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: The study aims to determine pattern of verbal memory and learning impairment and its associated factors among patients with bipolar I disorder in a psychiatric clinic of a university hospital. Methods: A case control study comparing verbal memory test
performance in 40 patients with bipolar I disorder to that of 40 healthy normal subjects using Rey Auditory Verbal Learning Test (RAVLT). The association between demographic, clinical
characteristics and poor verbal memory performance were examined. Results: Up to 92% of patients with bipolar I disorder have impaired short term working memory in this hospital-based study. They also recalled fewer words in all the RAVLT trials and had difficulties
learning the word list in comparison to that of normal healthy individuals. Verbal memory and learning impairment are observed in bipolar illness in the absence of active mood symptoms while duration and severity of illness are not found to have any effect on verbal memory and learning. Conclusion: There is consistent verbal memory and learning problems in individuals with bipolar I disorder and their presence in the absence of mania, depression and mixed symptoms during the course of the illness suggests a trait related deficit.
Study site: Psychiatric Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
The objective of this study is to determine the prevalence and factors associated with psychosis in Parkinson’s disease (PD) patients.
Method: This is a cross-sectional study of 108 PD patients from neurological clinic UKM Medical Centre and Kuala Lumpur Hospital. The patients were recruited from August to December 2004. Psychosis was determined using SCID, the severity of psychosis was rated using BPRS. The cognitive functions were evaluated with MMSE and the severity of depression was assessed with HAM-D.
Results: The result shows that the prevalence of psychosis in Parkinson's disease patients in this sample was 13%. The psychosis was found to be significantly associated with advancing age, duration of illness, severity of depression and cognitive impairment. Multivariate analysis demonstrates that severity of depression (OR = 1.08, 95% C.I. = 1.01 - 1.16) and advancing age (OR = 4.72, 95% C.I. = 1.37 - 16.29) increased risk of psychosis in PD patients.
Conclusion: We found that advancing age and severity of depression increase risk to develop psychosis in patients with PD.
Study site: neurological clinic UKM Medical Centre and Kuala Lumpur Hospita
This case report highlights Koro-like symptoms with erectile dysfunction.
Methods: We report a case of a Rohingya refugee who presented with Koro-like symptoms associated with erectile dysfunction and severe religious guilt.
Results: Sexual dysfunction, i.e. erectile dysfunction may be a predisposing factor for a Koro incidence. Religious issues complicated by superstitious beliefs pose a treatment challenge.
Conclusion: Treating patient with sexual dysfunction should involve exploring and addressing patient's conflicts to avoid worsening of symptoms. As this case illustrates, severe anxiety can present with Koro-like symptoms.
Objective: To determine the construct validity and the internal consistency of the Medical Student Stressor Questionnaire (MSSQ) among medical students hence in the future it could be used as a valid and reliable instrument to identify stressors among medical students. Methods: The blueprint for the development of MSSQ was developed after a review of literature on the subject and a discussion with experts in the field. It comprised of 40 items
with six hypothetical groups. The face validity of the questionnaire was established through discussion with 141 final year medical students whereas content validity was established through discussion with experts from field of Medical Education and Psychiatry. It was administered to a total of 761 medical students. Data was analysed using Statistical Package Social Sciences (SPSS) version 12. Factor analysis was applied to test construct validity of the MSSQ. Reliability analysis (Cronbach’s alpha and item total correlation) was applied to test internal consistency of the MSSQ. Results: The total Cronbach’s alpha value of the MSSQ was 0.95. All the preliminary 40 items were included in the MSSQ as the items had item total correlation value of more than 0.3. The items were loaded nicely into the six pre-determined hypothetical groups as their factor loading values were more than 0.3.
Conclusion: This study showed that MSSQ had good psychometric value. It is a valid and reliable instrument in identifying stressors among medical students.
Objective: Medical training has always been regarded as a highly stressful environment to students. This article described a preliminary data on impact of a stress-management programme on medical students’ stress level. Methods: This is a quasi-experimental before after comparison study design. The programme was run over half-day and convenient sampling method was applied. Sample size as calculated for this preliminary study was 38. The 12 items General Health Questionnaire (GHQ-12) was administered prior to the
programme and four months later. Data was analysed using SPSS version 12. Results: 34 participants were involved in this study. This study found that there was a significant difference in participants’ GHQ-12 scores before and after the programme (p
Objective: To determine the sensitivity, specificity and internal consistency of the Malay version GHQ-12 among medical student population. This study determined the appropriate GHQ-12 score to detect distressed medical students. Methods: The Malay version of GHQ-12 was derived based on two sources which were the original version GHQ-12 and the validated Malay version 30-items GHQ. The GHQ-12 and the Malay version Beck Depression Inventory-II (BDI-II) were administered to a total of 141 medical students. Distress diagnoses were made based on the Malay version BDI-II. ROC curve analysis was applied to determine the sensitivity and specificity of the GHQ-12 by testing against the BDI-II. Reliability analysis (Cronbach’s alpha and item total correlation) was applied to test internal consistency of the
GHQ-12. The analysis was done using SPSS version 12.Results: The GHQ-12 sensitivity and specificity at cut-off point of 3/4 was 81.3% and 75.3% respectively with positive predictive value (PPV) of 62.9% as well as area under ROC curve more than 0.7. The Cronbach’s alpha value of the GHQ-12 was 0.85.Conclusion: This study showed the Malay version GHQ-12 is a valid and reliable screening tool in detecting distressed medical students. The
GHQ-12 score equal to or more than 4 was considered as significant distress.
Objective: Postgraduate medical training has always been regarded as a highly stressful environment to students. This article described an initial finding on prevalence and sources of stress among postgraduate students. Method: This is a cross-sectional study conducted on postgraduate students in the School of Medical Sciences, Universiti Sains Malaysia. Sample size as calculated for this preliminary study was 38 and convenient sampling method was applied. The 12 items General Health Questionnaire (GHQ-12) and Postgraduate Stressors Questionnaire (PSQ) were administered during a workshop involving postgraduate students. Data was analysed using SPSS version 12. Results: Thirty three participants participated in this study. This study found that the prevalence of distressed postgraduate students was 36.4%. The top ten stressors were tests and examinations, large amount of content to be learnt, time pressure to meet deadlines, doing work beyond
ability, work overload, unfair assessment by superior, fears of making mistakes that can lead to serious consequences, doing work that mentally straining, work demands affect my personal and home life, and lack of time to review what have been learnt. Conclusion: This study found that there was a high prevalence of distressed postgraduate students. It also found that the major stressors were related to academic and performance pressure.
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.
Objectives: This paper aims to report on a case in which re-challenging with clozapine in combination with lithium in a patient who developed neutropenia was carried out. Methods: The patient was treated with clozapine for treatment- resistant schizophrenia. After five weeks he showed much improvement but developed neutropenia. Withdrawal of clozapine brought on a relapse of psychotic symptoms. Subsequently, clozapine was reintroduced along with Lithium. The neutrophil count was monitored closely. Results: The neutrophil and white blood cell count were noted to return to normal upon re-challenging, and the patient’s clinical condition also improved. Conclusion: Simultaneous administration of lithium and clozapine to patients experiencing neutropenia on clozapine is a possible strategy. However, very close monitoring of the white count is needed. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 90-92.
The incidence of benzodiazepine paradoxical reaction is uncommon. It may be implicated with crime as will be described in this case report. Method: We report a 37 year-old schizophrenia patient who was detained by the authority under Section 392/397 of Penal Code assaulting a lady using sharp weapon. He had history of illicit substance abuse and benzodiazepine dependence with significant history of aggression associated with benzodiazepine. Just prior to the incident, he took a significant amount of various types of benzodiazepine and suffered from amnesia of that event. During the time of the offense, he was in remission as far as schizophrenia is concerned. Result: He was under the forensic psychiatric care and observation at Hospital Bahagia Ulu Kinta (HBUK). He developed withdrawal symptoms of benzodiazepine in the ward. Conclusion: He was found by the expert team to be under the influence of benzodiazepine during the offence. The role of benzodiazepine and relevant factors leading to aggression will be discussed in this manuscript.
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.
Food is closely related with emotion. It often provides comfort and satisfaction. Some individuals choose to turn to food to curb their negative emotion, resulting in disturbances in
eating patterns, such as overeating which lead to obesity and severely controlling food intake, which culminate in eating disorders like anorexia nervosa, bulimia nervosa and binge eating. These disorders are not related to the eating problems per se but often due to underlying or complicated by psychological factors, namely depression, anxiety, impulse control problems and personality. The roles of psychological factors in eating disorders and obesity should therefore not be downplayed. These disorders should be managed comprehensively involving multiple approaches, including not only biological but also psychological interventions provided by a professional team comprising endocrinologists, psychiatrists, dietitians, exercise physicians and surgeons.
Objective: The objective of the present study was to determine the prevalence and factors contributing to psychological morbidity among doctors in Sana’a city, Yemen. Methods: A cross sectional study was conducted among 442 Yemeni doctors. The (GHQ12) was used as a measure of psychological morbidity. Sources of job stress were determined using a 37-item scale questionnaire. Results: The prevalence of psychological morbidity was 68.1 %. Gender, age range of 30 – 39 years old, chewing Khat, type of residence and income were significantly associated with psychological morbidity (p
Objective: This study was aimed to explore the perceptions and opinions of happiness among university students. Methods: This qualitative study was conducted in January for the academic year 2010 among 33 Medical Science Students from Management and Science University (MSU), Shah Alam, Malaysia. The facilitator wrote down the conversation during the discussion. The data obtained was classified into various categories. Due to the small sample size, the data was analyzed manually. Results: All participants mentioned that the main source of happiness is money. Good relationship with friends and family is the second source of happiness among university students. Some of the students mentioned that the stability of life and good health are causes of happiness. Few participants mentioned that success in life is one of the causes of the happiness.
Objective: This study explored the stress and coping strategies among retired people in Malaysia. Methods: In-depth interviews were conducted with 36 elderly Malaysian subjects. This protocol was approved by the Ethics Committee of the Management and Science University. The data obtained were sorted into various categories. Results: A total number of 36 retired elderly people participated in this study. The majority of them were in the age group of 55-59 years old, females, Malay and married. The majority defined stress as pressure or tension. Financial difficulties, family and work problems were the main causes of stress in the majority. Also, the majority of respondents mentioned that they coped with stress by sharing problems with others, by resting and relaxing, and/or by doing housework during their free time. A few of them coped with stress by hanging out with friends, going shopping,
doing photography, travelling, going fishing, and doing sports. Conclusion: Financial difficulties, family and work problems were the main causes of stress among elderly people. They coped with stress by sharing problems with others, resting and relaxing, and/or doing housework during their free time.
Objective: To determine the knowledge, attitude and practice (KAP) of sleep among medical students of IIUM towards and to determine the impact of socio-demographic data on the knowledge, attitude and practice. Methods: A cross-sectional study was carried out among 106 students from first, second and third year medical students of IIUM. Verbal consent was taken from the students who were willing to take part in this study. Student knowledge about sleep was studied using a questionnaire. Results: A total of 106 medical
students completed the survey, there were 54 female and 52 male. The mean age of the students was 20 ± 0.56 and ranged from 18 to 22 years. In terms of their sleep knowledge, the mean ± SD knowledge, attitude and practice scores were 81.8 ± 16.8, 65.9 ±15.3 and 176 ± 26.3 respectively. In univariate analysis, there was a significant difference between parents’ marital status regarding knowledge of the students (p = 0.03). There was a significant difference between gender regarding attitude of the students (p=0.05). In
multivariate analysis, gender and smoking status were significantly affected the overall KAP. Conclusion: This study showed that sleep medicine knowledge was generally low among medical students. Therefore, educational strategies to improve knowledge regarding sleep-related problems and the development of proper sleep practices among medical students are needed.
Objective: This paper aimed to determine the prevalence of sleeping pills use among university students and its associated factors in Malaysia. Methods: This cross-sectional study was conducted in January 2010 among 200 Malaysia. The survey was conducted by distributing self-administered questionnaires. The questionnaire was developed based on the literature review. The students were chosen randomly using convenience sampling.
Results: A total of 200 university students participated in this study. The prevalence of using sleeping pills among university students is 7.5%. The majority of the participants were Malay 146 (73.0%), from urban area 169 (84.5%), from medical and health sciences background 101 (50.5%). This study showed that there is a significant relationship between using sleeping pills and depression (p= 0.03). There is also a significant relationship between
using sleeping pills and inducing sleep by reading (p=0.04). Conclusion: The prevalence of sleeping pills usage among university students is relatively high. This study showed that there is a significant relationship between using sleeping pills and depression.
Objective: The objective of this study was to determine the prevalence of the most common phobias and associated factors among university students. Methods: This cross-sectional study was carried out at Management and Science University (MSU). Random sampling was performed throughout all faculties. The questionnaires were distributed randomly at classes, library and university cafe within MSU. Diagnosis of anxiety disorders were established according to DSM-IV criteria. These criteria are included in Liebowitz Social Anxiety Scale (LSAS). The questionnaire consists of two sections. The first section consists of socio-demographic characteristics such as (age, sex, race, type of faculty and income); the second section is LSAS standard questionnaire. Multiple linear regression using backward analysis was performed to obtain the associated factors. Results: A total number of four hundred sixty eight (468) students participated in this study. The majority of them were older than 20
years old, female, Malay and from non-medical and heath faculties (59.6%, 69.6%, 77.8%, 68.8%; respectively). Regarding history of abuse during childhood, the majority of the university students reported that there was no sexual, physical and emotional abuse during childhood (98.5%, 97.4%, 82.1%; respectively). The majority of the students (53.85%) reported that they have phobia. The highest type of phobia reported among university students was phobia from snake (11.5%), followed by speaking in front of crowd (9.2%) and the lowest were phobia of speed, dolls phobia, ropes phobia. Types of faculty, smoking status and history of physical abuse during childhood were the factors that significantly influence the social anxiety among university students in univariate and multivariate analysis. Conclusion: The prevalence of phobic symptoms among university students was
high types of faculty; smoking status and history of physical abuse during childhood significantly influenced social anxiety among university students. Education and counseling university students is necessary to educate the students who suffer from phobia to cope with different situations during study period.
Objective: This case report highlights the abuse and dependence potential of Zolpidem and the risk of life-threatening withdrawal symptoms upon abrupt discontinuation. Method: We report a case of Zolpidem dependence which presented with withdrawal symptoms upon abrupt discontinuation. Results: A 32 year old male, who had abused non-benzodiazepine Zolpidem for 6 years presented to the accident and emergency unit with generalized seizures upon stopping Zolpidem ‘cold turkey’. He required admission to the neurology high dependency unit for stabilization of the seizures and was later managed by the addiction team where a tapering dose of benzodiazepine was prescribed. Conclusion: This case demonstrates that non-benzodiazepine agents can cause tolerance and dependence, and thus produce withdrawal symptoms upon discontinuation.