Virtual reality assessment for obsessive compulsive disorder: a review

The use of advance computer-based technology is becoming necessary to address the growing complexity of human problems and enhance effective communication. The recent pandemic COVID-19 not only induces many morbidities and mortalities but also intensifies mental health problem worldwide. Due to the increasing benefits of virtual reality (VR) in addressing medical condition, it is believed that VR can be used as a diagnostic tool to assess numerous medical conditions and psychiatric disorders. To date, there is still scarce evidence of VR as a diagnostic tool to assess obsessive compulsive disorder (OCD). In this study, we had conducted a systematic review to investigate the use of VR as a diagnostic tool for OCD and assess its benefits and weaknesses in comparison to computer-assisted tools. Comprehensive searches of electronic databases including PubMed and Google Scholar were undertaken to discover peer review evidence of computer-based simulation tasks in detecting OCD symptoms. Twelve out of 9325 papers were screened and reviewed. Five articles reported on computerised tools and seven articles described VR tools. In comparison to computer-based tasks, VR is a promising assessment tool due to specific virtual environments and high resolutions which are able to induce anxiety symptoms. Despite numerous shortcomings, assessment can be utilised in computerised form to detect and generate a variety of psychiatry diagnoses among the general population. Although computerised assessment task and VR show promising results, the finding are uneven due to study design differences, wide variability content task use, small sample size, several methodological issue with the computerised tasks and lack of appropriate control groups. In conclusion, the choice to use computerisation or VR for OCD assessment will depend on aim, content, technical equipment and budget. More in-depth studies of these issues are required

Religious-integrated therapy for religious obsessive-compulsive disorder in an adolescent: a case report and literature review

Religious obsessive-compulsive disorder (OCD) is relatively underreported among adolescent and carries poorer outcome. We report a 20-year-old Muslim man who was diagnosed with religious OCD when he was 14 years old. He had recurrent blasphemous intrusive thoughts upon performing religious rituals which had hindered him from practising his religion. Despite being on tablet esticalopram 10 mg and conventional cognitive– behavioural therapy, the result was to no avail. A religiousintegrated therapy was introduced by incorporating some of the Islamic values, knowledge, and practice during the exposure and response prevention therapy for five consecutive days along with cognitive restructuring. A considerable amount of symptom and functional relief was achieved. He excelled in his studies and equally important was able to resume practising his religion. Religious-integrated therapy is an untapped area that should be offered as the treatment option in certain cases where religion plays an important role in illness’s phenomenology and patient’s coping

Clinicians’ perception of virtual reality therapy in treating patients with obsessive compulsive disorder: a preliminary study

In the Western context, virtual reality (VR)-based treatments had been suggested as an intervention for anxiety disorder. Despite its potential efficacy, there is a lack of study which using VR as an intervention, especially for obsessive-compulsive disorder (OCD) in Asian countries. Therefore, the present study aimed to examine what elements are required to design VR and the suitability of VR as an intervention in OCD for the local context. To address this, six clinicians, consisting of three clinical psychologists and three psychiatrists, were interviewed. They were interviewed using a semi-structured interview protocol related to their perception on VR as an intervention for OCD patients, as well as the cognitive behaviour therapy (CBT) elements that can be incorporated in VR. The findings showed that all clinicians anonymously supported CBT to be augmented into VR as part of intervention for OCD to overcome logistics issues, the interactive nature of the virtual environment and the sense of presence similar to a real-life situation. The side effects of VR also need to be studied before employing these new interventions. In conclusion, VR can be used as an intervention for OCD. CBT-VR intervention can be applied in the Asian context by using similar CBT modules which should be modified according to cultural context

The Malay version of patient activation measure: an instrument for measuring patient engagement in healthcare

Effective diabetes management depends on both pharmacological treatment and patients’ engagement in their own care. PAM is an instrument that measures patients’ ability to self-manage their chronic illnesses and determines patients’ level of activation. The purpose of this study was to develop a translated Malay version of the PAM instrument and subsequently, to conduct a reliability and validity assessment. A cross-sectional study among patients with type 2 diabetes was performed in a teaching public primary care clinic. Forward and backward translation was conducted, followed by pre-testing and cognitive interviewing. Data from 130 patients were analysed using SPSS software to assess the internal consistency and the psychometric properties of the Malay version of PAM instrument. Cronbach’s alpha for all items was 0.87, indicating good internal consistency. Exploratory Factor Analysis (EFA) showed a possibility of a three-factor model, which were labelled as a) confidence in performing preventive behaviors b) feel responsible and in charge of own health, and c) knowledge, ability to communicate and adherence to treatment. All items have a factor loading of higher than 0.4. The Cronbach’s alpha value was 0.85, 0.7 and 0.58 for the first, second and third subscales, respectively. The Malay version of PAM instrument showed a good reliability index and might have multiple subscales. Assessing these subscales are useful for the healthcare team in the evaluation of ‘patient activation’ among patients with diabetes. Efforts will thus be easier when responding to the patients’ needs and facilitating them to become active health managers

Initiating activation in diabetes self-management from patients’ perspective

Patients’ active role is crucial in managing chronic illnesses like type 2 diabetes. Current evidence demonstrated patients who were activated had better clinical outcomes. Some factors influencing patient activation have been identified but there is little knowledge on how patients successfully start to take their role in managing diabetes. This study aimed to explore how patients begin to activate themselves in self-management. The narrative inquiry was taken as the qualitative methodological approach. Ten participants with type 2 diabetes were purposively sampled from a public primary care clinic in Malaysia. In-depth interviews were conducted and recorded. The data were analysed with thematic analysis. Three themes and four subthemes were generated. The first theme, “Learning what to do” describes the learning process from social networks and healthcare professionals that helped to define their role. The second theme highlighted that patients wished for a gradual approach in initiating activation, i.e. “Taking one step at a time”. They started with a more straightforward self-management task and needed more time to take up their role. The third theme pointed out that when patients could not perform certain self-management tasks, they would engage with someone else to help: “Engaging with someone for challenging tasks.” In conclusion, diabetes self-management education is substantial in developing ‘patient activation,’ i.e. patient’s ability to self-manage. The self-management plan should also be realistic and suit patients’ circumstances. Having a health partner or buddy among family members or peers is helpful when trying to adopt good dietary habits and perform regular exercise

Reducing the isolation: A malaysian family in need

ABSTRACT Introduction: Many challenges are faced in the optimum management of a family caring for children with developmental disorders (FCCDD). Case Report: This case report highlights an isolated Malaysian family as victims of discrimination against special children, illustrates the factors and challenges that are associated with it. We report our experience, as part of a multiprofessional team in managing an isolated FCCDD. Our role of service providers, became that of the sole lifeline the family depended upon. We helped the family return from the brink of death; they helped us understand that no family should be an island and every family has a right to optimum care. Conclusion: Isolation that occurs in FCCDD is real and can be influenced by multiple factors such as low education and income. To help an FCCDD is to help Malaysian society overcome its prejudices. Getting FCCDD to participate in decisions regarding treatment and in other biopsychosocial needs is crucial i

Computer based rehabilitation of cognition

Research Doctorate - Doctor of Philosophy (PhD)Background: The challenges posed for computerised cognitive training recently are lack of generalization of learned skills as well as maintenance effects. These could be due to not targeting the right cognitive deficit that influences deficits in everyday functioning. This dissertation examined whether training of targeted impaired cognition achieves the intended aims of enhancement, generalization, and sustainability of training effects among people with schizophrenia and healthy aging. Therefore, verbal memory was not targeted in computer based cognitive training in the schizophrenia sample due to the assumption that deficits in verbal memory are underpinned by other cognitive skills. Unlike schizophrenia, broad cognitive skills were targeted in a healthy ageing group. The thesis also aimed to examine whether there is evidence of neuroplasticity following training via electrophysiological measures namely Mismatch Negativity (MMN) and P300 indices. Methodology: Two different experimental designs were used to achieve the aim s of the study. Both studies employed Cogpack software, a computerised cognitive training package. A simple pre- and post-experimental study with a three month follow-up was conducted to determine the efficacy of non-verbal-memory computerised cognitive training (cognitive training that did not include verbal memory) in improving cognition in schizophrenia patients. A randomised waitlist control group was used to evaluate the effect of broad computerised cognitive training in a healthy elderly population. Participants were randomised to an immediate training or a waitlist group and attended baseline assessments. For the immediate group, a 4 week cognitive training period commenced a week after baseline assessments while the waitlist group were assessed for a second time approximately 4 weeks after the initial assessment and then commenced the training program. Both groups were reassessed after completion of Cogpack training and again after three months. Both schizophrenia and healthy ageing people attended three consecutive EEG recordings: baseline, post treatment and 3 month follow-up. Similar to the EEG testing, all participants attended three consecutive neuropsychological testing sessions with the exception being the waitlist group in the ageing study whom attended 4 testing sessions to determine the effects of test practice. Results: Significant improvement on targeted cognitive processes was seen following the training. Generalization to untrained tasks was also evident specifically social cognition evident for groups as well as verbal memory and learning in the schizophrenia study. The training gains were in general maintained at three month follow-up for both groups but there was little evidence of further improvement at follow-up. Practice effects were seen in both executive function and social cognition tasks. Discussion: Participants in both studies tolerated training with Cogpack well. Despite different training exercises being used, these findings provide evidence that Cogpack significantly improved targeted cognition and generalization to other tasks in both schizophrenia and healthy ageing. Effects of training were evident although no effects on electrophysiological measures were found which suggested limited neuroplasticity following the training. There is a need to reduce the mismatch between the individual’s capacities and demands of training tasks to improve core cognitive impairments and promote generalization of learned skills. Further research needs to take account of an individual’s cognitive reserve and develop adaptive computerised cognitive training that can promote neuroplasticity

Religious cognitive behavioral therapy in specific phobia: a case report

This is a case report on the effectiveness of Religious Cognitive Behavioural Therapy sessions on a patient with Specific Phobia. The Word Health Organization (WHO) has included the spiritual aspect in its definition of health, with increasing attention being given to the role of religious beliefs and practices. We explore the role of RCBT which serves as an effective method of managing anxiety issues

Scrupulosity and Islam: a perspective

Scrupulosity is characterized by an excessive anxiety against sinning and it is found to be common in Muslim societies. Spirituality plays a significant role in its presentation and management. The role of Islamic spirituality is examined by revealing the relevance of Islamic spiritual values e.g. acceptance (rida), patience (sabr), to the therapy. Five cases where these values are integrated into the therapy are described. Limitations on the available evidence are addressed. This study proposes the integration of these spiritual values, supports the use of psychotherapeutic discourse and contributes to the field of healthcare through practical conceptual applications in the therap