Department of Psychological Medicine

Introduction

The Department of Psychological Medicine was established in 1965, soon after the founding of the Faculty of Medicine, University of Malaya in 1964. The department was then headed by Professor N.N. Wagner from the United States of America, a clinical psychologist. Professor Tan Eng Seong was the first Malaysian psychiatrist to head the department. In 1976, Associate Professor Teoh Jin Inn became the head of the department followed by Assosiate Professor Woon Tai Hwang in 1977, Associate Professor M. Subramaniam in 1991, Professor M. P. Deva in 1992, Professor Mohamad Hussain Habil in 1998 and Professor Nor Zuraida Zainal in 2010. The postgraduate training in Psychological Medicine was launched in 1973 to address the shortage of psychiatrist in Malaysia. It was initially started as a two-year MPM (Masters in Psychological Medicine).

Vision and Mission

The vision of the Department, is to strive for excellence and provide leadership in education and training, research and development, information resource and the provision of services in psychological medicine and in all its subspecialities.

The Department views its mission at the Undergraduate level as being charged with the responsibility, via the medical undergraduate instructional programme, for the preparation of the potential graduate instructional programme, for the preparation of the potential graduate to operate as an effective, safe and well informed medical practitioner To this aim the department facilitates the education of the undergraduate to be able to recognise and treat basic psychiatric conditions, to provide basic information and explanation to patients and the community and to understand and utilise referral mechanisms for more complicated psychiatric conditions.

The Department views its mission at the post-graduate level as being charged with the responsibility, via its post-graduate training programs, to produce a specialist in psychiatry. A specialist who possesses clinical skills, a discerning mind and high ethical standard to manage psychiatric problems, whether it may be simple or complex. A specialist with a keen interest in research and well versed in the different treatment modalities. And lastly, to produce a specialist with managerial skills to co-ordinate resources in the running of Psychiatric wards, rehabilitation and community service programmes in their future locality of practice.

The Department also considers its mission to share the knowledge gained in its various activities, to provide a forum for discussion and to disseminate information to the staff of UMMC, the Medical Faculty, General Practitioners, other Psychiatrists, as well as other medical and health workers.  This will be achieved in various ways including the conduct of short courses and workshops.

Contact Information
Department of Psychological Medicine,
Faculty of Medicine,
University of Malaya,
50603 Kuala Lumpur,
MALAYSIA.
Tel : +603-7949 2068
Fax : +603-7955 6477
Email:  ketua_psikologi@um.edu.my

 Services

Services provided including treating all kind of psychiatric conditions. These include depression, sleep disorders, functional pain disorders, anxiety disorders, child and adolescent disorders, adjustment disorders, geriatric disorders and drug addictions. Through UMCced, this department are also conducting certificate course in addiction, stress management, rehabilitation psychiatry and child and adolescent psychiatry. All these courses are not only meant for health workers but for NGOs, government officers, employers, managers and teachers.

Some of the main services provided by the department are as follows:

1. Out Patient Psychiatric Clinic
2. Addiction Psychiatric Services
3. Psychiatry Day Care Center
4. Consultation Liaison Psychiatry Services (adult and geriatric patients)
5. Psycho-Oncology Clinic
6. Psychiatry Adolescent & Child (PAC) Unit

 

Out Patient Psychiatric Clinic
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The number of patients attending the clinics have been steadily rising as awareness about mental illness has increased. In 1969 there were only 3962 patients attending the out patient psychiatric clinics compared to 22,914 people who attended the psychiatric clinic in 2004. This number has grown to 33,322 in 2009.

Through the years there have been many services added to the out patient clinic. These include the:

1. A special clinic known as the Clozapine Clinic was set up on Thursday mornings for those patients on Clozapine. This clinic has been in existence since 1998. Clozapine is a drug reserved for treatment resistant Schizophrenics.
2. The Memory Clinic was set up in 2003 for patients experiencing memory problems. This clinic functions on Thursday afternoons between 2 to 5 pm.
3. Early Psychosis Clinic was set up in 2005 to study the outcome of the psychosis.
4. Compliance Clinic was set up in 2005 - A clinic set up specifically to promote compliance among the patients.
5. The Methadone pilot project in collaboration with the Ministry Of Health was started in 2006 where 50 heroin dependent patients treated for 1 year with Methadone to show that Methadone can cut down high risk behaviour and crime rates.
6. In addition, there are audio CDs produced by the department on sale at the clinic on various topics such as Schizophrenia, Bipolar Affective Disorder, Depression & Attention Deficit and Hyperactivity Disorder (ADHD). Objectives of the CDs are:

• To educate family members and patients on their current illness.
• To help family members and patients to cope with their illness.
• To help patients and family members understand the nature of treatment they are on.
• To give family members the confidence that medical practitioners are striving to do their best for the patients.

Location
The out patient psychiatric clinic is located on the Ground Floor, Kompleks Perubatan Psikologi.
Operation hours
Various clinics are run between Monday and Friday.

1. Every Monday to Friday morning there is a "walk in clinic" known as the D1 clinic. This clinic caters to those patients who are already on follow up, who are experiencing a crisis, or whose medication has run out.
2. Also there is a "new case clinic" known as the D2 clinic from Monday to Friday. This clinic caters to cases coming for the first time to the psychiatric clinic. Currently there are about 1000 new patients coming annually to the psychiatric clinic. The cases are mainly referred from the primary care doctors as well as private general practitioners. However some patients come without any referral.
3. We also have follow up clinics that are run from Monday to Thursday both in the morning 9 - 1 pm and afternoon 2 - 5 pm.

 

Addiction Psychiatry Services
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Objectives:

1. To provide medical treatment for those with addictive problems; users of illicit drugs such as heroine, morphine, cocaine, amphetamine, cannabis, benzodiazepines and etc.
2. To provide psychosocial treatment for the drug misusers.
3. To deal with problems related to drug misuse.
4. To reduce the dangers associated with drug misuse, particularly the risk of HIV, Hepatitis B and C and other blood borne infections from injecting and sharing needles.
5. To reduce the duration of episodes of drug misuse
6. To reduce the chance of future relapse to drug misuse.
7. To reduce the need of criminal activities to finance drug misuse.
8. To stabilize the patient with appropriate substitution medication to alleviate withdrawal symptoms.
9. To improve overall personal, social and family functioning of the drug misuser.

Clinical services:

• Outpatient services:
• UMMC Substance abuse clinic
• UMMC consultation-liaison substance misuse clinic:
• Individual motivational enhancement therapy ( MET) and cognitive behavior therapy (CBT) sessions for selected patients with drug problems
• Individual and group therapy session for patients on national methadone maintenance program
• Support group for clients on drug substitute therapy ( DST Anonymous)
• Inpatient services
• UMMC consultation liaison substance misuse
• Admission via clinic to the ward for inpatient detoxification, drug induced psychosis, and cases with psychiatric co morbidities
• Admission via emergency and trauma department for intoxication, aggression and suicidality in related with substance use

 

Psychiatry Day Care Center
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Functions:

1. Offers therapeutic treatment dan rehabilitation services for patients with mental health difficulties.
2. Assists and supports the clients psychologically to achieve the desired level of mental health.
3. Assists teh clinets to understand and manage their difficulties that are related to their psychological problems.

Wellness programme

Cooking

Hari Keluarga Psikiatrik 2011

 

Consultation Liaison Psychiatry Services (adult and geriatric patients)
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Consultant: Prof Nor Zuraida Zainal.

Lecturers: Datin Dr Sharmilla Thanasan , Dr Ng Chong Guan , Dr Chong Lu Ann, Dr Zuraida Sabki and Dr Amarpreet Kaur.

Clinic Day: Every Tuesday between 9 am to 1 pm.

Location: Psychiatry Clinic, Ground Floor, Kompleks Perubatan Psikologi.

Services offered include assessment and treatment regarding all psychological issues arising or co occurring as comorbidities from medical or surgical conditions. This also includes patients with preexisting psychiatric disorders who are admitted in wards around the hospital. The sevices are for those above 18 years of age till 60 years of age. For those above 60 years of age there is a psychogeriatric team.

 

Psycho-Oncology Clinic
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Consultant: Prof Nor Zuraida Zainal

Lecturer: Dr Ng Chong Guan

Day: Every Thursday

Location: Oncology Clinic, 1st Floor, Menara Timur, UMMC

Time: 9 am to 1 pm

Type of cases:

• New cases (referral) from oncology, surgical, medical and palliative team
• Follow up cases (Outpatients cases and those discharge from the surgical, palliative and oncology wards)

Services:

Psychological distress related to cancer and its treatment. Psychiatric comorbidities in cancer patients. Distress and psychological issues in cancer patients under palliative care.

 

 

Psychiatry Adolescent & Child (PAC) Unit
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Profile
The Psychiatry Adolescent & Child (PAC) Unit was established in December 1999 as part of expanding services offered by the Department of Psychological Medicine. The Department of Psychological Medicine has been in operation since 1965 focusing more on adult mental health. With the increasing importance of child mental health and the need for services, the PAC Unit was established. The PAC Unit is a specialized mental health service for children 18 years old and below, who have difficulties in their academic, emotions, behavior and/or relationship with others.

The staffs are involved in clinical, teaching as well research work. There are currently 3 child and adolescents psychiatrists (academic-clinicians) along with support staffs consisting of counsellors, staff nurses, occupational therapists and supporting staffs. Assessing and managing these clients form the bulk of the work at the unit.

Services offered are:

1. Assessment of children with emotional, behavioral, speech, language or learning difficulties.
2. Assessment and treatment of children with hyperactive behavior and other behavioral difficulties (e.g. unable to listen and cooperate with others) and/or emotional symptoms (depress, irritable, anxious, fear of things or situations).
3. Assessment and treatment of children with odd behavior or thoughts (psychotic).
4. School visits and school mental health talks

A range of services are provided which includes:

• Assessment of mental health difficulties
• Individual therapy
• Group therapy
• Family therapy
• Working with parents
• Medication
• Group sensory-motor program
• Group social skills enhancement
• Seminar / workshop (which will be held from time to time)
• School visits / talks
• Parents support group
• Asperger’s family support group

5. Projects

• TEACH project

Aims:

• To improve and develop the field of research in child and adolescent mental health
• To increase knowledge and awareness among the educators in public schools.
• To help educators in identifying the common psychiatric disorders among children
• To form smart partnerships with the Ministry of Education and the Ministry of Health
• To push for a change in the teaching syllabus for educators [at the level of the teaching college] in order to create understanding about these conditions.

• Street Kids Project

Aims:

• To identify the psychosocial problems faced by orphaned or children who are living in the streets of Chow Kit. These are children who are currently living in drop in centres run by NGOs.
• To identify psychiatric disorders and co morbidities among these children

• Child Abuse Project

Aims:

• To identify the prevalence of child abuse among the children admitted or referred to the unit.
• To profile the typical abuser and the psychosocial circumstances surrounding abuse victims.
• To identify psychiatric disorders and co morbidities among these children

• ADVANCE clinic
  [Child and Adolescent Clinic for Affective Disorders and Schizophrenia]

This clinic offers an integrated and comprehensive mental health service aimed at addressing the needs of children with a first episode of psychosis.

Aims:

• Early detection of Bipolar Disorders and Schizophrenia in adolescents
• To offer the best treatment available.
• Improve awareness.
• Improve outcome.
• Improve functioning.
• Data collection for research
• Acquire data on number of children with these disorders i.e schizophrenia, bipolar disorder and [depression and anxiety disorders.]
• Acquire data to determine current level of functioning, co morbidities, treatment response, common presentation symptoms and outcome

• Child and Adolescent Community Psychiatry

Objectives

1. Universal health promotion/prevention activities that target an entire population to promote and enhance emotional wellness by increasing developmentally appropriate mental health skills.
2. To establish universal intervention activities that include the implementation of programs and practices that (a) address socio-environmental conditions and risk factors, (b) increase protective factors within the individual, family and/or community, and (c) foster resiliency within individuals, families and systems.
3. Early interventions programmes to target children and youth that are at greater risk for developing risky behaviors and mental health issues.
4. To target individuals identified as having significant mental health concerns that require referral to the hospital.
5. Develop a screening/assessment/referral process to identify children and youth in need of interventions.
6. Administer formal mental health, social/emotional, developmental, or behavioral screening and assessment tools to determine each referred child and adolescent''s level of functioning.
7. To determine the intervention necessary and available within the community to meet the child and family needs
8. To enhance the community''s ability to meet the mental health needs of children and youth with mental health issues.
9. Develop, monitor, and outcomes specific to the local community and the identified problem

Teaching

1. Medical students: the medical students are given an introduction to child and adolescents mental health difficulties through seminars and case presentations.
2. Medical officers doing Masters in Psychological Medicine: Medical officers are attached to the unit for a minimum of 3 months. During their attachment, they work closely with the consultants mastering assessment as well as management of the child and their families. The learning is very hands on, with interactive discussions and numerous learning opportunities.
3. *Medical officers of other speciality wanting to do attachment in Child and Adolescent Psychiatry.
4. *Allied health personals/ students

Of late, there have been an increased number of students, doctors and allied health personals/ students who have requested attachment to the unit. Again, they are given opportunities to sit in and watch the consultants handle the clients and their families. The consultants work in an interactive manner whereby these students are given the opportunities to participate in discussions with the consultants.

The academic staffs are also involved in research within the university and in collaboration with other universities. Worked that has been done and on-going includes research on children with psychosis, sex offenders, children with ADHD (on-going) and street children. There are many research opportunities in the field of Child and Adolescent Psychiatry.

Another important activity that has been taken on by the PAC Unit is working with the school and education units/ ministry. As such, the TEACH program has been set-up by the consultants. This is due to an increasing number of children with difficulties and not picked up during their schooling years. Through the TEACH program, mental health psycho-education to the teachers is actively carried out every year. In 2011, a series of discussions have been carried out especially with the Special Education Unit, Malaysia due to the significant number of children needing such services. Again, this is a interesting and challenging area, which the consultants feel that with persistence, and tiny steps, the main persons who will benefit the most are the children, their family and the community.

Child and adolescent psychiatry is an interesting and expanding field. There is a lot of work to be done, the difficulties can be overwhelming, and success can be difficult and takes time to be seen. Without intervention, any community can be overwhelmed with the children’s difficulties overflowing and affecting the community. Thus the training of Child and Adolescent psychiatrists is an immediate necessity and which the PAC Unit is working towards.

Child and adolescent psychiatrists are trained in a wide range of field including medical as well as non-medical intervention. All the consultants are well-versed in individual, family, couples, and group psychotherapy. The consultants are trained in long and short-term dynamic as well as cognitive-behavioral therapy. Often these therapies are integrated along with the pharmacotherapy in their work with patients of all ages. Though by name, the consultants are called Child and adolescent psychiatrists, but the consultants includes the families, schools, and community in their treatment process. Consultants from the unit are often called to do school talks along with school visits. We use this opportunity to introduce what mental health and mental health difficulties amongst children are, and where to seek help. Most importantly, the consultants work towards trying to reduce the stigma attached to mental health as it is a huge barrier to children and their family receiving help. The consultants hope with the expanding knowledge, the misconception attached to children with mental health difficulties will also be lessened.

Last but not least, with more students taught by the child psychiatrist consultants, they can become active in their community or government as advocates for child mental health. Through this action, they will hopefully develop programs at both the treatment and prevention levels to address issues detrimental to the mental health of child.

List of Staff

The unit consists of clinical and supporting teams.

Clinical team

Associate Professor Dr. Aili Hanim Hashim	Child & Adolescent Psychiatrist
Associate Professor Dr. Subash Kumar Pillai	Psychiatrist with special interest in child and adolescent
Dr. Manveen Kaur	Child & Adolescent Psychiatrist
En. Abdullah Anuar	Psychology Officer
Pn. Norhaniza bt. Idris	Psychology Officer
Pn. Nurul Iman Rozali	Occupational therapist
Pn. Nur Amirah Mohd Yusoff	Occupational therapist
Pn. Nurfasihah binti Mokhtar	Occupational therapist
Pn. Engku Nurul Hasanah binti Engku Kamal Bakri	Occupational therapist
Pn. Nor Nabillah binti Hamzah	Occupational therapist

Supporting team

Pn. Zarina Salleh	Staff nurse
Pn. Nurul Janah binti Azmi	Staff nurse
En. Mohd Shahril bin Azhar	Administrative Assistant
Pn. Norfadzlina Ab. Rahim	Health attendant
Pn. Rosmawanihafiza binti Mat Zahari	Health attendant