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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.


Mahendran R.,National University of Singapore | Hendricks M.M.,Institute of Mental Health Woodbridge Hospital
Clinica Terapeutica | Year: 2013

Aim: The association of second generation antipsychotic medications and hyperglycaemia has been reported for Caucasian populations but is unknown for asian patients who unfortunately are predisposed to diabetes. We report the findings from a health quality improvement project which tracked patients with schizophrenia and schizoaffective disorder newly started on second generation antipsychotics. Materials and Methods: 266 patients were newly started on second generation antipsychotics in a 2 year period. Amongst the baseline parameters monitored was the fasting plasma glucose levels. Repeat testing was done at 4 weeks, 12 weeks and 12 months. Results: 14 patients were excluded form the analysis as they had diabetes at the start of treatment with second generation antipsychotics. Hyperglycaemia was found in 88 patients (34.9%). 68 (77.3%) of these patients experienced the Hyperglycaemia at 12 weeks, 3 patients (3.4%) at 4 weeks and 17 patients (19.3%) at 12 months. Fasting plasma glucose levels were highest at 4 weeks. Conclusions: Despite the limitations of the project, the one third prevalence of hyperglycaemia amongst patients newly started on second generation antipsychotics is a cause for concern and suggests the need for further extensive follow-up and assessment of the problem. © Società Editrice Universo (SEU).


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.


Kathirvel N.,Institute of Mental Health Woodbridge Hospital | Mortimer A.,NAViGO Health and Social Care CIC North East Lincolnshire Mental Health Services
Progress in Neurology and Psychiatry | Year: 2013

Visceral hallucinations are unpleasant sensations that appear to arise from internal organs, and can occur in both psychiatric and neurological disorders. Here, Dr Kathirvel and Professor Mortimer discuss the differential diagnosis, pathophysiology and treatment of visceral hallucinations. © 2013 John Wiley & Sons, Ltd.


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.


Verma S.,Institute of Mental Health Woodbridge Hospital | Subramaniam M.,Institute of Mental Health Woodbridge Hospital | Abdin E.,Institute of Mental Health Woodbridge Hospital | Sim K.,Institute of Mental Health Woodbridge Hospital | And 3 more authors.
Human Psychopharmacology | Year: 2010

The study aimed to evaluate the efficacy of long-acting injectable risperidone (LAR) in Asian patients with schizophrenia spectrum disorders. Twenty-five patients enrolled in this 6-month open labelled study. They were switched from their current antipsychotic to LAR without a prior oral risperidone run-in phase. Efficacy was assessed by the positive and negative syndrome scale (PANSS) and clinical global impression (CGI) scales. Extra-pyramidal side effects (EPSE) was assessed using the Simpson Angus Scale (SAS), and weight and plasma levels of fasting blood glucose, lipids and prolactin were measured. Baseline and last visits differences were tested by paired t-test and Wilcoxon signed-rank test; ratings measured over time were analysed using repeated measures ANOVA. Participants' mean age was 30.3 (±6.6) years. Principal reason for switching to LAR was non-compliance (40.0%). Thirteen (52%) patients completed the trial. Over 6 months, there were significant reductions in total PANSS ( p=0.008) and CGI ( p=0.001) scores. There were significant increases in weight (p<0.001), levels of plasma cholesterol and fasting glucose. LAR was effective in improving symptom severity within the first month of starting treatment. However, significant increases in weight and plasma levels of fasting glucose and cholesterol raise concern about metabolic side effects. Copyright © 2010 John Wiley & Sons, Ltd.


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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