A Repeated Time-to-Positive Symptoms Improvement among Malaysian Patients with Schizophrenia Spectrum Disorders Treated with Clozapine

Clozapine remains the drug of choice for resistant schizophrenia. However, its dose-response relationship is still controversial. The current investigation aimed to develop a repeated time-to-positive symptoms improvement following the onset of clozapine treatment in Malaysian schizophrenia spectrum disorder patients. Data from patients’ medical records in the Psychiatric Clinic, Penang General Hospital, were retrospectively analyzed. Several parametric survival models were evaluated using nonlinear mixed-effect modeling software (NONMEM 7.3.0). Kaplan–Meier-visual predictive check (KM-VPC) and sampling-importance resampling (SIR) methods were used to validate the final model. A total of 116 patients were included in the study, with a mean follow-up of 306 weeks. Weibull hazard function best fitted the data. The hazard of positive symptoms improvement decreased 4% for every one-year increase in age over the median of 41 years (adjusted hazard ratio (aHR), 0.96; 95% confidence intervals (95% CI), (0.93–0.98)). However, patients receiving a second atypical antipsychotic agent had four-folds higher hazard (aHR, 4.01; 95% CI, (1.97–7.17)). The hazard increased 2% (aHR, 1.02; 95% CI, (1.01–1.03)) for every 1 g increase in the clozapine six months cumulative dose over the median of 34 g. The developed model provides essential information on the hazard of positive symptoms improvement after the first clozapine dose administration, including modifiable predictors of high clinical importance

The stress of caregiving: a study of family caregivers of breast cancer patients receiving oncologic treatment at a Malaysian General Hospital

Many studies among caregivers of breast cancer patients have revealed that stress affects a significant proportion of this particular group. The situation among caregivers of breast cancer patients in Malaysia was however not known. This cross-sectional study aimed to determine the proportion of the family caregivers who experienced stress while caring for the breast cancer patients who were on oncologic treatment in Kuala Lumpur Hospital and factors which predict the stress among these caregivers. A total of 130 family caregiver-breast cancer patient dyads who were attending the Institute of Radiotherapy & Oncology, Kuala Lumpur Hospital during a 3-month study period were recruited by non-random sampling method. The caregivers’ stress was measured using the stress domain of the depression, anxiety, stress scale (DASS-21) while other data obtained included the patients’ and caregivers’ socio demographic status, the patients’ illness characteristics and the caregiving factors and the caregivers’ perceived social support. About 1 in 4 (24.6%; n=32) caregivers of breast cancer patients were stressed. Duration of caregiving, sharing of caregiving burden, patients’ age and patients’ functionality were found to be significantly associated with stress (p value <0.05). All these factors, except for duration of caregiving, continue to be significant in the logistic regression analysis (p value <0.05). This study found that a high proportion of the family caregivers experienced stress. Identification of the predictors of stress among the caregivers may help in the prevention strategies of stress in this group of caregivers