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

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

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

118A>G AND IVS2+691G>C POLYMORPHISMS OF OPRM1 GENE HAVE NO INFLUENCE ON COLD-PAIN SENSITIVITY AMONG HEALTHY OPIOID-NAIVE MALAY MALES

Objective: Common polymorphisms of the mu-type opioid receptor (OPRM1) including 118A&gt;G and IVS2+691G&gt;C may affect experimental pain responses in healthy subjects, and the effect could be ethnic-dependent. The aim of this study was to investigate the influence of these OPRM1 polymorphisms on cold-pressor pain responses among healthy opioid-naive Malay males. Methods: Pain-threshold, pain-tolerance, and pain-intensity in response to the cold pressor test (CPT) were measured in healthy opioid-naive Malay males. DNA was extracted from the collected venous blood before PCR-genotyping. Repeated measure analysis of variance (RM-ANOVA) was used to compare CPT responses and OPRM1 polymorphisms (118A&gt;G and IVS2+691G&gt;C) according to their genotypes and allelic additive models, genotype dominant and recessive models, haplotypes, and diplotypes.Results: A total of 152 participants were recruited. Both 118A&gt;G and IVS2+691G&gt;C polymorphisms were not associated with cold-pressor pain-threshold, pain-tolerance and pain-intensity despite using genotypes and allelic additive models and genotype dominant and recessive models (all p&gt;0.05). Likewise, there were no significant associations between haplotypes and diplotypes for the 118A&gt;G and IVS2+691G&gt;C polymorphisms and the three cold-pain responses (all p&gt;0.05). Conclusion: The common OPRM1 polymorphisms (i.e., 118A&gt;G and IVS2+691G&gt;C), are not associated with cold-pressor pain responses in healthy opioid-naive Malay males. However, this may be unique for this particular ethnicity. Other polymorphisms may be more relevant for this population, and this should be further investigated.Keywords: Cold pressor test (CPT), Mu-type opioid receptor (OPRM1), Opioid receptor, mu 1 gene (OPRM1), Pain-threshold, Pain-tolerance, Pain-intensity, Opioid-naive, Male, Malay