“Diversity & Harmony in Care”
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Malaysian Journal of Psychiatry 2012; 21(Suppl) Compilation of Abstracts 17th Malaysian Conference on Psychological Medicine & The 6th Asian Society Against Dementia International Congress “Diversity & Harmony in Care” 14th - 16th June 2012 Venue: Sheraton Imperial Kuala Lumpur Hotel MJP-21(Suppl)-2012 CONTENTS Plenary Sessions Page 3-8 Symposia Sessions ASAD Symposium Page 9-26 General Symposium Page 26-27 Lunch Symposium Page 28 Oral Free Paper Presentation Page 28-42 Poster Presentation Page 42-57 2 MJP-21(Suppl)-2012 PLENARY SESSIONS Plenary 1 The Assessment and Care of Older People with Dementia from Culturally and Linguistically Diverse Backgrounds Prof. Dr. Daniel O’Connor Monash University, AUSTRALIA Cognitive assessment presents special challenges in the case of older people from culturally and linguistically diverse (CALD) backgrounds, particularly those with little education and limited fluency in the predominant language. Groups at risk of invalid assessment and incorrect diagnosis include members of marginalised indigenous communities, refugees and migrants. Even simple cognitive screening tests are subject to educational bias and examples will be given of attempts to develop more culturally appropriate tools. For CALD people who develop dementia, admission to a residential facility can result in great social isolation. Nursing homes that cater to members of particular ethnic groups help meet residents’ need for easy communication with staff and co-residents but such facilities are not always available or accessible. Ways of overcoming their isolation will be discussed. Plenary 2 Early Onset Familial Alzheimer Disease (EOFAD): Opportunity to Test Disease Modifying Drugs for AD Prof. Dr. Serge Gauthier McGill University, CANADA There is great interest in Early Onset Familial Alzheimer’s Disease (EOFAD) because the mutation carriers can be treated with amyloid-acting drugs in pre-symptomatic and early symptomatic stages. The availability of revised diagnostic criteria taking into account biomarkers of amyloid deposition and of neurodegeneration facilitates the enrolment in early stages of disease. Furthermore the natural history of the progression of such biomarkers has been studied in untreated patients with EOFAD through the Dominantly Inherited Alzheimer Network (DIAN), using a model similar to the Alzheimer Disease Neuroimaging Initiative (ADNI). It is possible that disease-modifying drugs for AD will be more effective in this group with relatively homogeneous amyloid pathology compared to late onset AD with vascular and Lewy body co-morbidity. Plenary 3 Restoring Circadian Rhythms: A New Way to Successfully Manage Depression Prof. Dr. Azhar Md Zain Universiti Putra Malaysia, MALAYSIA The heterogeneity of symptoms within MDD poses significant challenges for treatment and it is likely that current pharmacotherapies do not target all symptoms equally, although they may have similar efficacy rates. While there is still continuing interest in understanding monoamine interactions and consequent downstream effects, the limited efficacy and tolerability achieved with classical antidepressants provides a compelling argument to move beyond the monoamines. Recent advances in our understanding of the fundamental links between chronobiology and major mood disorders, as well as the development of new drugs (like Agomelatine) that target the circadian system, have led to a renewed focus on this area. Plenary 4 Managing Broad Symptoms of Major Depressive Disorder - Looking Beyond Remission Prof. Dr. Azhar Md Zain Universiti Putra Malaysia, MALAYSIA Major Depressive Disorder (MDD) is a devastating illness to patients, families and society and will likely become more burdensome in the coming decade. It has a progressive course and may be associated with functional and structural changes in the brain. 5HT and NE influence the balance between excitatory and inhibitory activity in the prefrontal cortex and limbic system. MDD can present with a broad range of symptoms; not just emotional symptoms, but also anxiety and physical symptoms that may need to be addressed. Improvement of these symptoms associated with depression may 3 MJP-21(Suppl)-2012 improve chances for remission. Successful treatment of broad range of symptoms may be an important consideration for optimizing depression treatment outcomes. Thus using an antidepressant that treats broad range of symptom increase the chance of remission and achieving optimal functioning outcomes. Plenary 5 Therapeutic Goals in the Management of Bipolar Disorder, and the Potential Role of Asenapine (Saphris) Prof. Dr. John Tiller University of Melbourne, AUSTRALIA Bipolar disorders are severe, complex and cyclical mood disorders associated with considerable morbidity, mortality, and unmet needs. Bipolar disorders are multidimensional characterised by dramatic mood swings between manic/hypomanic and depressive episodes, with intervening periods of normal mood often interrupted by subsyndromal symptoms. Patients may also present in a mixed state, whereby they meet the criteria for both a manic and a depressive episode simultaneously. Patients with bipolar disorder can also experience rapid cycling, characterised as the occurrence of .4 mood episodes within 12 months. Co-morbid psychiatric and somatic conditions not only further complicate diagnosis and therapy but also increase mortality which is a major concern in individuals with mood disorders. The mortality rate from suicide alone in bipolar disorder is approximately 10 times that of the general population. Bipolar disorder is a highly recurrent illness; more than 90% of patients report multiple affective episodes across their lifetime. Recent, large-scale, prospective studies have revealed that patients remain symptomatic for approximately 50% of their lives. Consequently, bipolar disorder has a dramatic long-term impact on patient’s social and occupational function and quality of life. The therapeutic goals are for symptomatic response and preferably remission. More importantly is that of functional recovery and rehabilitation. The atypical antipsychotic agent asenapine has been shown to be effective in the treatment of mania. The potential role of asenapine in bipolar disorder treatment will be reviewed. Plenary 6 The Relationship Between Depression, Cognitive Decline and Dementia: Reflecting on the New Criteria for the Dementias Prof. Dr. Daniel O’Connor Monash University, AUSTRALIA Most health professionals are now aware of the terrible consequences of falsely diagnosing dementia in older depressed patients. The pendulum has now swung the other way, though, with massive prescribing of antidepressant medications to people with dementia, often without adequate assessment or review. Our understanding of the relationships between depression, cognitive impairment and dementia is now much more nuanced. The cognitive impairment associated with depression does not always resolve and increases the risk of dementia in subsequent years. Conversely, some people with undoubted dementia are also persistently and severely depressed. Recent studies suggest that antidepressant medications are not effective in this group but contrary evidence and arguments will be presented to support their use in carefully selected cases. Plenary 7 Reflecting on the New Criteria for the Dementias Prof. Dr. Nicola T Lautenschlager Melbourne University and St Vincent’s Health, AUSTRALIA Recently changes to the current classification of dementias and causes of dementia, such as Alzheimer’s Disease have been suggested, acknowledging that newly accumulated knowledge, for example on biomarkers, should be incorporated. This plenary will review the newly suggested criteria for dementia due to Alzheimer’s Disease, mild cognitive impairment due to Alzheimer’s Disease and the preclinical stages of Alzheimer’s disease by the National Institute on Ageing and the Alzheimer’s Association. It will also critically review the revised definition of Alzheimer’s Disease published by the International Working Group for New Research Criteria for the diagnosis of Alzheimer’s Disease and the suggestions how to replace the term dementia in DSM-V. Whilst it is encouraging that more knowledge on the 4 MJP-21(Suppl)-2012 development of the underlying pathologies of dementias is available these new criteria have to be carefully investigated regarding their clinical utility. They also raise a number of ethical issues and highlight the challenge to bridge newest developments in research with clinical health care provision. Plenary 8 First Episode Schizophrenia: Treatment to Remission Assoc. Prof. Dr. Lee Wing-King Chinese University of Hong Kong, Shatin, New Territories, HONG KONG In this lecture, I shall re-visit the literature of the neuro-progression of schizophrenia, critical period hypothesis, the impact of duration of untreated psychosis (DUP) and the cost-effectiveness of specialized early intervention services versus generic services of first-episode psychosis, including Scandinavian TIPS, Danish OPUS, and UK LEO studies. Neuro-progression was demonstrated with duration and number of psychosis. DUP studies showed poorer prognosis with longer DUP. Early intervention studies demonstrated cost-effectiveness of specialized services compared with generic services. The primary outcome of time to and rates of discontinuation for any cause within 12 months of a recent large trial of first-episode schizophrenia and schizophreniform disorder was discussed. The result of a recent meta- analysis