Institute of Mental Health Woodbridge Hospital

Singapore, Singapore

Institute of Mental Health Woodbridge Hospital

Singapore, Singapore
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Cherlyn S.Y.T.,Institute of Mental Health Woodbridge Hospital | Woon P.S.,Institute of Mental Health Woodbridge Hospital | Liu J.J.,Agency for Science, Technology and Research Singapore | Ong W.Y.,National University of Singapore | And 2 more authors.
Neuroscience and Biobehavioral Reviews | Year: 2010

Schizophrenia (SZ) and bipolar disorder (BD) are debilitating neurobehavioural disorders likely influenced by genetic and non-genetic factors and which can be seen as complex disorders of synaptic neurotransmission. The glutamatergic and GABAergic neurotransmission systems have been implicated in both diseases and we have reviewed extensive literature over a decade for evidence to support the association of glutamate and GABA genes in SZ and BD. Candidate-gene based population and family association studies have implicated some ionotrophic glutamate receptor genes (GRIN1, GRIN2A, GRIN2B and GRIK3), metabotropic glutamate receptor genes (such as GRM3), the G72/G30 locus and GABAergic genes (e.g. GAD1 and GABRB2) in both illnesses to varying degrees, but further replication studies are needed to validate these results. There is at present no consensus on specific single nucleotide polymorphisms or halpotypes associated with the particular candidate gene loci in these illnesses. The genetic architecture of glutamate systems in bipolar disorder need to be better studied in view of recent data suggesting an overlap in the genetic aetiology of SZ and BD. There is a pressing need to integrate research platforms in genomics, epistatic models, proteomics, metabolomics, neuroimaging technology and translational studies in order to allow a more integrated understanding of glutamate and GABAergic signalling processes and aberrations in SZ and BD as well as their relationships with clinical presentations and treatment progress over time. © 2010 Elsevier Ltd.


Woon P.S.,Institute of Mental Health Woodbridge Hospital | Chia M.Y.,Institute of Mental Health Woodbridge Hospital | Chan W.Y.,Institute of Mental Health Woodbridge Hospital | Sim K.,Institute of Mental Health Woodbridge Hospital
Progress in Neuro-Psychopharmacology and Biological Psychiatry | Year: 2010

Quality of life (QOL) impairment is evident in patients with schizophrenia and is increasingly recognised as an important evaluation criterion of treatment outcome. Hence, this study aimed to identify the neurocognitive, clinical and functional parameters associated with subjective QOL in patients with schizophrenia within an Asian context, and specifically in an outpatient setting. This study was conducted on 83 outpatients with DSM-IV diagnosis of schizophrenia, and 47 age- and gender-matched healthy controls. All participants were administered with the World Health Organisation Quality of Life Assessment-Brief Form (WHOQOL-BREF) and Brief Assessment of Cognition in Schizophrenia (BACS), to measure quality of life and cognitive function respectively. Patients were also assessed for severity of psychopathology, as well as level of psychosocial functioning, using the Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) rating scales respectively. Specific psychopathology (greater severity of PANSS negative symptoms, general psychopathology subscale scores), cognitive deficits (working and verbal memories), and lower GAF scores were correlated with poorer QOL in patients. Multivariate analyses revealed that younger age, being single and lower level of psychosocial functioning were associated with poorer QOL but level of psychosocial functioning did not appear to mediate the effects of symptoms and neurocognitive deficits on QOL. Overall, this study highlighted the need for clinicians to pay more attention to these clinical, neurocognitive and functional parameters and their integrative relationships with QOL in order to optimise the treatment outcomes of patients with schizophrenia. © 2010 Elsevier Inc.


Kuswanto C.,Institute of Mental Health | Chin R.,Institute of Mental Health | Sum M.Y.,Institute of Mental Health | Sengupta S.,Institute of Mental Health Woodbridge Hospital | And 5 more authors.
Neuroscience and Biobehavioral Reviews | Year: 2016

Recent data from genetic and brain imaging studies have urged rethinking of bipolar disorder (BD) and schizophrenia (SCZ) as lying along a continuum of major endogenous psychoses rather than dichotomous disorders. We systematically reviewed extant studies (from January 2000 to July 2015) that directly compared neurocognitive impairments in adults with SCZ and BD. Within 36 included studies, comparable neurocognitive impairments were found in SCZ and BD involving executive functioning, working memory, verbal fluency and motor speed. The extent and severity of neurocognitive impairments in patients with schizoaffective disorder, and BD with psychotic features occupy positions intermediate between SCZ and BD without psychotic features, suggesting spectrum of neurocognitive impairments across psychotic spectrum conditions. Neurocognitive impairments correlated with socio-demographic (lower education), clinical (more hospitalizations, longer duration of illness, negative psychotic symptoms and non-remission status), treatment (antipsychotics, anti-cholinergics) variables and lower psychosocial functioning. The convergent neurocognitive findings in both conditions support a continuum concept of psychotic disorders and further research is needed to clarify common and dissimilar progression of specific neurocognitive impairments longitudinally. © 2015 Elsevier Ltd.


Jiang J.,Institute of Mental Health Woodbridge Hospital | Jiang J.,National University of Singapore | See Y.M.,Institute of Mental Health Woodbridge Hospital | Subramaniam M.,Institute of Mental Health Woodbridge Hospital | And 2 more authors.
PLoS ONE | Year: 2013

Male schizophrenia patients are known to have a heavier smoking pattern compared with the general population. However, the mechanism for this association is not known, though hypothesis that smoking could alleviate symptomatology of schizophrenia and reduce side effects of antipsychotics has been suggested. The aims of this study were to validate the heavier smoking pattern among male schizophrenia patients and to investigate the possible mechanisms for the association. To enhance the reliability of the study, we recruited two large independent samples with 604 and 535 male Chinese schizophrenia patients, and compared their smoking pattern with that of 535 healthy male controls recruited from general population. Validated multiple indicators and multiple causes structure equation model and regression models were used to investigate the association of smoking with factors of schizophrenia symptomatology and with the usage of antipsychotics and their extra-pyramidal side effects (EPS). Schizophrenia patients had significantly heavier smoking pattern compared with healthy controls in our sample (42.4% vs. 16.8%, p<0.001 for current smoking prevalence; 23.5% vs. 43.3%, p<0.001 for smoking cessation rate; 24.5% vs. 3.0%, p<0.001 for heavy smoker proportion). Their smoking status was also found to be consistently and significantly associated with reduced negative factor scores for schizophrenia symptomatology (β = -0.123, p = 0.051 for sample-A; β = -0.103, p = 0.035 for sample-B; β = -0.082, p = 0.017 for the combined sample). However, no significant association was found between smoking and antipsychotics usage or risk of EPS. These results support that smoking is associated with improved negative symptoms, which could account for the heavier smoking pattern among schizophrenia patients. © 2013 Jiang et al.


Yap Q.J.,Nanyang Technological University | Teh I.,National University of Singapore | Fusar-Poli P.,King's College London | Sum M.Y.,Institute of Mental Health Woodbridge Hospital | And 2 more authors.
Journal of Neural Transmission | Year: 2013

Delineating the normal development of brain white matter (WM) over the human lifespan is crucial to improved understanding of underlying WM pathology in neuropsychiatric and neurological conditions. We review the extant literature concerning diffusion tensor imaging studies of brain WM development in healthy individuals available until October 2012, summarise trends of normal development of human brain WM and suggest possible future research directions. Temporally, brain WM maturation follows a curvilinear pattern with an increase in fractional anisotropy (FA) from newborn to adolescence, decelerating in adulthood till a plateau around mid-adulthood, and a more rapid decrease of FA from old age onwards. Spatially, brain WM tracts develop from central to peripheral regions, with evidence of anterior-to-posterior maturation in commissural and projection fibres. The corpus callosum and fornix develop first and decline earlier, whilst fronto-temporal WM tracts like cingulum and uncinate fasciculus have protracted maturation and decline later. Prefrontal WM is most vulnerable with greater age-related FA reduction compared with posterior WM. Future large scale studies adopting longitudinal design will better clarify human brain WM changes over time. © 2013 Springer-Verlag Wien.


Tham M.W.,Institute of Mental Health Woodbridge Hospital | Tham M.W.,Nanyang Technological University | Woon P.S.,Institute of Mental Health Woodbridge Hospital | Sum M.Y.,Institute of Mental Health Woodbridge Hospital | And 2 more authors.
Journal of Affective Disorders | Year: 2011

Background: Until more recently, most studies have examined the changes in brain gray matter in major depressive disorder (MDD) with less studies focusing on understanding white matter pathology in MDD. Studies of brain white matter volume changes, connectivity disruptions, as well as genetic factors affecting myelination can throw light on the nature of white matter abnormalities underpinning MDD. Methods: We review the state of the art understanding of white matter changes in MDD from the extant neuropathology, neuroimaging and neurogenetic studies. Results: Overall, data are sparse and mostly conducted in older patients with MDD. Post-mortem studies have highlighted pathology of white matter in prefrontal brain region in terms of decreased oligodendrocyte density, reductions in the expression of genes related to oligodendrocyte function, molecular changes in intercellular cell adhesion molecule (ICAM) expression levels and suggestion of possible mechanism of ischemia. Structural magnetic resonance imaging studies have revealed deep white matter hyperintensities which are associated with clinical severity, and treatment responsiveness. Limitations: There is a particular dearth of genetic studies related to white matter pathology, studies of younger depressed subjects and specifically probing cortical and subcortical white matter pathology together in MDD. Conclusions: Future investigations would want to study white matter changes in different cerebral regions and incorporate multimodal and longitudinal levels of examination in order to better grasp the neural basis of this condition. © 2010 Elsevier B.V. All rights reserved.


PubMed | University of Barcelona, Institute of Mental Health, Institute of Mental Health Woodbridge Hospital, University of Siena and University of Toronto
Type: | Journal: Neuroscience and biobehavioral reviews | Year: 2016

Recent data from genetic and brain imaging studies have urged rethinking of bipolar disorder (BD) and schizophrenia (SCZ) as lying along a continuum of major endogenous psychoses rather than dichotomous disorders. We systematically reviewed extant studies (from January 2000 to July 2015) that directly compared neurocognitive impairments in adults with SCZ and BD. Within 36 included studies, comparable neurocognitive impairments were found in SCZ and BD involving executive functioning, working memory, verbal fluency and motor speed. The extent and severity of neurocognitive impairments in patients with schizoaffective disorder, and BD with psychotic features occupy positions intermediate between SCZ and BD without psychotic features, suggesting spectrum of neurocognitive impairments across psychotic spectrum conditions. Neurocognitive impairments correlated with socio-demographic (lower education), clinical (more hospitalizations, longer duration of illness, negative psychotic symptoms and non-remission status), treatment (antipsychotics, anti-cholinergics) variables and lower psychosocial functioning. The convergent neurocognitive findings in both conditions support a continuum concept of psychotic disorders and further research is needed to clarify common and dissimilar progression of specific neurocognitive impairments longitudinally.


PubMed | Institute of Mental Health Woodbridge Hospital and National Neuroscience Institute
Type: Case Reports | Journal: Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology | Year: 2016

Huntingtons disease (HD) is an autosomal dominant neurodegenerative disease characterized by a triad of progressive motor dysfunction, cognitive decline and psychiatric disturbances. The hallmark of HD is the distinctive choreiform movement disorder that typically has a subtle, insidious onset in the fourth to fifth decade of life and gradually worsens over 10 to 20 years until death. Notably, two-thirds of HD patients present with chorea and one third with mental changes. The prevalence of psychiatric symptoms is significantly higher than in the general population, and is estimated to be around 66-73%. Here, we report a unique case of subsequent onset of HD in a patient previously treated for schizophrenia and complicated by the extrapyramidal side effects to antipsychotics.


Yogaratnam J.,Institute of Mental Health Woodbridge Hospital
East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan | Year: 2013

Metabolic syndrome is a cluster of risk factors comprising obesity, dyslipidaemias, glucose intolerance, insulin resistance (or hyperinsulinaemia), and hypertension, and is highly predictive of type 2 diabetes mellitus and cardiovascular disease. The life expectancy of people with schizophrenia is reduced by 20%, with 60% of the excess mortality due to physical illness. Schizophrenia itself may be a risk factor for metabolic syndrome and there is also increasing concern that antipsychotic drugs, particularly second-generation antipsychotics, have metabolic consequences that contribute to the risk. Various diagnostic guidelines, updated facts with regard to epidemiology, pathophysiology, risk factors, and complications of metabolic syndrome are discussed in this review. Moreover, the impact of various antipsychotics on metabolic syndrome and their possible mechanisms are comprehensively reviewed. The authors emphasise that, while many adults with schizophrenia receive little or no medical care, such care is important given the risk of metabolic abnormalities associated not only with antipsychotic medications, but also with schizophrenia in general.


Rekhi G.,Institute of Mental Health Woodbridge Hospital
Journal of law and medicine | Year: 2012

Singapore is legally restrictive when it comes to research involving minors. The age of majority is 21 and parental consent is required for participation in medical research. This article explores the age of majority and the issues related to obtaining consent for research in Singapore, focusing on "young adults" (17-21 years), using an example of a translational and clinical research project called the Longitudinal Youth at Risk Study (LYRIKS). It describes the unique legal and social conditions pertaining to the age of majority in Singapore, before presenting an argument for consideration as to whether the age of consent to participate in research should be reviewed. It concludes that rather than a set of doctrinaire rules for the age of participation in research, there should be an assessment of the kind of tasks that minors can assume themselves in respect to a specific project, and the degree of parental involvement.

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