Psychiatry Commons^™

Evidence Based Treatment Of Schizophrenia: Do We Know Enough, Faheem Khan, Haider A Naqvi

Department of Psychiatry

No abstract provided.

The Constant Threat Of Terrorism: Stress Levels And Coping Strategies Amongst University Students Of Karachi, Ayesha Ejaz Ahmed, Komal Masood, Sohni Vicky Dean, Tanzila Shakir, Ahmed Abdul Hafeez Kardar, Usman Barlass, Syed Haider Imam, Mohammad Ghawar Khan Mohmand, Hussain Ibrahim, Imad Saeed Khan, Usman Akram, Farid Hasnain

Department of Psychiatry

OBJECTIVES: To assess the levels of stress in the face of terrorism and the adopted coping strategies, amongst the student population of universities in Karachi

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METHODS: A descriptive, cross sectional study was conducted on undergraduate students from four universities of Karachi. Self-administered questionnaires were filled out by 291 students. Pearson Chi-Square test was used to assess associations between stress levels and different variables at a level of significance of 0.05%

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RESULTS: A total of 65.8% of the students had mild stress levels, 91.5% of university students were exposed to terrorism through television, while only 26.5% students reported personal …

Fuzzy Logic: A “Simple” Solution For Complexities In Neurosciences?, Saniya Siraj Godil, Muhammad Shahzad Shamim, Ather Enam, Uvais Qidwai

Medical College Documents

Background: Fuzzy logic is a multi-valued logic which is similar to human thinking and interpretation. It has the potential of combining human heuristics into computer-assisted decision making, which is applicable to individual patients as it takes into account all the factors and complexities of individuals. Fuzzy logic has been applied in all disciplines of medicine in some form and recently its applicability in neurosciences has also gained momentum.
Methods: This review focuses on the use of this concept in various branches of neurosciences including basic neuroscience, neurology, neurosurgery, psychiatry and psychology.
Results: The applicability of fuzzy logic is not limited …

Suicide Bombing: A Geopolitical Perspective, Haider Naqvi, Syed Faraz Kazim, Shafqat Huma

Department of Psychiatry

Suicide bombing is a very complex phenomenon. It has been a focus of research in recent times. However inherent biases of researchers muddle the picture: researchers from western countries focus the issue around political liberty and notion of democracy, while those from Islamic countries tend to take the afterlife-reward notion as an incentive for suicide bombing. However in order to understand this complex phenomenon it is important to consider the contextual factors. In this review we have attempted to highlight various geopolitical factors which contribute to increased incidence of suicide bombing in South East Asia.

Prevalence Of Mistreatment Or Belittlement Among Medical Students--A Cross Sectional Survey At A Private Medical School In Karachi, Pakistan., Sana Shoukat, Mariam Anis, Danesh K Kella, Fahad Qazi, Fatima Samad, Faizia Mir, Maryah Mansoor, Mohammad B Parvez, Bushra Osmani, Sukaina A Panju, Haider Naqvi

Department of Psychiatry

Background: Mistreatment or belittlement of medical students either by faculty or fellow students has often been reported. Perception of mistreatment has also been associated with increased degree of psychological morbidity. There is a lack of such studies being conducted amongst the medical students of Pakistan. The aim of this study was to determine the prevalence and forms of perceived mistreatment and presence of mental health morbidity in a private medical school in Pakistan. Also, any association between mental health morbidity and mistreatment was to be identified. Methods: A cross sectional study was carried out on medical students from Aga Khan …

Students’ Research: Tradition Ahead Of Its Time, Haider A Naqvi

Department of Psychiatry

This view point describes the experience of introducing research at an undergraduate level during clinical rotation in psychiatry. Objective of this initiative was to encourage critical thinking, self directed learning and sensitization to mental health issues. This contributed to student learning besides galvanizing their interest in the subject. The opinion piece aims to expose various issues to students’ research in the context of medical education in Pakistan.

Gender Difference In Age At Onset Of Schizophrenia: A Cross Sectional Study From Pakistan, Imama Naqvi, Muhammad Murtaza, Muhammad Ressam Nazir, Haider Ali Naqvi

Department of Psychiatry

OBJECTIVE: To validate the effect of gender on age at onset of schizophrenia in a developing country

METHODS: Medical records of 252 patients diagnosed with schizophrenia according to DSM-IV criteria at a tertiary care hospital in Karachi, Pakistan between 2002 and 2008 were reviewed using a structured questionnaire. Age at onset was defined as age at onset of psychotic symptoms, age at first contact with a health care provider and age at first hospitalization. Socio-demographic variables were reported using descriptive statistics and all measures of age at onset were compared across gender using t-test.

RESULTS: There were 119 women and …

Terrorism And Health: The Responsibility Of Intellectuals, Haider A. Naqvi, Syed Faraz Kazim, Shafqat Huma

Department of Psychiatry

No abstract provided.

Emerging Issues In Adolescent Healthcare : An Urgent Call For Action, Waris Qidwai Dr, Tabinda Ashfaq Ashfaq

Department of Family Medicine

No abstract provided.

International Migration Of Doctors, And Its Impact On Availability Of Psychiatrists In Low And Middle Income Countries, Rachel Jenkins, Robert Kydd, Paul Mullen, Kenneth Thomson, James Sculley, Susan Kuper, Joanna Carroll, Oye Gureje, Simon Hatcher, Sharon Brownie, Christopher Carroll, Sheila Hollins, Mai Luen Wong

School of Nursing & Midwifery, East Africa

Background: Migration of health professionals from low and middle income countries to rich countries is a large scale and long-standing phenomenon, which is detrimental to the health systems in the donor countries. We sought to explore the extent of psychiatric migration.

Methods: In our study, we use the respective professional databases in each country to establish the numbers of psychiatrists currently registered in the UK, US, New Zealand, and Australia who originate from other countries. We also estimate the impact of this migration on the psychiatrist population ratios in the donor countries.

Findings: We document large numbers of psychiatrists currently …

Improving Schizophrenia Diagnosis Through Biomarkers: An Upcoming Prospect, Syed Mohammad Asad Zaidi, Abdul Latif Bikak, Rameez-Ul Hassan

Medical College Documents

No abstract provided.

Pathways To Care: Duration Of Untreated Psychosis From Karachi, Pakistan., Haider A. Naqvi, Sajjad Hussain, Muhammad Zaman, Mohammad Islam

Department of Psychiatry

Background: Substantial amount of time is lost before initiation of treatment in Schizophrenia. The delay in treatment is labelled as Duration of Untreated Psychosis (DUP). Most of these estimates come from western countries, where health systems are relatively better developed. There is dearth of information on pathway to care from developing countries. Methods And Results: Patients with ICD-10 based diagnosis of Schizophrenia were enrolled by convenient method of sampling. The pathway to care was explored through a semi-structured questionnaire. Onset, course and symptoms of psychosis were assessed using Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS). Ethical …

Psychotherapy As A Treatment Modality For Psychiatric Disorders: Perceptions Of General Public Of Karachi, Pakistan, Abdul Mueed Zafar, Ali Jawaid, Hiba Ashraf, Ambreena Fatima, Rubina Anjum, Salah U. Qureshi

Department of Psychiatry

Background: Psychiatric disorders affect about 450 million individuals worldwide. A number of treatment modalities such as psychotropic medications, psychotherapy and electroconvulsive therapy can be used to treat these disorders. Attitudes of general public play a pivotal role in effective utilization of mental health services. We explored the perceptions of general public of Karachi, Pakistan regarding psychotherapy. Methods: A cross-sectional study was conducted in Karachi, Pakistan during July-August, 2008. A three-step sampling strategy and a structured questionnaire were employed to survey knowledge and perceptions of adult general public about psychotherapy. Descriptive statistics were used for baseline characteristics. Logistic regression models were …

Comparison Of Urdu Version Of Strengths And Difficulties Questionnaire (Sdq) And The Child Behaviour Check List (Cbcl) Amongst Primary School Children In Karachi, Ehsan Ullah Syed, Sajida Abdul Hussein, Syed Iqbal Azam, Abdul Ghani Khan

Department of Psychiatry

OBJECTIVE: To compare CBCL (Child Behaviour Check Llist) Urdu, with the validated Urdu version of Strengths and Difficulties Questionnaire (SDQ) used as "gold standard" among school children in Karachi, Pakistan, and to develop local cutoffs for CBCL using SDQ as a gold standard.

STUDY DESIGN: A cross-sectional study.

PLACE AND DURATION OF STUDY: Schools of Karachi metropolitan area from January to December 2006.

METHODOLOGY: The Strengths and Difficulties Questionnaire (SDQ) and Child Behaviour Check List (CBCL) was completed by parents of 5-11 years old primary school children in Karachi. Appropriate cutoff points for total problem, internalizing and externalizing scales were …

Benzodiazepine: Slow Sand Of Addiction, Haider Naqvi, Sajjad Hussan, Fatema Dossa

Department of Psychiatry

No abstract provided.

Pattern Of Benzodiazepine Use In Psychiatric Outpatients In Pakistan: A Cross-Sectional Survey., Syed Ahmer, Sumera Salamat, Rashid Am Khan, Saleem Perwaiz Iqbal, Imran Ijaz Haider, Ayesha Shabaz Khan, Mohsan Zafar

Department of Psychiatry

Background: Benzodiazepines (BDZ) are the largest-selling drug group in the world. The potential of dependence with BDZ has been known for almost three decades now. In countries like Pakistan where laws against unlicensed sale of BDZ are not implemented vigorously the risk of misuse of and dependence on these drugs is even higher. Previous studies have shown that BDZ prevalence among Patients/visitors to general outPatient clinics in Pakistan may be as high as 30%. However, no research has been carried out on the prevalence of BDZ use in psychiatric Patients in Pakistan. Methods: We carried out a cross-sectional survey over …

Educating And Informing Patients Receiving Psychopharmacological Medications: Are Family Physicians In Pakistan Up To The Task?, Hammad Ashraf Ganatra, Hadi Bhurgri, Roomasa Channa, Fauzia Ahmad Bawany, Syed Nabeel Zafar, Rafia Ishfaq Chaudhry, Syeda Hina Batool, Abdul Basit, Mehmood Asghar, Sarah Saleem, Haider Naqvi

Community Health Sciences

Introduction: Studies have shown a high prevalence of psychiatric illnesses among Patients in primary health care settings. Family physicians have a fundamental role in managing psychiatric illness with psychopharmacological medications. Providing information about the disease, its management and the potential adverse effects of the medications is an important part of the management of mental illnesses. Our objective was to determine if Patients who were prescribed psychopharmacological drugs by family physicians at a community health center in Karachi, Pakistan were provided adequate education about their disease and its management.
Methods: A cross-sectional study was conducted at the Community Health Centre (CHC), …

Well-Being Of Medical Students And Their Awareness On Substance Misuse: A Cross-Sectional Survey In Pakistan., Abdul Wahab Yousafzai, Syed Ahmer, Ehsanullah Syed, Naila Bhutto, Saman Iqbal, Mohammed Naim Siddiqi, Mohammed Zaman

Department of Psychiatry

Objective: To investigate psychological well-being and substance abuse among medical students in Pakistan. Methods: A cross-sectional questionnaire-based survey was conducted in six medical colleges across Pakistan. Final-year medical students were interviewed by either a postgraduate trainee in psychiatry or a consultant psychiatrist. Results: A total of 540 medical students were approached, 342 participated and the response rate was 64.5%. Mean age was 23.73 years (SD 2.45 years), 52.5% were male and 90% single. Two out of every five respondents reported that work/study at medical school affected their personal health and well-being. A considerable proportion of students were aware of alcohol …

Bullying Of Medical Students In Pakistan: A Cross-Sectional Questionnaire Survey., Syed Ahmer, Abdul Wahab Yousafzai, Naila Bhutto, Sumira Alam, Amanullah Khan Sarangzai, Arshad Iqbal

Department of Psychiatry

Background: Several studies from other countries have shown that bullying, harassment, abuse or belittlement are a regular phenomenon faced not only by medical students, but also junior doctors, doctors undertaking research and other healthcare professionals. While research has been carried out on bullying experienced by psychiatrists and psychiatry trainees in Pakistan no such research has been conducted on medical students in this country. Methodology/Principal Findings: We conducted a cross-sectional questionnaire survey on final year medical students in six medical colleges of Pakistan. The response rate was 63%. Fifty-two percent of respondents reported that they had faced bullying or harassment …

Association Between Antipsychotics And Weight Gain Among Psychiatric Outpatients In Pakistan: A Retrospective Cohort Study., Syed Ahmer, Rashid A. M Khan, Saleem Perwaiz Iqbal

Department of Psychiatry

Background: It has been known for a long time that use of antipsychotics, particularly atypical antipsychotics, is associated with weight gain and increase in risk of metabolic disturbances. In this study we have tried to find out if use of antipsychotics is associated with increase in weight and body mass index (BMI) in the Pakistani population. Methods: We performed a case note review of all Patients who had been prescribed antipsychotic medication at the psychiatry outPatient clinic of a tertiary care university hospital in Pakistan over a 4-year period. Results: A total of 50% of Patients had a BMI in …

Factors Associated With Non-Adherence Among Psychiatric Patients At A Tertiary Care Hospital, Karachi, Pakistan: A Questionnaire Based Cross-Sectional Study, Fawad Taj, Mansoor Tanwir, Zarmeneh Aly, Ameer Ali Khowajah, Asma Tariq, Fahd Khalid Syed, Fahd Waqar, Khezar Shahzada

Department of Psychiatry

OBJECTIVE: To elucidate predictors of non-adherence among psychiatric patients presenting at a tertiary care hospital of Pakistan, for follow-up with consultant psychiatrist.

METHODS: A convenient sampleof psychiatric patients from Aga Khan University Hospital was enrolled between April and May, 2005. An interviewer assisted, standardized questionnaire was used for data collection. Patients with cognitive deficit or psychosis and those presenting for the first time were not included in the study.

RESULTS: Out of 128 patients, those with co-morbidity (32.81%) were less adherent than those without comorbidity (p-value:0.002). Adherence among depressed was 61.53%; psychotic was 58.82%; bipolar disorder was 73.91%. Reasons for …

Predictive Model Of Blood Transfusion During Cabg Surgery In Pakistan, Sana Shoukat, Saqib A Gowani, Farhad Khimani, Faraz A Khan, Mohammad Zaman, Hasanat Sharif

Section of Cardiothoracic Surgery

OBJECTIVE: To determine predictors of need for transfusion of blood and blood products and create a clinical predictive model to reduce indiscriminate use of blood products during surgery.

METHOD: We conducted a retrospective chart review of 485 patients who underwent coronary artery bypass surgery from January 2004 to December 2004 at a Tertiary Care Hospital in Karachi, Pakistan. Independent predictors associated with transfusion were identified and a clinical prediction model developed.

RESULTS: The transfusion rate was 37.1%. A predictive model was created based on the presence of pulmonary disease, diabetes mellitus, low ejection fraction and recent/ongoing myocardial infarction.

CONCLUSION: The …

Perceptions About The Cause Of Schizophrenia And The Subsequent Help Seeking Behavior In A Pakistani Population - Results Of A Cross-Sectional Survey, Syed Nabeel Zafar, Reema Syed, Sarah Tehseen, Saqib A. Gowani, Sana Waqar, Amina Zubair, Wajeeha Yousaf, Akbar J. Zubairi, Haider Naqvi

Department of Psychiatry

Background: There is a cultural variability around the perception of what causes the syndrome of schizophrenia. Generally Patients with schizophrenia are considered dangerous. They are isolated and treatment is delayed. Studies have shown favorable prognosis with good family and social support, early diagnosis and management. Duration of untreated psychosis is a bad prognostic indicator. We aimed to determine the perceptions regarding the etiology of schizophrenia and the subsequent help seeking behavior. Methods: This cross-sectional study was carried out on a sample of 404 people at the out Patient departments of Aga Khan University Hospital Karachi. Data was collected via a …

Schizophrenia: A Concept, Haider A Naqvi

Department of Psychiatry

Much of the current research-work into biological basis of mental disorders is predicted on implicit concept of disease that is less critical and sophisticated as it should be. It is remarkable, how the fundamental conceptual frame work of schizophrenia, as proposed by Professor Emil Kraepelin has stayed the same, since its inception almost 100-years ago. This review explores these issues besides highlighting alternative disease classification that suits behavioural neuroscience research.

What Do Patients Want From Their Psychiatrist? A Cross-Sectional Questionnaire Based Exploratory Study From Karachi, Roomasa Channa, M. N. Siddiqi

Department of Psychiatry

Background: The aspects of consultation that are important for psychiatric Patients have always remained a less acknowledged area. The aim of this study was to identify these aspects. Methods: A Cross- sectional, questionnaire based study was carried out in a psychiatry outPatient clinic of two tertiary care hospitals in a developing country. The Patients were asked to fill out the questionnaire containing a total of 11 close-ended questions plus 1 open- ended question. They graded them as not important, important, very important or do not know. Non-psychotic Patients aged 18 and above, visiting the clinic were recruited into the study …

Psychiatric Rating Scales In Urdu: A Systematic Review, Syed Ahmer, Rafey A. Faruqui, Anita Aijaz

Department of Psychiatry

Background: Researchers setting out to conduct research employing questionnaires in non-English speaking populations need instruments that have been validated in the indigenous languages. In this study we have tried to review the literature on the status of cross-cultural and/or criterion validity of all the questionnaires measuring psychiatric symptoms available in Urdu language.Methods: A search of Medline, Embase, PsycINFO and http://www.pakmedinet.com was conducted using the search terms; Urdu psychiatric rating scale, and Urdu and Psychiatry. References of retrieved articles were searched. Only studies describing either cross-cultural or criterion validation of a questionnaire in Urdu measuring psychiatric symptoms were included.Results: Thirty two …

Mapping Exercise Of Mental Health Research And Researchers In Pakistan, Haider A. Naqvi, Murad M. Khan

Department of Psychiatry

Objective: To systematically identify mental health research and researchers in Pakistan. Subsidiary objectives were to identify methodologies of studies published in the indexed journals along with their country wide mean impact factor.
Methods: A systematic search strategy using key words related to neuropsychiatry was carried out to identify various studies published in Indexed and Non-indexed databases.
Results: We identified 108 studies from Indexed data bases (77.8% Medline; 22.2% PsychInfo). Beside these, 51 studies were also identified from non-indexed databases. Among the indexed articles, 97 (89.8%) were Journal articles while 10 were other type of documents--there were 3 clinical trials of …

Keeping Alive The "Jazba", Murad M. Khan

Department of Psychiatry

No abstract provided.

Depression In Primary Care: Difficulties And Paradoxes, Haider Naqvi, Murad Moosa Khan

Department of Psychiatry

The presentation of depression in primary care is in many ways different from that seen in psychiatric settings. The process of detection and treatment is also different. This is particularly so in developing countries like Pakistan, which has high prevalence rates of depression but poorly organized primary health care services and primary care physicians (PCPs) who have little psychiatric training, either at undergraduate or postgraduate levels. There is a need to review difficulties faced by primary care physicians in detection and management of depression. It is hoped this would lead to better and more effective management of depression at primary …

Prescription Pattern Of Benzodiazepines For Inpatients At A Tertiary Care University Hospital In Pakistan, Muhammad Rizwanulhaq Khawaja, A Majeed, F Malik, K A. Merchant, M Maqsood, R Malik, S Mazahir, H Naqvi

Department of Psychiatry

Objective: To determine the point prevalence of benzodiazepine prescriptions for inpatients at a tertiary care university hospital in Pakistan and to correlate it with prescription patterns of various specialties, indications and demographic variables of the patients.Methods: This 24-hours point prevalence study was done at The Aga Khan University Hospital, Karachi. By convenient random sampling, 208 inpatients were interviewed. Patients' files were also studied to record the drugs administered. Data was entered into questionnaires and analyzed by SPSS 10.0.Results: The point prevalence of the benzodiazepines was 21.2%. It was higher among males than females and among surgical than non-surgical patients. Midazolam …