Proceedings of 10th National Neuropsycon on Psychiatric Updates

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10th National Neuropsycon at Lahore

Proceedings of 10th National
Neuropsycon on Psychiatric Updates

By Mubarak Ali

LAHORE: Many interesting scientific papers were presented during the 10th National Nuropsycon 2014 on Psychiatric Updates and Media-Public Awareness, held at Lahore from April 25-27, 2014. It was organized by Pakistan Psychiatric Society & Psychiatric Welfare Association in collaboration with Psychiatry Department Rahbar Medical and Dental College, Psychiatry Department FJMC, Lahore, Pakistan Society of Neurology, Pakistan Society of Neurosurgeons, Pakistan Academy of Family Physicians, Pakistan Psychological Association and Pakistan Association of Clinical Psychologist. The theme of the conference was “optimizing unmet needs of psychiatric care in developing countries”. Prof. M Riaz Bhatti was the Chairman of the Organizing Committee, he added

Prof. I. A. K Tareen along with Prof. Mowadat H. Rana, Dr. M. Ajmal Kazmi and Dr. Iftikhar Ahmed chaired the first scientific session while Dr. Nazish Imran was the moderator. Prof. Imran Ijaz Haider, Professor of Psychiatry at Fatima Memorial Medical & Dental College, Lahore was the first speaker who talked about the oral dispersible olanzapine – velotab a novel antipsychotic. He pointed out that we need fast and simple cure in acute psychotic episodes and schizophrenia patients. People presenting with agitated or violent behavior thought to be due to severe mental illness may require urgent pharmacological tranquillization. Sometimes it is necessary to use medication to help stop aggressive or agitated behavior that is thought to be caused by serious mental illness.


Two ways of doing this is to give an injection (IM / IV) or as oral preparation. Both these modes of treatment at times leads to aggressive behaviour ending in Physical violence both by patient and carers. The other worry is that patient may hide the medication and throw away afterwards. Olanzapine oro-dispersible (Velotab) was introduced in the United Kingdom in May 2000. It rapidly dissolves in the mouth, and therefore patients may find it preferable to swallowing tablets. Another advantage is that the opportunity to hide the medication is reduced. The advantage of this medication is that it can be dissolved in water, milk or juice according to BNF 2014. More advantage is that if it is placed in mouth it dissolves in less than a minute with saliva and no more spitting or hiding of medication in mouth. It is very effective, he added.

 

During the 10th National Neuropsycon Prof. I. A. K Tareen along with Prof. Riaz Bhatti presenting
certificates to Dr.  Mowadat H. Rana, and Prof. Imran Ijaz Haider.  Prof. Sharif Ch. Presenting
certificates to Prof. Raza ur Rahman, Prof. Murad M Khan and Prof. Rizwan Taj.  Mr. Salman
Rafique presenting Shield to Dr. Wasay while on right Prof. Hasan Aziz presenting
certificates to Dr. Muhammad Babar Khan and Dr. Wasim Ghani.

Prof. Rizwan Taj talking about the interface between neurology and psychiatry said that in medicine these are two closely related with many overlapping areas on both sides. Common neurological condition like Stroke, Parkinson’s disease, Epilepsy and MS has common psychiatric manifestations like mood related problems and to a lesser extent Psychoses. It is important for their recognition and treatment as they can easily worsen the prognosis, quality of life of the individual with the primary neurological disorder. Neurologist need to be aware of these phenomena and seek appropriate intervention where required. In most cases helping and treatment of associated Psychiatric symptoms can go a long way in assisting the patients. On the other side psychiatric disorders can also have neurological manifestation for which the mental health physicians should diagnose and seek help. It makes an interesting situation when both co exist such as in conversions disorders are more common in epileptic patients than in the general population. Knowledge on both sides, close liaison between the two specialties is very important to achieve the ultimate goal to help the patients besides cross specialty mandatory trainings and joint meeting and case discussion can be beneficial, he added.

Dr. Anjum Bashir from UK talking about acquired brain injury (ABI) in children said that children brain stuff is less myelin and risk of head injury is more in children than adults. Acquired brain injury in children is largely ignored. There is a high risk of ABI in childhood and the sufferers are at an increased risk of criminal behavior. It has been proved that with effective interventions the children can be restored to a near normal trajectory of development he added.

Prof. Murad M Khan from Karachi highlighted the challenge of suicide prevention in Pakistan. It is a major public health problem of our country and no city or part of the country is immune to it. Suicide, he said, is considered an unforgivable sin and strongly condemned in Islam. Historically, this has acted as a potent deterrent against suicide, evidenced by low rates in Islamic compared to non-Islamic countries. However, in recent years a number of Islamic countries including Iran, Turkey, Bangladesh and Indonesia have witnessed an increase in incidence of suicide. In Pakistan, over the last decade or so, there has been a dramatic increase in incidences of suicide and attempted suicide. A case-control psychological autopsy study in Karachi showed majority of suicide victims were suffering from clinical depression but only a small minority were receiving treatment for this and none of the victims had been in contact with a health professional in the month prior to suicide. Families lacked awareness and resources to seek help. There is need to address suicide prevention not only from mental health but also from the socio-cultural, religious and political perspectives in Pakistan. For prevention restricted access to means of suicide, responsible media reporting system of certification and recording is essential, he concluded.

Dr. Mowadat H Rana from Rawalpindi talking about an Allostatic approach to bridging the gap between psychiatry and mental health stated that mental health is state in which an individual is not only free of mental health but is able to realize his /her full potential . Psychiatry has come of age as an important branch of medicine that deals with mental illnesses. psychiatrists still do not fully play their role in enhancing human happiness, improve human resilience, and help the human race in realizing its full potential and responsibility. Psychiatrists have to make a decision sometimes very early in their career to choose to become physicians caring for diseases of mind and shrink the scope of their discipline or broaden their personal and academic horizons to become mental health professionals. We have to be doctor-centered rather than mental health team oriented. Treatment, rehabilitation and prevention of psychiatric disorders promotion of mental health, conceptual frame work social inclusion, freedom from discrimination and violence, economic emancipation must be given importance, he stated.

Prof. Mowadat Rana further said that we have to make strategies like healthy life style and child caring. Mental Health is disrupted by environmental socioeconomic psychological and biological factors. We need actions like social inclusion, economic participation freedom from discrimination. Training in mental health is lacking which must be our focus. University of Health Sciences in collaboration with WHO has planned a program in International masters in Public Mental Health policy and services which will start next year, he informed.
Lively discussion took place at the end of the session and all the presenters were appreciated for their quality work. One of the participants pointed out that we must keep in mind the cost of the treatment. One tablet of olanzapine – velotab cost Rs. 300/ which is very expensive and patients cannot afford it. Replying to the question Dr. Imran said that we don’t insist that all the patients should take this drug. But if we compare this one tablet with the cost of prescription written by our Psychiatrists having five to six drugs which is more expensive. We have to change our prescription habit to help the poor patients rather than promoting the Pharma industry for our personal gains, he remarked.

Dr. Iftikhar Ahmed in his concluding remarks said that awareness of mental health, treatment and management by the right person is only way out to get maximum benefits. We have to educate the masses to avoid visiting these quacks who are playing havoc with the lives of poor people. Prof. Tareen in his remarks said that everybody is doing everything, quacks are doing most of the things and there is no check on them. We should stick to our field and have to improve mental health if we have to do something. we talk lot about illness; we are too few as psychiatrists. We should go all together to improve the mental health, he added.
Prof. Muhammad Sharif Ch. along with Dr. Anjum Bashir and Prof. Mazhar Malik chaired the second session while Dr. Usman acted as Secretary. Dr. Sadia Saleem, speaking at the occasion said that depression is increasing day by day. Many researchers are now focused on identifying the early risk and protective factors that play a role in the development and maintenance of depressive symptoms in adolescents. In a study conducted on 385 adolescents with the age range of 13-18 has revealed that anxious and ambivalent attachment pattern and negative self-concept were found to be strong positive predictors of depressive symptoms among adolescents.

Prof. Raza ur Rahman from Karachi talking about challenges faced while integrating psychiatry and Behavioral Sciences in undergraduate curriculum said that in Pakistan the burden of psychiatric illnesses have increased tremendously due to growing terrorism, insecurity, worsening law & order condition, poverty, unemployment, load shading and disruption of the social fabric. In the presence of the increased number of psychiatric patients and scarcity of Psychiatrists and other mental health professionals in Pakistan there is dire need for integration of psychiatry and behavioral sciences in undergraduate curriculum. At Dow University of Health Sciences the behavioral sciences have been integrated in all 5 years of MBBS. While developing integration flexible approach was adopted to accommodate psychiatry and behavioral science in the existing curriculum. Besides behavioral sciences the topics of psychiatry have been effectively incorporated in neurosciences module, he informed.

Prof. Mazhar Malik talked about the the Dialogue of Diabetes and Depression (DDD) which is an international initiative of WPA and WHO and promotes the education, awareness and research on co-morbid diabetes and depression. Its aim is to review the evidence and experience relevant to co-morbidity of diabetes and depression in order to define gaps in knowledge and formulate strategies for priority research and action in this field. There is high and still increasing incidence of both these disorders i.e. depression and diabetes. At least one third patients with diabetes develop clinical depressive illness. There were about one hundred seventy million of diabetics in year 2000 which is expected to be risen to 366 million by the year 2030. This DDD initiative will work with various organizations to tackle this problem, he added.

Prof. Rizwan Taj talking about Diabetes and Depression - A local experience said that diabetes is risk factor for developing problems like anxiety and depression. A study is being conducted in PIMS Islamabad which consists of two phases. Phase one of this study has been completed and it showed that anxiety and depression are co morbid with diabetes.

Dr. Imran Ijaz Haider talking about management of major depressive disorders said that various antidepressants are available. We should consider tolerability and side effects. Depression is one of the commonest psychiatric disorder which is seen in the clinical practice. The ultimate goal is to have complete remission. Most patients with major depressive disorder do not respond to the first line medication prescribed. They are usually labeled treatment resistant. Many of them who are considered as treatment resistant are actually misdiagnosed or inadequately treated. A correct determination of what treatment resistant depression is, requires a criteria of treatment strategy. Three pharmacotherapy strategies are in clinical use which includes optimization of antidepressant dose, augmentation therapies and switching therapies. If we need to change the medication should change the class of drug otherwise it will be of no use, Dr. imran further added.

Dr. Murad Moosa Khan from, Aga Khan University Karachi talked about suicide& suicide bombing in Pakistan: do they have a common pathway? Eighty percent suicide bombing comes from Muslim countries and more than 33,213 people have been killed in Pakistan. Suicide bombing is a multi dimensional complex phenomena. It is postulated that both suicide and Suicide bombing are carried out by young people, predominantly males and from the lower socio-economic strata of the society. There are number of common distal factors including poverty, deprivation, unemployment, lack of education and poor social conditions. Research, Public health awareness, prevention programs should be our priority to tackle this problem, he added.

Prof. Sharif Ch. in his concluding remarks appreciated the efforts of the presenters and lauded the services of Prof. Riaz Bhatti for the cause of mental health services in the country by organizing this activity regularly.

Prof. Raza-ur-Rehman and Prof. Salah ud Din Babar chaired the first session on 2nd day of the conference. Dr. Imran Ijaz Haider was the Moderator. Ms. Madiha Qayyum discussed the impact of cyber bullying which is a growing phenomenon and cause serious impact on individuals life and they use multiple ways to cope with it. A study conducted on 300 students revealed that cyber bullied through cell phone and internet medium have Psychological, educational, Social and Physiological impact like insecurity, fear, anger, difficulty in concentrating in studies, decline in sleep, reduction in diet and weight of the victims.

Dr. Zulfiqar Lakhair who has established psychiatric clinic at Dadu shared his experience and satated that over 86% of the patients who visited psychiatric clinic have already visited faith healers Sufis Shrines and family physicians who have never been able to educate the sufferer of psychiatric disorders. Rural area clinic have to improve skills along with social interaction with the community which can be promoted through seminars, conferences and awareness programs at DHQ hospitals besides appointment of qualified psychiatrists.

Dr. Zahoor Memon talking about status of Psychiatry in Pakistan said that there are 445 psychiatrists to deal 180 million population of Pakistan. In 1986-87 DPM was started by Prof. Ijaz Haider. At present 120 psychiatrists are serving in Sind province. There is dire need of qualified psychiatrists in the country to deal with psychiatric ailments, he added.

Maj. Nadeem Ahmed highlighted the modification for psychiatric services in Pakistan with regards to personal recovery perspective. Multidisciplinary approach, incorporation of caregivers, modifications in indoor facilities, selection of drugs fostering personal recovery community participation besides awareness and destigmatization are the areas which need modifications. Personal recovery books are also available, he added.


 

Dr. Ahsan Noman talking about Dementia care said that early initiation of treatment is the main need of dementia. Sooner the best and it’s never too late. It can be managed and treated with early treatment and high dose. Mementine is the drug of choice in dementia, he added.

Prof. Salah ud Din Baber in his concluding remarks said that Cyber bullying is a unique topic. It has a long term effect on children. Due to Internet bullying we are facing lot of social problems at our homes and in the society. Regarding psychiatric care in rural areas we have to organize seminars, CME programs and create awareness among masses about mental health care. For treatment of dementia training of caregivers is very important. Prof. Raze urn Rehman in his remarks said that travel to Sindh is very risky and people avoid going there. People in other specialty should be trained to deal basic psychiatric problems, because there are fewer psychiatrists in the country.

Prof. Wasay along with Prof. Iqbal Afridi and Prof. Abdul Hameed Memon chaired the second session . Maj. Dr. Nadeem Ahmed was the Secretary. Dr Ali Burhan Mustafa discussed the emotions & emotional intelligence. There are variant types of inherent & acquired emotions which can lead to Emotional Eclipse if not handled properly. There are ‘Positive and Negative Emotions’ which can lead to bias, compromise in professionalism, relationship problems, anger issues, poor child bearing, broken homes, physical problems like diabetes and hypertension, drugs if unable to identify the ‘Power of Emotions. Emotional Literate person knows how to use the anger management prevention through using the layers of brain effectively by influencing the corticospinal tract. Emotionally literate person knows the ‘Power of Neurotransmitters’ and can handle it effectively in the interpersonal relations.

Ms. Sumaira Kausar, talked about psychosocial dysfunctions in female adolescents with conversion disorder and said psychotherapeutic treatment of patient with conversion disorder and their maladaptive schemas can be targeted for modification.

Dr. Fahad ul Zain presented the findings of a study regarding age co-relation among premature ejaculation cases. The study detected the dominant age range was within 22-39 years which is considered to be most active and reproductive age among male. In a country like Pakistan where multiple cultures and complex diversities adjoined and family system is relatively strong, the problem of premature ejaculation contributes in damaging the fabric of the family.

Dr. Iftikhar A. Minhas highlighted the burden on primary caregiver of schizophrenic patients. Poor people and lowly educated, he said, are the most affected and female are the major sufferers of Schizophrenia. Medical professionals well empathize the spectrum of schizophrenia and help achieve better control. We need to establish an intervention to improve quality of life and decrease burden of caregiver of schizophrenic patients. Social scientists , psychologists should also design counseling strategies to make schizophrenic patients productive for society.

Dr. Akram Sheikh talked about the prevalence of depression in patients with stroke in tertiary care. Stroke he stated , is a major public health problem. Post-stroke depression (PSD) is one of the common emotional disorders afflicting stroke survivors. Depression is under diagnosed following stroke. Chronic stroke sufferers should be screened for psychiatric ailments, he added.

Dr. Col. Amjad Akram, talking about visual hallucinations said that the symptom of visual hallucination overlaps multiple disciplines including ophthalmology psychiatry and neurology. These specialties should work together for its better management and understanding. From clinical point of view the content of a visual hallucination does not have much diagnostic value, he added.

Ms. Muneeza Hamid presented the findings of study regarding depression and suicidal ideation among 384 students of 12-25 years of age. Depression and suicidal ideation have been recognized as the major key factors in predicting the suicidal tendency of an individual. The major risk factors for suicide are mostly hopelessness, history of previous suicide attempts, social isolation, depressive disorder, alcohol /drug dependence, and other psychological and medical illnesses. Other than that, suicidal ideation has been found to be strongly related with substance abuse, social isolation and gender difference and greater risk was found among females. Students need support from family, friends and teachers. Parents and teachers should be educated about the sensitivity of the issue, she concluded.

Dr. Ajmal Kazmi talking about dementia care said that Dementia affects three areas of brain, cognitive, behavior and emotions. The fundamentals of dementia care are person centered care, attention on communication skills, verbal and nonverbal strategies, therapeutic fibbing, understanding, and responding to behavior. This becomes possible when younger people allow them to get involved in the life without rushing and avoid arguing. Other strategies can also be useful where elderly people participate which makes them calm and comfortable in the environment. Multidisciplinary approach is very important, he added. Dr. Ajmal Kazmi, who has joined as Director Medical Services, at Dr. A Q Khan Institute of Behavioral Science also informed that comprehensive psychiatric services at Karachi will be established with the help of the society their Institute will open branches in different cities.

Prof. Iqbal Afridi discussed the role of Duloxetine for the management of MDD. It is effective in pain relief and also effective in old age patients. Nausea is the major side effect, he added. Dr. Wasay in his concluding remarks advised the presenters to get their work published in scientific Journals.