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Fulltext Missing values in data analysis: Ignore or impute?

Ng, Chong Guan, Muhamad Saiful Bahri Yusoff

Education in Medicine Journal, 2011;3(1):6-11.
MyJurnal

Objective: Missing values is commonly encountered in data analysis in all types of research. Various methods were introduced to handle this matter. This study aims to compare the result of using complete data analysis, missing indicator method, means substitution and single imputation in dealing with this issue. Methods: 202 patients who were discharged from the psychiatric ward, University Malaya Medical Centre (UMMC) from 27th August 2007 to 15th April 2008 were recruited. The general psychopathology was measured with Brief Psychiatric Rating Scale (BPRS-24). The information on age, gender, race, marital status and psychiatric diagnosis were collected. On follow up, the patients who had early readmission (
Fulltext Model answer for critical review paper: conjoint examination for Malaysian Master of Medicine (psychiatry) and MPM June 2012

Suzaily Wahab, Hatta Sidi, Ng, Chong Guan

ASEAN Journal of Psychiatry, 2013;14(1):0-0.
MyJurnal

Objective: This paper aims to discuss the answers to Review Paper Exam for the Malaysian Master of Medicine (Psychiatry) May 2012 theory examination. The paper studied the psychotropic prescription practice in cancer patients using a health care registration database. Methods: One of the papers presented during the journal club presentation was picked-up for evaluation of student's critical appraisal. Results: Model answers were provided at the end of the Critical Review Paper. Conclusion: This review paper evaluates students' understanding and critical thinking on the topic of Psychotropic Drugs in cancer patients. This paper may serve as a guideline to teach students how to critically appraise topic related to psychiatry. ASEAN Journal of Psychiatry, Vol. 14 (1): January - June 2013: XX XX.
Fulltext Tianeptine dependence: a case report

Syed Nabil, Ng, Chong Guan, Rusdi Abd Rashid

Malaysian Journal of Psychiatry, 2018;27(1):0-0.
MyJurnal

Tianeptine is an atypical tricyclic antidepressant that is prescribed mainly for the treatment of depression and anxiety disorder. There have been scattered reported cases of tianeptine dependence and abuse in the literature. We report the case of a 32-year-old gentleman with resistant major depressive disorder that was initially successfully treated with Tianeptine. When his depression relapse due to work-related issue, he step-up his dosages without supervision. He developed tolerance and withdrawal to tianeptine making it difficult for him to stop without help. This case highlights the possibility of tianeptine abuse to its high tolerability and easy access for purchase.
Fulltext The prevalence of orgasmic dysfunction among Malaysian women receiving antidepressant: a comparison between escitalopram and fluoexetine

Rozita Hod, Duni Asmindar Ahmad, Ng, Chong Guan, Hatta Sidi

ASEAN Journal of Psychiatry, 2011;12(1):3-13.
MyJurnal

Objective: To investigate the prevalence of Female Orgasmic Dysfunction (FOD) focusing on the orgasm domain among female patients attending PPUKM Psychiatric clinic. To compare the prevalence of orgasmic dysfunction between female patients on Escitalopram and on Fluoxetine therapy.
Methods: A validated questionnaire for sexual function was used to assess orgasmic function. A total of 112 women aged between 24 and 57 participated in this study. The orgasmic dysfunction was compared between patients on selective serotonin reuptake inhibitors (SSRIs) fluoxetine and escitalopram.
Results: The prevalence of female orgasmic dysfunction was 58.9% (33/56) among patients treated with Fluoxetine and 41.1% (23/56) among patients treated with Escitalopram. However, there was no statistically significant difference between these two treatment groups (p=0.059). The odds to have FOD among patients on higher dose of antidepressants was found to be higher compared to those patients who were on lower dose of antidepressants (Odds ratio 5.32, p= 0.001).
Conclusion: There was no significant difference of Female Orgasmic Dysfunction between patients on Fluoxetine and Escitalopram.
Study site: Psychiatric clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Fulltext A journey from the known to the unknown: a qualitative study approach

Helenna M Hisham Hashim, Lee, Mei-Li, Ng, Chong Guan

ASEAN Journal of Psychiatry, 2013;14(1):0-0.
MyJurnal

Objective: Individuals deal with dying and death differently and may not experience the same journey. We investigated Kübler-Ross' Five Stages of Grief on terminally ill patients to review the current applicability of the model among this population. The aims of this paper is to share information regarding the Five Stages of Grief, the emotions associated with the stages, and the challenges that terminally ill patients, namely those diagnosed with cancer, experience. Methods: Non-structured interviews were conducted among terminally ill patients located at the palliative ward for two years. Results: We found that terminally ill patients at the palliative ward were undergoing the Five Stages of Grief, and that the emotions associated with the stages were reported to be similar to the emotions proposed in the model and among the patients. Conclusion: Kübler-Ross' Five Stages of Grief is still applicable among terminally ill patients. The thoughts regarding dying and death still remain negative, therefore, the change in the myths of dying and death are required to help improve the journey towards death. ASEAN Journal of Psychiatry, Vol. 14 (1): January - June 2013: XX XX.
Fulltext Psychiatrists in malaysia: the ratio and distribution

Lee, Toh Chin, Ng, Chong Guan, Benedict Francis, Tan, Shean Yen

Malaysian Journal of Psychiatry, 2018;27(1):0-0.
MyJurnal

We are aware of the shortage of psychiatrists in Malaysia.
However, there is no formal report on the distribution and ratio of
psychiatrists in each state in Malaysia. We aim to do a detailed count of the
number of psychiatrists in the country. Methods: We obtained the figures for
the psychiatrists practicing in the government, private and university settings
by accessing the Ministry of Health database, information from the
Malaysian Psychiatric Association, Malaysian Mental Health Association,
National Specialist Register and websites of the respective Universities. The
total number and ratio of psychiatrists per 100,000 population are calculated.
Results: There was a total of 410 registered psychiatrists in Malaysia in the
private universities, private clinics, public universities and government
hospitals. The state with the highest number of psychiatrists is Wilayah
Persekutuan Kuala Lumpur with a total of 94 psychiatrists which has a ratio
of 5.24 per 100, 000 population followed by Wilayah Persekutuan Putrajaya
with 3.38 per 100,000 population. The states with the least ratio of
psychiatrists are Sabah with 0.54 and Kedah with 0.55 per 100, 000
population. Conclusion: There is a discrepancy in the geographical
distribution of psychiatrists in Malaysia. People living in larger, urban states
have better access to mental health care whereas the smaller states face a
serious lack of psychiatrists. More effort should be taken to improve mental
healthcare in Malaysia as recommended by WHO with one psychiatrist for
every 10, 000 population.
Fulltext Extracranial carotid stenosis after radiotherapy in nasopharyngeal carcinoma, a Malaysian study

Ng, Chong-Guan, Govindasamy, Krishnan Gopala, Tai, Sharon Mei-Ling, Tan, Chong-Tin, Mariyam Niyaz

Neurology Asia, 2013;18(2):143-151.
MyJurnal

Background and objectives: Radiation treatment in nasopharyngeal carcinoma (NPC) is known to be associated with increased prevalence of carotid stenosis. The objectives of the study was to determine the prevalence of radiation-induced extracranial carotid stenosis, plaque, carotid intima thickness (CIMT) in NPC patients; to explore whether the stenosis is due to direct effect of radiation rather than general tendency to atherosclerosis. Methods: This was a cross-sectional study conducted in the University Malaya Medical Centre from July 2011 to February 2012. The study subjects consisted of 47 NPC patients who were treated with radiation, and 47 healthy control. The patients and control had carotid duplex ultrasound and transcranial Doppler (TCD). Results: The mean age of the patients was 55.1 years, the time lapse from radiation was 76.7 ± 95.3 months. Internal carotid artery (ICA) and common carotid artery (CCA) stenosis of ≥50% was seen in 17.0% of patients vs 2.1 % of controls (p = 0.031), with 61.7% of patients and 19.1% of controls having plaque in ICA and CCA (p=0.004). CIMT was increased in 70.2% of patients and 44.7% of controls (p =0.022). Both the patient group and control had similar rate of intracranial stenosis of 12.8% in TCD.
Conclusion: Extracranial internal carotid artery is the most common site of stenosis following radiotherapy in NPC. This suggests that local trauma from irradiation is the most important factor in predisposition to atherosclerosis following radiation therapy.
Fulltext Identifying depression among the human immunodeficiency virus (hiv) patients in University Malaya Medical Centre, Kuala Lumpur, Malaysia

Tung, Mun Yee, Mary, Lee Hong Gee, John, Tan Jin Teong, Adeeba Kamarulzaman, Ng, Chong Guan

ASEAN Journal of Psychiatry, 2009;10(2):135-147.
MyJurnal

Objective: The aim of this study was to identify depression among HIVinfected patients attending Infectious Disease Clinic in University Malaya Medical Centre (UMMC). Methods: This is a cross sectional study on HIVinfected patients attending Infectious Disease Clinic, UMMC. Those who fulfilled inclusion criteria were recruited and interviewed. Sociodemographic characteristics and clinical conditions such as mode of transmission, year of diagnosis, CD4+ counts, drug treatment and clinical stage were collected. The patients were then subjected to self-administered questionnaires, Patient Health Questionnaire, (PHQ-9) and Hospital Anxiety & Depression Scale (HADS). Results: 89 patients were recruited. Scores from PHQ9 showed 32% of depression rate while scores from HADS showed 19% of depression rate among the respondents. Non-self financial supporter, nonalcoholic drinkers and females were more likely to be depressed (P
Fulltext Premature ejaculation in urban malaysian population: the associations between erectile dysfunction(ED), anxiety and depression

Shamini Arasalingam, Hatta Sidi, Ng Chong Guan, Srijit Das, Marhani Midin, Ramli Musa

International Medical Journal Malaysia, 2016;15(1):89-96.
MyJurnal

Introduction: Both premature ejaculation(PE) and erectile dysfunction(ED) are prevalent sexual health disorders that have been inadequately investigated in Malaysia, a multiethnic and conservative nation.The objective of the study was to study the relationship between PE and ED, and other common mental health issues, i.e. anxiety and depression in Malaysian urban population.
Methods: The diagnosis for PE was established by clinical diagnosis using DSM-5 and ISSM definition criteria for PE, whereas a diagnosis of ED was established by the International Index of Erectile Function (IIEF) questionnaire. Anxiety and depression levels were detected from the Hospital Anxiety and Depression Scale (HADS).
Results: Based on DSM-V and ISSM clinical diagnosis for PE, the prevalence of PE was found to be 25%. Erectile dysfunction (p = 0.035, OR = 3.315, 95% CI 1.088, 10.103) and severe anxiety (p = 0.020, OR = 7.656, 95% CI 1.383, 42.396) significantly predicted presence of PE.
Conclusion: There was a strong association between PE and ED and between PE and anxiety. Routine examination for PE in male patients should address the issue and the management of both ED and anxiety among PE patients, especially in an urban Malaysian clinical and medical care setting.
The prevalence and correlates of alcohol use disorder amongst bipolar patients in a hospital setting, Malaysia

Yee HA, Loh HS, Ng CG

Int J Psychiatry Clin Pract, 2013 Oct;17(4):292-7.
PMID: 23170840 DOI: 10.3109/13651501.2012.752012

To determine the prevalence of alcohol-use disorder and associated correlates amongst bipolar patients in a university hospital in Malaysia.
Fulltext Development and validation of the malay premature ejaculation diagnostic tool (MAPET): a two-phase study

Arasalingam, Shamini, Chong, Yew Siong, Hatta Sidi, Ng, Chong Guan, Nik Ruzyanei Nik Jaafar, Marhani Midin, et al.

International Medical Journal Malaysia, 2018;17(1):37-46.
MyJurnal

Introduction: A validated diagnostic questionnaire is needed in the South-East Asia region, particularly in Malaysia to detect Premature Ejaculation (PE). The objective of this study was to determine the linguistic validity of the Malay Premature Ejaculation Diagnostic Tool (MAPET). Materials and Methods: This study was conducted in a teaching hospital. The first phase involved experts’ group discussions to develop the face, content, and factorial validity of the MAPET. The second phase measured the concurrent validity of MAPET. Results: We found that the MAPET has specificity, sensitivity, positive predictive value, and negative predictive value of 79.3%, 92%, 76.7% and 93.1%, respectively in the assessment of PE. The higher score indicates severity of PE. Conclusions: MAPET is a valid self-report instrument for the assessment of PE.
Depressive symptoms in residents of a tertiary training hospital in Malaysia: The prevalence and associated factors

Nair N, Ng CG, Sulaiman AH

Asian J Psychiatr, 2021 Feb;56:102548.
PMID: 33454562 DOI: 10.1016/j.ajp.2021.102548

The mental wellbeing of doctors is becoming an increasing concern in the world today. In Malaysia, residency is a challenging period in a doctor's life, with many changes professionally and possibly in their personal lives as well. This study aims to determine the prevalence of depressive symptoms and the socio-demographic correlates among residents in a tertiary training hospital in Malaysia. It is a cross sectional study and all residents were approached to participate in the study. The instruments used were a socio-demographic questionnaire and the Patient Health Questionnaire 9 (PHQ-9). Chi-square test was used to explore the association between the socio-demographic correlates, and those that were found to have significant associations were further tested using multivariate logistic regression. The prevalence of depression among residents was 25.1 %. Longer working hours, missing meals, and working in Department of Surgery and Department of Anaesthesia was significantly positively associated while having protected study time, CME/lectures, leisure/hobbies and exercise were negatively associated with depression. The Department of Rehabilitation Medicine had a significantly negative association with depression. After logistic regression, longer working hours and a lack of protected study time was significantly associated with depression in the respective departments. In summary, the prevalence of depression among residents is high and is associated with longer working hours, missing meals and a lack of protected study time are significantly associated with depression. Remedial steps should be taken to improve the mental health among residents.
Effects of brief acceptance and commitment therapy (ACT) on subjective cognitive impairment in breast cancer patients undergoing chemotherapy

Shari NI, Zainal NZ, Ng CG

J Psychosoc Oncol, 2021;39(6):695-714.
PMID: 33287685 DOI: 10.1080/07347332.2020.1856283

PURPOSE: This study examined the efficacy of a brief acceptance and commitment therapy (ACT) on subjective cognitive impairment in breast cancer patients undergoing chemotherapy.
METHODS: Data collection was carried out in 3-time points: baseline (T1), screening (T2), and post-treatment (T3). Respondents who had significant subjective cognitive impairment were randomly divided into two groups: intervention (n = 30) and waitlist (n = 30). Respondents in the intervention group received 4 sessions of 1 hour of ACT therapy.
FINDINGS: Respondents in the intervention group showed significant improvement in subjective cognitive impairment, depression, anxiety, and psychological inflexibility after the ACT intervention (p
Vortioxetine Treatment for Anxiety Disorder: A Meta-Analysis Study

Yee A, Ng CG, Seng LH

Curr Drug Targets, 2018;19(12):1412-1423.
PMID: 29149828 DOI: 10.2174/1389450118666171117131151

BACKGROUND: Vortioxetine is a multimodal antidepressant that has been developed for the treatment of major depressive and anxiety disorders. The aim of this review is to quantitatively synthesize all data of the efficacy, safety and tolerability of Vortioxetine in treating anxiety disorder.
METHOD: Terms of "Vortioxetine" OR "LuAA21004" AND "anxiety" OR "fear" OR "panic" OR "phobia" were searched. A total of two phase II and five phase III clinical trials were found.
RESULTS: Vortioxetine was overall superior to placebo in terms of the mean change from baseline in HAM-A total score at week 8 with the pool effect size of -2.95, 95% CIs, -4.37 to -1.53, p<0.01. The patients who received 5 mg of Vortioxetine had higher response rate when compared to placebo (pooled odds ratio=1.4, 95% CI = 1.08 to 1.82, p=0.01). However, the pooled odds ratio of the HAMA remission rate was not statistically significant for both Vortioxetine and placebo (pooled odds ratio= 1.06, 95% CI = 0.86 to 1.30, p=0.62). Although the discontinuation due to adverse effects was higher in Vortioxetine than placebo group (pooled OR= 1.55, 95% CI = 1.04 to 2.31, P= 0.037), the lack of efficacy (pooled OR= 0.39, 95% CI = 0.27 to 0.57, P<0.01) was higher in placebo than Vortioxetine group. Most of the adverse effects were mild and moderate. Overall, Vortioxetine displayed a good safety and tolerability profile.
CONCLUSION: This review supports the use of Vortioxetine for anxiety disorder. However, further longterm placebo-control observational study or a post market survey would help in strengthening the evidence for this treatment modality.
The prevalence of sexual dysfunction among male patients on methadone and buprenorphine treatments: a meta-analysis study

Yee A, Loh HS, Hisham Hashim HM, Ng CG

J Sex Med, 2014 Jan;11(1):22-32.
PMID: 24344738 DOI: 10.1111/jsm.12352

INTRODUCTION: For many years, methadone has been recognized as an effective maintenance treatment for opioid dependence. However, of the many adverse events reported, sexual dysfunction is one of the most common side effects.
AIM: We conducted a meta-analysis to evaluate the prevalence of sexual dysfunction among male patients on methadone and buprenorphine treatments.
METHODS: Relevant studies published from inception until December 2012 were identified by searching PubMed, OVID, and Embase. Studies were selected using prior defined criteria. Heterogeneity, publication bias, and odds ratio were assessed thoroughly.
MAIN OUTCOME MEASURES: To examine the prevalence and odds ratio of sexual dysfunctions among the methadone and buprenorphine groups.
RESULTS: A total of 1,570 participants from 16 eligible studies were identified in this meta-analysis. The studies provided prevalence estimates for sexual dysfunction among methadone users with a meta-analytical pooled prevalence of 52% (95% confidence interval [CI], 0.39-0.65). Only four studies compared sexual dysfunction between the two groups, with a significantly higher combined odds ratio in the methadone group (OR = 4.01, 95% CI, 1.52-10.55, P = 0.0049).
CONCLUSIONS: Evidence showed that the prevalence of sexual dysfunction was higher among the users of methadone compared with buprenorphine. Patients with sexual difficulty while on methadone treatment were advised to switch to buprenorphine.
Fulltext Sexual pain disorders among Malay women with type 2 diabetes mellitus in Malaysia

Ismail AH, Baw R, Sidi H, Ng CG

ASEAN Journal of Psychiatry, 2014;15(1):1-7.
MyJurnal

Objectives: This study aims to determine the prevalence and associated factors of sexual pain disorders among Malay women in Malaysia with type 2 diabetes mellitus.
Methods: This is a cross-sectional study involving 347 women (174 non- diabetic and 173 diabetic subjects) who attended the diabetic clinic in a university hospital. Sexual pain disorders were assessed using the Pain sub scale of Malay Version of the Female Sexual Function Index (MVFSFI). Socio-demographic information of the subjects was collected with a pre-designed questionnaire.
Results: Prevalence of sexual pain disorders among Malay women with type 2 diabetes mellitus was 10.4% and the control group was 9.2% but the difference was not statistically significant (p > 0.05). Multivariate logistic regression analysis did not find any relevant associated factor with sexual pain disorder.
Conclusion: Sexual pain disorders among Malay women were not dependent on the diabetic status. Further studies with different population of diabetic patients are needed to confirm the results.
Study site: Diabetic clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Psychological Distress, Burden of Care, and the Role of Coping Strategies Among Childminders in Residential Children's Homes

Sathiaray D, Kaur M, Hanim A, Ng CG, Siau CS

Asia Pac J Public Health, 2021 Oct 27.
PMID: 34706594 DOI: 10.1177/10105395211053730

This study aimed to identify the prevalence of psychological distress and its association with sociodemographic characteristics, burden of care, and the coping strategies used by childminders in residential homes. A total of 151 childminders (median age = 39; 64.7% female) participated in the study. The prevalence of psychological distress was 59.4%, and 74.0% recorded mild to moderate burden. Multivariate analyses showed that caregiver burden (adjusted beta = 0.464, P = .01), lesser application of problem-focused coping (adjusted beta = -0.292, P = .012), lower salary (adjusted beta = -0.196, P = .040), and lower educational qualification (adjusted beta = -0.212, P = .038) predicted higher psychological distress. Regular screening of psychological distress and burden of care is recommended among this population.
Fulltext Sexual Desire in Opiate-Dependent Men Receiving Methadone-Assisted Treatment

Yee A, Loh HS, Ng CG, Sulaiman AH

Am J Mens Health, 2018 07;12(4):1016-1022.
PMID: 29493379 DOI: 10.1177/1557988318759197

Low sexual desire (SD) is not life threatening, but its negative impact on the quality of life and intimacy of a relationship among the patients on methadone maintenance therapy (MMT) is significant. This cross-sectional study involved 183 men on MMT who were interviewed and who completed the Malay version of the SDI-2 (SDI-2-BM), the Malay version of the self-rated Montgomery-Asberg Depression Rating Scale (MADRS-BM) and World Health Organization Quality of Life-BREF Scale (WHOQOL-BREF) questionnaires. Findings showed 32.8% ( n = 60) participants had low SD. Those who were older, had sexual partners, and were smokers achieved lower scores in both dyadic SD (≤24) and solitary SD (≤6), and suffered lower quality of life in their social relationship. MMT is very cost-effective in rehabilitating opioid dependence; however, as clinicians, we need to address and manage the issues of low SD and depression among patients on MMT, especially the older men.
Ethical Issues in Photovoice Studies involving Key Populations: A Scoping Review

Ng CG, Ting SQ, Saifi RA, Kamarulzaman AB

Asian Bioeth Rev, 2024 Jan;16(1):109-129.
PMID: 38213991 DOI: 10.1007/s41649-023-00264-3

Photovoice, a community-based participatory research method, employs images and words to convey participants' needs, concerns, and desires. It proves particularly valuable in researching marginalized communities who face elevated health risks, disease transmission, and social and health disparities. This paper seeks to investigate the ethical considerations inherent in photovoice research projects. We conducted an extensive literature review spanning four databases to identify pertinent photovoice studies. Ethical issues from the selected articles were identified, categorized, and summarized. Our analysis of twenty-five photovoice studies uncovered various ethical concerns, which had been grouped into informed consent, participant safety and disclosure, privacy and confidentiality, misrepresentation, power dynamics, and compensation. In essence, our findings underscore the importance of addressing these ethical concerns to uphold the rights and autonomy of participants, even as photovoice research strives for authenticity, inclusivity, and empowerment.
Perceptions Toward Exercise or Mindful Exercise Participation Among Patients With Primary Osteoporosis: A Qualitative Study

Lyu FF, Ramoo V, Chui PL, Ng CG

Clin Nurs Res, 2024 Jan;33(1):40-50.
PMID: 37970808 DOI: 10.1177/10547738231198561

Exercise is significantly beneficial for patients with osteoporosis. However, physiological and psychological factors such as pain and kinesiophobia prevent patients from participating in exercise. Therefore, it is important to understand how these patients perceive participation in exercise. This qualitative study was conducted in China using conventional content analysis. Using a purposeful sampling method, 17 patients with primary osteoporosis were recruited. Data were collected through a semi-structured interview and managed using ATLAS.ti 21. Nine generic categories were developed from 26 subcategories and two main categories were identified: Barriers and facilitators, support systems, network resources, positive emotions, and reactions were the facilitators for exercise in this study. In addition, mindful exercise was positively viewed by the patients. Inefficient awareness, weak support systems, and burdens were identified as barriers. To improve compliance in clinical practice, targeted exercise protocols should be developed for patients based on these perceptions.

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