The pathways to health care a comparison between psychotic illness and epilepsy

INTRODUCTION: Identifying the pathways which patients take to reach health care is in1portant, as patients' experience of the first pathway to care n1ay determine their future compliance and progression of the illness. Understanding the type of pathways, hhich patients take and the associated factors that influence the selection are crucial infonnation for future intervention to irnprove the quality of health care. Studies on patlnvays to C'.!rc were sparse and patlnvays to care an1ong local psychiatric patients had not been explored. A Irv1: The airn of the study \Vas to describe the patlnvays to health care of psychotic patients (schizophrenia and schizophreniforn1 disorder) to the tertiary health center (psychiatry and n1edical specialized clinics in HUSM); and to cxatnine the dctnographic, social, clinical and other fl1ctors influencing the patln\'ay to care. Sin1ilar assessrnents \vere done in epilepsy patients for con1parison. f\1ETHOD: The nun1ber and type of previous healers (n1odern and traditional) visited by patients since onset of illness were assessed using nntltiplc sources of infonnation in 60 psychotic (schizophrenia and schizophrenifonn disorder) and 60 epileptic patients attending the respecti\·e specialist clinics for the first tin1e during the study period. The pathways taken by the patients before reaching the clinics were explored by using scnlistructured interview questionnaires and char1ed on a con1n1on diagram. Patients' sociodernographic data, details of the illness, and infonnation regarding the decision tnakers were also gathered during the interview from patients, and family members CONCLUSION: Epileptic and psychotic illness such as schizophrenia and schizophrcnifonn disorder have a slight different pathway in help seeking behavior. Asignificant higher nurnber of psychotic than epileptic patients consulted traditional/alternative healers. As a con1plen1entary treatrnent in Malay society, bon1oh is n1ore popular than the well-established alternative n1edicine in treating such illness. The author concluded that the study of path\vay to health care could provide a framework for better understanding of health services utilization and the associated factors that affect the services utilization. The effects of socio-cultural belief on the studied population were not - much different as con1pared to the findings fron1 the earlier studies. f Icnce there is a need for further understanding about traditional, con1plernentary and alternative medicine and collaboration between traditional/alternative and modern health services

Disaster relief and preparedness: coping with psychological distress among workers involved In flood disaster in Kelantan

Banjir yang melanda pantai timur Semenanjung Malaysia dari 15 Disember 2014 hingga 3 Januari 2015 telah dianggap sebagai bencana banjir yang paling teruk di negara ini. Kajian ini bertujuan untuk menentukan kekerapan tekanan psikologi dan mengenalpasti faktor-faktor penentu terjadinya tekanan psikologi termasuklah strategi penyesuaian (coping strategy) dalam kalangan pekerja perubatan dan penyelamat di Kelantan. Kajian ini di laksanakan 6 bulan selepas bencana banjir dan melibatkan 160 pekerja perubatan (kakitangan Hospital Kuala Krai) dan 160 pekerja penyelamat (Bomba dan JPAM) yang bertugas semasa bencana banjir lalu. Borang soal selidik, 'Impact Event Scale-Revised (IES-R)' dan 'Depression, Anxiety and Stress Scale (DASS-21 )' digunakan untuk mengenalpasti tekanan psikologi, manakala Brief-COPE digunakan untuk mengenalpasti jenis strategi penyesuaian. Data yang diperolehi dianallsis menggunakan kaedah multiple regresi logistic di dalam program SPSS versi 22. Secara kesimpulan, pekerja perubatan dan penyelamat yang terlibat dalam tugas bantuan sewaktu bencana banjir didapati berisiko tingi untuk mendapat tekanan psikologi terutamanya kerisauan dan PTSD. Kekerapan mengalamai tekanan psikologi ini berkaitan dengan faktor sosio-demografik, pengalaman sewaktu banjir dan juga kebiasaan menggunakan strategi penyesuaian tertentu. Dapatan dari kajian ini antaranya menyokong kepada keperluan latihan pertolongan cemas psikologi (psyhological first aid) kepada pekerja perubatan dan penyelamat yang berisiko tinggi untuk mengalami tekanan psikologi akibat bencana

Development, validity and reliability of Tramadol use and misuse knowledge assessment questionnaire

The prevalence of tramadol misuse in Nigeria and lack of a quantitative and valid instrument to assess knowledge on the use and misuse of tramadol necessitated this study. The objective of this studywas to develop and validate a questionnaire to assess knowledge about tramadol use and misuse among tramadol users in Benue State of Nigeria. A mixedmethod design was used. Literature review and focus group discussions were conducted to generate items for the questionnaire. Six experts were involved in content validation. The item-level content validity index (I-CVI) cut-off point was set at 0.83. Chain-referral sampling method was applied. Data were collected from tramadol users (n = 200) for the validation study. Item response theory model was applied in the assessment of the psychometric properties of the questionnaire. Cronbach alpha was computed to determine the internal consistency. Ten items were initially deleted for failing to meet the I-CVI cut-off point (I-CVIs < 0.83). The over-all CVI of the questionnaire was 0.86. Five more items were deleted for poor performance in both the difficulty and discrimination parameters, leaving 35 items for the final questionnaire. The reliability coefficient was 0.78 indicating good internal consistency. A valid and reliable self-report questionnaire therefore, emerged for the assessment of knowledge about tramadol in five domains including medical use, prescription, misuse, effects of misuse and withdrawal/detoxification. The questionnairecan serve as a valid and reliable tool for assessment of knowledge about tramadol and for evaluation of intervention efforts at curtailing tramadol abuse. Keywords: development; validity; questionnaire; knowledge; tramadol; misus

Verbs and gender: the hidden agenda of a multicultural society

This study explores the issue of gender inequality displayed in action verbs found in English language secondary school textbooks using the Hidden Curriculum Theory. The two aspects of hidden curriculum are the frequency imbalance, i.e., male occurrences are more than female, and gender stereotyping based on roles, i.e., masculine against feminine activities. This study used both quantitative and qualitative methods for collecting data. Wordsmith Tools 4.0 (WST) was used to analyse five categories of action verbs: activity verbs, process verbs, verbs of bodily sensation, transitional event verbs, and momentary verbs. The concordance tool from the WST was used to tabulate occurrences based on gender portrayals. School teachers who taught English at secondary schools were also interviewed to validate the findings and link them to the theoretical framework used. The findings reveal gender inequality is evident in these textbooks

Psychosis Induced by Cefuroxime and Metronidazole

We report a case 35-year-old lady who developed acute psychosis following administration of cefuroxime and metronidazole. Earliest mood changes occurred on the second day of antibiotics therapy. She developed hallucinations, delusions and bizarre behavior 1 day after the completion of the antibiotic therapy. All the relevant investigations including CT brain were normal. The psychosis resolved completely within 5 days of antipsychotic treatmen

Offenders with Schizophrenia: Relationship to Psychopathology

Objectives: To study the relationship between psychopathology and characteristics of offenders with schizophrenia. Methods: In this cross sectional study, 70 consecutive offenders with schizophrenia (aged 18-65) admitted to Hospital Bahagia Ulu Kinta within a six-month period were studied. Subjects’ psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS). Results: Offenders against person group received treatment at later age (p=0.043) compared to against property and drug or firearm-related offenders groups. Offenders in drug or firearm-related group had significantly higher PANSS negative scores (p=0.015). Unsound mind at the time of offense was significantly associated with high PANSS positive scores (p=0.011) and offenders against person or property groups (p=0.004). Conclusion: Offenders against person had a significantly later age of treatment and probably onset of illness. Unsoundness of mind was significantly associated with positive symptoms and more frequently reported among offenders against person or property. Offenders in drug or firearmrelated group were significantly associated with negative symptoms

Validation of Malay Gender Role Conflict Scale for Adolescents

Background: Living in a multiracial country undergoing rapid modernization with strong influence of Western media, exposed the Malaysian adolescents to conflicting gender role messages leading to potential gender role conflict. Objectives: This study aimed to validate the Malay Gender Role Conflict Scale for Adolescents (GRCS-AM). Methods: The GRCS-A was translated into Malay language and administered to 91 secondary school students in Kubang Kerian in July 2012. Results: The internal consistency coefficients of each subscale and the total scale were good with restricted affection between men 0.58; restricted emotionality 0.65; conflict between work, school, and family 0.64; need for success and achievement 0.62; and total scale 0.76. Conclusion: The GRCS-AM is a valid and reliable tool for assessment of gender role conflict in Malaysian adolescent population

Gender Role Conflict among Malay Adolescent Boys in Malaysia

Background: Modernization process brings in economic and demographic changes where traditional masculinity could be forced to transform as men face conflicting messages about appropriate role norms. Objectives: This study aimed to evaluate gender role conflict (GRC) among Malay adolescent boys and its associated socio-demographic factors using the newly validated Malay GRCS-A. Methods: A total of 282 Malay adolescent boys aged 13-17 from 6 secondary schools in Kota Bharu, Kelantan were randomly selected and evaluated using the Malay GRCS-A and DASS-21 to assess GRC and psychological wellbeing respectively. Results: GRC was significantly associated with anxiety and stress, but not with depression. Regression analysis showed GRC was positively correlated with upper secondary school (older age) and negatively correlated with separated parents and very low household income (< RM 1,000 per month). Conclusion: This study adds to the growing literature of GRC, particularly in the Malay adolescent boys. High GRC potentially worsen the already high prevalence of psychological distress among adolescents in Malaysi

Use of Queatiapine in Treatment of Unremitting Anxiety: A Case Report of Schizophrenia Prodrome

Objective: A 21-year-old man who presented with a 17-month history of unremitting anxiety associated with panic attacks was studied. Result: The anxiety with panic attacks did not abate with escitalopram 15 mg nocte and alprazolam 0.5 mg tds. At month 3, the patient reported low mood and unexplained sexual arousal in addition to the unremitting anxiety symptoms. His condition fairly improved with addition of quetiapine. At month 17, transition to psychotic disorder occurred when the patient experienced hallucinations for the first time. Quetiapine was increased to 500 mg nocte and the anxiety symptoms improved tremendously before he relapsed 6 months later due to poor compliance. Conclusion: Unremitting anxiety with depression can be a dominant feature during the schizophrenia prodrome. Atypical antipsychotic quetiapine is an interesting treatment option due to its status as approved adjunctive treatment for major depressive disorder and promising efficacy for generalized anxiety disorder

Drinking motives as mediator between social anxiety and alcohol misuse among private university students in Klang Valley

As social anxiety becomes a threat, drinking becomes a trend in experiencing relaxation, acceptance of peers and decreases performance fear. Individuals with social anxiety disorder are two to three times more likely to establish alcohol use disorder. This paper sought to assist in integrating a detailed analysis of potential unique mediator of alcohol use among socially anxious people. The findings suggested that students with high social anxiety endorsed greater negative reinforcing drinking motives (coping, conformity) which independently mediate the relationship between the social anxiety and alcohol use, whereas enhancement motives and social motives were statistically non-significant