Sexually deviant behaviour is a fairly common phenomenon but because it is socially embarassing, a few cases come forward for consultation and treatment on a voluntary basis. Most cases are referred by the law courts. Two such cases, one of exhibitionism and the other offetishism, were referred to the University Hospital, Kuala Lumpur in 1982. Their development histories were elaborated. A third case of sexual sadism came voluntarily for help out defaulted after the initial session. A review on the current western concepts on sexual deviation is included in the text. It is concluded that although it is generally thought that neurological conditions give rise to deviant sexual behaviour, this assumption should not be arrived at hastily, as many cases of organic mental disorders do not exhibit deviant sexual
behaviour.
Delusions are common among psychiatric patients. Delusions of passion can be very systematised and, at the same time, incredible. The delusions can remain fixed for a long time and treatment is usually not satisfactory. One of the exotic and rare psychiatric conditions is de Clerarnbault's Syndrome and the main feature is a pure erotomania. This condition defies satisfactory classification in the current ICD-IX and DSM-III, and remains as one of the most difficult to treat and troublesome syndromes. Two patients who developed the symptoms of erotomania were treated by the University Hospital, Kuala Lumpur in 1982-1983. One had the primary erotomania of de Clerambaults syndrome while the other suffered from erotomania as a secondary symptom which was part of the symptomatology of her primary illness of schizophrenia. Their case histories and the current western concepts on erotomania were described.
Some epidemiological aspects of antepartum psychoses have been discussed and wherever possible, are compared with some Western studies. On the whole, the disorder appears to be associated with the young lower social class Chinese lady who has family and / or marital relationship conflicts.
Three cases of acute psychosis during pregnancy had been treated with electroconvulsive therapy (ECT) during their stay in hospital, due to their slow response to anti-psychotic medication. All three responded well to the treatment and two subsequently delivered normal healthy infants and they did not suffer maternal complications. The authors feel that ECT is as safe, if not safer than the use of high dosage of anti-psychotic medication and a review of the world literature appears to confirm this view. In addition, the psychotic process usually settles faster with the use of ECT than with the use of anti-psychotic drugs.
Physical abuse of women has been documented since the dawn of history. However, it is not frequent that such patients come for help as such. Rather, they present as part ofrelated complicated problems such as marital discord, attempted suicide, depression and even psychotic illness. Women have been traditionally considered to be the inferior sex and as such, in many countries, social rehabilitation is difficult within the legal rights granted by the provisions of the appropriate laws. Two cases of physical abuse were admitted to the University Hospital in 1981-82 and their difficult rehabilitation is described to highlight the inadequacies of the existing laws under which protection and rehabilitation of the patients were sought. An account of what was and could be done for them is given.
Psychiatric consultation in schools is not a new concept in the Western Countries but it is so in Malaysia owing to the lack ofa sufficient number of trained psychiatrists available locally. The aim of consultation is to help the school authorities to understand and to solve emotional and behaviourial problems of school children. The authors have begun a study project, on a voluntary basis, on the psychiatric problems of the school children of a secondary school in Kuala Lumpur. This was possible with the cooperation between the Department of Education, Kuala Lumpur, the Department of Social Welfare, Federal Territory and the Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur. The authors used two methods to gather data, namely through individual evaluation of the referred students (a total of 23 students having been interviewed) and through the holding of group therapy sessions with the consultee as the cotherapist. The authors found that minor behaviourial problems such as inattentiveness, talking, eating and sleeping in the classrooms constituted the majority of the reasons for referral. This was followed by problems concerned with poor academic performance, including the quality of class work. Major problems such as theft, extortion and gangsterism and personal emotional problems such as interpersonal relationship problems, boyfriend/girfriend problems and sexual problems were also encountered. Female pupils appeared to be more forthcoming in discussing their problems. The project has resulted in the school gradually adopting the guidance rather than the purely disclplinary concept in understanding the pupils' problems and their maladjustment behaviour in many cases. Joint efforts by psychiatrists, psychologists, professional social workers and school health personnel should be invested in this important area of school education.
The authors, a psychiatrist and a clinical psychologist, have successfully treated two cases of phobic neurosis by simple behaviour therapy consisting of Jacobson's muscle relaxation technique and systemic desensitisation, at the University Hospital, Kuala Lumpur. The two patients, who were literally housebound because of the unpleasant symptoms of their illness, were able to mobilise themselves again following therapy. The authors feel that general practitioners with some basic training in these methods will be able to bring relief to such afflicted patients. Using the same technique, other conditions such as insomnia, alcoholism and sexual deviations can also be treated.
This case report highlights one of the common but usually unrecognised causes of sinus bradycardia in clinical practice. The reasons for misdiagnosis and/or delay in diagnosis of such a condition is also discussed.
In February to March 1982 at the psychiatric emergency service of the University Hospital, Kuala Lumpur, some data on 491 patients (92% of 531 patients seen) were collected. Two-hundred and eighty-three patients had received psychiatric treatment and 65 had previously received medical treatment. Fifty-three per cent of the patients have schizophrenic disorders, 5.1% had situational reactions and 1.63% had chronic alcoholism. Of the 111 patients presented with either physical complaints or insomnia, eleven of them were admitted to the psychiatric wards. Three-hundred and eleven patients were followed-up in the psychiatric outpatient clinics. The availability of a psychiatric emergency service in a general hospital can contribute towards early psychiatric case findings and preventive Intervention. II provides an opportunity for liaison and consultation with other medical colleagues in the care of patients with physical complaints and attempted suicides.
Study site: Universiti Malaya Medical Centre (UMMC)
In general, psychotic symptomatology falls within the major categories of mental disorders such as schizophrenia, affective disorder and organic mental
disorder. Those that do not fit the proposed diagnostic criteria for the aforementioned disorders are usually classified under the DSM-IV diagnosis of atypical psychosis. In the eastern culture, such symptoms are accepted as part of the cultural beliefs rather than being regarded as illness. Several such cases were seen at -the University Hospital, Kuala Lumpur and two such casesare reported in this paper. Cultural influences in determining symptomatology are also discussed.