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.
Neurological soft signs (NSS) are subtle indicators of brain dysfunction which are present in excess among patients with Schizophrenia. Its clinical significance remains unclear despite extensive researches in this area. The objective of this work was to determine the proportion of schizophrenia patients who have motor NSS and then to compare the clinical features between these two groups; with and without motor NSS. This cross-sectional study which utilized the brief motor scale (BMS) was used to investigate the presence of motor NSS in 80 schizophrenia patients who attended Universiti Kebangsaan Malaysia Medical Centre (UKMCC) Psychiatric clinic. The diagnosis of schizophrenia was confirmed by mini international neuropsychiatic interview (MINI). Symptomatology and abnormal motor movement were assessed using the brief psychiatric rating scale (BPRS) and abnormal involuntary movement scale (AIMS), respectively. A brief battery of cognitive tests covering aspects of attention, working memory and executive function was administered. The bivariate analyses were applied to look for any relationship between the study factors. Majority of schizophrenia patients (68.8%) in this study have motor NSS. The motor NSS were associated with ethnic group, level of education, age of onset, duration of illness and performance in cognitive assessment; verbal fluency, digit span forward, digit span backward
and trail making B (p<0.05) but not with trail making A. The assessment of motor NSS represents a brief, inexpensive and meaningful tool in assessing the cognitive functions in schizophrenia. It has the potential as an illness marker and a link between neurobiological research and clinical practice.
Objective: This study aims to report on the process of standard settings (SS) and to compare the passing rates between the norm-reference and SS methods, for OSCE in psychiatry undergraduate examination at UKM for 2009/2010 session. Methods: In the SS method, examiners were asked to imagine the performance of a minimally competent student and gave marks using a standardized check-list. The marks in particular outliers were discussed. After the first round, the examiners went through the same process again, to rate the minimally competent students independently. The median of the marks was taken as the passing mark for the particular question. The passing rate using the passing mark of 50% in the normreference method was compared to the passing rate from the passing mark obtained from the settings method. Results: For question 1, the passing rate with the norm-reference method (i.e. passing mark of 50%) was 93% (106/114) and that by the SS method was 72.8% (83/114). For question 2, the pass rate with the norm-reference method was 92% (105/114) and that by the SS method was 67.5% (77/114). Conclusion: The passing rates between the two methods showed significant differences. Although OSCE is an improvement to the undergraduate psychiatry examination in Universiti Kebangsaan Malaysia, there were few limitations and challenges that need to be tackled for further improvement.
Objective: According to Malaysian law, defendants found not guilty by reason of insanity may be admitted to a psychiatric hospital and discharge is subject to the state ruler’s assent. The objective of this study is to examine the clinical, socio-demographic and forensic factors that influence inpatient duration of insanity acquittees in a Malaysian mental institution. Methods:This is a cross-sectional study of one hundred and twelve insanity acquittee inpatients in Hospital Bahagia Ulu Kinta from January 2007 to February 2007. Patients with a clinical diagnosis of schizophrenia, major depressive disorder and bipolar disorder were assessed using the Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAMD) and Young Mania Rating Scale (YMRS) respectively. Other relevant sociodemographic, clinical and forensic factors were also assessed. Results: The inpatient duration varied widely from three months to forty-seven years with a median of seven years. Seventy five percent of patients were in remission. According to the multiple linear regression model, the strongest predictor of a longer duration of hospital stay for insanity acquittees was older age (p