Overview of schizophrenia research and treatment in Pakistan

TIWMFLP: Two-Tier Interactive Weighted Matrix Factorization and Label Propagation Based on Similarity Matrix Fusion for Drug-Disease Association Prediction

Accurately identifying new therapeutic uses for drugs is crucial for advancing pharmaceutical research and development. Matrix factorization is often used in association prediction due to its simplicity and high interpretability. However, existing matrix factorization models do not enable real-time interaction between molecular feature matrices and similarity matrices, nor do they consider the geometric structure of the matrices. Additionally, efficiently integrating multisource data remains a significant challenge. To address these issues, we propose a two-tier interactive weighted matrix factorization and label propagation model based on similarity matrix fusion (TIWMFLP) to assist in personalized treatment. First, we calculate the Gaussian and Laplace kernel similarities for drugs and diseases using known drug-disease associations. We then introduce a new multisource similarity fusion method, called similarity matrix fusion (SMF), to integrate these drug/disease similarities. SMF not only considers the different contributions represented by each neighbor but also incorporates drug-disease association information to enhance the contextual topological relationships and potential features of each drug/disease node in the network. Second, we innovatively developed a two-tier interactive weighted matrix factorization (TIWMF) method to process three biological networks. This method realizes for the first time the real-time interaction between the drug/disease feature matrix and its similarity matrix, allowing for a better capture of the complex relationships between drugs and diseases. Additionally, the weighted matrix of the drug/disease similarity matrix is introduced to preserve the underlying structure of the similarity matrix. Finally, the label propagation algorithm makes predictions based on the three updated biological networks. Experimental outcomes reveal that TIWMFLP consistently surpasses state-of-the-art models on four drug-disease data sets, two small molecule-miRNA data sets, and one miRNA-disease data set.

The relationship between schizophrenia or schizoaffective disorder and type 1 diabetes mellitus: a scoping review of observational studies

OBJECTIVE

Both schizophrenia and type 1 diabetes mellitus (T1D) are known as immune-related disorders. We systematically reviewed observational studies to explore the relationship between schizophrenia or schizoaffective disorder and T1D.

METHODS

A preliminary search of articles was completed using the following databases: Airiti Library, CINAHL Complete (via EBSCOhost), OVID MEDLINE, Embase, and PubMed. Two researchers independently assessed each study's quality based on Joanna Briggs Institute (JBI). A narrative review summarized the potential relationship between the two diseases.

RESULTS

Eleven studies were included in the final analysis. Six observational studies investigated the risk of schizophrenia and schizoaffective disorder in patients with T1D. Two studies showed negative correlations, one showed no correlation, and three showed positive correlations. On the other hand, five studies reported the prevalence of T1D in patients with schizophrenia. Two of them showed positive associations, and three others showed no association. Although the majority of the included studies suggested a positive association between the two medical conditions, these studies were still too heterogeneous to draw consistent results.

CONCLUSION

We found conflicting results regarding the bidirectional relationship between schizophrenia or schizoaffective disorder and T1D. These may stem from differences in study design, sampling methods, or definition of diagnoses, which are essential aspects to consider in future research.

A systematic review of the effectiveness and implementation readiness of psychosocial interventions for psychosis in South Asia

BACKGROUND

Little is known about the effectiveness and implementation of psychosocial interventions for psychosis in low- and middle-income countries (LMICs). In South Asia, specialist psychiatric resources are scarce. Support for psychosis often falls on the family or caregiver which can increase feelings of burden, impact caregivers' wellbeing, and increase mental health stigma. Psychosocial interventions are increasingly used for psychosis in South Asia and could reduce relapse and symptoms, reduce caregiver burden, conserve cost and resources. The aim of this review was to appraise the effectiveness and implementation readiness of psychosocial interventions for people with psychosis in South Asia.

METHOD

A systematic search was conducted on MEDLINE, PsycINFO, Global Health, and Web of Science. The review was prospectively registered on PROSPERO (CRD42022329254). Studies were rated on two scales assessing quality and implementation readiness.

RESULTS

Twenty-six papers were included, nine intervention-types including community-based interventions/assertive outreach; CaCBTp; FAP; psychoeducation; cognitive retraining/rehabilitation; social cognition/skills; family/ caregiver intervention; telehealth intervention; yoga-based intervention in six South Asian countries. Findings suggest a multicomponent community-based intervention (MCBI) was the most implementation ready due to its standardisation, good clinical outcomes for patients and caregivers, and training and cost evaluations.

CONCLUSION

Of the included studies, MCBI and community-based outreach interventions utilising lay health workers appear to be the most implementation ready and are suggested to best address the treatment gap in South Asia.

Exploring biomedical and traditional care pathways for people with psychosis in Karachi, Pakistan

Background

Psychosis is known to have an adverse impact on an individual's quality of life, social and occupational functioning. A lack of treatment options for psychotic disorders such as schizophrenia contributes to adverse outcomes for individuals. A significant proportion of people with psychosis consult both formal and traditional routes of care. This warrants a need to explore perceptions around treatment options provided by diverse care providers, as the identification of avenues for support can improve psychiatric, alternative treatment and social outcomes.

Methods

Focus groups discussions (FGDs) and in-depth interviews (IDIs) were used. Interactive Research and Development (IRD) research staff conducted 20 IDIs and 2 FGDs to obtain information about the perspectives, treatment pathways and experiences of individuals with psychosis, their caregivers, and service providers. Questions for clinician care providers and faith healers revolved around perceptions of psychosis, service users' background, subject knowledge and treatment, feedback and referral mechanisms, and promotion of services. A thematic analysis was used to analyze the interviews and coding was conducted on NVivo.

Results

The results were categorized into five themes: perception of psychosis, experience of seeking/receiving care, assessment and diagnosis methods, promotion of services, and living with psychosis. Across service providers and patients, there was a wide variety of causes attributed to psychosis, and an overall lack of awareness regarding severe mental health conditions from both formal and informal care-providers. Biomedical treatment received mixed reviews, while some reported it as beneficial, the limited number of institutes and clinicians to cater for patients, stigma within society and care providers, the burden of caregiving, and misinformation from faith healers were all significant barriers to treatment.

Conclusion

The results highlight the use of traditional healing practices for psychosis in Pakistan, which, coupled with inadequate referral mechanisms, present an opportunity to bridge the treatment gap between clinical and traditional healing practices through integration of treatment within community structures and systems. Better awareness of psychosis and its treatment methods, alongside interventions that reduce stigma could help facilitate help-seeking behavior and reduce the burden of caregiving.

Culturally adapted psychosocial interventions (CaPSI) for early psychosis in a low-resource setting: study protocol for a large multi-center RCT

BACKGROUND

Psychosis treatment guidelines recommend cognitive behaviour therapy (CBT) and family intervention (FI), for all patients with first episode psychosis (FEP), though guidance borrows heavily from literature in adults from high income countries. To our knowledge, there are few randomized controlled trials (RCTs) examining the comparative effect of these commonly endorsed psychosocial interventions in individuals with early psychosis from high-income countries and no such trials from low and middle-income countries (LMICs). The present study aims to confirm the clinical-efficacy and cost-effectiveness of delivering culturally adapted CBT (CaCBT) and culturally adapted FI (CulFI) to individuals with FEP in Pakistan.

METHOD

A multi-centre, three-arm RCT of CaCBT, CulFI, and treatment as usual (TAU) for individuals with FEP (n = 390), recruited from major centres across Pakistan. Reducing overall symptoms of FEP will be the primary outcome. Additional aims will include improving patient and carer outcomes and estimating the economic impact of delivering culturally appropriate psychosocial interventions in low-resource settings. This trial will assess the clinical-efficacy and cost-effectiveness of CaCBT and CulFI compared with TAU in improving patient (positive and negative symptoms of psychosis, general psychopathology, depressive symptoms, quality of life, cognition, general functioning, and insight) and carer related outcomes (carer experience, wellbeing, illness attitudes and symptoms of depression and anxiety).

CONCLUSIONS

A successful trial may inform the rapid scale up of these interventions not only in Pakistan but other low-resource settings, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority groups with FEP.

TRIAL REGISTRATION

NCT05814913.

Concurrent Obsessive-Compulsive Symptoms in Patients With Schizophrenia: A Retrospective Study From a Tertiary Care Centre in Sindh, Pakistan

INTRODUCTION

The present study aimed to evaluate the proportion of concurrent symptoms of obsessive-compulsive symptoms (OCSs) among patients with schizophrenia.

METHODS

A retrospective study was undertaken at the Department of Psychiatry, Jinnah Postgraduate Medical Center, Sindh, Pakistan between 1st March 2019 and 1st April 2020. All cases with diagnosed schizophrenia irrespective of gender, age, or ethnicity were eligible for the study. We excluded patients with acute psychosis due to isolated substance use disorder or any organic brain disease. The medical records for each patient were retrieved from the departmental database. Sociodemographic factors including age, gender, ethnicity, and presence of OCSs and other psychiatric comorbidities were recorded in a predefined pro forma. The presence of OCSs was noted by the attending psychiatrist during history taking as positive or negative.

RESULTS

A total of 139 patients were included. A predominance of the male gender was noted. There were 63 (45.3%) patients with concurrent OCSs. Out of the total patients, 42 (66.67%) males and 21 (33.33%) females had OCSs. A total of 28 (44.44%) patients between 31 and 45 years of age had OCSs. Out of the 63 patients with OCSs, 36 (57.14%) had a history of substance abuse (p = 0.471). In the study, 17 (26.98%) Balochi and 19 (30.16%) Pashtuns had OCSs. However, the difference was statistically insignificant.

CONCLUSION

In conclusion, OCSs were frequent in patients with schizophrenia, according to the current study. We discovered that males, individuals between the ages of 18 and 30 years, Balochis, Pashtuns, and those with a history of substance abuse were more likely to have OCSs. However, the difference was not statistically significant.