Mohd Hussain Habil

The risk and associated factors of methamphetamine psychosis in methamphetamine-dependent patients in Malaysia

OBJECTIVE The objective of this study was to determine the risk of lifetime and current methamphetamine-induced psychosis in patients with methamphetamine dependence. The association between psychiatric co-morbidity and methamphetamine-induced psychosis was also studied. METHODS This was a cross-sectional study conducted concurrently at a teaching hospital and a drug rehabilitation center in Malaysia. Patients with the diagnosis of methamphetamine based on DSM-IV were interviewed using the Mini International Neuropsychiatric Interview (M.I.N.I.) for methamphetamine-induced psychosis and other Axis I psychiatric disorders. The information on sociodemographic background and drug use history was obtained from interview or medical records. RESULTS Of 292 subjects, 47.9% of the subjects had a past history of psychotic symptoms and 13.0% of the patients were having current psychotic symptoms. Co-morbid major depressive disorder (OR=7.18, 95 CI=2.612-19.708), bipolar disorder (OR=13.807, 95 CI=5.194-36.706), antisocial personality disorder (OR=12.619, 95 CI=6.702-23.759) and heavy methamphetamine uses were significantly associated with lifetime methamphetamine-induced psychosis after adjusted for other factors. Major depressive disorder (OR=2.870, CI=1.154-7.142) and antisocial personality disorder (OR=3.299, 95 CI=1.375-7.914) were the only factors associated with current psychosis. CONCLUSION There was a high risk of psychosis in patients with methamphetamine dependence. It was associated with co-morbid affective disorder, antisocial personality, and heavy methamphetamine use. It is recommended that all cases of methamphetamine dependence should be screened for psychotic symptoms.

Attempted Suicide in Kuala Lumpur

A total of 306 patients were admitted to the University Hospital in Kuala Lumpur in 1989 after attempting suicide. Fourteen of them succumbed to injuries. Psychosocial data of 296 patients out of the 306 survivors are reported. Suicidal behaviour is more common in the young and especially amongst the females. Nearly 45.0% of them are from social class IV and V. Persons of Indian ethnic origin are over-represented, while in Malays suicidal behavior seemed to be less common. Self-poisoning was reported to be the commonest method in attempting suicide. Diagnosis of adjustment disorder was made in 58.5% of the patients. Two-thirds of the patients had an intention score of less than 10 on the Pierces Scale.

Metabolic syndrome and antipsychotic monotherapy treatment among schizophrenia patients in Malaysia

OBJECTIVE The objective of this study is to determine the prevalence of metabolic syndrome among schizophrenia patients receiving antipsychotic monotherapy in Malaysia. METHOD A cross-sectional study was conducted at multiple centres between June 2008 and September 2011. Two hundred and five patients who fulfilled the DSM IV-TR diagnostic criteria for schizophrenia and who had been on antipsychotic medication for at least one year, were screened for metabolic syndrome. Patients receiving a mood stabilizer were excluded from the study. Metabolic syndrome was defined by using the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Treatment Panel III (ATP III) modified for Asian waist circumference. RESULTS In the first-generation antipsychotic (FGA) group, the highest prevalence of metabolic syndrome was among patients treated with trifluoperazine and flupenthixol decanoate (66.7% each). For the second-generation antipsychotic (SGA) group, the highest prevalence of metabolic syndrome was among patients treated with clozapine (66.7%). The component with the highest prevalence in metabolic syndrome was waist circumference in both FGA and SGA groups except for aripiprazole in SGA. CONCLUSION The prevalence of metabolic syndrome in schizophrenia patients receiving antipsychotic monotherapy in Malaysia was very high. Intervention measures are urgently needed to combat these problems.

2801 – Effectiveness of electroacupuncture as adjunctive therapy in relieving opiate withdrawal symptoms among methadoe maintainance treatment (MMT) patient: a single blinded, randomized study

Introduction Over the last decades, acupuncture has been seen as an acceptable primary detoxification treatment for opiate dependence, and currently used to relieve the severity of opiate withdrawal symptoms among MMT patient. Objective To investigate the effectiveness of electroacupuncture treatment in reducing opiate withdrawal symptoms among MMT patient. Method This was a pilot study with randomized, single-blinded, and parallel. Recruitment of 22 subjects, 11 in methadone treatment + acupuncture and 11 in methadone treatment without acupuncture. The severity of withdrawal reaction was assessed by Objective Opiate Withdrawal Scale (OOWS) and Subjective Opiate Withdrawal Scale (SOWS) at baseline, third, fifth, seventh, tenth and fourteenth day of treatment. Result One way Analysis of Variance (ANOVA) comparing the mean scores of the OOWS between treatment and control group has shown at tenth day of treatment p value is 0.026 and at fourteenth day p value is 0.022. One way ANOVA comparing the mean scores of the SOWS between treatment and control groups has shown at tenth day of treatment, p value is 0.015 and at fourteenth day, p value is 0.009. Conclusion The study has shown the promising results, where electroacupuncture treatment had an effectiveness in relieving opiate withdrawal symptoms among MMT patient.

P03-117 - Ziprasidone treatment effects on lipids in patients with metabolic risk: preliminary results

Objective Atypical antipsychotics have been reported to induce severe metabolic side effects such as metabolic syndrome. However, ziprasidone has a safer metabolic profile and metabolic neutral for schizophrenic patient. In this prospective 24-week study, we investigate the improvements in lipids observed in patients switched from other antipsychotics. Methods 150 patients with schizophrenia treated with antipsychotic who were having metabolic risk were switched to ziprasidone. They were analyzed to quantify clinically significant changes in metabolic parameters. At baseline assessment, fasting lipid profile was taken for total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. The same assessment was repeated at 4-weeks, 12-week and 24-week. Paired t-test and last observation carried forward (LOCF) were used for the statistical analysis. Preliminary results for those who completed 12 weeks follow up were presented. Results 13 schizophrenic patients with 7 (53.8%) male and 6 (46.2%) female have completed the 12 weeks follow up. 6 (46.25%) patients were previously treated with olanzapine, 3 (23.1%) were on risperidal, 2(15.4%) were on paliperidone, 1(7.7%) was on haloperidol and 1(7.7%) was on trifluoperazine. There was statistically significant reduction in mean total cholesterol (5.40 ± 0.73 mmol) to (4.99 ± 0.71 mmol) p=0.007, mean LDL cholesterol (3.51 ± 0.65 mmol) to (3.21 ± 0.65 mmol) p=0.047. There was no statistically significant in mean difference for HDL cholesterol and triglycerides. Conclusion In short-term, switching to ziprasidone treatment resulted in clinically significant improvements in cholesterol and LDL cholesterol in at-risk patients.