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  1. Changing attitudes to psychiatry and interest in the specialty as a career choice during clinical undergraduate years at a medical school in Penang, Malaysia
    Hor ESL, Russell V, Vasudevan U, O' Brien F
    Ir J Med Sci, 2020 Feb;189(1):253-259.
    PMID: 31338691 DOI: 10.1007/s11845-019-02064-x
    BACKGROUND: Studies have suggested that the undergraduate clinical clerkship improves medical students' attitudes to psychiatry and career interest in the specialty, but few studies have explored the sustainability of these changes.

    AIMS: To explore changes in students' attitudes to psychiatry and career preference for psychiatry during the course of their senior clinical years at RCSI & UCD Malaysia Campus (RUMC).

    METHODS: All year 3 students (n = 111) at RUMC were invited to complete the Attitudes towards Psychiatry questionnaire (ATP-30) and a separate questionnaire seeking opinions on career preferences. The questionnaires were administered at 3 points in time: in year 3 before the 8-week psychiatry posting, following completion of the posting in year 4, and at the end of year 5. Quantitative data analysis was performed using SPSS version 18, and free-text responses were thematically analysed.

    RESULTS: One hundred completed questionnaires (90.1%) were returned. There was a significant improvement in students' ATP scores after their psychiatry rotation and this was sustained into year 5. Psychiatry as a career choice had highest preference levels following completion of the clerkship but declined in year 5 to below pre-clerkship preference levels. Qualitative analysis of factors influencing a career in psychiatry revealed themes of job satisfaction, lifestyle factors, perceived image of psychiatry, and self-appraisal.

    CONCLUSIONS: Our findings suggest that an enriched undergraduate clinical clerkship experience can help to sustain improved attitudes to psychiatry into the final medical year. However, declining interest in the specialty a career choice prior to graduation presents an enduring challenge.

  2. Atypical neuroleptic malignant syndrome and non-alcoholic Wernicke's encephalopathy
    Hor ESL, Singh GP, Omar NA, Russell V
    BMJ Case Rep, 2021 Aug 05;14(8).
    PMID: 34353834 DOI: 10.1136/bcr-2021-244082
    We report the case of a middle-aged woman with a history of bipolar disorder, in the absence of alcohol or substance misuse. The patient had been maintained on fluphenazine decanoate depot and now presented acutely with cognitive dysfunction and rigidity. Laboratory tests revealed elevated creatine kinase, acute kidney injury with metabolic acidosis and transaminitis, leading to a provisional diagnosis of neuroleptic malignant syndrome (NMS). Neuroleptics were withheld; dialysis was commenced; and blood biochemistry parameters improved in tandem. However, mental status changes persisted, and re-evaluation revealed multidirectional nystagmus with bilateral past-pointing. MRI confirmed the diagnosis of Wernicke's encephalopathy (WE). Prompt recovery followed treatment with high-dose intravenous thiamine. We discuss the co-occurrence of NMS and non-alcoholic WE-highlighting the need for a high index of suspicion for these relatively rare neuropsychiatric diagnoses which are often missed in those with atypical presentations.
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