East Asian Archives of Psychiatry最新文献

Objective: Clozapine is a potent antipsychotic medication with a complex receptor profile. It is reserved for treatment-resistant schizophrenia. We systematically reviewed studies of non-psychosis symptoms of clozapine withdrawal.

Methods: CINAHL, Medline, PsycINFO, PubMed, and the Cochrane Database of Systematic Reviews were searched using the keywords 'clozapine,' and 'withdrawal,' or 'supersensitivity,' 'cessation,' 'rebound,' or 'discontinuation'. Studies related to non-psychosis symptoms after clozapine withdrawal were included.

Results: Five original studies and 63 case reports / series were included in analysis. In 195 patients included in the five original studies, approximately 20% experienced non-psychosis symptoms following discontinuation of clozapine. In 89 patients in four of the studies, 27 experienced cholinergic rebound, 13 exhibited extrapyramidal symptoms (including tardive dyskinesia), and three had catatonia. In 63 case reports / series included, 72 patients with non-psychosis symptoms were reported, which were catatonia (n=30), dystonia or dyskinesia (n=17), cholinergic rebound (n=11), serotonin syndrome (n=4), mania (n=3), insomnia (n=3), neuroleptic malignant syndrome (NMS) [n=3, one of them had both catatonia and NMS], and de novo obsessive compulsive symptoms (n=2). Restarting clozapine appeared to be the most effective treatment.

Conclusions: Non-psychosis symptoms following clozapine withdrawal have important clinical implications. Clinicians should be aware of the possible presentations of symptoms to ensure early recognition and management. Further research is warranted to better characterise the prevalence, risk factors, prognosis, and optimal drug dosing for each withdrawal symptom.

Objective: Major depressive disorder (MDD) is the second-most prevalent mental health condition in Vietnam. This study aims to validate the Vietnamese versions of the self-reported and clinician-rated Quick Inventory of Depressive Symptomatology (QIDS-SR and QIDS-C, respectively) and the Patient Health Questionnaire (PHQ-9), and to assess the correlations between the QIDS-SR, QIDS-C, and PHQ-9.

Methods: 506 participants with MDD (mean age, 46.3 years; 55.5% women) were assessed using the Structured Clinical Interview for DSM-5. The internal consistency, diagnostic efficiency, and concurrent validity of the Vietnamese versions of QIDS-SR, QIDS-C, and PHQ-9 were determined using the Cronbach's alpha, receiver operating characteristic curve, and Pearson correlation coefficient, respectively.

Results: The Vietnamese versions of QIDS-SR, QIDS-C, and PHQ-9 demonstrated acceptable validity, with an area under the receiver operating characteristic curve of 0.901, 0.967, and 0.864, respectively. Sensitivity and specificity, respectively, were 87.8% and 77.8% for QIDS-SR and 97.6% and 86.2% for QIDS-C at the cut-off score of 6, and were 82.9% and 70.1% for PHQ-9 at the cut-off score of 4. Cronbach's alphas for QIDS-SR, QIDS-C, and PHQ-9 were 0.709, 0.813, and 0.745, respectively. The PHQ-9 highly correlated with the QIDS-SR (r = 0.77, p < 0.001) and the QIDS-C (r = 0.75, p < 0.001).

Conclusion: The Vietnamese versions of the QIDS-SR, QIDS-C, and PHQ-9 are valid and reliable tools for screening of MDD in primary healthcare settings.

Objective: To determine whether meaning in life (MIL) was associated with a lower risk of depression in people from low-income families during the COVID-19 pandemic.

Methods: Individuals from low-income families were recruited at a community centre during the fourth wave of the COVID-19 pandemic in Hong Kong. Levels of MIL were assessed using the Meaning in Life Questionnaire (MLQ). Severity of depressive symptoms was assessed using the Patient Health Questionnaire-9 (PHQ-9). Scores of ≥24 on the Presence of Meaning subscale (MLQ-P) and Search for Meaning subscale (MLQ-S) were considered high. A score of ≥10 on the PHQ-9 was indicative of clinical depression. Correlations between MLQ and PHQ-9 scores were examined, along with associations between presence of/search for meaning and risk of clinical depression.

Results: Among 102 participants, 64 (62.7%) had clinical depression; 14 (13.7%) had both high presence of meaning and high search for meaning. The MLQ score was correlated with the PHQ-9 score (r = -0.56, p < 0.001). The adjusted risk ratio for depression was 0.31 (p = 0.006) in participants with both high presence of meaning and high search for meaning.

Conclusion: Among people with lower socioeconomic status, MIL may be important for protecting against depression during the COVID-19 pandemic.

Clozapine is considered the most effective antipsychotic for schizophrenia, but it can cause neutropenia and even agranulocytosis. We describe the first case in Hong Kong involving the use of filgrastim, a recombinant form of human granulocyte colony-stimulating factor, to enable clozapine continuation therapy for a severely ill patient with treatment-resistant schizoaffective disorder who developed recurrent neutropenia after almost 20 years of continuous clozapine therapy. Therefore, clinical vigilance is important, regardless of clozapine treatment duration. Filgrastim can facilitate long-term clozapine therapy in patients with clozapine-induced neutropenia.

Objective: To systematically review case reports of psychosis related to withdrawal or overdose of baclofen, which is a gamma-aminobutyric acid (GABA) _B agonist.

Methods: PubMed, MEDLINE, CINAHL, and PsychINFO were searched to identify articles related to psychosis secondary to withdrawal or overdose of baclofen using the terms 'baclofen' and ' psychosis'. Comparisons were made between cases in terms of concomitant antipsychotic use, diagnosis of delirium, and evidence of association. Quality of case reports was assessed using the CARE Case Report Guidelines checklist.

Results: In total, 34 patients from 28 case reports were reviewed. Twenty-three patients experienced psychosis upon baclofen withdrawal; among them, 18 had resolution of psychosis upon reinitiation of baclofen, whereas antipsychotic monotherapy was less successful (only four of eight patients responded). An additional baclofen withdrawal period led to recurrence of psychotic symptoms in four of seven patients. Eleven patients had psychosis on induction or after overdose of baclofen; among them, four patients had resolution of psychosis upon cessation of baclofen. The mean quality of the case reports was 6.4 of 13.

Conclusion: Considering its GABAergic agonism, along with evidence of psychosis on induction or withdrawal, baclofen may have some antipsychotic and pro-psychotic properties.

Introduction: This study aims to investigate depressive symptoms and its association with resilience, pessimistic bias of COVID-19, lifestyle changes, and family conflicts among undergraduates in a Hong Kong university.

Methods: 1020 undergraduates in The University of Hong Kong completed the online survey between May and August 2020. Severity of depressive symptoms was assessed using the Patient Health Questionnaire-9. Resilience was assessed using the Connor-Davidson Resilience Scale. Pessimistic bias was assessed using two questions on the perceived risks of contracting COVID-19 and of dying from COVID-19. Changes in lifestyles and the presence of family conflicts were measured. Multivariable and mediation analyses were performed to examine association of depressive symptoms with other variables.

Results: 61.7% of the respondents reported having mild to severe depressive symptoms. 18.5% of the variance in depressive symptoms was explained by resilience, pessimistic bias, changes in the frequency of sleep, studying at home, and family conflict. Pessimistic bias partially mediated the association between resilience and depressive symptoms.

Conclusion: The proportion of undergraduates with mild to severe depressive symptoms during the pandemic was high. Measures to reduce family conflict, maintain healthy daily habits, adjust pessimistic bias, and enhance resilience may help to improve the mental well-being of undergraduates during the pandemic.

Objectives: The study aims to examine the reliability and validity of the Personal Stigma Scale and the intrapersonal variables that affect the personal stigma level towards depression among university students in Singapore.

Methods: University students aged 18 to 24 years old who were literate in English were recruited using convenience sampling through online platforms. Participants' stigma towards depression was assessed using the Personal Stigma Scale. Each item of the scale was rated from 1 (strongly disagree) to 5 (strongly agree); higher scores indicate higher stigmatising attitudes. Internal consistency, divergent validity, construct validity, and test-retest reliability of the Personal Stigma Scale were evaluated, as were the intrapersonal variables that affect the personal stigma level towards depression.

Results: Personal stigma level was significantly lower in female participants, those from healthcare faculties, those with prior contact with healthcare professionals, those without mental health disorders, and those with loved ones with mental health disorders. Exploratory factor analysis revealed a three-factor structure. The Personal Stigma Scale was negatively correlated with the Depression Literacy Scale weakly and the Anxiety Literacy Scale moderately. Cronbach's alpha for internal consistency was 0.71 for the overall scale and 0.18 to 0.67 for subscales. Test-retest reliability coefficient was 0.74 at 2 weeks and 0.70 at 2 months.

Conclusion: The Personal Stigma Scale is valid and reliable to measure self-stigma towards depression among university students in Singapore. Nonetheless, further studies are required to examine its factor structure, especially among various cultures and populations.

Objectives: To determine the prevalence of depression and the sociodemographic factors associated with depression in Malaysia during the COVID-19 pandemic METHODS. This study is part of the COVID-19 Mental Health International Study to collect data on the impact of the pandemic on mental health through an online survey. People who were aged ≥18 years, able to read Malay or English, had access to the internet, and consented to participate were asked to complete a pro forma questionnaire to collect their sociodemographic data. The presence of distress and depression was assessed using the English or Malay version of the Center for Epidemiologic Studies Depression Scale.

Results: Of 963 participants, 451 (46.8%) had depression and 512 (53.2%) had no depression who were either normal (n = 169, 17.5%) or had distress (n = 343, 35.6%). Participants had higher odds of having depression when living with two people (adjusted odds ratio [AOR] = 3.896, p = 0.001), three people (AOR = 2.622, p < 0.001) or four people (AOR = 3.135, p < 0.001). Participants with three children had higher odds of having depression (AOR = 2.084, p = 0.008), whereas having only one child was a protective factor for depression (AOR = 0.481, p = 0.01). Participants had higher odds of having depression when self-employed (AOR = 3.825, p = 0.003), retired (AOR = 4.526, p = 0.001), being housekeeper (AOR = 7.478, p = 0.004), not working by choice (AOR = 5.511, p < 0.001), or unemployed (AOR = 3.883, p = 0.009). Participants had higher odds of depression when living in a small town (AOR = 3.193, p < 0.001) or rural area (AOR = 3.467, p < 0.001). Participants with no chronic medical illness had lower odds of having depression (AOR = 0.589, p = 0.008).

Conclusion: In Malaysia during the COVID-19 pandemic, people who are living with two, three, or four people, having three children, living in a small town or rural areas, and having unstable income have higher odds of having depression. Urgent intervention for those at risk of depression is recommended.

Objective: This study aims to determine factors associated with hesitation and motivation to work among healthcare workers (HCWs) in Indonesia, Philippines, and Taiwan during the COVID-19 pandemic.

Methods: HCWs aged ≥20 years working in five hospitals in Indonesia, Philippines, and Taiwan were invited to participate in a self-administered mental health survey between 30 January 2021 and 31 August 2021. The 33-item questionnaire measured HCWs' perceived stress, level of motivation and hesitation to work, attitude and confidence regarding work, attitude on the policies by the hospital and government, and discrimination against the occupation. Each item was rated in a 4-point Likert scale from 0 (never) to 3 (always). Sociodemographic and occupational factors were also considered in data analysis.

Results: Of 1349 participants, 671 (49.7%) were from Indonesia, 365 (27.1%) from Philippines, and 313 (23.2%) from Taiwan. Overall, 20.8% of participants showed motivation to work and only 4.7% showed hesitation to work. Compared with HCWs in their 20s, HCWs in their 30s, 40s, and 50s had significantly lower hesitation to work (adjusted odds ratio [AOR] = 0.42, 0.33, and 0.11, respectively; p = 0.01, 0.02, and 0.03, respectively). Similarly, compared with HCWs in their 20s, HCWs in their 30, 40s, 50s, 60s, and 70s had significantly higher motivation to work (AOR = 1.71, 2.98, 5.92, 5.40, and 7.15, respectively; p = 0.01, <0.001, <0.001, <0.001, and 0.02, respectively). Clinical staff had lower motivation to work than non-clinical staff (AOR = 0.60, p = 0.01). Those who worked in high-risk areas had lower hesitation to work than those who worked in low-risk areas (AOR = 0.51, p = 0.03). Overall, higher hesitation to work was associated with 'wanting to leave job/study' (AOR = 4.54, p = 0.03) and 'feeling isolated' (AOR = 4.84, p = 0.01), whereas lower hesitation to work was associated with 'being confident about the future of medical practice' (AOR = 0.33, p = 0.02) and 'burden of child care including lack of nursery' (AOR = 0.30, p = 0.04). Higher motivation to work was associated with 'feeling of being protected by hospital' (AOR = 2.23, p = 0.001), 'confident in my country's pandemic prevention policy' (AOR = 2.19, p = 0.001), 'feeling of elevated mood' (AOR = 4.14, p = 0.004), and 'being confident about the future of medical practice' (AOR = 2.56, p < 0.001), whereas lower motivation to work was associated with 'exhausted mentally' (AOR = 0.35, p = 0.03).

Conclusion: Various stress-related factors contribute to hesitation and motivation to work among HCWs in Indonesia, Philippines, and Taiwan during the COVID-19 pandemic. Proactive and practical strategies should be implemented to protect HCWs from the negative behavioural and emotional effects of the COVID-19 pandemic.

Objectives: This study aims to examine the psychometric properties of the Persian version of the Structured Clinical Interview for DSM-5 for personality disorders (SCID-5-PD) among patients referred to psychiatric centres in Iran.

Methods: Between March 2017 and June 2019, 287 outpatients and inpatients aged 16 to 75 years who were referred to three psychiatric centres in Tehran, Iran were invited to participate. Patients were interviewed using the Persian version of the SCID-5-PD by two PhD students in clinical psychology who were blinded to patient records. Face validity and content validity of the Persian version of the SCID-5-PD were assessed by five specialists with ≥2 years of clinical experience. The agreement between the diagnoses made with the Persian version of the SCID-5-PD by the two PhD students in clinical psychology and the gold standard diagnoses made with DSM-5 by psychiatrists was determined, as were sensitivity, specificity, and positive and negative likelihood ratios. 109 (43.6%) patients were interviewed again after an interval of 7 to 10 days for inter-rater reliability and test-retest reliability.

Results: A total of 250 patients aged 17 to 74 (mean, 32.56) years were included. Face validity and content validity of the Persian version of SCID-5-PD were acceptable. The agreement between the Persian version of SCID-5-PD and DSM-5 (gold standard) was acceptable (kappa >0.4) for the diagnoses of obsessive-compulsive, paranoid, schizotypal, schizoid, histrionic, narcissistic, borderline, and antisocial personality disorders, whereas the agreement was unacceptable (kappa <0.4) for the diagnoses of avoidant and dependent personality disorders. Sensitivity for all diagnoses was high, except for avoidant (0.66) and dependent (0.66) personality disorders. Specificity for all diagnoses was high, except for avoidant personality disorder (0.66). The positive and negative likelihood ratios showed that the SCID-5-PD was accurate for diagnosing all personality disorders, except for schizoid personality disorder. Inter-rater reliability was good for all personality disorders, except for schizotypal personality disorder (0.531). Test-retest reliability was good for all personality disorders.

Conclusion: The Persian version of the SCID-5-PD can be used to evaluate those who seek psychotherapy for all personality disorders, except for avoidant, dependent, schizoid, and schizotypal personality disorders.