Psychophysiological effect associated to an event is inseparable with regard to the human’s mental health (Celik 2010; Cannon 1987; Roxo et al. 2011; Laird & Lacasse 2014). The manifestation of psychophysiological phenomenon in relation to an event has been observed during pre-modern era and inspired physician like Avicenna from the influence of the great thinker of Aristotle and Plato. Avicenna or IbnuSina, the Persian-born philosopher and physician from the Greco-Islamic era, has made his standpoint on the clinical importance of pulsology (Celik 2010). In his earlier concepts on pulse patterns, it was found that pulse would rise when he or she is anticipating an event, especially if an event is meaningful and related to him or her. Avicenna documented in dealing with such events, the psychophysiological changes that were observed, i.e. increased pulse from normal pulse. For example, a man who is approaching a house with a lady that he loved, started to experience tachycardia and palpitation. Sphygmology, a study of pulses is based on the contribution by Ibnu-Sina (Zarshenas et al. 2013). It is a relatively simple, practical and inexpensive means, having a significant diagnosis yield (Zarshenas et al. 2013). It has been recognised through the history of medicine, over the centuries, that we have a better understanding on the fundamental concept of coping with stress by observing our own pulses. Using this modest physiological approach, it has contributed to the modern way in dealing with distressed situation-the psychophysiology of biofeedback therapy and instilling the Buddhist teaching of mindfulness. For example in the former, biofeedback is a simple way of overcoming stress. Biofeedback therapy is a method that trains people to enhance their health by regulating certain bodily processes that normally happen involuntarily (Abgrall-Barbry & Consoli 2006). Once we are in a stressful state, our pulse and blood pressure will increase. Meditating, or self-dialogueand telling our brain that, “I am in control and can dictate my pulse from the highest to lowest possible beat,” can be helpful in dealing with our stress level via higher mental function coordination. Indeed, regulation of basic physiological phenomena and psychological input-“calming the mind” has both anatomical and neurophysiological explanation via the reticular activating system and thalamic integration. Understanding a simple way in managing with stress, especially during the difficult and stressful time can be gratifying and rewarding. This is especially true when it comes to inconveniences, hassle and problems due to coronavirus disease 2019 (COVID-19) pandemic, and during the movement control order (MCO).
Summary of Paper: This study aimed to assess the knowledge on basic sciences and clinical psychiatry (psychopathology and clinical syndromes) of the part I candidates on the mock MCQ paper. Methodology and results: The study is a descriptive and cross-sectional study and was carried out in a group of postgraduate students in psychiatry from Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) and Faculty of Medicine, Universiti Malaya (UM) attending a series of revision course organized by the Department of Psychiatry, UKM. Revision course in psychiatry is an annual intensive course organized by the Department of Psychiatry, UKM to help young candidates preparing postgraduate psychiatry examination to refresh and consolidate their knowledge on basic sciences and clinical psychiatry. Candidates from various universities sitting for part 1 exam and completed their lectures and training in area of basic sciences are invited to attend this course which is held in The Department of Psychiatry, Hospital UKM.
Transgender adalah satu keadaan biopsikososial yang kompleks dan merupakan sebahagian daripada dimensi seksualiti manusia. Ia merangkumi komponen kognitif-emosi dan tingkah-laku yang membuatkan seseorang insan itu unik di dalam ekspresi seksualitinya. Kaum transgender cenderung untuk menggunakan hormon-silang-seks untuk mengubah keadaan dirinya menyerupai gender bertentangan yang diingini dengan cara menutupi ciri sekunder seksnya. Seks hormon yang biasa digunakan ialah: ““Female to Male Treatment Options (FMTO)” iaitu testosterone and hormon wanita pada “Male to Female Treatment Options (MFTO)”, di mana kombinasi estrogen dan anti-androgen digunakan. Hormonsilang-seks iaitu FMTO, atau MFTO mempengaruhi sifat biologi dan psikologi individu transgender. Namun begitu, hormon-silang-seks mempunyai profil kesan sampingan tertentu yang juga memberi impak biologi dan psikologi. Impak psikologi menjurus kepada masalah kesihatan mental dan bunuh-diri. Pelbagai tahap pengaruh biopsikososial kesan hormon-silang-seks diterangkan dan ulasan ini memberi ruang membincangkan kepelbagaian pilihan rawatan. Di dalam psikiatri, perubahan biologi memberi pengaruh yang besar ke atas individu transgender, terutamnaya dari aspek psikososial dan budaya.
Soal-selidik Kecelaruan Keresahan Menyeluruh-7 (GAD-7) versi Bahasa Melayu telah menunjukkan kesahan bersamaan, iaitu kepekaan dan kekhususan yang tinggi sebagai alat saringan untuk keresahan. Namun, ciri-ciri psikometriknya dari segi kesahan faktor belum lagi dikaji dengan lebih lanjut. Kajian ini memeriksa struktur faktor GAD-7 versi Bahasa Melayu di antara 300 orang pesakit luar kencing manis (purata umur: 60.4 tahun, sisihan piawai: 13.4 tahun; 52.7% lelaki) di sebuah hospital universiti di Kuala Lumpur, Malaysia. Peserta kajian mengisi soal-soal selidik tentang maklumat sosiodemografik, GAD-7, Inventori Kemurungan Beck (BDI), dan WHOQOL-BREF. GAD-7 versi Bahasa Melayu menunjukkan konsistensi dalaman yang baik (Alfa Cronbach=0.91) dan kesahan konvergen yang tinggi dengan kemurungan (R Pearson=0.642, p
This case report highlights Charles Bonnet Syndrome as a precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment and the possible differential diagnoses that could be considered. We report a case of an elderly lady with no known previous medical illness, who presented for the first time to the psychiatric clinic with complex visual hallucinations consisting of well-formed images of people and inanimate objects of long standing duration of 18 months. About a year later, there was emergence of cognitive impairment which progressed gradually accompanied by other psychotic symptoms such as auditory hallucinations and persecutory delusions. There were no affective or obsessional symptoms. She had poor insight towards her illness. Ophthalmological examination revealed significant reduction in bilateral visual acuity. Otherwise, physical examination was unremarkable. She received inpatient treatment with Rivastigmine patch 4.6 mg/24 hours and Zydis 10 mg noctre. Her cognitive impairment and psychotic symptoms gradually improved over a period of 2 weeks upon commencing treatment and on subsequent follow-ups at outpatient clinic. She had also gained some insight into her illness. Charles Bonnet syndrome could be a possible precipitating factor and precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment which is often overlooked or misdiagnosed and hence under reported.
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
A case of rapid stabilization using electroconvulsive therapy (ECT) for a major
depressive disordered (MDD) patient with life-threatening low body mass index
(BMI) is reported. This case report focuses on a 55-year-old Malay housewife with
underlying hyperthyroidism in a euthyroid state who presented with MDD with
mood congruent psychotic features, which were precipitated by the death of her
husband. Her BMI was only 11 kg/m2
due to severe anorexia, and she was highly
suicidal. Peripheral total parenteral nutrition was started and ECT was commenced
for rapid stabilization on top of tablet escitalopram 15 mg nocte. Full remission was achieved after nine ECTs and steady healthy weight gain was achieved throughout
admission. The patient was discharged at BMI of 13 kg/m2
with good appetite. ECT
was safe for very low BMI MDD patient.
Vaginismus is a sexual dysfunction which results from vaginal musculature spasm
and makes the penetration almost impossible. It is commonly associated with
significant emotional distress. On several occasions, fear of pain during sexual
intercourse may perpetuate the sexual dysfunction. We report a case of primary
vaginismus that was associated with psychiatric squeale of anxiety and depression
psychopathology. It suggests that psychological problems related to a mentalhealth
problem in vaginismus should be dealt adequately for a holistic approach.
A combination of behavioural, psychological and pharmacological treatment is
important to ensure a good prognosis outcome.
Kebimbangan dan gangguan emosi amat biasa di dalam Penyakit Kecelaruan
Defisit Perhatian. Laporan kes ini mengetengahkan kes lelaki Melayu berusia
23 tahun yang menunjukkan masalah memberi perhatian dan kemerosotan
pencapaian akademiknya secara ketara. Kemerosotan pengajiannya disedari
oleh ahli keluarganya 2-3 tahun sebelum beliau mendapatkan rawatan psikiatri.
Beliau juga mengalami masalah kemurungan tetapi tidak mengalami gejala
biologi kemurungan. Beliau telah dirawat dengan ubat-ubatan Buproprion 150 mg
setiap hari dan juga ubat Ritalin 10 mg. Kebiasaannya ubat peransang digunakan
untuk rawatan penyakit kecelaruan deficit perhatian tetapi dalam kes ini ubat
anti kemurungan telah digunakan. Beliau telah menunjukkan penambahbaikan
selepas memakan ubat dan seterusnya dapat memberi fokus kepada pembelajaran
akademiknya.
Schizophtrenia is a chronic mental disorder that is characterized by perceptual,
thinking, cognitive, and behavioural disturbances. One of the important symptoms
of schizophrenia is auditory hallucinations. In this case report, we discussed a
31-year-old Rohigya refugee man who had his penis totally amputated. The auditory
hallucinations instructed him to do so. He was rushed to Universiti Kebangsaan
Malaysia Medical Centre (UKMMC) for the immediate surgical treatment. After
his condition was stabilized, he was admitted to the psychiatric ward for further
observation and medical treatment. Some issues related to psychosocial, economic
and politic were discussed which made this case unique. Patient was treated
with medication sulpride and was referred to the Urology Surgeon for further
management.
This article attempts to review the criteria for the amok phenomenon since the late 15th century and how its meaning has evolved into its present day usage.
Lack of knowledge and inappropriate attitude towards electroconvulsive therapy (ECT) treatment may affect the outcome of psychiatric’s morbidity and mortality. However, less systematic studies have been done on this area. This study aimed to assess the patients’ and relatives’ perspectives, i.e. knowledge, attitude and compliance on ECT in Khartoum State, Sudan. This was an observational hospital-based study conducted among 103 psychiatric patients and their relatives respectively who visited the Taha Basher and Eltigani Elmahi psychiatric hospitals during 2016. Both the patients and their relative inquired about different criteria of knowledge and attitude towards ECT. The percentage of score was calculated based on their positive answers by selecting the most appropriate answer or by calculating the mean of many positive answers. All the data were collected through a pre-designed questionnaire, and further analyzed statistically. Male was represented 61 (59.2%) and the commonest age group of patients was 16-30 years. The overall score of knowledge towards ECT among patients and their relative was 54.9% and 59.4%, respectively. Acceptance on the use of ECT were agreed by 43.7% of patients and more than 70% of patients and their relatives believed giving ECT for emergency psychiatric cases. Psychiatrist was the most frequent source of information reported by both patients (73.8%) and relatives (67%). Male relatives showed significantly higher attitude of recommending ECT treatment (p=0.004) for other patients. Patients and their relatives were reported to have moderate and better knowledge and attitude towards the use of ECT, respectively.
Major Depressive Disorder (MDD) in gynaecological cancer patients is a disabling illness with significant mental and physical suffering. Determining the risk factors of MDD in cancer patients enables us to pay more attention to those who are vulnerable and to device effective strategies for prevention, early detection, and treatment. The objective of the study is to determine the prevalence of MDD and its associated risk factors in gynaecological cancer patients at Hospital Sultanah Bahiyah, Alor Star. This is a hospital-based cross-sectional descriptive study of 120 gynaecological cancer patients in Gynae-Oncology Unit in Hospital Sultanah Bahiyah, Alor Star. Mini International Neuropsychiatry Interview (MINI) was used for diagnosis of MDD. Socio-demographic data and clinical variables were collected. MVFSFI (Malay version Female Sexual Function Index) was used to determine sexual dysfunction, and WHOQOL-BREF (World Health Organization – Quality of Life-26) was performed to assess quality of life. The prevalence of MDD in gynaecological cancer patients in the study was 18%. The variables found to be significantly associated with MDD were lack of perceived social support, greater physical pain perception, presence of past psychiatric history, and poorer quality of life. Meanwhile, sexual dysfunction was not associated with MDD. Logistic regression analysis revealed that only the psychological health domain of QOL was significantly associated with MDD, and contributed to 60% of the variation in MDD. The prevalence of MDD in gynaecological cancer patients is higher than those in the general population. In view that MDD can compromise cancer prognosis and patient’s well-being, psychosocial intervention is recommended as a part of multi- disciplinary and comprehensive management of gynaecological cancer.
Sexual dysfunction is common but not often assessed in the routine clinical care among males on opiate substitute treatment.
Objective: To determine the association between clinical variables and erectile dysfunction (ED) among men on methadone maintenance therapy (MMT).
Methods: A cross-sectional study involving 108 participants who attended the Drug Clinic, Hospital Kuala Lumpur. The instruments used include the Structured Clinical Interview for DSM-IV Axis-I Disorder (SCID-I), Beck Depression Inventory (BDI) and International Index of Erectile Function-15 (IIEF-15).
Results: Concurrent heroin abuse was significantly associated with presence of ED (p=0.024). Treatment factors including methadone dose and duration of methadone treatment were not significantly associated with ED.
Conclusion: Education on sexual dysfunction as a potential adverse effect and its association with illicit heroin use should be considered in the doctor-patient consultation to encourage treatment adherence and abstinence from heroin.
Study site: Drug Clinic, Hospital Kuala Lumpur, Malaysia
OBJECTIVE: To analyse the features of patients with vaginismus first presented to a gynaecologist for infertility before being referred for psychiatric evaluation and management. The case series aim to provide some insight on features and presentations of Asian women with vaginismus. Vaginismus is characterised by persistent or recurrent difficulties in vaginal penetration despite the woman's wish for coitus. Avoidance, phobia, anticipatory fear of pain and involuntary pelvic muscle contraction are the most common symptoms.
METHOD: We report a series of cases of Malaysian women who had been suffering from vaginismus and 'infertility'. All the cases had never been attended to medically and there were long delays in seeking intervention. There was no history of traumatic sexual experience or any major psychiatric illness in these patients. Majority of the patients had prominent symptoms of anxiety.
CONCLUSION: The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. The former have unique psychological features which require psychological interventions.
Introduction: Psoriasis is a chronic, immune mediated, hyperproliferative skin disease that has substantial impact on the sexual functions. This study aimed to determine the prevalence and associated factors of female sexual dysfunction (FSD) in patients with psoriasis.
Methods: A cross-sectional study involving 79 women with psoriasis attending two Dermatology Outpatient Clinics were interviewed and assessed for female sexual dysfunction and severity of psoriasis. The socio-demographic and clinical characteristics of the subjects were compared between the women with and without sexual dysfunction. The subjects were interviewed using Mini International Neuropsychiatric Interview (M.I.N.I.) to exclude any existing psychiatric illness. Sexual dysfunction was assessed using a validated questionnaire on sexual function and the severity of psoriasis was assessed using Psoriasis Area and Severity Index (PASI).
Results: The prevalence of FSD in the patients with psoriasis was 20.3%, with hypoactive sexual desire being the most prevalent problem (44.3%). Sexual dysfunction was associated with older age, menopause, low body mass index, longer duration of marriage and presence of psoriasis in the genital area. Female sexual dysfunction was highly prevalent in patients with psoriasis.
Conclusion: Management of psoriasis should include assessment in patients’ sexual health. Genital area involvement with psoriasis should not be overlooked as it can cause significant psychosexual distress.
Keywords: Psoriasis, female, sexual dysfunction, prevalence, risk factor, Malaysia
Study site: Dermatology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
The escalating problem of opiate dependence in Malaysia and the limitations of regimental approach of forced admission to rehabilitation centres had triggered the government to expand the methadone maintenance therapy to become a national programme. This study aimed to evaluate the short-term outcomes of the Methadone Maintenance Therapy programme in one of the busiest hospital in east coast Malaysia. We also explored the prevalence on non-compliance and factors associated to it. A total of 172 patient case notes at Methadone Clinic Hospital Tengku Ampuan Afzan (HTAA) were retrieved for relevant data. A short survey was also conducted to determine the subjects' current employment and marital status. The programme's retention rate was 62% and factors associated with poor compliance were unemployment, low quality of life scores and low dose of methadone. A special attention on the patients with these three risk factors may improve their compliance to MMT. The short-term evaluation of MMT at HTAA revealed favourable findings.
Study site: Psychiatric clinic, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
We present a simulation study on negative bias temperature instability (NBTI) induced hole trapping in E' center defects, which leads to depassivation of interface trap precursor in different geometrical structures of high-k PMOSFET gate stacks using the two-stage NBTI model. The resulting degradation is characterized based on the time evolution of the interface and hole trap densities, as well as the resulting threshold voltage shift. By varying the physical thicknesses of the interface silicon dioxide (SiO2) and hafnium oxide (HfO2) layers, we investigate how the variation in thickness affects hole trapping/detrapping at different stress temperatures. The results suggest that the degradations are highly dependent on the physical gate stack parameters for a given stress voltage and temperature. The degradation is more pronounced by 5% when the thicknesses of HfO2 are increased but is reduced by 11% when the SiO2 interface layer thickness is increased during lower stress voltage. However, at higher stress voltage, greater degradation is observed for a thicker SiO2 interface layer. In addition, the existence of different stress temperatures at which the degradation behavior differs implies that the hole trapping/detrapping event is thermally activated.
Female sexual dysfunction (FSD) has a major impact on interpersonal relationships and quality of life. For many women it has been emotionally distressing, physically disconcerting, and socially disruptive. To determine the prevalence and factors that contribute to female sexual dysfunction (FSD) and to evaluate the different sexual domains that influence sexual function amongst post menopausal women.
Depression and its treatment may influence all aspects of the female sexual function from desire to sexual satisfaction. This study aimed to examine the components of the female sexual response cycle (SRC) of women with major depression treated with Selective Serotonin Reuptake Inhibitors.