Optimizing unmet needs of mental health through Psychosocial Intervention

Print

Proceedings of 14th International Neuropsycon
Optimizing unmet needs of mental health
through Psychosocial Intervention

By Mubarak Ali

Bhurban: Many interesting scientific papers were presented during the 14th International Neuropsycon and 1st Int. Conference on Social Psychiatry organized by Pakistan Welfare Association and Pakistan Association of Social Psychiatry in collaboration with World Association of Social Psychiatry, University of Health Sciences, and Continental Medical College, Lahore at Bhurban, Murree from 12-14, April, 2019. The theme of the conference was Optimizing unmet needs of mental health through Psychosocial Intervention. Prof. M . Riaz Bhatti was the Chairman of the Organizing Committee.

Ms. Nargis Munir talked about psychology of learning entrepreneurship skills in the first session on Social Psychiatry. A study was conducted in ten universities of Khyber Pukhtunkhwa and five hundred twenty seven students were selected from cluster universities. The study found that students learn entrepreneurial skills through tactile learning style. Therefor the right learning strategy may be to explore ways to make students tactile learning.

Ms. Shamaila Ijaz discussed the effects of training to the mothers of Autistic children to improve the verbal and nonverbal skills of their children. Children suffering from Autism hardly learn and tend to be involved in routine interactions with adults and other children. It is manifested by repetitive behaviors. There is a significant relationship between training mothers and communication development of ASD. Training help to bring awareness for understanding the basic facts and functions of behavior and it helped parents to examine the root cause of the manifested behavior therefore they better managed the behavior of their ASD child.


Prof. Riaz Bhatti, Chairman Organizing Committee of 14th International Neuropsycon
photographed along with Chairman, Co Chairman and speakers of the 1st session during
14th International Neuropsycon held at Bhurban from 12-14th April, 2019.

Ms. Farzana Ashraf talked about Circadian Typology and sleep quality among nurses. Circadian Topology is defined as individual differences in diurnal preferences patterns of sleep and activities and activeness in the morning and evening. A study was conducted on 300 nurses from various hospitals which suggested that swing shift significantly moderated the relationship between eveningness and sleep quality if nurses work in swing shift and they had eveningness tendency, than they will suffer from sleep disorders.

Ms. Somyia Mahmood discussed the social issues of domestic workers. In a study conducted it was found that workers who permanently live at their workplace faced more restrictions as compared to non-resident domestic workers who work for part time. Laws are needed for implementation of rights of the domestic workers and NGOs can play an important role by identifying the issue.

Prof. Mazhar Malik talking about social determinants of mental health said that it is major contributors to health disparities and health inequities. Health begins and is dependent upon where we live, learn, work and play. Mental and substance use disorders are highly prevalent and highly disabling. Prejudice and discrimination have strong social determinants and behavioral health conditions are often expensive to treat but much more expensive if ignored. There is a dire need for a life course approach to understanding and tackling mental and physical health inequalities, he added.


Prof. Riaz Bhatti and Prof. Imran Ijaz Haider chairing a session during
14th International Neuropsycon held at Bhurban recently.

Prof. Imran IjazHaider discussed the innovations in the treatment of depressive disorders. He stated that Psychiatrists aim for remission in patients, reduction in future relapses, return to normal functioning and restoration of better quality of life. There are so many antidepressants available like TCAs, SSRI, SNRI, NDRI, NASSA, SARI and MAOIs with various mechanisms of action. Agomelatine is a new drug for depression, which helps in sleep restoration (being a Melatonin receptor agonist) and also have minimal sexual side effects. It is a melatonin receptor agonist and has moderate antagonist affinity for the 5-HT2c receptors, hence minimal sexual side effects.

Session II (Social Psychiatry)

Speaking in the second session Dr. Farzana Ashraf presented the findings of study Burnout as a Risk Factor of Mental Health Status of Medical Health Professionals (MHP) in Pakistan. Results suggest that the impact of burnout, depression, anxiety, and stress symptoms is pervasive across MHP’s personal and work lives. Self-assessment or disclosure of mental health concerns need to be managed positively. Burnout, depression, anxiety and stress symptoms can be acknowledged in the workplace as contributing factors, consequently impact could be minimized, and effective treatments can be implemented. Emotional well-being of the MHP has considerable implications for better medical care, staff retention and overall satisfaction.

Ms. Umara Rauf talking about Internalized stigma as a Predictor of Self-Esteem in Persons with Schizophrenia Spectrum Disorder said that it is a severe mental illness which is defined as an abnormality in five major domains, delusions, hallucinations, disorganized speech and behavior, grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms. In our culture, mostly people live in joint family setup that plays role of a defensive factor to manage a person with some severe mental illness who has lack of insight and it is a great challenge for family itself. Economic condition has its significance in meeting expenditures and improving quality of life.


Dr. Khalid Nawab along with Dr. Jameel Hussain and Dr. Sobia Haqqi chairing one of
the session during 14th International Neuropsycon held at Bhurban recently.

Dr. Haris Kamran discussed the Red Bull Induced Mania. The energy drink market, he said, has grown exponentially since Red Bull was first introduced in Austria in 1987 and in the U.S. in 1997. In Pakistan, we have numerous energy drinks which are promoted for their stimulant effects including increased attention, performance and endurance. Caffeine is the main active ingredient of energy drinks. Dr. Harris presented a case which suggests that the energy drink may have played a triggering role in an individual with no prior psychiatric history, but a family history of mood disorders. The energy drinks manufacturing companies he suggested should mention an upper limit/maximum daily dose of consumption for their energy drinks, he added.

Prof. Raza ur Rahman talking about optimizing unmet needs of mental health through Psychosocial intervention said that burden of Mental Health Problems is not only huge but also growing. In 2004, depression was the leading cause of disease burden among young adult women in low-/middle- and high-income countries, and was projected to become the leading cause of disease burden worldwide by 2030. The incidence and prevalence of psychiatric morbidity have both increased tremendously. The reasons are growing insecurity, terrorism, economical problems, political uncertainty, unemployment and disruption of the social fabric.

There is scarcity of psychiatrists approximately less than 500 psychiatrist are present in Pakistan. Mental health facilities in prisons across Pakistan were almost non-existent. Frequent relapses of Psychiatric illnesses contribute to neurobiological impairment, functional & social decline & poor treatment response. Psychiatric illness has a substantial impact on patients, their families, caregivers & society in general. It affects negatively all aspect of a person’s life. Mental illnesses can be managed effectively through adequate treatment but most of the patients do not receive appropriate, timely, and adequate treatment.


Group photograph of the speakers with Chairman and Co Chairman of the 3rd session
during 14th International Neuropsycon held at Bhurban from 12-14th April, 2019.

Psychiatric sub-specialties like Forensic Psychiatry, child and adolescent, learning disability and addiction psychiatry are not well developed. In forensic mental health issues there is interface of mental health services with the judicial system that require special attention without which the full realisation of the potential of the Mental Health Act may be severely compromised.

Ms. Sumaira Aslam discussed Physical Activity and Quality of Life among Patients of Rheumatoid Arthritis. Moderation analysis revealed that social support significantly moderates the relationship between physical activity and quality of life.

Ms. Ayesha Khalid talked about Impact of Cyber Victimization and Bullying on Mental Health of Medical Health Professionals. There is a strong association between victimization/bullying and mental health issues. Cyber victimization/bullying she stated can cause mental health problems and young people may experience victimization because of their mental health issues. Mental Health professionals who are responsible health care providers could be saved from psychological and emotional, psychological and social consequences of cyber victimization and bullying.

Session-III

Dr. Regina Mahmood in her presentation pointed out that Incidence of schizophrenia in Pakistan is about 1.5% of the total population. Challenges faced by the caregivers of the patients of schizophrenia are Mental , Physical and Social. A study was conducted to investigate the stress faced by the families of patients of schizophrenia which suggest that Burden perceived by the caregivers is a fundamental prognostic aspect as the caregiver burden is reportedly a critical determinant for negative caregiving outcomes. Stress faced by the caregivers ultimately leads to poor care, leaving the treatment of their patients and sometimes violent behavior with the patients. Doctors and psychiatrists focus their care more on the patients and ignore the family and do not consider their needs. Educational, economic and moral support are among the most important unmet needs of the caregivers.

Prof. Imran Ijaz Haider talked about Development and Validation of assessment of psycho-education which is an intervention integrating psychotherapeutic and educational strategies. Psycho-education is known to aid in psychiatric disorders, at present there is no known tool to assess the degree to which this is routinely provided by mental health professionals. Their objective was to develop and validate a tool, in English, which assesses psycho-education of careers of psychiatric patients in Pakistan. Sixty bilingual male and female primary carers, who were fluent in English had been in a care-giving role for more than three months were requested to complete the developed Questionnaire for the Assessment of Psycho-Education of Careers (APEC) at Fatima Memorial Hospital Psychiatry Out-patient department.

APEC was found to be easily understandable and capable of adequately assessing aspects of psycho-education. The re-audit showed a significant improvement in the provision (57.1%) and comprehensibility was now 60.3% of the information provided as well as an increase in with 48% moderate patient satisfaction and 22% were fully satisfied with psycho-education. Psycho-education, he stated is vital for effective mental health care and should be tailored to the patient’s level of understanding and informational needs.

Dr. Maryam Amjad spoke about Mobile Dependence as a Mediator between Gaming Addiction and Mental Health. Unlike outdoor activities, gaming and extensive use of mobile phones have become an important part in the everyday lives of most university students. Most assignments, quizzes and projects are completed in collaboration with a mobile phone device and the most common form of entertainment is the usage of internet, social media and gaming. While some researches do highlight the positive qualities of gaming and mobile phone use, there is also a visible decline in mental health that was not observed in young adults before the era of technology. She suggested minimize gaming and mobile phone usage especially in student population and eventually improving their mental health.


Prof. Mazhar Malik, Prof. Riaz Bhatti, Prof. Jamil Hussain, Prof. Raza Ur Rehman, Dr.
Ajmal Kazmi, Dr. Nadeem Ahmed photographed with speakers of the 4th session
during 14th International Neuropsycon held at Bhurban recently.

Dr. Khawar Abbas Chaudhry discussed the Dietary Habits of School going children in Lahore. Most of the eating habits and food preferences he stated are acquired very early in the childhood. School atmosphere and the peer pressure has a significant impact upon these likings and disliking . A study was carried out in Lahore which showed that nearly 60% of them favored burgers and fries without realizing that these were unfortunate nourishment inclinations. Nearly 31% of the population in this study viewed Pizza as the preferred food while 28% had Burgers in their priority list. There is a need to teach healthy nutrition from an early age via mass educational campaign.

Dr. Nazish Imran talking about the special risks of early electronic screen exposure said that the screen, whether it is computer, mobile, tablet or television, is a symbol of our modern age. For our children, the digital natives who have grown up surrounded by digital information and entertainment on screens, time on screens is a major part of contemporary life. Public health agencies advocate for minimal use of digital technology by young children as the result of concerns about the effects on physical, cognitive, emotional, and social health, well-being, and development.

At birth, the human brain is less developed compared to other mammals, and undergoes significant growth in volume of 1% per day during the early postnatal period. When an infant or very young child experiences screen media with images and sounds, he or she does not derive any meaning. The brain connectivity that allows an older typically developing child or adult to understand language, social meaning, and context from a screen has not yet occurred in an infant. Children who started watching television before 12 months and watched more than two hours a day were six times more likely to have language delays. The more TV watched by infants (aged 1-3), the more likely they were to have attention problems. Poor quality of interactions with parents combine with screen excessive use may have negative effects on children’s health and development. Attention problems are also associated with early screen viewing, with each additional hour of viewing/day at ages 1 and 3 years associated with a 9% increase in risk of ADHD diagnosis by age seven.

Associated findings with screen viewing in children 2-years and younger include ASD, Language delay, attention problems, Negative impact on parent-child interaction, Diminished toy play, less learning than from real-life experiences. Pediatric health providers are ideally placed to help families more successfully navigate through this rapidly evolving digital World.

Dr. Muhammad Ismail Tariq talking about effect of counseling in Preoperative anxiety among the Patients undergoing Third Molar Surgery (TMS) said that it is the commonest procedure carried out in oral and maxillofacial surgery and is associated with immense fear, anxiety and various intra and postoperative complications, ultimately affecting trust on clinician. Dental anxiety affects 10-20% of adult population adversely affecting attendance in dental clinics. Pain is the single most feared factor. Other contributing factors are gender, age, level of education, living, socio-economic status and earlier traumatic dental experiences. Structured counseling by a trained doctor comparing it with routine information delivered by doctors having no training in counseling can play an important role he added.

Dr. Khalid Nawab from UK provided information to young psychiatrist who wants to join as Clinical Fellows in Psychiatry from NHS Lanarkshire Scotland. Guidance for application is available at www.medicaljobs.scot.nhs.uk and Medical Training Initiative Programme through Royal College of Psychiatrists https://www.rcpsych.ac.uk/training/MTI. NHS Lanarkshire offers Visa Sponsorship, Employment for suitably qualified doctors, assistance with housing / residence, opportunities for career progression he informed.


From (L to R) Prof. Mowadat Rana presenting a shield to Prof. Fareed A. Minhas during 14th International
Neuropsycon. In (Centre) Prof. Fareed A. Minhas presenting shields to Dr. Nadeem Ahmed and
Dr. Khalid Nawab while on right Dr. Khalid Nawab presenting shield to Dr. Niaz Maqsood.

Prof. Riaz Bhatti discussed the Optimal Management of Major Depressive Disorder. Depression, he stated is the leading cause of disability worldwide, and is a major contributor to the global burden of disease. World Mental Health Survey conducted in 17 countries found that on average about one in twenty people reported having an episode of depression in the previous year and 50 % higher burden of depression amongst females than males. It is estimated that 50-85% people have recurrent episodes after the first one. Antidepressants are first-line therapy for moderate and severe major depression, SSRIs, SNRIs, and NDRIs are preferred due to tolerability profiles. Consider psychotherapy as monotherapy for mild depression and as adjunctive therapy for moderate or severe depression. Benzodiazepine monotherapy should be avoided. Treat to remission and monitor progress after remission. If remission is achieved, continue medication regimen for at least 6 months to prevent relapse. If remission is not achieved, assess the patient’s side effects, ensure patient compliance to the antidepressant. All antidepressants carry some risk of side effects like Nausea, Sedation, Insomnia, Sexual dysfunction, Weight gain. There is potential for emergence or worsening of suicidal behavior during antidepressant therapy in patients aged <25 years. Risks of untreated depression probably outweigh risk of side effects. Choice of treatment should consider impact of possible AEs on individual patient. If side effects become intolerable, consider lowering the dosage of the antidepressant .If side effects are still present after 2 weeks, consider switching to a different anti-depressant, he added.

Session-IV

Ms. Nida Zafar presented the finding of study of Social Media Fatigue, Insomnia and Mental Health Problems in University Students in Pakistan. It was found that day time and night time usage of internet has significant positive correlations with social media Fatigue, insomnia and mental health problems. Sleep hours during day and night in weekday and sleep hours during night on weekends have negative correlation with social media fatigue, insomnia and mental health problems. Social media fatigue has significant positive correlation with insomnia and mental health problems like anxiety, depression, inability to control behavior, and negative affect. Insomnia is found to be positively correlated with mental health problems. The positive relationship between social media fatigue, insomnia and mental health problems showed that a large number of participants were addicted to social media.

Syeda Ayat-e-Zainab Ali talked about Emotional Freedom Technique which is a Treatment Modality for Managing Psychological Distress among Female Undergrads. This treatment modality could play a role in the reduction of psychological distress among female undergrads.

Farwa Chaudhary spoke about Personality, Resilience, Coping Strategies and Quality of Life in Patients of Hepatitis B and C. To enhance resilience, some programs could be introduced for the patients of hepatitis C, so that they can improve resilience along with the practice of healthy coping strategies.

Dr. Nadeem Ahmed spoke about spirituality which he stated is among the most ubiquitous and powerful forces in human life. Genes can predispose us to believe. Spirituality is Connection, Compassion and Contribution.

Dr. Ajmal Kazmi talking about Psychiatric Rehabilitation Practices said that it is a comprehensive strategy for meeting the needs of persons with severe and persistent mental illness. It refers to efforts to restore individuals to optimal state of constructive activity, community integration, improved quality of life and recovery. It is a structured program that helps patients to define meaningful goals for themselves, acquire information and skills to develop more control over their psychiatric illness make progress towards their own personal recovery.

Prof. Riaz Bhatti, Prof. Raza Ur Rehman and others speaking during the second session of
the 14th International Neuropsycon held at Bhurban recently. Picture on left shows
Dr. Nazish Imran and Dr. Nisar chairing the session.

Col (R) Dr. Khalid Mahmood presented the overview of cognitive behavioral therapy (CBT) for primary care physicians and general practitioners. It is one of the most effective treatments for conditions where anxiety or depression is the main problem It is as effective as antidepressants for many types of depression. CBT can help you to control the symptoms.

Prof. S. Jamil Hussain talking about Post-Retirement Syndrome said that it has multiple avenues resulting in development of psychiatric symptoms and social disqualification. One must have friendly approach towards family and children. Ensure regular medical checkups, develop habit of book reading . If you have talent for writing then keep on writing regularly.

Prof. Mazhar Malik talking about Domestic Violence said that it is hidden dilemma of Pakistani women. A study of domestic violence and its relationship with depression, anxiety and quality of life of married women was conducted in a tertiary care hospitals of urban settings of Rawalpindi and Islamabad: The study confirmed that physical, emotional and sexual domestic violence has strong positive relationship with anxiety, depression and stress. This means that woman exposed to these types of domestic violence developed high level of anxiety, depression and stress. Verbal, physical, emotional and sexual violence has negative relationship with quality of life of those who were exposed to these types of domestic violence.

Prof. Raza ur Rahman talked about Depression : Black Dog. The phrase Black Dog is attributed to Winston Churchil as a metaphor for depression. This concept originates as mingling darkness with the fear of melancholy, disease and death projected on to Man’s best friend. Fortunately this Black Dog has a collar so depression can be managed by snapping a leash on that collar through pharmacological and non-pharmacological methods. No medication was available in those days as first antidepressant was developed through serendipity in fifties. The initially developed tricyclic antidepressants (TCAs) are gold standard for efficacy. Clomphramine is a SNRI which is effective in depression, OCD and other anxiety disorders including panic disorders with agoraphobia, social anxiety disorders etc. It is a cost effective drug, he added.

Session-V

Ms. Nudra Shaukat spoke about emotional behavioral Problems & self-esteem In children with absent fathers . The study revealed some substantial and essential relationships as well as provided an insight into new association and concepts that can still be explored to initiate a valuable research in future. The study concludes that with the absence of fathers, their children face emotional behavioral problems and as boys experience aggression but in girls somatic complaints and low self-esteem problems are more common. This study also revealed that in both categories (emigrants and deceased fathers) the emotional behavioral problems are high with the lower level of self-esteem in school children. Morbidity among the children was much less because of our collectivistic culture in which there are more than one caregivers in the absence of the father who provide the children with emotional and moral support.

Quratulain Ali Bukhari discussed Relationship between Academic Expectation Stress and Symptoms of Anxiety Disorder among Adolescents. Academic expectations stress from self, parents and teachers among school and college children negatively effects on their physical and mental health and is often linked with anxiety and poor academic performances . These findings have implications for clinician, parents and teachers who contribute in the better mental health of adolescents. Since last decades education is the most important aspect in every human’s life. Every student wants to do best in studies and set higher expectations from self and at the same time, parents and teachers also expect higher achievement from their children or students. More stress they take because of perceived expectations from self/parents/teachers more anxiety they face in their lives.


Prof. Mazhar Malik, Prof. Riaz Bhatti, Dr. Maryam Amjad and others chairing
a session during 14th International Neuropsycon held at Bhurban recently.

Dr. Maryam Amjad highlighted the Traumatic Repercussions of the Parents of Adolescents Diagnosed with Acute Lymphoblastic Leukemia. Peak incidence of acute lymphoblastic leukemia is seen at 2-10 years of age. Several clinical trials have shown disappointing results in adults as compared to children with cure rate of 90% and 30-40%, respectively. Various socioeconomic factors, such as lack of clinical trials, lower compliance rates, and long delays in the initiation of the treatment, may result in the poor outcomes in the AYA population Children with ALL are treated successfully, but prognosis deteriorates markedly with the onset of adolescence to adulthood. It was further stated that different Integrative model of psychotherapy including extensive psycho-education program of the illiterate parents and family should be developed and implemented by a health psychologist in each oncology unit of government hospitals of Pakistan.

Sajid Iqbal Alyana spoke about the perception of maternal autonomy support and wellbeing of adolescents. Parents are expected to develop the ability to know about the needs of their growing adolescents and encourage them to manifest desired behavior.

Dr. M. Khawar Abbas Chaudhry highlighted Sleep & Sleep Issues in the Pediatric Population. Sleep it was stated is a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity, inhibition of nearly all voluntary muscles, and reduced interactions with surroundings. The sleep history is most contributory when it is structured, detailed, and systematic. The history should include details about the duration and frequency of the problem, temporal profile of onset (abrupt, gradual, intermittent), and degree of variability from night to night. The clinician should note what interventions or strategies have been tried and whether medications have been used.

Dr. Naurose Ali talked about Memory, Paradigm shifts & Implications. Memory she stated is the glue that blinds our mental lives, without it we would be prisoners of the present ,unable to use the lessons of the past to change our future. For much of human history, memory has been seen as a tape recorder that faithfully registers information and replays intact, but now researchers are discovering that memory is far more malleable, always bring written and rewritten, not just by us but by others. We are discovering the precise mechanism that can explain and even control our memories.

Prof. Fareed Aslam Minhas talked about the birth of Assessment & management of borderline personality disorder interest group. The major goal of treatment he said is to build up emotional regulation muscles, so that they will be able to withstand the impact of those emotional waves. Emotional reactivity cannot be controlled, but we can give them skills to better respond to the emotional reaction. Our dilemma is that the assessment and management is often inconsistent, variable and unscientific, does not feature in the diagnostic breakdowns, Professionals lack the time, knowledge and skills that are needed to effectively address the needs of those suffering. Most therapists label these patients as treatment resistant, Paucity of human resource, repeated visits, often a poor response to treatment and dramatic presentations can overburden limited resources. The ill-equipped, ill- informed carers often resort to violence, ridicule, rejection, and sometimes even abandonment. There is dire need to raise awareness about the prevalence of the disorder, its accurate diagnosis and its evidence-based management.

Borderline Personality Interest Group aims are to produce manual which includes consensus guidelines for assessment, evaluation, diagnosis and structured management care. To serve as a potent information care resource for medical professionals & general community. To initiate support group for the patents & families, to produce training guidelines and formal training of therapists, to provide regular peer supervision for colleagues, combining the confluence of experienced and younger colleagues, to develop a workshop or certified course.

Prof. Mowadat H Rana was the last speaker of this session who talked about life skills for mental health Professionals. The professionals who lack the capacity to love lack the capacity to be professionals and life without love is live without happiness. The findings indicate that the prevalence of psychiatric morbidity among UK doctors is quite high, ranging from 17 to 52%. the most obvious cause of doctors’ unhappiness was that they feel overworked and under-supported.

Development of health and happiness, life skills / wellness centers & trainers are very important. Life Skills Training Syllabus as an integral part of curriculum, PG Training, CME, CPD, life skills training LST at par with ATLS, ACLS. Effective communication is much better rather than traditional history taking and clinical examination. Leadership and advocacy skills teach you not only how to lead but also how to get out of the way and be led when you can’t and then also inspire. Psychotherapy is very important organ of the treatment but is very difficult and sometime one get fed up with this. We do not practice what we tell others. Happiness and healthy people make people happy and healthy, he concluded. (Photographes Courtesy Surge Laboratories Pvt. Ltd.).

© Professional Medical Publications. All rights reserved.