The paper discusses on the complexity of the issues surrounding a patient with subluxation of cervical spine in a Down syndrome child. Several relevant issues are discussed including consent in a minor, conflicting decision making between parents and doctors, end-of-life issues, supporting handicapped child with minimal co-morbidities, community ethics, neglect of care by the caregiver and decision making after allowing zonal of parental discretion. Despite the difficulties surrounding parental actions, there are still ethical priorities which have to be considered individually to alleviate the suffering of the patients and the family members. Dealing with patients with chronic illnesses is a challenge for any medical doctors. The case warrants sensitive approach to allow appropriate respect for parental decision despite in disagreement with the clinical team. The term ‘zone of parental discretion’ refers to a controversial area of decision making; and has still many potential conflicts on day to day clinical cases, especially among the conservative society in the East Coast of Peninsular Malaysia.
Introduction: Peer mentoring is one of the mentoring essential components in any higher institution of learning. In the Medical Faculty of Universiti Malaysia Sarawak (UNIMAS), this mentoring system has existed long but has not undergone any formal evaluation. Objective: The main objective of this study is to determine the perception of peer mentoring among medical students of Faculty of Medicine and Health Sciences (FMHS), UNIMAS. Method: It was a cross-sectional study using self-administered questionnaire. All medical undergraduate students of FMHS were recruited. Data was analyzed using SPSS version 22. Result: A total of 234 respondents participated in this study. Peer mentoring system was preferred against other mentoring system. Majority of the respondents reported that academic gain was the main benefits they gained from peer mentoring system. Negative attitude of the mentee and poor time management for the meeting were the top two worst experience encountered by both mentors and mentees respectively. More than half of the mentor and mentee perceived that peer mentoring system was beneficial to them compared to other systems, with reason that the interaction between student themselves were more easier and comfortable. Nevertheless, there should be more interaction between the mentors and mentees. Conclusion: The findings indicated there is a positive contribution of peer mentoring towards the mentoring system of the faculty. There is a need to relook at the current mentoring system and consider peer mentoring to improve the student support.
MeSH terms: Cross-Sectional Studies; Faculty, Medical; Learning; Malaysia; Mentors; Perception; Surveys and Questionnaires; Students, Medical; Time Management
Many researchers have emphasized the importance of teaching stress management and self-care skills to medical students as they are vulnerable to develop psychological health problems. The researchers designed a 4-hour intervention based on the DEAL model to address these problems. This study aimed to determine outcomes of the DEAL-based intervention on medical students’ stress, anxiety and depression symptoms. Methods: A randomized controlled trial study was conducted on 171 medical students. Their stress, anxiety and depression symptoms were measured by the 21-item Depression Anxiety Stress Scale at five intervals; at 2 weeks before the intervention, and at 1 week, 8 weeks, 16 weeks and 32 weeks after the intervention. The mixed model ANCOVA was applied to determine the effect of the intervention on the participants’ psychological health at five intervals. Results: A total of 153 medical students (intervention = 73 and control = 80) completed this study. Results showed that the intervention group experienced significantly lower stress and depression symptoms than the control group. Although anxiety scores are consistently lower in the intervention group, no significant differences between groups were found. Conclusion: These results support the favourable outcomes of the intervention on psychological health of medical students. It is a promising intervention to be considered by medical schools as it consumes minimal amount of time, money, training and man power as well can be implemented easily.
Mental illness accounts for 12% of the global burden of disease with a reported 1 in 5 Malaysians suffering from a psychological disorder. Sufferers have been long plagued by stigma, which results in social isolation, low-selfesteem, lower opportunities for employment, housing, and ability to achieve life goals. This essay aims to suggest strategies to overcome such stigma in the local setting. Methods: Literature search was conducted through PubMed (http://www.ncbi.nlm.nih.gov/pubmed) and Google Scholar (http://scholar.google.com.my). Data obtained was compiled as an opinion piece. Results: Thefactors contributing to stigma in Malaysia include a lack of public knowledge, language and cultural influences, inaccurate media portrayal, doctors’ attitudes towards the field of psychiatry, and psychiatrists themselves. Stigma can be tackled in four areas: society, media, medical education, and the field of psychiatry. Firstly, psychiatric terminology can be adapted to local languages and cultural beliefs in order to avoid misconceptions. Secondly, public education is more effective if focused to targeted key groups. The media is crucial in influencing the public mind-set, and needs to be creatively engaged. Thirdly, more positive medical practitioner attitudes to mental illness can be moulded through early psychiatric postings during medical school. Finally, psychiatrists play a role in correcting misconceptions, avoiding misdiagnosis and ineffective treatments. Cultural competency leads to better management of patients by awareness towards socio-cultural and religious influences. Conclusion: A multifaceted, united coalition of effort is needed in order to tackle stigma in different contexts, and will require concerted leadership from different parties.
MeSH terms: Attitude; Mental Disorders; Diagnostic Errors; Education, Medical; Employment; Goals; Housing; Humans; Language; Leadership; Malaysia; Physicians; Psychiatry; Schools, Medical; Social Isolation; PubMed; Cultural Competency; Social Stigma
Currently, paliperidone palmitate is not approved for the treatment of schizophrenia in adolescents. It is only indicated for treatment of schizophrenia and schizoaffective disorder in adults. This case report highlights the successful treatment outcome with paliperidone palmitate in an adolescent with schizophrenia. Methods: We report a case of an adolescent who presented with psychotic symptoms and marked deterioration in functioning over a period of one year. Results: She showed significant improvement in functioning, and her psychotic symptoms gradually subsided with paliperidone palmitate. Conclusions: Paliperidone palmitate could be considered as an effective treatment modality in adolescents with schizophrenia.
This case report highlights the success of community services and supported employment program that may be of help to a woman with chronic inhalant use to achieve a complete abstinence. Methods: We report the case of a 45 year old lady who chronically abused glue, presented after 10 years with substance induced psychosis and comorbid mood disorder. Results: Abstinent from inhalant dependence was achieved after series of home treatment services and supported employment program. Conclusion: Provision of acute community service and incorporating this patient in supported employment program contribute to her successful journey in achieving abstinence from inhalant dependence.
The incidence of benzodiazepine paradoxical reaction is uncommon. It may be implicated with crime as will be described in this case report. Method: We report a 37 year-old schizophrenia patient who was detained by the authority under Section 392/397 of Penal Code assaulting a lady using sharp weapon. He had history of illicit substance abuse and benzodiazepine dependence with significant history of aggression associated with benzodiazepine. Just prior to the incident, he took a significant amount of various types of benzodiazepine and suffered from amnesia of that event. During the time of the offense, he was in remission as far as schizophrenia is concerned. Result: He was under the forensic psychiatric care and observation at Hospital Bahagia Ulu Kinta (HBUK). He developed withdrawal symptoms of benzodiazepine in the ward. Conclusion: He was found by the expert team to be under the influence of benzodiazepine during the offence. The role of benzodiazepine and relevant factors leading to aggression will be discussed in this manuscript.
This study aims to assess the factor structure and reliability of the General Health Questionnaire (GHQ-12). Additionally, the study also attempts to evaluate the psychological well-being among university students using the GHQ-12 scale and thereby determine a relationship between select demographic variables and well-being. Methods: An exploratory cross-sectional survey was conducted among undergraduate students of a public university in Sarawak, Malaysia. A self administered questionnaire consisting of the demographic aspects and the GHQ 12 scale were utilized to assess the well-being of students, who were selected by convenience sampling technique. Results: Factorability of the GHQ-12 was examined and a three-factor model explaining 55% total variance was found to be the best fit. Internal consistency of the scale was 0.78, which is within the acceptable range. The results also suggest that considerable proportion (57%) of students had psychological distress. Participants who were susceptible to psychological distress in the present study were identified as students from low income families, with poor social support, in a relationship with partner as well as the student with Hindu’s religion and male students. By multiple regression analysis, variables that significantly predicted psychological distress were gender; income; area of residence; relationship with parents; negative life events; smoking; drinking and event with the overall model fit were 34%. Conclusion: Based on these findings, it may be foreseen that if prompt intervention is not provided to students in distress, they may be susceptible to depression, anxiety and stress. The findings have implications for teachers and counsellors, who are in a position to influence a wide range of students and provide support to improve the psychological well-being of students.
MeSH terms: Alcohol Drinking; Anxiety; Cross-Sectional Studies; Depression; Humans; Malaysia; Male; Psychometrics; Surveys and Questionnaires; Regression Analysis; Smoking; Social Support; Stress, Psychological; Students; Universities; Reproducibility of Results; Validation Studies; Young Adult
The evaluation of mental health among older adults has become increasingly important in health and social science. Although this has been studied in developed countries, there are also issues for emerging countries, which have aging populations. The aims of this study were to determine the prevalence of loneliness/social isolation and late-life depression among older adults with cognitive impairment living in institutional care. Methods: A cross sectional survey involving residents of four government nursing homes in West Malaysia was carried out. All residents aged 60 years old and above with cognitive impairment were included in the study. Participants were assessed by the Short Mini Mental State Examination (SMMSE), Friendship Scale (FS) and Geriatric Depression Scale (GDS). Results: The prevalence of depression and loneliness/social isolation were 85.5% and 95.5% respectively. Depression was strongly associated with age, education attainment, financial conditions, health, cognitive impairment and loneliness/social isolation. Loneliness/social isolation was strongly associated to depression and relationship satisfaction with children. Conclusion: There was high prevalence of depression and loneliness/social isolation among older adults with cognitive impairment living in institutional care. Depression and loneliness/social isolation are interrelated and influence each other and these problems need to be addressed to improve their quality of life.
Device, Questionnaire & Scale: Mini Mental State Examination (MMSE-12); Friendship Scale (FS); Geriatric Depression Scale (GDS-15)
MeSH terms: Cognition Disorders; Cross-Sectional Studies; Depression; Depressive Disorder; Government; Humans; Loneliness; Malaysia; Mental Health; Neuropsychological Tests; Nursing Homes; Personal Satisfaction; Quality of Life; Surveys and Questionnaires; Social Isolation; Prevalence; Developed Countries; Friends
There are a number of validated questionnaires available for the screening of Post-Traumatic Stress Disorder (PTSD), and the PTSD Checklist for Civilians is one of them. However, none was translated into the Malay Language and validated for use in the Malaysian population. The aim of this study is to translate and validate the Malay PTSD Checklist for Civilians (MPCL-C). Methods: The PCL-C was translated into the Malay Language and back-translated. The reliability and validity of the MPCL-C were then determined by administering them to those who presented at the emergency department for motor vehicle accident at least one month before. Results: The MPCL-C has good face and content validity. In terms of reliability, it is also good, with Chronbach’s alpha values of 0.90, 0.77, 0.75 and 0.74 for the full scale, re-experiencing, avoidance and arousal domains respectively. Conclusions: The MPCL-C is a valid and reliable instrument to screen for PTSD in motor vehicle accident victims for the studied population.
MeSH terms: Accidents, Traffic; Arousal; Emergency Service, Hospital; Language; Surveys and Questionnaires; Stress Disorders, Post-Traumatic; Translating; Reproducibility of Results; Motor Vehicles; Checklist
Apart from environmental and social factors, psychological traits is largely linked with criminal and delinquent behaviour. The purpose of this article is to review four critical psychological traits of individuals that may lead to criminal behaviour in a nutshell. Methods: An archival research methodology was employed in this study where relevant search for literatures on these four psychological traits was made across search engines such as Google Scholar with relevant articles selected for this review. The literatures were microscopically reviewed in order to demonstrate the linkage between psychological traits and criminal behaviour. Results: Four psychological traits: personality trait, low selfcontrol, aggression behaviour, and cognitive distortion were chosen to address such linkages. All these four traits were discussed thoroughly in relation to crime and criminality contexts. Conclusion: It is crucial to understand the role of these traits and in-depth understanding of each psychological trait with relation of criminal behaviour offers an opportunity to the public at large to expand their knowledge on the importance of practicing and equipping oneself with healthy psychological traits to hinder from criminal and delinquent acts. ASEAN Journal of Psychiatry, Vol. 16 (2): July – December 2015: XX XX.
Objective: Several cases of suicide attempt by charcoal burning producing CO have been reported in Malaysia. This case report highlights a case of delayed delayed neuropsychiatry sequelae (DNS) in CO poisoning.
Method: We report a young Chinese homemaker who presented with DNS who was detained in a Malaysian forensic psychiatric ward.
Results: After approximately two weeks of admission, in a familicide attempt, she had started to exhibit subtle changes in her behaviour, including social withdrawal, impaired memory, and there was lack of emotional distress.
Conclusion: We report an interesting DNS as one of the two forms of chronic sequelae of CO poisoning, whereas the other type of neuropsychiatric sequelae is the persistently progressive type.
Objective: Living with epilepsy imposes great challenges on both patients and their family caregivers but most researchers only explored the impact on patients, with less attention given to family caregivers. Our study intended to explore the needs and problems of epilepsy family caregivers of epilepsy patients encountered during the caregiving process. Methods: Respondents were recruited from the Neurology Clinic of Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu. A semi-structured interview was conducted using openended and broad questions asking about their general experience in caregiving, daily routine activities, caregiving effects, caregiving difficulties and caregivers’ needs. The interviewed data were later transcribed into verbatim before further analysis using the QSR International’s NVivo10 software. Results: Fifteen Malay Muslim family caregivers between the age of 19 and 66 years participated. Most were females (53%), married (67%), with education level at secondary school or equivalent (73%) and were homemakers (40%). In particular, respondents expressed the need for extra support from their family members and experts in terms of physical (care relief), mental, and financial aspects. In addition, the major caregiving problems identified included: (i) emotional disturbances (sad, angry, depressed, and anxious); (ii) care giving challenges (family adjustments, physical burden, psychological burden, and time management); and (iii) financial issues (not working and limited family income). Some advantages in caregiving were also reported. Conclusion: In conclusion, their experiences while taking care of their loved ones in terms of feelings, beliefs and needs exposed the difficulties in caregiving, causing substantial emotional pressure which could later lead to poor quality of caregiving. ASEAN Journal of Psychiatry, Vol. 16 (1): Januray – June 2015: XX XX.
Study site: Neurology Clinic of Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu.
MeSH terms: Affective Symptoms; Anger; Anxiety; Attention; Emotions; Epilepsy; Family; Female; Hospitals, General; Humans; Islam; Malaysia; Outpatient Clinics, Hospital; Surveys and Questionnaires; Caregivers; Time Management; Qualitative Research
Objective: Transition of people with cognitive impairment to nursing home is often an option when their disease progresses and their needs become too complex. The aim of this study was to identify the needs of people with cognitive impairment living in nursing homes and factors associated with higher level of needs.
Methods: A cross sectional survey involving 110 respondents with cognitive impairment aged ≥60 was carried out. Respondents were assessed using the Short Mini Mental State Examination (SMMSE), Camberwell Assessment of Needs for Elderly (CANE), Barthel Index (BI), Friendship Scale (FS), and Geriatric Depression Scale (GDS).
Results: Respondents with cognitive impairment had a mean of 2.81 (SD=3.72) for unmet needs and 11.95 (SD=3.14) for the met needs, with higher mean suggesting a better outcome measure. The most frequent unmet needs were intimate relationships (66.40%), company (40.00%), and daytime activity (34.50%). Unmet needs were significantly associated with depression, social isolation, and cognitive impairment.
Conclusion: Most of the needs of people with cognitive impairment in nursing homes were fulfilled, except in social area. Therefore, attention should be given in improving the care system, which emphasizes collaboration between people with cognitive impairment, family members, community, and government in helping to reduce the risk of loneliness in those with cognitive impairment.
Objective: Literatures on factors influencing performance of the Stroop interference have been elusive on coping styles. Past investigations of coping influence on Stroop test have been indirect and inconclusive due to variability of multidimensional coping models and application of different Stroop test. The concept of constricted versus flexible or broad cognitive style have linked personality and coping styles to Stroop performance. The objective of this study was to determine the associations of coping styles with Stroop resistance towards interference (Stroop RI) and subsequently determine the predictors of Stroop performance. Methods: This was a cross-sectional community research design study with purposive sampling. In this study, the self-administered Brief COPE inventory questionnaires and Stroop Test were performed among 205 undergraduate medical students. Results: Findings revealed that behavioural disengagement (r=-0.361), dysfunctional coping (r=-0.355), self-blame (r = 0.222), and substance abuse (r = -0.173) showed negative correlation and proven strong association with Stroop RI. Further multiple regression analyses identified behavioural disengagement (R2 = 0.13), and dysfunctional coping (R2 = 0.024) as significant predictors for interference. Conclusion: Coping styles have implication on Stroop test exhibited in varied cognitive styles. Integrating coping styles factor on Stroop test has glimpsed the future direction of other neuropsychological assessment batteries on the importance of profiling individualistic baseline norms. ASEAN Journal of Psychiatry, Vol. 16 (1): January – June 2015: XX XX.
MeSH terms: Adaptation, Psychological; Cognition; Cross-Sectional Studies; Personality; Personality Inventory; Psychiatry; Psychometrics; Surveys and Questionnaires; Regression Analysis; Research Design; Students, Medical; Substance-Related Disorders; Stroop Test
The world population of older people is on the rise with improved health services. With longevity, older people are at increased risk of chronic non-communicable diseases (NCDs), which are also leading causes of death among older people. Screening through case finding in primary care would allow early identification of NCDs and its risk factors, which could lead to the reduction of related complications as well as mortality. However, direct evidence for screening older people is lacking and the decision to screen for diseases should be made based on comorbidity, functional status and life expectancy, and has to be individualised.
MeSH terms: Aged*; Cause of Death; Chronic Disease; Humans; Life Expectancy; Mass Screening*; Primary Health Care; Risk Factors; Comorbidity
Cerebral amyloid angiopathy (CAA) accounts for approximately 10–20% of spontaneous intracerebral haemorrhage (ICH). This figure is thought to be higher in the elderly population. With the increasing life expectancy of our population, we anticipate that the prevalence of CAA- related ICH will increase in tandem. Although CAA-related ICH and hypertension-related ICH are distinct entities based on histopathology and imaging, the clinical presentation of the two conditions is similar. The use of brain computed tomography (CT) scans remain the ICH imaging modality of choice in Malaysia due to its availability, cost, and sensitivity in detecting acute bleeds. On the other hand, the use of brain magnetic resonance imaging (MRI) with susceptibility-weighted imaging (SWI) sequencing enables the clinician to determine the presence of chronic blood products in the brain, especially clinically silent microbleeds associated with CAA. However, the use of brain MRI scans in our country is limited and leads to a blurring of lines when differentiating between hypertension- related ICH and CAA-related ICH. How this misrepresentation affects the management of these conditions is unclear. In this study, we present two cases of ICH to illustrate this point and to serve as a springboard to question current practice and promote discussion.
Background: Optimisation of average glandular dose (AGD) for two-dimensional (2D) mammography is important, as imaging using ionizing radiation has the probability to induce cancer resulting from stochastic effects. This study aims to observe the effects of kVp, anode/filter material, and exposure mode on the dose and image quality of 2D mammography.
Methods: This experimental study was conducted using full-field digital mammography. The entrance surface air kerma was determined using thermoluminescent dosimeter (TLD) 100H and ionization chamber (IC) on three types of Computerized Imaging Reference System (CIRS) phantom with 50/50, 30/70, and 20/80 breast glandularity, respectively, in the auto-time mode and auto-filter mode. The Euref protocol was used to calculate the AGD while the image quality was evaluated using contrast-to-noise ratio (CNR), figure of merit (FOM), and image quality figure (IQF).
Results: It is shown that AGD values in the auto-time mode did not decrease significantly with the increasing tube voltage of the silver filter (r = −0.187, P > 0.05) and rhodium filter (r = −0.131, P > 0.05) for all the phantoms. The general linear model showed that AGD for all phantoms had a significant effect between different exposure factors [F (6,12.3) = 4.48 and mode of exposure F (1,86) = 4.17, P < 0.05, respectively] but there is no significant difference between the different anode/filter combination [F (1,4) = 0.571].
Conclusion: In summary, the 28, 29, and 31 kVp are the optimum kVp for 50%, 30%, and 20% breast glandularity, respectively. Besides the auto-filter mode is suitable for 50%, 30%, and 20% breast glandularity because it is automatic, faster, and may avoid error done by the operator.
Background: Studies from the West have demonstrated that ready-to-eat cereals (RTECs) are a common form of breakfast and more likely to be consumed by children. This study aimed to investigate the breakfast eating pattern and RTECs consumption among schoolchildren in Kuala Lumpur.
Methods: In this cross-sectional study, a total of 382 schoolchildren, aged 10 and 11 years old, were recruited from seven randomly selected primary schools in Kuala Lumpur. Information on socio-demographics, breakfast eating patterns, and perceptions of RTECs and dietary intake (24- hour dietary recalls) were obtained.
Results: Among the respondents, only 22% of them consumed breakfast on a regular basis. The most commonly eaten food by children at breakfast was bread (27.2%), followed by biscuits (22.2%) and RTECs (20.5%). The majority of them (93%) reported that they consumed RTECs sometimes during the week. Chocolate RTECs (34.1%), corn flake RTECs (30.3%), and RTECs coated with honey (25.1%) were the most popular RTECs chosen by children. Respondents who consumed RTECs showed a significantly higher intake in calories, carbohydrate, vitamin A, vitamin B1, vitamin B2, vitamin B3, folate, vitamin C, calcium, iron, and fibre (P < 0.05), compared to those who skipped breakfast and those who had breakfast foods other than RTECs.
Conclusion: The lower levels of breakfast consumption among schoolchildren in Kuala Lumpur need serious attention. RTEC is a nutritious food which is well accepted by a majority of the schoolchildren in Kuala Lumpur. Nutrition intervention should be conducted in the future to include a well-balanced breakfast with the utilisation of RTECs for schoolchildren.
We report a case of a middle-aged gentleman with recalcitrant macular oedema (RMO) secondary to ischaemic central retinal vein occlusion (CRVO). He was given six injections of intravitreal ranibizumab (anti-VEGF) monthly. However, his visual acuity (VA) deteriorated and the macular oedema worsened. He then received an intravitreal dexamethasone implant eight months post-CRVO. His VA and macular oedema improved dramatically and significantly at first follow-up and remained stable at six months after implant. This case can be a reference for those who treating recalcitrant macular oedema. It shows the effect of an intravitreal dexamathasone implant might have in a patient with RMO due to CRVO. The patient enjoyed improvement of vision, with clinical evidence of reduction in central macular thickness (CMT) and with no serious adverse events after a single injection up to six months post implant.