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OBJECTIVE To study the performance of vortioxetine as a medication intervention in depression in Pakistan. STUDY DESIGN Non-interventional, multi-centred, cross-sectional, prospective study. PLACE AND DURATION OF THE STUDY The study was conducted in 16 psychiatry outpatient clinics in seven cities across Pakistan namely Rawalpindi, Faisalabad, Peshawar, Quetta, Wah, Multan, Lahore, Karachi and the state of Azad Jammu and Kashmir. SUBJECTS AND METHODS An opportunity sample of 498 patients aged 18 and over, attending out-patient psychiatric clinics in the study sites with a diagnosis of MDD were asked to participate in the study. The psychiatrists had prescribed vortioxetine to the study participants after assessment of variable included in table 1 as baseline record, later assessment was conducted at approximately 1 week (+/- 3 days), 1 month (+/- 7 days) and 3 months(+/- 14 days) after treatment initiation. CONCLUSION Vortioxetine experience in outpatient psychiatric clinics shows the therapeutic effectiveness of the compound. The claims of it to be efficacious in cognitive symptoms and cognitive functioning appears to stay substantiated. The drug also improves the social and occupational functioning as well as high tolerability. These features combine to improve treatment adherence. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency of depression in patients with diabetes mellitus and comparison of the frequency of depression in patients with diabetes mellitus (type1 & 2). Study Design: Descriptive Cross-Sectional Study. Setting: Diabetic Clinic of Benazir Bhutto Hospital, Rawalpindi. Period: From 6th June -5th December 2016. Material & Methods: A total of 200 patients with diabetes mellitus were inducted in the study through Diabetic Out Patient Department at Benazir Bhutto Hospital, Rawalpindi. Patients screening was done by using ICD10-criteria &Beck Depressive inventory (depression diagnosis and severity assessment). Designed proforma was used for demographic details and variables. The data was analyzed using SPSS version 16.0. Depression frequency and severity was calculated. Chi Square test was applied depression and categorical variables associations. Results: Frequency of depression in the study sample came out to be 57% (114 out of 200 patients). Results concluded that 26 patients have mild depression (13%), 38 (19%) moderate depression, and 24 (12%) with severe depression. There is no significant difference in frequencies of depression in terms of type of Diabetes mellitus i.e. T1DM vs T2DM (39% vs 61%, P value > 0.05). Monthly income and BMI were factors leading to mental distress. Conclusion: Many of the patients with diabetes have co-morbid depression. Screening and appropriate treatment of depression should be part of the management plan of all patients having diabetes. [ABSTRACT FROM AUTHOR]

Objective: To determine role of primary care physicians, in management of MH disorders at primary health care level, by assessing the proportion of cases they manage or refer and to identify the barriers effecting the management of common mental health disorders through primary care physicians working in Rawalpindi area. Study Design: Cross sectional study. Place and Duration of Study: Private and Public sector health facilities in Rawalpindi district for a duration of 6 months, from July to Dec 2016. Material and Methods: Data was collected from respondents, selected through convenient sampling, using a pretested structured questionnaire. Results: Of 114 (75.7%) of primary care physicians were found to have a negative attitude towards mental disorders and their management at primary care setups while 117 (78%) showed a positive attitude. Primary care physicians in aggregate had good knowledge of common mental disorders however participants’ knowledge about medicines used in management of mental disorders was below median value. Conclusion: The study provides evidence about knowledge and attitude of primary care physicians, working in Rawalpindi regarding mental disorders and their management primary care level. Moreover, it identifies major barriers in the system, through primary care physicians, which need to be addressed for successful integration of mental health into primary care. [ABSTRACT FROM AUTHOR]

Introduction: Delirium is a common and serious disorder with high morbidity and mortality. A large proportion of patients with UTI suffer from delirium hence UTI is a common cause of delirium. The current study was aimed at determining the frequency of delirium in patients with underlying UTI. Methods: A total of 96 patients aged 16-80 years, admitted to the medical unit with Urinary Tract Infection, excluding those with coma, speech/sensory impairments, generalized cognitive deficits, were consecutively recruited for the study. Having obtained the socio-demographic details via proforma, Confusion Assessment Method was administered to the patients and results were interpreted accordingly. Data was analyzed using SPSS 10.0. Results: The mean age of the patients was 35.73(S.D±18.54), with an age range of 17-80 years. There was almost an equal gender distribution, with 50(52.08%) females and 46(47.92%) males. Among the patients with underlying UTI, 30(31.25%) had delirium, while 66 (68.75%) did not have any symptoms of delirium. Conclusion: A large proportion of patients with UTI suffered from delirium which might indicate that UTI is a common cause of delirium. There should be more focus on detecting, preventing and treating UTI to avoid unnecessary suffering thus reducing morbidity and mortality. [ABSTRACT FROM AUTHOR]

The article discusses the 2nd International Scientific Conference of Rawalpindi Medical College 2015 that was held in Rawalpindi, Pakistan from December 11-18, 2015. Among the sessions in the conference include "Medical Education: The New Frontiers of 21st Century's Doctor" by Professor Mohammad Mussadiq Khan, "Gynecology and Obstetrics-I" by professors Khalida Waheed and Fehmida Shaheen, and "Global Mental Health" chaired by Doctor Ayesha Minhas.

Objectives: To study the socio-demographic profile, the circumstances leading to self harm (DSH) and presence of any psychiatric illness in patients presenting to Accident and Emergency (A&E) Departments of RMC allied hospitals in Rawalpindi with attempt of DSH Design: Descriptive study Place and Duration of study: A&E departments of RMC allied hospitals in Rawalpindi in six months, from 1st November 2008 to 30th April 2009. Subjects and Methods: All patients with deliberate self harm presenting to A&E departments of RMC allied hospitals in Rawalpindi who met inclusion criteria during the study duration were included in the study. Results: Out of 386 participants, (52.1%) were males (47.9%) were females. The mean age of participants was 25.50 years. 89.1% patients had self poisoned themselves, 10.4% had done self injury and 2 patients had attempted both when presented to hospital. Organophosphorus poison was most commonly used substance for self poisoning used in 41.4% of cases. In cases of self harm, 64.3% had presented with lacerations and 11.9% with hanging. 4.1% patients had a previous history of physical illness and 3.4% patients were suffering from a physical illness at time of presentation. 4.4% patients had a past psychiatric history. 3.6% patients were suffering from a psychiatric illness at the time of presentation. 6.2% patients had attempted DSH in the past. Substance abuse was found in 8.0% of patients. Family history of DSH or suicide was found in 3.9% patients. Conclusions: Among patients with DSH in A&E department male presented more than the females. Mean age belonged to about 25 years, mostly coming from low socio economic group. Self poisoning is the most commonly used method. Past history of DSH was found to be the major risk factor for future attempts. [ABSTRACT FROM AUTHOR]

OBJECTIVE The purpose of the study was to examine the Early Non-cognitive symptoms of Alzheimer's disease and to determine the duration and frequency of Non-cognitive symptoms of Alzheimers. STUDY & DESIGN It was cross-sectional descriptive study PLACE AND DURATION OF THE STUDY The duration of the study was nine months from May 2008 to February 2009 SUBJECTS AND METHODS Non- probability convenient sampling technique was used to collect the data. Patients were first screened on the scores of Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) and then detailed assessment of those patients was done with Coronell Scale for Depression in Dementia (CSDD). Furthermore, the measurements including, Informant Questionnaire on Cognitive Decline in Elderly (IQCODE), Personality Inventory (PI ), and section H of Cambridge Mental Disorder in Elderly Examination (CAMDEX). Data was analyzed using SPSS version 10. RESULTS The non-cognitive symptoms among the study participants were personality change, every day activity impairment, depressed mood, sleep, persecution, hallucination, and behavioral symptoms. The results also revealed that at least two non-cognitive symptoms were present among all the patients. CONCLUSION Behavioral and psychological symptoms encompass more than half of the presenting features of Alzheimer's disease. [ABSTRACT FROM AUTHOR]

The authors argue on the leadership in mental health services in Pakistan, and mentions topics including the impact of the lack of visionary leadership on mental health, the National Mental Health Plans and National Programmes of Mental Health, and the human resource development.

OBJECTIVE To determine the effectiveness of oral substitution therapy with Buprenorphine in Injectable drug Users (IDUs) DESIGN Interventional study. PLACE AND DURATION OF STUDY This study was conducted at the Institute of Psychiatry, Benazir Bhutto Hospital. Rawalpindi from January, 2012 to December, 2012. SUBJECTS AND METHODS Patients with opioid dependence meeting the inclusion criteria were recruited (or the study. After a 2 week period of symptomatic treatment, patients were put on sublingual buprenorphine (2-24mg daily). Follow ups were planned to monitor improvement, compliance, relapse, and side effects. Quantitative as well as qualitative assessments were carried out at 3,6,9 and 12 months follow up. Data was then analyzed using a software SPSS-14.0. Analysis of variance was also used to test the difference between the result sat different point of time. RESULTS A total of 121 participants were included in the study. Almost all of the patients were male and majority belonged to the age group of 26 35 years. 58.7% of the study population had co morbid medical disease. The participants showed a marked improvement in all domains of Addiction Severity Index (ASI). There was also a significant improvement in the quality of life of the patients as measured by WHO-QOL BREF before and after treatment with buprenorphine. CONCLUSIONS Oral Substitution Therapy (OST) is a widely accepted means of harm reduction in patients with opioid dependence. Our study showed that treatment with sublingual buprenorphine resulted in marked improvement in the quality of life of the participants as well as a decrease in the addiction severity of other agents. We hope that this study might be replicated on a larger population and that OST might be incorporated as a treatment in the substance abuse centers across the country. [ABSTRACT FROM AUTHOR]

To find out how common cognitive impairment is in people with major depressive disorder (MDD) and assess how well vortioxetine works for treating both cognitive dysfunction and depressive symptoms. Study Design Multicenter, cross-sectional, prospective follow up design Place & Duration of Study The research took place over the course of 12 weeks at 16 different psychiatric outpatient clinics throughout Pakistan. Method The study included 498 individuals with serious depressive disorder diagnoses. The degree of depression symptoms and cognitive impairment was assessed. Psychiatrists gave trial participants vortioxetine after completing the Clinical Global Impression-Severity scale (CGI-S), the Patient Health Questionnaire-9 (PHQ-9), and the Perceived Deficits Questionnaire (PDQ). The variables were reassessed one week (+/- 3 days), one month (+/- 7 days), and three months (+/- 14 days) after the treatment began. Results After completing a 12-week course of therapy with vortioxetine, mean PHQ 9 and PDQ scores of MDD individuals showed significant improvements. This indicates that vortioxetine is effective in reducing depression symptoms as well as cognitive impairments in MDD patients. A strong connection was seen between PHQ 9 and PDQ scores, indicating a direct relationship between cognitive impairment and depressed symptoms. Conclusions The results of the research demonstrate how well vortioxetine works to treat cognitive impairments in MDD patients while also reducing depressed symptoms. These findings demonstrate the possibility of vortioxetine as a beneficial therapeutic option for those with MDD diagnoses who also have cognitive impairment. Additional investigation is required to validate these findings and assess their suitability for other demographics. [ABSTRACT FROM AUTHOR]

OBJECTIVE To document the cases presenting to the consultation-liaison psychiatry service at the Institute of Psychiatry, to assess the changes in usage of the service over the first two years and to determine the types of problems that present through this service. DESIGN Longitudinal descriptive study. PLACE AND DURATION OF STUDY The study was conducted at the Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi. SUBJECTS AND METHODS Patients were assessed either in the referring departments on request, or they were sent to the Institute of Psychiatry for assessment. The doctor on call assessed the patient and recorded details in a liaison register, including demographic details, physical examination findings and psychiatric diagnosis. Comparisons between the years were made using the chi-squared test for most variables and the t-test forage. RESULTS Data were collected for 1131 occasions of referral. There was a 45% increase in referrals in the second year of the service. Emergency departments were the main source of referrals, providing 80% of the present study population. Most common reasons for referral included subjective distress, presentation suggestive of a specific psychiatric illness, suicidal thoughts or actions, somatic symptoms and behavioural disturbances. 30% of all patients referred were considered to require psychiatric admission. CONCLUSIONS Psychiatric consultation-liaison service forms an integral part of the functions of a good psychiatric unit. All departments of the hospital benefit from the availability of this service. The study highlighted the need for the development of such units in other hospitals around the country. [ABSTRACT FROM AUTHOR]

OBJECTIVE To explore the association of different variables and the role of Vortioxetine in managing suicidal ideation in patients suffering from depression in Pakistan. STUDY DESIGN This is a secondary-analysis of a large, multi-centre, noninterventional, prospective longitudinal study with patients who were prescribed Vortioxetine. PLACE AND DURATION OF THE STUDY The main study was conducted in 16 Psychiatry outpatient clinics in eight cities across Pakistan. The period of study was August 2019 to June 2020. SUBJECTS AND METHODS A total of 498 depressed patients aged 18- 65 years participated in the study. Suicidal ideation was measured using item number 9 of the Patient Health Questionnaire (PHQ-9). Participants were assessed at baseline, 1 week, 1-month and 3-month after treatment initiation. RESULTS There was statistically significant reduction in reporting of suicidal ideation from 80% at baseline to 13% at outcome assessment. There was significant positive correlation between suicidal ideation and cognitive dysfunction on Perceived Deficits Questionnaire (PDQ) and suicidal ideation and depression scores on PHQ-9. There was a statistically significant difference between those who reported suicidal ideation and those who did not report suicidal ideation on the clinical global impression-severity scale both at baseline and at 3-month outcome assessment. CONCLUSION Suicidal ideation is common in depressed patients and this study demonstrated that suicidal ideation was reduced significantly with Vortioxetine treatment. Future research is warranted to further confirm the findings with controlled groups. [ABSTRACT FROM AUTHOR]

OBJECTIVE To determine change in the attitudes of medical students toward psychiatry as a career choice before and after clinical rotat ion in psychiatry. STUDY DESIGN Cross-sectional design. PLACE AND DURATION OF STUDY 5tudy was conducted at the Institute of Psychiatry & WHO Collaborating Centre (IOP), Benazir Bhutto Hospital Rawalpindi, Pakistan from November 2016 to October 2017. SUBJECTS AND METHODS 212 medical students, who were completing their clinical rotation of psychiatry at IOP, were selected using convenient sampling. Pre and post assessment was conducted using the Attitude Towards Psychiatry (ATP)-30-item scale. RESULTS The ATP- 30 scores were analyzed using a Paired sample ttest and indicated no significant change in attitude towards psychiatry by the end of the study. Cronbach's alpha of the scale was measured twice and was in the acceptable range (0.74- 0.80). Result of the study revealed mi nimum to no impact of psychiatric education and training on students. CONCLUSION The study demonstrated the lack of effect of psychiatric training on the attitudes of medical students regarding psychiatry as a career choice. However, there was a slight trend towards a positive change in the male students regarding their attitude towards psychiatry after their two-week rotation. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of the regional meeting on mental health held by World Health Organization Collaborating Centers (WHOCCs) in September 2016. Particular focus is given to the objectives of the meeting. Suicide prevention, substance abuse prevention and early intervention in disasters are cited as focus areas of the joint collaboration.

Objectives: To determine the frequency of satisfied patients with ECTs in a public sector tertiary care hospital. Design: Cross-sectional, descriptive study Place and Duration of study: The study was carried out in the in-patient department of Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, a tertiary care public sector hospital, from October 2010 to June 2011. Subjects and Methods: A consecutive sample of 163 inpatients of both genders, excluding acutely disturbed patients was recruited. Proforma regarding the socio-demographic details was filled by the participants. ECT satisfaction Questionnaire was orally administered in Urdu to each participant for the assessment of their satisfaction with ECT. Data was analyzed using SPSS 10.0. Results: Using the ECT satisfaction Questionnaire, 62.6% patients were satisfied while 37.4% were dissatisfied with ECT. Conclusion: Majority of patient was satisfied with Electroconvulsive therapy. However there is a need to explore specific reasons for satisfaction/dissatisfaction with this treatment modality in order to im prove the delivery of this treatment in accordance with the patients' expectations for better treatment adherence and improved outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care., Methods: We recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centres for dementia care in 15 countries. The WHO "encounter form," a standardized schedule that enables data concerning basic socio-demographic, clinical, and pathways data to be gathered, was completed for each participant., Results: The median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians, and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy, and practical advice) were delivered in less than 3% of situations. The analyses of the "pathways diagram" revealed that the path of PwD to receiving care is complex and diverse across countries and that there are important barriers to clinical care., Conclusions: The study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally, and internationally., (© 2019 John Wiley & Sons, Ltd.)

Background: Patients' opinion regarding services has acquired great importance. Patient satisfaction is playing an increasingly important role in quality of care reforms and health-care delivery. The study aimed to measure patient satisfaction in a tertiary care hospital in order to know the patients' perspectives and expectations of the services and make appropriate improvements accordingly., Methods: This was a cross-sectional study conducted at the Out-patient and Inpatient Departments of the Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, for a period of 8 months from October 2008 till June 2009. Sample size was 246 patients; which included 123 participants from Out-patient and In-patient departments each. Patients aged 18 and above, of both genders, who gave informed written consent, were consecutively recruited for the study. Learning disabled patients, frankly psychotic and those with severe cognitive impairment and severe co-morbid physical illnesses were excluded. Performa was filled in by the participants for their demographic details. The Client Satisfaction Questionnaire-8 was then orally administered in the native language (Urdu/Punjabi) to assess the degree of patient satisfaction., Results: Among the participants, 72% were mostly satisfied, 18.7% mildly satisfied and 9.3% dissatisfied with the psychiatric care. Age was significantly associated with satisfaction however no such associations could be found for gender and economic status., Conclusion: Majority of the patients were satisfied with the psychiatric services. The younger people were more satisfied. Gender and economic status had no influence on patient satisfaction.

Objective: To determine the frequency and associated sociodemographic, obstetric and medical factors for postnatal depression in an outpatient sample., Study Design: A descriptive, cross-sectional study., Place and Duration of Study: Department of Obstetrics and Gynaecology, Benazir Bhutto Hospital (formerly Rawalpindi General Hospital), Rawalpindi, between June 2006 and February 2007., Methodology: The sample consisted of women who were in the puerperal period (6 weeks postpartum). They were screened with the help of Edinburgh Postnatal Depression Scale (Urdu version) and the severity of depression was rated with the Hamilton Rating Scale for Depression., Results: A total of 51 participants, or 33.1% of a sample of 154 women suffered from postnatal depression, the majority of whom were either moderately or severely depressed. The demographic profile of depressed patients showed that they were young (mean age around 25 years), had a low level of education (below the matriculate level) and came from the lower socioeconomic class. They had small families comprising of fewer than 3 children, were married for less than 5 years and the majority were from extended families (living with in-laws)., Conclusion: Postnatal depression was found in almost 1/3rd of the study participants and the preponderance of them suffered from moderate or severe depression. They were young and came from a background of socio-economic adversity. Since postnatal depression had adverse consequences for the mother and her newborn baby, there was an urgent need to direct more attention to this problem, in particular towards its early detection, so that morbidity could be reduced in this group of women.

Objective: To determine the frequency distribution of various types of dissociative disorders, along with existing co-morbid depression and its level of severity in patients with dissociative disorder., Study Design: Observational, cross-sectional study., Place and Duration of Study: The Institute of Psychiatry, Rawalpindi General Hospital from October 2004 to March 2005., Methodology: Fifty consecutive patients were included in the study through non-probable purposive sampling technique. Encounter form included socio-demographic profile and brief psychiatric history. ICD 10 diagnostic criteria for research were administered for determining the presentation of dissociative disorder. Present state examination was applied to make diagnosis of depressive disorder in the studied patients. Descriptive statistics for frequency analysis of sociodemographic variables, type of presentation of dissociative disorder and the frequency of depressive disorder in patients of dissociative disorder., Results: The mean age was 23.6+/-8.67 years with female preponderance (n=40, 80% patients). Most of them were single, unemployed and belonged to urban population. Main stress was primary support group issue. Mixed category of dissociative disorder was highest (n=18, 38%) followed by unspecified and motor symptoms (n=13, 26%) in each group. Depression was present in 42 (84%) patients. Moderate depression was most frequent (n=19, 38%)., Conclusion: Mixed dissociative symptoms were found in 38%, while 26% had motor and unspecified category of dissociative symptoms respectively. Depressive disorder was present in 42 (84%) cases of dissociative disorder with 38% having moderate depression.