Suwanna Arunpongpaisal

Comparisons of methamphetamine psychotic and schizophrenic symptoms: A differential item functioning analysis

The concept of negative symptoms in methamphetamine (MA) psychosis (e.g., poverty of speech, flatten affect, and loss of drive) is still uncertain. This study aimed to use differential item functioning (DIF) statistical techniques to differentiate the severity of psychotic symptoms between MA psychotic and schizophrenic patients. Data of MA psychotic and schizophrenic patients were those of the participants in the WHO Multi-Site Project on Methamphetamine-Induced Psychosis (or WHO-MAIP study) and the Risperidone Long-Acting Injection in Thai Schizophrenic Patients (or RLAI-Thai study), respectively. To confirm the unidimensionality of psychotic syndromes, we applied the exploratory and confirmatory factor analyses (EFA and CFA) on the eight items of Manchester scale. We conducted the DIF analysis of psychotic symptoms observed in both groups by using nonparametric kernel-smoothing techniques of item response theory. A DIF composite index of 0.30 or greater indicated the difference of symptom severity. The analyses included the data of 168 MA psychotic participants and the baseline data of 169 schizophrenic patients. For both data sets, the EFA and CFA suggested a three-factor model of the psychotic symptoms, including negative syndrome (poverty of speech, psychomotor retardation and flatten/incongruous affect), positive syndrome (delusions, hallucinations and incoherent speech) and anxiety/depression syndrome (anxiety and depression). The DIF composite indexes comparing the severity differences of all eight psychotic symptoms were lower than 0.3. The results suggest that, at the same level of syndrome severity (i.e., negative, positive, and anxiety/depression syndromes), the severity of psychotic symptoms, including the negative ones, observed in MA psychotic and schizophrenic patients are almost the same.

Psychosocial functioning in schizophrenia: are some symptoms or demographic characteristics predictors across the functioning domains?

This study aimed to examine symptoms/demographic characteristics as predictors for psychosocial functioning among individuals with schizophrenia. The Personal and Social Performance (PSP) scale was used to assess psychosocial functioning. Other measures of interest included were the Clinical Global Impression, Severity scale, and the Marder’s five-factor model of the Positive and Negative Syndrome Scale. This study included 199 participants with non-acute stage schizophrenia. Spearman correlation coefficients and stepwise multiple linear regression analyses were applied to determine the correlates and predictors of PSP domain/total scores. Younger age, earlier age of schizophrenia onset, severe illness, positive symptoms, negative symptoms, disorganized thought, hostility/excitement, and anxiety/depression were found to significantly correlate with poor functioning. Severe illness and negative symptoms are the main predictors of greater impairment of socially useful activities, personal and social relationships, and self-care. Further prospective studies in other settings, which would include an increased number of variables such as neurocognitive function and social support, are warranted.

Psychological Status in Patients Seeking Rhinoplasty

Background Rhinoplasty is the most common operation performed by our facial plastic surgery unit. Recognition of patients with psychological problems which may result in an unfavourable post-operative outcome is essential. The objective of this study was to evaluate the psychological status of patients seeking rhinoplasty, compared with the general population. Methods We prospectively collected the data from patients who requested rhinoplasty in Srinagarind hospital, Thailand and controls. We used the general health questionnaire-28 (GHQ-28) for psychological problems detection. Results We included a total of 196 participants, 98 in study group and 98 in control group. The study group has a 5.5 times (95% CI 1.25 to 24.17, P = 0.01) higher risk for poor mental status more than control group. Conclusions The patients seeking rhinoplasty group were more likely to have psychological problems when compared with the control group. Surgeons should be aware of the patients psychological status before performing the operation.

Predictive risk factors of seizure-related injury in persons with epilepsy

OBJECTIVE The clinical risk factors for seizure-related injuries (SRI) in adult persons with epilepsy (PWE) were studied and analyzed to develop a predictive model. METHODS We enrolled 300 consecutive cases from three epilepsy clinics in Northeast, Thailand. Subjects were eligible if reported to have at least one seizure attack during the past 12 months. Face-to-face questionnaire was used to evaluate SRI, baseline characteristics and other seizure-related variables. RESULTS There were 247 and 91 PWE who met a criterion and had SRI, respectively. By multivariate logistic regression method, GTC seizure type, having history of seizure attacks at least 12 times/year, and daytime seizure were significant risk factors of having SRI with odds ratio of 2.376, 2.460, and 3.562, respectively. We developed the predictive model for having SRI in PWE and it gave 90.3% sensitivity and 46.7% specificity on the occurrence of SRI. The estimated probability of SRI can be found online at http://sribykku.webs.com/. CONCLUSIONS The significant predictive factors for SRI in PWE were the occurrence of GTCs, seizures at least 12 times/year or daytime seizures. Clinicians or PWE can easily evaluate the risk of having SRI in individuals by the online predictive model.

Development and validity of two-question screening test for depressive disorders in Northeastern Thai community.

OBJECTIVES (1) To develop a screening test for depressive disorders which is simple and short. (2) To determine the diagnostic accuracy of this screening test in Northeastern Thai community. METHODS From August 2006 through October 2006, two phases of tool development were conducted. The first phase, a two-question screening test of depressive disorders was developed by selecting the dialect words to express depressive mood among Northeastern Thai population. The first item represented depressive mood and the second item represented loss of interest or pleasure in doing things. The second phase, a cross-sectional criterion standard validation study was conducted using stratified cluster randomization to identify 1002 subjects ≥18 years of age in 17 villages in nine districts of Yasothorn province. The two-question screening test was used to identify subgroups of subjects positive of both, positive of either one, and negative of both items. Psychiatrists then determined their diagnoses of mood disorders by administering a structured psychiatric examination (M.I.N.I.) that employed Diagnostic and Statistical Manual of Mental Disorder Text Revision (DSM-IV-TR). Data analysis used STATA 8.0 to calculate the sensitivity, specificity, positive predictive value, negative predictive value, percent of correct classified, and prevalence of depressive disorders with 95% confidence interval. RESULTS Of 1002 subjects, female were more predominant (58%), with mean age of 41.5 years. The overall time point rate of depressive disorders was 5.9% (95% CI=4.3-7.1%). Major depressive disorder 3.7% (95% CI=2.5-4.9%) and dysthymia 2.4% (95% CI=1.5-3.3%) occupied the preceding position. The first question of screening test was more positive 3 times than the second one. It showed a high sensitivity of 96.5% (95% CI=95.4-97.6%) but low specificity of 45.6% (95% CI=42.5-48.7%). The second question showed a low sensitivity of 71.9% (95% CI=69.2-74.7%) but high specificity of 84.1% (95% CI=81.9-86.4%). When either one of two questions was positive, this test showed high sensitivity of 96.5% (95% CI=95.4-97.6%) and the positive likelihood ratio was 1.74 (95% CI=1.61-1.88). If both of two questions were positive, it showed high specificity of 85.1% (95% CI=82.9-87.3%) and the positive likelihood ratio was 4.82 (95% CI=3.86-6.02). CONCLUSION Two questions for screening of depression would detect most cases of depressive disorders in the Thai community which has the advantage of brevity, high sensitivity and specificity.

Development of the Thai Cannabis Risky Use Screening Test

Cannabis use may affect drug users’ health and vitality, but few cannabis users seek health care assistance. This study’s objective is to develop an instrument to identify cannabis use disorder among Thai people and investigate its psychometric properties. A two-stage mixed-method research design was implemented. The first phase was conducted by literature review, in-depth interviews, a focus group, cognitive testing, and exploratory factor analysis. The second phase was conducted using a two-stage screening procedure in a field survey conducted among 1,120 subjects. The gold standard for diagnosis was based on one psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria. The optimal cut-off point was ⩾9.56 (sensitivity, 92%; specificity, 92%). Confirmatory factor analysis revealed two factors, namely loss of control and impacts of cannabis, with good model fit (comparative fit index [CFI] = 0.926, Tucker–Lewis index [TLI] = 0.909, root mean square error approximation [RMSEA] = 0.049). The final instrument, consisting of 13 items, was named “Thai Cannabis Risky Use Screening Test” or TCRUST.

Prevalence, clinical and psychosocial variables of depression, anxiety and suicidality in geriatric tertiary care settings

OBJECTIVE The study investigated the prevalence of depressive and anxiety disorders and suicide risk in geriatric outpatients in tertiary care hospitals. MATERIALS AND METHODS An observational, cross-sectional study was conducted with 803 participants aged 60 and above attending geriatric outpatient clinics in tertiary care hospitals in Thailand. Participants were assessed using DSM-IV-TR criteria to calculate the prevalence of deressive and anxiety disorders, and their suicide risk. Montreal Cognitive Assessment (MoCA), Perceived Stress Scale (PSS), Multidimensional Scale of Perceived Social Support, Core Symptom Index (CSI), 15-item Geriatric Depression Scale (GDS-15), Neuroticism Inventory (NI) and the Revised Experience of Close Relationships Questionnaire (ECR-R) were administered. Quality of life was assessed using the EuroQoL (EQ-5D). RESULTS The prevalence rate for depressive disorders was 23.7%, anxiety disorders was 6.4%, and current suicide risk was 20.4%. PSS, MSPSS, GDS, CSI, and NI scores were significantly higher in all clinical disorders and a suicide group compared with nonclinical subjects. MoCA and ECR-R did not differentiate between clinical disorder and nonclinical samples. Comparing all four outcomes, the EQ-5D differed most in the mixed depressive-anxiety disorder and nonclinical groups (t = 12.20, p < .001). CONCLUSION The present findings revealed a high prevalence of depression, anxiety and suicidality among elderly patients attending tertiary care hospitals. Perceived stress, perceived social support, and neuroticism scores were significantly higher in this group. Role of sociodemographic, clinical and psychosocial variables as risk factors for these clinical disorders should be further examined.

Effects of paliperidone extended release on hostility among Thai patients with schizophrenia

Objective This open-label prospective study investigated the effects of paliperidone extended release (ER) on hostility in Thai patients with schizophrenia. Background Patients diagnosed with schizophrenia may be hostile or exhibit aggressive behavior, which can occasion their admission to psychiatric hospital. Antipsychotic medications are often used to treat hostility and aggression in such patients. Paliperidone ER is effective and well tolerated in the treatment of schizophrenia. However, there are no data available for paliperidone ER with regard to its efficacy on hostility and aggression among Thai patients. This study was a part of the PERFEcT study, a 6-month, open-label, multicenter, multicountry, prospective trial to explore the safety, efficacy, and functionality of paliperidone ER tablets. The current study included only the data obtained from Thai participants. Materials and methods Flexible dosing of paliperidone ER in a range of 3–12 mg/day was used, allowing investigators to adjust the dosage of each subject individually. The 199 Thai patients had a stable Clinical Global Impression – severity score before enrollment. Demographic data were collected at enrollment, and assessments took place at 1, 2, 3, and 6 months postbaseline. The Positive and Negative Syndrome Scale (PANSS) and Personal and Social Performance (PSP) scale were used to evaluate efficacy. In this analysis, we report the findings for the specific PANSS factor P7 (hostility) and the PSP subscale disturbing and aggressive behavior. Data were analyzed using paired t-test method to investigate changes in mean PANSS and PSP total and subscale scores. The significance level was set at P<0.05. Results From a total of 199 Thai patients, 148 patients (74.4%) participated in all visits. There was a significant reduction in mean scores for all total PANSS measures from 1 month onward compared with baseline, as well as ongoing significant reductions in scores from visit to visit. There was a significant reduction in mean hostility score at 2 months (P<0.05), 3 months (P<0.05), and 6 months (P<0.01) (n=148). For the PSP scale, there was a significant across-the-board reduction of mean scores from 3 months onward, including in the disturbing and aggressive behavior subscale (P<0.001) (n=148). Conclusion Switching from previously unsuccessful antipsychotic treatments to paliperidone ER may be a useful option to reduce hostility and disturbing behavior in patients with schizophrenia. This study in Thai patients is in line with findings in other countries and cultures concerning the management of hostility in patients with schizophrenia.

Confirmatory factor analysis of the revised version of the Thai multidimensional scale of perceived social support among the elderly with depression

ABSTRACT Objective: Difficulties in modeling the Multidimensional Scale of Perceived Social Support (MSPSS) have occurred, and these were corrected in the revised version of the Thai MSPSS. However, the revised version has not been tested in elderly populations. The present study aimed at confirming the factor structure of the revised version of the MSPSS among the elderly with depressive disorders, in populations with or without depressive disorders. Methods: Eight hundred and three elderly patients were recruited from four tertiary hospitals; 190 (23.7%) had depressive disorders. All completed the revised Thai MSPSS consisting of 12 items, using a 7-point Likert scale. Confirmatory factor analysis (CFA) of the MSPSS was conducted in both groups. Results: The mean age was 69.24 years (SD 6.88), and 70% of the sample was female. There were no significant difference in demographic data between two groups. The revised version of the Thai MSPSS provided excellent internal consistency. The three-factor model was clearly superior to other alternative models in both depressed and non-depressed groups. CFA for the whole group revealed an acceptable model fit: χ2 = 147.44, df = 45, p < 0.001; Tucker-Lewis Index 0.975; Comparative Fit Index 0.982; Good Fit Index 0.966; and root-mean-square error of approximation 0.056. The fit statistics in the depressed group was better than in the non-depressed group across all models. Conclusions: Due to its robust factor structure, these data support the use of the revised MSPSS as a brief instrument for assessing perceived social support in the elderly with or without depressive disorders.

P-499 - Experiences of depression: learning from thai patients

Major depression is the fourth leading cause of global disease burden. This phenomenology study aims to explain the experiences of male and female patients with depressive disorder. The participants were patients diagnosed with major depressive disorder. A total of 42 participants including 21 male and 21 female patients were recruited from out-patient clinics. Data were collected by in-depth interviews and analyzed using thematic analysis method. Findings: Both female and male patients suffered from gender role internalization. They suffered from ruminative thoughts. Depressive symptoms do not present any concrete abnormality as other illnesses do; consequently it is difficult for others to understand their experiences. Female patients shared there were stigma from receiving treatment from psychiatric hospitals and therefore considered as a barrier to seek help from experts. Both male and female patients did not understand the illness, its course and treatment. In addition, many tended to adjust the medication doses by themselves. Female patients also indicated reasons for not complying with treatment; they included concern of gaining weight and the danger of being under medications for a long period of time. Some men would like to regain self-control so they stopped taking medication. The majority of patients received only medication treatment without psychosocial treatment. Both male and female patients shared that sex of therapist was not as significant as their characters. The findings suggest that new innovations that can enhance public awareness of depression are urgently needed in order to reduce stigma related to illness and enhance accessibility to treatment