Mythily Subramaniam | Institute of Mental Health (original) (raw)

Papers by Mythily Subramaniam

Research paper thumbnail of Subthreshold and threshold DSM-IV generalized anxiety disorder in Singapore: Results from a nationally representative sample

Journal of Anxiety Disorders, 2015

Previous nationally representative studies have reported prevalence of DSM-IV generalized anxiety... more Previous nationally representative studies have reported prevalence of DSM-IV generalized anxiety disorder (GAD). However, subthreshold and threshold GAD expressions remain poorly understood. The current study examined the prevalence, correlates and co-morbidity of a broader diagnosis of GAD in Singapore. The Singapore Mental Health Study (SMHS) was an epidemiological survey conducted in the population (N=6616) aged 18 years and older. The Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was used to establish mental disorder diagnoses. The lifetime prevalence for subthreshold GAD (2.1%) and threshold GAD (1.5%) in the current sample was found to be lower than in Western populations. Younger age group, Indian ethnicity, previously married, chronic physical conditions, and being unemployed were associated with higher odds of having more severe expression of generalized anxiety. The relatively lower prevalence rate of subthreshold GAD expression suggests possible cultural interferences in the reporting and manifestation of anxiety symptomatology. Despite the low prevalence, significant impacts on functioning and comorbidity among subthreshold generalized anxiety cases indicate the importance of early treatment to ensure a better prognosis.

Research paper thumbnail of Comorbid physical and mental illnesses among pathological gamblers: Results from a population based study in Singapore

Psychiatry Research, 2015

The aim of the current study was to examine the comorbidity of pathological gambling with other m... more The aim of the current study was to examine the comorbidity of pathological gambling with other mental and physical disorders as well as to examine health related quality of life perceived by those with pathological gambling using data from a community survey in Singapore. All respondents were administered the South Oaks Gambling Screen to screen for pathological gambling. The diagnosis of mental disorders was established using the Composite International Diagnostic Interview; while chronic physical conditions were established using a checklist. The weighted lifetime prevalence of pathological gambling was 2.7%. After multiple logistic regression, age 18-34 years (OR=5.3, 95% CI=1.6-17.4), male gender (OR=7.8, CI=3.8-16.2), widowhood (OR=4.2, 95% CI=1.02-17.5), and those with pre-primary (OR=17.1, CI=4.9-59.1), primary (OR=5.3, CI=1.7-16.6), and secondary education (OR=6, CI=2.5-14.7) had significantly higher odds of having pathological gambling. Those of Malay (OR=0.1, 95% CI=0.07-0.2) and Indian ethnicity (OR=0.2, 95% CI=0.1-0.3) had significantly lower odds of having pathological gambling compared to those of Chinese ethnicity. Pathological gamblers had significantly higher odds of having comorbid mental and physical disorders than non-gamblers/non-problem gamblers. The significant association of comorbid mental and physical disorders among those with pathological gambling indicates a need to screen for these disorders and for their subsequent treatment.

Research paper thumbnail of The Mental Health Screening of Conscripts for the Singapore Armed Forces: Rationale, Objectives, and Design

Military Medicine, 2007

Identification of mentally ill military conscripts is crucial, since these individuals may experi... more Identification of mentally ill military conscripts is crucial, since these individuals may experience an exacerbation of their illness during training with dire consequences for them and the organization. This article describes the design of a study to validate a screening instrument for psychiatric disorders as well as to establish their prevalence among male army conscripts in Singapore. It involved a two-stage process: the conscripts were screened with a new instrument which we termed the Mental Wellness Screening Questionnaire; those who screened positive, and a random sample of those who did not, were administered the computerized Composite International Diagnostic Interview which was the gold standard in making the diagnosis. This study is unusual in that it involved almost the entire male population in 1 year but its relevance is the development of a screening instrument that can be used with ease in a large population of conscripts.

Research paper thumbnail of Sociodemographic Correlates and Morbidity in Lottery Gamblers: Results from a Population Survey

Journal of Gambling Studies, 2015

The aim of the current study was to examine the socio-demographic correlates, the association of ... more The aim of the current study was to examine the socio-demographic correlates, the association of mental and physical illness, and the prevalence of pathological gambling among three groups (1) those with lottery gambling only (2) those with lottery and other types of gambling and (3) those with other types of gambling only-such as playing cards, sports betting, horse racing, casino gambling etc. Data was used from a nationwide cross-sectional epidemiological nationally representative survey of the resident (Singapore Citizens and Permanent Residents) population in Singapore of 6616 Singaporean adults aged 18 years and older. All respondents were administered the South Oaks Gambling Screen to screen for pathological gambling. The diagnoses of mental disorders were established using the Composite International Diagnostic Interview and relevant socio-demographic data was collected using a structured questionnaire. Lottery gambling was by far the most popular form of gambling in Singapore, with 83.5 % of those who had ever gambled indicating that they had participated in lottery gambling. Those who participated in lottery gambling alone were more likely to belong to the older age group (as compared to the 18-35 years age group), be of Indian ethnicity, have a secondary or vocational education, and earn a lower income as compared to the other two groups. Our findings that those with pure lottery gambling were significantly less likely to be pathological gamblers and had significantly lower odds of psychiatric and physical morbidity as compared to the other two groups are unique and need further research.

Research paper thumbnail of EQ-5D as a measure of programme outcome: Results from the Singapore early psychosis intervention programme

Research paper thumbnail of An assessment of the understanding and motivations of patients with schizophrenia about participating in a clinical trial

Enrollment of an adequate number of subjects for a clinical trial is a perennial challenge and th... more Enrollment of an adequate number of subjects for a clinical trial is a perennial challenge and this might arguably be even more difficult and complex in trials involving patients with schizophrenia. In this paper, we used a modification of the Prospective Preference Approach (PPA) as a prelude to an actual randomized placebo-controlled trial of a cognitive-enhancing agent for patients with schizophrenia. This approach sought to test and enhance subjects' understanding of the key concepts of the trial, and administered the PPA at baseline and following a brief educational module. The motivations and concerns regarding potential participation in the proposed trial were also elicited by the PPA. Of one hundred ninety patients with schizophrenia recruited for this PPA study, only 12 (6.3%) were assessed to have understood all key trial-related concepts after the initial explanation and baseline PPA administration (prior to the educational module). Following the education module, however, there was significant increase in the number of patients who understood all key trial elements. Younger age and higher level of education were significant factors associated with better understanding of the proposed trial. The main reasons cited for wishing to participate in clinical trials were personal medical benefits and altruistic desire to help others. Concerns regarding the safety of the trial medication were expressed in over 80% of the subjects. PPA administration with educational module supplementation may provide a valuable addition to clinical trial procedures in patients with schizophrenia.

Research paper thumbnail of Peptic ulcer disease and mental illnesses

General hospital psychiatry

Research paper thumbnail of Single mothers have a higher risk of mood disorders

Annals of the Academy of Medicine, Singapore, 2014

Previous research has shown single mothers to be at greater risk for both physical and mental hea... more Previous research has shown single mothers to be at greater risk for both physical and mental health disorders as compared to married mothers. Psychiatric disorders, in particular depression, have been shown to be more prevalent in single mothers than married mothers. This study was aimed at comparing the prevalence of depression, other mood, and anxiety disorders in single and married mothers in a multiethnic Asian society. The Singapore Mental Health Study (SMHS) was a cross-sectional survey of the representative population of Singapore. The survey targeted Singapore residents aged 18 years and above. Trained interviewers established the diagnoses of mental disorders using the Composite International Diagnostic Interview version 3.0 (CIDI 3.0). Physical illnesses, social support and sociodemographic correlates were established using structured interviews. For the purpose of this study, single mothers were defined as unmarried, divorced/separated/widowed mothers who had children aged 21 years and below. Face-to-face interviews were completed with 6616 respondents from December 2009 to December 2010. After controlling for sociodemographic correlates in multiple logistic regression model, single mothers had significantly higher odds of having mood disorders (OR = 5.28) as compared to married mothers. Our study found that single mothers in Singapore across ethnicities, experienced a higher risk for mood disorders as elsewhere in the world. Single motherhood was also associated with lower age and education. Our study identifies young, single mothers as a vulnerable group associated with mental illnesses that must be targeted with specific interventions to improve mental health and well-being.

Research paper thumbnail of Patient-reported outcomes in obsessive-compulsive disorder

Dialogues in clinical neuroscience, 2014

The purpose of the article was to provide an overview of patient-reported outcomes (PROs) and rel... more The purpose of the article was to provide an overview of patient-reported outcomes (PROs) and related measures that have been examined in the context of obsessive-compulsive disorder (OCD). The current review focused on patient-reported outcome measures (PROMs) that evaluated three broad outcome domains: functioning, health-related quality of life (HRQoL), and OCD-related symptoms. The present review ultimately included a total of 155 unique articles and 22 PROMs. An examination of the PROs revealed that OCD patients tend to suffer from significant functional disability, and report lower HRQoL than controls. OCD patients report greater symptom severity than patients with other mental disorders and evidence indicates that PROMs are sensitive to change and may be even better than clinician-rated measures at predicting treatment outcomes. Nonetheless, it should be noted that the measures reviewed lacked patient input in their development. Future research on PROMs must involve patient perspectives and include rigorous psychometric evaluation of these measures.

Research paper thumbnail of Typology of people with first-episode psychosis

Early intervention in psychiatry, Jan 29, 2014

The aim of the current study was to create a typology of patients with first-episode psychosis ba... more The aim of the current study was to create a typology of patients with first-episode psychosis based on sociodemographic and clinical characteristics, service use and outcomes using cluster analysis. Data from all respondents who were accepted into the Early Psychosis Intervention Programme (EPIP), Singapore from 2007 to 2011 were analysed. A two-step clustering method was carried out to classify the patients into distinct clusters. Two clusters were identified. Cluster 1 comprised largely of younger people with mean age of 25.5 (6.0) years at treatment contact, who were predominantly male (55.3%), single (98.3%) and living with parents (86.3%). Cluster 1 had a higher proportion of people diagnosed with the schizophrenia spectrum disorder (71.4%) and with a positive family history of psychiatric illness. Patients in cluster 2 were generally older with a mean age of 33.6 (4.7) years and the majority were women (74.2%). Cluster 1 had people with higher Positive and Negative Syndrome Scale (PANSS) scores at baseline as compared with cluster 2. After a 1-year follow up, their scores were still poorer than their counterparts in cluster 2, especially for PANSS negative score. The functioning level of people in cluster 1 showed less improvement than the people in cluster 2 after a year of treatment. There is a compelling need to develop new therapies and intensively treat young people presenting with psychosis as this group tends to have poorer outcomes even after 1 year of treatment.

Research paper thumbnail of Suicidal ideation, suicidal plan and suicidal attempts among those with major depressive disorder

Annals of the Academy of Medicine, Singapore, 2014

The aims of the study were to identify the prevalence and sociodemographic and clinical correlate... more The aims of the study were to identify the prevalence and sociodemographic and clinical correlates of suicidal behaviours using data from a cross-sectional survey among those with major depressive disorder (MDD) in Singapore. The Singapore Mental Health Study (SMHS) was a cross-sectional epidemiological study that surveyed Singapore residents (Singapore citizens and permanent residents) aged 18 years and above. The assessment of mental disorders was established using version 3.0 of the Composite International Diagnostic Interview (CIDI 3.0). For the purposes of this study, suicidal behaviour was assessed by questions which were asked to respondents who answered positively to the screening questions in the CIDI 3.0 "Depression" module. The prevalence of suicidal ideation, plan and attempt among those with lifetime MDD was 43.6%, 13.7% and 12.3%, respectively. We found that suicidal ideation, plan and attempt were significantly associated with ethnicity, education and income. The rate of those who had sought some professional help was higher among those with suicidal plan (71.7%) and attempt (72.3%) as compared to those with suicidal ideation (48.7%) and those with MDD but no suicidal behaviour (29%). Individuals with MDD and suicidal behaviour do differ from their non-suicidal counterparts as they have a different sociodemographic and clinical profile. There is a need for more research and a better understanding of this population which in turn could lead to the development and implementation of relevant interventions.

Research paper thumbnail of Hoarding in an asian population: prevalence, correlates, disability and quality of life

Annals of the Academy of Medicine, Singapore, 2014

Hoarding is defined as the acquisition of, and inability to discard items even though they appear... more Hoarding is defined as the acquisition of, and inability to discard items even though they appear to others to have no value. The objectives of the study were to establish the prevalence of hoarding behaviour among the general population and among individuals with obsessive-compulsive disorder (OCD) in a cross-sectional study conducted in Singapore. The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of residents aged 18 years or older, living in households. The diagnoses of mental disorders were established using Version 3.0 of Composite International Diagnostic Interview (CIDI 3.0). Differences between 3 groups i.e. those diagnosed with lifetime/12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) OCD with hoarding, those diagnosed with lifetime/12-month DSM-IV OCD without hoarding and those with lifetime hoarding behaviour without diagnosis of DSM-IV OCD were determined. The weighted prevalence of lifetime hoarding behaviour was 2% and that of hoarding among those with OCD was 22.6%. Those who met the criteria for hoarding behaviour alone were associated with lower odds of having obsessions of contamination, harming, ordering as well as compulsions of ordering and other compulsions than those who met criteria for both OCD and hoarding. Hoarders without OCD were less impaired, in terms of comorbid psychopathology, than those with OCD with and without hoarding, and had a higher quality of life versus those with both OCD and hoarding, though still lower than that of the general population.

Research paper thumbnail of Prevalence of Dementia in People Aged 60 Years and Above: Results from the WiSE Study

Journal of Alzheimer's disease : JAD, Jan 11, 2015

Background: The challenge of an aging population with its expected attendant problem of an increa... more Background: The challenge of an aging population with its expected attendant problem of an increase in the number of people with dementia is a growing concern across the world. Objective: The aims of this study were to establish the prevalence and risk factors of dementia in Singapore among the elderly resident population (age 60 years and above). Methods: The WiSE study was a comprehensive single phase, cross-sectional, epidemiological survey that adapted the 10/66 protocol to establish the 10/66 and the Diagnostic and Statistical Manual of mental disorders -fourth edition (DSM-IV) diagnosis of dementia. 10/66 and DSM-IV dementia diagnosis as established by the survey questionnaires was validated by comparing against a gold standard of clinical assessment. Results: A total of 2,565 respondents completed the study giving a response rate of 65.6%. The validity of 10/66 dementia was higher (sensitivity = 95.6%, specificity = 81.8%) than that of DSM-IV dementia (sensitivity = 75.6%, specificity = 88.6%) when compared against the clinical gold standard. The study found that the prevalence of 10/66 dementia was 10% in the older adult population while the prevalence of DSM-IV dementia was 4.6%. Older age (75 years and above); no formal education, or completed primary education (versus higher education); homemaker and retired status (versus employed); and a history of stroke were associated with a higher risk of 10/66 dementia. Conclusion: The establishment of accurate data on the number of people with dementia is essential in the planning of services and initiatives.

Research paper thumbnail of Re-thinking internet gaming: from recreation to addiction

Research paper thumbnail of The Longitudinal Youth at Risk Study (LYRIKS) — An Asian UHR perspective

Schizophrenia Research, 2013

and sharing with colleagues.

Research paper thumbnail of Substance abuse in schizophrenia. A Singapore perspective

Social Psychiatry and Psychiatric Epidemiology, 2002

s Abstract Background Most of the information on the prevalence and patterns of substance abuse i... more s Abstract Background Most of the information on the prevalence and patterns of substance abuse in patients with schizophrenia has been from studies conducted in North America and Europe and data from Asian countries are conspicuously lacking. This study was undertaken with the aim to identify the prevalence and patterns of substance abuse among patients with firstepisode schizophrenia in the city-state of Singapore. Methods All new patients with a diagnosis of firstepisode schizophrenia or schizophreniform disorder who were seen in one calendar year in the only state mental institute in Singapore and its affiliated outpatient clinics were evaluated for a lifetime history of substance use. Results In a sample of 272 patients, 201 (73.6 %) were abstainers, 43 (15.8 %) had "mild" substance use and 28 (10.3 %) had "heavy" use patterns. Alcohol was the most frequently abused substance. The substance users were more likely to be males and were more likely to have a criminal record than abstainers. Conclusions To our knowledge, this is the first study that examines the co-morbidity of substance abuse in schizophrenia in an Asian population. Our findings once again highlight the fact that patients with schizophrenia are at a high risk for substance abuse. s

Research paper thumbnail of Clinical characteristics and associated factors in antipsychotic-induced akathisia of Asian patients with schizophrenia

We studied the prevalence of akathisia and its relationship to a number of sociodemographic and c... more We studied the prevalence of akathisia and its relationship to a number of sociodemographic and clinical factors in a population of Chinese inpatients with Schizophrenia. Six-hundred and forty-five patients were recruited for the study. Akathisia was assessed using the Barnes Akathisia Rating Scale (BARS), dyskinesia by the Abnormal Involuntary Movement Scale (AIMS) and extrapyramidal side effects (EPSE) were assessed by the Simpson-Angus Rating Scale (SARS). Only 35 (5%) patients were assessed to have akathisia. There was no gender or ethnic difference in the rates of akathisia. However, the majority of the patients (65%) were receiving an anticholinergic agent at the time of the study. Our findings of an overlap between TD and EPSE support the suggestion that there may be a common vulnerability for these movement disorders. The finding of a low rate of akathisia among our Asian patients suggests an inter-ethnic difference in the vulnerability for the development of akathisia. However, comparing our results with the rates reported from other countries may be hampered by the diagnostic and methodological differences across studies.

Research paper thumbnail of Reducing the duration of untreated psychosis and changing help-seeking behaviour in Singapore

This study was conducted to examine the impact of early detection strategies of an early psychosi... more This study was conducted to examine the impact of early detection strategies of an early psychosis intervention programme on the duration of untreated psychosis (DUP) and the pattern of help-seeking behaviour. Patients with first-episode psychosis were compared before and after the initiation of a programme of public education and networking with primary health care providers. These two groups were compared on the DUP and the change in the pattern of help-seeking. The DUP was significantly reduced from a median of 12 to median of 4 months (p=0.002, Mann-Whitney U-test). There was an increase in the proportion of self and family referrals, and a fall in the proportion of police referrals. Awareness campaigns which target multiple groups and use various modes of communication are effective in influencing the DUP and patterns of help-seeking.

Research paper thumbnail of Aggression in asian patients with first-episode psychosis

International Journal of Social Psychiatry, 2005

Aims: The aims of this study were to examine the prevalence and severity of aggression in patient... more Aims: The aims of this study were to examine the prevalence and severity of aggression in patients with first-episode psychosis and to identify the association between aggression and sociodemographic and clinical factors.

Research paper thumbnail of Diagnostic stability 2 years after treatment initiation in the Early Psychosis Intervention Programme in Singapore

Australian and New Zealand Journal of Psychiatry, 2007

To evaluate the diagnostic stability of psychotic disorders over a 2 year period in patients pres... more To evaluate the diagnostic stability of psychotic disorders over a 2 year period in patients presenting with first-episode psychosis. One hundred and fifty-four patients were recruited from an early psychosis intervention programme (EPIP). They were diagnosed by the attending psychiatrist using the Structured Clinical Interview for DSM-IV Axis I at first contact (baseline) and after 24 months. The diagnoses were classified into the following categories: schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder and schizoaffective disorder), affective psychosis (bipolar and major depressive disorders with psychotic symptoms), and other non-affective psychosis (delusional disorder, psychosis not otherwise specified and brief psychotic disorder). Two measures of stability, the prospective and the retrospective consistency were determined for each diagnosis. The diagnoses with the best prospective consistency were schizophrenia (87.0%) and affective psychosis (54.5%). The shift into schizophrenia spectrum disorder was the most frequent diagnostic change. Duration of untreated psychosis was found to be the only significant predictor of shift. It is difficult to make a definitive diagnosis at first contact. The clinical need to review the diagnosis throughout the period of follow up is emphasized.

Research paper thumbnail of Subthreshold and threshold DSM-IV generalized anxiety disorder in Singapore: Results from a nationally representative sample

Journal of Anxiety Disorders, 2015

Previous nationally representative studies have reported prevalence of DSM-IV generalized anxiety... more Previous nationally representative studies have reported prevalence of DSM-IV generalized anxiety disorder (GAD). However, subthreshold and threshold GAD expressions remain poorly understood. The current study examined the prevalence, correlates and co-morbidity of a broader diagnosis of GAD in Singapore. The Singapore Mental Health Study (SMHS) was an epidemiological survey conducted in the population (N=6616) aged 18 years and older. The Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was used to establish mental disorder diagnoses. The lifetime prevalence for subthreshold GAD (2.1%) and threshold GAD (1.5%) in the current sample was found to be lower than in Western populations. Younger age group, Indian ethnicity, previously married, chronic physical conditions, and being unemployed were associated with higher odds of having more severe expression of generalized anxiety. The relatively lower prevalence rate of subthreshold GAD expression suggests possible cultural interferences in the reporting and manifestation of anxiety symptomatology. Despite the low prevalence, significant impacts on functioning and comorbidity among subthreshold generalized anxiety cases indicate the importance of early treatment to ensure a better prognosis.

Research paper thumbnail of Comorbid physical and mental illnesses among pathological gamblers: Results from a population based study in Singapore

Psychiatry Research, 2015

The aim of the current study was to examine the comorbidity of pathological gambling with other m... more The aim of the current study was to examine the comorbidity of pathological gambling with other mental and physical disorders as well as to examine health related quality of life perceived by those with pathological gambling using data from a community survey in Singapore. All respondents were administered the South Oaks Gambling Screen to screen for pathological gambling. The diagnosis of mental disorders was established using the Composite International Diagnostic Interview; while chronic physical conditions were established using a checklist. The weighted lifetime prevalence of pathological gambling was 2.7%. After multiple logistic regression, age 18-34 years (OR=5.3, 95% CI=1.6-17.4), male gender (OR=7.8, CI=3.8-16.2), widowhood (OR=4.2, 95% CI=1.02-17.5), and those with pre-primary (OR=17.1, CI=4.9-59.1), primary (OR=5.3, CI=1.7-16.6), and secondary education (OR=6, CI=2.5-14.7) had significantly higher odds of having pathological gambling. Those of Malay (OR=0.1, 95% CI=0.07-0.2) and Indian ethnicity (OR=0.2, 95% CI=0.1-0.3) had significantly lower odds of having pathological gambling compared to those of Chinese ethnicity. Pathological gamblers had significantly higher odds of having comorbid mental and physical disorders than non-gamblers/non-problem gamblers. The significant association of comorbid mental and physical disorders among those with pathological gambling indicates a need to screen for these disorders and for their subsequent treatment.

Research paper thumbnail of The Mental Health Screening of Conscripts for the Singapore Armed Forces: Rationale, Objectives, and Design

Military Medicine, 2007

Identification of mentally ill military conscripts is crucial, since these individuals may experi... more Identification of mentally ill military conscripts is crucial, since these individuals may experience an exacerbation of their illness during training with dire consequences for them and the organization. This article describes the design of a study to validate a screening instrument for psychiatric disorders as well as to establish their prevalence among male army conscripts in Singapore. It involved a two-stage process: the conscripts were screened with a new instrument which we termed the Mental Wellness Screening Questionnaire; those who screened positive, and a random sample of those who did not, were administered the computerized Composite International Diagnostic Interview which was the gold standard in making the diagnosis. This study is unusual in that it involved almost the entire male population in 1 year but its relevance is the development of a screening instrument that can be used with ease in a large population of conscripts.

Research paper thumbnail of Sociodemographic Correlates and Morbidity in Lottery Gamblers: Results from a Population Survey

Journal of Gambling Studies, 2015

The aim of the current study was to examine the socio-demographic correlates, the association of ... more The aim of the current study was to examine the socio-demographic correlates, the association of mental and physical illness, and the prevalence of pathological gambling among three groups (1) those with lottery gambling only (2) those with lottery and other types of gambling and (3) those with other types of gambling only-such as playing cards, sports betting, horse racing, casino gambling etc. Data was used from a nationwide cross-sectional epidemiological nationally representative survey of the resident (Singapore Citizens and Permanent Residents) population in Singapore of 6616 Singaporean adults aged 18 years and older. All respondents were administered the South Oaks Gambling Screen to screen for pathological gambling. The diagnoses of mental disorders were established using the Composite International Diagnostic Interview and relevant socio-demographic data was collected using a structured questionnaire. Lottery gambling was by far the most popular form of gambling in Singapore, with 83.5 % of those who had ever gambled indicating that they had participated in lottery gambling. Those who participated in lottery gambling alone were more likely to belong to the older age group (as compared to the 18-35 years age group), be of Indian ethnicity, have a secondary or vocational education, and earn a lower income as compared to the other two groups. Our findings that those with pure lottery gambling were significantly less likely to be pathological gamblers and had significantly lower odds of psychiatric and physical morbidity as compared to the other two groups are unique and need further research.

Research paper thumbnail of EQ-5D as a measure of programme outcome: Results from the Singapore early psychosis intervention programme

Research paper thumbnail of An assessment of the understanding and motivations of patients with schizophrenia about participating in a clinical trial

Enrollment of an adequate number of subjects for a clinical trial is a perennial challenge and th... more Enrollment of an adequate number of subjects for a clinical trial is a perennial challenge and this might arguably be even more difficult and complex in trials involving patients with schizophrenia. In this paper, we used a modification of the Prospective Preference Approach (PPA) as a prelude to an actual randomized placebo-controlled trial of a cognitive-enhancing agent for patients with schizophrenia. This approach sought to test and enhance subjects' understanding of the key concepts of the trial, and administered the PPA at baseline and following a brief educational module. The motivations and concerns regarding potential participation in the proposed trial were also elicited by the PPA. Of one hundred ninety patients with schizophrenia recruited for this PPA study, only 12 (6.3%) were assessed to have understood all key trial-related concepts after the initial explanation and baseline PPA administration (prior to the educational module). Following the education module, however, there was significant increase in the number of patients who understood all key trial elements. Younger age and higher level of education were significant factors associated with better understanding of the proposed trial. The main reasons cited for wishing to participate in clinical trials were personal medical benefits and altruistic desire to help others. Concerns regarding the safety of the trial medication were expressed in over 80% of the subjects. PPA administration with educational module supplementation may provide a valuable addition to clinical trial procedures in patients with schizophrenia.

Research paper thumbnail of Peptic ulcer disease and mental illnesses

General hospital psychiatry

Research paper thumbnail of Single mothers have a higher risk of mood disorders

Annals of the Academy of Medicine, Singapore, 2014

Previous research has shown single mothers to be at greater risk for both physical and mental hea... more Previous research has shown single mothers to be at greater risk for both physical and mental health disorders as compared to married mothers. Psychiatric disorders, in particular depression, have been shown to be more prevalent in single mothers than married mothers. This study was aimed at comparing the prevalence of depression, other mood, and anxiety disorders in single and married mothers in a multiethnic Asian society. The Singapore Mental Health Study (SMHS) was a cross-sectional survey of the representative population of Singapore. The survey targeted Singapore residents aged 18 years and above. Trained interviewers established the diagnoses of mental disorders using the Composite International Diagnostic Interview version 3.0 (CIDI 3.0). Physical illnesses, social support and sociodemographic correlates were established using structured interviews. For the purpose of this study, single mothers were defined as unmarried, divorced/separated/widowed mothers who had children aged 21 years and below. Face-to-face interviews were completed with 6616 respondents from December 2009 to December 2010. After controlling for sociodemographic correlates in multiple logistic regression model, single mothers had significantly higher odds of having mood disorders (OR = 5.28) as compared to married mothers. Our study found that single mothers in Singapore across ethnicities, experienced a higher risk for mood disorders as elsewhere in the world. Single motherhood was also associated with lower age and education. Our study identifies young, single mothers as a vulnerable group associated with mental illnesses that must be targeted with specific interventions to improve mental health and well-being.

Research paper thumbnail of Patient-reported outcomes in obsessive-compulsive disorder

Dialogues in clinical neuroscience, 2014

The purpose of the article was to provide an overview of patient-reported outcomes (PROs) and rel... more The purpose of the article was to provide an overview of patient-reported outcomes (PROs) and related measures that have been examined in the context of obsessive-compulsive disorder (OCD). The current review focused on patient-reported outcome measures (PROMs) that evaluated three broad outcome domains: functioning, health-related quality of life (HRQoL), and OCD-related symptoms. The present review ultimately included a total of 155 unique articles and 22 PROMs. An examination of the PROs revealed that OCD patients tend to suffer from significant functional disability, and report lower HRQoL than controls. OCD patients report greater symptom severity than patients with other mental disorders and evidence indicates that PROMs are sensitive to change and may be even better than clinician-rated measures at predicting treatment outcomes. Nonetheless, it should be noted that the measures reviewed lacked patient input in their development. Future research on PROMs must involve patient perspectives and include rigorous psychometric evaluation of these measures.

Research paper thumbnail of Typology of people with first-episode psychosis

Early intervention in psychiatry, Jan 29, 2014

The aim of the current study was to create a typology of patients with first-episode psychosis ba... more The aim of the current study was to create a typology of patients with first-episode psychosis based on sociodemographic and clinical characteristics, service use and outcomes using cluster analysis. Data from all respondents who were accepted into the Early Psychosis Intervention Programme (EPIP), Singapore from 2007 to 2011 were analysed. A two-step clustering method was carried out to classify the patients into distinct clusters. Two clusters were identified. Cluster 1 comprised largely of younger people with mean age of 25.5 (6.0) years at treatment contact, who were predominantly male (55.3%), single (98.3%) and living with parents (86.3%). Cluster 1 had a higher proportion of people diagnosed with the schizophrenia spectrum disorder (71.4%) and with a positive family history of psychiatric illness. Patients in cluster 2 were generally older with a mean age of 33.6 (4.7) years and the majority were women (74.2%). Cluster 1 had people with higher Positive and Negative Syndrome Scale (PANSS) scores at baseline as compared with cluster 2. After a 1-year follow up, their scores were still poorer than their counterparts in cluster 2, especially for PANSS negative score. The functioning level of people in cluster 1 showed less improvement than the people in cluster 2 after a year of treatment. There is a compelling need to develop new therapies and intensively treat young people presenting with psychosis as this group tends to have poorer outcomes even after 1 year of treatment.

Research paper thumbnail of Suicidal ideation, suicidal plan and suicidal attempts among those with major depressive disorder

Annals of the Academy of Medicine, Singapore, 2014

The aims of the study were to identify the prevalence and sociodemographic and clinical correlate... more The aims of the study were to identify the prevalence and sociodemographic and clinical correlates of suicidal behaviours using data from a cross-sectional survey among those with major depressive disorder (MDD) in Singapore. The Singapore Mental Health Study (SMHS) was a cross-sectional epidemiological study that surveyed Singapore residents (Singapore citizens and permanent residents) aged 18 years and above. The assessment of mental disorders was established using version 3.0 of the Composite International Diagnostic Interview (CIDI 3.0). For the purposes of this study, suicidal behaviour was assessed by questions which were asked to respondents who answered positively to the screening questions in the CIDI 3.0 "Depression" module. The prevalence of suicidal ideation, plan and attempt among those with lifetime MDD was 43.6%, 13.7% and 12.3%, respectively. We found that suicidal ideation, plan and attempt were significantly associated with ethnicity, education and income. The rate of those who had sought some professional help was higher among those with suicidal plan (71.7%) and attempt (72.3%) as compared to those with suicidal ideation (48.7%) and those with MDD but no suicidal behaviour (29%). Individuals with MDD and suicidal behaviour do differ from their non-suicidal counterparts as they have a different sociodemographic and clinical profile. There is a need for more research and a better understanding of this population which in turn could lead to the development and implementation of relevant interventions.

Research paper thumbnail of Hoarding in an asian population: prevalence, correlates, disability and quality of life

Annals of the Academy of Medicine, Singapore, 2014

Hoarding is defined as the acquisition of, and inability to discard items even though they appear... more Hoarding is defined as the acquisition of, and inability to discard items even though they appear to others to have no value. The objectives of the study were to establish the prevalence of hoarding behaviour among the general population and among individuals with obsessive-compulsive disorder (OCD) in a cross-sectional study conducted in Singapore. The Singapore Mental Health Study was a cross-sectional epidemiological survey of a nationally representative sample of residents aged 18 years or older, living in households. The diagnoses of mental disorders were established using Version 3.0 of Composite International Diagnostic Interview (CIDI 3.0). Differences between 3 groups i.e. those diagnosed with lifetime/12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) OCD with hoarding, those diagnosed with lifetime/12-month DSM-IV OCD without hoarding and those with lifetime hoarding behaviour without diagnosis of DSM-IV OCD were determined. The weighted prevalence of lifetime hoarding behaviour was 2% and that of hoarding among those with OCD was 22.6%. Those who met the criteria for hoarding behaviour alone were associated with lower odds of having obsessions of contamination, harming, ordering as well as compulsions of ordering and other compulsions than those who met criteria for both OCD and hoarding. Hoarders without OCD were less impaired, in terms of comorbid psychopathology, than those with OCD with and without hoarding, and had a higher quality of life versus those with both OCD and hoarding, though still lower than that of the general population.

Research paper thumbnail of Prevalence of Dementia in People Aged 60 Years and Above: Results from the WiSE Study

Journal of Alzheimer's disease : JAD, Jan 11, 2015

Background: The challenge of an aging population with its expected attendant problem of an increa... more Background: The challenge of an aging population with its expected attendant problem of an increase in the number of people with dementia is a growing concern across the world. Objective: The aims of this study were to establish the prevalence and risk factors of dementia in Singapore among the elderly resident population (age 60 years and above). Methods: The WiSE study was a comprehensive single phase, cross-sectional, epidemiological survey that adapted the 10/66 protocol to establish the 10/66 and the Diagnostic and Statistical Manual of mental disorders -fourth edition (DSM-IV) diagnosis of dementia. 10/66 and DSM-IV dementia diagnosis as established by the survey questionnaires was validated by comparing against a gold standard of clinical assessment. Results: A total of 2,565 respondents completed the study giving a response rate of 65.6%. The validity of 10/66 dementia was higher (sensitivity = 95.6%, specificity = 81.8%) than that of DSM-IV dementia (sensitivity = 75.6%, specificity = 88.6%) when compared against the clinical gold standard. The study found that the prevalence of 10/66 dementia was 10% in the older adult population while the prevalence of DSM-IV dementia was 4.6%. Older age (75 years and above); no formal education, or completed primary education (versus higher education); homemaker and retired status (versus employed); and a history of stroke were associated with a higher risk of 10/66 dementia. Conclusion: The establishment of accurate data on the number of people with dementia is essential in the planning of services and initiatives.

Research paper thumbnail of Re-thinking internet gaming: from recreation to addiction

Research paper thumbnail of The Longitudinal Youth at Risk Study (LYRIKS) — An Asian UHR perspective

Schizophrenia Research, 2013

and sharing with colleagues.

Research paper thumbnail of Substance abuse in schizophrenia. A Singapore perspective

Social Psychiatry and Psychiatric Epidemiology, 2002

s Abstract Background Most of the information on the prevalence and patterns of substance abuse i... more s Abstract Background Most of the information on the prevalence and patterns of substance abuse in patients with schizophrenia has been from studies conducted in North America and Europe and data from Asian countries are conspicuously lacking. This study was undertaken with the aim to identify the prevalence and patterns of substance abuse among patients with firstepisode schizophrenia in the city-state of Singapore. Methods All new patients with a diagnosis of firstepisode schizophrenia or schizophreniform disorder who were seen in one calendar year in the only state mental institute in Singapore and its affiliated outpatient clinics were evaluated for a lifetime history of substance use. Results In a sample of 272 patients, 201 (73.6 %) were abstainers, 43 (15.8 %) had "mild" substance use and 28 (10.3 %) had "heavy" use patterns. Alcohol was the most frequently abused substance. The substance users were more likely to be males and were more likely to have a criminal record than abstainers. Conclusions To our knowledge, this is the first study that examines the co-morbidity of substance abuse in schizophrenia in an Asian population. Our findings once again highlight the fact that patients with schizophrenia are at a high risk for substance abuse. s

Research paper thumbnail of Clinical characteristics and associated factors in antipsychotic-induced akathisia of Asian patients with schizophrenia

We studied the prevalence of akathisia and its relationship to a number of sociodemographic and c... more We studied the prevalence of akathisia and its relationship to a number of sociodemographic and clinical factors in a population of Chinese inpatients with Schizophrenia. Six-hundred and forty-five patients were recruited for the study. Akathisia was assessed using the Barnes Akathisia Rating Scale (BARS), dyskinesia by the Abnormal Involuntary Movement Scale (AIMS) and extrapyramidal side effects (EPSE) were assessed by the Simpson-Angus Rating Scale (SARS). Only 35 (5%) patients were assessed to have akathisia. There was no gender or ethnic difference in the rates of akathisia. However, the majority of the patients (65%) were receiving an anticholinergic agent at the time of the study. Our findings of an overlap between TD and EPSE support the suggestion that there may be a common vulnerability for these movement disorders. The finding of a low rate of akathisia among our Asian patients suggests an inter-ethnic difference in the vulnerability for the development of akathisia. However, comparing our results with the rates reported from other countries may be hampered by the diagnostic and methodological differences across studies.

Research paper thumbnail of Reducing the duration of untreated psychosis and changing help-seeking behaviour in Singapore

This study was conducted to examine the impact of early detection strategies of an early psychosi... more This study was conducted to examine the impact of early detection strategies of an early psychosis intervention programme on the duration of untreated psychosis (DUP) and the pattern of help-seeking behaviour. Patients with first-episode psychosis were compared before and after the initiation of a programme of public education and networking with primary health care providers. These two groups were compared on the DUP and the change in the pattern of help-seeking. The DUP was significantly reduced from a median of 12 to median of 4 months (p=0.002, Mann-Whitney U-test). There was an increase in the proportion of self and family referrals, and a fall in the proportion of police referrals. Awareness campaigns which target multiple groups and use various modes of communication are effective in influencing the DUP and patterns of help-seeking.

Research paper thumbnail of Aggression in asian patients with first-episode psychosis

International Journal of Social Psychiatry, 2005

Aims: The aims of this study were to examine the prevalence and severity of aggression in patient... more Aims: The aims of this study were to examine the prevalence and severity of aggression in patients with first-episode psychosis and to identify the association between aggression and sociodemographic and clinical factors.

Research paper thumbnail of Diagnostic stability 2 years after treatment initiation in the Early Psychosis Intervention Programme in Singapore

Australian and New Zealand Journal of Psychiatry, 2007

To evaluate the diagnostic stability of psychotic disorders over a 2 year period in patients pres... more To evaluate the diagnostic stability of psychotic disorders over a 2 year period in patients presenting with first-episode psychosis. One hundred and fifty-four patients were recruited from an early psychosis intervention programme (EPIP). They were diagnosed by the attending psychiatrist using the Structured Clinical Interview for DSM-IV Axis I at first contact (baseline) and after 24 months. The diagnoses were classified into the following categories: schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder and schizoaffective disorder), affective psychosis (bipolar and major depressive disorders with psychotic symptoms), and other non-affective psychosis (delusional disorder, psychosis not otherwise specified and brief psychotic disorder). Two measures of stability, the prospective and the retrospective consistency were determined for each diagnosis. The diagnoses with the best prospective consistency were schizophrenia (87.0%) and affective psychosis (54.5%). The shift into schizophrenia spectrum disorder was the most frequent diagnostic change. Duration of untreated psychosis was found to be the only significant predictor of shift. It is difficult to make a definitive diagnosis at first contact. The clinical need to review the diagnosis throughout the period of follow up is emphasized.