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Association of social support and quality of life among people with schizophrenia receiving community psychiatric service: A cross-sectional study

Munikanan T, Midin M, Daud TIM, Rahim RA, Bakar AKA, Jaafar NRN, et al.

Compr Psychiatry, 2017 05;75:94-102.
PMID: 28342379 DOI: 10.1016/j.comppsych.2017.02.009

OBJECTIVE: To understand the needs of patients with schizophrenia for recovery, this study examined the type and level of social support and its association with quality of life (QOL) among this group of patients in the city of Kuala Lumpur.
METHOD: A cross-sectional study was conducted on 160 individuals with schizophrenia receiving community psychiatric services in Hospital Kuala Lumpur (HKL). The WHOQOL-BREF, Brief Psychiatric Rating Scale (BPRS) and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess QOL, severity of symptoms and social support, respectively. The study respondents were predominantly Malay, aged less than 40, males, single, unmarried, had lower education levels and unemployed.
RESULTS: About 72% of the respondents had poor perceived social support, with support from significant others being the lowest, followed by friends and family. From multiple regression analysis, social support (total, friend and family) significantly predicted better QOL in all domains; [B=0.315 (p<0.001), B=0.670 (p<0.001), B=0.257 (p<0.031)] respectively in Physical Domain; [B=0.491 (p<0.001), B=0.735 (p<0.001), B=0.631 (p<0.001)] in Psychological Domain; [B=1.065 (p<0.001), B=0.670 (p<0.017), B=2.076 (p<0.001)] in Social Domain and; [B=0.652 (p<0.001), B=1.199 (p<0.001), B=0.678 (p<0.001)] in Environmental Domain. Being married and having shorter duration of illness, lower BPRS (total) scores, female gender and smoking, were also found to significantly predict higher QOL.
CONCLUSION: Social support is an important missing component among people with schizophrenia who are already receiving formal psychiatric services in Malaysia.
Meanings of Sexuality: Views from Malay Women with Sexual Dysfunction

Muhamad R, Horey D, Liamputtong P, Low WY, Sidi H

Arch Sex Behav, 2019 04;48(3):935-947.
PMID: 30066036 DOI: 10.1007/s10508-018-1228-1

In Malaysia, female sexual dysfunction (FSD) among Malays is common, so understanding the meanings of sexuality becomes crucial, as they can vary with identity, and this may influence each woman's subsequent reaction to sexual experience. In this article, we explore the meanings of sexuality that Malay women had developed throughout their lived experience. This qualitative study, situated within a social cognitive theory and a phenomenological framework, was conducted through in-depth and photograph elicitation interviews with 26 Malay women who had self-reported experiencing FSD. The findings suggest that the meanings of sexuality for these women linked closely with fundamental factors of Malay identity, which is comprised of tradition (Adat), religion (Islam), and language, that all influence gendered roles. Malay women understood sexuality to be sexual intimacy within marriage, privileging their marital role as a "good wife" over their personal rights within a sexual relationship. This understanding of sexuality was reinforced by meanings attributed to procreation, which Malay women linked closely to the purpose of marriage and their role as a "good mother." The findings should provide useful evidence that could be used in sexual health promotions to help reduce FSD and in clinical practice to generate appropriate therapy in Malaysia and elsewhere.
Serotonin transporter gene polymorphism and its association with bipolar disorder across different ethnic groups in Malaysia

Mohamed Saini S, Nik Jaafar NR, Sidi H, Midin M, Mohd Radzi A, Abdul Rahman AH

Compr Psychiatry, 2014 Jan;55 Suppl 1:S76-81.
PMID: 23410635 DOI: 10.1016/j.comppsych.2012.12.005

The risk variants have been shown to vary substantially across populations and a genetic study in a heterogeneous population might shed a new light in the disease mechanism. This preliminary study aims to determine the frequency of the serotonin transporter gene polymorphism (5-HTTLPR) in the three main ethnic groups in Malaysia and its association with bipolar disorder.
Try to Remember: Interplay between Memory and Substance Use Disorder

Mohamed RMP, Kumar J, Yap E, Mohamed IN, Sidi H, Adam RL, et al.

Curr Drug Targets, 2019;20(2):158-165.
PMID: 28641520 DOI: 10.2174/1389450118666170622092824

Memories associated with substance use disorders, or substance-associated cues increase the likelihood of craving and relapse during abstinence. There is a growing consensus that manipulation of synaptic plasticity may reduce the strength of substance abuse-related memories. On the biological front, there are new insights that suggest memories associated with substance use disorder may follow unique neurobiological pathways that render them more accessible to pharmacological intervention. In parallel to this, research in neurochemistry has identified several potential candidate molecules that could influence the formation and maintenance of long-term memory. Drugs that target these molecules (blebbistatin, isradipine and zeta inhibitory peptide) have shown promise at the preclinical stage. In this review, we shall provide an overview of the evolving understanding on the biochemical mechanisms involved in memory formation and expound on the premise that substance use disorder is a learning disorder.
Fulltext Sexual Dysfunction among Gynaecological Cancer Survivors: A Descriptive Cross-Sectional Study in Malaysia

Mohamad Muhit AM, Sy-Cherng Woon L, Nik Mhd Nor NS, Sidi H, Mohd Kalok AH, Kampan NC, et al.

Int J Environ Res Public Health, 2022 Nov 23;19(23).
PMID: 36497627 DOI: 10.3390/ijerph192315545

BACKGROUND: Sexual dysfunction is a major issue among gynaecological cancer survivors. This study aimed to evaluate the prevalence of sexual dysfunction among survivors of gynaecological cancer in Malaysia and to determine its risk factors.
METHODS: A cross-sectional study was conducted of 116 married women with gynaecological cancer who attended the gynaeoncology and oncology clinics at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Sociodemographic and clinical data were collected. Sexual dysfunction was measured using the Malay Version Female Sexual Function Index (MVFSFI). Univariate and multivariate logistic regression analyses were used to determine the risk factors of female sexual dysfunction.
RESULTS: The prevalence of sexual dysfunction among gynaecological cancer survivors was 60% (70 out of 116). Sexual dissatisfaction was the most prevalent domain of sexual dysfunction at 68.1%. Sexual dysfunction was significantly associated with low education levels (Primary level, AOR = 4.92, 95% CI: 1.12-21.63; secondary level, AOR = 4.06, 95% CI: 1.14-14.44). Non-Malays were significantly more likely to have sexual dysfunction compared with Malays (AOR = 3.57, 95% CI: 1.16-11.06). In terms of treatment, combinations of surgery and radiotherapy (AOR = 4.66, 95% CI: 1.01-21.47) as well as surgery and chemoradiation (AOR = 5.77, 95% CI: 1.20-27.85) were considered.
CONCLUSIONS: Gynaecological cancer survivors with lower education levels, non-Malay ethnicity, and receiving treatment combinations of surgery and radiotherapy or surgery and chemoradiation have a higher risk of sexual dysfunction. A holistic approach in managing the various sociocultural and clinical issues is required to prevent sexual dysfunction among these patients.
Sexual arousal difficulties in women treated with antidepressants: a comparison between escitalopram and fluoxetine

Midi M, Kanagasundram S, Sidi H, Asmidar D, Naing L, Guan NC

Int J Psychiatry Med, 2012;43(4):405-18.
PMID: 23094470

To compare the risk of sexual arousal difficulties between two groups of depressed female patients in remission who were treated with either escitalopram or fluoxetine. Associated factors were also examined.
Female sexual dysfunction in patients with major depressive disorder (MDD) treated with selective serotonin reuptake inhibitor (SSRI) and its association with serotonin 2A-1438 G/A single nucleotide polymorphisms

Masiran R, Sidi H, Mohamed Z, Mohd Nazree NE, Nik Jaafar NR, Midin M, et al.

J Sex Med, 2014 Apr;11(4):1047-1055.
PMID: 24533444 DOI: 10.1111/jsm.12452

INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) are known for their sexual side effects. Different SSRIs may affect different areas of sexual function at different rates.
AIMS: The study aimed to determine the prevalence of female sexual dysfunction (FSD), its clinical correlates, and association with 5HT2A (rs6311) single nucleotide polymorphisms (SNPs) in patients with major depressive disorder (MDD) who were on SSRI therapy.
METHODS: This was a cross-sectional study on 95 female outpatients with MDD treated with SSRI. The patients were in remission as determined by Montgomery-Asberg Depression Rating Scale. Genomic DNA was isolated from buccal swabs and samples were processed using a real time polymerase chain reaction.
MAIN OUTCOME MEASURES: The presence or absence of FSD as measured by the Malay Version of Female Sexual Function Index and 5HT2A-1438 G/A (rs6311) SNP.
RESULTS: The overall prevalence of FSD was 32.6%. After controlling for age, number of children, education level, total monthly income, SSRI types, and SSRI dosing, being employed significantly enhanced FSD by 4.5 times (odds ratio [OR] = 4.51; 95% confidence interval [CI] 1.00, 20.30; P = 0.05). Those having marital problems were 6.7 times more likely to have FSD (OR = 6.67; 95% CI 1.57, 28.34). 5HT2A-1438 G/A (rs6311) SNP was not significantly associated with FSD.
CONCLUSION: There was no significant association between FSD and the 5HT2A (rs6311) SNP in patients with MDD on SSRI therapy. Employment status and marital state were significantly associated with FSD among these patients.
Study site: Psychiatry clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Association between 5HT2A polymorphism and selective serotonin re-uptake inhibitor (SSRI)-induced sexual desire disorder (SDD) among Malaysian women

Masiran R, Sidi H, Mohamed Z, Mohamed Saini S, Nik Jaafar NR

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:41-9.
PMID: 23857836 DOI: 10.1111/appy.12043

SSRIs are known for their sexual side-effects with a variable rate of sexual dysfunction (SD). 5HT2A (rs6311) single nucleotide polymorphism (SNP) was found to have significant association with SD. The purpose of this study was to determine the prevalence of female SDD, its clinical correlates and association with 5HT2A (rs6311) SNP in patients with major depressive disorder (MDD) treated with SSRIs.
Perspectives in Malaysian psychiatry

Maniam T, Sidi H, Razali R

Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:2-3.
PMID: 23857829 DOI: 10.1111/appy.12035
Pre-marital sex and its predicting factors among Malaysian youths

Manaf MR, Tahir MM, Sidi H, Midin M, Nik Jaafar NR, Das S, et al.

Compr Psychiatry, 2014 Jan;55 Suppl 1:S82-8.
PMID: 23587530 DOI: 10.1016/j.comppsych.2013.03.008

This study aimed to examine the prevalence of pre-marital sex and its predicting factors among youth trainees undergoing a national skill training programme in the state of Malaysia.
Is increased libido an atypical symptom of bipolar depression? An interesting case

Mahadevan R, Nik Jaafar NR, Sidi H, Midin M, Das S

J Sex Med, 2013 Mar;10(3):883-6.
PMID: 23036068 DOI: 10.1111/j.1743-6109.2012.02949.x

Decreased libido is recognized as one of the vegetative symptoms of depression. Increased libido has not been acknowledged as one of its symptoms, neither has it been reported, particularly in depressed bipolar patients.
Biological and psychological influences of cross sex hormone in transgender

Ling LS, Sidi H, Lope RAR, Das S, Baharudin A

Curr Drug Targets, 2018 May 11.
PMID: 29749310 DOI: 10.2174/1389450119666180511161420

Transgender is a complex state of bio-psycho-social dimension of human sexuality. It encompasses cognitive-emotional-behavior component that makes the person unique in his or her sexual expression. Transgender tend to use cross sex hormone in order to eradicate their secondary sexual characteristics and to facilitate the shift to their experienced gender. The common masculinising sex hormone use, i.e. Female to Male Treatment Options (FMTO) is testosterone and for feminising hormone i.e. Male to Female Treatment Options (MFTO) is a combination of estrogen with anti-androgen, respectively. Cross sex hormone, i.e. FMTO, or MFTO has biological and psychological influences on the transgender individuals. Nevertheless, cross sex hormone may also poses a range of side effect profiles, varies from the biological to psychosocial impact. The psychological impact can be paramount until it causes severe mental-health problems and even suicide. Numerous ranges of bio-psycho-social influence of cross-sex hormone were highlighted in this review as fundamental core knowledge in the art to know practice when dealing with the treatment options. In psychiatry, the change in the biological appearance may have great influence in the transgender individual, especially in the context of psychosocial and cultural perspective.
Fulltext Validation of the malay version of the hospital anxiety and depression scale among patients with traumatic brain injury.

Leong Abdullah MFI, Sidi H, Ng YP

IIUM Medical Journal Malaysia, 2019;18(2):3-12.
MyJurnal

Depression and anxiety are common complications associated with traumatic brain injury (TBI) patients but screening tools which are validated to assess these complications in the TBI population are scarce. This study investigated the validity of the Malay version of Hospital Anxiety and Depression Scale (HADS) to screen for depression and anxiety among Malaysian TBI patients. Materials and Methods: This cross-sectional study recruited 101 TBI patients in which they were administered the Malay version of HADS and the Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorder 4thEdition (DSM-IV) for Axis I Disorders (SCID-I) (as comparison tool). Internal consistency (Cronbach’s α) and concurrent validity (using receiver operating characteristics) of the Malay version of HADS were evaluated. Results: The total Malay version of HADS score and its anxiety subscale exhibited good internal consistency of 0.80 and 0.78 respectively, but the internal consistency of its depressive subscale was low at 0.57. The depressive subscale of the Malay version of HADS exhibited high area under the curve (AUC) of 0.86, specificity of 82%, sensitivity of 76% and negative predictive value of 91% but its positive predictive value was 58%, at cut-off point of 8/9. While the anxiety subscale also demonstrated high AUC of 0.88, specificity of 71%, sensitivity of 93% and negative predictive value of 98% its positive predictive value was only 34%. Conclusion: The Malay version of HADS is a valid screening tool for depression and anxiety among Malaysian TBI population.
Fulltext Bridging exhibitionism and internet pornography: is there a link?

Lee SC, Sidi H, Zakaria H, Loo JL, Yahaya R

Malaysian Journal of Medicine and Health Sciences, 2018;14(3):51-53.
MyJurnal

Exhibitionism is a distressing condition which may have a link with the increasing availability and usage of online sexual activities (OSA). We highlight a 42-year-old man who presented with a constant craving for OSA to achieve his sexual satisfaction which included exposing his genitalia to virtual partners, unsuspected strangers, and colleagues in public areas. His sexual behaviours were further reinforced by an online video chatting with genitalia exposure, which ended commonly with an exchange of masturbatory acts. He denied any problem with his erection and able to achieve orgasm via common sexual acts. There was no past psychiatric history nor family history of mental disorder. He volunteered to seek psychiatric help and subsequently given a psycho education on his illness and how to cope with the distress associated with his sexual acts. He was scheduled for an intensive psychotherapy to instil insight and hope to deal with his sexual difficulties.
Resolution of Female Sexual Dysfunction (FSD) Among the Obese Multiethnic Malaysian Women Now a Reality with Bariatric Surgery: a Prospective Pilot Study in Malaysia

Lechmiannandan S, Panirselvam M, Muninathan P, Hussin N, Rajan R, Sidi H, et al.

Obes Surg, 2019 05;29(5):1571-1575.
PMID: 30706310 DOI: 10.1007/s11695-019-03722-w

INTRODUCTION: Female sexual dysfunction (FSD) among the obese women is often under diagnosed and ignored especially in Malaysia, a nation of conservative multiethnic society. There are only a few studies on FSD resolution post-bariatric surgery. The objective was to identify the rate and resolution or improvement of FSD, among obese multiethnic Malaysian women post-bariatric surgery.
MATERIAL AND METHODS: This is a prospective study of women undergoing bariatric surgery, between May 2017 and April 2018. FSD was diagnosed using the Malay version of Female Sexual Function Index (MVFSFI) questionnaire. Patients filled up the questionnaire before and 6 months after surgery. Association between BMI reduction and FSFI score improvement was measured using Fisher's exact test. Outcomes between types of surgery (sleeve gastrectomy and gastric bypass) was compared.
RESULTS: Fifty-two women completed the study. The mean age was 38.77 ± 6.7. There were 44 (84.6%) Malay patients, 7 (13.5%) Indian patients, and 1 (1.9%) Chinese patient. There was a significant reduction in mean BMI, 39.89 ± 6.9 pre-surgery to 30.32 ± 5.4 post-surgery (p value
Duration of hypertension and antihypertensive agents in correlation with the phases of female sexual response cycle

Latif RA, Muhamad R, Ann AY, Sidi H, Nik Jaafar NR, Midin M, et al.

Compr Psychiatry, 2014 Jan;55 Suppl 1:S7-12.
PMID: 23206495 DOI: 10.1016/j.comppsych.2012.10.008

This cross-sectional study aimed to determine the construct of the phases of the female sexual response cycle (SRC) in women with hypertension and their association with the duration of hypertension and types of antihypertensive agents.
The Phosphodiasterase 5-Inhibitors (PDE-5i) for Erectile Dysfunction (ED): A Therapeutic Challenge For Psychiatrists

Koon CS, Sidi H, Kumar J, Xi OW, Das S, Hatta MH, et al.

Curr Drug Targets, 2018;19(12):1366-1377.
PMID: 28215172 DOI: 10.2174/1389450118666170215164747

Erectile function (EF) is a prerequisite for satisfactory sexual intercourse (SI) and central to male sexual functioning. Satisfactory SI eventually initiates orgasm - a biopsychophysiological state of euphoria - leading to a sense of bliss, enjoyment and positive mental well being. For a psychiatrist, treating ED is self-propelled to harmonize these pleasurable experiences alongside with encouragement of physical wellness and sensuality. Hence, the role of PDE-5i is pivotal in this context and constitutes a therapeutic challenge. PDE-5i work via the dopaminergic-oxytocin-nitric oxide pathway by increasing the availability of endothelial's guanosine monophosphate (GMP), immediately causing relaxation of the penile smooth muscle and an erection. The PDE-5i, like sildenafil, vardenafil and tadalafil, are effective in the treatment of ED with some benefits/ flexibilities and disadvantages compared to other treatment modalities. Prescribed PDE-5i exclusively improve EF, fostering male's self-confidence and self-esteem. Treatment failures are associated with factors such as absent (or insufficient) sexual stimulation, psychosexual conflicts and the co-existence of medical disorders. Managing ED requires dealing with underlying medical diseases, addressing other co-morbid sexual dysfunctions like premature ejaculation (PE), and educating the patient on healthy life-styles. Furthermore, by dealing with interpersonal dynamics within the couple and embracing adequate lifestyles (managing stress and revising one's sexual scripts), PDE-5i treatment benefits may be enhanced. In this review, we propose a holistic conceptual framework approach for psychiatric management of patients with ED.
Fulltext Sexual function of malay women with type 2 diabetes mellitus: a preliminary study

Kamaralzaman S, Sidi H, Yau M, Budin SB, Sani A, Mohamed J

ASEAN Journal of Psychiatry, 2010;11(1):64-71.
MyJurnal

Objective: Female sexual dysfunction is a known complication of diabetes mellitus. The aims of this study is to estimate the prevalence of sexual dysfunction and the types of sexual dysfunction experienced by Malay women with type 2 diabetes mellitus.
Methods: Cross sectional study was conducted on married Malay women with type 2 diabetes mellitus, receiving treatment from two community clinics in Selangor, Malaysia. Female sexual function was assessed using Malay version of Female Sexual Function Index.
Results: This study found that sexual dysfunction was present among 18.2% women. Lack of libido was the commonest symptom among these women and was observed in 40.9% of women followed by sexual dissatisfaction (36.4%). Sexual arousal disorder was observed in 22.7%, 18.2% complained of lack of lubrication, and 22.7% had vaginal discomfort. Orgasmic dysfunction was found in only 4.5% of these women.
Conclusion: This preliminary research showed sexual desire disorder was the commonest type of sexual disorder among diabetic women.
Fulltext Relationship between sensory neuropathy and body imbalance among diabetic malay women. [Hubungan antara sensori neuropati dan ketidakseimbangan badan di kalangan wanita Melayu diabetik]

Kamaralzaman S, Budin SB, Mohamed J, Sidi H, Yau M, Sani A

Sains Malaysiana, 2011;40(8):945–951.

Neuropathy is a problem often suffered by patients with diabetes mellitus. Types of neuropathy that occur are peripheral neuropathy and autonomic neuropathy. This cross sectional study was conducted to determine the association between duration of diabetes and loss of protective sensation and the association between imbalance and loss of protective sensation among Malay women with diabetes mellitus. Eighty one Malay women with diabetes mellitus, aged 20 to 60 years from three clinics in Hulu Langat District participated in this study. Socio-demographic information were obtained from respondent using a questionnaire. Foot sensory evaluation was conducted using Semmes-Weinstein Monofilament
grade 5.07. Assessment of balance was done using Timed One-leg Stance. Chi-squared test was used to determine the association between the two variables. Result showed that 56.8% of respondent had loss of protective sensation on at least one foot. While, 17.3% had imbalance while eyes were open and 60.5% experienced imbalance while eyes were closed. However, there was no significant correlation (p<0.05) between imbalance while eyes opened [χ2=3.27, p=0.07] and while eyes close [χ2=0.29, p=0.59]) with loss of protective sensation in at least one foot. Similar result were obtained between duration of diabetes and the loss of protective sensation. (χ2=3.27, p=0.20). Although there was no association between these factors, a screening program should start early to ensure early problems are identified before more severe complications occur.
Keywords: Diabetes mellitus; imbalance; loss of protective sensation; Malay women
Study site: Klinik Kesihatan, Hulu Langat, Selangor, Malaysia
The Neurobiology and Psychiatric Perspective of Vaginismus: Linking the Pharmacological and Psycho-Social Interventions

Kadir ZS, Sidi H, Kumar J, Das S, Midin M, Baharuddin N

Curr Drug Targets, 2018;19(8):916-926.
PMID: 28228081 DOI: 10.2174/1389450118666170222153908

Vaginismus is an involuntary muscle contraction of the outer third of vaginal barrel causing sexual penetration almost impossible. It is generally classified under sexual pain disorder (SPD). In Diagnostic and Statistical Manual, 5th edition (DSM-5), it is classified under the new rubric of Genito-Pelvic Pain/Sexual Penetration Disorder. This fear-avoidance condition poses an ongoing significant challenge to the medical and health professionals due to the very demanding needs in health care despite its unpredictable prognosis. The etiology of vaginismus is complex: through multiple biopsycho- social processes, involving bidirectional connections between pelvic-genital (local) and higher mental function (central regulation). It has robust neural and psychological-cognitive loop feedback involvement. The internal neural circuit involves an inter-play of at least two-pathway systems, i.e. both "quick threat assessment" of occipital-limbic-occipital-prefrontal-pelvic-genital; and the chronic pain pathways through the genito-spinothalamic-parietal-pre-frontal system, respectively. In this review, a neurobiology root of vaginismus is deliberated with the central role of an emotional-regulating amygdala, and other neural loop, i.e. hippocampus and neo-cortex in the core psychopathology of fear, disgust, and sexual avoidance. Many therapists view vaginismus as a neglected art-and-science which demands a better and deeper understanding on the clinico-pathological correlation to enhance an effective model for the bio-psycho-social treatment. As vaginismus has a strong presentation in psychopathology, i.e. fear of penetration, phobic avoidance, disgust, and anticipatory anxiety, we highlighted a practical psychiatric approach to the clinical management of vaginismus, based on the current core knowledge in the perspective of neuroscience.

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