Introduction: Anxiety and depression are both associated with increased morbidity in diabetic population, especially those afflicted with foot ulcer, whereas Erectile Dysfunction (“ED”) and Female Sexual Dysfunction (“FSD”) are amongst the common complication found in diabetes. This study aimed to determine the prevalence of anxiety and depression as primary outcome and sexual dysfunction (“SD”) as a secondary outcome in diabetic patients with and without foot ulcer (“DFU”).
Methods: A cross-sectional study was conducted in Hospital Raja Permaisuri Bainun Ipoh, Perak, where 164 diabetic patients were recruited for the purpose of this study. Hospital Anxiety and Depression Scale (“HADS”) were utilised to measure anxiety and depression. International Index for Erectile Function 5 (“IIEF-5”) and the Malay version of Female Sexual Function Index (“MVFSFI”) were used to detect SD. Simple and multiple logistic regressions were referred to in order to evaluate the factors associated with anxiety, depression and SD.
Results: In the group with foot ulcer, 36.8% had depressive and anxiety risk respectively compared to without the foot ulcer, 37.5% and 38.5% respectively. Male gender (AOR=6.3,p=0.002,95%CI 1.975, 20.205) and having lower education status (AOR=6.0,p=0.018,95%CI1.36,26.59,) was associated with foot ulcer. High prevalence of SD found in foot ulcer group (52.6%,p=0.006). Those with depression (OR=4.421,95% CI 1.08,18.16,p=0.039) and male gender (OR=18.42,p<0.01,95%CI5.5,-61.62) predicts present of SD.
Conclusion: Depression and anxiety prevalent were similar for both with and without diabetic foot ulcer. Several significant predictor factors were identified for DFU group, for anxiety and depression risk and for SD in a diabetes patient. Further studies are required to establish the directional nature of this relationship.
Keywords: Depression, Anxiety, Diabetic food ulcer (DFU), Erectile Dysfunction (ED), Female Sexual Dysfunction (FSD)
Study site: outpatient clinic of medical and orthopedic departments in Hospital Raja Permaisuri Bainun (HRPB) Ipoh, Perak, Malaysia
Sexual dysfunction is highly prevalent in gynaecological cancer patients. Most of the time, sexual dysfunction in gynaecological cancer is underdiagnosed as there is overlapping of symptoms with other psychological morbidities, interplaying of multiple risks, patients’ reluctance to complain or incompetence of health care provider to assess. Determining the risk factors of sexual dysfunction in cancer patients enables us to pay more attention to those who are vulnerable and to device strategies for early detection, prevention and treatment of sexual dysfunction in them. The main aim of the study was to determine the prevalence of sexual dysfunction and its risk factors in gynaecological cancer patients in Hospital Sultanah Bahiyah, Alor Star, Malaysia. Sexual function of eighty-three gynaecological cancer patients who were married were assessed with self-rated MVFSFI (Malay version Female Sexual Function Index). Self-rated WHOQOL-BREF (World Health Organization- Quality of Life- 26) which assessed the domains of quality of life was used while MINI (Mini International Neuropsychiatry Interview) was used for diagnosis of major depressive disorder. The prevalence of sexual dysfunction among the married gynaecological cancer patients was 65% (54/83). Sexual dysfunction was significantly associated with low education level (OR 3.055, CI 1.009-9.250), shorter duration of cancer (OR 0.966, CI 0.966- 0.998), ongoing chemotherapy (OR 3.045, CI 1.149-8.067), pain perception (OR 3.230, CI 1.257-8.303), absence of sexual intercourse for more than one month (OR 1.862) and three domains of quality of life such as physical health, psychological health and social relationship (OR 0.942, CI 0.908-0.978; OR 0.955, CI 0.916-0.995; OR 0.933, CI 0.894-0.973, respectively). However, sexual dysfunction was not associated with major depressive disorder (χ2 ² = 1.224, p = 0.268). The prevalence of sexual dysfunction in gynaecological cancer patients was comparable to other studies of similar population. Since, the risk factors of sexual dysfunction in gynaecological cancer patients are multidimensional, the process of assessment and management need to be holistic and patient-oriented.
The compulsive behaviour of observing an unsuspecting person undressing or being naked in voyeurism may be related to Obsessive-Compulsive spectrum disorder. The aim of this paper is to report a case that reiterates a unique psychopathology of a Malaysian male voyeur with an obsession on female body parts. This 35 year-old voyeur man who attended psychiatric outpatient clinic in an academic medical centre presented to a psychiatrist for taking photos of his sisters' naked bodies and collected nails and hairs from their body, coded them with intend for masturbation. His voyeuristic thoughts and urges which came repeatedly and intrusively, involving attempts to resist them and was associated with an inner tension for the urges to be fulfilled. He responded both to Paroxetine and behaviour therapy. The possibility that voyeurism, a paraphilia can manifest itself as a subtype of OCD is discussed. Keywords: Malaysian voyeur, obsession-compulsive spectrum disorder, body parts
INTRODUCTION: Hospital-based community psychiatric service (HCPS) is a developing intervention in Malaysia targeted for patients with severe mental illnesses (SMIs). Its effectiveness had not been systematically measured. This study aimed to assess the outcome of HCPS with respect to re-hospitalization and factors associated with low re-hospitalization among patients with schizophrenia in the metropolitan city of Kuala Lumpur.
METHODS: A naturalistic and retrospective cohort study was conducted using within-subject pre-post design on 155 patients with schizophrenia who received HCPS in Hospital Kuala Lumpur (HKL). The selection was made by simple random sampling. The hospital admission profiles were obtained from clinical records. The socio-demographic and relevant clinical data were also assessed through clinical interviews.
RESULTS: One hundred and forty (90%) of 155 respondents had low rate of hospital admission with significant reduction of being hospitalized within 1 year after receiving HCPS (p
The aim of this paper was to review the literature on suicide ideation and intent in Malaysia. PsyINFO, PubMed, Medline databases from 1845 to 2012 and detailed manual search of local official reports from Ministry of Health, Malaysian Psychiatric Association and unpublished dissertations from 3 local universities providing postgraduate psychiatric training, were included in the current review. A total of 13 studies on suicide ideation and intent in Malaysia were found and reviewed. The review showed that research on suicide ideation and intent in Malaysia was fragmented and limited, at best. Approximately 50% of existing research on suicide ideation and intent simply focused on sociodemographic data. Fifty-four percent of the data were obtained from hospitals. No study has been conducted on treatment and interventions for suicide ideation and intent. None of the studies used validated suicide scales. The impact of culture was rarely considered. It was clear from the review that for researchers, clinicians and public health policy makers to gain a better understanding of suicide behavior especially suicide ideation and intent in Malaysia, more systematic and empirically stringent methodologies and research frameworks need to be used.
Objective: This case report highlights a case of young male referred for psychiatric evaluation due to paraphilic disorder. This 27-year old single male working as an assistant accountant was noted to have voyeuristic behaviour and presented with depressive symptoms since his teenage age. He has poor coping whenever he experiences stress in life. He started to watch pornographic videos and subsequently get involved by peeping pre-pubescent’s undergarments. These activities are followed by a compulsive behaviour such as masturbation to gratify his sexual arousal.
Results: The patient undergone several psychotherapy sessions, and medical report was furnished for the court's purpose. Our assessment revealed that he was suffering from a lifetime major depressive disorder,and he was prescribed with Tablet Sertraline 50mg/daily.He also has premature ejaculation, severe in nature. He regretted his voyeuristic urge and psychotherapyfocused on how to channel his sexual needs.
Conclusion: Mood disorder is seen in paraphilic disorder and has to be dealt with in order to establish good management care.
The Reasons For Living Inventory has been shown to have good psychometric properties in Western populations for the past three decades. The present study examined the psychometric properties and factor structure of English and Malay version of the Reasons For Living (RFL) Inventory in a sample of clinical outpatients in Malaysia. The RFL is designed to assess an individual's various reasons for not committing suicide. A total of 483 participants (283 with psychiatric illnesses and 200 with non-psychiatric medical illnesses) completed the RFL and other self-report instruments. Results of the EFA (exploratory factor analysis) and CFA (confirmatory factor analysis) supported the fit for the six-factor oblique model as the best-fitting model. The internal consistency of the RFL was α=.94 and it was found to be high with good concurrent, criterion and discriminative validities. Thus, the RFL is a reliable and valid instrument to measure the various reasons for not committing suicide among psychiatry and medical outpatients in Malaysia.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
INTRODUCTION: Depression is one of the most common psychiatric conditions in men. The aim of the study was to determine the depressive symptoms and associated factors among men on methadone maintenance therapy (MMT).
METHODS: A cross-sectional study was conducted involving 108 subjects who attended the Drug Clinic at Hospital Kuala Lumpur. The instruments used include the Structured Clinical Interview for Diagnostic and Statistical Manual, Fourth Edition Axis-I Disorder, Beck Depression Inventory and the 15-item International Index of Erectile Function.
RESULTS: The rate of depression was 44.4%. There were significant associations between Malay ethnicity, secondary education level and concurrent illicit cannabis use with depression (P
Decreased libido is recognized as one of the vegetative symptoms of depression. Increased libido has not been acknowledged as one of its symptoms, neither has it been reported, particularly in depressed bipolar patients.
Parkinson disease (PD) affects the lives of both the individuals and their family members. This study aims at investigating for clinical as well as socio-demographic factors associated with the perception of burden among the caregivers of individuals with PD in Malaysia.
AIM: The aim of this study was to investigate the prevalence of orgasmic dysfunction and the potential risk factors that may be associated with orgasmic dysfunction among women at a primary care setting in Malaysia.
METHODS: A validated questionnaire for sexual function was used to assess orgasmic function. A total of 230 married women aged 18 to 70 years participated in this study. Their sociodemographic and marital profiles were compared between those who had orgasmic dysfunction and those who did not, and the risk factors were examined.
RESULTS: The prevalence of orgasmic dysfunction in the primary care population was 51.9%. Women with orgasmic dysfunction were found to be significantly higher in the following groups: age >45 years, being non-Malay, having lower academic status, married longer, having more children, married to an older husband, and being at menopausal state.
CONCLUSION: Women with infrequent sexual intercourse are less likely to be orgasmic (odds ratio = 0.29, 95% confidence interval = 0.11-0.74).
The concept of a sexual response cycle (SRC) for women has gained interest lately with the reintroduction of terms with new definitions and a new model for the sexual response, especially the Basson's circular model.
The aim of the study was to compare sexual functioning among Malaysian women in a primary care setting between those with a low and high frequency sexual intercourse. Across-sectional study on 230 married Malaysian women in a primary-care setting was conducted at the Bandar Tun Razak Clinic, Cheras. A validated Malay version of Female Sexual Function Index questionnaire (MVFSFI) was used to assess the sexual functioning profiles among women with low and high sexual activity. The percentage of women who had sexual intercourse 3-4 times a week, 1-2 times a week and < 1-2 times a month were 13.4%, 44.3 % and 42.4 % respectively. Women with a low frequency of sexual intercourse (Low SI) tended to suffer from more sexual dysfunction, (χ²=28.98, p < 0.001) compared to those with a high frequency of sexual intercourse (High SI) group. Women who were less sexually active (having low frequency intercourse, ie. ≤ 1 – 2 times per week) were found to be less sexually aroused (χ²= 25.9, p< 0.001), less orgasmic (χ²=19.8, p< 0.001), less lubricated during sexual activity (χ²=11.1, p< 0.001), complain of sexual pain (χ²=4.3, p = 0.033) and feels less satisfied sexually (χ²=12.6, p< 0.001).The problem of female sexual dysfunction (FSD) in the Malaysian primary care population with low sexual activity needs to be addressed.
With the availability of the Internet, pornographic materials are readily accessible. Pornographic materials may have a link to addiction and other deviant sexual behaviour. In this case report, we highlighted a link between voyeuristic disorder and internet sex addiction. Mr. SK is a 22-year-old single gentleman who was referred for psychiatric assessment due to voyeuristic acts. He had been watching pornographic materials since 16 years old and became addicted to it.
Exhibitionism is a distressing condition which may have a link with the increasing availability and usage of online sexual activities (OSA). We highlight a 42-year-old man who presented with a constant craving for OSA to achieve his sexual satisfaction which included exposing his genitalia to virtual partners, unsuspected strangers, and colleagues in public areas. His sexual behaviours were further reinforced by an online video chatting with genitalia exposure, which ended commonly with an exchange of masturbatory acts. He denied any problem with his erection and able to achieve orgasm via common sexual acts. There was no past psychiatric history nor family history of mental disorder. He volunteered to seek psychiatric help and subsequently given a psycho education on his illness and how to cope with the distress associated with his sexual acts. He was scheduled for an intensive psychotherapy to instil insight and hope to deal with his sexual difficulties.
Nicotine dependence has progressively become a foremost community health interest in both the developed and developing nations due to the economic burden and health-related problems. Smoking was significantly higher among patients with schizophrenia in comparison to the general population. Nicotine dependence is not only associated with public stress, but among patients with schizophrenia, smoking brings major challenges to the management. Nicotine may diminish the therapeutic efficacy of the bioavailability of the psychopharmacological agents in-vivo. These duo perturbations, i.e. two clinical conditions co-existed may prevent psychotic symptoms remission among patients suffering from schizophrenia who smoke at the same time. The aim of this review was to highlight the role of pharmacological treatment options and strategies for patients with nicotine dependence in schizophrenia with emphasis on the underlying neurobiological process. The role of nicotine replacement therapy, i.e. norepinephrine-dopamine reuptake inhibition (NDRI) e.g. bupropion and selective partial agonist of α4β2 and full α7-nicotinic acetylcholine receptor e.g. varenicline was deliberated. An ideal choice of drug targets for patients with schizophrenia with nicotine dependence is pivotal to foster a better therapeutic alliance.
In Malaysia, female sexual dysfunction (FSD) among Malays is common, so understanding the meanings of sexuality becomes crucial, as they can vary with identity, and this may influence each woman's subsequent reaction to sexual experience. In this article, we explore the meanings of sexuality that Malay women had developed throughout their lived experience. This qualitative study, situated within a social cognitive theory and a phenomenological framework, was conducted through in-depth and photograph elicitation interviews with 26 Malay women who had self-reported experiencing FSD. The findings suggest that the meanings of sexuality for these women linked closely with fundamental factors of Malay identity, which is comprised of tradition (Adat), religion (Islam), and language, that all influence gendered roles. Malay women understood sexuality to be sexual intimacy within marriage, privileging their marital role as a "good wife" over their personal rights within a sexual relationship. This understanding of sexuality was reinforced by meanings attributed to procreation, which Malay women linked closely to the purpose of marriage and their role as a "good mother." The findings should provide useful evidence that could be used in sexual health promotions to help reduce FSD and in clinical practice to generate appropriate therapy in Malaysia and elsewhere.