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Dr Charmaine, Dr Wan, Dr Cyrus Ho Joint Write-up on Fukuoka conference

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The Singapore Psychiatric Association had very kindly supported our nominations to attend the 5th World Congress of Asian Psychiatry (WCAP) held in Fukuoka, Japan from 3rd to 6th March 2015. Being the official congress of the Asian Federation of Psychiatric Associations (AFPA), we were indeed privileged to have been awarded the Young Psychiatrist Award (YAP) to attend this conference.

The theme for this meeting – “Trend and Innovation of Psychiatry in Asia”, emphasized the compelling need to work together in spite of diversity in the field of mental health in Asia. True to its intentions, the conference brought together psychiatrists from all over Asia, as well as several international experts, for the purpose of exchanging and promoting ideas for the implementation of psychiatric services and programs in Asia. The organizing committee was able to organize a tour of the Kyushu University Hospital, which was indeed an exciting and enlightening experience. As YAP awardees, we also had the opportunity to interact with young psychiatrists from other Asian countries, both developed and developing, and this gave us valuable insights into psychiatric practices overseas. It was definitely heartening to know that Singapore was one of the frontrunners in provision of mental health care in the region.

The conference covered a vast breadth of topics ranging from gender identity disorder to public health approaches in mental health care. What we found particularly edifying were the seminars on “Trends in Psychiatry in the 21st century”. Both the expert speaker, Professor Norman Sartorius, and the AFPA President, Professor Pichet Udomratn, expounded on physical health issues in patients with severe mental illness, as well as “megatrends” (specifically, the aging population; digital psychiatry; urbanization and migrant workers’ health; and disaster psychiatry) influencing future psychiatric practices in Asia. We were also privileged to meet the esteemed Professor Sartorius, President of the Association for the Improvement of Mental Health Programmes (AMH), for a discussion on developing services for people with mental illness and their carers. Here, he introduced the concept of a “balanced care model” which highlights the importance of developing different services so as to provide mental health care to meet the needs of different types of patients in different settings. In this model, the needs of caregivers are also taken into consideration, and this may involve setting aside resources to provide subsidized respite care and other support services.

Overall, the conference was fruitful and expanded our minds by allowing us to gain new perspectives on mental health issues, particularly in Asia. Personally, we have also forged new friendships which will hopefully translate into international collaborations in future. We certainly look forward to the next WCAP conference.

Dr Charmaine Tang, Dr Wan Yimin, Dr Ho Su Hui

Members of the Singapore Psychiatric Association

10th March 2015

Dr Cyrus Ho Fukuoka Conference pic 2

Dr Cyrus Ho Fukuoka Conference pic 1

Dr Lee Cheng’s Fukuoka writeup

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As President of Singapore Psychiatric Association, I attended the 5th World Congress of Asian Psychiatry (WCAP) in Fukuoka, Japan from 3 to 6 March 2015. The WCAP is the official biennial congress of the Asian Federation of Psychiatric Associations (AFPA) and was last held in Bangkok, Thailand in 2013.

This year the theme of the Congress is “Trends and Innovation of Psychiatry in Asia’. The keynote speaker was Professor Norman Sartorius (Switzerland) and he touched on an important topic of ‘Comorbidity of mental and physical illness; a major challenge for psychiatry in the 21st Century’.

At the Congress, Prof Dinesh Bhugra (United Kingdom) was awarded the ‘AFPA Lifetime Award’ for his distinguished achievement. He also delivered the plenary lecture on ‘Psychiatry in the 21st Century’.

I was invited by Prof Naotaka Shinfuku (Japan) to be a speaker at the symposium on ‘Gender Identity Disorder in Asia’. With the support of Prof Tsoi Wing Foo, I was able to present his past and present work in this area. The other speakers from Japan presented the epidemiology of the condition in Japan and also their interest to do genetic studies in this area.

I was also a co-chair and co-judge for the oral presentation on ‘Transcultural and Child Psychiatry’. The 5 speakers from different countries reported on different areas ranging from women mental health, disaster psychiatry to treatment of aggressive behaviour in childhood.

As President of SPA, I attended the AFPA Board Meeting as well as the Japanese Society of Psychiatry and Neurology (JSPN) Round Table Discussion. At the latter meeting, each country took turn to do a brief introduction of the current situation of psychiatry in the home country. We also discussed on how to strengthen psychiatric collaboration among Asia-Oceania countries.

The 5th WCAP was well organized and provided an opportunity for mental health workers from Asian countries, Australia, the Pacific Islands and many other parts of the world to share their experiences and also collaborate on similar/related mental health disorders. The next WCAP will be held in India in 2017.

Dr_Lee_s_Picture _Fukuoka_Conference

Cannabis – Useful Information for Healthcare Workers

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Written by:  Dr Low Tchern Kuang Lambert, Honorary Treasurer, on behalf of Singapore Psychiatric Association

Edited by: Dr Wong Kim Eng, Emeritus Consultant

 

Cannabis, also known as Weed, Marijuana or Ganja belongs to the Cannabinoid class of drugs. The principal psychoactive compound being tetrahydrocannabinol or THC for short. It is usually rolled up into a joint and smoked. However it can also be eaten in the form of cakes or candies as in “pot brownies” or “Marijuana Munchies” respectively or brewed as a tea. When smoked as a joint, there are characteristic odours which can be easily identified. The acute effects of the drug include euphoria and a relaxed feeling (“stoned” in layman parlance) but it can also induce distressing hallucinations and feelings of paranoia.

Whilst legalized in some states in the USA, Cannabis is a class A drug in Singapore which means there are severe penalties associated with its use. Like other Class A drugs, e.g. Heroin, Methamphetamine, this means that any physician who knows of or suspects that a patient is using Marijuana has a legal obligation to notify the Central Narcotics Bureau within 7 days as per the Misuse of Drug Regulations, Section 19. The website for notification is www.cnb.gov.sg and users can log in using their SINGPASS account. When in doubt, a urine drug screen can be useful as Cannabis can be detected for several weeks after its last use in chronic users.

In 2013, based on the Central Narcotics Bureau drug situation report, Cannabis was the third most commonly abused drug.1 This is as compared with the United States where according to the Drug Enforcement Administration (DEA) website, it was stated that Cannabis was the most widely available and commonly abused illicit drug in the USA in 2013.2 DSM-V has also stated that Cannabis is probably the world’s most commonly used illicit substance.3 Cannabis use has been associated with several long term negative effects. There is a well known association between psychoses and cannabis use.4-7 Cannabis has also been linked to the development of schizophrenia when taken over a long period off time.4 Several reports have also indicated adverse effects of Cannabis on a variety of cognitive domains such as working memory and executive function.8-10

Some experts postulate the Cannabis use serves as a “gateway” drug, serving as an entry level drug towards more severe addictions like Heroin and Methamphetamine addictions although this “gateway” pattern observed may well be due to unmeasured background common factors rather than a true effect of specific drugs on the subsequent use of other drugs.11

An article published in BMJ revealed that the purity of Cannabis increased by 161% between 1990 and 2007.12 Whilst previously thought not to induce physical dependence but only psychological dependence, the increasing purity of Cannabis seen in the market has resulted in DSM-V acknowledging the presence of a physical symptoms secondary to Cannabis withdrawal.3 Such withdrawal symptoms can include irritability, feelings of restlessness, insomnia, anxiety or restlessness.3 The higher the purity of Cannabis, the more likely the risk of physical dependence and withdrawal symptoms. For a diagnosis of Cannabis Use Disorder under DSM-V, the patient would have to display typical symptoms over a 12 month period with clinically significant distress or impairment. These symptoms include saliency, cravings, tolerance, withdrawal symptoms, unsuccessful attempts to cut down, use in hazardous situations and continued use despite adverse consequences.3

More information on Cannabis can be found as a factsheet on the DEA website.13

 

References

  1. http://www.cnb.gov.sg/Libraries/CNB_Newsroom_Files/CNB_2013_Stats_Release_final_updated_as_of_15_May_2014.sflb.ashx
  2. http://www.justice.gov/dea/resource-center/DIR-017-13%20NDTA%20Summary%20final.pdf
  3. APA: Diagnostic and Statistical Manual. 5th edition. Arlington: American Psychiatric Association; 2013.
  4. Manrique-Garcia E, Zammit S, Dalman C, Hemmingsson T, Andreasson S, Allebeck P. Cannabis, schizophrenia and other non-affective psychoses: 35 years of follow-up of a population-based cohort. Psychol Med 2012;42:1321-8.
  5. Drake RE, Wallach MA, Hoffman JS. Housing instability and homelessness among aftercare patients of an urban state hospital. Hosp Community Psychiatry. 1989;40:46-51.
  6. Dixon L. Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes. Schizophr Res 1999;35 Suppl:S93-100.
  7. Negrete JC. Clinical aspects of substance abuse in persons with schizophrenia.Can J Psychiatry. 2003;48:14-21.
  8. Thames AD, Arbid N, Sayegh P. Cannabis use and neurocognitive functioning in a non-clinical sample of users. Addict Behav 2014;39:994-9.
  9. Becker MP, Collins PF, Luciana M. Neurocognition in college-aged daily marijuana users. J Clin Exp Neuropsychol 2014;36:379-98.
  10. Lisdahl KM, Wright NE, Kirchner-Medina C, Maple KE, Shollenbarger S. Considering Cannabis: The Effects of Regular Cannabis Use on Neurocognition in Adolescents and Young Adults. Curr Addict Rep 2014;1:144-156.
  11. Degenhardt L et al. Evaluating the drug use “gateway” theory using cross-national data: consistency and associations of the order of initiation of drug use among participants in the WHO World Mental Health Surveys. Drug Alcohol Depend. 2010;108:84-97.
  12. Werb D, Kerr T, Nosyk B, Strathdee S, Montaner J, Wood E. The temporal relationship between drug supply indicators: an audit of international government surveillance systems. BMJ Open 2013;3:e003077
  13. http://www.justice.gov/dea/pr/multimedia-library/publications/drug_of_abuse.pdf#page=68

 

 

 

 

 

 

 

14th Congress of the ASEAN Federation for Psychiatry & Mental Health