Attitude towards mental help-seeking, motivation, and economic resources in connection with positive, negative, and general psychopathological symptoms of schizophrenia: a pilot study of a psychoeducation program.

Introduction: Schizophrenia is typically treated with medication as the first approach, but additional strategies are necessary to enhance the effectiveness of this treatment for better outcomes. However, it is crucial to explore methods, alongside medication, that promote a positive attitude towards seeking mental health support and alleviate symptom severity among non-institutionalized individuals of different age groups in Pakistan. Thus, this pilot study aimed to utilize a psychoeducation program to enhance patients' motivation and attitudes toward seeking treatment, decrease symptom severity, and investigate the role of financial factors in their illness journey. Methods: In this preliminary investigation, our focus was on individuals who had been diagnosed with schizophrenia and were receiving treatment from various hospitals and primary care clinics. Following a thorough screening process, 255 participants met the eligibility criteria, and 220 completed the psychoeducation program. The study included both male and female participants, with 143 (56.08%) being men and 112 (43.82%) being women. Regarding marital status, 123 (48.24%) were single, 98 (38.43%) were married, and 34 (13.33%) were divorced widowers or widows. The age range of the respondents varied from 18 to 52 years, with a mean age of 35.45 and a standard deviation of 10.27. Results: The results indicated a decrease in symptom severity following a 16-week psychoeducation program. The psychoeducation program significantly reduced the positive symptoms, negative symptoms, and general psychopathological symptoms among patients. Similarly, significant improvement was observed in patients' motivation toward treatment and they actively participated in treatment after getting psychoeducation about the treatment. Similarly, after the psychoeducation program significant improvement was seen in patients' attitudes towards help-seeking and perceived mental health functioning. Conclusion: In summary, the findings suggest that our psychoeducation program has the potential to positively impact the motivation and help-seeking attitudes of schizophrenia patients towards treatment. Moreover, there is a need for further exploration of psychoeducation programs for schizophrenia, particularly in countries facing economic challenges. This study paves the way for the development of an indigenous psychoeducation program tailored to Pakistani schizophrenia patients, with potential applicability for Urdu-speaking individuals. Clinical Trial Registration: https://www.thaiclinicaltrials.org/show/TCTR20210208003, identifier TCTR20210208003.

The Leading Role Of Evidence-Based Practices In The Treatment Of Patients With Substance Use Disorders: A Systematic Review.

Objective: To explore the effectiveness of motivational interviewing, motivational enhancement therapy, and cognitive behaviour therapy for patients with substance use disorders, and to estimate the effect of such comparison in patient care setting. METHODS: The systematic review was conducted from September 2021 to February 2022, and comprised search on MEDLINE, EMBASE, Web of Science, PsycINFO, Google Scholar, Science Direct, PubMed, Clinical Trials.gov and OvidSP databases for experimental studies and randomised controlled trials related to substance use disorders published in peer-reviewed English-language journals between 2001 and 2021. Quality of the studies was assessed using the Modified Cochrane Collaboration risk of the bias assessment criteria. RESULTS: Of the 314 studies initially identified, 41(13%) were subjected to full-text assessment, and, of them, 16(39%) were reviewed and analysed. There were 8(50%) studies done is the United States, 4(25%) in the United Kingdom, and 1(6.25%) each in Germany, Australia, South Korea and South Africa. All the 16(100%) studies were intervention-based, with 6(37.5%) being randomised controlled trials. There were 8(50%) studies using motivational interviewing and cognitive behaviour therapy, 5(31.25%) had significant results with a combination of motivational enhancement therapy and cognitive behaviour therapy, 3(18.75%) supported motivational enhancement therapy and cognitive behaviour therapy in combination, and 2(12.5%) studies combined motivational interviewing, motivational enhancement therapy and cognitive behaviour therapy, reporting significant results while simultaneously addressing multiple patient variables. Conclusion: All studies were heterogeneous. Motivational interviewing produced short-term treatment outcomes and played a supportive role in sustaining motivation. Motivational enhancement therapy was an effective therapeutic intervention that significantly addressed inadequate causes, and enhanced motivation for treatment. Cognitive behaviour therapy had a short-term impact and remained influential in the long term as well in handling cognitive and behavioural setbacks.

Brief cognitive behavior therapy for stigmatization, depression, quality of life, social support and adherence to treatment among patients with HIV/AIDS: a randomized control trial.

OBJECTIVE: Individuals living with HIV/AIDs are at a high risk of many problems like depression, stigma, quality of life, decreased adherence to treatment, and lack of social support. The present study aimed to investigate the impact of brief-cognitive behavior therapy (B-CBT) on reducing depression and stigma and improving treatment adherence, quality of life, and social support among patients with HIV/AIDS attending antiretroviral therapy (ART). MATERIALS AND METHODS: This randomized clinical trial was conducted at ART Clinic in the Tehsil Headquarters Hospital Shahkot Nankana Sahib from July 2021 to October 2021. After baseline screening, 126 patients met the eligibility criteria and 63 were allocated to the experimental group (EXPg = 63) and 63 to waitlist-control group (WLCg = 63). Participants' age range was from 20 to 55 years. Participants who were taking ART treatment were enrolled for the CBT treatment. Before this, all the participants completed a baseline assessment to ensure a level of severity and diagnosis. A total of eight CBT based therapeutic sessions were conducted individually with EXPg. To assess the outcomes among patients receiving ART, we used Demographic form, Patient health questionnaire, HIV stigma scale, General medication adherence scale, Multidimensional scale of perceived social support, and WHOQOL BREF scale. RESULTS: Findings suggest that B-CBT significantly reduced the level of depression (i.e. F (1, 78) = 101.38, p < .000, η2 = .599), and social stigma (i.e. F (1, 78) = 208.47, p < .000, η2 = .787) among patients with HIV/AIDS. Furthermore, CBT substantially improved the level of adherence to treatment (i.e. F(1,78) = 24.75, p < .000, η2 = .503), social support (i.e. F (1, 78) = 128.33, p < .000, η2 = .606), and quality of life (i.e. F (1, 78) = 373.39, p < .000, η2 = .837) among patients with HIV/AIDS. Significant mean difference M(SD) on PHQ at post-analysis in the EXPg vs. WLCg was seen 1.22(0.47) vs. 2.30(0.68) and similarly, on MPSS at a post-analysis in the EXPg vs. WLCg 2.85(0.36) vs. 1.70(0.51) which indicates sound therapeutic outcomes. CONCLUSIONS: Cognitive behavioral therapy effectively decreases the level of depression and stigma and enhances the level of social support, quality of life, and adherence to treatment among HIV/AIDS patients. It is concluded that cognitive behavior therapy is an effective treatment approach for patients with HIV/AIDS. TRIAL REGISTRATION: Thai clinical trial registry (i.e. TCTR = TCTR20210702002 ).

Distress tolerance, anxiety-related symptoms, stress, and depression among dropout and non-dropout university students: a mediation analysis.

This study explores the relationship between distress tolerance and depression with mediating role of anxiety-related symptoms and stress among dropout and non-dropout university students. This cross-sectional study was conducted from October 2019 to December 2020. Participants' age ranged between 20-40 years. Data was collected using the Distress Tolerance Scale and Depression Anxiety and Stress Scale. Descriptive, t-test, and mediation analyses were performed to calculate the results. A sample of 500 respondents was recruited. A significant difference was noted between dropout and non-dropout students on CGPA (p<0.001), depression (p<.001), anxiety (p<0.001), stress (p<0.001), tolerance (p<.001), absorption (p<0.001), appraisal (p<0.001), and distress tolerance (p<0.001). Mediation analysis reveals that stress and anxiety significantly mediates between distress tolerance and depressive symptoms (i.e., F (498) = 31.14, p<0.001; F (498) =34.14, p<0.001; F (496) = 161.21, p<0.001). It is concluded that low distress tolerance increases stress and anxiety, triggering depressive symptoms.

Cognitive behavior therapy for diabetes distress, depression, health anxiety, quality of life and treatment adherence among patients with type-II diabetes mellitus: a randomized control trial.

OBJECTIVE: Diabetes distress typically causes depressive symptoms; common comorbidity of diabetes unpleasantly affects patients' medical and psychological functions. Psychotherapeutic interventions are effective treatments to treat depressive symptoms and to improve the quality of life in many chronic diseases including diabetes. The present study investigated the efficacy of cognitive behavior therapy (CBT) to treat depressive symptoms in patients with type 2 diabetes mellitus (T2DM) using experimental and waitlist control conditions. MATERIALS AND METHODS: A total of 130 diagnosed patients with T2DM were taken from outdoor patients services of different hospitals in Faisalabad. Ninety patients met the eligibility criteria and were randomly assigned to experimental (n = 45) and waitlist control (n = 45) conditions. All the patients completed clinical interviews and assessment measures at pre-and post-assessment stages (16 weeks intervals). Medical consultants at the respective hospitals diagnosed the patients on the base of their medical reports and then referred those patients to us. Then we used different scales to assess primary and secondary outcomes: Diabetes Distress Scale (DDS) and Patient Health Questionnaire (PHQ) to assess primary outcomes, and a Short Health Anxiety Inventory (SHAI), a Revised Version of the Diabetes Quality of Life Questionnaire (DQLQ), and a General Medication Adherence Scale (GMAS) were used to investigate secondary outcomes. Repeated measure ANOVA was used to analyze the results. RESULTS: The findings indicated that patients who received CBT got a significant reduction in their diabetes distress F(1,60) = 222.710, P < 0.001, η2 = .788), depressive symptoms F(1,60) = 94.436, P < 0.001, η2 = .611), health anxiety F(1,60) = 201.915, P < .0.001, η2 = 771), and a significant improvement in their quality of life F(1,60) = 83.352, P < 0.001, η2 = .581), treatment adherence F(1,60) = 67.579, P < 0.001, η2 = .566) and physical activity schedule F(1,60) = 164.245, P < .0.001, η2 = .736 as compared to the patients in waitlist control condition. CONCLUSION: It is concluded that cognitive behavior therapy is an effective and promising intervention for depressive symptoms, diabetes distress, and health anxiety which also helps the person to promote quality of life, treatment adherence and physical activity.

Reliability and validity estimation of Urdu version of Children Emotion Management Scales (CEMS) in Pakistan.

Introduction: The present study aimed to translate and validate Children's Emotion Management Scales into Urdu, the national language of Pakistan. Method: The current study comprised three different phases, i.e., phase I: Cross-language validation over a sample of (N = 169) school children, estimated at a 1-week interval. Results: The results indicate a significant correlation (r = 0.846-0.891) at p < 0.01. In phase II, the internal consistency reliability (r = 0.808-0.904) and split-half reliability (r = 0.737-0.898) of the scale were assessed (N = 683) at p < 0.01. Furthermore, significant results for test-retest reliability analysis (N = 168) were obtained (r = 0.736-0.917 at p < 0.01), following the confirmatory factor analysis (CFA) (N = 1,083). Exploratory factor analysis (EFA) was conducted on the same sample chosen for CFA. EFA resulted in the retention of original inhibition (INH), dysregulated expression (DYS), and emotional coping (EMO) factors. CFA findings suggest a good model fit. In phase III, convergent validity and divergent validity were checked (N = 385, 255, and 213). Convergent validity of INH and DYS subscales and divergent validity of EMO subscales were established, with SBI (r = 0.217-0.609; 0.210-0.445; -0.026 to -0.553), SHS (r = 0.417-0.441; 0.480-0.546; -0.338 to -0.582), and suppression subscale of ERQ (r = 0.430-0.480; 0.468-0.522; -0.245 to -0.369) at p < 0.01. For divergent validity of INH and DYS subscales and convergent validity of EMO subscales, their scores were correlated with the SPS (r = -0.204 to -0.350; -0.318 to -0.459; 0.191-0.531), RSE Scale (r = -0.226 to -0.351; -0.279 to -0.352; 0.255-0.507), DTS (-0.290 to -0.617; -0.369 to -0.456; 0.246-0.680), and reappraisal subscale of ERQ (r = -0.456 to -0.541; -0.329 to -0.544; 0.446-0.601) at p < 0.01. Discussion: It is concluded that the scale is reliable and valid with sound psychometric properties.

A clinical trial of cognitive behavior therapy for psychiatric comorbidity and quality of life with Cancer Patients during Chemotherapy (CPdC).

BACKGROUND: Cancer is a common worldwide illness; it evokes psychological distress at different stages, during chemotherapy patient perceives a variety of psychiatric symptoms due to various medication side-effects and psychological distress. Studies have shown a significant impact of cognitive behavior therapy (CBT) in the management of psychiatric symptoms during chemotherapy. This study aims to investigate the effectiveness of CBT for depression, anxiety, stress, death anxiety, satisfaction with life, and self-esteem among cancer patients during chemotherapy (CPdC). METHODS: Place and duration of the study: Department of Applied Psychology, Government College University Faisalabad in collaboration with Department of Oncology, Allied Hospital Faisalabad from November 20, 2020 and July 31, 2021. A total of 90 cancer patients were enrolled. 70 out of 90 met the eligibility criteria and 60 participants fulfilled all requirements. Participants were randomly allocated to four different groups. The pre-assessment screening was started along with the first trial of chemotherapy. The CBT-based treatment plan was formulated and one session per week was given to each patient for 3 to 4 months. Participants' age range was 18-65 years (M ± SD = 47.51 ± 12.36. Demographic form, Depression Anxiety and Stress Scale (DASS), Death Anxiety Scale (DAS), Satisfaction with Life Scale (SWLS), and Rosenberg Self-Esteem Scale (RSES) were administered. Descriptive, t-test, and repeated measure ANOVA statistics were used to investigate the findings. RESULTS: Results indicated significant mean difference on the variable of depression, anxiety and stress across four conditions (i.e. F(2, 56) = 39.55, p < .000, η2 = .679; F(2,56) = 73.32, p < .000, η2 = .797; F(2,56) = 119.77, p < .000, η2 = .865 respectively). On death anxiety significant difference across four conditions was found (F(2,56) = 22.71, p < .000, η2 = .549) with large effect size. Furthermore, findings indicated significant mean difference on the variable of satisfaction with life and self-esteem across four conditions was found (F(2,56) = 22.05, p < .000, η2 = .542; F(2,56) = 36.19, p < .000, η2 = .660) with large effect size. CONCLUSION: It is concluded that CBT played a very effective role to reduce depression, anxiety, and stress-related psychiatric symptoms. CBT reduces the level of death anxiety and improving the quality of life and level of self-esteem among CPdC. TRIAL REGISTRATION: The study trial was registered in the Thai Clinical Trial Registry-TCTR ( TCTR20201113002 ).

Investigating the nexus among sulfur dioxide emission, energy consumption, and economic growth: empirical evidence from Pakistan.

Developing countries like Pakistan majorly depend on fossil fuels for achieving higher economic growth but have sloppy environmental rules and regulations in order to attract foreign direct investment (FDI). As a result, energy consumption is considered the primary cause of environmental degradation. Besides CO2 emission, environmental degradation is also associated with emission of sulfur dioxide (SO2). The purpose of this study was to investigate the relationship among SO2 emissions, energy consumption, economic growth, and FDI in Pakistan. By applying the 3SLS method, study has estimated the scale effect, composition effect, and technique effect. The scale effect and technique effect findings indicated that capital stock, FDI, and SO2 emissions all had a significant impact on GDP. When the capital accumulation effects of FDI were considered, the relationship between FDI and stock of capital was found to be positive. According to the technique effect results, FDI, population density, and energy consumption were all significantly related to SO2 emissions. The study came to a conclusion with significant policy implications.

Relationship of Muslim Religiosity and Death Anxiety with the Mediating Effect of Optimism and Depression Among Cancer Patients in Pakistan.

Optimism and the practice of any religion are known to reduce depression and anxiety in cancer patients. In the present study, the specific role of Muslim religiosity, optimism, depression, and death anxiety in cancer patients has been explored. The sample of this study consisted of 200 cancer patients from different hospitals of the districts Faisalabad and Lahore (Pakistan). The sample's average age was 26.6 years. Parallel mediation findings show that optimism and depression are significant mediators between Muslim religiosity and death anxiety among cancer patients. Muslim religiosity is positively associated with optimism, and it helps to decrease the level of death anxiety, while depression is negatively associated with Muslim religiosity, and high depression increases the death anxiety level of cancer patients. In conclusion, Muslim religiosity and optimism play significant roles in managing depressive symptoms and death anxiety among cancer patients.

Role of religiosity, optimism, demographic characteristics and mental health problems among cancer patients.

OBJECTIVE: To investigate the role of religiosity, optimism, depression, death anxiety and differences in demographic characteristics among cancer patients. METHODS: The cross-sectional study was conducted from July 2018 to July 2019 in three different hospitals of Lahore and Faisalabad, Pakistan, and comprised patients with diagnosed stage 1 and 2 cancer. Non-cancer subjects were enrolled as the control group. Data was collected using the Short Muslim Practice and Brief Scale, the Siddiqui-Shah Depression Scale, Death Anxiety Scale and the revised version of Life Orientation Test. One-way analysis of variance and other tests were used for data analyses. RESULTS: Of the 400 subjects, 200(50%) each were cases and controls. Among the cases, 100(50%) each were males and females. There was a significant difference between cancer and non-cancer subjects on the variables of religiosity, optimism, depression and death anxiety (p<0.05). Significant gender differences were found on the variables of religiosity, depression and death anxiety (p<0.05), while the difference on the construct of optimism was non-significant among cancer patients (p>0.05). Cancer patients of rural and urban areas were significantly different on the variables of religiosity, depression and death anxiety (p<0.05), but the difference was non-significant on the optimism scale (p>0.05). Also, the differences on death anxiety scale were significantly related to the type of cancer (p<0.05). CONCLUSIONS: There was a greater role of religiosity and optimism in controlling the level of depression and fear of death among cancer patients. Also, the role of gender, residential area and type of cancer was significant.

Individualised cognitive behaviour therapy in patients of substance use disorders: three case studies.

The current study aims to investigate the effectiveness of Cognitive Behaviour Therapy (CBT) in the treatment of patients with substance use disorders. Three diagnosed patients with substance use disorders were recruited -i.e. 305.20 (F12.10) cannabis used disorder, 291.81 (FI0.239) alcohol withdrawal disorder and 292.0 (F11.23) opioid withdrawal disorder, respectively. The patients were detoxified and individual treatment plan was formulated on the basis of CBT. The CBT therapeutic outcomes were evaluated on the basis of pre- and post-assessment scores. Results indicate that CBT worked effectively in one-on-one session. CBT effectively worked to manage patients' anger, craving, stress, sleep hygiene and assertive behaviour. It is concluded that CBT is an effective approach to deal with patients' anger, stress, craving, sleep and assertive behaviour.

Dairy Production under Climatic Risks: Perception, Perceived Impacts and Adaptations in Punjab, Pakistan.

The changing climatic conditions coupled with fodder availability have posed severe challenges and threats for the dairy sector in Pakistan. The current paper determines the influence of climate change on the dairy sector in Pakistan. Comprehensive data set was collected from 450 farmers. The majority of farmers experienced the climate change and its variability and explained that severity and frequency of climatic extreme events such as droughts, heat waves, floods, pests and diseases and humidity is increasing. The study found that farmers considered drought as one of the major climatic risks which severely affects all aspects of dairy production. Specifically, to estimate the perceived impacts of climatic extreme event on milk production, an ordered probit model was applied and identified that climate change had high adverse impact on milk quantity in the study area. Different adaptation practices, such as changing cropping pattern for fodder production, off-farm income activities, diversifying the farm and regular vaccination are mostly used by dairy farmers. The study recommends policy initiatives to be taken by government for long term developments in the dairy farming.

Pattern of positive, negative and general psychopathological symptoms among schizophrenia patients at primary care setting: A comparative study.

OBJECTIVE: To investigate the patterns of positive, negative and general psychopathology symptoms on the Positive and Negative Syndrome Scale among a variety of schizophrenia patients. METHODS: The cross-sectional study was conducted at the Institute of Behavioural Sciences, Dow University of Health Sciences, Karachi, in 2016-17, and comprised schizophrenia patients aged 18-52 years registered with the institute regardless of gender, socioeconomic class, marital status and severity of the diseases. The Positive and Negative Syndrome Scale was administered after one month of psychotropic medication. SPSS 21 was used for data analysis. RESULTS: :Of the 104 patients, 62(59.6%) were males; 42(40.4%) were single; 45(43.3%) were married; 17(16.3%) were divorced/separated; 31(29.8%), belonged to low social class; 35(33.7%) to middle; and 38(36.5%) to upper class. Patients' scores were significantly different between in door and out-door patients (p<0.05); between patients who had come with single or multiple episodes (p<0.05), and between patients with acute and chronic phases of illness (p<0.05) in terms of positive, negative and general psychopathology symptoms. CONCLUSIONS: Out-door patients, those with multiples episodes and chronic illness were found more vulnerable compared to in-door patients, those with single episode and acute illness.

Occupational hazards and health cost of women cotton pickers in Pakistani Punjab.

BACKGROUND: Farm workers and female cotton pickers are exposed to residual impacts of pesticide use in cotton production, in addition to dust, ultraviolet radiation, etc. Cotton picking causes various health hazards among cotton pickers with varied health cost. A soil bacterium known as Bacillus thuringiensis (Bt) is incorporated in cotton seed through genetic modification and it has resistance against certain bollworms of cotton. So it is considered that Bt cotton fields have less pesticide exposure compared to non-Bt cotton fields. This study was designed to examine and compare the impacts and health cost of cotton picking among female cotton pickers working in Bt and non-Bt cotton fields. METHODS: The study used the data collected from Vehari district of Pakistani Punjab. Health hazards and associated health cost of the respondents involved in Bt cotton picking were compared with those who harvested non-Bt cotton. Comparative use of the personal protective measures among those respondents was also examined. Health cost function and its determinants were analyzed using ordinary least square method. RESULTS: Findings of the study showed that 61 % cotton pickers from Bt cotton households reported one or more health effects of pesticide during picking season whereas this percentage for non-Bt cotton households was 66 %. Health impacts included skin problems, headache, cough, flu/fever, eye irritation and sleeplessness, however, percentage of these health impacts was comparatively higher among non-Bt cotton households. Health cost from exposure to pesticide use in cotton was US$ 5.74 and 2.91 per season for non-Bt cotton and Bt cotton households, respectively. Education, picking in Bt cotton fields and preventive measures were significantly related with health cost. CONCLUSION: Cotton pickers working in Bt cotton fields are found to have less occupational health hazards compared to those working in non-Bt cotton fields. Thus generating awareness among cotton pickers for adopting precautionary measures during harvesting and the use of Bt cotton seed can result in a decline in the ill-effects of cotton picking.