Journal of Pakistan Psychiatric Society

IS PSYCHEDELIC TREATMENT OF MENTAL HEALTH DISORDERS READY FOR PRIME TIME?

Nauman Ashraf — 2024-06-30

Psychedelics, substances known to alter perception, mood, and consciousness, have been used across various cultures for centuries, often in religious ceremonies to facilitate spiritual experiences. Lysergic acid diethylamide (LSD) was used clinically from the 1950s until its ban in 1967. Recently, there has been a resurgence of interest in psychedelics for treating mental health disorders such as PTSD, anxiety, depression, and substance use disorders. The FDA has designated several psychedelic compounds as "breakthrough therapies," acknowledging their potential for safety and effectiveness. Psychedelics like Psilocybin, LSD, DMT/Ayahuasca, MDMA, Peyote, and Ketamine work through various mechanisms, including agonism at 5HT2A receptors and NMDA antagonism. These substances promote neuroplasticity and can disrupt pathological activity patterns in the brain's default mode network (DMN), facilitating new perspectives and emotional processing. Psychedelic-assisted therapy leverages these properties to help patients gain insight into repressed conflicts and reduce maladaptive defenses. The therapeutic process involves preparation, support during dosing, and integration phases. Safety concerns include hallucinogen persisting perception disorder (HPPD), serotonin toxicity, and potential boundary violations. Despite promising early results, comprehensive research is needed to fully understand the therapeutic potential and limitations of psychedelics. Psychedelic-assisted therapy could offer hope and transformation for millions suffering from mental illnesses if proven safe and effective.

CROSS SECTIONAL STUDY ON PROTECTIVE FACTORS AGAINST SUICIDE IN INDIVIDUALS WITH SEVERE DEPRESSION

Ajmal Shah — 2024-06-30

OBJECTIVE

The aim of this study is to find out “factors that prohibit those suffering from severe depression with suicidal ideation of committing suicide”, admitted to the psychiatric unit of a tertiary care hospital in Khyber Pakhtunkhwa, Peshawar.

STUDY DESIGN

Cross sectional study

PLACE AND DURATION OF STUDY

This study was conducted in psychiatry department of Khyber Teaching Hospital, Peshawar from May 2023 till November 2023.

SUBJECTS AND METHODS

We conducted this study on 230 admitted patients, and they were diagnosed with severe depression according to ICD-10 and beck scale for suicidal ideation was applied and a score of ≥ 8 was considered positive for the presence of suicidal ideations and then a “modified version of reasons for living scale” to identify protective factors against suicide. Data was analyzed using SPSS version 22.0.

RESULTS

The most common protective factor found in our study was religious and moral objections in 37.4% patients followed by fear of social disapproval in 17.4%, hopefulness and fear of suicide in 15.7% each and responsibility towards family was present in 13.9% patients. Data stratification for protective factors and other demographic characteristics including gender, residential, socioeconomic, marital, educational statuses and family system were statistically significant with their P-values of <0.001.

CONCLUSION

This study demonstrated that religious and moral objections were the most common protective factors in prevention of suicide, followed by fear of social disapproval, hopefulness, fear of suicide and responsibility towards family. Gender, residential, socioeconomic, marital, and educational statuses along with family system were significantly associated with the presence of protective factors against suicide.

IMPACT OF CREATING MENTAL HEALTH HELPLINE AT A TERTIARY CARE PSYCHIATRIC SET-UP IN PAKISTAN DURING THE COVID -19 PANDEMIC

Sara Afzal — 2024-06-30

Objectives

The objectives of this study were to analyze the calls received at a 24-hour helpline service set up at the Institute of Psychiatry during the first wave of the COVID-19 pandemic for the demographics of the service users, the reasons for calling the helpline phone, and the guidance provided.

Design

Descriptive retrospective clinical audit

Place and Duration of Study

The Institute of Psychiatry, from June 2020 and February 2021

Patients and Methods

The entries made detailing the call records by psychiatry residents managing the helpline were analyzed. Data was extracted regarding age, area of residence, and reasons for calling by the service users of the helpline, as well as the advice given by the resident on call. The statistical analysis was performed using SPSS version 26, and findings were evaluated in terms of age, geographical distribution, reasons for seeking assistance, and the type of guidance provided thereof.

Results

Of the 102 calls analyzed, most of the callers were between 30 to 39 years of age (33.3%), and hailed from Rawalpindi (78.4%), followed by Kashmir (5.9%), Chakwal (4.9%) and Murree (3.9%). The most frequently stated reasons for calling were to ask about availability of out-patient services (36.3%), to have medication revised (23.5%), and to enquire about the side effects of medication (11.8%). Other reasons included recurrence of symptoms or lack of improvement in patients already taking treatment (15.7%) and to seek help regarding new psychiatric symptoms (12.7%). The responses given to the callers were invitation to come to the hospital (44.1%), provision of relevant information about the particular questions asked (for example, relating to hospital timings) (36.3%), adjustment of medications (11.8%), and prescribing medication with advice of physical follow-up (7.8%).

Conclusion

Despite psychiatric out-patient department being temporarily closed down during the initial waves of the COVID 19 pandemic, efforts were made to continue service provision through innovative means, like the 24-hour helpline service. There is a need to further incorporate the use of technology in the delivery of psychiatric services.

EVALUATION OF MENTAL DISORDERS AMONG DAY SCHOLARS AND HOSTEL MEDICAL STUDENTS - PLACE OF RESIDENCE MATTERS

Muhammad Zafar Iqbal Hydrie — 2024-06-30

ABSTRACT

OBJECTIVE:

To assess stress, anxiety, and depression among medical students and compare the mental health status of medical students living at home and in hostels.

STUDY DESIGN:

Cross-sectional study

PLACE AND DURATION OF STUDY:

The study was conducted at a private Medical University from 10^th July to October 2019 in Karachi.

SUBJECTS AND METHODS:

Data was collected through convenient sampling technique from 300 undergraduate medical, of which, 284 participants completed the questionnaire. After taking informed consent data was collected. The data collection tools used was Perceived Stress Scale-10 for stress and Agha Khan University Anxiety Depression Scale for anxiety and depression. All the data were analyzed on SPSS version 26.

RESULTS:

Results showed the mean age of the students was 21.3± 1.9 years. A moderate to severe level of stress was found in 221 (77.8%) medical students while a majority (69 %) of the students screened positive for anxiety and depression. Moderate to severe stress was found in 162 (77.9%) of the hostel students, while anxiety and depression was also higher among hostel students (73.6%). According to PSS-10 scale, moderate to high levels of stress was found to be statistically significant in younger students as compared to older students (P-value 0.03).

CONCLUSION:

Most medical students had psychological issues especially higher in those living away from home. Early detection of stress, anxiety and depression and its counseling are a golden rule for curbing and preventing psychological issues in medical students.

SEXUAL DYSFUNCTION IN PAKISTANI MARRIED WOMEN WITH CURRENT EPISODE OF DEPRESSION AND BIPOLAR: A QUALITATIVE STUDY

Tahira Yosuf — 2024-06-30

The awareness of psychological disorders in the present times is increasing with the help of dynamic psychological assessment tools, advancing with progressive investigation methods. Current psychological literature significantly emphasizes on depression and bipolar disorders, their prevalence, assessment, and treatment protocols among the married individuals. Despite the increasing prevalence of depression among women, scholarly literature scarcely addresses on the impacts of sexual dysfunction on the married women in Pakistan, experiencing depression and associated bipolar disorder.

The aim of this research was to study the impact of Sexual Dysfunction in Pakistani Married Women with Depression and Bipolar Disorder. A sample of 8 participants was selected with the help of purposive sampling. Each of these participants was diagnosed with depression and/or bipolar disorder and was undergoing therapy for the same. A semi-structured interview was conducted with each of these participants to deduce information about their disorders and sexual dysfunction. Thematic analysis was employed as the qualitative analysis technique for the evaluation of results gathered from interviews. The analysis revealed two main themes: Past experiences and current relationships. In the theme, experiences sub themes of parental relationships and childhood experiences were observed. Whereas in the theme Current Relationships, subthemes of the current marital relationship and current sexual relationship were observed. The themes and sub-themes revealed that married Pakistani women who are facing Depression and Bipolar Disorder, also go through sexual dysfunction.

THE RELATIONSHIP OF PHUBBING, EMOTIONAL INTELLIGENCE AND PSYCHOLOGICAL DISTRESS IN YOUTH

Sana Arshad — 2024-06-30

Objectives: The purpose of this study was to investigate the relationship between phubbing behavior, emotional intelligence, and psychological distress in youth and the predicting role of phubbing and emotional intelligence in determining psychological distress in youth.

Research Design: Correlational research design was used.

Place And Duration of Study: This study was conducted between March 2022 to February 2023 at Department of Applied Psychology, University of Management and Technology Lahore.

Subjects and Methods: A total of 200 university students aged between 18 and 26 (M =21.36; SD =1.94) were selected from different public and private sector universities of Lahore through convenient sampling technique. The Phubbing Scale,⁵⁴ Wong and Law Emotional Intelligence Scale,⁵⁵ and Depression, Anxiety and Stress Scale 21⁵⁶ along with self-constructed demographic sheet were used to collect data.

Results: The results revealed a positive relationship between phubbing and psychological distress in young adults. Further, phubbing was found to be a significant predictor of psychological distress in young adults, however Overall emotional intelligence did not predict it. Further, no significant gender differences were found in phubbing, emotional intelligence, and psychological distress.

Conclusion: The study highlights the impact of excessive mobile usage on emotional intelligence and psychological distress levels and may help in proposing interventions to reduce phubbing and improve emotional intelligence as potential solutions to mitigate psychological distress.

PSYCHIATRY REGISTRY OF PAKISTAN: THE FIRST NATIONAL REGISTRY ON PSYCHIATRIC DISORDERS IN PAKISTAN

Marium Soomro — 2024-06-30

Not applicable

INTEGRATING FORENSIC MENTAL HEALTH IN LEGAL PROCESSES

Ali Burhan Mustafa — 2024-06-30

The special report titled "Integrating Forensic Mental Health in Legal Processes" focuses on an event held on December 15, 2023, at Sheikh Zayed Medical College in Rahim Yar Khan. This collaborative event, organized by Justice Project Pakistan (JPP), the Pakistan Psychiatric Society (Punjab Chapter), and the departments of Psychiatry and Forensic Medicine, highlighted the crucial intersection of mental health and criminal justice in Pakistan. The report discusses the situation of the death penalty and capital punishment in Pakistan, emphasizing the challenges faced by juvenile prisoners and those with mental health issues. It also features the screening of three documentaries depicting the struggles of individuals affected by the criminal justice system, emphasizing the need for a more compassionate and equitable legal system. The event included an interactive Q&A session with diverse stakeholders and concluded with an acknowledgment of JPP's contributions towards advocating justice reform. The report suggests enhancing the diversity of perspectives, focusing on actionable outcomes, and involving policymakers more directly in future events to strengthen their impact.

APPLICATION OF COGNITIVE BEAHVIORAL THERAPY FOR TREATMENT OF SEXUAL OCD

Madiha Rana — 2024-06-30

Our population growth problem is manifesting itself in physical and mental health issues which are growing at a steady pace. Viruses have various mutations, so is the case with mental health issues. As a clinical psychologist and practitioner, I observe a wide range of such variations. Mostly, individuals with obsessive compulsive disorder (OCD) can be characterized within the domain of fear due to contamination from dirt, fear of death, religious beliefs etc. There is a considerable group of people within those who also deal with unwanted sexual thoughts, impulses and illusions. The cultures that are conservative in nature have people who hold certain kind of beliefs or intrusive thoughts which is considered a taboo [1]. People don’t want to talk about it due to conditioning. As opposed to, if someone shares such thinking, the society at large, and the close associates such as friends and family stigmatize them, they are made to feel guilty and often labeled as a “wrongdoer.” This is as a result of lack of awareness [2].

POST TRAUMATIC GROWTH

creative Corner — 2024-06-30