Diagnostic stability 2 years after treatment initiation in the early psychosis intervention programme in Singapore

OBJECTIVE: To evaluate the diagnostic stability of psychotic disorders over a 2 year period in patients presenting with first-episode psychosis. METHODS: One hundred and fifty-four patients were recruited from an early psychosis intervention programme (EPIP). They were diagnosed by the attending psychiatrist using the Structured Clinical Interview for DSM-IV Axis I at first contact (baseline) and after 24 months. The diagnoses were classified into the following categories: schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder and schizoaffective disorder), affective psychosis (bipolar and major depressive disorders with psychotic symptoms), and other non-affective psychosis (delusional disorder, psychosis not otherwise specified and brief psychotic disorder). Two measures of stability, the prospective and the retrospective consistency were determined for each diagnosis. RESULTS: The diagnoses with the best prospective consistency were schizophrenia (87.0%) and affective psychosis (54.5%). The shift into schizophrenia spectrum disorder was the most frequent diagnostic change. Duration of untreated psychosis was found to be the only significant predictor of shift. CONCLUSION: It is difficult to make a definitive diagnosis at first contact. The clinical need to review the diagnosis throughout the period of follow up is emphasized.     

Predictors and ocular outcomes of rescue treatment in preterm infants with treated retinopathy of prematurity—a retrospective study

AimTo determine predictors of rescue treatment among infants treated for retinopathy of prematurity and to evaluate their ocular outcomes at 18–24 months of corrected age.MethodsThis is a single centre retrospective study of infants who received treatment for type 1 ROP, using laser photocoagulation or anti VEGF agents. Multivariable logistic regression was used to generate a prediction model for rescue treatment of ROP. The primary outcome was an abnormal refractive outcome by 24 months of corrected age, among infants primarily treated with laser therapy.ResultsTwo hundred and eight infants (including 416 eyes) who received single (n = 151) or rescue (multiple) treatments (n = 57) were included. Ninety three percent of the infants were primarily treated with laser photocoagulation. Lower gestational age, small for gestational age, early packed red blood cell transfusion (within 2 weeks of postnatal age), and presence of Zone 1 retinopathy predicted the need for rescue treatment in treated infants [area under the receiver operating characteristic curve: 0.81 (0.73–0.89)]. The incidence of abnormal refractive outcome, assessed in a total of 174 infants, was found to be significantly higher in the rescue treatment group (67% versus 21%, adjusted odds ratio: 7.56 (3.3–17.2), P < 0.001). Myopia, very high myopia and use of spectacles was significantly higher in the rescue treatment group (P < 0.001 for each).ConclusionsRescue treatment for ROP was associated with an increased incidence of refractive errors and requirement of spectacles by 2 years of age. Larger prospective multicentre studies are required to confirm the findings from our study.Subject terms: Paediatrics, Retinal diseases     

From well-being to positive mental health: conceptualization and qualitative development of an instrument in Singapore

Purpose

There is no global definition of well-being. Cultural differences in the perception of well-being and the social and behavioral contexts further limit its measurement. Existing instruments are developed in Western societies that differ in their conceptualization of well-being from Asian populations. Moreover, very few instruments address the multidimensional construct of well-being.

Methods

Literature was reviewed to develop a priori conceptual framework of mental health and well-being. Concepts were identified based on specific criteria to guide the qualitative investigations. Finally, focus group discussions were conducted among adults belonging to the three major ethnicities in Singapore to identify salient domains of mental health and well-being.

Results

Mental well-being is a multidimensional construct constituting of positive affect, satisfaction, and psychological functioning. While well-being explains the functional and psychological components, positive mental health is a combination of these and the skills required to achieve them. Although there is an overlap between the concepts identified from the literature and those identified in Singapore, certain differences existed, particularly with the relevance attributed to family interactions and religiosity or spirituality. Similar findings were observed across the three ethnic groups.

Conclusion

Domains identified can be used to develop a culturally relevant instrument in Singapore.     

The Singapore flagship programme in translational and clinical research in psychosis

Aim: This paper describes the rationale, aims and development of the Singapore Translational and Clinical Research in Psychosis, which is a 5‐year programme. Methods: The authors provide a selective review of the pertinent findings from the clinical, neuropsychological, genetics and neuroimaging studies on high‐risk population and how they were factored in the hypotheses and design of this translational clinical research programme. Results: This programme, which draws upon the previous work of various groups and the experience of the investigators of this consortium, comprises three interlinked studies. The first is a genome‐wide association and copy number variation analysis using the diagnostic phenotype of schizophrenia and cognitive phenotypes, and a joint genome‐wide analysis performed by combining our data with other datasets to increase the power to detect genetic risk factors. The second is a prospective study of a large group of individuals who are assessed to be at ultra‐high risk of psychosis, and the third is a randomized controlled trial to improve neurocognition in patients with schizophrenia. Conclusion: The convergence of various factors including the unique structured characteristics of the Singaporean society, the presence of political will with availability of funding and the established research infrastructure make it possible to accrue the sample size for adequate power to elucidate biomarkers of disease risk and resilience.     

Metabolic differences between Asian and Caucasian patients on clozapine treatment

OBJECTIVE: To establish if there are ethnic differences in the various metabolic disturbances that are common with clozapine treatment. METHOD: Forty subjects (20 Asians and 20 Caucasians) with a diagnosis of schizophrenia were recruited for the study. Clozapine blood levels as well as fasting blood glucose, lipid levels, and liver function tests were established. Other clinical parameters such as blood pressure and Body Mass Index (BMI) were recorded for each patient. RESULTS: The mean clozapine dose was significantly higher in the Caucasian subjects (432.5+/-194.7 mg) as compared to the Asian subjects (175.6+/-106.9 mg) (p<0.001) while the mean weight-corrected dose for Asian patients was lower (3.0+/-1.9 and 5.0+/-2.1 mg/kg, respectively, p=0.005). There were, however, no ethnic differences in the mean plasma clozapine concentration (415.3+/-185.8 ng/ml in Caucasians and 417.1+/-290.8 ng/ml in Asians). BMI were significantly higher in Caucasians, as were the number of subjects with hypertension; levels of hepatic enzymes were higher in the Asian group. CONCLUSIONS: Not only are there pharmacokinetic differences between Asian and Caucasian patients receiving clozapine, but there may also be differential emergence of certain metabolic abnormalities like hypertension and weight gain in these two ethnic groups. However, the effects of life style including diet and exercise cannot be excluded.