Abdul Hamid Abdul Rahman

Validation study of the Mini-Mental State Examination in a Malay-speaking elderly population in Malaysia

Background/Aims: In view of the differing sensitivity and specificity of the Mini-Mental State Examination (MMSE) in the non-English-speaking populations, we conducted the first validation study of the Malay version (M-MMSE) in Malaysia among 300 subjects (from the community and outpatient clinics). Methods: Three versions were used: M-MMSE-7 (serial 7), M-MMSE-3 (serial 3) and M-MMSE-S (spell ‘dunia’ backwards). Dementia was assessed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders IV. The optimal cutoff scores were obtained from the receiver operating characteristics curves. Results: Seventy-three patients (24.3%) had dementia and 227 (75.7%) were controls. Three hundred patients completed the M-MMSE-7, 160 the M-MMSE-3 and 145 the M-MMSE-S. All 3 versions were valid and reliable in the diagnosis of dementia. The optimal cutoff scores varied with each version and gender. In the control group, significant gender differences were observed in the patients with the lowest educational status. Increasing educational levels significantly improved the M-MMSE performance in both genders. Conclusion: All 3 versions of the M-MMSE are valid and reliable as a screening tool for dementia in the Malaysian population, but at different cutoff scores. In those with the lowest educational background, gender-adjusted cutoff scores should be applied.

The Hyperactivity of Efferent Auditory System in Patients with Schizophrenia: A Transient Evoked Otoacoustic Emissions Study

Objective Electrophysiological studies, which are mostly focused on afferent pathway, have proven that auditory processing deficits exist in patients with schizophrenia. Nevertheless, reports on the suppressive effect of efferent auditory pathway on cochlear outer hair cells among schizophrenia patients are limited. The present, case-control, study examined the contralateral suppression of transient evoked otoacoustic emissions (TEOAEs) in patients with schizophrenia. Methods Participants were twenty-three healthy controls and sixteen schizophrenia patients with normal hearing, middle ear and cochlear outer hair cells function. Absolute non-linear and linear TEOAEs were measured in both ears by delivering clicks stimuli at 80 dB SPL and 60 dB SPL respectively. Subsequently, contralateral suppression was determined by subtracting the absolute TEOAEs response obtained at 60 dBpe SPL during the absence and presence of contralateral white noise delivered at 65 dB HL. No attention tasks were conducted during measurements. Results We found no significant difference in absolute TEOAEs responses at 80 dB SPL, in either diagnosis or ear groups (p>0.05). However, the overall contralateral suppression was significantly larger in schizophrenia patients (p<0.05). Specifically, patients with schizophrenia demonstrated significantly increased right ear contralateral suppression compared to healthy control (p<0.05). Conclusion The present findings suggest increased inhibitory effect of efferent auditory pathway especially on the right cochlear outer hair cells. Further studies to investigate increased suppressive effects are crucial to expand the current understanding of auditory hallucination mechanisms in schizophrenia patients.

Evaluation of auditory hallucinations in patients with schizophrenia: A validation study of the Malay version of Psychotic Symptom Rating Scales (PSYRATS)

The Psychotic Symptom Rating Scales (PSYRATS) is the most widely used validated scale to measure the specific symptoms of auditory hallucination and delusion. The aim of this study was to validate and to examine the psychometric properties of the auditory hallucination component of the Malay PSYRATS (MyPSYRATS). The research was done in the Universiti Kebangsaan Malaysia Medical Center (UKMMC) among 51 schizophrenia inpatients and outpatients who had experienced or reported verbal auditory hallucination. The psychometric properties of MyPSYRATS (auditory hallucination) were studied and a comparison was made between the psychometric properties obtained and the Positive and Negative Syndrome Scale (PANSS). The internal consistency of MyPSYRATS was good as revealed by Cronbachs alpha value. Factor analysis replicated three components (emotional, cognitive, and physical) similar to the factorial structure of the original auditory hallucination scale. However, two items were regrouped under the emotional component. Spearmans rank-order correlation showed a significant positive relationship between the total score of auditory hallucinations and PANSS auditory hallucinations item (P3). In conclusion, the auditory hallucination domain of MyPSYRATS is a reliable and valid assessment tool for further clinical applications.

Polymorphism of the serotonin transporter gene (5-HTTLPR) in major depressive disorder patients in Malaysia.

The serotonin transporter promoter (5‐HTTLPR) is a potential susceptibility locus in the pathogenesis of major depressive disorder. However, data from Malaysia is lacking. The present study aimed to determine the association between the homozygous short variant of the serotonin transporter promoter gene (5‐HTTLPR) with major depressive disorder.

Psychosis post corona radiata and lentiform nucleus infarction.

Complications of stroke can include neuropsychiatric symptoms. However, post-stroke psychosis is rare. We report a case where an acute presentation of psychosis, depression and fluctuating cognitive impairment in a middle-aged man turned out to be related to a silent brain infarction. The patient had a background of poorly controlled type 2 diabetes mellitus with glycated haemoglobin level of 9.0–11.0%, hypertension and ischaemic heart disease. His CT brain results showed multifocal infarct with hypodensities at bilateral lentiform nucleus and bilateral corona radiata. His strong genetic predisposition of psychosis and a history of brief psychotic disorder with complete remission 3 years prior to the current presentation might possibly contribute to his post-stroke atypical neuropsychiatric presentation, and posed diagnostic challenges. He showed marked improvement with risperidone 6 mg nocte, chlorpromazine 50 mg nocte and fluvoxamine of 200 mg nocte. The need of comprehensive treatments to modify his stroke risk factors was addressed.

Listening to sentences in noise: Revealing binaural hearing challenges in patients with schizophrenia

Objective The present, case-control, study investigates binaural hearing performance in schizophrenia patients towards sentences presented in quiet and noise. Methods Participants were twenty-one healthy controls and sixteen schizophrenia patients with normal peripheral auditory functions. The binaural hearing was examined in four listening conditions by using the Malay version of hearing in noise test. The syntactically and semantically correct sentences were presented via headphones to the randomly selected subjects. In each condition, the adaptively obtained reception thresholds for speech (RTS) were used to determine RTS noise composite and spatial release from masking. Results Schizophrenia patients demonstrated significantly higher mean RTS value relative to healthy controls (p=0.018). The large effect size found in three listening conditions, i.e., in quiet (d=1.07), noise right (d=0.88) and noise composite (d=0.90) indicates statistically significant difference between the groups. However, noise front and noise left conditions show medium (d=0.61) and small (d=0.50) effect size respectively. No statistical difference between groups was noted in regards to spatial release from masking on right (p=0.305) and left (p=0.970) ear. Conclusion The present findings suggest an abnormal unilateral auditory processing in central auditory pathway in schizophrenia patients. Future studies to explore the role of binaural and spatial auditory processing were recommended.

Malignant catatonia secondary to viral meningoencephalitis in a young man with bipolar disorder.

A 23-year-old Malay man presented on 9 January 2012 with a 2-day history of abnormal behavior, fever and two episodes of generalized tonic-clonic seizures during a family trip to Phuket, Thailand. He was a known case of bipolar type I disorder, diagnosed in 2010. He had a total of three hospital admissions in the past. However, he had stopped his treatment in December 2010 due to extrapyramidal side-effects (body stiffness) and weight gain while on risperidone. There was no history of substance abuse and no family history of mental illness. He was admitted to a medical ward and was treated for viral meningoencephalitis based on clinical presentation (fever, episodes of seizures), serologically positive for Herpes simplex virus (HSV) immunoglobulin (Ig)G and cytomegalovirus IgG, with raised infection parameters such as C-reactive protein (CRP) of 1.62 mg/dL and white blood cell count (WBC) of 14.7 ¥ 10/L with predominant neutrophils of 12.8 ¥ 10/L. Computed tomography (CT), magnetic resonance imaging (MRI) of the brain, cerebrospinal fluid (CSF) and electroencephalogram (EEG) showed no significant abnormalities. His creatine kinase (CK) was raised at 2720 U/L. Urine for drugs was negative. Ceftriaxone 2 g b.i.d., phenytoin 100 mg t.d.s., acyclovir 500 mg t.d.s. were administrated i.v. for 14 days. He was discharged well on 23 January 2012 with lorazepam 0.5 mg p.r.n., risperidone 0.5 mg o.d., phenytoin 300 mg t.d.s. and folic acid 5 mg o.d. However, he was readmitted 3 days after discharge with complaints of insomnia, pacing up and down at home for 2 days, followed by depressed mood with neglected self-hygiene and being mute. He had not been taking risperidone as prescribed even in the ward as the family did not purchase the medication. Mental state examination showed a perplexed looking young man, in stupor, with presence of waxy flexibility, “psychological pillow” and restricted affect. Delusions and hallucinations could not be elicited. Physical examination revealed pyrexia with temperature ranging from 37.8–38°C, labile blood pressure ranging 108–168/55–90 mmHg, heart rate ranging 60–140 b.p.m. and respiratory rate of 18 b.p.m. Glasgow Coma Scale score was 15/15. Neurological examination showed that he had hypertonia with cogwheel rigidity and hyperreflexia on bilateral upper and lower limbs. The repeat CSF examination was bs_bs_banner Offi cial journal of the Pacifi c Rim College of Psychiatrists