Background: Substance Use is highly associated with bipolar affective disorder, however the reason for the co-occurrence is unknown. It was evident that if a bipolar patient use  drug of abuse his outcome will be poor. Either it can directly trigger the affective symptoms, or may affect the treatment compliance indirectly. Aims: The objective of this study was to study the demographic correlates of drug abuse in patients with bi-polar affective disorder. Method: Cross-Sectional research design and non-probability consecutive sampling was used to collect data from a private clinic in Lahore. Data was comprised of 368 patients of bipolar disorder. Results: Out of a total of 368 bipolar patients, drug abuse was found in 147 patients that is 39.9%. The results showed that the mean age of the patients was 31.03 ±5.837; mean monthly income was 229597.82 ±164626.77 PKR. The mean duration of illness was 6.54 ±5.157. The mean number of drugs used was 2 ±0.875. The mean cost of drug was 29945.7 ±19068.8 PKR. The mean number of hospitalization was 2.47 ±1.694. Association  between drug use and  occupation of  bipolar patients (0.006), factors leading to initiation of drug use (0.000), family history of drug use (0.001), current episode (0.000) and the type of drugs used (0.000)  was statistically significant. Conclusion: The cause and effect relationship between drug use and bipolar disorder cannot be clearly identified. However occupation of the patient, reasons of initiating drugs, drug abuse in family, current episode as well as  type of drugs used have  significant association  with drug abuse in bipolar patients .

ORIGINAL ARTICLE PREVALENCE OF SUICIDAL IDEATION AMONG THE PATIENTS SUFFERING FROM OBSESSIVE COMPULSIVE DISORDER ATTENDING PSYCHIATRY DEPARTMENTS OF A TERTIARY CARE HOSPITALS OF LAHORE, PAKISTAN Ahmed Waheed, M. Ismail Tariq, Sumira Qambar Bokhari, Shahid Hameed Warris, Aysha Rashid, Surya Fazal Hashmi.     ABSTRACT Background: Obsessive compulsive disorder (OCD) is a debilitating disease which runs a chronic course and affects patient’s functioning badly. Frequency of Suicidal thoughts and attempts is much more common in OCD patients than it was thought previously.   Objective: To determine the frequency of suicidal ideation among patients with obsessive compulsive disorder presenting in a tertiary care hospital.   Material & Methods This Cross-sectional study was done in a tertiary care hospital on 159 patients of OCD. Demographic data was taken. All patients were assessed for history of suicidal attempt. History of suicidal ideation was obtained from patients on a Performa comprising of BECK suicidal intent scale. Data was analyzed on SPSS version 20.   Results: Suicidal ideation was found in 40(25.2%) patients. Frequency of suicidal ideation was higher among female (57.5%) patients as compared to male (42.5%) patients. Socio-demographic factors like age, gender, duration of OCD, marital status, educational status and financial condition did not show any statistically significant association with suicidal ideation.   Conclusion: Current study showed that suicidal ideation was present in 25% of the patients of OCD which signifies the importance of assessment of suicidal ideation in all OCD patients routinely.   Key words: Suicidal ideation, Obsessive compulsive disorder, Psychiatry department.

Objective: The objective of this study was to explore the adherence to diabetic management in patients with co-morbid depression presenting in Diabetes Management Centre, Services Hospital Lahore and to compare it with adherence to treatment of diabetes in patients not suffering from co-morbid depression. Method: The sample (N=94) was all diabetic patients with either type 1 or type 2 diabetes and presenting at outpatient department, Diabetes Management Centre, Services Hospital Lahore and who are suffering from depression according to DSM-5 Criteria. Cross-sectional study designed was being used. Result: A one-way anova was used. Results showed that there was a significant difference in adherence to treatment between diabetic patient with co-morbid depression and diabetic patient without co-morbid depression at p<.05 for four groups [F (3, 88) =6.108, P=0.001). A Tukey post hoc test revealed that adherence of diabetic patient with no depression (97.43± 14.69) had statistically significant different than diabetic patient with mild depression (77.85± 21.76, p = .002) and moderate depress diabetic patient (80.43±28.20, p = .027). There was no statistically significant difference between diabetic patient without depression and with severe depression (90.27± 21.38, p = .922). Conclusion: The study concluded that diabetic patient without co-morbid depression are better adhered to treatment than those with comorbid depression diabetic patient. The impact of demographic factors should explore in future study. Keywords: Adherence, diabetes, co-morbid depression

AimsDeliberate self-harm is one of the common psychiatric emergencies in medical practice, and bipolar disorder carries one of the highest risks for self-harm among various other psychiatric and physical disorders. The relationship between self-harm and bipolar disorder and its risk factors has not been sufficiently studied in Pakistan and remains an area of investigation elsewhere. The objective of our study was to determine the frequency and factors associated with deliberate self-harm in patients with bipolar disorder.MethodsThis cross-sectional study was conducted in the outpatient department of psychiatry of a tertiary care hospital in Lahore, Pakistan, from May 2020 to April 2021. A total of 165 patients living with bipolar disorder, between the ages of 15 and 65 years, were included in our study. The diagnosis was in accordance with the criteria in International Classification of Diseases 11th Revision (ICD-11). Deliberate self-harm was defined as a non-fatal act in which an individual deliberately causes self-injury or ingests a substance in excess of any prescribed or generally recognized dosage. This was assessed through history (during last 6 months) and physical examination performed by the psychiatrist.Sociodemographic variables like age, gender, educational status, marital status and employment status, and the clinical variable of treatment compliance, were documented. The data were recorded and analysed using Statistical Package for the Social Sciences (SPSS) version 20. The association of above factors with the presence of self-harm in our study participants was then explored with Pearson Chi-Square test. The p-value of less than 0.05 was considered as significant.ResultsOut of 165 cases included in the study, 62.42% (n = 103) were male and 37.58% (n = 62) were females. The frequency of deliberate self-harm in bipolar disorder was 35.15%. In terms of association, only female gender was found to have a statistically significant relationship (p-value <0.001) with the presence of self-harm in our study.ConclusionWe concluded that deliberate self-harm is a common finding in cases of bipolar disorder in Pakistan. Additionally, vulnerable subgroups, such as female patients in this study, should receive more clinical attention and safeguarding support.

AimsChronic mania is variably defined but classically recognized as the presence of manic symptoms for more than 2 years without remission. The reported incidence ranges between 6–15% among all patients with bipolar disorders. Although it has been described in psychiatry literature for a long time, it has not yet found a place in current nosological systemsMethodsWe present a 32-year-old single and unemployed man who is supported by his family and living with a sudden-onset, continuous illness of 12 years’ duration characterized by a resistant and markedly euphoric and expansive mood with grandiose delusions. Other features such as distractibility, pressured speech, racing thoughts and psychomotor disturbance remain significant but vary and are more responsive to medical interventions. Psychotic symptoms are largely confined to mood-congruent delusions, grandiose and religious, and are reported to have followed the mood disturbance from early on. There is no history of substance use, past psychiatric or medical illness, or head trauma and no evidence of a neurological cause on workup. This gentleman has been treated with a range of mood stabilizers and antipsychotics and two courses of ECT over the years. In the recent years, he has been on a combination of Clozapine, Valproate, and Pregabalin with relatively favorable but inadequate response and limited functional improvement.ResultsChronic mania lasting for 12 years, in the absence of an organic cause, despite the use of a wide gamut of modern psychotropics, alone and in combination with ECT, and with adequate compliance is an exceptionally rare entity. It poses manifold challenges both in terms of diagnostic considerations and therapeutic approaches. The overlap of symptoms of mania, schizophrenia, and schizoaffective disorders along with chronicity adds a particular layer of complexity. The hallmark of chronic mania is euphoric and expansive mood along with grandiose delusions and the presentation is relatively less centered on sleep disturbance, hypersexuality, and psychomotor agitation as compared to an acute manic episode. It is distinguished from schizophrenia spectrum disorders as it lacks flat or inappropriate affect, incongruent delusions and disorganized thought. Course of illness, prior mood episodes and family history are important in differentiating from a schizoaffective pattern of disease.ConclusionUnremitting mania of this duration is unique in its psychiatric morbidity and devastating in its impact on the individual in terms of psychosocial functioning, quality of life, physical health and safety. It also brings unprecedented stress on the family and other support systems.