Illness perceptions in patients of schizophrenia: a preliminary investigation from Lahore, Pakistan

Background and Objective: Patient's perception of their illness influences their healthcare decisions

The objectives of this study were to explore patient's own beliefs about their illness [Schizophrenia] and perceived social support, and its impact on their attitudes toward pharmacological treatment in Lahore, Pakistan

Methods: This study was conducted at Mayo Hospital Lahore from March to September 2016. Hundred individuals suffering from Schizophrenia completed four questionnaires; a socio-demographic questionnaire, the Illness Perception Questionnaire for Schizophrenia [IPQ-S], Drug attitude Inventory-10 [DAI] and Multidimensional Scale of Perceived Social Support [PSS]

Results: Stress, family problems, lack of friends fit financial worries were endorsed strongly by patients as cause of their mental illness. Ambiguity regarding their mental illness duration and personal control was observed. Patients' perceived significant negative consequences, negative emotional response, as well as had poor understanding of their mental illness and treatment effectiveness. Statistically significant gender differences in treatment control and illness coherence subscales of IPQS were observed. Drug attitude inventory was positively correlated with Treatment control subscale [p < 0.01] and negatively correlated with Illness coherence subscale of IPQS [p < 0.05]. The negative consequences subscale and perceived social support was negatively correlated [p < 0.01]

Conclusion: Patient's perception about their own illness is predictor of their drug taking attitude and perceived social support. Study results should help to develop new interventions to correct inaccurate beliefs in patients with schizophrenia to improve illness outcome

Urdu translation of the Hamilton rating scale for depression: results of a validation study

Objective: To develop a standardized validated version of the Hamilton Rating Scale for Depression [HAM-D] in Urdu

Methods: After translation of the HAM-D into the Urdu language following standard guidelines, the final Urdu version [HAM-D-U] was administered to 160 depressed outpatients. Inter-item correlation was assessed by calculating Cronbach alpha. Correlation between HAM-D-U scores at baseline and after a 2-week interval was evaluated for test-retest reliability. Moreover, scores of two clinicians on HAM-D-U were compared for inter-rater reliability. For establishing concurrent validity, scores of HAM-D-U and BDI-U were compared by using Spearman correlation coefficient. The study was conducted at Mayo Hospital, Lahore, from May to December 2014

Results: The Cronbach alpha for HAM-D-U was 0.71. Composite scores for HAM-D-U at baseline and after a 2-week interval were also highly correlated with each other [Spearman correlation coefficient 0.83, p-value < 0.01] indicating good test-retest reliability. Composite scores for HAM-D-U and BDI-U were positively correlated with each other [Spearman correlation coefficient 0.85, p < 0.01] indicating good concurrent validity. Scores of two clinicians for HAM-D-U were also positively correlated [Spearman correlation coefficient 0.82, p-value < 0.01] indicated good inter-rater reliability

Conclusion: The HAM-D-U is a valid and reliable instrument for the assessment of Depression. It shows good inter-rater and test-retest reliability. The HAM-D-U can be a tool either for clinical management or research

Severity and risk factors of depression in Alzheimer's disease

To determine the frequency, severity and risk factors of depression in Alzheimer's disease. Descriptive study. The Department of Psychiatry, Sir Ganga Ram Hospital, Lahore, from August 2007 to December 2008. Consecutive patients of Alzheimer's disease reporting to the department during the study period were included and those with extreme cognitive impairment were excluded. The cognitive status was judged by using the Mini-Mental State Examination [MMSE]. The Hamilton rating scale for depression [Ham-D] was used as a symptom checklist to diagnose major depression according to the DSM-IV criteria. Chi-square test was used to check the significance of association. There were 73 patients comprising of 34 males and 42 females. The mean age was 67.74 +/- 6.71 years; 66% were married, 14% were single and 20% were widowed; 47% had family history of depression and medical co-morbidity was observed in 48%. Based on MMSE, 31.5% had mild Alzheimer, 55.3% had moderate and 13.1% had severe Alzheimer. Judging from Hamilton rating scale, 25% patients were free from depression, 19.7% had mild depression, 27.6% had moderate depression and 27.6% were suffering from severe depression. The frequency of depression was significantly higher [p= 0.0013] among females [90%] as compared to males [55.9%]. There is a high frequency of depression among patients of Alzheimer's disease particularly among female patients. This finding is consistent with the reports from other countries

Study of anxiety and depression during pregnancy

To find out the prevalence of anxiety and depression symptoms during pregnancy. The sample of one hundred pregnant women was screened while waiting for their prenatal visit in obstetric clinic of FMH [Fatima Memorial Hospital]. They were eligible for the study if they were pregnant and giving consent. Control group [n=100] was taken from non pregnant women matched on age, education, marital status and monthly income. This was cross-sectional study and the convenience sampling [non-probability sampling] technique was used. The study was spread over the period of six months. A brief questionnaire for collecting demographic information was used. DSM-IV criteria for assessing past psychiatric illness were also used by the researcher. HADS [Hospital Anxiety and Depression scale] was used to assess anxiety and depressive symptoms. Of one hundred pregnant women 39% and 18% scored above cut-off on anxiety and depression scale respectively. Among control group the percentage for anxiety and depression was 28% and 12% respectively. Seventeen percent of pregnant women reported receiving psychiatric [pharmacological or psychotherapy] treatment for psychological issues. The T-test results showed significant difference between two groups regarding anxiety and depression. Pregnant women experience more anxiety and depression as compared to their closely matched counterparts and most of them are not being monitored during this time. More work is needed for detection, referral and treatment of anxiety/ depression during pregnancy. Clinical studies for maternal mental health and fetal consequences are also needed

Demographic profile of patients with epilepsy in a community clinic

To study the Demographic profile of patients with Epilepsy. A descriptive study of five hundred patients with Epilepsy was counducted in, Ahbab Hospital, [Psychiatric Epilepsy clinic] Ravi Road, Lahore. All patients presented with seizures during that period were included in the study. Their detailed history and appropriate investigations were recorded on a study proforma. Epilepsy was classified according to EEG findings. Out of a total Five hundred patients with Epilepsy who visited Ahbab Hospital majority [62.9%] were of low socio-economic status and belong to rural areas of Pakistan. Males had Epilepsy [58%] more often compared to females [42%]. The most common type was Generalized Tonic Clonic Seizure.70% of the patients came with Epilepsy only, 13.0%were having Depression and 10.1%were Mental Retardation and 4.1%had a problem of Attention Deficit Hyperactive Disorder. The results of the study conclude that Epilepsy is more common among population with low socioeconomic status in the rural areas and dominantly involves the males.43% of the subjects were suffering from Generalized Tonic Clonic Seizures. The risk factors for developing Epilepsy include a positive family history of Epilepsy. Epilepsy is an important health problem. Identification of Demographic profile in a hospital setting will lead to more opportunities to improve preventive measures and quality of life in rural areas. It will also improve knowledge among rural backgrounds and health officials on the problems associated with this disease

Physical and psychological complications of cannabis ; an update

The use of illegal drug such as cannabis is most common. Young people are more vulnerable for its use. Prevalence is increasing markedly over the past decade. Long term use of cannabis use is found to be associated with increased risk of physical and psychological complications. This a brief review of recent literature on the use of cannabis in European society. Government has successful in increasing public awareness about cannabis misuse through media. More surveys and epidemiology studies are required in future to detect this change and any reduction in its use and dependence

Significant variablables associated with epilepsy

To study the characteristics of the epileptics and the risk factors contributing to the development of epilepsy. Design: Descriptive study. Place and Duration of Study: Epilepsy Clinic at Ahbab Hospital, Lahore, from June 2002 to August 2002. Subjects and Data was collected from 158 subjects, 89 males and 69 females, suffering from epilepsy. The information about socio-demographic characteristics and family history of illness, perinatal morbidity, birth place and mother's age at the time of delivery was obtained using a pre-tested questionnaire. Data was analyzed on SPSS version 10. Majority of the subjects were single [77.84%], 1st born among their siblings [25.95%], belonged to low social class [50.63%], and unemployed [25.31%]. The major risk factors were family history of illness [23.52%] and positive medical problem around birth [12.66%]. The presence of family history of illness, positive medical problem around birth and advanced maternal age at birth were associated with early onset of epilepsy. Vulnerability for the epilepsy also increases among hospital deliveries. Although the present study has identified various risk factors, yet the results need to be further confirmed through case-control studies

Changing pattern of dissociative [conversion] disorder

To analyze the prevalence of dissociative [conversion] disorder in psychiatric out patient department and to compare the rate of reporting over six years 1988-1993. Design and Setting: Six years 1988-1993 retrospective survey of all the patients who presented to the outpatient department of psychiatry Mayo Hospital Lahore. Outcome measures: Total psychiatric cases and patients suffering from dissociative [conversion] disorder with demographic variables of age, sex, source of referral and marital, social, literacy and residential status have been analyzed on the yearly basis. While the total psychiatric cases showed a progressive increase, the number of patients suffering from dissociative [conversion] disorder progressively decreased by 50%. No significant change in other demographic variables was observed. This 50% decrease of patients of dissociative [conversion] disorder may reflect a true fall in the incidence of this disorder in our society. Further well controlled epidemiological studies may help in clarifying this observation