Academy of Medicine-Ministry of Health clinical practice guidelines: attention deficit hyperactivity disorder.

The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, 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.

Screening for major and minor depression in a multiethnic sample of Asian primary care patients: a comparison of the nine-item Patient Health Questionnaire (PHQ-9) and the 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR16 ).

INTRODUCTION: Depression is common, disabling, and the single most important factor leading to suicide, yet it is underdiagnosed in busy primary care settings. A key challenge facing primary care clinicians in Asia is the selection of instruments to facilitate depression screening. Although the nine-item Patient Health Questionnaire (PHQ-9) and 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR16 ) are used internationally, they have not been directly compared or widely validated in Asian primary care populations. This study aimed to validate the PHQ-9 and QIDS-SR16 against a structured interview diagnosis of Diagnostic and Statistical Manual, 4th Edition, depression based on the Mini-International Neuropsychiatric Interview in a multiethnic Asian sample. METHODS: From April through August 2011, we enrolled 400 English-speaking Singaporean primary care patients. Participants completed a demographic data form, the PHQ-9, and the QIDS-SR16 . They were assessed independently for major and minor depression using the Mini-International Neuropsychiatric Interview. RESULTS: Sensitivity and specificity for diagnosing major depression were 91.7% and 72.2%, respectively, for the PHQ-9 (optimal cutoff score of 6), and 83.3% and 84.7%, respectively, for the QIDS-SR16 (optimal cutoff score of 9). The QIDS-SR16 also detected minor depression at an optimal cutoff score of 7, with a sensitivity of 94.4% and specificity of 77.9%. The PHQ-9 and QIDS-SR16 showed good internal consistency (Cronbach's α: 0.87 and 0.79, respectively) and good convergent validity (correlation coefficient: r = 0.73, P < 0.001). The overall prevalence of major and minor depressive disorders was 9%. DISCUSSION: The PHQ-9 and QIDS-SR16 appear to be valid and reliable for depression screening in Asian primary care settings.