Rusdi Abdul Rashid

Quantitation of Methadone and Metabolite in Patients under Maintenance Treatment

Gas chromatography-mass spectrometry quantitative method was developed to monitor concentrations of methadone and its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) in plasma and urine of patients. The developed method was simple, accurate and reproducible to quantify methadone and EDDP in plasma and urine samples in the concentration range of 15-1,000 and 50-2,000 ng/mL, respectively. The proposed analytical method was applied to plasma and urine samples obtained from 96 patients undergoing methadone maintenance treatment (MMT) with daily methadone doses of 2-120 mg/day. Urinary methadone excretion was observed to be significantly affected by pH, in which the ratio of methadone to EDDP was two times higher in acidic urine (P = 0.029). The findings of this study further enhance the guidelines for monitoring of methadone treatment among outpatients. Methadone-to-EDDP ratio in urine was found to be consistent at 24 and 4 h, hence suggesting the possibility that outpatients may be monitored with single urine sample in order to check for compliance. This study which provides data on peak concentrations of methadone and EDDP as well as the ratio of both compounds has added to the body of knowledge regarding pharmacokinetic properties of methadone among heroin-dependent patients under MMT.

2679 – A mixed methods approach: perception and practice in managing schizophrenia in malaysia among levels of service provider in hospital

Objectives The aim of this study is to investigate the “Hospital Service providers” perception, attitude and actual practice in managing schizophrenia in Malaysia. Method In this study, it was designed as a mixed -methods study. In the first phase, quantitative surveys have been implemented among 42 service providers. In the second phase, the descriptive qualitative study method was also used. Result The questionnaires designed to gather the data relating to the respondent satisfied in managing Schizophrenia in Malaysia. Thirty five (or 83.3%) of the respondents are satisfied with the current Schizophrenic overall management, but twenty one (or 50.1%) of the respondents does not satisfy with current psychosocial interventions available in Malaysia. The qualitative found that, the psychiatrists responded that they are satisfied with current use of atypical antipsychotic in the hospitals but they are concerned with the lack of community services particularly in the university hospitals. The medical officers and general practitioners responded that they received many patients who were brought by their families to see them in outpatient clinic. However, many doctors failed to diagnose the disorder as they have a lack of training in diagnosing mental illness diseases. This is mainly due to misperception about mental illness particularly in rural areas among the Malay population. Conclusion The study concluded that more community awareness program needs to be done which emphasis on mental illness to reduce the duration of untreated illness and ensure active roles of family members in supervision of treatment.

2678 – Alcohol use and psychosocial correlates among aborigine in central malaysia

This study surveyed Malaysian aborigine people to determine the prevalence of alcohol abuse dependence, psychiatric morbidity and psychosocial correlates among Malaysians aborigines. Studies among minority group in developed nations repeatedly showed severe drinking problems (Lomnitz, 1976; Gordon, 1978; Karno et al, 1987; Yamamoto et al, 1993). Household survey with informed consent taken. Selected household were chosen and orang asli (aborigines) age 18 above were interviewed in Kuala Betis areas. Alcohol screening used AUDIT questionnaires and Psychiatric morbidity measured by MINI. Odds ratio was used as measures of the association for the variables. The data analysis was done using SPSS version. 276 orang asli were interviewed during the study. Majority are within age group of 18-29 years of age (37%) with the mean age 36.51 years old. The M: F (50.7% and 49.3%). Senoi ethnic group is the majority (97.8%). 28% has no formal education and 58% received primary school education. Majority are married (82.2%). Half of them are employed and more than half received less than RM 500 monthly (USD 150). Types of alcohol use mainly beer and whisky. 90.24% have AUDIT score less than 7. Multivariate analysis showed only those employed are significantly associated with alcohol problems, Odds ratio= 0.089, 95% CI (0.033-0.246), P Prevalence of alcohol use among orang asli is comparable with general population. Employed people may have more money to buy alcoholic beverages. Orang asli probably need more attention on awareness program and further interventions.

P-1358 - Sleep disorders, psychiatric morbidity and substance use among motor vehicle accidents(MVA) attendees of accident emergency unit in University Malaya Medical Centre(UMMC), Kuala Lumpur

Introduction Motor Vehicle Accidents(MVA) are the main attendees of accident emergency unit in UMMC. Assessment by doctor found that some ot them used alcohol/substance prior to MVA event. They also found to have abnormal sleep pattern and “emotional problems” that contribute to MVA and injuries. Yet, limited study available in Malaysia that explore the relationship between sleep disorders, substance use, psychiatric morbidity and MVA events. Objectives To investigate the prevalence and associations of sleep disoders, substance use and psychiatric comorbidity among attendees in accident emergency unit, UMMC. Methods This is a cross-sectional hospital based study that examine all MVA attendees age 18 and above with written consent in accident emergency unit UMMC from 30 September to 30 November 2011. We exclude those patients with Glasgow Coma Sale(GCS) less than 10, intoxication and refused consent. We measure sleep disorders using Epsworth Sleep Scale(ESS), Psychiatric morbidity using Hospital Anxiety Depresion Scale(HADS) and substance use with Drug abuse screening tool(DAST). We also do rapid urine test kits for opiates, canabis, amphetamine type stimulants(ATS) and benzodiazepines. Chi square test will be analyses for the variable asssociations using SPSS 16. Results We expect that the prevalence of sleep disorders, subsatnce use and other psychiaric comorbidity are higher among MVA attendees. There are some association in between those factors that contributes to the MVA events. Conclusions MVA attendees probably need further assesment as routine e.g. sleep study, psychiatric morbidity and drug screening in order to better manage them and prevent further MVA in the future.

P-79 - Alcohol use and psychosocial correlates among aborigines in Malaysia

Introduction Malaysia is the tenth largest alcohol consumer in the world. Yet, there was limited data avaoilable about alcohol prevalence among Malaysian population at the moment. Apart from general population, the data on the usage of alcohol among the natives especially “Orang Asli” in central peninsular Malaysia are almost none. Orang asli are observed to use alcohol heavily as part of their cultural practices and end up with more complications e.g. intoxications, dependence syndrome and violence behavior. Objectives We investigate the prevalence of alcohol use among the aborigines and their psychosocial correlates related to alcohol use. Methods This is a household survey involving 200 participants, age 18 and above with written consent using sytematic sampling from the aborigine village area of Gombak Batu 11. We exclude those subjects who refused consent and those in the withdrawal or intoxication state during the interview. The Instruments use include Alcohol, Smoking and Substance Involvement Screening Tool linked with Brief-Intervention(ASSIST-BI) questionnaires and MINI neuropsychiatric inventory(MINI). We also conduct the focus group discussion for details interview on their belief,knowledge and practice regarding alcohol drinking habit,.Outcomes measures are analysed using SPSS version 16. Results We expect that the prevalence of alcohol and substance use among Malaysian aborigines are higher as compare to general population in Malaysia. Conclusions The aborigines in Malaysia pobably in need for specific awareness promotion and outreach treatment program that tailor to their unique way of life.