Jesjeet Singh Gill

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

Abstract 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, χ2 =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.

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.

Adherence to metabolic monitoring guidelines in atypical antipsychotic treated subjects: Do physicians comply?

Since the 1990s, the arrival of the new generation of antipsychotics, the atypical antipsychotics (AAP), heralded a new era in the management on psychotic patients as they are associated with much less side effects as the older drugs. However, the psychiatric community soon realized a new problem had emerged with these drugs, namely severe metabolic side effects. Several monitoring guidelines were soon published to guide treating physicians on how to deal with this issue. This study was aimed to assess adherence to the recommended guidelines by Malaysian doctors. Data concerning metabolic monitoring over 1 year were collected from 405 subjects newly started on AAP after June 2005, when the recommended guidelines were first implemented. Results showed that almost all the recommended tests/procedures were performed in less than 50% of patients during the recommended designated times. We recommend that the guidelines, which now serve only as a “guide”, be made a compulsory practice to safeguard the health of our patients.

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.To determine the quality of life of patients with epilepsy and its relationship with depression, and the clinical and sociodemographic variables.

Sexual desire disorder in female healthcare personnel in Malaysia

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.

Paradoxical pinpoint pupils with asenapine.

Dear Editor, Atypical antipsychotics have been the mainstay of treatment in various indications, ranging from rapid tranquilization to maintenance treatment (Koh et al., 2010; Hui et al., 2013). Mydriasis can occur due to their anticholinergic effect. We report a case of paradoxical pinpoint pupils with asenapine. To the best of our knowledge, this is the first such reported case with asenapine, though they have been sporadic reports with other antipsychotics (O’Malley et al., 1999; Hodge et al., 2001). A 33-year-old woman was admitted in a manic state after defaulting her medication for over a year. She was started on asenapine 10 mg bid, sodium valproate 600 mg bid and lorazepam 1 mg tds. The next morning, she was noted to be drowsy but still conscious. Her vital signs, electrocardiography and oxygen saturation were normal. Physical examination revealed pinpoint pupils. All her medications were withheld, and by that evening, her consciousness level and pupillary response had returned to normal. The next day, sodium valproate was restarted and two days later, we restarted asenapine. However, she was again very drowsy with pinpoint pupils. Asenapine was withheld again, and she recovered over several hours. Later, risperidone was added and she gradually recovered. How asenapine caused miosis instead of mydriasis could probably be explained by its unique receptor profile. Asenapine has no appreciable affinity for muscarinic receptors (Ki of 8128 nM for M1) but exhibits high affinity toward α1A (Ki of 1.2) and α2A (Ki of 1.2) adrenoreceptor receptors (Saphris Product Monograph., 2012). This can cause miosis with no mydriatic action to counter it Psychiatrists need to be attuned to the possibility of such uncommon side effects in order to effectively treat our patients, otherwise we may investigate the cause down the wrong path, while continuing to give the offending medication.

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.

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.

Development of a strategic tool for shared decision-making in the use of antidepressants among patients with major depressive disorder: a focus group study

Shared decision-making (SDM) has been recognized as an important tool in the mental health field and considered as a crucial component of patient-centered care. Therefore, the purpose of this study was to develop a strategic tool towards the promotion and implementation of SDM in the use of antidepressants among patients with major depressive disorder. Nineteen doctors and 11 major depressive disorder patients who are involved in psychiatric outpatient clinic appointments were purposively selected and recruited to participate in one of six focus groups in a large teaching hospital in Malaysia. Focus groups were transcribed verbatim and analyzed using a thematic approach to identify current views on providing information needed for SDM practice towards its implementation in near future. Patients’ and doctors’ views were organized into six major themes, which are; summary of treatment options, correct ways of taking medication, potential side effects of treatments related to patients, sharing of case study related to the treatment options, cost of treatment options, and input from pharmacist. The information may be included in the SDM tool which can be useful to inform further research efforts and developments that contribute towards the successful implementation of SDM into clinical practice.

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.

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.