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Tay Y.H.,National University of Singapore | Nurjono M.,Institute of Mental Health | Lee J.,Institute of Mental Health | Lee J.,National University of Singapore
Schizophrenia Research | Year: 2013

Background & hypothesis: Schizophrenia is associated with increased mortality rates, which has been attributed to the greater incidence of cardiovascular disease (CVD) events. The Framingham risk score (FRS) is a widely-used age- and gender-specific algorithm to estimate 10-year CVD risk and vascular age. The main aim of this study was to determine the cardiovascular risk profile in schizophrenia and examine the effect of metabolic syndrome (MetS) as a predictor of CVD risk. We hypothesized that patients with schizophrenia have an increased 10-year CVD risk. Methods: 83 Chinese patients with schizophrenia and 243 Chinese community controls were recruited. Their medical and smoking histories were obtained, and anthropometric parameters measured. All subjects provided fasted venous blood samples for lipid and glucose measurements. 10-year CVD risk and the difference between vascular and actual age (VAdiff) for each participant were computed using the FRS and compared between patients and controls. Results: Schizophrenia patients had a higher mean 10-year CVD risk of 4.6%, as compared with 3.1% in controls, and a greater VAdiff of 4.6years vs. 0.6years. Both smoking and MetS contributed significantly to the 10-year CVD risk in patients with schizophrenia, with smoking having a greater effect than MetS on this risk. Conclusion: This study found a significantly elevated mean 10-year CVD risk and VAdiff in patients with schizophrenia compared with controls. Findings point towards the importance of smoking cessation and screening for MetS to decrease the excess CVD risk in patients with schizophrenia. © 2013 Elsevier B.V.


Patent
Agency For Science, National University of Singapore and Institute Of Mental Health | Date: 2013-03-28

According to one aspect, there is provided a method for assessing the treatment of attention-deficit/hyperactivity disorder (ADHD) in a subject, the method comprising: obtaining electroencephalographic (EEG) data relating to a plurality of subjects diagnosed with ADHD; extracting, for each of the plurality of subjects, at least one feature from the EEG data relating to that subject; formulating a prediction model by performing regression analysis to map the extracted features against one or more markers for each of the plurality of subjects; and determining that the prediction model provides an ADHD assessment if one or more of the markers are indicators of a clinical measure of interest.


News Article | December 13, 2016
Site: www.eurekalert.org

A new study from The University of Nottingham has found that a certain type of yoga could potentially help to improve the health and psychological wellbeing of children in care. The study, 'Kundalini Yoga as Mutual Recovery: A feasibility study including children in care and their carers,' published at The Journal of Children's Services, found that the practice of Kundalini yoga in care homes, when both staff and children are involved, can lead to both individual and social benefits. Corporate care is far from perfect, with evidence showing that children in care are still among the most vulnerable in society. Research for the Department for Education has also shown that children in care have a higher degree of physical and mental health needs than their not-in-care counterparts, and in comparison to children who are in other forms of care, such as foster care. This new study was carried out under the belief of 'creative practice as mutual recovery', and looked at the idea that shared creativity, collective experience and mutual benefit can promote resilience in mental health and well-being among communities that have been traditionally divided (e.g. children's home staff and children). The study was carried out by experts from The University of Nottingham's Institute of Mental Health in conjunction with external collaborators Mark Ball, Edge of Care Hub Manager at Nottingham City Council (Children and Families), Emily Haslam-Jones, Kundalini yoga teacher at Yoganova and David Crepaz-Keay from the Mental Health Foundation. The experts tested a 20-week Kundalini yoga program in three children's homes situated in the East Midlands. The program was evaluated according to recruitment and retention rates, self-reporting questionnaires from the participants and semi-structured interviews. The findings show that yoga practice in children's homes, especially when participation is high, has the potential to encourage togetherness and mutuality and improve health and psychological outcomes for children in care, as well as within the workforce. All the participants reported that the study was personally meaningful and experienced both individual (i.e. feeling more relaxed) and social benefits (e.g. feeling more open and positive). Individuals reported that the yoga sessions helped to show them beneficial exercises that they could use in various contexts, such as before going to bed, or during emotionally challenging times at work as well as at home. The social benefits were also far-reaching with some participants reporting that they felt more positive, open to others and, as a consequence, had seen an improvement in their social lives and out of work. Some staff and residents noticed that other people also interacted more positively with them. Dr Elvira Perez, a Senior Research Fellow at Horizon, member of the Institute of Mental Health, and lead author of the study, says: "The findings are very exciting as they suggest that the practice of Kundalini yoga, involving both staff and children in care, is a plausible intervention that can lead to individual and social benefits. This could have potentially huge, wide-reaching benefits for children in care as well as for all the staff working in residential settings. "The study has generated a number of valuable guiding principles and recommendations that might underpin the development of any future intervention for children in care and the staff working in these homes." A full copy of the report can be found here.


Gibbon S.,Institute of Mental Health
Cochrane database of systematic reviews (Online) | Year: 2010

BACKGROUND: Antisocial personality disorder (AsPD) is associated with a wide range of disturbance including persistent rule-breaking, criminality, substance use, unemployment, homelessness and relationship difficulties. OBJECTIVES: To evaluate the potential beneficial and adverse effects of psychological interventions for people with AsPD. SEARCH STRATEGY: Our search included CENTRAL Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, ASSIA, BIOSIS and COPAC. SELECTION CRITERIA: Prospective, controlled trials in which participants with AsPD were randomly allocated to a psychological intervention and a control condition (either treatment as usual, waiting list or no treatment). DATA COLLECTION AND ANALYSIS: Three authors independently selected studies. Two authors independently extracted data. We calculated mean differences, with odds ratios for dichotomous data. MAIN RESULTS: Eleven studies involving 471 participants with AsPD met the inclusion criteria, although data were available from only five studies involving 276 participants with AsPD. Only two studies focused solely on an AsPD sample. Eleven different psychological interventions were examined. Only two studies reported on reconviction, and only one on aggression. Compared to the control condition, cognitive behaviour therapy (CBT) plus standard maintenance was superior for outpatients with cocaine dependence in one study, but CBT plus treatment as usual was not superior for male outpatients with recent verbal/physical violence in another. Contingency management plus standard maintenance was superior for drug misuse for outpatients with cocaine dependence in one study but not in another, possibly because of differences in the behavioural intervention. However, contingency management was superior in social functioning and counselling session attendance in the latter. A multi-component intervention utilising motivational interviewing principles, the 'Driving Whilst Intoxicated program', plus incarceration was superior to incarceration alone for imprisoned drink-driving offenders. AUTHORS' CONCLUSIONS: Results suggest that there is insufficient trial evidence to justify using any psychological intervention for adults with AsPD. Disappointingly few of the included studies addressed the primary outcomes defined in this review (aggression, reconviction, global functioning, social functioning, adverse effects). Three interventions (contingency management with standard maintenance; CBT with standard maintenance; 'Driving Whilst Intoxicated program' with incarceration) appeared effective, compared to the control condition, in terms of improvement in at least one outcome in at least one study. Each of these interventions had been originally developed for people with substance misuse problems. Significant improvements were mainly confined to outcomes related to substance misuse. No study reported significant change in any specific antisocial behaviour. Further research is urgently needed for this prevalent and costly condition.


Colovic O.,Institute of Mental Health
Journal of Nervous and Mental Disease | Year: 2016

ABSTRACT: Our study was intended to test whether there are any differences in the way defense mechanisms are used by patients suffering from pure anxiety and those with pure depressive disorders. The sample size was as follows: depressive disorders without psychotic symptoms 30, anxiety disorders 30, and the healthy control group 30. The assessment of defense mechanisms was made using the DSQ-40 questionnaire. Our findings show that “pure” anxiety disorders differ from “pure” depressive disorders only in the use of immature defense mechanisms. The group with depressive disorders was significantly more prone to use immature defense mechanisms than the group with anxiety disorders (p = 0.005), primarily projection (p = 0.001) and devaluation (p = 0.003). These defense mechanisms may therefore be used both to differentiate between anxiety and depressive disorders and also to determine which symptoms (anxiety or depressive disorders) are dominant at any given stage of treatment. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Rajaratnam K.,Institute of Mental Health
Journal of Clinical Psychopharmacology | Year: 2016

ABSTRACT: In this study, we sought to examine factors associated with dosing of antidepressants (ADs) in Asia. Based on reported data and clinical experience, we hypothesized that doses of ADs would be associated with demographic and clinical factors and would increase over time. This cross-sectional, pharmacoepidemiological study analyzed data collected within the Research Study on Asian Psychotropic Prescription Pattern for Antidepressants from 4164 participants in 10 Asian countries, using univariate and multivariate methods. The AD doses varied by twofold among countries (highest in PR China and RO Korea, lowest in Singapore and Indonesia), and averaged 124 (120–129) mg/d imipramine-equivalents. Average daily doses increased by 12% between 2004 and 2013. Doses were significantly higher among hospitalized patients and ranked by diagnosis: major depression > anxiety disorders > bipolar disorder, but were not associated with private/public or psychiatric/general-medical settings, nor with age, sex, or cotreatment with a mood stabilizer. In multivariate modeling, AD-dose remained significantly associated with major depressive disorder and being hospitalized. Doses of ADs have increased somewhat in Asia and were higher when used for major depression or anxiety disorders than for bipolar depression and for hospitalized psychiatric patients. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Olver M.E.,University of Saskatchewan | Wong S.C.P.,University of Saskatchewan | Wong S.C.P.,Institute of Mental Health
Criminal Justice and Behavior | Year: 2011

The authors investigated the efficacy of static versus dynamic approaches to risk assessment and the validity of the Risk Principle through comparing treatment changes made by high- versus lower-risk offenders. The investigations were carried out using a sample of 321 treated sex offenders followed up for an average 10 years postrelease. Risk was assessed using the Static 99, and treatment change was assessed using the Violence Risk Scale-Sexual Offender version. Actuarially high-risk/ low-change offenders had significantly higher rates of sexual recidivism than similarly high-risk offenders who had demonstrated greater treatment changes. The Static 99 predicted sexual recidivism well among sex offenders with smaller treatment change but demonstrated weaker prediction among offenders with greater treatment change, likely owing, in part, to the static nature of the risk predictors. Implications regarding the dynamic nature of risk and potential utility of incorporating treatment change-related information into sex offender risk assessments are discussed. © 2011 International Association for Correctional and Forensic Psychology.


Sum M.Y.,Institute of Mental Health
Molecular Psychiatry | Year: 2016

Volume deficits of the hippocampus in schizophrenia have been consistently reported. However, the hippocampus is anatomically heterogeneous; it remains unclear whether certain portions of the hippocampus are affected more than others in schizophrenia. In this study, we aimed to determine whether volume deficits in schizophrenia are confined to specific subfields of the hippocampus and to measure the subfield volume trajectories over the course of the illness. Magnetic resonance imaging scans were obtained from Data set 1: 155 patients with schizophrenia (mean duration of illness of 7 years) and 79 healthy controls, and Data set 2: an independent cohort of 46 schizophrenia patients (mean duration of illness of 18 years) and 46 healthy controls. In addition, follow-up scans were collected for a subset of Data set 1. A novel, automated method based on an atlas constructed from ultra-high resolution, post-mortem hippocampal tissue was used to label seven hippocampal subfields. Significant cross-sectional volume deficits in the CA1, but not of the other subfields, were found in the schizophrenia patients of Data set 1. However, diffuse cross-sectional volume deficits across all subfields were found in the more chronic and ill schizophrenia patients of Data set 2. Consistent with this pattern, the longitudinal analysis of Data set 1 revealed progressive illness-related volume loss (~2–6% per year) that extended beyond CA1 to all of the other subfields. This decline in volume correlated with symptomatic worsening. Overall, these findings provide converging evidence for early atrophy of CA1 in schizophrenia, with extension to other hippocampal subfields and accompanying clinical sequelae over time.Molecular Psychiatry advance online publication, 23 February 2016; doi:10.1038/mp.2016.4. © 2016 Macmillan Publishers Limited


Sarkar J.,Institute of Mental Health
Advances in Psychiatric Treatment | Year: 2013

Making potentially critical clinical decisions in complex cases with the real risk of death by suicide is a most challenging job in psychiatry. Sadly, risk assessment and management of harm to self is a largely ignored area compared with risk of harm to others. The legal and ethical challenges are more nuanced, and contemporary training schemes and textbooks on psychiatry have not always done justice to this area, where front-line clinicians require probably most assistance. This article is an attempt to integrate the seemingly disparate threads from legal, ethical and clinical realms to assist decision-making, and it introduces a set of principles for managing these in clinical practice. It refers in particular to legislation in England and Wales, but the clinical and ethical issues discussed are universal.


Liew T.M.,Institute of Mental Health
International Journal of Geriatric Psychiatry | Year: 2016

Objective: Pre-death grief is prevalent among dementia family caregivers. When unaddressed, it produces adverse outcomes. With its research primarily conducted in Caucasians, its applicability to non-Caucasians is uncertain. We explore the existence and the characteristics of pre-death grief in a multi-ethnic Asian population using an established pre-death grief scale—Marwit–Meuser Caregiver Grief Inventory (MM-CGI). Methods: Seventy-two dementia family caregivers were recruited from a tertiary hospital. Existence of pre-death grief was shown by its measurability on MM-CGI, together with good internal consistency reliability and construct validity. Characteristics of pre-death grief were explored through multivariate linear regression of MM-CGI and by comparing MM-CGI scores with those from the original US study using one-sample T-test. Results: In the Asian context, pre-death grief was measurable in a reliable and valid manner. Risk factors of pre-death grief included caring for patients with severe dementia, spousal relationship and secondary or below education. Influence of culture was palpable—Asians had more worries and felt isolation, and certain ethnicity showed more pre-death grief. Conclusions: Pre-death grief is applicable even to the non-Caucasian population. It bears much similarity to that in Caucasians. Yet, its expression is modified by culture. Clinicians working with non-Caucasian populations need to be sensitive to its presence and to the influence of culture on its expression. © 2015 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd. © 2015 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.

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