rss_2.0Global Psychiatry FeedSciendo RSS Feed for Global Psychiatry Psychiatry Feed Sulaiman Younis: A personal history of psychiatry in Iraq through war and conflict<abstract><title style='display:none'>Abstract</title><p>Across four decades of war and violence in Iraq between 1981 and 2003, I undertook my medical training in psychiatry. I chose this specialty in response to the suffering of the bereaved women in Iraq across these rough times. This article details a personal history of my journey specialising in psychiatry through this period in Iraq and the experience of being the first female psychiatrist who accomplished her training through the Iraqi Board of Psychiatry in a programme established in 1988. I reflect on how psychiatry was not the specialisation of choice for female doctors, which created a shortage in the field. This most acutely impacted female trauma victims, who preferred to be treated by female psychiatrists. From the 1950s to 1988, the ratio of psychiatrists in the country increased from 0.2 to 0.5 per 100,000 population. However, this saw a dramatic decrease because of two waves of migration in 1991 and 2003, as of 1998, the ratio of psychiatrists in the country had dropped to 0.1 per 100,000 of the population. The pursuit and development of this specialisation were disrupted by war, invasion and comprehensive sanctions. I also consider the socio-economic impact of these aforementioned events on society as a whole and, in particular, on the medical profession. This account tells the story of my lived experience during those difficult times and my efforts to become an example of a new generation of women psychiatrists.</p></abstract>ARTICLEtrue in adolescents exposed to war trauma Risk factors for development of depression in adolescents exposed to war trauma: does PTSD matter?<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Background</title><p>Depression is frequently comorbid with posttraumatic stress disorder (PTSD) and substantially influences its severity, course and outcomes. Published studies linking war-related paediatric PTSD and Major depressive disorder (MDD) were mainly based on cross-sectional studies.</p></sec><sec><title style='display:none'>Objective</title><p>To prospectively examine the role of PTSD and other risk/protective factors in the development of depression among adolescents with war-related trauma.</p></sec><sec><title style='display:none'>Methods</title><p>A longitudinal study of 160 adolescents aged 15–17 years with war-related trauma and displacement due to war in Eastern Ukraine was performed. Of the 160 adolescents, N = 86 met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-4) criteria for PTSD. All adolescents underwent comprehensive psychiatric assessments that included Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL) administered to both parents and children. Traumatic exposure was assessed using the modified Traumatic Events Screening Inventory for children (TESI-C). PTSD and MDD were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) and Children's Depression Rating Scale-Revised (CDRS-R), and diagnosed using DSM-4 criteria. Follow-up and repeated measurements occurred at 6 and 12 months. During the study, adolescents requiring clinical care were referred for best available care in the community.</p></sec><sec><title style='display:none'>Results</title><p>Among 92.6% of study completers, 26/79 youth with PTSD developed MDD (32.9%), compared to 6/70 without PTSD (8.5%): relative risk (RR) = 3.83 (95% CI 1.67–8.78), p = 0.0014; Number needed to harm (NNTH) = 4.108 (8.53–2.7). Using logistic regression, variables of school attendance, ‘secondary’ traumatic exposure, and treatment with Trauma-focused Cognitive Behavioral Therapy (TF-CBT) were significantly correlated with the incidence of new-onset depression among adolescents with PTSD.</p></sec><sec><title style='display:none'>Conclusions</title><p>War-related trauma with subsequent PTSD appears to be a significant risk factor for the later development of depression in adolescents. The role of PTSD as a moderator of depression merits further investigation in larger scale longitudinal studies in diverse populations.</p></sec></abstract>ARTICLEtrue variability of the current mental health practices around the globe: Twenty days in the lives of psychiatrists and other mental health care professionals from all over the world<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Introduction</title><p>The present is the future of the past, and the past of the future. This journal as well as this paper endeavour to document the lives and practices of psychiatrists and other mental health care professionals for the future mental health community and to help the clinicians of the future to understand the history and practice of psychiatry and mental health care in 2019/20. We, therefore, report the current days in the lives of psychiatrists and other mental health care professionals.</p></sec><sec><title style='display:none'>Material and Methods</title><p>To obtain reports of days in the lives of psychiatrists and other mental health professionals, we published the request on eight occasions from May 2019 to May 2020. We invited the prospective respondents/participants to send a relevant report of their psychiatric practice in a day with a maximum word count of 750 words.</p></sec><sec><title style='display:none'>Results</title><p>We received 20 reports of variable lengths from 10 countries from six continents, including from psychiatrists, psychiatrists in training, clinical psychologists and from medical students about their psychiatric training. The reports revealed a wide and highly variable range of psychiatric and mental health practices, experiences and expectations. Last but not least, the reports we received were informative and provided much information to reflect on.</p></sec><sec><title style='display:none'>Conclusions</title><p>There is a common strong commitment to support patients with mental health problems, but the ways this is achieved are so diverse that generalisations about a typical common practice seem impossible. Future studies should focus more systematically on the procedures and practices applied in helping patients with mental health problems in different countries and communities. This knowledge might eventually help identify the procedures and services that are most efficient and helpful in various clinical contexts.</p></sec></abstract>ARTICLEtrue of Association between Academic Achievement and Social Phobia among High School Students of Kathmandu<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Objectives</title><p>The general objective of this research was to see if academic achievement significantly relates with social anxiety of high school students. There were other specific and auxiliary objectives also. One among these was to gather prevalence data of social anxiety among adolescents of Kathmandu.</p></sec><sec><title style='display:none'>Method</title><p>A survey was conducted among 696 high school students of Kathmandu to see if academic achievement was associated with their social phobia. Convenient sample from a high school was used. Social Phobia Inventory (SPIN), a self-report test, was used to measure social anxiety disorder of adolescent students. Some demographic data were also collected. Data were organized in MS Excel and analysed in SPSS.</p></sec><sec><title style='display:none'>Results</title><p>The prevalence of ‘very severe’ social phobia among boys was 2.01% and girls had that of 1.71%. One-way ANOVA showed that academic achievement did not have a relationship with social phobia, F (2, 613) = 1.74, p &gt; 0.05.</p></sec><sec><title style='display:none'>Conclusions</title><p>Academic achievement was not associated with social phobia among students of a high school in Kathmandu. Boys have more prevalence of severe forms of social anxiety than girls when they are in adolescence.</p></sec></abstract>ARTICLEtrue of dance movements on stereotype and repetitive behaviours of cases with autism spectrum disorder<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Objective</title><p>The objective of the study was to observe the effects of dance movements on stereotypical and repetitive behaviours of children diagnosed with autism spectrum disorder (ASD).</p></sec><sec><title style='display:none'>Method</title><p>The sample consisted of 5 patients within the age range of 9 to 16 years. Of the pool of 15 patients, 5 were lying in the range of moderate autism spectrum disorder with a higher score on stereotypical and repetitive behaviours. There were three male and two female patients. The cases were regularly coming to the day care centre of a hospital located in the southern part of India. Participants were assessed by Autism Spectrum Screening Questionnaire (ASSQ) and BASIC-MR Part-B. Dance movement intervention was planned for these five cases.</p></sec><sec><title style='display:none'>Results</title><p>Pre- and post-test scores were taken to observe the effects of dance movements on their behaviours. Fifteen sessions with a duration of 60 minutes per session were given. The results showed improvement in the repetitive behaviour in the sample, in which of these five, three showed greater improvement.</p></sec><sec><title style='display:none'>Conclusion</title><p>Hence, the result shows that dance movement could be used as an effective method to improve stereotypical and repetitive behaviour in children diagnosed with ASD.</p></sec></abstract>ARTICLEtrue Multinational Pilot Study on the Lived Experiences and Mental Health Impacts from the COVID-19 Pandemic<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Objectives</title><p>To conduct a pilot study on the lived experiences of people affected by the COVID-19 pandemic, and the mental health impacts of the COVID-19 pandemic on affected people.</p></sec><sec><title style='display:none'>Methods</title><p>This mixed methods study used random and snowball techniques to recruit 91 respondents (age range 18–58 years) from 14 countries. Accessing patients with COVID-19 was restricted because of the nature of the disease and the treatment they were receiving which limited their access to being selected for our pilot study. Therefore, our respondents were members of the general population who were directly or indirectly affected by the pandemic. Respondents completed online surveys consisting of the Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9) and open-ended questions. Collected data were subjected to IBM SPSS statistics software (v. 22.0) and thematic analysis.</p></sec><sec><title style='display:none'>Results</title><p>Both quantitative and qualitative instruments reported very high feasibility, which is suggestive of an excellent feasibility of our mixed methods design. Second, we identified financial and time resources as major barriers to the recruitment process, and how to avert these in the main study was discussed. Third, COVID-19 pandemic had more anxious than depressive impacts on our respondents. We also found that more than half (58, 63.7%) of the total respondents showed high knowledge level of COVID-19, and the major sources from which they gained knowledge were television, radio, and online academic papers. Our qualitative insight showed five themes from the lived experiences of respondents from the COVID-19 pandemic. These themes were; changes in lifestyles, disruption of schooling activities, impact on options for health services, disruption of works and economy, and anxious and worrisome impacts, in that order.</p></sec><sec><title style='display:none'>Conclusion</title><p>Main study is feasible with minor addition required on our protocol. Given other findings, we recommend the need for adaptive coping skill training, and appropriate information sharing during pandemics. There is also the need for psychosocial preparation due to the uncertainty of pandemics. In addition, averting the likely adverse economic impacts from pandemics should be of concern to governments and other stakeholders during pandemics. Finally, we recommend that governments and other stakeholders should be cautious about the likelihood of limited health service options for the general public during pandemics.</p></sec></abstract>ARTICLEtrue structure of the Albanian version of the Clinical Assessment Interview for Negative Symptoms (CAINS): Associations with the Brief Symptoms Inventory (BSI)<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Objectives:</title><p>The measurement and assessment of the emergent symptoms in various psychotic disorders is essential to the delivery of efficacious, patient centred mental health care. Despite the existence of several instruments that can measure these factors, their applicability within a global context remains undetermined. This paper aims to provide evidence for a factor structure in Clinical Assessment Interview for Negative Symptoms (CAINS), tailored for use in the Albanian language.</p></sec><sec><title style='display:none'>Methods:</title><p>We recruited 106 patients with psychosis (68% male), who were aged 16 to 40 years old (M = 22, SD = 1.75), and treated in community services in Kosovo. We adapted, translated, and back-translated CAINS and the Brief Symptom Inventory (BSI) before these measures were administered in interviews with the participants. According to Kaiser-Guttman’s criterion (i.e., eigen-value &gt;1), four components were extracted from the original measure of CAINS.</p></sec><sec><title style='display:none'>Results:</title><p>Using Principal Component Analysis, CAINS was found to be a valid means of measurement of motivation and pleasure in various life domains (social, recreational, and work/school). Intercorrelation existed not only between the BSI scale and the CAINS scales, but within the CAINS scales themselves.</p></sec><sec><title style='display:none'>Conclusions:</title><p>In contrast to the previous studies that found Expression and Motivation and Pleasure as two major factors, our results revealed four components. Thus, it may be that the culture plays a substantial role in the factor structure of CAINS, and it might be related to different appraisal of emotional situations, which are influenced by different socio-cultural practices. These results have global implications for clinical practice and future research.</p></sec></abstract>ARTICLEtrue and Associated Factors among International Students in a Private University of Bangladesh<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Background</title><p>Depression is the second major cause of disability and is a principal source of disease burden worldwide which is quite common among international students.</p></sec><sec><title style='display:none'>Aim</title><p>This study explored the depression and its associated factors among international students of a private university in Bangladesh.</p></sec><sec><title style='display:none'>Methods</title><p>This cross-sectional study was conducted among 149 international students at a private university in Dhaka, Bangladesh using the Center for Epidemiologic Studies Depression (CES-D 10) Scale.</p></sec><sec><title style='display:none'>Results</title><p>The prevalence of depressive symptoms among international students was 47.7%. Students’ age, marital status, satisfaction with living conditions and problems concerning studies, food, homesickness, finances, accommodation, and health were significantly associated with depression.</p></sec><sec><title style='display:none'>Conclusion</title><p>This study concluded that there is an unmet need for psychological support for international students studying in Bangladesh. Appropriate support services should be directed to them to help and to overcome the challenges they face.</p></sec></abstract>ARTICLEtrue to measure the impact of the COVID-19 pandemic on quality of life: COV19-QoL – the development, reliability and validity of a new scale<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Objective</title><p>The primary objective of this paper is to present a short measure of perceptions on the impact of the COVID-19 pandemic on quality of life, along with analysis of its reliability and validity in non-clinical and clinical samples.</p></sec><sec><title style='display:none'>Methods</title><p>The scale was named The COV19 – Impact on Quality of Life (COV19-QoL) and it consists of six items presented in the form of a 5-point Likert scale. The items (i.e. statements) cover main areas of quality of life with regard to mental health. The scale was administered to 1346 participants from the general population in Croatia (the non-clinical sample) and 201 patients with severe mental illness recruited from four European countries (Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia), constituting the clinical sample. The clinical sample was part of the randomised controlled trial IMPULSE funded by the European Commission. Data on age and gender were collected for both samples, along with psychiatric diagnoses collected for the clinical sample.</p></sec><sec><title style='display:none'>Results</title><p>Main findings included a high internal consistency of the scale and a moderate to strong positive correlation among participants’ scores on different items. Principal component analysis yielded one latent component. The correlation between participants’ age and their results on COV19-QoL was negligible. Participants’ perceived quality of life was the most impacted domain, whereas mental health, personal safety and levels of depression were the least impacted domains by the pandemic.</p></sec><sec><title style='display:none'>Discussion</title><p>The COV19-QoL is a reliable and valid scale which can be used to explore the impact of COVID-19 on quality of life. The scale can be successfully used by researchers and clinicians interested in the impact of the pandemic on people experiencing various pre-existing mental health issues (e.g. anxiety, mood and personality disorders) as well as those without such issues.</p></sec></abstract>ARTICLEtrue portrayal of panic buying: A content analysis of online news portals<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Objectives</title><p>Media reporting has an influential role in panic buying (PB). We aimed to evaluate the media portrayal of PB during this COVID-19 pandemic.</p></sec><sec><title style='display:none'>Methods</title><p>We searched, collected, and analysed the news reports from the English media discussing the PB events. The search was done between 23 and 30 May 2020.</p></sec><sec><title style='display:none'>Results</title><p>A total of 525 news reports were analysed. Approximately half (49.3%) discussed the government action to handle the situation, 36.4% discussed the expert opinion regarding PB, 20.6% discussed the psychology of PB, 21.5% discussed the rumours, and 18.5% suggested remedial measures. Concerning the negative aspects, 96.6% of the titles mentioned panic buying, 75.4% mentioned the cause, and 62.3% mentioned the photos of empty shelves. The media in low–middle-income countries are 1.5 times more likely to include expert opinion (p = 0.03), 2.1 times more likely to discuss rumours regarding PB (p = 0.001), almost thrice more likely to report the cause of PB (p = 0.001), and thrice more likely to mention its impact (p = 0.001).</p></sec><sec><title style='display:none'>Conclusion</title><p>Media has been portraying more negative aspects of PB. Further, there are variations in reporting patterns between high-income and low–middle-income countries.</p></sec></abstract>ARTICLEtrue Physician Suicide: A Scoping Literature Review to Highlight Opportunities for Prevention<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Objective:</title><p>The aim of this scoping review is to map the current landscape of published research and perspectives on physician suicide. Findings could serve as a roadmap for further investigations and potentially inform efforts to prevent physician suicide.</p></sec><sec><title style='display:none'>Methods:</title><p>Ovid MEDLINE, PsycINFO, and Scopus were searched for English-language publications from August 21, 2017 through April 28, 2018. Inclusion criteria were a primary outcome or thesis focused on suicide (including suicide completion, attempts, and thoughts or ideation) among medical students, postgraduate trainees, or attending physicians. Opinion articles were included. Studies that were non-English or those that only mentioned physician burnout, mental health, or substance use disorders were excluded. Data extraction was performed by two authors.</p></sec><sec><title style='display:none'>Results:</title><p>The search yielded 1,596 articles, of which 347 articles passed to the full-text review round. The oldest article was an editorial from 1903; 210 (60.3%) articles have been published from 2000 to present. Authors originated from 37 countries, and 143 (41.2%) were opinion articles. The most discussed were suicide risk factors and culture of practice issues, while the least discussed themes included public health and postvention.</p></sec><sec><title style='display:none'>Conclusions:</title><p>Consistency and reliability of data and information about physician suicides could be improved. Data limitations partly contribute to these issues. Also, various suicide risk factors for physicians have been explored, and several remain poorly understood. Based on this scoping review, a public health approach, including surveillance and early warning systems, investigations of sentinel cases, and postvention may be impactful next steps in preventing physician deaths by suicide.</p></sec></abstract>ARTICLEtrue Novel Attention Bias Modification Single Session Training Improves Eye Gaze Behaviour in Social Anxiety Disorder: A Pilot Study<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Background</title><p>Attention bias modification (ABM) can reduce anxiety and attentional bias towards threatening stimuli, but evidence of its usefulness as a potential intervention for socially anxious individuals has been mixed. Eye contact avoidance, a maladaptive attentional strategy in social anxiety disorder (SAD), has yet to be targeted by ABM research.</p></sec><sec><title style='display:none'>Aims</title><p>This study sought to establish whether a new ABM training paradigm could increase attentional deployment towards eyes and what effect this would have on social and gaze-related anxiety.</p></sec><sec><title style='display:none'>Method</title><p>Participants (n = 23) recruited through adverts calling for people who felt anxious in social situations completed either a novel ABM training task designed to induce attentional bias towards images of eyes over images of noses, or control training. Data on response times (RTs), accuracy of responses, gaze behaviour (using an eye tracker) and scores on clinical measures of social and gaze-related anxiety were collected before and after both training tasks.</p></sec><sec><title style='display:none'>Results</title><p>ABM training produced a greater number of initial saccades towards eye images than did the control task, indicating an induced shift in early attentional deployment. ABM training was also associated with a marginal increase in fixation durations on eye images. No effect was observed on RTs or social and gaze-related anxiety.</p></sec><sec><title style='display:none'>Conclusions</title><p>Our results indicate that ABM can alter the gaze behaviour of socially anxious individuals. They also highlight the importance of eye tracking to ABM research, because it was more sensitive than analyses of RTs to changes in early attentional deployment.</p></sec></abstract>ARTICLEtrue Sartorius: A personal history of psychiatry<abstract><title style='display:none'>Abstract</title><p>As part of the intention to document the recent and current history of psychiatry, I was asked to present memories of my involvement in psychiatry over the past 50 years. Reviewers suggested that I should start this personal history of psychiatry with a summary of my curriculum vitae because this will make it easier to place the events I describe into their historical context. Here it goes, then.</p></abstract>ARTICLEtrue a psychosocial intervention DIALOG+ for patients with psychotic disorders in low and middle income countries in South Eastern Europe: protocol for a hybrid effectiveness-implementation cluster randomized clinical trial (IMPULSE)<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Objectives</title><p>Psychotic disorders have large treatment gap in low- and middle-income countries (LMICs) in South-Eastern Europe, where up to 45% of affected people do not receive care for their condition. This study will assess the implementation of a generic psychosocial intervention called DIALOG+ in mental health care services and its effectiveness at improving patients’ clinical and social outcomes.</p></sec><sec><title style='display:none'>Methods</title><p>This is a protocol for a multi-country, pragmatic, hybrid effectiveness–implementation, cluster-randomised, clinical trial. The trial aims to recruit 80 clinicians and 400 patients across 5 South-Eastern European LMICs: Bosnia and Herzegovina, Kosovo*, Montenegro, Republic of North Macedonia and Serbia. Clusters are clinicians working with patients with psychosis, and each clinician will deliver the intervention to five patients. After patient baseline assessments, clinicians will be randomly assigned to either the DIALOG+ intervention or treatment as usual, with an allocation ratio of 1:1. The intervention will be delivered six times over 12 months during routine clinical meetings. TThe primary outcome measure is the quality of life at 12 months [Manchester Short Assessment of Quality of Life (MANSA)]; the secondary outcomes include mental health symptoms [Brief Psychiatric Rating Scale (BPRS), Clinical Assessment Interview for Negative Symptoms (CAINS), Brief Symptom Inventory (BSI)], satisfaction with services [Client Satisfaction Questionnaire (CSQ-8)] and economic costs at 12 months [based on Client Service Receipt Inventory (CSRI), EQ-5D-5L and Recovering Quality of Life (ReQOL-10)]. The study will assess the intervention fidelity and the experience of clinicians and patients’ about implementing DIALOG+ in real-life mental health care settings. In the health economic assessment, the incremental cost-effectiveness ratio is calculated with effectiveness measured by quality-adjusted life year. Data will also be collected on sustainability and reach to inform guidelines for potentially scaling up and implementing the intervention widely. Conclusion: The study is expected to generate new scientific knowledge on the treatment of people with psychosis in health care systems with limited resources. The learning from LMICs could potentially help other countries to expand the access to care and alleviate the suffering of patients with psychosis and their families.</p><p>Trial registration: ISRCTN 11913964</p></sec></abstract>ARTICLEtrue for mitigating burnout among early career doctors in Nigeria: lessons learnt from the qualitative CHARTING study<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Background</title><p>Early career doctors (ECDs) are faced with many challenges due to their transition from undergraduate medical/dental studentship to being postgraduate doctors and being in an early phase of their career. The specific factors that affect ECDs in their careers and endeavors at the workplace range from poor remuneration, particularly in developing countries, to psychosocial problems (such as burnout [BO] syndrome). There is a dearth of information on BO among ECDs in Nigeria. This qualitative study aims to explore the opinions of ECDs in Nigeria on the causal/predisposing factors of BO, effects of BO, and strategies for mitigating BO among ECDs in Nigeria.</p></sec><sec><title style='display:none'>Method</title><p>Using purposive sampling method, two sessions of focus group discussions (FGDs) involving 14 ECDs (key informants) holding key leadership positions and who were delegates of other ECDs in Nigeria were conducted to explore their experiences on psychological issues among ECDs. Data collected were transcribed and analyzed thematically.</p></sec><sec><title style='display:none'>Results</title><p>BO is an issue of serious concern among ECDs in Nigeria. The causes of BO are diverse, some of which include low staff strength, prolonged work hours, wrong counseling, lack of job description and specification, and abuse of powers by trainers. In order to mitigate the issue of BO among ECDs, the respondents recommended that work policy review, medical workforce strengthening, stakeholder dialog on ECDs’ welfare, regular psychological review of ECDs, and provision of free yearly medicals need to be looked into. Conclusion: Our findings revealed that the participants considered BO issues among ECDs to be common, and it affected their performance and the overall quality of care in Nigeria health system. Based on our findings, there is an urgent need to mitigate the problem of emotional exhaustion among ECDs in Nigeria.</p></sec></abstract>ARTICLEtrue study of PTSD and depression in a war-exposed sample – comorbidity increases distress and suicide risk<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Background</title><p>Major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) are the most common mental disorders following traumatic experiences. The aim of this study was to investigate the extent to which PTSD and depression co-occurred in Serbian general population at baseline and 1 year after the follow-up, as well as how this co-occurrence was associated with sociodemographic factors, personal distress, suicidality and quality of life.</p></sec><sec><title style='display:none'>Subjects and methods</title><p>The sample consisted of 159 subjects, who fulfilled the IES criteria for PTSD, and were taken from a larger sample of 640 participants, which was chosen by a random walk technique in five regions of the country affected by major trauma. The assessment was carried out by the following instruments: Mini International Neuropsychiatric Interview 5 (MINI 5), Life Stressor Checklist-Revised (BSC-R), Brief Symptom Inventory (BSI), Impact of Event Scale-Revised (IES-R) and Manchester Short Assessment of Quality of Life Scale (MANSA). The follow-up study was carried out 1 year after the baseline.</p></sec><sec><title style='display:none'>Results</title><p>In the initial phase, PTSD was found in 100 out of 159 participants (62.9%), while 81 (51%) fulfilled the diagnostic criteria for MDD. Comorbidity of PTSD and depression was identified in 65 (40.9%) subjects of the sample. After 1 year, PTSD was found in 56 (35.2%) and MDD in 73 (45.9%) participants. Comorbidity of PTSD and depression in the follow-up phase was identified in 41 (25.8%) subjects of the sample. The subjects with comorbidity had significantly higher level of post-traumatic stress symptoms, general psychological distress as well as suicide risk and lower level of quality of life than participants with either condition alone.</p></sec><sec><title style='display:none'>Conclusion</title><p>PTSD–depression comorbidity is a common post-traumatic condition. Complex psychopathology, severity of symptoms and their consequences, both at individual and community levels, require attention to be paid to early diagnostics and treatment of affected persons.</p></sec></abstract>ARTICLEtrue effects of Rhodiola Rosea supplementation on depression, anxiety and mood – A Systematic Review<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Objectives</title><p>Rhodiola rosea is an adaptogen herb from the Crassulaceae family, which has been vastly used in the Russian and Chinese medicine. The herb is used against depression, anxiety, mental and physical fatigue and to promote overall health. In this systematic review, we examined the effects of R. rosea on depression, anxiety and mood, as these are the most relevant to mental health.</p></sec><sec><title style='display:none'>Methods</title><p>Literature searches were made in PubMed using the term ‘Rhodiola rosea’. Inclusion criteria were: Randomized controlled trials using interventions of R. rosea on any type of participants, while focusing on the effects of the intervention on depression, anxiety or mood. Mixed interventions of R. rosea with other herbs were excluded. Studies not published in English or Greek were excluded.</p></sec><sec><title style='display:none'>Results</title><p>A total of 39 randomized controlled trials were identified and their abstract was screened. After screening, a total of 17 papers were excluded because they were focusing on irrelevant outcomes. The full text of the remaining 22 papers was read and an additional 17 papers were excluded. These papers were excluded because they were eventually not focusing on our main outcome or they were using R. rosea interventions with other herbs. In the end, a total of 5 papers (n = 327 participants) were found eligible for our systematic review. In these studies, R. rosea seems to improve the symptoms of mild to moderate depression, symptoms of mild anxiety and to enhance mood. The last date of our search was October 13, 2019.</p></sec><sec><title style='display:none'>Conclusion</title><p>Rhodiola rosea supplementation may alleviate symptoms of mild to moderate depression and mild anxiety, while it may also enhance mood. The findings of our review are not definite due to the lack of available experimental data. Randomized controlled trials with a low risk of bias are needed to further study the herb.</p></sec></abstract>ARTICLEtrue Education in Psychiatry in India<abstract><title style='display:none'>Abstract</title><p>Medical education curricula, from around the world, have often neglected psychiatry as a subject of importance in undergraduate medical training.</p><p>In India, the scenario has not been different from the rest of the world. The National Mental Health Survey done in India, recently, estimates a treatment gap of around 80–85% for various mental illnesses. This provides a strong case to strengthen the undergraduate psychiatry curricula since it would help tackle the treatment gap of common mental disorders in the community.</p><p>Further, a strong educational foundation with meaningful inclusion of mental health and well-being, will also make the trainee aware of their own mental well-being and better help seeking behaviour in the medical student. In this article, we look to review the evolution of undergraduate medical education in India.</p></abstract>ARTICLEtrue Main Gaps for Randomized-controlled Trials in Psychiatry: A Bibliometric Study<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Background</title><p>There is evidence of a progressive increase in the number of Randomized Controlled Trials (RCTs) in the area of psychiatry. However, some areas of psychiatry receive more attention from researchers potentially to the detriment of others.</p></sec><sec><title style='display:none'>Methods</title><p>Aiming to investigate main gaps for RCTs in psychiatry, the present bibliometric study analysed the bi-annual and five-year rates of RCTs in the main database of medical studies (Pubmed) over the 1999–2018 period (n = 3,449). This analysis was carried out using the ICD-10 mental and behavioural chapter. ICD-10, was the edition of the manual used throughout the above period.</p></sec><sec><title style='display:none'>Results</title><p>Overall, after 16 years of considerable increase in the bi-annual absolute number of RCTs, there has been a slowdown in the last 4 years, similar to other medical areas. Affective, organic and psychotic disorders, and depression, schizophrenia and dementia were the top studied groups and disorders respectively – ahead of other groups/diagnoses. For substance use disorders, there has been a decrease of RCT in the last 5 years, in line with the fall of alcohol use disorder in the ranking of most studied disorders. Delirium and mild cognitive disorder are both ascending in this ranking. Personality disorders and mental retardation stand out as the least studied groups over the whole assessment period.</p></sec><sec><title style='display:none'>Conclusion</title><p>Novel treatments, ease of access to patient populations, and ‘clinical vogue’, seem to be more important in guiding the undertaking of RCTs than the actual need as indicated by prevalence and/or burden of disorders and public health impact. Regarding specific disorders, acute/transient psychosis; mixed anxiety and depression; adjustment disorder; dissociative and conversion disorders; somatization; hypochondria; and neurasthenia, would deserve future RCTs. Clinical researchers and editors of scientific journals should give special attention to the less studied areas and disorders, when considering conducting and publishing RCT studies, respectively.</p></sec></abstract>ARTICLEtrue of Pakistani community towards their mental health problems: a systematic review<abstract><title style='display:none'>Abstract</title><sec><title style='display:none'>Objectives</title><p>The objective of this research is to explore how Pakistani community perceive their mental health problems by systematically reviewing the scientific literature published on major databases. The findings expectedly will be useful for general public, for clinicians and for the researchers.</p></sec><sec><title style='display:none'>Methods</title><p>The methodology of this systematic literature search involved identifying and critically appraising studies that attempted to explore how Pakistani community perceives and understands its mental health problems. We carried out literature search on some major databases including PubMed, Cochrane database of systematic reviews and Google Scholar. We followed selection criteria where researchers aimed to find perceptions and understandings of Pakistani participants regarding their mental health by adopting scientific methodologies. The extraction of data was carried out after reading the selected papers and organising the findings under specific categories, in the form of a table. Data analysis was based on the information gathered from these studies.</p></sec><sec><title style='display:none'>Results</title><p>The results suggest that Pakistani community exhibits negligible to little understanding regarding their psychological experiences and emotional processes as separate identifiable entities. Nonetheless, multiple parallel sociocultural concepts such as religion or faith driven practices and mythical or supernatural understandings are highlighted by this research. These are accepted and practiced in order to address mental health problems.</p></sec><sec><title style='display:none'>Conclusion</title><p>It appears that Pakistani community has limited understanding and scarce vocabulary to describe their inner psychological and emotional experiences. However, in order to address the mental health issues, the community exhibits a variety of responses and reactions that are driven from several unique social, cultural and religious factors. Whether these are general perceptions or causations or protective factors towards illness or possible treatment options, they all are approached and addressed with some unique understandings and perceptions that are specific to this community.</p></sec></abstract>ARTICLEtrue