Browsing by Author "Ittasakul P."

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    A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age
    (2022-12-01) Chee K.Y.; Muhdi N.; Ali N.H.; Amir N.; Bernardo C.; Chan L.F.; Ho R.; Ittasakul P.; Kwansanit P.; Mariano M.P.; Mok Y.M.; Tran D.T.; Trinh T.B.H.; Mahidol University
    Background: The high prevalence of suicidal behavior among individuals with major depressive disorder (MDD) in Southeast Asia (SEA) underscores the need for optimized management to address depressive symptoms, reduce suicide risk and prevent suicide in these individuals. Given the lack of clear guideline recommendations for assessing and managing these patients, regional consensus-based recommendations which take into account diverse local contexts across SEA may provide useful guidance for clinical practice. Methods: A narrative literature review and pre-meeting survey were conducted prior to the consensus meeting of an SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with MDD with suicidal behavior. Utilizing the RAND/UCLA Appropriateness Method, the expert panel developed consensus-based recommendations on the assessment and treatment of adult patients with MDD with suicidal behavior under 65 years. Results: Screening of adult patients under 65 years with MDD for suicide risk using both a validated assessment tool and clinical interview is recommended. An improved suicide risk stratification – incorporating both severity and temporality, or using a prevention-focused risk formulation – should be considered. For a patient with an MDD episode with low risk of suicide, use of antidepressant monotherapy, and psychotherapy in combination with pharmacological treatment are both recommended approaches. For a patient with an MDD episode with high risk of suicide, or imminent risk of suicide requiring rapid clinical response, or for a patient who had received adequate AD but still reported suicidal behavior, recommended treatment strategies include antidepressant augmentation, combination use of psychotherapy or electroconvulsive therapy with pharmacological treatment, and inpatient care. Suicide-specific psychosocial interventions are important for suicide prevention and should also be part of the management of patients with MDD with suicidal behavior. Conclusions: There are still unmet needs in the assessment of suicide risk and availability of treatment options that can deliver rapid response in patients with MDD with suicidal behavior. These consensus recommendations on the management of adult patients with MDD with suicidal behavior under 65 years may serve as a useful guidance in diverse clinical practices across the SEA region. Clinical judgment based on careful consideration of individual circumstances of each patient remains key to determining the most appropriate treatment option.
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    Effects of a brief interpersonal mindfulness program embedded in a psychiatric nursing practicum: A controlled pilot study
    (2023-07-01) Yagi S.R.; Napa W.; Awirutworakul T.; Ittasakul P.; Yagi N.; Hartelius G.; Mahidol University
    Background: Nursing school is a stressful environment that demands high performance both professionally and academically. Interpersonal mindfulness training has shown promise for its stress-reducing capacity in other contexts; however, few descriptions or tests of this method in nursing training settings exist in the literature. Purpose: This pilot study examined effects of a brief interpersonal mindfulness program embedded in a 4-week psychiatric nursing practicum in Thailand. Methods: Mixed methods were used with 31 fourth-year nursing students to measure changes in mindfulness and assess their experiences of the program's impact. The control and experimental groups received the same clinical training, but the experimental group was also trained to practice interpersonal mindfulness throughout the course. Findings: The experimental group reported statistically significantly greater increases in Observing, Describing, and Non-reacting subscale scores, and in scores for the overall Five-Facet Mindfulness questionnaire, Thai version, than the control group (p < .05, Cohen's d = 0.83–0.95, large effect sizes). Group interviews revealed themes: initial challenges to mindfulness practice, experiences of becoming more mindful, intrapersonal benefits, and consequences of mindfulness on interpersonal skills. Conclusion: Overall, an interpersonal mindfulness program embedded in a psychiatric nursing practicum was effective. Further studies are required to address limitations of the present study.
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    Perceived attitudes toward LGBTQ+ physicians among Thai patients with psychiatric disorder: A multiregional cross-sectional study
    (2024-01-01) Pitanupong J.; Sathaporn K.; Ittasakul P.; Karawekpanyawong N.; Sangkool J.; Putthisri S.; Pitanupong J.; Mahidol University
    PURPOSE: This study aims to examine attitudes toward LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and more) physicians among Thai psychiatric patients and to identify associated factors across three regions of Thailand. PATIENTS AND METHODS: A cross-sectional survey was conducted from June to August 2023 in Central, Northern, and Southern Thailand. The Attitudes Toward LGBTQ+ Physician Questionnaire and a patient-doctor relationship questionnaire were utilized. Data analysis involved descriptive statistics and linear regression. RESULTS: The study included 543 participants with a median age of 37 years (IQR 26-52), predominantly female (68.9%) and Buddhist (78.1%). The median score for perceived attitudes toward LGBTQ+ physicians was 86 (IQR 73.0-95.5), with significant regional variations. Most participants perceived LGBTQ+ physicians as normal (85.5%) and integral to society (94.5%). A significant portion disagreed with the idea that being an LGBTQ+ physician was sinful (85.3%) or immoral (84.0%). However, 20.3% expressed discomfort with the possibility of LGBTQ+ physicians conducting private physical examinations. Lower perceived attitudes were associated with older age and being Muslim. Conversely, higher education, female gender, having LGBTQ+ connections, and a reported gender non-conformity showed a correlation with more positive attitudes. CONCLUSION: Thai psychiatric patients generally hold positive attitudes toward LGBTQ+ physicians, though demographic factors influence these attitudes. There needs to be a particular focus on improving attitudes regarding conducting private physical examinations to maximize patient comfort and trust.
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    Prevalence and Factors Associated with Caregivers’ Hesitancy in Immunizing Dependent Older Adults with COVID-19 Vaccines: A Cross-Sectional Survey
    (2022-10-01) Thanapluetiwong S.; Chansirikarnjana S.; Charernwat P.; Saranburut K.; Ittasakul P.; Mahidol University
    Background: Coronavirus disease 2019 (COVID-19) vaccinations have been proven to prevent hospitalization and mortality. However, some caregivers may be hesitant to authorize COVID-19 vaccination of people under their care. Our study aimed to evaluate factors associated with caregiver hesitancy to authorize vaccination of dependent older adults. Method: We conducted a cross-sectional telephone survey of vaccine hesitancy among caregivers of dependent older patients in the geriatric clinic of Ramathibodi Hospital. Caregivers were contacted and interviewed by trained interviewers from 20 June to 25 July 2021. Results: The study enrolled 318 participants with a mean age of 55.9 years. The majority of the participants were the patients’ children (86.5%). In total, 39.9% of participants were hesitant to authorize COVID-19 vaccination of the older adults under their care. Factors associated with caregiver vaccine hesitation were uneasiness, anxiety, agitation, sadness, and worry in association with social distancing, refusal to receive a COVID-19 vaccine, and concern about vaccine manufacturers. Conclusion: The prevalence of caregiver hesitancy to allow older adults to undergo COVID-19 vaccination was relatively high, and several factors associated with this vaccine hesitancy were identified. These findings may aid efforts toward COVID-19 vaccination of dependent older adults.
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    Relationship of mental health and burnout with empathy among medical students in Thailand: A multicenter cross-sectional study
    (2023-01-01) Pitanupong J.; Sathaporn K.; Ittasakul P.; Karawekpanyawong N.; Mahidol University
    Objectives To explore mental health, burnout, and the factors associated with the level of empathy among Thai medical students. Background Empathy is an important component of a satisfactory physician-patient relationship. However, distress, including burnout and lack of personal well-being, are recognized to affect a lower level of empathy. Material and methods A cross-sectional study surveyed sixth-year medical students at three faculties of medicine in Thailand at the end of the 2020 academic year. The questionnaires utilized were: 1) Personal and demographic information questionnaire, 2) Thai Mental Health Indicator-15, 3) The Maslach Burnout Inventory-Thai version, and 4) The Toronto Empathy Questionnaire. All data were analyzed using descriptive statistics, and factors associated with empathy level were analyzed via the Chi-square test or Fisher’s exact test, logistic regression., and linear regression. Results There were 336 respondents with a response rate of 70.3%. The majority were female (61.9%). Most participants reported a below-average level of empathy (61%) with a median score (IQR) of 43 (39–40). Assessment of emotion comprehension in others and altruism had the highest median empathy subgroup scores, whereas behaviors engaging higher-order empathic responses had the lowest median empathy subgroup score. One-third of participants (32.1%) had poor mental health, and two-thirds (62.8%) reported a high level of emotional exhaustion even though most of them perceived having a high level of personal accomplishment (97%). The multivariate analysis indicated that mental health was statistically significantly associated with the level of empathy. The participants with higher levels of depersonalization had statistically lower scores of demonstrating appropriate sensitivity, altruism, and behaviors engaging higher-order empathic responding. Conclusions Most medical students had below-average empathy levels, and two-thirds of them had high emotional exhaustion levels, yet most of them reported having a high level of personal accomplishment and good mental health. There was an association between mental health and the level of empathy. Higher levels of depersonalization related to lower scores of demonstrating sensitivity, altruism, and behaviors responding. Therefore, medical educators should pay close attention to promoting good mental health among medical students.
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    Response rate and factors associated with response in patients with schizophrenia undergoing bilateral electroconvulsive therapy
    (2023-05-24) Ruangsetakit C.; Ittasakul P.; Mahidol University
    Background Schizophrenia is a severe mental illness and a common indication for electroconvulsive therapy (ECT). Research is lacking on the factors that influence response to acute ECT treatment in schizophrenia patients. Aims This study examined the response rate and associated factors in patients with schizophrenia undergoing bilateral ECT. Method Demographic data, clinical characteristics, ECT data and treatment response were respectively reviewed in patients with schizophrenia undergoing bilateral ECT from January 2013 to June 2022. Results Forty-six patients were included. Nine responded after the first three sessions, 17 after six sessions, 20 after nine sessions, 25 after 12 sessions and 28 after the last ECT session, cumulatively. The mean of the baseline Brief Psychiatric Rating Scale psychotic symptom subscale score was significantly higher in responders (17.0) than non-responders (10.9) (P < 0.05). The mean of duration of electroencephalogram seizure was significantly longer in responders (53.9) than in non-responders (42.7). There was no association between demographic and ECT data and treatment response. Among 28 responders, 20 responded to ECT after nine sessions (faster responders) and eight responded later (slower responders). The number of failed antipsychotics prior to ECT was 2.8 for faster responders and 4.4 for slower responders (P = 0.02). Nominal logistic regression showed that the number of failed antipsychotics prior to ECT was associated with speed of response to ECT (P = 0.037, odds ratio = 1.77). Conclusions ECT is an effective treatment for schizophrenia and may be influenced by the number of failed antipsychotics prior to ECT.
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    The personality traits with depression and suicidal ideation among Thai medical students: a university-based multiregional study
    (2024-12-01) Pitanupong J.; Sa-i A.; Sathaporn K.; Jiraphan A.; Ittasakul P.; Karawekpanyawong N.; Pitanupong J.; Mahidol University
    Background: The prevalence of depression in medical students was greater than in the general population. Knowing of predictive factors for depression among medical students is useful. The objectives of this study included the assessment of personality traits as well as the association between the personality traits and the presence of symptoms of depression, and suicidal ideation among medical students covering several regions of Thailand. Methods: From April to July 2023, a cross-section study was conducted. The participants included first to sixth-year medical students studying at three Faculties of Medicine in Thailand; Prince of Songkla University; Ramathibodi Hospital, Mahidol University; and Chiang Mai University. Using the online process, the questionnaires were composed of three sections; demographic data; the International Personality Item Pool-NEO (IPIP-NEO), Thai version; and the Patient Health Questionnaire-9 (PHQ-9), Thai version. Demographics, personality traits, depression, and suicidal ideation were analyzed using descriptive statistics. The results were presented as frequency, mean, and standard deviation (SD) or median and interquartile range (IQR). The association between independent variables and the presence of depression was identified using binary logistic regression analysis, and the association with suicidal ideation was identified using ordinal logistic regression analysis. Results: The 868 medical students participated in this study. Most of them were female (63.5%), Buddhist (82.0%), and first-year medical students (31.8%). The mean age (SD) was 20.8 (2.2) years, and the mean cumulative Grade Point Average (SD) was 3.5 (0.4). They reported the median (IQR) score of PHQ-9 as 6.0 (3.0–9.0), 238 participants (27.4%) presented with depression, and 138 (15.9%) participants reported suicidal ideation. According to the IPIP-NEO, participants with depression or suicidal ideation had higher Neuroticism scores and lower Extraversion, Agreeableness, and Conscientiousness scores compared to those without such issues. An increase in the Neuroticism score was linked to higher odds of depression, while an increase in the Conscientiousness score was associated with lower odds of depression. Suicidal ideation significantly increased with higher Neuroticism scores and the presence of a psychiatric illness. Conclusions: More than a quarter of Thai medical students reported depression. A higher Neuroticism and lower Extraversion, Agreeableness, and Conscientiousness scores related to depression. Therefore, medical schools may benefit from knowing medical students’ personality traits, to identify coping mechanisms and predict those at a higher risk of developing depression in the future.