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Monpat Chamnanphon,1 Sorawit Wainipitapong,2 Teeravut Wiwattarangkul,3 Phenphichcha Chuchuen,2 Kunathip Nissaipan,1,4 Weeraya Phaisal,1,4 Sookjaroen Tangwongchai,2 Chonlaphat Sukasem,5 Supeecha Wittayalertpanya,1,4 Andrea Gaedigk,6 Daruj Aniwattanapong,2 Pajaree Chariyavilaskul1,4 1Clinical Pharmacokinetics and Pharmacogenomics Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 2Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 3Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 4Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 5Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 6Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children’s Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USACorrespondence: Daruj AniwattanapongDepartment of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandTel +66 2 256 4298Email daruj.a@chula.ac.thPajaree ChariyavilaskulDepartment of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandTel +66 2 256 4481 ext. 3020Email pajaree.l@chula.ac.thPurpose: Donepezil, a drug frequently used to treat dementia, is mainly metabolized by cytochrome P450 2D6 (CYP2D6). This study investigated the relationships between CYP2D6 genotype and activity scores as well as predicted phenotype of plasma donepezil concentrations in 86 Thai dementia participants.Materials and Methods: CYP2D6 was genotyped using bead-chip technology (Luminex xTAG® v.3). Steady-state trough plasma donepezil concentrations were measured using high-performance liquid chromatography.Results: Sixteen genotypes were found but the most frequent genotypes detected among our participants were CYP2D6*10/*10 (27.9%) and *1/*10 (26.7%). One-third of the participants had an activity score of 1.25 which predicted that they were normal metabolizers. The overall median (interquartile range) of plasma donepezil concentration was 51.20 (32.59– 87.24) ng/mL. Normal metabolizers (NMs) had lower plasma donepezil concentrations compared to intermediate metabolizers (IMs) (41.15 (28.44– 67.65) ng/mL vs 61.95 (35.25– 97.00) ng/mL). Multivariate analysis showed that CYP2D6 activity score (r2 = 0.50) and the predicted phenotype (independent of dose) could predict the plasma donepezil concentration (r2 = 0.49).Conclusion: Plasma donepezil concentration in NMs was lower compared to IMs. Additional studies with larger sample size and use of next-generation sequencing as well as its outcomes are warranted to confirm the benefit of using pharmacogenetic-guided treatment for donepezil.Keywords: CYP2D6, Luminex xTAG®, donepezil, dementia, pharmacogenetics

Background: Patients with serious mental illness (SMI) often engage in religious and superstitious activities. The implications of such engagements remain unclear, with no established guidelines for mental health professionals., Aims: This study aimed to survey perspectives and gather suggestions from various disciplines within mental healthcare regarding the engagement in religious/superstitious activities of SMI patients: schizophrenia spectrum disorders, bipolar disorder, major depressive disorder., Method: This cross-sectional study was conducted between November and December 2023 among Thai mental health professionals. Participants used 10-point Likert scales to rate their agreement levels for engaging each activity. Additional suggestions were obtained through textual responses, which were subsequently summarised and synthesised., Results: Of the 403 professionals participated, the majority were female (73.2%), Buddhist (87.6%) and psychiatrists (42.2%), with a median age of 34.0 years. Among patients with active symptoms, patients with major depressive disorder tended to receive the highest mean agreement scores for engagement, while patients with schizophrenia consistently scored the lowest across most activities. Similar trends were observed among patients in remission. From textual responses, two key themes were synthesised: (1) environmental factors and (2) impacts on natural courses., Conclusions: Patients with active schizophrenia received the lowest levels of agreement while patients with major depressive disorder tended to receive the highest mean agreement scores on engaging religious/superstitious activities.

Background: The well-being of LGBTQ + medical students can be influenced by religiosity, family support, and the disclosure of their gender identity or sexual orientation. These factors have frequently been overlooked and warrant further consideration in creating a supportive environment for all students., Methods: This multicenter study investigated two main outcomes including the differences in religiosity and perceived family support between LGBTQ + and non-LGBTQ + medical students in Thailand, and the gender disclosure to family among LGBTQ + medical students. It was conducted among students from five medical schools across Thailand, using online questionnaires during the academic year 2021-2022. Data were collected on demographic characteristics, religiosity, gender identity/sexual orientation disclosure to family, and perceived family support. Comparisons between groups were conducted using chi-square test and Wilcoxon rank-sum test., Results: Of the 1,322 participants, 31.2% identified themselves as LGBTQ+, among whom 81.8% were Buddhists. The proportion of non-religious LGBTQ + students was significantly higher (vs. non-LGBTQ+; 15.0% vs. 8.4%, respectively; p = 0.001). However, there was no statistical difference in religiosity between LGBTQ + and non-LGBTQ + students as well as between LGBTQ + subgroups. Although, 74% of LGBTQ + students reported good family support, significantly more LGBTQ + students perceived poor family support (vs. non-LGBTQ+, 7.0% vs. 4.7%; p = 0.002). Regarding the disclosure of gender identity or sexual orientation to the family, the majority of LGBTQ + individuals indicated either a non-disclosure or uncertainty. There were significant associations between perceived family support and the likelihood of disclosing one's identity to family members, as better perceived support was associated with higher disclosure rates., Conclusions: No statistically significant difference in religiosity was found between LGBTQ + and non-LGBTQ + students. The majority of LGBTQ + medical students reported receiving good family support; however, among those who perceived their family's support to be lacking, there was a greater tendency to conceal their gender identity from their families. For future studies, it is crucial to investigate whether this concealment extends to other spheres of their lives and to assess the potential impact on their well-being, including mental health and quality of life., Competing Interests: Declarations Ethical approval and consent to participate This study was approved by Institutional Review Boards at each site: Mahidol University (167/2022), Chulalongkorn University (0006/2022), Khon Kaen University (HE651083), Prince of Songkla University (65-085-3-1), and Chiang Mai University (PSY-2565-08832). Informed consent to participate in the study was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Conflict of interest The authors report no conflicts of interest with respect to the research, authorship, or publication of this article., (© 2024. The Author(s).)

Background: Medical students with sexual and gender diversity (SGD) often face challenges in educational performance and encounter more education-related problems, potentially due to discrimination in medical schools. This study aimed to compare academic difficulties, education-related issues, and experiences of discrimination among medical students with SGD versus those identifying as non-SGD., Methods: This was a cross-sectional study. Participants included a convenient sample of medical students aged at least 18 from five Thai medical schools, all recruited during the 2021 academic year. General demographic data, academic difficulties, education-related problems, and both positive and negative aspects of medical education, encompassing physical aspects, supporting systems, and discrimination, were assessed. The descriptive data and comparison between SGD and non-SGD medical students were performed. Binary logistic regression was adopted to evaluate the association between characteristics of discrimination in each categorized type of gender diversity., Results: Among 1322 medical students, 412 (31.2%) described themselves as having SGD. There was no significant difference in academic performance between SGD and non-SGD students. However, SGD students reported higher dropout thoughts (39.8% vs. 23.1%, p < 0.001) and self-perceived burnouts (84.2% vs. 74.9%, p < 0.001). The SGD group perceived lower support from medical staff and higher inadequate financial support (30.3% vs. 22.1%, p < 0.01; 11.2% vs. 23.1%, p < 0.01, respectively). 64.44% of students reported witnessing at least one form of discrimination. Lesbian students were more likely to report witnessing discrimination (OR = 3.85, [1.05-14.16]). Gay students were significantly associated with experiencing sexist remarks (OR = 6.53 [3.93-10.84]) and lower selectively prohibited educational opportunities (OR = 0.36 [0.21-0.63])., Conclusions: While academic performance did not differ between medical students with SGD and their non-SGD peers, SGD students reported more academic difficulties and perceived less support from medical staff and financial support. They also reported a higher incidence of discrimination. The need for specific interventions to address these issues should be further explored., (© 2024. The Author(s).)

This study evaluated the prevalence and associated factors of depression and generalized anxiety among LGBTQ+ in five medical schools in Thailand. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess major depressive disorder (MDD) and generalized anxiety disorder (GAD), respectively, and multivariable logistic regression was employed to identify associated factors. Of 1,322 students, 412 (31.16%) identified as LGBTQ+. The prevalence for MDD and GAD among LGBTQ+ students were 32.77% and 17.23%, respectively. Significant associated factors for both MDD and GAD were a history of psychiatric illness (AOR for MDD = 2.32, p  = .020; AOR for GAD = 3.67, p  < .001), educational problems (AOR for MDD = 6.62, p  < .001; AOR for GAD = 5.12, p  < .001), and dissatisfaction with gender identity or sexual orientation (AOR for MDD = 1.92, p  = .019; AOR for GAD = 2.47, p  = .005). Additional factors associated with MDD were preclinical years (AOR = 2.30, p  = .023), financial struggles (AOR = 2.05, p  = .021), and inadequate peer support (AOR = 2.57, p  = .044). In conclusion, nearly one-third and one-fifth of Thai LGBTQ+ medical students suffer from MDD and GAD, respectively. Our findings suggest that Thai medical schools should promote LGBTQ+ inclusivity to enhance students' identity satisfaction. Peer support groups should be encouraged, especially for preclinical LGBTQ+ students who face educational and financial challenges.

Purpose: This study evaluated the experiences and needs of lesbian, gay, bisexual, transgender, queer, and other sexual and gender minorities (LGBTQ+) attending medical schools in Thailand., Method: Medical students from 4 medical schools in Thailand were recruited in 2022. LGBTQ+ participants were selected via purposive sampling and invited for semistructured interviews. Verbatim transcripts were analyzed using reflexive thematic analysis., Results: Interviews were conducted with 39 students identifying as lesbian, gay, bisexual, transgender, queer, questioning, nonbinary, asexual, or androgynous, with a mean age of 21. The experiences of these LGBTQ+ individuals in medical school had 4 themes: (1) normalization of LGBTQ+ identity among friends, or not openly identifying as LGBTQ+ (because it was viewed as unnecessary), facilitated everyday life; (2) fear of negative judgments from being LGBTQ+ by attending physicians and patients; (3) authenticity to sexual or gender identity provided relief; and (4) personal histories of discrimination affected self-disclosure and social dynamics. Overall, approximately 17% of reported stressors were directly associated with participants' LGBTQ+ identity. The identified needs within medical schools comprised 2 themes: (1) treat each other with equal respect (with 3 subthemes: nonjudgmental attitudes supported by effective discrimination reporting systems; more LGBTQ+-related education and extracurricular activities; and activities driven by voluntariness without gender-based selection); and (2) abolishment or amendment of regulations that strictly enforce gender binaries. These amendments could include implementing flexible dress codes, establishing gender-neutral restrooms and dormitories, and introducing gender-neutral titles. Transgendered participants reported experiencing the most significant disparities due to binary regulations and infrastructures., Conclusions: LGBTQ+ medical students in Thailand reported fear of negative perceptions by attending physicians and patients. Exposing everyone, particularly attending physicians, to examples of unintentional discrimination is recommended. There is also a need to promote LGBTQ+-related education and extracurricular activities and to ensure activities and regulations are not gender-divided., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.)

Background: The global population of individuals with gender diversity or LGBTQ+ people is on the rise. However, negative attitudes towards LGBTQ+ individuals persist, even among healthcare professionals, creating barriers to healthcare access. These attitudes are influenced by cultural variations worldwide and necessitate investigation across diverse cultures and settings., Objectives: This study aimed to evaluate the attitudes towards LGBTQ+ people and describe associated factors with being LGBTQ+ among Thai medical students., Methods: During the 2021 academic year, a survey was conducted at a medical school in Bangkok, Thailand, collecting demographic data and attitudes measured by a standardised Thai questionnaire. Descriptive statistics as well as bivariate and multivariable logistic regression analyses were used to describe characteristics and association., Results: A total of 806 medical students participated, with a neutral attitude being the most prevalent (72.2%), followed by a positive attitude (27.2%), and a minority reporting a negative attitude (0.6%). Bivariate and multivariable logistic regression analyses revealed significant associations between positive attitudes and female sexual identity (aOR 2.02, 95%CI 1.45-2.81, p-value < 0.001), having LGBTQ+ family members (aOR 3.57, 95%CI 1.23-10.34, p-value = 0.019), having LGBTQ+ friend (aOR 1.46, 95%CI 1.02-2.11, p-value = 0.040), and coming from areas outside of Bangkok (aOR 1.41, 95%CI 1.01-1.97, p-value = 0.043)., Conclusion: Positive attitude towards the LGBTQ+ community are essential for physicians, emphasising the need to study factors that contribute to positive attitudes in order to foster an LGBTQ+-friendly environment for both patients and medical students., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Wiwattarangkul, Wainipitapong. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: This study aims to investigate sexual behaviors among gender diverse (LGBT and other sexual/gender minorities) and nongender-diverse medical students., Methods: In 2021 academic year, medical students from five Thai medical schools completed questionnaires identifying demographic data, psychosexual factors, sexual experiences, and risks., Results: Among 1,322 students, 32.1% were gender-diverse students who had lower age at first sexual intercourse and more experiences in solitary and partnered sexual activity., Conclusions: Use of hookup applications was more frequent among gay and bisexual males. Risky sexual behaviors were significantly higher among bisexual females. Gender-diverse medical students showed higher involvement in sexual activities. Future studies should be addressing sexual health in Thai medical education., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2023 Taylor & Francis Group, LLC.)

Purpose: Although many studies have shown that transgender women (TW) tend to have more depressive symptoms compared with the general population, the exact prevalence of major depressive disorder and contributing risk factors have not yet been studied, especially in those who have undergone gender-affirming genital surgery (GAS)., Methods: Every TW aged 20-60 years attending transgender clinics in the Thai Red Cross Society for postoperative checkup were invited to complete a self-report questionnaire, including (1) demographic data, (2) the Thai Patient Health Questionnaire 9 (PHQ-9), (3) satisfaction with psychosocial factors (relationship in family, friends, and society), sexual experiences and outcomes of gender-affirming treatments before and after GAS, and (4) contributing factors to depressive symptoms. Correlations between demographic data and depressive scores were tested. Paired t -test was used to compare pre- and post-GAS data., Results: A total of 97 TW were analyzed, with 22.7% considered to have "major depression" (PHQ-9≥9) after GAS. Postoperative improvement in satisfaction with psychosocial factors and gender-affirming treatment outcomes were observed, especially in sexual experience. Depression severity was found to be negatively correlated with age and sexual satisfaction. Notably, presence of male characteristics before surgery, poor social support and understanding, and postoperative surgical complications were greatly considered as factors contributing to depressive symptoms., Conclusion: Compared with non-GAS TW, depression among those who underwent GAS in Thailand was lower but still significant and was linked to younger age and poor postoperative sexual experiences. These findings were supported by the number of qualitative assessments in the psychosexual domain and postoperative treatment outcomes. Clinical Trial Registration Number - TCTR20190904003., Competing Interests: No competing financial interests exist., (Copyright 2022, Mary Ann Liebert, Inc., publishers.)

Introduction: Delayed ejaculation (DE) is a poorly understood and uncommon male sexual dysfunction. The etiology of DE includes psychological and biological factors, which are usually combined. Herein, we report a case of acquired and situational DE due to improper male condom size., Aims: To identify and correct the possible cause of acquired and situational DE., Methods: A male patient presented with new-onset DE for 6 months. His physical and mental examination was unremarkable. Laboratory results were all normal. He was diagnosed with acquired, situational DE and received sessions of sexual counseling. However, his DE persisted until he accidentally used a larger condom. He then reported normal orgasm., Main Outcome Measures: Resolution of acquired and situational DE., Results: His DE was improved after using a more proper condom size., Conclusion: Most patients are believed to have psychological problems and proper condom use is under-recognized. To the best of our knowledge, this is the first report of DE caused by this etiology. Wainipitapong S, Wiwattarangkul T, Bumphenkiatikul T. Delayed Ejaculation Due to Improper Male Condom Size: A Case Report. Sex Med 2021;9:100373., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)