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Pitanupong J, Sa-I A, Sathaporn K, Jiraphan A, Ittasakul P, Karawekpanyawong N. The personality traits with depression and suicidal ideation among Thai medical students: a university-based multiregional study. BMC Psychol 2024; 12:223. [PMID: 38654365 DOI: 10.1186/s40359-024-01707-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The prevalence of depression in medical students was greater than in the general population. Knowing of predictive factors for depression among medical students is useful. The objectives of this study included the assessment of personality traits as well as the association between the personality traits and the presence of symptoms of depression, and suicidal ideation among medical students covering several regions of Thailand. METHODS From April to July 2023, a cross-section study was conducted. The participants included first to sixth-year medical students studying at three Faculties of Medicine in Thailand; Prince of Songkla University; Ramathibodi Hospital, Mahidol University; and Chiang Mai University. Using the online process, the questionnaires were composed of three sections; demographic data; the International Personality Item Pool-NEO (IPIP-NEO), Thai version; and the Patient Health Questionnaire-9 (PHQ-9), Thai version. Demographics, personality traits, depression, and suicidal ideation were analyzed using descriptive statistics. The results were presented as frequency, mean, and standard deviation (SD) or median and interquartile range (IQR). The association between independent variables and the presence of depression was identified using binary logistic regression analysis, and the association with suicidal ideation was identified using ordinal logistic regression analysis. RESULTS The 868 medical students participated in this study. Most of them were female (63.5%), Buddhist (82.0%), and first-year medical students (31.8%). The mean age (SD) was 20.8 (2.2) years, and the mean cumulative Grade Point Average (SD) was 3.5 (0.4). They reported the median (IQR) score of PHQ-9 as 6.0 (3.0-9.0), 238 participants (27.4%) presented with depression, and 138 (15.9%) participants reported suicidal ideation. According to the IPIP-NEO, participants with depression or suicidal ideation had higher Neuroticism scores and lower Extraversion, Agreeableness, and Conscientiousness scores compared to those without such issues. An increase in the Neuroticism score was linked to higher odds of depression, while an increase in the Conscientiousness score was associated with lower odds of depression. Suicidal ideation significantly increased with higher Neuroticism scores and the presence of a psychiatric illness. CONCLUSIONS More than a quarter of Thai medical students reported depression. A higher Neuroticism and lower Extraversion, Agreeableness, and Conscientiousness scores related to depression. Therefore, medical schools may benefit from knowing medical students' personality traits, to identify coping mechanisms and predict those at a higher risk of developing depression in the future.
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Affiliation(s)
- Jarurin Pitanupong
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Adchara Sa-I
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Katti Sathaporn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Aimorn Jiraphan
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Yagi SR, Napa W, Awirutworakul T, Ittasakul P, Yagi N, Hartelius G. Effects of a brief interpersonal mindfulness program embedded in a psychiatric nursing practicum: A controlled pilot study. J Prof Nurs 2023; 47:46-55. [PMID: 37295912 DOI: 10.1016/j.profnurs.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Nursing school is a stressful environment that demands high performance both professionally and academically. Interpersonal mindfulness training has shown promise for its stress-reducing capacity in other contexts; however, few descriptions or tests of this method in nursing training settings exist in the literature. PURPOSE This pilot study examined effects of a brief interpersonal mindfulness program embedded in a 4-week psychiatric nursing practicum in Thailand. METHODS Mixed methods were used with 31 fourth-year nursing students to measure changes in mindfulness and assess their experiences of the program's impact. The control and experimental groups received the same clinical training, but the experimental group was also trained to practice interpersonal mindfulness throughout the course. FINDINGS The experimental group reported statistically significantly greater increases in Observing, Describing, and Non-reacting subscale scores, and in scores for the overall Five-Facet Mindfulness questionnaire, Thai version, than the control group (p < .05, Cohen's d = 0.83-0.95, large effect sizes). Group interviews revealed themes: initial challenges to mindfulness practice, experiences of becoming more mindful, intrapersonal benefits, and consequences of mindfulness on interpersonal skills. CONCLUSION Overall, an interpersonal mindfulness program embedded in a psychiatric nursing practicum was effective. Further studies are required to address limitations of the present study.
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Affiliation(s)
- Sudaros Rongmuang Yagi
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand.
| | - Wilai Napa
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
| | - Tantawan Awirutworakul
- Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand
| | | | - Glenn Hartelius
- School of Consciousness and Transformation, California Institute of Integral Studies, 1453 Mission St, San Francisco, CA 94103, United States
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Sombatcharoen-non N, Yamnim T, Jullagate S, Ittasakul P. Effect of Continuation-Maintenance Electroconvulsive Therapy on Hospitalization: A Retrospective Mirror-Image Study. Neuropsychiatr Dis Treat 2023; 19:1427-1433. [PMID: 37342756 PMCID: PMC10278859 DOI: 10.2147/ndt.s415878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023] Open
Abstract
Objective To examine the effect of continuation-maintenance electroconvulsive therapy (ECT) on psychiatric hospitalization in Thai patients. Methods This retrospective mirror-image study reviewed medical records of Thai patients who received continuation-maintenance ECT at Ramathibodi Hospital, Bangkok, between September 2013 and December 2022. The initiation of continuation-maintenance ECT served as the index event, establishing pre-initiation and post-initiation periods. The primary outcome measured the differences in admissions and admission days before and after continuation-maintenance ECT. Results Forty-seven patients were included in the study, with diagnoses of schizophrenia (38.3%), schizoaffective disorder (21.3%), and bipolar disorder (19.1%) being the most common. The mean (standard deviation; SD) age was 44.6 (12.2) years. The total duration that patients received continuation-maintenance ECT was 53 ± 38.2 months. Following the initiation of ECT, there was a significant reduction in the median (interquartile range) number of hospitalizations for all patients (2 [2] versus 1 [2], p < 0.001), as well as for the psychotic disorder group (2 [2] versus 1 [2.75], p = 0.006) and the mood disorder group (2 [2] versus 1 [2], p = 0.02). Moreover, there was a significant reduction in the median (interquartile range) length of admission days for all patients after the initiation of continuation-maintenance ECT (66 [69] versus 20 [53], p < 0.001). Specifically, the psychotic disorder group (64.5 [74] versus 15.5 [62], p = 0.02) and mood disorder group (74 [57] versus 20 [54], p = 0.008) demonstrated statistically significant decreases in admission days. Conclusion Continuation-maintenance ECT may be an effective treatment option for reducing hospitalizations and admission days in patients with various psychiatric diagnoses. However, the study also highlights the need to carefully consider the potential adverse effects of ECT in clinical decision-making.
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Affiliation(s)
- Nujaree Sombatcharoen-non
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thidarat Yamnim
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sudawan Jullagate
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Ruangsetakit C, Ittasakul P. Response rate and factors associated with response in patients with schizophrenia undergoing bilateral electroconvulsive therapy. BJPsych Open 2023; 9:e75. [PMID: 37092674 PMCID: PMC10134241 DOI: 10.1192/bjo.2023.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Schizophrenia is a severe mental illness and a common indication for electroconvulsive therapy (ECT). Research is lacking on the factors that influence response to acute ECT treatment in schizophrenia patients. AIMS This study examined the response rate and associated factors in patients with schizophrenia undergoing bilateral ECT. METHOD Demographic data, clinical characteristics, ECT data and treatment response were respectively reviewed in patients with schizophrenia undergoing bilateral ECT from January 2013 to June 2022. RESULTS Forty-six patients were included. Nine responded after the first three sessions, 17 after six sessions, 20 after nine sessions, 25 after 12 sessions and 28 after the last ECT session, cumulatively. The mean of the baseline Brief Psychiatric Rating Scale psychotic symptom subscale score was significantly higher in responders (17.0) than non-responders (10.9) (P < 0.05). The mean of duration of electroencephalogram seizure was significantly longer in responders (53.9) than in non-responders (42.7). There was no association between demographic and ECT data and treatment response. Among 28 responders, 20 responded to ECT after nine sessions (faster responders) and eight responded later (slower responders). The number of failed antipsychotics prior to ECT was 2.8 for faster responders and 4.4 for slower responders (P = 0.02). Nominal logistic regression showed that the number of failed antipsychotics prior to ECT was associated with speed of response to ECT (P = 0.037, odds ratio = 1.77). CONCLUSIONS ECT is an effective treatment for schizophrenia and may be influenced by the number of failed antipsychotics prior to ECT.
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Affiliation(s)
- Chanaichon Ruangsetakit
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Ruangsetakit C, Ittasakul P. Factors Associated with Response in Patients with Schizophrenia Undergoing Bilateral Electroconvulsive Therapy: Retrospective Study. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Pitanupong J, Sathaporn K, Ittasakul P, Karawekpanyawong N. Relationship of mental health and burnout with empathy among medical students in Thailand: A multicenter cross-sectional study. PLoS One 2023; 18:e0279564. [PMID: 36602955 DOI: 10.1371/journal.pone.0279564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/11/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To explore mental health, burnout, and the factors associated with the level of empathy among Thai medical students. BACKGROUND Empathy is an important component of a satisfactory physician-patient relationship. However, distress, including burnout and lack of personal well-being, are recognized to affect a lower level of empathy. MATERIAL AND METHODS A cross-sectional study surveyed sixth-year medical students at three faculties of medicine in Thailand at the end of the 2020 academic year. The questionnaires utilized were: 1) Personal and demographic information questionnaire, 2) Thai Mental Health Indicator-15, 3) The Maslach Burnout Inventory-Thai version, and 4) The Toronto Empathy Questionnaire. All data were analyzed using descriptive statistics, and factors associated with empathy level were analyzed via the Chi-square test or Fisher's exact test, logistic regression., and linear regression. RESULTS There were 336 respondents with a response rate of 70.3%. The majority were female (61.9%). Most participants reported a below-average level of empathy (61%) with a median score (IQR) of 43 (39-40). Assessment of emotion comprehension in others and altruism had the highest median empathy subgroup scores, whereas behaviors engaging higher-order empathic responses had the lowest median empathy subgroup score. One-third of participants (32.1%) had poor mental health, and two-thirds (62.8%) reported a high level of emotional exhaustion even though most of them perceived having a high level of personal accomplishment (97%). The multivariate analysis indicated that mental health was statistically significantly associated with the level of empathy. The participants with higher levels of depersonalization had statistically lower scores of demonstrating appropriate sensitivity, altruism, and behaviors engaging higher-order empathic responding. CONCLUSIONS Most medical students had below-average empathy levels, and two-thirds of them had high emotional exhaustion levels, yet most of them reported having a high level of personal accomplishment and good mental health. There was an association between mental health and the level of empathy. Higher levels of depersonalization related to lower scores of demonstrating sensitivity, altruism, and behaviors responding. Therefore, medical educators should pay close attention to promoting good mental health among medical students.
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Affiliation(s)
- Jarurin Pitanupong
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Katti Sathaporn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Nakhon Pathom, Thailand
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Thanapluetiwong S, Chansirikarnjana S, Charernwat P, Saranburut K, Ittasakul P. Prevalence and Factors Associated with Caregivers’ Hesitancy in Immunizing Dependent Older Adults with COVID-19 Vaccines: A Cross-Sectional Survey. Vaccines (Basel) 2022; 10:vaccines10101748. [PMID: 36298613 PMCID: PMC9612071 DOI: 10.3390/vaccines10101748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) vaccinations have been proven to prevent hospitalization and mortality. However, some caregivers may be hesitant to authorize COVID-19 vaccination of people under their care. Our study aimed to evaluate factors associated with caregiver hesitancy to authorize vaccination of dependent older adults. Method: We conducted a cross-sectional telephone survey of vaccine hesitancy among caregivers of dependent older patients in the geriatric clinic of Ramathibodi Hospital. Caregivers were contacted and interviewed by trained interviewers from 20 June to 25 July 2021. Results: The study enrolled 318 participants with a mean age of 55.9 years. The majority of the participants were the patients’ children (86.5%). In total, 39.9% of participants were hesitant to authorize COVID-19 vaccination of the older adults under their care. Factors associated with caregiver vaccine hesitation were uneasiness, anxiety, agitation, sadness, and worry in association with social distancing, refusal to receive a COVID-19 vaccine, and concern about vaccine manufacturers. Conclusion: The prevalence of caregiver hesitancy to allow older adults to undergo COVID-19 vaccination was relatively high, and several factors associated with this vaccine hesitancy were identified. These findings may aid efforts toward COVID-19 vaccination of dependent older adults.
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Affiliation(s)
- Saran Thanapluetiwong
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sirintorn Chansirikarnjana
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Piangporn Charernwat
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Krittika Saranburut
- Cardiovascular and Metabolic Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Correspondence: or ; Tel.: +66-2-201-1235
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Chee KY, Muhdi N, Ali NH, Amir N, Bernardo C, Chan LF, Ho R, Ittasakul P, Kwansanit P, Mariano MP, Mok YM, Tran DT, Trinh TBH. A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age. BMC Psychiatry 2022; 22:489. [PMID: 35864465 PMCID: PMC9306096 DOI: 10.1186/s12888-022-04140-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The high prevalence of suicidal behavior among individuals with major depressive disorder (MDD) in Southeast Asia (SEA) underscores the need for optimized management to address depressive symptoms, reduce suicide risk and prevent suicide in these individuals. Given the lack of clear guideline recommendations for assessing and managing these patients, regional consensus-based recommendations which take into account diverse local contexts across SEA may provide useful guidance for clinical practice. METHODS A narrative literature review and pre-meeting survey were conducted prior to the consensus meeting of an SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with MDD with suicidal behavior. Utilizing the RAND/UCLA Appropriateness Method, the expert panel developed consensus-based recommendations on the assessment and treatment of adult patients with MDD with suicidal behavior under 65 years. RESULTS Screening of adult patients under 65 years with MDD for suicide risk using both a validated assessment tool and clinical interview is recommended. An improved suicide risk stratification - incorporating both severity and temporality, or using a prevention-focused risk formulation - should be considered. For a patient with an MDD episode with low risk of suicide, use of antidepressant monotherapy, and psychotherapy in combination with pharmacological treatment are both recommended approaches. For a patient with an MDD episode with high risk of suicide, or imminent risk of suicide requiring rapid clinical response, or for a patient who had received adequate AD but still reported suicidal behavior, recommended treatment strategies include antidepressant augmentation, combination use of psychotherapy or electroconvulsive therapy with pharmacological treatment, and inpatient care. Suicide-specific psychosocial interventions are important for suicide prevention and should also be part of the management of patients with MDD with suicidal behavior. CONCLUSIONS There are still unmet needs in the assessment of suicide risk and availability of treatment options that can deliver rapid response in patients with MDD with suicidal behavior. These consensus recommendations on the management of adult patients with MDD with suicidal behavior under 65 years may serve as a useful guidance in diverse clinical practices across the SEA region. Clinical judgment based on careful consideration of individual circumstances of each patient remains key to determining the most appropriate treatment option.
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Affiliation(s)
- Kok Yoon Chee
- NEURON, Department of Psychiatry & Mental Health, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
| | - Nalini Muhdi
- grid.440745.60000 0001 0152 762XDepartment of Psychiatry, Dr Soetomo General Hospital; Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Nor Hayati Ali
- grid.413442.40000 0004 1802 4561Department of Psychiatry & Mental Health, Selayang Hospital, Selayang, Selangor Malaysia
| | - Nurmiati Amir
- grid.9581.50000000120191471Department of Psychiatry, Ciptomangunkusumo Hospital; Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Carmina Bernardo
- grid.416330.30000 0000 8494 2564Mood and Anxiety Resource and Referral Center, Professional Services, Department of Neuroscience, Makati Medical Center, Makati City, Philippines
| | - Lai Fong Chan
- grid.412113.40000 0004 1937 1557Department of Psychiatry, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Roger Ho
- grid.412106.00000 0004 0621 9599Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Pichai Ittasakul
- grid.10223.320000 0004 1937 0490Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Melissa Paulita Mariano
- grid.449706.80000 0000 8667 0662Department of Psychiatry, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Yee Ming Mok
- grid.414752.10000 0004 0469 9592Institute of Mental Health, Singapore, Singapore
| | - Duy Tam Tran
- Ho Chi Minh Psychiatric Hospital, Ho Chi Minh, Vietnam
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Kittayarak K, Ittasakul P. Electroconvulsive Therapy Practice in Thailand: A Nationwide Survey. Neuropsychiatr Dis Treat 2022; 18:2477-2484. [PMID: 36338515 PMCID: PMC9635544 DOI: 10.2147/ndt.s385598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To determine the characteristics of electroconvulsive therapy (ECT) practice in Thailand. METHODS A cross-sectional survey of ECT practice in Thailand was conducted. A questionnaire was sent to all 34 hospitals providing ECT services nationwide. ECT staff of each hospital were asked to complete the questionnaire. RESULTS All 34 hospitals responded to the survey. The most common diagnosis was schizophrenia (5,958 patients/year), followed by bipolar disorder (982 patients/year) and major depressive disorder (869 patients/year). Brief pulse device was used in all hospitals. Bitemporal ECT was the most common type of electrode placement (88.2%), followed by bifrontal (44.1%) and right unilateral (38.2%) placement. The initial dose was determined by titration method in 24 hospitals (70.6%) and by age-based method in the remainder (29.4%). Modified ECT was always used in 25 hospitals (73.5%), including all university hospitals, 6 psychiatric hospitals (17.6%) and 10 general hospitals (29.4%). The primary anesthetics used were thiopentone (60.7%) and propofol (39.3%). Regarding acute ECT, ECT was performed three times per week in most hospitals (91.2%). The number of acute ECT treatment sessions in most hospitals was in the range of 4-6. In total, 22 hospitals (64.7%) performed continuation/maintenance ECT. Headache was the most common adverse event, followed by cognitive side effects and myalgia. CONCLUSION ECT practice in Thailand has developed over the past two decades in many aspects. The most notable change is that the majority of patients are now treated with modified ECT. In addition, pre-treatment investigations, use of a device providing a brief pulse, unilateral electrode placement, and the monitoring of parameters during treatment are now used more widely in practice to maximize treatment efficacy while minimizing side effects. However, certain aspects of ECT can still be improved; promoting ECT education among psychiatrists and psychiatry residents could improve the quality of practice, for example.
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Affiliation(s)
- Kannapas Kittayarak
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Tor PC, Amir N, Fam J, Ho R, Ittasakul P, Maramis MM, Ponio B, Purnama DA, Rattanasumawong W, Rondain E, Bin Sulaiman AH, Wiroteurairuang K, Chee KY. A Southeast Asia Consensus on the Definition and Management of Treatment-Resistant Depression. Neuropsychiatr Dis Treat 2022; 18:2747-2757. [PMID: 36444218 PMCID: PMC9700522 DOI: 10.2147/ndt.s380792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD and available treatment pathways for the management of TRD vary across the Southeast Asia (SEA) region, highlighting the need for a uniform definition and treatment principles to optimize the management TRD in SEA. METHODS Following a thematic literature review and pre-meeting survey, a SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA Appropriateness Method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management. RESULTS The expert panel agreed that "pharmacotherapy-resistant depression" (PRD) is a more suitable term for TRD and defined it as "failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode". A stepwise treatment approach should be employed for the management of PRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Non-pharmacological treatments, such as electroconvulsive therapy and repetitive transcranial magnetic stimulation, are also appropriate options for patients with PRD. CONCLUSION These consensus recommendations on the operational definition of PRD and treatment principles for its management can be adapted to local contexts in the SEA countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with PRD.
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Affiliation(s)
- Phern Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, Singapore
| | - Nurmiati Amir
- Department of Psychiatry, Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | - Johnson Fam
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Roger Ho
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Margarita M Maramis
- Department of Psychiatry, Dr. Soetomo General Academic Hospital-Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Benita Ponio
- Department of Psychiatry, Metro Psych Facility, Manila, Philippines
| | | | | | - Elizabeth Rondain
- Department of Psychiatry, Makati Medical Center, Makati City, Philippines
| | - Ahmad Hatim Bin Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Kok Yoon Chee
- Department of Psychiatry, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Ittasakul P, Boncharoen P, Tor PC. The effectiveness of non-clozapine antipsychotics combined with electroconvulsive therapy versus clozapine combined with electroconvulsive therapy for treatment-resistant schizophrenia. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Thanapluetiwong S, Chansirikarnjana S, Sriwannopas O, Assavapokee T, Ittasakul P. Factors associated with COVID-19 Vaccine Hesitancy in Thai Seniors. Patient Prefer Adherence 2021; 15:2389-2403. [PMID: 34754180 PMCID: PMC8568699 DOI: 10.2147/ppa.s334757] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Older people are the most vulnerable group for developing SARS-CoV-2 infection. Although vaccination against coronavirus disease 2019 (COVID-19) reduces infection, hospitalization, and mortality rates, some older people have refused to get vaccinated. Our study aimed to evaluate factors associated with COVID-19 vaccine hesitancy among Thai seniors. METHODS We conducted a cross-sectional telephone survey on vaccine hesitancy in a geriatric clinic at Ramathibodi Hospital in Bangkok, Thailand. Patients aged ≥60 years were contacted and interviewed by trained interviewers between June 20 and July 25, 2021. RESULTS In total, we interviewed 282 participants aged 60-93 years (mean age 73.0±7.5 years). We found that 44.3% of participants were hesitant to get a COVID-19 vaccination. Factors associated with high vaccine hesitancy were low education, lack of confidence in the healthcare system's ability to treat patients with COVID-19, vaccine manufacturers, being offered a vaccine from an unexpected manufacturer, and a low number of new COVID-19 cases per day. CONCLUSION The prevalence of COVID-19 vaccine hesitancy among Thai seniors is relatively high, and is associated with specific factors. These findings will help in promoting COVID-19 vaccination among Thailand's senior citizens.
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Affiliation(s)
- Saran Thanapluetiwong
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirintorn Chansirikarnjana
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Orapitchaya Sriwannopas
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Taweevat Assavapokee
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Subsoontorn P, Lekprasert V, Waleeprakhon P, Ittasakul P, Laopuangsak A, Limpoon S. Premedication with dexmedetomidine for prevention of hyperdynamic response after electroconvulsive therapy: a cross-over, randomized controlled trial. BMC Psychiatry 2021; 21:408. [PMID: 34404384 PMCID: PMC8371895 DOI: 10.1186/s12888-021-03406-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an effective therapy for psychiatric disorders, but is associated with acute hyperdynamic responses including transient hypertension and tachycardia. This study aimed to assess the effectiveness of premedication with dexmedetomidine for hemodynamic attenuation after ECT and to evaluate its effects on seizure duration, postictal asystole duration, post ECT agitation and recovery time. METHODS Twenty-four psychiatric patients who underwent a total of 72 ECT sessions (three sessions per patient) were randomly allocated to receive either dexmedetomidine 0.5 mcg/kg intravenous, dexmedetomidine 1 mcg/kg intravenous, or saline (control group) 15 min before the first ECT session. The patients subsequently received the other two premedication options for their next two ECT sessions. Blood pressure and heart rate were recorded at 5, 10, and 15 min after drug infusion and at 2.5, 5, 7.5, 10, 15, 20, 25, and 30 min after ECT. Asystole duration, seizure duration, post ECT agitation and recovery times were also recorded. RESULTS The baseline characteristics were similar between the groups. Systolic blood pressure in both dexmedetomidine groups was significantly lower than that in the control group after ECT (p = 0.002). Diastolic blood pressure and heart rate were significantly lower in the dexmedetomidine 1 mcg/kg group (p = 0.002 and p = 0.013, respectively) compared with the control group. Asystole duration, seizure durations, post ECT agitation and recovery times were similar between the groups. CONCLUSIONS Dexmedetomidine 1 mcg/kg administered 15 min before ECT attenuated the hemodynamic response, including suppressing the systolic, diastolic and heart rate increases, during ECT without affecting recovery time. It also did not prolong the post-stimulus asystole duration. TRIAL REGISTRATION TCTR20170715003 , registered at Thai Clinical Trials Registry (TCTR), principal investigator: Pattika Subsoontorn, date of registration: 15/07/2017.
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Affiliation(s)
- Pattika Subsoontorn
- grid.10223.320000 0004 1937 0490Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Varinee Lekprasert
- grid.10223.320000 0004 1937 0490Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Punjaporn Waleeprakhon
- grid.10223.320000 0004 1937 0490Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rachathewi, Bangkok, 10400 Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rachathewi, Bangkok, 10400, Thailand.
| | - Atchaporn Laopuangsak
- grid.10223.320000 0004 1937 0490Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suwimon Limpoon
- grid.10223.320000 0004 1937 0490Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Thanapluetiwong S, Ruangritchankul S, Sriwannopas O, Chansirikarnjana S, Ittasakul P, Ngamkala T, Sukumalin L, Charernwat P, Saranburut K, Assavapokee T. Efficacy of quetiapine for delirium prevention in hospitalized older medical patients: a randomized double-blind controlled trial. BMC Geriatr 2021; 21:215. [PMID: 33789580 PMCID: PMC8010962 DOI: 10.1186/s12877-021-02160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background Delirium is a common disorder among hospitalized older patients and results in increased morbidity and mortality. The prevention of delirium is still challenging in older patient care. The role of antipsychotics in delirium prevention has been limited. Therefore, we conducted a trial to investigate the efficacy of quetiapine use to prevent delirium in hospitalized older medical patients. Methods This study was a randomized double-blind controlled trial conducted at Ramathibodi Hospital, Bangkok, Thailand. Patients aged ≥65 years hospitalized in the internal medicine service were randomized to quetiapine 12.5 mg or placebo once daily at bedtime for a maximum 7-day duration. The primary end point was delirium incidence. Secondary end points were delirium duration, length of hospital stay, ICU admission, rehospitalization and mortality within 30 and 90 days. Results A total of 122 patients were enrolled in the study. Eight (6.6%) left the trial before receiving the first dose of the intervention, whereas 114 (93.4%) were included in an intention-to-treat analysis allocated to the quetiapine or placebo group (n = 57 each). The delirium incidence rates in the quetiapine and placebo groups were 14.0 and 8.8% (OR = 1.698, 95% CI 0.520–5.545, P = 0.381), respectively. Other endpoints in the quetiapine and placebo groups were the median length of hospital stay, 6 (4–8) days versus 5 (4–8) days (P = 0.133), respectively; delirium duration, 4 (2.3–6.5) versus 3 (1.5–4.0) days (P = 0.557), respectively; ICU admission, 3 (5.3%) patients from both groups (P = 1.000); and mortality in the quetiapine and placebo groups, 1 (1.8%) versus 2 (3.5%) at 30 days (P = 0.566) and 7 (12.3%) versus 9 (15.8%) days at 90 days (P = 0.591). There were no significant differences in other outcomes. None of the participants reported adverse events. Conclusions Quetiapine prophylaxis did not reduce delirium incidence in hospitalized older medical patients. The use of quetiapine to prevent delirium in this population group should not be recommended. Trial registration This trial was retrospectively registered with the Thai clinical trials registry (TCTR) at clinicaltrials.in.th (TCTR20190927001) on September 26, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02160-7.
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Affiliation(s)
- Saran Thanapluetiwong
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Sirasa Ruangritchankul
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Orapitchaya Sriwannopas
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Sirintorn Chansirikarnjana
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tipanetr Ngamkala
- Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lalita Sukumalin
- Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piangporn Charernwat
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Krittika Saranburut
- Cardiovascular and Metabolic Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Taweevat Assavapokee
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
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Ittasakul P, Jarernrat P, Tor PC. Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy. Neuropsychiatr Dis Treat 2021; 17:283-289. [PMID: 33564234 PMCID: PMC7866936 DOI: 10.2147/ndt.s281961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/19/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To investigate the prevalence and predictors of postictal confusion (PIC) in patients who received electroconvulsive therapy (ECT). METHODS We conducted chart reviews for 79 patients who were receiving inpatient ECT. Subjects with PIC were identified. PIC was defined by confusion, disorientation, motor restlessness, purposeless movement, and nonresponse to verbal commands following ECT within an hour, intravenous benzodiazepine was necessary to manage disturbed behavior. Multivariable logistic regression analysis was used to examine the association of PIC with demographic and clinical variables. RESULTS Prevalence of PIC was 36.7%. In 912 ECT sessions, the occurrence of PIC was 86 times. Patients with PIC (n = 29) had significant higher body mass index (BMI) (27 ± 6.6 kg/m2 vs 24.1 ± 5.2 kg/m2, t = -2.22, df = 77, p = 0.029) than patients without PIC (n = 50). PIC associated with BMI (Pearson correlation = 0.25, p = 0.029). BMI was significant predictor of PIC after adjusting for other covariates (odds ratio = 0.91, 95% CI= 0.83-0.99, p < 0.035). CONCLUSION PIC was not uncommon in patients receiving ECT. BMI was an independent predictor of PIC. Psychiatrists should be aware of the risks of PIC in patients with high BMI receiving ECT.
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Affiliation(s)
- Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phathamon Jarernrat
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phern-Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, Singapore
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Ittasakul P, Vora-Arporn S, Waleeprakhon P, Tor PC. Number of Electroconvulsive Therapy Sessions required for Thai Psychiatric Patients: a Retrospective Study. Neuropsychiatr Dis Treat 2020; 16:673-679. [PMID: 32184606 PMCID: PMC7061719 DOI: 10.2147/ndt.s244031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/17/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To study predictors of the number of electroconvulsive therapy (ECT) sessions required for symptom remission in psychiatric patients. PATIENTS AND METHODS We conducted chart reviews for 95 patients whose condition remitted following inpatient ECT. We analyzed the clinical characteristics of the patients and compared the number of ECT sessions between adult (age 18-59 years) and elderly (age ≥ 60 years) patients. RESULTS The overall mean ± SD of the number of ECT sessions was 11.8 ± 4.7 (range: 6-24). By diagnosis, it was 13.3 ± 5.5 for individuals with schizophrenia, 10.1 ± 2.7 for schizoaffective disorder, 14.4 ± 5.6 for bipolar depression, 9.4 ± 1.9 for bipolar mania, 10.9 ± 4.3 for major depressive disorder (MDD), and 11.8 ± 4.3 for those with other diagnoses. For MDD, the number of ECT sessions in elderly patients (13.4 ± 4.6) was statistically greater than that in adult patients (9 ± 2.9) (p = 0.008). CONCLUSION The number of ECT sessions varied by age and diagnosis. The number of ECT sessions in elderly MDD patients was higher than that in adult MDD patients.
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Affiliation(s)
- Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Siraprapha Vora-Arporn
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Punjaporn Waleeprakhon
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phern-Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, Singapore
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Ittasakul P, Likitnukul A, Pitidhrammabhorn U, Waleeprakhon P, Goldman MB. Stimulus intensity determined by dose-titration versus age-based methods in electroconvulsive therapy in Thai patients. Neuropsychiatr Dis Treat 2019; 15:429-434. [PMID: 30799921 PMCID: PMC6369840 DOI: 10.2147/ndt.s187589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study aimed to compare the accuracy of the stimulus intensity (SI) calculated by age-based methods with that using the dose-titration method. METHODS The initial seizure threshold (IST) was determined using a standardized dose titration in hospitalized Thai patients treated with right unilateral (RUL, n=32) and bilateral (BL, n=57) electrode placement. The correlation between the IST and clinical variables was analyzed. The estimated SI based on the patient's age was compared with the SI determined by dose titration. RESULTS Age was highly predictive of the IST for both groups (RUL, P=0.012; BL, P=0.045). Gender (P=0.006) and anticholinergic drug use (P=0.025) predicted the IST for the BL group. For the RUL group, the mean±SD (median) SI estimated using the half-age and age methods was 158±46 (169) mC and 315±92 (338) mC, respectively. The SI determined using the dose-titration method was higher compared with the half-age method and lower compared with the age method. For the RUL group, 31% of subjects using the half-age method and 22% of subjects using the age method would have received an SI within ±20% of that computed using dose titration. Additionally, 19% of subjects using the half-age method and 19% using the age method would have received unacceptably low (<50%) or high (>200%) intensities. For the BL group, 18% of subjects using the half-age method and 32% using the age method would have received an SI within ±20% of that computed using dose titration. Additionally, 39% with the half-age method and 18% with the age method would have received an unacceptably low or high SI, respectively. CONCLUSION Age strongly predicts the IST, but it does not robustly predict the SI compared with dose titration because the SI calculated using age-based methods results in an unacceptably low or high SI that is associated with a marked risk of adverse effects or inadequate response. We recommend the dose-titration method to determine the SI.
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Affiliation(s)
- Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,
| | - Apichaya Likitnukul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,
| | - Umporn Pitidhrammabhorn
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,
| | - Punjaporn Waleeprakhon
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,
| | - Morris B Goldman
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Sukhato K, Lotrakul M, Dellow A, Ittasakul P, Thakkinstian A, Anothaisintawee T. Efficacy of home-based non-pharmacological interventions for treating depression: a systematic review and network meta-analysis of randomised controlled trials. BMJ Open 2017; 7:e014499. [PMID: 28706086 PMCID: PMC5734422 DOI: 10.1136/bmjopen-2016-014499] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To systematically review and compare the efficacy of all available home-based non-pharmacological treatments of depression. DESIGN Systematic review and network meta-analysis of randomised controlled trials. DATA SOURCES Medline, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched since inceptions to 7 August 2016. ELIGIBILITY CRITERIA Randomised controlled trials comparing the efficacy of home-based non-pharmacological interventions with usual care of patients with depression were included in the review. MAIN OUTCOMES Depression symptom scores and disease remission rates at the end of treatment. RESULTS Seventeen studies were included in the review. Home-based non-pharmacological interventions were categorised as (1) home-based psychological intervention, (2) home-based exercise intervention, (3) combined home-based psychological intervention with exercise intervention and (4) complementary medicine. Complementary medicine approaches were excluded from the meta-analysis due to heterogeneity. The standardised mean differences of post-treatment depression symptom scores between usual care groups and home-based psychological intervention, home-based exercise intervention and combined home-based psychological intervention with exercise intervention were âˆ'0.57 (95% CI âˆ'0.84 to âˆ'0.31), âˆ'1.03 (95% CI âˆ'2.89 to 0.82) and âˆ'0.78 (95% CI âˆ'1.09 to âˆ'0.47), respectively. These results suggest that only home-based psychological intervention and combined home-based psychological intervention with exercise intervention could significantly decrease depression scores. Compared with usual care groups, the disease remission rate was also significantly higher for home-based psychological intervention (pooled risk ratio=1.53; 95% CI 1.19 to 1.98) and combined home-based psychological intervention with exercise intervention (pooled risk ratio=3.47; 95% CI 2.11 to 5.70). Of all the studied interventions, combined home-based psychological intervention with exercise intervention had the highest probability of resulting in disease remission. CONCLUSION Our study confirms the efficacy of home-based psychological intervention and combined home-based psychological intervention with exercise intervention in the treatment of depression. Combined home-based psychological intervention and exercise intervention was the best treatment and should be considered for inclusion in clinical guidelines for managing depression.
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Affiliation(s)
- Kanokporn Sukhato
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Manote Lotrakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Alan Dellow
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Ittasakul P, Archer A, Kezman J, Atsariyasing W, Goldman MB. Rapid Rechallenge with Clozapine Following Pronounced Myocarditis in a Treatment-Resistant Schizophrenia Patient. ACTA ACUST UNITED AC 2016; 10:120-2. [PMID: 27440213 DOI: 10.3371/1935-1232-10.2.120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clozapine is an atypical antipsychotic which is often effective in patients who fail to respond to other antipsychotics, but its use carries substantial risk. Myocarditis is one of the life-threatening adverse effects, which occurs in about 1% of exposed patients. Rechallenge with clozapine is controversial, particularly shortly after the occurrence of the myocarditis, and when there is clear and convincing evidence of cardiac damage. Aggressive use of clozapine, however, may be critical for the recovery of patients early in the course of their illness. Here we report a successful case of clozapine rechallenge following an initial aggressive dosage titration in an inpatient setting.
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Abstract
BACKGROUND Psychiatric comorbidities are common in major depressive disorder (MDD). They may worsen outcome and cause economic burden. The primary objective was to examine the prevalence of psychiatric comorbidities in MDD. The secondary objectives were to compare the presence of comorbidities between currently active and past MDD, and between patients with and without suicidal risk. METHODS This was a cross-sectional study. A total of 250 patients with lifetime MDD and age ≥18 years were enrolled. The Mini International Neuropsychiatric Interview (MINI), Thai version, was used to confirm MDD diagnosis and classify comorbidities. MDD diagnosis was confirmed in 190, and 60 patients were excluded due to diagnosis of bipolar disorder. RESULTS Of the 190 MDD patients, 25.8% had current MDD and 74.2% had past MDD. Eighty percent were women. The mean age at enrollment was 50 years, and at MDD onset was 41 years. Most patients were married (53.2%), employed (54.8%), and had ≥12 years of education (66.9%). There were 67 patients (35.3%) with one or more psychiatric comorbidities. Comorbidities included dysthymia (19.5%), any anxiety disorders (21.1%) (panic disorder [6.8%], agoraphobia [5.8%], social phobia [3.7%], obsessive-compulsive disorder [OCD] [4.7%], generalized anxiety disorder [5.3%], and post-traumatic stress disorder [4.2%]), alcohol dependence (0.5%), psychotic disorder (1.6%), antisocial personality (1.1%), and eating disorders (0%). Compared with past MDD, the current MDD group had significantly higher OCD (P<0.001), psychotic disorder (P=0.048), past panic disorder (P=0.017), and suicidal risk (P<0.001). Suicidal risk was found in 32.1% of patients. Patients with suicidal risk had more comorbid anxiety disorder of any type (P=0.019) and psychotic disorder (P=0.032). CONCLUSION Several comorbidities were associated with MDD. Patients with active MDD had higher comorbid OCD, psychotic disorder, past panic disorder, and suicidal risk. Patients with suicide risk had higher comorbid anxiety and psychotic disorders.
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Affiliation(s)
- Papan Thaipisuttikul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Punjaporn Waleeprakhon
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pattarabhorn Wisajun
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sudawan Jullagate
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Waleeprakhon P, Ittasakul P, Lotrakul M, Wisajun P, Jullagate S, Ketter TA. Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire Thai version. Neuropsychiatr Dis Treat 2014; 10:1497-502. [PMID: 25170269 PMCID: PMC4144938 DOI: 10.2147/ndt.s67842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Mood Disorder Questionnaire (MDQ) has been translated to many languages and has been used in many countries as a screening instrument for bipolar disorder. The main objective of this study was to evaluate validity of the Thai version of the MDQ as a screening instrument for bipolar disorder in a psychiatric outpatient sample, and to determine its optimum question #1 item threshold value for bipolar disorder. METHODS The English language Mood Disorder Questionnaire (MDQ) was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the prefinal version, as well as final adjustments. Two hundred and fifty major depressive disorder outpatients were further assessed by the Thai version of the MDQ and the Thai version of the Mini International Neuropsychiatric Interview (MINI). During the assessment, reliability and validity analyses, and receiver operating characteristic curve (ROC) analysis were performed. RESULTS The Thai version of the MDQ screening had adequate internal consistency (Cronbach's alpha =0.791, omega total =0.68, and omega hierarchical =0.69). The optimal question #1 item threshold value was at least five positive items, which yielded adequate sensitivity (76.5%), specificity (72.7%), positive predictive value (74.3%), and negative predictive value (75.0%). The ROC area under the curve (AUC) for this study was 0.82 (95% confidence interval: 0.70 to 0.90). CONCLUSION The Thai version of the MDQ had some useful psychometric properties for screening for bipolar disorder in a mood disorder clinic setting, with a recommended question #1 item threshold value of at least five positive items.
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Affiliation(s)
- Punjaporn Waleeprakhon
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Manote Lotrakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pattarabhorn Wisajun
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sudawan Jullagate
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Terence A Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Ittasakul P, Archer A, Kezman J, Atsariyasing W, Goldman MB. Rapid Re-challenge with Clozapine Following Pronounced Myocarditis in a Treatment-Resistance Schizophrenia Patient. Clin Schizophr Relat Psychoses 2013:1-11. [PMID: 24047759 DOI: 10.3371/csrp.itar.091313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Clozapine is an atypical antipsychotic which is often effective in patients who fail to respond to other antipsychotics, but its use carries substantial risk. Myocarditis is one of the life-threatening adverse effects which occurs in about 1% of exposed patients. Re-challenge with clozapine is controversial, particularly shortly after the occurrence of the myocarditis and when there is clear and convincing evidence of cardiac damage. Aggressive use of clozapine, however, may be critical for the recovery of patients early in the course of their illness. Here we report a successful case of clozapine rechallenge following an initial aggressive dosage titration in an inpatient setting.
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Affiliation(s)
- Pichai Ittasakul
- Department of Psychiatry, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Ittasakul P, Johnson KR, Srivastava S, Childers ME, Brooks JO, Hoblyn JC, Ketter TA. Effectiveness of quetiapine plus lamotrigine maintenance therapy in challenging bipolar disorder patients. J Affect Disord 2012; 137:139-45. [PMID: 22240084 DOI: 10.1016/j.jad.2011.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 11/15/2011] [Accepted: 12/01/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Assess quetiapine plus lamotrigine (QTP+LTG) combination maintenance therapy effectiveness in challenging bipolar disorder (BD). METHOD Outpatients assessed with the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) Affective Disorders Evaluation and followed with the STEP-BD Clinical Monitoring Form were naturalistically prescribed QTP+LTG. RESULTS Fifty-four outpatients with challenging BD, taking in addition to QTP+LTG, a mean±SD of 2.1±1.6 (in 63.0% at least 2) other psychotropic and 2.3±1.9 non-psychotropic prescription medications, had QTP+LTG maintenance trials. Median(mean±SD) QTP+LTG duration was 401(730±756) days. Final QTP and LTG doses were 87.5(188±211) and 300(287±108) mg/day, respectively. Half (27/54) of patients discontinued QTP (in 19), LTG (in 6), or QTP+LTG (in 2), after 294(415±414) days - due to side-effects in 10, inefficacy in seven, non-adherence in five, and other reasons in five. 42.6%(23/54) had additional pharmacotherapy intervention for emergent mood symptoms, after 175(261±237) days, with at least one psychotropic added (in 16/54) or substantively (by ≥50%) increased (in 7/54). 55.6%(30/54) had recurrent mood episodes, after 126(187±158) days, most often depressive (in 35.2%), although 64.8%(35/54) were euthymic at final visit taking QTP+LTG. Sedation increased significantly during treatment among those with side-effect discontinuations, and 19.2%(10/52, all having QTP added to LTG) had clinically significant (≥7%) weight gain. LIMITATIONS No placebo comparison group. Small sample of predominantly female Caucasian insured outpatients taking complex concurrent medication regimens. CONCLUSION Additional studies are warranted to confirm our preliminary observation that QTP+LTG maintenance may be effective in patients with challenging BD.
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Affiliation(s)
- Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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