The use of antidepressants for physical and psychological symptoms in cancer

Cancer patients are commonly associated with various physical and psychological symptoms. In palliative setting, the aims are to relieve those symptoms, improve quality of life, and increase medication adherence among cancer patients. Antidepressants are generally accepted for the treatment of depression among patients with or without cancer. Some other potential benefits of the antidepressants have been reported in cancer patients. Objective: This study aims to review the use of antidepressants for physical and psychological symptoms in cancer patients. Results: Our findings showed the mixed result of positive and negative findings in various symptoms associated with cancer patients. These studies are categorised according to the hierarchy of evidence from high to low level, namely randomised controlled trials, cohort studies, case-control studies, case series, case reports, as well as other type of publications. The majority of antidepressants used in cancer patients seem to be beneficial for the treatment of depression, anxiety, hot flashes and other symptoms such as sexual dysfunction, fatigue, nicotine dependence, vasomotor symptoms, executive functions, sleep problems, pruritus, as well as for hypochondriasis. While fluoxetine was found to be associated with the reduction of antiemetic property in ondansetron, mirtazapine was identified to be a good alternative in treating nausea and cachexia among cancer patients. Conclusion: More research studies with adequate statistical power are warranted to validate the use of antidepressants among cancer patients in treating these physical and psychological symptoms

Metabolic syndrome and cardiovascular risk among patients with schizophrenia receiving antipsychotics in Malaysia

INTRODUCTION This study aimed to determine the prevalence of metabolic syndrome and risk of coronary heart disease (CHD) in patients with schizophrenia receiving antipsychotics in Malaysia. METHODS This cross-sectional study, conducted at multiple centres, involved 270 patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR diagnostic criteria for schizophrenia, were on antipsychotic medications for at least one year, and were screened for metabolic syndrome. Patients receiving mood stabilisers were excluded. Metabolic syndrome was defined according to the National Cholesterol Education Program ATP III criteria modified for Asian waist circumference. Risk for cardiovascular disease was assessed by using Framingham function (all ten-year CHD events). RESULTS The prevalence of metabolic syndrome was 46.7 (126/270). Among all the antipsychotics used, atypical antipsychotics (monotherapy) were most commonly used in both the metabolic and non-metabolic syndrome groups (50.8 vs. 58.3). The ten-year risk for CHD was significantly higher in patients with metabolic syndrome. The proportion of patients with high/very high risk for CHD (Framingham >= 10) was greater in patients with metabolic syndrome than in those with non-metabolic syndrome (31.5 vs. 11.0, odds ratio 3.9, 95 confidence interval 2.0-7.6; p < 0.001). The mean body mass index was higher in patients with metabolic syndrome than in those without (29.4 +/- 5.1 kg/m(2) vs. 25.0 +/- 5.6 kg/m(2); p < 0.001). CONCLUSION Patients with schizophrenia receiving antipsychotics in Malaysia have a very high incidence of metabolic syndrome and increased cardiovascular risk. Urgent interventions are needed to combat these problems in patients

Patient-centred communication in the use of antidepressants among people with depression: a scoping review

Antidepressants are the mainstay of depression treatment. However, little information is known about patient-centred communication related to the use of antidepressant among people with depression. This review aims to provide a comprehensive mapping of previously published studies on patient-centred communication in the use of antidepressants among patients with depression. A scoping review of the literature was conducted using PubMed, CINAHL, and Cochrane to answer the following questions: What is the nature of published scientific literature on this topic? and To what extent do the published articles address the six core components of patient-centred communication, which are: encouraging effective clinician-patient relationships, obtaining and providing information, responding to emotional states, handling uncertainty, achieving the best decision as well as advocating patient self-management? Out of 494 records identified, a total of 13 articles were included in the scoping review (2 randomised controlled trials, 1 observational cohort study, 5 cross-sectional studies, 4 qualitative studies, and 1 review article). All 6 core components of the patient-centred communication were discussed extensively in the literature except for 2 of them, which were handling uncertainty and patient self-management. Shared decision making (SDM) was found to be a critical feature in patient-centred communication. The six core components of patient-centred communication have been consistently recognized as vital for the process of achieving patient-centred care. SDM can be included as a tool to assist clinicians and patients in addressing effective clinician-patient relationships

Internet Use by Older Adults with Bipolar Disorder: International Survey Results

Background: The world population is aging and the number of older adults with bipolar disorder is increasing. Digital technologies are viewed as a framework to improve care of older adults with bipolar disorder. This analysis quantifies Internet use by older adults with bipolar disorder as part of a larger survey project about information seeking. Methods: A paper-based survey about information seeking by patients with bipolar disorder was developed and translated into 12 languages. The survey was anonymous and completed between March 2014 and January 2016 by 1222 patients in 17 countries. All patients were diagnosed by a psychiatrist. General estimating equations were used to account for correlated data. Results: Overall, 47% of older adults (age 60 years or older) used the Internet versus 87% of younger adults (less than 60 years). More education and having symptoms that interfered with regular activities increased the odds of using the Internet, while being age 60 years or older decreased the odds. Data from 187 older adults and 1021 younger adults were included in the analysis excluding missing values. Conclusions: Older adults with bipolar disorder use the Internet much less frequently than younger adults. Many older adults do not use the Internet, and technology tools are suitable for some but not all older adults. As more health services are only available online, and more digital tools are developed, there is concern about growing health disparities based on age. Mental health experts should participate in determining the appropriate role for digital tools for older adults with bipolar disorder

Association between solar insolation and a history of suicide attempts in bipolar I disorder

In many international studies, rates of completed suicide and suicide attempts have a seasonal pattern that peaks in spring or summer. This exploratory study investigated the association between solar insolation and a history of suicide attempt in patients with bipolar I disorder. Solar insolation is the amount of electromagnetic energy from the Sun striking a surface area on Earth. Data were collected previously from 5536 patients with bipolar I disorder at 50 collection sites in 32 countries at a wide range of latitudes in both hemispheres. Suicide related data were available for 3365 patients from 310 onset locations in 51 countries. 1047 (31.1%) had a history of suicide attempt. There was a significant inverse association between a history of suicide attempt and the ratio of mean winter solar insolation/mean summer solar insolation. This ratio is smallest near the poles where the winter insolation is very small compared to the summer insolation. This ratio is largest near the equator where there is relatively little variation in the insolation over the year. Other variables in the model that were positively associated with suicide attempt were being female, a history of alcohol or substance abuse, and being in a younger birth cohort. Living in a country with a state-sponsored religion decreased the association. (All estimated coefficients p <0.01). In summary, living in locations with large changes in solar insolation between winter and summer may be associated with increased suicide attempts in patients with bipolar disorder. Further investigation of the impacts of solar insolation on the course of bipolar disorder is needed.Peer reviewe

Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

Background: Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods: Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results: This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p &lt; 0.01. Conclusion: A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed

Methamphetamine dependence in Malaysia: psychiatric co-morbidity and suicidality, methamphetamine induced psychosis, genetic polymorphisms and efficacy of aripiprazole in the treatment of methamphetamine dependence / Ahmad Hatim Sulaiman

Methamphetamine dependence remains a worldwide problem and Malaysia is no exception. The widespread of methamphetamine dependent has given an impact that can be felt at various levels, from the individual, to the individual’s family, community and society. Unfortunately, there are not many studies done on the issues of methamphetamine dependence in Malaysia. We are still lacking in published data especially in terms of prevalence, psychiatry morbidity, genetic risk factors and treatment aspect. Based on the result of the study, we found that the prevalence of psychiatric co-morbidity was 54.4% and the prevalence of suicidality was 12.1 %. The subjects had high rates for methamphetamine-induced psychosis with 47.9% had at least one episode of psychotic symptoms and 13.0% were still having psychotic symptoms at the time of assessment. Our results showed that the distribution of the BDNF Val66Met genotype in Chinese subjects with methamphetamine dependence and methamphetamine psychosis were significant compared with controls. The frequency of the 66Val allele in methamphetamine-dependent subjects was higher than that in the control group, suggesting that the 66Val carriers are more susceptible to methamphetamine dependence. However, 66Val allele frequency in other ethnicities was not significantly different from the controls. Among those who were having methamphetamine-induced psychosis, treatment with aripiprazole was associated with significant decline in the Positive And Negative Symptoms Scale (PANSS) and Clinical Global Impression of Severity (CGI-S) score. Aripiprazole was generally well tolerated with no serious adverse event occur. In the randomised controlled trial study, 84.2% of participants randomized to aripiprazole completed the study compared to only 50% of the placebo group completed. There was a statistically significant difference between groups in the amount of time spent in treatment, with those given aripiprazole retained for an average of 48.7 days (+ 4.0) compared with only 37.1 days (+ 5.0) for the placebo group. The survival curves results showed that participants in the aripiprazole group were less likely to drop out of the study than those in the placebo group. The difference was statistically significant. Psychotic symptoms as measured by PANSS and CGI were decreased among participants who were randomized to aripiprazole treatment but those who were randomized to placebo showed an increased in the total PANSS and CGI score. However there were no statistically significant effects for aripiprazole relative to placebo on methamphetamine use verified by urine drug screen. Aripiprazole treatment was not associated with any serious adverse event. Based on the findings: - Support the fact that methamphetamine users are a high-risk population for psychosis. - Suggest that the BDNF Val66Met polymorphism may contribute to methamphetamine dependence and psychosis in the Chinese population but not in other Malaysian ethnicities. - Suggest that aripiprazole was efficacious and safe options for the treatment of methamphetamine-induced psychosis. - Aripiprazole was no more effective than placebo in maintaining abstinence from methamphetamine use. However, it facilitated treatment retention and reduced the occurrence of psychotic symptoms in patients with methamphetamine dependence

Development of a Remote Psychological First Aid Protocol for Healthcare Workers Following the COVID-19 Pandemic in a University Teaching Hospital, Malaysia

The purpose of this article is to discuss the importance of addressing the psychological impact of coronavirus disease 2019 (COVID-19) on healthcare workers (HCWs) who are frontliners directly involved in mitigating the spread of the disease. This paper focuses on the utilization of a clinical practice protocol for identifying HCWs who are COVID-19-positive or under investigation and surveillance for suspected infection, in a tertiary, university teaching hospital of Malaysia. The protocol for Psychological First Aid (PFA), which is applied remotely via a mobile application and phone calls, outlines the work process in stages, with expected immediate, intermediate, and long-term goals within a &ldquo;Specific, Measurable, Attainable, Relevant, and Realistic Timeframe&rdquo; (SMART). This protocol is developed to provide a guideline for psychological crisis interventions that promote safety, calm, and hope in HCWs, allowing them to return to psychological functioning without being stigmatized. The unprecedented remote PFA protocol may serve as a platform for further research on the application of a goal-directed approach in a healthcare organization