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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.
Previous cross-lagged studies on depression and memory impairment among the elderly have revealed conflicting findings relating to the direction of influence between depression and memory impairment. The current study aims to clarify this direction of influence by examining the cross-lagged relationships between memory impairment and depression in an Asian sample of elderly community dwellers, as well as synthesizing previous relevant cross-lagged findings via a meta-analysis.
A total of 160 participants (Mage = 68.14, s.d. = 5.34) were assessed across two time points (average of 1.9 years apart) on measures of memory and depressive symptoms. The data were then fitted to a structural equation model to examine two cross-lagged effects (i.e. depressive symptoms→memory; memory→depressive symptoms). A total of 14 effect-sizes for each of the two cross-lagged directions were extracted from six studies (including the present; total N = 8324). These effects were then meta-analyzed using a three-level mixed effects model.
In the current sample, lower memory ability at baseline was associated with worse depressive symptoms levels at follow-up, after controlling for baseline depressive symptoms. However, the reverse effect was not significant; baseline depressive symptoms did not predict subsequent memory ability after controlling for baseline memory. The results of the meta-analysis revealed the same pattern of relationship between memory and depressive symptoms.
These results provide robust evidence that the relationship between memory impairment and depressive symptoms is unidirectional; memory impairment predicts subsequent depressive symptoms but not vice-versa. The implications of these findings are discussed
Singapore is a multi-ethnic Asian society with a unique sociocultural and economic background. This is an overview of the characteristics of psychiatry in this nation in terms of service provision, mental health funding, education and training, and the challenges it faces in the midst of an evolving mental health landscape. Over the past 5 years, Singapore has maintained a closer tie with the Royal College of Psychiatrists through the the College's Membership examination.
Depression in the elderly is often associated with coexisting medical illnesses. We investigated the individual and combined impacts of depression and medical illnesses on disability and quality of life among community-living older persons.
Cross-sectional and longitudinal analyses of data from 1,844 participants aged 55 and above of the Singapore Longitudinal Aging Study (SLAS-1). Baseline depressive symptoms (Geriatric Depressive Scale, GDS≥5) and chronic medical comorbidity (≥2) from self-reports were related to baseline and 2-year follow up instrumental and basic activities of daily living (IADL-BADL), and quality of life (Medical Outcomes Study 12-item Short Form (SF-12) physical component summary (PCS) and mental component summary (MCS) scores.
The prevalence of depressive symptoms was 11.4%. In main effect analyses of cross-sectional and longitudinal relationships, depression and medical comorbidity were individually associated with higher risk of IADL-BADL disability and lower PCS and MCS scores of quality of life, and only medical comorbidity was associated with increased risk of hospitalization. Significant interactive effects of depression and medical comorbidity were observed in longitudinal relationships with IADL-BADL disability (p = 0.03), PCS (p < 0.01), and MCS (p < 0.01) scores at follow up. The associations of medical comorbidity with increased odds of IADL-BADL disability and decreased SF-12 PCS and MCS scores were at least threefolds stronger among depressed than nondepressed individuals.
Medical comorbidities and depression exert additive and multiplicative effects on functional disability and quality of life. The adverse impact and potential treatment benefits of coexisting mental and physical conditions should be seriously considered in clinical practice.
If the established winter excess in births of people who subsequently develop schizophrenia is an effect of ‘seasonality’, this would be testable by examining the pattern of births in an equatorial region with no formal seasons.
To investigate whether there is any variation in month of birth among patients from equatorial Singapore with a diagnosis of schizophrenia.
All 9655 patients discharged from Singapore's national psychiatric hospital with a diagnosis of schizophrenia were included (year of birth range 1930–1984). We analysed aggregated data, as well as the data of subsamples grouped according to birth-year periods, in order to examine secular trends. One patient subsample (those born 1960–84) allowed exact matching againstthe general population data set and close testing of any seasonal influence.
Monthly variation in births was evident for both patients and controls; the patterns were very similar, apart from the patient sample showing a trough in March–April.
In an equatorial region, where ‘seasons’ are absent, no seasonal excess in births of those later developing schizophrenia was evident.
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