Telomere Biology in Mood Disorders: An Updated, Comprehensive Review of the Literature

Major psychiatric disorders are linked to early mortality and patients afflicted with these ailments demonstrate an increased risk of developing physical diseases that are characteristically seen in the elderly. Psychiatric conditions like major depressive disorder, bipolar disorder and schizophrenia may be associated with accelerated cellular aging, indicated by shortened leukocyte telomere length (LTL), which could underlie this connection. Telomere shortening occurs with repeated cell division and is reflective of a cell’s mitotic history. It is also influenced by cumulative exposure to inflammation and oxidative stress as well as the availability of telomerase, the telomere-lengthening enzyme. Precariously short telomeres can cause cells to undergo senescence, apoptosis or genomic instability; shorter LTL correlates with compromised general health and foretells mortality. Important data specify that LTL may be reduced in principal psychiatric illnesses, possibly in proportion to exposure to the ailment. Telomerase, as measured in peripheral blood monocytes, has been less well characterized in psychiatric illnesses, but a role in mood disorder has been suggested by preclinical and clinical studies. In this manuscript, the most recent studies on LTL and telomerase activity in mood disorders are comprehensively reviewed, potential mediators are discussed, and future directions are suggested. An enhanced comprehension of cellular aging in psychiatric illnesses could lead to their re-conceptualizing as systemic ailments with manifestations both inside and outside the brain. At the same time this paradigm shift could identify new treatment targets, helpful in bringing about lasting cures to innumerable sufferers across the globe.

Patients leaving against medical advice: an inpatient psychiatric hospital-based study

To determine the frequency of patients leaving against medical advice [LAMA] in an inpatient psychiatric facility in Rawalpindi, Pakistan. Descriptive cross-sectional study. Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, from August 2010 to February 2011. Patients who got admitted during study period irrespective of duration of illness and mode of admission were recruited through non-probability consecutive sampling and followed till discharge to determine their mode of leaving hospital. A thirteen-item proforma was developed and information was obtained on demographic, socioeconomic, patient related and disease related variables. Descriptive statistics were calculated on SPSS 14. The total number [n] of participants was 246. Among the participants, 96 [39%] left against medical advice [LAMA] whereas 150 [61%] left on regular discharge on physician's advice. Frequency of patients who left against medical advice was found to be more in males [63.5%], younger age groups [21 - 30 years], lesser educated [more than half were under matric] and with the ICD-10 diagnosis of substance abuse [23.9%]. About half of patients who LAMA had a prior history of psychiatric illness and a significant number [37.5%] had a history of previous psychiatric admission. Leaving against medical advice is a frequent problem in psychiatric inpatients and is a matter of great concern for the treating doctors

Frequency of compliance with antidepressants using antidepressant compliance questionnaire

To find out the frequency of compliance of patients using anti-depressants prescribed at out-patient department. Descriptive cross sectional study. This study was conducted in the out-patient department of Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi from September 10,2010 till May 10,2011. One hundred and sixteen patients aged 18 years and above, presenting with moderate depressive illness, able to understand and speak Urdu, taking treatment for at least 4 weeks and belonging to both genders were recruited from out-patient department using consecutive [non-probability] sampling technique. Patients having severe depressive illness with psychotic features and severe agitation were excluded. Antidepressant Compliance Questionnaire was translated and validated through a pilot study and then the Urdu translation was orally administered to each participant for the assessment of compliance with antidepressant medication. Among the participants 74.1% were compliant and 25.9% were non-compliant with anti-depressant medications. This study found a high degree of patient compliance with anti-depressants. The results would help in early recognition of non-compliant patients, so that necessary changes could be made in the treatment plan to ensure better compliance

Patient satisfaction with electroconvulsive therapy in a tertiary care hospital

To determine the frequency of satisfied patients with ECTs in a public sector tertiary care hospital. Cross-sectional, descriptive 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. 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. Using the ECT satisfaction Questionnaire, 62.6% patients were satisfied while 37.4% were dissatisfied with ECT. 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 improve the delivery of this treatment in accordance with the patients' expectations for better treatment adherence and improved outcomes

Assessment of patient satisfaction with mental health services in a tertiary care setting

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. This was a crosssectional 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. 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. 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

Type of presentation of dissociative disorder and frequency of co-morbid depressive disorder

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. Observational, cross-sectional study. Place and Duration of Study: The Institute of Psychiatry, Rawalpindi General Hospital from October 2004 to March 2005. 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. 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%]. 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

Frequency and associated factors for postnatal depression

To determine the frequency and associated sociodemographic, obstetric and medical factors for postnatal depression in an outpatient sample. A descriptive, cross-sectional study. Department of Obstetrics and Gynaecology, Benazir Bhutto Hospital [formerly Rawalpindi General Hospital], Rawalpindi, between June 2006 and February 2007. 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. 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]. Postnatal depression was found in almost 1/3rd of the study participants and the pre-ponderance 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