Helen Fk Chiu

Mental health in China: challenges and progress

Over the past three decades, China’s economic reforms have achieved great success. However, rapid urban isation and economic growth are generating new challenges for the country and its mental health system. For various historical reasons, mental health services have been a low priority in China. In the past 5 years, both the international community and media have shown great interest in these services. Most international experts have assessed China’s mental health system according to western standards, and have focused on negative events that occasionally arise. We feel that a more balanced introduction to China’s mental health system is warranted, one that includes its pitfalls, progress, and challenges. An estimated 173 million Chinese people have a diagnosable psychiatric disorder, of whom 158 million have never received any treatment. China has roughly 20 000 psychiatrists, of whom only about 4000 are fully qualifi ed, which largely explains the extremely high number of untreated patients. Furthermore, two-thirds of the country’s 1·3 billion citizens live in rural areas, yet most mental health care resources are concentrated in psychiatric hospitals in cities. Until 2010, only one mental health professional was working in Tibet. The provision of accessible, dependable, and aff ordable mental health care for China’s massive rural population is thus a matter of urgency. In the past 5 years, the importance of mental health has begun to gain recognition. The Chinese Government has started taking eff ective steps to fi nance mental health services and provide regular training in mental health for primary care providers. Important steps included the 2005 eff ort to ensure that most new psychotropic drugs were covered by basic health insurance, and a 2010 initiative to build 550 psychiatric hospitals and psychological units in general hospitals by 2012. A promising development was the initiation of a national community-based service delivery model in psychiatry (the 686 project) in 2004. This project has integrated the resources of psychiatric hospitals and existing community health systems with the aim of training a core group of mental health pro fessionals in case management and the use of indiv idual service plans, to enable them to deliver training programmes and estab lish community-based services. The 686 project has helped to con vince central government to invest more than RMB 220 million (US

Sociodemographic and clinical features of bipolar disorder patients misdiagnosed with major depressive disorder in China

32·2 million) in communitybased mental health since 2004. As of Nov 30, 2011, the community-based service model within this project covered 391 million people at 766 sites in 170 cities. Approximately 1·83 million patients with severe psychiatric disorders have been registered, of whom about 390 000 patients with a high risk of violence have received rehabilitation services and regular follow-ups. China has more than 200 million migrant workers who take up temporary jobs in faraway urban regions and return home to rural areas only during the Lunar New Year. They are not covered by either communitybased mental health services or health insurance in the cities where they work. Provision of services to meet the mental health needs of this migrant population will be another huge challenge. In China, around 287 000 suicides (23 per 100 000 popu lation) took place each year during 1995–99, accounting for up to a third of suicides globally. Unlike suicide patterns in the west, China’s has a high female-to-male ratio (about 1·25:1); ingestion of pesticides is the most common method of suicide. Government data suggest that the suicide rate might be falling (6·6 per 100 000 by 2008), but much work is still needed towards suicide prevention. Local and western media have often blamed Chinese health authorities for the inadequate protection of

Quality of life and mental health in Chinese culture.

Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD), which may lead to inappropriate treatment and poor outcomes. This study aimed to compare demographic and clinical features between patients with MDD and those with BD, but being misdiagnosed as MDD, in China.

Antipsychotic polypharmacy in schizophrenia patients in China and its association with treatment satisfaction and quality of life: Findings of the third national survey on use of psychotropic medications in China:

Purpose of review Quality of life (QOL) has become a standard outcome measure in psychiatry. The QOL concept is culture-dependent, which means that the results of Western studies may not be applicable to Chinese patients. The aim of this study is to summarize the recent literature on QOL and mental health in Chinese culture. Recent findings QOL has increasingly been used as an outcome measure of pharmacotherapeutic or psychosocial interventions in Chinese societies. Recent studies have suggested that socio-cultural factors exert an influence on the QOL of Chinese psychiatric patients. Patients with major psychiatric disorders have a poorer QOL than the general population. Socio-demographic characteristics have no, or only weak, associations with QOL in schizophrenia, whereas novel antipsychotics and antidepressants improve QOL relative to traditional psychotropic medications in the short term. Summary The inclusion of QOL measures in routine clinical practice and research in Chinese societies should be encouraged, and culture-sensitive QOL measures should be developed. Chinese psychiatry should also implement appropriate strategies and effective measures in line with the findings on the relationship between QOL and socio-demographic and clinical factors.

Apolipoprotein epsilon-4 allele and the two-year progression of cognitive function in Chinese subjects with late-onset Alzheimer's disease

Objective: This study examined the use, demographic and clinical correlates of antipsychotic polypharmacy (APP) and its associations with treatment satisfaction and quality of life (QOL) in schizophrenia patients in China. Method: A total of 4239 patients in 45 nationwide Chinese psychiatric hospitals/centers were interviewed in 2012 in the third cross-sectional study, with the first two having been conducted in 2002 and 2006. Patients’ socio-demographic and clinical characteristics, including psychopathology, side effects, satisfaction with treatment and QOL, were recorded using a standardized protocol and data collection procedure. Results: The proportion of APP prescriptions in 2012 was 34.2%, which was significantly higher than the frequency of APP in 2002 (26.1%) and 2006 (26.4%) (p<0.001). Of patients on APP, 91.1% received two antipsychotics, 8.6% received three and 0.3% received four or more antipsychotics. Multiple logistic regression analyses revealed that compared to those on antipsychotic monotherapy, patients on APP and their families had lower satisfaction with treatment, had higher QOL in the mental domain, younger age of onset, more side effects, higher doses of antipsychotics and were more likely to receive first-generation antipsychotics and less likely to receive benzodiazepines (total R2=0.31, p<0.001). Conclusions: APP was found in about one in three schizophrenia patients. The prevalence of APP seems to have been increasing since 2002. Considering the increased frequency of drug-induced side effects and the patients’ and their relatives’ dissatisfaction with antipsychotic treatment, further examination of the rationale and appropriateness of APP and its alternatives is warranted.

Antipsychotic Medications in Major Depression and the Association with Treatment Satisfaction and Quality of Life: Findings of Three National Surveys on Use of Psychotropics in China Between 2002 and 2012

Background: Although the significance of apolipoprotein E4 (Apo E4) in Alzheimers disease (AD) has been well established in Caucasian populations, its role in determining the rate of cognitive decline in other ethnic groups has yet to be determined This study examined the two-year progression of cognitive decline and its association with Apo E4 allelic status in a group of Chinese elderly subjects with AD. Method: One hundred andfour Chinese subjects with mild and moderate AD as assessed by the Clinical Dementia Rating (CDR 1 and 2) were followed up at a mean (SD) duration of 22.53 (5.21) months. The rate of cognitive decline and its association with Apo E4 allelic status was evaluated. Results: At follow-up, 74 (73 percent) subjects were reassessed. Forty-nine remained stable at the same CDR and 25 had deteriorated The mean (SD) deterioration in the Mini-Mental State Examination (MMSE) was 2.52 (4.38) and in the Mattis Dementia Rating Scale (DRS) was 9.03 (14.98) (paired t-test, p < 0. 001). There was no significant difference in the baseline MMSE and DRS scores between the “stable,” “deteriorated,” or “deceased” groups. Mildly demented subjects with the Apo E4 allele were more likely to have deteriorated to a more severe CDR than subjects without the Apo E4 allele (Pearson χ2 = 5.72, df 1, p = 0.017, Odds ratio = 6.3, CI 1.3 to 30.53). Conclusion: The presence of the Apo E4 allele may influence the rate ofcognitive deterioration, particularly in subjects with mildAD.

Welcome from the Editors of Asia Pacific Psychiatry

Background: Optimizing treatment outcomes for depression requires understanding of how evidence-based treatments are utilized in clinical practice. Antipsychotic medications concurrent with antidepressant treatment are frequently used in major depression, but few studies have investigated trends and patterns of their use over time. This study aimed to examine the prescription patterns of antipsychotic medications for major depression in China from 2002 to 2012 and their association with treatment satisfaction and quality of life (QOL). Methods: A total of 3655 subjects with major depression treated in 45 Chinese psychiatric hospitals/centers nationwide were interviewed between 2002 and 2012. Patients’ socio-demographic and clinical characteristics including psychopathology, medication side effects, satisfaction with treatment and QOL were recorded using a standardized protocol and data collection. Results: The frequency of antipsychotic use was 24.9% in the whole sample; the corresponding figures were 17.1%, 20.3%, and 32.8% in 2002, 2006, and 2012, respectively (&khgr; 2 = 90.3, df = 2, P < 0.001). Multiple logistic regression analyses revealed that patients on concurrent antipsychotics had significantly more delusions or hallucinations, longer illness duration, greater side effects, and more likely to be treated as inpatients and in major hospitals (i.e., Level-III hospital). Antipsychotic use was associated with lower treatment satisfaction while there was no significant difference with respect to physical and mental QOL between the antipsychotic and nonantipsychotic groups. Conclusions: Concurrent antipsychotic use was found in about one in four treated depressed patients in China, which has increased over a 10-year period. Considering the association of drug-induced side effects and the lack of patients’ and relatives’ satisfaction with antipsychotic treatment, further examination of the rationale and appropriateness of the use of antipsychotics in depression is needed.

Sleep problems in Chinese elderly in Hong Kong

Asia-Pacific Psychiatry (APPSY) welcomes the opportunity to publish this supplement with a selection of articles from colleagues working in Malaysia. The publication highlights the strengths of psychiatric research and scholarship in Malaysia and is consistent with the role of APPSY in supporting dissemination and translation across the region. Most of the articles included in this volume were first selected by senior colleagues in Malaysia, from those presented at the 2012 Annual Meeting of the Malaysian Psychiatric Association. The authors revised and updated their submissions when necessary based on the reviews by the editors. Additional articles are included to highlight various aspects of psychiatric research in Malaysia. The guest editors of the supplement are distinguished Malaysian colleagues Professor Hatta Sidi, Associate Professor Rosdinom Razali and Professor Thambu Maniam. They worked with the journal editorial team to finalize the content and its presentation in the kind of successful partnership welcomed by APPSY. This is not only a promising inaugural effort, but also a model to be followed in the future by other national and regional professional and scientific organizations. We commend the supplement to you as a showpiece of the work underway in Malaysia, a country that has strengthened the presence of psychiatry in undergraduate and postgraduate medical education, and has provided valuable support for psychiatric research. This has made it a respected actor in the development of our discipline in the region. Highcaliber education, research and publications in psychiatry are vital in any country for the success of continuing efforts to support the improvement of mental health, and the growth and quality of community-based mental health care in this era of globalization and diversity. We are very pleased that the supplement contributes to these goals in Malaysia and in the region, and that our Malaysian colleagues chose us to highlight their best scholarship. bs_bs_banner Offi cial journal of the Pacifi c Rim College of Psychiatrists