Delusions are common among psychiatric patients. Delusions of passion can be very systematised and, at the same time, incredible. The delusions can remain fixed for a long time and treatment is usually not satisfactory. One of the exotic and rare psychiatric conditions is de Clerarnbault's Syndrome and the main feature is a pure erotomania. This condition defies satisfactory classification in the current ICD-IX and DSM-III, and remains as one of the most difficult to treat and troublesome syndromes. Two patients who developed the symptoms of erotomania were treated by the University Hospital, Kuala Lumpur in 1982-1983. One had the primary erotomania of de Clerambaults syndrome while the other suffered from erotomania as a secondary symptom which was part of the symptomatology of her primary illness of schizophrenia. Their case histories and the current western concepts on erotomania were described.
A total of 1018 and 812 first degree relatives (FDR) of schizoprencies and controls respectively, were studied to find out the psychiatric morbidity in the families of paranoid and non-paranoid schizophrenia patients. The risk of schizophrenia and affective disorders was found to be independent of the probands subtype diagnosis. The risk for schizoid-schizotypal and paranoid personality disorders was found to be increased in the first degree relatives of paranoid schizophrenic, as compared to non-paranoid schizophrenic, thus suggesting that the psychopathology in the FDR may differ with the subtype diagnosis of the proband.
A case of a 53-year old-single, Kelantanese lady with a diagnosis of paranoid schizophrenia for 28 years is reported with aims to illustrate the influence of life experiences particularly based on education and intelligent on delusion illustrate the evolving nature of the complexity of delusions as well as to show the importance of documentation in psychiatric practice. We concluded that this patient had used defense mechanism of suppression, reaction formation and persecution throughout her delusion. The final persecutory delusion evolved through series of transformation via object of admirations. We postulated that in-depth emotional insight about effects of schizophrenia might have contributed to her self-reflection that have made her frustrated with her poor achievement in life.
Most studies on predictors of vocational outcomes are cross-sectional and results are varied. This study aimed to examine the vocational rates of patients with first-episode psychosis (FEP), identify factors predicting a lack of engagement in age-appropriate roles, and evaluate the predictive ability of a model with baseline sociodemographic information and 2-year symptom and functioning trajectories on vocational outcomes. The Singapore Early Psychosis Intervention Program (EPIP) has maintained a standing database on patient clinico-demographic information. The primary outcome, vocational status, was operationalized as "meaningfully employed", that is, being gainfully employed or engaged in an age-appropriate role, and "unemployed". Using logistic regression, the predictive ability of the proposed model was evaluated. Vocational data was available for 1177 patients accepted into EPIP between 2001 and 2012. At the end of two years in the service, 829 (70.4%) patients were meaningfully employed and 348 (29.6%) patients were unemployed. The binary logistic regression model on the prediction of 2-year vocational outcomes yielded an AUC of 0.759 (SE = 0.016, p-value schizophrenia, schizophreniform, or delusional disorder at baseline; and belonging to the 'delayed response' or 'slower response and no response' general psychopathology trajectories. We have proposed a model that allows vocational outcomes to be predicted with high specificity. The results of this study will be relevant in developing future intervention models to improve outcomes among FEP patients with different illness trajectories.
The past decade has seen a marked increase in the popularity of ATS use, particularly methamphetamine, within East Asia,and the Pacific region. In Malaysia, the National Anti Drug Agency has identified 8,870 addicts (from January till August 2008) out of which 1,126 was ATS dependence. During the same period, the police have arrested 46,388 people under the Dangerous Drug Act 1952. They also has seize 283kg of syabu, 545kg of ecstacy powder, 66194 tablets of esctacy pills and 222,376 tablets of yaba pills from Jan till August this year. The occurrence of psychosis arising from the use of ATS was first reported in the late 1930's. With growing ATS use, particularly methamphetamine, ATS-induced psychosis has become a major impact on public health.Symptoms of ATS-induced psychosis: Methamphetamine use produces a variety of effects, ranging from irritability, to physical aggression, hyperawareness, hypervigilance, and psychomotor agitation. Repeated or high-dose use of the stimulant can cause drug-induced psychosis resembling paranoid schizophrenia, characterized by hallucinations, delusions and thought disorders. When used in long term, methamphetamine may lead to development of psychiatric symptoms due to dopamine depletion in the striatum. The most common lifetime psychotic symptoms among methamphetamine psychotic patients - as reported in a cross-country study involving Australia, Japan, the Philippines and Thailand - are persecutory delusion, auditory hallucinations, strange or unusual beliefs and thought reading. Those patients were also reported to suffer from impaired speech, psychomotor retardation, depression and anxiety. An ATS psychosis can be distinguished from primary psychotic disorders by time. In ATS-induced psychosis symptoms usually resolve after the drug is discontinued. If symptoms do not resolve within 2 weeks after cessation of stimulant use, a primary psychiatric disorder should be suspected. When compared with other stimulants, such as cocaine, psychosis is induced more commonly by ATS, possibly due to the longer duration of action produced by amphetamines.For example, while smoking cocaine produces a high that lasts for 20-30 minutes, smoking methamphetamine produces a high that lasts 8-24 hours. Other symptoms of ATS-induced psychosis reported include affective blunting,(6) violent behavior, and self-mutilation and self-injurious behavior.