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Pakistan Psychiatric Society urged to come up with its own guidelines on use of ECT.

KARACHI -- ECT is a very useful and effective treatment modality in various psychiatric disorders if used judiciously particularly in case of mood disorders and schizophrenia. This was stated by various speakers participating in the discussion following an excellent presentation on Use of ECT in clinical practice by Dr Sohail Ahmad from Karachi Medical and Dental College. He made this presentation in one of the sessions during the recently concluded Prof.Musarrat Husain Memorial Psychiatric Conference at Karachi. This session was jointly chaired by Prof. Iqbal Afridi from Karachi, Dr. Nassar Sayeed Khan from Lahore and Dr. M.Irfan from Peshawar.

Dr. Sohail Ahmad in his presentation pointed out that some psychiatrists use ECT rarely but some use it much more. He did this e mail survey on use of ECT among psychiatrists and confidentiality was assured to those who participated. He got response from fifty six which included 44 male and 12 female. Their mean age was forty two years. Seventy five percent of them were practicing for over fifteen years and 60% of them said they use if frequently while 7% said they do not use it at all. Reasons for not using ECT were mentioned as few indications, fear of complications and other treatment options being available. Twenty two percent patients, it was stated were not willing to accept ECT. Almost 82% use ECT in mood disorders and schizophrenia. The complications which they encountered included confusion, memory impairment. Again 70% use ECT under general anesthesia and 25% use it in Wards. It was also stated that counseling before the use of ECT was very useful.

Written informed consent is taken by most of the psychiatrists. As regards response 35% got excellent response while 44% got good response. Some did not agree with the use of ECT stating that it was an old fashioned treatment. Pregnancy, epilepsy, age over eighty years was mentioned as some of the contraindications for use of ECT. The number of ECT used in a treatment session included six to eight which depended on response.

His conclusions were that ECT is being used and majority of those using it are satisfied with the results. Mood disorders were a major indication. It was mostly being used in Operation Theatre or in Wards and unmodified use of ECT should be discouraged.

During the discussions it was also pointed out that old psychiatrists use it more as compared to younger psychiatrists who are less confident while some centers use it frequently. Mr. Shaukat Ali Jawaid referred to the NICE guidelines in UK on ECT and said that it was an effective and quite useful treatment modality. However, some of the psychiatrists who do not use ECT misguide the patients frightening them of the complications. Hence it was important that Pakistan Psychiatric Society comes up with its own modified guidelines on the use of ECT in Clinical Practice keeping in view our cultural values and socioeconomic environment benefitting from the NICE guidelines. Prof. Iqbal Afridi said that ECT was an evidence based medicine and we do need our own local guidelines. GPs should be encouraged to see more psychiatric patients.

Dr.M. Irfan from Peshawar was the next speaker who gave details of a survey he conducted in Peshawar about diagnosis and treatment of schizophrenia among the General Practitioners. One of the objectives was to find out the frequency of schizophrenia seen in GP clinics. One hundred fourteen out of 155 GPs in Peshawar city agreed to participate in the study. Those who gave more than 60% correct answers were considered as having good knowledge. The response rate was 84.4%, 97% of the GPs were male and 13% of them treated more than ten schizophrenia patients annually. While 32% got good response, 60% had poor knowledge of psychiatry while 8% had no knowledge at all about schizophrenia. The conclusions from the study were that only 12% GPs had good knowledge about the subject while the rest had very poor knowledge. Most of the psychiatric patients are usually referred to the psychiatrists due to stigma attached to it.

There is no organized CME programme for the GPs Family Physicians and the young doctors do not have adequate training in psychiatry. There is a poor communication between GPs and psychiatrists. Dr. Irfan was of the view that let us give chance to the GPs to treat these patients. He also emphasized the need for a collaborative approach. Poor and delayed diagnosis coupled with inadequate treatment makes the life of these patients' worse hence it calls for effective measures to ensure care of these patients.

In another session chaired by Dr. Azizur Rehman Yousufzai along with Dr. Shauib Ahmad, Dr. Imran Ijaz Haider from Lahore made a presentation on Depression and medical conditions and its management. He referred to sudden cardiac episode in an eminent psychiatrist leading to death which showed that we are unable to identify cardiac problems. Anxiety and depression has a very vicious cycle. Anxiety, he said, can be an independent risk factor for cardiologists. He then referred to anxiety and coronary heart disease, heightened level of perceived fear and nervousness. Figures from USA reveal that 30% cardiac patients suffer from depression and there is four times more depression in cardiac patients after AMI. Many die within six months. Twenty percent of cardiac patients in coronary care units suffer from severe depression. He also referred to anxiety and depression in various other medical conditions like diarrhea, TB.

Physical activity, Cognitive Behavioral Therapy and rehabilitation structure which are effective therapeutic interventions. He further suggested that collaboration between cardiologists and healthcare professionals should be improved.

Dr. Mazhar Malik from Rawalpindi made a presentation on relationship of socio demographic variables and psycho social stresses in dissociative disorder patients. This was based on a study of one hundred patients. He pointed out that in many cases females are not allowed to go out for higher education. About 61% had depression and 61% had anxiety in conversion disorders. This is seen very rare in the West but failure to achieve goals in our set up leads to abdominal pain among these female patients. During the discussion it was stated that since most female have no freedom of expression, they develop seizures, psychogenic fits etc.

In the session chaired by Prof. M. Sultan along with Dr. Imtiaz Dogar and Dr. Sohail Ahmad, Dr. Mohsin was the first speaker who talked about management of treatment resistant depression. Dr. Sarwat Jahan spoke on level of emotional disturbance among culturally deprived, hearing impaired and mentally retarded children while Dr. Faiza Batool discussed differences in emotional intelligence, self esteem and subjective well being of working women and non-working women.

Mr. Shauakt Ali Jawaid Managing Editor of Pakistan Journal of Medical Sciences in his presentation talked about basic principles of medical writing and the second part of his presentation was on how to write a scientific paper. All the presentations were followed by lively discussion. The chairpersons in particular commended the presentation on writing a scientific paper and felt that it was quite useful and informative for most of them. They were of the view that the art of medical writing needs to be popularized and the healthcare professionals should concentrate on documentation and publication of their experience, research work. A number of other presentations were also made in the concurrent sessions while the Pakistan Psychiatric Society also held its Executive Committee meeting during the conference and discussed various important issues.
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Publication:Pulse International
Date:Jul 31, 2012
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