Psychiatric rating scales in Urdu: a systematic review

<p>Abstract</p> <p>Background</p> <p>Researchers setting out to conduct research employing questionnaires in non-English speaking populations need instruments that have been validated in the indigenous languages. In this study we have tried to review the literature on the status of cross-cultural and/or criterion validity of all the questionnaires measuring psychiatric symptoms available in Urdu language.</p> <p>Methods</p> <p>A search of Medline, Embase, PsycINFO and <url>http://www.pakmedinet.com</url> was conducted using the search terms; Urdu psychiatric rating scale, and Urdu and Psychiatry. References of retrieved articles were searched. Only studies describing either cross-cultural or criterion validation of a questionnaire in Urdu measuring psychiatric symptoms were included.</p> <p>Results</p> <p>Thirty two studies describing validation of 19 questionnaires were identified. Six of these questionnaires were developed indigenously in Urdu while thirteen had been translated from English. Of the six indigenous questionnaires five had had their criterion validity examined. Of the thirteen translated questionnaires only four had had both their cross-cultural and criterion validity assessed.</p> <p>Conclusion</p> <p>There is a paucity of validated questionnaires assessing psychiatric symptoms in Urdu. The BSI, SRQ and AKUADS are the questionnaires that have been most thoroughly evaluated in Urdu.</p

Deliberate self-harm and attachment: mediating and moderating roles of depression, anxiety, social support and interpersonal problems among Pakistani school going adolescents

Introduction: In Pakistan there is dearth of research on deliberate self-harm (DSH) and its predictors among adolescents. While the lack of research in Pakistan can be partly attributed to the sacrilegious status, criminalization and stigmatization attached to DSH, it is also an attribute of paucity of Urdu versions of the standardized psychological instruments. Previous research in developed countries has indicated that attachment theory can be used as a useful framework to understand the development of austere psychopathologies like DSH, as well as for studying pathways of interaction of interpersonal and intrapersonal factors of psychopathologies. In this study, standardized psychological instruments are translated into Urdu language as a first step. These instruments are then used to study pathways of interaction of interpersonal and intrapersonal factors of DSH, conceptualized within attachment framework. Method: The study was conducted in two steps. In step 1, Youth Health Risk Behavior Survey (YHRB), Inventory of Interpersonal Problems-32 (IIP-32) and Significant Others Scale (SOS), were translated into Urdu language. Along with these scales, Urdu translated versions of Hospital Anxiety and Depression Scale (HADS), Adolescent Relationship Scales Questionnaire (ARSQ), Life Events scale (LES) from CASE questionnaire and Family Affluence Scale-II (FAS-II) were reviewed for accuracy of translation through expert judgement and psychometric evaluation. Secondly, a cross sectional survey was conducted with 1290 adolescents (10 - 19 years age) using the translated Urdu versions of the instruments and demographic pro forma. Structural equation modelling was used to study the pathways of associations between predictors of DSH. Results: The extensive process of translation resulted in establishment of semantic, content, technical and construct equivalence of the translated instruments with the original English versions. Multiple imputation was performed to account for missing values in SPSS 20. Important structural adaptations were made in the scales based on factor analyses conducted in M plus. After modifications, all scales showed satisfactory CFI (≥ 0.90) and RMSEA (≤ 0.06). Results of the survey indicated that the prevalence of DSH (with, without and ambivalent suicidal intentions) was 7%. Two SEM models were constructed involving both mediation and moderation pathways. Results of Model 1 showed association of attachment with DSH was double mediated by social support, depression and anxiety. Model 2 also confirmed association of attachment with DSH with double mediation through relationship style problems, depression and anxiety. In order to understand the contextual picture of the concepts studied in this research both SEM models were also constructed by controlling for demographic factors. This resulted in confirming age, gender and family affluence as significant contributors but with very small effects. Discussion and conclusion: In the present study translation of the instruments helped in building a reservoir for future research. The results of translation and validation of instruments indicated that cultural differences, language needs and age must be accounted for while using standardized psychological instruments. Taking into consideration specific cultural and demographic background of Pakistan, this study also confirms the key role of attachment in influencing interaction of predictors of DSH. It is suggested that intrapersonal and interpersonal factors are influential points of intervention for designing clinical, school and community based awareness and prevention programs for DSH. The thesis also discusses the implications for policy guidelines along with recommendations for future research and other applications of the study

Minocycline benefits negative symptoms in early schizophrenia : a randomised double-blind placebo-controlled clinical trial in patients on standard treatment

The onset and early course of schizophrenia is associated with subtle loss of grey matter which may be responsible for the evolution and persistence of symptoms such as apathy, emotional blunting, and social withdrawal. Such ‘negative’ symptoms are unaffected by current antipsychotic therapies. There is evidence that the antibiotic minocycline has neuroprotective properties. We investigated whether the addition of minocycline to treatment as usual (TAU) for 1 year in early psychosis would reduce negative symptoms compared with placebo. In total, 144 participants within 5 years of first onset in Brazil and Pakistan were randomised to receive TAU plus placebo or minocycline. The primary outcome measures were the negative and positive syndrome ratings using the Positive and Negative Syndrome Scale. Some 94 patients completed the trial. The mean improvement in negative symptoms for the minocycline group was 9.2 and in the placebo group 4.7, an adjusted difference of 3.53 (s.e. 1.01) 95% CI: 1.55, 5.51; p < 0.001 in the intention-to-treat population. The effect was present in both countries. The addition of minocycline to TAU early in the course of schizophrenia predominantly improves negative symptoms. Whether this is mediated by neuroprotective, anti-inflammatory or others actions is under investigation