Comorbidity of Mental Disorder in Patients with Chronic Disease: A Comparative Study of Heroin Dependence Patients and Diabetes Mellitus Patients.

BACKGROUND: Chronic patients are at greater risk for a psychiatric problem than the normal population; yet, the increased rate of mental disorder among one chronic patient compared to another chronic patient is uncertain. We aimed to assess the rate of mental disorder among people with heroin dependence and diabetes mellitus in comparison with the healthy population. METHODS: This cross-sectional study was carried out in Kuala Lumpur, Malaysia in 2017-2020. The study consisted of 648 participants including heroin dependence patients, diabetes mellitus patients, and healthy population. The GHQ-28 and SCL-90-R scales were used to assess mental disorder among the study populations. RESULTS: The current study revealed the rate of mental disorder among heroin dependence patients, diabetes mellitus patients, and healthy population respectively at 52.1%, 49.5%, and 23.2% using SCL-90-R and GHQ-28. The rate of mental disorder in both heroin dependent (OR 95%= 3.59: 2.37-5.44) and diabetic groups (OR 95%=3.25: 2.14-4.92) were significantly more than the healthy population; however, the odds ratio of mental disorder was not significantly different between heroin dependent and diabetic groups. Furthermore, the results revealed an acceptable agreement between SCL-90-R and GHQ-28 to detect mental disorders (Kappa=0.60; P<0.001). CONCLUSION: People with diabetes mellitus and heroin dependence have significantly poorer mental health than healthy people in Malaysia have. Furthermore, the equivalent rate of mental disorder among such patients suggests that heroin dependence patients are not more distressed than diabetes mellitus patients are. However, further comparative studies are needed to prove these findings.

Religion, Spirituality and Risk of Coronary Heart Disease: A Matched Case-Control Study and Meta-Analysis.

Although the association between religion/spirituality (R/S) and psychological outcomes is well established, current understanding of the association with cardiovascular disease remains limited. We sought to investigate the association between Islamic R/S and coronary heart disease (CHD), and place these findings in light of a meta-analysis. In this case-control study, 190 cases with non-fatal CHD were identified and individually matched with 383 hospital-based controls. R/S was measured by self-administered 102 items questionnaire. A tabular meta-analysis was performed of observational studies on R/S (high level versus low level) and CHD. In addition, a dose-response meta-analysis was conducted using generalized least-squares regression. Participants in the top quartile had decreased odds of CHD comparing to participants in the lowest quartile of religious belief (OR 0.20, 95% confidence interval (CI) 0.06-0.59), religious commitment (OR 0.36, CI 95% 0.13-0.99), religious emotions (OR 0.39, CI 95% 0.18-0.87), and total R/S score (OR 0.30, CI 95% 0.13-0.67). The meta-analysis study showed a significant relative risk of 0.88 (CI 95% 0.77-1.00) comparing individuals in high level versus low level of R/S. In dose-response meta-analysis, comparing people with no religious services attendance, the relative risks of CHD were 0.77 (CI 95% 0.65-0.91) for one times attendance and 0.27 (CI 95% 0.11-0.65) for five times attendance per month. R/S was associated with a significantly decreased risk of CHD. The possible causal nature of the observed associations warrants randomized clinical trial with large sample size.

Acute effects of methadone on EEG power spectrum and event-related potentials among heroin dependents.

Methadone as the most prevalent opioid substitution medication has been shown to influence the neurophysiological functions among heroin addicts. However, there is no firm conclusion on acute neuroelectrophysiological changes among methadone-treated subjects as well as the effectiveness of methadone in restoring brain electrical abnormalities among heroin addicts. This study aims to investigate the acute and short-term effects of methadone administration on the brain's electrophysiological properties before and after daily methadone intake over 10 weeks of treatment among heroin addicts. EEG spectral analysis and single-trial event-related potential (ERP) measurements were used to investigate possible alterations in the brain's electrical activities, as well as the cognitive attributes associated with MMN and P3. The results confirmed abnormal brain activities predominantly in the beta band and diminished information processing ability including lower amplitude and prolonged latency of cognitive responses among heroin addicts compared to healthy controls. In addition, the alteration of EEG activities in the frontal and central regions was found to be associated with the withdrawal symptoms of drug users. Certain brain regions were found to be influenced significantly by methadone intake; acute effects of methadone induction appeared to be associative to its dosage. The findings suggest that methadone administration affects cognitive performance and activates the cortical neuronal networks, resulting in cognitive responses enhancement which may be influential in reorganizing cognitive dysfunctions among heroin addicts. This study also supports the notion that the brain's oscillation powers and ERPs can be utilized as neurophysiological indices for assessing the addiction treatment traits.

Evaluation of Psychometric Properties of the Second Version of the Taqwa (Piety) Questionnaire in Bahasa Melayu.

The aim of the study is to evaluate the psychometric properties of the Bahasa Melayu version of the Taqwa (piety) questionnaire, used for the measurement of behaviour of Drug Dependency Syndrome (DDS), in Malay patients. A sample of 98 males with a psychiatric diagnosis (DSM-IV-R) as the DDS was randomly selected from Kajang Khafidz Polyclinic Kuala Lumpur, Malaysia. After receiving their agreement to attend the study, they completed the Taqwa (piety) questionnaire. The reliability was assessed by determining the Cronbach's [Formula: see text] to measure the consistency of related questions for all four dimensions (subscales), including individual, social, cognitional, and emotional Taqwa behaviour. In the next step to evaluate the composite reliability, convergent, and discrimination validity, a measurement model was determined via Conformity Factor Analysis (CFA) based on Partial List Square method (Smart- PLS Ver: 2M3). The reliability of four dimensions of the questionnaire was acceptable ([Formula: see text] correlated to each other. However, according to the CFA method, the items with low loading factor (<0.5) were excluded from each dimension. Item 24 and 35 that were related to individual Taqwa, and item 35 that belonged to emotional Taqwa were excluded from the analysis. The composite reliability and convergent, and discrimination validity were satisfied in all conformity factor loading that exceeded 0/05. The psychometric properties of the Taqwa questionnaire are acceptable, and the scale is a good instrument for assessing the Islamic attitude, beliefs, and behaviour of the Bahasa Melayu DDS patients.

Investigation of brain electrophysiological properties among heroin addicts: Quantitative EEG and event-related potentials.

This study aims to introduce a new approach of a comprehensive paradigm to evaluate brain electrophysiological properties among addicts. Electroencephalographic spectral power as well as amplitudes and latencies of mismatch negativity (MMN), P300, and P600 components were evaluated among 19 male heroin addicts and 19 healthy nonsmoker subjects using a paradigm consisting of three subparadigms, namely (1) digit span Wechsler test, (2) auditory oddball, and (3) visual cue-reactivity oddball paradigms. Task 1 provided auditory P300 and P600 in association with working memory. Task 2 provided auditory P300 as well as small and large deviant MMN event-related potential (ERPs). Finally, task 3 provided visual cue-reactivity P300. Results show that beta power was higher among heroin addicts while delta, theta, and alpha powers were decreased compared with healthy subjects. ERP analysis confirmed the decline of brain-evoked potential amplitudes when compared with healthy subjects, thus indicating a broad neurobiological vulnerability of preattentive and attentional processing including attentional deficits and compromise of discrimination abilities. The prolonged latency of ERPs reflects poor cognitive capacity in the engagement of attention and memory resources. On the other hand, an increase of attention towards the heroin-related stimuli could be concluded from the increase of P300 in the cue-reactivity condition among heroin addicts. Findings suggest that applying this paradigm in addiction studies benefits comprehensive evaluation of neuroelectrophysiological activity among addicts, which can promote a better understanding of drugs' effects on the brain as well as define new neuroelectrophysiological characteristics of addiction properties. © 2016 Wiley Periodicals, Inc.

Construct Validity of Symptom Checklist-90-Revised (SCL-90-R) and General Health Questionnaire-28 (GHQ-28) in Patients with Drug Addiction and Diabetes, and Normal Population.

BACKGROUND: Given that validity is the baseline of psychological assessments, there is a need to provide evidence-based data for construct validity of such scales to advance the clinicians for evaluating psychiatric morbidity in psychiatric and psychosomatic setting. METHODS: This comparative cross-sectional study aimed to investigate the construct validity of the Malaysian version of the GHQ-28 and the SCL-90-R. The sample comprised 660 individuals including diabetics, drug dependents, and normal population. The research scales were administered to the participants. Convergent and discriminant validity of both scales were investigated by Confirmatory Factor Analysis (CFA) using AMOS. The Pearson correlation coefficient was utilized to obtain the relationship between the two scales. RESULTS: The internal consistency of the GHQ-28 and SCL-90-R were highly acceptable, and confirmatory factor analysis confirmed the convergent validity of both scales. The results of this study revealed that the construct validity of GHQ-28 was acceptable, whereas discriminant validity of SCL-90-R was not adequate. According to Pearson correlation coefficient the relationships between three common subscales of the GHQ-28 and SCL-90-R were significantly positive; somatization (r=0.671, P<0.01), Anxiety (r=0.728, P<0.01), and Depression (r=0.660, P <0.01). CONCLUSIONS: This study replicated the construct of the Malaysian version of GHQ-28, yet failed to support the nine-factor structure of the SCL-90-R. Therefore, multidimensionality of the SCL-90-R as clinical purposes is questionable, and it may be a better unitary measure for assessing and screening mental disorders. Further research need to be carried out to prove this finding.

Acupuncture therapy for drug addiction.

Acupuncture therapy has been used to treat substance abuse. This study aims to review experimental studies examining the effects of acupuncture on addiction. Research and review articles on acupuncture treatment of substance abuse published between January 2000 and September 2014 were searched using the databases ISI Web of Science Core Collection and EBSCO's MEDLINE Complete. Clinical trial studies on the efficacy of acupuncture therapy for substance abuse were classified according to substance (cocaine, opioid, nicotine, and alcohol), and their treatment protocols, assessments, and findings were examined. A total of 119 studies were identified, of which 85 research articles addressed the efficacy of acupuncture for treating addiction. There were substantial variations in study protocols, particularly regarding treatment duration, frequency of electroacupuncture, duration of stimulation, and choice of acupoints. Contradictory results, intergroup differences, variation in sample sizes, and acupuncture placebo effects made it difficult to evaluate acupuncture effectiveness in drug addiction treatment. This review also identified a lack of rigorous study design, such as control of confounding variables by incorporating sham controls, sufficient sample sizes, reliable assessments, and adequately replicated experiments.

Neuroelectrophysiological approaches in heroin addiction research: A review of literatures.

Neuroelectrophysiological properties have been used in human heroin addiction studies. These studies vary in their approach, experimental conditions, paradigms, and outcomes. However, it is essential to integrate previous findings and experimental methods for a better demonstration of current issues and challenges in designing such studies. This Review examines methodologies and experimental conditions of neuroelectrophysiological research among heroin addicts during withdrawal, abstinence, and methadone maintenance treatment and presents the findings. The results show decrements in attentional processing and dysfunctions in brain response inhibition as well as brain activity abnormalities induced by chronic heroin abuse. Chronic heroin addiction causes increased ß and α2 power activity, latency of P300 and P600, and diminished P300 and P600 amplitude. Findings confirm that electroencephalography (EEG) band power and coherence are associated with craving indices and heroin abuse history. First symptoms of withdrawal can be seen in high-frequency EEG bands, and the severity of these symptoms is associated with brain functional connectivity. EEG spectral changes and event-related potential (ERP) properties have been shown to be associated with abstinence length and tend to normalize within 3-6 months of abstinence. From the conflicting criteria and confounding effects in neuroelectrophysiological studies, the authors suggest a comprehensive longitudinal study with a multimethod approach for monitoring EEG and ERP attributes of heroin addicts from early stages of withdrawal until long-term abstinence to control the confounding effects, such as nicotine abuse and other comorbid and premorbid conditions.

Achieving a Spiritual Therapy Standard for Drug Dependency in Malaysia, from an Islamic Perspective: Brief Review Article.

Religion is one of the protective factors that facilities positive outcomes by preventing individuals from engaging in addictive substance. A recent study has confirmed that religion inhibits drug addiction. The concept of psychospiritual therapy was to introduce drug addiction. Therefore, of the various methods of psychotherapy, the usage of Taqwa (piety) emerged as an applicable method of Islamic spiritual therapy. This study was conducted in Malaysia as a Muslim country and focuses on Islamic recommendations and its relation to spiritual therapy.

A mosque-based methadone maintenance treatment strategy: implementation and pilot results.

BACKGROUND: This paper describes the rationale, implementation and operation of a "world first" Islamic inspired methadone maintenance treatment project delivered in a mosque setting and presents the outcome for the first group of participants. The project explored the viability of expanding addiction recovery services through the network of mosques in Muslim communities. METHODS: The project combined methadone maintenance with peer and religious counseling. Participants consisted of 36 male Muslim heroin users who went through the project. Urine tests and self-reported measures on various dimensions relevant to drug use and quality of life were collected at baseline and 12 months. RESULTS: The project had a 12 month retention rate of 80%. At 12 months all but one participant tested negative for opioids and other substances. Self-report measures showed significant reductions in the degree and variety of drug use, improvements in general health, and psychological and social functioning of participants. Qualitative data showed that availability of methadone, convenient location and religion were the main reasons drawing participants to the program. CONCLUSIONS: Mosques are viable venues for offering medication assisted recovery services and offer an alternative approach for managing addiction in Muslim communities. The prospect of mobilizing community resources to offer community-oriented long-term recovery management programs in mosques and other places of worship deserves consideration.

Self-poisoning suicide attempts among students in Tehran, Iran.

BACKGROUND: This study aim was to describe the epidemiology of intentional self-poisoning among students. SUBJECTS AND METHODS: A cross-sectional study was conducted on self-poisoned students admitted to Loghman-Hakim Hospital in Tehran, Iran. Variables studied included age, sex, substance abuse, personal history, familial history and the immediate precipitant for the suicide attempt. RESULTS: A total of 248 students (200 F and 48 M) studied. The mean age was 16.3+/-1.42 years. Self poisoning with a pharmaceutical agent was the most common attempt modality (87.5%). The most common precipitant for the suicide attempt was family conflict (54.4%), followed by romantic disappointment (29.4%). The most common psychiatric disorders were adjustment disorder (84.3%). and depression (18.1%). CONCLUSION: The emphasis in student suicide prevention programs must be on early identification of students at risk, and appropriate treatment of episodes of psychopathology.