Objective: A study was conducted at the Universiti Kebangsaan Malaysia Medical Center (UKMMC) adult psychiatric clinic from June 2006 to December 2006. The aim was to assess the rate of the metabolic syndrome in a group of outpatients with mood disorders and schizophrenia and also to determine the relationship of this condition with sociodemographic factors and psychiatric illness characteristics.
Methods: A total of 51 subjects agree to participate of which 100 were approached. The International Diabetes Federation (IDF)(2005) criteria are used for the diagnosis of metabolic syndrome and Diagnostic Statistical Manual Version IV (DSM-IV) criteria are used to made psychiatric diaognosis.
Results: The prevalence of metabolic syndrome was found to be 37.2% and was significantly higher amongst mood disorders patient. However the metabolic syndrome is not associated with the anti psychotic therapy (p=0.41).
Conclusion: This study suggests that it is important for the psychiatrist to monitor metabolic syndrome in any of their patients.
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Objective: Mental health is often stigmatized in Asia, and electroconvulsive therapy (ECT) is portrayed negatively in the media. The objective of this short report is to obtain an insight on Asian countries’ perception on Electroconvulsive Therapy, mainly through the media.
Methods: Several online movie databases were searched, with emphasis on Asian movies’ portrayal of Electroconvulsive Therapy.
Results: Electroconvulsive Therapy (ECT) was portrayed in 9 television programme, 4 in films and 2 on Youtube. All patients (15) had no proper information given on possible side effects and consent not taken in all of them. 5 patients (33%) were tortured via ECT, 3(20%) of them had, ECT for Schizophrenia. In all scenes (15/15, 100%) ECT were given without general anaesthesia and the patients were fully awake. Basic monitoring (2/15, 13%) was performed, and all patients had no oxygenation. Tonic Clonic seizures were visible because all patients received no muscle relaxant. Bilateral electrode's placements (13/15, 87%) were common. One (6.6%) patient had a trilateral electrode placement. Most patients (9/15, 60%) received one shock, 4 patients (27%) received 2 shocks. One patient (6.6%) received 3 and 1 patient (6.6%) 4 shocks. 100% of patients were in obvious discomfort and ECT was portrayed as barbaric. There was no death depicted post ECT.
Conclusion: ECT is under portrayed in the Asian media. Only the Indian and Pakistani medium broached the subject. In the majority of the scenes, ECT was portrayed
negatively. This shows a total lack of knowledge of ECT among the Asian population. Alarmingly, ECT was used as a torture device in 5 mediums. This only adds to the stigma of ECT in Asia. More needs to be done to correct the misconceptions of ECT in Asia.
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.
Introduction: A validated diagnostic questionnaire is needed in the South-East Asia region, particularly in Malaysia to detect Premature Ejaculation (PE). The objective of this study was to determine the linguistic validity of the Malay Premature Ejaculation Diagnostic Tool (MAPET). Materials and Methods: This study was conducted in a teaching hospital. The first phase involved experts’ group discussions to develop the face, content, and factorial validity of the MAPET. The second phase measured the concurrent validity of MAPET. Results: We found that the MAPET has specificity, sensitivity, positive predictive value, and negative predictive value of 79.3%, 92%, 76.7% and 93.1%, respectively in the assessment of PE. The higher score indicates severity of PE. Conclusions: MAPET is a valid self-report instrument for the assessment of PE.
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: This study aimed to determine the association between the personality traits and
social factors with compliance to anti-hypertensive pharmachotherapy. Methods: This cross
sectional study was conducted from 1st of June until 31st of December 2004, which involved
Hospital Universiti Kebangsaan Malaysia Primary Polyclinic in Bandar Tasik Selatan,
Cheras and Salak Polyclinic in Sepang, Selangor. A total of 200 patients who fulfilled all the inclusion criteria, were selected as respondents. This study used the Mini International Neuropsychiatric Interview (M.I.N.I) for the psychiatric diagnoses and personality characteristics were assessed by using Personality Assessment Schedule (PAS) Results: The prevalence rate of non-compliance was 38.5%. Paranoid personality trait (27.3%) was the most common type of personality traits that associated with non-compliance to the medications prescribed. The results of this study revealed a statistically significant difference between drug compliance and age, race, gender and the site where the study was conducted. No association was found between patients’ education level, occupation, income, marital status, family history of hypertension and personality traits and drug compliance. Conclusion: This study suggested that drug compliance among hypertensive patients was influenced by the presence of psychosocial factors. Hence, it is important for medical practitioners to understand these factors and administer treatment more individual.
The critical review paper is a component of the theory examination for postgraduate psychiatry in Malaysia. Majority of students find this paper difficult, thus this article is intended to help the students understand the critical review paper better. The paper discussed below aimed to determine the knowledge, attitude and practice towards sleep among medical students of International Islamic University Malaysia (IIUM). Model answers were provided at the end of each question, as marked in italic font.
Objectives: This study aimed to determine the prevalence of depressive disorder
and its association with perceived social support among patients with HIV
attending the Infectious Disease Clinic in HTJS.
Methods: A cross-sectional
study was conducted, and systematic random sampling method was employed
for the selection of participants. Socio-demographic and clinical details were
obtained through a self-rated questionnaire and participants’ medical records.
Depressive disorder was screened and diagnosed using the Mini International
Neuropsychiatric Interview (M.I.N.I.) and perceived social support was
determined using the Multidimensional Scale of Perceived Social Support
(MSPSS). Appropriate statistical analyses were used to determine the prevalence
of depressive disorder and its association with perceived social support.
Results:
A total of 99 patients participated in this study. The mean age of participants
was 38.16 ± 1.01 years, and the majority of participants were male (69.7%). Most
of the participants were Malay (58.6%), followed by Indians (20.2%), Chinese
(17.2%) and others (4.0%). The majority had completed secondary education
(54%), and most were employed (79.8%). Most of the participants were single
(45.5%) or married (45.5%). The lifetime and point prevalence of depressive
disorder was 24.2% and 17.2%, respectively. About 64.7% of patients with
depressive disorder were undiagnosed. Out of the 3 sources of perceived social
support, perceived social support from a significant other (OR=0.53, p=0.042,
Cl=0.29, 0.98) and perceived social support from friends (OR=0.49, p=0.015,
Cl=0.27, 0.87) were found to be negative predictors for depressive disorder.
Conclusion: This study reports that the prevalence disorder among patients with
HIV in HTJS is higher than that of the general population. Patients without
depressive disorder reported significantly higher perceived social support scores.
Perceived social supports from significant others and friends were found to be
important associated factors for lower depressive disorder vulnerability. Hence,
physicians should routinely screen for depressive disorder in this vulnerable
group and explore and mobilize their social support to reduce patients’
vulnerability to develop depressive disorder.
Lecturers are expected to cope with stress in their workplace in order to continue to be productive. The demand to fulfill targets will increase the incidence of occupational stress. The aim of the study was to determine the factors associated with occupational stress among state university lecturers in Bandung, Indonesia. The study was carried out on 354 state university lecturers in Bandung, who came to the research location during May 2017. It was conducted by means of a diagnostic survey with the use of the Self Reporting Questionnaire (SRQ), Spiritual Wellness Inventory-R (SWI-R), Social Readjustment Rating Scale (SRRS), Miller Smith lifestyle assessment inventory, and Occupational Stress Scale (OSC). A total of 330 respondents became our study subjects with response rate of 92.94%. A correlation bivariate was applied to analyse the correlation of external and internal factors with occupational stress. The statistical analysis was conducted by means of SPSS Statistics 18.0 with p≤0.05. From 330 lecturers, there were 153 (46.4%) males and 177 (53.6%) females. The marital status included 257 (77.9%) married, 27 (8.2%) single, while 46 (13.9%) did not answer. The results proved the existence of a correlation between life, stress event, life style, mental emotional disorders, with occupational stress. The spirituality factors contributed to occupational stress were selfworth, control, and connectedness. Lecturer had to cope with occupational stress. There are some factors, which could influence occupational stress among lecturers.
Objective: To assess postgraduate candidates’ knowledge on basic sciences and to compare
their achievement based on two years study in the Department of Psychiatry, National University of Malaysia (UKM), Kuala Lumpur, Malaysia. Methods: This is a study assessing
areas of difficulties in basic sciences for the Malaysian postgraduate candidates sitting for
mock MCQ examination papers in two consecutive years. Results: The candidates in both
years failed on MCQ papers (scoring marks are only 43% and 40% for the year 2006 and
2005 respectively), which is consistent with their final examination outcomes. The candidates in the year 2006 were much superior in neuroanatomy (percentages of median scores: 47% vs. 31%, p
Objective: To investigate patient’s perceived satisfaction and adequacy of information given by doctors on prescribed drugs in an outpatient psychiatric setting.
Methods: The sampling was done consecutively with a target sample size of 200 patients. A simple questionnaire that was developed with 10 close-ended questions and yes or no answers was administered by the interviewing team. This questionnaire assessed patients' knowledge on prescribed medications and their perception on the adequacy of information given.
Results: More than 80% of the patients were informed regarding the reasons, timing to take medication(s), duration of drug treatment and type of prescribed drugs. Half of them were informed regarding the side effect profiles of their prescribed medications. Majority of them (80%) were satisfied with the information given despite only 49% of the patients being given adequate information on their medications.
Conclusion: Patients who are adequately informed about their medications are more significantly satisfied than those inadequately informed. (χ2=4.085, p<0.05).
Key words: perceived satisfaction, adequacy of information, prescribed psychotropic drug
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Objective: To investigate the prevalence of genital arousal disorder and the potential risk
factors that may impair genital arousal among women at a primary care setting in Malaysia.
Methods: A validated questionnaire for sexual function was used to assess genital arousal
function. A total of 230 married women aged 18–70 years old participated in this study. Their sociodemographic and marital profiles were compared between those who had genital arousal disorder and those who did not. The risk factors were examined. Results: The prevalence of genital arousal disorder in the primary care population was 50.4% (116/230). Women with genital arousal disorder were found to be significantly higher in groups of more than 45 years old (p55) (p=.001), those having 4 children or more (p=.028), those having less sexual intercourse (less than 1–2 times a week) (p=.001), and those at post-menopausal state (p=.002). There was no significant difference between these two groups in term of salary (p=.29), suffering from medical problems (p=.32), dysmenorrhea (p=.95), menarche (p=.5) and hormonal replacement therapy (p=.6). Conclusion: Women with infrequent sexual intercourse are less likely to be sexually aroused (OR=0.29, 95% CI: 0.11-0.74).
The complexity of physical, hormonal and psychocological changes in menopause may affect the sexual function in women. This study measured the prevalence of female sexual dysfunction (FSD) in Malaysian menopausal women. The associated factors were also examined in the study. A cross-sectional study involved 310 menopausal (defined as last menstrual period more than 12 months ago) who visited a menopausal clinic in a secondary referral hospital in the East Peninsular Malaysia. The prevalence and associated factors of female sexual dysfunction in the study subjects were determined. Sexual dysfunction was assessed using the Malay version of the female sexual function index (MVFSFI). Possible associated factors were collected in a pre-designed questionnaire. The prevalence of FSD for the menopausal women was 21.3%. Younger age was the only factor significantly associated with FSD in the study subjects (adjusted odds ratio=0.916, 95% CI=0.851-0.987). The prevalence of FSD was low in the Malaysian menopausal women and associated with younger age.
Mild cognitive impairment (MCI) is a common condition among the elderly and is believed to be a precursor to Alzheimer disease. This study aims to detect the prevalence of MCI and factors associated with it. A cross-sectional study was conducted on a group of elderly patients attending various medical clinics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in 2010. Only patients aged 60 years and above, literate with no hearing or visual impairments were included. Screening instruments included the Mini Mental State Examination (MMSE) and a questionnaire on
sociodemographic and clinical data. The cut-off points for MMSE for MCI was 21/30 to 28/30. The prevalence rate based on MMSE score for ‘normal’ and MCI were 35.3% and 64.7%, respectively. Most of the 346 patients (33.9%) had only one type of medical illness and on one type of medication. MCI was significantly associated with low educational achievement (p<0.05) and rheumatological diseases (p= 0.05). However, it is not associated with the number of medical illnesses suffered by patients and the number of medications prescribed. This study highlighted that MCI was a common condition among the elderly UKMMC Medical clinic attendees and was significantly associated with their low education level.
Objective: Sexual problems are common among patients who are on antidepressants treatment. The objective of this study is to determine the prevalence of PE and ED, and their potential risk factors that may impair their sexual function in a TH
Methods: A cross-sectional study using simple random sampling was conducted among adult male patients who are on antidepressant treatment in the TH psychiatric outpatient clinic. Respondents’ sociodemographic data were obtained. Participants were interviewed using a structured self-report questionnaire with 15-item International Index of Erectile Function (IIEF-15)where the scores lesser than 25 were indicative for having an ED. A validated Malay Premature Ejaculation Diagnostic Tool (MAPET) was used to assess PE and those with a score ≥ 23 were considered to have PE.
Results: Hundred respondents were participated, and the prevalence of PE and ED was 66% and 85%, respectively. Using multivariate binary logistic regression, the potential risk factors of PE were race, i.e. being non-Malay (p=0.044), lesser in the frequency of sexual activity (p=0.03) and also an ED (p=0.03), respectively. The only risk factor for ED was PE (p=0.026). No significant association was noted for the other factors, including type of the antidepressant, dose and duration of antidepressant used (p>0.05). There was a strong correlation of MAPET and IIEF-15 (r=-0.345, p < 0.01) signifying patient with more severe PE had more severe ED.
Conclusions: Due to very high rate of ED and PE in this group of respondents, it is pivotal to screen for sexual problem among patients who are taking an antidepressant in a psychiatric setup.
Study site: Psychiatric clinic, Pusat Perubatan University Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia.
This study aims to describe the pattern of sexual behaviour among methamphetamine and heroin users. It describes the pattern of sexual behaviour based on aspects of sex such as desire, interest, drive and obsession in relation to the drug use. A cross-sectional study was carried out among attendees of drug rehabilitation programmes in Kota Kinabalu, Kota Bharu and Kuala Lumpur. All subjects were living in the community with satisfactory psychosocial functioning. This study was primarily based on a validated sexual behaviour self-rated questionnaire followed by face-to-face interview. A total of 227 subjects were included with 124 (54.6%) using methamphetamine while 103 (45.4%) using heroin. Majority (218; 96%) were heterosexuals with 104 (45.8%) reported having been involved in high risk sexual behaviour. More methamphetamine than heroin subjects agreed that their sexual thoughts, feelings and behaviours were often associated with the drug (p<0.05). Methamphetamine subjects agreed that the use of methamphetamine caused them to be more obsessed with sex and they found themselves to be preoccupied with sexual thoughts while being under the influence of the drug (p<0.05). Heroin subjects mainly reported on negative effects of the drug on their sexual behaviour. Methamphetamine subjects reported that the use of drug had positively affected their sexual interest and drive (p<0.05). Methamphetamine subjects were also 1.97 times more likely than heroin subjects to be involved in risky sexual behaviour. The results of this study can be utilized to improve the drug treatment and rehabilitation programme. Methamphetamine subjects were more likely than heroin subjects to be involved in risky sexual behaviour.
Objective: Long-term use of ecstasy is known to be a risk factor for structural brain damage and psychosis. Most patients suffering from ADHD in childhood will not develop psychosis during adulthood but the risk is increased when there is concomitant significant drug use. However, it is difficult to distinguish between substance-induced psychoses with schizophrenic psychosis.
Method: We report a case of a patient with history of ADHD who was untreated, who later developed psychotic symptoms soon after initiation of ecstasy uses. The symptoms persisted despite in a ‘drug-free period’ and intensified while on the ecstasy.
Results: Present case helps to understand common neurobiological mechanism behind psychosis and brain atrophy, and risk factors such as ADHD and ecstasy abuse.
Conclusion: More research in this area is vital for management and further understanding on the importance of treating ADHD earlier and to be more vigilant in establishing the history of substance use.
The study of medicine is often regarded by students as a stressful environment particularly during examination period. Studies found a high percentage of medical students experience significant psychological distress during the examination period. This study compared percentage and level of psychological distress between two batches of first year medical students who underwent different selection admission processes during a stressful examination period. A comparative
cross-sectional study was done on two batches of first year medical students; one group selected based on academic merit (2008/2009 batch) and the other selected based on academic merit, psychometric tests and interview (2009/2010 batch). The psychological distress was measured by the 12-item general health questionnaire (GHQ-12). The data were collected right after the final examinations. A total of 99 (46.05%) medical students of the 2008/2009 batch and 196 (100%) medical students of the 2009/2010 batch participated. The percentage of medical students who had psychological distress of the 2008/2009 and the 2009/2010 batches were 58.59% and 42.3%, respectively. The mean GHQ-12 score and percentage of psychological distress were significantly different between the two batches (p< 0.01). The older batch had 2.01 times higher risk for developing psychological distress compared with the newer batch (p< 0.01). The newer batch
of medical students had better psychological health status and was less likely to develop psychological distress during the stressful period compared with older batch.
Objectives: To determine the association of students’ perception of schooling with externalizing/internalizing scores; and to examine the different perceptions related to truancy. Methods:A total of 373 predominantly 16 year-old students attending three high risk schools in Pudu, Kuala Lumpur completed the questionnaires on schooling variables (four items) and externalizing/internalizing syndromes (Youth Self-Report, 112 items). Results: Certain negative perceptions (uncertainty of the schooling purpose, thinking schooling as time wasting) were significantly associated with higher internalizing (p
Objective: Critical appraisal is a process of systematically examining research evidence to assess its validity, results and relevance before using it to form a decision. A basic knowledge in statistic and epidemiology is important among postgraduate students in psychiatry to acquire the skills for appraising clinical research evidence. This is a descriptive study that attempts to look into the level of knowledge among the postgraduate psychiatry students in
terms of statistic and epidemiology. Methods: A total of 31 postgraduate students in their second (N= 26) and third year (N=5) Master of Medicine (Psychiatry) and Master of Psychological Medicine from three different universities, namely: Universiti Kebangsaan Malaysia, Universiti Malaya and Universiti Sains Malaysia participated in this research. The participants were asked to answer 7 questions within 30 minutes. The passing mark for this
critical review paper is set at 25 out of 50. Results: Overall, only 32.3% passed the mock critical review paper. About 67.7% of the students passed their epidemiology component and only 19.4% passed the statistic component. Conclusion: We found poor performance in basic statistics among psychiatric trainees which highlights the need for further improvement in the subject’s training.