Relationship between psychopathology and problem behaviour of schizophrenic patients and burden experienced by primary caregivers

Trend terkini ke arah psikiatri komuniti menyaksikan peralihan sebahagian besar beban penjagaan pesakit mental yang kronik dari institusi kepada keluarga. Tujuan kajian ini adalah untuk menilai hubungan di antara psikopatologi dan tingkah laku bermasalah empat puluh lima pesakit skizofrenia dan beban yang ditanggung oleh penjaga mereka. Psikopatologi dan tingkah laku bermasalah pesakit masing-masing dinilai berpandukan Skala Sindrom Positif dan Negatif (PANSS) dan Jadual Tingkah Laku Sosial (SBS). The recent trend towards community psychiatry appears to have shifted much of the burden of care of the chronically mentally ill from the institutions to the family. The aim of this study is to assess · the relationship between psychopathology and problem behaviour of the forty five schizophrenic patients and burden imposed on their primary caregivers. Patients' psychopathology and problem behaviour were assessed using Positive and Negative Syndrome Scale (PANSS) and Social Behaviour Schedule (SBS) respectively

Validation of the Malay Version of Hospital Anxiety and Depression Scale (HADS) in Hospital Universiti Sains Malaysia

Objective: To validate the translated Malay version of the HADS and determine the optimal cutoff point and respective sensitivity and specificity. Design: Cross sectional study. Muteriuls and Methods: Sixty cases and 60 controls were assessed using the Malay version of HADS followed by interviewed using Hamilton Rating Scale for Anxiety (HDRS), Hamilton Rating Scale for Depression (HARS) and then reassessed by using the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to establish the diagnosis. Results: The best cutoff point was 8/9. Sensitivity 90.07o and specificity 86.2oh for anxiety and sensitivity 93.2"h and specificity 90.8"/o for depression was detected Conclusion: Malay version of HADS showed a good sensitivity and specificity and therefore is valid instrument for use in a Malaysia population

Nurse engagement: Examining the role of resilience

Work engagement within nursing workforce has become an increasingly significant factor and a prerequisite for high-quality health care performance, thus influencing the success of the organization.As the nursing profession is regarded as an emotionally demanding work environment, nurses as boundary-spanners of healthcare institutions need to have greater resilience.This study aimed to explore the relationship between resilience and work engagement.The sample comprised of 305 staff nurses working in two public hospitals in Peninsular Malaysia. Statistical results using regression analysis indicated that resilience was positively related to work engagement. Nursing management should develop resilience among nurses to enhance their work engagement

Validation of the Quality of Life Scale (QLS) Malay Version among Patients with Schizophrenia

Objectives: The Quality Of Life Scale (QLS) is an English version of semi-structured interview that assesses quality of life (QOL) among patients with schizophrenia. The aim of this study was to translate and validate the QLS into Malay version for more widespread use in clinical practice. Methods: This study was conducted on 30 schizophrenia patients attending Hospital Raja Perempuan Zainab II (HRPZ II) and Hospital Universiti Sains Malaysia (HUSM). The QLS was translated into Malay language using forward and backward translation method. The final Malay version of the QLS was tested for the content validity by two experienced psychiatrists. Its face validity was tested on 10 Malay patients with schizophrenia. The internal consistency analysis was performed by measuring Cronbach's alpha in all four domains of QLS Results: The Malay version QLS was found to have good content and face validity. It also displayed good internal consistency with Cronbach's alpha of between 0.87 and 0.93. Conclusion: The Malay version QLS is a good tool to be used in future research to assess quality of life of patients with schizophrenia

Depression, Anxiety, and Stress among Secondary School Teachers in Klang, Malaysia

Background: Teaching has been identified as a highly stressful job. Recent changes such as the increasing use of information technology and diversity of teacher's role potentially increase the stress even further. Objectives: This study aimed to determine the prevalence of psychological distress of depression, anxiety, and stress among secondary school teachers in Klang zone, Malaysia. Methods: A total of 356 teachers from 6 randomly selected secondary schools in Klang zone were recruited into the study. The Malay Depression Anxiety Stress Scales (DASS) was employed to measure the psychological distress depression, anxiety, and stress. Results: The teachers had a high prevalence of depressive (43.0%), anxiety (68.0%) and stress (32.3%) symptoms. While severe to extremely severe depression, anxiety and stress were reported by 9.9%, 23.3% and 7.0% of subjects, respectively. Depression, anxiety, and stress were consistently more common among teachers with socio-demographic and work-related characteristics such as female, lowest educational status, having 1-3 children, staying with in-laws, shorter distance to school, living in a high-rise building and own house. Conclusions: The prevalence of depression, anxiety, and stress were high among secondary schools teachers. Appropriate steps should be taken to improve the mental health of teachers, thereby ensuring good quality education

Extent and Sources of Anxiety among Employees Attending a University Hospital Clinic

Objective: To study the extent and sources of anxiety among employees of Universiti Sains Malaysia. Methods: This was a cross-sectional study over a period of 4 months. A total of 300 employees of Universiti Sains Malaysia attending the staff clinic was recruited and given self-administered questionnaires including the Hospital Anxiety and Depression scale (HADS), Job Stress Scale and Life Event Scale to assess anxiety, job stress and life events, respectively. Result: The prevalence of anxiety among employees attending the staff clinic were 14.3% overall, 18.5% for males and 10.4% for females. Using multiple logistic regression, 4 independent variables were noted which include number of children, LCU score, relationship with supervisor and gender. Conclusion: The prevalence of anxiety among employees attending the staff clinic was comparable to other similar studies. The strongest predictor of anxiety in this study was poor relationship with superior with OR 9.58. This was followed by life events (i.e., high LCU scores) with OR 6.52 and number of children 5 or more with OR 3.40

Validation of Malay Beck Cognitive Insight Scale (BCIS)

Background: Although the dominant current viewpoint of insight is related to clinical insight, cognitive insight has been gaining popularity since the introduction of Beck Cognitive Insight Scale (BCIS) in 2004. Therefore, an easy and reliable assessment tool of cognitive insight is needed to complement the assessment of clinical insight to improve the psychiatric services and outcomes. Objectives: This study aimed to validate the Malay Beck Cognitive Insight Scale (BCIS-M). Methods: The BCIS was translated into Malay language with good face and content validity. It was administered to 75 patients with schizophrenia in psychiatric outpatient clinic, Hospital Universiti Sains Malaysia (HUSM) in April 2014. Results: The BCIS-M showed good psychometric property. The internal consistency (Cronbach alpha) for self-certainty and self-reflectiveness in this study were 0.609 and 0.699, respectively. Conclusion: The BCIS-M is a valid and reliable tool for assessment of cognitive insight in local Malaysian population

Insight in Offenders with Schizophrenia: Relationship to Psychopathology and Cognitive Function

Objectives: To study the insight in offenders with schizophrenia and its relationship of psychopathology and cognitive function. Methods: Seventy consecutive offenders with schizophrenia (aged 18-65) admitted to Hospital Bahagia Ulu Kinta within a six-month period were studied. Subjects' insight, psychopathology and cognitive function were assessed using the Insight and Treatment Attitude Questionnaire (ITAQ), Positive and Negative Syndrome Scale (PANSS), and Mini Mental State Examination (MMSE) respectively. Results: High PANSS positive scores were significantly associated with unsoundness of mind (p = 0.011). Low ITAQ and MMSE scores were significantly associated with PANSS total, negative and general scores. Conclusion: Positive symptoms were significantly associated with unsoundness of mind. Poor insight and cognitive function were significantly associated with negative symptoms as well as general and global psychopathology. This study however, failed to find significant insight-unsoundness of mind or insight-cognitive function relationships

Combined Aripiprazole and Electroconvulsive Therapy in a Patient with Treatment-Resistant Schizophrenia and QT Prolongation

Introduction: Clozapine is regarded as the most effective antipsychotics for patients with treatment-resistant schizophrenia. Of late cardiac safety becomes a principal concern including QTc prolongation that can lead to sudden cardiac death. Objective: This case report will highlight the development of clozapine-induced QTc prolongation, and subsequent stabilization with combined aripiprazole and electroconvulsive therapy (ECT) in a patient with treatment-resistant schizophrenia. Result: We reported a 30-year-old male patient with treatment-resistant schizophrenia who developed QTc prolongation. In 2014, prolonged QTc 521ms was attributed to hypocalcemia. Then in 2016, prolonged QTc 492 ms was noted after the ECT, and most recently QTc 504 ms while on clozapine 100 mg daily. Other investigations including electrolytes, echocardiogram, thyroid, renal and liver function tests were normal. Subsequently, the patient was stabilized on combined aripiprazole and ECT. The QTc ranged 460 to 494 ms while he was on aripiprazole 15 mg daily. Conclusion: The combined use of aripiprazole and ECT is safe for treatment of treatment-resistant schizophrenia with prolonged QTc. Close monitoring is recommended since QTc impact of aripiprazole may be additive to the arrhythmia risk

Burden of Care and Social Behaviour Problem of Patients with Schizophrenia

Objective: To assess the relationship between levels of burden on primary caregivers and social behaviour problem of patients with schizophrenia. Design : Cross-sectional study. Materials and Methods.' The study involved forty five patients attending Psychiatry Clinic. The level of burden on primary caregivers was assessedu sing Burden on Family Interview Sineaute (BFS) and the social behaviour problem of patients with schizophrenia was assessedu sing Social Behaviour Schedule (SBS). Results: Employment status and monthly household income of primary caregivers were significantiy correlated with amount of burden. Caregivers experienced enormous amount of botl subjective ana onlective burden. Financial burden was the greatest objective burden affecting at least one third of the caregivelrs. Amount of burden experienced by primary caregivers was significantly correlated with social behaviiur problem of patients particularly hostility, over activity, restlessness, and destructive behaviour. Conclusion: The levels of burden on caregivers are high with employment status and monthly household income of caregivers are predictive of higher levels of burden