MyMedR

Fulltext Psychiatric problems among the elderly in Malaysia

Krishnaswamy S

Med J Malaysia, 1997 Sep;52(3):222-5.

Fulltext A case of schizophrenia with the Klippel-Feil syndrome

Krishnaswamy S, Mohamed M

Med J Malaysia, 1985 Dec;40(4):330-2.

A case of the Klippel-Feil syndrome presenting with schizophrenia is described. The Klippel-Feil syndrome is reported to be associated with abnormalities in many systems of the body, but its association with a schizophrenic illness has not been described.

Fulltext A pilot study on the use of the World Health Organisation self reporting questionnaires (S.R.Q.) on a Malaysian population

Krishnaswamy S, Kyaw OH

Singapore Med J, 1985 Oct;26(6):431-4.

PMID: 4095555

The W.H.O. self reporting questionnaires were distributed to 50 psychiatric outpatients with neurotic disorders and 50 medical staff as controls. This pilot study shows that it can differentiate between normal and neurotic patients and that if a cut off point of 3 is taken, there Is a very good chance that no psychiatric case in any epidemiological study will be missed. This study also picked up the 10 most sensitive items in the S.R.Q. which will be validated In future studies.
Study site: Psychiatric clinic, Hospital Kuala Lumpur, Malaysia

A prevalence survey of mental disorders among children in a rural Malaysian village

Kasmini K, Kyaw O, Krishnaswamy S, Ramli H, Hassan S

Acta Psychiatr Scand, 1993 Apr;87(4):253-7.

PMID: 8488745

This is the first epidemiological survey of mental disorders among children in a Malaysian village. The WHO Research Questionnaire for Children (RQC) was used for initial screening followed by a semistructured interview, the Follow-up Interview for Children (FIC) at its second stage. Diagnosis was obtained by using Rutter's multi-axial classification. The prevalence rates obtained for the diagnostic categories were described in 3 age groups, in accordance with the age of attending school in Malaysia. Of 507 children screened aged 1-15, 6.1% were classified as having a mental disorder.

Fulltext A prevalence survey of psychiatric morbidity in a rural Malaysian village: a preliminary report

Ramli H, Ohn K, Krishnaswamy S, Kasmini K, Hassan S

Singapore Med J, 1987 Dec;28(6):530-3.

PMID: 3441795

An open label study of the use of EEG biofeedback using beta training to reduce anxiety for patients with cardiac events

Michael AJ, Krishnaswamy S, Mohamed J

Neuropsychiatr Dis Treat, 2005 Dec;1(4):357-63.

PMID: 18568116

To establish the effectiveness of EEG biofeedback using beta training as a relaxation technique and ultimately reducing anxiety levels of patients with confirmed unstable angina or myocardial infarction.

Fulltext Test anxiety: state, trait and relationship with exam satisfaction

Ping LT, Subramaniam K, Krishnaswamy S

Malays J Med Sci, 2008 Apr;15(2):18-23.

PMID: 22589620

Test anxiety is defined as the reaction to stimuli that is associated with an individual's experience of testing or evaluating situations. This study aims to examine the fluctuation pattern of anxiety symptoms during a clinical examination and its relationship with underlying anxiety traits. Fourth year medical students of Penang Medical College undertaking the Ophthalmology clinical examination participated in this study. First phase of the survey, on anxiety symptoms was conducted immediately after the Ophthalmology clinical examination while the second phase, on pre-existing anxiety traits was conducted six weeks later with the aid of STAI instrument. Responses for both stages were combined and analyzed. Sixty-three of 122 students responded to both phases of the study, giving a response rate of 52%. All symptoms except trembling peaked 10 minutes before the exam begun showing a downward progression with no resurgence thereafter. Students with pre-existing anxiety traits had high anxiety scores 10 minutes into the examination and while with the examiners. Anticipatory anxiety is a source of concern and can effect performance and appropriate steps should be taken to help the students with this. A few other studies should be done to conclude.

The 2004 tsunami in Penang, Malaysia: early mental health intervention

Krishnaswamy S, Subramaniam K, Indran T, Low WY

Asia Pac J Public Health, 2012 Jul;24(4):710-8.

PMID: 22790355 DOI: 10.1177/1010539512453261

Disasters, natural or man-made, bring numerous health care challenges. In any crisis, mental health programs are a requirement during both the acute and postemergency phases. In the Asian tsunami on December 26, 2004, some of the northwestern coastal areas of Malaysia, particularly the island of Penang, were affected with devastating effects on the residents. Such disasters can predispose to mental health problems among the affected people. An early mental health intervention program was carried out in Balik Pulau, Penang, an area badly affected by the tsunami. The objective of the intervention program was to identify the victims, counsel them, make referrals if necessary, and provide help and resources to prevent the development of mental health problems. Penang residents identified as tsunami victims by the local health authorities were recruited. A group of health care workers, school teachers, village authorities, and volunteers were trained to carry out the crisis intervention program by health care workers experienced in crisis interventions. A total of 299 adults participated in the crisis intervention program, with follow-up assessments being made 4 to 6 weeks later. At the follow-up assessment, 1% of the victims had a problem and they were then referred for further medical assessment. This indicates that the intervention program in the first 2 weeks after the tsunami disaster with referrals to medical services may have helped stabilize the victims.

Sociodemographic risk factors and correlates of dementia in older Malaysians

Hamid TA, Krishnaswamy S, Abdullah SS, Momtaz YA

Dement Geriatr Cogn Disord, 2010;30(6):533-9.

PMID: 21252548 DOI: 10.1159/000321672

The rapid expansion of the aged population in Malaysia is expected to greatly increase the number of persons with dementia in the country. However, data on dementia prevalence at the national level is lacking, and little is known about the sociodemographic risk factors and correlates of dementia. This paper describes a nationwide study of dementia prevalence and its sociodemographic risk factors and health correlates among older Malaysians.

Predictors of Quality of Life among Older People with Mild Cognitive Impairment Attending Urban Primary Care Clinics

Samy AL, Kamaruzzaman SB, Krishnaswamy S, Low WY

Clin Gerontol, 2019 05 20;43(4):441-454.

PMID: 31107185 DOI: 10.1080/07317115.2019.1608611

OBJECTIVES: To study the prevalence of Mild Cognitive Impairment (MCI) among older people attending primary care clinics and its predictors of QOL.

METHODS: A cross-sectional study was conducted at two primary care clinics in Kuala Lumpur, Malaysia, recruiting 271 participants by utilizing the universal sampling method. Every patient who attended both the clinics during the study period and met the inclusion and exclusion criteria were approached and briefed about the study. Patients who gave consent were recruited as study participants. Information on sociodemographic, medical condition, and lifestyle behaviors were obtained. The Montreal Cognitive Assessment (MoCA) was used to screen for MCI at a score < 23. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire was used to evaluate QOL.

RESULTS: Prevalence of MCI was 27.3%. Lower QOL scores were found in the physical (67.3 ± 1.4), psychological (67.3 ± 1.4), social (66.9 ± 1.6) and environmental (71.3 ± 1.3) domains among participants with MCI. Among them, predictors of QOL were depression in the physical domain, age and stroke in the psychological domain, presence of other types of disorders in the social domain and diabetes and stroke in the environmental domain.

CONCLUSIONS: MCI was prevalent among study participants and were associated with poorer QOL in all domains of QOL. A better understanding of predictors of QOL in older people with MCI is deemed important.

CLINICAL IMPLICATION: Routine cognitive screening at primary care clinics will facilitate early recognition of MCI and facilitates referral to memory clinics for further assessment and treatment.

Delayed fathering and risk of mental disorders in adult offspring

Krishnaswamy S, Subramaniam K, Ramachandran P, Indran T, Abdul Aziz J

Early Hum Dev, 2011 Mar;87(3):171-5.

PMID: 21220193 DOI: 10.1016/j.earlhumdev.2010.12.004

Delayed parenting and child bearing at a very young age impose various risks to development of the offspring.

Anxiety, depression and psychosocial stress in patients with cardiac events

Michael AJ, Krishnaswamy S, Muthusamy TS, Yusuf K, Mohamed J

Malays J Med Sci, 2005 Jan;12(1):57-63.

PMID: 22605948

Stress tends to worsen the prognosis of patients with coronary heart disease. The aim of the study is to determine the relationship between stress related psychosocial factors like anxiety, depression and life events and temporally cardiac events specified as acute myocardial infarction and unstable angina 65 subjects with confirmed myocardial infarction or unstable angina were interviewed using 2 sets of questionnaire, the Hospital Anxiety and Depression Scale (HADS) and Life Changes Stress Test, a segment of the Rahe's Stress and Coping Inventory first at time of occurrence of their cardiac event and the second time was 6 months later. Anxiety, depression and life events scores were calculated for both and recurrence of cardiac event for the 6 month duration was also recorded. Patients who had significant levels of depression and or life events were ten times more likely to have recurrence of cardiac events as compared to those without risk for either of these psychological symptoms. Anxiety, depression and stress levels are significantly increased after the onset of ischemic heart disease and could be contributing or predisposing factors for the recurrence of cardiac events for these patients.

Fulltext Psychometric properties of the malay version of the Dutch Eating Behaviour Questionnaire (DEBQ) in a sample of Malaysian adults attending a health care facility

Subramaniam K, Low WY, Chinna K, Chin KF, Krishnaswamy S

Malays J Med Sci, 2017 Aug;24(4):64-73.

PMID: 28951691 MyJurnal DOI: 10.21315/mjms2017.24.4.8

OBJECTIVE: This study aims to investigate the psychometric properties of the Malay version of the Dutch Eating Behaviour Questionnaire (DEBQ) among Malaysian adults.
METHOD: The Malay version of the DEBQ instrument was administered to 398 outpatients (269 women and 129 men) at the University of Malaya Medical Centre (UMMC). Confirmatory Factor Analysis (CFA) was conducted to study the construct validity of the instrument. Composite reliability coefficient, Raykov's rho, was used to determine the internal consistency.
RESULTS: The proposed three-factor structure for the DEBQ instrument was appropriate, although three items (Items 21, 14 and 27) showed problematic loadings with inappropriate model fit and were removed. The modified version had an appropriate model fit χ(2)/df = 2.129, TLI = 0.908, CFI = 0.918, RMSEA = 0.053 (90%CI = 0.048-0.058), close-fit P-value = 0.136 and satisfactory internal consistency of 0.914 for emotional eating scale, 0.819 for external eating scale and 0.856 for restrained eating scale.
DISCUSSION: The Malay version of the DEBQ is a valid instrument to study eating behaviour traits among Malaysian adults. Further research is warranted to determine if Items 14 and 27 are appropriate for the Malaysian population.
Study site: Pharmacy, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

The Clinical Interview Schedule-Revised (CIS-R)-Malay Version, Clinical Validation

Subramaniam K, Krishnaswamy S, Jemain AA, Hamid A, Patel V

Malays J Med Sci, 2006 Jan;13(1):58-62.

PMID: 22589592

Use of instruments or questionnaires in different cultural settings without proper validation can result in inaccurate results. Issues like reliability, validity, feasibility and acceptability should be considered in the use of an instrument. The study aims to determine the usefulness of the CIS-R Malay version in detecting common mental health problems specifically to establish the validity. The CIS-R instrument (PROQSY* format) was translated through the back translation process into Malay. Inter rater reliability was established for raters who were medical students. Cases and controls for the study were psychiatric in patients, out patient and relatives or friends accompanying the patients to the clinic or visiting the inpatients. The Malay version of CIS-R was administered to all cases and controls. All cases and controls involved in the study were rated by psychiatrists for psychiatric morbidity using the SCID as a guideline. Specificity and sensitivity of the CIS-R to the assessment by the psychiatrist were determined. The Malay version of CIS-R showed 100% sensitivity and 96.15% specificity at a cut off score of 9. The CIS-R can be a useful instrument for clinical and research use in the Malaysian population for diagnosing common mental disorders like depression and anxiety.

Factors contributing to utilization of health care services in Malaysia: a population-based study

Krishnaswamy S, Subramaniam K, Low WY, Aziz JA, Indran T, Ramachandran P, et al.

Asia Pac J Public Health, 2009 Oct;21(4):442-50.

PMID: 19783559 DOI: 10.1177/1010539509345862

This paper examines the factors contributing to the under utilisation of health care services in the Malaysian population.

Psychometric assessment of the Bahasa Malaysia version of the Older Americans Resources and Services-Instrumental Activities of Daily Living (OARS-IADL)

Samy AL, Kamaruzzaman SB, Chinna K, Shunnmugam B, Krishnaswamy S, Low WY

Australas J Ageing, 2021 Dec;40(4):423-429.

PMID: 33942961 DOI: 10.1111/ajag.12958

OBJECTIVE: This study aimed to determine the psychometric properties of the Bahasa Malaysia (BM) version of the Older Americans Resources and Services-Instrumental Activities of Daily Living (OARS-IADL) questionnaire among older persons in Malaysia.

METHODS: The English version of OARS-IADL was translated to BM. The psychometric properties of the BM version of OARS-IADL were tested among older persons attending a health-care facility.

RESULTS: Two hundred and seventy-one older persons participated in the study. The mean age of participants was 67.7 ± 6.1 years. Internal consistency of the items was good (Cronbach's alpha, >0.7). Exploratory factor analysis revealed a single dimension with item factor loadings of >0.5. Confirmatory factor analysis results confirmed a single-factor model (AVE > 50%, CR > 0.7 and CR > AVE).

CONCLUSION: The BM version of the OARS-IADL questionnaire is a valid and reliable instrument that can be used to assess the IADL among older persons in Malaysia.

Paternal age and common mental disorders

Krishnaswamy S, Subramaniam K, Indran H, Ramachandran P, Indran T, Indran R, et al.

World J Biol Psychiatry, 2009;10(4 Pt 2):518-23.

PMID: 19191074 DOI: 10.1080/15622970802653691

There is evidence in the literature that there are associations between advancing paternal age and psychosis or more specifically schizophrenia, but not enough to support a strong link between advancing paternal age and common mental disorders.

Peritoneal dialysis: Status report in South and South East Asia

Bhargava V, Jasuja S, Tang SC, Bhalla AK, Sagar G, Jha V, et al.

Nephrology (Carlton), 2021 Nov;26(11):898-906.

PMID: 34313370 DOI: 10.1111/nep.13949

BACKGROUND: Peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) is largely underutilized globally. We analyzed PD utilization, impact of economic status, projected growth and impact of state policy(s) on PD growth in South Asia and Southeast Asia (SA&SEA) region.

METHODS: The National Nephrology Societies of the region responded to a questionnaire on KRT practices. The responses were based on the latest registry data, acceptable community-based studies and societal perceptions. The representative countries were divided into high income and higher-middle income (HI & HMI) and low income and lower-middle income (LI & LMI) groups.

RESULTS: Data provided by 15 countries showed almost similar percentage of GDP as health expenditure (4%-7%). But there was a significant difference in per capita income (HI & HMI -US$ 28 129 vs. LI & LMI - US$ 1710.2) between the groups. Even after having no significant difference in monthly cost of haemodialysis (HD) and PD in LI & LMI countries, they have poorer PD utilization as compared to HI & HMI countries (3.4% vs. 10.1%); the reason being lack of formal training/incentives and time constraints for the nephrologist while lack of reimbursement and poor general awareness of modalities has been a snag for the patients. The region expects ≥10% PD growth in the near future. Hong Kong and Thailand with 'PD first' policy have the highest PD utilization.

CONCLUSION: Important deterrents to PD underutilization were lack of PD centric policies, lackadaisical patient/physician's attitude, lack of structured patient awareness programs, formal training programs and affordability.

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