Emotion recognition and duration of untreated first-episode psychosis among patients in Pakistan.

OBJECTIVE: To investigate the impact of duration of untreated psychosis on emotion recognition in patients with first-episode psychosis. METHODS: A sample of 60 patients with schizophrenia, schizoaffective and substance-induced psychoses were selected from psychiatric inpatients and outpatients of 3 hospitals in Lahore and 1 in Faisalabad, Pakistan. Patients were divided into short (n = 28) and long (n = 32) duration of untreated psychosis groups, according to whether they had had symptoms for < 80 or ≥ 80 weeks, respectively. Emotion recognition ability was assessed with the help of the Urdu version of a computerised experimental FEEL (Facially Expressed Emotion Labeling) test using 6 basic emotional expressions that appeared on a computer screen followed by possible responses. RESULTS: Patients with prolonged durations of untreated psychosis showed poorer performance in recognition of facial expressions of emotion than those with short durations of untreated psychosis. This was apparent in general and especially for expressions of anger, surprise, and sadness. First-episode psychosis patients showed higher accuracy rates for recognising positive as opposed to negative emotions. The duration of untreated psychosis correlated positively with positive symptoms of psychosis. Symptom distribution differed across categories of psychosis, but there were similarities in patients with schizophrenia and schizoaffective disorders. CONCLUSIONS: These findings support recourse to early detection and intervention strategies in psychosis and provide valuable information on how first-episode psychosis patients behave in complex emotional and social situations.

Computational fluid dynamic simulation to assess flow characteristics of an in vitro aneurysm model.

BACKGROUND: Modifications of in vitro aneurysm modeling to study the effects of morphology on flow dynamics are time consuming, costly and analysis tends to be more qualitative than quantitative. This study develops a virtual two-dimensional flow model replicating an in vitro aneurysm model and analyzes how changes in morphology modify flow characteristics. METHODS: Using finite volume analysis, a two-dimensional saccular aneurysm model was created with a configuration matching a published, experimental, in vitro model. Qualitative comparisons were made determining whether a two-dimensional fluid dynamic model can replicate the results of an in vitro model. Quantitative changes in flow patterns, wall shear stress, dynamic pressure and maximum velocities were assessed by modifying the shape of the neck and proximal dome without modifying the overall size of the aneurysm. RESULTS: A two-dimensional computational fluid dynamic model reproducing the shape of a published aneurysm demonstrated excellent qualitative fidelity to an in vitro flow model. Additional information regarding dynamic pressure, shear stress and velocity along the aneurysm neck and within the aneurysm dome were determined. Although all dimensions were kept constant, slight modifications of the neck and proximal dome resulted in quantitative changes in studied parameters, such as wall shear stress and dynamic pressure. CONCLUSIONS: Computer generated aneurysm flow models, when carefully developed, reproduce flow events within in vitro aneurysms providing objective data on biophysical parameters. Effective flow modeling of aneurysms depends on flow input, size of the parent vessel and aneurysm, and other factors. These data suggest that neck and proximal dome configuration, independent of size, are important characteristics of flow.

Primary care treatment for child and adolescent neuropsychiatric conditions in remote rural Punjab, Pakistan - a cross-sectional survey.

BACKGROUND: Pakistan is one of the most populous regions of the world. Previous work has demonstrated that there is reliance on traditional healthcare systems when seeking psychiatric care; however, there is a lack of information on help seeking for child and adolescent population. The aim of this study was to describe types of treatments and families' perceptions of the effectiveness of those treatments for childhood neuropsychiatric disorders in remote rural Punjab. METHOD: Cross-sectional survey of consecutive attendees at an advertised mental health consultation day in a remote rural area. RESULTS: The effectiveness of these treatments, as rated by patients and their families, was variable, with highest reported effectiveness for general practitioner treatments. In families with a past history of care from a general practitioner, those who had epilepsy reported treatments to be more effective than those with mental retardation. Carers and users described consulting five different types of primary healthcare practitioners that used both physical and psychotherapeutic treatments. CONCLUSIONS: There is considerable variation in treatments available for child and adolescent neuropsychiatric disorders in remote rural areas of Punjab, a large proportion of which are considered ineffective by the users and carers. This highlights the need to develop effective interventions for child and adolescent neuropsychiatric conditions that can be administered by primary health workers. Our data suggest that the need for this is greatest for mental retardation.

Effectiveness and safety of olanzapine in the treatment of Asian outpatients with schizophrenia.

OBJECTIVE: The objective of this study was to assess the effectiveness and safety of olanzapine in the treatment of schizophrenia among Asian patients in an outpatient setting. METHODS: This was an open-label, prospective, observational study involving 339 patients from Indonesia, Pakistan, Malaysia, Thailand, and Singapore. Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression Severity scale (CGI-S), and safety parameters were assessed. RESULTS: 62% of patients responded to olanzapine treatment, defined a priori as a reduction in BPRS of > 40% from baseline. Following the 8-week treatment period, the BPRS total, BPRS positive, BPRS negative, and CGI-S scores decreased by 18.7 (95% CI: 17.4, 20.2), 6.1 (5.6, 6.6), 2.9 (2.6, 3.2), and 1.5 points (median 1.0), respectively (p < 0.0001). In total, 31 of the 339 patients (9.1%) failed to complete the study according to the study description. Loss to follow-up and personal conflict were the most common reasons for discontinuation. There were 30 treatment-emergent adverse events with six serious cases, assessed as unrelated to study drug, reported. CONCLUSION: This study further demonstrates the effectiveness and safety of olanzapine in actual clinical practice settings, in reducing the severity of psychopathological symptoms in Asian patients with schizophrenia.

Fifteen-year follow-up of conversion disorder.

The terms 'conversion', 'hysteria' and 'conversion hysteria' were used interchangeably to describe a condition characterised by a single somatised symptom, often pseudo-neurological in nature. DSM-III (American Psychiatric Association, 1980) expanded the concept of conversion to generalised symptoms involving loss or alteration of physical functioning suggestive of a physical disorder, along with a clinical indication that the conversion was an expression of psychological conflict or need. The type of symptom or deficit should be specified as: with motor symptom or deficit, with sensory symptom or deficit, with seizure or convulsions, or with mixed presentation (Kaplan & Sadock, 2004).

On the use of infinite elements for the determination of optimal closure patterns based on stress analysis.

Solid infinite elements are used in conjunction with finite elements to compute the stress and displacement distribution resulting from the suturing of wounds of symmetric and nonsymmetric shapes in orthotropic, abdominal human skin. The optimal pattern of suturing of wounds are investigated from a stress perspective. Highly accurate, quantitative and qualitative improvements over the use of finite elements to approximate distant boundaries are obtained. Numerical results quantitatively agree with analytic results computed using complex analysis techniques. The technique used and the results obtained will aid surgeons in closing nonsymmetrical wounds on regions of the body that exhibit orthotropy.

Efficacy and tolerability of Paroxetine 20 mg daily in the treatment of depression and depression associated anxiety.

OBJECTIVE: To assess the efficacy and tolerability of paroxetine 20mg daily, for the treatment of depression and depression associated with anxiety. METHOD: An open, non-comparative study undertaken at three centers in three cities of Pakistan. A total of 112 in- or out-patients, presenting with a major depressive episode were included in the study. Depression was diagnosed according to DSM IV criteria and a Hamilton Rating Scale for Depression (HAMD-D) score of >18 on the first 17 items of the HAM-D-21. After a placebo washout period of 7 days, patients were given a 20-mg fixed dose of paroxetine daily in the morning for a period of 6 weeks. After baseline, regular assessments were made at 1, 2, 4 and 6 weeks. Efficacy measures included the HAMD-D, the Clinical Anxiety Scale, The Clinical Global Impression Severity of Illness Scale (CGI-S), and the Clinical Global Impression Improvement Scale (CGI-I). Tolerability was assessed by any adverse event. The primary therapeutic outcome measures were patients who achieved a 50% or greater reduction in HAMD-D score at the end of the treatment or achieved a reduction in final HAMD-D score of < or = 10 points. The final scores of 1 or 2 for CGI-S and CGI-I were considered as full clinical response. RESULTS: Of 112 cases evaluated, 57 were males and 55 females whose ages ranged from 18 to 65 years. There was a clear and statistically significant efficacy of paroxetine on all the major outcome variables. A total of 88% patients achieved a reduction in the final HAMD-D score at the end of treatment. The total HAM-D score reduced to 10 or less in 73% patients at 6 weeks and by this week 76% and 92% patients achieved a score of 1 or 2 for CGI-S and CGI-I, respectively. The mean Clinical Anxiety Scale score reduced from 12.6 at the baseline to 4.4 at the end of treatment. Safety data was evaluated in all 112 patients and paroxetine was well tolerated. Adverse events were experienced by 10% of patients of whom 4% were dropped from the study. Nausea was the commonest adverse event reported. CONCLUSION: The study shows that paroxetine is an effective, well-tolerated, and safe drug for the treatment of depression.

Optimal patterns for suturing wounds of complex shapes to foster healing.

Stress is one of the many biological factors that plays an important role in wound healing. It is therefore essential to analyze stresses around the wound closure theoretically, especially when no invasive/noninvasive technique to measure stress directly is available. The objective of this paper is to determine the regions of high stresses and the optimal pattern of suturing wounds of complex shapes. It is hypothesized that the optimal pattern of suturing wounds is that pattern which will produce minimum principal stresses. The finite element method (FEM) employing the basic equations of elasticity theory for orthotropic materials is utilized to compute the principal stresses and displacements resulting from suturing fusiform, elliptical and triangular wounds in human abdominal skin. The optimal suturing pattern for the triangular wound is determined. The average stress indices for varying suturing density are also determined which can provide useful clinical information for the surgeon. Since regions of high stresses in surgical closures produce adverse affects on healing and scar production, this work of predicting areas of high stresses is useful in indicating regions of slow healing in wounds.

Guilt and depression: a cross-cultural comparative study.

Although nearly a century has passed since Kraepelin's investigations in Java [Cbl Nervenheilk Psychiatr 1904; 27:468-469], one crucial question regarding guilt in the course of depression has still not been decided: Is there a more or less stable connection independent of culture, or is guilt confined to certain civilisations? This study investigated this issue in 100 Pakistani and 100 Austrian out-patients diagnosed with 'major depression' according to DSM-IV by means of standardised instruments (Schedule for Affective Disorders and Schizophrenia-Life Time Version, Hamilton Rating Scale for Depression, 21-item version). The experiences of guilt were subdivided into ethical feelings (ethical anxiety and feelings of guilt) and delusions of guilt. It turned out that ethical feelings could be found in both cultures regardless of age and sex. They seem to be primarily related to the extent of depressive retardation. However, the distribution of the two subsets of ethical feelings was culture dependent. Delusions of guilt were confined to patients of the Austrian sample. So, our data qualify the exclusivity of the aforementioned two points of view and support the need for a psychopathologically differentiated approach.

Prolactin and beta-endorphin serum elevations after ECT in manic patients.

OBJECTIVE: Alterations in prolactin and beta-endorphin serum levels after ECT are well-established findings in depression. The present study focuses on electroconvulsive therapy (ECT) response patterns of the mentioned parameters in patients suffering from acute mania. METHOD: Following the first three ECTs of a treatment series in 19 patients diagnosed according to DSM-III-R criteria as suffering from mania, blood samples were drawn before, and 20, 30 and 40 minutes after ECT. Serum prolactin and beta-endorphin levels were established in order to gain information about the effects of ECT on different neurotransmitter systems. RESULTS: A significant transient increase in serum prolactin after ECT was found. Furthermore, in females but not males, delta(max)prolactin diminished over the course of treatment as prolactin baseline levels increased. beta-endorphin levels showed a stable transient increase after ECT stimulus regardless from sex or treatment. CONCLUSION: The reported findings reflect those established in depression. This suggests that they are epiphenomenal to ECT.

Sibling orders of schizophrenic patients in Austria and Pakistan.

The influence of siblings on the socialization of the individual has been recognized as a fact by both psychology and sociology. The significance of sibling order for the outbreak of psychiatric diseases on the other hand is still discussed controversially. In our study, we compared the expected values and the positions actually found in the sibling order of 379 (233 males, 146 females) Austrian and 144 (101 males, 43 females) Pakistani patients diagnosed with schizophrenia according to DSM-IV (295). The position in the sibling order had no influence on the outbreak of schizophrenia in Austria; with Austrian schizophrenics, the results found were very near to the expected values. In Pakistan on the other hand, the eldest brothers from families with 2-4 siblings had a significantly higher risk of falling ill. The investigation of the composition of the sibships of schizophrenic patients also showed a high overrepresentation of men in the firstborn position in Pakistan. These facts seem to exercise influences that may either protect against the outbreak or encourage it. The differences found agree well with the fact that in Pakistan, both the gender of a child and the position in the sibling order entail different ways of treatment and different scopes of responsibility. Socialization in Austria on the other hand, at least in the recent decades, has become very uniform for both sexes, regardless of the sibling position.

Adaptation of passive rat left ventricle in diastolic dysfunction.

This article deals with providing a theoretical explanation for quantitative changes in the geometry, the opening angle and the deformation parameters of the rat ventricular wall during adaptation of the passive left ventricle in diastolic dysfunction. A large deformation theory is applied to analyse transmural stress and strain distribution in the left ventricular wall considering it to be made of homogeneous, incompressible, transversely isotropic, non-linear elastic material. The basic assumptions made for computing stress distributions are that the average circumferential stress and strain for the adaptive ventricle is equal to the average circumferential stress and strain in the normotensive ventricle, respectively. All the relevant parameters, such as opening angle, twist per unit length, axial extension, internal and external radii and others, in the stress-free, unloaded and loaded states of normotensive, hypertensive and adaptive left ventricle are determined. The circumferential stress and strain distribution through the ventricular wall are also computed. Our analysis predicts that during adaptation, wall thickness and wall mass of the ventricle increase. These results are consistent with experimental findings and are the indications of initiation of congestive heart failure.

Comparison of delusions among schizophrenics in Austria and in Pakistan.

One of the central purposes of cross-cultural psychiatry is to scrutinize the sociocultural influences on the phenomenology of psychiatric diseases. On the other hand it is possible to lay bare a nucleus of symptoms, common to all cultures, which, independently of all influences, occupies a central position for an understanding of the disease considered. In this study an attempt was made to approach this problem by means of investigating the contents of delusion of schizophrenic patients in Austria and Pakistan. The contents of delusion among 126 Austrian and 108 Pakistani patients diagnosed as having schizophrenia according to DSM-III-R (art. 295) were compared following the classification of Huber and Gross. Additionally the kind of persecution and the type of the persecutor were registered. However it appeared that only a few contents of delusion are frequent in both countries. In both countries persecution was the most frequently mentioned content of delusion. The comparison of the contents of delusion revealed significantly higher frequencies of delusions of grandeur, guilt and religious delusions in Austrian patients. Significant differences could also be found with the kind of persecution and the persecutor's type. Cultural factors seem to have a decisive influence on shaping the contents of delusion.

Dopamine D3 receptor gene polymorphism and response to clozapine in schizophrenic Pakastani patients.

The dopamine D3 receptor (DRD3) appears to play an important role in the mediation of antipsychotic drug action. Genetic association of treatment response to the atypical antipsychotic drug clozapine with the DRD3 polymorphism Ser9Gly was investigated in a sample of 32 schizophrenic patients. We found association of treatment response with allele Gly-9 (P=0.0058) and with genotypes consisting of Gly-9 (P=0.033) by this pharmacogenetic approach. A combined analysis with two previous studies (Shaikh et al., Hum. Genet. 97 (1996) 714-719; Malhotra et al., Mol. Psychiatry 3 (1998) 72-75) further substantiates these results (P=0.0041).

Noninvasive light-reflection technique for measuring soft-tissue stretch.

A novel, to our knowledge, sensor for measuring the stretch in soft tissues such as skin is described. The technique, which is a modification of two-dimensional polarization imaging, uses changes in the reflectivity of polarized light as a monitor of skin stretch. Measurements show that the reflectivity increases with stretch. Measurements were made on guinea pig skin and on nonbiological materials. The changes in reflectivity result from the changes that take place in the interface roughness between skin or material layers and the consequential changes in the diffuse reflective characteristics of the skin. Conceptually, as the roughness of an interface decreases, a smoother reflecting interface is produced, resulting in a commensurate increase in specular reflection. A simple roughness model correctly predicts the main experimental results. Results can be extended easily to real-time stretch analysis of large tissue areas that would be applicable for predicting stresses in skin during and after the surgical closure of wounds.

Optimal patterns for suturing wounds.

A mathematical model for computing stresses in sutured human skin wounds is presented. The model uses the incremental law of elasticity and elastic constants valid for in vivo orthotropic skin. The model is applied to compute the principal stress and displacements resulting from suturing small elliptical and circular wounds in a large flat sheet of skin, in order to determine the optimal suturing patterns. It is observed that the average stress index for a circular wound sutured toward the center is almost double that of a wound sutured transverse to the diameter. Thus, the latter type of suturing pattern is preferable. Similarly, suturing an elliptical wound transversely produces a lower average stress index than a circular wound of the same area. It is also found that the optimal ratio of semi-major to semi-minor axis of an elliptical wound is near 3 (for abdominal wounds), i.e., this ratio produces the most uniform stresses along the wound edges, where wound healing is slowest. Since high stresses have adverse effects on healing and blood flow, this work, depicting regions of high stresses, may be used along with other biological factors to help predict regions of slower healing in sutured wounds.

Evaluation of residual stress in rabbit skin and the relevant material constants.

Material constants are needed in order to evaluate stresses. The material constants for orthotropic rabbit skin when residual stresses are eliminated, have been evaluated by Tong & Fung [(1976). J. Biomechanics 9, 649-657]. It is well documented that a circular skin sample taken from the human body becomes elliptical in shape. Thus, it is clear that there are residual stresses in human skin which need to be taken into consideration when evaluating the material constants. In this paper, we therefore evaluate the material constants for rabbit skin taking into account residual stresses.

Residual stresses in oscillating thoracic arteries reduce circumferential stresses and stress gradients.

The purpose of this paper is to examine the effects of residual stresses and strains in the oscillating arteries on the stress distribution in the vascular wall. We employ a static theory of large elastic deformations for orthotropic material (Chuong and Fung, 1986, J. biomech. Engng 108, 189-192) with the acceleration term added to make the theory dynamic. We use the static elastic parameters of residual stresses in our analysis because the dynamic parameters are not available in the literature. Our analysis reveals that the effect of considering the residual stresses is to decrease the very large circumferential stresses at the inner wall by 62% and reduces the stress gradient through the arterial wall by 94% compared to the case when residual stresses are ignored. Thus, because the arteries do contain residual stresses, the consequent lower stresses at the inner wall and the reduced stress gradient may reduce the progression of atheroma. Our computations show that the stress gradients do not depend on the heart rate.

5-Hydroxy-indolacetic-acid (5-HIAA) serum levels in depressive patients and ECT.

In 31 drug and ECT naive melancholic patients, serum levels of the major metabolite of serotonin 5-hydroxy-indolacetic-acid (5-HIAA) were estimated in the first and third ECT of a course. Plasma samples were taken before ECT and 1, 60 and 120 min thereafter. The estimations were done by a new high performance liquid chromatography method (HPLC). After the seizure, a statistically significant decrease of 5-HIAA serum levels was observed over both ECTs. There was a significant increase in 5-HIAA serum levels from the first to the third ECT. ECT was found to influence serotonin turnover. It might be interpreted that ECT improves serotonergic responsiveness and neurotransmission. There was no significant correlation between 5-HIAA levels and gender, or age of the patients, or seizure duration. Furthermore, the severity of depression and treatment response did not correlate with certain 5-HIAA serum level patterns.