Catatonic schizophrenia is defined by catatonia seen either with alternating phases of stupor and motor rigidity or the extreme phase of catatonic excitement. This variant of schizophrenia has been identified with poor prognosis, mainly due to the higher association with negative symptoms and young age onset. In this paper, we illustrate a similar clinical picture of catatonic schizophrenia in two brothers, with no genetic predisposition to schizophrenia and no proximal stressors apart from the aggressive/violent behavior of their elder brother. Case presentation 1 (Patient A): An 18-year-old male from a lower socio-economic class with no previous mental health issues presented to the emergency department with complete mutism, marked psychomotor retardation, posturing along with a refusal to drink or eat, and complete lack of self-care for about two months. The diagnosis of catatonic schizophrenia was made, and the patient was started orally on aripiprazole and lorazepam. On the third day of admission, noticeable changes were observed, and in the following days, he started eating and going to the toilet while still being completely mute. After two weeks on treatment, he started responding with one-word answers. Case presentation 2 (Patient B): The biological brother of patient A, a 30-year-old male, presented on the same day with an identical history of mutism, decreased psychomotor activity, posturing along with a refusal to drink or eat, and lack of self-care for the past few months. The diagnosis of catatonic schizophrenia was made. The patient was started orally on both, olanzapine and lorazepam. He showed a quicker response to treatment with the maintenance of eye contact on the second day of treatment and started giving short answers to questions on the fifth post-admission day. We here discuss a possible genetic predisposition to catatonic schizophrenia and its initial improvement with lorazepam and subsequent treatment with olanzapine proving to be more efficacious than aripiprazole.
Background Escitalopram is widely used for the management of the major depressive disorder and generalized anxiety disorder, but there is no to very limited data available regarding efficacy and safety in Pakistani patients. This study was conducted to evaluate the efficacy and safety of escitalopram oral drops to manage the major depressive disorder and generalized anxiety disorder in a local cluster within Pakistan. Methods This prospective multicenter observational study was conducted in the department of psychiatry from August 2018-August 2019. Eighty-five patients meeting the selection criteria were included in the study. Adolescent, adult, and geriatric patients of either gender with generalized anxiety disorder having Hamilton Anxiety Rating Scale (HAM-A) rate ≥ 10 and major depressive disorder having Montgomery-Asberg Depression Rating Scale (MADRS) rate ≥ 7 or patients with co-morbid generalized anxiety disorder (GAD), major depressive disorder (MDD) were selected for the study. We are reporting patients' improvement from baseline, response rate, and remission rate. Data analysis is performed by using SPSS version 21 (IBM Inc, Armonk, USA). Results Among enrolled patients, 42 were adolescents, 22 were adults, and 21 were geriatric. The mean age of an adolescent, adult, and geriatric patients was 14.92 ± 2.04, 44.54 ± 12.08, and 64.61 ± 3.16 years, respectively. Among enrolled patients, the mean change in a total score of HAM-A for anxiety and MADRS for depression were-10.04 ± 4.32 and-17.67 ± 14.42, respectively. At the end of the study, the remission rate and response rate for depression were 82 % and 75%, respectively. Similarly, the remission rate and the response for anxiety were 76% and 81%, respectively. Mean HAM-A and MADRS scores were significantly improved for adolescent, adult, and geriatric patients. Adverse events were reported in eight (9.41%) patients with six having gastrointestinal (GI) disturbance and two having to worsen anxiety. All reported adverse events were of mild severity. Conclusion Escitalopram oral drops are found effective and tolerable in reducing both anxiety and depression 1 2 3 4 5 6 6
Pakistan is one of the largest and most populated nations of South Asia and ranked sixth among the most crowded countries in the world, with a population exceeding 196 million. Because of a lack of research and the cultural setting, it is exceptionally hard to obtain an exact number of individuals suffering from dementia. However, the extrapolated prevalence of people with dementia in Pakistan is around 200,000. Compared to developed countries, only 4.2% of the Pakistani population are aged above 65 years, possibly due to an average life expectancy of 66 years for both genders . Although no specific data on elderly people with dementia in Pakistan are available, it is estimated that 8–10% of the general population aged above 65 years suffer from chronic memory loss. According to the latest 2014 World Health Organization data, Alzheimer’s disease/dementia-related deaths in Pakistan reached a total of 1776 or 0.16% of total deaths. Pakistan currently has the largest generation of young people ever recorded in its history, who will be at risk for dementia and Alzheimer’s disease by 2050, at which time, life expectancy would be expected to continue rising. Thus, the economic burden of treating patients with Alzheimer’s disease and other types of dementia will increase considerably.
AimsTo Improve the mental health of psychiatric inpatients and caregivers. To improve communication skills of postgraduate trainees.MethodsSetting; Consented, monitoring and observation of communication skills during weekly, inpatient Psychoeducation sessions at Department of Psychiatry and Behavioural Sciences, JPMC, Karachi.Data collection; Retrospective, communication skill records of postgraduate trainees from last 10 sessions from July 2019 to October, 2020. Based on a 13-items self-made questionnaire for communication skill. The overall communication skills of each postgraduate trainee were recorded from excellent, very good, good, improvement needed and lots of improvement needed category based on their performance.ResultsCurrent practice showed that communication skills of 70% of postgraduate trainees were recorded as very good communication skill, 30% into excellent while none was noticed in another category.Re-audit: It was started soon after implementation of action plan from November, 2019 to January, 2020, with monitoring of weekly inpatient psychoeducation sessions similarly as done previously. The result of reaudit concluded significant improvement in individual and overall communication skill which were recorded as very good 50% and excellent 50% and none had other poorer categories of communications Skills.ConclusionIndividual feedbacks to doctors immediately after the psychotherapy session according to the audit tool questionnaire to improve current communication skills.
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