Consensus statements on the clinical uses of pregabalin for Hong Kong.

To facilitate the understanding of pregabalin and optimize its clinical usage in Hong Kong, an expert panel (11 psychiatrists, one family physician and one anesthesiologist) experienced in treating anxiety and somatic symptoms was invited to establish a set of consensus statements based on several discussion areas. A non-systematic literature search for relevant articles was conducted. The panelists addressed the discussion areas by sharing their clinical experience and available literature in a couple of meetings. At the last meeting, consensus statements derived from the proceedings were discussed and finalized. A total of 11 statements were ultimately accepted by panel voting based on their practicability of recommendation in Hong Kong. These statements are aimed to act as a practical reference for local clinicians when they consider prescribing pregabalin in different clinical situations.

Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up.

BACKGROUND: Short-term follow-up studies of severe acute respiratory syndrome (SARS) survivors suggested that their physical conditions continuously improved in the first year but that their mental health did not. We investigated long-term psychiatric morbidities and chronic fatigue among SARS survivors. METHODS: All SARS survivors from the hospitals of a local region in Hong Kong were assessed by a constellation of psychometric questionnaires and a semistructured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) to determine the presence of psychiatric disorders and chronic fatigue problems. RESULTS: Of 369 SARS survivors, 233 (63.1%) participated in the study (mean period of time after SARS, 41.3 months). Over 40% of the respondents had active psychiatric illnesses, 40.3% reported a chronic fatigue problem, and 27.1% met the modified 1994 Centers for Disease Control and Prevention criteria for chronic fatigue syndrome. Logistic regression analysis suggested that being a health care worker at the time of SARS infection (odds ratio [OR], 3.24; 95% confidence interval [CI], 1.12- 9.39; P = .03), being unemployed at follow-up (OR, 4.71; 95% CI, 1.50-14.78; P = .008), having a perception of social stigmatization (OR, 3.03; 95% CI, 1.20-7.60; P = .02), and having applied to the SARS survivors' fund (OR, 2.92; 95% CI, 1.18-7.22; P = .02) were associated with an increased risk of psychiatric morbidities at follow-up, whereas application to the SARS survivors' fund (OR, 2.64; 95% CI, 1.07-6.51; P = .04) was associated with increased risk of chronic fatigue problems. CONCLUSIONS: Psychiatric morbidities and chronic fatigue persisted and continued to be clinically significant among the survivors at the 4-year follow-up. Optimization of the treatment of mental health morbidities by a multidisciplinary approach with a view for long-term rehabilitation, especially targeting psychiatric and fatigue problems and functional and occupational rehabilitation, would be needed.

Sleepwalking in psychiatric patients: comparison of childhood and adult onset.

OBJECTIVES: In contrast to the 'benign and self-limiting nature' of childhood sleepwalking, some population and case studies have suggested that adult sleepwalking is more likely to be associated with psychopathology and psychotropic medications. There is a paucity, however, of systematic study in adult psychiatric populations, and the aim of the present study was therefore to compare the impact of psychopathology and medication usage on sleepwalking with reference to age of onset. METHODS: Clinical characteristics, sleep symptoms, psychiatric diagnosis and psychotropic usage in 66 childhood- and adult-onset sleepwalkers as identified from a psychiatric clinic, were studied. RESULTS: There was a higher proportion of adult-onset sleepwalking in the psychiatric population. In comparison with childhood-onset sleepwalkers, adult-onset sleepwalkers had higher peak frequency of attacks and a high comorbidity with sleep-related eating features. Factors including frequent insomnia (odds ratio (OR) = 5.39, 95% confidence interval (CI) = 1.58-18.40, p = 0.007) and lifetime usage of regular zolpidem (OR = 5.58, 95%CI = 1.65-18.84, p < 0.006) were associated with a higher risk of adult-onset sleepwalking. CONCLUSIONS: Adult-onset sleepwalking in a psychiatric sample has unique clinical characteristics and specific risk factors. These patients were more likely to present with sleep-related eating features, comorbid insomnia, had and lifetime usage of non-benzodiazepine hypnotics, especially zolpidem. A heightened awareness of the presence of sleepwalking and their associated risk factors among the adult psychiatric population is needed.

Longitudinal follow up of primary insomnia patients in a psychiatric clinic.

OBJECTIVE: Insomnia could be a symptom of underlying psychiatric or physical disorder, a risk factor for other psychiatric disorder, or a discrete psychiatric disorder per se. In order to determine the nosological status of primary insomnia, an outcome study was carried out to investigate its diagnostic stability and its relationship to subsequent psychiatric disorders. METHODS: Fifty-three primary insomnia patients in a university hospital psychiatric outpatient clinic were assessed by retrospective case note review, followed by a 6 month prospective follow up with Structured Clinical Interview Schedule for DSM-IV In-patient (SCID-I/P, version 2.0, and a sleep questionnaire. RESULTS: The majority of patients (n =44, 83%) did not develop other psychiatric disorders after 13.4+/-1.2 years from the onset of insomnia. Nine patients (17%) developed mood disorder (n =6), anxiety disorder (n =2) and somatoform disorder (n =1) at 6.3+/-2.3 years after the onset of insomnia. Subjective deterioration of insomnia and a shorter duration of sleep symptoms at the first consultation were associated with the development of secondary psychiatric disorders. Approximately one-third (n =17, 32%) reported symptoms improvement and six (13.2%) were free from medications. Better education was the only factor that predicted improvement in symptoms. CONCLUSIONS: There existed a longitudinal diagnostic stability of primary insomnia in a majority of clinical patients. However, in a proportion of patients, it might either be a risk factor or a prodrome of mood or anxiety disorders.