Dementia Neuropsychiatric Symptom Frequency, Severity, and Correlates in Community-Dwelling Thai Older Adults.

BACKGROUND: Thailand is experiencing a rapid increase in the number of older people with dementia (PWD). We examined the frequency, severity, and correlates of dementia neuropsychiatric symptoms (NPS) among community-dwelling Thai older adults. METHODS: This study was based on analysis of baseline data from a larger clinical trial comparing two different implementation approaches of an evidence-based exercise intervention for people with dementia. To be eligible, participants needed to be age 60 and above, have probable dementia, have one or more NPS, be ambulatory, and have an adult (age 18+) family caregiver. In the 353 eligible participants, we examined the correlation between NPS severity and caregiver distress (assessed by the Neuropsychiatric Inventory Questionnaire or NPI-Q) and used ordinary least squares (OLS) regression to examine associations between PWD and caregiver characteristics and NPS severity. RESULTS: NPS frequency varied from 18% for appetite and/or eating changes to 42% for delusions. NPS severity was significantly (p <0.05) associated with caregiver stress for all individual NPS. Among PWD characteristics, higher ADL score (less functional impairment) was inversely associated with NPS total severity (b = -0.16, p <0.05). More physical role limitation was significantly associated with higher NPS total severity (b = 0.77, p <0.001). Among caregivers' characteristics, higher burden was significantly associated with higher NPS total severity (b = 0.19, p <0.001). CONCLUSION: Our study found NPS to be common among community-dwelling PWD in Thailand and have adverse impacts on both PWD and family caregivers. These findings highlight the clinical importance of NPS symptoms among Thai older adults.

Migraine prophylaxis by anodal transcranial direct current stimulation, a randomized, placebo-controlled trial.

BACKGROUND: Migraine is a common headache syndrome in adult populations. Prophylaxis is necessary to improve the quality of life but some patients with migraine have contraindication or suffer from side effects of medication, and therefore, establishing non-medical, neuromodulatory approaches is necessary. Past evidence had shown that consecutive motor cortex (M1) stimulation with anodal transcranial direct current stimulation (tDCS) was effective to relieve central pain. OBJECTIVE: To determine whether 20 consecutive days of the left M1 can be an effective prophylactic treatment for migraine. MATERIAL AND METHOD: Forty-two episodic migraine patients who had never received any prophylactic treatment, failed prophylactic treatment, or discontinued treatment due to adverse events were recruited in the present study. Patients were randomized to receive either active tDCS or sham tDCS 1mA, 20 m for 20 consecutive days and followed up for 12 weeks. Differences between and within groups were determined using repeated measures ANOVA. The level of significance was set at p < 0.05. RESULTS: Thirty-seven patients participated in the final analyses (active: n = 20, sham: n = 17). Between-groups comparison of attack frequency, pain intensity, and abortive medications used were performed at 4, 8, and 12 weeks after treatment. The results showed statistically significant reduction in attack frequency and abortive medications at week 4 and 8 after treatment. The pain intensity was statistically significant reduced at week 4, 8, and 12. All patients tolerated the tDCS well without any serious adverse events. CONCLUSION: The present study suggests that anodal M1 tDCS may be a safe and useful clinical tool in migraine prophylaxis. The mechanism of action of anodal tDCS on neuromodulation in migraine patients needs further investigation.

Breathing meditation by medical students at Khon Kaen University: effect on psychiatric symptoms, memory, intelligence and academic achievement.

OBJECTIVE: To examine the short-term effects on fifth-year medical students of a 4-week, breathing meditation-based, stress reduction intervention on psychiatric symptoms, memory function, intelligence, and academic achievement. MATERIALS AND METHOD: Using a randomized control trial, the meditation group practiced every 8.00 to 8.20 a.m. before beginning daily learning schedule. Meditation emphasized mindful awareness of the breath during inhaling and exhaling. The control group went about their normal activities in the other room. The psychiatric symptoms were measured using the Symptom Checklist-90 (SCL-90), the memory used the Wechsler Memory Scale-I (WMS-I), the intelligence used the Raven's Advanced Progressive Matrices (APM), and the academic achievement used psychiatry course MCQ examination score. Analysis was done using Ancova statistic. RESULTS: Fifty-eight volunteer medical students during their psychiatry rotation between June 2008 and May 2009, were randomized into either in the meditation (n = 30) or the control (non-meditation) (n = 28) group. There was no significant difference between the groups in their respective SCL-90, WMS-I, APM, and psychiatry course MCQ examination score. CONCLUSION: Among normal, intelligent, mentally healthy persons, short-term breathing meditation practice will not likely change psychiatric symptoms, memory function, intellectual performance, and academic achievement.

Validity and reliability study of the Thai version of WHO Schedules for Clinical Assessment in Neuropsychiatry: Eating Disorders Section.

OBJECTIVE: To determine the validity and reliability of the Thai version of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Version 2.1, Eating Disorders Section MATERIAL AND METHOD: The SCAN interview version 2.1 Eating Disorders Section (section 9) was translated into Thai. The content validity of the translation was verified by comparing the back-translation to the English original. Whenever inconsistencies were encountered, the Thai version was adapted so that it correctly conveyed the meaning of the original English version. The revised Thai version was then field-tested in four regions (Suanprung Psychiatric Hospital, Jitavejkhonkaen Hospital, Srithanya Hospital and Suansaranrom Psychiatric Hospital, each place comprised 20 volunteers) for comprehensibility of the relatively technical language. Re-edition of the Thai version was made in accordance with suggestions from the field trial. The reliability study was done between October 2005 and September 2008 in which 30 persons (4 males; 26 females) were recruited. Fifteen persons (1 males and 14 females) were eating disorders patients (4 anorexia nervosa and 11 bulimia nervosa patients) and the other 15 (3 males and 12 females) were normal. The number of years of formal education varied widely and occupations were diverse. Subjects were interviewed using SCAN eating disorders section by a psychiatrist competent in using the Thai version of SCAN. The interviews were recorded on video so that the material could be re-rated. RESULTS: Regarding validity of WHO SCAN eating disorders section, based on the response from Thai subjects and consultations with competent psychiatrists, the content validity was established. Regarding the reliability study, the time taken to interview an eating disorder patient averaged 23.80 +/- 5.15 minutes (range, 18.35-34.26) versus 17.27 +/- 4.05 minutes (range, 9.07-22.37) for a normal subject. The mean of inter-rater reliability (kappa) of the eating disorder section was 0.73, standard error (SE) = 0.02, 95% confident interval (CI = 0.68-0.77). Seventy-eight point five percent of the items in the section had a substantial kappa. The mean of intra-rater reliabilities was 0.76, SE = 0.03, 95% CI = 0.70-0.82. Sixty-eight point four percent and 31.58% of the items had a substantial and almost perfect kappa respectively. CONCLUSION: The Thai version of the Eating Disorders Sections of SCAN version 2.1 proved to be a valid and reliable tool for assessing eating disorders among Thai speakers.

Meditation therapies for attention-deficit/hyperactivity disorder (ADHD).

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common developmental disorders experienced in childhood and can persist into adulthood. The disorder has early onset and is characterized by a combination of overactive, poorly modulated behavior with marked inattention. In the long term it can impair academic performance, vocational success and social-emotional development. Meditation is increasingly used for psychological conditions and could be used as a tool for attentional training in the ADHD population. OBJECTIVES: To assess the effectiveness of meditation therapies as a treatment for ADHD. SEARCH STRATEGY: Our extensive search included: CENTRAL, MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, C2-SPECTR, dissertation abstracts, LILACS, Virtual Health Library (VHL) in BIREME, Complementary and Alternative Medicine specific databases, HSTAT, Informit, JST, Thai Psychiatric databases and ISI Proceedings, plus grey literature and trial registries from inception to January 2010. SELECTION CRITERIA: Randomized controlled trials that investigated the efficacy of meditation therapy in children or adults diagnosed with ADHD. DATA COLLECTION AND ANALYSIS: Two authors extracted data independently using a pre-designed data extraction form. We contacted study authors for additional information required. We analyzed data using mean difference (MD) to calculate the treatment effect. The results are presented in tables, figures and narrative form. MAIN RESULTS: Four studies, including 83 participants, are included in this review. Two studies used mantra meditation while the other two used yoga compared with drugs, relaxation training, non-specific exercises and standard treatment control. Design limitations caused high risk of bias across the studies. Only one out of four studies provided data appropriate for analysis. For this study there was no statistically significant difference between the meditation therapy group and the drug therapy group on the teacher rating ADHD scale (MD -2.72, 95% CI -8.49 to 3.05, 15 patients). Likewise, there was no statistically significant difference between the meditation therapy group and the standard therapy group on the teacher rating ADHD scale (MD -0.52, 95% CI -5.88 to 4.84, 17 patients). There was also no statistically significant difference between the meditation therapy group and the standard therapy group in the distraction test (MD -8.34, 95% CI -107.05 to 90.37, 17 patients). AUTHORS' CONCLUSIONS: As a result of the limited number of included studies, the small sample sizes and the high risk of bias, we are unable to draw any conclusions regarding the effectiveness of meditation therapy for ADHD. The adverse effects of meditation have not been reported. More trials are needed.

Transcranial magnetic stimulation for treatment resistant depression: six case reports and review.

BACKGROUND: Depressive disorder is a common, recurrent, and chronic disorder that is a leading cause of functional impairment and disability An estimated 20-40% of patients do not benefit sufficiently from existing therapies. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for psychiatric illness. Evidences support its use in depression, either alone or combined with antidepressants. During rTMS, a time-varying current is discharged in an insulated coil attached to the scalp surface, generated a brief dynamic magnetic field that can freely, non-invasively penetrate the skull and induce the eddy current in the neural tissue. The rTMS works as a neuro-stimulator and neuro-modulator at the same time, which can modify the functionality of the brain circuits involved in the pathophysiology of mental illness especially in depressive disorder. MATERIAL AND METHOD: The authors reported six cases of various types of depressive disorder, double depression, borderline personality disorder with depression, psychotic depression with nihilistic delusion, post-schizophrenic depression, and treatment resistant depression non-respond to electroconvulsive therapy (ECT). RESULTS: Four in six cases responded well with 10 daily sessions of rTMS. However, a patient with psychotic depression yielded no response. Five patients with moderate depression reached the remission criteria of Hamilton Depression Rating Scale-17 items (HAM-D-17). The means HAM-D-17 of rTMS responders were decreased from 22.4 (SD = 4.1) to 5.2 (SD = 2.9). A patient with psychotic depression did not show any benefit from rTMS and got subsequent modified ECT. CONCLUSION: This is the first cases report of using rTMS for the treatment of depression in Thailand. The rTMS gave promising results in various forms of depression. Due to its safety needing no anesthesia, suitable for out-patient care, rTMS might be a treatment alternative in the acute phase of moderate non-psychotic depression. The authors also reviewed the current evidence.

Validity and reliability study of the Thai version of WHO Schedules for Clinical Assessment in Neuropsychiatry version 2.1.

OBJECTIVE: To determine the validity and reliability of the Thai version of WHO Schedule for Clinical Assessment in Neuropsychiatry (SCAN) version 2.1. MATERIAL AND METHOD: The SCAN interview book version 2.1 was translated from English into Thai. The content validity of the translation was verified by examining the back-translation. Whenever inconsistencies were encountered, the Thai version was adapted to convey the meaning of the original. The revised Thai version was then field-tested in 4 regions of Thailand for comprehensibility of the relatively technical language. Re-edition of the Thai version was made in accordance with suggestions from the field trial. The complete SCAN Thai version was put into the computerized I-Shell program for inter and intra-rater reliability study. RESULTS: Based on the response from Thai subjects and consultations with competent and well SCAN-trained psychiatrists, content validity was established. The inter- and intra-rater agreement of somatoform and dissociative symptoms module were 0.77, 0.85; anxiety: 0.79, 0.84; mood: 0.80, 0.86; eating disorders: 0.73, 0.76; use of alcohol: 0.66, 0.82; stress and adjustment disorders: 0.90, 0.94; psychosis: 0.68, 0.76; cognitive impairment: 0 72, 0.78 and observed behavior, affect and speech module were 0.45 and, 0.51 respectively. CONCLUSION: The SCAN version 2.1 Thai version proved to be a reliable tool for assessing psychiatric illness among Thais.

Stress and Adjustment Disorder Section of WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN)--Thai version: validity and reliability study.

OBJECTIVES: To determine the validity and reliability of the Thai version of the Stress and Adjustment Disorder section of WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN) version 2.1. MATERIAL AND METHOD: The SCAN interview version 2.1 Stress and Adjustment Disorder section was translated into Thai and its content validity tested by back translation. The linguistic clarity of the psychiatric schedules for Thais from the country's four regions was tested by psychiatrists competent in the use of the schedules and aware of their underlying objectives. The reliability of SCAN: Stress and Adjustment Disorder section was tested between June and November 2006 on 30 participants, including 18 patients with stress-related disorders (adjustment disorder post-traumatic stress disorder, acute stress reaction) and 12 normal volunteers. RESULTS: Based on reactions from the sample and consultations from competent psychiatrists, content validity was established The duration of interviews for the Stress and Adjustment Disorder section averaged 17.92 min (25.59 for patients with stress-related disorders and 6.41 for normal subjects). The respective mean inter- and intra-rater reliability kappa was 0.90 (SD = 0.12) and 0.94 (SD = 0.09). A respective 77.05% and 85.26% of the items reached a substantial to almost perfect level of inter- and intra-rater agreement. CONCLUSION: The Stress and Adjustment Disorder section of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version) is demonstrably an effective tool for diagnosing stress-related disorders among Thais.

Validity and reliability of WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN)-Thai version: Cognitive Impairment or Decline Section.

OBJECTIVE: To determine the validity and reliability of the Thai version of the Cognitive Impairment or Decline section of WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN) version 2.1. MATERIAL AND METHOD: The SCAN interview version 2.1 Cognitive Impairment or Decline Section was translated into Thai and its content validity tested by back translation. Psychiatrists competent in the use of the schedules and aware of their underlying objectives tested the linguistic clarity of the psychiatric schedules for Thais from the country's four regions. The reliability of SCAN: Cognitive Impairment or Decline Section was tested between June and November 2005 on 30 participants, including 15 patients with cognitive impairment and 15 normal volunteers. RESULTS: Based on reactions from Thais and consultations from competent psychiatrists, content validity was indeed established. The duration of interviews for the Cognitive Impairment or Decline Section averaged 48.99 min (59.71 for patients with cognitive impairment and 33.77 for normal subjects). The respective mean inter- and intra-rater reliability kappa was 0.72 (SD = 0.31) and 0.78 (SD = 0.23). The reliability of the majority of items reached a substantial to almost perfect level; however, three items (3.66%) had poor and nine (6.67%) only slight inter-rater agreement. Some items needed clarification of the scoring method. The respective inter- and intra-rater reliability of the continuous data was 0.93 and 0.96. CONCLUSION: The Cognitive Impairment or Decline Section of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version) is demonstrably an effective tool for diagnosing cognitive impairment disorders among Thais.

Validity and reliability study of the Thai version of WHO schedules for clinical assessment in neuropsychiatry: sections on psychotic disorders.

OBJECTIVE: To determine the validity and reliability of the Thai version of the WHO Psychotic Disorders Sections of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Version 2.1 MATERIAL AND METHOD: The SCAN interview version 2.1 Psychotic Symptoms Sections (Section 16: Perceptual disorders other than hallucinations, Section 17: Hallucinations, Section 18: Experiences of thought disorder and replacement of will, and Section 19: Delusions) were translated into Thai. The content validity of the translation was established by comparing a back-translation of the Thai version to the English original. Whenever inconsistencies were encountered, the Thai version was adapted to convey the meaning of the original. The revised Thai version was then field-tested in 4 regions (Suanprung Psychiatric Hospital, Jitavejkhonkaen Hospital, Srithanya Hospital and Suansaranrom Psychiatric Hospital, each place comprised 20 volunteers ) for comprehensibility of the relatively technical language. Between October 2004 and July 2006, thirty persons were recruited for the reliability study (16 males; 14 females). Sixteen persons were schizophrenic patients (9 males; 7 females) and 14 (7 males; 7 females) were normal persons or nonpsychotic psychiatric patients. Education and occupations varied widely. The subjects were interviewed by a psychiatrist competent in using the Thai version of SCAN and these interviews were recorded on video for later re-rating. RESULTS: Based on the response from Thai subjects and consultations with competent psychiatrists, content validity was established The time taken to interview a schizophrenic patient averaged 140.2 +/- 36.0 minutes (range, 75-193) vs. 81.9 +/- 25.9 minutes (range, 48-124) for a comparison subject. The respective mean +/- SD of inter-rater reliability (kappa) of Section 16, 17, 18 and 19 was 0.66 +/- 0.17, 0.71 +/- 0.16, 0. 70 +/- 0.22 and 0.64 +/- 0.23. Some items in some sections had 100 percent agreement between raters. The respective intra-rater reliability was 0.65 +/- 0. 11, 0. 74 +/- 0.17, 0.86 +/- 0.17 and 0.80 +/- 0.18. Some sections had items with 100 percent agreement from the same rater even when rated 2 weeks apart. More than half of the items in each section had kappa values, both inter-rater and intra-rater, at least in substantial level. CONCLUSION: The Thai version of the Psychotic Disorders Sections of SCAN version 2.1 proved to be a valid and reliable tool for assessing psychotic symptoms among Thais.

The incidence of clozapine-induced leukopenia in patients with schizophrenia at Srinagarind Hospital.

OBJECTIVE: Define the incidence of clozapine-induced leukopenia, neutropenia, and agranulocytosis in patients with schizophrenia at Srinagarind Hospital. MATERIAL AND METHOD: A descriptive study was done by retrospective reviews of the medical records of schizophrenic outpatients at psychiatric clinic in Srinagarind Hospital who had received clozapine from January 1st, 2003 to December 31st, 2005. The demographic data, incidence rate, and incidence density of leukopenia, neutropenia, and agranulocytosis were collected. RESULTS: One hundred and seventeen medical records were reviewed, 65 patients met the inclusion criteria. One patient developed neutropenia. The incidence rate of neutropenia was 1.5% and the incidence density of neutropenia was 0.01/year. No leukopenia or agranulocytosis was found in the present study. The complete blood counts were not obtained regularly due to the problems of patient's adherence and variations in practice among the physicians. CONCLUSION: Neutropenia is uncommon. No leukopenia and agranulocytosis were found. According to variations of incidence reports among different studies, the monitoring of white blood count should be continued.

The validity and reliability of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version): anxiety disorders section.

BACKGROUND: Anxiety disorders are some of the most prevalent psychiatric disorders, have early onset, are chronic and can cause functional impairment. It is, therefore, crucial to establish an accurate diagnosis for treatment and research purposes. OBJECTIVE: To test the validity and reliability of the W.H.O. Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version): Anxiety Disorders Section. MATERIAL AND METHOD: The linguistic clarity of the psychiatric schedules for Thais was tested by psychiatrists from the country's four regions. The psychiatrists were competent in the use of the schedules and their underlying objectives. Then between October 2004 and August 2005, Reliability of SCAN: anxiety disorder section was tested among 30 participants, including patients with anxiety disorders and normal volunteers. RESULTS: Based on reactions from Thais and consultations from competent psychiatrists, content validity was established. The duration of interviews for anxiety disorders section averaged 45.1 min (SD = 13.5). The reliability determined by Cohen's kappa coefficient for the 83 items that related to anxiety disorders in the SCAN were in Section 3, 4, 5. This overall inter-rater reliability was 0.79 (SD = 0.22), which were in substantial level of agreement. The overall intra-rater reliability was rated by the same psychiatrist 2 weeks apart. The result was 0.84 (SD = 0.21), which was near perfect agreement. There were three items (3.6%) of fair agreement and five items (6%) of moderate agreement that were caused from discrepancy of item definitions and the subjectivity of raters. CONCLUSION: The Anxiety Disorders Sections of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version) were an effective tool for assessing symptoms of anxiety disorders among Thais.

The validity and reliability of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version): Mood Disorders Section.

BACKGROUND: Mood disorders are one of the most prevalent psychiatric disorders that have early onset, are chronic and can cause functional impairment. It is therefore crucial to establish an accurate diagnosis for treatment and research purposes. OBJECTIVES: The authors aimed to test the validity and reliability of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version): Mood Disorders Section. MATERIAL AND METHOD: First, psychiatrists competent in the use of the schedules and their underlying objectives tests the linguistic clarity of the Thai psychiatric schedules in four regions of the country. Then between October 2003 and August 2004, Reliability of SCAN: mood disorder section was tested among 30 participants, including mood disordered patients and normal volunteers. RESULTS: Based on reactions from Thais and consultations from competent psychiatrists, content validity was established. The duration of interviews for the mood disorder sections averaged 63.6 min (SD = 17.1). The inter- and intra-rater reliability kappa were 0.80 (0.77-0.83) and 0.86 (0.84-0.88), respectively. The reliability of the majority of items reached substantial to almost perfect agreement; however, 1 item (1%) had only slight agreement and 15 items (12%) had moderate agreement, and needed clarification of the scoring method CONCLUSION: The Mood Disorders Sections of the WHO Neuropsychiatry Schedules for Clinical Assessment (SCAN Thai Version) were effective tools for diagnosing mood disorders among Thais.

Inter- and intra-rater reliability of the Thai version of SCAN: Use of Alcohol and Use of Tobacco Section.

OBJECTIVE: To assess inter and intra rater reliability of the Thai version of Use of Alcohol and Use of Tobacco Section of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN). MATERIAL AND METHOD: Fifteen alcohol and/or tobacco dependence patients and fifteen controls with ages of > or = 18 years were recruited from October 2003 to August 2004 at Srinagarind Hospital. One psychiatrist interviewed and first rated under video-recording, then re-rated two weeks later. Another psychiatrist rated independently by looking at the videotapes for inter-rater reliability testing. RESULTS: The intra-rater kappa was 'excellent' for both sections. The inter-rater kappa for all items of "tobacco use" were 'excellent' (mean kappa = 0.84), and 'good' (mean kappa = 0.66) for the "alcohol use". Items of dependence had 'good' kappa (mean kappa = 0.73-0.95), except items of 'activities limitation (interest neglect)' and 'use despite knowledge of psychological/physical problems (continued use)' was 'fair' (mean kappa 062-0.49). The poor kappa (mean kappa = 0.17-0.38) was found in the item of 'physical and mental health problems due to drinking'. CONCLUSION: Thai SCAN provided reliable inter-rater diagnostic information for alcohol and tobacco dependence, but fair reliability for alcohol abuse. Improve understanding of the item concepts, better validity in questioning; giving examples of the focus symptoms, and frequent discussion about the respondent's answers, might improve overall validity and reliability.

Validity and reliability study of the Thai version of WHO SCAN: somatoform and dissociative symptoms section.

OBJECTIVES: To determine the validity and reliability of the Thai version of the WHO Somatoform and Dissociative Symptoms Section of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Version 2.1 MATERIAL AND METHOD: The SCAN interview version 2.1 Somatoform and Dissociative Symptoms Section was translated into Thai. The content validity of the translation was verified by comparing a back-translation (to English) of the Thai version to the English original. Whenever inconsistencies were encountered, the Thai version was adapted so that it correctly conveyed the meaning of the original English version. The revised Thai version was then field-tested nationwide for the comprehensibility of the relatively technical language. Between October 2003 and August 2004, 30 persons were recruited for the reliability study (16 males; 14 females) Fifteen subjects had somatoform disorders and 15 were normal. The number of years of formal education varied widely and occupations were diverse. Subjects were interviewed by a psychiatrist competent in using the Thai version of SCAN. The interviews were recorded on video so that the material could be rerated. RESULTS: Based on the response from Thai subjects and consultations with competent psychiatrists, the content validity was established. The time taken to interview a somatoform patient averaged 57.1 +/- 12.1 minutes while it was 42.1 +/- 13.9 minutes for a normal subject. The inter-rater reliability (kappa) of the 113 Items were: 0.81-1.0, 0.61-0.80 and 0. 00-0.20 in 49.6, 30.0 and 8.9 percent, respectively. Kappas could not be calculated for 11.5% of the Items. The intra-rater reliabilities were. 0.81-1.0, 0.61-0.80 and 0.00-0.20 in 54.9, 26.5 and 2.7 percent, respectively. Kappas could not be calculated for 15.9% of the Items. CONCLUSION: The Thai version of the Somatoform and Dissociative Symptoms Section of SCAN version 2.1 proved to be a valid and reliable tool for assessing somatoform and dissociative symptoms among Thai speakers.