Ehsan Ullah Syed

Attitudes of Pakistani Medical Students Towards Psychiatry as a Prospective Career: A Survey.

ObjectivePakistan is facing a shortage of psychiatrists; there are about 350 psychiatrists in a country of 150 million. Medical specialty choice surveys of medical students have approached this issue from various angles. The authors’ objective is to explore the attitudes of Pakistani medical students toward psychiatry as their future career.MethodsThird-year medical students from four medical colleges in different regions of Pakistan participated. A questionnaire was hand distributed and collected in each medical college by a contact person who was not affiliated with the department of psychiatry in any of the medical colleges included in the survey.ResultsThe response rate was 60% out of a sample of 381 students. The mean age was 21 years, and 57% were female. The majority (98.4%) were Muslims. Respondents were similar in all demographic characteristics except household income. Only 7.6% reported psychiatry to be either their chosen career or a highly likely choice. A Friedman test found a significant difference in mean scores of ratings of the attractiveness of various career aspects of different specialties.ConclusionsRelatively small numbers of students identified psychiatry as their specialty of choice. This trend is similar to many other studies. Given the small number of practicing psychiatrists in Pakistan, this finding is not very encouraging.

Association of depression with treatment outcomes in Type 2 Diabetes Mellitus: A cross-sectional study from Karachi, Pakistan

BackgroundTo assess the associations of depression with glycemic control and compliance to self-care activities in adult patients with Type 2 Diabetes MellitusMethodsThis cross-sectional study was conducted at a tertiary-care hospital in Karachi (Aga Khan University Hospital). Equal numbers of depressed and non-depressed patients were consecutively recruited from the diabetic clinic. Information on demographic and clinical characteristics was collected in face-to-face interviews and from medical records. Hospital Anxiety Depression Scale (HADS) was used to measure depression. Associations of depressed status (HADS ≥ 8) with poor glycemic control (Hemoglobin A1c level ≥ 7%) and compliance to self-care activities were assessed by logistic regression analyses.ResultsA total of 286 patients were included in this study with a male-female ratio of 1.2:1. Mean age was 52 years and in 64.7% of them, the duration of diabetes was more than 3 years. Depressed patients were more likely to be female (adjusted odds ratio [OR] = 1.88; 95% confidence interval [95%CI] = 1.07-3.31), had a family history of diabetes (OR = 2.64; 95%CI = 1.26-5.55), and poor glycemic control (OR = 5.57; 95%CI = 2.88-10.76) compared with non-depressed patients. Depression was also associated with low compliance to self-care activities such as taking dose as advised (OR = 0.32; 95%CI = 0.14-0.73), dietary restrictions (OR = 0.45; 95%CI = 0.26-0.79) and foot care (OR = 0.38; 95%CI = 0.18-0.83).ConclusionsAdult patients with Type 2 Diabetes who have depression were more likely to have poor glycemic control and lower compliance to self-care activities, and they might need particular attention during follow-up visits.

Increase in Teachers' Knowledge about ADHD after a Week-Long Training Program: A Pilot Study.

Objectives: ADHD affects 3% to 5% of school-age children. Clinical and community based epidemiological studies in Pakistan have shown a high prevalence of ADHD among school going children. A thorough review of literature shows that no studies of teachers’ training programs regarding ADHD have been published in Pakistani research literature. The aim of the present study is the development and evaluation of an ADHD training program for teachers. Methods: A teachers’ training program for ADHD was designed and a pilot run in 3 schools of Karachi, Pakistan. Teachers knowledge regarding signs and symptoms of ADHD was tested before and after the workshop and then again after 6 months using an ADHD knowledge questionnaire. Results: Forty-nine teachers, all of them women, completed the questionnaires before and after the training program, and 35 of them filled it out at the 6-month interval. Mean scores of these tests were compared using a paired t test. The authors found the difference of mean score of 1.48 ± 2.95, and this was statistically significant (p < .005). Conclusion: The authors conclude that the workshop improved the knowledge of the school teachers regarding ADHD symptomatology, and it remained significant even after 6 months of training (J. of Att. Dis. 2010; 13(4) 420-423).

Prevalence of emotional and behavioural problems among primary school children in Karachi, Pakistan — multi informant survey

ObjectiveTo determine emotional and behaviourable problem among school going children in Pakistan.MethodsA cross sectional survey of school children of certain towns within Karachi metropolitan area, aged 5 to 11 years during 1st half of 2006. SDQ was filled out by parents and school teachers for the same children. Demographic data of parents, teachers and children were also collected using a separate performa.Results7 private and 8 community schools agreed to participate. 1488 consent forms were sent to 700 parents of private school and 788 parents of community school children. A total of 675 parents agreed to participate in the study. The response rate was 45.3%. Assessment of children’s mental health was conducted using Strength and Difficulties Questionnaire (SDQ). Parents rated 34.4% of children as falling under the “abnormal category on SDQ, slightly higher estimates 35.8% were reported by the teacher. The findings suggest a striking difference between the informants’ ratings as well as gender wise difference in prevalence of common child mental health problems.ConclusionIn the present study prevalence of child mental health problems was higher than reported in studies from other countries. There was also a gender difference in prevalence; boys had higher estimates of behavior/externalizing problems, whereas emotional problems were more common amongst females. There is a need for developing programs to train, sensitise and mobilize teachers and parents regarding child’s psychological, emotional and behavioral problems.

Vitamin B12 supplementation in treating major depressive disorder: a randomized controlled trial.

Background/Objective: Recent literature has identified links between vitamin B12 deficiency and depression.We compared the clinical response of SSRI-monotherapy with that of B12-augmentation in a sample of depressed patients with low normal B12 levels who responded inadequately to the first trial with the SSRIs. Methods: Patients with depression and low normal B12 levels were randomized to a control arm (antidepressant only) or treatment arm (antidepressants and injectable vitamin B12 supplementation). Results: A total of 199 depressed patients were screened. Out of 73 patients with low normal B12 levels 34 (47%) were randomized to the treatment group while 39 (53%) were randomized to the control arm. At three months follow up 100% of the treatment group showed at least a 20% reduction in HAM-D score, while only 69% in the control arm showed at least a 20% reduction in HAM-D score (p<0.001). The findings remained significant after adjusting for baseline HAM-D score (p=0.001). Conclusion: Vitamin B12 supplementation with antidepressants significantly improved depressive symptoms in our cohort.

Suicide ideation and attempts and bullying in children and adolescents: psychiatric and general population samples.

BACKGROUND Studies of the relationship between bullying and suicide behavior yield mixed results. AIMS This is the first study comparing frequencies of suicide behavior in four bullying groups (bully, victim, bully/victim, and neither) in two large psychiatric and community samples of young children and adolescents. METHOD Maternal ratings of bullying and suicide ideation and attempts were analyzed for 1,291 children with psychiatric disorders and 658 children in the general population 6-18 years old. RESULTS For both the psychiatric and community samples, suicide ideation and attempt scores for bully/victims were significantly higher than for victims only and for neither bullies nor victims. Differences between victims only and neither victims nor bullies were nonsignificant. Controlling for sadness and conduct problems, suicide behavior did not differ between the four bullying groups. All children with suicide attempts had a comorbid psychiatric disorder, as did all but two children with suicide ideation. CONCLUSION Although the contribution of bullying per se to suicide behavior independent of sadness and conduct problems is small, bullying has obvious negative psychological consequences that make intervention imperative. Interventions need to focus on the psychopathology associated with being a victim and/or perpetrator of bullying in order to reduce suicide behavior.

Mother, Father, and Teacher Agreement on Disruptive Mood Dysregulation Disorder Symptoms in Children with Psychiatric Disorders

Objective: Disruptive Mood Dysregulation Disorder (DMDD) was established as a new DSM-5 disorder despite little published research, and there are no studies investigating agreement between informants on the presence of DMDD symptoms. Methods: Mothers, fathers, and teachers rated DMDD symptoms (irritable-angry mood and temper outbursts) in 768 children with psychiatric disorders ages 6-16. Results: Mother and father ratings were similar, but parent-teacher agreement was poor. Mothers and fathers identified a substantially higher percentage of children with DMDD symptoms (30% and 25%) than did teachers (12%). Conclusion: Our findings are consistent with previous studies demonstrating that parents perceive more externalizing and internalizing symptoms in their children than do teachers. This has implications for interpreting mother, father, and teacher report, which is particularly important for disorders like DMDD that have DSM-5 cross-setting diagnostic requirements. Given our findings, it seems prudent to obtain ratings from both parents and teachers and recognize that parents are likely to report greater DMDD symptoms than teachers.