Welcome and Opening Ceremony

Bipolar disorder is a complex psychiatric condition with pleomorphic presentations, varied course and high comorbidity. While several options are available for treating mania and preventing mania, many challenges remain in providing optimal outcomes for patients with bipolar disorder. For instance, treatment options continue to be limited for treating acute depressive symptoms in patients with bipolar I and bipolar II disorder and few proven strategies are available for preventing relapse of depressive episodes. Similarly, while cognitive impairment is common and impacts functioning in patients with BD, no proven treatments exist for improving cognition in BD. Comorbidities are common in bipolar disorder, and there is limited data to guide management of such patients. Finally, prevention of mood episodes in patients at high risk for BD remain unexplored. This presentation will review these challenges and suggest some strategies to advance the field.

Chairperson:  Chay Hoon Tan, Singapore

Schizophrenia continues to present a major public health problem associated with enormous personal suffering, diminished functioning, family burden and societal costs. Although current treatments (ideally combinations of medication and psychosocial modalities) can substantially improve outcome for many affected individuals, a substantial subgroup qualifies as having “treatment resistant schizophrenia (TRS).” Estimates suggest that 15-20% of patients at their very first episode of psychosis do not derive expected/sufficient benefit from antipsychotic medications. Over time this proportion increase to greater than 30%. In recent decades considerable research has been done evaluating the efficacy of a variety of treatment for these individuals. At the same time there has been insufficient consensus on how to define treatment resistance and many clinical trials employed different criteria for inclusion of subjects. The TRIPP guidelines, published in 2017, were an attempt to provide a consensus of international experts on how to define TRS.

Clozapine remains the only specific medication that has received regulatory approval in many countries for the treatment of TRS. At the same time, however, it remains markedly underutilized. Although there remains some debate regarding clozapine’s unique qualities, a good deal of research supports its role in the management of TRS. Research also suggests that clozapine’s efficacy is greater if it is administered within one to two years after the emergence of TRS.

We still lack good biomarkers to identify those individuals likely to experience TRS and those most likely to benefit from clozapine; however, promising leads have emerged in prospective clinical assessment as well as the use of resting state MRI, PET and EEG perspectives.

Recent research has also suggested that psychotic relapse is associated with poorer response to standard treatment than that observed in prior episodes, suggesting that repeated relapse might also be part of the trajectory towards TRS.

Chairperson:  Jimmy Lee, Singapore

Hypermethylation of RUFY1 associated with high risks of schizophrenia and poor treatment responses in Han Chinese
Weihua Yue, China

Frontal-posterior functional imbalance and aberrant function developmental patterns in schizophrenia
Fei Wang, China

The role of white blood cell counts in metabolic changes and clinical symptom improvement after antipsychotics in patients with schizophrenia: evidence from a large Chinese cohort
Yamin Zhang, China

Developing new drugs for schizophrenia: Mechanism study of fingolimod and a novel AMPA receptor positive allosteric modulator LT-102 as therapeutic agents for facilitating cognitive function in schizophrenia model
Xueli Yu, China

Chairperson: Tao Li, China

Lunch break and poster viewing

Polypharmacy in Bipolar disorder: Findings from REAP Bipolar Disorder study
Vie Cheong Thong, Malaysia

Clinical use of mood stabilizers in REAP Study – Focus on clinical symptoms of bipolar disorder
Isa Multazam Noor, Indonesia

Clinical use of mood stabilizers in Asian patients: summary from REAP-BD and MS studies
Pornjira Pariwatcharakul, Thailand

Research on Asian Psychotropic Prescription Patterns on Minor Psychiatric Disorders: Focusing on Generalized Anxiety disorder, Obsessive Compulsive Disorder and Panic Disorder
Lin Shih Ku, Thailand

Chairperson: Lin Shih Ku, Taiwan

“Treatment resistance” is a definition that does not belong to the classification system, because it depends on the availability of suitable therapies at a given point in history. However, it has regulatory implications, and it may be useful for clinical practice. Treatment resistance is quite well defined in the field of depression, but not so much in the field of bipolar disorder: hence, concepts such as “treatment resistent mania”, “treatment resistent bipolar depression” and “treatment resistent bipolar disorder” await standardized definitions that may guide clinical practice. This presentation will review this concepts and provide hints for optimal treatment of all those clinical scenarios, with a sight to the future.

Chairperson: Yu Wei Lee, Singapore

Provision of the virtual auditorium venue for this session is made possible by a kind donation from Otsuka Pharmaceutical Co., Ltd to the Pharmacological Society (Singapore).

An evidence-based decision about a specific intervention (either pharmacological or not) is not determined only by its demonstrated efficacy and tolerability; it may vary from one patient to another depending on individual clinical circumstances (sex, age, clinical history, etc) and personal preferences. However, ‘evidence’ is not necessarily ‘evident’. Evidence is anything presented in support of an assertion. This support may be strong or weak, but it is the closest that we can get to the truth itself and the only objective starting point we can use for our clinical reasoning. We need all good quality, available data to justify our rational choice; otherwise patients will be treated according to mere opinion. This is the reason why I strongly disagree with opponents of Evidence Based Mental Health who say that it is the wrong paradigm to answer our routine clinical questions. On the contrary, given the inevitability of biases and inaccuracies in the scientific literature, we have a simple choice: we can either make the best use of the available evidence or dismiss and ignore it. Clinicians (and patients and carers) should favour the former approach and reject nihilism. Valid conclusions can be drawn from a critical and cautious use of the best available, if flawed, evidence. Also ‘the best available evidence’ implies the continuous update and progress of scientific knowledge, doubting, testing and retesting previous findings. Scientific knowledge in medicine can develop and increase only if there are researchers, clinicians, patients and public who strive to see things from a different perspective, always pursuing the truth (which almost always means avoiding easy answers). Evidence Based Mental Health should be seen as a tool to engage new generations of psychiatrists and psychologists to develop and implement the evidence-based approach into daily clinical practice.

Chairperson: Roger Ho, Singapore