An artistic inquiry into gender identity disorder/ gender dysphoria: A silent distress

Gender Dysphoria is a condition with a strong and persistent incongruence between one's experienced and assigned gender. The magnitude of disturbance is enormous, ranging from social isolation, rejection, segregation and exclusion from the society to some severe mental health problems such as anxiety, depression, self-harm and death. The condition been recognized across wide range of cultures around the world; however the degree of its expression and tolerance varies. Art has long been used as a medium for expression as well as a tool for therapy. In this paper, the researcher has used the medium to highlight the challenges associated with Gender Dysphoria.

Prevalence and pattern of self-medication in Karachi: A community survey

Objective:

To study the prevalence and pattern of self-medication among adult males and females in Karachi, Pakistan.

Methods:

This cross-sectional community- based survey was carried out at five randomly selected towns of Karachi (Defence, Gulshan-e-Iqbal, North Nazimabad, Malir, Orangi town) over a period of 3 months (October, November & December 2012). A sample size of 500 adult cases (250 males & 250 females), with systemic random selection from different towns of Karachi were inducted in this study. The city was divided in 5 zones and one town from each zone was selected by systemic randomization. First available male and female from each randomly selected house were included in the study. After consent and confidentiality assurance they were interviewed on semi-structured Performa designed for this purpose. Results were analyzed and tabulated through SPSS v14.0.

Result:

The prevalence of self-medication in males and females in Karachi is found to be 84.8% (males 88.4% and females 81.2%). The most frequent symptoms for which self-medication used were headache (32.7%), fever (23.3%) and the medicines used were painkillers (28.8%), fever reducer medicines (19.8%). The most common reason 33.3% was previous experience with similar symptom.

Conclusion:

Self-medication is highly prevalent (84.8%) in Karachi. It was frequently used for headache followed by fever. Predominantly painkillers, fever reducer and cough syrups were used in the form of tablets and syrups. Main source of medicines for males were friends and for females were relatives.

Assessment of cardiovascular disease risk in depressed women of reproductive and menopausal age

It is well documented that depression increases the risk of cardiovascular disease (CVD). Women of age 55 and younger with depression are more likely to have CVD. The present study aims to investigate CVD risk in depressed women of reproductive age (RA) and menopausal age (MA). Adult women of RA and MA were divided in to two groups; healthy and depressed. Women were screened for depression (ICD-10 criteria) at outpatients department of local psychiatric hospital. Fasting serum cortisol, estradiol and lipid profile levels were determined. Data was analyzed using two-way ANOVA followed by Newman's Keuls q-test. Total cholesterol (TC), low-density lipoproteins (LDL) and triglycerides (TGs) were raised in MA women however high density lipoprotein (HDL) and estradiol were lower as compared to RA women. Depressed RA women showed increased TC, LDL and HDL but decreased estradiol as compared to healthy women of similar age group. MA depressed women showed increased TC and LDL but decreased HDL and estradiol as compared to healthy controls. We found that MA depressed women had low HDL and estradiol as compared to RA depressed women. Circulating cortisol levels were increased in both depressed RA and MA women compared to respective healthy controls. Low HDL/LDL ratio was found in both healthy and depressed MA women when compared with respective RA women. A significant negative correlation of estradiol and cortisol was found in depressed RA women. It is concluded that low HDL/LDL ratio and hypercortisolemia in both healthy and depressed MA women make them more vulnerable to CVD.

Frequency and predictors of cognitive decline in patients undergoing coronary artery bypass graft surgery

OBJECTIVE

To determine the frequency of cognitive impairment and its predictors in patients, who underwent first time coronary artery bypass graft surgery (CABGS).

STUDY DESIGN

An observational study.

PLACE AND DURATION OF STUDY

The National Institute of Cardiovascular Diseases (NICVD), Karachi, from December 2008 to December 2009.

METHODOLOGY

Study included patients > 18 years, who underwent first-time elective CABGS. Emergency CABGS, with additional cardiac procedures, myocardial infarction (MI) within one month and known psychiatric illness were excluded. Patients were evaluated for their socio-demographic profile, medical history, intra-operative, anesthetic and surgical techniques and postoperative complications/therapy in ICU. Cognitive functioning, before the surgery, at discharge, 6 weeks and 6 months post-CABG was evaluated by McNair's and MMSE scales. HDRS was added to see if depression was a confounding factor for cognitive decline.

RESULTS

One hundred and thirty four patients were followed-up at discharge, 74 at 6 weeks and 73 at 6 months. There were 113 (84.3%) males and 21 (15.7%) females, with mean age of 53.7 ± 8.36 years. Prevalence of cognitive disturbance at baseline was 44.8%, which increased to 54.5% at discharge, and improvement was seen at 6 months, it was 39.7%. Older age, female gender, higher bleeding episodes, and high post-surgery creatinine level were more frequently associated with cognitive decline.

CONCLUSION

Postoperative cognitive deficit was common and remained persistent at short-term. Older age, females and high postoperative creatinine were identified as its important predictors. There was high frequency of acute depression before surgery with significant reduction over time.

Cognitive disturbance comparison among drug-naïve depressed cases and healthy controls

OBJECTIVE

To assess and compare cognitive disturbances among newly diagnosed depressed and healthy control cases on the McNair and Kahn auto-evaluation scale.

STUDY DESIGN

Comparative, cross-sectional study.

PLACE AND DURATION OF STUDY

Out-patients Department of Psychiatry, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from February to May, 2007.

METHODOLOGY

All consecutive new cases reporting at the out patient department were screened for depressive illness. They were matched with healthy-controls aged between 18-40 years. Clinical assessment was carried out on the basis of detailed history, physical examination, mental state examination by psychiatrists. For diagnostic purpose, application of ICD-10 followed by administration of Scale for Cognitive Difficulties.

RESULTS

Sixty subjects, 30 depressed patients (20 females and 10 males) and 30 healthy-controls (18 females and 12 males) were assessed. The age of cases with depressive disorder ranged 18-38 years. It was found that 63.3% (65% females and 60% males) depressed patients had cognitive difficulties compared to 3.3% of healthy-controls (p < 0.001). Proportions were compared using chi-square test with significance at p < 0.05.

CONCLUSION

Depression is not merely an emotional (mood) disorder but has an impact on cognition domain as well. Attention/concentration was the most common domain of cognition affected, followed by memory disturbance among the drug-naïve depressed patients.

Clinical features of depressive disorder among patients below 18 years of age

OBJECTIVE

To determine clinical manifestations of depressive disorder among cases below 18 years.

DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

Carried out at NMI (Neurospinal Medical Institute), Karachi, over a period of 3 years (October 2001 to 2004).

PATIENTS AND METHODS

Four hundred consecutive cases, below the age of 18 years, were evaluated. One hundred cases were inducted in this study based on detailed history and interview by psychiatrists. The diagnostic criteria of ICD-10 (International classification of diseases in its tenth revision) of WHO was used. Results based on clinical features were tabulated and analysed with SPSS-10. Fisher s exact test/Chi-square test were used for comparison between male and female cases.

RESULTS

A total number of 400 consecutive cases, below the age of 18, who approached for psychiatric consultation, were evaluated. After applying the ICD-10 diagnostic criteria, a 100 (25%) of them were found to be suffering from depressive disorder. Among them, 54 were girls and 46 boys, giving a male to female ratio of 1:1.32 and statistically insignificant gender difference. Instead of mood disturbance, the most frequent presenting complaints included pain (55%), insomnia (33%), fear (16%), weakness (14%) and aggression (13%).

CONCLUSION

Depression is a common psychiatric disorder among the pediatrics and adolescents. The clinical presentation was usually found to be atypical.

Anxiety, depression and stress among the husbands of obstetric cases at Karachi

OBJECTIVE

To determine the level of Anxiety, Depression and Stress among the Husbands of Obstetric Cases.

SUBJECTS AND METHODS

This hospital-based prospective study was conducted at Karachi, during the year 1998. A semi-structured proforma along with Hospital Anxiety Depression Scale (HAD) and Life Events Scale were administered to the consenting spouses of obstetric cases.

RESULTS

Only 23% of lower socio-economic group husbands accompanied their wives to the hospital compared to 70% of the higher socio-economic group. Out of the 56% of husbands of 82 consecutive obstetric cases interviewed, 13% of those whose wives were NVD showed anxiety and depression as compared to 25% of those with Cesarean Section (C/S). Life Events Scale showed 50% of lower socio-economic group having stress compared to only 10% in higher socio-economic group.

CONCLUSION

Contrary to the West, where majority of the Obstetric cases are accompanied by their spouses, in our study only 23% of the cases had their husbands present within the obstetric facility. There is a need of such a study, based on a larger sample in order to address this critical period/issue, considering the concept of 'paternity leaves'. Surprisingly, majority of husbands did not have Anxiety or Depression during the Obstetric period (a critical period needing appropriate attention) of their wives.

Assessment of "insight" understanding of mental illness in developing countries

'Insight', which is an indication of patient's understanding about his/her illness, needs particularly sensitive measures for its assessment. A questionnaire regarding insight, and brief psychosocial profile of the patients was applied to 103 cases. The cases were categorized according to the diagnosis and initial understanding of mental illness and 'insight' by the patients in our culture. The study did not support the popular belief that neurotics have and psychotics do not have insight.