A roadmap to develop dementia research capacity and capability in Pakistan: a model for low- and middle-income countries

Objective To produce a strategic roadmap for supporting the development of dementia research in Pakistan. Background While global research strategies for dementia research already exist, none is tailored to the specific needs and challenges of low- and middle-income countries (LMIC) like Pakistan. Methods We undertook an iterative consensus process with lay and professional experts to develop a Theory of Change-based strategy for dementia research in Pakistan. This included Expert Reference Groups (ERGs), strategic planning techniques, a “research question” priority survey, and consultations with Key Opinion Leaders. Results We agreed on ten principles to guide dementia research in Pakistan, emphasizing pragmatic, resource sparing, real-world approaches to support people with dementia, both locally and internationally. Goals included capacity/capability building. Priority research topics included raising awareness and understanding of dementia, and improving quality of life. Conclusion This roadmap may be a model for other LMIC health ecosystems with emerging dementia research cultures

Building Resilience Against ViolencE (BRAVE): protocol of a parenting intervention for mothers and fathers with post-traumatic stress disorder in Pakistan

Abstract Background Prevalence of post-traumatic stress disorder (PTSD) is high in Pakistan both due to natural disasters and ongoing conflicts. Offspring of trauma survivors are at increased risk for mental and physical illnesses. Parental PTSD has been linked to troubled parent–child relationships, behaviour problems, trauma symptoms, and depression in children. This study aims to explore the acceptability, feasibility and indications of the effectiveness of group learning through play plus trauma-focused cognitive behaviour therapy (LTP Plus TF-CBT) for parents experiencing PTSD. Methods/Design This is a two-arm pilot cluster randomised controlled trial (RCT). We aim to recruit 300 parents with a diagnosis of PTSD. The screening will be done using the Impact of Event Scale-Revised. Diagnosis of PTSD will be confirmed using the Clinician-Administered PTSD Scale-5 (CAPS-5). Union Councils from Peshawar and Karachi will be randomised into either group LTP Plus TF CBT arm or treatment as usual (TAU). The intervention includes 12 sessions of LTP Plus TF-CBT delivered weekly in the first 2 months and then fortnightly in a group setting by trained psychologists. The groups will be co-facilitated by the community health workers (CHWs). Parents will be assessed at baseline and 4th month (end of the intervention), using the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7) Scale, Client Service Receipt Inventory (CSRI), and Ages and Stages Questionnaire (ASQ-3) Discussion This trial would help build an understanding of the acceptability, feasibility and indications of the effectiveness of a low-cost parenting intervention

CONVENTIONAL AND ATYPICAL ANTIPSYCHOTICS;

Objective: The objective of the study was to compare changes in fasting blood glucose and serum cholesterol levels followinginitiation of conventional and atypical antipsychotics in patients of psychosis. Study Design: An Interventional Comparative design was used.Place and Duration of Study: The study was conducted at Department of Psychiatry, Military Hospital Rawalpindi from August 2007 to August2008. Patients and Methods: A total of 110 patients were assigned to treatment with haloperidol (n=35), risperidone (n=36) and olanzapine(n=39). Fasting blood glucose and serum cholesterol levels were recorded at baseline and subsequently repeated at 02nd week, 06th week and08th week of treatment. In all the subjects, all the blood samples were drawn as a fasting sample in early morning. Results: ANOVA analysesindicated that changes in mean fasting glucose and cholesterol levels reached significance in period 2 (from 2nd week to 6th week) but not inperiod 1 (from 0 to 2nd week) and period 3 (from 6th week to 8th week). The increase in mean fasting glucose and cholesterol levels over timereached statistical significance in the olanzapine group after 6 weeks. No significant change in glucose was detected in the haloperidol andrisperidone groups. Conclusions: There is a higher risk of hyperglycemia and hypercholesterolemia with olanzapine treatment as compared torisperidone and haloperidol in the study population. These changes appear between 2 to 6 weeks after starting treatment.</jats:p

TRICYCLIC ANTIDEPRESSANTS;

Introduction: Despite advancements in the treatment of depression and availability of newer compounds, TCAs likeamitriptyline remain to be the cornerstone of antidepressive therapy for more than three decades, however significantly more patients receivinga tricyclic withdraw from treatment mainly because of side effects. Higher response, lower incidence of side effects and improved compliancecan be enhanced by the optimal use of Therapeutic Drug Monitoring (TDM). No research data is currently available on the therapeutic drugmonitoring of TCAs in Pakistan. Objectives: To compare the relative efficacy of Tricyclic antidepressant in the treatment of depression, with andwithout Therapeutic Drug Monitoring Main Outcome Measures: Changes in HAMD scores in patients on TCAs. Study Design: A Quasiexperimental study design was used. Setting: The study was conducted at Department of Psychiatry, Military Hospital Rawalpindi. Subjects:34 patients completed the study in the monitored group (with TDM) and 33 in control group (without TDM). Methods: Serum TCA levels andHAMD scores at baseline and subsequently at sixth, eighth and tenth week of treatment were collected. In all the subjects, all the blood sampleswere drawn as a fasting sample in early morning. Results: The mean age of the monitored group was 31.97 years (SD=10.432) while that of thecontrol group was 33.52 years (SD=9.385). in the monitored group 20 (58.82 %) of the patients were males while 14 (41.17%) were females, inthe control group 22 (66.66%) were males and 11(33.33%) were female patients. A significant reduction in HAMD scores was noted at 8 weeksof treatment. The groups did not differ in terms of efficacy of TCAs, however the monitored group had fewer dropouts than the control group.Conclusions: Lower incidence of side effects and improved compliance can be enhanced by the optimal use of Therapeutic Drug Monitoring(TDM) of TCAs.</jats:p

KOMPLEKS TRAVMA SONRASI STRES BOZUKLUĞU ÖTESİNDE GÖZ HAREKETLERİYLE DUYARSIZLAŞTIRMA VE YENİDEN İŞLEME TEDAVİSİNİN YARARLILIĞI: PAKİSTAN’DAKİ BİR EMDR VAKA ÇALIŞMASI

Objective: To demonstrate the efficacy of EMDR in complex multiple psychological trauma after failed drug treatment from selective serotonin reuptake inhibitor (SSRI) in a diagnosed case of post traumatic stress disorder (PTSD). Material and method: Single participant of this case study, a sitting session judge of judicial governmental scaffold reported to this mental health tertiary care facility at his own accord with features of intense anxiety, depression, maladjustment issues and posttraumatic stress for a duration of several months. As a partial responder to full trial of SSRI he was enrolled for EMDR therapy to address his symptoms of intense anxiety, panic attacks, being overwhelmingly fearful, depressed, low self-esteem, inappropriate feelings of guilt, flashbacks, avoidance, nightmares, hyper-arousal and inability to perform as a judicial head in active war stricken area of northern Pakistan. Complete psychiatric evaluation was carried out and after the discontinuation of SSRIs he was scored on Impact of Event Scale (IES). He fulfilled the diagnostic criteria for PTSD as evaluated by the English version of the PTSD module of the Structured Clinical Interview for DSM-IV administered once before commencement of EMDR. Safe place of the client was established and 8 staged protocol of EMDR was started with him. Multiple EMDR sessions were conducted. Result: The case presented in this paper had multiple psychological trauma forms and failed drug treatment and yet it was observed that EMDR provided marked improvement in all the domains of his deficits and this was at a prompt speed as compared to cognitive behavioural therapy (CBT) which usually takes longer duration of therapy to achieve similar results. Conclusion: EMDR provides marked improvement in all domains of complex mental trauma and traumatic memories. Improvement attained was prompt and enduring as compared to other forms of established therapies and drug treatment indicating permanent changes happening at neurobiological levels of brain

EFFICACY OF EYE MOVEMENT

Objectives: To demonstrate the efficacy of EMDR in complex multiplepsychological trauma after failed drug treatment from selective serotonin reuptake inhibitor(SSRI) in a diagnosed case of post-traumatic stress disorder (PTSD). Method: Singleparticipant of this case study, a sitting session judge of judicial governmental scaffold reportedto this mental health tertiary care facility at his own accord with features of intense anxiety,depression, maladjustment issues and post- traumatic stress for a duration of several months.As a partial responder to full trial of SSRI he was enrolled for EMDR therapy to address hissymptoms of intense anxiety, panic attacks, being overwhelmingly fearful, depressed, low selfesteem,inappropriate feelings of guilt, flashbacks, avoidance, nightmares, hyper-arousal andinability to perform as a judicial head in active war stricken area of northern Pakistan. Completepsychiatric evaluation was carried out and after the discontinuation of SSRIs he was scoredon Impact of Event Scale (IES). He fulfilled the diagnostic criteria for PTSD as evaluated by theEnglish version of the PTSD module of the Structured Clinical Interview for DSM-IV administeredonce before commencement of EMDR. Safe place of the client was established and 8 stagedprotocol of EMDR was started with him. Multiple EMDR sessions were conducted. Result:The case presented in this paper had multiple psychological trauma forms and failed drugtreatment and yet it was observed that EMDR provided marked improvement in all the domainsof his deficits and this was at a prompt speed as compared to cognitive behavioural therapy(CBT) which usually takes longer duration of therapy to achieve similar results. Conclusions:EMDR provides marked improvement in all domains of complex mental trauma and traumaticmemories. Improvement attained was prompt and enduring as compared to other formsof established therapies and drug treatment indicating permanent changes happening atneurobiological levels of brain.</jats:p