Introduction: Help-seeking pathway in psychiatry is the important link between the onset of a mental disorder and mental health service provision. Understanding of the help-seeking pathway can help us to device more effective strategies for early detection and treatment. Objectives: To determine the help-seeking pathways and treatment delaying factors of in-patients with first-episode psychosis in Hospital Kuala Lumpur (HKL). Methods: This is a hospital-based cross-sectional descriptive study of 50 in-patients with first-episode psychosis in HKL. Structured Clinical Interview for DSM-IV - Clinical Version for Axis I Disorders (SCID-CV) was used for establishing diagnosis. Socio-demographic data, information on help-seeking pathways, and treatment delaying factors were determined through faceto- face interview and semi-structured questionnaires. Results: The number of non-psychiatric helpseeking contacts prior to first consultation with psychiatric service ranged from 0 to 10. The mean number of contacts was 2.3 ( 2.6), and median was 1 (IQR = 0 to 3). About a third of them (32%) had three or more non-psychiatric contacts. The most common point of first non-psychiatric contact was with traditional healer 24 (48%), followed by general practitioners 12 (24%), and only 14 (28%) of them sought help directly from psychiatric service. The most common reason reported for delay in seeking psychiatric treatment was, “not aware that changes were related to mental illness” (74%). Conclusions: History of contacts with traditional healers was common among in-patients with first episode psychosis in HKL. Treatment delay was mainly contributed by factors related to lack of awareness on psychosis. More strategic mental health education program is needed for early detection and treatment of psychosis.

This case report emphasizes the role of Assertive Community Treatment (ACT)in managing a family with four members suffering from mental illness, mainly schizophrenia. We report a case of middle-aged lady who was diagnosed with treatment resistant schizophrenia (TRS) living with two other family members with the same illness and their carer who developed major depression from shouldering the burden of caring for mentally ill family members. ACT, through its holistic approach, proved to have reduced hospitalizations and improve symptom control and quality of life in this family.
Schizophrenia

Employment among patients with schizophrenia is known to positively influence patients’ recovery. In their crucial supporting role for patients, caregivers’ burden of care and quality of life may also be influenced by the employment status of patients. This study aimed to investigate the association between employment among patients with schizophrenia and burden and quality of life (QOL) of their caregivers. It was a cross-sectional survey among the primary caregivers of patients meeting DSM-IV-TR’s diagnostic criteria for schizophrenia who were under outpatient or community care at Hospital Bahagia Ulu Kinta. Socio-demographic data, including patients’ employment status, were collected. The Burden on Family Interview Schedule (BFS) and the 36-Item Short Form (SF-36) questionnaires were used to evaluate caregiver burden and quality of life, respectively. Altogether, 201 primary caregivers of patients with schizophrenia participated. Most caregiver burden was experienced in the aspects of finance and routine family activities. There was significant association between patient employment status (p<0.001), salary (p<0.001), duration of employment (p<0.001), and type of employment (p<0.001) with the level of caregiver burden. Caregivers of employed patients also had better QOL in the mental health aspect with significantly better mental component scores for SF-36 compared to the unemployed group (mean scores: 51.83 vs. 47.99, p<0.001). Supported employment programmes for patients with schizophrenia may also benefit their caregivers by reducing burden and improving quality of life.

This report stresses on the occurrence of a rare adverse reaction to clozapine, i.e. allergic cutaneous and visceral angioedema, in a patient with treatment resistant schizophrenia (TRS). We report the case of a schizophrenic patient who was resistant to treatment and developed an allergic reaction involving her skin and gastro-intestinal system upon the commencement of clozapine. She was then treated with a combination pharmacotherapy which left some residual symptoms. The manifestation of allergic reactions to clozapine and its management strategies are discussed in the paper. There is a pressing need to develop a new psychotropic which is on par with clozapine.
Schizophrenia ; Clozapine

Miscarriage is one of the most common complications in pregnancy. There is emerging evidence that psychological impact following miscarriage is not unusual. Understanding the magnitude of psychological morbidity is important in the management of miscarriage. The main objective of this study was to compare the mean Hospital Anxiety and Depression Scale (HADS) score between women with miscarriage and women with successful pregnancy and to determine the socio-demographic factor and clinical characteristic that are associated with anxiety and depression. A descriptive case control study was conducted in a teaching hospital, over a period of 12-months (from October 2014 till September 2015). A total of 65 women were recruited with 32 women as the study group (miscarriage) and another 33 women as the control group (women with successful pregnancy). Mean HADS-anxiety score was higher in the study group compared to control group although it was not statistically significant (6.53 ± 3.427 vs 5.73 ± 2.875, p=0.309). Mean HADS-depression score was higher in the control group (4.34 ±2.695 vs 4.45 ± 3.073, p=0.878). Women with maternal age more than 35 years and history of previous miscarriage had a higher tendency of anxiety and depression with higher mean HADS score. There was no association between other socio-demographic data and clinical characteristic with risk of anxiety and depression. As conclusion, there was no significant difference in women with miscarriage as compared to those with successful pregnancies, although older women with history of miscarriage had a preponderance to both disord