Alot has been said and debated about evidence-based clinical practice. What is it really and why so much of significance is attached to it? Is all the evidence from clinical trials relevant and reliable? How about experience-based clinical practice? How much of our practice is influenced by clinical data and how much of it by years of practice and number of patients managed? The clinician will still need to exercise common sense when treating patients and they must always remember that each individual patient is unique and a clinician’s approach will have to be catered to their needs. After all, the caveat is that we are treating individuals with feelings and emotions and not textbooks or journal articles.
The problem of illicit drug use has been a long standing problem in Malaysia. It is well recognized that drug mis-use is associated with many social, economic and health problems, including mental health problems. Anxiety disorders have consistently been cited as the commonest type of psychiatric disorder in drug users. In Malaysia, many drug users are incarcerated in rehabilitation centres and prison. They form a different type of population as compared to the drug user in the general population, due to the effects of incarceration. With this in mind, a study was carried out in a rehabilitation centre, looking at anxiety disorders. Utilizing the SCID, we found current and lifetime diagnoses for anxiety disorders at 63.4% and 67.6% respectively. Suggestions are made in regards to our findings.
Mental health difficulties in children are often missed or dismissed. Adults too are often wary of bringing their children to such a facility. This paper is a descriptive study of a child mental health service utilization in Kuala Lumpur. Methods: The cases consisted of new cases from the month of January to December 2007 who attended the Psychiatry Adolescent and Child (PAC) Unit, University Malaya Medical Center (UMMC). Results: The children presented with a range of development, academic, behavior and emotional difficulties. There were 373 new cases of which the highest number of children were in the primary school-going age group (54.7%) and males (65.4%). Sixty percent of the cases had one single diagnosis. Children with Attention Deficit Hyperactive Disorder (ADHD) were the highest disorder seen in the single diagnosis group (27.3%) as well as in those with more than one diagnosis (61.5%). Primary support group difficulties were the most common co-morbid condition noted. Conclusion: It is essential that extensive screening of children and their families be done to detect family difficulties and co- morbid conditions, which would be necessary for favorable outcomes to be met.
It has been long known that affective disorders as a result of organic brain diseases are not uncommon. Neurological disorders seem to be significant as risk factors for newly diagnosed mania in the elderly. It has been theorized that lesions in the right cerebral hemisphere and limbic structures may produce symptoms suggestive of mania. Even though specific areas of involvement had not been determined, this case discussed below clearly reports a right sided lesion. One of the reasons why not much is known yet about this clinical entity is the rarity of this occurrence. In fact, in one large scale study, only 2 patients out of 700 were identified with mania.
The population of incarcerated sex offenders in Malaysia is steadily growing. Objective: This is a descriptive study to look at what clinical and developmental characteristic are present amongst the sex offenders in Malaysia, which could be possible mitigating factors. Methods: Data was collected from offenders located in 3 prisons where the offenders are held. Results: a total of 147 prisoners participated in the study. Slightly more than half of the victims were below the age of 18, of which 10% were below the age of 12. Three quarters of offenders were thirty years and older, while 12% were below 18 years. However their problems begun much earlier in their life with 50% of the offenders reporting that they had difficulties in their
primary support group, resulting in them feeling their families were less expressive, their parents were distant and unsupportive.29% of the offenders had not lived with their parents from the age of 16. More than half of the offenders reported academic, behavior and developmental difficulties; they reported losing interest in their studies and were struggling during their schooling days. 43% had history of aggressive behaviour during their adolescent years and 76% had peers who often indulged in risky behaviors. 85% of the offenders were Muslim. 40% made the criteria of Attention Deficit Hyperactive Disorder and conduct disorder while a quarter were diagnosed with having personality disorder. Slightly more than half of the offenders had alcohol and drug-related problems, 36% had history of previous crimes, mainly drug and theft offence. Conclusion: The findings show that the sex offenders are indeed a heterogeneous group with pervasive familial, behaviour, academic and social problems which are possible risk that can be identified early in the lives of offenders.