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

Comparative study of alterations in tri-iodothyronine [T3] and thyroxine [T4] hormone levels in breast and ovarian cancer

The present study was designed to investigate variations in the levels of thyroid hormones [T3, T4] in breast and ovarian cancers patients. A total 120 subjects were recruited [without thyroid history] divided into three groups; A, B and C. Group A as control with healthy individuals. While group B and group C were consisting of breast cancer and ovarian cancer patient respectively. Blood samples [5 ml] were taken and analyzed to estimate the levels of serum T3 [tri-iodothyronine] and T4 [thyroxin] hormones. Statistically significant difference [P=0.000* and P=0.017*] was obtained among all groups. A significant increase in T3 [P=0.000*] and T4 [0.005*] levels was observed among breast cancer patients as compared to healthy controls. While for ovarian cancer patients conflicting results were found for T3 and T4 levels in the serum i.e. insignificant difference was found in T3 [P=0.209] and T4 [P=0.050] as compared to control. Our results showed that in the breast cancer and ovarian cancer patients the thyroid hormone [T3 and T4] level has been altered from the normal ranges as compared to the normal healthy individuals. We conclude that hyperthyroidism has profound effects on breast cancer and ovarian cancer cells proliferation

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

Beliefs and attitudes of family members towards patients suffering from conversion disorder

To evaluate the attitudes and beliefs of family members towards patients suffering from conversion disorder. Descriptive Cross Sectional study. Place and Duration of study: The study was carried out in Khalifa Gul Nawaz Teaching Hospital Bannu, Pakistan, from February to May 2013. Subjects and Methods: A consecutive sample of sixty patients, suffering from conversion disorder was approached for the study. Family members were interviewed, using the Urdu version of a questionnaire modified from that of short explanatory model interview [SEMI] by Jackob et al. Data was analyzed by SPSS version 15 using descriptive statistics. Among sixty family members interviewed 56[93.6%] were males, and 30% of them were uneducated. Clinical presentation in most of the patients was in the form of pseudo seizures. One third of the family members were of the view that conversion symptoms were precipitated by stressful events in the close environment. One third of the informants thought that some of the close relative's behavior was working as maintaining factor behind the mental illness. Most of the family members visited psychiatric facility at "other's" advice. Before contacting the nearby mental health facility most of patients were first taken to faith healers [87%]. Ninety percent of them did not agree with any form of punishment therapy for their patients. Majority of family members had reasonable awareness about the psychological nature of the problem. However they also believe in spiritual and super natural forces as causative factors behind the common psychiatric disorder

Patterns of prescription writing in psychiatric clinics

To screen the prescription-writing pattern of psychiatrists in private clinic in Peshawar for the essential elements of prescriptions and to investigate the prescribing trends at Peshawar. This observational study was carried out at LRH Peshawar on 602 prescriptionsin 5 months duration. The prescriptions were collected from the patients admitted to LRH and the variables were checked and noted directly into electronic form. Averagely 3.34 drugs were prescribed per prescription, in which drug-related variables: [i] strength of medication was indicated for all drugs in 409 [67.94%] of the prescriptions and were missing for some drugs in 177 [29.4%] prescriptions, [ii] total quantity of a drug to be dispensed was indicated for any drug in just over 111[18.43%] of prescriptions, [iii] The instructions for taking the medication were complete in only 301 [50%] of prescriptions. Fluoxetine alone or in combination [8.4%] was the most commonly prescribed antidepressant. There were 319 [15.8%] non-steroidal anti-inflammatory drugs [NSAIDs] and/or analgesics. Vitamin preparations accounted for 4.02% of all drugs dispensed. SSRI's were the most frequently prescribed medication in majority of prescriptions. Inconsistency regarding different prescription components was observed, such as strength of medication, frequency or instruction for medication use etc

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

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

Knowledge and practice of general practitioners about schizophrenia

To obtain information about the number of patients attended by general practitioners in different stages of schizophrenia; relevant knowledge, diagnostic skills and ongoing practice concerning management of patients suffering from severe mental illness. For this cross sectional survey conducted from May to September 2010, a semi-structured questionnaire, obtained and modified from that of Simon AE et al was distributed among general practitioners working in Bannu district. The participants were requested to fill the questionnaire anonymously and return it to research worker. Out of 100, 72 general practitioners responded to the request of filling the questionnaire. Among them 60 [85%] were males. Only 17% replied that they could spare more than half an hour for the assessment of schizophrenic patients. Sixty four percent reported delusions and hallucinations as the most frequent symptoms of schizophrenia. Seventy percent relied on personal history for diagnosis of schizophrenia. Sixty percent practitioners considered pharmacotherapy as the first line therapy. More than half of them wanted to continue treatment for six to twelve months in first psychotic episode. Seventy percent preferred to refer the patients to specialist care for complete handover. No one of the working practitioners participated in continuing medical education CME on schizophrenia during the past few months of their professional life. The knowledge of general practitioners about signs and symptoms of schizophrenia is reasonable but they lack interventional skills. They need easily accessible specialized services for referral and regular training programmes to update their knowledge