Patients may not recognize cognitive dysfunction as a feature of depression-Bernhard Baune


 CME meeting by Lundbeck Pakistan

Patients may not recognize cognitive dysfunction
as a feature of 
depression-Bernhard Baune

Cognition should be considered important
in depression and treated effectively

KARACHI: Lundbeck Pakistan organized a scientific meeting as a part of its Continuing Medical Education programme for healthcare professionals on Cognitive Disorders in Depression at Karachi recently. Prof. Bernhard Baune Professor and Chair, Dept. of Psychiatry from University of Adelaide, Australia was the guest speaker. The topic of his presentation was “Cognitive Disorders in Depression-Burden, Implications and Treatment.  The meeting was jointly chaired by Prof.  Syed Haroon Ahmad, Prof. Iqbal Afridi, Dr. Unaiza Niaz and Prof. Ejaz Ahmad Vohra all eminent psychiatrists and physicians of the country. It was attended by a select group of psychiatrists while Dr.Amjad Abdi acted as the moderator.

Cognitive symptoms in depression, it may be mentioned here, cause significant impairment in work function as well as productivity.  In his presentation Prof. Bernhard said that we try to change thinking, behaviour and emotions. Depression also leads to social cognition and all the patents do not present with similar symptoms. Depression, he further stated, is a multidimensional disorder which not only affects cognition but physical and behavioural changes also takes place.  Adolescents and adults who suffer some of them do recover and are cured but almost 50-70% has a relapse episode in the next five years. This leads to decline in their functioning. They cannot continue their studies, do not go to university or schools. About 70% of these patients do respond after three trials of treatment. Drugs are not always suitable for patients who suffer from depression. For better remission outcome, we need to treat them better. Cognitive part effects emotions and feelings. At times these are expressed verbally.

Dr. Unaiza Niaz presenting Life Time Achievement Award to Prof.Syed
Haroon Ahmad at a scientific meeting organized by Lundbeck Pakistan
at Karachi recently. Also seen in the picture are M.Aslam Sheikh from
Lundbeck, Prof. Prof. Bernhard Baune the guest speaker from
Prof. Ejaz Ahmad Vohra and Dr. Majid Abidi.

Speaking about social cognition, he said, it refers to how individuals think about other people and environment. All these things have impact on their functions. He then discussed in detail cognitive functions, memory, recognition, imagination, perceptions, learning process, thinking, judgment and speech. Patients with MDD have broad spectrum of cognitive functions and 25-40% of them exhibit cognitive deficit. They are consistent, clinically significant and are small to medium in effect and size. Some of these patients suffer from short or long term memory loss. Even after remission they have overall cognitive deficit. Younger age group is also affected by cognitive deficit. As regards cognitive complaints in depressed patients, it includes memory loss, poor concentration. In order to diagnose cognitive deficit, one can ask some questions like Do you have difficulty in reading newspapers? Do you have difficulty in making decisions? Do you misplace items like keys, lose track of the task? One has to prioritize other symptoms of depression for definite successful treatment. Patients may not recognize cognitive dysfunction as a feature of depression. He also talked about impaired emotions processing in MDD and effectiveness of treatment that affects cognitive dysfunction. Abnormal responses to negative feedback, he opined, is specific to depression.

Talking about burden of social cognition dysfunction Prof. Bernhard Baune said that these patients are isolated, they are unable to express their emotions, and they cannot interact with other people. While we treat our patients, it is essential that we address all these issues, he remarked. Social cognition in depression includes anxiousness, mental disorders, happy, angry, disgust and surprise.  Some of these patients have better functional recovery after six months. Those patients who do not respond in six months do suffer from disability. Studies have showed that unemployed persons are affected worse as compared to others. Those patients who are admitted to hospitals and later discharged, 1% of them have poor integration in the society even after discharge. He then presented a few case studies. One of the patients was 56 years old female who had recent MDD. She had onset of depression twenty three years ago. She had three children of which one was suffering from psychosis, other was obsessive compulsive. She was working as social workers. She suffered from cognitive confusion at workplace. With treatment, her delusions stopped and overall she had significant improvement. He also referred to emotional and non-emotional cognitive impairment. With the use of some anti-depressants, cognition and memory improves. Learning improvement has also been documented in these patients. Cognition, he further stated, should be considered important in depression and treated effectively. One should use drugs which have primary efficacy. Explore secondary anti-depressants to improve cognition and efficacy but avoid tricycles. He concluded his presentation by stating that depression is a complex disease. Cognitive symptoms are present in these patients but they are overlooked. They are responsible for loss of functions even during remission.  If left untreated, it can affect impairment.


Prof. Bernhard Baune from Australia was the guest speaker at a scientific meeting organized
by Lundbeck Pakistan. Picture shows him with the participants of the meeting.

Participating in the discussion Dr. Unaiza Niaz commended the speaker by making a most comprehensive presentation on the subject which covered not only cognition but social cognition as well as behaviour.  Cognitive deficit is different in young and old patients. The clinical test for recognizing cognition which the speaker has developed is wonderful. Responding to a question the speaker informed that this test should be available digitally in the coming ten months’ time. It could be easily used even on iPad, Android or Tablet. Dr. Unaiza Niaz also referred to the violence, feelings of insecurity which results in bad feelings. Even people who are not depressed are affected by these things. Even environment has its effects. It affects many people. Constantly working in such an environment in Pakistan, one tends to suffer from burn out syndrome too quickly. The whole world has become insecure and unlivable. We Pakistanis, she remarked, are not violent but happy, nice people and the overall image which has been created of Pakistan is bad. We all need to change this. At present we are going through a phase of crisis and she hoped that it will soon be over.

Prof. Iqbal Afridi said that all such things occur in the life of young Nations. These are the burden of modern living and attitudes. People have become more emotional particularly those who live in poverty. Mention of residual cognitive disability during the lecture was important. Issues like bipolar disorders and depression are not easy to handle, he remarked. Depression, he further stated was much more than mood.

Prof. Bernhard Baune also delivered a lecture on Cognitive Dysfunction and Depression at a meeting
organized by Lundbeck Pakistan at Lahore. Picture taken on this occasion shows
him with the participants of the meeting.

Prof. Ejaz Ahmad Vohra in his remarks commended the speaker for a clear message to recognize cognitive dysfunction in depression which needs to be treated effectively.

                Responding to another question from the audience as to how the minority living in Australia was feeling in that set up, Prof. Bernhard Baune said that they are very open to ask questions. They are talking to people and quite interested in psychotherapy. They like biological interventions and are also interested in cognitive therapy.  You want people to change their behaviour but they are not willing to change. We have such patients as well. We need to motivate patients where they can benefit from CBT. Minority patients do open it up, how they think but changing their behaviour is a great challenge. Dr. Naeem Siddiqui consultant psychiatrist at SIUT referred to multimodal anti-depressants. Negative bias in depressed patients is specific to depression. Dr. Ajmal Kazmi referred to Hot and Cold emotions. It was also stated that patients who are more emotional are referred to as Hot and non-emotional are known as Cold concept and they do interfere with each other. There are several receptors available in Mind and they seem to play a major role in cognitive functions.  At the end of the meeting Prof. Syed Haroon Ahmad was given the Lifetime Achievement Award in recognition of his services to promote the cause of psychiatry and Mental Healthcare in Pakistan. Dr. Unaiza Niaz paid rich tributes to Prof. Syed Haroon Ahmad, termed him her mentor. He has trained a large number of people and also founded the Pakistan Psychiatric Society.

According to another report Prof. Bernhard Baune was the guest speaker at a CME meeting organized by Lundbeck Pakistan at Lahore on March 3rd 2016.  Prof. Nasar Sayeed acted as the moderator of the session while the panel of experts included Prof. Saad Bashir Malik, Prof. Aftab Asif and Prof. Nadir Zafar. Presentation by the guest speaker was followed by lively discussion. Different aspects of cognitive dysfunction, how to diagnose and manage this were discussed in detail.