44 research outputs found
Survey of psychiatrists on forensic psychiatric assessments in Singapore
No full textIntroduction: The quality of forensic psychiatry assessments in Singapore has come under recent criticism from the judiciary resulting in a loss of confidence in forensic psychiatric assessments. There is no local published standards or practice guidelines for forensic psychiatric assessments. We set out to survey local psychiatrists on various key aspects of local forensic psychiatric assessments. Methods: A survey was developed by two local senior psychiatrists with extensive experience in forensic psychiatry. It was sent out electronically to all Singapore registered psychiatrists. Results: The response rate was 33.6% (48 of 143 psychiatrists). Respondents agreed that risk assessment and management, capacity and competence assessments and critical appraisal of symptoms were specific forensic psychiatry skill sets. There was also a consensus that separation of treating versus assessment roles and an independent panel of psychiatrist would be useful. There was no clear consensus on which psychiatrists should perform forensic assessments or if language used and time taken for assessments were important. The estimated time for assessments ranged from 1.9 hour (SD 1.3) to 9.1 hours (SD 5.4) with time required for criminal > civil > capacity assessments. Private sector psychiatrists were more likely than public sector psychiatrists to feel that forensic psychiatric qualifications were not necessary to conduct forensic assessments. Conclusion: There is a consensus in the local psychiatric community on various key aspects of forensic psychiatric assessment. Stakeholders in forensic assessments should begin a dialogue on the way forward for forensic psychiatric assessments in Singapore
Association of electroconvulsive therapy with psychiatric readmissions in Singapore tertiary mood disorder unit
No full textMirror Readmission Study of the Association of Electroconvulsive Therapy With 1-Year Mood Disorder Readmissions in a Tertiary Mood Disorder Unit
No full textThe Impact of Electroconvulsive Therapy on Negative Symptoms in Schizophrenia and Their Association with Clinical Outcomes
No full textObjective: The treatment efficacy of electroconvulsive therapy (ECT) for negative symptoms amongst patients with schizophrenia remains unclear. In this study, we aim to examine the effects of ECT on negative symptoms in schizophrenia and their association with other clinical outcomes, including cognition and function. Methods: This is a retrospective data analysis of patients with schizophrenia/schizoaffective disorder treated with ECT at the Institute of Mental Health (IMH), Singapore, between January 2016 and December 2019. Clinical outcomes were assessed by the Brief Psychiatric Rating Scale (BPRS), the Montreal Cognitive Assessment (MoCA), and Global Assessment of Function (GAF). Changes in scores were compared with repeated measures analysis of variance. Sequential structural modelling was utilized to examine the pathway relationships between changes in negative symptoms, global functioning, and cognition functioning after ECT. Results: A total of 340 patients were analysed. Hence, 196 (57.6%), 53 (15.5%), and 91 (26.7%) showed improvements, no change, and deterioration in negative symptoms, respectively. ECT-induced improvement of negative symptoms was significantly associated with improvement of global functioning (direct effect correlation coefficient (r): −0.496; se: 0.152; p = 0.001) and cognition function (indirect effect r: −0.077; se: 0.037; p = 0.035). Moreover, having capacity to consent, more severe baseline negative symptoms, lithium prescription, and an indirect effect of voluntary admission status via consent capacity predicted ECT associated negative symptoms improvement. Conclusion: ECT is generally associated with improvements of negative symptoms in people with schizophrenia, which correlate with improvements of overall function. Possible novel clinical predictors of negative symptom improvement have been identified and will require further research and validation
A Retrospective Study of Patients Undergoing Acute Electroconvulsive Therapy for Predominately Manic or Mixed Episodes With and Without Lithium in Singapore
No full textQualities of a good Singaporean psychiatrist: Qualitative differences between psychiatrists and patients
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