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  1. Fulltext Charles Bonnet syndrome: a precursor to Alzheimer disease
    Janaki, V., Rosdinom, R., Hatta, S.
    Medicine & Health, 2015;10(2):146-150.
    MyJurnal
    This case report highlights Charles Bonnet Syndrome as a precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment and the possible differential diagnoses that could be considered. We report a case of an elderly lady with no known previous medical illness, who presented for the first time to the psychiatric clinic with complex visual hallucinations consisting of well-formed images of people and inanimate objects of long standing duration of 18 months. About a year later, there was emergence of cognitive impairment which progressed gradually accompanied by other psychotic symptoms such as auditory hallucinations and persecutory delusions. There were no affective or obsessional symptoms. She had poor insight towards her illness. Ophthalmological examination revealed significant reduction in bilateral visual acuity. Otherwise, physical examination was unremarkable. She received inpatient treatment with Rivastigmine patch 4.6 mg/24 hours and Zydis 10 mg noctre. Her cognitive impairment and psychotic symptoms gradually improved over a period of 2 weeks upon commencing treatment and on subsequent follow-ups at outpatient clinic. She had also gained some insight into her illness. Charles Bonnet syndrome could be a possible precipitating factor and precursor to the development of major neurocognitive disorder due to Alzheimer’s disease in the elderly with visual impairment which is often overlooked or misdiagnosed and hence under reported.
    Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
  2. Fulltext Anorexia Nervosa in Schizophrenia: a starving mind within a susceptible brain
    Nik Ruzyanei, N.J., Wan Salwina, W.I., Choo, S.P., Rosdinom, R.
    Malaysian Journal of Psychiatry, 2011;20(1):1-5.
    MyJurnal
    Schizophrenia poses challenges in diagnosis and treatment strategies when the predominant clinical features represent another spectrum of disorder like eating disorders. Nevertheless, symptoms of eating disorder in schizophrenia are not entirely uncommon although never included in the diagnostic criteria. We reported a case of a woman who first presented at seventeen years old with food refusal and underlying psychosis resulting in severe weight loss, but defaulted treatment for almost a decade. In 2009, she presented again with sinus bradycardia and secondary amenorrhoea. In this report, we discussed about the patient’s vulnerability for psychosis and its psychodynamic drive which led to a complex symptoms manifestation. Our aim is to highlight its diagnostic dilemma and suggestions to treatment strategies unique to this presentation.
  3. Fulltext Sociodemographic profiles of caregivers and their association with burden of care in dementia
    Rosdinom, R., Norzarina, M.Z., Ruzanna, Z., Zanariah, M.S.
    Malaysian Journal of Psychiatry, 2011;20(1):1-10.
    MyJurnal
    Caring for a family member with dementia is associated with distress and several caregiver factors are known to be determinants of burden of care.
    Objective: To determine the relationship between the caregivers’ sociodemographic variables and their perceived burden of care. 
    Methods: Patients diagnosed as having dementia with their caregivers were selected through a non-randomised sampling method from the psychogeriatric and memory clinics in Universiti Kebangsaan Malaysia Medical Centre and Hospital Kuala Lumpur. Burden of care was assessed using the Zarit Burden Interview.
    Results: Age, gender, educational achievement, ethnicity and kinship of the 65 caregivers did not show any significant statistical difference in relation to their perceived burden. Conclusion: Burden in caring after patients with dementia was not significantly determined by the sociodemographic characteristics of their caregivers
    Study site: Psychogeriartic clinics and memory clinics of Pusat Perubatan University Kebangsaan Malaysia (PPUKM) and Hospital Kuala Lumpur (HKL), Kuala Lumpur, Malaysia
  4. Pisa syndrome secondary to rivastigmine: a case report
    Muthupalaniappen L, Rosdinom R, Suguna M
    Clin Ter, 2012;163(1):31-2.
    PMID: 22362231
    Pisa syndrome or pleurothotonus is the persistent flexion of the body and head to one side giving the appearance of the leaning tower of Pisa. It is most commonly caused by typical and atypical antipsychotic drugs. We report a case of Pisa Syndrome caused by prolonged use of high dose cholinesterase inhibitor, rivastigmine. Symptoms subsided when rivastigmine was withdrawn and did not reappear when a different cholinesterase inhibitor, donepezil was introduced. Physicians should be aware of Pisa syndrome and should alert patient of this possibility when starting and stepping up medications. The purpose of reporting this case is to create awareness among general practitioners as it is a reversible condition which responds to removal of the offending drug.
  5. Fulltext Caring for moderate to severe dementia patients - Malaysian family caregivers experience
    Zuria Idura A.M., Noorlaili M.T., Rosdinom R., Azlin B.., Tuti Iryani M.D.
    International Medical Journal Malaysia, 2018;17(1):93-102.
    MyJurnal
    Introduction: Caring for those with dementia affects the quality of life for both the caregivers and the patients themselves, particularly in the informal care system here in Malaysia. To date, only a few studies have explored from the family caregivers’ perspectives in the communities of different cultural background. The purpose of this study is to describe the Malaysian family caregivers’ perspectives of their experiences in providing care to for their family members suffering from moderate to severe dementia in Kuala Lumpur, Malaysia. Methods: This qualitative study involved in-depth individual interviews with twelve caregivers to patients with moderate to severe dementia. Participants were recruited via purposive sampling from the outpatient psycho-geriatric clinic at UKM Medical Centre, Kuala Lumpur. All interviews were audio-recorded and transcribed verbatim. Transcribed data was later analysed using a thematic approach. Results: Four themes identified in this study were; i) the feeling that ‘it is like caring for a baby’, ii) the caregivers’ perception of inadequate knowledge and skills, iii) the need for caregivers’ support system and iv) the importance of spirituality in enhancing care giving experiences. Conclusions: The framework of care shared by the caregivers in this study demonstrated strong cultural and spirituality influences in addition to the common issues of the challenges in managing the behavioural and psychological symptoms in people with dementia. Hence, culture and spirituality aspects should be addressed in the development of appropriate intervention to manage the needs of informal caregivers in this community.
  6. Capgras syndrome in a very late onset, treatment resistant schizophrenia
    Ain MK, Rosdinom R, Raynuha M
    Int Psychogeriatr, 2015 Sep;27(9):1573-5.
    PMID: 25794136 DOI: 10.1017/S1041610215000332
    We report a Malay man, with underlying chronic medical illnesses, presenting with positive symptoms of schizophrenia, including Capgras syndrome (CS) at the age of 73. Physical examination and blood investigations were normal and brain CT scan showed age-related cerebral atrophy. Neuropsychological assessment showed probable right hemisphere lesions but relatively intact memory and intellectual functions. Several neuroleptics including depot injections were tried but ineffective. Positive symptoms including CS eventually improved with clozapine before his death from myocardial infarction. This case report highlights the uncommon occurrence of CS in treatment resistant schizophrenia (TRS) of very late onset and its treatment challenges.
  7. Fulltext Prevalence of Psychological Distress and Depressive Disorders among Married Working Women in Malaysia
    Umi Adzlin, S., Marhani, M., salina, A.A., Ruzanna, Z., Rosdinom, R., Rozhan Sharif, M.R., et al.
    Malaysian Journal of Psychiatry, 2011;20(1):1-12.
    MyJurnal
    This two-phase study examined the prevalence of depressive disorders among married working women in a sub-urban area in Malaysia. The Malay version of the General Health Questionnaire-12 (GHQ-12) was used for initial screening. Using multistage cluster sampling, there were 700 subjects from 25 workplaces that were approached, of which 307 filled out GHQ-12 in the initial phase. The prevalence of psychological distress (GHQ 2/3 cut off) is 22.8% (n=70, 95% CI 18.1-27.5). In the second phase, all 49 consenting patients who were screened positive for severe psychological distress (GHQ 3/4 cut off point) were telephone-interviewed by a trained psychiatrist with the Malay version of Mini International Neuropsychiatric Interview (M.I.N.I) to diagnose depressive disorders. The prevalence of depressive disorders was 5.5% (n=17, 95% CI 3.5-7.5). The prevalence of depressive disorders is comparable to those found in the working population worldwide.
  8. Factors associated with cognitive impairment in patients with Parkinson disease: an urban study
    Rosdinom R, Fazli A, Ruzyanei NJ, Azlin B, Srijit D
    Clin Ter, 2011;162(1):23-9.
    PMID: 21448542
    BACKGROUND AND AIMS: Parkinson disease (PD) is the second most prevalent neurodegenerative disorder after Alzheimer disease. Besides motor presentations, cognitive impairment is among the other likely complications as the illness progresses. This study aimed to determine the prevalence of cognitive impairment in PD and the factors associated with the cognitive impairment.
    MATERIALS AND METHODS: A cross-sectional, descriptive study was conducted on all PD patients at different stages of their illness, in two major tertiary hospitals in Malaysia with their caregivers, over a three month period in 2002. Patients' cognitive functions were tested using the Mini Mental State Examination (MMSE). Important sociodemographic data and relevant clinical information of the patients as well as caregivers' information on income, duration of care-giving, relationship with the patient, and other relevant variables were gathered. Patients' level of functioning was assessed using the Activities of Daily Living (ADL) index. Staging of illness was done based on the Hoehn and Yahr Scale.
    RESULTS: Out of 115 eligible patients, 35% were in the 60-69 age group with 57% in stage 2 of illness, A total of 29% of patients experienced various degrees of cognitive impairment , with almost half (47%) in the stage 3 and 4 exhibiting MMSE scores <24. Factors which were significantly associated with impaired cognitions were race, educational level and stage of illness.
    CONCLUSION: Cognitive impairment was fairly common in PD and the severity of impairment in cognition and physical functioning increased with the advancement of the illness.
  9. Fulltext A case control study on factors that influence depression among the elderly in Kuala Lumpur Hospital and Universiti Kebangsaan Malaysia Hospital
    Salimah O, Rahmah MA, Rosdinom R, Azhar SS
    Med J Malaysia, 2008 Dec;63(5):395-400.
    PMID: 19803299 MyJurnal
    Depressive illness is common among the aged population. A case control study was conducted, focusing on risk factors influencing depression among the elderly. This study involved 130 elderly patients diagnosed to have depressive illness from the psychiatric clinics of Kuala Lumpur Hospital (HKL) and Universiti Kebangsaan Malaysia Hospital (HUKM). Another group of 130 elderly patients with no history of depressive illness were recruited from the medical specialist clinics. The majority of cases were female (75.4%), aged 60-74 years (92.3%) and from Chinese ethnic group (59.2%). Non-Malay elderly has three times risk (AOR 2.537, 95% CI 1.439-4.471) of suffering the depressive illness compared to the Malay elderly, the elderly with chronic health problems are more likely to be depressed compared to those who do not suffer from any chronic illness (p trend <0.001). Other risk factors identified were family history of depression with four times risk (AOR 4.225, 95% CI 2.017-8.848) and lower social support with eight times risk (AOR 7.949, 95% CI 2.588-24.417). Social support is not only important in encouraging the elderly to practice healthy life style but proven to influence the risk of getting depression among them. Hence, it is very crucial that the elderly is given total attention, respect and love from all parties to ensure prosperity and meaningfulness in life.
  10. Behavioural and psychological symptoms of dementia, cognitive impairment and caregiver burden in patients with dementia
    Rosdinom R, Zarina MZ, Zanariah MS, Marhani M, Suzaily W
    Prev Med, 2013;57 Suppl:S67-9.
    PMID: 23313789 DOI: 10.1016/j.ypmed.2012.12.025
    OBJECTIVE: This study aims to determine the relationships between behavioural and psychological symptoms of dementia (BPSD), cognitive impairment and burden of care of patients with dementia.
    METHOD: A cross-sectional, non-randomised study of 65 elderly patients with dementia and their caregivers was conducted over a 3-month period in January 2007 at the memory clinics of Universiti Kebangsaan Malaysia Medical Centre and Hospital Kuala Lumpur. Patients' cognitive functions were assessed with the Mini Mental State Examination (MMSE). Caregivers were interviewed to determine the severity of BPSD and caregiver burden (CB) using the Neuropsychiatric Inventory (NPI) Questionnaire and Zarit Burden Interview (BI) respectively.
    RESULTS: Cognitive impairment did not contribute significantly to CB. Multiple linear regression analysis showed that high BPSD scores contributed 0.27 more in BI score, female patients contributed 0.37 less in BI score and caregivers with higher educational level contribute 0.5 more in BI score.
    CONCLUSION: Patients' BPSD and male gender, but not cognitive impairment, were associated with CB. Even though CB was experienced more among caregivers with better education, all caregivers should be screened to ensure their general well-being.
    KEYWORDS: BPSD; Caregiver burden; Cognitive impairment
    Study site: Memory clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) and Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  11. Fulltext Psychiatric presentation of Huntington's disease in a Malaysian family
    Chin CN, S'ng KH, Philip G, Rosdinom R, Wahidah A
    Med J Malaysia, 1996 Mar;51(1):153-6.
    PMID: 10968000
    A 32-year-old Chinese lady presented to the Psychiatric Clinic with a history of change in personality for 2 years and abnormal movements for a year. After thorough investigations and observation a diagnosis of Huntington's Disease was made. Her elder brother was traced and found to have Huntington's Disease as well. He had a long standing history of antisocial behaviour and substance abuse long before the onset of the choreiform movements. Her younger brother also has choreiform movements for the last 2 years and had recent change in personality. Their mother also had abnormal movements and was recorded to be depressed and attempted suicide. The maternal grandfather had a mental illness and was warded at a mental institution till his death in 1942. Psychiatric presentation of Huntington's Disease in this Malaysian family is prominent and preceded the characteristic movements in the present generation.
  12. Fulltext Development of TUA-WELLNESS screening tool for screening risk of mild cognitive impairment among community-dwelling older adults
    Vanoh D, Shahar S, Rosdinom R, Din NC, Yahya HM, Omar A
    Clin Interv Aging, 2016;11:579-87.
    PMID: 27274208 DOI: 10.2147/CIA.S102925
    BACKGROUND AND AIM:
    Focus on screening for cognitive impairment has to be given particular importance because of the rising older adult population. Thus, this study aimed to develop and assess a brief screening tool consisting of ten items that can be self-administered by community dwelling older adults (TUA-WELLNESS).
    METHODOLOGY:
    A total of 1,993 noninstitutionalized respondents aged 60 years and above were selected for this study. The dependent variable was mild cognitive impairment (MCI) assessed using neuropsychological test batteries. The items for the screening tool comprised a wide range of factors that were chosen mainly from the analysis of ordinal logistic regression (OLR) and based on past literature. A suitable cut-off point was developed using receiver operating characteristic analysis.
    RESULTS: A total of ten items were included in the screening tool. From the ten items, eight were found to be significant by ordinal logistic regression and the remaining two items were part of the tool because they showed strong association with cognitive impairment in previous studies. The area under curve (AUC), sensitivity, and specificity for cut-off 11 were 0.84%, 83.3%, and 73.4%, respectively.
    CONCLUSION: TUA-WELLNESS screening tool has been used to screen for major risk factors of MCI among Malaysian older adults. This tool is only suitable for basic MCI risk screening purpose and should not be used for diagnostic purpose.
    KEYWORDS: TUA-WELLNESS; mild cognitive impairment; screening; sensitivity; specificity
  13. Validation Study of the Malay version of the Neuropsychiatric Inventory
    Rosdinom R, Ng IT, Teh EE, Norhayati A, Ng CG, Yeoh SH, et al.
    Clin Ter, 2014;165(6):287-93.
    PMID: 25524183 DOI: 10.7417/CT.2014.1770
    OBJECTIVES: There is a lack of local instruments to assess behavioural and psychological symptoms of dementia (BPSD). This 2-stage cross-sectional study was aimed at validating a Malay translated version of the Neuropsychiaric Inventory (MvNPI).

    MATERIALS AND METHODS: It was conducted on a selected group of 138 elderly outpatients with dementia and their caregivers in Hospital Pulau Pinang. Severity of dementia was assessed using the Malay-translated version of Mini Mental State Examination (MMSE). The original NPI was translated and then back-translated before it was pilot-tested. The MvNPI was administered twice, a week apart on the same caregiver by the same investigator.

    RESULTS: The individual items and total scale score of MvNPI had high internal consistency, with Corrected Item-Total Correlation ranging from satisfactory to good (0.41 to 0.77). The Cronbach's alpha for all the NPI domains showed high internal consistency (0.83), and subtotal for severity and distress scores were perfect (0.998 to 1.00). There was no significant difference between test-retest mean scores (p>0.05) and their correlations were perfect (0.996 to 1.00). Content validity indicated mild and inverse relationship between MMSE scores and severity, and distress score (-0.281 and -0.268, respectively, with p<0.001). Discriminant validity calculated using Mann-Whitney U test was found to be significant (p<0.001) in differentiating severity of cognitive impairment. Factor analysis revealed four possible components existed in MvNPI.

    CONCLUSIONS: The MvNPI is a valid and reliable tool for assessing BPSD among Malay speaking populations of Malaysia and its neighbouring South East Asian countries.

    Study site: Hospital Pulau Pinang
  14. Fulltext Prevalence of depression in stroke patients with vascular dementia in universiti kebangsaan malaysia medical center
    Khoo KF, Tan HJ, Rosdinom R, Raymond AA, Norlinah MI, Shamsul A, et al.
    Med J Malaysia, 2013 Apr;68(2):105-10.
    PMID: 23629553 MyJurnal
    Depression among patients with vascular dementia is frequently overlooked and potentially causes significant morbidity. There is limited data in Malaysia on the subject and this study was conducted to determine the prevalence of depression in vascular dementia (VaD) in UKMMC.
  15. Fulltext Does clinical exposure to patients in medical school affect trainee doctors' attitudes towards mental disorders and patients?--A pilot study
    Tan SMK, Azmi MT, Reddy JP, Shaharom MH, Rosdinom R, Maniam T, et al.
    Med J Malaysia, 2005 Aug;60(3):328-37.
    PMID: 16379188
    Stigmatising attitudes towards mental illness may improve with clinical exposure during medical school training. Attitudes of 48 fourth year medical students in Universiti Kebangsaan Malaysia were assessed before and after their compulsory attachment in Psychiatry, using the Attitude Towards Psychiatry-30 (ATP) and the Attitude towards Mental Illness (AMI) questionnaires. ATP scores improved significantly with training (104.8 and 114.4, pre- and post-attachment respectively) as did AMI scores (63.4 and 68.1 respectively). Both improvements were statistically significant. (ATP: z = 4.55, p < 0.0005) (AMI: z = 3.75, p < 0.0005). Attitudes towards mental illness appeared to have become more favourable with clinical training in psychiatry.
  16. The effect of a clinical posting in psychiatry on the attitudes of medical students towards psychiatry and mental illness in a Malaysian medical school
    Reddy JP, Tan SM, Azmi MT, Shaharom MH, Rosdinom R, Maniam T, et al.
    Ann Acad Med Singap, 2005 Sep;34(8):505-10.
    PMID: 16205829
    INTRODUCTION: The stigma attached to mental illness and the mentally ill is a universal phenomenon and a major barrier to the provision of mental health services. Stigmatising attitudes among doctors themselves can result in compromised patient care. The aim of this research project is to study the impact of a clinical posting in psychiatry on the attitudes of medical students to mental illness and to psychiatry. This paper reports the results of the first phase of a longitudinal study.

    MATERIALS AND METHODS: A total of 122 year 4 medical students responded to this study. The Attitudes Towards Mental Illness (AMI) and Attitudes Towards Psychiatry (ATP) questionnaires were administered before and after an 8-week attachment in psychiatry.

    RESULTS: We found that students had somewhat favourable attitudes towards psychiatry and mental illness at the start of their attachment, with a mean score of 108.34 on ATP (neutral score, 90) and 68.24 on AMI (neutral score, 60). There was a significant increase in the mean scores of both scales following the psychiatric attachment for female students (ATP: P = 0.003; AMI: P <0.0005), but not male students (ATP: P = 0.435; AMI: P = 0.283).

    CONCLUSIONS: An 8-week clinical posting of fourth-year medical students in psychiatry was associated with an increase in positive attitudes to mental illness and to psychiatry among female students but not among male students.

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