Failure in achieving abstinence in methamphetamine dependence population is a common scenario. The use of methamphetamine in pregnancy however, was not so often brought to attention. This report highlights the challenges and issues encountered in the management of a pregnant lady with the problem of methamphetamine dependence, who presented with psychosis. Among the areas outlined were issues in commencing treatment for methamphetamine psychosis, presence of psychosocial conditions that impeded total abstinence and the risks of methamphetamine use during pregnancy.
Methamphetamine ; Pregnancy Women

Background: Good coronary care begins from the patient's home, including early transportation. As such, it is recommended that the patients activate ambulances, rather than to use their own transportations to reach the hospitals. It is not known whether Malaysian patients prefer to use private transportations or ambulances when they develop chest pain. Objectives: This study is conducted to explore the question of the choice of transportation modes among patients with acute coronary syndrome and the reasons behind their choices. Methods: This is a structured interview survey on patients diagnosed with acute coronary syndrome (ACS) in emergency department of Hospital Universiti Sains Malaysia from April 2012 to September 2012. Results: Out of the 110 patients surveyed, 105 (95.5%) patients chose to use own transportation when they developed symptoms suggestive of ACS. Only 3 patients (2.7%) came to the emergency department within 1 hour of onset, and all these 3 patients chose to use ambulances as their modes of transportation. None of the patients who chose own transportation came within the first hour of symptoms onset. This is shown to be statistically significant (p<0.001). The level of education as well as past history of ischemic heart disease did not significantly influence the patients’ choice of transportation. Conclusion: The admonishment by various international resuscitation councils that patients with chest pain should be transported via ambulances may not be as straightforward as it seems. Numerous local and regional socio-cultura and logistic factors may need to beaddressed.
Acute Coronary Syndrome ; Emergency Service, Hospital

Introduction: The forward psychiatry practice in the combat field has proven effective in reducing the attrition rates due to combat and operational stress of the service members. The concept has evolved over the years with the same objective to conserve the fighting troops' strength and minimize the incident rates of post-traumatic stress disorder among the soldiers. The Combat and Operational Stress Reaction (COSR) team has been deployed to the conflict zone and applied the forward psychiatry principles to the troops on the battlefield. Case Series : Here, we presented 3 case series of service members that were attended by the COSR team during their deployment on the frontline. First, a serviceman presented with late recognition of acute stress symptoms following active combat duty with poor support from his unit. Second, a combat engineer presented with anxiety and somatic symptoms after combat duty; third, a combat radio operator with early detection of acute stress symptoms by his unit commander. Results: In the first case, the patient's psychological condition deteriorated, requiring frequent sedation and transfer to a military tertiary hospital. In the second and third cases, both patients improved and returned to their duties with individualized psychotherapy and relaxation techniques. Conclusion Early detection of the symptoms and intervention based on the principles of forward psychiatry in active combat zone facilitate service members' return to function and reduce complications and morbidity to their psychological health

Objectives: Soldiers can manifest a wide range of psychological symptoms that varies from anxiety, depression to somatic symptoms in combative and noncombative situations. This paper aims to discuss the issue related to the challenges of establishing the diagnosis of a soldier in a stressful non-battlefield condition. Methods: : We herein report a young soldier with no underlying medical condition who presented with initial abnormal behaviour associated with progressive mutism for two years. Physical examination was unremarkable. Relevant blood investigations and Magnetic Resonance Imaging (MRI) brain revealed no abnormalities. He was initially treated as brief psychotic disorder and was revised into Schizophrenia based on Diagnostic and Statistical Manuals of Mental Disorders (DSM-5) and was started on antipsychotics. However, he showed no improvement after two years on treatment. He was on the verge of being discharged from the service due to medical reasons. Therefore, he was readmitted to the ward for evaluation of the diagnosis while all of his medications were withheld. Different psychological approaches including supportive therapy and occupational therapy were employed. Results: Following series of individual supportive therapy sessions, we uncovered the unconscious psychological conflicts within him. He gradually started to communicate verbally and his psychosocial functions began to improve. Upon discharged, the soldier was diagnosed as Functional Neurological Symptom Disorder. Conclusion A thorough and careful evaluation was crucial in assessing patients with progressive mutism to ensure a correct diagnosis was made. In a patient who failed to improve after optimum treatments were given, a different approach may be utilized to explore the possible factors that hindered the patient’ recovery.