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  1. McLean D, Barrett R, Loa P, Thara R, John S, McGrath J, et al.
    Asia Pac Psychiatry, 2015 Mar;7(1):36-44.
    PMID: 24038814 DOI: 10.1111/appy.12093
    INTRODUCTION: The symptom profile of schizophrenia can vary between ethnic groups. We explored selected symptom variables previously reported to be characteristic of schizophrenia in the Iban of Sarawak in transethnic populations from Australia, India, and Sarawak, Malaysia. We tested site differences to confirm previous research, and to explore implications of differences across populations for future investigations.
    METHODS: We recruited schizophrenia samples in Australia (n = 609), India (n = 310) and Sarawak (n = 205) primarily for the purposes of genetic studies. We analyzed seven identified variables and their relationship to site using logistic regression, including: global delusions, bizarre delusions, thought broadcast/insertion/withdrawal delusions, global hallucinations, auditory hallucinations, disorganized behavior, and prodromal duration.
    RESULTS: We identified a distinct symptom profile in our Sarawak sample. Specifically, the Iban exhibit: low frequency of thought broadcast/insertion/withdrawal delusions, high frequency of auditory hallucinations and disorganized behavior, with a comparatively short prodrome when compared with Australian and Indian populations.
    DISCUSSION: Understanding between-site variation in symptom profile may complement future transethnic genetic studies, and provide important clues as to the nature of differing schizophrenia expression across ethnically distinct groups. A comprehensive approach to subtyping schizophrenia is warranted, utilizing comprehensively ascertained transethnic samples to inform both schizophrenia genetics and nosology.
    Matched MeSH terms: Schizophrenia/ethnology
  2. Azhar MZ, Varma SL, Hakim HR
    Singapore Med J, 1995 Jun;36(3):273-5.
    PMID: 8553090
    Two hundred and seventy schizophrenia patients were interviewed using the Present State Examination to elicit the phenomenological symptoms of the illness. Cultural factors and ethnicity were found to be significant variables associated with the symptoms. Higher prevalence of religious and other subculturally related delusions were common in Kelantan patients. Our general belief that Malaysian culture influences symptomatology of mental illness seems to be proven.
    Matched MeSH terms: Schizophrenia/ethnology*
  3. McLean D, Thara R, John S, Barrett R, Loa P, McGrath J, et al.
    Cult Med Psychiatry, 2014 Sep;38(3):408-26.
    PMID: 24981830 DOI: 10.1007/s11013-014-9385-8
    There is significant variation in the expression of schizophrenia across ethnically different populations, and the optimal structural and diagnostic representation of schizophrenia are contested. We contrasted both lifetime frequencies of DSM-IV criterion A (the core symptom criterion of the internationally recognized DSM classification system) symptoms and types/content of delusions and hallucinations in transethnic schizophrenia populations from Australia (n = 776), India (n = 504) and Sarawak, Malaysia (n = 259), to elucidate clinical heterogeneity. Differences in both criterion A symptom composition and symptom content were apparent. Indian individuals with schizophrenia reported negative symptoms more frequently than other sites, whereas individuals from Sarawak reported disorganized symptoms more frequently. Delusions of control and thought broadcast, insertion, or withdrawal were less frequent in Sarawak than Australia. Curiously, a subgroup of 20 Indian individuals with schizophrenia reported no lifetime delusions or hallucinations. These findings potentially challenge the long-held view in psychiatry that schizophrenia is fundamentally similar across cultural groups, with differences in only the content of psychotic symptoms, but equivalence in structural form.
    Matched MeSH terms: Schizophrenia/ethnology*
  4. Loh HC, Chow TJ, Tang PY, Yong HS
    Psychiatry Res, 2013 Oct 30;209(3):732-3.
    PMID: 23747160 DOI: 10.1016/j.psychres.2013.05.017
    We aim to replicate AKT1 gene variants studies using Malaysian samples. Seven AKT1 single nucleotide polymorphisms (SNPs) were studied in 417 patients and 429 controls. Haplotype showed significant association (p=0.036) with schizophrenia, especially in Malays and Indians. Meta-analysis of rs2494732 showed significant association worldwide (p=0.018) and in Asians (p=0.023).
    Matched MeSH terms: Schizophrenia/ethnology
  5. McLean D, John S, Barrett R, McGrath J, Loa P, Thara R, et al.
    Psychiatry Res, 2012 Apr 30;196(2-3):194-200.
    PMID: 22401968 DOI: 10.1016/j.psychres.2011.12.027
    We contrasted demographic and clinical characteristics in transethnic schizophrenia populations from Australia (n=821), India (n=520) and Sarawak, Malaysia (n=298) and proposed cultural explanations for identified site differences. From these we aimed to identify candidate variables free from significant cultural confounding that are hence suitable for inclusion in genetic analyses. We observed five phenomena: (1) more individuals were living alone in Australia than India or Sarawak; (2) drug use was lower in India than Australia or Sarawak; (3) duration of untreated psychosis (DUP) was longer in India than Australia or Sarawak; (4) the rate of schizoaffective disorder was lower in India than Australia or Sarawak; and (5) age at psychosis onset (AAO) was older in Sarawak than Australia or India. We suggest that site differences for living arrangements, drug use and DUP are culturally confounded. The schizoaffective site difference likely results from measurement bias. The AAO site difference, however, has no obvious cultural or measurement bias explanation. Therefore, this may be an ideal candidate for use in genetic studies, given that genetic variants affecting AAO have already been proposed.
    Matched MeSH terms: Schizophrenia/ethnology*
  6. Tee SF, Tang PY, Loh HC
    Genet. Mol. Res., 2011;10(3):1850-5.
    PMID: 21948748 DOI: 10.4238/vol10-3gmr1237
    Molecular components of the dopamine D3 receptor (DRD3) may play an important role in the pathophysiology of schizophrenia. Previous studies have demonstrated an association between DRD3 Ser9Gly and cathechol-o-methyltransferase (COMT, SNP = rs165656) polymorphisms and schizophrenia but the results were inconclusive. We investigated this apparent association between Ser9Gly (A/G) polymorphism and an intronic SNP (dbSNP or rs165656) in 261 Malay patients diagnosed with schizophrenia and 216 controls, using PCR-RFLP. The genotype distribution of the polymorphism DRD3 Ser9Gly was in Hardy-Weinberg equilibrium (HWE) for patients (P = 0.1251) and out of HWE for controls (P = 0.0137). However, both healthy controls and schizophrenia patients were out of HWE for the polymorphism COMT rs165656. Based on allele and genotype frequencies in both groups, we found no significant association of DRD3 Ser9Gly polymorphisms and COMT (rs165656) with schizophrenia in Malays. Further studies should examine the association between other dopamine-related genes and the behavioral phenotypes of schizophrenia.
    Matched MeSH terms: Schizophrenia/ethnology
  7. Mubarak AR, Baba I, Chin LH, Hoe QS
    Aust N Z J Psychiatry, 2003 Oct;37(5):577-85.
    PMID: 14511086
    This is a study of the quality of life (QOL) of 174 community-based chronic schizophrenia patients in Penang, Malaysia.
    Matched MeSH terms: Schizophrenia/ethnology*
  8. Chong SA, Remington G, Mahendran R, Chua HC
    J Clin Psychopharmacol, 2001 Apr;21(2):235-7.
    PMID: 11270922
    While ethnocultural differences in risk of tardive dyskinesia (TD) have been suggested, no previous studies have examined whether this factor also plays a role in lack of awareness of TD. This study examined this question in an Asian population with schizophrenia. Six hundred seven patients in a state mental hospital in Singapore were assessed using the Abnormal Involuntary Movement Scale (AIMS) and the Simpson-Angus Rating Scale. Of the 607 patients, 242 (39.9%) met criteria for TD, and 163 (67.4%) patients were not aware of the presence of TD. No significant differences in terms of age, gender, and duration of illness were found between those aware of their TD and those not aware. Daily neuroleptic doses and scores for the AIMS and Simpson-Angus Rating Scale were significantly different, although after logistic regression, only the Simpson-Angus Rating Scale scores remained significant. The finding that a large proportion of our patients lacked awareness of their TD is consistent with other reports in the West and provides evidence that this feature is characteristic of the illness rather than of a specific ethnocultural group. We found an association between lack of awareness and greater severity of extrapyramidal symptoms (EPS), suggesting that there may be a subtype of TD in which lack of awareness and greater vulnerability of developing EPS are features.
    Matched MeSH terms: Schizophrenia/ethnology*
  9. Peet M, Shah S, Selvam K, Ramchand CN
    World J. Biol. Psychiatry, 2004 Apr;5(2):92-9.
    PMID: 15179668
    There are several reports of reduced levels of polyunsaturated fatty acids (PUFA), particularly arachidonic acid (AA) and docosahexaenoic acid (DHA), in membrane phospholipid from various tissues including red blood cells (RBC) taken from schizophrenic patients. However, reports have not been entirely consistent and most studies have been confounded by the potential effects of environmental factors including antipsychotic medication and diet. We measured PUFA levels in RBC from two separate groups of unmedicated patients and control subjects from India and Malaysia, populations which have substantial differences in diet. We found no significant difference in levels of AA between patients and control subjects in either population. Levels of adrenic acid were significantly reduced, and levels of DHA significantly increased in both clinical populations. However, diet-related differences in DHA between the populations from India and Malaysia were much greater than differences between schizophrenic patients and controls. It is concluded that reduced RBC membrane levels of AA and DHA are not pathognomic of schizophrenia but that variations in cell membrane fatty acid levels are an epiphenomenon which may reflect underlying abnormalities of phospholipid and fatty acid metabolism and their interaction with environmental factors including medication and diet.
    Matched MeSH terms: Schizophrenia/ethnology
  10. Mahendran R, Mahendran R, Chan YH
    Ann Acad Med Singap, 2004 May;33(3):320-3.
    PMID: 15175772
    INTRODUCTION: Most research in interleukin activity in schizophrenia has been in Caucasian populations. We examined interleukin-2 (IL-2) levels and their relation to the duration of the illness, psychopathology and treatment effects, in chronic schizophrenia patients of Asian origin.

    MATERIALS AND METHODS: Thirty chronic schizophrenia patients were recruited for the study and their demographic data and medication dosage were noted. Symptom severity was scored on the Positive And Negative Syndrome scale for Schizophrenia (PANSS) and blood sampling done. Ten healthy Chinese males were recruited as controls. Phytohaemagglutinin-stimulated production of serum levels of IL-2 were measured by enzyme-linked immunosorbent assay.

    RESULTS: IL-2 levels (1327 +/- 596.2) of all 30 patients were significantly lower than that of the Chinese controls (2420 +/- 342.5). This effect was noted throughout the entire duration of the illness. Ethnic and age differences in IL-2 levels were not found. There was, however, a negative correlation with the duration of the illness and a positive correlation with the dosage of medication.

    CONCLUSIONS: The results of this study of a population of mostly Chinese patients with schizophrenia replicate an important finding. Data such as this has not been reported previously on Asians of this racial group.

    Matched MeSH terms: Schizophrenia/ethnology
  11. Barrett RJ
    Commun Med, 2004;1(1):25-34.
    PMID: 16808686
    An analysis is presented of psychiatric research interviews conducted among the Iban, a longhouse dwelling people of Sarawak, Malaysia. It draws on transcripts of interviews recorded in the course of carrying out research into schizophrenia in this group. The article examines three different interview spaces within the longhouse--public, family, and private--in order to explore the interplay between ethnographic context and interview conversation. The public setting is notable for the number of relatives who join in and transform the communication from dyadic to collective interlocution; the role of repetition in recruiting them into the conversation is explored. Indirect contrast is the private space, which allows for a level of confidentiality commensurate with Western psychiatric research practice. Intermediate between the two is the family space. The communicative forms that correspond to these settings influence the way symptoms of schizophrenia are experienced and expressed in the Iban. Implications for the practice of psychiatry cross-culturally are examined.
    Matched MeSH terms: Schizophrenia/ethnology*
  12. Tee SF, Tang PY, Loh HC
    Psychiatry Res, 2012 Jan 30;195(1-2):83-4.
    PMID: 21872942 DOI: 10.1016/j.psychres.2011.07.039
    The present study included a total 261 patients with schizophrenia and 261 healthy controls to replicate the genetic association between the cathechol-o-methyltransferase gene and schizophrenia using a haplotype block-based gene-tagging. The G-G-G haplotype was found to show a highly significant association with schizophrenia.
    Matched MeSH terms: Schizophrenia/ethnology
  13. Razali SM, Yassin AM
    Transcult Psychiatry, 2008 Sep;45(3):455-69.
    PMID: 18799643 DOI: 10.1177/1363461508094676
    The objective of this article is to describe and compare the use of traditional/complementary medicine (T/CM) among psychotic (schizophrenia and schizophreniform disorder) and epileptic Malay patients in peninsular Malaysia. There were 60 patients in each group. T/CM consultation was uniformly spread across all levels of education and social status. We could not find a single over-riding factor that influenced the decision to seek T/CM treatment because the decision to seek such treatment was complex and the majority of decisions were made by others. Fifty-three patients (44.2%), consisting of 37 (61.7%) psychotic and 16 (26.7%) epileptic patients had consulted Malay traditional healers (bomoh) and/or homeopathic practitioners in addition to modern treatment; of these, only three had consulted bomoh and homeopathic practitioners at the same time. The use of T/CM was significantly higher in psychotic than in epileptic Malay patients.
    Matched MeSH terms: Schizophrenia/ethnology*
  14. Lim CH, Zain SM, Reynolds GP, Zain MA, Roffeei SN, Zainal NZ, et al.
    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.
    Matched MeSH terms: Schizophrenia/ethnology
  15. Swami V, Furnham A, Kannan K, Sinniah D
    Int J Soc Psychiatry, 2008 Mar;54(2):164-79.
    PMID: 18488409
    Lay beliefs about schizophrenia have been extensively studied in cross-cultural settings, but research on ethnic differences are currently lacking.
    Matched MeSH terms: Schizophrenia/ethnology*
  16. Chong SA, Mahendran R, Machin D, Chua HC, Parker G, Kane J
    J Clin Psychopharmacol, 2002 Feb;22(1):26-30.
    PMID: 11799339
    The prevalence of tardive dyskinesia (TD) was studied with the Abnormal Involuntary Movements Scale in Chinese and Malay patients with schizophrenia who were hospitalized in a Singapore state psychiatric institute. We also studied the relationship of neuroleptic-induced extrapyramidal side effects to TD. By using established criteria, the rates of TD were 40.6% for Chinese and 29.0% for Malays, higher than previously reported for Chinese subjects. Older age and lower current neuroleptic dose were significantly associated with TD. Multivariate analysis, after controlling for other salient risk variables, did not show a significant difference in TD prevalence rates between the two races. We conclude that suggested differences in interethnic rates of TD among Chinese, Malays, and Westerners are unlikely to exist and that any variation in prevalence is more likely to be determined by differences in duration of exposure and dose levels of neuroleptic drugs.
    Matched MeSH terms: Schizophrenia/ethnology
  17. Bruxner G, Burvill P, Fazio S, Febbo S
    Aust N Z J Psychiatry, 1997 Aug;31(4):532-42.
    PMID: 9272263
    Recent Australian Government initiatives have emphasised problems with service provision to the ethnic mentally ill. This study aims to address the paucity of contemporary data describing the disposition of the ethnic mentally ill in hospital settings.
    Matched MeSH terms: Schizophrenia/ethnology
  18. Lee C, Wu KH, Habil H, Dyachkova Y, Lee P
    Aust N Z J Psychiatry, 2006 May;40(5):437-45.
    PMID: 16683970
    To examine clinical outcomes in Asian patients with schizophrenia receiving monotherapy with olanzapine, risperidone or typical antipsychotics in naturalistic settings.
    Matched MeSH terms: Schizophrenia/ethnology*
  19. Tan CH, Chiang PC, Ng LL, Chee KT
    Br J Psychiatry, 1994 Sep;165(3):381-3.
    PMID: 7994510
    BACKGROUND: The objective was to investigate the occurrence and characteristics of oculogyric spasm (OGS) in an Asian country.

    METHOD: All 2035 Asian (88% Chinese, 7% Malays and 5% Indonesians) psychiatric in-patients in the state psychiatric hospital in Singapore were surveyed for occurrence of oculogyric spasm (OGS) over a two-month period.

    RESULTS: Thirty-four patients (1.7%) developed OGS (53% male and 47% female). All the 34 patients had been on maintenance antipsychotic drugs for more than five months. Eighteen patients had recurrent attacks. The mean chlorpromazine equivalent daily dose for those patients with recurrent OGS was 511 mg. This was significantly higher (P < 0.05) than the 277 mg daily dose received by those without recurrent OGS. Most (68%) of the attacks occurred between 1400-2000 h suggesting that OGS may have a diurnal variation.

    CONCLUSIONS: OGS presenting as tardive dystonia may be due to a relative increase in cholinergic activity.

    Matched MeSH terms: Schizophrenia/ethnology
  20. Salleh MR
    Acta Psychiatr Scand, 1994 Mar;89(3):180-5.
    PMID: 8178676 DOI: 10.1111/j.1600-0447.1994.tb08089.x
    Deinstitutionalization has shifted much of the burden of care of chronic schizophrenia from mental institutions to the family. The aim of this study is to asses the prevalence of mental disorders among 210 primary carers of Malay schizophrenic patients, explored the burden and hardship experienced by them. This is a two-stage psychiatric screening procedure. All the cases suspected from initial screening with WHO Self-Reporting Questionnaires (SRQ-20) were called for clinical interview. Patients' behavioural problems and the burden of relatives were assessed by the Social Behaviour Schedule and the Interview Schedule respectively. It was found that about 23% of the carers developed neurotic disorders resulting from the stress; nearly half of them had neurotic depression. Despite their burden, they do not complaint about it. Neurotic carers compared with non-neurotic carers had significantly more subjective burden and distress related to the product of active psychosis. The carers were generally able to tolerate the negative symptoms of schizophrenia. The number of problem behaviours and previous admissions were significantly correlated with the severity of burden.
    Matched MeSH terms: Schizophrenia/ethnology
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