Chronic Pain: Among Tertiary Care Psychiatric Out-Patients in Singapore-Prevalence and Associations with Psychiatric Disorders.

Objective: The study aimed to determine the prevalence and severity of chronic pain and its associations amongst psychiatric out-patients in a tertiary care hospital in Singapore. Methodology. The cross-sectional study was conducted among 290 psychiatric out-patients aged 21-65 years. Sociodemographic and clinical information, as well as data from Brief Pain Inventory-Short Form (BPI-sf), Beck's Depression Inventory II (BDI-II), and Beck's Anxiety Inventory (BAI) were collected. Cut points (C.P.s) dividing the sample into mild, moderate, and severe groups were created for the ratings of average pain. Eight possible cut-off values for the C.P.s between 3 and 7, representing 8 different categorical variables, were created and their relationships were examined with BPI's set of seven interference items using multivariate analysis of variance. Sociodemographic and clinical correlates of chronic pain were determined using multinomial logistic regression analysis. Analysis of covariance was used to determine the association of BPI with continuous scores of BAI and BDI. Results: Based on the C.P. pain severity classification, 38.5% of the sample had mild pain, 22.9% had moderate pain, and 11.8% had severe pain. Patients with severe pain were more likely to be associated with older age (p ≤ 0.006) (versus young age), less likely to be married (p ≤ 0.025) (versus single), and more likely to have high risk for obesity (p ≤ 0.030) (versus low risk for obesity). Participants with mild pain were seen to be significantly associated with older age (p ≤ 0.021), whereas moderate pain (p ≤ 0.002) and severe pain (p ≤ 0.001) (versus no pain) were seen to be significantly associated with higher BAI scores. Conclusion: The current study observed high prevalence of pain among patients with psychiatric illness that was determined by optimal C.P.s for mild, moderate, and severe pain. Patients diagnosed with anxiety disorders and those with higher BMI were seen to be associated with pain of moderate to severe intensity. Improving the knowledge of correlates and co-morbidities of physical pain would aid in early identification, use of prophylactic strategies, and the intervention techniques to formulate basic guidelines for pain management among psychiatric population.

Stigma and discrimination in individuals with first episode psychosis; one year after first contact with psychiatric services.

Stigma and discrimination in psychotic illness has not been robustly studied in those presenting with their first episode of psychosis (FEP). We prospectively examined patterns of stigma and discrimination one year after index presentation with FEP and correlates with baseline demographic, symptom burden, depression and level of functioning. We surveyed 101 subjects using the Discrimination and Stigma Scale-12 (DISC-12) and administered the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Function (GAF) and the Patient Health Questionnaire (PHQ-9).  Discrimination was experienced in 76%; being shunned by people because of mental illness, making and keeping friends and from family were most affected. Older age, female gender, marital status and a family history of mental illness were significantly associated with higher unfair treatment. Higher PANSS score at baseline, 3-month and 12-month was significantly associated with lower positive treatment, higher stopping self-scores and lower overcoming stigma scores, respectively. Higher GAF score at 12-month was associated with higher overcoming stigma scores. Lower PHQ-9 scores was significantly correlated with overcoming stigma. In conclusion, stigma and discrimination is highly prevalent among individuals with FEP; the extent is associated with specific demographic variables, symptom burden, presence of depression and level of functioning. Limitations include selection bias of subjects, potential underestimation of stigma from participants who defaulted or refused to participate and inability to establish causality.