Objective: Medical housemanship training has always been regarded as a highly stressful environment to doctors. This article described findings on stress, stressors and coping strategies among house officers in a Malaysian hospital. Methods: A cross-sectional study was conducted on house officers in a Malaysian hospital. The 12 items General Health Questionnaire (GHQ-12), General Stressors Questionnaire (GSQ) and Brief COPE inventory were administered to measure perceived stress, sources of stress and coping strategies among house officers respectively. Data was analysed using SPSS version 12. Results: Forty two house officers participated in this study. This study found that approximately 31% of the house officers were in distress. The top five stressors were fears of making mistakes that can lead to serious consequences, work overload, working with uncooperative colleagues, doing
work that mentally straining and feeling of being underpaid. The most frequent coping strategies used by house officers were religion, acceptance and self-distraction. Conclusion: This study found that there was a high percentage of distressed house officers. It also found that major stressors were related to performance pressure. The main coping strategy used by house officer was emotion-focused coping.
This study aims to assess the factor structure and reliability of the General Health Questionnaire (GHQ-12). Additionally, the study also attempts to evaluate the psychological well-being among university students using the GHQ-12 scale and thereby determine a relationship between select demographic variables and well-being. Methods: An exploratory cross-sectional survey was conducted among undergraduate students of a public university in Sarawak, Malaysia. A self administered questionnaire consisting of the demographic aspects and the GHQ 12 scale were utilized to assess the well-being of students, who were selected by convenience sampling technique. Results: Factorability of the GHQ-12 was examined and a three-factor model explaining 55% total variance was found to be the best fit. Internal consistency of the scale was 0.78, which is within the acceptable range. The results also suggest that considerable proportion (57%) of students had psychological distress. Participants who were susceptible to psychological distress in the present study were identified as students from low income families, with poor social support, in a relationship with partner as well as the student with Hindu’s religion and male students. By multiple regression analysis, variables that significantly predicted psychological distress were gender; income; area of residence; relationship with parents; negative life events; smoking; drinking and event with the overall model fit were 34%. Conclusion: Based on these findings, it may be foreseen that if prompt intervention is not provided to students in distress, they may be susceptible to depression, anxiety and stress. The findings have implications for teachers and counsellors, who are in a position to influence a wide range of students and provide support to improve the psychological well-being of students.
Objectives: This paper aims to discuss the issue related to the application of temporary insanity plea through a case report of a man who was earlier certified as mentally sound following a murder and suicide attempt. Methods: We report a man who committed murder and attempted suicide 7 years ago, had a psychiatric certification of not having mental illness and recently requested for a second psychiatric assessment. The factors taken into consideration in arriving at the final diagnosis are discussed. Results:The man was found to have brief psychotic disorder precipitated by psychological blow and sleep deprivation with underlying undiagnosed borderline mental retardation.Conclusion: In assessing patient with
temporary insanity plea, various areas in the history need to be explored deeply with thorough investigations to be done in order to arrive at a fair conclusion for the patient’s and victim’s sake.
This case report highlights the success of community services and supported employment program that may be of help to a woman with chronic inhalant use to achieve a complete abstinence. Methods: We report the case of a 45 year old lady who chronically abused glue, presented after 10 years with substance induced psychosis and comorbid mood disorder. Results: Abstinent from inhalant dependence was achieved after series of home treatment services and supported employment program. Conclusion: Provision of acute community service and incorporating this patient in supported employment program contribute to her successful journey in achieving abstinence from inhalant dependence.
Objective: Family Environment Scale (FES) is one of the most widely used instruments to measure many family aspects. Cross cultural adaptation of the original FES is essential prior to local utilization as different cultures percept their family environments differently. We attempted to translate the FES into the Bahasa Malaysia language for adolescents, evaluate its reliability using internal consistency and compare its results with the original
study. Methods: This is a cross-sectional study, involving adolescents aged 12-17 from four secondary schools. The adolescents were selected using quota sampling for different age, ethnic and academic performance. The study was divided into four phases, namely: i) translation of FES, ii) pilot test iii) internal consistency reliability test and iv) comparison of the study results with the original FES. Results: A total of 295 adolescents participated in this study. All of the reliability measurements generated (ranged between Cronbach’s alpha 0.10 - 0.70) were lower than those originally reported for this instrument (ranged between Cronbach’s alpha 0.61 -0.78). Five subscales in the Bahasa Malaysia version were found to be less than Cronbach’s alpha 0.5, which were below the acceptable level for practical or research use. There was considerable variation observed between the sample population of this study and that of the original study, which could be due to the social cultural differences. Conclusion: The Bahasa Malaysia version of FES requires further culturally
appropriate revision. A new measuring scale could also be devised to provide an accurate evaluation of the family environment as perceived by Malaysian adolescents, which has acceptable levels of reliability and validity.
Objectives: The aim of this study is to validate the Malay version of the Aggression Questionnaire (AQ) for the purpose of the future study related to aggression. Furthermore, the study seeks to identify types of aggression hold by the female inmates.
Methods: A cross-sectional study was designed involving 90 Malaysian female prisoners. The analyses include descriptive analysis, confirmatory factor analysis, and reliability testing. After one-week interval, a test-retest was conducted.
Results: The preliminary analysis confirmed that factor analysis was appropriate for the Malay-translated version of the AQ. The four factors structure was assessed but the factor loadings are remarkable different from the original versions. The total Cronbach's alpha coefficients is very high (α= 0.91). The Pearson's correlation however is low (r = 0.48) but acceptable for the instrument. Reliability of the subscales and the factors were also found satisfactory. Consequently, anger and hostility were identified as the most common types of aggression among the participants, followed by verbal aggression. In contrast, physical aggression was the least scored type of aggression.
Conclusion: The Malay-translated version of the AQ was found to be valid and reliable to be used in future studies.
Objective: This study aims to establish the validity and reliability of the Malay- translated version of the CES-D. Methods: This study employed a cross-sectional study design. The participants were female inmates (n=90) from local prisons which were selected based on purposive-selective sampling. The analyses include face validation, factor analysis, and reliability testing. A test-retest was conducted within a one-week interval. Results: The mean score for depression among the participants is 18.97 (SD=6.51). Further descriptive analysis showed that 58.9% of them scored above the mean score, which is considered high. Preliminary construct validation analysis confirmed that factor analysis was appropriate for the Malay-translated version of the CES-D. Furthermore, the factor analysis showed similar factor loadings to the original English version. The total internal consistency of the translated version, which was measured by Cronbach’s alpha coefficient, was equal to 0.75. The test-retest reliability of the total score, measured by Pearson’s correlation was equal to 0.69. Conclusions: Face validity, construct validity, and reliability analysis were found satisfactory for the Malay-translated version of the CES-D. The Malay-translated version of the CES-D was found valid and reliable to be used in future studies, with comparable properties to the original version and to previous studies. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 54-65.
Objective: The family caregiver has a pivotal role in the management of HIV/AIDS patients and their well-being is consequently crucial as it could impact negatively on the quality of caregiving. This preliminary qualitative investigation intended to explore and describe the challenges and experiences of HIV/AIDS family caregivers in Terengganu, Malaysia. Methods: A convenient sample of family caregivers of HIV/AIDS patients who were aware of the diagnosis was enrolled. Recruitment was conducted in Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia and semi-structured interviews were used. Results: Results were transcribed into verbatim before being subjected to analysis. Twelve Muslim caregivers consented participation (age range = 18.0 - 81.0; female = 75.0%, mother/wife = 50.0%; married = 83.3%; ≤ primary school
= 50.0%; and self-employed = 66.7%). The four major themes that emerged were challenges of caregiving, financial issues, stigma and discrimination, and support for caregivers. Additionally, caregivers did mention several positive aspects of their caregiving role including satisfaction from helping family member and improved family relationships. Conclusion: A variety of life aspects were negatively affected by caring for HIV patients, thus requiring a multidisciplinary approach to address such issues. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 120-130.
Objective: The MINI International Neuropsychiatric Interview (MINI) is a short, structured diagnostic interview compatible with the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). It was designed for clinical practice, research in psychiatric, primary care settings and epidemiological surveys. This preliminary study aims to evaluate the reliability and validity of the Malaysian Version of MINI for Major Depressive Disorder and Generalized Anxiety Disorder symptoms criteria only.
Methods: Six hours of MINI training was given as part of a National Health Morbidity Survey training program for layman interviewers (n=229) and three videos were prepared by an expert psychiatrist for inter-rater reliability purposes. Meanwhile, for validity purposes, the MINI was administered to patients with Major Depressive Disorder (n=30), Generalized Anxiety Disorder (n=20) and to a normal population (n=60), to conform against the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) that was administered by psychiatrists.
Results: Overall the inter-rater reliability was satisfactory (0.67 to 0.85) and the concordance between the MINI’s and expert diagnoses was good, with kappa values of greater than 0.88.
Conclusions: The Malay version of the MINI is adjusted to the clinical setting and for the assessment of positive cases in a community setting. Modifications were highlighted to correct any identified problems and to improve the reliability of the MINI for future research and clinical use.
We aimed to report the first case of anorexia nervosa in a young Malaysian Malay homosexual man with underlying borderline personality disorder and major depression. Patient and parents were interviewed. The Structured Clinical Interview for DSM IV was used to generate Axis-I diagnosis. The Hamilton Depressive Rating Scale was used to assess the severity of depression. His parents had marital discord. His father was overinvolved. Regarding anorexia nervosa, he had 163 cm height, 46kg weight and a body mass index (BMI) of 17 kg/m2. His four limbs had multiple scratch marks. Laboratory test results showed anemia, leukocytosis and hypoalbuminemia. Family pathology, borderline personality disorder and homosexuality could be the risk factors of anorexia nervosa in this patient.
Objective: The number of people surviving until old age has been increasing worldwide. Reductions in both fertility and mortality rates, better living standards, nutrition and health care are claimed to be the key factors that increase the proportion of aged people within the population. Nevertheless, growing numbers of older adults also increases the susceptibility to diseases that commonly afflict the elderly, such as dementia. In this article, we discuss on the current issues of dementia in Malaysia and its challenge in providing a
better management and services for this population. Methods and Results:Review of literature by searching the databases CINAHL, SCOPUS, MEDLINE and PsychINFO from June 2010 to November 2010 was done on the issues involving dementia patients in Malaysia such as ageing trend, awareness and availability of services. Conclusion: Despite a limited number of studies on dementia in Malaysia, literature revealed the importance of
acknowledging the issues and improving the services for the patients. Efforts should be made by the government and private sectors to promote healthy ageing in Malaysia.
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: 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.
Introduction and Objective: Tobacco use is a significant risk factor for oral diseases. Periodontal disease has been known to be associated with tobacco use for over twenty years. Despite that, dentists and particularly periodontist does not include tobacco use cessation as part of their initial treatment in treating periodontal disease or placing implants in patients who use tobacco. The increase in prevalence and severity of periodontitis among smokers
cannot be explained by differences in the amount of plaque between smokers and nonsmokers. A possible explanation is that smoking may alter the quality of the flora. Dental professionals also have a crucial role to play in tobacco cessation counseling, particularly for patients with chronic periodontitis. More patients will be affected by periodontitis than will ever be affected by oral cancer. Methods and Results: Reviews of literatures were
done on a clearly formulated question on the need of smoking cessation intervention to increase positive outcome of treatment on periodontal disease. Conclusion: Various epidemiological studies strongly suggest that tobacco use cessation is beneficial to patients following periodontal treatments for a better outcome.
This article highlights the issues pertaining to psychiatry and smoking as reported in a symposium on smoking cessation in Malaysia. Methods: A report on a meeting outcome of a symposium on “Making smoking free agenda for psychiatrists in Malaysia.” Results: Smoking is still the number one public health problem and those with mental illness were at a high risk. Despite that, they are often under served in service provision by those caring for them. These shortcoming are seen more and more in Malaysia, where smoking and psychiatry is under researched. Conclusion: More research are needed on the why and how psychiatrist can play a major role in ensuring that those with mental illness in Malaysia are provided equal opportunities to quit smoking.
Objective: Smoking is a prevalent problem globally but more so among most ASEAN countries. Worldwide, six million lives are lost annually and this number is expected to grow. In light of this, the World Health Organization recognises the 31st of May to be World No Tobacco Day. For 2013, the theme is "Ban Tobacco Advertising, Promotion and Sponsorship". This article aims to increase awareness among mental health workers, in particular psychiatrists, on the dangers of smoking, the tactics of the tobacco industry, and simple measures to address these problems within their daily activities.
Method: A brief review of recent relevant literature in the field and actual experience from the field were highlighted in this opinion section.
Results and Conclusion: Mental health workers are at an advantage as they have training in both psychological treatments such as brief intervention, cognitive behavioural therapy or counselling skills and for some others, pharmacological treatments. It is timely that health workers in the region take up this challenging but meaningful opportunity to help those with mental illness to stop their dependence for tobacco.
Objective: The psychological impact of care giving responsibility for dementia patients is significant regardless of the cultural background. Most of the current advanced caregivers’ interventions, originating from developed western countries, do not necessarily apply to local settings. Hence, there is a need for an effective culturally competent psychological intervention for these caregivers. The aim of the study is to assess the effectiveness of the cultural-based support group for Malay caregivers of dementia patients in Kelantan towards their burden, anxiety and depression level, and quality of life.
Methods: This was an experimental study, without control, investigating pre and post support group intervention effectiveness in reducing caregiver burden, anxiety and depression, and improving the quality of life. Sixteen caregivers completed the program, which involved seven fortnightly support group sessions with duration of 2 hours each, conducted over twelve weeks. Caregivers’ burden was assessed using Caregiver Strain Index (CSI) while their psychological well-being was objectively assessed using Hospital Anxiety and Depression Scale (HADS). WHO Quality of Life questionnaire (WHOQOL-BREF) was used to measure the quality of life. The validated Malay versions of the questionnaires were used.
Results: There was a statistically significant reduction in the level of caregiver burden (p = or < 0.001). Measurement of both scores of anxiety and depression comparing pre and post intervention also showed improvement, but statistically were not significant. Assessment of caregivers’ quality of life showed statistically significant improvement in the domains of social, psychological and physical (all with the p-value <0.05). Discussion: Our cultural-based support group is an effective intervention to improve burden, psychological well-being and quality of life among local caregivers of dementia patients.
Keyword: Dementia Caregivers, Support Group, Malay, Burden, Quality of Life
Study site: Memory clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
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
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