Mental Health Information and Research Webpage

Board of Study Post-garduate Program M.Med. IIUM

2012-02-08T19:24:00.000-08:00

On 30th of January 2012, Department of Psychiatry conducted the Board of Study meeting for Post-graduate Master program (M.MED) Psychiatry IIUM. Among the panel members of the BOS were Professor Dr Mohamad Fauzi Abdul Rani, Professor Dr Hussain Habil, Professor Dr Hata Sidi, Dr Zafri Abu Bakar (the head of department HTAA) and other department members. The panel members had given comprehensive comments and suggestions on how to improve the intended program. On behalf of the department and Kulliyyah of Medicine IIUM,I would like to express our heartfelt gratitude to their inputs and strong support to the estabilishment of the program.

Insyaallah may this effort be a quantum leap to the milestone of the whole program and our would effort will be granted a favour from Allah SWT.

Prof Madya Dr Ramli Musa. Head, Dept of Psychiatry IIUM.

APA KURANGNYA PENDEKATAN PSYCHOLOGY DALAM ISLAM?

2011-04-22T01:45:00.000-07:00

Modern Psychiatry & Psychology has drafted guidelines on many aspects such as Anger Management, Breathing Exercise and etc.

Ironically not many of us as Muslim doctors are aware that Islam has its own unique ways to deal with these issues in psychology:

ANGER MANAGEMENT IN ISLAM

Islam has acknowledged that to be angry is okay but you have to know how to contain it and deal with it properly. in the Qur’an, Allah says:

“And when your Lord said to the angels, “I am creating successors on the earth.” They said, “Will You create on it those who will spread corruption and spill blood, although we celebrate Your praise and extol Your Holiness?” He said,” I know what you do not know.” (Qur’an 2:30) I quote from surah Al Baqarah (surah terpanjang dlm Quran)

Abu Hurayrah relates that a man said to the Prophet: “Counsel me.” The Prophet SAW said: “Do not get angry.” The man repeated his request many times, but the Prophet SAW kept saying: “Do not get angry.” [al-Bukhari ] hadis yang sahih....

When you are in anger, these steps are suggested to adopt

1. To take wuduk and perform prayer (solat sunat)

2. Doing zikir & salawat to Prophet Muhammad SAW

3. If you are standing then sit down, if you are sitting down then lying down. If you still feel angry while lying down, then I think try yr best to fall asleep. (I suppose)

4. To recite surah Taha verse 1-5

5. My next suggestion is, the easy way is to leave the place or avoid confronting the person that caused you to be angry; this is to avoid further worsening of the situation. Leaving does not mean surrender or lost.

BREATHING TECHNIQUE

Islam has taught us how to do “breathing technique” which is proven to be effective in Panic Disorder or GAD; that is by reciting any surah in Quran with proper "tajwid". When we properly reciting Quran we tend to control of breathing by taking deep breath and exhale it slowly upon recitation of the verses.

Does this look exactly like breathing technique? Plus a bonus for you for chosen this approach; that is “pahala”

RELAXATION TECHNIQUE

Nowadays we have the tendency to adopt Yoga as a form of relaxation technique. Do you aware performing solat with full conviction and "kyushuk" is a form of relaxation. It’s even has a few advantages such as closer to Allah SA to request from Him for you wellness and spiritually strong.

CERAMAH ASPEK PEMBELAJARAN DAN PSIKOLOGI DI KALANGAN KANAK-KANAK SEKOLAH KHAS

2010-05-12T18:15:00.001-07:00

Satu ceramah seperti tajuk di atas akan diadakan di Sekolah Kebangsaan Jaya Gading pada 22 Jun 2010, 9.00am.
Semua ibu-bapa mempunyai anak dengan masalah pembelajaran di daerah Kuantan dijemput hadir.Tiada yuran dikenakan.
Ceramah yang sama telah dianjurkan oleh Sekolah Kebangsaan Tanah Putih Kuantan sebulan sebelumnya.

Guru Besar Sekolah Jaya Gading

Other Informative Website

2009-12-22T06:00:00.000-08:00

Dedication to your - ramlimusa.blogspot.com

Hi,

When I visited your website, it came to my attention that you have the same concerns and questions about various disorders that affect millions of people each day. At Disorder.org we are developing our website to continually feed information to the interested public. Our website is a great resource for those looking for answers to the hundreds of disorders today. We offer up to date articles, interviews, and informative videos. We would love to be associated with your blog/website to make the public aware the disorders that continue to affect us and our loved ones. I have the Disorder resource tab. It will be beneficial to your readers. I will send it to you at your request.

Regards,
Lisa HopeAssistant Editor/WriterDisorder.org
Disorders:
_________________________________________________________
Hi,

My name is Kathy Sanders and I am the Assistant Editor for Hospital.com. Hospital.com is a medical publication geared towards offering information on hospitals while also covering other issues within the medical field. We are a member of the AHA (American Hospital Association), and while reviewing medical related websites, I happened to come across your page. I see that you have a number of quality resources on your site, and I was hoping that you'd be able to add Hospital.com as well.

Please let me know if you are able to make this addition. Thank you and don't hesitate to contact me if you have any questions.

Thanks and regards,
Kathy Sanders
editorial.hospital@gmail.com
www.hospital.com

CHILDHOOD PSYCHOLOGICAL DISORDERS AND PARENTING SKILLS COURSE 2009

2009-12-22T05:20:00.000-08:00

My gratitude goes to all the committee members of the Child Psychological & Parenting Skill Seminar for your cooperation. Finally we managed to conduct the seminar successfully with minimal hiccups especially in the technical aspect. There were about 65 participants participated in this seminar. Unfortunately we found quite a significant number of participants who initially registered for the seminar had pull out their attendance at last minute due to unforeseen reasons.

The feedbacks we got from participants were very encouraging. About 80% gave their opinion that the seminar was really beneficial and interesting.

During the seminar, we have conducted a short survey among the participants to find out about their opinion on the importance of parenting skill education, their perception on parenting skill and the level of knowledge on parenting skill among fathers and mothers. Here I briefly present the result of the survey:

RESULTS

Table 1: Socio-demographic data

Number of children Number % Total
0-1 38 59.4 64
2-3 20 31.3
4-6 6 9.3

Profession
Teacher 6 9.3 64
Psychologist/counselor 4 6.3
Lecturer 10 15.6
Medical officer/paramedic 26 40.6
Students 16 25.0
Others 2 3.1

Age
Median 30 64

Gender
Male 18 28.1 64
Female 46 71.9

1) The first question was to enquire about the reason why they attended the seminar (the answer can be more than 1)
80% of respondents gave the reasons to improve their parenting skills and curiosity. Only 3% (2 persons) said it was due to their own children were having the psychological difficulties.

2) Eighty eight percent (36 persons) gave the response that they have heard about parenting skill before in contrast 12% (8) never heard.
3) Only 31% (20 participants) gave the response that they have attended the parenting skill course before.
4) When we asked their opinion as to should the course be compulsory or encourage to every individual?
78% said it should be compulsory to be conducted to every individual and 22% said we should just encourage the public to have it.
5) The next question is how frequent should the course be held?
6) 53% answered every year, 40% twice a year and 6.3% every 2 years.

7) The last 2 questions are bout their opinion on the level of knowledge on parenting skills between fathers and mothers. Here are the outcomes of these questions;
In conclusion, level of knowledge among mothers was higher.

Investigators Meeting

2009-12-22T05:07:00.003-08:00

Following the educational & research visit to Dept. of Psychiatry & Psychological Medicine UMMC, Dept. of Psychiatry IIUM has engaged on research collaborations with them.

On 13th of December 2009, the investigators (psychiatrists) from UMMC, Ministry of Health, Ministry of Defense and IIUM had a meeting to discuss on a project collaboration. The Investigators Meeting was held in Langkawi and hosted by UMMC.

Thanks to AP Dr Hatim & Dr Mas Ayu.

t

2009-12-05T05:57:00.001-08:00

UMMC visit by the Department of Psychiatry IIUM & HTAA

2009-10-15T23:55:00.000-07:00

The visit to the UMMC Clinical Trial Centre and the UM Centre for Addiction Science UMCAS on October 15, 2009 was really an eye-opener to me and other delegates. The HTAA Department of Psychiatry staff (Dr. Ahmad Zafri Abu Bakar, Dr. Junid Mohamed Rozali, Dr. Nor Azlin Mustapha En. Ahmad Sabri Muhamad Nawai, SN. Fatimah Rahman SN Zabedah Mohamed, JM. Hasnida Kamaruzaman) has given their overwhelming response to the visit. There were 3 delegates from IIUM Department of Psychiatry (Br Aidil, SN Norhayati & myself).

I regard the visit is really fruitful and has achieved its objectives. Many valuable knowledge and new experiences we managed to tap from the visit. We learned right from strategies how to handle & managing clinical trials, research strategies, industrial linked studies and to the ward & daycare management. We would like to thank for all members of UMMC Department of Psychiatry particularly the head of department Professor Dr Zuraida and the UMMC Clinical Trial Centre head; AP Dr Mohd Hatim for their warm welcome and hospitality during the visit. My conclusion on the journey back from the visit is; the IIUM Department of Psychiatry has to build up stable foundation especially the manpower, basic research facilities before venture into industrial & commercialized-related research projects. They have offered us a few potential studies as the starting point for further collaborations. I have expressed to them my intention to appoint AP Dr Hatim as our future Clinical Trial Centre consultant. Insyaallah.

My aspiration, is to set up a well established clinical trial centre for east-coast region.

VALIDATION WORSHOP BY THE CLINICAL RESEARCH CENTRE

2009-06-29T23:21:00.000-07:00

I’m so grateful for having close collaborations with the CRC (Clinical Research Centre) Hospital KL. Many thanks to the CRC and the organizing committee for inviting me to present and share the results of 2 validation studies on Eating Disorders Examination Questionnaire (EDE-Q) and Family Environment Scale (FES) to many researchers in Malaysia…. June 25, 2009.

Ramli M,
Dept of psychiatry.IIUM

STRESS MANAGEMENT IN UPM

2009-06-23T01:45:00.000-07:00

On June 8, 2009 the Registrar’s Office of UPM invited me to organize a workshop on Stress Management and Screening Tools. It was a-day workshop for all the “pegawai psikologi” particularly from the Unit Kerjaya, Kaunseling dan Hal Ehwal Pelajar Universiti Putra Malaysia Serdang. I had a nice experience to share my knowledge with them. Many thanks for their warm hospitalities during my stay…. Hope this will not be the first and last affiliation with them..

Many had expressed their intention to come to the Child and Parenting Skill Seminar organized by IIUM Kuantan...

I welcome any organization (govermental or non-govermental) to organize the similar workshop on Stress Management and Coping with Stress for their employees..

Regards……

SEMINAR ON CHILD & ADOLESCENT PSYCHOLOGICAL DISORDERS AND PRENTAL SKILLS 2009

2009-04-27T19:52:00.000-07:00

The Department of Psychiatry International Islamic University Malaysia is planning to conduct a seminar on child psychiatry.

Herewith are the details of the programme:

SEMINAR ON CHILD & ADOLESCENT PSYCHOLOGICAL DISORDERS AND PRENTAL SKILLS 2009

"From Knowledge to Practice"

OBJECTIVES

a) To provide knowledge and alertness on the importance of psychological childhood development.
b) Advancing the knowledge regarding childhood psychiatric disorders and approaches to the problems.
c) To develop a positive mind and environment for the parents.
d) To initiate the development of parental support groups in society.

ORGANIZERS

Department of Psychiatry, Kulliyyah of Medicine, IIUM, Kuantan, Pahang.

ORGANIZING COMMITTEE

Patron; Prof. Dr. Mohammed Fauzi Abdul Rani
Chairman; Asst. Prof. Dr. Ramli Musa
Vice Chairman; Asst. Prof. Dr. Hjh. Nora Mat Zin
Special task committee; Dr. Umeed Ali Khan, Dr. Hajee Mohamed Ismail, Br. Aidil Faszrul, S/n Norhayati Mohamed

Publicity: Dr Kartini

SPEAKERS

6.1 Asst. Prof. Dr. Nora Mat Zin
Department of Psychiatry
Kulliyyah of Medicine, IIUM Kuantan

6.2 Asst. Prof. Dr. Ramli Musa
Department of Psychiatry
Kulliyyah of Medicine, IIUM Kuantan

6.3 Dr. Ahmad Zafri Abu Bakar
Consultant Psychiatrist, Department of Psychiatry
Hospital Tengku Ampuan Afzan, Kuantan, Pahang

6.4 Dr. Junid Mohamed Rozali
Psychiatrist, department of Psychiatry
Hospital Tengku Ampuan Afzan, Kuantan, Pahang

6.5 Dr. Mohd. Nizam
Consultant Child Psychiatrist, Department of Psychiatry
Hospital Kuala Terengganu, Kuala Terengganu, Terengganu

6.6 Dr Fauzi Ismail
Consultant Child Psychiatrist Hosp Selayang

TARGET PARTICIPANTS

This programme is open for all medical and public applicants including medical specialist, medical officer, nurses, paramedics, medical and paramedic students, parents, parents with special children, teachers, pre-education owners, IIUM staffs and public.

FEE: RM 80 per participant

TENTATIVE PROGRAM

Date: 28 October 2009 (1st Day)
Venue: Jalan Hospital City Campus, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang.
08.00-08;15 Registration
08;30 Open & Closing Ceremony, and Acknowledgement Session
08.45 am Introduction to Child Psychosocial development - Dr Nizam
09.45 am Identifying and Managing Children with Hyperactivity –Dr Nizam
10.45 am Refreshment
11.15 am How to identify Autism and to handle a child with speech delay –Dr. Kartini
12.15 am QA & sharing experience session
01.00 pm Lunch and Solah
02.00 pm How to identify children with learning disabilities at school.-Dr Zafri/Junid
02.45 pm Managing children with special needs Dr Nora
03.45 pm Question and Answer Session
04.30 pm Tea Break and Adjourned

Date: 29 October 2009 (2nd Day)
Venue: Jalan Hospital City Campus, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang.
08.30 am Registration
08.45 am Adolescent with behavioural disturbance- Dr Fauzi
09.45 am Parenting skills and styles - Dr Fauzi
10.45 am Refreshment
11.15 am Managing Stress among caretakers Dr Ramli Musa
12;15am QA & sharing experience session
12.15 am Closing & Souvenir presentation
01.00 pm Lunch and Solah

You may submit your application to Br Aidil at faszrul_rahim@iiu.edu.my

or register your application online to http://cpdps2009.blogspot.com/

PMP END BLOCK QUESTION

2009-04-08T01:38:00.000-07:00

Here is the recent end block PMP question that I prepared and marked recently. There are a lot of things that you can learn and also could be a "muhasabah" to me as well....... The answers and comments are right at the bottom.....

Trigger I
Time 20 minutes

Mrs. G is a 45 year-old lady was referred by a physician when her series of blood investigations and endoscopic examination performed revealed normal findings. She frequently visited many doctors for many somatic symptoms such as body ache, epigastric burning sensation, non-specific headache and insomnia for the last 6 months. Occasionally she would feel that her heart was beating too fast when she thought of her physical symptoms. When her physician suggested her to meet a psychiatrist, she was initially skeptical as she did not feel that she had any psychiatric ailments.

1. Based on the short explanation above, list down 4 psychiatric differential diagnoses.

_____________________________________
_____________________________________
_____________________________________

2. What 6 other relevant information would you try to acquire to ascertain the diagnosis?

____________________________________________
____________________________________________

Trigger II

The patient persistently denied having weird experiences such as hearing voices or first rank Schneiderian symptoms. A part from having multiple body complaints as mentioned earlier, there was no other body pain, neurological symptom or sexual dysfunction. She developed many somatic symptoms after her divorce 6 months ago. Her appetite was reduced and most of the time she would toss and turn in bed for some time before falling asleep. With lack of social support, she felt that life was so demanding and she did not think she could go through this difficult situation. There were times she had thought of ending her life.

3. What is your provisional diagnosis of this case? Give 3 supporting evidences of your above diagnosis. (7 marks)

________________________________________
________________________________________
________________________________________

4. What is one relevant laboratory investigations would you order for this patient to help you come to the diagnosis?

________________________________________

Trigger III (20 min)

Further assessment revealed she had symptoms of melancholia such as anhedonia. The diagnosis of Major Depressive Disorder was ascertained by the psychiatrist. Due to the risk of harming herself, she had to be admitted to psychiatric ward. After 1 week on treatment, she defaulted her follow-up and treatment.

5. Give 5 other melancholic features of depression. (5 marks)
_____________________________________
_____________________________________
_____________________________________
_____________________________________

6. Outline the management of this case. (10 marks)

_______________________________________
_______________________________________

7. List down your strategies to ensure her compliance to her treatment. (3 marks)

_____________________________________
_____________________________________
_____________________________________

ANSWER

Q1 Answer:
Somatization disorder – top on the list
Major Depressive disorder with prominent somatic symptoms – good answer
Pain disorder
Hypochondriasis
Generalized anxiety disorder
Substance abuse/dependence- ½ mark (hardly they present with above symptoms)

Common mistakes done by students when they answer:
Somatoform disorder – wrong (non-specific)
Anxiety disorder - wrong (non-specific)
Factitious, Malingering disorder – wrong (should not think along this line first, not fair to your patient)

Q2 The answer is based on your diagnoses in question 1:
Any episode of persistent feeling depressed
Other depressive symptoms such as hopelessness, or melancholic features
For somatization disorder; other form of pain; sexual complaint, neurological symptoms (numbness)
Any drug abuse
Family history of similar symptoms or psychiatric disorder
Any recent stressor

Q3
Comment: Many students failed to get the right answer although the presentation is very clear.
The correct answer is Major depressive disorder with prominent somatic symptoms.
Supporting evidences:
No other symptoms of somatization disorder
There are a lot of pessimistic ideas about her current and future life.
There is thought of dying.

Please bear in mind that among middle aged and elderly women in Asia, they tend to present with many somatic symptoms but in actual fact they are having major depression). Even the presentation of depression is commonly with somatic complaints.

Statistics on the result;
60% of students (12 students) answered major depressive disorder
15% (3) answered Adjustment Disorder (not accurate answer due to suicidal thought)
15% answered Somatization disorder (wrong it is clearly mentioned no other body complaint)
5% Conversion (0 mark – commonly conversion presents with neurological deficit e.g. paralysis)
5% (1 student) answered mixed anxiety and depressive symptoms (I’m speechless and no comment on the answer because it is not the diagnosis and the mark is definitely 0)
Common mistake made by students

Q4 Acceptable answers; Thyroid function test or cortisol

Q5 Answer:
Anhedonia
Early morning awakening (more than 2 hours from usual time)
Diurnal variation of mood (feeling depressed esp in early morning)
Excessive guilt
Psychomotor retardation/agitation

Common mistakes/wrong answers by students:
Feeling low mood every day, feeling low mood most of the time (this is a core symptom depression not melancholic feature)
Anorexia
Loss of emotional reactivity
Poor sleep

Q6 Answer
Bio-psychosocial spiritual model of management
Antidepressant SSRI
Psychoeducation
Family psychoeducation
CBT
Community or social welfare helps

Common mistake;
Students did not lay out the bio-psychosocial and spiritual model.
ECT is correct answer but if you mention ECT as the first choice, then it is wrong

Q7 Answer:
To develop therapeutic relationship and good rapport with the patient
Psychoeducation to the patient and family
Single dose antidepressant
Prescribe less side effect medicine.
Explanation on early relapse symptoms and possible side effects
Ensure good social support

Common mistakes:
When students answered depot injection (antidepressant has no depot form!!!!!!)
CBT or psychodynamic psychotherapy (they are targeting on cognitive errors not for insight enhancement!!!)

Patient and Family Support Groups / Persatuan Pesakit dan Keluarga

2009-04-02T01:59:00.000-07:00

One of my aspirations is to establish “Patient and Family Support Groups” to cater East Coast areas (Pahang, Terengganu and Kelantan). There are 3 main support groups that we plan for;

1) Patient and Family Support Group for Psychiatric Illness
2) Parental and Family Support Groups for ADHD (Hyperactive)
3) Parental and Family Support Groups for Autism

We are in the stage of congregation all the potential members to these support groups. If you are interested to join these support groups, kindly submit your name or any of your family members to my email ramlidr@yahoo.com.

There are many activities planned for benefits of the future members such as educational programmes, supported employment and etc.
_____________________________________________________

Salah satu aspirasi kami adalah mewujudkan “Persatuan Pesakit dan Ahli Keluarga” untuk kawasan Pantai Timur (Pahang, Terengganu dan Kelantan). Terdapat 3 kumpulan sokongan yang dirancang;

1) Persatuan Pesakit dan Keluarga Psikiatri
2) Persatuan Ibubapa dan Keluarga ADHD (Hyperactive)
3) Persatuan Ibubapa dan Keluarga Autisma

Kami dalam peringkat mengumpulkan sebanyak mungkin nama peserta dan ahli keluarga yang berminat. Jika anda berminat sila hantarkan nama anda atau nama ahli keluarga ke email saya ramlidr@yahoo.com.

Terdapat beberapa aktiviti yang dirancang untuk manafaat anggota kumpulan ini seperti aktiviti pengajaran, sokongan kerja dan lain-lain.

Sekian… Dr Ramli

OCCUPATIONAL THERAPY AND REHABILITATION DEPARTMENT OF PSYCHIATRY HTAA

2009-03-04T18:35:00.000-08:00

INTRODUCTION

Rehabilitation has been defined broadly as a process of minimizing psychiatric impairments, social disadvantages and adverse personal reactions, so that the disabled person is helped to use his or her talents and to acquire confidence and self-esteem through experiencing success in social roles. The purpose of this visit is to learn about the role of occupational therapy and rehabilitation centre in psychiatric department, Hospital Tengku Ampuan Afzan (HTAA) with regard to management of psychiatric patients. There were 21 patients at the time of visit with 2 occupational therapists and 2 medical attendants. Both in-patient and out-patient were involved in this program.

ACTIVITIES:

The aims for this occupational and rehabilitation program are as following:
1) To encourage patients’ social interactions
2) To improve patients’ concentration and learning ability
3) To increase patients’ confidence level
4) To encourage healthy physical activity among patients

In order to achieve these objectives, several activities were planned by occupational therapist. Stable patients assessed by doctors were chosen to join the program. During our visit, the activities conducted were as following:
§ Session started with physical exercise, warming up followed by aerobic exercise. Medical students and staffs were also involved to encourage patient’s involvement.

§ After physical exercise, reinforcement of daily activities such as grooming and dressing were done by checking patients’ hygiene and instructing them to do basic activities such as clipping nails, brushing teeth and combing their hair. The facility was equipped with self-care corner for this purpose.

§ Next, cognitive activity was conducted. Crossword puzzles were distributed to each patient and they were given 15 minutes to complete the task. Some patients had difficulties in completing the task. However, the medical students and the staffs were available to guide them through the process. The answers were discussed and individual patient was asked to write the answer on the board.

§ Other than cognitive therapy, it has been informed that among other aspects being focused on include occupational training skills, social training skills, art therapy and psychoeducation. These activities were conducted in alternate weeks when appropriate.

§ Patients’ motivation and involvements were assessed by the occupational therapist. Their motivation plays an integral part in determining patients’ improvement.

PROBLEMS

1. There were only 2 trained occupational therapists for a total of about 20 patients at a time. Hence there was lack of individual attention for the patient which is necessary to assess individual performance, involvement and encourage self-esteem. The objectives of this program would be better met with a smaller therapist-to-patient ratio.

2. The activities were not specific to patient’s disorders and severity as all of them were grouped together and made to do the same activities. Such conditions do not address specific individual needs as per their illness/ disabilities. For example, a mentally retarded patient was made to be involved in a cross-word puzzle; due to his disability, he was unable to fully appreciate the benefits of the cognitive exercise. Our suggestion would be to have smaller therapy groups each focusing on specific disorders or disabilities.

CONCLUSION

Medications are necessary to help patients gain a better insight to their illnesses, which is imperative in ensuring therapy and rehabilitation to take effect. Rehabilitation program and therapy aim at improving patients’ social and occupational functions in a sheltered environment that would encourage self-confidence in preparation for them to return to the community.

IIUM MS REPORT

Penyakit Psikiatri Kanak-kanak (Childhood Psychiatric Disorders)

2009-01-18T22:08:00.000-08:00

Topik ini adalah topik yang amat luas tetapi amat penting. Ianya amat luas kerana di dalam topik ini terdapat pelbagai jenis penyakit dan masalah berkaitan dengan kanak-kanak. Ianya amat penting kerana sekiranya tidak dikesan dan dirawat, awal akan mengakibatkan pelbagai implikasi sama ada untuk jangka masa singkat dan panjang seperti melibatkan terencat perkembangan minda, pembelajaran akademik, skil pergaulan, pembentukan insan serta kerjaya kanak-kanak itu di masa hadapan.

Walaupun isu ini amat penting namun di kalangan masyarakat Malaysia faktor stigma dan takut berjumpa pakar psikiatri masih menebal. Persepsi berjumpa pakar psikiatri akan dilebel sebagai pesakit mental adalah pandangan yang telah jauh ketinggalan dan harus dihapuskan. Walaupun amat sukar mengikisnya tetapi saya merasakan kita tiada jalan lain selain terus berusaha membetulkan keadaan dengan berterusan memberi penerangan kepada masyarakat.

Bermula dari isu seperti kemurungan, kerisauan (anxiety), Panic disorder, masalah rumahtangga, conduct disorder, membuli atau dibuli, ponteng sekolah, school refusal, masalah penbelajaran, dyslexia (sukar membaca), terlibat dengan dadah, bedwetting, rebellious child, autisma, hyperactive (ADHD) dan sebagainya adalah antara sebahagian masalah yang dilihat dan dirawat oleh pakar psikiatri. Penyakit serius seperti schizophrenia (tidak siuman) adalah sebahagian kecil kes-kes yang diberi perhatian oleh pakar psikiatri. Maka adalah tidak benar persepsi yang mengatakan sesiapa sahaja berjumpa pakar psikiatri adalah pesakit mental serius.

Penyakit-penyakit atau masalah-masalah berkaitan kanak-kanak bolehlah kita bahagikan kepada beberapa kumpulan.
Developmental disorders atau penyakit perkembangan kanak-kanak. Antara contoh penyakit dalam kumpulan ini adalah seperti Autisma, Attention Deficit and Hyperactice Disorder, Aspergas syndrome.
Emotional disorders seperti depression / kemurungan di kalangan kanak-kanak, Anxiety disorder, separation anxiety dan lain-lain
Behavioral disorders seperti kanak-kanak yang terlalu nakal (conduct disorder). Risk taking bahaviors dll

Apabila kita bercakap tentang isu kanak-kanak, selalunya kita tidak dapat lari dari mendalami 2 isu penting iaitu 2 situasi yang amat berkait rapat kepada dunia kanak-kanak. Ia adalah situasi keluarga dan persekolahan. Hubungan di antara tingkah laku kanak-kanak dan 2 environments/situasi ini adalah hubungan reciprocal (2 arah) dan berkait rapat.

Contoh: jika situasi di sekolah tidak baik atau dilihat sebagai sebagai memberi ancaman kepada kanak-kanak itu seperti buli, ini menyebabkan kanak-kanak tersebut akan memperlihatkannya melalui tingkahlaku yang tidak sepatutnya. Begitu juga sebaliknya sekiranya dari segi emosi mereka terganggu, ia akan menjejaskan pencapaian akademik mereka.

Begitu juga untuk isu keluarga. Situasi tidak selesa di rumah seperti pertelingkahan atau penceraian ibubapa akan mengganggu emosi dan tingkah laku kanak-kanak. Sebaliknya sekiranya berlaku tingkahlaku tidak diingini kanak-kanak juga akan menyebabkan keluarga ini menjadi lebih stress dan tidak harmoni.

Penilaian psikologi oleh pakar psikiatri selain dari penilaian secara langsung (direct), adalah amat penting penilaian situasi keluarga dan sekolah dinilai secara mendalam. Bagi setiap penyakit-penyakit berkaitan kanak-kanak akan diterangkan secara mendalam pada setuan topic berikutnya.

Penyakit/masalah Emosi Di kalangan Kanak-kanak

Satu fakta yang harus kita sedar, bukan di kalangan dewasa sahaja menghadapi masalah kemurungan. Kanak-kanak juga sebenarnya boleh menghadapi masalah tekanan dan kemurungan (stress & depression). Walaubagaimana pun prevalen atau kekerapan masalah ini lebih kepada wanita dewasa. Mengikut kajian di Negara-negara lain prevalen kemurungan teruk dan sederhana adalah 2-4% di kalangan kanak-kanak, 10% di kalangan remaja dan 15-20 peratus di kalangan dewasa. Kajian di Malaysia peratusannya adalah 10.5% dikalangan pelajar sekolah rendah (Ramli M et al, Hong Kong Journal of Psychiatry) yang secara dalam boleh di rujuk di webpage ini:

http://www.hkjpsych.com/past0802.htm
.
Antara kesimpulan kajian ini di antara lelaki dan perempuan, perempuan lebih berisiko mendapat kemurungan. Juga di kalangan mereka dari ibubapa pendapatan rendah, di kalangan keturunan cina, dan mereka yang terlibat dalam masalah disiplin seperti mencuri dan mengambil alcohol.

Kemurungan dalam kajian lain sememangnya berkait rapat di kalangan mereka dari sosio-ekonomi rendah. Di sebabkan tekanan hidup menyebabkan mereka lebih cenderung mendapatnya. Mengapa di kalangan keturunan cina lebih cenderung? Antara spekulasi mengapa kajian ini mendapat keputusan begini kerana masyarakat cina lebih terbuka menzahirkan tanda-tanda dan perasaan mereka berbanding masyarakat lain.

Apabila kita memperkatakan masaalah emosi kanak-kanak, kanak-kanak akan memperlihatkan masalah emosi mereka melalui beberapa perubahan tingkahlaku mereka yang berlainan dengan orang dewasa. Sekiranya seorang dewasa mengalami kemurungan, depression mereka akan menunjukkan tanda-tanda seperti rasa sedih, kurang selera makan, hilang berat badan, rasa hidup tidak berguna.

Walaubagaimana pun di kalangan kanak-kanak, mereka menunjukan tanda kemurungan atau symptom yang berbeza dari golongan dewasa. Mereka memperlihatkan tanda-tanda melalui salah satu cara berikut. 1)Externalizing behaviours seperti berkelakuan memberontak, (rebellious) seperti menunjukkan kemarahan (tamper tantrum) memecahkan barang, berkelakuan nakal, melawan peraturan dan arahan. Salah satu cara meluahkan rasa kesedihan dengan cara 2)internalizing behaviours menjadi lebih senyap, menyendiri, menjauhkan diri dari keluarga dan masyarakat, serta terganggu prestasi pelajaran.

Maka adalah tidak benar semua kanak-kanak yang dilabelkan nakal atau memberontak seperti terlibat dalam masalah disiplin ini sebagai semuanya mempunyai masalah sikap (attitude problem). Kerana apabila kita memperkatakan ininya adalah masalah sikap, maka jawapan kepada permasalahan ini adalah hukuman physical seperti merotan mereka. Adalah penting ibubapa dan guru cuba mendekati perasaan mereka mengapa mereka berkelakuan begitu. Di sebalik tingkah laku mereka ada dikalangan mereka tidak bernasib baik seperti datang dari keluarga bermasalah, ibubapa bercerai, berlaku konflik keluarga, kurang tumpuan dan kasih saying dan perhatian ibubapa, bapa yang mengabaikan tanggung jawab, berlaku penderaan physical atau seksual dan sebagainya.

Apa yang harus dilakukan?

Penilaian perasaan boleh dilakukan oleh ibubapa atau guru yang mempunyai skil ini. Walaubagaimana pun tidak semua kes-kes boleh di tangani terutama kes-kes berat. Bantuan pihak ketiga seperti counselor, psychologist dan psychiatrist (pakar psikiatri) banyak membantu. Fikirkan kepentingan anak dan tolak ke tepi pandangan masyarakat apabila berlaku delema dan halangan untuk berjumpa pakar psikiatri. Ini adalah stigma masyarakat yang jauh ketinggalan.

Masyarakat Malaysia telah jauh berubah sekarang dan mereka telah sedar sekarang tentang pentingnya mendapatkan khidmat pakar psikiatri.
Fakta sedih yang saya hadapi sendiri adalah bukan pandangan serong masyarakat tetapi pandangan serong mereka yang dikatakan berada di dalam aliran perubatan itu sendiri terhadap pesakit-pesakit atau pengidap-pengidap ini. Menyedihkan….. Tidak dinafikan sebahagian besar terdapat ramai yang berfikiran positif (psychologically minded) yang meminta perkhidmatan ini datang ke unit mereka dan merujuk kes-kes untuk pandangan psikiatri.

Bagaimana penilaian dibuat ? Pakar psikiatri akan menilai melalui beberapa soalan kepada kanak-kanak dan ahli keluarga, pemerhatian tingkah laku dan lain-lain. Memberi kertas soal-jawab adalah membantu, menyenangkan dan lebih objektif. Ia lebih objektif kerana penting kita menilai samaada pesakit berubah semakin baik atau sebaliknya melalui skor kertas soal-jawab ini.

Rawatan ubat antidepressant bagi kes kanak-kanak dimulakan apabila rawatan kaunseling, play therapy, art therapy, supportive psychotherapy CBT dan lain-lain gagal dan bagi kes yang teruk seperti ada idea menamatkan riwayat. Walaubagaimana pun sebarang ubat hanya dimulakan selepas mendapat pandangan ibubapa. Memulakan ubat adalah “mutual decision” bukan “one-side decision”. Kami sedar tentang kerisauan ibubapa apabila anak mereka mangambil ubat.

LIAISON PSYCHIATRY SERVICE

2008-11-05T16:40:00.000-08:00

Liaison Psychiatry.

Liaison Psychiatry is my real passion. Due to this reason, I establish a new expansion of psychiatric services. This is what do we plan as Liaison Psychiatric Clinic in Nephrology Clinic HTAA. Stigma related to Psychiatry is a reality. Yet when we look at the prevalence of psychiatric morbidities particularly among medically ill patients is substantial. 40 to 60% of these patients suffer mostly depression and anxiety disorders. The main focus of Liaison Psychiatry is on the field of oncology and nephrology. This mainly related to the nature of the illnesses in Oncology and Nephrology. Due to stigma, they are not aware the need to have psychological helps from psychiatrists. To minimize the stigma, ideally the delivery of psychiatric services to patients and their families should be at their main setting. Psychiatric care providers should have a step ahead or outreach approach to get out from their comfort zone (psychiatric ward and clinic) to reach these patients.

With the help by Dr Mohd Ramli Seman, the head of department, HTAA Nephrology Unit, this clinic is established.

Liaison Psychiatric Clinic at Nephrology Unit Hospital Tengku Ampuan Afzan (HTAA)
Department of Psychiatry International Islamic University

Objective:
The aim of this clinic is to provide psychiatric care and services to chronic renal failure patients with psychiatric morbidities.

Medical students may also benefit on the aspect of psychiatric care among medically ill patients.

Running of the Liaison Clinic
The psychiatric clinic is scheduled once a month on every Tuesday second week of the month.
The time of this clinic is between 9 am to 1 pm.
At the beginning, the clinic can accommodate 4-5 new cases per day. Once it is established, 4-5 follow-up cases and 2 new cases will be scheduled per day.
All patients referred must be administered with 2 Psychological forms for depressive and anxiety. They are Depressive, Anxiety and Stress Scale (DASS) and Hospital Anxiety and Depressive Scale (HADS). These questionnaires will help the Nephrology doctors to have an idea on the severity of the depression or anxiety. Both questionnaires have been translated and validated for its Bahasa Malaysia version.
Appointment list must contain patient’s name, medical diagnosis and more importantly the contact number.
One assigned Nephrology staff nurse will be in-charged for the appointment book and oversee the smooth running of the clinic. She will be assisted by a nurse from Department of Psychiatry IIUM (SN Nur Hayati). However during normal psychiatric clinic day SN Nur Hayati will be stationed at Psychiatric Clinic Department of Psychiatry HTAA.
The cancellation of the clinic should be most tried to avoid. In unavoidable circumstances, the cancellation will be done by SN Nur Hayati.
In an ideal situation, 1 medical officer from Nephrology Unit with interest in psychology can attach with me during the clinic to learn on psychological aspect of chronic renal failure patients.

Psychiatric medicines mainly antidepressants will be dispensed at the Hospital Main Pharmacy or Pharmacy of Department of Psychiatry HTAA.
Liaison patients can also be referred to Psychiatric clinic Department of Psychiatry HTAA under my list or to the Private Clinic Indera Mahkota Campus UIA if Liaison clinic cannot accommodate anymore or patients require immediate follow-up for important reasons.
A talk on the topic of “Psychiatric Care among Chronic Renal Failure Patient” and the briefing on the Liaison clinic will be held to give overview to the staff and professional medical providers of Nephrology Unit HTAA.
One collaborative research between Nephrology Unit HTAA and Department Psychiatry on the topic of “Quality of Life and Psychological Disabilities among Chronic Renal Failure Patients” will be conducted.

The clinic day is scheduled as below:
Date 9/12/2008, 13/1/2009, 10/2/2009, March 10/3/2009

2008-11-05T01:19:00.001-08:00

Malaysian Medical Related Journal

2008-05-27T07:15:00.000-07:00

Here is the collection of most medical journals in Malaysia with its websites. This is really useful for young researchers. Please take note that not all are indexed journals.

Malaysian Journal of Psychiatry
http://ejournal.psychiatry-malaysia.org/

Jurnal Sains Kesihatan Malaysia
http://pkukmweb.ukm.my/~penerbit/jskm.html

Malaysian Journal of Medical Sciences
http://www.medic.usm.my/publication/mjms/

Malaysian Journal of Public Health Medicine
http://161.142.92.108/mjphm/about.asp

Medical Journal of Malaysia
http://www.mma.org.my/

Malaysian Journal of Pathology
www.mjpath.org.my/contactus.html

Malaysian Biomedical Journal
http://ejournal.afpm.org.my/2007v2n1/pdf/Malaysian%20biomedical%20journals%20on%20the%20web.pdf

Malaysian Journal of Nutrition
http://nutriweb.org.my/publications/mjn0010_2/default.php

Malaysian Family Physician-ejournal
http://ejournal.afpm.org.my/

Singapore

Singapore Medical Journal
http://smj.sma.org.sg/smjcurrent.html

2008-05-27T00:41:00.000-07:00

Apakah itu Kemurungan?

Kemurungan atau Depression adalah penyakit emosi yang kerap ditemui dikalangan masyarakat. Mengikut kajian, secara am 20 hingga 25% wanita dan 8 -10% lelaki pernah menghidapi penyakit ini sepanjang hayat mereka. Pengidap masalah kemurungan mempunyai tanda-tanda seperti perasaan sedih yang berpanjangan dan teruk, hilang selera makan, hilang berat badan, lemah anggota badan, tidak bermaya sakit-sakit badan dan tidur tergangu. Mereka yang mempunyai tahap yang teruk mempunyai symptom-simptom seperti hilang tumpuan pada tugas harian, merasakan hidup ini tidak berguna, masa hadapan dipandang suram dan jiga dibiarkan mereka ada perasaan ingin menamatkan riwayat sendiri.

Penyakit ini mempunyai rawatan ubat yang dipanggil antidepressant yang amat berkesan. Di samping itu kaunseling dan psychotherapy boleh membantu mereka.