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.

Holistic management of traumatic spinal cord injury resulting from a fracture of T-09 vertebra.

Traumatic spinal cord injury (SCI) is an disastrous condition resulting in not only disability and handicap to the victims but also profound psychological damage. We report a case of complete spinal cord injury resulting from a fracture of T-9 vertebra in a car accident. Emergency management is needed to prevent further damage to the neural tissue, as well as to treat a life threatening condition. Surgical treatment to maintain spinal alignment and stability provides early mobilization to prevent the complications caused by the immobilization syndrome. A holistic approach to management is fundamental to the rehabilitation program. Although physical impairment and disability are permanent, psychosocial management focused on cognitive and behavioral modification together with home modification plays an important role in reducing disability and handicap and allowing a patient to return to his home and previous social function with the best quality of life as possible.

Factitious disorder with abdominal pain and multiple surgical operations: A case report.

Factitious disorder is characterized by physical or psychological symptoms that a person intentionally produces or feigns to pretend to be sick although not for external benefits such as financial compensation. As a result of the difficulty in diagnosing the disorder, its prevalence is relatively rare. The definite diagnosis and its proper management is important, particularly in preventing unneeded medical procedures as well as reducing stress in these patients’ families and reducing cost of management. We report a 17-year-old woman who presented to the Department of Surgery with severe abdominal pain and underwent her 5th abdominal operation due to provisional diagnosis of gut obstruction. The surgeon found only some fibrosis which could not explain her severe abdominal pain. After the operation, she still had abdominal pain, distension and intermittent fever although no source of infection nor physical illness could be found to explain this. Psychiatric consultation was came out because of her disturbed behavior and because she was uncooperative. We found that she had been admitted to several hospitals more than 50 times and had undergone 4 major operations in the past 4 years because of her abdominal pain. Surprisingly she was not distressed at all despite these chronic physical illnesses. After close observation by ward nurses, her persistent fever finally disappeared. We transferred her to our psychiatric ward and gave one of serotonin-specific reuptake inhibitors (SSRIs) which is effective in treating compulsion as well as depression, together with family counseling and individual psychotherapy. Finally she confessed that she feigned the symptoms, so we could make the definite diagnosis of factitious disorder with predominantly physical signs and symptoms.

Neuroleptic malignant syndrome in a diabetic patient with eye complication and acute psychosis.

Neuroleptic malignant syndrome is a life-threatenting complica-tion of antipsychotic treatment. The prevalence is estimated to be 0.02 to 2.4 percent of patients exposed to dopamine receptor antagonists. Mortality rates are reported to be 10-20 percent. The important clinical signs and symptoms are severe muscle rigidity and fever. Other features are changes in level of consciousness ranging from confusion to coma, autonomic instability and laboratory evidence of muscle injury (eg, elevated CPK). We report a diabetic patient with eye complications and acute psychosis, developing neuroleptic malignant syndrome four days after receiving haloperidol 15 mg/day. The patient recovered well within 5 days after discontinuation of haloperidol and symptomatic treatment and had undergone an eye operation which yielded good result.

Nocturnal enuresis, a new side effect of valproate in adult: A case report.

Valproate is anticonvulsant which has been used in treatment and prevention of bipolar disorders. Its common side effects are nausea, tremor, weight gain. Other less common side effects are sedation, hair loss, thrombocytopenia, hepatotoxicity. There were several studies of valproate in children treated for seizures recording enuresis as a side effect. As far as we know, this unwanted side effect has not been previously reported in adult patients nor in bipolar disorder patients. So we report here a case of 45-year-old man with rapid cycling bipolar disorder, whose symptoms responded well to valproate, developed enuresis as a side-effect of valproate.

Hyperventilation syndrome and family therapy: A case report.

Hyperventilation syndrome usually occurs in patients who have psychological and/or psychosocial stress(es). Hyperventilative patients breathe rapidly and deeply for several minutes, feel light-headed, and then faint because of cerebral vasoconstriction and a respiratory alkalosis. Other symptoms such as paresthesias and carpopedal spasm, may be presented. Conventional treatment consists of instruction or retrataining regarding particular symptoms and how they are evoked by hyperventilation so that patients can consciously avoid precipicular symptoms. Breathing into a paper bag can abort the attack. Reassurance, supportive psychotherapy and antianxiety medication are also indicated. As far as we know, there has been no report about treating hyperventilation syndrome with family therapy. We report here on a 13-year-old adolescent girl who presented with a history of multiple hyperventilation syndrome attacks in four months precipitated with psychosocial stressors and a family problem. Her symptoms had not been recovered by conventional treatment. Family therapy was given to the patient and her family for one session. After the treatment, her symptoms were cured, she and her family understood and solved the problem. She has been healthy and can study well.

Alzheimer’s disease sufferers’ caregivers: Family beliefs and degree of burden.

This paper is a pilot study which looks family beliefs which influence the choice of a caregiver for an Alzheimer’s disease sufferer. It focuses on the characteristics of caregivers, as well as the process through which they are identified. That is, how families ‘choose’ a caregiver (the family patterns of choosing a caregiver) and the beliefs about their choice. The burdens of caring are also considered. In this study, three of four caregivers are husbands looking after and having a very close and strong positive relationship with their wives. They have slightly to moderate stress. The family beliefs about the most important factors for being a caregiver are having good physical and mental health, a good giving and having the same gender as the dementia sufferer.