Medical schools have existed in Malaysia for a very long time. The majority of practicing doctors has trained locally. From the early nineteen sixties when the first medical school was established to the current 7 public medical faculties, the standards of local trained doctors have always been exemplary. Now with more need for doctors to serve the country and the mushrooming of medical schools, the question of needs and wants of future medical schools and medical education need to be addressed. In this paper I will try to highlight what we in Universiti Putra Malaysia have been working on to improve the Medical and Health Sciences faculty to achieve greater heights to reach the future in the shortest possible time.
Mental health is becoming an important issue. Several local and international studies have proven that the incidence of mental illness is on the rise. Doctors have also been able to make more accurate diagnoses and treat mental disorders more reliably with the aid of recent research and newer drugs. As such it is necessary for the medical curricula to respond to this shift. Medical students must now be exposed to new psychiatric disorders and ways of managing them. The time spent in psychiatry and the mode of teaching must also be revised and modified to the current needs of patients.
A number of psychological approaches to alleviating psychotic symptoms have been reported in the literature. The latest technique among them is cognitive therapy (CT). This paper describes an open trial that makes use of cognitive psychotherapy to treat chronic drug resistant delusions (more than 2 years duration) in 20 patients with schizophrenia. The positive response of all patients with the absence of symptom replacement and maintenance of response at 3 months follow-up, seem to imply that this technique is useful and more effort needs to be invested into this new area of psychotherapy for psychosis. This paper also shows that those patients on risperidone maintenance respond better to CT than those on other neuroleptics.
This paper reports the result of a brief therapy attempt at treating panic in a busy outpatient psychiatric clinic. The patients were cases of panic referred from the various outpatient clinics within the hospital complex. The patients were divided into three groups at random using one of three modalities of treatment, i.e. cognitive behaviour therapy (CBT), CBT and Fluvoxamine (FVX), and FVX alone. The therapy was aimed for a maximum of nine sessions after which the patients were to be discharged. There were 14 patients in each group. The results show that all the groups were similar in the severity and scores pre treatment but after the different types of treatment there was a significant difference among them. The FVX alone group, showed significant improvement from the pretreatment levels but did not show as much improvement as the other groups and the mean score was only 9.07 after nine sessions. The best group was the CBT in combination with FVX. This indicates that the best way to treat panic is to combine drug treatment and psychological treatment. It is also shown from the study that the combination group requires less FVX than the FVX alone group. This finding has implications for the treatment of panic at the family physician clinic.
Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia
Introduction: The Cyclooxygenase-2 (COX-2) enzyme is responsible for the synthesis of prostaglandin which is responsible for inflammation and pain. Celecoxib a cyclooxygenase-2 inhibitor was first used as a non-steroidal anti-inflammatory drug in 1999. Celecoxib is as effective as NSAIDs but causes less ulceration of the gastrointestinal tract, hence it is commonly used. It has been widely used in patients with osteoarthritis and rheumatoid arthritis. We present 3 cases of temporary psychiatric disorders associated with consumption of celecoxib, two of the patients presented with auditory hallucinations while one was diagnosed to be having depression. None had pre-existing psychiatric disorders or consumed alcohol or substance of abuse. All 3 patients recovered from their temporary psychiatric disorders after stopping celecoxib. Discussion: It is important to be aware of the psychiatric side effects when prescribing the drug for prolonged periods.
This study was conducted to find out the psychiatric symptomatology in the patients and their families attending a primary health care facility. The most frequent symptoms found were of depression (13.2%), followed by hypochondriacal symptoms (8.2%), anxiety symptoms (6.1%) and psychotic symptoms. A large proportion (21.5%) of children had psychiatric symptoms. The common symptoms include enuresis, hostility, tantrums, problems of conduct and destructiveness. Surprisingly, concern for these symptoms was lacking in both the patient and their family members.
This study was aimed at determining the effect of psychotherapy in patients in bereavement. Fifteen patients in a control group were given brief psychotherapy and 15 study group patients received psychotherapy with a religious perspective. The patients in the study group showed consistently significant improvements as compared with the control group at the end of 6 months. The results indicate that highly religious patients with grief and bereavement tend to improve faster when a religious psychotherapy is added to a cognitive-behaviour approach.
This study was conducted to explore the outcome of psychotherapy in ethnic Malays with strong religious and cultural background. The patients were divided into two groups. The study and control groups consisted of 32 depressed patient each. In the study group brief psychotherapy of 15-20 sessions was attempted with the addition of a religious perspective, while in the control group the religious perspective was omitted. Patients in the study group showed more rapid improvement in the initial 3 months of the study period than those in the control group, but at the end of the 6 months the difference became nonsignificant.
Introduction: A cross-sectioned study was carried out on 1016 drug addicts from Johor state to better understand their profile.
Method: A structured questionnaire prepared in three languages was used to collect the data which was analyzed using the Statistical Package for Social Sciences.
Result & Discussion: The overall mean age of the respondents was 33.8 (95% CI= 33.3 - 34.4) years and ranged from 16 to 61 years. ANOVA post hoc multiple comparison tests showed that there was a significant difference in the mean age between Malays and Chinese (p<0.05). The majority of the respondents were Malay (79.6%) and had secondary education (72.1%) or primary education (21.7%). The majority (79%) was either semi-skilled or unskilled. More than 70% had mores than five siblings. About 36% of the respondents had past a history of discipline problem at school. The majority (99.6%) of the drugs addicts had smoked before and more than 90% were currently smoking. More than 80% had consumed alcoholic beverages. The majority did not use condom when they had sex. Only 24% stated that they did use a needle or syringe that had previously been used by someone else. Less than 4% had either bleached or boiled the needle or syringe that had previously been used by someone else. About 17% were tested positive for HIV. The mean age at which the respondents first started injecting drugs was 21.5 (95% CI= 20.7 - 22.2) years. ANOVA post hoc multiple comparison tests showed that there was no significant difference in the mean age of the different ethnic groups at which the respondents first started injecting drugs. The majority (84.2%) of the drug addicts started injecting drugs between 10 and 20 years of age. Friends introduced 80% of the drug addicts to drugs. The common reasons given for first taking drugs was " I was curious about the feeling of taking drugs (43.6%), "my friends asked me to try" (23.4%), "to release tension" (15.6%) and 5% stated "to try for fun", and 3% that they were "depressed". The majority (64.2%) of the drug addicts spend RM 500 or more per month on drugs and more than 10% of them spend as much as RM 1000 or more per month.
Conclusion: These results indicate an urgent need for a more comprehensive prevention program involving family, schools, commmunities and the media and aimed at reducing drug abuse. Keywords: Profile, drug addicts, Malaysia
The families of 83 schizophrenic patients were studied to find out the level of expressed emotion in them leading to the relapse of these patients. The patients were having more than two episodes of schizophrenia (DSM-III-R). The most salient finding was the virtual absence of high level of expressed emotion as the cause of relapse. It was found that the majority of the families (72.3%) had low expressed emotion while only 25.3% had high expressed emotion and only 2.4% families were equivocal in this respect. This finding is in contrast with various other findings in this area. The most likely explanation for this disagreement is the cultural differences between Malaysian patients and Western patients.
Study design: A cross-sectional study was conducted in all states of Malaysia to determine the prevalence, awareness, treatment and control of hypertension. A stratified two-stage cluster sampling design with proportional allocation was used.
Methods: Trained nurses obtained two blood pressure measurements from each subject. Hypertension was defined as mean systolic blood pressure >140 mmHg, diastolic blood pressure >90 mmHg, or a self-reported diagnosis of hypertension and taking antihypertensive medication. All data were analysed using Stata 9.2 software and took the complex survey design into account. A two-sided P-value of <0.05 was considered to be statistically significant.
Results: The overall prevalence of hypertension for subjects aged 15 years was 27.8% (95% confidence interval (CI) 26.9-28.8). The prevalence of hypertension was significantly higher in males (29.6%, 95% CI 28.3-31.0) compared with females (26.0%, 95% CI 25.0-27.1). Multivariate logistic regression showed that the odds of having hypertension increased with increasing age, in males, in subjects with a family history of hypertension, with increasing body mass index, in non-smokers and with decreasing levels of education. Only 34.6% of the subjects with hypertension were aware of their hypertensive status, and 32.4 were taking antihypertensive medication. Amongst the latter group, only 26.8% had their blood pressure under control. The prevalence of hypertension amongst those aged 30 years has increased from 32.9% in 1996 to 40.5% in 2004.
Conclusion: In Malaysia, the prevalence of hypertension is high, but levels of awareness, treatment and control are low. There is an urgent need for a comprehensive integrated population-based intervention programme to ameliorate the growing problem of hypertension in Malaysians.
Two hundred and seventy patients with schizophrenia (104 patients in Kelantan and 166 patients in Penang) were interviewed using the Present State Examination to elicit the differences in the phenomenology of their hallucinations. The results indicate that there are significant differences in the phenomenology of hallucinations between the Malays of Penang and Kelantan and also among some Chinese patients. These findings indicate that culture does affect the phenomenology of schizophrenia, even among people of the same race but of different regions.
Religious patients with generalized anxiety disorder were given religious psychotherapy in addition to supportive psychotherapy anxiolytic drugs. Those receiving religious psychotherapy showed significantly more rapid improvement in anxiety symptoms than those who received supportive psychotherapy and drugs only. Thus, religious patients may require a different form of psychotherapy.
The Community Follow-up Project involves a scheme by which clinical students follow the progress of patients after discharge from hospital. The Community Follow-up Project begins with the student choosing a hospital in-ward patient during their first clinical ward based attachment and follows this patient's progress after discharge from the hospital. The students do a series of home visits and also accompany their patients for some of their follow-ups to the hospital or government clinics; to their general practitioners and even to the palliative care or social welfare centres. The students assess the physical, psychological and social impact of the illness on the patient, family and community. This project supplements students' knowledge of the natural history of disease and emphasizes the importance of communication and the use of community resources. By commitment to the patient for a duration of time, the students are able to take an active role in patients' care, understand in depth the problems faced by patients and in assessing a patient's progress, students find themselves in the role of a teacher and advisor to their patient as well. We outline the main components of this project, describe its outcome and consider areas that invite further developments.
Two hundred and seventy schizophrenia patients were interviewed using the Present State Examination to elicit the phenomenological symptoms of the illness. Cultural factors and ethnicity were found to be significant variables associated with the symptoms. Higher prevalence of religious and other subculturally related delusions were common in Kelantan patients. Our general belief that Malaysian culture influences symptomatology of mental illness seems to be proven.
The Community Follow-up Project (CFUP) is a project where medical students choose a hospital in-ward patient during their clinical ward-based attachments and follow-up this patient's progress after discharge from the hospital. The students do a series of home visits and also accompany their patients for some of their follow-ups at the hospital, government clinics, general practitioners' clinics and even to the palliative care or social welfare centres. The students assess the physical, psychological and social impact of the illness on the patient, family and community. By following their patients from the time their patients were in the hospital and back to their homes and community, the students are able to understand in depth the problems faced by patients, the importance of communication skills in educating patients on their illness and the importance of good communication between primary, secondary and tertiary care.
Schizophrenics (n = 250) and normal controls (n = 90) were studied to investigate and compare their dermatoglyphic patterns. Their fingerprint patterns were studied. The frequency of arches in the patient and control groups was similar. The frequency of loops in the control group was higher than in the patient group, and the trend was consistent in all the digits. The whorls in the patient group showed an increase over the control group in all the digits, although this finding was not statistically significant.
Objectives: To determine the relationship between major depressive disorder, anxiety disorders and the quality of life of haematological cancer patients.
Methods: This cross-sectional study was conducted at Ampang Hospital Kuala Lumpur, Malaysia, a tertiary referral centre hospital for haematological cancer. The Mini-International Neuropsychiatric Interview was used for the diagnosis of major depressive disorder and anxiety disorders. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was utilised to measure patients’ quality of life.
Results: A total of 105 haematological cancer patients ere included in the study with response rate of 100%. Major depressive disorder correlated with almost all domains of the quality of life, except the pain scores. Logistic regression showed that insomnia and financial difficulties were related to major depressive disorder. Different anxiety disorders also correlated with quality of life in specific domains. The leading anxiety disorders that correlated mostly with quality﹣of life scales were generalised anxiety disorder, followed by obsessive-compulsive disorder, social anxiety disorder, as well as post-traumatic stress disorder and panic disorder with agoraphobia (p < 0.05).
Conclusions: Psychological treatment along with medication and intervention should be implemented to improve the overall quality of life and psychiatric disorder symptoms among the haematological cancer patients.
Key words: Anxiety; Depression; Hematologic neoplasms; Quality of life
Objectives: To determine the relationship between major depressive disorder, anxiety disorders and the quality of life of haematological cancer patients.
Methods: This cross-sectional study was conducted at Ampang Hospital Kuala Lumpur, Malaysia, a tertiary referral centre hospital for haematological cancer. The Mini-International Neuropsychiatric Interview was used for the diagnosis of major depressive disorder and anxiety disorders. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was utilised to measure patients’ quality of life.
Results: A total of 105 haematological cancer patients were included in the study with response rate of 100%. Major depressive disorder correlated with almost all domains of the quality of life, except the pain scores. Logistic regression showed that insomnia and financial difficulties were related to major depressive disorder. Different anxiety disorders also correlated with quality of life in specific domains. The leading anxiety disorders that correlated mostly with quality of life scales were generalised anxiety disorder, followed by obsessive-compulsive disorder, social anxiety disorder, as well as post-traumatic stress disorder and panic disorder with agoraphobia (p < 0.05).
Conclusions: Psychological treatment along with medication and intervention should be implemented to
improve the overall quality of life and psychiatric disorder symptoms among the haematological cancer
patients.
Key words: Anxiety; Depression; Hematologic neoplasms; Quality of life