Understanding the way in which people seek care for mental disorders is important for planning services, training and referral mechanisms. Pathways to care fall broadly into three categories: via primary care physicians; via native healers; and via patient choice (patients can have direct access to mental health professionals). The pattern and nature of access to service in low-income countries are different from those in high-income countries. In many societies, deep-seated cultural beliefs on the part of patients and families about the causes of mental disorders are a major barrier to the receipt of modern psychiatric care.
Developed economies are at the forefront of facing the brunt of non-communicable diseases (NCD). The majority of the health expenditures are routed in managing obesity and mental disorder-related patients, and there is a fall in the productivity of the distressed and NCD prone labour. Several indicators of stress are used in literature to assess its implications. However, empirically no database has maintained the longitudinal data of national stress level. This study focused on constructing the socioeconomic antecedent of non-communicable stress which is leading to several NCDs. For this Multiple Indicator and Multiple Causes (MIMIC) model is utilized for 151 countries between 2008 and 2018. The results show that macroeconomic conditions, trade, and environmental quality follow fundamentals in explaining stress. While, national stress index is a significant source of smoking and mental disorder prevalence.
The aim of this study was to investigate the effect of different inter-stimulus intervals to the Cortical Auditory Evoked Potential (CAEP) findings in adult participants. Nineteen normal hearing individuals aged between 20 and 24 years old participated in this study. CAEP were measured by presenting 1000 Hz tone burst stimulus at 70dBnHL at three different inter-stimulus intervals (ISI)s of 2000, 909 and 555 ms in randomized order. Results revealed significant changes in the CAEP’s amplitude as a function of ISI with a reduction of P1-N1 amplitude of up to 50%. N2 peak was absent in some subjects using short ISI (555 ms). This study concluded that the use of very short ISI (e.g. 555 ms) may not be appropriate clinically because it can reduce the CAEP wave amplitude
and can cause an absence of peak N2. In contrast, the use of short ISI may be useful for other clinical applications that may benefit from neural habituation and refractoriness, for example to predict the potential future outcome of speech and mental disorders.
Objective: The aim of this study was to study the rate of readmission and look into factors that may contribute to this. Methods: This is a retrospective descriptive study of all psychiatric patients who were discharged from University Malaya Medical Center (UMMC). Case notes of those discharged during the study period was retrieved and analyzed. Those fulfilling the inclusion criteria were recruited and subjected to a questionnaire. Results: A total 107 patients were identified and only 95 participated. The readmission rate was 16.8%. Severity of illness was identified as the main risk factor for readmission in this study. Conclusion: Our readmission rate was similar to some developed nations and indicated good quality of care in UMMC. There appears to be other factors that may influence rate for readmission other than quality of in-patient care and outpatient community care. Keywords: readmission, mental illness, quality of care, Malaysia
The Beck Depression Inventory (BDI) has been shown to have good psychometric properties in Western and non-Western populations for the past 40 years. The present study reported on the factor structures and provided evidence of the psychometric properties of the BDI for the Malays in Malaysia. A total of 1090 Malays in four samples (students, general community, general medical patients, and patients with major depressive disorders) were recruited in this study. They completed a battery of questionnaires that included symptoms, cognition and quality of life measures. Two factors of the BDI-Malay namely Cognitive/Affective and Somatic/Vegetative were extracted from Exploratory Factor Analysis (EFA) and were confirmed through Confirmatory Factor Analysis (CFA). Internal consistency (Cronbach's ) ranging from = .71 to .91 and validity of the BDI-Malay were satisfactory. The BDI-Malay can be used with confidence as an instrument to measure levels of depression for Malays in Malaysia. Keywords: Beck Depression Inventory, Malaysia, psychometric, confirmatory factor analysis
For a person with mental illness, travelling abroad can be challenging but it can be easier when the traveller and healthcare practitioner have a clear understanding of the likely impact of travel on the illness and of the illness on the travel experience. Travel may also precipitate first presentations of mental illness or unmask previously undiagnosed mental disorders. We propose that mental health problems should receive greater recognition in travel medicine and that psychiatrists should collaborate more closely with travel medicine clinicians to ensure that their patients benefit from the opportunities afforded by international travel.
Japan's prototype of depression was traditionally a melancholic depression based on the premorbid personality known as shūchaku-kishitsu proposed by Mitsuzo Shimoda in the 1930s. However, since around 2000, a novel form of depression has emerged among Japanese youth. Called 'modern type depression (MTD)' by the mass media, the term has quickly gained popularity among the general public, though it has not been regarded as an official medical term. Likewise, lack of consensus guidelines for its diagnosis and treatment, and a dearth of scientific literature on MTD has led to confusion when dealing with it in clinical practice in Japan. In this review article, we summarize and discuss the present situation and issues regarding MTD by focusing on historical, diagnostic, psychosocial, and cultural perspectives. We also draw on international perspectives that begin to suggest that MTD is a phenomenon that may exist not only in Japan but also in many other countries with different sociocultural and historical backgrounds. It is therefore of interest to establish whether MTD is a culture-specific phenomenon in Japan or a syndrome that can be classified using international diagnostic criteria as contained in the ICD or the DSM. We propose a novel diagnostic approach for depression that addresses MTD in order to combat the current confusion about depression under the present diagnostic systems.
Matched MeSH terms: Diagnostic and Statistical Manual of Mental Disorders
The Malaysian Mental Health Act 2001 did not come into effect until the Mental Health Regulations 2010 came into force. The Act provides a framework for the delivery of comprehensive care, treatment, control, protection and rehabilitation of those with mental disorders. The Act governs the establishment of private and government psychiatric hospitals, psychiatric nursing homes and community mental health centres. This paper outlines the provisions of the Act and the Regulations.
Introduction: Attention deficit hyperactivity disorder (ADHD) is a frequently encountered clinical condition in children. Based on DSM IV-TR criteria it can be sub-classified into three distinct types namely hyperactiveimpulsive, inattentive and combined. Materials and Methods: In the present study, salivary antioxidant activity (AOA) in children with ADHD was compared with age-matched normal control subjects, both as a whole and also with regard to the three subtypes. Additionally, the effect of therapy on the altered AOA levels was investigated following short term (
Matched MeSH terms: Diagnostic and Statistical Manual of Mental Disorders
Pain is infl uenced by multiple factors including personal experience, psychological, sociocultural and situational factors. Failure to recognise pain will lead to poor patient management and deleterious effect on the patients wellbeing. Assessing pain in paediatric and cognitively compromised patients remains a challenge. Pain assessment in these groups of patients depends on the observers assessment and studies have shown the discrepancy between the observers assessment and patients verbal report. A specifi c and accurate tool is required to assist in the pain assessment. Although there are assessment tools available using behaviour scoring system and physiological indicators, none of the tool demonstrates its superiority than the others. Biochemical indicators such as stress hormones are frequently measured and used in con-junction with verbal reports; however they are non specifi c to pain and are increased in infl ammation, haemodynamic and emotional changes. The association between immunological indicators e.g. IL-1 , IL-6, IL- 8 and clinical pain has been shown, however; the defi nite correlation of the changes in the indicators and the level of pain is still unclear and may require further investigation.
About 60% of people with mental illness developed co-morbid medical and physical illness that invariably worsens their lives. However, most of the studies regarding this issue were done either in the out-patient or community settings, ignoring long stay inpatients. Locally, no data exists among long stay patients in psychiatric institutions. The aim of this retrospective study was to look at the prevalence of physical illness among long-stay patients and to compare the occurrence of physical illness before and after admission to the psychiatric institution. We found that 85 (63.4%) out of 134 subjects there was suffering with co-morbid physical and medical illnesses. There were 33 (24.6%) subjects with hyperlipidaemia, 22 (16.4%) subjects with hypertension and 17 (12.7%) subjects with diabetes. Approximately 75 (55.9%) subjects developed medical illness after admission. In conclusion, long-stay psychiatric patients are at a high risk of developing medical problems that tends to begin after admission to the psychiatric institution.
Study site: Hospital Bahagia, Ulu Kinta, Perak, Malaysia
This short report aims to describe the Circle of Care (COC) Project in Malaysia. This is an example of smart partnership between the Malaysian Psychiatric Association (MPA) and Johnson and Johnson which began in 2003. By means of philanthropic funds from an industrial company, many people have benefited in many different aspects through the project. It consists of three main psychosocial activities: education and support programme for carers and families of people with mental illness; psychosocial rehabilitation for patients with mental illness; and mass education for the people in promoting mental health and prevention of mental health problems and illness. To date, the project has either fully or partially funded hundreds of activities along the line of these three objectives. While there has been growth of psychosocial interventions in the country contributed by the project, it is faced with a few challenges which are becoming the next focus of actions of MPA.
The vital importance of the mental health of a nation for the overall well being of the population and socioeconomic development is increasingly recognized. In Malaysia, psychiatric disorders were responsible for 8.6% of the total Disability Adjusted Life Years and were ranked fourth as the leading cause of burden of disease by disease categories. More and more evidence shows that physical illnesses are strongly associated with psychiatric disorders. Those with physical illnesses have much higher risk of developing psychiatric disorders compared to that without. The mechanisms of co-morbidity of psychiatric and physical illness are complex. It is a two-way interaction and there are five different possible ways to describe this.
This study explores the quality of life, social integration and the effects of perceived stigma of people with mental illness living in the community. Adopting a complimentary mixed method, this study was represented by 165 people with mental illness in Kuching, Sibu and Miri. Findings indicated that the quality of life scale was poor, 49.67% and 78.43% often experienced stigma. Anticipated stigma 43.79%; 16.99% all the time and 4.58% never experienced stigma. Findings also noted that people with mental illness living in the community are still largely depending on and needed continuous support from their family members/carers for financial aid and their living arrangement for a “better” quality of life. Where treatment is concerned, follow up care at home by health care providers continue to play a significant role. In order to “erase” the perceived or stigma experienced, establishing therapeutic relationship, communication and creating awareness on “stigma discrimination paradigm” poses a phenomenal challenge in the current misrepresentations of mental health messages.
Systemic lupus erythematosus (SLE) is a debilitating and chronic autoimmune disease which strikes insidiously. The disease currently has a prevalence of 43/ 100 000 individuals in Malaysia. The presentation of the disease is varied resulting in delay in diagnosis and onset of complications prior to management. The disease commonly presents as joint pain and cutaneous manifestations. Neuropsychiatric presentation accounts for 24% of symptoms during onset of illness. This case report highlights that we encountered a patient who presented with neuropsychiatric manifestations, whereby the patient was managed for the psychiatric symptoms prior to the organic diagnosis being made.
This article aims at exploring the trust establishment among patients with depression during their journey to psychiatric patient-hood. This study was undertaken in government hospital involving 29 psychiatric outpatient users in Kedah and Pulau Pinang respectively using phenomenological study and gender lens. Semi-structured in-depth interview and non-participant observation were the tools used in data collection. The data explicated with the aid of a qualitative data analysis tool, Atlas.ti., version 7.5. Through the findings, the study identified “Trust” appears critical in the accounts of the patients in shaping the doctor-patient relationship. Five interlocking subthemes describing the health professional’s characteristic while giving the service include doctor’s integrity, concern, competencies, empathy, and autonomy enabler. The findings had highlighted that both female and male physicians had different approach to their patients, where the female physician had better chances in getting the mandate of trust. This research is useful to health professionals and governance of mental health care to fulfil the patients’ needs based on their genders.
Study site: government hospital involving 29 psychiatric outpatient users
in Kedah and Pulau Pinang
The aim of this study was to assess community pharmacists' (CPs) perceptions toward mental healthcare, and the barriers faced in providing pharmaceutical care (PC) services to these patients. A 40-item survey was posted to CPs. Ninety-six pharmacists participated. The majority (84.2%) agreed there is a role for CPs to play in mental health care, while approximately 60% agreed it is their responsibility to provide PC to these patients. The biggest barrier to providing this service is the lack of knowledge, cited by close to 50% of respondents. This corresponds with the revelation that close to 60% believe that they have a poor or fair understanding of mental disorders. About 30% of respondents said they do not stock psychotropic drugs at all, mainly due to medico-legal reasons, and low prescription requests. Our findings highlight the need for more training of CPs in managing patients with mental disorders.
Objective: This study was conducted to determine the prevalence of anxiety among medical students at a local university in Malaysia and to identify its associated factors.
Methods: Across-sectional study design was used. Three-hundred and ninety-six medical students at a local university in Malaysia were included in the study. A pre-tested, modified, self-administered Beck Anxiety Inventory (BAI) was used to screen for anxiety.
Results: Three-hundred-and-ninety-six out of 414 medical students participated (response rate 95.7%).38.4% of the medical students were found to have anxiety.
Conclusion: The overall prevalence of anxiety among medical students was high (38.4%). Factors found to be significantly associated with anxiety were gender, perceived level of pressure, year of study in medical school, ethnicity and depression(p<0.05).
Keywords: Anxiety, depression, medical students, prevalence
Parent-youth conflict and behavioural difficulties are common issues in the field of developmental psychology. This study examines the correlations of conflict and behavioural difficulties, to see if these factors predicted a negative affect on a sample of at-risk youth. A sample of 335 at-risk youth aged 13-24 years old from Public Housing Projects in Kuala Lumpur was selected. Conflict with the father was significantly associated with negative affect. Further analysis showed that three factors were required to produce negative affect. The results support claims that father conflict, emotional problems and conduct problems are an integral part of the close relationships of at-risk youth, and discourage positive youth development among at-risk youth.