Stephen Thevananthan A L Jambunathan

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.

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.

Characteristics of patients with organic brain syndromes : A cross-sectional 2-year follow-up study in Kuala Lumpur, Malaysia

BackgroundOrganic Brain Syndromes (OBS) are often missed in clinical practice. Determining their varied presentations may help in earlier detection, better management, and, assessing prognosis and outcome. We described the in-patient referrals of patients suffering from the psychiatric effects of organic states and compared the symptomatology and mortality between those with the Acute and Chronic varieties.Methods59 patients referred to our Consultation-Liaison (C-L) Psychiatry services and given a clinical diagnosis of OBS were selected over a 6-month period. Psychiatric and cognitive abnormalities and treatment regimes were recorded and fatality rates determined. Information regarding their condition 24 months after their index hospitalization was recorded. All data were entered into a proforma and analyzed after exclusion.ResultsThe mean duration of detecting the symptoms by the physician was 3.52 days. The presence of a premorbid psychiatric illness had no influence on the clinical presentation but did on the mortality of patients with OBS (p = 0.029).Patients with the Acute syndrome had significantly more symptom resolution as compared to those with the Chronic syndrome (p = 0.001) but mortalityrates did not differ. Elderly patients and those with symptom resolution upon discharge did not show statistically significant higher mortality rates. The most popular combination of treatment was that of a low-dose neuroleptic and a benzodiazepine (34.7%). The need for maintenance treatment was not significantly different in any group, even in those with a past history of a functional disorder.ConclusionOther than the Acute group having a significantly better outcome in terms of symptom resolution, our findings suggest that there was no significant difference in the clinical presentation between those with Acute or Chronic OBS. Mortality-wise, there was also no difference between the Acute and Chronic syndromes, nor was there any difference between the elderly and the younger group. There was also no significant difference in the need for continued treatment in both groups.

Cognitive complaints and predictors of perceived cognitive dysfunction in adults with major depressive disorder: Findings from the Cognitive Dysfunction in Asians with Depression (CogDAD) study

BACKGROUND Several studies have described the presence of perceived cognitive dysfunction amongst Asian patients with major depressive disorder (MDD). To date, no study has been conducted investigating the predictors of perceived cognitive dysfunction amongst Asian MDD patients. METHODS This was a post-hoc analysis of the Cognitive Dysfunction in Asian patients with Depression (CogDAD) study. Descriptive statistics were used to describe the most common cognitive complaints by patients. Univariate and multivariate analyses were performed to determine variables associated with perceived cognitive dysfunction (Perceived Deficit Questionnaire-Depression, PDQ-D). RESULTS The CogDAD study population is comprised of MDD patients with mild-to-moderate depression (Patient Health Questionnaire 9-item [PHQ-9]: 11.3 ± 6.9) who reported perceived cognitive dysfunction (PDQ-D = 22.6 ± 16.2). The most common cognitive complaints were: mind drifting (42.3%), trouble making decision (39.6%) and trouble concentrating (38.0%). Predictors of perceived cognitive dysfunction were: being Southeast Asians (vs. Taiwanese) (p < 0.001), current episode longer than 8 weeks (vs. 1-8 weeks) (p < 0.05), the presence of disability (vs. no disability) (p < 0.05), younger age (p < 0.01), and higher PHQ-9 total scores (p < 0.001). LIMITATIONS The causal relationship between predictive variables and PDQ-D could not be tested due to the cross-sectional nature of the study. Furthermore, a neuropsychological test was not included in the CogDAD study and use of concomitant medications, including anti-depressants, could have impacted patients perceived cognitive ability. CONCLUSIONS The present study results suggest a potential role for subjective cognitive assessment in patients with MDD who are young, with long durations of depression or severe depression.

Parkinson disease and Neuroleptic withdrawal

Background Abrupt cessation of most psychiatric drugs leads to varying withdrawal symptoms. Although Clozapine withdrawal symptoms are well documented, this case presentation addresses issues pertaining to the severity of the withdrawals and the similarities to Neuroleptic Malignant Syndrome (NMS). This patient who was only on 100mg of Clozapine required ventilation in Intensive care unit. Neurologist found no causative factor but treated the patient symptomatically to recovery. Family history however revealed that both the patient’s parents suffered from severe Parkinson disease. This case presentation discusses the association between NMS like symptoms and neuroleptic withdrawal syndrome in patients with a family history of Parkinson disease.