Introduction: A number of researches suggest smoking serves as a form of self-medication to reduce the side effects of antipsychotic medications, to alleviate negative symptoms, and/or to ameliorate a number of cognitive deficits associated with schizophrenia. Objective: The aim of this study was to investigate the association of cigarette smoking with verbal working memory and psychopathology of patients with schizophrenia. Methods: Fifty-three patients with schizophrenia were assessed by a single rater using the Malay Version of Auditory Verbal Learning Test (MVAVLT) and Positive and Negative Syndrome Scale (PANSS). Smokers (n=30) were compared with nonsmokers (n=23) on socio-demographic, clinical, psychopathology and verbal memory variables. Single linear and multiple regression analysis were performed to determine factors associated with verbal memory performance.
Results: Verbal working memory performance is associated with lower number of admission to ward, lesser severity of the negative symptoms or general psychopathology of schizophrenia and use of atypical antipsychotics in all schizophrenic subjects. Smokers with schizophrenia scored higher than non- smoker in measures that reflect immediate memory, delayed recall and recognition memory. However, the association between verbal working
memory performance and smoking status was found to be not significant. Conclusion: Verbal working memory performance is associated with negative symptoms but not positive symptoms. This study failed to detect association of smoking on verbal working memory.
Objective: The aim of this study was to evaluate the validity and reliability of the Malay version of the Fagerstrom Test for Nicotine Dependence (FTND-M) based on a group of male staffs in the hospital. This study will also determine whether an abbreviated version of the FTND-M can be used as a screening tool for nicotine dependence. Method: 107 male staffs participated in the study. They were given the FTND-M and Malay version of Mini-International Neuropsychiatric Interview (M.I.N.I.)-L component. Their carbon monoxide level measured in their breath by using exhaled air. One week later, these participants were again given FTND-M. Results: The discriminatory ability of FTND-M was good with AUC 0.74 (P2 with the sensitivity of 70.1%, specificity of 70%, PPV of 79.7% and NPV of 58.3%. The FTND-M had moderate internal consistency with a Cronbach’s alpha of 0.67. The testretest reliability after 1 week was fair (Spearman’s rho=0.5, p)
Caring for a family member with dementia is associated with distress and several caregiver factors are known to be determinants of burden of care.
Objective: To determine the relationship between the caregivers’ sociodemographic variables and their perceived burden of care.
Methods: Patients diagnosed as having dementia with their caregivers were selected through a non-randomised sampling method from the psychogeriatric and memory clinics in Universiti Kebangsaan Malaysia Medical Centre and Hospital Kuala Lumpur. Burden of care was assessed using the Zarit Burden Interview.
Results: Age, gender, educational achievement, ethnicity and kinship of the 65 caregivers did not show any significant statistical difference in relation to their perceived burden. Conclusion: Burden in caring after patients with dementia was not significantly determined by the sociodemographic characteristics of their caregivers
Study site: Psychogeriartic clinics and memory clinics of Pusat Perubatan University Kebangsaan Malaysia (PPUKM) and Hospital Kuala Lumpur (HKL), Kuala Lumpur, Malaysia
Bipolar Mood Disorder (BMD) is one of the most common, severe, and persistent mental illnesses. The Malaysian Consensus Statement for the Treatment of Bipolar Mood Disorder, published in 2007 is still the major reference for managing the condition in this country. However, recently the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines was revised and at the moment, this contains the most up-to-date recommendations. This paper reviewed and compared both documents to establish the latest information on managing Bipolar Mood Disorder.
Study on motivational readiness for change is crucial to promote understanding of behavioural change among Methadone Maintenance Tretment (MMT) patients. A widely used method recently is via Stages of Change and Treatment Eagerness Scale for drug abusers (SOCRATES-8D). The aims of this study were to; 1) determine the general level of readiness for change, 2) assess differences in terms of readiness to change (RtC) based on socio-demography and clinical characteristics and 3) compare RtC with different health-related quality of life (HRQOL) levels. Methods: A convenient sample of MMT volunteers from Terengganu, Malaysia was enrolled. The SOCRATES-8D was administered (3 subscales; Likert-type responses 1-5; higher score, better RtC). Data was analysed using SPSS 15, employing descriptive statistics and non-parametric tests for score comparisons. Results: The mean age of 55 Malay respondents was 37.0 years, male (98.2%), = lower secondary qualification (65.5%) and addiction period > 15 years (52.7%). Generally the Recognition level was "low", Ambivalence and Taking Steps were moderately-rated. Most of them within unsatisfactory levels of RtC. Abusers with < 20 months treatment were significantly "more ready" for behavioural changes (p0.05). Conclusion: Findings demonstrated that patients were rather ready to adopt positive behavioural changes regardless of their sociodemographic backgrounds. Thus continuous efforts and psychosocial support from various authorities should be geared towards enhanced readiness as part of ensuring the success of MMT programme in the future.
Objective: Anxiety and depressive symptoms are common among cancer patients and have been shown to adversely affect their health-related quality of life (HRQoL). Dark chocolate is popular for its beneficial effects on mood regulations. This study aimed to assess the effects of dark chocolate consumption on anxiety and depressive symptoms and the HRQoL status
among cancer patients. Methods: A sample of 133 cancer patients was recruited from 3 public hospitals in the East Coast Peninsular of Malaysia. The anxiety and depressive symptoms was assessed by the Malay Hospital Anxiety and Depression Scale (HADS) while HRQoL was measured via the Malay McGill Quality of Life questionnaire (MMQoL). Patients were randomly assigned to Study Group (SG) and Control Group (CG) whereby dark chocolate (50g) was administered to SG while CG consumed mineral water for 3 consecutive days. Results: Specifically, the anxiety and depressive symptoms was significantly reduced after dark chocolate consumption. The HRQoL score was also significantly increased in SG at post-intervention. Conclusion: These findings indicated that a 3-day dark chocolate consumption may reduce anxiety, depressive symptoms and thus also improved the HRQoL status in hospitalised cancer patients.
Objective: This study intends to investigate the reliability, validity and patients’ perception towards the Malay Hospital Anxiety Depression Scale (HADS) and Malay McGill Quality of Life Questionnaire (MMQoL) in Terengganu cancer patients. Methods: It was conducted cross-sectionally in Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu, Malaysia
recruiting 80 patients fulfilling the inclusion criteria. Socio-demographic data was analyzed descriptively and presented as frequencies. To examine patients’ perception towards the applicability and practicality, completion time, comprehension, comprehensiveness difficulty and instrusiveness of the instruments were inquired via a 5-item survey. For reliability purposes, the internal consistency reliability (Cronbach's α) was calculated while
Spearman’s rank correlation coefficient (rs) was used to examine the strength of associations between and within instruments (convergent/divergent validity). Results: To the majority of patients, both HADS and MMQoL instruments were considered clear, comprehensive and not difficult to complete (completion time < 10 minutes). The internal consistency reliability
for both HADS and MMQoL domains ranged from moderate to high. Within HADS itself, the individual items produced strong correlations with their own domains than with other domains (rs ≥ 4.0). Similarly, majority of individual items in MMQoL correlated stronger within their own domains compared to other domains (except Existential Well-Being and Support Issues) supporting validity. Conclusion: The overall findings suggested that both instruments have exhibited adequate evidence of reliability and validity plus being perceived as favourable for assessing health outcomes among cancer sufferers.
Study site: Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu, Malaysia
Device, Questionnaire & Scale: Malay Hospital Anxiety Depression Scale (HADS); Malay McGill Quality of Life Questionnaire
This two-phase study examined the prevalence of depressive disorders among married working women in a sub-urban area in Malaysia. The Malay version of the General Health Questionnaire-12 (GHQ-12) was used for initial screening. Using multistage cluster sampling, there were 700 subjects from 25 workplaces that were approached, of which 307 filled out GHQ-12 in the initial phase. The prevalence of psychological distress (GHQ 2/3 cut off) is 22.8% (n=70, 95% CI 18.1-27.5). In the second phase, all 49 consenting patients who were screened positive for severe psychological distress (GHQ 3/4 cut off point) were telephone-interviewed by a trained psychiatrist with the Malay version of Mini International Neuropsychiatric Interview (M.I.N.I) to diagnose depressive disorders. The prevalence of depressive disorders was 5.5% (n=17, 95% CI 3.5-7.5). The prevalence of depressive disorders is comparable to those found in the working population worldwide.
Objective: This study intended to determine the prevalence of anxiety and depressive symptoms and to compare their severities among rural residents based on their socio-demographic variables. Methods: A cross sectional study was conducted among 520 residents in East Coast Peninsular Malaysia who completed the Malay Hospital Anxiety and Depression Scale (HADS). Data were analyzed with SPSS 17.0, whereby descriptive statistics and nonparametric tests were utilised for scores comparison. Results: The prevalence of mild anxiety and depressive symptoms was at 12.90% and 11.30% respectively. Statistically significant associations between gender and monthly income with anxiety and depressive symptoms were observed (p < 0.01). Conclusion: Findings in our study indicated that the prevalence of anxiety and depressive symptoms among rural residents was low. Nevertheless, females and those with higher education (> PMR) background were comparatively more prone to these mood disorders. Healthcare professionals should be constantly alerted to these tendencies in the process of providing medical services especially in rural areas.
Wilson disease is an inherited metabolic disorder. It is an autosomal recessive disorder caused by mutation of ATP7B gene, which results in excessive accumulation of copper in the body and deposition in various organs. The clinical presentation varies and neuropsychiatric manifestations are common. It is a diagnostic challenge in the initial phase where it mimics other psychiatric conditions and the diagnosis of Wilson disease is based on a combination of laboratory tests and clinical features. Wilson disease treatment comprises of copper chelating therapy such as D-Penicillamine and zinc sulphate wheras the behavior and mood symptoms response well with atypical antipsychotic treatment. The present report illustrates two cases of Wilson disease in middle-aged patients. The first presentation involved changes in behavior and personality. There was some delay in making the diagnosis in the initial stage. Both cases were diagnosed to have Wilson disease after further investigations. Their condition improved with the combination of copper chelating agent and atypical antipsychotic. In conclusion, it emphasizes the awareness of psychiatric manifestations as the initial presentation of Wilson disease.
Eating disorders are a group of mental health concerns characterized by disturbance in eating behaviour that include, anorexia, bulimia, binge eating disorder, and other types of disordered eating. Adolescents are becoming increasingly vulnerable to eating disorders. The Eating Disorder Attitude Test (EAT-40) is a widely used screening instrument for detecting eating disorders. Several authors have translated the EAT-40 in various languages and validated the scale. The objective of the study included determining the factor structure of EAT-40 and to find the reliability. Method: 217 undergraduate university students in Malaysia were administered the EAT-40. In addition, they were also administered the Rosenberg’s Self Esteem scale to study the correlates of EAT-40. Results: The mean age of students was 22 years. The factor analysis of EAT-40 revealed a 34 item EAT model, with four subscales, ‘Dieting Behaviour’, ‘Oral Control’, ‘Food Preoccupation’ and ‘Body Image’. The short form is composed of 34 items and shows good internal consistency = 0.799.
Conclusion: It may be established that the EAT-34 shows an unidimensional structure with good internal consistency even though some items needs to be revised.
Background: Metabolic Syndrome is a major concern for the general population but more so for depressed patients. While it is well established that it is highly prevalent among patients who are depressed, none of the local studies identified the factors contributing to the syndrome.
Objective: This study aimed to determine the rate of metabolic syndrome and its associated factors (socio-demographic, clinical features and lifestyle risk factors) in depressed patients.
Methods: A cross sectional study was conducted on patients with major depressive disorders (MDD) attending psychiatric outpatient clinic in Universiti Kebangsaan Malaysia Medical Centre (UKMMC), a teaching hospital in Kuala Lumpur. A total of 72 outpatients who fulfilled the selection criteria were informed to fast prior to blood taking. The diagnosis of MDD was made based on Diagnostic Statistical Manual Version IV (DSM-IV) while the metabolic syndrome diagnosis was made using the International Diabetes Federation (IDF) criteria based on the patients’ waist circumference, blood pressure, serum glucose level and lipid profile.
Results: The rates of metabolic syndrome was 37.5% (n = 27). The results showed significant associations between metabolic syndrome and race (p = 0.043), illness duration (p = 0.043) and pre-existing hyperlipidaemia (p = 0.032). Interestingly, lifestyle factors like physical activity (p = 0.762), dietary intake (p = 0.671), severity of depression (p = 0.161) and the different types of medications (p = 0.242 to 1.000) were not found to significantly associated with metabolic syndrome among the study sample.
Conclusions: Metabolic syndrome was found to be disproportionately high among depressed patients. Two significant factors associated with this syndrome were race and long duration of depression (ten years or more). This study suggests that early screening and identification can be beneficial to be incorporated in the management of depression in anticipation of future complications.
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Objectives: Occupational stress among healthcare workers is an important concern due to its crucial contribution in attaining maximum job output and optimal quality of working life. Our study aims to compare job stress levels of healthcare employees based on 1) sector, 2) category and 3) specialisation. Methods: Stress severity and frequency were evaluated using the 9-point scale Job Stress Survey (Job Stress, Job Pressure, Lack of Support). A crosssectional sample of 223 healthcare providers were enrolled from seven health institutions in Peninsular Malaysia (East Coast = 55%; mean age = 30 years; female = 78.9%; < 2 years experience = 35.9%; government-based = 48%; supportive = 62.8%). Results: No significant difference was found between government and private sector workers. Supportive staff reported significantly higher stress frequency in contrast to professionals who demonstrated significantly higher stress severity in all dimensions (p < .05). Within the supportive group, radiographers were the most stressed, followed by nurses and medical laboratory technologists (p > .05). Research-based professionals experienced significantly worse stress frequency in all components compared to professional practitioners (p < .05). Conclusion: Because stress levels are affected by job category and specialisation, flexible strategies to ensure employees’ job productivity, contentment and personal well-being should be implemented.
Objective: This study assesses the impact of prescribed undergraduate psychiatry training program on medical students’ attitudes to psychiatry. It is hypothesized that training may cause positive attitude changes towards the discipline and status perceptions of the profession of psychiatry. Methods: A 23 item questionnaire was administered to 89 medical students before and after prescribed training in psychiatry as per the medical curriculum. Results: Participation in psychiatry training enhanced students’ belief that it is a rapidly expanding frontier of medicine and that psychiatry can be viewed as precise and scientific. Psychiatric referrals were seen as useful to medical and surgical patients. However there was less agreement that psychiatric treatment is helpful to most people. Support for choice of psychiatry as a career was less as students were more negatively influenced by family. Poor income prospects and perceived low status among other medical disciplines were also endorsed following the completion of training.Conclusion: There is a pressing need to revise the psychiatric training for medical students. A total attitude change is difficult to achieve and hence, the curriculum has to identify focal areas for emphasis. A multidisciplinary, bio-psychosocial model through liaison with other disciplines like medicine and surgery is a definite option. Psychiatrists have to be role models to alter the image of psychiatry among other medical professionals.
Introduction: As eating disorders such as anorexia nervosa and others are generally becoming more prevalent, it is essential to have a culturally accepted and locally validated questionnaire that is able to detect abnormal eating habits. Objective: To translate the Eating Disorders Examination Questionnaire (EDE-Q) into Bahasa Malaysia (BM) and to determine the construct validity, reliability and other psychometric properties of the BM version. Method: Two parallel forward and backward translations were done in BM in accordance to guideline. Its validation was determined by using confirmatory factor analysis among 298 secondary school children. Results: The BM EDE-Q had very good internal consistency with global Cronbach’s alpha value of 0.879. For construct validity, majority of the items managed to produce values of more than 0.4 for confirmatory factor analysis with four unforced distinct factors detected. Conclusions: Analyses of reliability and validity of this BM version of EDE-Q yielded satisfactory results. The BM version produced in this study had good psychometric properties and it is applicable to the Malaysian population. Findings indicated that cultural factors in eating habits certainly influences the effort to adapt the questionnaire within a Malaysian setting.
Introduction: Women are exposed to stress such as working full time while still being responsible for the family and house.
Objective: The objective of this study was to determine the prevalence of depressive symptoms among adult women in Selangor, and to determine the potential risk factors associated with depression.
Method: A community based cross sectional study was conducted in all districts of Selangor state, Malaysia in July 2004. Multi stage stratified proportionate to size sampling method was used to collect data. The Patient Health Questionnaire (PHQ-9) was used to determine the presence or absence of depressive symptoms among the respondents. All respondents aged 20 to 59 years old in the selected households were interviewed.
Results: Out of 1032 women, 972 agreed to participate in this study, giving a response rate of 94.2%. The mean age of the respondents was 37.91 ± 10.91. Majority were Malays (54.9%), married (83.8%) and had secondary education (54.5%). The results showed that the prevalence of depressive symptoms was 8.3% in Selangor. Race, religion, education level, history of having a miscarriage within the last 6 months and history of difficulty in getting pregnant were significantly associated with depressive symptoms (p<0.05). Women with history of a miscarriage within the last 6 months and absence of formal education were potential risk factors for depressive symptoms (OR, CI = 2.576 (1.165-5.696), p<0.01 and OR, CI = 5.766 (1.949-17.053), p < 0.01).
Conclusion: Depressive symptoms among adult women in Selangor was 8.3% and was associated with race, religion, education, history of miscarriage and difficulty in getting pregnant. The main potential risk factors were having a miscarriage within the last 6 months and absence of formal education.
Keywords: Depressive symptoms, Prevalence and Risk Factors, Selangor Women
107 secondary school teachers were surveyed to find out about their observations of children with learning disorders at schools. The respondents reported that the most commonly observed disorders involved difficulty paying attention, difficulty learning a second language, being fidgety and having difficulty sitting still, and having poor comprehension. They also indicated that whilst some children made fun of their classmates with learning disorder, others tried to assist their classmates. The most common reaction of parents was to send the child for lots of tuition, and to be very frustrated with the child. In addition, some parents neglected their children’s learning disorder, and many did not seem to realise how serious the problem was. When it came to the needs of teachers, the most common need that the teachers reported was to have the parents cooperate with them and to have support from the education authorities. The paper discusses the implications of these findings and proposes suggestions for dealing with the training needs of teachers working in the area of learning disorders.
Objective: The objectives of this study were to asses body mass index, fasting blood sugar , serum cholesterol levels and prevalence of Diabetes Mellitus among outpatients attending the Clozapine clinic at University Malaya Medical Center. Method: 36 patients had their height and weight taken at the start of the study. Their BMI (body mass index) was calculated. Fasting blood sugar, (FBS) and Fasting Serum Lipid (FSL) were performed. Result: The mean body mass index was 24.63. The prevalence of obesity was 13.89%. The prevalence of overweight was 27.8 % and the prevalence of underweight was 5.55%. The prevalence of Diabetes Mellitus was 2.78 %. Serum triglyceride levels appear to be elevated in those receiving Clozapine.Conclusion: It appears that Clozapine may predispose one to obesity. From our study we cannot conclude if Clozapine causes Diabetes Mellitus. However treatment with Clozapine may be associated with elevated levels of serum triglycerides.
Study site: Clozapine clinic at University Malaya Medical Center
The past decade has seen a marked increase in the popularity of ATS use, particularly methamphetamine, within East Asia,and the Pacific region. In Malaysia, the National Anti Drug Agency has identified 8,870 addicts (from January till August 2008) out of which 1,126 was ATS dependence. During the same period, the police have arrested 46,388 people under the Dangerous Drug Act 1952. They also has seize 283kg of syabu, 545kg of ecstacy powder, 66194 tablets of esctacy pills and 222,376 tablets of yaba pills from Jan till August this year. The occurrence of psychosis arising from the use of ATS was first reported in the late 1930's. With growing ATS use, particularly methamphetamine, ATS-induced psychosis has become a major impact on public health.Symptoms of ATS-induced psychosis: Methamphetamine use produces a variety of effects, ranging from irritability, to physical aggression, hyperawareness, hypervigilance, and psychomotor agitation. Repeated or high-dose use of the stimulant can cause drug-induced psychosis resembling paranoid schizophrenia, characterized by hallucinations, delusions and thought disorders. When used in long term, methamphetamine may lead to development of psychiatric symptoms due to dopamine depletion in the striatum. The most common lifetime psychotic symptoms among methamphetamine psychotic patients - as reported in a cross-country study involving Australia, Japan, the Philippines and Thailand - are persecutory delusion, auditory hallucinations, strange or unusual beliefs and thought reading. Those patients were also reported to suffer from impaired speech, psychomotor retardation, depression and anxiety. An ATS psychosis can be distinguished from primary psychotic disorders by time. In ATS-induced psychosis symptoms usually resolve after the drug is discontinued. If symptoms do not resolve within 2 weeks after cessation of stimulant use, a primary psychiatric disorder should be suspected. When compared with other stimulants, such as cocaine, psychosis is induced more commonly by ATS, possibly due to the longer duration of action produced by amphetamines.For example, while smoking cocaine produces a high that lasts for 20-30 minutes, smoking methamphetamine produces a high that lasts 8-24 hours. Other symptoms of ATS-induced psychosis reported include affective blunting,(6) violent behavior, and self-mutilation and self-injurious behavior.
Smoking cessation programmes have been available for almost 2 decades in Malaysia. However the programmes have mainly focussed on outpatient primary care settings. More attention is needed to address and treat smokers presenting to hospitals with acute and chronic medical illness as hospitals provide good settings to implement smoking cessation intervention. For instance, a tobacco related medical illness may boosts a smoker\'s motivation to stop, especially when the smoker perceives smoking as the cause of his illness and understands the gains achieved by smoking cessation. Besides bringing a smoker in contact with health personnel who may offer assistance to a smoker to help him stop smoking, a hospital stay also provide an opportunity for the health carer to initiate and practice the government policy of no smoking in the hospitals. This article addresses the importance of having a hospital-based smoking cessation programme for the Malaysian hospitals.