This paper discusses the ethical issues of patient autonomy based on a case of a patient who refused medication during Ramadhan fasting period. Issues on patient autonomy include the right of a patient to refuse medication, informed decision making, the importance of effective communication and the physician roles and responsibilities are discussed. In conclusion, patient autonomy must be respected and valued. However, the need of effective communication in facilitating informed decision making to improve doctor-patient relationship, should not be overlooked and compromised.
The significance of learning research methodology and performing research has been accepted by various medical schools in Malaysia as well as in other countries. The aim of integrating research into medical curriculum is to inculcate the research culture and form part of the evidence-based practice among medical professionals. Hence, the Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak has incorporated the research component into the preclinical year of the medical curriculum. A survey was conducted to gauge the second year medical students' level of knowledge of research process at the end of the course using a set of questionnaires. Seventy nine of second year medical students participated in the study. The outcome of the study shows significant improvement in the students’ knowledge on research components after completing the one year course (p
MeSH terms: Cross-Sectional Studies; Curriculum; Faculty; Humans; Learning; Malaysia; Surveys and Questionnaires; Research Design; Schools, Medical; Self-Assessment*; Students, Medical; Universities
Objective: The study aimed to obtain the perspective and teaching practice of novice lecturers serving at the training institutions, Ministry of Health Malaysia (MOH).
Method: A qualitative research was conducted on 4 novice lecturers at the Medical Assistant College, Seremban. Data were obtained from interview and observation on their teaching in the lecture rooms. The data analysis was performed by using NVivo 9 software.
Result: In the aspect of the teaching perspective, the finding showed that there were two main themes; teaching concept and the teaching method. As far as the teaching concept is concerned, respondents perceived that lecturers were the source of knowledge and those who transfered the knowledge to the students. Meanwhile, the second perspective related to the teaching approach in which lecturers need to use their experiences, they need to be knowledgeable and creative in their teaching. The integration of the themes has formed the main perspective, which was the lecturer-centered teaching. In turn, in the teaching practice, it was consistent with their perspective whereby the approach of teaching is lecturer-centered.
Conclusion: This study showed that new lecturers would employ the lecturer-centered approach. Apart from that, they were also lacking of the skills in terms of class control and value inculcation. The deficiency in both these aspects needs to be overcome as it can affect the effectiveness of the teaching, also the quality of the graduates produced.
MeSH terms: Malaysia; Surveys and Questionnaires; Software; Students; Universities; Qualitative Research
Objective: To determine association between academic performance and absenteeism in classroom among first year medical students.
Methods: A one-year prospective study was conducted on 196 first year medical students. Academic performance was measured by examination scores at four examinations. Absenteeism score was measured by the cumulative number of absence in an academic session of each student recorded by academic office at the end of the first year of medical training. The academic performance was categorized into pass and fail for analysis purpose. Data was analyzed by SPSS version 20.
Results: The independent-t analysis showed that, in all examinations, students who passed the examinations had significantly lower absenteeism scores than those who failed (p < 0.001).
Conclusion: This study found significant associations between academic performances and absenteeism scores among first year medical students. Medical schools should pay more attention on this matter since it may result in poor academic performances.
Introduction: Just-in-Time Teaching (JiTT) is a novel method of teaching-learning used in various disciplines of science and humanities. It is a technique that scaffolds the students learning process by reducing the cognitive load which is the load related to the executive control of working memory. Just in time teaching underpins the concept that expertise in learning originates from the knowledge already stored in long term memory and with subsequent interaction between the learner and teacher motivates enhanced active learning and optimizes the intellectual performance.
Objective: The objective of the study is to assess the acceptability of JiTT over traditional lecture teaching among the medical students.
Method: In a cross sectional pilot study, three hundred thirty five students participated in a questionnaire based study that grades the various aspects of the traditional lecture series. After the implementation of JiTT method for a period of four months, three hundred two students completed the questionnaire, grading the same variables for JiTT. The analysis was done by using SPSS version 11 applying Paired t test and McNemar's Test.
Result: The results of our study highlighted that JiTT technique was perceived superior to traditional teaching with statistically significant outcomes in the clarity of the topic (p=0.003,) duration of the session (p=0.002), knowledge gained and orientation for exams (p=0.044). The students perceived JiTT method as less monotonous (p=0.005) increasing their alertness during these sessions (p=0.002).
Conclusion: We therefore propose that Just-in-Time Teaching method is a more interactive and acceptable teaching-learning tool shifting the nature of teaching to a more student-centric approach as perceived by the medical students. This is the first pioneer study on JiTT to be performed on undergraduate medical students so far.
Objective: The objective of this study was to establish the relationship between symptoms of PTSD and various scores of emotional intelligence scales. This study employed a cross-sectional research design. Participants were recruited from the local community health centre in Dearborn, Michigan, USA. The Child Posttraumatic Stress Reaction Index (CPTS-RI) measured the presence of PTSD symptoms and the Adolescents Multifactor Emotional Intelligence Scale (AMEIS) measured emotional intelligence. Results: The findings suggest an inverse relationship between PTSD severity and emotional intelligence. The PTSD score was negatively correlated with all AMEIS subscales. Two significant negative correlations were found in the tasks of using emotion and understanding emotion. Conclusion: Findings suggest that individuals with severe PTSD symptoms appear to lack the abilities to understand and use emotions. These findings might be useful in identifying factors that may contribute to decreasing the severity of PTSD symptoms of these children. Implications of the findings were discussed, and recommendations for future research are presented. ASEAN Journal of Psychiatry, Vol. 15 (2), July - December 2014: 220-224.
MeSH terms: Adolescent; Child; Community Health Centers; Cross-Sectional Studies; Emotions; Humans; Michigan; Psychiatry; Research Design; Stress Disorders, Post-Traumatic; Comprehension; Emotional Intelligence
Objective: This case report highlights the psychosocial complications of chronic mania in a mother and the role of CMHT in improving the condition’s outcome. Methods: We report a case of a Malay mother who had underlying chronic mania for 20 years. Results: She was aggressive and abusive towards her children causing tremendous trauma in them, had lost her child custody and almost lost her husband to another woman. Lithium with multiple psychosocial interventions delivered to the patient and her family had improved her mood symptoms significantly and improved the family’s quality of life. Conclusion: Chronic mania causes tremendously high illness burdens, and with extra care, the outcome of the condition can be improved. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 217-219.
Objective: Type D personality, tendency trait to experience increased NA (Negative Affect) and SI (Social Inhibition) has been associated with negative psychological conditions linked to heart disease. This study aimed to examine the psychometric properties of the Malay version of Type D personality scale (DS14) among Malaysian patients with coronary artery disease (CAD). Methods: In this cross-sectional study 195 patients diagnosed with CAD were selected from National Heart Institute, Kuala Lumpur. They completed the questionnaire including demographic information and the Malay version of DS14 and Hospital Anxiety and Depression Scale (HADS). Results: The structural validity, as demonstrated by exploratory factor analysis of the DS14 was acceptable. The Cronbach's α coefficient for the NA and SI subscales were 0.876 and 0.732, respectively. With the standardized cut-off of NA ≥ 10 and SI ≥ 10, 28.2% of the patients with CAD were defined as having a Type D personality. Anxiety was significantly higher among patients with Type D personality. Conclusion: The results indicate that the Type D personality (DS14) questionnaire is a valid and reliable tool in the Malaysian population. The prevalence of Type D personality in Malaysia falls close to what has been found in Western countries, at least for CAD patients. This study indicates also that it is possible to use the DS14 among the Malaysian population in future cross-cultural studies. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 186-195.
MeSH terms: Accidental Falls; Anxiety; Anxiety Disorders; Coronary Artery Disease; Cross-Sectional Studies; Cross-Cultural Comparison; Depression; Factor Analysis, Statistical; Humans; Malaysia; Psychiatry; Psychometrics; Surveys and Questionnaires; Prevalence; Type D Personality
Objective: A sizable body of criminology literature has suggested that personality factors are critical to the development of aggressive behaviour. While research on personality focusing on aggression often revolves on "Eynseck Three Factor Model" and "Big Five Model", research on "Alternative Five Factor Model" (AFFM) is rather inadequate. Objective: The present study aimed to examine the association between five types of personality traits and subscales of aggression. Methods: This observational cross-sectional study was conducted in two prisons in Peninsular Malaysia among 198 Malay adult male inmates. The participants were selected based on the purposive sampling method from those who were convicted for various types of crime. Two psychometric instruments adapted to the Malaysian context were used: Malay version of Zuckerman-Kuhlman Personality Questionnaire-40-Cross Culture (ZKPQ-M-40-CC) and Aggression Questionnaire (AQ-M). Pearson correlation coefficient test was conducted to determine the association between five types of personality traits and subscales of aggression. Results: The results showed that there was a significant association between certain types of personality traits and subscales of aggression. The results were discussed in relation to theory and the context of crime. Conclusion: There is evidence that personality traits are linked to aggressive behaviour which may lead a person to commit offenses. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 176-185.
Objective: The involvement of families in assisting health professionals in providing care for their family members who suffer a stroke during hospitalization is common in Malaysia. Family caregivers are accountable in providing for the first-ever stroke survivor’s needs, including maintaining functional improvements gained in rehabilitation and the long-term well-being of the stroke survivors. The objective of this study was to determine the predictors of life satisfaction among family caregivers of hospitalized first-ever stroke patients. Methods: This was a cross-sectional community research design study with purposive sampling. It involved 102 family caregivers of hospitalized first-ever stroke patients of two tertiary hospitals in Kelantan. The Bakas Caregiving Outcomes Score (BCOS) was used to measure life satisfaction. Multiple linear regression was used to determine the predictors of life satisfaction. Results: Out of 102 respondents, 21 were males and 81 were females with age range of 16 to 76 years. Significant predictors of life satisfaction of caregivers while caring for their hospitalized first-ever stroke family members were caregivers’ health (β: -2.875, 95%CI: -5.725, -0.025, p = 0.048), patients’ age (β: - 4.251, 95% CI: - 6.379, -2.123, p
MeSH terms: Cross-Sectional Studies; Family; Female; Hospitalization; Humans; Malaysia; Male; Personal Satisfaction; Surveys and Questionnaires; Research Design; Linear Models; Caregivers; Survivors; Stroke; Tertiary Care Centers
Objective: The objective of this study is to determine the optimal cut-off score for the Centre for Epidemiologic Studies Depression scale (CESD) according to Malaysian adolescent norms. Methods: This is a cross-sectional study. Nine hundred and thirty-one adolescents aged 13 to 17 years-old completed the CESD and Hopkins Symptom Checklist-depression scale (HSCL-depression). Results: Results from the receiver operating characteristic (ROC) curve, kappa coefficients and odds ratio analysis showed that CESD cut-off score of 27 was suitable to be used according to Malaysian norms, demonstrating a specificity of 93%. Conclusion: The findings suggest a cut-off score 27 should be used for screening of depression for Malaysian adolescents using the CESD. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 146-152.
Objective: This study was conducted to assess the effects of Methadone Maintenance Therapy (MMT) and buprenorphine-naloxone Maintenance Therapy (BNX) on the Quality of life (QoL) of opiate abusers. Methods: The QoL status of opioid-dependent patients was assessed using the WHOQOL-BREF questionnaire. It is a cross-sectional study involving a total of 108 patients who received MMT or BNX therapy in Malaysia from May 2011 to September 2011. Results: A statistically significant difference in the overall QoL and psychological aspect among patients on MMT was observed. On the contrary, the scores of overall QoL and quality of social relationship for BNX group were higher in patients with lower dosage. Conclusion: The comparison between patients on high dose MMT and high dose BNX exhibited significant difference in the overall QoL especially in psychological, social relationship and environment domains, with the high dose MMT group having better mean score. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 131-139.
MeSH terms: Buprenorphine, Naloxone Drug Combination; Analgesics, Opioid; Cross-Sectional Studies; Humans; Malaysia; Methadone; Narcotics; Psychiatry; Quality of Life; Surveys and Questionnaires; Opiate Substitution Treatment
Objective: The family caregiver has a pivotal role in the management of HIV/AIDS patients and their well-being is consequently crucial as it could impact negatively on the quality of caregiving. This preliminary qualitative investigation intended to explore and describe the challenges and experiences of HIV/AIDS family caregivers in Terengganu, Malaysia. Methods: A convenient sample of family caregivers of HIV/AIDS patients who were aware of the diagnosis was enrolled. Recruitment was conducted in Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia and semi-structured interviews were used. Results: Results were transcribed into verbatim before being subjected to analysis. Twelve Muslim caregivers consented participation (age range = 18.0 - 81.0; female = 75.0%, mother/wife = 50.0%; married = 83.3%; ≤ primary school
= 50.0%; and self-employed = 66.7%). The four major themes that emerged were challenges of caregiving, financial issues, stigma and discrimination, and support for caregivers. Additionally, caregivers did mention several positive aspects of their caregiving role including satisfaction from helping family member and improved family relationships. Conclusion: A variety of life aspects were negatively affected by caring for HIV patients, thus requiring a multidisciplinary approach to address such issues. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 120-130.
MeSH terms: Acquired Immunodeficiency Syndrome; Empathy; Family Relations; Female; Humans; Islam; Malaysia; Marriage; Mothers; Personal Satisfaction; Psychiatry; HIV Infections; Caregivers; Spouses; Social Stigma
Objective: This case report highlights the complexity of eating disorder in schizophrenia and outlines the diagnostic dilemma and challenges associated with the treatment. Methods: We report a 13 years old female with early onset schizophrenia who developed anorexic symptoms and binge eating. Her eating disturbances worsened after olanzapine was commenced. Results: A combination of pharmacological and psychosocial intervention led to remission of schizophrenia co-morbid with eating disorder NOS. Conclusion: Co-morbid diagnosis of schizophrenia and eating disorder is not uncommon. Early diagnosis and evidence-based intervention are imperative as untreated illness greatly impacts the developmental trajectory of young people. Meeting family’s needs improves family functioning which in turn improves patient’s outcome. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 101-105.
Objective: This case report aims to discuss the diagnosis of mental retardation as insanity defence in a crime offender. Methods: We report a gentleman who committed murder and rape 9 years ago, and currently being treated at a mental institution. Results: Patient was certified to have mental retardation, and was pleaded on the defence of unsoundness of mind because he had defect of reason at the time of alleged offence. Conclusion: Mental retardation does fulfil the McNaughton’s rule. Unsoundness of mind becomes the insanity defence even for murder under section 84 of the Penal Code. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 97-100.
Objective: This case report highlights the challenges in managing Frontal Lobe Syndrome (FLS) in a patient with end-stage renal disease. Methods: This is a case description of a 58 year-old gentleman who presented with behavioural changes: irritability, mood lability, aggression, psychosis, and overfamiliarity. His presenting symptoms were in keeping with (FLS) with positive findings on Computed Tomography (CT) scan of the brain and also neuropsychological assessments. Difficulties arose in attempts to control his aggression without further compromising his renal function. Results: The usage of the commonly used antipsychotics in controlling aggression was restricted in view of the patient’s renal impairment. Augmentation with low dose memantine proved to be beneficial in this case, without causing further deterioration in renal function. Conclusion: The use of memantine to augment the effect of risperidone was observed to be safe and successful in managing the behavioural changes associated with FLS in adults with end-stage renal disease. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 93-96.
Objectives: This paper aims to report on a case in which re-challenging with clozapine in combination with lithium in a patient who developed neutropenia was carried out. Methods: The patient was treated with clozapine for treatment- resistant schizophrenia. After five weeks he showed much improvement but developed neutropenia. Withdrawal of clozapine brought on a relapse of psychotic symptoms. Subsequently, clozapine was reintroduced along with Lithium. The neutrophil count was monitored closely. Results: The neutrophil and white blood cell count were noted to return to normal upon re-challenging, and the patient’s clinical condition also improved. Conclusion: Simultaneous administration of lithium and clozapine to patients experiencing neutropenia on clozapine is a possible strategy. However, very close monitoring of the white count is needed. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 90-92.
Objective: This case report aims to highlight the importance of parental contribution to the school refusal problem. Methods: We report a case of a 9- year old boy who presented with school refusal behaviour. Results: There was no psychiatry diagnosis made in this patient. Parental issues such as ineffective and inconsistent parenting, and parental marital disharmony contribute significantly to the school refusal behaviour. Conclusion: Parents in particular are important team players in the management of school refusal. Parental issues need to be explored and managed accordingly to ensure good outcome. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 83-85.
Objective: The Snaith-Hamilton Pleasure Scale (SHAPS) is a self-assessment scale designed to evaluate anhedonia in various psychiatric disorders. To facilitate its use in Malaysian settings, our current study aimed to examine the validity of the Simplified-Chinese translated version of the SHAPS (SHAPS-SC) in a group of subjects at a university out-patient clinic. Method: A total of 40 depressed patients were recruited in this cross sectional study. They were given both the Simplified Chinese and Malay versions of SHAPS, General Health Questionnaire 12 (GHQ-12) and Beck Depression Inventory (BDI) to assess their hedonic state, general mental health condition and level of depression. Results: Our study showed that SHAPS-SC had impressive internal consistency (Cronbach’s alpha 0.84) and concurrent validity, and fair parallel-forms reliability (Pearson’s correlation 0.39). Conclusion: SHAPS-SC demonstrated good psychometric properties in the evaluation of hedonic state among a group of Chinese speaking depressed patients in an out-patient setting. It is easy to administer and suitable as a valid and reliable questionnaire in assessing anhedonia among depressed patients in Malaysia. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 66-71.
Study site: psychiatric out-patient clinic, University
Malaya Medical Centre (UMMC)
Objective: This study aims to establish the validity and reliability of the Malay- translated version of the CES-D. Methods: This study employed a cross-sectional study design. The participants were female inmates (n=90) from local prisons which were selected based on purposive-selective sampling. The analyses include face validation, factor analysis, and reliability testing. A test-retest was conducted within a one-week interval. Results: The mean score for depression among the participants is 18.97 (SD=6.51). Further descriptive analysis showed that 58.9% of them scored above the mean score, which is considered high. Preliminary construct validation analysis confirmed that factor analysis was appropriate for the Malay-translated version of the CES-D. Furthermore, the factor analysis showed similar factor loadings to the original English version. The total internal consistency of the translated version, which was measured by Cronbach’s alpha coefficient, was equal to 0.75. The test-retest reliability of the total score, measured by Pearson’s correlation was equal to 0.69. Conclusions: Face validity, construct validity, and reliability analysis were found satisfactory for the Malay-translated version of the CES-D. The Malay-translated version of the CES-D was found valid and reliable to be used in future studies, with comparable properties to the original version and to previous studies. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 54-65.