Suicide is an important, understudied public health problem in Bangladesh, where risk factors for suicide have not been investigated by case–control psychological autopsy study.

To identify the major risk factors for suicide in Dhaka, Bangladesh.

We designed a matched case–control psychological autopsy study. We conducted a semi-structured interview with the next-of-kin of 100 individuals who died by suicide and 100 living controls, matched for age, gender and area of residence. The study was conducted from July 2019 to July 2020.

The odds ratios for the risk factors were 15.33 (95% CI, 4.76–49.30) for the presence of a psychiatric disorder, 17.75 (95% CI, 6.48–48.59) for life events, 65.28 (95% CI, 0.75–5644.48) for previous attempts and 12 (95% CI, 1.56–92.29) for sexual abuse.

The presence of a psychiatric disorder, immediate life events, previous suicidal attempts and sexual abuse were found as significant risk factors for suicide in Dhaka, Bangladesh.

The issue of school attendance is currently the focus of intense activity in Schools & Local Educational Authorities in England. The latest figures from the Department for Schools, Children and Families shows the overall absenteeism as 6.26%, in England. It is thought approximately 1 to 5 percent of all school-aged children have school refusal (Fremont, 2003) and is one of the reason of School non attendance.

To investigate if the current practice regarding the assessment and management of school refusal is compliant with the local CAMHS School refusal protocol.

20 case notes of clients diagnosed with anxiety based school refusal were reviewed against standards

Majority (80%) of the patients attended their first CAMHS Clinic during which evaluations of Child (100%), family (100%) & school factors (70%) contributing to School refusal was carried out. We found anxiety disorders (83%) & depression (66%) as the main contributing child factors. We also found that nearly half of the children had parental mental illness as a signification contributory factor.

Following the initial assessment, school reports including attendance were requested in 84% of the cases. Unfortunately 33% of the patients who attended the 1st clinic did not attend further appointments. All the patients (67%) were offered gradual return to school, attendance at pupil referral unit and home tuition.25% were offered family therapy and 16% of the patients have their parents referred to the adult mental health unit. Individual works including behavioural and cognitive approach was undertaken in 42% of the cases.

The transition from a child and adolescent to an adult mental health service is necessary for young people whose mental health problems are likely to be both severe and enduring.

Adolescents between the ages of 10 and 20 make up 13-15% of the total population of the UK and they form a significant social group with major health needs.

The issue of concern is that some young people fail to make the transition, usually for reasons of service design, configuration and ethos.

The Trust transition protocol was developed to ensure that young people with continuing mental health problems, are effectively supported during the transition from child and adolescent mental health services (CAMHS) to adult mental health services(AMH) or other adult services.

To determine the compliance with trust guidelines in transfer of care from CAMHS to Adult mental health.

Consider practical and administrative issues that come up when implementing the current protocol.

Review of case notes of clients transferred to AMH between March 08 - July 09.

12 cases identified

All transfer had detailed written referral letter.In three-quarters of cases a care coordinator in AMH was allocated within 2-3 weeks of the referral, following which a formal transfer meeting took place in 75% of cases and during the transfer any crisis was managed by the CAMHS team.

GP & CMHT received a detailed discharge letter in majority of cases.However only 1/2 of cases had a planning meeting, and attendance at meetings was incomplete.

Relapse in patients of opiod addiction is very common. Dynamics of addiction relapse are not fully understood as yet. Psychiatrists would explain it on basis neurotransmitter mediated disorders like anxiety, depression, OCD, lack of impulse control and etc. For sociologist relapse is an outcome of contradictions with in society. For a psychologist it is due to maladaptive life style. In this study integrated approach has been adopted to find out relative importance of different factors implicated in relapse.

Team of psychiatrists, psychologists, addiction counselor identified different causes of relapse in patients with opiod addiction. They designed graded scale in which 10 factors were included. Study group was comprised of hundred relapsed patients. They filled Performa’s according to their personal experiences. Regression method was used for factor analysis.

Statistical analysis revealed that peer group pressure, anhedonia, and premature ejaculation are first, second and third, factors respectively. Factors like pains and aches, insomnia, impulsivity and etc followed.

Every relapse prevention program should adopt policy keeping in view relative importance of causes of relapse. For peer pressure narcotic anonymous meeting is the best solution. Anhedonia is due to reduction dopaminergic input at nucleus accumben. Dopamine agonist drugs like bupropion can be used for that. Inordinate sexual behavior and substance abuse are strongly associated. Premature ejaculation plays vital role in relapse of patients of opiod addiction. Sex therapy and drugs like SSRI,s and gabapentine can improve intra vaginal latency time.

Factor analysis can be helpful in relapse prevention program.

Erectile dysfunction is twice common in patient with depression. Testosterone plays vital role in erectile function. Low testosterone level is found in patients of depression. High level of prolactin has depressive effect on libido function. Hypogonadism and hyperprolactinemia can be the causative factor for depression. Hormonal changes can be both cause and effect of depression with ED.

In sample of 76 patients having depression with co morbid ED blood levels of prolactin, and free testosterone were determined.

Half of patients were treated with sex friendly antidepressants while in other half mesterolone and piribedil were used as adjunct medicines.

In 9.2% free testosterone level was below than reference value. In 28.9% prolactin level was high .51 .31% were found having border line free testosterone level.

In younger age group free testosterone level was lower than older age group. There exist inverse relation between prolactin level and free testosterone level. Patients who were given adjunct medication showed rapid improvement both for depression and erectile dysfunction.

Reduced level of free testosterone and high level of prolactin has bilateral relation with depression with co morbid ED. Although prevalence of hypogonadism and hyperprolactinemia is low in the study yet high numbers of borderline cases are of great significance. It is postulated that fall in sexual function is directly proportional to change in levels of these hormones from the base line that are reversed by adjunct medicines.

In patients with concomitant major depression and erectile dysfunction hormonal changes plays important role.

To determine incidence of complicated grief in the families of enforced disappearance in the conflict torn Kashmir valley. Complicated GRIEF is a recently identified symptom complex marked by continued separation distress and bereavement related accompanying traumatic distress.

A total of 100 family members who were recruited from a workshop conducted by department of psychiatry and MEDICENS SAN FRONTIERS with family members of enforced disappearances were screened by psychiatrists.

COMPLICATED GREIF was very prevalent, 79% screened positive for complicated grief, PTSD was present in 30% of screened, 41% met criteria for major depressive disorder, 38% neither met criteria for major depressive disord: er nor PTSD, even though everybody who met criteria for PTSD had major depressive disorder as comorbidity.

COMPLICATED GRIEF is a important diagnosis in this subgroup of population and results into significant distress and dysfunction and hence warrants attention.

Earthquake disaster of Pakistan in 2005 caused massive destruction. Death toll was more than 70000. Many survivors were diagnosed as having variable anxiety disorders including panic disorder and PTSD. Frequency of female patients was much higher than male. The major factors responsible are loss of life and property and uncertainty regarding future, harsh weather and repeated tremors.

Data was collected from various agencies including WHO, Turkish Red Crescent, Canadian team of relief and some other NGOs working with earth quake hit area. Diagnosis was made using semi-structured interviews.

Data analyses of women (1056), men (281) and children (204) indicate high prevalence of anxiety disorders including PTSD (853 women, 153 men) and depression (73 women, 31 men). Results vary from the observations made from other disasters. Sex ratio shows huge difference in prevalence between males and females.

Patients with PTSD have dysregulation of HPA axis response. This alteration is more pronounced in case of women. Studies show that estrogen plays important role in the genesis of disease. Dexamethasone suppression test also indicates greater dysregulation of glucocorticoid receptor. Studies reveal predisposition in women for PTSD and depression.

Women and children were affected most because most of them were at home and in schools. Hence, they sustained more physical injuries and psychiatric consequences.

In our study depression came out to be more prevalent in females. This can be explained as comorbidity of PTSD and because of its own dynamics.

After exposure to trauma male and female respond differently.

To investigate the effect of perinatal depression on birth weight, head circumference, length and infant behaviour in a group of Pakistani women living in the Greater Manchester area of the United Kingdom.

Using a prospective cohort design British Pakistani women were screened using the Edinburgh Postnatal Depression Scale (n=714), the Life events and Difficulty Schedule was used to measure social stress and the Schedule for Clinical Assessment in Neuropsychiatry interview to confirm the diagnosis of depression. Details of birth weight and height were taken from hospital records. Physical and cognitive development of the infants using the Bayleys Scale of Infant Development (BSID-111) was assessed at 6 months postnatal.

There was no significant difference in birth weight (p=0.0948) and head circumference (p=0.75) at baseline or at 6 months between the two groups. The length of the infants of depressed mothers at 6 months was significantly less (p=0.02) than the infants of non depressed mothers. There was also a significant difference between the two groups in adaptive behaviour in leisure (p=0.043) and health & safety (p=0.049).

Infants of depressed British Pakistani mothers are not more likely to weigh less at birth or 6 months when compared to infants of non depressed mothers. However they are more likely to be shorter at 6 months and score lower on the BSID on leisure and health & safety areas of adaptive behaviour.

Perinatal depression (PND) has adverse effects on the well being of the mother-infant dyad. Women with PND often show different patterns of help seeking behaviour.

We aimed to examine the association between PND and the reporting of health events and healthcare use in a cohort of British women of Pakistani origin.

Participants were recruited from antenatal clinics in the North West of England and followed up 6 months postnatal. Sixty-seven women diagnosed with depression using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) were compared with 156 non depressed controls in terms of reporting of health events elicited using the Life Events and Difficulties Schedule (LEDS). Health events included any condition that involved attending primary or secondary care.

Depressed mothers were 1.5 times more likely to report a health event within the perinatal period (p=0.005) and 1.8 times more likely to report a health event (0.031) outside the perinatal period. Depressed mothers were more likely to attend secondary care services for their children (p=0.001) but there was no significant difference in terms of attendance at primary care.

Depressed mothers were more likely to report personal health events and more likely to access secondary care rather than primary care services for health events affecting their children. This highlights the hidden costs of this condition and the need for adequate diagnosis and management of this treatable but under recognised illness.

To evaluate the long-term safety and efficacy of adjunctive aripiprazole (ARI) to lithium (LI) or valproate (VAL) in delaying time to relapse in bipolar I disorder.

Bipolar I disorder subjects with a current manic or mixed episode received LI or VAL for at least 2 weeks; inadequate responders (YMRS score ≥ 16 and ≤35% decrease from baseline at 2 weeks) received adjunctive ARI. Subjects maintaining mood stability (YMRS and MADRS ≤ 12 for 12 consecutive weeks) were randomised 1:1 to double-blind ARI (10 to 30 mg/day) or placebo (PBO) plus LI or VAL. Relapse was monitored up to 52 weeks.

337 subjects were randomised to continuation of mood stabiliser plus adjunctive ARI or PBO; 61.3% and 52.7%, respectively, completed the study. Adjunctive ARI significantly delayed the time to any relapse, hazard ratio = 0.544 (95% CI: 0.33, 0.89, log-rank p = 0.014). Overall relapse rates at 52 weeks were 14.9% and 25.4% in ARI vs PBO subjects. A superior reduction in CGI-BP Mania Severity of Illness from baseline at 52 weeks was also observed (0.3 vs. 0.0, respectively, p = 0.01). Adverse events generally were as expected per known drug and illness profiles with no significant difference in mean change in body weight between adjunctive PBO (0.60 kg) and adjunctive ARI (1.07 kg) (p = 0.49 Week 52, LOCF).

Continuation of aripiprazole treatment increased time to relapse to any mood episode compared with placebo plus LI/VAL over 1 year, indicating a long-term benefit in continuing adjunctive aripiprazole to a mood stabiliser after sustained remission is achieved.

The age of onset of mental health problems is becoming younger and the severity of illness presentation throws lots of challenges for health professionals and service providers. Currently there are only four recognised Psychiatric intensive care units in England.

Little data is available regarding the characteristics of patients referred and treated in adolescentPICU's. This presents a challenge for clinicians and service providers for delivery of care for this patient group and developing care pathways. The main objective of this study to get a better understanding of the young people referred to help optimise care whilst in hospital and develop appropriate care pathwaysAimsThe study aims at identifying demographic, diagnostic characteristics and care pathways for young people admitted to an adolescent PICU.

A retrospective case note study was undertaken of all the patients admitted over three years since opening of the adolescent PICU at Cheadle Royal hospital.

Data was collected from all the young people admitted to the ward between April 2007 and April 2010.Information regarding demographics including age of presentation, gender characteristics, ethnicity and area of referral were looked. The authors looked at the care pathways including reasons for referral, where admitted from, risk issues on admission, diagnostic criteria and discharge pathways.

This study has highlighted the widely held impression that there are still gaps in adolescent crisis provisions and the need for further acute interventions. The study highlights the challenges for service providers the current gaps in care pathways for young people with multiple diagnosis and lack of adequate crisis interventions in the community.

Early psychosis is not a discrete disorder; rather it is mixed-up state .Different states like depression, anxiety, psychosis, obsession manifest during this period. 20% to 40% of BLIPS positive subjects eventually make transition to psychosis. Large proportion of remaining patients develops anxiety or mood disorders. During early psychosis unitary psychosis, manifest itself in forms of different psychiatric disorders.

An electronic search was made at data based websites including pub med and Blackwell synergy using key words, unitary psychosis, prodrom, early psychosis .This was followed by manual and internet study of relevant articles .

Cognitive deficits and defects of facial recognition were present in both schizophrenic and bipolar prodrom .In 24.2% schizo-obsessive patients reduced size of the left hippocampus was found. 84% subjects reported depressive symptoms before transition to psychosis, 73% of patient of schizophrenia starts with non-specific affective and negative symptoms. In presence of depression, probability of transition to psychosis increased from 4% to 21.7%. In 47.3% of patients, OCD occur before onset of frank psychosis.

High prevalence of comorbidities during prodromal phase indicates that shared common factor is involved. Anxiety, depression and attenuated psychosis are integral components of early psychosis. Overlapping of bipolar and schizophrenic prodrms depicts commonality of origin of two disorders.OCD is associated with schizo-obsessive subgroup. Strong interactive relationship among different disorders could be explained on basis of unitary psychosis.

Presence of unitary psychosis is realized in the studies of early psychosis.

In psychiatry there exist, parallel trends of splitting and clumping of disorders. Former represents dichotomous Kraepelinian trend and latter stands for integrated approach of unitary psychosis .Advancement of biochemical studies and genetics have provided some evidences in favor of unitary psychosis.

Authors made an internet search at various databases websites including pub med, and Blackwell synergy using, early psychosis, prodrom, neuroprotection, apoptosis as key words. It was followed by manual and internet study of authentic psychiatric journals.

Anatomical, functional and neurochemical studies of brain reveal structural changes in early psychosis.

In schizophrenia, pathological process is progressive. Brain volume loss continues even after onset of overt symptoms.

Study of subjects in prodromal phase shows 15-point drop in GAD. Significant proportion also met criterion of anxiety 86% depression 76% low energy 62% and, social with drawl 71%.

Unitary psychosis symbolizes concept of unity in diversity. Neurodevelopmental apoptotic process has its own direction that manifests in form of affective symptoms, anxiety symptoms, obsessive symptoms cognitive deficits, positive psychotic symptoms and ends with negative symptoms. It is assumed that neurodevelopmental process move from lower to higher centers of brain. Neuroprotection during emerging phase of psychotic disorder can delay the onset. Neurochemical studies shows that SSRIs atypical antipsychotic, anticonvulsants, and lithium has antiapototic properties which modulate the progression This suggests that apoptotic process is the thread that connects apparently different disorder is unitary psychosis.

Neurobiological model can account for unitary psychosis.

Using a cross sectional study design 1366/1401 women in their 3rd trimester of pregnancy were screened for depression using the Self-Rating Questionnaire (SRQ) and the Edinburgh Postnatal Depression Scale (EPDS). These instruments are validated, available in Urdu and have been used in the pre and postnatal period in Pakistan. The life events checklist was used to measure social stress and the Brief Disability Questionnaire (BDQ) for disability.

342 women scored ≥ 12 on the EPDS giving an estimated AND prevalence of 25.6 %. The EPDS and SRQ scores showed a high positive correlation. A significantly higher percentage of depressed women experienced problems in marital relations, work, finances, housing and domestic violence. Depressed women had higher disability scores. 32% of the depressed and 14% of non depressed were unable to perform usual daily activities. 35% of depressed women stayed in bed due to illness as compared to only 16 % of non-depressed.

This study confirms a high prevalence of AND in less educated women, experiencing a large number of social difficulties.

Premature ejaculation (PME) is the most prevalent sexual disorder. It affects more than 30% of male population. Thus far SSRI,s clomipramine, local anesthetic along with psychological therapies are the mainstay in the treatment of PME. However, not all the cases are amenable to these treatments. Attempts are underway to find out better remedies for this problem. Gabapentine an anticonvulsant drug is being tested for treatment of PME.

Electronic search was made at database websites, using key words gabapentine, premature ejaculation. It was followed by manual research to find out possible mechanism by which gabapentine could delay orgasm.

Search could not provide concert mode of action which explain inhibitory action on premature ejaculation by gabapentine; except for its anti anxiety effect mediated by gabanergic properties.

Gabanergic action explains its anti anxiety, muscle relaxant and CNS depressant properties which could be beneficial, for premature ejaculation. Gabapentine has anti glutamate properties as well. This action further imparts anti excitatory effect which is helpful for PME. Excellent efficacy on neuralgic pains and neuropathies indicates that gabapentine desensitize the receptors which are oversensitive as are found in erogenous zones of premature ejaculators. Orgasm and partial seizure share many common features. Hence anti antiepileptic properties increase threshold of physiological seizure that is orgasm.

Gabapentine can be considered as medicine which works on PME with a mode of action different from SSRI,s.

Ego defense mechanisms, defined by Freud as unconscious resources used by the ego to reduce conflict between the id and superego, are a reflection of how an individual deals with conflict and stress. Vaillants’ proposed Hierarchy of Defenses states that mature defenses are associated with better adaptive functioning and health, as opposed to immature defense which are correlated negatively with measures of adaptive adult functioning.

This study assesses the prevalence of various ego defense mechanisms employed by medical students of Karachi, which is a group with higher stress levels than the general population.

A questionnaire based cross-sectional study was conducted on 682 students from five major medical colleges of Karachi in November 2006. Ego defense mechanisms were assessed using the Defense Style Questionnaire(DSQ-40) individually and as grouped under Mature, Immature, and Neurotic factors.

Neurotic defenses had a higher mean score(5.62) than Mature(5.60) and Immature(4.78) mechanisms. Immature mechanisms were more commonly employed by males whereas females employed more Neurotic mechanisms than males. Neurotic and Immature defenses were significantly more prevalent in first and second year students. Mature mechanisms were significantly higher in students enrolled in Government colleges than Private institutions (p< 0.05).

Neurotic mechanisms are more commonly encountered than Mature or Immature mechanisms among medical students of Karachi, and this could reflect greater stress levels than the general population. Employment of these mechanisms was associated with female gender, enrollment in a private medical college, and students enrolled in the first 2 years of medical school.

Orgasm is the most powerful reinforcer of behavior. Feelings can be spiritual in miniorgasm and sensational in complete orgasm. Orgasmic conditioning act as underlying mechanism of development of paraphilias and sex addiction.

An electronic search was made on various database websites including, pubmed, science direct,and etc using key words orgasm, conditioning, paraphilias. It was followed by study of literature in journals and books.

Professional websites produced only couple of studies on orgasmic conditioning. This indicates this topic is not well taken by researchers.

Orgasmic center in brain is located in para ventricular nucleus of anterior hypothalamus and medial preoptic area. Intraorgasmic EEG exhibits visible changes. Orgasm produces euphoria and alleviate anxiety, pain, muscular tension and stress. Orgasm is mediated by dopamine which also act on nucleus accumben. During that process serotonin, endorphin and oxytocin are released. Oxytocin secretion start with arousal and during orgasm reaches its climax. It induces cuddling behavior which serve as basis o f physical and emotional intimacy. Orgasmic conditioning can bring about pairing of neutral stimuli with erotic sensation. Both male and female are capable of achieving multiple orgasms after some training. Prolongation of arousal and multiorgasmic capacity can pronounce its effects. For treatment of paraphilias like fetishism and pedophilias orgasmic condition is utilized. Positive association with healthy objects and activities can be used for treatment of various addictions.

With advanced biological understandings, orgasmic conditioning can be used in novel ways.