Frequency of psychotropic drugs use by patients with schizophrenia in eight years follow-up

Objective: To measure the frequency of various psychotropic drugs used by patients with schizophrenia in 8 years follow up

Methodology: It was a descriptive observational study. This study was conducted at Department of Psychiatry Lady Reading Hospital Peshawar from 2004 to 2012. A sample of 52 patients diagnosed as schizophrenics was included through consecutive sampling. These patients were part of a project known as Severe Mental Illness [SMI]. They were regularly assessed once in a month and were provided antipsychotic, antidepressants and mood stabilizers

Results: The study included 52 [n = 52] patients. Males were 33 [62%] and females were 19 [37%]. Age of patients ranged from 15-60 with the mean age of 28.82 +/- 10.67. Mean age of males was 31.08 +/- 9.66 and of females was 25.84 +/- 11.43. Number of visits missed during the study was 2%. Fifty two% of patients were stable on 4mg of risperidone per day. Fifty percent of the patients were stable on 5 to 10mg of olanzapine per day. Depot preparation was required by 38% and less than 50% of the patients required carbamazepine as mood stabilizers from 200 to 400mg per day. Twenty three percent of the patients required 20gm of fluoxetine per day

Conclusion: During 8 years follow up the most frequent anti psychotic drugs used by patient to remain stable were risperidone 4mg per day followed by olanzapine 5 to 10 mg per day

Beliefs about illness of patients with schizophrenia

To elicit the beliefs and perception of patients with schizophrenia about their illness by using Short Explanatory Model Interview [SEMI]. This cross sectional study was conducted in the department of psychiatry, Lady Reading Hospital. One hundred and three patients of schizophrenia were included in the study. Short Explanatory Model Interview [SEMI] was used to assess the explanatory model of illness of the sample. Four major areas covered in SEMI were "Concept" i.e., naming the illness, "Cause", "Treatment Choice" i.e., help seeking behaviour, and "Severity" of the illness. Mean age of the sample was 30.52 +/- 9.41 years. Regarding Concept, 34[33%] patients who although couldn't name any but attributed their condition to mental illness. The major response to the cause for the development of schizophrenia was stress of social issues by 22[23.30%] patients. A total of 56[54.3%] patients reported a combination of medication and spiritual healer to be the help seeking/ treatment choice. Only 44 [42.7%] patients considered the illness to be very serious. Our study suggests that patients suffering from schizophrenia believe that they have some form of mental illness but mostly attribute it to stress and other social factors. They prefer visiting spiritual healers along with medication for seeking help regarding their illness

follow up study of use of memantine on cognitive functions and level of dependency of patients with Alzheimer's dementia

To evaluate the effect of Memantine on cognitive functions and level of dependency of patients with Alzheimer dementia. This descriptive study was conducted at department of Psychiatry, Lady Reading Hospital Peshawar from February to June 2012. Sample consisted of 55 patients; both male and female and were included through consecutive sampling. Patients were assessed at baseline and at three months follow up for Cognitive functions and level of dependency with the use of Mini Mental State Examination [MMSE] and Clifton Assessment Procedures for the Elderly [CAPE] as psychometric tools. Fifty five patients with Dementia were included in the study. Forty three patients completed their follow up visits. Mean score of the patients who completed follow up on MMSE at baseline was 17.47 +/- 6.04, while mean dependency grade of CAPE at baseline was 3.67 +/- 1.44. Mean score on MMSE at follow up was 19.67 +/- 5.88 while mean dependency grade of CAPE was 2.67 +/- 1.39. Significant difference was found between the scores on base line and follow up with the p=0.00. We concluded from our study that Memantine has useful role in the improvement of the cognitive functions and behavioral dependency of the demented patients as there were significant improvements seen in both cognitive functions and level of dependency of the patients with Alzheimer dementia after 3 months follow up assessment

Symptomatic and general functioning in schizophrenic patients: five years follow up at outpatient department

To compare the level of global assessment of functioning and scores on PANSS of schizophrenic patients with 5years follow up. Descriptive observational study. This study was conducted at department of Psychiatry Lady Reading Hospital Peshawar from March 2007 to May 2012. A sample of 44 patients diagnosed as schizophrenics were included through consecutive sampling. All patients were enrolled in SMI [i.e. Severe Mental Illness] they came for regular assessment once in a month. All patients were assessed on Positive and Negative Syndrome Scale [PANSS] and Global Assessment of Functioning [GAF] at baseline and at five years follow up. Statistically significant difference was found between scores of PANSS and GAF at baseline and follow up. We concluded from our study that there is negative correlation between the score on PANSS and the level of GAF at baseline as well as at five years follow up

Substance abuse in patients with co-morbid adhd

To study the tendency of occurrence of attention-deficit hyperactivity disorder [ADHD] with substance abuse. A cross-sectional, hospital based study. The study was carried out at Lady Reading Hospital and Khyber Teaching Hospital, Peshawar, Pakistan from 4th April 2012 to 29th August 2012. A sample of 110 adult patients with 53 heroin dependents, 23 THC, 15 opium, 11 poly drug and 8 alcohol dependents were analyzed that whether they were ADHD and that childhood problem continues to manifest symptoms in adults. For retrospective assessment of childhood ADHD, the Wender Utah Rating Scale [WURS] as well as the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] symptom checklist for ADHD was used. The Conners' Adult ADHD Rating Scales [CAARS] was used to assess the persisting symptoms of ADHD in adults.Patient diagnosed with drug and alcohol dependence according to DSM-IV were included in the study whereas patient co-morbid with any other psychiatric illnesses were excluded. Heroin dependent showed 41.5% [WURS] and 37.7% [DSM-IV diagnostic criteria], whereas THC validated 34.7% [WURS] and 30.4% [DSM-IV], opium demonstrated 46.6% [WURS] and 40%[DSM-IV], poly drug dependence established 63.6% [WURS] and 54.5% [DSM-IV] and alcohol dependent showed 50% [WURS] and 37.5% [DSM-IV] indicated evidence of retrospective ADHD affliction in childhood. CAARS was presented in 35.8% heroin dependent, 34.7% THC, 46.6% opioid, 33.3% poly drug dependence and 37.5% alcohol dependent; and exhibited a substantiation of ADHD persistent in adulthood. The difference between the mean score of WURS and CAARS of ADHD patients were significantly greater [P = 0.029], than the normal patients. Pese results revealed that ADHD is a risk factor associated with substance dependence, expressed in the form of heroine, THC, opioid, alcohol dependence and also in poly drug dependence

Cost of depressive disorders in indoor patients

To estimate the direct and indirect cost of depressive disorders in indoor patients. This hospital based descriptive study was carried out on thirty patients admitted consecutively in department of psychiatry Jinnah Postgraduate Medical Center Karachi from January to July 2000. International Classification of Disease-10 diagnostic criteria for depressive disorders were used to identify the patients. Cost prof or ma was devised to calculate direct and indirect cqst. The cost of hospital stay per day was calculated by using opportunity costs model. There were 9 [30%] male and 21 [70%] female patients. Majority of the patients were in their twenties [n=ll, 36.67%] and thirties [n=9, 30%]. There were 24 [80.02%] married and 6 [19.98%] unmarried patients. A total of 20 [66.66%] were jobless and 10 [33.33%] were having a job. Most of the patients were suffering from moderate depressive disorder and recurrent depressive disorder [n=ll, 36.67% and n=10, 33.33%]. The overall cost of all the patients was Rs. 472,542 with Rs. 73,026 [15%] in direct and Rs. 399,516 [85%] in indirect costs with a ratio of 1:5.5. The diagnosis of moderate depressive disorder was the commonest in the sample. The indirect cost of depressive disorder in indoor patients was 5.5 times more than the direct cost

Frequency of religious themes in obsessive compulsive disorder

To assess the theme of religion on the symptomatology of obsessive compulsive disorder. This study was carried out at the Department of Psychiatry, Lady Reading Hospital, Peshawar from October 2005 to March 2006. Those who satisfied DSM-III R criteria for obsessive compulsive disorder were included in the study. Those suffering from neurological illnesses or any other psychiatric illness were excluded from the study. Fifty Muslim patients [36 Males and 14 females] fulfilled the DSM-III R criteria for obsessive compulsive disorder. The mean age of the group was 25.87 +/- 7.39 and for the 1[st] onset of obsessive compulsive disorder was 21.36 +/- 8.21 years. Themes of obsessions and compulsions were religious [60%], contamination [28%], and order/ safety [20%], in decreasing order of frequency. This study reflects the role of religion which gives content to various obsessions and compulsions which may be helpful in early diagnosis of obsessive compulsive disorder in our culture. Further more the impact of these findings in term of psychological method of treatment such as cognitive behavioral therapy [CBT] could be significant in Islamic culture

Does anxiety and depression cause acute myocardial infarction?

To study the frequency of depression and anxiety in patients admitted with acute myocardial infarction [AMI]. Two hundred consecutive patients of AMI without complications presenting to the coronary care unit of Cardiology department of Lady Reading Hospital and 200 healthy controls among patient's attendants were interviewed with standard scales of HADS and HRS for the presence of depression from to date. Two hundred consecutive patients of AMI and 200 healthy controls among patient's relatives were assessed on HADS and HRS scale for the presence of depression. Sixty three percent of the patients were male in both groups. Mean age of patients was 59 +/- 11 years while that of controls was 52 +/- 10 years. Although significantly different between the two groups, age had no significant effect on the presence of depression in any group [p < 0.4]. A significant difference was noted in the number of events reported between patients of AMI and control group, 4.21 +/- versus 2.71+ respectively [p<0.001]. On Hospital Anxiety and Depression Scale [HADS] 77.5% of the acute MI patients had depression compared to 64% in the control group [p< 0.003]. When HADS was used to asses the level of anxiety and depression in the two groups, 83% of patients in the AMI group reported abnormal i.e. scores above 17 compared to 70% in the control group [p< 0.001]. Depression was more common in patients presenting with acute myocardial infarction as assessed by standard scales as compared to controls

Psychosocial stressors in patients with conversion disorder presenting with non epileptic fit

To study the psychosocial stressors in patients with conversion disorder presenting with non epileptic fit. This descriptive study was carried out at Lady Reading Hospital Peshawar Pakistan from January to June 2009. 101 consecutive patients with conversion disorder satisfying the inclusion and exclusion criteria were selected. They were interviewed by using Holmes and Rahe stress scale for the exploration of stressors and the results were analyzed from the entries in the Proform. Stressors were clearly identified in all patients. Ninety six [95.04%] out of the total 101 subjects had a history of stressors, while the rest 5 [4.95%] could not come up with any. The commonest stressors were Troubles with in-laws [21.78%], Major change in family get together [17.82%], Death of close family member [12.87%] respectively. Significantly higher number of the patients presents with the stressor of troubles with in-laws, when assessed on the Holmes and Rahe social scale

Present and severity of depressive symptoms in Schizophrenia

The present study aims to assess the presence and severity of depressive symptoms in persons suffering from schizophrenia as compared to normal healthy controls. This case control comparative study was carried out at the Department of Psychiatry, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January to December 2005. One twenty subjects were included in the study by non probability convenient sampling. Group 1 [the study group] included sixty patients suffering from schizophrenia between the ages of 15-60 and Group 2 [the control group] included sixty normal subjects without any major psychiatric disorder proportionally matched for age and gender. Those suffering from schizoaffective illness, major depression and organic brain damage were excluded. Hamilton Depression Rating Scale [HDRS], a 21 item scale was used to assess the presence and severity of depressive symptoms. The spectrum of depressive symptoms was broad in the schizophrenic sample. The difference in two groups was observed specially in depressed mood i.e., 19 patients in the study vs. 3 subjects in the control group with a p value of 0.0001 and in psychomotor retardation i.e., 19 patients in the study vs. 4 subjects in the control group, again with a p value of 0.0001. The results of this study suggest that depressive symptoms are a part and parcel of schizophrenia and every patient suffering from schizophrenia should be assessed in detail for the presence and severity of depressive symptoms

Sociodemographic and clinical characteristics of IV drug users presenting to a tertiary care treatment centre

To identify the association between sociodemographic factors and injectable drug use. This descriptive study was carried out in drug abuse treatment centre of psychiatry department Lady Reading Hospital Peshawar. The patients were recruited through United Nations Office, Drug and Crime Programme [UNODC]. They were interviewed in detail by a psychologist and psychiatrist, through an instrument, specifically designed to collect the information about sociodemographic factors among injecting drug users. Data was recorded and analyzed by using SPSS. The sample consisted of 52 injecting drug users out of the total five hounded patients [10.4%]. All of them were male. Majority belonged to the age group 21-40 years [76.9%]. One third of them [34.6%] were illiterate while about half [50.5%] had professional skills. About one fourth patients [26.9%] started drug use in early age [11-20 years], and only four patients admitted sharing syringe or needle with others patients. The most common reason for 1/V drug use was, influence of friends followed by the desire to get quick and light response. Problem of injectable drug use is common in the illiterate and in younger age group and needs attention of health care planners and research workers

audit of electroencephalography [EEG] referral in tertiary care teaching hospital

The aim of the study is to describe the various findings of electroencephalography in assessing diseases encountered in clinical practice, to audit the use of EEG in a tertiary teaching hospital, and to describe the diagnostic categories in which EEG can be helpful as diagnostic tool. Descriptive study This study has been carried out at Department of Psychiatry Khyber Teaching Hospital, Peshawar. Cases were examined retrospectively over a period of one year from January to December 1998. All the record of the patients who had EEG during one year period i.e. from January to December 1998 was examined. Relevant informations were recorded on a performa prepared for this study. The total number of request during year 1998 were 971, out of which 570 [59%] were male and 401 [41%] were female. In 588 [61%] cases result was positive and in 383 [39%] was negative. Electroencephalography was helpful in assessing the diagnosis of epilepsy in 344 cases [58%] and delirium in 181 cases [31%]. This paper highlights the importance of EEG is an important electrophysiological investigation especially in cases of delirium and epilepsy. It is recommended that it should be available in every tertiary teaching hospital

Inpatients psychiatric morbidity at Pakistan institute of medical sciences [PIMS]

The present study aims to describe the socio-demographic variables and the frequency of different diagnostic categories of the patients admitted in Pakistan Institute of Medical Sciences Descriptive study. Psychiatry Department, Pakistan Institute of Medical Sciences, Islamabad. Data collection was done for six months [July 2000 to January 2001]. 113 consecutively randomized patients were admitted in the psychiatry department at Pakistan Institute of Medical Sciences. Patients were admitted to psychiatry Department Pakistan Institute of Medical Sciences, Islamabad, between [July 2000 to January 2001]. Three cases were excluded because of age group under 10, restricting the analysis to 113 cases. Data was collected for the following variables age, sex, duration of admission reason for admission diagnosis and the treatment given during their stay. Of 113 patients, 64 were males and 48 were females between the age group of 11 and 80 years. Data was established with reference to the patients admitted with different psychiatric illnesses, their ages and gender. Our study found a trend toward a higher risk of admission in different psychiatric disease with reference to different age groups and genders

Symptomatology of obsessive-compulsive disorder

The aim of the study was to assess the influence of religion on the symptomatology of Obsessive - Compulsive Disorder. Fifty patients all Muslims, 36 males and 14 females, suffering from Obsessive-Compulsive Disorder [OCD] were studied, in order to assess the various forms and contents of obsessions and compulsions in our culture Five types of obsessions were identified; namely doubts, thinking, fear, impulses and images in descending order of their frequency; Compulsions included repetition of prayers and / or their associated washing, cleaning and checking rituals. The content of obsession and compulsions in decreasing order of frequency were religious, contamination, inanimate impersonal, aggression, sex and death. This study reflects the frequency that religion accords as content to various obsessions and compulsions. Seventy Eight% patients who were suffering from severe to extreme OCD on Yale-Brown Obsessive-Compulsive Scale were not willing for admission in Psychiatry unit but continued taking medical advice at an out-patient level. Forty% of patients contacted general medical practitioners for help so it is recommended that primary care physicians should be encouraged to effectively diagnose and treat this condition. Associated features of anxiety and depression were seen in 54% cases, therefore it is recommended that screening OCD should be a routine part of every mental state examination in psychiatric practice, particularly in patients who present with anxiety or depression. The impact of these findings in terms of psychological method of treatment, such as cognitive behavioural therapy could be significant in islamic culture. It is suggested that further studies should be carried out to complement the pharmacological treatment