exudates and Psychotic-Disorders

This article attempts to review the criteria for the amok phenomenon since the late 15th century and how its meaning has evolved into its present day usage.. A literature search was conducted examining and quoting Western sources vis-a-vis amok in the Malay context, ancient and modern.. This crosscultural approach overlaps with the forensic aspects of the phenomenon. This is inevitable as the word "amok' itself brings to mind the phenomenon of violence which most often results in the breaching of the law. The changing face of amok as defined by Western authors is highlighted and compared to amuk as understood by modern Malays.. It is inferred that amok as understood and classified in modern psychiatry has a different criteria set when compared and contrasted with the Malay understanding of amuk. With the broadening of the definition of amok, it is finally portrayed as being a syndrome that belongs to the East as well as the West.

Topics: Cross-Cultural Comparison; Ethnicity; Humans; Insanity Defense; Malaysia; Medicine, Traditional; Psychiatric Status Rating Scales; Psychotic Disorders; Social Perception

Most studies on predictors of vocational outcomes are cross-sectional and results are varied. This study aimed to examine the vocational rates of patients with first-episode psychosis (FEP), identify factors predicting a lack of engagement in age-appropriate roles, and evaluate the predictive ability of a model with baseline sociodemographic information and 2-year symptom and functioning trajectories on vocational outcomes. The Singapore Early Psychosis Intervention Program (EPIP) has maintained a standing database on patient clinico-demographic information. The primary outcome, vocational status, was operationalized as "meaningfully employed", that is, being gainfully employed or engaged in an age-appropriate role, and "unemployed". Using logistic regression, the predictive ability of the proposed model was evaluated. Vocational data was available for 1177 patients accepted into EPIP between 2001 and 2012. At the end of two years in the service, 829 (70.4%) patients were meaningfully employed and 348 (29.6%) patients were unemployed. The binary logistic regression model on the prediction of 2-year vocational outcomes yielded an AUC of 0.759 (SE = 0.016, p-value < 0.001). Clinico-demographic risk factors for being unemployed at the end of two years included being Malay, single, and unemployed at baseline; having a longer duration of untreated psychosis (DUP); a diagnosis of schizophrenia, schizophreniform, or delusional disorder at baseline; and belonging to the 'delayed response' or 'slower response and no response' general psychopathology trajectories. We have proposed a model that allows vocational outcomes to be predicted with high specificity. The results of this study will be relevant in developing future intervention models to improve outcomes among FEP patients with different illness trajectories.

Topics: Adult; Affective Disorders, Psychotic; China; Disease Progression; Employment; Ethnicity; Female; Humans; India; Logistic Models; Malaysia; Male; Marital Status; Psychotic Disorders; Risk Assessment; Risk Factors; Schizophrenia; Schizophrenia, Paranoid; Singapore; Time Factors; Unemployment; Young Adult

The aim of the study is to screen and evaluate the efficacy of the screening tools in detecting subjects with sub-threshold psychosis among asymptomatic individuals at genetic risk, as compared with persons in the general public.. This was a two-stage study of the relatives of patients with schizophrenia and general individuals. Subjects were screened with a Screening Questionnaire (SQ) and General Health Questionnaires (GHQ-12) in the initial stage. Those who screened positive were reassessed using the Comprehensive Assessment of At-Risk Mental State (CAARMS) in the second stage.. A total of 190 (29%) subjects initially screened positive from a sample of 660 individuals. The proportion of persons in the general public (63%) who progressed to the second stage was significantly higher than at-risk relatives (37.4%) (X(2)=17.028, df=1, p<0.001). After final assessment, about 4% of the sample was positive; subjects at sub-threshold UHR (ultra-high risk) was higher (69%) than subjects at UHR (31%). Detection rate was higher when both GHQ and SQ (26.4%) measures were positive in the initial screening. In both categories of sub-threshold psychosis, the percentage of subjects at genetic risk was higher (62%), and the proportion steadily increased as the psychosis progressed.. The prevalence of sub-threshold psychosis was higher in subjects at genetic risk. Clinical assessment following a self-report questionnaire should be mandatory as the rate of false positive results is high. The SQ has poor validation indexes, which is partly contributed to low detection rate and the GHQ is not suitable for screening early psychosis.

Topics: Adolescent; Adult; Disease Progression; Family; Female; Humans; Malaysia; Male; Prodromal Symptoms; Psychiatric Status Rating Scales; Psychometrics; Psychotic Disorders; Schizophrenia; Surveys and Questionnaires; Young Adult

To examine the prescription rates in cancer patients of three common psychotropic drugs: anxiolytic/ hypnotic, antidepressant and antipsychotic.. In this retrospective cohort study, data were extracted from the pharmacy database of University Malaya Medical Center (UMMC) responsible for dispensing records of patients stored in the pharmacy's Medication Management and Use System (Ascribe). We analyzed the use of psychotropics in patients from the oncology ward and cardiology from 2008 to 2012. Odds ratios (ORs) were adjusted for age, gender and ethnicity.. A total of 3,345 oncology patients and 8,980 cardiology patients were included. Oncology patients were significantly more often prescribed psychotropic drugs (adjusted OR: anxiolytic/hypnotic=5.55 (CI: 4.64-6.63); antidepressants=6.08 (CI: 4.83-7.64) and antipsychotics=5.41 (CI: 4.17-7.02). Non-Malay female cancer patients were at significantly higher risk of anxiolytic/hypnotic use.. Psychotropic drugs prescription is common in cancer patients. Anxiolytic/hypnotic prescription rates are significantly higher in non-Malay female patients in Malaysia.

Topics: Anti-Anxiety Agents; Antidepressive Agents; Antipsychotic Agents; Anxiety Disorders; Cohort Studies; Databases, Pharmaceutical; Depressive Disorder, Major; Drug Prescriptions; Drug Utilization; Female; Heart Diseases; Hospitals, Teaching; Humans; Malaysia; Male; Middle Aged; Neoplasms; Practice Patterns, Physicians'; Psychotic Disorders; Psychotropic Drugs; Retrospective Studies

The objective of this study was to describe and compare the pathways followed by Malay patients with psychoses (schizophrenia and schizophreniform disorder) and Malay patients with epilepsy to a tertiary health center in the northeastern area of peninsular Malaysia. There were 60 patients in each group. The most popular pathway for both groups was first contact with traditional or alternative healers. Consultation with Malay traditional healers (bomohs) and/or homeopathic practitioners (44.2%) was significantly higher for psychotic patients (61.7%) than for patients with epilepsy (26.7%) (chi(2)(2)=15.609, P<0.001). Direct access (24.2%) was the second most popular pathway and almost equally followed by both groups of patients. The third and last pathway was initial contact with private general practitioners and government doctors, respectively. Patients with epilepsy dominated the last two pathways. The treatment delay (TD) was significantly longer in epileptic than psychotic patients regardless of their visit to a bomoh and/or homeopathic practitioner (P<0001) or not (p<0.01). The socioeconomic status of psychotic patients also was significantly better than people with epilepsy (chi(2)=9.957, chi(2)(4), p=0.041).

Topics: Adolescent; Adult; Complementary Therapies; Cross-Sectional Studies; Developing Countries; Epilepsy; Family Practice; Female; Health Services Accessibility; Health Services, Indigenous; Homeopathy; Humans; Malaysia; Male; Middle Aged; Patient Acceptance of Health Care; Primary Health Care; Psychotic Disorders; Referral and Consultation; Schizophrenia; Socioeconomic Factors

The objective of this article is to describe and compare the use of traditional/complementary medicine (T/CM) among psychotic (schizophrenia and schizophreniform disorder) and epileptic Malay patients in peninsular Malaysia. There were 60 patients in each group. T/CM consultation was uniformly spread across all levels of education and social status. We could not find a single over-riding factor that influenced the decision to seek T/CM treatment because the decision to seek such treatment was complex and the majority of decisions were made by others. Fifty-three patients (44.2%), consisting of 37 (61.7%) psychotic and 16 (26.7%) epileptic patients had consulted Malay traditional healers (bomoh) and/or homeopathic practitioners in addition to modern treatment; of these, only three had consulted bomoh and homeopathic practitioners at the same time. The use of T/CM was significantly higher in psychotic than in epileptic Malay patients.

Topics: Adolescent; Adult; Complementary Therapies; Culture; Epilepsy; Female; Homeopathy; Humans; Magic; Malaysia; Male; Medicine, East Asian Traditional; Mental Healing; Patient Acceptance of Health Care; Psychotic Disorders; Schizophrenia; Young Adult

The aims of this study were to examine the prevalence and severity of aggression in patients with first-episode psychosis and to identify the association between aggression and sociodemographic and clinical factors.. Consecutive patients with first-episode psychosis admitted to the Early Psychosis Intervention Programme, Singapore, were assessed for a history of aggressive acts. Diagnosis was confirmed using the Structured Clinical Interview for DSM-IV and psychopathology was assessed using PANSS.. Of the 146 patients, 63.0% had no history of aggressive acts, 13.7% demonstrated severe aggression (defined as weapon use, sexual assault or victim injury) and 23.3% had lesser aggression (all other acts of aggression). Patients with aggression had a significantly longer duration of untreated psychosis (DUP) than those with no history of aggression (p = .01). The mean total PANSS scores did not differ significantly among the three groups. However, the General Psychopathology scores and the scores for 'hostility', 'poor impulse control', 'lack of insight and judgement' and 'somatic concern' were all significantly elevated in patients with aggression (p < .05).. The significant association between aggression and longer DUP once again reiterates the need for early detection and effective management of first-episode psychosis.

Topics: Adult; Aggression; Asian People; Demography; Female; Humans; India; Malaysia; Male; Prevalence; Psychotic Disorders; Singapore

The psychiatric morbidity following hysterectomy has received increasing attention. One of the sequelae of hysterectomy has been a brief, acute psychosis with excellent outcome, the etiology and pathomechanism of which is still unclear. Two Chinese patients born of Southeast Asian origin who manifested brief, acute psychosis following hysterectomy are presented. Therapy comprised drug treatment with low dose antipsychotics and benzodiazepines coupled with hypnosis and marital therapy to explore and treat the underlying pathology. Both psychotic states resolved. Follow-up at 12 months revealed stable mental condition in one subject; however, the second patient was lost to follow up. The impact of the womb's removal is explored in the context of the ethnicity of the patients and their sociocultural background.

Topics: Acute Disease; Adult; Anti-Anxiety Agents; Antipsychotic Agents; Anxiety Disorders; China; Culture; Female; Follow-Up Studies; Hong Kong; Humans; Hypnosis; Hysterectomy; Lorazepam; Malaysia; Marital Therapy; Myanmar; Psychotic Disorders; Trifluoperazine

This paper reports the characteristics and psychopathology of alcohol dependents with alcohol induced psychotic disorder admitted to the Seremban Hospital. The method is that of a case study of all alcohol dependents with alcohol induced psychotic disorder admitted to the Psychiatric Ward, Hospital Seremban over 3 years (1993-1995). There were 34 subjects, 30 Indians, 3 Chinese and 1 Malay with a mean age of 43 years. 32 were men and predominantly of Social Class IV and V (91%). They had a mean duration of drinking of 14.2 years and had a mean weekly consumption of 69.5 units of alcohol. There was a family history of alcohol dependence in (44%). The majority (68%) consumed samsu with beer the second choice. Auditory hallucinations (26) and delusions (16) were common while visual hallucinations (3) and depression (2) were less frequent. Speech disorder occurred in 4 subjects. 2 developed delirium tremens and 1 died. Liver function test was normal in 55%. All except the death from delirium tremens responded to treatment with a combination of anxiolytics, thiamine and antipsychotics and were rapidly discharged. The mean stay was 7 days. However, (68%) did not return for follow up and only 4 were abstinent from alcohol at the time of follow up.

Topics: Adult; Alcoholism; Anti-Anxiety Agents; Antipsychotic Agents; Diazepam; Drug Therapy, Combination; Female; Haloperidol; Hospitals; Humans; Longitudinal Studies; Malaysia; Male; Psychotic Disorders; Thiamine

The concept of aetiology of mental illness in 134 Malay patients was investigated by means of a 20-item checklist. About 53% of the patients attributed their illnesses to supernatural agents. Witchcraft and possession by evil spirits were regarded as common causes of illness. The number of patients who believed in supernatural causes of their mental illness was significantly higher among those who had consulted bomohs (Malay traditional healers) than among those who had not consulted them. The belief that mental illness is caused by supernatural agents is firmly held by bomohs, who reinforce this notion in those who seek their advice. Belief in supernatural causes of mental illness was not significantly associated with age, gender, level of education or occupation of the patients. Patients who believed in supernatural causes of mental illness were also found to show poor drug compliance, and the number of such patients at 6 months follow-up was significantly lower than the corresponding figure for those who did not believe in supernatural causes. The importance of understanding the patients' cultural background when treating psychiatric patients is highlighted.

Topics: Adolescent; Adult; Aged; Ethnicity; Female; Follow-Up Studies; Humans; Magic; Malaysia; Male; Medicine, Traditional; Mental Disorders; Mental Healing; Middle Aged; Patient Admission; Patient Compliance; Psychotic Disorders; Psychotropic Drugs; Witchcraft

The objective was to investigate the occurrence and characteristics of oculogyric spasm (OGS) in an Asian country.. All 2035 Asian (88% Chinese, 7% Malays and 5% Indonesians) psychiatric in-patients in the state psychiatric hospital in Singapore were surveyed for occurrence of oculogyric spasm (OGS) over a two-month period.. Thirty-four patients (1.7%) developed OGS (53% male and 47% female). All the 34 patients had been on maintenance antipsychotic drugs for more than five months. Eighteen patients had recurrent attacks. The mean chlorpromazine equivalent daily dose for those patients with recurrent OGS was 511 mg. This was significantly higher (P < 0.05) than the 277 mg daily dose received by those without recurrent OGS. Most (68%) of the attacks occurred between 1400-2000 h suggesting that OGS may have a diurnal variation.. OGS presenting as tardive dystonia may be due to a relative increase in cholinergic activity.

Topics: Adult; Antipsychotic Agents; China; Cross-Cultural Comparison; Dose-Response Relationship, Drug; Drug Administration Schedule; Dyskinesia, Drug-Induced; Ethnicity; Female; Humans; Indonesia; Malaysia; Male; Middle Aged; Neurologic Examination; Ocular Motility Disorders; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology; Singapore; Spasm

Nineteen acutely disturbed psychotic Asian patients were treated with a single intramuscular injection of 50 mg of zuclopenthixol acetate in Viscoleo. Patients were assessed clinically before and after treatment using the Brief Psychiatric Rating Scale (BPRS). Serum zuclopenthixol and the inactive geometric isomer trans(E)-clopenthixol were determined by high-performance liquid chromatography after intramuscular injection. All patients improved, with the BPRS being significantly reduced (p < 0.001) at 72 h after injection. Adverse effects were generally few. The mean +/- SEM serum zuclopenthixol concentrations at 24, 48, and 72 h were 19.9 +/- 2.8, 31.5 +/- 4.5, and 17.8 +/- 2.9 micrograms/L, respectively. trans(E)-Clopenthixol concentrations ranged from negligible to 39.5 micrograms/L. This study confirms that a single intramuscular injection of 50 mg is adequate for managing severely disturbed psychotic patients for the first 3 days. The serum zuclopenthixol concentrations attained in the Asian patients were higher than those reported in Caucasian psychiatric patients. In some patients, a considerable amount of zuclopenthixol had been transformed to trans(E)-clopenthixol.

Topics: Adolescent; Adult; Aged; Antipsychotic Agents; Bipolar Disorder; China; Clopenthixol; Female; Humans; India; Injections, Intramuscular; Malaysia; Male; Middle Aged; Psychotic Disorders; Schizophrenia; Singapore

Topics: Adult; Hallucinations; Humans; Malaysia; Male; Psychotic Disorders

This study examines twenty-four cases of amok, believed the largest number of cases ever collected. They were observed in Sarawak, East Malaysia. They occurred in all indigenous groups in Sarawak, excluding the Chinese, such as Malay, Sea Dayak, Land Dayak, Kayan, Punan and Melanau at frequencies more or less following the proportion of these groups in the total population. No differences were found according to religion, the Malay being Muslim and the other groups either predominantly Christian like the Iban or animistic. Only slight diminution in the frequency was observed from 1954 to 1968. The education level of the amok runners was much lower than that of the average population. The weapons used were those immediately at hand be it parang (short sword), ax, sticks, knives, guns, bare hands or a lorry. The classical four stages were largely present: (a) brooding and withdrawal, (b) homicidal paroxysm, (c) continuation of homicidal behaviour until killed, restrained or falling into stupor of exhaustion, (d) complete or partial amnesia. While in 14 no motive could be ascertained, insult, jealousy and paranoid ideation was present in the others. Both family history of mental illness and personal psychiatric history were predominant. All cases fell into accepted diagnostic categories from organic and endogenous psychosis to neurosis and behaviour disorder.

Topics: Adolescent; Adult; Aged; Aggression; Amnesia; Borneo; Depression; Ethnicity; Female; Humans; Hysteria; Malaysia; Male; Middle Aged; Psychotic Disorders; Schizophrenia; Sleep

The authors present evidence of an indigenous diagnostic system by which Malay culture defines Amok, and of the disparate relations between individual conceptualization, behavior, and tradition which contributes to the labeling process. Amok is viewed as a cultural prescription for violent behavior in response to a given set of conditions. It is not a disease but rather a behavioral sequence, perceived as illness, that may be precipitated by various etiological factors. Finally, evidence is presented to support the hypothesis that traditional forms of Amok are being replaced by new variants in which psychopathology is increasingly evident.

Topics: Adult; Commitment of Mentally Ill; Cultural Characteristics; Homicide; Humans; Malaysia; Male; Mental Disorders; Psychotic Disorders; Recurrence; Violence

In an attempt to discover how the phenomenon of amok is viewed within its indigenous culture, the authors studied and interviewed 21 subjects in West Malaysia who were labeled as amok. This investigation showed that both the subjects and the Malay culture view amok as psychopathology, that amok cases are disposed of in line with this view, and that the behavior of the amok person conforms to social expectations of the phenomenon. Despite cultural proscriptions, however, the act is purposive and motivated and is subtly sanctioned by Malay society.

Topics: Adult; Aged; Commitment of Mentally Ill; Ethnicity; Hospital Records; Humans; Interview, Psychological; Length of Stay; Malaysia; Male; Mental Disorders; Middle Aged; Motivation; Psychotic Disorders; Rural Population; Seasons; Social Perception; Stress, Psychological; Time Factors; Violence

Topics: Adolescent; Adult; Culture; Ethnicity; Female; Fluphenazine; Hospitalization; Hospitals; Humans; Malaysia; Male; Middle Aged; Paranoid Disorders; Phenothiazines; Psychotic Disorders; Schizophrenia; Stress, Psychological

Topics: Adolescent; Anxiety; Birth Order; Depression; Family Characteristics; Female; Humans; Income; Juvenile Delinquency; Malaysia; Male; Psychotic Disorders; Schizophrenia

Topics: Adult; Forensic Psychiatry; Homicide; Humans; Indonesia; Malaysia; Male; New Guinea; Psychopathology; Psychotic Disorders; Social Conformity

Topics: Borneo; Communication; Culture; Hospitals, Psychiatric; Humans; Interpersonal Relations; Language; Malaysia; Nurse-Patient Relations; Occupational Therapy; Physician-Patient Relations; Psychotherapy; Psychotic Disorders