Related Articles

Navigating health challenges: Singapore’s National University Health System’s approach to child and family well-being

Dear Editor, Singapore’s progressive commitment to addressing child and family well-being is anchored in its forward-thinking public health agenda. Recognising that long-term population health outcomes are shaped by early-life interventions, Singapore has directed increasing attention towards addressing complex health challenges that emerge during childhood and across the family unit. These...

Exploring the perspectives of child health strategy stakeholders on resilience and well-being in children and youths in Singapore: A qualitative study

Dear Editor, Resilience has been defined as the capacity of a dynamic system to adapt well to potential threats,1 while mitigating the negative impact of behavioural and physiological changes due to chronic stress,2 and the resumption of positive functioning thereafter.3 Resilience enables one to adapt positively to adversities in life...

Knowledge and attitudes towards sarcopenia among healthcare professionals

Dear Editor, Sarcopenia is the age-related loss of skeletal muscle mass as well as muscle strength and/or performance.1 Sarcopenia is an important public health issue as it has a significant impact on patient health outcomes, and personal and social economic outcomes. It leads to increased adverse outcomes such as increased...

Navigating the evolving landscape in the prescribing of medications for insomnia in Singapore: Principles and considerations from a psychiatrist’s perspective

The risks of prescribing benzodiazepines and Z-drugs for insomnia are well recognised by regulators, where the prescribing of such medications in contravention of guidelines has been the subject of regulatory action.1,2 Medical practitioners involved in the prescription of such medications need to grapple with complex clinical, legal, ethical and...

Pharmacogenomics in psychiatry: Practice recommendations from an Asian perspective (2024)

Pharmacogenomic testing in psychiatry is an emerging area with the potential clinical application of guiding medication choice and dosing. Interest in this area has been fanned by commercial pharmacogenomic providers, who have commonly marketed multiple-gene or combinatorial panels that are direct-to-consumer tests. However, this has not been adopted widely...

The promise and challenges of pharmacogenomics in psychiatry

Pharmacogenomics (PGx) is an expanding field within precision medicine that is poised to play a crucial role in optimising patient outcomes, particularly in the realm of psychiatry. The remission rate for the initial antidepressant prescribed in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial was only approximately 30%,...

Mental wellness and health-related quality of life of young adult survivors of childhood cancer in Singapore

Advancements in technology and cancer treatments have improved childhood cancer survival rates, with up to 85% surviving 5 years or more.1 The Malaysia-Singapore Leukaemia Study Group reported an improvement in overall 5-year survival for the past 20 years in Singapore, from 69% to 91% for acute lymphoblastic leukaemia, which...

Transcranial magnetic stimulation in psychiatry: A Singapore perspective

The use of repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) and obsessive-compulsive disorder (OCD) has not been described in Singapore. Reports on the effectiveness of rTMS in populations outside of Western countries are also limited. Thus, Ye et al.’s study on the naturalistic outcomes of rTMS...

Quality of life of children and young adults with Down syndrome from caregivers’ perspective: A systematic review and meta-analysis

Down syndrome (DS), with an incidence of about 1/1000 to 1/1100 live births1 is the most common autosomal trisomy and genetic cause of intellectual disability. Individuals with DS may have multiple comorbidities including congenital cardiac and gastrointestinal anomalies, obesity, sleep disorders, and visual and hearing impairments.2,3 Despite the comorbidities,...

Prevalence and risk factors of depression and anxiety in primary care

The global prevalence of individuals living with a mental disorder in 2019 was 970 million, with anxiety and depressive disorders being the most common.1 The Singapore Mental Health Study 2016 showed that the lifetime prevalence of at least one mood, anxiety or alcohol use disorder was 13.9% in the...

Illicit drug consumption in Singapore: Where are we in the fight against drugs?

Illicit drug consumption is associated with significant negative health, financial and social consequences. Yet, illicit drug consumption remains highly prevalent and continues to be a growing problem worldwide. In 2021, 1 in 17 people aged 15–64 in the world had used a drug in the past 12 months. Notwithstanding...

Asian media reporting on suicide: Concerning trends

Asharani et al. present an enlightening study of media influences on suicidality and suicides from multinational data, all within Asia.1 This is important, as knowledge based on media and suicide has been dominated by Western cultures and English and other European languages. Pulling together various independent studies, as Asharani...

Consensus statement on Singapore perinatal mental health guidelines on depression and anxiety

Perinatal mental health conditions have been recognised as a key area of focus by the World Health Organization, with the new guide published in September 20221 highlighting the importance of screening, diagnosis and management of perinatal mental health conditions that are integrated into maternal and child health (MCH) services....

Perinatal mental health in Singapore: Implementation opportunities and relevance of gender-carer roles in screening

In this issue of the Annals, the consensus statement on perinatal mental health by Chen et al. covers the handling of depression and anxiety symptoms in pregnancy, childbirth and the postnatal period.1 The guidelines were developed by a workgroup involving experts in perinatal mental health and obstetrics using a...

Impact of pre-existing depression on severe COVID-19 outcomes

The outbreak of the COVID-19 virus in 2019 had rapidly developed into a global pandemic, causing more than 6.8 million deaths and impacting the lives of billions of individuals around the world.1 Public healthcare around the work have mainly focused on the clinical manifestations and treatment of the deadly...

Investigating the stressors and coping mechanisms of students in medical school: A qualitative study

Dear Editor, Medical school can be a stressful experience for students, with burnout being increasingly common.1 Stressors in medical education include a heavy academic workload, pressure of good academic performance, and comparison with peers of high aptitude.2 Stress can be either beneficial or detrimental to development, depending on personal regulation...

Healthcare worker job burnout, anxiety and depression: A one-year comparison during COVID-19 in Singapore

Dear Editor, The mental health of our healthcare workforce has never been as scrutinised as it has the last three years since the COVID-19 pandemic. Worldwide, appreciation of healthcare workers (HCWs) as the first line of defence during the pandemic soared, even as studies of HCW mental wellness increased exponentially.1,2...

Risk and protective factors of mental health during the COVID-19 pandemic: A cross-sectional study in Singapore

The COVID-19 pandemic has significantly impacted people’s well-being globally.1 Individuals faced several stressors during the pandemic, including fear of contracting the disease, experiencing severe symptoms of COVID-19, losing loved ones to the disease, financial insecurity, and social isolation. Furthermore, children and youths experienced disruption to their usual routine such...

Impact of COVID-19 on mental health and social service provision in Singapore: Learnings from a descriptive mixed-methods study for future resource planning

Coronavirus disease 2019 (COVID-19) was declared a global health emergency by the World Health Organization in January 2020.1 Singapore reported its first case of COVID-19 on 23 January 2020 and the subsequent emergence of clusters led to a string of restrictions to contain the outbreak and protect the health...

Impact of COVID-19 on mental health and healthcare service delivery

The COVID-19 pandemic has claimed more than 6.8 million lives globally.2 While there is yet a cure for the disease, vaccines are now available to minimise transmission risk and protect against severe infection. However, COVID-19 vaccines have had a mixed reception, with concerns of their side effects and of...

Self-esteem and positive body image to overcome female sexual dysfunction

Human sexuality is arguably one of the main pillars of health, like nutrition and sleep. Improvements in diagnostic and therapeutic biotechnologies have enabled focus on not only deadly diseases, but also on the quality of life and sexual functions of men and women. Digital media also play a considerable...

Exploring loss and grief during the COVID-19 pandemic: A scoping review of qualitative studies

As of mid October 2022, the World Health Organization recorded that more than 620 million people worldwide have been infected by SARS-CoV-2, the virus causing COVID-19, while over 6.5 million have succumbed to the disease. Many have lost family members and friends as well as jobs and familiar lifestyles,...

The impact of COVID-19 pandemic on loss and grief

As of 17 October 2022, the COVID-19 pandemic has claimed more than 6.5 million lives globally, with 1,639 deaths reported in Singapore.1 With numerous countries imposing measures such as lockdowns and social distancing measures that isolate individuals, there has been a steady increase in a variety of mental disorders...

Prevalence of perceived weight-based stigmatisation in a multiethnic Asian population

Dear Editor, People with obesity contend with obesity-related stigmas, in addition to health complications.1 In contrast to the West, literature documenting the prevalence of such stigmas in Asia is sparse. We report the prevalence of perceived weight-based stigmatisation in Singapore. An anonymised questionnaire was administered to 101 consecutive patients presenting to...

Screening for somatisation in an Asian children’s hospital emergency setting

Dear Editor, In recent years, self-harm is the leading cause of morbidity and mortality among adolescents in Singapore.1,2 This is just the tip of the iceberg as youths with undiagnosed mental health disorders often present to the healthcare system with non-psychiatric symptoms.3 These psychosomatic symptoms do not have an organic...

The global emergence of monkeypox

Monkeypox is so named because the poxvirus was first identified in 2 outbreaks among cynomolgus monkeys housed at the Statens Serum Institut, Denmark, in 1958.1 Both outbreaks occurred approximately 2 months after the monkeys arrived by plane from Singapore.1 However, the natural reservoir of the virus is not monkeys...

Prevalence of burnout among healthcare professionals in Singapore

Burnout was first described in 1974 by Herbert Freudenberger, where he discussed the concept based on physical signs, behavioural indicators, judgment, emotional factors, and the preventive measures to avoid burnout.1 In 2019, the World Health Organization defined burnout as an occupational phenomenon in the International Classification of Diseases 11th...

Bridging electroconvulsive therapy in schizophrenia with cognition and quality of life

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...

Prevalence and correlates of psychological distress and coronavirus anxiety among hospital essential services workers in Singapore

The Coronavirus Disease 2019 (COVID-19) has affected almost all geographies in the world since 2020. Many countries have imposed strict isolation measures to contain the spread of this disease. While the majority of the population has been working from home, essential workers continue manning the frontlines, facing risks such...

Use of Atypical Neuroleptics in a State Mental Institute

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.

Somatisation among Asian Refugees and Immigrants as a Culturally-shaped Illness Behaviour

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...

How the Mental Hospital was Renamed Woodbridge Hospital in 1951

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 Inhibitor Discontinuation Symptoms

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...

Under-diagnosed Psychiatric Syndrome II: Pathologic Skin Picking

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,...

A Clinical Study of Seven Cases of Trichotillomania in Singapore

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...

Under-diagnosed Psychiatric Syndrome I: Trichotillomania

Trichotillomania (TTM) is a chronic psychiatric condition characterised by uncontrollable, self-inflicted, hair pulling, resulting in noticeable hair loss. First described by Hallopeau a century ago, it was previously regarded as an obscure condition. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Psychological Trauma, Physical Health and Somatisation

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.

Medical Leave Granted to Psychiatric Inpatients—A One-year Retrospective Review

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...

Mental Health Literacy in Singapore: A Comparative Survey of Psychiatrists and Primary Health Professionals

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...

Identification of Genes for Schizophrenia Susceptibility

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...

Muscle Dysmorphia in a Young Chinese Male

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...

Contrasting Clozapine Prescribing Patterns in the East and West?

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 moderating effect of employment status on the relationship between lifetime major depressive disorder and positive mental health

Studies across the world have reported a high prevalence of mental disorders,1-3 highlighting that mental disorders remain one of the major causes of “non-fatal burden”.4 In particular, major depressive disorder (MDD) has been identified as a highly prevailing mental disorder and the leading cause of disability worldwide. More than...

The relationship between major depressive disorder and employment status

Major depressive disorder is associated with executive dysfunction that includes impairment in problem-solving and decision-making,1 as well as with occupational impairment.2 One of the challenges during the COVID-19 pandemic has been to maintain employment status. It has been reported that employment status is associated with measures of quality of...

Cardiac Effects of Psychotropic Drugs

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...

Men Who Commit Rape in Singapore

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...

Psychiatric Illness, Personality Traits and the Irritable Bowel Syndrome

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....

Behavioural Disorders in Childhood: A Singapore Perspective

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...

The Views of Mental Health Professionals Towards Psychotherapy—A Singapore Survey

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....

Pilot Study to Assess the Viability of a Rape Trauma Syndrome Questionnaire

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...

Thyroid Dysfunction in Chronic Schizophrenia Within a State Psychiatric Hospital

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...

Mental Disorders and Public Safety of the Community at Large—Does the Tarasoff Principle Apply in Singapore?

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...

Preventing Youth Suicide

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...

Eating Disorders in Singapore: A Review

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...

Youth Suicide and Parasuicide in Singapore

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...

Five-Year Review of Adolescent Mental Health Usage in Singapore

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...

Stress among emergency medicine residents during the COVID-19 pandemic: A qualitative study

Dear Editor, The COVID-19 pandemic has disrupted medical education1,2 and distressed clinicians.3,4 Understanding the impact of this pandemic on emergency medicine (EM) residents’ experience of stress will allow for more effective interventions to aid residents, while reducing attrition and its impact on pandemic response. We present our qualitative study, guided by...

Post-SARS Psychological Morbidity and Stigma Among General Practitioners and Traditional Chinese Medicine Practitioners in Singapore

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”...

A Risk Reduction Approach for Schizophrenia: The Early Psychosis Intervention Programme

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...

Interleukin-2 Levels in Chronic Schizophrenia Patients

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.

Abuse of Prescription Buprenorphine, Regulatory Controls and the Role of the Primary Physician

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...

Reducing Polypharmacy Through the Introduction of a Treatment Algorithm: Use of a Treatment Algorithm on the Impact on Polypharmacy

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...

Socio-demographic Profile and Help-seeking Behaviour of Buprenorphine Abusers in Singapore

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”...

Medicalising the Treatment of Opioid Dependence

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...

“The one” Annoying Patient

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 Risk of Suicidality with Selective Serotonin Reuptake Inhibitors

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...

Clinical and Social Correlates of Duration of Untreated Psychosis in First-episode Psychosis Patients

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...

Attitudes of First-year Medical Students in Singapore Towards Older People and Willingness to Consider a Career in Geriatric Medicine

With the exponential increase in the elderly population in Singapore, the training of young physicians of tomorrow in the care of elderly patients will need to change accordingly. A potential way to fulfill this need is to increase the number of specialists proportionately to manage elderly patients effectively. This article...

The Media and Suicide

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...

Performance Measures for Mental Healthcare in Singapore

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...

Evidence-based Medicine (EBM) for Undergraduate Medical Students

The practice of evidence-based medicine (EBM), which integrates individual clinical expertise with the best available evidence from systematic research, demands a set of skills. These skills help clinicians retrieve, appraise and apply the current best evidence. This article is available only as a PDF. Please click on “Download PDF” on...

Mental Health Professionals’ Perceived Barriers and Benefits, and Personal Concerns in Relation to Psychiatric Research

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...

Pathways to Specialist Care in an Insomnia Clinic at a Psychiatric Hospital: A Comparative Analysis of Two Periods

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....

Suicide

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...

Behavioural Sleep Disorders in Children and Adolescents

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.

Hypnotherapy for Sleep Disorders

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.

Sleep Disturbances in Singaporean Children with Attention Deficit Hyperactivity Disorder

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,...

Neuropsychiatry – An Emerging Field

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...

Providing Integrated Mental Health Services in the Singapore Primary Care Setting – the General Practitioner Psychiatric Programme Experience

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.

Prevalence and Correlates of Excessive Internet Use among Youth in Singapore

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...

Surgical Training in Singapore: Will Patients Consent to Trainee Surgeons Performing Their Operations?

Teaching, training, appraising and assessing doctors and students are important for the care of patients now and in the future.1 In most hospitals, trainee surgeons play a substantial role in providing healthcare and surgical services, under the supervision of a consultant. The Departments of Hand Surgery and Orthopaedic Surgery...

A Brief History of the Chapter of Psychiatrists

The Inaugural Meeting of the Chapter of Psychiatrists and Chapter of Pathologists, Academy of Medicine, was held on 5 December 1986 at King’s Hotel.1,2 At that time the Academy already had 7 Chapters in her fold. The Chairman, Dr Lawrence Chan (then Master of the Academy of Medicine) remarked...

The personal recovery movement in Singapore – past, present and future

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,...

Impact of Depression on Health Related Quality of Life in Patients with Diabetes

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,...

Management of a Patient with Schizophrenia and Underlying Pituitary Macroadenoma

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...

Psychological Symptoms in People Presenting for Weight Management

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...

Preventive Psychiatry

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...

Monthly Take-Home Methadone Maintenance Regime for Elderly Opium-Dependent Users in Singapore

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...

Panic Attack and its Correlation with Acute Coronary Syndrome – More Than Just a Diagnosis of Exclusion

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,...

Junior Doctors’ Attitudes Towards Older Adults and its Correlates in a Tertiary-care Public Hospital

Singapore is a rapidly ageing society. The proportion of older persons above the age of 65 was 6.8% of the population in 1995 and is projected to increase to 20% by the year 2030. The medical community is also faced with a similar problem in caring for an ageing...

Reply from Author: Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?

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...

Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?

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...

Socio-demographic Profile and Psychiatric Comorbidity of Subjects with Pathological Gambling

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 in Asian Patients on Second-generation Antipsychotics

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...

The Health-Related Quality of Life of Junior Doctors

It is widely reported that junior doctors experience a large amount of work-related stress and fatigue. This has detrimental effects both on the well-being of the junior physicians and the health and well-being of the patients that they are treating. Junior doctors, especially those undergoing traineeship, have shown high...

Where do People with Mental Disorders in Singapore go to for Help?

Not only are mental disorders prevalent in any country, it is also common that many of those with mental disorders are neither seeking nor receiving help. This is the case even in developed countries: of the 31% of the US population affected by at least one mental illness, 67%...

Effectiveness of Assertive Community Management in Singapore

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),...

Height and Mental Health and Health Utility Among Ethnic Chinese in a Polyclinic Sample in Singapore

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...

You Are Worth More Than What You Weigh: Preventing Eating Disorders

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...

An Analysis of Blinding Success in a Randomised Controlled Trial of Fish Oil Omega-3 Fatty Acids

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...

Schizophrenia as a Lifelong Illness: Implications for Care

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...

Integrating mental healthcare in primary care in Singapore

Management of mental health conditions can be both resource-intensive and costly. The rigour of obtaining appointments and the long waiting time at tertiary hospitals, coupled with the need to obtain leave from work form a significant financial and logistical burden on patients for the treatment of mental health conditions....

Prehabilitation and Its Role in Geriatric Surgery

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...

Seasonal haze: Knowledge gaps and risk perception behaviours

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...

Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study

Several reviews and meta-analyses have established an association between unemployment and psychological distress. This relationship between unemployment and mental health is complex and likely bidirectional. On the one hand, unemployment may lead to psychological distress and mental disorders (social causation), but on the other, those with poor mental health...

Dietary intake of persons with depressive and psychotic disorders in Singapore

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...

Nutritional psychiatry: The next frontier in mental health treatment

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...

Stress and resilience of paediatric healthcare workers during COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has caused multiple changes in healthcare systems as governments implement measures to boost acute services. Healthcare workers (HCWs) across different specialties are reported to have decreased quality of life and increased stress, further aggravated during the pandemic. This article is available only as a...

Impact of COVID-19 on mental health and occupational burnout in a surgical unit in Singapore

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...

A resuscitation course designed for a psychiatric hospital

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...

Psychosocial impact of the COVID-19 pandemic on paediatric healthcare workers

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 impact of COVID-19 pandemic on global mental health: From the general public to healthcare workers

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...

Autism Spectrum Disorder and COVID-19: Helping Caregivers Navigate the Pandemic

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....

Mental Health Strategies to Combat the Psychological Impact of Coronavirus Disease 2019 (COVID-19) Beyond Paranoia and Panic

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...