Elaine Pek

Institute of Mental Health, Singapore, Singapore, Singapore

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Publications (13)25.02 Total impact

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    ABSTRACT: While the risk for a number of medical illnesses is well established for those who smoke, the risk for psychiatric disorders is not so well studied in Singapore. This study sought to establish the lifetime prevalence of nicotine dependence in a population of young males in Singapore and to establish its relationship with other psychiatric disorders. The study was conducted among a cohort of males reporting for their mandatory physical examination prior to their enlistment for National Service in a 1-year period between August 2004 and August 2005. Definitive diagnoses in accordance with DSM-IV criteria were made with the Composite International Diagnostic Interview (CIDI). In the population of 9,702 males assessed by CIDI, the prevalence of nicotine dependence was 12.3%. Academic attainments were significantly poorer in those with nicotine dependence than those without dependence. Nicotine dependence was most strongly associated with delusional disorder and major depressive disorder, which remained even after adjusting for ethnicity and educational attainments (odds ratio [OR] of 59.8 for delusional disorder and OR of 36.3 for major depressive disorder). Our study highlights the pervasive extent of nicotine dependence among a population of young men. The pervasiveness of nicotine dependence across different psychiatric disorders suggests either a shared biological substrate or a common consequence of these disorders.
    Nicotine & Tobacco Research 08/2009; 11(9):1107-13. · 2.48 Impact Factor
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    ABSTRACT: Singapore has one of the world's highest rates of diabetes mellitus (DM). DM is also associated with depression, the nature of this relation is possibly bidirectional and complex and there are a number of putative associated factors. To establish the prevalence of depressive symptoms in an Asian multiracial population with diabetes and identify some of these putative risk factors including ethnicity for depressive symptoms while controlling for multiple confounding variables. This is a cross-sectional epidemiological study in an Asian multiracial population with DM. The subjects were 537 outpatients (aged 21 years and above) attending a specialist diabetes treatment centre in a general hospital. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) with a cut-off score of 16 or more indicating the presence of depressive symptoms. The prevalence of depressive symptoms was 31.1%. Following a logistic regression with depression as the dependent variable, Indian race, type of treatment, activity level and marital status (divorced/separated) were significantly associated with a high risk of depression. This is the first study done among 3 ethnic groups Chinese, Malays and Indians within the same geographical location, and the findings show that depressive symptoms are common among diabetic patients and highest among those of Indian ethnicity.
    Asian Journal of Psychiatry 06/2009; 2(2):66-70.
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    ABSTRACT: Poor academic performance can reflect the neurobiological abnormalities underlying schizophrenia and has been suggested as a premorbid marker for the disorder. However, it is not clear as to how academic performance compares as a marker for other mental disorders. The objective of this study was to examine whether educational attainment is a candidate marker for certain psychiatric disorders. Using a retrospective cohort design, we compared the early educational performance of 6957 National Service male conscripts. The presence of mental illness was assessed using the Composite International Diagnostic Interview. Academic performance was assessed using the results of a standardized national examination after 6 years of primary education. Adjusting for ethnicity, the scores from this examination revealed that those with schizophrenia spectrum disorders scored significantly lower than those without any mental illness. Poor educational attainment predicts the onset of schizophrenia spectrum disorders and could be a possible predictor for this specific group of mental illness.
    Social Psychiatry 04/2009; 44(11):999-1004. · 2.05 Impact Factor
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    ABSTRACT: Tardive dyskinesia (TD) is a severe and potentially irreversible movement, and previous studies have suggested increased mortality among patients with TD, but most of these studies are limited by small sample sizes and short periods of follow-up. This study examined the mortality rate of a cohort of 608 Asian patients with schizophrenia during a 6-year period and used survival analyses on time from case ascertainment to outcome (death). Data on the survival status were collected and compared between those with and without TD, and cross-tabulation was performed to show the correlation between survival and mortality rates among patients with and without TD.Seventy-two patients died, 39 (54.2%) of whom had TD previously. Of the 536 surviving cases, 239 (44.6%) have TD. The mortality rates between those with TD and those without TD were statistically significant (hazard ratio, 2.62; 95% confidence interval, 1.58-4.33; P = 0.0006).The mortality rate was dependent on age; nevertheless, the adverse effect of TD on survival rate, although reduced, remains after controlling for age (hazard ratio, 1.90; 95% confidence interval, 1.12-3.20; P = 0.017). Our finding showed a robust association with increased mortality rate and TD, but we failed to find any significant association with any specific cause of death and TD.
    Journal of clinical psychopharmacology 03/2009; 29(1):5-8. · 5.09 Impact Factor
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    ABSTRACT: The objective of this study was to examine the extent of health care utilisation (excluding costs) of diabetic patients with and without depressive symptoms attending a specialist clinic in Singapore. A total of 537 Asian outpatients (aged 21 years and above) who were attending a Diabetes Centre were recruited on a consecutive basis between August 2006 and February 2007. Sociodemographic data, clinical and health care utilisation data were collected from the participants. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Individuals with depressive symptoms, on average, had more hospitalizations and hospitalization days. Those with depression reported losing significantly more working days as compared to the nondepressed individuals (1.9 vs. 1.4, P=.001). Our findings in this population suggest that the presence of depressive symptoms has an independent effect on the greater utilization of medical services.
    General hospital psychiatry 01/2009; 31(3):220-4. · 2.67 Impact Factor
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    ABSTRACT: Mental health professionals can contribute to generating a strong evidence base for policy and practice in psychiatry. An insight into their perception of psychiatric research is important for planning support strategies. This study explored healthcare professionals' perceptions of barriers, benefits and concerns about psychiatric research in a Singapore psychiatric hospital. Self-administered questionnaire was employed to collect socio-demographic data and opinions on research. Likert scale was used for the responses and descriptive statistics and ordinal regression were used for data analysing. 93.8% respondents perceived "contribution to medical knowledge/public health" to be a major benefit of conducting research. 86.7% respondents felt that "learning experience" was important. "Prestige/publication" (52.7%) and "financial gain" (76%) were perceived to be unimportant. "Clinical load of patients", "lack of skilled personnel to assist in research" and "insufficient funding" were identified as important barriers by 72.4%, 70.6% and 68.9% respondents. "Time constraints", "patient and family readiness to research participation", "insufficient training" and "concerns about patient welfare" are major concerns while conducting research. To the study team's best knowledge, this is the only study of mental health professionals' perceptions on psychiatric research. It is useful for strategising research planning and enhancing the research culture in the hospital.
    Annals of the Academy of Medicine, Singapore 10/2008; 37(9):738-44. · 1.36 Impact Factor
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    ABSTRACT: Identification of mentally ill military conscripts is crucial, since these individuals may experience an exacerbation of their illness during training with dire consequences for them and the organization. This article describes the design of a study to validate a screening instrument for psychiatric disorders as well as to establish their prevalence among male army conscripts in Singapore. It involved a two-stage process: the conscripts were screened with a new instrument which we termed the Mental Wellness Screening Questionnaire; those who screened positive, and a random sample of those who did not, were administered the computerized Composite International Diagnostic Interview which was the gold standard in making the diagnosis. This study is unusual in that it involved almost the entire male population in 1 year but its relevance is the development of a screening instrument that can be used with ease in a large population of conscripts.
    Military medicine 01/2008; 172(12):1245-9. · 0.77 Impact Factor
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    ABSTRACT: To evaluate the diagnostic stability of psychotic disorders over a 2 year period in patients presenting with first-episode psychosis. One hundred and fifty-four patients were recruited from an early psychosis intervention programme (EPIP). They were diagnosed by the attending psychiatrist using the Structured Clinical Interview for DSM-IV Axis I at first contact (baseline) and after 24 months. The diagnoses were classified into the following categories: schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder and schizoaffective disorder), affective psychosis (bipolar and major depressive disorders with psychotic symptoms), and other non-affective psychosis (delusional disorder, psychosis not otherwise specified and brief psychotic disorder). Two measures of stability, the prospective and the retrospective consistency were determined for each diagnosis. The diagnoses with the best prospective consistency were schizophrenia (87.0%) and affective psychosis (54.5%). The shift into schizophrenia spectrum disorder was the most frequent diagnostic change. Duration of untreated psychosis was found to be the only significant predictor of shift. It is difficult to make a definitive diagnosis at first contact. The clinical need to review the diagnosis throughout the period of follow up is emphasized.
    Australian and New Zealand Journal of Psychiatry 07/2007; 41(6):495-500. · 3.29 Impact Factor
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    ABSTRACT: To establish if there are ethnic differences in the various metabolic disturbances that are common with clozapine treatment. Forty subjects (20 Asians and 20 Caucasians) with a diagnosis of schizophrenia were recruited for the study. Clozapine blood levels as well as fasting blood glucose, lipid levels, and liver function tests were established. Other clinical parameters such as blood pressure and Body Mass Index (BMI) were recorded for each patient. The mean clozapine dose was significantly higher in the Caucasian subjects (432.5+/-194.7 mg) as compared to the Asian subjects (175.6+/-106.9 mg) (p<0.001) while the mean weight-corrected dose for Asian patients was lower (3.0+/-1.9 and 5.0+/-2.1 mg/kg, respectively, p=0.005). There were, however, no ethnic differences in the mean plasma clozapine concentration (415.3+/-185.8 ng/ml in Caucasians and 417.1+/-290.8 ng/ml in Asians). BMI were significantly higher in Caucasians, as were the number of subjects with hypertension; levels of hepatic enzymes were higher in the Asian group. Not only are there pharmacokinetic differences between Asian and Caucasian patients receiving clozapine, but there may also be differential emergence of certain metabolic abnormalities like hypertension and weight gain in these two ethnic groups. However, the effects of life style including diet and exercise cannot be excluded.
    Human Psychopharmacology Clinical and Experimental 06/2007; 22(4):217-22. · 2.10 Impact Factor
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    ABSTRACT: This study aims to examine the socio-demographic and clinical correlates of the duration of untreated psychosis (DUP) in first-episode psychosis patients in an Asian country. Three hundred thirty-four patients from the Early Psychosis Intervention Programme (EPIP) of Singapore were recruited for the study. Socio-demographic data were collected and patients were diagnosed using SCID I (Structural Clinical Interview for DSM-IV Axis I Disorders). Other assessment scales were used to assess the level of psychopathology, overall functioning and the awareness of mental illness. Mean (SD) DUP was 16.3 (31.5) months. Patients who were single, unemployed, or brought by the police had a significantly longer DUP. Patients with a diagnosis of schizophrenia had a longer DUP as compared to patients with other forms of psychosis. The better functioning patients as indicated by a higher Global Assessment of Functioning score and those who were more insightful had a shorter DUP. This study suggests that certain socio-demographic features and clinical diagnosis may determine DUP.
    Annals of the Academy of Medicine, Singapore 01/2006; 35(1):24-6. · 1.36 Impact Factor
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    ABSTRACT: Introduction: This study aims to examine the socio-demographic and clinical correlates of the duration of untreated psychosis (DUP) in first-episode psychosis patients in an Asian country. Material and Methods: Three hundred thirty-four patients from the Early Psychosis Interven-tion Programme (EPIP) of Singapore were recruited for the study. Socio-demographic data were collected and patients were diagnosed using SCID I (Structural Clinical Interview for DSM-IV Axis I Disorders). Other assessment scales were used to assess the level of psychopathology, overall functioning and the awareness of mental illness. Results: Mean (SD) DUP was 16.3 (31.5) months. Patients who were single, unemployed, or brought by the police had a significantly longer DUP. Patients with a diagnosis of schizophrenia had a longer DUP as compared to patients with other forms of psychosis. The better functioning patients as indicated by a higher Global Assessment of Functioning score and those who were more insightful had a shorter DUP. Conclusions: This study suggests that certain socio-demographic features and clinical diagnosis may determine DUP. Ann Acad Med Singapore 2006;35:24-6
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  • Annals of the Academy of Medicine, Singapore 10/2004; 33(5 Suppl):S33-5. · 1.36 Impact Factor
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    ABSTRACT: This study aimed to establish the prevalence of diabetes mellitus (DM) and impaired glucose tolerance in patients with schizophrenia and to elucidate some of the factors associated with hyperglycemia. We studied a sample of 194 patients with schizophrenia. We determined fasting blood glucose and insulin levels at the start of the testing period; patients were given an oral glucose tolerance test after an overnight fast. The overall prevalence of diabetes and impaired glucose tolerance in these patients was 16.0% and 30.9%, respectively. These rates were higher than those reported in the general population. Patients with disordered glucose homeostasis were significantly older (P = 0.005, Kruskal-Wallis test). There was no significant effect of sex or ethnicity on diabetes. Our findings suggest that patients with schizophrenia are more vulnerable to developing DM. We caution clinicians to be mindful of the increased risk and to be vigilant for such a development.
    Canadian journal of psychiatry. Revue canadienne de psychiatrie 07/2003; 48(5):345-7. · 2.48 Impact Factor