Prevalence and risk factors associated with alcohol consumption among indigenous people in Sabah Borneo Island.

OBJECTIVES: In this study, we aimed to determine the prevalence and risk factors of alcohol use among a cohort of population in Sabah. DESIGN: This is a prospective, cohort study involving rural community residents. SETTING: Rural community resident at Bingkor, Keningau, Sabah. PARTICIPANTS: 363 individuals aged 13 years old and above. INTERVENTION: Community-based participatory research to determine the prevalence and risk factors associated with alcohol use. MAIN OUTCOME MEASURES: Measurement of alcohol use using Alcohol Use Disorders Identification Test (AUDIT) and assessment of psychiatric morbidity using Mini International Neuropsychiatric Interview (MINI) questionnaires. RESULTS: Most alcohol drinkers aged between 36-45 years old, followed by 26-35 years old and 46-55 years old. Interestingly, there are almost similar female to male ratio. Most were Kadazan-Dusun ethnic, non-Muslims, and married. Although only less than a third of the participants received tertiary education, the majority were working. Based on the findings, being a male, non-Muslim and having an obsessive-compulsive disorder (OCD) (current) posed a significantly higher risk of alcohol consumption. CONCLUSION: A worryingly high prevalence of hazardous alcohol consumption among the locals is reported. There is a need for population-wide intervention towards preventive measures based on the identified risk factors for hazardous alcohol use.

Effectiveness of Methadone Maintenance Therapy and Improvement in Quality of Life Following a Decade of Implementation.

Methadone maintenance therapy has been found to be an effective harm reduction treatment for opioid use disorder. However evidence of its benefits over a longer duration of treatment is limited as most studies focus on its short term benefits. As methadone maintenance therapy reaches a decade since its implementation in Malaysia, this study sought to examine the effectiveness of methadone treatment, change in quality of life among patients since entry to methadone treatment, as well as factors predicting the magnitude of change in quality of life. This study found that methadone maintenance therapy was effective in reducing heroin use, injecting practices and crime, and in improving in social functioning and physical symptoms, but not in reducing sex-related HIV risk-taking behavior. Though patients had a significantly better quality of life at follow-up than at entry to methadone maintenance therapy, the improvement in quality of life was not significantly greater as the duration of treatment increased. Age above 50 years old, human immunodeficiency virus (HIV) positive status and physical symptoms predicted a poorer improvement in quality of life between baseline and follow-up. On the other hand, patients with hepatitis B showed a greater improvement in quality of life in the social relationships domain compared to patients without hepatitis B. In conclusion, methadone maintenance therapy is an effective treatment for opioid use disorder and improves quality of life but its benefits in further improving quality of life beyond a decade of treatment need further evaluation.

Psychiatric comorbidity among patients on methadone maintenance therapy and its influence on quality of life.

BACKGROUND AND OBJECTIVES: Co-occurring psychiatric disorders are among the difficulties faced by patients with opioid dependence on methadone maintenance therapy (MMT). This study aims to assess the prevalence of psychiatric comorbidity among patients on MMT, the factors predicting psychiatric comorbidity and to examine the association between psychiatric comorbidity and quality of life. METHODS: A total of 225 male patients on MMT in a tertiary hospital in Malaysia were assessed for psychiatric comorbidity and substance use disorders using the Mini-International Neuropsychiatric Interview (MINI) and Opiate Treatment Index (OTI). Their quality of life was assessed using World Health Organization Quality of Life (WHOQOL)-BREF. RESULTS: The prevalence of a current and lifetime non-substance use Axis I psychiatric disorder was 14.2% and 15.6% respectively, while 14.7% fulfilled the criteria for antisocial personality disorder. 80.9% had comorbid substance dependence, predominantly nicotine dependence. Factors significantly associated with a non-substance use Axis I psychiatric disorder on multivariate analysis were use of psychiatric medications, antisocial personality disorder and poorer physical health. Patients with a non-substance use Axis I psychiatric disorder had a significantly poorer quality of life in all domains namely physical health, psychological, social relationships, environment as well as combined quality of life and general health after controlling for possible confounders. CONCLUSION: Psychiatric comorbidity among patients on MMT negatively impacts quality of life. SCIENTIFIC SIGNIFICANCE: The detection of psychiatric disorders and provision of appropriate treatment is needed to improve the quality of life of patients on MMT.

The treatment outcome of psychotic disorders by traditional healers in central Sudan.

BACKGROUND: Alternative and traditional healing methods are common and popular in Sudan, particularly for treating people with mental disorders, but little information is available about the outcome of theses traditional healing approaches. OBJECTIVES: To study the outcome of treating patients with psychotic disorders by traditional healers, and to understand the type of services, interventions procedures and treatments methods used by traditional healers to manage patients with psychotic disorders. METHOD: A prospective follow-up quantitative study of a cohort of inpatients with psychotic disorders was carried out from admission until discharge. Subjects were people with psychotic disorders undergoing treatment in traditional healer centres in central Sudan. The Mini International Neuropsychiatric Interview (MINI) was used to diagnose the psychotic disorders and the Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of psychotic symptoms on admission and discharge from the traditional healer centre. RESULTS: We interviewed 129 inpatients with psychotic disorders on admission and discharge from the traditional healers centres. There was a significant reduction in the PANSS score (p = .0001) after a mean period of stay of 4.5 months. The mean for the overall PANSS score was 118.36 on admission and 69.36 on discharge. CONCLUSION: Although traditional-healing approaches produce a significant improvement in the signs and symptoms of psychotic disorders measured on the PANSS, they need to be further investigated, assessed and studied.

The characteristics of people with mental illness who are under treatment in traditional healer centres in Sudan.

AIMS: To determine the general characteristics of people with mental disorders in traditional healers centres in Sudan in terms of sociodemographic profile, common clinical presentations and diagnostic features, and to look at the treatment methods and intervention procedures used in these centres for treating people with mental illness. METHODS: This is a descriptive cross-sectional study using both quantitative and qualitative research methods. All inpatients with mental illness (405) from 10 selected traditional healers centres in Sudan who gave consent were interviewed, using a specially designed questionnaire and the Mini International Neuropsychiatric Interview (MINI). RESULTS: Most of the visitors to the centres were from central Sudan with a mean age of 31 years, illiterate or with only a primary basic education, male and jobless. The average mean duration of stay in the traditional healer centre was five months and the mean duration of untreated illness before coming to the centre was 13 months. Only 17% reported a history of alcohol abuse and only 11% of drug abuse. The most common prevalent diagnosis was psychotic disorder. CONCLUSION: This study improves the understanding about what types of people with mental illness are treated at these traditional healer centres and gives recommendations that can help in improving the quality of services in these centres. It can probably be used in building bridges of collaboration between these centres and the available mental health and psychiatric services in Sudan, especially at primary healthcare level.

Association of brain-derived neurotrophic factor (Val66Met) genetic polymorphism with methamphetamine dependence in a Malaysian population.

Methamphetamine is a highly addictive psychostimulant that has surged in popularity worldwide in the last decade. Brain-derived neurotrophic factor (BDNF), a member of the neurotrophic factor family, is widely expressed in the adult mammalian brain and plays an important role in the long-term survival, differentiation, and outgrowth of neurons. Previous studies suggested that the BDNF gene may be involved in the mechanisms underlying substance dependence. This study investigated the association of the BDNF gene Val66Met polymorphism with methamphetamine dependence and with psychosis in a Malaysian population with different ethnicities. The BDNF Val66Met polymorphism was genotyped by PCR-RFLP in 186 male methamphetamine-dependent subjects and in 154 male controls of four different ethnicities, namely, Malay, Chinese, Kadazan-Dusun, and Bajau. Our results showed that the distribution of the BDNF Val66Met genotype in Chinese subjects with methamphetamine dependence (OR=2.6, p=0.015) and methamphetamine psychosis (OR=0.2, p = 0.034) were significant compared with controls. The frequency of the 66Val allele in methamphetamine-dependent subjects was higher than that in the control group, suggesting that the 66Val carriers are more susceptible to methamphetamine dependence. However, 66Val allele frequency in other ethnicities was not significantly different from the controls. The results of the study also showed that in the Chinese methamphetamine-dependent subjects, there was a difference in allele frequency when comparing those who developed psychosis and those who did not. Our findings suggest that the BDNF Val66Met polymorphism may contribute to methamphetamine dependence and psychosis in the Chinese population but not in other Malaysian ethnicities.