Proceedings of Psychosocial & Psychiatric Rehabilitation Conference organized by Karwan-e-Hayat


 Proceedings of Psychosocial and 
Psychiatric Rehabilitation Conference
organized by Karwan-e-Hayat

By Mubarak Ali

KARACHI: Karwan-i-Hayat Psychiatric Care and Rehabilitation Centre Organized its first international conference on psychosocial and psychiatric rehabilitation on June 29-30th 2018 where experts discussed a diverse range of subjects related to mental health.

Prof. Fareed A Minhas Director CGMPH, talking about School Mental Health programme said that we should establish diploma in child psychiatry. We had orientation sessions on role of teachers and schools in promoting child mental health and participants included two hundred newly inducted teachers, principals, AEO’s & Tehsil Coordinators. CGMPH plans to introduce certificate courses of diploma in mental health for general family physicians, Leadership in mental health diploma, diploma in psychiatric and mental health nursing, diploma in clinical psychology, masters in clinical research besides diploma in child psychiatry and MD Psychiatry.

Karwan-i-Hayat Psychiatric Care and Rehabilitation Centre Organized its first international conference on
psychosocial and psychiatric rehabilitation on June 29-30th 2018. Picture shows Dr. Ajmal Kazmi and
Dr. Zafar Haider presenting mementoes to the key note speakers from (L to R) Mr.Shaukat Ali Jawaid,
Dr. Unaiza Niaz. On right Dr. Ajmal Kazmi alongwith Dr. Rizwan Taj and
Prof. Iqbal Afridi is presenting a memento to Dr. Jamil.

Prof. Raza Ur Rehman and Prof. Zafar Haider spoke about evidence based concept of QALB/Heart. Heart break, Prof. Raza Ur Rehman stated will not kill you but it does heart. There is a heart in the brain of an individual which can be treated by Psychiatrist not by cardiologist. In folk & factional tales, characters die after suffering a devastating loss but in reality people can die from broken heart. The symptom of broken heart & heart attack mimic like chest pain. Unlike heart attack there is no vascular blockade rather there is transient short-lived stunning of the left ventricles. As a result the heart become temporarily frozen and cannot pump enough blood forward. The anterior cingulate cortex during stress may over stimulate the vagus nerve that causing pain, nausea or muscle tightness in the chest. Study has also showed that the same regions of the brain that become active in response to painful sensory experiences are also activated during intense social rejection or social loss in general. Heartache is felt when blend of emotions are experienced in our chest, he added.

Prof. Zafar Hider explained the meaning of “Qalb” with different definitions with the help of Quranic Verses. Intention of this presentation, he stated, is to clarify the concept of Qalb in Holy Quran, generally it is considered that in Holy Quran the world Qalb relates to heart while there are so many meanings of Qalb in Arabic and one of them is mind Cognition/ Execution, he added.

Dr. Ali Burhan talking about prevalence of family burden among caregivers of patients of schizophrenia said that caregivers face enormous burdens, stigma, and behavioral issues from the patients. Findings of a study conducted at Sheikh Zayed Medical College/ Hospital Rahim Yar Kahn has showed that all care givers experience up to some extent family burden and burden was not significantly associated with age, gender. Efforts should be made to reduce the burden associated with caring of patients with schizophrenia. Government should subsidize the cost of treatment and make mental health facilities more accessible to the community. Emphasis should be laid on prevention, early diagnosis and prompt treatment of mental illness, he added. 

Dr. Ajmal Kazmi, Dr. Rizwan Taj and Prof. Iqbal Afridi presenting mementoes to Prof. Iqbal Afridi and
Prof. Raza Ur Rehman during the Karwan-e-Hayat during its first international conference
on psychosocial and psychiatric rehabilitation held at Karachi recently.

Dr. Unaiz Niaz discussed the functional impairment in Major Depressive Disorders (MDD), from Mood to Function-Evolving goals in depression treatment. Major Depressive Disorders has the highest lifetime prevalence of any psychiatric disorders. Rates of chronic MDD are conservatively estimated to be at approximately 20% with high rates of relapse and recurrence is also reported. It has been hypothesized that over 25% of the impact of a MDD on role functioning and psychosocial outcome is mediated by cognitive function. Patients also commonly report inter-episodic cognitive complaints during the remission phases of the disorder that negatively affect their ability to engage in more cognitively demanding activities. Ultimate goal of treatment in depression, she stated is to achieve full functional recovery. Impaired concentration is a core symptom of depression. In addition to the need for targeted treatment of this functional domain, increased awareness and ease of assessment for these impairments are greatly needed. Functional recovery, especially occupational functioning is the target for depression treatment. Cognitive dysfunction is a mediator of functional impairment in patients with depression. Treatment that address cognitive functioning in MDD can optimize functional recovery Dr. Unaiza Niaz concluded.

Prof. Mazhar Malik presented the findings of REAP A4 survey which has reported that more than half of patients with schizophrenia are receiving polypharmacy and co- prescription of anxiolytics in Pakistan. This survey was conducted in fifteen countries including Pakistan. In total 3744 prescription of patients with schizophrenia were collected from 15 countries and areas in Asia. From Pakistan two hundred ninety eight patients were included. The objective of this survey was to assess the trend and change of psychotropic drug prescriptions for patients with Schizophrenia. Polypharmacy is defined as concurrent use of multiple medications prescribed by physicians. The prescription of two or more antipsychotic drug has also been described as polypharmacy. Antipsychotic polypharmacy has been the usual mode of treatment for patients with schizophrenia, spectrum disorder, despite scanty evidence about their beneficial use. Resperidone was the most commonly prescribed drug given to 62.4% followed by Haloperidon to 26.5% and Quetiapine to 18.5% patients. Education and training on the proper use of psychotropic drugs are recommended to Psychiatrists in Pakistan. The guidelines on pharmacotherapy for patients with schizophrenia should be developed and promoted, he concluded.

Prof. Sohail alongwith Dr. Rizwan Taj and Prof. Mazhar Malik chairing one of the sessions
during the Karwan-e-Hayat conference held recently.

Dr. Sohail Ahmed talking about Media & Mental Health highlighted both positive and negative effects of the media, including selfie addiction and internet gaming disorder. Relationship of media with mental health is very important and sensitive area, it has strong influence on all aspects of our daily life including health. He suggested that there should be guidelines for the media. All of us can contribute to it but preferably elected representative body of Psychiatrists should take up this task. Electronic media can be directly approached. The Pakistan Electronic Media Regulatory Authority can also be approached, he said.

Speaking about self-harm and suicide prevention, Prof Imran B. Chaudhry, said that though Pakistan had high suicide rates, suicidal behavior was an under studied and under researched subject in the country. Pakistan, he said, was one of the few countries in which attempted suicide was still a punishable offence. Self-harm also carries a substantial economic burden, and has been associated with large treatment costs in Pakistan. Predictors of suicides in Pakistan included psychiatric disorders, unemployment, stressful events in life and poor problem-solving skills.

Prof. Rizwan Taj talking about Media and Mental health stated that Television is the most important source of entertainment and information for the population, what it shows influences and effects the public. A study conducted at PIMS Islamabad has pointed out that those who watch television news more than one hour a day showed more stress symptoms and depression. Study concluded that media persons should follow their moral code of ethics and they need to use their supremacy in a productive way. Keeping in mind the most important role of media in today’s era series of training workshops were organized for creating mental health awareness among media persons. The outcome of this training program demonstrate the significant of change in knowledge and awareness regarding mental health among media professionals. Mental Health awareness training can enhance the knowledge and help media persons in reporting mental health issues, he added.

Dr. S. Jamil Hussain discussed the post retirement syndrome in Pakistan which have multiple avenues resulting in psychiatric syndrome and social disqualification. He suggested that retired persons must keep the pension intact using it with appropriate planning. They must have friendly approach towards family and children, must go for mental checkups and psychotherapeutic sessions and be ready for leisure activities and tours with friend and dear ones.

Pubbing and its effects on wellbeing and relationship was discussed by Dr. Ayesha Sarwat. The addiction of mobile phone, she pointed out, could cause neck and shoulder pain, tendinitis, insomnia and depression and phantom vibration syndrome. Glancing at your phone in the middle of a conversation, checking your phone when the conversation stalls, keeping your phone close by even during one-on one time with someone or interrupting a real-life conversation to answer your phone are all acts of phubbing, she added. Pubbing could interrupt one`s ability to engage with people, seriously disrupt in-person relationships, decrease marital happiness and make face-to-face communications less satisfying. `Social media can make feelings of depression worse, and the more you use social media, the more likely you are to feel depression or anxiety. Positive interactions will ultimately benefit our mental health and sense of connection and belonging, she concluded.

Prof. Iqbal Afridi alongwith Prof.Rizwan Taj and Dr. Jamil chairing one
of the sessions during the Karwan-e-Hayat Conference.

Prof. Raza ur Rehman spoke about Early Optimized Treatment and Functional Recovery in Major Depressive Disorder which means early diagnosis, assessment and treatment for optimal management of MDD through monitoring symptoms and function early in treatment. MDD is associated with impairment in physical social cognitive functioning in the workplace and household resulting in decrease in work productivity. Functional recovery is the key goal of MDD treatment and is important to patient in consideration of remission. There is growing evidence that different anti-depressants can improve functional outcomes. MDD Patients who have achieved symptoms remission but still have impaired functioning are at greater risk of relapse. To protect relapse and other negative consequences clinicians must monitor symptoms and functional impairment validated scales, he added.

Prof. Nasim Chaudhry, said that Pakistan has the worst infant mortality rate in the World. We are the 6th most populous country in the World and literacy rates is about 35-40%. Pakistan is the fifth largest contributor to maternal mortality and six percent of the World’s maternal deaths occur in Pakistan. Depression is two times higher in women than men. In Pakistan, the rate of depression in women is amongst the highest in the World. Depression in mothers was associated with factors including immature births and low birth weight, malnutrition and stunting, behavioral problems in children as well as childhood depression.

Dr. Kamila Haider spoke about Forensic Psychiatry which is concerned with helping people who have mental disorders and who present a significant risk to the public. Its management requires multidisciplinary approach consisting medical team, nursing team, psychologist, occupational therapists, social workers, physiotherapist etc. Our main purpose is to treat individuals with mental disorders who pose risk to others and to provide this treatment in community, hospitals and prisons. As compared to generic mental health services this population will have a higher complexity of disorder, a higher incidence of mental illness that is resistant to treatment and will pose a significant risk to others.

Dr. Furrukh Z Ahmed speaking about treatment challenges in psychiatric rehabilitation said that we should know psychology of our patients. If we have a will we can do wonders. She highlighted how psychology was started in Karachi University. Now we have institute of clinical psychology which is doing commendable job but latest technology of rehabilitation must be updated, she added.

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