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The second Singapore Mental Health Study (SMHS) – a nationwide, cross-sectional, epidemiological survey - was initiated in 2016 with the intent of tracking the state of mental health of the general population in Singapore. The study employed the same methodology as the first survey initiated in 2010. The SMHS 2016 aimed to (i) establish the 12-month and lifetime prevalence and correlates of major depressive disorder (MDD), dysthymia, bipolar disorder, generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD) and alcohol use disorder (AUD) (which included alcohol abuse and dependence) and (ii) compare the prevalence of these disorders with reference to data from the SMHS 2010.
Door-to-door household surveys were conducted with adult Singapore residents aged 18 years and above from 2016 to 2018 (n = 6126) which yielded a response rate of 69.0%. The subjects were randomly selected using a disproportionate stratified sampling method and assessed using World Health Organization Composite International Diagnostic Interview version 3.0 (WHO-CIDI 3.0). The diagnoses of lifetime and 12-month selected mental disorders including MDD, dysthymia, bipolar disorder, GAD, OCD, and AUD (alcohol abuse and alcohol dependence), were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.
The lifetime prevalence of at least one mood, anxiety or alcohol use disorder was 13.9% in the adult population. MDD had the highest lifetime prevalence (6.3%) followed by alcohol abuse (4.1%). The 12-month prevalence of any DSM-IV mental disorders was 6.5%. OCD had the highest 12-month prevalence (2.9%) followed by MDD (2.3%). Lifetime and 12-month prevalence of mental disorders assessed in SMHS 2016 (13.8% and 6.4%) was significantly higher than that in SMHS 2010 (12.0% and 4.4%). A significant increase was observed in the prevalence of lifetime GAD (0.9% to 1.6%) and alcohol abuse (3.1% to 4.1%). The 12-month prevalence of GAD (0.8% vs. 0.4%) and OCD (2.9% vs. 1.1%) was significantly higher in SMHS 2016 as compared to SMHS 2010.
The high prevalence of OCD and the increase across the two surveys needs to be tackled at a population level both in terms of creating awareness of the disorder and the need for early treatment. Youth emerge as a vulnerable group who are more likely to be associated with mental disorders and thus targeted interventions in this group with a focus on youth friendly and accessible care centres may lead to earlier detection and treatment of mental disorders.
To identify the common causal beliefs of mental illness in a multi-ethnic Southeast Asian community and describe the sociodemographic associations to said beliefs. The factor structure to the causal beliefs scale is explored. The causal beliefs relating to five different mental illnesses (alcohol abuse, depression, obsessive-compulsive disorder (OCD), dementia and schizophrenia) and desire for social distance are also investigated.
Data from 3006 participants from a nationwide vignette-based study on mental health literacy were analysed using factor analysis and multiple logistic regression to address the aims. Participants answered questions related to sociodemographic information, causal beliefs of mental illness and their desire for social distance towards those with mental illness.
Physical causes, psychosocial causes and personality causes were endorsed by the sample. Sociodemographic differences including ethnic, gender and age differences in causal beliefs were found in the sample. Differences in causal beliefs were shown across different mental illness vignettes though psychosocial causes was the most highly attributed cause across vignettes (endorsed by 97.9% of respondents), followed by personality causes (83.5%) and last, physical causes (37%). Physical causes were more likely to be endorsed for OCD, depression and schizophrenia. Psychosocial causes were less often endorsed for OCD. Personality causes were less endorsed for dementia but more associated with depression.
The factor structure of the causal beliefs scale is not entirely the same as that found in previous research. Further research on the causal beliefs endorsed by Southeast Asian communities should be conducted to investigate other potential causes such as biogenetic factors and spiritual/supernatural causes. Mental health awareness campaigns should address causes of mental illness as a topic. Lay beliefs in the different causes must be acknowledged and it would be beneficial for the public to be informed of the causes of some of the most common mental illnesses in order to encourage help-seeking and treatment compliance.
Serum thyroglobulin is used as a surrogate marker for well-differentiated thyroid carcinoma recurrence. This study investigates whether thyroglobulin measured at the time of ablative radioactive iodine therapy predicts disease-free survival.
A retrospective review was conducted of patients with well-differentiated thyroid carcinoma presenting from 1989 to 2010 at the Royal Prince Alfred Hospital, New South Wales, Australia. Disease-free survival of patients with a significantly elevated stimulated thyroglobulin level (27.5 µg/l or higher) at the time of ablative radioactive iodine therapy was compared to that of patients without a significantly elevated thyroglobulin level using univariate analysis.
Patients with a thyroglobulin level of 27.5 µg/l or higher had an increased relative risk of disease recurrence of 4.50 (95 per cent confidence interval = 1.35–15.04). If lateral neck dissection was required at the time of surgery, patients also had an increased relative risk of macroscopic disease recurrence of 4.94 (95 per cent confidence interval = 1.47–16.55).
An elevated thyroglobulin level of 27.5 µg/l or higher at the time of ablative radioactive iodine therapy is a prognostic indicator for macroscopic disease recurrence in well-differentiated thyroid carcinoma.
The dissociation channels of two prominent bound exciton complexes in wurtzite GaN thin films are determined via an extensive temperature dependent photoluminescence study. The shallow donor bound exciton dissociation at low temperatures (T ≤ 50 K) is found to be dominated by the release of a free exciton with thermal activation energy consistent with the exciton localization energy. At higher temperatures a second dissociation channel with activation energy EA = 28 ± 2 meV is observed. The dissociation of a bound exciton complex with exciton localization energy EXloc = 11.7 meV is also dominated by the release of a free exciton. In contrast to previous studies evidence is presented against the hypothesis of this emission being due to the exciton bound to an ionized donor. We find that it originates most likely from an exciton bound to a neutral acceptor.
Alterations in gray matter (GM) are commonly observed in schizophrenia. Accumulating studies suggest that the brain changes associated with schizophrenia are distributed rather than focal, involving interconnected networks of areas as opposed to single regions. In the current study we aimed to explore GM volume (GMV) changes in a relatively large sample of treatment-naive first-episode schizophrenia (FES) patients using optimized voxel-based morphometry (VBM) and covariation analysis.
High-resolution T1-weighted images were obtained using 3.0-T magnetic resonance imaging (MRI) from 86 first-episode drug-naive patients with schizophrenia and 86 age- and gender-matched healthy volunteers. Symptom severity was evaluated using the Positive and Negative Syndrome Scale (PANSS). GMV was assessed using optimized VBM and in 16 regions of interest (ROIs), selected on the basis of a previous meta-analysis. The relationships between GMVs in the ROIs were examined using an analysis of covariance (ANCOVA).
The VBM analysis revealed that first-episode patients showed reduced GMV in the hippocampus bilaterally. The ROI analysis identified reductions in GMV in the left inferior frontal gyrus, bilateral hippocampus and right thalamus. The ANCOVA revealed different patterns of regional GMV correlations in patients and controls, including of inter- and intra-insula, inter-amygdala and insula–postcentral gyrus connections.
Schizophrenia involves regional reductions in GMV and changes in GMV covariance in the insula, amygdala and postcentral gyrus. These findings were evident at the onset of the disorder, before treatment, and therefore cannot be attributable to the effects of chronic illness progression or medication.
The incidence of papillary thyroid cancer is rising, with an increase in the number of microcarcinomas being discovered. There is controversy in the literature regarding the optimal management of these tumours. This study aimed to review our institution's experience with the presentation and management of papillary thyroid microcarcinoma.
Retrospective analysis from the Sydney Head and Neck Cancer Institute, from 1987 to 2009.
A total of 228 patients were analysed. Papillary thyroid microcarcinomas were discovered incidentally in 116 (50.9 per cent) patients and non-incidentally in the remaining 112 (49.1 per cent) patients. Amongst the non-incidental group, 11.6 per cent of patients presented with lateral cervical lymph node involvement. Non-incidental microcarcinomas were significantly associated with younger age (<45 years) (p = 0.007) and larger tumours (5–10 mm) (p < 0.001). Only four patients in the incidental group suffered recurrent disease (locoregional). No patient developed distant metastatic disease or died during follow up.
Papillary thyroid microcarcinomas present both incidentally and non-incidentally, with equal prevalence. Non-incidental tumours not infrequently present with cervical lymph node disease. The patient outcome is generally excellent.
It is not clear whether the progressive changes in brain microstructural deficits documented in previous longitudinal magnetic resonance imaging (MRI) studies might be due to the disease process or to other factors such as medication. It is important to explore the longitudinal alterations in white-matter (WM) microstructure in antipsychotic-naive patients with first-episode schizophrenia during the very early phase of treatment when relatively ‘free’ from chronicity.
Thirty-five patients with first-episode schizophrenia and 22 healthy volunteers were recruited. High-resolution diffusion tensor imaging (DTI) was obtained from participants at baseline and after 6 weeks of treatment. A ‘difference map’ for each individual was calculated from the 6-week follow-up fractional anisotropy (FA) of DTI minus the baseline FA. Differences in Positive and Negative Syndrome Scale (PANSS) scores and Global Assessment of Functioning (GAF) scores between baseline and 6 weeks were also evaluated and expressed as a 6-week/baseline ratio.
Compared to healthy controls, there was a significant decrease in absolute FA of WM around the bilateral anterior cingulate gyrus and the right anterior corona radiata of the frontal lobe in first-episode drug-naive patients with schizophrenia following 6 weeks of treatment. Clinical symptoms improved during this period but the change in FA did not correlate with the changes in clinical symptoms or the dose of antipsychotic medication.
During the early phase of treatment, there is an acute reduction in WM FA that may be due to the effects of antipsychotic medications. However, it is not possible to entirely exclude the effects of underlying progression of illness.
Evidence shows that cognitive deficits and white matter (WM) dysconnectivity can independently be associated with clinical manifestations in schizophrenia. It is important to explore this triadic relationship in order to investigate whether the triplet could serve as potential extended endophenotypes of schizophrenia.
Diffusion tensor images and clinical performances were evaluated in 122 individuals with first-episode schizophrenia and 122 age- and gender-matched controls. In addition, 65 of 122 of the patient group and 40 of 122 controls were measured using intelligence quotient (IQ) testing.
The schizophrenia group showed lower fractional anisotropy (FA) values than controls in the right cerebral frontal lobar sub-gyral (RFSG) WM. The schizophrenia group also showed a significant positive correlation between FA in the RFSG and performance IQ (PIQ); in turn, their PIQ score showed a significant negative correlation with negative syndromes.
Overall, these findings support the hypothesis that WM deficits may be a core deficit that contributes to cognitive deficits as well as to negative symptoms.
Brain structure appears to alter after antipsychotic administration, but it is unknown whether these alterations are associated with improvement of psychopathology in patients with schizophrenia. In this study, the authors explore this relationship.
Altogether, 66 first-episode, drug-naive patients with schizophrenia and 23 well-matched healthy controls underwent brain magnetic resonance imaging scans at baseline. All 23 healthy controls and 42 of the patients were rescanned after 6 weeks follow-up. The patients received regular antipsychotic treatment during the 6-week period and their psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS) at baseline and 6 weeks. The difference in PANSS scores between baseline and 6 weeks was expressed as a ratio of the scores at baseline – ‘PANSS reduction ratio’. A modified tensor-based morphometry procedure was applied to analyse longitudinal images. Correlations between regional volume changes, PANSS reduction ratio and antipsychotic drug dosages were explored.
Compared with healthy controls, there was a significant increase in grey-matter volume of the right putamen in patients after 6 weeks treatment. This volume change was positively correlated with a positive PANSS reduction score but not related to drug dosages.
Putaminal volume increased after 6 weeks antipsychotic treatment in first-episode schizophrenia. The increased volume was closely correlated with improved psychopathology, suggesting the putamen might be a biomarker to predict the treatment response in schizophrenia.
Intersubband transitions (ISTs) in GaN/AlxGa1-xN multiple quantum wells (MQWs) were investigated using an optical absorption technique. Several samples were grown by either Molecular Beam Epitaxy (MBE) or Metal-Organic Chemical Vapor Deposition (MOCVD) and were investigated using both normal incident and waveguide configurations. The waveguides were fabricated by dicing each sample into 2 mm wide by 5 mm long pieces with two facets polished at 45 degrees with respect to the surface such that light propagates across the sample's width. Preliminary results indicate that ISTs are observable in Si-doped and undoped GaN/AlxGa1-xN MQWs. The source of these charge carriers in the undoped samples are explained as being due to the spontaneous polarization effect which exists at the GaN/AlxGa1-xN interfaces where the GaN surface has Ga-polarity. Scanning Electron Microscopy indicates that a sample containing what appeared to be a large number of cracks and or hexagonal voids lacked the presence of ISTs.
The optical absorption spectra of intersubband transitions in In0.3Ga0.7As/GaAs multiple quantum dots (MQDs) grown by molecular beam epitaxy were investigated. By varying the number of In0.3Ga0.7As monolayers deposited, a series of samples with varying dot sizes ranging from 10 – 50 monolayers were obtained. The quantum dots grown with size less than 15 monolayers or more than 50 monolayers did not yield any observable measurements of intersubband transition. This suggests that there exist a critical upper and lower limit of In0.3Ga0.7As quantum dots for infrared detectors. A wavelength range of 8.60 – 13.70 μm is achieved for structures grown with the above monolayers range. The theoretical line-shape of the intersubband transition absorption was compared to the experimental measurements. From the lineshape, it was deduced that bound-to-continuum transtition is present in thick quantum dots and bound-to-bound transition is present in thinly grown quantum dots.
The dissociation channels of two prominent bound exciton complexes in wurtzite GaN thin films are determined via an extensive temperature dependent photoluminescence study. The shallow donor bound exciton dissociation at low temperatures (T ≤ 50 K) is found to be dominated by the release of a free exciton with thermal activation energy consistent with the exciton localization energy. At higher temperatures a second dissociation channel with activation energy EA = 28 ± 2 meV is observed. The dissociation of a bound exciton complex with exciton localization energy Exloc = 11.7 meV is also dominated by the release of a free exciton. In contrast to previous studies evidence is presented against the hypothesis of this emission being due to the exciton bound to an ionized donor. We find that it originates most likely from an exciton bound to a neutral acceptor.
Luminescence imaging techniques such as Photoluminescence (PL) and Cathodoluminescence (CL) have been extensively used to characterize the optical properties of GaN. However, analysis using these techniques is limited to near surface regions and may not represent bulk material properties. This restricts the understanding of the defect-related yellow luminescence in GaN, which tends to originate at the interface region. In this work, we propose the use of MeV protons to probe several microns into a Epitaxial Lateral Overgrown GaN layer. Monte Carlo simulations of the ionization profile show that MeV ions have a much higher penetration depth than the keV electrons used in CL. The well-defined electronic energy loss peak or ‘Bragg peak’ at the end of range for MeV ions enables us to perform depth resolved imaging of the yellow luminescence distribution. Another advantage of using a MeV ion beam over keV electrons is the relatively small lateral spreading of ions in a material, making it a more suitable technique for providing high-resolution images of any buried defects in GaN.
We report the first observation of voids in sub-quarter micron Ti-salicided BF2-dopedpolycrystalline silicon (polySi) lines. Some of the voids, with sizes ranging from 10 to 100nm, can be clearly seen on the surface of the TiSi2 film whereas others are situated below the TiSi2 surface. The void density and size increase with decreasing polySi line-width, especially for line-widths < 0.24 µm. The voiding phenomenon was also observed to be moresevere for TiSi2 fabricated with enhanced salicidation techniques such as pre-amorphization-implant(PAl) and implant-through-metal (ITM) as compared to the conventional salicidationmethod without amorphization. The origin of the voids is found to coincide with the fluorinepeak at the TiSi2/polySi interface in the SIMS depth-concentration profiles.
We present a novel, simple, and accurate approach based on low frequency voltage fluctuations to determine the averaged carrier lifetime in semiconductor materials and devices. This technique serves to address the limitations faced by existing techniques that use light as the excitation source for lifetime measurement. In this paper, the minority carrier lifetime is inferred from the 1/f low frequency noise profile exhibited by the device during low current operation. The current dependence of the power spectral density and its relation to minority carrier lifetime is modeled and derived directly giving a current dependent carrier lifetime. This technique is solely based on the electrical noise and no light source is required for excitation. The low frequency noise can be easily acquired without significant distortion via a signal analyzer as long as there is a sufficiently good Ohmic contact between the probe and the device under test, and that the device is sufficiently shielded from the influence of EMI. This technique has lower crosstalk, fewer fitting parameters, is low cost and allows the lifetime to be extracted directly from data collected at lower frequencies. These characteristics make our method useful in encapsulated devices, applicable on wafers and devices in
The Low Frequency Noise (LFN) characteristics of Organic Light Emitting Diodes (OLEDs) were investigated in relation to device degradation. The standard layer structure of indium tin oxide (anode), hole transport layer, Alq3, Lithium Fluoride and Aluminium (cathode) was used. With duration of operation, the device degradation is characterized by an eventual drop in the luminance level and the electroluminescence efficiency. Additionally, the driving voltage at a fixed current and the LFN increase gradually during device degradation, accompanied with the formation of non-emissive areas (dark spots). It is found that the coefficient of correlation between voltage fluctuations across the device and low frequency fluctuations of the optical signals remains constant for an initial period and then decreases exponentially with duration of operation and is a sensitive parameter to predict OLED device lifetime. For a number of OLEDs driven at constant current, the device with higher initial correlation coefficient possesses a longer lifetime. The direct relation between LFN correlation and device lifetime can be explained by carrier recombination mechanisms at the microscopic level. An increase in trap density can reduce the internal radiative recombination rate which at the macroscopic level is reflected by a decrease in the correlation coefficient.
Abnormalities in the connectivity of white-matter (WM) tracts in schizophrenia are supported by evidence from post-mortem investigations, functional and structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). The aims of this study were to explore the microstructural changes in first-episode schizophrenia in a Han Chinese population and to investigate whether a family history of psychiatric disorder is related to the severity of WM tract integrity abnormalities in these patients.
T1-weighted MR and DT images were collected in 68 patients with first-episode schizophrenia [22 with a positive family history (PFH) and 46 with a negative family history (NFH)] and 100 healthy controls. Voxel-based analysis was performed and WM integrity was quantified by fractional anisotropy (FA). Cluster- and voxel-level analyses were performed by using two-sample t tests between patients and controls and/or using a full factorial model with one factor and three levels among the three sample groups (patients with PFH or NFH, and controls), as appropriate.
FA deficits were observed in the patient group, especially in the left temporal lobe and right corpus callosum. This effect was more severe in the non-familial schizophrenia than in the familial schizophrenia subgroup.
Overall, these findings support the hypothesis that loss of WM integrity may be an important pathophysiological feature of schizophrenia, with particular implications for brain dysmaturation in non-familial and familial schizophrenia.
We investigated cerebral structural connectivity and its relationship to symptoms in never-medicated individuals with first-onset schizophrenia using diffusion tensor imaging (DTI).
We recruited subjects with first episode DSM-IV schizophrenia who had never been exposed to antipsychotic medication (n=34) and age-matched healthy volunteers (n=32). All subjects received DTI and structural magnetic resonance imaging scans. Patients' symptoms were assessed on the Positive and Negative Syndrome Scale. Voxel-based analysis was performed to investigate brain regions where fractional anisotropy (FA) values significantly correlated with symptom scores.
In patients with first-episode schizophrenia, positive symptoms correlated positively with FA scores in white matter associated with the right frontal lobe, left anterior cingulate gyrus, left superior temporal gyrus, right middle temporal gyrus, right middle cingulate gyrus, and left cuneus. Importantly, FA in each of these regions was lower in patients than controls, but patients with more positive symptoms had FA values closer to controls. We found no significant correlations between FA and negative symptoms.
The newly-diagnosed, neuroleptic-naive patients had lower FA scores in the brain compared with controls. There was positive correlation between FA scores and positive symptoms scores in frontotemporal tracts, including left fronto-occipital fasciculus and left inferior longitudinal fasciculus. This implies that white matter dysintegrity is already present in the pre-treatment phase and that FA is likely to decrease after clinical treatment or symptom remission.