Shalisah Sharip

Religious-integrated therapy for religious obsessive-compulsive disorder in an adolescent: a case report and literature review

ABSTRACT Religious obsessive-compulsive disorder (OCD) is relatively under-reported among adolescent and carries poorer outcome. We report a 20-year-old Muslim man who was diagnosed with religious OCD when he was 14 years old. He had recurrent blasphemous intrusive thoughts upon performing religious rituals which had hindered him from practising his religion. Despite being on tablet esticalopram 10 mg and conventional cognitive–behavioural therapy, the result was to no avail. A religious-integrated therapy was introduced by incorporating some of the Islamic values, knowledge, and practice during the exposure and response prevention therapy for five consecutive days along with cognitive restructuring. A considerable amount of symptom and functional relief was achieved. He excelled in his studies and equally important was able to resume practising his religion. Religious-integrated therapy is an untapped area that should be offered as the treatment option in certain cases where religion plays an important role in illness’s phenomenology and patient’s coping.

A Case of Sexual Abuse by a Traditional Faith Healer: Are There Potential Preventions?

Adolescent sexual abuse is not an uncommon phenomenon in Malaysia. It is a traumatic experience that complicates the psychosocial development of young people on the threshold of adulthood. This case report highlights the psychosocial sequelae of adolescent sexual abuse by a traditional healer and discusses management issues in the context of unique cultural and belief systems.

Islamic integrated exposure response therapy for mental pollution subtype of contamination obsessive-compulsive disorder: a case report and literature review

ABSTRACT Contamination obsession is the commonest subtype of obsessive-compulsive disorder (OCD), and has been found to be higher among Muslim populations. The presentation of clinical OCD is influenced by one’s religious belief, practice, and culture. Islamic rituals that emphasise on cleanliness or ritual purity could explain why the common contents of obsessions/compulsions among Muslim population are contamination and religion. We want to examine whether Islamic Integrated exposure response therapy (IERT) is suitable for mental pollution. We report a 27-year-old Muslim lady with an acute onset of contamination OCD, complicated with secondary depression. Her fear of contamination was strongly related to impurity and pertaining to Islamic rituals. Ten sessions of IERT were conducted. The patient improved clinically and objectively following the IERT. IERT is another variant of treatment mode that can be used to treat OCD, especially with contamination themes.

Seeking help at an Islamic spiritual healing centre: Malaysia’s perspective

ABSTRACT Spiritual healing centre is a popular place to seek help among Malaysians whether for medical, psychiatric or other reasons. This study aims to understand the characteristics and illness perception of those patients who seek help at Islamic spiritual healing centre. A cross-sectional study was conducted at an established Islamic spiritual healing centre with 357 respondents. Younger age (OR .97, 95%CI .94–.99, p = .002), higher education level (OR 1.99, 95%CI 1.15–3.45, p = .014) and a more threatening view of the illness (OR 1.19, 95%CI 1.13–1.26, p ≤ .001) were found to confer risk of seeking help at this centre among attendees with psychiatric diagnosis. Supernatural attribution to illness is common among the attenders with or without a psychiatric diagnosis. Spirituality is important to bring balance and healing. Collaboration with Islamic spiritual healing practitioners to co-manage patients is recommended.

Psychosis post corona radiata and lentiform nucleus infarction.

Complications of stroke can include neuropsychiatric symptoms. However, post-stroke psychosis is rare. We report a case where an acute presentation of psychosis, depression and fluctuating cognitive impairment in a middle-aged man turned out to be related to a silent brain infarction. The patient had a background of poorly controlled type 2 diabetes mellitus with glycated haemoglobin level of 9.0–11.0%, hypertension and ischaemic heart disease. His CT brain results showed multifocal infarct with hypodensities at bilateral lentiform nucleus and bilateral corona radiata. His strong genetic predisposition of psychosis and a history of brief psychotic disorder with complete remission 3 years prior to the current presentation might possibly contribute to his post-stroke atypical neuropsychiatric presentation, and posed diagnostic challenges. He showed marked improvement with risperidone 6 mg nocte, chlorpromazine 50 mg nocte and fluvoxamine of 200 mg nocte. The need of comprehensive treatments to modify his stroke risk factors was addressed.

Aggression in Malaysian schizophrenia patients: Its clinical determinants and association with COMT Val158Met genotypes

Aggression committed by schizophrenia patients is a major public health concern. Low Catechol-O-Methyltransferase (COMT) activity allele has been implicated in aggression and highly impulsive schizophrenia patients (Strous et al., 1997; Lachman et al., 1996). COMT is an enzyme involved in inactivation of catecholamine neurotransmitters (Siever, 2008). A substitution of single amino acid G-to-A transition at codon 158 resulted in differences in COMT activity: Val/Val displays high activity, Val/Met as intermediate and Met/Met has 4–5 folds lower activity (Lachman et al., 1998). A recent meta-analysis of Val158Met COMT found that male schizophrenia patients who carry the low activity Met allele in the COMT gene are at a modestly elevated risk of violence (Singh et al., 2012). Owing to accumulating evidences suggesting the role of COMT in aggression, replication study in a multiethnic population is essential so as to shed a new light in understanding aggression in schizophrenia patients. Various disease vulnerability and response to pharmacological agents could arise from genetic heterogeneity in culturally mixed populations (Mohamed Saini et al., 2014; Hatin et al., 2011). We have genotyped the COMT gene on 110 unrelated multiethnic schizophrenia patients in the University Kebangsaan Malaysia Medical Centre. This study was granted approval by the University Kebangsaan Malaysia Research Ethics Committee (UKMREC). Informed consent was taken from all patients and their relatives before their enrolment. Aggression was assessed using the Overt Aggression Scale Modified (OAS-M) (Coccaro et al., 1991). The questionnaire measures aggression, irritability and suicidality (Coccaro et al., 1991). A total score of three and above of all subscales is classified as being aggressive or violent (Bobes et al., 2006; Swanson et al., 2006). All episodes of aggression were ascertained by self, family report and respondents’ case notes. We found that the prevalence of aggression in this study was 20.7%. The aggressive patients were young with the mean age of 23.0 10.1 years (t = 108, p = 0.008), had early age at onset of schizophrenia (t = 108, p = 0.001), history of substance abuse (x = 4.99, p = 0.025), poor treatment adherence (x = 3.85, p = 0.05) and previous history of aggression (x = 3.75, p = 0.044). Patients who abused substances were 3 times more likely to become aggressive compared to those without substance abuse (x = 3.85, p = 0.025, OR = 2.86, 95% CI = 1.11–7.35). Both aggressive and non-aggressive patients did not differ in terms of gender, ethnicity, educational level, employment, marital status, duration of illness and family history of psychiatric illness.

Generalization of cognitive training in an Australian sample of schizophrenia patients

OBJECTIVE The present study was undertaken to evaluate the effect of cognitive training in improving trained and untrained cognitive processes in schizophrenia. METHODS A simple pre- and post experimental study with a three month follow-up was conducted to determine the efficacy of cognitive training in speed of processing and executive functions improving cognition in 22 schizophrenia patients. RESULTS Significant improvement was found in those cognitive domains specifically targeted in the training protocol, but also to a limited extent on verbal memory and social cognition. There was also evidence of improvements in symptoms and social functioning. The training effects failed to transfer to community functioning skills however. Except for social cognition, these improvements were maintained at 3month follow-up. CONCLUSION The study highlights the importance of understanding the mechanisms that contribute to the transfer of skills as well as the maintenance of cognitive changes in individuals with schizophrenia.