East Asian Archives of Psychiatry最新文献

Objective: To investigate the characteristics and treatment outcomes of inpatients with schizophrenia at a psychiatric hospital in Salé, Morocco.

Methods: Medical records of patients aged ≥15 years, diagnosed with schizophrenia, and treated as inpatients at a psychiatric hospital in Salé, Morocco, between January 2021 and December 2023 were retrospectively reviewed.

Results: In total, 592 male and 88 female inpatients aged 16 to 87 (mean, 34) years were included in the analysis. Most were single (77.5%), unemployed (91.5%), living in urban area (90.7%), of modest to poor socioeconomic status (94.3%), had secondary to high school education (75.8%), and lived with their families (92.1%). Among the inpatients, 75.4% had a psychiatric history; 77.9% had a substance use history; 22.1% had suicide attempts; 26.0% had a criminal record; 37.6% had a family history of psychosis; 45.0% had poor treatment adherence; 45.3% had experienced at least one relapse; and 33.5% had discontinued medication. Additionally, 98.8% had gradual onset; 64.5% had onset between the age of 16 and 25 years; 73.1% were forcibly taken to hospital by their families or the authorities; and 52.6% had one hospitalisation. Regarding schizophrenia symptoms, most inpatients exhibited normal speech (79.7%), neutral mood (84.4%), blunted affect (92.0%), impaired judgement (99.4%), preserved basic mental activity (98.7%), poor insight (99.7%), and danger to others (64.1%). A history of suicide attempts was associated with younger age and earlier onset, whereas poor treatment adherence was associated with male sex, lower education level, being a danger to others, and having a psychiatric history. The triple-neuroleptic regimen achieved favourable outcomes in 99.3% of inpatients.

Conclusion: Inpatients with schizophrenia at a psychiatric hospital in Salé, Morocco were typically young men from socioeconomically disadvantaged urban backgrounds, with a history of cannabis use and poor treatment adherence. They had high rates of suicide attempts, poor insight, and psychomotor agitation. Encouragingly, almost all inpatients achieved favourable outcomes.

Objective: This study aimed to adapt and validate the Glasgow Antipsychotic Side-Effect Scale (GASS) in Bangla.

Methods: Patients aged ≥18 years with a psychiatric disorder who were currently taking antipsychotics were recruited from a tertiary care psychiatric hospital using convenience sampling. Additionally, patients aged ≥18 years with a psychiatric disorder who had not received any antipsychotic medications in the past 6 months were recruited as controls. Participants were assessed using the newly adapted GASS Bangla. Internal consistency was assessed using McDonald's omega. Principal component analysis with varimax rotation was used to determine the factor structure. Discriminant validity was examined.

Results: In total, 153 male and 67 female patients (mean age, 27.8 years) who were receiving antipsychotic medications were included. The most common diagnoses were schizophrenia spectrum disorders (49.1%) and bipolar disorders (46.8%). The median duration of illness was 36 months, and the median duration of antipsychotic medication was 4 months. Additionally, 29 male and 21 female controls (mean age, 30.2 years) were included. The mean GASS Bangla score of the patients was 13.3 ± 8.4. Among the 220 patients, 181 (82.3%) reported absent or mild adverse effects, 34 (15.5%) reported moderate adverse effects, and five (2.3%) reported severe adverse effects. In contrast, all controls reported either absent or mild adverse effects. Patients taking antipsychotic medication had higher median GASS Bangla scores than controls (12 vs 2, p < 0.001), supporting the scale's discriminant validity. Internal consistency of the GASS Bangla was moderate (McDonald's omega = 0.604). Factor loadings ranged from 0.040 to 0.573, with most items loading above the conventional threshold of 0.30. Principal component analysis revealed a seven-factor structure that explained 58.9% of the total variance.

Conclusion: The GASS Bangla is a user-friendly instrument for use as a screening tool. Despite moderate internal consistency, its clinical relevance and strong discriminant validity support its application in clinical practice.

Objectives: To compare the efficacy of fluoxetine and N-acetylcysteine (NAC) in reducing craving, relapse, and improving treatment adherence in men with alcohol dependence syndrome (ADS).

Methods: Men aged 18 to 65 years with a diagnosis of ADS who had maintained ≥7 days of abstinence from alcohol were recruited. Participants were randomised in a 1:1 ratio to receive either oral fluoxetine 20 mg/day or NAC 600 mg twice/day for 12 weeks. Participants were followed up at weeks 4, 8, and 12. Outcome measures included the Penn Alcohol Craving Scale (PACS), relapse rate, treatment adherence, and adverse effects.

Results: In total, 100 men were equally randomised to receive either fluoxetine or NAC. Both fluoxetine and NAC were effective in lowering PACS scores over 12 weeks, with scores being lower in the NAC group than in the fluoxetine group at week 4 (15.4 vs 17.6, p = 0.03), week 8 (11.3 vs 14.2, p = 0.002), and week 12 (7.8 vs 11.1, p < 0.001). The reduction in PACS scores was significantly greater in the NAC group from week 4 onward. Relapse rates were lower in the NAC group (18.0% vs 32.0%, p = 0.049). Treatment adherence was higher (but not significantly) in the NAC group (90.0% vs 84.0%, p = 0.38). Both medications were well tolerated. All adverse effects were mild.

Conclusion: Both fluoxetine and NAC were effective in reducing alcohol craving over 12 weeks, with greater reduction in the NAC group at each follow-up assessment. The NAC group also had a lower relapse rate and better adherence and tolerability.

Objective: This systematic review aimed to explore the pathways to care among individuals in Asia experiencing first-episode psychosis (FEP), focusing on the initial points of contact and the final referral source to psychiatric care, as well as key determinants that may influence the duration of untreated psychosis.

Methods: Electronic databases of PsycINFO, PubMed, EMBASE (Ovid), and Scopus were searched for quantitative observational studies involving Asian participants diagnosed with FEP, including both affective and non-affective psychoses, with mentioning of duration of untreated psychosis, first contact, last contact, and/or determinants and barriers to help-seeking.

Results: In total, 22 studies were included. Traditional healers were the most frequent initial point of contact, while family members were the most common final referral source to psychiatric care. Key determinants of help-seeking behaviours included symptom profiles, knowledge and awareness of psychosis, and the influence of family members. Pathways to care for individuals experiencing FEP in Asia are diverse, reflecting wide variations in social, cultural, and health system factors.

Conclusion: This review highlights the roles of traditional healers and family members in help-seeking, as well as the challenges posed by limited awareness, stigma, and cultural beliefs. Psychoeducation for traditional healers and family members may facilitate earlier detection and treatment. Asia-specific research may allow development of culturally sensitive approaches for early intervention services.

Objective: To determine the associations between psychotropic medications and falls among adult psychiatric inpatients.

Methods: This study retrospectively reviewed fall incidents among adult psychiatric inpatients at Kwai Chung Hospital between 1 January 2019 and 31 December 2024. Falls secondary to acute medical events (eg, cardiac arrest or seizures) were excluded. An operational definition of >4 medications for general polypharmacy and >3 psychotropic medications for psychotropic polypharmacy was used. Fall severity was categorised as severity category (SC) 1, which refers to minor injuries resulting in no or simple treatment, or SC2, which includes injuries that require surgical treatments.

Results: In total, 67 SC1 and 58 SC2 falls occurring in 86 female and 39 male inpatients (mean age, 51.8 years) were included in the analysis. Among the 125 inpatients, 64 (51.2%) had general polypharmacy alone, one had psychotropic polypharmacy alone (0.8%), and 35 (28.0%) had both. In univariable logistic regression analysis, SC2 falls were associated with general polypharmacy (odds ratio [OR] = 3.69, p = 0.010), psychotropic polypharmacy (OR = 2.73, p = 0.014), number of psychotropic medications (OR = 1.45, p = 0.023), and number of anticonvulsants (OR = 1.94, p = 0.012).

Conclusions: General polypharmacy, psychotropic polypharmacy, and anticonvulsant use are associated with increased severity of fall-related injuries in adult psychiatric inpatients. These findings underscore the importance of medication review and fall prevention strategies for at-risk patients.

Objective: We systematically reviewed the literature regarding the use of transcranial direct current stimulation in older adults with any psychiatric disorder and cognitive impairment, focusing on its potential to enhance cognitive functions, particularly working memory.

Methods: Data extracted included stimulation parameters, patient characteristics, and cognitive outcomes.

Results: Findings were mixed; variations may be due to differences in stimulation parameters, disease severity, and neuroanatomy.

Conclusion: Combining transcranial direct current stimulation with cognitive training showed synergistic effects.

Objective: To investigate barriers and facilitators that influence family decisions to seek mental healthcare at psychiatric hospitals.

Methods: Family members aged ≥18 years who accompanied their relatives for psychiatric care at a psychiatric hospital in Aceh, Indonesia, between September and October 2024 were recruited using convenience sampling. Participants were asked a single open-ended question: "Why did you decide to go to the psychiatric hospital?" Responses were transcribed verbatim, and thematic analysis was conducted.

Results: In total, 168 family members participated. Seven themes were identified: (1) deterioration of the patient's condition, (2) desire for appropriate treatment, (3) influence from family and healthcare workers, (4) difficulty managing patient behaviour, (5) limitations of previous treatments, (6) financial considerations, and (7) urgency to seek recovery.

Conclusion: Clinical or patient-related factors as well as social and contextual influences affect treatment-seeking behaviour among families of individuals with mental illness in Indonesia. There is a need for improved access to mental health services and support systems to aid families making decisions. Raising awareness and educating families about mental health resources may facilitate more informed decision making.

Objective: To determine factors associated with relapse among men who underwent inpatient treatment for alcohol dependence syndrome (ADS).

Methods: Medical records of men aged 18 to 65 years who underwent inpatient treatment for ADS between January 2018 and January 2020 were retrospectively reviewed. Demographic and clinical data were collected to identify factors associated with relapse.

Results: Of 199 men with ADS included in the analysis, 109 (54.8%) had relapsed within 2 years of treatment; of these relapses, 74 (67.9%) occurred within the first 3 months after treatment. Relapse rates were higher in those who developed dependence at age ≥25 years (50.5% vs 35.6%, p = 0.035), had previous relapses after inpatient treatment (56.0% vs 41.1%, p = 0.037), were at the pre-contemplation stage of motivation (45.0% vs 10.0%, p < 0.001), had level 0 of insight (51.4% vs 15.6%, p < 0.001), and used denial as a defence mechanism (18.3% vs 2.2%, p = 0.001).

Conclusion: Relapse was associated with an age of dependence of ≥25 years, previous relapse, lower levels of motivation and insight, and denial as a defence mechanism. Most relapses occurred within the first 3 months after treatment; more intensive follow-up during this period is needed.

Early intervention for psychosis (EIP) programmes have been implemented in many locations. Many of these programmes have now been operational for over 2 decades. There have, however, been few long-term reviews of how EIP programmes fared over time. In this review of the EIP for Hong Kong, we assembled key individuals directly involved in the programme from its initiation 25 years ago. Many of the authors have remained with the programme for extended periods, serving in various capacities, including as psychiatrists, psychologists, programme designers, educators, researchers, communicators, and advocates. In part 1 of the review, we describe the processes and decision points that led to the programme's initiation and its operation during the first decade. The review reveals some unexpected salient factors impacting the development of the EIP. A positive ripple effect of EIP success, promoting other areas of mental health development, may eventually result in competition for the workforce with the EIP programme. The power of a suitable term for psychosis in public communication was paramount. As the digital age arrived, demands in public communication also necessitated agile charitable organisations working in concert with the public institutions. Collaborative relationships with academic units enable insights from data, such as the duration of untreated psychosis, which can inform timely programme development. A long-term narrative review of EIP can reveal a number of less intuitive factors that inform future planning for existing and new programmes.