Evaluation of sleep profile in schizophrenia patients treated with extended-release paliperidone: an open-label prospective study in Southeast Asia.

OBJECTIVE: To evaluate the effect of 6 months of treatment with paliperidone extended-release (ER) tablets on the sleep profile of patients with schizophrenia. METHODS: A total of 984 patients meeting the The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia who switched their antipsychotic to paliperidone ER were recruited from 61 sites in five countries in Southeast Asia. We recorded patient demographics and assessed sleep quality and daytime drowsiness using visual analog scales. RESULTS: Approximately 70% of patients completed the 6-month study. After the use of paliperidone ER, patients reported significantly better sleep quality (76.44 vs 65.48; p<0.001) and less daytime drowsiness compared with their baseline value (23.18 vs 34.22; p<0.001). Factors predicting sleep profile improvement were completion of the study and higher baseline Positive and Negative Syndrome Scale scores. CONCLUSION: Paliperidone ER can help schizophrenia patients to improve sleep quality and reduce daytime drowsiness; this was seen especially in the patients who completed the 6-month treatment period and had higher baseline Positive and Negative Syndrome Scale scores.

Effects of paliperidone extended release on hostility among Thai patients with schizophrenia.

OBJECTIVE: This open-label prospective study investigated the effects of paliperidone extended release (ER) on hostility in Thai patients with schizophrenia. BACKGROUND: Patients diagnosed with schizophrenia may be hostile or exhibit aggressive behavior, which can occasion their admission to psychiatric hospital. Antipsychotic medications are often used to treat hostility and aggression in such patients. Paliperidone ER is effective and well tolerated in the treatment of schizophrenia. However, there are no data available for paliperidone ER with regard to its efficacy on hostility and aggression among Thai patients. This study was a part of the PERFEcT study, a 6-month, open-label, multicenter, multicountry, prospective trial to explore the safety, efficacy, and functionality of paliperidone ER tablets. The current study included only the data obtained from Thai participants. MATERIALS AND METHODS: Flexible dosing of paliperidone ER in a range of 3-12 mg/day was used, allowing investigators to adjust the dosage of each subject individually. The 199 Thai patients had a stable Clinical Global Impression - severity score before enrollment. Demographic data were collected at enrollment, and assessments took place at 1, 2, 3, and 6 months postbaseline. The Positive and Negative Syndrome Scale (PANSS) and Personal and Social Performance (PSP) scale were used to evaluate efficacy. In this analysis, we report the findings for the specific PANSS factor P7 (hostility) and the PSP subscale disturbing and aggressive behavior. Data were analyzed using paired t-test method to investigate changes in mean PANSS and PSP total and subscale scores. The significance level was set at P<0.05. RESULTS: From a total of 199 Thai patients, 148 patients (74.4%) participated in all visits. There was a significant reduction in mean scores for all total PANSS measures from 1 month onward compared with baseline, as well as ongoing significant reductions in scores from visit to visit. There was a significant reduction in mean hostility score at 2 months (P<0.05), 3 months (P<0.05), and 6 months (P<0.01) (n=148). For the PSP scale, there was a significant across-the-board reduction of mean scores from 3 months onward, including in the disturbing and aggressive behavior subscale (P<0.001) (n=148). CONCLUSION: Switching from previously unsuccessful antipsychotic treatments to paliperidone ER may be a useful option to reduce hostility and disturbing behavior in patients with schizophrenia. This study in Thai patients is in line with findings in other countries and cultures concerning the management of hostility in patients with schizophrenia.

Psychosocial functioning in schizophrenia: are some symptoms or demographic characteristics predictors across the functioning domains?

This study aimed to examine symptoms/demographic characteristics as predictors for psychosocial functioning among individuals with schizophrenia. The Personal and Social Performance (PSP) scale was used to assess psychosocial functioning. Other measures of interest included were the Clinical Global Impression, Severity scale, and the Marder's five-factor model of the Positive and Negative Syndrome Scale. This study included 199 participants with non-acute stage schizophrenia. Spearman correlation coefficients and stepwise multiple linear regression analyses were applied to determine the correlates and predictors of PSP domain/total scores. Younger age, earlier age of schizophrenia onset, severe illness, positive symptoms, negative symptoms, disorganized thought, hostility/excitement, and anxiety/depression were found to significantly correlate with poor functioning. Severe illness and negative symptoms are the main predictors of greater impairment of socially useful activities, personal and social relationships, and self-care. Further prospective studies in other settings, which would include an increased number of variables such as neurocognitive function and social support, are warranted.

Positive effects of Ska game practice on cognitive function among older adults.

BACKGROUND: Ska is a traditional board game in Thailand that involves high levels of cognition, planning, and decisionmaking. There have been no previous studies on the benefits of the Ska game as a cognitive function aid for older adults. OBJECTIVE: To examine the effects of Ska game practice on improving cognitive functioning among older adults. MATERIAL AND METHOD: Forty older adults living in the municipality of Phetchabun province, volunteered to take part in the present study. They were randomly selected and arranged into two intervention groups, an experiment and a control group (20 participants each group; 10 females and 10 males). Each group was repeatedly trained as planned for at least 50 minutes per day, three sessions per week for the continuous duration of 16 weeks. The cognitive function measured in term of memory, Verbal Pair Association I and II (VPA I; VPA II), Visual Reproduction I and II (VR I; VR II), the attention used of Trail Making Test part A (TMT-A), and the executive function used by means of the Wisconsin Card Sorting Test (WCST). The examination was done by a clinical psychologist and a medical technologist using neurotransmitter to measure Acetylcholinesterase (AChE) activity, before and after the intervention. The independent variables were measured with t-test to compare the mean scores of two different groups and between males and females of the Ska group. The level of significance considered was p < 0.05. RESULTS: The findings revealed that those who joined the Ska group reported statistically significant better scores of cognitive function in memory, attention, executive function from VPA I, VPA II, VR I, VR II, TMT-A, and WCST compared to those who were in the control group (p < 0.05). However, there was no significant difference of AChE activity between the Ska and the control group (p > 0.05). In addition, there was no significant difference mean in cognitive function between male and female Ska group (p > or = 0.05). CONCLUSION: Finding shows that the Ska game could enhance the cognitive functioning in terms of memory, attention, and executive function in older adults.

RAPID progression: tool for screening aggressive course of disease (ACD) in Alzheimer dementia.

OBJECTIVE: There is a need for a tool in clinical practice to assess the rate of progression of Alzheimer's disease (AD) patients. The present study purpose was to develop a tool for screening and progression assessing of AD patients with Aggressive Course of Disease (ACD). MATERIAL AND METHOD: The Thai Realtime Assessment of Progression In Dementia (RAPID) was developed for screening AD patients with ACD through a caregiver questionnaire. At baseline and at a 6-month follow up visit, patients were tested by the Alzheimer's Disease Assessment Scale cognitive component (ADAS-Cog), while their caregivers completed the Thai RAPID. The tests were run by a team of psychiatrists in the Department of Psychiatry, Chulalongkorn Memorial Hospital. RESULTS: Fifty patients with cognitive impairment were recruited. As a screening tool, the Thai RAPID cut-off point of 9-points yielded a fair sensitivity and specificity (0.625 and 0.643, respectively) for rapid progression as defined by 4 point or greater deterioration in ADAS-Cog. As a progression assessment tool, a cutoff point of 3-points yielded a good sensitivity and specificity (0.875 and 0.810, respectively). CONCLUSION: The present pilot study suggests that the Thai RAPID can be a valuable tool for the ACD screening and for progression assessment in AD patients.

Universality of interpersonal psychotherapy (IPT) problem areas in Thai depressed patients.

BACKGROUND: Many studies have shown the efficacy of interpersonal psychotherapy (IPT) on depression; however, there are limited studies concerning the universality of the IPT problem areas in different countries. This study identifies whether the interpersonal problem areas defined in the IPT manual are endorsed by Thai depressed patients. METHODS: The Thai Hamilton Rating Scale for Depression (Thai HRSD) and Thai Interpersonal Questionnaire were used to assess 90 depressed and 90 non-depressed subjects in King Chulalongkorn Memorial Hospital, during July 2007 - January 2008. The association between interpersonal problem areas/sociodemographic variables and depressive disorder were analyzed by chi-square test. A multivariable analysis was performed by using logistic regression to identify the remaining factors associated with depressive disorder. RESULTS: Most of the subjects were young to middle-aged females living in Bangkok and the Central Provinces. All four interpersonal problem areas (grief, interpersonal role disputes, role transitions, and interpersonal deficits) were increased in the depressed subjects as compared to the non-depressed subjects, as were the sociodemographic variables (low education, unemployment, low income, and having a physical illness). Logistic regression showed that all interpersonal problem areas still remained problems associated with depression (grief: adjusted OR = 6.01, 95%CI = 1.93 - 18.69, p < 0.01; interpersonal role disputes: adjusted OR = 6.01, 95%CI = 2.18 - 16.52, p < 0.01; role transitions: adjusted OR = 26.30, 95%CI = 7.84 - 88.25, p < 0.01; and interpersonal deficits: adjusted OR = 2.92, 95%CI = 1.12 - 7.60, p < 0.05). CONCLUSION: All four interpersonal problem areas were applicable to Thai depressed patients.

Safety and tolerability of galantamine in possible Alzheimer's disease with or without cerebrovascular disease and vascular dementia in Thai patients.

The purpose of this study was to explore factors that influence the clinical safety and tolerability associated with galantamine administration in Thai Alzheimer's disease patients with or without cerebrovascular disease and vascular dementia. This was an analysis of previous study. Tolerability and safety profile were analyzed according to sex, age, body weight, Thai mental state examination (TMSE) score, Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) score, and Alzheimer's disease cooperative study/activities of daily living (ADCS/ADL) score. The most common adverse events were nausea, dizziness, and weight loss which more often occurred during the dose-escalation phase. Mean body weight lost at week 24 was 0.9 kg. Sex, age, body weight, and ADAS-cog score did not influence the incidence of any adverse events. Dizziness was more likely to occur in patients with low TMSE and high ADCS/ADL score (p = 0.02 and p = 0.050, respectively). Patients with TMSE score equal or higher than 23 more often experienced muscle cramps and fatigue than who had TMSE lower 23 (p < 0.05). However, flexible dose escalation of galantamine with a 4-week schedule was safe and well tolerated in Thai AD patients.

Posttraumatic mental health establishment of the Tsunami survivors in Thailand.

The natural disaster known as "the Tsunami" occurred in Andaman coast of Thailand in December 2004, and there had been questions whether it could cause PTSD amongst the population who lives in the affected area and how to avoid PTSD condition to occur.The purpose of this study is to establish statistical results of psychosocial factors, and their correlation to PTSD and other mental disorders in order to generate the PTSD database. Cross sectional community surveys had been conducted in two phases from the same sampling group, the first phase is concerned with prevalence of PTSD, depression and related factors. Results were collected from 3,133 samples and shows that 33.6% suffered from PTSD, 14.27% with depression and 11.27% suffered from both. The second phase is focused on chronic PTSD and other mental disorders 2,573 samples were collected and only 21.6% were diagnosed with chronic PTSD.The statistical analysis has identified risks factors that could cause PTSD, and protective actions which could help to prevent PTSD.

Posttraumatic stress disorder of the Tsunami survivors in Thailand.

BACKGROUND: The natural disaster known as "the Tsunami" occurred in the Andaman sea coast of Thailand in December 2004, and there had been questions whether it could cause PTSD amongst the population who lives in the affected area and how to avoid PTSD condition to occur. OBJECTIVE: Establish statistical results of psychosocial factors, and their correlation to PTSD and other mental disorders to generate the PTSD database. MATERIAL AND METHOD: A cross-sectional community surveys from 3,133 samples had been conducted in two phases from the same sampling group. The first phase was concerned with prevalence of PTSD, depression, and related factors. The second phase included 2,573 samples from the first phase and focused on chronic PTSD and other mental disorders. RESULTS: The 3,133 samples used in the first phase show that 33.6% suffered from PTSD, 14.27% with depression, and 11.27% suffered from both. The 2,573 samples from the first phase were followed, collected the blood, and interview data only 21.6% were diagnosed with chronic PTSD. CONCLUSION: The statistical analysis has identified risks factors that could cause PTSD, and protective actions that could help to prevent PTSD. The prevalence of PTSD was still higher in the affected region six months after the Tsunami.

Interpopulation linkage disequilibrium patterns of GABRA2 and GABRG1 genes at the GABA cluster locus on human chromosome 4.

GABRA2 and GABRG1, which encode the alpha-2 and gamma-1 subunits, respectively, of the GABA(A) receptor, are located in a cluster on chromosome 4p. The GABRA2 locus has been found to be associated with alcohol dependence in several studies, but no functional variant that can account for this association has been identified. To understand the reported associations, we sought to understand the linkage disequilibrium (LD) patterns and haplotype structures of these genes. With close intergenic distance, approximately 90 kb, it was anticipated that some markers might show intergenic LD. Variation in 13-SNP haplotype block structure was observed in five different populations: European American, African American, Chinese (Han and Thai), Thai, and Hmong. In the Hmong, a 280-kb region of considerably higher LD spans the intergenic region, whereas in other populations, there were two or more LD blocks that cross this region. These findings may aid in understanding the genetic association of this locus with alcohol dependence in several populations.

Sequence variation and linkage disequilibrium in the GABA transporter-1 gene (SLC6A1) in five populations: implications for pharmacogenetic research.

BACKGROUND: GABA transporter-1 (GAT-1; genetic locus SLC6A1) is emerging as a novel target for treatment of neuropsychiatric disorders. To understand how population differences might influence strategies for pharmacogenetic studies, we identified patterns of genetic variation and linkage disequilibrium (LD) in SLC6A1 in five populations representing three continental groups. RESULTS: We resequenced 12.4 kb of SLC6A1, including the promoters, exons and flanking intronic regions in African-American, Thai, Hmong, Finnish, and European-American subjects (total n = 40). LD in SLC6A1 was examined by genotyping 16 SNPs in larger samples. Sixty-three variants were identified through resequencing. Common population-specific variants were found in African-Americans, including a novel 21-bp promoter region variable number tandem repeat (VNTR), but no such variants were found in any of the other populations studied. Low levels of LD and the absence of major LD blocks were characteristic of all five populations. African-Americans had the highest genetic diversity. European-Americans and Finns did not differ in genetic diversity or LD patterns. Although the Hmong had the highest level of LD, our results suggest that a strategy based on the use of tag SNPs would not translate to a major improvement in genotyping efficiency. CONCLUSION: Owing to the low level of LD and presence of recombination hotspots, SLC6A1 may be an example of a problematic gene for association and haplotype tagging-based genetic studies. The 21-bp promoter region VNTR polymorphism is a putatively functional candidate allele for studies focusing on variation in GAT-1 function in the African-American population.

Effects of psycho-educational program on knowledge and attitude upon schizophrenia of schizophrenic patients' caregivers.

BACKGROUND: Schizophrenia is mainly characterized by chronic psychotic symptoms such as delusions, hallucinations, and negative symptoms such as social withdrawal. These symptoms cause behavior problems, i.e. aggressive behavior violence, or social isolation that affect the patients' lives, and the health status and daily routine of caregivers or family members. Psychological distress or burden of caregivers often results in poor care provided to these patients. Most studies showed that high expressed emotion in the family leads to high a relapse rate of schizophrenia. The psycho-educational program is aimed to provide education about this disorder help the caregivers to deal with the patients' problems more effectively, reduce psychological distress of caregivers, and provide social support for caregivers. OBJECTIVE: Study the effects of psycho-educational program on knowledge and attitude of schizophrenia on caregivers of schizophrenic patients. MATERIAL AND METHOD: The participants completed the one-day psycho-educational program run by a team of psychiatrists in the Department of Psychiatry, Chulalongkorn Memorial Hospital. The psycho-educational program was composed of didactic session on schizophrenia, group discussion, and communication skill building. The participants were evaluated for the knowledge and attitude, before and after the program. The mean scores of knowledge, attitude before and after the program were compared by using paired t-test. RESULTS: Ninety-one caregivers of schizophrenic patients participated into the present study. The results showed that the mean scores of knowledge and attitude before the program were 6.06 (SD = 1.86) and 37.57 (SD = 6.46) and after the program were 6.91 (SD = 3.35), and 29.37 (SD = 15.79), respectively. The scores of knowledge and attitude of caregivers, before and after the program were statistically different. The participants evaluated the program as an interesting and very useful program. CONCLUSION: Psycho-educational program on schizophrenia increase the knowledge and shape the attitude of caregivers. Therefore, interventions targeting caregivers of schizophrenic patients should result in the successful treatment and rehabilitation of schizophrenic patients.

Demographic changes and marker properties affect detection of human population differentiation.

BACKGROUND: Differentiating genetically between populations is valuable for admixture and population stratification detection and in understanding population history. This is easy to achieve for major continental populations, but not for closely related populations. It has been claimed that a large marker panel is necessary to reliably distinguish populations within a continent. We investigated whether empirical genetic differentiation could be accomplished efficiently among three Asian populations (Hmong, Thai, and Chinese) using a small set of highly variable markers (15 tetranucleotide and 17 dinucleotide repeats). RESULTS: Hmong could be differentiated from Thai and Chinese based on multi-locus genotypes, but Thai and Chinese were indistinguishable from each other. We found significant evidence for a recent population bottleneck followed by expansion in the Hmong that was not present in the Thai or Chinese. Tetranucleotide repeats were less useful than dinucleotide repeat markers in distinguishing between major continental populations (Asian, European, and African) while both successfully distinguished Hmong from Thai and Chinese. CONCLUSION: Demographic history contributes significantly to robust detection of intracontinental population structure. Populations having experienced a rapid size reduction may be reliably distinguished as a result of a genetic drift -driven redistribution of population allele frequencies. Tetranucleotide markers, which differ from dinucleotide markers in mutation mechanism and rate, are similar in information content to dinucleotide markers in this situation. These factors should be considered when identifying populations suitable for gene mapping studies and when interpreting interpopulation relationships based on microsatellite markers.

Social support in depressed patients who attempted suicide.

OBJECTIVES: To identify the level of perceived social support in depressed patients who attempted suicide and to determine whether perceived social support is associated with suicidal attempt in depressed patients. MATERIAL AND METHOD: The sample consisted of 90 patients who presented with suicidal attempt and had clinical depression and 90 depressed patients who had never attempted suicide. The subjects were clinically assessed for depression, availability of social support and their satisfaction, number of friends and consultants and family history. Subjects were recruited at King Chulalongkorn Memorial Hospital from July 2000 to June 2002. RESULTS: The depressed patients who attempted suicide had lower mean scores in all areas of perceived social support and reported having fewer friends and consultants than those without suicidal attempt. They also had a higher rate of financial problems, substance abuse and family history of alcohol or substance use disorder. The scores for severity of depression and level of perceived social support were negatively correlated with statistical significance. CONCLUSION: Depressed patients who attempted suicide were more likely to report fewer of friends and a lower level of social support. Assessment of patient's support network as well as their perception of available social support should be included in the evaluation of depressed patients particularly in those with substance use disorder and intervention to prevent suicide should focus more on increasing their capacity to obtain social resources and modulating their perception.