Academic journal article Hong Kong Journal of Psychiatry

Symptom Presentation in Patients with Acute Schizophrenia: Comparison in Three Major Malaysian Ethnic Groups

Academic journal article Hong Kong Journal of Psychiatry

Symptom Presentation in Patients with Acute Schizophrenia: Comparison in Three Major Malaysian Ethnic Groups

Article excerpt


Objective: This cross-sectional study was conducted to examine the difference in presenting symptoms among Malay, Chinese, and Indian patients with schizophrenia, who were admitted to the psychiatric wards of Hospital Kuala Lumpur, Malaysia.

Participants and Methods: This study was conducted between 13 March 2004 and 13 June 2004. The Structured Clinical Interview for DSM-III-R (SCID) to generate DSM-IV diagnoses was used to diagnose schizophrenia, and Positive and Negative Syndrome Scale (PANSS) was used to compare differences in presenting symptoms among the 3 ethnic groups. A total of 97 patients were recruited; 49% were Malay, 28% Chinese, and 24% Indian.

Results: There were no significant differences among the 3 ethnic groups with regard to the demographic factors except the level of education; more Malays had tertiary education than Chinese and Indians (p < 0.04). In this study, the PANSS score on emotional withdrawal was high among Indians (p < 0.03), and on passive / apathetic social withdrawal and stereotyped thinking were low among Malays (p < 0.002 and p < 0.001 respectively). The scores on tension and active social avoidance were also high among Indians as compared to the Malays (p < 0.02 in both). There was a significant reduction of the total PANSS score over 2 weeks, no difference was noted for the mean change of total PANSS score from baseline, i.e. 'on admission' to 'at week 2' among the 3 ethnic groups. A significant difference was observed in the mean PANSS positive scores, whereby reduction of the positive symptoms was greatest in Malays and least in Chinese (p < 0.004).

Conclusion: There was no significant difference among the 3 ethnic groups in terms of positive symptoms, but there were significant differences among them for some negative symptoms.

Key words: Ethnic groups; Schizophrenia; Signs and symptoms



Malaysia's population has many ethnic groups, the 3 major ones being Malay (58%), Chinese (24%), and Indian (8%). Before the country became independent in 1957, the Malays largely resided in rural areas, while the Chinese and the majority of the Indians were urban dwellers. There were fairly distinct differences between the group members in terms of economic and social positions achieved. The Chinese have historically played an important role in trade and business. Most are descendents of immigrants from the south coastal provinces of China. The Indian community in Malaysia is the smallest among the 3 main ethnic groups. For statistical purposes, those of Punjabi and Sri-Lankan origin are also included in the 'Indian' category. Hindu traditions remain strong in the Indian community of Malaysia.

One study examined symptoms in schizophrenia patients among White and African-Caribbeans living in Britain. (1) Factor analysis was applied to symptom data obtained by the Present State Examination from the 2 groups of patients and identified 6 symptoms dimensions: mania, depression, first-rank delusions, other delusions, hallucinations, and a manic / catatonic category. (1) There were no differences between White and African-Caribbean patients with schizophrenia in terms of core symptoms of the disorder, but the African-Caribbean patients appeared to present with more symptoms of a mixed affective nature. (1)

Results of a local study suggested that the symptoms of schizophrenia are influenced by culture. (2,3) Phenomenology of hallucinatory experiences among Chinese patients from a predominantly Chinese area of Malaysia (Penang state) was compared with Malay patients from a predominantly Malay area (Kelantan state). Most Malays heard voices that they attributed to God, demons or spirits, while the Chinese attributed them to friends, relatives, or neighbours. However, Chinese brought up in Malay communities had auditory hallucination like their Malay counterparts. …

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