Brain Atrophy And Psychosis In An Untreated Attention Deficit Hyperactivity Disorder (Adhd) With Ecstasy Abuse

@#Objective: Long-term use of ecstasy is known to be a risk factor for structural brain damage and psychosis. Most patients suffering from ADHD in childhood will not develop psychosis during adulthood but the risk is increased when there is concomitant significant drug use. However, it is difficult to distinguish between substance-induced psychoses with schizophrenic psychosis. Method: We report a case of a patient with history of ADHD who was untreated, who later developed psychotic symptoms soon after initiation of ecstasy uses. The symptoms persisted despite in a ‘drug-free period’ and intensified while on the ecstasy. Results: Present case helps to understand common neurobiological mechanism behind psychosis and brain atrophy, and risk factors such as ADHD and ecstasy abuse. Conclusion: More research in this area is vital for management and further understanding on the importance of treating ADHD earlier and to be more vigilant in establishing the history of substance use.

Depression among chronic pain patients at Hospital Tengku Ampuan Rahimah, Klang

Introduction: Despite the high prevalence rates of depression amongst chronic pain patients reported globally, the condition is often under-recognised and under-treated. Depression frequently complicates the effective management of pain and is associated with poor quality of life. This study aimed to explore the incidence of depression and its’ associated factors in a sample of chronic pain patients in Malaysia. Materials and methods: This descriptive cross-sectional study was conducted amongst clinically diagnosed chronic pain patients from the pain management clinic of Hospital Tengku Ampuan Rahimah over a period of seven months. Socio-demographics and clinical data were obtained from patients’ interview and medical records. The validated Depression Anxiety Stress Scale-21 (DASS-21) was used for screening and Mini International Neuropsychiatric Interview (MINI) was used to establish the depression diagnoses among the patients. Numeric pain intensity scale was used to assess the severity of pain. Results: Eighty-three patients with a mean age of 50.4±12.50 years participated in this study. The majority of the patients were females (56.6%), married (85.5%) and being employed (49.4%). The percentage of depression was 37.4%. Depression was significantly associated with severity of pain (p<0.001) and the duration of pain (p <0.05). Conclusion: Almost one third of chronic pain patients in this study have depression. Depression was significantly associated with the severity and duration of pain. Depression should be regularly screened among patient with chronic pain.

Objective structured clinical examination (OSCE) in psychiatry new curriculum undergraduate posting and its standard setting procedure: An experience in Universiti Kebangsaan Malaysia (UKM)

Objective: This study aims to report on the process of standard settings (SS) and to compare the passing rates between the norm-reference and SS methods, for OSCE in psychiatry undergraduate examination at UKM for 2009/2010 session. Methods: In the SS method, examiners were asked to imagine the performance of a minimally competent student and gave marks using a standardized check-list. The marks in particular outliers were discussed. After the first round, the examiners went through the same process again, to rate the minimally competent students independently. The median of the marks was taken as the passing mark for the particular question. The passing rate using the passing mark of 50% in the norm-reference method was compared to the passing rate from the passing mark obtained from the settings method. Results: For question 1, the passing rate with the norm-reference method (i.e. passing mark of 50%) was 93% (106/114) and that by the SS method was 72.8% (83/114). For question 2, the pass rate with the norm-reference method was 92% (105/114) and that by the SS method was 67.5% (77/114). Conclusion: The passing rates between the two methods showed significant differences. Although OSCE is an improvement to the undergraduate psychiatry examination in Universiti Kebangsaan Malaysia, there were few limitations and challenges that need to be tackled for further improvement.

Factors influencing inpatient duration among insanity acquittees in a malaysian mental institution

Objective: According to Malaysian law, defendants found not guilty by reason of insanity may be admitted to a psychiatric hospital and discharge is subject to the state ruler’s assent. The objective of this study is to examine the clinical, socio-demographic and forensic factors that influence inpatient duration of insanity acquittees in a Malaysian mental institution. Methods: This is a cross-sectional study of one hundred and twelve insanity acquittee inpatients in Hospital Bahagia Ulu Kinta from January 2007 to February 2007. Patients with a clinical diagnosis of schizophrenia, major depressive disorder and bipolar disorder were assessed using the Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAMD) and Young Mania Rating Scale (YMRS) respectively. Other relevant socio-demographic, clinical and forensic factors were also assessed. Results: The inpatient duration varied widely from three months to forty-seven years with a median of seven years. Seventy five percent of patients were in remission. According to the multiple linear regression model, the strongest predictor of a longer duration of hospital stay for insanity acquittees was older age (p<0.001) followed by murder as the index offence (p=0.005). Good family support predicted a shorter inpatient duration. This model explains 56% of the variance in the inpatient duration. Conclusion: Social factors such as family support may be increasingly important in determining the discharge process of insanity acquittees besides clinical rehabilitation. Issues such as stigma of violent forensic patients and the role of community forensic rehabilitation services need to be further explored.