Azlin Baharudin

Risk Factors of Erectile Dysfunction in Patients Receiving Methadone Maintenance Therapy

INTRODUCTION While methadone effectively treats opiate dependence, the side effect of erectile dysfunction (ED) may interfere with treatment adherence and benefits. AIM To determine the rate of ED and the associated factors which predict ED in male patients on methadone maintenance therapy (MMT) in a Malaysian population. MAIN OUTCOME MEASURES The main outcome measures were the International Index of Erectile Function-15 (IIEF-15) and the Beck Depression Inventory (BDI). METHODS A total of 108 participants diagnosed with heroin dependence were assessed. We used the Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I) on subjects who received MMT, and they were assessed using the IIEF-15, the BDI, and measures of other clinical and sociodemographic variables. RESULTS The rate of ED among men on MMT was 68.5% (mild ED, 36.1%; mild to moderate ED, 22.2%; severe ED, 3.7%). The mean age of the participants was 43.45 years. Older age (P = 0.002), concurrent illicit heroin use (P = 0.024), and having an older partner (P = 0.039) were significantly associated with ED. Following multivariate analysis, it was found that older age was the only significant predictor of ED, with an adjusted odds ratio of 1.07 (95% CI = 1.02-1.16). Methadone dose and duration of methadone treatment were not significantly associated with ED. CONCLUSION ED was highly prevalent among male patients on MMT. This suggests that there is a need for routine assessment of sexual function in patients on methadone. Among the risk factors, age was the only factor that was significantly associated with ED. The current use of MMT in Malaysia in terms of dosage and duration did not pose a significant risk for ED.

Mirtazapine for Anorexia Nervosa with Depression

Objective: To report the use of Mirtazapine in the treatment of anorexia nervosa with depression primarily regarding its propensity for weight gain. Method: We present an outpatient case report of anorexia nervosa with depression. The patients subsequent progress was recorded. Results: The patient gained 2.5 kg within 3 months to eventually attain a body mass index of 15 after 5 months. Her depression achieved full remission at 6 weeks of treatment. Conclusions: Mirtazapine is the choice medication in this case. However, treating depression requires caution, given these patients’ physical vulnerability. Controlled trials of Mirtazapine for anorexia nervosa are needed.

Depression in male patients on methadone maintenance therapy

Depression is one of the most common psychiatric conditions in men. The aim of the study was to determine the depressive symptoms and associated factors among men on methadone maintenance therapy (MMT).

Functional remission and employment among patients with schizophrenia in Malaysia

OBJECTIVE The study aimed to determine the rates of functional remission and employment as well as the factors associated with functional remission among patients with Schizophrenia, receiving community psychiatric service in an urban setting in Malaysia. METHODS From a total of 250 patients randomly selected, 155 fulfilled the study requirement and were assessed on their functional remission status using the Personal and Social Performance Scale. The relationships between functional remission and socio-demographic factors, clinical factors, social support, symptom remission and rates of hospitalization were examined. RESULTS The results revealed that 74% (n=115) of the respondents had functional remission with only 20% (n=31) currently employed. Functional remission was found to be significantly associated with good social support (84.4% versus 36.4% p<0.001, OR=9.487 [95% CI=4.008-22.457]); shorter illness duration of less than 10 years (81.2% versus 66.7% p=0.038, OR=2.167 [95% CI=1.035-4.535]); good medication compliance (79.1% versus 50.0% p=0.002, OR=3.778 [95% CI=1.570-9.090]); hospital admissions of lower than 3 per year (80.5% versus 44.4% p<0.001 OR=5.150 [95% CI=2.145-12.365]) and; symptomatic remission (87.3% versus 37.4% p<0.001 [95% CI=0.070 (0.029-0.168]). A multiple regression analysis revealed only social support, lower hospitalization rate and symptom remission, as significant predictors of functional remission. CONCLUSION A majority of patients with Schizophrenia in this study achieved functional remission, however, only a small percentage of them were employed. Functional remission was influenced by severity of illness and levels of social support in these patients.

Excessive internet use in young women: What are the implications?

Purpose of review There are considerable gender differences in youth engaging in excessive internet use (EIU). This review provides updates based on the recent literature focusing on the EIU in young women to describe its implications including what it constitutes of, its correlates, sequelae and preventive and/or treatment strategies. Recent findings Definition of EIU and its conceptualization still requires refinement. Recent studies indicate a changing trend towards female predominance of EIU. Women also differ in their internet use compared with men regarding their preference in the internet content and online activities, motives of use and factors related to access to the internet, including the device, sociocultural restrictions, etc. The correlates and sequelae of EIU encompass psychological, physical, biological, family and social domains that could form the basis of identifying individuals at risk and strategizing treatment. Summary The findings indicate the need for standardization in definition and measures of EIU for better recognition of EIU and identification of its at-higher-risk females. Effective preventive and treatment measures are still limited by various methodology flaws outlined here.