Prevalence & experience of contact with traditional healers among patients with first-episode psychosis in Hospital Kuala Lumpur.

Introduction: Patients with mental disorders in Malaysia often seek help from traditional healers prior to consulting psychiatric service. The objective of the study is to determine the prevalence and experience of contact with traditional healers among patients with first-episode psychosis in Hospital Kuala Lumpur (HKL). Methods: This is a hospital-based cross-sectional descriptive study of 50 in-patients with first-episode psychosis in HKL. Structured Clinical Interview for DSM-IV Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Socio-demographic data, information on help-seeking pathways, and experience of contact with traditional healers were determined through face-to-face interview and semi-structured questionnaires. Results: Twenty seven (54%) of the patients had at least one contact with traditional healers prior to consulting psychiatric service, and it was the most popular first point of non-psychiatric help-seeking contact (48%). About a quarter of them (24%) had 3 or more contacts with traditional healers prior to consulting psychiatric service. The most common type of traditional treatment received was prayer (25, 96.3%). Only 2 patients (7.41%) reported having some beneficial effects from traditional treatments. There were two patients who reported having adverse experience with traditional healers. Among those who had sought help from traditional healers, one third was recommended by at least one of their traditional healers to seek medical help. Conclusion: History of contact with traditional healers prior to consulting psychiatric service was common among inpatients with first-episode psychosis in HKL. There may be potential meaningful collaborations between psychiatrists and traditional healers for better management of patients

Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

BACKGROUND: The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes. METHODS: General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants. RESULTS: Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356) gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298). CONCLUSIONS: Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented through survey method is required to support these conclusions

Psychiatric morbidity among adult patients in a semi-urban primary care setting in Malaysia

<p>Abstract</p> <p>Background</p> <p>Screening for psychiatric disorders in primary care can improve the detection rate and helps in preventing grave consequences of unrecognised and untreated psychiatric morbidity. This is relevant to the Malaysian setting where mental health care is now also being provided at primary care level. The aim of this paper is to report the prevalence of psychiatric illness in a semi-urban primary care setting in Malaysia using the screening tool Patient Health Questionnaire (PHQ).</p> <p>Methods</p> <p>This is a cross-sectional study carried out in a semi-urban primary healthcare centre located south of Kuala Lumpur. Systematic random sampling was carried out and a total of 267 subjects completed the PHQ during the study period.</p> <p>Results</p> <p>The proportion of respondents who had at least one PHQ positive diagnosis was 24.7% and some respondents had more than one diagnosis. Diagnoses included depressive illness (n = 38, 14.4%), somatoform disorder (n = 32, 12.2%), panic and anxiety disorders (n = 17, 6.5%), binge eating disorder (n = 9, 3.4%) and alcohol abuse (n = 6, 2.3%). Younger age (18 to 29 years) and having a history of stressors in the previous four weeks were found to be significantly associated (p = 0.036 and p = 0.044 respectively) with PHQ positive scores.</p> <p>Conclusion</p> <p>These findings are broadly similar to the findings of studies done in other countries and are a useful guide to the probable prevalence of psychiatric morbidity in primary care in other similar settings in Malaysia.</p

OVERCOMING CHALLENGES IN COVID-19 PANDEMIC : A PERSPECTIVE IN ADAPTATION OF THE COMMUNITY MENTAL HEALTH SERVICE IN A TEACHING HOSPITAL

During the current COVID-19 pandemic, Malaysia had implemented a lockdown via Movement Control Order (MCO) nationwide, beginning from 18 March 2020 until present. The restrictions affected health services including community mental health services as there were no clear response guidelines yet available for it. We aim to share our experience in adapting services at a teaching hospital setting to the changes during MCO. Our goals were to minimize cross infection between clients and staff while maximizing service delivery to ensure clients’ continuation of care. We identified limitations and potentially sustainable improvements to direct further service development. The main community mental health services of Hospital Canselor Tuanku Muhriz (HCTM) consists of assertive home care and psychosocial rehabilitation programs for the severely mentally ills. Modifications in assertive care include regular risk stratification of patient’s symptoms and COVID-19 risks, phone consultations, drive-thru injection services, mobilizing other available resources such as family members or nearby clinics and practicing strict home visit standard operating procedures. Psychosocial rehabilitation services such as social skills training, supported employment, family intervention and peer support groups were modified by means of teleconsultations using video calls and instant messaging services for a continuous therapeutic efforts. These modifications were practiced for the past one year and were adjusted accordingly over time to accommodate the changing MCO restrictions. There had been no recorded positive cases among staff and clients with no increase rates of relapse among the clients during this period. Clients also reacted positively with the modifications. The innovative modifications in ensuring continuing service delivery while preserving safety in this centre can act as a guide to improvise healthcare deliveries during a pandemic

MANIA INDUCED BY STEROID-ADULTERATED HERBAL MEDICINE: A CASE REPORT

Traditional herbal medicines are generally perceived as natural and safe. Nonetheless, adulteration of such complementary products, including Chinese Proprietary Medicines with undeclared drugs, notably steroids, is a recognized problem. While there are many accounts of Cushing's syndrome due to steroid content in traditional medicines, psychiatric complications caused by the similar insults are not reported throughout the literature. We report a case of acute mania after the short-term use of steroid-adulterated herbal product in a previously healthy young male. It shows that psychiatric complications can occur in such a scenario without the physical and metabolic features of Cushing's syndrome, and pharmacodynamic interaction between the herbal ingredient and adulterant is a possible factor. The case also highlights the need for awareness of culturally influenced health product consumption and its potential effects on clinical conditions, as well as the important role of a robust surveillance system for such products

Validation of the Malay-Version of Recovery Knowledge Inventory among mental health providers in Malaysia

BackgroundThe Recovery Knowledge Inventory (RKI) is a widely used self-report instrument that assesses recovery-oriented knowledge among mental health professionals. The purpose of this study is to translate the RKI into the Malay language (RKI-M) and to examine its psychometric properties among Malaysian health care workers.MethodsA cross-sectional study involving 143 participants was conducted at an urban teaching hospital, an urban government hospital, and a rural government hospital. Following the translation of the RKI, its internal reliability was determined using Cronbach’s alpha. Construct validity was also determined using confirmatory factor analysis.ResultsThe Malay-Version RKI (RKI-M) has good internal reliability with a Cronbach’s alpha of 0.83. However, the Malay-version RKI failed to replicate the original four-factor structure. The final model only achieved the best model fit after the removal of 9 items with two-factor loadings: (GFI = 0.92; AGFI = 0 0.87; CFI = 0.91; RMSEA = 0.074).ConclusionThe 20-item RKI-M is reliable but has poor construct validity. However, the modified 11-item Malay-version RKI is a more reliable measure as it has good construct validity, with room for future studies to examine the psychometric properties of the modified 11-item RKI among mental health care workers. More training on recovery knowledge should be done, and a simple worded questionnaire should be developed in keeping with local practitioners

Model Answer For Critical Review Paper: Conjoint Examination For Malaysian Master Of Medicine (Psychiatry) And Master Of Psychological Medicine May 2013

Objective: This paper aims to discuss the answers to a Critical Review Paper used in the Malaysian Master of Medicine (Psychiatry) and Master of Psychological Medicine examination conducted in May 2013. Methods: One part of this broader postgraduate examination is to evaluate the students’ skills of critical appraisal through answering questions based on a journal paper. Results: Model answers were provided at the end of the Critical Review Paper. The objective of the study presented in the review paper was to investigate the association of cigarette smoking with verbal working memory and psychopathology of patients with schizophrenia. Conclusion: This review paper had fairly evaluated the students’ understanding and critical thinking on the given topic. This paper may serve as a guideline to teach students how to critically appraise research papers related to psychiatry

Chronic Mania: Psychosocial impact to the family and role of community mental health team in providing care

This case report highlights the psychosocial complications of chronic mania in a mother and the role of CMHT in improving the condition’s outcome. Methods: We report a case of a Malay mother who had underlying chronic mania for 20 years. Results: She was aggressive and abusive towards her children causing tremendous trauma in them, had lost her child custody and almost lost her husband to another woman. Lithium with multiple psychosocial interventions delivered to the patient and her family had improved her mood symptoms significantly and improved the family’s quality of life. Conclusion: Chronic mania causes tremendously high illness burdens, and with extra care, the outcome of the condition can be improve

Clinical and cognitive correlates of employment among patients with schizophrenia: a cross-sectional study in Malaysia

<p>Abstract</p> <p>Background</p> <p>Gainful employment is one major area of functioning which is becoming an important goal in psychiatric rehabilitation of patients with schizophrenia. Studies in western countries are pointing to evidence that certain sociodemographic and clinical factors may contribute to employment outcomes in this group of people. However, the area is still largely unexplored in Malaysia. The aim of this study was to examine the sociodemographic, clinical and cognitive correlates of employment status among patients with Schizophrenia.</p> <p>Methods</p> <p>This was a cross-sectional study. All participants who fulfilled the requirements of the study according to the inclusion and exclusion criteria were enrolled. Study instruments included a demographic data questionnaire, Positive and Negative Symptom Scale (PANSS), Trail Making Tests, Rey's Auditory Verbal Learning Test (RAVLT) and Digit Span. Bivariate analyses were done using chi-square for categorical data and t-test for continuous data and multiple logistic regression analysis was done to identify predictors of employment status.</p> <p>Results</p> <p>A total of 95 participants who fulfilled the inclusion criteria were enrolled into the study. Among the sociodemographic, clinical and cognitive variables studied marital status, educational level, mean scores of negative symptoms, Digit Span and RAVLT and Trail Making Tests were found to show significant association with employment status on bivariate analyses. However, when entered into a logistic regression model, only cognitive variables ie. Trail A and B, Digit Span and RAVLT were significant predictors of employment status.</p> <p>Conclusions</p> <p>The results from this study support the role of cognitive function, particularly, attention, working memory and executive functioning on attaining and maintaining employment in persons with schizophrenia as measured by the RAVLT, Digit Span and Trail Making Tests. These findings may act as preliminary evidence suggesting the importance of integrating cognitive rehabilitation in the psychosocial rehabilitation program for patients with schizophrenia in Malaysia.</p

Schizophrenia in Malaysian families: A study on factors associated with quality of life of primary family caregivers

<p>Abstract</p> <p>Background</p> <p>Schizophrenia is a chronic illness which brings detrimental effects in the caregivers' health. This study was aimed at highlighting the socio-demographic, clinical and psychosocial factors associated with the subjective Quality of Life (QOL) of Malaysian of primary family caregivers of subjects with schizophrenia attending an urban tertiary care outpatient clinic in Malaysia.</p> <p>Methods</p> <p>A cross-sectional study was performed to study patient, caregiver and illness factors associated with the QOL among 117 individuals involved with caregiving for schizophrenia patients. The study used WHOQOL-BREF to assess caregivers' QOL and Brief Psychiatric Rating Scale (BPRS) to assess the severity of patients' symptoms. Social Readjustment Rating Scale (SRRS) assessed the stress level due to life events.</p> <p>Results</p> <p>The mean scores of WHOQOL-BREF in physical, psychological, social and environmental domains were 66.62 (14.36), 61.32 (15.52), 62.77 (17.33), 64.02 (14.86) consecutively. From multiple regression analysis, factors found to be significantly associated with higher QOL were higher educational level among caregivers in social and environmental domains; caregivers not having medical problem/s in physical and psychological domains; later onset and longer illness duration of illness in social domains; patients not attending day care program in environmental domain; lower BPRS score in physical and environmental domains. SRRS score of caregivers was also found to have a significant negative correlation with QOL in environmental and psychological domains. Other factors were not significantly associated with QOL.</p> <p>Conclusion</p> <p>Caregivers with more social advantages such as higher educational level and physically healthier and dealing with less severe illness had significantly higher QOL in various aspects. Supporting the caregivers in some of these modifiable factors in clinical practice is important to achieve their higher level QOL.</p