Right of The Wife


1. How cruel keeping a wife but deny her of any right. What if she goes bonkers?

2. A wife must be obedient to her husband but only if the rights of Allah come first. On the other hand, if the man commits cruelty, he shouldn’t deserve to be followed.

3. The way I see it, marriage as a lifetime commitment but if this is impossible then divorce may be necessary. The wife can divorce her husband by requesting faskh and approved by the Syariah Court.

4. Advice to her: When you suffer some adversity, physical or mental, remember there will have some reward for enduring it with patience and contented acceptance.

5. Remember that health is a blessing which you should work diligently to preserve.

Magical Thinking


1. One fine day, a splendid splash of idea run through your mind like a flash of light, a scene of a man in a motorbike speeding and finally hit in a motor vehicle accident. You are puzzled and ask what is happening. Your innerself explain that is the vengeance of speeding. You are asking if you keep on counter-talking you are going to look absurd.

2. Magical thinking may be a normal phenomenon in children. It is a belief in adults. Unfortunately, the implication of the belief is beyond normal cause and effect. If the innerself is indeed a ‘perception that comes without any stimulus’ than you are indeed facing a problem then. If not, you are safe.

3. Magical thinking is quite normal in people with stress and to people dealing with helplessness and worthlessness. OCD with a lot of rumination might end up with some kind of magical thinking. Narcissistic, borderline and schizotypal are not spared to have magical thinking. Way beyond; no doubt, is psychosis.

4. In schizotypal, the odd thinking is like having a funny communication with the ruh, something normal to the bomoh and pawang. Don’t tell me bomoh and pawang are psychotics.

5. In borderline personality, the thoughts are believed to cause events in the context when the person devalue themselves and their environment.

6. The magical thinking in persons with the narcissistic trait is when they would fully believe that whatever happens they will prevail and those good things will happen to them forever.

7. Finally, I am now settling down with the final diagnosis. Am writing a referral to my colleague in Hospital Ipoh. Dear colleague,….

The Right to Live


1. An old man was dumped near the roadside. The unknown had subjected this old man to torture by dumping him near the rubble dumping site. When he was rescued, he was confused and demented.

2. After several searches with the police and relevant authorities for about two months, we manage to get his identity and relatives. All I don’t understand is how a man in a ‘dump truck‘ (the unknown) who happen to be a big brother dare to throw away his own brother like throwing a cat near the roadside. Then spreading stories that he is living on welfare aid. For sure, I hope I am wrong and I need another side of the story.

3. Elderly abuse is not a new phenomenon. A Malaysian survey has shown an alarming statistics. 636,461 elderly parents have been abandoned and did not receive support from their children. A new Mental Health Act 2001 makes a compulsory regulation for children to take care of mentally ill parents.

4. The government must help to ease the family burden by formulating Mental Health Benefits Act. Malaysians require some level of coverage to be provided for patients with serious mental illnesses. This group of patient needs some level of care which encompass their basic human right to live and breathe as we do.

5. Now it’s the time to act, dear parliamentarians..

Attitude in Clinical Medicine


1. When a student comes late, he deserves to be scolded. No hatred, but teaching isn’t just imparting knowledge BUT improving attitude AND skill.

2. I’d come across a student who fell asleep in the car and one who had difficulty waking up early in the morning and subsequently both of them came late for the exam.

3. Mass production of medical undergraduates has invited a newly emerging phenomenon of producing poor quality medical graduates and low-quality doctors.

4. Cognitive aspects such as must know, need to know and good to know stuff are nowhere if teachers don’t really implement the psychomotor skill component and attitude development in the clinical teaching.

5. The question is, how assertive one needs to adhere to when it comes to practice?

Stress-free?


1. When someone says he is all right and stress-free, I will always in doubt.

2. All the craziness in today’s world will never make you totally stress-free, I guess.

3. When we saw cases of conversion disorder, almost all present as if nothing is happening; a situation in which patients show lack of concern for the disability but in one case, unfortunately, later we found she has porphyria.

4. Workplace culture and adjustment failure are usually subtle. Many have the symptoms even after years of working.

5. We need some stresses in life to propel us ahead of others..

PANDAS


1. PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections.

2. Common in the West but quite rare in our practice. Reasons: (i) acute condition, most acute cases are referred, treated and discharged. A week or 2 later patients developed neuropsychiatric disorders, waxing and waning with subsequent reinfection  (ii) diagnosis is controversial; not classified in DSM/ICD (iii) temporal relationship between beta hemolytic strep infection and neuropsychiatric manifestation is unclear.

3. Childhood-onset neuropsychiatric disorder is widely used to describe a disorder caused by antineuronal antibodies which appear to arise in response to group A [beta]-hemolytic streptococcal (GABHS) infections and to cross-react with cells within the central nervous system (CNS).

4. Based on clinical observations of children with Sydenham’s chorea, Tourette’s syndrome (TS), and/or obsessive-compulsive disorder (OCD), scientists hypothesize that neuroimmunological dysfunction secondary to anti-neuronal antibodies may result in behavioral disturbances, such as:

-anxiety,

-emotional lability,

-obsessive-compulsive symptoms,

-hyperactivity, and inattention,

-sleep disturbances; and

-neurological abnormalities, such as motor and phonic tics, ballismus, chorea, and choreiform movements.

4. Unlike Rheumatic Fever, treatment using antibiotic prophylaxis is inconclusive. Symptomatic treatment for tics and OCD is warranted.

Who Tend To Be More Stressful After Trauma?


1. Women outweigh men twofold higher prevalence of developing posttraumatic stress disorder (PTSD).

2. Reason: (i) report-bias because men tend to underreport and women tend to overreport symptoms (ii) social expectancy with regards to their gender role where women are expected to be vulnerable and men more resilient to trauma.

3. The way it goes is if women are exposed during menopausal period, they show increase cardiovascular and epinephrine response to mental stress compared to premenopausal age.

4. Men are different creatures. They begin in the late teens last to the early 40s. This is the time where men are tied up with work and family responsibilities. Life, therefore, become less autonomy and they could develop more stress resulting in the midlife crisis.

5. After the 50s, women tend to be less likely at risk for PTSD but man settled down after 40s. The lowest risk is found for men in their 60s. Perhaps at this age, they would already accept their earlier experiences well and death is more imminent than the earlier age. This is also the time to spend time for quiet reflection and looking back at experiences with wisdom and dignity.

6. Looking at the data, it is shown that lifespan distribution of PTSD is different for men and women and women show a higher prevalence of PTSD than men.

[Annals of General Psychiatry]

Social Analysis in Psychiatric Formulation


1. Psychiatrist works very closely with the social worker but in most cases psychiatric case presentation lack thorough social analysis.

2.  In most cases, psychiatrists tend to focus on inadequacies inherent in individual genes, social interaction, inter- and intrapersonal relationships. That is OK. But definitely inadequate. For future presentation, the following themes in social history have to be given more emphasis:

a) tracing personal problems in the socioeconomic structure and what role they play in causing the problem situation.

b) social control i.e. function of certain groups and individual members of this group so that existing social and power divisions are maintained. I give example of how families are isolated from certain quarters that are powerful in the society.

c) some critique of existing social and economic arrangement.

d) issues like oppression, exploitation, gender and social change.

3. A gentleman is seeking assistance for stress management after his divorce. His wife said that the husband was boring. Though he has tried to be a good husband and very hard working, but it is still hard “to know what the women want these days” he confessed. “Now I can’t sleep at night because I am awake thinking none of my sacrifices been worth it”

4. Well, in this case, for instance, this man seems puzzled that he doesn’t measure up to his wife’s expectations. He is wondering whether this is his fault or his wife, or the fault of women generally for not being clear about what they want.

5. This man is worried about the current social expectations women place on men. He is implying women want too much or that what they want is unrealistic or they are unclear about it.

6. Stress management is the issue for the psychiatrist to manage here. Probing on anxiety, depression and a long list of psychiatric disorders is a must.

7. Not to forget issues like (1) socioeconomic structure of the family, (2) social and religious controls pertaining to concept like redha and tawakal (for Muslim) (3) critique on probable workaholic attitude that wife found him boring and last but not least is the issue pertaining to the stress of modern living.

8. Social analysis helps for better understanding and management of the case.

Love Is Blind


1. Puzzle like never before when she was just smiling. Didn’t know where she came from; the kampung? the name of her sister? BF (other than just Abe) and even her class teacher.

2. All we knew she had forbidden love and expecting a labor of love with someone.

3. Love is blind. As Shakespeare writes in Two Gentlemen of Verona: If you love her you cannot see her. Why? Because Love is blind. True enough in her case, If you love him, forget about his name, Abe is enough. Why? Because Love is blind. Never before, I witness blind love in life drama.

4. My friend had a funny answer: he said, ‘no’ love is not blind. It is after you know her true color, you wish you’d been blind.

5. But the drama has to continue. I had told my two friends, go and get the follow-up. The faster the better. The ending must be tragic and broken-hearted….

……………
Update

1. Shakespeare must be making some errors in real LIFE.

2. Living in the animal world where the mighty win, cognitive weakness was capitalized to the benefit of the predator. It is as tragic and broken-hearted as I said.

3. The local version of true love…

Exasperated Me


1. Getting so exasperate when a final year student can’t even talk to the patient and ask open-ended questions.

2. The inquisitive mind is basically what it is needed from medical professionals. In order to be inquisitive, proper technique of questioning, different ways of maneuvering the interview has to be mastered to the maximum.

3. A student can’t be too naive to accept answers and explanations. He/She would have to think the follow-up questions, restate right paraphrases and most important evaluate answers in term of rationality, relevancy, and congruity. All those processes have to occur in seconds. Hence, the student has to stay alert and keep thinking all the time during the interview. It is an active and dynamic process.

4. Trying to assuage pain and suffering quickly at the initial interview stage will hinder information gathering and result in poor history taking. To my mind, to a certain extent, Kelantanese language are peacemaking, tolerant and pleasing. Sometimes, students who converse in Kelantanese language avoid hurting patients’ feeling, but they are acquiescent and chose to agree without critical thinking.

5. I used to remind my students to be careful with the agreeableness attitude with patients giving the example of a patient coming to casualty following a motor vehicle accident without obvious physical injury and the doctor concurs by saying: ‘Ok deh’. ‘Deh’ is a suffix which is usually used in Kelantan language to present a sentence as rather light-going and not so serious and it has no specific meaning. The obvious reply the doctor gets is: OK; failing to realize (and examine) the patient would have suffered intracranial or intraabdominal injury.

6. Students were told that doctors do not please their patients all the time. It is a matter of balancing the critical thinking, acting, and empathetic feeling which to some students is difficult to master.