Ministry of Health Clinical Practice Guidelines: Anxiety Disorders.

The Ministry of Health (MOH) has developed the clinical practice guidelines on Anxiety Disorders to provide doctors and patients in Singapore with evidence-based treatment for anxiety disorders. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on anxiety disorders, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Do intercultural factors play a role in exacerbating psychiatric symptoms?

We report the case of a 29-year-old mixed-race woman suffering from recurrent major depressive episodes, with suicidal ideation and risk, involving several inpatient admissions. A comorbid diagnosis of borderline personality disorder was also recorded in one of her previous inpatient admissions. During her last inpatient admission, a multidisciplinary case discussion and review of the patient's life highlighted several possible intercultural trigger factors that could have contributed to the exacerbation of her psychiatric illness. We emphasise the need to explore intercultural predisposing and precipitating factors for a more complete psychodynamic understanding of psychiatric illnesses among the multiracial population of Singapore. This also adds to the discussion on the management of such patients with the option of formal in-depth psychotherapy in adjunct to medication. This may prevent recurrent relapses, modify suicide intent and reduce the necessity for inpatient treatment, which will be cost-effective and result in efficacious treatment.

Survey Of Psychiatry On Forensic Psychiatry Assessments In Singapore

Introduction: The quality of forensic psychiatry assessments in Singapore has come under recent criticism from the judiciary resulting in a loss of confidence in forensic psychiatric assessments. There is no local published standards or practice guidelines for forensic psychiatric assessments. We set out to survey local psychiatrists on various key aspects of local forensic psychiatric assessments. Methods: A survey was developed by two local senior psychiatrists with extensive experience in forensic psychiatry. It was sent out electronically to all Singapore registered psychiatrists. Results: The response rate was 33.6% (48 of 143 psychiatrists). Respondents agreed that risk assessment and management, capacity and competence assessments and critical appraisal of symptoms were specific forensic psychiatry skill sets. There was also a consensus that separation of treating versus assessment roles and an independent panel of psychiatrist would be useful. There was no clear consensus on which psychiatrists should perform forensic assessments or if language used and time taken for assessments were important. The estimated time for assessments ranged from 1.9 hour (SD 1.3) to 9.1 hours (SD 5.4) with time required for criminal > civil > capacity assessments. Private sector psychiatrists were more likely than public sector psychiatrists to feel that forensic psychiatric qualifications were not necessary to conduct forensic assessments. Conclusion: There is a consensus in the local psychiatric community on various key aspects of forensic psychiatric assessment. Stakeholders in forensic assessments should begin a dialogue on the way forward for forensic psychiatric assessments in Singapore.

Mental health literacy beliefs. A comparison of psychiatric trained nurses and enrolled nurses in Singapore.

The views of mental health professionals may influence diagnosis and management options. This study reports nurses' views about the management of three common psychiatric disorders--schizophrenia, depression, and mania. Results demonstrate the effect of greater psychiatric education and training, received by psychiatric trained nurses, on mental health literacy.