CASE PRESENTATION: A 48-year-old Malay man presented with compulsive sexual behavior, encompassing voyeuristic, frotteurism, and exhibitionistic behavior, increasing progressively over the years, with accompanying overvalued ideas of erotomania. Despite the high level of dysfunction occupationally and socially, there were no apparent psychotic, manic, or depressive symptoms. An organic workup was unremarkable, and he was diagnosed with multiple paraphilias. Treatment with selective serotonin reuptake inhibitors was commenced, and psychologically he was managed with techniques specific to compulsive sexual behavior.
CONCLUSION: Though rare in the literature, both paraphilic disorders and compulsive sexual behaviors are very distressing to sufferers and their families alike, and thorough biopsychological investigations are essential to ensure reversible causes are not overlooked.
Method: Generalized logistic growth modelling (GLM) approach was adopted to make prediction of growth of cases according to each state in Malaysia. The data was obtained from official Ministry of Health Malaysia daily report, starting from 26 September 2020 until 1 January 2021.
Result: Sabah, Johor, Selangor and Kuala Lumpur are predicted to exceed 10,000 cumulative cases by 2 February 2021. Nationally, the growth factor has been shown to range between 0.25 to a peak of 3.1 throughout the current Movement Control Order (MCO). The growth factor range for Sabah ranged from 1.00 to 1.25, while Selangor, the state which has the highest case, has a mean growth factor ranging from 1.22 to 1.52. The highest growth rates reported were in WP Labuan for the time periods of 22 Nov - 5 Dec 2020 with growth rates of 4.77. States with higher population densities were predicted to have higher cases of COVID-19.
Conclusion: GLM is helpful to provide governments and policymakers with accurate and helpful forecasts on magnitude of epidemic and peak time. This forecast could assist government in devising short- and long-term plan to tackle the ongoing pandemic.
Case presentation: We present a 36-year-old lady with underlying end-stage renal failure (ESRF) and undiagnosed mental health issues who was treated for recurrent episodes of gastritis. Imaging modalities revealed intragastric foreign body ingestion which is consistent with gastric trichobezoar. She eventually underwent laparotomy and gastrotomy to remove the foreign body. Postoperatively, she was referred and followed-up by the psychiatric team.
Conclusion: Gastric trichobezoar has strong associations with psychiatric disorders. With the co-existence of an ESRF, uraemia might contribute to the aetiology of the trichotillomania and trichophagia. Open surgery is the choice of definitive management especially if bezoars are larger. Should the recurrence be remitted, a biopsychosocial modality and regular haemodialysis is the most sustainable approach to ensure the behaviour does not persist.