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Aims: The aims of this study were to examine the prevalence and severity of aggression in patients with first-episode psychosis and to identify the association between aggression and sociodemographic and clinical factors. Methods: Consecutive patients with first-episode psychosis admitted to the Early Psychosis Intervention Programme, Singapore, were assessed for a history of aggressive acts. Diagnosis was confirmed using the Structured Clinical Interview for DSM-IV and psychopathology was assessed using PANSS. Results: Of the 146 patients, 63.0% had no history of aggressive acts, 13.7% demonstrated severe aggression (defined as weapon use, sexual assault or victim injury) and 23.3% had lesser aggression (all other acts of aggression). Patients with aggression had a significantly longer duration of untreated psychosis (DUP) than those with no history of aggression (p 1/4 .01). The mean total PANSS scores did not differ significantly among the three groups. However, the General Psychopathology scores and the scores for 'hostility', 'poor impulse control', 'lack of insight and judgement' and 'somatic concern' were all significantly elevated in patients with aggression (p < .05). Conclusion: The significant association between aggression and longer DUP once again reiterates the need for early detection and effective management of first-episode psychosis.

Background:Some studies have suggested ethnicity as being one of the causes leading to a longer duration of untreated psychosis (DUP) in first episode psychosis.Aim:We sought to investigate this issue, in a large cohort of patients with a first episode of psychosis, in Singapore.Method:In this naturalistic retrospective study, 794 patients accepted into Early Psychosis Intervention Programme (EPIP) services in Singapore were recruited. Diagnosis was made based on SCID 1 (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), Axis I Disorders). Information about DUP and sociodemographic characteristics was collected from patients and relatives. Positive and Negative Symptom Scale (PANSS) and Global Assessment of Functioning (GAF) Scale were used as tools to assess the severity of symptoms and functioning of the patient, respectively, at baseline, 3, 6, 12 and 24  months.Results:The mean and 50th quantile (median) of DUP for this sample were 14.2 and 6, respectively. The mean and median DUP were higher among Indians than in the other ethnic groups. After adjusting for demographic variables, Indian ethnicity was significantly associated with higher median and 75th Percentile DUP than Chinese. Secondary and tertiary education and diagnosis of affective psychosis and brief psychotic disorder (vs. schizophrenia spectrum and delusional disorder) were also significantly associated with lower mean, median and 75th percentile DUP symptoms. Increase in age was significantly associated with higher mean, median and 75th percentile DUP while married and separated/divorced (vs. single) was significantly associated with lower mean and 75th percentile DUP.Conclusion:This study found a positive correlation between certain ethnic groups and DUP. Indian ethnicity, older age, single, lower education and patients diagnosed with schizophrenia spectrum and delusional disorders were more likely to be associated with longer DUP.

Abstract
This is an exploratory paper of the ethical implications for genomic research and mental illness with specific reference to Singapore. Singapore has a unique context due to its social and political systems, and although it is a relatively small country, its population is religiously and culturally diverse. The issues that we identify here, therefore, will offer new perspectives and will also shed light on the existing literature on psychiatric genomics in society. We contextualise issues such as risk and stigma in the identification and diagnosis of psychosis in the way they relate to Singaporean society, and use a current study (LYRIKS) as a case example.
Genomic research has the potential to change significantly he practice of clinical medicine if, as expected, fast and inexpensive sequencing becomes a reality. It will likely also change how society thinks and acts in respect to multi-factorial diseases, conditions, traits, and syndromes that have a genetic component. Genomic research already raises a number of ethical concerns relating to the privacy of individuals, including the disclosure of research results and incidental findings, surreptitious tests, third party access to data, and the re-emergence of genetic determinism. These issues are potentially exacerbated when genomics - the study of whole genomes to understand complex illness and behavioural traits - is applied to psychiatric research, because of the stigma that is often attached to mental illness. In this paper, we discuss some of the issues that have arisen in the context of a study in Singapore that is currently investigating the genomics and biomarkers of psychosis. We argue that although a genomic study rarely creates data that is directly useful to the participant, it can have incidental benefits to the individual who is identified during the study as being at high risk of developing psychosis and its related states. Understanding these potential benefits requires us to examine the implications that this type of research may have on public understandings of genomic data and risk.

This is an exploratory paper of the ethical implications for genomic research and mental illness with specific reference to Singapore. Singapore has a unique context due to its social and political systems, and although it is a relatively small country, its population is religiously and culturally diverse. The issues that we identify here, therefore, will offer new perspectives and will also shed light on the existing literature on psychiatric genomics in society. We contextualise issues such as risk and stigma in the identification and diagnosis of psychosis in the way they relate to Singaporean society, and use a current study (LYRIKS) as a case example.

Abstract This is an exploratory paper of the ethical implications for genomic research and mental illness with specific reference to Singapore. Singapore has a unique context due to its social and political systems, and although it is a relatively small country, its population is religiously and culturally diverse. The issues that we identify here, therefore, will offer new perspectives and will also shed light on the existing literature on psychiatric genomics in society. We contextualise issues such as risk and stigma in the identification and diagnosis of psychosis in the way they relate to Singaporean society, and use a current study (LYRIKS) as a case example. Genomic research has the potential to change significantly he practice of clinical medicine if, as expected, fast and inexpensive sequencing becomes a reality. It will likely also change how society thinks and acts in respect to multi-factorial diseases, conditions, traits, and syndromes that have a genetic component. Genomic research already raises a number of ethical concerns relating to the privacy of individuals, including the disclosure of research results and incidental findings, surreptitious tests, third party access to data, and the re-emergence of genetic determinism. These issues are potentially exacerbated when genomics - the study of whole genomes to understand complex illness and behavioural traits - is applied to psychiatric research, because of the stigma that is often attached to mental illness. In this paper, we discuss some of the issues that have arisen in the context of a study in Singapore that is currently investigating the genomics and biomarkers of psychosis. We argue that although a genomic study rarely creates data that is directly useful to the participant, it can have incidental benefits to the individual who is identified during the study as being at high risk of developing psychosis and its related states. Understanding these potential benefits requires us to examine the implications that this type of research may have on public understandings of genomic data and risk.

AbstractAs social work under normal circumstances is already a stress‐laden helping profession, this study intended to examine the level of psychological distress among the frontline social workers during the COVID‐19 pandemic and whether resilience and organizational support played a part in mitigating their psychological distress. Frontline social workers from various social service sectors across Singapore were surveyed using two standardized measurements to assess resilience (Connor‐Davidson Resilience Scale 25) and psychological distress (Depression Anxiety and Stress Scale 21). A self‐designed questionnaire comprising 10 items measured "personal" and "work‐related" support at the organization. Sociodemographic data were captured using a structured questionnaire. The results showed that the frontline social workers, although resilient, were psychologically distressed in all the three areas of depression, anxiety and stress. The results indicated that those working in the Family Service Centers (FSC) were the most affected. Significant correlations were observed between psychological distress, resilience, and organizational support. Organizations must be mindful that support can help frontline staff who are usually younger and less experienced during challenging times such as the pandemic. Building the resilience of social workers will prepare them for their daily challenges and those that accompany unexpected situations.

Background: The study examined the association between sedentary behavior and self-rated health-related quality of life (HRQoL) in a sample of patients with multimorbidity in Singapore recruited from a primary care clinic. Methods: Sedentary behavior and physical activity were assessed with the International Physical Activity Questionnaire short form (IPAQ-SF). HRQoL was assessed with EuroQol-5 Dimension (EQ-5D) utility index, visual analogue scale (EQ-VAS) and its 5 subscales (Mobility, Self-care, Usual Activities, Pain/Discomfort, and Anxiety/Depression). Depression was assessed via Patient Health Questionnaire (PHQ-9). Logistic and linear regression analyses adjusting for the effect of physical activity, depression, and sociodemographic variables (i.e., age, gender, ethnicity, education) were conducted. Results: 932 patients participated in the study (mean age:64.5±8.5 years, range: 35-80) and 55% were men. Results indicated that women were less likely to have sedentary behavior (≥7 hrs/day) than men. Results indicated sedentary behavior was associated with lower EQ-5D index scores, but not EQ-VAS scores. Participants who were sedentary for ≥7 hrs/day were more likely to endorse having problems with mobility, self-care, and usual activities, but not with pain/discomfort, nor anxiety/depression. Conclusion: Sedentary behavior was associated with poorer HRQoL. There is a need for interventions and health promotions to reduce sedentary behavior in patients with multimorbidity.

PURPOSE: The physical and mental wellbeing of an individual is impacted by the type occupation one does. This study aims to establish the prevalence of mental and physical disorders, the association of occupational groups and health-related quality of life, and the extent of work-loss and work-cut back in past 30 days among the employed in the Singapore resident population. METHODS: Data from a population-based, epidemiological survey of a representative sample of Singapore citizens and permanent residents aged 18 years and above were used. Lifetime diagnosis of select mental disorders was established using the World Health Organization's Composite International Diagnostic Interview version 3.0 (WHO-CIDI 3.0). Data on nicotine dependence, work productivity, quality of life and socio-demographics were obtained via self-report. Ten major occupational groups based on the Singapore Standard Occupational Classification were included in the analysis. RESULTS: The sample comprised 4021 employed individuals who were predominantly males (54.7%) and aged 35–49 years (35.4%). 'Service and sales workers' (22.6%), 'Professionals' (17.3%) and 'Legislators, senior officials and managers' (16.4%) were the three largest occupational groups. Socio-demographic characteristics differed significantly (p < 0.001) across all occupational groups. Lifetime prevalence of mood disorders among the employed was 8.4% and the most prevalent physical disorder was chronic pain (18.9%). No significant differences were observed in work productivity loss across the occupational groups. CONCLUSIONS: The disparities in the socio-demographic characteristics and prevalence of mental and physical disorders across occupational categories provide policymakers with vital information to pilot effective interventions that can improve the psychosocial and physical conditions at work.

Causal attributions of mental illness have received substantial attention given their influence on help-seeking patterns of individuals and the level of engagement with health services. Few studies, however, have examined caregivers' perspectives of their relatives' illness. The current study aimed to examine caregivers' causal attributions of their relatives' mental illness and its association with perceived stigma in a multi-ethnic Asian sample. Primary caregivers ( N = 350) of psychiatric outpatients were recruited from a psychiatric hospital. The attribution and stigma sections of the Family Interview Schedule (FIS) were utilized to obtain caregivers' causal report of their relatives' illness and stigma perception. Logistic regressions were performed to examine the socio-demographic and diagnostic correlates of the four categories of causal attributions (psychosocial, biological, drug-/substance use-related, supernatural). The majority of caregivers identified psychosocial causes, followed by biological, supernatural, and lastly drug-/substance use-related causes for their relatives' illness. Marital status, religion, employment status and the diagnosis of depressive disorders were significant correlates of biological attributions. Ethnicity and not knowing their relatives' diagnosis were significantly associated with psychosocial attributions. For drug-/substance use-related attributions, ethnicity was the only significant correlate. Supernatural attributions did not yield any significant associations. Caregivers who endorsed drug-/substance use-related reasons also reported significantly higher stigma than caregivers who did not endorse these attributions. A tendency to endorse biological and psychosocial causes for their relative's illness was noted among caregivers. Further research on caregivers' causal attributions is warranted to account for and replicate current study findings.

Objective: Informal caregivers are often placed in a better position to understand and advocate for the vocational needs of young persons with mental health conditions. However, their opinions are largely ignored in the planning of vocational outcomes. This qualitative study had two broad aims: to explore (1) the perceptions of caregivers of young adults with mental health conditions on issues of paid employment and (2) their views and expectations of employment support services. Methods: A total of 30 semi-structured interviews were conducted. Caregivers were 45 years old on average, the majority were women (73%) and were of Chinese ethnicity (53%). Most participants (60%) were parents of the young persons with psychotic disorders (57%), or affective and mood disorders, such as depression or anxiety disorders (43%). Results: Thematic analyses of data revealed three superordinate themes: (1) caregiving roles, (2) caregivers' expectations and hopes, and (3) barriers to employmentof young persons with mental health conditions. Conclusions and implications for practice: Caregivers strongly believed that employment support services should prioritise and advocate for recovery while securing employment. Local mental health employment support services should incorporate the views and expectations of caregivers of young persons with mental health conditions to foster better coordination between stakeholders, and enhance support for successful employment, reintegration into the community, and ultimately recovery for these individuals.