The DUP of our patients was longer than that reported in studies done in the West. The attitudes and beliefs of family in the Asian society are likely to be crucial in the pathways to care.

The putative role of dopamine in the pathophysiology of tardive dyskinesia (TD) makes the genes coding for dopamine receptors the appropriate candidates for study. We investigate the association of the polymorphism of the Ser311Cys and Ser9Gly of the dopamine D2 (DRD2) and D3 receptor (DRD3) genes respectively with TD in Chinese patients with schizophrenia. In a case-control study, 117 Chinese patients with TD were compared to 200 patients without TD. Patients were diagnosed to have schizophrenia according to DSM-IV criteria. Dyskinesia was assessed by the Abnormal Involuntary Movement Scale (AIMS), whereas extrapyramidal side-effects (EPSE) were assessed by the Simpson-Angus Rating Scale. Genotype groups were comparable in age, gender, duration of illness, daily neuroleptic and benzodiazepine dose as well as the mean scores for EPSE. We failed to find an association between the polymorphism of the DRD2 gene with TD but found an increased risk of developing TD among those with D3 serine/serine genotype. Our results did not indicate that the D2 genotype has a role in the pathophysiology of TD in Chinese patients with schizophrenia. The association of TD with the serine/serine genotype of the DRD3 may be an epiphenomenon of patients with a subtype of schizophrenia who had more exposure to neuroleptics.

Psychotropic drugs have been associated with sudden deaths and the lengthening of corrected-QT interval (QTc) on the electrocardiogram which may be a precursor of life-threatening arrhythmias as reported with some of these drugs. The objectives of this study were to measure the frequency of QTc lengthening in patients with schizophrenia receiving psychotropic drugs, and to assess whether QTc lengthening was associated with certain psychotropic drugs and other risk factors. One hundred and sixty three patients with schizophrenia (104 males and 59 females) were included in the study. Clinical and demographic data were collected from the case records. One hundred healthy volunteers were recruited to establish values for upper limits of normal for measurement of QTc interval and dispersion. Eleven (6.7%) of the patients had a prolonged QTc interval. The significant predictors obtained from a logistic regression modelling were chlorpromazine, flupenthixol decanoate and fluphenazine decanoate. Caution should be exercised and monitoring with ECG should be considered in patients prescribed chlorpromazine and depot antipsychotic medications even at recommended doses.

Our study has identified male gender, history of self-harm and a short duration of illness to be risk factors for 'revolving door' phenomena.

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