Psychiatric services in primary care settings: a survey of general practitioners in Thailand

BACKGROUND: General Practitioners (GPs) in Thailand play an important role in treating psychiatric disorders since there is a shortage of psychiatrists in the country. Our aim was to examine GP's perception of psychiatric problems, drug treatment and service problems encountered in primary care settings. METHODS: We distributed 1,193 postal questionnaires inquiring about psychiatric practices and service problems to doctors in primary care settings throughout Thailand. RESULTS: Four hundred and thirty-four questionnaires (36.4%) were returned. Sixty-seven of the respondents (15.4%) who had taken further special training in various fields were excluded from the analysis, giving a total of 367 GPs in this study. Fifty-six per cent of respondents were males and they had worked for 4.6 years on average (median = 3 years). 65.6% (SD = 19.3) of the total patients examined had physical problems, 10.7% (SD = 7.9) had psychiatric problems and 23.9% (SD = 16.0) had both problems. The most common psychiatric diagnoses were anxiety disorders (37.5%), alcohol and drugs abuse (28.1%), and depressive disorders (29.2%). Commonly prescribed psychotropic drugs were anxiolytics and antidepressants. The psychotropic drugs most frequently prescribed were diazepam among anti-anxiety drugs, amitriptyline among antidepressant drugs, and haloperidol among antipsychotic drugs. CONCLUSION: Most drugs available through primary care were the same as what existed 3 decades ago. There should be adequate supply of new and appropriate psychotropic drugs in primary care. Case-finding instruments for common mental disorders might be helpful for GPs whose quality of practice was limited by large numbers of patients. However, the service delivery system should be modified in order to maintain successful care for a large number of psychiatric patients

Reliability and validity of the Thai version of the PHQ-9

<p>Abstract</p> <p>Background</p> <p>Most depression screening tools in Thailand are lengthy. The long process makes them impractical for routine use in primary care. This study aims to examine the reliability and validity of a Thai version Patient Health Questionnaire (PHQ-9) as a screening tool for major depression in primary care patients.</p> <p>Methods</p> <p>The English language PHQ-9 was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the pre-final version, as well as final adjustments. The PHQ-9 was then administered among 1,000 patients in family practice clinic. Of these 1,000 patients, 300 were further assessed by the Thai version of the Mini International Neuropsychiatric Interview (MINI) and the Thai version of the Hamilton Rating Scale for Depression (HAM-D). These tools served as gold-standards for diagnosing depression and for assessing symptom severity, respectively. In the assessment, reliability and validity analyses, and receiver operating characteristic curve analysis were performed.</p> <p>Results</p> <p>Complete data were obtained from 924 participants and 279 interviewed respondents. The mean age of the participants was 45.0 years (SD = 14.3) and 73.7% of them were females. The mean PHQ-9 score was 4.93 (SD = 3.75). The Thai version of the PHQ-9 had satisfactory internal consistency (Cronbach's alpha = 0.79) and showed moderate convergent validity with the HAM-D (r = 0.56; P < 0.001). The categorical algorithm of the PHQ-9 had low sensitivity (0.53) but very high specificity (0.98) and positive likelihood ratio (27.37). Used as a continuous measure, the optimal cut-off score of PHQ-9 ≥ 9 revealed a sensitivity of 0.84, specificity of 0.77, positive predictive value (PPV) of 0.21, negative predictive value (NPV) of 0.99, and positive likelihood ratio of 3.71. The area under the curve (AUC) in this study was 0.89 (SD = 0.05, 95% CI 0.85 to 0.92).</p> <p>Conclusion</p> <p>The Thai version of the PHQ-9 has acceptable psychometric properties for screening for major depression in general practice with a recommended cut-off score of nine or greater.</p

No additional benefit of shortwave diathermy over exercise program for knee osteoarthritis in peri-/post-menopausal women: an equivalence trial

SummaryObjectiveTo evaluate the benefit of shortwave diathermy (SWD) supplemented to an exercise program for knee osteoarthritis (OA) in peri-/post-menopausal women.MethodsA double-blind randomized placebo-controlled equivalence trial was conducted in a university hospital. Participants including 113 women aged 50–85 years with primary knee OA were instructed to do regular quadriceps exercise, and randomized to control (n=60) and treatment (n=53) groups receiving sham SWD and therapeutic SWD, respectively. The treatment being evaluated was continuous SWD, 20min/session, 3sessions/week for 3 weeks. The outcomes including Thai Western Ontario and McMaster Universities OA (WOMAC) index, 100-m walking speed, stair ascent-and-descent time, global assessment, patient's satisfaction, and adverse events were assessed at baseline and end of treatment.ResultsAt the end of treatment, both groups had trivial but statistical improvement in all outcomes. Intention-to-treat analysis showed no statistically significant difference between the two groups in all outcomes. Per protocol analysis demonstrated the equivalence in Thai WOMAC total score, as the 95% confidence interval of difference (−0.62, 0.92) was within confidence limits of ±1cm.ConclusionThe addition of SWD to an exercise program for knee OA in peri-/post-menopausal women is not superior to the exercise program alone

Pain reduction, physical performance, and psychological status compared between Hatha yoga and stretching exercise to treat sedentary office workers with mild/moderate neck/shoulder pain: A randomized controlled non-inferiority trial

Objective: To investigate pain reduction, physical performance, and psychological status compared between Hatha yoga and stretching exercises. Design: Randomized controlled non-inferiority trial Subjects: 150 sedentary office workers with mild/moderate neck/shoulder pain. Interventions: Participants received group Hatha yoga or stretching exercise once a week (30 min for 4 weeks), and were asked to practice at home. Subjects were followed up at 4 and 8 weeks. Main outcome measures: The primary outcome was a numeric rating scale (NRS) score. The secondary outcomes were a sit-and-reach test, Functional Reach Test, Neck Disability Index, pain pressure threshold, Patient Health Questionnaire-9, General Anxiety Disorder-7, and the EuroQoL. Results: Of the 150 subjects, 59 and 71 participants in the Hatha yoga and stretching groups were analyzed. At baseline, no significant differences between groups were found. After 4 weeks, the mean difference in the NRS score was statistically significant between groups (p  0.05 between groups). The most common adverse events were musculoskeletal pain and muscle tension. Repeated measures analysis of variance that compared among weeks 0, 4, and 8 revealed no significant difference between groups. Conclusion: Hatha yoga was tentatively found to be non-inferior to stretching exercise relative to safety, for decreasing pain, anxiety, and depression, and for improving flexibility, neck functions, and quality of life

Effectiveness of simple balancing training program in elderly patients with history of frequent falls

Vilai Kuptniratsaikul1, Rungnirand Praditsuwan2, Prasert Assantachai3, Teerada Ploypetch1, Suthipol Udompunturak4, Julaporn Pooliam41Department of Rehabilitation Medicine, 2Department of Medicine, 3Department of Preventive Medicine, 4Office for Research and Development, Siriraj Hospital, Mahidol University, ThailandObjective: To study the effectiveness of simply-performed balancing exercises in fall prevention.Design: Pre- and post-trial.Setting: University hospital from January 2009 to May 2010.Participants: Elderly with falls in the previous year.Intervention: Simple balancing exercise was performed at home every day and was recorded in the booklet.Measurements: New falling events and a battery of balancing abilities including the Timed Up and Go Test (TUGT), chair stand, functional reach, and Berg balance scale-short form were evaluated at baseline, 3-, 6-, 9-, and 12-month periods. Fear of falling and quality of life scores were assessed at baseline and 12-month periods.Results: 146 subjects were recruited, 116 female (79.5%) with a mean age of 67.1 years. At the end of the study, 49% of participants had not fallen. All of the balancing abilities were compared between frequent and infrequent fallers and were significantly improved (P&nbsp;&lt; 0.001) except for functional reach in the frequent fall group. Most subjects (72%&ndash;79%) complied well with the exercise program. However, compliance had no effect on balancing abilities. About 36.4% of participants had adverse events from exercise, of which knee pain was the top ranked. The quality of life and the fall efficacy scores increased significantly at the end of the study. Factors affecting falling were compliance with exercise (adjusted odds ratio [OR]: 2.55, 95% confidence intervals [CI]: 1.04, 6.30) and a history of falling &ge;3 times in the previous year (adjusted OR: 3.76, 95% CI: 1.18, 11.98).Conclusion: Performing simply-designed balancing exercises, at least 3 days per week, can increase balancing abilities, and decrease fall rates in the elderly with a history of previous falls. However, strategies to encourage elderly compliance may prevent falling.Keywords: balancing training, exercise, fall prevention, frequent fall, elderl