The effectiveness of the community reinforcement approach (CRA) in the context of quality of life and happiness among people using drugs.

Introduction: The Community Reinforcement Approach is an evidence-based treatment modality for alcohol and drug addiction treatment with proven efficacy and cost-effectiveness. The present study investigated the effectiveness of the Community Reinforcement Approach (CRA) in the context of quality of life among drug addicts. Materials and methods: A total of 60 inpatient substance abusers post detoxification in Fountain House, Lahore, Pakistan, participated in this study. Fountain House was selected as the Minnesota model is primarily used there. Therefore, a new treatment approach was introduced to investigate its effectiveness for individuals with substance abuse. A randomized 12-week trial was conducted as a substance use disorders (SUDs) treatment program. Persons with SUD (i.e., identified patients) enrolled in a residential treatment program were randomized into the integrated model of the Community Reinforcement Approach (CRA) and traditional Minnesota model treatment (n = 30), and traditional Minnesota model treatment only (TMM; n = 30). All the participants in the experimental group attended the group therapy sessions and other activities in the facility in addition to the treatment conditions. The participants attended the individual therapeutic sessions, which were conducted according to the CRA guidelines used in the experimental group. In this study, each individual in the CRA treatment group received 12 one-to-one sessions ranging from 45 min to 1 h. The WHOQOL-BREF scale and Happiness Scale (1) were used for data collection. Result: The results showed a significant increase in the quality of life of participants in the treatment group with CRA compared with the control group with TMM. The findings also indicated that the individuals in the treatment group with CRA had improved levels of happiness compared with individuals with TMM. Discussion: The CRA is an effective and adaptable treatment approach that works well in combination with other treatment approaches. The proven efficacy, compatibility, and cost-effectiveness distinguish it from other treatment methods. Implications: The CRA should be adapted, assessed, and evaluated further, especially in Pakistan, where there is a pressing need to adopt an effective treatment strategy for addiction problems.

Psychological intervention for a person living with amblyopia: a case study from home-based integrated care.

Amblyopia is a common developmental disability resulting in reduced visual acuity and gaze stability; it occurs in approximately 5% of the general population. Here, we present the case of an 18-year-old girl diagnosed with amblyopia. Subsequent to her diagnosis of amblyopia, she developed a depressive episode with co-morbid anxiety symptoms. She was treated with low intensity psychological intervention, Problem Management Plus, as home-based intervention. This intervention was associated both subjectively and objectively utilising psychometric measures (i.e. psychiatric interview, depression, anxiety and stress scale, general health questionnaire) with a significant amelioration of her mental state. This case provides preliminary evidence for the effectiveness of Problem Management Plus intervention and suggests that this intervention should be considered for other individuals with similar clinical presentations.

Dysfunctional schema modes as determinants of psychiatric comorbidities: a study in a cohort of people with epilepsy.

INTRODUCTION AND AIMS: Symptomatology of epilepsy and its' associated alteration in brain processes, stigma of experiencing seizures, and adverse sequelae of anti-epileptics have been demonstrated to impact behaviour and exacerbate psychopathology. This study examines the role of dysfunctional schema modes in People with Epilepsy (PWE) and their association with psychiatric symptoms. METHODS: Semi-structured interviews were conducted with 108 PWE treated with anti-epileptics for at least one year and with no history or mental disorder or psycho-active substance use. Clinical symptoms were measured utilising the Symptom Checklist-90 (SCL-90) with schema modes measured utilising the Schema Mode Inventory (SMI). RESULTS: Maladaptive coping and child schema modes were significantly higher in individuals from lower socio-economic status group (p < 0.01), with several maladaptive schema modes more prevalent in males. Hostility symptoms were increased in individuals from lower socio-economic classes and were more prevalent early in disease course. Several psychological symptoms including somatisation, interpersonal, obsession, depression, paranoia, hostility, phobia, anxiety, and psychoticism, were predicted by various maladaptive schema modes (p < 0.001). CONCLUSION: This study highlights the impact of maladaptive schemas, suggesting that PWE might benefit from the introduction of appropriate psychotherapeutic interventions such as schema-focused therapy, particularly if from lower socio-economic classes or in the early stages of theirdisease course.

Impulsivity, suicidal thoughts, psychological distress, and religiosity in adolescents and young adults.

Background: Impulsivity is associated with suicidal acts and ideation, whereas higher religious commitment has been identified as a potential protective factor linked to lower suicidal ideation. Objectives: We examined the extent to which higher religious commitment is associated with lower suicidal ideation and whether religious commitment modifies the relationship between impulsivity and suicidal ideation. Methods: Adolescent and young adult males, with a prior history of suicidal act and ideations, completed standardized questionnaires [i.e., Beck Scale for Suicidal Ideation (BSS), Barratt Impulsivity Scale-II (BIS-II), Depression Anxiety Stress Scale (DASS), and Religious Commitment Inventory-10 (RCI-10)], to assess impulsivity, suicidal ideation, distress, and religious commitment. Regression and mediation analyses were performed to investigate the relationships among impulsivity, religious commitment, and suicidal ideation. Results: Of the 747 study participants (mean age 18.8 years, SD = 4.1), 151 (20.2%) had a history of suicidal acts and 177 (23.7%) had a history of suicidal ideation. Non-planning impulsivity (predictor) was inversely associated with religious commitment (r = -0.33, p < 0.01), and religious commitment (mediator) was inversely related to suicidal ideation (outcome) (r = -0.32, p < 0.01). These findings remained statistically significant when controlling for either religious commitment or non-planning impulsivity, as appropriate. Higher religious commitment reduced the association between non-planning impulsivity and suicidal ideation (p < 0.01). Conclusion: The findings highlight the potential for cultivating spirituality to buffer against higher suicidal ideation, and thus could be considered as an additional therapeutic strategy for individuals with higher levels of impulsivity and co-morbid suicidal ideation.

Suicidal tendencies and psychiatric symptoms as consequence of anabolic androgenic steroid usage among athletes in District Rawalpindi.

OBJECTIVE: To elucidate the possible association between suicidal tendencies and psychiatric symptoms associated with anabolic androgenic steroid usage among athletes. Methods: The cross-sectional study was conducted from December 2016 to July 2017 in Rawalpindi and Wah Canttonment, Pakistan, after approval from the International Islamic University, Islamabad, and comprised male athletes aged >18 years. Those using androgenic anabolic steroid formed group A, while the non-users were in group B. In addition to demographics, data was collected using Beck Scale for Suicidal Ideation and the Symptoms Checklist-90. Data was analysed using SPSS 22. RESULTS: Of the 60 subjects, there were 30 (50%) in each of the two groups. The majority were aged 24-26 years 41 (68.30%). Group A scored significantly higher compared to group B on suicidal ideation, had more interpersonal problems, depression, hostility, paranoia and psychoticism (p<0.05). Unemployment and low household income increased steroid usage (p<0.05). CONCLUSIONS: There was found to be a significant association of anabolic androgenic steroid use with suicidal tendencies and mental health issues.

Stakeholders' perspective on mental health laws in Pakistan: A mixed method study.

The present study explored awareness and opinions pertaining to mental health legislation in Pakistan in the context of the United Nation Convention on Rights of People with Disabilities (UNCRPD) through a mixed method research design. In the quantitative arm of the study, a structured questionnaire examined awareness and opinions of key stakeholders pertaining to national mental health legislation. In the qualitative arm, face-to-face interviews further elaborated stakeholders perspectives pertaining to these topics with thematic analysis conducted. Stakeholders demonstrated a good awareness of legislation pertaining to guardianship (83.0 %) appointment of property managers (89.7%) and salary or pension entitlements (89.2%). Compared to other stakeholders, patients had less understanding of processes pertaining to involuntary admission (χ2 = 20.54, p = 0.02) and appointing a guardian (χ2 = 34.67, p < 0.01). High consensus across stakeholders was noted for processes of involuntary detention (83.5%) and appointment of guardians or property managers (80.0%) albeit patients demonstrated less agreement on these topics (p <0.01). Minimal support was noted for an involuntary patient to be discharged solely on a psychiatrist's recommendation (25.4%). Thematic analysis indicated fifteen emergent themes: 1) Alienation/ Seclusion; 2) Capacity building; 3) Communication Gap; 4) Conflict of interests; 5) Discomfort at hospital; 6) Economic burden; 7) Government's liability; 8) Family involvement; 9) Imbalance; 10) Acceptance of Legal Incapacity; 11) Legal reforms; 12) Patient centred environment; 13) Quality assurance; 14) Under developed infrastructure and 15) Potential unethical practices. This study advocates for increased patient involvement in collaborative decision making with mental health professionals and the creation of more appropriate inpatient treatment environments.

Indigenously adapted cognitive-behavioral therapy for excessive smartphone use (IACBT-ESU): A randomized controlled trial.

This study aims to assess whether 12 sessions of indigenously adapted cognitive-behavioral therapy for excessive smartphone use (IACBT-ESU) would reduce excessive smartphone use. A single-blind randomized controlled trial was conducted in students (12 to 19 years of age) to examine the potential beneficial effects of IACBT-ESU (n = 62) compared with brief educational data alone (n = 62). Symptoms of depression, anxiety, stress, and peer relations were also compared between the two groups. The IACBT-ESU group demonstrated significant reductions in excessive smartphone use, with reduced symptoms of depression, anxiety, stress, hyperactivity, and emotional difficulties at both trial end and at 3-month follow-up (p < .01) compared with control participants. IACBT-ESU was associated with reduced excessive smartphone use and improved psychological well-being, with beneficial findings maintained 3 months after the trial's end. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Smartphone addiction and its associated factors among students in twin cities of Pakistan.

OBJECTIVE: To determine the prevalence and indicators of smartphone addiction in local population. METHODS: The cross-sectional study was conducted in the twin cities of Islamabad and Rawalpindi, Pakistan, from August 2017 to August 2018, and comprised school, college and university students of either gender aged 12-19 years. Data was collected using Smartphone Addiction Scale-Short Version with a cut-off score of 31 for boys and 33 for girls. Data was analysed using SPSS 23. RESULTS: Of the 702 subjects screened, 422(60%) had smartphone addiction; 242(57.3%) males and 180(42.6%) females. Social networking applications were significant indicators of the addiction (p<0.05). CONCLUSIONS: Smartphone addiction was found to be high among Pakistani adolescents.

Effects of internalizing problems on quality of life among cardiac patients: mediating role of coping strategies.

OBJECTIVE: To study the effects of internalising problems on quality of life among cardiac patients and to explore the mediating role of coping strategies.. METHODS: The cross-sectional study was conducted at different government and private cardiac and diabetic care centres Multan, Pakistan, from September 2017 to December 2017. Quality of Life Scale, Novaco Anger Scale, Depression, Anxiety and Stress Scale and Brief Cope Inventory were used to collect data. The sample of the study was taken from different government and private cardiac care centres located in Multan city of Pakistan. RESULTS: Of the 300 subjects, 199(66.3%) were males 101(33.7%) were females. Internalized problems were significantly negatively associated with the quality of life (p<0.01). However, coping strategies except dysfunctional focused were significantly positively associated with the quality of life (p<0.01). A significant mediating effect of emotion focused coping, problem focused coping and dysfunctional focused coping was found between internalising problems and quality of life (p<0.01). CONCLUSIONS: Internalised problems and coping strategies significantly influenced the quality of life among patients suffering from cardiac diseases.

An Urdu adaptation of smartphone addiction scale-short version (SAS-SV).

OBJECTIVE: To adapt the English version of Smartphone Addiction Scale-Short Version into Urdu language. METHODS: The cross-sectional study was conducted from October 2017 to January 2018 at the International Islamic University, Islamabad, Pakistan. In the first stage, Smartphone Addiction Scale-Short Version was translated by 8 experts. In stage 2, the translated version was pilot-tested on 30 university students aged 18-19. Finally, the version was tested on the actual subjects who were students aged 11-30 years at schools, colleges and universities within Rawalpindi and Islamabad. SPSS 22 was used for data analysis. RESULTS: Of the 348 subjects, 216(62%) were males. Overall, 194(55.7%) students were above the addiction cutoff value. Inter-item reliability of the translated version was good (α = 0.81); the construct validity was adequate (P<0.001); Comparative Fit Index = 0.95; Tucker Lewis Index= 0.93; Normative Fit Index= 0.92; and Root Mean Squared Error Approximation = 0.05. CONCLUSIONS: Smartphone Addiction Scale-Short Version can be used as a screening tool for assessment and identification of smartphone addiction in Pakistan..

Impact of Conventional Beliefs and Social Stigma on Attitude Towards Access to Mental Health Services in Pakistan.

This study aims to explore the role of conventional beliefs and social stigma on attitude towards access to mental health services. From 50 caregivers data were collected by Perceived Public Stigma Scale and an in-depth semi-structured interview. The majority (86%) of patients having significant symptoms of major mental illness visited traditional healer prior to engagement with the mental health services. However a significant positive finding, related to carers predominantly perceiving that individuals with mental health difficulties were trustworthy, capable of engagement in employment and were comfortable with having them as their friends were identified.

Psychological autopsy review on mental health crises and suicide among youth in Pakistan.

INTRODUCTION: Ascertaining putative sociodemographic and clinical causes for death by probable suicide can potentially help implement region-specific strategies to reduce suicide rates. In this study, we wanted to investigate methods utilized and the psychosocial and mental health characteristics of youths (aged 12-26 y) who died by probable suicide. METHOD: We examined data from mental health clinical files and forensic reports and performed qualitative psychological autopsy interview from more than multiple sources for each youth who died by probable suicide between 1 May and 31 December 2015 in the Khyber Pakhtunkhwa Province of Pakistan. RESULTS: The two most common methods of probable suicide were by firearm use and self-poisoning utilizing pesticides that were significantly associated with male and female gender, respectively. The most common mental health difficulties were major depressive disorder and harmful use of psychoactive substances. Other clinical features particularly evident included thoughts of self-harm, irritability and aggression, low self-esteem, treatment nonadherence, family dispute, and financial distress. CONCLUSION: Efforts to reduce the ease of access to firearms and pesticides may potentially have a beneficial effect in reducing the suicide rate in this region of Pakistan.

Reasons associated with treatment non-adherence in schizophrenia in a Pakistan cohort.

TREATMENT: non-adherence in patients with schizophrenia is the most common reason for a relapse of psychosis. In a cohort of participants in Pakistan who suffered a relapse of psychosis, we aimed to identify the principal factors associated with non-adherence, including any culture specific factors that might not be as significant in other jurisdictions. Semi-structured interviews were undertaken at four psychiatric hospitals in the Peshawar region in Pakistan with 55 participants (44 male and 11 female) diagnosed with schizophrenia, who had suffered a relapse of psychosis subsequent to treatment non-adherence. The five principal documented reasons for treatment non-adherence were: 1) alternative treatment pathway chosen with a traditional faith healers (n=53, 96.4%), 2) lack of insight (n=36, 65.5%), 3) poor economic status (n=33, 60.0%), 4) adverse effects of medications (n=33, 60.0%) and 5) utilising psycho-active substances as an alternative to psychotropic medications (n=27, 41.1%). A number of identified factors associated with a relapse of psychosis are potentially modifiable including the provision of a range of pharmacological options including second generation antipsychotic agents, long acting injectable antipsychotics and psycho-therapeutic interventions including psycho-education. These interventions should prove cost effective and be associated with reduced relapse rates of psychosis.

Mindfulness in Salah Prayer and its Association with Mental Health.

Plethora of researches has been carried out for the last many decades and has identified relationship between mental health and religious convictions; in particular, range of religious practices has been found instrumental in the promotion of mental health. The aim of this paper is to find out association between mindfulness in Salah (prayer) and mental health of individuals who identify themselves with Islam and to examine the mental health of those Muslims who offer Salah prayer with mindfulness and those who offer without mindfulness. A total of 174 participants with mean age of 21.57 including 62% males and females 38% were selected through convenient sampling. RAND Mental Health Inventory was used to measure mental health and other three variables; three self-reported measures were constructed. They included Islamic religious education scale, Salah education scale and mindfulness in Salah scale. Psychometric properties for all scales were established. The findings indicated that mean on mindfulness and mental health was significantly higher for those who were offering Salah (prayer) regularly (p < 0.01) as compared with those who were not offering it regularly. Moreover, those who were offering Salah (prayer) with mindfulness had also significantly higher mean for mental health (p < 0.01) as compared with those who were offering it without mindfulness. Religious education, Salah education and mindfulness were able to account for 13% of the variance in mental health (p < 0.01). Of note two of the measures included Salah education and mindfulness made a significant contribution in the prediction of mental health (p < 0.01). The present study indicated that individuals who offer prayer regularly and with mindfulness have better mental health as compared with those who don't offer it regularly and with mindfulness. The findings of this study urge to spread awareness regarding offering prayer regularly with mindfulness for the better outcome of mental health in people.

Factors associated with psychotic relapse in patients with schizophrenia in a Pakistani cohort.

Despite a large body of research evaluating factors associated with the relapse of psychosis in schizophrenia, no studies in Pakistan have been undertaken to date to identify any such factors, including specific cultural factors pertinent to Pakistan. Semistructured interviews and psychometric measures were undertaken with 60 patients diagnosed with schizophrenia (49 male and 11 female) and their caregivers at four psychiatric hospitals in the Peshawar region in Pakistan. Factors significantly associated with psychotic relapse included treatment non-adherence, comorbid active psychiatric illnesses, poor social support, and high expressed emotion in living environments (P < 0.05). The attribution of symptoms to social and cultural values (97%) and a poor knowledge of psychosis by family members (88%) was also prevalent. In addition to many well-documented factors associated with psychotic relapse, beliefs in social and cultural myths and values were found to be an important, and perhaps treatable, factor associated with relapse of psychosis in Pakistan. The provision of evidence-based psychotherapeutic interventions, such as behaviour and family therapy and cognitive behaviour therapy for psychosis, could potentially ameliorate the relapse rate of psychosis in Pakistan.

Indigenous Adoption of Novaco's Model of Anger Management Among Individuals with Psychiatric Problems in Pakistan.

The present study was designed to indigenously adopt Novaco's model of anger management and examine its efficacy among individuals with psychiatric problems in Pakistan. For the assessment of anger and psychiatric problems, Urdu-translated versions of Novaco Anger Inventory (NAI), Anger Self-Report Questionnaire (ASR) and Depression Anxiety Stress Scale were used. A sample of 100 individuals was divided into two groups: a treatment group (received the indigenously adopted model of anger management) and a control group (received general counseling). Results of mixed repeated-measures ANOVA revealed that individuals in the treatment group significantly (p < .01) scored lower on the NAI and ASR (at post-assessment) as compared to the control group. Therefore, the indigenous model of anger management was shown to be more effective than general counseling for anger management.

Post-Traumatic Stress Disorder (PTSD) Symptoms in Adults with Psychiatric Disorders.

OBJECTIVE: This study explores unrecognised symptoms related to post-traumatic stress disorder (PTSD) in individuals with a range of psychiatric disorders in the absence of traumatic events. We also examine the association between PTSD symptoms, social interaction with peers and therapeutic alliance with mental health professionals. METHOD: A purposive sample of 120 adults consecutively referred to the psychology department from September 2008 to September 2010 was included in this study. We used the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) to ascertain the presence of PTSD symptoms, social interaction levels and treatment alliance with health professionals. RESULTS: Individuals previously undiagnosed with PTSD, referred without any noted traumatic event had high levels of symptoms related to PTSD, as measured by the PK scale of the MMPI-2. The PK scale was significantly correlated with several MMPI-2 clinical scales, the Social Introversion Scale (Si) and the Treatment Alliance Scale (TRT) (p < 0.001). CONCLUSION: This study demonstrated the presence of symptoms related to PTSD in individuals with a range of psychiatric disorders despite the absence of reported trauma. The presence of symptoms related to PTSD may be associated with an indirect negative impact on social contacts and a poorer therapeutic alliance with mental health professionals. Investigating symptoms of PTSD during a psychological assessment even when trauma is not the presenting complaint is merited in most cases.

Mental health problems in Pakistani society as a consequence of violence and trauma: a case for better integration of care.

OBJECTIVES: This paper discusses the increasing incidence of mental health problems in Pakistan, and specifically in the Swat Valley, in relation to the growing insurgency and current violence in Pakistani society. The paper argues that the health care system's response in Pakistan is not adequate to meet the current challenges and that changes in policy are needed to build mental health care services as an important component of the basic health package at primary care level in the public sector. METHOD: This paper reviews the existing mental health situation in Pakistan with reference to the findings of a case study in the Swat Valley in Khyber Pukhtoonkhwa Pakistan. The figures presented in the case study are used to support the need for an integrated national mental health policy. CONCLUSION: Mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy.

Psychological assessment through performance-based techniques and self-reports: a case study of a sexually abused girl at preschool age.

We investigated the implicit psychological and behavioral consequences of sexual abuse in an adolescent girl who suffered child sexual abuse at preschool age in this case report. We report the manifestations of this abuse on her personality and psychological functioning using a structured clinical interview and a comprehensive psychological battery including the Beck Anxiety Inventory, the Beck Depression Inventory, the Standard Progressive Matrices, Rorschach Ink Blots, and the Schema Mode Inventory. These investigations were useful in formulating both a diagnosis and a management plan. The girl fulfilled diagnostic criteria for a major depressive episode and borderline personality disorder. This combination of psychological testing may be useful in establishing an accurate multiaxial diagnosis and for understanding the behavioral and psychological sequelae of child sexual abuse in similar cases. The study further suggests that schema-focused therapy is a useful therapeutic tool for individuals who have suffered child sexual abuse at an early age and who have borderline personality disorder.

Investigation of schema modes currently activated in patients with psychiatric disorders.

OBJECTIVES: To investigate schema modes currently activated in individuals with psychiatric disorders and to attain a greater understanding of healthy and dysfunctional schema modes in this population. Furthermore, we wish to ascertain if individuals who fulfil criteria for clinical (psychiatric) disorders with the Minnesota Multiphasic Personality Inventory (MMPI), also manifest dysfunctional modes and weaker healthy modes on the Schema Mode Inventory (SMI). METHOD: Fifty individuals were administered the MMPI and SMI during routine psychological assessments between September 2008 and June 2010. RESULTS: Both healthy schema modes (Happy Child (HC) and dysfunctional schema modes (Compliant Surrender (CS), Detached Self-soother (DSS) and Demanding Parent (DP)) were evident in this population. Positive correlations were noted between several dysfunctional schema modes from the Child, Maladaptive Coping and Maladaptive Parent domains of the SMI and several scales of the MMPI including: Depression (D), Psychopathic deviate (Pd), Masculine feminine (Mf), Paranoia (Pa), Psychasthenia (Ps), Mania (Ma), Schizophrenia (Sc), and Social introversion (Si) (p < 0.001). A negative correlation (p < 0.001) was found between the Healthy Adult (HA) and Happy Child (HC) schema modes of the SMI and the Hypochondriasis (Hs), Depression (D), Psychopathic deviate (Pd), Psychasthenia (Pt), and Social introversion (Si) scales of MMPI. CONCLUSION: This study demonstrates the presence of several dysfunctional schema modes in individuals with a wide range of clinical (psychiatric) disorders and a strong correlation between dysfunctional schema modes and clinical disorders of the MMPI. The SMI can aid in the assessment and understanding of individuals with a wide range of psychiatric disorders and can also form the basis for Schema Focused Therapy (SFT), a therapy showing promise for a number of clinical conditions, particularly borderline personality disorder.