Objective: This case report highlights a case of young male referred for psychiatric evaluation due to paraphilic disorder. This 27-year old single male working as an assistant accountant was noted to have voyeuristic behaviour and presented with depressive symptoms since his teenage age. He has poor coping whenever he experiences stress in life. He started to watch pornographic videos and subsequently get involved by peeping pre-pubescent’s undergarments. These activities are followed by a compulsive behaviour such as masturbation to gratify his sexual arousal. Results: The patient undergone several psychotherapy sessions, and medical report was furnished for the court's purpose. Our assessment revealed that he was suffering from a lifetime major depressive disorder, and he was prescribed with Tablet Sertraline 50mg/daily. He also has premature ejaculation, severe in nature. He regretted his voyeuristic urge and psychotherapy focused on how to channel his sexual needs. Conclusion: Mood disorder is seen in paraphilic disorder and has to be dealt with in order to establish good management care

A significant proportion of patients with treatment-resistant depression do not attain functional recovery despite administration of multiple steps of pharmacotherapeutic strategies. This highlights the elusiveness of meeting unmet needs in existing pharmacotherapies for treatment-resistant depression. There is accumulating evidence that antidepressant agents involving the glutamatergic system such as brexpiprazole and esketamine/ketamine have more rapid onset of action and potentially improved effectiveness as an augmentation therapy in treatment-resistant depression. This case series aimed to report five complex cases of unipolar and bipolar treatment-resistant depression where conventional treatment strategies were inadequate in managing high risk suicidal behavior and achieving functional recovery. We discussed further the possible synergistic mechanisms of the novel combination strategy of brexpiprazole and esketamine/ketamine, clinical and patient factors that influenced treatment response, challenges with this combination strategy and implications for future practice and research.

We reported a case of severe symptomatic hyponatremia with a serum sodium level of 113 mmol/l after 2 weeks commencement of 2 types atypical antipsychotics; clozapine and amisulpiride with indapamide, a thiazide-like diuretic antihypertensive medication. Discontinuation of indapamide despite of continuation of his antipsychotics showed improvement in his serum sodium level. The aim of our case-report is to emphasize the life-threatening complication associated with the combination of agents that may cause hyponatremia. Both agents are known to cause electrolytes imbalance. Hence, close monitoring of the serum sodium is important during the treatment course.

Introduction: This policy brief examines the national health and action plans, laws and regulations, public health policies, and clinical practice guidelines in Malaysia on postnatal depression (PND). Methods: We examined and included 13 documents for the presence or lack of a statement of intent and/or actions related to caring for women at risk for or experiencing PND. Results: Although PND is actively researched and included in the clinical practice guidelines, no other policy documents mention PND. Conclusion: General recommendations to address this matter include channeling resources into developing care for PND, increasing advocacy work to reduce stigma, setting up appropriate training pathways for health care providers, and creating more roles and user-friendly modules for local volunteers to deliver mental health interventions.

The internet has become an important medium for learning and communication during the COVID-19 pandemic, particularly for university students. Nevertheless, an increase in internet usage could predispose people to internet addiction (IA) and internet gaming (IG). Equally, there is concern that anxiety levels have increased during the pandemic. The aim of this study is to determine the prevalence of IA and IG, and their associations with anxiety among medical students during the pandemic. Data were collected during the second wave of the “Conditional Movement Control Order” (CMCO) in Malaysia between 12 November and 10 December 2020. A total of 237 students participated through proportionate stratified random sampling in this cross-sectional study. They completed a set of online questionnaires which consisted of a sociodemographic profile, the Malay version of the internet addiction test (MVIAT), the Malay version of the internet gaming disorder short form (IGDS9-SF) and the Malay version of the depression, anxiety and stress scale (DASS-21). The prevalence of IA and internet gaming disorder (IGD) were 83.5% and 2.5%, respectively. A multiple logistic regression showed that those in pre-clinical years had a greater risk of anxiety than those in clinical years [(AOR) = 2.49, p-value 0.01, 95% CI = 1.22–5.07]. In contrast, those who scored high on IA were protected against anxiety [AOR = 0.100, p-value 0.03, 95% CI = 0.01–0.76)]. In conclusion, IA was highly prevalent during the COVID-19 pandemic and its high usage might serve as a protective factor against anxiety among the medical students in this study sample.