Objective: This case report highlights the risk of Torsade de Pointes (TdP), a life threatening cardiac arrhythmia in a heroin dependent patient receiving methadone substitution therapy who was prescribed erythromycin for upper respiratory tract infection. Method: We report a case of a 35-year-old Malay man on methadone maintenance treatment who developed TdP possibly due to drug interaction between methadone and erythromycin. Results: The patient reported feeling unwell, chest pain and feeling dizzy after consuming 2 doses of erythromycin. ECG monitoring showed prolonged rate-corrected QT interval leading to TdP. The patient was admitted to the ward where the cardiac arrhythmia ceased following methadone discontinuation. This cardiac arrhythmia was most likely due to drug interaction between methadone and erythromycin (an enzyme inhibitor) which led to an increase in methadone concentration and potentiated the adverse effects. Conclusion: As methadone is a beneficial treatment for heroin dependent patients, the risk of cardiac arrhythmia is of great concern. To avoid complications of drug interaction, patients on methadone therapy should be advised to seek medical assessment before taking other drugs. As TdP is life threatening, it is thus important that physicians and psychiatrists involved in the treatment of heroin dependent patients on methadone substitution therapy be made aware of this risk.

Objectives: To determine the best possible programme that suits our local setting, to determine the average dose required, and to determine possible problems that can arise from implementing such a programme locally and how best to address them. Methods: The inclusion criteria were those above 18, a positive urine test, the presence of a supportive carer and willing to engage in the programme. Methadone was initiated and observations relating to dose, adverse events, relationship with carers, work performance, crime and high risk behaviours were monitored for 18 weeks. Results: Two thirds of the 45 subjects completed the trial over the 18 week period. No significant adverse events occurred and improvement in relationship with carers and work performance were noted with reduction in crime and high risk behaviours. Conclusion: Methadone is a safe and effective drug that can be used in the local Malaysian setting.

Objective: This case report highlights the abuse and dependence potential of Zolpidem and the risk of life-threatening withdrawal symptoms upon abrupt discontinuation. Method: We report a case of Zolpidem dependence which presented with withdrawal symptoms upon abrupt discontinuation. Results: A 32 year old male, who had abused non-benzodiazepine Zolpidem for 6 years presented to the accident and emergency unit with generalized seizures upon stopping Zolpidem ‘cold turkey’. He required admission to the neurology high dependency unit for stabilization of the seizures and was later managed by the addiction team where a tapering dose of benzodiazepine was prescribed. Conclusion: This case demonstrates that non-benzodiazepine agents can cause tolerance and dependence, and thus produce withdrawal symptoms upon discontinuation.

Objective: The smoking rate among patients with mental health problem is higher than in the general population. Effective pharmacotherapy to treat nicotine addiction is thus needed to reduce the morbidity and mortality associated with cigarette smoking among these patients. This article reviews the literature on the suitability of varenicline for smokers with mental health problems. Methods: A search of the literature was conducted using PubMed from year 2001 to July 2009 using key words varenicline alone and varenicline and mental health. Articles chosen were narrowed to those published in English. The type of articles chosen included clinical trials, meta-analyses, case reports, and review articles. Results: The search produced a total of 322 articles on varenicline and 14 articles on varenicline and mental health. Varenicline, a new drug for smoking cessation is an α4β2 partial agonist and partial antagonist at nicotinic acetylcholine receptor. As a partial agonist, varenicline relieves craving and withdrawal symptoms that occur during smoking abstinence and also reduce the rewarding effects of smoking in patients who relapse. However, at present, there is concern regarding the neuropsychiatric side effects such as aggressive behaviour, suicidal ideation, mania and depression associated with varenicline use in patients with mental health problems, but these reports did not show a causal-link or lack of link between these symptoms and varenicline. Conclusion: Current available data support the effectiveness of varenicline to treat nicotine dependence. However its safety among smokers with mental health problems remains to be elucidated. At present, further safety assessment is needed in this patient population. Until new data is available regarding the safety of varenicline in these populations, psychiatrists and physicians prescribing this medication should be extra cautious and monitor for possible psychiatric side effects when prescribing this medication to patients with pre-existing psychiatric disorders or have vulnerability to psychoses.

Objectives: The objective of the study is to determine the prevalence of substance abuse for alcohol, cannabis, opiates, stimulants, solvent and other substances among patients with schizophrenia in Hospital Bahagia Ulu Kinta (HBUK), Perak , Central Peninsular of Malaysia. This study also aims to determine the association of substance abuse with aggression, the demographic characteristics and total duration of hospitalization. Methods: This was a retrospective cross-sectional study whereby the first 194 subjects diagnosed to have schizophrenia based on International Classification of Disease, 10th edition (ICD-10) criteria were taken from data registry of patients admitted to HBUK from January until February 2004. The subjects’ medical files were examined for documentation of substances abuse, aggression and accumulative duration of hospitalization. Results: The results showed the prevalence of substances misuse among patients with schizophrenia in general (including alcohol) was 24.7%. Cannabis 16.7%, alcohol 13.4%, opiates(heroin) 6.7%, Amphetamine type stimulants (amphetamine, metamphetamine, ecstacy) 5.7%, and other substances (benzodiazepine, solvents) 1.5%. Conclusion: There is higher prevalence of substance misuse in patients with schizophrenia as compared to general population. Male patients with history of substance misuse are more likely to have aggression than female. This group needs special precaution and probably in need of specialist help.

Objective: In Malaysia, opioid abuse is an acknowledged problem with severe health and economic repercussions. Until recently, drug addicts were mainly criminalised and forcefully rehabilitated in correctional facilities. However, the high relapse rates of this approach, coupled with the high rates of blood borne infections among drug users, led to increasing acceptance of a healthcare-based approach in the rehabilitation of drug addicts. Methadone was among the medications introduced as substitution maintenance therapy in 2005 and Universiti Malaya Medical Centre (UMMC) is a centre for MMT. This study aimed to determine the effects of MMT on quality of life in patients here. Methods: The sample was 46 patients who attended the Psychiatric outpatient clinic in fill in UMMC. The instrument used to assess quality of life was the WHOQOL-BREF. Results: The study design was cross-sectional with retrospective elements. Baseline QOL scores were obtained from case records and follow-up scores from the month of September 2007. Statistically significant improvements in all four domains of WHOQOL-BREF were found. Physical: p<0.01, C.I. 1.46-3.05. Psychological: p<0.01, C.I. 1.44-3.11. Social: p=0.03, C.I. 0.66-3.05. Environmental: p<0.01, C.I. 0.85-2.24. Conclusion: Methadone maintenance therapy substantially improves quality of life in ex-opioid abusers.

Background: The Snaith-Hamilton Pleasure Scale (SHAPS) is a self-assessment scale designed to evaluate anhedonia in various psychiatric disorders. In order to facilitate its use in Malaysian settings, our current study aimed to examine the validity of a Malay-translated version of the SHAPS (SHAPS-M). Methods: In this cross-sectional study, a total of 44 depressed patients and 82 healthy subjects were recruited from a university out-patient clinic. All participants were given both the Malay and English versions of the SHAPS, Fawcett-Clark Pleasure Scale (FCPS), General Health Questionnaire 12 (GHQ-12), and the Beck Depression Inventory (BDI) to assess their hedonic state, general mental health condition and levels of depression. Results: The results showed that the SHAPS-M has impressive internal consistency (α = 0.96), concurrent validity and good parallel-form reliability (intraclass coefficient, ICC = 0.65). Conclusion: In addition to demonstrating good psychometric properties, the SHAPS-M is easy to administer. Therefore, it is a valid, reliable, and suitable questionnaire for assessing anhedonia among depressed patients in Malaysia.

INTRODUCTIONThis study aimed to determine the prevalence of metabolic syndrome and risk of coronary heart disease (CHD) in patients with schizophrenia receiving antipsychotics in Malaysia.

METHODSThis cross-sectional study, conducted at multiple centres, involved 270 patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR diagnostic criteria for schizophrenia, were on antipsychotic medications for at least one year, and were screened for metabolic syndrome. Patients receiving mood stabilisers were excluded. Metabolic syndrome was defined according to the National Cholesterol Education Program ATP III criteria modified for Asian waist circumference. Risk for cardiovascular disease was assessed by using Framingham function (all ten-year CHD events).

RESULTSThe prevalence of metabolic syndrome was 46.7% (126/270). Among all the antipsychotics used, atypical antipsychotics (monotherapy) were most commonly used in both the metabolic and non-metabolic syndrome groups (50.8% vs. 58.3%). The ten-year risk for CHD was significantly higher in patients with metabolic syndrome. The proportion of patients with high/very high risk for CHD (Framingham ≥ 10%) was greater in patients with metabolic syndrome than in those with non-metabolic syndrome (31.5% vs. 11.0%, odds ratio 3.9, 95% confidence interval 2.0-7.6; p < 0.001). The mean body mass index was higher in patients with metabolic syndrome than in those without (29.4 ± 5.1 kg/m2 vs. 25.0 ± 5.6 kg/m2; p < 0.001).

CONCLUSIONPatients with schizophrenia receiving antipsychotics in Malaysia have a very high incidence of metabolic syndrome and increased cardiovascular risk. Urgent interventions are needed to combat these problems in patients.

Adolescent ; Adult ; Aged ; Antipsychotic Agents ; adverse effects ; therapeutic use ; Body Mass Index ; Cardiovascular Diseases ; epidemiology ; etiology ; Cross-Sectional Studies ; Female ; Humans ; Incidence ; Malaysia ; epidemiology ; Male ; Metabolic Syndrome ; epidemiology ; etiology ; Middle Aged ; Odds Ratio ; Prevalence ; Retrospective Studies ; Risk Factors ; Schizophrenia ; complications ; drug therapy ; epidemiology ; Young Adult