Pathway to psychiatric care in Karachi.
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Biomedical subjects
Publications and source records attributed to Murad M Khan.
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Suicidal behavior includes ideation, attempts and completed suicides. Information on suicidal behavior from Pakistan, a conservative South Asian Islamic country, is lacking. To address the issue, a pilot study was carried out to assess the prevalence of suicidal ideation in Pakistani college students. Suicidal ideation was assessed on the basis of responses to four questions contained in the depression subscale of the General Health Questionnaire-28. Of the total 217 completed questionnaires, the overall rate of suicidal ideation was 31.4%. While there was no significant difference between genders, more females (33%) than males (29.2%) responded positively. Respondents belonging to single parent families and those living at home, compared to those using hostel facilities, reported higher rates. The reported rate in our sample is higher than similar studies conducted elsewhere. There is the need for more information in this important area of suicidal behavior, including studying such feelings in school going children as well as in a larger community sample. The findings of such studies can contribute to our understanding of the suicidal process in the Pakistani population and to address it at various levels.
There are very few reports of electroconvulsive therapy (ECT) from developing countries, where lack of regulation and misuse has lead to negative publicity. We present our experience of ECT use at a university hospital in Karachi, Pakistan, over the course of 13 years. During the study period, 4013 patients were admitted to our inpatient unit, of which 136 (3.38%) received ECT. ECT was conducted under the supervision of consultant psychiatrist and anesthetist with continuous monitoring during and after the procedure. The most common indications were mood disorders. The average number of ECTs administered per patient was 6 (range, 1-20). A total of 35% of patients had medical comorbidities but did not suffer any deleterious effect from the procedure. A total of 75% patients showed improvement in their clinical condition. No major complication was observed in any of the patients. Our study demonstrates the effectiveness if ECT in a low-income, developing country. We strongly recommend following guidelines to ensure patient safety and minimizing side effects. This will ensure better patient acceptability and compliance.
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The Indian subcontinent comprises eight countries (India, Pakistan, Bangladesh, Nepal, Sri Lanka, Afghanistan, Bhutan, and the Maldives) and a collective population of more than 1.3 billion people. 10% of the world's suicides (more than 100,000 people) take place in just three of these countries, viz. India, Sri Lanka, and Pakistan. There is very little information on suicides from the other four countries. Some differences from suicides in Western countries include the high use of organophosphate insecticides, larger numbers of married women, fewer elderly subjects, and interpersonal relationship problems and life events as important causative factors. There is need for more and better information regarding suicide in the countries of the Indian subcontinent. In particular, studies must address culture-specific risk factors associated with suicide in these countries. The prevention of this important public health problem in an area of the world with myriad socio-economic problems, meager resources, and stigmatization of mental illness poses a formidable challenge to mental health professionals, policy makers, and governments of these countries.