INTRODUCTION: Pharmacogenomic testing in psychiatry is an emerging area with potential clinical application of guiding medication choice and dosing. Interest has been fanned by commercial pharmacogenomic providers who have commonly marketed combinatorial panels that are direct-to-consumer. However, this has not been adopted widely due to a combination of barriers that include a varying evidence base, clinician and patient familiarity and acceptance, uncertainty about cost-effectiveness, and regulatory requirements. This review aims to examine recent updates in this field and provide a contextualised summary and recom-mendations for Asian populations in order to guide healthcare professionals in psychiatric practice. METHOD: A review of recent literature about current evidence and guidelines surrounding pharmacoge-nomics in psychiatric practice was carried out with particular attention paid to literature evaluating Asian populations. The Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework was applied. Consensus meetings comprising workgroup psychiatrists from the public and private sectors were held prior to arriving at the key recommendations. RESULTS: Pharmacogenomic testing should be mainly limited to drug-gene pairs with established clinical evidence, such as antidepressants and CYP2C19/ CYP2D6. Direct-to-consumer pharmacogenomic panels that assay multiple genes and analyse them via proprietary algorithms, are not presently recommended in Singapore's psychiatric setting due to inconclusive evidence on clinical outcomes. CONCLUSION Pharmacogenomic testing in psychiatry is not recommended as standard clinical practice. Exceptions may include concerns about drug concentrations or potential severe adverse drug reactions. Studies investigating newly identified drug-gene associations, and clinical effectiveness and cost-effectiveness of utilising pharmacogenomic testing in psychiatry is encouraged.
Humans ; Psychiatry/methods* ; Pharmacogenetics ; Cytochrome P-450 CYP2C19/genetics* ; Asian People/genetics* ; Pharmacogenomic Testing/methods* ; Antidepressive Agents/therapeutic use* ; Cytochrome P-450 CYP2D6/genetics* ; Practice Guidelines as Topic ; Singapore ; Mental Disorders/genetics* ; Psychotropic Drugs/therapeutic use*

In this paper, we provide guidance to clinicians who care for infants born to mothers with suspected/confirmed COVID-19 during this current pandemic. We reviewed available literature and international guidelines based on the following themes: delivery room management; infection control and prevention strategies; neonatal severe acute respiratory syndrome coronavirus 2 testing; breastfeeding and breastmilk feeding; rooming-in of mother-infant; respiratory support precautions; visiting procedures; de-isolation and discharge of infant; outpatient clinic attendance; transport of infant; and training of healthcare staff. This guidance for clinical care was proposed and contextualised for the local setting via consensus by members of this workgroup and was based on evidence available as of 31 July 2020, and may change as new evidence emerges.
Infant, Newborn ; Pregnancy ; Female ; Humans ; Mothers ; COVID-19/epidemiology* ; Singapore/epidemiology* ; COVID-19 Testing ; Pandemics/prevention & control* ; Infectious Disease Transmission, Vertical/prevention & control* ; Pregnancy Complications, Infectious/prevention & control*

Objective: Anorexia nervosa and eating disorder not otherwise specified (NOS), an eating disorder not fulfilling anorexia nervosa DSM-IV criteria are on a rising trend in Singapore. The aims of this paper were to study the clinical characteristics and features of patients with anorexia and eating disorder NOS in Singapore. Methods: A retrospective cohort analysis of 373 patients between 2003 and 2010 at a tertiary hospital was done. Inclusion criteria included inpatients and outpatients with the age range of 12 years old to 40 years old fulfilling the Diagnostic and Statistical Manual (DSM)-IV criteria for anorexia nervosa and patients with the diagnosis of eating disorder NOS. The subjects are analyzed based on the severity of the eating disorder and the presentation subtypes. Results: An analysis of the overall demographic data revealed the female to the male ratio to be 22.4:1. The Chinese formed the largest ethnic group in the study population with 242 (86.1%) patients, and the bulk of the patients (75.8%) patients were between 12 to 20 years old. Anorexia nervosarestricting subtype was the most common eating disorder (55.2%) and the most common body mass Index (BMI) was between BMI 14.6 – 16.5 (35.2%). Restriction technique (p = 0.01), binge/purge (p = 0.03) and exercise (p < 0.001) are statistically significant to cause transaminitis in patients. Conclusion: There were significant changes in the demographics compared to the study reviewing patients from 1994 and 2002. There was a significant increase in the Caucasian population with changes in the Singapore immigration policy. A detail history taken during first visit can reduce the morbidity and mortality of these patients.

INTRODUCTIONAnorexia nervosa (AN) and eating disorders not otherwise specified (EDNOS) are on the rise in Singapore. Abnormal liver function tests have been reported for up to 12.2% of patients with AN. These patients are also known to present with comorbid psychiatric disorders. This study aims to investigate the correlation between body mass index (BMI) and the severity of abnormal liver function tests, and between BMI and the presence of comorbid psychiatric disorders.

METHODSA retrospective cohort analysis of 373 patients diagnosed with AN or EDNOS at a tertiary hospital was performed. The clinical course of transaminitis and comorbid psychiatric disorders was correlated with the patient's BMI.

RESULTSPatients with a BMI of ≥ 16.6 kg/m(2) at their first consult had a significantly lower risk of having comorbid psychiatric disorders (χ(2) = 32.08, p < 0.001). These patients were five times less likely to have comorbid psychiatric disorders as compared to patients from the other BMI groups (odds ratio [OR] 0.21). On the other hand, patients with a BMI of < 14.6 kg/m(2) had a significantly higher risk of having transaminitis (χ(2) = 72.5, p < 0.001). They were 11.1 times more likely to develop transaminitis as compared to patients with a BMI of ≥ 14.6 kg/m(2) (OR 11.05).

CONCLUSIONSeverity of BMI can be used by clinicians as an indicator to assess for secondary psychiatric comorbidities and/or transaminitis during the first consultation. This could help reduce the morbidity and mortality rates in patients with AN or EDNOS.

Adolescent ; Adult ; Alanine Transaminase ; blood ; Alkaline Phosphatase ; blood ; Anorexia Nervosa ; complications ; diagnosis ; epidemiology ; Aspartate Aminotransferases ; blood ; Body Mass Index ; Child ; Comorbidity ; Diagnostic and Statistical Manual of Mental Disorders ; Feeding and Eating Disorders ; complications ; diagnosis ; epidemiology ; Female ; Humans ; Liver Diseases ; complications ; diagnosis ; epidemiology ; Liver Function Tests ; Male ; Mental Disorders ; complications ; diagnosis ; epidemiology ; Odds Ratio ; Prevalence ; Psychiatric Status Rating Scales ; Retrospective Studies ; Singapore

To examine the clinical features of male patients with eating disorders in Singapore; and determine the differences in clinical features between the patients across the diagnostic categories. Methods: This is a database analysis of all male cases presenting to the Eating Disorders Clinic at Singapore General Hospital between 2003 and 2012. Results: 72 cases were identified; 36.1% were diagnosed with anorexia nervosa, 33.3% had bulimia nervosa and 30.5% had the diagnosis of eating disorder not otherwise specified. The mean presenting age was 19.9 years. 63.9% were heterosexual, while 15.3% were homosexual/bisexual. 61.1% had comorbid psychiatric diagnoses, with depression being the most common. 59.7% recorded premorbid obesity, while 66.7% reported excessive exercise. The patients in the various diagnostic categories had more similarities than differences. Conclusion: With more male cases over the years, it is important to further understand this condition, to better refine prevention, detection and treatment strategies.
Eating Disorders ; Asian Continental Ancestry Group ; Men