Effectiveness of Cannabinoids for Treatment of Dementia: A Systematic Review of Randomized Controlled Trials.

Objective: In the last decade, research has focused on developing novel medications for the treatment of dementia. Cannabinoids are one of the potential agents under investigation. The present study aimed to examine the evidence concerning the effectiveness of cannabinoids for the treatment of dementia. Methods: We undertook a systematic review complying to PRISMA guidelines. Four databases were searched including Medline, Embase, Cochrane Library, and PsychINFO. Results: Five studies evaluated the use of cannabinoids for anorexia and agitation in dementia. One study used dronabinol 5 mg/day to target anorexic symptoms of dementia which positively impacted on weight. Results of two trials investigating the effectiveness of tetrahydrocannabinol (THC) 1.5-4.5 mg/day for the treatment of agitation indicated no significant differences between THC and placebo. The most recent trial reported significant improvement in agitation using nabilone at 1-2 mg/day. However, levels of evidence of these agents were rated as low and very low because of low sample size and methodology issues. No studies were available that investigated the use of cannabinoids to moderate cognitive symptoms in dementia. Conclusions: Findings from a few robust randomized controlled trials suggest that nabilone might be useful for the treatment of agitation in patients with dementia, but there is no convincing evidence for THC. Additional studies are needed to further clarify and assess the benefits of these treatments. Clinical Implications: There were no randomized controlled trials investigating the use of cannabinoids for the treatment of cognitive decline in dementia. Studies on THC reported no significant improvement in agitation. It may be too early to postulate that cannabinoids have any effect on dementia symptoms or their progression.

Psychological impacts on patients with COVID-19 in a Thai field hospital

ABSTRACT Objective: This study investigates the psychological impacts and their associated factors on patients with COVID-19 at a Thai field hospital. Methods: All eligible patients confirmed to have COVID-19 at Thammasat University field hospital completed an online self-reported mental health screening questionnaire which collected sociodemographic data, their clinical characteristics, and used the depression, anxiety, and stress scale (DASS-21). Results: A total of 40 patients participated in the study. The depression rate was found to be 22.5%, while the anxiety rate was 30%, and the stress rate was 20%. Having a history of psychiatric disorder alone was significantly associated with a higher DASS-21 score (p = 0.001). Meanwhile, gender, age, level of education, occupation, living status, severity of COVID-19, and the number of days admitted to hospital prior to the field hospital were not found to be associated with the DASS-21 scores (P > 0.05). Conclusion: The depression, anxiety, and stress symptoms in patients with COVID-19 at the field hospital were common. Patients with a history of psychiatric disorder should undergo specific evaluation during the isolation phase.

Development of clinical prediction rule for diagnosis of autistic spectrum disorder in children.

PURPOSE: This study aims to develop a clinical prediction rule for the diagnosis of autistic spectrum disorder (ASD) in children. DESIGN/METHODOLOGY/APPROACH: This population-based study was carried out in children aged 2 to 5 years who were suspected of having ASD. Data regarding demographics, risk factors, histories taken from caregivers and clinical observation of ASD symptoms were recorded before specialists assessed patients using standardized diagnostic tools. The predictors were analyzed by multivariate logistic regression analysis and developed into a predictive model. FINDINGS: An ASD diagnosis was rendered in 74.8 per cent of 139 participants. The clinical prediction rule consisted of five predictors, namely, delayed speech for their age, history of rarely making eye contact or looking at faces, history of not showing off toys or favorite things, not following clinician's eye direction and low frequency of social interaction with the clinician or the caregiver. At four or more predictors, sensitivity was 100 per cent for predicting a diagnosis of ASD, with a positive likelihood ratio of 16.62. ORIGINALITY/VALUE: This practical clinical prediction rule would help general practitioners to initially diagnose ASD in routine clinical practice.

The Reading the Mind in the Eyes Test: Validity and Reliability of the Thai Version.

BACKGROUND AND OBJECTIVE: Until now there has not been a validated measure of theory of mind available in the Thai language. Our goal in this study was to assess the validity and reliability of our Thai-language translation of the Reading the Mind in the Eyes Test (the "Eyes Test"). METHODS: We gave our Thai version of the Eyes Test to 70 participants: 30 people with schizophrenia and 40 normal controls. We also gave Thai versions of the Faces Test and the Addenbrooke's Cognitive Examination to assess convergent validity. RESULTS: For known groups validity, the controls scored significantly higher than the participants with schizophrenia on the Eyes Test: 24.6 (standard deviation=3.9) versus 18.2 (standard deviation=4.1), P<0.001. The Eyes Test correlated with the Addenbrooke's Cognitive Examination (r=0.68, P<0.001) and the Faces Test (r=0.51, P<0.001). Internal consistency by the Cronbach alpha for the Eyes Test was 0.7, and test-retest reliability by intraclass correlation was 0.92 (P<0.001). CONCLUSIONS: The Thai version of the Eyes Test is a valid and reliable measurement that can be used in clinical practice and in future investigations of theory of mind in neurologic and psychiatric disorders.

The Thai Version of the Addenbrooke's Cognitive Examination III.

The objective of our study was to assess the accuracy of the Thai version of the Addenbrooke's Cognitive Examination III (ACE-T). We used the ACE-T to assess 107 participants aged 60 or over, divided into the following groups: early dementia, n=30; mild cognitive impairment (MCI), n=29; and normal controls (NC), n=48. The ACE-T exhibited good internal consistency (0.93) and inter-rater reliability (1.0). The optimal cut-off score for the ACE-T to differentiate MCI from NC was 75/76, giving a sensitivity of 0.9 and specificity of 0.86. At the optimal cut-off of 61/62, the ACE-T had excellent sensitivity (1.0) and specificity (0.97) to distinguish early dementia from non-dementia. The ACE-T had high diagnosis accuracy in the detection of the MCI and early dementia in the Thai population.

Depression and burden among caregivers of children with autistic spectrum disorder.

OBJECTIVE: To study depression prevalence and burden among caregivers of children with autistic spectrum disorder and the related factors. MATERIAL AND METHOD: This is a cross-sectional descriptive study. Measures included questionnaires, CES-D and burden interview. Patients' diagnoses andfunctions were obtainedfrom childpsychiatrists and developmental pediatricians responsible for the patients. RESULTS: There were 51 participants. The depression prevalence was 5.9%. Concerning the burden, 45.1% ofthe participants reported little or no burden, and 45.1% reported mild to moderate burden. Only 7.8% and 2.0% experienced moderate to severe and severe burdens, respectively. There was a significant positive correlation between depression and burden (p = 0.012). Significant correlations were also observed between burden and months after diagnosed, the number ofpatient' problems and the number of hours that caregiver spent with patient per day. Moreover the burden was significantly associated with patient's communication problems and patient's inappropriate odd repetitive behaviors (p<0. 05). CONCLUSION: The prevalence of depression in and severe burden on caregivers of autistic childrenfrom the present study was low. Factors related to the burden were months after diagnosed, the number of patient's problems, the number of hours that caregiver spent with patient, patient's communication problems and inappropriate or odd repetitive behaviors.

Does the 'hikikomori' syndrome of social withdrawal exist outside Japan? A preliminary international investigation.

PURPOSE: To explore whether the 'hikikomori' syndrome (social withdrawal) described in Japan exists in other countries, and if so, how patients with the syndrome are diagnosed and treated. METHODS: Two hikikomori case vignettes were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated the syndrome's prevalence in their country, etiology, diagnosis, suicide risk, and treatment. RESULTS: Out of 247 responses to the questionnaire (123 from Japan and 124 from other countries), 239 were enrolled in the analysis. Respondents' felt the hikikomori syndrome is seen in all countries examined and especially in urban areas. Biopsychosocial, cultural, and environmental factors were all listed as probable causes of hikikomori, and differences among countries were not significant. Japanese psychiatrists suggested treatment in outpatient wards and some did not think that psychiatric treatment is necessary. Psychiatrists in other countries opted for more active treatment such as hospitalization. CONCLUSIONS: Patients with the hikikomori syndrome are perceived as occurring across a variety of cultures by psychiatrists in multiple countries. Our results provide a rational basis for study of the existence and epidemiology of hikikomori in clinical or community populations in international settings.

Post-traumatic stress disorder in children after the tsunami disaster in Thailand: a 5-year follow-up.

BACKGROUND: Children may suffer from post-traumatic stress disorder after disaster. There was a severe tsunami following an undersea earthquake off the Sumatra coast of Indonesia. There were 20,000 children in 6 southwestern provinces of Thailand who were possibly affected. OBJECTIVE: To study the prevalence of post-traumatic stress disorder (PTSD) in Thai students in the area affected by the December 26th, 2004 tsunami disaster, Thailand. MATERIAL AND METHOD: One thousand six hundred and fifteen surviving students from two schools in Takua Pa district located in Phang-nga Province, Thailand participated in this longitudinal study. Screening was done by using Pediatric Symptom Checklists part II (PSC-II), Childhood Depressive Intervention (CDI) and the Revised Child Impact of Events Scales (CRIES 8). PTSD was diagnosed by child and adolescent psychiatrists by using criteria of DSM-IV. The intervention included psychological first aid, psycho-education, cognitive-behavioral therapy, medication in severe cases, group support for students, parents and teachers which was done, beginning at 10 days after the tsunami disaster. Data were analyzed by using SPSS version 12.0. RESULTS: The prevalence rates of PTSD in the students facing the tsunami disaster in the study group were 573, 46.1, 31.6, 7.6, 4.5, 3.9 and 2.7% at 6 weeks, 6 months, 1 year, 2 years, 3 years, 4 years and 5 years after the disaster, respectively. Female to male ratio was 1.7: 1. The peak age was 9-10 years old. The top five on the list of symptoms in PTSD were distress with cue, intrusive thought, functioning impairment, startled response, terrified and hyper vigilance. Seven cases (3.1%) were diagnosed partial PTSD, still exhibited a wide range of PTSD symptoms but did not fulfill the DSM-IV diagnostic criteria. The top five on the list of symptoms in partial PTSD were avoiding thought/feelings, terrified, avoiding place/activities, distress with cue and startled response. CONCLUSION: The prevalence of PTSD among tsunami victims was 57.3% at 6 weeks after the disaster. It declined sharply at 2 years after the event. Despite receiving financial, rehabilitation and mental health support, 2.7% of the victims continued to suffer from PTSD 5 years after the disaster.

Introducing the concept of modern depression in Japan; an international case vignette survey.

AIM: Japanese psychiatrists have increasingly reported patients with depression that does not seem to fit the criteria of the ICD-10 and the DSM-IV, and which has recently been called modern type depression (MTD). We explored whether MTD is frequently seen in Japan and also in other countries, and if so, how patients with MTD are diagnosed and treated. METHODS: The questionnaires, with two case vignettes (traditional type depression (TTD) and MTD), were sent to psychiatrists in Australia, Bangladesh, India, Iran, Japan, Korea, Taiwan, Thailand and the USA. Participants rated their opinions about each case's prevalence in their country, etiology, diagnosis, suicide risk, and treatment using Likert scales. RESULTS: Out of 247 responses (123 from Japan and 124 from other countries), two hundred thirty-nine valid responses were received. MTD was recognized in all participating countries, and especially in urban areas. Generally, the factor of personality was regarded as the most probable cause of MTD. Whereas about 90% of Japanese psychiatrists applied the ICD/DSM criteria to TTD, only about 60% applied the criteria to MTD. CONCLUSION: Our results indicate that Japan's MTD seems to be occurring in many other countries, and that the present ICD/DSM criteria may not be sufficient to diagnose MTD. Therefore, it could be an important candidate for a new international diagnostic criterion as a subtype of depression. A clear diagnostic framework and consensus on the interventions to treat MTD would be valuable. Further clinical, psychopathological and international epidemiological studies are needed to confirm our preliminary findings of MTD.

Parenting, parent and child mental health in the families of maltreated children registered with the Child Protection Unit, Thammasat University Hospital.

BACKGROUND: Mental health outcomes of maltreated children can be various. There are mediated by several factors including parental and family variables. Less is known in Thailand on how these variables and children's mental health are related. OBJECTIVE: To study mental health of the maltreated children and their parents and to examine the relationships between parent mental health, parenting behaviors, family function and child mental health. MATERIAL AND METHOD: A sample of 48 parents who contacted mental health service via the child protection unit from October 2009 to 2010 was recruited in this cross-sectional study. Child mental health, parent mental health, parenting behaviors and family functions were measured by the Strength and Difficulties Questionnaires--parent version, General Health Questionaire-28, the Conflict Tactic Scale parent-child version and Chulalongkorn Family Inventory, respectively. Chi-square test was conducted to explore the associations between each independent variable and child mental health. RESULTS: Thirty-eight point six percent of the children and 56.8% of the parents had mental health problems. Poor family function (OR = 24.6; 95% CI = 2.8, 219.1) and negative parental behaviors (OR = 5.9; 95% CI = 1.3, 26.3) had statistically significant relationships with child mental health problem. CONCLUSION: Mental health problems were prevalent among the maltreated children and their parents. Parent training programs focusing on positive parenting strategies and enhancing family function may be beneficial to maltreated children and their parents in order to improve their mental health.

Assessment of psychopathological consequences in children at 3 years after tsunami disaster.

BACKGROUND: At 1 year after the Tsunami disaster, 30% of students in two high risk schools at Takuapa district of Phang Nga Province still suffered from post traumatic stress disorder (PTSD). The number ofpatients was sharply declined after 18 months. The psychological consequences in children who diagnosed PTSD after the event were reinvestigated again at 3 years, as there were reports of significant comorbidity and continuing of subsyndromal post traumatic stress symptoms in children suffered from other disasters. OBJECTIVE: To assess psychological outcomes and factors contributed at 3-year follow up time in children diagnosed PTSD at 1-year after the Tsunami disaster MATERIAL AND METHOD: There were 45 students who were diagnosed PTSD at 1-year after the disaster At 3-year follow up time, clinical interview for psychiatric diagnosis was done by psychiatrists. RESULTS: 11.1% of students who had been diagnosed as PTSD at 1-year after Tsunami still had chronic PTSD and 15% had either depressive disorder or anxiety disorder 25% of students completely recovered from mental disorders. Nearly 50% ofstudents were categorized in partial remission or subsyndromal PTSD group. Factors which influenced long-term outcomes were prior history of trauma and severe physical injury from the disaster. CONCLUSION: Although the point prevalence of PTSD in children affected by Tsunami was declined overtime, a significant number of students still suffer from post traumatic stress symptoms, depressive disorder or anxiety disorder which need psychological intervention.