Anne Yee

The Prevalence of Sexual Dysfunction among Male Patients on Methadone and Buprenorphine Treatments: A Meta-Analysis Study

INTRODUCTION For many years, methadone has been recognized as an effective maintenance treatment for opioid dependence. However, of the many adverse events reported, sexual dysfunction is one of the most common side effects. AIM We conducted a meta-analysis to evaluate the prevalence of sexual dysfunction among male patients on methadone and buprenorphine treatments. METHODS Relevant studies published from inception until December 2012 were identified by searching PubMed, OVID, and Embase. Studies were selected using prior defined criteria. Heterogeneity, publication bias, and odds ratio were assessed thoroughly. MAIN OUTCOME MEASURES To examine the prevalence and odds ratio of sexual dysfunctions among the methadone and buprenorphine groups. RESULTS A total of 1,570 participants from 16 eligible studies were identified in this meta-analysis. The studies provided prevalence estimates for sexual dysfunction among methadone users with a meta-analytical pooled prevalence of 52% (95% confidence interval [CI], 0.39-0.65). Only four studies compared sexual dysfunction between the two groups, with a significantly higher combined odds ratio in the methadone group (OR = 4.01, 95% CI, 1.52-10.55, P = 0.0049). CONCLUSIONS Evidence showed that the prevalence of sexual dysfunction was higher among the users of methadone compared with buprenorphine. Patients with sexual difficulty while on methadone treatment were advised to switch to buprenorphine.

Sexual Dysfunction in Heroin Dependents: A Comparison between Methadone and Buprenorphine Maintenance Treatment.

Introduction Methadone has long been regarded as an effective treatment for opioid dependence. However, many patients discontinue maintenance therapy because of its side effects, with one of the most common being sexual dysfunction. Buprenorphine is a proven alternative to methadone. This study aimed to investigate sexual dysfunction in opioid-dependent men on buprenorphine maintenance treatment (BMT) and methadone maintenance treatment (MMT). The secondary aim was to investigate the correlation between sexual dysfunction and the quality of life in these patients. Methods Two hundred thirty-eight men participated in this cross-sectional study. Four questionnaires were used, the Mini International Neuropsychiatric Interview, Opiate Treatment Index, Malay version of the International Index of Erectile Function 15 (Mal-IIEF-15), and World Health Organization Quality of Life-BREF Scale. Multivariate analysis of covariance was used to examine the relationship between MMT and BMT and the Mal-IIEF 15 scores while controlling for all the possible confounders. Results The study population consisted of 171 patients (71.8%) on MMT and 67 (28.2%) on BMT. Patients in the MMT group who had a sexual partner scored significantly lower in the sexual desire domain (p < 0.012) and overall satisfaction (p = 0.043) domain compared with their counterparts in the BMT group. Similarly, patients in the MMT group without a sexual partner scored significantly lower in the orgasmic function domain (p = 0.008) compared with those in the BMT group without a partner. Intercourse satisfaction (p = 0.026) and overall satisfaction (p = 0.039) were significantly associated with the social relationships domain after adjusting for significantly correlated sociodemographic variables. Conclusions Sexual functioning is critical for improving the quality of life in patients in an opioid rehabilitation program. Our study showed that buprenorphine causes less sexual dysfunction than methadone. Thus, clinicians may consider the former when treating heroin dependents who have concerns about sexual function.

Validation of a Malay Version of the Smartphone Addiction Scale among Medical Students in Malaysia

Introduction This study was initiated to determine the psychometric properties of the Smart Phone Addiction Scale (SAS) by translating and validating this scale into the Malay language (SAS-M), which is the main language spoken in Malaysia. This study can distinguish smart phone and internet addiction among multi-ethnic Malaysian medical students. In addition, the reliability and validity of the SAS was also demonstrated. Materials and Methods A total of 228 participants were selected between August 2014 and September 2014 to complete a set of questionnaires, including the SAS and the modified Kimberly Young Internet addiction test (IAT) in the Malay language. Results There were 99 males and 129 females with ages ranging from 19 to 22 years old (21.7±1.1) included in this study. Descriptive and factor analyses, intra-class coefficients, t-tests and correlation analyses were conducted to verify the reliability and validity of the SAS. Bartlett’s test of sphericity was significant (p <0.01), and the Kaiser-Mayer-Olkin measure of sampling adequacy for the SAS-M was 0.92, indicating meritoriously that the factor analysis was appropriate. The internal consistency and concurrent validity of the SAS-M were verified (Cronbach’s alpha = 0.94). All of the subscales of the SAS-M, except for positive anticipation, were significantly related to the Malay version of the IAT. Conclusions This study developed the first smart phone addiction scale among medical students. This scale was shown to be reliable and valid in the Malay language.

Clinical factors associated with sexual dysfunction among men in methadone maintenance treatment and buprenorphine maintenance treatment: a meta-analysis study

Methadone maintenance treatment is proven to be effective treatment for opioid dependence. Of the many adverse events reported, sexual dysfunction is one of the most common side effects. However, there may be other clinical factors that are associated with sexual dysfunction among methadone users. We conducted a meta-analysis to examine the clinical factors associated with sexual dysfunction among male patients on methadone and buprenorphine treatments, of which eligible studies were selected using prior defined criteria. A total of 2619 participants from 16 eligible studies, published from inception till December 2012, were identified from the PubMed, OVID and EMBASE databases. The included studies provided prevalence estimates for sexual dysfunction among methadone users with a meta-analytical pooled prevalence of 52% (95% confidence interval (CI), 0.39–0.65). Only four studies compared sexual dysfunction between the two groups, with a significantly higher combined odds ratio in the methadone group (odds ratio=4.01, 95% CI, 1.52–10.55, P=0.0049). Our study shows that eight clinical factors are associated with sexual dysfunction among men receiving opioid substitution treatment, namely age, hormone assays, duration of treatment, methadone dose, medical status, psychiatric illness, other current substance use and familial status, and methadone versus buprenorphine treatment. Despite the methodological limitations, the findings of this meta-analysis study may offer better insights to clinicians in dealing with both sexual dysfunction and its related problems.

Erectile Dysfunction Among Patients on Methadone Maintenance Therapy and Its Association With Quality of Life.

OBJECTIVES Erectile dysfunction (ED) is a problem commonly encountered by patients on methadone maintenance therapy (MMT). This study aimed to assess the prevalence of ED among this group of patients along with its risk factors and association with quality of life (QOL). METHODS Male patients on MMT in a tertiary hospital in Malaysia were included in the study. A total of 134 patients with sexual partners were assessed for ED using the International Index of Erectile Function. Patients were assessed for substance use using Opiate Treatment Index (OTI) and depression using the Malay version of the self-rated Montgomery-Asberg Depression Rating Scale (MADRS-BM). QOL was evaluated using World Health Organisation Quality of Life (WHOQOL)-BREF. RESULTS The prevalence of ED among patients on MMT was 67%, with 26.1% having mild ED, 30.4% having mild-to-moderate ED, 7.0% having moderate ED, and 17.2% having severe ED. Patients with depression were 4 times more likely to have ED compared with patients without depression, whereas increasing age significantly correlated with the severity of ED. Having ED predicted a poorer QOL in the social relationships domain. CONCLUSION Depression is highly associated with ED, which negatively influences the social aspect of QOL among patients on methadone maintenance therapy.

Mindfulness-Based Supportive Therapy (MBST) Proposing a Palliative Psychotherapy From a Conceptual Perspective to Address Suffering in Palliative Care

Objective: To develop a mindfulness-based palliative psychotherapy to address psychoexistential suffering in palliative care. Conceptualization: First, a theory of suffering was formulated by merging 2 models of suffering from 2 thematic analyses of 20 palliative care patients and 15 informal caregivers. Second, the results from a secondary thematic analysis of suffering caused by health care interactions were conceptualized into a psychotherapy framework. Third, principles of mindfulness were incorporated into the framework to form a mindfulness-based psychotherapy. Results: Mindfulness-based supportive therapy (MBST) was developed with the following 5 components of presence, listening, empathy, compassion, and boundary awareness. Conclusion: We believe that MBST is a potentially useful psychological intervention in palliative care, specifically designed to address psychoexistential suffering of terminally ill patients.

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.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. (Am J Addict 2015;XX:XX–XX)

The natural progression and outcomes of adrenal incidentaloma: a systematic review and meta-analysis.

INTRODUCTION Long-term outcome of patients with adrenal incidentaloma (AI) is unknown. The aim of this study was to systematically summarize the follow-up and outcome of clinically silent AI who do not undergo surgery. EVIDENCE ACQUISITION All major databases and medical literature in English-language, published from 1998 to May 2015, were systematically searched for publications on AI. Primary endpoint was hormonal hyper function; secondary endpoints were time from diagnosis to study endpoint and the outcome of adrenalectomy. Meta-analysis was performed using both qualitative and quantitative approach. EVIDENCE SYNTHESIS A total of 11 publications were included. Total sample size was 1298 patients. Mean follow-up duration was 44.2 months. There were 82 patients confirmed to have subclinical Cushings syndrome at diagnosis, with 1.79% new cases at the end of follow up (95% CI, 0.002 to 0.045). Incidence of Cushings syndrome was 0.7% (95% CI, 0.001 to 0.013) and pheochromocytoma 0.4% (95% CI, 0.001 to 0.008). The mean tumor size was 2.52cm, with mean increment of 0.03cm to 2.9cm at the end of follow up. About 3% of patients ended up with surgery (95% CI, 0.01 to 0.05) but none were due to primary adrenal malignancy. Time of greatest risk of developing Cushings syndrome and pheochromocytoma was between months 36 and 42 (hazard rate 14%), and between months 48 and 54 (hazard rate 7%) respectively. CONCLUSIONS Malignant change in non-functioning AI is rare. The risk of developing overt disease over the follow-up period is low. A less stringent imaging and functional work-up interval can be considered.

The Effect of Nicotine Dependence on Psychopathology in Patients with Schizophrenia

Introduction. Our study aims to determine the prevalence of nicotine dependence and investigate the effect of nicotine dependence on psychopathology among schizophrenia patients. Methods. A cross-sectional study was carried out in an outpatient psychiatric clinic at a general hospital in Malaysia. 180 recruited subjects were administered the Malay version of Mini International Neuropsychiatric Interview (MINI), the Positive and Negative Symptom Scale (PANSS), and the Malay version of Fagerstrom Test for Nicotine Dependence (FTND-M) questionnaires. Results. The prevalence of nicotine dependence among the subjects was 38.1% (n = 69) and they were mainly composed of male gender, Malay ethnicity, being treated with atypical antipsychotics, and taking other illicit drugs or alcohol. Subjects with severe nicotine dependence scored less in the negative subscale of PANSS compared with the nonsmokers (P = 0.011). On performing the hierarchy multiple regressions, dependence status still significantly predicted negative scores after adjusting the confounders (t = −2.87, P = 0.005). Conclusion. The rate of nicotine use disorder among schizophrenia patients in this study is higher than that of the general population in Malaysia. The significant association between nicotine dependence and negative psychopathology symptoms will help the healthcare practitioners in their management of nicotine dependence among schizophrenia patients.

Comparative studies of dipeptidyl peptidase 4 inhibitor vs sulphonylurea among Muslim Type 2 diabetes patients who fast in the month of Ramadan: A systematic review and meta-analysis

AIM To systematically review the literature to compare the use of DPP4 inhibitors vs sulphonylurea in type 2 diabetic Muslim patients who fast in Ramadan, with regards to its safety, tolerability, glycemic control, and body weight changes. METHODS All English-language medical literature published from inception till October 2014 which met the inclusion criteria were reviewed and analyzed. RESULTS A total of nine papers were included, reviewed and analyzed. The total sample size was 4276 patients. All studies used either of the two DPP4 inhibitors - Vildagliptin or Sitagliptin, vs sulphonylurea or meglitinides. Patients receiving DPP4 inhibitors were less likely to develop symptomatic hypoglycemia (risk ratio 0.46; 95% CI, 0.30-0.70), confirmed hypoglycemia (risk ratio 0.36; 95% CI, 0.21-0.64) and severe hypoglycemia (risk ratio 0.22; 95% CI, 0.10-0.53) compared with patients on sulphonylureas. There was no statistically significant difference in HbA1C changes comparing Vildagliptin and sulphonylurea. CONCLUSION DPP4 inhibitor is a safer alternative to sulphonylurea in Muslim patients with type 2 diabetes mellitus who fast during the month of Ramadan as it is associated with lower risk of symptomatic, confirmed and severe hypoglycemia, with efficacy comparable to sulphonylurea.