Early psychosis symptoms

To determine the prodromal symptoms of schizophrenia in the pathways to help-seeking. A cross-sectional study. The Department of Psychiatry, the Aga Khan University, Karachi, from 2008 to 2009. A total of 93 patients were interviewed in the pathways to care of schizophrenia. The diagnosis was based on ICD-10 criteria. The pathways to care were assessed through a semi-structured questionnaire. The onset, course and symptoms of psychosis were assessed through Interview for Retrospective Assessment at Age at Onset of Psychosis [IROAS]. Fifty five [59%] participants were male while 41% [n=38%] were female. Using IROAS, 108 symptoms were identified as concerning behaviour. Alternatively, 60 [55%] concerning behaviours were reported in the open-ended inquiry of the reasons for help seeking as assessed by the pathways to care questionnaire with a statistically significant difference between most symptoms category. The difference was most pronounced [p < 0.001] for depressed mood [66%], worries [65%], tension [63%], withdrawal/mistrust [54%] and loss of self-confidence [53%]. Thought withdrawal [22%] and passivity [15%] were elicited only through structured interview [IROAS]. When symptoms were categorized together, about 83% of the subjects presented with affective and non-specific prodromal symptoms. Roughly, 10% of the subjects presented with positive symptoms and 3% presented with the negative symptoms of psychosis. The non-specific, affective symptoms appear to predominate the prodromal phase of the illness. Prodromal symptoms of schizophrenia include non-specific, affective symptoms. Attention needs to be paid on identifying the prodromal symptoms and change in social functioning in order to identify those who are at risk of longterm psychosis

Generalized anxiety disorder: can we rest now?

Generalized anxiety disorder is a complex psychiatric syndrome. Current understanding on the epidemiological risk factors, genetic vulnerability and neurobiology of the GAD is beginning to unfold the complexities behind this disorder. This narrative review has attempted to put together the recent advances in the area of GAD research with intent to identify the gaps requiring further research

Students' research: tradition ahead of its time

This view point describes the experience of introducing research at an undergraduate level during clinical rotation in psychiatry. Objective of this initiative was to encourage critical thinking, self directed learning and sensitization to mental health issues. This contributed to student learning besides galvanizing their interest in the subject. The opinion piece aims to expose various issues to students' research in the context of medical education in Pakistan

Magnetic resonance imaging findings in patients with schizophrenia

To determine structural abnormalities in the brain of patients with schizophrenia by Magnetic Resonance Imaging [MRI]. Comparative study. The Departments of Radiology and Psychiatry, the Aga Khan University Hospital, Karachi, from January 2007 to June 2008. Thirty-three cases of schizophrenia [n=33] and thirty-three age-matched controls, [n=33] were enrolled for this study. Screening Magnetic Resonance Imaging [MRI] of brain was done in order to see structural changes in brain matter. Findings were compared among groups using chi-square and Fisher's exact test with significance at p <0.05. Among the total of 66 [n=66] MRI films studied for brain abnormalities, brain atrophy, presence of septum pellicudum and enlarged Virchow-Robins spaces were significantly associated with schizophrenia [p<0.001]. There was no significant difference between cases and controls for ventricular dilatation [p=0.5]. Sinusitis was mostly associated with controls and well correlated with their symptoms [p<0.001]. Brain atrophy was the most commonly seen brain change in the studied sample of patients with schizophrenia. MRI brain can be used to identify structural abnormalities in patients with schizophrenia

Economics of health care: an ethical dilemma

Health care has become a lucrative business where firms enter the market to earn exorbitant amount of money. In this article we have made an attempt to highlight the inequitable Agency relation governing interaction between patients and health care providers. In the absence of any robust legal frame work, patients with mental illness are at risk of exploitation and abuse

Depression in Pakistan: an epidemiolgical critique

The epidemiological studies from Pakistan have given rise conflicting findings. Besides very high prevalence in different studies, rates from Northern Pakistan are much different from big urban centre such as Karachi. If the findings of these studies are to be taken at face value than every third Pakistani is expected to be suffering from depression and Anxiety. Obviously this has serious implications for the country's mental health care scenario. There are design, sampling and methodological issues which needs to be revisited. This review aims to This review presents a critique, from an epidemiological perspective, on studies carried out in Pakistan on estimating rates and risk factors of depression. It is expected that this critique will serve to enhance awareness on research methods in psychiatry and suggest future directions for research in this important area.

Pathway to psychiatric care in Karachi

This research was done to study the care and referral pathway taken by patients before they present to a psychiatrist at a university teaching hospital in Karachi, Pakistan. The key study variables were the obstacles and delays at each level of care i.e. community, primary care physician and psychiatrist. A consultant psychiatrist conducted an initial interview for diagnostic assessment. Patients' diagnosis was based on ICD-10 clinical care version. During the study period a total of 94 initial patients were seen and assessed in the psychiatry screening of Aga Khan University Hospital [AKUH]. Of them, there were 52 [55.3%] males and 42 [44.0%] females. Among the whole sample, 15% patients were in adolescent age group [<20 years age], while 38% were in the age range of 21-to-30 years, 17% in the age range 31-to-40 years, 15% between 41-to-50, while 6.5% were above the age of 60 years. Majority [64.5%] was single while 29 [10 females, 19 males] patients were married. Only 3% were divorced or widowed. Majority of patients were housewives [30%], followed by students [20%, 12 males, 6 females] and professionals [16%; 7 females, 8 males]. Five patients were unemployed at the time of referral while 5 had retired from their respective occupation The most common diagnosis in both genders was depression [females n=26, 52%; males n=21, 37%], while schizophrenia, bipolar disorder and obsessive-compulsive disorder was diagnosed with similar frequency in both genders