Suriati Mohamed Saini

Sexual abuse and substance abuse increase risk of suicidal behavior in Malaysian youth

The aim of this study was to determine the association between sexual abuse, substance abuse and socio‐demographic factors with suicidal ideation (SI), plans (SP) and deliberate self‐harm (DSH) and propose steps to prevent youth suicidal behavior.

Association between 5HT2A polymorphism and selective serotonin re‐uptake inhibitor (SSRI)‐induced sexual desire disorder (SDD) among Malaysian women

SSRIs are known for their sexual side‐effects with a variable rate of sexual dysfunction (SD). 5HT2A (rs6311) single nucleotide polymorphism (SNP) was found to have significant association with SD. The purpose of this study was to determine the prevalence of female SDD, its clinical correlates and association with 5HT2A (rs6311) SNP in patients with major depressive disorder (MDD) treated with SSRIs.

Female Sexual Dysfunction in Patients with Major Depressive Disorder (MDD) Treated with Selective Serotonin Reuptake Inhibitor (SSRI) and Its Association with Serotonin 2A—1438 G/A Single Nucleotide Polymorphisms

INTRODUCTION Selective serotonin reuptake inhibitors (SSRIs) are known for their sexual side effects. Different SSRIs may affect different areas of sexual function at different rates. AIMS The study aimed to determine the prevalence of female sexual dysfunction (FSD), its clinical correlates, and association with 5HT2A (rs6311) single nucleotide polymorphisms (SNPs) in patients with major depressive disorder (MDD) who were on SSRI therapy. METHODS This was a cross-sectional study on 95 female outpatients with MDD treated with SSRI. The patients were in remission as determined by Montgomery-Asberg Depression Rating Scale. Genomic DNA was isolated from buccal swabs and samples were processed using a real time polymerase chain reaction. MAIN OUTCOME MEASURES The presence or absence of FSD as measured by the Malay Version of Female Sexual Function Index and 5HT2A-1438 G/A (rs6311) SNP. RESULTS The overall prevalence of FSD was 32.6%. After controlling for age, number of children, education level, total monthly income, SSRI types, and SSRI dosing, being employed significantly enhanced FSD by 4.5 times (odds ratio [OR] = 4.51; 95% confidence interval [CI] 1.00, 20.30; P = 0.05). Those having marital problems were 6.7 times more likely to have FSD (OR = 6.67; 95% CI 1.57, 28.34). 5HT2A-1438 G/A (rs6311) SNP was not significantly associated with FSD. CONCLUSION There was no significant association between FSD and the 5HT2A (rs6311) SNP in patients with MDD on SSRI therapy. Employment status and marital state were significantly associated with FSD among these patients.

Polymorphism of the serotonin transporter gene (5-HTTLPR) in major depressive disorder patients in Malaysia.

The serotonin transporter promoter (5‐HTTLPR) is a potential susceptibility locus in the pathogenesis of major depressive disorder. However, data from Malaysia is lacking. The present study aimed to determine the association between the homozygous short variant of the serotonin transporter promoter gene (5‐HTTLPR) with major depressive disorder.

Anxiety Disorders in Family Caregivers of Breast Cancer Patients Receiving Oncologic Treatment in Malaysia

Background: Anxiety is recognized as a normal psychological reaction of those caring for cancer patients. However, anxiety disorders in caregivers may interfere with their care-giving role and require further clinical attention. Objectives: To determine the prevalence and associated factors of anxiety disorders among caregivers of breast cancer patients receiving oncologic treatment in Kuala Lumpur Hospital. Methodology: A cross-sectional study was conducted on 130 caregiver-patient dyads, recruited by non-random sampling at Kuala Lumpur Hospital. Data were collected in 2 stages: 1) the caregivers were screened for psychological distress using the Depression, Anxiety, Stress, Scale (DASS-21) while other related factors for the patients and their caregivers were obtained; 2) the identified distressed caregivers (n=64) were then administered the Mini International Neuropsychiatric Interview (MINI) to diagnose anxiety disorders. Results: A total of 11.5% (n=15) of the caregivers reported suffering from anxiety disorders. Bivariate analysis found duration of caregiving (OR=3.31; CI=2.21-11.93), shared caregiving (OR=4.07; CI=1.34-12.36), and patients’ treatment type (OR=3.42; CI=1.92-12.76) were significantly associated with anxiety disorders (p value <0.05), with shared caregiving and patient’s treatment type remaining significant using logistic regression (p value < 0.05, R2 = 0.255). Conclusions: Every one in ten of the caregivers in this study had a diagnosable anxiety disorder, associated with certain care-giving factors and patients’ treatment. This should alert clinicians to such risk and indicates psychological support needs for family caregivers.

Seeking help at an Islamic spiritual healing centre: Malaysia’s perspective

ABSTRACT Spiritual healing centre is a popular place to seek help among Malaysians whether for medical, psychiatric or other reasons. This study aims to understand the characteristics and illness perception of those patients who seek help at Islamic spiritual healing centre. A cross-sectional study was conducted at an established Islamic spiritual healing centre with 357 respondents. Younger age (OR .97, 95%CI .94–.99, p = .002), higher education level (OR 1.99, 95%CI 1.15–3.45, p = .014) and a more threatening view of the illness (OR 1.19, 95%CI 1.13–1.26, p ≤ .001) were found to confer risk of seeking help at this centre among attendees with psychiatric diagnosis. Supernatural attribution to illness is common among the attenders with or without a psychiatric diagnosis. Spirituality is important to bring balance and healing. Collaboration with Islamic spiritual healing practitioners to co-manage patients is recommended.

Psychosis post corona radiata and lentiform nucleus infarction.

Complications of stroke can include neuropsychiatric symptoms. However, post-stroke psychosis is rare. We report a case where an acute presentation of psychosis, depression and fluctuating cognitive impairment in a middle-aged man turned out to be related to a silent brain infarction. The patient had a background of poorly controlled type 2 diabetes mellitus with glycated haemoglobin level of 9.0–11.0%, hypertension and ischaemic heart disease. His CT brain results showed multifocal infarct with hypodensities at bilateral lentiform nucleus and bilateral corona radiata. His strong genetic predisposition of psychosis and a history of brief psychotic disorder with complete remission 3 years prior to the current presentation might possibly contribute to his post-stroke atypical neuropsychiatric presentation, and posed diagnostic challenges. He showed marked improvement with risperidone 6 mg nocte, chlorpromazine 50 mg nocte and fluvoxamine of 200 mg nocte. The need of comprehensive treatments to modify his stroke risk factors was addressed.

Aggression in Malaysian schizophrenia patients: Its clinical determinants and association with COMT Val158Met genotypes

Aggression committed by schizophrenia patients is a major public health concern. Low Catechol-O-Methyltransferase (COMT) activity allele has been implicated in aggression and highly impulsive schizophrenia patients (Strous et al., 1997; Lachman et al., 1996). COMT is an enzyme involved in inactivation of catecholamine neurotransmitters (Siever, 2008). A substitution of single amino acid G-to-A transition at codon 158 resulted in differences in COMT activity: Val/Val displays high activity, Val/Met as intermediate and Met/Met has 4–5 folds lower activity (Lachman et al., 1998). A recent meta-analysis of Val158Met COMT found that male schizophrenia patients who carry the low activity Met allele in the COMT gene are at a modestly elevated risk of violence (Singh et al., 2012). Owing to accumulating evidences suggesting the role of COMT in aggression, replication study in a multiethnic population is essential so as to shed a new light in understanding aggression in schizophrenia patients. Various disease vulnerability and response to pharmacological agents could arise from genetic heterogeneity in culturally mixed populations (Mohamed Saini et al., 2014; Hatin et al., 2011). We have genotyped the COMT gene on 110 unrelated multiethnic schizophrenia patients in the University Kebangsaan Malaysia Medical Centre. This study was granted approval by the University Kebangsaan Malaysia Research Ethics Committee (UKMREC). Informed consent was taken from all patients and their relatives before their enrolment. Aggression was assessed using the Overt Aggression Scale Modified (OAS-M) (Coccaro et al., 1991). The questionnaire measures aggression, irritability and suicidality (Coccaro et al., 1991). A total score of three and above of all subscales is classified as being aggressive or violent (Bobes et al., 2006; Swanson et al., 2006). All episodes of aggression were ascertained by self, family report and respondents’ case notes. We found that the prevalence of aggression in this study was 20.7%. The aggressive patients were young with the mean age of 23.0 10.1 years (t = 108, p = 0.008), had early age at onset of schizophrenia (t = 108, p = 0.001), history of substance abuse (x = 4.99, p = 0.025), poor treatment adherence (x = 3.85, p = 0.05) and previous history of aggression (x = 3.75, p = 0.044). Patients who abused substances were 3 times more likely to become aggressive compared to those without substance abuse (x = 3.85, p = 0.025, OR = 2.86, 95% CI = 1.11–7.35). Both aggressive and non-aggressive patients did not differ in terms of gender, ethnicity, educational level, employment, marital status, duration of illness and family history of psychiatric illness.

Malignant catatonia secondary to viral meningoencephalitis in a young man with bipolar disorder.

A 23-year-old Malay man presented on 9 January 2012 with a 2-day history of abnormal behavior, fever and two episodes of generalized tonic-clonic seizures during a family trip to Phuket, Thailand. He was a known case of bipolar type I disorder, diagnosed in 2010. He had a total of three hospital admissions in the past. However, he had stopped his treatment in December 2010 due to extrapyramidal side-effects (body stiffness) and weight gain while on risperidone. There was no history of substance abuse and no family history of mental illness. He was admitted to a medical ward and was treated for viral meningoencephalitis based on clinical presentation (fever, episodes of seizures), serologically positive for Herpes simplex virus (HSV) immunoglobulin (Ig)G and cytomegalovirus IgG, with raised infection parameters such as C-reactive protein (CRP) of 1.62 mg/dL and white blood cell count (WBC) of 14.7 ¥ 10/L with predominant neutrophils of 12.8 ¥ 10/L. Computed tomography (CT), magnetic resonance imaging (MRI) of the brain, cerebrospinal fluid (CSF) and electroencephalogram (EEG) showed no significant abnormalities. His creatine kinase (CK) was raised at 2720 U/L. Urine for drugs was negative. Ceftriaxone 2 g b.i.d., phenytoin 100 mg t.d.s., acyclovir 500 mg t.d.s. were administrated i.v. for 14 days. He was discharged well on 23 January 2012 with lorazepam 0.5 mg p.r.n., risperidone 0.5 mg o.d., phenytoin 300 mg t.d.s. and folic acid 5 mg o.d. However, he was readmitted 3 days after discharge with complaints of insomnia, pacing up and down at home for 2 days, followed by depressed mood with neglected self-hygiene and being mute. He had not been taking risperidone as prescribed even in the ward as the family did not purchase the medication. Mental state examination showed a perplexed looking young man, in stupor, with presence of waxy flexibility, “psychological pillow” and restricted affect. Delusions and hallucinations could not be elicited. Physical examination revealed pyrexia with temperature ranging from 37.8–38°C, labile blood pressure ranging 108–168/55–90 mmHg, heart rate ranging 60–140 b.p.m. and respiratory rate of 18 b.p.m. Glasgow Coma Scale score was 15/15. Neurological examination showed that he had hypertonia with cogwheel rigidity and hyperreflexia on bilateral upper and lower limbs. The repeat CSF examination was bs_bs_banner Offi cial journal of the Pacifi c Rim College of Psychiatrists