Personality disorder and functioning in major depressive disorder: a nested study within a randomized controlled trial

Objective: This study aimed to determine if personality disorder (PD) predicted functional outcomes in patients with major depressive disorder (MDD). Methods: Data (n=71) from a double-blind, randomized, placebo-controlled 12-week trial assessing the efficacy of 200 mg/day adjunctive minocycline for MDD were examined. PD was measured using the Standardized Assessment of Personality Abbreviated Scale. Outcome measures included Clinical Global Impression - Improvement (CGI-I), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Social and Occupational Functioning Scale (SOFAS), and Range of Impaired Functioning (RIFT). Analysis of covariance was used to examine the impact of PD (dichotomized factor [≥ 3] or continuous measure) on the outcome measures-treatment group correlation. Results: PD was identified in 69% of the sample. After adjusting for age, sex, and baseline scores for each of the outcome measures, there was no significant difference between participants with and without PD on week 12 scores for any of the outcome measures (all p > 0.14). Conclusion: In this secondary analysis of a primary efficacy study, PD was a common comorbidity among those with MDD, but was not a significant predictor of functional outcomes. This study adds to the limited literature on PD in randomized controlled trials for MDD. Clinical trial registration: ACTRN12612000283875.

Posttraumatic stress disorder of the Tsunami survivors in Thailand.

BACKGROUND: The natural disaster known as "the Tsunami" occurred in the Andaman sea coast of Thailand in December 2004, and there had been questions whether it could cause PTSD amongst the population who lives in the affected area and how to avoid PTSD condition to occur. OBJECTIVE: Establish statistical results of psychosocial factors, and their correlation to PTSD and other mental disorders to generate the PTSD database. MATERIAL AND METHOD: A cross-sectional community surveys from 3,133 samples had been conducted in two phases from the same sampling group. The first phase was concerned with prevalence of PTSD, depression, and related factors. The second phase included 2,573 samples from the first phase and focused on chronic PTSD and other mental disorders. RESULTS: The 3,133 samples used in the first phase show that 33.6% suffered from PTSD, 14.27% with depression, and 11.27% suffered from both. The 2,573 samples from the first phase were followed, collected the blood, and interview data only 21.6% were diagnosed with chronic PTSD. CONCLUSION: The statistical analysis has identified risks factors that could cause PTSD, and protective actions that could help to prevent PTSD. The prevalence of PTSD was still higher in the affected region six months after the Tsunami.

Health-related quality of life in Thai bipolar disorder.

BACKGROUND: Bipolar disorder (BPD) affects both patients 'functioning and well-being. Quality of life (QoL) has gained increasing attention as an important functional outcome in BPD. The present study was conducted to assess QoL of Thai BPD patients. MATERIAL AND METHOD: The authors obtained cross-sectional demographic, clinical, and functional ratings from 285 BPD outpatients. SF-36 and Thai Mania Rating Scale (TMRS) were used to assess QoL and severity of symptoms respectively. RESULTS: The mean TMRS was 4.42 +/- 5.87. Compared with the Thai general population, SF-36 scores of study population were significantly lower, except for bodily pain and social functioning domains. Sodium valproate treated group's SF-36 scores was better than lithium carbonate treated group' (p = 0.02). CONCLUSION: The present study is one of the pioneers in assessing the impact of co-morbidity on health-related QoL in Thai BPD patients. Even in the stable phase, patients were less functioning than the normal Thai population.

Antipsychotic-induced tardive movement disorders: a series of twelve cases.

BACKGROUND: Prolonged use of antipsychotic drugs (AP) with or without sudden withdrawal as well as high dosage of AP (at least 3 months) may result in a variety of movement disorders such as classical tardive dyskinesia (tongue rolling, lip pouting, trunkal choreiform movements), tardive myoclonus (sudden, brief involuntary jerking), tardive dystonia (tongue protrusion, torticollis, scoliosis, jaw spasm, bruxism, abnormal trunkal posture, or "Pisa syndrome", strong contraction of arm and leg). Patients with severe symptoms often suffer from body pain and fractures of bones due to frequent fallings. They are also accused of "faking" to call attention or they believe that the symptoms are signs of being "cursed or posses in". OBJECTIVE: To report twelve patients of antipsychotic drug induced tardive movement disorders including tardive dystonia, tardive myoclonus, and tardive Parkinsonism. Patients were incorrectly diagnosed as epilepsy, conversion (pseudo seizure), or hypochondriasis. RESULTS: In the present series, there were eight men and four women with age ranging from 13 to 72 years. All patients had been taking both typical and atypical antipsychotic drugs for at least one year. Strong involuntary movement disorders, torticollis, scoliosis, body pain, difficulty in swallowing, and aphonia were observed Most patients were thin and anemic. They responded well to diazepam, anticholinergic drug, clonazepam lithium, and antidepressant while antipsychotic drugs were discontinued in most cases. Calcium salt and iron supplement appeared to be useful. CONCLUSION: Physicians should be aware of these abnormal movement disorders induced by AP drugs to detect early and provide prompt treatment. AP drug should be used cautiously to prevent this iatrogenic effect particularly in high- risk patients.

Neuroleptic malignant syndrome: a review and report of six cases.

The typical symptoms and signs of neuroleptic malignant syndrome (NMS) consist of fever muscle rigidity (stiffness, myoclonus, rod-like), alterations of consciousness (confusion, agitation, aggression, or catatonia), autonomic nervous system disturbances (i.e., hypertension, tachycardia, tachypnea, profuse sweating, and urine incontinence), abnormal blood tests such as low serum electrolytes, elevated serum creatinine phosphokinase (CPK) level, and leukocytosis. Muscle rigidity is often associated with myonecrosis, myoglobinuria, and elevated serum CPK. The mortality among NMS cases is in the 10 to 70% range depending on the severity of the symptoms and time of therapeutic approach. Mandatory therapy should include removal of causative agents, correction of body fluid and electrolytes, administration of benzodiazepine, clonazepam and bromocriptine (dopamine agonist), proved life-saving medications. The authors reported herein six cases with unusual clinical features of NMS. Four of them had been on antipsychotic for a year before becoming anorexic, dehydrated, agitated, and violent with paranoid delusion. One instance with underlying delirium tremens developed NMS after receiving haloperidol (30 mg IV) in addition to diazepam (200 mg IV) within 24 hours. Another patient was found to suffer from severe NMS after receiving bupropion (Dopamine inhibitor antidepressant) 300 mg/day. All patients displayed cardinal signs and symptoms of NMS in addition to dehydration and pallor. They were treated in the psychiatric ward and recovered rapidly from NMS after receiving clonazepam and bromocriptine and removal of the offending agents.

Validity of clock drawing test (CDT), scoring by Chula clock-drawing scoring system (CCSS) in screening dementia among Thai elderly in community.

OBJECTIVE: The present paper was to study the validity of screening dementia among Thai elderly by clock drawing test (CDT). MATERIAL AND METHOD: The scoring method selected to apply with CDT was Chula clock-drawing scoring system (CCSS) that was originally developed as clinically-based in Thai elderly patients. The 669 elderly subjects gathered from "Rom Klao" community in Bangkok, Thailand were asked to perform CDT and be examined by a neurologist, using NINCDS-ADRDA diagnosis criteria for probable Alzheimer's disease (AD). CDT was scored by psychiatrists using CCSS. RESULTS: The authors found the demented by clinical diagnosis in 25 cases. Using a CCSS cutoff score of 7, CDT produced positive test results in 191 subjects. Sensitivity was 88%, the specificity was 74% and the area under receiver operation characteristics (ROC) curve was 0.91. The results also showed that comparatively to cutoff point 7, a cutoff point 6 would contribute the higher specificity of 82% and have a similar sensitivity of 88% in this community-based sample. CONCLUSION: The present study provided strong support that CDT scoring by CCSS is efficient to screen dementia in the general community with satisfactory sensitivity and specificity. However modifying the CCSS cutoff score from 7 to 6 increases the specificity and is proposed to be applied in the community.

Quality of life after successful epilepsy surgery: evaluation by occupational achievement and income acquisition.

OBJECTIVES: A comprehensive epilepsy surgery program has been developed at Chulalongkorn University Hospital, Thailand to reach an international standard level, rendering patients good surgical outcomes comparable to developed countries. After successful operation, seizure free patients have become independent, self earning or employed. However, quality of life (QOL) in terms of occupational achievement and income acquisition after epilepsy surgery has never been studied. These indicators reflect the ultimate QOL in the aspects of actual independency, intact brain functions, mental health and psycho-social interactions. The authors therefore conduct the study on improvement of QOL after successful epilepsy surgery using these parameters. MATERIAL AND METHOD: One hundred and eleven intractable epilepsy who have become seizure free to worthwhile improved (Engel class I to III) after standard presurgical evaluation and epilepsy surgery from January 2002 to December 2004 were evaluated. The patients were followed up for 3 years. The occupational status and incomes were categorized according to the ranking of the patients' functioning levels. The pre and post surgery work abilities, employment and incomes were interviewed and compared. Mc Nemar test and paired t-test were used for statistical analyses. RESULTS: The average age of the 111 adults (54 males and 57 females) was 33.7 +/- 9.2 years. Eighty two percent of the patients had temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS) and underwent standard anterior temporal lobectomy. The rest had tumors, cortical dysplasia or scar and received lesionectomy or cortical resection assisted by intra-operative or intra-cranial EEG. The overall seizure free rate is 83.8%. The occupational status of the subjects was shown to improve significantly after surgery from unemployed to higher categories of professional achievement (p < 0.001). The number of unemployed and no income individuals decreased from 66 to 25 cases (62.1% reduction rate) after surgery (p < 0. 001). Reciprocally, the number of persons who achieved professional jobs with regular incomes or salaries increase from 30 to 53 cases (43.4% increasing rate) (p < 0.001). The patients who have not acquired any income increment showed improvement in working ability after epilepsy surgery. The average annual incomes per capita shows the increasing rate of 45.08%, from 55,657.85 Baht (approximately U.S. dollars 1390) to 80,748.15 Baht (approximately U.S. dollars 2018), with strong statistical significance (p < 0.001). The improvement is best seen in seizure free than in non-seizure free subjects. CONCLUSION: The present study, to the authors 'knowledge, is the first to use work abilities, professional achievement and income acquisition to assess the ultimate QOL after epilepsy surgery. Most subjects have been shown to significantly improve their postoperative lives in terms of occupational accomplishment and income increment, especially in seizure free individuals. The need for expansion of epilepsy surgery is emphasized.

Happiness and related factors in pregnant women.

BACKGROUND AND OBJECTIVES: Pregnancy is a crisis in the human life cycle as an important turning point in aspects of anatomical, physiological and psychosocial changes. An unhappy pregnanus could influence the fetal growth and development and sense of maternal competence as well as bonding with the fetus which profoundly affect the nurture of the infant after delivery. The authors'purposes were to study happiness and related factors in pregnant women having antenatal care at King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: Four hundred and thirty-eight pregnant women from the antenatal clinic at King Chulalongkorn Memorial Hospital were randomly selected to complete a set of questionnaires that consisted of personal information, pregnant information, The Oxford Happiness Questionnaire (OHQ), The Maudsley Personality Inventory (MPI) and The Marital Satisfaction Scale (MSS). Prevalence of happiness level was classified by descriptive analysis. Unpaired t-test, ANOVA and Pearson's Product Moment Correlation analyzed related factors to happiness in pregnant woman. Also Stepwise Multiple Regression Analysis was used to define predictive factors for happiness in pregnant women. RESULTS: The sample had a high level of happiness of 57.3%. Significant related factors to happiness were age between 31-35 years, high education level, high individual and family income, having saving deposition, no drug abuse, improved marital relationship, no conflict with relatives, extrovert and stable personality types and no concerns about post-partum body image. Four predictive factors for happiness in pregnant women were extrovert personality, stable personality, high family income and improved marital relationship. CONCLUSION: Level of happiness in pregnant women could be predicted by type of personality, family income and marital relationship.