Antidepressant-induced Paradoxical Anxiety, Akathisia, and Complex Vocal Tics in a Patient with Panic Disorder and Crohn's Disease: A Case Report.

BACKGROUND: Antidepressant-induced paradoxical anxiety is a fairly common phenomenon seen in patients who are initiated on antidepressants. However, akathisia is a very uncommon manifestation of antidepressants. Much more rarely, antidepressants are also associated with the emergence of motor and vocal tics. This case adds to the growing literature of rare adverse events induced by antidepressants and aims to stimulate future research into the mechanism and risk factors of this phenomenon. CASE PRESENTATION: In this case report, we describe a patient with panic disorder and co-morbid Crohn's disease who developed worsening anxiety, akathisia and vocal tics upon initiation of fluvoxamine. This is the first case report to describe the emergence of both akathisia and vocal tics in the same patient following antidepressant initiation. After discontinuation of fluvoxamine, the patient's symptoms resolved. CONCLUSION: Antidepressant-induced akathisia and tics are often distressing both to the patient and their loved ones, and they can be very puzzling to the clinician. It is important for clinicians to recognise that, although rare, antidepressants can have the adverse effects of akathisia and tics in patients. When these symptoms arise, it should prompt immediate discontinuation of the offending antidepressant.

World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - Version 3. Part I: Anxiety disorders.

AIM: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders (published in 2002, revised in 2008). METHOD: A consensus panel of 33 international experts representing 22 countries developed recommendations based on efficacy and acceptability of available treatments. In total, 1007 RCTs for the treatment of these disorders in adults, adolescents, and children with medications, psychotherapy and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medications. RESULT: This paper, Part I, contains recommendations for the treatment of panic disorder/agoraphobia (PDA), generalised anxiety disorder (GAD), social anxiety disorder (SAD), specific phobias, mixed anxiety disorders in children and adolescents, separation anxiety and selective mutism. Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications. Cognitive behavioural therapy (CBT) is the first-line psychotherapy for anxiety disorders. The expert panel also made recommendations for patients not responding to standard treatments and recommendations against interventions with insufficient evidence. CONCLUSION: It is the goal of this initiative to provide treatment guidance for these disorders that has validity throughout the world.

World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - Version 3. Part II: OCD and PTSD.

AIM: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders which was published in 2002 and revised in 2008. METHOD: A consensus panel of 34 international experts representing 22 countries developed recommendations based on efficacy and acceptability of the treatments. In this version, not only medications but also psychotherapies and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medication treatments. RESULT: The present paper (Part II) contains recommendations based on published randomised controlled trials (RCTs) for the treatment of OCD (n = 291) and PTSD (n = 234) in children, adolescents, and adults. The accompanying paper (Part I) contains the recommendations for the treatment of anxiety disorders.For OCD, first-line treatments are selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT). Internet-CBT was also superior to active controls. Several second-line medications are available, including clomipramine. For treatment-resistant cases, several options are available, including augmentation of SSRI treatment with antipsychotics and other drugs.Other non-pharmacological treatments, including repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and others were also evaluated.For PTSD, SSRIs and the SNRI venlafaxine are first-line treatments. CBT is the psychotherapy modality with the best body of evidence. For treatment-unresponsive patients, augmentation of SSRI treatment with antipsychotics may be an option. CONCLUSION: OCD and PTSD can be effectively treated with CBT and medications.

Protocol for a multi-site randomized controlled trial of a stepped-care intervention for emergency department patients with panic-related anxiety.

BACKGROUND: Approximately 40% of Emergency Department (ED) patients with chest pain meet diagnostic criteria for panic-related anxiety, but only 1-2% are correctly diagnosed and appropriately managed in the ED. A stepped-care model, which focuses on providing evidence-based interventions in a resource-efficient manner, is the state-of-the art for treating panic disorder patients in medical settings such as primary care. Stepped-care has yet to be tested in the ED setting, which is the first point of contact with the healthcare system for most patients with panic symptoms. METHODS: This multi-site randomized controlled trial (RCT) aims to evaluate the clinical, patient-centred, and economic effectiveness of a stepped-care intervention in a sample of 212 patients with panic-related anxiety presenting to the ED of Singapore's largest public healthcare group. Participants will be randomly assigned to either: 1) an enhanced care arm consisting of a stepped-care intervention for panic-related anxiety; or 2) a control arm consisting of screening for panic attacks and panic disorder. Screening will be followed by baseline assessments and blocked randomization in a 1:1 ratio. Masked follow-up assessments will be conducted at 1, 3, 6, and 12 months. Clinical outcomes will be panic symptom severity and rates of panic disorder. Patient-centred outcomes will be health-related quality of life, daily functioning, psychiatric comorbidity, and health services utilization. Economic effectiveness outcomes will be the incremental cost-effectiveness ratio of the stepped-care intervention relative to screening alone. DISCUSSION: This trial will examine the impact of early intervention for patients with panic-related anxiety in the ED setting. The results will be used to propose a clinically-meaningful and cost-effective model of care for ED patients with panic-related anxiety. TRIAL REGISTRATION: ClinicalTrials.gov NCT03632356. Retrospectively registered 15 August 2018.

A robotic leg inspired from an insect leg.

While most insect-inspired robots come with a simple tarsus, such as a hemispherical foot tip, insect legs have complex tarsal structures and claws, which enable them to walk on complex terrain. Their sharp claws can smoothly attach and detach on plant surfaces by actuating a single muscle. Thus, installing an insect-inspired tarsus on legged robots would improve their locomotion on complex terrain. This paper shows that the tendon-driven ball-socket structure provides the tarsus with both flexibility and rigidity, which is necessary for the beetle to walk on a complex substrate such as a mesh surface. Disabling the tarsus' rigidity by removing the socket and elastic membrane of a tarsal joint, means that the claws could not attach to the mesh securely. Meanwhile, the beetle struggled to draw the claws out of the substrate when we turned the tarsus rigid by tubing. We then developed a cable-driven bio-inspired tarsus structure to validate the function of the tarsus as well as to show its potential application in the legged robot. With the tarsus, the robotic leg was able to attach and retract smoothly from the mesh substrate when performing a walking cycle.

Exposure Therapy With Personalized Real-Time Arousal Detection and Feedback to Alleviate Social Anxiety Symptoms in an Analogue Adult Sample: Pilot Proof-of-Concept Randomized Controlled Trial.

BACKGROUND: Exposure therapy is highly effective for social anxiety disorder. However, there is room for improvement. OBJECTIVE: This is a first attempt to examine the feasibility of an arousal feedback-based exposure therapy to alleviate social anxiety symptoms in an analogue adult sample. METHODS: A randomized, pilot, proof-of-concept trial was conducted to evaluate the acceptability, safety, and preliminary efficacy of our treatment program. Sessions were administered once a week for 4 weeks (1 hour each) to an analogue sample of 50 young adults who reported at least minimal social anxiety symptoms. Participants in both intervention and waitlist control groups completed assessments for social anxiety symptoms at the baseline, week 5, and week 10. RESULTS: Most participants found the intervention acceptable (82.0%, 95% CI 69.0%-91.0%). Seven (14.9%, 95% CI 7.0%-28.0%) participants reported at least one mild adverse event over the course of study. No moderate or serious adverse events were reported. Participants in the intervention group demonstrated greater improvements on all outcome measures of public speaking anxiety from baseline to week 5 as compared to the waitlist control group (Cohen d=0.61-1.39). Effect size of the difference in mean change on the overall Liebowitz Social Anxiety Scale was small (Cohen d=0.13). CONCLUSIONS: Our results indicated that it is worthwhile to proceed to a larger trial for our treatment program. This new medium of administration for exposure therapy may be feasible for treating a subset of social anxiety symptoms. Additional studies are warranted to explore its therapeutic mechanisms. TRIAL REGISTRATION: ClinicalTrials.gov NCT02493010; https://clinicaltrials.gov/ct2/show/NCT02493010.

Internalized stigma, disclosure and self-esteem among psychiatric patients in a general hospital outpatient clinic.

OBJECTIVE: Psychiatric patients often experience internalized stigma. This occurs when persons accept the negative attitudes of others towards them, then internalize and apply these beliefs to themselves. We assess the effects of internalized stigma on illness disclosure and on self-esteem in psychiatric outpatients, hypothesizing that internalized stigma is more pronounced in psychiatric patients than in medical patient controls and that internalized stigma is associated with avoidance of disclosure, as well as reduced self-esteem. METHODS: Psychiatric and medical outpatients were randomly selected to participate in the study, conducted at a general hospital specialist outpatient clinic. RESULTS: Psychiatric patients demonstrated significantly lower self-esteem than controls. Internalized stigma was the highest for singles, and the lowest among married and older patients. Among psychiatric patients, a higher internalized stigma was significantly associated with experienced discrimination and with lower levels of self-esteem. Those who avoided disclosure had significantly higher internalized stigma than those who self-disclosed. CONCLUSION: The results confirmed our study hypotheses. Marriage and older age seemed to confer a protective effect on self-esteem.

Screening for panic-related anxiety in emergency department patients with cardiopulmonary complaints: A comparison of two self-report instruments.

The present study examined 1) the accuracy of two self-report measures for detecting panic-related anxiety in emergency department (ED) patients with cardiopulmonary complaints; and 2) whether modified scoring resulted in improved performance. English-speaking adults presenting to the ED of a large public hospital with palpitations, chest pain, dizziness, or difficulty breathing were evaluated for the presence of panic-related anxiety with the Structured Clinical Interview for DSM-IV (SCID) over a one-year period. Patients completed the panic disorder modules of the Patient Health Questionnaire (PHQ-PD) and Psychiatric Diagnostic Screening Questionnaire (PDSQ-PD). Sensitivity, specificity, area under the curve (AUC), and predictive values were compared for various cut-offs and scoring algorithms using SCID diagnosis of panic attacks (in the absence of panic disorder) or panic disorder as the reference standard. In this sample of 200 participants, the majority had a chief complaint of chest pain and 46.5% met SCID criteria for panic-related anxiety. The PDSQ-PD demonstrated only fair operating characteristics for panic attacks (AUC = 0.57) and good operating characteristics for panic disorder (AUC = 0.79). The PHQ-PD achieved adequate operating characteristics (AUC = 0.66) for panic attacks and good operating characteristics for panic disorder (AUC = 0.76) using a modified scoring algorithm or a single screening question (AUC = 0.72).

A Brief Interview to Detect Panic Attacks and Panic Disorder in Emergency Department Patients with Cardiopulmonary Complaints.

OBJECTIVES: Patients with panic-related anxiety often initially present to the emergency department (ED) complaining of respiratory or cardiac symptoms, but rates of detection of panic symptoms by ED physicians remain low. This study was undertaken to evaluate the relevance of panic attacks and panic disorder in ED patients who present with cardiopulmonary symptoms and to determine whether a brief symptom-based tool could be constructed to assist in rapid recognition of panic-related anxiety in the ED setting. MATERIALS AND METHODS: English-speaking adult ED patients with a chief complaint of palpitations, chest pain, dizziness, or difficulty breathing were evaluated for the presence of panic attacks and panic disorder with the Structured Clinical Interview for DSM-IV Axis I Disorders. Participants completed self-report measures to assess panic-related symptoms, comorbid psychiatric conditions, health-related disability, and health service use. RESULTS: In this sample (N=200), 23.5% had panic attacks and 23.0% had panic disorder. Both groups reported higher rates of panic attack symptoms, greater psychiatric comorbidity, greater health-related disability, and higher rates of ED and mental health service use compared with those without either condition. A brief 7-item tool consisting of panic symptoms identified patients with panic attacks or panic disorder with 85% accuracy (area under the curve=0.90, sensitivity=82%, specificity=88%). CONCLUSIONS: Patients with panic attacks or panic disorder commonly present to the ED, but often go unrecognized. A brief 7-item clinician rating scale accurately identifies these patients among those ED patients presenting with cardiopulmonary complaints.

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.

Mania following antidepressant discontinuation in depression: two case reports.

OBJECTIVE: Antidepressant-induced mania and an antidepressant discontinuation syndrome are well documented, whereas mania occurring after antidepressant cessation has been infrequently reported. METHOD: We describe antidepressant discontinuation-related mania in two Chinese patients, as well as a review of the literature on this phenomenon in unipolar depression. RESULTS: A 72-year-old man and a 65-year-old woman had late-onset depression with vascular risk factors, but no personal or family history of mood disorders. Manic symptoms started after stopping escitalopram and venlafaxine during depressive relapse, and resolved with the initiation of olanzapine and valproate. In the literature, 29 episodes of antidepressant discontinuation-related mania were reported. Tricyclic antidepressants were most frequently implicated, followed by selective serotonin reuptake inhibitors. There was spontaneous resolution of manic symptoms in half of the cases. CONCLUSION: This is the first report of antidepressant discontinuation-related mania in an Asian population, in the setting of late-onset depression. This phenomenon is rare and is amenable to standard treatment.

Attitudes toward utility, effects and side effects of treatment for anxiety and depression.

OBJECTIVES: Negative perceptions about psychiatric treatment are likely to affect treatment adherence. We compared attitudes of patients with psychiatric illness and those of medical patients towards psychiatric treatment. METHODS: Both patients with psychiatric illness and medical patients (controls) were shown a printed copy of two vignettes depicting major depression and generalized anxiety disorder. They were asked for their perceptions on the utility, effects and possible side effects of psychiatric medications, as well as the utility of psychotherapy in treating major depression and generalized anxiety disorder. Responses between psychiatric patients and medical patients were compared using appropriate statistical tests, including logistic regression. RESULTS: Patients with psychiatric illness were more likely than medical patients to endorse the utility of medications in treating major depression and generalized anxiety disorder (p<0.001). Those with psychiatric illness were more likely to endorse the utility of psychotherapy in treating major depression (p=0.004). Both groups of patients were of the view that psychotherapy would benefit generalized anxiety disorder. Older and lesser educated patients held negative beliefs about medications. CONCLUSIONS: While patients with psychiatric illnesses endorsed favourable attitudes toward medications (p<0.001), the older and lesser educated were more likely to hold negative views (p<0.05). Psychoeducation should be tailored to the needs of older and lesser educated patients.

Validation of the emotion thermometers and hospital anxiety and depression scales in Singapore: Screening cancer patients for distress, anxiety and depression.

AIM: To validate the emotion thermometer (ET) and hospital anxiety and depression scales (HADS) in Singapore, screening cancer patients for distress, anxiety and depression. METHODS: Three hundred fifteen cancer patients from National Cancer Centre and Singapore General Hospital participated in the study. Interviews and assessments were conducted in English, assessing patients' sociodemographic data and screening for emotional symptoms using the ET, HADS and Mini-International Neuropsychiatric Interview (MINI) tools. RESULTS: Fifty-three patients (16.83%) fulfilled the MINI criteria for major depressive disorder and 30 patients (12.77%) for generalized anxiety disorder. The ET depression thermometer correlated positively with HADS depression subscale, r = 0.645 (P < 0.01), with area under curve (AUC) value being 0.76, when cutoff score is 3. The ET anxiety thermometer correlated positively with HADS anxiety subscale, r = 0.632 (P < 0.01), with an AUC value of 0.76, when cutoff score is 4. The ET distress thermometer correlated positively with HADS depression subscale, r = 0.506 (P < 0.01), with AUC value being 0.72, when cutoff score is 2, the ET distress thermometer also correlated positively with HADS anxiety subscale, r = 0.652 (P < 0.01), with the AUC value being 0.77, when cutoff score is 4. Using MINI diagnoses for anxiety and depression as the gold standard, cutoff score for HADS depression scale is 7, which yielded an AUC of 0.826. The cutoff score for HADS anxiety scale is 5, yielding an AUC of 0.779. CONCLUSION: Results from the study support the use of both ET and HADS as valid and reliable instruments assessing for distress, anxiety and depression in cancer patients.

Ministry of Health Clinical Practice Guidelines: Anxiety Disorders.

The Ministry of Health (MOH) has developed the clinical practice guidelines on Anxiety Disorders to provide doctors and patients in Singapore with evidence-based treatment for anxiety disorders. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on anxiety disorders, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Jikoshu-kyofu in Singapore.

OBJECTIVE: Jikoshu-kyofu (JKF), a condition characterised by a fear of offending others through emitting foul body odour, was first described in Japan in the 1960s. Although initially thought to be a culture-bound syndrome, it has been described in other countries. It is well established that there are two variants, a non- delusional and a delusional variant. METHOD: We describe two cases of JKF who sought treatment from a hospital in Singapore, compare and contrast their characteristics, and in view of overlaps with other conditions, discuss differential diagnoses. RESULTS: Both cases involved women with fairly similar symptomatology except that the first case was younger, had overvalued ideas (but not delusions), an earlier age of onset and good treatment response, while the other had delusions, late age of onset, became too distressed to continue working and was initially resistant to treatment. CONCLUSION: It appears that the delusional variant may have a longer symptomatic duration before presentation, poorer insight, more resistance to treatment and multiple physician consultations, as well as greater impairment of socio-occupational functioning in contrast to the non-delusional variant.

Bipolar patients sing more in singapore: singing as a signal for mania in psychotic patients.

INTRODUCTION: Singing in psychotic patients has received little attention in the psychiatric literature. In this preliminary study, we test the hypothesis that manic patients sing more than schizophrenic patients (SPs). MATERIALS AND METHODS: Manic patients and SP inpatients and outpatients were interviewed using a semi-structured questionnaire which included questions on musical interests, and how much they felt like singing prior to their most recent admission to hospital. They were asked if they were willing to sing during the interview and responses were observed. RESULTS: Of the 69 manic patients and 68 SPs interviewed, manic patients were more likely to report singing than SPs (76% vs 24%) prior to their most recent admission to hospital. There was a trend for manic inpatients to be more willing to sing during the interview. CONCLUSION: Increased singing is suggested as a useful symptom and sign in patients suffering from a manic illness.

Asthma, life events and psychiatric disorders: a population-based study.

PURPOSE: Although asthma and other chronic physical conditions have been shown to be associated with psychiatric symptoms, the relative contributions of negative life events to this association and impaired quality of life (QOL) are not clear. METHODS: This is a cross-sectional study of a nationally representative sample of Singaporean adults aged 20-59 (n = 2,847). Individuals were grouped by asthma, other chronic physical conditions, and no chronic physical conditions. Participants were assessed life events (list of threatening experiences questionnaire), psychiatric disorders [schedule for clinical assessment in neuropsychiatry diagnoses of psychiatric disorder including any psychiatric disorder, major depressive disorder (MDD) and generalized anxiety disorder (GAD)], and QOL (medical outcomes study 12-item short form). RESULTS: In multivariate analyses controlling for confounding variables, asthma and other chronic physical conditions, compared to no chronic physical conditions, both showed similarly (two- to four-fold) elevated odds ratio (OR) of association with MDD and GAD. However, the asthma group reported more life events as compared to other chronic physical conditions (OR = 4.33, 95 % CI: 2.09-8.95) or no chronic physical conditions (OR = 7.64, 95 % CI: 3.87-15.06). Life events accounted significantly for excess coexistence of psychiatric disorders with asthma over participants without chronic physical conditions. It also contributed significantly to relatively worse QOL observed among individuals with asthma. CONCLUSIONS: In this cross-sectional study, life events among adults in Singapore appeared to mediate the co-occurrence of psychiatric disorders and functional impairment with asthma, more than with other chronic physical conditions. This should be further investigated in longitudinal studies.

A case of Jikoshu-Kyofu treated with cognitive behavioural therapy.

Jikoshu-Kyofu (JKF) is a subtype of Taijin-Kyofu-Sho (TKS), a form of social anxiety first described in Japanese sufferers. Unlike the Diagnostic and Statistical Manual of Mental Disorders - 4th edition text revised definition of social anxiety disorder, TKS is characterised by a fear of offending others, whereas in the case of JKF, it is the fear of giving off a smell, thus causing offence. We describe the symptoms of JKF in a young woman who was treated with cognitive behavioural therapy (CBT). After only four sessions, the patient's anxiety ratings, as measured on the Social Phobia Inventory and Brief Social Phobia Scale, dropped considerably. This case illustrates the successful treatment of a patient with JKF-like symptoms using CBT.

Anxiety and depression, chronic physical conditions, and quality of life in an urban population sample study.

OBJECTIVE: No previous studies have empirically demonstrated a multiplicative interactive effect of anxiety disorders and/or depression (ADD) and chronic medical conditions on quality of life (QOL). We hypothesized that QOL impairment was worsened by the presence of ADD and medical co-morbidity, more than when it was with either medical co-morbidity alone or ADD alone. METHODS: Complete data of 2,801 participants from the National Mental Health Survey of Adults in Singapore were analyzed, using SCAN diagnoses of anxiety disorders and depression, self-reports of chronic medical conditions, and SF-12 measures of QOL (Mental Component Summary, MCS, and Physical Component Summary, PCS). RESULTS: Persons diagnosed with ADD (compared to those without) had considerably more medical co-morbidities (59 vs. 33%, p < 0.001). In multiple regression analyses, ADD (vs. no ADD) was associated with lower PCS (b = -1.013, p = 0.045) and MCS scores (b = -9.912, p < 0.001), as was number of medical co-morbidities (0, 1-2, 3 +), PCS scores (b = -2.058, p < 0.001) and MCS scores (b = -1.138, p < 0.001). There were significant interactive effects of medical co-morbidities and ADD on PCS (p < 0.001), and MCS (p = 0.086), suggesting that the negative effects of medical conditions on quality of life was aggravated non-additively by the co-morbid presence of ADD, and vice versa. CONCLUSION: The individual effects of medical and psychiatric morbidity on functional status and quality of life were considerably worse when both were present in the same individual. Future studies should examine the impact of identifying and treating anxiety and depressive disorders in patients with medical problems for better outcomes.

Qualities of a psychiatric mentor: a quantitative Singaporean survey.

OBJECTIVE: Psychiatric mentors are an important part of the new, seamless training program in Singapore. There is a need to assess the qualities of a good psychiatric mentor vis-à-vis those of a good psychiatrist. METHOD: An anonymous survey was sent out to all psychiatry trainees and psychiatrists in Singapore to assess quantitatively the relative importance of 40 qualities for a good psychiatrist and a good mentor. RESULTS: The response rate was 48.7% (74/152). Factor analysis showed four themes among the qualities assessed (professional, personal values, relationship, academic-executive). A good mentor is defined by professional, relationship, and personal-values qualities. Mentors have significantly higher scores than psychiatrists for two themes (relationship and academic-executive). CONCLUSION: Being a good mentor, in Asia, means being a good psychiatrist first and foremost but also requires additional relationship and academic-executive skills. Mentors should be formally trained in these additional skills that were not part of the psychiatric curriculum.