Mapping the evolution of neurofeedback research: a bibliometric analysis of trends and future directions.

Introduction: This study conducts a bibliometric analysis on neurofeedback research to assess its current state and potential future developments. Methods: It examined 3,626 journal articles from the Web of Science (WoS) using co-citation and co-word methods. Results: The co-citation analysis identified three major clusters: "Real-Time fMRI Neurofeedback and Self-Regulation of Brain Activity," "EEG Neurofeedback and Cognitive Performance Enhancement," and "Treatment of ADHD Using Neurofeedback." The co-word analysis highlighted four key clusters: "Neurofeedback in Mental Health Research," "Brain-Computer Interfaces for Stroke Rehabilitation," "Neurofeedback for ADHD in Youth," and "Neural Mechanisms of Emotion and Self-Regulation with Advanced Neuroimaging. Discussion: This in-depth bibliometric study significantly enhances our understanding of the dynamic field of neurofeedback, indicating its potential in treating ADHD and improving performance. It offers non-invasive, ethical alternatives to conventional psychopharmacology and aligns with the trend toward personalized medicine, suggesting specialized solutions for mental health and rehabilitation as a growing focus in medical practice.

Assessing the factor structure of the Eating Attitude Test-26 among undergraduate students in Malaysia.

The objective of this study was to assess the factor structure of the 26-item Eating Attitude Test (EAT-26) through confirmatory factor analysis (CFA) among 1,084 undergraduate students in Malaysia. The initial findings indicated a lack of support for the proposed three-factor structure. Model modifications were made due to the inadequate initial fit. The fit of the model was significantly improved by excluding items with factor loadings below 0.40 and integrating residual covariances. In conclusion, it is necessary to make contextual modifications to the EAT-26 in order to effectively utilize it among Malaysian undergraduates. This highlights the significance of cultural adaptations in psychological instruments.

Relationship of Psychological Flexibility and Mindfulness to Caregiver Burden, and Depressive and Anxiety Symptoms in Caregivers of People with Dementia.

Caregivers of People with dementia (PwD) commonly experience burdens and other mental health issues, e.g., depression and anxiety. At present, there are limited studies that examine the relationships between caregiver psychological factors and caregiver burden, and depressive and anxiety symptoms. Therefore, this study's objectives were to examine the relationships between psychological flexibility and mindfulness in caregivers of PwD, and to determine the predictors of these three outcomes. This was a cross-sectional study conducted in the geriatric psychiatry clinic of Kuala Lumpur Hospital, Malaysia, and the sample (n = 82) was recruited via a universal sampling method over three months. The participants completed a questionnaire that consisted of the sociodemographics of the PwD and caregivers, illness characteristics of the PwD, Acceptance and Action Questionnaire-II (AAQ-II), Mindful Attention Awareness Scale (MAAS), Zarit Burden Interview Scale (ZBI), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). The results show that despite significant relationships between psychological flexibility and mindfulness and lower levels of caregiver burden, and depressive and anxiety symptoms (p < 0.01), only psychological inflexibility (p < 0.01) remained as a significant predictor of the three outcomes. Therefore, in conclusion, intervention programs that target the awareness of the caregiver's psychological inflexibility should be implemented to alleviate these adverse outcomes in dementia caregivers.

Paraphilia without symptoms of primary psychiatric disorder: a case report.

BACKGROUND: Paraphilias are recurrent and arousing fantasies, thoughts, and behaviors that cause distress to sufferers and surrounding people. This case report details the challenge of managing multiple paraphilias with compulsive sexual behavior. CASE PRESENTATION: A 48-year-old Malay man presented with compulsive sexual behavior, encompassing voyeuristic, frotteurism, and exhibitionistic behavior, increasing progressively over the years, with accompanying overvalued ideas of erotomania. Despite the high level of dysfunction occupationally and socially, there were no apparent psychotic, manic, or depressive symptoms. An organic workup was unremarkable, and he was diagnosed with multiple paraphilias. Treatment with selective serotonin reuptake inhibitors was commenced, and psychologically he was managed with techniques specific to compulsive sexual behavior. CONCLUSION: Though rare in the literature, both paraphilic disorders and compulsive sexual behaviors are very distressing to sufferers and their families alike, and thorough biopsychological investigations are essential to ensure reversible causes are not overlooked.

Psychological Resilience and Coping Strategies with Anxiety among Malaysian Medical Students during the COVID-19 Pandemic.

Coronavirus Disease 2019 (COVID-19) swept the world by storm and caused a myriad of devastating consequences, particularly disruptions in medical education. This study aims to examine the association between sociodemographic factors, psychological factors, coping strategies and anxiety among medical students, as well as to identify the predictors of anxiety among them. A cross-sectional study design was used. Self-rated Rosenberg Self-Esteem Scale (RSES), General Self-Efficacy Scale (GSES), Brief Coping Orientation to Problems Experienced Scale (Brief COPE), and General Anxiety Disorder-7 Scale (GAD-7) were used. A total of 371 respondents from a tertiary education center were recruited. The prevalence of anxiety was 37% which corresponded to 21.6% and 15.4% for moderate and severe anxiety, respectively. Sociodemographic factors such as age group and academic year were significantly associated with anxiety, while those with higher self-esteem (rs = -0.487), self-competence (rs = -0.407), self-liking (rs = -0.499), and self-efficacy (rs = -0.245) had lower anxiety. Inversely, those who adopted emotion-focused (rs = 0.130) and dysfunctional coping styles (rs = 0.559) showed higher anxiety. The main predictors of anxiety were self-liking as a protective factor (aOR = 0.81) and dysfunctional coping as a risk factor (aOR = 1.16). Therefore, resilience building and inculcating positive coping strategies are imperative in equipping our budding healthcare providers to weather through future unforeseeable disasters.

Efficacy of a single-session online ACT-based mindfulness intervention among undergraduates in lockdown during the COVID-19 pandemic.

INTRODUCTION: COVID-19 has trickle-down psychological effects on multiple strata of society, particularly university students. Apart from the worry of contracting or spreading COVID-19, Malaysian university students were also locked down on their campuses, suffering significant psychological distress. Hence, an online mindfulness intervention was proposed to alleviate psychological distress and improve psychological flexibility and mindfulness. METHODS: This was a quasi-experimental study with university students as participants. Intervention group participants were instructed to complete online questionnaires which covered basic demographics and instruments assessing depression, anxiety, stress, mindfulness, psychological flexibility, and fear of COVID-19 before and after the one-hour intervention. The control group also completed before and after questionnaires and were subsequently crossed over to the intervention group. Repeated measures ANOVA was conducted to assess time*group effects. RESULTS: 118 participants were involved in this study. There were significant differences in anxiety (F(1,116) = 34.361, p < 0.001, partial eta-squared = 0.229) and psychological flexibility between the two groups (F(1,116) = 11.010, p = 0.001, partial eta-squared = 0.087), while there were no differences in depression, stress, mindfulness, or fear of COVID-19. CONCLUSION: The results of this study corroborate the efficacy of online single-session mindfulness therapy as a viable short-term psychological intervention under financial and time constraints. Since university students are in the age group with the highest incidence of depressive and anxiety disorders, it is crucial to utilize resources to address as many students as possible to ensure maximum benefit.

Psychometric Properties of the Coronavirus Stress Measure with Malaysian Young Adults: Association with Psychological Inflexibility and Psychological Distress.

The COVID-19 pandemic has resulted in multiple physical and psychological stressors, which require quantification and establishment of association with other psychological process variables. The Coronavirus Stress Measure (CSM) is a validated instrument with acceptable validity and reliability. This study aimed to examine the psychometric properties of the CSM in a Malaysian population. University participants were recruited via convenience sampling using snowball methods. The reliability and validity of the Malay CSM (CSM-M) were rigorously evaluated, utilising both confirmatory factor analysis and Rasch analysis, in relation to sociodemographic variables and response to the depression, anxiety, and stress subscales of the Malay validation of the DASS-21, and also perceived stress (measured by the PSS) and psychological flexibility (AAQ-II). The sample comprised of 247 Malaysian participants. The McDonald's omega value for the Malay CSM was 0.935 indicating very good internal reliability. The CSM was significantly correlated with stress, anxiety, depression, perceived stress, and psychological flexibility. The Malay CSM properties were examined also with Rasch analysis, with satisfactory outcomes. There was positive correlated error between items 1 and 3, as well as negative correlated error between items 1 and 4. Hence, item 1 was excluded, leaving with 4 items. Confirmatory factor analysis demonstrated good data-model fit, and model fit statistics confirmed that Malay CSM showed a single-factor model. The Malay CSM hence demonstrates good validity and reliability, with both classical and modern psychometric methods demonstrating robust outcomes. It is therefore crucial in operational and research settings in establishing the true extent of stress levels as a consequence of the COVID-19 pandemic.

Correction to: Malay Version of the Fear of COVID-19 Scale: Validity and Reliability.

[This corrects the article DOI: 10.1007/s11469-020-00355-4.].

Relationship between Internet Addiction, Personality Factors, and Emotional Distress among Adolescents in Malaysia.

COVID-19 has significantly affected the mental health of adolescents, thus increasing the emotional distress among them. Studies have reported that heavy Internet use during COVID-19 was linked with poor mental health among adolescents. Additionally, it was found that personality factors are linked with mental health in general. Although past literature has reported the effect of personality factors on mental health, there are limited studies examining the underlying mechanisms among Malaysian adolescents. Therefore, the current study offers an understanding of the intervening role of personality factors in the relationship between Internet addiction and emotional distress among adolescents in Malaysia. This study also aimed to determine the prevalence of Internet addiction and emotional distress (depression, stress, and anxiety) among adolescents in Malaysia. There are a total of 500 participants from 7 secondary schools who range from 13 to 19 years of age. This was a cross-sectional study, and 3 valid questionnaires were used: The Internet Addiction Test (IAT), the Depression, Anxiety, and Stress Scale (DASS-21), and the Ten-Item Personality Inventory (TIPI). Partial least square structure equation modelling (SmartPLS) was used to analyse the mediation models. The results showed that the prevalence of Internet addiction among adolescents was 29.6% and the prevalence of depression, anxiety, and stress among adolescents were 64.8%, 78%, and 51.4%, respectively. Furthermore, mediation analysis showed only emotional stability mediated the relationship between Internet addiction and emotional distress, but not openness to experience, extraversion, conscientiousness, or agreeableness. It is proposed that mental health providers should focus on providing emotion-related interventions to adolescents confronting COVID-19 challenges, ultimately improving mental health.

Comparing the effectiveness of a group-directed video instruction versus instructor-led traditional classroom instruction for learning cardiopulmonary resuscitation skills among first-year medical students: A prospective randomized controlled study.

Introduction: Bystander cardiopulmonary resuscitation (CPR) training is inconsistent among students and the public. Existing CPR teaching courses are costly, time-consuming, and inconsistent. This study aimed to determine the association between overall CPR competency and two teaching modules, a group-directed video instruction module versus an instructor-led traditional classroom instruction module. Methods: This randomized prospective interventional study involved first year medical students of Universiti Sains Malaysia Health Campus from November 2018 until January 2019. Pass-fail scores representing the overall CPR, individual skill performance, and willingness to perform CPR for strangers and family members were collected. Factors associated with reluctance to perform CPR were assessed in a questionnaire. Results: A total of 99 participants were included, 50 in the group-directed video instruction as the intervention module and 49 in the traditional classroom instruction as the control module. There was no statistical significance between the pass and fail outcomes for both video module (p=0.436). Participants in both modules performed similarly in 8 out of 12 individual CPR skills. There was a significant difference in the distribution of skill scores between the pass and fail outcomes (p=<0.001). The intervention module is non-inferior compared to the control module, in relation to CPR willingness rates for strangers (p=0.999) and family members (p=0.117) after the training. Conclusions: The group-directed video self-instruction method is as effective as the instructor-led traditional classroom method to help participants to be competent and willing to perform CPR. It can be used as an independent or supplementary teaching tool for first-time learners and refreshers, especially in a group setting when teaching materials are limited.

Adaptation and Validation of the Malay Version of the SAVE-9 Viral Epidemic Anxiety Scale for Healthcare Workers.

Viral epidemics have surfaced frequently over the past quarter-century, with multiple manifestations of psychological distress. This study sought to establish the psychometric properties of the Malay version of SAVE-9 among healthcare workers. A total of 203 healthcare workers across Malaysia participated in the research. The Malay version of SAVE-9 was translated and back-translated using the WHO instrument validation protocols. Classical Test Theory (CTT) and Rasch analysis were used to assess the validity and reliability of the Malay version of the SAVE-9 scale. The analysis was run using IBM SPSS 26.0 and JAPS. Cronbach's alpha was used to measure the internal consistency of SAVE-9, which was found to be satisfactory (Cronbach's α = 0.795). The correlations between the SAVE-9 and other measured scales (GAD-7 and PHQ-9) were statistically significant. A score of 22 was defined as a cut-off point with good sensitivity (0.578) and specificity (0.165). The Malay version of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) scale is valid and reliable after testing among healthcare workers. It is psychometrically suitable to be used in assessing healthcare workers' stress and anxiety specific to viral epidemics.

The Development and Validation of the Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT)-Malay Version.

OBJECTIVES: psychological flexibility is a crucial construct highly correlated with psychological wellness. There is a need for a tool to measure psychological flexibility in order to accurately ascertain the effects of treatment. The existing industry standard, the Acceptance and Action Questionnaire-II (AAQ-II), has issues with conflating psychological flexibility with distress; moreover, it does not cover the hexaflexes. The 23-item CompACT was designed to surmount these limitations. METHODS: the classical test theory (CTT) and Rasch measurement theory (RMT) were used to check the validity and reliability of the Malay version of the CompACT Scale. Cronbach's α, McDonald's Ω, and greatest lower bound were used to measure internal consistency. A Pearson's correlation test was used to measure test-retest reliability of the Malay versus the original English version. For validity, convergent validity was established by using the Malay AAQ-7 Scale. The dimensionality of the Malay version of the CompACT Scale was explored using exploratory factor analysis. For the RMT, weighted fit statistics (infit) and outlier sensitive fit statistic (outfit) mean square (MnSq) values were used at the item level, while item and person separation reliability values and item and person separation indices were applied at the scale level. RESULTS: the internal consistency measures, including Cronbach α and McDonald's Ω, passed the suggested cutoff points. Convergent validity with the AAQ-II was 0.693. The quality of the Malay version of the CompACT Scale was also satisfactory, as all item and person reliability values and indices exceeded the suggested cut-off points. CONCLUSIONS: the Malay CompACT is a psychometrically sound instrument to assess psychological flexibility in both clinical and research settings.

Mediating Effect of Psychological Process Variables on the Relationship between Dysfunctional Coping and Psychopathologies: A Comparative Study on Psychopathologies during COVID-19.

The COVID-19 crisis has had repercussions on global mental wellbeing. This study aimed: (1) to identify the mediating role of psychological process variables, namely psychological mindedness, psychological mindfulness, and psychological inflexibility on the relationship between dysfunctional coping and psychopathologies in Indonesian undergraduate students subjected to national quarantine orders throughout July, 2020 and (2) to compare the level of anxiety, depression, and anxiety between Indonesian and Malaysian undergraduate students. A cross-sectional study was performed with 869 Indonesian undergraduate students from Nahdlatul Ulama University of Surabaya (UNUSA) and 515 undergraduate students from Universiti Malaysia Sabah (UMS). The BIPM, MAAS, AAQ-I, DASS-21, and Brief COPE were used to assess the research variables. The proportion who scored "moderate" and above for depression, anxiety, and stress were 20.2%, 25.0%, and 14.2%, respectively, in Malaysian samples and 22.2%, 35.0%, and 23.48% in Indonesian samples. In Study 1, psychological mindedness, psychological mindfulness, and psychological inflexibility significantly mediated the relationship between dysfunctional coping and psychopathologies. In Study 2, Indonesians demonstrated significantly higher anxiety and stress compared to Malaysian samples. Despite the contrasting COVID-19 situations in Malaysia and Indonesia, psychopathologies were more affected in Indonesia. Hence, our study suggests how crucial it is for mental health providers to consider promoting psychological mindedness, psychological mindfulness, and psychological flexibility to alleviate the corresponding psychopathologies among undergraduate students.

Adaptation and Validation of the Malay Version of the Stress and Anxiety to Viral Epidemics-6 Items Scale Among the General Population.

The coronavirus disease pandemic has caused untold distress owing to both its physical and psychological sequelae, and such distress is further exacerbated by multiple socioeconomic ramifications. The Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6). Scale was developed to specifically assess the anxiety response of the general population to viral epidemics. This study aimed to establish the psychometric properties of the Malay version of the SAVE-6 Scale in the general population. Herein, a total of 257 individuals participated. World Health Organization instrument validation protocols were used to translate and back-translate the Malay SAVE-6 Scale. Subsequently, the classical test theory and Rasch analysis were used to ascertain the validity and reliability of the scale. Cronbach α was used to measure the internal consistency, which was found to be satisfactory (α = 0.866). The correlations between the SAVE-6 Scale and other scales, including the Generalized Anxiety Disorder-7 Items Scale (r = 0.421, p < 0.001) and Patient Health Questionnaire-9 Items (r = 0.354, p < 0.001) were significant. Taken together, the Malay version of the SAVE-6 Scale is valid and reliable for use in the general population and is psychometrically suitable for assessing stress and anxiety specific to viral epidemics.

Seroprevalence of COVID-19 and Psychological Distress among Front Liners at the Universiti Malaysia Sabah Campus during the Third Wave of COVID-19.

In 2020, the COVID-19 pandemic struck the globe and disrupted various aspects of psychological wellbeing, more so in frontline workers. Research on assessing the seroprevalence of COVID-19 has been scarce; in addition, there are limited studies assessing the association between the seroprevalence of COVID-19 and psychological distress. Therefore, this study aimed to determine the seroprevalence of COVID-19 and the prevalence of psychological distress and to determine whether sociodemographic variables, occupational information variables, coping styles, and psychological processes might contribute to the development of psychological distress. A cross-sectional study involving 168 Universiti Malaysia Sabah (UMS) front liners was carried out to assess these issues. The Depression, Anxiety and Stress Scale (DASS-21) was employed to assess psychological distress, together with the COVID-19 Rapid Test Kit Antibody (RTK Ab) and a series of questionnaires, including a sociodemographic and occupational information questionnaire, the Balanced Index of Psychological Mindedness (BIPM) questionnaire, the Mindfulness Attention and Awareness Scale (MAAS), the Acceptance and Action Questionnaire (AAQ-II), and the Brief COPE questionnaire. The results demonstrated a seroprevalence of COVID-19 at 8.3% (95% CI = 5.0-14.0). Non-healthcare workers (HCWs) had a higher COVID-19 prevalence. Meanwhile, the prevalence of depression, anxiety, and stress among front liners was low (3.0%, 3.6%, and 1.2%, respectively). Younger people (aged 30 years old or less) and HCWs had a higher prevalence of psychological distress; being a HCW was significantly associated with a higher level of anxiety. Dysfunctional coping and psychological inflexibility were consistently found to be predictors for higher levels of the three psychological distress variables. This study suggested some alternatives that could be explored by mental health providers to address mental health issues among front liners at universities.

Factors Contributing to Burnout among Healthcare Workers during COVID-19 in Sabah (East Malaysia).

The third wave of COVID-19 in Malaysia has significantly strained the healthcare system of the country and increased the level of burnout among the healthcare workers (HCWs) in the country. Therefore, this study aimed to identify the various factors associated with burnout among HCWs. A cross-sectional study was conducted among 150 HWCs in Kota Kinabalu, Sabah, Malaysia. An online survey was administered using the Copenhagen Burnout Inventory, Multidimensional Scale of Perceived Social Support, Brief COPE, and Fear of COVID-19 scales. Pearson correlations were assessed amongst all variables. Subsequently, a multiple linear regression analysis was performed using burnout dimensions as dependent variables. Multiple linear regression results showed: (a) lower work-related burnout (ß = −0.217, p < 0.01) among married HCWs; (b) higher personal-related burnout (ß = 0.228, p < 0.01), work-related burnout (ß = 0.425, p < 0.01), and client-related burnout (ß = 0.359, p < 0.01) among doctors; (c) fear towards COVID-19 was significantly associated with client-related burnout (ß = 0.243, p < 0.01); (d) an avoidant coping strategy was significantly associated with personal-related burnout (ß = 0.322, p < 0.01); (e) social support from family was significantly associated with personal-related burnout (ß = −0.264, p < 0.01), work-related burnout (ß = −0.186, p < 0.05), and client-related burnout (ß = −0.326, p < 0.01);(f) and social support from friends was significantly associated with work-related burnout (ß = −0.202, p < 0.05). This study demonstrated significant theoretical contributions and clinical implications in the healthcare system in Sabah by addressing the impact of various factors on burnout among HWCs.

Malay Version of the Fear of COVID-19 Scale: Validity and Reliability.

The newly developed Persian Fear of COVID-19 Scale (FCV-19S) is a seven-item uni-dimensional scale that assesses the severity of fear of COVID-19. A translation and validation of the FCV-19S in the Malay language was expedited due to the severe psychological sequelae of COVID-19 in Malaysia. Formal WHO forward and backward translation sequences were employed in translating the English version into Malay. Malaysian university participants were recruited via convenience sampling online using snowball methods. The reliability and validity properties of the Malay FCV-19S were rigorously psychometrically evaluated (utilising both confirmatory factor analysis and Rasch analysis) in relation to socio-demographic variables and response to the depression, anxiety and stress subscales of the Malay validation of the DASS-21. The sample comprised 228 Malaysian participants. The Cronbach α value for the Malay FCV-19S was 0.893 indicating very good internal reliability. The results of the confirmatory factor analysis showed that the uni-dimensional factor structure of the FCV19S fitted well with the data. The FCV-19S-M was significantly correlated with anxiety (r = 0.481, p < 0.001) and stress (r = 0.389, p < 0.001) subscales of DASS-21. The FCV-19S-M's properties tested using Rasch analysis were also satisfactory. Hence, the Malay FCV-19S is valid and reliable, with robust psychometric properties from classical and modern psychometric methods. It therefore is a highly crucial and timely addition to the psychological toolkit both in operational and research settings in identifying, managing and responding to the psychological distress engendered by COVID-19.

Relationship Between Fear of COVID-19, Psychopathology and Sociodemographic Variables in Malaysian Population.

COVID-19 has affected Malaysia in multitude aspects. Although Malaysia is on the right track to flatten the curve attributed to swift and decisive actions by the government, it is important to assess the psychological after effect that caused by the pandemic and the movement control order. This study performed in Borneo, Malaysia, was conducted using principles of snowballing, and by invitation through university students and staffs mailing list to participate. The survey collected data on sociodemographic, along with measuring psychological impact by using the newly validated Malay version Fear of COVID-19 Scale and DASS-21 scale. There were a total of 255 respondents. The majority of the respondents' age was 25 years and below, with a female male ratio of 2:1 and around 70% respondents were students. Below 25-year-old age group, and females are having significantly higher levels of fear of COVID-19, depression, anxiety, and stress. Single people have higher depression level. There was a significant difference between students and non-students for depression, anxiety, and stress, but not for fear of COVID-19. It is imperative to allay the fears and psychological sequalae of COVID-19, especially those individuals at higher risks. Psychological interventions as well as telepsychiatry mobilisation could prove useful in dealing with the distress.

Efficacy of a single-session online ACT-based mindfulness intervention among undergraduates in lockdown during the COVID-19 pandemic

Abstract Introduction COVID-19 has trickle-down psychological effects on multiple strata of society, particularly university students. Apart from the worry of contracting or spreading COVID-19, Malaysian university students were also locked down on their campuses, suffering significant psychological distress. Hence, an online mindfulness intervention was proposed to alleviate psychological distress and improve psychological flexibility and mindfulness. Methods This was a quasi-experimental study with university students as participants. Intervention group participants were instructed to complete online questionnaires which covered basic demographics and instruments assessing depression, anxiety, stress, mindfulness, psychological flexibility, and fear of COVID-19 before and after the one-hour intervention. The control group also completed before and after questionnaires and were subsequently crossed over to the intervention group. Repeated measures ANOVA was conducted to assess time*group effects. Results 118 participants were involved in this study. There were significant differences in anxiety (F(1,116) = 34.361, p < 0.001, partial eta-squared = 0.229) and psychological flexibility between the two groups (F(1,116) = 11.010, p = 0.001, partial eta-squared = 0.087), while there were no differences in depression, stress, mindfulness, or fear of COVID-19. Conclusion The results of this study corroborate the efficacy of online single-session mindfulness therapy as a viable short-term psychological intervention under financial and time constraints. Since university students are in the age group with the highest incidence of depressive and anxiety disorders, it is crucial to utilize resources to address as many students as possible to ensure maximum benefit.

Deliberate self-harm in a patient with hyperthyroidism with acute psychosis.

A woman in her 30s with underlying Graves' disease, who recently completed radioactive iodine treatment, presented with 2 weeks of acutely altered behaviour associated with auditory hallucinations and religious preoccupations. Laboratory investigation demonstrated elevated free thyroxine levels and suppressed thyroid-stimulating hormone levels. Additionally, there was a presence of antithyroid peroxidase antibodies consistent with autoimmune thyroid disease. She responded to antipsychotics and achieved biochemical euthyroidism. Subsequently, antipsychotic was tapered off during outpatient follow-up at the patient's own request, with supplement thyroxine continuing. After 1 week, acute hallucinations and religious preoccupations re-emerged, driving her to inflict self-injuries by swallowing coins and nails and banging her head against the wall, sustaining laceration wounds. Furthermore, she hammered a roofing nail into the external genitalia, embedded in the symphysis pubis. After supplemental thyroxine was stopped and olanzapine was started, she achieved biochemical euthyroid followed by remission of psychosis within 1 week. This case illustrates the importance of elucidating organic causes of psychosis as they are easily and swiftly reversible.