A study of antidepressant prescription in major depressive disorders in the out-patient psychiatric department of Siriraj Hospital.

Objective: This study is aimed to study antidepressant prescription in new cases of major depressive disorders in the Out-patient Psychiatric Department and to compare antidepressant prescription between staff and residents. Another reason was to study basic data of major depressive disorders such as incidence, response and follow - up patterns for further study. Methods: A retrospective study of new cases of major depressive disorders who came to the Out-patient Psychiatric Department from April 2003 to September 2003 (6-month period). Personal data, treatment data, as well as result and follow – up data were collected. Data were analyzed in percentage and Chi-square. Results: The incidence of major depressive disorders in the Out-patient Psychiatric Department was 5.9 %. The subjects of the study consisted of 53 cases; the largest group was over 51 years old (41.5 %), with females doubling the number males (66 % and 34 %), most of whom were housewives (35.8 %). The predominant diagnosis was major depressive disorder with no psychotic symptoms or psychosocial stress (81.1 %). Selective serotonin reuptake inhibitors (SSRI) or new generation antidepressants were mainly prescribed (64.2 %); most of the antidepressants were in the National Drug Prescription (71.7 %). About 52.8 % of patients had been prescribed one co-drug treatment and the most frequently prescribed was benzodiazepine. The major pattern of antidepressant prescription was a non-adjustment dose (41.5 %). Antidepressants at the therapeutic period were mostly unchanged compared to the initial period (58.5 %) and were in the National Drug Prescription (54.7 %). There was no statistically significant difference between staff and residents in antidepressant prescription except that residents prescribed antidepressants in the National Drug Prescription at first visit and the therapeutic period with no side effects, unlike members of the staff , which was statistically significant (P < 0.001***; P < 0.01** ; P < 0.05,* respectively). Conclusion: The antidepressant prescription in the Out-patient Psychiatric Department commonly prescribed selective serotonin reuptake inhibitors (SSRI) or new generation antidepressants and non-adjustment doses. Residents prescribed more antidepressants in the National Drug Prescription than staff members were, which was statistically significant. This study found that the patients of residents did not continue follow-up after the first visit, a higher number than that of the staff (19.4 %, 5.6 %), further study should be considered.

SPECT as an aid for clinicians in the diagnosis of alzheimer's disease: A case report and review of current diagnostic approaches and the need forearly accurate diagnosis to optimize treatment.

A case of 66 year-old male with Alzheimer's dementia with classical 99mTc-ECD SPECT imaging findings is reported. The history, physical examination, and investigation, are described. Biological markers which are new used for the diagnosis of Alzheimer's dementia and current treatment are discussed.

An instrument for assessment of depression among spinal cord injury patients: comparison between the CES-D and TDI.

OBJECTIVE: To search for a simple, practical and appropriate instrument for the assessment of depression among Thai SCI patients: comparison between two self-rating instruments. MATERIAL AND METHOD: Eighty-three SCI patients were asked to complete a questionnaire composed of the Thai depression inventory (TDI) and the Center for Epidemiological Studies Depression Scale (CES-D), Thai version. All subjects were interviewed by a psychiatrist and were diagnosed according to the categories of depression of the Diagnostic and Statistical Manual of Mental fourth edition, (DSM-IV). STATISTICS: Receiver Operating Characteristic (ROC) curve and Logistic regression analysis. RESULTS: Twenty patients were confirmed to have a depressed mood or adjustment disorder. The area under the ROC curve for the CES-D and TDI was 0.826 and 0.827. The sensitivities and specificities of the CES-D and TDI were 80.0, 69.8 per cent and 70.0, 79.4 per cent respectively. The positive predictive value and negative predictive value of the two tests were 45.7, 91.7 per cent and 51.9, 89.3 per cent. Using Logistic regression analysis, the CES-D produces a better model than the TDI (Chi-square value = 23.196 and 4.578). CONCUSION: The CES-D is more appropriate for screening for depression in SCI patients than the TDI.

Research on development of the manual for self detection of depression in the Thai elderly.

The purposes of this study were to develop an effective manual for the early self detection of depression in the Thai elderly, to detect the comorbidity of depression (pattern of drug and alcohol abuse, suicidal idea) and to ascertain the quality of life. A quasi experimental field research methodology (Randomized Control Group Pretest-Posttest Design) was implemented. The sample consisted of 1,390 elderly people in 35 communities from 4 districts surrounding Siriraj Hospital-Bangkok Noi, Bangkok Yai, Taling Chan and Bang Phlat. These areas are the peripheral parts of Bangkok and most of them have extended families. The result showed that: 1. The internal consistency reliability of the nine criteria of the manual for the self detection of depression in the Thai elderly ranged from 0.84 to 0.94. The validity tested by epidemiological methods, disclosed that the sensitivity was 82.14 per cent and the specificity was 97.56 per cent. 2. There was a statistically significant difference in the incidence of depression between the study and the control group (p<0.000); self referred cases = 86.7 per cent and 9.8 per cent respectively. The study group was able to detect depression in 42 days, while the control group did so in 122 days. In addition, in the associated comorbidity, there were differences in the patterns of drug and alcohol abuse, suicidal ideas and quality of life after the experiment. These findings showed a decreasing pattern of self medication for depression, and suicidal ideas and an improvement in the quality of life in the study group.

Prevalence and incidence of depression in the Thai elderly.

The purposes of this study were to study the prevalence and incidence of depression in elderly Thais. A field survey study was implemented. The sample consisted of 1,713 elderly people in 35 communities from 4 districts surrounding Siriraj Hospital Bangkok Noi, Bangkok Yai, Taling Chun and Bang Plud. These areas are the peripheral part of Bangkok and most of them have extended family. The Thai Geriatric Depression Scale (TGDS) and the Thai Mini Mental State Examination (TMSE) were used as screening tests, for data collection. The prevalence of depression was 12.78 per cent, of which 8.23 per cent had only depressive symptomatology (male 5.43%, female 9.63%) while 4.55 per cent had both depression and cognitive impairment (male 2.8%, female 5.54%). The point incidence (one year) of depression was 7.27 (male 1.58%, female 5.68%). The major contributing factors in depression were financial, poor family relationships and physical illness. The prevention and management of these factors may bring about a better quality of life for the elderly in Thailand.

The study of risk factors for re-admission in schizophrenic patients at Siriraj Hospital 1992-1996.

A retrospective study of eighty - three in - patients with schizophrenia re-admitted to Siriraj Hospital between 1992 and 1996 was carried out to determine what risk factors had accounted for their re-admission. Of the 83 patients, 44 (53%) had previously been admitted at least twice, while 39 (47%) had been treated once. Only the duration of illness was found to be significantly different between these two groups. This was more prominent in those who had been ill for more than five years. When a comparison was made between patients who relapsed within one year and those with a longer remission period, there were significant differences in their occupation, childhood history and their family responsibilities. Patients with a remission period of one-year or less appeared to have a worse prognosis and tended to be have chronic disease, be more depedent and we found that in childhood they had been brought up by their own parent.

Clozapine treatment in 12 chronic-resistant schizophrenic patients.

Schizophrenia is a chronic disease and has been treated by typical antipsychotic drugs which act on dopamine receptor antagonists. The result of treatment is usually 1/3 response and 2/3 partial response or non-response. Clozapine is a typical anti-psychotic drug which act on serotonin and dopamine receptor antagonists. Between 40 and 80 percent of chronic resistant schizophrenia cases respond to clozapine. The effect was studied of clozapine on 12 chronic resistant schizophrenia cases, five males (41.7 percent) and seven females (58.3 percent); with a mean age of 36.6 years; average duration of illness 15.8 years; average dose 100 mg/day; duration of follow-up 231.6 days. Ten cases (83.3 percent) showed improvement, while two cases showed mild or no improvement.

A study of suicide rates in Thailand in 1990.

The suicide rates in Thailand in 1990 were studied from death certificates. There were 3,323 suicides, suicide a rate was of 5.9/100,000 or 1.4% of death in Thailand. More men committed suicide than women (1.8:1). The highest rate occurred among 15-25-year-olds of both sexes. The suicide rate among 56-65-year-olds was higher than in the 46-55-year-olds and over 65-year-olds. More single people committed suicide than married ones. More single males committed suicide than single females (2.18:1). (Fore the place of birth and death) people from northern provinces committed suicide more often than those from southern provinces. There were no significant differences in the frequency of suicide according t month of year or an occupation. More suicides were discovered by close relatives than by officials. Hanging is the most common suicide method. Poisoning and firearms are also common methods. The findings showed that methods of suicide were more violent and effective than in the past.