Cognitive impairments predict the behavioral and psychological symptoms of dementia.

Introduction: The purpose of this study was to (1) validate the Thai version of the Neuropsychiatric Inventory Questionnaire (NPI-Q) as a screening tool for behavioral and psychological symptoms of dementia (BPSD), and (2) examine the relationship between cognitive performance and BPSD in an elderly population with amnestic mild cognitive impairment (aMCI) and dementia of Alzheimer's type (DAT). Methods: One hundred and twenty participants, comprising 80 aMCI and 40 DAT patients, and their respective caregivers were included in the study. Participants completed the NPI-Q and the Neuropsychiatric Inventory (NPI) within 2 weeks of each other and cognitive performance was primarily assessed using the Montreal Cognitive Assessment (MoCA). Results: The Thai NPI-Q had good validity and reliability. Pure exploratory bifactor analysis revealed that a general factor and a single-group factor (with high loadings on delusions, hallucinations, apathy, and appetite) underpinned the NPI-Q domains. Significant negative correlations between the MoCA total score and the general and single-group NPI-Q scores were found in all subjects (aMCI + DAT combined) and DAT alone, but not in aMCI. Cluster analysis allocated subjects with BPSD (10% of aMCI and 50% of DAT participants) into a distinct "DAT + BPSD" class. Conclusion: The NPI-Q is an appropriate instrument for assessing BPSD and the total score is largely predicted by cognitive deficits. It is plausible that aMCI subjects with severe NPI-Q symptoms (10% of our sample) may have a poorer prognosis and constitute a subgroup of aMCI patients who will likely convert into probable dementia.

The Effects of Cognitive Training in Healthy Community Residing Thai Elderly: A Randomized Controlled Trial.

Purpose: Cognitive training intervention (CTI) is defined as any mechanism of action of a non-pharmacological procedure provided to improve cognitive function. CTI in healthy elderly has the potential to improve cognitive function; however, the effects of interactive computerized-CTI in old ages have been inconclusive. The present study aimed to determine the effects of low-technology CTI in community-based populations. Patients and Methods: The study was a 2-arm parallel single-blinded randomized controlled intervention trial. The main outcome measured global cognitive function utilizing the Thai Mental State Examination (TMSE); the minor outcomes were cognitive subdomains and psychosocial outcomes (ie, quality of life and depression). The primary endpoint assessed the treatment effect at the 12th week (T1), while the secondary endpoint evaluated the carry-over effect at the 24th week (T2). Results: Eighty-six eligible participants were recruited from a senior society on the edge of Bangkok. At baseline (T0), the mean age and TMSE score among CTI (n = 44) and wait-list (n = 42) groups were similar (age; 66.66 ± 5.52 and 67.52 ± 6.46; TMSE; 28.84 ± 1.38 and 28.83 ± 1.12, respectively). For the CTI group, the mean number of cognitive training sessions was 14.82 ± 7.62. By using intention-to-treat analysis at the primary endpoint, the mean difference score of TMSE in the CTI group was significantly higher than the wait-list group (∆TMSEbetween group at T1-T0 = 0.57; 95% CI = 0.07 to 1.08), while the effect size was 0.48. At the secondary endpoint, there was no significant difference observed between the CTI and wait-list groups (∆TMSEbetween group at T2-T0 = 0.33; 95% CI = -0.23 to 0.88), while the effect size was 0.25. The cognitive subdomains and psychosocial outcomes were discovered with no significant difference. Conclusion: CTI showed significant treatment effect for improvement in global cognitive function in healthy Thai elderly but did not demonstrate carry-over effect. This study provided preliminary evidence of the feasibility of implementing low-technology CTI in middle-income countries.

Etiology of Dementia in Thai Patients.

INTRODUCTION: Molecular imaging has been developed and validated in Thai patients, comprising a portion of patients in the dementia registry. This should provide a more accurate diagnosis of the etiology of dementia, which was the focus of this study. METHODS: This was a multicenter dementia study. The baseline characteristics, main presenting symptoms, and results of investigations and cognitive tests of the patients were electronically collected in the registry. Functional imaging and/or molecular imaging were performed in patients with an equivocal diagnosis of the causes of dementia, especially in atypical dementia or young onset dementia (YOD). RESULTS: There were 454 patients in the study. The mean age of the patients was 78 years, with 60% female. Functional imaging and/or molecular imaging were performed in 57 patients (57/454 patients, 13%). The most common cause of dementia was Alzheimer's disease (AD; 50%), followed by vascular dementia (VAD; 24%), dementia with Lewy bodies (6%), Parkinson's disease dementia (6%), frontotemporal dementia (FTD; 2.6%), progressive supranuclear palsy (2%), multiple system atrophy (0.8%), and corticobasal syndrome (0.4%). YOD accounted for 17% (77/454 patients), with a mean age of 58 years. The causes of YOD were early onset amnestic AD (44%), VAD (16%), behavioral variant FTD (8%), posterior cortical atrophy (6.5%), and logopenic variant primary progressive aphasia (5.2%). CONCLUSION: AD was the most common cause of dementia in Thai patients and the distribution of other types of dementia and main presenting symptoms were similar to previous reports in Western patients; however, the proportion of YOD was higher.

Psychological impacts on patients with COVID-19 in a Thai field hospital

ABSTRACT Objective: This study investigates the psychological impacts and their associated factors on patients with COVID-19 at a Thai field hospital. Methods: All eligible patients confirmed to have COVID-19 at Thammasat University field hospital completed an online self-reported mental health screening questionnaire which collected sociodemographic data, their clinical characteristics, and used the depression, anxiety, and stress scale (DASS-21). Results: A total of 40 patients participated in the study. The depression rate was found to be 22.5%, while the anxiety rate was 30%, and the stress rate was 20%. Having a history of psychiatric disorder alone was significantly associated with a higher DASS-21 score (p = 0.001). Meanwhile, gender, age, level of education, occupation, living status, severity of COVID-19, and the number of days admitted to hospital prior to the field hospital were not found to be associated with the DASS-21 scores (P > 0.05). Conclusion: The depression, anxiety, and stress symptoms in patients with COVID-19 at the field hospital were common. Patients with a history of psychiatric disorder should undergo specific evaluation during the isolation phase.

Prevalence of Facebook Addiction and Related Factors Among Thai High School Students.

OBJECTIVE: To determine the prevalence ofFacebook (FB) addiction and its related factors among Thai high school students. MATERIAL AND METHOD: This cross-sectional study was performed among 972 high school students in four provinces associated with high economic prosperity in Thailand: Bangkok, Ubon Ratchathani, Chiang Mai and Songkhla, utilizing a multistage cluster sampling technique. A self-administrative questionnaire was produced composing of three parts; demographic data, a Thai version of the Bergen Facebook Addiction Scale (Thai-BFAS) and the Thai version of the General Health Questionnaire-28 items. Multivariate analysis was employed to analyze thefactors associated with FB addiction. RESULTS: The prevalence ofFB addiction amongst Thai adolescents was 41.8% (95% CI; 38.6, 45.2). Related factors included gender school location, sufficiency ofpersonalfinance, devices ofFB access, duration ofstaying online via FB, andFB usage during holidays. In addition, every 1-hour increase in usage enhanced the risk for FB addiction (OR = 1.12, 95% CI; 1.05, 1.19). CONCLUSION: The prevalence of FB addiction in Thai high school students was found to be higher than in many other countries. Relatedfactors should be controlled in order to reduce FB addiction and its detrimental impacts, such as behavior modification and the promotion of healthier free-time activities. Further studies are recommended to understand why FB addiction is so high in Thailand.

Facebook Addiction and Its Relationship with Mental Health among Thai High School Students.

OBJECTIVE: To investigate the relationship between Facebook addiction and mental health among high school students. MATERIAL AND METHOD: This cross-sectional analytic study was performed among 972 high school students from four provinces associated with high economic prosperity in Thailand: Bangkok, ChiangMai, Ubon Ratchathani and Songkhla, utilizing a multistage cluster sampling technique. Facebook addiction was assessed using the Thai version of the Bergen-Facebook Addiction Scale (Thai-BFAS), while a Thai version ofthe General Health Questionnaire (Thai GHQ-28) was used for mental health evaluation. The relationship between Facebook addiction and mental health was analyzed through multiple logistic regressions. RESULTS: The prevalence of Facebook addiction and abnormal mental health were 41.9% (95% CI; 38.6, 45.2), and 21.9% (95% CI; 19.2, 24.8), respectively. After adjustment for confounding factors (sufficiency of household income, school location, level of education, GPAX learning deficits and attention deficit hyperactivity disorder), the individuals identified as having Facebook addiction were discovered to be at a high risk of developing abnormal general mental health (ORadj = 1.7, 95% CI: 1.1, 2.4), somatic symptoms (OR = 1.2, 95% CI: 0.9, 1.7), anxiety and insomnia (ORadj = 1.3, 95% CI: 0.9, 1.8), social dysfunction (OR = 1.5, 95% CI: 1.1, 2.1) and severe depression (ORadj = 1.5, 95% CI: 1.0, 2.2). Moreover; there were pronounced trends of increasing risk according to the level of Facebook addiction (Ptrend < 0.05). CONCLUSION: It was found that Facebook addiction among high school students could be associated with abnormal, general mental health status, somatic symptoms, anxiety & insomnia, social dysfunction, and severe depression. Therefore, it is essential that the relevant authorities educate young people about the mental health impacts linked with Facebook addictive usage and impose appropriate public health policies by screening Facebook addiction and mental health issues in risk groups.

Validation of the Thai version of Bergen Facebook addiction scale (Thai-BFAS). .

OBJECTIVE: To determine the validity ofthe Thai version ofthe Bergen FacebookAddiction Scale (Thai-BFAS) using Facebook addiction screening in Thai high school students. MATERIAL AND METHOD: The original BFAS was authorized for translation and validation in Thai. After content validity and usability were approved by three Thai psychiatrists, the Thai-BFAS was adjusted again by the authors and back translated by an English expert. Thisfinal version was investigated using the internal consistency method among 874 high schools students in Bangkok, Chiang Mai, Ubon Ratchathani and Songkhla, and confirmatoy factor analysis (CFA) was employed to prove that the six-component model could be representative of addiction behaviors. In addition, test-retest reliability was performed separately among 30 pilot high school students in Bangkok. RESULTS: The Thai-BFAS has six items, which are each scored on a 5-point scale with total score ranges from 0 to 24; the cutoff score for Facebook addition stands at least 12 points. The Cronbach s alpha coefficient was 0.91 (95% CI; 0.90, 0.92) and the inter-class correlation coefficient was 0.80 (95% CI; 0.49, 0.92). The CFA showed that the six items accurately represent the six-component model of addiction such as salience, mood modification, tolerance, withdrawal, relapse and conflict. CONCLUSION: The Thai-BFAS is consistent as a screening testfor Facebook addiction among high school students due to good reliability and validity. It also conforms well to the original version. The six items in the Thai-BFAS are a good representation of the addiction behaviors. Further studies should be undertaken in cases of sensitivity and specificity when compared with other similar tests of addiction as well as in various additional populations and circumstances.

Prevalence of neuropsychiatric symptoms in Alzheimer's disease: a cross-sectional descriptive study in Thailand.

OBJECTIVE: To estimate the prevalence of neuropsychiatric symptoms in Thai patients with Alzheimer's disease. MATERIAL AND METHOD: The present study is a cross-sectional descriptive design. The participants comprised 62 patients from the Memory Clinic at Thammasat University Hospital, Thailand. Subjects were diagnosed as having Alzheimer's disease according to the National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's disease and Related Disorders Association (NINCDS-ADRDA) criteria and received global Clinical Dementia Rating scale (CDR) score of at least stage 1. All participants were assessed using the Neuropsychiatric Inventory Questionnaire (NPI) and the Thai Mental State Examination (TMSE). RESULTS: The subjects were female 62.9% and male 37.1%, the mean age was 76 +/- 6.7 years. The majority of them (62.9%) were in the mild stage (CDR = 1). The result showed that the prevalence of neuropsychiatric symptoms (> or = 1 symptom) reported was 100%. The most common symptoms were apathy (71%), aberrant motor behavior (61.3%), sleep problems (56.5%), eating problems (51.6%) and agitation/aggression (45.2%), whereas the least was euphoria (6.5%). The number of neuropsychiatric symptoms increased with severity of the disease. The result also showed that 61.3% of the participants presented with the chief complaint of neuropsychiatric symptoms, whereas memory complaints were only 38.7%. CONCLUSION: Neuropsychiatric symptoms are very common in Thai Alzheimer's disease patients. Therefore, management of Alzheimer's patients should include an assessment of neuropsychiatric symptoms and also concentrate on reducing these symptoms. The number of neuropsychiatric symptoms increases with disease progression. Moreover, neuropsychiatric symptoms were the most common presenting problem rather than memory problem in Thai patients with Alzheimer's disease.

Workload and attitude toward profession among young Thai psychiatrists: a national survey.

OBJECTIVE: To survey workload and attitude toward profession of young Thai psychiatrists. MATERIAL AND METHOD: The present study was a cross sectional descriptive survey The researcher team invented the questionnaire and posted it to 142 young Thai psychiatrists (age < or = 40 years old). RESULTS: There were 82 participants. Response rate was 57.7%. The respondents were 30 males (36.6%), 52 females (63.4%), 66 general psychiatrists (80.5%), 16 child and adolescent psychiatrists (19.5%). Their mean of age was 31.4 years old. Those worked at hospitals under the Department of Mental Health (36.6%), the Office of Permanent Secretary (29.7%), universities (13.4%) and other institutions (12.2%). In office hours, the respondents had an average working hour 39.5 hours/week, while an average outpatient service working hour 15.6 hours/week. An average amount of outpatients was 89.9 patients/week. Each institution was significantly different in consultation liaison, teaching, administration, community psychiatry, and research. The percentages of young psychiatrists who agreed with the opinions "proud to be a psychiatrist", "working effectively as a psychiatrist" and "satisfied with psychiatric working system" were 98.9, 95.1 and 65.9 respectively. The average amount of outpatients (patients/week) affected job satisfaction. CONCLUSION: The full-time working hour of young Thai psychiatrists was not different from other studies. However they had more psychiatric patients and spent more time doing outpatient service because of scarcity of psychiatrists in Thailand. Even though the number of psychiatric outpatients affected job satisfaction, most of them had positive professional attitude.

Psychotherapy practices and training experiences: a national survey of young Thai psychiatrists.

OBJECTIVE: To survey the psychotherapy practices among young Thai psychiatrists, including perceptions pertaining to training experience and satisfaction of psychotherapy supervision. MATERIAL AND METHOD: The present study employed a cross-sectional descriptive survey. The sample consisted of all psychiatrists aged 40 years old or under. A questionnaire was developed by the research team and mailed to 142 young psychiatrists. RESULTS: There were 82 responders (57.7% response rate). The majority of the responding psychiatrists (80.5%) expressed their willingness to perform psychotherapy, however 57 of them (69.6%) were actually practicing it for 4 hours or less per month. Additionally, 41.5% had no self-confidence in using psychological interventions. The common barriers to practicing psychotherapy reported were lack of time to practice (85.4%), and no psychotherapy advisor (54.9%). Regarding psychotherapy training experience, 67.1% indicated that the training was sufficient. Types of psychotherapy training that young psychiatrists had received the most were supportive psychotherapy, Satir's systemic psychotherapy and cognitive behavioral therapy, respectively. The main factor affecting specific psychotherapy training experiences was the difference in the availability of training courses offered between the institutes. In regards to perceptions of psychotherapy supervision, 72.0% of the sample satisfied with psychotherapy supervision, although they had received an average of 4.8 hours per month only. CONCLUSION: Most of young Thai psychiatrists showed positive attitude to psychotherapy, and also preferred further training. However they performed psychotherapy in their work only a few hours per month due to heavy workloads, no supervisor and lack of confidence. The findings may have implications for individuals who are interested in the improvement of the quality and standard of the residency training program.