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The dearth of child and adolescent mental health services (CAMHS) is a global problem. Integrating CAMHS in primary care has been offered as a solution. We sampled integrated care perspectives from colleagues around the world. Our findings include various models of integrated care namely: the stepped care model in Australia; shared care in the United Kingdom (UK) and Spain; school-based collaborative care in Qatar, Singapore and the state of Texas in the US; collaborative care in Canada, Brazil, US, and Uruguay; coordinated care in the US; and, developing collaborative care models in low-resource settings, like Kenya and Micronesia. These findings provide insights into training initiatives necessary to build CAMHS workforce capacity using integrated care models, each with the ultimate goal of improving access to care. Despite variations and progress in implementing integrated care models internationally, common challenges exist: funding within complex healthcare systems, limited training mechanisms, and geopolitical/policy issues. Supportive healthcare policy, robust training initiatives, ongoing quality improvement and measurement of outcomes across programs would provide data-driven support for the expansion of integrated care and ensure its sustainability.

This article focuses on potential neurological side effects secondary to psychotropic agents. Clinicians often have to manage these relatively commonly occurring neurological side effects. These potential side effects, if not managed in a timely manner, could be a significant negative factor impacting compliance and tolerability as well as efficacy. This article reviews mechanism of action, assessment, diagnosis, and management of extrapyramidal side effects including akathisia, acute dystonia, parkinsonism, and tardive dyskinesia, as well as motor tics, tremors, myoclonus, seizures, and delirium. Prescribing clinicians need to be cognizant of these potential side effects and knowledgeable in assessing and managing them. [ Psychiatr Ann . 2021;51(9):402–409.]

Background: Stressful situations are often linked with poor health and lifestyle behaviors (e.g., unhealthy diet, limited physical activity, poor sleep quality etc.). Subsequent to the nationwide lockdown in Pakistan due to COVID-19 pandemic, medical students experienced substantial lifestyle changes along with academic stresses. The goal of this study was to measure the impact that the COVID-19 lockdown had on lifestyle like sleep, physical activity and nutrition, substance abuse, dealing with finances, spirituality and family life, with respect to a sample of Pakistani medical students. Methods: This cross- sectional online study involving 1100 medical students (68.7% females) from five medical colleges in Pakistan, used self-administered questionnaire to evaluate the impact of pandemic related restrictions on lifestyle of medical students in Pakistan from August- September 2020. Parameters such as physical activity, sleep, nutrition, smoking and substance abuse, family life, finances, internet use and spirituality were studied. Results: Fifty-nine percent of medical students reported a significant effect of lockdown on their physical activity. Only 5.8% people clearly followed or adhered to a routine during the pandemic. About 54.6% students have found that physical activity and exercise significantly reduced their anxiety. More than half of respondents reported increase in screen time, weight gain and poor sleep with 3.1% of students stating an increased use of sleeping pills to fall asleep Another 18.3% students had an increased worry regarding COVID19 based on the information they received on internet. No significant increase in substance uses and alcohol use or family conflicts among students post pandemic was noted. Conclusion: Our findings underscore that COVID-19 pandemic has led to undesired changes in health and lifestyle habits of medical students, which may, to some extent, be responsible for higher negative impact. Hence it is important for medical colleges to start awareness campaigns to tackle challenges for medical students physical and emotional well-being. doi: https://doi.org/10.12669/pjms.38.7.6031 How to cite this:Tahir SM, Imran N, Haider II, Mustafa AB, Aqeeb-ur-Rehman, Azeem MW, et al. A study to evaluate the impact of COVID-19 on Lifestyle of Medical students. Pak J Med Sci. 2022;38(7):1730-1737. doi: https://doi.org/10.12669/pjms.38.7.6031 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Pregnancy can be a colossal change for some women, with the commencement of motherhood possibly generating emotional health problems, including peripartum depression (PPD). PPD significantly affects the parent-child relationship, which is the foundation for the socioemotional development of the child. In this article, we reviewed the association between PPD and resilience, and identified their mediators and moderators. Eight studies were included after a rigorous screening process. There was a significant relationship between PPD and childhood resiliency, resulting in an increased risk of psychiatric disorders in children and adolescents. Maternal sensitivity and emotional availability were possible mediators. Maternal education, income level, maternal trauma, life adversities, marital conflicts, and perceived social support were reported moderators. This article highlights the need for timely recognition and treatment of PPD with targeted interventions to improve the parent-child relationship. [ Psychiatr Ann . 2021;51(7):322–330.]

Since the start of January 2019, COVID-19 has caused unparalleled disruption to all aspects of life globally, including the delivery of medical education. Each university and institution have a different approach on how medicine, as a course, is taught and delivered, however, generally there is a consensus that in the earlier years, more emphasis should be given to the acquisition of theoretical and scientific knowledge, including anatomy and physiology. In the later years, medical students are then expected to apply their theoretical knowledge in a practical setting by attending various placements and interacting with patients and other healthcare professionals. The duality of this approach results in doctors who are both competent in their knowledge of the basic sciences whilst being good clinicians with sound practical and inter-personal skills. Covid-19 causes an unprecedented interruption to all students, however with courses such as Medicine, whereby a practical element is crucial, the adaptation to deliver the course effectively is more of a challenge. Clinical rotations were cancelled during the start of the pandemic due to concerns about the students and their families contracting the virus and also for the protection of the vulnerable patients in hospitals. In this manuscript we have explored the adaptations made in order to deliver medical education and evaluate the effectiveness of these methods. We will also be discussing the implications and limitations of these methods. doi: https://doi.org/10.12669/pjms.38.1.5269 How to cite this:Karim Z, Javed A, Azeem MW. The effects of Covid-19 on Medical Education. Pak J Med Sci. 2022;38(1):320-322. doi: https://doi.org/10.12669/pjms.38.1.5269 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Food security is a serious issue in developing countries like Pakistan because of ever-increasing population. To feed the hunger population, safe and nutritious vegetables are growing concern as they are being polluted by heavy metals. The present study was conducted to investigate the concentration of heavy metals such as cadmium (Cd), chromium (Cr), lead (Pb), nickel (Ni), iron (Fe), manganese (Mn), and zinc (Zn) in highly consumed vegetable collected from peri-urban markets of Rawalpindi and Multan region. Health risk associated with the consumption of these vegetables in term of estimated daily intake of metals (EDIM) and health risk index (HRI) was also evaluated among local consumers. Results showed that mean values of cadmium (Cd), and lead (Pb) in all vegetable samples from both region were exceeding the respective MAL set by FAO/WHO. Estimated daily intake of heavy metals was found below than the permissible limit. EDIM showed following decreasing trend Fe > Zn > Mn > Ni > Pb > Cr and Cd, respectively. The health risk index (HRI) for all heavy metals were less than the threshold level (1), indicating no significant threat to the local population through the consumption of these vegetables.

Diversity provides better patient outcomes, reduces physician burnout, and therefore lessens the burden of the healthcare system. In this study, we explore the gender and racial trends in the recruitment of medical graduates into US psychiatry residency programs. Retrospective data analysis was performed utilizing the data from the Accreditation Council for Graduate Medical Education (ACGME) Data's annual Resource Books from the year 2007 to 2018. Demographic data, including gender and race, were extracted for psychiatry residents. Gender was categorized as Male, Female, and Not Reported. Race/ethnicity was categorized as White (Non-Hispanic), Asian/Pacific Islander, Hispanic, Black/African-American (Non-Hispanic), Native American/Alaskan, Others (not in the aforementioned categories), and Unknown. Female psychiatry residents relatively decreased by 2.6% whereas male psychiatry residents relatively increased by 15.5% from 2007 to 2018. Between the years 2011 and 2018, there was a relative increase in African American/Black and Native American/Alaskan psychiatry residents by 5.5% and 1%, respectively, whereas the Asian/Pacific Islanders, White (Non-Hispanic), and Hispanic/Latino psychiatry residents relatively decreased by 5.1%, 2.3%, and 1.7%, respectively. Despite the overall increase of women and ethnic minorities in US medical schools, women and racial minorities remain significantly under-represented in psychiatry residency programs in the US.

Iron deficiency has become a common nutritional problem of developing countries, especially in children. This study approached to tackle the issue of iron deficiency by inexpensive fortified food such as chewing gums, which is commonly consumed by children. In this study, iron-fortified chewing gums were prepared by adding ferrous sulfate (FeSO4) and sodium iron EDTA (NaFeEDTA) 30 mg/100 g. An efficacy trial was conducted to determine the impact of iron-fortified chewing gums on the blood profile and iron status of school-going children (n = 300). Results showed maximum increase in blood profile and iron status that is, serum ferritin (10.43%), hemoglobin (3.22%), hematocrit (3.42%), red blood cells (3.05%), mean cell volume (1.55%), mean cell hemoglobin (5.43%), total white blood cells count (9.09%), and platelets count (4.40%) as compared with control whereas decrease in mean cell hemoglobin concentration (1.90%) and neutrophils (3.33%) was also observed. The study concluded that FeSO4 and NaFeEDTA (1:1) fortification of chewing gums is an appropriate approach for mitigating iron deficiency among the target population.

Background & Objective: The Coronavirus disease 2019 (COVID-19) pandemic has caused widespread psychological distress. The aims of the study were a) to assess mental health symptoms experienced by expatriate hospital staff and b) to determine the impact of staff wellbeing interventions specific to pandemic related stress. Methods: The study was conducted from June 2020 until August 2020. A 16-question survey was disseminated online via Survey Monkey to assess the mental health needs of hospital staff during the pandemic. Based on results, a virtual, tiered mental health support model was developed, and staff feedback was collected. Results: Almost 46.2% of respondents (N: 1001) reported at least one mental health symptom in the initial survey. The most common symptoms were anxiety, low mood and feelings of isolation. Being single and in poor health status were predictors of developing mental health symptoms (P

Background & Objective: Child & adolescent mental health needs to be considered as an integral component of overall health, however significant gaps exist in service provision especially inpatient services in Pakistan. The paper presents the characteristics of admitted youths and response to treatment in Pakistan’s first dedicated child & adolescent psychiatry inpatient unit in Lahore over a period of first seven years. The aim of this study was to better understand the various characteristics of children and youth admitted to this inpatient unit and response to treatment over a seven years’ period since the inception of the unit. Methods: Inpatient medical records of children & adolescents admitted to dedicated Child & Adolescent Inpatient Unit at King Edward Medical University, Lahore were reviewed. Data was extracted regarding referral patterns, sociodemographic factors and diagnosis for the first seven years, from 2012 to 2019. Patients’ scores on Strengths and Difficulties Questionnaire and Clinical Global Impressions Scales administered during intake were also reviewed. Results: Six hundred and thirty-four (634) patients, 56% (355) being females were admitted to the unit during seven years with mean age of 12.3±2.3. Mean duration of admission was 15.60±6.3 days. Most predominant ICD-10 Axis-I psychiatric diagnosis were neurotic, stress related and somatoform disorders (262); mood disorders (78); schizophrenia, schizotypal & delusional disorders (77) and behavioral and emotional disorders with onset usually occurring in childhood and adolescence (44). One hundred and fifty-nine (25%) children had comorbid diagnosis of intellectual disability on Axis-III. Strengths and difficulties questionnaire scores were in abnormal range for significant proportion (>50 %) of patients. CGI mean scores showed marked improvement at discharge. Conclusion: Neurotic, stress related and somatoform disorders are the most common diagnosis in youth needing inpatient treatment in Pakistani setup. Study results indicate that there is a clear need for specialized inpatient child and adolescent services such as ours in low- & middle-income countries. doi: https://doi.org/10.12669/pjms.37.2.2611 How to cite this:Imran N, Bodla ZH, Asif A, Shoukat R, Azeem MW. Pakistan’s First Child & Adolescent Psychiatry Inpatient Unit: Characteristics of admitted patients and response to treatment over a 7-year period. Pak J Med Sci. 2021;37(2):305-311. doi: https://doi.org/10.12669/pjms.37.2.2611 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The groundwater resources have always been explored for its utilization in domestic and agriculture purposes. In this study, Winder area in Balochistan which is along the coast of Offshore Indus Basin has been explored using electrical resistivity method for deeper understanding of hydrogeological and hydrogeophysical conditions. Schlumberger electrode arrays have been used to acquire vertical electrical sounding data for 23 different sites in this area. The field data were calibrated with theoretical curves during processing using software with graphical interface. The true resistivities, depths, thicknesses, aquifer attributes, soil type and groundwater quality has been extracted from the processed data. Pseudo-sections and geo-electrical lithology sections have been generated for lateral distribution of hydrogeological settings. Furthermore, Dar-zarrouk parameters calculations have been made and 3D surfaces generated at 30m and 60 m depth for transverse resistance (T), longitudinal conductance (S) and anisotropy (λ) plotted for resistivity distribution and coastal salinity intrusion analysis. The soundings results depict five layers mainly composed of silty sand, sandy clay, sand, and sandy gravel and the depth ranges from 0-110m. The interpretation illustrates that freshwater unconfined aquifer are present in the quaternary sand and sandy gravel deposits. The water table is at shallow depth along the river and deeper in northeast and away from Winder river. The resistivity ranges 29-1091 Ωm in layer-3 interpreted as saturated zone. The approximate range of water table is 19-30 m. The higher value of T greater than 10000 shows fresh water and low value 8200 for salinity intrusion in southwest toward sea., Izvori podzemne vode uvijek su se istraživali radi njihove upotrebe u kućne i poljoprivredne svrhe. U ovoj je studiji područje Windera u Beludžistanu, uz obalu priobalnoga bazena Inda, istraženo korištenjem metode električnoga otpora radi dubljega razumijevanja hidrogeoloških i hidrogeofizičkih uvjeta. Nizovi elektroda Schlumberger korišteni su za prikupljanje podataka o vertikalnome električnom sondiranju za 23 različita mjesta u ovome području. Podatci na terenu kalibrirani su teoretskim krivuljama tijekom obrade s pomoću softvera s grafičkim sučeljem. Iz obrađenih podataka izdvojena je stvarna otpornost, dubine, debljine, svojstva vodonosnika, vrsta tla i kvaliteta podzemne vode. Za bočnu raspodjelu hidrogeoloških postavki stvoreni su pseudopresjeci i geoelektrični litološki odsjeci. Nadalje, izrađeni su proračuni Dar-zarroukovih parametara i generirane su 3D površine na dubini od 30 m i 60 m za poprečni otpor (T), uzdužnu vodljivost (S) i anizotropiju (λ). Ti su parametri ucrtani za raspodjelu otpora i analizu upada slane obale. Rezultati sondiranja prikazuju četiri sloja uglavnom sastavljena od muljevitoga pijeska, pjeskovite gline, pijeska i pješčanoga šljunka, a dubina se kreće od 0 do 110 m. Tumačenje ilustrira da su slatkovodni vodonosnici prisutni u kvartarnim pjeskovitim i pjeskovitim naslagama šljunka. Vodeni je sloj na maloj dubini uz rijeku, a dublje na sjeveroistoku i dalje od rijeke Winder. Otpornost se kreće od 29 do 1091 Ωm u sloju 3, što se tumači kao zasićena zona. Približni je domet vodostaja 19 – 30 m. Viša vrijednost T veća od 10000 pokazuje slatku vodu i nisku vrijednost 8200 za prodiranje slanosti na jugozapadu prema moru.

Purpose This study aims to ascertain the relevance of Carroll’s four dimensions of corporate social responsibility (CSR), namely, economic, legal, ethical and discretionary in a dynamic regulatory context of a developing economy – Pakistan. Design/methodology/approach This study has operationalized these dimensions as four categories of CSR disclosure index. This disclosure index measured the relevance of CSR dimensions by examining CSR disclosure practices of Pakistan Stock Exchange-100 index firms. Findings The authors have found that the firms of Pakistan disclose more information pertaining to discretionary dimension of CSR than economic, legal and ethical dimensions. Interestingly, the authors have observed that after the enactment of state regulation, there is an increasing trend of the overall CSR disclosure level at a decreasing rate. Practical implications For policymakers, these findings imply that firms tend to perceive law as a box-ticking exercise and refrain to involve in those CSR activities that can have both strategic and societal benefits over the long run. These finding imply for business managers that if they will not undertake CSR notion seriously then the policymakers will take statutory initiatives to curtail the greenwashing effect and these initiatives can lead to higher transaction costs. Originality/value This study presents evidence about the relevance of Carroll’s four dimensions of CSR in a developing economy. The evidence shows that the CSR disclosure in developing economy continues to take a largely philanthropic form thereby dominating other CSR dimensions namely ethical, legal and economic. These findings also confirm that CSR practices are context-dependent and these cannot be isolated from their unique social context.

In this paper, we present a multi-region ensemble classifier approach (MRECA) using a cognitive ensemble of classifiers for accurate identification of attention-deficit/hyperactivity disorder (ADHD) subjects. This approach is developed using the features extracted from the structural MRIs of three different developing brain regions, viz., the amygdala, caudate, and hippocampus. For this study, the structural magnetic resonance imaging (sMRI) data provided by the ADHD-200 consortium has been used to identify the following three classes of ADHD, viz., ADHD-combined, ADHD-inattentive, and the TDC (typically developing control). From the sMRIs of the amygdala, caudate, and hippocampus regions of the brain from the ADHD-200 data, multiple feature sets were obtained using a feature-selecting genetic algorithm (FSGA), in a wraparound approach using an extreme learning machine (ELM) basic classifier. An improved crossover operator for the FSGA has been developed for obtaining higher accuracies compared with other existing crossover operators. From the multiple feature sets and the corresponding ELM classifiers, a classifier-selecting genetic algorithm (CSGA) has been developed to identify the top performing feature sets and their ELM classifiers. These classifiers are then combined using a risk-sensitive hinge loss function to form a risk-sensitive cognitive ensemble classifier resulting in a simultaneous multiclass classification of ADHD with higher accuracies. Performance evaluation of the multi-region ensemble classifier is presented under the following three scenarios, viz., region-based individual (best) classifier, region-based ensemble classifier, and finally a multiple-region-based ensemble classifier. The study results clearly indicate that the proposed “multi-region ensemble classification approach” (MRECA) achieves a much higher classification accuracy of ADHD data (normally a difficult problem because of the variations in the data) compared with other existing methods.

Autism is a fascinating topic that has attracted the interest of researchers and the lay public alike. The history of autism is filled with accomplishments of people who were astute observers of childhood psychopathology. Autism spectrum disorder affects a diverse group of children who share certain commonalities. There are ongoing attempts to understand its etiology and to refine diagnostic criteria for improved and timely recognition. In recent years, rapidly evolving research has highlighted the limits of our understanding of a disorder that at one time was considered rare, but now presents itself in 1 in every 59 children in the United States. This article particularly focuses on the history of autism as well as the changing criteria in the Diagnostic and Statistical Manual of Mental Disorders . [ Psychiatr Ann . 2019;49(3):103–108.]

Depleting petroleum resources coupled with the environmental consequences of fossil fuel combustion have led to the search for renewable alternatives, such as biodiesel. In this study, sunflower (Helianthus annus), mustard (Brassica compestres) and pearl millet (Pennisetum americanum) seed oils were converted into biodiesel (fatty acid methyl esters) by acid-, base- and lipase-catalyzed transesterification, and the resultant fuel properties were determined. The methyl esters displayed superior iodine values (102–139), low densities, and a high cetane number (CN). The highest yield of biodiesel was obtained from mustard seed oil, which provided cloud (CP) and pour (PP) points of −3.5 and 5 °C, respectively, and a CN of 53. The sunflower seed oil methyl esters had a density of 0.81–0.86 kg/L at 16 °C, CP of 2 °C, PP of −8 °C, and a CN of 47. The pearl millet seed oil methyl esters yielded a density 0.87–0.89 kg/L, CP and PP of 4 °C and −5 °C, respectively, and a CN of 46. The major fatty acids identified in the sunflower, mustard, and pearl millet seed oils were linolenic (49.2%), oleic acid (82.2%), and linoleic acid (73.9%), respectively. The present study reports biodiesel with ideal values of CP and PP, to extend the use of biodiesel at the commercial level.

The study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in the Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students' responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of enhanced range of integrated training opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them.

The World Health Organization identified a chronic shortage of psychiatrists in Low- Middle- and High-Income Countries. In Qatar, the situation is dire with reports there is one psychiatrist per 170,000 people in the population. A one-day, student-led mental-health conference was held in Doha, Qatar under the auspices of the World Psychiatric Association with the aim of increasing interest in psychiatry as a career.In this single-arm, pre-post comparison study, a questionnaire assessing interest in psychiatry as a career was administered on participants before and after attending the conference. Demographic information was obtained and response items were on a 5-point Likert scale. Statistical analysis was performed using a two-sample t-test with a significant p-value set at0.05.The conference was attended by 102 individuals. Fifty-four attendees completed the pre-conference survey (53% response rate) and 36 participants completed the post-conference survey (35% response rate). Data for the 36 matched pre-post responses were included in our analyses. The average age of respondents was 22 years and 81% were female. There was improvement in post-conference results however these changes were not statistically significant.To the best of our knowledge this is the first intervention study on increasing interest in psychiatry as a career carried out in Qatar. It is likely that psychiatry enthusiasts attended the conference and therefore their interest in this medical specialty was already high as corroborated by the favorable pre-conference survey results. This might explain why there was a lack of statistical significance in comparison to post- intervention scores. We recommend that such an event be integrated into the medical school curricula throughout Qatar to include students with low baseline interest in psychiatry. Further research in this area with more robust methodology is urgently needed to help narrow the pervasive treatment gap.

Autism spectrum disorder (ASD) is a neurological and developmental disorder characterized by social impairment and restricted interactive and communicative behaviors. It may occur as an isolated disorder or in the context of other neurological, psychiatric, developmental, and genetic disorders. Due to rapid developments in genomics and imaging technologies, imaging genetics studies of ASD have evolved in the last few years. Increased risk for ASD diagnosis is found to be related to many specific single-nucleotide polymorphisms, and the study of genetic mechanisms and noninvasive imaging has opened various approaches that can help diagnose ASD at the nascent level. Identifying risk genes related to structural and functional changes in the brain of ASD patients provide a better understanding of the disease’s neuropsychiatry and can help identify targets for therapeutic intervention that could be useful for the clinical management of ASD patients.

Obsessive-compulsive disorder (OCD) can be found in about 4% of the general population and is characterized by various compulsions and obsessions that interfere with the person's quality of life from a mild to severe degree. The following discussion reflects on current concepts in this condition, including its epidemiology and etiologic underpinnings (behavioral, neurological, immunological, gastroenterological, as well as genetic). The interplay of PANS and PANDAS are included in this review. In addition, the core concepts of OCD diagnosis, differential diagnosis, and co-morbidities are considered. It is stressed that the quality of life for persons with pediatric OCD as well as for family members can be quite limited and challenged. Thus, principles of management are presented as a guide to improve the quality of life for these persons as much as possible.

Sources of data This article is based on key recent published literature including international guidelines and relevant reviews and meta-analyses. Authors have also supplemented this material with their own clinical experience. Areas of agreement There is an agreement that autism spectrum disorder (ASD) have a strong hereditary component. There is also a consensus that the reported prevalence estimates have increased in the last 5 years. There is strong support for using the broader spectrum disorder conceptualization of the DSM-5. Areas of controversy Higher public awareness of ASD has generated several controversial theories of causation. We review a number of environmental risk factors receiving media attention including: vaccines, mercury, heavy metal exposure and Selective Serotonin Uptake Inhibitors (SSRIs). Popular yet controversial treatment interventions are discussed. Early diagnostic screening tools are also addressed. Growing points There is increasing scientific interest in identifying biomarkers of autism with potential for early diagnosis, prognostic indicators and predictive treatment responses. We review evidence from genetics, neuroimaging and eye tracking as candidate biomarkers. Area timely for developing research Family studies point to a strong hereditary component in the aetiology of autism. However these studies have not established 100% concordance rates, suggesting a role for environmental factors. The gene-environment interplay has not received enough attention in scientific research. This represents an important new avenue for research in ASD.

Generalized anxiety disorder (GAD), despite being among the most common psychopathology of children and adolescents, often goes undetected and untreated. GAD is characterized by excessive worry for more than 6 months about a variety of situations, events, or activities (especially school performance among children), inability to control the worry, and presence of at least one physical symptom. The interplay of various risk factors (genetic, environmental, and psychosocial) and protective factors is seen in youth with GAD, and comorbidity is common. GAD is associated with significant distress and disability independent of comorbid disorders. A multimodal approach that includes psychoeducation, psychological therapies (in particular cognitive-behavioral therapy), family therapy, and pharmacological treatment provides the best outcome for children and adolescents with GAD. [ Psychiatr Ann. 2017;47(10):497–501.]

Depressive disorders in children and adolescents constitute a significant burden on social and public health. The impairment can affect several domains of functioning including family, school, and social. Depression is also a significant risk factor in suicide and other psychiatric disorders. The prevalence of major depressive disorder is estimated to be 2% in children and 4% to 8% in adolescents. The rates are much higher in subsyndromal depression, which also affects the functioning of youth. Most youth do recover; however, recurrence is common, with 40% to 70% of youth experiencing relapse within 3 to 5 years. Biopsychosocial assessment of depression requires gathering information from multiple informants and synthesizing the information to diagnose depression. Treatment of pediatric depression consists of social, psychological, and pharmacological interventions. [ Psychiatr Ann. 2017;47(10):502–506.]

Pediatric obsessive-compulsive disorder (OCD) is a complex neuropsychiatric disorder that is characterized by the presence of distressing and impairing recurrent obsessions and/or compulsions. OCD affects up to 4% of children and adolescents, and constitutes a significant societal burden and causes marked distress and functional impairments in affected people and their families. The assessment of pediatric OCD should comprehensively capture comorbid conditions. Cognitive-behavioral therapy (CBT) is the first-line treatment for pediatric OCD. For moderate to severe cases, CBT may be combined with pharmacological treatment. First-line medications for pediatric OCD are selective serotonin reuptake inhibitors, and the US Food and Drug Administration has approved fluoxetine, sertraline, and fluvoxamine for use in pediatric OCD. Most children with OCD achieve remission or significant improvement in their symptoms. [ Psychiatr Ann. 2017;47(10):512–518.]

Children and adolescents are susceptible to developing posttraumatic stress disorder (PTSD), which has serious consequences for their emotional, physical, social, and cognitive development. Sources of traumatic stress in children are many, such as loss of a loved one, accidents, community or school violence, domestic violence, physical or sexual abuse, man-made or natural disasters, and terrorism. Due to the wide range of reactions seen in children according to their age and developmental levels, it is not possible to directly apply adult PTSD criteria to them. This article discusses issues related to etiology, assessment, and diagnosis of PTSD in children and adolescents. It describes the comorbidities and the neurobiological basis of PTSD symptomatology and critically evaluates current psychological and pharmacological treatments of PTSD in the pediatric population. [ Psychiatr Ann . 2017;47(3):139–144.]

Autism spectrum disorder (ASD) is a genetic heterogeneous neurodevelopmental disorder that is characterized by impairments in social interaction and speech development and is accompanied by stereotypical behaviors such as body rocking, hand flapping, spinning objects, sniffing and restricted behaviors. The considerable significance of the genetics associated with autism has led to the identification of many risk genes for ASD used for the probing of ASD specificity and shared cognitive features over the past few decades. Identification of ASD risk genes helps to unravel various genetic variants and signaling pathways which are involved in ASD. This review highlights the role of ASD risk genes in gene transcription and translation regulation processes, as well as neuronal activity modulation, synaptic plasticity, disrupted key biological signaling pathways, and the novel candidate genes that play a significant role in the pathophysiology of ASD. The current emphasis on autism spectrum disorders has generated new opportunities in the field of neuroscience, and further advancements in the identification of different biomarkers, risk genes, and genetic pathways can help in the early diagnosis and development of new clinical and pharmacological treatments for ASD.

Objective: To measure the knowledge of healthcare professionals about increasingly prevalent Autism Spectrum Disorder (ASD) along with perceptions around its management and prognosis and comparison across various specialties. Methods: This Cross sectional survey based comparative analysis took place at Maternity and Children Hospital and King Faisal Hospital Makkah from December 2017 to May 2018. The validated self-administered “Knowledge about childhood autism among health workers” questionnaire was used along with additional questions regarding perceptions about ASD. The mean and mean percent scores were calculated. Chi squared test and ANOVA were applied to find the association between quantitative and qualitative variables respectively. Results: Out of 162 participants, 153 returned the questionnaire and 147 were included in final analysis. Physicians constituted 81.6% (120) of participants. The mean score for participants was 9.80(S.E.M ±0.32) where non-physicians yielded higher mean score (11.2±4.41) as compared to physicians (9.6±3.28) (p=0.113). Psychiatrists had highest score of 16/19 while general physicians had lowest (6/19). Participants with more years of experience had higher mean scores (p-value = 0.01). About 72.10% (106) of participants opted for medication as a treatment option. Nearly 38.1% (56) of participants were skeptical about improvement of ASD with early interventions. Conclusion: There is a lack of knowledge about ASD amongst healthcare professionals in Saudi Arabia. Experienced professionals working with ASD children can be utilized to deliver targeted trainings nationwide.

Objective: To measure the knowledge of healthcare professionals about increasingly prevalent Autism Spectrum Disorder (ASD) along with perceptions around its management and prognosis and comparison across various specialties. Methods: This Cross sectional survey based comparative analysis took place at Maternity and Children Hospital and King Faisal Hospital Makkah from December 2017 to May 2018. The validated self-administered “Knowledge about childhood autism among health workers” questionnaire was used along with additional questions regarding perceptions about ASD. The mean and mean percent scores were calculated. Chi squared test and ANOVA were applied to find the association between quantitative and qualitative variables respectively. Results: Out of 162 participants, 153 returned the questionnaire and 147 were included in final analysis. Physicians constituted 81.6% (120) of participants. The mean score for participants was 9.80(S.E.M ±0.32) where non-physicians yielded higher mean score (11.2±4.41) as compared to physicians (9.6±3.28) (p=0.113). Psychiatrists had highest score of 16/19 while general physicians had lowest (6/19). Participants with more years of experience had higher mean scores (p-value = 0.01). About 72.10% (106) of participants opted for medication as a treatment option. Nearly 38.1% (56) of participants were skeptical about improvement of ASD with early interventions. Conclusion: There is a lack of knowledge about ASD amongst healthcare professionals in Saudi Arabia. Experienced professionals working with ASD children can be utilized to deliver targeted trainings nationwide. doi: https://doi.org/10.12669/pjms.35.4.605 How to cite this:Hayat AA, Meny AH, Salahuddin N, Alnemary FM, Ahuja KR, Azeem MW. Assessment of knowledge about childhood autism spectrum disorder among healthcare workers in Makkah- Saudi Arabia. Pak J Med Sci. 2019;35(4):951-957. doi: https://doi.org/10.12669/pjms.35.4.605 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Mental health disorders are a burgeoning global public health challenge, and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80 % of the mental health disease burden. Stigma associated with mental health results in delayed help seeking, reduced access to health services, suboptimal treatment, poor outcomes and an increased risk of individuals' human rights violations. Moreover, widespread co-occurrence of physical comorbidities such as noncommunicable diseases with mental health disorders makes the treatment of both conditions challenging and worsens prognosis. This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals (mental health professionals, non-psychiatric specialists and general practitioners) imparting mental health care. Cultural, socio-economic and religious factors determine various aspects of mental health in LMICs, ranging from perceptions of health and illness, health seeking behavior, attitudes of the individuals and health practitioners and mental health systems. Addressing stigma requires comprehensive and inclusive mental health policies and legislations; sustainable and culturally-adapted awareness programs; capacity building of mental health workforce through task-shifting and interprofessional approaches; and improved access to mental health services by integration with primary healthcare and utilizing existing pathways of care. Future strategies targeting stigma reduction must consider the enormous physical comorbidity burden associated with mental health, prioritize workplace interventions and importantly, address the deterioration of population mental health from the COVID-19 pandemic.