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The individual effects of medical and psychiatric morbidity on functional status and quality of life were considerably worse when both were present in the same individual. Future studies should examine the impact of identifying and treating anxiety and depressive disorders in patients with medical problems for better outcomes.

This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders which was published in 2002 and revised in 2008. A consensus panel of 33 international experts representing 22 countries developed recommendations based on efficacy and acceptability of available treatments. Since the publication of the last version of this guideline, a substantial number of new randomised controlled trials (RCTs) have been published. In this version, not only medications but also psychotherapies and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medication treatments. A systematic search for published trials for the treatment of these disorders in adults, adolescents, and children was performed, resulting in 1007 evaluable RCTs. The present paper (Part I) contains recommendations for the treatment of panic disorder/agoraphobia (PDA), generalised anxiety disorder (GAD), social anxiety disorder (SAD), specific phobias, mixed anxiety disorders in children and adolescents, separation anxiety and selective mutism. Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications for anxiety disorders. Cognitive behavioural therapy (CBT) is the is the first-line psychotherapy for for anxiety disorders. The expert panel also made recommendations for patients who do not respond to standard treatments and recommendations against certain interventions which failed to provide sufficient evidence.It is the goal of this initiative to provide treatment guidance for these disorders that has validity throughout the world.

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Objective: Although antidepressants are the recommended first-line pharmacological treatments for depressive and anxiety disorders, their prescribing patterns have not been studied in Singapore. We investigate antidepressant prescription patterns for outpatients with depressive and anxiety disorders in a general hospital in Singapore. We hypothesize that intolerance to side effects and lack of efficacy may contribute to medication switching, and that initiation of antidepressant therapy is not easily tolerated. Methods: A retrospective review of the casenotes of outpatients was carried out between January 2013 and December 2013. A total of 206 patients were randomly selected. The study was approved by the hospital's institutional review board. Data analysis was carried out using SPSS version 18. Results: There were more females than males (ratio 1.7:1) with a mean age of 50.6 ± 15.2 years. Depressive disorder, comprising 50% of the sample, was the most frequent diagnosis followed by anxiety disorder (27.2%), mixed anxiety-depression (16%) and adjustment disorder (5.8%). Almost all patients (97.1%) were prescribed antidepressants, the most common being selective serotonin reuptake inhibitors (SSRI) (75.5%), followed by the noradrenaline and specific serotonin antidepressant (NaSSA) (13.5%) and tricyclic antidepressants (TCA) (8.5%). Patients prescribed SSRIs tended to be younger and better educated (p = 0.0005). More than half of the patients (52.1%) required antidepressant switching mainly due to lack of efficacy and intolerance of side effects. Combination therapy was prescribed for 17% of patients with SSRI-NaSSA, the most preferred combination. Nearly a quarter (23.8%) patients required augmentation therapy with atypical antipsychotics. Combination (p = 0.024) and augmentation (p = 0.033) were utilized more often for depression than for anxiety disorders. Conclusion: Antidepressant medications are commonly prescribed for depression and anxiety disorders. The main reasons for switching antidepressants were intolerance and lack of efficacy. That about half of the patients reported side effects necessitating medication change confirmed our hypothesis that an-*

This paper discusses how Singapore's labor market policies since independence have been molded by the state-driven, foreign investment-led, export-oriented, manufacturing-focused development model the country has followed over the past fifty years. The literature we review shows that high GDP growth has been achieved through factor accumulation rather than productivity increase, a strategy of extensive growth that has now run into diminishing returns as well as political, social and resource constraints. Prolonged heavy dependence on imports of foreign labor and skills to attract foreign investment has contributed to low, declining and even negative productivity growth, with low real GDP growth in recent years. In response, the government is pursuing renewed economic restructuring, limiting foreign labor inflows, targeting investments more selectively, and promoting productivity and innovation, so far with uncertain results. This paper suggests that Singapore should let market forces propel the economy toward services, domestic consumption and regional trade, led by domestic private enterprise. But the retreat from established state industrial and social policies will be difficult.

The Ministry of Health (MOH) has developed the clinical practice guidelines on Anxiety Disorders to provide doctors and patients in Singapore with evidence-based treatment for anxiety disorders. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on anxiety disorders, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh. gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Central pontine and extrapontine myelinolysis (CPEM) are rare conditions usually associated with rapid correction of hyponatremia. Neurologic complications are the usual sequelae although neuropsychiatric features are rare. Described herein are unusual psychotic symptoms following CPEM and discussion of the likely pathogenesis and implications for treatment.