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

Depression in post-mastectomy breast cancer patients

Objective: to compare the frequency and association of depression in post-mastectomy breast cancer patients

Methods: two Fifty consecutive outdoor breast cancer patients were included in the study that had undergone mastectomy in the preceding 2-4weeks. They were compared with physically healthy matched females who were accompanying the patients suffering from various cancers to the outpatient department of oncology units. A semi structured interview and Present State Examination [PSE] were administered to assess symptomatology. Patients were diagnosed as suffering from depression on the basis of Diagnostic and Statistical Manual of Mental disorders; fourth edition [DSM-IV]. The Hamilton Rating Scale for Depression [HRDS] was administered to the positive cases in order to determine the severity of the depressive symptoms

Results: depressive disorder was found in 20% of post mastectomy breast cancer patients in comparison to 16 % of control group. Depressive disorder was more prevalent [88.8%] in breast cancer females who were younger than their husbands by 0-4 years and those women who had nuclear family system. Among the control group [caregivers/ attendants], depressive disorder was more prevalent [87%] among mothers and sisters of cancer patients [p

Conclusion: the patients who are suffering from breast cancer should be screened for depressive disorder and intervention must be given wherever possible, Moreover care givers attendants of patients suffering from various cancers and other life threatening illnesses should also be assessed and managed for depressive disorder as a part of multi modal management plan to improve the level of care giving behavior

Health ethics education: knowledge, attitudes and practice of healthcare ethics among interns and residents in Pakistan

To assess the knowledge, attitudes, and practices among interns and residents about healthcare ethics in an attempt to assist in development of ethics curriculum in Pakistan. Four hundred respondents comprising of interns, junior and senior postgraduate trainees were recruited from two Public sector teaching institutions in different provinces of Pakistan for this cross sectional study. A self- administered questionnaire was used to collect data. Data was analysed using SPSS-17. More than half of the respondents in all three groups encountered ethical problems on daily basis. These ethical issues were being discussed with the clinical supervisor in only 25% of the instances. Unethical behaviour of seniors towards junior doctors and patients were observed by more than three quarter of the respondents. A very high proportion of respondents [57%] had no knowledge of code of ethics of Pakistan Medical and Dental council. Helsinki declaration was known only to a few individuals. There were difference between interns, junior and senior residents with respect to their views about adherence to patient's wishes, paternalistic attitude of physicians, treatment of children without parental consent, euthanasia, confidentiality and treatment of noncompliant patients. Junior doctors representing different levels of training in Pakistan face ethical dilemmas on a regular basis but their current teaching and training in ethics is insufficient to help them deal with these competently.

fiery landscape of depression: a review of the inflammatory hypothesis

The purpose of this article is to review the evidence linking depression with inflammation, to examine the bi-directional relationship between the neuro-humeral circuitry of depression and the inflammatory response, and point out new treatment implications of these ideas. The evidence available is in areas of genetic links, association of depression with raised inflammatory markers such as Tumour Necrosis Factor [TNF]-alpha, Interleukin [IL]-1, IL-6, co-morbidity of depression with inflammatory medical illnesses, administration of cytokines leading to depression, and the recognition that anti-depressants have anti-inflammatory and neuro-protective properties. Inflammatory response and mood regulation constitute a system of bi-directional communication such that inflammatory cytokines can penetrate the CNS and influence behavior. Activation of the CNS cytokine network leads to a cascade of effects such as disturbed metabolism of amino acids, neurotoxicity, diminished neurotrophic support, decreased neurogenesis, impaired negative feedback regulation of HPA axis function and glucocorticoid resistance. Treatment implications include strategies to screen for patients with increased inflammatory activity, possible treatment with anti-inflammatory agents, and the recognition of new target areas for antidepressant medications. A literature search for articles published during the last ten years was conducted using various combinations of key words ['depression', 'inflammation', 'cytokines', 'immune system', 'interleukins'] utilizing the databases Google Scholar and PubMed. An outline of the most relevant aspects of the role of inflammatory processes in depression was created. Major papers, including other review articles, were identified in accordance with our outline. These articles were subsequently hand searched and reviewed individually for further references of significance. The inflammatory response leading to formation of inflammatory cytokines plays a significant role in the pathophysiology of depression, and this has important implications with regards to new and personalized treatment of depression