Parents' Knowledge, Attitude, and Practices toward Methamphetamine Abuse among Youth and its Risk Factors in Saudi Arabia

Objective

The present study aimed to conduct an assessment of parents' knowledge, attitudes, and practices toward methamphetamine "shabu" abuse among youth and its risk factors.

Materials and Methods

The present cross-sectional descriptive study was conducted on a sample of 1179 parents. Parents were assured that questionnaire content would stay classified and was given anonymously. It had 20 demographic, drug use, and addiction treatment questions. Statistical Package for Social Sciences v. 24 and Chi-Square test were used to examine the data after evaluating and coding it.

Results

Out of a total of 1179 participants, only 11% had not heard about shabu, about 38% did not know the main symptoms of crystal addiction, and 46% did not know the long side effects of crystal addiction. The majority of participants mentioned that shabu is available in powder format (57%) or liquid (13%), while 27% did not know its form. Most of the participants (97%) think that the drug of shabu or crystal or ice is dangerous; about 60% of participants mentioned that there is an addict in the family.

Conclusion

Parents have good knowledge levels regarding different aspects of methamphetamine or shabu abuse, symptoms, and its risk factors. Further in-depth studies are needed at whole Saudi Arabia.

Comorbidity of Mental Disorder in Patients with Chronic Dis-ease: A Comparative Study of Heroin Dependence Patients and Diabetes Mellitus Patients

Background:

Chronic patients are at greater risk for a psychiatric problem than the normal population; yet, the increased rate of mental disorder among one chronic patient compared to another chronic patient is uncertain. We aimed to assess the rate of mental disorder among people with heroin dependence and diabetes mellitus in comparison with the healthy population.

Methods:

This cross-sectional study was carried out in Kuala Lumpur, Malaysia in 2017–2020. The study consisted of 648 participants including heroin dependence patients, diabetes mellitus patients, and healthy population. The GHQ-28 and SCL-90-R scales were used to assess mental disorder among the study populations.

Results:

The current study revealed the rate of mental disorder among heroin dependence patients, diabetes mellitus patients, and healthy population respectively at 52.1%, 49.5%, and 23.2% using SCL-90-R and GHQ-28. The rate of mental disorder in both heroin dependent (OR 95%= 3.59: 2.37–5.44) and diabetic groups (OR 95%=3.25: 2.14–4.92) were significantly more than the healthy population; however, the odds ratio of mental disorder was not significantly different between heroin dependent and diabetic groups. Furthermore, the results revealed an acceptable agreement between SCL-90-R and GHQ-28 to detect mental disorders (Kappa=0.60; P<0.001).

Conclusion:

People with diabetes mellitus and heroin dependence have significantly poorer mental health than healthy people in Malaysia have. Furthermore, the equivalent rate of mental disorder among such patients suggests that heroin dependence patients are not more distressed than diabetes mellitus patients are. However, further comparative studies are needed to prove these findings.

Methadone maintenance therapy (MMT): low versus high regulated model

Introduction

In Malaysia, MMT started with low regulated model since year 2002 to address increasing prevalence of HIV/AIDS among intravenous drug users. However, fear of widespread diversion and overdose death forced the government to implement high regulated MMT model. Universiti Malaya conducted both model among self-sponsored(low supervision) and government-sponsored(high supervison) program.

Objectives

To investigate the biodemographic profiles, psychosocial correlates, pattern of substance use, methadone dosing and client satisfaction level among the two groups.

Methods

We conducted a cross sectional study involving 50 clients from each model. The inclusion criteria inludes opiates dependents age > 18 years and above with written consent using convenience sampling from October to December 2008. Semistructured questionare for demographic and pattern of substance use interview, MINI Neuropsychiatric interview for psychiatric morbidity and CSQ-8 for client satisfaction measurement. Analysis was done using SPSS version 16.

Results

All the participants are males with the mean age of 40 years. 61% are married and 90% are employed during the interview. 80% received MMT more than one year and 65% achieved maintenance dose more than 50mg daily. 68% used substance more than 10 years prior to the MMT and 73% starts using heroin below age of 20 years old. 57% have comorbid psychiatric illness(anti-social personality, major depression and psychotic disorders) and 33% have medical illness(HIV+, Hepatitis B/C and tuberculosis). There were no significance difference in demographic profiles, pattern of substance use, psychiatric/medical comorbidities and clients satisfasfaction level between the two groups.

Conclusion

Both group are similar from the clients satisfaction perpectives.

Evaluation of Psychometric Properties of the Second Version of the Taqwa (Piety) Questionnaire in Bahasa Melayu

The aim of the study is to evaluate the psychometric properties of the Bahasa Melayu version of the Taqwa (piety) questionnaire, used for the measurement of behaviour of Drug Dependency Syndrome (DDS), in Malay patients. A sample of 98 males with a psychiatric diagnosis (DSM-IV-R) as the DDS was randomly selected from Kajang Khafidz Polyclinic Kuala Lumpur, Malaysia. After receiving their agreement to attend the study, they completed the Taqwa (piety) questionnaire. The reliability was assessed by determining the Cronbach's [Formula: see text] to measure the consistency of related questions for all four dimensions (subscales), including individual, social, cognitional, and emotional Taqwa behaviour. In the next step to evaluate the composite reliability, convergent, and discrimination validity, a measurement model was determined via Conformity Factor Analysis (CFA) based on Partial List Square method (Smart- PLS Ver: 2M3). The reliability of four dimensions of the questionnaire was acceptable ([Formula: see text] correlated to each other. However, according to the CFA method, the items with low loading factor (<0.5) were excluded from each dimension. Item 24 and 35 that were related to individual Taqwa, and item 35 that belonged to emotional Taqwa were excluded from the analysis. The composite reliability and convergent, and discrimination validity were satisfied in all conformity factor loading that exceeded 0/05. The psychometric properties of the Taqwa questionnaire are acceptable, and the scale is a good instrument for assessing the Islamic attitude, beliefs, and behaviour of the Bahasa Melayu DDS patients.

Acupuncture therapy for drug addiction

Acupuncture therapy has been used to treat substance abuse. This study aims to review experimental studies examining the effects of acupuncture on addiction. Research and review articles on acupuncture treatment of substance abuse published between January 2000 and September 2014 were searched using the databases ISI Web of Science Core Collection and EBSCO’s MEDLINE Complete. Clinical trial studies on the efficacy of acupuncture therapy for substance abuse were classified according to substance (cocaine, opioid, nicotine, and alcohol), and their treatment protocols, assessments, and findings were examined. A total of 119 studies were identified, of which 85 research articles addressed the efficacy of acupuncture for treating addiction. There were substantial variations in study protocols, particularly regarding treatment duration, frequency of electroacupuncture, duration of stimulation, and choice of acupoints. Contradictory results, intergroup differences, variation in sample sizes, and acupuncture placebo effects made it difficult to evaluate acupuncture effectiveness in drug addiction treatment. This review also identified a lack of rigorous study design, such as control of confounding variables by incorporating sham controls, sufficient sample sizes, reliable assessments, and adequately replicated experiments.

The structure of clinical consultation: a case of non-native speakers of English as participants

BACKGROUND

In many parts of the world, patients may find it difficult to visit doctors who share the same language and culture due to the intermingling of people and international recruitment of doctors among many other reasons. In these multilingual multicultural settings (MMSs), doctor-patient interactions face new communication challenges. This study aims to identify the structure of clinical consultation and its phases in an MMS where both doctors and patients are non-native speakers (NNSs) of English.

METHOD

This study takes on a discourse analytic approach to examine the structure of clinical consultation as an activity type. 25 clinical consultation sessions between non-native speakers of English in a public healthcare centre in Malaysia were audio-recorded.

FINDINGS & DISCUSSION

The results show that there are some deviations from the mainstream structure of clinical consultations although, in general, the pattern is compatible with previous studies. Deviations are particularly marked in the opening and closing phases of consultation.

CONCLUSION

In almost all interactions, there is a straightforward manner of beginning medical consultations. The absence of greetings may have naturally reduced the length of talk. Hence, by directly entering medical talks, the doctors voice their concern on the curing aspects of the consultation rather than its caring facets. The preference of curing priority to caring is more goal-oriented and in alignment with the consultation as an activity type.

Use of antidepressants in the treatment of depression in Asia: guidelines, clinical evidence, and experience revisited

Major depressive disorder is prevalent worldwide, and only about half of those affected will experience no further episodes or symptoms. Additionally, depressive symptoms can be challenging to identify, with many patients going undiagnosed despite a wide variety of available treatment options. Antidepressants are the cornerstone of depression treatment; however, a large number of factors must be considered in selecting the treatment best suited to the individual. To help support physicians in this process, international and national treatment guidelines have been developed. This review evaluates the current use of antidepressant treatment for major depressive disorder in six Asian countries (China, Korea, Malaysia, Philippines, Taiwan, and Thailand). No remarkable differences were noted between Asian and international treatment guidelines or among those from within Asia as these are adapted from western guidelines, although there were some local variations. Importantly, a shortage of evidence-based information at a country level is the primary problem in developing guidelines appropriate for Asia, so most of the guidelines are consensus opinions derived from western research data utilized in western guidelines. Treatment guidelines need to evolve from being consensus based to evidence based when evidence is available, taking into consideration cost/effectiveness or cost/benefit with an evidence-based approach that more accurately reflects clinical experience as well as the attributes of each antidepressant. In everyday practice, physicians must tailor their treatment to the patient's clinical needs while considering associated external factors; better tools are needed to help them reach the best possible prescribing decisions which are of maximum benefit to patients.

Effect of mindfulness based stress management on reduction of generalized anxiety disorder

BACKGROUND

The aim of this study was to evaluate whether an eight-week group mindfulness-based stress reduction program would be an acceptable and effective treatment for patients suffering from GAD.

METHODS

Eligible subjects with generalized anxiety disorder were recruited to Parsa Hospital and Shahid Rajaee Counseling and Social Work Center from June 2009 to October 2011. An experienced psychiatrist diagnosed these patients with a structured clinical interview for axis I disorders and a clinical psychologist conducted a clinical interview for in order to confirm the diagnosis. Subjects were randomized to an eight week course of group mindfulness based stress reduction program (16 subjects) or a control group (15 subjects). Subjects completed measures of anxiety, depressive symptoms and worry at baseline and end of treatment. To investigate the relationship between anxiety, depression and worry symptoms and mindfulness based stress reduction as well as controlling pretest effect, data were analyzed with analysis of covariance.

RESULTS

There were significant reductions in anxiety (P<0/001), depressive (P<0/001) and worry symptoms (P<0/001) from baseline to end of treatment.

CONCLUSION

Mindfulness- based stress reduction may be an acceptable intervention in the improvement of generalized anxiety disorder symptoms. Future trials include development of randomized clinical trials of MBSR for GAD.

Reasons for underutilisation of drug therapy for smoking cessation among Malaysian aboriginal smokers

Introduction

The smoking rate among Malaysian aboriginal people is double the rate of other Malaysians. Smoking is a major cause of morbidity and mortality in aboriginal people but smoking cessation among this population is very low. At present, pharmacotherapy for smoking cessation is not subsidised in the health services.

Objective and aim

The study aimed to explore potential reasons for the underutilisation of drug therapy for smoking cessation among aboriginal and non-aboriginal smokers.

Methods

A cross-sectional study was conducted among aboriginal and non-aboriginal smokers in the state of Selangor between March 2010-August 2010. Participants were asked to complete a questionnaire on demographics, smoking behaviour, physician counselling on smoking cessation and perceptions about drug therapy for smoking cessation.

Results

The overall response rate was 85% (250 Aboriginal smokers and 105 non-aboriginal smokers). Majority of smokers reported smoking cessation or reduction in the previous 6 months (Aboriginal 62% vs non-aboriginal 68%). Aboriginal participants were less likely to seek physician services (p = 0.001) and less willing to use nicotine replacement therapy (p = 0.01) or varenicline (p = 0.001). Among all smokers, having to buy the medication and price of the medication was the most important factor associated with less willingness to use the drugs but advice from physician was associated with willingness to use the drugs.

Conclusions

Regardless of ethnic origin, smokers were interested to quit smoking, but cost of medication may explain their lower uptake of drug therapy. Malaysian policy makers should consider making the drugs for smoking cessation freely available in the Malaysian health services.

Psychiatric and substance abuse comorbidity among HIV seropositive and HIV seronegative prisoners in Malaysia

OBJECTIVE

To examine the association between HIV infection and psychiatric disorders among prisoners, where mental illness, substance abuse, and HIV are disproportionately represented.

DESIGN

Cross-sectional study.

METHODS

Using a sequential randomization scheme, 200 HIV-seropositive and 200 HIV-seronegative prisoners were selected for evaluation of psychiatric illnesses with the Structured Clinical Interview for Diagnostic Statistical Manual of Mental Disorders-IV (SCID-I).

RESULTS

The prevalence of mental illness and substance use disorders, particularly opioid dependence, was extremely high. HIV infection was significantly correlated with age, ethnicity, marital status, history of injection drug use, lifetime duration of incarceration, substance abuse, and polysubstance drug use. After controlling for potential confounders, HIV infection was significantly associated with non-substance-induced psychiatric disorders (AOR = 1.92; 95% CI: 1.03-3.59). While prisoners with a triple diagnosis (psychiatric disorders, substance use disorders, and HIV) spent 46.7 more cumulative lifetime months in prison than those with only a psychiatric diagnosis (p < .01), those with a dual diagnosis (psychiatric plus substance use disorders) were comparable to those with one psychiatric diagnosis only. Neither HIV infection nor triple diagnosis was associated with violent offenses.

CONCLUSION

These findings suggest that a public health approach that simultaneously addresses psychiatric illnesses, substance abuse, and HIV infection is needed in both the correctional and the community settings in order to provide adequate care for triply-diagnosed patients and prevent them from returning to prison.

Long-term, naturalistic treatment with olanzapine, risperidone, quetiapine, or haloperidol monotherapy: 24-month results from the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) study

Objective. To compare the effectiveness of olanzapine, risperidone, quetiapine, or haloperidol monotherapy in patients with schizophrenia who were treated in routine clinical practice settings for a period of 2 years. The incidence and persistence of adverse events encountered during long-term therapy are also reported. Method. Outpatients with schizophrenia who entered this 3-year, prospective, observational study were classified according to their initially prescribed antipsychotic monotherapy: olanzapine (n=3222), risperidone (n=1116), quetiapine (n=189), or haloperidol (n=256). Patients were included in the analysis for as long as this treatment was maintained. Results. Over 2 years, olanzapine recipients had significantly (P≤0.001) greater reduction in overall CGI-S score (and the negative, depressive, and cognitive symptoms domains), lower incidence of sexual and motor dysfunction, and greater odds of response compared to risperidone or haloperidol-treated patients. However, olanzapine patients gained more weight than patients in other treatment groups. The incidence of motor dysfunction was significantly (P≤0.001) greater in haloperidol-treated patients, relative to the atypical treatment groups. Conclusion. The results of this observational study indicate that, in these patients with schizophrenia, long-term monotherapy with olanzapine may offer benefits over risperidone and haloperidol, but the potential for weight gain should be considered in the clinical management of these patients.

Safety and efficacy of rapid dose administration of quetiapine in bipolar mania

In this open-label pilot study, 20 adult patients hospitalized for acute bipolar mania received oral quetiapine as a single evening dose of 200 mg on day 1, increased by 200 mg/day on days 2, 3, and 4 until 800 mg/day taken in 2 divided doses on day 4. From day 5 onward, patients received a flexible total dose of 400-800 mg/day until completion of 3 weeks of treatment. Safety and tolerability were assessed by adverse-event (AE)-related dropouts in week 1, incidence of AEs including EPS, changes in electrocardiogram, and vital signs. Efficacy was assessed using the YMRS, PANSS, and CGI scales. Nineteen of 20 patients (95%) completed the quetiapine rapid titration during week 1. Significant improvement was observed in YMRS, PANSS, and CGI Severity of Illness scores by day 5, and was maintained throughout the study. A reduction of > or = 50% in YMRS score was achieved by 75% of patients by day 7, and maintained to day 21. Overall, 20% of patients discontinued due to AEs. Agitation was the most common cause of AE-related study discontinuation. Thirty-five per cent of patients required dose adjustment due to AEs after rapid dose administration was completed. Most patients tolerated rapid titration of quetiapine to 800 mg/day by day 4 of therapy, with a significant improvement in manic symptoms by day 7 of treatment.

Treatment with olanzapine, risperidone or typical antipsychotic drugs in Asian patients with schizophrenia

OBJECTIVE

To examine clinical outcomes in Asian patients with schizophrenia receiving monotherapy with olanzapine, risperidone or typical antipsychotics in naturalistic settings.

METHOD

In this report, data from the first 12 months of the prospective, observational, 3-year Intercontinental Schizophrenia Outpatient Health Outcomes study are presented for patients from participating Asian countries (Korea, Taiwan and Malaysia) who were started on, or switched to, monotherapy with olanzapine (n = 484), risperidone (n = 287) or a typical antipsychotic drug (n = 127) at baseline.

RESULTS

At 12 months, overall reduction in the score of Clinical Global Impressions-Severity of Illness rating scale was greatest with olanzapine (p < 0.001 vs typical agents), followed by risperidone (p = 0.007 vs typical agents) treatment. Olanzapine treatment was found to have significantly better effects than typical agents on negative and depressive symptom scores, and significantly greater improvements than risperidone on negative and cognitive symptoms. The occurrence of extrapyramidal symptoms was least likely with olanzapine (p < 0.001 vs typical agents, and p = 0.012 vs risperidone), while the estimated odds of tardive dyskinesia were greatest in the typical treatment group (p = 0.046 vs olanzapine, and p = 0.082 vs risperidone). Mean weight increase was greater for olanzapine-treated patients compared with the other agents (p = 0.030 vs typical agents and p < 0.001 vs risperidone). The risk of menstrual disturbance was relatively high with risperidone when compared with olanzapine treatment (p < 0.001).

CONCLUSIONS

The results of this observational study indicate that, in Asian patients with schizophrenia, olanzapine may offer benefits when compared with typical agents or risperidone. However, the significantly greater odds of weight gain should be considered in the clinical management of olanzapine-treated patients.