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Bipolar disorder (BD) is a severe psychiatric disorder associated with a high risk of suicide. This meta-analysis examined the prevalence of suicide attempts (SA) in patients with BD and its associated factors.
A systematic literature search was conducted in the PubMed, PsycINFO, EMBASE and Web of Science databases from their inception to 11 June 2018. The prevalence of SA in BD was synthesised using the random-effects model.
The search identified 3451 articles of which 79 studies with 33 719 subjects met the study entry criteria. The lifetime prevalence of SA was 33.9% (95% CI 31.3–36.6%; I2 = 96.4%). Subgroup and meta-regression analyses revealed that the lifetime prevalence of SA was positively associated with female gender, BD-I, BD Not Otherwise Specified and rapid cycling BD subtypes, income level and geographic region.
This meta-analysis confirmed that SA is common in BD and identified a number of factors related to SA. Further efforts are necessary to facilitate the identification and prevention of SA in BD. Long-term use of mood stabilisers coupled with psycho-social interventions should be available to BD patients to reduce the risk of suicidal behaviour.
Suicide attempt is an important indicator of suicide and potential future mortality. However, the prevalence of suicide attempts has been inconsistent across studies. This meta-analysis aimed to examine the prevalence of suicide attempts in individuals with schizophrenia and associated correlates.
Relevant publications in Embase, PsycINFO, PubMed, Web of science and Cochrane were systematically searched. Data on the prevalence of suicide attempts in individuals with schizophrenia were pooled using a random-effects model.
Thirty-five studies with 16 747 individuals with schizophrenia were included. The pooled lifetime prevalence of suicide attempts was 26.8% (95% CI 22.1–31.9%; I2 = 97.0%), while the 1-year prevalence, 1-month prevalence and the prevalence of suicide attempts from illness onset were 3.0% (95% CI 2.3–3.7%; I2 = 95.6%), 2.7% (95% CI 2.1–3.4%; I2 = 78.5%) and 45.9% (95% CI 42.1–49.9%; I2 = 0), respectively. Earlier age of onset (Q = 4.38, p = 0.04), high-income countries (Q = 53.29, p < 0.001), North America and Europe and Central Asia (Q = 32.83, p < 0.001) were significantly associated with a higher prevalence of suicide attempts.
Suicide attempts are common in individuals with schizophrenia, especially those with an early age of onset and living in high-income countries and regions. Regular screening and effective preventive measures should be implemented as part of the clinical care.
Clozapine treatment increases the risk of agranulocytosis, but findings on the epidemiology of agranulocytosis have been inconsistent. This meta-analysis examined the prevalence of agranulocytosis and related death in clozapine-treated patients.
A literature search in the international (PubMed, PsycINFO, and EMBASE) and Chinese (WanFang, Chinese National Knowledge Infrastructure, and Sinomed) databases was conducted. Prevalence estimates of agranulocytosis and related death in clozapine-treated patients were synthesized with the Comprehensive Meta-Analysis program using the random-effects model.
Thirty-six studies with 260 948 clozapine-treated patients published between 1984 and 2018 were included in the meta-analysis. The overall prevalence of agranulocytosis and death caused by agranulocytosis were 0.4% (95% CI 0.3–0.6%) and 0.05% (95% CI 0.03–0.09%), respectively. The prevalence of agranulocytosis was moderated by sample size, study quality, year of publication, and that of data collection.
The prevalence of clozapine-associated agranulocytosis is low. Agranulocytosis-related death appears rare.
Suicide attempt (SA), which is one of the strongest predictors of completed suicide, is common in major depressive disorder (MDD) but its prevalence across epidemiological studies has been mixed. The aim of this comprehensive meta-analysis was to examine the pooled prevalence of SA in individuals with MDD.
A systematic literature search was conducted in PubMed, Embase, PsycINFO, Web of Science and Cochrane Library from their commencement date until 27 December 2017. Original studies containing data on prevalence of SA in individuals with MDD were analyzed.
In all, 65 studies with a total of 27 340 individuals with MDD were included. Using the random effects model, the pooled lifetime prevalence of SA was 31% [95% confidence interval (CI) 27–34%], 1-year prevalence was 8% (95% CI 3–14%) and 1-month prevalence was 24% (95% CI 15–34%). Subgroup analyses revealed that the lifetime prevalence of SA was significantly associated with the patient setting, study region and income level, while the 1-month prevalence of SA was associated with only the patient setting.
This meta-analysis confirmed that SA was common in individuals with MDD across the world. Careful screening and appropriate interventions should be implemented for SA in the MDD population.
The APEC Mental Health Roadmap has a vision to strengthen mental health and reduce the economic impact of mental illness in the Asia Pacific. To facilitate its implementation, the APEC Digital Hub will heighten exchange and dissemination of best practices in Asia Pacific mental health partnerships, and increase multi-sectoral recognition to invest in mental health to support economic growth.
This brief report examines the extent to which community-based treatment and integration support are provided for people living with mental illness across 15 selected Asia-Pacific economies. Some of the key findings are discussed in light of the diversity of economies and cultural contexts.
Little is known about the combined use of benzodiazepines and antidepressants in older psychiatric patients. This study examined the prescription pattern of concurrent benzodiazepines in older adults treated with antidepressants in Asia, and explored its demographic and clinical correlates.
The data of 955 older adults with any type of psychiatric disorders were extracted from the database of the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) project. Demographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Both univariate and multiple logistic regression analyses were performed.
The proportion of benzodiazepine and antidepressant combination in this cohort was 44.3%. Multiple logistic regression analysis revealed that higher doses of antidepressants, younger age (<65 years), inpatients, public hospital, major comorbid medical conditions, antidepressant types, and country/territory were significantly associated with more frequent co-prescription of benzodiazepines and antidepressants.
Nearly, half of the older adults treated with antidepressants in Asia are prescribed concurrent benzodiazepines. Given the potentially adverse effects of benzodiazepines, the rationale of benzodiazepines and antidepressants co-prescription needs to be revisited.
In this manuscript, we study the magnetic property of Al-doped/Al2O3-doped ZnO films. We found that metallic Al-doped ZnO film shows room temperature ferromagnetism (RTFM). RTFM is correlated with the interaction of Al metallic clusters and ZnO matrix. The charge transfer has been observed between metallic Al and ZnO matrix. Therefore, RTFM in metallic Al doped ZnO may be highly probable due to charge transfer between metallic Al clusters and ZnO matrix. For Al2O3-doped ZnO film (denoted as (Zn1-x, Alx)O), RTFM was found in (Zn1-x, Alx)O film with a certain Al concentration range (16 mol%<x<50 mol%). The saturation magnetization is maximized in (Zn0.70, Al0.30)O film. The mechanism of RTFM can be explained as the interaction of ZnO nanocrystals (NCs) embedded in the amorphous phase and defects surrounding them.
No one reacts or responds to a drug in exactly the same way, just as no two persons are exactly alike. Individual and ethnic differences in drug response have been consistently found in clinical practice. This book covers all the important factors that explain how and why drug treatments used in psychiatry affect individuals and ethnic groups differently. It will increase understanding of how biological differences interact with social, cultural and environmental factors to bring about overall effects of medications, particularly in individuals from various ethnicities. This book uniquely brings these varied aspects together to consider a holistic approach to drug therapy across diverse biological make-up and cultures. This information has direct practical use in the clinical setting.
Inter-individual and inter-ethnic differences in drug response have been regularly found in clinical practice. This is not surprising given the remarkable diversity in genetic polymorphisms, environmental factors, cultural contexts, and treatment settings. Although some of the key research reports and pertinent data have been summarized in previous chapters, systematically conducted studies in this field remain scarce, sporadic, and lacking in consistency (Lin et al., 1999). Ethnic and sociocultural variables are rarely analyzed or controlled in published studies on drug effects. Such paucity of cross-ethnic data exists even though there is widespread use of psychotropics to treat people with mental disorders globally. There are compelling reasons why research in this area is very much needed to understand cross-cultural differences in psychopharmacology better. There is significant demographic shift with increasing multicultural populations in both Western and non-Western societies. As a consequence, there has been a significant growth of cultural psychiatry internationally. For instance, Asians represent more than half of the global population, and all the major psychotropics are widely prescribed in Asia. With increasing pressure on the health dollar, there is a need to improve the cost-effectiveness of pharmacotherapeutic agents by reducing the morbidity and mortality of medication side effects occurring in drug-sensitive individuals and populations (e.g., in many parts of Asia). Given that factors involved in determining inter-ethnic differences in drug response are often similar to those responsible for inter-individual variations, advances in cross-ethnic psychopharmacology can contribute to greater understanding of individual differences as well (Lin et al., 1993).
Chee H. Ng, Department of Psychiatry, The University of Melbourne, St Vincent Hospital & The Melbourne Clinic, Victoria, Australia,
Steven Klimidis, Centre for International Mental Health, School of Population Health, The University of Melbourne, Victoria, Australia
The prescription and use of medications fundamentally involves a social transaction that carries both symbolic and social meanings based on the interactions between the patient, doctor, and their social environment (Moerman, 1979). Consequently medication uptake and use is considerably influenced by sociocultural factors, ultimately influencing therapeutic benefit, as first surmised by Murphy (1969). Cross-cultural and cross-ethnic differences in drug response are considerable, and beyond explanations based simply on the biological effects of the medication. Sociocultural factors include beliefs and expectations concerning the illness, the treatment and its mechanisms of action, compliance behavior, the role of the social network in using medicines, propensity to placebo effects, and use of alternative or concurrent herbal and other strategies from traditional medicines. The patient's willingness to accept medication is related to cross-cultural variability in drug tolerance and metabolism, as well as past experiences and current beliefs and perceptions held about psychiatric drugs.
Sociocultural, illness, and biological factors affect individual attitudes towards psychotropic medications. Health beliefs or explanatory models, particularly causal attributions regarding the illness and the treatment options afforded within such models, exert a profound influence on patients' attitudes and behavior regarding medications (Smith, Lin & Mendoza, 1993). Such effects can be subtle and can occur during the course of treatment even if there has been initial successful negotiation about the nature of the illness and treatment.
Pichet Udomratn, Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand,
Chee H. Ng, Department of Psychiatry, The University of Melbourne, St Vincent Hospital & The Melbourne Clinic, Victoria, Australia
Every country has its differences in the characteristics of psychiatric practice including those relating to prescribing psychotropic drugs. In Asian countries only limited data is available. Most of the earlier data involved Asian refugees or Asian patients born in Western countries and the results were also inconsistent (Bond, 1991). However, Asia covers a large geographical area and diverse populations with different physical features, cultural backgrounds, and dietary habits. The socioeconomic differences in Asian countries also have implications on the number of psychiatrists and mental health workers, and infrastructure for mental health services. A review of outpatients prescribing patterns hence can add to our understanding of important systemic and cultural determinants of psychotropic prescription in the management of major mental disorders. Furthermore, prescribing practice in outpatients services are reflective of real-life clinical settings and long-term exposure to psychotropics affecting patients.
Reports on prescribing psychotropic practice have mostly comprised antipsychotics in the treatment of schizophrenia and major psychoses. Studies can be broadly divided into “self-reported” questionnaires of prescribing habit or “revealed” data of actual prescription via for example an audit of psychotropic drug usage. An example of the former comes from a questionnaire given to practicing Asian psychiatrists after reading a case vignette of a 28-year-old unmarried businessman with a first episode of paranoid schizophrenia (Udomratn, 1999). The average daily dose of haloperidol that would be prescribed following the first week in the absence of any serious side effects was compared between psychiatrists across Asia.