身心相印 (之一) - 心臟病與憂鬱症

根據世界衛生組織 (WHO) 報告，心臟病與憂鬱症，是全球疾病負擔的主要元兇。憂鬱症與心臟病之間，互相影響，並存在一定的聯繫。雖然，心血管疾病能直接導致死亡，憂鬱症，卻能降低與健康相關的生活品質。這兩種常見的疾病，已經成為現代人群中的流行疾病。心臟學者研究證實，憂鬱症是心臟病發後常見的狀況，憂鬱症的發生更能增加心臟問題的復發和死亡率。

美國心臟協會(AHA)相信憂鬱症與心血管疾病的照護有重要關聯，並評估20％患者因罹患冠心病(acute coronary syndrome)而悲傷，對前景感到灰黯，也有研究認為憂鬱症會使他們死亡的風險加倍。2005年，研究追蹤311位罹患憂鬱症的心臟病患，及367位一般心臟病患。研究發現，罹患憂鬱症的心臟病患，死亡率為一般心臟病患的3倍！然而，憂鬱症為何增加死亡風險，仍是一個謎。

2003年研究顯示，心臟衰竭(congestive heart failure) 與憂鬱症也有關連。約30%的心臟衰竭病患同時罹患憂鬱症，較冠心病患的風險高1.5倍。2004年一項研究追蹤，沒有憂鬱症的心臟衰竭病人，發現21.2%的病患於一年後呈現憂鬱症。

憂鬱症本身，也是心血管與腦血管疾病的罪魁禍首。2011年，AHA的研究，對8萬名婦女進行6年追蹤調查，結果發現，有抑鬱症歷史的婦女，中風機率較沒有憂鬱症的婦女高23%。此外，現時罹患憂鬱症的婦女，中風的風險更高達41％！

正如癌症和心血管疾病的早期鑑定和干預一樣，及早發現和治療憂鬱症，可減少日後的發生率。美國心臟協會，呼籲所有心血管疾病患者，接受憂鬱症篩檢。治療心臟病患者的憂鬱症，可提高生活品質。認知行為治療(Cognitive Behavioral Therapy)，可幫助患者克服憂鬱症的負面健康行為 (如抽煙、缺乏運動和肥胖)。

角聲醫療中心，將為千多位低收入和沒有保險的華人，提供免費的憂鬱症篩檢，希望有助亞太裔社區降低憂鬱症的罹患率。

所以，憂鬱症防治與心血管疾病治療是相輔相成的。根據美國精神健康議會（National Advisory Mental Health Council）的報告說，如果憂鬱症獲得適當的治療，五個病人中有四個能改善病情。抗抑鬱病藥 (SSRI) ，能治療一般的憂鬱症和心臟病患的憂鬱症。認知行為治療，能改善心臟病患對前景的看法。更重要的是，要常常喜樂... 凡事謝恩！


◎胡啟贇醫師

Using a Chinese Radio Station to Disseminate Dementia Knowledge to Chinese Americans

Volume 60, Issue 11, pages 2175–2176, November 2012

Using a Chinese Radio Station to Disseminate Dementia Knowledge to Chinese Americans

Benjamin K. P. Woo, M. D. 

Although Chinese Americans are one of the fastest-growing minority groups in the country, they are not well represented in studies of dementia. Prior literature has highlighted that Asian Americans with dementia are particularly vulnerable to the stigma of chronic and severe mental illnesses.[1] Previous research has also suggested that Chinese Americans are likely to underuse mental health services.[2] There is a paucity of research on the knowledge of the Chinese-American general public about dementia, particularly in first-generation Chinese Americans.

Using ethnic minority radio stations to disseminate medical information may be a viable option to decrease stigma against dementia of Chinese Americans because many may be primarily Chinese speaking with low levels of education. In the greater Los Angeles metropolitan area, KMRB AM1430 is the only Cantonese station that broadcasts 24 hours a day. The program Rainbow Beneath the Sky broadcasts Monday through Friday from 7PM to 8PM. A psychiatrist fluent in Cantonese was asked to narrate the story of a Hong Kong Nobel Laureate, Charles Kao Kuen, who has had dementia. The program was aired on June 12, 2012, and the public was asked to call after the radio program to respond to a questionnaire. The survey consisted of three items about Chinese-Americans opinion about dementia. For each question, respondents were asked to answer yes or no in Chinese. Question 1 asked, “Is dementia a disease that affects the brain?” Question 2 asked, “Do all elderly adults develop dementia?” Question 3 asked, “Is dementia a mental illness?” The correct responses were yes, no, yes, respectively.

Twenty-two Chinese Americans participated in the survey. The sample consisted of 73% (n = 18) women, 36% (n = 8) with a high school degree or better, 45% (n = 10) with family history of dementia, and 59% (n = 13) who had immigrated to the United States more than 20 before. Seventy-seven percent (n = 17) were aged 40 to 64, and 23% (n = 5) were aged 65 and older. One hundred percent (n = 22), 64% (n = 14), and 14% (n = 3) responded with the correct answers for Questions 1, 2, and 3, respectively.

An ethnic radio program may be useful for Chinese Americans, especially for immigrants. Many of the respondents were primarily Chinese speaking, with low levels of education, so they were able to learn about mental health in their own language. As the survey identified, all Chinese Americans (100%) tend to view dementia as an illness that affects the brain. For example, one participant stated in Chinese, “Playing mah-jongg can eliminate dementia because it activates my brain!” but as Question 3 revealed, only 14% of Chinese Americans were able to conceptualize dementia as a mental disorder that can influence mood, thinking, and behavior. This is consistent with previous research that has showed that Asian Americans with dementia are particularly vulnerable to the stigma of chronic and severe mental illnesses.[1] Thus, it is critically important to develop culturally appropriate programs and services to ensure that Chinese Americans receive medical and mental health services for dementia when appropriate.

Forty-six percent of respondents believed that all elderly adults would have dementia. A previous study reported that, for Asian Americans, the aging mind and body as a machine is a culturally shaped metaphor that suggests the inevitability of deterioration.[3] The stereotype of dementia as part of normal aging may further delay Chinese Americans in seeking proper diagnostic evaluation and treatment. It is necessary to use ethnic media outlets to build public awareness against such stigma, as well as to highlight that successful aging is achievable.

In conclusion, from the program development perspective, we have the following recommendations to promote dementia awareness in ethnic minority: increase dementia information available in the Chinese language; raise public awareness through collaborating with media outlets, such as ethnic radio stations; present the medical background of dementia, and put a face on mental illness!

References

1. Liu D, Hinton L, Tran C et al. Reexamining the relationships among dementia, stigma, and aging in immigrant Chinese and Vietnamese family caregivers. J Cross Cult Gerontol 2008;23:283–299.
2. Woo BK, Lo TT. How often do Chinese Americans stay on treatment after transitioning from outpatient mental health to primary care setting? Gen Hosp Psychiatry 2011;33:e5–e6.
3. Hinton WL, Fox K, Levkoff S. Introduction: Exploring the relationships among aging, ethnicity, and family dementia caregiving. Cult Med Psychiatry 1999;23:403–413.

 

General Hospital Psychiatry

Available online 6 July 2012

Letter to the Editor

Are there race/ethnicity differences in disposition of older patients in psychiatric emergency service?

• Benjamin K.P. Woo, M.D. 

• Olive View–UCLA Medical Center, University of California, Los Angeles, CA

• Received 21 April 2012. Revised 31 May 2012. Accepted 1 June 2012. Available online 6 July 2012.

To the Editor,

The number of older patients with psychiatric disorders is rapidly increasing nationwide, yet little is known about the outcomes of care for geriatric patients with psychiatric emergencies [1]. This population is also increasing in diversity, and as a result, emergency room clinicians must expand their awareness of ethnicity and its effect on psychiatric emergencies among older patients. Few studies [2] and [3] have examined the utilization patterns of psychiatric emergency service (PES) by older patients, but little is known about the impact of race and ethnicity on PES clinical outcomes. To better understand the mental health needs of diverse, older patients in the PES, it is import to study the associations between ethnicity and PES disposition of this population.

This retrospective study utilized a PES database from a California county of 780,000 people. The PES database was extracted from the Mental Health Management Information System (MIS). Variables included age, gender, legal status, marital status, insurance status, ethnicity, previous psychiatric diagnoses, current psychiatric diagnosis and disposition [4]. There were 2591 PES evaluations in this 10-month study period (August 2005 to May 2006). Data were abstracted from the MIS in 2007. Older patients (aged ≥ 50) accounted for 438 (16.9%) evaluations. All patients who were identified as African Americans, Hispanics or Whites were included in the study. The sample size of older patients of other ethnic backgrounds was less than 11, insufficient for meaningful analyses. Thus, the final sample for this study was reduced to 427 older patients. One-way analysis of variance and χ² analyses were used to determine racial/ethnic group differences on sociodemographic and clinical factors for continuous variables and categorical variables, respectively.

The sample consisted of 6.8% (29) African Americans, 19.7% (84) Hispanics and 73.5% (314) Whites. The mean age±S.D. was 58.9±9.5, 59.8±10.5 and 57.4±8.0 for African Americans, Hispanics and Whites, respectively (F= 2.69, df=2, P=.07). Comparing among African Americans, Hispanics and Whites, there were 58.6% (17) vs. 45.9% (31) vs. 45.9% (144) males (χ²= 4.49, df=2, P=.11); 10.3% (3) vs. 19.1% (91) vs. 22.9% (72) married (χ²= 2.83, df=2, P=.24); 41.4% (12) vs. 23.8% (20) vs. 29.0% (91) uninsured (χ²= 3.26, df=2, P=.20); 44.8% (13) vs. 32.1% (27) vs. 45.9% (144) without previous psychiatric diagnoses (χ²= 5.12, df=2, P=.08); 58.6% (17) vs. 77.1% (62) vs. 77.1% (242) admitted on involuntary status (χ²= 4.95, df=2,P=.08), respectively. There were no statistically significant differences on any of the sociodemographic and clinical variables. Finally, 22.6% (71) of Whites compared to 24.1% (7) of African Americans and 19.0% (16) of Hispanics were discharged from the PES after evaluations. There were no ethnicity differences on PES dispositions (χ²=.57, df=2, P=.75).

These data present critical information on whether ethnicity plays a role in sociodemographic and clinical factors as well as dispositions of older patients presenting to a PES. Ethnic disparities in medical and mental health treatments have been well documented in numerous studies [5], [6], [7] and [8]. In the adult population, African Americans were overutilizing the PES compared to Whites [5]. Findings from an epidemiological study of a national sample also found ethnic differences in psychiatric treatment among older adults [6]. Clinical findings from the current study, however, demonstrate that among older patients of PES, minority populations have equal disposition rates compared with Whites. Nevertheless, this study is limited by its small sample of African Americans. Thus, multivariable logistic regression was not performed because of the small number of patients. The aggregate data for the PES utilization also did not permit us to infer correlation between race/ethnicity with clinical factors for older PES patients. The PES database also did not include relevant clinical information, such as acuity, comorbidity and severity.

Ethnic disparities in delivery of psychiatric emergency care would contribute to excess mortality among minorities. This study suggests that ethnicity may not play a role in PES disposition rates, despite multiple barriers that may exist for older adults to receive quality PES care. It is likely that, regardless of race, emergency room clinicians adhere to clinical necessity to determine inpatient admission or discharge from PES. Another possibility is that older minority patients presenting to the PES suffer greater acuity and comorbidity, thus restricting the likelihood of being discharged [9] and [10]. As older ethnic minorities are less likely to consult outpatient mental health services [11], PES may have become their last resort during psychiatric crises. Thus, the PES may also be providing care for a significant number of ethnic minorities who contribute a disproportionate share of disease burden. Further investigations should utilize structured interviews to determine whether racial disparities exist in clinical severities among ethnic minorities presenting to PESs. Future studies should investigate the impact of race and ethnicity on PESs nationwide. Given the high prevalence of psychiatric and medical conditions among older PES patients, future studies should also examine the effect of ethnicity on this comorbidity in the acute settings.

References

1. • [1]
   • B.K. Woo Utilization patterns of psychiatric emergency services by elderly patients J Am Geriatr Soc, 57 (1) (2009), pp. 182–183
2. • [2]
   • P.G. Walsh, G. Currier, M.N. Shah et al. Psychiatric emergency services for the U.S. elderly: 2008 and beyond Am J Geriatr Psychiatry, 16 (9) (2008), pp. 706–717
3. • [3]
   • B.K. Woo What role does ethnicity play in psychiatric emergency service? Gen Hosp Psychiatry, 33 (6) (2011), pp. 535–536
4. • [4]
   • T.T. Lo, B.K. Woo The impact of unemployment on utilization of psychiatric emergency services Gen Hosp Psychiatry, 33 (3) (2011), pp. e7–e8
5. • [5]
   • G.J. Unick, E. Kessell, E.K. Woodard et al. Factors affecting psychiatric inpatient hospitalization from a psychiatric emergency service Gen Hosp Psychiatry, 33 (6) (2011), pp. 618–625
6. • [6]
   • A. Akincigil, M. Olfson, J.T. Walkup et al. Diagnosis and treatment of depression in older community-dwelling adults: 1992–2005 J Am Geriatr Soc, 59 (6) (2011), pp. 1042–1051
7. • [7]
   • B.K. Woo, T.T. Lo How often do Chinese Americans stay on treatment after transitioning from outpatient mental health to primary care setting? Gen Hosp Psychiatry, 33 (1) (2011), pp. e5–e6
8. • [8]
   • K.J. August, H. Nguyen, Q. Ngo-Metzger et al. Language concordance and patient–physician communication regarding mental health needs J Am Geriatr Soc, 59 (12) (2011), pp. 2356–2362
9. • [9]
   • B.K. Woo, W. Chen Substance misuse among older patients in psychiatric emergency service
   • Gen Hosp Psychiatry, 32 (1) (2010), pp. 99–101
10. • [10]
    • B.K. Woo Unrecognized medical disorders among older patients in psychiatric emergency service Int J Geriatr Psychiatry, 26 (8) (2011), pp. 877–878
11. • [11]
    • D.H. Sorkin, E. Pham, Q. Ngo-Metzger Racial and ethnic differences in the mental health needs and access to care of older adults in California J Am Geriatr Soc, 57 (12) (2009), pp. 2311–2317

腦退化症知多少 (粵語健康講座)

Please click below for the links:

腦退化症知多少 (粵語健康講座), Part 1
腦退化症知多少 (粵語健康講座), Part 2
腦退化症知多少 (粵語健康講座), Part 3
腦退化症知多少 (粵語健康講座), Part 4
腦退化症知多少 (粵語健康講座), Part 5
腦退化症知多少 (粵語健康講座), Part 6
腦退化症知多少 (粵語健康講座), Part 7

From the front

From the back

你或你家人有没有... 剛做過的事轉頭即忘？ 腦退化症，前稱老人痴呆症，你到底知多少?認識腦退化症刻不容緩，齊來為身邊人提供身心支援。由胡啟贇醫生以粵語主講，胡醫生是洛杉磯加大醫學院臨床助理教授, 並洛杉磯華語廣播電台(AM1430)特約講員。

時間：2012 -- 6月16日 (星期六) 晚上七時正地點：羅省華人宣道會 (320 Cypress Ave, Alhambra, CA 91801)查詢：626-300-9078

2011-2012 Teaching Awards -- Outstanding Medical Student Teaching

2011-2012 Teaching Awards

The Psychiatry Teaching awards are presented annually during Psychiatry Grand Rounds.  Their purpose is to honor excellence in teaching, supervision, mentoring or related instructional activities in a number of categories.  Nominees for each award are selected for their ingenuity, clinical skill, innovation, availability, supportiveness, dedication, humanism, respect for diversity, improvement in the teaching process, and introduction of new important subjects.

Outstanding Medical Student Teaching

Eligible candidates are full-time faculty in the department who lecture, supervise or tutor in any of the courses for first or second year medical students or in any of the psychiatry clerkship or medical student electives (include those offered at our V.A. or affiliated medical programs).
Benjamin Woo, M.D.
Dr. Benjamin Woo is the site director for the third year Psychiatry clerkship at the Olive View Medical Center and works with the medical students that rotate through the inpatient psychiatry unit. One student that had begun their rotation with no particular interest in the field acknowledged that he had an epiphany about psychiatry while under the guidance of Dr. Woo, stating “I suppose that is what the truly great teachers do. They take something that may initially seem so foreign and unattractive and change it into the most interesting and fascinating thing in the world. This is indeed what Dr. Woo did for me in psychiatry. He undoubtedly planted an infectious desire to learn more about psychiatry and a new found drive to be instrumental in the treatment of the mentally ill. Subsequently, I have now decided to pursue a career in psychiatry.” A former student believes that the traits that Dr. Woo modeled early on have been indispensable in their development as a clinician and educator, adding that “Dr. Woo has been an invaluable part of my career, and I look forward to him inspiring future generations to come”. For his dedication to teaching students, Dr. Benjamin Woo is truly deserving of the 2012 Outstanding Medical Student Teaching Award.   

「腦退化症知多少?」 免費健康講座

你或你家人有没有... 剛做過的事轉頭即忘？ 腦退化症，前稱老人痴呆症，你到底知多少?認識腦退化症刻不容緩，齊來為身邊人提供身心支援。由胡啟贇醫生以粵語主講，胡醫生是洛杉磯加大醫學院臨床助理教授, 並洛杉磯華語廣播電台(AM1430)特約講員。

時間：2012 -- 6月16日 (星期六) 晚上七時正
地點：羅省華人宣道會 (320 Cypress Ave, Alhambra, CA 91801)
查詢：626-300-9078

Simple ways to test for Dementia (腦退化症)

畫鐘測驗 (CLOCK DRAWING TEST, aka CDT)

CDT is a simple method to detect whether you may be suffering from memory loss. Ask your loved one to draw a clock, point the hands to "10 after 11," and voila -- you are done! It is one of the ways to screen for dementia. Even if you have depression on top dementia, this simple test can still be useful (http://www.ncbi.nlm.nih.gov/pubmed/15533989)

畫鐘測驗是一個簡單的方法來檢測您是否患有記憶力減退。請你畫一個時鐘，指向 11:10. 畫鐘測驗也適用於同時患有抑鬱和腦退化患者.

If your clocks look like the above, please seek help immediately.