Anti-Diabetic and Haemodialysis Treatment Are Associated with Better Verbal Memory Performance

Aim: The study aimed to evaluate verbal memory performance in end stage renal disease (ESRD) patients on maintenance haemodialysis (HD) and determine the relationship between the socio-demographic, clinical and biochemical characteristics of patients with verbal memory performance. Methods: A cross-sectional study of 91 ESRD patients on HD from December 2012 to May 2013 was conducted in nephrology unit, Hospital Sultanah Bahiyah and 3 private dialysis centres in Alor Setar, Kedah during the study period. Verbal memory performance and depression were assessed using the Malay version of the Auditory Verbal Learning Test (MVAVLT) and the Beck Depression Inventory (BDI) respectively during the first hour of HD procedures. Results: Older age, male gender and none/primary education were independently associated with worse verbal memory performance. In contrast, longer duration of HD and anti-diabetic treatment were associated with better verbal memory performance. Other factors, including depression, were not significantly associated with verbal memory performance. Conclusion: Anti-diabetic and HD treatment are associated with better cognitive function. Hence, this study suggests the importance of good diabetic control and regular maintenance HD to prevent cognitive impairment in ESRD patient

Verbal Working Memory in Schizophrenia: Relationship to Cigarette Smoking and Psychopathology

A number of researches suggest smoking serves as a form of self-medication to reduce the side effects of antipsychotic medications, to alleviate negative symptoms, and/or to ameliorate a number of cognitive deficits associated with schizophrenia. Objective: The aim of this study was to investigate the association of cigarette smoking with verbal working memory and psychopathology of patients with schizophrenia. Methods: Fifty-three patients with schizophrenia were assessed by a single rater using the Malay Version of Auditory Verbal Learning Test (MVAVLT) and Positive and Negative Syndrome Scale (PANSS). Smokers (n=30) were compared with nonsmokers (n=23) on socio-demographic, clinical, psychopathology and verbal memory variables. Single linear and multiple regression analysis were performed to determine factors associated with verbal memory performance. Results: Verbal working memory performance is associated with lower number of admission to ward, lesser severity of the negative symptoms or general psychopathology of schizophrenia and use of atypical antipsychotics in all schizophrenic subjects. Smokers with schizophrenia scored higher than non- smoker in measures that reflect immediate memory, delayed recall and recognition memory. However, the association between verbal working memory performance and smoking status was found to be not significant. Conclusion: Verbal working memory performance is associated with negative symptoms but not positive symptoms. This study failed to detect association of smoking on verbal working memory

Comparing the Sensitivity and Specificity of Wilson-Sims Fall Risk Assessment Tool, Clinical Judgment and Morse Fall Scale in the Assessment of Fall Risk among Psychiatric Inpatients

Effective fall risk assessment tool is important for preventive measures to be instituted among psychiatric inpatients. Our study aimed to compare the sensitivity and specificity of Wilson-Sims Fall Risk Assessment Tool (WSFRAT), clinical judgment and Morse Fall Scale (MFS) in the assessment of the risk of fall among psychiatric inpatients. All psychiatric inpatients who were admitted to psychiatric ward of Hospital Tuanku Fauziah, Malaysia from April 1st, 2019, till December 31st, 2020 were assessed for their risk of fall using WSFRAT, clinical judgment and MFS. The frequency and characteristics of actual fall event during period of hospitalization was documented. The study included a total of 400 psychiatric inpatients. Clinical judgment stratified 17 patients as high risk of fall (Mean age: 50.9 ± 12.13 years old, male predominance at 76.5 % and otherwise physically healthy), among which, five actually fell. Among these, four were considered as high risk by WSFRAT and two by MFS. The WSFRAT demonstrated higher sensitivity of fall detection as compared to MFS (60 % vs. 40 %), while the sensitivity of clinical judgment alone without specific fall risks tools was 80 % and a specificity of 96.7 %. Clinical judgement is derived from a comprehensive psychiatric assessment. The value of any objective assessment tool proved to be superior when an element of clinical judgement is concurrently added

Demographic and Clinical Factors Associated With Verbal Memory Performance in Patients with Schizophrenia in Hospital Universiti Sains Malaysia (HUSM), Malaysia

Objective: The present study aims to assess verbal memory performance in patients with schizophrenia attending HUSM and determine the relationship between the patients’ verbal memory performance and their demographic/clinical factors. Methods: A cross sectional study of 114 patients with schizophrenia attending HUSM psychiatric services from December 2007 to May 2008 was conducted. The schizophrenia symptoms as well as verbal memory performance were assessed using the Brief Psychiatric Rating Scale, the Malay version of the Calgary Depression Scale (MVCDS), and the Malay version of the Auditory Verbal Learning Test (MVAVLT). The relationship between verbal memory performance and demographic/clinical symptoms was evaluated using Pearson Correlation. Results: Overall MVAVLT scores in all the trials were lowered in patients with schizophrenia compared to average healthy controls. There were significant relationships between occupational status and MVAVLT performance in Trial A1-A5 Total; between educational level and MVAVLT performance in Trial A1 and Trial A1-A5 Total and between severities of illness and MVAVLT performance in all indexes except Trial A1 after controlled for occupation and educational level. Conclusions: Patient with schizophrenia in HUSM performed significantly worse than healthy controls in verbal memory with or without interference. There were significant relationships between MVAVLT performance and patient’s occupational status, educational level and severity of the illness but not depressive symptom

Validation of the Malay Version of Auditory Verbal Learning Test (MVAVLT) Among Schizophrenia Patients in Hospital Universiti Sains Malaysia (HUSM), Malaysia

Objective: Many studies have emphasized the significance of verbal memory for the functional outcome in schizophrenia. A preserved capability to encode and recall verbal information is essential for the long-term efficacy of psychoeducational programs and other psychological intervention to ensure the successful transfer of newly acquired skills or knowledge into everyday life. Aims of this study aimed to validate the MVALT among schizophrenia patients in HUSM. Methods: The subjects were 15 schizophrenia patients conveniently selected from the patients that attended follow up at the psychiatry clinic in HUSM or inpatients who have been admitted during the study period and 15 healthy control subjects as a comparison. Reliability and validity of the MVAVLT were analyzed. Results: The validation study showed that the Malay version Auditory Verbal Learning Test (MVAVLT) had a good validity (factor analysis 0.66 to 0.98) and test-retest reliability (pearson correlation ranged from 0.24 to 0.84) and has been shown to be sensitive in discriminating between normal and schizophrenia patients. In line with the previous research, the schizophrenia patients performed significantly worse than healthy control in all indexes measured in MVAVLT. Conclusion: The screening of deficits in verbal learning and memory among the schizophrenia patients is important, for early detection and treatment since it can be helpful for clinicians and psychologists in their counseling sessions. Subsequently, it helps patients to reduce such cognitive difficulties and their impact by using specific rehabilitation with the usage of newer antipsychotic agents

Low Diastolic Blood Pressure Predicts Depression in End Stage Renal Disease Patients on Maintenance Haemodialysis

Aim: This study aimed to measure the prevalence and identify the predictors of depression in end stage renal disease (ESRD) patient on maintenance haemodialysis (HD). Methods: A 6-month cross-sectional study from December 2012 to May 2013 was conducted in nephrology unit, Hospital Sultanah Bahiyah and 3 private dialysis centres in Alor Setar, Kedah during the study period. Depression was assessed during the first hour of dialysis procedure in all participants using the Beck Depression Inventory (BDI). Results: A total of 91 patients were studied. The prevalence of depression was 19.8% with BDI cut-off score of 11. Lower diastolic blood pressure (P = 0.035) and presence of heart disease (P = 0.043) or stroke (P = 0.043) were found to be significantly associated with depression in ESRD patients on maintenance HD. None of the socio-demographic or laboratory parameters, including serum albumin, urea and hemoglobin, were signifícantly associated with depression. Conclusion: Depression is common and affecting about one-fifth of ESRD patients on HD. Hence, it is important to regularly assess the patients for depression giving particular attention to those with low diastolic blood pressure and co-morbid heart or cerebrovascular diseases

The Third National Health and Morbidity Survey (NHMS III) 2006: nutritional status of adults aged 18 years and above

1Department of Nutrition Research, Institute for Public Health, Ministry of Health, Kuala Lumpur; 2Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor; 3Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur; 4Epidemiology and Biostatistics Unit, Institute for Medical Research,Kuala Lumpur; 5Clinical Epidemiology Unit, Clinical Research Centre, Ministry of Health, Kuala Lumpur; 6Department of Paediatrics, Universiti Kebangsaan Malaysia, Kuala Lumpur; 7Department of Community Health and Family Medicine, Faculty of Medicine, International Islamic University, Kuantan The Third National Health and Morbidity Survey (NHMS III) was conducted in 2006 to determine the nutritional status of a nationally representative sample of Malaysian adults aged 18 years and above. Body weight, height and waist circumference measurements were taken by trained health nurses according to a standard procedure (WHO, 1998). Body Mass Index (BMI) was determined among 33,055 eligible adults, while risk of abdominal obesity based on waist circumference (WC) was obtained from 32,900 individuals. In addition, peripheral muscle wasting was determined using calf circumference (CC) among 4,282 older individuals aged 60 years and above. The national prevalence of normal BMI (BMI 18.5-24.9 kg/m2) was 48.4% (47.7–49.0)*. The prevalence of underweight (BMI <18.5 kg/m2) was 8.5% (8.2–8.9), being higher in rural areas {9.8% (9.2–10.4)} than in urban areas {7.8% (7.4–8.3)}. Meanwhile, 29.1% (28.6–29.7) of the adults were overweight (BMI 25.0-29.9 kg/m2). Among the ethnic groups, Indians had the highest prevalence of overweight followed by Malays and Chinese. In addition, 14.0% (13.6–14.5) of the adults were obese (BMI >30.0 kg/m2). Women had higher obesity prevalence at 17.4% (16.7–18.0) than men at 10.0% (9.5–10.5). In terms of ethnic groups, Indians and Malays had higher obesity prevalence than other groups. By occupation category, housewives showed the highest prevalence of obesity at 20.3% (19.4–21.3). The prevalence of abdominal obesity (WC for women >88 cm and men >102 cm) was 17.4% (16.9-17.9), with women showing higher prevalence {26.0% (25.2-26.8)} than men {7.3% (6.7-7.6}. The prevalence of older persons with peripheral muscle wasting (calf circumference for women < 27.3 cm and men < 30.1 cm) was 19.9% (18.5–21.6), with a higher prevalence of men {23.7% (21.6-25.9)} than women {16.8% (15.1-18.5)} at risk of malnutrition according to this indicator. In comparison, the present national prevalence of underweight of 8.5% was three times lower than that (25.2%) reported in the NHMS II in 1996. In contrast, the prevalence of overweight hasof 14.0% in this study and 12.7% in the MANS were approximately three times the level of 4.4% found in 1996 (NHMS III). This alarming trend calls for serious re-examination of public health programmes for more effective reduction of obesity among Malaysian adults. increased from 16.6% in the NMHS II to 29.1% in the present study. The latter is comparable with the finding of 27.4% reported in another nationally representative sample involving over 5,000 adults namely, the Malaysian Adults Nutrition Survey (MANS) conducted in 2003. It is noted that obesity prevalence of 14.0% in this study and 12.7% in the MANS were approximately three times the level of 4.4% found in 1996 (NHMS III). This alarming trend calls for serious re-examination of public health programmes for more effective reduction of obesity among Malaysian adults

Enhancing employment outcome among stable psychiatric patients: lesson learnt on innovative model of work inclusion

Background Poor employment rate among psychiatric patients is poorly discussed.Purpose To share our strategies in boosting employment rate among stable psychiatric patients and discuss the lessons learnt.Particular focus Multifaceted strategies were remodelled to ensure a three-dimensional optimisation: (1) strengthening clinical service to ensure stable disease and appropriate patient selection through battery of assessments, (2) provision of psychosocial support to boost self-esteem and foster discipline among patients through encouragement, guidance and regular monitoring by the multidisciplinary community mental health team and (3) encourage willingness and confidence among stakeholders and local market to host job opportunities to stable mental health patients.Overview The yearly employment rate among our stable psychiatric patients under supported employment programme from 2020 to 2021 was 28.6% (2/7) and 30.0% (3/10), respectively. A qualitative survey found the main hindrance to recruitment were employers’ scepticism on work performance, while poor work retention was due to patients’ lack of specific skill set and discipline to adhere to routine. We restructured our supported employment programme by adding the role of community mental health facility to foster discipline and routine for 6 months prior to referral to a job coach. Until June 2022, two out of five patients managed to secure job positions (40.0%). Despite our efforts to improve employment with the instituted remedial strategy, we still fail to reach the minimum standard set by ministry. Future plan will focus on tailoring individual interests to a specific set of skills that match industrial expectation prior to seeking employment. Additionally, enhancing public education using social media may foster better inclusion of psychiatric patients and social acceptance

Anti-Diabetic and Haemodialysis Treatment are Associated with Better Verbal Memory Performance

Aim: The study aimed to evaluate verbal memory performance in end stage renal disease (ESRD) patients on maintenance haemodialysis (HD) and determine the relationship between the socio-demographic, clinical and biochemical characteristics of patients with verbal memory performance. Methods: A cross-sectional study of 91 ESRD patients on HD from December 2012 to May 2013 was conducted in nephrology unit, Hospital Sultanah Bahiyah and 3 private dialysis centres in Alor Setar, Kedah during the study period. Verbal memory performance and depression were assessed using the Malay version of the Auditory Verbal Learning Test (MVAVLT) and the Beck Depression Inventory (BDI) respectively during the first hour of HD procedures. Results: Older age, male gender and none/primary education were independently associated with worse verbal memory performance. In contrast, longer duration of HD and anti-diabetic treatment were associated with better verbal memory performance. Other factors, including depression, were not significantly associated with verbal memory performance. Conclusion: Anti-diabetic and HD treatment are associated with better cognitive function. Hence, this study suggests the importance of good diabetic control and regular maintenance HD to prevent cognitive impairment in ESRD patients