Friends in Psychiatry

I had the pleasure to share space during the recently concluded Masters Conjoint Exam with these two young psychiatrists, both my juniors and leading the way in advocacy.

(Dr Fadzli Mohd Isa – addiction psychiatrist, Dr Ahmad Rostam – budding liaison psychiatrist and I)

It was an interesting session we had. We were discussing the way forward for the use of social media for mental health advocacy, apart from the pitfalls which can or has happened as we work in this area using social media. This included responding to questions posed, handling emails and private if not direct messages and also the inadvertent viral tweet/statement/opinion.

Of recent concern is the over eager trainee who advocates with, at times, little knowledge and to much enthusiasm which, can, be a problem. Now we are not saying don’t do it, but be careful. If you’re a trainee you’re bound by the university code of conduct and as a medical doctor, you’re also bound by the medical code. If you’re a Ministry of Health practitioner, you need the relevant clearance too. Also, unless you’re really really good in your studies, you’re also playing with the risk of the halo effect which might be a problem for some.

Nevertheless, we are excited by the interest among our younger colleagues and we believe it augurs well for psychiatry in Malaysia.

To all exam goers – good luck. Results out on Friday 😊

(Dr Ahmad Rostam and I are also members of the #MedtweetMY family)

Meeting Prof John Kane

Prof John Kane and I.

For all #medstudents and in particular trainees in psychiatry, this is one of the “legends” in psychiatry. Even as a medical student, (I), we were taught the Kane Criteria for diagnosing Treatment Resistant Schizophrenia (TRS). TRS are people with schizophrenia who have not responded to available treatments. According to Prof Kane, one needs to have failed 2 types of treatment – with adequate dose and adequate duration – before a diagnosis of TRS is made. The criteria to diagnose TRS is important as it is a reason to start or to justify the use of clozapine, a highly effective treatment for schizophrenia but requires some caution.

We had an extremely fruitful discussion as a group and a more intimate session for some of us in discussing the management of schizophrenia, particularly in the use of long acting injectables (LAIs). If you have been listening to my podcasts. I’ve been using these for my own patients and am convinced that this is way to go to protect brain function, reduce relapse and increase Quality of Life and day to day functionality. I hope to add more podcasts on this to share with all of you my learnings.

Today’s session was also extremely helpful as concerns that Malaysian psychiatrists have in the treatment of this population was no different from the international psychiatrists which was reassuring.

I only wish all medical students and trainees in psychiatry could have met and be inspired by him and his work. He is truly an inspiration as a clinician, scientist and advocate for mental health.

World Mental Health Day Month coming to an end

Hi there everyone.

Sincere apologies for the silence here. I’ve been updating other sites in this crazy month. There has been a number of activities in University Malaya and beyond and it is our hope that you have managed to catch a few of these activities.

I wanted to share with you one of my smaller initiatives to end the month – the green ribbon campaign – which some of you are aware of. You will note over the past month in the few television appearances and also public appearances that I have with me a green ribbon. This is in support of World Mental Health Day. I’ve run a small project which some of you have participated in. I hope that those of you who did will be able to get one of these ribbons too. It’s a small gesture from me and others but it has a big meaning for everyone struggling with mental illness and mental health issues.

I do hope that I’ll be able to share with you the few pictures of people who have taken part in making this 36 hour campaign a success.

Depression during pregnancy

Depression during pregnancy can happen anytime before, during or after delivery.

We include a simple fact sheet in Malay which was highlighted by Wanita Hari Ini today with Fiza Sabjahan (26/9/2018) for the relevant audience which was made by my undergraduate students and field tested during their community visit.

Phamplet 1

Phamplet 2

You can also learn more about this in these podcasts too


Thank you to TV3 for the support in #mentalhealthawareness

Innovations in Global Health Professions Education 2018

Interesting times are here in medical education.

Currently in a conference for innovations for medical education where a number of innovative strategies are now in place for medical education. Using AI together with current strategies appear to increase learning and eventually service. This to me is ground breaking. I’m hoping that this will introduce better health care provision to the people of Malaysia.

However we must be careful to avoid addictive behaviour and also psychological consequences of technology, especially when we are unprepared.

Excitement in Munich

I wanted to share with you a recent happening in my life. I’m in Munich to attend a conference on smoking cessation but realised on entering that the venue is in the Department of Psychiatry at the Ludwig Maximilian University. At first this was not a big deal, not that it really registered. However, as I was walking to the first keynote, I was greeted by Prof Dr Emil Kraepelin!!

It turns out, I’m in the department which Kraepelin started and later a person named Prof Dr Aloys Alzheimer was also a faculty member here. Yes, that Alzheimer’s!!!

What luck!

So I wanted to share some pictures and a video with you about this so you too can experience what I did. For my students and trainees, you will want to watch this.

Now, for others here, you might be wondering Kraepelin who? Alzheimer’s? Well these two psychiatrists did wonders for the field. One defined what we now understand as schizophrenia and bipolar disorder and the difference between the two. He described schizophrenia as dementia praecox and bipolar as a separate entity. We still use his understanding until now. The other person found the cause of a neurodegenerative disorder of the brain which caused people in late life to lose their memory. His work has allowed us to better understand the brain and as a result have massive research programs to be set up allowing people with this illness to prolong their memory and thinking with new medical inventions and discovery.

Hope you enjoy the video. Another video on the Head of Department introducing his department is in my Facebook feed too.

This video is for all my trainees in psychiatry. Here I am in the Dept which Prof Dr Emil Kraepelin started and sitting in the hall which Prof Kraepelin lectured! I’ll let the HOD of the Dept of Psychiatry Munich introduce to you his beautiful department. Now also listen about the importance of smoking cessation for our patients. My personal take is that if you’re not treating people with mental illness for their tobacco use, you’re doing an injustice to them too. #mentalhealthawareness #mentalmalaysia

Posted by Dr Amer Siddiq on Jumaat, 7 September 2018

We talk about suicide reporting again

Good morning everyone and a friendly reminder to all my friends in the media as we strive to improve mental health care and #suicideprevention in Malaysia

We have been awoken time and time again with sad news on untimely deaths. More importantly the method of reporting at times have been noted to be wanting.

In lieu of this and other reasons, some of us have in recent times taken up the challenge and decided to do a little bit more.

Do take the time to also read our latest paper on this issue. We provide some context on why this is important. We call upon all stakeholders to take part in this effort. We encourage people to improve in the way they report the news.

For all my trainees and students, this is also very relevant to you. You are training in a very interesting time for psychiatry. There is slow but steady rise in mental health awareness. You must be ready to take up this challenge when called upon.

As part of our efforts, myself and few others (A/Prof Dr Chan Lai Fong from UKM and Dr Nurashikin from MOH) with the support of University of Malaya will be hosting a workshop on best practices for reporting suicide. Stay tuned 😉

For more you can also listen to podcasts episode 39 and you might want to also hear episode 12

Have a great day

Health Talk on Stress and Depression

Thank you to the team from OCBC bank which invited me and my team to give a health talk this morning. We hope you enjoyed the session as much as we did. For this event, myself and Roana had worked hard to ensure that we had some good content for you. Our collaboration with Psyberr as usual provided the video support with our ever loved video on depression.

You might not be aware but stress is one of the most common complaints we get in clinic and also chronic stress is a risk factor for multiple medical conditions. Only this morning I was informed regarding some disturbing news on how unmanaged stress had possibly led to early heart conditions in young people. With our lack of exercise, smoking rates of 22.8% and undiagnosed issues with alcohol among others, there is the possibility that stress will lead to other problems.

Depression as we know is a consequence of chronic stress and has its own complications – namely suicide – which we try to prevent.

We hope you all had a great session today and we hope that all of you who attended had gotten some value from our talk. For other organisations that might be keen to have us with you, do get in touch. We might be able to make a difference for you too.

Pics of the sessions.

Getting a point across by Dr Amer

The crowd undergoing practice on mindfulness by Ms Roana a certified counsellor

Ms Roana doing the practical session

Thank you again to the team from OCBC who invited me and my team over.

Screening for children with mental health issues

These are amazing times. With just one question and a few tweets we now have a massive opportunity to open up the discussion on screening by teachers for mental health issues in particular conditions where early detection can make a huge difference in the quality of life of our children – ADHD and autism for example.

Now we must be mindful that even with the part played by our respected teachers to detect and refer we still have a long way to. It’s not so easy folks.

Why? Well consider this;

1. You detect and refer but parents refuse to bring the child to see us in psychiatry.

2. Child is brought to psychiatry but we don’t have as many skilled people ready to cater to the load that comes forward. In our centre it’s a year long wait for a new case to be seen due to the loss of one child psychiatrist.

3. Your child is assessed and a plan is made. However, the centre does not have the supporting allied health providers (get to know who they are in our October campaign). These people include trainee psychologist, occupational therapist etc

4. You decide to go “outside” because you cannot wait. The price for private care is high due to scarcity of the aforementioned people involved.

5. Ongoing stigma in mental illness.

6. Insurance still does NOT cover for people with mental illness.

7. We want to train a child psychiatrist to cater for the possible load. We don’t have enough training funds to do so.

I think that’s quite a list already.

Therefore although I’m very optimistic and believe this is the first step we need to ensure that both upstream and downstream issues are sorted and sorted out fast.

Once we’ve sorted the children let’s then look at the elderly. Did you know by 2030 15% of Malaysians will be >65. Are we ready?