Displaying publications 1 - 20 of 23 in total

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  1. Development of the clinical assessment scale in autoimmune encephalitis
    Lim JA, Lee ST, Moon J, Jun JS, Kim TJ, Shin YW, et al.
    Ann Neurol, 2019 03;85(3):352-358.
    PMID: 30675918 DOI: 10.1002/ana.25421
    OBJECTIVE: There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale.

    METHODS: The key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38).

    RESULTS: A new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p

    Matched MeSH terms: Delusions/psychology
  2. Fulltext Amphetamine type stimulant (ATS) induced psychosis: A rising problems in Malaysia
    Ahmad, H.S.
    Malaysian Journal of Psychiatry, 2008;17(2):1-4.
    MyJurnal
    The past decade has seen a marked increase in the popularity of ATS use, particularly methamphetamine, within East Asia,and the Pacific region. In Malaysia, the National Anti Drug Agency has identified 8,870 addicts (from January till August 2008) out of which 1,126 was ATS dependence. During the same period, the police have arrested 46,388 people under the Dangerous Drug Act 1952. They also has seize 283kg of syabu, 545kg of ecstacy powder, 66194 tablets of esctacy pills and 222,376 tablets of yaba pills from Jan till August this year. The occurrence of psychosis arising from the use of ATS was first reported in the late 1930's. With growing ATS use, particularly methamphetamine, ATS-induced psychosis has become a major impact on public health.Symptoms of ATS-induced psychosis: Methamphetamine use produces a variety of effects, ranging from irritability, to physical aggression, hyperawareness, hypervigilance, and psychomotor agitation. Repeated or high-dose use of the stimulant can cause drug-induced psychosis resembling paranoid schizophrenia, characterized by hallucinations, delusions and thought disorders. When used in long term, methamphetamine may lead to development of psychiatric symptoms due to dopamine depletion in the striatum. The most common lifetime psychotic symptoms among methamphetamine psychotic patients - as reported in a cross-country study involving Australia, Japan, the Philippines and Thailand - are persecutory delusion, auditory hallucinations, strange or unusual beliefs and thought reading. Those patients were also reported to suffer from impaired speech, psychomotor retardation, depression and anxiety. An ATS psychosis can be distinguished from primary psychotic disorders by time. In ATS-induced psychosis symptoms usually resolve after the drug is discontinued. If symptoms do not resolve within 2 weeks after cessation of stimulant use, a primary psychiatric disorder should be suspected. When compared with other stimulants, such as cocaine, psychosis is induced more commonly by ATS, possibly due to the longer duration of action produced by amphetamines.For example, while smoking cocaine produces a high that lasts for 20-30 minutes, smoking methamphetamine produces a high that lasts 8-24 hours. Other symptoms of ATS-induced psychosis reported include affective blunting,(6) violent behavior, and self-mutilation and self-injurious behavior.
    Matched MeSH terms: Delusions
  3. Capgras syndrome in a very late onset, treatment resistant schizophrenia
    Ain MK, Rosdinom R, Raynuha M
    Int Psychogeriatr, 2015 Sep;27(9):1573-5.
    PMID: 25794136 DOI: 10.1017/S1041610215000332
    We report a Malay man, with underlying chronic medical illnesses, presenting with positive symptoms of schizophrenia, including Capgras syndrome (CS) at the age of 73. Physical examination and blood investigations were normal and brain CT scan showed age-related cerebral atrophy. Neuropsychological assessment showed probable right hemisphere lesions but relatively intact memory and intellectual functions. Several neuroleptics including depot injections were tried but ineffective. Positive symptoms including CS eventually improved with clozapine before his death from myocardial infarction. This case report highlights the uncommon occurrence of CS in treatment resistant schizophrenia (TRS) of very late onset and its treatment challenges.
    Matched MeSH terms: Delusions
  4. Fulltext Cognitive impairment and depressive symptoms coexisting in an elderly man
    Masiran R, Pang NT
    BMJ Case Rep, 2017 Feb 08;2017.
    PMID: 28179386 DOI: 10.1136/bcr-2016-218267
    We report a case of a man aged 67 years presenting with recent depressive symptoms and paranoid ideations in addition to 1-year cognitive impairment. He has vascular risk factors and family history of memory loss. An episode of depression 2 decades ago resolved spontaneously but was followed by occupational decline. On mental state examination, he denied having depressed mood, hallucinations or delusions, but there were prominent word-finding difficulties and impaired attention and concentration.
    Matched MeSH terms: Delusions
  5. Fulltext Charles Bonnet syndrome: a precursor to Alzheimer disease
    Janaki, V., Rosdinom, R., Hatta, S.
    Medicine & Health, 2015;10(2):146-150.
    MyJurnal
    This case report highlights Charles Bonnet Syndrome as a precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment and the possible differential diagnoses that could be considered. We report a case of an elderly lady with no known previous medical illness, who presented for the first time to the psychiatric clinic with complex visual hallucinations consisting of well-formed images of people and inanimate objects of long standing duration of 18 months. About a year later, there was emergence of cognitive impairment which progressed gradually accompanied by other psychotic symptoms such as auditory hallucinations and persecutory delusions. There were no affective or obsessional symptoms. She had poor insight towards her illness. Ophthalmological examination revealed significant reduction in bilateral visual acuity. Otherwise, physical examination was unremarkable. She received inpatient treatment with Rivastigmine patch 4.6 mg/24 hours and Zydis 10 mg noctre. Her cognitive impairment and psychotic symptoms gradually improved over a period of 2 weeks upon commencing treatment and on subsequent follow-ups at outpatient clinic. She had also gained some insight into her illness. Charles Bonnet syndrome could be a possible precipitating factor and precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment which is often overlooked or misdiagnosed and hence under reported.
    Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
    Matched MeSH terms: Delusions
  6. Pisa syndrome secondary to rivastigmine: a case report
    Muthupalaniappen L, Rosdinom R, Suguna M
    Clin Ter, 2012;163(1):31-2.
    PMID: 22362231
    Pisa syndrome or pleurothotonus is the persistent flexion of the body and head to one side giving the appearance of the leaning tower of Pisa. It is most commonly caused by typical and atypical antipsychotic drugs. We report a case of Pisa Syndrome caused by prolonged use of high dose cholinesterase inhibitor, rivastigmine. Symptoms subsided when rivastigmine was withdrawn and did not reappear when a different cholinesterase inhibitor, donepezil was introduced. Physicians should be aware of Pisa syndrome and should alert patient of this possibility when starting and stepping up medications. The purpose of reporting this case is to create awareness among general practitioners as it is a reversible condition which responds to removal of the offending drug.
    Matched MeSH terms: Delusions/drug therapy
  7. The psychiatric aspects of epilepsy
    Teoh JI
    Med J Malaysia, 1973 Sep;28(1):8-15.
    PMID: 4273788
    Matched MeSH terms: Delusions/etiology
  8. Fulltext Psychosis induced by cefuroxime and metronidazole
    Zahiruddin O, Shanooha M, Mohd Azhar MY
    Med J Malaysia, 2014 Feb;69(1):33-4.
    PMID: 24814627 MyJurnal
    We report a case 35-year-old lady who developed acute psychosis following administration of cefuroxime and metronidazole. Earliest mood changes occurred on the second day of antibiotics therapy. She developed hallucinations, delusions and bizarre behavior 1 day after the completion of the antibiotic therapy. All the relevant investigations including CT brain were normal. The psychosis resolved completely within 5 days of antipsychotic treatment.
    Matched MeSH terms: Delusions
  9. Fulltext Antidepressant induced Mania and Steroid Psychosis in a Patient with Bell’s Palsy
    Tan, C.L., Anne Yee, H.A., Majid, S.M., Koh, O.H., Ng, C.G.
    Malaysian Journal of Psychiatry, 2010;19(2):1-5.
    MyJurnal
    Steroid is commonly used for various connective tissue diseases and immunological related disorders. Psychiatric side effects are common in patient with systematic treatment of steroid. The reported prevalence ranges from 6% to 28%. Antidepressant-induced mania occurs when the mood of a patient switches to manic or hypomanic from depression after the use of antidepressant. We reported a case of a 55 year old lady, who presented with agitation and grandiosity after the treatment with antidepressant. She was initially diagnosed as having Bell’s palsy with unilateral facial muscle weakness. Oral prednisolone was prescribed for seven days where she became depressed, having auditory hallucination and delusion of guilt. She was then started on antidepressant where she became irritable, agitated and developed grandiose delusion. The antidepressant was withheld and she was started on atypical antipsychotic. Her condition improved and discharged well after three days of stay in the ward.
    Matched MeSH terms: Delusions
  10. Fulltext Conversion Symptoms In Schizophrenia: A Case Report
    Ting, J.H., Nor Zuraida, Z., Sharmilla, K., Salina, M.
    Malaysian Journal of Psychiatry, 2009;18(2):1-5.
    MyJurnal
    We report a 35 year-old Iranian female who presented with a sudden onset of left sided hemiparesis associated with temporary loss of consciousness of about 3 minutes. Neurological examination revealed a power of 0/5 over the left upper/lower limbs but reflexes were normal and plantar reflex was downgoing and equivocal. A computed tomography scan was done and it revealed mild bilateral frontal atrophy and a temporal arachnoid cyst which was decidedly an incidental finding and it did not have any relation to the clinical presentation. Electroencephalogram and other laboratory findings were all normal. When the psychiatric team interviewed her, it was revealed that the patient had recently experienced a major stressful event just prior to the hemiparesis. On further interview, the patient had complained of delusions of persecution, delusions of reference and also auditory hallucinations for approximately a year prior to admission. There have been only a spatter of reports of conversion symptoms seen in patients with schizophrenia and this is such a case.
    Matched MeSH terms: Delusions
  11. Fulltext Organic disorder with neuropsychiatric symptoms - case report of anti-NMDA receptor encephalitis with neuropsychiatric manifestations
    Sivarooban, V., Yogitagavari, Y., Che, C.K., Lee, C.W.
    Malaysian Journal of Psychiatry, 2017;26(1):0-0.
    MyJurnal
    Neuropsychiatric symptoms are symptoms that caused by organic brain
    disorders. Multiple neuropsychiatric symptoms can occur concurrently in the
    course of brain related organic disorders. Two main components of
    neuropsychiatric symptoms are cognitive impairment and disturbance of
    consciousness while other neuropsychiatric symptoms, such as hallucinations,
    delusions, mood disorders, anxiety, apathy, behavioural and personality
    changes also commonly occur. Some of the mild neuropsychiatric symptoms
    could possibly be the earliest manifestations of brain related organic
    disorders. Clinicians should carefully evaluate organic factors in the
    treatment of psychosis, especially in patients of very young age or older age.
    They should have enough knowledge and experience in the integrating
    neuroscience, that is, neuropsychiatry. The present report illustrates a case of
    organic disorder with neuropsychiatric manifestations. It is about a young
    male patient who was diagnosed with anti-NMDA receptor encephalitis and
    subsequently developed acute delirium secondary to the illness.
    Matched MeSH terms: Delusions
  12. Fulltext DSM-IV "criterion A" schizophrenia symptoms across ethnically different populations: evidence for differing psychotic symptom content or structural organization?
    McLean D, Thara R, John S, Barrett R, Loa P, McGrath J, et al.
    Cult Med Psychiatry, 2014 Sep;38(3):408-26.
    PMID: 24981830 DOI: 10.1007/s11013-014-9385-8
    There is significant variation in the expression of schizophrenia across ethnically different populations, and the optimal structural and diagnostic representation of schizophrenia are contested. We contrasted both lifetime frequencies of DSM-IV criterion A (the core symptom criterion of the internationally recognized DSM classification system) symptoms and types/content of delusions and hallucinations in transethnic schizophrenia populations from Australia (n = 776), India (n = 504) and Sarawak, Malaysia (n = 259), to elucidate clinical heterogeneity. Differences in both criterion A symptom composition and symptom content were apparent. Indian individuals with schizophrenia reported negative symptoms more frequently than other sites, whereas individuals from Sarawak reported disorganized symptoms more frequently. Delusions of control and thought broadcast, insertion, or withdrawal were less frequent in Sarawak than Australia. Curiously, a subgroup of 20 Indian individuals with schizophrenia reported no lifetime delusions or hallucinations. These findings potentially challenge the long-held view in psychiatry that schizophrenia is fundamentally similar across cultural groups, with differences in only the content of psychotic symptoms, but equivalence in structural form.
    Matched MeSH terms: Delusions/ethnology*
  13. Fulltext Alcohol-induced psychotic disorder with suicidal attempt: a case report
    Tengku Mohd Saifuddin, Chong Wei Wei, Aida Farina Ismail, Noorul Amilin Harun
    Malaysian Journal of Psychiatry, 2018;27(1):0-0.
    MyJurnal
    Alcohol-induced psychotic disorder (AIPD) is a rare complication of alcohol
    abuse which is characterized by an acute onset of auditory or visual
    hallucinations that occur either during or after a period of heavy alcohol
    consumption. Other symptoms include delusions, thought disorder,
    psychomotor disturbances, and abnormal affect. To establish the diagnosis,
    one must rule out other disorders such as alcohol withdrawal delirium or
    other psychotic disorders. Although it is well recognised, relatively little is
    known about the condition. Moreover, the pathogenesis and treatment of
    AIPD are still unclear despite high co-morbidity with other psychiatric
    disorders, high re-hospitalization as well as mortality rates and suicidal
    behaviour. Therefore, the prognosis appears less favourable. We present a
    case of young man with AIPD with suicidal attempt secondary to auditory
    hallucination.
    Matched MeSH terms: Delusions
  14. Fulltext Retrospective review on patients admitted for violent crime in Permai Hospital, Malaysia
    Najwa Hanim, M.R., Abdul Kadir, A.B., Badiah, Y.
    Malaysian Journal of Psychiatry, 2011;20(1):1-8.
    MyJurnal
    Objective: To study the demographic data of patients and the pattern of crime in the study group, to look at the outcome of assessment by psychiatrist on fitness to plea and insanity at time of offense and to assess association between the nature of crime with presence of psychopathology during the crime. Method: This is a retrospective study. All available case notes for 342 forensic admissions from January 2007 until March 2010 were reviewed. All related information on 135 patients that committed violent crime was taken for analysis. Result: Majority of patients were male, Malay, single, education up to secondary school and unemployed. Only 38% of patients had encountered psychiatric services, 20% had previous imprisonment and 49% had history of substance usage. In cases involving victims (87%), 64% the victims were known to the patient, 53% had hallucination or delusion or both at the time of crime and 90% was found to have some diagnosis of mental illness after psychiatrist assessment. Only 81% of formal forensic reports were available in the case note and it showed 94% were fit to plea and 82% were at sound mind at the time of offense. Conclusion: Substance abuse had high prevalence among the patient. Almost 2/3 never had any encounter with psychiatric services before the admission. Even with the high percentage of patient diagnosed with mental illness, they were still found to be fit to plea in court and are at sound mind at the time of offense
    Matched MeSH terms: Delusions
  15. Fulltext Psychosis post craniotomy for craniopharyngioma
    Siti Rohana Abdul Hadi, Saminah Md Kassim, Suriati Mohamed Saini
    ASEAN Journal of Psychiatry, 2013;14(2):183-186.
    MyJurnal
    Objective: This case report highlights psychosis post craniopharyngioma surgery.

    Methods: We report a case of a young Malay lady who presented with psychotic symptoms after she underwent craniotomy for craniopharyngioma.

    Results: Presence of prominent hallucinations and delusions after removal of the tumour and the symptoms lasted more than a month. The psychosis subsided with antipsychotic.

    Conclusion: Psychosis post craniopharyngioma surgery is still possible whether possibly due to the residual tumour or as a result of treatment sequealae.
    Matched MeSH terms: Delusions
  16. Fulltext Recollections Expressed by Mechanically Ventilated Patients of Intensive Care Unit (ICU), Hospital Universiti Kebangsaan Malaysia (HUKM)
    Ho, Siew Eng, Hamidah Hassan, Sanisah Saidi, Syed Zulkfli
    Medicine & Health, 2008;3(1):46-53.
    MyJurnal
    Ventilated patients who require intensive care unit (ICU) treatment may encounter unpleasant experiences. These experiences may include factual incidents and delusional memories of ICU such as dreams, hallucinations and frightening experiences. A cross sectional study using “Intensive Care Experience Questionnaire” consisted of four domains: awareness of surrounding, frightening experiences, recall of experience and satisfaction with nursing care. Forty five participants who fulfilled the inclusion criteria were recruited in this study. This study was conducted in ICU of HUKM from January to March 2006. Results showed that 20 respondents (44%) were aware of their surrounding and 31 respondents (69%) reported frightening experiences. Majority of respondents (43 respondents, 96%) reported satisfaction with the delivery of nursing care. There was positive correlation between awareness of surrounding and their abilities to recall their experiences (p
    Matched MeSH terms: Delusions
  17. Fulltext Love tragedy, she wrote
    Mat Esa MS, Othman Z, Jamil Yaacob M
    Malays J Med Sci, 2004 Jan;11(1):86-9.
    PMID: 22977365
    A case of a 53-year old-single, Kelantanese lady with a diagnosis of paranoid schizophrenia for 28 years is reported with aims to illustrate the influence of life experiences particularly based on education and intelligent on delusion illustrate the evolving nature of the complexity of delusions as well as to show the importance of documentation in psychiatric practice. We concluded that this patient had used defense mechanism of suppression, reaction formation and persecution throughout her delusion. The final persecutory delusion evolved through series of transformation via object of admirations. We postulated that in-depth emotional insight about effects of schizophrenia might have contributed to her self-reflection that have made her frustrated with her poor achievement in life.
    Matched MeSH terms: Delusions
  18. Fulltext Folie a deux complicate management of a childhood onset schizophrenia
    Seen, Heng Yeoh, Kok, Wei Wee, Maryam Amaran, Hazura Hamzah
    ASEAN Journal of Psychiatry, 2012;13(2):0-0.
    MyJurnal
    Objective: This case report highlights folie a duex of a caregiver that complicate the management of a case of childhood onset schizophrenia.
    Methods: We report a case of a young Malay girl with symptoms of schizophrenia and her caregiver who share her delusion.
    Result: Folie a duex in the caregiver caused difficulty in the initiation and maintenance of treatment of a child with schizophrenia.
    Conclusion: Treating children with schizophrenia is not easy and could be complicated by the folie a duex in caregiver. Although Child Act 2001 can be applied in order to deliver appropriate treatment to this group of patients, one must be cautious about the implication in therapeutic alliance.
    Matched MeSH terms: Delusions
  19. Common cultural medical complaint presenting as a delusion
    George P, Ramasamy P
    Malaysian Journal of Psychiatry, 2006;14(1):41-42.
    MyJurnal
    Symptoms presented by patients suffering from Schizophrenia can be influenced by cultural factors. A case of Schizophrenia presenting with a common cultural medical complaint as a delusion, is described here. The appropriate assessment, identification and treatment have led to an improved out.
    Matched MeSH terms: Delusions
  20. Fulltext A case series on the use of atypical long acting injectable as first-line antipsychotic treatment in Malaysia: who benefits and how?
    Nik Ruzyanei, N.J., Hazli, Z., Chong, Y.S.
    Malaysian Journal of Psychiatry, 2013;22(1):1-5.
    MyJurnal
    Introduction: The use of long acting injectable (LAI) antipsychotics is mainly reserved as the second line treatment when all efforts to ensure patients’ adherence to regular oral medication failed. We aim to describe the common clinical features of patients with schizophrenia who benefited from the use of LAI early in the course of illness. Methods: We report four patients with first presentation of schizophrenia, all of whom were started with atypical LAI antipsychotics without prior history of oral antipsychotic. Results: In all of the cases, short acting major tranquilizers were not administered in the acute phase of psychosis because the patients were not agitated. Beside absence of agitation, other common clinical features observed in the four patients were prominent delusion (rather than hallucination), obstinate refusal of oral medication, good pre-morbid functioning and very poor insight. Interestingly, following the remission of the acute psychotic phase, all showed marked improvement in their insight and had better than expected therapeutic alliance. Discussion: LAI may improve the doctor-patient therapeutic alliance due to its minimal side effects and by ways of increasing the patients’ sense of control and allowing psychoeducation to take place when the patient is ready. We conclude that LAI may be used as the first line antipsychotic treatment in the acute psychotic phase in patients who are nonagitated but have prominent symptom of delusions with poor insight.
    Matched MeSH terms: Delusions
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