Transcranial magnetic stimulation: scientific and modern technology for treatment of psychiatric and neurological disorders- Tarannum S et al.

Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Transcranial Magnetic Stimulation (TMS) is one of the most scientific and modern techniques for treatment of neuropsychiatric disorders. Recently it has been introduced in Ashiyan Medical College Hospital, Dhaka, Bangladesh. The aim of this review article is to introduce this new intervention and provide a clinically useful update about it. For this purpose twenty three articles were selected through searching internet and then reviewed. This article summarized its use in neuro-psychiatric disorders, mechanism of action, adverse effects and outcome issues. It is used in clinical and research practice around the world by psychiatrists. More research is needed to establish the role of TMS in clinical practice in Bangladesh. Bang J Psychiatry 2015;29(1):41-43

Suicidal ideation in bully victimized school children and adolescents – Shabuj MKH et al.

In the recent years there has been increased attention to the association of bullying involvement and suicidal ideation in school going children and adolescents. This meta analytic study was conducted by online searching of articles using Pub Med data bases and Google scholar. Total 21 both USA based and non USA based studies were included and sample size were 219,929. We used the research term ‘bullying’, ‘suicide’, ‘children’, ‘adolescence’ , ‘school bullying’ , ‘suicidal ideation’ and by using the term ‘cross sectional studies’, from 2010 to 2013 for studies identification. One predictor bully victimization and one outcome suicidal ideation were analyzed. Inverse weighted average was measured to see the effect size and forest plot was applied for data presentation. All the steps of meta analysis were followed. Our pooled data showed increase risk of suicidal ideation in bully victim.The results showed that odd ratio of suicidal ideation was 2.18 in bully victims in USA based studies and 95% CI 2.12 to 2.24 and odds ratio of non USA based studies was 2.31 and 95% CI 1.73 to 3.09 whereas combined USA and non USA studies odd ratio was 2.6 and 95% CI 2.20 to 3.22. Findings concluded that bully victims had the increased risk of suicidal ideation. Bang J Psychiatry 2015;29(1):35-40

Quality of life of schizophrenic patients in a tertiary care hospital in Bangladesh- Mahmud MHS et al.

Schizophrenia is one of the major mental disorders which affect individual’s thinking ability, social interaction or attention. It affects person’s entire quality of life. The purpose of the study was to find out the quality of life of schizophrenic patient in Bangladesh. Cross sectional study design was used to conduct this study. The convenient sampling procedure was used throughout the process of participant’s selection and the numbers of respondents were 83. The study was carried out at National Institute of Mental Health and Hospital (NIMH), Dhaka. Data was collected by using face to face interview with a structured questionnaire WHOQOL-BREF (The World Health Organization Quality of Life- BREF) scale. It was found that most of the participants lead poor to moderate quality of life in four domains of the WHOQOL-BREF scale. Results showed that mean scores were for physical health (mean 2.7, SD+0.106); psychological health (mean 2.108, SD +0.0787); social relationship (mean 2.226; SD+0.116) and environmental health (mean 2.47; SD+0.077).This study indicated that, quality of life poor on psychological domain. It was also found statistically significance with age and social relationship domain (p value 0.005< 0.05); marital status and physical health domain (p value 0.004<0.05); educational level and physical health domain (p value 0.005<0.05) and environmental health domain (p value 0.025<0.05). There were no statistically significant difference between gender and other variables. Schizophrenia affects all aspects of person’s life such as physically, psychologically, socially and economically. Schizophrenic patients as well as their family members led very poor quality of life. Bang J Psychiatry 2015;29(1):30-34

Assessment of depression, anxiety and stress among first year MBBS students- Alim SMAHM et al.

Medical students confront significant academic, psychosocial and existential stressors for coping with new college and schedule,. So assessment of the symptoms of depression, anxiety and stress among medical students are essential to take necessary steps to treat or prevent any psychiatric morbidity. The objective of the study was to assess depression, anxiety and stress among the first year MBBS students. This was a cross sectional and descriptive study conducted in Khulna Medical College, Bangladesh from December 2009 to July 2010. For this purpose, 105 students fulfilling inclusion and exclusion criteria were taken as sample. They filled up personal data and the short-form Bangla version of DASS (DASS-21 BV) scale. The results showed that, the mean age of students was 18.8 years with male predominance (54.3%). Symptoms of depression, anxiety and stress were found among 54.3%, 64.8% and 59.0% of students respectively. Eighty five (81%) students either had depression, anxiety or stress alone or in combination. Combination of depression, anxiety and stress was highest (36.2%). No significant association was found between gender difference and depression, anxiety or stress. Age was positively correlated with depression (p=0.004) and stress (p=0.001). Percentage of 1st year MBBS students suffering from depression, anxiety and stress were very high. Adequate psychiatric services should be provided to manage these symptoms among medical students. Bang J Psychiatry 2015;29(1):23-29

Quality of life of patients with obsessive compulsive disorder- Ahmed F et al.

Obsessive-Compulsive Disorder (OCD) is a severe and debilitating anxiety disorder which causes severely impaired quality of life. The objective of the study was to assess the quality of life of the patients suffering from OCD. It was a cross-sectional study conducted from January 2011 to June 2011 among 46 patients who attended the out-patient department of the National Institute of Mental Health Sher-E-Bangla Nagar, Dhaka, Bangladesh and Holy Family Red Crescent Medical College and Hospital, Dhaka, Bangladesh by using purposive sampling technique. A Semi-structured questionnaire, Dhaka University Obsessive Compulsive Scale (DUOCS), World Health Organization Quality of Life-Scale Brief Version (WHOQOL-BREF), Diagnostic and Statistical Manual for Mental Disorder, 4th edition (DSM-IV) were used in each case for this assessment. Results showed that mean age of the patients was (29.07±6.11) years, majority of the respondents (71.7%) were male, 63.0% were unmarried and 34.8% were students. Patients were least satisfied with social domain and patients having only obsession had lower mean score (23.54±1.80) in environmental domain than in patients having both obsession and compulsion (25.15±3.70). OCD patients having major conflict (52.2%) were least satisfied with environmental health domain and patients suffering from OCD for more than ten years (78.3%) had low score than those suffering for less than ten years (21.7%) in overall quality of life domain. Patients having strained family relationship (34.8%) were less satisfied to psychological health domain and patients getting medication (91.3%) had better quality of life in all domains than those getting no medication (8.7%). Bang J Psychiatry 2015;29(1):18-22

Major depressive disorder and generalized anxiety disorder among the patients with Diabetes Mellitus- Monzur MS et al.

Diabetes mellitus (DM) is a chronic condition which is associated with long term damage, dysfunction and failure of various organs. Many psychiatric disorders associated with DM have been also reported and among them major depressive disorder (MDD) and generalized anxiety disorder (GAD) are more common. The objective of the study was to find out the proportion of MDD and GAD among the patients with DM. This was a cross sectional study conducted in North Bengal Medical College hospital, Sirajgang, Bangladesh during the period from 1st January 2016 to 30th June 2016. For this purpose, 80 diabetic patients satisfying inclusion and exclusion criteria were selected from primarily selected sample done by convenient sampling technique. Data were collected by face to face interview using semi-structured questionnaire. MDD and GAD were confirmed by Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5) among the respondents who were found screened positive by General Health Questionnaire-12 (GHQ-12). The results showed that maximum respondents 29 (36.2%) were in the age group between 40-49 years with male predominance (57%). Among the respondents 52 (65%) were married, 48 (60%) came from a lower class family and 46 (57.5%) were rural resident. General Health Questionnaire-12 (GHQ-12) was positive in 35 (43.7%) of respondents. Among them 18 (22.5%) were suffering from MDD and 11 (13.7%) were suffering from GAD. It was shown that both MDD and GAD were higher among female patients. So physicians should pay attention to rule out psychiatric disorders in patients with DM. Bang J Psychiatry 2015;29(1):14-17

Pattern of prescribing psychotropics in the outpatient department- Alam MT et al.

Pattern of prescriptions for psychiatric patients varies which is influenced by patient variation, types of disorders, cultural and environmental influences, socioeconomic status, availability of drugs and psychiatrists own preference. The aim of this study was to determine the patterns of prescribing psychotropic drugs in psychiatry Outpatient Department (OPD) in a tertiary care hospital. The cross-sectional study was conducted in the OPD of National Institute of Mental Health (NIMH), Dhaka from January to June, 2016. In the study, the prescriptions prescribed by psychiatrists were considered as study population. Using convenient sampling method, data were collected by observation using checklist from selected 604 latest prescriptions prescribed by psychiatrists in OPD of NIMH for the patients coming there for treatment. The data on the psychotropic drugs collected for the study were antipsychotics, antidepressants, mood stabilizers and sedative-hypnotics. Results showed that a total of 1802 psychotropic drugs were prescribed with an average of 2.98 psychotropics per prescription. The most common drug group prescribed was antipsychotics (44.8%). Majority (49.7%) of the prescriptions contained 3 psychotropics simultaneously. Most common (27.8%) combination was that of antipsychotics and sedativehypnotics. Dosage regimen was twice/day for the majority (55.6%). There was a combination of oral and parenteral drugs in 48.3% of prescriptions. All the drugs were prescribed by brand names. There was no diagnosis written in 60.9% of the prescriptions. The prescription pattern was not rational and this should be intervened by educating prescribers about rational prescribing in psychiatry. Bang J Psychiatry 2015;29(1):10-13

Dementia among older patients attending National Institute of Mental Health (NIMH)- Haq AI et al.

Dementia has become the focus of attention of health care professionals’ worldwide. The objective of the study was to find out the proportion of dementia among older patients as well as to identify the socio-demographic characteristics of patients with dementia attending National Institute of Mental Health (NIMH), Sher-E-Bangla Nagar, Dhaka, Bangladesh. This was a cross sectional study conducted in NIMH during the period from 1st November 2014 to 30th April 2015. For this purpose, 78 elderly patients aged e”60 years attending both in outpatient and inpatient departments of NIMH, satisfying inclusion and exclusion criteria were selected by convenient sampling technique. Data were collected by face-to-face interview using semi-structured questionnaire. Cognitive impairment was assessed by Bengali version of Mini Mental State Examination (MMSE) and dementia was diagnosed according to Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5). The results showed that most of the patients (51.3%) were in between the ages of 60 to 64 years with male predominance (56.4%). The mean (± SD) age of the patients was 66.84 (±5.49) years. Among the patients 43.6 % came from urban area, 39.7% from the family with monthly income within 30001-45000 Bangladeshi taka (BDT) and 53.9% had family members in between 4 to 6. Among them 61.5% patients were married, 43.6% were retired from service, 32.1% studied up to primary level and 62.8% had caregivers. Most of them (88.5%) scored between 24-30 in Mini Mental State Examination (MMSE) and only 5.1% respondents had dementia. This study has provided baseline information about the proportion of dementia among elderly patients in Bangladesh that can be used in future studies. Bang J Psychiatry 2015;29(1):5-9

Psychiatric morbidity among patients in cardiac outpatient department- Sultana B et al.

Psychiatric morbidity among patients attending cardiac outpatient department has been revealed as a significant problem in many studies. The objective of this study was to determine the proportion of psychiatric morbidity among cardiac outdoor patients in National Institute of Cardio-Vascular Diseases (NICVD), Dhaka. It was a cross-sectional study conducted from September 2015 to February 2016 among the purposively selected patients of NICVD outdoor. Convenient sampling technique was used to select 151 patients aged 18 to 65 years who were attending the cardiac outpatient department in NICVD, Dhaka. A semi-structured questionnaire including Self-Reporting Questionnaire (SRQ) was used to screen psychiatric symptoms. Results showed that the mean (+SD) age of the patients was 46.09 (+11.17) years and majority of the respondents (60.9%) were male. The most common cardiac morbidity was ischemic heart disease (29.8%). Among all the respondents, 21.9% were suffering from psychiatric disorders. Maximum of the cases were diagnosed with major depressive disorder (11.3%). Thus, it was apparent that psychiatric morbidity was commonly present in patients who attended cardiac outpatient departments. Bang J Psychiatry 2015;29(1):1-4