Self-insertion of needles by a patient of schizophrenia

Self-insertion of foreign bodies is a rare phenomenon, not commonly seen in clinical practice. We report a case of a young female who presented with pain and pricking sensation. On radiological investigations, self-insertion of multiple sewing needles in different parts of the body, under the effect of hallucinatory voices due to Schizophrenia, was found. Most of the needles were removed by surgical intervention but some are still there. The Schizophrenia is well settled by the initiation and compliance with antipsychotics and no subsequent act of self-insertion was reported. The patient is now being followed up in psychiatric outpatient clinic

Frequency of depression, anxiety and stress in patients referred for endoscopy with symptoms of dyspepsia

OBJECTIVE: This study was aimed to see the frequency of anxiety, depression and stress in patients with dyspeptic symptoms referred for endoscopy

DESIGN: Cross sectional study

SETTING: Department of medicine and psychiatry Baqai Medical University, Fatima hospital, Gadap, Karachi

DURATION: The study was conducted from Jan 2011 to Jun 2011

METHOD: Patients referred from department of medicine with symptoms of dyspepsia were assessed at department of psychiatry Baqai University before endoscopy

A total of 40 patients, fulfilling the inclusion criteria were enrolled for the study and their demographic variables were obtained using a Performa specially designed for this purpose. Urdu version of DASS [Depression Anxiety Stress Scale] was administered to the selected sample to establish the presence of three emotional states--anxiety, depression and stress. The DASS is a 42-item self report instrument designed to measure the three inter-related negative emotional states of depression, anxiety and tension/stress. The findings are mentioned in the results

RESULTS: A total of 40 patients comprising 29 females and 11 males ranging between 15-70 years of age with a mean age of 32.8 years completed the study. In the studied sample of 40 patients, 82.5% had anxiety, 60% had depression and 67.5 % had stress. Moreover 80% of sample group were found to have inflammatory changes on endoscopy and in this group anxiety was the most prominent emotional state. In the remaining 20% who had no inflammatory findings on endoscopy, depression, anxiety and stress were equally prevalent

CONCLUSION: Emotional disturbances in the form of anxiety, depression and stress were frequently seen in patients suffering from dyspepsia and anxiety was the most dominant among these three negative emotional states. Evaluation of anxiety in the management of dyspepsia is suggested

Clozapine induced neutropenia in patients suffering from schizophrenia: a multi centre audit

To determine the frequency of clozapine induced neutropenia and its associated clinical features among the patients suffering from schizophrenia. Cross sectional, comparative study. The study is based on the blood count reports from various centres in Pakistan using Clozapine during a period 1992-2005. The medical records of 917 patients with a diagnosis of schizophrenia, aged 18 years and above were reviewed. Patient's profile was evaluated consisting of gender, dose of clozapine, duration of treatment and complete blood count [CBC] findings including white blood cell [WBC] count or absolute neutrophil count [ANC], before starting the treatment. The case records showing WBC count below 3000 and ANC count less than 500 were identified and details of the clinical and sociodemographic variables were recorded on a proforma. Thirty eight patients [4.1%] developed clozapine induced neutropenia. Median duration of clozapine treatment in these patients was 6.0 years that was significantly higher than Median = 1 year of those patients who did not develope neutropenia [p < 0.001]. An inverse correlation [r = -0.046] was observed between ANC and duration of clozapine induction. Median dose [mg] of clozapine induced neutropenia patients was higher [200 vs. 150, p = 0.262], however statistically insignificant. The incidence of clozapine induced neutropenia of our study is comparable with that of worldwide reported incidence. Prolongation of treatment also increase the incidence

Anxiety and depression in pre-operative catractectomy patients: a pilot study

The objective of this study is to use the hospital anxiety and depression scale which is a valid scale to rule out whether these patients are undergoing anxiety or depression prior to surgery. A random surveillance [prospective]. The department of psychiatry conducted a random survey of all the patients reporting for cataract elective surgery in the Department of Ophthalmology during the months of August and September 2004. In total 52 patients were interviewed, after informed consent out of which fourteen had clinical levels of anxiety where as fourteen had depression. All these patients were rated on a standardized urdu version of hospital anxiety and depression scale. Those suffering from anxiety there were ten females and three males whereas depressed were six males and nine females. In all there was a morbidity of twenty-seven cases out of fifty-two which had either anxiety or depression. Local studies as well as international studies carried out have indicated the importance of recognizing and intervening before surgery. This is to enhance recovery and achieve level of satisfaction in surgery patients. The limitation of this study was the small number of cases selected to conduct the study. Anxiety and depression is very common in patients undergoing surgery. Reassurance and counseling is necessary before surgery

Anxiety assessment in orthopedic patients

Orthopedic specialty is a very versatile specialty, it deals with a wide variety of conditions like degenerative joint disorder, deformities of spine and limbs, including congenital and acquired both, bones and joint infections and of course traumatology which is a major part of orthopedic patient. We did a study to assess pre operative anxiety in orthopedic patients. All the patients above the age of 12 years, admitted to orthopedic unit II of Abbasi Shaheed Hospital, were asked to fill a performa designed to assess different aspects of anxiety- associated problem. The subjects were also inquired about their knowledge of imminent surgery being, its out come and the time period required to get back to their daily activities. Fifty eight percent of patients were anxious about their upcoming surgery, They were anxious due to different reasons like surgery. anesthesia, pain, the risk of complications and of becoming dependent on others. Our study showed a significant proportion of orthopedic patients undergoing surgery as being anxious. In this regard, social and occupational therapist can play a major role in reducing the anxiety of our patients by doing detailed counseling and making the patients maximally aware of their surgery

Validity of visual analogue scale in assessment of anxiety: a comparative study in anesthesia clinic

To compare the level of Pre-Operative anxiety in patients reporting 24 to 72 hours before Surgery in Government Hospital, with patients assessed 24 to 72 hours before Surgery in Private Hospital. Comparative study. Out patient Anaesthesia clinic at Karachi Medical and Dental College, Abbasi Shaheed Hospital and Imam Clinic and General hospital North Nazimabad Karachi from January 2004 to October 2004. Two groups of 20 patients each were studied who underwent Abdominal hysterectomy. Group-A patients were assessed in Pre-Anaesthesia out patient Clinic 24 to 72 hours before admission in Abbasi Shaheed Hospital [Government hospital] and Group-B had Pre-Anaesthesia assessment 24 to 72 hours before surgery in private sector hospital. The visual analogue scale of anxiety [VAS] was used to assess anxiety in patients participated in study and p-value was derived by using independent t-test: The median anxiety score is 4[2-6] in Group A and 6[4-9] in Group-B. This anxiety score [VAS] is significantly lower Group-A when compared with Group-B [P< 0.01]. We conclude that Pre-Anaesthetic assessment in Anaesthesia clinic 24 to 72hours before Surgery in Government Sector hospital reduces Pre-Operative anxiety more when compared with an Pre-Anaesthesia assessment in private sector hospital