Objective: This study aims to determine the quality of life (QOL) of Malaysian women based on their physical and mental scores and correlates with age and cervical disease severity. Methods: This is a cross-sectional study from Nov 2006 till Dec 2007 from participating
Gynecology-Oncology outpatient and in patient’s wards. QOL interviews used the SF-36 questionnaires. Main domains were the Physical Composite Scores (PCS) and the Mental Composite Scores (MCS). Results: A total of 396 participated in the study. Mean respondents age were 53.31 ± 11.21 years, educated till secondary level (39.4%), Malays (44.2%) with mean marriage duration of 27.73 ± 12.12 years. Among pre-invasive diseases, the cervical intra epithelial neoplasia (CIN) 1 was the highest in percentage of cases
(8.1%). Among invasive cancer, stage 1 cancer was highest (31.1%), followed with stage 2 (28.3%), stage 3 (7.3%) and stage 4 cancers (5.8%). PCS scores are highest among the pre-invasive and stage 1 cancer (F=4.357; p
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Objective: The aim of this study was to identify depression among HIVinfected patients attending Infectious Disease Clinic in University Malaya Medical Centre (UMMC). Methods: This is a cross sectional study on HIVinfected patients attending Infectious Disease Clinic, UMMC. Those who fulfilled inclusion criteria were recruited and interviewed. Sociodemographic characteristics and clinical conditions such as mode of transmission, year of diagnosis, CD4+ counts, drug treatment and clinical stage were collected. The patients were then subjected to self-administered questionnaires, Patient Health Questionnaire, (PHQ-9) and Hospital Anxiety & Depression Scale (HADS). Results: 89 patients were recruited. Scores from PHQ9 showed 32% of depression rate while scores from HADS showed 19% of depression rate among the respondents. Non-self financial supporter, nonalcoholic drinkers and females were more likely to be depressed (P
Objectives: The aim of this study is to validate the Malay version of the Aggression Questionnaire (AQ) for the purpose of the future study related to aggression. Furthermore, the study seeks to identify types of aggression hold by the female inmates.
Methods: A cross-sectional study was designed involving 90 Malaysian female prisoners. The analyses include descriptive analysis, confirmatory factor analysis, and reliability testing. After one-week interval, a test-retest was conducted.
Results: The preliminary analysis confirmed that factor analysis was appropriate for the Malay-translated version of the AQ. The four factors structure was assessed but the factor loadings are remarkable different from the original versions. The total Cronbach's alpha coefficients is very high (α= 0.91). The Pearson's correlation however is low (r = 0.48) but acceptable for the instrument. Reliability of the subscales and the factors were also found satisfactory. Consequently, anger and hostility were identified as the most common types of aggression among the participants, followed by verbal aggression. In contrast, physical aggression was the least scored type of aggression.
Conclusion: The Malay-translated version of the AQ was found to be valid and reliable to be used in future studies.
Objective: Living with epilepsy imposes great challenges on both patients and their family caregivers but most researchers only explored the impact on patients, with less attention given to family caregivers. Our study intended to explore the needs and problems of epilepsy family caregivers of epilepsy patients encountered during the caregiving process. Methods: Respondents were recruited from the Neurology Clinic of Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu. A semi-structured interview was conducted using openended and broad questions asking about their general experience in caregiving, daily routine activities, caregiving effects, caregiving difficulties and caregivers’ needs. The interviewed data were later transcribed into verbatim before further analysis using the QSR International’s NVivo10 software. Results: Fifteen Malay Muslim family caregivers between the age of 19 and 66 years participated. Most were females (53%), married (67%), with education level at secondary school or equivalent (73%) and were homemakers (40%). In particular, respondents expressed the need for extra support from their family members and experts in terms of physical (care relief), mental, and financial aspects. In addition, the major caregiving problems identified included: (i) emotional disturbances (sad, angry, depressed, and anxious); (ii) care giving challenges (family adjustments, physical burden, psychological burden, and time management); and (iii) financial issues (not working and limited family income). Some advantages in caregiving were also reported. Conclusion: In conclusion, their experiences while taking care of their loved ones in terms of feelings, beliefs and needs exposed the difficulties in caregiving, causing substantial emotional pressure which could later lead to poor quality of caregiving. ASEAN Journal of Psychiatry, Vol. 16 (1): Januray – June 2015: XX XX.
Study site: Neurology Clinic of Hospital Sultanah Nur Zahirah (HSNZ), Kuala Terengganu.
Objective: Several cases of suicide attempt by charcoal burning producing CO have been reported in Malaysia. This case report highlights a case of delayed delayed neuropsychiatry sequelae (DNS) in CO poisoning.
Method: We report a young Chinese homemaker who presented with DNS who was detained in a Malaysian forensic psychiatric ward.
Results: After approximately two weeks of admission, in a familicide attempt, she had started to exhibit subtle changes in her behaviour, including social withdrawal, impaired memory, and there was lack of emotional distress.
Conclusion: We report an interesting DNS as one of the two forms of chronic sequelae of CO poisoning, whereas the other type of neuropsychiatric sequelae is the persistently progressive type.
Objective: This case report highlights the psychosocial complications of chronic mania in a mother and the role of CMHT in improving the condition’s outcome. Methods: We report a case of a Malay mother who had underlying chronic mania for 20 years. Results: She was aggressive and abusive towards her children causing tremendous trauma in them, had lost her child custody and almost lost her husband to another woman. Lithium with multiple psychosocial interventions delivered to the patient and her family had improved her mood symptoms significantly and improved the family’s quality of life. Conclusion: Chronic mania causes tremendously high illness burdens, and with extra care, the outcome of the condition can be improved. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 217-219.
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: The involvement of families in assisting health professionals in providing care for their family members who suffer a stroke during hospitalization is common in Malaysia. Family caregivers are accountable in providing for the first-ever stroke survivor’s needs, including maintaining functional improvements gained in rehabilitation and the long-term well-being of the stroke survivors. The objective of this study was to determine the predictors of life satisfaction among family caregivers of hospitalized first-ever stroke patients. Methods: This was a cross-sectional community research design study with purposive sampling. It involved 102 family caregivers of hospitalized first-ever stroke patients of two tertiary hospitals in Kelantan. The Bakas Caregiving Outcomes Score (BCOS) was used to measure life satisfaction. Multiple linear regression was used to determine the predictors of life satisfaction. Results: Out of 102 respondents, 21 were males and 81 were females with age range of 16 to 76 years. Significant predictors of life satisfaction of caregivers while caring for their hospitalized first-ever stroke family members were caregivers’ health (β: -2.875, 95%CI: -5.725, -0.025, p = 0.048), patients’ age (β: - 4.251, 95% CI: - 6.379, -2.123, p
Objective: The purpose of this study was to evaluate the effectiveness of nutrition education intervention among university students in terms of social, psychological factors and nutrition-related Quality of Life (NQoL) outcomes after receiving a 10-week nutrition education. Longitudinal and randomised study design was adopted for the study. Methods: A total of 417 respondents from four public universities in Terengganu were randomly assigned to either intervention group (IG = 205) or control group (CG = 212). The IG received nutrition education through three tools; 1) conventional lecture, 2) brochures and 3) text messages via short messaging system (SMS) while the CG not received any intervention. Students completed the Malay version of NQoL (6 domains; 49 items; Likert-type responses=1-5) and SF-36 (8 domains; 36 items) at pre-intervention and post-intervention. Data analysis was carried out by using SPSS 16.0 utilising descriptive and parametric statistics. Results: Ninety-one percent of participants (IG = 178; CG = 202) completed the study (age = 19.1±1.1 years; female = 87.6%; Malay = 98.2%). After controlling for possible confounders (eg. weight, waist, hip circumferences and pre-intervention scores for each domain), IG possessed relatively higher NQoL score in Food Impact (p = 0.001), Social / Interpersonal (p = 0.008), Physical Functioning (p = 0.011) and Overall NQoL (p = 0.001). However, Psychological Factors did not show any significant difference for both groups. Conclusion: Although the intervention did not generate significant impact in the psychological component over a period of 10 weeks, significant positive impacts in Social/Interpersonal aspects and NQoL were clearly shown. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 39-53.
Objective: This study aims to establish the validity and reliability of the Malay- translated version of the CES-D. Methods: This study employed a cross-sectional study design. The participants were female inmates (n=90) from local prisons which were selected based on purposive-selective sampling. The analyses include face validation, factor analysis, and reliability testing. A test-retest was conducted within a one-week interval. Results: The mean score for depression among the participants is 18.97 (SD=6.51). Further descriptive analysis showed that 58.9% of them scored above the mean score, which is considered high. Preliminary construct validation analysis confirmed that factor analysis was appropriate for the Malay-translated version of the CES-D. Furthermore, the factor analysis showed similar factor loadings to the original English version. The total internal consistency of the translated version, which was measured by Cronbach’s alpha coefficient, was equal to 0.75. The test-retest reliability of the total score, measured by Pearson’s correlation was equal to 0.69. Conclusions: Face validity, construct validity, and reliability analysis were found satisfactory for the Malay-translated version of the CES-D. The Malay-translated version of the CES-D was found valid and reliable to be used in future studies, with comparable properties to the original version and to previous studies. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 54-65.
Objectives: This study aims to determine the prevalence and associated factors of sexual pain disorders among Malay women in Malaysia with type 2 diabetes mellitus.
Methods: This is a cross-sectional study involving 347 women (174 non- diabetic and 173 diabetic subjects) who attended the diabetic clinic in a university hospital. Sexual pain disorders were assessed using the Pain sub scale of Malay Version of the Female Sexual Function Index (MVFSFI). Socio-demographic information of the subjects was collected with a pre-designed questionnaire.
Results: Prevalence of sexual pain disorders among Malay women with type 2 diabetes mellitus was 10.4% and the control group was 9.2% but the difference was not statistically significant (p > 0.05). Multivariate logistic regression analysis did not find any relevant associated factor with sexual pain disorder.
Conclusion: Sexual pain disorders among Malay women were not dependent on the diabetic status. Further studies with different population of diabetic patients are needed to confirm the results.
Study site: Diabetic clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Objective: This case report highlights the clinical dilemmas encountered in deciding the diagnostic status of persons with unipolar depression who develop hypomania during antidepressant/electroconvulsive therapy.
Methods: We report a case of a 52 year-old Chinese lady, diagnosed with unipolar depression, which developed hypomania after she was started on T. Fluvoxamine 100mg daily and completed 8 sessions of Electroconvulsive therapy.
Results: Her diagnosis was revised to Bipolar Disorder and she was treated with T. Sodium Valproate 400mg twice daily after which she improved.
Conclusion: Treatment-emergent hypomania is likely a subtype of bipolar spectrum disorder and patients with Treatment - emergent Hypomania should be treated as Bipolar Disorder.
Objectives: Prayers, spiritual healing, yoga, meditation, t'ai chi, qigong and support groups are classified as mind body complementary therapies (MBCTs). The study aimed to examine the prevalence of MBCTs use and the Health Related Quality of Life (HRQoL) in a group of Malaysian cancer patients.
Methods: This crosssectional study was conducted on 184 cancer patients at the oncology clinic of Penang general hospital, Malaysia. MBCTs was assessed using a self- administered questionnaire while the HRQoL of the participants was assessed by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30).
Results: Among the complementary and alternative medicines (CAM) users, 75(40.7%) patients self-reported using MBCTs while having cancer. Majority of MBCTs users were female 60(80%, p=0.01), aged between 38 and 57 (58%), and were of Malay ethnicity (61%). Socio-demographic factors including age (r=0.15, p=0.03) and monthly house-hold income (r= -0.25, p<0.001) were significantly correlated with MBCTs use. Prayers for health reasons was the most frequently practised MBCTs modality, followed by spiritual practices 20(10.8%), meditation 7(5.9%), t'ai chi 7(3.8%), music therapy 4(2.1%), qigong 1(0.5%), hypnotherapy 1(0.5%), and reiki 1(0.5%). Recommendations from friends and family members 53(70%) were the most common reasons of MBCTs use followed by patient's own will 22(29.3%). Health related Quality of Life (HRQoL) scores showed significant difference in all functional and symptoms scores among MBCTs users and non-users (p<0.05). Conclusion: The study helps to identify numerous MBCTs commonly practised by a group of Malaysian cancer patients. Prayers specifically for health reasons and spiritual practices were somewhat common among patients. Viewing MBCTs, not as alternative but to complement conventional cancer therapies may help to address cancer patients' emotional and psychological needs.
Study site: Oncology clinic, Hospital Pulau Pinang, Malaysia
Objective: This case report highlights the complexity of eating disorder in schizophrenia and outlines the diagnostic dilemma and challenges associated with the treatment. Methods: We report a 13 years old female with early onset schizophrenia who developed anorexic symptoms and binge eating. Her eating disturbances worsened after olanzapine was commenced. Results: A combination of pharmacological and psychosocial intervention led to remission of schizophrenia co-morbid with eating disorder NOS. Conclusion: Co-morbid diagnosis of schizophrenia and eating disorder is not uncommon. Early diagnosis and evidence-based intervention are imperative as untreated illness greatly impacts the developmental trajectory of young people. Meeting family’s needs improves family functioning which in turn improves patient’s outcome. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 101-105.
Objective: The family caregiver has a pivotal role in the management of HIV/AIDS patients and their well-being is consequently crucial as it could impact negatively on the quality of caregiving. This preliminary qualitative investigation intended to explore and describe the challenges and experiences of HIV/AIDS family caregivers in Terengganu, Malaysia. Methods: A convenient sample of family caregivers of HIV/AIDS patients who were aware of the diagnosis was enrolled. Recruitment was conducted in Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia and semi-structured interviews were used. Results: Results were transcribed into verbatim before being subjected to analysis. Twelve Muslim caregivers consented participation (age range = 18.0 - 81.0; female = 75.0%, mother/wife = 50.0%; married = 83.3%; ≤ primary school
= 50.0%; and self-employed = 66.7%). The four major themes that emerged were challenges of caregiving, financial issues, stigma and discrimination, and support for caregivers. Additionally, caregivers did mention several positive aspects of their caregiving role including satisfaction from helping family member and improved family relationships. Conclusion: A variety of life aspects were negatively affected by caring for HIV patients, thus requiring a multidisciplinary approach to address such issues. ASEAN Journal of Psychiatry, Vol. 15 (2): July - December 2014: 120-130.
Objective: This study validates The Malay Version of The Inventory of Socially Supportive Behaviour. Methods: The psychometric properties of the ISSB- Malay Version were examined on sixty-eight women who were Malay native speakers and diagnosed with breast cancer. Respondents answered the questionnaire at three weeks and ten weeks following surgery for breast cancer. Results: The Malay Version of ISSB showed excellent internal consistency (Cronbach’s alpha=0.96). Test-retest Intraclass Correlation Coefficient (ICC) was 0.03. Small mean differences were observed at test-retest measurement with Effect Size Index 0.18. Conclusion: The Malay Version of the ISSB could be an appropriate tool to measure the supportive behavior of the Malaysian population. ASEAN Journal of Psychiatry, Vol. 15 (1): January – June 2014: 23-29.
Objective: This case report highlights psychosis post craniopharyngioma surgery.
Methods: We report a case of a young Malay lady who presented with psychotic symptoms after she underwent craniotomy for craniopharyngioma.
Results: Presence of prominent hallucinations and delusions after removal of the tumour and the symptoms lasted more than a month. The psychosis subsided with antipsychotic.
Conclusion: Psychosis post craniopharyngioma surgery is still possible whether possibly due to the residual tumour or as a result of treatment sequealae.
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.
Currently, paliperidone palmitate is not approved for the treatment of schizophrenia in adolescents. It is only indicated for treatment of schizophrenia and schizoaffective disorder in adults. This case report highlights the successful treatment outcome with paliperidone palmitate in an adolescent with schizophrenia. Methods: We report a case of an adolescent who presented with psychotic symptoms and marked deterioration in functioning over a period of one year. Results: She showed significant improvement in functioning, and her psychotic symptoms gradually subsided with paliperidone palmitate. Conclusions: Paliperidone palmitate could be considered as an effective treatment modality in adolescents with schizophrenia.
Objective: Pritchard Criteria are adopted in a Malaysian criminal-justice system while assessing fitness to plead. There is limited data on the reason of unfitness to plead for female offenders in Malaysia.
Methods: A case series of five patients hospitalized to Hospital Bahagia Ulu Kinta, Malaysia due to unfitness to plead was presented and discussed.
Result: The offences include three homicides, one assault, and one stealing. All of them were diagnosed to have schizophrenia with prominent looseness of association. Four of them subsequently treated as Treatment-Resistant Schizophrenia (TRS) with a minimal response toward clozapine.
Conclusion: Looseness of association may be a contributing factor for unfitness to plead among Malaysian female offenders, which can result in indeterminate hospitalization. This should be confirmed in a larger prospective study.