Humans ; Suicide ; prevention & control ; psychology

Objective: To assess patient satisfaction with psychiatric case management service provided at a tertiary psychiatric hospital in Singapore. Method: A prospective study, using the Client Satisfaction Questionnaire (CSQ), on 100 patients who had received case management during their stay in the hospital. Results: The primary findings of the study revealed that 87% of the patients rated the service as good to excellent with the same percentage responding that overall, in the general sense, they were satisfied with the service received from the case managers. Also, 95% would recommend the programme to a friend who required similar help although only 74% responded that most or almost all of their needs were met. Conclusion: This study enabled case managers to understand their patients’ needs and satisfaction with the service. They have used this information to improve and enhance their service delivery.

Objective: This study assessed the opinion of mental healthcare professionals on ethical issues in psychiatric research and investigated whether previous research experience had an impact. Methods: Healthcare professionals at a psychiatric institution were invited to participate in this survey. Using a self-administered questionnaire, attitudes on statements covering ethical concerns and consent process in psychiatric research were assessed and responses of participants with and without research experience were compared. Results: Mental health professionals, irrespective of their research backgrounds, acknowledged the importance of training in research ethics and accepted placebo use in psychiatric research. More respondents with research experience felt that patients with mental illnesses are capable of making a decision about research participation, could provide written informed consent and even if involuntarily admitted, had the ability to participate in research. They also considered randomization of treatment to be justified in psychiatric research. Conclusion: Training and update on ethical regulations and requirements for research involving psychiatric subjects could bring about a change in the perspective towards ethical concerns in psychiatric research.

No abstract available.
Dexfenfluramine ; Recurrence

Activities of Daily Living ; Aged ; Aged, 80 and over ; Aging ; Health Services for the Aged ; Humans ; Population Dynamics ; Quality of Life ; Singapore

INTRODUCTIONIn this study, the pathways patients followed to treatment in an Insomnia Clinic in a psychiatric hospital were compared over 2 periods. The time interval to specialist referrals and patient clinical presentations were also studied. The aim was to better understand referrers' knowledge, needs and accessibility to services.

MATERIALS AND METHODSA retrospective review of cases seen between 2002 and 2005 was compared with an earlier review of cases referred between 1997 and 2000. The information gathered from medical records was similar for the 2 periods.

RESULTSThere were no significant differences in the socio-demographic profiles of patients in the 2 periods. Primary Insomnia was diagnosed in 48.2% of the first period cohort and in 47.5% of the second period cohort. However, among the remaining patients there was a shift from more depressive disorders in the first period to neurosis in the second period. Significantly, there was no difference in alcohol or substance abuse or dependence between the 2 periods. More than three-quarters of the patients had received treatment prior to the referral and for 51.8% in both periods, the providers were family physicians. Treatment was mainly pharmacotherapy with an increase in the use of Sleep Hygiene measures in the second period.

CONCLUSIONThere is a need for continuing medical education on insomnia as well as a need to highlight the risks of untreated insomnia and assessment for other psychiatric disorders in this common complaint.

Adult ; Ambulatory Care Facilities ; Depressive Disorder ; complications ; diagnosis ; Female ; Hospitals, Psychiatric ; Humans ; Male ; Middle Aged ; Neurotic Disorders ; complications ; diagnosis ; Patient Acceptance of Health Care ; psychology ; Referral and Consultation ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders ; complications ; diagnosis ; therapy ; Young Adult

INTRODUCTIONThere is increasing evidence that second-generation antipsychotics are associated with weight gain. However almost all available literature has been for Caucasian populations.

MATERIALS AND METHODSA health quality improvement project was undertaken at the Institute of Mental Health/Woodbridge Hospital to monitor patients who were started on second-generation antipsychotics. This 2-year survey of 266 patients on second-generation antipsychotics closely tracked weight gain and other physical and biochemical parameters.

RESULTSOf the 222 patients regularly monitored, 78.4% had weight gain (mean weight gain 1.9 kg, maximum weight gain 20.1 kg). Weight gain group liability was highest for clozapine (72.4%), followed by olanzapine (66.7%) and risperidone (65%). Most of the weight gain occurred in the fi rst 4 weeks of treatment and 95.9% of those who gained weight had done so in the fi rst 6 months. The maximum weight gain was seen at 12 weeks for risperidone and 8 weeks for clozapine, quetiapine and olanzapine; the latter having another peak at 6 months.

CONCLUSIONThe survey confirms that weight gain is also a problem for Asian patients treated with second-generation antipsychotics. It reinforces the need for the regular monitoring of patients and the need for psychoeducation and advice on diet and a healthy lifestyle.

Adult ; Aged ; Antipsychotic Agents ; adverse effects ; Asia ; ethnology ; Female ; Health Surveys ; Humans ; Male ; Middle Aged ; Singapore ; Weight Gain ; drug effects ; ethnology ; Young Adult

Attitude ; Career Choice ; Humans ; Psychiatry ; education ; Social Stigma

Objective: Psychiatric case management was introduced in inpatient general psychiatry wards in a tertiary psychiatric hospital in late 2003. A brokerage model of case management is used espousing advocacy with case managers acting in their patient’s best interest to encourage and facilitate use of appropriate psychiatric care and reduce fragmentation and costs. Data on patients’ case managed in 2004 and 2005 was analysed to determine the effectiveness of the service in terms of clinical outcomes and service linkages provided. Methods: Psychiatric case managers maintained databases on the patients referred to them. There were 231 patients in 2004 and 375 patients in 2005. Analyses were performed by using SPSS 13.0 with statistical significance set at P <0.05. Descriptive statistics was used and differences between the 2 cohorts in outcome measures were assessed using Chi-square or Fisher’s Exact test. Results: The service developed with a 62.3% increase in the number of cases accepted for case management in the second year. There was improvement in clinical outcomes, such as reductions in unplanned re-admissions within 28 days from 4.8% in the first year to 2.1% in the second year. A reduction in suicide attempts and forensic complications was also found. There were significant reductions in re-hospitalisation in 2004, from 28.1% to just 6.9% after case management was provided (p<0.001). Conclusion: The brokerage model of case management used in this setting was effective in reducing re-hospitalisation, unplanned readmissions, suicide attempts and forensic complications for psychiatric patients

Antidepressants are efficacious in the treatment of depression but they are not without side effects. The recent findings on the risk of suicide with selective serotonin reuptake inhibitor treatment, however, have raised serious concerns about the risk-benefit ratio of their use. The development of the concerns is traced and the risks discussed, particularly in the child and adolescent group. The prescriber needs to be aware of the issues and of the need for close clinical monitoring of patients started on selective serotonin reuptake inhibitor treatment.
Adolescent ; Adult ; Age Factors ; Child ; Depressive Disorder, Major ; diagnosis ; Humans ; Risk Assessment ; Serotonin Uptake Inhibitors ; adverse effects ; Suicide ; statistics & numerical data