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

This case report highlights Koro-like symptoms with erectile dysfunction. Methods: We report a case of a Rohingya refugee who presented with Koro-like symptoms associated with erectile dysfunction and severe religious guilt. Results: Sexual dysfunction, i.e. erectile dysfunction may be a predisposing factor for a Koro incidence. Religious issues complicated by superstitious beliefs pose a treatment challenge. Conclusion: Treating patient with sexual dysfunction should involve exploring and addressing patient’s conflicts to avoid worsening of symptoms. As this case illustrates, severe anxiety can present with Koro-like symptoms.

Introduction: Caregivers often experience stressful situations while in the midst of the caregiving process. Thus, various methods of coping have been widely applied and studied in previous researches. The aim of this study was to develop a novel questionnaire to assess the coping strategies employed by those who provide care to patients, and to further validate it among caregivers of schizophrenia patients in Malaysia. Methods: This study, which involved the caregivers of schizophrenia patients from a hospital in Kuala Lumpur, Malaysia, was comprised of three parts, namely in-depth interviews, a pilot study, and the validation of the developed questionnaire, known as Caregiver Cope (CgCopeTM). Results: Part A originally consisted of eight themes, and it was later modified to seven themes with four items each after discussions with some experts. Part B initially had 28 items derived from the seven themes in Part A, which were then reduced to six components after a factor analysis. Part C of the questionnaire consisted of 19 items, with six components (Distraction, Caring for patient, Venting, Religion, Recreation, and Social support) having a moderate to high reliability ranging from a Cronbach’s alpha coefficient of 0.54 to 0.82. A factor analysis showed that the six factors of coping accounted for 62.36% of the total variance. Conclusion: The CgCOPETM questionnaire is suitable for use among caregivers of schizophrenia patients. There is a need to further validate the instrument among caregivers of other patient populations.

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

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.

Making a medical diagnosis in an elderly person presenting with first time psychiatric symptoms can be challenging. A 61 year old lady presented with 4 years history of tactile hallucinations in her legs and delusions of persecution, and 2 weeks history of depression and mild cognitive impairment. There were no other significant physical findings, except for dysarthria and fine bilateral hand tremors. As patient had no prior psychiatric history, she was investigated for differential diagnoses of late-onset schizophrenia, psychotic depression and early dementia. A thorough investigation for concomitant medical illnesses was done which revealed low serum calcium, high serum phosphate and relatively low serum parathyroid hormone levels. A diagnosis of Fahr’s syndrome (FS) was made based on history, hematological findings of idiopathic hypoparathyroidism and bilateral basal ganglia calcifications (BGC) on neuroimaging. Treatment of FS is non-specific and mainly symptomatic. This patient improved with treatment comprising antidepressant, antipsychotic and calcium supplement.

Sexual dysfunction in women is a significant health problem that harms marriage stability. Women in the Western countries were reportedly being affected by this condition after childbirth but the magnitude of the problem in our local setting is still unknown. The aim of this cross-sectional study was to determine the prevalence of women with sexual dysfunction at four to six months postpartum and its possible risk factors in an urban primary care setting. The participants were given a set of questionnaire, consisting of three parts; i) sociodemographic and maternal characteristics ii) Malay version of Female Sexual Function Index and iii) Malay DASS-21 questionnaire. Responses from 249 women were analyzed. More than half (57.0%,n=142) were found to have sexual dysfunction. The most prevalent types of sexual dysfunction reported by the affected women were sexual satisfaction disorder (98.6%), followed by arousal disorder (58.5%) and lubrication disorder (28.9%). Three factors were found to be significantly associated with sexual dysfunction; household income of less than RM2000 (adj OR = 0.31, 95% CI 0.14, 0.70), Malay ethnic group (adj OR = 1.93,95% CI 1.02, 3.66) and breastfeeding (adj OR = 2.24,95% CI 1.03, 4.85). In conclusion, the prevalence of sexual dysfunction in the postpartum period was considerably high. Efforts should be made to incorporate sexual health as part of the routine postnatal assessment in primary care practice.

Objective: This case report highlights males as victims of sexual abuse, ascertain the factors that are associated with male sexual abuse and outline problems in management of sexual abuse with the presence of co morbidities. Methods: We report a case of sexual abuse in a 14 year old boy who has borderline mental retardation and ADHD. Results: The victim was traumatized due to the abuse. The perpetrator was not charged due to lack of evidence of the abuse and stigma. Conclusion: Sexual abuse that occurs in males can be influenced by multiple factors such as the presence of comorbidities. Strong awareness must be present in caregivers to prevent abuse in this population and to take appropriate and early action to effect the necessary intervention.

Objective: This case report highlights the success of community services and supported employment program that may be of help to a woman with chronic inhalant use to achieve a complete abstinence. Methods: We report the case of a 45 year old lady who chronically abused glue, presented after 10 years with substance induced psychosis and comorbid mood disorder. Results: Abstinent from inhalant dependence was achieved after series of home treatment services and supported employment program. Conclusion: Provision of acute community service and incorporating this patient in supported employment program contribute to her successful journey in achieving abstinence from inhalant dependence.

Marital satisfaction is vital to the wellbeing and functioning of the individual and family. Marital dissatisfaction can lead to detrimental effects on mental, physical and family health. The study aimed to determine the proportion of marital dissatisfaction in outpatient setting and its association with sexual functioning and psychiatric morbidity in Kuala Lumpur, Malaysia. Materials & Methods: A crosssectional study was conducted in selected primary care using purposive sampling. Data collection was done using socio-demographic questionnaire and several validated Malay version of self-administered questionnaires. Marital satisfaction was measured by the Malay version of Golombok–Rust Inventory of Marital State (Mal-GRIMS). Results: The prevalence of marriage dissatisfaction in sample population was about 37.3% with almost equal prevalence in both, 36.5% (male) and 37.8% (female). Using a regression analysis, the significant factors that affect marital dissatisfaction were respondent’s age group between 31- 40 years old (Adjusted Odds Ratio, AOR. =11.4, 95% Confidence Interval, CI. =1.2-110.9), spouse’s salary of RM1000-RM2000 (lower income category) (AOR=7.3, 95% CI= 1.9-28.1), anxiety case (AOR= 4.8, 95% CI=1.1- 21.5), depression case (AOR= 4.8, 95% CI=1.0-22.8), female sexual dysfunction in term of arousal function (AOR= 0.01, 95% CI=0.0-0.7), satisfaction dysfunction (AOR= 9.4, 95% CI= 1.5-58) and pain function (AOR=43.7, 95% CI=1.28 - 1489.2). Conclusion: Marital dissatisfaction can be influenced by financial factor, sexual dysfunction and presence of psychiatric morbidity. Hence, in management of marital discord, thorough screening of these factors should be prioritized in clinical setting.