Objective: Pathological laughter, pseudobulbar affect or a myriad of its other synonyms, is a condition common secondary to neurological injury, presenting with uncontrolled laughing or crying, appearing to be mood-incongruent and significantly debilitating. The objective of this case report is to highlight a rare case of pathological laughter associated with Cerebral Lupus.
Methods: We report a case of a 27-year-old lady presenting with signs and symptoms of stroke with dysarthria progressing to aphasia and then pathological laughter, with an underlying poorly controlled Systemic Lupus Erythematosus, manifesting as Cerebral Lupus.
Results: An improvement in affect congruency followed by decreased frequency of outbreaks among bouts of pathological laughter.
Conclusion: The combination of Escitalopram and Topiramate is effective in the symptomatic treatment of Pathological Laughter.
Objective: The main aim of this study is to assess the prevalence of early
readmissions to inpatient care in Hospital Bahagia Ulu Kinta and the associated
socio-demographic and clinical factors.
Methods: This is an observational study
for all patients with readmissions within 3 months from the last discharge, dated
from 1 January 2013 to 31 December 2013. Related socio-demographic and
clinical details are obtained from the medical records and compared between the
patients who were readmitted within the first month after discharge to those who
were readmitted later in the second and third month.
Results: Total of 149
records of patients who were readmitted within 3 months of last discharge were
analyzed. Majority of them were from the same state of Perak (83.9%), male
(74.5%), single (71.1%), unemployed (85.9%), taken care by family (75.2%),
achieved secondary education level (59.7%) with mean age of 37.89 years (SD
11.53). They were discharged for a mean of 32.52 days (SD 26.48) before
readmission with a mean duration of 72.98 days in the previous admission, and
mean previous admissions of 10.17 times. 69.8% of the patients were treated for
psychotic disorders and the main reason for readmission was relapse (84.6%).
Up to 34.2% of the patients reported to have substance abuse while 25.5% had
medical co-morbidities. Most of the patients (63.8%) were not compliant to the
treatment from the last discharge. Socioeconomic and clinical factors did not
show statistical significance when the readmissions within the first month after
discharge were compared to those who were admitted later at the second and
third month.
Conclusions: Due to limitations, further studies need to be done to
identify risk factors associated with readmissions and adequate measures need to
be taken to prevent these readmissions.
Objective: This case reported highlighted psychotic disorder due to dengue fever
is rare. Hence we describe a case which clearly presented with psychotic
symptoms during the illness.
Methods: We reported a case of psychotic disorder
due to dengue fever who presented with psychotic symptoms of auditory and
visual hallucination, and persecutory delusion, which had significant temporal
correlation with dengue fever symptoms. There were no neurological deficits
noted, no altered sensorium and cognitive impairment during the episode. He
has no past and family history of mental illness and there was no evidence of
encephalitis and metabolic disturbances.
Results: Our case suggests that
prominent psychotic symptoms can occur during an episode of dengue fever,
which remitted when one recovering from dengue fever.
Conclusion: We
demonstrated that patients who presented with the acute onset of psychosis
accompanied by symptoms of viral fever should be screened for dengue fever,
particularly if the person lived in or visited the area where dengue fever is
endemic.
Objective: Long-term use of ecstasy is known to be a risk factor for structural brain damage and psychosis. Most patients suffering from ADHD in childhood will not develop psychosis during adulthood but the risk is increased when there is concomitant significant drug use. However, it is difficult to distinguish between substance-induced psychoses with schizophrenic psychosis.
Method: We report a case of a patient with history of ADHD who was untreated, who later developed psychotic symptoms soon after initiation of ecstasy uses. The symptoms persisted despite in a ‘drug-free period’ and intensified while on the ecstasy.
Results: Present case helps to understand common neurobiological mechanism behind psychosis and brain atrophy, and risk factors such as ADHD and ecstasy abuse.
Conclusion: More research in this area is vital for management and further understanding on the importance of treating ADHD earlier and to be more vigilant in establishing the history of substance use.
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.
Objective: The purpose of this study was to determine the level of psychosocial burden and its associated risk factors among women with abnormal Pap smear and post colposcopy.
Methods: A cross-sectional study was conducted employing universal sampling of 218 respondents with abnormal Pap smear and post colposcopy. They fulfilled the specific inclusion and exclusion criteria. Three tertiary hospitals in the East Coast of Malaysia were participated. Self-administration of validated Malay-version Psychosocial Effect of Abnormal Pap smear Questionnaire was used to assess the psychosocial burden. The General Health Questionnaire-12 (GHQ-12) was applied to assess the general health factor. Data was analyzed using IBM-SPSS of version 22.
Results: The results showed that respondents with an abnormal Pap smear and post-colposcopy women (43.1%) demonstrated a high level of psychosocial burden. The significant risk factor of psychosocial burden was living in an urban and semi-urban area of residence (p≤0.001) and distress condition (p≤0.001) respectively.
Conclusions: A substantial number of women with abnormal Pap smear results were experiencing psychosocial burden. Women with an abnormal Pap-smear who were living in the urban and semi-urban and distressed were more likely to experience a higher psychosocial burden.
Objective: A quick assessment tool for screening individuals with depression or anxiety is pertinent in mental-health set up. This study aims to validate the K10 and the K6 to screen patients with non-specific
psychological distress in a Malaysian population.
Methods: Translation of the questionnaire was done from English to Malay. Face validity was conducted on patients, and a pilot study was performed to assess the reliability of the K10 questionnaire. Fieldwork was conducted to determine the reliability and validity of the K10 questionnaire based on convenience sampling of healthy individuals and patients diagnosed with psychiatric illness. Malay version for K10 was administered to healthy participants (group without psychological distress) and patients on psychiatric clinic follow up (psychological distress). Data collection was done between August 2016 and September 2016.
Result: A total of 94 subjects were recruited in the study, of which 32 formed the case group. The Cronbach’s alpha coefficients for K10
were 0.837(control) and 0.885 (case), as for K6 were 0.716 (control) and 0.859 (case). The total score of the
K10 and the K6 clearly differentiated between the control and case groups (p
Introduction: Kratom (Mitragyna speciosa Korth) dependence is a common psychiatric complication associated with regular kratom use in Malaysia. Hence, it is important to assess the severity of kratom dependence among regular kratom users. The Kratom Dependence Scale (KDS) was introduced to evaluate the degree of severity of kratom dependence among users. This study aimed to translate the original English version of the KDS into Malay and examine the psychometric properties of the KDS (Malay) among Malaysian kratom users.
Methods: Initially, parallel translation and back translation of the original English version of the KDS was performed. The KDS (Malay) then was administered to 20 active Malaysian kratom users to assess face and content validities in a pilot study. Finally, the final version was administered to 150 active kratom users to evaluate its internal consistency (Cronbach’s α), face and content validities, discriminative validity, and construct validity, i.e. via exploratory factor analysis (EFA).
Results: The KDS (Malay) Cronbach’s α of 0.94 exhibited excellent internal consistency. It also demonstrated construct validity, as EFA showed that all items of the KDS (Malay) fit into a single domain, similar to the original English version. Discriminative validity was also demonstrated by the KDS (Malay), as it could differentiate kratom dependent users from non-kratom dependent users.
Conclusion: The KDS (Malay) has acceptable psychometric properties and is suitable to assess severity of kratom dependence in Malaysian kratom users.
Objective: Smart phones have become an important part of human’s life, including the healthcare population and medical students. However, pathological use of smart phones could lead to smart phones addiction. The aim of this study is to observe a pattern of usage of smart phones among the medical students and staffs in the Faculty of Medicine Universiti Teknologi MARA (UiTM) and screen for smart phone addiction among the respondents.
Methods: A cross sectional, quasi-experimental study design involving medical students and staffs in the Faculty of Medicine Universiti Teknologi MARA (UiTM) was employed. A total of 598 respondents was approached to participate, and all consented to this study. Measurements used in the study include a self-developed questionnaire to measure pattern of smart phone usage and Smart phone addiction scale (Malay version).
Result: We found that 65.9% of the respondents were heavy users of the smart phone (more than 3 hours daily) and majority of them were using it for social networking. More than half of the respondents (52.2%) were at risk of developing smart phone addiction based on Smart phone Addiction Scale (Malay Version).
Conclusion: This study revealed that medical students, and the faculty staffs were heavy users of smart phones, and they were at risk to develop smart phone addiction.
Objective: Suicide pacts are rare subsets of suicides amounting to less than 1% of suicides globally. Usually, there is one dominant participant to persuade the other by their shared experiences to agree to the suicide pact. There is also the perceived loss of a partner (which is a contributing factor in about 20% of cases) with the impending death of one member acting as a trigger.
Methods: We report a 46-year-old Burmese lady who presented with deliberate self- poisoning immediately after the death of her husband to honour a suicide pact they made. She had no previous history of psychiatric illnesses. The pact, initiated by her husband, was well planned six months prior to his death.
Result: She was discharged well after a thorough medical evaluation and supportive therapy. Input of family members knowledgeable in Buddhism helped allay her obligation to the pact citing religious reasons.
Conclusion: The case highlights a suicide pact that was initially unrecognised in the ward. In a multicultural country, psychiatrists need to be more sensitive and aware of erroneous beliefs that may lead to a suicide pact.
Objective: Lysergic-acid-diethylamide (LSD) users are the hidden population of drug users as they do not present to medical personal for treatment. The method of transporting the drug is usually by-pass the law enforcers’ monitoring. We describe a rare case of LSD use in Malaysia Novel Psychoactive Substances (NPS) which is difficult to capture as LSD users remained as a hidden population of drug users in the country.
Methods: We reported a 23-year-old male with chronic use of Lysergic-acid-diethylamide (LSD) presented with retrospective history of acute intoxication. Later, he presented with depressive symptoms, occasional flashbacks and physical complications such as premature ejaculation (PE), urinary incontinence, reduced sweating and headache despite abstinence from LSD and other drugs. The reported physical complications remitted after 4 months of abstinence.
Result: Our case report suggested that LSD use not only causes acute intoxication but leads to several complications, which may persist even after cessation of LSD use.
Conclusion: This case-report had pointed out the importance of future studies to look into the complications of LSD and the case-report as well demonstrated the harmful psychological and physical effects of LSD use, which would warrant proper surveillance and interventions curbing the emergence of LSD use in Malaysia.
Objective: Bradycardia due to the combination of amisulpride and fluvoxamine is not commonly known in the literature.
Methods: We report a case of asymptomatic sinus bradycardia that occurred when amisulpride and fluvoxamine were given concurrently and resolved after cessation of both these two medications. The Naranjo scale for Adverse Drug Reaction was used to determine the likelihood of medications’ in causing bradycardia. Other possible causes were also assessed and ruled out through medical consultations.
Results: This case strongly suggests that the bradycardia occurred due to the combined effect of these medications’ independent risk in causing this potentially harmful cardiac event.
Conclusion: Therefore, it is important to monitor for bradycardia whenever both these medications are prescribed even at therapeutic dosages.
Objective: The objective of this study to assess the comparative effectiveness of exposure and response prevention (GERP) and cognitive-behaviour therapy (GCBT) in a group of Iranian patients with obsessive-compulsive disorder (OCD) and comorbid depression symptoms (CDS).
Methods: Ninety OCD patients were selected (both genders, married or unmarried and ages from 18-65 years) using a non-probability sampling (availability sampling) procedure. The respondents subsequently sampled via cluster randomization into three equal groups: a control group (n = 30) that did not receive any treatment intervention during the study and two other groups who received 12 weeks of psychotherapy in the form of GERP (n=30) or GCBT (n=30). This study obtained the required data through a clinical interview with all participants based on the diagnostic and statistical manual of mental disorders text revision (DSM-IV-TR). The statistical analysis was performed using analysis of variance (ANOVA), Bonferroni correction and Pearson correlations.
Result: We found that GCBT and GERP are effective treatments for alleviating OCD symptoms among patients. The results demonstrated that OCD scores were significantly reduced among participants after receiving GCBT and GERP treatments, with mean (standard deviation, SD) changes of 0.829 (0.287) and 0.970 (0.258), respectively. The study measured CDS through the Persian-language version of the Beck Depression Inventory-II (BDI-II-PERSIAN). The study further found a significant correlation between OCD and CDS. The findings suggested that GCBT and GERP improved comorbid depression symptoms (CDS) significantly with mean (SD) changes of 13.57 (3.92) and 12.85 (4.50) respectively.
Conclusion: GCBT and GERP separately produced equivalent improvements for OCD and CDS.
Introduction: Psychotherapy is a form of treatment intervention targeting problematical human behaviour, emotion, and cognition using various psychological techniques and approaches. In Malaysia, the application of psychotherapy in ameliorating criminality among forensic populations is developing and evidence shows that some therapies like Cognitive-Behavioural Therapy and Reality Therapy have been practiced in many correctional institutions.
Objective: This paper aims to review the role of psychotherapy for help in correctional settings as a means to ameliorate criminal behaviour and reduce recidivism rates.
Method: An archival research was utilised, where articles and books regardless of the year of publication from different countries, including Malaysia were examined. Several keywords were used for the purpose of retrieval of related articles.
Results and Discussion: Three different approaches of psychotherapies, i.e. Behavioural Therapy, Cognitive Therapy and Cognitive-Behavioural Therapy and their principles and effectiveness in rehabilitating the forensic populations were elaborated in this review. The principle behind the effectiveness of the psychotherapy was different, and this influences the choice of treatment that should be used in dealing with the forensic populations.
Conclusion: Forensic populations have rights to obtain treatment, and the choice of therapy has to be relevant within the context of cost-effectiveness to ensure optimum effectiveness in ameliorating criminal tendencies.