Subclinical hypothyroidism among patients with depressive disorders

Subclinical hypothyroidism (SHT) is a biochemical diagnosis, defined as an elevated Thyroid Stimulating Hormone (TSH) with normal free thyroxine (FT4). It affects 4-10% of the adult population and is more prevalent in elderly women. Its commonest cause is autoimmune thyroiditis, detected by anti-thyroid peroxidase antibody (TPO-Ab). About 2-5% of SHT patients progress to overt hypothyroidism annually. The SHT prevalence among depressed patients ranges between 3% and 17%. This study aimed to determine the prevalence of SHT and TPO-Ab positivity among patients diagnosed with depressive disorders. It was a cross-sectional study carried out in the Universiti Kebangsaan Malaysia Medical Centre over a 12 months period. Serum TSH, FT4 and TPO-Ab were measured. Results showed that 82% of depressed patients were euthyroid, 4% had SHT, 11% had subclinical hyperthyroidism and 2% had discordant thyroid function. TPO-Ab positivity among the subjects was 7%, one of whom had SHT. In conclusion, the prevalence of SHT and TPO-Ab positivity in the study population, at 4% and 7%, respectively, were comparable to previous findings

Validation and Optimal Cut-Off Scores of the Bahasa Malaysia Version of the Montreal cognitive assessment (MoCA-BM) for mild cognitive impairment among community dwelling older adults in Malaysia

The goal of this study was to examine the reliability and validity of the Bahasa Malaysia version of the Montreal cognitive assessment (MoCA-BM) and to determine its optimal cut-off score among older adults with mild cognitive impairment (MCI), after adjustments for age, gender, levels of education, physical functioning and depressive symptoms. A total of 2237 community dwelling older adults aged 60 years and above were randomly selected for the study, excluding those with MMSE score below 14. Instruments administered were the MoCA-BM, the Malay Mini-Mental State Examination (MMMSE), the Rey Auditory Verbal Learning Test (RAVLT), the Digit Span and the Digit Symbol subtests of the Wechsler Adult Intelligence Scale (WAIS), activities of daily living (ADL) and the Geriatric Depression Scale (GDS). MCI were determined using the Petersen’s 2014 criteria as the gold standard. SPSS version 22 was used for reliability and validity analysis and optimal cut-off score detection. Cronbach’s α of the MoCA-BM was 0.691 and concurrent validity was high between MoCA-BM and MMMSE scores (r=0.741). Optimal cut-off point for MoCA-BM to detect MCI among older adults in Malaysia was 17/18, with sensitivity of 68.2% and specificity of 61.3%. Using this cut-off, 38.9% of participants were detected to be at risk of MCI. In conclusion, MoCA-BM is a reliable and valid screening instrument for MCI among Malaysian elderly community. The newly derived optimal cut-off for MCI is much lower than the original MoCA with modest ability to discriminate between normal and MCI older adults in the community

Projek perintis album memori digital untuk warga tua demensia ringan dan sederhana di Malaysia – satu kajian kebolehlaksanaan

Peningkatan trend menggunakan informasi dan komunikasi teknologi dalam penyampaian proses kenangan pada orang yang mengidap demensia semakin ketara. Kajian ini bertujuan untuk meninjau kesesuaian penggunaan Album Memori Digital (DMA) dalam proses kenangan dan seterusnya mengkaji manfaat psikososial penggunaan DMA ini pada warga tua demensia yang tinggal di komuniti. Kaedah: Kajian ini menglibatkan lima peserta berdemensia ringan dan sederhana dan penjaga utama mereka. Setiap peserta berpeluang untuk mengenang kisah hidup mereka dengan seorang terapis selama 8 minggu berturut-turut dengan menggunakan Life Review Experience Form (LREF). Justerus itu, kisah hidup individu berdigital setiap peserta digubalkan. Proses ini juga direkodkan secara audio. Kisah hidup berdigital ini disampaikan dengan format multimedia dan disiarkan dengan menggunakan DMA. DMA ini diberikan kepada peserta sebagai hadiah. Data kualitatif dikumpulkan sejurus selepas penggubalan DMA dan 6 minggu kemudian. Keputusan: Analisis rekod audio dan data interview menunjukkan DMA memberikan kesan-kesan positif psikososial pada peserta termasuk keseronokan, keselesaan, merangsang memori jangka panjang dan meningkatkan komunikasi dan interaksi sosial di antara ahli-ahli keluarga dan rakan-rakan mereka. Penjaga-penjaga utama turut menyatakan DMA membantu mereka memahami dan mengimbas kembali masa lepas orang kesayangan mereka. DMA turut mengalihkan fokus penjaga pada keupayaan peserta daripada kelemahan mereka. Kesimpulan: Kajian ini menunjukkan kesesuaian penggunaan DMA dalam meningkatkan kesan positif psikososial pada individu yang demensia di Malaysi

Validation study of the Mini-Mental State Examination in a Malay-speaking elderly population in Malaysia

Background/Aims: In view of the differing sensitivity and specificity of the Mini-Mental State Examination (MMSE) in the non-English-speaking populations, we conducted the first validation study of the Malay version (M-MMSE) in Malaysia among 300 subjects (from the community and outpatient clinics). Methods: Three versions were used: M-MMSE-7(serial 7), M-MMSE-3 (serial 3) and M-MMSE-S (spell ‘dunia’backwards). Dementia was assessed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders IV . The optimal cutoff scores were obtained from the receiver operating characteristics curves. Results: Seventy-three patients (24.3%) had dementia and 227 (75.7%) were controls. Three hundred patients completed the M-MMSE-7, 160 the MMMSE-3 and 145 the M-MMSE-S. All 3 versions were valid and reliable in the diagnosis of dementia. The optimal cutoff scores varied with each version and gender. In the control group, significant gender differences were observed in the patients with the lowest educational status. Increasing educational levels significantly improved the M-MMSE performance in both genders. Conclusion: All 3 versions of the M-MMSE are valid and reliable as a screening tool for dementia in the Malaysian population, but at different cutoff scores.In those with the lowest educational background, gender adjusted cutoff scores should be applied

Factor analysis study on sexual responses in women with Type 2 diabetes mellitus

Aims: This study compared the components of sexual responses between Malaysian women with Type 2 diabetes mellitus and those without the disease. Methods: This cross-sectional study measured sexual responses by using the validated Malay version of Female Sexual Function Index. A factor analysis with varimax rotation method was employed using principal component analysis to explore the correlation structure of the different domains of sexual responses between the two groups. Components of sexual responses were obtained using Kaiser's criteria and compared between those in the diabetic and non-diabetic groups. Results: A total of 353 women (178 with diabetes and 175 without diabetes) were recruited. Three components of sexual responses emerged from the analysis in the study and control groups. Sexual pain was found to form a component together with lubrication and orgasm domains among the women with diabetes, unlike those without diabetes, where pain stood on its own. Sexual desire and arousal formed one component and satisfaction formed another in both groups. Conclusions: The domains in the sexual responses of Malaysian women were highly overlapping. It is concluded that the presence of pain as part of lubrication and orgasm component in women with diabetes indicates the importance of intact genital sensation, even though an adverse type of sensation, for vaginal congestion and orgasm to occur in this group of women

Influence of gender disparity in predicting occurrence of successful aging, usual aging and mild cognitive impairment

Background: The aim of this study was to investigate the prevalence of successful aging, usual aging and mild cognitive impairment among older men and women, and further determine the influence of gender in predicting cognitive decline. Method: A total of 1,993 respondents aged 60 years old and above were selected through a multi-stage random sampling method from Johor, Kelantan, Selangor and Perak. The respondents were interviewed to obtain information on socio-demography, diet, cognitive functions, psychosocial conditions and lifestyle. Subjects were classified in either the category of successful aging, usual aging and mild cognitive impairment. Results: The predictors of cognitive decline among men were poor upper body flexibility and lower body strength, higher fasting blood sugar, hyperlipidaemia, lower education level, and poor participation in mechanical repairing activities. Meanwhile, hyperlipidaemia, not adhering to calorie restrictions, poor lower body flexibility, disabilities and lower education status were the risk factors for memory impairment among women. Conclusion: Specific gender-tailored interventions are essential for preventing or managing cognitive decline among older adults and preserving mental healt

Clinical and cognitive correlates of employment among patients with schizophrenia: a cross-sectional study in Malaysia

<p>Abstract</p> <p>Background</p> <p>Gainful employment is one major area of functioning which is becoming an important goal in psychiatric rehabilitation of patients with schizophrenia. Studies in western countries are pointing to evidence that certain sociodemographic and clinical factors may contribute to employment outcomes in this group of people. However, the area is still largely unexplored in Malaysia. The aim of this study was to examine the sociodemographic, clinical and cognitive correlates of employment status among patients with Schizophrenia.</p> <p>Methods</p> <p>This was a cross-sectional study. All participants who fulfilled the requirements of the study according to the inclusion and exclusion criteria were enrolled. Study instruments included a demographic data questionnaire, Positive and Negative Symptom Scale (PANSS), Trail Making Tests, Rey's Auditory Verbal Learning Test (RAVLT) and Digit Span. Bivariate analyses were done using chi-square for categorical data and t-test for continuous data and multiple logistic regression analysis was done to identify predictors of employment status.</p> <p>Results</p> <p>A total of 95 participants who fulfilled the inclusion criteria were enrolled into the study. Among the sociodemographic, clinical and cognitive variables studied marital status, educational level, mean scores of negative symptoms, Digit Span and RAVLT and Trail Making Tests were found to show significant association with employment status on bivariate analyses. However, when entered into a logistic regression model, only cognitive variables ie. Trail A and B, Digit Span and RAVLT were significant predictors of employment status.</p> <p>Conclusions</p> <p>The results from this study support the role of cognitive function, particularly, attention, working memory and executive functioning on attaining and maintaining employment in persons with schizophrenia as measured by the RAVLT, Digit Span and Trail Making Tests. These findings may act as preliminary evidence suggesting the importance of integrating cognitive rehabilitation in the psychosocial rehabilitation program for patients with schizophrenia in Malaysia.</p

Psychiatric comorbidity among community-based, treatment seeking opioid dependents in Klang Valley

The main objectives in this study were to determine the percentage of psychiatric comorbidity among treatment seeking opioid dependents in Klang Valley. A cross sectional study of opioid dependence patients was conducted between December 2007 and May 2008 at ten community-based drug substitution therapy clinics in Klang Valley. A total of 204 opioid dependence patients participated in the study using the structured clinical interview for DSM-IV Axis I disorders (SCID-I) as its instruments. The percentage of psychiatric comorbidity among opioid dependents was 43.6%. Major depressive disorder had the highest prevalence at 32.6%, followed by dysthymia at 23.6% and Panic disorder at 14.6%. Psychiatric comorbidity were found to have significant differences (p<0.05) in connection with history of polysubstance abuse, previous history of court sentences (legal status) and family history of psychiatric illnesses. This study showed that the percentage of psychiatric comorbidity is high among the opioid dependents. It highlights the urgent need for the psychiatric comorbidity to be assessed and early intervention is important for this group of patients

Clinical overlap between progressive supranuclear palsy (PSP) and frontotemporal dementia (FTD) in an elderly patient with earlier depression and psychosis

Overlapping of symptoms frequently occur in progressive supranuclear palsy (PSP), frontotemporal dementia (FLD) and corticobasal degeneration (CBD). Apathy, behavioral changes, cognitive impairment, prominent parkinsonism, impaired mobility and falls are ‘‘classical’’ features of this clinical spectrum of taupathies, with no definite disease-modifying treatmen