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1 Mohamed Hatta Shaharom Forensic Psychiatrist & Founding Dean Faculty of Medicine Cyberjaya University College of Medical Sciences Malaysia 28 th FIMA.

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Presentation on theme: "1 Mohamed Hatta Shaharom Forensic Psychiatrist & Founding Dean Faculty of Medicine Cyberjaya University College of Medical Sciences Malaysia 28 th FIMA."— Presentation transcript:

1 1 Mohamed Hatta Shaharom Forensic Psychiatrist & Founding Dean Faculty of Medicine Cyberjaya University College of Medical Sciences Malaysia 28 th FIMA Council Meeting Indonesian Islamic Medical Association Scientific Convention YARSI University Jakarta September 2011 / Shawwal 1432

2 بسم الله الرحمن الرحيم وَلَوْ جَعَلْنَاهُ قُرْآنًا أَعْجَمِيًّا لَّقَالُوا لَوْلَا فُصِّلَتْ آيَاتُهُ أَعْجَمِيٌّ وَعَرَبِيٌّ قُلْ هُوَ لِلَّذِينَ آمَنُوا هُدًى وَشِفَاء وَالَّذِينَ لَا يُؤْمِنُونَ فِي آذَانِهِمْ وَقْرٌ وَهُوَ عَلَيْهِمْ عَمًى ( ٤٤ ) أُوْلَئِكَ يُنَادَوْنَ مِن مَّكَانٍ بَعِيد 2 Had We sent this as a Qur’an (in the language) other than Arabic, they would have said: "Why are not its verses explained in detail? What! (a Book) not in Arabic and (a Messenger) an Arab?" Say: "It is a Guide and a Healing to those who believe; and for those who believe not, there is a deafness in their ears, and it is blindness in their (eyes); They are (as it were) being called from a place far distant!" Fussilat (Explained in Detail) 41:44

3 3 The Elderly (Mental Health & Illness) 1.Mental health, medicine and sociology 2.Psychiatric disorders and management 3.Islamic care of the elderly.

4 Pencegahan Lebih Baik Daripada Rawatan Prevention is Better Than Cure 4

5 1 Mental Health, Medicine and Sociology 5

6 6 الَّذِينَ آمَنُواْ وَتَطْمَئِنُّ قُلُوبُهُم بِذِكْرِ اللّهِ أَلاَ بِذِكْرِ اللّهِ تَطْمَئِنُّ الْقُلُوبُ "Those who believe, and whose hearts find tranquillity in the remembrance of Allah; for in the remembrance of Allah do hearts find tranquillity. Ar-Ra‘d (The Thunder) 13:28

7 7 Experiencing Old Age i.Retirement ii.Dependence and independence in old age Alan Clarke, The Sociology of Healthcare. London: Prentice Hall. Pp

8 8 Sociology and Older People i.Disengagement theory ii.Structured dependency theory iii.Theory of the third age iv.Cultures of ageing Paul Higgs, Later life, health and society. In Graham Scambler (ed). Sociology as Applied to Medicine. Edinburgh: Saunders. Pp

9 9 Fact 1 Many gerontologists are substituting age 85 for age 65 as the new chronological definition of old age. James McKenzie, Robert Pinger, Jerome Kotecki, An Introduction to Community Health. Boston: Jones and Bartlett. Pp

10 10 Fact 2 There are more differences among elders than any other segment of the U.S. population. James McKenzie, Robert Pinger, Jerome Kotecki, An Introduction to Community Health. Boston: Jones and Bartlett. Pp

11 11 Fact 3 Elders are the least likely to be lonely of any age group; and those who live alone are likely to be in close contact. James McKenzie, Robert Pinger, Jerome Kotecki, An Introduction to Community Health. Boston: Jones and Bartlett. Pp

12 12 Fact 4 It is only in the last half of the twentieth century that a large portion of the U.S. population lived to be 65 years old.

13 13 Fact 4 (cont) If people did live to be old, they were not treated any better than they are today. James McKenzie, Robert Pinger, Jerome Kotecki, An Introduction to Community Health. Boston: Jones and Bartlett. Pp

14 14 Fact 5 Senility is the result of disease and only affects about 5% of elders living in non- institutional setting. James McKenzie, Robert Pinger, Jerome Kotecki, An Introduction to Community Health. Boston: Jones and Bartlett. Pp

15 15 Fact 6 Though elders do gain certain advantage when they retire and when their children leave home, they still face a number of concerns. James McKenzie, Robert Pinger, Jerome Kotecki, An Introduction to Community Health. Boston: Jones and Bartlett. Pp

16 16 Fact 7 Most older people do have at least one chronic health problem, but the majority of elders live active lifestyles. James McKenzie, Robert Pinger, Jerome Kotecki, An Introduction to Community Health. Boston: Jones and Bartlett. Pp

17 17 Fact 8 Sexual interest does not diminish with age, but there is an alteration in sexual response. James McKenzie, Robert Pinger, Jerome Kotecki, An Introduction to Community Health. Boston: Jones and Bartlett. Pp

18 18 Fact 8 (cont) Nonetheless, many elder in reasonably good health have active and satisfying sex lives. James McKenzie, Robert Pinger, Jerome Kotecki, An Introduction to Community Health. Boston: Jones and Bartlett. Pp

19 19 Fact 9 Only approximately 4% of those above the age of 65 live in nursing homes, homes for the age, or other group quarters. James McKenzie, Robert Pinger, Jerome Kotecki, An Introduction to Community Health. Boston: Jones and Bartlett. Pp

20 20 Fact 10 Older adults are more likely to be retired, but they are very likely to be productively engaged at home and in the community. James McKenzie, Robert Pinger, Jerome Kotecki, An Introduction to Community Health. Boston: Jones and Bartlett. Pp

21 21 Mental State Examination i.Memory impairment ii.Disorientation iii.Needs physical help iv.Risk in the home v.Risk outside vi.Apathy

22 22 Mental State Examination (cont) vii. Poor communication viii. Repetitiveness ix. Uncontrolled behavior x. Incontinence xi. Emotional reactions

23 23 Neil Anderson, Alan Jacques, Old-age psychiatry. In Eve Johnstone, D. Owens, S. Lawrie, M. Sharpe. C. Freeman. Companion to Psychiatric Studies. Edinburgh: Churchill Livingstone. Pp Mental State Examination (cont) xiii.Other reactions xiv.Mistaken beliefs xv.Decision Making xvi.Burden on family

24 24 Investigations and Differential diagnoses i.Physical examination ii.Full blood count iii.ESR iv.Urea and electrolytes v.Liver function tests

25 25 Investigations and Differential diagnoses (cont) vi.Thyroid function test vii.Calcium and phosphate viii.Midstream urine ix.Glucose x.Chest X-ray

26 26 Investigations and Differential diagnoses (cont) xi.ECG xii.Vitamin B 12 and folate xiii.Syphilis serology xiv.HIV testing xv.Autoantibody screen

27 27 Investigations and Differential diagnoses (cont) xvi. Copper studies xvii.Heavy metal screen xviii.Lumbar puncture xix.EEG xx.CT scan

28 28 Investigations and Differential diagnoses (cont) xxi. MRI scan xxii. SPECT scan Neil Anderson, Alan Jacques, Old-age psychiatry. In Eve Johnstone, D. Owens, S. Lawrie, M. Sharpe. C. Freeman. Companion to Psychiatric Studies. Edinburgh: Churchill Livingstone. Pp

29 29 Neuroimaging in dementia i.Alzheimer’s disease ii.Vascular dementia iii.Dementia with Lewy bodies iv.Frontotemporal dementia Neil Anderson, Alan Jacques, Old-age psychiatry. In Eve Johnstone, D. Owens, S. Lawrie, M. Sharpe. C. Freeman. Companion to Psychiatric Studies. Edinburgh: Churchill Livingstone. Pp

30 2 Psychiatric Disorders and Management 30

31 بسم الله الرحمن الرحيم فِي قُلُوبِهِم مَّرَضٌ فَزَادَهُمُ اللّهُ مَرَضاً وَلَهُم عَذَابٌ أَلِيمٌ بِمَا كَانُوا يَكْذِبُونَ In their hearts is a disease; and Allah has increased their disease; and grievous is the penalty they (incur), because they are false. Al-Baqarah (The Cow) 2:10 31

32 32 The Elderly and Mental Illness 1.From 15 to 25 percent of elderly people suffer from significant symptoms of mental disorders 2.Ratio of Moderate organic disorders : Severe organic mental disorders (Ratio of 2 : 1).

33 33 The Elderly and Suicide The highest suicide rate in America is among those aged 65 and older. In 1985, this age group represented 12 percent of the total U.S. population, but accounted for 20 percent of suicides nationwide.

34 34 The Elderly and Mental Illness Worldwide, elderly people lead the World Health Organization's list of new cases of mental illness: 236 elderly people per 100,000 suffer from mental illness, compared to 93 per 100,000 for those aged 45 to 64, the next younger group.

35 35 1.Nearly 25% of elderly persons suffer from symptoms of mental illness, 2.Only 4% of the patients in community mental health centers, 2% of the patients seen in private practitioners' offices or hospitals are elderly 3.Less than 1.5% of the direct costs for treating mental illness is spent on older people living in the community.

36 36 Depression (Epidemiology) 1.Most common mental disorder, afflicts up to 5% of people aged 65 and older 2.Can mimic dementia 3.About 10% of those diagnosed with dementia actually suffer from depression that, if treated, is reversible 4.More than one third of all depressed patients seen by doctors will go untreated due to misdiagnosis 5.Lifetime risk for major depression is only 7-12% in men, but a whopping 20-25% in women!

37 37 Depression (and Women’s Indirect Complaints) The elderly are also commonly taking many more medications than younger people are; some of these medications: Anti-inflammatory drugs Progesterone Anticancer drugs

38 38 Depression (and Medications of the Elderly) Usually women will not complain directly of sadness; symptoms can include, but are not limited to: 1.Alzheimer's disease 2.Cancer (including breast and ovarian) 3.Congestive heart failure 4.Parkinson's disease 5.Rheumatoid arthritis 6.Sexual dysfunction 7.Diabetes

39 39 Depression (Signs & Symptoms) 1.Feelings of worthlessness, hopelessness, helplessness, inappropriate guilt; 2.Prolonged sadness, crying spells; 3.Jumpiness, irritability; 4.Loss of interest in and withdrawal from formerly enjoyable activities, family, friends, work or sex (anhedonia); 5.Intellectual problems: loss of memory, cannot concentrate, disorientation.

40 40 Depression (presentation in brief) 1.Disturbances in sleep, self-esteem, libido, appetite, interest, energy, concentration, memory, and movement 2.Feelings of guilt 3.Suicidal thoughts, plans, or attempts 4.Physical pain

41 41 Therapies for Depression Pharmacotherapy (anti-depressants) is fairly successful at improving the quality of life of the elderly patient. Psychotherapy is often used in combination with anti-depressants, which can include drugs in these classes:

42 42 Anti-Depressants (Types) 1.Heterocyclics 2.Selective serotonin reuptake inhibitors (SSRIs) such as Prozac 3.Monoamine oxidase inhibitors (MAOIs) 4.Tricyclics such as imipramine, desipramine, amitryptyline, and nortriptyline.

43 43 Anti-Depressants (Side-effects) (the elderly is more susceptible to) Blurred vision Dry mouth Urinary retention Confusion Constipation Drowsiness Insomnia Cardiac arrhythmia Hypotension Weight fluctuations Gastrointestinal distress Sexual dysfunction

44 44 Dementias 1.Characterized by confusion, memory loss, and disorientation 2.Only 15% of older Americans suffer from this condition (of that number, an estimated 60% suffer from Alzheimer's disease, a progressive mental deterioration for which no cause or cure has been found) 3.Alzheimer's being the most prevalent type (degeneration can last from 5 to 20 years).

45 45 Dementias (Causes) About 40% of all dementias can be caused by complications of chronic high blood pressure, blood vessel disease or a previous stroke. Deterioration is in steps rather than in a steady progression.

46 46 Dementia (Symptoms) 1.Delirium 2.Depressed mood 3.Behavioral disturbances 4.Delusions

47 47 Sometimes medications are used to treat symptoms that are secondary to dementia, such as sleep disruption, depression, and aggressive behaviors. These medications are only treating the symptoms that arise out of the underlying dementia, and do not treat the dementia itself.

48 48 Dementia (and Parkinson’s) Parkinson's disease, which generally begins with involuntary and small tremors or problems with voluntary movements. Dementia may occur when the disease is severe or very advanced.

49 49 Dementia (and Huntington’s) Huntington's disease, a genetic disorder that begins in middle age and has symptoms of changed personality, mental decline, psychosis and movement disturbance.

50 50 Dementia and Creutzfeldt-Jakob Creutzfeldt-Jakob disease, thought to be caused by a viral infection leading to rapid and progressive dementia.

51 51 Delirium Elderly patients, and especially women, are extremely sensitive to things such as surgery and anesthesia, drug toxicity, and infections like urinary tract infections (especially in women). The symptoms of delirium are often misdiagnosed as relating to other conditions. Symptoms can be reduced with Haloperidol.

52 52 Delirium (common symptoms) EEG shows a slowing of activity in the brain 1.Disturbed consciousness 2.Sudden reduced ability to focus, sustain, or shift attention 3.Sudden onset of misperceptions 4.Impaired judgement 5.Increased or decreased motor activity

53 53 Psychosis 1.Schizophrenia is a group of mental disorders that involve disturbances of thinking, mood, and behaviour 2.Bipolar disorders involve periods of depression followed by periods of mania (accompanied by grandiosity, lack of sleep, and excessive activity) 3.Elderly patients who are diagnosed with psychosis may also experience delirium or dementia, so these conditions must be treated in addition to the psychosis.

54 54 Schizophrenia 1.Only 3% of patients with schizophrenia experience their first symptoms in their sixties or after 2.The treatment of schizophrenia for elderly patients is largely the same as in other schizophrenic patients 3.Minor differences in treatment are the necessity to treat depression that often results in elderly patients as a result of psychosis.

55 3 Islamic Care of the Elderly 55

56 بسم الله الرحمن الرحيم يَا أَيُّهَا النَّاسُ قَدْ جَاءتْكُم مَّوْعِظَةٌ مِّن رَّبِّكُمْ وَشِفَاء لِّمَا فِي الصُّدُور وَهُدًى وَرَحْمَةٌ لِّلْمُؤْمِنِينَ O mankind! There has come to you an admonition from your Lord-Sustainer, and a Healing for all (the diseases) that are in the breasts; and a Guidance and a Mercy for the Believers. Yunus 10:57 56

57 57 Psychological Bio-physical Spiritual Social Holistic Approach

58 58 Human Psychology Cognition & Emotion Human Psychology Psikologi Insan Basic Characteristics Sifat Asas Excellent Characteristics Sifat Cemerlang Cognition (Thinking) Al-‘Aql (Fikiran) Sanity Kewarasan Maturity Kematangan Emotion (Feeling) Al-Qalb (Perasaan) Sincerity Keikhlasan Tranquility Ketenangan

59 59 Pantun Akal Tunduk padi kerana isi Kekal emas tidaklah senang Tunjuk budi disanjung tinggi Akal waras menjadi matang.

60 60 Pantun Kalbu Fasih lisan biar berbudi Buku Hadis menyuluh terang Kasih Tuhan berperi-peri Kalbu ikhlas menjadi tenang.

61 61 أَفَلَمْ يَسِيرُوا فِي الْأَرْضِ فَتَكُونَ لَهُمْ قُلُوبٌ يَعْقِلُونَ بِهَا أَوْ آذَانٌ يَسْمَعُونَ بِهَا فَإِنَّهَا لَا تَعْمَى الْأَبْصَارُ وَلَكِن تَعْمَى الْقُلُوبُ الَّتِي فِي الصُّدُور ِ Do they not travel through the land, so that their hearts gain understanding and causing their ears to hear? Truly it is not their eyes that are blind, but blind have become their hearts which are in the breasts. Al-Haj (The Pilgrimage) 22:46

62 Allah Maha Sombong, Maha Agung Dari Abu Hurairah r.a., ia berkata: Rasulullah s.a.w. bersabda, “Allah ‘azzawajalla berfirman, “Kesombongan (al-kibriyaa’) selendang-Ku, dan Keagungan itu sarung- Ku; sesiapa yang melawan-Ku dalam salah satu daripadanya, maka akan Aku lemparkan ke dalam neraka.”” (Abu Dawud) Achmad Sunarto & Syamsuddin Noor, S.Ag., Himpunan Hadits Qudsi. Jakarta: An Nur, hal

63 63 Care and Therapies for the Elderly 1.Pharmacotherapy 2.Psychotherapy & Religio-spiritual therapy 3.Social therapy

64 Pertemuan Dengan Allah Dari Aisyah r.a., ia berkata: Rasulullah s.a.w. bersabda, “Barangsiapa yang kasihkan pertemuan dengan Allah, maka Allah kasihkan pertemuan dengannya, dan barangsiapa yang bencikan pertemuan dengan Allah, maka Allah bencikan pertemuan dengannya; sedangkan mati adalah sebelum pertemuan dengan Allah.” (Muslim) Achmad Sunarto & Syamsuddin Noor, S.Ag., Himpunan Hadits Qudsi. Jakarta: An Nur, hal

65 65 Care of the Elderly 1.Prevention better than cure 2.The Islamic approach is a cross pollination of different modalities (accepted by Islam) 3.The care-giver and care-recipient are beloveds of Allah.


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