Published on

A comprehensive journal club presentation regarding a research published in pakistan on schizophrenia

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide


  1. 1. BySaad Bin Zafar Mahmood
  2. 2. Perceptions about the cause of Schizophrenia and the subsequent help seeking behaviour in a Pakistani Population - A Cross-sectional survey Zafar SN, Syed R, Tehseen S, Gowani SA, Waqar S, Zubair A, Yousaf W, Zubairi AJ & Naqvi H BMC Psychiatry 2008, 8:56
  3. 3.  Original Research article Published in BioMed Central Psychiatry Date of publication : 17th July 2008 Main corresponding author : Syed Nabeel Zafar - AKU
  4. 4.  Background & Objectives of study Methodology Results Discussion & Conclusion References
  5. 5.  What is Schizophrenia Severe mental illness characterized by fundamental disturbances in thoughts, emotions and perceptions. 8th leading cause of DALYS in age group of 15-44 years (Rossler et al., 2005)
  6. 6.  Wrong perceptions regarding the cause of schizophrenia & various stigmata Delayed treatment Studies show favorable prognosis with good family and social support, early diagnosis and management
  7. 7.  To determine the perceptions regarding the etiology of schizophrenia and the subsequent help seeking behaviour
  8. 8.  Questionnaire based cross sectional study Conducted at Agha Khan University Hospital between 18th to 22nd December 2006 (5 days) Three areas were chosen  Community Health Centre (CHC)  Consulting Clinics (CC)  Inpatient family waiting areas
  9. 9.  Sample  Total of 404 participants  Culturally diverse populations  Inclusion / Exclusion criteria applied Inclusion Exclusion • all individuals • No medical staff or medical above 18 years student was interviewed • Attendants of psychiatric patients also excluded • People unable to read urdu were excluded • anyone under the age of 18 years was excluded
  10. 10.  Questionnaire  Developed in Urdu  Three sections  Section 1 - Demographic details  Age,  sex,  marital status,  education level,  religion,  religious inclination,  Profession  Family System (Joint or Nuclear)
  11. 11. Section 2 Questionnaire Asking the participant views regarding the possible causes for a case of schizophrenia  22 choices were given  Four point likert scale used ( main reason, possible reason, not likely a reason and definitely not a reason)  Lastly asked to state the most important cause
  12. 12. Section 3 Questionnaire Asking the participant regarding the probable approach they would employ if they had a relative with a psychotic problem  15 interventional choices were given  Three point likert scale useed (definitely do, will consider doing and will not do at all)  Lastly asked to state the most important step they would take
  13. 13.  Ethical considerations  Research was in accordance with the Helsinki declaration  Participants were verbally explained the nature of research, its advantages and disadvantages  Confidentiality maintained and no such information was recorded  Written informed consent was taken
  14. 14.  Results of the demographic profile  Mean age = 31.35 ± 9.93 years  77 % males and 23 & females  Majority of participants well educated (62 % holding bachelor’s degree  Majority were Muslim (92 %)
  15. 15. Before Categorization After CategorizationCause of Schizophrenia Cause of Schizophrenia Primary level of education 8.4 22.3 12.1 54.0 13.6 38.4 Females 13.4 10.1 Nuclear family 15.6 Age greater than 47 Biological Cause Mental illness Low IQ Religious Cause Gods will Others Personality Issue Psycho-social Stressor Other Social Issues and Superstitious beliefs
  16. 16. Before Categorization After Categorization Help seeking behaviour Help seeking behaviour 10.6 3 26.7 Males 14.9Young (17-26 years) 40.6 Very religious 52.2 6.7Less educated Females 7.4 19.3 8.9 9.7Nuclear family Joint family system Moderately religious Visit Psychiatrist Professional Medical help Visit Family Physician Religious Remidies Do nothing No Help seeking behaviour Pray Social alterations Offer sadqa / Khirat Magic and Excorcism steps Others
  17. 17.  Well known that the general population of especially the developing countries attributes non biological beliefs to the cause of schizophrenia As a result there is an increase in DUP DUP is a very important factor of prognosis
  18. 18.  This study shows that those who gave biological causes for the disease were 3 times more likely to seek professional medical help. Relatives of psychiatric patients have different beliefs than that of general population (Angermeyer et al., 2003)
  19. 19.  Study shows that there is increased awareness in people living in nuclear family Underreporting of the disease due to lack of help seeking behaviour As a result unable to design nationwide strategies
  20. 20.  Limitations / Biasness in this study The sample population is not representative of the Pakistani population  Sample is highly educated  Study was conducted in a hospital setting  Likert scale used always have a tendency of bias
  21. 21.  The study gives a good impression regarding perceptions of pakistanis It shows that to decrease the burden of schizophrenia more awareness have to be created
  22. 22.  Javed Z, Naeem F, Kingdon D, Irfan M, Izhar N, Ayub M: Attitude of the university students and teachers towards mentally ill, in Lahore, Pakistan. J Ayub Med Coll Abbottabad 2006, 18:55-58. Srinivasan TN, Thara R: Beliefs about causation of schizophrenia: Do Indian families believe in supernatural causes? Soc Psychiatry, Psychiatr Epidemiol 2001, 36:134-140. Kadri N, Manoudi F, Berrada S, Moussaoui D: Stigma impact on Moroccan families of patients with schizophrenia. Can J Psychiatry, 2004, 49:625-629. Kulhara P, Avasthi A, Sharma A: Magico-religious beliefs in schizophrenia: a study from north India. Psychopathology 2000, 33:62-68.
  23. 23. 1. Rossler W, Salize HJ, van Os J, Riecher-Rossler A: Size of burden of schizophrenia and psychotic disorders. Eur Neuropsychopharmacol, 2005, 15:399-409.2. Salloum IM, Moss HB, Daley DC: Substance abuse and schizophrenia: impediments to optimal care. Am J Drug Alcohol Abuse, 1991, 17:321-336.3. Grover SAA, Chakrabarti S, Kulhara P: Cost of illness of Schizophrenia. J Pak Psych Society 2006, 3:12-20.4. Siegel SJ, Irani F, Brensinger CM, Kohler CG, Bilker WB, Ragland JD, Kanes SJ, Gur RC, Gur RE: Prognostic variables at intake and long-term level of function in schizophrenia. Am J Psychiatry,2006, 163:433- 441.5. Giron M, Gomez-Beneyto M: Relationship between family attitudes and social functioning in schizophrenia: a nine-month follow-up prospective study in Spain. J Nerv Ment Dis 2004, 192:414-420.6. Perkins DO, Gu H, Boteva K, Lieberman JA: Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry, 2005, 162:1785-1804.7. Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T: Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 2005, 62:975-983.8. Srinivasan TN, Thara R: Beliefs about causation of schizophrenia: do Indian families believe in supernatural causes? Soc Psychiatry, Psychiatr Epidemiol 2001, 36:134-140.9. Kadri N, Manoudi F, Berrada S, Moussaoui D: Stigma impact on Moroccan families of patients with schizophrenia. Can J Psychiatry, 2004, 49:625-629.
  24. 24. 10. Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P: "Mental health literacy": a survey of the publics ability to recognise mental disorders and their beliefs about the effectiveness of treatment. ed J Aust 1997, 166:182-186.11. Karim S, Saeed K, Rana MH, Mubbashar MH, Jenkins R: Pakistan mental health country profile. Int Rev Psychiatry 2004, 16:83-92.12. Javed Z, Naeem F, Kingdon D, Irfan M, Izhar N, Ayub M: Attitude of the university students and teachers towards mentally ill, in Lahore, Pakistan. J Ayub Med Coll Abbottabad 2006, 18:55-58.13. Sultan SM: Factors delaying psychiatric consultation in first episode psychosis – A retrospective cross- sectional study. J ,Med Sci 2006, 14:21-25.14. Angermeyer MC, Matschinger H: Causal beliefs and attitudes to people with schizophrenia. Trend analysis based on data from two population surveys in Germany. Br J Psychiatry 2005, 186:331-334.15. Angermeyer MC, Matschinger H: Lay beliefs about schizophrenic disorder: the results of a population survey in Germany. Acta, Psychiatr Scand Suppl 1994, 382:39-45.16. Kulhara P, Avasthi A, Sharma A: Magico-religious beliefs in schizophrenia: a study from north India. Psychopathology 2000, 33:62-68.17. Shibre T, Negash A, Kullgren G, Kebede D, Alem A, Fekadu A, Fekadu D, Madhin G, Jacobsson L: Perception of stigma among family members of individuals with schizophrenia and major affective disorders in rural Ethiopia. Soc Psychiatry Psychiatr Epidemiol, 2001, 36:299-303.18. Magliano L, De Rosa C, Fiorillo A, Malangone C, Maj M: Perception of patients unpredictability and beliefs on the causes and consequences of schizophrenia- a community survey. Soc Psychiatry Psychiatr Epidemiol 2004, 39:410-416.
  25. 25. 19. Kapur RL: Mental health care in rural India: a study of existing patterns and their implications for future policy. Br J Psychiatry, 1975, 127:286-293.20. Large M, Nielssen O: Evidence for a relationship between the duration of untreated psychosis and the proportion of psychotic homicides prior to treatment. Soc Psychiatry Psychiatr Epidemiol, 2008, 43:37-44.21. Padmavati R, Thara R, Corin E: A qualitative study of religious practices by chronic mentally ill and their caregivers in South India. Int J Soc Psychiatry 2005, 51:139-149.22. Saravanan B, David A, Bhugra D, Prince M, Jacob KS: Insight in people with psychosis: the influence of culture. Int Rev Psychiatry, 2005, 17:83-87.23. Schulze B, Angermeyer MC: Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals. Soc Sci Med 2003, 56:299-312.24. Lysaker PH, Davis LW, Warman DM, Strasburger A, Beattie N: Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: associations across 6 months. Psychiatry Res 2007, 149:89-95.25. Mann CE, Himelein MJ: Factors associated with stigmatization of persons with mental illness. Psychiatr Serv 2004, 55:185-187.26. Angermeyer MC, Matschinger H: Relatives beliefs about the causes of schizophrenia. Acta Psychiatr Scand 1996, 93:199-204.27. Gaebel W, Baumann A, Witte AM, Zaeske H: Public attitudes towards people with mental illness in six German cities: results of a public survey under special consideration of schizophrenia. Eur Arch Psychiatry Clin Neurosci 2002, 252:278-287.28. Lauber C, Ajdacic-Gross V, Fritschi N, Stulz N, Rossler W: Mental health literacy in an educational