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Brain tumours often present with a variety of early subtle, non-specific symptoms. This can obscure an organic origin of the illness, which deters timely referral and management. We report a rare case of psychosis in a patient with a left frontal lobe tumour, preceded by 2 months of lethargy and word- finding difficulty with minimal neurological deficits, who was referred to our psychiatric unit from a primary care facility. Blood investigation findings including tumour marker levels were normal. Prompt neuroimaging revealed a left frontal lobe lesion with findings indicating a glioblastoma. The patient was subsequently referred to the neurosurgical team for surgical resection of the tumour. A high index of suspicion is paramount among atypical sociodemographic groups of patients with atypical psychiatric presentations. The primary care setting, which is often the first point of contact for patients, provides an avenue for early detection of such cases and timely referral to the appropriate healthcare system to ensure an optimal outcome.
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The transition from trainee early career psychiatrist (ECP) to independent practitioner can be challenging. Upon completion of training in well-equipped academic settings, an ECP from Myanmar is required to serve in a divisional hospital for at least 3 years. Significant challenges are faced by ECPs practising solo in divisional hospitals, including inexperience in administrative aspects, lack of future-proof training, scarcity of resources and facilities, struggles in the provision of holistic biopsychosocial treatment, work-life imbalance, and limited career advancement and access to continuous training. The solutions tried thus far include the incorporation of information and communication technology in training, gathering support and distant supervision from both local and international settings, and task shifting. Bigger challenges are often rewarded by faster growth, and difficult times stimulate creative solutions. The sacrifice of these solo ECPs has significantly improved the mental health service of Myanmar district regions.
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BACKGROUND: There is strong evidence that collaborative practice in mental healthcare improves outcomes for patients. The concept of collaborative practice can include collaboration between healthcare workers of different professional backgrounds and collaboration with patients, families and communities. Most models of collaborative practice were developed in Western and high-income countries and are not easily translatable to settings which are culturally diverse and lower in resources. This project aimed to develop a set of recommendations to improve collaborative practice in Malaysia. METHODS: In the first phase, qualitative research was conducted to better understand collaboration in a psychiatric hospital (previously published). In the second phase a local hospital level committee from the same hospital was created to act on the qualitative research and create a set of recommendations to improve collaborative practice at the hospital for the hospital. Some of these recommendations were implemented, where feasible and the outcomes discussed. These recommendations were then sent to a nationwide Delphi panel. These committees consisted of healthcare staff of various professions, patients and carers. RESULTS: The Delphi panel reached consensus after three rounds. The recommendations include ways to improve collaborative problem solving and decision making in the hospital, ways to improve the autonomy and relatedness of patients, carers and staff and ways to improve the levels of resources (e.g. skills training in staff, allowing people with lived experience of mental disorder to contribute). CONCLUSIONS: This study showed that the Delphi method is a feasible method of developing recommendations and guidelines in Malaysia and allowed a wider range of stakeholders to contribute than traditional methods of developing guidelines and recommendations.Trial registration Registered in the National Medical Research Register, Malaysia, NMRR-13-308-14792.
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@#Introduction: Doctors are known to deal with high occupational stress, causing increased risk of depression, anxiety and stress.Nevertheless, the prevalence and associatedfactors of depression, anxiety and stress among registered doctorsworking in 24 public hospitals in Sabah, Malaysia are not known yet. Methods: This cross-sectional study was conducted using convenient sampling from September-October 2018. The data of 21-item Depression Anxiety Stress Scale (DASS-21) was collected via online link anonymously. Results: Among 314 doctors, majority of them were females (62.1%), mean age 29 (SD 2.72), non-Sabahan (82.8%), Malays (46.8%), not married (78.3%) and medical officers (93.6%). Prevalence of severe/extremely severe anxiety symptoms was 27.4%,depression (22.9%) and stress (18.5%). Doctors perceiving themselves to be depressed, anxious and/or stressed were more likely to develop the corresponding symptoms. Females and Chinese were twice more likely to report anxiety symptoms. Being married had protective effect against depressive symptoms, while working in same hospital for longer time had a significant but weak protective effect against anxiety and stress symptoms. Conclusions: Mental health issue among doctors is substantial and need to be addressed effectively for the benefit of their life, patients and country.
