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Sleep problems are common in children and adolescents with up to 50% of children experience some sleep difficulties and up to 4% have a formal sleep disorder diagnosis1,2. In Pakistan there is a shortage of child psychiatrists and pediatric physicians, therefore it is important for the physicians in primary care and general psychiatry to befamiliarwith common sleepdisorders.This article provides an overview of common sleep disorders in children and adolescents. Moreover, many children do not get adequate amount of sleep, which now is known to cause behavioral and emotional problems3. [ABSTRACT FROM AUTHOR]

Insomnia is a common complaint in primary care and psychiatric settings. It can present independently or co-morbidly with a medical, a psychiatric or a sleep disorder. It is important to recognize and treat insomnia independently in addition to treating the co-morbid condition. Non-pharmacological treatments include various approaches, which mainly include Cognitive Behavioral Therapy for Insomnia (CBT-I). Cognitive Behavioral Therapy for Insomnia is the first line treatment in addition to pharmacological therapies. This review focuses on describing non-pharmacological approaches, mainly CBT-I and provides specific techniques for implementation of these approaches. [ABSTRACT FROM AUTHOR]

The authors discuss the condition of child psychiatry in Pakistan. It notes the Second Fellowship in Child Psychiatry by the College of Physicians and Surgeons which scores the realization of setting up scientific and modern mental health services for Pakistani children. It also highlights the medical organizations dedicated to child psychiatric research including the American Academy of Child and Adolescent Psychiatry and the International Association for Child and Adolescent Psychiatry.

The evolution of personalized medicine has begun, and personalized psychiatry is following the approach of personalized medicine. The US Food and Drug Administration (FDA) reports that there are currently over 100 prescription medications that have pharmacogenomic information in their product labels and approximately 30% of these are psychotropic medications. For these psychotropics, the pharmacogenomic information included within the label addresses genotypes of either CYP2D6 or CYP2C19. This makes our understanding of cytochrome P450 enzyme (CYP450) pharmacogenomics especially important. In addition, a high percentage of psychotropic medications are metabolized by these enzymes. Enzymes that are most relevant to the metabolism of psychotropics Include CYP450 1A3,2B6,2C9,2C19,2D6,and 3A4. The fields of pharmacogenetics and pharmacogenetics have experienced tremendous development Polymorphisms in the genes which code for the production of CYP450 enzymes can alter the rate at which affected enzymes ran metabolize medications (also referred to as substrates). I or each enzyme, a patient may be characterized as being an: extensive (normal) mctabolizcr, intermediate mctabolizcr, poor mctabolizcr, or ultra-rapid mctabolizcr. Extremes in metabolic rates resulting from gene polymorphisms may contribute to either poor tolerability (poor metabolizers), or to poor efficacy (ultra-rapid metabolizers) when using psychotropics that are dosed in anempirical manner, The capacity to genotype a patient's CYP450 enzymes is currently available. Therefore knowing the patient's inherited metabolizer status can be helpful in selecting psychotropic medications that avoid metabolism through a polymorphic pathway, or to adjust a dosing strategy in an effort to avoid poor treatment outcomes when the patient is treated with a meditation thai is being metabolized through a polymorphic pathway. This review will focus on the metabolism of psychotropics and important aspects of understanding the genomics of the cytochrome P450 enzymes. This review will also discuss a case scenario which illustrates a process that physicians can use when applying genomic laboratory data to patient care. [ABSTRACT FROM AUTHOR]

Individuals with intellectual disability have been shown to suffer from affective disorders at a higher rate than the general population. Effective treatment of mood disorders in those with intellectual disabilities has not been well documented in the literature, and particularly not with psychological modalities or in adolescents. Here we report the treatment course of a 14-year old girl with intellectual disability and depression. [ABSTRACT FROM AUTHOR]

OBJECTIVE To assess quality of sleep and associated health issues in psychiatric patients. STUDY DESIGN Cross-sectional design. PLACE AND DURATION OF THE STUDY The study was conducted in the department of Psychiatry and Behavioral Sciences, D.H.Q Hospital, Faisalabad, Pakistan over the period of six months. SUBJECTS AND METHODS Through purposive consecutive sampling, 108 psychiatric patients participated in the study. Data were collected on Demographic variable Performa and Pittsburgh Sleep Quality Index. RESULTS Results demonstrated that more than half of the sample was females and married. One sample t-test confirmed thai majority of sample had poor quality of sleep (M = 11.57, SD = 4.14), t (107) = 13.89, p - 0.00. Further Analysis of Variance showed that psychiatric patients with lung disease and obesity had poor quality of sleep, similarly negative correlation was found between pain andquality of sleep. CONCLUSION Research findings concluded that most of the psychiatric patients were females suffering from different types of physical health issues and had poor quality of sleep. [ABSTRACT FROM AUTHOR]

OBJECTIVE To examine the self-esteem, quality of Life and psychiatric disturbances in HIV positive Drug dependents in Pakistan. STUDY DESIGN Cross-sectional design. PLACE AND DURATION OF STUDY The study was conducted, in Model Drug Abuse; Trcatment Center DHQ Hospital, Faisalabad, Pakistan from February 2016 to February 2017. SUBJECTS AND METHODS 114 HIV positive drug dependents participated in the study through non-probability consecutive sampling. Demographic variable Proforma, Rosenberg Self Esteem Scale, WHO QOL BREF and Self Report Questionnaire-24 wereadministered. RESULTS Results showed that about half of the sample lived in urban areas, was married and started abusing drugs on peer pressure and there was significantly positive correlation among all four domains of QOL. One sample t-test confirmed that majority of sample had low self-esteem (M = 11.25, SD - 432), t(113) - -9.26, p - 0.00 and high psychiatric symptomatology (M = 14, SD=4.4), t( 113)=23.1, p=0.00. CONCLUSION HIV positive drug abusers belonged to special population segments like young males, uneducated daily wagers or unemployed. Most of the HIV positive drug abusers had low self-esteem and high psychiatric disturbances. [ABSTRACT FROM AUTHOR]

Objective: To assess the rate of anxiety and depression in the patients suffering from various medical diseases. Design: Cross sectional study. Palace and Duration of Study: The study was conducted in District Headquarter Hospital and Allied Hospital, Faisalabad from 2005 to 2007. Subjects and Methods: Participants were inducted in the study through purposive convenient sampling technique. 339 patients of cardiac, cancer, hepatic, and dermatological diseases from both the above mentioned hospitals participated in this study. Co morbidity of psychiatric disorders was screened out with the help of DSM IV TR's criteria for depression and generalized anxiety. Results: Anxiety (n=32, 9.43%) was the major diagnosis in age group 40 - 49 and depression (n=31, 9.14%) in age group 50 - 59. All the diagnosis i.e., anxiety (n=30, 8.84%), depression (n=51, 15.04%) and both anxiety and depression (n=25, 7.37%) were common in illiterate patients. Anxiety (n=37, 10.91%) and depression (n=57, 16.81%) was found more in housewives. All the diagnosis i.e., anxiety (n=77, 22.71%), depression (n=93, 27.43%) and both anxiety and depression (n=45, 13.27%) were common in married patients. Anxiety (n=54, 15.92%) was common in hepatic patients and cardiac patients were having highest share of depression (n=51, 15.04%) and both anxiety and depression (n=32, 9.43%). Conclusion: Most cardiac patients were depressed; most heaptic patinets were anxious; almost half of cancer patients were both anxious and depressed; while majority of dermatological patients were having no psychiatric illness. [ABSTRACT FROM AUTHOR]

OBJECTIVE To look at factors contributing to successful transition from inpatient psychiatric unit to outpatient psychiatric treatment SUBJECTS AND METHODS Information regarding the effectiveness of the discharge plan was collected by phone in the cases of 33 patients randomly chosen from those discharged from an in patient psychiatric unit in a period of one month. The study was performed at Westchester Medical Center, New York Medical College. Either the patient or significant others were contacted within 3 months of discharge. Compliance with the follow-up appointment and medication, general condition, effectiveness of living arrangements were assessed either by self report or from collateral sources of information like parents, treating clinicians. RESULTS Most of the patients used the follow-up arrangements and did go to the first outpatient visit yet only a little more than a half were still in any form of treatment at the moment of the interview. Patients gave two main reasons for non compliance: either lack of geographical accessibility (lack of transportation to and from the clinic) or Ineffectiveness of treatment. Discharge to places other than non therapeutic home placements appeared in this group of patients to be the least associated with compliance after discharge, placement in a residence the most. CONCLUSION: Discharge planning is a crucial phase of inpatient treatment. Patients do use the discharge arrangements but fail to persist in their relation with the outpatient facilities. The type of housing has a major impact on further compliance after discharge even more so than diagnosis, age or gender. [ABSTRACT FROM AUTHOR]

OBJECTIVE The objective of study is to assess the severity of Depression in patients with Diabetes Mellitus (DM) Type II, and to compare the severity of Depression among those using insulin versus oral hypoglycemic medications. DESIGN Cross sectional study SETTING Outpatient department of District Headquarters Hospital, Faisalabad METHODS 70 patients (Males: 57% and Females: 43%) with diagnosis of Diabetes Mellitus type II were recruited. 50 % of the patients were taking insulin and the other 50% oral hypoglycemic agents as part of their treatment regimen. Patients were interviewed according to ICD-10 criteria of Depression to establish the diagnosis as well as severity of Depression. RESULTS According to ICD-10 criteria, Depression was present among 53% of the patients. The severity of Depression was: mild in 20% of the surveyed population, moderate in 23% and severe in 10% of subjects. Among the 35 patients on insulin, 31% had Depression with severity of mild (9%), moderate (11%) and severe (11%) intensity. Among 35 patients on oral hypoglycemic medications, 74% were depressed with severity of mild (31%), moderate (34%), and severe (9%) intensity. CONCLUSIONS The frequency of depression is high among patients with Diabetes Mellitus type II. Patients with DM type II, who were on oral hypoglycemic medications, found to be at a higher risk of developing Depression as compared to patients on insulin (P value<.001). [ABSTRACT FROM AUTHOR]