Journal of Pakistan Psychiatric Society

PUBLIC MENTAL HEALTH: AN AGENDA FOR ACTION

Afzal Javed — 2023-03-03

Mental disorders accounts for at least 20-25% of global disease burden. This could be due to a combination of most lifetime mental disorder arising before adulthood, and broad range of impacts across health, education, employment, social relationships, crime, violence, and stigma. Poor mental wellbeing has a similar range of impacts. It is a pity that crises such as COVID-19 are likely to further increase prevalence of risk of mental disorder, relapse of mental disorder and poor mental wellbeing across all populations. The public mental health conceptual framework brings together many perspectives into a comprehensive agenda for future action. Public mental health (PMH) takes a population approach to sustainably reduce mental disorder and promote mental wellbeing through provision of population required levels of PMH interventions. This approach does acknowledges that a wide range of determinants across individual, family & community levels contribute positively or negatively to mental health and well-being. Taking public mental health as a conceptual framework, the World Psychiatric Association’s Action Plan for 2020-23 also defines emerging needs and priorities, from a worldwide perspective, in some specific areas of public mental health. Given that globally, only a minority with mental disorder receive any treatment, there is an outstanding need to promote and practice mental health as public mental health.

DEVELOPMENT, DELIVERY AND EVALUATION OF MICRO-CERTIFICATE MENTAL HEALTH AMBASSADORSHIP COURSE

Tayyeb Tahir — 2023-03-03

Mental illnesses can impact anyone. However, those who suffer from mental ill health can face stigma contributing to a barrier in help-seeking behaviour. The Brain and Mind Institute, at the Aga Khan University (BMI AKU) aims to create a small ‘army’ of mental health ambassadors for mental health awareness, identification, and referral for those in need of help for their mental well-being. This is a narrative of designing, approving, standardising, delivering, evaluating and a proposing future evolution of a unique Micro-certificate Mental Health Ambassadorship course.

TOLERANCE AND ACCEPTABILITY OF INTRAVENOUS KETAMINE THERAPY FOR TREATMENT RESISTANT DEPRESSION: A MIXED METHODS ASSESSMENT

Sawera Mansoor — 2023-03-03

Objectives: This study was conducted to evaluate the response of treatment resistant depression to IV ketamine therapy protocol and explore the perspectives of patients regarding the acceptability of this treatment modality.

Study Design: Mixed methods assessment including Quasi experimental design and Qualitative interviews.

Place and Duration of Study: The study was conducted at Department of Psychiatry, Fauji Foundation Hospital, Rawalpindi from Jan to Jun 2022.

Subjects and Methods: Through purposive sampling, 14 patients of treatment resistant depression were made part of the sample. Hamilton Rating scale for Depression (HAM-D) was used to measure response to 6 Ketamine infusions administered over 2 weeks. Paired t-test was applied to analyze changes in HAM-D scores compared to pretreatment baseline at 1 hour, 2 weeks and 1 month after last dose of ketamine using SPSS 26.0. Semi structured interviews were conducted to explore the attitudes of patients regarding ketamine treatment. Thematic analysis was carried out and data driven themes were identified.

Results: There was a statistically significant improvement in severity of depression scores at 1 hour and 2 weeks after the last dose of ketamine. This effect was not significantly sustained at 1 month after the last dose. Some patients expressed initial hesitation related to safety of this treatment, citing comparisons with General anesthesia. By the end of treatment, most patients were keen to be advocates for the access to Ketamine therapy due to experiencing rapid transformational effects on severe depressive symptoms.

Conclusion: IV Ketamine therapy was found to be a rapid, effective and acceptable tool for treatment resistant depression; however its longer-term effects could not be established.

PARENTAL CAREGIVER BURDEN FOR CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER AT TERTIARY CARE HOSPITAL IN HYDERABAD

Jahangir Liaquat — 2023-03-03

PREVALENCE OF EMOTIONAL AND BEHAVIOURAL PROBLEMS AMONG ADOLESCENTS IN PAKISTAN: A CROSS-SECTIONAL STUDY

Sheza Farooq — 2023-03-03

OBJECTIVE

To determine the prevalence and severity of emotional and behavioral problems among adolescents.

STUDY DESIGN

Cross Sectional study

PLACE AND DURATION OF STUDY

The study was conducted at private sector secondary schools of Karachi, from August, 2021- February, 2022.

SUBJECTS AND METHODS

Sample comprised o 1470 students between the age 11 to 17 years from different private sector secondary schools of Karachi.. The sample was collected through purposive sampling technique. Socio demographic Information Form, Asian Adolescents Depression Scale (AADS) and School Children Problem Scale (SCPS) were used. SPSS 26 was used to analyze the data.

RESULTS

The mean age of study respondents was 13.62 years (SD 1.39). Findings of present study reveal that emotional and behavioral problems were more common among female adolescents as compared to their male counterparts. Overall all 20% of study respondents were found to have very severe level of emotional and behavioral problems, and aggression was the most common problem among 14% of adolescents, followed by academic problems in 9.7% of adolescents.

About 20% of the school going adolescents struggling with emotional and behavioral problems (i.e., anxiousness, aggression, social withdrawal, rejection, somatic problems, & depression), and academic problems. Further, there found to have statistically significant association between gender and emotional and behavioral problems. Mental health experts should focus on prevention and treatment interventions in school settings to reduce the risk of emotional and behavioral problems of Pakistani adolescents so that they could grow socially and emotionally healthy and excel in their academics and contribute to their family and community.

POST TRAUMATIC STRESS DISORDER AS ONE OF EMERGING PSYCHIATRIC CONSEQUENCES OF COVID-19

Hafiz Shafique Ahmed — 2023-03-03

Objective: In this study, we aimed to determine the associated factors in prevalence of PTSD among patients with COVID-19 who were treated.

Study Design: Cross-sectional study

Place and duration of the study: the study was conducted in medical OPD of DG khan from August, 2021 to December, 2021.

Subjects and method: 120 PTSD patients were approached through convenient sampling technique. PCL-5 scale was used to assess severity of PTSD symptoms. SPSS-22 was used to analyse the data.

Results: showed the severity of PTSD symptoms, in the patients re-experiencing symptoms were quite a bit 31.7%, avoidance were extreme 30%, symptoms of negative alteration in cognition and mood were moderate 37.5% in most of the patients and hyperarousal was quite a bit severe 37.5% in most of the patients.

Conclusions
the findings confirm that PTSD symptoms were moderate to severe including the re-experiencing, avoidance, alteration in mood and cognition and hyperarousal in most of the participants who were exposed to COVID-19 symptoms. There should be some preventive measures and interventions to overcome and protect individuals from PTSD symptoms.

Key Words: COVID-19, Post-traumatic Stress Disorder, Eye witnessed

The THE STATE OF MENTAL HEALTH AND AVAILABLE SERVICES FOR POST-SECONDARY STUDENTS IN PAKISTAN; A GAP IN EDUCATIONAL INSTITUTION HEALTH POLICY

Ayesha Tahir — 2023-03-03

We have explored the literature to evaluate the status of mental health among post-secondary students at the global and local levels with a special interest in medical students along with the detrimental effects on mental health caused by the CoVID-19 pandemic. The implementation strategies already developed and in the process by some countries to improve the mental health of post-secondary students are also covered in this review. The results of this literature review have brought to light the presence of a high number of mental health disorders among post-secondary students throughout the world including Pakistan which is further deteriorated by the negative effects of CoVID 19 pandemic. Several challenges and treatment gaps have been identified globally, especially in LMIC including Pakistan which shows a lack of data as well as a lack of services which warrants a need for a framework that will use a holistic approach to tackle these issues in post-secondary students.

MISSED SEIZURE DURING ELECTROCONVULSIVE THERAPY

Muhammad Ayub — 2023-03-03

Abstract

Background

Here, the authors reported two cases of electroconvulsive therapy with a missed seizure and present a literature review to explore the possible reasons and recommendations. To date, most authorities agreed seizure duration correlates to the effectiveness of the ECT, and a reason to a minimum of 25 seconds duration of seizure is defined as a good seizure. Many aspects of the seizures during the ECT are well researched and lots of data is available about the possible modifiers of seizures, indicators of an effective seizure, and ways to monitor an effective seizure but very few data reported missed seizures and strategies to follow in the events of no fits. In this case series, we described two cases of missed seizures which were identified and addressed appropriately with subsequent successful ECT sessions. We also presented the literature regarding the strategies to follow immediately post-event.

Cases:

CASE 1: A 42-year-old married lady with a diagnosis of bipolar type I disorder, current episode manic, with psychotic symptoms (6A60.1) according to the ICD-11 diagnostic and classification system.

CASE 2: A middle-aged male with a diagnosis of severe depressive episodes with psychotic symptoms.

Both cases had missed seizures during the 3^rd session of the electroconvulsive therapy.

Conclusion

Studies have shown that the phenomena of missed seizures are common but less reported and are caused by a number of factors including individual factors, the ECT technical parameters as well as concurrent use of pharmacological treatment and anesthetic agent which should be considered before every ECT session. There is a paucity of literature on the strategies to follow immediately after an event of no fits. Therefore, we tried to summarize some possible recommendations which need to be personalized according to a case-to-case basis.

Keywords: Missed Seizure, Brief Seizure, ECT, Electroconvulsive therapy, Psychostimulation

TWINNING PROJECT: SIR COWASJEE JEHANGIR INSTITUTE OF PSYCHIATRY/BEHAVIOURAL SCIENCES PAKISTAN & THE STATE HOSPITAL CARSTAIRS SCOTLAND

Khuram H Khan — 2023-03-03

Sir Cowasjee Jehangir Institute of Psychiatry Jehangir Institute of Psychiatry is a hospital located in Latifabad suburb of the city of Hyderabad, in Sindh, Pakistan. It was established in 1852 during the British Raj and was named after Jehangir Cowasji Jehangir Readymoney. It is the largest psychiatric hospital in Pakistan. It is locally known as Giddu Bandar Mental Hospital.

The State Hospital Scotland is a psychiatric hospital near the village of Carstairs Junction, in South Lanarkshire, Scotland. It provides care and treatment in conditions of high security for around 140 patients from Scotland and Northern Ireland. The hospital is managed by the State Hospitals Board for Scotland which is a public body accountable to the First Minister of Scotland through the Scottish Government Health and Social Care Directorates. It is a Special Health Board, part of the NHS Scotland and the only hospital of its kind within Scotland.

JOURNEY OF ORGANIZING WPA THEMATIC CONGRESS

Majid Ali Abidi — 2023-03-03

How the Journey Started?

"Hey, Majid, why are you not taking any dessert?" asked Prof. Afzal Javed,¹ the President of World Psychiatric Association.

"No. Thank you, Sir. I want to maintain my weight," I answered.

"You know there is another good strategy to control your weight. Why don't you organise a WPA Thematic Congress in Karachi!" intervened Prof. Nasar Sayeed Khan, a former President of Pakistan Pakistan Psychiatric Society.²

This was almost two years ago in Lahore, while I was enjoying dinner in the company of these esteemed colleagues.

The next evening at the Fountain House Lahore3 dinner, the three of us had the same idea. This is how the seed for organising a WPA Thematic Congress in Karachi was planted.

The following day, we conducted an unofficial meeting to plan the first-ever WPA Thematic Congress in Karachi.

To think it all began there…!

HERITAGE OF "THE CITY OF LIGHTS"

creative Corner — 2023-03-03

The term "heritage" describes the natural, cultural, and historical resources that have been passed down through generations and are valuable to both the present and the future. A society's history, traditions, beliefs, and customs are represented by both concrete and abstract elements known as "cultural heritage". Physical treasures, like monuments, structures, artefacts, documents, and landscapes, are examples of tangible heritage. These sites and artefacts are frequently regarded as important to a culture's memory, history, and identity. Cultural practices, customs, traditions, and knowledge are examples of intangible heritage.