Relations between clinical characteristics and cognitive deficits among adult patients diagnosed with major depressive disorder.

OBJECTIVE: The present study examined the relations between clinical characteristics and cognitive deficits in adult patients with major depressive disorder (MDD) from a local outpatient psychiatric clinic in Malaysia. METHODS: The present sample included 110 participants aged 20-60 years old. Participants were invited to provide their information on sociodemographic variables (age, gender, and educational level) and clinical characteristics (age at onset of depression and duration of illness) and to complete a series of cognitive performance measures including the Trail Making Tests A (psychomotor speed) and B (executive function), the Digit Symbol Substitution Test (attention), and the Auditory Verbal Learning Test (immediate free recall, acquisition phase, and delayed recall). The Mini International Neuropsychiatric Interview Version 6.0 was used to confirm the diagnosis of MDD and the Montgomery-Åsberg Depression Rating Scale was used to assess illness severity. RESULTS: At the bivariate level, relations of age and educational level to all cognitive deficit domains were significant. At the multivariate level, only educational level and illness severity consistently and significantly predicted all cognitive deficits domains. CONCLUSIONS: Therapeutic modalities should be individualised whilst considering the impacts of cognitive deficits in an attempt to prevent further deterioration in psychosocial functioning of MDD patients.KEY POINTSCognitive deficits are an elemental component of Major Depressive Disorder (MDD) persisting during a current major depressive episode or during remission, altering individuals' ability to process information and changes the way they perceive and interact with the environment.Cognitive deficits in MDD are evident among the upper-middle income groups in South-Eastern Asian countries warranting more local research as such deficits could lead to functional decline and work performance such as absenteeism and presenteeism.Therapeutic modalities should be individualised by taking the impacts of cognitive deficits into consideration to promote psychosocial functioning of MDD patients.

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.

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.

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.

A "good enough" remote psychodynamic psychotherapy - A psychiatry trainee's novice experience during Coronavirus pandemic.

Covid-19 pandemic and the public health measure have forced an en masse transition to remote therapy from physical sessions. Remote psychodynamic psychotherapy is not a new treatment modality, but its effectiveness in holding the analytic frame has been concerned by some therapists. We would like to highlight some of the therapeutic processes involved with remote psychodynamic psychotherapy, via the help of a narrative experience of a psychiatry trainee who was novice to this delivery method of therapy. Reflections on these concerns have been made in line with the experiences highlighted.

The fear of what goes up must come down: A case report of vulnerable narcissism.

Pathological narcissism or narcissistic personality disorder is commonly characterized by an exaggerated sense of self-importance, condescending attitude, need for excessive admiration, diminished empathy and exploitativeness. In contrast to these overt attributes, there is a different presentation of pathological narcissism which is underrecognized, as one's preoccupation with hypervigilant, self-effacement and proneness to shame in the context of covert grandiose fantasies. This report illustrates a patient who had this subtype of vulnerable narcissism, and how his defence had been activated to preserve own self agency during a session with the doctor by revealing his paraphilic fantasy.

Learning Psychodynamic Psychotherapy in Southeast Asia.

The subjective nature of psychodynamic psychotherapy (PP) makes training and supervision more abstract compared to other forms of psychotherapy. The issues encountered in the learning and supervision process of PP of Malaysian psychiatry trainees are discussed in this article. Issues of preparation before starting PP, case selection, assessment of patients, dynamic formulations, supervision, anxieties in the therapy, countertransference, termination of therapy, the treatment alliance, transfer of care, the therapeutic setting, and bioethical considerations are explored. Everyone's experience of learning PP is unique and there is no algorithmic approach to its practice. With creative thinking, effort, and "good enough" supervision, a trainee can improve PP skills, even in underserved areas of the world.

Association between perceived parental style and depressive symptoms among adolescents in Hulu Langat District, Malaysia.

Depression among adolescents is increasing and worrying because of its morbidity and mortality from suicide. It has been found to be associated with negative parental styles. The objective of this study was to determine the relationship between perceived negative parental styles and depressive symptoms among adolescents in Hulu Langat District, Selangor, Malaysia. A cross-sectional study was carried out on 1769 secondary school students by using a multistage cluster sampling method. Data were collected by using a set of validated, pre-tested and standardized questionnaires which included the Measures of Parental styles (MOPS) and modified Depression, Anxiety and Stress Scale 12 (DASS-12) for adolescents. Data were analyzed by using the chi-square test, Pearson's correlation coefficient and independent t-tests. Out of 1800, 1769 completed the questionnaire giving a response rate of 98.3%. The prevalence of severe depressive symptoms was about 14% while 18.0% and 36.1% of respondents have moderate and mild depressive symptoms, respectively. There were significantly moderate and positive correlations between perceived indifferent parents (Father: r = 0.367; Mother: r = 0.340, p < 0.05), perceived abusive parents (Father: r = 0.338; Mother: r = 0.331, p < 0.05) and depressive symptoms among the respondents. While perceived over control parents shows a significantly positive but weak correlation (Father: r = 0.206; Mother: r = 0.244, p < 0.05) with depressive symptoms among respondents. All types of parental styles in this study were significantly different among respondents with different categories of depressive symptoms (p < 0.008). Perceived negative parental styles have significant influence on adolescents' depressive symptoms. Intervention on modifying parental style is needed to reduce depressive symptoms.