Introduction: The quality of forensic psychiatry assessments in Singapore has come under recent criticism from the judiciary resulting in a loss of confidence in forensic psychiatric assessments. There is no local published standards or practice guidelines for forensic psychiatric assessments. We set out to survey local psychiatrists on various key aspects of local forensic psychiatric assessments. Methods: A survey was developed by two local senior psychiatrists with extensive experience in forensic psychiatry. It was sent out electronically to all Singapore registered psychiatrists. Results: The response rate was 33.6% (48 of 143 psychiatrists). Respondents agreed that risk assessment and management, capacity and competence assessments and critical appraisal of symptoms were specific forensic psychiatry skill sets. There was also a consensus that separation of treating versus assessment roles and an independent panel of psychiatrist would be useful. There was no clear consensus on which psychiatrists should perform forensic assessments or if language used and time taken for assessments were important. The estimated time for assessments ranged from 1.9 hour (SD 1.3) to 9.1 hours (SD 5.4) with time required for criminal > civil > capacity assessments. Private sector psychiatrists were more likely than public sector psychiatrists to feel that forensic psychiatric qualifications were not necessary to conduct forensic assessments. Conclusion: There is a consensus in the local psychiatric community on various key aspects of forensic psychiatric assessment. Stakeholders in forensic assessments should begin a dialogue on the way forward for forensic psychiatric assessments in Singapore.

AIMSIt is possible to define at risk mental states (ARMS) that predict conversion to schizophrenia in up to 40% of help seeking individuals within a year of screening. Treatment of ARMS is controversial due to difficulties with diagnosis and uncertainties of treatment effectiveness. This survey was conducted to assess and compare attitudes of Singapore psychiatrists vs primary healthcare physicians towards ARMS.

MATERIALS AND METHODSAn anonymous survey containing a clinical vignette and questions related to the diagnosis and management of ARMS was sent out to all registered psychiatrists/ psychiatry trainees and all doctors in a public primary healthcare group in Singapore.

RESULTSThe response rate was 62.1% (87/140) and 72.3% (107/ 148) for psychiatrists and primary healthcare physicians respectively. The proportion of psychiatrists diagnosing ARMS vs psychosis was 44.8% vs 43.7% respectively. Among primary care physicians, the corresponding proportion was 54.2% vs 40.2%. The difference between the 2 groups did not reach statistical significance. Among psychiatrists who diagnosed ARMS, 74.4% (29/39) would treat the patient with active management. Of the total number of psychiatrists surveyed, 49.4% would advocate population screening of high risk groups compared to 30.8% of primary healthcare physicians. And 64.4% of psychiatrists felt that there was no consensus regarding the management of ARMS.

CONCLUSIONSThere is currently clinical equipoise with regards to both diagnosis and management of ARMS in Singapore. Primary care physicians may be more likely to diagnose psychosis vs ARMS when compared to psychiatrists. Psychiatrists were more likely than primary healthcare physicians to advocate population screening of ARMS in high-risk groups. Most psychiatrists would manage ARMS actively.

Adult ; Attitude of Health Personnel ; Female ; Health Care Surveys ; Humans ; Male ; Mental Disorders ; diagnosis ; Middle Aged ; Physicians, Family ; Psychiatry ; Risk Assessment ; Schizophrenia ; Singapore ; Young Adult

Bipolar Disorder ; therapy ; Deep Brain Stimulation ; Depressive Disorder ; therapy ; Electroconvulsive Therapy ; Humans ; Mental Disorders ; therapy ; Obsessive-Compulsive Disorder ; Schizophrenia ; therapy ; Singapore ; Transcranial Direct Current Stimulation

Suicide is a common and preventable event that is often reported by the media when there are sensationalistic elements or if the suicide involves a celebrity. Media reports of suicide can induce a copycat or "Werther effect". There is increasing evidence that sensationalistic reporting of suicides has a direct effect on increasing suicide rates. Responsible reporting guidelines drawn up in consultation with media professionals have been shown to improve reporting of suicides. Local reporting on suicides tends to be sensationalistic but also has a strong educational slant. The media should educate both the public and the medical professional about their role in suicide prevention.
Guidelines as Topic ; Humans ; Imitative Behavior ; Mass Media ; standards ; Singapore ; Suicide ; prevention & control

INTRODUCTION: The effects of electroconvulsive therapy (ECT) on quality of life (QoL), and its relationship with symptom and cognitive change remains unclear. We aim to examine the association of QoL changes with psychiatric symptom and cognitive changes among patients with schizophrenia who underwent ECT. METHODS: This is a retrospective cohort study of 132 patients who received ECT from July 2017 to December 2019. Sociodemographic and clinical characteristics were obtained from medical records. Changes in QoL, psychiatric symptoms and cognition function were examined after 6 sessions of ECT. Generalised linear regression was used to examine the associations of Brief Psychiatric Rating Scale (BPRS) scores and Montreal Cognitive Assessment (MoCA) scores with QoL as measured by EQ-5D scores. RESULTS: The mean (standard error) improvements after ECT were statistically significant for the assessment scales of EQ-5D utility score: 0.77 (0.02) to 0.89 (0.02), P<0.001; EuroQol-5-Dimension (EQ-5D) visual analogue scale score: 66.82 (2.61) to 73.05 (1.93), P=0.012; and EQ-5D subdomain scores. Both improvement in BPRS (adjusted β coefficient -0.446, 95% confidence interval [CI] -0.840 to -0.052) and MoCA (adjusted β 12.068, 95% CI 0.865 to 12.271) scores were significantly associated with improvement in EQ-5D utility scores after adjustment for sociodemographic and clinical characteristics. Improvement of BPRS scores (psychiatric symptoms) was significantly associated with improvement of the patients' mental health that was assessed by EQ-5D subdomain scores of pain (adjusted β coefficient 0.012, 95% CI 0.004 to 0.021) and anxiety (adjusted β coefficient 0.013, 95% CI 0.002 to 0.024). Improvement of MoCA scores (cognitive function) was significantly associated with patients' physical health as assessed by EQ-5D subdomain score of usual activity (adjusted β coefficient -0.349, 95% CI -0.607 to -0.09). CONCLUSION ECT was associated with an overall improvement of QoL among patients with schizophrenia. The improvement of psychiatric symptoms was found to be significantly associated with better mental health while the improvement of cognitive function was associated with better physical health.
Cognition ; Electroconvulsive Therapy/methods* ; Humans ; Quality of Life ; Retrospective Studies ; Schizophrenia/therapy* ; Surveys and Questionnaires

The definition of a "good" psychiatrist has varied over the past decades due to changing roles of psychiatrists. Studies on the qualities of "good" psychiatrists have been completed in many countries. However, no such study has been undertaken in Korea. In Korea, recent growing interest in psychiatry demands the identification of qualities for a good psychiatrist. The purpose of this study was to define the qualities of a good psychiatrist in Korea, subsequently facilitating the improvement of psychiatric training programs. The questionnaire was based on a Singaporean survey with the permission from the original authors. Respondents were divided into patient group and psychiatrist group. The 40-item questionnaire contained items grouped into four themes: Professional, Personal Values, Academic Executive and Relationship. Of the four themes, both patient and psychiatrist groups considered Professional as the most important, whereas Academic Executive as the least important. The mean scores for all items of each theme in the patient group were higher than those in the psychiatrist group, reflecting higher expectations for good psychiatrist in the patient group. Patients emphasized Relationship more than psychiatrists did. It is concluded that a good psychiatrist in Korea can be defined as "a good communicator and listener with a professional manner, who respects confidentiality and has good doctor-patient relationships."
Adult ; Aged ; Asian Continental Ancestry Group ; Female ; Humans ; Internship and Residency ; Male ; Middle Aged ; Patients/*psychology ; Physician-Patient Relations ; Physicians/*psychology ; Psychiatry/*classification ; Republic of Korea ; Surveys and Questionnaires ; Translating

INTRODUCTION: The use of electroconvulsive therapy (ECT) in Singapore dates back to 1947. However, there is little local information on the clinical practice of ECT and its standards. We aimed to conduct a comprehensive national survey of ECT practice in Singapore. METHODS: A cross-sectional structured questionnaire assessing the types of ECT (e.g. electrode placement, stimulus parameters), indications, anaesthetic technique, dosing methods, monitoring of outcomes and credentialing was sent in 2015 to all ECT centres in Singapore via email to collect qualitative and quantitative data regarding ECT. RESULTS: Data was obtained from all ECT centres (n = 6), which represented that ECT was available in 23.1% of all hospitals and 50.0% of all psychiatric specialist centres. The rate of ECT was 5.89 treatments per 10,000 residents per year, and each patient received an average of 5.4 ECT per course. Only 7.0% of ECT was administered for continuation/maintenance ECT. The most common indication for ECT was depression in 5 (83.3%) out of six centres, with schizophrenia being the second most common. In 5 (83.3%) out of six centres, ECT was brief (0.5 ms) bitemporal ECT with age-based dosing, and 93.0% of the sessions were conducted in an inpatient setting. All ECT was conducted under general anaesthesia, with propofol (66.7%) being the most common type of anaesthetic used. CONCLUSION The practice of ECT in Singapore was highly uniform. The rates and indications for ECT were consistent with those of other developed countries, with greater use of ECT for schizophrenia. Future advances for ECT in Singapore include the use of individualised dosing based on empirical seizure threshold titration, expanded electrode placements and increased utilisation of continuation/maintenance ECT.

Aim: To examine the trend of youth depression diagnosed in a healthcare group in Singapore over a 6-year period. Methods: This is a retrospective analysis of the medical records of patients who had been diagnosed with depression from Jan 2013 to Dec 2018 in a healthcare group in Singapore. The yearly trend of depression diagnosis among the youths (10-24 years of age) was compared with adults (25-64 years of age) and the elderly (≥ 65 years of age). The mean age at diagnosis, distribution of gender, ethnicity and clinical care settings among the subgroup of youth patients were compared across the years using analysis of variance or Pearson’s chi-square test. Results: A total of 4701 youths, 15243 adults and 6908 elderly patients were included in the analysis. Between 2013 and 2018, the rise in depression diagnosis in the youth was greater than in the adult and elderly populations, and the mean age at diagnosis decreased from 49.7 ± 0.3 (mean ± SE) years in 2013 to 39.6 ± 0.3 years in 2018. Among the youths, more females had been diagnosed with depression than males and females displayed a larger increase in diagnosis of depression. There was also a larger increase in the diagnosis of depression in primary care compared to emergency departments, outpatient specialist clinics and in-hospital wards. Conclusion Youth depression is a major health problem in Singapore. There is a need for the expansion of resources in a variety of avenues for depressed youths to seek help.