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Electroconvulsive therapy in a 91-year old Asian lady with late onset bipolar mania

Francis B, Petrus CF, Wong HH

Asian J Psychiatr, 2020 Apr;50:101986.
PMID: 32135484 DOI: 10.1016/j.ajp.2020.101986

BACKGROUND: Electroconvulsive therapy (ECT) is safe and efficacious in the elderly population. However, clinicians are still weary to use it among the old-old population, citing safety concerns. Our case report highlights the use of ECT in a 91 year old lady with late onset Bipolar Mania.
CASE REPORT: A 91 year old lady presented with an acute manic relapse for the past 2 weeks. She was previously on oral Sodium Valproate, and during this current admission was augmented with oral Quetiapine IR 100 mg bd. She remained unwell and was planned for right unilateral ECT with age-based dosing stimuli. After only 4 sessions, she showed complete resolution of her manic symptoms.
RESULT: In our case study, the patient showed rapid response to right unilateral ECT. Even though the Post Suppression Index (PSI) was not significant, there is some evidence that in elderly patients, burst suppression (not measured in this case) may be more accurate measure of ECT efficacy. The transient treatment emergent delirium was short lived and ECT was very tolerated in this patient.
CONCLUSION: Clinicians should not delay ECT in old-old patients who do not respond to pharmacologic treatment, as early switch to ECT results in rapid response with good safety profile.
Fulltext The impact of mental health stigma in a young Malaysian lady with recurrent suicidal ideations and moribund presentations to the Emergency Department: a case report

Petrus CF, Mohd Salleh Sahimi H, Midin M, Lim JTY

Front Psychiatry, 2023;14:1243015.
PMID: 37937231 DOI: 10.3389/fpsyt.2023.1243015

INTRODUCTION: Mental health stigma (MHS) has been a pervasive social issue and a significant barrier to treatment seeking behavior. The treatment pathways and outcomes for people with mental illness, specifically those with recurrent suicidal ideations and attempts have been influenced by how MHS was experienced in clinical practice.
METHODS: We reported a case of a young lady diagnosed with bipolar II disorder, obsessive-compulsive disorder and borderline personality disorder who had recurrent visits to various emergency departments (ED) of tertiary hospitals in Malaysia for suicidality; each time presenting with increased mortality risk and escalating near-lethal outcomes. Among the multiple ED visits after her alleged overdoses of psychotropic medications, thrice she was near-unconscious and had to be intubated for airway protection, subsequently requiring ventilatory support and ICU care. These near-lethal presentations in ED were due to her delays in seeking treatment for fear of re-experiencing the stigmatizing environment among healthcare staff and professionals in the ED.
DISCUSSION: The impact of MHS is detrimental. Effective interventions at various levels in the clinical setting is of utmost importance to prevent the negative consequences of suicidality against MHS.
Negative religious coping mediates dementia caregiver burden and depression in a Malaysian setting

Cheang YW, Ng CG, Petrus CF, Ramly SS, Teh EE, Ng YH, et al.

Psychogeriatrics, 2023 Jul;23(4):738-741.
PMID: 37283246 DOI: 10.1111/psyg.12989
Fulltext Religious Coping, Religiosity, Depression and Anxiety among Medical Students in a Multi-Religious Setting

Francis B, Gill JS, Yit Han N, Petrus CF, Azhar FL, Ahmad Sabki Z, et al.

Int J Environ Res Public Health, 2019 01 17;16(2).
PMID: 30658450 DOI: 10.3390/ijerph16020259

Medical students are vulnerable to depression and anxiety due to the nature of their academic life. This study aimed to determine the prevalence of depressive and anxiety symptoms among medical students and the association between religious coping, religiosity and socio-demographic factors with anxiety and depressive symptoms. A cross sectional design was used for this study. Scales used were the Malay version of the Duke Religious Index (DUREL-M), the Malay version of the Brief Religious Coping Scale (Brief RCOPE) and the Malay version Hospital and Anxiety Depression Scale (HADS-M). 622 students participated in this study. They scored moderately on the organized (mean: 3.51) and non-organized religious (mean: 3.85) subscales of the DUREL, but had high intrinsic religiosity (mean: 12.18). The prevalence of anxiety and depressive symptoms were 4.7% and 17.4% respectively, which is lower than local as well as international data. Islam, negative religious coping and the presence of depressive symptoms were significantly associated with anxiety symptoms. Only the presence of anxiety symptoms was significantly associated with depressive symptoms. Negative religious coping, rather than positive religious coping, has significant association with depressive and anxiety symptoms. Redirecting focus towards negative religious coping is imperative to boost mental health outcomes among medical students.
Fulltext Religious Coping During the COVID-19 Pandemic: Gender, Occupational and Socio-economic Perspectives Among Malaysian Frontline Healthcare Workers

Francis B, Ken CS, Han NY, Ariffin MAA, Md Yusuf MH, Wen LJ, et al.

Alpha Psychiatry, 2021 Jul;22(4):194-199.
PMID: 36424939 DOI: 10.5152/alphapsychiatry.2021.21185

OBJECTIVE: At the dawn of the new decade of the 20th century, the world was taken aback by the scourge of the COVID-19 pandemic. The study aimed to study the nature of religious coping of frontline healthcare workers seen through the perspective of gender, socio-economic status, and occupation.
METHODS: An online-based study was carried out among frontline healthcare workers involved in the care of COVID-19 patients (n = 200). Sociodemographic data form and the Brief Religious Coping scale were used in this study.
RESULTS: There were more female healthcare workers (60.5%) and doctors (69.5% vs. 30.5%). Healthcare workers used more positive religious coping than negative religious coping (median score: 22 vs. 9). Positive religious coping was seen more in females (median score: 23 vs. 21, P = .015). Non-doctors applied positive coping more than doctors (median score: 26 vs. 21, P < .001). There were significant differences in positive religious coping scores across income groups, with the B40 group having the highest score (median score: 24). Post hoc pairwise comparison concluded that the B40 group had significantly higher positive religious coping scores than the M40 group.
CONCLUSION: Positive coping was utilized more among female healthcare workers, nondoctors, and the lowest socio-economic group. As prior literature has shown that positive religious coping is desirable and has superior mental health outcomes, our findings show that more effort should be channeled into enhancing positive religious coping, particularly among male healthcare workers, doctors, and the middle and high socio-economic group.