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Fulltext Psychological impact of coronavirus outbreak on borderline personality disorder from the perspective of mentalizing model: A case report

Chong SC

Asian J Psychiatr, 2020 Aug;52:102130.
PMID: 32361209 DOI: 10.1016/j.ajp.2020.102130
Psychometric properties of the Medical Student Well-Being Index among medical students in a Malaysian medical school

Yusoff MS, Yaacob MJ, Naing NN, Esa AR

Asian J Psychiatr, 2013 Feb;6(1):60-5.
PMID: 23380320 DOI: 10.1016/j.ajp.2012.09.001

This study evaluated the convergent, discriminant, construct, concurrent and discriminative validity of the Medical Student Wellbeing Index (MSWBI) as well as to evaluate its internal consistency and optimal cut-off total scores to detect at least moderate levels of general psychological distress, stress, anxiety and depression symptoms. A cross sectional study was done on 171 medical students. The MSWBI and DASS-21 were administered and returned immediately upon completion. Confirmatory factor analysis, reliability analysis, ROC analysis and Pearson correlation test were applied to assess psychometric properties of the MSWBI. A total of 168 (98.2%) medical students responded. The goodness of fit indices showed the MSWBI had a good construct (χ(2)=6.14, p=0.803, RMSEA<0.001, RMR=0.004, GFI=0.99, AGFI=0.97, CFI=1.00, IFI=1.02, TLI=1.04). The Cronbach's alpha value was 0.69 indicating an acceptable level of internal consistency. Pearson correlation coefficients and ROC analysis suggested each MSWBI's item showed adequate convergent and discriminant validity. Its optimal cut-off scores to detect at least moderate levels of general psychological distress, stress, anxiety, and depression were 1.5, 2.5, 1.5 and 2.5 respectively with sensitivity and specificity ranged from 62 to 80% and the areas under ROC curve ranged from 0.71 to 0.83. This study showed that the MSWBI had good level of psychometric properties. The MSWBI score more than 2 can be considered as having significant psychological distress. The MSWBI is a valid and reliable screening instrument to assess psychological distress of medical students.
Psychometric validation of revised Olweus Bully/Victim Questionnaire (OBVQ-R) among adolescents in Bangladesh

Mahmood S, Siraji MA, Naher R, Arató N, Kaló Z

Asian J Psychiatr, 2023 Feb 17;83:103514.
PMID: 36906995 DOI: 10.1016/j.ajp.2023.103514

BACKGROUND: The assessment of bullying-related attributes is vital in developing anti-bullying intervention and prevention programs. The revised Olweus Bully/Victim Questionnaire (OBVQ-R) is one tool that has been widely used for this purpose. Thus, as we noticed a rising interest in research on bullying and there is a scarcity of proper psychometric tools to assess bullying-related attributes in Bangladesh, our study aimed to translate the OBVQ-R and test the psychometric properties of the Bangla version of this questionnaire on a large Bangladeshi adolescent sample.
METHOD: In Bangladesh, we collected data from grade 8-10 students (N = 567, 309 females, 258 males, AgeMean±SD=15.12 ± 0.81). The participants completed Bangla OBVQ-R, Beck Youth Inventory (BYI), and Children's Revised Impact of Events Scale-13 (CRIES-13).
RESULTS: The item response theory (IRT) analysis discarded five items and retained 15 items (Victimization=8, Perpetration=7). Both subscales had items with high discrimination (Victimization: 3.14 ± 0.67; Perpetration: 3.40 ± 1.04). Confirmatory factor analysis supported a correlated two-factor model (CFI=0.99; TLI=0.99). Both subscales (Victimization and Perpetration) and the 15-item full scale exhibited satisfactory reliability (>0.80). In line with our predictions, both subscales demonstrated significant positive correlations with BYI and CRIES-13, indicating satisfactory concurrent validity.
CONCLUSION: The results of the psychometric analyses supported the reliability and validity of the 15-item Bangla-version OBVQ-R to assess bullying involvement. Hence, this new, adapted measurement can facilitate further bullying research in Bangladesh and, thus, the development of prevention and intervention programs.
Fulltext Psychosocial support for healthcare frontliners during COVID-19 pandemic in Malaysia

Bakar AYA, Ramli S

Asian J Psychiatr, 2020 Dec;54:102272.
PMID: 32653851 DOI: 10.1016/j.ajp.2020.102272
Public knowledge and beliefs about depression among urban and rural Chinese in Malaysia

Loo PW, Furnham A

Asian J Psychiatr, 2012 Sep;5(3):236-45.
PMID: 22981052 DOI: 10.1016/j.ajp.2012.02.003

The study compared knowledge and beliefs about depression among urban and rural Chinese in a Malaysian sample. A total of 409 participants were asked to identify cases of depression varying in intensity from two vignettes and rate their beliefs regarding a list of possible causes and treatments for depression. The urban Chinese were more likely to identify depression as the problem in the vignette. Beliefs about causes of depression were factored into five components, whereas beliefs about treatment for depression factored into four components. The results indicated that the causes most strongly endorsed were stress and pressure, and standard treatments rated the highest as treatments for depression. Overall, depression literacy was moderate for Chinese Malaysians. The results are discussed in relation to Chinese cultural beliefs about depression. Limitations of this preliminary study were acknowledged.
Fulltext Reducing the stigma of mental health disorders with a focus on low- and middle-income countries

Javed A, Lee C, Zakaria H, Buenaventura RD, Cetkovich-Bakmas M, Duailibi K, et al.

Asian J Psychiatr, 2021 Apr;58:102601.
PMID: 33611083 DOI: 10.1016/j.ajp.2021.102601

Mental health disorders are a burgeoning global public health challenge, and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80 % of the mental health disease burden. Stigma associated with mental health results in delayed help seeking, reduced access to health services, suboptimal treatment, poor outcomes and an increased risk of individuals' human rights violations. Moreover, widespread co-occurrence of physical comorbidities such as noncommunicable diseases with mental health disorders makes the treatment of both conditions challenging and worsens prognosis. This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals (mental health professionals, non-psychiatric specialists and general practitioners) imparting mental health care. Cultural, socio-economic and religious factors determine various aspects of mental health in LMICs, ranging from perceptions of health and illness, health seeking behavior, attitudes of the individuals and health practitioners and mental health systems. Addressing stigma requires comprehensive and inclusive mental health policies and legislations; sustainable and culturally-adapted awareness programs; capacity building of mental health workforce through task-shifting and interprofessional approaches; and improved access to mental health services by integration with primary healthcare and utilizing existing pathways of care. Future strategies targeting stigma reduction must consider the enormous physical comorbidity burden associated with mental health, prioritize workplace interventions and importantly, address the deterioration of population mental health from the COVID-19 pandemic.
Regional update: Cambodia

Deva MP, D'Souza R, Sundram S

Asian J Psychiatr, 2009 Oct;2(3):120-1.
PMID: 23051055 DOI: 10.1016/j.ajp.2009.09.001

Cambodia is a developing south-east Asian country located in the fertile Mekong delta. Its recent past has been complicated by European colonialism and internal conflict. Health including mental health services are limited and sparse in regional and rural areas. Very constrained public mental health facilities and services are hampered by a shortage of a skilled workforce and insufficient training programs. The recent formation of the Mental Health Association of Cambodia promises to be a positive step forward in promoting mental health throughout the country.
Fulltext Remote Psychological First Aid (rPFA) in the time of Covid-19: A preliminary report of the Malaysian experience

Francis B, Juares Rizal A, Ahmad Sabki Z, Sulaiman AH

Asian J Psychiatr, 2020 Dec;54:102240.
PMID: 32593120 DOI: 10.1016/j.ajp.2020.102240
School refusal in adolescents with systemic lupus erythematosus (SLE): A case series

Lee KKS, Chong JQ, Abu Bakar AK

Asian J Psychiatr, 2018 Apr;34:59-60.
PMID: 29653342 DOI: 10.1016/j.ajp.2018.04.021
Screening for schizophrenia in initial prodromal phase: Detecting the sub-threshold psychosis

Razali SM, Abidin ZZ, Othman Z, Yassin MA

Asian J Psychiatr, 2015 Aug;16:26-31.
PMID: 26182843 DOI: 10.1016/j.ajp.2015.06.011

The aim of the study is to screen and evaluate the efficacy of the screening tools in detecting subjects with sub-threshold psychosis among asymptomatic individuals at genetic risk, as compared with persons in the general public.
Social anhedonia in Malaysian schizophrenia patients and healthy participants

Balasingam K, Kanagasundram S, Ann AYH, Kasmuri K, Gooding DC

Asian J Psychiatr, 2023 Jan;79:103350.
PMID: 36462388 DOI: 10.1016/j.ajp.2022.103350

The reduced capacity for social and interpersonal interactions, social anhedonia, is an important aspect of various psychiatric disorders, especially schizophrenia-spectrum disorders. The goal of the present study was to validate a Malay translation of the adult version of the Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS; Gooding and Pflum, 2014), a relatively short and easy to administer indirect measure of social anhedonia. This cross-sectional study included 95 (47 male, 48 female) schizophrenia patients and 300 (77 male, 223 female) healthy subjects. Participants were given Malay versions of the ACIPS, Snaith Hamilton Pleasure Scale (SHAPS-M), and Beck Depression Inventory (BDI-M). The ACIPS exhibited good internal consistency (Ordinal alpha = 0.966). Total ACIPS scores were inversely correlated with the BDI-M scores, and positively correlated with total SHAPS-M scores. Factor analysis yielded a three-factor solution which accounted for 52.06% of the variance. As expected, the schizophrenia patients scored significantly lower than the healthy community participants on the ACIPS, t(130) = 4.26, p
Suicidal behaviors and associated factors among university students in six countries in the Association of Southeast Asian Nations (ASEAN)

Peltzer K, Yi S, Pengpid S

Asian J Psychiatr, 2017 Apr;26:32-38.
PMID: 28483087 DOI: 10.1016/j.ajp.2017.01.019

A large data gap remains on suicidal behaviors among youth in the Association of Southeast Asian Nations (ASEAN) countries, despite the increasing rates of suicide in Asian cultures that may be related to rapid economic changes and the loss of social stability. This study was therefore conducted to explore the prevalence of and factors associated with suicidal ideation and suicide attempts among university students in six ASEAN member states. Data were collected in a cross-sectional survey of 4675 undergraduate university students, mean age 20.6 years (SD=2.7), range of 18-30 years, from Cambodia, Indonesia, Malaysia, Myanmar, Thailand and Vietnam. The overall prevalence of ever suicidal ideation and ever suicide attempt among students in this study was 11.7% and 2.4%, respectively. Different rates of these suicidal behaviors were observed across the countries. In multivariable logistic regression models, suicidal ideation was significantly associated with psychosocial factors including childhood sexual abuse, depressive symptoms, involvement in physical fights, and poor academic performance as well as socio-environmental factors including living with parents or guardians and low involvement in organized religious activity. Suicide attempt was significantly associated with childhood sexual abuse, depressive symptoms, low involvement in organized religious activity and being underweight or overweight. Our findings suggest that individual-level strategies for suicide prevention should be targeted toward students with poor academic performance, mental health problems and a history of adverse childhood experiences. Particular attention should be paid to the role of families that could be a potential stressor in the lives of university students.
Teacher ratings of ODD symptoms: measurement equivalence across Malaysian Malay, Chinese and Indian children

Gomez R

Asian J Psychiatr, 2014 Apr;8:52-5.
PMID: 24655627 DOI: 10.1016/j.ajp.2013.10.017

The study examined the measurement equivalence for teacher ratings across Malaysian Malay, Chinese and Indian children.
The asian Federation of psychiatric associations society section

Parameshwara Dev M

Asian J Psychiatr, 2008 Sep;1(1):15-9.
PMID: 23050980 DOI: 10.1016/j.ajp.2008.07.007
The burden of HIV-associated neurocognitive disorder (HAND) in the Asia-Pacific region and recommendations for screening

Ian E, Gwen CL, Soo CT, Melissa C, Chun-Kai H, Eosu K, et al.

Asian J Psychiatr, 2016 Aug;22:182-9.
PMID: 26617385 DOI: 10.1016/j.ajp.2015.10.009

HIV-associated neurocognitive disorder incurs a significant burden on HIV patients in Asia-Pacific countries; however, the incidence is difficult to estimate due to a lack of local epidemiological data. The impact of neurocognitive impairment in HIV patients is often underestimated due to a lack of education and awareness, and there are consequently gaps in the provision of screening and diagnosis to enable earlier intervention to limit neurocognitive impairment.
The cascade to a serendipitous discovery of lithium-induced nephrogenic diabetes insipidus

Chandrasekaran PK, Yan Qi OW, O Brien FM

Asian J Psychiatr, 2021 Dec;66:102884.
PMID: 34740125 DOI: 10.1016/j.ajp.2021.102884

Lithium therapy is a common treatment for affective disorders and is widely regarded as a lifesaving drug. However, because its elimination is almost wholly unchanged via the kidneys, both acute and long-term adverse effects relating to toxicity may occur, including declining renal function and nephrogenic diabetes insipidus (DI). DI may be difficult to detect and is frequently preceded by dehydration and which, in our patient, was discovered by chance. We describe a case of an elderly woman on chronic lithium therapy for bipolar affective disorder who initially presented with dehydration from vomiting but possibly developed extra-pontine myelinolysis (EPM) after over-zealous correction of hyponatraemia. Steroids administered appeared to have prevented further progression but a persisting hyperosmolar state then alerted us to the presence of nephrogenic DI. Although both conditions were later successfully reversed with no obvious chronic sequelae, the recovery of the patient was protracted. Clinicians should be vigilant for complications of managing dehydration states in people prescribed with lithium.
The fear of what goes up must come down: A case report of vulnerable narcissism

Chong SC, Ang JK, Hashim H

Asian J Psychiatr, 2020 Dec;54:102117.
PMID: 32623189 DOI: 10.1016/j.ajp.2020.102117

Pathological narcissism or narcissistic personality disorder is commonly characterized by an exaggerated sense of self-importance, condescending attitude, need for excessive admiration, diminished empathy and exploitativeness. In contrast to these overt attributes, there is a different presentation of pathological narcissism which is underrecognized, as one's preoccupation with hypervigilant, self-effacement and proneness to shame in the context of covert grandiose fantasies. This report illustrates a patient who had this subtype of vulnerable narcissism, and how his defence had been activated to preserve own self agency during a session with the doctor by revealing his paraphilic fantasy.
The prevalence and clinical correlates of suicide attempts in patients with bipolar disorder misdiagnosed with major depressive disorder: Results from a national survey in China

Chen L, Xu YY, Lin JY, Ji ZP, Yang F, Tan S, et al.

Asian J Psychiatr, 2024 Mar;93:103958.
PMID: 38364597 DOI: 10.1016/j.ajp.2024.103958

BACKGROUND AND AIM: Suicide is nearly always associated with underlying mental disorders. Risk factors for suicide attempts (SAs) in patients with bipolar disorder (BD) misdiagnosed with major depressive disorder (MDD) remain unelucidated. This study was to evaluate the prevalence and clinical risk factors of SAs in Chinese patients with BD misdiagnosed with MDD.
METHODS: A total of 1487 patients with MDD from 13 mental health institutions in China were enrolled. Mini International Neuropsychiatric Interview (MINI) was used to identify patients with BD who are misdiagnosed as MDD. The general sociodemographic and clinical data of the patients were collected and MINI suicide module was used to identify patients with SAs in these misdiagnosed patients.
RESULTS: In China, 20.6% of patients with BD were incorrectly diagnosed as having MDD. Among these misdiagnosed patients, 26.5% had attempted suicide. These patients tended to be older, had a higher number of hospitalizations, and were more likely to experience frequent and seasonal depressive episodes with atypical features, psychotic symptoms, and suicidal thoughts. Frequent depressive episodes and suicidal thoughts during depression were identified as independent risk factors for SAs. Additionally, significant sociodemographic and clinical differences were found between individuals misdiagnosed with MDD in BD and patients with MDD who have attempted suicide.
CONCLUSIONS: This study highlights the importance of accurate diagnosis in individuals with BD and provide valuable insights for the targeted identification and intervention of individuals with BD misdiagnosed as having MDD and those with genuine MDD, particularly in relation to suicidal behavior.
The prevalence of psychotic symptoms in kratom (Mitragyna speciosa Korth.) Users in Malaysia

Leong Bin Abdullah MFI, Singh D, Swogger MT, Rahim AA, Vicknasingam B

Asian J Psychiatr, 2019 Jun;43:197-201.
PMID: 31302592 DOI: 10.1016/j.ajp.2019.07.008

BACKGROUND: Kratom is a traditional medicinal herb widely used in Malaysia and Thailand. Despite its widespread use and statements by regulatory agencies on the potential for kratom-associated psychosis, there is little data regarding the prevalence of psychotic symptoms among kratom users. This study investigated the prevalence of psychosis among kratom users, described psychotic symptomatology and severity, while examining associations between kratom use characteristics and the occurrence of psychotic symptoms.
METHODS: This cross-sectional clinical survey recruited 150 regular kratom users. The Mini International Neuropsychiatric Interview (MINI) and Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) diagnostic criteria were used to evaluate psychotic symptomatology among kratom users, and the Brief Psychiatric Rating Scale (BPRS) was used to assess the severity of psychiatric symptoms. Chi-square tests with Yate's correction were performed to determine the association between kratom use characteristics and the occurrence of psychotic symptoms among kratom users in this study.
RESULTS: Six out of 150 kratom users (4%) presented with any psychotic symptoms. The psychotic symptoms reported were positive symptoms and thought alienation, with a mean BPRS score of 33 (i.e., mild severity). Variables related to kratom use (such as intake of kratom with diphenhydramine, duration of kratom use, and quantity and frequency of daily kratom use) were not associated with the occurrence of psychotic symptoms among kratom users.
CONCLUSION: Although psychotic symptoms could occur among regular kratom users, they were rare and not significantly associated with kratom use characteristics. We found no evidence of elevated psychosis among regular users.
The utility and cultural specificity of cognitive-based interventions in preventing cognitive decline among healthy older adults in Asia: A systematic review

Vasantha Kumar P, Subramaniam P, Che Din N

Asian J Psychiatr, 2021 Jun;60:102646.
PMID: 33873045 DOI: 10.1016/j.ajp.2021.102646

BACKGROUND: The effects of aging and its associated cognitive decline is particularly acute in Asia given the exponential growth of older adults as a proportion of the population as a whole. Many structured cognitive interventions have been proposed to prevent the cognitive decline typically seen in older age, but their utility as a viable means of achieving these goals is questionable.
OBJECTIVES: To summarize and synthesize evidence on the utility and methodological quality of cognitive-based interventions on cognitive performance and associated secondary outcomes among healthy older adults in Asia, as well as novel, culture-specific components of cognitive interventions across the region.
DATA SOURCES: The PubMed/Medline, Web of Science, Scopus, and ScienceDirect databases were searched through May 2020.
ELIGIBILITY: Studies including individuals aged 60 years and above, who had no previous history of physical and/or mental illness. Few restrictions placed on intervention design, duration and mode of delivery, provided that participants were randomized to study conditions, and intervention included components addressing at least one cognitive domain.
RESULTS: A total of 17 studies from six countries met the eligibility criteria and were included in the final review. Evidence from those studies indicated that cognitive interventions may be most effective when the design and aims were directed towards improvement in specific cognitive domains, but evidence regarding long-term effectiveness in preventing progression to clinical-level cognitive deficits is still unclear. Several studies highlighted culture-specific activities as components of their interventions, though these will need to be further outlined and standardized clearly in future research.

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