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Special Issue "Adult Psychiatry"

Special Issue Editors

Guest Editor
Dr. Roger C.M. Ho

Department of Psychological Medicine, National University of Singapore,Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore 119228, Singapore
Website | E-Mail
Interests: mood disorders; personality disorders; electronic mental health service delivery and the interface between psychiatry and medicine; application of optical topography in psychiatry
Guest Editor
Dr. Bach Tran

Vice Head, Department of Health Economics, Hanoi Medical University, Vietnam
Vietnam Young Physician Association
Bloomberg School of Public Health, Johns Hopkins University, USA
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Interests: health economics and policy; global health; e-Health
Guest Editor
Dr. Ng Chong Guan

Department of Psychological Medicine, University of Malaya, Kuala Lumpur, Malaysia
Website | E-Mail
Interests: epidemiology; depression; palliative psychiatry; psychooncology

Special Issue Information

Dear Colleagues,

Psychiatric disorders affect the brain, which is the most important organ of human body, by a combination of aetiologies involving biological and environmental factors. Psychiatric disorders are common in the adult population with prevalence ranges from 1% (schizophrenia) to 15% (depression). Despite recent advances in psychopharmacology, psychiatric disorders are associated with work-related disability, productivity loss and stigma in the adult population. Psychiatric disorders have negative impacts on patient quality of life and contribute significantly to the human and economic costs in the society. More research is required to understand the biological, psychological and social aspects of psychiatric disorders in adults.  Such research findings will help governments and health authorities to formulate mental health policy in prevention, detection and treatment of psychiatric disorders.

This Special Issue aims to showcase and summarize latest research findings about psychiatric disorders which affect adults in different countries. This Special Issue is open to any subject area related to “Adult Psychiatry”. We welcome papers that report research findings related to schizophrenia, depressive disorder, bipolar disorder, suicide and deliberate self-harm, anxiety disorders, personality disorders, addiction and substance abuse, as well as other psychiatric disorders. Studies using innovative research methods to study psychiatric disorders are most welcome.

Dr. Ho Chun Man Roger
Dr. Bach Tran
Dr. Ng Chong Guan
Guest Editors

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Keywords

  • Schizophrenia
  • Depressive disorder
  • Bipiolar disorder
  • Anxiety disorder
  • Suicide
  • Addiction
  • Substance abuse
  • Personality disorder

Published Papers (33 papers)

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Open AccessArticle Robustness and Findings of a Web-Based System for Depression Assessment in a University Work Context
Int. J. Environ. Res. Public Health 2019, 16(4), 644; https://doi.org/10.3390/ijerph16040644 (registering DOI)
Received: 18 December 2018 / Revised: 14 February 2019 / Accepted: 15 February 2019 / Published: 21 February 2019
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Abstract
Depression is associated with absenteeism and presentism, problems in workplace relationships and loss of productivity and quality. The present work describes the validation of a web-based system for the assessment of depression in the university work context. The basis of the system is [...] Read more.
Depression is associated with absenteeism and presentism, problems in workplace relationships and loss of productivity and quality. The present work describes the validation of a web-based system for the assessment of depression in the university work context. The basis of the system is the Spanish version of the Beck Depression Inventory (BDI-II). A total of 185 participants completed the BDI-II web-based assessment, including 88 males and 97 females, 70 faculty members and 115 staff members. A high level of internal consistency reliability was confirmed. Based on the results of our web-based BDI-II, no significant differences were found in depression severity between gender, age or workers’ groups. The main depression risk factors reported were: “Changes in sleep”, “Loss of energy”, “Tiredness or fatigue” and “Loss of interest”. However significant differences were found by gender in “Changes in appetite”, “Difficulty of concentration” and “Loss of interest in sex”; males expressed less loss of interest in sex than females with a statistically significant difference. Our results indicate that the data collected is coherent with previous BDI-II studies. We conclude that the web-based system based on the BDI-II is psychometrically robust and can be used to assess depression in the university working community. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessArticle Mortality Risk and Risk Factors in Patients with Posttraumatic Epilepsy: A Population-Based Cohort Study
Int. J. Environ. Res. Public Health 2019, 16(4), 589; https://doi.org/10.3390/ijerph16040589
Received: 19 January 2019 / Revised: 14 February 2019 / Accepted: 14 February 2019 / Published: 18 February 2019
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Abstract
Aim: Use the National Health Insurance Research Database of Taiwan to determine whether patients with posttraumatic epilepsy (PTE) have an increased risk of mortality. Methods: Patients ≥20 years old ever admitted because of head injury (per International Classification of Diseases, Ninth Revision, Clinical [...] Read more.
Aim: Use the National Health Insurance Research Database of Taiwan to determine whether patients with posttraumatic epilepsy (PTE) have an increased risk of mortality. Methods: Patients ≥20 years old ever admitted because of head injury (per International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 850–854 and 959.01) during 2000–2012 were enrolled into a traumatic brain injury (TBI) cohort. The TBI cohort was divided into with PTE (ICD-9-CM code 345) and posttraumatic nonepilepsy (PTN) cohorts. We compared the PTE and PTN cohorts in terms of age, sex, and comorbidities. We calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk in these cohorts. Results: Patients with PTE had a higher incidence rate (IR) of mortality than did patients with TBI alone (IR per 1000 person-years: 71.8 vs. 27.6), with an aHR 2.31 (95% CI = 1.96–2.73). Patients with PTE aged 20–49, 50–64, and ≥65 years had, respectively, 2.78, 4.14, and 2.48 times the mortality risk of the PTN cohort. Patients with any comorbidity and PTE had 2.71 times the mortality risk as patients in the PTN cohort. Furthermore, patients with PTE had 28.2 increased hospital days and 7.85 times as frequent medical visits per year compared with the PTN cohort. Conclusion: Taiwanese patients with PTE had approximately 2 times the mortality risk and an increased medical burden compared to patients with TBI only. Our findings provide crucial information for clinicians and the government to improve TBI outcomes. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessArticle Socioeconomic Vulnerability to Depressive Symptoms in Patients with Chronic Hepatitis B
Int. J. Environ. Res. Public Health 2019, 16(2), 255; https://doi.org/10.3390/ijerph16020255
Received: 3 December 2018 / Revised: 12 January 2019 / Accepted: 13 January 2019 / Published: 17 January 2019
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Abstract
Depression is considered one of the most prevalent psychiatric disorders among patients with hepatitis B virus (HBV)-related liver disease and has adverse effects on the disease progression. However, there is a scarcity of studies contributing to the assessement of depression in hepatitis B [...] Read more.
Depression is considered one of the most prevalent psychiatric disorders among patients with hepatitis B virus (HBV)-related liver disease and has adverse effects on the disease progression. However, there is a scarcity of studies contributing to the assessement of depression in hepatitis B patients. There is also little research into risk factors, particularly underlying socio-economic factors in Vietnam where the prevalence of hepatitis B is high. This study aimed to examine depression and identify whether differences in socio-economic status is related to the level of depression amongst chronic hepatitis B patients. A cross-sectional study was conducted on 298 patients with chronic hepatitis B at The Chronic Hepatitis Clinic in the Viet-Tiep Hospital, Hai Phong, Vietnam. The Patient Health Questionnaire-9 (PHQ-9) and EuroQol-5 dimensions-5 levels (EQ-5D-5L) were used to assess the severity of depression and health-related quality of life (HRQOL). Of chronic hepatitis B patients, 37.5% experienced depressive symptoms and most of them suffered minimal depressive symptoms (31.4%). According to the result of the multivariate logistic regression model, we found that higher age, lower income level, unemployement, living with spouse/partners were positively associated with having depression. Furthermore, having physical health problems and lower health-related quality of life were also related to a higher risk of depression. We recommend family support, financial support and active participation in consultation should be conducted during treatment to improve the quality of life and the emotional state of HBV patients. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessArticle Relationship of Anxiety and Depression with Respiratory Symptoms: Comparison between Depressed and Non-Depressed Smokers in Singapore
Int. J. Environ. Res. Public Health 2019, 16(1), 163; https://doi.org/10.3390/ijerph16010163
Received: 19 November 2018 / Revised: 20 December 2018 / Accepted: 3 January 2019 / Published: 8 January 2019
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Abstract
The rising prevalence of smokers in the community, specifically psychiatric patients, necessitates smoking cessation as an important strategy for reducing the harmful effects of tobacco. This study aims to compare the profiles of depressed and non-depressed smokers and evaluate how psychiatric symptoms influence [...] Read more.
The rising prevalence of smokers in the community, specifically psychiatric patients, necessitates smoking cessation as an important strategy for reducing the harmful effects of tobacco. This study aims to compare the profiles of depressed and non-depressed smokers and evaluate how psychiatric symptoms influence respiratory symptoms. A cross-sectional survey was administered to 276 non-depressed adult smokers in the community and 69 adult smokers who had been formally diagnosed with depression in the outpatient clinic of a University Hospital in Singapore. Participants were administered questionnaires on smoking attitudes and perceptions, psychiatric symptoms, and respiratory symptoms. Correlations and multiple regression analyses were conducted. The mean age of smokers in the study was 35.32 ± 13.05 years. Smokers in the community and psychiatric samples were largely similar on all of the sociodemographic factors, except that fewer depressed people were employed (χ2 = 8.35, p < 0.01). Smokers with depression also reported more attempts to quit smoking (χ2 = 7.14, p < 0.05), higher mean depressive, anxiety, and stress symptom (DASS) scores (t = −10.04, p < 0.01), and endorsed more respiratory symptoms than smokers in the community (t = −2.40, p < 0.05). The DASS scores, number of cigarettes smoked daily, years of smoking, general perception of smokers getting heart disease, and presence of lung disease were positively and significantly correlated with respiratory symptoms. On multiple regression, only anxiety symptoms (β = 0.26, p < 0.05) and the presence of lung disease (β = 0.22, p < 0.001) were significantly correlated with respiratory symptoms. Depressed smokers reported greater difficulty in quitting tobacco use, and they perceived more severe respiratory symptoms compared to non-depressed counterparts. Anxiety symptoms were positively associated with the severity of respiratory symptoms. Smoking cessation campaigns need to specifically target psychological symptoms in smokers and focus more psychoeducation on the risk of cardiovascular disease in the middle-aged population. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessArticle Depression and Quality of Life among Patients Living with HIV/AIDS in the Era of Universal Treatment Access in Vietnam
Int. J. Environ. Res. Public Health 2018, 15(12), 2888; https://doi.org/10.3390/ijerph15122888
Received: 10 October 2018 / Revised: 23 November 2018 / Accepted: 10 December 2018 / Published: 17 December 2018
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Abstract
Although antiretroviral treatment (ART) access has been universal in recent years, few studies have examined if this policy contributes to the mental health of the patients. This study assessed depression and its relations with health-related quality of life (HRQOL), which is defined as [...] Read more.
Although antiretroviral treatment (ART) access has been universal in recent years, few studies have examined if this policy contributes to the mental health of the patients. This study assessed depression and its relations with health-related quality of life (HRQOL), which is defined as the status of general well-being, physical, emotional, and psychological, among HIV patients. A cross-sectional study was conducted in 482 patients at five outpatient clinics. Patient Health Questionnaire-9 (PHQ-9) and EuroQol-5 dimensions-5 levels (EQ-5D-5L) were used to assess the severity of depression and HRQOL. About one-fifth of patients reported symptoms of depression. According to the result of a multivariate logistic regression model, patients who had a lower number of CD4 cells at the start of ART, who received ART in the clinic without HIV counseling and testing (HCT) services, who had a physical health problem, and who experienced discrimination were more likely to have depression. Depression was associated with significantly decreased HRQOL. Depression is prevalent and significantly negatively associated with HRQOL of HIV/AIDS patients. We recommend screening for depression and intervening in the lives of depressed individuals with respect to those who start ART late, and we also recommend community-based behavioral change campaigns to reduce HIV discrimination. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessArticle The Comorbidity of Gambling Disorder among Macao Adult Residents and the Moderating Role of Resilience and Life Purpose
Int. J. Environ. Res. Public Health 2018, 15(12), 2774; https://doi.org/10.3390/ijerph15122774
Received: 11 November 2018 / Revised: 30 November 2018 / Accepted: 3 December 2018 / Published: 7 December 2018
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Abstract
Macao, China’s only city with legalized casinos, has maintained a high prevalence of gambling participation and gambling disorder (GD) over the past decade. The mental health risks associated with such high levels have been overlooked. In order to estimate the comorbid prevalence of [...] Read more.
Macao, China’s only city with legalized casinos, has maintained a high prevalence of gambling participation and gambling disorder (GD) over the past decade. The mental health risks associated with such high levels have been overlooked. In order to estimate the comorbid prevalence of GD with depression, anxiety, and Internet gaming disorder (IGD) and to explore the potential buffering effect of psychological resilience and purpose in life, this study obtained a representative adult Chinese sample (N = 1000, 44% male, aged 18–97 years) from a telephone survey conducted between October and November of 2016. As hypothesized, the highest psychiatric comorbid prevalence was observed in the GD subgroup (n = 19, 21.1% probable IGD, 26.3% probable depression, and 37.0% probable anxiety). All these mental health problems could increase one’s proclivity to GD, and vice versa. Psychological resilience was found to buffer the association between anxiety symptoms and probable GD (χ2(1) = 4.30, p = 0.04/GD symptoms, Fchange (1,162) = 6.29, p = 0.01), whereas purpose in life did not display any hypothesized moderating effect. These results indicate the usefulness of mental health screening for GD, taking into consideration its associated risks, and of fostering psychological resilience in prevention and treatment programs. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessArticle Media Exposure and General Trust as Predictors of Post-traumatic Stress Disorder: Ten Years after the 5.12 Wenchuan Earthquake in China
Int. J. Environ. Res. Public Health 2018, 15(11), 2386; https://doi.org/10.3390/ijerph15112386
Received: 3 October 2018 / Revised: 22 October 2018 / Accepted: 25 October 2018 / Published: 27 October 2018
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Abstract
There is a paucity of literature on the roles of media exposure, general trust, and their interactions in long-term post-traumatic stress disorder (PTSD) symptoms after a natural disaster. Trying to address this knowledge gap, our study aimed to (a) investigate whether exposure to [...] Read more.
There is a paucity of literature on the roles of media exposure, general trust, and their interactions in long-term post-traumatic stress disorder (PTSD) symptoms after a natural disaster. Trying to address this knowledge gap, our study aimed to (a) investigate whether exposure to media coverage during the traumatic event and general trust directly affected adult survivors’ long-term PTSD symptoms 10 years after the 5.12 Wenchuan earthquake, and (b) to identify the potential differential pattern of the influence of media exposure on PTSD symptoms for adult survivors with various levels of general trust. Using cross-sectional methodology, we surveyed participants (N = 1000) recruited from six disaster-affected counties. We assessed PTSD symptoms, media exposure, general trust, demographic characteristics, socioeconomic status, and earthquake exposure. Data were analyzed descriptively and with Tobit regression analyses. Reversed relationships between general trust and PTSD were verified, whereas no direct links were found between media exposure and PTSD. Interaction tests revealed that media exposure alleviated PTSD for high-trust survivors, but aggravated PTSD for low-trust survivors. These results suggest that general trust building should be considered in post-disaster construction activities. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessArticle Depression Negatively Impacts Survival of Patients with Metastatic Prostate Cancer
Int. J. Environ. Res. Public Health 2018, 15(10), 2148; https://doi.org/10.3390/ijerph15102148
Received: 29 August 2018 / Revised: 24 September 2018 / Accepted: 25 September 2018 / Published: 29 September 2018
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Abstract
The prevalence of depression in patients with cancer is high, especially for patients with advanced cancer. In this study, we evaluated the prevalence of depression in prostate cancer patients in Taiwan and the association between depression and mortality in prostate cancer. This study [...] Read more.
The prevalence of depression in patients with cancer is high, especially for patients with advanced cancer. In this study, we evaluated the prevalence of depression in prostate cancer patients in Taiwan and the association between depression and mortality in prostate cancer. This study included 1101 newly diagnosed patients with prostate cancer. We tracked the medical information of these patients from diagnosis until the end of 2012. Patients were divided into two groups according to presence or absence of depression diagnosis, and were further divided into three stages by initial treatments: localized or locally advanced, metastatic, and castration-resistant prostate cancer. Of 1101 participants, 267 (24.3%) had depression. By the end of the follow-up period (M = 8.30 ± 3.12 years), 77 (28.8%) patients in the depression group and 194 (23.3%) in the non-depressed group died. Depression was associated with higher mortality risk, (aHR 1.37; 95% CI [ 1.04–1.80]; p value 0.01). Patients in the metastatic prostate cancer group with depression had a significantly higher mortality risk compared to the non-depressed group, (aHR, 1.49; 95% CI [1.05–2.11]; p value 0.02). The impact of depression on mortality risk was not significant in either the localized or locally advanced or the castration-resistant prostate cancer groups. Our study showed that depression is related to an increased mortality risk for patients with prostate cancer, especially for metastatic prostate cancer. These results indicate that urologists should pay attention to the mood and psychiatric disorders of patients with prostate cancer. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessArticle Investigation of the Effects of Purpose in Life, Grit, Gratitude, and School Belonging on Mental Distress among Chinese Emerging Adults
Int. J. Environ. Res. Public Health 2018, 15(10), 2147; https://doi.org/10.3390/ijerph15102147
Received: 7 September 2018 / Revised: 26 September 2018 / Accepted: 27 September 2018 / Published: 29 September 2018
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Abstract
Given the high prevalence of mental distress indicators, such as depression, among emerging adults, it is imperative to identify not only factors that place them at risk for mental distress, but also those that protect against it. This study tested the direct and [...] Read more.
Given the high prevalence of mental distress indicators, such as depression, among emerging adults, it is imperative to identify not only factors that place them at risk for mental distress, but also those that protect against it. This study tested the direct and indirect effects (via purpose in life) of gratitude, two aspects of grit (i.e., consistency of interest and perseverance of effort), and school belonging on three indicators of mental distress (i.e., depression, anxiety, and stress). A total of 468 Chinese university students (58.3% female), aged 18 to 27, in Macao, China responded to an anonymous questionnaire between April to May, 2016. As expected, all psychosocial factors were negatively associated with all three indicators of mental distress (r = −0.15 to −0.42, p < 0.05), with the exception of perseverance of effort, which had a significant, negative association with depression only. The results of path analysis showed that purpose in life significantly mediated the effect of school belonging and perseverance of effort on depression, whereas school belonging, gratitude, and consistency of interest all had direct effects on all three indicators of mental distress (p < 0.05). Our results also suggested that the two components of grit may have differential effects on mental distress among Chinese emerging adults. School-based programs should consider positive psychology interventions in Chinese populations. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessArticle Factors Associated with the Risk of Developing Coronary Artery Disease in Medicated Patients with Major Depressive Disorder
Int. J. Environ. Res. Public Health 2018, 15(10), 2073; https://doi.org/10.3390/ijerph15102073
Received: 15 August 2018 / Revised: 12 September 2018 / Accepted: 20 September 2018 / Published: 21 September 2018
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Abstract
Background: The aim of this study was to identify factors associated with high Framingham Risk Score (FRS) in medicated patients with major depressive disorder (MDD). Methods: We examined 61 medicated patients with MDD (mean age 37.77 ± 7.67, 90.2% women) and 43 non-depressed [...] Read more.
Background: The aim of this study was to identify factors associated with high Framingham Risk Score (FRS) in medicated patients with major depressive disorder (MDD). Methods: We examined 61 medicated patients with MDD (mean age 37.77 ± 7.67, 90.2% women) and 43 non-depressed controls (mean age 38.26 ± 9.20, 90.7% women). We administered the Hamilton Depression Rating Scale (HAM-D) and measured systolic blood pressure (SBP), diastolic BP (DBP), mean arterial BP (MAP), pulse wave velocity (PWV), intima-media thickness (IMT), interleukin-6 (IL-6) and triglycerides. Results: We found that medicated patients with MDD had significantly higher levels of HAM-D score (p < 0.01), SBP (p = 0.015), MAP (p = 0.037), IL−6 level (p = 0.007), as compared with controls. Medicated patients who remained moderately to severely depressed showed significantly higher SBP (p = 0.049), DBP (p = 0.009), MAP (p = 0.024), IL−6 level (p = 0.019), left PWV (p = 0.004) and average PWV (p = 0.026) than those with mild depression. Multivariate regression showed that the interaction effect between HAM-D score and triglyceride level (p = 0.018) was significantly associated with FRS in medicated patients with MDD. Conclusions: This study highlights that the interaction effect of the severity of depression and the triglyceride level, was a modifiable factor positively associated with high FRS. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessArticle Core Symptoms of Major Depressive Disorder among Palliative Care Patients
Int. J. Environ. Res. Public Health 2018, 15(8), 1758; https://doi.org/10.3390/ijerph15081758
Received: 31 May 2018 / Revised: 30 June 2018 / Accepted: 15 July 2018 / Published: 16 August 2018
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Abstract
A valid method to diagnose depression in palliative care has not been established. In this study, we aim to determine the prevalence of depression and the discriminant validity of the items of four sets of diagnostic criteria in palliative care. This is a [...] Read more.
A valid method to diagnose depression in palliative care has not been established. In this study, we aim to determine the prevalence of depression and the discriminant validity of the items of four sets of diagnostic criteria in palliative care. This is a cross-sectional study on 240 palliative care patients where the presence of depression was based on the Diagnostic and Statistical Manual of Mental Disorders, DSM–IV Criteria, Modified DSM–IV Criteria, Cavanaugh Criteria, and Endicott’s Criteria’s. Anxiety, depression, and distress were measured with Hospital Anxiety and Depression Scale and Distress Thermometer. The prevalence of depression among the palliative care patients was highest based on the Modified DSM–IV Criteria (23.3%), followed by the Endicott’s Criteria (13.8%), DSM–IV Criteria (9.2%), and Cavanaugh Criteria (5%). There were significant differences (p < 0.05) in the depressive symptoms showed by DSM–IV item 1 (dysphoric mood), item 2 (loss of interest or pleasure), and Endicott’s criteria item 8 (brooding, self-pity, or pessimism) among the palliative patients, even after adjustment for the anxiety symptoms and distress level. We found that dysphoric mood, loss of interest, and pessimism are the main features of depression in palliative patients. These symptoms should be given more attention in identifying depression in palliative care patients. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessArticle Effects of Horticultural Therapy on Asian Older Adults: A Randomized Controlled Trial
Int. J. Environ. Res. Public Health 2018, 15(8), 1705; https://doi.org/10.3390/ijerph15081705
Received: 8 July 2018 / Revised: 1 August 2018 / Accepted: 7 August 2018 / Published: 9 August 2018
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Abstract
The effect of horticultural therapy (HT) on immune and endocrine biomarkers remains largely unknown. We designed a waitlist-control randomized controlled trial to investigate the effectiveness of HT in improving mental well-being and modulating biomarker levels. A total of 59 older adults was recruited, [...] Read more.
The effect of horticultural therapy (HT) on immune and endocrine biomarkers remains largely unknown. We designed a waitlist-control randomized controlled trial to investigate the effectiveness of HT in improving mental well-being and modulating biomarker levels. A total of 59 older adults was recruited, with 29 randomly assigned to the HT intervention and 30 to the waitlist control group. The participants attended weekly intervention sessions for the first 3 months and monthly sessions for the subsequent 3 months. Biological and psychosocial data were collected. Biomarkers included IL-1β, IL-6, sgp-130, CXCL12/SDF-1α, CCL-5/RANTES, BDNF (brain-derived neurotrophic factor), hs-CRP, cortisol and DHEA (dehydroepiandrosterone). Psychosocial measures examined cognitive functions, depression, anxiety, psychological well-being, social connectedness and satisfaction with life. A significant reduction in plasma IL-6 level (p = 0.02) was observed in the HT intervention group. For the waitlist control group, significant reductions in plasma CXCL12 (SDF-1α) (p = 0.003), CXCL5 (RANTES) (p = 0.05) and BDNF (p = 0.003) were observed. A significant improvement in social connectedness was also observed in the HT group (p = 0.01). Conclusion: HT, in reducing plasma IL-6, may prevent inflammatory disorders and through maintaining plasma CXCL12 (SDF-1α), may maintain hematopoietic support to the brain. HT may be applied in communal gardening to enhance the well-being of older adults. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessArticle Misophonia in Singaporean Psychiatric Patients: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2018, 15(7), 1410; https://doi.org/10.3390/ijerph15071410
Received: 1 June 2018 / Revised: 19 June 2018 / Accepted: 2 July 2018 / Published: 4 July 2018
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Abstract
Misophonia, also known as selective sound sensitivity syndrome, is a condition characterized by strong dislike of specific sounds with accompanying distressing reactions. To date, misophonia is still poorly understood. This study aimed to identify factors associated with severity of misophonic symptoms in Singaporean [...] Read more.
Misophonia, also known as selective sound sensitivity syndrome, is a condition characterized by strong dislike of specific sounds with accompanying distressing reactions. To date, misophonia is still poorly understood. This study aimed to identify factors associated with severity of misophonic symptoms in Singaporean psychiatric patients. Ninety-two psychiatric patients were recruited from a large teaching hospital in Singapore in a cross-sectional study. Socio-demographics, severity of depression, anxiety and stress, and severity of misophonic symptoms were analyzed. Correlation analysis showed that anxiety, depression, and stress scores—as measured by the Depression, Anxiety and Stress Scales-21 (DASS-21)—were significantly positively correlated with the Amsterdam Misophonia Scale (A-MISO-S) scores. After adjustment for confounding factors, multivariate regression analysis showed that anxiety (β = 0.385, p = 0.029) remained significantly associated with A-MISO-S. Age, gender, depression, and stress were not significantly associated with the severity of misophonia. The findings showed that the severity of anxiety was associated with severity of misophonia in Singaporean psychiatric patients. Further research is needed to explore the nature of misophonia and its relationship with other psychiatric disorders. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessArticle ADHD Symptoms in Pathological and Problem Gamblers in Singapore
Int. J. Environ. Res. Public Health 2018, 15(7), 1307; https://doi.org/10.3390/ijerph15071307
Received: 25 May 2018 / Revised: 14 June 2018 / Accepted: 19 June 2018 / Published: 22 June 2018
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Abstract
Background: There is relatively little research examining the relationship between Attention-Deficit/Hyperactivity Disorder (ADHD) and gambling addiction. This study seeks to explore for ADHD symptoms in adult gambling addiction patients and to evaluate their gambling-related cognitions. Materials and Methods: A cross-sectional survey [...] Read more.
Background: There is relatively little research examining the relationship between Attention-Deficit/Hyperactivity Disorder (ADHD) and gambling addiction. This study seeks to explore for ADHD symptoms in adult gambling addiction patients and to evaluate their gambling-related cognitions. Materials and Methods: A cross-sectional survey was conducted at National Addictions Management Service, Institute of Mental Health, in Singapore. Patients presenting for gambling treatment were screened for ADHD symptoms and assessed for severity of gambling-related cognitions. The primary objective was to observe the rate of patients screening positive for ADHD. Results: 20% of the sample screened positive for ADHD. These individuals also had lower levels of gambling-related cognitions. No significant correlation was noted between ADHD symptoms and gambling-related cognition scores. Conclusions: Positive screening results for ADHD occurred frequently in our sample of Pathological Gambling (PG) and Problem Gambling patients and these affected individuals also exhibited lower levels of gambling-related cognitions. This finding may suggest that the gambling behavior in patients with ADHD-PG comorbidity is driven by impulsivity rather than gambling-related cognitions, which has implication on treatment considerations. Further research with a larger sample size is indicated. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessArticle Effect of Cardiac Rehabilitation on Quality of Life, Depression and Anxiety in Asian Patients
Int. J. Environ. Res. Public Health 2018, 15(6), 1095; https://doi.org/10.3390/ijerph15061095
Received: 13 April 2018 / Revised: 25 May 2018 / Accepted: 26 May 2018 / Published: 28 May 2018
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Abstract
This study explored the effect of cardiac rehabilitation on quality of life, depression, and anxiety in Asian patients in Singapore. Out of the 194 patients who were recruited into the study, 139 patients (71.6%) completed both the pre- and post-cardiac rehabilitation questionnaires. Their [...] Read more.
This study explored the effect of cardiac rehabilitation on quality of life, depression, and anxiety in Asian patients in Singapore. Out of the 194 patients who were recruited into the study, 139 patients (71.6%) completed both the pre- and post-cardiac rehabilitation questionnaires. Their ages ranged from 28 to 80 (M = 56.66, SD = 8.88), and 103 patients (74.1%) were males and 21 patients (15.1%) were females. As hypothesized, there was a statistically significant difference between the pre- and post-cardiac rehabilitation scores on the combined dependent variables, F (4, 135) = 34.84, p < 0.001; Wilks’ Lambda = 0.49; partial eta squared = 0.51. An inspection of the mean scores indicated that patients reported higher levels of physical and mental quality of life and lower levels of depression post-cardiac rehabilitation. The findings were discussed in regards to implications in cardiac rehabilitation in Singapore. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessArticle Which Patients Are Prescribed Escitalopram?: Predictors for Escitalopram Prescriptions and Functional Outcomes among Patients with Acute Ischemic Stroke
Int. J. Environ. Res. Public Health 2018, 15(6), 1085; https://doi.org/10.3390/ijerph15061085
Received: 20 April 2018 / Revised: 21 May 2018 / Accepted: 25 May 2018 / Published: 28 May 2018
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Abstract
Recent studies have demonstrated that antidepressants could enhance functional recovery via neuroplasticity beyond solely treating depression. However, since Koreans typically show a greater aversion to seeking psychiatric care than citizens of Western countries, the number of antidepressant prescriptions is low. Through this study, [...] Read more.
Recent studies have demonstrated that antidepressants could enhance functional recovery via neuroplasticity beyond solely treating depression. However, since Koreans typically show a greater aversion to seeking psychiatric care than citizens of Western countries, the number of antidepressant prescriptions is low. Through this study, we aim to identify the factors that lead to the prescription of antidepressants in subjects with acute ischemic stroke (AIS) in clinical practice. A total of 775 patients with ischemic stroke (IS) participated in this study from March 2010 to May 2013. We used binary logistic regression to find predictors for escitalopram prescriptions. To reveal predictors for short-term functional outcomes, we used an adjusted regression model using a propensity score. Among the 775 participants, 39 (5.03%) were prescribed escitalopram. The duration of hospital stay (odds ratio (OR) = 1.07; 95% confidence interval (CI) = 1.04–1.10) and the use of mechanical ventilation were significantly more closely related to escitalopram prescriptions as compared to non-escitalopram prescriptions (OR = 5.15; 95% CI = 1.53–17.40). The use of escitalopram, on the other hand, was not significantly associated with short-term functional outcomes (OR = 1.27; 95% CI = 0.50–3.25). Duration of hospital stay and use of mechanical ventilation were significantly related to escitalopram prescriptions. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessArticle Metabolic Syndrome in First Episode Schizophrenia, Based on the National Mental Health Registry of Schizophrenia (NMHR) in a General Hospital in Malaysia: A 10-Year Retrospective Cohort Study
Int. J. Environ. Res. Public Health 2018, 15(5), 933; https://doi.org/10.3390/ijerph15050933
Received: 18 March 2018 / Revised: 25 April 2018 / Accepted: 26 April 2018 / Published: 7 May 2018
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Abstract
Schizophrenia has been linked with various medical comorbidities, particularly metabolic syndrome. The number of studies on this aspect is lacking in Malaysia. (1) Objective: To investigate metabolic syndrome rates and its associated factors. (2) Method: This is the first 10-year retrospective-outcome study of [...] Read more.
Schizophrenia has been linked with various medical comorbidities, particularly metabolic syndrome. The number of studies on this aspect is lacking in Malaysia. (1) Objective: To investigate metabolic syndrome rates and its associated factors. (2) Method: This is the first 10-year retrospective-outcome study of patients with first episode schizophrenia in Malaysia. Out of 394 patients diagnosed with first episode schizophrenia and registered with the National Mental Health Registry of Schizophrenia (NMHR) in the General Hospital Kuala Lumpur (GHKL) in 2004–2005, 174 patients consented to participate in the study. They were interviewed using a Schizophrenia outcome questionnaire and the International Physical Activity Questionnaire (IPAQ). The diagnosis of metabolic syndrome was made using the National Cholesterol Education Program—Third Adult Treatment Panel (NCEP ATP III). (3) Results: All patients’ weight, body mass index, fasting blood sugar, and blood pressure are significantly increased. Sixty-three subjects (36.2%) developed metabolic syndrome while 36 (23.2%) were hypertensive, and 41 (28.1%) were diabetic. Use of fluphenthixol depot (CI = 1.05–5.09, OR: 0.84, p = 0.039), reduced physical activity (CI = 0.13–1.00, OR: −1.04, p = 0.049), and substance use disorder (CI = 1.40, 13.89, OR: 1.48, p = 0.012) were significantly associated with metabolic syndrome based on univariate analysis. In further multivariate analysis, comorbid substance abuse was the only significant factor associated with metabolic syndrome after adjusting for physical activity and intramuscular depot. (4) Conclusion: Patients with schizophrenia are at high risk of metabolic syndrome. It is important to address substance use problems as an important risk factor of this comorbidity. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessArticle Electrocardiographic and Electrooculographic Responses to External Emotions and Their Transitions in Bipolar I and II Disorders
Int. J. Environ. Res. Public Health 2018, 15(5), 884; https://doi.org/10.3390/ijerph15050884
Received: 23 February 2018 / Revised: 11 April 2018 / Accepted: 27 April 2018 / Published: 28 April 2018
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Abstract
Bipolar disorder has two main types, bipolar I (BD I) and II (BD II), which present different affective states and personality characteristics, they might present different modes of emotional regulation. We hypothesized that the electrocardiogram and electrooculogram to external emotions are different in [...] Read more.
Bipolar disorder has two main types, bipolar I (BD I) and II (BD II), which present different affective states and personality characteristics, they might present different modes of emotional regulation. We hypothesized that the electrocardiogram and electrooculogram to external emotions are different in BD I and BD II. We asked 69 BD I and 54 BD II patients, and 139 healthy volunteers to undergo these tests in response to disgust, erotica, fear, happiness, neutral, and sadness, and their transitions. Their affective states were also measured. The heart rate in BD I was significantly higher under background fear after target neutral. The eyeball movement was quicker in BD I under target happiness after background disgust; in BD I under target sadness after background disgust; and in BD I under background disgust after target neutral. Some electrocardiographic and electrooculographic changes were correlated with affective states in patients. BD I and BD II had different physiological responses to external emotions and their transitions, indicating different pathophysiologies and suggesting different emotional-therapies for BD I and BD II. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessArticle Differentiating Medicated Patients Suffering from Major Depressive Disorder from Healthy Controls by Spot Urine Measurement of Monoamines and Steroid Hormones
Int. J. Environ. Res. Public Health 2018, 15(5), 865; https://doi.org/10.3390/ijerph15050865
Received: 7 February 2018 / Revised: 22 April 2018 / Accepted: 23 April 2018 / Published: 26 April 2018
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Abstract
Introduction: Major Depressive Disorder (MDD) is a common psychiatric disorder. Currently, there is no objective, cost-effective and non-invasive method to measure biological markers related to the pathogenesis of MDD. Previous studies primarily focused on urinary metabolite markers which are not proximal to [...] Read more.
Introduction: Major Depressive Disorder (MDD) is a common psychiatric disorder. Currently, there is no objective, cost-effective and non-invasive method to measure biological markers related to the pathogenesis of MDD. Previous studies primarily focused on urinary metabolite markers which are not proximal to the pathogenesis of MDD. Herein, we compare urinary monoamines, steroid hormones and the derived ratios amongst MDD when compared to healthy controls. Methods: Morning urine samples of medicated patients suffering from MDD (n = 47) and healthy controls (n = 41) were collected. Enzyme-linked immunosorbent assay (ELISA) was performed to measure five biomarkers: cortisol, dopamine, noradrenaline, serotonin and sulphate derivative of dehydroepiandrosterone (DHEAS). The mean urinary levels and derived ratios of monoamines and steroid hormones were compared between patients and controls to identify potential biomarkers. The receiver operative characteristic curve (ROC) analysis was conducted to evaluate the diagnostic performance of potential biomarkers. Results: Medicated patients with MDD showed significantly higher spot urine ratio of DHEAS/serotonin (1.56 vs. 1.19, p = 0.004) and lower ratio of serotonin/dopamine (599.71 vs. 888.60, p = 0.008) than healthy controls. A spot urine serotonin/dopamine ratio cut-off of >667.38 had a sensitivity of 73.2% and specificity of 51.1%. Conclusions: Our results suggest that spot urine serotonin/dopamine ratio can be used as an objective diagnostic method for adults with MDD. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessArticle Online Gambling among Treatment-Seeking Patients in Singapore: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2018, 15(4), 832; https://doi.org/10.3390/ijerph15040832
Received: 4 February 2018 / Revised: 18 April 2018 / Accepted: 18 April 2018 / Published: 23 April 2018
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Abstract
Given that technology has greatly facilitated easier access to gambling in previous years, it is timely to look in-depth into online gambling activities and behaviors. There have been several studies that examined online gambling. However, most of the current studies to date have [...] Read more.
Given that technology has greatly facilitated easier access to gambling in previous years, it is timely to look in-depth into online gambling activities and behaviors. There have been several studies that examined online gambling. However, most of the current studies to date have focused on determining the prevalence and the epidemiology of problem gambling arising from online gambling in Western cohorts. There remains a paucity of research looking at the problem of online gambling among Asian individuals. The objectives of the current study are to elucidate the characteristics of online gambling among an Asian cohort and to explore the harm associated with online gambling and the potential mechanisms by which harm associated with online gambling could be minimized. It is hoped that the findings of the current paper will bridge the existing gaps in the research literature. A cross-sectional study design was utilized to recruit 100 participants who were attending outpatient services at the National Addictions Management Service (NAMS) from March 2014 to October 2015. The majority of the participants were male, of Chinese ethnicity and under the age of 30 years old (48%). Mobile phones and smartphones were the most commonly utilized platforms for gambling online. The median largest ever debt incurred as a result of online gambling ($20,000) was significantly more than that due to offline gambling ($500) (Z = −4.17, p < 0.001). As for the biggest ever loss, participants had incurred a significantly larger median loss from online gambling ($7000) (Z = −2.73, p < 0.01) compared to offline gambling ($2000). A total of 18.4% of participants had waited between 1 to 2 years from their first online gambling experience to seek treatment and 17.3% had waited for more than 10 years. This is perhaps one of the first Asian studies to investigate the serious harm involved in online gambling. The findings from our study are intended to guide further interventions in the treatment of online gambling related disorders; and would be of interest to governmental organizations in their planning of regulations for online gambling. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessArticle Thematic Analysis of Medical Notes Offers Preliminary Insight into Precipitants for Asian Suicide Attempters: An Exploratory Study
Int. J. Environ. Res. Public Health 2018, 15(4), 809; https://doi.org/10.3390/ijerph15040809
Received: 26 March 2018 / Revised: 17 April 2018 / Accepted: 17 April 2018 / Published: 20 April 2018
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Abstract
One important dynamic risk factor for suicide assessment includes suicide precipitant. This exploratory study used a qualitative paradigm to look into the themes surrounding precipitants for suicide attempts in Singapore. Medical records related to suicide attempters who were admitted to the emergency department [...] Read more.
One important dynamic risk factor for suicide assessment includes suicide precipitant. This exploratory study used a qualitative paradigm to look into the themes surrounding precipitants for suicide attempts in Singapore. Medical records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore over a three year period were subjected to analysis. A total of 666 cases were examined (69.2% females; 63.8% Chinese, 15% Malays, 15.8% Indians), ages ranged from 10 years old to 85 years old (Mean = 29.7, Standard Deviation = 16.1). The thematic analysis process that was applied to the textual data elicited key concepts labelled as Relationship issues, Financial strain, Socio-legal-academic—environmental stress, and Physical and mental illness and pain. Interpreted with other recent local research on suicide attempters in Singapore, the findings have implications for informing suicide interventions. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessArticle Predictors of Response to Ketamine in Treatment Resistant Major Depressive Disorder and Bipolar Disorder
Int. J. Environ. Res. Public Health 2018, 15(4), 771; https://doi.org/10.3390/ijerph15040771
Received: 28 February 2018 / Revised: 5 April 2018 / Accepted: 12 April 2018 / Published: 17 April 2018
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Abstract
Objectives: Extant evidence indicates that ketamine exerts rapid antidepressant effects in treatment-resistant depressive (TRD) symptoms as a part of major depressive disorder (MDD) and bipolar disorder (BD). The identification of depressed sub-populations that are more likely to benefit from ketamine treatment remains a [...] Read more.
Objectives: Extant evidence indicates that ketamine exerts rapid antidepressant effects in treatment-resistant depressive (TRD) symptoms as a part of major depressive disorder (MDD) and bipolar disorder (BD). The identification of depressed sub-populations that are more likely to benefit from ketamine treatment remains a priority. In keeping with this view, the present narrative review aims to identify the pretreatment predictors of response to ketamine in TRD as part of MDD and BD. Method: Electronic search engines PubMed/MEDLINE, ClinicalTrials.gov, and Scopus were searched for relevant articles from inception to January 2018. The search term ketamine was cross-referenced with the terms depression, major depressive disorder, bipolar disorder, predictors, and response and/or remission. Results: Multiple baseline pretreatment predictors of response were identified, including clinical (i.e., Body Mass Index (BMI), history of suicide, family history of alcohol use disorder), peripheral biochemistry (i.e., adiponectin levels, vitamin B12 levels), polysomnography (abnormalities in delta sleep ratio), neurochemistry (i.e., glutamine/glutamate ratio), neuroimaging (i.e., anterior cingulate cortex activity), genetic variation (i.e., Val66Met BDNF allele), and cognitive functioning (i.e., processing speed). High BMI and a positive family history of alcohol use disorder were the most replicated predictors. Conclusions: A pheno-biotype of depression more, or less likely, to benefit with ketamine treatment is far from complete. Notwithstanding, metabolic-inflammatory alterations are emerging as possible pretreatment response predictors of depressive symptom improvement, most notably being cognitive impairment. Sophisticated data-driven computational methods that are iterative and agnostic are more likely to provide actionable baseline pretreatment predictive information. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessArticle Suicide Precipitants Differ Across the Lifespan but Are Not Significant in Predicting Medically Severe Attempts
Int. J. Environ. Res. Public Health 2018, 15(4), 691; https://doi.org/10.3390/ijerph15040691
Received: 8 March 2018 / Revised: 3 April 2018 / Accepted: 4 April 2018 / Published: 5 April 2018
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Abstract
An important risk factor for suicide assessment is the suicide precipitant. This study explores suicide attempt precipitants across the lifespan. Three years of medical records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore [...] Read more.
An important risk factor for suicide assessment is the suicide precipitant. This study explores suicide attempt precipitants across the lifespan. Three years of medical records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. These cases were divided into three age groups: Adolescence, Early Adulthood, and Middle Adulthood. A total of 540 cases were examined (70.9% females; 63.7% Chinese, 13.7% Malays, 15.9% Indians), whose ages ranged from 12 to 62. There were eight cases above the age of 65 years which were excluded from the analysis. Significant differences were found in precipitants for suicide attempts across the lifespan. Middle adults had relatively fewer relationship problems, and adolescents had comparatively fewer financial and medical problems. The models to predict medically severe attempts across the age groups using suicide precipitants were not significant. The findings were discussed in regards to implications in suicide assessment and primary prevention in Singapore, as well as limitations and recommendations for future research. Full article
(This article belongs to the Special Issue Adult Psychiatry)

Review

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Open AccessReview Smartphone Applications for Mindfulness Interventions with Suicidality in Asian Older Adults: A Literature Review
Int. J. Environ. Res. Public Health 2018, 15(12), 2810; https://doi.org/10.3390/ijerph15122810
Received: 7 November 2018 / Revised: 5 December 2018 / Accepted: 6 December 2018 / Published: 10 December 2018
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Abstract
Elderly suicide is a rising concern. Despite the advent of mobile technology, there remained a gap in the evidence base as to whether smartphone applications could be used for mindfulness intervention for suicidality in Asian older adults. This paper aimed to review recent [...] Read more.
Elderly suicide is a rising concern. Despite the advent of mobile technology, there remained a gap in the evidence base as to whether smartphone applications could be used for mindfulness intervention for suicidality in Asian older adults. This paper aimed to review recent research relevant to smartphone applications that could be used in providing mindfulness interventions for suicidality to Asian older adults. The inclusion criteria for this review were papers published in peer-reviewed journals from 2008 to 2018 with the usage of specific search terms, namely, ‘smartphone application’, ‘mobile application’, and ‘mindfulness’, assessed against the inclusion criteria and screened by an experienced Asian clinician to be of clinical utility for mindfulness intervention for suicidality with Asian older adults. Initial search on databases yielded 236 results. A total of 35 full text papers that fit the inclusion criteria were assessed for eligibility and 10 papers were included in the current review. This review highlighted the paucity of rigorous empirically validated research into effective smartphone applications that can be used for mindfulness interventions for suicidality with Asian older adults. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessReview Prevalence of Depression among Migrants: A Systematic Review and Meta-Analysis
Int. J. Environ. Res. Public Health 2018, 15(9), 1986; https://doi.org/10.3390/ijerph15091986
Received: 26 August 2018 / Revised: 8 September 2018 / Accepted: 10 September 2018 / Published: 12 September 2018
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Abstract
As the number of migrants worldwide increases, it is worthwhile to examine the extent to which depression has affected this group of often vulnerable individuals. The purpose of this systematic review and meta-analysis is to examine the aggregate prevalence of depression among international [...] Read more.
As the number of migrants worldwide increases, it is worthwhile to examine the extent to which depression has affected this group of often vulnerable individuals. The purpose of this systematic review and meta-analysis is to examine the aggregate prevalence of depression among international migrants and to explore the variations in prevalence with demographic and educational factors. A search was conducted on the online databases PubMed and ScienceDirect whole using the terms “depression”, “depressive disorder”, “immigration”, “immigrant”, “migration”, and “migrant”. A total of 25 studies met our inclusion criteria. A random-effects model meta-analysis calculated an aggregate prevalence of 15.6% among migrants. Heterogeneity was identified by meta-regression and subgroup analyses, and the level of educational attainment, employment status, and length of residency spent in country of migration were found to be significant moderators contributing to depression prevalence. In conclusion, newly arrived migrants appear to be susceptible to developing depression and it is imperative that more in the form of preventive strategies and increased assistance be incorporated to ensure their psychological wellbeing and improve their mental health outcomes. Further research should be conducted to better understand the risk of psychiatric disorders among members of this subpopulation. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessReview The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression
Int. J. Environ. Res. Public Health 2018, 15(8), 1789; https://doi.org/10.3390/ijerph15081789
Received: 13 July 2018 / Revised: 16 August 2018 / Accepted: 18 August 2018 / Published: 20 August 2018
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Abstract
Objectives: This meta-analysis aims to study the effects of atomoxetine and methylphenidate on heart rate (HR), systolic blood pressure (SBP), and a number of adverse cardiac events on patients receiving treatment for attention-deficit hyperactive disorder (ADHD) in comparison to placebo and between [...] Read more.
Objectives: This meta-analysis aims to study the effects of atomoxetine and methylphenidate on heart rate (HR), systolic blood pressure (SBP), and a number of adverse cardiac events on patients receiving treatment for attention-deficit hyperactive disorder (ADHD) in comparison to placebo and between atomoxetine and methylphenidate. Methods: We searched the following databases: PubMed, EMBASE, and ScienceDirect. Meta-analysis was performed on studies that examined the relationships between methylphenidate or atomoxetine and HR, SBP, as well as a number of adverse cardiac events. These studies were either placebo-controlled or comparison studies between methylphenidate and atomoxetine. Meta-regression identified patient- and treatment-related factors that may contribute to heterogeneity. Results: Twenty-two studies were included and the total number of participants was 46,107. Children/adolescents and adults treated with methylphenidate had more significant increases in post- vs. pre-treatment HR (p < 0.001) and SBP (p < 0.001) than those treated by placebo. Children and adolescents treated with atomoxetine had more significant increases post- vs. pre-treatment HR (p = 0.025) and SBP (p < 0.001) than those treated with methylphenidate. Meta-regression revealed mean age of participants, mean dose, and duration of atomoxetine and methylphenidate as significant moderators that explained heterogeneity. There were no differences in the number of adverse cardiac events between participants with methylphenidate treatment and placebo or atomoxetine. Conclusions: Children/adolescents and adults treated with methylphenidate resulted in significant increases in post- vs. pre-treatment HR and SBP as compared to placebo. Similarly, children and adolescents treated with atomoxetine had significant increases in post- vs. pre-treatment HR and SBP than those treated with methylphenidate. These findings have potential implications for continuous monitoring of HR and SBP throughout the course of treatment although the risk for adverse cardiac events were insignificant. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessReview Prevalence of All-Cause Mortality and Suicide among Bariatric Surgery Cohorts: A Meta-Analysis
Int. J. Environ. Res. Public Health 2018, 15(7), 1519; https://doi.org/10.3390/ijerph15071519
Received: 23 June 2018 / Revised: 13 July 2018 / Accepted: 13 July 2018 / Published: 18 July 2018
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Abstract
Introduction: Prior meta-analysis has reported mortality rates among post-operative bariatric patients, but they have not considered psychiatric factors like suicide contributing to mortality. Objectives: The current meta-analysis aims to determine the pooled prevalence for mortality and suicide amongst cohorts using reported suicides post [...] Read more.
Introduction: Prior meta-analysis has reported mortality rates among post-operative bariatric patients, but they have not considered psychiatric factors like suicide contributing to mortality. Objectives: The current meta-analysis aims to determine the pooled prevalence for mortality and suicide amongst cohorts using reported suicides post bariatric surgery. It is also the aim of the current meta-analytical study to determine moderators that could account for the heterogeneity found. Results: In our study, the pooled prevalence of mortality in the studies which reported suicidal mortality was 1.8% and the prevalence of suicide was 0.3%. Mean body mass index (BMI) and the duration of follow-up appear to be significant moderators. Conclusions: Given the prevalence of suicide post bariatric surgery, it is highly important for bariatric teams to consider both the medical and psychiatric well-being of individuals pre- and post-operatively. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessReview The Effects of Temperament on Depression According to the Schema Model: A Scoping Review
Int. J. Environ. Res. Public Health 2018, 15(6), 1231; https://doi.org/10.3390/ijerph15061231
Received: 30 April 2018 / Revised: 3 June 2018 / Accepted: 9 June 2018 / Published: 11 June 2018
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Abstract
Background: Recent studies have shown that not every depressed patient responds to Cognitive Behavioral Therapy, and some of those who do relapse upon termination. Due to its dual focus on the past and present, Schema Model (SM) represents a promising alternative model [...] Read more.
Background: Recent studies have shown that not every depressed patient responds to Cognitive Behavioral Therapy, and some of those who do relapse upon termination. Due to its dual focus on the past and present, Schema Model (SM) represents a promising alternative model to understand depression. However, studies examining SM often operationalize the same construct differently, resulting in inconsistent evidence of change. There is no known review clarifying (1) how best to assess schema constructs; and (2) the relevant pathways to depression, without which, the empirical basis for SM cannot be examined. Methods: A scoping review was conducted in accordance to PRISMA guidelines to map evidence of the relationship between constructs of SM and depression, and measures used to assess the constructs. 2463 articles were identified with 49 primary research studies included. This paper is a subset of the scoping review and focuses on the five studies examining effects of temperament on depression. Results: Two models were used to operationalize temperament: The Five Factor Model (FFM) and the Psychobiological Model of Personality (PBM). The variables of neuroticism and harm avoidance were positively associated with depressive symptoms while self-directedness and cooperativeness were negative associated with depressive symptoms. Conclusion: The FFM is more suited to operationalize temperament in studies of SM and depression due to its theoretical compatibility with SM, established psychometric properties of its measures, and widespread use among studies of SM. Out of the five factors in the FFM, only neuroticism exerts direct and indirect effects on depression. These findings are limited by homogeneous sampling, hence future research studies should consider extending it to adult clinical samples. Nevertheless, this review represents a first step in the systematic examination of the empirical basis of SM and a contribution to treatment innovation and practice for depression. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessReview A Systematic Review of Attention Biases in Opioid, Cannabis, Stimulant Use Disorders
Int. J. Environ. Res. Public Health 2018, 15(6), 1138; https://doi.org/10.3390/ijerph15061138
Received: 25 April 2018 / Revised: 19 May 2018 / Accepted: 30 May 2018 / Published: 1 June 2018
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Abstract
Background: Opiates, cannabis, and amphetamines are highly abused, and use of these substances are prevalent disorders. Psychological interventions are crucial given that they help individuals maintain abstinence following a lapse or relapse into substance use. Advances in experimental psychology have suggested that [...] Read more.
Background: Opiates, cannabis, and amphetamines are highly abused, and use of these substances are prevalent disorders. Psychological interventions are crucial given that they help individuals maintain abstinence following a lapse or relapse into substance use. Advances in experimental psychology have suggested that automatic attention biases might be responsible for relapse. Prior reviews have provided evidence for the presence of these biases in addictive disorders and the effectiveness of bias modification. However, the prior studies are limited, as they failed to include trials involving participants with these prevalent addictive disorders or have failed to adopt a systematic approach in evidence synthesis. Objectives: The primary aim of this current systematic review is to synthesise the current evidence for attention biases amongst opioid use, cannabis use, and stimulant use disorders. The secondary aim is to determine the efficacy of attention bias modification interventions and other addictions related outcomes. Methods: A search was conducted from November 2017 to January 2018 on PubMed, MEDLINE, Embase, PsycINFO, Science Direct, Cochrane Central, and Scopus. The selection process of the articles was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A qualitative synthesis was undertaken. Risk of bias was assessed using the Cochrane Risk of Bias tool. Results: Six randomised trials were identified. The evidence synthesized from these trials have provided strong evidence that attentional biases are present in opioid and stimulant use disorders. Evidence synthesis for other secondary outcome measures could not be performed given the heterogeneity in the measures reported and the limited number of trials. The risk of bias assessment for the included trials revealed a high risk of selection and attrition bias. Conclusions: This review demonstrates the potential need for interventions targeting attention biases in opiate and cocaine use disorders. Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Other

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Open AccessCase Report Dangers of Mixed Martial Arts in the Development of Chronic Traumatic Encephalopathy
Int. J. Environ. Res. Public Health 2019, 16(2), 254; https://doi.org/10.3390/ijerph16020254
Received: 2 January 2019 / Revised: 12 January 2019 / Accepted: 14 January 2019 / Published: 17 January 2019
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Abstract
Chronic traumatic encephalopathy (CTE) was first discovered in professional boxers after they exhibited memory impairments, mood and behavioral changes after years of boxing. However, there is now a growing acceptance that CTE can develop in athletes of other sports due to the repetitive [...] Read more.
Chronic traumatic encephalopathy (CTE) was first discovered in professional boxers after they exhibited memory impairments, mood and behavioral changes after years of boxing. However, there is now a growing acceptance that CTE can develop in athletes of other sports due to the repetitive head trauma they receive. We present a case of a middle-aged male who presented with worsening memory, poor concentration, and behavioral changes for a year. On further cognitive testing, it was revealed that he had difficulties with short-term memory and processing speed as well as difficulties in organizing and multitasking. He had been practicing mixed martial arts (MMA) for 10 years, and later was an instructor of the sport. Through a detailed examination of his history, it was discovered that he sustained recurrent minor head concussions due to his line of work. To date, there has been limited large-scale research on head trauma in MMA. There is thus an urgent need for more studies in this area as CTE can be a chronic and debilitating illness with incapacitating neuropsychiatric sequelae. This case highlights the importance of public awareness of the risks of MMA and the dangers it poses to the brain, especially with more young people being attracted to this sport. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessViewpoint Enhancing the Quality and Utility of Content Analyses for Addictive Disorders
Int. J. Environ. Res. Public Health 2018, 15(7), 1389; https://doi.org/10.3390/ijerph15071389
Received: 20 April 2018 / Revised: 27 June 2018 / Accepted: 30 June 2018 / Published: 2 July 2018
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Abstract
The advances in Mobile Health (M-health) technologies has led to an increase in the numbers of alcohol and drugs applications on the commercial stores. Content analyses and reviews of applications to date have demonstrated that most of these applications are for entertainment or [...] Read more.
The advances in Mobile Health (M-health) technologies has led to an increase in the numbers of alcohol and drugs applications on the commercial stores. Content analyses and reviews of applications to date have demonstrated that most of these applications are for entertainment or information purposes. More recent content analyses have identified common behavioural change techniques in substance applications. Nevertheless, there remain several limitations of existing content analyses and reviews of applications. There is an increasing prevalence of other substance-related disorders, such as that of stimulants and opioids, but the existing content analyses are limited to an analysis of alcohol and cannabis applications. Only two of the content analyses performed to date have attempted to identify applications that have their basis on a theoretical approach, based on the identification of behavioural change techniques or motivational techniques. There is a need to identify applications on the commercial stores that replicate conventional psychological interventions, or at least provide elements of conventional psychological interventions using behavioural change techniques that are integrated into the application. Further evaluative research could be done on these applications to determine if they are efficacious before using them for patient care. To address the limitation that existing content analyses have only focused on reviews of alcohol and cannabis applications, we propose for there to be updated content analyses for alcohol and cannabis, and new content analyses for other substances of abuse (such as opioids and stimulants). We like to suggest that future reviews consider keywords such as abstinence or recovery, and ones that relate to psychological therapies, such as self-determination or attention bias retraining, as commercial applications that have an underlying psychological basis might be categorised differently, under different keyword terms. We have evidence of how a better search strategy identifies previously unrecognised applications for attentional bias modification. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Open AccessCase Report Chronic Manganese Toxicity Associated with Voltage-Gated Potassium Channel Complex Antibodies in a Relapsing Neuropsychiatric Disorder
Int. J. Environ. Res. Public Health 2018, 15(4), 783; https://doi.org/10.3390/ijerph15040783
Received: 19 March 2018 / Revised: 13 April 2018 / Accepted: 16 April 2018 / Published: 18 April 2018
Cited by 1 | PDF Full-text (669 KB) | HTML Full-text | XML Full-text
Abstract
Heavy metal poisoning is a rare but important cause of encephalopathy. Manganese (Mn) toxicity is especially rare in the modern world, and clinicians’ lack of recognition of its neuropsychiatric manifestations can lead to misdiagnosis and mismanagement. We describe the case of a man [...] Read more.
Heavy metal poisoning is a rare but important cause of encephalopathy. Manganese (Mn) toxicity is especially rare in the modern world, and clinicians’ lack of recognition of its neuropsychiatric manifestations can lead to misdiagnosis and mismanagement. We describe the case of a man who presented with recurrent episodes of confusion, psychosis, dystonic limb movement and cognitive impairment and was initially diagnosed with anti-voltage-gated potassium channel (VGKC) complex limbic encephalitis in view of previous positive autoantibodies. His failure to respond to immunotherapy prompted testing for heavy metal poisoning, which was positive for Mn. This is the first report to examine an association between Mn and VGKC antibodies and the effects of Mn on functional brain activity using functional near-infrared spectroscopy (fNIRS). Full article
(This article belongs to the Special Issue Adult Psychiatry)
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Open AccessPerspective Recent Advances in Attention Bias Modification for Substance Addictions
Int. J. Environ. Res. Public Health 2018, 15(4), 676; https://doi.org/10.3390/ijerph15040676
Received: 5 February 2018 / Revised: 21 March 2018 / Accepted: 2 April 2018 / Published: 4 April 2018
Cited by 3 | PDF Full-text (277 KB) | HTML Full-text | XML Full-text
Abstract
Research on attentional bias modification has increased since 2014. A recent meta-analysis demonstrates evidence for bias modification for substance disorders, including alcohol and tobacco use disorders. Several pharmacological trials have shown that pharmacological agents can attenuate and modify such attentional bias. The pharmacological [...] Read more.
Research on attentional bias modification has increased since 2014. A recent meta-analysis demonstrates evidence for bias modification for substance disorders, including alcohol and tobacco use disorders. Several pharmacological trials have shown that pharmacological agents can attenuate and modify such attentional bias. The pharmacological trials that have appeared to date have produced mixed results, which has clinical implications. Developments in Internet and mobile technologies have transformed how attention bias modification is currently being achieved. There remains great potential for further research that examines the efficacy of technology-aided attention bias interventions. Full article
(This article belongs to the Special Issue Adult Psychiatry)
Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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