Comparison of effect of Olanzapine and Resperidone on Serum Prolactin levels in patients with first episode Psychosis

Objective: To compare frequency of Hyperprolactinemia with Risperidone and Olanzapine in patients with first episode psychosis

Study Design: Randomized controlled trial

Place and Duration of Study: Combined Military Hospital [CMH] Lahore, over a period of six months from Sep 2015 to Feb 2016

Subjects and Methods: Total 60 patients who had psychosis as accompanying feature in any of the various psychiatric illnesses according to ICD-10 diagnostic criteria were enrolled in this Randomized controlled Trial. Fasting venous blood samples for serum prolactin were collected between 0800 hrs and 1000 hrs at baseline [first visit]. The patients were then randomly assigned to receive risperidone or olanzapine by lottery method. Serum prolactin levels were then collected at 3 months follow-up visit. All samples were tested in labortary of Pathology department, CMH Lahore for measurement of serum prolactin levels and results were verified by a classified pathologist. Confounding variables were identified and excluded by exclusion criteria

Result: A total of 35 patients [58.33 percent] developed hyperprolactinemia. The olanzapine group showed 13 out of 30 patients [43.33 percent] and risperidone group showed 22 out of 30 patients [73.33 percent] with raised prolactin levels with p-value of 0.018 indicating that the difference was statistically significant

Conclusion: Frequency of hyperprolactinemia is high with risperidone than with olanzapine in first episode psychosis

Psychosocial impact of October 2005 earthquake on children and adolescents aged 9 to 18 years, assessed after one year in Kashmir, Pakistan

On 8 October 2005, an earthquake of 7.6 magnitude hit Pakistan leaving about 75,000 dead and thousands homeless. Worst damage was in the territory of Kashmir. Children exposed to a natural disaster can develop symptoms of post-traumatic stress symptoms and disorder whose prevalence, associated symptoms and vulnerability varies from population to population. To asses post-traumatic stress symptoms and disorder, associated other symptoms and trauma related risk factors in children and adolescents one year after the earthquake. This is a comparative study to assess post traumatic stress disorder in children who faced the disasters of earthquake and comparisons were made with same age and gender children who faced the earthquake but did not face the disaster. The psychometric tools included Impact of Event Scale, Strengths and Difficulties Questionnaire and post-traumatic stress symptoms and disorder part of Kiddie-SADS Present and Lifetime [K-SADS PL] version 1.0. The mean age of cases was 11 years and they showed significantly high [p=0.03] levels of psychological impact of the disaster [49.2%] as compared to the controls [12.8%]. They also showed more difficulties in coping with life [mean SDQ=18] as compared to the controls [mean Strengths and Difficulties Questionnaire = 21]. Posttraumatic Stress Disorder was 8.6% in the exposed group and 1.2% in control group. A considerable proportion of children and adolescents exhibited difficulties as post-traumatic symptoms, and 8.6% had the psychological disorders. Policy message: Health care providers should be aware that children and adolescents need psychological evaluation and therapy in post disaster situations

Biological markers of psychological trauma: a review

To review current evidence on the patho-physiology of psychotrauma and its biological markers. The authors made a comprehensive literature search using internet databases, PubMed, Medicine and google search engine, Am J Psychiatry, British Journal of Psychiatry, Arch Gen Psychiatry, J Neurosci, ISTSS journal for evidence for biological markers of Psychotrauma spanning over a period last 28 years, up to 1980. The key words used for the search were psychotrauma and biological marker. A total of 109 papers and articles were included in the study. The patho-physiology of psychotrauma involves a complex interplay between trauma-related factors and the neurobiological and psychosocial influences that determine individual differences in resilience and vulnerability. In psychotrauma, dysregulation of HPA axis takes place associated with changes in autonomic nervous system. The structures mostly related to psychotrauma are amygdale, hippocampus, anterior cingualte cortex, prefrontal cortex etc. The related hormones are CRF, ACTH, Cortisol, Catecholamines, Serotonin, GABA, Dopamine, Opioids, and Substance P. Psychotrauma is not a mere psychological or a social pathology. There are clear and well-defined biological markers of the change seen in consequence to exposure to trauma. The understanding of patho-phsyiology of the consequent disorders is however still infancy. This calls for consorted scientific enquiry into the biological basis of psychotrauma through rigorous methods

Communication skills of specialist doctors: assessment with SKAF scale a new tool

To evaluate the standards and uses of communication skills of specialist doctors during the doctor-patient interactions among a sample of specialists belonging to various specialities and based at different hospitals of Lahore. One hundred specialists were asked to participate in the prospective, questionnaire based survey in Lahore. These volunteers were asked to fill a form keeping in view their current practices. The scores thus achieved were measured using a proposed SKAF score. The results were graded into four parts depending upon the score achieved by the subjects. Twelve people never returned the survey instrument. Of those who did majority scored as good or excellent. Females showed a better score than males. Those who had previously been instructed formally did better on the SKAF scale. The need of formal hands on training workshops on Communication Skills in both under graduate as well as post graduate trainees cannot be reiterated

Knowledge, attitude and practice regarding immunization among family practice patients

To determine the knowledge, attitude and practices about immunization among family practice patients. A questionnaire based survey. A questionnaire was developed in line with the study objectives. It was administered to patients visiting family physicians, after they were administered, informed consent and assurance with regards to confidentiality was provided. Epi-info and SPSS software was used for data management. A total of 97 patients were surveyed. The majority were men [59.8%] with a mean age of 29.69 years. Majority was unmarried [51.5%], with graduate and post-graduate education [73%], and in government and private service [48%]. Vaccination was believed to prevent disease by 94%. Majority was informed about immunization by doctors and parents [94%]. Media provided information about immunization to 62% of the patients. A 58% would recommend vaccination to others. Source about harmful effects of immunization was provided by friends and parents [80%]. Hurdles against immunization were lack of education and lack of funds according to 43 [45%] and 29 [30%] respondents respectively. Education of population and mothers were ways to promote immunization according to 23 [24%] and 19 [20%] respondents respectively. Immunization exists against Hepatitis "C" and Malaria according to 35 [36%] and 10 [10%] respondents respectively. Immunization were received against polio, measles and hepatitis "B" by 86 [89%], 51 [53%] and 26 [27%] respondents respectively. The study results have identified a strong need for education program for the masses about immunization, since major deficiencies have been identified. Further studies are strongly recommended along with debate on this important public health issue

clinical manifestations of systemic lupus erythematosus in Pakistan correlate with rest of Asia?

Systemic Lupus Erythematosus [SLE] is known to be different among people with different racial, geographical and socio-economic back grounds. Asia has diverse ethnic groups broadly, Orientals in the East and Southeast Asia, Indians in South Asia and Arabs in the Middle East. These regions differ significantly from the Caucasians with reference to SLE. The purpose of this study was, therefore, to delineate the clinical pattern and disease course in Pakistani patients with SLE and compare it with Asian data. Patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association admitted at the Aga Khan University Hospital between 1986 and 2001 were studied by means of a retrospective review of their records. The results were compared with various studies in different regions of Asia. Demographically, it was seen that SLE is a disease predominantly of females in their third decade, which is generally consistent with Asian data. There was less cutaneous manifestations, arthritis, serositis, haematological and renal involvement compared to various regions in Asia. The neurological manifestations of SLE, however, place Pakistani patients in the middle of a spectrum between South Asians and other Asian races. This study has shown that the clinical characteristics of SLE patients in our country may be different to those of other Asian races. Although our population is similar to South Asians, but clinical manifestations of our SLE patients are considerably different, suggesting some unknown etiology. Further studies are required to confirm the above results and to find statistically sounder associations

Mental health and psychosocial relief of earthquake survivors - activities and interventions

Earthquakes are natural calamities which are unpredictable and destructive in nature. The October 8[th], 2005 quake put forth a challenge for the whole nation. The authors describe the methods of appraisal of the situation, methods of needs assessment in emergency phase of disaster, organization of mental health relief efforts and implementation strategies of these services for the survivors, keeping in line with local cultural and social needs and consensus of world authorities on trauma psychiatry and disaster management. Three specific needs were identified, namely, need for psychosocial services for majority of the population, need for people in psychological distress requiring Psychological first aid and people with severe mental illnesses requiring long term psychiatric management. With the objectives of ensuring availability of Psychological first aid to maximum, early detection, intervention and establishing a chain of referral for the severely affected cases, incorporating psychosocial care and rational use of psychotropic in medical and surgical care at all tiers of health services, public mental health education, community mobilization and caring for the relief workers, the Dept. of Psychiatry MH Rawalpindi launched the comprehensive plan for the earthquake survivors. The summary describes the services rendered by the teams of the Dept. during the six months in tabulated forms

Performance measurement in a service: the parameters and their application in a newly established service

The objective of this clinical audit was to evaluate the performance of a newly established Psychiatry department during the first ten and a half months of its existence.Cross-sectional study. The audit took place from February 2004 to December 3004, at the Department of Psychiatry and Behavioral Sciences, Independent Medical College.Data was collected by the staff members during their routine work. This data was then compiled, categorized and analyzed, to evaluate the quality of work.125 total teaching hours during the audit period and 658 sessions conducted. Monthly growth rate of client turnover was 10%. Multiple research projects were undertaken during this period.A service like this in the private sector is both valuable and commercially viable. The findings of this audit can be used to forecast the future service use. It will also provide the parameters for auditing the services provided by the department in future

Addictive drugs; effect on haematological and hormonal profiles in men

The phenomenon of drug abuse and its sequalae affect health of the abuser in multiple ways, e.g. changes in body weight, changes in nutrient metabolism due to the pharmacokinetic and pharmacodynamic effects of the drugs, changes in the endocrine system, etc. There is a paucity of research in this area, in Pakistan. To study the effects of drugs of abuse on the physiological and biochemical processes of the body, in a Pakistani population of drug addicts; and then to compare these findings with an age and gender matched control group. This research study was carried out at the District Headquarters Hospital Faisalabad, at the Model Drug Abuse Treatment and Rehabilitation Centre located in the hospital. It was a cross-sectional, non-interventional, comparative study. Subjects were recruited by a consecutive sampling method. The study group consisted of 100 subjects, consisting of 80 drug addicts and 20 age and sex matched controls. The following measurements were made: Physical parameters, Plasma biochemistry, Liver function tests, Thyroid hormone levels , Plasma electrolytes and trace element levels Statistical analysis was carried out by two way analysis of variance and Student's t test. The threshold for statistical significance was set at a p value equal to or less than 0.05. Mean age of drug addicts was 31 years. Most of them were poly-drug addicts and mean duration of addiction was 8 years. The drug addicts had low body weight and high blood pressure and temperature, as compared to the control group. The laboratory tests revealed that the addicts as a group had decreased albumin, globulin and total protein levels; while plasma glucose, SGOT, SGPT, T3 and T4 levels were generally higher in the drug addicts, as compared to the control group. Besides the problem of addiction, the effects of drugs of abuse on the physiology and biochemistry of the human body are harmful in their own right. These results are significant because they highlight the importance of holistic assessment and management of drug abusers beyond just managing their addiction

Clinico-laboratory findings in male lupus patients from a tertiary care hospital, Pakistan

This study was conducted to delineate the clinical pattern of a cohort of Pakistani male patients with systemic lupus erythematosus [SLE]. Clinical and laboratory data were collected of 24 male patients who were diagnosed with SLE and admitted to a tertiary care hospital between 1986 and 2001. Imaging and invasive studies [including aspirations and biopsies] were also recorded. Fourteen patients [58%] had renal involvement, with WHO class 4 and 5 comprising 89% of the cases. Eight patients [33%] had neurological involvement. Out of these 8 patients, 3 presented with psychosis [12.5%] and 4 [17%] with seizures. Twenty three patients [96%] had hematological involvement, 6 [25%] had serosal and 10 [41%] had articular involvement. Cutaneous lesions were noted in 10 [41%] patients. A majority of the patients were noncompliant and were lost to follow-up; therefore, ultimate outcome could not be clearly delineated. A high index of suspicion for SLE in males may permit early diagnosis and dictate the need for more aggressive therapy

Systemic lupus eryhematosus presenting as Hemolytic uremic syndrome: a case Report

Associating systemic lupus erythematosus [SLE], with an initial presentation of hemolytic uremic syndrome [HUS] is rare. We report a case of 21-year old Afghani female admitted to our hospital with an initial complaint of high grade fever and diffuse maculopapular rash and swelling of lower limbs. Diagnosis of atypical HUS was established according to the clinical triad of HUS without a veriotoxin-producing organism in her stool and the pathological finding compatible to thrombotic microangiopathy. In addition, her symptoms fulfilled the 1982 revised criteria for the classification of SLE. After pulse methylprednisolone, cyclophosphamide and plasmapheresis therapies, her laboratory findings and general condition improved. Unfortunately she was lost to follow up as she decided to return back to Afghanistan

Level of prepatedness of patients for medical emergency

A questionnaire-based survey was conducted at the Emergency Room, The Aga Khan University Hospital, Karachi, during March and April 2003. One hundred patients visiting the Emergency Room for the treatment of a medical emergency were surveyed. The average age of patients was 42 years, with 54 men and 46 women. The majority was married, well educated, housewives or in private/government services. Only those patients who were well enough to respond to questions were interviewed. Seventy [70%] respondents had financial resources available to meet the expenses of the medical emergency. Patients were accompanied by someone in 89% cases. The majority was accompanied by husband [20%], son [20%], brother [14%], father [08%], wife [06%], sister [06%], mother [05%], daughter[05%] or a friend [05%]. Seventy-nine% respondents felt that experiencing the present medical emergency will enable them to be better prepared for such events in the future. Since we conducted the study at the Emergency Room of a teaching facility, and the study subjects were well-educated and socioeconomically better off, we cannot generalize the results to the population at large. We should not be surprised that 70% of the study subjects had the resources to pay for the expenses the medical emergency. Far less people in the community will be able to meet such expenses

Renal cortical necrosis: a case series of nine patientns and review of literature

The purpose of this study is to review cases of renal cortical necrosis [RCN] which we came across during a period of five years, confirmed on needle biopsy specimens, with literature available so far. All renal biopsy records between January 1996 to December 2001 at the Aga Khan University Hospital, Karachi, Pakistan were reviewed to identify patients with histologically proven renal cortical necrosis. Seven patients were also referred by the department of Nephrology, Lady Reading Hospital, Peshawar, Pakistan. Patients' medical records were reviewed for demographic, clinical, and follow up data. There were total of nine patients identified with renal cortical necrosis. The mean age was 26.21 +/- 13.01 year. Five cases [55.5%] were caused by obstetric complications. The most common histology type of RCN was patchy cortical necrosis in seven patients [77.8%]. Three patients were alive at last follow up; remaining patients were lost to follow up. Obstetric complications remain the leading cause of renal cortical necrosis in our setting. The recognition of this entity and value of renal biopsy in cases of acute renal failure needs to be emphasized as this helps in establishing diagnosis, to assess prognosis and to aid in selection of a rational approach to therapy