Alot has been said and debated about evidence-based clinical practice. What is it really and why so much of significance is attached to it? Is all the evidence from clinical trials relevant and reliable? How about experience-based clinical practice? How much of our practice is influenced by clinical data and how much of it by years of practice and number of patients managed? The clinician will still need to exercise common sense when treating patients and they must always remember that each individual patient is unique and a clinician’s approach will have to be catered to their needs. After all, the caveat is that we are treating individuals with feelings and emotions and not textbooks or journal articles.
The problem of illicit drug use has been a long standing problem in Malaysia. It is well recognized that drug mis-use is associated with many social, economic and health problems, including mental health problems. Anxiety disorders have consistently been cited as the commonest type of psychiatric disorder in drug users. In Malaysia, many drug users are incarcerated in rehabilitation centres and prison. They form a different type of population as compared to the drug user in the general population, due to the effects of incarceration. With this in mind, a study was carried out in a rehabilitation centre, looking at anxiety disorders. Utilizing the SCID, we found current and lifetime diagnoses for anxiety disorders at 63.4% and 67.6% respectively. Suggestions are made in regards to our findings.
It has been long known that affective disorders as a result of organic brain diseases are not uncommon. Neurological disorders seem to be significant as risk factors for newly diagnosed mania in the elderly. It has been theorized that lesions in the right cerebral hemisphere and limbic structures may produce symptoms suggestive of mania. Even though specific areas of involvement had not been determined, this case discussed below clearly reports a right sided lesion. One of the reasons why not much is known yet about this clinical entity is the rarity of this occurrence. In fact, in one large scale study, only 2 patients out of 700 were identified with mania.
Steroid is commonly used for various connective tissue diseases and immunological related disorders. Psychiatric side effects are common in patient with systematic treatment of steroid. The reported prevalence ranges from 6% to 28%. Antidepressant-induced mania occurs when the mood of a patient switches to manic or hypomanic from depression after the use of antidepressant. We reported a case of a 55 year old lady, who presented with agitation and grandiosity after the treatment with antidepressant. She was initially diagnosed as having Bell’s palsy with unilateral facial muscle weakness. Oral prednisolone was prescribed for seven days where she became depressed, having auditory hallucination and delusion of guilt. She was then started on antidepressant where she became irritable, agitated and developed grandiose delusion. The antidepressant was withheld and she was started on atypical antipsychotic. Her condition improved and discharged well after three days of stay in the ward.
Objective: The aim of this study is to translate the original English version of List of Threatening Experiences (LTE) into Malay and to test the reliability on a group of medical students. Method: The LTE was translated into Malay and back-translated. The Malay LTE (LTE-M) was then tested on a total of 237 medical students. They were given LTE-M, General Health Questionnaire (GHQ), Beck Depression Inventory (BDI) and English version of LTE. A week later, these students were again given the LTE-M. Results: The parallel and test-retest reliability were satisfactory for 7 out of the 12 event categories (Kappa=0.67- 0.88). However 3 event categories were not reported. There was no statistical significant difference in the BDI and GHQ scores between the students with and without threatening experiences. Conclusion: The parallel and test-retest reliability of the LTE-M were acceptable. An association between the threatening experiences and increased disorders was not established.