The Effect of Nicotine Dependence on Psychopathology in Patients with Schizophrenia

Introduction. Our study aims to determine the prevalence of nicotine dependence and investigate the effect of nicotine dependence on psychopathology among schizophrenia patients. Methods. A cross-sectional study was carried out in an outpatient psychiatric clinic at a general hospital in Malaysia. 180 recruited subjects were administered the Malay version of Mini International Neuropsychiatric Interview (MINI), the Positive and Negative Symptom Scale (PANSS), and the Malay version of Fagerstrom Test for Nicotine Dependence (FTND-M) questionnaires. Results. The prevalence of nicotine dependence among the subjects was 38.1% () and they were mainly composed of male gender, Malay ethnicity, being treated with atypical antipsychotics, and taking other illicit drugs or alcohol. Subjects with severe nicotine dependence scored less in the negative subscale of PANSS compared with the nonsmokers (). On performing the hierarchy multiple regressions, dependence status still significantly predicted negative scores after adjusting the confounders (, ). Conclusion. The rate of nicotine use disorder among schizophrenia patients in this study is higher than that of the general population in Malaysia. The significant association between nicotine dependence and negative psychopathology symptoms will help the healthcare practitioners in their management of nicotine dependence among schizophrenia patients

Escitalopram in the treatment of Malaysian patients with Obsessive-compulsive disorder

Objective: This post-hoc analysis examined the efficacy and tolerability of escitalopram in the prevention of relapse in Malaysian patients with obsessive-compulsive disorder. Participants and Methods: In Malaysia, 47 patients with obsessive-compulsive disorder were treated with open-label escitalopram (10 mg or 20 mg/day) for 16 weeks, after which the 34 responders (Yale-Brown Obsessive Compulsive Scale total decrease score, 25) were randomised to placebo or escitalopram for 24 weeks, using a double-blind protocol. Results: The primary efficacy analysis suggested a trend in favour of escitalopram treatment with respect to time to relapse (log-rank test, p = 0.07). A higher proportion of patients relapsed after placebo treatment (5 of 14, 36) than with escitalopram treatment (2 of 20, 10) Fishers exact test, 2-sided; p = 0.10. The risk of relapse was 4-fold higher for placebo than escitalopram treatment (p = 0.09). During the double-blind period, the proportion of patients reporting treatment-emergent adverse events was comparable in the 2 groups (10% in the escitalopram group vs. 14% in the placebo group); no serious events being reported. Conclusions: This post-hoc subgroup analysis suggests that escitalopram is well tolerated in Malaysian patients with obsessive-compulsive disorder and appears to confer an advantage over placebo, in terms of time to relapse and other efficacy variables

Pattern of the Use of Physical Restraint on Psychiatric Inpatients in University Malaya Medical Centre

Restraint and seclusion is a commonly used management technique In manypsychiatric Institutes worldwide. However, this practice is viewed by many as aviolation of human rights.In order to understand the circumstances surrounding thispractice, a descriptive study on this subject was conducted at the University MalayaMedical Centre over a three month period, analyzing the socio-demographic characteristics, diagnoses, patterns of restraint and the indications. Results showed that patients with Schizophrenia were the most frequently restrained (42.5%) and the commonest indication for restraint was for being physically assaultative (25.3%).Approximately 50% of patients on electroconvulsive therapy (ECT) werealso restrainedprior to ECT. Most restraints occurred during the night shift with the four pointrestraint being the commonest method. The above results are discussed criticallyand based on these findings suggestions are made how physical restraint inpsychiatry can be reduced

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 400-800mg/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 >= 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. Copyright (c) 2006 John Wiley & Sons, Ltd