The Tempest: a Reflection in Pandemic Loneliness

“The Tempest” is one of Shakespeare’s great late-period plays focusing on isolation. This article examines a viewing during Covid-19 lockdown of “The Tempest” as a reflection on the stressors and difficulties of medical professionals facing Covid-19, both at work and in society. It discusses the difficulties of adapting to the new normal, the physical and psychological isolation of tending to patients with Covid-19, stigma associated with Covid-19, and the effects of burnout on healthcare professionals, through reflections on various pertinent segments of the play. The reflection also focuses on the crucial role of leadership styles and organisational management in dealing with Covid-19 through the conceit of a viewing of “The Tempest”. In conclusion, the article reminds the readers that like all tempests, Covid-19 will end too

“Maniac” and “Crazy Ex-Girlfriend”: A Novel Adaptation of Two TV Series for Classroom Undergraduate Psychiatry Education in an Age of COVID-19 Social Distancing

Aim: Psychiatry has traditionally been taught bedside. Multiple ethical and logistics issues preclude use of certain patient groups, and in the current COVID-19 pandemic, there is the additional obstacle of not being able to access bedside patients. There is utility in using new media, e.g., television and movies, in psychiatry education. Methods: “Maniac” and “Crazy Ex-Girlfriend”, both available on Netflix, were used in an undergraduate psychiatry module to illustrate clinical lessons regarding schizophrenia and borderline personality disorder respectively. Results: “Maniac” was helpful in illustrating subtle changes in affect, occupational and social dysfunction, and showcasing disrupted family dynamics and distress from experiencing hallucinations and delusions. “Crazy Ex-Girlfriend” was instructional in crystallising psychopathology of borderline personality disorder and providing more nuanced, less cross-sectional views of psychiatric illness. Conclusions: Even though television and movies will and should not replace face-to-face bedside teaching as a primary mode of education, they are an adjunct to stimulate discussion and observe psychopathologies that are ethically difficult to capture. Both of them can be used judiciously in the current COVID-19 pandemic as bedside teaching substitutes

Cognitive impairment and depressive symptoms coexisting in an elderly man

We report a case of a man aged 67 years presenting with recent depressive symptoms and paranoid ideations in addition to 1-year cognitive impairment. He has vascular risk factors and family history of memory loss. An episode of depression 2 decades ago resolved spontaneously but was followed by occupational decline. On mental state examination, he denied having depressed mood, hallucinations or delusions, but there were prominent word-finding difficulties and impaired attention and concentration

Intellectual disability complicated by sexual addiction: an uncommon presentation of a common condition

A young man presented with high libido for 3 years, associated with preoccupation with sexual thoughts combined with his pursuit of pornographic materials. He had strong psychological cravings for and had spent large amount of money on sex, resulting in a dispute with his family. There were no mood or psychotic symptoms. Medical history revealed recent diagnosis of gonococcal urethritis. Cognitive assessment showed subtle deficiencies in reasoning and executive functions. There was occasional use of alcohol. Sexual addiction with comorbid mild intellectual disability was diagnosed, and pharmacological as well as psychological management were started

Psychological mindedness as a mediator in the relationship between dysfunctional coping styles and depressive symptoms in caregivers of children with autism spectrum disorder

Purpose Psychological mindedness (PM) can partly explain depressive symptoms in caregivers of autism spectrum disorder (ASD). This cross‐sectional study examines PM in mediating the relationship between dysfunctional coping styles and depressive symptoms. Design and Methods One hundred fifty‐five adult ASD caregivers completed the Malay version of Brief COPE, the Patient Health Questionnaire‐9, and the Balanced Index of PM. Findings Direct paths between dysfunctional coping style and depressive symptoms, between insight and depressive symptoms, and between dysfunctional coping style and all PM variables (insight and interest) were obtained. Multiple regression analyses revealed that insight, but not interest, significantly mediates the relationship between dysfunctional coping and depressive symptoms. Practical Implications PM can be enhanced via psychological interventions

Peer-Led Group Tele-Supervision of Clinical Psychologists: Optimization of Resources – A Malaysian Case Study

Inaccessibility to clinical supervision is an issue faced by solo clinical psychologist practitioners. Combination use of web-based instant messaging and video call application were tried by 28 clinical psychologists in conducting a peer-led group tele-supervision to address ethical dilemmas, discuss case management, provide technical instruction, explore resistance and analyse countertransference, provide emotional support, and share knowledge and updated guidelines. Despite facing challenges including difficulty in face-to-face session scheduling, limited time for in-depth discussion, internet connection issues, and documentation dilemma, we believe it has potential to influence supervision practice for clinicians working in isolation in rural or remote location

The use of Mindfulness Acceptance Commitment (MAC) approach for Malaysian elite triathletes

Mindfulness Acceptance Commitment (MAC) approach has been introduced into the sport psychology field and has shown a lot of interest in the applied practices. Athletes who receive MAC approach are taught to deal with challenging internal experiences in a non-judgmental way, choosing to persist with their task-at-hand despite discomforts and to remain focused on being grounded at the present moment. In Malaysia, the elite triathletes have not been exposed to the MAC approach before. This paper aims to describe how the MAC approach was provided to the Malaysian elite triathletes. MAC was taught over six weeks, with one MAC theme introduced per week. Each triathlete was given a one-on-one session of 60-90 minutes per week with homework and practical exercises. After six weeks, the triathletes reported marked improvement in their sport and additional improvements in other domains of their life. Considering the promising improvements of the elite triathletes who received the MAC approach, it is worth considering that the MAC approach should be adapted and incorporated into the triathlon sport

COVID-19 pandemic - A review and assessing higher education institution undergraduate student’s mental health

Introduction: The current COVID-19 pandemic has sequelae reverberating around Malaysia, particularly in university students, as Malaysian university students are isolated in their university campuses in semi-quarantine status. This article seeks to review the existing literature on the specialized issue of university student-related psychological sequelae of COVID-19, and seeks to offer some recommendations through the process. Methods: Existing literature demonstrates that COVID-19 has affected university students psychosocially, with the rate of anxiety and depression markedly increased. There have been significant alterations of lifestyle related to education, in accordance with the new normal, resulting in isolation and feelings of disengagement with education. Moreover, with the current uncertainties regarding their studies and possible financial depression post-pandemic, the future is deeply worrying and will adversely affect their mental health. Results: Quantitatively, recent findings indicate 33.3% of the undergraduates in a higher education institution are noted to be in stress. Therefore, multiple interventions have been implemented; a customized ultra-brief psychological module, an online tele psychiatry hotline (COVID Cares) and tele-counselling, which have received universally positive feedback. Conclusion: In conclusion, the review demonstrates that undergraduates’ psychological health is an aspect that needs urgent attention as it is not merely limited to the fear of COVID-19, but also related to the social aspects of the pandemic. Multiple interventions have been seen to be efficacious in reducing the psychological sequelae

Sarcoidosis and Corticosteroid Therapy: Dilemma from a Psychiatric Point of View

Introduction and Methods: A man diagnosed with sarcoidosis developed partial retrograde amnesia followed by three months of depressive symptoms with panic attacks, which remitted with an antidepressant and a benzodiazepine. However, three months later hallucinations and overvalued persecutory ideations subsequently emerged, only to show partial response to antipsychotic treatment. Results: Sarcoidosis was treated with corticosteroids but serial thorax imaging shows minimal response. Corticosteroid was onboard throughout treatment, corresponding with non-remission of psychotic symptoms. There are persistent subjective cognitive difficulties but Mini Mental State Exam score is full. He is currently being treated with escitalopram, alprazolam and quetiapine. Conclusion: This case illustrated the dilemma between prolonging the corticosteroid therapy for sarcoidosis treatment and the psychiatric sequalae. While symptomatic antipsychotic treatment is effective, multi-disciplinary approach is imperative in determining the duration of the corticosteroid therapy