Assertive community treatment (ACT) is one of the most important elements of mental health care reform in Malaysia. Many studies worldwide have reliably found that ACT has positive impact on several outcome domains such as reduced hospitalization rate, improvement of symptoms and quality of life. This study aimed to assess the outcome of ACT in the aspect of symptom remission and its influencing factors among patients with schizophrenia in the urban city of Kuala Lumpur. A cross sectional study was conducted on 155 patients with schizophrenia who received ACT in Hospital Kuala Lumpur (HKL). The selection was made by simple random sampling. The abbreviated Brief Psychiatric Rating Scale (BPRS) was used to determine the status of symptom remission. The socio demographic and relevant clinical data were also assessed. A total of 76% (118) was noted to be in remission. According to logistic regression, the strongest predictor of patients receiving ACT with symptom remission was having good social support (p<0.001) and with higher educational level (p=0.024). The study revealed the effectiveness of ACT in terms of high prevalence of patients with symptom remission. This was despite the model of ACT being studied not fulfilling all fidelity measurements of the standard version of the service. The finding would hopefully act as a propeller for further development in this service area. However, the study
needs to be replicated through studies with better designs and involving more psychiatric centers.
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.
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.
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.
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.
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.
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.
Introduction: Both premature ejaculation(PE) and erectile dysfunction(ED) are prevalent sexual health disorders that have been inadequately investigated in Malaysia, a multiethnic and conservative nation.The objective of the study was to study the relationship between PE and ED, and other common mental health issues, i.e. anxiety and depression in Malaysian urban population.
Methods: The diagnosis for PE was established by clinical diagnosis using DSM-5 and ISSM definition criteria for PE, whereas a diagnosis of ED was established by the International Index of Erectile Function (IIEF) questionnaire. Anxiety and depression levels were detected from the Hospital Anxiety and Depression Scale (HADS).
Results: Based on DSM-V and ISSM clinical diagnosis for PE, the prevalence of PE was found to be 25%. Erectile dysfunction (p = 0.035, OR = 3.315, 95% CI 1.088, 10.103) and severe anxiety (p = 0.020, OR = 7.656, 95% CI 1.383, 42.396) significantly predicted presence of PE.
Conclusion: There was a strong association between PE and ED and between PE and anxiety. Routine examination for PE in male patients should address the issue and the management of both ED and anxiety among PE patients, especially in an urban Malaysian clinical and medical care setting.
Objective: To investigate the prevalence of Female Orgasmic Dysfunction (FOD) focusing on the orgasm domain among female patients attending PPUKM Psychiatric clinic. To compare the prevalence of orgasmic dysfunction between female patients on Escitalopram and on Fluoxetine therapy.
Methods: A validated questionnaire for sexual function was used to assess orgasmic function. A total of 112 women aged between 24 and 57 participated in this study. The orgasmic dysfunction was compared between patients on selective serotonin reuptake inhibitors (SSRIs) fluoxetine and escitalopram.
Results: The prevalence of female orgasmic dysfunction was 58.9% (33/56) among patients treated with Fluoxetine and 41.1% (23/56) among patients treated with Escitalopram. However, there was no statistically significant difference between these two treatment groups (p=0.059). The odds to have FOD among patients on higher dose of antidepressants was found to be higher compared to those patients who were on lower dose of antidepressants (Odds ratio 5.32, p= 0.001).
Conclusion: There was no significant difference of Female Orgasmic Dysfunction between patients on Fluoxetine and Escitalopram.
Study site: Psychiatric clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
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.
Objective: This study aims to report on the process of standard settings (SS) and to compare the passing rates between the norm-reference and SS methods, for OSCE in psychiatry undergraduate examination at UKM for 2009/2010 session. Methods: In the SS method, examiners were asked to imagine the performance of a minimally competent student and gave marks using a standardized check-list. The marks in particular outliers were discussed. After the first round, the examiners went through the same process again, to rate the minimally competent students independently. The median of the marks was taken as the passing mark for the particular question. The passing rate using the passing mark of 50% in the normreference method was compared to the passing rate from the passing mark obtained from the settings method. Results: For question 1, the passing rate with the norm-reference method (i.e. passing mark of 50%) was 93% (106/114) and that by the SS method was 72.8% (83/114). For question 2, the pass rate with the norm-reference method was 92% (105/114) and that by the SS method was 67.5% (77/114). Conclusion: The passing rates between the two methods showed significant differences. Although OSCE is an improvement to the undergraduate psychiatry examination in Universiti Kebangsaan Malaysia, there were few limitations and challenges that need to be tackled for further improvement.
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.
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
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: 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).
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.
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
This is a model answer of Critical Review paper for Malaysian postgraduate examination in psychiatry. This model answer was used for marking the review paper for Master of Medicine (Psychiatry) and Master of Psychological Medicine, May 2009.
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.