Sains Malaysiana 42(3)(2013): 417–421

Psychiatric Comorbidity Among Community-based, Treatment Seeking

Opioid Dependents in Klang Valley

(Komorbiditi Penyakit Psikiatri dalam Kalangan Penagih yang Berganting pada

Opioid di Lembah Kelang)

Azlin Baharudin¹*, Lotfi Anuar², Suriati Saini, Osman Che Bakar³, Rosdinom Razali¹ & Nik Ruzyanei Nik Jaafar¹

¹Department of Psychiatry, Faculty of Medicine,Universiti Kebangsaan Malaysia Medical Centre

Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia

²Department of Psychiatry, Hospital Tuanku Mizan, Jalan 4/27A, Seksyen 2, Wangsa Maju

53300 Kuala Lumpur, Malaysia

³Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA

40450 Shah Alam Selangor, Malaysia

Diserahkan: 6 Julai 2012/Diterima: 23 Julai 2012

ABSTRACT

The main objectives in this study were to determine the percentage of psychiatric comorbidity among treatment seeking opioid dependents in Klang Valley. A cross sectional study of opioid dependence patients was conducted between December 2007 and May 2008 at ten community-based drug substitution therapy clinics in Klang Valley. A total of 204 opioid dependence patients participated in the study using the structured clinical interview for DSM-IV Axis I disorders (SCID-I) as its instruments. The percentage of psychiatric comorbidity among opioid dependents was 43.6%. Major depressive disorder had the highest prevalence at 32.6%, followed by dysthymia at 23.6% and Panic disorder at 14.6%. Psychiatric comorbidity were found to have significant differences (p<0.05) in connection with history of polysubstance abuse, previous history of court sentences (legal status) and family history of psychiatric illnesses. This study showed that the percentage of psychiatric comorbidity is high among the opioid dependents. It highlights the urgent need for the psychiatric comorbidity to be assessed and early intervention is important for this group of patients.

Keywords: Opioid dependents; psychiatry comorbidity

ABSTRAK

Objektif utama kajian ini adalah untuk melihat peratusan komorbiditi penyakit psikiatri dalam kalangan penagih yang bergantung pada opioid di Lembah Kelang. Kajian rentas ini dilakukan antara bulan Disember 2007 sehingga bulan Mei 2008 di sepuluh klinik swasta yang mempunyai program ‘terapi gentian dadah’ sekitar Lembah Kelang. Sejumlah 204 penagih opioid menyertai kajian ini menggunakan temuduga klinikal berstruktur untuk disorder paksi 1 DSM-IV (SCID-I) untuk melihat sama ada mereka mempunyai komorbiditi. Dilihat 43.6% daripada kumpulan penagih opioid ini mempunyai komorbiditi psikiatri. Penyakit Kemurungan mempunyai peratusan tertinggi pada 32.6%, diikuti oleh penyakit disthiamia pada 23.6% dan penyakit Panik pada 14.6%. Komorbiditi psikiatri didapati mempunyai perbezaan siknifikan (p<0.05) pada sejarah penyalahgunaan pelbagai jenis dadah, sejarah dijatuhi hukuman mahkamah dan sejarah penyakit psikiatri dalam kalangan ahli keluarga. Kajian ini menunjukkan peratusan komorbiditi psikiatri adalah tinggi. Ini memperlihatkan bahawa amat penting komorbiditi psikiatri dikaji dan intervensi awal penting untuk kumpulan pesakit ini.

Kata kunci: Komorbiditi psikiatri; pergantungan pada opioid

RUJUKAN

Ahmad, B., Mufti, K.A. & Farooq, S. 2001. Psychiatric comorbidity in substance abuse (opioids). Journal of Pakistan Medical Association 88(5).

Breslau, N., Peterson, E.L., Schultz, L.R., Chilcoat, H.D., Andreski, P. 1998. Major depression and stages of smoking- a longitudinal investigation. Archives of General Psychiatry 55: 161-166.

Brooner, R.K., King, V.L., Kidorf, M., Schmidt, C.W. & Bigelow, G.E. 1997. Psychiatric and substance use comorbidity among treatment seeking opioid abusers. Archives of General Psychiatry 54: 71-80.

Dansky, B.S., Saladin, M.E., Brady, K.T., Kilpatrick, D.G. & Resnick, H.S. 1995. Prevalence of victimization and posttraumetic stress disorder among woman with substance use disorders: Comparison of telephone and in-person assessment samples. International Journal of Addiction 30: 1079-1099.

Hein, D., Zimberg, S., Weisman, S., First, M. & Ackerman, S. 1997. Dual diagnosis subtypes in urban substance abuse and mental health clinics. Journal of Psychiatric Services 48: 1058-1063.

Hussain, H. 2001. Managing heroin addicts through medical therapy. In: Mental Health in Malaysia: Issues and Concern, edited by Haque, A. Kuala Lumpur: University Malaya Press.

Kaplan, H.I. & Saddock, B.J. 2003. Substance-related disorder; opioid-related disorder. 9^th ed. Baltimore, US. pp. 163, 386-387, 450.

Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H-U. & Kendler, K.S. 1994. Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders in the United States. Results from national comorbidity survey. Arch Gen Psychiatry 51(1): 8-19.

Kessler, R.C., Nelson, C.B., McGonagle, K.A., Edlund, M.J., Frank, R.G. & Leaf, P.J. 1996. The epidemiology of enoccuring addictive and mental disorders: implications for prevention and services utilizations. Am. J. Orthopsychiatry 66(1): 17-31.

Lehman, A.R., Myers, C.P., Dixon, L.B. & Johnson, J.J. 1994. Defining subgroups of dual diagnosis patients for service planning. Journal of Hospital and Community Psychiatry 45: 556-561.

Limbeek, J.V., Wouters, L., Kaplan, C.D., Geerlings, P.J. & Alem, V.V. 1992. Prevalence of psychopathology in drug addicted. Journal of Substance Abuse Treatment 9(1): 43-52.

Lintzeris, N. 2001. Methadone and other pharmacotherapies in the management of heroin dependence: Training Manual for Victorian Medical Practitioners. (Handbook).

NADA . 2007. Agensi Antidadah Kebangsaan, Buletin Dadah. www.adk.gov.my (accessed May 2012)

Norliza 2004. Psychiatric morbidity among the incarcerated sex offenders In two main prisons in Malaysia. A Master of Medicine (Psychiatry) dissertation, Universiti Kebangsaan Malaysia (unpublished).

Rasidi 1992. Characteristics, psychiatric diagnosis and relapse of heroin dependents under supervision. A Master of Medicine (Psychiatry) dissertation, Universiti Kebangsaan Malaysia (unpublished).

Robins, L.N., Helzer, J.E., Weissman, M.M., Orvaschel, H., Gruenberg, E., Burke, J.D. Jr. & Regier, D.A. 1984. Lifetime prevalence of specific psychiatric disorders in three sites. Arch. Gen. Psychiatry 41(10): 949-958.

Rounsaville, B.J., Weissman, M.M., Kleber, H. & Wilber, C. 1982. Heterogeneity of psychiatric diagnosis in treated opiate addicts. Archives of General Psychiatry 39: 161-166.

Rounsaville, B.J., Kosten, T.R., Weissman, M.M., Prusoff, B., Pauls, D., Anton, S.F. & Merikanqas, K. 1991. Psychiatric disorders in relatives of probands with opiate addiction. Archives of General Psychiatry 48(1): 33-42.

Rusdi Abd. Rashid. 2006. Prevalence of depressive and anxiety disorders among heroin dependence receiving buphrenorphine maintenance therapy in a community based drug rehabilitation centre (PROKIM) Kuala Lumpur. A Master of Medicine (Psychiatry) dissertation, University of Malaya (unpublished).

Trosi, A., Pasini, A., Saracco, M. & Spaletta, G. 1998. Psychiatric symptoms in male cannabis users not using other illicit drugs. Journal of Addiction 93: 487-492.

*Pengarang untuk surat-menyurat; email: jelin72@hotmail.com