Background: According to the latest report, over 15 million people in Pakistan are suffering from some form of mental illness. But for a population of 220 million, only 400 trained psychiatrists exist with few state-run psychiatric hospitals and a small number of psychiatric units in teaching and general hospitals. In a traditionalist society, there is frequently a social disgrace together with discussing dysfunctional or abnormal behaviors as mental health problems and is generally described as a “shortcoming of character.” Methods: We carried out comprehensive literature review to collect data on the current mental health picture in Pakistan, and we also compared and formulated the recommendations from the literature of the related countries in the region and developed countries whenever possible. Results: Mental healthcare is still not a priority in the health system in Pakistan. A dire need still exists for a recognition from both public and private sectors for improving mental health planning and services in the country. Government must actualize social strategies that should be simple, equitable, and practical, as well as being able to address the issues of the regular needs. Asset allotment for emotional wellness is horrifyingly low and wasted away by defilement and fumble. A requirement exists for expanded spending on mental healthcare and psychological and emotional well-being just as appropriate usage of accessible assets. Conclusion: In this review, we suggest that a progressive change is required in the current state of psychiatry in Pakistan and that a need exists for a continuing review about existing strategies with a focus on setting sustainable priorities in the field of mental health, especially in policymaking, capacity building, awareness among public, and the use of media to minimize stigma.

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Objectives: Studies reposted that children and adolescents entering foster care systems are at risk of mental health conditions. In this study, we intended to describe the prevalence of mental illnesses as well as the characteristics of emotional and behavioral problems of children and adolescents in foster care residential institutions in Northern Taiwan. Methods: From July 2011 to January 2014, we recruited 97 children and adolescents from four foster care residential institutions due to child maltreatment or loss of dependency. They were assigned through the social welfare bureau (three group homes, n = 76) or the judiciary department due to delinquent or conduct behaviors (one youth home, n = 21). Psychiatric illnesses were diagnosed through semi-structured interviews using the Kiddie Schedule for Affective Disorder and Schizophrenia, Epidemiological Version. Emotional and behavioral problems were assessed by main caregivers in foster care residential institutions and the youths themselves. Results: We found higher rates of lifetime (54.6% in total, 44.7% in group home, and 90.5% in youth home) and current (28.9% in total, 31.6% in group home, and 19.0% in youth home) for any psychiatric disorders among the children and adolescents in the foster care residential institutions compared to those in the general population in Taiwan (31.6% in lifetime and 25% current). The rates of lifetime psychiatric diagnoses in total entire cohort, group home, and youth home were as follows: attention deficit/hyperactivity disorder (15.5%, 15.8%, and 14.3%), oppositional defiant disorder (13.4%, 2.6%, and 52.4%), conduct disorder (22.7%, 6.6%, and 81.0%), posttraumatic stress disorder (4.1%, 5.3%, and 0%), adjustment disorder (11.3%, 9.2%, and 19.0%), and nicotine use disorder (12.4%, 2.6%, and 47.6%), respectively. Self-reported depression rates were 9.0% among youths aged between 8 and 16 years, and 17.2% among those aged between 8 and 12 years. Conclusion: The results underscore the importance of receiving a comprehensive mental health assessment in the beginning and periodically for those children and adolescents in foster care residential institutions for them to receive appropriate mental health care.

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Objective: Persistent vegetative state (PVS) has similar clinical presentations with catatonia. Both PVS and catatonia can be evaluated using clinical observation and rating scales. We intended to study how catatonia rating scales perform in assessing PVS patients as compared to the standard PVS scale. Methods: Thirty residents from two nursing homes for PVS patients were evaluated with Coma Recovery Scale-Revised (CRS-R) and two catatonia rating scales (Bush–Francis Catatonia Rating Scale [BFCRS] and KANNER scale). Ten residents recovering from PVS were selected as controls, and twenty residents still meeting the criteria of PVS were selected as PVS group. Three evaluations were assessed over 6 months. We compared and analyzed the scores of each visit. The components of BFCRS and KANNER scales were also analyzed to create a simpler version for PVS patients. Results: BFCRS and KANNER scales, as well as their simplified versions, had significant correlations with CRS-R (p < 0.001 for all). This could imply that catatonia rating scales could also be used in evaluating PVS patients. Upon closer examinations of scale components, all the three scales shared components such as consciousness levels and eye movements, but BFCRS and KANNER have evaluations on rigidity and negativism, which CRS-R does not had. Conclusion: Our data suggest that PVS and catatonia share an underlying pathological mechanism. Evaluations of muscle tension, an important component of catatonia rating scales, might offer a more thorough assessment of PVS patients. Further study of using catatonia rating scales in PVS patients is warranted.

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Objectives: Depression with partial remission and residual symptoms following treatments is common. Elucidating the problems remaining in the remitted patients would help optimize treatment. In this study, we intended to study remission rate and related factors as well as their unresolved problems in patients with treated depressive disorder. Methods: We included 65 medicated patients with depression for 6–12 months. We also chose 65 healthy persons as a control group. The study participants completed Beck Depression Inventory (BDI), checklists of side effects, Sheehan Disability Scale, World Health Organization Quality-of-Life-brief version, and Pittsburgh Sleep Quality Index (PSQI). Remission was defined as a BDI score of ≤ 15. Results: We found that the PSQI score was still higher in the remission group than the control group. Conclusion: Sleep problems, which may still be a commonly unresolved problem in medicated patients with depression, should be noticed by clinicians.

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Objectives: Evidence showed that the etiology of cognitive impairment in bipolar disorder (BD) is related to genetic susceptibility. But results from many studies evaluating the association between candidate genes and cognitive function in BD are inconsistent. To define the effect of risk target single-nucleotide polymorphisms (SNPs) on the association of cognition in BD, we did a systematic review and meta-analysis to study the risk genetic variants. Methods: A search for literature was conducted through online databases updated as of October 2018. Recruited studies were compared for cognitive difference in BD patients with certain gene polymorphisms. Results: Meta-analyses were conducted, for two SNPs of target genes including brain-derived neurotrophic factor (rs6265) and calcium channel, voltage-dependent, L type, alpha 1C subunit (rs1006737), in the recruited seven studies. Quantitative analysis showed no significance in the association between the polymorphisms of rs6265 or rs1006737 with global intelligence quotient or rs6265 with Wisconsin Card Sorting test in BD. Conclusion: Our results implied that the cognitive impairment in patients with BD might not be explained by a SNP in current evidence. We suggest that further studies with larger sample size and deeper phenotype are needed to elucidate the relevance of gene variant model contributed to the susceptibility of cognitive dysfunction in patients with BD.

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