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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.
Using data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) study, we aimed to present the rates and clinical correlates of suicidal thoughts/acts in patients recruited from a total of 40 centres in 10 Asian countries/areas: China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Singapore, Taiwan, and Thailand.
Data from 1122 patients with depressive disorders in the REAP-AD study were used. The ICD-10 was employed to diagnose depressive episodes and recurrent depressive disorder. The presence or absence of suicidal thoughts/acts and profile of other depressive symptoms was established using the National Institute for Health and Clinical Excellence guidelines for depression. Country/area differences in rates of suicidal thoughts/acts were evaluated with the χ2 test. In addition, depressive symptom profiles, other clinical characteristics, and patterns of psychotropic drug prescription in depressed patients with and without suicidal thoughts/acts were compared using analysis of covariance for continuous variables and logistic regression analysis for discrete variables to adjust the effects of covariates.
The rates of suicidal thoughts/acts in 10 countries/areas varied from 12.8% in Japan to 36.3% in China. Patients with suicidal thoughts/acts presented more persistent sadness (adjusted odds ratio [aOR]=2.64, p<0.001), loss of interest (aOR=2.33, p<0.001), fatigue (aOR=1.58, p<0.001), insomnia (aOR=1.74, p<0.001), poor concentration (aOR=1.88, p<0.001), low self-confidence (aOR=1.78, p<0.001), poor appetite (aOR=2.27, p<0.001), guilt/self-blame (aOR=3.03, p<0.001), and use of mood stabilisers (aOR=1.79, p<0.001) than those without suicidal thoughts/acts.
Suicidal thoughts/acts can indicate greater severity of depression, and are associated with a poorer response to antidepressants and increased burden of illness. Hence, suicidal thoughts/acts can provide a clinical index reflecting the clinical status of depressive disorders in Asians.
The escalating tendency of elderly population aged 65 and over, which grown up to 9% since 2001 in Taiwan, remarks the important issue of mental health among ageing population. Depression in the elderly is frequently undetected or inadequately treated. This study aimed to investigate the pharmacotherapy of elderly patients with depression by comparing the patterns of prescribing psychotropic drugs (psychotropics) of psychiatrists and non-psychiatrists.
A random sampling of 5% of inpatients from the National Health Insurance (NHI) database in Taiwan from 2001 to 2003 was selected. In all, 1058 (0.9%) inpatients aged 65 and older with a diagnosis of any depressive disorder were included. The psychotropic prescribing pattern and the dosages used were analysed and compared. Physician specialties were based on the record of NHI database. Non-psychiatrists were defined by physicians other than psychiatry.
A total of 88% of elderly depressed inpatients had two or more comorbid physical illnesses. The most commonly prescribed psychotropics were: antidepressants (71.4%), anxiolytics (62.6%) and hypnotics (51.4%). Psychiatrists had a higher rate of prescribing psychotropics, except anxiolytics, than non-psychiatrists. Although selective serotonin reuptake inhibitors were commonly prescribed, non-psychiatrists preferred the use of tricyclic antidepressants and moclobemide. Trazodone was the most preferred antidepressant, but was generally used in low dosages.
Psychiatrists generally utilised higher dosages of newer antidepressants than non-psychiatrists. Differences in the prescribing pattern of psychotropics existed between physician specialties. Further investigations are warranted to determine how the selection and dosing of drugs influence the outcome of depression on the elderly.
Background: This study examined the use of low doses of antipsychotic medications (300 mg/day CPZeq or less) in older Asian patients with schizophrenia and its demographic and clinical correlates.
Methods: Information on hospitalized patients with schizophrenia, aged 55 years or older, was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study (2001–2009). Data on 1,452 patients in eight Asian countries and territories including China, Hong Kong, Japan, Korea, Singapore, Taiwan, India, and Malaysia were analyzed. Sociodemographic and clinical characteristics and antipsychotic prescriptions were recorded using a standardized protocol and data collection procedure.
Results: The prescription frequency for low doses of antipsychotic medications was 40.9% in the pooled sample. Multiple logistic regression analysis of the whole sample showed that patients on low doses of antipsychotic medications were more likely to be female, have an older age, a shorter length of illness, and less positive symptoms. Of patients in the six countries and territories that participated in all the surveys between 2001 and 2009, those in Japan were less likely to receive low doses of antipsychotics.
Conclusion: Low doses of antipsychotic medications were only applied in less than half of older Asian patients with schizophrenia.
Few studies have prospectively examined psychosocial and psychiatric
predictors of adolescent substance use disorders simultaneously.
To identify psychosocial and psychiatric predictors of substance use
disorders in adolescence.
School children aged 12 years (s. d. =0. 3) free from any substance use
disorder at grade7(n=428) were assessed in three
consecutive years, using a standardised psychiatric interview. Their
baseline psychosocial information was also collected. The outcome was the
onset age of a substance use disorder. The Cox regression model was used
for data analysis.
The most significant predictive factors for adolescent substance use
disorder included male gender, attention-deficit hyperactivity disorder,
conduct disorder and sibling use of tobacco. Three protective factors
against such morbidity included living in a household with two parents, a
good academic grade at grade 7 and objection to the use of
Early intervention for disruptive behaviour disorders and specific
psychosocial risk factors might prevent substance use disorders in early
The sudden emergence of severe acute respiratory syndrome (SARS) caused international anxiety owing to its highly contagious and pandemic transmission. Health workers are vulnerable and are at high risk of infection.
To assess SARS-related stress and its immediate psychological impact and responses among health workers.
Health workers in a tertiary hospital affected by SARS were invited to complete a questionnaire designed to evaluate exposure experience, psychological impact and psychiatric morbidity. The risk and rates of psychiatric morbidity were estimated for exposure experience.
Altogether, 1257 health workers successfully completed the survey. In the initial phase of the outbreak, when the infection was spreading rapidly, feelings of extreme vulnerability, uncertainty and threat to life were perceived, dominated by somatic and cognitive symptoms of anxiety. During the ‘repair’ phase, when the infection was being brought under control, depression and avoidance were evident. The estimated prevalence of psychiatric morbidity measured by the Chinese Health Questionnaire was about 75%.
The outbreak of SARS could be regarded as an acute episode of a bio-disaster, leading to a significantly high rate of psychiatric morbidity.
Published studies of prevalence of depression in old age in Taiwan have yielded equivocal results.
To study the prevalence of depressive disorders among community-dwelling elderly; further, to assess socio-demographic correlates and life events in relation to depression.
A randomised sample of 1500 subjects aged 65 and over was selected from three communities. Research psychiatrists conducted all assessments using the Geriatric Mental State Schedule. The diagnosis of depression was made with the GMS–AGECAT (Automated Geriatric Examination for Computerised Assisted Taxonomy); data on life events were collected with the Taiwanese version of the Life Events and Difficulties Schedule.
One-month prevalence of psychiatric disorders was 37.7%, with 15.3% depressive neurosis and 5.9% major depression. A high risk of depressive disorders was found among widows with a low educational level living in the urban community, and among those with physical illnesses.
Contrary to most previous reports, we found that the prevalence of depressive disorders among the elderly in the community in Taiwan is high and comparable to rates reported in some studies of UK samples.
In his memorial speech given on the 30th anniversary of the Chinese Society of Psychiatry in Taiwan, the founder of the Society, Professor T. Lin, spoke on the evolution of psychiatry in Taiwan. He stressed that the “building up of psychiatry from almost nothing against all odds” just after World War II in an area where “the general attitude of the medical profession as well as the lay public to psychiatry was characterised by indifference and contempt arising from their ignorance and also prejudice against mental illness” (Lin, 1961) is like Robinson Crusoe surviving on his desert island. Today, the Society with its 518 members has had considerable success in the development of psychiatry in Taiwan.
A study of the validity of the 30- and 12-item versions of the Chinese Health Questionnaire (CHQ) was carried out with a consecutive sample of 386 patients admitted during one year to a medical centre in Taiwan for a 3-day comprehensive general health screening. The Chinese version of the Clinical Interview Schedule was used to derive a criterion measure of minor psychiatric morbidity.
The areas under the Relative Operating Charcteristic curves of both short versions of the CHQ were equivalent (area = 0·85, S.D. = 0·02). The sensitivities of the CHQ-30 and CHQ-12 were found to be 76 and 78% respectively, while the specificity of both was 77%. The estimated prevalence of minor psychiatric morbidity in the sample was 37% (95% confidence intervals 32–41%). In contrast, physicians diagnosed 11% of these patients as having psychiatric disorders, and their sensitivity was 29%.
Taken altogether, the above findings suggest that the CHQ-12 is as effective as and is more efficient than the CHQ-30 in this context, and could be used by physicians in similar settings to improve their identification of minor psychiatric disorders in Chinese patients.
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