Displaying publications 1 - 20 of 29 in total

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  1. Mohd Amiruddin Mohd Kassim, Pang, Nicholas Tze Ping, Sandi James
    MyJurnal
    Introduction: The current COVID-19 pandemic has sequelae reverberating around Malaysia, particularly in university students, as Malaysian university students are isolated in their university campuses in semi-quarantine status. This article seeks to review the existing literature on the specialized issue of university student-related psychological sequelae of COVID-19, and seeks to offer some recommendations through the process.
    Methods: Existing literature demonstrates that COVID-19 has affected university students psychosocially, with the rate of anxiety and depression markedly increased. There have been significant alterations of lifestyle related to education, in accordance with the new normal, resulting in isolation and feelings of disengagement with education. Moreover, with the current uncertainties regarding their studies and possible financial depression postpandemic, the future is deeply worrying and will adversely affect their mental health.
    Results: Quantitatively, recent findings indicate 33.3% of the undergraduates in a higher education institution are noted to be in stress. Therefore, multiple interventions have been implemented; a customized ultra-brief psychological module, an online tele psychiatry hotline (COVID Cares) and tele-counselling, which have received universally positive feedback.
    Conclusion: In conclusion, the review demonstrates that undergraduates’ psychological health is an aspect that needs urgent attention as it is not merely limited to the fear of COVID-19, but also related to the social aspects of the pandemic. Multiple interventions have been seen to be efficacious in reducing the psychological sequelae
  2. Lee,Sze Chet, Ng,Chun Keat, Mohd Amiruddin Mohd Kassim, Pang,Nicholas Tze Ping
    Borneo Epidemiology Journal, 2020;1(1):79-87.
    MyJurnal
    COVID-19 has impacted the world in many ways due to fears of contracting the pandemic, social distancing, and large-scale movement control rules. These have especially grave consequences for inpatient psychiatry. This article reviews measures taken to adapt to the new norm in inpatient care, both for standalone psychiatry units and consultation-liaison units. For inpatient units, changes have been made for personal protective equipment usage, screening and triaging policies, and training and educational policies. Consultation liaison units together with inpatient units have been required to expand the scope of coverage and difficulties by providing certain teleconsultation services. As the new norm takes precedence, Sabah has to embrace and empower community-based psychiatry services for better outreach and coverage. This article discusses the issues underlying the new norm in the management of inpatient psychiatry patients in both units and presents some points and practical solutions on the ground to instil hope
  3. Pang,Nicholas Tze Ping, Koh,Eugene Boon Yau, Sandi James, Mohd Amiruddin Mohd Kassim
    Borneo Epidemiology Journal, 2020;1(2):157-162.
    MyJurnal
    Background and Objective: Biostatistics and epidemiology have been integral subjects in any postgraduate courses, including medical specialties Master programs. Both are widely accepted as among the difficult and confusing subjects, which worsen by lack of adequate exposure and often, time constraints. Hence, peer-led learning approach was proposed as a viable option to the traditional lecturer-driven learning style
    Method: The peer-led approach intends to promote targeted learning and conceptual understanding, instead of widely sweeping learning, which is rather directionless and could cause information overload
    Discussion: Students were divided into two groups, namely humanities-inclined group and science inclined group. Different pedagogical methods to address the different groups were discussed.
    Conclusion: This approach helps to make the learning more palatable, boosting knowledge retention and fostering camaraderie spirit among colleagues
  4. Masiran R, Pang NT
    BMJ Case Rep, 2017 Feb 08;2017.
    PMID: 28179386 DOI: 10.1136/bcr-2016-218267
    We report a case of a man aged 67 years presenting with recent depressive symptoms and paranoid ideations in addition to 1-year cognitive impairment. He has vascular risk factors and family history of memory loss. An episode of depression 2 decades ago resolved spontaneously but was followed by occupational decline. On mental state examination, he denied having depressed mood, hallucinations or delusions, but there were prominent word-finding difficulties and impaired attention and concentration.
  5. Pang NT, Masiran R
    BMJ Case Rep, 2017 Mar 08;2017.
    PMID: 28275020 DOI: 10.1136/bcr-2016-218738
    A young man presented with high libido for 3 years, associated with preoccupation with sexual thoughts combined with his pursuit of pornographic materials. He had strong psychological cravings for and had spent large amount of money on sex, resulting in a dispute with his family. There were no mood or psychotic symptoms. Medical history revealed recent diagnosis of gonococcal urethritis. Cognitive assessment showed subtle deficiencies in reasoning and executive functions. There was occasional use of alcohol. Sexual addiction with comorbid mild intellectual disability was diagnosed, and pharmacological as well as psychological management were started.
  6. Wong HH, Pang NTP
    BMJ Case Rep, 2021 Oct 14;14(10).
    PMID: 34649855 DOI: 10.1136/bcr-2021-242333
    A woman in her 30s with underlying Graves' disease, who recently completed radioactive iodine treatment, presented with 2 weeks of acutely altered behaviour associated with auditory hallucinations and religious preoccupations. Laboratory investigation demonstrated elevated free thyroxine levels and suppressed thyroid-stimulating hormone levels. Additionally, there was a presence of antithyroid peroxidase antibodies consistent with autoimmune thyroid disease. She responded to antipsychotics and achieved biochemical euthyroidism. Subsequently, antipsychotic was tapered off during outpatient follow-up at the patient's own request, with supplement thyroxine continuing. After 1 week, acute hallucinations and religious preoccupations re-emerged, driving her to inflict self-injuries by swallowing coins and nails and banging her head against the wall, sustaining laceration wounds. Furthermore, she hammered a roofing nail into the external genitalia, embedded in the symphysis pubis. After supplemental thyroxine was stopped and olanzapine was started, she achieved biochemical euthyroid followed by remission of psychosis within 1 week. This case illustrates the importance of elucidating organic causes of psychosis as they are easily and swiftly reversible.
  7. Mohd Amiruddin Mohd Kassim, Friska Ayu, Assis Kamu, Pang,Nicholas Tze Ping, Ho,Chong Mun, Hafid Algristian, et al.
    Borneo Epidemiology Journal, 2020;1(2):124-135.
    MyJurnal
    Background and Objective: The Fear of COVID-19 Scale (FCV-19S) is a seven-item uni-dimensional scale assessing the severity of COVID-19 concerns. A translation and validation of the FCV-19S in Bahasa Indonesia language was expedited in view of the worrying trends of COVID-19 in Indonesia as well as its psychological squeal.
    Methods:Formal WHO forward and backward translation sequences were applied in translating the English FCV-19S into Bahasa Indonesia. Indonesian university participants were recruited viaconvenience sampling online using snowball methods. The reliability and validity of the Indonesian FCV-19S was psychometrically evaluated by applying confirmatory factor analysis and Rasch analysis in relation to sociodemographic variables and response to the depression, anxiety, and stress components of the Indonesian version of DASS-21. The sample consisted of 434 Indonesian participants.
    Results:The Cronbach α value for the Indonesia FCV-19-I was 0.819 indicated very good internal reliability. The results of the confirmatory factor analysis showed that the uni-dimensional factor structure of the FCV19S fitted well with the data. The FCV-19-I was significantly correlated with anxiety (r=0.705, p
  8. Pang NTP, Masiran R, Alimuddin AS
    J Med Case Rep, 2023 Feb 13;17(1):46.
    PMID: 36775819 DOI: 10.1186/s13256-023-03774-8
    BACKGROUND: Paraphilias are recurrent and arousing fantasies, thoughts, and behaviors that cause distress to sufferers and surrounding people. This case report details the challenge of managing multiple paraphilias with compulsive sexual behavior.

    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.

  9. Pang NTP, Kamu A, Mohd Kassim MA, Ho CM
    Infect Dis Model, 2021;6:898-908.
    PMID: 34377875 DOI: 10.1016/j.idm.2021.07.004
    Introduction: COVID-19 has affected almost every country in the world, which causing many negative implications in terms of education, economy and mental health. Worryingly, the trend of second or third wave of the pandemic has been noted in multiple regions despite early success of flattening the curve, such as in the case of Malaysia, post Sabah state election in September 2020. Hence, it is imperative to predict ongoing trend of COVID-19 to assist crucial policymaking in curbing the transmission.

    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.

  10. Pang NTP, Mohamad Isa MF, Suarn Singh V, Masiran R
    BMJ Case Rep, 2017 Jul 27;2017.
    PMID: 28754761 DOI: 10.1136/bcr-2017-221048
    A young male presented with many years of delusions and hallucinations, with concurrent heroin use and subsequent amphetamine uses. There were no depressive or manic symptoms and psychotic symptoms prior to the amphetamine use. After the trials of two atypical antipsychotics and later clozapine due to treatment resistance, adherence and functionality were poor and there was still persistent drug use. As a result, a long acting injectable adjunct was commenced, but only minimal effects were observed. However after initiation of directly observed treatment of clozapine with methadone, there has been functional and clinical response and drug use has ceased.
  11. Yadanar SM, Htoo NC, Zaw T, Pang NTP, Chua SH, Loo JL
    BJPsych Int, 2021 May;18(2):37-39.
    PMID: 34287407 DOI: 10.1192/bji.2020.36
    The transition from trainee early career psychiatrist (ECP) to independent practitioner can be challenging. Upon completion of training in well-equipped academic settings, an ECP from Myanmar is required to serve in a divisional hospital for at least 3 years. Significant challenges are faced by ECPs practising solo in divisional hospitals, including inexperience in administrative aspects, lack of future-proof training, scarcity of resources and facilities, struggles in the provision of holistic biopsychosocial treatment, work-life imbalance, and limited career advancement and access to continuous training. The solutions tried thus far include the incorporation of information and communication technology in training, gathering support and distant supervision from both local and international settings, and task shifting. Bigger challenges are often rewarded by faster growth, and difficult times stimulate creative solutions. The sacrifice of these solo ECPs has significantly improved the mental health service of Myanmar district regions.
  12. Marcus M, Abdullah AA, Nor J, Tuan Kamauzaman TH, Pang NTP
    GMS J Med Educ, 2022;39(4):Doc45.
    PMID: 36310890 DOI: 10.3205/zma001566
    Introduction: Bystander cardiopulmonary resuscitation (CPR) training is inconsistent among students and the public. Existing CPR teaching courses are costly, time-consuming, and inconsistent. This study aimed to determine the association between overall CPR competency and two teaching modules, a group-directed video instruction module versus an instructor-led traditional classroom instruction module. Methods: This randomized prospective interventional study involved first year medical students of Universiti Sains Malaysia Health Campus from November 2018 until January 2019. Pass-fail scores representing the overall CPR, individual skill performance, and willingness to perform CPR for strangers and family members were collected. Factors associated with reluctance to perform CPR were assessed in a questionnaire. Results: A total of 99 participants were included, 50 in the group-directed video instruction as the intervention module and 49 in the traditional classroom instruction as the control module. There was no statistical significance between the pass and fail outcomes for both video module (p=0.436). Participants in both modules performed similarly in 8 out of 12 individual CPR skills. There was a significant difference in the distribution of skill scores between the pass and fail outcomes (p=<0.001). The intervention module is non-inferior compared to the control module, in relation to CPR willingness rates for strangers (p=0.999) and family members (p=0.117) after the training. Conclusions: The group-directed video self-instruction method is as effective as the instructor-led traditional classroom method to help participants to be competent and willing to perform CPR. It can be used as an independent or supplementary teaching tool for first-time learners and refreshers, especially in a group setting when teaching materials are limited.
  13. Tan KP, Ang JK, Koh EBY, Pang NTP, Mat Saher Z
    PMID: 36901243 DOI: 10.3390/ijerph20054232
    Caregivers of People with dementia (PwD) commonly experience burdens and other mental health issues, e.g., depression and anxiety. At present, there are limited studies that examine the relationships between caregiver psychological factors and caregiver burden, and depressive and anxiety symptoms. Therefore, this study's objectives were to examine the relationships between psychological flexibility and mindfulness in caregivers of PwD, and to determine the predictors of these three outcomes. This was a cross-sectional study conducted in the geriatric psychiatry clinic of Kuala Lumpur Hospital, Malaysia, and the sample (n = 82) was recruited via a universal sampling method over three months. The participants completed a questionnaire that consisted of the sociodemographics of the PwD and caregivers, illness characteristics of the PwD, Acceptance and Action Questionnaire-II (AAQ-II), Mindful Attention Awareness Scale (MAAS), Zarit Burden Interview Scale (ZBI), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). The results show that despite significant relationships between psychological flexibility and mindfulness and lower levels of caregiver burden, and depressive and anxiety symptoms (p < 0.01), only psychological inflexibility (p < 0.01) remained as a significant predictor of the three outcomes. Therefore, in conclusion, intervention programs that target the awareness of the caregiver's psychological inflexibility should be implemented to alleviate these adverse outcomes in dementia caregivers.
  14. Wider W, Mutang JA, Chua BS, Lin J, Kamu A, Pang NTP
    Front Nutr, 2023;10:1212919.
    PMID: 38035347 DOI: 10.3389/fnut.2023.1212919
    The objective of this study was to assess the factor structure of the 26-item Eating Attitude Test (EAT-26) through confirmatory factor analysis (CFA) among 1,084 undergraduate students in Malaysia. The initial findings indicated a lack of support for the proposed three-factor structure. Model modifications were made due to the inadequate initial fit. The fit of the model was significantly improved by excluding items with factor loadings below 0.40 and integrating residual covariances. In conclusion, it is necessary to make contextual modifications to the EAT-26 in order to effectively utilize it among Malaysian undergraduates. This highlights the significance of cultural adaptations in psychological instruments.
  15. Muhamad AB, Pang NTP, Salvaraji L, Rahim SSSA, Jeffree MS, Omar A
    Front Psychiatry, 2021;12:558591.
    PMID: 33967840 DOI: 10.3389/fpsyt.2021.558591
    Introduction: Much has been known about the psychological issues that can emerge in people who are quarantined and unable to move freely. The COVID-19 pandemic has no contrast from previous outbreaks like SARS and MERS regarding their ensuing worries and boosted anxiety levels. This article seeks to examine the unique psychological changes that occur in students who have been quarantined inside a university campus and assess sociodemographic factors associated with certain psychological factors. Methodology: The data was collected from students in an Agricultural Campus. In the first phase, the factor structure of the modified National Index Psychological Wellness (NIPW) was acceptable, and to establish statistical parameters for validation an exploratory factor analysis was done. In the second phase, Independent T-tests, ANOVA, and Hierarchical Multiple regression were performed. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26.0. Result/Discussion: A total of 46 male and 76 female students enrolled in this study. The Bartlett's test of sphericity was significant (p < 0.001) and the Kaiser-Mayer-Olkin measure of sampling adequacy for the AUDIT-M was 0.901. The Cronbach's alpha of the entire modified NIPW was 0.657 which suggests reasonable internal consistency and subscales between 0.913 and 0.924. Raw scores of 12 positive items were higher for the quarantined group except for "I can do daily routines," "I understand what happens," and "I understand the action that is performed is fair." Raw mean scores of eight negative scoring items were higher in the quarantined group, except for "I feel angry" (2.88 vs. 2.89 for non-quarantined group). There were statistically significant differences between year groups for the questions "I understand what happens," "I understand the action that is performed is fair," and "I think everyone is good." Conclusion: Movement control orders or compulsory quarantine orders can be distressing and may cause understandable psychological sequelae. Holistic management of a quarantine center that addresses the needs and health of an individual student will give a positive impact on psychological wellness. Quarantining facilities can be a place of positivity, allowing people to live a shared experience together, provide peer support for each other, and give each other hope.
  16. Ali AA, Gurung R, Fuad ZM, Moosa M, Ali I, Abdulla A, et al.
    Ann Med Surg (Lond), 2020 Oct;58:76-79.
    PMID: 32953103 DOI: 10.1016/j.amsu.2020.08.021
    Background: Gastric trichobezoar happens when there is an indigestible substance or food found in the gastrointestinal tract. It is a rare presentation which is usually associated with trichotillomania and trichopagia. The presentation may not be specific and is usually related to dyspepsia-like symptoms. In the worst-case scenario, this may cause gastric outlet or intestinal obstruction which eventually requires surgery.

    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.

  17. Subhas N, Pang NT, Chua WC, Kamu A, Ho CM, David IS, et al.
    Int J Environ Res Public Health, 2021 Sep 28;18(19).
    PMID: 34639482 DOI: 10.3390/ijerph181910182
    Previous pandemics have demonstrated short and long-term impacts on healthcare workers' mental health, causing knock-on effects on patient care and professional functioning. Indeed, the present COVID-19 pandemic has created unprecedented disruption in social interactions and working conditions. Malaysia has been under the Recovery Movement Control Order since June 2020; however, with the upsurge of cases, healthcare workers face pressure not only from working in resource-deprived settings but also from the increasing patient load. The primary objective of the present study was to examine the cross-sectional relationship of COVID-19 fear and stress to psychological distress (operationalized as anxiety and depression) in healthcare workers. The present sample included 286 frontline healthcare workers from three hospitals in Selangor, Malaysia. Self-administered questionnaires containing sociodemographic and occupational items, the Malay versions of the Coronavirus Stress Measure scale, the Fear of Coronavirus-19 scale, the Generalized Anxiety Disorder-7, and the Patient Health Questionnaire-9 were distributed via online platforms. Hierarchical multiple regression findings suggest that age, shift work, and COVID-19 stress consistently predicted anxiety and depression among frontline healthcare workers after adjusting for sociodemographic and occupational variables. The present findings suggest that frontline healthcare workers are not only inoculated against COVID-19 itself but also against the psychological sequelae of the pandemic.
  18. Wasimin FS, Thum SCC, Tseu MWL, Kamu A, Ho CM, Pang NTP, et al.
    Int J Environ Res Public Health, 2022 Aug 27;19(17).
    PMID: 36078389 DOI: 10.3390/ijerph191710673
    Viral epidemics have surfaced frequently over the past quarter-century, with multiple manifestations of psychological distress. This study sought to establish the psychometric properties of the Malay version of SAVE-9 among healthcare workers. A total of 203 healthcare workers across Malaysia participated in the research. The Malay version of SAVE-9 was translated and back-translated using the WHO instrument validation protocols. Classical Test Theory (CTT) and Rasch analysis were used to assess the validity and reliability of the Malay version of the SAVE-9 scale. The analysis was run using IBM SPSS 26.0 and JAPS. Cronbach's alpha was used to measure the internal consistency of SAVE-9, which was found to be satisfactory (Cronbach's α = 0.795). The correlations between the SAVE-9 and other measured scales (GAD-7 and PHQ-9) were statistically significant. A score of 22 was defined as a cut-off point with good sensitivity (0.578) and specificity (0.165). The Malay version of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) scale is valid and reliable after testing among healthcare workers. It is psychometrically suitable to be used in assessing healthcare workers' stress and anxiety specific to viral epidemics.
  19. Pang NTP, Tio VCS, Singh ASB, Tseu MWL, Shoesmith WD, Abd Rahim MA, et al.
    Trends Psychiatry Psychother, 2023 Feb 17;44:e20200172.
    PMID: 34392668 DOI: 10.47626/2237-6089-2020-0172
    INTRODUCTION: COVID-19 has trickle-down psychological effects on multiple strata of society, particularly university students. Apart from the worry of contracting or spreading COVID-19, Malaysian university students were also locked down on their campuses, suffering significant psychological distress. Hence, an online mindfulness intervention was proposed to alleviate psychological distress and improve psychological flexibility and mindfulness.

    METHODS: This was a quasi-experimental study with university students as participants. Intervention group participants were instructed to complete online questionnaires which covered basic demographics and instruments assessing depression, anxiety, stress, mindfulness, psychological flexibility, and fear of COVID-19 before and after the one-hour intervention. The control group also completed before and after questionnaires and were subsequently crossed over to the intervention group. Repeated measures ANOVA was conducted to assess time*group effects.

    RESULTS: 118 participants were involved in this study. There were significant differences in anxiety (F(1,116) = 34.361, p < 0.001, partial eta-squared = 0.229) and psychological flexibility between the two groups (F(1,116) = 11.010, p = 0.001, partial eta-squared = 0.087), while there were no differences in depression, stress, mindfulness, or fear of COVID-19.

    CONCLUSION: The results of this study corroborate the efficacy of online single-session mindfulness therapy as a viable short-term psychological intervention under financial and time constraints. Since university students are in the age group with the highest incidence of depressive and anxiety disorders, it is crucial to utilize resources to address as many students as possible to ensure maximum benefit.

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