Difficulty falling asleep or maintaining sleep, poor sleep quality, nightmares, and excessive daytime sleepiness are some of the key clinical symptoms of sleep disturbances observed among individuals with psychiatric illnesses. This study aimed to determine the prevalence of symptoms of sleep disorders including parasomnia, narcolepsy, obstructive sleep apnea, circadian rhythm disorder and restless leg syndrome/periodic limb movement (RLS/PLMS) and its correlates in patients with psychiatric diagnoses. Patients aged 21-65 years (n = 400) attending the outpatient clinics with a primary diagnosis of either schizophrenia, mood or anxiety disorder based on ICD-9 criteria were included in this cross-sectional study. Sociodemographic information was collected and screening questions pertaining to specific symptoms of sleep disorders were administered by a study team member. The overall prevalence of symptoms of sleep disorders in the psychiatric outpatient sample was 40.75% (163/400). The prevalence for symptoms of narcolepsy, sleep breathing disorder, PLMS/RLS, circadian rhythm disorder and parasomnia were 12.5%, 14.5%, 14.8%, 4.5%, and 13.8% respectively. These symptoms were associated with age, low physical activity, and anxiety disorder. Results highlight the high prevalence of symptoms of sleep disorders in psychiatric patients. Present study findings should be confirmed using diagnostic interviews and objective measures.
With the new calling from DSM-5, clinicians treating psychiatric patients should view insomnia less as a symptom of their mental illnesses and treat clinical insomnia as a primary disorder. Patients should also be educated on the importance of reporting and treating their sleep complaints. Nonmedical (cognitive and behavioral) interventions for insomnia need to be further explored given their proven clinical effectiveness.
Agomelatine, escitalopram and mirtazapine had favourable balance between efficacy and tolerability. In addition, mirtazapine was a cost-effective option in the Singapore healthcare system.
BackgroundChina confirmed person to person transmission of a novel coronavirus (now named SARS-CoV-2) on 21 st Jan 2020 1 with more than 200 cases and 4 deaths. The World Health Organization (WHO) declared the COVID-19 outbreak as one of international concern on 30 th Jan 2020 2 . By 11 th Mar 2020 the WHO Director-General declared the COVID-19 outbreak a pandemic with 118,00 cases in 114 countries and 4291 deaths 3 . COVID-19 is currently understood as a droplet spread illness with a reproduction number of approximately 2.2 4 , transmitted via respiratory droplets, contact, fomites and fecal-oral routes 5,6 and with high lethality (3.4%) 7 . Many more patients with COVID-19 than SARS (Severe Acute Respiratory Syndrome) 8 have mild symptoms that contribute to spread as these patients are not picked up by current screening mechanisms 9 . The current outbreak is expected to last at least till the end of 2020 10 with the possibility of a second deadlier wave several months after the current outbreak like the 1918 Spanish Flu 11 . There is no known specific treatment or vaccine.
Challenges Facing ECT during COVID-19This situation poses significant challenges for ECT services around the world. ECT is an essential psychiatric service that provides lifesaving treatment for severe mental illnesses like depression and catatonia if given in a timely fashion 12,13 and for which there is no viable alternative. However, ECT service is often not prioritized in hospitals 14 and may be stopped if anaesthesia resources are limited. This occurred at the beginning of the COVID-19 situation in a general hospital in Singapore, resulting in an acute ECT course stopping halfway for a patient
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