Objective: To assess psychiatric morbidity, personality profiles and saliva cortisol levels in overweight and obese individuals at dietician clinic. Method: This cross-sectional study is based on individuals who attended dietician clinic between June to November 2008. They had completed questionnaires that included General Health Questionnaire 30-items, assessment for psychiatric illness using Structured Clinical Interview for DSM-IV and personality profiles using Personality Assessment Schedule. Saliva and body mass index were taken. Results: Of the 102 patients, 16 (15.7%) were diagnosed to have psychiatric illness. There were no differences between obese and overweight patients in terms of personality traits and psychological problem. Presence of psychiatric illness was associated with higher mean body mass index. Saliva cortisol levels were not elevated in patients who had psychiatric illness. Conclusions: Psychiatric illnesses are common in individuals who seek weight treatment. Careful psychological evaluation is important at (or before) commencement of a diet program.
Objective: To study the demographic data of patients and the pattern of crime in the study group, to look at the outcome of assessment by psychiatrist on fitness to plea and insanity at time of offense and to assess association between the nature of crime with presence of psychopathology during the crime. Method: This is a retrospective study. All available case notes for 342 forensic admissions from January 2007 until March 2010 were reviewed. All related information on 135 patients that committed violent crime was taken for analysis. Result: Majority of patients were male, Malay, single, education up to secondary school and unemployed. Only 38% of patients had encountered psychiatric services, 20% had previous imprisonment and 49% had history of substance usage. In cases involving victims (87%), 64% the victims were known to the patient, 53% had hallucination or delusion or both at the time of crime and 90% was found to have some diagnosis of mental illness after psychiatrist assessment. Only 81% of formal forensic reports were available in the case note and it showed 94% were fit to plea and 82% were at sound mind at the time of offense. Conclusion: Substance abuse had high prevalence among the patient. Almost 2/3 never had any encounter with psychiatric services before the admission. Even with the high percentage of patient diagnosed with mental illness, they were still found to be fit to plea in court and are at sound mind at the time of offense
This study aims to determine the prevalence of obsessive compulsive disorder (OCD) among schizophrenic patients and the association of this condition with clinical and selected neurocognitive factors. This is a cross sectional study on one hundred schizophrenic patients who attended psychiatric clinic in National University Hospital and Kuala Lumpur Hospital over a four-months period. All patients diagnosed as schizophrenia according to DSM 1V were assessed using Mini International Neuropsychiatric Interview (MINI) Version 5 for the presence of Obsessive Compulsive Disorder, Brief Psychiatric rating Scale (BPRS) for severity of psychosis and Yale Brown Obsessive Compulsive Scale (YBOCS) for severity of obsessive compulsive (OC) symptoms. Socio-demographic data were obtained by direct interview. The neurocognitive assessment were done using Mini Mental State Examination , Rey Auditory Verbal Learning Test (RAVLT) and Digit Span. Fifteen percent of schizophrenic patients (15%) in this sample were found to have a diagnosis of Obsessive compulsive Disorder (OCD). The OCD and non-OCD schizophrenic patients did not differ significantly in term of age ,gender, race and family history of mental illness. However they differ significantly on employment, type of treatment medication and the presence or severity of current psychosis. Schizophrenic patients with OCD also showed no significant different in selected neurocognitive functions.
Introduction: Patients with mental disorders in Malaysia often seek help from traditional healers prior to consulting psychiatric service. The objective of the study is to determine the prevalence and experience of contact with traditional healers among patients with first-episode psychosis in Hospital Kuala Lumpur (HKL). Methods: This is a hospital-based cross-sectional descriptive study of 50 in-patients with first-episode psychosis in HKL. Structured Clinical Interview for DSM-IV Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Socio-demographic data, information on help-seeking pathways, and experience of contact with traditional healers were determined through face-to-face interview and semi-structured questionnaires. Results: Twenty seven (54%) of the patients had at least one contact with traditional healers prior to consulting psychiatric service, and it was the most popular first point of non-psychiatric help-seeking contact (48%). About a quarter of them (24%) had 3 or more contacts with traditional healers prior to consulting psychiatric service. The most common type of traditional treatment received was prayer (25, 96.3%). Only 2 patients (7.41%) reported having some beneficial effects from traditional treatments. There were two patients who reported having adverse experience with traditional healers. Among those who had sought help from traditional healers, one third was recommended by at least one of their traditional healers to seek medical help. Conclusion: History of contact with traditional healers prior to consulting psychiatric service was common among inpatients with first-episode psychosis in HKL. There may be potential meaningful collaborations between psychiatrists and traditional healers for better management of patients.
About 60% of people with mental illness developed co-morbid medical and physical illness that invariably worsens their lives. However, most of the studies regarding this issue were done either in the out-patient or community settings, ignoring long stay inpatients. Locally, no data exists among long stay patients in psychiatric institutions. The aim of this retrospective study was to look at the prevalence of physical illness among long-stay patients and to compare the occurrence of physical illness before and after admission to the psychiatric institution. We found that 85 (63.4%) out of 134 subjects there was suffering with co-morbid physical and medical illnesses. There were 33 (24.6%) subjects with hyperlipidaemia, 22 (16.4%) subjects with hypertension and 17 (12.7%) subjects with diabetes. Approximately 75 (55.9%) subjects developed medical illness after admission. In conclusion, long-stay psychiatric patients are at a high risk of developing medical problems that tends to begin after admission to the psychiatric institution.
Study site: Hospital Bahagia, Ulu Kinta, Perak, Malaysia
Mental health difficulties in children are often missed or dismissed. Adults too are often wary of bringing their children to such a facility. This paper is a descriptive study of a child mental health service utilization in Kuala Lumpur. Methods: The cases consisted of new cases from the month of January to December 2007 who attended the Psychiatry Adolescent and Child (PAC) Unit, University Malaya Medical Center (UMMC). Results: The children presented with a range of development, academic, behavior and emotional difficulties. There were 373 new cases of which the highest number of children were in the primary school-going age group (54.7%) and males (65.4%). Sixty percent of the cases had one single diagnosis. Children with Attention Deficit Hyperactive Disorder (ADHD) were the highest disorder seen in the single diagnosis group (27.3%) as well as in those with more than one diagnosis (61.5%). Primary support group difficulties were the most common co-morbid condition noted. Conclusion: It is essential that extensive screening of children and their families be done to detect family difficulties and co- morbid conditions, which would be necessary for favorable outcomes to be met.
Medical professionalism is now more crucial than ever. Recently, more and more misconduct among doctors widely portrayed and unashamedly publicized by the popular press. Medical Schools in Malaysia are working hard to rectify their weaknesses so that their products are competent and professional doctors. Cyberjaya University College of Medical Sciences (CUCMS) certainly views this matter seriously and has incorporated professionalism training or as we call it Affective Domain Training into the curriculum implemented in all phases of the medical education. An example is the innovative inclusion of Community Project in the curriculum of undergraduate psychiatry. Although it started off with wanting to get students involved in creating awareness amongst the public about mental illness, but through it, students attained exposure in leadership, team-working and communication skills as well as what it means to be altruistic, to work under stress, to be empathic and many more. The students themselves enjoyed it. Although the down side include extra time, money and manpower, it can be safely concluded that having a community project in psychiatry undergraduate curriculum or other specialties for that matter could be an innovative and enjoyable way to nurture medical professionalism.
The discipline of psychiatry requires the use of thinking skills to perform a number of tasks. The assessment of a patient’s history, his mental state especially the evaluation of thought disorders, the formulation of a diagnosis and differential diagnosis, the formulation of a management plan for what are often complex human problems and the wise application of therapeutic techniques, all require complex thinking skills. The process of communication with patients and their relatives is often fraught with pitfalls that requires a thoughtful approach that makes use of consciously shared information as well as non-verbal information. Evaluating scientific papers is another area that requires critical thinking. At times the lack of critical thinking is painfully apparent. It appears that schools, and sadly universities too, are merely training people and not educating them. Occasionally, of course, one is pleasantly surprised to come across a student with a very sharp and critical mind.
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.
Previous studies have shown that the experience of infertility is linked with psychological responses such as depression, anxiety, guilt, social isolation, and decreased self-esteem in both men and women. The prevalence of depression among infertile women ranges from 8% to 54%. Treating gynecologists and healthcare professionals seldom recognized the psychosocial distress in women undergoing fertility treatment. Therefore this paper reviewed the bio-psychosocial response towards infertility among women with infertility.
Background: Duke University Religion Index (DUREL) is a brief and easy to use instrument for measurement of religious commitment. Objective: The aim of this study was to validate the Malay version of DUREL (DUREL-M) among a group of nursing students. Methods: This is a cross-sectional validation study conducted in a nursing school involved a group of year 1 nursing students. The students were given the Malay version of DUREL, Malay version of General Health Questionnaire (GHQ), Malay version of Brief COPE, Malay version of Depression Anxiety Stress Scale (DASS21), English version of DUREL. A week later, they were again given the Malay version of DUREL. Results: The instrument displayed good parallel reliability (0.70), test-retest reliability (0.68) (Spearman’s rho, p.
Living with borderline personality disorder (BPD) involves a lot of emotional suffering which may be hidden behind the complex and controversial nature of the condition and treatment. The condition is still largely under-diagnosed, undertreated and stigmatized. This paper described the emotional battle faced by a patient living with the disorder and the application of psychosocial treatments in helping her to recover.
This short report aims to describe the Circle of Care (COC) Project in Malaysia. This is an example of smart partnership between the Malaysian Psychiatric Association (MPA) and Johnson and Johnson which began in 2003. By means of philanthropic funds from an industrial company, many people have benefited in many different aspects through the project. It consists of three main psychosocial activities: education and support programme for carers and families of people with mental illness; psychosocial rehabilitation for patients with mental illness; and mass education for the people in promoting mental health and prevention of mental health problems and illness. To date, the project has either fully or partially funded hundreds of activities along the line of these three objectives. While there has been growth of psychosocial interventions in the country contributed by the project, it is faced with a few challenges which are becoming the next focus of actions of MPA.
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.
Alot has been said and debated about evidence-based clinical practice. What is it really and why so much of significance is attached to it? Is all the evidence from clinical trials relevant and reliable? How about experience-based clinical practice? How much of our practice is influenced by clinical data and how much of it by years of practice and number of patients managed? The clinician will still need to exercise common sense when treating patients and they must always remember that each individual patient is unique and a clinician’s approach will have to be catered to their needs. After all, the caveat is that we are treating individuals with feelings and emotions and not textbooks or journal articles.
Postnatal depression is common and affects 10-15% of postpartum women. While there are many studies on the depressive episode in the postnatal period, its association with the bipolar spectrum disorder is often go unrecognized and undiagnosed.
Objective: To study the rate of bipolar spectrum disorder in mothers presented with postpartum depression and its associated factors.
Method: This is a cross sectional study on the women who visited the postnatal clinic in University Malaya Medical Centre. Subjects who consented were asked to complete a short questionnaire looking at the socio-demographic details and asked to answer the Multidimensional Scale of Perceived Social Support (MSPSS), Mood Disorder questionnaire (MDQ) and Edinburgh Postnatal Depression Scale (EPDS) whish assess the perceived social support and mood disorder.
Result: A total of 93 women were recruited into the study. Independent t-test and stepwise regression analysis identified that unemployment and baby with health problem were the only associated factors for postnatal depression. 28.6% of the mother with possible postnatal depression (EPDS = 12) might have bipoar spectrum disorder (MDQ = 7).
Conclusion: Postnatal depression as part of bipolar spectrum disorder needed additional attention. Postnatal check with screening tools may help to identify mood disturbance in postpartum women
Study site: Postnatal clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
This study aimed to determine the psychosocial factors associated with school truancy in secondary school students attending three high risk schools in Kuala Lumpur. It is a cross-sectional study involving 373 Form Four students. Socio demographic, family, living and school characteristics of the respondents were obtained through self-administered questionnaires. There were significantly greater percentage of divorced parents (p=0.025, OR=2.52, 1.01
The aim of review was to find the recent evidence for the management of conversion disorder. The study was conducted at the Psychiatry Unit of Govt. Lady Reading Hospital, Peshawar, Pakistan. A systematic literature search was done using Medline and Extra Medline. A total of 10 articles fulfilled the inclusion criteria. In the literature reviewed hypnosis and self hypnosis, psychoanalytical intervention, behavioral intervention, paradoxical intervention, treatment by strong suggestion and trans-cranial magnetic stimulation were the treatments used by the clinicians for the management of conversion disorder. Conclusion: The literature review did not give details concerning the treatment used for conversion disorders adequately. Behavioral interventions were in general found to be more successful treatment course for the management of conversion disorders.
Objective: The objective of the study is to compare insight in Schizophrenia, bipolar affective disorder with psychosis and major depressive disorder with psychosis. Also to ascertain if impaired insight is associated with poorer psychosocial function. Method: 90 consecutively'admitted patients who were diagnosed with Schizophrenia, bipolar affective disorder with psychosis and major depressive disorder with psychosis were administered the scale to assess unawareness to mental illness to measure insight, the global assessment of function to measure psychosocial function and the brief psychiatric rating scale to measure psychosis.
Results: Schizophrenia was found to be associated wit h the poorest insight compared to the affective disorders. Major depression with psychosis was found to be associated with better insight than bipolar affective disorder. Results being significant in both cases. Also it was noted that there was a negative correlation between insight and psychosocial function.
Conclusion: We can conclude that Schizophrenics have the poorest insight followed by bipolar affective disorder with psychosis and then major depressive disorder with psychosis. We also infer that Schizophrenics have the poorest psychosocial function followed by bipolar affective disorder with psychosis and then major depressive disorder patients with psychosis. Also impaired insight is associated with impaired function.