associated with PM functions.
The study supports the clinical utility of the CAMPROMPT-C in chronic schizophrenia and corroborated the significant relationship between PM and education, intelligence, and retrospective memory.
Bipolar disorders are relatively frequent but easily misdiagnosed. The Korean version of the Mood Disorder Questionnaire (K-MDQ) is a screening instrument for bipolar disorders. The aim of this study was to establish the pattern of responses to the K-MDQ for several psychiatric disorders.
The subjects for this study were 345 patients with bipolar disorders, schizophrenia, depressive disorders or anxiety disorders, as determined using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and 96 controls from five hospitals. The subjects completed the questionnaire by themselves.
The total K-MDQ score was higher in the bipolar disorder group than the other groups. Although the mean K-MDQ score differed significantly between the bipolar disorder group and the other groups, the distributions of total scores for the groups overlapped, and in particular with the schizophrenia group. The area under the receiver operating characteristics curve was relatively high for the bipolar disorder group and the other subjects, but it was less than 0.8 between the bipolar disorder group, and the schizophrenia and control groups.
There are some distinguishing features of the K-MDQ pattern for each disorder, but their similarities were significant. This made it difficult to differentially diagnose the disorder using only the total K-MDQ score. The diagnostic power of the K-MDQ can only be improved in the clinical setting by utilizing reinforcing criteria to diagnose bipolar disorders. Clinicians should be cautious in their interpretation of the K-MDQ, and the use of additional data is essential.
The aim of this study was to investigate the factors associated with weight gain by psychiatric inpatients in short-term treatment.
A total of 378 medical records were reviewed, and sociodemographic, clinical, and baseline biochemical data from 221 psychiatric inpatients were analyzed.
Evaluation of baseline characteristics indicated that the following were significant predictors of weight gain: Axis I diagnosis, treatment with second-generation antipsychotics and mood stabilizers, length of stay, admission body weight, low-density lipoprotein value, triglyceride level, and triglyceride/high-density lipoprotein ratio. Multiple linear regression analysis showed that the independent predictors of weight gain were length of stay and taking both a second-generation antipsychotic and a mood stabilizer. The triglyceride/high-density lipoprotein ratio was an influencing factor inversely associated with weight gain (P = 0.063).
Length of hospitalization and polypharmacy strongly predicted weight gain among psychiatric inpatients receiving short-term treatment.
Depression and hepatitis C virus (HCV) infection are two common conditions among heroin users in methadone maintenance treatment (MMT). However, the comorbid relationship between depression and HCV infection among MMT patients is not well understood.
One hundred and fifteen MMT patients were recruited from the Yangpu MMT Clinic in Shanghai. Demographic characteristics, drug use and HCV-related information were collected using a structured interview. The Beck Depression Inventory (BDI-II) and the Perceived Stress Scale (PSS) were administered to evaluate participants’ symptoms of depression and stress severity. HCV antibody (anti-HCV) test results were collected from patients’ MMT clinical medical records.
58.2% of participants were anti-HCV positive, and 41.3% scored moderate-to-severe for symptoms of depression (BDI-II scores >19). The prevalence of depressive symptoms (BDI-II score >19) was greater in HCV positive than HCV negative participants (51.6% versus 27.7%, respectively; P = 0.02). There was no significant difference in the perceived stress level by anti-HCV status; overall, the perceived stress level score was 15.9 ± 5.7. In logistic regression analysis, positive anti-HCV status (OR = 3.75, 95% CI = 1.42–9.90), and greater perceived stress (OR = 1.23, 95% CI = 1.11–1.36) were independently associated with depression, after controlling for gender, age, duration of drug use and the awareness of HCV infection.
Depression and HCV infection are common and co-occurring among MMT patients in Shanghai. HCV infection itself appears to be associated with depressive symptoms regardless of whether the individual is aware of his HCV infection status. This finding indicates that it is important to consider the impact of depressive symptoms on injection risk behaviors and HCV transmission when planning intervention programs in MMT clinics.
The primary objective of this study was to assess the overall safety and tolerability of atomoxetine in Korean, Chinese, and Taiwanese adults with attention-deficit/hyperactivity disorder (ADHD).
A total of 44 patients aged ≥18 years who met the Conners' Adult ADHD Diagnostic Interview for DSM-IV diagnostic criteria for ADHD were enrolled from China, Korea, and Taiwan. In this open-label, dose-escalation study, patients received atomoxetine orally once daily over a period of eight weeks, starting at 40 mg/day (one week) up to a maximum dosage of 120 mg/day. Tolerability was evaluated by rate of discontinuation due to adverse events. Safety was assessed by recording all adverse events, laboratory tests, vital signs, and electrocardiograms. ADHD symptoms were evaluated by the Conners' Adult ADHD Rating Scale-Investigator Rated: Screening Version (CAARS-Inv:SV) for efficacy assessment.
Thirty-four patients (77.3%) completed the study. Atomoxetine was well tolerated with a discontinuation rate of 2.3% (1/44) due to adverse events. The most commonly reported adverse events were nausea, dizziness, and somnolence. The mean change from baseline to endpoint in CAARS-Inv:SV total ADHD symptom score was −12.5 (P < 0.001). A significant reduction in the CAARS-Inv:SV subscales (inattentive, hyperactive/impulsive, and ADHD index score, P < 0.001) was observed.
This is the first atomoxetine clinical trial in adult patients with ADHD in China, Korea, and Taiwan. Atomoxetine was well tolerated in doses of up to 120 mg/day with no unknown safety concerns.
Previous studies have reported an association between biogenetic temperament/character and circadian preference in Spanish or French college students. Our aim is to investigate the association between temperament/character and circadian preference in psychiatrically healthy, community-dwelling Korean adults of a wide age range.
Subjects free of Axis I disorders (n = 342) completed the Morningness-Eveningness Questionnaire and the Temperament and Character Inventory.
High Novelty Seeking and low Self-Directedness was associated with eveningness. In contrast to prior studies on college students, eveningness was associated with high (not low) Harm Avoidance. Eveningness-Novelty Seeking association and Eveningness-Harm Avoidance association were prominent in females. Eveningness-Novelty Seeking was prominent in the older group (age ≥40), while Eveningness-Harm Avoidance was prominent in the younger group (age ≤40).
Despite the limitation of the small sample size, the present study suggests that eveningness is associated with high Novelty Seeking/Harm Avoidance and low Self-Directedness in community-dwelling adults, and that this association may be related to age, gender, and other sociocultural factors.
A review of the Western mental health scales that have been utilized in Nepal was conducted. Academic search engines (PubMed, MEDLINE, PsychLIT, Social Sciences Citation Index, and Anthropology Plus) were searched using relevant terms for the years 1990–2011. Search results indicated a limited number of mental health scales had been used and/or developed in Nepal with mixed emphasis on reliability and validity, as well as cultural considerations. These scales, methods and limitations are discussed within the cultural and social background of Nepal.
No previous study has been designed to analyze the reasons for electroconvulsive therapy (ECT) without patients’ consent. In the present study we compared the clinical characteristics and one-year outcomes between patients with refusal to undergo ECT and patients without competency for ECT consent.
In a retrospective cohort study, 29 patients were treated with ECT without providing consent between 1 January 2006 and 31 August 2010. A surrogate family member gave informed consent for ECT to meet current legal requirements. Patients were assigned to one of two groups: a consent-refusal group comprising patients who refused to give consent for ECT and could clearly say “no” or argue with psychiatric staff about receiving ECT; and a consent-incompetent group comprising patients who were incompetent for consent but underwent ECT passively or reluctantly without argument.
The patients were clinically diagnosed with schizoaffective disorder (n = 6), psychotic disorder (n = 12), bipolar I disorder (n = 8) and major depressive disorder with psychotic features (n = 3). The consent-incompetent patients had longer hospital stays and more recurrence in one year than the consent-refusal patients, which may be because the former group had more psychotic disorders and fewer mood disorders. All patients improved rapidly and efficiently. However, remission was temporal in two-thirds of patients and the rehospitalization rate in one year was 66% (n = 19).
ECT can be applied early, emergently and successfully to patients who have a wide range of psychiatric disorders and life-threatening conditions without threat of lawsuits, even during their first hospitalization.
Mental Health Care Services are part of the National Health Services for Samoa. Their function is to provide mental health care services to the population of Samoa, which numbers 180,000 people. However, like many other countries in the Pacific region, mental health is considered a low priority. The mental health budget allocation barely covers the operation of mental health care services. More broadly, there is a lack of political awareness about mental health care services and mental health rarely becomes an issue of deliberation in the political arena. This article outlines the recent development of mental health care services in Samoa, including the Mental Health Policy and Mental Health Act 2007. It tells the story of the successful integration of aiga (family) as an active partner in the provision of care, and the development of the Aiga model utilizing Samoan cultural values to promote culturally appropriate family-focused community mental health care for Samoa. Mental Health Care Services today encompass both clinical and family-focused community mental health care services. The work is largely nurse-led. Much has been achieved over the past 25 years. Increased recognition by government and increased resourcing are necessary to meet the future health care needs of the Samoan people.
To determine the quality of life of patients with epilepsy and its relationship with depression, and the clinical and sociodemographic variables.
This was a cross-sectional study in which a total of 120 epilepsy patients were recruited from a neurology outpatient clinic. Sociodemographic and clinical variables were recorded. Hospital Anxiety and Depression Scale (HADS) and Mini International Neuropsychiatric Interview (M.I.N.I.) were used to screen and diagnose for depression, respectively. Quality of Life Inventory of Epilepsy (QOLIE-31) was used to assess quality of life.
Patients with epilepsy with major depression had poorer quality life (36.4 ± 1.8) compared to those without depression (41.7 ± 3.8, P < 0.001). Depression, having one seizure or more per month and having seizures within one month of interview were correlated with poorer quality of life, P < 0.001. Multivariate linear regression analyses showed that depression and recent seizures predicted having poorer quality of life in patients with epilepsy.
Depression and poor seizure control were predictors for poor quality of life in patients with epilepsy. Therefore, epilepsy patients should be regularly screened for depression and treatment for epilepsy must be optimized to minimize the negative impact of having epilepsy for these patients.
Schizophrenia and major depressive disorder (MDD) are among the most common psychiatric diagnoses associated with suicide. There is a dearth of published research systematically comparing suicidal behavior in schizophrenia and MDD. The present study aimed to compare suicide attempts in schizophrenia and MDD.
In this hospital-based, cross-sectional study, 50 outpatients each of schizophrenia and MDD were evaluated for their sociodemographic characteristics. In subjects with a history of suicide attempt(s), additional information related to the attempt(s) was obtained. Suicide Intent Scale (SIS) was used to assess the suicidal intent and Mini International Neuropsychiatric Interview (MINI) was used to measure the current suicidal risk.
Thirty-four percent and 44% of patients with schizophrenia and MDD, respectively, attempted suicide. The attempters in schizophrenia compared to those in MDD were younger and more likely to be single (unmarried, separated or divorced). Suicidal intent was stronger in schizophrenia, while the attempters with MDD were more often preoccupied with a death wish and reported that stressful life events influenced the attempt. There were no differences in the attempt methods of the two groups. Current suicidal risk was higher in attempters compared to the non-attempters in schizophrenia as well as MDD.
Suicide attempts in schizophrenia and MDD have similar features, with quite a few notable differences, which have been discussed at length in the present paper.
Our objective was to identify the factors related to returning to smoking by analyzing data obtained from a smoking cessation clinic.
We analyzed data from 2,089 subjects (age 44.0 ± 12.9 years) who started a smoking cessation program between 16 July 2007 and 31 December 2008 in a community health center in the city of Ulsan. We analyzed demographic information and clinical variables using Kaplan–Meier survival analysis and calculated the hazard ratio for returning to smoking.
Mean abstinence time differed according to the following factors: sex, past attempts to quit, employment status, type of health insurance, CO levels, results from Fagerstrom test for nicotine dependence (FTND), number of cigarettes smoked daily, use of a nicotine replacement, and number of contacts in the program. Using multivariate analysis, we identified negative relationships between treatment intensity and hazard ratio for the following: visits ≤4 (Exp(B) = 3.752, P < 0.001, reference: 5 visits ≤), telephone contacts ≤5 (Exp(B) = 10.528, P < 0.001, reference: 6 calls ≤) and SMS ≤ 20 (Exp(B) = 3.821, P < 0.001 in 0–10 group; Exp(B) = 1.407, P = 0.003 for the 11–20 group; reference: 21 messages ≤).
Type of insurance, baseline CO, FTND level, and intensity of smoking cessation intervention positively affects outcomes in a smoking cessation clinic. A cost-effectiveness study on the intensity of interventions in smoking cessation clinics is needed.
As the world's fastest growing “addiction”, Internet addiction is still controversial. The present study aimed to examine the potential personality predictors of Internet addicts.
Eight hundred and sixty-eight students were tested using the Eysenck Personality Questionnaire after they had just entered university. Two years later, 49 were found to be addicted to the Internet as defined by high Internet addiction test scores. Comparisons of means and logistic regression analysis were used to explore their relationship.
Students addicted to the Internet showed higher Neuroticism/Stability scores, higher Psychoticism/Socialization scores, and lower Lie scores than their normal peers before their addiction. Regression results showed that Internet addiction was accounted by three independent variables: Neuroticism/Stability, Psychoticism/Socialization, and Lie.
These results suggest that the risk personality traits of Internet addiction include neuroticism, psychoticism, and immaturity.
Public speaking fears (PSF) are highly prevalent in the general population. They are also among the most common symptoms of social anxiety disorder, which typically has an adolescent onset and has recently been increasingly recognized as a persistent and impairing disorder across various cultures in the world.
This study examined PSF and their associated factors among 17,615 adolescents, aged 12–18, in a large-scale school-based community survey in Japan.
PSF was noted in 7.3% of the students. The prevalence was higher among girls than among boys, and it had a tendency to decrease with age. Across the gender and age groups, PSF was associated with psychopathology, including depression and anxiety, suicidal thoughts, deliberate self-harm, violence towards objects and people, and increased difficulties at school.
We should no longer make light of public speaking fears among adolescents as transient, common-sense phenomena.
Values and life goals are associated with one's general well-being and quality of life. However, there is insufficient documentation about issues that are linked with the notions of spiritual values and life goals among college students in Asia. This study addressed this lack of research by focusing on the spiritual values and life goals among students in Singapore.
Four hundred and ninety structured surveys and 64 follow-up interviews were taken in two government-sponsored universities in Singapore.
Statistics showed that spiritual values were positively correlated with intrinsic goals, which had been shown to strongly relate to subjective well-being (SWB).
Developing spiritual values may promote subjective well-being by enabling college students to find meaning and purpose in life.
Anxiety and depression are prevalent during pregnancy. Estimates of the prevalence of anxiety and depression during pregnancy vary according to the criteria used, variable methodologies and population characteristics.
A cross-sectional survey design was used. A total of 175 antenatal mothers participated. Their socio-demographic and obstetric histories were recorded. The Hospital Anxiety and Depression Scale (HADS) and Mini International Neuropsychiatric Interview (M.I.N.I.) were used.
The prevalence of anxiety and depression disorders among antenatal mothers using diagnostic clinical interview were 9.1% and 8.6%, respectively. Factors associated with antenatal anxiety were marital status (being unmarried), positive history of mental illness, gestational age (<20 weeks), unplanned pregnancy and depressive comorbidity. However, only gestational age of less than 20 weeks and depressive disorder remained significant factors in the multivariate analysis.
The prevalence rate of antenatal depression detected by HADS screening was comparable to the rate from diagnostic interview, but there was a slight overestimation for antenatal anxiety. Nonetheless, HADS as a screening tool offers a practical solution for detecting these two conditions in a busy antenatal clinic or a large epidemiological survey. In view of the deleterious effects of antenatal anxiety and depression on mothers and children, these two conditions should be screened and managed appropriately.
The aim of this study was to determine the prevalence and risk factors for female sexual desire disorder (FSDD) among healthcare personnel at selected healthcare facilities in Malaysia.
Two hundred and one female healthcare workers from three large tertiary hospitals were selected by stratified random sampling to participate in this cross-sectional study. Validated questionnaires were used to assess depression, anxiety, and sexual function in women and erectile dysfunction (ED) in their partners.
The prevalence of FSDD was 18.9%. Women with low sexual desire were more likely to have higher educational attainment (OR = 3.06; 95% CI; 1.22–7.66), lower frequency of sexual intercourse (OR = 12.81; 95% CI; 4.43–37.83), two or more children (OR = 3.05; 95% CI; 1.02–9.09), duration of marriage of 20 years or more (OR = 2.62; 95% CI; 1.27–5.40), and a spouse with ED (OR = 2.86; 95% CI; 1.08–7.56).
FSDD is common among female healthcare personnel in Malaysia, affecting nearly one in five women. The implication of low sexual desire is important in terms of contributing to a meaningful sexual relationship, and indirectly affects the quality of life of the healthcare personnel.
The objective of this study was to examine the risk of female sexual orgasmic disorder among a group of women with hypertension in Malaysia. The associated factors were also examined.
This cross-sectional study involved 348 hypertensive women attending the primary care or hypertension clinic in a teaching hospital in Malaysia. Female sexual orgasmic disorder was assessed using the Orgasmic subscale of the Malay Version of the Female Sexual Function Index (MVFSFI). Basic socio-demographic data of the subjects was collected using a predesigned questionnaire. Medical records were reviewed to gather patients' medical information.
The risk of female sexual orgasmic disorder among hypertensive women was 14.1%. Univariate analysis found that older age, longer duration of marriage, lower educational level, and menopause were associated with higher risk of female sexual orgasmic disorder. These factors were not significant in multivariate analysis.
The risk of female sexual orgasmic disorder was relatively low in Malaysian women with hypertension. No risk factors were associated with female sexual orgasmic disorder in the current study.
To examine the relationship between externalizing/internalizing syndromes and school truancy among Form Four (10th grade) students attending “high-risk” schools in Kuala Lumpur.
This is a cross-sectional study conducted upon 16-year-old adolescents attending three high-risk schools in Kuala Lumpur. A total of 373 students completed self-administered questionnaires on the sociodemographic variables and externalizing/internalizing syndromes. The number of truant-days per student during the study period was obtained from the school records.
The mean internalizing score, externalizing score and total problem score of those who were truant were found to be significantly higher (P < 0.05) than those who were non-truant. Multiple logistic regressions showed externalizing syndrome (odds ratio [OR] = 1.044; confidence interval [CI] = 1.012–1.078, P = 0.018) significantly predicts truancy but not the internalizing syndrome. Two other psychosocial factors, namely, having divorced parents (OR = 2.495, CI = 1.058–5.886, P = 0.037) and did not understand or were uncertain of the purpose of schooling (OR = 2.621, CI = 1.265–5.433, P = 0.010) were also showed to be stronger predictors of truancy compared to externalizing/internalizing syndromes.
Truancy has significant association to externalizing syndrome, in addition to other significant psychosocial variables like parental and schooling factors. This finding indicated the need for comprehensive assessment of students presenting with truant behavior, including the identification of associated psychological and behavioral problems which highlights the roles of mental health professionals in tackling truancy.
Research on depression in local patients with end-stage renal disease (ESRD) is sparse. Thus, this study aims to examine the frequency and severity of depression among ESRD patients and relate depression with their coping skills.
A cross-sectional study using universal sampling method was conducted at several dialysis centers in Kuala Lumpur, Selangor and Johor, Malaysia. The Beck Depression Inventory II (BDI-II) and the Brief COPE scale were used to measure depression and coping skill, respectively.
The study involved 274 ESRD patients, comprising of 183 hemodialysis and 91 continuous ambulatory peritoneal dialysis patients. The result showed that 21.1% of the patients experienced moderate to severe depression. Several components of coping skill were associated with depression. However, only two components in the Brief COPE (behavioral disengagement and self-blame) were identified as predictors.
This study showed that depression is common in ESRD patients and is related to the types of coping skills adopted by patients. Hence, this study provides some insight into ESRD patients with depression. Appropriate counseling should be given to these patients to empower them to cope with the illness so as to enhance their quality of life.
SSRIs are known for their sexual side-effects with a variable rate of sexual dysfunction (SD). 5HT2A (rs6311) single nucleotide polymorphism (SNP) was found to have significant association with SD. The purpose of this study was to determine the prevalence of female SDD, its clinical correlates and association with 5HT2A (rs6311) SNP in patients with major depressive disorder (MDD) treated with SSRIs.
This was a cross-sectional study. We evaluated 95 female outpatients with MDD treated with SSRIs who were in remission. Outcome measures were stratified by the presence or absence of SDD. A buccal swab was obtained from each patient and sent for genotyping in the Pharmacogenomics and Medical Biotechnology Laboratory of Universiti Malaya.
The overall prevalence of female SD was 32.6%. The prevalence of female SDD was 62.1%. Those with arousal problem, lubrication problem, sexual satisfaction problem, orgasm problem and problematic marriage were more likely to have sexual desire disorder. The majority of participants who had sexual desire disorder had genotype TT (42.4%) but there was no significant association observed. After controlling for age, number of children, education level, SSRI type, lubrication problem, orgasm problem, satisfaction problem and marital problem, only arousal problem significantly enhanced the presence of sexual desire disorder by 8.5 times (odds ratio = 8.46, 95% confidence interval = 1.24–57.58; P = 0.018).
This study showed that there was no significant association between SDD and the 5HT2A (rs6311) SNP. Arousal problem significantly enhanced the presence of sexual desire disorder.
This cross-sectional study aimed to determine the construct of the phases of the female sexual response cycle (SRC) among women attending an infertility clinic in a Malaysian tertiary center.
The sexual response phases were measured with a validated Malay version of the Female Sexual Function Index (FSFI). The correlation structure of the items of the SRC phases (i.e. desire, arousal, orgasm, satisfaction and pain) was determined using principal component analysis (PCA), with varimax rotation method. The number of factors obtained was decided using Kaiser's criteria.
A total of 150 married women with a mean age of 32 years participated in this study. Factor loadings using PCA with varimax rotation divided the sexual domains into three components. The first construct comprised sexual arousal, lubrication and pain (suggesting a mechanical component). The second construct were orgasm and sexual satisfaction (suggesting a physical achievement). Sexual desire, suggesting a psychological component, stood on its own as the third.
The findings suggest that three constructs could be identified and in favor of the Basson model (a non-linear concept of SRC) for Malaysian women's sexual functioning. Understanding this would help clinicians to strategize the treatment approach of sexual dysfunction in women with infertility.
This study aimed to examine the role of social support and depression in predicting the quality of life among the elderly living in a rural Federal Land Development Authority (FELDA) community in Malaysia.
A total of 162 elderly settlers of FELDA Sungai Tengi, aged 60 years and above, were selected by universal sampling method in this cross-sectional study. Three standardized instruments – the 12-item Short Form (SF-12), 15-item Geriatric Depression Scale (GDS-15) and Medical Outcome Study Social Support (MOS-Social Support) – were used to assess for quality of life, depression and social support.
Quality of life of the elderly people in this community was high, especially in terms of physical components as compared to mental components. The mean scores for emotional role in the SF-12 was relatively the highest (90.74 ± 21.59) with social functioning being the lowest (30.35 ± 22.29). The results also showed that the mean value was higher for physical component summary (74.40) as compared to mental component summary (51.51). Approximately 23.5% suffered mild depression and only 2.5% had severe depression.
This study showed that the elderly FELDA settlers have a high quality of life, mainly on the physical components of life and low rate of severe depression, a positive indicator of their psychological well-being. Social support in the form of emotional/informational support, and depression were significant factors related to their good quality of life.
Depression is one of the most common psychiatric conditions in men. The aim of the study was to determine the depressive symptoms and associated factors among men on methadone maintenance therapy (MMT).
A cross-sectional study was conducted involving 108 subjects who attended the Drug Clinic at Hospital Kuala Lumpur. The instruments used include the Structured Clinical Interview for Diagnostic and Statistical Manual, Fourth Edition Axis-I Disorder, Beck Depression Inventory and the 15-item International Index of Erectile Function.
The rate of depression was 44.4%. There were significant associations between Malay ethnicity, secondary education level and concurrent illicit cannabis use with depression (P < 0.05). However, there was no significant associations between depression and erectile dysfunction (P = 0.379).
Even though depression is common among men on MMT, it is often missed by the treating doctors. It is important to make the treating doctors aware that depression is a serious clinical condition that has a profound impact on the individual and compliance to treatment.
Anxiety among house officers may impair functioning and health care delivery. This study aimed to determine the association between anxiety among house officers at Universiti Kebangsaan Malaysia Medical Center, sociodemographic and work-related factors.
A cross-sectional study using the self-rated and validated Malay Depressive Anxiety and Stress Scale 21, the General Stressor Questionnaire and a sociodemographic questionnaire.
Of the 89 house officers, 60.7% were anxious. Multivariate logistic analysis showed work-related challenges, performance pressure (odds ratio [OR] = 9.000, 95% confidence interval [CI] = 1.812–44.705), poor relationship with supervisors (OR = 5.212, 95% CI = 2.033–3.365), poor relationship with colleagues (OR = 4.642, 95% CI = 1.816–11.866), bureaucratic constraints (OR = 3.810, 95% CI = 1.541–9.415) and poor job prospects (OR = 3.745, 95% CI = 1.505–9.321) strongly associated with anxiety. Family-related stressors were less significant (OR = 1.800, 95% CI = 0.760–4.266) unless they were work related (work–family conflicts [OR = 8.253, 95% CI = 2.652–25.684]).
Almost two-thirds of this cohort reported work-related anxiety symptoms. Administrators need to address these mental health needs early. The subsequent improvement in communication skills, conflict resolution and anxiety reduction will result in short- and long-term benefits towards the young doctors's mental health. The cascading impact on these individuals, thus empowered, will be good work–life balance, improved patient care and safety, a satisfying medical career whilst contributing maximally to the country's health care.
Chronic stress in adolescents may cause physical, mental and emotional health issues which lead to poor outcomes if left untreated. The present study aimed to determine the prevalence of depression, anxiety and stress, and their association with stressors.
A cross-sectional study was conducted among 350 students in a selected boarding school. Two validated Malay version questionnaires were used as instruments, which comprised the 21-item Depression, Anxiety and Stress Scale to assess depression, anxiety and stress level, and Soalselidik Stressor Sekolah Menengah to assess stressors.
The prevalence of depression, anxiety and stress were 39.7%, 67.1% and 44.9%, respectively. The highest mean score was 2.3 (±0.80) for the academic-related stressor. All stressors (academic, interpersonal, intrapersonal, teacher, learning/teaching and social group) had significant association with depression, anxiety and stress (P < 0.001). Multiple regression showed that both the intrapersonal-related stressor and learning/teaching-related stressor were 2.8- and 2.0-times more likely (adjusted odds ratio [OR] = 2.8 [P < 0.001] and OR = 2.0 [P = 0.002], respectively) to cause depressive symptoms. On the other hand, the interpersonal-related stressor was 2.9-times more likely (adjusted OR = 2.9, P < 0.001) to cause anxiety. The learning/teaching-related and intrapersonal-related stressors were 2.7- and 2.5-times more likely to develop stress (adjusted OR = 2.7 [P < 0.001] and OR = 2.5 [P = 0.001], respectively).
The possibility of introducing screening for mental health problems among boarding school students needs to be considered and investigated. Addressing the possible stressors and employing healthy coping may help in reducing negative emotional outcomes in these students.
Neurosyphilis may presents with a range of psychiatric symptoms. This report illustrates a case of neurosyphilis in a man who presented with psychosis and cognitive dysfunction. Clinical findings and investigations done in the present case showed positive results for syphilis. Reduction of symptoms was noted after treatment with antibiotic. This case further highlights the importance of having high index of suspicion for neurosyphilis in patients presenting with psychiatric symptoms.
Research in the field of child sexual abuse is lacking in Malaysia. The aims of this study are to identify the association between sociodemographic factors and depression among sexually abused females.
A cross-sectional study was conducted among 51 young sexually abused female attendees at the Suspected Child Abuse and Neglect (SCAN) clinic of Hospital Kuala Lumpur, a tertiary referral centre. Upon obtaining informed consent from participant and guardian, participants were screened for depression using the Strength and Difficulty Questionnaire (SDQ) and interviewed using the Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS) for depressive disorders and K-SADS-PL (Present and Lifetime version) to diagnose depression. Sociodemographic data and details of the abuse were also obtained.
Of the survivors, 33.3% were depressed. Univariate analysis showed significant association between legal guardianship, living environment and duration of abuse with depression, however, multivariate analyses later showed that the sole predictor for depression was living environment. Respondents who lived with others were 23-times more likely to be depressed as compared to those who lived with their parents.
Depression is common among young survivors of sexual abuse. Those who lived with parents appeared to have a better outcome. Thus, further research to explore possible protective factors associated with living with parents is vital. This will help clinicians develop strategies to empower parents and families help these young survivors get back on track with their lives despite the abuse.
The objective of this study was to determine the relationship between clinical/socio-demographic factors with knowledge and attitude on sex among medical students of the National University of Malaysia (UKM).
A cross-sectional study assessing 452 students using a self-administered questionnaire of knowledge and attitude was performed and had a response rate of 80%.
The majority of respondents were Malays (56%), females (57.5%), lived in urban areas (66.4%), had a median family income of RM3000 and perceived themselves as moderately religious (60%). The overall score on knowledge about sex was 21.7 of 35 (a higher score indicates better knowledge about sex). It was noted that 73.2% of students felt that they did not receive adequate training in medical school to deal with patients' sexuality and sexual problems, while 51.5% felt uncomfortable talking to patients about these issues. Students in the clinical year were more knowledgeable than those in pre-clinical years (22.67 versus 20.71, P < 0.001). No significant differences were found in terms of their backgrounds, such as being from urban or rural areas (P = 0.349) and between genders (P = 0.286). Only 54.9% of students had a satisfactory level of knowledge on sex (>22 marks [median score]).
The students' attitude on sex was considered conservative as the majority of them disagreed on premarital sex, masturbation, abortion, homosexuality and oral sex. Gender and religiosity have a large influence on attitudes on controversial sexual issues, whereas clinical status plays a small role. Knowledge on sex among UKM medical students is inadequate and their attitudes on sex are considered conservative. Integration of sexual medicine and health modules in the medical curriculum is crucial for students to more effectively address patients' sexual problems and promote non-judgmental attitudes towards patients.
The rapidly increasing of incidence colorectal cancer (CRC) in Malaysia and the introduction of new treatments that prolong survival advocating treatment outcome measures such as patients' quality of life (QOL) are evaluated in this study. The study aims to determine QOL in CRC patients according to cancer stage and age.
A cross-sectional study was performed from June to December 2011 at four public tertiary hospitals. The European Organization for Research and Treatment in Cancer (EORTC) Quality of Life Questionnaire Core-30 (EORTC QLQ C-30) questionnaire was used through face-to-face interview and the medical records of 160 respondents were reviewed.
The mean age of respondents was 58.47 ± 12.04 years with 57.5% of respondents being male and 42.5% female. The majority of respondents were in CRC stages III and IV. Median global health status (GHS) score was 83.33 (IQR 16.67). Sikhs and Indians had a higher median GHS score compared to other ethnicities (Kruskal–Wallis, χ2 = 12.12, p = 0.007). Emotional, cognitive and social functions were higher in respondents with earlier stage of disease (Kruskal-Wallis, χ2 = 6.06, 6.36, 10.58, p = 0.048, 0.042, 0.005). Median pain, dyspnea, diarrhea and financial implication scores were significantly higher in advanced stage of disease (Kruskal-Wallis, χ2 = 9.31, 6.26,6.77, 7.28, p = 0.010, 0.044,0.034,0.026). Median diarrhea score (p = 0.012) was significantly different between age groups.
Emotional, cognitive and social functions deteriorate with advanced stage of disease. Patients with advanced stage disease experience more pain, dyspnea, diarrhea and financial implications. A systematic screening program to detect cases as early as possible is essential nationwide.
This study aims to examine the validity and reliability of the Malay version of Attitudes toward Lesbians and Gay Men (MVATL/MVATG) among a group of medical students in Malaysia.
It is a cross-sectional study of 173 medical students in the Faculty of Medicine, University of Kuala Lumpur, Malaysia. The participants were given the MVATL/MVATG, Index of Attitudes toward Homosexuals (IATH), Homosexuality Attitude Scale (HAS) and the English version of Attitude toward Lesbians and Gay Men. Two weeks later, these students were given the MVATLG again.
Significant correlation was found between the individual scores of MVATL and MVATG with IATH and HAS in the results. The scale was able to differentiate Muslim and Non-Muslim subjects. The internal consistency (Cronbach's alpha) of both the MVATL and MVATG were good, at 0.76 and 0.82, respectively. The parallel form reliability (Pearson's correlation) of MVATL was 0.0.73 and 0.74 for MVATG. The test-retest reliability of MVATL/MVATG was good (Intraclass correlation coefficient, ICC = 0.67 for MVATL and 0.60 for MVATG).
The MVATLG demonstrated good psychometric properties in measuring attitudes toward homosexuality among a group of medical students in Malaysia and it could be used as a simple instrument on young educated Malaysian adults.
The aim of this study was to determine the association between sexual abuse, substance abuse and socio-demographic factors with suicidal ideation (SI), plans (SP) and deliberate self-harm (DSH) and propose steps to prevent youth suicidal behavior.
This was a cross-sectional study of 6786 adolescents aged 17–18 years, selected randomly from all Malaysian adolescents to undergo compulsory youth camps located in Selangor, Malaysia (2008–2009). Participants were assessed using self-administered questionnaires developed to reflect the local cultural setting. However, only 4581 subjects were analyzed after excluding incomplete data.
The rates of SI, SP and DSH were 7.6%, 3.2% and 6.3%, respectively. The multivariable-adjusted odds ratio showed that sexual abuse was associated with SI 1.99 (95% CI: 1.56–2.55), SP 1.57 (95% CI: 1.09–2.27) and DSH 2.26 (95% CI: 1.75–2.94); illicit drug use was associated with SI 4.05 (95% CI: 2.14–7.67), SP 2.62 (95% CI: 1.05–6.53) and DSH 2.06, (95% CI: 1.05–4.04); for alcohol use DSH was 1.34 (95% CI: 1.00–1.79). Being female was associated with all suicidal behaviors: SI 2.51 (95% CI: 1.91–3.30), SP 2.07 (95% CI: 1.39–3.08) and DSH 1.59 (95% CI: 1.19–2.11).
Given the well-founded concern of increasing risk of suicidal behavior among youth, preventive efforts should adopt a more comprehensive approach in dealing with sexual abuse and substance abuse, and their sequelae, especially in girls.
Hospital-based community psychiatric service (HCPS) is a developing intervention in Malaysia targeted for patients with severe mental illnesses (SMIs). Its effectiveness had not been systematically measured. This study aimed to assess the outcome of HCPS with respect to re-hospitalization and factors associated with low re-hospitalization among patients with schizophrenia in the metropolitan city of Kuala Lumpur.
A naturalistic and retrospective cohort study was conducted using within-subject pre-post design on 155 patients with schizophrenia who received HCPS in Hospital Kuala Lumpur (HKL). The selection was made by simple random sampling. The hospital admission profiles were obtained from clinical records. The socio-demographic and relevant clinical data were also assessed through clinical interviews.
One hundred and forty (90%) of 155 respondents had low rate of hospital admission with significant reduction of being hospitalized within 1 year after receiving HCPS (p < 0.001). Having good social support was significantly associated with lower rate of rehospitalization (p = 0.001).
The study revealed the effectiveness of HCPS in terms of reducing rates of hospital admission among patients with schizophrenia in Malaysia. The finding may be used as an evidence to develop the service further in other hospitals. However, the finding needs to be replicated through studies with better design involving more psychiatric centres.
Loneliness has long been known to have strong association with depression. The relationship between loneliness and depression, however, has been associated with other risk factors including social support. The aim of this paper is to describe the role of social support in the association between loneliness and depression.
This cross-sectional study examined the mediating effects of social support among 161 community-based elderly in agricultural settlement of a rural area in Sungai Tengi, Malaysia. Subjects were investigated with De Jong Gierveld Loneliness Scale, Geriatric Depression Scale and Medical Outcome Survey Social Support Survey. Data were analyzed using Pearson correlation, linear and hierarchical regression.
Results indicated that social support partially mediated the relationship between loneliness and depression.
This suggests that social support affects the linear association between loneliness and depression in the elderly.