Introduction: The daily life problems of patients with schizophrenia as well as their symptoms are challenging sit- uations that may interfere with their psychological well-being. The purpose of this study is to investigate the factors affecting the psychological well-being of patients with schizophrenia and factors affecting it. Methods: A cross sec- tional study was conducted to examine the socio-demographic factors, health level, social support and self-esteem of patients with schizophrenia. A total of 255 respondents consisting of patients on follow-up from specialist clinics at three Psychiatric Hospitals in this country were selected to answer the questionnaire. The questionnaires used were the Affect Balance Scale, the Multidimensional Scale of Perceived Social Support Scale and the Rosenberg Self-Esteem Scale for the measurement of the psychological well-being, social support and self-esteem respectively. The data was analysed using Chi-Square and Mann-Whitney U test. Results: A total of 62% of the respondents had positive psychological wellbeing. Socio demographic factors, namely occupation (p=0.007), overall social support (p=0.023), family support (p=0.040), significant others’ support (p=0.046), and self-esteem (p < 0.001), were associ- ated with positive psychological well-being. Conclusion: This study has proven that patients with schizophrenia who regularly received treatment can achieve positive psychological well-being when they have high self-esteem, strong support from their family members as well as people around them and are stable occupation.
The British government in Malaya conducted treatment for women suffering mental illness in an effort to deal with the increasing number of cases in the Federated Malay States in 1930-57. This paper explores the role of mental asylums and society in contributing to methods of treatment during the twentieth century.
AIM: This study compared the demographics, clinical characteristics, and antidepressant prescription patterns between Asian patients aged 50 years and older attending psychiatric hospitals and those attending general hospitals.
METHODS: In total, 955 patients (604 in general hospitals, 351 in psychiatric hospitals) aged 50 years or older treated with antidepressants in 10 Asian countries and territories were examined. Patients' demographics, clinical features, and prescriptions of psychotropic drugs were recorded using a standardized protocol and data collection procedure.
RESULTS: Binary logistic regression revealed that high income and diagnosis of schizophrenia were independently associated with psychiatric hospital treatment, whereas outpatient care, diagnosis of anxiety disorders, and multiple major medical conditions were independently associated with general hospital treatment. In addition, tetracyclic and noradrenergic and specific serotonergic antidepressants were more likely to be prescribed in general hospitals.
CONCLUSION: Older adults treated with antidepressants showed different demographic and clinical features between general hospitals and psychiatric hospitals in Asia.
Recent innovations in the treatment of schizophrenia reflect a growing trend towards community-based care. Malaysia had in the past few years attempted to deinstitutionalise mental patients in the mental hospitals. Therefore it is important to conduct research to compare the two groups of schizophrenia patients (community-based patients against chronic hospitalised patients) to ascertain if deinstitutionalisation has been beneficial. The main objective of the study was to compare levels of depression and function in community-based patients against chronic hospitalised patients as depression is prevalent among schizophrenia patients. This study was cross sectional in nature where data was collected from 51 inpatients in Hospital Bahagia Ulu Kinta (HBUK) and 23 community-based patients. Calgary Depression Scale for Schizophrenia (CDSS) and Global Assessment of Functioning scale (GAF) were the assessment tools used. Community-based patients were found to have significantly lower scores in the CDSS scale (1.96) as compared to chronic hospitalised patients (4.04); p < 0.01). They also showed higher functional capability between community-based and hospitalised patients respectively (74.04 vs 57.92) respectively. (p < 0.001). Community services appeared to be more effective than long stay in-patient services in preventing depression and promoting better functional levels.
OBJECTIVE: The aim of this study was to determine the prevalence of alcohol or non-alcohol substance use dual diagnosis among inpatients with severe mental illness in a psychiatric institution in Malaysia. In addition, this study aimed to determine adverse outcomes between dual diagnosis versus single diagnosis. Methods: This was a cross-sectional study conducted in the inpatient ward using the Mini-International Neuropsychiatric Interview (MINI) to establish the diagnosis of severe mental illness and to screen for alcohol or non-alcohol substance use disorder comorbidity. Outcomes and severity of different domains among severe mental illness patients were assessed using the Addiction Severity Index (ASI). Results: Out of 152 patients who participated in this study, 51.3% (n = 78) had comorbid alcohol use disorder, and 29.6% (n = 45) had non-alcohol substance use disorder. Males with Kadazan ethnicity with severe mental illness and alcohol use disorder had a higher risk of having comorbid non-alcohol substance use disorder. Similarly, male Kadazan patients with severe mental illness and non-alcohol substance use disorder had a higher risk of having a comorbid alcohol use disorder. Dual diagnosis patients with alcohol and non-alcohol substance use disorder had higher rates of hospitalizations (p < .001 and p = .001). Family and social relationships were affected among the alcohol use disorder group as shown by the higher composite score for family status (FCOMP; p < .001). This group also showed more severe psychiatric status, as the composite score for psychiatric status (PCOMP) was high (p = .004). Suicidality was higher among patients with alcohol use disorder and severe mental illness (p < .001). Conclusions: The prevalence of severe mental illness dual diagnosis was high in this study with poorer outcomes, higher rates of admissions, and risk of suicidality. This highlights the importance of provisions for a more holistic treatment approach among patients with dual diagnosis.
Objective: This case report aims to discuss the diagnosis of mental retardation as insanity defence in a crime offender. Methods: We report a gentleman who committed murder and rape 9 years ago, and currently being treated at a mental institution. Results: Patient was certified to have mental retardation, and was pleaded on the defence of unsoundness of mind because he had defect of reason at the time of alleged offence. Conclusion: Mental retardation does fulfil the McNaughton’s rule. Unsoundness of mind becomes the insanity defence even for murder under section 84 of the Penal Code. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 97-100.
Extract: In 1910 I was holding the appointment of Medical Officer and Magistrate at Anguilla in the St. Kits presidency of the Leeward Islands, British West Indies, when the Administrator one day handed me a cable, asking if I would accept the Medical Superintendency of the “Central Lunatic Asylum,” Tanjong Rambutan, Perak, Federated Malay States. Fortunately the cable explained that Tanjong Rambutan was in the Federated Malay States, as neither he nor I had the slightest idea where it was.
The main aim of the study was to determine the effect of psychoeducation program on insight of patients with schizophrenia and to determine other factors associated with the change of the insight. This was an interventional study of 70 patients with schizophrenia who underwent a psychoeducation program. Diagnosis was confirmed using Mini International Neuropsychiatric Interview (M.I.N.I). Insight was assessed using the Schedule for the Assessment of Insight (SAI) before and after the psychoeducation programme. Effect on insight was measured as the change in SAI scores. There was an improvement in insight after the psychoeducation programme which was significant (p< 0.001). Patient’s age, shorter duration of illness and no previous history of admission to mental institution were significantly related to the improvement of insight (p< 0.05). Conclusion: Psychoeducation is an important tool in improving insight into illness among patients with schizophrenia. It needs to be given as early as possible during the course of the illness.
Objectives: The objective of the study is to determine the prevalence of substance abuse for alcohol, cannabis, opiates, stimulants, solvent and other substances among patients with schizophrenia in Hospital Bahagia Ulu Kinta (HBUK), Perak , Central Peninsular of Malaysia. This study also aims to determine the association of substance abuse with aggression, the demographic characteristics and total duration of hospitalization.
Methods: This was a retrospective cross-sectional study whereby the first 194 subjects diagnosed to have schizophrenia based on International Classification of Disease, 10th edition (ICD-10) criteria were taken from data registry of patients admitted to HBUK from January until February 2004. The subjects’ medical files were examined for documentation of substances abuse, aggression and accumulative duration of hospitalization.
Results: The results showed the prevalence of substances misuse among patients with schizophrenia in general (including alcohol) was 24.7%. Cannabis 16.7%, alcohol 13.4%, opiates(heroin) 6.7%, Amphetamine type stimulants (amphetamine, metamphetamine, ecstacy) 5.7%, and other substances (benzodiazepine, solvents) 1.5%.
Conclusion: There is higher prevalence of substance misuse in patients with schizophrenia as compared to general population. Male patients with history of substance misuse are more likely to have aggression than female. This group needs special precaution and probably in need of specialist help.
Tujuan menjalankan kajian ini adalah untuk mengetahui tahap kekerapan penyelidikan yang berkaitan dengan kesihatan mental yang dijalankan di fasiliti Kementerian Kesihatan Malaysia. Sebanyak 258 fasiliti Kementerian Kesihatan yang terlibat dalam kajian ini meliputi Hospital Mental, Hospital dengan perkhidmatan Pakar Psikiatri, Hospital tanpa perkhidmatan Pakar Psikiatri dan Pejabat Kesihatan Daerah. Borang kajiselidik telah dihantar melalui pos kepada Pengarah Hospital dan Pegawai Kesihatan Daerah dengan kadar maklumbalas 70.2%. Hasil kajian mendapati hanya 23(13.1%) fasiliti sahaja yang menjalankan kajian mengenai kesihatan mental. Sebanyak 37 kajian berkaitan kesihatan mental telah dijalankan bagi tahun 2003-2004. Penyebab utama penyelidikan kurang dijalankan disebabkan oieh peruntukan yang tidak mencukupi dan tiada kepakaran untuk menjalankan penyelidikan yang berkaitan dengan kesihatan mental. Antara penyebab lain adalah kekurangan anggota, NGO tidak berminat dan tiada latihan. Kesimpulannya menunjukkan tahap penyelidikan kesihatan mental di fasiliti Kementerian Kesihatan masih rendah.
Objective: To determine the prevalence of depressive disorders among caregivers of patients with schizophrenia, its association with patient’s and caregiver’s socio-demographic characteristics and family functioning.
Methods: This was a cross-sectional study of caregivers of patients with schizophrenia at the outpatient clinic, Hospital Permai Johor Bahru, Malaysia. The study was conducted between August and October 2008. A total of 243 caregivers who fulfilled the inclusion criteria were enrolled, of whom 232 completed the self-administered socio-demographic questionnaire, the General Health Questionnaire (GHQ-30) and the McMaster Family Assessment Device. A total of 33 caregivers with the GHQ-30 cut-off point of 7/8 were assessed further by the Mini International Neuropsychiatric Interview to diagnose depressive disorder.
Results: The prevalence of psychological distress in our study sample was 14% (n = 33) and that of depressive disorders was 6% (n = 14). There was no association between patients’ and caregivers’ sociodemographic characteristics with depressive disorders, but there were significant associations between depressive disorders and family functioning dimensions in terms of Communication and Roles.
Conclusion: Although the causal link was not established, the results suggested that depression had a significant association with family functioning among caregivers of patients with schizophrenia.
Key words: Caregivers; Depressive disorder; Schizophrenia
Study site: outpatient clinic, Hospital Permai Johor Bahru, Malaysia.
OBJECTIVES. Obesity is an issue of concern among patients with schizophrenia as it is a co-morbid condition that is closely related to metabolic syndrome. The present study assessed the correlation of body mass index with antipsychotic use among multiracial schizophrenia outpatients. The study also compared the patients' body mass index with Malaysian Adult Nutrition Survey (MANS) data.
METHODS. A total of 216 participants were recruited into a cross-sectional study conducted over 5 months, from December 2010 to April 2011. Body weight and height were measured using the standard methods. Demographic data and treatment variables were gathered through interview or review of the medical records.
RESULTS. There were differences in mean body mass index between men and women (p = 0.02) and between Malay, Chinese and Indian races (p = 0.04). Stratified by sex, age, and race, the body mass index distributions of the patients were significantly different to those of the reference MANS population. The prevalence of obesity among patients was more than 2-fold greater than among the reference population in all variables. Although body mass index distribution was related to antipsychotic drugs (χ(2) = 33.42; p = 0.04), obesity could not be attributed to any specific drug.
CONCLUSION. The prevalence of obesity among patients with schizophrenia was significantly greater than that in the healthy Malaysian population, and affects the 3 main races in Malaysia.
Study site: Psychiatry Clinic, Tengku Ampuan Afzan Hospital, Kuantan, Pahang, Malaysia.
Galactorrhoea is non-lactational milk production and it may or may not be associated with prolactinemia1. It causes embarrassment and distress to a schizophrenic patient, especially, if the patient is male. One study in Germany reported that incidence and prevalence of galactorrhoea in schizophrenia are 14% and 19%, respectively2. Although galactorrhoea is not rare in schizophrenic patients, managing and understanding the a etiology can be problematic. In psychiatric patients, antipsychotics can be a cause but other causes need to be ruled out. Galactorrhoea also needs to be differentiated from pathologic nipple discharge which can be due to breast tumours. Usually, galactorrhoea is bilateral, multiductal, and milky, but discharge can be yellow, green or brown3. This case report describes a 32-year old patient with schizophrenia who visited a government psychiatric hospital in Kota Kinabalu, Sabah, Malaysia. This report highlights the clinical challenges to determine the aetiology of galactorrhoea and to manage it in schizophrenics. It raises the following clinical questions: Why a psychiatric patient develops galactorrhoea? How a schizophrenic patient presents with galactorrhoea? What hormonal imbalances are associated with this psychiatric disorder? How should a doctor handle a schizophrenic patient complaining of galactorrhoea? What is the danger of having galactorrhoea in a male?