Listening to Sentences in Noise: Revealing Binaural Hearing Challenges in Patients with Schizophrenia

OBJECTIVE: The present, case-control, study investigates binaural hearing performance in schizophrenia patients towards sentences presented in quiet and noise. METHODS: Participants were twenty-one healthy controls and sixteen schizophrenia patients with normal peripheral auditory functions. The binaural hearing was examined in four listening conditions by using the Malay version of hearing in noise test. The syntactically and semantically correct sentences were presented via headphones to the randomly selected subjects. In each condition, the adaptively obtained reception thresholds for speech (RTS) were used to determine RTS noise composite and spatial release from masking. RESULTS: Schizophrenia patients demonstrated significantly higher mean RTS value relative to healthy controls (p=0.018). The large effect size found in three listening conditions, i.e., in quiet (d=1.07), noise right (d=0.88) and noise composite (d=0.90) indicates statistically significant difference between the groups. However, noise front and noise left conditions show medium (d=0.61) and small (d=0.50) effect size respectively. No statistical difference between groups was noted in regards to spatial release from masking on right (p=0.305) and left (p=0.970) ear. CONCLUSION: The present findings suggest an abnormal unilateral auditory processing in central auditory pathway in schizophrenia patients. Future studies to explore the role of binaural and spatial auditory processing were recommended.

The Hyperactivity of Efferent Auditory System in Patients with Schizophrenia: A Transient Evoked Otoacoustic Emissions Study

OBJECTIVE: Electrophysiological studies, which are mostly focused on afferent pathway, have proven that auditory processing deficits exist in patients with schizophrenia. Nevertheless, reports on the suppressive effect of efferent auditory pathway on cochlear outer hair cells among schizophrenia patients are limited. The present, case-control, study examined the contralateral suppression of transient evoked otoacoustic emissions (TEOAEs) in patients with schizophrenia. METHODS: Participants were twenty-three healthy controls and sixteen schizophrenia patients with normal hearing, middle ear and cochlear outer hair cells function. Absolute non-linear and linear TEOAEs were measured in both ears by delivering clicks stimuli at 80 dB SPL and 60 dB SPL respectively. Subsequently, contralateral suppression was determined by subtracting the absolute TEOAEs response obtained at 60 dBpe SPL during the absence and presence of contralateral white noise delivered at 65 dB HL. No attention tasks were conducted during measurements. RESULTS: We found no significant difference in absolute TEOAEs responses at 80 dB SPL, in either diagnosis or ear groups (p>0.05). However, the overall contralateral suppression was significantly larger in schizophrenia patients (p<0.05). Specifically, patients with schizophrenia demonstrated significantly increased right ear contralateral suppression compared to healthy control (p<0.05). CONCLUSION: The present findings suggest increased inhibitory effect of efferent auditory pathway especially on the right cochlear outer hair cells. Further studies to investigate increased suppressive effects are crucial to expand the current understanding of auditory hallucination mechanisms in schizophrenia patients.

Anxiety and Depressive Symptoms among Ischaemic Heart Disease Patients in a Malaysian Tertiary University Hospital

Anxiety and depression were known to bring detrimental outcome in patients with ischemic heart disease (IHD). Notwithstanding their high prevalence and catastrophic impact, anxiety and depression were unrecognized and untreated. The aim of this study was to determine the prevalence of anxiety and depression among IHD patients and the association of this condition with clinical and selected demographic factors. This was a cross-sectional study on 100 IHD patients admitted to medical ward in UKMMC. Patients diagnosed to have IHD were randomly assessed using Hospital Anxiety and Depression Scale (HADS) and Perceived Social Support (PSS) Questionnaire. Socio-demographic data were obtained by direct interview. Fifteen percent of IHD patients in this sample were noted to have anxiety, fourteen percent noted to have depression while thirty two percent was noted to have both anxiety and depression. Patients’ age group and the duration of illness were found to have significant association with anxiety. Socio-demographic data were obtained by direct interview. Fifteen percent of IHD patients in this sample were noted to have anxiety, fourteen percent noted to have depression while thirty two percent was noted to have both anxiety and depression. Patients’ age group and the duration of illness were found to have significant association wit¬h anxiety. The other clinical and selected demographic factors such as gender, race, marital status, education level, occupation, co-existing medical illness and social support were not found to be significantly associated with anxiety or depression among the IHD patients. In conclusion, proper assessment of anxiety and depression in IHD patients, with special attention to patients’ age and duration of illness should be carried out routinely to help avert detrimental consequences.​

Psychosis in Parkinson's Disease Patients

The objective of this study is to determine the prevalence and factors associated with psychosis in Parkinson’s disease (PD) patients. Method: This is a cross-sectional study of 108 PD patients from neurological clinic UKM Medical Centre and Kuala Lumpur Hospital. The patients were recruited from August to December 2004. Psychosis was determined using SCID, the severity of psychosis was rated using BPRS. The cognitive functions were evaluated with MMSE and the severity of depression was assessed with HAM-D. Results: The result shows that the prevalence of psychosis in Parkinson’s disease patients in this sample was 13%. The psychosis was found to be significantly associated with advancing age, duration of illness, severity of depression and cognitive impairment. Multivariate analysis demonstrates that severity of depression (OR = 1.08, 95% C.I. = 1.01 – 1.16) and advancing age (OR = 4.72, 95% C.I. = 1.37 – 16.29) increased risk of psychosis in PD patients. Conclusion: We found that advancing age and severity of depression increase risk to develop psychosis in patients with PD.

Verbal Memory Test Performance In Patients With Bipolar I Disorder Attending A Psychiatric Clinic Of A University Hospital In Kuala Lumpur, Malaysia

Objective: The study aims to determine pattern of verbal memory and learning impairment and its associated factors among patients with bipolar I disorder in a psychiatric clinic of a university hospital. Methods: A case control study comparing verbal memory test performance in 40 patients with bipolar I disorder to that of 40 healthy normal subjects using Rey Auditory Verbal Learning Test (RAVLT). The association between demographic, clinical characteristics and poor verbal memory performance were examined. Results: Up to 92% of patients with bipolar I disorder have impaired short term working memory in this hospital-based study. They also recalled fewer words in all the RAVLT trials and had difficulties learning the word list in comparison to that of normal healthy individuals. Verbal memory and learning impairment are observed in bipolar illness in the absence of active mood symptoms while duration and severity of illness are not found to have any effect on verbal memory and learning. Conclusion: There is consistent verbal memory and learning problems in individuals with bipolar I disorder and their presence in the absence of mania, depression and mixed symptoms during the course of the illness suggests a trait related deficit.

Metabolic Syndrome In Psychiatric Patient With Primary Psychotic And Mood Disorders

Objective: A study was conducted at the Universiti Kebangsaan Malaysia Medical Center (UKMMC) adult psychiatric clinic from June 2006 to December 2006. The aim was to assess the rate of the metabolic syndrome in a group of outpatients with mood disorders and schizophrenia and also to determine the relationship of this condition with sociodemographic factors and psychiatric illness characteristics. Methods: A total of 51 subjects agree to participate of which 100 were approached. The International Diabetes Federation (IDF)(2005) criteria are used for the diagnosis of metabolic syndrome and Diagnostic Statistical Manual Version IV (DSM-IV) criteria are used to made psychiatric diaognosis. Results: The prevalence of metabolic syndrome was found to be 37.2% and was significantly higher amongst mood disorders patient. However the metabolic syndrome is not associated with the anti psychotic therapy (p=0.41). Conclusion: This study suggests that it is important for the psychiatrist to monitor metabolic syndrome in any of their patients.