Postnatal depression is common and affects 10-15% of postpartum women. While there are many studies on the depressive episode in the postnatal period, its association with the bipolar spectrum disorder is often go unrecognized and undiagnosed.
Objective: To study the rate of bipolar spectrum disorder in mothers presented with postpartum depression and its associated factors.
Method: This is a cross sectional study on the women who visited the postnatal clinic in University Malaya Medical Centre. Subjects who consented were asked to complete a short questionnaire looking at the socio-demographic details and asked to answer the Multidimensional Scale of Perceived Social Support (MSPSS), Mood Disorder questionnaire (MDQ) and Edinburgh Postnatal Depression Scale (EPDS) whish assess the perceived social support and mood disorder.
Result: A total of 93 women were recruited into the study. Independent t-test and stepwise regression analysis identified that unemployment and baby with health problem were the only associated factors for postnatal depression. 28.6% of the mother with possible postnatal depression (EPDS = 12) might have bipoar spectrum disorder (MDQ = 7).
Conclusion: Postnatal depression as part of bipolar spectrum disorder needed additional attention. Postnatal check with screening tools may help to identify mood disturbance in postpartum women
Study site: Postnatal clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Objective: To illustrate the results of dichotomizing a continuous variable in a prediction model. Method: 202 patients who were discharged from the psychiatric ward, University Malaya Medical Centre (UMMC) from 27th August 2007 to 15th April 2008 were recruited. The general psychopathology was measured with Brief Psychiatric Rating Scale (BPRS-24). The information on age, gender, race, marital status, occupation, psychiatric diagnosis, first onset, electroconvulsive therapy, substance use, oral treatment and depot injection were collected. On follow up, the patients who had early readmission.
Introduction: Depression is the most common psychological sequelae in cancer patients. It is challenging to diagnose depression in cancer patients. Furthermore, the presentation is influenced by the patients’ cultural background. Objectives: This literature review aims to determine the prevalence of depression in cancer patients across regions of different cultural background. Methods: A literature search was undertaken by using Pubmed electronic database. Studies were included in this review if they (a) examined the prevalence of depression in cancer patients and (b) published in English peer-review journal between 2000 and 2009. Results: A total of 59 studies from 21 countries were reviewed and summarised. The prevalence of depression in cancer patients ranged from 3% to 72%. Studies from Asia reported the lowest prevalence (3-39%) and Europe reported the highest prevalence (7-72%). Conclusion: Cultural influence may play a role in the prevalent difference of depression in cancer patients. Somatization and stigmatization are suggested as the possible reasons of lower prevalence of depression in Asia region. The biopsychiatric model of mental illness and western psychologization explain the higher prevalence in Western region. Future research on the cross-cultural variability in the presentation of depression in cancer patients is recommended.
Introduction: Positive emotions in depressed patients are always disregarded and overlooked due to the inadequacy of assessment tool. There is a newly developed self-report scale, yet has good psychometric properties named Positive Emotion Rating Scale (PERS). Objective: The aim of this study were to translate and examine the psychometric properties of the Chinese version PERS (PERS-C). Method: This is a cross-sectional study involved 52 depressed and 106 control subject. Both groups were assessed with PERS-C, original PERS, Malay version of Snaith-Hamilton Pleasure Scale (SHAPS-M) and Malay version of Center for Epidemiological Studies Depression (CESDM). Results: PERS-C displayed good internal consistency (Cronbach’s α = 0.91) and parallel reliability with PERS (r = 0.95, p
Distress has become a major issue in cancer population. Patients may suffer from either physical,psychological distress or both. Cancer patients who are undergoing chemotherapy are more likely to experience psychological distress. This could be due to the negative effects of chemotherapy agents, the uncertainty of post-treatment, and the occurrence of psychosocial problems. As a result, the patient may experience a normal reaction such as sadness or may develop common psychiatric disorders such as depression and anxiety.
Objective: The aim of this study was to evaluate the validity and reliability of the Malay version of the Fagerstrom Test for Nicotine Dependence (FTND-M) based on a group of male staffs in the hospital. This study will also determine whether an abbreviated version of the FTND-M can be used as a screening tool for nicotine dependence. Method: 107 male staffs participated in the study. They were given the FTND-M and Malay version of Mini-International Neuropsychiatric Interview (M.I.N.I.)-L component. Their carbon monoxide level measured in their breath by using exhaled air. One week later, these participants were again given FTND-M. Results: The discriminatory ability of FTND-M was good with AUC 0.74 (P2 with the sensitivity of 70.1%, specificity of 70%, PPV of 79.7% and NPV of 58.3%. The FTND-M had moderate internal consistency with a Cronbach’s alpha of 0.67. The testretest reliability after 1 week was fair (Spearman’s rho=0.5, p)
Positive emotion is often neglected in the depressed patients due to the lack of assessment tool. Positive Emotion Rating Scale (PERS) is a newly invented self-report questionnaire, nevertheless has an impressive psychometric properties.
Objective: The aim of this study was to study the psychometric properties of the Malay version PERS (PERS-M), in order to facilitate its use in the local setting.
Method: In this cross-sectional study convenient sampling, total of 43 depressed subjects and 85 non-depressed subjects who were presented to the outpatient clinic of HBUK were recruited. Both groups were assessed with PERS-M, original PERS, Dispositional Positive Emotion Scale (DPES), Malay version of Snaith-Hamilton Pleasure Scale (SHAPS-M) and Malay version of Center for Epidemiological Studies Depression CESDM).
Results: PERS-M displayed good internal consistency (Cronbach’s α = 0.89), parallel reliability (intraclasss coefficient = 0.95, p<0.001) and concurrent validity with the DPES (r=0.32, p<0.05) and SHAPS-M (r=0.77, p<0.01). The PERS-M was negatively correlated with CESD-M (r= -0.61, p<0.01). The optimal cut-off value was 32, with sensitivity = 0.68 and specificity = 0.63, positive predictive value of 0.49 and negative predictive value of 0.79. The area under the curve (AUC) for receiver operating characteristic (ROC) was 0.71 (95% CI = 0.604 - 0.813).
Conclusion: the PERS-M is a brief and easy to administer tool to measure positive emotion in depressed subjects, with demonstrable satisfactory psychometric properties.
Keywords: Positive Emotion, Depression, Psychometric Properties, Instrument
Study site: Psychiatric clinic, Hospital Bahagia Ulu Kinta, Perak, Malaysia
Background: Caregiver burden is an important outcome commonly
investigated in both observational and interventional literatures associated
with caregiving of patients. Zarit Burden Interview (ZBI) is the oldest and
most widely used measure for assessment of caregiver burden. Since the
publication of the original version in 1980, various translated and shorter
revised versions of the ZBI in multiple languages have been produced.
Objectives: This study aimed to evaluate the validity and reliability of the
Malay version of Zarit Burden Interview (MZBI) for assessment of the
caregiver burden among the local family caregivers of cancer patients.
Methods: In total, 50 family caregivers of cancer patients in a government
tertiary hospital in Sarawak were recruited in this cross-sectional study using
non-random sampling method. The caregivers were given the MZBI scale,
followed by the Malay version of Center for Epidemiologic Studies –
Depression (MCES-D) scale and English version of Zarit Burden Interview
(EZBI) scale. Statistical analyses were performed to assess the reliability and
validity of the MZBI.
Results: The MZBI demonstrated good reliability with
high internal consistency (α = 0.898) and split-half correlation of 0.912, and
significant positive correlation with MCES-D (rs = 0.58, p < 0.01) and EZBI
(rs = 0.84, p < 0.01). A score of 22 was selected as the suitable cut-off score for
MZBI scale in the local population based on ROC curve with the area under
the curve of 0.786 (CI 0.658 – 0.914, p = 0.001). At the score of 22, the
sensitivity and specificity of the MZBI were 70.8% and 69.2% respectively.
Conclusion: The MZBI demonstrated fairly good psychometric properties in
assessing the caregiver burden in local Malaysian population. Further study
on the factorial structure of the MZBI would be useful to enhance the overall
validity of the scale in the context of caregiver burden assessment.
Objective: The objective of this study was study the psychometric properties
the Malay Version of the Demoralisation Scale (DS-M) in cancer patients.
Method: This was a cross sectional study where 178 subjects were recruited
from Universiti Malaya Medical Centre (UMMC). The subjects answered
both English and Malay versions of the Demoralisation Scales, Centre for
Epidemiologic Studies Depression (CESD) Scale, Distress Thermometer and
Positive Emotion Rating Scale (PERS). Principal component factor analysis
was conducted. The internal consistency, convergent, divergent and
discriminant validity were examined.
Results: The mean score for the DS-M
of the subjects was 18.79 + 15.30 where 37.6% of the cancer patients scored >
23. The principal component analysis of DS-M yielded four-factor structures.
The Cronbach’s alpha for the scale was 0.95, and the subscales ranged
between 0.81-0.92. The Spearman’s correlation showed a good convergent
validity between DS-M and CESD (r = 0.78, p < 0.01) and Distress
Thermometer (r = 0.64, p < 0.01); and divergent validity between DS-M and
PERS (r = -.69, p < 0.01). The AUC was 0.92 (SE: 0.02, p < 0.01, 95% CI 0.88-
0.97).
Conclusion: The DS-M has good psychometric properties as a
screening tool for demoralisation in patients with cancer in Malaysia.
Introduction: Atypical antipsychotic drugs are effective in the treatment of bipolar disorder. Studies have shown that atypical antipsychotic drugs are more superior to typical antipsychotic in term of neurocognitive function, negative symptoms and extrapyramidal side effects. Both aripiprazole and quetiapine are atypical antipsychotic drugs that are effective and commonly used in all phases of bipolar disorder treatment. Objective: The aim of this study is to examine and compare the clinical outcomes of aripiprazole and quetiapine in bipolar disorder patients. Method: This was a retrospective cohort study among patients from psychiatric unit, University Malaya Medical Center. Prescription records dated between January 1, 2013 and December 31, 2014 for psychiatric unit were extracted. The data of the subjects with prescription of the two atypical antipsychotic, namely aripiprazole and quetiapine was extracted. The outcome measures were the co-prescription of antihypertensive drugs, antidiabetic drugs and lipid lowering drugs. Results: A total of 58 subjects were recruited, 11 were on aripiprazole and 47 were on quetiapine. Statistical analysis has shown that both aripiprazole and quetiapine do not have any association with compliance to the medication and also follow up. Study also revealed that there is no association between the aripiprazole and quetiapine group with the metabolic side effects that were measured such as systolic or diastolic blood pressure, waist circumference, weight, glucose level and body mass index. Conclusion: This study has shown that both aripiprazole and quetiapine were similar in terms of metabolic side effect, compliance to medications and follow up.
Background: Duke University Religion Index (DUREL) is a brief and easy to use instrument for measurement of religious commitment. Objective: The aim of this study was to validate the Malay version of DUREL (DUREL-M) among a group of nursing students. Methods: This is a cross-sectional validation study conducted in a nursing school involved a group of year 1 nursing students. The students were given the Malay version of DUREL, Malay version of General Health Questionnaire (GHQ), Malay version of Brief COPE, Malay version of Depression Anxiety Stress Scale (DASS21), English version of DUREL. A week later, they were again given the Malay version of DUREL. Results: The instrument displayed good parallel reliability (0.70), test-retest reliability (0.68) (Spearman’s rho, p.
Pathological laughing or crying (PLC) were recognized after the occurrence of stroke, with a prevalence of 15% to 18%. There is no apparent triggering stimulus, and is often misdiagnosed as a mood disorder as it is a disorder of emotional expression rather than a primary disturbance of feeling. We reported a case of a 32 year old lady, who presented with giddiness and altered consciousness progressing to fever and neck stiffness, who’s CT showed a massive left cerebellar infarct. No risk factors were identified. Psychiatrically, she developed sudden crying spells after one month and a diagnosis of Major Depressive Disorder was made with subsequent commencement of anti-depressants. A week later, she developed continuous inappropriate laughter without the feeling of elation, which was beyond her control. There were no symptoms of mania or psychosis.
Objective: The aim of the study was to determine the early readmission rate among the psychiatric patients discharged from a teaching hospital in Malaysia. The associated factors were also examined. Methods: This is a prospective and observational study. The socio-demographic and clinical data of 202 patients from the psychiatric ward were collected on discharge along with the administration of instruments including Brief Psychiatric Rating Scale (BPRS), Life Events Questionnaire (LEQ), and Multidimensional Scale of Perceived Social Support (MSPSS). Assessment of compliance to medication and substance use was reliant on self-report data. Medication compliance was categorized as “poor” vs “good”, whereas poor compliance was the complete discontinuation of medication for at least two weeks. The patients were followed up to determine whether they were readmitted within 6 months. Results: At the end of 6 months follow-up, 32.2% of the subjects were readmitted. Univariate regression analysis indicated that patients with psychotic disorder, past episodes, previous admission, poor compliance, on conventional or depot injectable antipsychotic and higher BPRS scores on discharge were significantly associated with early readmission (p
There have been concerns about the growing number of children living in residential homes in Malaysia. The objective of this study was to determine the presence of depression and its association with the socio-demographic, personal characteristics and coping skills of adolescents residing in fourteen residential homes in Kinta Valley, Perak. A total of 235 adolescents participated in the study. They completed a self-report questionnaire gathering socio-demographic and personal factors, the Adolescent Coping Scale (ACS) and were assessed for presence of depression using The Mini International Neuropsychiatric Interview for children and adolescents (MINI Kid). The prevalence of depression was found to be 9.8 %, with 43% of the participants had history of being abused. Emotional abuse (OR=25.95, CI=4.51-149.43) and maintaining contact with parents (OR=0.02, CI=0.003- 0.10) were significant factors associated with being depressed. Depression is common among adolescents living in the residential homes. Detecting depression and understanding factors associated with depression allows appropriate management and intervention strategies.
Objective: As Internet use becomes ubiquitous among adolescents, Internet
addiction turns out to be as a potential problem in adolescents. The aim of
this cross-sectional study was to examine the prevalence of internet addiction
and its associated factors among the adolescents in Malaysia.
Methods: The
association between internet addiction and attention deficit hyperactivity
disorder (ADHD) symptoms was also examined in this cross-sectional study,
which was conducted at four secondary schools in Malaysia. In this study,
Malaysian Version of Internet Addiction Test (MVIAT), Conners-Wells
Adolescent Self-report: Short Form (CASS:S), The Conners Teachers Rating
Scale: Short Form (CTRS:S) and The Conners’ Parents Rating Scale: Short
For (CPRS: S) were used.
Results: The results demonstrated 28.6% of the
subjects were addicted to the internet and there was a positive association
with ADHD symptoms. Male gender, early age of first internet use, longer
total time of internet use are associated with internet addiction problem
among the adolescents. Internet addiction has become highly prevalent
among the adolescent in Malaysia.
Conclusions: It is important to provide
support for this group of adolescent with internet use problem. Measure to
prevent the worsening of the situation and future research on the causal
factors of internet addiction such as ADHD is needed.
Introduction: Cancer patients often have concurrent physical and psychological symptoms. These problems may become barriers towards the healing process. Antidepressants seem to be beneficial for the purpose of palliative care in this type of patients. One of the useful medications is mirtazapine, which is known as noradrenergic and specific serotonergic antidepressant (NaSSA). This paper examines the use of mirtazapine in physical and psychological symptoms of cancer patients. Methods: Literature search was done on PubMed (from inception to January 2017) by matching the key terms: ‘noradrenergic and specific serotonergic antidepressants’ or ‘NaSSA’ ‘mirtazapine’ AND ‘cancer’ or ‘oncol*’ or ‘malignancy’ or ‘carcinoma’. Eligible papers were screened at the title and abstract level. Various types of study included in this review, according to certain criteria. Additional papers were also identified by screening of reference lists. Results: A total of twelve papers were reviewed and summarized. Positive findings obtained for the use of mirtazapine in cancer patients associated with various symptoms, including depression, anxiety, cachexia, nausea, hot flashes, and pruritus. Some rare side effects are reported, including constipation, myalgia sedation, dry mouth, stimulation of appetite and weight gain. Conclusion: Mirtazapine has the potential to be beneficial for cancer patients suffering from these physical and psychological symptoms. However, more research studies with sufficient power are warranted to validate the findings.
Dalam situasi wabak COVID-19 ketika ini, maklumat yang tidak disahkan telah membanjiri platform media sosial, lalu meningkatkan tahap kegelisahan dan gejala kemurungan di kalangan orang ramai. Penyelidikan ini bertujuan untuk menilai hubungan antara pengetahuan, sikap, dan amalan (KAP) yang berkaitan dengan COVID-19 dan kesan psikologinya, seperti kegelisahan dan gejala kemurungan pada rakyat Malaysia. Tinjauan dalam talian telah dilaksanakan dari 8-22 April 2020, yang melibatkan 227 responden. Set soal selidik tersebut merangkumi ciri-ciri sosiodemografi, soal selidik KAP - 11 soalan mengenai pengetahuan (K1-K11), 3 soalan mengenai sikap (A1-A3), 4 soalan mengenai amalan (P1-P4), bersama dengan Soal Selidik ‘Patient Health Questionnaire (PHQ-9)’ dan ‘Generalized Anxiety Disorder (GAD-7) Scale’. Untuk mentafsir hasil penyelidikan, analisis deskriptif, ujian chi-square dan analisis teori respons barang telah dilaksanakan. Peratusan responden yang menjawab soalan penyataan benar dari komponen Pengetahuan (K1-K3) dengan betul adalah hampir 100%. Walau bagaimanapun, item yang menguji maklumat palsu COVID-19 (K4-K11) berkisar dari 38.8% hingga 95.2%. Satu-satunya item dari komponen Sikap yang kurang dari 95% dijawab dengan betul adalah A1 (78.9%), mengenai penggunaan topeng muka. Dari komponen Latihan, lebih daripada 80% responden mengenal pasti bahawa mereka menggunakan media sosial untuk mendapatkan kemas kini mengenai COVID-19 sepanjang masa. Ini merupakan sesuatu yang membimbangkan kerana kebanyakan maklumat yang beredar di media sosial belum disahkan oleh pihak berwajib, yang mungkin menyebabkan, dan terus-menerus memperkuat maklumat palsu yang menimbulkan kegelisahan. Kajian ini menunjukkan bahawa skor KAP keseluruhan yang lebih rendah, terutamanya untuk item komponen Pengetahuan, berkaitan langsung dengan tahap kegelisahan dan kemurungan yang lebih tinggi.
Steroid is commonly used for various connective tissue diseases and immunological related disorders. Psychiatric side effects are common in patient with systematic treatment of steroid. The reported prevalence ranges from 6% to 28%. Antidepressant-induced mania occurs when the mood of a patient switches to manic or hypomanic from depression after the use of antidepressant. We reported a case of a 55 year old lady, who presented with agitation and grandiosity after the treatment with antidepressant. She was initially diagnosed as having Bell’s palsy with unilateral facial muscle weakness. Oral prednisolone was prescribed for seven days where she became depressed, having auditory hallucination and delusion of guilt. She was then started on antidepressant where she became irritable, agitated and developed grandiose delusion. The antidepressant was withheld and she was started on atypical antipsychotic. Her condition improved and discharged well after three days of stay in the ward.
Objective: The aim of this study is to translate the original English version of List of Threatening Experiences (LTE) into Malay and to test the reliability on a group of medical students. Method: The LTE was translated into Malay and back-translated. The Malay LTE (LTE-M) was then tested on a total of 237 medical students. They were given LTE-M, General Health Questionnaire (GHQ), Beck Depression Inventory (BDI) and English version of LTE. A week later, these students were again given the LTE-M. Results: The parallel and test-retest reliability were satisfactory for 7 out of the 12 event categories (Kappa=0.67- 0.88). However 3 event categories were not reported. There was no statistical significant difference in the BDI and GHQ scores between the students with and without threatening experiences. Conclusion: The parallel and test-retest reliability of the LTE-M were acceptable. An association between the threatening experiences and increased disorders was not established.
Wilson disease is an inherited metabolic disorder. It is an autosomal recessive disorder caused by mutation of ATP7B gene, which results in excessive accumulation of copper in the body and deposition in various organs. The clinical presentation varies and neuropsychiatric manifestations are common. It is a diagnostic challenge in the initial phase where it mimics other psychiatric conditions and the diagnosis of Wilson disease is based on a combination of laboratory tests and clinical features. Wilson disease treatment comprises of copper chelating therapy such as D-Penicillamine and zinc sulphate wheras the behavior and mood symptoms response well with atypical antipsychotic treatment. The present report illustrates two cases of Wilson disease in middle-aged patients. The first presentation involved changes in behavior and personality. There was some delay in making the diagnosis in the initial stage. Both cases were diagnosed to have Wilson disease after further investigations. Their condition improved with the combination of copper chelating agent and atypical antipsychotic. In conclusion, it emphasizes the awareness of psychiatric manifestations as the initial presentation of Wilson disease.