Amin A. Muhammad Gadit

Prevalence of Depression among Households in Three Capital Cities of Pakistan: Need to Revise the Mental Health Policy

Background Pakistan, among the other developing countries, has a higher prevalence rate of depression because of the current social adversities. There is, thus, a great need for systematic studies on prevalence of depression. The current study aims at exploring the prevalence of depression among households in three capital cities of Pakistan. Methodology and Principal Findings A sample of N = 820 was randomly selected, and a cross sectional telephone-based study was conducted for a duration of six months. It was found that there was a regional variation in prevalence rates for depression among the three cities. Lahore had the highest number of depressives (53.4%), as compared to Quetta (43.9%) and Karachi (35.7%). Middle age, female gender and secondary school level of education were significantly associated with depression among the study group. Conclusions/Significance The different rates of prevalence among the three cities could be attributed to local cultural influence, geographical locations and social adversities. There is a need for revision of existing health policy by the government.

Efficacy of ECT in severe obsessive-compulsive disorder with Parkinson's disease.

A man in his 60’s was admitted following a serious suicide attempt secondary to severe obsession with bowel movements and severe depression. He had multiple previous admissions with similar presentations and responded partially to psychotropic medications. It was transpired that obsessive compulsive disorder preceded depression and being overwhelmed with this obsession related to bowel movement, he decided to end his life. Electro-convulsive therapy was commenced with good results. His obsessive-compulsive disorder came under control to a greater extent and there was an improvement in his mood.

International migration of doctors from developing countries: need to follow the Commonwealth Code

There is an ongoing debate on the migration of doctors, especially psychiatrists, from developing countries. It is argued that these countries, which are already running short of psychiatrists, will further be jeopardised and their health systems will collapse if this migration and subsequent recruitment continue. In this paper the author presents a personal view of the ethics and human rights of this matter. He emphasises the importance of migration of doctors in view of the current situation in developing countries and advises that the Commonwealth Code be followed to address the problem of the shortage of psychiatrists in developing countries and psychiatrists’ basic right to avail themselves of the opportunities in the developed world.

Health Services Delivery by Shamans: A Local Experience in Pakistan

Abstract Mental health services in Pakistan are still in the developing stages with less than 300 psychiatrists for a population of more than 140.5 million against the background of a low literacy rate, stigma, and the high cost of psychotropic medications that have disturbing side effects. Shamans are alternate therapists in whom people invest faith, and they approach shamans in growing numbers seeking cures from mental ill health. These therapists act as good counselors and in a way help the health system indirectly. Such therapists have a different concept about causations of mental illness and their treatment approaches are unique. This article examines health service delivery by these shamans against the background of Pakistan’s socio-economic system, and also identifies the need for collaboration with these therapists.

Insightful hallucination: psychopathology or paranormal phenomenon?

This report describes a 26-year-old man who was so emotionally attached to his mother that the mere thought of separating from her caused immense anxiety. The death of his mother after a brief illness resulted in prolonged bereavement. However, the patient started seeing and talking to his mother after her death, which led to huge improvement in his mood and social functioning. His wife brought him in for consultation but no obvious psychopathology was detected. This gave rise to the dilemma of whether to consider this a real psychopathology and treat it, or to disregard this reported hallucination. No active treatment is being given to this patient at the moment.This report describes a 26-year-old man who was so emotionally attached to his mother that the mere thought of separating from her caused immense anxiety. The death of his mother after a brief illness resulted in prolonged bereavement. However, the patient started seeing and talking to his mother after her death, which led to huge improvement in his mood and social functioning. His wife brought him in for consultation but no obvious psychopathology was detected. This gave rise to the dilemma of whether to consider this a real psychopathology and treat it, or to disregard this reported hallucination. No active treatment is being given to this patient at the moment.

Schizophrenia and Parkinson's disease: challenges in management.

A 57-year-old gentleman was admitted for relapse of psychotic symptoms. He had prior diagnosis of schizophrenia and Parkinson’s disease. His psychotropic medications were adjusted but his neurological symptoms worsened, mainly dysphagia. His speech and mobility also posed significant problem. Neurology department was contacted for joint management. In the event of resolution of psychotic symptoms, he was transferred to the neurology department for further management. His medication for Parkinson’s disease was reviewed; a percutaneous endoscopic gastrostomy tube was inserted in stomach for feeding as dysphagia did not improve. He was transferred back to psychiatry unit for further adjustment in psychotropic medication in order to see a possible improvement in dysphagia. Minor adjustment was done in this regard in view of his mental health stability. Change of medication was not possible for the possible side effects and patient’s compliance issue. He was discharged with adequate plans; follow-up arrangement and suggestions for further management.

Myth of reincarnation: a challenge for mental health profession

Mental health practitioners often come across a number of challenges in their clinical practice. One such challenge that posed a management dilemma presented with the history of reincarnation. This subject has been discussed in non-scientific literature at length but there is an absolute paucity in scientific literature. This paper describes a case where a boy presented with memories of previous life that started haunting him and caused significant anxiety. The subject of reincarnation needs extensive research in order to understand and manage the resultant clinical challenges.

Psychosis and temporal lobe epilepsy-role of electroconvulsive therapy

A 49-year-old female presented for admission with features of being withdrawn, inability to comprehend questions, auditory hallucinations and disorganised thoughts. She also had a previous diagnosis of temporal lobe epilepsy. She did not respond well to psychotropic medications. During her sleep deprived EEG, she had a brief episode of seizures. Following this, she showed improvement in psychosis for a day or so. Based on this finding, it was decided to initiate a course of electroconvulsive therapy. She improved remarkably on six treatments. At the time of discharge, she was in a stable condition.

Possession: a clinical enigma.

This is a case of a 21-year-old lady who presented with history of episodes where she would display extraordinary strength while becoming aggressive towards her family members, speak in foreign language and display bizarre behaviour. The episode would last for 15–20 min and would resolve spontaneously. She would always claim amnesia for the event. This would remain irritable in the intervening period. The frequency of such episodes is at least three times a week. The family members took her to several faith healers with no improvement in her condition. On the suggestion of a family friend, the patient was brought in for consultation in the psychiatric clinic. The patient remained a diagnostic dilemma though there has been some reduction in intensity of such episodes on psychotropic medication. Unfortunately, there is no remission in episodes.

Uses and Limitations of Ethnotherapy

It has been observed that treatment by alternate practitioners in mental health have caused problems as well as beneficial effects. This article aims to assess the benefits and adverse effects of ethnotherapeutic treatment; to carry out a substantive literature search into the nature and outcomes of ethnotherapeutic practices in Pakistan; to identify those conditions in which ethnotherapeutic practices are perceived to be beneficial by Western-oriented practitioners within the ethnic catchments provided by the city of Karachi; to promote further understanding of potential beneficial uses of such techniques by proponents of Western psychiatric medicine; to establish a database for behavioral change strategies involving future psychiatrists and ethnotherapists, which will safeguard against the use of ethnotherapeutic methods in circumstances where patients are likely to be harmed; to implement and monitor the outcomes of a consensual educational strategy involving attitudes, perceptions, and resultant practices of a selected group of ethnotherapists practicing in the city of Karachi. Twelve psychiatrists and twelve ethnotherapists were selected through random sampling and their practices were observed. A questionnaire was administered and interviews were conducted. A number of patients who were in the care of both types of therapists were also interviewed. The results demonstrate that ethnotherapeutic practice is beneficial in minor depression, anxiety, and psychosomatic disorders, while it is detrimental in psychosis and organic brain conditions.