Objective: This case report highlights a case of young male referred for psychiatric evaluation due to paraphilic disorder. This 27-year old single male working as an assistant accountant was noted to have voyeuristic behaviour and presented with depressive symptoms since his teenage age. He has poor coping whenever he experiences stress in life. He started to watch pornographic videos and subsequently get involved by peeping pre-pubescent’s undergarments. These activities are followed by a compulsive behaviour such as masturbation to gratify his sexual arousal.
Results: The patient undergone several psychotherapy sessions, and medical report was furnished for the court's purpose. Our assessment revealed that he was suffering from a lifetime major depressive disorder,and he was prescribed with Tablet Sertraline 50mg/daily.He also has premature ejaculation, severe in nature. He regretted his voyeuristic urge and psychotherapyfocused on how to channel his sexual needs.
Conclusion: Mood disorder is seen in paraphilic disorder and has to be dealt with in order to establish good management care.
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
Sexual dysfunction is highly prevalent in gynaecological cancer patients. Most of the time, sexual dysfunction in gynaecological cancer is underdiagnosed as there is overlapping of symptoms with other psychological morbidities, interplaying of multiple risks, patients’ reluctance to complain or incompetence of health care provider to assess. Determining the risk factors of sexual dysfunction in cancer patients enables us to pay more attention to those who are vulnerable and to device strategies for early detection, prevention and treatment of sexual dysfunction in them. The main aim of the study was to determine the prevalence of sexual dysfunction and its risk factors in gynaecological cancer patients in Hospital Sultanah Bahiyah, Alor Star, Malaysia. Sexual function of eighty-three gynaecological cancer patients who were married were assessed with self-rated MVFSFI (Malay version Female Sexual Function Index). Self-rated WHOQOL-BREF (World Health Organization- Quality of Life- 26) which assessed the domains of quality of life was used while MINI (Mini International Neuropsychiatry Interview) was used for diagnosis of major depressive disorder. The prevalence of sexual dysfunction among the married gynaecological cancer patients was 65% (54/83). Sexual dysfunction was significantly associated with low education level (OR 3.055, CI 1.009-9.250), shorter duration of cancer (OR 0.966, CI 0.966- 0.998), ongoing chemotherapy (OR 3.045, CI 1.149-8.067), pain perception (OR 3.230, CI 1.257-8.303), absence of sexual intercourse for more than one month (OR 1.862) and three domains of quality of life such as physical health, psychological health and social relationship (OR 0.942, CI 0.908-0.978; OR 0.955, CI 0.916-0.995; OR 0.933, CI 0.894-0.973, respectively). However, sexual dysfunction was not associated with major depressive disorder (χ2 ² = 1.224, p = 0.268). The prevalence of sexual dysfunction in gynaecological cancer patients was comparable to other studies of similar population. Since, the risk factors of sexual dysfunction in gynaecological cancer patients are multidimensional, the process of assessment and management need to be holistic and patient-oriented.
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.
Introduction: Anxiety and depression are both associated with increased morbidity in diabetic population, especially those afflicted with foot ulcer, whereas Erectile Dysfunction (“ED”) and Female Sexual Dysfunction (“FSD”) are amongst the common complication found in diabetes. This study aimed to determine the prevalence of anxiety and depression as primary outcome and sexual dysfunction (“SD”) as a secondary outcome in diabetic patients with and without foot ulcer (“DFU”).
Methods: A cross-sectional study was conducted in Hospital Raja Permaisuri Bainun Ipoh, Perak, where 164 diabetic patients were recruited for the purpose of this study. Hospital Anxiety and Depression Scale (“HADS”) were utilised to measure anxiety and depression. International Index for Erectile Function 5 (“IIEF-5”) and the Malay version of Female Sexual Function Index (“MVFSFI”) were used to detect SD. Simple and multiple logistic regressions were referred to in order to evaluate the factors associated with anxiety, depression and SD.
Results: In the group with foot ulcer, 36.8% had depressive and anxiety risk respectively compared to without the foot ulcer, 37.5% and 38.5% respectively. Male gender (AOR=6.3,p=0.002,95%CI 1.975, 20.205) and having lower education status (AOR=6.0,p=0.018,95%CI1.36,26.59,) was associated with foot ulcer. High prevalence of SD found in foot ulcer group (52.6%,p=0.006). Those with depression (OR=4.421,95% CI 1.08,18.16,p=0.039) and male gender (OR=18.42,p<0.01,95%CI5.5,-61.62) predicts present of SD.
Conclusion: Depression and anxiety prevalent were similar for both with and without diabetic foot ulcer. Several significant predictor factors were identified for DFU group, for anxiety and depression risk and for SD in a diabetes patient. Further studies are required to establish the directional nature of this relationship.
Keywords: Depression, Anxiety, Diabetic food ulcer (DFU), Erectile Dysfunction (ED), Female Sexual Dysfunction (FSD)
Study site: outpatient clinic of medical and orthopedic departments in Hospital Raja Permaisuri Bainun (HRPB) Ipoh, Perak, Malaysia