The compulsive behaviour of observing an unsuspecting person undressing or being naked in voyeurism may be related to Obsessive-Compulsive spectrum disorder. The aim of this paper is to report a case that reiterates a unique psychopathology of a Malaysian male voyeur with an obsession on female body parts. This 35 year-old voyeur man who attended psychiatric outpatient clinic in an academic medical centre presented to a psychiatrist for taking photos of his sisters' naked bodies and collected nails and hairs from their body, coded them with intend for masturbation. His voyeuristic thoughts and urges which came repeatedly and intrusively, involving attempts to resist them and was associated with an inner tension for the urges to be fulfilled. He responded both to Paroxetine and behaviour therapy. The possibility that voyeurism, a paraphilia can manifest itself as a subtype of OCD is discussed. Keywords: Malaysian voyeur, obsession-compulsive spectrum disorder, body parts
The use of Electro-Convulsive Therapy (ECT) has again risen, and so have the restrictions laid in the path for its use. This communication serves to discuss the thoughts and practices of ECT in our setting and that in the West, which we all know vary from center to center and individual to individual. A reminder guide, incorporating those ideas along with a simple risk-benefit assessment checklist, is suggested to induce an approved perspective that will enable the drawing-up of a standard, sanctioned guideline on the applications of ECT in our region. This proposal will then be hoped to be of substantial medico-legal benefit in the future. Keywords: Re-stimulation, dosing, unilateral ECT, bilateral ECT, frequency, multiple monitored ECT
Satisfaction on teaching in basic science is an important element for academic performance in final postgraduate examination. Basic sciences is an important subject in bridging understanding in clinical psychiatry but often poses difficulties among young postgraduate trainees, especially if they have not been exposed frequently to the topic areas like integrative neuroanatomy, neurophysiology and neurochemistry. Simple questionnaire regarding satisfaction on teaching was asked to 17 postgraduate candidates from Universiti Kebangsaan Malaysia (UKM) and Universiti Malaya (UM) and their MCQ paper performance was obtained to validate between satisfaction on teaching and their academic achievement. This simple descriptive study was to determine areas of difficulties and teaching satisfactory levels on basic sciences. Moderately satisfied candidates scored better on basic sciences topic compared to candidates with low and high satisfaction ((Mean, SD = 49.7 ± 4.5, 41.6 ± 5.9 and 39.6 ± 0) respectively. Recommendation avenues for improvement in the near future, especially concerning the ongoing revision course that is organized by the Department of Psychiatry, Universiti Kebangsaan Malaysia was briefly discussed. Keywords: satisfaction, postgraduate psychiatry, training
The Beck Depression Inventory (BDI) has been shown to have good psychometric properties in Western and non-Western populations for the past 40 years. The present study reported on the factor structures and provided evidence of the psychometric properties of the BDI for the Malays in Malaysia. A total of 1090 Malays in four samples (students, general community, general medical patients, and patients with major depressive disorders) were recruited in this study. They completed a battery of questionnaires that included symptoms, cognition and quality of life measures. Two factors of the BDI-Malay namely Cognitive/Affective and Somatic/Vegetative were extracted from Exploratory Factor Analysis (EFA) and were confirmed through Confirmatory Factor Analysis (CFA). Internal consistency (Cronbach's ) ranging from = .71 to .91 and validity of the BDI-Malay were satisfactory. The BDI-Malay can be used with confidence as an instrument to measure levels of depression for Malays in Malaysia. Keywords: Beck Depression Inventory, Malaysia, psychometric, confirmatory factor analysis
The phenomenon of 'lost fetus' to orang bunian is quite commonly heard of in our culture. It may present in psychiatric settings and may potentially create confusion and difficulties in diagnostic and management aspects. A case of feigned full-term pregnancy followed by a pregnancy loss is described. This review emphasizes the need to recognize this phenomenon of 'lost advanced pregnancy' in context of the Malay belief. Possible etiological factors, diagnostic indicators of factitious disorder and management strategies are discussed. The possibility of cultural beliefs being used as psychological defenses is also discussed. Keywords: lost pregnancy, orang bunian, Malay mystical belief, factitious disorder
Parasuicide has become an increasingly common response to emotional distress in young adults. The general pattern of parasuicide shows variations among the developing countries. The objectives of this study were to determine the pattern of parasuicide and suicide beside comparing the characteristics between different ethnic groups. The study was a retrospective case review of all parasuicide cases treated in Hospital Sungai Bakap and all suicides from the hospital mortuary from January 2001 to December 2005. We collected data concerning demographic data, information on method used and the circumstances. A total of 189 cases of parasuicide were analysed. There was a significant increase of parasuicide from 26.5 per 100,000 persons in 2001 to 32.1 per 100,000 persons in 2005. Seventy two percent of the cases were female. Indians constituted 64 % of the cases, followed by the Chinese (19 %), Malays (13 %) and foreigners (4 %). The age group 18-30 years ranked at the top, constituting 59.7% of the cases. Majority of the cases were by intentional poisoning and only 2 cases (1.1 %) were intentional injuries by sharp objects. In the past 5 years, the agents implicated were drugs (43.9 %), pesticides (23.5 %), household products (11.8 %), and others (20.8 %). Intentional Paracetamol poisoning had doubled from 11.7 % in 2001 to 23.4 % in 2005 while the use of pesticides had decreased from 32 % in 2001 to 17 % in 2005. Only 2 % of the cases had history of underlying disorders like schizophrenia and personalities disorders. As for suicide, the rates remained relatively unchanged at 5 per 100,000 populations. In this study, the demographic characteristics of suicide differ from parasuicide as suicides were associated with higher percentage of males and Chinese. There were 2 peaks in the age group of 31-40 and above 60 years old. The highest mode of suicide was hanging (53.5 %), followed by pesticide poisoning (25.6 %) and inhaled carbon monoxide (9.3 %).There is a need to improve on prevention and interventions for parasuicide and decrease suicide prevalence. Keywords: parasuicide, suicide, self-harm, Penang
Introduction: This study was designed to determine the effectiveness of combined group Cognitive-Behavioral Therapy (CBT) in improving diabetes distress and glycemic control among 60 adults with type 2 diabetes.
Methods: Half the participants were the experimental group (n = 30), and the other half was the control group (n = 30). Group therapy consisted of eight sessions for three months. Measures obtained at pre-test and post-test included the Diabetes Distress Scale (DDS-17) and blood examination to examine the level of HbA1c.
Result: The results indicated that group CBT had significant effects on the amelioration of diabetes distress and level of HbA1c among the participants of the experimental group.
Conclusion: The effectiveness of group CBT in the maintenance of good diabetic control in people who are suffering from type 2 diabetes was successfully demonstrated.
Study site: Pusat Sejahtera (Universiti Sains Malaysia Clinic), Pulau Pinang, Malaysia
Background: Self-esteem is a person’s appraisal of his own worth, significance, attractiveness, and competence. Low self-esteem could also lead to social, health and psychological problems including eating disorders. Eating disorder is when a person uses measures such as dieting, restricting intake of food or purging to control his or her body weight. Objective: The current study explores the relationship between self-esteem and anorectic eating concerns among female university students in Malaysia. Method: 217 female university students were studied, using Rosenberg’s Self Esteem Scale (SE-10) and Eating Attitude Test (EAT-40). Results: Students with low self esteem had higher anorectic eating concerns. Race of the student had no significance in predicting eating disorder. Age plays an important role in eating disorder. Young students with low self-esteem are more vulnerable to anorectic eating concerns than older students. Conclusion: It was found that there exists an inverse but low correlation between the two variables self esteem and anorectic eating concerns.
Objective: The study aimed to explore the prevalence of burnout among the junior doctors and to examine the psychometric properties of abbreviated Maslach Burnout Inventory (aMBI). Methods: A cross-sectional study was conducted using aMBI self-reported questionnaire and Hospital Anxiety Depression Scale which was carried out on a sample of 117 junior doctors working in a teaching hospital in Malaysia. Results: Exploratory factor analysis of aMBI revealed a three-factor structure labelled as emotional exhaustion, depersonalization and personal accomplishment with Crohnbach’s alpha of 0.85, 0.59 and 0.64 respectively. The total variance was 67%. Prevalence of burnout was found at 26.5%. Emotional exhaustion and depersonalization were positively correlated with depression and anxiety. Shorter duration of residence (less than six months) and being posted to Trauma & Emergency unit were associated with higher mean score of burnout. Conclusion: This study provides the knowledge of level of burnout among the junior doctors and the abbreviated Maslach Burnout Inventory has a satisfied psychometirc properties for screening burnout among junior doctors in Malaysia.
Introduction: Interest in mindfulness and its enhancements have quietly exploded in recent years, bringing with it the need for validated instruments to assess mindfulness in the Malaysian population. The study aims to assess the reliability, factor structure and validity of the Malay version of The Mindful Attention Awareness Scale (MMAAS) in a group of nursing students. Methods: The MMAAS was ‘forward-backward’ translated from English to Malay. Two hundred and sixty six nursing students answered the MMAAS. At the same time, they responded to the General Health Questionnaire (GHQ) and Rosenberg Self-Esteem Scale (RSES). We performed Exploratory Factor Analysis (EFA) with varimaxrotation to examine the factor structure of the MMAAS. Associations of retained factors were estimated by Spearman correlation coefficients. Results: Internal consistency reliability of MMAAS was good (Cronbach’s α = 0.851) and showed temporal stability in a 3-week period. Exploratory Factor Analysis (EFA) suggested three factors labelled as “Attention related to generaldomain”, “Attention related to the physicaldomain” and “Attention related to psychological domain”. These factors explained 52.09% of the variance. The Malay MAAS and the English version was highly correlated (r=0.82, p
Background: Most PTSD screening tools for children and adolescents have been validated in Western contexts which is not necessarily generalizable to non-western cultures. Therefore, the objective of this cross-sectional study was to determine the psychometric properties of the Child Posttraumatic Stress Disorder Reaction Index (CPTS-RI) within a Malaysian population. Methods: Eighty-five adolescents aged 13- to 14-years-old completed the CPTS-RI, Harvard Trauma Questionnaire (HTQ) and Hopkins Symptom Checklist scale (HSCL). Results: Results showed a good internal consistency for the overall scale (α =.92), for the subscale -re-experience, avoidance and arousal subscales (α = .89, α = .73, α = .56 respectively) and for different gender groups and ethnicity. CPTS-RI demonstrated good construct and divergent validity, and showed good concurrent validity with the use of HTQ and HSCL as the criterion measure. Conclusion: Findings suggest that CPTS-RI is a valid and reliable instrument to assess PTSD symptoms among Malaysian adolescents.
A 61 year old Indian man presented with clinical depression after a longstanding of “head heaviness”. Looking through the literatures, there is scant information on the subjective complaint of “a heavy head” despite it being a very common encounter at many primary care clinics. We feel that this is an unusual presentation of the symptom as it was very dramatic, to the extent that the patient was overly preoccupied with his head heaviness and subsequently became depressed. Here we undertake to present the case of a man who became clinically depressed due to his “heavy head”.
Objective: A rare case of induced hypomania was reported. Method: Patient was a 78-year-old Indian female with squamous cell carcinoma of the nasal septum, childhood bronchial asthma and underlying bipolar disorder. Her bipolar disorder is currently in remission. She developed hypomanic symptoms after one week of initiation of montelukast sodium for treatment of acute exacerbation of bronchial asthma. Result: Her hypomanic symptoms improved after stopping usage of montelukast sodium. Conclusion: Montelukast sodium likely had induced hypomania in this patient.
Objective: A case of caffeine-induced sleep disorder is reported to illustrate the clinical benefits of assessing culturally determined health beliefs in such presentations. Method: A middle-aged Malaysian Chinese male presented with caffeine-induced sleep disturbance arising from dietary modifications. Result: Assessing the contribution of cultural beliefs regarding hot and cold drinks led to successful management of the patient’s sleep disturbance. Conclusion: It is important for clinicians to explore health beliefs and associated dietary and lifestyle behaviours in caffeine-related sleep disorders.
Objective: Individuals with ADHD are known to have more risk of developing substance use disorder (SUD). However the underlying mechanisms behind it are not straightforward. Method: We report a case of an adult with ADHD, who has a long standing history of polysubstance use, since the age of 10. He had multiple relapses, even after numerous efforts undertaken to keep him drug-free. Result: ADHD symptoms were not optimally treated during admission. He had preference towards opioid-based and amphetamine-type substances in order to attain euphoria. Conclusion: Taking into account the biological and psycho-social condition of this man, we discussed the role of ADHD from the perspective of dysfunctional rewards system and other possible factors in explaining his drug-craving behavior.
Although comorbidity of obsessive compulsive disorder (OCD) with schizophrenia is well-established, the occurrence of psychotic symptoms especially hallucinations with OCD still requires further studies. We report a case of a child with OCD who experienced auditory hallucination with the recurrence of his OCD symptoms and the management involved. We discussed the possible differentials when auditory hallucinations occur in the context of OCD.
Introduction: Depression is the most common psychological sequelae in cancer patients. It is challenging to diagnose depression in cancer patients. Furthermore, the presentation is influenced by the patients’ cultural background. Objectives: This literature review aims to determine the prevalence of depression in cancer patients across regions of different cultural background. Methods: A literature search was undertaken by using Pubmed electronic database. Studies were included in this review if they (a) examined the prevalence of depression in cancer patients and (b) published in English peer-review journal between 2000 and 2009. Results: A total of 59 studies from 21 countries were reviewed and summarised. The prevalence of depression in cancer patients ranged from 3% to 72%. Studies from Asia reported the lowest prevalence (3-39%) and Europe reported the highest prevalence (7-72%). Conclusion: Cultural influence may play a role in the prevalent difference of depression in cancer patients. Somatization and stigmatization are suggested as the possible reasons of lower prevalence of depression in Asia region. The biopsychiatric model of mental illness and western psychologization explain the higher prevalence in Western region. Future research on the cross-cultural variability in the presentation of depression in cancer patients is recommended.
The aim of the study was to determine coping strategies among breast cancer patients with depression and anxiety during chemotherapy. Methods: Breast cancer patients with confirmed diagnosis who were undergoing out-patient chemotherapy at the Oncology Unit, University Malaya Medical Centre were invited to participate in the study. They were assessed on their socio demographic profiles and clinical history. The Hospital Anxiety Depression Scale (HADS) was used by patients to report anxiety and depression. The Brief COPE Scale was used to assess coping strategies among the patients. Results: One hundred and forty one patients with mean age of fifty years participated in the study. Prevalence for depression was 19.1% and prevalence for anxiety was 24.1%. Patients who were having anxiety symptoms scored significantly higher on denial, behavioural disengagement and venting as their coping strategies compared to patients who were not anxious. Patients with depressive symptoms scored significantly higher in behavioural disengagement and self-blame as their coping strategies compared to those who were not depressed. Conclusion: Breast cancer patients undergoing chemotherapy experienced high level of depressive and anxiety symptoms. However different coping strategies were adopted to cope with their illness, chemotherapy treatment, practical and family problems, emotional and physical symptoms.
Study site: Oncology clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
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.
A total of 200 university students were surveyed to ascertain if gender, personality traits and social support were associated with self-esteem. There were equal numbers of males and females in the study, with controls for living and education status. The results showed that gender was not significantly associated with self-esteem. Whilst all the personality and social support factors were found to be associated with levels of self-esteem, only extraversion, openness to new experiences, conscientiousness, emotional stability and total amount of social support were found to predict self-esteem. Recommendations are made for early identification and interventions for populations at risk of low self-esteem based on the findings of the study.