Dear Editor, The advantages of employment for young people with mental health conditions (PMHC) are well known and documented,1 but many remain unemployed. Besides offering monetary benefits, employment provides a better self and social identity, helps the person gain a sense of personal achievement, and enhances mental well-being. Being unemployed...

Schizophrenia is one of the most debilitating severe mental illnesses with significant impact,1 irrespective of culture or socioeconomic class.2 Over the decades, antipsychotic medication has been the mainstay of treatment for patients with schizophrenia. Nevertheless, about 25% of patients do not respond to first-line antipsychotic medication, with more than...

The objective of a cervical screening programme is to prevent invasive cancer of the cervix by detecting and treating pre-invasive disease of the cervix. The impact of the programme depends both on the detection of women with cervical intraepithelial neoplasia (CIN) and upon their being treated effectively. This article is...

Schizophrenia is the most severe of all mental disorders and affects about 1% of the population. The main disturbances of schizophrenia comprise positive symptoms, negative symptoms and disorganisation. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Osteoporosis is becoming an increasing public health problem in most countries. Osteoporosis literally means “porous bones” and involves skeletal fragility leading to an increased risk of fracture. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Gout occurs in 3 overlapping phases: a long phase of asymptomatic hyperuricaemia, a period of recurrent acute gouty attacks separated by asymptomatic intervals (interval gout), followed in about 10% of patients by chronic tophaceous gouty arthritis. Gout is one of the better understood of the arthritic disorders, and certainly...

During the past two decades, close to one million Southeast Asian refugees of war have resettled in North America. Together with the already significant Asian immigrant population, they represent one of the fastest growing minority groups in the United States. This article is available only as a PDF. Please click...

Apart from the nasal bone, the mandible is the most commonly fractured bone in the face. It is also the 10th most often broken bone in the body. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

In the 1920s the government embarked on an ambitious programme to build hospitals, staffed largely by graduates of the King Edward College of Medicine. The “Mental Hospital”, commissioned and built by the British in 1928, was sited at Yio Chu Kang and spread out over 80 hectares of sprawling...

Selective serotonin reuptake inhibitors (SSRIs) are a new class of antidepressants which are effective, better tolerated with less side effects and more specific in receptor activity than the older tricyclic antidepressants. However, like tricyclic antidepressants and other groups of antidepressants such as the monoamine oxidase inhibitors (MAOIs) and the...

Pathologic skin picking may be defined as the habitual picking of skin lesions, which when chronic and extensive, can lead to significant distress, dysfunction and disfigurement. The underlying skin lesions may range from benign ones, e.g. barely noticeable irregularities of the skin, to more severe ones, e.g. acne, eczema,...

Trichotillomania was first described by a French dermatologist Hallopeau (1889) of a young man who pulled out his hair in tufts. The word trichotillomania is derived from the Greek thrix which means hair; tillein, to pull; and mania, madness or frenzy. This article is available only as a PDF. Please...

Twenty years ago, the therapy of glomerulonephritis (GN) was relatively simple as it was believed that treatment with prednisolone should be confined to patients with minimal change nephrotic syndrome and lupus nephritis. For those patients who failed to respond, they were treated with oral cyclophosphamide. This article is available only...

Trauma does not respect persons or culture. While Singapore is fortunate to have been spared large-scale disaster and war for decades, it has nevertheless had its share of traumatic incidents. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Department of Psychological Medicine, National University Hospital (NUH) has a 26-bedded inpatient unit. This study retrospectively examines the medical leave granted to all admitted patients over a one-year period in 1998. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

The management of mental health disorders within a nation requires a system of care extending from the primary health care setting to tertiary and specialist care settings. To that end, professional knowledge of the recognition, management and prevention of mental disorders is critical. This article is available only as a...

Schizophrenia, described as “the most human of all diseases,” affects about 0.5 % to 1% of the population and typically develops in the early 20s in men and the late 20s to early 30s in women. It is one of the most severe, if not the most severe, of...

In 1891, Morselli described “dysmorphophobia” in 78 patients who were severely miserable, preoccupied and distressed by perceived deformities. The word “dysmorphia” in Greek means ugly. Body dysmorphic disorder appeared in DSM-III in 1987. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Schizophrenia is a severe mental illness which causes enormous suffering, impaired social and occupational functioning, as well as higher mortality among the sufferers. The mainstay of treatment is neuroleptics which are largely effective for certain symptoms of this illness. This article is available only as a PDF. Please click on...

The incidence of mortality is higher among psychiatric patients than among the general population and the cause of which may be the psychiatric disorder itself or other related factors like life-style and medications. Reports of sudden deaths among patients taking psychotropic drugs have raised concerns that some of the...

Of all the sexual crimes committed, rape stands out as one of the most serious forms of sexual assault, yet there is a general lack of clinical information on convicted rapists in Singapore and elsewhere. We believe this to be the first such study in Singapore. This article is available...

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder seen by gastroenterologists and has been found to account for 50% of referrals to a Gastroenterology clinic. It has an estimated prevalence of between 15% and 25% in the non-patient population. This article is available only as a PDF....

There have been many reports on the use of conventional doses of cyclosporine A (CsA) in inducing remission among adults with minimal change nephrotic syndrome (MCNS), including those who fail steroids and cyclophosphamide therapy or who are steroid dependent and frequent relapsers. We report 3 cases which demonstrate the...

A review of five Western epidemiological studies of children aged 6 to 11 years revealed an average prevalence of 25% for psychiatric disorder (ranging from 12.4% to 48%). Asian studies show a similar prevalence range, with a 6.1% prevalence in a Malaysian study of 1- to 15-year-old children, a...

There is a trend in Asia towards a greater application of psychotherapeutic approaches in multidisciplinary settings to emotional and behavioural disturbances. The inaugural issue of Asian Psychologist announced landmarks in the education and training of clinical psychology in two major Asian communities. This article is available only as a PDF....

In their 1974 study, Burgess and Holmstrom1 interviewed a heterogeneous sample of 92 adult females admitted between 1972 and 1973 to the emergency ward of the Boston City Hospital with the presenting complaint of being raped. From the analysis of the responses of these women, the authors identified “an...

Stroke is the fourth leading cause of death and a leading cause of morbidity in Singapore. The number of hospital admissions for cerebrovascular disorders has been rising dramatically over the last few years, exceeding 10,400 in 2001. This article is available only as a PDF. Please click on “Download PDF”...

Thyroid dysfunction can give rise to various psychiatric symptoms. While there is a persistent interest in the role of thyroid axis in affective disorders, there is limited data on the interaction of thyroid dysfunction with psychotic disorders such as schizophrenia. This article is available only as a PDF. Please click...

In the course of their work, psychiatrists treat patients who, because of their mental disorders, may pose a danger to themselves and/or to others. What is the duty of the psychiatrist treating this patient? This article is available only as a PDF. Please click on “Download PDF” on top to...

Fractures, the most serious complication of osteoporosis, are increasing and constitute an evolving public health problem in terms of disability, mortality and cost. A paradigm shift in the management of osteoporosis has resulted from the development of techniques which can diagnose osteoporosis before fractures occur, and effective medications which...

Osteoporosis is regarded as an important public health problem in many Caucasian populations. Much of the research on epidemiology, diagnosis, treatment, genetic and molecular aspects has been carried out in the West. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Fibroids are the most common, solid benign pelvic tumours occurring in about 30% of women beyond the age of 30. They are asymptomatic in most women. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

This letter is in reference to Dr Ung’s article published in the Annals which investigated youth suicide and parasuicide in Singapore. The study of suicide has a very respectful tradition as many studies have led to the recognition of cultural and environmental risk factors. This article is available only as...

Colorectal carcinoma is the second commonest cancer in both males and females in Singapore, accounting for about 15% of all cancer cases. The liver is the most common site of distant metastases from colorectal cancer. This article is available only as a PDF. Please click on “Download PDF” on top...

Hypercalcaemia is a relatively common clinical problem with the widespread use of routine biochemical screening. Population studies have suggested a prevalence of 3% in women and <1% in men above the age of 60 years. This article is available only as a PDF. Please click on “Download PDF” on top...

From September 1998 to June 1999, there was an outbreak of viral encephalitis in several pig farming villages in Malaysia. The outbreak, which started in Ulu Piah, Tambun and Ampang near Ipoh in the state of Perak, later involved Sikamat, Sungai Nipah, Kampong Sawah and Bukit Pelanduk areas in...

Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms of shape/weight dissatisfaction and eating abnormalities. Anorexia nervosa is characterised by significant self-induced weight loss secondary to fear of fatness, amenorrhoea (cessation of menstruation for...

The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or herself in the knowledge, or expectation, of its fatal outcome. Parasuicide or attempted suicide is distinguished from suicide by the non-fatal outcome. This article is available...

The past 20 years have seen much growth in the knowledge of child and adolescent psychiatric practice. Research has provided an improved understanding in almost every area, including epidemiology, classification and treatment. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Severe acute respiratory syndrome (SARS) is the first severe and readily transmissible new disease to emerge in the 21st century (WHO). The countries most severely affected by this epidemic were Hong Kong, China, Taiwan, Canada and Singapore. This article is available only as a PDF. Please click on “Download PDF”...

Schizophrenia is a serious mental disorder with a profound impact on patients, their caregivers and society. The Global Burden of Disease lists schizophrenia among the top 10 contributors to health burden and disability around the world. This article is available only as a PDF. Please click on “Download PDF” on...

Autoimmune processes have been implicated in the pathogenesis of schizophrenia. Several pieces of indirect evidence point towards a role of autoimmune processes in at least some cases of schizophrenia. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Worldwide, asthma is estimated to affect between 5% and 10% of the population and, among adults, 4% to 9% of these cases have been attributed to an occupational cause. Yet, only 3 cases were reported and confirmed in Singapore in the year 2000 – an incidence of only 0.14/100,000...

Bile duct perforation (BDP) and biliary ascites in children is a rare clinical entity. The aetiopathogenesis is still elusive. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Buprenorphine is an opiate partial agonist that has been used for pain management, and in the past few years has been approved for the treatment of opioid dependence in Singapore and other countries. Buprenorphine is available in primary care clinics and can be prescribed by all licensed physicians who...

The use of 2 or more antipsychotic medications (polypharmacy) for an episode of psychosis is pervasive despite the lack of evidence-based data. It is also associated with higher daily dosing, more frequent use of adjunctive medications such as anticholinergic agents, higher rate of adverse effects and under-utilisation of atypical...

Opiate dependence is a major health and social concern in many countries across the world. The burden of disease is considerable, with surveys indicating that up to 2% of the population had used opiates for non-medicinal reasons. This article is available only as a PDF. Please click on “Download PDF”...

Traditionally the treatment of opioid dependence in Singapore has not been viewed as a public health problem, but rather as a social problem that necessitated custodial and other punitive approaches. The turning point came in 1996, when, after a pilot programme in the Prisons Department, naltrexone was introduced as...

Schizophrenia – a mind torn asunder – is a difficult illness to live with, both for the patient as well as for the caregiver; thus, it is not an uncommon sight to see the authorities bring such patients to our psychiatric practice, whether abandoned or simply lost. What was...

The first antidepressants were discovered 50 years ago by chance. Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) dominated the treatment of depression from the late 1950s until the late 1980s, when selective serotonin reuptake inhibitors (SSRIs) were introduced. This article is available only as a PDF. Please click on...

Foreign body (FB) ingestion in children is a frequent and frightening experience to the patients and caregivers. It is a common paediatric problem necessitating occasional immediate intervention to avoid serious complications. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

First-episode studies of schizophrenia have reported that the longer the duration of untreated psychosis (DUP), the poorer the response to antipsychotic medication and treatment outcome. The findings of these studies have led to the assertion that by reducing DUP, treatment outcome for schizophrenia and other related psychosis might be...

This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Status epilepticus (SE) describes a clinical condition characterised by an epileptic seizure or a series of seizures that lasts for at least 30 minutes without consciousness being regained.1 Some authors have added a time line of 60 minutes. The incidence of generalised convulsive status epilepticus (GCSE) is between 40...

Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020. This is equal to the burden due to wars and homicide, roughly twice the burden of diabetes and equal to the...

Mental disorders are prevalent worldwide and while they are disabling and costly, they have not received that amount of attention and resources needed. A recent survey of low-income and middle-income countries (as per World Bank classification) revealed that government spending on mental health is much lower than what is...

Epidemiological research has shown that mental disorders can result in considerable healthcare and other opportunity costs. There are some reports that have highlighted the negligence of mental health and the lack of recognition of the importance of mental disorders. This article is available only as a PDF. Please click on...

The complaint of insomnia is common and patients generally either self-medicate and/or consult primary healthcare providers. Referrals to a specialist for further management largely depends on the initial assessments and findings, the presence of comorbidity and/or difficulties in treating the underlying problems. This article is available only as a PDF....

The word suicide is derived from the Latin word suicidium, itself derived from sui (of oneself) and cidium (a killing; caedere = to kill. The word appears to have been first used around 1651, although the self-killing act itself is recorded in antiquity. This article is available only as a...

Overall, children spend one-third to one-half of their life sleeping. Although sleep comprises such a significant portion of a child’s day, sleep disturbances are often overlooked by healthcare practitioners. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a problem affecting about 10% to 15% of our school-going population in Singapore, affecting disease burden in virtually every medical subspecialty. This article is available only as...

Derived from ‘Hypnos’, the Greek God of sleep, the word hypnosis literally means sleep. Ironically, hypnosis is not a form of sleep but a state of increased concentration and awareness. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Attention deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder with various studies reporting prevalence rates of between 1.7% and 16%. The most current version of the Diagnostic and Statistical Manual of Diseases (DSM), fourth edition, has 2 lists of behavioural symptoms grouped under “inattentive” and “hyperactive-impulsive” symptoms,...

The management of idiopathic Parkinson’s disease is deceptively simple. Current practice, which consists of replacing dopamine on a twice or thrice daily regime may actually be responsible for causing the involuntary movements (dyskinesias) which were formerly thought to be inevitable in the disease and which occur in association with...

Neuropsychiatry can be described as the interface between neurology and psychiatry – the intersecting field of enquiry for both the brain and the mind. In more practical terms, it often, though not necessarily, narrows down to psychiatric comorbidities of neurologic diseases (e.g. depression in a patient with stroke) and...

Mental disorders are recognised as a major public health problem worldwide, and the management of mental health problems places an enormous burden on health services. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

There has been an explosive growth of Internet usage worldwide and this is expected to continue with its use becoming an integral part of everyday life. The Internet has become more accessible in homes, schools, colleges, libraries and Internet cafes; access is further aided with the increasing affordability of...

Despite perforated appendicitis (PA) being a common surgical emergency in childhood, controversy still exists with regard to its management in this era of minimal access surgery. Open appendicectomy (OA) has been accepted as the standard procedure for PA. However, OA has been associated with prolonged hospitalisation and significant complications...

Early psychiatric conceptions of successful mental health recovery traditionally focused on reducing or eradicating symptoms.1 The personal recovery movement of the early 1990s in the US prioritised a more holistic and consumer-driven understanding of recovery.2 This paradigm shift emphasises that recovery is best defined by people with lived experiences,...

Diabetes Mellitus (DM) is a serious chronic illness that imposes significant morbidity and mortality and has a major impact on the quality of life of the individuals suffering from this illness. Singapore, a multi-ethnic country in Southeast Asia, with Chinese, Malay and Indian as the three main ethnic groups,...

Hyperprolactinemia was found to be prevalent in a multi-centred study of 402 patients with schizophrenia, schizoaffective disorder and schizophreniform disorder treated with conventional antipsychotics and Risperidone. Antipsychotics inhibit the dopamine receptors and induce hyperprolactinemia via the tubulo-infundibular pathway, with subsequent downstream effects on multiple systems. This article is available only...

Multiple factors contribute to the genesis and maintenance of obesity which is a difficult condition to treat and weight loss is often not maintained. The psychological problems found in obese patients have recently received increasing attention. This article is available only as a PDF. Please click on “Download PDF” on...

In medicine, measures that save the most lives and improved the quality of life of millions have largely been public health measures that in most instances, had been preventive measures. The most obvious examples are the infectious diseases which were – to use the cliché – the scourge of...

The misuse of illicit opiates remains a global problem, placing a heavy burden on society. Literature on the effectiveness of opiate substitution pharmacotherapies in reducing consumption of illegal drug use, criminal activities, injecting and sharing behaviours, the spread of blood-borne diseases and mortality, now spans several decades and countries. This...

Acute coronary syndrome (ACS) is a life-threatening condition which benefits from prompt evaluation and proper treatment, such that it would be considered negligent for a physician not to consider it as a possible diagnosis in any patient presenting with acute symptoms of chest tightness or discomfort, palpitations, dyspnoea, diaphoresis,...

We would like to thank the author for suggesting that the definition of ADHD should be revised. This is an important consideration in the light of some of the points raised such as frequent comorbidities that occur with ADHD as is the case of Autistic disorder and other conditions...

I read with interest the article published in the Annals entitled “Attention Deficit Hyperactivity Disorder: Coping or Curing?”, which concluded that coping rather than curing for attention deficit hyperactivity disorder (ADHD) is taking place. There are some evidence-based points that should be noted. This article is available only as a...

Gambling has been defined as a wager of any type of item or possession of value upon a game or event of uncertain outcome in which chance, of a variable degree, determines the outcome. The failure to resist the impulse to gamble despite disruption to personal, family and vocational...

Weight gain is a serious side-effect with antipsychotic medication use. There is increasing evidence that with certain second-generation antipsychotics (SGA) weight gain liability is greater than with the high potency first-generation antipsychotics (FGA). This article is available only as a PDF. Please click on “Download PDF” on top to view...

Male breast cancer is a rare disease entity, traditionally said to represent <1% of all diagnosed breast cancers. Recent statistics, however, suggest that its incidence may be on the rise, although the clinical significance of this is unknown. This rarity has precluded large randomised controlled trials, and most treatment...

The Internet has in recent years become ubiquitous in the lives of young persons and children due to rapid information technology (IT) development, high speed wire connection, easy accessibility and increasing affordability. Its growth has also been fuelled by a huge customer demand created by social and print media,...

In Asia, various community programmes have been adopted and studied in several countries in an effort to promote de-institutionalisation, community psychiatric services and reduce relapses or readmission rates. In Manila, Philippines, the National Mental Hospital has successfully reduced hospitalisation by 70% after introducing the Acute Crisis Intervention Services (ACIS),...

Rhabdomyosarcoma (RMS) constitutes nearly 4% of all children diagnosed with cancer in the ethnically diverse small island city of Singapore. It is the most common primary soft tissue malignancy of childhood and one which is highly sensitive to chemotherapy and radiation therapy leading to excellent overall survivals. In KK...

Several studies have found adult height predictive of mental health and emotional well-being. A study of Swedish conscripts demonstrated an inverse association between height at age 18 to 19 and suicide mortality over 15 years of follow-up. Similarly, a study of Filipinos demonstrated an inverse association between height at age...

Times have changed. Maternal mortality rates at the start of the 1900s were around 1 in 100 live births in the best maternity institutions. This has declined by around 3 orders of magnitude in the last 100 years to about 3 in 100,000 live births in places like Singapore. Perinatal...

There has been growing interest in the use of dietary supplementation to treat psychiatric disorders. In particular, supplementation of omega-3 fatty acids has been researched as a potential means of preventing and managing psychopathology. These fatty acids are ingested through dietary sources (e.g. fish), with inadequate concentrations implicated in...

The management of schizophrenia has advanced considerably since the term was first coined in 1911, with Kraepelin’s early pessimism tempered by more recent evidence examining outcome. The discovery of antipsychotics represented a major breakthrough in the treatment of schizophrenia, while more recently we have witnessed promising initiatives such as...

The population in Singapore is ageing rapidly. According to statistics, by 2030, 1 in 2 adults in Singapore will be >65 years old. As the life expectancy of the population has improved significantly in the past few decades, a substantial portion of this rapidly ageing population will place a...

The seasonal haze in Southeast Asia has been a recurrent concern whenever we enter the southwest monsoon season (June–September). This phenomenon, caused by agricultural fires, has vast effects on multiple countries in the region. This article is available only as a PDF. Please click on "Download PDF" to view the...

Unhealthy diet is a modifiable risk factor in many health conditions, including mental disorders. Nutritional psychiatry is an emerging field that examines the role of diet and nutrition in mental health. Since its beginnings in the 2000s, a notable change in the field was a switch in focus from...

The World Health Organization has envisioned for every human being’s fundamental right to be able to enjoy the highest attainable standard of health, even in the presence of disease or infirmary. Singaporeans’ average life expectancy is projected to reach 85.4 years by the year 2040 and the burden of...

In this study, we assessed the impact of COVID-19 on the psychological well-being and burnout among staff who manage critically ill general surgery and trauma patients as part of the Acute Care Surgery (ACS) service at the Singapore General Hospital, Singapore. The ACS team may be exposed to COVID-19...

It is challenging to maintain the resuscitation skills of doctors in a psychiatric hospital. Our study describes a resuscitation course designed specifically for the Institute of Mental Health in Singapore to address competency gaps, which proved to be relevant and helpful to the trainees.   This article is available only as...

Early studies done in China during this COVID-19 pandemic have shown considerable mental health impact on healthcare workers (HCWs), especially those working on the frontline. HCWs exposed directly to COVID-19 may be affected not only by fears of contracting the virus and spreading it to their loved ones, but...

The COVID-19 pandemic began in late 2019 and was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. To decrease the spread of the virus and demand on the healthcare system, governments globally executed multiple public health measures including lockdown, social distancing, significant closure of...

The coronavirus disease 2019 (COVID-19) pandemic has disrupted societies globally. As of 11 May 2020, 53 children have been infected with COVID-19 in Singapore (Ministry of Health, Singapore, unpublished data). Children generally have mild disease, although there is emerging literature on paediatric multisystem inflammatory syndrome temporally associated with COVID-19....

On 30 January 2020, the World Health Organization (WHO) declared the outbreak of coronavirus disease 2019 (COVID-19) an international public health emergency after the number of cases soared across 34 regions in Mainland China and surpassed that of severe acute respiratory syndrome (SARS) in 2003. The virus was believed...

Gout is a common metabolic disease that causes arthritis which is often painful and sometimes disabling. It results from the deposition of monosodium urate monohydrate crystals in the joints and soft tissue giving rise to an acute inflammatory response. This article is available only as a PDF. Please click on...