Objective: According to Malaysian law, defendants found not guilty by reason of insanity may be admitted to a psychiatric hospital and discharge is subject to the state ruler’s assent. The objective of this study is to examine the clinical, socio-demographic and forensic factors that influence inpatient duration of insanity acquittees in a Malaysian mental institution. Methods:This is a cross-sectional study of one hundred and twelve insanity acquittee inpatients in Hospital Bahagia Ulu Kinta from January 2007 to February 2007. Patients with a clinical diagnosis of schizophrenia, major depressive disorder and bipolar disorder were assessed using the Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAMD) and Young Mania Rating Scale (YMRS) respectively. Other relevant sociodemographic, clinical and forensic factors were also assessed. Results: The inpatient duration varied widely from three months to forty-seven years with a median of seven years. Seventy five percent of patients were in remission. According to the multiple linear regression model, the strongest predictor of a longer duration of hospital stay for insanity acquittees was older age (p
The objective of this study is to determine the prevalence and factors associated with psychosis in Parkinson’s disease (PD) patients.
Method: This is a cross-sectional study of 108 PD patients from neurological clinic UKM Medical Centre and Kuala Lumpur Hospital. The patients were recruited from August to December 2004. Psychosis was determined using SCID, the severity of psychosis was rated using BPRS. The cognitive functions were evaluated with MMSE and the severity of depression was assessed with HAM-D.
Results: The result shows that the prevalence of psychosis in Parkinson's disease patients in this sample was 13%. The psychosis was found to be significantly associated with advancing age, duration of illness, severity of depression and cognitive impairment. Multivariate analysis demonstrates that severity of depression (OR = 1.08, 95% C.I. = 1.01 - 1.16) and advancing age (OR = 4.72, 95% C.I. = 1.37 - 16.29) increased risk of psychosis in PD patients.
Conclusion: We found that advancing age and severity of depression increase risk to develop psychosis in patients with PD.
Study site: neurological clinic UKM Medical Centre and Kuala Lumpur Hospita
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 objective of this study is to determine the optimal cut-off score for the Centre for Epidemiologic Studies Depression scale (CESD) according to Malaysian adolescent norms. Methods: This is a cross-sectional study. Nine hundred and thirty-one adolescents aged 13 to 17 years-old completed the CESD and Hopkins Symptom Checklist-depression scale (HSCL-depression). Results: Results from the receiver operating characteristic (ROC) curve, kappa coefficients and odds ratio analysis showed that CESD cut-off score of 27 was suitable to be used according to Malaysian norms, demonstrating a specificity of 93%. Conclusion: The findings suggest a cut-off score 27 should be used for screening of depression for Malaysian adolescents using the CESD. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 146-152.
Evidence linking cannabis use and depression remains inconsistent. Variations of clinical features were observed in those with history of cannabis use presented with affective symptoms. We report a case of a 19-year-old male college student with a history of heavy cannabis use for at least seven months. A month after stopping cannabis, he presented with severe persistent depressive symptoms. He had no withdrawal symptoms prior to this. He had severe depressive symptoms with melancholic features and progressed to multiple and serious suicidal attempts. While the use of cannabis is implicated in neither the patient’s diagnosis nor management, its use has a significant role in influencing the clinical features and course of the illness. This case suggests that depression can start long after cessation of cannabis use with the history of cannabis remained as a significant risk factor.
Objective: The aim of this study was to identify depression among HIVinfected patients attending Infectious Disease Clinic in University Malaya Medical Centre (UMMC). Methods: This is a cross sectional study on HIVinfected patients attending Infectious Disease Clinic, UMMC. Those who fulfilled inclusion criteria were recruited and interviewed. Sociodemographic characteristics and clinical conditions such as mode of transmission, year of diagnosis, CD4+ counts, drug treatment and clinical stage were collected. The patients were then subjected to self-administered questionnaires, Patient Health Questionnaire, (PHQ-9) and Hospital Anxiety & Depression Scale (HADS). Results: 89 patients were recruited. Scores from PHQ9 showed 32% of depression rate while scores from HADS showed 19% of depression rate among the respondents. Non-self financial supporter, nonalcoholic drinkers and females were more likely to be depressed (P
Objective: This interventional study was aimed to investigate the effects of dark chocolate
consumption on anxiety, depression, and stress (ADS) among trainee nurses. Methods: A
parallel and open-label experimental study was conducted. Of the 128 nurses enrolled, only 47 participated in the intervention study (mean age = 20.32 years; ranging from 19 to 22 years old). They were randomly assigned to an intervention group (IG, n = 25) or a control group (CG, n = 22). The IG consumed dark chocolate and CG ingested mineral water for 3 consecutive days. The validated Malay Hospital Anxiety and Depression Scale (HADS) and Depression, Anxiety and Stress Scale (DASS-21) were utilised for measuring ADS levels. Data were analysed descriptively and score comparisons were conducted using non-parametric tests. Results: No significant differences between IG and CG in ADS scores were detected at baseline (all p > 0.05). At post-consumption, ADS score were significantly reduced in IG (all p < 0.01) compared with CG (all p < 0.05). Larger effect sizes among these respondents had also revealed that there were mood-elevating effects of dark chocolate consumption. Conclusion: This study has discovered that 3-day consumption of dark chocolate may alleviate ADS status among trainee nurses suggesting that dark chocolate may have a more prominent role in improving emotional and mood generally. Further investigations are however warranted to confirm this finding.
encountered particularly in mental health issues and to additionally analyze the methodologies used in studies involving HIV/AIDS informal caregivers.
Methods: Four electronic databases; Science Direct, EBSCOhost, Ovid and Springer Link were searched for articles published in the past 10 years (2002 - 2012). Only full-text English articles related to research on care giving of HIV-infected adult patients were selected.
Results: Twenty two out of 293 articles (7.5%) were reviewed, involving 2,765 caregivers in the USA (n=1,610), Africa (n=253), Asia (n=838) and Oceania (n=64) regions. A variety of age categories was involved in care giving with the youngest carer being 12 years old and the oldest, 60 years on average. Females and whites appeared to be dominant and 603 caregivers themselves were HIV positive. The main outcomes measured were care giving burden, challenges and coping. Stress and depression, stigma and discrimination, insufficient support, role overload and extreme poverty were the main challenges experienced in care giving. Both qualitative (n=11) and quantitative (n=9) were the equally preferred types of study. Purposive sampling emerged as the most preferred sampling technique. Various instruments were utilized, but the Beck Depression Inventory (BDI) was the most popular particularly in quantitative studies.
Conclusion: A variety of life aspects were negatively affected in the process of care giving for HIV/AIDS patients and studies of such nature commonly focused on caregivers' psychosocial burden.
This is a retrospective and descriptive study of 30 children and adolescents with conduct disorders diagnosed for the first time this year (1993) at the Child and Family Consultation Unit, UKM. Eleven of them were diagnosed to have a Socialized Conduct Disorder, 8 had symptoms of Unsocialized Conduct Disorder, whilst 4 had Conduct Disorder confined to the family context. Another 5 had Depressive Conduct Disorders while 2 had features of other mixed disorders of conduct and emotions. Most them were boys and were ten years old and above. The majority presented with at least one year history of illness and school authorities played an important role in being the main referral agency. Prominent abnormal psychosocial situations were inadequate or inconsistent parental control and discordant intro familial relationships. Socio-economic status and geographical differences were associated with the prevalence of the disorder. The main symptomatology found were disobedience and frequent lying, stealing, truancy and fighting or bullying.
Study site: outpatient clinic, Hospital Kuala Lumpur
Childhood brain injury is an important and complicated public health issue worldwide. Extensive work has been done in this field. This review highlights issues that are frequently misinterpreted or overlooked in the management of childhood brain injury. The incidence of traumatic brain injury is higher than non-traumatic brain injury. However it is frequently over-reported due to various confounding factors. In ascertaining the severity of injury, assessment of brainstem functions is important and should be included in routine clinical assessment. Most rehabilitative efforts are usually aimed at improving the physical outcome. However, non-physical sequelae are also common and may be more disabling with significant impact on the learning and functioning of the child. These areas, which include depression, cognitive functioning and health-related quality of life of children, should not be overlooked in the management of childhood brain injury. In addition to caregiver’s stress, family dynamic and siblings’ well-being also play a crucial role in the recovery process of the child. By highlighting the frequently missed issues in the management of childhood brain injury, it is hoped that clinicians and professionals could pay more attention to these issues and provide a comprehensive medical care for the patients and their families.
Background: Having a validated questionnaire in any field would nurture a research path in that particular area. The aim of this study was to validate the Depression Anxiety Stress Scales 21-item (DASS-21) Bahasa Malaysia (BM) version among clinical subjects who were diabetic patients. Objectives: To determine the reliability and construct validity of the BM DASS by looking at internal consistency and exploratory factor analysis respectively. Methods: The BM DASS was administered to a total of 153 diabetic patients. These patients were selected when they came to 15 retail pharmacies all over the Klang Valley. Results: The BM DASS-21 had very good Cronbach’s alpha values of 0.75, 0.74 and 0.79, respectively for depression, anxiety and stress subscales. For construct validity, it also had good factor loading values for 17 out of 21 items (.31 to .75). Conclusions: The results of this study entrenched the evidence that the BM DASS-21 had excellent psychometric properties and therefore it is suitable to be used for the Malaysian clinical population.
Parkinson Disease (PD) is a neurodegenerative disorder of the central nervous system that often impairs the patient’s motor skills, speech and other functions. The four cardinal signs of parkinsonism are resting tremor, bradykinesia, cogwheel rigidity and postural instability. The prevalence of depression in PD ranges from 4% to 75%. However depression in PD is often mistakenly as the presentation of the disease itself. Therefore this paper reviewed the clinical feature of depression in PD and explored the aetiology of depression in PD.
Objective: To evaluate the health-related quality of life (HRQOL) of patients with chronic depression. Methods: The study involved patients with chronic depression being followed-up at an outpatient clinic at a local hospital in Malaysia. HRQOL was assessed using the Sheehan Disability Scale (SDS); while symptom severity was assessed using the Montgomery-Asberg Depression Rating Scale (MADRS). Results: 104 patients of Malay, Chinese and Indian ethnic groups met the selection criteria. Mean total SDS and MADRS scores was 9.36 ± 7.92 and 13.99 ± 11.58 respectively. There were no significant differences of HRQOL scores between the different ethnicities and between males and females. Symptom severity significantly influenced total and component HRQOL scores. Conclusions: The HRQOL of patients with chronic depression was found to be significantly influenced by symptom severity. Data obtained in this study can be used in the design and implementation of therapeutic and preventive interventions.
Objective: to review the field of epigenetics, and present basic and recent material that may be of interest to clinical psychiatrists. We include basic molecular mechanism, a consideration of findings related to mental disorders, evidence of sustained effects, and the evidence for and implications of transgenerational epigenetic modifications. Method: we examined all the available papers for the last five years identified by PubMed using the words ‘epigenetics’ and ‘epigenetics psychiatry’, and the available leading specialized textbooks. Results: we report on molecular mechanisms including DNA and histone modifications, and non-coding RNAs. While some modifications are short-lived, others are life-long. Depression, suicide, schizophrenia, PTSD, borderline personality disorder and drug addiction are among the conditions for which epigenetic involvement has been proposed. Transgenerational epigenetics enables the environmental experience of one generation to be non-genetically inherited by subsequent generations. This has been molecularly demonstrated in laboratory animals and epidemically suggested in humans. Conclusions: epigenetics provides a new way of understanding human behavior and points to potential therapies for mental disorders. Should it transpire that transgenerational epigenetic modifications apply with force in humans as they do to laboratory animals, this will emphasize the need for cultural shift, safe societies with ample opportunities.
The objective of this study is to evaluate the depression and coping strategies used by postnatal mothers during the postpartum period.This study used cross-sectional design and was conducted at the University Malaya Medical Centre from November 2013 to January 2014. This study involved 150 respondents (postnatal mothers) and used instrumentation adopted from the Malay version of Edinburgh Postnatal Depression Scale (EPDS) and the Malay version of Brief COPE. The results showed 32 (21.3%) postnatal mothers have had severe depression. Emotional coping strategies were reported to be the most used by postnatal mothers (mean = 4.77 ± 0.70). There was a significant association between problem-focused coping strategies and race (p=0.045) where it was mostly used by Malay participants (mean = 3.39±0.46). There was a mild negative relation between EPDS and problem focus (r=-0.168, p=0.04). On the other hand, there was a mild positive relation between depression level and avoidant emotion (r= 0.162, p= 0.047). The psychological support from nurses and family was needed to improve depression and coping strategies used so that it can improve health outcome among postnatal mothers.
This case report highlights on the dilemma in making a decision for termination of pregnancy (TOP) for a muslim rape victim in Malaysian setting. We report a case of 17 year-old student at 7 weeks of pregnancy after being gang-raped, who, together with her parents, had requested for a TOP. Psychiatric assessment showed that the patient suffered from a major depressive disorder and post-traumatic stress disorder which justified termination of pregnancy on a psychological and clinical basis. However the available Malaysian Islamic fatwa had caused some uncertainties on the final decision making. This case demonstrated on the needs to understand the relevant issues beyond clinical judgment in relation to TOP in our setting which encompasses the legal provision, ethical obligation as well as the needs for a clear religious understanding and stand to support the medical decision.
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.
This two-phase study examined the prevalence of depressive disorders among married working women in a sub-urban area in Malaysia. The Malay version of the General Health Questionnaire-12 (GHQ-12) was used for initial screening. Using multistage cluster sampling, there were 700 subjects from 25 workplaces that were approached, of which 307 filled out GHQ-12 in the initial phase. The prevalence of psychological distress (GHQ 2/3 cut off) is 22.8% (n=70, 95% CI 18.1-27.5). In the second phase, all 49 consenting patients who were screened positive for severe psychological distress (GHQ 3/4 cut off point) were telephone-interviewed by a trained psychiatrist with the Malay version of Mini International Neuropsychiatric Interview (M.I.N.I) to diagnose depressive disorders. The prevalence of depressive disorders was 5.5% (n=17, 95% CI 3.5-7.5). The prevalence of depressive disorders is comparable to those found in the working population worldwide.
Objectives: To study relationship of depressive symptoms to hypertension. Methods: A cross sectional study was carried out on respondents from Kampung Awal. Hypertension was defined as self-reported or by measurement using a mercury sphymomanometer and depressive symptoms were evaluated by CES-D scale. Results: A total 103 respondents were studied. The male:female ratio was 1:1.5 with mean age of 41.8 years. Majority had formal education up to secondary school. 45% were government servant and over 95% subjects had income of RM1000 or less per each family member per month. 21.4% (n=22) self-reported to have hypertension and 7.8%(n=91) met the criteria for incident hypertension. 7.8% met the criteria for both. Mean score based on CES-D was 13.08. 32.0% subjects had depression. 54 subjects reported never experienced any strain for past 6 months and 24 reported to have 2 or more .61 subjects were overweight with mean value of BMI=26.19 kg/m2. Self-reported hypertension and incident hypertension were strongly associated with age but only selfreported hypertension was strongly associated with overweight. However, there was no significant association between hypertension with chronic strains and depressive symptoms. Conclusions: Depressive symptomatology was not associated with hypertension in this survey. Women had a significant risk in having depressive symptoms. Age =45 years & overweight were significant risks for hypertension. A prospective study will be more useful in the future to find out the association between depression and hypertension.
One of the commonest psychological problems that a clinician would encounter in primary care is depression. The prevalence of depression is high in women, the elderly and those with underlying physical problems or during the postpartum period. The spectrum of clinical presentations is wide and somatic complaints are more common in primary care clinics. Depression may present as a primary disorder and co-morbidity with other psychological problems or physical illnesses is high. A good clinical interview is an important form of assessment and a quick screening of depression can be done with the administration of proper rating scales, such as the Patient Health Questionnaire, Hamilton Depression Rating Scale or Geriatric Depression Scale. Repeated use of the same scale in a patient would help the clinician to monitor the progress objectively.