Depressive symptoms, monoamines levels, MAO-B activity and effect of treatment in a subset of depressed individuals from government sector hospital at Karachi

Depression is one of the leading causes of disability in developing countries including Pakistan. This study was designed to assess the frequency and severity of depressive symptoms, monoamines and their metabolite levels, MAO-B activities before and after treatment with antidepressants in a sub-set of Karachi population in Pakistan. Drug naive depressed subjects were evaluated before and after treatment with selective serotonin reuptake inhibitors. Symptoms of depressed mood and anxiety psychic [90%] were more frequent whereas, suicidal thoughts [tilde50%] and feelings of guilt [tilde30%] were less common. Hamilton Depression Rating Scale scores were 21.4 +/- 0.8 in both genders with a significantly higher score [1.3x] in females. Homovanillic acid, 5- hydroxyindoleacetic acid and MAO-B activity were significantly higher 43%, 66% and 25% respectively, in depressed than normal subjects. A significant decline after 2 weeks treatment in HDRS scores with fluoxetine [19%] and paroxetine [40%] and in MAO-B activity [20%] was observed. In conclusion, in our population early decline in HDRS scores supports that they are SSRIs responders, whereas a concomitant reduction in MAO-B activities indicates that it can be considered as one of the parameters for early detection of response. Additionally, the low frequency of suicidal thoughts could be associated with higher levels of monoamine metabolites

Internally displaced persons [IDPS]; anxiety and depression

Most internally displaced persons [IDPs] live in low-income countries experiencing a war; their psychosocial health has not been well addressed. Objectives: To find out the prevalence of anxiety and depression in internally displaced persons [IDPs]. Design: A r and omized cluster sampling, case-controlled study. Period: 10th April 2009 to 10th July 2009. Setting: This study was conducted at Kacha Ghari camp and Sheikh Yaseen camp for IDPs. Patients and Method: A total of 220 cases [those whom were exposed to traumatic experiences] were selected through cluster r and om sampling. 220-matched controls [those whom were not exposed to traumatic experiences] were selected same day using the same sampling method. Both sexes were included. Socio-demographic information was obtained from IDP- information form. Anxiety and depression was assessed using Hopkins symptoms checklist – 25 [HSCL-25]. SPSS version -17 was used for statistical analysis. Chi square test was applied for group comparison to calculate statistical significance. Results: More than half of the participants [60 %] in this study were in age group between 18 to 38 years. 55 % of the population were females. Majority of participant were married [86% - 90%] and were uneducated [74% - 90%] belongs to lower socio-economical class. The total Scores and the Depression Scores on Hopkins symptoms checklist – 25 [HSCL-25], were significant high in case group than in control group with the P values of 0.04 and 0.05 respectively. Discussion:Traumaandtorture leaves a permanent scar on the survivors. It has physical, psychological and social squeals. Hopkins Symptoms Checklist-25 is intended to provide primary care physicians, mental health practitioners and other health care providers with an instrument for detecting anxiety and depression in torture and trauma victims. Conclusions: Besides being displaced from their residence exposure to trauma come out to be the important causative factor in creating psychological disturbance among internally displaced persons.

Breast cancer; frequency of risk factors

To assess the risk factors for breast cancer in patients attending oncology OPD of civil hospital Karachi, Pakistan. Introduction: Breast cancer is the single largest cause of death among women1,2. The probability of American woman developing breast cancer in their life is 7 in 11. Studies from subcontinent show that the incidence of breast cancer is increasing, with an estimated 80,000 new cases diagnosed annually. Breast cancer is the second most common type of cancer after lung cancer in Pakistan and ranked first in women. Only 10% women are diagnosed, out of them, 75% women do not get treatment and die within 5 years6. Data from Pakistan about the risk factors or association is not only scanty but also does not comment on the use of fatty diet in breast cancer patients. A cross-sectional descriptive study conducted at Oncology OPD of civil hospital Karachi [CHK] from October 2009 -April 2011. One Hundred and Fifty consecutive patients having histopathalogical diagnosis of breast cancer were assessed for different risk factors that included marital status, parity, age, menopausal status, family history of breast cancer, prolong use of oral contraceptives, breast feeding, , early menarche, trauma to the breast and fatty diet. Mean age of patients was 48 years. Three fourth [73%] of these female were above the age of 40 years. Consumption of fatty diet was found in 62.67% while positive family history of breast cancer was present in 34% of the cases. Early menarche and being nulliparous were not as strong risk factors as in previous studies. Our study has highlighted the need of further exploration in this area that would not only help this population but also enhance our understanding of different risk factors. This will have important implications for the overall management of breast cancer

Comparison between helicobacter pylori fecal antigen detection and endoscopic gastric biopsy in diagnosis of H. Pylori infection in 50 adult cases

Objective: To compare the effectiveness of fecal antigen detection test with gastric biopsy via upper GI endoscopy for H pylori

Design: Comparative, observational, non- randomized

Place and Duration of Study: Sultan Qaboos University Hospital, Oman. February 2005 - February 2006

Patients and Methods: Fifty patients with epigastric pain and heart burn were subjected to upper GI endoscopy and gastric biopsy for H. pylori and at the same time stool was sent for fecal antigen detection for H. pylori

Results: Out of 30 females, 12 had biopsy proven H. pylori while 5 had positive fecal antigen test. In 20 male patients, 15 had positive biopsy while 12 had fecal antigen proven H. pylori

Conclusion: This study doesn't prove the effectiveness of fecal antigen detection test in comparison with upper GI endoscopy and biopsy, which is the gold standard test for H. pylori. Hence we cannot recommend the test to replace upper GI endoscopy and biopsy despite of the low cost and less trouble to the patient

Preferred antipsychotic by mental health professionals of Sindh and Balauchistan

Objective: To determine the preferred antipsychotic drug of mental health professionals

Material and Methods: This cross-sectional survey was conducted among mental healthcare professionals of 25 public/private healthcare facilities of Sindh and Blochistan provinces form April 2007 to March 2008. After approval from ethical committee of Dow University of Health Sciences mental health professionals [trainees, consultants with experience only and consultant with postgraduate qualification] present on the day of visit to a facility were approached and asked to fill a semi-structured questionnaire to determine the preferred antipsychotic for patient as well as for themselves if they got ill and the factors they consider while choosing that antipsychotic. Descriptive analysis of the data was performed by SPSS v. 14

Results: One-hundred five mental health professionals were divided in 3 groups i.e. trainees [29], experienced doctors [24] and consultants psychiatrists [52]. They have almost equal experience of using typical [48%] and atypical [49%] antipsychotic, but when asked to chose antipsychotic for themselves, atypical [81%] were preferred over typical [14%] antipsychotic with Risperidone as the most common choice [55%] followed by quetiapine, olanzapine and clozapine. Regarding the factors influencing prescription, efficacy and safety were most considered factor while choosing antipsychotic for themselves as compare to efficacy and cost while experiencing prescription for patients

Conclusion: Clinical approach varies while prescribing anti-psychotic drug for the patients and for themselves between typical and atypical. Efficacy and safety were considered while choosing for themselves, whereas efficacy and cost while prescribing for patients

Depression and drug non- adherence

To determine the different levels of drug non-adherence in patients suffering from Depression. A case-controlled study. Hayatabad Medical Complex Peshawar, From February 2008 to August 2008. 50-Cases were selected from the out patient department with the DSM-IV diagnosis of major depressive disorder, 50- non psychotic patients were selected as controls. Both sexes were included. The basic socio-demographic characteristics and the clinical profile of all the patients were collected. The level of drug non-adherence was recorded at week 4, week 8 and week 12. SPSS version 15 was used for statistical analysis. The applied method for group comparison was the Chi-square test. The age in mean was 33.78 +/- .30 for the sample and 30.65 +/- 40 for control group. 38% of these patients were males and 62% females. 58% were married and uneducated from lower socio-economical class. 70% of the study group and 59% of control group received treatment. The rates of non adherence were statistically not significant at week 4. However, at week 8 and week 12 the rates of non adherence were statistically significant with the p values of less than [0.001] respectively. Rates of non-adherence with psychotropic / antidepressants are difficult to summarize because they vary with setting, diagnosis, severity of illness and type of adherence difficulties. Drug non-adherence is a serious clinical problem and it has direct effects on illness management and prognosis. The available evidence suggests that the outcome for patients who vary medication doses without consulting a professional is poor

Association of order of birth with schizophrenia

To asses the association between Birth Order and Schizophrenia in relation to other demographic factors. A cross sectional study was done and data of twelve hundred and eight patients were evaluated and managed in the psychiatric department of Isra University Hospital, Hyderabad. Eighty two Schizophrenics were compared with the rest of the psychiatric population with reference to gender, catchment area, and family type. Statistically no significant difference was found between any of the birth order for the risk of Schizophrenia. Risk of Schizophrenia appears to be minimum in first born males, and maximum in first born females, but this does not reach statistical significance. Risk apparently seems to decrease as birth order goes down among urban setting; and decrease as birth order goes up; but again this finding does not reach the level of statistical significance. There appears to be no association between any birth order and risk of Schizophrenia, in our studied population

Factors determining, the time lost between onset of psychiatric disorders and first psychiatric consultation

To find out delay between onset of psychiatric illness and first psychiatric consultation; and the factors leading to such delay. Retrospective Study. Isra University Hospital from January 2002 to February 2004. The record of patients who had attended for psychiatric consultation at Isra University Hospital from January 2002 to February 2004; was transferred to a proforma on which demographic characteristics, diagnosis, delay and reason of delay in psychiatric contact after first onset of psychiatric disorder was recorded. The data was subjected to analysis after being fed on SPSS. Descriptive Statistics, i.e. frequencies, percentages and means were calculated. An average delay was of about 36.34 months. Neurotic patients, Females [37.63 months, as compared to 33.93 months' delay of males], and patients belonging to urban catchments [delay of 37.37 months as compared to 39.59 months' delay], had greater delay. Lack of awareness [25.41%] was found to be the most common reason for delay, followed by Un-reachable psychiatric facility [23.01%], non-affordability [21.27%], Stigma feeling [19.03%] and misconception that medicines are addictive [11.25%]. The delayed psychiatric help was pervasive in majority of people with the psychiatric disorders, studied. Most common reason of delay was found to be the lack of awareness about psychiatric illness

Birth order and depressive disorder

Objective: to determine any relationship of birth order with depressive disorder

Method: this is a retrospective study from record of twelve hundred and eight patients who attended psychiatric department in OPD and wards of Isra University Hospital Hyderabad between January 2002 and February 2004 out of which 626 were diagnosed as cases of Depressive Disorder who were compared with the rest of the population. These were also studied with reference to gender, catchment area, and family type. Data were analyzed on 13th version of SPSS

Results: cases with depressive disorder were clustered in birth order-two; 36.42% of depression patients were found out to be birth order-two. The pattern remains almost the same irrespective of gender, catchment area, and family type

Conclusion: birth-order two is found to be more vulnerable to depressive disorder in our sample

Correlation of Urdu version of hospital anxiety depression scale and Hamilton depression rating scale in quantifying depression among post-myocardial infarction patients

Objective: to validate the use of Urdu Version of Hospital Anxiety Depression Scale as screening as well as quantifying tool for depression among non-psychiatric hospital population

Material and methods: this retrospective study was conducted at National Institute of Cardiovascular Disease [NICVD] Karachi and Civil Hospital Karachi [CHK] from 23rd October to 22nd November 1998. We searched the record of a previous study on the patients on myocardial infarction. A comparison of scores of Hospital Anxiety Depression Scale and Hamilton Depression Rating Scale, done on the patients with first myocardial infarction at an interval of about two weeks during hospitalization and after their discharge, was made

Results: correlation co-efficient between Hospital Anxiety Depression Scale scores and Hamilton Depression Rating Scale scores was found to be statistically significant [r =55; p<0.001]

Conclusion: results suggest that Hospital Anxiety Depression Scale can be used as an effective tool to screen and quantify depression

Socio-demographic correlates of stigma attached to mental illness

Objective: To identify socio-demographic correlates of stigma attached to psychiatric illnesses

Method: This is a retrospective study. Data of the patients who had attended psychiatry department; either as a referral or direct consultation; and as in-patient or outpatient; at Isra University Hospital at Hyderabad during the years 2001 to 2004, were reviewed and presence or absence of stigma feelings were compared to their socio-demographic backgrounds. Demographic characteristics of a total of 1208 patients with different psychiatric illnesses were recorded. Data obtained, was subjected to analysis using SPSS 13[th] version

Results: Feelings of stigma was present in forty seven percent of the studied population. Males had slightly more feelings of stigma. People from urban areas were also carrying more feelings of stigma but it was statistically insignificant. Apart from people with no formal education who had maximum stigma feelings; education level was found to increase such feelings, in the population studied

Conclusion: In our studied population, feeling of stigma seems to prevail in every demographic class; this is specially so among neurotics, male gender, urban patients. Level of education has interesting relation with the feeling of Stigma, which is found to increase with level of education