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.
Objective: This is a case report discussing the comorbidity of obsessive compulsive disorder (OCD) and schizophrenia. Such clinical phenomenon merits recognition as a distinct subgroup of schizophrenia with unique challenges and treatment needs. Method: A case report presenting schizophrenia with preceding obsessive-compulsive disorder over five years. Results: This report describes the clinical course and treatment challenges of a patient with obsessive compulsive schizophrenia (OCS). Conclusion: This case illustrates that OCS is a complex disorder with atypical clinical characteristics. In managing this patient, several clinical dilemmas including diagnostic ambiguity, problems with pharmacotherapy and difficulties in his rehabilitation were highlighted.
Objective: This study aims to report on the process of standard settings (SS) and to compare the passing rates between the norm-reference and SS methods, for OSCE in psychiatry undergraduate examination at UKM for 2009/2010 session. Methods: In the SS method, examiners were asked to imagine the performance of a minimally competent student and gave marks using a standardized check-list. The marks in particular outliers were discussed. After the first round, the examiners went through the same process again, to rate the minimally competent students independently. The median of the marks was taken as the passing mark for the particular question. The passing rate using the passing mark of 50% in the normreference method was compared to the passing rate from the passing mark obtained from the settings method. Results: For question 1, the passing rate with the norm-reference method (i.e. passing mark of 50%) was 93% (106/114) and that by the SS method was 72.8% (83/114). For question 2, the pass rate with the norm-reference method was 92% (105/114) and that by the SS method was 67.5% (77/114). Conclusion: The passing rates between the two methods showed significant differences. Although OSCE is an improvement to the undergraduate psychiatry examination in Universiti Kebangsaan Malaysia, there were few limitations and challenges that need to be tackled for further improvement.
Objective: This study aimed to determine the prevalence of obesity among patients with schizophrenia and its association with the demographic profile. Methods: This is a cross sectional study. Subjects were selected using systematic sampling. Patients attending the out patient psychiatric clinic, Hospital Universiti Kebangsaan Malaysia, who fulfilled the criteria and able to give consent were included in this study. Diagnosis of schizophrenia was made using Structured Clinical Interview (SCID) for DSM-IV. Demographic profiles of the patients were obtained and anthropometric measurements were measured and classified according to Body Mass Index (BMI) and Waist Circumference (WC) of Asian population. Results: A total of 97 patients were included. The prevalence of overweight (BMI: 23.0- 27.4 kg/m2) was 39.2% (n=38), and the prevalence of obesity (BMI: >27.0 kg/m2) was 35.1% (n=34). BMI was higher among non-Chinese (Malay and Indian, p=.03) and those who had low total household income (p=.03). Sixty-two patients (63.9%) had high WC, which was associated with male (p=.003) and non-Chinese (p=.03). Conclusions: Obesity is highly prevalent among patients with schizophrenia. The risk factors for obesity include male, non-Chinese and those with low total income. The high WC among non-Chinese and male patients suggests that they are at a higher risk of developing obesity-related physical illnesses. These findings support that obesity is a common critical issue among schizophrenic patients, and it warrants serious clinical interventions.
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Objective: This case report highlights the abuse and dependence potential of Zolpidem and the risk of life-threatening withdrawal symptoms upon abrupt discontinuation. Method: We report a case of Zolpidem dependence which presented with withdrawal symptoms upon abrupt discontinuation. Results: A 32 year old male, who had abused non-benzodiazepine Zolpidem for 6 years presented to the accident and emergency unit with generalized seizures upon stopping Zolpidem ‘cold turkey’. He required admission to the neurology high dependency unit for stabilization of the seizures and was later managed by the addiction team where a tapering dose of benzodiazepine was prescribed. Conclusion: This case demonstrates that non-benzodiazepine agents can cause tolerance and dependence, and thus produce withdrawal symptoms upon discontinuation.
The critical review paper is a component of the theory examination for postgraduate psychiatry in Malaysia. Majority of students find this paper difficult, thus this article is intended to help the students understand the critical review paper better. The paper discussed below aimed to determine the knowledge, attitude and practice towards sleep among medical students of International Islamic University Malaysia (IIUM). Model answers were provided at the end of each question, as marked in italic font.
Objective: This paper aims to discuss the answers to Review Paper Exam for the Malaysian Master of Medicine (Psychiatry) May 2012 theory examination. The paper studied the psychotropic prescription practice in cancer patients using a health care registration database. Methods: One of the papers presented during the journal club presentation was picked-up for evaluation of student's critical appraisal. Results: Model answers were provided at the end of the Critical Review Paper. Conclusion: This review paper evaluates students' understanding and critical thinking on the topic of Psychotropic Drugs in cancer patients. This paper may serve as a guideline to teach students how to critically appraise topic related to psychiatry. ASEAN Journal of Psychiatry, Vol. 14 (1): January - June 2013: XX XX.
Objective: A study was conducted at the Universiti Kebangsaan Malaysia Medical Center (UKMMC) adult psychiatric clinic from June 2006 to December 2006. The aim was to assess the rate of the metabolic syndrome in a group of outpatients with mood disorders and schizophrenia and also to determine the relationship of this condition with sociodemographic factors and psychiatric illness characteristics.
Methods: A total of 51 subjects agree to participate of which 100 were approached. The International Diabetes Federation (IDF)(2005) criteria are used for the diagnosis of metabolic syndrome and Diagnostic Statistical Manual Version IV (DSM-IV) criteria are used to made psychiatric diaognosis.
Results: The prevalence of metabolic syndrome was found to be 37.2% and was significantly higher amongst mood disorders patient. However the metabolic syndrome is not associated with the anti psychotic therapy (p=0.41).
Conclusion: This study suggests that it is important for the psychiatrist to monitor metabolic syndrome in any of their patients.
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Objective: This review paper will be discussing on mental health of children and adolescents in Malaysia. Behavioural problems, academic failure and underachievement in school are common reasons for referral of children to the medical services. Epidemiological research has substantiated a possible seriously mismatch between the rates of child mental health problems across a broad spectrum and the number of children actually referred to existing services. These data suggest it is imperative in Malaysia to empirically investigate the present realities in the schools in regard to special education needs and their neglect. Methods: The present preliminary study is based on a literature review of epidemiological features of learning disorders and comorbidities using the Cochran library key word search. Available statistics for learning disorders from the WHO are compared with records for the
year 2007 from the Ministry of Education in Malaysia. Results: Findings of this comparison with international prevalence rates of learning disorders and related diseases show a sizable gap between real existing needs in Malaysia, and their perception. Based on quantitative estimates, the findings suggest that some 1.4 million children in Malaysia have mental health difficulties that interfere with normal functioning and development, but adequate services for intervention are largely not available. Conclusion: The present undersupply of adequate service for children with learning difficulties is aggravated by the lack of systematic developmental screening in early childhood in Malaysia. This status affects the outcomes and development of the general education system in efforts to meet challenges in the new century.
encountered particularly in mental health issues and to additionally analyze the methodologies used in studies involving HIV/AIDS informal caregivers.
Methods: Four electronic databases; Science Direct, EBSCOhost, Ovid and Springer Link were searched for articles published in the past 10 years (2002 - 2012). Only full-text English articles related to research on care giving of HIV-infected adult patients were selected.
Results: Twenty two out of 293 articles (7.5%) were reviewed, involving 2,765 caregivers in the USA (n=1,610), Africa (n=253), Asia (n=838) and Oceania (n=64) regions. A variety of age categories was involved in care giving with the youngest carer being 12 years old and the oldest, 60 years on average. Females and whites appeared to be dominant and 603 caregivers themselves were HIV positive. The main outcomes measured were care giving burden, challenges and coping. Stress and depression, stigma and discrimination, insufficient support, role overload and extreme poverty were the main challenges experienced in care giving. Both qualitative (n=11) and quantitative (n=9) were the equally preferred types of study. Purposive sampling emerged as the most preferred sampling technique. Various instruments were utilized, but the Beck Depression Inventory (BDI) was the most popular particularly in quantitative studies.
Conclusion: A variety of life aspects were negatively affected in the process of care giving for HIV/AIDS patients and studies of such nature commonly focused on caregivers' psychosocial burden.
Objective: This case report highlights the challenges in managing Frontal Lobe Syndrome (FLS) in a patient with end-stage renal disease. Methods: This is a case description of a 58 year-old gentleman who presented with behavioural changes: irritability, mood lability, aggression, psychosis, and overfamiliarity. His presenting symptoms were in keeping with (FLS) with positive findings on Computed Tomography (CT) scan of the brain and also neuropsychological assessments. Difficulties arose in attempts to control his aggression without further compromising his renal function. Results: The usage of the commonly used antipsychotics in controlling aggression was restricted in view of the patient’s renal impairment. Augmentation with low dose memantine proved to be beneficial in this case, without causing further deterioration in renal function. Conclusion: The use of memantine to augment the effect of risperidone was observed to be safe and successful in managing the behavioural changes associated with FLS in adults with end-stage renal disease. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 93-96.
Objective: This case report highlights the optimum end-of-life care of an adolescent dying of cancer. Method: We report our experience, as part of a multidisciplinary team in managing the cancers of a female student who died an untimely death at the age of 15. Results: Our role of motivating her for chemotherapy of her initial treatable carcinoma, became that of palliative care upon discovery of a second malignancy. We helped the patient “live life to the fullest” during her last days, she helped us realize that helping her master the tasks of adolescence was optimum “end-of-life care” as well. Conclusion: to help an ill adolescent die with dignity is to help her live whatever time she has left of her life. Allowing her to participate in decisions regarding her treatment and in other bio-psycho-social needs of that stage of life is crucial in helping her prepare for the end of life.
Objective: To assess postgraduate candidates’ knowledge on basic sciences and to compare
their achievement based on two years study in the Department of Psychiatry, National University of Malaysia (UKM), Kuala Lumpur, Malaysia. Methods: This is a study assessing
areas of difficulties in basic sciences for the Malaysian postgraduate candidates sitting for
mock MCQ examination papers in two consecutive years. Results: The candidates in both
years failed on MCQ papers (scoring marks are only 43% and 40% for the year 2006 and
2005 respectively), which is consistent with their final examination outcomes. The candidates in the year 2006 were much superior in neuroanatomy (percentages of median scores: 47% vs. 31%, p
This is a model answer of Critical Review paper for Malaysian postgraduate examination in psychiatry. This model answer was used for marking the review paper for Master of Medicine (Psychiatry) and Master of Psychological Medicine, May 2009.
Apart from environmental and social factors, psychological traits is largely linked with criminal and delinquent behaviour. The purpose of this article is to review four critical psychological traits of individuals that may lead to criminal behaviour in a nutshell. Methods: An archival research methodology was employed in this study where relevant search for literatures on these four psychological traits was made across search engines such as Google Scholar with relevant articles selected for this review. The literatures were microscopically reviewed in order to demonstrate the linkage between psychological traits and criminal behaviour. Results: Four psychological traits: personality trait, low selfcontrol, aggression behaviour, and cognitive distortion were chosen to address such linkages. All these four traits were discussed thoroughly in relation to crime and criminality contexts. Conclusion: It is crucial to understand the role of these traits and in-depth understanding of each psychological trait with relation of criminal behaviour offers an opportunity to the public at large to expand their knowledge on the importance of practicing and equipping oneself with healthy psychological traits to hinder from criminal and delinquent acts. ASEAN Journal of Psychiatry, Vol. 16 (2): July – December 2015: XX XX.
This case report highlights Koro-like symptoms with erectile dysfunction.
Methods: We report a case of a Rohingya refugee who presented with Koro-like symptoms associated with erectile dysfunction and severe religious guilt.
Results: Sexual dysfunction, i.e. erectile dysfunction may be a predisposing factor for a Koro incidence. Religious issues complicated by superstitious beliefs pose a treatment challenge.
Conclusion: Treating patient with sexual dysfunction should involve exploring and addressing patient's conflicts to avoid worsening of symptoms. As this case illustrates, severe anxiety can present with Koro-like symptoms.
Objective: To determine the knowledge, attitude and practice (KAP) of sleep among medical students of IIUM towards and to determine the impact of socio-demographic data on the knowledge, attitude and practice. Methods: A cross-sectional study was carried out among 106 students from first, second and third year medical students of IIUM. Verbal consent was taken from the students who were willing to take part in this study. Student knowledge about sleep was studied using a questionnaire. Results: A total of 106 medical
students completed the survey, there were 54 female and 52 male. The mean age of the students was 20 ± 0.56 and ranged from 18 to 22 years. In terms of their sleep knowledge, the mean ± SD knowledge, attitude and practice scores were 81.8 ± 16.8, 65.9 ±15.3 and 176 ± 26.3 respectively. In univariate analysis, there was a significant difference between parents’ marital status regarding knowledge of the students (p = 0.03). There was a significant difference between gender regarding attitude of the students (p=0.05). In
multivariate analysis, gender and smoking status were significantly affected the overall KAP. Conclusion: This study showed that sleep medicine knowledge was generally low among medical students. Therefore, educational strategies to improve knowledge regarding sleep-related problems and the development of proper sleep practices among medical students are needed.
Objective: Critical appraisal is a process of systematically examining research evidence to assess its validity, results and relevance before using it to form a decision. A basic knowledge in statistic and epidemiology is important among postgraduate students in psychiatry to acquire the skills for appraising clinical research evidence. This is a descriptive study that attempts to look into the level of knowledge among the postgraduate psychiatry students in
terms of statistic and epidemiology. Methods: A total of 31 postgraduate students in their second (N= 26) and third year (N=5) Master of Medicine (Psychiatry) and Master of Psychological Medicine from three different universities, namely: Universiti Kebangsaan Malaysia, Universiti Malaya and Universiti Sains Malaysia participated in this research. The participants were asked to answer 7 questions within 30 minutes. The passing mark for this
critical review paper is set at 25 out of 50. Results: Overall, only 32.3% passed the mock critical review paper. About 67.7% of the students passed their epidemiology component and only 19.4% passed the statistic component. Conclusion: We found poor performance in basic statistics among psychiatric trainees which highlights the need for further improvement in the subject’s training.
Objective: The objective of this study was to establish the relationship between symptoms of PTSD and various scores of emotional intelligence scales. This study employed a cross-sectional research design. Participants were recruited from the local community health centre in Dearborn, Michigan, USA. The Child Posttraumatic Stress Reaction Index (CPTS-RI) measured the presence of PTSD symptoms and the Adolescents Multifactor Emotional Intelligence Scale (AMEIS) measured emotional intelligence. Results: The findings suggest an inverse relationship between PTSD severity and emotional intelligence. The PTSD score was negatively correlated with all AMEIS subscales. Two significant negative correlations were found in the tasks of using emotion and understanding emotion. Conclusion: Findings suggest that individuals with severe PTSD symptoms appear to lack the abilities to understand and use emotions. These findings might be useful in identifying factors that may contribute to decreasing the severity of PTSD symptoms of these children. Implications of the findings were discussed, and recommendations for future research are presented. ASEAN Journal of Psychiatry, Vol. 15 (2), July - December 2014: 220-224.
This case report highlights the success of community services and supported employment program that may be of help to a woman with chronic inhalant use to achieve a complete abstinence. Methods: We report the case of a 45 year old lady who chronically abused glue, presented after 10 years with substance induced psychosis and comorbid mood disorder. Results: Abstinent from inhalant dependence was achieved after series of home treatment services and supported employment program. Conclusion: Provision of acute community service and incorporating this patient in supported employment program contribute to her successful journey in achieving abstinence from inhalant dependence.