Singapore medical journal最新文献

Introduction: Treatment-resistant schizophrenia (TRS) affects around 30% of individuals with schizophrenia. About half of the patients with TRS who are treated with clozapine do not show a meaningful clinical response, that is, clozapine resistance. To date, the relationship between cognitive function and treatment response categories is not entirely clear. This study evaluated the cognitive performance across subgroups stratified by treatment response, and we hypothesised that cognitive impairment increases with increased treatment resistance.

Methods: This study was conducted at the Institute of Mental Health, Singapore, and included healthy controls and people with schizophrenia categorised into these groups: antipsychotic-responsive schizophrenia (ARS), clozapine-responsive TRS (TRS-CR) and clozapine-resistant TRS (ultra-treatment-resistant schizophrenia [UTRS]). Cognitive function was assessed using the Brief Assessment of Cognition-Short Form. Symptoms were measured with the Positive and Negative Syndrome Scale (PANSS). The planned statistical analyses included adjustments for covariates such as age, sex, PANSS scores and antipsychotic dose, which might affect cognitive function.

Results: There were significant differences in overall cognitive performance between the groups: ARS had the least impairment, followed by TRS-CR and UTRS. Antipsychotic dose, and PANSS negative and disorganisation/cognitive factors were significant predictors of overall cognitive function in all patient groups.

Conclusions: Our study found differences in cognitive function that aligned with levels of treatment resistance: the greater the degree of treatment resistance, the poorer the cognitive function. Interventions to improve negative and disorganisation symptoms might be effective to enhance the cognitive function and treatment outcomes in schizophrenia.

Introduction: Mobile health (mHealth) technologies, including smartphone apps and wearables, have improved health care by providing innovative solutions for monitoring, education and treatment, particularly in mental health.

Method: This review synthesises findings from a series of reviews on mHealth interventions in psychiatry. Publications were systematically searched in PubMed, MEDLINE, PsycINFO, ScienceDirect, Scopus, Web of Science and Cochrane Library.

Results: Out of 2147 records, 111 studies from 2014 to 2024 focusing on anxiety and depression were included. These studies highlight the effectiveness of mHealth interventions in reducing symptoms through cognitive-behavioural therapy, mindfulness and psychoeducation, benefitting adolescents, perinatal women and marginalised groups. Additionally, mHealth shows promise in managing substance use disorders and severe mental illnesses like schizophrenia, bipolar disorder and psychosis.

Conclusion: Despite positive outcomes, challenges such as data privacy, user engagement and healthcare integration persist. Further robust trials and evidence-based research are needed to validate the efficacy of mHealth technologies.

Abstract: Transcranial magnetic stimulation (TMS) is a promising intervention for treatment-resistant psychiatric disorders. However, conventional TMS typically utilises a one-size-fits-all approach when determining stimulation targets. Recent retrospective brain circuit-based analyses using lesion network mapping have suggested that a left dorsal lateral prefrontal cortex target has a higher efficacy for alleviating depression symptoms, a dorsomedial prefrontal cortex target is more effective for anxiety symptoms, and a rostromedial prefrontal cortex target is effective for schizophrenia-associated psychiatric symptoms. Nonetheless, symptom-specific brain circuit targeting has not been tested prospectively. We conducted a narrative review of selected literature to investigate individualised targeting for TMS and discuss potential future directions to elucidate the efficacy of this approach.

Introduction: This qualitative study aimed to understand the lived experiences of adolescents with depression seeking help in our healthcare system, with the focus on initial symptoms, experience of care and reflection after recovery.

Methods: Semi-structured interviews were conducted with 14 adolescents, aged between 13 and 19 years, who were diagnosed and treated for diagnostic and statistical manual of mental disorders, 5 th edition major depressive disorder and clinically judged to have recovered at the time of recruitment. Data were analysed qualitatively using thematic analysis, with a focus on how the adolescents spoke about their experience of depression.

Results: The findings suggested that our adolescent participants had initially tried managing depression within their own circle, and that thoughts of suicide and self-harm, as well as anhedonia-avolition symptoms were the most challenging to deal with. Recovered participants were observed to express a high degree of empathy towards others going through depression.

Conclusion: This study is the first to have surveyed adolescents in our Asian city-state on multiple aspects of their experience of depression. It allows a wide-ranging description of this condition and has the potential to improve understanding and inform care delivery.

Introduction: Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental condition characterised by inattention and/or hyperactivity-impulsivity. The ADHD symptoms are often evaluated and quantified using various assessment tools, such as the Conners' Continuous Performance Test II (CCPT-II), ADHD Rating Scale (ADHD-RS), Child Behaviour Checklist (CBCL), Clinical Global Assessment Scale (CGAS) and Clinical Global Impression Scale (CGIS). This study sought to compare CCPT-II with parent- and clinician-rated rating scales (ADHD-RS, CBCL, CGAS and CGIS) in measuring the core ADHD symptoms within the paediatric ADHD population.

Methods: The data, gathered from a large-scale randomised controlled trial involving 172 children aged 6-12 years with ADHD, was pooled, and a Pearson correlation analysis was conducted.

Results: No significant correlations were observed between CCPT-II and ADHD-RS, as well as the various subscales of CBCL, CGAS and CGIS.

Conclusion: While CCPT-II may offer insights into ADHD symptomatology, its relationship with parent- and clinician-rated rating scales such as ADHD-RS, CBCL, CGAS and CGIS appears limited. Further research is warranted to elucidate the nuances of these assessment tools and their roles in evaluating ADHD.

Introduction: Anaphylaxis was the first serious adverse event (AE) of special interest surfaced in Singapore following coronavirus disease 2019 (COVID-19) vaccination. Individuals who developed physician-diagnosed severe allergic reactions to the mRNA vaccines would be medically ineligible for mRNA vaccines and offered non-mRNA alternatives. This paper describes anaphylaxis reports received by the Health Sciences Authority (HSA) and presents a review of individuals who received heterologous COVID-19 vaccination.

Methods: Reports of anaphylaxis associated with the COVID-19 vaccines received till 31 July 2022 were reviewed and adjudicated using the Brighton Collaboration case definition criteria by an HSA-appointed expert panel. Additional review was conducted for cases with heterologous vaccination for any subsequent reactions until administration of third dose of COVID-19 vaccines.

Results: Among 112 adjudicated anaphylaxis cases, majority occurred in females, adults and persons with allergy histories, which were consistent with global observations. Most cases (71%) occurred within 30 minutes of vaccination. The reporting incidence rates (IRs) of 0.67 and 0.55 per 100,000 administered doses for Comirnaty and Spikevax vaccines, respectively, were comparable with IRs reported overseas, whereas the IRs for non-mRNA vaccines (Sinovac-CoronaVac and Nuvaxovid) were much higher at 4.14 and 29.82 per 100,000 administered doses, respectively, likely due to selection bias. Review of the 20 cases following heterologous vaccination found varying reactions to subsequent vaccinations.

Conclusion: Anaphylaxis is a rare but serious AE in which outcomes can be mitigated with timely medical intervention. The case review helped to guide vaccination strategies and added to the cumulative knowledge of safety with heterologous vaccination.