Psychiatry - Research Publications
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ItemThe assessment of decision-making competence in patients with depression using the MacArthur competence assessment tools: A systematic review(WILEY, 2018-04)PURPOSE: This is a systematic review of the usefulness of the MacArthur Competence Assessment Tools (MacCAT) in assessing the decision-making competence in patients with depression. DESIGN AND METHODS: A systematic literature search was performed. FINDINGS: Eleven studies met the search criteria. The decision-making capacity was impaired in 9-31% of the patients with depression. There was inconsistency regarding the differences of MacCAT scores between patients with depression and controls, while relatively large effect sizes were found on the Appreciation and Reasoning MacCAT subscales. PRACTICE IMPLICATIONS: The MacCAT appears to be a useful tool for measuring decision-making capacity in patients with depression, but the association between depression and competence is not consistent. The mechanisms mediating such association are likely to be complex and multifactorial.
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ItemA comparison of clinical characteristics of older adults treated with antidepressants in general and psychiatric hospitals in Asia(WILEY, 2017-11)AIM: This study compared the demographics, clinical characteristics, and antidepressant prescription patterns between Asian patients aged 50 years and older attending psychiatric hospitals and those attending general hospitals. METHODS: In total, 955 patients (604 in general hospitals, 351 in psychiatric hospitals) aged 50 years or older treated with antidepressants in 10 Asian countries and territories were examined. Patients' demographics, clinical features, and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure. RESULTS: Binary logistic regression revealed that high income and diagnosis of schizophrenia were independently associated with psychiatric hospital treatment, whereas outpatient care, diagnosis of anxiety disorders, and multiple major medical conditions were independently associated with general hospital treatment. In addition, tetracyclic and noradrenergic and specific serotonergic antidepressants were more likely to be prescribed in general hospitals. CONCLUSION: Older adults treated with antidepressants showed different demographic and clinical features between general hospitals and psychiatric hospitals in Asia.
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ItemComparison of the 32-item Hypomania Checklist, the 33-item Hypomania Checklist, and the Mood Disorders Questionnaire for bipolar disorder(WILEY, 2017-06)AIM: Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD) and hence reliable and culturally appropriate screening tools are needed. This study compared the 32-item Hypomania Checklist (HCL-32), the 33-item Hypomania Checklist (HCL-33), and the Mood Disorders Questionnaire (MDQ) for BD. METHODS: Altogether, 350 depressed patients were included. The HCL-32, HCL-33, and MDQ were completed by patients to identify manic and/or hypomanic symptoms. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve among the HCL-32, HCL-33, and MDQ for BD and MDD were calculated and compared, using cut-offs suggested by respective validation studies. RESULTS: Of the three scales, the MDQ had the highest sensitivity and NPV (sensitivity = 0.90, 0.81, and 0.90 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively; NPV = 0.78, 0.86, and 0.86 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively), while the HCL-33 had the highest specificity and PPV (specificity = 0.74, 0.69, and 0.66 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively; PPV = 0.74, 0.55, and 0.56 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively). CONCLUSION: Compared to both HCL scales, the MDQ had higher sensitivity and lower specificity in screening for BD. These results contradict previous findings in Western populations. As a screening instrument for BD in Chinese clinical settings, the MDQ appears to be appropriate.
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ItemComparison of treatment patterns in schizophrenia between China and Japan (2001-2009)(WILEY, 2017-12)INTRODUCTION: To date no study has compared the treatment patterns for schizophrenia specifically between China and Japan. This study examined the cross-national differences in the use of psychotropic drugs and electroconvulsive therapy (ECT) in schizophrenia. METHOD: Data on 3248 schizophrenia inpatients (n = 1524 in China and n = 1724 in Japan) were collected by either chart review or interviews during the designated 3 study periods between 2001 and 2009. Patients' socio-demographic and clinical characteristics, prescriptions of psychotropic drugs, and ECT use were recorded using a standardized protocol and data collection procedure. RESULTS: Multivariate analyses revealed that compared to their Japanese counterparts, Chinese inpatients had a shorter length of current hospitalization, were significantly less frequently prescribed second-generation antipsychotics (except clozapine), antipsychotic polypharmacy, benzodiazepines, and mood stabilizers, and more likely to receive clozapine, antidepressants, and ECT. DISCUSSION: Substantial variations in inpatient treatment patterns for schizophrenia were found between China and Japan. The common use of ECT and clozapine in Chinese inpatients and the frequent use of antipsychotic polypharmacy and high antipsychotic doses in Japanese inpatients need to be addressed.
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ItemMemory Impairment Following Electroconvulsive Therapy in Chinese Patients with Schizophrenia: Meta-Analysis of Randomized Controlled Trials(WILEY, 2018-04)PURPOSE: To evaluate memory impairment associated with electroconvulsive therapy (ECT)-antipsychotic (AP) combination in comparison to AP monotherapy in schizophrenia. DESIGN AND METHODS: A systematic literature search of randomized controlled trial (RCTs) was performed. FINDINGS: Eleven RCTs that compared ECT-AP combination (n = 508) with AP monotherapy (n = 510) were analyzed. ECT-AP combination was associated with greater impairment than AP monotherapy in (1) endpoint memory quotient (MQ) of the Wechsler Memory Scale (WMS)-Revised at the end of the ECT course; and (2) picture recall, counting, recognition, and associative learning of the WMS. However, no group difference was found in MQ at 1 and 2 weeks post-ECT. PRACTICE IMPLICATIONS: The ECT-AP combination was associated with greater transient memory impairment compared to AP monotherapy.
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ItemQuality of life and clinical correlates in older adults living in the community and in nursing homes in Macao(WILEY, 2017-05)AIM: There have been no previous studies of quality of life (QOL) in older adults in Macao. This study aimed to examine QOL in relation to the sociodemographic and clinical characteristics of adults aged ≥50 years in Macao. METHODS: A sample of 451 subjects (203 living in the community, 248 living in nursing homes) was interviewed using standardized instruments. Basic sociodemographic and clinical data including QOL were collected. RESULT: There were no significant differences between the community and nursing home groups in any of the QOL domains. Multiple linear regression analyses revealed that poor physical QOL was significantly predicted by severe depressive symptoms, insomnia, major medical conditions, unmarried status, and lower education ( F 11,438 = 26.2, P < 0.001), which accounted for 38.2% of the variance. Poor psychological QOL was significantly predicted by severe depressive symptoms and lower educational level ( F 11,438 = 24.3, P < 0.001), which accounted for 36.4% of the variance. Poor social QOL was significantly predicted by severe depressive symptoms, male gender, and unmarried status ( F 11,438 = 5.6, P < 0.001), which accounted for 12.5% of the variance. Poor environment QOL was significantly predicted by lower educational level, severe depressive symptoms, and younger age ( F 11,438 = 6.6, P < 0.001), which accounted for 12.1% of the variance. CONCLUSION: Older Macanese adults had poorer scores on physical and social QOL domains than the general Hong Kong Chinese population. Their QOL was more strongly related to severe depressive symptoms, major medical conditions, and insomnia.
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ItemAdjunctive antidepressant use in schizophrenia in China: A national survey (2002-2012)(WILEY, 2017-01)OBJECTIVE: This study examined the pattern of adjunctive antidepressant use in schizophrenia patients and its demographic and clinical correlates in a nationwide survey in China. METHODS: Fourteen thousand and thirteen patients in 45 Chinese psychiatric hospitals or centers were interviewed (4,486 in 2002, 5,288 in 2006, and 4,239 in 2012). Patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Chi-square test, independent-samples t test, Mann-Whitney U test, and multiple logistic regression analysis were used in data analyses. RESULTS: Antidepressant use was found in 5.2% of the study population with 4.6% in 2002, 4.3% in 2006, and 6.9% in 2012, respectively. A significant increase in use from 2006 to 2012 was found (p < .001). Multiple logistic regression analyses in the whole population revealed that patients receiving adjunctive antidepressants were more likely to be outpatients in tertiary referral centers (level-III hospitals) and who had an earlier age of onset, less severe global illness, but more depressive symptoms. They were less likely to receive first-generation antipsychotics but more likely to receive benzodiazepines (R2 = 0.255, p < .001). CONCLUSIONS: Despite an increasing trend, the frequency of antidepressant use in schizophrenia in China was considerably lower than in Western countries. The benefits and risks associated with concomitant use of antidepressants in schizophrenia need to be studied further.
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ItemPrescribing patterns of psychotropic medications and clinical features in patients with major depressive disorder with and without comorbid dysthymia in China(WILEY, 2017-03)INTRODUCTION: Little has been reported about the demographic and clinical features of major depressive disorder (MDD) with comorbid dysthymia in Chinese patients. This study examined the frequency of comorbid dysthymia in Chinese MDD patients together with the demographic and clinical correlates and prescribing patterns of psychotropic drugs. METHODS: Consecutively collected sample of 1178 patients with MDD were examined in 13 major psychiatric hospitals in China. Patients' demographic and clinical characteristics and psychotropic drugs prescriptions were recorded using a standardized protocol and data collection procedure. The diagnosis of dysthymia was established using the Mini International Neuropsychiatric Interview. Medications ascertained included antidepressants, antipsychotics, benzodiazepines, and mood stabilizers. RESULTS: One hundred and three (8.7%) patients fulfilled criteria for dysthymia. In multiple logistic regression analyses, compared to non-dysthymia counterparts, MDD patients with dysthymia had more depressive episodes with atypical features including increased appetite, sleep, and weight gain, more frequent lifetime depressive episodes, and less likelihood of family history of psychiatric disorders. There was no significant difference in the pattern of psychotropic prescription between the 2 groups. CONCLUSIONS: There are important differences in the demographic and clinical features of comorbid dysthymia in Chinese MDD patients compared with previous reports. The clinical profile found in this study has implications for treatment decisions.
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ItemThe Relationship Between Sleep Patterns, Quality of Life, and Social and Clinical Characteristics in Chinese Patients With Schizophrenia(WILEY, 2017-10)PURPOSE: The purpose of the study was to determine the pattern of sleep behavior in schizophrenia patients treated in primary care. DESIGN AND METHODS: Altogether 623 schizophrenia patients in 22 primary care services were recruited. Sleep duration and demographic and clinical characteristics were recorded. FINDINGS: The mean expected total sleep time was 8.8 hr (SD 1.8) and the mean actual total sleep time was 8.2 hr (SD 2.1). The frequency of short, medium, and long sleepers was 18.1, 38.4, and 43.5%, respectively. Major medical conditions and any type of insomnia were independently associated with short sleep, while long sleep was associated with unemployment and use of second-generation antipsychotics. PRACTICE IMPLICATIONS: More attention should be paid to sleep duration in this population group.