This is a model answer of Critical Review paper for Malaysian postgraduate examination in psychiatry. This model answer was used for marking the review paper for Master of Medicine (Psychiatry) and Master of Psychological Medicine, May 2009.

Both premature ejaculation(PE) and erectile dysfunction(ED) are prevalent sexual health disorders that have been inadequately investigated in Malaysia, a multiethnic and conservative nation.The objective of the study was to study the relationship between PE and ED, and other common mental health issues, i.e. anxiety and depression in Malaysian urban population. Methods: The diagnosis for PE was established by clinical diagnosis using DSM-5 and ISSM definition criteria for PE, whereas a diagnosis of ED was established by the International Index of Erectile Function (IIEF) questionnaire. Anxiety and depression levels were detected from the Hospital Anxiety and Depression Scale (HADS). Results: Based on DSM-V and ISSM clinical diagnosis for PE, the prevalence of PE was found to be 25%. Erectile dysfunction (p = 0.035, OR = 3.315, 95% CI 1.088, 10.103) and severe anxiety (p = 0.020, OR = 7.656, 95% CI 1.383, 42.396) significantly predicted presence of PE. Conclusion: There was a strong association between PE and ED and between PE and anxiety. Routine examination for PE in male patients should address the issue and the management of both ED and anxiety among PE patients, especially in an urban Malaysian clinical and medical care setting.

This study aimed to determine the prevalence of depressive disorder and its association with perceived social support among patients with HIV attending the Infectious Disease Clinic in HTJS. Methods: A cross-sectional study was conducted, and systematic random sampling method was employed for the selection of participants. Socio-demographic and clinical details were obtained through a self-rated questionnaire and participants’ medical records. Depressive disorder was screened and diagnosed using the Mini International Neuropsychiatric Interview (M.I.N.I.) and perceived social support was determined using the Multidimensional Scale of Perceived Social Support (MSPSS). Appropriate statistical analyses were used to determine the prevalence of depressive disorder and its association with perceived social support. Results: A total of 99 patients participated in this study. The mean age of participants was 38.16 ± 1.01 years, and the majority of participants were male (69.7%). Most of the participants were Malay (58.6%), followed by Indians (20.2%), Chinese (17.2%) and others (4.0%). The majority had completed secondary education (54%), and most were employed (79.8%). Most of the participants were single (45.5%) or married (45.5%). The lifetime and point prevalence of depressive disorder was 24.2% and 17.2%, respectively. About 64.7% of patients with depressive disorder were undiagnosed. Out of the 3 sources of perceived social support, perceived social support from a significant other (OR=0.53, p=0.042, Cl=0.29, 0.98) and perceived social support from friends (OR=0.49, p=0.015, Cl=0.27, 0.87) were found to be negative predictors for depressive disorder. Conclusion: This study reports that the prevalence disorder among patients with HIV in HTJS is higher than that of the general population. Patients without depressive disorder reported significantly higher perceived social support scores. Perceived social supports from significant others and friends were found to be important associated factors for lower depressive disorder vulnerability. Hence, physicians should routinely screen for depressive disorder in this vulnerable group and explore and mobilize their social support to reduce patients’ vulnerability to develop depressive disorder. ASEAN Journal of Psychiatry, Vol. 18 (1): January – June 2017: XX XX.

Objective: This case report highlights a case of young male referred for psychiatric evaluation due to paraphilic disorder. This 27-year old single male working as an assistant accountantwas noted to have voyeuristic behaviour andpresented with depressive symptoms since his teenage age. He has poor coping whenever he experiences stress in life. He started to watch pornographic videosand subsequently get involved by peeping pre-pubescent’s undergarments. These activities are followed by a compulsive behavioursuch as masturbation to gratify his sexual arousal. Results: The patient undergone several psychotherapy sessions, and medical report was furnished for the court's purpose. Our assessment revealed that he was suffering from a lifetime major depressive disorder,and he was prescribed with Tablet Sertraline 50mg/daily.He also has premature ejaculation, severe in nature. He regretted his voyeuristic urge and psychotherapyfocused on how to channel his sexual needs. Conclusion: Mood disorder is seen in paraphilic disorder and has to be dealt with in order to establish good management care.

Objective: This paper aims to highlights the answer for Review Paper Mock Exam for the Malaysian Master of Medicine (Psychiatry) theory examination. The paper compared the risk of sexual dysfunction associated with the use of two antidepressants in patients attending a university hospital. Methods: One of the papers presented during the journal club presentation was picked-up for evaluation of student’s critical appraisal. Results: Model answer was given at the end of the Mock Critical Review Paper. Conclusion: This review paper is an important method of evaluating the student’s understanding and critical thinking on the topic of risk of sexual dysfunction associated with escitalopram and fluoxetine in female patients. This paper may serve as a guideline for nurturing young talents at the postgraduate level to critically appraise topic related to Psychiatry and sexuality

Objective: To investigate patient’s perceived satisfaction and adequacy of information given by doctors on prescribed drugs in an outpatient psychiatric setting. Methods: The sampling was done consecutively with a target sample size of 200 patients. A simple questionnaire that was developed with 10 close-ended questions and yes or no answers was administered by the interviewing team. This questionnaire assessed patients' knowledge on prescribed medications and their perception on the adequacy of information given. Results: More than 80% of the patients were informed regarding the reasons, timing to take medication(s), duration of drug treatment and type of prescribed drugs. Half of them were informed regarding the side effect profiles of their prescribed medications. Majority of them (80%) were satisfied with the information given despite only 49% of the patients being given adequate information on their medications. Conclusion: Patients who are adequately informed about their medications are more significantly satisfied than those inadequately informed. (χ2=4.085, p<0.05).

This paper aims to discuss the answers to Review Paper Exam for the Malaysian Master of Medicine (Psychiatry) May 2012 theory examination. The paper studied the psychotropic prescription practice in cancer patients using a health care registration database. Methods: One of the papers presented during the journal club presentation was picked-up for evaluation of student’s critical appraisal. Results: Model answers were provided at the end of the Critical Review Paper. Conclusion: This review paper evaluates students’ understanding and critical thinking on the topic of Psychotropic Drugs in cancer patients. This paper may serve as a guideline to teach students how to critically appraise topic related to psychiatry.

The aim of the study was to compare sexual functioning among Malaysian women in a primary care setting between those with a low and high frequency sexual intercourse.Across-sectional study on 230 married Malaysian women in a primary-care setting was conducted at the Bandar Tun Razak Clinic, Cheras. A validated Malay version of Female Sexual Function Index questionnaire (MVFSFI) was used to assess the sexual functioning profiles among women with low and high sexual activity. The percentage of women who had sexual intercourse 3-4 times a week, 1-2 times a week and < 1-2 times a month were 13.4%, 44.3 % and 42.4 % respectively. Women with a low frequency of sexual intercourse (Low SI) tended to suffer from more sexual dysfunction, (χ²=28.98, p < 0.001) compared to those with a high frequency of sexual intercourse (High SI) group. Women who were less sexually active (having low frequency intercourse, ie. ≤ 1 – 2 times per week) were found to be less sexually aroused (χ²= 25.9, p< 0.001), less orgasmic (χ²=19.8, p< 0.001), less lubricated during sexual activity (χ²=11.1, p< 0.001), complain of sexual pain (χ²=4.3, p = 0.033) and feels less satisfied sexually (χ²=12.6, p< 0.001).The problem of female sexual dysfunction (FSD) in the Malaysian primary care population with low sexual activity needs to be addressed.

Objective: To investigate the prevalence of Female Orgasmic Dysfunction (FOD) focusing on the orgasm domain among female patients attending PPUKM Psychiatric clinic. To compare the prevalence of orgasmic dysfunction between female patients on Escitalopram and on Fluoxetine therapy. Methods: A validated questionnaire for sexual function was used to assess orgasmic function. A total of 112 women aged between 24 and 57 participated in this study. The orgasmic dysfunction was compared between patients on selective serotonin reuptake inhibitors (SSRIs) fluoxetine and escitalopram. Results: The prevalence of female orgasmic dysfunction was 58.9% (33/56) among patients treated with Fluoxetine and 41.1% (23/56) among patients treated with Escitalopram. However, there was no statistically significant difference between these two treatment groups (p=0.059). The odds to have FOD among patients on higher dose of antidepressants was found to be higher compared to those patients who were on lower dose of antidepressants (Odds ratio 5.32, p= 0.001). Conclusion: There was no significant difference of Female Orgasmic Dysfunction between patients on Fluoxetine and Escitalopram