Tjhin Wiguna

Effect of 12-week administration of 20-mg long-acting methylphenidate on Glu/Cr, NAA/Cr, Cho/Cr, and mI/Cr ratios in the prefrontal cortices of school-age children in Indonesia: a study using 1H magnetic resonance spectroscopy (MRS).

ObjectivesRecent studies on the neurobiology of attention-deficit/hyperactivity disorder (ADHD) have suggested that there is dysregulation of dopamine-mediated neurotransmission, particularly in the prefrontal cortex and basal ganglia, and that treatment with methylphenidate reverses this dysregulation. Using methodology similar to previous studies involving putative markers of brain functioning, we used 1H magnetic resonance spectroscopy to study the effect of 12-week treatment with daily 20-mg long-acting methylphenidate on the glutamate/creatine, N-acetyl-aspartate/creatine, choline/creatine, and myoinositol/creatine ratios in the prefrontal cortices of medication-naive children with ADHD. MethodThis was a prospective study, using a pretest and posttest design, on a single group of 21 children (mean age, 8.52 years; 17 males and 4 females) with a diagnosis of ADHD. A low time echo (TE) magnetic resonance spectroscopic scans sampled voxels of interest (1.5 × 1.5 × 2.0) from both the right and left prefrontal cortices. ResultsAfter treatment, the N-acetyl-aspartate/creatine ratio increased 18.8% in the right prefrontal cortex (P = 0.001) and 10% in the left prefrontal cortex (P = 0.007); the glutamate/creatine ratio decreased 15% in the right prefrontal cortex (P = 0.005) and 14.1% in the left prefrontal cortex (P = 0.005); the choline/creatine ratio decreased 12.4% in the right prefrontal cortex (P = 0.037) and 16% in the left prefrontal cortex (P = 0.006); and the myoinositol/creatine ratio decreased 14.7% in the left prefrontal cortex (P = 0.011) and 7.7% in the right prefrontal cortex (P = 0.129). ConclusionNotwithstanding the limitations of this pilot study, we found, after stimulant treatment, significant neurochemical changes (thought to reflect functional improvement and improved neuroplasticity) in the prefrontal cortices of children with ADHD.

Association of rs1344706 in the ZNF804A gene with schizophrenia in a case/control sample from Indonesia.

BACKGROUND Association of rs1344706 in the ZNF804A gene (2q32.1) with schizophrenia was first reported in a genome wide scan conducted in a sample of 479 cases and replicated in 6666 cases. Subsequently, evidence by replication was obtained in several samples with European- and Asian ancestral background. METHODS We report ascertainment, clinical characterization, quality control, and determination of ancestral background of a case control sample from Indonesia, comprising 1067 cases and 1111 ancestry matched controls. Genotyping was performed using a fluorescence-based allelic discrimination assay (TaqMan SNP genotyping assay) and a newly designed PCR-RFLP assay for confirmation of rs1344706 genotypes. RESULTS We confirmed association of the T-allele of rs1344706 with schizophrenia in a newly ascertained sample from Indonesia with Southeast Asian ancestral background (P=0.019, OR=1.155, 95%, CI 1.025-1.301). In addition, we studied several SNPs in the vicinity of rs1344706, for which nominally significant results had been reported. None of the association P values of the additional SNPs exceeded that of rs1344706. CONCLUSION We provide additional evidence for association of the ZNF804A gene with schizophrenia. We conclude that rs1344706 or a yet unknown polymorphism in linkage disequilibrium is also involved in conferring susceptibility to schizophrenia in samples with different (Asian) ancestral backgrounds.

Psychiatric morbidity among children in North Aceh district (Indonesia) exposed to the 26 December 2004 tsunami

Introduction: The aim of the study was to ascertain, using available data from the Bio‐psychosocial Program for children, psychiatric morbidity and specific diagnoses among youths in North Aceh in the year after the tsunami disaster.

Attitudes of patients and family members towards implantable psychiatric medication

INTRODUCTION Medication is a necessary part of treatment for severe psychiatric illnesses such as schizophrenia and nonadherence to prescribed medication is one of the most important public health issues in psychiatry today. The devastating consequences of nonadherence have motivated the development of novel therapeutic strategies, including a new long-term implantable medication delivery system. METHODS The current study assesses attitudes towards implantable medication in psychiatric patients and their family members. Patients included in the study had diagnoses of Schizophrenia, Schizoaffective Disorder, Mood or Anxiety related disorders. RESULTS 49.62% of patients and 74.47% of family members endorse support for implantable medication. CONCLUSIONS This study demonstrates that implants may be an acceptable alternative to oral and injectable medication for a subset of psychiatric patients and their families.

The Amygdala's Neurochemical Ratios after 12 Weeks Administration of 20 mg Long-acting Methylphenidate in Children with Attention Deficit and Hyperactivity Disorder: A Pilot Study Using (1)H Magnetic Resonance Spectroscopy.

Objective Recent pediatric studies have suggested a correlation between decreased amygdala volume and attention deficit and hyperactivity disorder (ADHD) symptoms, including the emotional dysregulation. To investigate the hypothesis that medication treatment of ADHD specifically improves amygdala function, we used 1H magnetic resonance spectroscopy (MRS) to study the effect of 12 weeks of treatment with daily 20 mg long-acting methylphenidate on the Glu/Cr, NAA/Cr, Cho/Cr, and mI/Cr ratios in the amygdala of medication-naïve children with ADHD. Methods This was a prospective study, using a pre- and post-test design, on a single group of 21 children (average age 8.52 years, 17 males and 4 females) diagnosed with ADHD. Low Time Echo MRS scans sampled voxels of interest (1.5×1.5×2.0) from both the right and left amygdala. Results There was significant clinical improvement after 12 weeks of treatment with 20 mg long-acting methylphenidate. On 1H MRS, there were no statistical significant differences of NAA/Cr ratio, Cho/Cr ratio, mI/Cr ratio before and after 12 weeks administration of 20 mg long-acting methylphenidate both in the right and left amygdala. In addition, Glu/Cr ratio decreased 14.1% in the right amygdala (p=0.029) and 11.4% in the left amygdala (p=0.008). Standardized mean effect sizes ranged from 0.14-0.32. Conclusion The findings are consistent with the possibility that hyperglutamatergic processes in the amygdale are related to the hyperactive-impulsive symptoms of ADHD.

Care for the seafarers: A review of mental health in Austronesia

Continent‐based regional reviews of mental health may not fully describe the status of ethnocultural groups that are widely dispersed across multiple continents or traditional world regions. Our aim was to describe the Austronesians, an ethno‐linguistic group living primarily in islands and coastal areas in the Pacific and Indian Oceans and Southeast Asia.

The effect of lactose-isomaltulose-containing growing-up milks on cognitive performance of Indonesian children: a cross-over study.

Glycaemic response to dietary carbohydrates might have an impact on cognitive performance. The present study investigated the effects of growing-up milks (GUM) with isomaltulose and extra minerals and vitamins or lower protein content on cognitive parameters in children aged 5–6 years. In a blinded, partly randomised, controlled, cross-over study, four GUM were provided, each taken over 14 d (2 × 200 ml/d): standard (Std) GUM; Std GUM+5 g isomaltulose (Iso-5 GUM); Iso-5 GUM with 26 % less protein (Iso-5 LP GUM); Std GUM with 2·5 g isomaltulose and extra Mg, Zn, Se, D3, B1, B2, B12, folic acid and choline (Iso-2·5 GUM). At test days, when GUM replaced breakfast, repeated (0, 60, 120 and 180 min post-dose) cognitive tasks were performed (picture presentation, simple reaction time, digit vigilance, choice reaction time, spatial and numeric working memory and picture recognition). Task performance of all subjects (n 50) worsened over the morning. Best performance was seen on isomaltulose GUM, most notably at 180 min. Iso-2·5 GUM showed best performance on several parameters of attention and memory, Iso-5 GUM performed best on parameters of memory and Iso-5 LP GUM was positively associated with parameters of attention but less with memory. Std GUM showed only a benefit on one attention and one memory task. Thus, isomaltulose-enriched GUM positively affected parameters of attention and memory at 180 min post-dose when compared with Std GUM. Extra minerals and vitamins seem beneficial, whereas lowering protein content might improve attention in particular.

The University of Hawaii/University of Indonesia Collaboration to Build and Sustain a Child Psychiatric Workforce

The authors describe the University of Hawaii/University of Indonesia collaboration, which introduced the specialty of child psychiatry to Indonesia in the early 1970s via a specially designed program, based in Hawaii, for five jointly selected Indonesian psychiatrists. All five graduates remained in Indonesia to practice and establish their own training program, which has since trained all of the “newer generation,” such that there are currently 40 child and adolescent psychiatrists in Indonesia. Since 2009, collaboration between the two institutions has been renewed and modernized through videoteleconferencing, jointly conducted with teaching sessions. The authors present this program as an example of a collaboration that developed the local workforce and that has utilized modern technology in international, bidirectionally beneficial education.

Family responses to a child with schizophrenia: An Indonesian experience.

Indonesian culture puts a high value on family bonding. Therefore, support and encouragement for each family member is high that any problems are the responsibility of the whole family. This paper explores the implications of the phenomena whether is a schizophrenic child in the family affected the parental relationship in Indonesian family and trying to find out the implication of parental relationship on medication adherence. This was a cross-sectional study which involved 180 parents of children with schizophrenia and parents with aged matched non-schizophrenic children as a control group; consisting of 45 parents of children with schizophrenia and 135 parents of non-schizophrenic children. The parental relationship was examined by using the Indonesian version of Family Adaptability and Cohesion Evaluation Scale IV (Indonesian version of FACES IV). Our study revealed that 75.6% parents of children with schizophrenia experienced a healthy parental relationship compared to 94.80% in the parents of non-schizophrenic children group. The most prevalent of unhealthy relationship among parents of children with schizophrenia was chaotic disengagement. Parental adherence to give medication for their child with schizophrenia was better if they had a healthy parental relationship. In conclusion, a small number of Indonesian parents with schizophrenic children experienced an unhealthy parental relationship. Therefore, psycho-education and supportive psychotherapy still needed to facilitate those families to express their emotion adapt and cope.

Learning Difficulties and Working Memory Deficits among Primary School Students in Jakarta, Indonesia

Objective There are multiple possible etiologies for learning difficulties in children. There is growing evidence that many students identified as having learning difficulties have significant working memory deficits. To determine, in a sample of primary school students in Jakarta, Indonesia, the prevalence of learning difficulties and learning difficulties co-morbid with working memory deficits. Methods Subjects (N=423) were recruited via proportional random sampling from 27 primary schools. The first stage was a cross-sectional study of these students, while the second stage was a case-control study comparing all students with learning difficulties and working memory deficits with controls matched by school type, grade level, and gender. Results Among the students, whose mean age was 9.34 years (1.78), 13.7% had a learning difficulty, while 8.04% had a learning difficulty with working memory deficit. The odds ratio of comorbid working memory deficit (in the face of a learning difficulty) was 7.0 (χ2= 35.96, p<0.001). Conclusion Learning difficulties and comorbid working memory deficits were relatively common among primary school students. Efforts should be made to identify these students and provide timely assistance, in order to optimize their educational success and mental health outcomes.