This is a model answer of Critical Review paper for Malaysian postgraduate examination in psychiatry. This model answer was used for marking the review paper for Master of Medicine (Psychiatry) and Master of Psychological Medicine, May 2009.
The critical review paper is a component of the theory examination for postgraduate psychiatry in Malaysia. Majority of students find this paper difficult, thus this article is intended to help the students understand the critical review paper better. The paper discussed below aimed to determine the knowledge, attitude and practice towards sleep among medical students of International Islamic University Malaysia (IIUM). Model answers were provided at the end of each question, as marked in italic font.
Objective: To investigate patient’s perceived satisfaction and adequacy of information given by doctors on prescribed drugs in an outpatient psychiatric setting.
Methods: The sampling was done consecutively with a target sample size of 200 patients. A simple questionnaire that was developed with 10 close-ended questions and yes or no answers was administered by the interviewing team. This questionnaire assessed patients' knowledge on prescribed medications and their perception on the adequacy of information given.
Results: More than 80% of the patients were informed regarding the reasons, timing to take medication(s), duration of drug treatment and type of prescribed drugs. Half of them were informed regarding the side effect profiles of their prescribed medications. Majority of them (80%) were satisfied with the information given despite only 49% of the patients being given adequate information on their medications.
Conclusion: Patients who are adequately informed about their medications are more significantly satisfied than those inadequately informed. (χ2=4.085, p<0.05).
Key words: perceived satisfaction, adequacy of information, prescribed psychotropic drug
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Objective: This paper aims to discuss the answers to Review Paper Exam for the Malaysian Master of Medicine (Psychiatry) May 2012 theory examination. The paper studied the psychotropic prescription practice in cancer patients using a health care registration database. Methods: One of the papers presented during the journal club presentation was picked-up for evaluation of student's critical appraisal. Results: Model answers were provided at the end of the Critical Review Paper. Conclusion: This review paper evaluates students' understanding and critical thinking on the topic of Psychotropic Drugs in cancer patients. This paper may serve as a guideline to teach students how to critically appraise topic related to psychiatry. ASEAN Journal of Psychiatry, Vol. 14 (1): January - June 2013: XX XX.
Assertive community treatment (ACT) is one of the most important elements of mental health care reform in Malaysia. Many studies worldwide have reliably found that ACT has positive impact on several outcome domains such as reduced hospitalization rate, improvement of symptoms and quality of life. This study aimed to assess the outcome of ACT in the aspect of symptom remission and its influencing factors among patients with schizophrenia in the urban city of Kuala Lumpur. A cross sectional study was conducted on 155 patients with schizophrenia who received ACT in Hospital Kuala Lumpur (HKL). The selection was made by simple random sampling. The abbreviated Brief Psychiatric Rating Scale (BPRS) was used to determine the status of symptom remission. The socio demographic and relevant clinical data were also assessed. A total of 76% (118) was noted to be in remission. According to logistic regression, the strongest predictor of patients receiving ACT with symptom remission was having good social support (p<0.001) and with higher educational level (p=0.024). The study revealed the effectiveness of ACT in terms of high prevalence of patients with symptom remission. This was despite the model of ACT being studied not fulfilling all fidelity measurements of the standard version of the service. The finding would hopefully act as a propeller for further development in this service area. However, the study
needs to be replicated through studies with better designs and involving more psychiatric centers.
Objective: To investigate the prevalence of Female Orgasmic Dysfunction (FOD) focusing on the orgasm domain among female patients attending PPUKM Psychiatric clinic. To compare the prevalence of orgasmic dysfunction between female patients on Escitalopram and on Fluoxetine therapy.
Methods: A validated questionnaire for sexual function was used to assess orgasmic function. A total of 112 women aged between 24 and 57 participated in this study. The orgasmic dysfunction was compared between patients on selective serotonin reuptake inhibitors (SSRIs) fluoxetine and escitalopram.
Results: The prevalence of female orgasmic dysfunction was 58.9% (33/56) among patients treated with Fluoxetine and 41.1% (23/56) among patients treated with Escitalopram. However, there was no statistically significant difference between these two treatment groups (p=0.059). The odds to have FOD among patients on higher dose of antidepressants was found to be higher compared to those patients who were on lower dose of antidepressants (Odds ratio 5.32, p= 0.001).
Conclusion: There was no significant difference of Female Orgasmic Dysfunction between patients on Fluoxetine and Escitalopram.
Study site: Psychiatric clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Objective: This study aimed to determine the association between the personality traits and
social factors with compliance to anti-hypertensive pharmachotherapy. Methods: This cross
sectional study was conducted from 1st of June until 31st of December 2004, which involved
Hospital Universiti Kebangsaan Malaysia Primary Polyclinic in Bandar Tasik Selatan,
Cheras and Salak Polyclinic in Sepang, Selangor. A total of 200 patients who fulfilled all the inclusion criteria, were selected as respondents. This study used the Mini International Neuropsychiatric Interview (M.I.N.I) for the psychiatric diagnoses and personality characteristics were assessed by using Personality Assessment Schedule (PAS) Results: The prevalence rate of non-compliance was 38.5%. Paranoid personality trait (27.3%) was the most common type of personality traits that associated with non-compliance to the medications prescribed. The results of this study revealed a statistically significant difference between drug compliance and age, race, gender and the site where the study was conducted. No association was found between patients’ education level, occupation, income, marital status, family history of hypertension and personality traits and drug compliance. Conclusion: This study suggested that drug compliance among hypertensive patients was influenced by the presence of psychosocial factors. Hence, it is important for medical practitioners to understand these factors and administer treatment more individual.
Objective: To assess postgraduate candidates’ knowledge on basic sciences and to compare
their achievement based on two years study in the Department of Psychiatry, National University of Malaysia (UKM), Kuala Lumpur, Malaysia. Methods: This is a study assessing
areas of difficulties in basic sciences for the Malaysian postgraduate candidates sitting for
mock MCQ examination papers in two consecutive years. Results: The candidates in both
years failed on MCQ papers (scoring marks are only 43% and 40% for the year 2006 and
2005 respectively), which is consistent with their final examination outcomes. The candidates in the year 2006 were much superior in neuroanatomy (percentages of median scores: 47% vs. 31%, p
Objective: To investigate the prevalence of genital arousal disorder and the potential risk
factors that may impair genital arousal among women at a primary care setting in Malaysia.
Methods: A validated questionnaire for sexual function was used to assess genital arousal
function. A total of 230 married women aged 18–70 years old participated in this study. Their sociodemographic and marital profiles were compared between those who had genital arousal disorder and those who did not. The risk factors were examined. Results: The prevalence of genital arousal disorder in the primary care population was 50.4% (116/230). Women with genital arousal disorder were found to be significantly higher in groups of more than 45 years old (p55) (p=.001), those having 4 children or more (p=.028), those having less sexual intercourse (less than 1–2 times a week) (p=.001), and those at post-menopausal state (p=.002). There was no significant difference between these two groups in term of salary (p=.29), suffering from medical problems (p=.32), dysmenorrhea (p=.95), menarche (p=.5) and hormonal replacement therapy (p=.6). Conclusion: Women with infrequent sexual intercourse are less likely to be sexually aroused (OR=0.29, 95% CI: 0.11-0.74).
Objective: Critical appraisal is a process of systematically examining research evidence to assess its validity, results and relevance before using it to form a decision. A basic knowledge in statistic and epidemiology is important among postgraduate students in psychiatry to acquire the skills for appraising clinical research evidence. This is a descriptive study that attempts to look into the level of knowledge among the postgraduate psychiatry students in
terms of statistic and epidemiology. Methods: A total of 31 postgraduate students in their second (N= 26) and third year (N=5) Master of Medicine (Psychiatry) and Master of Psychological Medicine from three different universities, namely: Universiti Kebangsaan Malaysia, Universiti Malaya and Universiti Sains Malaysia participated in this research. The participants were asked to answer 7 questions within 30 minutes. The passing mark for this
critical review paper is set at 25 out of 50. Results: Overall, only 32.3% passed the mock critical review paper. About 67.7% of the students passed their epidemiology component and only 19.4% passed the statistic component. Conclusion: We found poor performance in basic statistics among psychiatric trainees which highlights the need for further improvement in the subject’s training.
Objective: Mental health is often stigmatized in Asia, and electroconvulsive therapy (ECT) is portrayed negatively in the media. The objective of this short report is to obtain an insight on Asian countries’ perception on Electroconvulsive Therapy, mainly through the media.
Methods: Several online movie databases were searched, with emphasis on Asian movies’ portrayal of Electroconvulsive Therapy.
Results: Electroconvulsive Therapy (ECT) was portrayed in 9 television programme, 4 in films and 2 on Youtube. All patients (15) had no proper information given on possible side effects and consent not taken in all of them. 5 patients (33%) were tortured via ECT, 3(20%) of them had, ECT for Schizophrenia. In all scenes (15/15, 100%) ECT were given without general anaesthesia and the patients were fully awake. Basic monitoring (2/15, 13%) was performed, and all patients had no oxygenation. Tonic Clonic seizures were visible because all patients received no muscle relaxant. Bilateral electrode's placements (13/15, 87%) were common. One (6.6%) patient had a trilateral electrode placement. Most patients (9/15, 60%) received one shock, 4 patients (27%) received 2 shocks. One patient (6.6%) received 3 and 1 patient (6.6%) 4 shocks. 100% of patients were in obvious discomfort and ECT was portrayed as barbaric. There was no death depicted post ECT.
Conclusion: ECT is under portrayed in the Asian media. Only the Indian and Pakistani medium broached the subject. In the majority of the scenes, ECT was portrayed
negatively. This shows a total lack of knowledge of ECT among the Asian population. Alarmingly, ECT was used as a torture device in 5 mediums. This only adds to the stigma of ECT in Asia. More needs to be done to correct the misconceptions of ECT in Asia.
Objectives: This study aimed to determine the prevalence of depressive disorder
and its association with perceived social support among patients with HIV
attending the Infectious Disease Clinic in HTJS.
Methods: A cross-sectional
study was conducted, and systematic random sampling method was employed
for the selection of participants. Socio-demographic and clinical details were
obtained through a self-rated questionnaire and participants’ medical records.
Depressive disorder was screened and diagnosed using the Mini International
Neuropsychiatric Interview (M.I.N.I.) and perceived social support was
determined using the Multidimensional Scale of Perceived Social Support
(MSPSS). Appropriate statistical analyses were used to determine the prevalence
of depressive disorder and its association with perceived social support.
Results:
A total of 99 patients participated in this study. The mean age of participants
was 38.16 ± 1.01 years, and the majority of participants were male (69.7%). Most
of the participants were Malay (58.6%), followed by Indians (20.2%), Chinese
(17.2%) and others (4.0%). The majority had completed secondary education
(54%), and most were employed (79.8%). Most of the participants were single
(45.5%) or married (45.5%). The lifetime and point prevalence of depressive
disorder was 24.2% and 17.2%, respectively. About 64.7% of patients with
depressive disorder were undiagnosed. Out of the 3 sources of perceived social
support, perceived social support from a significant other (OR=0.53, p=0.042,
Cl=0.29, 0.98) and perceived social support from friends (OR=0.49, p=0.015,
Cl=0.27, 0.87) were found to be negative predictors for depressive disorder.
Conclusion: This study reports that the prevalence disorder among patients with
HIV in HTJS is higher than that of the general population. Patients without
depressive disorder reported significantly higher perceived social support scores.
Perceived social supports from significant others and friends were found to be
important associated factors for lower depressive disorder vulnerability. Hence,
physicians should routinely screen for depressive disorder in this vulnerable
group and explore and mobilize their social support to reduce patients’
vulnerability to develop depressive disorder.
Objectives: To determine the association of students’ perception of schooling with externalizing/internalizing scores; and to examine the different perceptions related to truancy. Methods:A total of 373 predominantly 16 year-old students attending three high risk schools in Pudu, Kuala Lumpur completed the questionnaires on schooling variables (four items) and externalizing/internalizing syndromes (Youth Self-Report, 112 items). Results: Certain negative perceptions (uncertainty of the schooling purpose, thinking schooling as time wasting) were significantly associated with higher internalizing (p
Objective: A study was conducted at the Universiti Kebangsaan Malaysia Medical Center (UKMMC) adult psychiatric clinic from June 2006 to December 2006. The aim was to assess the rate of the metabolic syndrome in a group of outpatients with mood disorders and schizophrenia and also to determine the relationship of this condition with sociodemographic factors and psychiatric illness characteristics.
Methods: A total of 51 subjects agree to participate of which 100 were approached. The International Diabetes Federation (IDF)(2005) criteria are used for the diagnosis of metabolic syndrome and Diagnostic Statistical Manual Version IV (DSM-IV) criteria are used to made psychiatric diaognosis.
Results: The prevalence of metabolic syndrome was found to be 37.2% and was significantly higher amongst mood disorders patient. However the metabolic syndrome is not associated with the anti psychotic therapy (p=0.41).
Conclusion: This study suggests that it is important for the psychiatrist to monitor metabolic syndrome in any of their patients.
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Objective: Several cases of suicide attempt by charcoal burning producing CO have been reported in Malaysia. This case report highlights a case of delayed delayed neuropsychiatry sequelae (DNS) in CO poisoning.
Method: We report a young Chinese homemaker who presented with DNS who was detained in a Malaysian forensic psychiatric ward.
Results: After approximately two weeks of admission, in a familicide attempt, she had started to exhibit subtle changes in her behaviour, including social withdrawal, impaired memory, and there was lack of emotional distress.
Conclusion: We report an interesting DNS as one of the two forms of chronic sequelae of CO poisoning, whereas the other type of neuropsychiatric sequelae is the persistently progressive type.
Objective: This case report highlights the challenges in managing Frontal Lobe Syndrome (FLS) in a patient with end-stage renal disease. Methods: This is a case description of a 58 year-old gentleman who presented with behavioural changes: irritability, mood lability, aggression, psychosis, and overfamiliarity. His presenting symptoms were in keeping with (FLS) with positive findings on Computed Tomography (CT) scan of the brain and also neuropsychological assessments. Difficulties arose in attempts to control his aggression without further compromising his renal function. Results: The usage of the commonly used antipsychotics in controlling aggression was restricted in view of the patient’s renal impairment. Augmentation with low dose memantine proved to be beneficial in this case, without causing further deterioration in renal function. Conclusion: The use of memantine to augment the effect of risperidone was observed to be safe and successful in managing the behavioural changes associated with FLS in adults with end-stage renal disease. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 93-96.
Objective: ADHD is a complex neurobiological disorder, which required tactful
intervention. Besides pharmacotherapy, there is still limited information in
addressing the efficacy of cognitive behavior therapy (CBT) for treating this
developmental disorder.
Methods: We report a case of late diagnosed of ADHD
whose facing difficulty to cope with her undergraduate degree. She has to repeat
her semester examination due to lack of attention. Denial was seen in both
patient and family in accepting the diagnoses, and posed roadblock for
successful intervention.
Results: Six sessions of CBT were conducted, coupled
with psycho education for both the family and patient. Consultation from the
university’s management helped her to accept and cope with her ADHD
symptoms, i.e. attention and impulsivity. The patient showed improvement
following this intensive bio-psycho-social intervention.
Conclusion: The short
duration of CBT was found suitable to be adapted and implemented in young
adult ADHD.
Introduction: Both premature ejaculation(PE) and erectile dysfunction(ED) are prevalent sexual health disorders that have been inadequately investigated in Malaysia, a multiethnic and conservative nation.The objective of the study was to study the relationship between PE and ED, and other common mental health issues, i.e. anxiety and depression in Malaysian urban population.
Methods: The diagnosis for PE was established by clinical diagnosis using DSM-5 and ISSM definition criteria for PE, whereas a diagnosis of ED was established by the International Index of Erectile Function (IIEF) questionnaire. Anxiety and depression levels were detected from the Hospital Anxiety and Depression Scale (HADS).
Results: Based on DSM-V and ISSM clinical diagnosis for PE, the prevalence of PE was found to be 25%. Erectile dysfunction (p = 0.035, OR = 3.315, 95% CI 1.088, 10.103) and severe anxiety (p = 0.020, OR = 7.656, 95% CI 1.383, 42.396) significantly predicted presence of PE.
Conclusion: There was a strong association between PE and ED and between PE and anxiety. Routine examination for PE in male patients should address the issue and the management of both ED and anxiety among PE patients, especially in an urban Malaysian clinical and medical care setting.
Objective: Long-term use of ecstasy is known to be a risk factor for structural brain damage and psychosis. Most patients suffering from ADHD in childhood will not develop psychosis during adulthood but the risk is increased when there is concomitant significant drug use. However, it is difficult to distinguish between substance-induced psychoses with schizophrenic psychosis.
Method: We report a case of a patient with history of ADHD who was untreated, who later developed psychotic symptoms soon after initiation of ecstasy uses. The symptoms persisted despite in a ‘drug-free period’ and intensified while on the ecstasy.
Results: Present case helps to understand common neurobiological mechanism behind psychosis and brain atrophy, and risk factors such as ADHD and ecstasy abuse.
Conclusion: More research in this area is vital for management and further understanding on the importance of treating ADHD earlier and to be more vigilant in establishing the history of substance use.
Objective: This study aims to report on the process of standard settings (SS) and to compare the passing rates between the norm-reference and SS methods, for OSCE in psychiatry undergraduate examination at UKM for 2009/2010 session. Methods: In the SS method, examiners were asked to imagine the performance of a minimally competent student and gave marks using a standardized check-list. The marks in particular outliers were discussed. After the first round, the examiners went through the same process again, to rate the minimally competent students independently. The median of the marks was taken as the passing mark for the particular question. The passing rate using the passing mark of 50% in the normreference method was compared to the passing rate from the passing mark obtained from the settings method. Results: For question 1, the passing rate with the norm-reference method (i.e. passing mark of 50%) was 93% (106/114) and that by the SS method was 72.8% (83/114). For question 2, the pass rate with the norm-reference method was 92% (105/114) and that by the SS method was 67.5% (77/114). Conclusion: The passing rates between the two methods showed significant differences. Although OSCE is an improvement to the undergraduate psychiatry examination in Universiti Kebangsaan Malaysia, there were few limitations and challenges that need to be tackled for further improvement.