Association of coping mechanisms with medication adherence among young People living with HIV (PLHIV) in Klang Valley.

Background: As young People Living with HIV (PLHIV) will need to take antiretroviral therapy (ART) for life, there is a need to understand their coping mechanisms in living with the disease. Lack of coping mechanisms leads to poor medication adherence and hospital follow-up, poor health outcomes and shortened life expectancy. Objectives: This study aimed to determine the pattern of coping mechanisms in young PLHIV and its association with medication adherence. Methods: This study was a cross-sectional study amongst young PLHIV patients (aged 20-39 years old) attending two HIV clinics in Klang Valley. Data was collected between February to August 2022. The pattern of coping strategies was assessed using the 28-item Brief Coping Orientation to Problems Experienced (COPE) questionnaire in English and Malay language, which was validated and found to have good internal consistency. Self-reported medication adherence was measured using the one-item Medical Outcomes Study (MOS) Specific Adherence Scale. Statistical analysis included descriptive statistics, single and multiple logistic regression. Results: A total of 395 respondents were recruited for the study. The mean scores for each coping mechanism were: 1) problem-focused coping 2.98 (SD 0.62), 2) emotion-focused coping 2.40 (SD 0.48), 3) dysfunctional coping 1.84 (SD 0.44) and 4) religion/spirituality coping 3.07 (SD 0.97). The majority of the respondents (66.8%) were adherent to their ART. Respondents who had a longer duration of medication [OR:1.014 (95% CI: 1.002,1.026)] and those who adopted less religion/spirituality coping mechanisms [OR: 0.495 (95% CI:0.246, 0.997)] were found to be significantly associated with medication adherence. Conclusion: This study revealed an overall medication adherence rate of 66.8%. Patients with longer ART duration and who adopted less religion or spirituality coping had better medication adherence. These study findings provide input into the design of intervention by clinicians and healthcare policy makers for young PLHIV in clinical practice.

The Osseous Pathology of Purpura Fulminans in a Two-Year-Old Child: A Case Report.

Purpura fulminans (PF) is a severe clinical manifestation of Neisseria meningitides infection that is associated with high mortality rates in children. Survivors are frequently left with debilitating musculoskeletal sequelae. There is a paucity of reports on the musculoskeletal pathology of purpura fulminans. We report on a 2-year-old boy with purpura fulminans due to meningococcemia. The child developed distal gangrene in both the upper and lower limbs. Amputations were done for both lower limbs. Histological examination of the amputated specimens showed an inflammatory process and features of osteonecrosis. The latest follow-up at the age of 6 years showed a right knee valgus due to asymmetrical growth arrest of the proximal tibia. PF and its complications are challenging to treat and may require a multidisciplinary approach to improve patient's functional ability.

The Osseous Pathology of Purpura Fulminans in a TwoYear-Old Child: A Case Report

@#Purpura fulminans (PF) is a severe clinical manifestation of Neisseria meningitides infection that is associated with high mortality rates in children. Survivors are frequently left with debilitating musculoskeletal sequelae. There is a paucity of reports on the musculoskeletal pathology of purpura fulminans. We report on a 2-year-old boy with purpura fulminans due to meningococcemia. The child developed distal gangrene in both the upper and lower limbs. Amputations were done for both lower limbs. Histological examination of the amputated specimens showed an inflammatory process and features of osteonecrosis. The latest follow-up at the age of 6 years showed a right knee valgus due to asymmetrical growth arrest of the proximal tibia. PF and its complications are challenging to treat and may require a multidisciplinary approach to improve patient’s functional ability.

Sociodemographic Factors of Depression During the COVID-19 Pandemic in Malaysia: the COVID-19 Mental Health International Study.

OBJECTIVES: To determine the prevalence of depression and the sociodemographic factors associated with depression in Malaysia during the COVID-19 pandemic METHODS. This study is part of the COVID-19 Mental Health International Study to collect data on the impact of the pandemic on mental health through an online survey. People who were aged ≥18 years, able to read Malay or English, had access to the internet, and consented to participate were asked to complete a pro forma questionnaire to collect their sociodemographic data. The presence of distress and depression was assessed using the English or Malay version of the Center for Epidemiologic Studies Depression Scale. RESULTS: Of 963 participants, 451 (46.8%) had depression and 512 (53.2%) had no depression who were either normal (n = 169, 17.5%) or had distress (n = 343, 35.6%). Participants had higher odds of having depression when living with two people (adjusted odds ratio [AOR] = 3.896, p = 0.001), three people (AOR = 2.622, p < 0.001) or four people (AOR = 3.135, p < 0.001). Participants with three children had higher odds of having depression (AOR = 2.084, p = 0.008), whereas having only one child was a protective factor for depression (AOR = 0.481, p = 0.01). Participants had higher odds of having depression when self-employed (AOR = 3.825, p = 0.003), retired (AOR = 4.526, p = 0.001), being housekeeper (AOR = 7.478, p = 0.004), not working by choice (AOR = 5.511, p < 0.001), or unemployed (AOR = 3.883, p = 0.009). Participants had higher odds of depression when living in a small town (AOR = 3.193, p < 0.001) or rural area (AOR = 3.467, p < 0.001). Participants with no chronic medical illness had lower odds of having depression (AOR = 0.589, p = 0.008). CONCLUSION: In Malaysia during the COVID-19 pandemic, people who are living with two, three, or four people, having three children, living in a small town or rural areas, and having unstable income have higher odds of having depression. Urgent intervention for those at risk of depression is recommended.

Relationship between ultrasonographic nerve morphology and severity of diabetic sensorimotor polyneuropathy.

BACKGROUND AND PURPOSE: In the current study, the aim was to characterize the nerve ultrasound cross-sectional areas (CSAs) of type 2 diabetic patients with diabetic sensorimotor polyneuropathy (DSP) of different severities. METHODS: A hundred symptomatic DSP patients and 40 age-matched healthy controls were prospectively recruited. DSP severity was ascertained through the Toronto Clinical Scoring System (TCCS). Nerve electrophysiology and ultrasound were performed on both lower limbs and the non-dominant upper limb. RESULTS: The sural nerve was inexcitable in 19.1% of mild, 40.0% of moderate and 69.0% of severe DSP groups. In contrast, CSAs were measurable in all nerves of DSP patients and were significantly larger compared to controls. Patients with severe DSP had significantly larger ulnar, peroneal, tibial and sural nerves compared to mild DSP patients. By receiver operating characteristic curve analysis, the cut-off value for the sural nerve at 2 mm(2) was a good discriminator (area under the curve 0.88) between the presence and absence of DSP (sensitivity 0.90; specificity 0.74) but performed less well in discriminating between the severity of DSP (cut-off 2.75 mm(2); area under the curve 0.62; sensitivity 0.59; specificity 0.73). Significant correlations were demonstrated between TCSS scores, most neurophysiology parameters and CSAs of the ulnar, peroneal, tibial and sural nerves. CONCLUSION: Nerve ultrasound in DSP reveals enlarged CSAs and these changes worsen with increasing disease severity, thus serving as a useful diagnostic tool especially when neurophysiology is unrevealing.

Maternal Filicide among Women Admitted to Forensic Psychiatric Institutions in Malaysia: Case Series.

OBJECTIVES: To examine the characteristics of maternal filicide and describe the adverse life events experienced by women who have committed filicide and been hospitalised in forensic psychiatric institutions in Malaysia. METHODS: Registration records from 2000 through 2012 of female patients from 2 main forensic psychiatric institutions in Malaysia were reviewed. The medical records of patients who had committed maternal filicide were selected and descriptively evaluated. RESULTS: A total of 18 cases of maternal filicide were identified. Family dysfunction that presented with marital discord, domestic violence, or husband with substance abuse was the main stress experienced by the women. Three social circumstances, including an adolescent who became a victim of date rape; immigrants who experienced sexual abuse; and filicide-suicide precipitated by financial difficulties were highlighted. CONCLUSION: Women who committed filicide had experienced various difficulties in their life. The presence of such life events might alert mental health professionals to investigate the possibility of filicide among their patients.

Medication adherence in schizophrenia: a comparison between outpatients and relapse cases.

OBJECTIVE: Adherence to medication is essential for maximising the outcomes of patients with schizophrenia as the consequences of poor adherence are devastating. The study aimed to compare medication adherence between patients with relapse schizophrenia and those attending psychiatric follow-up clinics, and to determine the factors affecting adherence. METHODS: This was a cross-sectional study involving 70 patients with schizophrenia who were divided equally into 2 groups. Medication adherence was assessed with the Medication Adherence Rating Scale. Appropriate instruments were used to measure insight, social support, and psychopathology. Various socio-demographic and clinical variables were explored to find associations with medication adherence. RESULTS: Medication adherence among patients with schizophrenia was poor; 51% of the patients did not adhere to a medication regimen. Adherence was better in outpatients with schizophrenia (61%) than in relapse cases (39%), although the difference was not statistically significant (t = 1.70; p = 0.09). Besides, relapse patients had significant higher number of admission (X(2) = 22.95; p < 0.05) and severe psychopathology (t = -29.96; p < 0.05), while perceived social support was significantly better in outpatients with schizophrenia (t = 2.90; p < 0.05). Frequency of admission (adjusted b = -0.55; 95% confidence interval [CI], -0.99 to -0.10; p < 0.05) and psychopathology (adjusted b = -0.12; 95% CI, -0.24 to -0.01; p < 0.05) were also significantly associated with medication adherence. CONCLUSION: Medication adherence among both groups of patients with schizophrenia was poor. If adherence is addressed appropriately, the number of admissions and severity of psychopathology could be improved.

The pathway followed by psychotic patients to a tertiary health center in a developing country: a comparison with patients with epilepsy.

The objective of this study was to describe and compare the pathways followed by Malay patients with psychoses (schizophrenia and schizophreniform disorder) and Malay patients with epilepsy to a tertiary health center in the northeastern area of peninsular Malaysia. There were 60 patients in each group. The most popular pathway for both groups was first contact with traditional or alternative healers. Consultation with Malay traditional healers (bomohs) and/or homeopathic practitioners (44.2%) was significantly higher for psychotic patients (61.7%) than for patients with epilepsy (26.7%) (chi(2)(2)=15.609, P<0.001). Direct access (24.2%) was the second most popular pathway and almost equally followed by both groups of patients. The third and last pathway was initial contact with private general practitioners and government doctors, respectively. Patients with epilepsy dominated the last two pathways. The treatment delay (TD) was significantly longer in epileptic than psychotic patients regardless of their visit to a bomoh and/or homeopathic practitioner (P<0001) or not (p<0.01). The socioeconomic status of psychotic patients also was significantly better than people with epilepsy (chi(2)=9.957, chi(2)(4), p=0.041).

Drug substitution therapy: a new approach in preventing the spread of HIV/AIDS in Malaysia.

The prevalence of HIV/AIDS among drug addicts in Malaysia is high, especially among intravenous drug users. The present treatment and rehabilitation of drug addiction is considered as a failure. The government finally decided to start on Drug Substitution Therapy in early 2005 as an effort to prevent the spread of HIV/AIDS in the country.

Help-seeking pathways among Malay psychiatric patients.

The aim of this study is to explore the help-seeking behaviour of Malay psychiatric patients. A semi-structured interview based on a standard proforma was conducted to assess help seeking process and delays for Malay psychiatric patients attending the psychiatric clinic for the first time. Help-seeking process and delays were defined. Among 134 patients evaluated in the study, 69% had visited traditional healers (bomoh) for the present illness before consulting psychiatrists. The second popular choice of treatment was medical practitioner and only a small percentage of them had consulted homeopathic practitioners and herbalists. Patients who had consulted bomohs were significantly delayed in getting psychiatric treatment compared with those who had not consulted them. Consultation of bomohs was significantly higher among married patients, those with major psychiatric illnesses and in family who believed in supernatural causes of mental illness. However, there was no significant difference in age, gender, educational status and occupation between patients who had consulted and not consulted bomoh. We concluded that majority of the Malay psychiatric patients had sought the traditional treatment prior to psychiatric consultation. The strength of social support and the belief of the patients, friends, and/or relatives in supernatural causes of mental illness were strongly associated with the rate of traditional treatment. Deep-seated cultural beliefs were major barrier to psychiatric treatment.

Conversion disorder: a case report of treatment with the Main Puteri, a Malay shamanastic healing ceremony.

We report on the case of a 38-year-old Malay housewife diagnosed with conversion disorder. It was believed that 'evil spirits' caused her symptoms. The patient was eventually treated by the Main Puteri, a Malay shamanistic healing ceremony, after previous treatments failed. The patient improved on the third day of the performance, which was attributed to the departure of the spirits from her body. This case documents the potential benefits of indigenous psychotherapy.

Religious--sociocultural psychotherapy in patients with anxiety and depression.

OBJECTIVE: To show the effectiveness of incorporating religious-sociocultural components in the management of patients with generalised anxiety disorders and major depression who have strong religious and cultural backgrounds as compared with a normal psychotherapeutic approach. METHODS: One hundred and three cases of anxiety and 100 cases of depression with strong religious and cultural backgrounds were randomly assigned to the study or control groups. Both groups received standard treatment for their respective illnesses. The study group was given additional religious-sociocultural psychotherapy. They were followed for 6 months and were assessed in a double-blind fashion using the Hamilton Anxiety Rating Scale or the Hamilton Depression Rating Scale. RESULTS: Patients receiving additional religious-sociocultural psychotherapy responded significantly faster than those who received standard treatment. However, the difference became non-significant at the end of 6 months. CONCLUSIONS: Incorporating a religious and sociocultural component in the treatment program rapidly improved anxiety and depressive symptoms in patients with strong religious and cultural backgrounds. The present study demonstrates a need for more sensitivity to religious-sociocultural issues in the field of mental health.

Reduced red-cell folate in mania.

Forty-five hospitalised patients with DSM-III-R diagnosis of mania, were found to have a mean red-cell folate level of 193 nmol/l, as compared to 896 nmol/l in the control group (P < 0.00001). Assessment of serum folate in both groups showed no significant differences in the levels. Furthermore the manic patients and the controls were matched by the socio-economic status. This indicated that the reduced red-cell folate in mania is associated with the illness and not due to reduced absorption or dietary deficiency of folate. Considering previous studies that showed reduced red-cell folate in depression, our findings suggest that reduced red-cell folate occurred in both phases of bipolar disorders.