Psychiatry Commons^™

Extract And Active Principal Of The Neotropical Vine Souroubea Sympetala Gilg. Block Fear Memory Reconsolidation, Anthony Murkar, Hristian Cayer, Jon James, Tony Durst, John T. Arnason, Pablos E. Sanchez-Vindas, M. Otarola Rojas, Zul Merali

Brain and Mind Institute

Background: Souroubea sympetala Gilg. is a neotropical vine native to Central America, investigated as part of a targeted study of the plant family Marcgraviaceae. Our previous research showed that extract of S. sympetala leaf and small branch extract had anxiolytic effects in animals and acts as an agonist for the GABAA receptor at the benzodiazepine binding site. To date, the potential effects of S. sympetala and its constituents on reconsolidation have not been assessed. Reconsolidation, the process by which formed memories are rendered labile and susceptible to change, may offer a window of opportunity for pharmacological manipulation of learned fear. …

Psychosocial Factors Of Deliberate Self-Harm In Afghanistan: A Hospital Based, Matched Case-Control Study, Akbar Paiman, Murad M. Khan Dr., Tazeen S. Ali, Nargis Asad, Iqbal Azam Syed

Department of Psychiatry

Background: Deliberate self-harm is not only a major global public health problem but also an important index of psychological distress and a risk factor for suicide.
Aims: We aimed to determine the psychosocial risk factors for deliberate self-harm in patients aged ≥ 16 years presenting to tertiary care hospitals in Kabul, Afghanistan.
Methods: A matched case-control study was conducted from February 2015 to May 2015. We recruited 185 cases (patients with deliberate self-harm) and 555 age- and sex-matched controls (patients with general medical conditions) from 4 tertiary care hospitals in Kabul. We developed a questionnaire to record the sociodemographic characteristics …

Resilience And Quality Of Life (Qol) Of Head And Neck Cancer And Brain Tumour Survivors In Pakistan: An Analytical Cross-Sectional Study Protocol, Nida Zahid, Wardah Khalid, Khabir Ahmad, Shireen Shehzad, Iqbal Azam Syed, Nargis Asad, Adnan Jabbar, Mumtaz J Khan, Ather Enam

Department of Surgery Docs

Background: Cancer is a devastating disease and has detrimental effects on the quality of life (QoL) of cancer survivors and interferes with their treatment compliance. The aim of the study is to assess resilience and QoL among cancer survivors and to evaluate the important factors affecting their resilience and QoL, with respect to the Pakistani cultural context.
Method and Analysis: A cross-sectional study will be conducted at a tertiary care hospital in Karachi, Pakistan. A minimum sample size of 250 head and neck cancers and 250 brain tumour survivors with 10% inflation for non-response rate will be required. The SD …

Nash-Wo-Numa (Childhood Growth & Development) Study Protocol: Factors That Impact Linear Growth In Children 9 To 15 Years Of Age In Matiari, Pakistan, Susan C. Campisi, Yaqub Wasan, Sajid Bashir Soofi, Suneeta Monga, Daphne J. Korczak, Wendy Lou, Olle Soder, Ashley Vandermorris, Khadija N Humayun, Ayesha Mian, Peter Szatmari, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Introduction: Adolescence is a time of significant physical and emotional change, and there is emerging concern that adolescents living in low- and middle-income countries (LMIC) may face substantial challenges in relation to linear growth and mental health. Data on the global burden of stunting after 5 years of age are limited, but estimates suggest up to 50 per cent of all adolescents in some LMIC are stunted. Additionally, many LMIC lack robust mental health care delivery systems. Pakistan has one of the world's largest populations of adolescents (10 to 19 years) at approximately 40 million. The Nash-wo-Numa study's primary objective …

Need Of Physical And Chemical Restraints: Experiences At Inpatient Psychiatric Ward In A Tertiary Care Hospital In Karachi, Pakistan, Humera Saeed, M. Shameel Khan, Syeda Maheen Batool, Asma Akbar Ladak, Nadia Karim, Rabeeka Aftab

Department of Psychiatry

In psychiatry, agitated / aggressive patients are often treated with de-escalation techniques. If this does not work, physical or chemical restrains are required; but in the event of resistance, seclusion is applied. We report the findings of baseline study of experiences of physical and chemical restraints in a tertiary care hospital in Karachi, where 104 files were evaluated retrospectively. The mean age of patients was 32.5 ±14.3 years with 54.8% men, while the average length of stay was 11.5 ±9.3 days. Agitation, violent behaviour, and aggression were the most common indications for restraints. In total, 94.5% of patients had both …

Mental Health Services For Youth In The Eastern Mediterranean Region: Challenges And Opportunities (Editorial), Atif Rahman, Hesham M. Hamoda, Afarin Rahimi-Movaghar, Murad M. Khan Dr., Khalid Saeed

Department of Psychiatry

The Global Burden of Disease study shows that the burden from mental and substance use disorders, measured in Disability Adjusted Life Years (DALYs), has steadily risen in the Eastern Mediterranean Region (EMR) over the last three decades and is higher than the global average for almost all EMR countries). Even more alarming is the finding that depression, self-harm, anxiety and conduct disorders constitute four of the top 10 causes of DALYs among girls and boys aged 15-19 years and suicide is a leading cause of adolescent mortality.

Integration Of Mental Health Into Primary Healthcare: Perceptions Of Stakeholders In Pakistan, Syed S. Hussain, Murad M. Khan Dr., Raisa B. Gul, Nargis Asad

Department of Psychiatry

Background: In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care (PHC).
Objectives: This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan.
Methods: A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making (from the Department of Health) and implementation-level stakeholders (mental health and public health professionals and primary care staff) from both the …

Stress, Anxiety And Depression In Students Of A Private Medical School In Karachi, Pakistan, Noman Rehmani, Qurat Ul Ain Khan, Syeda Sadia Fatima

Department of Psychiatry

Objective: To determine frequency of stress, anxiety and depression and their coping mechanisms in undergraduate students of a private sector university.

Methods: A cross sectional study was conducted at Aga Khan University recruiting students from Medical School, School of Nursing & Midwifery, and Dental Hygiene program who had attended at least six months on campus from October 2016 until August 2017. The “Aga Khan University Anxiety and Depression Scale” and “Student-Life Stress Inventory” scales were used to assess depression and anxiety, and stressors.

Results: A total of 283 students participated in this study and all of them scored higher than …

Premenstrual Syndrome: Existence, Knowledge, And Attitude Among Female University Students In Karachi, Aleena Mohib, Amara Zafar, Areeba Najam, Hafsa Tanveer, Rehana Rehman

Department of Biological & Biomedical Sciences

Objective: The aim of this study was to investigate the existence, knowledge, and the attitude of female students towards premenstrual syndrome (PMS).
Methods: This cross-sectional study was conducted in three universities in Karachi, Pakistan. A total of 448 female students participated in the study. The clinical criterion of American College of Obstetricians and Gynecologists (ACOG) for PMS was used to assess the prevalence of PMS in the participants. The questionnaire was set in four parts, one each to assess the knowledge, the attitude, and practices regarding PMS and one to assess the gap between self-perceived PMS and actual PMS. Data …

Suicide And Deliberate Self-Harm In Pakistan: A Scoping Review, Sualeha S. Shekhani, Shagufta Perveen, Dur-E-Sameen Hashmi, Khawaja Akbar, Sara Bachani, Murad M. Khan Dr.

Department of Psychiatry

Background: Suicide is a major global public health problem with more than 800,000 incidents worldwide annually. Seventy-five percent of the global suicides occur in low and middle-income countries (LMICs). Pakistan is a LMIC where information on suicidal behavior is limited. The aim of the review is to map available literature on determinants, risk factors and other variables of suicidal behavior in Pakistan.
Method: This study was based on Arksey and O'Malley's methodological framework of scoping review, combining peer reviewed publications with grey literature. Ten databases including Applied Social Sciences Index and Abstracts (ASSIA), Cochrane Trials Register (CRG), Cumulative Index to …

Self-Reported Academic Performance In Relation To Health Behaviours Among Bahria University Students, Rehana Rehman, Amara Zafar, Aleena Mohib, Mehwish Hussain, Rabiya Ali

Department of Biological & Biomedical Sciences

Objective: To find an association between self-reported academic performance with different socio-demographic factors, health behaviours and mental health amongst university students.
Methods: This cross-sectional study was conducted at Bahria University, Karachi, from January 2012 to December 2013, and comprised university students of different disciplines. An anonymous, self-reported questionnaire was distributed among the subjects. Convenient sampling technique was used. Demographic information, including age, gender and field of study, were obtained. Depresion was evaluated via Centre for Epidemiological Studies Depression Scale. SPSS 22 was used to analyse data.
Results: Of the 813 respondents, 334(41.1%) were males and 479(58.9%) females. The mean age …

Use Of M-Health Technology For Preventive Medicine In Pakistan, Minaz Mawani, Muhammad Masood Kadir

Section of Internal Medicine

No abstract provided.

Factors Affecting Depression Among Married Women Living In Urban Squatter Settlements Of Karachi, Pakistan, Shireen Shehzad, Salima Farooq, Yasmin Parpio, Rozina Karmaliani Professor, Nargis Asad, Iqbal Azam Syed, Omrana Pasha

School of Nursing & Midwifery

Background: Depression is one of the growing public health concerns among women worldwide. This is one of the most under-recognized and under-treated mental illnesses worldwide. Women of developing countries are inexplicably affecting with depression. Purpose: The purpose of study is to assess the prevalence and associative factors of depression among women of aged 20 to 40 years living in urban squatter settlements of Karachi, Pakistan. The identification of all the potential determinants will potentially help in formulating preventive strategies in order to decline the prevalence of depression among women and improve the well being of women.
Methods: An analytical cross-sectional …

Remission Of Psychosis In Treatment-Resistant Schizophrenia Following A Seizure: A Case Report, Hena Jawaid, Sana Younus, Hanif Mesiya

Department of Psychiatry

The authors report a case of treatment-resistant schizophrenia in a 22-year-old woman, who, despite multiple trials of antipsychotics, did not respond to treatment. Clozapine treatment was initiated, but the patient's symptoms did not remit until after she had a clozapine-induced seizure. The authors discuss the importance in considering that electroconvulsive therapy may be effective in reducing positive and negative symptoms in patients suffering from treatment-resistant schizophrenia.

Translating Knowledge For Action Against Stroke--Using 5-Minute Videos For Stroke Survivors And Caregivers To Improve Post-Stroke Outcomes: Study Protocol For A Randomized Controlled Trial (Movies4stroke)., Ayeesha Kamran Kamal, Adeel Khoja, Bushra Usmani, Nargis Asad, Asma Ahmed, Iqbal Azam, Sarah Saleem, Saleem Sayani

Department of Medicine

Background: Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world’s sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing >70 % mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers.

Methods: Movies4Stroke will be a randomized control, outcome assessor …

The Clinical Trial Design, Haider A. Naqvi

Department of Psychiatry

No abstract provided.

Early Psychosis Symptoms, Haider A. Naqvi, Sajjad Hussain, Muhammad Islam, Shafqat Huma

Department of Psychiatry

Objective: To determine the prodromal symptoms of schizophrenia in the pathways to help-seeking.STUDY Design: A cross-sectional study.PLACE AND DURATION OF STUDY: The Department of Psychiatry, the Aga Khan University, Karachi, from 2008 to 2009.METHODOLOGY: A total of 93 patients were interviewed in the pathways to care of schizophrenia. The diagnosis was based on ICD-10 criteria. The pathways to care were assessed through a semi-structured questionnaire. The onset, course and symptoms of psychosis were assessed through Interview for Retrospective Assessment at Age at Onset of Psychosis (IROAS).Results: Fifty five (59%) participants were male while 41% (n=38%) were female. Using IROAS, 108 …

Vitamin B12 Supplementation In Trea Ting Major Depressive Disorder: A Randomized Controlled Trial, Ehsan Ullah Syed, Mohammad Wasay, Safia Awan

Department of Medicine

Recent literature has identified links between vitamin B12 deficiency and depression. We compared the clinical response of SSRI-monotherapy with that of B12-augmentation in a sample of depressed patients with low normal B12 levels who responded inadequately to the first trial with the SSRIs. Methods: Patients with depression and low normal B12 levels were randomized to a control arm (antidepressant only) or treatment arm (antidepressants and injectable vitamin B12 supplementation). Results: A total of 199 depressed patients were screened. Out of 73 patients with low normal B12 levels 34 (47%) were randomized to the treatment group while 39 (53%) …

Interventions For Common Perinatal Mental Disorders In Women In Low- And Middle-Income Countries: A Systematic Review And Meta-Analysis, Atif Rahman, Jane Fisher, Peter Bower, Stanley Luchters, Thach Tran, M. Taghi Yasamy, Shekhar Saxena, Waquas Waheed

Population Health, East Africa

Objective: To assess the effectiveness of interventions to improve the mental health of women in the perinatal period and to evaluate any effect on the health, growth and development of their offspring, in low- and middle-income (LAMI) countries.

Methods: Seven electronic bibliographic databases were systematically searched for papers published up to May 2012 describing controlled trials of interventions designed to improve mental health outcomes in women who were pregnant or had recently given birth. The main outcomes of interest were rates of common perinatal mental disorders (CPMDs), primarily postpartum depression or anxiety; measures of the quality of the mother-infant relationship; …

Trauma And Posttraumatic Stress Disorder In South Africa: Analysis From The South African Stress And Health Study, Lukoye Atwoli, Dan J. Stein, David R. Williams, Katie A. Mclaughlin, Maria Petukhova, Ronald C. Kessler, Karestan C. Koenen

Internal Medicine, East Africa

Background: South Africa’s unique history, characterised by apartheid, a form of constitutional racial segregation and exploitation, and a long period of political violence and state-sponsored oppression ending only in 1994, suggests a high level of trauma exposure in the general population. The aim of this study was to document the epidemiology of trauma and posttraumatic stress disorder (PTSD) in the South African general population.

Methods: The South African Stress and Health Study is a nationally representative survey of South African adults using the WHO’s Composite International Diagnostic Interview (CIDI) to assess exposure to trauma and presence of DSM-IV mental …

General Practitioners' Awareness And Management Of Common Psychiatric Disorders: A Community-Based Survey From Karachi, Pakistan, H A. Naqvi, S Sabzwari, S Hussain, M Islam, M Zaman

Department of Psychiatry

This study assessed the knowledge and management of common psychiatric disorders by general practitioners (GPs) in Karachi, Pakistan. Structured interviews were carried out in 2009 with 360 GPs selected by cluster random sampling. Patients with psychiatric disorders were estimated to be up to 10% of the daily caseload according to 71.8% of doctors. Two-thirds of GPs were unaware of the ICD-10 diagnostic criteria for depression and anxiety disorders. Benzodiazepines were the most recognized category of medication (75.3%) and were the most commonly used medication for all mental health conditions. Fewer GPs were familiar with selective serotonin reuptake inhibitors (35.1%) or …

Readers Are Leaders In Publishing, Kiran Ejaz, Haider Naqvi

Department of Psychiatry

No abstract provided.

Irritable Bowel Syndrome And Psychiatric Disorders In Pakistan: A Case Control Study., Amna Subhan Butt, Mohammad Salih, Wasim Jafri, Javed Yakoob, Mohammad Wasay, Saeed Hamid

Section of Gastroenterology

Background:The psychiatric disorders like anxiety and depression could have a profound influence on onset, expression, and course of Irritable bowel syndrome (IBS). Aim: To estimate the frequency and strength of association of common mental disorders (CMDs) in Patients with IBS and Patients with other chronic diseases, that is, migraine and hypertension. Method: This was a case control study. Individuals aged 18-70 years diagnosed as IBS were enrolled as cases. The control groups consisted of Patients without IBS but diagnosed to have a chronic disease, that is, migraine or HTN. Self-Reporting Questonnaire-20(SRQ-20) was used as a screening tool for the …

Vitamin D: Does It Play A Role In Psychiatry, Mukesh Mohan Bhimani

Department of Psychiatry

No abstract provided.

Medical Educational: The Development Of Intellect, Haider A. Naqvi

Department of Psychiatry

No abstract provided.

Coping Styles In Patients With Anxiety And Depression, Pashtoon Murtaza Kasi, Haider Ali Naqvi, Abaseen Khan Afghan, Talha Khawar, Farooq Hasan Khan, Umber Zaheer Khan, Urooj Bakht Khuwaja, Jawad Kiani, Hadi Mohammad Khan

Department of Psychiatry

Different individuals use different coping styles to cope with their problems. In patients with anxiety and/or depression, these have important implications. The primary objective of our study was to estimate the frequency of different coping mechanisms used by patients with symptoms of anxiety and depression. A descriptive, cross-sectional survey was conducted and patients with symptoms of anxiety and depression were identified using the Aga Khan University's Anxiety and Depression Scale (AKUADS). Coping styles were determined by using the 28-item Brief COPE inventory. We were able to recruit 162 people. The prevalence of anxiety and depression was found to be 34%. …

Gender Roles And Their Influence On Life Prospects For Women In Urban Karachi, Pakistan: A Qualitative Study, Tazeen S. Ali, Gunilla Krantz, Raisa Gul, Nargis Asad, Eva Johansson, Ingrid Mogren

School of Nursing & Midwifery

BACKGROUND: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women's and men's life prospects.
OBJECTIVE: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men's and women's life circumstances.
DESIGN: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied.
FINDINGS: TWO MAJOR THEMES EMERGED DURING ANALYSIS: 'Reiteration of gender roles' and 'Agents of change'. The first theme included perceptions …

Medical Education: Value Based Teaching, Haider Naqvi, Ather Hussain

Department of Psychiatry

No abstract provided.

Male Gender Preference, Female Gender Disadvantage As Risk Factors For Psychological Morbidity In Pakistani Women Of Childbearing Age - A Life Course Perspective, Farah Qadir, Murad M. Khan Dr., Girmay Medhin, Martin Prince

Department of Psychiatry

Background: In Pakistan, preference for boys over girls is deeply culturally embedded. From birth, many women experience gendered disadvantages, less access to scarce resources, poorer health care, higher child mortality, limited education, less employment outside of the home and circumscribed autonomy. The prevalence of psychological morbidity is exceptionally high among women. We hypothesise that, among women of childbearing age, gender disadvantage is an independent risk factor for psychological morbidity. Methods: A cross-sectional catchment area survey of 525 women aged 18 to 35 years living in Islamabad and Rawalpindi. The effect of gender disadvantage was assessed as a latent variable using …

Respiratory Dyskinesia--An Under-Recognized Side-Effect Of Neuroleptic Medications, Mukesh Mohan Bhimani

Department of Psychiatry

Respiratory dyskinesia is an under-recognized side effect of neuroleptic administration. There are only few studies that have addressed the prevalence of respiratory dyskinesia in patients with tardive dyskinesia. Our case report highlights the need to regularly examine patients on antipsychotics for any evidence of dyskinetic movements including respiratory musculature. Since RD is underrecognized and misdiagnosed, early detection can improve long term prognosis as treatment options are few and usually of only limited effect. A 62-year-old Asian male, retired civil engineer, had more than 20 years history of depressive illness, developed antidepressant induced hypomania, and was given risperidone upto 1 mg …