Rasaiah Munidasa Winslow
Email Address
pcmrmw@nus.edu.sg
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Publication Addiction in Singapore: Changing patterns and evolving challenges(2012-07) Peh, A.L.H.; Lim, Y.C.; Winslow, R.M.; PSYCHOLOGICAL MEDICINEData from recent studies have shown an increase in substance use and addictive behaviours in Singapore. However, training and services still lag behind this trend, which means the provision of adequate treatment is lacking in spite of good evidence that treatment approaches for addiction disorders are effective. There is a need to train more manpower for this purpose, especially in primary healthcare. Another challenge is to ramp up services as quickly as possible to manage the growing number of addicts. Research should also focus on special populations, while public health education and national policies can be improved, particularly to curb binge drinking. We need to be open to the use of harm-reduction therapies and substitution treatments, as addiction is a chronic relapsing disorder with significant health and psychosocial morbidity.Publication Quality of life in pathological gamblers in a multiethnic asian setting(2011-06) Mythily, S.; Edimansyah, A.; Qiu, S.; Munidasa, W.; PSYCHOLOGICAL MEDICINEIntroduction: Few studies have examined the impact of pathological gambling on quality of life especially in the Asian context. The aim of the current study was to examine the quality of life in pathological gamblers in a multiracial population in Singapore and we hypothesised that those with pathological gambling would have poorer quality of life as compared to controls. Materials and Methods: Forty subjects with "compulsive gambling behaviour" were recruited and matched (for gender and age) with 40 controls. Subjects with pathological gambling were compared with control subjects with regard to sociodemographic data as well as on the World Health Organization Quality of Life assessment - abbreviated version (WHOQOL-BREF). Results: A one-way MANOVA revealed that pathological gamblers had signifi cantly diminished quality of life as compared with the healthy controls using the summary scores of the 4 domains of quality of life (Pillai's Trace = 0.338, F = 9.5, PPublication Stress-coping morbidity among family members of addiction patients in Singapore(2011-07) Lee, K.M.T.; Manning, V.; Teoh, H.C.; Winslow, M.; Lee, A.; Subramaniam, M.; Guo, S.; Wong, K.E.; PSYCHOLOGICAL MEDICINEIntroductions and Aims. Research from western countries indicates that family members of addiction patients report heightened stress and psychological morbidity. This current study aimed to examine stress, coping behaviours, related morbidity and subsequent resource utilisation among family members of patients attending a national treatment program in Singapore. Design and Methods. The study used a matched case-control design. One hundred family members of addiction patients attending treatment and 100 matched controls completed a semi-structured interview with a researcher. This included the Beck Depression Inventory-II, Short-Form Health Survey-36, General Health Questionnaire-28, Perceived Stress Scale, Family Member Impact Scale and Coping Questionnaire, and also assessed service utilisation. Results. T-tests revealed significantly greater depression, stress and psychiatric morbidity and poorer overall well-being (Short-Form Health Survey-36) among family members compared with controls. Despite the apparent negative impact on mental health, their physical morbidity did not differ from controls and services utilisation was low. Tolerant-inactive coping was found to be most strongly correlated with psychological well-being. Multivariate analysis indicated that perceived stress was the strongest predictor of overall strain (General Health Questionnaire), but this was not moderated by coping style. Discussion and Conclusions. Subjective appraisal of stress and coping responses are essential factors affecting the morbidity of family members. Family members demonstrated a need and willingness to engage in formal treatment/counselling for their own problems that were attributed to living with an addiction patient. This provides an opportunity for stress management and brief interventions to modify coping styles, thereby minimizing the potential negative mental health impact on family members. © 2011 Australasian Professional Society on Alcohol and other Drugs.Publication Plant food and incense: The new substances of abuse(2013-07) Winslow, M.; Wong, J.C.M.; Mahendran, R.; DUKE-NUS GRADUATE MEDICAL SCHOOL S'PORE; PSYCHOLOGICAL MEDICINEPublication Qualities of a psychiatric mentor: A quantitative Singaporean survey(2011-11) Tor, P.-C.; Goh, L.-G.; Ang, Y.-G.; Lim, L.; Winslow, R.-M.; Ng, B.-Y.; Wong, S.-T.; Ng, T.-P.; Kia, E.-H.; DUKE-NUS GRADUATE MEDICAL SCHOOL S'PORE; PSYCHOLOGICAL MEDICINEObjective: Psychiatric mentors are an important part of the new, seamless training program in Singapore. There is a need to assess the qualities of a good psychiatric mentor vis-a-vis those of a good psychiatrist. Method: An anonymous survey was sent out to all psychiatry trainees and psychiatrists in Singapore to assess quantitatively the relative importance of 40 qualities for a good psychiatrist and a good mentor. Results: The response rate was 48.7% (74/152). Factor analysis showed four themes among the qualities assessed (professional, personal values, relationship, academic-executive). A good mentor is defined by professional, relationship, and personal-values qualities. Mentors have significantly higher scores than psychiatrists for two themes (relationship and academic-executive). Conclusion: Being a good mentor, in Asia, means being a good psychiatrist first and foremost but also requires additional relationship and academic-executive skills. Mentors should be formally trained in these additional skills that were not part of the psychiatric curriculum. Copyright © 2011 Academic Psychiatry.Publication Monthly take-home methadone maintenance regime for elderly opium-dependent users in Singapore(2010-06) Guo, S.; Winslow, M.; Manning, V.; Thane, K.K.W.; PSYCHOLOGICAL MEDICINEIntroduction: Research suggests that methadone maintenance treatment (MMT) effectively reduces opiate dependence and related health and social problems. However, few studies have examined its effectiveness among the elderly. This study examined a monthly MMT regime for elderly opium addicts attending the National Addictions Management Service, Singapore. Materials and Methods: This study used a cross-sectional design and comprised 40 patients attending the addiction service and 40 caregivers who monitored methadone consumption (mostly patients' sons and daughters). Participants completed a semi-structured interview comprising measures of opiate craving and withdrawal, physical and psychological health. Objective measures were urine drug screens and blood tests. Results: Participants who averaged 74.8 years old had been using opium for around 44 years and had been in MMT for an average of 35 months. The maintenance dose of methadone was 9.2 mg/day. At interview, no opiate usage (other than methadone) was detected in urine screens; however, clinical records indicated that 6 had tested positive during the previous 6 months of MMT. No major withdrawal symptoms, side effects, or incidents of diversion were reported. Quality-of-life scores were in the normal range and satisfaction with the treatment regime was expressed by caregivers. Conclusion: Whilst MMT is the predominant pharmacotherapy for opiate dependence for users of all ages elsewhere, our study group constitutes a unique population that differs markedly from younger opiate users who will eventually grow old. In Singapore, MMT appears to be an effective treatment for stable, elderly opium-dependent patients where families are fully engaged in the treatment regime.Publication Examining the Attitudes of Non-Psychiatric Practicing Healthcare Workers Towards Patients With Alcohol Problems in General Hospital Setting(SAGE Publications, 2022-01-01) Tan, HT; Lui, YS; Peh, LH; Winslow, RM; Guo, S; Dr Yit Shiang Lui; DEAN'S OFFICE (DUKE-NUS MEDICAL SCHOOL); PSYCHOLOGICAL MEDICINE; DUKE-NUS MEDICAL SCHOOLBackground and objectives: Problematic alcohol-use affect the physical and mental well-being of hospitalised individuals and may receive screening and brief-intervention during treatment. Non-psychiatric doctors and nurses might respond inadequately due to negative attitudes and beliefs. This study aimed to examine these attitudes of non-psychiatric workers in the medical and surgical wards. Methods: A total of 457 doctors and 1643 nurses were recruited from the medical, surgical and orthopaedic disciplines over a period of 4 months. Three questionnaires were administered: demographics, Alcohol & Alcohol-Problems Perceptions Questionnaire (AAPPQ) and Staff Perception of Alcohol Treatment Resources. Results: About 128 doctors and 785 nurses responded. Around 75.5% doctors and 51.9% nurses endorsed role-legitimacy in the AAPPQ. Both the doctor (86.7%) and nurse (77.6%) groups agreed on the importance to initiate intervention for patients with problematic alcohol-use in daily work. Both groups were sceptical and negative towards these patients endorsing low-level role-adequacy (41.2%), role-support (36.9%), motivation (36.5%), task-specific self-esteem (25.1) as well as work satisfaction (20.5%). Conclusion/discussion: Doctors and nurses demonstrated low levels of therapeutic commitments towards patients with problematic alcohol-use thereby necessitating the introduction of in-house programmes to educate, empower and emphasise the importance of therapeutic contact with patients for alcohol intervention. Scientific significance: The prompt identification and treatment of patients with alcohol problems are contingent on the workers’ attitudes towards them. This study’s results should spark a nation-wide interest to improve the training and recognition of such patients and providing adequate educational resources.