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Objective: Aim of the study was to explore the perceived stress in students at various medical and dental universities across Pakistan during the COVID 19 pandemic, using a validated scale.Materials and Methods: The study took place at the Institute of Psychiatry (IOP) Rawalpindi Medical University (RMU). Results: About 400 medical students participated countrywide. The final analysis was conducted on 333 participants who completed the survey form. Study participants comprised 69.1% female and 30.9% male students. About 74.5% of the participants represented Punjab province, 1.2% were from Sindh, another 1.2% belonged to Baluchistan, 2.4% were from KPK, and 1.5% were from AJK while 19.2% of them resided in Islamabad. The majority of participants were enrolled in MBBS (78.4%) while the rest were from BDS (3%), Allied Health Sciences (12.9%), Clinical Psychology (3.6%), and Pharm D (2.1%).The mean perceived stress score was 21.34, SD=4.90 suggesting high perceived stress levels. Approximately 4.5% of students perceived low levels of stress, 80.2% perceived moderate stress, whereas 15.3% scored high on the perceived stress scale. Male students had statistically significant (p=0.38) lower stress levels (M=19.99, SD=5.91) as compared to females (M= 21.95, SD= 4.26). Conclusions: Perceived stress level in medical students was alarmingly high and requires urgent intervention by the Medical and Dental Universities for immediate action and policy guidance for early identification and effective management. This can be achieved by delivering targeted e-workshops and evidence-based e-trainings for stress management like psychological first aid and mindfulness techniques.

Background and Objective: With the increasing life expectancy of the populations and rising prevalence of depressive and neurocognitive disorders, there is a need to address the association between the two in terms of magnitude of the neurocognitive disorders and the severity of depression. The current study addresses this issue and aims to observe the association between the two. Methods: This cross-sectional descriptive study was conducted from September 2014 to March 2015 at the Institute of Psychiatry at Benazir Bhutto Hospital, Rawalpindi, Pakistan where consecutive patients aged ≥ 65 years were screened for depression using Geriatric Depression Scale (GDS). Neurocognitive impairment was assessed using Mini Mental State Examination (MMSE). -square test was used to compute the association between depression severity and neurocognitive deficit. Results: There was approximately equal gender distribution with a mean age of 63.6 ± 9.68 years. Eighty six percent of the study population was found to be suffering from clinical depression while seventy percent had neurocognitive deficit. The severity of depression came out to be directly proportional to the magnitude of the neurocognitive disorder (P = 0.000) with 68.8% of the patients with severe depression having moderate to severe neurocognitive deficit. Conclusions: Depression is associated with significant neurocognitive impairment in elderly in the local population; higher the severity of depression more the magnitude of cognitive impairment. How to Cite This: Yasir S, Yasir SB, Haider N, Fatima S, Mazhar M, Chaudhry S, et al. Magnitude of neurocognitive impairment and severity of depression in geriatric population. Biomedica. 2020; 36 (4): 400-4. Doi: https://doi.org/10.51441/BioMedica/5-87.

IntroductionThe prevalence of smoking is high among people living with severe mental illness (SMI). Evidence on feasibility, acceptability and effectiveness of smoking cessation interventions among smokers with SMI is lacking, particularly in low- and middle-income countries. We aim to test the feasibility and acceptability of delivering an evidence-based intervention (i.e., the IMPACT 4S intervention) that is a combination of behavioural support and smoking cessation pharmacotherapies among adult smokers with SMI in India and Pakistan. We will also test the feasibility and acceptability of evaluating the intervention in a randomised controlled trial.MethodsWe will conduct a parallel, open label, randomised controlled feasibility trial among 172 (86 in each country) adult smokers with SMI in India and Pakistan. Participants will be allocated 1:1 to either Brief Advice or the IMPACT 4S intervention. BA comprises a single five-minute BA session on stopping smoking. The IMPACT 4S intervention comprises behavioural support delivered in up to 15 one-to-one, face-to-face or audio/video, counselling sessions, with each session lasting between 15 and 40 minutes; nicotine gum and/or bupropion; and breath carbon monoxide monitoring and feedback. The outcomes are recruitment rates, reasons for ineligibility/non-participation/non-consent of participants, length of time required to achieve required sample size, retention in study and treatments, intervention fidelity during delivery, smoking cessation pharmacotherapy adherence and data completeness. A process evaluation will also be conducted.Ethics and disseminationThe study has been approved by the University of York’s Health Sciences Research Governance Committee; Health Ministry Screening Committee, India; the Ethics Committee (Behavioural Sciences Division), NIMHANS, Bangalore, India; National Bioethics Committee Pakistan and; Institutional Research and Ethics Forum of Rawalpindi Medical University, Pakistan. Feasibility study results will be disseminated through peer-review articles, and presentations at national and international conferences and policy-engagement forums.Trial registrationISRCTN34399445 (Updated 22/03/2021), ISRCTN Registry https://www.isrctn.com/

BackgroundPeople with severe mental illness (SMI) die earlier than the general population, primarily due to physical disorders. There is limited information on physical illnesses and health-risk behaviours in people with SMI in low and middle-income countries.MethodsWe conducted a cross-sectional survey in adults with SMI attending specialist mental health services in Bangladesh and Pakistan. Data were collected on non-communicable diseases (NCDs), their risk factors, health-risk behaviours, treatments and health risk modification advice (using questions from the WHO STEPwise approach to Surveillance of NCDs (STEPS)) and on common mental disorders, health-related quality of life and infectious diseases. We performed a descriptive analysis, and compared weighted prevalence for these variables in our survey with prevalence for the general population in the STEPS reports from Bangladesh and Pakistan.ResultsWe recruited 2,344 participants with bipolar disorder (36.7%), non-affective psychosis (42.2%), and depression with psychosis (21.1%). Eight percent had diabetes, 24.7% hypertension and 3.1% tuberculosis. 43.4% were overweight or obese, and half had hypercholesterolemia. Most participants with diabetes, hypertension and hypercholesterolemia were previously undiagnosed; of those diagnosed only around half were receiving treatment. Fifty-four percent of men and 17.2% of women used tobacco; 46.9% and 87.1% did not meet WHO recommendations for physical activity and fruit and vegetable intake respectively. Compared with the general population, people with SMI were more likely to have diabetes (O.R.=1.56,95%C.I.=1.30 to 1.88 Bangladesh), hypercholesterolemia (O.R.=2.35,95%C.I.=2.08 to 2.65 Bangladesh) and overweight or obesity (O.R.=1.97, 95%C.I.=1.75 to 2.22 Bangladesh; O.R.=1.61,95%C.I.=1.40 to 1.86 Pakistan). They were less likely to receive tobacco cessation (O.R.=0.33,95%C.I.=0.26 to 0.42 Bangladesh; O.R.=0.42,95%C.I.=0.31 to 0.55 Pakistan), and weight management advice (O.R.=0.51,95%C.I.=0.41 to 0.63 Bangladesh; and O.R.=0.65,95%C.I.=0.51 to 0.82 Pakistan).ConclusionDespite the high prevalence we found significant gaps in detection, prevention and treatment of NCDs and their risk factors in people with SMI.RegistrationISRCTN88485933; https://doi.org/10.1186/ISRCTN88485933

IntroductionPeople with severe mental illness (SMI) die on average 10–20 years earlier than the general population. Most of these deaths are due to physical health conditions. The aim of this cross-sectional study is to determine the prevalence of physical health conditions and their associations with health-risk behaviours, health-related quality of life and various demographic, behavioural, cognitive, psychological and social variables in people with SMI attending specialist mental health facilities in South Asia.Methods and analysisWe will conduct a survey of patients with SMI attending specialist mental health facilities in Bangladesh, India and Pakistan (n=4500). Diagnosis of SMI will be confirmed using the Mini-international neuropsychiatric interview V.6.0. We will collect information about physical health and related health-risk behaviours (WHO STEPwise approach to Surveillance (STEPS)); severity of common mental disorders (Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder scale (GAD-7)) and health-related quality of life (EQ-5D-5L). We will measure blood pressure, height, weight and waist circumference according to WHO guidelines. We will also measure glycated haemoglobin, lipid profile, thyroid function, liver function, creatinine and haemoglobin. Prevalence rates of physical health conditions and health-risk behaviours will be presented and compared with the WHO STEPS survey findings in the general population. Regression analyses will explore the association between health-risk behaviours, mental and physical health conditions.Ethics and disseminationThe study has been approved by the ethics committees of the Department of Health Sciences University of York (UK), Centre for Injury Prevention and Rehabilitation (Bangladesh), Health Ministry Screening Committee and Indian Council of Medical Research (India) and National Bioethics Committee (Pakistan). Findings will be disseminated in peer-reviewed articles, in local and international conferences and as reports for policymakers and stakeholders in the countries involved.Trial registration numberISRCTN88485933; 3 June 2019.

Background Escitalopram is widely used for the management of the major depressive disorder and generalized anxiety disorder, but there is no to very limited data available regarding efficacy and safety in Pakistani patients. This study was conducted to evaluate the efficacy and safety of escitalopram oral drops to manage the major depressive disorder and generalized anxiety disorder in a local cluster within Pakistan. Methods This prospective multicenter observational study was conducted in the department of psychiatry from August 2018 - August 2019. Eighty-five patients meeting the selection criteria were included in the study. Adolescent, adult, and geriatric patients of either gender with generalized anxiety disorder having Hamilton Anxiety Rating Scale (HAM-A) rate ≥ 10 and major depressive disorder having Montgomery-Asberg Depression Rating Scale (MADRS) rate ≥ 7 or patients with co-morbid generalized anxiety disorder (GAD), major depressive disorder (MDD) were selected for the study. We are reporting patients’ improvement from baseline, response rate, and remission rate. Data analysis is performed by using SPSS version 21 (IBM Inc, Armonk, USA). Results Among enrolled patients, 42 were adolescents, 22 were adults, and 21 were geriatric. The mean age of an adolescent, adult, and geriatric patients was 14.92 ± 2.04, 44.54 ± 12.08, and 64.61 ± 3.16 years, respectively. Among enrolled patients, the mean change in a total score of HAM-A for anxiety and MADRS for depression were -10.04 ± 4.32 and -17.67 ± 14.42, respectively. At the end of the study, the remission rate and response rate for depression were 82 % and 75%, respectively. Similarly, the remission rate and the response for anxiety were 76% and 81%, respectively. Mean HAM-A and MADRS scores were significantly improved for adolescent, adult, and geriatric patients. Adverse events were reported in eight (9.41%) patients with six having gastrointestinal (GI) disturbance and two having to worsen anxiety. All reported adverse events were of mild severity. Conclusion Escitalopram oral drops are found effective and tolerable in reducing both anxiety and depression over the duration of study in all age groups, including adolescents, adults, and geriatrics.

This study was conducted assess the frequency of suicide attempt among the transgender population and analyse the relationship of depression and other socio-demographic factors with the suicide attempt Cross-sectional study.The sample population comprised of one hundred and forty-eight transgender people of Rawalpindi and Islamabad. Suicidal attempt was assessed by the simple question that "Have you ever performed an action with the intent to take your own life in your life time?" Answer of yes or no was recorded. Hamilton rating scale for Depression (HAM-D) was used to look for the presence of depression among the target population. Relationship of the age, smoking, family income, illicit substance use and depression was studied with the presence of suicidal attempt among these transgender population of twin cities of Pakistan.A total of 148 transgender people were included in the final analysis. Mean age of the study participants was 38.24±3.18. Out of these, 70.9% had no suicidal attempt in their whole life while 29.1% had one or more suicidal attempts during the course of their life. Twelve had more than one suicidal attempt while 19 had attempt in last one year. Fifty-five did not showed depression while 93 had depression on HAM-D. With binary logistic regression we found that presence of depression and low income had significant association with the presence of suicidal attempt among the target population.This study showed a high prevalence of suicidal attempts among the transgender population of twin cities of Pakistan. Routine screening for mental health problems should be performed on this high-risk group and adequate employment resources should be generated in order to enable them to earn their livelihood and prevent them from making attempts to take their own life.

OBJECTIVE: This paper presents the results of a trans-cultural study looking at the possible differences in the symptomatology of Alzheimer's disease (AD) in people from Manchester, UK and Rawalpindi, Pakistan. METHODS: Two groups of people with AD (45 in each group) were recruited at the two sites. The participants and their carers were interviewed to investigate possible differences in demographics and symptomatology including cognition, depression, personality change and every day activities. The instrument used included the Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Cornell Scale for Depression in Dementia (CSDD), The Brooks and McKinlay Personality Inventory and Informant Questionnaire on Cognitive Decline in the Elderly (IQ CODE). RESULTS: The data analysis showed that compared to people from Manchester the Pakistanis had lower literacy levels but similar cognitive deficits when MMSE scores were adjusted for education. They were however more depressed; they had a different profile of personality change since the onset of illness and their reported changes in activities of daily living were more severe. CONCLUSION: The study has shown a number of possible cultural differences in affective symptoms, personality changes and every day activities. It highlights the need for developing mental health services for older people in Pakistan and making UK services more accessible for this growing community. Further research on service and care needs along with developing culturally sensitive instruments for assessing cognition, psychiatric symptoms, personality changes and daily activities is needed.

The ‘brain drain’, resulting from the recruitment by the UK of highly qualified mental health professionals from middle- and low-income countries, has been described as a serious problem effecting the service provision, training and research capacity of these countries (Doku & Mallett, 2003; Thara et al, 2004). Although this issue is important, the benefits of such migration are seldom highlighted. Professionals who migrate often invest in families and businesses in their home country and are a source of valuable foreign income. Many professionals undergo specialised training and gain experience not available in their home countries and then return to provide an enhanced level of service (Tareen, 2000). Such movement may also serve a catalytic purpose. An example of a sector that has gained enormously from the so-called brain drain is information technology in India, which is built largely around expatriates in the USA and their networks back home. The high profile of Indian information technology experts has encouraged a whole new generation to pursue excellence in this field.