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Fulltext A Case of Post-Stroke Mania

Koh, O.H., Azreen Hashim, N., Gill, J.S., Pillai, S.K.

Malaysian Journal of Psychiatry, 2010;19(1):1-5.
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It has been long known that affective disorders as a result of organic brain diseases are not uncommon. Neurological disorders seem to be significant as risk factors for newly diagnosed mania in the elderly. It has been theorized that lesions in the right cerebral hemisphere and limbic structures may produce symptoms suggestive of mania. Even though specific areas of involvement had not been determined, this case discussed below clearly reports a right sided lesion. One of the reasons why not much is known yet about this clinical entity is the rarity of this occurrence. In fact, in one large scale study, only 2 patients out of 700 were identified with mania.
Fulltext Delayed neuropsychiatric sequelae of carbon monoxide poisoning: a case report

Nurul Azreen Hashim, Norley Shuib, Salina Mohamed, Ling SL, Khariah Mat Nor

Journal of Clinical and Health Sciences, 2016;1:64-68.

Delayed neuropsychiatric sequelae is an important condition which commonly occur during recovery from acute carbon monoxide poisoning. Typical presentation would be apathy, disorientation, amnesia, hypokinesia, bizarre behavior, insomnia and neurological manifestations such as gait disturbance, hypertonia and tremor. We report here a case of a man presented with delayed neuropsychiatric sequelae one month after the carbon monoxide poisoning in his suicidal attempt. He presented with the typical presentation and diagnosis confirmed with the MRI findings. His MRI showed abnormal signal in subcortical hemisphere white matter of both temporo-fronto-parietal-occipital regions along the insula and both globus pallidus. He was treated with Olanzapine, Fluvoxamine, Chlorpromazine and Levodopa and his condition slowly improved. It is important for clinicians to recognize the symptoms and risk factors to develop delayed neuropsychiatric sequelae in patients who previously had carbon monoxide poisoning.
Fulltext Non-benzodiazepine hypnotic dependence: a case report

Amer Siddiq Amer Nordin, Azreen Hashim, Mohamad Hussain Habil, Noor Zurani Md Haris Robson

ASEAN Journal of Psychiatry, 2010;11(1):108-112.
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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.
Fulltext Depression and loneliness/social isolation among patients with cognitive impairment in nursing home

Azlina Wati Nikmat, Nurul Azreen Hashim, Siti Aminah Omar, Salmi Razali

ASEAN Journal of Psychiatry, 2015;16(2):222-231.
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The evaluation of mental health among older adults has become increasingly important in health and social science. Although this has been studied in developed countries, there are also issues for emerging countries, which have aging populations. The aims of this study were to determine the prevalence of loneliness/social isolation and late-life depression among older adults with cognitive impairment living in institutional care. Methods: A cross sectional survey involving residents of four government nursing homes in West Malaysia was carried out. All residents aged 60 years old and above with cognitive impairment were included in the study. Participants were assessed by the Short Mini Mental State Examination (SMMSE), Friendship Scale (FS) and Geriatric Depression Scale (GDS). Results: The prevalence of depression and loneliness/social isolation were 85.5% and 95.5% respectively. Depression was strongly associated with age, education attainment, financial conditions, health, cognitive impairment and loneliness/social isolation. Loneliness/social isolation was strongly associated to depression and relationship satisfaction with children. Conclusion: There was high prevalence of depression and loneliness/social isolation among older adults with cognitive impairment living in institutional care. Depression and loneliness/social isolation are interrelated and influence each other and these problems need to be addressed to improve their quality of life.
Device, Questionnaire & Scale: Mini Mental State Examination (MMSE-12); Friendship Scale (FS); Geriatric Depression Scale (GDS-15)
Fulltext The use and addiction to smart phones among medical students and staffs in a public university in Malaysia

Azlina Wati Nikmat, Nurul Azreen Hashim, Muhammad Farid Saidi, Nur Suhailah Mohd Zaki, Nur Nabihah Hasan Shukri, Nur Basyariah Abdulla

ASEAN Journal of Psychiatry, 2018;19(1):0-0.
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Objective: Smart phones have become an important part of human’s life, including the healthcare population and medical students. However, pathological use of smart phones could lead to smart phones addiction. The aim of this study is to observe a pattern of usage of smart phones among the medical students and staffs in the Faculty of Medicine Universiti Teknologi MARA (UiTM) and screen for smart phone addiction among the respondents.

Methods: A cross sectional, quasi-experimental study design involving medical students and staffs in the Faculty of Medicine Universiti Teknologi MARA (UiTM) was employed. A total of 598 respondents was approached to participate, and all consented to this study. Measurements used in the study include a self-developed questionnaire to measure pattern of smart phone usage and Smart phone addiction scale (Malay version).

Result: We found that 65.9% of the respondents were heavy users of the smart phone (more than 3 hours daily) and majority of them were using it for social networking. More than half of the respondents (52.2%) were at risk of developing smart phone addiction based on Smart phone Addiction Scale (Malay Version).

Conclusion: This study revealed that medical students, and the faculty staffs were heavy users of smart phones, and they were at risk to develop smart phone addiction.
Fulltext Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism

N Fountoulakis K, N Karakatsoulis G, Abraham S, Adorjan K, Ahmed HU, Alarcón RD, et al.

Soc Psychiatry Psychiatr Epidemiol, 2023 Sep;58(9):1387-1410.
PMID: 36867224 DOI: 10.1007/s00127-023-02438-8

INTRODUCTION: The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak.
MATERIALS AND METHODS: The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively.
STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables.
RESULTS: Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p
Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study)

Fountoulakis KN, Karakatsoulis GN, Abraham S, Adorjan K, Ahmed HU, Alarcón RD, et al.

CNS Spectr, 2024 Apr;29(2):126-149.
PMID: 38269574 DOI: 10.1017/S1092852924000026

BACKGROUND: The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.
METHODS: The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.
RESULTS: About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.
CONCLUSIONS: The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.