Course and predictors of disability in Thai patients with schizophrenia: A 2-year, multi-center, prospective, observational study.

PURPOSE: This 2-year, multi-center, prospective, observational study aimed to describe the course and examine baseline characteristics for predicting disability in Thai patients with schizophrenia. METHODS: Participants were patients with schizophrenia aged 18-65 years receiving treatment in five tertiary hospitals. Disability was defined by a score of 10 or more of the 12-item World Health Organization Disability Assessment Schedule, version 2.0 (12-item WHODAS 2.0). Other data being collected included socio-demographic data, course of illness, antipsychotics, antipsychotic drug attitudes, behavioral/psychiatric symptoms, alcohol use, social supports, and quality of life at five visits, including weeks 0 (baseline), 24, 48, 72, and 96. RESULTS: Of the 158 enrolled patients, we analyzed the data of 119 participants who were reassessed at least once during the follow-up. These 119 participants (70% male) had median age and age at psychotic onset of 38 and 22 years, respectively. Disability was found in 43 (36.1%) participants at baseline and 72 (64.7%) participants at week 96. The median [interquartile ranges] WHODAS scores at five time points were 6 [3-12], 9 [4-13], 10 [6-10], 10 [4-10], and 10 [6-10], respectively (p < 0.001). The multivariate logistic regression analysis revealed that duration of psychosis (adjusted odds ratio = 1.08, 95%CI = 1.04 - 1.14, p = 0.001) and depression (adjusted odds ratio = 3.54, 95%CI = 1.14 - 11.06, p = 0.029) at baseline predicted 2-year disability. CONCLUSIONS: Thai patients with schizophrenia had an increase in disability over a 2-year follow-up period. Duration of psychosis and depression were predictors of disability in these patients.

Validity and reliability of the Thai version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).

PURPOSE: The purpose of this study was to determine the validity and reliability of the Thai version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), when compared to the diagnoses made by delirium experts. PATIENTS AND METHODS: This was a cross-sectional study conducted in both surgical intensive care and subintensive care units in Thailand between February-June 2011. Seventy patients aged 60 years or older who had been admitted to the units were enrolled into the study within the first 48 hours of admission. Each patient was randomly assessed as to whether they had delirium by a nurse using the Thai version of the CAM-ICU algorithm (Thai CAM-ICU) or by a delirium expert using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. RESULTS: The prevalence of delirium was found to be 18.6% (n=13) by the delirium experts. The sensitivity of the Thai CAM-ICU's algorithms was found to be 92.3% (95% confidence interval [CI] =64.0%-99.8%), while the specificity was 94.7% (95% CI =85.4%-98.9%). The instrument displayed good interrater reliability (Cohen's κ =0.81; 95% CI =0.64-0.99). The time taken to complete the Thai CAM-ICU was 1 minute (interquatile range, 1-2 minutes). CONCLUSION: The Thai CAM-ICU demonstrated good validity, reliability, and ease of use when diagnosing delirium in a surgical intensive care unit setting. The use of this diagnostic tool should be encouraged for daily, routine use, so as to promote the early detection of delirium and its rapid treatment.