CASE REPORT: A 91 year old lady presented with an acute manic relapse for the past 2 weeks. She was previously on oral Sodium Valproate, and during this current admission was augmented with oral Quetiapine IR 100 mg bd. She remained unwell and was planned for right unilateral ECT with age-based dosing stimuli. After only 4 sessions, she showed complete resolution of her manic symptoms.
RESULT: In our case study, the patient showed rapid response to right unilateral ECT. Even though the Post Suppression Index (PSI) was not significant, there is some evidence that in elderly patients, burst suppression (not measured in this case) may be more accurate measure of ECT efficacy. The transient treatment emergent delirium was short lived and ECT was very tolerated in this patient.
CONCLUSION: Clinicians should not delay ECT in old-old patients who do not respond to pharmacologic treatment, as early switch to ECT results in rapid response with good safety profile.
MATERIALS AND METHODS: Using stratified sampling at the community level, 640 parents including 419 mothers and 221 fathers participated in the study. Tools included a socio-demographic pro-forma; Parental attitude inventory (PAI) to assess parenting attitudes, Parent Global Report of the Alabama Parenting Questionnaire (APQ) to assess current parenting dimensions, and the parent version of the Strengths and Difficulties Questionnaire (SDQ) to assess behavioural problems among adolescents. We examined the prevalence and predictors of total difficulties, externalizing and internalizing behavioural problems among adolescents from paternal and maternal reports.
RESULTS: Paternal and maternal reports of total difficulties (11.3 %, 13.6 %), externalizing (2.3 %, 1.9 %) and internalizing behaviours (8.6 %, 7.4 %) among adolescents are reported. Predictors of abnormal behaviours per paternal reports included lower social class and poor paternal control. Being a male adolescent increased the odds of total difficulties and externalizing problems. Favourable maternal attitude, good maternal warmth and control predicted the reduced likelihood of total difficulties and externalizing behaviours per maternal reports. Paternal control and maternal warmth and control were found to reduce the likelihood of internalizing behaviours among adolescents.
CONCLUSION: Maternal attitude, paternal control and maternal warmth and control dimensions emerged as significant predictors of total difficulties, externalizing and internalizing behavioural problems among adolescents.
MATERIAL AND METHODS: A questionnaire based on the study aims and previous literature was developed by the authors and mailed to all currently registered GPs in private clinics in Penang. Survey responses were analysed using SSPS version 21.
RESULTS: From a total of 386 questionnaires distributed, 112 (29%) were returned. Half of the respondents were unaware of the existence of any CPG for depression. One quarter reported not managing depression at all, while one third used anxiolytic monotherapy in moderate-severe depression. Almost 75 % of respondents reported making referrals to specialist psychiatric services for moderate-severe depression. Time constraints, patient non-adherence and a lack of depression management skills were perceived as the main barriers to depression care.
CONCLUSIONS: Our findings highlight the need to engage privately practising primary care physicians in Malaysia to improve their skills in the management of depression. Future revisions of the Malaysian Depression CPG should directly involve more GPs from private practices at the planning, development and implementation stages, in order to increase its impact.
METHODS: This cross-sectional survey across 15 Asian countries/territories collected socio-demographic and clinical data with standardized procedures between March and May 2016. The socio-demographic and clinical characteristics of the patients were recorded with a standardized questionnaire.
RESULTS: Altogether 3,537 adult patients with schizophrenia were consecutively screened and enrolled in the survey. The mean age was 38.66 ± 11.55 years and 59.7% of the sample were male. The mean dose of antipsychotics in chlorpromazine equivalents (CPZeq) was 424 ± 376 mg/day; 31.3% and 80.8% received first- and second- generation antipsychotics, respectively and 42.6% had antipsychotic polypharmacy, 11.7% had antidepressants, 13.7% had mood stabilizers, 27.8% had benzodiazepines, and 45.6% had anticholinergics.
CONCLUSIONS: Psychotropic prescription patterns in Asian adult patients with schizophrenia varied across countries. Regular surveys on psychotropic medications for schizophrenia are important to monitor pharmacotherapy practice in Asia.
METHOD: After translating all 39 items of the questionnaire into Bangla, it was administered on 206 children, aged 3 to 6 years, recruited randomly from ten preschools in Dhaka. The schools were selected randomly from the official list of preschools prepared by the Dhaka City Corporation. Class teachers of the respective children completed the questionnaire with the assistant of research assistants.
RESULTS: The Bangla version of the questionnaire retained all 39 items, with seven factors as they were in the English version. The Bangla version shows sufficient reliability (Cronbach's alpha = 0.87; test-retest reliability = 0.89 for whole questionnaire and .79-.89 for sub-scales; inter-rater reliability = 0.88 for whole questionnaire and .79-.88 for sub-scales), and validity (correlated positively with the English version; r = 0.85).
CONCLUSION: Due to its robust psychometric properties, the Bangla DMQ-18 is suggested to be used for Bangladeshi preschool children to assess their mastery motivation.
METHODS: This cross-sectional clinical survey recruited 150 regular kratom users. The Mini International Neuropsychiatric Interview (MINI) and Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) diagnostic criteria were used to evaluate psychotic symptomatology among kratom users, and the Brief Psychiatric Rating Scale (BPRS) was used to assess the severity of psychiatric symptoms. Chi-square tests with Yate's correction were performed to determine the association between kratom use characteristics and the occurrence of psychotic symptoms among kratom users in this study.
RESULTS: Six out of 150 kratom users (4%) presented with any psychotic symptoms. The psychotic symptoms reported were positive symptoms and thought alienation, with a mean BPRS score of 33 (i.e., mild severity). Variables related to kratom use (such as intake of kratom with diphenhydramine, duration of kratom use, and quantity and frequency of daily kratom use) were not associated with the occurrence of psychotic symptoms among kratom users.
CONCLUSION: Although psychotic symptoms could occur among regular kratom users, they were rare and not significantly associated with kratom use characteristics. We found no evidence of elevated psychosis among regular users.
AIM: To determine the neighbourhood factors influencing the prevalence of abnormal mental health status among adolescents in an urban population.
METHOD: A cross-sectional study was conducted among adolescents aged 13, 14 and 16 years old from thirteen secondary schools in Kuala Lumpur using validated questionnaires. A total of 567 adolescents participated in this study.
RESULTS: The prevalence of abnormal mental health status in this study was 4.4%. In multivariable analysis, female (OR = 1.79, 95%CI: 1.11-2.89), having divorced parents (OR = 3.53, 95%CI: 1.96-6.36), high educational stress (OR = 8.18, 95%CI: 4.25-15.75), medium educational stress (OR = 2.99, 95%CI: 1.53-5.83), whose house has been broken in before (OR = 2.02, 95%CI: 1.11-3.68) and living in a neighbourhood with low socioeconomic status (OR = 2.09, 95%CI: 1.23-3.56) were more likely to have abnormal mental health status.
CONCLUSIONS: Neighbourhood factors were found to be significant in determining adolescents' mental health status. The findings emphasize the importance of those in the public health sector to highlight these significant neighbourhood factors to the Ministry of Housing and Local Government. Swift action needs to be taken by the Ministry to provide solutions related to the neighbourhood factors and this can contribute to improvement in the adolescents' mental health.