Association of Tinnitus with Anxiety and Depression among Active-Duty Army Personnel and Veterans at Hospital Angkatan Tentera Tuanku Mizan, Malaysia.

OBJECTIVES: To study the prevalence of tinnitus, its characteristic and its association with anxiety and depression among active-duty army personnel and veterans. This study also wants to determine the correlation of Tinnitus Handicap Inventory (THI) with Hospital Anxiety Depression Scale (HADS) among active-duty army personnel and veterans at Hospital Angkatan Tentera Tuanku Mizan. MATERIALS AND METHODS: A cross-sectional study was conducted at the Otorhinolaryngology Head and Neck Surgery Department of Hospital Angkatan Tentera Tuanku Mizan from January 2020 until June 2021, involving active-duty army personnel and veterans with at least 3 years of service. Those patients who fulfilled inclusion and exclusion criteria were recruited. Their feedback was recorded based on Malay version of Tinnitus Handicap Inventory (THI) and Malay version of Hospital Anxiety Depression Scale (HADS). RESULTS: 106 subjects responded to our questionnaires, (51 active-duty army personnel and 55 veterans) in which 4.7% (n=5) reported to have anxiety and none had depression. Overall mean score for Total THI was 27.66, suggesting that majority of our subjects only felt mild handicap due to their tinnitus. Individual THI subdomain mean scores shows that the functional subdomain (17.79) affects subjects the most as compared to the emotional (5.7) and catastrophic scores (4.21). CONCLUSION: Tinnitus can occur in all degrees of hearing loss, and it is associated with poor functional THI scores. Tinnitus is associated with anxiety but not depression among army personnel. These findings suggest that tinnitus should be addressed by healthcare providers in the military in order to maximise function and Quality of Life (QOL) among the nation's military personnel.

Generalization of cognitive training in an Australian sample of schizophrenia patients.

OBJECTIVE: The present study was undertaken to evaluate the effect of cognitive training in improving trained and untrained cognitive processes in schizophrenia. METHODS: A simple pre- and post experimental study with a three month follow-up was conducted to determine the efficacy of cognitive training in speed of processing and executive functions improving cognition in 22 schizophrenia patients. RESULTS: Significant improvement was found in those cognitive domains specifically targeted in the training protocol, but also to a limited extent on verbal memory and social cognition. There was also evidence of improvements in symptoms and social functioning. The training effects failed to transfer to community functioning skills however. Except for social cognition, these improvements were maintained at 3month follow-up. CONCLUSION: The study highlights the importance of understanding the mechanisms that contribute to the transfer of skills as well as the maintenance of cognitive changes in individuals with schizophrenia.

Association between the Internet Gaming Disorder and Anxiety and Depression among University Students during COVID-19 Pandemic.

Introduction: Internet gaming is now a major concern since its overuse has had a detrimental impact on people's well-being. This study aims to investigate the association between Internet Gaming Disorder and depression, anxiety, and stress, as well as gaming elements during the COVID-19 pandemic, among university students. Methods: The cross-sectional study involved 213 students from two different institutions who were randomly selected. The participants were required to complete three sets of online questionnaires via Google Forms. The online questionnaire consists of the Internet Gaming Disorder Scale-Short Form (IGD9-SF) and the Depression, Anxiety, and Stress Scale (DASS-21). Results: The prevalence rate of IGD among university students during the COVID-19 pandemic was 9.86%. Bivariate analysis revealed biological sex (p-value = 0.011), preferred gaming platforms (p-value = <0.001), game gameplay (p-value = 0.03), history of substance use (p-value = <0.001), and stress (p-value = <0.001) to be associated with IGD. Meanwhile, binary logistic regression demonstrated that males have a higher risk of developing IGD compared with females (adjusted odds ratio (AOR) = 3.426, p-value 0.015, CI = 1.27-9.21). Students who used consoles as their preferred gaming platform were 13 times more likely to develop IGD in comparison to another platform (AOR = 13.031, p-value = 0.010, 95% CI = 1.87-91.02). Extensive gaming duration of more than 4 h a day showed a higher risk of developing IGD (AOR = 8.929, p-value 0.011, CI = 1.659-48.050). High-stress levels significantly increased the risk of IGD (AOR = 13.729, p-value = 0.001, 95% CI = 2.81-67.1). Conclusion: The prevalence of IGD among university students was high during the COVID-19 pandemic. Thus, interventions for reducing stress among university students should be implemented to reduce the risk of IGD.

Maternal COVID-19 vaccine acceptance among Malaysian pregnant women: A multicenter cross-sectional study.

Introduction: The coronavirus disease 2019 (COVID-19) caused a global pandemic that resulted in devastating health, economic and social disruption. Pregnant mothers are susceptible to COVID-19 complications due to physiological and immunity changes in pregnancy. We aimed to assess the maternal vaccine acceptance of the COVID-19 vaccine. Methods: A multi-center study across four teaching hospitals in the Klang Valley, Malaysia was conducted between September 2021 and May 2022. A survey was conducted using a self-administered electronic questionnaire. The survey instruments included; (1) maternal perception and attitude toward COVID-19 vaccination, (2) COVID-19 pregnancy-related anxiety, and 3) generalized anxiety disorder. Results: The response rate was 96.6%, with a final number for analysis of 1,272. The majority of our women were Malays (89.5%), with a mean age (standard deviation, SD) of 32.2 (4.6). The maternal vaccine acceptance in our study was 77.1%. Household income (p < 0.001), employment status (p = 0.011), and health sector worker (p = 0.001) were independent predictors of maternal willingness to be vaccinated. COVID-19 infection to self or among social contact and greater COVID-19 pregnancy-related anxiety were associated with increased odds of accepting the SARS-CoV-2 vaccine. Women who rely on the internet and social media as a source of vaccine information were more likely to be receptive to vaccination (adjusted odd ratio, AOR 1.63; 95% CI 1.14-2.33). Strong correlations were observed between maternal vaccine acceptance and the positive perception of (1) vaccine information (p < 0.001), (2) protective effects of vaccine (p < 0.001), and (3) getting vaccinated as a societal responsibility (p < 0.001). Discussion: The high maternal vaccine acceptance rate among urban pregnant women in Malaysia is most likely related to their high socio-economic status. Responsible use of the internet and social media, alongside appropriate counseling by health professionals, is essential in reducing vaccine hesitancy among pregnant women.

A case of sexual abuse by a traditional faith healer: are there potential preventions?

Adolescent sexual abuse is not an uncommon phenomenon in Malaysia. It is a traumatic experience that complicates the psychosocial development of young people on the threshold of adulthood. This case report highlights the psychosocial sequelae of adolescent sexual abuse by a traditional healer and discusses management issues in the context of unique cultural and belief systems.

Metabolomic Profiling Reveals Common Metabolic Alterations in Plasma of Patients with Toxoplasma Infection and Schizophrenia.

Toxoplasma gondii is an opportunistic protozoan parasite known to affect the human brain. The infection has been associated with an increased incidence of schizophrenia; however, the link between the two conditions remains unclear. This study aimed to compare the plasma metabolome of schizophrenia and non-schizophrenia subjects with or without Toxoplasma infection. Untargeted metabolomic profiling was carried out by liquid chromatography-mass spectrometry. Elevation of the α-hydroxyglutaric acid level and reduced adenosine monophosphate, inosine, hypoxanthine and xanthine were found in the subjects with either toxoplasmosis or schizophrenia alone. These results suggest that purine catabolism is a common metabolic alteration in Toxoplasma infection and schizophrenia. The roles of these metabolites on the pathogenesis of schizophrenia in relation to Toxoplasma infection warrant further studies.

The Role of Virtual Reality as a Psychological Intervention for Mental Health Disturbances during the COVID-19 Pandemic: A Narrative Review.

The COVID-19 pandemic spread throughout the world and created many problems. The COVID-19 pandemic caused an increase in mortality and morbidity, including mental health problems. Around the world, the movement control order (MCO) was strictly enforced, but the spread of the infection epidemic was still rampant. The magnitude of the increase in mental health illnesses has caused many individuals to suffer. Given that face-to-face interventions are challenging to carry out during an outbreak, we need to address this critical problem through an online approach, such as virtual reality (VR). This approach is vital to helping patients deal with their existing problems in more pragmatic, practical, and customer-friendly ways. Thus, in the present review, we proposed the development of a virtual digital device for this noble purpose. Various challenges, improvements, and expectations for VR applications were outlined and discussed in this narrative review.

Psychometric Evaluation of the Malay Version of the Childbirth Experience Questionnaire (CEQ-My).

Negative childbirth experience may cause adverse psychological effects in postpartum mothers. The Childbirth Experience Questionnaire (CEQ) is a multidimensional tool designed to assess women's perceptions of labour and birth. We aim to validate the Malay version of the CEQ (CEQ-My) and evaluate its psychometric properties. The previously published Malay-translated CEQ was reviewed by a panel of experts and underwent minor changes. The original visual analogue scoring (VAS) was changed to a numerical scale. The reliability and construct validity of CEQ-My was assessed using Cronbach's alpha and exploratory analysis, respectively. Known-groups validation was conducted using the Mann−Whitney U test, whilst the inter-item correlations between CEQ-My and its subdomains were evaluated through Spearman's correlation. The final analysis involved 246 women. The questionnaire was easy to understand and all women preferred numeric scoring to the VAS. Based on the principal component factor analysis, we deleted one item and rearranged the domain for four items. The twenty-one items CEQ-My demonstrated good reliability with Cronbach's alpha of 0.77. Women who had spontaneous vaginal delivery demonstrated significantly greater CEQ-My scores than those who underwent operative delivery (p = 0.002). The domain of professional support was positively correlated to that of own capacity and participation (p-value of < 0.001 and 0.002, respectively). The CEQ-My is a valid and reliable instrument to assess Malaysian women's childbirth experiences. The easy-to-use electronic version of CEQ-My will improve future research and ease data collection.

Case report: Bipolar disorder in 48,XXYY syndrome.

48,XXYY syndrome is a rare condition. The presentations of impulsive and aggressive behavior have been reported in several case reports among patients with 48,XXYY syndrome. The management of the psychological impact and neuropsychiatric sequela of this condition is a significant issue faced by families, carers, and healthcare professionals. We report a patient, 21-year-old Malay male, with underlying 48,XXYY syndrome with attention deficit hyperactivity disorder (ADHD) and intellectual disability, diagnosed later in adulthood with a bipolar mood disorder and benefited after being started on lithium. We describe the key clinical features and diagnostic workouts that allowed the arrival of the correct psychiatric diagnosis. Challenges in psychopharmacotherapy, including the risks of metabolic syndrome and deep vein thrombosis associated with 48,XXYY syndrome, are also considered. We suggest that for patients with 48,XXYY syndrome, routine psychological screening for mood symptoms such as mania and depression should be done by healthcare professionals with early involvement of psychiatrist in the multidisciplinary team due to the challenges in the management of these patients.

Virtual Reality (VR) Technology for Treatment of Mental Health Problems during COVID-19: A Systematic Review.

There was a surge in psychological distress and emotional burnout during the COVID-19 pandemic. Virtual reality (VR) is helpful as a psychological intervention whilst maintaining physical or social distancing. The present systematic review assessed the role of VR as a psychological intervention tool for mental health problems during the COVID-19 pandemic. We conducted a systematic review that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. This study used the search-related terms: (Virtual reality OR simulated-3D-environment OR VR) AND (covid! or corona!) AND (mental* OR psychologic* OR well* OR health*) AND (intervention) on six databases, i.e., MEDLINE, PsycINFO, Ovid Medline, EMBASE, ACM digital library, and Cochrane Central Register of Controlled Trials (CENTRAL) from the inception date until 23 June 2021. We finally included four studies in the systematic review out of the 379 references imported for screening. These studies reveal that VR is beneficial as a psychological tool for intervention in individuals with mental health problems. Immersed in the telepresence, interacting in a 3-D format compared to a 2-D layout, having a sense of enjoyment and engagement, activating an affective-motivational state, "escaping" to a virtual from the real world are pivotal faucets of VR as a psychological tool for intervention.

Psychometric Properties of Malay Obsessive-compulsive Inventory-child Version (OCI-CV) in Malaysian Perspectives.

Background: This study aimed to examine the psychometric properties of reliability and validity of OCI-CV in a non-clinical sample of Malaysian children and adolescents. Method: Participants of school-age and adolescent students from Klang Valley School completed the 21-item Malay OCI-CV using Google Form. OCI-CV English version was translated backward and forward to the Malay language. Face validity was conducted first before distributing the questionnaire to the participants. Exploratory Factor analysis (EFA) and Confirmatory Factor Analysis (CFA) was conducted to evaluate the psychometric properties of OCI-CV. Results: A total of 102 school-age children and adolescents with a mean age of 15.96 years (male: 41.2%, female: 58.8%) participated in the study. The Malay OCI-CV showed high internal consistency, with Cronbach Alpha values of 0.90 for the whole scale. EFA showed multifactorial components. Five factors were labelled as "Washing / Ordering, Doubting, Obsessions, Checking, and Hoarding,". In the CFA, the five-factor model indicates adequate fit indices of (χ2/df = 1.51, RMSEA = .071, GFI = .824, AGFI = .769, NFI = .724, CFI = .880). Conclusion: The Malay OCI-CV has good psychometric properties and is suitable for use in the Malaysian context. Further validation studies should be conducted among a clinical population to enhance the generalization of this finding.

Excessive smartphone use and its correlations with social anxiety and quality of life among medical students in a public university in Malaysia: A cross-sectional study.

Introduction: Smartphone usage has significantly increased in the last decade among young adults has significantly increased in the last decade. While its benefits are undeniable, its negative implications are increasingly emerging. Studies are needed to investigate the effects of excessive smartphone use on a young person's life. This study aimed to determine the prevalence of excessive smartphone use among medical students and its relations with social anxiety, self-esteem, and quality of life. Methods: A cross-sectional study was conducted among medical students from Universiti Kebangsaan Malaysia (UKM) in UKM Medical Center. A total of 273 students have consented to participate and completed self-reported questionnaires encompassing sociodemographic information, the Short Version Smartphone Addiction Scale (SAS-SV), the Social Interaction Anxiety Scale (SIAS), the World Health Organization Quality of Life (WHOQOL-BREF) and the Rosenberg Self-esteem Scale (RSES). Sociodemographic data, SIAS score, WHOQOL-BREF score and the Rosenberg Self-esteem Scale score were treated as independent variables. Smartphone addiction Scale score was treated as the dependent variable. Bivariate analysis was used to explore the relationship between independent and dependent variables using the Fisher exact test, Pearson Chi-Square and Pearson correlation coefficient. Multiple linear regression analysis was used to analyze the variables with a p-value of < 0.05 from the Pearson correlation coefficient test. Results: The percentage of excessive smarphone use among UKM medical students is 48%. The bivariate analysis showed that excessive smartphone use has a small but significant positive correlation with social anxiety (r = 0.173, p = 0.004) and negative correlations with physical health (r = -0.133, p = 0.028), psychological wellbeing (r =-0.135, p = 0.026), social relationships (r = -0.232, p = 0.001), environment (r = -0.260, p = 0.001) and self-esteem (r = -0.128, p = 0.035). In the multiple regression analysis, a better environment predicted a reduced risk for smartphone addiction (ß = -0.233, p = 0.013). Conclusion: Almost half of the students were found to have smartphone overdependence. Excessive smartphone use has shown a significant relationship with an increased risk for social anxiety, reduction in self-esteem, and quality of life among medical students. A closer look into the possible intervention is needed in the future to curb the negative effects arising from excessive smartphone use.

Validation of the Malay Self-Report Quick Inventory of Depressive Symptomatology in a Malaysian Sample.

Depression is ranked as the second-leading cause for years lived with disability worldwide. Objective monitoring with a standardized scale for depressive symptoms can improve treatment outcomes. This study evaluates the construct and concurrent validity of the Malay Self-Report Quick Inventory of Depressive Symptomatology (QIDS-SR16) among Malaysian clinical and community samples. This cross-sectional study was based on 277 participants, i.e., patients with current major depressive episode (MDE), n = 104, and participants without current MDE, n = 173. Participants answered the Malay QIDS-SR16 and were administered the validated Malay Mini-International Neuropsychiatric Interview (MINI) for DSM-IV-TR. Factor analysis was used to determine construct validity, alpha statistic for internal consistency, and receiver operating characteristic (ROC) analysis for concurrent validity with MINI to determine the optimal threshold to identify MDE. Data analysis provided evidence for the unidimensionality of the Malay QIDS-SR16 with good internal consistency (Cronbach's α = 0.88). Based on ROC analysis, the questionnaire demonstrated good validity with a robust area under the curve of 0.916 (p < 0.000, 95% CI 0.884−0.948). A cut-off score of nine provided the best balance between sensitivity (88.5%) and specificity (83.2%). The Malay QIDS-SR16 is a reliable and valid instrument for identifying MDE in unipolar or bipolar depression.

Heterogeneity in brain functional changes of cognitive processing in ADHD across age: A systematic review of task-based fMRI studies.

This review aims to establish the cognitive processing of patients with attention-deficit hyperactive disorder (ADHD) across age. Functional magnetic resonance imaging (fMRI) studies on children and adult populations were conducted, thus delineating deficits that could have been maintained and ameliorated across age. This allowed for the examination of the correlation between patterns of brain activation and the corresponding development of functional heterogeneity in ADHD. A systematic literature search of fMRI studies on ADHD was conducted using the PubMed and Scopus electronic databases based on PRISMA guidelines. References and citations were verified in Scopus database. The present study has identified 14 studies on children, 16 studies on adults, and one study on both populations of ADHD consisting of 1371 participants. Functional heterogeneity is present in ADHD across age, which can manifest either as different brain activation patterns, intra-subject variability, or both. This is shown in the increased role of the frontal regions and the specialized network in adults with ADHD from inefficient non-specific activation in childhood. Functional heterogeneity may manifest when delayed maturation is insufficient to normalize frontal lobe functions.

Cognitive reserve in stroke patients.

At present, a limited amount of information exists on the association between cognitive reserve and cognitive impairment in stroke populations. To determine predictors of cognitive reserve among stroke patients, 80 stroke patients attending the neurological and rehabilitation clinic in two different Malaysian general hospitals participated in this study. The Malay Cognitive Reserve Index questionnaire (CRIq-M), Depression Anxiety and Stress Scales-Short Form (DASS-21), WHO Quality of Life assessment BREF-21 (WHO-QOL BREF-21), Montreal Cognitive Assessment (MoCA), and modified Rankin Scale (mRS) were used as instruments in this study. The study found that cognitive reserve (CRIq-M) is positively correlated with cognitive function (MoCA), r = 0.529, p < .01. Multiregression showed that education was a significant predictor of cognitive impairment whereas cognitive impairment as assessed by the MoCA is a significant predictor for cognitive reserve in people with stroke. Early identification of cognitive impairment among stroke patients is important so that effective individual rehabilitation can be designed to enhance individual cognitive reserve and quality of life.

COVID-19 Pandemic and Maternal Psychological Wellbeing During the Malaysian Movement Control Order: A Cross-Sectional Study.

Background: COVID-19 pandemic had resulted in nationwide lockdown as a disease control measure. Potential harm to self and baby due to COVID-19 infection as well as uncertainties about delivery are among contributors to maternal anxiety. We aimed to assess the prevalence of psychological distress among pregnant women during the Malaysian Movement Control Order (MCO). Methods: A cross-sectional study was conducted between May and June 2020 in a teaching hospital in Kuala Lumpur, Malaysia. A self-administered electronic questionnaire was distributed which included the following; (1) Depression, Anxiety and Stress Scale-21 (DASS 21), (2) Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), (3) MCO effect questionnaire, and (4) newly designed COVID-19 pregnancy-related anxiety. Chi-square test and logistic regression were performed to determine significant associations whilst mean scores comparison were conducted through Mann-Whitney-U-test. Results: Four hundred and fifteen women were included in the final analysis. The prevalence of psychological distress among our cohort was 14.7%; with a two-fold increase of risk among the non-Malays (AOR 1.98, 95% CI 1.00-3.89) whilst a greater number of social support showed a protective effect (AOR 0.51, 95%CI 0.28-0.92). Malay ethnicity (p < 0.001) alongside greater household income (p = 0.014) were positive predictors of a higher sense of maternal wellbeing. Multiparous women and those of higher economic status experienced the more negative effect of the MCO. Around 88% of our women reported a higher level of COVID-19 pregnancy-related anxiety. Younger (p = 0.017) and first-time mothers (p = 0.039) were more likely to be anxious. Although adequate maternal knowledge on COVID-19 was associated with a greater sense of maternal wellbeing (p = 0.028), it was also linked to a higher level of COVID-19 related anxiety (AOR 3.54, 95% 1.29-9.70). Conclusion: There was a relatively low prevalence of psychological distress among expectant mothers in Malaysia during the first wave of the COVID-19 pandemic. Expectant mothers should receive accurate and reliable information on the effect of COVID-19 on pregnancy to relieve some maternal anxiety. Maternal health screening is important to identify individuals who would benefit from extra support and mental health intervention, especially in prolonged lockdown.

Understanding the Turning Point of Patients with Diabetes.

BACKGROUND: The patient's intention to engage in diabetes care is the hallmark of role acceptance as a health manager and implies one's readiness to change. The study aimed to understand the process of having the intention to engage in diabetes care. METHODS: A qualitative study using narrative inquiry was conducted at a public primary care clinic. Ten participants with type 2 diabetes of more than a 1-year duration were selected through purposive sampling. In-depth interviews were conducted using a semi-structured protocol guide and were audio-taped. The interviews were transcribed and the texts were analyzed using a thematic approach with the Atlas.ti ver. 8.0 software (Scientific Software Development GmbH, Berlin, Germany). RESULTS: Three themes emerged from the analysis. The first theme, "Initial reactions toward diabetes," described the early impression of diabetes encompassing negative emotions, feeling of acceptance, a lack of concern, and low level of perceived efficacy. "Process of discovery" was the second overarching theme marking the journey of participants in finding the exact truth about diabetes and learning the consequences of ignoring their responsibility in diabetes care. The third theme, "Making the right decision," highlighted that fear initiated a decision-making process and together with goal-setting paved the way for participants to reach a turning point, moving toward engagement in their care. CONCLUSION: Our findings indicated that fear could be a motivator for change, but a correct cognitive appraisal of diabetes and perceived efficacy of the treatment as well as one's ability are essentially the pre-requisites for patients to reach the stage of having the intention to engage.

Pregnancy and COVID-19 Pandemic Perception in Malaysia: A Cross-Sectional Study.

Pregnant women are susceptible to COVID-19 complications due to gestation-related physiological changes. We aimed to evaluate the level of maternal knowledge, perception, and practice during the pandemic. A cross-sectional study was conducted during the Malaysian Movement Control Order (MCO) between April and June 2020. A self-administered electronic questionnaire that included the knowledge and practice domains was distributed. A newly designed set of questions was used to evaluate (1) women's perception of MCO and (2) maternal experience, which was subdivided into clinical care provision and maternal anxiety. The survey response rate was 93% with the final number for analysis of 415. The majority of women (95%) demonstrated an adequate level of knowledge on COVID-19, whilst 99% had a good practice. We found that tertiary education (p < 0.001), employment status (p = 0.03), higher household income (p < 0.001), and multiple sources of information (p < 0.001) were independent predictors of adequate maternal knowledge on COVID-19. Women with adequate knowledge also reported a more positive perception of MCO (p < 0.001) and better obstetric care experience (p = 0.037), as did those of Malay ethnicity. Younger (p < 0.001) and nulliparous (p = 0.01) women demonstrated greater anxiety levels. The majority of our women reported good practice and adequate knowledge, which contributed to a positive perception of MCO and better maternal obstetric experience. First-time mothers may benefit from extra support and reassurance during the pandemic to alleviate maternal anxiety.

Reactivation of Latent Toxoplasmosis in a Schizophrenia Patient: A Case Report.

Schizophrenia is a serious mental disorder characterized by chronic relapsing episodes of psychosis. The disease is multifactorial, where infections, genetic vulnerability and environmental factors are involved in the development of the illness. Toxoplasma gondii is one of the parasites that has long been known associated with schizophrenia in many studies. To date, there is growing evidence of association between T. gondii infections and schizophrenia. Herein we report a rare case of reactivated toxoplasmosis in a schizophrenia individual. This patient was incidentally diagnosed with reactivated T. gondii infection. He denied any symptoms of toxoplasmosis but experienced a mild psychiatric auditory hallucination. Serology test for T. gondii immunoglobulin antibodies measured a high positive IgG titer (135.9 IU/ml) and negative for IgM. Interestingly, nested PCR exhibited a positive result for the type I strain of T. gondii dense granular (GRA) 7 gene (GRA7). This case highlights the detection of probable reactivation of toxoplasmosis in an immunocompetent schizophrenic patient without psychiatric treatment-resistant and remains asymptomatic for toxoplasmosis. Both serology and molecular tools have been a helpful aid in establishing the diagnosis. Nonetheless, early detection as in this case may aid the patient management in the future.

Adaptability of "Management of Really Sick Patients with Anorexia Nervosa" (MARSIPAN) for extreme anorexia nervosa in a developing country: A case report.

OBJECTIVE: For the management of patients with severe eating disorders, coordinated collaboration between a multidisciplinary team is imperative. Ideally, these cases should be treated in a specialized eating disorder unit (SEDU). METHOD: This case report highlights the use of an integrated approach based on "Management of Really Sick Patients with Anorexia Nervosa" report in managing a case of extreme anorexia nervosa where a SEDU is unavailable. RESULT: In this case, early psychiatric team support is key in the patient's path to recovery. PRACTICE IMPLICATION: This highlights the importance of having a SEDU and staff trained in eating disorder.