POLITICAL POLARIZATION AND ITS IMPACT ON MENTAL HEALTH: WHERE DO WE STAND?

Political and social polarization is the division of people in to distinct groups with contrasting viewpoints and minimum likelihood to converge on a uniform agenda. It has varied connotations in the field of social science. However, the given political climate of polarization and its impact on mental health, it is imperative to focus the issue in a scientific way. Furthermore, in recent years the situation has been made more volatile and complicated by social media amplifications with greater effects on psychosocial well-being of people. There is plenty of literature, suggesting that polarization is widely perceived as a loss or gain of social status, which has a direct link with psychological disorders.1 There is scarcity of research in developing world about the psychosocial effects of polarization. Most of the research looking at the psychological adverse implications of this phenomenon has been carried out in the west. For example, a study conducted by Smith KB, reported that adverse effects of recent American polarization in politics and contrasting political views on psychosocial well-being were not less than a public health concern, leading to damaged friendships, persistent fatigue and even suicidal behavior in significant number of population.2   Similarly, the stress associated with political disagreements has the add-on effect on psychosocial well-being of people holding diverse political views leading to deleterious effect on mental and physical health. The harming effects of political polarization is a known perpetuating stressor, cluttering society and traversing daily life through media, various internet platforms and persisting news feed.3 Additionally, the American Psychological Association identified politics as a major source of stress for American adults.4 The findings of a recently conducted survey showed that nearly 40% Americans reported that they were stressed out because of politics and nearly 20% had lost sleep due to the effects of social upheaval and almost same number were tired of political news.5 In addition to psychological consequences political stress, French JA et al, reported increased blood cortisol, increased skin conductance and decreased testosterone levels in people engaging in emotionally draining political debates.6 It’s equally, important to understand the mechanism through which the polarized politics harm the psychological health, and how it should be managed in order to ward off its deleterious consequences? The mechanism is well understood that people can’t isolate themselves from politics bearing in mind the vast array of information feed on daily basis. Secondly, as part of human society one can’t get away with social network and individual identity. As far the negative effects are concerned, they, permeate through various means, irrespective of people being either actively involved in politics or passive only observer. For, instance, the harassment, bullying, grandstanding attitude on social media is not uncommon while personal political debates, demeaning comments and its association with psychosocial sickness is well documented.7 The cult indoctrination is another distressing phenomenon, where the leaders coerce the followers through persuasions, thoughts reformation and brainwashing leading to immense suffering of exposed population to such condition, at times along with their family, friends and community at large.8   There is large body of research pointing towards the abusive effects of cultic politics and its adverse emotional consequences. The psychological damages perpetrated by cultic indoctrination, fake and occult information have been extensively reported in scientific publications over the last many years.9   Pakistan is a South Asian Muslim country of more than 220 million population with relatively unstable political history and abysmal socio-economic and health indicators. Mental health statistics are staggering with a wide treatment gap and no dedicated budgetary allocation of annual gross domestic product (GDP).10 In addition to the existing heavy burden of mental health issues and traditional entrenched religious   intolerance in Pakistan, the recent wave of political intolerance has polarized the society to an unprecedented level. This wave of political polarization has permeated into all stratums of society, with sporadic reports of violence, which is likely to deteriorate further in the presence of unregulated and excessive use of social media. The widespread consumption of social media reports without verification of its authenticity could be one of the sources of social and political polarization which may cause further deterioration in near future.11 Regrettably, the young population constitute about 60% of the Pakistani population has been found to be affected more easily by the polarized environment in the country, which otherwise should be the most productive segment of society. As a matter of fact, depriving them of critical thinking and ability to formulate and ask appropriate questions tantamount to a huge social capital loss. Scientific literature shows that younger population is more impressionable and highly vulnerable to become radicalized easily in a polarized a society, unfortunately, Pakistan is not an exception, currently a fertile ground to support the growth of such tendencies.12 The recent published reports in lay press pointing to a shocking situation of violence in various part of the country due to political rivalry and contrasting posts on social media. The vulnerability of people being affected psychologically by political polarization has been reported extensively by previously published research. Various reports indicate that perpetuating exposure to political stress is associated with increased rates of psychiatric disorders like anxiety, depression and even suicidal behavior.1 Similarly, mental health professionals are also facing the dilemma of unfriendly environment generated around politics, which highlights the need for further training to deal with such issues without being judgmental or biased in clinical setting.13 It is the right time that scientific community, social scientists, political and religious opinion makers open a dialogue to raise awareness about the possible causes and devastating effects of polarization on the society. Country like ours with entrenched religious intolerance, economical inequalities, social disparity and alarming mental health statistics can’t afford to get plunged into yet another social and psychological chaos in the background heated polarized political discourse. We need to encourage our younger generation to be more tolerant and equipped with critical thinking to meet the social challenges with grace and scientific reasoning in order to ward off the impending onslaught of polarization, radicalization and psychosocial sickness. There is dire need to bring back the lost political sanity and put a full stop to the rising psychosocial turmoil in Pakistan

CHILD ABUSE: ARE WE DOING ENOUGH TO PREVENT IT?

Violence against children has been recognized as public health problem by World Health Organization (WHO). The eighth Millennium Development Goals (MGDs) set by the special session of United Nations general assembly in 2015; five out of eight goals are directly related to the wellbeing of children. Child abuse is not limited to battering only. WHO defines child maltreatment as “the abuse and neglect faced by children under the age of 18 years, includes physical, sexual and emotional abuse”.1 Physical abuse encompasses inflicting temporary or permanent damage to the physical functioning of a child, for example, corporal punishment, beating, choking, biting and intentionally burning.2-4 Sexual abuse is engaging children in sexual activities they cannot understand or consent to, including exposing the child to sexually explicit material or using the child in pornography, and rape.5,6 Emotional abuse is the ongoing emotional maltreatment of a child. It is also called psychological abuse and can significantly damage child’s mental health and development. Emotional abuse involves bullying, deliberately trying to scare, humiliate, isolate, ignore, corrupt or terrorize a child.7 There is ample research evidence confirms the deleterious effect of childhood abuse, effecting psychological and social wellbeing, physical health and educational performance of a child.2,3 In addition to immediate physical and emotional damage, abused children are at high risk of becoming depressed, suicidal, aggressive, or withdrawn. Older children may develop substance abuse or running away from home. As adults, they are more likely to develop marital and sexual difficulties, depression, suicidal behavior or addictions and even they may have shortened life span.8 Similarly maltreated children are more likely to be the perpetrators in future, conforming to the social cycle theory of abuse. Some research shows that 90 percent of maltreating adults were abused as children.9 Children often don’t disclose the abuse explicitly thus the goal of identifying the abuse is usually thwarted. Therefore, it becomes essential to pay attention to subtle or some time drastic changes in child’s mood and behavior. Some time sudden and dramatic changes indicate that something may be wrong. Children who have been abused or neglected may have different behavioral changes or emotional manifestations. They may include the child being withdrawn, quiet or have a bad temper, anger outburst or disruptive behavior, excessive crying, specific fear of a place or person, nightmares and bedwetting. Drastic changes in academic performance (dropping grades). Changes in sleep patterns (excessive or lack of sleep) and appetite (eating too much or too little) may also be indicators of abuse.1- 3 In majority of cases of child abuse, emotional damage is more severe than any physical damage with long lasting effects. The magnitude of child abuse is alarming in our region. The largest number of child labour, abuse, prostitution and trafficking has been reported in India, Pakistan, Bangladesh, Bhutan and Nepal. The largest number of working children in the world, fulfilling the criteria of child abuse resides in India. 10 There is scarcity of meaningful research in Pakistan; most of the studies looking at this menace are descriptive and inconclusive in nature. The available data show that girls predominate as the victim of abuse11 and there has been steady increase in incidence over the last few years.4 There has been some progress in promulgation of laws recently in Pakistan, addressing the problem of child abuse. In 2016 the 2nd Amendment of the Criminal Law Act was approved by National Assembly, passing the long overdue bill on Child Abuse. This Bill rose the age of criminal responsibility from 7 years to 12 years. It provides protection to children from all forms of physical maltreatment including corporal punishment. Additionally, it widened its definition of child sexual abuse to include and penalize paraphelia like voyeurism, exhibitionism and using the child in pornography, whereas, previously only rape was criminalized.12 Mental Health professionals and also pediatricians play a key role in the path to recovery for children with a history of abuse. Parents and other family members are strongly recommended to seek counseling in order to provide comfort and support to the child.13 Psychological treatment like Abuse-Focused Cognitive Behavioral Therapy (AF-CBT) is one such mode of intervention, designed for children who are victim of abuse.13 In country like ours with limited resources and scarce child mental health services there is dire need to focus on this grievous problem to reform the laws and develop child-protection services. Similarly quality and meaningful research is required to inform policy and raise awareness about child abuse. Even though these safeguards will go a long way in protecting children, better we ask ourselves, are we doing enough to prevent child abuse

Anti-Nmda Receptor Encephalitis Presenting with Severe Episodic Hypertension: A Case Report

Anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis is one of the most commonly emerging autoimmune encephalitis in children and young adults in recent years. Clinical manifestations range from prodromal symptoms to seizures, movement disorder, psychiatric manifestations, cognitive/speech impairment, and autonomic dysfunction. Our case presented with initial symptoms of severe episodic hypertension, sweating, agitation, and tachycardia. She received early care for pheochromocytoma and panic disorder in Qatar, but there was no relief. Three weeks later, she presented in our emergency room with seizures, cognitive/speech impairment, and orofacial dyskinesia. Electroencephalography (EEG) revealed right hemispheric delta activity and cerebrospinal fluid CSF anti-NMDA Receptor IgG was positive. Magnetic resonance imaging MRI brain and CSF studies were normal. She was treated symptomatically for hypertension and psychiatric manifestations. She received high dosage pulse intravenous methylprednisolone, followed by intravenous immunoglobulin, which significantly alleviated her cognitive, neuropsychiatric, and autonomic features. Severe hypertension is an uncommon presentation of Anti- NMDAR encephalitis. Early recognition and prompt management improves prognosis and long term sequelae

Perceived coercion and need for hospital admission among psychiatric in-patients: figures from a Pakistani tertiary care hospital

In Pakistan, an increasing proportion of psychiatric patients present to community health services as crisis admissions, with their relatives as the main decision makers. Patients are bound to perceive this process as coercive. Farnham & James (2000) report that elements of coercion are found even in voluntary hospital admission, in the form of verbal persuasion, physical force and threats of commitment. Few patients consider hospitalisation justified and most view the process of admission negatively (Swartz et al, 2003; Katsakou & Priebe, 2006; Priebe et al, 2009)

Patient satisfaction with Telepsychiatry consultations in the time of covid19 : Data from a tertiary care hospital in Pakistan

OBJECTIVES: To assess the patient satisfaction with telepsychiatry consultations, and whether time and money was saved by patients availing the service. METHODS: Anonymous internet survey using Google Form method, was conducted between April 2020 and September 2020 to collect data from patients using teleconsultation in out-patients psychiatry clinic. The google form consisted of patient satisfaction questionnaire, demographic details, and additional questions about the money and time saved by patients using the service. RESULTS: Out of 260 participants, 152, (58.5%) were males, 148 (58.3 %) were married and majority (n=157: 60.4%) of patients were <40 years of age. About 62.7% (n=163) were highly educated. Majority (n=108; 41.5%) of the survey participants were from Khyber Pakhtunkhwa province. The average cost saving was Pakistani Rupees 3000 for the consultation whereas the average time saved was 1.5 days. Patients were happy during communication with doctor including seeing doctor on screen (85.7%), hearing to doctor (90.4%), talking to doctor (84.6%) and discussion of their care plan (81.6%). Majority (79.2%) of the survey participants were happy with the meeting of care needs and 86.5% were happy to avail the service in future. CONCLUSION: The study underscores the importance of telepsychiatry as mode of service delivery during the pandemics. The findings demonstrated a high level of patient satisfaction, considerable amount of time and money saving indicates the effectiveness of telepsychiatry consultation. It needs to expand the telepsychiatry service both in public and private hospitals and also test this model on a representative sample of patients in Pakistan

Well-being of medical students and their awareness on substance misuse: a cross-sectional survey in Pakistan.

Objective: To investigate psychological well-being and substance abuse among medical students in Pakistan. Methods: A cross-sectional questionnaire-based survey was conducted in six medical colleges across Pakistan. Final-year medical students were interviewed by either a postgraduate trainee in psychiatry or a consultant psychiatrist. Results: A total of 540 medical students were approached, 342 participated and the response rate was 64.5%. Mean age was 23.73 years (SD 2.45 years), 52.5% were male and 90% single. Two out of every five respondents reported that work/study at medical school affected their personal health and well-being. A considerable proportion of students were aware of alcohol and smoking as coping strategies for stress in medical students. The main factors causing stress were heavy workload (47.4%), relationship with colleagues (13.5%) and staff (11.9%). A total of 30% reported a history of depression and 15% among them had used an antidepressant. More than half were aware of depression in colleagues. The majority of respondents said that teaching provided on substance misuse in the areas of alcohol and illegal drugs, management/treatment of addiction, and models of addiction was poor. There was significant association (p = 0.044) between stress and awareness about alcohol as a coping strategy for stress among medical students. A significant negative association was also found between medical colleges in public sector (p = 0.052), female gender (p = 0.003) and well-being. Conclusion: The majority of the medical students reported a negative impact of heavy workload on their psychological well-being. Significant numbers of medical students think that substance misuse is a coping strategy for stress. Teaching on addiction/addictive substances is poor at undergraduate level in Pakistani medical colleges

Bullying of medical students in Pakistan: a cross-sectional questionnaire survey.

Background: Several studies from other countries have shown that bullying, harassment, abuse or belittlement are a regular phenomenon faced not only by medical students, but also junior doctors, doctors undertaking research and other healthcare professionals. While research has been carried out on bullying experienced by psychiatrists and psychiatry trainees in Pakistan no such research has been conducted on medical students in this country. Methodology/Principal Findings: We conducted a cross-sectional questionnaire survey on final year medical students in six medical colleges of Pakistan. The response rate was 63%. Fifty-two percent of respondents reported that they had faced bullying or harassment during their medical education, about 28% of them experiencing it once a month or even more frequently. The overwhelming form of bullying had been verbal abuse (57%), while consultants were the most frequent (46%) perpetrators. Students who were slightly older, males, those who reported that their medical college did not have a policy on bullying or harassment, and those who felt that adequate support was not in place at their medical college for bullied individuals, were significantly more likely to have experienced bullying. Conclusion: Bullying or harassment is faced by quite a large proportion of medical students in Pakistan. The most frequent perpetrators of this bullying are consultants. Adoption of a policy against bullying and harassment by medical colleges, and providing avenues of support for students who have been bullied may help reduce this phenomenon, as the presence of these two was associated with decreased likelihood of students reporting having being bullied

Gender identity disorder Is this a potentially fatal condition?

A person with a Gender Identity Disorder (GID) is a person who strongly identifies with the other sex. The individual may identify with the opposite sex to the point of believing that he/she is, in fact, a member of the other sex who is trapped in the wrong body. The treatment option is sex reassignment surgery. In Pakistan There is no specialized facility sex reassignment surgery. This case report deals with possible serious outcome of GID in Pakistan as a result of castration procedure which is carried out by \u27gurus\u27 in Pakistan. A systemic research in our country to this effect is required to find out the outcome of GID in Pakistan