This article highlights the issues pertaining to psychiatry and smoking as reported in a symposium on smoking cessation in Malaysia. Methods: A report on a meeting outcome of a symposium on “Making smoking free agenda for psychiatrists in Malaysia.” Results: Smoking is still the number one public health problem and those with mental illness were at a high risk. Despite that, they are often under served in service provision by those caring for them. These shortcoming are seen more and more in Malaysia, where smoking and psychiatry is under researched. Conclusion: More research are needed on the why and how psychiatrist can play a major role in ensuring that those with mental illness in Malaysia are provided equal opportunities to quit smoking.
Objective: Smoking is a prevalent problem globally but more so among most ASEAN countries. Worldwide, six million lives are lost annually and this number is expected to grow. In light of this, the World Health Organization recognises the 31st of May to be World No Tobacco Day. For 2013, the theme is "Ban Tobacco Advertising, Promotion and Sponsorship". This article aims to increase awareness among mental health workers, in particular psychiatrists, on the dangers of smoking, the tactics of the tobacco industry, and simple measures to address these problems within their daily activities.
Method: A brief review of recent relevant literature in the field and actual experience from the field were highlighted in this opinion section.
Results and Conclusion: Mental health workers are at an advantage as they have training in both psychological treatments such as brief intervention, cognitive behavioural therapy or counselling skills and for some others, pharmacological treatments. It is timely that health workers in the region take up this challenging but meaningful opportunity to help those with mental illness to stop their dependence for tobacco.
Introduction and Objective: Tobacco use is a significant risk factor for oral diseases. Periodontal disease has been known to be associated with tobacco use for over twenty years. Despite that, dentists and particularly periodontist does not include tobacco use cessation as part of their initial treatment in treating periodontal disease or placing implants in patients who use tobacco. The increase in prevalence and severity of periodontitis among smokers
cannot be explained by differences in the amount of plaque between smokers and nonsmokers. A possible explanation is that smoking may alter the quality of the flora. Dental professionals also have a crucial role to play in tobacco cessation counseling, particularly for patients with chronic periodontitis. More patients will be affected by periodontitis than will ever be affected by oral cancer. Methods and Results: Reviews of literatures were
done on a clearly formulated question on the need of smoking cessation intervention to increase positive outcome of treatment on periodontal disease. Conclusion: Various epidemiological studies strongly suggest that tobacco use cessation is beneficial to patients following periodontal treatments for a better outcome.
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.
The media can be a double-edged sword in suicide prevention
with the Werther and Papageno effect as risk and protective factors
respectively. Objective: This article provides a brief overview of the impact
of media suicide reporting on suicidal behaviour and suicide prevention.
Results: In the Malaysian context, current practices of media suicide
reporting, advocacy strategies for responsible media suicide reporting as
well as challenges in stakeholder awareness and engagement are highlighted.
A review of the literature suggested limited implementaton and adherence of
media guidelines locally. Conclusions: Future research is warranted to
establish the evidence base for effective strategies to improve stakeholder
awareness, engagement and implementation of responsible media reporting
of suicide.
Introduction: The electronic cigarette (EC) usage has raised public health concerns; whether its advantages to smok- ers as a potential smoking cessation aid have outweighed its negative health impacts among EC users. This study aims to estimate health risks associated with chemical exposures to nicotine, propylene glycol (PG) and selected To- bacco-Specific Nitrosamines (TSNAs) namely 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and N’-nitro- sonornicotine (NNN) in e-liquids locally-manufactured in Malaysia. Methods: The health risk assessment (HRA) was performed using established guideline by the Environmental Protection Agency (EPA). The average daily dose (ADD) and lifetime average daily dose (LADD) were calculated using previously published data on chemical concentration of selected compounds and local EC usage topography data. Next, the non-carcinogenic risk (nicotine and PG) and carcinogenic risk (NNK and NNN) were calculated and denoted as total hazard quotient (HQT) and total lifetime cancer risk (LCRT) value, respectively. Results: For non-carcinogenic risk, the mean of HQT was 78.9 which falls un- der “unacceptable” risk as demonstrated by HQT value of more than 1. While for carcinogenic risk, the mean of total LCRT value was 1.54E-04 which may place EC users at risk of developing cancer resulted from exposure to selected TSNAs. Conclusion: Comprehensive HRA using currently available data of local EC usage topography and chemical evaluation of Malaysian-made e-liquids have revealed that the exposure to nicotine, PG and selected TSNAs are expected to be a significant health concern for local EC users. This finding supports the local health authority to issue a stringent health policy in considering EC as a tool for smoking cessation among heavy smokers.
Electronic Cigarette (EC) usage has been gaining acceptance in Malaysia despite its lack of analytical evidence on the chemical constituents of its liquid formulations. This study aims to evaluate the chemical concentrations of nicotine, propylene glycol (PG) and selected Tobacco-Specific Nitrosamines (TSNAs); 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and N’-nitrosonornicotine (NNN) in e-liquids locally sourced from the Malaysian market. Methods: A total of 17 e-liquids from a variety of flavours and brands were purchased from local EC retailers in Klang Valley, Malaysia. Nicotine and PG concentrations were assessed using Gas Chromatography-Flame Ionization Detector (GC-FID) while NNK and NNN were quantified using Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). The concentrations of nicotine and PG (mg/mL) were described in comparison with the levels indicated on the labels when present while levels of TSNAs were descriptively explained. Results: Nicotine was detected in all e-liquid samples, despite several samples being declared as nicotine-free. The average (standard deviation) level of nicotine, PG, NNN and NNK were 3.26 (1.04) mg/mL, 484.10 (98.24) mg/mL, 0.383(0.288) μg/L and 0.086 (0.057) μg/L, respectively. Labelling discrepancies (when indicated on the label) of nicotine and PG were between the range of 27%-73% and 3%-63%, respectively. Conclusion: The concentrations of nicotine and PG in local e-liquids were varied. There were evidences of labelling discrepancy in that local e-liquids. TSNAs were detected in all samples of e-liquids. This study brought forth strong evidence on the need for the implementation of regulation on e-liquid manufacturing and sales, particularly on the accuracy of labelling and licensing to protect the public health.