Mental health is becoming an important issue. Several local and international studies have proven that the incidence of mental illness is on the rise. Doctors have also been able to make more accurate diagnoses and treat mental disorders more reliably with the aid of recent research and newer drugs. As such it is necessary for the medical curricula to respond to this shift. Medical students must now be exposed to new psychiatric disorders and ways of managing them. The time spent in psychiatry and the mode of teaching must also be revised and modified to the current needs of patients.
The Community Follow-up Project (CFUP) is a project where medical students choose a hospital in-ward patient during their clinical ward-based attachments and follow-up this patient's progress after discharge from the hospital. The students do a series of home visits and also accompany their patients for some of their follow-ups at the hospital, government clinics, general practitioners' clinics and even to the palliative care or social welfare centres. The students assess the physical, psychological and social impact of the illness on the patient, family and community. By following their patients from the time their patients were in the hospital and back to their homes and community, the students are able to understand in depth the problems faced by patients, the importance of communication skills in educating patients on their illness and the importance of good communication between primary, secondary and tertiary care.
The objective of the study was to determine the proportion of sound HIV knowledge and common misconceptions about HIV among university students. A set of pre tested and validated questionnaire assessing sound HIV knowledge and common misconceptions about HIV was used in this cross sectional study. HIV knowledge was defined as sound when one was able to identify correctly two ways of preventing the sexual transmission of HIV and reject three major misconceptions about HIV. Out of 300 respondents, 298 completed the questionnaire giving a response rate of 99.3%. A total of 40.9% of university students have sound HIV knowledge. The majority of those who lacked sound HIV knowledge were young (60.2%) and female (60.4%). A significant proportion still believed that HIV can be transmitted via social contact (13.8%), by sneezing or coughing (11.4%) and mosquito bites (10.1%). About 6.7% were believed wrongly that HIV can be treated by vaccine and healthy-looking people cannot have HIV.
Study site: Universiti Putra Malaysia (UPM), Malaysia
This study was conducted to explore the outcome of psychotherapy in ethnic Malays with strong religious and cultural background. The patients were divided into two groups. The study and control groups consisted of 32 depressed patient each. In the study group brief psychotherapy of 15-20 sessions was attempted with the addition of a religious perspective, while in the control group the religious perspective was omitted. Patients in the study group showed more rapid improvement in the initial 3 months of the study period than those in the control group, but at the end of the 6 months the difference became nonsignificant.
Religious patients with generalized anxiety disorder were given religious psychotherapy in addition to supportive psychotherapy anxiolytic drugs. Those receiving religious psychotherapy showed significantly more rapid improvement in anxiety symptoms than those who received supportive psychotherapy and drugs only. Thus, religious patients may require a different form of psychotherapy.
This study was aimed at determining the effect of psychotherapy in patients in bereavement. Fifteen patients in a control group were given brief psychotherapy and 15 study group patients received psychotherapy with a religious perspective. The patients in the study group showed consistently significant improvements as compared with the control group at the end of 6 months. The results indicate that highly religious patients with grief and bereavement tend to improve faster when a religious psychotherapy is added to a cognitive-behaviour approach.
The families of 83 schizophrenic patients were studied to find out the level of expressed emotion in them leading to the relapse of these patients. The patients were having more than two episodes of schizophrenia (DSM-III-R). The most salient finding was the virtual absence of high level of expressed emotion as the cause of relapse. It was found that the majority of the families (72.3%) had low expressed emotion while only 25.3% had high expressed emotion and only 2.4% families were equivocal in this respect. This finding is in contrast with various other findings in this area. The most likely explanation for this disagreement is the cultural differences between Malaysian patients and Western patients.
The aim of this study was to determine the prevalence of symptoms and problems in hospitalized hematological cancer patients. A cross-sectional design was carried out with 105 respondents in Ampang hospital in Kuala Lumpur. The European Organization for Research and Treatment of Cancer Quality Of Life questionnaire (EORTC QLQ-C30) was used. Patients with a minimum response of "a little" were defined as having a symptom/problem while patients with a response of "quite a bit" were classified as having a "severe symptom/problem". The four most prevalent symptoms/problems identified were fatigue, financial difficulties, reduced role function and reduced social function. Multiple myeloma patients (MM) were identified as having the most symptoms/problems.
This study was conducted to find out the psychiatric symptomatology in the patients and their families attending a primary health care facility. The most frequent symptoms found were of depression (13.2%), followed by hypochondriacal symptoms (8.2%), anxiety symptoms (6.1%) and psychotic symptoms. A large proportion (21.5%) of children had psychiatric symptoms. The common symptoms include enuresis, hostility, tantrums, problems of conduct and destructiveness. Surprisingly, concern for these symptoms was lacking in both the patient and their family members.
Introduction: The Cyclooxygenase-2 (COX-2) enzyme is responsible for the synthesis of prostaglandin which is responsible for inflammation and pain. Celecoxib a cyclooxygenase-2 inhibitor was first used as a non-steroidal anti-inflammatory drug in 1999. Celecoxib is as effective as NSAIDs but causes less ulceration of the gastrointestinal tract, hence it is commonly used. It has been widely used in patients with osteoarthritis and rheumatoid arthritis. We present 3 cases of temporary psychiatric disorders associated with consumption of celecoxib, two of the patients presented with auditory hallucinations while one was diagnosed to be having depression. None had pre-existing psychiatric disorders or consumed alcohol or substance of abuse. All 3 patients recovered from their temporary psychiatric disorders after stopping celecoxib. Discussion: It is important to be aware of the psychiatric side effects when prescribing the drug for prolonged periods.
Study design: A cross-sectional study was conducted in all states of Malaysia to determine the prevalence, awareness, treatment and control of hypertension. A stratified two-stage cluster sampling design with proportional allocation was used.
Methods: Trained nurses obtained two blood pressure measurements from each subject. Hypertension was defined as mean systolic blood pressure >140 mmHg, diastolic blood pressure >90 mmHg, or a self-reported diagnosis of hypertension and taking antihypertensive medication. All data were analysed using Stata 9.2 software and took the complex survey design into account. A two-sided P-value of <0.05 was considered to be statistically significant.
Results: The overall prevalence of hypertension for subjects aged 15 years was 27.8% (95% confidence interval (CI) 26.9-28.8). The prevalence of hypertension was significantly higher in males (29.6%, 95% CI 28.3-31.0) compared with females (26.0%, 95% CI 25.0-27.1). Multivariate logistic regression showed that the odds of having hypertension increased with increasing age, in males, in subjects with a family history of hypertension, with increasing body mass index, in non-smokers and with decreasing levels of education. Only 34.6% of the subjects with hypertension were aware of their hypertensive status, and 32.4 were taking antihypertensive medication. Amongst the latter group, only 26.8% had their blood pressure under control. The prevalence of hypertension amongst those aged 30 years has increased from 32.9% in 1996 to 40.5% in 2004.
Conclusion: In Malaysia, the prevalence of hypertension is high, but levels of awareness, treatment and control are low. There is an urgent need for a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension in Malaysians.
Two hundred and seventy patients with schizophrenia (104 patients in Kelantan and 166 patients in Penang) were interviewed using the Present State Examination to elicit the differences in the phenomenology of their hallucinations. The results indicate that there are significant differences in the phenomenology of hallucinations between the Malays of Penang and Kelantan and also among some Chinese patients. These findings indicate that culture does affect the phenomenology of schizophrenia, even among people of the same race but of different regions.
Two hundred and seventy schizophrenia patients were interviewed using the Present State Examination to elicit the phenomenological symptoms of the illness. Cultural factors and ethnicity were found to be significant variables associated with the symptoms. Higher prevalence of religious and other subculturally related delusions were common in Kelantan patients. Our general belief that Malaysian culture influences symptomatology of mental illness seems to be proven.
Medical schools have existed in Malaysia for a very long time. The majority of practicing doctors has trained locally. From the early nineteen sixties when the first medical school was established to the current 7 public medical faculties, the standards of local trained doctors have always been exemplary. Now with more need for doctors to serve the country and the mushrooming of medical schools, the question of needs and wants of future medical schools and medical education need to be addressed. In this paper I will try to highlight what we in Universiti Putra Malaysia have been working on to improve the Medical and Health Sciences faculty to achieve greater heights to reach the future in the shortest possible time.
Schizophrenics (n = 250) and normal controls (n = 90) were studied to investigate and compare their dermatoglyphic patterns. Their fingerprint patterns were studied. The frequency of arches in the patient and control groups was similar. The frequency of loops in the control group was higher than in the patient group, and the trend was consistent in all the digits. The whorls in the patient group showed an increase over the control group in all the digits, although this finding was not statistically significant.
Objectives: To determine the relationship between major depressive disorder, anxiety disorders and the quality of life of haematological cancer patients.
Methods: This cross-sectional study was conducted at Ampang Hospital Kuala Lumpur, Malaysia, a tertiary referral centre hospital for haematological cancer. The Mini-International Neuropsychiatric Interview was used for the diagnosis of major depressive disorder and anxiety disorders. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was utilised to measure patients’ quality of life.
Results: A total of 105 haematological cancer patients ere included in the study with response rate of 100%. Major depressive disorder correlated with almost all domains of the quality of life, except the pain scores. Logistic regression showed that insomnia and financial difficulties were related to major depressive disorder. Different anxiety disorders also correlated with quality of life in specific domains. The leading anxiety disorders that correlated mostly with quality﹣of life scales were generalised anxiety disorder, followed by obsessive-compulsive disorder, social anxiety disorder, as well as post-traumatic stress disorder and panic disorder with agoraphobia (p < 0.05).
Conclusions: Psychological treatment along with medication and intervention should be implemented to improve the overall quality of life and psychiatric disorder symptoms among the haematological cancer patients.
Key words: Anxiety; Depression; Hematologic neoplasms; Quality of life
A number of psychological approaches to alleviating psychotic symptoms have been reported in the literature. The latest technique among them is cognitive therapy (CT). This paper describes an open trial that makes use of cognitive psychotherapy to treat chronic drug resistant delusions (more than 2 years duration) in 20 patients with schizophrenia. The positive response of all patients with the absence of symptom replacement and maintenance of response at 3 months follow-up, seem to imply that this technique is useful and more effort needs to be invested into this new area of psychotherapy for psychosis. This paper also shows that those patients on risperidone maintenance respond better to CT than those on other neuroleptics.
This paper reports the result of a brief therapy attempt at treating panic in a busy outpatient psychiatric clinic. The patients were cases of panic referred from the various outpatient clinics within the hospital complex. The patients were divided into three groups at random using one of three modalities of treatment, i.e. cognitive behaviour therapy (CBT), CBT and Fluvoxamine (FVX), and FVX alone. The therapy was aimed for a maximum of nine sessions after which the patients were to be discharged. There were 14 patients in each group. The results show that all the groups were similar in the severity and scores pre treatment but after the different types of treatment there was a significant difference among them. The FVX alone group, showed significant improvement from the pretreatment levels but did not show as much improvement as the other groups and the mean score was only 9.07 after nine sessions. The best group was the CBT in combination with FVX. This indicates that the best way to treat panic is to combine drug treatment and psychological treatment. It is also shown from the study that the combination group requires less FVX than the FVX alone group. This finding has implications for the treatment of panic at the family physician clinic.
Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia