Background: The Philippines is an autonomous Southeast Asian country which has long been encumbered with the burden of mental health-related concerns. Aside from the commonly occurring psychiatric illnesses, it also has to contend with the dearth of epidemiological data on such disorders as well as the scarcity of mental health practitioners. On top of these, one enduring challenge is the absence of mental health legislation. Thus, the passage of Republic Act (R.A.) 11036 or the Philippine Mental Health Act has been considered one of the greater achievements in Philippine psychiatry in the recent years. Methods: In this review, the author examines the origins, highlights, and updates on the legislature of R.A. 11036. Results: This legislature (or the Philippine Mental Health Act) elaborates on its highlights which equitably covers the rights of patients and their families as well as that of the mental health professionals; the standards of psychiatric, psychosocial, and neurologic services that need to be upheld in both government and private hospitals; the promotion of mental health in educational institutions and in the workplace; the need for mental health providers to undergo capacity building and proper training in research and development; the duties and responsibilities of the government agencies involved; the creation of a council to serve as a policymaking, planning, coordinating, and advisory body to oversee the implementation of the law; and the penalty clauses involved with violations of the law. It also provides updates on the enactment of the law's implementing rules and regulations, namely, the upgrading of existing mental health facilities, the standardization of a community-based mental health program, the development of a national suicide prevention strategy, the integration of mental health into the educational system and the workplace, the first-ever Philippine national survey on mental health and well-being, as well as the augmentation of the practice of telepsychiatry to extend the reach of services to the geographically isolated Filipinos. Conclusion: The Philippines made a history through the passage of the first-ever Mental Health Act on June 21, 2018, now known as R.A. 11036. The Philippine Psychiatric Association and other related organizations spearheaded a multisectoral lobby in the drafting of the bill. It took 16 years, and 31 drafts before R.A. 11036 became a reality. We still need to monitor the implementation of the law closely. Future revisions are expected to better improve the mental health law for citizens to receive better rights of mental health treatment and human rights protection.

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Background: Mental illness and burden of care on family is widely discussed in the context of the general population. However, mental health in tribal people also needs the same attention from researchers. In this study, the authors intended to find out the effect of mental illness on tribal families having a person with mental illness. Methods: A descriptive study was done to collect data at the Ispat General Hospital from 50 tribal respondents who were admitted to the Department of Psychiatry. We used open-ended questions to collect the qualitative data. Then, we did content analysis to build themes of the issues of their mental illnesses. Results: We found that the effect of mental illness is on education, marriage, financial crisis, family stress, disruption of family routine activities, physical abuse and violence in the family, social isolation, lack of caregiver's personal care and care for other children in the family, as well as damage to household accessories. Conclusion: In this study, the authors created major themes, to dissect and trisect into adverse events, which were frequent and appear the same in the general and tribal family having a patient with mental illness.

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Background: Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is related to the pathophysiology of treatment-resistant depression (TRD). But whether the Val66Met polymorphism is associated with the clinical manifestations of TRD (such as treatment refractoriness and melancholic and anxious distress features) remains unclear. Methods: Totally, 106 patients with TRD were genotyped for the BDNF Val66Met polymorphism. We used the 17-item Hamilton Depression Rating Scale evaluate depressive symptoms (melancholic and anxious distress features) and Maudsley Staging Method to measure treatment refractoriness. Logistic regression models were constructed to study the relationships among the Val66Met polymorphism, melancholic or anxious distress features, and treatment refractoriness. Results: The risk of Val/Met heterozygosity was associated with significantly greater melancholic features than that of Val/Val homozygosity (odds ratio [95% confidence interval (CI)] = (4.67 [1.16–14.24], p < 0.05). The melancholic feature in Val/Met heterozygosity was significantly higher to have the risk in treatment refractoriness than that of Val/Val homozygosity odd ratio (95% CI) = (6.42 [1.70–24.25], p < 0.05). Conclusion: Patients with TRD carrying the BDNF Val/Met genotype are more likely to present with melancholic feature, which is in turn related to high treatment refractoriness.

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Objectives: The symptoms of attention-deficit/hyperactivity disorder (ADHD) have been positively documented to be correlated with unintentional mind-wandering (MW) in the literature. In this study, we intended to explore the link between the types of MW and the attention laboratory performance in adults with ADHD symptoms. Methods: We recruited 24 adult patients with ADHD and 30 controls: (a) to receive a semi-structured psychiatric interview for ADHD and other diagnoses, (b) to complete questionnaires about adult ADHD symptoms and other psychiatric symptoms, (c) to receive intelligence assessment, (d) to have thought probes during a Sustained Attention to Response Task (SART), and (e) to be assessed with the MW: Spontaneous Scale (WM-S). Results: Adult patients with ADHD symptoms showed a more impulsive SART response style (increased commission errors and fast response speed) and unintentional MW. Increased unintentional MW was associated with reduced task performance. A positive association existed between MW-S scores and unintentional MW during the SART. Conclusion: Spontaneous MW may be significant impairment in adults with ADHD. Different measurements of MW had the associated and consistent findings measured by cognitive laboratory task with thought probe or WM-S measurement.

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Objectives: We investigated the prevalence and risk factors of psychological distress, depression, anxiety, and posttraumatic stress disorder (PTSD) among COVID-19 inpatients during the initial and peak coronavirus phase in the largest public sector hospital in India. Methods: With a prospective observational design, we included 761 male and female COVID-19-hospitalized patients. The Self-Reporting Questionnaire, Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), and Hospital Anxiety and Depression Scale were used. Results: Totally, 612 males and 149 females had a mean age of 36.68 ± 11.72 (mean ± standard deviation) years. The prevalences of psychological distress, anxiety, depression, and PTSD symptoms for the total sample were 12.6%, 19.2%, 19.2%, and 8.4%, respectively. Significant differences existed in the prevalence of psychological distress, anxiety, and depression between the initial coronavirus and peak coronavirus phase (13.7% vs. 11%, χ² = 9.37 p < 0.01), 22.1% vs. 14.7%, χ² = 23.04, p < 0.01), 21.04% vs. 16.3%, χ² = 15.78, p < 0.01) but not in that of PTSD. Except for psychological distress, there was no gender difference. Coronavirus phase and employment status had significant interaction effects (p < 0.01) on anxiety and depression. Conclusion: Younger age, males in full-time jobs, in marital relationship, poor socioeconomic status were the risk factors, and comorbidity was the important risk factor. The result of this study could highlight the need for compulsory mental health screening and necessary medical/non-medical mental health support to all admitted patients.

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Background: Those who have infected with coronavirus disease 2019 (COVID-19), experience a range of symptoms, from mild and self-resolving respiratory illnesses to severe respiratory complications, as well as a range of the emotional symptoms of fear, guilt, anger, or anxiety due to the need of quarantine isolation. Clinical cases with a new onset of psychiatric symptoms in the acute stage or aftermath of COVID-19 have also been described in the literature. The impact of COVID-19 on psychological health across all stages of illness has become an area of interest in psychiatry. Methods: We at Johor Bahru, Malaysia, would like to report two patients without any history of any known psychiatric illness, who had their first manic episodes during the acute stage of COVID-19 infection. Results: Patient A was a 29-year-old married female patient, had a COVID-19 infection which were treated smoothly. But unfortunately, the devastating news of her husband's hospitalization for COVID-19 infection and the death of her sister-in-law due to the deadly virus came on the day of her discharge. Since she developed a picture of a manic episode with as elated mood, irritability, talkativeness, increased energy, decreased need for sleep, spending spree, reckless driving, excessive ideas concerning COVID-19 infection, and excessive sexual drive. She subsequently responded to treatment and was discharged with daily 600 mg of oral lithium carbonate, 200 mg of oral chlorpromazine, and 1,000 mg of sodium valproate Chrono. Patient B was a 31-year-old married homemaker and she presented herself to the emergency department for stage COVID-19 infection and witnessed resuscitation and eventual deaths of several patients diagnosed with COVID-19 infection. She was so frightened that she had become easily distracted, increasingly irritable, and talkative. Having reduced need for sleep at night, she would repeatedly call her friends and family around the clock to check if they had COVID-19 infection. She claimed to have the power to heal bone fractures with naked eyes. Furthermore, she started to see supernatural creatures around her at home. She subsequently responded to daily 750 mg of lithium carbonate and 1,000 mg of amisulpride during a 14-day inpatient stay. Conclusion: We content that our two patients had a new onset of manic episode after COVID-19 infection. We suggest that manic symptoms may have been triggered through an episode of COVID-19.

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