29 January 2005	Saturday	18 Zilhaj 1425

KARACHI, Jan 28: Speakers at the 15th International Psychiatric Conference, opened here on Friday, sought immediate measures to formulate a standard drug prescription guideline for local psychiatrists coupled with steps for its proper implementation.

The three-day conference has been organized by the Pakistan Psychiatric Society. Deliberating upon the issue at a session "Dialogue with pharmaceutical industry with focus on the central nervous system drugs", expert psychiatrists observed that the issues of cost, benefits, side effects, contraindications and possible irrationality ought to be taken into serious account.

They were unanimous in their opinion that constant research has led to introduction of new, much safer and lesser toxic CNS drugs hence the argument that the cost of drugs have to be comparatively higher may be valid but keeping in view the socio-economic status and health safety of local population an extremely cautious approach is required on part of prescribers.

Meanwhile, unwilling to let the drug industry go scot-free, the speakers urged the multi-national companies to market cost-effective drugs of high quality in accordance with local needs without any pressure to meet their parent country's targets.

It was further observed that in addition to drug therapy there were also some other interventions that could help recuperation of a patient suffering from mental ailments, particularly depression, hence the government must employ more psychologists and counsellors in public sector institutions.

Senior psychiatrist Dr Noor Jehan, who was the co-chairperson of the session, while responding to the research paper "Effects of the merger of pharmaceuticals on new central nervous system research projects" of Dr Mubashar Hasan Syed dispelled the impression that psychiatrists might be recommending drugs without proper diagnosis.

Dr Mubashar in his Pakistan-based study had observed that since the merger of multinational companies on new central nervous system research a considerable decline had been noticed in the production of anti-depressive drugs though it was still found to be the commonest of mental ailments.

Deliberating on the issue of drug shortage and rising prices, the Executive Director of Punjab Institute of Mental Diseases, Brig (Dr) Said, pointed out that black marketing of medicines was the major factor leading to artificial rise in the cost of medicines.

Prof Farid Minhas, chairman of the session, while responding to the remarks made by Brig Dr Said suggested that besides increasing interaction with industry, certain stringent administrative measures were also pre-requisite to check black marketing.

Prof Malik A. Mubbashar, the vice-chancellor of Lahore University of Health Sciences, in his keynote address on "Mental health in primary health care" mentioned that no less than 24 million were in need of psychiatric help and 10 to 65 per cent of these people suffered from anxiety and depressive illness while one per cent from psychotic illnesses yet there happened to be no separate mental health programme or budget in Pakistan.

It was also mentioned that 16 to 22 of every 1,000 children between three and nine years of age suffered from severe mental retardation, seven to 18 children among every 1,000 children suffered from epilepsy while 4.01 million people were substance dependent.

This was in backdrop of the situation where only 320 psychiatrists were based in major urban centres with almost nil in rural parts of the country. Prof Malik said that around 400 clinical psychologists, 25 psychiatric nurses and handful of concerned paramedical staff were available across the country.

He attributed the scenario not only to massive brain drain but also to the fact that psychiatrists had never been appropriately involved in legislation, policy making, planning or financing or even as an efficient tool to implement what others had planned.

However, he observed that the government while taking notice of the situation had come forward with meaningful measures in 2001 to address the problems as neuro-psychiatric conditions were registered to figure in the top 20 causes of disability coupled with rising suicidal tendencies.

In addition to the much warranted Mental Health Legislation, essential drug list was also updated last year and the drugs required to treat the neurological and psychiatric disorders were also included in the list.

The senior psychiatrist claimed that due consideration was being paid towards components of mental health services with integration of mental health in primary health care system.

The focus of the programme was said to be accessibility and affordability, early identification, comprehensive care, continuous care, minimal stigma, cost effectiveness and positive results in short period of time.

Prof Malik acknowledged that immediate impact could not be possible, but in the same breath he discussed the initiation of integration project under which five districts namely Jehlum, Pishin, Sukkur, Dera Ismail Khan and Mirpur where psychiatry was incorporated into primary health care centres.

In this regard, he claimed that the roles of tertiary psychiatric facilities were redefined and indigenous teaching and training material was developed leading to modified attitude of the concerned health care providers.

As many as 2,000 primary health care physicians were trained along with 30,000 other primary health care personnel while training evaluation highlighted the need for ongoing on-job training, he said adding that a consequent follow up spread over a two-year duration showed that there was considerable decline in maternal mortality and infant deaths owing to psycho-social interventions both in short and long terms.

He also highlighted the significance of traditional wisdom adding that this was being harnessed through community health workers, good parenting skills, life skills education. The inaugural session was also addressed by senior psychologist Prof Haroon Ahmed and Prof Mussarat Hussain. - APP