Generalised tonic-Clonic seizures on the subtherapeutic dose of olanzapine

Olanzapine is a second-generation antipsychotic. Incidence of olanzapine-induced seizures (OIS) is low with monotherapy. Combination therapy with another antipsychotic, drug metabolism and old age are risk factors for OIS. Our patient was a 71-year-old man, admitted to the psychiatry unit. He was managed on the lines of bipolar affective disorder current episode depression and dementia. He was started on olanzapine 1.25 mg two times/day. The patient developed generalised tonic–clonic seizure that lasted for around two and a half minutes within 24 hours of olanzapine treatment. His electroencephalogram showed findings that were suggestive of mild slowing. Our case discusses the incidence of OIS on the subtherapeutic dose. This presentation involves multiple risk factors for OIS: a history of stroke, poststroke seizure, old age and cognitive impairment. Due to scarcity of evidence of OIS; mostly with recommended therapeutic dose range physicians may underestimate seizure risk at subtherapeutic doses

Caregiver strain and its associated factors in autism spectrum disorder in Karachi, Pakistan

Objective: To determine the frequency of caregiver strain and its associated factors in Autism Spectrum Disorder (ASD) at a tertiary care teaching hospital in Karachi, Pakistan. Study design: An analytical cross-sectional study. Place and Duration of the Study: Psychiatry inpatient and outpatient units at The Aga Khan University Hospital, Karachi, Pakistan, from December 2018 to December 2019. Methodology: The study participants were caregivers of ASD. Data were collected from the inpatient and outpatient departments using Caregiver Strain Questionnaire (CGSQ), and a demographic questionnare. Data were analysed using descriptive and inferential analysis. Results: A total of 76 caregivers participated in the study. Among them, 61 (80.3%) were females and 15 (19.7%) were males, with mean age of 37.09±6.91 years. The overall caregiver strain (both subjective and objective) was reported to be severe by 11.8%, moderate by 47.4% and low by 40.8%. About 50% of the participants had a low objective strain on CGSQ whereas 59.2% of the participants subjectively felt the strain to be at moderate level. An association was found between the gender of the participants and subjective strain (p=0.016), and gender with internalised subjective strain (p =0.002). Conclusion: Parenting of a child with ASD involves challenges and demands support. This study supports the recommendation that the caregivers need access to appropriate means to channelize their strain and manage their role productively

Liaison psychiatry in low & middle income countries: Experiences at the Aga Khan University Hospital (AKUH), Karachi, Pakistan

Aims and methods: Our study investigated the pattern of referrals made to psychiatric services from the general wards of Aga Khan University Hospital (AKUH). Data on all cases referred between years 2015 to 2016 was collected retrospectively from the medical records. Information included socio-demographic details, reason for referral, past psychiatric history, treatment, management suggested and outcome of referral. SPSS version 19.0 was used for data entry and analyzing.Results: During the study period 1166 cases were referred for psychiatric consultations of which 995 were analyzed. The results show an almost equal distribution of females and males. Most referrals were from Internal Medicine. The most common reason for referral was behavioral problem and the most common psychiatric diagnosis made was delirium.Clinical Implications: Review of the service has identified areas that need improvement such as late referrals, problems with documentation, and issues in following through with the recommended management and will help us improve the existing services