Dietary intake of persons with depressive and psychotic disorders in Singapore

INTRODUCTION@#Nutritional psychiatry is an emerging field of study that investigates the role of diet and nutrition in mental health. Studies conducted in the general population have linked depressive symptoms with poor dietary patterns. The aim of this study was to characterise the dietary intake and analyse the dietary pattern using the Dietary Approach to Stop Hypertension (DASH) in a sample of psychiatric patients in a multiethnic Asian nation.@*METHODS@#Participants were recruited from an outpatient clinic and an inpatient unit at the Institute of Mental Health in Singapore. Self-reported dietary habits of a sample of psychiatric patients (N=380) were analysed using DASH. To examine the variables associated with DASH scores, a linear regression was conducted with the full sample and sociodemographic variables.@*RESULTS@#Persons with depressive disorders had a mean DASH score of 21.3 (±4.2), while persons with psychotic disorders had a mean DASH score of 21.2 (±4.9). Respondents who were older (B=1.94, 95% confidence interval [CI] 0.91-2.96, @*CONCLUSION@#Dietary patterns of persons with mental disorders were characterised. A host of sociodemographic factors, and not diagnosis of mental disorders, influenced the dietary quality of people with depressive and psychotic disorders. Clinicians treating psychiatric patients need to be aware of the nuanced reasons behind poor dietary choices and provide targeted psychoeducation to specific subgroups within the patient population.

Psychiatrists' opinion towards medication discontinuation in remitted first-episode psychosis: A multi-site study of the Asian Network for Early Psychosis.

AIM: The study investigated psychiatrists' views towards the issue of medication discontinuation for patients in remission from first-episode psychosis in four countries (Hong Kong, Korea, Singapore and Japan) that are part of the Asian Network for Early Psychosis, focusing on whether the views of these countries differ with one another. METHODS: A questionnaire was distributed to psychiatrists for completion. The questionnaire contained three sections: direct questions probing at views on medication discontinuation, case vignettes to assess applied decision-making and a checklist of criteria psychiatrists may view as necessary for the patient to satisfy before discontinuation. Total of 484 psychiatrists (97 from Hong Kong, 88 from Korea, 64 from Singapore and 233 from Japan) completed the questionnaire. RESULTS: We found that (a) Asian psychiatrists believed that 1% to 19% of remitted patients can discontinue medication, an estimation that was lower than Western psychiatrists; (b) in agreement with clinical guidelines, Asian psychiatrists believed that patients should remain on medication for at least 1 to 2 years following the absence of psychotic symptoms; (c) "Absence of any relapsing episode following first episode" was considered the most important criterion when making a decision; and (d) there were significant differences in clinicians' perceptions across the four countries: for instance, Korean psychiatrists were more conservative with the duration of antipsychotics maintenance, while Singaporean psychiatrists were more open-minded towards clinical trials. CONCLUSIONS: Culture and social norms appear to determine the relative importance of factors that psychiatrists might consider during the decision-making process, thereby producing variations in the views held in different countries.

Prevalence and Correlates of Internet Gaming Problem among Internet Users: Results from an Internet Survey

<p><b>INTRODUCTION</b>The current study aimed to establish the prevalence of internet gaming disorder (IGD) and its association with demographic characteristics, game genre, game use (time spent on gaming), as well as psychological distress, social phobia and well-being among current online gamers in Singapore.</p><p><b>MATERIALS AND METHODS</b>A total of 1251 participants aged 13 to 40 years completed the study which was administered as a web survey. The online questionnaire was designed using QuestionPro, and consisted of 8 sections and 105 questions. The 9-item Internet Gaming Disorder Questionnaire was used to establish the prevalence of IGD in the study. A series of logistic regression models were used to examine the associations between IGD, demographic characteristics and game genre, as well as IGD and psychological distress, social phobia and well-being.</p><p><b>RESULTS</b>The prevalence of IGD established using a cutoff of 5 among those who were current online gamers was 17.7%. Multiple logistic regressions revealed that those meeting criteria of IGD were more likely to be older, reported an earlier age of onset of playing online games, had primary and secondary education versus tertiary education, were currently students versus being currently employed and played massively multiplayer online role-playing games. Distress and social anxiety were higher while satisfaction with life was significantly lower among those who met criteria for IGD than those who did not meet the criteria.</p><p><b>CONCLUSION</b>The prevalence of IGD and its negative consequences in our sample of current online gamers was significant and point towards the need for further clinical studies and innovative interventions to address the problem.</p>

Thin At What Cost? Case Reports Of Sibutramine-Induced Psychotic Disorders

Objective: The objective of these 4 case reports is to highlight that psychotic symptom can occur due to the consumption of sibutramine. The psychosis is usually self-remitting, once its consumption is stopped. Methods: All cases with first episode psychosis presenting to a tertiary mental health Institute in Singapore were screened and 4 consecutive sibutramine-induced psychoses cases are reported. Results: All the 4 cases that were diagnosed with Sibutramine induced psychoses, had history of consumption of the substance in the tablet form or in substances like slimming tea or slimming powders. In 2 out of the 4 cases, no antipsychotics were started. In the 2 cases that received antipsychotics, they were for short duration. There was a temporal association between the consumption of sibutramine containing substances and the onset of psychotic symptoms. All patients were on follow up for two years and in 2 patients, there were no recurrence of psychotic symptoms. In 2 patient recurrent psychotic symptoms were temporally related with consumption of sibutramine and symptoms remitted when the consumption was stopped. Conclusions: Despite sibutramine being banned in several countries, it can still be purchased from countries allowing its sale and from online stores. Labeling a patient having schizophrenia can be avoided if detailed history, specifically enquiring about the consumption of sibutramine is obtained.

Outcomes of the Early Psychosis Intervention Programme (EPIP) Singapore

Psychoses are serious and potentially chronic mental disorders with a profound impact, in terms of economic cost and human suffering, on patients, their families and society. Early detection and treatment, through reducing the duration of untreated psychosis, however, could lead to a better outcome. In 2001, the Early Psychosis Intervention Programme (EPIP), Singapore was started with the following key strategies: (1) early detection of psychosis through outreach to and network with the community and our partners; (2) provision of clinical treatment that is evidence-based; and (3) conducting clinically relevant research to evaluate our service to be accountable to the stake-holders and to ensure cost-effectiveness. A myriad of structure, process and outcome measures offering a multi-dimensional evaluation were chosen to make us accountable to a broad range of stakeholders, from our funders, other service providers, to our patients and their families. EPIP has shown good outcomes in terms of number of patients accepted into the programme, as well as our clinical service provision. Such outcomes are achieved with our community partners playing an important role. General Practitioners, in particular, are vital not only in the detection, management of such individuals, but also in the re-integration of our patients back to community.

Performance measures for mental healthcare in Singapore

Mental disorders are both common and costly. The mental health system in Singapore lacks co-ordination as well as being underdeveloped in certain areas. To address these gaps as well to face emerging challenges like an ageing population, and other socioeconomic changes, the Ministry of Health of Singapore has commissioned a Committee to formulate a 5-year Mental Health Policy and Blueprint. A task group has been formed to implement this blueprint and evaluation of these various initiatives with performance measures are inevitable. The choice of these measures, however, can be a daunting task with the various and diverse interests of multiple stakeholders. This paper describes the process of choosing the relevant measures with the appropriate attributes, and suggests a framework, which can serve as a guide for selecting mental health performance measures.