Most general hospitals in the country have a psychiatric department. According to the Malaysia Mental Health Regulations 2010, "a psychiatric facility shall ensure that each patient has a care plan for the management of the patient during the treatment and upon discharge of the patient". However not every psychiatric department has a trained consultation-liaison psychiatrist. In Malaysia there are only a few numbers of psychiatrists that have undergone a formal sub-specialty training in Consultation-Liaison Psychiatry.
Objective: A rare case of induced hypomania was reported. Method: Patient was a 78-year-old Indian female with squamous cell carcinoma of the nasal septum, childhood bronchial asthma and underlying bipolar disorder. Her bipolar disorder is currently in remission. She developed hypomanic symptoms after one week of initiation of montelukast sodium for treatment of acute exacerbation of bronchial asthma. Result: Her hypomanic symptoms improved after stopping usage of montelukast sodium. Conclusion: Montelukast sodium likely had induced hypomania in this patient.
Introduction: Depression is the most common psychological sequelae in cancer patients. It is challenging to diagnose depression in cancer patients. Furthermore, the presentation is influenced by the patients’ cultural background. Objectives: This literature review aims to determine the prevalence of depression in cancer patients across regions of different cultural background. Methods: A literature search was undertaken by using Pubmed electronic database. Studies were included in this review if they (a) examined the prevalence of depression in cancer patients and (b) published in English peer-review journal between 2000 and 2009. Results: A total of 59 studies from 21 countries were reviewed and summarised. The prevalence of depression in cancer patients ranged from 3% to 72%. Studies from Asia reported the lowest prevalence (3-39%) and Europe reported the highest prevalence (7-72%). Conclusion: Cultural influence may play a role in the prevalent difference of depression in cancer patients. Somatization and stigmatization are suggested as the possible reasons of lower prevalence of depression in Asia region. The biopsychiatric model of mental illness and western psychologization explain the higher prevalence in Western region. Future research on the cross-cultural variability in the presentation of depression in cancer patients is recommended.
The aim of the study was to determine coping strategies among breast cancer patients with depression and anxiety during chemotherapy. Methods: Breast cancer patients with confirmed diagnosis who were undergoing out-patient chemotherapy at the Oncology Unit, University Malaya Medical Centre were invited to participate in the study. They were assessed on their socio demographic profiles and clinical history. The Hospital Anxiety Depression Scale (HADS) was used by patients to report anxiety and depression. The Brief COPE Scale was used to assess coping strategies among the patients. Results: One hundred and forty one patients with mean age of fifty years participated in the study. Prevalence for depression was 19.1% and prevalence for anxiety was 24.1%. Patients who were having anxiety symptoms scored significantly higher on denial, behavioural disengagement and venting as their coping strategies compared to patients who were not anxious. Patients with depressive symptoms scored significantly higher in behavioural disengagement and self-blame as their coping strategies compared to those who were not depressed. Conclusion: Breast cancer patients undergoing chemotherapy experienced high level of depressive and anxiety symptoms. However different coping strategies were adopted to cope with their illness, chemotherapy treatment, practical and family problems, emotional and physical symptoms.
Study site: Oncology clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Parkinson Disease (PD) is a neurodegenerative disorder of the central nervous system that often impairs the patient’s motor skills, speech and other functions. The four cardinal signs of parkinsonism are resting tremor, bradykinesia, cogwheel rigidity and postural instability. The prevalence of depression in PD ranges from 4% to 75%. However depression in PD is often mistakenly as the presentation of the disease itself. Therefore this paper reviewed the clinical feature of depression in PD and explored the aetiology of depression in PD.
Aims: To review the psychosocial risk factors for colorectal cancer (CRC),
report the types and explore their association with CRC.
Methods: We
followed PRISMA guidelines to conduct the systematic review. We searched
electronic databases (PubMed, CINAHL, PsychINFO and EMBASE) and
hand searched up to 15th April 2015 for studies on psychosocial or stress or
depression or anxiety or personality or support or coping as risk factor for
CRC. We extracted information about the place of the study, study design,
measurement tools, participant’s characteristics, psychosocial risk factor and
its association with CRC. We limited the studies in English language only.
The findings were synthesized and analysed. We presented them in tables
and text.
Results: We identified eight research papers which met the criteria.
The studies reported four different types of psychosocial factor i.e.
personality, stress, anxiety and depression. Four studies explored on
personality, two on stress, one on anxiety and one on depression. There were
four case-control studies and three longitudinal prospective studies. Two of
the studies showed a significant association between personality and risk of
CRC and two studies reported otherwise. Aggressive-hostility personality
and negative emotions were significantly associated with risk of CRC. One
study reported high level of job stress, higher anxiety levels and high level of
depressive symptoms in females was also associated with increased risk of
CRC. However, one study showed a lower risk of CRC in highly stressed
females and no clear relationship between stress and risk of CRC in men.
Conclusion: There is still inconclusive evidence to show that psychosocial
factors are risk for colorectal cancer.
Introduction: Interest in mindfulness and its enhancements have quietly exploded in recent years, bringing with it the need for validated instruments to assess mindfulness in the Malaysian population. The study aims to assess the reliability, factor structure and validity of the Malay version of The Mindful Attention Awareness Scale (MMAAS) in a group of nursing students. Methods: The MMAAS was ‘forward-backward’ translated from English to Malay. Two hundred and sixty six nursing students answered the MMAAS. At the same time, they responded to the General Health Questionnaire (GHQ) and Rosenberg Self-Esteem Scale (RSES). We performed Exploratory Factor Analysis (EFA) with varimaxrotation to examine the factor structure of the MMAAS. Associations of retained factors were estimated by Spearman correlation coefficients. Results: Internal consistency reliability of MMAAS was good (Cronbach’s α = 0.851) and showed temporal stability in a 3-week period. Exploratory Factor Analysis (EFA) suggested three factors labelled as “Attention related to generaldomain”, “Attention related to the physicaldomain” and “Attention related to psychological domain”. These factors explained 52.09% of the variance. The Malay MAAS and the English version was highly correlated (r=0.82, p
Objective: The aim of the study was to determine the early readmission rate among the psychiatric patients discharged from a teaching hospital in Malaysia. The associated factors were also examined. Methods: This is a prospective and observational study. The socio-demographic and clinical data of 202 patients from the psychiatric ward were collected on discharge along with the administration of instruments including Brief Psychiatric Rating Scale (BPRS), Life Events Questionnaire (LEQ), and Multidimensional Scale of Perceived Social Support (MSPSS). Assessment of compliance to medication and substance use was reliant on self-report data. Medication compliance was categorized as “poor” vs “good”, whereas poor compliance was the complete discontinuation of medication for at least two weeks. The patients were followed up to determine whether they were readmitted within 6 months. Results: At the end of 6 months follow-up, 32.2% of the subjects were readmitted. Univariate regression analysis indicated that patients with psychotic disorder, past episodes, previous admission, poor compliance, on conventional or depot injectable antipsychotic and higher BPRS scores on discharge were significantly associated with early readmission (p
Objective: This study investigates the relationship between antidepressant response to escitalopram and polymorphism of the serotonin transporter gene promoter region (5-HTTLPR) in multi ethnic Malaysian patients with Major Depressive Disorder. Methods: An eight weeks prospective study of treatment response to escitalopram was conducted on 29 Malaysian patients with Major Depressive Disorder. The severity and improvement of depression were assessed with the Montgomery-Asberg Depression Rating Scale. Patients were also genotyped for long (L) and short (S) polymorphisms in 5-HTTLPR using polymerase chain reaction. Results: Response to escitalopram treatment was more frequent in patients with 5-HTTLPR SS genotype than in those with LL or LS genotypes (p = 0.04, OR = 10.0, 95% CI = 1.05-95.2). The favourable allelic variant for response was S allele (p
Objective: This systematic review is aimed to quantitatively summarise the
prevalence of sexual dysfunction among non-SSRI second generation
antidepressants namely agomelatine, bupropion, duloxetine, venlafaxine, and
mirtazapine.
Methods: Relevant studies published from inception till
December 2012 were identified by searching PubMed, OVID and Embase.
We included all literatures encompassing randomized controlled, cohort,
case-controlled and cross-sectional studies, which contained quantitative data
for prevalence on all aspects of sexual dysfunction in depressive patients who
were older than 18 years of age. Heterogeneity, publication bias and odds
ratio were assessed thoroughly.
Results: In the non-SSRI second generation
antidepressant group which consisted of 17,316 subjects, various studies
showed the range of sexual dysfunction prevalence between 0% and 67%.
Sexual dysfunction in patients who took non-SSRI second generation
antidepressants constituted a meta-analytical pooled prevalence of 15%, and
36% in those who took SSRIs. The combined relative risk of sexual
dysfunction in the non-SSRI second generation antidepressant group when
compared with SSRI was 0.57.
Conclusions: The pooled prevalence of sexual
dysfunction in non-SSRI second generation antidepressant is lower than in
SSRI antidepressants.
Objectives: To study relationship of depressive symptoms to hypertension. Methods: A cross sectional study was carried out on respondents from Kampung Awal. Hypertension was defined as self-reported or by measurement using a mercury sphymomanometer and depressive symptoms were evaluated by CES-D scale. Results: A total 103 respondents were studied. The male:female ratio was 1:1.5 with mean age of 41.8 years. Majority had formal education up to secondary school. 45% were government servant and over 95% subjects had income of RM1000 or less per each family member per month. 21.4% (n=22) self-reported to have hypertension and 7.8%(n=91) met the criteria for incident hypertension. 7.8% met the criteria for both. Mean score based on CES-D was 13.08. 32.0% subjects had depression. 54 subjects reported never experienced any strain for past 6 months and 24 reported to have 2 or more .61 subjects were overweight with mean value of BMI=26.19 kg/m2. Self-reported hypertension and incident hypertension were strongly associated with age but only selfreported hypertension was strongly associated with overweight. However, there was no significant association between hypertension with chronic strains and depressive symptoms. Conclusions: Depressive symptomatology was not associated with hypertension in this survey. Women had a significant risk in having depressive symptoms. Age =45 years & overweight were significant risks for hypertension. A prospective study will be more useful in the future to find out the association between depression and hypertension.
Introduction: There is increasing awareness of the contribution of perceived social support (PSS) to emotional and physical well-being. Numerous scales measuring PSS have been developed, including the widely used Multidimensional Scale of Perceived Social Support (MSPSS). The psychometric properties of the MSPSS have been demonstrated in diverse samples, however mostly are conducted in English. Malay is the official languange in Malaysia, and this study was conducted to provide evidence of the validity and reliability of a Malay version MSPSS (MSPSS-M) suited for our population.
Methods: This is a cross sectional study. The socio-demographic and clinical information of the selected patients from psychiatric outpatient clinic over a 3-month period, were obtained via pre-designed questionnaire, interviews and medical records. Assessment of psychiatric symptoms and social support were measured by various instruments including the Brief Psychiatric Rating Scale (BPRS-E), Depressive, Anxiety and Stress Scale (DASS) and MSPSS-M.
Results: Data were reported for 228 psychiatric outpatients with the mean age of 40.3 years old. The 3-factor structure of the MSPSS-M (significant others, family, and friends) fitted the data well. The MSPSS-M showed good internal consistency (Cronbach α of 0.89) and validity. The scores of the total subscales for MSPSS-M were negatively correlated with the depression subscale in DASS (P < 0.05). BPRS was negatively correlated with significant others (P < 0.01) compared to the other two subscales in MSPSS-M.
Conclusions: The Malay version MSPSS (MSPSS-M) is a psychometrically valid instrument with high internal consistency, which is useful in assessing perceived social support in Malaysian population.
Study site: psychiatric clinic, University Malaya
Medical Center (UMMC)