Qatar is one of the four countries to have National Autism Plan and Pakistan also needs one -Prof. Waqar Azeem


Qatar is one of the four countries to have
National Autism 
Plan and Pakistan also
needs one -Prof. Waqar Azeem
Eating disorders has its impact on mental,
physical health- Dr. Durre Shahwar
Average age at diagnosis of ASD in children is 4.5
and they need multiprofessional approach
for management- Prof. Shazia Maqbool

LAHORE: Dr. Durre Shahwar was the first speaker in the 5th scientific session during the International Psychiatric Conference on “Prescription for Wellness” held here from 2-3rd August 2019. The topic of her presentation was Assessment and Management of Eating disorders in adolescents. She pointed out that abnormality in eating pattern is seen during individual’s attitude towards weight and shape. She discussed at length Anorexia, Bulimia Nervosa and atypical disorders. As per ICD-10 criteria, anorexia is body image distortion, dread of fatness, imposing low weight threshold. It leads to endocrine changes of amenorrhoea in females. Bulimia nervosa is recurrent episodes of overeating.

He then discussed in detail a self-critical approach analyzing body shape and weight, Anxiety and low confidence, restoration of food intake and the psychological factors. He also referred to family lack of conflict resolution. Malabsorption, chronic infections, illicit substances, prescribed medications were mentioned in differential diagnosis. Teen agers, she said, may start simple dieting. Some may lose control. Diagnosis is based on initial face assessment. Speaking about signs and symptoms she mentioned dramatic weight loss. She advocated family based approach for management of these patients. Assess eating habits, return control over eating to adolescents. Psychological therapies and family therapy is useful empowering the parents. Create awareness about problems of eating disorders in which media can play a very important role. It has its impact on mental and physical health. Media often highlights the images of underweight celebrities, she added.

Prof. Shazia Maqbool from Children Hospital Lahore talked about autism disorders. Its prevalence, she stated is between 0.2-5%. It has four times increase in nineteen years and studies have reported 15-19% recurrence in siblings. She pointed out that more children suffer from Autism Spectrum Disorders than diabetes mellitus and Aids or Cancer. Now there is more awareness about autism disorders. She pointed out that anti-social behaviour may not be autism. These children are non-communicative. Adults are role models. Children live is isolation if their parents are active on social media. Though these people have too many friends on social media but when they die, one does not see many people attending their Nimaze Jinaza, she remarked.

Continuing Prof. Shazia Maqbool said that the average age of diagnosis of Autism Spectrum Disorders is about 4.5 years. Impairments are observed at twelve to eighteen months. She advised the parents not to wait. Pediatricians are now much more educated to suspect ASD early in life. These children do not have an eye contact at four to six months hence impairment should be looked at. Those children who are not responding by fourteen months must be immediately referred to specialists. Six months child, she said, should look at the object which is pointed out. Avoid mix up of diagnosis i.e. Behaviour communication disorders, social communication disorders, language disorders. Find out if there is no eye contact; look at the hand movements, and use of objects. She then showed a video of sensory deficit, frustration, and anger and highlighted the importance of one window diagnosis. She then described in detail the one window model which consists of multidisciplinary services which consists of fetal medicine, educationist, psychiatrist and nurses. History is extremely important. Parental report, examination, developmental profile, generalized and specific investigations, speech assessment, child behaviour inventory are all important. She suggested multi professional approach including audiologist. NGOs have a great role to play to pay attention to family distress. We at the Children Hospital, Prof. Shazia Maqbool stated, have established a full- fledged department of developmental pediatrics. Early intervention in autism ensures good results. Parents support is very important and they need to become our partners. As regards drug therapy, antipsychotic Resperidon is approved by FDA. Treatment is for symptoms and not the disease. We have established a learning center. These kids can be kept in schools and some of these centers are our partners. In the OPD almost 33% of the patients we see are of cerebral palsy. At present seventy people work in our department. She concluded her presentation by stating that winners never quit.

Madam Rukhsana talked about shared care for care givers. She highlighted the emotional and financial burden of care givers. They have to look after the needs and disabilities. They are supposed to have a positive attitude. Diseases like autism, ADHD, ODD, OCD have a heavy toll on parents. Almost 80% parents of autism children have stress. She also referred to the low level of social support available. Afflicted parents, care givers need proper counseling. They also need training, support from the government and society. She then showed a video of autism. The child never spoke a single word. She then referred to Indian approach and gave details of Action for Autism. The Autism Center is located at ten acres of land.

Speaking about solution to the problem she mentioned trained doctors, teachers, and therapists. All medical colleges and universities should have a department of psychology. Autism should be included in their curriculum. Autism centers should be established in all big cities. They should be provided funding for training, support for rehabilitation and independent living.

Prof. Waqar Azeem, Dr. Felicia Watt, Prof. Shazia Maqbool, Dr. Durre Shahwar and Dr. Rukhsana Shah
speaking at the Int. Conference on Prescription for Wellness held at Lahore recently.

Prof. Waqar Azeem highlighted the excerpts from Qatar National Autism Plan and they are one of the four countries to have a National Plan. Pakistan, he opined, also need to have such a national plan for autism. In 2019, Qatar has about 2.8 million populations. We had a working plan from 2013-2018. Lot of infrastructure is being developed. Government is spending lot of funds on Health and Education. We have formed various working groups. Previously we had no data, hence no services were available. We faced problem in diagnosis hence we formed Six Task Forces which are working in the field of awareness, education. The main task force is headed by the Prime Minister; six ministers are its members which includes the Health and Education ministers. We have a five years strategy and during the last two years we have made some progress. We have nine clinical psychologists, three perinatal psychologists and we have an excellent facility in Qatar he added. He also showed the pictures of various stages of development of Qatar and at present the country has a large number of high rise buildings which have all given Qatar a new look as one of most developed country in the region, he added.

Prof. Riaz Bhatti and Dr. Saeed Farooq made presentations through SKIPE from UK. Prof.Riaz Bhatti talked about looking after the families of mentally ill patients while Dr. Saeed Farooq discussed Treatment Response- Remission and Resistance in psychosis. He discussed in detail the obstacles in achieving remission and treatment goals in schizophrenia. Response and maintenance leads to remission and then full recovery which means autonomy. Response and maintenance leads to suppression of stress and stability while remission is important in social functioning. He then referred to clinical and global impression scale for schizophrenia. He laid emphasis on optimal use of pharmacological interventions, consider switching over, response to antipsychotics should be carefully measured. He also talked about psychosocial interventions besides the use of clozapine. Only about 30% of patients who are eligible to take it get this drug. One must consider switching over if a particular drug is not working. Speaking about the side effects of antipsychotics he mentioned cardiomyopathies, epileptic seizures, agranulocytosis and metabolic syndrome.

Last session

Dr. Omar Mehmood from Qatar was the first speaker in this session who talked about maintaining psychological wellbeing and resilience: strategies for therapies and caregivers working with emotionally demanding patients. He highlighted the importance of training young psychologists. Burn out is expected because they see so many chronic cases. Caregivers or parents of these children have numerous problems. Since they focus on child wellbeing, they ignore their own mental health. He emphasized the importance of maintaining the psychosocial health and self-care of these caregivers. If they look after their own health, they will be in a much better position to look after the loved ones.

Continuing Dr. Mahmoud said that these care givers must take a break. Come back more relaxed to look after their children. As therapists we know life style changes, holiday and break are good for self-care. They have no dedicated time. People working on the front line have no time for their self-care. They should have a dedicated time to look after their own mental and physical health. Work load should be equally distributed among all members of the healthcare team. Some people do good work in difficult situations. Paediatric oncology is a very difficult field to work in. You must know your personality and how best you can take care. He further stated that the role of spirituality is very important in self-care. It is getting popular and getting more importance. It also offers a great advantage to Muslim therapists. He also talked about stress reduction techniques. Drugs will benefit therapists to reduce stress, he added.

Dr. Mohammad Al Rawi from UK discussed care giving for patients with addiction. His presentation was based on a case history of a thirty years old female emotionally unstable. She was suffering from personality disorders, risky behaviour, indulged in over spending. She had huge debt spending family credit. In aging population family members have to take care of complex care tasks. It results in great cost to their own mental health. About 19% suffer from both mental and physical disabilities. Almost 49% of women who suffer are between 45-64 years of age. In one of the surveys about 30% rated their health as fair or poor while 49% had long standing health problems. Caring responsibility made them feel worried. About 32% said they feel depressed, suffer from stress and tension. He also talked about social and cultural factors and highlighted the importance of Carer’s Support for Groups training and counseling. Carer’s assessment is also important, he remarked.

In his concluding remarks Prof. Naim Siddiqui said that clozapine was indiscriminately used in developing countries. Dr. Mohammad Omer has highlighted the importance of giving time for our self-care. Spiritual bondage is important. One should relax. Dr. Mohammad has given us an insight in UK practice of care giving. In Pakistan it is the family members who take care of such people while it is the professionals who take care of such patients in the West. Prof. Azizur Rehman Yusufzai said that we must take care of our sick old parents. It is good and Swab. Home based care is important. He suggested Prof. Waqar Azeem to provide the copies of the Qatar National Action Plan for Autism so that we in Pakistan can also benefit from it. It is said that behind every successful man there is a women but I would add that behind every successful women, there is a man and we have seen it during this conference, he remarked.

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