MEDICAL STUDENTS AND THE ACCEPTANCE BY PSYCHIATRIC PATIENTS

Introduction   Psychiatric interviewing skills with real psychiatric patients are important for medical students. There are many factors regarding the patient acceptance being interviewed by students. Objective To investigate the acceptance of fifth-year medical students by psychiatric patients with variety of diagnoses who came for mental health care service at a university hospital in Chiang Mai, Thailand. Method A cross-sectional 3-month survey was conducted with regard to the patient attitude, satisfaction and acceptance of being interviewed by medical students. Information associated with language used and general appearance such as appearance, were explored. Results Among 197 participants, satisfaction with the interview by medical students was 72.0%. Willingness to accept further interviews was 78.2%. Having an opportunity to contribute themselves for medical education was the main reason that the patients allowed the students to interview (76.6%). Conclusion The acceptance for interview by fifth-year medical students was high. Culture had influences on language used and general appearance of medical students. Chiang Mai Med Bull2005;44(4):147-153.

COMPARISON OF METHODS USED IN MEASURING NONADHERENCE AND THE BARRIERS AGAINST ADHERENCE TO ANTIPSYCHOTIC DRUGS IN OUTPATIENTS WITH SCHIZOPHRENIA

Background Methods Results Conclusion Chiang Mai Medical Journal 2010;49(3):97-103.Subjective methods such as self-reporting and psychiatrist rating might underestimatenonadherence to antipsychotic drugs. Objective methods such as the pill count should be added toevaluate nonadherence. Furthermore, barriers against adherence in Thailand may differ in someaspects from those in western countriesOf the 75 participants in the previous study, four were lost to follow-up. In this study theprevalence of nonadherence reported by the 71 remaining patients and psychiatrists was only 5.1%and 16.9%, respectively, while that measured by pill count was 46.5%. The three most commonbarriers reported by patients with schizophrenia were memory problems, stigma, and adverse drugreactions.A prospective study was conducted at Chiang Mai University Hospital, Thailand, in which75 patients with schizophrenia were followed up from a pervious study for three months to evaluatetheir adherence to antipsychotic drugs measured by self-reporting, psychiatrist rating and pill count.The nine domains of barriers against adherence were assessed, and risk factors associated with highbarriers were analyzed using the chi-square and independent t-tests.Although patient self-reporting was the method used most commonly to measureadherence to antipsychotic drugs in schizophrenia, it may underestimate the degree of nonadherence.In addition, little is known about barriers against adherence in patients with schizophrenia inThailand.

THE ROLES OF NEUROTRANSMITTERS, HORMONES AND BRAIN-DERIVED NEUROTROPHIC FACTORS IN THE PATHOGENESIS OF DEPRESSION

Depression is one of the five leading causes of disability and disease burden worldwide. Neurotransmitters and hormones have been the focus of pathogenic studies in depression. Since knowledge of depression’s neurophysiology has become more advanced, evidence currently shows that in depression underactivation of serotonergic and noradrenergic systems play major roles in the pathogenesis of neurotransmitters, while elevated hypothalamic-pituitary-adrenal (HPA) axis activity is a hallmark of stress responses and hormonal dysfunction. Other hormones such as thyroid hormones, growth hormone, prolactin and gonadal hormones have also been found significant. Recently, there has been greater concern that Brain-derived neurotrophic factor (BDNF) might also be involved in the pathogenesis of depression. Future research may shift from dealing with neurotransmitters to focus on the interventions that modulate the HPA axis and BDNF for the treatment of depression.

Benzodiazepine overuse in an internal medicine outpatient department: a prospective study

Objective: This study aims to assess benzodiazepine overuse, in particular indications, prolonged use, and dependence for usage in out-patients treated at the internal medicine clinic of Chiang Mai University Hospital. Methods: The indications of benzodiazepine usage were examined by using the Thai Hospital Anxiety and Depression Scale in patients who were started on benzodiazepines. The duration of benzodiazepine usage was classified into: i) less than 1 month; ii) 1-6 months; and iii) longer than 6 months, and benzodiazepine dependence was assessed by using the Severity of Dependence Scale. Results: Of 40 out-patients started on benzodiazepines, only one of them (2.5%) had clinically significant anxiety. Of 58 outpatients receiving benzodiazepines, 42 patients (72.4%) had used benzodiazepines longer than 6 months. In addition, 8 patients (13.8%) were dependent on benzodiazepines. Conclusions: Benzodiazepine overuse is common in physically ill out-patients, even in the university hospital. Almost half of the surveyed patients appear to have prolonged benzodiazepine use; however, only a few patients are dependent on benzodiazepines.