MyMedR

The fear of what goes up must come down: A case report of vulnerable narcissism

Chong SC, Ang JK, Hashim H

Asian J Psychiatr, 2020 Dec;54:102117.

PMID: 32623189 DOI: 10.1016/j.ajp.2020.102117

Pathological narcissism or narcissistic personality disorder is commonly characterized by an exaggerated sense of self-importance, condescending attitude, need for excessive admiration, diminished empathy and exploitativeness. In contrast to these overt attributes, there is a different presentation of pathological narcissism which is underrecognized, as one's preoccupation with hypervigilant, self-effacement and proneness to shame in the context of covert grandiose fantasies. This report illustrates a patient who had this subtype of vulnerable narcissism, and how his defence had been activated to preserve own self agency during a session with the doctor by revealing his paraphilic fantasy.

Fulltext A "good enough" remote psychodynamic psychotherapy - A psychiatry trainee's novice experience during Coronavirus pandemic

Chong SC, Ang JK, Tan KP

Asian J Psychiatr, 2021 Nov;65:102835.

PMID: 34534918 DOI: 10.1016/j.ajp.2021.102835

Covid-19 pandemic and the public health measure have forced an en masse transition to remote therapy from physical sessions. Remote psychodynamic psychotherapy is not a new treatment modality, but its effectiveness in holding the analytic frame has been concerned by some therapists. We would like to highlight some of the therapeutic processes involved with remote psychodynamic psychotherapy, via the help of a narrative experience of a psychiatry trainee who was novice to this delivery method of therapy. Reflections on these concerns have been made in line with the experiences highlighted.

Relations between clinical characteristics and cognitive deficits among adult patients diagnosed with major depressive disorder

Subhas N, Ang JK, Tan KA, Ahmad SNA

Int J Psychiatry Clin Pract, 2023 Sep;27(3):219-231.

PMID: 36448673 DOI: 10.1080/13651501.2022.2149415

OBJECTIVE: The present study examined the relations between clinical characteristics and cognitive deficits in adult patients with major depressive disorder (MDD) from a local outpatient psychiatric clinic in Malaysia.

METHODS: The present sample included 110 participants aged 20-60 years old. Participants were invited to provide their information on sociodemographic variables (age, gender, and educational level) and clinical characteristics (age at onset of depression and duration of illness) and to complete a series of cognitive performance measures including the Trail Making Tests A (psychomotor speed) and B (executive function), the Digit Symbol Substitution Test (attention), and the Auditory Verbal Learning Test (immediate free recall, acquisition phase, and delayed recall). The Mini International Neuropsychiatric Interview Version 6.0 was used to confirm the diagnosis of MDD and the Montgomery-Åsberg Depression Rating Scale was used to assess illness severity.

RESULTS: At the bivariate level, relations of age and educational level to all cognitive deficit domains were significant. At the multivariate level, only educational level and illness severity consistently and significantly predicted all cognitive deficits domains.

CONCLUSIONS: Therapeutic modalities should be individualised whilst considering the impacts of cognitive deficits in an attempt to prevent further deterioration in psychosocial functioning of MDD patients.KEY POINTSCognitive deficits are an elemental component of Major Depressive Disorder (MDD) persisting during a current major depressive episode or during remission, altering individuals' ability to process information and changes the way they perceive and interact with the environment.Cognitive deficits in MDD are evident among the upper-middle income groups in South-Eastern Asian countries warranting more local research as such deficits could lead to functional decline and work performance such as absenteeism and presenteeism.Therapeutic modalities should be individualised by taking the impacts of cognitive deficits into consideration to promote psychosocial functioning of MDD patients.

A case of sexual abuse by a traditional faith healer: are there potential preventions?

Chan LF, Tan SM, Ang JK, Kamal Nor N, Sharip S

J Child Sex Abus, 2012;21(6):613-20.

PMID: 23194137 DOI: 10.1080/10538712.2012.719597

Adolescent sexual abuse is not an uncommon phenomenon in Malaysia. It is a traumatic experience that complicates the psychosocial development of young people on the threshold of adulthood. This case report highlights the psychosocial sequelae of adolescent sexual abuse by a traditional healer and discusses management issues in the context of unique cultural and belief systems.

Learning Psychodynamic Psychotherapy in Southeast Asia

Loo JL, Ang JK, Subhas N, Ho BK, Zakaria H, Alfonso CA

Psychodyn Psychiatry, 2017;45(1):45-57.

PMID: 28248565 DOI: 10.1521/pdps.2017.45.1.45

The subjective nature of psychodynamic psychotherapy (PP) makes training and supervision more abstract compared to other forms of psychotherapy. The issues encountered in the learning and supervision process of PP of Malaysian psychiatry trainees are discussed in this article. Issues of preparation before starting PP, case selection, assessment of patients, dynamic formulations, supervision, anxieties in the therapy, countertransference, termination of therapy, the treatment alliance, transfer of care, the therapeutic setting, and bioethical considerations are explored. Everyone's experience of learning PP is unique and there is no algorithmic approach to its practice. With creative thinking, effort, and "good enough" supervision, a trainee can improve PP skills, even in underserved areas of the world.

Prevalence and predictors of depression and suicidal ideation among adolescents attending government secondary schools in Malaysia

Ibrahim N, Sherina MS, Phang CK, Mukhtar F, Awang H, Ang JK, et al.

Med J Malaysia, 2017 08;72(4):221-227.

PMID: 28889133 MyJurnal

No abstract available.

Fulltext Relationship of Psychological Flexibility and Mindfulness to Caregiver Burden, and Depressive and Anxiety Symptoms in Caregivers of People with Dementia

Tan KP, Ang JK, Koh EBY, Pang NTP, Mat Saher Z

Int J Environ Res Public Health, 2023 Feb 27;20(5).

PMID: 36901243 DOI: 10.3390/ijerph20054232

Caregivers of People with dementia (PwD) commonly experience burdens and other mental health issues, e.g., depression and anxiety. At present, there are limited studies that examine the relationships between caregiver psychological factors and caregiver burden, and depressive and anxiety symptoms. Therefore, this study's objectives were to examine the relationships between psychological flexibility and mindfulness in caregivers of PwD, and to determine the predictors of these three outcomes. This was a cross-sectional study conducted in the geriatric psychiatry clinic of Kuala Lumpur Hospital, Malaysia, and the sample (n = 82) was recruited via a universal sampling method over three months. The participants completed a questionnaire that consisted of the sociodemographics of the PwD and caregivers, illness characteristics of the PwD, Acceptance and Action Questionnaire-II (AAQ-II), Mindful Attention Awareness Scale (MAAS), Zarit Burden Interview Scale (ZBI), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). The results show that despite significant relationships between psychological flexibility and mindfulness and lower levels of caregiver burden, and depressive and anxiety symptoms (p < 0.01), only psychological inflexibility (p < 0.01) remained as a significant predictor of the three outcomes. Therefore, in conclusion, intervention programs that target the awareness of the caregiver's psychological inflexibility should be implemented to alleviate these adverse outcomes in dementia caregivers.

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