Pattern of tobacco consumption among adult women of low socioeconomic community. Karachi, Pakistan

To assess pattern and to determine risk factors associated with tobacco consumption in various forms among adult women above 18 years of age in a low socioeconomic community of Manora Island, Karachi. A cross-sectional survey was conducted and 200 adult women above 18 years of age were selected using systematic sampling with random start from a community of 5000 people in Manora Island, Karachi. There were 400 households in the community. Every 2nd household was visited and a woman above 18 years was selected. A semi-structured pre-tested questionnaire was administered to respondents by investigators. Data on tobacco consumption and other variables such as age, sex, marital status, education, employment and stress and anxiety related symptoms were obtained. A total of 104 [52%] reported tobacco consumption. Use of huqqa [hubble bubble] was more prevalent [79%]. Women above 30 years of age, being married and living in a joint family were more likely to consume tobacco. Illiterate women as compared to women with more than five years of schooling were more likely to consume tobacco [OR=3.16,95% CI=1.13-7.72]. Women having household income more than 5000 rupees were more likely to consume tobacco [OR=2.63,95% CI=1.36-5.09] and face more financial difficulties at home [OR=4.72, 95% CI=2.45-9.81]. Women consuming tobacco reported anxiety related symptoms more as compared to women who did not consume tobacco. Our study concluded that in this particular study setting, huqqa is the commonest form of tobacco consumption among women of low socioeconomic class. They start huqqa usually in childhood and after marriage by peer pressure especially in joint families. Women consuming tobacco report more psychosomatic symptoms and financial difficulties at home

Liaison psychiatry and referral rates among hospitalized patients

The study was conducted to assess the psychiatric co-morbidity among general hospital patients and their rate of referrals. Design: A hospital based descriptive observational study. place and duration of study: The study was conducted in a private teaching hospital for a period of 6 months. Method: All admitted patients in different disciplines were assessed on a structured proforma supplemented by detailed psychiatric interview on positive cases. Morbidity patterns were assessed on the basis of ICD-10 classification. The total referral record was also maintained and compared with the data of morbidity and the number of referred cases. Out of the total 487 patients seen, 180 patients were found to have psychiatric co-morbidity; depression outnumbered all psychiatric disorders followed by mixed anxiety depression and somatoform disorders. Married female formed the majority group and the vulnerable age was between 41 to 60 years. Large segment of patients belonged to the discipline of internal medicine with the lowest [12%] referral rate. Out of 121 patients, referred from department of psychiatry, 44% were seen by the department of medicine followed by the gynecology and other disciplines. There is generally a low referral rate despite significant mental health co-morbidity. Training is needed for non-psychiatrists and there is a need for development of consultation-liaison psychiatry services in hospitals

Patterns of mental health morbidity

A retrospective study was conducted on patients attending a community psychiatric clinic to assess the mental health morbidity. Design: A retrospective type study. Place and Duration of Study: The study was conducted in a community psychiatric clinic, located in the central district of Karachi, during the period 1998-2000. Subjects and One thousand four hundred and thirty patients attending a community psychiatric clinic were included in the study. A comprehensive proforma was developed to ascertain the psychiatric diagnosis, relevant management and prognosis along with brief demographic profile and a comparative trend in diagnosis was recorded. The results of the study showed high prevalence of various types of mental disorders like depression 51.9%, anxiety neurosis 5.9%, schizophrenia 6.2%, substance abuse 1.9%, seizure disorder 17.6%, behavioral disorder 4.2%, personality disorder 0.8%, psychosomatic disorder 8.9%, mania/hypomania 3.9%, sexual disorder 3.2%, mental retardation 3.3%, dementia 2.3%, unspecified psychosis 1.9% and obsessive-compulsive disorder 2.7%. It was concluded that there is a high mental health morbidity among patients presented to psychiatric clinic in District Central which implies the high prevalence of mental disorders in Karachi. Moreover, the study also stresses the need to replicate this type of study on national level and conduct more studies for comparison

preliminary study of educational intervention program for altenative mental health practitioners

This paper is based on an original doctoral study on the subject of ethnopsychiatry, which looked into the aspects of comparative management by the psychiatrists and ethnotherapists in relation to mental illness. It emerged that the ethnotherapeutic treatment was beneficial in some aspects but hazardous in many others. It was decided to conduct a training program for selected ethnotherapists with the aim of bringing a change in their practice whereby they could understand the theoretical background of mental illness, act as psychotherapists and refrain from hazardous practice. A selected group of ethnotherapists was included in the study on the basis of convenience sampling and were given the educational package which followed the periodical review of the impact of training on their resultant practice. The study was conducted in Karachi for duration of 12 months. The educational intervention program demonstrated beneficial outcome as the practice of the members of the study group improved and they refrained from hazardous practice. It was concluded that with suitable training, the ethnotherapists can collaborate effectively with the mental health practitioners, thus, becoming helpful in strengthening the existing mental health services

Magnitude of stress among medical practitioners

It has been observed that the medical practitioners are becoming excessively vulnerable to the stress which affects the general health and the mental health in particular. In order to assess the magnitude of stress and its resulting complications, a study was conducted with the help of 150 doctors from all five districts of Karachi through random selection [lottery method] who were given questionnaires to fill-in and were interviewed in the second stage. Of the respondants [n= 143] 55 percent of the doctors were highly stressed because of academic, work and financial challenges with bleak hope for future prospects, 35 percent were stressed because of dealing with patients and relatives while the remaining number of doctors were stressed because of time, family and other factors. It was concluded that the magnitude of stress has reached alarming proportion and there is a need to take steps towards reducing stress factors

Mental health morbidity pattern in Pakistan

Pakistan is a developing country with meager mental health facilities, low number of psychiatrists and dearth of systematic data on mentally ill patients. A study was conducted with a view to obtain data on mental health morbidity patterns and the socio-demographic profile of mentally ill patients. Sixty psychiatrists who met the agreed criteria were included in the study and were asked to fill-in a questionnaire eliciting relevant information. The results indicated that 45 percent of the patients attending these psychiatrists were suffering from depression, 17 percent from schizophrenia, 11 percent from substance abuse disorder and 2 percent from dementia besides other mental disorders. Antidepressant regime outnumbered all other treatment methods. It was reflected that depression was commonest followed by schizophrenia and substance abuse disorder. It was concluded that there was a high number of psychiatric disorders among patients attending clinics and hence there is a need to conduct and compare studies, which are community-based in order to get elaborate insight into the magnitude and prevalence of mental disorders

Shamanic concepts and treatment of mental illness in Pakistan

A study was conducted to learn about shamanic concepts and treatment of mental illness. For this purpose 100 shamans were selected by lottery method and a questionnaire was administered supplemented by interview to determine their educational and training background, concepts about mental illness, and methods of diagnosis and treatment. Causes commonly attributed were Jinn [50%], evil influence [20%], evil eye, magic and witchcraft [10%], and medical reasons [10%]. Treatment offered included amulets, holy water, rituals, recitation, talisman, etc. Study findings highlight the importance of understanding cultural issues, placebo effects of the treatment regime and knowledge of folk beliefs

Depression among abused children

A study was conducted on 200 children who were diagnosed and managed for the clinical problem of depression in a community mental health clinic of Karachi. A questionnaire supplemented by detailed mental state examination and personal in depth interview inquiring specifically about the social circumstances of these children were used as tools. The results indicate that 65% of the children were the victim of torture in the form of either physical or sexual abuse, emotional deprivation, false implication in crimes and harassment by employers. Remaining 35% of children were the victims of social disadvantages like poverty, lack of opportunity for education, poor residence, large family size or need for work. The different manifestations of depression were in the form of behavioural disorders academic failure and conduct disorders. There is an urgent need to address this problem in order to prevent the mental health morbidity among the juvenile population at all levels

Children of the corn A study conducted at juvenile prison in Karachi - overview I

A study was conducted in Juvenile Prison of Karachi where children and adolescents are kept in custody on account of various charges. 200 children were interviewed in the initial stage with the help of a questionnaire aiming at getting demographic information, reviewing social milieu, examining crime circumstances, custody details, biological profile, psychiatric assessment and the prognostic prediction. The preliminary results indicate that 78.6% were subjected to severe torture during investigation, 17.4% were subjected to torture while in custody, besides being deprived from other basic rights, emotional and psychological support. Majority of these children were the victims of social disorganization, poverty, lack of opportunities, faulty role model, and evil influence of political scenario. The psychological consequences of the circumstances leading to incarceration and the agony of the non-conducive custody environment are manifested in depression, anxiety, neurosis, psychosis, seizure disorder along with physical ailments. 52% of these children needed psychotherapeutic intervention while 17% were in need of psychotropic medication in addition to psychotherapy. 9% of these children had psychopathic traits in their personality and there remain chances that they would form potential group of criminals unless corrective rehabilitative measures are taken. It is concluded that preventive measures should be taken at primary, secondary and tertian levels to avoid psychiatric morbidity and to prevent these children from becoming potential criminals

Knowledge of depression among general practitioners

General practitioners [GPs] are the backbone of any health care delivery system. This is also true for Pakistan where a large number of patients approach them as a first line of care for their health related problems. Among psychiatric illnesses, depression is the most common and a cause of great psychiatric morbidity. Most of the patients presenting to general practitioners with the problem of depression are treated for physical illness and hence the core problem remains unaddressed. A study was conducted with the aim of assessing the level of knowledge among the general practitioners about depression. A proforma comprising objective test items was designed and administered to 115 GPs from all the districts of Karachi who were conveniently selected. The expected standard of answers was compared with the answers given by the GPs. This proforma besides eliciting demographic information also yielded a score which when converted into a percentage scale gave a mean score of 33.9%. On the basis of the international standard, a score of 60 was acceptable in order to judge that the knowledge was adequate. The scoring did not have significant association with the years of practice, age group and postgraduate qualification of the general practitioners. It was thus concluded that the level of knowledge of GPs about depression was inadequate and there was a need to improve undergraduate training in psychiatry and promotion of continuing medical education for general practitioners