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Fulltext A fatal case of metformin and gliclazide poisoning and its management

Low, Qin Jian, Chew, Soo Foong

Borneo Journal of Medical Sciences, 2017;11(3):35-40.
MyJurnal

Both metformin and gliclazide have been used extensively in the management of type II diabetes mellitus. Metformin and gliclazide overdose can lead to severe hypoglycaemia refractory to intravenous (IV) dextrose rescue therapy. A 21-year-old man complained of vomiting and felt dizzy after four hours of taking 70 tablets of Metformin 500 mg and 40 tablets of Gliclazide 80 mg. He had major depressive disorder and wanted to commit suicide. He was given IV Dextrose 50% 50 cc immediately. Octreotide had been used successfully to reverse the refractory hypoglycaemia caused by gliclazide overdose. Unfortunately, he developed severe lactic acidosis with acute kidney injury. Dialysis had been done by continuous venovenous haemodiafiltrationa and intravenous sodium bicarbonate 8.4% infusion was given. However, the patient succumbed due to the severe lactic acidosis and kidney failure despite of urgent dialysis. Octreotide infusion helps in preventing refractory hypoglycaemia secondary to sulfonylurea overdose by inhibit calcium-mediated insulin release. Metformin overdose causes severe lactic acidosis due to conversion of glucose to lactate. Sodium bicarbonate therapy in metformin induced lactic acidosis is also controversial. Though sulfonylurea and metformin are the most commonly-prescribed anti-hypoglycaemic agents, thus during prescribing everyone has to be careful about the overdoses and side effects of these drugs.

Matched MeSH terms: Depressive Disorder, Major
Fulltext Features of parasuicide cases presented to Hospital Melaka in year 2015 - "a wake-up call"

Kumar, P.R., Vincent, S.D.

Malaysian Journal of Psychiatry, 2016;25(1):0-0.
MyJurnal

Objective: This study aimed to collect data on features of parasuicide cases
presented to Hospital Melaka from January to December 2015. Methods:
This was a descriptive study with retrospective review of medical records of
parasuicide cases that were warded for observation in Hospital Melaka from
January to December 2015. Data collected included sociodemographic factors,
previous attempts, methods implicated and reasons for parasuicide which
were presented in descriptive statistics. Results: A total of 88 parasuicide
cases were studied. The median age was 25.6 (17.7) with a majority in age
group between 15-24 years old (43.2%). Females were the highest with 58
cases (65.9%). In terms of ethnicity, the Malays was the highest at 38 cases
(43.2 %). However, after corrected to proportion of ethnicity in Melaka,
Indians yield the highest cases. Those who were single (50.0%) and
unemployed (64.8%) contributed to higher number of cases. About 40 cases
(45.5%) had underlying psychiatry illness and majority of them were those
diagnosed with major depressive disorder (47.5%). In general, the most
common method used was self poisoning with anti-epileptics,
sedative-hypnotic, psychotropics (22.1%). Among male cases, pesticide
ingestion (37%) was more common while among female, medication overdose
(53%) was preferred. In terms of reasons for parasuicide, individuals with
interpersonal conflicts contributed to the highest percentage of cases (57.7%).
Conclusion: Data gathered in this study is useful to reflect the current
situation of parasuicide in Melaka and could serve as a foundation in
designing future studies on preventive and intervention programs in Hospital
Melaka.

Matched MeSH terms: Depressive Disorder, Major
Fulltext Prevalence and related factors of depression among healthcare personnel at primary healthcare centers

Eusof Izzudin MP, Al–Bedri A, Subramaniam V, Matthews P, Cheong AT

Malaysian Journal of Medicine and Health Sciences, 2018;14(Special 2):32-36.
MyJurnal

Depressive disorders are common. As compared to the general population, healthcare personnel are hypothesized to have an above than average risk to develop this condition. The aim of this study is to assess the prevalence of this condition and its contributing factors amongst primary healthcare personnel.
Methods: A cross-sectional study was conducted by universally sampling 179 primary healthcare personnel at nine primary healthcare centers across Kuala Lumpur and Selangor in May 2015. Depressive symptoms were screened using self-administered Patient Health Questionnaire-9 (PHQ-9) questionnaire. Socio-demographic and work profile data were also assessed.
Results: 92.7% of the 179 personnel agreed to participate. Near half of the respondents were staff nurses (49%), followed by doctors (22%), assistant medical officers (10%), attendants (10%) and the remaining were pharmacists, dieticians, and laboratory technicians (9%). Depression was found to be present in 38% of the participants with one-third found to have moderate to severe depression. Bivariate analysis show that males (p=0.043), assistant medical officers (p=0.048), and working more than 10 hours per day (p=0.019) are significant risk factors. Further analysis by logistic regression shows that working more than 10 hours per day increases the odds of depression by 3.1 (OR 3.1, 95% CI 1.1-8.7, p=0.03).
Conclusions: A high prevalence of depression was found within the healthcare personnel population at the primary healthcare centres studied. Being a male, employed as an assistant medical officer, and, prolonged hours at the workplace is a significant risk factor for depression.

Matched MeSH terms: Depressive Disorder, Major
Fulltext The prevalence of severe depression in Iranian older adult: a meta-analysis and meta-regression

Salari N, Mohammadi M, Vaisi-Raygani A, Abdi A, Shohaimi S, Khaledipaveh B, et al.

BMC Geriatr, 2020 02 03;20(1):39.
PMID: 32013895 DOI: 10.1186/s12877-020-1444-0

BACKGROUND: Depression is one of the most common psychiatric disorders in the older adult and one of the most common risk factors for suicide in the older adult. Studies show different and inconsistent prevalence rates in Iran. This study aims to determine the prevalence of severe depression in Iranian older adult through a meta-analysis approach.
METHODS: The present meta-analysis was conducted between January 2000-August 2019. Articles related to the subject matter were obtained by searching Scopus, Sciencedirect, SID, magiran, Barakat Knowledge Network System, Medline (PubMed), and Google Scholar databases. The heterogeneity of the studies was evaluated using I2 index and the data were analyzed in Comprehensive Meta-Analysis software.
RESULTS: In a study of 3948 individuals aged 50-90 years, the overall prevalence of severe depression in Iranian older adult was 8.2% (95% CI, 4.14-6.3%) based on meta-analysis. Also, in order to investigate the effects of potential factors (sample size and year of study) on the heterogeneity of severe depression in Iranian older adult, meta-regression was used. It was reported that the prevalence of severe depression in Iranian older adult decreased with increasing sample size and increasing years of the study, which is significantly different (P

Matched MeSH terms: Depressive Disorder, Major
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*
Association between 5HT2A polymorphism and selective serotonin re-uptake inhibitor (SSRI)-induced sexual desire disorder (SDD) among Malaysian women

Masiran R, Sidi H, Mohamed Z, Mohamed Saini S, Nik Jaafar NR

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:41-9.
PMID: 23857836 DOI: 10.1111/appy.12043

SSRIs are known for their sexual side-effects with a variable rate of sexual dysfunction (SD). 5HT2A (rs6311) single nucleotide polymorphism (SNP) was found to have significant association with SD. The purpose of this study was to determine the prevalence of female SDD, its clinical correlates and association with 5HT2A (rs6311) SNP in patients with major depressive disorder (MDD) treated with SSRIs.

Matched MeSH terms: Depressive Disorder, Major/drug therapy
Clinical use of mood stabilizers with antidepressants in Asia: Report from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) Projects in 2004 and 2013

Rajaratnam K, Xiang YT, Tripathi A, Chiu HF, Si TM, Chee KY, et al.

J Clin Psychopharmacol, 2017 Apr;37(2):255-259.
PMID: 28146001 DOI: 10.1097/JCP.0000000000000670

OBJECTIVE: As most reports concerning treatment with combinations of mood stabilizer (MS) with antidepressant (AD) drugs are based in the West, we surveyed characteristics of such cotreatment in 42 sites caring for the mentally ill in 10 Asian countries.
METHODS: This cross-sectional, pharmacoepidemiologic study used 2004 and 2013 data from the REAP-AD (Research Study on Asian Psychotropic Prescription Patterns for Antidepressants) to evaluate the rates and doses of MSs given with ADs and associated factors in 4164 psychiatric patients, using standard bivariate methods followed by multivariable logistic regression modeling.
RESULTS: Use of MS + AD increased by 104% (5.5% to 11.2%) between 2004 and 2013 and was much more associated with diagnosis of bipolar disorder than major depression or anxiety disorder, as well as with hospitalization > outpatient care, psychiatric > general-medical programs, and young age (all P < 0.001), but not with country, sex, or AD dose.

CONCLUSIONS: The findings provide a broad picture of contemporary use of MSs with ADs in Asia, support predictions that such treatment increased in recent years, and was associated with diagnosis of bipolar disorder, treatment in inpatient and psychiatric settings, and younger age.

Matched MeSH terms: Depressive Disorder, Major/drug therapy
Fulltext Psychiatric Sequelae of Former "Comfort Women," Survivors of the Japanese Military Sexual Slavery during World War II

Lee J, Kwak YS, Kim YJ, Kim EJ, Park EJ, Shin Y, et al.

Psychiatry Investig, 2018 Apr;15(4):336-343.
PMID: 29669407 DOI: 10.30773/pi.2017.11.08.2

"Comfort women" refers to young women and girls who were forced into sexual slavery by the Imperial Japanese military during World War II. They were abducted from their homes in countries under Imperial Japanese rule, mostly from Korea, and the rest from China, Philippines, Malaysia, Taiwan, Indonesia, the Netherlands, etc. "Comfort women" endured extreme trauma involving rape, sexual torture, physical abuse, starvation, threats of death, and witnessed many others being tortured and killed. This article reviews all the studies that have investigated the psychiatric or psychosocial sequelae of the survivors of the Japanese military sexual slavery. Most importantly, a recent study which conducted a psychiatric evaluation on the former "comfort women" currently alive in South Korea is introduced. The participants' unmarried rate was relatively high and their total fertility rate was relatively low. Majority of the participants reported having no education and being the low economic status. They showed high current and lifetime prevalence of posttraumatic disorder, major depressive disorder, somatic symptom disorder, social anxiety disorder, panic disorder, and alcohol use disorder. Participants showed high suicidality and majority of the participants still reported being ashamed of being former "comfort women" after all these years. This article high-lights the fact that the trauma has affected the mental health and social functioning of former "comfort women" throughout their lives, and even to the present day.

Matched MeSH terms: Depressive Disorder, Major
Hypoactive sexual desire among depressed female patients treated with selective serotonin reuptake inhibitors: a comparison between escitalopram and fluoxetine

Sidi H, Asmidar D, Hod R, Jaafar NR, Guan NC

Int J Psychiatry Clin Pract, 2012 Mar;16(1):41-7.
PMID: 22122658 DOI: 10.3109/13651501.2011.617457

To determine the risk of hypoactive sexual desire (HSD) in depressed female patients treated with selective serotonin reuptake inhibitors, comparing escitalopram and fluoxetine. The associated factors were also examined.

Matched MeSH terms: Depressive Disorder, Major/drug therapy; Depressive Disorder, Major/epidemiology*