Rate of Serum Valproate Concentration Monitoring in Patients with Bipolar Disorder Type I at Srinagarind Hospital Outpatient Clinic.

Objective: Determine in the out-patient setting the rate and the purpose of serum valproate concentration monitoring during treatment with valproate, either single valproate or valproate in combination with other psychotropics in patients with bipolar disorder type I (BD-I), to determine the rate of recording valproate associated adverse effects, the rate of the follow-up and the length (days) that the patients were in the condition of full remission/recovery and symptomatic. Material and Method: The present study was a retrospective descriptive study done between January 1, 2007 and December 31, 2008. The data were from the medical records of DSM-IV-TR BD-I out-patients at Srinagarind Hospital, Khon Kaen who were treated either by single valproate or valproate in combination with other drugs for at least six weeks long. The studied variable included the annual rate and the reason that psychiatrist requested serum valproate concentration (SVC) monitoring per patient, the annual rate that psychiatrist recorded the valproate associated adverse effects, the annual rate that the patient returned to have a follow-up visit, and the length (days) that the patient was in full remission/recovery and symptomatic. Results: During the study period, of the 199 patients with BD-I, only 57 patients (28.6%) that were treated with valproate had complete records. The SVC monitoring occurred 17 times from 13 patients (22.8%). The mean SVC was 76.4 microgram/ml (SD = 31.8). The mean value +SD and range of SVC during the remission/recovery period were 75.1+17.5 µg/ml and 43.5-96.8 µg/ml, which was not significantly different from the symptomatic period, which was 77.1+39.9 µg/ml and 0.7 to 124.9 µg/ml. However, the oral dosage of valproate during the remission/recovery period (944.7+275.4 mg/day, median 1,000 mg/day) was significantly higher than during the symptomatic period (699.0+592.5 mg/day, 1,000 mg/day) (t = 2.7, df = 104 and p = 0.009). Of all the SVC monitoring, 58.8% occurred during the symptomatic period and most of the monitoring was due to the emergence of adverse effects. The causes for requesting the SVC determination were the emergence of adverse effects (29.4%), no reason specified (29.4%), and to monitor the clinical response (11.8%). The rate of valproate associated adverse effects recording was 1.1 times/person/year, which was 18.6% of the average rate of follow-up visits (6.6 times/person/year). The most frequent adverse effect was sedation. The treatment of BD-I by valproate or in combination with other psychotropics resulted in the remission/recovery period lasting 470.2 days (SD 256.8, median 517.0) while the symptomatic period lasted 176.1 days (SD 157.5, median 139.5). Conclusion: During treatment of BD-I, the rate of serum valproate concentration monitoring was very few. However, when determination was requested, the SVC was within the therapeutic range. In addition, rate of recording of valproate associated adverse effects was very low and the most frequent adverse effect was mild. The reason for monitoring the clinical response was rarely found. Valproate seems to be easily administered. The dosage can be adjusted using only clinical response and adverse effects. Therefore, valproate was effective and safe in treatment of BD-I.

Clinical outcome of valproate maintenance treatment in bipolar I disorder at Srinagarind Hospital.

OBJECTIVE: To determine-in a clinical setting-the rate and time to recurrence of any mood episode during valproate maintenance treatment for bipolar I disorder. MATERIAL AND METHOD: A retrospective cohort based on medical records of both in- and out-patient with bipolar I disorder (DSM-IV-TR) seen at Srinagarind Hospital between January 1, 2009 and December 31, 2010 was done. A recurrence was observed if the patient had fulfilled the remission criteria and valproate was the maintenance drug. Survival analysis and Cox regression analysis were used to analyze the data. RESULTS: Eighty-five patients with 124 remitted mood episodes met the inclusion criteria. Of the 85 patients, the average age was 41.4 +/- 17.1 years (range, 18-89); 49.4% were males; 48.2% married; 42.4% completed secondary school, 30.6% completed a bachelor degree; 35.3% were unemployed, and 34.1% were government employees. Twenty remitted mood episodes (16.1%) were in maintenance treatment with valproate only. The remaining 104 (83.9%) were in maintenance treatment with valproate in combination with other agents. There were 50 recurrences from 36 patients during the two years of study, the recurrence per a patient ranged from 1 to 3 times. The rate of recurrence was 21%/year or 2.2/100 person-months (95% CI = 1.65-2.93). The average time to recurrence to any mood episode was 33 months (95% CI = 15.06-50.94). With multivariable Cox regression, a statistically significant greater risk for a recurrence was associated with: (a) the previous episode being hospitalized (adjusted hazard ratio = 5.88, 95% CI = 2.76-12.36, p < 0.001); (b) blood valproate concentration during maintenance treatment < 50 microg/mL (adjusted hazard ratio = 3.07, 95% CI = 1.11-8.53, p = 0.03); and (c) time duration (month) of valproate maintenance treatment (adjusted hazard ratio = 0.98, 95% CI = 0.96-0.99, p = 0.001). With the adjusted hazard ratio 0.98, it could be interpreted in the other way that each additional month of taking valproate was associated with a statistically significant protective factor that decreased the risk of recurrence by 2% from the previous month. CONCLUSION: In the authors'clinical setting, valproate both singly and in combination with other psychotropic agents used for maintenance treatment of bipolar I disorder yielded a recurrence rate of 21% per year or 2.2 per 100 person-months and time to any mood episode recurrence of 33 months. The present result has importance for both clinical treatment decision-making and patient economic status.

Characteristics and burden of hospitalization because of intentional self-harm: Thai national, hospital-based data for 2010.

BACKGROUND: There is a paucity of data on intentional self-harm and suicide in Thailand. It is crucial to re-evaluate the burden and health outcomes. OBJECTIVE: To measure the character and burden of acts of intentional self-harm in the Thai hospitalized population. MATERIAL AND METHOD: Acts of intentional-self harm were categorized using ICD 10 classification. All of inpatient-related data were analyzed using SPSS 17. RESULTS: Overall intentional self-harm in 2010 led to 24,924 hospitalizations and 854 deaths; an incidence of 35.6/100,000 people with the highest level in two age groups: 18-25 and 26-40 year-olds. Self-poisoning (89%) was the most common method and pesticide was the leading used chemical agents. The total cost of treatment was 149,672,190 baht and the mean length of stay was 2.9 +/- 6.7 days. The mortality rate increased as the population got older with the highest rate being 10.6% for 70-79 year-olds. In 33.8% of cases, psychiatric co-diagnosis were found with anxiety disorders was the leading comorbidity. CONCLUSION: The incidence of intentional self-harm was medium to high, compared to other East Asians countries. Self-poisoning by exposure to pesticides was the most common self-harm method. Age over 60 had the highest mortality rate. Having a psychiatric co-diagnosis was common.

Epidemiology of assault-related hospitalizations in Thailand in the fiscal year 2010: comparison between with and without psychiatric disorder.

BACKGROUND: Assault is a leading cause of injury and death; however little is known regarding the psychiatric epidemiology of assault-related hospitalizations (ARH) in Thailand. OBJECTIVE: To analyze the epidemiological data of ARH in Thailand for the fiscal year 2010 and to compare the epidemiology of ARH between with and without psychiatric disorder MATERIAL AND METHOD: The data analyzed were from the annual reports for the fiscal year 2010 (October 1, 2009-September 30, 2010), on every kind of hospitalization reimbursed by the Universal Health Coverage System, the Social Welfare System, and the Civil Servant Medical Benefits Scheme, altogether provided medical coverage for more than 96% of the Thai population. The information on ARH (X85-Y09: ICD-10 version for 2010) and comorbid psychiatric disorder(s) (F00-F99) were extracted. Number of in-patient hospitalizations by sex, age, geographical region, month, hospital charges, length of hospital stay (LOS) and mortality rate (MR) were analyzed. Frequencies (percentages) of ARH and subgroups were reported. RESULTS: The national ARH care cost was 0.98% of the overall national in-patient care expenses (88,964 million Baht). The rate of ARH was 0.72 of every 100 hospitalizations or 7.74 incidents/100,000 general population. Assaults leading to hospitalizations frequently occurred among males (80.86%); in 25-39 year-olds (35.60%), 40-59 year-olds (22.85%); by sharp object (29.44%), blunt object (24.40%) and bodily force (23.71%); in the Central (39.48%) and Northeast region (31.16%). There was a tri-modal monthly peak distribution: April (11.12%), December (9.45%) and October (8.90%). A minority i.e. 0.4% (male to female ratio of 4.22:1) of ARH had a concomitant psychiatric disorder(s): the most frequent being 'mental and behavioral disorders due to psychoactive substance use' (66.54%) followed by 'schizophrenia, schizotypal and delusional disorders' (14.230%). The MR of ARH with and without concomitant psychiatric disorder was 1.03% and 0.30%, respectively. The LOS of overall ARH was 5.15 +/- 12.41 days, min-max was 1-568 days and the mode was 1 day. The LOS of ARH with/without psychiatric disorder was 5.2 +/- 12.4 vs. 3.7 +/- 7.5 days. The expenses paid for ARH with/without psychiatric disorder was 75,811,383.40 Baht vs. 791,214,659.90 Baht. CONCLUSION: Assault accounted for 0.72 hospitalization of every 100 hospitalizations and 7.74 times/100,000 population. A fraction (0.04%) of ARH had concomitant psychiatric disorder(s): most frequently psychoactive substance use disorders followed by schizophrenia and related psychosis.

Epidemiology of mental and behavioral disorders among the elderly: based on data of hospitalized patients in Thailand 2010.

BACKGROUND: To date, only small, selected groups of elderly hospitalized with mental and behavioral disorders (EHMBD) have been studied. Since no national epidemiological studies have been published, the recent advent of universal healthcare in Thailand makes doing such a study timely for improving the medical curricula and service provision. OBJECTIVE: To analyze the epidemiology of the EHMBD in the year 2010 of Thailand. MATERIAL AND METHOD: The data analyzed were gathered from Medical Expense Reimbursement forms submitted for the fiscal year 2010. The particular focus of this research was on elderly inpatient aged 60 years and over with ICD-10 (for 2010) diagnosis: F00-F99 Mental and Behavioral Disorders. The authors extracted and analyzed the number of in-patient department (IPD) admissions, psychiatric diagnoses, length of hospital stays, hospital charges and mortality rate. Data were analyzed using SPSS 17 for Windows. RESULTS: In 2010, EHMBD accounted for 11,418 admissions which was 1.56 admission per 1000 elderly people or 13.9% of overall admission (19 years and over). Of the 11,418 admission, 44 died (0.39%). The mean in-patient charges/admission in Thai Baht (SD) for the EHMBD with any F00-F99 diagnosis was 12,896 (51,659). The average range of stay was 8.3 +/- 22.2 days. The leading diagnosed clusters of behavioral and mental disorders were organic mental disorders (F00-F09: 23.8%), neurotic, stress-related and somatoform disorders (F40-F48: 21.1%); and mental and behavioral disorders due to use of alcohol (F10: 20.3%). Alcohol use disorders among the elderly resulted in four times more men being hospitalized than women. Regarding the F30-F39 cluster mood (affective) disorders, the prevalence of depressive episodes increased with age and bipolar affective disorder decreased with age. CONCLUSION: The prevalence of hospitalization among the elderly with mental and behavioral disorders was about one-eighth that of all admission of adult from 19 years old. Death was an uncommon result. The most common psychiatric diagnoses were organic mental disorders, neurotic, stress-related and somatoform disorders and mental and behavioral disorders due to use of alcohol.

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.

Brain laterality evaluated by F-18 fluorodeoxyglucose positron emission computed tomography in autism spectrum disorders.

Background and rationale: Autism spectrum disorder (ASD) is a neuropsychiatric disorder that has no curative treatment. Little is known about the brain laterality in patients with ASD. F-18 fluorodeoxyglucose positron emission computed tomography (F-18 FDG PET/CT) is a neuroimaging technique that is suitable for ASD owing to its ability to detect whole brain functional abnormalities in a short time and is feasible in ASD patients. The purpose of this study was to evaluate brain laterality using F-18 FDG PET/CT in patients with high-functioning ASD. Materials and methods: This case-control study recruited eight ASD patients who met the DSM-5 criteria, the recorded data of eight controls matched for age, sex, and handedness were also enrolled. The resting state of brain glucose metabolism in the regions of interest (ROIs) was analyzed using the Q.Brain software. Brain glucose metabolism and laterality index in each ROI of ASD patients were compared with those of the controls. The pattern of brain metabolism was analyzed using visual analysis and is reported in the data description. Results: The ASD group's overall brain glucose metabolism was lower than that of the control group in both the left and right hemispheres, with mean differences of 1.54 and 1.21, respectively. We found statistically lower mean glucose metabolism for ASD patients than controls in the left prefrontal lateral (Z = 1.96, p = 0.049). The left laterality index was found in nine ROIs for ASD and 11 ROIs for the control. The left laterality index in the ASD group was significantly lower than that in the control group in the prefrontal lateral (Z = 2.52, p = 0.012), precuneus (Z = 2.10, p = 0.036), and parietal inferior (Z = 1.96, p = 0.049) regions. Conclusion: Individuals with ASD have lower brain glucose metabolism than control. In addition, the number of ROIs for left laterality index in the ASD group was lower than control. Left laterality defects may be one of the causes of ASD. This knowledge can be useful in the treatment of ASD by increasing the left-brain metabolism. This trial was registered in the Thai Clinical Trials Registry (TCTR20210705005).

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.

Quetiapine for primary insomnia: a double blind, randomized controlled trial.

OBJECTIVE: To evaluate the clinical efficacy of Quetiapine 25 mg for the treatment of primary insomnia. MATERIAL AND METHOD: A randomized, double-blind, placebo-controlled clinical trial was conducted. Patients with DSM-IV-TR defined primary insomnia were asked to record a sleep diary one week prior to treatment, followed by 2 weeks of nightly treatment with either Quetiapine 25 mg or placebo. The primary outcomes were total sleep time (TST), sleep latency (SL), daytime alertness and functioning and sleep satisfaction; side effects were recorded as secondary outcome. Data were collected between January 2007 and December 2007, at Srinagarind Hospital of Khon Kaen University. RESULTS: Thirteen patients completed the present study (mean age 45.95 years old; range 25-62). Quetiapine group increased mean TST by 124.92 minutes and 72.24 minutes in the placebo group. Mean SL was reduced by 96.16 minutes in the Quetiapine group and 23.72 minutes in the placebo group. Statistical significance was not reached between both groups. In the Quetiapine group two patients reported side effects of dry lips, dry tongue and morning drowsiness. CONCLUSION: The present study is the first study to evaluate the effect of Quetiapine in primary insomnia in a randomized controlled trial. Quetiapine at 25 mg at night did show a trend for improvement of TST and reduced SL in primary insomnia with few side effects but not reaching statistical significance. A study with a larger sample size is needed to demonstrate its efficacy.

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 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.

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.

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.

Clomipramine-resistant, fluoxetine-responsive obsessive compulsive disorder: a case report.

Serotonin re-uptake inhibitors (SRIs), clomipramine and selective serotonin re-uptake inhibitors (SSRIs), are the first-line pharmacologic therapies for patients with obsessive compulsive disorder (OCD). However, 40 to 60 per cent of patients do not respond to adequate treatment trials of SRIs. SRI partial- and non-responders must be treated with augmentation strategies or put on another SRI since non-response to the first SRI does not necessarily indicate a non-response to a second SRI. Each treatment trial should run at least 10 weeks and if successful, the drug should be continued for at least 1 to 2 years and withdrawn gradually. The presented patient had a second episode of OCD which was resistant to more than 10 weeks of high dosage clomipramine even though he responded very well during the first episode 4 years earlier and had been off clomipramine for 3 years. Augmentation to clomipramine with lithium and then haloperidol consecutively also failed. When clomipramine was changed to fluoxetine, the OCD symptoms were responsive even at a starting dosage of 20 mg/day. The response improved as the dosage of fluoxetine was increased. The response reached a maximum and the patient coped very well in every aspect of daily life when the dosage of fluoxetine was increased to 60 mg/day. He had taken fluoxetine at this daily dosage for one year before the drug was tapered off. It has now been more than two years since he has had any OCD symptoms and clomipramine was terminated.

Risk factors for an anxiety disorder comorbidity among Thai patients with bipolar disorder: results from the Thai Bipolar Disorder Registry.

BACKGROUND: The aim of the study was to determine in a clinical setting the risk factors for current anxiety disorder (AD) comorbidity among Thai patients with bipolar disorder (BD), being treated under the Thai Bipolar Disorder Registry Project (TBDR). METHODS: The TBDR was a multisite naturalistic study conducted at 24 psychiatric units (ie, at university, provincial mental, and government general hospitals) between February 2009 and January 2011. Participants were in- or out-patients over 18 years of age who were diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Instruments used in this study included the Thai Mini International Neuropsychiatric Interview version 5; Thai Montgomery-Åsberg Depression Rating Scale (MADRS); Thai Young Mania Rating Scale; Clinical Global Impression of Bipolar Disorder-Severity (CGI-BP-S), CGI-BP-S-mania, CGI-BPS-depression, and CGI-BP-S-overall BP illness; and the Thai SF-36 quality of life questionnaire. RESULTS: Among the 424 BD patients, 404 (95.3%) had BD type I. The respective mean ± standard deviation of age of onset of mood disturbance, first diagnosis of BD, and first treatment of BD was 32.0±11.9, 36.1±12.2, and 36.2±12.2 years. The duration of illness was 10.7±9.0 years. Fifty-three (12.5%) of the 424 participants had a current AD while 38 (9%) had a substance use disorder (SUD). The univariate analysis revealed 13 significant risks for current AD comorbidity, which the multivariate analysis narrowed to age at first diagnosis of BD (odds ratio =0.95, P<0.01), family history of SUD (odds ratio =2.18, P=0.02), and having a higher current MADRS score (odds ratio =1.11, P<0.01). CONCLUSION: A diagnosis of AD comorbid with BD is suggested by early-age onset of BD together with a higher MADRS score and a family history of SUD. The likelihood of AD comorbidity decreases by 5% with each passing year; early-age onset of BD is a risk while later age onset is protective. Our results underscore how SUD within the family significantly contributes to the risk of an AD comorbidity.