Objective: Long-term use of ecstasy is known to be a risk factor for structural brain damage and psychosis. Most patients suffering from ADHD in childhood will not develop psychosis during adulthood but the risk is increased when there is concomitant significant drug use. However, it is difficult to distinguish between substance-induced psychoses with schizophrenic psychosis. Method: We report a case of a patient with history of ADHD who was untreated, who later developed psychotic symptoms soon after initiation of ecstasy uses. The symptoms persisted despite in a ‘drug-free period’ and intensified while on the ecstasy. Results: Present case helps to understand common neurobiological mechanism behind psychosis and brain atrophy, and risk factors such as ADHD and ecstasy abuse. Conclusion: More research in this area is vital for management and further understanding on the importance of treating ADHD earlier and to be more vigilant in establishing the history of substance use.

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.

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.

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.

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.

Objective: Several cases of suicide attempt by charcoal burning producing CO have been reported in Malaysia. This case report highlights a case of delayed delayed neuropsychiatry sequelae (DNS) in CO poisoning. Method: We report a young Chinese homemaker who presented with DNS who was detained in a Malaysian forensic psychiatric ward. Results: After approximately two weeks of admission, in a familicide attempt, she had started to exhibit subtle changes in her behaviour, including social withdrawal, impaired memory, and there was lack of emotional distress. Conclusion: We report an interesting DNS as one of the two forms of chronic sequelae of CO poisoning, whereas the other type of neuropsychiatric sequelae is the persistently progressive type.

This study aims to determine the prevalence and associated factors of sexual pain disorders among Malay women in Malaysia with type 2 diabetes mellitus. Methods: This is a cross-sectional study involving 347 women (174 nondiabetic and 173 diabetic subjects) who attended the diabetic clinic in a university hospital. Sexual pain disorders were assessed using the Pain sub scale of Malay Version of the Female Sexual Function Index (MVFSFI). Sociodemographic information of the subjects was collected with a pre-designed questionnaire. Results: Prevalence of sexual pain disorders among Malay women with type 2 diabetes mellitus was 10.4% and the control group was 9.2% but the difference was not statistically significant (p > 0.05). Multivariate logistic regression analysis did not find any relevant associated factor with sexual pain disorder. Conclusion: Sexual pain disorders among Malay women were not dependent on the diabetic status. Further studies with different population of diabetic patients are needed to confirm the results.
Diabetes Mellitus, Type 2 ; Women ; Malaysia

This case report highlights the challenges in managing Frontal Lobe Syndrome (FLS) in a patient with end-stage renal disease. Methods: This is a case description of a 58 year-old gentleman who presented with behavioural changes: irritability, mood lability, aggression, psychosis, and overfamiliarity. His presenting symptoms were in keeping with (FLS) with positive findings on Computed Tomography (CT) scan of the brain and also neuropsychological assessments. Difficulties arose in attempts to control his aggression without further compromising his renal function. Results: The usage of the commonly used antipsychotics in controlling aggression was restricted in view of the patient’s renal impairment. Augmentation with low dose memantine proved to be beneficial in this case, without causing further deterioration in renal function. Conclusion: The use of memantine to augment the effect of risperidone was observed to be safe and successful in managing the behavioural changes associated with FLS in adults with end-stage renal disease.
Frontal Lobe ; Memantine ; Kidney Failure, Chronic

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.