Newer antidepressant drug use in East Asian psychiatric treatment settings: REAP (Research on East Asia Psychotropic Prescriptions) Study.

AIMS: Antidepressant use in East Asia is poorly documented. We compared patients given newer and older antidepressants to test the hypothesis, suggested in the literature, that use of newer antidepressants is associated with treatment settings rather than specific diagnostic categories. METHODS: We compared rates of use of older (pre1990) vs. newer antidepressants among 1898 patients identified as antidepressant treated at 21 centres in five East Asian countries (China, Japan, Korea, Singapore, Taiwan) in 2003. Demographics, treatment setting and clinical factors associated with preferential use of newer drugs were tested in univariate and multivariate analyses. RESULTS: Newer antidepressants were included in the treatment regimens of 67.5% (N = 1282/1898) of study subjects. Prescription for newer antidepressants was significantly associated with younger age (z = -4.55, d.f. = 1888, P < 0.001), hospitalization [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.07, 1.64, P < 0.01] and treatment within psychiatric hospitals (OR 1.59, 95% CI 1.27, 2.00, P < 0.001). On multivariate analyses, treatment with newer antidepressants was independently associated with younger age (P < 0.001), country (P < 0.001) and treatment within private hospitals (P < 0.001), but not with sex or diagnosis of affective or anxiety disorders (all P > 0.1). CONCLUSION: Demographic factors and treatment settings appear to influence antidepressant choice more than clinical factors such as diagnosis.

Five-year review of adolescent mental health usage in Singapore.

INTRODUCTION: To provide a review of adolescent mental health service utilisation in a child and adolescent mental health outpatient clinic in Singapore. MATERIALS AND METHODS: Data from all new adolescent cases seen over a 5-year period in the Child Guidance Clinic were analysed. A review of services provided is also included. RESULTS: Adolescent mental health usage has been on an increase with a rise in the number of cases diagnosed with depression. There has also been an increase in the number of forensic cases seen in the department. CONCLUSIONS: There is a growing demand for adolescent mental health services. As the demands and stresses on today's youth increase, there is likely to be a continued increase in the demand for such services. The challenge in the future is to provide adolescent mental health services in cost-effective packages that will meet the needs as well as stay financially viable.

Ocular manifestations of Noonan syndrome.

Noonan syndrome is a genetic condition inherited in an autosomally dominant manner, characterised by congenital heart disease, short stature, abnormal facies and the somatic features of Turner's syndrome, but a normal Karyotype. The ophthalmological and orthoptic findings on 58 patients with Noonan syndrome are reported. External features were hypertelorism (74%), downward sloping palpebral apertures (38%), epicanthic folds (39%) and ptosis (48%). The orthoptic examination revealed strabismus in 48%, refractive errors in 61%, amblyopia in 33%, and nystagmus in 9% of cases. Sixty-three per cent of cases had anterior segment changes consisting of: Prominent corneal nerves (46%), anterior stromal dystrophy (4%), cataracts (8%) and panuveitis (2%). Fundal changes occurred in 20% of the study group, including optic nerve head drusen, optic disc hypoplasia, colobomas and myelinated nerves. Forty-seven per cent required non surgical treatment and a further 16% had undergone surgery for strabismus or ptosis. Only three patients had no visual defects. With such a high incidence of ophthalmic abnormalities it is clearly important that children with Noonan syndrome are screened by an ophthalmologist at an early age.

Biomicroscopic examination of the ocular fundus with a +150 dioptre lens.

This article describes the design of a +150 dioptre compound lens for biomicroscopic examination of the fundus. To compare the lens with other fundal examination techniques a method is described for measuring the magnification and vertical angle of view of the various examination lenses. By this method the +150 dioptre lens is shown to have an angle of view of 60 degrees. This is similar to that of the indirect ophthalmoscope when used with a 20 dioptre lens which has an angle of view of 57 degrees. However, the magnification of the +150 dioptre lens is greater at X5.2 compared with X3.0 for the indirect ophthalmoscope. The practical applications of the lens are discussed. In comparison the field of view of the +78 and +90 dioptre lenses are 37 degrees and 29 degrees respectively. The +150 dioptre lens has proved a useful adjunct enabling a rapid global screening of the ocular fundus on the slit-lamp before examining any particular area of interest in more detail.

Sensitivity of touch corpuscles in vitamin A-deficient rats.

Fifty percent of a population of thirty weanling rats were fed a vitamin A-deficient diet. The remaining 50% were fed a control diet. In comparison with the control group, the rate of growth started to slow down in the vitamin A-deficient animals around day 33. Single unit recordings were made from sensory nerve fibres supplying slowly adapting type I cutaneous mechanoreceptors (touch corpuscles). Touch corpuscles were stimulated repetitively with low force mechanical stimuli. Receptors in vitamin A-deficient animals showed clearly reduced nervous responses compared with receptors in control animals. Most receptors remained responsive even after prolonged repetitive stimulation.