Journal of Pakistan Psychiatric Society <p>ISSN: <strong>2224-8897</strong> (Online)<br>ISSN: <strong>1726-8710</strong> (Print)</p> <p>The Journal of Pakistan Psychiatric Society (JPPS) is the official publication of Pakistan Psychiatric Society (PPS), the pioneer representative body of psychiatrists in Pakistan.<br>This journal is dedicated to encouraging and facilitating research at all levels and in all fields of Psychiatry and Mental Health.<br>We are devoted to reporting original investigations in the biomedical and health sciences relevant to the mental health including research in the basic sciences; clinical trials of therapeutic agents; effectiveness of diagnostic or therapeutic techniques; or studies relating to the behavioral, epidemiological or educational aspects of Psychiatry.</p> <p>JPPS is the only quarterly published journal in the field of Psychiatry in Pakistan with distribution amongst members of PPS both locally and globally. JPPS holds a strong position as the trailblazer in the Mental Healthcare and wellbeing sector of Pakistan, and is a prestigious medium owing to its credibility, acceptability and reach.</p> Pakistan Psychiatric Society en-US Journal of Pakistan Psychiatric Society 1726-8710 MAJOR DEPRESSIVE DISORDER, ENVIRONMENTAL FACTORS AND EPIGENETICS <p>ABSTRACT</p> <p>New insights in the epigenetics have declared depression as genetic malady. For psychiatric disorders evaluation of epigenetic basis influenced by environment insults showed deeper understanding of complex multifactorial psychiatric disorder like Major depressive disorder (MDD). The World Health Organization (2008 report) has ranked MDD globally as the third cause of burden of diseases and predicted it to be the number one by 2030. Eight hallmarks of insults that lead to MDD are contaminated air, soil, food/water, ecological stressors, chemicals in households, occupational hazards as well as food/diet linked to absence of essential nutrients. Epigenetics, according to National Human Genome Research Institute, refers to changes in gene function causing their activation or deactivation without any alteration in DNA sequence. &nbsp;Epigenetics include histone modifications, DNA methylations, miRNAs and lncRNAs. Hypermethylation of serotonin transporter gene has been consistently found in loci encoding brain derived neurotrophic factors <em>BDNF</em> and <em>SLC6A4</em>. During pregnancy fetal epigenetic reprogramming may occur due to maternal stress and nutritional restriction. &nbsp;Increased cortisol or malnutrition in mothers, down-regulate cortisol enzyme, decreasing its expression in&nbsp; fetal cortex, making these children 4 times more at risk to stress later in life. Histones modifications including methylation and acetylation at lysine moiety during posttranslational modifications, affect neurons of CNS significantly leading to pathophysiology of MDD. Dysregulation of miRNAs&nbsp; and lncRNAs cause negative neural plasticity, stress responses, neurotrophic factors expression, neuroinflammation, neurotransmission, HPA axis, neurogenesis and gliogenesis and neural stem cell maintenance. Among epigenetic multifactorial disorders, psychiatric ailments have received prominence in etiology than other diseases.</p> saeeda Baig Copyright (c) 2023 Journal of Pakistan Psychiatric Society 2023-12-30 2023-12-30 20 04 BARRIERS TO CLOZAPINE USE IN TREATMENT-REFRACTORY POPULATION IN KARACHI, PAKISTAN <p><strong>ABSTRACT</strong></p> <p><strong>&nbsp;</strong></p> <p><strong>Background &amp; Objective: </strong><strong>Following its volatile emergence after the famous 1975 agranulocytosis scare, clozapine remains to be under-prescribed in Pakistan. It has evidently proven to improve prognosis in such patients when initiated at an early stage. However, healthcare barriers and adverse effects continue to haunt psychiatrists to prescribe it more frequently. Although much research targeting clozapine has been done, the factors responsible for the under-prescription of this drug have never been formally elucidated in Pakistan. This study was designed to investigate the causes accountable for serving as barriers in prescribing clozapine in several outpatient departments in Karachi, Pakistan.</strong></p> <p><strong>&nbsp;</strong></p> <p><strong>Method: </strong>A cross-sectional study was conducted over three months (May 2022 to July 2022) using a structured questionnaire from 105 physicians with previous formal training in psychiatry. Statistical analysis was done using the Chi-Square test of association.</p> <p><strong>&nbsp;</strong></p> <p><strong>Results: </strong>Out of 105 doctors offering psychiatric services at various locations, 70% mentioned that they were uncomfortable prescribing clozapine earlier in the course, with its adverse effects profile being the most popular reason for its avoidance by the patients and/or their families. Clozapine's availability and its cost were also common barriers to prescribing clozapine. Most doctors agreed that they would have felt more comfortable if they had had some clozapine training and attended clozapine clinics during their training.</p> <p><strong>&nbsp;</strong></p> <p><strong>Conclusion: </strong>The anticipation of medication nonadherence and monitoring requirements coupled with overestimating the adverse effect profile stems from inadequate experience with the drug&nbsp; Steps should be taken by the graduate medical education at the training hospitals to organize clozapine clinics and offer clozapine training to promote the use of this effective drug to improve the prognosis and function suffering from this debilitating illness.</p> <p>&nbsp;</p> Mujeeb U Shad Shahzain Hasan Copyright (c) 2023 Journal of Pakistan Psychiatric Society 2023-12-30 2023-12-30 20 04 PREVIDA- IMPACT OF VORTIOXETINE ON MAJOR DEPRESSIVE DISORDER AND PERCEIVED COGNITIVE DYSFUNCTION- A MULTICENTER STUDY <p>Exploring Cognitive Dysfunction and Treatment Efficacy of Vortioxetine in Major Depressive Disorder: Previda in Pakistan</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>&nbsp;</p> <p>Objective:</p> <p>To investigate the prevalence of cognitive Dysfunction in major depressive disorder (MDD) and evaluate the efficacy of vortioxetine in treating both depressive symptoms and cognitive dysfunction.</p> <p>&nbsp;</p> <p>Design:</p> <p>&nbsp;Prospective, Cross-sectional and multicentered</p> <p>&nbsp;</p> <p>Place &amp; Duration of Study:</p> <p>The study was conducted in 16 Psychiatric outpatients Departments in Pakistan, for a period of 12 weeks.</p> <p>&nbsp;</p> <p>Patients &amp; Methods:</p> <p>A total of 498 participants with diagnosis of major depression disorder were included in the study. The severity of depression &nbsp;and cognitive dysfunction were measured. The Psychiatrists prescribed vortioxetine to participants after assessments&nbsp; by Clinical Global Impression-Severity scale (CGI-S), the Patient Health Questionnaire-9 (PHQ-9).and Perceived Deficits Questionnaire (PDQ). The variables were again assessed after treatment initiation&nbsp; at 1 week (+/– 3 days), 1 month ( +/– 7 days) and 3 months(+/– 14 days).</p> <p>&nbsp;</p> <p>Results</p> <p>Upon completion of a 12 week treatment regimen involving vortioxetine subjects with MDD showced notable improvements in mean PHQ 9 and PDQ scores. This signifies vortioxetines efficiency in alleviating depressive symptoms alongside cognitive deficits within individuals diagnosed with MDD. There was positive correlation noted &nbsp;between PHQ 9 and PDQ scores, demonstrating a close association linking depressive symptoms to cognitive dysfunction.</p> <p>&nbsp;</p> <p>Conclusions</p> <p>The study findings shows the effectiveness of vortioxetine in addressing cognitive deficits in patients diagnosed with MDD while also improving depressive symptoms. These results highlight the potential of vortioxetine as a valuable treatment alternative for individuals facing cognitive impairment alongside their MDD diagnosis. Further research is necessary to verify these results and consider their applicability to diverse populations.</p> <p>&nbsp;</p> Ali Ahsan Mufti Huma Mughal Mukhtar Ul Haq Azeemi Muhammad Asif Kamal Fazale Rabbani Khalid Attaullah Mufti Syed Muhammad Sultan Bashir Ahmad Zainab Nawaz Adil Afridi Fatima Amir Khan Muhammmad Fahim Qasim Shakil Asif Syed Usman Hamdani Ayesha Minhas FAREED ASLAM MINHAS Copyright (c) 2023 Journal of Pakistan Psychiatric Society 2023-12-30 2023-12-30 20 04 ASSOCIATION BETWEEN PSYCHOLOGICAL STRESS AND SKIN SYMPTOMS AMONG MEDICAL STUDENTS STUDYING IN KARACHI <p><strong>Objectives&nbsp;</strong>To determine any association between psychological stress and skin symptoms in medical students.</p> <p><strong>Study design and setting</strong><strong>&nbsp;</strong><strong>:</strong>It is a cross-sectional study conducted over a period of 12 months, from &nbsp;september 30,2022 to August 1, 2023 on medical students enrolled in MBBS program at Liaquat National Hospital and Medical College.</p> <p><strong>Methodology&nbsp;</strong><strong>:</strong>We studied medical students through self-reported, validated questionnaires that inquired about socio-demographic information, perceived stress, and skin complaints. All data analysis is done on SPSS version 22. Descriptive frequencies are presented in the form of the mean and standard deviation. Associations were assessed by applying the chi-square test among the variables.</p> <p><strong>Results </strong>A total of 401 questionnaires were used to analyze the data, with a mean age of 20.9 SD 1.6. We found out that 15.7% (n = 28) of the medical students were highly stressed, 77.3% (n = 310) were moderately stressed, and 7% (n = 63) were found to be under low stress. The most common skin symptoms found among medical students were hair fall (76.6%) (n = 315) and dark circles (77.3%) (n = 314). Individuals with high PS levels were more likely to develop skin symptoms such as itchy skin on the hands (p = 0.005), pimples or acne (p = 0.049), troublesome sweating (p = 0.04), dark circles (p = 0.01), and hair greying (p = 0.035).</p> <p><strong>&nbsp;</strong></p> <p><strong>Conclusions&nbsp;&nbsp;</strong>Psychological stress is associated with skin symptoms reported by medical students, especially dark circles, loss of hair, hair greying, troublesome sweating, and itchy rashes on the hands. Further studies and interventions should be done to assess and assist medical students.</p> <p><strong>&nbsp;</strong></p> <p><strong>Keywords</strong>&nbsp;Dark circles, Hair greying, Medical students, Loss of hair, Psychological stress, Skin symptoms,&nbsp;</p> Mustafa Hussain Imam Muzzamil Ahmed Karatela Muskan Kamal Muskan Baig Muhammed Aalam Shah Muhammad Umer Barry Muhammad Shoaib Hussain Muhammad Yahya ayan ali Dr .Umm-e-Rabab Copyright (c) 2023 Journal of Pakistan Psychiatric Society 2023-12-30 2023-12-30 20 04 FREQUENCY OF DEPRESSION IN PATIENTS OF CHRONIC HEPATITIS C BEFORE STARTING TREATMENT <p><strong>&nbsp;Introduction:</strong> Pre-existing psychiatric illnesses, such as mood and psychotic disorders, are 3–4 times more common and frequently undetected in HCV patients. This could be brought on by a diminished desire to use or access mental and primary health care services, actual or imagined stigma against HCV patients, or denial of their psychiatric symptoms. Comorbid depression can impact the outcome because it is linked to decreased HCV therapy adherence.</p> <p><strong>Objectives</strong>: To quantify the prevalence of depression among Hepatitis C patients not receiving treatment.</p> <p><strong>Study Design</strong>: This was a cross-sectional study.</p> <p><strong>Setting:</strong> Medical Department, Faisalabad Medical University and affiliated Allied Hospital, Faisalabad.</p> <p><strong>Study duration: </strong>30<sup>th</sup> December 2021 to 29<sup>th</sup> June 2022.</p> <p><strong>Materials &amp; Methods:</strong> A total of 310 patients having &nbsp;Hepatitis C infection, with an age range of 20 years to 60 years, were included, while the patients suffering from an additional underlying chronic medical disease like CKD, COPD and diabetes, which can cause depression, were excluded. Demographic data, including age, gender, residence (rural or urban), education of patient (Primary,&nbsp;&nbsp; middle or higher education), marital status (single, married or separated), income of patient and duration of Hepatitis C infection were recorded. The researcher interviewed the selected patients by using Beck Depression Inventory.&nbsp;</p> <p><strong>Results:</strong> The study's age ranged from 20 to 60 years, with a mean age of 41.75 + 8.62. Most 163 patients (52.58%) were in the 20–40 age range. 166 (53.55%) of the 310 patients were men, and 144 (46.45%) were women, for a male-to-female ratio of 1.2:1. In our study, the frequency of depression in patients with Hepatitis C infection not receiving any treatment was found in 187 (60.32%) patients.</p> <p><strong>Conclusion: </strong>The conclusion of the study is that the frequency of depression in patients suffering from Hepatitis C infection not receiving any treatment is very high.</p> Muhammad Owais Fazal Ahmed Bilal Ghulam Abbas Tahir Yasir Yaqoob Kamran Ahmed Ayesha Izzat Copyright (c) 2023 Journal of Pakistan Psychiatric Society 2023-12-30 2023-12-30 20 04 DETERMINANTS OF PSYCHOSOCIAL REACTIONS IN UNIVERSITY STUDENTS POST COVID-19: A CROSS-SECTIONAL STUDY <p><strong>Objective:</strong> To identify the mediating role of Perceived Social Support in Psychological Strength and Psychosocial Reactions in university students post COVID-19.</p> <p><strong>Study Design: </strong>Cross-sectional (correlation) research design was used.</p> <p><strong>Place and Duration of study: </strong>The data was collected from November 2021 to January 2022 from different state and private universities in Lahore, Pakistan.</p> <p><strong>Subject and Method: </strong>The purposive sample of <em>N</em>=150 (men=70 and women=80) university students studying in first and last year of 18-24 years old (<em>M</em>=20.75, <em>SD</em>=1.76) were drawn from different public and private universities of Lahore. &nbsp;Data was collected using Psychological Strength Scale (PSS; Bashir, 2020), Multidimensional Scale of Perceived Social Support (MSPSS; Zimet et al., 19&nbsp; 88) and Psychosocial Reactions Scale (PRS; Mahmood et al., 2020). Data was analyzed using SPSS 25.</p> <p><strong>Results:</strong> Of the 150 participants, 70(46.7%) were men and 80(53.3%) were women. The overall mean age was 20.75 ± 1.76 years. Pearson Product Moment Correlation revealed that a significant negative relation of Psychological Strength and Perceived Social Support with Psychosocial Reactions. Psychological Strength and Perceived Social Support had positive significant relationship (<em>r</em>= .68***), but a negative relationship between Perceived Social Support and Psychosocial Reactions (<em>r</em>= -.56***) and Psychological Strength with Psychosocial Reactions (<em>r</em>= -.33***) was also found in university students post COVID-19. Mediation analysis showed that Perceived Social Support fully mediated the relation among Psychological Strength and Psychosocial Reactions (p&lt;.001).</p> <p><strong>Conclusion:</strong> Study implicates that by increasing Psychological Strength and Perceived Social Support in university students we could reduce Psychosocial Reactions faced by them.</p> Mishal Khan Muqqadas Ghafoor Copyright (c) 2023 Journal of Pakistan Psychiatric Society 2023-12-30 2023-12-30 20 04 RELATIONSHIP BETWEEN PARENTING STYLES AND ACADEMIC PERFORMANCE IN PAKISTANI STUDENTS; A LITERATURE REVIEW <p>There is ample research on the role of parenting in the academic performance of students that highlights parenting styles and their importance. While this research is extensively done in the Western world, research in the cultural context of South Asia and particularly Pakistan is lacking. Therefore, this review was done to analyse the existing research on the two variables in Pakistan and to provide guidance for future research. The review included studies that were previously conducted on parenting styles and academic performance of students from elementary to postgraduate level. The focus was to analyse relevant data exclusively from Pakistan. For this purpose, 17 studies from the past ten years were selected. Articles from six databases (including PubMed, Google Scholar, Springer Link, Science Direct, SAGE Journals, and Taylor and Francis Journals) were identified relating to the topic using a pre-established set of terms that included both parenting styles and academic performance. 15 of the studies highlighted that parenting styles affect the academic achievement of students, while 2 studies showed no association. It was analysed that the authoritative parenting style was the most effective in enhancing the academic performance of young children. More in-depth research is needed on parenting styles to have a better understanding of the cultural effect of parenting styles on academic performance in Pakistan.</p> Tahira Abrar Muhammad Zeshan Waheed Iqbal Copyright (c) 2023 Journal of Pakistan Psychiatric Society 2023-12-30 2023-12-30 20 04 PAKISTAN PSYCHIATRIC SOCIETY- A REFLECTION OF EARLY YEARS <p>It is nostalgic to recall formative years of the society for the reason that we psychiatric met in different cities of West and the then East Pakistan (now BanglaDesh) to ponder and agree to set up this society.</p> <p>We should be grateful to the Pakistan Medical Association, our national and parent bowly because it was during its annual and biennial conferences that few of us psychiatrists first met to share our frustrations regarding the sate of mental health and psychiatric profession in</p> <p>At a time when our morale was at its lowest ebb and in an attempt to overcome our inhibitions, we, during one of the bigger ventures of Pakistan Medical Association, the joint meeting of Pakistan Medical Association and British Medical Association, met to discuss the possibility of organizing ourself. It was at the lawns of the Boat Club, on a sunny aftercon of a cold December, in 1966, that we used the hospitality of Dr. Afzal Habib. Besides the host, those present included the late Dr. G. A. Asghar, Dr. Zaki Hasan, Dr. H.A.G. Kazi. Dr.</p> <p>Iftikhar, Dr. Raihana Beg and the writer Dr. Farrukh Hashmi from U.K. also attended.</p> S.Haroon Ahmed Copyright (c) 2023 Journal of Pakistan Psychiatric Society 2023-12-30 2023-12-30 20 04 SOUL CARE TERRACE NURTURING THE SOULS <p>Green spaces have become essential in the face of increasing globalization and modernization (1). Increasing trends of urbanization have adversely affected lifestyles owing to the absence of green zones. While policymakers address the lack of recreational areas, providing such spaces to patients suffering from psychiatric disorders requiring hospitalization remains a challenge. This is especially striking in countries like Pakistan that are still evolving from traditional psychiatric practices.</p> Shahab Muhammad Khan Copyright (c) 2023 Journal of Pakistan Psychiatric Society 2023-12-30 2023-12-30 20 04 GREED <p>Humans have been exploiting glaciers through unsustainable practices like overextraction, hydropower projects, reckless tourism, and mining, driven by their greed for water, power, and profit. Rising sea levels, loss of biodiversity, and water scarcity are all consequences of this avarice threatening glaciers and their ecosystems. Stricter laws, community involvement, ethical travel, and investments in renewable energy are needed to counteract this in order to preserve these natural treasures and secure a sustainable future.</p> <p>By recognising the perils of greed and taking proactive steps to address its role in exploitation of nature and its resources such as glaciers, we can protect these magnificent natural wonders and ensure a sustainable future for ourselves and future generations. Thus, it is imperative for us to understand that glaciers are not just frozen rivers, but they are vital components of our planet's ecosystems, and their preservation is intricately connected to our own existence.</p> creative Corner Copyright (c) 2023 Journal of Pakistan Psychiatric Society 2023-12-30 2023-12-30 20 04