Prevalence and treatment of neurological and psychiatric disorders among tertiary hospitals in Pakistan; findings and implications

Adolopment of clinical practice guidelines and creation of referral pathways for psychiatric conditions in Pakistan

Psychiatric disorders are highly prevalent in Pakistan and burdens the scarce number of psychiatrists present in the country. The establishment of evidence-based clinical practice guidelines (EBCPGs) and primary-care referral pathways within the local context is imperative to make the process efficient. In this Health Policy, we aimed to develop EBCPGs and primary-care referral pathways that are specific to Pakistan's primary-care setting, with the aim of facilitating the management of psychiatric conditions. Ten EBCPGs were created through the GRADE-ADOLOPMENT process; two recommendations were adopted with minor changes, 43 were excluded, and all others were adopted without any changes. Ten primary-care referral pathways for managing ten psychiatric disorders were created and 23 recommendations were added which will help to bridge the gap in care provision. These psychiatric referral pathways and EBCPGs will bring Pakistan's healthcare system a step closer to achieving optimal health outcomes for patients.

Exploring the Longitudinal Relationship Between Short Sleep Duration, Temperament and Attention Deficit Hyperactivity Disorder Symptoms in a Biethnic Population of Children Aged Between 6 and 61 Months: A Born in Bradford Study

OBJECTIVE

Examine the association between sleep duration, temperament and symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in a biethnic child-population from The Born in Bradford cohort.

METHOD

Parent-report sleep duration categorized children as: early short, late short, consistently short or consistently normal sleepers between 6 and 36 months. Temperament was measured using the Infant Characteristics Questionnaire at 6 months. The Strengths and Difficulties Questionnaire assessed symptoms of ADHD at 37, 54, and 61 months.

RESULTS

Normal sleepers before 18 months had significantly fewer ADHD symptoms at 37 months compared with consistently short sleepers. Fussiness at 6 months was significantly positively associated with ADHD symptoms at 37 and 54 months; but does not appear to mediate the relationship between sleep duration and ADHD symptoms.

CONCLUSION

Awareness of the relationship between short sleep duration and fussiness in infancy and later ADHD symptomatology may support earlier identification of arising difficulties in children.

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.

Exploring the trend of Schizophrenia at Hiwot Fana specialized university referral hospital, Eastern, Ethiopia (2016-2020): A 5-year retrospective analysis

Schizophrenia is one of the most troublesome psychiatric problems requiring long-term antipsychotic treatments. There is a scarcity of data regarding its overtime trend in Ethiopia.

IMPACT OF EDUCATIONAL TRAINING ON NEUROLOGICAL ASSESSMENT SKILLS OF FEMALE NURSES IN EVALUATING TRAUMATIC BRAIN INJURY PATIENTS THROUGH GLASGOW COMA SCALE IN LAHORE GENERAL HOSPITAL, LAHORE, PAKISTAN

Background: Traumatic Brain Injury (TBI) is a leading cause of death and disability worldwide. The objective of this study was to determine the impact of educational training on neurological assessment skill of female nurses in evaluating traumatic brain injury patients through Glasgow Coma Scale in Lahore General Hospital, Lahore, Pakistan.Material Methods: This quasi-experimental one group pre-posttest design study was conducted at Lahore School of Nursing, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan from April 3, 2021 to May 15, 2021. Pre-test neurological assessment skill of 70 nurses was noted by an observer, two weeks educational training was given and four weeks later on, post-test score was noted. For neurological assessment skill, a 20 items observatory checklist was used. Age groups, marital status, job experience, work experience in recent department and work place were four demographic, while neurological assessment skill score was one research variable. Paired sample t test was used for hypothesis testing.Results: Out 70 nurses, 26 (37.1%) were in age group 25-30 years, 18 (25.7%) in 31-35, 16 (22.9%) in 36-40, six (8.6%) in 41-45 and four (5.7%) in 46-50 years. Marital status was; 36 (51.4%) single, 27 (38.6%) married, three (4.3%) divorced and four (5.7%) widow. Job experience was; eight (11.4%) had 2 years, 33 (47.1%) 2-5 years, 25 (35.7%) 6-10 years and four (5.7%) had 10 years. Work experience in recent department was; 16 (22.9%) had 1 year, 39 (55.7%) 1-3 years, 13 (18.6%) 4-5 years and two (2.9%) had 5 years. Work place was Trauma Unit in 12 (17.1%), neurosurgery ICUs in 38 (54.3%) and surgical units in 20 (28.6%) cases. Mean 16.89±2.52 posttest skills score was significantly higher than mean 12.56±2.67 pretest skills score (p=.0001).Conclusion: Our study confirmed that the effect of educational training was significant in improving neurological assessment skills of nurses in evaluating traumatic brain injury patients through Glasgow Coma Scale in Lahore General Hospital, Lahore, Pakistan. Further studies are suggested with increased sample size and multiple research settings.

Perceptions, Expectations, and Experience of Physicians About Pharmacists and Pharmaceutical Care Services in Pakistan: Findings and Implications

Background: Optimal collaboration between pharmacists and other healthcare professionals such as physicians is integral in implementing pharmaceutical care. However, there are concerns regarding the role of pharmacists, especially among low- and middle-income countries. This study explored the perceptions, expectations, and experience of physicians working in various hospital settings of Punjab, Pakistan, about pharmacists and their roles.

Methods: A self-administered questionnaire consisting of four sections was administered from October to December 2020. Descriptive and inferential statistics such as Kruskal-Wallis and Mann-Whitney tests were used for data analysis using SPSS.

Results: Six hundred and seventy-eight physicians participated in this study with a response rate of 77.9%. Most of the physicians reported minimal to no interaction with pharmacists (n = 521, 76.8%). However, more than three-quarters of physicians (n = 660, 97.3%) accepted pharmacists as evidence-based sources of drug information. In addition, many physicians (n = 574, 84.7%) strongly agreed that pharmacists should attend patient care rounds to respond promptly to questions related to patient medication. A limited number of physicians (n = 124, 18.3%) assumed that pharmacists were advising their patients regarding the judicial use of their drugs. Median expectation and experience score had a significant association with age, experience, and education of physicians (P < 0.05).

Conclusions: The perception of physicians was positive toward certain roles of pharmacists, coupled with high expectations. However, their experience was low, with most of the activities of pharmacists due to inadequate interprofessional coordination.