MyMedR

A systematic review of mental health literacy in Pakistan

Munawar K, Abdul Khaiyom JH, Bokharey IZ, Park MS, Choudhry FR

Asia Pac Psychiatry, 2020 Dec;12(4):e12408.

Individual mental health has become a primary global concern. In Pakistan, the prevalence of mental health issues is still unclear, as not many studies have assessed the level of mental health literacy (MHL) in the country. This systematic review aims to bridge this gap by encouraging the early detection of mental disorders, lessening stigma, and improving help-seeking behavior. Nine electronic databases were searched to identify empirical literature in this area. Only studies that evaluated MHL efficacy and those published in English were selected. Non-peer reviewed articles and gray literature were excluded. From 613 studies retrieved, 59 studies met the inclusion criteria and were reviewed. Forty-three of the included studies mentioned mental health outcome measures (of which only four mentioned reliability indices), 13 discussed stigma, 18 examined help-seeking approaches to mental illness treatments, and 47 discussed mental health knowledge. Additionally, the outcome of the MHL measures had considerable heterogeneity and limited validity. Meta-analysis was not conducted due to a lack of MHL operationalization. Besides, the measurement tools in the studies lacked consistency and standardization. This review compiled the available studies on MHL to assist researchers currently studying the various dimensions of MHL, as well as those designing new studies or investigating effective methods to increase MHL. This review highlights the need for well-designed controlled intervention studies. Further implications for researchers, practitioners, and policymakers are mentioned.

Anxiety, depression and marital satisfaction in women with hyperemesis gravidarum: A comparative cross-sectional study in Hospital Tengku Ampuan Rahimah, Klang, Malaysia

Azlan WAW, Ramalingam M, Razali R, Abdullah MF, Rahman FNA

Asia Pac Psychiatry, 2022 Mar;14(1):e12416.

PMID: 32929893 DOI: 10.1111/appy.12416

INTRODUCTION: Hyperemesis Gravidarum (HG) is a severe form of vomiting that occurs among pregnant mothers. Due to the nature of HG, pregnant mothers may feel fatigued and burdened by it and questions have been raised about the emergence of psychiatric illness during this period of vulnerability.

METHODS: A comparative cross-sectional study using Hospital Anxiety and Depression Scale (HADS), M.I.N.I (MINI International Neuropsychiatric Interview) and ENRICH- EMS (Evaluation and Nurturing Relationship Issues, Communication and Happiness - Marital Satisfaction Scale) were performed in a group of 112 pregnant women.

RESULTS: There were no differences in the prevalence rate of any anxiety disorder among the patient with HG vs comparative group (9% vs 3%, P > 0.05) and depressive disorder in women with HG vs comparative group (16% vs 8%, P > 0.05) respectively. There were associations between HG and gravida, past history of miscarriage, and gestational diabetes (P

Association between 5HT2A polymorphism and selective serotonin re-uptake inhibitor (SSRI)-induced sexual desire disorder (SDD) among Malaysian women

Masiran R, Sidi H, Mohamed Z, Mohamed Saini S, Nik Jaafar NR

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:41-9.

PMID: 23857836 DOI: 10.1111/appy.12043

SSRIs are known for their sexual side-effects with a variable rate of sexual dysfunction (SD). 5HT2A (rs6311) single nucleotide polymorphism (SNP) was found to have significant association with SD. The purpose of this study was to determine the prevalence of female SDD, its clinical correlates and association with 5HT2A (rs6311) SNP in patients with major depressive disorder (MDD) treated with SSRIs.

Association of brain-derived neurotrophic factor valine to methionine polymorphism with sexual dysfunction following selective serotonin reuptake inhibitor treatment in female patients with major depressive disorder

Nazree NE, Mohamed Z, Reynolds GP, Mohd Zain S, Masiran R, Sidi H, et al.

Asia Pac Psychiatry, 2016 Dec;8(4):260-268.

PMID: 27787964 DOI: 10.1111/appy.12210

INTRODUCTION: The occurrence of female sexual dysfunction (FSD) in patients with major depressive disorder (MDD) receiving selective serotonin reuptake inhibitors (SSRIs) treatment gives negative impacts on patients' quality of life and causes treatment discontinuation. We aimed to investigate whether genetic polymorphism of identified candidate gene is associated with FSD in our study population.

METHODS: This is a cross-sectional study. A total of 95 female patients with MDD who met the criteria of the study were recruited and were specifically assessed on the sexual function by trained psychiatrists. Patients' DNA was genotyped for BDNF Val66Met polymorphism using real-time polymerase chain reaction.

RESULTS: The prevalence of FSD in this study is 31.6%. In the FSD group, patients with problematic marriage were significantly more frequent compared with patients who did not have problematic marriage (P = 0.009). Significant association was detected in the lubrication domain with BDNF Val66Met polymorphism (P = 0.030) using additive genetic model, with even stronger association when using the recessive model (P = 0.013).

DISCUSSION: This study suggested that there was no significant association between BDNF Val66Met with FSD. However, this polymorphism is significantly associated with lubrication disorder in patients treated with SSRIs.

Clinical features of depression in Asia: results of a large prospective, cross-sectional study

Srisurapanont M, Hong JP, Tian-Mei S, Hatim A, Liu CY, Udomratn P, et al.

Asia Pac Psychiatry, 2013 Dec;5(4):259-67.

PMID: 24038919 DOI: 10.1111/appy.12104

The objective of this study was to investigate the clinical features of depression in Asian patients.

Cognitive dysfunction in Malaysian patients with major depressive disorder: A subgroup analysis of a multicountry, cross-sectional study

Zainal NZ, Kalita P, Herr KJ

Asia Pac Psychiatry, 2019 Mar;11(1):e12346.

PMID: 30511420 DOI: 10.1111/appy.12346

INTRODUCTION: Cognitive dysfunction has been significantly associated with functional impairment in patients with major depressive disorder (MDD).

METHODS: This is a subgroup analysis of 211 Malaysian patients recruited from the multicountry, multicenter, cross-sectional Cognitive Dysfunction in Asian patients with Depression (CogDAD) study. Depression severity, cognitive dysfunction, and functional disability were assessed and compared with the overall CogDAD study population. Factors associated with functional disability were also evaluated in this Malaysian patient population.

RESULTS: Approximately half of the Malaysian patients were in their first depressive episode, with the majority being treated for mild-to-moderate depression. Furthermore, Malaysian patients experienced cognitive dysfunction, with self-reported Perceived Deficits Questionnaire (PDQ-D) scores falling within the third quartile of PDQ-D severity. Malaysian patients also reported functional disability evidenced by a mean total Sheehan Disability Scale (SDS) score of 11.47 ± 6.68, with the highest SDS score reported in the "Social Life/Leisure Activities" domain. Compared with the overall CogDAD study population, the Malaysian patient population had comparable patient demographics in terms of marital and working status; outcome scores for PHQ-9 (9-item Patient Health Questionnaire for self-reported depression severity), PDQ-D and SDS; and worst perceived cognitive dysfunction reported in the "Attention/Concentration" domain. Factors found to be significantly associated with functional disability were PDQ-D score, sick leave taken, and antidepressant treatment (P

Fulltext Comparing schizophrenia symptoms in the Iban of Sarawak with other populations to elucidate clinical heterogeneity

McLean D, Barrett R, Loa P, Thara R, John S, McGrath J, et al.

Asia Pac Psychiatry, 2015 Mar;7(1):36-44.

PMID: 24038814 DOI: 10.1111/appy.12093

INTRODUCTION: The symptom profile of schizophrenia can vary between ethnic groups. We explored selected symptom variables previously reported to be characteristic of schizophrenia in the Iban of Sarawak in transethnic populations from Australia, India, and Sarawak, Malaysia. We tested site differences to confirm previous research, and to explore implications of differences across populations for future investigations.

METHODS: We recruited schizophrenia samples in Australia (n = 609), India (n = 310) and Sarawak (n = 205) primarily for the purposes of genetic studies. We analyzed seven identified variables and their relationship to site using logistic regression, including: global delusions, bizarre delusions, thought broadcast/insertion/withdrawal delusions, global hallucinations, auditory hallucinations, disorganized behavior, and prodromal duration.

RESULTS: We identified a distinct symptom profile in our Sarawak sample. Specifically, the Iban exhibit: low frequency of thought broadcast/insertion/withdrawal delusions, high frequency of auditory hallucinations and disorganized behavior, with a comparatively short prodrome when compared with Australian and Indian populations.

DISCUSSION: Understanding between-site variation in symptom profile may complement future transethnic genetic studies, and provide important clues as to the nature of differing schizophrenia expression across ethnically distinct groups. A comprehensive approach to subtyping schizophrenia is warranted, utilizing comprehensively ascertained transethnic samples to inform both schizophrenia genetics and nosology.

Cotard delusion in a depressed patient: "My throat is missing!"

Huan WY, Wan Azlan WA, Lee YT

Asia Pac Psychiatry, 2023 Mar;15(1):e12524.

PMID: 36575636 DOI: 10.1111/appy.12524

Cotard's syndrome is a rare neuropsychiatric disorder characterized by marked nihilistic delusions. This report describes an Indonesian woman from a small town in Malaysia who was diagnosed with depression and Cotard's delusion. The diagnosis was confirmed after thorough history-taking, clinical examination, and relevant laboratory tests. Herein, we highlight the unique psychopathology of a possible Cotard's syndrome subtype and efficacy of pharmacological combination strategies, rather than monotherapy and electroconvulsive therapy, for its treatment.

Country variations in depressive symptoms profile in Asian countries: Findings of the Research on Asia Psychotropic Prescription (REAP) studies

Chee KY, Tripathi A, Avasthi A, Chong MY, Xiang YT, Sim K, et al.

Asia Pac Psychiatry, 2015 Sep;7(3):276-85.

PMID: 25641910 DOI: 10.1111/appy.12170

This study was to assess differences in the symptom profile of depressive illness across various countries/territories in Asia. The study was a part of the Research on Asia Psychotropic Prescription project. The participating countries/territories include China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Singapore, Taiwan, and Thailand.

Cross-cultural translation and validation of the Malay version of the Swanson, Nolan, and Pelham Parent Rating Scale of attention deficit hyperactivity disorders symptoms among Malaysian probands: A preliminary study

Jusoh M, Dzulkarnain AAA, Rahmat S, Musa R, Che Azemin MZ

Asia Pac Psychiatry, 2021 Jun;13(2):e12414.

PMID: 32815284 DOI: 10.1111/appy.12414

The aim of this study is to evaluate the psychometric properties of the Malay version of the Swanson, Nolan, and Pelham Parent Rating Scale of attention deficit hyperactivity disorders (ADHD) symptoms (M-SNAP-IV). For this purpose, the SNAP-IV scale was translated into the Malay language and was pilot-tested on 91 parents of children aged 8 to 11 years (ADHD [n = 36] and non-ADHD children [n = 55]). The findings depicted that the M-SNAP-IV has excellent content validity, internal consistency, and test-retest reliability. The M-SNAP-IV is a valid and reliable screening tool to detect ADHD symptoms in children and has the advantages to assess the specific presentation of ADHD.

Depression and coping in adults undergoing dialysis for end-stage renal disease

Ibrahim N, Kong NCT, Desa A, Razali R

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:35-40.

PMID: 23857835 DOI: 10.1111/appy.12042

Introduction: Research on depression in local patients with end-stage renal disease (ESRD) is sparse. Thus, this study aims to examine the frequency and severity of depression among ESRD patients and relate depression with their coping skills.
Methods: A cross-sectional study using universal sampling method was conducted at several dialysis centers in Kuala Lumpur, Selangor and Johor, Malaysia. The Beck Depression Inventory II (BDI-II) and the Brief COPE scale were used to measure depression and coping skill, respectively.
Results: The study involved 274 ESRD patients, comprising of 183 hemodialysis and 91 continuous ambulatory peritoneal dialysis patients. The result showed that 21.1% of the patients experienced moderate to severe depression. Several components of coping skill were associated with depression. However, only two components in the Brief COPE (behavioral disengagement and self-blame) were identified as predictors.
Discussion: This study showed that depression is common in ESRD patients and is related to the types of coping skills adopted by patients. Hence, this study provides some insight into ESRD patients with depression. Appropriate counseling should be given to these patients to empower them to cope with the illness so as to enhance their quality of life.

Depression and psychosocial correlates of liver transplant candidates: a systematic review

Mohamed S, Sabki ZA, Zainal NZ

Asia Pac Psychiatry, 2014 Dec;6(4):447-53.

PMID: 25132651 DOI: 10.1111/appy.12145

Liver transplant candidates are vulnerable to develop depression. This paper aims to ascertain the prevalence of depression in liver transplant candidates and its psychosocial factors in a systematic review.

Depression in male patients on methadone maintenance therapy

Baharudin A, Mislan N, Ibrahim N, Sidi H, Nik Jaafar NR

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:67-73.

PMID: 23857840 DOI: 10.1111/appy.12069

INTRODUCTION: Depression is one of the most common psychiatric conditions in men. The aim of the study was to determine the depressive symptoms and associated factors among men on methadone maintenance therapy (MMT).
METHODS: A cross-sectional study was conducted involving 108 subjects who attended the Drug Clinic at Hospital Kuala Lumpur. The instruments used include the Structured Clinical Interview for Diagnostic and Statistical Manual, Fourth Edition Axis-I Disorder, Beck Depression Inventory and the 15-item International Index of Erectile Function.
RESULTS: The rate of depression was 44.4%. There were significant associations between Malay ethnicity, secondary education level and concurrent illicit cannabis use with depression (P

Dialectical behavior therapy in the Asia-Pacific Rim region

Loo JL, Keng SL, Ramírez-Espinosa IG, Nor Hadi NM, Ramírez-Gutiérrez JA, Shoesmith W

Asia Pac Psychiatry, 2021 Mar;13(1):e12437.

PMID: 33188568 DOI: 10.1111/appy.12437

BACKGROUND: Borderline personality disorder (BPD) contributes to suicide-related morbidity and mortality and requires more intensive psychotherapeutic resources due to its high mental health service usage. Accessibility to an evidence-based treatment program is a cornerstone to support patients with BPD and part of broader suicide prevention efforts as well as improving their quality of life.

AIMS: In this article, the authors aim to discuss and review available dialectical behavior therapy (DBT) and DBT-informed services of selected countries in the Asia-Pacific Rim, namely Singapore, Malaysia, and Mexico.

MATERIALS & METHODS: We contacted providers of different services and gathered information on the process of setting up the service and adapting the treatment, in addition to reviewing the available literature published in the countries.

RESULTS: To date, there have been a pair of DBT-informed services in Singapore, four in Malaysia, and several in Mexico with a few of them offering standard DBT. Different efforts have been put in place to increase the accessibility to training and also the number of DBT practitioners.

DISCUSSION: Important considerations during the process of setting up new services include the use of domestic examples and local language that are contextually appropriate for the local community. Selected challenges faced in common include shortage of workforce, affordability of training programs, and the need for language adaptation with or without translation.

CONCLUSION: Further long-term evaluation of locally adapted DBT-informed mental health services will help to elucidate the effectiveness and efficacy of the program which will potentially serve as a guide for other resource-scarce regions.

Editorial: Transcultural aspects and cultural adaptations of psychotherapeutic treatments in the Asia Pacific-Rim Region

Alfonso CA, Botbol M

Asia Pac Psychiatry, 2021 Mar;13(1):e12429.

PMID: 33098748 DOI: 10.1111/appy.12429

Educational environments in Asian medical schools: A cross-national comparison between Malaysia, Singapore, and China

Arokiamary B, Russell V, Lim HA, Koay JM, Xia J, Zhao XH, et al.

Asia Pac Psychiatry, 2021 Jun;13(2):e12454.

PMID: 33646626 DOI: 10.1111/appy.12454

INTRODUCTION: Perceptions of the educational environment (EE) represent an important source of information on medical students' learning experience. Understanding and addressing these perceptions can help inform initiatives designed to improve the learning experience and educational outcomes, while comparison of student perceptions across medical schools can provide an added perspective. The aim of the study was to compare the EEs of three Asian medical schools: Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, Yong Loo Lin School of Medicine, Singapore and Xiangya School of Medicine, China.

METHODS: Medical students in the clinical years (N = 1063) participated in a cross-sectional study using the Dundee Ready Educational Environment Measure (DREEM). Data were analyzed using SPSS version 22.

RESULTS: There were significant differences between the three medical schools in the total DREEM scores (F [2, 1059] = 38.29, p

Efficacy and safety of esketamine nasal spray in addition to standard of care in patients with major depressive disorder who have active suicidal ideation with intent: A subgroup analysis of the Asian cohort of ASPIRE I (a randomized, double-blind, placebo-controlled study)

Hong JP, Malek AZA, Li CT, Paik JW, Sulaiman AH, Madriaga G, et al.

Asia Pac Psychiatry, 2023 Dec;15(4):e12548.

PMID: 37771084 DOI: 10.1111/appy.12548

This post-hoc analysis evaluated the efficacy and safety of intranasal esketamine in the Asian subgroup from ASPIRE I. Patients with major depressive disorder and suicidal ideation with intent received intranasal esketamine (n = 26) or placebo (n = 27), plus standard of care for 25 days. The primary endpoint was the change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score from baseline to Day 2. The MADRS score improved in favor of esketamine (least squares mean difference: -3.8). No unexpected safety concerns were noted. The Asian subgroup showed a similar efficacy and safety profile as the total ASPIRE I cohort.

Externalizing and internalizing syndromes in relation to school truancy among adolescents in high-risk urban schools

Nik Jaafar NR, Tuti Iryani MD, Wan Salwina WI, Fairuz Nazri AR, Kamal NA, Prakash RJ, et al.

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:27-34.

PMID: 23857834 DOI: 10.1111/appy.12072

To examine the relationship between externalizing/internalizing syndromes and school truancy among Form Four (10th grade) students attending "high-risk" schools in Kuala Lumpur.

Hospital-based community psychiatric service for patients with schizophrenia in Kuala Lumpur: a 1-year follow-up study of re-hospitalization

Dahlan R, Midin M, Sidi H, Maniam T

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:127-33.

PMID: 23857849 DOI: 10.1111/appy.12058

INTRODUCTION: Hospital-based community psychiatric service (HCPS) is a developing intervention in Malaysia targeted for patients with severe mental illnesses (SMIs). Its effectiveness had not been systematically measured. This study aimed to assess the outcome of HCPS with respect to re-hospitalization and factors associated with low re-hospitalization among patients with schizophrenia in the metropolitan city of Kuala Lumpur.
METHODS: A naturalistic and retrospective cohort study was conducted using within-subject pre-post design on 155 patients with schizophrenia who received HCPS in Hospital Kuala Lumpur (HKL). The selection was made by simple random sampling. The hospital admission profiles were obtained from clinical records. The socio-demographic and relevant clinical data were also assessed through clinical interviews.
RESULTS: One hundred and forty (90%) of 155 respondents had low rate of hospital admission with significant reduction of being hospitalized within 1 year after receiving HCPS (p

Influence of coping mechanisms on emotional problems among adolescents in Malaysian orphanages

Mohammadzadeh M, Awang H, Ismail S, Kadir Shahar H

Asia Pac Psychiatry, 2017 12;9(4).

PMID: 29193714 DOI: 10.1111/appy.12288

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