Hazli Zakaria

Clinical and cognitive correlates of employment among patients with schizophrenia: a cross-sectional study in Malaysia.

BackgroundGainful employment is one major area of functioning which is becoming an important goal in psychiatric rehabilitation of patients with schizophrenia. Studies in western countries are pointing to evidence that certain sociodemographic and clinical factors may contribute to employment outcomes in this group of people. However, the area is still largely unexplored in Malaysia. The aim of this study was to examine the sociodemographic, clinical and cognitive correlates of employment status among patients with Schizophrenia.MethodsThis was a cross-sectional study. All participants who fulfilled the requirements of the study according to the inclusion and exclusion criteria were enrolled. Study instruments included a demographic data questionnaire, Positive and Negative Symptom Scale (PANSS), Trail Making Tests, Reys Auditory Verbal Learning Test (RAVLT) and Digit Span. Bivariate analyses were done using chi-square for categorical data and t-test for continuous data and multiple logistic regression analysis was done to identify predictors of employment status.ResultsA total of 95 participants who fulfilled the inclusion criteria were enrolled into the study. Among the sociodemographic, clinical and cognitive variables studied marital status, educational level, mean scores of negative symptoms, Digit Span and RAVLT and Trail Making Tests were found to show significant association with employment status on bivariate analyses. However, when entered into a logistic regression model, only cognitive variables ie. Trail A and B, Digit Span and RAVLT were significant predictors of employment status.ConclusionsThe results from this study support the role of cognitive function, particularly, attention, working memory and executive functioning on attaining and maintaining employment in persons with schizophrenia as measured by the RAVLT, Digit Span and Trail Making Tests. These findings may act as preliminary evidence suggesting the importance of integrating cognitive rehabilitation in the psychosocial rehabilitation program for patients with schizophrenia in Malaysia.

An Integrative Approach to Treatment-Resistant Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that often runs a chronic unremitting course. Treatment outcomes can be unsatisfactory despite the availability of various somatic and psychological therapies. Psychodynamic psychotherapy in combination with cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) could help patients with treatment-resistant OCD achieve better outcomes. An integrative approach can help patients gain insight, strengthen the therapeutic alliance, improve treatment adherence, and provide symptomatic relief when other treatments seem insufficient or have failed. We describe the treatment process of a person with treatment-resistant OCD who received pharmacotherapy, concurrent CBT/ERP, and a brief course of psychodynamic psychotherapy. Case formulations from cognitive behavioral and psychodynamic perspectives are presented. The authors discuss the advantages of doing a psychodynamic assessment and formulation in treatment refractory cases and the wisdom of integrating psychotherapy interventions for OCD, as well as the unique clinical features of cases that warrant a multimodal treatment approach.

Knowledge and attitude on sex among medical students of a Malaysian university

The objective of this study was to determine the relationship between clinical/socio‐demographic factors with knowledge and attitude on sex among medical students of the National University of Malaysia (UKM).

Knowledge and attitude on sex among medical students of a Malaysian university: A comparison study

The objective of this study was to determine the relationship between clinical/socio‐demographic factors with knowledge and attitude on sex among medical students of the National University of Malaysia (UKM).

Anxiety Disorders in Family Caregivers of Breast Cancer Patients Receiving Oncologic Treatment in Malaysia

Background: Anxiety is recognized as a normal psychological reaction of those caring for cancer patients. However, anxiety disorders in caregivers may interfere with their care-giving role and require further clinical attention. Objectives: To determine the prevalence and associated factors of anxiety disorders among caregivers of breast cancer patients receiving oncologic treatment in Kuala Lumpur Hospital. Methodology: A cross-sectional study was conducted on 130 caregiver-patient dyads, recruited by non-random sampling at Kuala Lumpur Hospital. Data were collected in 2 stages: 1) the caregivers were screened for psychological distress using the Depression, Anxiety, Stress, Scale (DASS-21) while other related factors for the patients and their caregivers were obtained; 2) the identified distressed caregivers (n=64) were then administered the Mini International Neuropsychiatric Interview (MINI) to diagnose anxiety disorders. Results: A total of 11.5% (n=15) of the caregivers reported suffering from anxiety disorders. Bivariate analysis found duration of caregiving (OR=3.31; CI=2.21-11.93), shared caregiving (OR=4.07; CI=1.34-12.36), and patients’ treatment type (OR=3.42; CI=1.92-12.76) were significantly associated with anxiety disorders (p value <0.05), with shared caregiving and patient’s treatment type remaining significant using logistic regression (p value < 0.05, R2 = 0.255). Conclusions: Every one in ten of the caregivers in this study had a diagnosable anxiety disorder, associated with certain care-giving factors and patients’ treatment. This should alert clinicians to such risk and indicates psychological support needs for family caregivers.

Innovative Educational Initiatives to Train Psychodynamic Psychiatrists in Underserved Areas of the World

Psychodynamic psychiatry remains a challenging subject to teach in underserved areas, where enthusiasm to learn is substantial. Besides logistical and psychiatric workforce shortcomings, sensible cultural adaptations to make psychodynamic psychiatry relevant outside of high-income countries require creative effort. Innovative pedagogical methods that include carefully crafted mentoring and incorporate videoconferencing in combination with site visits can be implemented through international collaborations. Emphasis on mentoring is essential to adequately train future psychodynamic psychotherapy supervisors. Examples of World Psychiatric Association initiatives in countries such as Indonesia, Iran, Malaysia, and Thailand are presented as possible models to emulate elsewhere.

Psychodynamic psychotherapy training in South East Asia: a distance learning pilot program

Leuzinger-Bohleber M., Hautzinger M., Fiedler G., Keller W., Bahrke U., Kallenbach L., Kaufhold J., Ernst M., Negele A., Schött M., Küchenhoff H., Günther F., Rüger B. & Beutel M. (2018) Outcome of psychoanalytic and cognitive-behavioral therapy with chronic depressed patients. A controlled trial with preferential and randomized allocation. Br J Psychiatry, submitted. Norcross J. C. (2005) The psychotherapist’s own psychotherapy: educating and developing psychologists. Am Psychol, 60, 840–850.

EPA-1258 – Diagnosable impulse control behaviours in patients with parkinson's disease

Introduction Impulse control behaviours (ICB) are repetitive and excessive activities that are subsyndromal, unfulfilled the diagnostic criteria but potentially challenging problem. Impulse control disorder (ICD) on contrary is an established diagnosis which requires clinical attention. Objective To determine the proportion of patients with ICD among those screened positive with ICB among patients with Parkinsons disease in an Asian population. The factors associated with ICB were also examined. Method Eighty consecutive patients attending neurology clinic who fulfilled the inclusion criteria i.e. diagnosis of idiopathic Parkinsons, on stable dopaminergic medication for at least 3 months were recruited in this prospective cross-sectional study. ICB were identified using the Questionnaire for Impulsive-Compulsive Disorder for Parkinsons disease (QUIP). Those who were screened positive, with controls, then underwent semi structured interview based on SCID-ICD. Results 11.3% were screened positive for ICB; these were significantly associated with higher education (p=0.022), advanced stage of disease (p=0.026) and higher levodopa dosage (p= 0.01). The most frequent ICB was compulsive medication use (7.5%), followed by hobbyism (6.25%), hypersexuality (5%), compulsive buying (3.75%), punding (2.5%), walkabout (2.5%), compulsive eating (1.25%) and pathological gambling (1.25%). 50% of those with positive QUIP (section1) fulfilled the criteria for ICD (50% positive-predictive value) while none with negative QUIP had ICD (100% negative predictive value). Conclusions About 1 in 10 patients with Parkinsons disease displayed ICB, half of which might have a diagnosable ICD. The risk should alert the physicians of the need for routine assessment of impulse control problems in patients with Parkinsons disease.

2809 – Clinical factors associated with high dosage of methadone among clients attending the methadone clinic in hospital permai, malaysia

Introduction One of the most researched factors which contribute to the good outcome of methadone therapy is the dosage, but local studies which look into the factors associated with the dosage of methadone itself is lacking. Objective To compare clinical factors including level of motivation and the quality of life among the active male clients on high and low methadone dosage. Aim To determine the factors associated with high dosage of methadone in order to improve the services provided. Methods A cross sectional study of active male methadone clients who are on maintenance treatment attending the Methadone Clinic. It was conducted from early January to the end of March 2010. The questionnaires used include Mini International Neuropsychiatric Interview (MINI), Circumstances, Motivation and Readiness to Change (CMR) and WHO-Quality of Life (WHOQOL-BREF). Results Those on higher dosages were noted to have significantly better urinalysis results and had a higher CMR score, but quality of life did not differ between the two groups. Motivational level remained significant after regression analysis was done. Conclusions This study also confirms previous findings of higher methadone dosage having better outcomes in terms of urinalysis results. As the high dose group were also found to be more motivated to change, the regular formal counselling sessions or motivational enhancement therapy was advocated to improve the services of methadone maintenance therapy.

P-1332 - Motor neurological soft signs and verbal fluency among patients with schizophrenia: a significant correlation

Background Neurological soft signs (NSS) are subtle indicator of brain dysfunction which are present in excess among patients with schizophrenia. Its clinical significance remains unclear despite extensive researches. Objective To determine the proportion of schizophrenia patients who have motor NSS and then to compare the verbal fluency between these two groups; with and without motor NSS. Method This cross-sectional study utilized the Brief Motor Scale (BMS) to investigate the presence of motor NSS in 80 schizophrenia patients attended Universiti Kebangsaan Malaysia Medical Centre (UKMMC) psychiatric clinic. The diagnosis was confirmed by Mini International Neuropsychiatic Interview (MINI). Symptomatology and abnormal motor movement were assessed using the Brief Psychiatric Rating Scale (BPRS) and Abnormal Involuntary Movement Scale (AIMS) respectively. A brief verbal fluency test was administered. Bivariate and multivariate analyses were applied to look for any relationship between study factors. Results Majority of schizophrenia patients (68.8%) in this study have motor NSS. The motor NSS were correlated with verbal fluency. Verbal fluency was the only factor that remained significantly correlated with motor NSS after multivariate analysis. Conclusions The assessment of motor NSS represents a brief, inexpensive and meaningful tool in psychiatry. Together with verbal fluency, it has the potential as an illness marker and a link between neurobiological research and clinical practice.