Governance for disaster risk reduction: exploring emotional distress and resilience in adolescent affected by flood in Kelantan and the development of peer support group for trauma module

Background: Natural disaster such as flooding can lead to a com bi nation of physical, health and psychological trauma in both adults and children. This study was conducted to assess the factors associated with psychological trauma among school children affected by flooding which occurred in Kelantan in 2014. Methods: A validation study of the Malay version of Sense of Coherent (SOC-M) and Trauma Screening Questionnaire (TSQ-M) was conducted in the first phase. In the second phase, a cross-sectional study was conducted among school children using SOC-M and TSQ-M as well as a questionnaire for socio-demographic, flood experiences and consequences. Statistical Package for the Social Sciences (SPSS) version 22 was used to perform data analysis using descriptive, independent t test, Pearson correlation and linear regression analysis. Results: From 160 participants, 86 (53.8%) were male and 74 (46.3%) were female. The mean score of TSQ·M was 2.81 (S0=1. 70) and for SOC-M was 48.58 (S0=9.02). Four factors were found to be associated with trauma score, including female gender (p=0.047), moving from home during the flooding (p= 0.013), having difficulty after the flood in relation to schooling and living (p=0.024) and the place to stay after the flood regards to home and property damage (p=0.005). There was a negative correlation between TSQ-M score and SOC (r=· 0.23, p=0.003). Further analysis using multiple linear regression found that moving from house (p=0.016), places to stay after the flood (p=0.009) and SOC-M (p=0.002) were significantly associated with trauma score. In conclusion, the findings of this study were comparable with other studies in other countries

A Descriptive Study on Quality of Life among Adolescents with Beta-Thalassemia Major in the Maldives

Background: The Maldives has the highest prevalence of thalassemia in the world. However, there is little research done on the psychosocial aspects of this illness. Objectives: This study aimed to examine health related quality of life (HRQOL) among adolescents with beta-thalassemia major attending the National Thalassemia and Other Hemoglobinopathies Centre (NTC), Maldives Blood Services, Maldives. Thus, appropriate recommendation could be proposed. Methods: A total of 81 adolescents (mean age 15.7 years) with beta-thalassemia major were engaged. HRQOL was assessed using the Pediatric Quality of Life Inventory (PedsQL). Other relevant information was gathered through interview or medical record. Results: The HRQOL was reduced. The mean for physical, emotional, social, school and psychosocial HRQOL was 80.50, 72.30, 88.18, 76.44, and 78.96, respectively. The total HRQOL was 79.50 and this was lower in females (75.29) compared to males (83.29). Ferritin levels of 1,001-2,499 μg/l and > 2,500 μg/l were noted in 34.2% and 53.9%, respectively. Good compliance was reported in 55% of participants. Conclusions: Adolescents with beta-thalassemia major in the Maldives have reduced HRQOL. The high ferritin level could reduce the HRQOL and hence an attempt should be made towards lowering ferritin and improving compliance to chelation treatments. The gender difference in HRQOL signifies the need for more attention to the female patients and for areas of improvement to be explore

Severity of Tardive Dyskinesia and Negative Symptoms are Associated with Poor Quality of Life in Schizophrenia Patients

Objective: Aim of this study is to determine the association between tardive dyskinesia (TD) and quality of life (QOL). Methods: Seventy-one stable schizophrenia patients with TD attending psychiatric clinic at Hospital Raja Perempuan Zainab H (HRPZ II) or Hospital Universiti Sains Malaysia (HUSM) between January to November 2011 were assessed by a single rater. TD, QOL and psychopathology were assessed using Abnormal Involuntary Movement Scale (AIMS), Quality of Life Scale (QLS) and Positive and Negative Symptom Scale (PANSS) respectively. The main outcome in this study was QLS total score. Descriptive analysis, simple linear regression and multiple linear regressions were appropriately used in data analysis. Results: Majority of subjects were unemployed (73.2%), single (63.4%), Malay (98.6%) male (70.4%), and on typical antipsychotics before onset of TD (95.8%). The mean duration of illness and mean duration on treatment were 22 (SD 9.9) and 21.8 (SD 10.1) respectively. Mild, moderate and severe TD was experienced by 54.9, 32.4 and 12.7 % of subjects in that order. The mean QLS total score was 52.11 (SD 26.7) with the majority of subjects (76.1%) scored lower than mid score indicating low level of QOL. Employment status, marital status, PANSS negative symptoms and severity of TD were negatively associated with QOL. Conclusions: These fíndiugs convey important message to the health care providers to recognize QOL was significantly and negatively associated with severity of TD and negative symptoms. Further, low QOL was also associated with the subjects being single, unemployed or partially employed

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

Religiosity in Malay Patients with HIV/AIDS: Correlation with Emotional Distress

Religion promotes better health behavior, including less drug use and safer sexual practices. A total of 100 (60 males, 40 females) Malay Muslim HIV/AIDS patients were recruited in this study. Religiosity, emotional distress and stigma were measured using Hatta Islamic Religiosity Scale (HIRS), Depression Anxiety and Stress Scales (DASS)-21 and HIV Stigma Scale (HSS), respectively. It was found depression, anxiety and stress occurred in 28%, 6% and 2% of all subjects. Female were significantly more depressed than male subjects (P=0.006). Islamic practice was significantly higher in male subject (P<0.001). The Islamic religious practice was correlated with lower emotional distress; depression (r= -0.31, P= 0.016), anxiety (r= -0.25, P= 0.012) and stress (r= -0.28, P=0.015). Islamic religious knowledge was fairly correlated with disclosure concern (r=0.25, P=0.003). In conclusion, lower emotional distress was correlated with Islamic religious practice but not knowledge. Therefore, it is important to ensure improvement of Islamic practice in rehabilitation programs of HIV/AIDS patient

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

Self-Esteem among Malay Children of Parents with Schizophrenia in Kelantan, Malaysia

Background: Studies have demonstrated that children of parents with schizophrenia have low self-esteem. However, only scant data exist for the local population. Objectives: The objective of this study was to evaluate self-esteem of Malay children of parents with schizophrenia and to determine the associated socio-demographic and clinical factors. Methods: A total of 118 children of parents with schizophrenia who attended Hospital Universiti Sains Malaysia (HUSM) between May-September 2012 participated in the study. The children's self-esteem was measured using the Malay version of Rosenberg self-esteem scale (RSES). Patient's psychopathology and level of functioning were measured using the positive and negative syndrome scale (PANSS) and global assessment of functioning (GAF), respectively. Results: The RSES mean score was 23.86 ± 5.31 and low self-esteem (RSES score < 20) was reported by 32.2% subjects. In multivariate analysis, the independent factors associated with low self-esteem were girls (OR 6.29), poor academic achievement (OR 5.49), school attendance/ stopped schooling (OR 9.43), awareness of parental mental illness (OR 5.12) and parent was divorced/widow/separated (OR 3.56). Psychopathology and level of functioning of parents were not significantly associated with self-esteem of the children. Conclusion: Malay children, particularly girls, of parents with schizophrenia had low self-esteem. Children with school problems and whose parents divorced/separated also had low self-esteem

Adolescent to Adolescent Transformation Program- Nurturing, Enhancing and Promoting Adolescents’ Healthy Habit (ATAP-NEPAH): Curbing Social Problems Among Adolescents in Kelantan Through Peer-To-Peer Health Education

The objectives of ATAP-NEPAH are to enhance and nurture healthy habits among adolescents as well as to empower adolescents in inculcating these healthy habits among them. Health education through peer-to-peer approach is used to instill the knowledge on important areas such as sexual and reproductive health, smoking, substance abuse, illegal street racing (rempit) and mental health. Specific modules were developed by experts (lecturers) in multidisciplinary fields in collaboration with Malaysian Association for Adolescent Health (MAAH), National Population and Family Development Board (NPFDB), Reproductive Health Association of Kelantan (REHAK) and Rhaudatus Sakinah Kelantan. The trained Medical Students Facilitator Team (MSFT) of USM became trainers to secondary one school students. The selected school students were trained by the medical students to become peer educators to their juniors and peers. There was improvement in the readiness level of peer educators, knowledge and attitude towards healthy habits and risky behaviors of other school students after the intervention

Neuroleptic malignant syndrome in a patient with bipolar depression on stable dose of quetiapine

We report a case of a 37-year-old widow with a diagnosis of bipolar I disorder who presented with catatonia and neuroleptic malignant syndrome (NMS) while in the depressive phase of her illness. The neuroleptic malignant syndrome developed in the context of a stable dose of long-acting quetiapine (300mg) for five years. Her depression and catatonic state were hypothesised as the contributing factors for her NMS. Her catatonic symptoms were initially managed with regular benzodiazepines and she was later given electroconvulsive therapy during her admission. Her NMS improved after five days and her catatonic symptoms fully resolved after the second electroconvulsive therapy. The aim of this case report is to highlight the presentation of NMS in a depressed and catatonic patient, despite her long-term stability and a relatively low dose of quetiapine

The Malay Self–Efficacy Questionnaire for School Situations: Development, reliability, and validity among early adolescents in primary school

Low perceived self–efficacy (SE) for responding to school–related situations is posited to be associated with school refusal. This study examined the validity and reliability of the Malay version of the Self–Efficacy Questionnaire for School Situations (SEQ–SS) among early adolescents in Kota Bharu. The English version of the 25–item SEQ–SS was translated into Malay. Employing a cross–sectional design, students (10-11 years) from five randomly selected public primary schools were recruited via proportionate cluster sampling. Two hundred and fifteen students, 65% female, mean age of 10.3 years (SD=0.5), completed the Malay SEQ–SS. Validity was examined with exploratory factor analysis (EFA). Cronbach’s alpha was used to determine internal consistency. Means and standard deviations were used to describe the total and subscale scores. EFA analyses retained 19 items which clustered into four factors: ‘SE in socially challenging situations’, ‘SE in personally challenging situations’, ‘SE in separation situations’, and ‘SE in situations of disengagement from school’. Internal consistencies were low, approaching moderate, with Cronbach’s alpha values between 0.64 and 0.69. The four–factor solution of the Malay SEQ–SS appears to permit identification of specific domains of low SE which could inform individualized interventions targeting early adolescents in primary school.La baja autoeficacia percibida (AP) para responder a situaciones relacionadas con la escuela se considera asociada con el rechazo escolar. Este estudio examinó la validez y confiabilidad de la versión malaya del Cuestionario de autoeficacia para situaciones escolares (SEQ-SS) entre adolescentes tempranos en Kota Bharu. La versión en inglés del SEQ-SS de 25 ítems se tradujo al malayo. Empleando un diseño transversal, los estudiantes (10-11 años) de cinco escuelas primarias públicas seleccionadas al azar fueron reclutados a través de un muestreo de grupo proporcional. Doscientos quince estudiantes, 65% mujeres, con una edad promedio de 10.3 años (SD=0.5), completaron la SEQ-SS versión malaya. La validez se examinó con análisis factorial exploratorio (AFE). El alfa de Cronbach se utilizó para determinar la consistencia interna. Se utilizaron promedios y desviaciones estándar para describir las puntuaciones totales y subescala. Los análisis de AFE conservaron 19 elementos que se agruparon en cuatro factores: "AP en situaciones socialmente desafiantes", "AP en situaciones personalmente desafiantes", "AP en situaciones de separación" y "AP en situaciones de desvinculación de la escuela". Las consistencias internas fueron bajas, se acercaron a moderadas, con valores alfa de Cronbach entre 0,64 y 0,69. La solución de cuatro factores de la SEQ-SS malaya parece permitir la identificación de dominios específicos de baja AP que podrían informar a las intervenciones individualizadas dirigidas a los adolescentes en la escuela primaria. Palabras clave: Autoeficacia, desarrollo de instrumento, malayo, validez, fiabilidad