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Campion J, Javed A, Lund C, Sartorius N, Saxena S, Marmot M, Allan J, Udomratn P. Public mental health: required actions to address implementation failure in the context of COVID-19. Lancet Psychiatry 2022; 9:169-182. [PMID: 35065723 PMCID: PMC8776278 DOI: 10.1016/s2215-0366(21)00199-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/19/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022]
Abstract
Mental disorders account for at least 18% of global disease burden, and the associated annual global costs are projected to be US$6 trillion by 2030. Evidence-based, cost-effective public mental health (PMH) interventions exist to prevent mental disorders from arising, prevent associated impacts of mental disorders (including through treatment), and promote mental wellbeing and resilience. However, only a small proportion of people with mental disorders receive minimally adequate treatment. Compared with treatment, there is even less coverage of interventions to prevent the associated impacts of mental disorders, prevent mental disorders from arising, or promote mental wellbeing and resilience. This implementation failure breaches the right to health, has increased during the COVID-19 pandemic, and results in preventable suffering, broad impacts, and associated economic costs. In this Health Policy paper, we outline specific actions to improve the coverage of PMH interventions, including PMH needs assessments, collaborative advocacy and leadership, PMH practice to inform policy and implementation, training and improvement of population literacy, settings-based and integrated approaches, use of digital technology, maximising existing resources, focus on high-return interventions, human rights approaches, legislation, and implementation research. Increased interest in PMH in populations and governments since the onset of the COVID-19 pandemic supports these actions. Improved implementation of PMH interventions can result in broad health, social, and economic impacts, even in the short-term, which support the achievement of a range of policy objectives, sustainable economic development, and recovery.
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Affiliation(s)
- Jonathan Campion
- South London and Maudsley NHS Foundation Trust, London, UK; Public Mental Health Implementation Centre, Royal College of Psychiatrists, London, UK.
| | - Afzal Javed
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Shekhar Saxena
- Department of Global Health and Population at the Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Michael Marmot
- Institute of Health Equity, Department of Epidemiology and Public Health, UCL, London, UK
| | - John Allan
- Office of the President, Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia; Mental Health, Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia; Mayne Academy of Psychiatry, University of Queensland Medical School, University of Queensland, Brisbane, QLD, Australia
| | - Pichet Udomratn
- Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Nakagami Y, Hayakawa K, Horinouchi T, Pereira-Sanchez V, Tan MPJ, Park SC, Park YC, Moon SW, Choi TY, Avasthi A, Grover S, Kallivayalil RA, Rai Y, Shalbafan M, Chongsuksiri P, Udomratn P, Kathriarachchi ST, Xiang YT, Sim K, Javed A, Chong MY, Tan CH, Lin SK, Inada T, Murai T, Kanba S, Sartorius N, Shinfuku N, Kato TA. A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists. Psychiatry Investig 2021; 18:1058-1067. [PMID: 34732030 PMCID: PMC8600221 DOI: 10.30773/pi.2021.0169] [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: 05/27/2021] [Accepted: 07/02/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists' attitude toward polypharmacy has been under debate. METHODS We developed an original questionnaire about Psychiatrists' attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide. RESULTS The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively). CONCLUSION Policy on polypharmacy may influence psychiatrists' decision-making. Thus, policies considering rational polypharmacy should be established.
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Affiliation(s)
- Yukako Nakagami
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Preventive Services, School of Public Health/Medicine and Medical Science, Kyoto University, Kyoto, Japan
| | - Kohei Hayakawa
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toru Horinouchi
- Department of Neuroscience, Trafford Centre for Medical Research, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Victor Pereira-Sanchez
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, USA
| | - Marcus P J Tan
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Seon-Cheol Park
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Yong Chon Park
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Seok Woo Moon
- Department of Psychiatry, Konkuk University Chungju Hospital, Institute of Medical Science, Chungju, Republic of Korea
| | - Tae Young Choi
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Yugesh Rai
- Essex Partnership University Trust, Colchester, UK
| | | | | | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Samudra T Kathriarachchi
- Department of Psychiatry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, University of Macau, Macao SAR, China
| | - Kang Sim
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung & Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Chay-Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | - Shih-Ku Lin
- Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Toshiya Inada
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Toshiya Murai
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Naotaka Shinfuku
- Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Tang CT, Chua EC, Chew QH, He YL, Si TM, Chiu HFK, Xiang YT, Kato TA, Kanba S, Shinfuku N, Lee MS, Park SC, Park YC, Chong MY, Lin SK, Yang SY, Tripathi A, Avasthi A, Grover S, Kallivayalil RA, Udomratn P, Chee KY, Tanra AJ, Rabbani MG, Javed A, Kathiarachchi S, Waas D, Myint WA, Sartorius N, Tran VC, Nguyen KV, Tan CH, Baldessarini RJ, Sim K. Patterns of long acting injectable antipsychotic use and associated clinical factors in schizophrenia among 15 Asian countries and region. Asia Pac Psychiatry 2020; 12:e12393. [PMID: 32468725 DOI: 10.1111/appy.12393] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 04/05/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Patterns of clinical use of long-acting injectable (LAI) antipsychotic drugs in many countries, especially in Asia, for treatment of patients diagnosed with chronic psychotic disorders including schizophrenia are not well established. METHODS Within an extensive research consortium, we evaluated prescription rates for first- (FGA) and second-generation antipsychotic (SGA) LAI drugs and their clinical correlates among 3557 subjects diagnosed with schizophrenia across 15 Asian countries and region. RESULTS Overall, an average of 17.9% (638/3557; range: 0.0%-44.9%) of treated subjects were prescribed LAI antipsychotics. Those given LAI vs orally administered agents were significantly older, had multiple hospitalizations, received multiple antipsychotics more often, at 32.4% higher doses, were more likely to manifest disorganized behavior or aggression, had somewhat superior psychosocial functioning and less negative symptoms, but were more likely to be hospitalized, with higher BMI, and more tremor. Being prescribed an FGA vs SGA LAI agent was associated with male sex, aggression, disorganization, hospitalization, multiple antipsychotics, higher doses, with similar risks of adverse neurological or metabolic effects. Rates of use of LAI antipsychotic drugs to treat patients diagnosed with schizophrenia varied by more than 40-fold among Asian countries and given to an average of 17.9% of treated schizophrenia patients. We identified the differences in the clinical profiles and treatment characteristics of patients who were receiving FGA-LAI and SGA-LAI medications. DISCUSSION These findings behoove clinicians to be mindful when evaluating patients' need to be on LAI antipsychotics amidst multifaceted considerations, especially downstream adverse events such as metabolic and extrapyramidal side effects.
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Affiliation(s)
- Chao Tian Tang
- Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| | - Ee Cheong Chua
- Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| | - Qian Hui Chew
- Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
| | - Yan-Ling He
- Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China
| | - Tian-Mei Si
- Institute of Mental Health, Peking University, Beijing, China
| | - Helen F-K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu-Tao Xiang
- Centre for Cognition and Brain Sciences, University of Macau, Macao SAR, China
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | | | - Min-Soo Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, South Korea
| | - Seon-Cheol Park
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Yong-Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, South Korea
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaoshiung Chang Gung Memorial Hospital and Chang Gung University School of Medicine, Kaohsiung, Taiwan
| | - Shih-Ku Lin
- Department of Pharmacy, Taipei City Hospital and Fu Jen University, Taipei, Taiwan
| | - Shu-Yu Yang
- Department of Pharmacy, Taipei City Hospital and Fu Jen University, Taipei, Taiwan
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, India
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kok Yoon Chee
- Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur, Malaysia
| | - Andi J Tanra
- Department of Psychiatry, Hasanuddin University Faculty of Medicine, Makassar, Indonesia
| | | | - Afzal Javed
- Pakistan Psychiatric Research Center, Fountain House, Lahore, Pakistan
| | | | - Dulshika Waas
- Department of Psychiatry, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Wing Aung Myint
- Mental Health Society, Myanmar Medical Association, Yangon, Myanmar
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Van Cuong Tran
- Vietnam Psychiatric Association (VPA), Thuong Tin, Hanoi, Vietnam
| | - Kim Viet Nguyen
- Vietnam Psychiatric Association (VPA), Thuong Tin, Hanoi, Vietnam
| | - Chay-Hoon Tan
- Department of Pharmacology, National University Hospital, Singapore, Singapore
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Kang Sim
- Institute of Mental Health, Buangkok Green Medical Park, Singapore, Singapore
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Lim WK, Chew QH, He YL, Si TM, Chiu FKH, Xiang YT, Kato TA, Kanba S, Shinfuku N, Lee MS, Park SC, Park YC, Chong MY, Lin SK, Yang SY, Tripathi A, Avasthi A, Grover S, Kallivayalil RA, Udomratn P, Chee KY, Tanra AJ, Rabbani MG, Javed A, Kathiarachchi S, Waas D, Myint WA, Sartorius N, Tran VC, Nguyen KV, Tan CH, Baldessarini RJ, Sim K. Coprescription of mood stabilizers in schizophrenia, dosing, and clinical correlates: An international study. Hum Psychopharmacol 2020; 35:1-7. [PMID: 32738085 DOI: 10.1002/hup.2752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/06/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Studies examining coprescription and dosages of mood stabilizers (MSs) with antipsychotics for psychotic disorders are infrequent. Based on sparse extant data and clinical experience, we hypothesized that adjunctive MS use would be associated with certain demographic (e.g., younger age), clinical factors (e.g., longer illness duration), and characteristics of antipsychotic treatment (e.g., multiple or high antipsychotic doses). METHODS Within an Asian research consortium focusing on pharmaco-epidemiological factors in schizophrenia, we evaluated rates of MS coprescription, including high doses (>1000 mg/day lithium-equivalents) and clinical correlates. RESULTS Among 3557 subjects diagnosed with schizophrenia in 14 Asian countries, MSs were coprescribed with antipsychotics in 13.6% (n = 485) of the sample, with 10.9% (n = 53) on a high dose. Adjunctive MS treatment was associated (all p < 0.005) with demographic (female sex and younger age), setting (country and hospitalization), illness (longer duration, more hospitalizations, non-remission of illness, behavioral disorganization, aggression, affective symptoms, and social-occupational dysfunction), and treatment-related factors (higher antipsychotic dose, multiple antipsychotics, higher body mass index, and greater sedation). Patients given high doses of MSs had a less favorable illness course, more behavioral disorganization, poorer functioning, and higher antipsychotic doses. CONCLUSIONS Schizophrenia patients receiving adjunctive MS treatment in Asian psychiatric centers are more severely ill and less responsive to simpler treatment regimens.
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Affiliation(s)
| | | | - Yan-Ling He
- Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China
| | - Tian-Mei Si
- Institute of Mental Health, Peking University, Beijing, China
| | | | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macau, China
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | | | - Min-Soo Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, South Korea
| | - Seon-Cheol Park
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Yong-Chon Park
- Department of Psychiatry, Hanyang University, Seoul, South Korea
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaoshiung Chang Gung Memorial Hospital and Chang Gung University School of Medicine, Kaohsiung, Taiwan
| | - Shih-Ku Lin
- Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Shu-Yu Yang
- Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kok Yoon Chee
- Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur, Malaysia
| | - Andi J Tanra
- Department of Psychiatry, Hasanuddin University Faculty of Medicine, Makassar, Indonesia
| | | | - Afzal Javed
- Pakistan Psychiatric Research Center, Fountain House, Lahore, Pakistan
| | | | - Dulshika Waas
- Department of Psychiatry, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Wing Aung Myint
- Mental Health Society, Myanmar Medical Association, Yangon, Myanmar
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | | | | | - Chay-Hoon Tan
- Department of Pharmacology, National University Hospital, Singapore, Singapore
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Kang Sim
- Institute of Mental Health, Singapore, Singapore
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Park SC, Jang EY, Xiang YT, Kanba S, Kato TA, Chong MY, Lin SK, Yang SY, Avasthi A, Grover S, Kallivayalil RA, Udomratn P, Chee KY, Tanra AJ, Tan CH, Sim K, Sartorius N, Park YC, Shinfuku N. Network analysis of the depressive symptom profiles in Asian patients with depressive disorders: Findings from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD). Psychiatry Clin Neurosci 2020; 74:344-353. [PMID: 32048773 PMCID: PMC7318233 DOI: 10.1111/pcn.12989] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/13/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 12/13/2022]
Abstract
AIM We aimed to estimate the network structures of depressive symptoms using network analysis and evaluated the geographic regional differences in theses network structures among Asian patients with depressive disorders. METHODS Using data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD), the network of the ICD-10 diagnostic criteria for depressive episode was estimated from 1174 Asian patients with depressive disorders. The node strength centrality of all ICD-10 diagnostic criteria for a depressive episode was estimated using a community-detection algorithm. In addition, networks of depressive symptoms were estimated separately among East Asian patients and South or Southeast Asian patients. Moreover, networks were estimated separately among Asian patients from high-income countries and those from middle-income countries. RESULTS Persistent sadness, fatigue, and loss of interest were the most centrally situated within the network of depressive symptoms in Asian patients with depressive disorders overall. A community-detection algorithm estimated that when excluding psychomotor disturbance as an outlier, the other nine symptoms formed the largest clinically meaningful cluster. Geographic and economic variations in networks of depressive symptoms were evaluated. CONCLUSION Our findings demonstrated that the typical symptoms of the ICD-10 diagnostic criteria for depressive episode are the most centrally situated within the network of depressive symptoms. Furthermore, our findings suggested that cultural influences related to geographic and economic distributions of participants could influence the estimated depressive symptom network in Asian patients with depressive disorders.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Eun Young Jang
- Department of Counseling Psychology, Honam University College of Humanities and Social Sciences, Gwangju, Republic of Korea
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macau, China
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung & Chang Gung University School of Medicine, Linkou, Taiwan
| | - Shih-Ku Lin
- Psychiatry Center, Tapei City Hospital, Taipei, Taiwan
| | - Shu-Yu Yang
- Department of Pharmacy, Taipei City Hospital and Fu Jen University, Taipei, Taiwan
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kok Yoon Chee
- Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur, Malaysia
| | - Andi J Tanra
- Faculty of Medicine, Department of Psychiatry, Hasanuddin University, Makassar, Indonesia
| | - Chay-Hoon Tan
- Department of Pharmacology, National University Hospital, Singapore
| | - Kang Sim
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Yong Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Naotaka Shinfuku
- Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
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Oon-Arom A, Likhitsathian S, Maneeton B, Sulaiman AH, Shih-Yen EC, Udomratn P, Chen CH, Srisurapanont M. Subjective depressive symptoms associated with pain in patients with major depressive disorder: Findings from the study on the aspect of Asian depression. Perspect Psychiatr Care 2020; 56:188-193. [PMID: 31148197 DOI: 10.1111/ppc.12403] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/04/2019] [Accepted: 05/14/2019] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To examine subjective depressive symptoms associated with physical pain symptoms (PPSs) in Asian patients with major depressive disorder (MDD). DESIGN AND METHODS Four PPSs, including headache, chest pain, low back pain, and muscle pain, and subjective depressive symptoms were assessed using the Symptom Checklist-90-Revised. FINDINGS Out of 528 participants, 390 (73.9%) had at least one PPS. After adjusting for sex, depression severity, disability, fatigue, physical health status, and mental health status, PPSs were found to be associated with crying easily, blaming oneself, feeling lonely, feeling blue, and worrying too much. PRACTICAL IMPLICATIONS Almost three-quarters of Asian patients with MDD experience PPSs. PPSs are associated with some subjective feelings of depression.
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Affiliation(s)
- Awirut Oon-Arom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Edwin Chan Shih-Yen
- Singapore Clinical Research Institute, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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7
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Dong M, Zeng LN, Zhang Q, Ungvari GS, Ng CH, Chiu HFK, Si TM, Sim K, Avasthi A, Grover S, Chong MY, Chee KY, Kanba S, Lee MS, Yang SY, Udomratn P, Kallivayalil RA, Tanra AJ, Maramis MM, Shen WW, Sartorius N, Mahendran R, Tan CH, Shinfuku N, Xiang YT. Concurrent antipsychotic use in older adults treated with antidepressants in Asia. Psychogeriatrics 2019; 19:333-339. [PMID: 30734411 DOI: 10.1111/psyg.12416] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/15/2018] [Accepted: 12/24/2018] [Indexed: 12/23/2022]
Abstract
AIM Depressive disorders are common in old age. Antipsychotics (APs) are often used as an adjunctive treatment with antidepressants (ADs) in this population but its patterns of use in Asia are not known. This study explored the rate of combination of APs and ADs in older adult psychiatric patients in Asia. METHODS This is a secondary analysis of the database of a multicentre study which recorded participants' basic demographical and clinical data in standardised format in 10 Asian countries and territories. The data were analysed using univariate and multivariate logistic regression analyses. RESULTS A total of 955 older adult psychiatric in- and outpatients were included in this study. The proportion of concurrent AP and AD use was 32.0%, ranging from 23.3% in Korea to 44.0% in Taiwan. Multivariate logistic regression analysis found that younger age, inpatient status and diagnosis of schizophrenia, anxiety and other mental disorders were significantly related to a higher proportion of concurrent use of APs and ADs. CONCLUSION Around a third of older adult psychiatric patients had concurrent AP and AD use in the Asian countries/regions surveyed. Considering the uncertain effectiveness and questionable safety of the AP and AD combination in this patient population, such should be cautiously used.
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Affiliation(s)
- Min Dong
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Liang-Nan Zeng
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders, China & Center of Depression, Beijing Institute for Brain Disorders & Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia.,Division of Psychiatry, School Medicine, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Tian-Mei Si
- Peking University Institute of Mental Health (the sixth Hospital) & National Clinical Research Center for Mental Disorders & the key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Kang Sim
- Institute of Mental Health, Singapore, Singapore
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mian-Yoon Chong
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi & Chang Gung University, Taoyuan, Taiwan
| | - Kok-Yoon Chee
- Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
| | - Min-Soo Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea
| | - Shu-Yu Yang
- Department of Pharmacy, Songde Branch, Taipei City Hospital, & College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, India
| | - Andi J Tanra
- Department of Psychiatry, Hasanuddin University Faculty of Medicine, Makassar, Indonesia
| | - Margarita M Maramis
- Dr. Soetomo Hospital - Faculty of Medicine, Airlangga University, Surabaya, Jawa Timur, Indonesia
| | - Winston W Shen
- Departments of Psychiatry, TMU-Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Rathi Mahendran
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Chay-Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Naotaka Shinfuku
- International Center for Medical Research, Kobe University School of Medicine, Kobe, Japan
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
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8
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Sun Y, Chen G, Wang L, Li N, Srisurapanont M, Hong JP, Hatim A, Chen CH, Udomratn P, Bae JN, Fang YR, Chua HC, Liu SI, George T, Bautista D, Chan E, Rush AJ, Yang H, Su YA, Si TM. Perception of Stigma and Its Associated Factors Among Patients With Major Depressive Disorder: A Multicenter Survey From an Asian Population. Front Psychiatry 2019; 10:321. [PMID: 31156476 PMCID: PMC6529583 DOI: 10.3389/fpsyt.2019.00321] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 05/05/2018] [Accepted: 04/25/2019] [Indexed: 01/22/2023] Open
Abstract
Stigma of major depressive disorder (MDD) is an important public health problem. This study aimed to examine the level of perceived stigma and its associated factors in MDD patients in five Asian countries, including China, Korea, Malaysia, Singapore, and Thailand. A total of 547 outpatients with MDD were included from Asian countries. We used the stigma scale of the Explanatory Model Interview Catalogue (EMIC) to assess stigma. The Montgomery-Asberg Depression Rating Scale (MADRS), Symptoms Checklist 90-Revised (SCL-90-R), Fatigue Severity Scale (FSS), Sheehan Disability Scale (SDS), 36-Item Short-Form Health Survey (SF-36), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess symptoms, clinical features, functional impairment, health status, and social support. The stigma scores of patients under 55 years old were significantly higher than those equal to or greater than 55 years old (P < 0.001). The stigma scores exhibited significant negative correlation with age; MSPSS scores of family, friends, and others; and SF-36 subscale of mental health, but significant positive correlation with MADRS, FSS, SDS, and SCL-90-R subscale scores of depression, interpersonal sensitivity, obsession-compulsion, psychoticism, and somatization. Multivariate regression analysis revealed that age, SCL-90-R interpersonal sensitivity, obsession-compulsion, psychoticism, MSPSS scores of friends and others, and SF-36 of mental health were significantly associated with the level of perceived stigma. These findings suggest that MDD patients who are young, have a high degree of interpersonal sensitivity and psychoticism, have low health-related quality of life, and have low social support are the target population for stigma interventions in Asia.
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Affiliation(s)
- Yan Sun
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
- Department of Psychiatry, Shanxi Dayi Hospital, Taiyuan, China
| | - Gang Chen
- Department of Psychiatry, Huai’an No.3 People’s Hospital, Jiangsu, China
| | - Li Wang
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Nan Li
- Department of Epidemiology, Peking University Third Hospital, Beijing, China
| | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Muang, Thailand
| | - Jin Pyo Hong
- Department of Psychiatry, University of Ulsan College of Medicine, Asian Medical Center, Seoul, South Korea
| | - Ahmad Hatim
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chia-hui Chen
- Department of Psychiatry, Chang Gung Medical Center and Chang Gung University, Tao-Yuan, Taiwan
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jae Nam Bae
- Department of Psychiatry, Faculty of Medicine, Inha University Hospital, Incheon, South Korea
| | - Yi-Ru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Choon Chua
- Institute of Mental Health, Woodbridge Hospital, Singapore, Singapore
| | - Shen-Ing Liu
- Department of Psychiatry, Faculty of Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tom George
- North West Specialist Centre, Everton Park, QLD, Australia
| | - Dianne Bautista
- Singapore Clinical Research Institute, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Edwin Chan
- Singapore Clinical Research Institute, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - A. John Rush
- Singapore Clinical Research Institute, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Hong Yang
- Department of Psychiatry, Shanxi Dayi Hospital, Taiyuan, China
| | - Yun-Ai Su
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Tian-Mei Si
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
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9
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Reed GM, First MB, Kogan CS, Hyman SE, Gureje O, Gaebel W, Maj M, Stein DJ, Maercker A, Tyrer P, Claudino A, Garralda E, Salvador‐Carulla L, Ray R, Saunders JB, Dua T, Poznyak V, Medina‐Mora ME, Pike KM, Ayuso‐Mateos JL, Kanba S, Keeley JW, Khoury B, Krasnov VN, Kulygina M, Lovell AM, de Jesus Mari J, Maruta T, Matsumoto C, Rebello TJ, Roberts MC, Robles R, Sharan P, Zhao M, Jablensky A, Udomratn P, Rahimi‐Movaghar A, Rydelius P, Bährer‐Kohler S, Watts AD, Saxena S. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 2019; 18:3-19. [PMID: 30600616 PMCID: PMC6313247 DOI: 10.1002/wps.20611] [Citation(s) in RCA: 292] [Impact Index Per Article: 58.4] [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] [Indexed: 12/12/2022] Open
Abstract
Following approval of the ICD-11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD-10 to the ICD-11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders following ICD-11's approval. The development of the ICD-11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD-11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture-related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery-based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, and the development of two new ICD-11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD-11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD-11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.
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Affiliation(s)
- Geoffrey M. Reed
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland,Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA
| | - Michael B. First
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA,New York State Psychiatric InstituteNew YorkNYUSA
| | - Cary S. Kogan
- School of PsychologyUniversity of OttawaOttawaONCanada
| | - Steven E. Hyman
- Stanley Center for Psychiatric ResearchBroad Institute of Harvard and Massachusetts Institute of TechnologyCambridgeMAUSA
| | - Oye Gureje
- Department of PsychiatryUniversity of IbadanIbadanNigeria
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical FacultyHeinrich‐Heine UniversityDüsseldorfGermany
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
| | - Dan J. Stein
- Department of PsychiatryUniversity of Cape Town, and South African Medical Research Council Unit on Risk and Resilience in Mental DisordersCape TownSouth Africa
| | | | - Peter Tyrer
- Centre for Mental HealthImperial CollegeLondonUK
| | - Angelica Claudino
- Department of PsychiatryUniversidade Federal de São Paulo (UNIFESP/EPM)São PauloBrazil
| | | | - Luis Salvador‐Carulla
- Research School of Population HealthAustralian National UniversityCanberraACTAustralia
| | - Rajat Ray
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - John B. Saunders
- Centre for Youth Substance Abuse ResearchUniversity of QueenslandBrisbaneQLDAustralia
| | - Tarun Dua
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
| | - Vladimir Poznyak
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
| | | | - Kathleen M. Pike
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA
| | - José L. Ayuso‐Mateos
- Department of PsychiatryUniversidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La PrincesaMadridSpain
| | | | - Jared W. Keeley
- Department of PsychologyVirginia Commonwealth UniversityRichmondVAUSA
| | - Brigitte Khoury
- Department of PsychiatryAmerican University of Beirut Medical CenterBeirutLebanon
| | - Valery N. Krasnov
- Moscow Research Institute of PsychiatryNational Medical Research Centre for Psychiatry and NarcologyMoscowRussian Federation
| | - Maya Kulygina
- Moscow Research Institute of PsychiatryNational Medical Research Centre for Psychiatry and NarcologyMoscowRussian Federation
| | - Anne M. Lovell
- Institut National de la Santé et de la Recherche Médicale U988ParisFrance
| | - Jair de Jesus Mari
- Department of PsychiatryUniversidade Federal de São Paulo (UNIFESP/EPM)São PauloBrazil
| | | | | | - Tahilia J. Rebello
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA,New York State Psychiatric InstituteNew YorkNYUSA
| | - Michael C. Roberts
- Office of Graduate Studies and Clinical Child Psychology ProgramUniversity of KansasLawrenceKSUSA
| | - Rebeca Robles
- National Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | - Pratap Sharan
- Department of PsychiatryAll India Institute of Medical SciencesNew DelhiIndia
| | - Min Zhao
- Shanghai Mental Health Center and Department of PsychiatryShanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Assen Jablensky
- Centre for Clinical Research in NeuropsychiatryUniversity of Western AustraliaPerthWAAustralia
| | - Pichet Udomratn
- Department of PsychiatryPrince of Songkla UniversityHat YaiThailand
| | - Afarin Rahimi‐Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical SciencesTehranIran
| | - Per‐Anders Rydelius
- Department of Child and Adolescent PsychiatryKarolinska InstituteStockholmSweden
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10
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Park YC, Lee MS, Si TM, Chiu HF, Kanba S, Chong MY, Tripathi A, Udomratn P, Chee KY, Tanra AJ, Rabbani G, Javed A, Kathiarachchi S, Myint WA, Cuong TV, Sim K, Yang SY, Sartorius N, Tan CH, Shinfuku N, Park SC. Psychotropic drug-prescribing correlates of disorganized speech in Asians with schizophrenia: The REAP-AP study. Saudi Pharm J 2019; 27:246-253. [PMID: 30766437 PMCID: PMC6362172 DOI: 10.1016/j.jsps.2018.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 11/12/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Although disorganized speech is seen as one of the nuclear features of schizophrenia, there have been few reports of disorganized speech-associated psychotropic drug-prescribing patterns in large samples of schizophrenia patients. OBJECTIVE We aimed to examine the prevalence of disorganized speech and its correlates in terms of psychotropic drug prescribing, using the data from the Research on Asian Psychotropic Patterns for Antipsychotics (REAP-AP) study. METHOD A total of 3744 patients with the ICD-10 diagnosis of schizophrenia were enrolled from 71 survey centers in 15 Asian countries/areas. An essential criterion of disorganized speech was that it was "severe enough to impair substantially effective communication" as defined in the DSM-5. A binary logistic model was fitted to identify the psychotropic drug-prescribing correlates of disorganized speech. RESULTS After adjusting for the potential effects of confounding variables, the binary logistic regression model showed that the presence of disorganized speech was directly associated with adjunctive use of mood stabilizers (P < 0.001) and cumulative diazepam equivalent dose (P < 0.0001), and inversely associated with adjunctive use of anti-Parkinson drugs (P < 0.0001). CONCLUSION The association between disorganized speech and adjunctive use of mood stabilizers could perhaps be understood in the context of a relationship with impulsiveness/aggressiveness, or in terms of deconstructing the Kraepelinian dualism.
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Affiliation(s)
- Yong Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Min-Soo Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Tian-Mei Si
- Institute of Mental Health, Peking University, Beijing, China
| | - Helen F.K. Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
| | - Mian-Yoon Chong
- Chang Gung Memorial Hospital, Chiayi, and Chang Gung University School of Medicine, Taiwan
| | - Adarsh Tripathi
- Department of Psychiatry, King George’s Medical University, Chowk, Lucknow, India
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkhla University, Songkhla, Thailand
| | - Kok Yoon Chee
- Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Andi J. Tanra
- Wahidin Sudirohusodo University, Makassar, Sulawesi Selatan, Indonesia
| | - Golam Rabbani
- National Institute of Mental Health, Dhaka, Bangladesh
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | | | - Win Aung Myint
- Department of Mental Health, University of Medicine (1), Yangon, Myanmar
| | | | - Kang Sim
- Institute of Mental Health, Singapore, Singapore
| | - Shu-yu Yang
- Deparment of Pharmacy, Songde Branch, Tapei City Hospital, Tapei, Taiwan
| | - Norman Sartorius
- Association of the Improvement of Mental Health Programs, Geneva, Switzerland
| | - Chay-Hoon Tan
- Department of Pharmacology, National University Hospital, Singapore, Singapore
| | - Naotaka Shinfuku
- Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Seon-Cheol Park
- Department of Psychiatry, Inje University College of Medicine and Haeundae Paik Hospital, Busan, Republic of Korea
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11
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Zhong XM, Dong M, Wang F, Zhang Q, Ungvari GS, Ng CH, Chiu HFK, Si TM, Sim K, Avasthi A, Grover S, Chong MY, Chee KY, Kanba S, Lee MS, Yang SY, Udomratn P, Kallivayalil RA, Tanra AJ, Maramis MM, Shen WW, Sartorius N, Mahendran R, Tan CH, Shinfuku N, Xiang YT. Physical comorbidities in older adults receiving antidepressants in Asia. Psychogeriatrics 2018; 18:351-356. [PMID: 29989257 DOI: 10.1111/psyg.12327] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/20/2017] [Accepted: 02/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The present study explored the patterns of physical comorbidities and their associated demographic and clinical factors in older psychiatric patients prescribed with antidepressants in Asia. METHODS Demographic and clinical information of 955 older adults were extracted from the database of the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) project. Standardized data collection procedure was used to record demographic and clinical data. RESULTS Proportion of physical comorbidities in this cohort was 44%. Multiple logistic regression analyses showed that older age (OR = 1.7, P < 0.001), higher number of depressive symptoms (OR = 1.09, P = 0.016), being treated in psychiatric hospital (OR = 0.5, P = 0.002), living in high income countries/territories (OR = 2.4, P = 0.002), use of benzodiazepines (OR = 1.4, P = 0.013) and diagnosis of 'other psychiatric disorders' (except mood, anxiety disorders and schizophrenia) (OR = 2.7, P < 0.001) were significantly associated with physical comorbidities. CONCLUSIONS Physical comorbidities in older patients prescribed with antidepressants were common in Asia. Integrating physical care into the treatment of older psychiatric patients should be urgently considered.
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Affiliation(s)
- Xiao-Mei Zhong
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Hui Hospital), Guangzhou, China.,Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Min Dong
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Fei Wang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia / Graylands Hospital, Perth, Victoria, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Tian-Mei Si
- Peking University Institute of Mental Health (the sixth Hospital) & National Clinical Research Center for Mental Disorders & the key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Kang Sim
- Institute of Mental Health, Buangkok View, Buangkok Green Medical Park, Singapore
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Center and School of Medicine, Chang Gung University, Taiwan
| | - Kok-Yoon Chee
- Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
| | - Min-Soo Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea
| | - Shu-Yu Yang
- Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, India
| | - Andi J Tanra
- Department of Psychiatry, Hasanuddin University Faculty of Medicine, Makassar, Sulawesi Selatan, Indonesia
| | - Margarita M Maramis
- Dr. Soetomo Hospital - Faculty of Medicine, Universitas Airlangga, Surabaya, Jawa Timur, Indonesia
| | - Winston W Shen
- Departments of Psychiatry, TMU-Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Rathi Mahendran
- Departments of Psychological Medicine, National University of Singapore, Singapore
| | - Chay-Hoon Tan
- Departments of Pharmacology, National University of Singapore, Singapore
| | - Naotaka Shinfuku
- International Center for Medical Research, Kobe University School of Medicine, Kobe, Japan
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
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12
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Park SC, Lee MS, Hahn SW, Kanba S, Chong MY, Chee KY, Udomratn P, Tripathi A, Sartorius N, Shinfuku N, Tanra AJ, Park YC. Clinical Characteristics and Psychotropic Prescribing Patterns Associated with impaired Concentration in Asians with Depressive Disorders: The REAP-AD Study. TOHOKU J EXP MED 2018. [PMID: 28637942 DOI: 10.1620/tjem.242.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) study aimed to survey and review antidepressant prescribing patterns in different clinical settings in Asian countries/areas. The REAP-AD study collected comprehensive data for psychiatric patients prescribed antidepressants in 10 Asian countries/areas during the period from March to June 2013. Depressive disorders have been an important issue closely associated with ill-health and disability in the realm of mental health. Impaired concentration was found to be a consistent symptom in depressive disorders regardless of clinical course, and a predictor of poor treatment outcome. In this work we aimed to identify clinical characteristics independently associated with impaired concentration in patients with depressive disorders, using data from the REAP-AD study. A total of 336 depressive disorder patients with impaired concentration and 786 depressive disorder patients without impaired concentration were recruited from 40 centers in 10 Asian countries/areas. A binary logistic regression model was fitted to identify the independent correlates of impaired concentration in patients with depressive disorders. After adjusting the effects of covariates, the binary logistic model showed that impaired concentration was independently associated with higher rates of loss of interest (P < 0.0001), fatigue (P < 0.0001), low self-confidence (P < 0.0001) and appetite disturbance (P < 0.0001) and with a lower rate of adjunctive antipsychotic prescription (P = 0.007). Our findings suggest that impaired concentration and its associated depressive symptom profiles constitute a unitary depressive symptom cluster that is also an intervening variable for poor social function.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Inje University College of Medicine and Haeundae Paik Hospital
| | - Min-Soo Lee
- Department of Psychiatry, Korea University College of Medicine
| | - Sang Woo Hahn
- Department of Psychiatry, Soonchunhyang University Seoul Hospital
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University
| | - Mian-Yoon Chong
- Chang Gung Memorial Hospital, Chiayi, and Chang Gung University School of Medicine
| | - Kok Yoon Chee
- Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University
| | | | | | - Naotaka Shinfuku
- Department of Social Welfare, School of Human Sciences, Seinan Gakuin University
| | - Andi J Tanra
- Department of Psychiatry, Hasanuddin University Faculty of Medicine
| | - Yong Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital
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13
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Abstract
In Thailand, we have only two programmes for residency training in psychiatry: one is general or adult psychiatry, which takes 3 years to complete; the other is child and adolescent psychiatry, which takes 4 years. There are nine institutes that offer residency training but only three medical schools have the capacity to offer training in both general and child psychiatry (Table 1).
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14
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Abstract
Thailand is located in Southeast Asia and covers an area of 513 115 km2. In 2006 its population was approximately 64 million. The major nationality is Thai. About 80% of the total population live in rural areas. The country is composed of 76 provinces, divided into a total of 94 districts and 7159 sub-districts.
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15
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Wang YY, Xiang YT, Ungvari GS, Ng CH, Chiu HFK, Yim LCL, Si TM, Chee KY, Avasthi A, Grover S, Chong MY, Sim K, Kanba S, He YL, Lee MS, Yang SY, Udomratn P, Kallivayalil RA, Tanra AJ, Maramis MM, Shen WW, Sartorius N, Mahendran R, Teng JY, Tan CH, Shinfuku N. A comparison of clinical characteristics of older adults treated with antidepressants in general and psychiatric hospitals in Asia. Psychogeriatrics 2017; 17:348-355. [PMID: 28429844 DOI: 10.1111/psyg.12243] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/03/2016] [Accepted: 11/30/2016] [Indexed: 11/28/2022]
Abstract
AIM This study compared the demographics, clinical characteristics, and antidepressant prescription patterns between Asian patients aged 50 years and older attending psychiatric hospitals and those attending general hospitals. METHODS In total, 955 patients (604 in general hospitals, 351 in psychiatric hospitals) aged 50 years or older treated with antidepressants in 10 Asian countries and territories were examined. Patients' demographics, clinical features, and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure. RESULTS Binary logistic regression revealed that high income and diagnosis of schizophrenia were independently associated with psychiatric hospital treatment, whereas outpatient care, diagnosis of anxiety disorders, and multiple major medical conditions were independently associated with general hospital treatment. In addition, tetracyclic and noradrenergic and specific serotonergic antidepressants were more likely to be prescribed in general hospitals. CONCLUSION Older adults treated with antidepressants showed different demographic and clinical features between general hospitals and psychiatric hospitals in Asia.
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Affiliation(s)
- Yuan-Yuan Wang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Taipa, Macau.,Department of Psychiatry, Faculty of Public Health, Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Gabor S Ungvari
- Department of Psychiatry, The University of Notre Dame Australia / Marian Centre, Perth, Western Australia, Australia.,Faculty of Medicine, Dentistry and Health, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
| | - Larina C L Yim
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
| | - Tian-Mei Si
- Department of Psychiatry, The Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders, Peking University Institute of Mental Health (The Sixth Hospital), Ministry of Health (Peking University), Beijing, China
| | - Kok-Yoon Chee
- Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Center and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kang Sim
- Department of General Psychiatry, Institute of Mental Health, Singapore
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
| | - Yan-Ling He
- Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China
| | - Min-Soo Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea
| | - Shu-Yu Yang
- Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla, India
| | - Andi J Tanra
- Faculty of Medicine, Department of Psychiatry, Hasanuddin University, Makassar, Indonesia
| | - Margarita M Maramis
- Department of Psychiatry, Faculty of Medicine, Dr Soetomo Hospital, Airlangga University, Surabaya, Indonesia
| | - Winston W Shen
- Department of Psychiatry, TMU-Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Rathi Mahendran
- Department of General Psychiatry, Department of Psychological Medicine, National University of Singapore, Singapore
| | - Jia-Ying Teng
- Department of General Psychiatry, Department of Psychological Medicine, National University of Singapore, Singapore
| | - Chay-Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | - Naotaka Shinfuku
- International Center for Medical Research, Kobe University School of Medicine, Kobe, Japan
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16
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Maneeton N, Suttajit S, Maneeton B, Likhitsathian S, Eurviyanukul K, Udomratn P, Chan ESY, Si TM, Sulaiman AH, Chen CH, Bautista D, Srisurapanont M. Clinical and socio-demographic correlates of anxious distress in Asian outpatients with major depressive disorder. Nord J Psychiatry 2017. [PMID: 28632428 DOI: 10.1080/08039488.2017.1335344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND Anxious distress in major depressive disorder (MDD) is common and associated with poor outcomes and management difficulties. AIMS This post hoc analysis aimed to examine the socio-demographic and clinical correlates of anxiety distress in Asian outpatients with MDD. METHODS Instead of two out of five specifiers defined by the Diagnostic and Statistical Manual Version-5, anxious distress defined in this study was operationalized as the presence of at least two out of four proxy items drawn from the 90-item Symptom Checklist, Revised (SCL-90-R). Other measures included the Montgomery-Asberg Depression Rating Scale (MADRS), the Fatigue Severity Scale, the Sheehan Disability Scale and the Multidimensional Scale of Perceived Social Support. RESULTS The data of 496 patients with MDD were included. Anxious distress was found in 371 participants (74.8%). The binary logistic regression analysis found that anxious distress was independently and significantly correlated with working status, higher MADRS scores, severe insomnia and functional impairment. CONCLUSIONS Three-fourths of Asian patients with MDD in tertiary care settings may have DSM-5 anxious distress of at least moderate distress. Its prevalence may vary among working groups. The specifier was associated with greater depressive symptom severity, severe insomnia and functional impairment.
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Affiliation(s)
- Narong Maneeton
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Sirijit Suttajit
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Benchalak Maneeton
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Surinporn Likhitsathian
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Kanokkwan Eurviyanukul
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Pichet Udomratn
- b Department of Psychiatry, Faculty of Medicine , Prince of Songkla University , Songkhla , Thailand
| | | | - Tian-Mei Si
- d National Clinical Research Center for Mental Disorders and the Key Laboratory of Mental Health , Ministry of Health (Peking University) , Beijing , China.,e Peking University Institute of Mental Health (The Sixth Hospital) , Beijing , China
| | - Ahmad Hatim Sulaiman
- f Department of Psychological Medicine, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Chia-Hui Chen
- g Department of Psychiatry , Taipei Medical University Shuang-Ho Hospital , Taipei , Taiwan
| | - Dianne Bautista
- c Singapore Clinical Research Institute , Singapore.,h Duke-NUS Medical School , Singapore
| | - Manit Srisurapanont
- a Department of Psychiatry, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
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17
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Bhugra D, Tasman A, Pathare S, Priebe S, Smith S, Torous J, Arbuckle MR, Langford A, Alarcón RD, Chiu HFK, First MB, Kay J, Sunkel C, Thapar A, Udomratn P, Baingana FK, Kestel D, Ng RMK, Patel A, Picker LD, McKenzie KJ, Moussaoui D, Muijen M, Bartlett P, Davison S, Exworthy T, Loza N, Rose D, Torales J, Brown M, Christensen H, Firth J, Keshavan M, Li A, Onnela JP, Wykes T, Elkholy H, Kalra G, Lovett KF, Travis MJ, Ventriglio A. The WPA-Lancet Psychiatry Commission on the Future of Psychiatry. Lancet Psychiatry 2017; 4:775-818. [PMID: 28946952 DOI: 10.1016/s2215-0366(17)30333-4] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/28/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Dinesh Bhugra
- Department of Health Services and Population Research, King's College London and South London and Maudsley NHS Foundation Trust, London, UK; World Psychiatric Association, Geneva, Switzerland.
| | - Allan Tasman
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Shubulade Smith
- Department of Forensic and Neurodevelopmental Science, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - John Torous
- Department of Psychiatry and Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Melissa R Arbuckle
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Alex Langford
- Psychological Medicine Service, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Renato D Alarcón
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA; Department of Psychiatry, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Helen Fung Kum Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Michael B First
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Jerald Kay
- Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Charlene Sunkel
- SA Federation for Mental Health, Johannesburg, South Africa; Movement for Global Mental Health, Johannesburg, South Africa
| | - Anita Thapar
- Child & Adolescent Psychiatry Section, Division of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics & Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Florence K Baingana
- Mental Health Lead Basic Package of Essential Health Services Cluster, WHO Sierra Leone Country Office, Freetown, Sierra Leone
| | - Dévora Kestel
- Mental Health and Substance Use Unit, Pan American Health Organization/World Health Organization, Washington DC, USA
| | | | - Anita Patel
- Centre for Primary Care & Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Livia De Picker
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
| | - Kwame Julius McKenzie
- Wellesley Institute, Toronto, Ontario, Canada; General Psychiatry and Health Systems, Centre for Addictions and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Driss Moussaoui
- Ibn Rushd University Psychiatric Center, Casablanca, Morocco
| | - Matt Muijen
- Danish Mental Health Association, Copenhagen, Denmark
| | - Peter Bartlett
- School of Law and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sophie Davison
- State Forensic Mental Health Service, Department of Health, Clinical Research Centre, Mount Claremont, WA, Australia; School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia
| | - Tim Exworthy
- Department of Forensic and Neurodevelopmental Science, King's College London and South London and Maudsley NHS Foundation Trust, London, UK; Cygnet Healthcare, Stevenage, UK
| | | | - Diana Rose
- Service User Research Enterprise, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Julio Torales
- Department of Psychiatry, National University of Asunción, San Lorenzo, Paraguay
| | | | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Joseph Firth
- NICM, School of Science and Health, University of Western Sydney, Sydney, NSW, Australia
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ang Li
- Department of Psychology, Beijing Forestry University, Beijing, China
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Til Wykes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Hussien Elkholy
- World Psychiatric Association, Geneva, Switzerland; Institute of Psychiatry, Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Gurvinder Kalra
- Flynn Adult Inpatient Psychiatric Unit, Latrobe Regional Hospital Mental Health Services (LRH-MHS), Traralgon, VIC, Australia; School of Rural Health (La Trobe Valley & West Gippsland), Monash University, VIC, Australia
| | | | - Michael J Travis
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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18
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Eurviriyanukul K, Srisurapanont M, Udomratn P, Sulaiman AH, Liu CY. Correlates of Disability in Asian Patients With Major Depressive Disorder. Perspect Psychiatr Care 2016; 52:265-272. [PMID: 26031315 DOI: 10.1111/ppc.12127] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 03/17/2015] [Accepted: 04/23/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To examine correlates of disability in Asian patients with major depressive disorder (MDD). DESIGN AND METHODS Participants were outpatients with DSM-IV MDD. Global disability and three disability domains (i.e., work/school, social life/leisure, and family/home life) were key outcomes. Several socio-demographic and clinical characteristics were determined for their associations with disability. FINDINGS The sample was 493 MDD patients. Apart from the number of hospitalizations, the global disability was significantly associated with depression severity, fatigue, physical health, and mental health. Several clinical but only few socio-demographic characteristics associated with the other three disability domains were similar. PRACTICE IMPLICATIONS Disability among Asian patients with MDD correlates with the severity of psychiatric symptoms and the hospitalizations due to depression. Socio-demographic characteristics have little impact on the overall disability.
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Affiliation(s)
| | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Medical Center and Chang Gung University, Tao-Yuan County, Taiwan
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19
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Chee KY, Tripathi A, Avasthi A, Chong MY, Xiang YT, Sim K, Kanba S, He YL, Lee MS, Chiu HFK, Yang SY, Kuga H, Udomratn P, Tanra AJ, Maramis MM, Grover S, Mahendran R, Kallivayalil RA, Shen WW, Shinfuku N, Tan CH, Sartorius N. Prescribing Pattern of Antidepressants in Children and Adolescents: Findings from the Research on Asia Psychotropic Prescription Pattern. East Asian Arch Psychiatry 2016; 26:10-17. [PMID: 27086755] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Pharmacotherapy of depression in children and adolescents is complex. In the absence of research into the efficacy and safety of antidepressants in this group of patients, their off-label prescription is common. This paper aimed to illustrate the prescription pattern of antidepressants in children and adolescents from major psychiatric centres in Asia. METHODS The Research on Asia Psychotropic Prescription Pattern on Antidepressants worked collaboratively in 2013 to study the prescription pattern of antidepressants in Asia using a unified research protocol and questionnaire. Forty psychiatric centres from 10 Asian countries / regions participated and 2321 antidepressant prescriptions were analysed. RESULTS A total of 4.7% antidepressant prescriptions were for children and adolescents. Fluoxetine, sertraline, and escitalopram were the most common antidepressants prescribed for children and adolescents. Almost one-third (30.3%) of prescriptions were for diagnoses other than depressive and anxiety disorders. There was less antidepressant polypharmacy and concomitant use of benzodiazepine, but more concomitant use of antipsychotics in children and adolescents compared with adults. CONCLUSION Off-label use of antidepressants in children and adolescents was reported by 40 Asian psychiatric institutions that participated in the study. In-service education and regulatory mechanisms should be reinforced to ensure efficacy and safety of antidepressants in children and adolescents.
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Affiliation(s)
- K Y Chee
- Department of Psychiatry & Mental Health, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - A Tripathi
- Department of Psychiatry, King George's Medical University, Chowk, Lucknow, India
| | - A Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - M Y Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Center and School of Medicine, Chang Gung University, Taiwan
| | - Y T Xiang
- Faculty of Health Sciences, University of Macao, Macao SAR, PR China
| | - K Sim
- Institute of Mental Health, Buangkok View, Buangkok Green Medical Park, Singapore
| | - S Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Y L He
- Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, PR China
| | - M S Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, South Korea
| | - H F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, PR China
| | - S Y Yang
- Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - H Kuga
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - P Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - A J Tanra
- Department of Psychiatry, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - M M Maramis
- Dr Soetomo Hospital-Faculty of Medicine, Airlangga University, Jawa Timur, Indonesia
| | - S Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - R Mahendran
- Department of Psychological Medicine, National University Hospital, Singapore
| | - R A Kallivayalil
- Department of Psychiatry, Pushpagiri Medical College, Thiruvalla, India
| | - W W Shen
- Department of Psychiatry, TMU-Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - N Shinfuku
- Department of Psychiatry, Kobe University, Kobe, Japan
| | - C H Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | - N Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
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20
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Srisurapanont M, Likhitsathian S, Chua HC, Udomratn P, Chang S, Maneeton N, Maneeton B, Chen CH, Shih-Yen Chan E, Bautista D, Bin Sulaiman AH. Clinical and sociodemographic correlates of severe insomnia in psychotropic drug-free, Asian outpatients with major depressive disorder. J Affect Disord 2015; 186:26-31. [PMID: 26226430 DOI: 10.1016/j.jad.2015.06.032] [Citation(s) in RCA: 9] [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: 05/21/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Little has been known regarding the correlates of severe insomnia in major depressive disorder (MDD). This post-hoc analysis aimed to examine the sociodemographic and clinical correlates of severe insomnia in psychotropic drug-free, Asian adult outpatients with MDD. METHODS Participants were psychotropic drug-free patients with MDD, aged 18-65 years. By using the Symptom Checklist-90 Items, Revised (SCL-90-R), a score of 4 (severe distress) on any one of three insomnia items was defined as severe insomnia. Other measures included the Montgomery-Asberg Depression Rating Scale (MADRS), the Fatigue Severity Scale (FSS), the nine psychopathology subscales of SCL-90-R, the Physical and Mental Component Summaries of Short Form Health Survey (SF-36 PCS and SF-36 MCS), and the Sheehan Disability Scale (SDS). RESULTS Of 528 participants, their mean age being 39.5 (SD=13.26) years, 64.2% were females, and 239 (45.3%) had severe insomnia. The logistic regression model revealed that low educational qualifications (less than secondary school completion), high SCL-90-R Depression scores, high SCL-90-R Anxiety scores, and low SF-36 PCS scores were independently correlated with severe insomnia (p's<.05). LIMITATIONS Insomnia was determined only by the patient's distress. Middle insomnia was not assessed. Psychotropic drug-free patients with MDD are not commonly seen in psychiatric practice. CONCLUSION Severe insomnia is common in patients with MDD. It is closely related with low educational qualification, subjective depression and anxiety severity, and poor physical health. These findings may implicate the treatment of comorbid MDD and severe insomnia, for example, sleep hygiene education, pharmacological treatment.
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Affiliation(s)
- Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | | | | | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sungman Chang
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Benchaluk Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chia-Hui Chen
- National Health Research Institute, Department of Psychiatry, Taipei Medical University Shuang-Ho Hospital, Taiwan
| | - Edwin Shih-Yen Chan
- Duke-NUS Graduate Medical School, Singapore; Singapore Clinical Research Institute, Singapore
| | - Dianne Bautista
- Duke-NUS Graduate Medical School, Singapore; Singapore Clinical Research Institute, Singapore
| | - Ahmad Hatim Bin Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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21
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Chen C, Si TM, Xiang YT, Ungvari GS, Wang CY, He YL, Kua EH, Fujii S, Sim K, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Tan CH, Shinfuku N. Prevalence and prescription of antidepressants in depression with somatic comorbidity in Asia: the Research on East Asian Psychotropic Prescription Patterns study. Chin Med J (Engl) 2015; 128:853-8. [PMID: 25836602 PMCID: PMC4833998 DOI: 10.4103/0366-6999.154272] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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] [Indexed: 12/31/2022] Open
Abstract
Background: Depression is often comorbid with chronic somatic diseases. Few previous studies have investigated the prevalence of somatic diseases in depression or the prescription pattern of antidepressants in comorbidly depressed patients in Asia. This study aimed to investigate the prevalence of somatic comorbidity (SC) in depression and compared the prescriptions of antidepressants in depressed patients with and without SC. Methods: A total of 2320 patients treated with antidepressants in 8 Asian countries were examined, and a diagnosis was based on the International Classification of Disease, 10th revision. We listed 17 common chronic somatic diseases. Patients’ socio-demographic and clinical characteristics and psychotropic drug prescriptions were recorded using a standardized protocol and data collection procedure. Results: Of the patients examined, 1240 were diagnosed with depression and 30% of them (n = 375) had SC. The most common comorbid condition was diabetes (23.7%). The patients with SC were more likely to seek help at a general hospital (74.7% vs. 47.2%), and had a higher incidence of symptoms involving sadness, disturbed sleep, and poor appetite. Noradrenergic and specific serotonergic antidepressant was prescribed more for patients with SC than for those without SC (30.4% vs. 22.9%). Conclusions: SC is common in depressed Asian patients. It is important to strengthen the recognition of depression, especially in general hospitals and when patients report some somatic discomfort. It is also a matter of urgency to establish evidence-based guidelines for the use of new antidepressants in depressed patients with SC.
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Affiliation(s)
| | - Tian-Mei Si
- Key Laboratory of Mental Health, Ministry of Mental Health and Peking University Institute of Mental Health, Beijing 100083, China
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22
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Xiang YT, Ungvari GS, Correll CU, Chiu HFK, Lai KYC, Wang CY, Si TM, Lee EHM, He YL, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MKH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Tan CH, Shinfuku N. Use of electroconvulsive therapy for Asian patients with schizophrenia (2001-2009): Trends and correlates. Psychiatry Clin Neurosci 2015; 69:489-96. [PMID: 25708964 DOI: 10.1111/pcn.12283] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 10/03/2014] [Revised: 01/14/2015] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Abstract
AIMS Little is known about electroconvulsive therapy (ECT) use in Asian inpatients with schizophrenia. This study examined trends of ECT use for schizophrenia patients in Asia between 2001 and 2009 and its independent demographic and clinical correlates. METHODS Data on 6761 hospitalized schizophrenia patients (2001 = 2399, 2004 = 2136, and 2009 = 2226) in nine Asian countries and territories were collected by either chart review or interviews during a 1-month period. Patients' sociodemographic and clinical characteristics, prescriptions of psychotropic drugs and ECT use were recorded using a standardized protocol and data-collection procedure. RESULTS The frequency of ECT was 3.3% in the whole sample; rising from 1.8% in 2001 to 3.3% in 2004 and 4.9% in 2009 (P < 0.0001). However, this increased trend was driven solely by increased ECT use in China (P < 0.0001), and the inclusion of India in the 2009 survey. There were wide inter-country variations: 2001, 0% (Hong Kong, Korea) to 5.9% (China); 2004, 0% (Singapore) to 11.1% (China); 2009, 0% (Hong Kong) to 13.8% (India) and 15.2% (China). Multiple logistic regression analysis of the whole sample revealed that patients receiving ECT were less likely in the 35-64-year age group, had shorter length of current hospitalization and fewer negative symptoms, and were more likely to receive second-generation antipsychotic medications compared to those who were not treated with ECT (R(2) = 0.264, P < 0.001). CONCLUSIONS ECT use for schizophrenia has increased over the past decade in China, being low/relatively stable in other Asian countries/regions. Reasons for substantial variations in ECT frequency in Asia require further study.
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Affiliation(s)
- Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao, China.,Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Gabor S Ungvari
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia.,University of Notre Dame Australia, Perth, Australia
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, USA
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Kelly Y C Lai
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Chuan-Yue Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Tian-Mei Si
- Key Laboratory of Mental Health, Ministry of Mental Health & Peking University Institute of Mental Health, Beijing, China
| | - Edwin H M Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Yan-Ling He
- Shanghai Mental Health Center, Shanghai, China
| | | | - Mian-Yoon Chong
- Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Chang Gung, Taiwan
| | - Ee-Heok Kua
- Department of Psychological Medicine, National University of Singapore, Singapore, Japan
| | - Senta Fujii
- Fukushima Medical University, Fukushima, Japan
| | - Kang Sim
- Institute of Mental Health, Buangkok View, Singapore, Japan
| | | | - Jitendra K Trivedi
- Department of Psychiatry, C. S. M. Medical University UP, Lucknow, India
| | - Eun-Kee Chung
- Department of Psychiatry, National Seoul Hospital, Seoul, Korea
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kok-Yoon Chee
- Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programs, Geneva, Switzerland
| | - Chay-Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore, Japan
| | - Naotaka Shinfuku
- School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
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Lloyd CE, Sartorius N, Cimino LC, Alvarez A, Guinzbourg de Braude M, Rabbani G, Uddin Ahmed H, Papelbaum M, Regina de Freitas S, Ji L, Yu X, Gaebel W, Müssig K, Chaturvedi SK, Srikanta SS, Burti L, Bulgari V, Musau A, Ndetei D, Heinze G, Romo Nava F, Taj R, Khan A, Kokoszka A, Papasz-Siemieniuk A, Starostina EG, Bobrov AE, Lecic-Tosevski D, Lalic NM, Udomratn P, Tangwongchai S, Bahendeka S, Basangwa D, Mankovsky B. The INTERPRET-DD study of diabetes and depression: a protocol. Diabet Med 2015; 32:925-34. [PMID: 25659409 DOI: 10.1111/dme.12719] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/26/2022]
Abstract
AIM People with diabetes are at an increased risk of developing depression and other psychological disorders. However, little is known about the prevalence, correlates or care pathways in countries other than the UK and the USA. A new study, the International Prevalence and Treatment of Diabetes and Depression Study (INTERPRET-DD) aims to address this dearth of knowledge and identify optimal pathways to care across the globe. METHOD INTERPRET-DD is a 2-year longitudinal study, taking place in 16 countries' diabetes outpatients' facilities, investigating the recognition and management of depressive disorders in people with Type 2 diabetes. Clinical interviews are used to diagnose depression, with clinical and other data obtained from medical records and through patient interviews. Pathways to care and the impact of treatment for previously unrecognized (undocumented) depression on clinical outcomes and emotional well-being are being investigated. RESULTS Initial evidence indicates that a range of pathways to care exist, with few of them based on available recommendations for treatment. Pilot data indicates that the instruments we are using to measure both the symptoms and clinical diagnosis of depression are acceptable in our study population and easy to use. CONCLUSIONS Our study will increase the understanding of the impact of comorbid diabetes and depression and identify the most appropriate (country-specific) pathways via which patients receive their care. It addresses an important public health problem and leads to recommendations for best practice relevant to the different participating centres with regard to the identification and treatment of people with comorbid diabetes and depression.
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MESH Headings
- Adult
- Ambulatory Care Facilities
- Comorbidity
- Depression/diagnosis
- Depression/epidemiology
- Depression/therapy
- Depressive Disorder/diagnosis
- Depressive Disorder/epidemiology
- Depressive Disorder/therapy
- Depressive Disorder, Major/diagnosis
- Depressive Disorder, Major/epidemiology
- Depressive Disorder, Major/therapy
- Diabetes Complications/epidemiology
- Diabetes Complications/prevention & control
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Female
- Global Health
- Humans
- Incidence
- Longitudinal Studies
- Male
- Pilot Projects
- Practice Guidelines as Topic
- Prevalence
- Psychiatric Status Rating Scales
- Referral and Consultation
- Stress, Psychological/diagnosis
- Stress, Psychological/epidemiology
- Stress, Psychological/therapy
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Affiliation(s)
- C E Lloyd
- Faculty of Health & Social Care, The Open University, UK
| | - N Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | | | - A Alvarez
- Endocrinology, Metabolism and Nuclear Medicine, Hospital Italiano de Buenos Aires, Argentina
| | | | - G Rabbani
- Department of Psychiatry, Popular Medical College, Dhaka, Bangladesh
| | - H Uddin Ahmed
- Child Adolescent & Family Psychiatry, National Institute of Mental Health (NIMH), Dhaka, Bangladesh
| | - M Papelbaum
- Obesity and Eating Disorders Group - State Institute of Diabetes and Endocrinology of Rio de Janeiro, Brazil
| | - S Regina de Freitas
- Obesity and Eating Disorders Group - State Institute of Diabetes and Endocrinology of Rio de Janeiro, Brazil
| | - L Ji
- Department of Endocrinology and Metabolism, People's Hospital, Peking University, Beijing, China
| | - X Yu
- Institute of Mental Health, Peking University, Beijing, China
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Facility, Heinrich Heine University, Düsseldorf, Germany
| | - K Müssig
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - S K Chaturvedi
- National Institute of Mental Health & Neurosciences, Bangalore, India
| | - S S Srikanta
- Samatvam Endocrinology Diabetes Centre, Bangalore, India
- Jnana Sanjeevini Medical Centre, Bangalore, India
| | - L Burti
- Department of Public Health and Community Medicine, University of Verona, Brescia, Italy
| | - V Bulgari
- Unit of Psychiatry Epidemiology and Evaluation Unit, St John of God Clinical Research Centre, Brescia, Italy
| | - A Musau
- Africa Mental Health Foundation, Kenya
| | - D Ndetei
- University of Nairobi, Africa Mental Health Foundation, Kenya
| | - G Heinze
- Department of Psychiatry and Mental Health, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - F Romo Nava
- Department of Psychiatry and Mental Health, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - R Taj
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - A Khan
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - A Kokoszka
- Department of Psychiatry, Medical University, Warszawa, Poland
| | | | - E G Starostina
- Department of Endocrinology, Moscow Regional Clinical and Research Institute, Moscow, Russia
| | - A E Bobrov
- Moscow Research Institute of Psychiatry, Moscow, Russia
| | - D Lecic-Tosevski
- Serbian Academy of Sciences and Arts, Institute of Mental Health, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - N M Lalic
- Clinic for Endocrinology, Serbian Academy of Sciences and Arts, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - P Udomratn
- Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - S Tangwongchai
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - S Bahendeka
- The Mother Kevin Post Graduate Medical School, Uganda Martyrs University, Kampala, Uganda
| | - D Basangwa
- The Mother Kevin Post Graduate Medical School, Uganda Martyrs University, Kampala, Uganda
| | - B Mankovsky
- Department of Diabetology, National Medical Academy for Postgraduate Education, Kiev, Ukraine
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24
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Xiang YT, Chiu HFK, Ungvari GS, Correll CU, Lai KYC, Wang CY, Si TM, Lee EHM, He YL, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MKH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Tan CH, Shinfuku N. QTc prolongation in schizophrenia patients in Asia: clinical correlates and trends between 2004 and 2008/2009. Hum Psychopharmacol 2015; 30:94-9. [PMID: 25611192 DOI: 10.1002/hup.2458] [Citation(s) in RCA: 9] [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: 09/11/2014] [Revised: 11/09/2014] [Accepted: 12/03/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Little is known about the pattern of QT interval (QTc) prolongation in Asian patients with schizophrenia. This study examined trends of QTc prolongation in schizophrenia inpatients in six Asian countries and territories between 2004 and 2008/2009 and its independent demographic and clinical correlates. METHOD Data on 3482 hospitalized schizophrenia patients (2004 = 1826 and 2008/2009 = 1656) in six Asian countries and territories were collected by either chart review or interviews during a 1-month period. Patients' sociodemographic and clinical characteristics, prescriptions of psychotropic drugs, and QTc interval were recorded using a standardized protocol and data collection procedure. RESULTS The frequency of QTc prolongation (>456 ms) was 2.4% in the whole sample, decreasing from 3.1% in 2004 to 1.6% in 2008/2009 (p = 0.004) with wide intercountry variations. However, this decreased trend was driven by decreased QTc prolongation detected in China and Hong Kong (both p-values < 0.05). Multiple logistic regression analysis of the whole sample revealed that patients having more likely to have an illness lasting longer than 5 years and received antipsychotics classified as list-1 drugs according to the Arizona Centre for Education and Research on Therapeutics. Compared with 2004, patients in 2008/2009 were less likely to have QTc prolongation. Thioridazine caused QTc prolongation most frequently (odds ratio (OR) 4.4; 95% confidence interval (CI) 1.2-15.2), followed by sulpiride (OR 2.4; 95% CI 1.3-4.5), clozapine (OR 2.4; 95% CI 1.4-4.2), and chlorpromazine (OR 1.9; 95% CI 1.07-3.5). CONCLUSIONS Frequency of QTc prolongation was low in Asian patients with schizophrenia. QTc prolongation in schizophrenia decreased in China and Hong Kong between 2004 and 2008/2009 but increased in Taiwan over the same period, remaining low in the other countries.
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Affiliation(s)
- Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao, Special Administrative Region, China; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
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25
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Srisurapanont M, Bautista D, Chen CH, Wang G, Udomratn P, Eurviriyanukul K. Subjective memory and concentration deficits in medication-free, non-elderly Asians with major depressive disorder: prevalence and their correlates. J Affect Disord 2015; 171:105-10. [PMID: 25303026 DOI: 10.1016/j.jad.2014.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Subjective cognitive impairment (SCI) in major depressive disorder (MDD) is prevalent and correlated with disability. This study aimed to examine the prevalence rates and correlates of subjective memory deficit (SMD) and subjective concentration deficit (SCD) in medication-free, non-elderly Asians with MDD. METHODS The SMD and SCD were assessed by using two items of the Symptom Checklist-90-Revised (SCL-90-R). Other measurements of interest included the Montgomery-Asberg Depression Rating Scale (MADRS), the Fatigue Severity Scale (FSS), the Sheehan Disability Scale (SDS), and the Short Form Health Survey (SF-36). Adjusted odds ratios with 95% confidence intervals were calculated. RESULTS Of 515 participants from China, Korea, Malaysia, Singapore, Taiwan, and Thailand, 347 (67.4%) and 377 (73.2%) had SMD and SCD, respectively. In total, 420 participants (81.6%) had SMD alone, SCD alone, and both deficits. Severe depression and poor mental health were significant correlates of SMD. Severe depression, clinically significant disability, poor physical health, and poor mental health were significantly independent correlates of SCD. Compared with young adults (18-34 years), older adults aged 50-65 years had a significantly lower risk of SCD (OR=.33, 95% CI: .19-.57). LIMITATIONS Only two SCL-90-R items were used to assess the SMD and SCD. The exclusion of MDD patients treated with psychotropic medications eliminated many patients commonly seen in typical clinic settings. CONCLUSION SMD and SCD are prevalent in medication-free, non-elderly Asians with MDD. Both deficits are correlated with depression and mental health status. The independent correlation between SCD and disability underscores the crucial role of SCI in MDD.
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Affiliation(s)
- Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intavarorod Road, Si Poom, Muang, Chiang Mai 50200, Thailand.
| | - Dianne Bautista
- Duke-NUS Graduate Medical School, Singapore; Singapore Clinical Research Institute, Singapore
| | - Chia-Hui Chen
- National Health Research Institute, Department of Psychiatry, Taipei Medical University Shuang-Ho Hospital, Taiwan
| | - Gang Wang
- Depression Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kanokkwan Eurviriyanukul
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intavarorod Road, Si Poom, Muang, Chiang Mai 50200, Thailand
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26
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Sulaiman AH, Bautista D, Liu CY, Udomratn P, Bae JN, Fang Y, Chua HC, Liu SI, George T, Chan E, Tian-mei S, Hong JP, Srisurapanont M, Rush AJ. Differences in psychiatric symptoms among Asian patients with depression: a multi-country cross-sectional study. Psychiatry Clin Neurosci 2014; 68:245-54. [PMID: 24829935 DOI: 10.1111/pcn.12118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to compare the symptomatic and clinical features of depression among five groups of patients with major depressive disorder (MDD) living in China, Korea, Malaysia/Singapore, Taiwan, and Thailand. METHODS Consecutive consenting adults (aged 18-65) who met DSM-IV criteria for non-psychotic MDD – based on the Mini International Neuropsychiatric Interview – and who were free of psychotropic medication were evaluated in a cross-sectional study. Depressive symptoms were evaluated using the 10-item Montgomery–Asberg Depression Rating Scale (MADRS) and the 13-item depression subscale of the Symptoms Checklist 90-Revised (SCL-90-R). In addition, the 10-item SCL-90-R Anxiety Subscale was completed. ancova were conducted, adjusting for confounders: age, completion of secondary education, marital status, work status, religion, index episode duration, and depressive severity. For the magnitude of differences, a threshold of 0.10 was taken as the minimum effect size representing clinical significance, and an effect size of 0.25 was considered moderate. RESULTS Four MADRS symptoms differentiated these five groups, the most prominent being ‘lassitude’ and ‘inner tension’. Nine SCL-90-R depression items also differentiated the groups, as did eight SCL-90-R Anxiety Subscale items. The MADRS lassitude item had the largest effect size (0.131). The rest of those statistically significant differences did not exceed 0.10. CONCLUSION MDD is more similar than different among outpatients in these diverse Asian countries. The between-country differences, while present and not due to chance, are small enough to enable the use of common clinician and self-report rating scales in studies involving Asians with MDD from various ethnic backgrounds.
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Affiliation(s)
- Ahmad H. Sulaiman
- Department of Psychological Medicine, Faculty of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Dianne Bautista
- Graduate Medical School; Duke-National University of Singapore; Singapore
- Singapore Clinical Research Institute; Woodbridge Hospital; Singapore
| | - Chia-Yih Liu
- Department of Psychiatry; Chang Gung Medical Center and Chang Gung University; Tao-Yuan Taiwan
| | - Pichet Udomratn
- Department of Psychiatry; Faculty of Medicine; Prince of Songkla University; Songkhla Thailand
| | - Jae Nam Bae
- Department of Psychiatry; Faculty of Medicine; Inha University Hospital; Incheon Korea
| | - Yiru Fang
- Division of Mood Disorders; Shanghai Mental Health Center; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Hong C. Chua
- Institute of Mental Health; Woodbridge Hospital; Singapore
| | - Shen-Ing Liu
- Department of Psychiatry; Faculty of Medicine; Mackay Memorial Hospital; Taipei Taiwan
| | - Tom George
- North West Specialist Centre; Brisbane Australia
| | - Edwin Chan
- Graduate Medical School; Duke-National University of Singapore; Singapore
- Singapore Clinical Research Institute; Woodbridge Hospital; Singapore
| | - Si Tian-mei
- Peking University Institute of Mental Health; Beijing China
| | - Jin Pyo Hong
- Department of Psychiatry; Faculty of Medicine; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Manit Srisurapanont
- Department of Psychiatry; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - A. John Rush
- Graduate Medical School; Duke-National University of Singapore; Singapore
- Singapore Clinical Research Institute; Woodbridge Hospital; Singapore
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27
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Xiang YT, Li Y, Correll CU, Ungvari GS, Chiu HFK, Lai KYC, Tang QS, Hao W, Si TM, Wang CY, Lee EHM, He YL, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MKH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Tan CH, Shinfuku N. Common use of high doses of antipsychotic medications in older Asian patients with schizophrenia (2001-2009). Int J Geriatr Psychiatry 2014; 29:359-66. [PMID: 23939789 DOI: 10.1002/gps.4011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 01/27/2013] [Revised: 06/30/2013] [Accepted: 07/17/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to examine the use of high doses of antipsychotic medications (≥600 mg/day chlorpromazine equivalent) in older Asian patients with schizophrenia and its demographic and clinical correlates. METHOD Information on hospitalized patients with schizophrenia aged ≥50 years was extracted from the database of the Research on Asian Psychotropic Prescription Patterns study (2001-2009). Data on 2203 patients in six Asian countries and territories, including China, Hong Kong, Japan, Korea, Singapore and Taiwan, were analyzed. Socio-demographic and clinical characteristics and antipsychotic prescriptions were recorded. RESULTS The frequency for high-dose antipsychotic medications was 36.0% overall, with 38.4% in 2001, 33.3% in 2004 and 36.0% in 2009. Multiple logistic regression analysis of the whole sample showed that compared to patients receiving low-medium antipsychotic doses, those on high doses had a longer illness duration (odds ratio (OR): 2.0, 95% confidence interval (CI):1.2-3.3, p = 0.008), were more likely in the 50-59-year group (OR: 0.95, 95% CI: 0.94-0.97, p < 0.001), more often had current positive (OR: 1.5, 95% CI: 1.2-1.8, p < 0.001) or negative symptoms (OR: 1.3, 95% CI: 1.03-1.6, p = 0.03), and more commonly received antipsychotic polypharmacy (OR: 5.3, 95% CI: 4.1-6.7, p < 0.001). Extrapyramidal symptoms (p = 0.25) and tardive dyskinesia (p = 0.92) were not more frequent in the high-dose group. CONCLUSIONS High doses of antipsychotic medications were used in more than one third of older Asian patients with schizophrenia. The reasons for the frequent use of high antipsychotic doses in older Asian patients warrant further investigation.
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Affiliation(s)
- Yu-Tao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Beijing Anding Hospital, Capital Medical University, Beijing, China
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28
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Lim AY, Lee AR, Hatim A, Tian-Mei S, Liu CY, Jeon HJ, Udomratn P, Bautista D, Chan E, Liu SI, Chua HC, Hong JP. Clinical and sociodemographic correlates of suicidality in patients with major depressive disorder from six Asian countries. BMC Psychiatry 2014; 14:37. [PMID: 24524225 PMCID: PMC3937022 DOI: 10.1186/1471-244x-14-37] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 12/16/2013] [Accepted: 02/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND East Asian countries have high suicide rates. However, little is known about clinical and sociodemographic factors associated with suicidality in Asian populations. The aim of this study was to evaluate the factors associated with suicidality in patients with major depressive disorder (MDD) from six Asian countries. METHODS The study cohort consisted of 547 outpatients with MDD. Patients presented to study sites in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Singapore (n = 40), Thailand (n = 103), and Taiwan (n = 99). All patients completed the Mini-International Neuropsychiatric Interview (MINI), the Montgomery-Asberg Depression Rating Scale (MADRS), the Global Severity Index(SCL-90R), the Fatigue Severity Scale, the 36-item short-form health survey, the Sheehan Disability Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients were classified as showing high suicidality if they scored ≥ 6 on the MINI suicidality module. Multivariate logistic regression analysis was used to examine sociodemographic and clinical factors related to high suicidality. RESULTS One hundred and twenty-five patients were classed as high suicidality. Unemployed status (adjusted odds ratio [OR] 2.43, p < 0.01), MADRS score (adjusted OR 1.08), p < 0.001, and GSI (SCL-90R) score (adjusted OR 1.06, p < 0.01) were positively related to high suicidality. Hindu (adjusted OR 0.09, p < 0.05) or Muslim (adjusted OR 0.21, p < 0.001) religion and MSPSS score (adjusted OR 0.82, p < 0.05) were protective against high suicidality. CONCLUSIONS A variety of sociodemographic and clinical factors were associated with high suicidality in Asian patients with MDD. These factors may facilitate the identification of MDD patients at risk of suicide.
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Affiliation(s)
- Ah-Young Lim
- Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Ah-Rong Lee
- Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Ahmad Hatim
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Si Tian-Mei
- Peking University Institute of Mental Health, Beijing, China
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Medical Center and Chang Gung University, Tao-Yuan County, Taiwan
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Dianne Bautista
- Singapore Clinical Research Institute, Singapore, Singapore,Duke-National University of Singapore, Singapore, Singapore
| | - Edwin Chan
- Singapore Clinical Research Institute, Singapore, Singapore,Duke-National University of Singapore, Singapore, Singapore
| | - Shen-Ing Liu
- Department of Psychiatry, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Hong Choon Chua
- Institute of Mental Health, Woodbridge Hospital, Singapore, Singapore
| | - Jin Pyo Hong
- Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea.
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29
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Srisurapanont M, Hong JP, Tian-Mei S, Hatim A, Liu CY, Udomratn P, Bae JN, Fang Y, Chua HC, Liu SI, George T, Bautista D, Chan E, Rush AJ. Clinical features of depression in Asia: results of a large prospective, cross-sectional study. Asia Pac Psychiatry 2013; 5:259-67. [PMID: 24038919 DOI: 10.1111/appy.12104] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 06/25/2012] [Accepted: 07/23/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective of this study was to investigate the clinical features of depression in Asian patients. METHODS It was a cross-sectional, observational study of depression in China, Korea, Malaysia, Singapore, Taiwan, and Thailand. Participants were drug-free outpatients with depressed mood and/or anhedonia. Symptoms and clinical features were assessed using the Montgomery-Asberg Depression Rating Scale, Symptoms Checklist 90-Revised (SCL-90-R), and the Fatigue Severity Scale. Other measures included the Medical Outcome Survey 36-Item Short-Form Health Survey (SF-36), the Sheehan Disability Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). RESULTS A total of 547 outpatients with major depressive disorder were included in the analyses. Among the Montgomery-Asberg Depression Rating Scale symptoms, "reported sadness" and "reduced sleep" had the highest severity, with means (SDs) of 3.4 (1.2) and 3.4 (1.6), respectively. Apart from the SCL-90-R depression and anxiety domains, the SCL-90-R obsession-compulsion syndrome had the highest domain score, with a mean (SD) of 1.9 (0.9). Among eight domains, the mean (SD) SF-36 pain subscale score of 58.4 (27.7) was only second to that for the SF-36 physical function. In comparison to other disability domains, the Sheehan Disability Scale work/school had the highest subscale score, with a mean (SD) of 6.5 (2.9). The mean (SD) MSPSS "family" subscale score of 4.7 (1.7) was higher than the MSPSS "friends" and "significant others" subscale scores. DISCUSSION This study suggests that pain has a minimal impact on the quality of life in Asian patients with depression. Noteworthy issues in this population may include insomnia, obsessive-compulsive symptoms, working/school disability, and family support.
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Affiliation(s)
- Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Muang, Thailand
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30
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Xiang YT, Buchanan RW, Ungvari GS, Chiu HFK, Lai KYC, Li YH, Si TM, Wang CY, Lee EHM, He YL, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MKH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Tan CH, Shinfuku N. Use of clozapine in older Asian patients with schizophrenia between 2001 and 2009. PLoS One 2013; 8:e66154. [PMID: 23762478 PMCID: PMC3677908 DOI: 10.1371/journal.pone.0066154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/02/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To date there has been no large-scale international study that examined the use of clozapine in older patients with schizophrenia. This study examined the use of clozapine and its demographic and clinical correlates in older patients with schizophrenia in East Asia during the period between 2001 and 2009. METHOD Information on 1,157 hospitalized patients with schizophrenia aged 50 or older in five East Asian countries and territories (China, Hong Kong, Korea, Singapore and Taiwan) was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) project. Socio-demographic and clinical characteristics and prescription of psychotropic medications were recorded. RESULTS Clozapine was prescribed for 20.6% of the pooled sample; 19.0% in 2001, 19.4% in 2004 and 22.9% in 2009. Multiple logistic regression analysis of the whole sample revealed that patients taking clozapine had a longer duration of illness, more negative symptoms and were less likely to receive first generation antipsychotic and anticholinergic drugs, but more likely to report weight gain compared to those not receiving clozapine. Compared to those in other sites, older patients in China were more likely to receive clozapine. CONCLUSIONS The prescription of clozapine for older Asian schizophrenia inpatients has remained at a stable level during the past decade. The appropriateness of use of clozapine in China needs to be further explored.
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Affiliation(s)
- Yu-Tao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
- Beijing Anding Hospital, Capital Medical University, Beijing, China
- * E-mail: (YTX); (TMS)
| | - Robert W. Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Gabor S. Ungvari
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
- The University of Notre Dame Australia/Marian Centre, Perth, Australia
| | - Helen F. K. Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Kelly Y. C. Lai
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - You-Hong Li
- The Key Laboratory of Mental Health, Ministry of Mental Health & Peking University Institute of Mental Health, Beijing, China
| | - Tian-Mei Si
- The Key Laboratory of Mental Health, Ministry of Mental Health & Peking University Institute of Mental Health, Beijing, China
- * E-mail: (YTX); (TMS)
| | - Chuan-Yue Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Edwin H. M. Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Yan-Ling He
- Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China
| | - Shu-Yu Yang
- Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - Mian-Yoon Chong
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University School of Medicine, Kaohsiung, Taiwan
| | - Ee-Heok Kua
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Senta Fujii
- Hyogo Institute for Traumatic Stress (HITS), Kobe, Japan,
| | - Kang Sim
- Department of General Psychiatry, Institute of Mental Health, Buangkok View, Singapore, Singapore
| | - Michael K. H. Yong
- Department of Medicine, Alexandra Hospital/Jurong Health Services, Singapore, Singapore
| | - Jitendra K. Trivedi
- Department of Psychiatry, C.S.M. Medical University UP, Lucknow, Uttar Pradesh, India
| | - Eun-Kee Chung
- Department of Psychiatry, National Seoul Hospital, Seoul, Korea
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kok-Yoon Chee
- Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programs, Geneva, Switzerland
| | - Chay-Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Naotaka Shinfuku
- Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
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Xiang YT, Ungvari GS, Wang CY, Si TM, Lee EHM, Chiu HFK, Lai KYC, He YL, Yang SY, Chong MY, Tan CH, Kua EH, Fujii S, Sim K, Yong MKH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Adjunctive antidepressant prescriptions for hospitalized patients with schizophrenia in Asia (2001-2009). Asia Pac Psychiatry 2013; 5:E81-7. [PMID: 23857816 DOI: 10.1111/j.1758-5872.2012.00231.x] [Citation(s) in RCA: 14] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/18/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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. DISCUSSION 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.
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Affiliation(s)
- Yu-Tao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China.
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Xiang YT, Dickerson F, Kreyenbuhl J, Ungvari GS, Wang CY, Si TM, Lee EHM, Chiu HFK, Lai KYC, He YL, Yang SY, Chong MY, Tan CH, Kua EH, Fujii S, Sim K, Yong MKH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Common use of anticholinergic medications in older patients with schizophrenia: findings of the Research on Asian Psychotropic Prescription Pattern (REAP) study, 2001-2009. Int J Geriatr Psychiatry 2013; 28:305-11. [PMID: 22565547 DOI: 10.1002/gps.3827] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 12/16/2011] [Accepted: 04/11/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study surveyed the use of anticholinergic medications (ACMs) in older Asian patients with schizophrenia and examined its demographic and clinical correlates. METHOD A total of 1452 hospitalized patients with schizophrenia aged 55 years or older in nine Asian countries and territories were surveyed between 2001 and 2009. The cross-sectional data of patients' socio-demographic and clinical characteristics and the prescriptions of antipsychotic drugs and ACM were recorded using a standardized protocol and data collection procedure. RESULTS The frequency of ACM prescription was 64.6% in the pooled sample, with 72.4%, 61.9%, and 59.5% in 2001, 2004, and 2009, respectively. Multiple logistic regression analysis of the whole sample revealed that patients on ACM had a higher dose of antipsychotic medications, and were more likely to have extrapyramidal side effects and receive first-generation antipsychotic medications. CONCLUSIONS Anticholinergic medications were frequently used in older Asian patients with schizophrenia. Considering the potential side effects of ACM, the rationale for their widespread use in this patient population should be revisited.
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Affiliation(s)
- Yu-Tao Xiang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, SAR, China.
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Xiang YT, Kreyenbuhl J, Dickerson FB, Ungvari GS, Wang CY, Si TM, Lee EH, He YL, Chiu HF, Yang SY, Chong MY, Tan CH, Kua EH, Fujii S, Sim K, Yong MK, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Use of first- and second-generation antipsychotic medications in older patients with schizophrenia in Asia (2001-2009). Aust N Z J Psychiatry 2012; 46:1159-64. [PMID: 22790175 DOI: 10.1177/0004867412453625] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examined the prescribing patterns of several first- (FGAs) and second-generation antipsychotic (SGAs) medications administered to older Asian patients with schizophrenia during the period between 2001 and 2009. METHOD Information on hospitalized patients with schizophrenia aged 65 or older was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study (2001-2009). There were no older patients in Thailand, therefore data on 467 patients in eight Asian countries and territories including China, Hong Kong SAR, India, Japan, Korea, Malaysia, Singapore, and Taiwan were analysed. Cross-sectional socio-demographic data, clinical characteristics and antipsychotic prescriptions were assessed using a standardized protocol and data collection procedure. RESULTS Of the 467 patients, 192 patients (41.1%) received FGAs only, 166 (35.5%) received SGAs only and 109 (23.3%) received a combination of FGAs and SGAs. Of the FGAs, haloperidol was the most commonly used (31.3%; mean 9.4 ± 6.7 mg/day), followed by chlorpromazine (15.4%; mean 126.4 ± 156.4 mg/day) and sulpiride (6.6%; mean 375.0 ± 287.0 mg/day). Of the SGAs, risperidone was the most commonly used (31.5%; mean 4.5 ± 2.7 mg/day), followed by olanzapine (13.1%; mean 13.6 ± 6.5 mg/day), quetiapine (7.3%; mean 325.0 ± 237.3 mg/day) and aripiprazole (1.9%; mean 17.6 ± 7.7 mg/day). CONCLUSIONS FGAs and higher doses of certain SGAs (risperidone, olanzapine and quetiapine) were still commonly dispensed to older Asian patients with schizophrenia. Considering older patients' reduced tolerability of potentially severe side effects associated with FGAs and higher doses of certain SGAs, continuing education and training addressing the rational use of antipsychotics in this population is clearly needed.
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Affiliation(s)
- Yu-Tao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
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Abstract
Acute and transient psychotic disorders (ATPD), introduced in the International Classification of Diseases (ICD-10) diagnostic system, have not received much attention in Asia. As the World Health Organization (WHO) is in the process of revising the ICD-10 and ICD-11 is expected to be published in the near future, it seems appropriate to review the status of ATPD in this region. A PubMed search using appropriate keywords was conducted to identify literature describing samples from Asian countries with the diagnosis of ATPD for evidence of ATPD as a distinct diagnostic group. A total of 103 papers were found, but only nine publications were specifically related to ATPD and the ICD-10 criteria. The total number of patients receiving a diagnosis of ATPD in these studies was 390. Immigrants appear prone to ATPD, especially foreign domestic workers. When compared to schizophrenia, ATPD as a group had a different family history, course and outcome. However, ATPD was diagnostically unstable over time. A range of 35.5% to 73.3% in Asian patients with baseline ATPD retained their diagnoses over 3-12 years. Most individuals with polymorphic subtypes of ATPD in India and Hong Kong were rediagnosed with bipolar disorder after 3-5 years. In Japan, 31.2% of polymorphic cases were diagnosed as schizophrenia after 12 years of follow-up. This review supports the ICD-10 concept of separating ATPD into its own group; however, polymorphic subtypes may need revision in ICD-11. Before firm suggestions are submitted to the WHO, further research and data review from other regions is necessary.
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Affiliation(s)
- Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
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Xiang YT, Dickerson F, Kreyenbuhl J, Ungvari GS, Wang CY, Si TM, Lee EHM, He YL, Chiu HFK, Yang SY, Chong MY, Tan CH, Kua EH, Fujii S, Sim K, Yong MKH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Adjunctive mood stabilizer and benzodiazepine use in older Asian patients with schizophrenia, 2001-2009. Pharmacopsychiatry 2012; 45:217-22. [PMID: 22290203 DOI: 10.1055/s-0031-1301292] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE This study surveyed the use of adjunctive mood stabilizers (MS) and benzodiazepines (BZD) in older Asian schizophrenia patients and examined their demographic and clinical correlates. METHOD Information on hospitalized schizophrenia patients aged 55 years or more were extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study. A total of 1,452 patients from 9 Asian countries and territories was included in the study. The patients' sociodemographic and clinical characteristics and the prescriptions of antipsychotics, MS and BZD were recorded using a standardized protocol and data collection procedure. RESULTS The frequency of MS prescription was 26.7% in the pooled sample, with 25.5% in 2001, 26.9% in 2004 and 27.7% in 2009. The corresponding figures for BZD were 20.7%, 20.2%, 18.4% and 23.1%, respectively. Multiple logistic regression analysis of the whole sample revealed that patients on MS were younger and more likely to be men and to have extrapyramidal side effects (EPS) and a longer duration of illness. Compared to patients in China, those in Japan were more likely to receive MS, while Korean patents were prescribed less MS. In contrast, there were no significant sociodemographic or clinical correlates of BZD use. Compared to patients in China, their Korean and Singaporean counterparts were more likely to be on BZD. CONCLUSIONS The use of MS and BZD is not uncommon in older Asian patients with schizophrenia. Given the paucity of empirical data on the efficacy of these agents in individuals with schizophrenia of any age and concerns about added side effects in older patients in particular, the rationale for the prescription of these agents in this population warrants further examination.
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Affiliation(s)
- Y-T Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR
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Xiang YT, Wang CY, Si TM, Lee EHM, He YL, Ungvari GS, Chiu HFK, Shinfuku N, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MKH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Dixon LB, Kreyenbuhl JA, Tan CH. Clozapine use in schizophrenia: findings of the Research on Asia Psychotropic Prescription (REAP) studies from 2001 to 2009. Aust N Z J Psychiatry 2011; 45:968-75. [PMID: 21888603 DOI: 10.3109/00048674.2011.607426] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Optimizing treatment and outcomes for people with schizophrenia requires understanding of how evidence-based treatments are utilized. Clozapine is the most effective antipsychotic drug for treatment-refractory schizophrenia, but few studies have investigated trends and patterns of its use over time internationally. This study examined the prescription patterns of clozapine and its demographic and clinical correlates in Asia from 2001 to 2009. METHOD Clozapine prescriptions were collected in a sample of 6761 hospitalized schizophrenia patients in nine Asian countries and regions using a standardized protocol and data collection procedure. RESULTS Overall, the proportion of patients receiving clozapine prescriptions was stable across the three surveys from 2001 to 2009, ranging from 14.5% to 15.9%. However, the rates and patterns observed within different regions and countries at each survey differed considerably. Clozapine use decreased significantly over time in China, while it increased in Korea and Singapore. Multiple logistic regression analysis revealed that patients taking clozapine were significantly younger, had a higher dose of antipsychotic drugs in chlorpromazine equivalents, were more likely to be female, had fewer extrapyramidal symptoms, and had more negative symptoms, admissions and weight gain in the past month than those not receiving clozapine. CONCLUSION The variability in overall rates and changes in prescription rates over time in these samples suggest that factors other than psychopharmacological principles play an important role in determining the use of clozapine in schizophrenia in Asia.
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Affiliation(s)
- Yu-Tao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po Hospital, New Territories, Hong Kong
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Xiang YT, Wang CY, Si TM, Lee EHM, He YL, Ungvari GS, Chiu HFK, Yang SY, Chong MY, Tan CH, Kua EH, Fujii S, Sim K, Yong KH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Antipsychotic polypharmacy in inpatients with schizophrenia in Asia (2001-2009). Pharmacopsychiatry 2011; 45:7-12. [PMID: 21989602 DOI: 10.1055/s-0031-1286345] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE This study aimed to identify trends in the use of antipsychotic polypharmacy (APP) and their demographic and clinical correlates in the treatment of schizophrenia in Asia between 2001 and 2009. METHOD A total of 6,761 schizophrenia inpatients in 9 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. RESULTS The proportion of APP prescription decreased from 46.8 % in 2001, to 38.3 % in 2004, and increased to 43.4 % in 2009, with wide intercountry variations at each survey. Multiple logistic regression analysis of the whole sample revealed that patients on APP were younger, had a higher dose of antipsychotics in chlorpromazine equivalents, and more severe positive and negative symptoms. They were also more likely to receive depot and fi rst-generation antipsychotic drugs. CONCLUSIONS The frequency of APP prescription varied between countries and territories, suggesting that a host of clinical and socio-cultural factors played a role in determining APP use in Asia. To resolve the discrepancy between treatment recommendation and clinical practice, regular reviews of prescription patterns are needed.
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Affiliation(s)
- Y-T Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, P. R. China.
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38
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Xiang YT, Wang CY, Si TM, Lee EHM, He YL, Ungvari GS, Chiu HFK, Yang SY, Chong MY, Tan CH, Kua EH, Fujii S, Sim K, Yong MKH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. The low frequency of reported sexual dysfunction in Asian patients with schizophrenia (2001-2009): low occurrence or ignored side effect? Hum Psychopharmacol 2011; 26:352-7. [PMID: 21751252 DOI: 10.1002/hup.1213] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [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: 10/27/2010] [Accepted: 05/06/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of the study was to evaluate the frequency of reported sexual dysfunction (SD) in schizophrenia and its associations with sociodemographic and clinical variables in selected Asian countries. METHODS A total of 5877 schizophrenia patients in nine Asian countries and territories were examined between 2001 and 2009. The patients' sociodemographic and clinical characteristics, prescription of psychotropic drugs, and drug-induced side effects were recorded using a standardized protocol and data collection. SD was evaluated as "present" or "absent" according to the clinical judgment of experienced psychiatrists. RESULTS The frequency of reported SD in the whole sample in women and men was 3.0%, 0.8%, and 4.6%, respectively, with variations across study sites. In the multivariate analyses, male sex, more second-generation antipsychotics, benzodiazepines, and antidepressants were independently associated with higher likelihood of reported SD, whereas negative symptoms had an inverse association with reported SD. CONCLUSIONS The results of this study indicate that SD was seldom recorded as a side effect by Asian psychiatrists while treating patients with schizophrenia. It is unclear whether the low prevalence of reported SD compared with Western data is real or whether the results are being insufficiently recognized.
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Affiliation(s)
- Yu-Tao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China.
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Xiang YT, Wang CY, Si TM, Lee EHM, He YL, Ungvari GS, Chiu HFK, Yang SY, Chong MY, Tan CH, Kua EH, Fujii S, Sim K, Yong KH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Use of Anticholinergic Drugs in Patients with Schizophrenia in Asia from 2001 to 2009. Pharmacopsychiatry 2011; 44:114-8. [DOI: 10.1055/s-0031-1275658] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Xiang YT, Wang CY, Si TM, Lee EHM, He YL, Ungvari GS, Chiu HFK, Yang SY, Chong MY, Shinfuku N, Tan CH, Kua EH, Fujii S, Sim K, Yong KH, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N. Sex differences in use of psychotropic drugs and drug-induced side effects in schizophrenia patients: findings of the Research on Asia Psychotropic Prescription (REAP) studies. Aust N Z J Psychiatry 2011; 45:193-8. [PMID: 21142850 DOI: 10.3109/00048674.2010.538839] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [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] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the sex differences in prescribing patterns of psychotropic drugs and drug-induced side effects in schizophrenia patients in Asia using the data of the Research on Asian Psychotropic Prescription Pattern (REAP) surveys. METHOD The prescription patterns of 6,441 schizophrenia inpatients in six Asian countries and regions were investigated during the 2001-2009 period. The patients' socio-demographic and clinical characteristics and their prescriptions for psychotropic drugs were recorded using a standardized protocol and data collection procedure. RESULTS Univariate analyses found the following factors to be significantly associated with the male sex: a younger age, higher doses of antipsychotics, less prominent delusions and hallucinations, more prominent negative symptoms, less likelihood of a prescription for second-generation antipsychotics (SGAs), greater use of antipsychotic polypharmacy, mood stabilizers and depot antipsychotics, more frequent tardive dyskinesia (TD), and less weight gain. In multivariate analyses, fewer prescriptions for SGAs, greater use of mood stabilizers, anticholinergics, antipsychotic polypharmacy and depot antipsychotics, extrapyramidal side effects (EPS) and TD, and less weight gain were independently associated with the male sex. CONCLUSIONS Sex is one of the independent contributors to psychotropic prescription and side effects in Asian schizophrenia patients. Psychopharmacological treatment guidelines for schizophrenia should consider the sexes separately.
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Affiliation(s)
- Yu-Tao Xiang
- Beijing Anding Hospital, Capital Medical University, China
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Phanthunane P, Vos T, Whiteford H, Bertram M, Udomratn P. Schizophrenia in Thailand: prevalence and burden of disease. Popul Health Metr 2010; 8:24. [PMID: 20712909 PMCID: PMC2936278 DOI: 10.1186/1478-7954-8-24] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [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: 04/06/2010] [Accepted: 08/17/2010] [Indexed: 11/24/2022] Open
Abstract
Background A previous estimate of the burden of schizophrenia in Thailand relied on epidemiological estimates from elsewhere. The aim of this study is to estimate the prevalence and disease burden of schizophrenia in Thailand using local data sources that recently have become available. Methods The prevalence of schizophrenia was estimated from a community mental health survey supplemented by a count of hospital admissions. Using data from recent meta-analyses of the risk of mortality and remission, we derived incidence and average duration using DisMod software. We used treated disability weights based on patient and clinician ratings from our own local survey of patients in contact with mental health services and applied methods from Australian Burden of Disease and cost-effectiveness studies. We applied untreated disability weights from the Global Burden of Disease (GBD) study. Uncertainty analysis was conducted using Monte Carlo simulation. Results The prevalence of schizophrenia at ages 15-59 in the Thai population was 8.8 per 1,000 (95% CI: 7.2, 10.6) with a male-to-female ratio of 1.1-to-1. The disability weights from local data were somewhat lower than the GBD weights. The disease burden in disability-adjusted life years was similar in men (70,000; 95% CI: 64,000, 77, 000) and women (75,000; 95% CI: 69,000, 83,000). The impact of using the lower Thai disability weights on the DALY estimates was small in comparison to the uncertainty in prevalence. Conclusions Prevalence of schizophrenia was more critical to an accurate estimate of burden of disease in Thailand than variations in disability weights.
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Affiliation(s)
- Pudtan Phanthunane
- Setting Priorities Using Information on Cost-Effectiveness (SPICE) project, Ministry of Public Health, Nonthaburi, Thailand.
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Abstract
Much has been written on the devasting effects of the 2004 tsunami in general but no report has reviewed the epidemiological data concerning major psychiatric disorders in Thai survivors. Therefore, this article aims to review the prevalence of tsunami-related mental disorders, especially posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). The data came from searching PUBMED and unindexed journals, and also from contacting researchers or authors. The prevalence of PTSD and PTSD symptoms varied from 6.3% to 13% while the prevalence of MDD and depressive symptoms varied from 1.1% to 30%. The rate of PTSD in affected students in two schools was 57.3% at 6 weeks but decreased to 7.6% at 2 years after the disaster. The rate of PTSD in children and PTSD symptoms in adults decreased over time, while MDD in children did not, and the depressive symptoms in adults showed a modest decrease at 9 months of follow-up. It is rather difficult to compare data from these reports as methodologies and reference sources of population from these studies were quite different. Therefore, further research on this topic, including protective factors, has been recommended.
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Affiliation(s)
- Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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Affiliation(s)
- K Phabphal
- Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Ratta-Apha W, Sitdhiraksa N, Saisavoey N, Lortrakul M, Udomratn P. Postgraduate psychiatric training in Thailand. Seishin Shinkeigaku Zasshi 2009; 111:1238-1243. [PMID: 20058678] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In Thailand, after medical students graduated from medical schools, the general practitioners have to work for the government for at least three years. Then, they can enroll in postgraduate training program. Postgraduate training usually takes three to four years. All of the psychiatric training programs are supervised and monitored by the board of education of the Royal College of Psychiatrists of Thailand (RCPsychT). One of the missions of all training institutes is to prepare residents to be the high qualified psychiatrists to serve the mental well-being of Thai people. Additionally, they should teach the learners to be the leaders in academic and research fields in psychiatry. Currently, there are nine psychiatric training institutions in Thailand, most of which are running by university programs. The training program core curriculum composes of the compulsory rotations such as general psychiatry, child and adolescent psychiatry, neurology, consultation-liaison psychiatry, mental hospital psychiatry and addiction psychiatry. Moreover, the residents also have three months for elective in each program. The learning process includes practicing in an out-patient and in-patient unit under psychiatric staff supervision, individual and group supervision, case conference, journal club, book club and grand round etc. Research in field of psychiatry and social sciences is also compulsory for board examination. The RCPsychT approved two Certificate Diplomas including Diploma of Thai Board of Psychiatry, and Diploma of Thai Board of Child and Adolescent Psychiatry. There are only nine psychiatric training institutes and only thirty to forty residents enrolled in these programs in each year. The compact and collaboration of all training institutes bring about the benefits in efficiency programs management by regular meeting of representatives from each institute. They keep the standard of training program to progress in the same vision and direction. Furthermore, residents of each training programs can exchange and request for elective rotation at the other institutes.
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Affiliation(s)
- Woraphat Ratta-Apha
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University
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Abstract
This article presents an overview of natural disasters in Asia, as well as mental disorders and psychosocial interventions related to disasters. Although most of the top ten worst natural disasters occurred in Asia over the past century, little is known about the mental health and psychosocial aspects. After the tsunami incident in 2004, research reports in international journals related to Asian disasters have been growing. The prevalence rate of post-traumatic stress disorder related to natural disasters is currently between 8.6% and 57.3% depending on assessment methodologies, instruments and timing. Cognitive behaviour therapy has been found to be effective with Asian survivors but needs to be adapted for cultural and local sensitivities. Further research is needed in the areas of epidemiology for mental disorders and suitable psychosocial interventions for disaster survivors in Asia.
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Affiliation(s)
- Pichet Udomratn
- Faculty of Medicine, Department of Psychiatry, Prince of Songkla University, Thailand.
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Phuaphanprasert B, Srisurapanont M, Silpakit C, Pannarunothai S, Udomratn P, Geater A, Prapaphomrn P. Reliability and validity of the Thai version of the Health of the Nation Outcome Scales (hoNOS). J Med Assoc Thai 2007; 90:2487-2493. [PMID: 18181339] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Measurement in psychiatric services is important for the development of a psychiatric tool for budget allocation. OBJECTIVE To translate the Health of the Nation Outcome Scales (HoNOS) into Thai and to assess its psychometric properties. MATERIAL AND METHOD The HoNOS was translated into Thai, by using the standard of "forward-backward" translation procedure. Two psychiatric nurses interviewed subjects together but independently rated their scores. The subjects were 23 acute inpatients and 23 sub-acute inpatients. The reliability and validity was assessed. RESULTS The Cronbach's alpha coefficient of the Thai HoNOS was 0.68. It had a high correlation (r > 0.80) with the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning (GAF) and the Clinical Global Impression (CGI). It suggested high concurrent validity. It had a satisfactory power (p < 0.05) in discriminating overall clinical outcomes between acute and sub-acute psychiatric inpatients. CONCLUSION The Thai HoNOS fulfils the requirements of a psychiatric outcome scale for routine use in inpatient service.
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Udomratn P. The teaching and training of psychiatry in Thailand. Int Psychiatry 2007; 4:41-42. [PMID: 31507889 PMCID: PMC6734773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In Thailand, we have only two programmes for residency training in psychiatry: one is general or adult psychiatry, which takes 3 years to complete; the other is child and adolescent psychiatry, which takes 4 years. There are nine institutes that offer residency training but only three medical schools have the capacity to offer training in both general and child psychiatry (Table 1).
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Affiliation(s)
- Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand, email
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Udomratn P. Mental health and psychiatry in Thailand. Int Psychiatry 2007; 4:11-14. [PMID: 31507875 PMCID: PMC6734756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thailand is located in Southeast Asia and covers an area of 513 115 km2. In 2006 its population was approximately 64 million. The major nationality is Thai. About 80% of the total population live in rural areas. The country is composed of 76 provinces, divided into a total of 94 districts and 7159 sub-districts.
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Affiliation(s)
- Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand, email
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Udomratn P, Srisurapanont M. Impact on Thai psychiatrists of passive dissemination of a clinical practice guideline on prescribing attitudes in treatment-resistant schizophrenia. Neuropsychobiology 2002; 45:186-90. [PMID: 12097807 DOI: 10.1159/000063669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study aimed to determine the impact of a particular clinical practice guideline (CPG) following its passive dissemination on Thai psychiatrists' prescribing attitudes towards treatment-resistant schizophrenia (TRS). Two surveys were conducted before and after the dissemination of the CPG. Ninety-four questionnaires from the first survey and 84 from the second were analysed. Over 70% of the respondents were male. The mean age and duration of practice were 42.3 and 15.3 years, respectively. The respondents' characteristics were not significantly different in sex, age, years of practice, specialty, or clinical setting. In the first survey, the first three favoured interventions for TRS were switching to risperidone alone, switching to another conventional antipsychotic (CA), and adding carbamazepine to the on-going CA. In the second round, the first three interventions were switching to risperidone alone, switching to another CA, and switching to clozapine alone. Although there was a trend in the direction suggested by the CPG, there was no significant difference between the two surveys. The interventions chosen as first, second-, and third-line treatments were also not significantly different. Of 80 respondents who expressed their opinions on the CPG, 55, 15, and 10 stated that they knew, did not know, and were uncertain about the availability of a guideline, respectively. Of 55 respondents who knew about the availability of the guideline, 40 had read it. The mean (SDs) of the guideline acceptance and the impact of the guideline on the practice obtained from those 40 respondents were 70.9 (13.7) and 58.9 (19.6), respectively.
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Affiliation(s)
- Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
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Udomratn P. Panic disorder in Thailand: a report on the secondary data analysis. J Med Assoc Thai 2000; 83:1158-66. [PMID: 11143481] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Panic disorder (PD) is one of the most common psychiatric illnesses in Thailand but the picture of PD in Thailand is not clear. Therefore, the objective of this research was to review, summarize, and analyse data from research reports concerning the clinical aspects of PD in Thailand. Relevant papers were searched comprehensively. Four groups of data including prevalence and incidence rates, sex differences, clinical symptoms during panic attacks, and scores of the Hamilton anxiety scale (HAM-A) were extracted where available. Data thus obtained were then grouped and compared. It was found that 2.1 per cent to 12.4 per cent of patients who visited the psychiatric outpatient clinic for the first time were diagnosed as having PD. Males were affected at a similar rate to females with a ranging ratio of female:male from 1.3:1 to 0.67:1. The most common symptoms during panic attacks were palpitations, chest pain or discomfort, and dizziness or vertigo, similar to South American studies. Regarding scores of original HAM-A, mean somatic anxiety scores of PD patients who attended the cardiology clinic were significantly higher than generalized anxiety disorder patients (15.0 vs 9.8, p < 0.05). PD patients who attended the psychiatric clinic had higher mean scores of HAM-A when compared to PD patients who visited the cardiology clinic, but it was not statistically significant (27.7 vs 26.6, p > 0.05). However, the fear item of PD patients at the psychiatric clinic had significantly higher scores (2.1) than the other one (0.7). The difference between these findings and those of Western studies may be caused by cultural factors. Thai men tend to react more promptly to panic attacks and seek medical attention while women mostly attributed their symptoms to "Air Disease". However, incidence rates from other rural areas are lacking. Before conclusions can be drawn, research on epidemiologic data in the community should be further investigated.
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Affiliation(s)
- P Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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