Anxiety and mood regulating treatment for adult attention deficit disorder

Anxiety and mood symptoms are common in Attention Deficit Disorder. We highlight a case of 23-year-old man who presented with poor attention and gradual poor academic performance. His poor academic achievement was noted by the parent, only for the past 2-3 yrs prior to the psychiatric consultation. He developed low mood but there was no biological symptoms of depression. He was started on both daily treatment of Buproprion 150 mg daily, and Ritalin 10 mg PRN basis. The common treatment for attention deficit disorder in was a stimulant but in this case an antidepressant was used. It was shown that patient started to show improvement with treatment and was able to focus on his study

Penile amputation as to secondary to the psychopathology of shizophrenia

Schizophtrenia is a chronic mental disorder that is characterized by perceptual, thinking, cognitive, and behavioural disturbances. One of the important symptoms of schizophrenia is auditory hallucinations. In this case report, we discussed a 31-year-old Rohigya refugee man who had his penis totally amputated. The auditory hallucinations instructed him to do so. He was rushed to Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for the immediate surgical treatment. After his condition was stabilized, he was admitted to the psychiatric ward for further observation and medical treatment. Some issues related to psychosocial, economic and politic were discussed which made this case unique. Patient was treated with medication sulpride and was referred to the Urology Surgeon for further management

Sexual pain disorder with anxiety and depressive psychopathology as complication: a case-report

Vaginismus is a sexual dysfunction which results from vaginal musculature spasm and makes the penetration almost impossible. It is commonly associated with significant emotional distress. On several occasions, fear of pain during sexual intercourse may perpetuate the sexual dysfunction. We report a case of primary vaginismus that was associated with psychiatric squeale of anxiety and depression psychopathology. It suggests that psychological problems related to a mental-health problem in vaginismus should be dealt adequately for a holistic approach. A combination of behavioural, psychological and pharmacological treatment is important to ensure a good prognosis outcome

Is electroconvulsive therapy safe for patient with very low BMI? a case report

A case of rapid stabilization using electroconvulsive therapy (ECT) for a major depressive disordered (MDD) patient with life-threatening low body mass index (BMI) is reported. This case report focuses on a 55-year-old Malay housewife with underlying hyperthyroidism in a euthyroid state who presented with MDD with mood congruent psychotic features, which were precipitated by the death of her husband. Her BMI was only 11 kg/m2 due to severe anorexia, and she was highly suicidal. Peripheral total parenteral nutrition was started and ECT was commenced for rapid stabilization on top of tablet escitalopram 15 mg nocte. Full remission was achieved after nine ECTs and steady healthy weight gain was achieved throughout admission. The patient was discharged at BMI of 13 kg/m2 with good appetite. ECT was safe for very low BMI MDD patient

Factor structure of the Malay-version Generalized Anxiety Disorder-7 (GAD-7) questionnaire among patients with diabetes mellitus

The Malay-version Generalised Anxiety Disorder-7 (GAD-7) questionnaire previously demonstrated good concurrent validity, i.e. sensitivity and specificity as a screening instrument for anxiety. However, its psychometric properties on factorial validity had not been further investigated. This study investigated the factor structure of the Malay-version GAD-7 in among 300 diabetic outpatients (mean age: 60.4 years, SD: 13.4 years; 52.7% male) in a Malaysian university hospital in Kuala Lumpur. Study participants completed questionnaires on sociodemographic information, the GAD-7, the Beck’s Depression Inventory (BDI), and the WHOQOL-BREF instrument. The Malay-version GAD-7 displayed good internal consistency (Cronbach’s α=0.91) and satisfactory convergent validity with depression (Pearson’s R=0.642, p1 (eigenvalue=4.614), suggesting a unidimensional factor structure. All seven items were loaded on a higher-order factor (‘generalized anxiety’) in confirmatory factor analysis. This model did not have a good fit with the data. After examining the modification indices, the model was respecified to allow covariance of the error terms of items 1 and 2, and 2 and 3. The respecified model appeared to fit the data better (χ2=35.216, df=12, p<0.001, CFI=0.98, TLI=0.97, RMSEA=0.08, and AIC=67.22). The findings suggested that items 1, 2 and 3 of GAD-7 may share distinctive variance out of that explained by the ‘generalized anxiety’ factor. Overall, the Malay-version GAD-7 appeared to be a valid measurement of the symptoms of anxiety in this study

Sexual pain disorders among Malay women with type 2 diabetes mellitus in Malaysia

Objectives: This study aims to determine the prevalence and associated factors of sexual pain disorders among Malay women in Malaysia with type 2 diabetes mellitus. Methods: This is a cross-sectional study involving 347 women (174 nondiabetic and 173 diabetic subjects) who attended the diabetic clinic in a university hospital. Sexual pain disorders were assessed using the Pain sub scale of Malay Version of the Female Sexual Function Index (MVFSFI). Sociodemographic information of the subjects was collected with a pre-designed questionnaire. Results: Prevalence of sexual pain disorders among Malay women with type 2 diabetes mellitus was 10.4% and the control group was 9.2% but the difference was not statistically significant (p > 0.05). Multivariate logistic regression analysis did not find any relevant associated factor with sexual pain disorder. Conclusion: Sexual pain disorders among Malay women were not dependent on the diabetic status. Further studies with different population of diabetic patients are needed to confirm the results

Associated risk factors to non-compliance to methadone maintenance therapy

The escalating problem of opiate dependence in Malaysia and the limitations of regimental approach of forced admission to rehabilitation centres had triggered the government to expand the methadone maintenance therapy to become a national programme. This study aimed to evaluate the short-term outcomes of the Methadone Maintenance Therapy programme in one of the busiest hospital in east coast Malaysia. We also explored the prevalence on non-compliance and factors associated to it. A total of 172 patient case notes at Methadone Clinic Hospital Tengku Ampuan Afzan (HTAA) were retrieved for relevant data. A short survey was also conducted to determine the subjects’ current employment and marital status. The programme’s retention rate was 62% and factors associated with poor compliance were unemployment, low quality of life scores and low dose of methadone. A special attention on the patients with these three risk factors may improve their compliance to MMT. The short-term evaluation of MMT at HTAA revealed favourable findings

Serotonin selective reuptake inhibitors (SSRIs) and female sexual dysfunction (FSD): hypothesis on its association and options of treatment

Sexual dysfunctions are commonly seen in women on selective serotonin reuptake inhibitors (SSRIs). The complexities of female sexual functioning are reflected through modulation of inter- playing factors like the neuropsychophysiological factors, inter-personal and relationship issue, psychiatric co-morbidities and physical disorder. The incidence of SSRIs-induced FSD is difficult to estimate because of the potential confounding effects of SSRIs, presence of polypharmacy, marital effect, socio-cultural factors and due to the design and assessment problems in majority of the studies. The exact mechanism of FSD-induced SSRIs is unknown. It has been postulated that although SSRIs may modulate other neurotransmitter system such as nitric oxide (NO), noradrenergic and dopamine in inducing FSD. In the present review, we highlight current evidence regarding potential mechanism of SSRIs in causing FSD, which include low sexual desire (low libido), arousal difficulties (lack of lubrication), and anorgasmia. The specific association of FSD to SSRI use, has not been ellucidated. The relationship is dose-dependent, and may vary among the groups with respect to mechanism of serotonin and dopamine reuptake, induction of release of prolactin from the pituitary gland, anticholinergic side-effects, inhibition of NO synthesis and emotional-memory circuit encryption for sexual experiences. Various interventional strategies exist regarding the treatment of SSRI-induced FSD and this includes tolerance, titration dosage, substitution to another antidepressant drug and psychotherapy. There is a need of better understanding of SSRIs-induced FSD for better treatment outcome

Bridging Exhibitionism and Internet Pornography: Is There A Link?

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

Kesukaran menulis manuskrip penyelidikan dalam Bahasa Inggeris: langkah-langkah untuk meningkatkan penulisan

Di seluruh dunia, terdapat keperluan yang mendesak untuk menerbitkan hasil kajian dalam jurnal terkemuka yang berimpak tinggi, yang biasanya diterbitkan dalam bahasa Inggeris. Salah satu kriteria utama bagi penilaian kedudukan universiti global adalah bilangan penerbitan dan petikan di dalam pangkalan data utama seperti Institut Maklumat Saintifik (ISI) dan Scopus. Manuskrip mengenai topik bagaimana menulis manuskrip penyelidikan dengan betul sering diterbitkan, namun, tidak banyak penerbitan yang mengajar teknik yang terbaik untuk menguasai penulisan Bahasa Inggeris. Bengkel-bengkel dijalankan bagi membantu penyelidik menulis manuskrip, tetapi terdapat kurangnya penekanan dalam aspek penguasaan tatabahasa dan gaya penulisan. Justeru, ramai penulis muda tidak tahu bagaimana untuk menulis dengan baik. Artikel kajian ini membincangkan secara terperinci kesalahan biasa semasa menulis kertas penyelidikan dalam Bahasa Inggeris dan mencadangkan langkah-langkah bagi mengatasinya. In termasuklah tatacara menulis laporan keputusan, memilih kata-kunci yang betul, bagaimana menulis seksyen pendahuluan secara kemas serta membincangkan hasil keputusan secara menarik dan memberi impak. Kami mencadangkan penulis mentelaah serta membuat latihan latih-tubi dengan membiasakan diri menulis dengan ayat-ayat pendek, menggunakan tanda baca yang seimbang dan menggunakan kedudukan subjek dan kata kerja yang betul dalam susunan ayat. Begitu juga, penggunaan ayat-ayat yang menyatakan perbuatan lampau, atau ayat-ayat “past-tense” adalah perlu apabila seseorang penulis itu melaporkan hasil sesuatu kajian serta ditegaskan dengan penggunaan ayat-ayat aktif. Isu penulis hantu dan cabaran mengupah orang lain menulis bagi sesuatu artikel penulisan juga disentuh. Secara ringkas, menulis manuskrip penyelidikan dalam Bahasa Inggeris boleh menjadi mudah jika fakta-fakta yang dinyatakan ini dapat diikuti secara terperinci. Adalah diharapkan agar cadangan-cadangan ini akan dapat membantu para penulis muda menulis dengan baik lalu memudahkan penerimaan manuskrip oleh sidang pengarang jurnal berkenaan