ABSTRACTS FOR INTERNATIONAL HEALTH AND MEDICAL SCIENCES CONFERENCE 2019
IHMSC 2019. Accelerating Innovations in Translational and Precision Medicine. Held at Taylor’s University Lakeside Campus, Subang Jaya, Selangor, Malaysia, 8-9th March, 2019
Introduction: Depression is becoming increasingly prevalent as a mental health disorder worldwide. The prevalence of clinical depression is between about five and fifteen percent globally. Clinical depression has also increased in prevalence among the ageing. Some of the etiological factors associated with depression in the ageing include grief and loss, and role transitions. Interpersonal Psychotherapy (IPT), an evidenced based psychotherapy for clinical depression, has been proven to be effective for depression in the ageing. IPT addresses four main problem areas, namely - interpersonal disputes, grief and loss, role transitions and interpersonal sensitivity. The adaptation of IPT for the ageing is IPT for late-life depression or IPT – LLM which was utilized to treat the patient discussed in this case study. Methods: The patient was treated with 12 sessions of psychotherapy which is often the minimum number of sessions required in the treatment of depression with IPT. The initial sessions included the development of an Interpersonal Formulation and Interpersonal Inventory. Her problem areas were grief as her husband had passed away recently, and role transitions. The problem areas were addressed during the 8 middle IPT sessions. The final two sessions were utilized to conclude IPT treatment. Results: The patient was assessed to have a PHQ – 9 (Patient Health Questionnaire--9) score of 17 before treatment with IPT, indicating moderate depression. Her PHQ – 9 score after 12 sessions of IPT was 4 indicating minimal depression. Conclusion: This case study highlights that some of the factors that contribute to depression in the ageing are grief and role transitions, and that IPT is efficacious in the treatment of depression in the ageing.
The management of depression in the primary care setting should ideally take a biological, psychological, and sociological approach. Antidepressants are the most commonly used biological agents in the treatment of depression. Psychological therapies and psychosocial interventions improve the outcome of treatment when combined with pharmacotherapy. Clinical depression is treatable and thus efforts should be made to alleviate the suffering of patients with depression.
One of the commonest psychological problems that a clinician would encounter in primary care is depression. The prevalence of depression is high in women, the elderly and those with underlying physical problems or during the postpartum period. The spectrum of clinical presentations is wide and somatic complaints are more common in primary care clinics. Depression may present as a primary disorder and co-morbidity with other psychological problems or physical illnesses is high. A good clinical interview is an important form of assessment and a quick screening of depression can be done with the administration of proper rating scales, such as the Patient Health Questionnaire, Hamilton Depression Rating Scale or Geriatric Depression Scale. Repeated use of the same scale in a patient would help the clinician to monitor the progress objectively.
Interpersonal Psychotherapy (IPT) has been utilized with great efficacy and effectiveness across many cultural settings. The attachment theory upon which IPT rests provides a strong foundation for IPT cross-culturally: regardless of their geographic location, people are people and their relationships are important. Though the structure of families and individual social roles varies greatly across cultures, people relate to one another. They become distressed when they have problems with interpersonal conflict, change, and loss of relationships. In this article, we review the basics of IPT and then describe the ways in which cultural adaptations can be made for people in Asia. Both are large tasks-to summarize IPT concisely while providing sufficient information is difficult; describing cultural adaptions for people in geographical areas from Russia to China to India to Southeast and Central Asia and all of the ethnic and language groups that area includes is nigh well impossible within a review article. Thus we have restricted our cultural overview to areas in which we have experience clinically and in which we have been active with IPT training, supervision, and implementation. All of the work we describe, however, elaborate on the principles of cultural adaptations which can be used to implement IPT in other local contexts.
Interpersonal psychotherapy (IPT) is a highly regarded evidence-based psychotherapy that aims to alleviate the suffering of clients and improve their interpersonal functioning. Research has demonstrated the effectiveness of IPT in depressive, bipolar and eating disorders. IPT also focuses on grief and loss as a problem area to help clients address and process their grief symptoms, leading them to reach a phase of finding meaning. However, traumatic grief which is characterized by someone who has both symptoms of trauma and grief can further complicate treatment. As for Posttraumatic Stress Disorder (PTSD), IPT can be a choice of treatment by addressing perceived isolation and emotional dysregulation through mobilizing adequate social support. This case study highlights the efficacy of IPT in treating complicated grief with traumatic experiences caused by the loss of a loved one during the COVID-19 pandemic, without undergoing exposure-based therapy. The treatment course consisted of 12 sessions scheduled twice weekly, and the client received antidepressant medication augmented with antipsychotic medication. After undergoing IPT, the client experienced an improvement in symptoms, gradual recovery of functional disability, and more meaningful interpersonal relationships. The case study presented provides evidence to suggest that IPT is a promising treatment approach for individuals struggling with trauma related to grief.
BACKGROUND: Tobacco smoking issues in developing countries are usually taught non-systematically as and when the topic arose. The World Health Organisation and Global Health Professional Student Survey (GHPSS) have suggested introducing a separate integrated tobacco module into medical school curricula. Our aim was to assess medical students' tobacco smoking habits, their practices towards patients' smoking habits and attitude towards teaching about smoking in medical schools.
METHODS: A cross-sectional questionnaire survey was carried out among final year undergraduate medical students in Malaysia, India, Nepal, Pakistan, and Bangladesh. An anonymous, self-administered questionnaire included items on demographic information, students' current practices about patients' tobacco smoking habits, their perception towards tobacco education in medical schools on a five point Likert scale. Questions about tobacco smoking habits were adapted from GHPSS questionnaire. An 'ever smoker' was defined as one who had smoked during lifetime, even if had tried a few puffs once or twice. 'Current smoker' was defined as those who had smoked tobacco product on one or more days in the preceding month of the survey. Descriptive statistics were calculated.
RESULTS: Overall response rate was 81.6% (922/1130). Median age was 22 years while 50.7% were males and 48.2% were females. The overall prevalence of 'ever smokers' and 'current smokers' was 31.7% and 13.1% respectively. A majority (> 80%) of students asked the patients about their smoking habits during clinical postings/clerkships. Only a third of them did counselling, and assessed the patients' willingness to quit. Majority of the students agreed about doctors' role in tobacco control as being role models, competence in smoking cessation methods, counseling, and the need for training about tobacco cessation in medical schools. About 50% agreed that current curriculum teaches about tobacco smoking but not systematically and should be included as a separate module. Majority of the students indicated that topics about health effects, nicotine addiction and its treatment, counselling, prevention of relapse were important or very important in training about tobacco smoking.
CONCLUSION: Medical educators should consider revising medical curricula to improve training about tobacco smoking cessation in medical schools. Our results should be supported by surveys from other medical schools in developing countries of Asia.