Objective: The objective of these 4 case reports is to highlight that psychotic symptom can occur due to the consumption of sibutramine. The psychosis is usually self-remitting, once its consumption is stopped. Methods: All cases with first episode psychosis presenting to a tertiary mental health Institute in Singapore were screened and 4 consecutive sibutramine-induced psychoses cases are reported. Results: All the 4 cases that were diagnosed with Sibutramine induced psychoses, had history of consumption of the substance in the tablet form or in substances like slimming tea or slimming powders. In 2 out of the 4 cases, no antipsychotics were started. In the 2 cases that received antipsychotics, they were for short duration. There was a temporal association between the consumption of sibutramine containing substances and the onset of psychotic symptoms. All patients were on follow up for two years and in 2 patients, there were no recurrence of psychotic symptoms. In 2 patient recurrent psychotic symptoms were temporally related with consumption of sibutramine and symptoms remitted when the consumption was stopped. Conclusions: Despite sibutramine being banned in several countries, it can still be purchased from countries allowing its sale and from online stores. Labeling a patient having schizophrenia can be avoided if detailed history, specifically enquiring about the consumption of sibutramine is obtained.

Adenoma ; complications ; pathology ; Adult ; Antipsychotic Agents ; adverse effects ; therapeutic use ; Aripiprazole ; Benzodiazepines ; adverse effects ; therapeutic use ; Bromocriptine ; adverse effects ; therapeutic use ; Dopamine Antagonists ; adverse effects ; therapeutic use ; Female ; Hormone Antagonists ; adverse effects ; therapeutic use ; Humans ; Hyperprolactinemia ; complications ; etiology ; Piperazines ; adverse effects ; therapeutic use ; Pituitary Neoplasms ; complications ; pathology ; Quinolones ; adverse effects ; therapeutic use ; Risperidone ; adverse effects ; therapeutic use ; Schizophrenia ; drug therapy ; etiology ; pathology ; Serotonin Antagonists ; adverse effects ; therapeutic use ; Trifluoperazine ; adverse effects ; therapeutic use

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.

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

Achievement ; Health Promotion ; Humans ; Mental Disorders ; Mental Health Services ; Risk ; Singapore

Mental disorders are both common and costly. The mental health system in Singapore lacks co-ordination as well as being underdeveloped in certain areas. To address these gaps as well to face emerging challenges like an ageing population, and other socioeconomic changes, the Ministry of Health of Singapore has commissioned a Committee to formulate a 5-year Mental Health Policy and Blueprint. A task group has been formed to implement this blueprint and evaluation of these various initiatives with performance measures are inevitable. The choice of these measures, however, can be a daunting task with the various and diverse interests of multiple stakeholders. This paper describes the process of choosing the relevant measures with the appropriate attributes, and suggests a framework, which can serve as a guide for selecting mental health performance measures.
Humans ; Mental Health Services ; standards ; Quality Assurance, Health Care ; methods ; standards ; Quality Indicators, Health Care ; standards ; Singapore

INTRODUCTIONDiabetes mellitus (DM) is a serious chronic illness that has a major impact on the quality of life of the individuals. Our aim was to examine the determinants of health-related quality of life (HRQOL) in patients with DM.

MATERIALS AND METHODSAdult outpatients attending a Diabetes Centre were recruited on consecutive basis between August 2006 and February 2007. Clinical data were collected from interviews with the subjects and from medical records. Assessment of depressive symptoms was done using the Center for Epidemiologic Studies Depression Scale (CES-D) and HRQOL using the Short Form 36 Health Survey (SF-36). A two-step regression analysis was conducted for identifying factors affecting patients' quality of life.

RESULTSFive hundred and thirty-seven patients participated in the study. The mean (SD) age of the participants was 54.7 (13.3) years and 315 (58.7%) were males. The prevalence of depressive symptoms was 31.1% (n = 167). After adjusting for other variables, the effects of depressive symptoms persisted for all the 8 domains of SF-36 (P <0.001 for all). The medical factors that were negatively associated with HRQOL were a diagnosis of Type 1 DM, duration of the illness of more than 10 years, HbA1c levels of ≥7%, and comorbidity of stroke and retinopathy. Being male and a regular exerciser had a positive effect on HRQOL.

CONCLUSIONThese findings highlight the importance of detecting and treating comorbid depression in DM.

Adult ; Aged ; Depression ; epidemiology ; physiopathology ; psychology ; Diabetes Mellitus, Type 1 ; epidemiology ; physiopathology ; psychology ; Diabetes Mellitus, Type 2 ; epidemiology ; physiopathology ; psychology ; Female ; Health Status ; Health Surveys ; Humans ; Interviews as Topic ; Male ; Medical Records ; Middle Aged ; Quality of Life ; Singapore ; epidemiology

Attitude ; Employment ; Humans ; Mental Disorders/therapy* ; Mental Health