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Background and aim: Orthopedic trauma patients experience anxiety and depression, both of which are undesirable psychological issues. The present study aimed was to determine the prevalence of anxiety and depression. Material and Methods: This cross-sectional study was conducted on 188 orthopedic trauma patients in Orthopaedics Department of Federal Govt. Polyclinic Hospital (FGPC) Islamabad and Wah Medical College / POF hospital Wah Cantt from October 2020 to September 2022. Prior to study conduction, ethical approval from research and ethical committee was taken. Informed written consent was obtained from each individual. Social characteristics, demographic details, and clinical examination were recorded. Hospital anxiety and depression scale (HADS) was used for the assessment of patient’s anxiety and depression. SPSS version 26 was used for data analysis. Results: Of the total 188 patients, there were 112 (60%) male and 76 (40%) females. The overall mean age was 46.82 ± 12.94 years with an age range (15-75 years). Age-wise distribution of patients was as follows: 56 (29.8%) in 15-30 years, 44 (23.4%) in 31-45 years, 38 (20.2%) in 46-60 year, and 50 (26.6%) in 61-75 years. Out of 188 orthopedic trauma patients, the incidence of road traffic accident (RTA) and ground fall was 96 (51.1%) and 92 (48.9%) respectively. The incidence of anxiety and depression before and after orthopedic surgery was 22 (11.7%) and 32 (17%) and 36 (19.1%) and 46 (24.5%) respectively. Anxiety and depression on HADS was 4.12 and 5.21 before surgery and increased substantially to 4.62 and 5.81 after surgery. The incidence of single, double, and triple fracture was 162 (85.2%), 24 (12.8%), and 2 (1.1%) respectively. Conclusion: The present study found that orthopedic trauma in the elderly often leads to emotional disorders. Anxiety and depression levels were low before surgery and increased after surgery in orthopedic trauma patients. However, age, poverty, and gender are directly related to anxiety and depression. Patients with geriatric disorders should be monitored closely by clinicians. Keywords: Orthopedic trauma, Psychological problems, anxiety, depression

Introduction: Patients with conversion disorder (dissociative disorder) are common in various hospitals and communities in Pakistan. What people think about the disease decides what treatment they receive. Therefore, this analysis was held to determine the attribution and health seeking behaviours for conversion disorder. Study Design: A cross-sectional and exploratory hospital study. Place and Duration: In the department of Psychiatry and Behavioral Sciences PGMI /AMC / LGH, Lahore Pakistan for the duration from February 2022 to July 2022. Methods: A total of 60 patients were included in this study and selected with purposive sampling method. Conferring to the criteria of ICD 10; the analysis of dissociative disorder was made. A self-developed questionnaire was used. The help seeking behavior and knowledge regarding dissociative disorder was assessed by self developed questionnaire. Results: The results exhibited that the frequency of dissociative convulsions (26.8%) and possession and trance (33.3%) were higher than in the other groups. Similarly, 8 (13.3%) had stupor, 6 (10%) has motor disorders in all movement and (3.3%) has sensory disorders and (5%) had mixed dissociative disorder. It was found that the majority of family members seeking treatment from faith healer (63.3%), trailed by paramedics (11.7%) and doctors (25%). Of all subjects, 46.6% visited a mental health professional for more than 2 weeks, 31.7% visited them within 48 hrs to two weeks, and 21.7% within 48 hours. 38.3% of members answered to ailment as a physical cause. About 43.3% of participants said conversion disorder was a mental condition. The participants who replied disease as a supernatural problem were 40%. Solitary 35% of contributors believed that counseling, psychotherapy and medicine could cure conversion disorder, while 46.7% believed that a faith-healer might cure it. Conclusion: Societies in Pakistan still have their roots in ethnic practices and faith healing. It is very important to run the awareness program and work in co-operation with faith healers is significant. Keywords: Conversion (Dissociative) Disorder, Attribution, health seeking, attribution

Introduction: In schizophrenia, non-compliance with treatment leads to the disease burden in the community. It is considered as a challenge worldwide due to the need for long-term treatment and additional associated factors in Schizophrenia. Aim: The goal of the study is to identify patients with treatment non-compliance in schizophrenia and determine the related factors from environmental, socio-cultural and familial perspectives. Place and Duration: The study was carried out at the department of Behavioral Sciences, PGMI /AMC / LGH Lahore, Pakistan, from November 2021 to April 2022. Methods: The study included 100 patients with non-compliance to treatment in schizophrenia who visited the relevant psychiatric departments. For the research a descriptive cross-sectional design was chosen with non-random, purposive sample selection technique being utilised. Prior to the study, ethical approval from the authorities and informed consent from patients were obtained. Educated patients completed questionnaires whereas uneducated patients asked their relatives to provide such information on questionnaires. Results: Out of 100 participants, 56 were males and 44 were females, with a ratio of 1.4:1. The participants mean age was 32.25 ± 11.1. About 23% of them were uneducated, and above sixty percent (61%) had a family income < 20,000 PKR rupees per month. A substantial percentage of family-members (15%) were unaware of their role and that of their family members, and the majority (77%) stated that people made a negative contribution. Factors contributing to treatment non-compliance included belief as a major life event (6%), perception about the disease being incurable (25%), lack of nearby treatment access (76%), migration (8%), forgetting an appointment with medical professional (18%), discontinuation of medication on the advice of a faith healer (16%), discontinuation of medication due to social stigma (14%), no follow-up being arranged (22%), and refusal to continue treatment (13%). Conclusions: The study aimed to identify the possible reasons for medication non-compliance in patients of schizophrenia from environmental, socio-cultural and familial perspectives. Many factors have been recognised that contribute indirectly or directly to the treatment non-compliance. Keywords: Non-Compliance, Compliance and Schizophrenia.

Background: Schizophrenia is a psychiatric disorder that incapacitates & overpowers the way a person conceives, perceives, conjectures and executes his internal thoughts and reciprocates with the external world. It can also be defined as a persistent deficit in cognition with the negative and positive symptoms, which typically starts in young age. Schizophrenia is characterized by social and functional disabilities not only of the affected patient, but also for the society and the family. Therefore, the current research focused on the impact and burden on quality of life of the primary caregivers of schizophrenic patients. Aims & Objective: To determine the quality of life, predictors of QOL and caregiver burden among primary caretakers of patients having schizophrenia. Methods: The cross-sectional research design was used in the present study and was conducted in Lahore General Hospital from January 2022 to June 2022. Using purposive sampling technique, 150 patients who attended the Psychiatry outpatient department of the hospital were recruited for this study. Results: It shows that out of total 150 people, 98 (65.3%) males and 52 (34.7%) females were present in this study. Mostly parents 101(67.4%) were primary caregivers in the present population along with spouses 13(8.7%) and 26(17.4%) were real brothers/sisters. The frequency and percentage of son/daughter 3(2.2%) and 7 (4.3%) caregivers were with other relationships. Most of the caregivers 121(80.4%) were married, and 13(8.7%) were single. It also shows that the mean age of the male patients was 43.50 (14.73) years and mean age of the female was 48.91 (16.50). Family Burden Schedule interview identifies that financial burden has highest mean and effect on physical health of others has lowest mean. In WHOQOL-BREF physical, psychological and social health subscales has highest mean than environmental one. And that significant inverse relationship of financial burden has been found with social relationships, physical health and environment of caregivers. As financial burden increases environmental conditions, physical health and social relationships of caretakers decreases. Conclusion: Caregiver burden is found to be negatively linked to QOL of the caregivers of individuals having schizophrenia. Moreover, caregiver burden is found to be a significant negative predictor of QOL of individuals taking care of people having schizophrenia. Keywords: Schizophrenia, Quality of Life, Caregivers, Patient Welfare, Burden of Life

Aim: The goal of this analysis is to determine the proportion of psychoactive substance disorder and socio-demographic profile of Psychoactive Substance Users. Study Design: A descriptive study. Place and Duration: In the Psychiatry and Behavioral Sciences department PGMI/AMC/LGH Lahore, Pakistan and Mardan Medical Complex for six months duration from October 2021 to March 2022. Methods: A total of 120 subjects with psychoactive substance use disorder (conferring to the ICD-10 criteria) were recruited after attaining their written informed consent. In the course of the study, all patients with substance use disorders were interviewed through partially structured addiction questionnaire. Data was analyzed with SPSS version 21.0 using inferential and descriptive statistics. Results: Out of the 120 subjects, 100 were men and 20 were women. The adults and adolescents were the main groups indulging in the consumption of psychoactive substances. Most of the subjects, 45%, started substance abuse at 16-20 years of age. Of the remaining 18.3%, started substance abuse at 26 years old and older, 24.2% started at the age of 21-25 years, and 12.5% started at the age of 13-15 years. It was found that 50% were in the recovery process. The relapse rate was 33.3%, 12.5% were not in contact, 2.5% died, and 1.7% were in prison. Opioid was the psychoactive substance preferred by 66.7% of the young population. The most common opioid was brown sugar; 13.3% prefer cannabis, 2.5% prefer tablets, 4.2% prefer injectable use and 0.83% prefer volatile usage of substances. Conclusion: The main consumers of psychoactive substances were the adults and adolescents and majority start using it at a younger age. Psychoactive substance abuse is a serious problem effecting young people, which is a sensitive group. So, special consideration should be paid to psychoeducation about psychoactive substances prior to adolescent. Keywords: Psychoactive substance, Sociodemographic profile.

Background and Aim: Dementia psychological and behavioral symptoms are significantly associated to Alzheimer’s disease (AD). Clinical profile and characterization of Alzheimer’s disease patients might assist in evolution, diagnosis, and better treatment of the disease. The present study aimed to evaluate the behavioral manifestation of Alzheimer’s disease patients. Methodology: This multi-centered cross-sectional study was carried out on 96 Alzheimer’s disease patients in the department of Psychiatry Lahore General Hospital and Psychiatry unit, Khyber Teaching Hospital Peshawar, Pakistan for duration of six months from 1st July 2021 to 30th December 2021. Alzheimer’s disease patients with lower and higher Behavioural and psychological symptoms of dementia (BPSD) scores (≤25 and 26-50 respectively) were enrolled. The patient’s demographic details and clinical information were gathered. Mini-Mental State Examination (MMSE) was used for the evaluation of dementia severity whereas severity varies from mild 27-21 to severe ≤10. Demographic details, AD pharmacological treatments, psychotic breaks presence, AD diagnosis, treatment of concomitant diseases, and extrapyramidal symptoms such as hypokinesia, fluctuating cognition, tremors, etc. were secondary outcomes. Results: Of the total 96 AD patients, 44 (45.8%) had higher and 52 (54.2%) had lower BPSD scores. About 62 (64.6%) were women and 34 (35.4%) were male patients. The overall mean age was 79.6±8.4 years. The majority of the patients had a BPSD score at inclusion and the incidence of psychotic out breaks was reported in 19 (19.8%) patients. The prevalence of symptoms such as depression, delusions, lack of concentration, lack of cooperation, and tremors was 41 (42.5%), 33 (34%), 52 (54.6%), 34 (35.9%), and 52 (54.6%) respectively. Psychotic symptoms such as hallucinations, delusions, and delirium were significantly prevalent in patients with high BPSD scores whereas Apathy and tearfulness-like emotional symptoms were predominated in lower BPSD patients. ADAS-non cognitive score and MMSE were adversely related (p=0.0314), signifying BPSD and cognitive impairment correlation. Appetite changes and lack of concentration were prominently associated with MMSE (p=0.035 and 0.052). Conclusion: Our study found a higher prevalence of non-cognitive symptoms in Alzheimer’s disease patients. Also, BPSD and cognitive impairment are significantly associated with AD. ADAS-non cognitive is a useful assessment tool. Keywords: Behavioral Manifestation, Alzheimer’s disease, Cognitive Impairment

Background and Aim: Parkinson’s disease's common symptoms are anxiety and depression and play a determinant role in the quality of a patient’s life. Numerous studies identified several risk factors but very few investigated the specific risk factors associated with Parkinson's disease (PD). The objective of the present study was to assess the depression and anxiety among Parkinson’s disease patients, prevalence, risk factors, and impact on life’s quality. Methodology: This cross-sectional study was conducted on 78 Parkinson’s disease patients at the department of Psychiatry & Behavioral Sciences LGH Lahore, Pakistan and Div HQ hospital, Mirpur AJK in collaboration with Neurology department for the duration from 15 May 2021 to 15 November 2021. All the patients were assessed for anxiety and depression. Unified Parkinson’s Disease Rating Scale (UPDRS) and Holmes and Rahe scale were used for the evaluation of staging and severity among Parkinson’s disease patients. Clinically diagnosed Parkinson’s disease patients aged between 25 and 85 years and stages 1 to 4 on the H-Y scale were enrolled. Patients with movement disorders other than PD, atypical Parkinson's, deep brain stimulation (DBS), visual loss, and secondary Parkinsonism were excluded. Ethical approval was taken from the institutional ethical committee. Depression and anxiety impact on life quality were assessed using World Health Organization Quality of Life (WHOQOL)-BREF. Results: Of the total 78 Parkinson’s disease patients, the prevalence of depression and anxiety was 26 (33.3%) and 32 (41.03%) respectively. About 40 were male and 38 were female patients. The overall mean age was 67±5.9 years. The young population was more susceptible to anxiety and depression was significantly higher in females. The depression and anxiety overlap were in 19 (24.4%) patients. The UPDRS and H-Y scale variance accounted for depression 34.5% and anxiety 38.9%. The severity and advanced disease stage were depression independent predictors whereas younger age and severity were anxiety main predictors. Overall, anxiety and depression had adverse impacts on life quality of Parkinson’s disease patients. Conclusion: Depression and anxiety were found in 33.3% and 41.03% of current Parkinson's disease patients, respectively. Depression and anxiety are relatively common in Parkinson's disease. The main risk factors for developing depression were female gender, low socioeconomic status, and a history of depression. Anxiety was associated with a young age and a history of anxiety. Both had a negative effect on one's quality of life. Keywords: Depression, Anxiety, Risk factors, Prevalence

Background and Aim: The acute and transient psychotic disorders (ATPDs) as an independent diagnostic entity have become a subject of nosological debate. Numerous studies considered these psychosis as schizophrenia variants or mood disorders leading to diagnostic instability. The present study aimed to investigate the clinical characteristics and diagnostic stability in acute and transient psychotic disorders. Methodology: A total of 45 acute and transient psychotic disorders diagnosed patients were investigated at Psychiatry and Behavioral Sciences LGH Lahore and Psychiatry unit, Khyber Teaching Hospital Peshawar Pakistan for six months duration from 1st June 2021 to 30th November 2021. All the patients with ages ranging from 17 to 65 years fulfilling ATPDs criteria as per ICD-10 were enrolled. The written informed consent form was taken from the patients’ relatives. Patients with drug intoxication, psychotic illness history, brain disorders, mental retardation, and those taking regular antipsychotic treatment were excluded. Patients were followed up for one month and three months and diagnosis was reevaluated after each follow-up. During the follow-up period, global functioning, clinical manifestations, and quality of life were all evaluated on a regular basis. Results: Of the total 45 ATPD diagnosed patients, male and female patients were 18 (40%) and 27 (60%) respectively. Overall mean age was 29.7±7.9 years. After one month follow-up, the prevalence of ATPD, mood disorder, and schizophrenia was 39 (86.7%), 4 (8.9%), and 2 (4.4%) respectively. After 3 months follow-up, the incidence of diagnosed ATPDs, schizophrenia, and mood disorder were 36 (80%), 5 (11.1%), and 4 (8.9%) respectively. About 36 (80%) patients retained ATPDs whereas diagnosis of psychotic disorders changed in 9 (20%) patients. Conclusion: The acute and transient psychotic disorder was diagnostically stable entity. Patient’s sizable proportion of ATPDs initial diagnosis changed to Schizophrenia-related disorders representing early manifestations. Keywords: Acute and Transient Psychotic Disorders, Schizophrenia, Diagnostic Stability

Depression is a disorder that affects the persons mood and its incidence is one in four females occurs at any time in their lives, so it's no wonder that pregnant women are also affected by this condition. However, depression during pregnancy is often misdiagnosed as fluctuations in a woman's hormone levels are believed to be the cause of many of these changes. In the hope that a diagnosis can, be made at a very early stage and that preventive measures can be taken later, the first step is to govern the pervasiveness of depression in pregnant females. The available evidence of depression in pregnancy varies widely. We need relatively short estimates to determine the severity of a depressive illness and develop a coping strategy for disorders of depression. Aim: To access the depression prevalence among pregnant females admitted to the gynecology department. Place and Duration: In the Psychiatry department of Behavioral Sciences PGMI/AMC/LGH, Lahore and Timergara Psychiatry Clinic in Pakistan for the duration of six months from September 2021 to February 2022. Methods: Data were gathered from 250 pregnant women by randomly collecting samples during their antenatal visits. The Depression Standard Scale named the "Hamilton Rating Scale for Depression," was used and depression was labelled if score greater than 7 on the Standard Rating Scale. The analysis of the result was performed using the SPSS program and chi-square test. Results: The incidence of depression in gravid females was 82%. The study found 45 (18%) completely normal, 100 (40%) mild depression, 65 (26%) moderate depression, 28 (11.2%) had severe depression, and 12 (4.3%) were very severe depression. 0.013 was a statistically significant value of P. Conclusion: The data showed increased prevalence of depression among pregnant females in Pakistan, reaching 82%. Depression is much common in younger females, those with fewer births and pregnancies, and those living in a shared family system. Keywords: Depression; Prevalence; Pregnancy and Prenatal period; Psychiatric disorders and Mood disorders.

Background: Smoking is common and people with mental disorders are no exception. Few studies have looked at the pervasiveness of usage of tobacco and dependence of nicotine in depressed patients in undeveloped states such as Pakistan. Therefore, in this study, the aim was to determine the prevalence of tobacco use, addiction of nicotine and the inspiration to quit smoking in major depressive disorder affected patients. Study Design: A cross-sectional descriptive study. Place and Duration: In the Department of Psychiatry and Behavioral Sciences, LGH Lahore, Pakistan and Psychiatry Alfalah diagnostic centre, Azhar Medical Plaza Timergara for the duration of six months from August 2021 to January 2022. Methods: The study was held amongst patients with diagnosis of depression form the Department of Psychiatry (outpatient and inpatient). A semi-structured form was used to collect data using and for nicotine use; WHO STEPS tool was used. The Nicotine Dependence was assessed by Fagerstrom Test, Smokeless Tobacco by Modified Fagerstrom and Motivation Assessment were used: Willingness to Quit Ladder was pragmatic for users of nicotine. The data was analyzed and compiled using the SPSS version 20.0. Results: The study comprised 110 subjects (mean age: 36.2 ±9.80 years, 50 men and 60 women) diagnosed with Major Depressive Disorder (mean disease duration: 1.56 ± 2.21 years) were included. 60 of 110 patients (54.5%) used one type or numerous types of tobacco. The patients smoked only tobacco were (n = 38, 63.4%), smokeless tobacco was used by 14 subjects (23.3%) and 13.3% (n = 8) used smokeless and smoked tobacco both. The percentage of smokers of any type of tobacco is greater in men as compared to women (p = 0.029). Among who smokes (n = 38), about fifty percent were heavily addicted 24(63.2%), and 14 (36.8%) were moderately addicted. Almost all (92.8%) of the smoke-less category (n = 14) were highly addicted. Among the combined users, almost all (6/8 = 75%) were heavily addicted to nicotine. A comparatively insignificant proportion (23.3%) of users of nicotine were strongly agreed to stop using any tobacco type. Conclusions: The usage of nicotine prevalence and dependence was supposed to be greater in individuals with depression. In low-resource environments such as Pakistan, the practice of translated and standardized tools of screening can be effectively cast-off to assess the nicotine usage burden in standard practice clinically. Keywords: Nicotine, Depression, Tobacco and Nicotine dependence.

Introduction: The depression and diabetes both are important community health concerns. Depression is a common comorbid disease in diabetic patients. The goal of this analysis was to assess the depression prevalence in diabetic patients and to recognise the numerous influences related with it. Study Design: A cross-sectional study. Place and Duration: In the Psychiatry and Medicine department of Behavioral Sciences, LGH Lahore, Pakistan and Psychiatry Alfalah diagnostic centre, Azhar Medical Plaza Timergara for the duration of six months from July 2021 to December 2021. Methods: The patients with diabetes mellitus who visited the OPD Internal Medicine Department and Psychiatry department were referred for a psychiatric assessment. 140 total patients were studied for 6-month period. Face-to-face interviews were directed to collect the clinical profile and sociodemographic data of the subjects. To classify and describe depression; Patient Health Questionnaire-9 was applied. The percentage, frequency, multivariate regression and test were applied. Results: The total depression prevalence was 30.2% and institute to be higher significantly in women (p = 0.008), subjects on insulin treatment (p = 0.028), diabetes mellitus >15 years (p = 0.049) and patients with uncontrolled blood glucose levels (p = 0.018) even after treatment. A regression analysis found that the type of treatment, blood glucose level, gender, and type of treatment were independent forecasters of depression in patients with DM. The subjects treated with insulin were 4 times additional probable to develop depression (CI: 2.129 - 8.865, OR = 4.344, p

Introduction: Nephrectomy means removal of kidney. Laparoscopic nephrectomy is an effective way to remove a diseased or cancerous kidney. Nephrectomy is performed to treat malignant or benign tumors of the kidney and symptomatic non functioning kidney. Laparoscopic nephrectomy is performed through transperitoneal or retroperitoneal approach. Aims & Objectives: To determine the initial experience of laparoscopic nephrectomy. Place and duration of study: Department of Urology, Services Hospital, Lahore from 1st January 2018 to 30th June 2019. Material & Methods: A total of 50 patients who underwent laparoscopic nephrectomy were included. The demographic data like age, gender, site of operation, operative time, conversion rates, postoperative complications and postoperative hospital stay were recorded. Data was analyzed using SPSS 20.0 and reported as mean± s.d, frequencies and percentages. Results: There were 28 (56%) female patients and 22 (44%) male patients. Six (12%) patients were ages