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Fulltext QTc prolongation and antipsychotic medications in psychiatric patients – a review

Zainuddin, Z., Zaini, S.

Malaysian Journal of Psychiatry, 2017;26(2):0-0.
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Background: Antipsychotic medications are the cornerstones of the acute and
long-term treatment of schizophrenia. Despite their benefits in minimizing
the schizophrenia symptoms, they have been associated with the risk of
inducing QTc prolongation, which may lead to a serious life-threatening
arrhythmia and cause sudden death. Objective: To review the QTc
prolongation caused by antipsychotic medications used among psychiatric
patients. Methods: Literature search was conducted using databases such as
Scopus, Science Direct, Pubmed, and Springer link. The keywords used for
the search were “QTc prolongation”, “antipsychotic medications” and
“schizophrenia”. The inclusion criteria are articles from 2001 to 2014,
articles written in English and articles related to the effects of antipsychotics
in causing sudden cardiac death. The inclusion criteria are the articles
written in other languages and the article about other adverse effect of
antipsychotics. Results: Twenty-seven articles were found to be relevant to
this study and twenty of them which discusses about antipsychotic-induced
QT interval prolongation have been included in the table of evidence.
Conclusion: Antipsychotics regardless of the generations have the potential of
causing QT interval prolongation. The risk-to-benefit ratio that accounts for
the danger of sudden cardiac death should be evaluated before prescribing
an antipsychotic medicine and each individual patient should be assessed on
the potential contributing factors to the prolongation of QTc.
Fulltext A review of the use of mirtazapine in cancer patients

Zaini, S., Ng, C.G., Sulaiman, A.H., Huri, N.Z., Shamsudin, S.H.

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

Introduction: Cancer patients often have concurrent physical and psychological symptoms. These problems may become barriers towards the healing process. Antidepressants seem to be beneficial for the purpose of palliative care in this type of patients. One of the useful medications is mirtazapine, which is known as noradrenergic and specific serotonergic antidepressant (NaSSA). This paper examines the use of mirtazapine in physical and psychological symptoms of cancer patients. Methods: Literature search was done on PubMed (from inception to January 2017) by matching the key terms: ‘noradrenergic and specific serotonergic antidepressants’ or ‘NaSSA’ ‘mirtazapine’ AND ‘cancer’ or ‘oncol*’ or ‘malignancy’ or ‘carcinoma’. Eligible papers were screened at the title and abstract level. Various types of study included in this review, according to certain criteria. Additional papers were also identified by screening of reference lists. Results: A total of twelve papers were reviewed and summarized. Positive findings obtained for the use of mirtazapine in cancer patients associated with various symptoms, including depression, anxiety, cachexia, nausea, hot flashes, and pruritus. Some rare side effects are reported, including constipation, myalgia sedation, dry mouth, stimulation of appetite and weight gain. Conclusion: Mirtazapine has the potential to be beneficial for cancer patients suffering from these physical and psychological symptoms. However, more research studies with sufficient power are warranted to validate the findings.
The Use of Antidepressants for Physical and Psychological Symptoms in Cancer

Zaini S, Guan NC, Sulaiman AH, Zainal NZ, Huri HZ, Shamsudin SH

Curr Drug Targets, 2018;19(12):1431-1455.
PMID: 29484993 DOI: 10.2174/1389450119666180226125026

Cancer patients are commonly associated with various physical and psychological symptoms. In palliative setting, the aims are to relieve those symptoms, improve quality of life, and increase medication adherence among cancer patients. Antidepressants are generally accepted for the treatment of depression among patients with or without cancer. Some other potential benefits of the antidepressants have been reported in cancer patients.
OBJECTIVE: This study aims to review the use of antidepressants for physical and psychological symptoms in cancer patients.
RESULTS: Our findings showed the mixed result of positive and negative findings in various symptoms associated with cancer patients. These studies are categorised according to the hierarchy of evidence from high to low level, namely randomised controlled trials, cohort studies, case-control studies, case series, case reports, as well as other type of publications. The majority of antidepressants used in cancer patients seem to be beneficial for the treatment of depression, anxiety, hot flashes and other symptoms such as sexual dysfunction, fatigue, nicotine dependence, vasomotor symptoms, executive functions, sleep problems, pruritus, as well as for hypochondriasis. While fluoxetine was found to be associated with the reduction of antiemetic property in ondansetron, mirtazapine was identified to be a good alternative in treating nausea and cachexia among cancer patients.
CONCLUSION: More research studies with adequate statistical power are warranted to validate the use of antidepressants among cancer patients in treating these physical and psychological symptoms.
Fulltext Development of a Strategic Tool for Shared Decision-Making in the Use of Antidepressants among Patients with Major Depressive Disorder: A Focus Group Study

Zaini S, Manivanna Bharathy HA, Sulaiman AH, Singh Gill J, Ong Hui K, Zaman Huri H, et al.

Int J Environ Res Public Health, 2018 07 03;15(7).
PMID: 29970848 DOI: 10.3390/ijerph15071402

Shared decision-making (SDM) has been recognized as an important tool in the mental health field and considered as a crucial component of patient-centered care. Therefore, the purpose of this study was to develop a strategic tool towards the promotion and implementation of SDM in the use of antidepressants among patients with major depressive disorder. Nineteen doctors and 11 major depressive disorder patients who are involved in psychiatric outpatient clinic appointments were purposively selected and recruited to participate in one of six focus groups in a large teaching hospital in Malaysia. Focus groups were transcribed verbatim and analyzed using a thematic approach to identify current views on providing information needed for SDM practice towards its implementation in near future. Patients’ and doctors’ views were organized into six major themes, which are; summary of treatment options, correct ways of taking medication, potential side effects of treatments related to patients, sharing of case study related to the treatment options, cost of treatment options, and input from pharmacist. The information may be included in the SDM tool which can be useful to inform further research efforts and developments that contribute towards the successful implementation of SDM into clinical practice.

Study site: University Malaya Medical Centre (UMMC)
Heavy metals in offal and canned food sold in the Malaysian market

Anual ZF, Ahmad NI, Anak Robun C, Ahmad Suhaimi LR, Surawi NH, Sudin K, et al.

Food Addit Contam Part A Chem Anal Control Expo Risk Assess, 2023 Oct 26.
PMID: 37883683 DOI: 10.1080/19440049.2023.2272726

Food contaminated with heavy metals poses a serious threat to consumers. This study aims to assess levels of lead (Pb) and cadmium (Cd) in offals of chicken, cattle, and pig as well as tin (Sn) in canned food. A total of 378 offal samples was collected from wet markets, while 218 canned food samples were purchased locally. Samples were digested using a microwave before analysis with inductively coupled plasma mass spectrometry (ICP-MS). Pb was determined, highest in cattle lung (0.11 ± 0.20 mg/kg) followed by cattle spleen (0.09 ± 0.14 mg/kg), and cattle tripe (0.09 ± 0.12 mg/kg). For Cd, the highest concentrations were in cattle liver (0.13 ± 0.12 mg/kg), pig liver (0.08 ± 0.05 mg/kg), and chicken liver (0.03 ± 0.02 mg/kg). Significant variations of Sn levels existed in different canned food categories with 3.21% samples (n = 7) exceeded the maximum level of 250 mg/kg set by Codex Alimentarius. All offal samples were below the Malaysian regulatory limits, indicating their safety for human consumption. However, Sn levels varied significantly among canned food categories, with the highest levels found in canned pineapple chunks in syrup, mixed pineapple cubes in syrup, pineapple slices and longan. Samples exceeding the maximum level set by Codex Alimentarius may pose a risk to consumers.