Depression is one of the leading causes of mortality and morbidity worldwide. In the year 2000 depression accounted for 4.4% of the global disability adjusted life years (DALYs). The Kingdom of Saudi Arabia (KSA) has a population of 28 million people and is one of the countries experiencing demographic transition in its population structure. Improvements in socioeconomic status have been shown to be associated with increased chronic diseases including chronic mental diseases like depression, but still there is no comprehensive review summarizing the various reports currently existing in the literature. Although individual studies within Saudi Arabia have reported prevalence rates and risks, the quality of such studies need to be subjected to rigorous assessment and their findings pooled to give combined weighted evidence that will provide basis for targeted intervention. Pooled risks have the advantage of adjusting inherent variations within sampled populations and therefore providing more reliable estimates even though there are concerns about possible magnification of smaller individual risks.
Adherence to antidepressant treatment is an essential step in the management of patients with major depressive disorder, and several factors can contribute to antidepressant nonadherence. Evidence supports the hypothesis that patient treatment satisfaction will result in improved adherence; therefore, the aim of this study was to investigate the relationship between patient treatment satisfaction and adherence to antidepressants, and the role of patient beliefs toward medication in patient treatment satisfaction.
Adherence to antidepressant treatment is essential for the effective management of patients with major depressive disorder. Adherence to medication is a dynamic decision-making process, and pharmacists play an important role in improving adherence to antidepressant treatment in different settings within the healthcare system. The aim of this study was to assess whether pharmacist interventions based on shared decision making improved adherence and patient-related outcomes.
This research aimed to determine the correlation between level of depression, anxiety and stress among counselling students at Universiti Malaysia Sarawak. This research adopted a correlational study with a quantitative approach in order to observe the correlation between the variables. Eighty six (86) respondents participated in this study. The study was conducted using Depression, Anxiety and Stress Scale (DASS-21) instrument. The result showed that there was a significant relationship between the level of depression, anxiety and stress among counselling students at Universiti Malaysia Sarawak. This research also provides awareness towards the counselling students on their level of depression, anxiety and stress. For future research, it is suggested that personality test and scoring test be conducted for level of depression, anxiety and stress in order to see the correlations between variables.
Pathological laughing or crying (PLC) were recognized after the occurrence of stroke, with a prevalence of 15% to 18%. There is no apparent triggering stimulus, and is often misdiagnosed as a mood disorder as it is a disorder of emotional expression rather than a primary disturbance of feeling. We reported a case of a 32 year old lady, who presented with giddiness and altered consciousness progressing to fever and neck stiffness, who’s CT showed a massive left cerebellar infarct. No risk factors were identified. Psychiatrically, she developed sudden crying spells after one month and a diagnosis of Major Depressive Disorder was made with subsequent commencement of anti-depressants. A week later, she developed continuous inappropriate laughter without the feeling of elation, which was beyond her control. There were no symptoms of mania or psychosis.
The sight of clustered holes can bring about uneasiness in people, and the disgust response towards it is called trypophobia. Reactions in humans vary from nausea to severe depression. We explore the possible causes of this unique phenomenon, such as evolutionary adaptation and spectral features. We also uncover the clinical features and its relationship to other psychological conditions for example, obsessive-compulsive disorder.
The aim of this study is to compare depression in terms of treatment between psychotherapy and medical approach or to combine these approaches among cancer patients in Malaysia with respect to the cancer categories. It also studies the major prevalence of depressive disorder in the group together with the specialized clinical connection to the health outcomes. The annual incidence of cancer cases in Malaysia is 30,000 at late stage of the disease. We found 17 eligible researches out of 142 articles which most were under designed of cross-sectional or prospective study, and contained 2,523 cancer patients. This study was conducted on systematic electronic review using the databases such as PubMed, Scopus, ScienceDirect, Google Scholar, Wiley Online Library were carried out from the period of time between 2006 and 2015. For data collection purposes, the study goes through the Malaysian articles in English language, in which some of the considered factors were general management principles, cancer level among the depressed patients, the selection of the psychological therapies and the use of antidepressant medication. However, the evidences are still not enough to present an effective diagnostic method for the depressive disorders in cancer patients, and to find a successful antidepressant drug and/or an appropriate psychotherapy in this group of patients. Hence, many different approaches could be presented for psychotherapy. In conclusion, we found increased hazard rates for the cancer death among psychiatric patients compared to the control group without a registered mental illness.
Reports from non-Asian populations indicate that painful physical symptoms (PPS) are associated with poorer clinical and functional outcomes in major depressive disorder (MDD). The purpose of this study is to report comparative changes in disease severity, treatment patterns and quality of life observed in East Asian patients with MDD, with and without PPS, as assessed prospectively over a 3-month observation period.
The traditional physical and cosmetic-centered model without paying serious attention on the underlying psychosocial issues of care are ill suited to successful treatment outcome of obesity. The objective of this article is to report a case of a retired Malay army sergeant who presented with night eating syndrome (NES) with morbid obesity and dysthymia, and to discuss the psychobiological aspect of the case including to evaluate the effectiveness of the combination treatment of pharmacotherapy and cognitive behavior therapy along with diet counseling. The diagnosis was made by using the Structured Clinical Interview Diagnosis (SCID) for DSM-III-R diagnosis and the severity of depression was assessed by Hamilton Depressive Rating Scale. The patient’s body mass index was 45, He was found to have dysthymia and the Hamilton Depressive Rating Scale score was 13. We found that the combination of pharmacotherapy, cognitive behavior therapy and nutritional education with the help of the physician proved to be effective in treating morbid obesity with NES and Dysthymia.
Objective: The Snaith-Hamilton Pleasure Scale (SHAPS) is a self-assessment scale designed to evaluate anhedonia in various psychiatric disorders. To facilitate its use in Malaysian settings, our current study aimed to examine the validity of the Simplified-Chinese translated version of the SHAPS (SHAPS-SC) in a group of subjects at a university out-patient clinic. Method: A total of 40 depressed patients were recruited in this cross sectional study. They were given both the Simplified Chinese and Malay versions of SHAPS, General Health Questionnaire 12 (GHQ-12) and Beck Depression Inventory (BDI) to assess their hedonic state, general mental health condition and level of depression. Results: Our study showed that SHAPS-SC had impressive internal consistency (Cronbach’s alpha 0.84) and concurrent validity, and fair parallel-forms reliability (Pearson’s correlation 0.39). Conclusion: SHAPS-SC demonstrated good psychometric properties in the evaluation of hedonic state among a group of Chinese speaking depressed patients in an out-patient setting. It is easy to administer and suitable as a valid and reliable questionnaire in assessing anhedonia among depressed patients in Malaysia. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 66-71.
Study site: psychiatric out-patient clinic, University
Malaya Medical Centre (UMMC)
This study identified the effectiveness between home-based and hospital-based pulmonary rehabilitation program on the quality of life of chronic obstructive pulmonary disease (COPD) patients. Thirty five patients who met the inclusion criteria were referred by physicians and randomized to either hospital-based pulmonary rehabilitation (PRPH) or home-based pulmonary rehabilitation (PRPR). The PRPH program was scheduled twice a week for eight weeks at the Physiotherapy Department, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Whilst, the PRPR group was required to attend sessions at the Physiotherapy Department twice to learn the exercise regimens before carrying out the exercises themselves at home. Subjects were asked to record activitites in a diary and a telephone call was made once every two weeks to ensure compliance towards the exercise regimens. The SF-36 questionnaire and Geriatric Depression Scale were outcome measures used in assessing status of patients prior to treatment and after intervention at the 8th week Seventeen (48.6%) subjects completed the PRPH and 15 (43%), the PRPR. Results indicated that in the PRPH group there were significant improvements in some of the domains of SF-36, i.e., role physical (p = 0.012) body pain (p = 0.040), general health (p = 0.008) and role emotional (p = 0.012). In the PRPR group, the Geriatric Depression Scale mean score was 1.8 ± 0.41 at baseline compared to 1.69 ± 0.48 following intervention (p > 0.05). Whilst, among the PRPH group, the mean was 1.87 ± 0.35 at baseline and 1.53 ± 0.52 after eight week (p < 0.05). In conclusion, hospital-based pulmonary rehabilitation is more effective than the home-based pulmonary rehabilitation in improving the quality of life and reducing depression among patients with COPD.
Keywords: Home Based Pulmonary Rehabilitation Program (PRPR); Hospital based Pulmonary Rehabilitation Program (PRPH); COPD; Quality of life (QOL).
Serotonin (5-HT) antagonists and reuptake inhibitors (SARIs) are atypical antidepressants for managing major depressive disorder. They are oftentimes applied as adjuvants for ameliorating aftereffects of SSRI antidepressants including insomnia and sexual dysfunction. The few available candidates of this class including lorpiprazole and trazodone also display some daunting side effects, making a continuous search for improved alternatives essential. Natural β-carboline alkaloids (NβCs) are interestingly renowned with broad pharmacological spectrum against several neuropsychiatric disorders including depression. However, their potentials as SARIs remain underexplored. In this study, 982 NβCs retrieved from the Ambinter-Greenpharma (Amb) database were virtually screened for potent SARI alternatives using computational and biocheminformatics approaches: homology modelling of 5-HT1A receptor, Glide HTVS, SP and XP molecular docking, molecular dynamics (MD) simulation, ADMET and mutagenicity predictions. The homology receptor was validated as a good representative of human 5HT1A receptor using the RCSB structure validation and quality protocols. From the virtual screening against the 5-HT1A receptor, Amb ligands, Amb18709727 and Amb37857532 showed higher binding affinities by XP scores of -8.725 and -7.976 kcal/mol, and MMGBSA of -87.972 and -107.585 kcal/mol respectively compared to lorpiprazole, a reference SARI with XP score and MMGBSA of -6.512 and -62.788 kcal/mol respectively. They maintained ideal contacts with pharmacologically essential amino acid residues implicated in SARI mechanisms and expressed higher stability and compactness than lorpiprazole throughout the trajectories of 100 ns MD simulation. They also displayed interesting ADME, druggability, low toxicity and mutagenicity profiles, ideal for CNS drug prospects, thus, recommended as putative SARI candidates for further study.Communicated by Ramaswamy H. Sarma.
The human serotonin transporters (hSERTs) are neurotransmitter sodium symporters of the aminergic G protein-coupled receptors, regulating the synaptic serotonin and neuropharmacological processes related to neuropsychiatric disorders, notably, depression. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and (S)-citalopram are competitive inhibitors of hSERTs and are commonly the first-line medications for major depressive disorder (MDD). However, treatment-resistance and unpleasant aftereffects constitute their clinical drawbacks. Interestingly, vilazodone emerged with polypharmacological (competitive and allosteric) inhibitions on hSERTs, amenable to improved efficacy. However, its application usually warrants adjuvant/combination therapy, another subject of critical adverse events. Thus, the discovery of alternatives with polypharmacological potentials (one-drug-multiple-target) and improved safety remains essential. In this study, carbazole analogues from chemical libraries were explored using docking and molecular dynamics (MD) simulation. Selectively, two IBScreen ligands, STOCK3S-30866 and STOCK1N-37454 predictively bound to the active pockets and expanded boundaries (extracellular vestibules) of the hSERTs more potently than vilazodone and (S)-citalopram. For instance, the two ligands showed docking scores of -9.52 and -9.59 kcal/mol and MM-GBSA scores of -92.96 and -65.66 kcal/mol respectively compared to vilazodone's respective scores of -7.828 and -59.27 against the central active site of the hSERT (PDB 7LWD). Similarly, the two ligands also docked to the allosteric pocket (PDB 5I73) with scores of -8.15 and -8.40 kcal/mol and MM-GBSA of -96.14 and -68.46 kcal/mol whereas (S)-citalopram has -6.90 and -69.39 kcal/mol respectively. The ligands also conferred conformational stability on the receptors during 100 ns MD simulations and displayed interesting ADMET profiles, representing promising hSERT modulators for MDD upon experimental validation.Communicated by Ramaswamy H. Sarma.
The purpose of this study is to identify the effectiveness of integrative therapy treatment towards
depression and aggression among prison inmates. Integrative therapy in this study refers to treatment
module which are consisted of four integrated theories in a counselling process. It involved the
combined therapy of Person Client Centred (PCC), Rational Emotions Behaviour Therapy (REBT)
and Choice Theory Reality Therapy (CTRT) as technical treatment. Meanwhile, Stimulus Organism
Response (SOR) act as educational principle or training. Integrative therapy is conducted on the
respondents for six session of group counselling. This study is a quasi-experiment involving 160 depressed prison inmates (80 treatment; 80 control) and 140 aggressive inmates (70 treatment; 70
control) from five prison institutions as the respondent for this study using purposive sampling.
Inmates are identified as respondents using high cutting point of depression using Beck Depression
Inventory (BDI) and high aggression using Aggressive Questionnaires (AQ). For the data analysis, nonparametric
test such as Mann-Whitney Test and Wilcoxon Signed Rank Test were used based on the
normality test using Kolmogorov-Smirnov and Shapiro-Wilk test. Result from the Mann-Whitney Test
shows that the treatment group had higher declining rate as compared to the controlled group for
depression and aggression. Wilcoxon Signed Rank Test also shows the same result as the treatment
group indicates a decline in rate from the pre and post of the treatment compared to the controlled
group. The results of this study are hope to act as the medium for using integrative model which is
rarely use in studies in this country especially in the field of treatment for prison inmates. It is also
expected that it can be applied in different setting which offer treatment service such as hospitals,
social work institution, police institute, schools, higher learning institutions and others.
This study was aimed at determining the effect of psychotherapy in patients in bereavement. Fifteen patients in a control group were given brief psychotherapy and 15 study group patients received psychotherapy with a religious perspective. The patients in the study group showed consistently significant improvements as compared with the control group at the end of 6 months. The results indicate that highly religious patients with grief and bereavement tend to improve faster when a religious psychotherapy is added to a cognitive-behaviour approach.
This study was conducted to explore the outcome of psychotherapy in ethnic Malays with strong religious and cultural background. The patients were divided into two groups. The study and control groups consisted of 32 depressed patient each. In the study group brief psychotherapy of 15-20 sessions was attempted with the addition of a religious perspective, while in the control group the religious perspective was omitted. Patients in the study group showed more rapid improvement in the initial 3 months of the study period than those in the control group, but at the end of the 6 months the difference became nonsignificant.
The main objectives in this study were to determine the percentage of psychiatric comorbidity among treatment seeking opioid dependents in Klang Valley. A cross sectional study of opioid dependence patients was conducted between December 2007 and May 2008 at ten community-based drug substitution therapy clinics in Klang Valley. A total of 204 opioid dependence patients participated in the study using the structured clinical interview for DSM-IV Axis I disorders
(SCID-I) as its instruments. The percentage of psychiatric comorbidity among opioid dependents was 43.6%. Major depressive disorder had the highest prevalence at 32.6%, followed by dysthymia at 23.6% and Panic disorder at 14.6%. Psychiatric comorbidity were found to have significant differences (p<0.05) in connection with history of polysubstance abuse, previous history of court sentences (legal status) and family history of psychiatric illnesses. This study showed that the percentage of psychiatric comorbidity is high among the opioid dependents. It highlights the urgent need for the psychiatric comorbidity to be assessed and early intervention is important for this group of patients.
Introduction: In recent years there has been an increase in the number of young people in prison. This
study is the first to look at the proportion of psychiatric disorders among young adult prisoners. Objective: The main objective is to determine the percentage of psychiatric disorders among young adult male prisoners Method: A cross sectional study of young adult male prisoners, with ages ranged between 18 and 21 years old, was conducted between September and December, 2008 at the Kajang Prison. A total of 225 inmates participated in the study which used the Mini International Neuropsychiatric Interview (M.I.N.I) as its instrument. Results: The percentage of psychiatric disorders was 60.0%. Alcohol and substance related disorders had the highest prevalence at 50.2%, followed by Major Depressive Disorders and Dysthymia at 16.9%. About 39.6% were observed to have antisocial personality disorder. Psychiatric disorders were found to have significant differences (p
Objective: Transition of people with cognitive impairment to nursing home is often an option when their disease progresses and their needs become too complex. The aim of this study was to identify the needs of people with cognitive impairment living in nursing homes and factors associated with higher level of needs.
Methods: A cross sectional survey involving 110 respondents with cognitive impairment aged ≥60 was carried out. Respondents were assessed using the Short Mini Mental State Examination (SMMSE), Camberwell Assessment of Needs for Elderly (CANE), Barthel Index (BI), Friendship Scale (FS), and Geriatric Depression Scale (GDS).
Results: Respondents with cognitive impairment had a mean of 2.81 (SD=3.72) for unmet needs and 11.95 (SD=3.14) for the met needs, with higher mean suggesting a better outcome measure. The most frequent unmet needs were intimate relationships (66.40%), company (40.00%), and daytime activity (34.50%). Unmet needs were significantly associated with depression, social isolation, and cognitive impairment.
Conclusion: Most of the needs of people with cognitive impairment in nursing homes were fulfilled, except in social area. Therefore, attention should be given in improving the care system, which emphasizes collaboration between people with cognitive impairment, family members, community, and government in helping to reduce the risk of loneliness in those with cognitive impairment.
The evaluation of mental health among older adults has become increasingly important in health and social science. Although this has been studied in developed countries, there are also issues for emerging countries, which have aging populations. The aims of this study were to determine the prevalence of loneliness/social isolation and late-life depression among older adults with cognitive impairment living in institutional care. Methods: A cross sectional survey involving residents of four government nursing homes in West Malaysia was carried out. All residents aged 60 years old and above with cognitive impairment were included in the study. Participants were assessed by the Short Mini Mental State Examination (SMMSE), Friendship Scale (FS) and Geriatric Depression Scale (GDS). Results: The prevalence of depression and loneliness/social isolation were 85.5% and 95.5% respectively. Depression was strongly associated with age, education attainment, financial conditions, health, cognitive impairment and loneliness/social isolation. Loneliness/social isolation was strongly associated to depression and relationship satisfaction with children. Conclusion: There was high prevalence of depression and loneliness/social isolation among older adults with cognitive impairment living in institutional care. Depression and loneliness/social isolation are interrelated and influence each other and these problems need to be addressed to improve their quality of life.
Device, Questionnaire & Scale: Mini Mental State Examination (MMSE-12); Friendship Scale (FS); Geriatric Depression Scale (GDS-15)