The Effects of a One-day Mindfulness-based Intervention on Psychological Distress for Caregivers of Children with Speechlanguage Pathology: A Pilot Randomized Control Trial

Abstract@#Introduction: Caregivers of children with speech-language pathology experience psychological distress as speech impedes communication and interferes children’s development. This study aimed to determine the effects of a oneday mindfulness-based intervention (MBI) in reducing depression, anxiety, and stress for caregivers of children with speech-language pathology in a Malaysian hospital. Methods: Caregivers (n = 62) who fulfilled the selection criteria were recruited and randomly assigned to either MBI or treatment-as-usual control groups. The caregivers completed self-rated questionnaires, namely the Depression Anxiety Stress Scale 21 (DASS 21) and Mindful Attention Awareness Scale (MAAS) before and at one-month post-intervention. Results: Hierarchical multiple regression analyses demonstrated significant improvement in DASS 21 and MAAS scores in the intervention group compared to control group. There were significant improvements at one-month post-intervention in all outcome measures: depression (β = 4.20, ΔR2 = 0.09, p = 0.008, f2 = 0.10); anxiety (β = 5.12, ΔR2 = 0.13, p = 0.001, f2 = 0.15); stress (β = 5.36, ΔR2 = 0.14, p <0.001, f2= 0.16); mindfulness (β = -5.89, ΔR2 = 0.05, p = 0.022, f2 = 0.05). Medium effect sizes were observed in anxiety and stress symptoms reduction. Conclusion: The one-day MBI was effective in reducing psychological distress for caregivers of children with speech-language pathology.

Parental Issues Contributing To School Refusal: A Case Report

Objective: This case report aims to highlight the importance of parental contribution to the school refusal problem. Methods: We report a case of a 9-year old boy who presented with school refusal behaviour. Results: There was no psychiatry diagnosis made in this patient. Parental issues such as ineffective and inconsistent parenting, and parental marital disharmony contribute significantly to the school refusal behaviour. Conclusion: Parents in particular are important team players in the management of school refusal. Parental issues need to be explored and managed accordingly to ensure good outcome.

Polypharmacy in a nine year old boy with Attention Deficit Hyperactivity Disorder and Tourette Syndrome: what worsened the ties?

Introduction: Attention Deficit Hyperactivity Disorder(ADHD) and Tourrete Syndrome(TS) commonly co-occur, imposing a special challenge in the management. Case report: This is a case of a nine year old boy with ADHD and TS, who had been on methylphenidate, risperidone, fluvoxamine and atomoxetine, alone and in combination. Tics worsened with methylphenidate but improved after its withdrawal, and the addition of risperidone and fluvoxamine. Later, atomoxetine was added which worsened the tics, even when it was removed. Significant improvement in the tics were only obvious when fluvoxamine was taken off. Discussion: The possible roles of dopamine and serotonin neurotransmission, and metabolism of cytochrome P450 D26 in the pathophysiology were discussed. Conclusion: The use of multiple medications need cautious consideration and monitoring in a child patient to avoid unwanted complications and risks.

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.

Externalizing and internalizing syndromes in relation to school truancy among adolescents in high-risk urban schools.

INTRODUCTION: To examine the relationship between externalizing/internalizing syndromes and school truancy among Form Four (10th grade) students attending "high-risk" schools in Kuala Lumpur. METHODS: This is a cross-sectional study conducted upon 16-year-old adolescents attending three high-risk schools in Kuala Lumpur. A total of 373 students completed self-administered questionnaires on the sociodemographic variables and externalizing/internalizing syndromes. The number of truant-days per student during the study period was obtained from the school records. RESULTS: The mean internalizing score, externalizing score and total problem score of those who were truant were found to be significantly higher (P < 0.05) than those who were non-truant. Multiple logistic regressions showed externalizing syndrome (odds ratio [OR] = 1.044; confidence interval [CI] = 1.012-1.078, P = 0.018) significantly predicts truancy but not the internalizing syndrome. Two other psychosocial factors, namely, having divorced parents (OR = 2.495, CI = 1.058-5.886, P = 0.037) and did not understand or were uncertain of the purpose of schooling (OR = 2.621, CI = 1.265-5.433, P = 0.010) were also showed to be stronger predictors of truancy compared to externalizing/internalizing syndromes. DISCUSSION: Truancy has significant association to externalizing syndrome, in addition to other significant psychosocial variables like parental and schooling factors. This finding indicated the need for comprehensive assessment of students presenting with truant behavior, including the identification of associated psychological and behavioral problems which highlights the roles of mental health professionals in tackling truancy.

Objective structured clinical examination (OSCE) in psychiatry new curriculum undergraduate posting and its standard setting procedure: An experience in Universiti Kebangsaan Malaysia (UKM)

Objective: This study aims to report on the process of standard settings (SS) and to compare the passing rates between the norm-reference and SS methods, for OSCE in psychiatry undergraduate examination at UKM for 2009/2010 session. Methods: In the SS method, examiners were asked to imagine the performance of a minimally competent student and gave marks using a standardized check-list. The marks in particular outliers were discussed. After the first round, the examiners went through the same process again, to rate the minimally competent students independently. The median of the marks was taken as the passing mark for the particular question. The passing rate using the passing mark of 50% in the norm-reference method was compared to the passing rate from the passing mark obtained from the settings method. Results: For question 1, the passing rate with the norm-reference method (i.e. passing mark of 50%) was 93% (106/114) and that by the SS method was 72.8% (83/114). For question 2, the pass rate with the norm-reference method was 92% (105/114) and that by the SS method was 67.5% (77/114). Conclusion: The passing rates between the two methods showed significant differences. Although OSCE is an improvement to the undergraduate psychiatry examination in Universiti Kebangsaan Malaysia, there were few limitations and challenges that need to be tackled for further improvement.

The association between the attention deficit hyperactivity disorder (ADHD) symptoms and bully/victim problem among Malaysian sixth-graders

Objective: School bullying in Malaysia is on the rise. While efforts are put together to combat the problem, the psychiatric aspect has been neglected. This is a cross-sectional study aimed to determine the association between the symptoms of ADHD and bully/victim problems among Malaysian sixth-graders attending primary schools in Kuala Lumpur. Methods: A total of 410 sixth-graders from seven randomly selected schools were assessed with regards to bully/victim problems and ADHD symptoms using self-reported questionnaires. Malaysian Bullying Questionnaire was used to rate bully/victim problems while ADHD symptoms were assessed using Conners-Wells’ Adolescent Self-report Scale (CASS). Teachers and parents also assessed students’ ADHD symptoms using Conner’s Teachers Rating Scale (CTRS) and Conner’s Parents Rating Scale (CPRS), respectively. Results: Self-reported questionnaires showed that 61.2% of the children were involved in bully/victim problems. The ADHD symptoms were found significant in relation to bully/victim problems as tested by multiple logistic regression. Only students and parents reported significant ADHD symptoms among the bully/victim groups. The ADHD symptoms reported by students were significant among bullies(OR=0.59,CI=0.42-0.83, p<0.01) and bully-victims(OR=0.55 CI=0.37-0.81,p<0.00). Parents reported significant ADHD symptoms only in victims(OR=1.260,CI=1.02-1.56,p=0.03). Conclusion: The ADHD symptoms were significantly present among bullies, victims and bully-victims. These findings open a new perspective of managing bully/victim problems since effective treatment is available for ADHD.

Carers As Teachers

Objectives: This paper reports the outcome of Session With Carer, one of the activities in the Year 4 Personal and Professional Development (PPD) module in the new integrated curriculum of the Undergraduate Medical Programme at the Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM). Methods: This activity involves groups of 14 – 15 students sitting in with family members of individuals with mental illness. The session starts with the carer giving his or her perspective of patient’s care and the challenges involved. This is followed by a question and answer session. Finally, the carer provides a written feedback by way of scoring certain items as well as brief comments. After the session, each student is required to prepare an individual report in the form of reflective writing. Results: Out of a total of 224 students, the reflections of 126 students were reviewed to assess what they had learnt from the Session With Carer. Among the more significant findings were: 100% learnt about the various challenges faced by carers. 31.7% learnt the importance of faith/spirituality of the carer in caring for a mentally ill family member. 29.4% learnt the importance of family and others’ support. An equal number, that is, 26.2% learnt that it helps for the carer to have good mental health and a positive attitude, as well as good knowledge of the illness. Those who became aware of the benefits of the carer having patience and determination made up 23.8% of the total reflections reviewed. Conclusion: The findings show that the Session With Carer is very educational, and helps create more awareness of the importance of the carer’s role in patient management and support. In other words, carers can act as teachers in creating more public awareness about mental illness and ultimately, help in gradually removing the stigma associated with mental illness. Therefore, carers should be utilized for this purpose.