Anxiety, depression and marital satisfaction in women with hyperemesis gravidarum: A comparative cross-sectional study in Hospital Tengku Ampuan Rahimah, Klang, Malaysia.

INTRODUCTION: Hyperemesis Gravidarum (HG) is a severe form of vomiting that occurs among pregnant mothers. Due to the nature of HG, pregnant mothers may feel fatigued and burdened by it and questions have been raised about the emergence of psychiatric illness during this period of vulnerability. METHODS: A comparative cross-sectional study using Hospital Anxiety and Depression Scale (HADS), M.I.N.I (MINI International Neuropsychiatric Interview) and ENRICH- EMS (Evaluation and Nurturing Relationship Issues, Communication and Happiness - Marital Satisfaction Scale) were performed in a group of 112 pregnant women. RESULTS: There were no differences in the prevalence rate of any anxiety disorder among the patient with HG vs comparative group (9% vs 3%, P > 0.05) and depressive disorder in women with HG vs comparative group (16% vs 8%, P > 0.05) respectively. There were associations between HG and gravida, past history of miscarriage, and gestational diabetes (P < 0.05). After adjustment, only past history of gestational diabetes was associated with HG as a protective factor (AOR 0.034 95% CI 0.002-0.181; P = 0.0014). We found that women in the HG group tended to score statistically significantly higher than the comparison group for depressive symptoms in the HADS Depression subscale (P = 0.041). DISCUSSION: We found no convincing association between HG and anxiety disorder, depressive disorder, and marital satisfaction, but women with HG statistically significantly reported more depressive symptoms than women who were not diagnosed with HG. Psychiatric evaluation should be considered for women with HG.

Attention deficit hyperactivity disorder symptoms reporting in Malaysian adolescents: do adolescents, parents and teachers agree with each other?

Attention Deficit Hyperactivity Disorder (ADHD) is a clinical diagnosis relying on persistence of symptoms across different settings. Information are gathered from different informants including adolescents, parents and teachers. In this cross-sectional study involving 410 twelve-year old adolescents, 37 teachers and 367 parents from seven schools in the Federal Territory of Kuala Lumpur, reliability of ADHD symptoms among the various informants were reported. ADHD symptoms (i.e. predominantly hyperactive, predominantly inattentive and combined symptoms) were assessed by adolescents, teachers and parents, using Conners-Wells' Adolescent Self-report Scale (CASS), Conner's Teachers Rating Scale (CTRS) and Conner's Parents Rating Scale (CPRS) respectively. For predominantly hyperactive symptoms, there were statistically significant, weak positive correlations between parents and teachers reporting (r=0.241, p<0.01). Statistically significant, weak positive correlations were found between adolescents and parents for predominantly inattentive symptoms (r=0.283, p<0.01). Correlations between adolescents and parents reporting were statistically significant but weak (r=0.294, p<0.01). Weak correlations exist between the different informants reporting ADHD symptoms among Malaysian adolescents. While multiple informant ratings are required to facilitate the diagnosis of ADHD, effort should be taken to minimize the disagreement in reporting and better utilize the information.

Stressors in secondary boarding school students: association with stress, anxiety and depressive symptoms.

INTRODUCTION: Chronic stress in adolescents may cause physical, mental and emotional health issues which lead to poor outcomes if left untreated. The present study aimed to determine the prevalence of depression, anxiety and stress, and their association with stressors. METHODS: A cross-sectional study was conducted among 350 students in a selected boarding school. Two validated Malay version questionnaires were used as instruments, which comprised the 21-item Depression, Anxiety and Stress Scale to assess depression, anxiety and stress level, and Soalselidik Stressor Sekolah Menengah to assess stressors. RESULTS: The prevalence of depression, anxiety and stress were 39.7%, 67.1% and 44.9%, respectively. The highest mean score was 2.3 (±0.80) for the academic-related stressor. All stressors (academic, interpersonal, intrapersonal, teacher, learning/teaching and social group) had significant association with depression, anxiety and stress (P < 0.001). Multiple regression showed that both the intrapersonal-related stressor and learning/teaching-related stressor were 2.8- and 2.0-times more likely (adjusted odds ratio [OR] = 2.8 [P < 0.001] and OR = 2.0 [P = 0.002], respectively) to cause depressive symptoms. On the other hand, the interpersonal-related stressor was 2.9-times more likely (adjusted OR = 2.9, P < 0.001) to cause anxiety. The learning/teaching-related and intrapersonal-related stressors were 2.7- and 2.5-times more likely to develop stress (adjusted OR = 2.7 [P < 0.001] and OR = 2.5 [P = 0.001], respectively). DISCUSSION: The possibility of introducing screening for mental health problems among boarding school students needs to be considered and investigated. Addressing the possible stressors and employing healthy coping may help in reducing negative emotional outcomes in these students.

Mirtazapine for anorexia nervosa with depression.

OBJECTIVE: To report the use of Mirtazapine in the treatment of anorexia nervosa with depression primarily regarding its propensity for weight gain. METHOD: We present an outpatient case report of anorexia nervosa with depression. The patient's subsequent progress was recorded. RESULTS: The patient gained 2.5 kg within 3 months to eventually attain a body mass index of 15 after 5 months. Her depression achieved full remission at 6 weeks of treatment. CONCLUSIONS: Mirtazapine is the choice medication in this case. However, treating depression requires caution, given these patients' physical vulnerability. Controlled trials of Mirtazapine for anorexia nervosa are needed.