Leslie Lim

Generalised anxiety disorder in Singapore: prevalence, co-morbidity and risk factors in a multi-ethnic population

BackgroundThere has been a relative lack of epidemiological data on generalised anxiety disorder (GAD) in Southeast Asia. A previous study reported a lifetime prevalence of 1.5% and highlighted low preference for seeking professional help and consultation by persons suspected to be suffering from mental health problems. The present study is part of a National Mental Health survey of adults conducted from February 2003–March 2004 specifically assessing anxiety and depression in Singapore. In this paper we report on prevalence, co-morbidity and risk factors associated with GAD.MethodsWe interviewed 2,847 households from an ethnically stratified random sample of adults aged 20–59 years who were Singapore citizens or permanent residents. The General Health Questionnaire and Schedule for Clinical Assessment of Neuropsychiatry were administered, which generated Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of GAD. We assessed socio-demographic correlates, life events, medical and other psychiatric co-morbidities related to GAD.ResultsLifetime prevalence of GAD was 3.3%, current prevalence is 3.0%. Female to male ratio is 3.6:1. GAD was significantly associated (p<0.001) with the presence of other psychiatric co-morbidities, including major depressive disorder, dysthymia, panic disorder, agoraphobia and social phobia. Prevalence increased in older individuals, with the odds of association greatest in subjects with three or more co-morbid medical conditions [adjusted odds ratio (OR) 3.66]. Those who had experienced one or more threatening life events showed increased odds of association with GAD. Chinese ethnicity, the divorced and persons from both the upper and the lowest socio-economic status had highest odds of association with GAD.ConclusionsWe challenge established notions that GAD tends to be a disorder of the socially disadvantaged. Life events are important as precipitating factors in GAD, and uniquely different types of events appear to affect both extremes of social classes. High co-morbidity associations with current GAD are grounds for concern. This may suggest failure to seek treatment, hence giving rise to an increase in severity of the primary condition.

Health Beliefs and Help Seeking for Depressive and Anxiety Disorders Among Urban Singaporean Adults

OBJECTIVE This study examined whether help seeking for mental problems was predicted by beliefs about mental illness and services and by family and social support. METHODS Singaporean adults (N= 2,801) were interviewed with the Schedule for Clinical Assessment in Neuropsychiatry and with questions on mental health status, beliefs about the curability of mental illness, embarrassment and stigma, ease of discussing mental problems, effectiveness and safety of treatment, and trust in professionals. RESULTS Although 10% of respondents had a depressive or anxiety disorder or combination, only 3% acknowledged having mental problems, 5% rated their mental health as fair or poor, and 6% sought help for their mental health problems. Help seeking was predicted by poor self-rated mental health and acknowledged mental illness but not by health beliefs and social support. CONCLUSIONS Self-rated mental health status was predictive of help seeking, but other health beliefs and social support were neither strong nor robust predictors.

A community study of the health-related quality of life of schizophrenia and general practice outpatients in Singapore

Abstract.Background:Health-related quality of life (HRQOL) is an important outcome indicator of healthcare that has been little studied in East Asia, where, culturally, there is greater family interdependence than in the West. We aimed to study the HRQOL of schizophrenia outpatients compared to general practice outpatients, and to examine determinants of schizophrenia HRQOL in our community.Methods:The HRQOL of 94 schizophrenia and 90 general practice outpatients was assessed using the COOP/WONCA chart. Clinical status, demographics, medication dosages, extrapyramidal side-effects, and frequency of personal, family and social functioning were assessed using standardized questionnaires.Results:Some 90% of schizophrenia outpatients still lived with their immediate families, and the majority were single, unemployed, and rarely engaged in social activities. They had poorer satisfaction with overall HRQOL compared to general practice outpatients. Using stepwise linear regression analysis, poorer schizophrenia overall HRQOL was predicted by dissatisfaction with and poorer participation in family relationships, dissatisfaction with emotional well-being and male gender [R2 = 0.40, p = 0.040; F(4, 5.1) = 14.3, p < 0.001].Conclusions:Strained family relationships appeared to be an important contributor to poorer schizophrenia HRQOL in our East Asian community. This could possibly be related to the narrowing of social-occupational functioning and its burden on the family.

Validation of the emotion thermometers and hospital anxiety and depression scales in Singapore: Screening cancer patients for distress, anxiety and depression

To validate the emotion thermometer (ET) and hospital anxiety and depression scales (HADS) in Singapore, screening cancer patients for distress, anxiety and depression.

Alcohol and aldehyde dehydrogenase polymorphisms in Chinese and Indian populations.

The association between two functional polymorphisms in alcohol dehydrogenase (ADH2/ADH1B) and aldehyde dehydrogenase (ALDH2) genes and alcohol dependence was examined in 182 Chinese and Indian patients undergoing treatment for alcohol dependence and 184 screened control subjects from Singapore. All subjects were screened by the Alcohol Use Disorders Identification Test (AUDIT). Patients were also administered the Severity of Alcohol Dependence Questionnaire (SADQ). Polymorphisms were genotyped by allele-specific polymerase chain reaction and selected genotypes confirmed by DNA sequencing or restriction fragment length polymorphism. Our results showed that frequencies of ADH1B**2 and ALDH2**2 were higher in controls compared to alcohol-dependent subjects for both Chinese and Indians. Frequencies of these two alleles were also higher in the 104 Chinese controls compared to the 80 Indian controls. None of the eight Chinese who were homozygous for both protective alleles was alcohol dependent. The higher frequencies of the protective alleles could explain the lower rate of alcohol dependence in Chinese.

Psychotic disorder in a patient with central and extrapontine myelinolysis

Abstract  Central pontine and extrapontine myelinolysis (CPEM) are rare conditions usually associated with rapid correction of hyponatremia. Neurologic complications are the usual sequelae although neuropsychiatric features are rare. Described herein are unusual psychotic symptoms following CPEM and discussion of the likely pathogenesis and implications for treatment.

Qualities of a good psychiatrist

Introduction: There is limited published work regarding the qualities of a good psychiatrist in Asia. With greater attention paid to psychiatry training in Singapore as a result of the Ministry of Healths National Mental Health Blueprint, there is a need to assess the qualities of a good psychiatrist to guide training.

Attitudes toward utility, effects and side effects of treatment for anxiety and depression

Objectives: Negative perceptions about psychiatric treatment are likely to affect treatment adherence. We compared attitudes of patients with psychiatric illness and those of medical patients towards psychiatric treatment. Methods: Both patients with psychiatric illness and medical patients (controls) were shown a printed copy of two vignettes depicting major depression and generalized anxiety disorder. They were asked for their perceptions on the utility, effects and possible side effects of psychiatric medications, as well as the utility of psychotherapy in treating major depression and generalized anxiety disorder. Responses between psychiatric patients and medical patients were compared using appropriate statistical tests, including logistic regression. Results: Patients with psychiatric illness were more likely than medical patients to endorse the utility of medications in treating major depression and generalized anxiety disorder (p<0.001). Those with psychiatric illness were more likely to endorse the utility of psychotherapy in treating major depression (p=0.004). Both groups of patients were of the view that psychotherapy would benefit generalized anxiety disorder. Older and lesser educated patients held negative beliefs about medications. Conclusions: While patients with psychiatric illnesses endorsed favourable attitudes toward medications (p<0.001), the older and lesser educated were more likely to hold negative views (p<0.05). Psychoeducation should be tailored to the needs of older and lesser educated patients.

Screening for panic-related anxiety in emergency department patients with cardiopulmonary complaints: A comparison of two self-report instruments

The present study examined 1) the accuracy of two self-report measures for detecting panic-related anxiety in emergency department (ED) patients with cardiopulmonary complaints; and 2) whether modified scoring resulted in improved performance. English-speaking adults presenting to the ED of a large public hospital with palpitations, chest pain, dizziness, or difficulty breathing were evaluated for the presence of panic-related anxiety with the Structured Clinical Interview for DSM-IV (SCID) over a one-year period. Patients completed the panic disorder modules of the Patient Health Questionnaire (PHQ-PD) and Psychiatric Diagnostic Screening Questionnaire (PDSQ-PD). Sensitivity, specificity, area under the curve (AUC), and predictive values were compared for various cut-offs and scoring algorithms using SCID diagnosis of panic attacks (in the absence of panic disorder) or panic disorder as the reference standard. In this sample of 200 participants, the majority had a chief complaint of chest pain and 46.5% met SCID criteria for panic-related anxiety. The PDSQ-PD demonstrated only fair operating characteristics for panic attacks (AUC = 0.57) and good operating characteristics for panic disorder (AUC = 0.79). The PHQ-PD achieved adequate operating characteristics (AUC = 0.66) for panic attacks and good operating characteristics for panic disorder (AUC = 0.76) using a modified scoring algorithm or a single screening question (AUC = 0.72).