Dissociation, including multiple personality disorder, has long been a controversial topic. Patients with suggestive symptoms are often misdiagnosed as malingering or even having
schizophrenia. The former as a result of the overlooking of a clinician on the fact that suggestibility itself plays a key role in the emergence and perpetuation of this illness and the latter due to the lack of knowledge of the whole dissociative disorder spectrum, often resembling that of a psychotic disorder. Another contributing factor to the small number of patients with this diagnosis is due to the reluctance of a psychiatrist to do so because of his/her lack of experience and also fear of humiliation of being accused of seeking fame from diagnosing this somewhat glamorous phenomenon. In Malaysia, various culture bound syndromes often present with similar symptoms too. This article will attempt to understand this dissociation on the local context using case studies as a reference point.
Somnambulism or sleepwalking is a sleep disorder of arousal. Compared to in adults, pediatric and adolescent sleep disorders is still under-researched and poorly described. We report the successful use of low dose quietiapine, an atypical antipsychotic, in the treatment of a 15-year-old Indian male who presented with significant somnambulism. To the best of our knowledge, this is the first report on the use of quetiapine for the treatment of somnambulism in the literature. The presence of high voltage delta waves in sleepwalkers has been offered as a possible explanation for the patho-physiology of sleepwalking Quetiapine has been reported to decrease brain delta activity, and we postulate that this may be the mechanism on how it was beneficial for our patient.
INTRODUCTION: This study aims to examine the validity and reliability of the Malay version of Attitudes toward Lesbians and Gay Men (MVATL/MVATG) among a group of medical students in Malaysia.
METHODS: It is a cross-sectional study of 173 medical students in the Faculty of Medicine, University of Kuala Lumpur, Malaysia. The participants were given the MVATL/MVATG, Index of Attitudes toward Homosexuals (IATH), Homosexuality Attitude Scale (HAS) and the English version of Attitude toward Lesbians and Gay Men. Two weeks later, these students were given the MVATLG again.
RESULTS: Significant correlation was found between the individual scores of MVATL and MVATG with IATH and HAS in the results. The scale was able to differentiate Muslim and Non-Muslim subjects. The internal consistency (Cronbach's alpha) of both the MVATL and MVATG were good, at 0.76 and 0.82, respectively. The parallel form reliability (Pearson's correlation) of MVATL was 0.0.73 and 0.74 for MVATG. The test-retest reliability of MVATL/MVATG was good (Intraclass correlation coefficient, ICC = 0.67 for MVATL and 0.60 for MVATG).
DISCUSSION: The MVATLG demonstrated good psychometric properties in measuring attitudes toward homosexuality among a group of medical students in Malaysia and it could be used as a simple instrument on young educated Malaysian adults.
KEYWORDS: Malaysia; attitude; gay men; homosexuality; lesbians; validation
Oxidative damage has been associated with the pathophysiology of depression. Macroalgae are equipped with antioxidant defense system to counteract the effects of free radicals. We explored the use of Malaysian Padina australis to attenuate high dose corticosterone-mediated oxidative damage in a cellular model mimicking depression. Fresh specimen of P. australis was freeze-dried and extracted sequentially with hexanes, ethyl acetate and ethanol. The extracts were screened for their phytochemical contents and antioxidant activities. Ethanol extract demonstrated the most potent antioxidant capacity and was selected for subsequent assays against high dose corticosterone of 600 µM-mediated oxidative damage in the rat pheochromocytoma (PC12) cells. The corticosterone reduced the cell viability, glutathione (GSH) level, aconitase activity, and mitochondrial membrane potential (MMP); and increased the lactate dehydrogenase (LDH) release, intracellular reactive oxygen species (ROS) level and apoptosis. However, the extent of oxidative damage was reversed by 0.25-0.5 mg/mL ethanol extract suggesting a possible role of P. australis-based antioxidants in the mitochondrial defense against constant ROS generation and regulation of antioxidant pathway. The effects were similar to that of desipramine, a tricyclic antidepressant. Our findings indicate that P. australis can be developed as a mitochondria-targeted antioxidant to mitigate antidepressant-like effects.
Schizophrenia has been linked with various medical comorbidities, particularly metabolic syndrome. The number of studies on this aspect is lacking in Malaysia. (1) Objective: To investigate metabolic syndrome rates and its associated factors. (2) Method: This is the first 10-year retrospective-outcome study of patients with first episode schizophrenia in Malaysia. Out of 394 patients diagnosed with first episode schizophrenia and registered with the National Mental Health Registry of Schizophrenia (NMHR) in the General Hospital Kuala Lumpur (GHKL) in 2004⁻2005, 174 patients consented to participate in the study. They were interviewed using a Schizophrenia outcome questionnaire and the International Physical Activity Questionnaire (IPAQ). The diagnosis of metabolic syndrome was made using the National Cholesterol Education Program—Third Adult Treatment Panel (NCEP ATP III). (3) Results: All patients’ weight, body mass index, fasting blood sugar, and blood pressure are significantly increased. Sixty-three subjects (36.2%) developed metabolic syndrome while 36 (23.2%) were hypertensive, and 41 (28.1%) were diabetic. Use of fluphenthixol depot (CI = 1.05⁻5.09, OR: 0.84, p = 0.039), reduced physical activity (CI = 0.13⁻1.00, OR: −1.04, p = 0.049), and substance use disorder (CI = 1.40, 13.89, OR: 1.48, p = 0.012) were significantly associated with metabolic syndrome based on univariate analysis. In further multivariate analysis, comorbid substance abuse was the only significant factor associated with metabolic syndrome after adjusting for physical activity and intramuscular depot. (4) Conclusion: Patients with schizophrenia are at high risk of metabolic syndrome. It is important to address substance use problems as an important risk factor of this comorbidity.