1.The results of the test for assessing the manifestation of side effects of antipsychotic drugs, which are characterized by abnormal involuntary movements
Khishigsuren Z ; Tergel Kh ; Khongorzul E ; Elik M
Mongolian Journal of Health Sciences 2025;85(1):125-129
Background:
According to WHO research, there are approximately 24 million people living with schizophrenia worldwide and schizophrenia is characterized by a combination of psychotic and non-psychotic symptoms. Since the cause of
the disease is not fully understood, antipsychotic medications are used as symptomatic treatment. According to the 2022
statistics of the NCMH, 718 people with schizophrenia are being treated under active surveillance in Mongolia. The reason for conducting this study is that the manifestation of drug side effects resulting movement disorders in patients with
schizophrenia, which has not been studied in Mongolia.
Aim:
To investigate the relationship between adherence of medication regimen and abnormal involuntary movements in
patients with schizophrenia.
Materials and Method:
The study was conducted using a descriptive method, cross-sectional design, purposive sampling with the questionnaire and standardized tests. Ethical approval for this study was approved by the NCMH (№3/77
30th of January, 2023) and Research Ethics Review Committee of MNUMS (№2023/3-02). Each participant was asked to
complete 5 groups of 36 questionnaires, and standard tests were used to assess patients’ adherence to medication regimens
(Morisky scale) and abnormal involuntary movement scale (AIMS). The study was conducted between March and August
2023, and the results were summarized and analyzed using STATA 14 software.
Results:
The study included 209 patients with schizophrenia, aged 18-79 years, of whom 47.4% (n=99) were male
and 52.6% (n=110) were female (p=0.21). Of the participants, 28.2% (n=59) had less than secondary education, 76.5%
(n=160) were unmarried, and 85.2% (n=178) had a disability due to mental health. 32.5% (n=68) of the patients with
schizophrenia in the study used a combination of typical and atypical medications, and the most commonly used antipsychotic drugs were haloperidol (30.6%), chlorpromazine (26.8%), levomepromazine (25.8%), risperidone (24.4%),
and quetiapine (21.1%). 1.4% (n=3) of the patients had good, 52.6% (n=110) had moderate, and 45.9% (n=96) had poor
adherence to the medication regimen (Cronbach’s α=0.781). However, according to the results of the test for assessing
abnormal involuntary that are performed without self-control, 49.76% (n=104) responded that they felt more sensitive to
facial and oral movements, and 44.5% (n=93) to limb movements. The patients’ adherence to the medication regimen was
statistically significant with facial and oral movements (n=104; p=0.036) and general body movement disorders (n=94;
p=0.05).
Conclusion
32.5% of patients with schizophrenia were taking typical and atypical antipsychotics, and 45.9% had poor
adherence to medication regimens and were more likely to exhibit clinical forms of abnormal involuntary movements,
including facial (p=0.036) and general movement disorders (p=0.05).
2.Analysis of various risk factors associated with poor sleep quality
Purevdulam B ; Khishigsuren Z ; Tovuudorj A ; Tsagaankhuu G ; Delgermaa Ts
Mongolian Journal of Health Sciences 2025;85(1):207-213
Background:
Sleep quality is frequently highlighted in the literature as a key factor for overall health. Poor sleep quality
significantly affects both physical and mental health, diminishing quality of life and potentially harming personal finances. While this issue is influenced by various risk factors, no well-studied research has been conducted on it in Mongolia.
Aim:
The aim of this study was to assess the frequency of poor sleep quality among visitors to the Sleep center in Mongolia and to identify the factors associated with poor sleep quality.
Materials and Methods:
This study, conducted using a cross-sectional design, included 200 participants aged 18 to 65
years who visited the Sleep Center at the General Hospital for State Special Servants between January and May 2024.
Data were collected using a structured questionnaire. Sleep quality was assessed using the Mongolian version of the Pittsburgh Sleep Quality Index, with a global score above 6 indicating poor sleep. Participants were divided into two groups:
“Good sleepers” (n=105) and “Poor sleepers” (n=95). Socio-demographic and clinical variables such as age, sex, levels
of education were also recorded. The level of depression, anxiety, and stress was assessed using the DASS 21 (Depression
Anxiety Stress Scale) criteria. Univariate analysis was performed using the t-test, Mann-Whitney U test for continuous
data, the Х2 or Fishers’s exact test for categorical data, and logistic regression for multivariable analysis. A P-value of less
than or equal to 0.05 was considered significant.
Results:
Poor sleep quality, indicated by a PSQI global score above 6, was observed in 52.5% of the total participants.
Univariate analtysis’s test results showed that age, being female, having depression, anxiety, BMI ≥ 25, alcoholism,
comorbidities, and using concomitant medications were significantly associated with poor sleep quality (all p<0.05). In
the multivariate logistic regression analysis, 50 < age (OR 3.133, 95% CI, 1.245-7.884, p<0.05), BMI ≥ 25 (OR 2.084,
1.039-4.179, p<0.05), alcoholism (OR 3.018, 95% CI, 1.495-6.093, p<0.01) and depression (OR 15.957, 95% CI, 1.592-159.922, p<0.05) were identified as significant risk factors for poor sleep quality. Depression and alcoholism were associated with longer sleep latency and decreased daytime activity (p<0.05).
Conclusions
1. In our study, more than half of the participants experienced poor sleep quality.
2. Age over fifty, depression, BMI ≥ 25, and alcoholism emerged as independent significant risk factors for sleep disturbance. Alterations in sleep latency, sleep disruption, and impaired daytime functioning may be associated with
poor sleep quality.
3.Results of evaluation memory changes in epilepsy patients
Tergel Kh ; Sarina SU ; Tovuudorj A ; Khishigsuren Z
Mongolian Journal of Health Sciences 2025;85(1):214-218
Background:
Memory is a complex combination of the activities of fixation, keeping and recalling information, which
is manifested by quantitative and qualitative changes due to organic mental disorders. Epilepsy is a disorder with neurological and mental symptoms, and depending on the course of the disease, adherence to medication regimen, and the
frequency of seizures, memory can decrease leading to partial or complete dementia. Therefore, we conduct this study by
Luria A.Ya’s assessment evaluating memory’s changes, such as mechanic memory.
Aim:
The aim of the study is to evaluate the memory changes in patients with epilepsy using standart questionnaire.
Materials and Methods:
The study was a hospital-based, descriptive, cross-sectional design, using a questionnaire survey method, and using a standard 10-word memorizing test. The study was conducted in NCMH from 1st of July to 1st of
August of 2023 and ethical approval for this study was approved by the NCMH (3/603 14th of June, 2023) and Research
Ethics Review Committee of MNUMS (2023/3-08 16th of June 2023). Collected data statistics were created by graphics
and tables on Microsoft Word and Microsoft Excel programs and were analyzed in SPSS 21.0 software.
Results:
The study included 30 patients, 19 (62.5%) men and 11 (36.3%) women, aged 25-59, with a disease duration
of 4-59 years. In 60% of cases cause of the disease was brain injury, n=18 had less than secondary education, and n=26
(86.6%) had defined with disability. 73.2% of the study participants fell 2-3 times a week, 73.3% did not take medication
as prescribed, and 56.7% did not follow the medication regimen. The results of the 10-word memorizing test showed that
1-9 words were said more often in each repetition, with an average value of 3.2-3.9 for each repetition, and the frequency
of the extra words was 0.8. When examining whether the word memorizing test scores depended on the duration of the
illness, the number of words recalled by patients with illness lasting up to 59 years was 1-3, indicating that the longer the
illness lasted, the lower memory.
Conclusion
73.3% of patients do not take medications as prescribed by their doctor (p=0.35), 56.7% do not follow
the medication regimen, the average value of the mechanical memory test is 3.2-3.9, and the results show that memory
decreases with the duration of the disease, indicating that there are many reasons for the decrease in patients’ memory.
4.Neuroticism as a risk factor for anxiety, depression, and insomnia during the covid-19 pandemic
Enkhtuvshin R ; Mongoljin A ; Munkhzul E ; Uranchimeg M ; Oyundari G ; Yerkibulan A ; Khishigsuren Z
Diagnosis 2025;115(4):36-42
Background:
The COVID-19 pandemic has profoundly impacted global mental health, exacerbating anxiety, depression, and insomnia, with prevalence rates of 25–30%, 27–32%, and 30–45%, respectively—2–3 times higher than pre-pandemic levels. Neuroticism, a key personality trait from the Big Five model, characterized by heightened negative emotions and stress reactivity, has been linked to increased vulnerability. Meta-analyses show neuroticism triples anxiety risk (OR=3.21; 95% CI: 2.35–4.39) and correlates strongly with insomnia (r=0.46, p<0.001) and depression during the pandemic. In Mongolia, empirical data on neuroticism's role remains limited.
Objective:
This study examines whether neuroticism acts as a risk factor for anxiety, depression, and insomnia among hospitalized patients during COVID-19.
Methods:
A cross-sectional descriptive study enrolled 552 patients (72.3% COVID-19 cases, 27.7% controls) from tertiary hospitals in Mongolia (2024). Participants (mean age 52.8±15.5 years; 60.5% female) completed self-reported questionnaires: Eysenck Personality Inventory (EPI) for neuroticism, PHQ-9 for depression, GAD 7 for anxiety, ISI for insomnia, and PCL 5 for PTSD. Sociodemographics were assessed. Data were analyzed using SPSS 26.0 with chi-square tests (p<0.05 significance). Instruments showed high reliability (Cronbach’s α=0.81–0.89). Ethical approval was obtained from MNUMS Ethics Committee (No. 2024-Psy-17).
Results:
Overall, 79.5% were depression free, 84.8% anxiety-free, and 77.5% insomnia-free. High neuroticism (n=381) was significantly associated with depression (24.4% vs. 11.7%, p<0.001), anxiety (18.6% vs. 7.6%, p<0.001), insomnia (28.3% vs. 9.4%, p<0.001), and any mental disorder (21.3% vs. 7%, p<0.001), but not PTSD (p=0.472). Cholerics (n=200) showed elevated risks (depression 29.5%, insomnia 34.5%, p<0.001), while sanguines/phlegmatics were protective. Verbal expression and trust levels showed no significant associations.
Conclusion
Neuroticism significantly heightens risks for anxiety, depression, and insomnia during COVID-19, underscoring the need for targeted psychological interventions. Temperament-informed screening could enhance prevention strategies in crisis settings.
5.Risk factors for common mental disorders in hospitalized patients during the covid-19 pandemic
Enkhtuvshin R ; Yerkyebulan M ; Munkh-Uchral D ; Enkhnaran T ; Mongoljin A ; Munkh E ; Uranchimeg M ; Maidar E ; Amarsaikhan A ; Amirlan B ; Otgonbayar R ; Nasantsengel L ; Khishigsuren Z
Mongolian Journal of Health Sciences 2025;90(6):32-38
Background:
The COVID-19 pandemic has profoundly impacted mental health, particularly exacerbating conditions
such as depression, anxiety, insomnia, post-traumatic stress disorder (PTSD), and emotional disorders among hospitalized
patients. This study examined the prevalence of COVID-19-related mental health issues and risk factors in hospitalized
patients affiliated with MNUMS, compared to a control group.
Aim:
To assess the prevalence of mental health disorders such as depression, anxiety, insomnia, and post-traumatic stress
disorder (PTSD), and to identify their associated risk factors.
Materials and Methods:
The study was conducted at hospitals under MNUMS, including the Mongolian-Japanese Hospital,
Central Hospital, and the National Center for Maternal and Child Health. A total of 552 participants (399 case
group, 153 control group) who were hospitalized were included. Depression (PHQ-9≥10), anxiety (GAD-7≥10), insomnia
(ISI≥15), and PTSD (PCL-5≥33) were assessed using standardized scales. Analysis was performed using chi-square tests
and binary logistic regression (crude odds ratio [cOR]/adjusted odds ratio [aOR], 95% confidence interval [CI]), adjusted
for group, age, and sex.
Results:
In the case group, depression (23.1% vs. 13.7%, p=0.015, cOR=1.884 [1.124-3.156]), anxiety (16.8% vs. 11.1%,
p=0.096), and any mental disorder (18.0% vs. 13.7%, p=0.225) were higher, while insomnia was lower (19.5% vs. 30.1%,
p=0.008). PTSD was low overall (1.8% vs. 0.7%, p=0.333). Risk factors included female sex (p<0.001, cOR=0.362 for
depression in males), younger age (p=0.004), unemployment (p=0.017), and prior trauma (p<0.001). COVID-19 symptoms
(difficulty breathing) increased the risk of depression (p<0.001, cOR=2.828 [1.708-4.682]).
Conclusion
Hospitalization for COVID-19 increases the risk of depression and anxiety, modulated by demographic,
clinical, and socioeconomic factors. Targeted interventions for vulnerable groups are essential.
6.Changes in mental health following COVID-19 infection: results of a prospective cohort study in mongolia
Enkhtuvshin R ; Mongoljin A ; Munkh.E ; Uranchimeg M ; Yerkyebulan A ; Munkh-Uchral D ; Enkhnaran T ; Nasantsengel L ; Khishigsuren Z
Mongolian Journal of Health Sciences 2025;90(6):39-44
Background:
COVID-19, first identified in Wuhan, China, in December 2019, was declared a global pandemic by the
WHO on March 11, 2020, leading to over 770 million infections and 7 million deaths worldwide. In Mongolia, the first
case emerged on March 10, 2020, followed by more than 1 million infections and over 2,100 deaths by 2023. The virus
affects the central nervous system, manifesting as depression, anxiety, insomnia, and PTSD through biological pathways
(e.g., ACE-2 receptor invasion, cytokine storm) combined with psychological stressors (e.g., fear, isolation). Global
studies (WHO Mental Health Atlas 2022; Ettman et al., JAMA 2020; Huang et al., Lancet Psychiatry 2021; Xie et al.,
BMJ 2022) indicate a 25–40% rise in depression and anxiety during the pandemic’s first year, with 30–60% of infected
individuals experiencing persistent symptoms 6–12 months post-infection. In Mongolia, cross-sectional surveys (National
Center for Mental Health 2021: 28.7% moderate-to-severe depression, 22.4% high anxiety) have been conducted, but
long-term prospective data remain scarce. This study evaluates longitudinal changes in depression, anxiety, insomnia, and
PTSD among COVID-19 patients over 12 months, compared to a control group.
Aim:
To conduct long-term follow-up and comparative assessment of depression, anxiety, insomnia, and post-traumatic
stress disorder (PTSD) among individuals who have had COVID-19
Materials and Methods:
In this prospective cohort study, 459 adults (326 COVID-19 cases, 133 controls) were recruited
from MNUMS-affiliated hospitals, Central Hospital, and the National Center for Maternal and Child Health between 2021
and 2023. Participants without baseline mental disorders underwent follow-up assessments at 14 days, 3 months, and 12
months using validated scales: PHQ-9 (depression), GAD-7 (anxiety), ISI (insomnia), and PCL-5 (PTSD). Incident cases
were identified through baseline exclusion. Data were analyzed via χ² tests, t-tests, relative risk (RR) calculations, and
multivariable logistic regression (p < 0.05).
Results:
Baseline demographics were comparable between groups (mean age 46.3 ± 13.8 years; 58.4% female). At 12
months, the COVID-19 group exhibited higher rates of depression (37.3% vs. 16.9%; RR = 2.22, 95% CI: 1.28–3.83, p =
0.003) and anxiety (28.0% vs. 11.2%; RR = 2.49, 95% CI: 1.25–4.96, p = 0.006). Insomnia was lower in the COVID-19
group (33.3% vs. 49.4%; RR = 0.67, p = 0.037), while PTSD rates remained low (<3%, p > 0.05). Adjusted odds ratios
confirmed COVID-19 as an independent predictor of depression (aOR = 2.18) and anxiety (aOR = 2.41). Females and
individuals aged 40–59 years were at elevated risk.
Conclusions
1. In the cohort of individuals who had contracted COVID-19, levels of depression after 12 months were 2.2 times
higher, levels of anxiety were 2.5 times higher, and levels of insomnia were 0.67 times lower compared to the control
group.
2. Post-traumatic stress disorder was observed in 3.1% of participants 14 days post-exposure, but was not detected
after 12 months; this resolution is posited to be associated with the adaptive capacity of the population.
3. COVID-19 constitutes a long-term independent risk factor for the onset of depression and anxiety.
7.The result of the changes of the work-related stress of physicians and nurses with the critical ill patient units
Bazarragchaa S ; Munkh-Erdene L ; Khishigsuren Z ; Delgermaa E ; TSeden P
Mongolian Pharmacy and Pharmacology 2019;15(2):7-11
Background:
The career and work of medical workers are considered to be the occupation of
the highly responsible job of the worldwide.
Goal:
To identify the percentage of the work-related stress, the burnout, and the symptoms of
work-related stress of the physicians and nurses who is working at the critical and intensive care
units of UB hospitals.
Materials and methodology:
The survey was done by quantitative methods and cross sectional design. The study data was collected using the validated questionnaire for the work related stress. The results of the study were analyzed by the Microsoft Excel and SPSS 20 program.
Results
The response rate was 97.3% The study found that 78.7% of respondents reported having regular stress; and 89.4% of all participants in the survey had a personal burnout, 90.4% had work-related burnout and 94.5% had a high level of client-related burnout.
Physical symptoms include the insomnia 76.7%; psychological symptoms - the headaches 65%; behavioral symptoms as like forgetfulness and annoyance 53.3%; cognitive symptoms as like an increase in sick days or absenteeism by 40% for all physicians and nurses.
8.ҮЙЛЧЛҮҮЛЭГЧДИЙН СЭТГЭЦИЙН ЭРҮҮЛ МЭНДИЙН ТУСЛАМЖИНД ХҮРЭХ ЗАМЫН СУДАЛГАА
Uyanga M ; Nomin-Erdene B ; Khishigsuren Z
Innovation 2017;11(2):73-76
BACKGROUND. In 1929, Mongolian mental health department established and since
then it has been showing qualified professional health care towards population. In code
of mental health (7.1.2) it is defined as “mental health care can be carried out by person
with professional license that indicated in health law” However, recently people tend
to seek help from nonprofessional organizations. Because of psychiatric misconception
among population, people usually don’t seek help from professional service that it makes
diagnostic delay and people suffer longer from their illness. GOAL. To define diagnoses
and pathway of people who seek help first-time from mental health care. MATERIAL AND
METHOD. This study was relied upon to NCMH out and inpatient unit. Cross-sectional
study method with purposive sampling and questionnaire method wasused in this study.
RESULT. In total of 145 patients, 76 males and 69 females, who are aged between 18 to 56
years participated in our study. According to ICD 10, majority of participants (40.7%, n=59)
had schizophrenia and schizophrenia spectrum disorders, 21.4%had stress induced disorder,
12.4 % had organic disorder, 11% had affective disorder, and 14.5 % had substance
use disorder.According to their help seeking pathway, every patient sought help from
professional organization or several nonprofessional organizations and individual person.
As we demonstrated the initial help seeking pathway of participants 40% sought help from
religious service, 26.2% sought help from psychiatrist, 17.2% sought help from general
and 16.6% sought help from other professional doctors. Therefore we demonstrated the
amount of participants who sought help from nonprofessional organization and individual
person that 60.6% sought help from shaman, 62% sought help from lama. Primary or
secondary educated people are tend to seek help from religious service which was statistically
significant (p≤0.006).in total of 107 participants sought help from nonprofessional
organization and each patient spent about 5,629,122.30±928799 tugrug, but average of
total medical fee for per patients in NCMH was 83916±7793 tugrug which costs 7 times
lower than nonprofessional organization but improves patients` mental state more, significantly
(p≤0.001) Primary or secondary educated patients likely to have diagnostic delay 1
time more than high educated patients, people with nonprofessional initial help seeking
likely to have diagnostic delay 2 times more than psychiatric initial help seeking patients
and people who imply that religion causes mental illness have diagnostic delay with 2
times more, significantly. (p≤0.001). CONCLUSION. According to study result stress induced
disorder and schizophrenia were the majority of total participants. People tend to
seek professional help far lately from symptom onset. Psychiatric misconception and inadequate
health education among the population are the main reason of diagnostic delay.
9.Sexual violence against child and adolescents in Ulaanbaatar
Gou Wang W ; Minjmaa E ; Oyunsuren D ; Khishigsuren Z
Mongolian Medical Sciences 2016;175(1):63-69
Introduction
Violence is defi ned by the WHO as “the intentional use of physical force or power, threatened or actual,
against oneself, another person, or against a group or community, which either results in or has a high
likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation”. Violence
can be divided into many types such as physical, psychological, sexual, neglect and economical etc.
Violence against women and child is a manifestation of historically unequal power relations between
men and women or child due to patriarchy in many countries of the world. Child maltreatment or violence
is one of common public health problems in worldwide and psychologically harm in child’s later life.
Objective
To detect types, percent and some infl uencing factors of violence against child and adolescent among
cases, which were involving into forensic psychiatric evaluation procedures.
Materials and Methods
We are analyzed all archive documents of NCMH, 2000-2014 by retrospective methodology on based
ethical approval of NCMH administration (by ordering 2/189 Oct 28, 2015).
Results
Total 1067 cases of violence against child and adolescent were registered in 2000-2014 years and 84.7
percent of those (n=904) were sexual violence cases. Gender difference was defi ning among sexual
violence cases (girls n=885, p<0.000; boys n=19, p<0.000) with statistically signifi cant. Sexual offender
can be act his violence in drunken (OR=2.355; p<0.000; CI 95%; 1.601-3.463) or negative relationship
between family members (OR=3.723; p<0.000; CI 95%-2.356-5.883) are more infl uenced to sexual
violence against child and adolescent.
Conclusion
Sexual violence is more registered among child and adolescent maltreatment cases. Children and
adolescents are more affected into sexual violence likely to have a negative relationship between the
family members or offenders have used alcohol.
10.ADHERENCE TO MEDICATION REGIMEN IN PATIENT WITH GRAND MAL SEIZURE: ASSESSED BY MORISKY MEDICATION ADHERENCE SCALES
Orkhonselenge Ts ; Khishigsuren Z ; Sarantsetseg Ts
Innovation 2015;9(1):56-59
Grand mal is the main characteristic of epileptic isorder. Other seizures that caused by non-epileptic disorders are called symptomatic epilepsy, epilepsy-like seizure and symptomatic seizure. The primary treatment of seizure patient is anticonvulsive medication. Therefore, adherence to medication regimen is important to reducing seizure incidence and preventing complications.
Accreditation processes to study that how influence on the institution and individual development
The survey was conducted by descriptive cross-sectional design in outpatient clinic of NCMH. Morisky Medication Adherence Scales are used to assess adherence to medication regimen of seizure patient’s. Folstein rapid test is used to assess dementia. Overall, 70 patients, aged 20-71 years, 36 males and 34 females were participated our survey. 81.4% of total participants were patients with seizure syndrome caused by brain injure; 14.3% were patients suffering from congenital epilepsy and 4.3% of them could not described causes of their disease. 29.9% of all participants assessed as mild and moderate dementia, 34.3% of participants assessed non-adherent to medication regimen by scale 4 item and 77.1% of
participants assessed non-adherent to medication regimen by scale 8 item.
29.9% of all participants have dementia, and 34.3%-77.1% of patients are non-adherent to medication regimen. Thus, our study suggests that there is a direct correlation between dementia and an adherence to medication regimen.
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