Are the demographic and clinical features of pathological gamblers seeking treatment in Singapore changing?

INTRODUCTION: The expansion in gambling activities over the past decade has made gambling more accessible than ever. This could bring changes in the sociodemographic and clinical profiles of those seeking treatment for pathological gambling. METHODS: This study examined the differences between two cohorts of 150 patients each, treated at the National Addictions Management Service between 2001 and 2006 (cohort-1) and between 2006 and 2008 (cohort-2), respectively. RESULTS: Compared to cohort-1, cohort-2 was significantly younger (p-value less than 0.01), comprised fewer Chinese and were more highly educated (p-value less than 0.05), with no significant difference in gender or marital status. Regarding the type of gambling activities, cohort-2 was more likely to engage in soccer betting (p-value less than 0.01). Although the proportion presenting with any comorbidity remained unchanged, alcohol use disorders had increased more than three-fold and suicide risk was slightly elevated, although not significantly. DISCUSSION: Clinicians should undertake routine screening and assessment of alcohol misuse and suicide risk, offering brief interventions, where necessary, for this vulnerable population.

1,25-Dihydroxyvitamin D3 targeting of NF-kappaB suppresses high glucose-induced MCP-1 expression in mesangial cells.

Macrophages accumulate in kidney glomeruli and interstitium of patients with diabetic nephropathy in response to monocyte chemoattractant protein-1 (MCP-1); a chemokine produced by both tubular epithelial and mesangial cells (MCs). Vitamin D and its analogs have been shown to have renoprotective effects; however, there are few studies involving diabetic nephropathy. We explored mechanisms by which 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) can be renoprotective by measuring MCP-1 expression in MCs. Using a luciferase reporter assay, we found that high glucose (HG)-induced MCP-1 transcription and that this induction is blocked by 1,25(OH)2D3. Electrophoretic mobility shift and chromatin immunoprecipitation assays showed that HG increased the p65/p50 binding to the two NF-kappaB sites within the promoter. This was suppressed by 1,25(OH)2D3, but this decrease was reversed by overexpression of p65. 1,25(OH)2D3 was found to stabilize IkappaBalpha leading to an inhibition of p65 translocation to the nucleus and subsequent reduction of NF-kappaB binding. In primary MCs prepared from vitamin D receptor knockout animals, basal MCP-1 levels were elevated but not affected by 1,25(OH)2D3. The analog paricalcitol inhibited the induction and activity of MCP-1 while ameliorating glomerulosclerosis in streptozotocin-diabetic mice. Our results suggest that 1,25(OH)2D3 might block hyperglycemia-induced renal injury by blunting NF-kappaB activation.

A 20-year follow-up study on schizophrenia in Singapore.

OBJECTIVE: To assess the outcome and predictors of patients with schizophrenia 20 years later. METHOD: The patients, aged 15-39 years, with diagnosis of schizophrenia and first admitted to a national mental hospital in Singapore in 1975 were included. In 1980, 1985, 1990 and 1995, their hospital records were examined and the patients were interviewed to determine their working and treatment status. Possible predictors of good outcome and suicide data were determined. RESULTS: A total of 402 patients were included. Over 20 years, there was lower percentage of patients working full time and proportionately more patients were receiving out-patient treatment. Overall, about two-third of the patients had a good/fair outcome. Shorter illness duration before admission was significantly associated with a good outcome. The suicide rate was the highest in the first 10 years. CONCLUSION: Most patients with schizophrenia had a good/fair outcome at 20 years.

Clinical evaluation of risperidone in Asian patients with schizophrenia in Singapore.

OBJECTIVE: To evaluate the short-term efficacy and safety of risperidone in a group of Asian patients with schizophrenia in an 8-week open-label, prospective study. METHODS: Patients with DSM-IV schizophrenia were recruited from Woodbridge Hospital. After a washout period, they were started on a 56-day trial of risperidone. Outcome was assessed with the positive and negative syndrome scale (PANSS), the clinical global impression scale (CGI) and the extrapyramidal symptom rating scale (ESRS). RESULTS: The mean daily risperidone dose at end point was 5.6 mg (range, 3 to 8 md/day). Mean PANSS scores were reduced significantly from 78 +/- 15.1 at baseline to 56.6 +/- 10.9 at end point. Seventeen patients (85%) who were treatment responders, showed at least a 20% reduction in total PANSS scores at end point while nine patients (45%) had a greater than 50% reduction in the total PANSS scores. According to the CGI scale, 85% improved at end point. The severity of extrapyramidal symptoms (mean ESRS scores) were significantly lower at end point than at baseline. CONCLUSIONS: Risperidone was effective in the treatment of positive and negative symptoms of schizophrenia.

Use of atypical neuroleptics in a state mental institute.

The authors sought to give a perspective of the local use of two atypical neuroleptics which may represent a new era in the treatment of schizophrenia. The findings from local drug trials and clinical reports are summarised. Both clozapine and risperidone are efficacious in reducing the psychotic symptomatology of schizophrenia as well as inducing less extrapyramidal side-effects. Differences in plasma clozapine levels were found in local Chinese patients when compared to American subjects. Combined use of clozapine and risperidone may give rise to adverse reactions. Both clozapine and risperidone are efficacious and safe in the treatment of schizophrenia.

Association between allele 1 of T102C polymorphism, 5-hydroxytryptamine 2a receptor gene and schizophrenia in Chinese males in Singapore.

The T102C polymorphism at the 5-hydroxytryptamine 2a receptor (5HTR2a) gene was studied in 101 Chinese male schizophrenics and 103 controls. Genotyping revealed a predominance of allele 1 among schizophrenics. This is in contrast to previous reports in Caucasians and Japanese which showed an association of allele 2 of this polymorphism with schizophrenia.

Initial experience with clozapine in Woodbridge Hospital.

OBJECTIVES: This study was performed to evaluate the efficacy and side-effect profile of the atypical neuroleptic clozapine in local Asian patients with treatment-resistant schizophrenia. METHOD: Patients were treated with 12 weeks of clozapine after undergoing a washout of all previous neuroleptics. They were assessed weekly on the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) and the Simpson-Angus Scale for Extrapyramidal Side-Effects. RESULTS: Clinical improvement (according to criteria established a priori) at study end point was shown in 78.9% of the patients. There was no statistical difference in the incidence of the extrapyramidal side-effects at starting and end points. The mean daily dosage was 356.6 mg. The most common adverse effect was hypersalivation. CONCLUSION: Clozapine is effective and well tolerated in local patients with treatment-resistant schizophrenia.

Clinical evaluation and plasma clozapine concentrations in Chinese patients with schizophrenia.

The relationships between clozapine dosages, plasma concentrations, and clinical responses in Chinese schizophrenics were studied. Fourteen treatment-refractory schizophrenic patients were treated with clozapine for 12 weeks. Patients were assessed before and after 6 and 12 weeks of treatment using the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI), and the Simpson-Angus Scale for Extrapyramidal Side Effect. Plasma clozapine concentrations were determined by high-performance liquid chromatography. Ten patients (71.4%) responded after 12 weeks of treatment. Although the mean daily dosage at week 12 (373 +/- 90 mg/day) was lower than that reported in American trials (444 mg/day), the mean plasma clozapine concentration attained (1,078 +/- 385 ng/ml) was higher. This higher concentration may be due to the lower body wight and the preponderance of women among our patients, absence of smoking and alcohol use, and/or ethnic difference between Chinese and non-Chinese. There was wide interindividual variation in the plasma clozapine concentrations. Compared with other studies, the plasma clozapine concentrations and the response rate were higher. Although the sample size was small, the findings are suggestive of pharmacokinetic and pharmacodynamic ethnic differences in Chinese with clozapine therapy.

A postmarketing surveillance study of zopiclone in insomnia.

Zopiclone, a novel cyclopyrrolone compound has recently become available for the treatment of insomnia in Singapore. Pharmacodynamic and pharmacokinetic studies have shown it to be an effective hypnotic with a good safety profile and minimal side-effects. The efficacy of Zopiclone was studied in a group of patients with insomnia (n = 40). The study group comprised patients with and without a psychiatric diagnosis. About two-thirds (65%) of the patients had been on hypnotics previously without relief of the insomnia. There was improvement in the various sleep parameters studied: sleep latency, sleep duration, night awakening, sleep quality, dreams, "day-after" effects. The drug was well-tolerated and only four patients experienced minor side-effects.

A practical approach to the management of psychoses.

The importance of differentiating between the organic and functional psychoses is stressed. The salient features of the different types of functional psychoses are discussed and the management of the psychoses is approached from biological, psychological and sociological angles at the same time. Corroboration of history by concerned relatives or friends is deemed indispensable.

A 15-year follow-up study of Chinese schizophrenic patients.

A cohort of 330 Chinese schizophrenic patients below age 40 were interviewed 5, 10 and 15 years later to determine which variables could predict their outcome. There were 189 males (57%) and 141 females (43%). At the end of 15 years, 48 (15%) died (34 (10%) from suicide). At the end of 5, 10 and 15 years, the percentages of patients still able to work were 55%, 54% and 48%, and still receiving treatment were 45%, 41% and 45% respectively. The patients who were well in 1990 had fewer readmissions. The only variables that consistently predicted outcome was duration of illness. Age and education level were fairly useful in predicting outcome. Sex, family history, work status, marital status, alcohol, drug and suicide history, and such symptoms as thought disorder, affective blunting, depression, delusions and hallucinations were not useful in predicting outcome.

Stevens-Johnson syndrome in neuroleptic-carbamazepine combination.

Three cases of Stevens-Johnson Syndrome developing after the addition of Carbamazepine to existing neuroleptic medication are described. In all 3, the syndrome developed within two weeks of starting Carbamazepine. It is suggested that neuroleptic-Carbamazepine combination predisposes the patient to increased risk of Stevens-Johnson Syndrome. This observation is pertinent in everyday psychiatric practice as there is indication of increasing prescription of Carbamazepine.

Depersonalization syndrome--a report of 9 cases.

Depersonalization is defined and the clinical characteristics of 9 patients presenting with Depersonalization Syndrome are discussed. The cases comprise 5 males and 4 females with an age range of 15-47 years, of which two-thirds presented with an acute onset of symptoms. The diagnosis is made on the patients' own descriptions of their symptoms. Criteria laid out by Ackner and ICD-9 are closely adhered to. The findings of the study are compared with those of Shorvon's 66 cases and similarities are found. Depersonalization symptoms described by Mayer-Gross are reviewed. That depersonalization itself appears to have an affective aspect and a somatic aspect is noted, and an explanation for both aspects is attempted. The resistance to various treatment is confirmed.

A comparative study of pipothiazine palmitate and fluphenazine decanoate in the maintenance of remission of schizophrenia.

This paper reports a randomized, controlled, partially-blinded, flexible dose, parallel group, comparative study of the efficacy and tolerance of pipothiazine palmitate and fluphenazine decanoate in patients in remission from Schizophrenia over a 28 week period. The results show that pipothiazine palmitate is at least as efficacious and well-tolerated as fluphenazine decanoate in preventing relapses from maintained Schizophrenia.