East Asian Archives of Psychiatry最新文献

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.

Objectives: To determine the prevalence of continued illicit drug use among people enrolled in methadone maintenance treatment (MMT), the association between hepatitis C status and methadone dosage, and the predictors for illicit drug abstinence during MMT.

Methods: Clinical records of active opioid dependents who underwent MMT between 1 January 2007 and 31 March 2021 in Hospital Tuanku Fauziah, Perlis, Malaysia were retrospectively reviewed. Data collected included baseline demographics, history of illicit drug use, temporal trend in methadone dosage modulation, and co-use of illicit drugs during the MMT.

Results: A total of 87 patients (mean age, 43.9 ± 8.33 years) were included. Their mean duration of involvement in MMT was 7.8 ± 3.69 years. The most commonly used drug was heroin (88.5%), followed by kratom (51.7%). Between 2019 and 2021, 61 (70.1%) patients had ceased abusing opioid, but 51 (58.6%) patients continued using any of the illicit drugs. Methamphetamine and amphetamine co-use was most common (n = 12, 37.5%). Hepatitis C status was not associated with the current methadone dose (U = 539.5, p = 0.186) or the highest dose required (t = -0.291, df = 74, p = 0.772). No predictor for illicit drug abstinence during MMT was identified. Methadone dose positively correlated with frequency of defaulting treatments (r = 0.22, p = 0.042).

Conclusion: Among our patients, MMT for opioid dependents cannot sufficiently curb illicit drug use, and there is a shift toward stimulants abuse.

Introduction: Vitamin D deficiency is associated with osteoporosis, cancer, and autoimmune disease; evidence on its association with depression remains controversial. During the COVID-19 pandemic, preventive measures lead to reduced outdoor time and sunlight exposure, which is the major source of vitamin D. This study aims to assess the prevalence of vitamin D deficiency in Thai medical students during the pandemic and to determine its association with depression.

Methods: Medical students of year 4 and year 5 rotating in the Srinakharinwirot University Hospital who had no diseases associated with vitamin D deficiency and had not taken vitamin D supplement in the past year were invited to participate. Their total serum 25-hydroxyvitamin D levels were assessed with ELISA. Their demographic data were recorded, including age, sex, family income, class year, grade point average, current and history of psychiatrist-diagnosed psychiatric illnesses, other underlying diseases, and perceived difficulties in academic, relationship, substance use, and social supports. Students' depressive symptoms were assessed using the Thai version of Patient Health Questionnaire-adolescent (PHQ-A).

Results: A total of 63 female and 36 male medical students participated. 47.5% were year 4 and 52.5% were year 5. The mean vitamin D level was 21.7 ng/mL. The prevalence of vitamin D deficiency/insufficiency during the COVID-19 pandemic was 52.6% (using the cut-off of <20 ng/mL) or 69.5% (using the cut-off of <30 ng/mL). The mean vitamin D level in year 4 students was significantly lower than that in year 5 students (12.2 vs 30.2 ng/mL, t = -10.00, p < 0.01). Vitamin D level was associated with age (r = 0.38, p < 0.01) and sex (marginally) [t = -1.80, p = 0.07]. In linear regression analysis, vitamin D level remained associated with the year of class after adjusting for age and sex (B = 18.67, p < 0.01). The mean PHQ-A score was 5.8. 16 participants were identified to have depression. Vitamin D level was not correlated with PHQ-A score (r = 0.03, p = 0.80). In stepwise regression analysis, only total perceived difficulties score remained a predictor for PHQ-A score. In linear regression analysis, vitamin D level was not associated with PHQ-A score after adjusting for total perceived difficulties score (B = -0.02, p = 0.46).

Conclusion: The prevalence of vitamin D deficiency/insufficiency in Thai medical students during the COVID-19 pandemic was high (52.6% or 69.5%), probably owing to a lack of sunlight exposure. Nonetheless, vitamin D level was not associated with depressive symptoms, probably owing to the small sample size or delayed onset of depressive symptoms.

We describe a case of stress-induced haematohidrosis in a 14-year-old boy who responded well to stress management together with sertraline medication.

Objectives: To evaluate the Mental Health Youth Ambassador Programme between 2016 and 2019 in terms of participants' improvement in attitudes towards individuals with depression or psychosis.

Methods: This anti-stigma programme was provided to secondary students (form 3 and above) and comprised three levels. Level 1 involved attending lectures about mental health; level 2 and level 3 involved social contact with persons-in-recovery. Students' attitudes towards those with depression and those with psychosis were assessed at baseline and after completion of each level of programme using the Chinese version of the Social Distance Scale.

Results: Only 25 students who were assessed at all four time points were included in analysis. The mean Social Distance Scale scores for attitudes towards depression and psychosis improved significantly across all time points. Specifically, significant improvement occurred after completion of level 2 and level 2 but not after completion of level 1.

Conclusion: Social contact with people with mental illness (rather than attending lectures about mental health) contributed significantly to the improvement in students' attitude towards depression and psychosis. With the positive preliminary results, the Mental Health Youth Ambassador Programme should be extended to more students.