Displaying publications 1 - 20 of 34 in total

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  1. Lai, M.H., Tan, Susan M.K.
    ASEAN Journal of Psychiatry, 2014;15(1):101-105.
    MyJurnal
    Objective: This case report highlights the complexity of eating disorder in schizophrenia and outlines the diagnostic dilemma and challenges associated with the treatment. Methods: We report a 13 years old female with early onset schizophrenia who developed anorexic symptoms and binge eating. Her eating disturbances worsened after olanzapine was commenced. Results: A combination of pharmacological and psychosocial intervention led to remission of schizophrenia co-morbid with eating disorder NOS. Conclusion: Co-morbid diagnosis of schizophrenia and eating disorder is not uncommon. Early diagnosis and evidence-based intervention are imperative as untreated illness greatly impacts the developmental trajectory of young people. Meeting family’s needs improves family functioning which in turn improves patient’s outcome. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 101-105.
    Matched MeSH terms: Benzodiazepines
  2. Lee C, Wu KH, Habil H, Dyachkova Y, Lee P
    Aust N Z J Psychiatry, 2006 May;40(5):437-45.
    PMID: 16683970
    To examine clinical outcomes in Asian patients with schizophrenia receiving monotherapy with olanzapine, risperidone or typical antipsychotics in naturalistic settings.
    Matched MeSH terms: Benzodiazepines/adverse effects; Benzodiazepines/therapeutic use
  3. Fan PC, Lai TH, Hor CC, Lee MT, Huang P, Sieghart W, et al.
    Neuropharmacology, 2018 09 15;140:1-13.
    PMID: 30016665 DOI: 10.1016/j.neuropharm.2018.07.017
    Novel treatments against migraine are an urgent medical requirement. The α6 subunit-containing GABAA receptors (α6GABAARs) are expressed in trigeminal ganglia (TG), the hub of the trigeminal vascular system (TGVS) that is involved in the pathogenesis of migraine. Here we reveal an unprecedented role of α6GABAARs in ameliorating TGVS activation using several pharmacological approaches in an animal model mimicking pathological changes in migraine. TGVS activation was induced by intra-cisternal (i.c.) instillation of capsaicin in Wistar rats. Centrally, i.c. capsaicin activated the trigeminal cervical complex (TCC) measured by the increased number of c-Fos-immunoreactive (c-Fos-ir) TCC neurons. Peripherally, it elevated calcitonin gene-related peptide immunoreactivity (CGRP-ir) in TG and depleted CGRP-ir in the dura mater. Pharmacological approaches included a recently identified α6GABAAR-selective positive allosteric modulator (PAM), the pyrazoloquinolinone Compound 6, two α6GABAAR-active PAMs (Ro15-4513 and loreclezole), an α6GABAAR-inactive benzodiazepine (diazepam), an α6GABAAR-selective antagonist (furosemide), and a clinically effective antimigraine agent (topiramate). We examined effects of these compounds on both central and peripheral TGVS responses induced by i.c. capsaicin. Compound 6 (3-10 mg/kg, i.p.) significantly attenuated the TCC neuronal activation and TG CGRP-ir elevation, and dural CGRP depletion induced by capsaicin. All these effects of Compound 6 were mimicked by topiramate, Ro15-4513 and loreclezole, but not by diazepam. The brain-impermeable furosemide antagonized the peripheral, but not central, effects of Compound 6. These results suggest that the α6GABAAR in TG is a novel drug target for TGVS activation and that α6GABAAR-selective PAMs have the potential to be developed as a novel pharmacotherapy for migraine.
    Matched MeSH terms: Benzodiazepines/pharmacology
  4. Mohamad FH, Has ATC
    J Mol Neurosci, 2019 Feb;67(2):343-351.
    PMID: 30607899 DOI: 10.1007/s12031-018-1246-4
    GABAA receptors are the major inhibitory neurotransmitter receptor in the human brain. The receptors are assembled from combination of protein subunits in pentameric complex which may consist of α1-6, β1-3, γ1-3, ρ1-3, δ, ε, θ, or π subunits. There are a theoretical > 150,000 possible assemblies and arrangements of GABAA subunits, although only a few combinations have been found in human with the most dominant consists of 2α1, 2β2, and 1γ2 in a counterclockwise arrangement as seen from the synaptic cleft. The receptors also possess binding sites for various unrelated substances including benzodiazepines, barbiturates, and anesthetics. The α5-containing GABAARs only make up ≤ 5% of the entire receptor population, but up to 25% of the receptor subtype is located in the crucial learning and memory-associated area of the brain-the hippocampus, which has ignited myriads of hypotheses and theories in regard to its role. As well as exhibiting synaptic phasic inhibition, the α5-containing receptors are also extrasynaptic and mediate tonic inhibition with continuously occurring smaller amplitude. Studies on negative-allosteric modulators for reducing this tonic inhibition have been shown to enhance learning and memory in neurological disorders such as schizophrenia, Down syndrome, and autism with a possible alternative benzodiazepine binding site. Therefore, a few α5 subunit-specific compounds have been developed to address these pharmacological needs. With its small population, the α5-containing receptors could be the key and also the answer for many untreated cognitive dysfunctions and disorders.
    Matched MeSH terms: Benzodiazepines
  5. Singh D, Narayanan S, Grundmann O, Boyer EW, Vicknasingam B
    J Psychoactive Drugs, 2019 06 20;52(1):86-92.
    PMID: 31218929 DOI: 10.1080/02791072.2019.1632505
    The leaves from Mitragyna speciosa (Korth.) trees, also known as kratom, are traditionally used in Southeast Asia as a mild psychotropic agent. We investigated the demographic characteristics of persons who used both kratom cocktail and benzodiazepines (BZO) in a sample drawn from a rural area in Penang, Malaysia, and the reasons for BZO use. Seventy-seven participants who currently use a kratom cocktail along with BZO were recruited through snowball sampling for this cross-sectional study. The participants were male, and the majority were Malays (99%, n = 76/77), single (57%, n = 44/77) and employed (91%, n = 70/77). BZO was used with kratom cocktail 1) to increase euphoria; 2) to reduce dependence on methamphetamine; 3) to promote sleep; 4) to ease methamphetamine-associated psychological symptoms and 5) to decrease the craving for kratom. There were no significant differences in the intake of kratom use (p = .751), BZO use duration (p = .259), frequency (p = .188) and quantity (p = .888) of BZO use in the last 7 days, and quantity of BZO use in the last 30 days (p = .337) between kratom users and kratom poly-drug users. An awareness of the health consequences of the co-use of kratom with BZO is needed to prevent untoward health incidents.
    Matched MeSH terms: Benzodiazepines
  6. Abdullah JM, Zhang J
    Mini Rev Med Chem, 2013 Apr 01;13(5):744-8.
    PMID: 23373649
    The γ-aminobutyric acid (GABA) A receptor is composed of a variety of subunits and combinations and shows a characteristic distribution in the CNS. To date, 20 subunits of the GABA A receptor have been cloned: α1-6, β1-4, γ1-3, δ, π, ε , Θ, and ρ1-3. Oocyte of Xenopus laevis is one of the most frequently used heterologous expression systems, which are used to design and analyze specific combinations of GABA A receptor subunits. In oocytes, a certain GABA A receptor function is studied only by comparing the amplitude of the response to GABA and other drugs by physiological and pharmacological methods. According to the studies on Xenopus laevis oocytes, the α1β2γ2S receptor combination is mostly used. The α1-containing receptors mediate sedative and anticonvulsant acts. The results of studies on oocytes show that PKA, NKCC1, P2X3 receptors, and GABA A receptor-associated protein, etc., are existing systems that show different reactivity to the GABA A receptors. The GABA A receptor subunits contain distinct binding sites for BZDs, neurosteroids, general anesthetics, etc., which are responsible for the numerous functions of the GABA A receptor. A variety of other drugs, such as topiramate, TG41, (+)- and (-)-borneol, apigenin, and 6-methylflavone could also have modulatory effects on the GABA A receptors. Some of the different models and hypotheses on GABA A receptor structure and function have been achieved by using the two-electrode voltage clamp method in oocytes.
    Matched MeSH terms: Benzodiazepines/metabolism; Benzodiazepines/chemistry
  7. Chander S, Tang CR, Al-Maqtari HM, Jamalis J, Penta A, Hadda TB, et al.
    Bioorg Chem, 2017 06;72:74-79.
    PMID: 28371664 DOI: 10.1016/j.bioorg.2017.03.013
    In the present study, a series of fourteen 5-benzoyl-4-methyl-1,3,4,5-tetrahydro-2H-1,5-benzodiazepin-2-one derivatives were designed, synthesized and characterized by appropriate spectral analysis. Further, titled compounds were in-vitro screened against wild HIV-1 RT enzyme using ELISA based colorimetric assay, in which four compounds significantly inhibited the RT activity with IC50≤25µM. Moreover, two significantly active compounds of the series, A10 and A11 exhibited IC50 values 8.62 and 6.87µM respectively, during the in-vitro assay. Structure Activity Relationship (SAR) studies were performed for the synthesized compounds in order to estimate the effect of substitution pattern on the RT inhibitory potency. The cytotoxicity of the synthesized compounds was evaluated against T lymphocytes. Further, putative binding modes of the significantly active (A11) and the least active (A4) compounds with wild HIV-1 RT were also investigated using docking studies.
    Matched MeSH terms: Benzodiazepines/chemical synthesis; Benzodiazepines/pharmacology*; Benzodiazepines/chemistry
  8. Saifuddin, T.M., Amilin, N., Zafri, A.
    MyJurnal
    Huntington disease (HD) is a neurodegenerative disorder with psychiatric, cognitive, and motor symptoms. Psychiatric symptoms often manifest years before neurologic signs in HD patients. The present of psychiatric symptoms might increase risk of suicide in HD patient. We presented a case of HD who admitted to Psychiatry ward due to suicidal attempt and shows improvement with low dose of Olanzapine.
    Matched MeSH terms: Benzodiazepines
  9. Rusdi Abd. Rashid, Ahmad Hatim Sulaiman, Nor Zuraida Zainal, Noorzurani Robson, Mas Ayu Said, Mohammad Hussain Habil, et al.
    ASEAN Journal of Psychiatry, 2010;11(1):72-78.
    MyJurnal
    Objectives: The objective of the study is to determine the prevalence of substance abuse for alcohol, cannabis, opiates, stimulants, solvent and other substances among patients with schizophrenia in Hospital Bahagia Ulu Kinta (HBUK), Perak , Central Peninsular of Malaysia. This study also aims to determine the association of substance abuse with aggression, the demographic characteristics and total duration of hospitalization.
    Methods: This was a retrospective cross-sectional study whereby the first 194 subjects diagnosed to have schizophrenia based on International Classification of Disease, 10th edition (ICD-10) criteria were taken from data registry of patients admitted to HBUK from January until February 2004. The subjects’ medical files were examined for documentation of substances abuse, aggression and accumulative duration of hospitalization.
    Results: The results showed the prevalence of substances misuse among patients with schizophrenia in general (including alcohol) was 24.7%. Cannabis 16.7%, alcohol 13.4%, opiates(heroin) 6.7%, Amphetamine type stimulants (amphetamine, metamphetamine, ecstacy) 5.7%, and other substances (benzodiazepine, solvents) 1.5%.
    Conclusion: There is higher prevalence of substance misuse in patients with schizophrenia as compared to general population. Male patients with history of substance misuse are more likely to have aggression than female. This group needs special precaution and probably in need of specialist help.
    Matched MeSH terms: Benzodiazepines
  10. Hatim, A., Yen, T.H.
    JUMMEC, 2006;9(1):23-29.
    MyJurnal
    The objective of this study was to compare in-patient drug use patterns, costs, and outcomes associated with risperidone or olanzapine in a naturalistic clinical setting. Retrospective chart reviews of 92 patients with psychotic disorders were conducted at the University of Malaya Medical Centre (UMMC). Data was collected from patients who were hospitalized and for whom risperidone or olanzapine was the drug of first choice for long-term pharmacologic treatment. Proportion of patients for whom efficacy of the studied treatment could be established (as rated by the treating physician) was higher, but not significantly, with risperidone compared to olanzapine (p = 0.46). The average dose of the studied medication was 2.9 ± 1.0 mg/day for risperidone and 9.7 ± 2.4 mg/day for olanzapine. The total cost was significantly higher (p
    Matched MeSH terms: Benzodiazepines
  11. Dong M, Zeng LN, Zhang Q, Yang SY, Chen LY, Najoan E, et al.
    Asian J Psychiatr, 2019 Oct;45:74-80.
    PMID: 31520884 DOI: 10.1016/j.ajp.2019.08.010
    OBJECTIVE: Regular surveys are important to monitor the use of psychotropic medications in clinical practice. This study examined the psychotropic prescription patterns in adult Asian schizophrenia patients based on the data of the Research on Asian Psychotropic Prescription (REAP) 2016 survey.

    METHODS: This cross-sectional survey across 15 Asian countries/territories collected socio-demographic and clinical data with standardized procedures between March and May 2016. The socio-demographic and clinical characteristics of the patients were recorded with a standardized questionnaire.

    RESULTS: Altogether 3,537 adult patients with schizophrenia were consecutively screened and enrolled in the survey. The mean age was 38.66 ± 11.55 years and 59.7% of the sample were male. The mean dose of antipsychotics in chlorpromazine equivalents (CPZeq) was 424 ± 376 mg/day; 31.3% and 80.8% received first- and second- generation antipsychotics, respectively and 42.6% had antipsychotic polypharmacy, 11.7% had antidepressants, 13.7% had mood stabilizers, 27.8% had benzodiazepines, and 45.6% had anticholinergics.

    CONCLUSIONS: Psychotropic prescription patterns in Asian adult patients with schizophrenia varied across countries. Regular surveys on psychotropic medications for schizophrenia are important to monitor pharmacotherapy practice in Asia.

    Matched MeSH terms: Benzodiazepines/therapeutic use
  12. Muthupalaniappen L, Rosdinom R, Suguna M
    Clin Ter, 2012;163(1):31-2.
    PMID: 22362231
    Pisa syndrome or pleurothotonus is the persistent flexion of the body and head to one side giving the appearance of the leaning tower of Pisa. It is most commonly caused by typical and atypical antipsychotic drugs. We report a case of Pisa Syndrome caused by prolonged use of high dose cholinesterase inhibitor, rivastigmine. Symptoms subsided when rivastigmine was withdrawn and did not reappear when a different cholinesterase inhibitor, donepezil was introduced. Physicians should be aware of Pisa syndrome and should alert patient of this possibility when starting and stepping up medications. The purpose of reporting this case is to create awareness among general practitioners as it is a reversible condition which responds to removal of the offending drug.
    Matched MeSH terms: Benzodiazepines/adverse effects; Benzodiazepines/therapeutic use
  13. Zain MA, Jahan SN, Reynolds GP, Zainal NZ, Kanagasundram S, Mohamed Z
    BMC Med Genet, 2012;13:91.
    PMID: 23031404 DOI: 10.1186/1471-2350-13-91
    One of the genes suggested to play an important role in the pathophysiology of bipolar disorder (BPD) is PDLIM5, which encodes LIM domain protein. Our main objective was to examine the effect of olanzapine treatment on PDLIM5 mRNA expression in the peripheral blood leukocytes of BPD patients.
    Matched MeSH terms: Benzodiazepines/therapeutic use*
  14. Navaratnam V, Foong K
    Curr Med Res Opin, 1990;11(10):620-30.
    PMID: 1968829
    In a recent epidemiological study of 249 opiate addicts in the State of Penang, Malaysia, the use of benzodiazepines, its temporal relationship to opiate addiction and the reasons for use of benzodiazepines were examined. Just over a half of the opiate addicts indicated use of benzodiazepines in their lifetime. Use of 7 different benzodiazepines was reported, among them flunitrazepam most frequently. A substantial proportion had discontinued the use of benzodiazepines after initial experimentation. Just over a quarter had used them in the last 24 hours. Benzodiazepine use starts on average 3 to 6 years later than heroin use. The most common reason cited for benzodiazepine use was to enhance the feeling of 'high' from the opiates. These findings can be explained, at least partly, by economic factors. Reasons that could be qualified as attempts to autotherapy did not exceed 20%. None of the opiate addicts had reported isolated benzodiazepine use for fun and pleasure. From the time course of use as well as from the reasons given by the addicts, it is evident that benzodiazepines are not primary drugs of abuse. Comparing their figures from Malaysia with figures from Germany and England the authors cannot explain the preferred use of flunitrazepam by Malaysian addicts by the existence of special properties of this substance.
    Matched MeSH terms: Benzodiazepines
  15. Pang N, Thrichelvam N, Naing KO
    East Asian Arch Psychiatry, 2017 Mar;27(1):35-7.
    PMID: 28387211
    Unlike clozapine, and despite its structural similarities, olanzapine is not usually associated with haematological suppression. Nonetheless this case report highlights an incident of olanzapine-induced thrombocytopenia and neutropenia in a first-contact patient. We report on a 50-year-old male who presented with 7 years of delusions and hallucinations. A diagnosis of schizophrenia was made in the absence of any suggestive features of mood disorders, substance abuse or organicity, and olanzapine as second-line treatment. Within a week of starting treatment he developed biochemical neutropenia and thrombocytopenia without any clinical symptoms that resolved after cessation of the offending drug. An organic workup for infective, inflammatory, and neoplastic causes was unremarkable. Comparison with other case reports and 3 postulated mechanisms are discussed. Despite its comparative rarity, the addition of this case report to a growing corpus suggests that clinicians should maintain heightened surveillance of patients prescribed olanzapine, to identify any untoward iatrogenic haematological abnormalities or immunosuppression.
    Matched MeSH terms: Benzodiazepines/adverse effects*
  16. Puttegowda B, Theodore J, Basappa R, Nanjappa MC
    Malays J Med Sci, 2016 Mar;23(2):82-4.
    PMID: 27547120
    A 28-year-old male patient with bipolar disorder taking olanzapine and lorazepam for almost 10 years presented with weight gain, diabetes, and anasarca was examined in this study. Evaluation of the patient revealed he was in heart failure. The reason for his heart failure was ambiguous and an investigation into it revealed negative results. Literature search conducted showed a few reported cases of putative olanzapine induced cardiomyopathy. One such relatively rare case is presented here.
    Matched MeSH terms: Benzodiazepines
  17. Amer Siddiq Amer Nordin, Azreen Hashim, Mohamad Hussain Habil, Noor Zurani Md Haris Robson
    ASEAN Journal of Psychiatry, 2010;11(1):108-112.
    MyJurnal
    Objective: This case report highlights the abuse and dependence potential of Zolpidem and the risk of life-threatening withdrawal symptoms upon abrupt discontinuation. Method: We report a case of Zolpidem dependence which presented with withdrawal symptoms upon abrupt discontinuation. Results: A 32 year old male, who had abused non-benzodiazepine Zolpidem for 6 years presented to the accident and emergency unit with generalized seizures upon stopping Zolpidem ‘cold turkey’. He required admission to the neurology high dependency unit for stabilization of the seizures and was later managed by the addiction team where a tapering dose of benzodiazepine was prescribed. Conclusion: This case demonstrates that non-benzodiazepine agents can cause tolerance and dependence, and thus produce withdrawal symptoms upon discontinuation.
    Matched MeSH terms: Benzodiazepines
  18. Chong HY, Lim KS, Fong SL, Shabaruddin FH, Dahlui M, Mei Lai PS, et al.
    Br J Clin Pharmacol, 2023 Nov;89(11):3340-3351.
    PMID: 37294011 DOI: 10.1111/bcp.15818
    AIMS: Despite the availability of newer antiseizure medications, carbamazepine (CBZ) remains the gold standard. However, patients of Asian ancestry are susceptible to CBZ-related severe cutaneous adverse reactions. Universal HLA-B*15:02 screening is a promising intervention to address this. With the increasing recognition of integrating real-world evidence in economic evaluations, the cost-effectiveness of universal HLA-B*15:02 screening was assessed using available real-world data in Malaysia.

    METHODS: A hybrid model of a decision tree and Markov model was developed to evaluate 3 strategies for treating newly diagnosed epilepsy among adults: (i) CBZ initiation without HLA-B*15:02 screening (current practice); (ii) universal HLA-B*15:02 screening prior to CBZ initiation; and (iii) alternative prescribing without HLA-B*15:02 screening. The model was populated with real-world inputs derived from the Malaysian population. From a societal perspective, base-case analysis and sensitivity analyses estimated the costs and outcomes over a lifetime. Incremental cost-effectiveness ratios were calculated.

    RESULTS: In the base-cases analysis, universal HLA-B*15:02 screening yielded the lowest total costs and the highest total quality-adjusted life years (QALYs) gained. Compared with current practice, universal screening was less costly by USD100 and more effective by QALYs increase of 0.1306, while alternative prescribing resulted in 0.1383 QALYs loss at additional costs of USD332. The highest seizure remission rate (56%) was estimated for universal HLA-B*15:02 screening vs. current practice (54%) and alternative prescribing (48%).

    CONCLUSION: Our study suggests that universal HLA-B*15:02 screening is a cost-effective intervention in Malaysia. With the demonstrated value of real-world evidence in economic evaluations, more relevant standardization efforts should be emphasized to better inform decision-making.

    Matched MeSH terms: Benzodiazepines/therapeutic use
  19. Seed, H.F., Thong, K.S., Siti-Nor Aizah, A.
    MyJurnal
    Although disturbance of consciousness in delirium patients have been well
    established, but sudden drop of Glasgow Coma Scale (GCS) level to three is
    frightening and mysterious. We are reporting a case of a delirious elderly
    man with multiple medical illnesses presented with acute precipitous
    decrement of GCS with pin point pupils bilaterally after given a course of
    benzodiazepines and regained full consciousness spontaneously 32 hours
    later. We discussed the use of deliriogenic medications in the context of
    delirious elderly gentleman with multiple medical illnesses. We also looked
    into the possible differentials of sudden drop of conscious level with bilateral
    pin point pupils.
    Matched MeSH terms: Benzodiazepines
  20. Has ATC, Chebib M
    Curr Pharm Des, 2018;24(17):1839-1844.
    PMID: 29766792 DOI: 10.2174/1381612824666180515123921
    GABAA receptors are members of the Cys-loop family of ligand-gated ion channels which mediate most inhibitory neurotransmission in the central nervous system. These receptors are pentameric assemblies of individual subunits, including α1-6, β1-3, γ1-3, δ, ε, π, θ and ρ1-3. The majority of receptors are comprised of α, β and γ or δ subunits. Depending on the subunit composition, the receptors are located in either the synapses or extrasynaptic regions. The most abundant receptors are α1βγ2 receptors, which are activated and modulated by a variety of pharmacologically and clinically unrelated agents such as benzodiazepines, barbiturates, anaesthetics and neurosteroids, all of which bind at distinct binding sites located within the receptor complex. However, compared to αβγ, the binary αβ receptors lack a benzodiazepine α-γ2 interface. In pentameric αβ receptors, the third subunit is replaced with either an α1 or a β3 subunit leading to two distinct receptors that differ in subunit stoichiometry, 2α:3β or 3α:2β. The consequence of this is that 3α:2β receptors contain an α-α interface whereas 2α:3β receptors contain a β-β interface. Apart from the replacement of γ by α1 or β3 in binary receptors, the incorporation of ε subunit into GABAA receptors might be more complicated. As the ε subunit is not only capable of substituting the γ subunit, but also replacing the α/β subunits, receptors with altered stoichiometry and different pharmacological properties are produced. The different subunit arrangement of the receptors potentially constructs novel binding sites which may become new targets of the current or new drugs.
    Matched MeSH terms: Benzodiazepines/pharmacology*
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