Burnout study during the COVID-19 pandemic in Thailand: psychometric evaluation of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel.

Objectives: This study aimed (1) to determine the psychometric properties of a Thai version of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS [MP]) and (2) to examine the mean scores of burnout and associated factors during the COVID-19 pandemic. Methods: Forward and back translations of the MBI-HSS (MP) questionnaire were performed. The Thai version was subsequently completed by 682 Thai physicians and nurses who worked during the COVID-19 pandemic. Exploratory factor analysis was performed on the first subsample (n = 341) by conducting Kaiser Mayer-Olkin sampling adequacy measurement and Bartlett's test of sphericity whereas confirmatory factor analysis (CFA) was performed on the second subsample (n = 341) using fit indices of the normed chi-square (χ2/df), the comparative fit index, the Tucker-Lewis index, and the root mean square error of approximation. This version's internal consistency was investigated using Cronbach's alpha coefficient. Demographic profiles were evaluated with descriptive and analytical statistics. Results: The Thai version of the MBI-HSS (MP) displayed good psychometric characteristics, as the Cronbach's alpha values of the 3 burnout factors ranged from 0.843 to 0.945. The CFA also showed good fit indices (χ2/df = 4.473; P < 0.001; RMSEA = 0.075 (95%CI = 0.055-0.079); CFI = 0.946; and TLI = 0.936). The physicians' mean EE, DP, and PA scores were 25.28 ± 13.27, 7.15 ± 6.11, and 36.83 ± 8.13, respectively, whereas The nurses' mean EE, DP, and PA scores were 23.10 ± 14.14, 4.43 ± 5.06, and 35.67 ± 10.24, respectively. Healthcare professionals who were younger, single, had fewer years of practice, and had more working hours per week tended to express more burnout scores. Conclusions: The Thai version of the MBI-HSS (MP) demonstrates good psychometric properties in assessing burnout among healthcare professionals. Several factors may be pivotal in intensifying burnout.

Effects of cannabis legalization on the use of cannabis and other substances.

PURPOSE OF REVIEW: As more jurisdictions legalize cannabis for non-medical use, the evidence on how legalization policies affect cannabis use and the use of other substances remains inconclusive and contradictory. This review aims to summarize recent research findings on the impact of recreational cannabis legalization (RCL) on cannabis and other substance use among different population groups, such as youth and adults. RECENT FINDINGS: Recent literature reports mixed findings regarding changes in the prevalence of cannabis use after the adoption of RCL. Most studies found no significant association between RCL and changes in cannabis use among youth in European countries, Uruguay, the US, and Canada. However, some studies have reported increases in cannabis use among youth and adults in the US and Canada, although these increases seem to predate RCL. Additionally, there has been a marked increase in unintentional pediatric ingestion of cannabis edibles postlegalization, and an association between RCL and increased alcohol, vaping, and e-cigarette use among adolescents and young adults. SUMMARY: Overall, the effects of cannabis legalization on cannabis use appear to be mixed. Further monitoring and evaluation research is needed to provide longer-term evidence and a more comprehensive understanding of the effects of RCL.

Treatment outcomes in patients with globus: A randomized control trial of psychoeducation, neuromodulators, and proton pump inhibitors.

BACKGROUND: Globus is a persistent or intermittent nonpainful sensation of a lump or foreign body, which markedly affect patient's quality of life. Treatment options for globus are limited and unsatisfying. This study aims to compare the effects of cognitive-behavioral-theory-based psychoeducation (CBT), neuromodulators (NMD), and proton pump inhibitor (PPI) on treatment outcomes in patients with globus. METHODS: Eligible patients were randomly received CBT, 0.5 mg flupenthixol and 10 mg melitracen; NMD, or omeprazole 20 mg; PPI, for 4 weeks. The primary endpoint was the reduction in symptom scores; Glasgow Edinburgh Throat Scale (GETS). The secondary endpoints included treatment efficacy on Reflux Symptom Index (RSI), Hospital Anxiety Depression Scale (HADS), and quality of life (QoL) based on a 36-item short-form health survey (SF-36). Treatment compliance and adverse effects were recorded. KEY RESULTS: Forty patients were completed study. Baseline characteristics between the groups were comparable. By the end of treatment, both CBT and NMD provided greater reduction in GETS than PPI (CBT vs PPI; 6.46 ± 8.56 vs 0.21 ± 5.42; p = 0.031, NMD vs PPI; 6.92 ± 9.85 vs 0.21 ± 5.42; p = 0.036). The improvement of RSI, HADS, and SF-36 among the groups was similar. Neuromodulators caused more adverse events. CONCLUSIONS & INFERENCES: Both CBT and NMD provided equally effective treatment and better than PPI in patients with globus determined by the reduction in GETS. The improvement in RSI, HADS, and QoL of the three groups was not different. Given less of adverse effect than NMD, CBT should be considered as a substantial treatment.

Prevalence of Depressive Symptoms and Their Impact on Perceived Stress and Quality of Life Among Patients with Psoriasis.

Objective: This study aimed to investigate the prevalence of depressive symptoms in patients with psoriasis and the association between depressive symptoms, perceived stress level, and quality of life of the participants. Methods: Patients with psoriasis were invited to complete the Thai versions of the Patient Health Questionnaire, Perceived Stress Scale-10, Psoriasis Disability Index, and Simplified Psoriasis Index. To identify significantly related factors of depression, the independent sample t-test or Mann-Whitney U-test was performed to compare continuous variables between groups, and the chi-square test or Fisher's exact test was used to compare categorical variables between groups. The association between the severity of depression and other variables was examined using Spearman's correlation coefficient. Results: Of the 150 participants assessed, 32 (21.3%) had depressive symptoms. Elevated stress scores, subjective psychosocial impact of psoriasis, self-perceived current severity of psoriasis, and impaired quality of life were significantly associated with depressive symptoms. Depressive symptom severity was determined to be positively correlated with perceived stress, quality-of-life impairment, current severity, and the psychosocial impact of psoriasis. Conclusion: Depressive symptoms are prevalent among patients with psoriasis. Those with high scores for perceived stress, a psychosocial impact of psoriasis, or disease severity should be evaluated for depression, as it can hamper their quality of life.

Association of supply sources of alcohol and alcohol-related harms in adolescent drinkers: the baseline characteristics of a high school cohort across Thailand.

BACKGROUND: The main objective of this study was to investigate the association between parental supply of alcohol, alcohol-related harms, and the severity of alcohol use disorder in Thai 7th grade middle school students. METHODS: A cross-sectional descriptive study obtained the baseline data from the project named the Thailand Parental Supply and Use of Alcohol, Cigarettes & Drugs Longitudinal Study Cohort in Secondary School Students in 2018. The sample size was 1187 students who have ever sipped or drank alcohol in the past 12 months. Pearson's Chi square, binary logistic regression, and ordinal logistic regression are applied in the analysis. RESULTS: A single source of parental supply is not significantly associated with any alcohol-related harm and the severity of alcohol use disorder, while parental supply with peers and siblings supply of alcohol plays an important role in both outcomes. The increasing number of sources of alcohol supply increases the risk of alcohol-related harm and the severity of alcohol use disorder. Other risk factors found in both associations included binge drinking, alcohol flushing, low household economic status, distance from the student's family, and poor academic performance. Gender, exposure to alcohol ads on social media and location of residency were not associated with alcohol-related harms or severity of alcohol use disorder. CONCLUSIONS: The results did not support parental guidance in teaching or giving children a drink or sip of alcohol within family to prevent related harms when drinking outside with their peers.

Correlation of BDNF, VEGF, TNF-α, and S100B with cognitive impairments in chronic, medicated schizophrenia patients.

Cognitive impairment is a prominent cause of disability in schizophrenia. Although antipsychotic drugs can rescue the psychotic symptoms, the cognitive impairments persist, with no treatment available. Alterations of BDNF, VEGF, TNF-α, and S100B have been linked to cognitive impairment in several neurological disorders. However, it remains unclear whether their levels are correlated with the cognitive functions of schizophrenia patients. Forty-one chronic, medicated schizophrenia patients were included in this study. Enzyme-linked, immunosorbent assays were used to measure the serum concentrations of BDNF, VEGF, TNF-α, and S100B. Associations between serum protein levels and various domains of the cognitive functions of the schizophrenia patients were observed. We found significant, positive correlations between serum BDNF and the processing speed and attention levels of the patients. Serum VEGF was also positively correlated with their memory and learning functions. In contrast, serum S100B and TNF-α were negatively correlated with the processing speed and attention of the schizophrenia patients. The findings warrant further investigation of these molecules as potential prognostic markers or treatment targets for cognitive impairment in schizophrenia patients.

Impact of the COVID-19 pandemic on older adults living in long-term care centers in Thailand, and risk factors for post-traumatic stress, depression, and anxiety.

BACKGROUND: There is a lack of data concerning impact of COVID-19 among older adults (OA) living at long-term care (LTC) centers. This study investigated how COVID-19 has affected this population. The prevalence of and risk factors for post-traumatic stress, depression, and anxiety were investigated. METHODS: A semi-structured interview to determine the effect of COVID-19 was conducted to 200 OA at two government LTC centers. The 17-item Post-traumatic Stress Disorder Checklist, the 9-item Patient Health Questionnaire, and the 7-item Generalized Anxiety Disorder Scale were used to evaluate post-traumatic stress, depression, and anxiety, respectively. RESULTS: Most OA reported moderate or severe impact of COVID-19. The most impacted area was financial due to decreased support from outside the center. Seventy percent of OA reported no or mild psychological stress from COVID-19; however, 5.5% had post-traumatic stress, 7.0% had depression, and 12.0% had anxiety. Higher psychological stress from COVID-19 and having respiratory tract infection symptoms were independently associated with post-traumatic stress, depression, and anxiety. Receiving COVID-19 news via social media was independently associated with post-traumatic stress and depression. Having psychiatric comorbidity was independently associated with depression. CONCLUSIONS: OA living in LTC centers reported moderate or severe impact from COVID-19, especially financial, but relatively low psychological stress. Psychological stress from COVID-19, having respiratory tract infection symptoms, and receiving COVID-19 news via social media were risk factors for psychological disorders. LIMITATIONS: The data reflected the post-outbreak period. There is limitation in the generalizability of the results for other countries with different health care systems.

Prevalence and Factors Associated with Fear of Falling in Community-Dwelling Thai Elderly.

BACKGROUND: Falls are common in older people. The fear of falling (FOF) can lead elderly persons to restrict their activities which reduces quality of life. We aimed to estimate the prevalence and factors associated with FOF in community-dwelling Thai elderly to improve screening, treatment and prevention policies and practices. OBJECTIVES: We aimed to estimate the prevalence and factors associated with FOF in suburban-dwelling Thai seniors. METHODS: Seniors aged 60-85 years old from 4 suburban communities near Bangkok, Thailand, were interviewed and examined. Questionnaires were used to collect data on the FOF, symptoms of depression, anxiety and balance tests. T tests, χ2 tests, and logistic regressions were used in statistical analysis. RESULTS: 210 subjects were enrolled. The mean age was 70.3, and 74.3% were female. Fifty-three (25.2%) reported a previous history of falls. The prevalence of FOF was 35.8% in the subjects with previous history of falls and 21.7% in subjects without previous history of falls. FOF was associated with female gender, age ≥80, living alone, impaired balance, and functional impairment but not with previous history of falls. CONCLUSION: FOF is associated with balance impairment, anxiety, depression, and functional impairment of daily routine activities.

Help-seeking behaviors for mental health problems in medical students: Studies in Thailand and India.

OBJECTIVES: To compare the rate of help-seeking from mental health professionals (MHPs) and other sources of help for mental health problems of medical students in Thailand and India, and explore factors associated with help-seeking from MHPs. METHODS: Cross-sectional survey-based study was conducted in two medical schools in Thailand and India. Students were asked to rate their preferences for each source of help on a Likert-scale basis. Mental health status was measured by the General health questionnaire-12 (GHQ-12). Attitudes and stigma toward mental illness were collected using the Mental illness clinician's attitude scale: medical student version or MICA v2. RESULTS: 593 students participated in the survey. The percentage of students who chose to seek help from any source was lower in Thailand than in India. 81 % of students in India site chose to seek help from MHPs, compared to 66 % in Thailand site. The risk factors for avoiding seeking help from MHPs in Thailand were history of alcohol use (OR = 1.88, p = .014) and total GHQ score (OR = 1.11, p = .006), whereas having GHQ score ≥ 2 was a significant risk factor in India (OR = 2.20, p = .044). Total MICA score, which reflected overall attitude toward mental illness, was not associated with seeking help from MHPs. CONCLUSIONS: The rate of help-seeking behaviors for mental health problems and factors associated differed between medical students in Thailand and India. A high GHQ score was a common risk factor of not seeking help from MHPs in both countries.

Access to Healthcare and Harm Reduction Services During the COVID-19 Pandemic for People Who Use Drugs.

: Globally, there are concerns about access to healthcare and harm reduction services for people who use drugs (PWUD) during the coronavirus disease 2019 (COVID-19) pandemic. Members from the Network of Early Career Professionals working in Addiction Medicine shared their experiences of providing treatment to PWUD during the COVID-19 pandemic. Drawing on these qualitative reports, we highlight the similarities and discrepancies in access to services for PWUD in 16 countries under COVID-10 restrictions. In most countries reported here, efforts have been made to ensure continued access to services, such as mobilising opioid agonist maintenance treatment and other essential medicines to patients. However, due to travel restrictions and limited telemedicine services, several Network of Early Career Professionals working in Addiction Medicine members from lower-resourced countries experienced challenges with providing care to their patients during periods of COVID-19 lock-down. The insights provided in this commentary illustrate how the COVID-19 lock-down restrictions have impacted access to services for PWUD.

The Changing Landscape of Alcohol Use and Alcohol Use Disorder During the COVID-19 Pandemic - Perspectives of Early Career Professionals in 16 Countries.

: Alcohol use is a major risk factor for infectious disease and reduction of harms associated with alcohol consumption are essential during times of humanitarian crises, such as the COVID-19 pandemic. As a network of early career professionals working in the area of addiction medicine, we provide our views with regards to national actions related to reducing alcohol-related harm and providing care for people with alcohol use disorder during COVID-19. We believe that COVID-19 related measures have affected alcohol consumption in the majority of countries represented in this commentary. Examples of these changes include changes in alcohol consumption patterns, increases in cases of alcohol withdrawal syndrome, disruptions in access to medical care for alcohol use disorder and increases in illegal production of alcohol. Our members urge that treatment for acute and severe conditions due to substance use should be considered as essential services in times of humanitarian crises like COVID-19.

miR-19b is elevated in peripheral blood of schizophrenic patients and attenuates proliferation of hippocampal neural progenitor cells.

MicroRNAs (miRNAs) have been investigated in neurodevelopmental and psychiatric disorders including schizophrenia (SZ). Previous studies showed miRNAs dysregulation in postmortem brain tissues and peripheral blood of SZ patients. These suggest that miRNAs may play a role in the pathophysiology of SZ and be a potential biomarker of SZ. Previous studies also showed that miRNAs regulated neurogenesis and that neurogenesis was involved in the pathophysiology of SZ. In addition, a recent study showed that miR-19a and 19b, enriched in neural progenitor cells (NPC) in adult hippocampus, were increased in human NPC derived from induced pluripotent stem cell derived from SZ patients. However, it remains unclear whether the levels of miR-19a and 19b are altered in peripheral blood of SZ patients and how miR-19a and 19b affects neurogenesis. To elucidate them, first we examined the levels of miR-19a and 19b in peripheral blood of SZ patients with quantitative RT-PCR and showed that the level of miR-19b, but not miR-19a, was significantly higher (miR-19a: p = 0.5733, miR-19b: p = 0.0038) in peripheral blood of SZ patients (N = 22) than that of healthy controls (N = 19). Next, we examined the involvement of miR-19b in proliferation and survival of mouse neonatal mice hippocampus-derived NPC with BrdU assay and TUNEL assay. The silencing of miR-19b significantly increased proliferation (N = 5, p = 0.0139), but not survival (N = 5, p = 0.9571), of neonatal mice hippocampus-derived NPC. These results suggest that the level of miR-19b in peripheral blood is a potential biomarker of schizophrenia and that the higher level of miR-19b may increase the vulnerability of SZ via attenuating proliferation of hippocampal NPC.

Restless legs syndrome in children and adolescents with attention-deficit/hyperactivity disorder: prevalence, mimic conditions, risk factors, and association with functional impairment.

OBJECTIVES: To determine the prevalence of restless legs syndrome (RLS) and RLS-mimic conditions, the risk factors for RLS, and whether RLS contributes to functional impairment in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). METHODS: ADHD children and adolescents were prospectively studied at the outpatient psychiatric clinic. A trained registered nurse used the 2012 Revised International Restless Legs Syndrome Study Group diagnostic criteria to diagnose RLS. Sociodemographic data and medical records were reviewed. Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) Thai version was used to identify association between RLS and 6 domains of function [family, school (learning), school (behavior), life skills, child self-concept, social activities, and risky activities]. RESULTS: A total of 217 patients were included. Of those, 23 (11%) patients met the criteria for RLS, and 49 (23%) had RLS-mimic conditions. Those conditions included myalgia (30/49), habitual foot tapping (23/49), positional discomfort (20/49), leg ulcer/bruise (1/49), and arthralgia/arthritis (1/49). Binary logistic regression revealed first-degree relative having RLS symptom to be significantly associated with RLS in study patients (OR: 5.06, p < 0.01). Multivariate linear regression showed RLS to be independently associated with school (behavior) (Β = 1.18, p = 0.05) and life skills (Β = 2.36, p = 0.05) impairment. CONCLUSIONS: RLS was found to be common in ADHD children and adolescents. RLS-mimic conditions were found in two-thirds of patients who previously met 4 essential RLS criteria. First-degree relative with RLS symptom was associated with RLS, and RLS was associated with functional impairment in the life skills and school (behavior) domains.

Relationship Between Depression and Quality of Life Among Vitiligo Patients: A Self-assessment Questionnaire-based Study.

BACKGROUND: Vitiligo is a common chronic autoimmune disease that is characterized by progressive loss of skin color due to melanocyte destruction. In addition to the physical effects of vitiligo, this condition exerts adverse psychological effects and causes social stigmatization. Earlier studies reported that individuals with vitiligo suffer from poor quality of life (QoL), but data about the QoL of Thai vitiligo patients is scarce. OBJECTIVE: This study aimed to investigate the QoL and prevalence of depression in Thai vitiligo patients, association between QoL and depression, and factors associated with QoL and depression among Thai people with vitiligo. METHODS: This cross-sectional self-assessment questionnaire-based study was conducted at the phototherapy and vitiligo clinics of the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University (Bangkok, Thailand). QoL was assessed using the Dermatology Life Quality Index (DLQI) questionnaire, and depression was evaluated via the Patient Health Questionnaire (PHQ-9). RESULTS: Among the 104 vitiligo patients that were recruited, the mean DLQI score was 7.46, and the prevalence of depression (PHQ-9 ≥9) was 13.5%. Factors significantly associated with a higher mean DLQI score were skin phototype IV compared to phototype III, active disease, new lesions within the last three months, lesions involving upper extremities, and PHQ-9 ≥9 (p<0.05). Moderate correlation was found between DLQI score and PHQ-9 score (Pearson's correlation coefficient: 0.524, p<0.001). Factors significantly associated with depression were working status and developing new lesions within the last three months (p<0.05). Patients with new lesions were 4.12 times more likely to be depressed than those without new lesions (OR: 4.12, 95%CI: 1.20-14.16; p=0.025). CONCLUSION: Developing new lesions, active disease, dark skin phototype (IV), and lesion on upper extremity had significant adverse effects on QoL. Vitiligo patients who were employed and who had new vitiligo lesions are significantly more likely to be depressed.

Depression, quality of life and coping style among Thai doctors before their first year of residency training.

OBJECTIVES: Depression and suicide often affect young physicians coping with the demands of residency training. To support effective prevention programmes, we aim to assess depression, quality of life (QoL) and coping style of doctors prior to beginning residency training. METHODS: A cross-sectional study of physicians prior to their first year of residency training at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, was conducted. Questionnaires including the Thai versions of the Proactive Coping Inventory, Patient Health Questionnaire and the Pictorial Thai Quality of Life (PTQL) scale were emailed to all first-year residents 1 week before the beginning of residency training in 2015. Descriptive statistics, χ2 test, independent-sample t-test and Pearson's correlation test were analysed. RESULTS: Among 277 doctors, 102 (36.8%) responded to the survey. The average age of respondents was 26.8 (range 25-33; SD=1.2) and 69.6% were women. Nearly all (99.0%) had moderate-to-high overall QoL scores. Depression was found in 10 (9.8%) of respondents. Depression severity was negatively correlated with proactive coping and QoL. Proactive coping (r=0.509, p<0.001), reflective coping (r=0.266, p=0.007), strategic planning (r=0.347, p<0.001), preventive coping (r=0.298, p=0.002) and emotional support seeking (r=0.252, p=0.011) were positively correlated with QoL. Furthermore, proactive was correlated with lower depressive symptoms severity (r=-0.303, p=0.002). CONCLUSIONS: Although nearly all doctors reported moderate-to-high QoL, positive screening for depression was observed in 9.8% of doctors which is much higher than the prevalence in Thais (1.2%). Mental health promotion policies are essential to help residents effectively cope with the stress and demands of training.

Clozapine-induced agranulocytosis and leukopenia: Incidence, associated factors, and rate of hematologic adverse-effects monitoring in psychiatric out-patient services in Thailand.

The present study aimed to investigate the incidence of agranulocytosis and leukopenia and its associated factors in Thai schizophrenia patients treated with clozapine and the rate of hematologic adverse events monitored in clinical practice. Data were collected from the medical records of 641 outpatients at two hospitals. The results showed no cases of agranulocytosis and 20 cases of leukopenia (3.1%), 85% of which were observed after 1 year of prescription. The associated factors were female (p = 0.019) and duration of clozapine prescription (p = 0.026). According to the guideline for safety monitoring, 23.6% of cases had neutrophils count monitoring.

A decrease in protein level and a missense polymorphism of KIF17 are associated with schizophrenia.

It has been shown that the dysfunction of N-methyl-d-asparate (NMDA) receptors-mediated neurotransmission plays a role in the pathophysiology of schizophrenia. Especially, GluN2B, a subunit of NMDA receptors, associated trafficking complex is altered in the prefrontal cortex of schizophrenia. The kinesin superfamily motor protein 17 (KIF17) is known as a transporter of NR2B.Previous studies showed that a structural variant of KIF17 gene is associated with a schizophrenic phenotype. Therefore, here we investigated KIF17 levels in postmortem prefrontal cortex in schizophrenia and the association of a missense polymorphism (Ile341Val) in KIF17 with schizophrenia. The protein expression of KIF17 in schizophrenic postmortem brains was significantly lower than that in controls. Next, the association of missense polymorphisms (rs631375, rs13375609, rs522496 and rs2296225) of KIF17 gene in 567 schizophrenia and 710 healthy subjects was examined. Both genotypic distribution and allelic frequency of rs2296225 polymorphism were significantly different between the chronic schizophrenia subjects and controls. However, our findings described above were not replicated with the independent subjects (555 schizophrenia and 814 healthy controls). Furthermore, the two alleles of rs2296225 polymorphism did not affect the mRNA expression of KIF17. These results suggest that the dysfunction of KIF17 might be involved in the pathophysiology of schizophrenia.