Journal of the Psychiatric Association of Thailand

Effectiveness of Home Visits and Telemedicine for Attention Deficit Hyperactivity Disorder (ADHD) Children Patients in the Community who Loss to Follow-Up to Return to Continuity of Treatment: Pilot Randomized Controlled Trial

2026-06-03T21:09:07+07:00

Objective: To compare the effectiveness of home visits combined with telemedicine consultation in re-engaging pediatric patients with attention-deficit/hyperactivity disorder (ADHD) who were lost to follow-up back into continuous care at Vachira Phuket Hospital.

Methods: This pilot randomized controlled trial was conducted among children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who had been lost to follow-up. Eligible participants whose parents or legal guardians provided informed consent were randomly assigned to either the intervention group or the control group using a computer-generated randomization sequence. The allocation assignments were kept in sealed envelopes, which were opened only after informed consent had been obtained. Owing to the nature of the intervention, blinding was not performed. Participants in the intervention group received one home visit combined with a telemedicine consultation, whereas those in the control group received one routine telephone follow-up. The primary outcome was re-engagement in care with continued treatment attendance over a 3-month period.

Results: A total of 38 participants were enrolled, including 18 in the control group and 20 in the intervention group. Baseline characteristics were comparable between the two groups. The intervention group showed a higher rate of re-engagement in continuous treatment within 3 months than the control group (80.0% vs. 50.0%; RR = 1.60, 95% CI 0.96 – 2.67; p = 0.052), although the difference did not reach statistical significance. In addition, after adjustment for baseline SNAP-IV scores using analysis of covariance (ANCOVA), the intervention group demonstrated significantly lower post-intervention scores for Inattention, Hyperactivity, and Oppositional symptoms than the control group (p < 0.05 for all comparisons).

Conclusion: A home visit combined with telemedicine consultation showed a favorable trend toward improving re-engagement in continuous treatment among children with ADHD who had been lost to follow-up compared with routine telephone follow-up. Although the primary outcome did not reach statistical significance, participants in the intervention group demonstrated significantly greater improvement in ADHD symptom severity than those in the control group. These findings support the potential value of proactive community-based follow-up, and larger randomized controlled trials are warranted to confirm its long-term effectiveness.

The Factors Influencing Job Turnover and Retention among Child and Adolescent Psychiatrists in Thailand: A Cross-Sectional Study

2026-02-23T09:17:09+07:00

Objective: The demand for mental health services for children and adolescents in Thailand has surged significantly. Turnover of child and adolescent psychiatrists affects service capacity. Therefore, this research aims to identify the factors that differ between the turnover and retention groups of psychiatrists.

Methods: This cross-sectional study collected data from the registered members of the Thai Psychiatric Association for Children and Adolescents. Data were gathered using an online questionnaire from April to September 2025. Statistical analyses employed the Chi-square test for categorical variables and the student’s t-test or Mann–Whitney U test for continuous variables. Finally, stepwise regression analysis was conducted to select and test statistically significant variables influencing workplace relocation.

Results: Factors that showed significant differences between child and adolescent psychiatrists in Thailand who changed versus did not change their workplace included province of the first workplace (OR = 0.08, 95% CI = 0.01 – 0.43, p-value < 0.01), emotional exhaustion (OR = 2.44, 95% CI = 1.16 – 5.12, p-value = 0.01), work-related stress affecting family (OR = 1.91, 95% CI = 1.10 – 3.33, p-value = 0.02), income (OR = 0.99, 95% CI = 0.99 – 0.99, p-value = 0.03), and workplace relationships (OR = 0.48, 95% CI = 0.24 – 0.94, p-value = 0.03).

Conclusion: The findings highlight key determinants associated with workplace transitions among child and adolescent psychiatrists in Thailand. These insights provide valuable guidance for developing strategies to support the healthcare of child and adolescent psychiatric services nationwide.

Prevalence and Association of Primary Caregivers' Parenting Styles with Gaming Addiction in Adolescents with ADHD at King Chulalongkorn Memorial Hospital: A Mediation Analysis of Self-Esteem and Self-Control

2026-05-02T15:13:08+07:00

Objective: This study aimed to investigates the prevalence of game addiction and examine the correlation between caregiver's parenting styles and game addiction in adolescents with ADHD outpatient treatment at King Chulalongkorn Memorial Hospital, with self-esteem and self-control posited as mediating variables.

Methods: This cross-sectional correlational study recruited 130 dyads of adolescents with ADHD aged 12 – 15 years and their primary caregivers from outpatient department of Child and Adolescent Psychiatry at King Chulalongkorn Memorial Hospital from August to October 2025. Data were collected using validated questionnaires; the Alabama Parenting Questionnaire (APQ), Rosenberg Self-Esteem Scale (RSES), Brief Self-Control Scale (BSCS), Game Addiction Screening Test (GAST), and Swanson, Nolan, and Pelham-IV (SNAP-IV). Data were analyzed using bootstrapping with bias-corrected confidence intervals via the SPSS version 29.0 PROCESS Macro.

Results: The prevalence of game addiction in this group was 11%, with an additional 34% classified as being at high risk for addiction. The findings indicate that neither positive nor negative parenting styles had a significant direct or indirect relationship with game addiction (Direct: (β = -0.101, 95% CI = [-0.290, 0.087]; β = -0.022, 95% CI = [-0.207, 0.164] respectively) Indirect: (β = -0.046, 95% CI = [-0.173, 0.066]; β = -0.023, 95% CI = [-0.163, 0.090] respectively). However, both self-control and self-esteem were found independently to have a highly significant negative correlation with the level of gaming addiction.

Conclusion: The findings demonstrate that increased self-esteem and self-control are critical factors significantly associated with a reduced level of gaming addiction in adolescents with ADHD. This evidence underscores the importance of focusing on these internal protective mechanisms. Therefore, the study strongly suggests that clinicians and healthcare professionals utilize this information to develop intervention programs aimed at fostering self-control and self-esteem, critically by promoting parental awareness and involvement. Such a strategy represents a potent approach for the prevention and mitigation of gaming addiction risk in this population.

The Effect of Sleep Quality on Burnout Syndrome among Practical and Registered Nurses at Siriraj Hospital

2025-12-31T17:43:54+07:00

Objective: This study aimed to determine the prevalence of occupational burnout and poor sleep quality, and to examine the association between these two factors among practical nurses and registered nurses working at Siriraj Hospital.

Methods: This was a descriptive cross-sectional study. The sample consisted of 170 practical nurses and registered nurses at Siriraj Hospital. Data were collected using a demographic questionnaire, the Thai version of the Pittsburgh Sleep Quality Index (Thai-PSQI), and the Thai version of the Copenhagen Burnout Inventory (Thai-CBI). Data were analyzed using descriptive statistics, Pearson’s chi-square test, Fisher’s exact test, and binary logistic regression analysis.

Results: Poor sleep quality was found in 74.7% of participants, and occupational burnout was found in 34.7% or 59 of 170 participants. Among those with occupational burnout, 86.4% had poor sleep quality, compared with 13.6% who had good sleep quality. Sleep quality was significantly associated with occupational burnout (p = 0.010). Univariable logistic regression analysis showed that participants with poor sleep quality had 2.94 times higher odds of occupational burnout than those with good sleep quality (OR = 2.94, 95% CI 1.26 – 6.84, p = 0.013). In the multivariable model, factors associated with occupational burnout included poorer subjective sleep quality, greater sleep disturbance, shorter actual sleep duration, psychiatric comorbidity, and divorced or widowed marital status.

Conclusion: Sleep quality, particularly subjective sleep quality, sleep disturbance, and actual sleep duration, was associated with occupational burnout among practical nurses and registered nurses at Siriraj Hospital. These findings highlight the importance of promoting sleep quality and designing work systems that support adequate recovery among nursing personnel.

Effectiveness of Long-Acting Injectable Antipsychotics in Managing Violence among Patients with Co-Occurring Substance-Induced Psychotic Disorder and Serious Mental Illness with High Risk to Violence (SMI-V)

2026-07-07T07:52:49+07:00

Objective: To evaluate the effectiveness and safety of long-acting injectable antipsychotics (LAIs) compared to oral antipsychotics in controlling violent behavior, reducing relapse, and improving global functioning among patients with substance-induced psychotic disorder (SIPD) who are at high risk to violence (SMI-V).

Methods: This quasi-experimental study employed a non-randomized two-group pre-posttest design with a 6-month follow-up. Participants were recruited using purposive sampling from patients aged 15 – 65 years diagnosed with substance-induced psychotic disorder (SIPD) who met the criteria for serious mental illness with high risk of violence (SMI-V) at Trakanphuetphon Hospital between October 2025 and May 2026. Of the 56 patients initially enrolled, 50 completed the study, all of whom were male. Participants were divided into an LAI group (n = 25) and a control group (non-LAIs/oral medication, n = 25). Assessment tools included violent incidents, psychiatric relapse requiring emergency department visits or hospitalization (ER/IPD), and the global assessment of functioning (GAF) scale. Data were analyzed using paired t-tests, independent t-test, ANCOVA, and multivariable logistic regression.

Results: After 6 months, the LAI group demonstrated a significant reduction in mean violent incidents (from 3.36 to 0.08, p < 0.001). At the 6-month follow-up, the mean violent incidents in the LAI group (0.08) were significantly lower than in the control group (0.44) (p = 0.014). The LAI group also achieved significantly higher GAF scores than the control group (71.28 vs. 46.68, p < 0.001). Furthermore, the LAI group was 19.24 times more likely to successfully control violent behavior (95% CI: 1.65 – 224.35, p = 0.018) and 17.35 times less likely to be readmitted to the hospital or visit the emergency department (95% CI: 1.84 – 162.92, p = 0.012). Regarding safety, no significant difference in the incidence of serious adverse events was observed between the two groups (p = 0.312).

Conclusion: Patients with SIPD who were at high risk of violence (SMI-V) and received LAIs demonstrated a greater reduction in violent behaviors, lower rates of psychiatric relapse requiring rehospitalization, and greater improvement in overall functioning (GAF) compared with those receiving oral antipsychotics after 6 months of follow-up, with no significant difference in safety outcomes between treatment groups. In real-world settings characterized by widespread substance use, ongoing substance consumption among patients, and limitations in specialized mental health personnel, LAIs may represent a valuable therapeutic option for this high-risk population. These findings support consideration of expanding access to long-acting injectable antipsychotics to reduce harm and improve the safety of patients, families, communities, and society, while providing preliminary real-world evidence to inform mental health policy development and future violence prevention strategies.