CONGENITAL HYPERTROPHIC PYLORIC STENOSIS by Dr M.KARTHIK EMMANUEL
OutlineOfReap1999-2015
1. Overview of REAP Study
Past ,present and future
research collaboration in Asia
Naotaka Shinfuku, M.D.Ph.D
Fukuoka Japan
2. REAP
Research on Asian Psychotropic
Prescription Pattern
• Started in 1999 to study the different
prescription patterns in psychiatry
• More than 6,000 prescription of in-patients
schizophrenics in China,Korea, Japan, Taiwan,
Singapore, Thailand, Malaysia and India.
• The longest and the largest international
collaborative research in psychiatry in Asia.
• More than 30 papers resulted from REAP survey
accepted by International Journals.
6. Research at Kobe University ICMR
• ICMR Kobe University had been a core
Univeristy to promote large scale research
collaboration with Asia
• Japan Society for Promotion of Sciences
• Research collaboration among leading
Universities in Indonesia, Japan,
Philippines, Singapore and Thailand.
• Mostly Malaria, Perinatal care, tropical
diseases.
8. Research on East Asia Prescription
Pattern (REAP )
• International Collaborative Research on
Psychotropic Drug Prescription
for Schizophrenia in Asian Countries
• The long lasting and the largest collaboration
in research in the field of psychiatry in Asia
• Started in 1999 involving 6 East Asian
countries and still growing after 10 years.
• First supported by Japan Society for
Promotion of Science (JSPS)
10. JSPS-NUS conference in 1999
International Sympsosium on New Challenges
of Neuropscyhopahrmacology
• Singapore:Kua Eee Heok,Tan Chay Hoon
• Japan: Kanba Shigenobu, Yamawaki
Shigeto,Maeda Kiyoshi,Shinfuku Naotaka.
• ASEAN: Sasanto Wibisono (Indonesia),
Lourdes Igancio(Philippines) , Malaysia
and Thai psychiatrists
11. Recommendation from JSPN-NUS
Conference in 1999
• Differences in prescribing pattern of
psychotropics among participating
countries were noted.
• Interests to initiate a collaborative
research to study prescription pattern of
psychotropics in Asian countries.
• Prof Kua Eee Heok, Prof Tan Chay Hoon
and Prof N Shinfuku discussed the plan.
12. Personal interest
• As clinician in Japan, I used the hige dose
of chlorpromazine, haloperidol ,
levemepromazine and a variety of
sedatives, anti-parkinson drugs while
working at National psychiatric Hospital in
Kyusyu from 1967 to 1976.
• I witnessed the difference of prescription
pattern of anti-psychotics in China and in
other Asian countries while working at
WHO.
13. Preparation of research protocole
• We spent almost one and half year to prepare
the research protocole and questionnaire in
2000.
• Recruitements of researchers from East Asia.
using the peronal network.
• Objectives
-to study prescription of psychotropic drugs and their
changes in Asian countreis
-to suggest ways and means to improve prescription
patttern.
Survey on Schizophrenic inpatients
14. Principles
• Unified research protocol
• Standardized assessment tools
• Agreed definition of terms and criteria
• Careful preparation and friendship
• Meetings of investigators
• Friendly criticism among researchers
• Common data inputs and analysis
• Presentation at meetings and journals.
15. Participating centers
• China (Beijing, Shanghai,Chengdu)
• Hong Kong
• Japan ( Kobe, Kita-Kyusyu, Fukuoka,
Hiroshima, Yamanashi )
• Korea (Seoul)
• Taiwan ( Kaohsiung)
• Singapore
Other cities (Jakarta,Kuala Lumpur etc)
17. Before the survey to start
• Pilot survey (september -December 2000)
• 1st ,2nd , 3rd invesitigators meetings to
agree on the plan of works (Kobe ,Osaka
and Beijing)
• Finalization of protocole and agreements on
format for data entry ( May 2001 at 4th Meeting
in Osaka)
18. Survey in 2001
• Survey ( 1st to 31st July 2001) at 6 countries.
• Data entry ( Date to be sent from participating
countries to Kobe coordianting center)
• 5th Investigator's meeting in Singaprore in
October 2001 to evaluate the data.
• Data only from China,Korea, Japan, Taiwan ,
Hong kong and Singapore were accepted for
final computation.
19. Presentation of the data
• 6th investigator's meeting in Kobe (
February 9th 2002),ICMR Kobe University
School of Medicine.
• Reports from each aprticipating countries.
• China,Hong Kong,Indonesia, Japan,
Korea,Malaysia,Singapore,Taiwan etc.
• Publication of the Proceeding of REAP
21. REAP AP 1 findings
• 2,398 prescription from 6 countries and areas were
collected and analyzed.
• China 611 cases from Beijing,Shanghai and Chengdu.
• Hong kong 108 cases from one hospital.
• Indonesia 21 cases from 6 hospitals ( data imcomplete)
• Japan:627 cases from 10 hospitals.
• Korea:441 cases from 12 hospitals/clinics
• Malaysia :(Incomplete inputs).
• Singapore:300 cases from Woodbridge Hospital
• Taiwan:311 cases from 4 hospitals.
22. REAP 2001 Survey Summary
• Prescription pattern differs greatly country by
country
• China uses clozapine as the first choice
• Japan has a tendency of poly-pharmacy and
a prescription of the high dosage
• Singapore favors the use of depot
• Prescription habits might be influenced the
licensing policy and cost rather than scientific
data.
23. Follow up survey in 2004
Anti-psychotic drugs
• To review the change since 2001.
• Used the same research protocol
• 25 hospitals and 203 psychiatrists participated
from 6 countries and areas
• China (504 cases), Hong Kong (100), Japan
(583),Korea(412),Singapore(91) and Taiwan
(446).
• In total 2138 cases collected as valid entry.
24. Mean Doses of Antipsychotics
（ in CPZ equivalent means ）
p-value<0.05
mg
25. REAP AD
• REAP on anti-depressants.
• At several REAP symposia, requests were
made to do a survey on presecription on
depressive disorders since 2001.
• The difficulties were anti-depressants were
prescribed for varieties of psychiatric
diseases.
• Another difficulty was diagnostic criteria of
mood disorders. Subjectivity.
26. REAP on anti-depressants
Survey carried out in 2004.
• The major change from REAP AP was to use
anti-depressants as inclusion criteria
- Inclusion criteria: 56 anti-depressants
listed at ATC-DDD (WHO Center Oslo)
• Five countries/regions have agreed to
participate. China, Korea, Japan,Taiwan
and Singapore.
27. Results-Overall
• Total 1.898 samples from 20 teaching hospitals and
major psychiatric institutions in East Asia
• China 537
• Japan 609
• Korea 293
• Singapore 72
• Taiwan 387
• Total 1.898 samples
• Disparity in number from participating countries/areas
• Differences in settings where samples were collected.
29. Results of REAP AD 2004
• One third of prescription was made for non-
mood (affective) disorders.(non-F3).
• Out of 56 anti-depressants (ATC-DDD), 26 anti-
depressants were prescribed in East Asia.
• F4 neurotic ,stress related and somatoform and
F3 schizophrenia received anti-depressants.
• SSRI and SNRI are most commonly prescribed.
• Amitriptyline was prescribed for 6.3%.
• The prescription of anti-depressants differed
greatly country by country.
30. Japanese exception
• Japan had very limited choice.
• Fluoxetine, sertraline,citalopram ,venlafaxine
were not available in Japan at the time of the
survey in 2004.
• This made a sharp contrast with Korea where all
of the above anti-depressants were prescribed.
• Government regulation to approve new drug is
strict in Japan.
• The above situation has changed recently.
31. REAP AP 2008
• REAP AP 3 survey was completed in October
2008
• Overall,2,226 outpatients were recruited from 50
hospital psychiatric units on 9 regions:China,
Korea, Japan, Taiwan, Hong Kong, Singapore ,
Thailand ,Malaysia and India.
• The first report on REAP 2008 was made by Ms
Yang Syu Yu at the 2nd World Congress of
Asian Psychaitry (WCAP) held at Taipei in
November 2009.
32. The third survey in 2008
• Use the same research protocol and
questonniare
• Mostly the same institutions participated in 2001
and 2004.
• India, Thailand and Malaysia joined.(ITM)
• The survey was carried out from October 2008
to March 2009 (India).
• The data was analysed at Taipei.
• Total number was 2,226. (1,906 without ITM)
33. REAP: Distribution of subjects and country
Country 2001 2004 2008
China 611 504 409
H K 108 100 100
Japan 627 583 514
Korea 442 412 284
Singapore 300 91 100
Taiwan 311 446 499
India - - 181
Malaysia - - 100
Thailand - - 39
Total 2399 2136 2226
34. Mean Doses of Antipsychotics
(in CPZ eq mg/day)
p-value<0.05
mg
38. REAP AP Tasks
• Analysis of REAP 2001,2004 and 2008
data. Chronological changes.
• Publish in international and domesitic
journals.
• Propose REAP Sympsoium at WPA
International Meeting Beijing Sept 2010.
• REAP 2008 included data from
Malaysia,Thailand and India.
• Compare with other Regions.
• Pharmaco-economical analysis.
39. REAP AD follow up
• REAP AD was carried out in 2004 with the
participation of China,Korea, Japan,
Taiwan and Singapore.
• The follow up survey of REAP -AD could
be organized in 2010 using the similar
format.
• We have to identify the coordinating
center for the REAP AD follow up survey.
41. Conclusion
• REAP has several shortcomings as
refined research group but it might have
contributed to Asian psychiatry.
• Possible impacts for the better
understanding and improvement of
prescription of anti-psychotics in
participating countries.
• Possible contribution to friendship and
scientific exchange among Asian
psychiatrists
42. Merit of REAP
• Easy going friendly network.
• Not much requirement of research fund.
• Very simple research protocol and
questionnaire.
• Provided the opportunities for psychiatrists from
developing countries to undertake collaborative
research.
• Might have influenced the improvement of
prescription pattern in participating countries.
43. Thanks
• REAP was supported by many leading and
active psychiatrists in East Asia
• In particular,
Prof Tan Chay Hoon,Prof Kua Eee Heok, Dr Sim Kang : Singapore
Prof Mian Yoon Chong, Ms Yang Shu Yu :Taiwan.
Prof Ungvari: Hong Kong.
Prof N Shinfuku ,Dr Senta Fujii :Japan
Prof Si Tian Mei, Prof He Yang Lin: China
Dr Eng Kee Chung, Prof S W Lee: Korea
Thanks for your kind and continuing collaboration.
