Humans ; Mental Disorders ; epidemiology ; Mental Health Services ; trends ; Singapore ; epidemiology

Schizophrenia is characterised by multiplicity of symptoms affecting cognition, emotion and perception. The early age of onset, varying degree of intellectual and psychosocial impairment and possibility of long-term disability makes it a severe and devastating mental illness. Symptoms of schizophrenia are divided into four categories: positive, negative, disorganised and cognitive symptoms. Various combinations of severity of these four categories are found in patients. They may also experience symptoms of other mental disorders, including depression, obsessive and compulsive symptoms, somatic concerns, and mood or anxiety symptoms. More than 80% of patients with schizophrenia have parents who do not have the disorder. The risk of having schizophrenia is greater in persons whose parents have the disorder. The peak incidence of schizophrenia is at 21 years. The onset is earlier for men (between ages 15 and 25 years) and later in women (between ages 25 and 35 years). Childhood onset schizophrenia is rare. The first psychotic episode is often preceded by a prodromal phrase lasting weeks or even years. The psychotic phase progresses through an acute phase, a recovery or stabilisation phase, and a stable phase. Early detection and treatment results in a better outcome. Management of schizophrenia is holistic and multidisciplinary. Family physicians play an important role in the early detection of those who are psychotic; managing patients who are stabilised and require maintenance pharmacotherapy; and the detection of physical illnesses of cardiovascular diseases, obesity and diabetes which have a higher prevalence among patients with schizophrenia as compared to the general population.

Humans ; Preventive Psychiatry ; Psychotic Disorders ; etiology ; prevention & control ; Risk Assessment

Chronic Disease ; Comorbidity ; Humans ; Mental Disorders ; epidemiology

Psychoses are serious and potentially chronic mental disorders with a profound impact, in terms of economic cost and human suffering, on patients, their families and society. Early detection and treatment, through reducing the duration of untreated psychosis, however, could lead to a better outcome. In 2001, the Early Psychosis Intervention Programme (EPIP), Singapore was started with the following key strategies: (1) early detection of psychosis through outreach to and network with the community and our partners; (2) provision of clinical treatment that is evidence-based; and (3) conducting clinically relevant research to evaluate our service to be accountable to the stake-holders and to ensure cost-effectiveness. A myriad of structure, process and outcome measures offering a multi-dimensional evaluation were chosen to make us accountable to a broad range of stakeholders, from our funders, other service providers, to our patients and their families. EPIP has shown good outcomes in terms of number of patients accepted into the programme, as well as our clinical service provision. Such outcomes are achieved with our community partners playing an important role. General Practitioners, in particular, are vital not only in the detection, management of such individuals, but also in the re-integration of our patients back to community.

Deinstitutionalization ; Hospitals, Psychiatric ; Humans ; Mental Disorders ; therapy

Science is a human activity and like all human activities, it has its share of drama and pathos. The scientific product is often an interaction of certain ways of thinking, personality traits, and circumstances. This essay examines these factors and how the melding of that could lead to breakthrough discoveries. It may in some instances, go wrong, or take a morally ambiguous path.
Creativity ; Philosophy, Medical ; Research

INTRODUCTIONThe aim of our programme was to right site a selected group of patients to the care of the primary sector for follow-up management. Mental disorders are recognised as a major public health problem worldwide which places an enormous burden on health services. Patients on treatment in the hospitals are largely managed by specialists either in the restructured hospitals or in private practice with minimal involvement of general practitioners (GPs). Yet, there are many patients with chronic mental illnesses who are stable, require maintenance medications and are best managed in the community.

STRATEGIESGPs were given appropriate training and support to help them manage patients with mental illnesses in their clinics. The training involved in-depth, comprehensive training on mental illness, providing the GPs with the skills necessary to manage the stable patients within the community. It also facilitated Early Detection Intervention by enhancing the GPs capabilities to detect and manage the mentally ill. Patients screened by psychiatrists who fulfill the referral criteria agreed upon by both the specialist team and the GP partners were referred to the GPs with initial support from case managers when required. The benefits to patients include: increased convenience, savings in terms of transport costs and travel time, the flexibility of being seen during after office hours, less stigma and the option of managing their other medical conditions, if any, by the same doctor.

RESULTSTo date, a total of 200 patients have been successfully referred to the 30 GPs in the programme. This represents an average savings of more than 1000 consultation visits to the hospital per year.

CONCLUSIONThe programme allows for the right siting of care for patients and allows the hospital to channel precious resources to more appropriate uses.

Delivery of Health Care, Integrated ; Humans ; Mental Disorders ; therapy ; Mental Health Services ; Physician's Role ; Physicians, Family ; education ; Primary Health Care ; Singapore

Employment ; Employment, Supported ; methods ; Humans ; Mental Disorders ; epidemiology ; rehabilitation ; Prejudice ; Rehabilitation, Vocational ; methods ; Return to Work ; Singapore ; epidemiology ; Social Stigma ; Unemployment ; statistics & numerical data