A recent article in this journal (Razali et al., 2015) reports the results of a 2-stage study screening for psychosis risk in Malaysia. The researchers incorporated both selective and indicated prevention strategies and included self-report items probing non-specific "early" experiences as well as attenuated psychotic symptoms associated with the prodromal phase of schizophrenia. Given that increased stigma and reduced services may reduce help-seeking in many Asian countries, population screening may be more important to early detection of individuals at risk for psychosis. In fact, the availability of large population centers and greater trust of providers may make Asian research centers uniquely suited for conducting badly needed research on screening strategies and the role of cultural factors in the emergence of psychosis.
In general, psychotic symptomatology falls within the major categories of mental disorders such as schizophrenia, affective disorder and organic mental
disorder. Those that do not fit the proposed diagnostic criteria for the aforementioned disorders are usually classified under the DSM-IV diagnosis of atypical psychosis. In the eastern culture, such symptoms are accepted as part of the cultural beliefs rather than being regarded as illness. Several such cases were seen at -the University Hospital, Kuala Lumpur and two such casesare reported in this paper. Cultural influences in determining symptomatology are also discussed.
Complications of stroke can include neuropsychiatric symptoms. However, post-stroke psychosis is rare. We report a case where an acute presentation of psychosis, depression and fluctuating cognitive impairment in a middle-aged man turned out to be related to a silent brain infarction. The patient had a background of poorly controlled type 2 diabetes mellitus with glycated haemoglobin level of 9.0-11.0%, hypertension and ischaemic heart disease. His CT brain results showed multifocal infarct with hypodensities at bilateral lentiform nucleus and bilateral corona radiata. His strong genetic predisposition of psychosis and a history of brief psychotic disorder with complete remission 3 years prior to the current presentation might possibly contribute to his post-stroke atypical neuropsychiatric presentation, and posed diagnostic challenges. He showed marked improvement with risperidone 6 mg nocte, chlorpromazine 50 mg nocte and fluvoxamine of 200 mg nocte. The need of comprehensive treatments to modify his stroke risk factors was addressed.
Alternative and traditional healing methods are common and popular in Sudan, particularly for treating people with mental disorders, but little information is available about the outcome of theses traditional healing approaches.
The aim of the study is to screen and evaluate the efficacy of the screening tools in detecting subjects with sub-threshold psychosis among asymptomatic individuals at genetic risk, as compared with persons in the general public.
The objective of this study was to describe and compare the pathways followed by Malay patients with psychoses (schizophrenia and schizophreniform disorder) and Malay patients with epilepsy to a tertiary health center in the northeastern area of peninsular Malaysia. There were 60 patients in each group. The most popular pathway for both groups was first contact with traditional or alternative healers. Consultation with Malay traditional healers (bomohs) and/or homeopathic practitioners (44.2%) was significantly higher for psychotic patients (61.7%) than for patients with epilepsy (26.7%) (chi(2)(2)=15.609, P<0.001). Direct access (24.2%) was the second most popular pathway and almost equally followed by both groups of patients. The third and last pathway was initial contact with private general practitioners and government doctors, respectively. Patients with epilepsy dominated the last two pathways. The treatment delay (TD) was significantly longer in epileptic than psychotic patients regardless of their visit to a bomoh and/or homeopathic practitioner (P<0001) or not (p<0.01). The socioeconomic status of psychotic patients also was significantly better than people with epilepsy (chi(2)=9.957, chi(2)(4), p=0.041).
Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia HUSM