Anxiety and depressive symptoms in patients with conversion disorder.

OBJECTIVE: To determine symptom pattern of conversion disorder and its association with co-existent anxiety and depressive symptoms. DESIGN: Descriptive, cross-sectional study. PLACE AND DURATION OF STUDY: The study was conducted in the Department of Psychiatry, Services Hospital, Lahore from August 2003 to January 2004. MATERIALS AND METHODS: One hundred patients, suffering from conversion disorder, diagnosed on the basis of DSM-IV criteria, were assessed for severity of anxiety and depressive symptoms by using hospital anxiety and depression scale (HADS). A semi-structured interview was used for demographic details. RESULTS: Anxiety was seen to be present in 35% of cases, depression in 29% and 31% of the patients had both anxiety and depressive symptoms. Overall co-morbidity of anxiety and depressive symptoms in conversion disorder was high i.e. 95% and only 5% of the patients were without any co-morbid anxiety and depressive symptoms. A significant association was found between depressive and sensory symptoms (p=<0.05) in patients with conversion disorders. CONCLUSION: The patients with a diagnosis of conversion disorder need to be managed for anxiety and depressive symptoms appropriately for better outcome.

Brief culturally adapted CBT (CaCBT) for depression: a randomized controlled trial from Pakistan.

OBJECTIVES: To determine the efficacy of brief Culturally adapted CBT (CaCBT) for depression when added to Treatment As usual (TAU)-delivered by trained therapists using a manual compared with alone TAU. METHODS: This was an assessor-blinded, randomised controlled clinical trial. Particpants with a diagnosis of depression, attending psychiatry departments of three teaching hospitals in Lahore, Pakistan, were included in the study. We screened a total of 280 patients and randomly allocated 137 of them to CaCBT plus Treatment As Usual (TAU) [Treatment group] or to TAU alone [Control group]. Assessments were completed at baseline, at 3 months and at 9 months after baseline. Reduction in depression score (Hospital Anxiety and Depression-Depression Subscale) at 3 months was primary outcome measure. The secondary outcome measures included anxiety scores (Hospital Anxiety and Depression-Anxiety Subscale), somatic symptoms (Bradford Somatic Inventory), disability (Brief Disability Questionnaire) and satisfaction with the treatment. FINDINGS: A total of 69 participants were randomised to Treatment group and 68 to Control group. Participants in Treatment group showed statistically significant improvement in depression (p=0.000), anxiety (p=0.000), somatic symptoms (p=0.005) and disability (p=0.000). This effect was sustained at 9 months after baseline (Except for disability). Participants in Treatment group also reported higher satisfaction with treatment compared with those in Control group. CONCLUSION: Brief CaCBT can be effective in improving depressive symptoms, when compared with treatment as usual. This is the first report of a trial of Culturally adapted CBT from South Asia and further studies are needed to generalise these findings.

Translation and validation of quality of life scale, the brief version.

OBJECTIVES: To translate The World Health Organization quality of life scale, WHO-QOL BREF, in Urdu and validate it. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of Psychiatry, Postgraduate Medical Institute, Lahore, from July 2002 to October 2002. MATERIALS AND METHODS: The English version of WHO-QOL BREF was translated in Urdu and later back translated. The process was checked and evaluated at each step by a translation committee comprising of group of bilingual experts. The whole process was carried out in four stages. The translated version was further evaluated statistically in three ways to check linguistic equivalence, concept equivalence and scale equivalence. RESULTS: A significant level of equivalence was seen at all parameters. CONCLUSION: This study concludes that the Urdu version of WHO-QOL BREF is a reliable and valid version to be used in our population to measure the quality of life in Pakistan.