Clinical proceedings of 11th National Neuropsycon on psychiatric updates


11th National Neuropsycon Conference at Lahore 

Clinical proceedings of 11th National
Neuropsycon on psychiatric updates

LAHORE: Many interesting scientific papers were presented during the 11th National Neuropsycon, held here from April 24-26, 2015. It was organized by Pakistan Psychiatric Society & Psychiatric Welfare Association in collaboration with various institutions and organizations interested in mental healthcare. Two pre conference workshops on Phenomenology in General Psychiatry and phenomenology in patients suffering from psychotrauma which were conducted by Prof. Mowadat Hussain Rana along with Prof. Aftab Asif were also part of the conference. Dr. Nazish Imran and Dr. Usman Amin Hotiana were the facilitators.

Prof. Mazhar Malik along with Prof. M. Riaz Bhatti chaired the first scientific session. Ms. Rabia Waqar Khan highlighted the findings of study about impact of terrorism catastrophizing on the mental health of rescue workers. Study comprised of 100 rescue workers and 100 university students. Findings of the study suggested significant differences in the level of terrorism catastrophizing, death anxiety and hopelessness among rescue workers as compared to university students thereby suggesting that rescue workers were at high risk of suffering from death anxiety and hopelessness as compared to university students. Workplace spirituality, stress and job satisfaction among nurses was the topic of study presented by Fatima Saeed. It showed a significant positive relationship between stress and job satisfaction among nurses.

Speaker National Assembly Mr.Ayaz Sadiq presenting mementoes to late Prof. Humayun Maqsood,
Maj. Gen. Prof. M. Aslam VC UHS and Prof. M. Riaz Bhatti at the Neuropsycon held at Lahore recently.

Dr. Nazish Imran presented the findings froma cross sectional study regarding medical students’ stress, psychological morbidity &coping strategies. Questionnaire based survey was carried out among the undergraduate medical students of King Edward Medical University, Lahore during May to September 2013. The most common stressors were related to academic concerns. ‘Syllabus being too vast & broad , increased frequency of exams, tough routine, lack of guidance by seniors and faculty, poor living conditions in hostel, fear off ailing in exams’ which were considered as most important and severe sources of stress. The high level of psychological morbidity and distress observed in the study warrants need to establish support systems to help students deal with these challenges. Main stressors being academic, there is urgent need to bring about evidence based changes to teaching and evaluation systems. Adequate counseling facilities should be made available and students must be encouraged to seek help, she concluded.

Dr. Nazish Imran in her second presentation talked about perception of postgraduate clinical learning andteaching educational environment and burnoutamong residents across multiple teaching sites in Lahore. Educational environment and burnout among residents has gainedsignificant attention over the last decade. This cross sectional study was conducted across two postgraduate medical institutes in Lahore. Postgraduate Hospital Educational Environment Measure (PHEEM) and Maslach Burnout Inventory were used to collect data from residents following informed consent. Total respondents were 253 with 148 (62%) males. Total Mean PHEEM score was found “more positive than negative but there is room for improvement. Females perceived postgraduate teaching environment as more positive. Significant burnout was detected among residents with high mean emotional exhaustion.

Late Prof. Humayun Maqsood Principal of FMMDC presenting mementoes to some of the speakers at the
Neuropsycon held at Lahore recently. On extreme right is Prof. Riaz Bhatti chief organizer of the conference.

Prof. I.A.K. Tareen along with Prof. Rizwan Taj chaired the 2nd session. Dr. Bashir Ahmad presented the results from 20 patients who received cognitive behavior therapy (CBT). Cognitive Behavior Therapy he stated is an effective intervention in the management of various psychiatric disorders including depression of varying severity, panic, obsessive compulsive, social anxiety and posttraumatic stress disorders. NICE guidelines recommend CBT as the first line intervention in most of the psychiatric conditions. An attempt was made to train psychologists and trainee psychiatrists in providing structured CBT services in psychiatry department Khyber Medical College Peshawar. The first CBT group started in March 2015 who would complete three modules of 4 sessions each. The group is designed in such a way that new patients who meet the eligibility criteria would enter the group at the end of every 4sessions. We are intending to train people from other psychiatry departments in Peshawar to enable them start CBT services in their respective departments. This would not only ensure provision of the best evidence based service to the general public but would also raise the profile of psychiatry departments in the teaching hospitals, Dr. Bashir added. .

Dr. Ahmed Waqas talked about psychosocial factors of antenatal anxiety and depression in Pakistan. Pregnancy, he said, is generally viewed as a time of fulfillment and joy, however, for many women it can be a stressful event. In South Asia it is associated with cultural stigmas revolving around gender discrimination, abnormal births and genetic abnormalities. A total of 500 pregnant women from obstetrics and gynecology departments were interviewed and 49% were suffering from severe anxiety. Mothers who have more than one daughter were significantly more likely to have anxiety whereas higher numbers of sons were associated with the opposite trends.

Prof. Dr. Aziz Ur Rehman Yousafzai talking about assessment of headache said that it is the most common medical complaint, location of the headache, duration of the headache and intensity of the headache is very important. Headache due to vascular abnormalities, aneurysm or arteriovenous malformation should be described separately. Pain of new onset can be challenging. Though history is very important, unnecessary use of MRI for Head must be discouraged. Cluster headache may sometimes be confused with the serious headache. Patient with any of the danger sign need urgent brain injury, others do not need imaging, he added.

Dr. Majid Ali Abidi’s pictorial commentary on Mera Pakistan an attitude of common Pakistanis was really enjoyed by the participants. He referred to a US magazine Foreign Policy which has termed Karachi, the economic hub of Pakistan as the most dangerous megacity in the world for the year 2013. The prime reason was law and order situation of the city. However behaviour and attitudes of general public were also amongst the factors. Political parties have also been involved in unethical practices. Corruption in all levels of society, non-following traffic rules, seeking treatment of health problems from non-authentic health practitioners and faith healers, poor municipality services, ineffective public transport, mis-management of water resources and worst performance of administrative institutes are leading causes of poor social behavior of the society. In spite of all these worse condition it is still best part of my country Dr. Abidi added.


Prof. Riaz Bhatti photographed along with some of the participants
the psychiatric conference held at Lahore recently.

Dr. Nadeem Ahmed, talking about social attributes in personal recovery concept of mental health said that this is relatively new concept in the field of mental health. The personal recovery is finding a new meaning in life while fighting the catastrophic effects of mental illness and it signifies spending a fully productive and meaningful life even with mental illness. Social attributes are the key concepts of personal recovery like we give hope to patient, provide social identity and role social responsibility, supporting social relationships and meaning of life.

Dr. Ajmal Kazmi talking about Evidence Based Psychiatric Rehabilitation Practices highlighted the work being done at Karwan-e-Hayat, Karachi in collaboration with the Department of Psychiatric Rehabilitation, University of Medicine and Dentistry of New Jersey, USA. About ten to twelve Practitioners are being trained. Basic concept of this training programme is to help people make progress towards personal recovery goals, teach people about recovery. Educational handouts are also provided. Almost seventy five percent problems can be solved if patient is given proper Psycho- therapy, he added.

 Prof. Mazher Malik talking about collaboration between mental health service providers and faith based healers in Pakistan said that eighty percent of psychiatric patients believe they have Saya/Jin and refuse medical treatment. They approach Faith healers report to psychiatrist very late. Psychiatric facilities in Pakistan are scarce and faith healers are very common and approachable. Therefore there is a dire need to develop a collaborative model to involve these faith healers and Amils which will get a chance to educate them and will also help to improve mental health services in Pakistan.

Prof. Rizwan Taj talking about disaster Trauma and Psychosocial relief services said that we need support fromthe people, we should not be negative. We are 171 million population and growing double by the year 2025. Urban migration, large number of population under 16-35 years of age and increase in old age population are the main worries. . Our governments have their own priorities. A trauma Centre at PIMS which was to be built at five crore will now cost ten crore rupees but no one is bother about it. On other hand a Gama Knife Center is being established with huge money. Pakistan is not where it should be with its talent, resources and capabilities. What we need, is stable environment, stable relationship, be safe and be protected from Evils, be able to communicate, receive positive regard and our needs to be met.  

Prof. I. A. K Tareen in his concluding remarks became very emotional and got standing ovation from the participants. There is no country like Pakistan, we have the talented people, and resources, we built this country from scratches. There are people who do not want to see us flourish but they will not succeed. We are all decent working people and we should never give up. One day we will reach the height of this country, Prof. Tareen concluded.

Prof. Muhammad Sharif Chaudary chaired the third session Prof. Rizwan Taj delivered a Pharma sponsored talk on the efficacy of Zyprexa Zydis a novel antipsychotic. Self-compassion and positive psychological functioning in women with primary and secondary infertility was discussed by Nida Zafar. Ms. Fauzia Naz, talked about perceived parental neglect, emotional unresponsiveness negative self-adequacy, and comorbidity in girls with somatic symptoms. Dr. Mamoona Mushtaq, talking about anorexia nervosa, self-consciousness and learning disability in college girls said that Anorexia predicted significant behavioral attitude and emotional attitude problems among college girls.

Prof. Sultan talked aboutprodrome of Bipolar disorders- a myth or reality. Its onset, he said, is mostly in teenagers and it is chronic relapsing illness. Prevention, identification and early treatment can prevent lot of deaths. We need to develop guidelines for Prodromal stages of Bipolar disorders management similar to schizophrenia prodrrome, he added.

Dr. Abdul Malik talking about optimizing unmet needs of the Psycho trauma sufferers said that PTSD is a disorder that is stated to specific external events, provide an opportunity to test different type of interventions, either as prevention or modify its course early.  PTSD is common disorder, once established, it can be quite difficult to treat. So prevention could well be economically as well as medically viable. SSRI,s are most commonly used drugs, besides benzodiazepine is also effective but its long time use may cause sedation.

Col. (R) Dr. Khalid Mahmood giving general information on post-traumatic stress disorder said that PTSD is an anxiety disorder that some people suffer after seeing an ugly incident. Anyone can get PTSD at any age. Children and teens can have extreme reactions to trauma but their symptoms may not be the same as adults. The state of affairs has directly affected the general population resulting in increasing incidence of PTSD. As the general medical practitioners and family physicians are the vanguard of the health care system, they come across such cases in increasing numbers. They must be trained, so that they are able to detect, treat and handle such cases.

Prof. Sharif Chaudhary in his concluding remarks advised that number of speakers in a session should not be more than five or six so that speakers do not have to rush and some time is left for discussion.

Prof. Khalid Mahmood along with Prof. Riaz Bhatti chaired the morning session on 2nd day of the conference in which four papers were presented by Col. Sajid Naqi Ms. Nida Zafar, Ms. Saba Akram and Dr. Urooj Zafar. Col Sajjad Naqvi talking about Urban vs Suburban mental Health said that poor resources in remote areas forced the children to go to madrissahs. If father is abroad, children get involved in unethical practices. Healthcare facilities are not sound enough to cater the requirements. Government should fill the vacancies of psychiatrist, awareness programme should be organized besides training at private clinics. Referral link between private and public hospitals needs to be initiated. He also pointed out that there is very little representation of private sector in the Pakistan psychiatric Society. There is need to widen the structure of the body beside developing Divisional set ups involving private sector in CME and research projects.

Col. Khalid in his concluding remarks said that our daughters and girls are not trained to take responsibility after marriage, they must be trained to take care of home. Our society is detracting our women. Child psychiatry should be taught to every women, he added.

Prof. Riaz Bhatti in his remarks said divorce rate is increasing because we have not trained our daughters to adjust in new family. We should train them to adjust in the new home. One cannot be the head of the department very first day. Take your time, give your input and when you are adjusted then proceed cautiously. Divorce problem affects the children and they become involved in depressive disorders. Prof. Bhatti further said that people doing wonderful job in THQ/DHQ hospital level and are doing more work than us. DPM is backbone of psychiatry and we always try to arrange special sessions for DPM. Platform of PSS is open for everyone and everybody is part of it.

Next session was chaired by Prof. Khalid Mufti along with Dr. Imtiaz Dogar and Dr. Wajid Akhunzada. Dr. Nisar Hussain talking about drug abuse and its treatment in Pakistan said commonly use drugs and tranquilizers are easily available in any part of the country. The chemists are playing a role of killer. There are about 6.4 million drug addicts in Pakistan. It is a treatable disease hence media , religious leaders and Families have to play their role.

Dr. Wajid Ali Akhunzada , talking about attitude of female medical students towards Psychiatry said that it is a new specialty as compared to other branches of medical sciences. Society in general and medical students in particular are not fully aware of the scope and knowledge of psychiatry. A study was conducted in Khyber Girls Medical College, Khyber Pakhtunkhwa to assess the attitude of students towards psychiatry. Overall there was a positive attitude from 3rd, 4th and final year students towards psychiatry. First and second year students with limited exposure to psychiatry consider psychiatric hospitals to be more like prisons. There is number of reasons for this attitude such as negative portrayal ofpsychiatric hospital and treatment in the media and reduced exposure of medical students to psychiatry due to competition from other medical departments for curriculum time in medical schools.

Prof. Khalid Mufti talking about mindfulness based cognitive therapy for depression said that paying attention to yourself when you are mindful, your attention stays in present situation. Selected attention increases decent ring. Mindfulness enhances your self-esteem. Mindfulness training has significant impact on how the brain is shaped wired and activated. Define your challenges technologically as well as personally, set realistic approach, keep your eye on the goal mentorship programme. Mastery is not achieved overnight, we should give message of hope. Dr. Omama Tariq discussed the parental acceptance rejection and interpersonal difficulties in patients with conversion disorder andpatients with general medical conditions.

Epilepsy Session

One of the sessions during the 11th National Neuropsycon was devoted to diagnosis and management of epilepsy which was addressed by many speakers. Late Prof. Humayun Maqsood along with Col. Wasim and Prof. Riaz Bhatti chaired this session while Dr. Ali Burhan acted as moderator.

Prof. Zarin Mughal from Karachi was the first speaker who with the help of video presentation discussed the clinical presentations of epileptic disorders besides partial seizures, generalized seizures and complex partial seizures. Clinical history, she stated is the key to diagnosis. With the help of video presentation she described the different seizures like absence seizure, atonic seizure, psychogenic seizures temporal lobe epilepsy. Not everything that twitches or jerks is epilepsy and we should avoid over and under diagnosis, she added.

Dr. Muhammad Babar Khan talking about diagnosis of Epilepsy said that it is complex subject. It can cause social exclusion, isolation and other family problems. Diagnosis must be confirmed. Diagnosis is based on history, and history by patient and witness are the two sources. History and EEG are the most important factors for the diagnosis of Epilepsy which provides useful information about other CNS disease but EEG is not a definitive diagnostic test for epilepsy. Different causes of new-onset and chronic epilepsy requires different structural imaging protocols. MRI, Dr. Babar stated is a superior structural imaging modality for patients with partial seizures and all patients having epilepsy must have an MRI done. He also discussed the role of video EEG and PET scanning in the diagnosis of epilepsy. Diagnosis of epilepsy is not always straight forward, he added.

Prof. Nazir Malik talking about management of Epileptic disorders said that management may vary from patient to patient. One has to choose, classify and select the right drug. For treatment of epilepsy, diagnosis is must, type of epilepsy, best drug, single drug, start minimum and reach at effective dose. In epilepsy there is no emergency so diagnosis must be clear. Start single drug with minimum dose, if not effective gradually decrease the dose and start the next drug and gradually increase its dose. Making the correct diagnosis is very important. Simply diagnosing epilepsy and seizures are insufficient. How to diagnose is most important than how to treat. Basic medicines are still the drug of choice because 2nd line drugs are expensive and patient can’t afford them. Valporic Acid is still the drug of choice in adults while oral steroids in children are effective. Talking about management of epilepsy during pregnancy he said that one has to be very careful and risk of relapse of seizures is three times more during delivery. New drugs are equally effective but expensive. Valproate is one drug which is effective in almost in all cases of epilepsy. Phenobarbitone is still mostly used drug in the World but our Pharma companies have no interest in promoting it. Government should look in to it so that poor people can get benefit of it. Epival is not given in Hepatitis and pregnancy. Talking about surgical approaches to Treat Epilepsy Prof. Nazir said that 50 t0 60% cases can be improved but accurate diagnosis is must and those patient can be considered for surgery who have failed on two to three drugs he added.