Establishing associated risk factors, including fungal and parasitic infections among Malaysians living with schizophrenia.

The aetiology of schizophrenia is multifactorial, and the identification of its risk factors are scarce and highly variable. A cross-sectional study was conducted to investigate the risk factors associated with schizophrenia among Malaysian sub-population. A total of 120 individuals diagnosed with schizophrenia (SZ) and 180 non-schizophrenic (NS) individuals participated in a questionnaire-based survey. Data of complete questionnaire responses obtained from 91 SZ and 120 NS participants were used in statistical analyses. Stool samples were obtained from the participants and screened for gut parasites and fungi using conventional polymerase chain reaction (PCR). The median age were 46 years (interquartile range (IQR) 37 to 60 years) and 35 years (IQR 24 to 47.75 years) for SZ and NS respectively. Multivariable binary logistic regression showed that the factors associated with increased risk of SZ were age, sex, unemployment, presence of other chronic ailment, smoking, and high dairy consumption per week. These factors, except sex, were positively associated with the severity of SZ. Breastfed at infancy as well as vitamin and supplement consumption showed a protective effect against SZ. After data clean-up, fungal or parasitic infections were found in 98% (39/42). of SZ participants and 6.1% (3/49) of NS participants. Our findings identified non-modifiable risk factors (age and sex) and modifiable lifestyle-related risk factors (unemployment, presence of other chronic ailment, smoking, and high dairy consumption per week) associated with SZ and implicate the need for medical attention in preventing fungal and parasitic infections in SZ.

Cariprazine in an Adolescent with Tourette Syndrome with Comorbid Attention Deficit Hyperactive Disorder and Depression: A Case Report.

Tourette syndrome is a complex neuropsychiatric condition that manifests in childhood and is often associated with other psychiatric comorbidities. This case report describes a young male with Tourette syndrome with major depressive disorder and attention deficit hyperactivity disorder (ADHD) who experienced troublesome side effects due to his existing medications (escitalopram, risperidone, and methylphenidate). In order to control his tics, ameliorate depressive symptoms, and eliminate side effects of stiffness and sedation, risperidone was switched to cariprazine, a third-generation antipsychotic medication with D3-D2 partial agonism. In addition, the antidepressant dose was also increased. With the new combination, the patient reported good control of his tics, together with significant improvement in depressive symptoms and no side effects. Based on this case and the reviewed literature, cariprazine might be a viable option for patients with Tourette syndrome with other comorbid illnesses who are prone to side effects of medication.

Coping Strategies and Mental Disorders among the LGBT+ Community in Malaysia.

The LGBT+ community in Malaysia is vulnerable to mental disorders due to the pressures of being in a conservative heteronormative culture. This study aimed to study the association between coping strategies as well as the sociodemographic factors of LGBT+ individuals with mental disorders and quantify the occurrence of mental disorders among them. This study used a cross-sectional design. The self-rated Brief Coping Orientation to Problem Experienced Inventory (Brief COPE) and the Mini International Neuropsychiatric Interview (MINI) were used to this end. A total of 152 participants were recruited. Among the participants, 67.8% used mainly problem-focused coping strategies, 29.6% employed emotion-based coping, and 6.6% used avoidance coping. The prevalence of mental disorders in general and major depressive disorder was much higher than in the general Malaysian population (80.3% and 40.1%, respectively). The only sociodemographic factor that was significantly associated with mental disorders was bisexuality. Problem-focused coping is associated with fewer mental disorders, and emotion-based coping is associated with a higher prevalence of mental disorders. More studies need to be conducted to better understand and better manage the mental disorders of the Malaysian LGBT+ community.

Higher amoebic and metronidazole resistant forms of Blastocystis sp. seen in schizophrenic patients.

BACKGROUND: Blastocystis sp. is one of the most common colonisers of the intestinal tract that demonstrate strong interaction with accompanying gut bacteria. Previously, the protozoan isolated from individuals with irritable bowel syndrome (IBS) showed altered phenotypic features suggesting that it can be triggered to become pathogenic. Previous studies reported altered gut microbiota and high prevalence of Blastocystis sp. in schizophrenia patients. However, the phenotypic characteristics of Blastocystis sp. isolated from individuals with SZ have yet to be described. METHODS: In this study, faecal samples from 50 patients with severe schizophrenia (SZ) and 100 non-schizophrenic (NS) individuals were screened for Blastocystis sp. INFECTION: Positive isolates were subjected to genotypic and phenotypic characterization. RESULTS: We found that 12 out of 50 (24%) SZ and 5 out of 100 (5%) NS individuals were detected Blastocystis sp. positive using both in vitro culture and PCR method with no significant association to age and gender. Out of the 15 sequenced isolates, ST3 was the most prevalent subtype (66.7%) followed by ST1 (20%) and ST6 (13.3%). The isolates from SZ individuals demonstrated significant slower growth rate (34.9 ± 15.6 h) and larger range of cell diameter (3.3-140 µm). We detected higher amoebic forms and metronidazole resistance among SZ isolates with variation in cell surface glycoprotein where 98% of cells from SZ showed consistent medium to high binding affinity (+ 2 to + 3) to Concavalin A staining compared to NS isolates that demonstrated only 76% high lectin (+ 3) binding affinity. Cysteine and serine protease levels were predominantly found among SZ isolates. We also demonstrate the presence of metalloprotease in Blastocystis sp. especially among NS isolates. Introduction of solubilised antigens from SZ isolates increased the cell proliferation of HCT116 cells by two fold when compared to NS isolates. CONCLUSION: Our findings demonstrated Blastocystis sp. isolated from SZ individuals showed variation in phenotype specifically in morphology and drug resistance. The findings indicate that the gut environment (SZ and NS) and treatment of SZ could have influenced the phenotype of Blastocystis sp.

Religious Coping During the COVID-19 Pandemic: Gender, Occupational and Socio-economic Perspectives Among Malaysian Frontline Healthcare Workers.

Objective: At the dawn of the new decade of the 20th century, the world was taken aback by the scourge of the COVID-19 pandemic. The study aimed to study the nature of religious coping of frontline healthcare workers seen through the perspective of gender, socio-economic status, and occupation. Methods: An online-based study was carried out among frontline healthcare workers involved in the care of COVID-19 patients (n = 200). Sociodemographic data form and the Brief Religious Coping scale were used in this study. Results: There were more female healthcare workers (60.5%) and doctors (69.5% vs. 30.5%). Healthcare workers used more positive religious coping than negative religious coping (median score: 22 vs. 9). Positive religious coping was seen more in females (median score: 23 vs. 21, P = .015). Non-doctors applied positive coping more than doctors (median score: 26 vs. 21, P < .001). There were significant differences in positive religious coping scores across income groups, with the B40 group having the highest score (median score: 24). Post hoc pairwise comparison concluded that the B40 group had significantly higher positive religious coping scores than the M40 group. Conclusion: Positive coping was utilized more among female healthcare workers, nondoctors, and the lowest socio-economic group. As prior literature has shown that positive religious coping is desirable and has superior mental health outcomes, our findings show that more effort should be channeled into enhancing positive religious coping, particularly among male healthcare workers, doctors, and the middle and high socio-economic group.

An Open-Label, Head to Head Comparison Study between Prucalopride and Lactulose for Clozapine Induced Constipation in Patients with Treatment Resistant Schizophrenia.

Clozapine remains as the gold standard for the management of treatment resistant schizophrenia. Nevertheless, mortality and morbidity associated with Clozapine is partly contributed by its adverse effect of constipation in view of its prominent anticholinergic properties. Despite the evidence that approximately 60% of patients on Clozapine will experience constipation, there is no proper guideline as to the best laxative in the treatment of Clozapine induced constipation. Hence this study was conducted to evaluate the efficacy and safety of Prucalopride and Lactulose in the treatment of Clozapine induced constipation. This was a four week, prospective, open-label head to head comparison study between Prucalopride and Lactulose in the treatment of Clozapine induced constipation. Male and female patients on Clozapine between the age of 18-60 with an established diagnosis of treatment resistant schizophrenia with ≤2 spontaneous complete bowel movement per week were recruited in this study. Eligible patients were assigned into two groups. Patients received Prucalopride 2 mg once daily or Lactulose 10 g once daily for four weeks. Efficacy was analyzed in 58 patients. The proportion of patient with ≥3 spontaneous complete bowel movement (SCBM) was higher in the Prucalopride 2 mg group, reaching significance at Week 4 with p-value of (p = 0.029). The proportion of patient with ≥3 SCBM at Week 1 was 71.4% in the Prucalopride 2 mg group and 60% in the Lactulose 10 g group. The proportion of patient with ≥3 SCBM at Week 4 was 85.7% in the Prucalopride 2 mg group and the proportion remained at 60% in the Lactulose 10 g group. The improvement in the dissatisfaction and treatment satisfaction subscales of the patient assessment of constipation-quality of life (PAC-QOL) were higher in the Prucalopride 2 mg group compared to the Lactulose 10 g group. The common adverse events associated with Prucalopride 2 mg were abdominal pain and loose stools which was transient and subsided within a few days. Over four weeks, in this population of patients with Clozapine induced constipation, Prucalopride 2 mg significantly improved the bowel movement and it was safe.

Elucidating Mental Health Disorders among Rohingya Refugees: A Malaysian Perspective.

Mental health disorders (MHDs) among refugees has been recognized as a major public health issue. However, to date, there is limited evidence on the prevalence of MHDs among Rohingya refugees in Malaysia. This study aimed to examine the prevalence and associated factors of major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD) among Rohingya refugees in Malaysia. A total of 220 refugees were randomly selected to participate in this cross-sectional study, conducted from June 2019 to November 2019. Perceived social support, religious orientation, food security, and sociodemographic characteristics were assessed as independent variables. The dependent variables assessed were MDD, GAD, and PTSD. The prevalence of GAD, PTSD, and MDD was reported at 92 (41.8%), 84 (38.2%), and 71 (32.3%). Several factors were significantly associated with MDD following multivariate analysis such as perceived low to moderate social support (AOR = 2.17; 95% CI 1.13, 4.19) and food insecurity (AOR = 2.77; 95% CI 1.19, 6.47). Exposure to violence (AOR = 38.46; 95% CI 16.27, 90.91) and food insecurity (AOR = 3.74; 95% CI 1.41, 9.91) were significantly associated with PTSD. Addressing these risk factors could be key in improving mental health outcomes among this vulnerable population.

Religious Coping, Religiosity, Depression and Anxiety among Medical Students in a Multi-Religious Setting.

Medical students are vulnerable to depression and anxiety due to the nature of their academic life. This study aimed to determine the prevalence of depressive and anxiety symptoms among medical students and the association between religious coping, religiosity and socio-demographic factors with anxiety and depressive symptoms. A cross sectional design was used for this study. Scales used were the Malay version of the Duke Religious Index (DUREL-M), the Malay version of the Brief Religious Coping Scale (Brief RCOPE) and the Malay version Hospital and Anxiety Depression Scale (HADS-M). 622 students participated in this study. They scored moderately on the organized (mean: 3.51) and non-organized religious (mean: 3.85) subscales of the DUREL, but had high intrinsic religiosity (mean: 12.18). The prevalence of anxiety and depressive symptoms were 4.7% and 17.4% respectively, which is lower than local as well as international data. Islam, negative religious coping and the presence of depressive symptoms were significantly associated with anxiety symptoms. Only the presence of anxiety symptoms was significantly associated with depressive symptoms. Negative religious coping, rather than positive religious coping, has significant association with depressive and anxiety symptoms. Redirecting focus towards negative religious coping is imperative to boost mental health outcomes among medical students.

Core Symptoms of Major Depressive Disorder among Palliative Care Patients.

A valid method to diagnose depression in palliative care has not been established. In this study, we aim to determine the prevalence of depression and the discriminant validity of the items of four sets of diagnostic criteria in palliative care. This is a cross-sectional study on 240 palliative care patients where the presence of depression was based on the Diagnostic and Statistical Manual of Mental Disorders, DSM⁻IV Criteria, Modified DSM⁻IV Criteria, Cavanaugh Criteria, and Endicott's Criteria's. Anxiety, depression, and distress were measured with Hospital Anxiety and Depression Scale and Distress Thermometer. The prevalence of depression among the palliative care patients was highest based on the Modified DSM⁻IV Criteria (23.3%), followed by the Endicott's Criteria (13.8%), DSM⁻IV Criteria (9.2%), and Cavanaugh Criteria (5%). There were significant differences (p < 0.05) in the depressive symptoms showed by DSM⁻IV item 1 (dysphoric mood), item 2 (loss of interest or pleasure), and Endicott's criteria item 8 (brooding, self-pity, or pessimism) among the palliative patients, even after adjustment for the anxiety symptoms and distress level. We found that dysphoric mood, loss of interest, and pessimism are the main features of depression in palliative patients. These symptoms should be given more attention in identifying depression in palliative care patients.

QTc Prolongation and Ventricular Trigemini with Asenapine: A Case Report.

Asenapine is one of the newer atypical antipsychotics on the market. It is a sublingually administered drug that is indicated for the treatment of both schizophrenia and bipolar disorder, and is considered to be safe and well tolerated. Herein, we report a 71-year-old female with a history of bipolar disorder who had ventricular trigemini and experienced a large increase in her QTc interval after starting treatment with asenapine. These changes ceased following withdrawal of asenapine. In this case report, we discuss the importance of cardiac monitoring when switching antipsychotics, even to those that are considered to have low cardiac risk.

Metabolic Syndrome in First Episode Schizophrenia, Based on the National Mental Health Registry of Schizophrenia (NMHR) in a General Hospital in Malaysia: A 10-Year Retrospective Cohort Study.

Schizophrenia has been linked with various medical comorbidities, particularly metabolic syndrome. The number of studies on this aspect is lacking in Malaysia. (1) Objective: To investigate metabolic syndrome rates and its associated factors. (2) Method: This is the first 10-year retrospective-outcome study of patients with first episode schizophrenia in Malaysia. Out of 394 patients diagnosed with first episode schizophrenia and registered with the National Mental Health Registry of Schizophrenia (NMHR) in the General Hospital Kuala Lumpur (GHKL) in 2004⁻2005, 174 patients consented to participate in the study. They were interviewed using a Schizophrenia outcome questionnaire and the International Physical Activity Questionnaire (IPAQ). The diagnosis of metabolic syndrome was made using the National Cholesterol Education Program—Third Adult Treatment Panel (NCEP ATP III). (3) Results: All patients’ weight, body mass index, fasting blood sugar, and blood pressure are significantly increased. Sixty-three subjects (36.2%) developed metabolic syndrome while 36 (23.2%) were hypertensive, and 41 (28.1%) were diabetic. Use of fluphenthixol depot (CI = 1.05⁻5.09, OR: 0.84, p = 0.039), reduced physical activity (CI = 0.13⁻1.00, OR: −1.04, p = 0.049), and substance use disorder (CI = 1.40, 13.89, OR: 1.48, p = 0.012) were significantly associated with metabolic syndrome based on univariate analysis. In further multivariate analysis, comorbid substance abuse was the only significant factor associated with metabolic syndrome after adjusting for physical activity and intramuscular depot. (4) Conclusion: Patients with schizophrenia are at high risk of metabolic syndrome. It is important to address substance use problems as an important risk factor of this comorbidity.

Prevalence and risk factors of female sexual dysfunction among healthcare personnel in Malaysia.

OBJECTIVE: To determine the prevalence and risk factors of female sexual dysfunction (FSD) among healthcare personnel in selected healthcare facilities in Malaysia. METHODS: This was a cross-sectional study carried out at three large healthcare facilities that were selected by convenience sampling. Within each facility, stratified random sampling was used to select suitable candidates to participate in the study (n=201). Validated questionnaires were used to assess depression, anxiety, sexual function in women and erectile dysfunction (ED) in their partners. RESULTS: The prevalence of FSD was 5.5%. Women with sexual dysfunction were more likely to be married longer (OR=4.08; 95% CI; 1.15-4.50), had lower frequency of sexual intercourse (OR=5.00; 95% C; 1.05-23.76) and had a spouse with ED (OR=24.35; 95% CI; 4.55-130.37). Multivariate analysis showed that ED was the strongest predictor for FSD (AOR=27.30; 95% CI; 4.706-159.08). CONCLUSION: One in eighteen female healthcare personnel suffered from FSD and presence of ED in the partner strongly impacted her sexual function, negatively. The findings highlight the importance of including the male partner in clinical assessment of FSD.

Quality of life of patients with epilepsy in Malaysia.

INTRODUCTION: To determine the quality of life of patients with epilepsy and its relationship with depression, and the clinical and sociodemographic variables. METHODS: This was a cross-sectional study in which a total of 120 epilepsy patients were recruited from a neurology outpatient clinic. Sociodemographic and clinical variables were recorded. Hospital Anxiety and Depression Scale (HADS) and Mini International Neuropsychiatric Interview (M.I.N.I.) were used to screen and diagnose for depression, respectively. Quality of Life Inventory of Epilepsy (QOLIE-31) was used to assess quality of life. RESULTS: Patients with epilepsy with major depression had poorer quality life (36.4 ± 1.8) compared to those without depression (41.7 ± 3.8, P < 0.001). Depression, having one seizure or more per month and having seizures within one month of interview were correlated with poorer quality of life, P < 0.001. Multivariate linear regression analyses showed that depression and recent seizures predicted having poorer quality of life in patients with epilepsy. DISCUSSION: Depression and poor seizure control were predictors for poor quality of life in patients with epilepsy. Therefore, epilepsy patients should be regularly screened for depression and treatment for epilepsy must be optimized to minimize the negative impact of having epilepsy for these patients.

Sexual desire disorder in female healthcare personnel in Malaysia.

INTRODUCTION: The aim of this study was to determine the prevalence and risk factors for female sexual desire disorder (FSDD) among healthcare personnel at selected healthcare facilities in Malaysia. METHODS: Two hundred and one female healthcare workers from three large tertiary hospitals were selected by stratified random sampling to participate in this cross-sectional study. Validated questionnaires were used to assess depression, anxiety, and sexual function in women and erectile dysfunction (ED) in their partners. RESULTS: The prevalence of FSDD was 18.9%. Women with low sexual desire were more likely to have higher educational attainment (OR = 3.06; 95% CI; 1.22-7.66), lower frequency of sexual intercourse (OR = 12.81; 95% CI; 4.43-37.83), two or more children (OR = 3.05; 95% CI; 1.02-9.09), duration of marriage of 20 years or more (OR = 2.62; 95% CI; 1.27-5.40), and a spouse with ED (OR = 2.86; 95% CI; 1.08-7.56). DISCUSSION: FSDD is common among female healthcare personnel in Malaysia, affecting nearly one in five women. The implication of low sexual desire is important in terms of contributing to a meaningful sexual relationship, and indirectly affects the quality of life of the healthcare personnel.

Reliability and validity of the Malay version of Attitudes toward Lesbians and Gay Men (MVATL/MVATG): a study on a group of medical students in Malaysia.

INTRODUCTION: This study aims to examine the validity and reliability of the Malay version of Attitudes toward Lesbians and Gay Men (MVATL/MVATG) among a group of medical students in Malaysia. METHODS: It is a cross-sectional study of 173 medical students in the Faculty of Medicine, University of Kuala Lumpur, Malaysia. The participants were given the MVATL/MVATG, Index of Attitudes toward Homosexuals (IATH), Homosexuality Attitude Scale (HAS) and the English version of Attitude toward Lesbians and Gay Men. Two weeks later, these students were given the MVATLG again. RESULTS: Significant correlation was found between the individual scores of MVATL and MVATG with IATH and HAS in the results. The scale was able to differentiate Muslim and Non-Muslim subjects. The internal consistency (Cronbach's alpha) of both the MVATL and MVATG were good, at 0.76 and 0.82, respectively. The parallel form reliability (Pearson's correlation) of MVATL was 0.0.73 and 0.74 for MVATG. The test-retest reliability of MVATL/MVATG was good (Intraclass correlation coefficient, ICC = 0.67 for MVATL and 0.60 for MVATG). DISCUSSION: The MVATLG demonstrated good psychometric properties in measuring attitudes toward homosexuality among a group of medical students in Malaysia and it could be used as a simple instrument on young educated Malaysian adults.

A randomized, placebo-controlled trial of aripiprazole for the treatment of methamphetamine dependence and associated psychosis.

OBJECTIVES: The objectives of this study were to determine the efficacy and safety of aripiprazole for treatment of psychosis, retention and abstinence in patients with methamphetamine dependence. METHODS: This was a double-blind study where 37 methamphetamine dependent patients with history of psychosis were randomly assigned to receive aripiprazole (5-10 mg daily, N = 19) or placebo (N = 18) for 8 weeks. Follow-up evaluation was scheduled on day 7, 14, 28, 42 day 56 after enrolment. RESULTS: Participants on aripiprazole were retained significantly longer in treatment (48.7 days, SD =4.0) compared to placebo (37.1 days, SD =5.0). The Kaplan-Meier survival analysis showed that participants on aripiprazole were less likely to drop out of the study than the placebo group (P =0.02, χ(2) =5.3). Psychotic symptoms significantly decreased among those on aripiprazole as compared to placebo (P < 0.05). However, no statistically significance was found between the two groups in maintaining abstinence (generalised estimation equation (GEE) analysis, P = 0.41). No serious adverse events were reported in either group. CONCLUSION: Aripiprazole was no more effective than placebo in maintaining abstinence from methamphetamine use. However, it facilitated treatment retention and reduced the severity of psychotic symptoms. Aripiprazole was found to be generally safe and well tolerated.

Low dose quetiapine in the treatment of an adolescent with somnambulism: a case report.

Somnambulism or sleepwalking is a sleep disorder of arousal. Compared to in adults, pediatric and adolescent sleep disorders is still under-researched and poorly described. We report the successful use of low dose quietiapine, an atypical antipsychotic, in the treatment of a 15-year-old Indian male who presented with significant somnambulism. To the best of our knowledge, this is the first report on the use of quetiapine for the treatment of somnambulism in the literature. The presence of high voltage delta waves in sleepwalkers has been offered as a possible explanation for the patho-physiology of sleepwalking Quetiapine has been reported to decrease brain delta activity, and we postulate that this may be the mechanism on how it was beneficial for our patient.

[Non-fatal paliperidone overdose: a case report]. / Ölümcül Olmayan Paliperidon Doz Asimi Üzerine Bir Olgu Sunumu.

Paliperidone, a novel serotonin and dopamine antagonist, is one of the newest atypical antipsychotics on the market. It is an orally administered drug that is indicated for the treatment of schizophrenia, and is considered to be safe and well tolerated. A 37-year-old female with a long-standing history of schizophrenia had been taking paliperidone 12 mg d-1 for about 1.5 years. She overdosed on a total of 756 mg of paliperidone in response to auditory command hallucinations. She was promptly hospitalized, and fortunately did not suffer any major adverse clinical events, adverse laboratory parameters, or long lasting sequelae. Herein we discuss the inherent characteristics of paliperidone that limit the danger associated with overdosing.