The author during a long tropical service has seen a distressing number of cases of tropical neurasthenia including a number that ended in suicide. The condition is common in Malaya of which he is writing. In a group of rubber plantations with an average staff of 75 (presumably Europeans) in the past two years, one has committed suicide, eight have been repatriated for nervous breakdown, and two have been sent on home leave for the same reason. In a series of 33 invalidings analysed by SQUIRES [no reference given] 45 per cent. [15] were for psychological reasons. Neurasthenia in the tropics differs from that seen in practice in temperate countries by the predominance of cerebral over spinal symptoms. The mild cases show increased irritability with occasional outbursts of uncon rolled rages, restlessness, and moderate amnesia. In the intermediate cases these symptoms are worse and periods of worry and depression occur, often amounting to delusions of persecution with insomnia. In the severe cases, the depression is predominant; to this is added procrastination and indecision, loss of confidence, fear of insanity and of loss of employment, which constitute a vicious cycle that may end in suicide. The author classes the causes as personal and environmental, the former being the more important; the prominence of the personal factor is due to the tendency for social misfits and others who are dissatisfied with home conditions to seek employment in the tropics where they hope to find life easier. The environmental factors are (i) Exile from one's own country and loss of firm roots in a place that one calls home, (ii) The excessive stimuli of the tropics; under this heading the author includes the direct effects of the climate and discusses the sexual factor, (iii) Overwork and excessive responsibility, (iv) Isolation and monotony; under this last heading [the sequence of thought is obscure to the reviewer] he includes a suggestion that the recent increased rate of breakdown in Malaya may be due to years of war strain and present economic and political difficulties. The preventive measures he advocates include more careful selection of candidates for service in the tropics and the suggestion that a psychiatric assessment as well as a physical examination should be made; more frequent home leave; annual local leave to a hill station; shorter office hours; more security of tenure of appointments in commercial undertakings; and freedom to marry early in his service. Finally, the author suggests that, since this problem is an admittedly serious one, the Malayan branch of the British Medical Association should make a study of its aetiology and prevention, and convey their conclusions to the Government and to commercial and industrial associations. L. E. Napier.
In a study of suicide in Singapore in 1980 there were 230 cases and the suicide rate for the general population was 9.5 per 100,000. The age-specific rates increased steeply after 50 years and there was a male preponderance especially in the age group 60 years and over. Comparing the three major ethnic groups in Singapore, the highest rate was seen in the Indians and Chinese, whereas the Malays had the lowest. Amongst the suicides there were 59 (25.7%) with mental illness, mainly schizophrenia, and they were of a younger age group, 20-39 years. The commonest method of suicide was jumping from high-rise flats.
This study presents the demographical characteristics of 271 cases of parasuicide seen at the Psychiatric Clinic, General Hospital, Kuala Lumpur, during 1982. The majority of cases were women in the 20 - 30 year age group, from a lower economic class, with minimal education. About one-half were single and 61.5% were actively religious. The racial breakdown was Indians 55%, Chinese 32% and Malays 13%. Self-poisoning using easily available drugs was the most common method employed and more than one-half intended to die at the time of the suicidal act. Most attempts were impulsive, carried out while alone, inside the
house. The findings are discussed and compared with earlier studies of attempted suicides in Malaysia and Singapore.
A patient with organophosphate poisoning who survived the acute phase and subsequently developed delayed neuropathy is presented. The features of this form of delayed neuropathy are described and the implications in our local context discussed.
Ninety-five cases of suicide and 134 cases of parasuicide that occurred between October 1973 and September 1984 in the hill resort district of Cameron Highlands in Malaysia were analysed. Eighty-one per cent of suicides and 78% of parasuicides were of Indians, although they only form 25% of the population. The average annual suicide rate for Indians (over 10 years of age) was 157 per 100,000. About 94% of suicides and 66% of parasuicides were by ingesting agricultural poisons. The age- and sex-specific suicide rates for women were highest in the 20-24-year-old age group. Some possible reasons for high suicide rates among Indians are discussed.
A study of completed in-patient suicides at the University Hospital Kuala Lumpur (UHKL) and Hospital Bahagia Ulu Kinta (HBUK) between 1st January 1967 to 31st December 1987 were conducted. Records of completed in-patient suicides during the period were exhaustively studied. Only 18 cases were from UHKL and 23 cases were from HBUK. It was found that the suicide patients were mainly young Chinese males from the lower socio economic group. The main reasons for suicide were interpersonal conflicts and physical illness. Alcohol was not an important factor unlike patients in the West.. Suicidal intent was also important. Many of the suicides were committed during the early hours of the morning and they usually occurred at inaccessible places. The method was strongly influenced by availability. To the best knowledge of the author, this is the first study of in-patient suicides in Malaysia.
A body recovered from the water does not necessarily imply that death was due to drowning. The diagnosis of drowning is discussed together with the significance of the "diatom" and biochemical tests.