MyMedR

Fulltext Suicide attempts in Malaysia from the year 1969 to 2011

Sinniah A, Maniam T, Oei TP, Subramaniam P

ScientificWorldJournal, 2014;2014:718367.

PMID: 24672358 DOI: 10.1155/2014/718367

The aim of this paper is to review the literature on suicide attempts in Malaysia. PsycINFO, PubMed, and Medline databases from 1845 to 2012 and detailed manual search of local official reports from the Ministry of Health and the Malaysian Psychiatric Association and unpublished dissertations from 3 local universities providing postgraduate psychiatric training were included in the current review. A total of 38 studies on suicide attempts in Malaysia were found and reviewed. Twenty-seven (76%) of the studies on suicide attempts were descriptive studies looking at sociodemographic data, psychiatric illnesses, and methods and reasons for suicide attempts. No study has been conducted on treatment and interventions for suicide attempts and the impact of culture was rarely considered. The review showed that in order for researchers, clinicians, and public health policy makers to obtain a better understanding of suicide attempts in Malaysia, more systematic and empirically stringent methodologies and research frameworks need to be used.

Fulltext Psychological distress, quality of life and coping in cancer patients: a prospective study

Suthahar A, Gurpreet K, Ambigga D, Dhachayani S, Fuad I, Maniam T, et al.

Med J Malaysia, 2008 Dec;63(5):362-8.

PMID: 19803291 MyJurnal

We present the results and conclusions of an observational prospective cohort design study using self-administered questionnaires to determine correlation between psychosocial factors and cancer outcome among 80 consecutive newly diagnosed treatment naïve cancer subjects who were being referred to the Oncology Clinic, Hospital Universiti Kebangsaan Malaysia. Subjects were recruited over a period of 43 weeks from October 2000 till July 2001. Follow-up assessments were carried out at 6-months and 12 to 26 months later. The prediction of survival time was performed by the Cox Regression Analysis method with adjustments for biological and psychosocial risk factors. It was noted that depression (p = 0.001), stage 4 cancer disease (p = 0.016), neurological (p = 0.032), gastrointestinal tract (p = 0.04), head and neck (p = 0.011), gynaecological (p = 0.005) and bone and soft tissue (p = 0.030) malignancies were independent and statistically significant prognostic factor of survival during the study period. It was further shown than depressed patients were found to have almost four fold greater risk of dying than non-depressed patients and patients with stage 4 cancer illness have a five fold greater risk of dying than patients with stage 1 disease. Furthermore, based on tumour types subjects with neurological, gynaecological, head and neck, bone and soft tissue and gastro intestinal tract malignancies were found to have approximately thirty-six, twenty-five, twenty-two, sixteen and seven fold greater risk of dying respectively when compared to subjects with genitourinary cancers. This study further affirms the need for health care providers to be aware of the psychological aspects of the cancer patient and provide appropriate therapy so as to ensure that this group of individuals would have enhanced survival rates.

Study site: Oncology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Fulltext Prevalence of insulin resistance in schizophrenia in HUKM

Fairuz AR, Maniam T, Khalid BA

Med J Malaysia, 2007 Oct;62(4):290-3.

PMID: 18551931 MyJurnal

This is a cross-sectional study to determine the prevalence of insulin resistance and its associated factors in Hospital UKM patients with schizophrenia using the Homeostatic Model Assessment (HOMA) model. Fasting glucose and insulin from 85 patients were obtained. Fasting glucose revealed 15% of the patients were diabetic, while another 15% had impaired fasting glucose. Using the HOMA model, 68% of the patients had insulin resistance. Univariate analyses found BMI (p < 0.001) and waist circumference (p < 0.001) to be associated with insulin resistance. The statistical significance disappeared after multivariate analyses. All patients with schizophrenia should be screened and managed as a group at high risk for development of diabetes with emphasis on body weight management.
Study site: inpatient and outpatients, Psychiatric department, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Fulltext Does clinical exposure to patients in medical school affect trainee doctors' attitudes towards mental disorders and patients?--A pilot study

Tan SMK, Azmi MT, Reddy JP, Shaharom MH, Rosdinom R, Maniam T, et al.

Med J Malaysia, 2005 Aug;60(3):328-37.

PMID: 16379188

Stigmatising attitudes towards mental illness may improve with clinical exposure during medical school training. Attitudes of 48 fourth year medical students in Universiti Kebangsaan Malaysia were assessed before and after their compulsory attachment in Psychiatry, using the Attitude Towards Psychiatry-30 (ATP) and the Attitude towards Mental Illness (AMI) questionnaires. ATP scores improved significantly with training (104.8 and 114.4, pre- and post-attachment respectively) as did AMI scores (63.4 and 68.1 respectively). Both improvements were statistically significant. (ATP: z = 4.55, p < 0.0005) (AMI: z = 3.75, p < 0.0005). Attitudes towards mental illness appeared to have become more favourable with clinical training in psychiatry.

Fulltext All elevated creatine kinase is not neuroleptic malignant syndrome

Maniam T, Rahman MA

Med J Malaysia, 1994 Sep;49(3):252-4.

PMID: 7845275

Creatine kinase (CK) is an enzyme that is found widely in muscle tissues. Raised levels would occur when there is muscle damage. Raised levels are used as one of the diagnostic criteria for Neuroleptic Malignant Syndrome (NMS). This study looks at CK levels in 30 psychotic inpatients without NMS and compares them with 10 patients with NMS. It was found that 67% of the patients without NMS had raised CK levels, 20% of whom had levels in excess of 1000 IU/L. The rest had a two to five-fold increase over normal limits. Raised levels were associated with the use of intramuscular injections and physical restraints, situations which are well known to result in muscle injury. All the NMS patients had raised CK levels but 40% had levels below 1000 IU/L. Our findings support the idea that CK levels, though helpful, should be interpreted with care as raised levels are nonspecific.

Fulltext Family characteristics of suicides in Cameron Highlands: a controlled study

Maniam T

Med J Malaysia, 1994 Sep;49(3):247-51.

PMID: 7845274

Cameron Highlands has one of the highest suicide rates in the world, especially among Indians. Forty Indian families (19 suicides; 21 controls) were studied to compare family characteristics such as income, overcrowding, birth order of index cases of suicide, family history of suicidal behaviour or mental illness, marital disharmony, presence of alcohol abuse, availability of, and knowledge about, weedicides/insecticides, talk/threat of suicide among family members and experience of significant losses in the past year. Controls were matched for age, sex and educational level with the index cases of suicide. A significant difference was only found for one of the above factors, namely increased experience of significant losses in the past year in the family of index cases of suicide. More than 75% in both groups had alcohol related problems. About equal proportions in each group had a family history of suicidal behaviour and mental illness. There was more marital disharmony in families of suicides but this failed to reach significance. These results and methodological limitations of this study are discussed.

Fulltext Psychiatric morbidity in an urban general practice

Maniam T

Med J Malaysia, 1994 Sep;49(3):242-6.

PMID: 7845273

Two hundred and six patients attending an urban general practice were surveyed using a self-rating questionnaire, the 30-item version of the General Health Questionnaire. At a cut-off score of 6/7, 34.5% of the respondents were found to be high-scorers which gives a corrected estimate of psychiatric morbidity of 29.9% in this clinic. Among those who presented with general complaints, such as aches and pains for which no organic cause was found, a significant proportion (70%) were high-scorers. There were no significant differences in the sex and age distribution of the high-scorers. However the mean score of Malays was significantly higher than that of Chinese.

Fulltext Drinking habits of Malaysians in general practice

Maniam T

Med J Malaysia, 1994 Dec;49(4):369-74.

PMID: 7674973

Five hundred and sixty-two consecutive attenders at an urban general practice were studied using the Consumption Index which has been successfully used in a general hospital sample. Seventy per cent of Chinese, 11% of Malays and 42% of Indians have used or are currently using alcohol-a vast majority of them were social drinkers. Among those who ever drank, 6% of Chinese and 22% of Malays drank more than 14 units per week. The hypotheses that more Indians used alcohol and used it more heavily were not supported in this urban sample. Possible explanations for these findings and the limitations of this study are discussed.

Fulltext Psychiatric aspects of the acquired immunodeficiency syndrome. A case report

Maniam T, Abu Bakar AK

Med J Malaysia, 1988 Jun;43(2):166-9.

PMID: 3237133

Fulltext The prescription of psychotropic medication in general practice--a descriptive study

Maniam T, Ting GS

Med J Malaysia, 1990 Sep;45(3):225-30.

PMID: 2152083

The prescriptions of all patients who attended an urban general practice from September 1987 to December 1987 were studied. Of the 111 patients (60 females and 51 males) who received a psychotropic prescription the commonest presenting complaint was insomnia (56 patients or 50.5%). This was followed by tension, headache and unexplained aches and pains (19 patients or 17.1%), and anxiety (nine patients or 8.1%). Consistent with these presentations a vast majority (92.8%) received a benzodiazepine. The commonest drugs prescribed were Lorazepam and Bromazepam whereas the longer acting benzodiazepines were rarely used. Polypharmacy was rare.

Fulltext Paranoid psychosis in myxoedema: a case report

Samuel W, Maniam T

Med J Malaysia, 1984 Jun;39(2):156-8.

PMID: 6513856

A case of paranoid psychosis in myxoedema is described. Though depression is commonly encountered in myxoedema, the disorder can also manifest itself with schizophrenic features; this can lead to problems in diagnosis and management.

Fulltext Exorcism and psychiatric illness. Two case reports

Maniam T

Med J Malaysia, 1987 Dec;42(4):317-9.

PMID: 3454406

Traditional methods of treatment are extremely popular with Malaysians especially for psychiatric illnesses. Those who seek such treatment come from all cultures, social classes and different educational levels in this country. In one hospital as much as 49% of psychiatric patients had been to traditional healers . Some receive simultaneously traditional and modern modes of treatment. While many reports have been written on traditional healers such as the bomoh and spirit mediums, relatively less is written about Christian healers who practise exorcism. This paper describes two patients who had received psychiatric diagnoses of major illnesses, and who subsequently underwent Christian exorcism. The process of exorcism and the short-term and long-term outcome are reported.

Fulltext Suicide and parasuicide in a hill resort in Malaysia

Maniam T

Br J Psychiatry, 1988 Aug;153:222-5.

PMID: 3255436 DOI: 10.1192/bjp.153.2.222

Ninety-five cases of suicide and 134 cases of parasuicide that occurred between October 1973 and September 1984 in the hill resort district of Cameron Highlands in Malaysia were analysed. Eighty-one per cent of suicides and 78% of parasuicides were of Indians, although they only form 25% of the population. The average annual suicide rate for Indians (over 10 years of age) was 157 per 100,000. About 94% of suicides and 66% of parasuicides were by ingesting agricultural poisons. The age- and sex-specific suicide rates for women were highest in the 20-24-year-old age group. Some possible reasons for high suicide rates among Indians are discussed.

General health mediates the relationship between loneliness, life satisfaction and depression. A study with Malaysian medical students

Swami V, Chamorro-Premuzic T, Sinniah D, Maniam T, Kannan K, Stanistreet D, et al.

Soc Psychiatry Psychiatr Epidemiol, 2007 Feb;42(2):161-6.

PMID: 17180631

OBJECTIVE: To examine the associations between life satisfaction, loneliness, general health and depression among 172 medical students in Malaysia.

METHOD: Participants completed a questionnaire battery, which included the 12-item General Health Questionnaire, Beck's Depression Inventory, the Revised UCLA Loneliness Scale and the Satisfaction With Life Scale.

RESULTS: Life satisfaction was negatively and significantly correlated with suicidal attitudes, loneliness and depression; and positively with health, which was negatively and significantly correlated with depression and loneliness. Self-concept was negatively correlated with loneliness and depression, depression was positively and significantly correlated with loneliness. Mediational analyses showed that the effects of loneliness and life dissatisfaction on depression were fully mediated by health.

CONCLUSION: Even though less satisfied, and particularly lonelier, individuals are more likely to report higher levels of depression, this is only the case because both higher loneliness and life dissatisfaction are associated with poorer health. These results are discussed in terms of their implications for the diagnosis and treatment of mental health disorders in developing nations.

Fulltext A profile of cancer patient outcomes from a tertiary care teaching hospital in Malaysia

Suthahar A, Gurpreet K, Ambigga D, Maniam T, Dhachayani S, Fuad I, et al.

Singapore Med J, 2009 Jul;50(7):720-3.

PMID: 19644630

The aim of this paper was to determine the sociodemographic and cancer characteristics of patients with cancer at a tertiary care centre.

Are predictors of future suicide attempts and the transition from suicidal ideation to suicide attempts shared or distinct: a 12-month prospective study among patients with depressive disorders

Chan LF, Shamsul AS, Maniam T

Psychiatry Res, 2014 Dec 30;220(3):867-73.

PMID: 25240940 DOI: 10.1016/j.psychres.2014.08.055

Our study aimed to examine the interplay between clinical and social predictors of future suicide attempt and the transition from suicidal ideation to suicide attempt in depressive disorders. Sixty-six Malaysian inpatients with a depressive disorder were assessed at index admission and within 1 year for suicide attempt, suicidal ideation, depression severity, life event changes, treatment history and relevant clinical and socio-demographic factors. One-fifth of suicidal ideators transitioned to a future suicide attempt. All future attempters (12/66) had prior ideation and 83% of attempters had a prior attempt. The highest risk for transitioning from ideation to attempt was 5 months post-discharge. Single predictor models showed that previous psychiatric hospitalization and ideation severity were shared predictors of future attempt and ideation to attempt transition. Substance use disorders (especially alcohol) predicted future attempt and approached significance for the transition process. Low socio-economic status predicted the transition process while major personal injury/illness predicted future suicide attempt. Past suicide attempt, subjective depression severity and medication compliance predicted only future suicide attempt. The absence of prior suicide attempt did not eliminate the risk of future attempt. Given the limited sample, future larger studies on mechanisms underlying the interactions of such predictors are needed.

Positive effects of Individual Cognitive Behavior Therapy for patients with unipolar mood disorders with suicidal ideation in Malaysia: A randomised controlled trial

Sinniah A, Oei TPS, Maniam T, Subramaniam P

Psychiatry Res, 2017 08;254:179-189.

PMID: 28463716 DOI: 10.1016/j.psychres.2017.04.026

The aim of this study was to investigate the effectiveness of Individual Cognitive Behavior Therapy (ICBT) in treating patients with mood disorders with suicidal ideation. A total of 69 patients (48 females, 21 males) with the diagnoses above were randomly allocated to either the group of Treatment As Usual (TAU)+ICBT (n=33) or the TAU group (n=36). All participants completed the Beck Depression Inventory (BDI), Beck Scale for Suicide Ideation (BSS), Positive and Negative Suicide Ideation Inventory (PANSI), Beck Hopelessness Scale (BHS), and Depression Anxiety Stress Scale-21 (DASS-21). These questionnaires were administered at pre-treatment, midway through treatment (week 4), post-treatment (week 8), and at follow-ups after three months (week 20) and six months (week 32). Factorial ANOVA results showed that the TAU+ICBT patients improved significantly and at faster rate as compared to the TAU group, which showed improvement only from pre to mid treatment on DASS-D and BHS-T measures. The effect size (Cohen's d), for the TAU+ICBT group showed large effect (1.47) for depressive symptoms and suicidal ideation (1.00). These findings suggest that ICBT used in addition to the TAU, was effective in enhancing treatment outcome of patients with unipolar mood disorders as well as, reducing risk for suicide behavior.

Suicide prevention program for at-risk groups: pointers from an epidemiological study

Maniam T, Chinna K, Lim CH, Kadir AB, Nurashikin I, Salina AA, et al.

Prev Med, 2013;57 Suppl:S45-6.

PMID: 23454536 DOI: 10.1016/j.ypmed.2013.02.022

The aim of this paper is to identify at-risk groups for a focused suicide prevention program for Malaysia.

Fulltext Psychiatric Morbidity, Personality Profile and Saliva Cortisol Levels in Overweight and Obese Patients Referred to Dietician Clinics in UKMMC

Loo, T.H., Maniam, T., Ainsah, O.

Malaysian Journal of Psychiatry, 2011;20(1):1-12.

MyJurnal

Objective: To assess psychiatric morbidity, personality profiles and saliva cortisol levels in overweight and obese individuals at dietician clinic. Method: This cross-sectional study is based on individuals who attended dietician clinic between June to November 2008. They had completed questionnaires that included General Health Questionnaire 30-items, assessment for psychiatric illness using Structured Clinical Interview for DSM-IV and personality profiles using Personality Assessment Schedule. Saliva and body mass index were taken. Results: Of the 102 patients, 16 (15.7%) were diagnosed to have psychiatric illness. There were no differences between obese and overweight patients in terms of personality traits and psychological problem. Presence of psychiatric illness was associated with higher mean body mass index. Saliva cortisol levels were not elevated in patients who had psychiatric illness. Conclusions: Psychiatric illnesses are common in individuals who seek weight treatment. Careful psychological evaluation is important at (or before) commencement of a diet program.

Fulltext Psychiatric Education: Thinking Skills for Trainee Psychiatrists

Maniam, T.

Malaysian Journal of Psychiatry, 2010;19(2):1-5.

MyJurnal

The discipline of psychiatry requires the use of thinking skills to perform a number of tasks. The assessment of a patient’s history, his mental state especially the evaluation of thought disorders, the formulation of a diagnosis and differential diagnosis, the formulation of a management plan for what are often complex human problems and the wise application of therapeutic techniques, all require complex thinking skills. The process of communication with patients and their relatives is often fraught with pitfalls that requires a thoughtful approach that makes use of consciously shared information as well as non-verbal information. Evaluating scientific papers is another area that requires critical thinking. At times the lack of critical thinking is painfully apparent. It appears that schools, and sadly universities too, are merely training people and not educating them. Occasionally, of course, one is pleasantly surprised to come across a student with a very sharp and critical mind.

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