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Fulltext Quetiapine-induced sleep-related eating disorder: A case report

Kanagasundram S

Clin Case Rep, 2021 Jun;9(6):e04168.
PMID: 34194765 DOI: 10.1002/ccr3.4168

This is the first case report of two depressed Malay females prescribed quetiapine, the first patient developed sleep related eating disorder (SRED) on 200 mg per day and the second patient at 50 mg per day. Both resolved with discontinuation of the drug. Assessment for SRED should be done at every follow up.
Fulltext “Head heaviness” – a purview of possible diagnoses

Ng CG, Kanagasundram S

Malaysian Journal of Psychiatry, 2015;24(1):68-80.
MyJurnal

A 61 year old Indian man presented with clinical depression after a longstanding of “head heaviness”. Looking through the literatures, there is scant information on the subjective complaint of “a heavy head” despite it being a very common encounter at many primary care clinics. We feel that this is an unusual presentation of the symptom as it was very dramatic, to the extent that the patient was overly preoccupied with his head heaviness and subsequently became depressed. Here we undertake to present the case of a man who became clinically depressed due to his “heavy head”.
Fulltext Dissociative identity disorder: an attempt to understand the disorder in Malaysian context

Jambunathan, Stephen T., Gill, Jesjeet Singh, Kanagasundram, Sharmilla, Koh, Ong Hui

ASEAN Journal of Psychiatry, 2008;9(2):118-125.
MyJurnal

Dissociation, including multiple personality disorder, has long been a controversial topic. Patients with suggestive symptoms are often misdiagnosed as malingering or even having
schizophrenia. The former as a result of the overlooking of a clinician on the fact that suggestibility itself plays a key role in the emergence and perpetuation of this illness and the latter due to the lack of knowledge of the whole dissociative disorder spectrum, often resembling that of a psychotic disorder. Another contributing factor to the small number of patients with this diagnosis is due to the reluctance of a psychiatrist to do so because of his/her lack of experience and also fear of humiliation of being accused of seeking fame from diagnosing this somewhat glamorous phenomenon. In Malaysia, various culture bound syndromes often present with similar symptoms too. This article will attempt to understand this dissociation on the local context using case studies as a reference point.
Fulltext Late Complications of Allogenic Stem Cells Transplantation in Leukaemia

Kanagasundram S, Amini F

Tissue Eng Regen Med, 2019 Feb;16(1):1-9.
PMID: 30815345 DOI: 10.1007/s13770-018-0157-3

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) can cure leukaemia. However, long term complications of post transplantation interfere with the patients' full recovery. The objective of this review was to identify the various long term complications and to assess their individual prevalences.
METHODS: Electronic databases including PubMed, Google Scholar and Cochrane were searched for years 2004-2017. The keywords used were leukaemia, allogenic stem cell transplantation, prevalence, side effects, long term, delayed, adverse effects, complications and outcome.
RESULTS: A total of ten articles were included for analysis. There were 5 prospective studies, 3 retrospective studies and 2 cross sectional studies. A total of 40,069 patients, (20,189 males and 17,191 females) participated in these 10 studies. The gender of 2689 patients were not disclosed. Most common late complications and prevalence were chronic graft versus host disease (43% at 5 years post HSCT), secondary tumor (21% at 20 years post HSCT), hypothyroidism (11% at 15 years), bronchiolitis obliterans (9.7% at 122 days), cardiovascular disease (7.5% at 15 years) and avascular necrosis (5.4% at 10 years). The prevalence of azoospermia was 71.1% and depression, 18%. For the latter two conditions no time limit was available. Follow up duration ranged from 2 years till 30 years post HSCT.
CONCLUSION: While allogenic stem cell transplantation is an effective cure for leukaemia, the procedure is associated with complications that can have their onset many years after the procedure.
Schizophrenia or frontotemporal dementia in a young Chinese female: a purview of possible diagnoses

Grewal GS, Kanagasundram S, Jambunathan S

Turk Psikiyatri Derg, 2011;22(4):266-8.
PMID: 22143952

Frontotemporal dementia (FTD) is now increasingly being recognized as one of the causes of young onset dementia (YOD). The presentation of FTD can be subtle with a broad range of symptoms. This frequently causes misdiagnosis and a delay in initiating the correct treatment. While subtle personality changes, disinhibition and problems in executive functioning are frequently encountered in FTD, frank psychotic symptoms resembling schizophrenia are unusual. This is a case of a 38 year old Chinese female that highlights how obsessive compulsive symptoms which progressed to florid psychosis and disorganized speech and behavior can be a presenting picture in FTD. For seven years, this patient was treated as a case of schizophrenia and was thought to have poor response to electroconvulsive therapy (ECT) as well as antipsychotic medication. Her blood work and electroencephalogram (EEG) were normal. Magnetic resonance imaging (MRI) showed progressive cerebral atrophy. This case report suggests that psychosis should be investigated in detail especially when the clinical presentation is not typical of a functional disorder and more so when the patient is not responsive to conventional treatment. This report also highlights the importance of eliciting symptoms suggestive of an "organic" etiology, such as incontinence and disorientation. In addition, the usefulness of repeated imaging to show the rapidly progressive course of FTD has been illustrated. Other possible differential diagnoses of this patient are also discussed.
Fulltext The Effect of 5-Min Mindful Breathing on Pain in Palliative Care Cancer Patients: A Randomized Controlled Study

Guan NC, Beng TS, Sue-Yin L, Kanagasundram S

Indian J Palliat Care, 2021 02 17;27(1):83-88.
PMID: 34035622 DOI: 10.4103/IJPC.IJPC_122_20

Context: While pain is a common complaint among palliative cancer patients, there is little research looking into nonpharmacological methods for the reduction of pain in the palliative setting.
Aim: This study aims to study the efficacy of 5-min mindful breathing for rapid reduction of pain in a palliative care setting.
Methods: This is a sub-analysis of the previous randomized controlled study on distress reduction. Sixty patients were recruited and randomly assigned to either the intervention (5-min mindful breathing) or the control (5-min normal listening) group. Participants reported their pain on a 10-item analog scale at baseline, immediately after intervention and 10 min postintervention. Changes in pain scores were further analyzed.
Results: Pain scores decreased for both the intervention and control groups. However, the reduction of pain did not reach statistical difference in both groups (P > 0.05).
Conclusion: Five-minute mindful breathing is a quick and easy to administer therapy but does not have significant effects in terms of pain reduction in palliative settings. Future research and directions are nonetheless suggested and encouraged to look for short-term mindfulness-based therapies on pain reduction for this population.
Social anhedonia in Malaysian schizophrenia patients and healthy participants

Balasingam K, Kanagasundram S, Ann AYH, Kasmuri K, Gooding DC

Asian J Psychiatr, 2023 Jan;79:103350.
PMID: 36462388 DOI: 10.1016/j.ajp.2022.103350

The reduced capacity for social and interpersonal interactions, social anhedonia, is an important aspect of various psychiatric disorders, especially schizophrenia-spectrum disorders. The goal of the present study was to validate a Malay translation of the adult version of the Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS; Gooding and Pflum, 2014), a relatively short and easy to administer indirect measure of social anhedonia. This cross-sectional study included 95 (47 male, 48 female) schizophrenia patients and 300 (77 male, 223 female) healthy subjects. Participants were given Malay versions of the ACIPS, Snaith Hamilton Pleasure Scale (SHAPS-M), and Beck Depression Inventory (BDI-M). The ACIPS exhibited good internal consistency (Ordinal alpha = 0.966). Total ACIPS scores were inversely correlated with the BDI-M scores, and positively correlated with total SHAPS-M scores. Factor analysis yielded a three-factor solution which accounted for 52.06% of the variance. As expected, the schizophrenia patients scored significantly lower than the healthy community participants on the ACIPS, t(130) = 4.26, p
Nonsynonymous polymorphisms of the PDLIM5 gene association with the occurrence of both bipolar disorder and schizophrenia

Zain MA, Roffeei SN, Zainal NZ, Kanagasundram S, Mohamed Z

Psychiatr Genet, 2013 Dec;23(6):258-61.
PMID: 24064681 DOI: 10.1097/YPG.0000000000000015

Two single nucleotide polymorphisms of PDLIM5, rs7690296 and rs11097431, were genotyped using Mass-Array SNP genotyping by Sequenom technology in 244 bipolar disorder patients, 471 schizophrenia patients, and 601 control individuals who were Malay, Chinese, and Indian ethnic groups in the Malaysian population. A significant association was observed in allele frequency between the rs7690296 polymorphism and bipolar disorder in the Indian ethnic group [P=0.02, adjusted odds ratio (OR) 0.058, 95% confidence interval (CI) 0.36-0.93]. A significant association was also observed between the rs7690296 polymorphism and schizophrenia under the recessive model for both Malay (P=0.02, adjusted OR 1.86, 95% CI 1.12-3.10) and Indian (P=0.02, adjusted OR 1.92, 95% CI 1.10-3.37) ethnic groups. However, no association was detected between the rs11097431 polymorphism either with bipolar disorder or with schizophrenia. Therefore, it can be deduced that the nonsynonymous rs7690296 polymorphism could play an important role in the pathophysiology of both bipolar disorder and schizophrenia.
Risk and associated factors of female sexual orgasmic disorder in women with hypertension in Malaysia

Abdul Latif R, Muhamad R, Kanagasundram S, Sidi H, Nik Jaafar NR, Midin M, et al.

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:21-6.
PMID: 23857833 DOI: 10.1111/appy.12039

The objective of this study was to examine the risk of female sexual orgasmic disorder among a group of women with hypertension in Malaysia. The associated factors were also examined.
Sexual arousal difficulties in women treated with antidepressants: a comparison between escitalopram and fluoxetine

Midi M, Kanagasundram S, Sidi H, Asmidar D, Naing L, Guan NC

Int J Psychiatry Med, 2012;43(4):405-18.
PMID: 23094470

To compare the risk of sexual arousal difficulties between two groups of depressed female patients in remission who were treated with either escitalopram or fluoxetine. Associated factors were also examined.
Preliminary examination of microRNA expression profiling in bipolar disorder I patients during antipsychotic treatment

Lim CH, Zainal NZ, Kanagasundram S, Zain SM, Mohamed Z

Am J Med Genet B Neuropsychiatr Genet, 2016 09;171(6):867-74.
PMID: 27177356 DOI: 10.1002/ajmg.b.32457

Although major progress has been achieved in research and development of antipsychotic medications for bipolar disorder (BPD), knowledge of the molecular mechanisms underlying this disorder and the action of atypical antipsychotics remains incomplete. The levels of microRNAs (miRNAs)-small non-coding RNA molecules that regulate gene expression, including genes involved in neuronal function and plasticity-are frequently altered in psychiatric disorders. This study aimed to examine changes in miRNA expression in bipolar mania patients after treatment with asenapine and risperidone. Using a miRNA microarray, we analyzed miRNA expression in the blood of 10 bipolar mania patients following 12 weeks of treatment with asenapine or risperidone. Selected miRNAs were validated by using real-time PCR. A total of 16 miRNAs were differentially expressed after treatment in the asenapine group, 14 of which were significantly upregulated and the other two significantly downregulated. However, all three differentially expressed miRNAs in the risperidone group were downregulated. MiRNA target gene prediction and gene ontology analysis revealed significant enrichment for pathways associated with immune system response and regulation of programmed cell death and transcription. Our results suggest that candidate miRNAs may be involved in the mechanism of action of both antipsychotics in bipolar mania. © 2016 Wiley Periodicals, Inc.
Sexual dysfunction in polycystic ovary syndrome: a systematic review and meta-analysis

Loh HH, Yee A, Loh HS, Kanagasundram S, Francis B, Lim LL

Hormones (Athens), 2020 Sep;19(3):413-423.
PMID: 32462512 DOI: 10.1007/s42000-020-00210-0

PURPOSE: Polycystic ovarian syndrome (PCOS) is a common disorder characterized by clinical or biochemical hyperandrogenism and ovulary dysfunction. Female sexual dysfunction (FSD) adversely affects quality of life and interpersonal relationships. We aimed to compare the prevalence of FSD in women with and without PCOS.
METHODS: We pooled data from 28 observational studies involving 6256 women. Apart from the total prevalence of FSD, subgroup analyses based on different PCOS diagnostic criteria and obesity status (body mass index [BMI] ≥ 25 kg/m2) were performed. The differences in total and subscale scores of the Female Sexual Function Index (FSFI) among women with and without PCOS were also compared.
RESULTS: Women with PCOS were younger (mean ± SD 28.56 ± 3.0 vs 31.5 ± 3.2 years, p
Fulltext Peripheral PDLIM5 expression in bipolar disorder and the effect of olanzapine administration

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.
Genetic association of LMAN2L gene in schizophrenia and bipolar disorder and its interaction with ANK3 gene polymorphism

Lim CH, Zain SM, Reynolds GP, Zain MA, Roffeei SN, Zainal NZ, et al.

Prog Neuropsychopharmacol Biol Psychiatry, 2014 Oct 3;54:157-62.
PMID: 24914473 DOI: 10.1016/j.pnpbp.2014.05.017

Recent studies have shown that bipolar disorder (BPD) and schizophrenia (SZ) share some common genetic risk factors. This study aimed to examine the association between candidate single nucleotide polymorphisms (SNPs) identified from genome-wide association studies (GWAS) and risk of BPD and SZ. A total of 715 patients (244 BPD and 471 SZ) and 593 controls were genotyped using the Sequenom MassARRAY platform. We showed a positive association between LMAN2L (rs6746896) and risk of both BPD and SZ in a pooled population (P-value=0.001 and 0.009, respectively). Following stratification by ethnicity, variants of the ANK3 gene (rs1938516 and rs10994336) were found to be associated with BPD in Malays (P-value=0.001 and 0.006, respectively). Furthermore, an association exists between another variant of LMAN2L (rs2271893) and SZ in the Malay and Indian ethnic groups (P-value=0.003 and 0.002, respectively). Gene-gene interaction analysis revealed a significant interaction between the ANK3 and LMAN2L genes (empirical P=0.0107). Significant differences were shown between patients and controls for two haplotype frequencies of LMAN2L: GA (P=0.015 and P=0.010, for BPD and SZ, respectively) and GG (P=0.013 for BPD). Our study showed a significant association between LMAN2L and risk of both BPD and SZ.
Fulltext The Prevalence of Smoking, Determinants and Chance of Psychological Problems among Smokers in an Urban Community Housing Project in Malaysia

Abd Rashid R, Kanagasundram S, Danaee M, Abdul Majid H, Sulaiman AH, Ahmad Zahari MM, et al.

Int J Environ Res Public Health, 2019 05 18;16(10).
PMID: 31109033 DOI: 10.3390/ijerph16101762

Objective: This study was conducted to assess the prevalence, pattern of smoking and sociodemographic factors among Kerinchi residents in Kuala Lumpur, as well as to identify the association between smoking, stress, anxiety and depression. Methods: This study was carried out at four community housing projects in the Lembah Pantai area in Kuala Lumpur. Data was collected between 3 February 2012, and 29 November 2012. Data collectors made house visits and used interviewer administered questionnaires containing questions on demographic data and smoking patterns. Depression anxiety stress scale (DASS) was used to assess psychological symptoms. Alcohol smoking and substance involvement screening tool (ASSIST) scale was used to assess nicotine use. Results: Data from 1989 individuals (833 households) showed the age of respondents ranged from 18 to 89 years and the mean age was 39.12 years. There were 316 smokers indicating the prevalence of smoking was 15.85%, with 35.5% among males and 1.8% among females. Further, 86.6% of smokers were Malay and 87% were Muslims. Divorce was associated with smoking. Unemployment and housewives were less associated with smoking. Depression and anxiety were significantly associated with smoking (OR = 1.347. 95% CI: 1.042-1.741) and (OR = 1.401. 95% CI: 1.095-1.793) respectively. Conclusion: Screening for depression and anxiety should be routinely performed in the primary care setting and in population-based health screening to intervene early in patients who smoke.

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