Psychosocial concerns predict longitudinal trajectories of distress in newly diagnosed cancer patients

INTRODUCTION@#Unmet psychosocial concerns are associated with emotional distress among cancer patients. This longitudinal study aimed to identify specific psychosocial concern profiles and trajectories of emotional distress, and examine their association among newly diagnosed adult cancer patients across the first year of diagnosis.@*METHODS@#Adult patients aged 21-64 years were screened to determine their eligibility for this study. Psychosocial concerns and psychological distress were measured using the Problem List and the Distress Thermometer, respectively (n = 221). Latent transition mixture analysis was used to determine specific psychosocial concern profiles and trajectories of emotional distress, and examine associations with adjustments made for demographic and medical variables.@*RESULTS@#Two classes of psychosocial concerns were identified: low (81%) and high (19%) concerns. Two trajectories of distress were identified: low stable (69%) and high stable (31%) trajectories. Patients in the high concerns class were significantly more likely to demonstrate the high stable trajectory of distress.@*CONCLUSION@#Our findings highlight the importance of concurrent assessment of multiple psychosocial concerns and screening of emotional distress throughout a cancer patient's treatment journey. Such assessments can effectively guide interventions to address individual concerns and alleviate emotional distress among newly diagnosed cancer patients.

Fear of cancer recurrence among cancer survivors in Singapore

INTRODUCTION@#Fear of cancer recurrence (FCR) among cancer survivors is a persistent and distressing psychosocial concern that affects recovery and quality of life. The prevalence of FCR in Singapore is unknown. This cross-sectional study was designed to examine FCR and identify factors associated with FCR in mixed-cancer survivors locally.@*METHODS@#Cancer survivors in remission (n = 404) were assessed for: FCR using the Fear of Cancer Recurrence Inventory (FCRI); emotional distress using the Hospital Anxiety and Depression Scale; and quality of life using the World Health Organization Quality of Life-BREF. Clinical and severe/pathological FCR was determined based on the severity scale of FCRI, known as FCRI-Short Form. Multivariate logistic regression was performed to examine factors associated with FCR.@*RESULTS@#The mean score on the FCRI was 59.5 ± 30.4. 43.6% of cancer survivors had clinical FCR and 32.1% had severe/pathological FCR. Younger age (odds ratio [OR] 0.952, 95% confidence interval [CI] 0.911-0.995, p < 0.05), higher educational status (OR 2.55, 95% CI 1.15-5.65, p < 0.05) and higher levels of emotional distress (OR 1.17, 95% CI 1.10-1.24, p < 0.001) were significantly associated with severe/pathological levels of FCR.@*CONCLUSION@#The present study is the first to determine levels of FCR among cancer survivors in Singapore. While the total FCR scores were similar to those of international studies, severe/pathological levels of FCR were found to be four times higher. These findings highlight a problem that is not widely recognised or acknowledged, but which deserves greater attention.

Successful ageing in Singapore: prevalence and correlates from a national survey of older adults

INTRODUCTION@#The current study aimed to estimate the overall prevalence and sociodemographic correlates of successful ageing, as defined by Rowe and Kahn, among a national sample of multiethnic adults aged 60 years and older in Singapore.@*METHODS@#Data from older adults who participated in the Well-being of the Singapore Elderly study was analysed. Successful ageing was defined with five indicators: no major diseases; no disability; high cognitive functioning; high physical functioning; and active engagement with life.@*RESULTS@#The prevalence of successful ageing was 25.4% in this older population. Older adults aged 75-84 years and ≥ 85 years had 0.3 times and 0.1 times the odds of successful ageing, respectively, than those aged 60-74 years. Compared to older adults of Chinese ethnicity, those of Malay (odds ratio [OR] 0.6) and Indian (OR 0.5) ethnicities were less likely to be associated with successful ageing. Older adults with lower education levels, who had no formal education (OR 0.2), some schooling but did not complete primary education (OR 0.4) or only primary education (OR 0.5), had lower odds of ageing successfully than those with tertiary education.@*CONCLUSION@#Older adults in Singapore tend to have much more active engagement with life as compared to their counterparts from other countries. Further research into this population is needed, both in terms of qualitative research to gain a better understanding of successful ageing from the older adult's perspective, as well as longitudinal studies that explore behavioural determinants of successful ageing.

Quality of life of family caregivers of cancer patients in Singapore and globally

<p><b>INTRODUCTION</b>Family caregivers of cancer patients often suffer from impaired quality of life (QOL) due to stress arising from the responsibility of caregiving. Most research on such QOL impairments was conducted in Western populations. Thus, this exploratory study sought to (a) examine the QOL levels of family caregivers of cancer patients in an Asian population in Singapore, in relation to caregivers from other countries within and outside of Asia; and (b) investigate the association between sociodemographic factors and QOL impairments in family caregivers in Singapore.</p><p><b>METHODS</b>A total of 258 family caregivers of cancer patients who were receiving outpatient treatment completed the Caregiver Quality of Life Index-Cancer (CQOLC) and a sociodemographic survey. We compared the published CQOLC total scores from Turkey, Iran, Taiwan, South Korea, the United Kingdom, the United States and Canada with the Singapore dataset and examined the demographic relationships.</p><p><b>RESULTS</b>Caregivers in Singapore and Asia had lower CQOLC total scores than their Western counterparts. Caregivers who were male, of Chinese ethnicity, had parental relationships with their care recipient, or cared for advanced-stage cancer patients were found to have impaired QOL.</p><p><b>CONCLUSION</b>The findings of this study highlight possible areas in which support can be provided for family caregivers of cancer patients, and underscore the need to reconcile cultural diversity, values, societal expectations and demographic characteristics in Singapore.</p>

Comorbid Diabetes and Depression among Older Adults - Prevalence, Correlates, Disability and Healthcare Utilisation

<p><b>INTRODUCTION</b>The objectives of this current study were to: 1) examine the prevalence and correlates of diabetes mellitus (DM) among older adults (aged 60 years and above) in a multi-ethnic population; 2) examine the prevalence and correlates of comorbid DM and depression among them; and 3) assess the effect of comorbid depression on disability, cognition and healthcare utilisation.</p><p><b>MATERIALS AND METHODS</b>Data for the current study came from the Well-being of the Singapore Elderly (WiSE) study; a single phase, cross-sectional survey conducted among Singapore residents aged 60 years and above. A total of 2565 respondents completed the survey; depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) while a diagnosis of DM was considered if respondents stated that a doctor had diagnosed them with DM.</p><p><b>RESULTS</b>DM was reported by 25.5% of the population. The prevalence of depression was significantly higher in those diagnosed with DM than those without DM (6% vs 3%). After adjusting for sociodemographic correlates, smoking and other chronic conditions, DM remained significantly associated with depression and subsyndromal depression. However, after including measures of functioning and cognitive impairment as covariates, DM was not significantly related to depression and subsyndromal depression. Those with comorbid DM and depression were more likely to be of Indian and Malay ethnicity, aged 75 to 84 years (versus 60 to 74 years) and widowed.</p><p><b>CONCLUSION</b>Given the significant association of certain sociodemographic groups with comorbid depression among those with DM, targeted interventions for prevention and early diagnosis in these groups should be considered.</p>

Prevalence of Depression among Older Adults-Results from the Well-being of the Singapore Elderly Study

<p><b>INTRODUCTION</b>Depression is a significant public health issue across all sociodemographic groups and is identified as a common and serious mental health problem particularly among the older adult population. The aims of the current study were to determine the prevalence of depression and subsyndromal depression among older adults in Singapore.</p><p><b>MATERIALS AND METHODS</b>The Well-being of the Singapore Elderly (WiSE) study was a comprehensive single phase, cross-sectional survey. Stage 1 Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) depression syndrome was used for this analysis. Association of depression and subsyndromal depression with sociodemographic characteristics, social support as well as comorbidity with chronic physical illnesses and quality of life was assessed.</p><p><b>RESULTS</b>The prevalence of GMS-AGECAT depression and subsyndromal depression was 3.7% and 13.4%, respectively. The odds of depression were significantly higher among those aged 75 to 84 (2.1) as compared to those aged 60 to 74 years and in those who had a history of depression diagnosis by a doctor (4.1). The odds of depression were higher among those of Indian and Malay ethnicities (5.2 and 3.2 times, respectively) as compared to those of Chinese ethnicity. Those with depression and subsyndromal depression were associated with more disability, poorer life satisfaction, and medical comorbidities.</p><p><b>CONCLUSION</b>Our study suggests that the prevalence of depression seems to have decreased as compared to a decade ago wherein the prevalence of depression was estimated to be 5.5%. This positive trend can be ascribed to concerted efforts across various disciplines and sectors, which need to be continually strengthened, monitored and evaluated.</p>

From divination to madness: features of acute intoxication with Salvia use

Salvia divinorum is a psychoactive botanical plant that is increasingly used for the 'legal' highs that it can produce. It is readily available for purchase on the Internet, and most abusers are unaware of the toxicity and abuse potential associated with its use. As the use of novel compounds among abusers is not uncommon, physicians need to increase their awareness and recognition of these new substances. Herein, we report a case of an acute presentation of Salvia intoxication.

Psychosocial care for cancer patients--too little, too late?

Assessment of psychosocial and psychiatric needs is an increasingly important component of cancer care. Clinical experience with patients indicate that distress, anxiety and depression are prevalent from early stages of the illness. Strategies to enhance psychosocial care are presented and these include early identification through screening, training for healthcare staff working with cancer patients and support not only for patients but their caregivers as well.

Improving mental health care for people with an intellectual disability in Singapore: bridging the health-social care divide

Intellectual disability is known to be associated with a high incidence of psychiatric co-morbidity and problem behaviours. However, there are many challenges in trying to meet the mental health needs of people with an intellectual disability, and these are often not adequately addressed in Singapore's current healthcare system. This article outlines the present service provisions for this area in the country and details the importance of, as well as difficulties in the integration of health and social care measures in service development and delivery.

Acute Manic Relapse with Dexfenfluramine

No abstract available.

Weight gain in Asian patients on second-generation antipsychotics

<p><b>INTRODUCTION</b>There is increasing evidence that second-generation antipsychotics are associated with weight gain. However almost all available literature has been for Caucasian populations.</p><p><b>MATERIALS AND METHODS</b>A health quality improvement project was undertaken at the Institute of Mental Health/Woodbridge Hospital to monitor patients who were started on second-generation antipsychotics. This 2-year survey of 266 patients on second-generation antipsychotics closely tracked weight gain and other physical and biochemical parameters.</p><p><b>RESULTS</b>Of the 222 patients regularly monitored, 78.4% had weight gain (mean weight gain 1.9 kg, maximum weight gain 20.1 kg). Weight gain group liability was highest for clozapine (72.4%), followed by olanzapine (66.7%) and risperidone (65%). Most of the weight gain occurred in the fi rst 4 weeks of treatment and 95.9% of those who gained weight had done so in the fi rst 6 months. The maximum weight gain was seen at 12 weeks for risperidone and 8 weeks for clozapine, quetiapine and olanzapine; the latter having another peak at 6 months.</p><p><b>CONCLUSION</b>The survey confirms that weight gain is also a problem for Asian patients treated with second-generation antipsychotics. It reinforces the need for the regular monitoring of patients and the need for psychoeducation and advice on diet and a healthy lifestyle.</p>

Psychiatric Research and Ethics: Attitudes of Mental Healthcare Professionals in Singapore

Objective: This study assessed the opinion of mental healthcare professionals on ethical issues in psychiatric research and investigated whether previous research experience had an impact. Methods: Healthcare professionals at a psychiatric institution were invited to participate in this survey. Using a self-administered questionnaire, attitudes on statements covering ethical concerns and consent process in psychiatric research were assessed and responses of participants with and without research experience were compared. Results: Mental health professionals, irrespective of their research backgrounds, acknowledged the importance of training in research ethics and accepted placebo use in psychiatric research. More respondents with research experience felt that patients with mental illnesses are capable of making a decision about research participation, could provide written informed consent and even if involuntarily admitted, had the ability to participate in research. They also considered randomization of treatment to be justified in psychiatric research. Conclusion: Training and update on ethical regulations and requirements for research involving psychiatric subjects could bring about a change in the perspective towards ethical concerns in psychiatric research.

Patient Satisfaction With Psychiatric Case Management In Singapore

Objective: To assess patient satisfaction with psychiatric case management service provided at a tertiary psychiatric hospital in Singapore. Method: A prospective study, using the Client Satisfaction Questionnaire (CSQ), on 100 patients who had received case management during their stay in the hospital. Results: The primary findings of the study revealed that 87% of the patients rated the service as good to excellent with the same percentage responding that overall, in the general sense, they were satisfied with the service received from the case managers. Also, 95% would recommend the programme to a friend who required similar help although only 74% responded that most or almost all of their needs were met. Conclusion: This study enabled case managers to understand their patients’ needs and satisfaction with the service. They have used this information to improve and enhance their service delivery.

Mental health professionals' perceived barriers and benefits, and personal concerns in relation to psychiatric research

<p><b>AIM</b>Mental health professionals can contribute to generating a strong evidence base for policy and practice in psychiatry. An insight into their perception of psychiatric research is important for planning support strategies. This study explored healthcare professionals' perceptions of barriers, benefits and concerns about psychiatric research in a Singapore psychiatric hospital.</p><p><b>MATERIALS AND METHODS</b>Self-administered questionnaire was employed to collect socio-demographic data and opinions on research. Likert scale was used for the responses and descriptive statistics and ordinal regression were used for data analysing.</p><p><b>RESULTS</b>93.8% respondents perceived "contribution to medical knowledge/public health" to be a major benefit of conducting research. 86.7% respondents felt that "learning experience" was important. "Prestige/publication" (52.7%) and "financial gain" (76%) were perceived to be unimportant. "Clinical load of patients", "lack of skilled personnel to assist in research" and "insufficient funding" were identified as important barriers by 72.4%, 70.6% and 68.9% respondents. "Time constraints", "patient and family readiness to research participation", "insufficient training" and "concerns about patient welfare" are major concerns while conducting research.</p><p><b>CONCLUSION</b>To the study team's best knowledge, this is the only study of mental health professionals' perceptions on psychiatric research. It is useful for strategising research planning and enhancing the research culture in the hospital.</p>

Pathways to specialist care in an insomnia clinic at a psychiatric hospital: a comparative analysis of two periods

<p><b>INTRODUCTION</b>In this study, the pathways patients followed to treatment in an Insomnia Clinic in a psychiatric hospital were compared over 2 periods. The time interval to specialist referrals and patient clinical presentations were also studied. The aim was to better understand referrers' knowledge, needs and accessibility to services.</p><p><b>MATERIALS AND METHODS</b>A retrospective review of cases seen between 2002 and 2005 was compared with an earlier review of cases referred between 1997 and 2000. The information gathered from medical records was similar for the 2 periods.</p><p><b>RESULTS</b>There were no significant differences in the socio-demographic profiles of patients in the 2 periods. Primary Insomnia was diagnosed in 48.2% of the first period cohort and in 47.5% of the second period cohort. However, among the remaining patients there was a shift from more depressive disorders in the first period to neurosis in the second period. Significantly, there was no difference in alcohol or substance abuse or dependence between the 2 periods. More than three-quarters of the patients had received treatment prior to the referral and for 51.8% in both periods, the providers were family physicians. Treatment was mainly pharmacotherapy with an increase in the use of Sleep Hygiene measures in the second period.</p><p><b>CONCLUSION</b>There is a need for continuing medical education on insomnia as well as a need to highlight the risks of untreated insomnia and assessment for other psychiatric disorders in this common complaint.</p>

Psychiatric case management in a tertiary psychiatric hospital

Objective: Psychiatric case management was introduced in inpatient general psychiatry wards in a tertiary psychiatric hospital in late 2003. A brokerage model of case management is used espousing advocacy with case managers acting in their patient’s best interest to encourage and facilitate use of appropriate psychiatric care and reduce fragmentation and costs. Data on patients’ case managed in 2004 and 2005 was analysed to determine the effectiveness of the service in terms of clinical outcomes and service linkages provided. Methods: Psychiatric case managers maintained databases on the patients referred to them. There were 231 patients in 2004 and 375 patients in 2005. Analyses were performed by using SPSS 13.0 with statistical significance set at P <0.05. Descriptive statistics was used and differences between the 2 cohorts in outcome measures were assessed using Chi-square or Fisher’s Exact test. Results: The service developed with a 62.3% increase in the number of cases accepted for case management in the second year. There was improvement in clinical outcomes, such as reductions in unplanned re-admissions within 28 days from 4.8% in the first year to 2.1% in the second year. A reduction in suicide attempts and forensic complications was also found. There were significant reductions in re-hospitalisation in 2004, from 28.1% to just 6.9% after case management was provided (p<0.001). Conclusion: The brokerage model of case management used in this setting was effective in reducing re-hospitalisation, unplanned readmissions, suicide attempts and forensic complications for psychiatric patients

Sleep disturbances in Singaporean children with attention deficit hyperactivity disorder

<p><b>INTRODUCTION</b>Many studies have reported various levels of association between sleep disorders and attention deficit hyperactivity disorder (ADHD). This study aims to investigate sleep disturbances in children with ADHD prior to treatment and during treatment.</p><p><b>MATERIALS AND METHODS</b>This study recruited 114 child and adolescent patients diagnosed with ADHD and 60 normal patients. Sleep disturbances are assessed using the parent-rated Child Behaviour Checklist (CBCL) questionnaire. In addition, chart reviews and semi-structured clinical interviews were conducted for 54 patients with ADHD who had been seen at the clinic since 2002 to examine the sleep disturbances they experienced during treatment over a 4-year period.</p><p><b>RESULTS</b>Compared to the normal subjects, parents of children with ADHD reported that their children slept less. The summation score of the sleep items on the CBCL was also significantly higher in the ADHD group. Girls with ADHD also had more "trouble sleeping". When children with ADHD received treatment with medications, they experienced sleep-related side effects. Out of the 54 children with ADHD, 18.5% experienced sleep disturbance related to medication, with 13.0% reporting daytime somnolence and 5.5% reporting insomnia.</p><p><b>CONCLUSION</b>Our study showed that there was an increased frequency of sleep disturbances in children with ADHD prior to treatment with medications. The children in our study appeared to sleep less. A significant proportion also experienced sleep disturbance during treatment with medication, of which daytime somnolence and insomnia were the most commonly reported problems. Future research in this area is needed to further examine the range of sleep disorders in ADHD children locally.</p>

The risk of suicidality with selective serotonin reuptake inhibitors

Antidepressants are efficacious in the treatment of depression but they are not without side effects. The recent findings on the risk of suicide with selective serotonin reuptake inhibitor treatment, however, have raised serious concerns about the risk-benefit ratio of their use. The development of the concerns is traced and the risks discussed, particularly in the child and adolescent group. The prescriber needs to be aware of the issues and of the need for close clinical monitoring of patients started on selective serotonin reuptake inhibitor treatment.