OBJECTIVES
To determine the frequency of depression in caregivers of stroke patients at a tertiary care teaching hospital in Karachi Pakistan.
METHODS
A cross-sectional study was conducted among caregivers of stroke, who were recruited from the Aga Khan University Hospital Karachi Pakistan, between January 2018 to October 2018. Data was collected through the Urdu Hamilton rating scale for depression (HAM-D-U) and it was analyzed using descriptive and inferential statistics.
RESULTS
A total of 136 caregivers participated in the study. Among them, 44.1 % were male and 55.9% were female. The mean age of caregivers was 45.38 ± 10.33 years. Using the HAM-D-U scale, depression was present in 64 (47.1%) caregivers. Out of them (n=64), 46 (33.8%) caregivers had mild depression whereas 18 (13.2%) had moderate depression. Depression was found to have a significant relationship with the age of the patient (p=0.002), education level of caregiver (p= 0.012), employment status of caregiver (p=0.012), being a sole caregiver (p=0.039), and monthly family income (p=0.016).
CONCLUSIONS
Caring for patients with neurological disorders is highly challenging and demanding. The need for this role may arise unexpectedly in one’s life; leaving little space for adjustment and coping. Depression itself can be very paralyzing for the sufferer especially if moderate to severe in intensity. Depression in stroke caregivers can be missed as patients are the center of a clinical visit. Hence, strategies should be designed and reinforced to screen patients and caregivers for depression along with a pathway for an easy and timely referral.
Mental health problems like schizophrenia, bipolar affective disorder and use of second generation antipsychotics (SGA) are linked to the risk of developing metabolic syndrome. The purpose of our study was to determine the level of compliance to monitoring metabolic symptoms associated with second generation antipsychotics according to the standards of NICE guidelines. Secondly, we aim to develop a workable standardized protocol. A total of 385 patients admitted to psychiatric ward from February 2015-January 2016 were included in the study. Case files were reviewed to obtain relevant clinical information. Assessment of height, weight, pulse, blood pressure, movement disorders, level of physical activity and nutritional status were measured in all patients. Fasting blood glucose was measured in 99 (26.5%), glycosylated hemoglobin (HbA1c) in 39 (10.4%), blood lipid profile in 44 (11.8%) and prolactin in 3 (0.8%) patients. Less than half of the patients (118, 31.6%) underwent ECG investigation. Slow titration of medication (331, 88.5%) and a trial at optimum dosage (343, 81.7%) were routinely seen. Overall physical health and patient well-being was recorded in the majority of subjects (310, 82. 9%). A significant number of physical and biochemical parameters were not routinely monitored. Our study reports findings consistent with previous literature. With this we hope to highlight important concerns and make recommendations, especially in country like Pakistan where these monitoring systems are non-existing. This will not only reduce the risk of a number of complications secondary to antipsychotic medications, but will also improve patient adherence and compliance to the pharmacological treatment.
In psychiatry, agitated / aggressive patients are often treated with de-escalation techniques. If this does not work, physical or chemical restrains are required; but in the event of resistance, seclusion is applied. We report the findings of baseline study of experiences of physical and chemical restraints in a tertiary care hospital in Karachi, where 104 files were evaluated retrospectively. The mean age of patients was 32.5 ±14.3 years with 54.8% men, while the average length of stay was 11.5 ±9.3 days. Agitation, violent behaviour, and aggression were the most common indications for restraints. In total, 94.5% of patients had both physical and chemical restraints with the latter being used as the first choice in 70 patients; whereas, 67.1% of patients' families were not informed before application of restraints. The seclusion need assessment was conducted in 4.1% of patients.
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