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Rapid response to methylphenidate as an add-on therapy to mirtazapine in the treatment of major depressive disorder in terminally ill cancer patients: a four-week, randomized, double-blinded, placebo-controlled study

Ng CG, Boks MP, Roes KC, Zainal NZ, Sulaiman AH, Tan SB, et al.

Eur Neuropsychopharmacol, 2014 Apr;24(4):491-8.
PMID: 24503279 DOI: 10.1016/j.euroneuro.2014.01.016

This is a 4 week, randomized, double-blind, placebo-controlled study to examine the effects of methylphenidate as add-on therapy to mirtazapine compared to placebo for treatment of depression in terminally ill cancer patients. It involved 88 terminally ill cancer patients from University of Malaya Medical Centre, Kuala Lumpur, Malaysia. They were randomized and treated with either methylphenidate or placebo as add on to mirtazapine. The change in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to day 3 was analyzed by linear regression. Changes of MADRS and Clinical Global Impression-Severity Scale (CGI-S) over 28 days were analyzed using mixed model repeated measures (MMRM). Secondary analysis of MADRS response rates, defined as 50% or more reduction from baseline score. A significantly larger reduction of Montgomery-Åsberg Depression Rating Scale (MADRS) score in the methylphenidate group was observed from day 3 (B=4.14; 95% CI=1.83-6.45). Response rate (defined as 50% or more reduction from baseline MADRS score) in the methylphenidate treated group was superior from day 14. Improvement in Clinical Global Impression-Severity Scale (CGI-S) was greater in the methylphenidate treated group from day 3 until day 28. The drop-out rates were 52.3% in the methylphenidate group and 59.1% in the placebo group (relative risk=0.86, 95%CI=0.54-1.37) due to cancer progression. Nervous system adverse events were more common in methylphenidate treated subjects (20.5% vs 9.1%, p=0.13). In conclusions, methylphenidate as add on therapy to mirtazapine demonstrated an earlier antidepressant response in terminally ill cancer patients, although at an increased risk of the nervous system side effects.

Matched MeSH terms: Depressive Disorder, Major/drug therapy*
Fulltext Psychological Distress Among Infertile Women: Exploring Biopsychosocial Response To Infertility

Zuraida, A.S.

Malaysian Journal of Psychiatry, 2010;19(2):1-11.
MyJurnal

Previous studies have shown that the experience of infertility is linked with psychological responses such as depression, anxiety, guilt, social isolation, and decreased self-esteem in both men and women. The prevalence of depression among infertile women ranges from 8% to 54%. Treating gynecologists and healthcare professionals seldom recognized the psychosocial distress in women undergoing fertility treatment. Therefore this paper reviewed the bio-psychosocial response towards infertility among women with infertility.

Matched MeSH terms: Depressive Disorder
Fulltext A Brief Psychotic Episode with Depressive Symptoms in Silent Right Frontal Lobe Infarct

Badrin S, Mohamad N, Yunus NA, Zulkifli MM

Korean J Fam Med, 2017 Nov;38(6):380-382.
PMID: 29209479 DOI: 10.4082/kjfm.2017.38.6.380

Psychiatric symptoms may be related to a silent cerebral infarct, a phenomenon that has been described previously in literature. Acute psychosis or other neuropsychiatric symptoms including depression may present in stroke patients and patients with lesions either within the prefrontal or occipital cortices, or in subcortical areas such as the basal ganglia, thalamus, mid-brain, and brainstem. Psychosis in clinical stroke or in silent cerebral infarction is uncommon and not well documented in the literature. Neurological deficits are the most common presentation in stroke, and nearly a third of patients that suffer a stroke may experience psychological disorders such as depression and anxiety, related to physical disability. The present case report describes an elderly female patient who presented with hallucinations and depressive symptoms, and was discovered to have a recent right frontal brain infarction, without other significant neurological deficits.

Matched MeSH terms: Depressive Disorder
Fulltext Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS)

Ramli Musa, Mohd Ariff Fadzil, Zaini Zain

ASEAN Journal of Psychiatry, 2007;8(2):82-89.
MyJurnal

Background: Up to date, there are handful questionnaires that have been validated in Bahasa Malaysia (BM). This study aimed to translate the Depression Anxiety Stress Scales 21-item (DASS-21) and measure its psychometric properties. Objectives: To determine the construct validity and acceptability of the DASS, BM. Methods: Two forward and backward translations were done in BM in accordance to guideline, and its validation was determined by using confirmatory factor analysis. A total of 263 subjects were selected by systematic random sampling to represent Malaysian population for reliability and validity purposes. Results: The BM DASS-21 had very good Cronbach’s alpha values of .84, .74 and .79, respectively, for depression, anxiety and stress. In addition, it had good factor loading values for most items (.39 to .73). Correlations among scales were between .54 and .68. Conclusions: BM DASS-21 is correctly and adequately translated to Bahasa Malaysia with high psychometric properties. Further studies are required to support these findings.

Matched MeSH terms: Depressive Disorder
Fulltext Depression In Parkinson Disease: Clinical Features And Aetiology

Chan, Y.F., Zainal, N.Z.

Malaysian Journal of Psychiatry, 2010;19(1):1-11.
MyJurnal

Parkinson Disease (PD) is a neurodegenerative disorder of the central nervous system that often impairs the patient’s motor skills, speech and other functions. The four cardinal signs of parkinsonism are resting tremor, bradykinesia, cogwheel rigidity and postural instability. The prevalence of depression in PD ranges from 4% to 75%. However depression in PD is often mistakenly as the presentation of the disease itself. Therefore this paper reviewed the clinical feature of depression in PD and explored the aetiology of depression in PD.

Matched MeSH terms: Depressive Disorder
Fulltext Relationship of Depressive Symptoms to Hypertension in a Household Survey

Lam, H.H., Ng, E.K., Ooi, A.L., Ooi, P.Y., Sellymiah, A., Siti Fareeda, A., et al.

Malaysian Journal of Psychiatry, 2011;20(1):1-12.
MyJurnal

Objectives: To study relationship of depressive symptoms to hypertension. Methods: A cross sectional study was carried out on respondents from Kampung Awal. Hypertension was defined as self-reported or by measurement using a mercury sphymomanometer and depressive symptoms were evaluated by CES-D scale. Results: A total 103 respondents were studied. The male:female ratio was 1:1.5 with mean age of 41.8 years. Majority had formal education up to secondary school. 45% were government servant and over 95% subjects had income of RM1000 or less per each family member per month. 21.4% (n=22) self-reported to have hypertension and 7.8%(n=91) met the criteria for incident hypertension. 7.8% met the criteria for both. Mean score based on CES-D was 13.08. 32.0% subjects had depression. 54 subjects reported never experienced any strain for past 6 months and 24 reported to have 2 or more .61 subjects were overweight with mean value of BMI=26.19 kg/m2. Self-reported hypertension and incident hypertension were strongly associated with age but only selfreported hypertension was strongly associated with overweight. However, there was no significant association between hypertension with chronic strains and depressive symptoms. Conclusions: Depressive symptomatology was not associated with hypertension in this survey. Women had a significant risk in having depressive symptoms. Age =45 years & overweight were significant risks for hypertension. A prospective study will be more useful in the future to find out the association between depression and hypertension.

Matched MeSH terms: Depressive Disorder
Fulltext Factorial validation of the Malay version of multidimensional scale of perceived social support among a group of psychiatric patients

Ng, C.G., Nurasikin, M.S., Loh, H.S., Yee, Anne H.A., Zainal, N.Z.

Malaysian Journal of Psychiatry, 2012;21(2):0-0.
MyJurnal

Introduction: There is increasing awareness of the contribution of perceived social support (PSS) to emotional and physical well-being. Numerous scales measuring PSS have been developed, including the widely used Multidimensional Scale of Perceived Social Support (MSPSS). The psychometric properties of the MSPSS have been demonstrated in diverse samples, however mostly are conducted in English. Malay is the official languange in Malaysia, and this study was conducted to provide evidence of the validity and reliability of a Malay version MSPSS (MSPSS-M) suited for our population.
Methods: This is a cross sectional study. The socio-demographic and clinical information of the selected patients from psychiatric outpatient clinic over a 3-month period, were obtained via pre-designed questionnaire, interviews and medical records. Assessment of psychiatric symptoms and social support were measured by various instruments including the Brief Psychiatric Rating Scale (BPRS-E), Depressive, Anxiety and Stress Scale (DASS) and MSPSS-M.
Results: Data were reported for 228 psychiatric outpatients with the mean age of 40.3 years old. The 3-factor structure of the MSPSS-M (significant others, family, and friends) fitted the data well. The MSPSS-M showed good internal consistency (Cronbach α of 0.89) and validity. The scores of the total subscales for MSPSS-M were negatively correlated with the depression subscale in DASS (P < 0.05). BPRS was negatively correlated with significant others (P < 0.01) compared to the other two subscales in MSPSS-M.
Conclusions: The Malay version MSPSS (MSPSS-M) is a psychometrically valid instrument with high internal consistency, which is useful in assessing perceived social support in Malaysian population.

Study site: psychiatric clinic, University Malaya
Medical Center (UMMC)

Matched MeSH terms: Depressive Disorder
Fulltext Serotonin transporter gene polymorphism is associated with antidepressant response to escitalopram in multiethnic Malaysians with major depressive disorder: a preliminary study

Tiong, C.P., Loke, A.C., Mohamed, Z., Zainal, N.Z.

Malaysian Journal of Psychiatry, 2013;22(2):59-71.
MyJurnal

Objective: This study investigates the relationship between antidepressant response to escitalopram and polymorphism of the serotonin transporter gene promoter region (5-HTTLPR) in multi ethnic Malaysian patients with Major Depressive Disorder. Methods: An eight weeks prospective study of treatment response to escitalopram was conducted on 29 Malaysian patients with Major Depressive Disorder. The severity and improvement of depression were assessed with the Montgomery-Asberg Depression Rating Scale. Patients were also genotyped for long (L) and short (S) polymorphisms in 5-HTTLPR using polymerase chain reaction. Results: Response to escitalopram treatment was more frequent in patients with 5-HTTLPR SS genotype than in those with LL or LS genotypes (p = 0.04, OR = 10.0, 95% CI = 1.05-95.2). The favourable allelic variant for response was S allele (p

Matched MeSH terms: Depressive Disorder, Major
Depression and psychosocial correlates of liver transplant candidates: a systematic review

Mohamed S, Sabki ZA, Zainal NZ

Asia Pac Psychiatry, 2014 Dec;6(4):447-53.
PMID: 25132651 DOI: 10.1111/appy.12145

Liver transplant candidates are vulnerable to develop depression. This paper aims to ascertain the prevalence of depression in liver transplant candidates and its psychosocial factors in a systematic review.

Matched MeSH terms: Depressive Disorder/etiology*; Depressive Disorder/epidemiology
Anxiety and Depression in Cancer Patients: The Association with Religiosity and Religious Coping

Ng GC, Mohamed S, Sulaiman AH, Zainal NZ

J Relig Health, 2017 Apr;56(2):575-590.
PMID: 27287259 DOI: 10.1007/s10943-016-0267-y

There is a lack of studies looking into religiosity and religious coping in cancer patient. In this cross-sectional study, we examined the religiosity using Duke University Religion Index, religious coping using Brief Religious Coping Scale, anxiety and depression based on Hospital Anxiety and Depression Scale among 200 cancer patients. The association between religiosity and religious coping with anxiety and depression was studied. The findings showed that subjects with anxiety or depression used more negative religious coping and had lower non-organization religiosity. Hence, measurements in reducing negative religious coping and encouraging religious activities could help to reduce psychological distress in cancer patients.

Matched MeSH terms: Depressive Disorder/complications; Depressive Disorder/psychology*
Association of brain-derived neurotrophic factor valine to methionine polymorphism with sexual dysfunction following selective serotonin reuptake inhibitor treatment in female patients with major depressive disorder

Nazree NE, Mohamed Z, Reynolds GP, Mohd Zain S, Masiran R, Sidi H, et al.

Asia Pac Psychiatry, 2016 Dec;8(4):260-268.
PMID: 27787964 DOI: 10.1111/appy.12210

INTRODUCTION: The occurrence of female sexual dysfunction (FSD) in patients with major depressive disorder (MDD) receiving selective serotonin reuptake inhibitors (SSRIs) treatment gives negative impacts on patients' quality of life and causes treatment discontinuation. We aimed to investigate whether genetic polymorphism of identified candidate gene is associated with FSD in our study population.
METHODS: This is a cross-sectional study. A total of 95 female patients with MDD who met the criteria of the study were recruited and were specifically assessed on the sexual function by trained psychiatrists. Patients' DNA was genotyped for BDNF Val66Met polymorphism using real-time polymerase chain reaction.
RESULTS: The prevalence of FSD in this study is 31.6%. In the FSD group, patients with problematic marriage were significantly more frequent compared with patients who did not have problematic marriage (P = 0.009). Significant association was detected in the lubrication domain with BDNF Val66Met polymorphism (P = 0.030) using additive genetic model, with even stronger association when using the recessive model (P = 0.013).
DISCUSSION: This study suggested that there was no significant association between BDNF Val66Met with FSD. However, this polymorphism is significantly associated with lubrication disorder in patients treated with SSRIs.

Matched MeSH terms: Depressive Disorder, Major/drug therapy*
Fulltext Prevalence of depression in cancer patients: a review on the comparison between different regions

Ng, C.G., Zainal N.Z.

Malaysian Journal of Psychiatry, 2014;23(2):90-113.
MyJurnal

Introduction: Depression is the most common psychological sequelae in cancer patients. It is challenging to diagnose depression in cancer patients. Furthermore, the presentation is influenced by the patients’ cultural background. Objectives: This literature review aims to determine the prevalence of depression in cancer patients across regions of different cultural background. Methods: A literature search was undertaken by using Pubmed electronic database. Studies were included in this review if they (a) examined the prevalence of depression in cancer patients and (b) published in English peer-review journal between 2000 and 2009. Results: A total of 59 studies from 21 countries were reviewed and summarised. The prevalence of depression in cancer patients ranged from 3% to 72%. Studies from Asia reported the lowest prevalence (3-39%) and Europe reported the highest prevalence (7-72%). Conclusion: Cultural influence may play a role in the prevalent difference of depression in cancer patients. Somatization and stigmatization are suggested as the possible reasons of lower prevalence of depression in Asia region. The biopsychiatric model of mental illness and western psychologization explain the higher prevalence in Western region. Future research on the cross-cultural variability in the presentation of depression in cancer patients is recommended.

Matched MeSH terms: Depressive Disorder
Fulltext The pyramid counteracts chronic prenatal restraint-stress effects on the milestones, anthropometry, and body, brain and adrenal gland weights of pups in rats

George, Mitchel Constance, Murthy, Krishna Dilip, Zainal Arifin Mustapha

Borneo Journal of Medical Sciences, 2018;12(1):49-56.
MyJurnal

Prenatal exposure to chronic stress during critical periods of foetal development produces depression, attention and learning deficits, hormonal imbalances and affects the brain. The effect of prenatal restraint-stress on the postnatal developmental milestones, anthropometric measurements, and the body, brain and adrenal gland weights of the pups were examined and compared with the unrestrained control and the restrained group under the pyramid at postnatal day 10 and 21. Pregnant rats were restrained (9h/day) from gestation day 7 until parturition. Results showed significant delay in the milestones by one day in the restraint control (RC) compared to the unrestrained normal control (NC), while pups of the restrained pyramid (RP) group did not show the delay. Significant decreases in the anthropometric measurements, body and brain weights in RC group were observed at both postnatal days, while the RP group results matched with the NC group. Significant increase in the adrenal weights was found in the RC group compared to NC group and not the RP group. Results suggest prenatal restraint-stress definitely hampers the developmental milestones, anthropometric measurements, and body and brain weights of the young offspring. Results suggest, pyramid environment counteracts and protects the deleterious effects of chronic prenatal stress.

Matched MeSH terms: Depressive Disorder
Screening for depression with a brief questionnaire in a primary care setting: validation of the two questions with help question (Malay version)

Mohd-Sidik S, Arroll B, Goodyear-Smith F, Zain AM

Int J Psychiatry Med, 2011;41(2):143-54.
PMID: 21675346 DOI: 10.2190/PM.41.2.d

OBJECTIVE: To determine the diagnostic accuracy of the two questions with help question (TQWHQ) in the Malay language. The two questions are case-finding questions on depression, and a question on whether help is needed was added to increase the specificity of the two questions.
METHOD: This cross sectional validation study was conducted in a government funded primary care clinic in Malaysia. The participants included 146 consecutive women patients receiving no psychotropic drugs and who were Malay speakers. The main outcome measures were sensitivity, specificity, and likelihood ratios of the two questions and help question.
RESULTS: The two questions showed a sensitivity of 99% (95% confidence interval 88% to 99.9%) and a specificity of 70% (62% to 78%), respectively. The likelihood ratio for a positive test was 3.3 (2.5 to 4.5) and the likelihood ratio for a negative test was 0.01 (0.00 to 0.57). The addition of the help question to the two questions increased the specificity to 95% (89% to 98%).
CONCLUSION: The two qeustions on depression detected most cases of depression in this study. The questions have the advantage of brevity. The addition of the help question increased the specificity of the two questions. Based on these findings, the TQWHQ can be strongly recommended for detection of depression in government primary care clnics in Malaysia. Translation did not apear to affect the validity of the TQWHQ.

Matched MeSH terms: Depressive Disorder/diagnosis*
Fulltext Association between health-related quality of life and psychological distress at different stages of chronic kidney disease

Norhayati Ibrahim, Rafidah Aini Pakri Mohamed, Sharlene Teo, Normah Che In, Abdul Halim Abdul Gafor, Rozmi Ismail, et al.

Sains Malaysiana, 2016;45(5):753-759.

The prevalence of chronic kidney disease (CKD) have increased and become one of the major public health concerns
worldwide including Malaysia. Previous studies on CKD generally focused on patients who were already undergoing
dialysis treatment; however, studies investigating the stresses experienced by pre-dialysis CKD patients were limited. This
study aimed to examine the prevalence of psychological distress and their association with the Health Related Quality
of Life (HRQoL) during the different stages of CKD. This cross-sectional study involved 200 pre-dialysis patients from
stages 3 to 5, who were recruited from the Nephrology Clinic at the National University of Malaysia Medical Centre
(UKMMC). The instruments used in this study were the Short Form 36 (measuring HRQoL) and Hospital Anxiety and
Depression Scale (HADS) to measure the psychological distress. The results showed that the prevalence of depression
and anxiety increased proportionally with the CKD stages. The HRQoL sub-component scores declined as the CKD stages
increased except for social functioning. An impaired HRQoL was associated with depression and anxiety in the CKD
patients. The results suggested that it is very important to manage kidney disease at an early stage and that a healthier
lifestyle is adopted.

Matched MeSH terms: Depressive Disorder
Fulltext Dissociative identity disorder with depression in a man with traumatic childhood: a case report

Saifuddin, T.M., Amilin, N., Zafri, A.

Malaysian Journal of Psychiatry, 2016;25(2):0-0.
MyJurnal

Dissociative identity disorder (DID) previously known as multiple personality disorder is associated with depression and traumatic childhood which can be either physically or sexually abuse. It is hard to establish diagnosis of DID because of the complexity and controversies that surrounding it. We report a case of a young man who has DID and Major Depressive Disorder in the background of traumatic childhood experience who was recently admitted to our inpatient psychiatric unit and demonstrated transitions to other distinct personality state.

Matched MeSH terms: Depressive Disorder, Major
Fulltext The outcomes that an interview-based medical school admission process has on academic performance, psychological health, personality traits, and emotional intelligence

Yusoff MSB

J Taibah Univ Med Sci, 2018 Dec;13(6):503-511.
PMID: 31435370 DOI: 10.1016/j.jtumed.2018.09.003

Objectives: This study investigated the outcomes that an interview-based medical school admission process has on academic performance, psychological health, personality traits, and emotional intelligence.
Methods: A comparative cross-sectional study was conducted on the interviewed and non-interviewed cohorts. Their examination marks were obtained from the academic office, psychological health was measured by DASS-21, personality traits were measured by USMaP-15, and emotional intelligence was measured by USMEQ-17.
Results: The interviewed cohort performed significantly better in the clinical examination than the non-interviewed cohort. Conversely, the non-interviewed cohort performed significantly better in the theoretical examination. Depression, anxiety, and stress level between the two cohorts showed no difference. The interviewed cohort demonstrated more desirable personality traits, higher emotional intelligence, and social competence than the non-interviewed cohort.
Discussion: This study provides evidence to support the claim that the interview-based admission process has favourable outcomes on clinical performance, emotional intelligence, and personality traits. Several insights gained as a result of this study are discussed.

Matched MeSH terms: Depressive Disorder
Fulltext Patterns of Referral to Clinical Psychology Services in the Ministry of Health Malaysia

Martadza M, Saedon UI, Darus N, Badli TST, Ghazalan SA, Yunus WMAWM

Malays J Med Sci, 2019 Nov;26(6):111-119.
PMID: 31908592 MyJurnal DOI: 10.21315/mjms2019.26.6.11

Background: This descriptive study identifies the demographic characteristics and patterns of referral to clinical psychology services, which include types of diagnosis, types of referral and source of referrals in child, adolescent, adult and geriatric cases in Malaysia.
Methods: We utilised 2,179 referrals between January and December 2015 from six general hospitals and three mental health institutions that provide clinical psychology services.
Results: The percentage of male referrals (60.3%) is higher than that of female referrals (39.7%). Adult cases had the highest percentage of referrals (48.2%). Children (48.8%) and adolescent (28.1%) cases were mainly referred for psychological assessment. Meanwhile, adult cases (74.8%) were mainly referred for psychological intervention. Neurodevelopmental disorders was the diagnosis with the highest percentage of referrals recorded (41.4%), followed by depressive disorders (13.3%) and anxiety disorders (12.7%), and the combination of other disorders. Psychiatrists provided the highest number of referrals (82.2%), which is unsurprising as both fields are closely related.
Conclusion: Clinical psychology services within the Ministry of Health (MOH) Malaysia play an important role in mental health care.

Matched MeSH terms: Depressive Disorder
Fulltext Determining the cut-off score for a Malay language version of the centre for epidemiologic studies depression scale (CESD)

Siti Raudzah Ghazali, Elklit, Ask, Rekaya Vincent Balang, Ameenudeen Sultan, M., Yoke, Yong Chen

ASEAN Journal of Psychiatry, 2014;15(2):146-152.
MyJurnal

Objective: The objective of this study is to determine the optimal cut-off score for the Centre for Epidemiologic Studies Depression scale (CESD) according to Malaysian adolescent norms. Methods: This is a cross-sectional study. Nine hundred and thirty-one adolescents aged 13 to 17 years-old completed the CESD and Hopkins Symptom Checklist-depression scale (HSCL-depression). Results: Results from the receiver operating characteristic (ROC) curve, kappa coefficients and odds ratio analysis showed that CESD cut-off score of 27 was suitable to be used according to Malaysian norms, demonstrating a specificity of 93%. Conclusion: The findings suggest a cut-off score 27 should be used for screening of depression for Malaysian adolescents using the CESD. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 146-152.

Matched MeSH terms: Depressive Disorder
Fulltext Beneficial Properties of Probiotics

Shi LH, Balakrishnan K, Thiagarajah K, Mohd Ismail NI, Yin OS

Trop Life Sci Res, 2016 Aug;27(2):73-90.
PMID: 27688852 MyJurnal DOI: 10.21315/tlsr2016.27.2.6

Probiotics are live microorganisms that can be found in fermented foods and cultured milk, and are widely used for the preparation of infant food. They are well-known as "health friendly bacteria", which exhibit various health beneficial properties such as prevention of bowel diseases, improving the immune system, for lactose intolerance and intestinal microbial balance, exhibiting antihypercholesterolemic and antihypertensive effects, alleviation of postmenopausal disorders, and reducing traveller's diarrhoea. Recent studies have also been focused on their uses in treating skin and oral diseases. In addition to that, modulation of the gut-brain by probiotics has been suggested as a novel therapeutic solution for anxiety and depression. Thus, this review discusses on the current probiotics-based products in Malaysia, criteria for selection of probiotics, and evidences obtained from past studies on how probiotics have been used in preventing intestinal disorders via improving the immune system, acting as an antihypercholesterolemic factor, improving oral and dermal health, and performing as anti-anxiety and anti-depressive agents.

Matched MeSH terms: Depressive Disorder

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