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Introduction: There is a high prevalence of psychiatric comorbidities in patients with Chronic Obstructive Pulmonary Disease (COPD). It has been reported that if left untreated, the psychiatric comobidities can lead to poorer quality of life. The present study was initiated to investigate the prevalence of major depressive disorder, generalized anxiety disorder and panic disorder in hospitalized COPD patients and their quality of life. Methods: The Patient Health Questionnaire (PHQ) of the Primary Care Evaluation of Mental Disorders (PRIME-MD) was administered to screen an opportunistic sample of COPD patients admitted to a general hospital for the abovementioned psychiatric disorders. The Medical Outcomes Study (MOS) 36-Item Short Form Health Survey (SF-36) was utilized to assess quality of life. Results: Fifty-one patients were analyzed. The prevalence of major depressive disorder in this sample on screening was 7.8% (95% CI 2.2–18.9) and that of anxiety disorders (generalized anxiety disorder and panic disorder) was 5.9% (95% CI 1.2–16.2). The quality of life of COPD patients with psychiatric comorbidities in the present study was severely impaired in seven of the eight domains measured by the SF-36. Discussion: Despite the small sample size of COPD patients, the prevalence of psychiatric comorbidities was not insignificant. The present study showed that the quality of life of hospitalized COPD patients with psychiatric illnesses was significantly lowered. Treatment of COPD should include addressing psychosocial issues.

The Ministry of Health (MOH) has developed the clinical practice guidelines on Anxiety Disorders to provide doctors and patients in Singapore with evidence-based treatment for anxiety disorders. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on anxiety disorders, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Mental health literacy studies consider the capacity of respondents to recognize certain psychiatric disorders, judge the comparative utility of a range of interventions, and make estimates about outcome and prognostic issues. We report such a study involving a sample of nursing staff employed at a large psychiatric institution in Singapore, and who were provided with separate brief vignettes of mania, schizophrenia and depression. Subjects were highly accurate in 'diagnosing' schizophrenia, less accurate for depression and even less accurate in diagnosing mania. Depression was alternately diagnosed as stress, mania was most commonly misdiagnosed as schizophrenia, and for both psychotic conditions, a percentage returned non-psychotic diagnoses. In terms of treatment options, staff distinctly favoured a 'medical model' and viewed traditional and alternative healing options as distinctly harmful. Analyses contrasted psychiatrically trained and generally trained nurses, but identified few significant differences. Such information has the potential to shape the education and training of mental health professional staff, as well as provide important insights about how nurses may diagnose, view and favour alternative treatments and strategies to assist those with common psychiatric disorders.

We report the case of a 29-year-old mixed-race woman suffering from recurrent major depressive episodes, with suicidal ideation and risk, involving several inpatient admissions. A comorbid diagnosis of borderline personality disorder was also recorded in one of her previous inpatient admissions. During her last inpatient admission, a multidisciplinary case discussion and review of the patient's life highlighted several possible intercultural trigger factors that could have contributed to the exacerbation of her psychiatric illness. We emphasise the need to explore intercultural predisposing and precipitating factors for a more complete psychodynamic understanding of psychiatric illnesses among the multiracial population of Singapore. This also adds to the discussion on the management of such patients with the option of formal in-depth psychotherapy in adjunct to medication. This may prevent recurrent relapses, modify suicide intent and reduce the necessity for inpatient treatment, which will be cost-effective and result in efficacious treatment. Language: en

The views of mental health professionals may influence diagnosis and management options. This study reports nurses' views about the management of three common psychiatric disorders--schizophrenia, depression, and mania. Results demonstrate the effect of greater psychiatric education and training, received by psychiatric trained nurses, on mental health literacy.