Antenatal depression and its predictors in Lahore, Pakistan

Mental health is an important but neglected component of reproductive health. This study aimed to determine the prevalence and risk factors for antenatal depression among women attending for antenatal care at an urban tertiary care hospital in Lahore, Pakistan. In a cross-sectional study/ structured questionnaires were filled and screening for depression was done using the Edinburgh postnatal depression scale [EPDS]. Out of 506 antenatal attendees 126 [24.9%] had no depression [EPDS scores < 10], 53 [10.5%] scored 10-12 and 327 [64.6%] EPDS scores > 12. Depression scores [> 10] were more common in mothers aged < 20 years [93.7%] than those aged > 35 years [55.0%]. Fear of childbirth and separation from husband were identified as significant risk factors for development of antenatal depression, while family history of psychiatric illness was significant protective factor. Domestic violence, drug abuse, lack of support, previous miscarriage and personal history of previous psychiatric illness were not found to be significant risk factors

Introduction of voucher scheme in 6 union councils of Tehsil Choa Saiden Shah, district Chakwal [MoH- UNFPA supported district] for pregnant women to reduce maternal mortality

To reduce maternal and neonatal mortality rates encouraged by a 'voucher' system for provision of free transport service to the pregnant women mothers: Voucher scheme along with community transport system was established to reduce 2[nd] delay in maternal mortality/ morbidity for marginalized populations in MOH-UNFPA supported district Chakwal. Under SMTS program ambulances was parked in each union council to provide emergency transport services. The vouchers were available to all service providers and each voucher will be used for a single referral case. The study was done in 6 union councils of district Chakwal during 4[th] November 2008 to 4[th] February 2009. After the implementation of scheme there were 453 beneficiaries out of which all were reported in time to health care facility and no mortality/ morbidity were reported. The result showed that SMTS is found to be a beneficent scheme for the people of CSS as it remarkably reduces the maternal mortality and morbidity

Violence by psychiatric inpatients

The case notes of all the inpatients [n=107] committing assaults during their stay at Government Hospital for Psychiatric Diseases, Lahore in the year 1992 were analyzed. The most common victims were ward attendants followed by other patients and doctors. More doctors were assaulted than nurses and other patients. The violent patients were more likely to be schizophrenics, deluded [persecutory], hallucinated and to have undergone repeated admissions. Violence tended to be repetitive, and the violent patients were usually identifiable from previous aggressive disturbed behaviour. These patients tended to be younger, psychotic and more seriously sick. They were particularly treated in a closed ward

Mania in the elderly

In a retrospective study of 102 patients admitted with mania aged over 55 years, it was found that 43.3% had no prior history of affective illness: 35.2% had previously experienced only depression, and one-third of later had at least three episodes of depression before the first manic illness. Patients with a family history of affective disorder had a significantly earlier age of onset of illness. There was evidence of cerebral organic impairment in 21.5% of the patients, and this group had an onset of illness significantly at a later age. prognosis was good, with only 8% still in hospital at six months. Half of the Patients were started on lithium prophylaxis, but this did not significantly alter the number of readmissions. A quarter of those started on lithium developed evidence of lithium toxicity