Showing papers by "Chee H. Ng published in 2009"

Sexual side-effects of contemporary antidepressants: review

Abstract: The aim of the present study was to review the sexual side-effects of contemporary antidepressants in Australia, comparing the selective serotonin re-uptake inhibitors (SSRIs) with venlafaxine, reboxetine, mirtazepine, duloxetine, bupropion, desvenlafaxine and agomelatine. Double-blind, randomized comparative studies of these antidepressants that included assessment of sexual dysfunction with validated rating scales in patients with major depressive disorder were identified from the literature using MEDLINE, EMBASE and PsychINFO databases. Bupropion and duloxetine caused significantly less sexual dysfunction than the SSRIs in short-term studies and reboxetine significantly less in both short- and longer term studies. Bupropion and agomelatine caused significantly less sexual dysfunction than venlafaxine. The evidence for mirtazepine having an advantage over the SSRIs is lacking and there are currently insufficient data for desvenlafaxine. Well-designed comparative studies of contemporary antidepressants with direct assessment of sexual side-effects as the primary outcome measure are scarce. Future studies should be randomized, double-blind, active controlled trials in sexually active subjects with major depressive disorder. There should be direct assessment of sexual function and depression using reliable, validated rating scales before and during treatment. Studies should assess treatment-emergent effects in patients with normal function and resolution of baseline dysfunction over treatment, in both the short and long term. Further research should compare available instruments for measuring sexual function, and include separate analyses of both remitters/non-remitters and male/female subjects.

China–Australia training on psychosocial crisis intervention: response to the earthquake disaster in Sichuan

Abstract: Objective: This paper describes the AusAID-funded psychosocial training program conducted jointly by Chinese and Australian mental health facilitators in the wake of the devastating earthquake disaster in Sichuan.Conclusions: A total of 280 professional and volunteer leaders in disaster mental health response from across China took part in the national disaster mental health training program. A comprehensive, evidence-based and practical program was collaboratively developed and delivered to meet the needs of the medical professionals and volunteer mental health workers working in the field. Results of the training evaluation indicated high levels of uptake and usefulness for the participants. Further outcome assessments will be utilized at the service delivery and community levels. The training program has contributed significantly to the building of national and local capacity to deliver psychological first-aid and psychosocial response management to assist the populations who have been affected by disa...

Moving towards best-practice community mental health care in the Asia-Pacific

Abstract: Global trends in mental health services reform include the reduction of large standalone psychiatric institutions, a shift from hospital to community care, the development of community treatment teams, community-based rehabilitation and closer links with community agencies, and the provision of mental health care as part of primary health services (WHO, 2001). Community psychosocial rehabilitation services provide better and earlier care for people with mental disorders, help preserve the human rights of mental illness sufferers, and limit the stigma of mental illness. However, community care facilities exist only in 68.1% of countries and in South-East Asia, such facilities are present in less than half of the countries (WHO, 2005). Where present, community mental health services are not equally available, often being restricted to a few well-resourced urban areas. Innovative approaches are needed to scale up and expand community mental health resources, services and facilities (Lancet Global Mental Health Group, 2007). In the Asia-Pacific region, significant efforts have been made to develop community-based mental health services in accord with the recommendations in the World Health Report (WHO, 2001) and WHO Policy and Service Standards (WHO, 2003). However, the different socioeconomic and cultural factors in AsiaPacific countries do not necessarily lend themselves to direct application of typically Western community mental health models of care. Locally appropriate and culturally sensitive approaches are needed to implement sustainable mental health services that can be embedded in local community and health infrastructures. The AsiaPacific Community Mental Health Development Project was established to explore the diverse local approaches to community mental health service delivery currently in existence in the region and to promote further development. Through the exchange of experiences and learning between countries across the Asia-Pacific, it was hoped that a shared understanding of the key principles and components in community mental health care would be developed. The following report is based on the Summary Report of the Asia-Pacific Community Mental Health Development Project (2008a,b).

Somatic Symptoms of Depression and Anxiety in the Western Pacific Region: Questions and Answers

Abstract: It is a commonly held belief among mental health care providers that patients from the Western Pacific region with major depressive disorder (MDD) and anxiety disorders disproportionately present with somatic symptoms as opposed to emotional symptoms. Cultural norms, such as the stigma associated with psychiatric disorders, may lead members of this population to ignore the emotional aspects of these disorders or deny the presence of psychological symptoms. Empirical support is provided by the lower prevalence of these disorders in some Western Pacific nations in relation to the rest of the world. For example, MDD rates in India (9%), Japan (2%), China (2% to 4%), Malaysia (8%) and Australia (3%) are generally lower than rates in the United States (16%) and worldwide (10%). These discrepancies may be the result of missed diagnoses. Misdiagnosis is related to the increased somatization of MDD symptoms in these populations. As defined by the WHO, the Western Pacific region consists of 37 countries with a total population of 1.8 billion people (1.3 billion in China alone) with diverse cultural backgrounds and demographic profiles, which makes the issue of cultural effects on MDD diagnosis more complex.Patients with MDD or anxiety disorders worldwide often present with somatic symptoms, which frequently accompany psychological symptoms. For example, in a recent report of pooled data from Canada, scores on the Somatic Symptoms Inventory, the 17-item Hamilton Rating Scale for Depression (HAM-D17), and the Hamilton Rating Scale for Anxiety (HAM-A) were used to evaluate the association between somatic symptoms and MDD. Of the 2,191 patients randomly enrolled in the study, 78% reported moderate-to-severe fatigue and weakness. Painful physical symptoms commonly occur in patients with anxiety disorders as well. In a European study, painful physical symptoms were reported by 28% of those without anxiety disorders and 45% of those with anxiety disorders.

Community mental health care in Mongolia: adapting best practice to local culture.

Abstract: Objectives: The aim of this paper is to describe the development of community mental health care in Mongolia, as exemplified by a best practice model of care in the community.Conclusion: Through the Asia-Pacific Community Mental Health Development Project, Mongolia has identified local best practice such as the ‘Ger’ project that provides community psychosocial rehabilitation, which has been adapted according to local conditions and culture. Cultural considerations are important in producing effective clinical outcomes and a better quality of life for people with mental illness. The project has also shown that it is possible for persons with mental illness to receive rehabilitation effectively in local community settings. Inter-sectoral collaboration with multiple stakeholders is essential to achieve optimal community mental health service development.

The China-Australia training on psychological crisis intervention for medical aid leaders and volunteers after the Sichuan earthquake.

Abstract: Three of us (B R, an expert on mental health response to trauma; A C, a senior manager leading emergency management for the Australian Red Cross; and R M P, who played a significant role in mental health recovery of Australians affected by the second Bali bombing 6 ) were invited to conduct the training in association with senior faculty members of the Peking University Institute of Mental Health, with representatives from the provinces and from volunteer organisations such as Hope China. The training program was funded by AusAID and supported at a very high level in the Chinese Government, with Bai Huan, Deputy Director-General of the Bureau of Diseases Prevention and Control and Yang Gonghuan, Executive Director of the China Center for Disease Control and Prevention attending the opening ceremony. In his speech, Yang Gonghuan emphasised that mental health is an essential component of disease control in China.