Psych Times - Portal - The Aga Khan University

Psych Times
February 2016 | Volume 1 Issue 2
A quarterly newsletter by the Department of Psychiatry at the Aga Khan University Hospital, Pakistan
EDITORIAL TEAM
FROM THE CHAIR’S DESK
Dr Ayesha I. Mian
Dear all,
Ayesha Mian, Associate
Professor and Department Chair.
As 2016 takes off, we, in the Department of Psychiatry, embark on She has a special interest in teaching
our own initiatives and plans for the coming year. Dr Hena Jawaid and network-building.
is moving on to join faculty rank as senior instructor, two of our
graduating residents, Aisha Noor and Aisha Sanobar, are getting
Murad Moosa Khan, Professor, an
ready to join us as instructors and Sana Younus, another
avid reader with special interest in suicide
graduating resident, jump starts our child psychiatry fellowship
and geriatric psychiatry.
program as our first trainee.
Drs Humera and Shameel Khan have firmly established themselves
within the rubric of the department and have taken lead in Riffat Moazzam-Zaman,
establishing service collaboration with the Oncology department Professor, a clinician with a particular
and will be piloting biweekly psych-onc clinics to develop and fill a inclination towards women’s rights &
much needed niche. Dr Shameel has also worked on establishing social issues.
group therapy at AKU; the first therapeutic group, Beating the
Hena Jawaid, Senior instructor in
Blues, starts Feb 27th, and another one, Overcoming Mood Swings,
Psychiatry, enthusiast of poetry,
is set to start in March. On the horizon are patient caregiver
literature, art and psychiatric research.
support groups, set to be piloted within the Mind and Brain Service
Line in the next couple of months. Dr Qurat Khan has successfully
led the 3rd in the series of Dementia Support Group and
collaborated with Neurology and Ophthalmology in their successful
Waliyah Mughis, Research
specialist & autism prog. coordinator,
CME course delivered this January.
with obsessive tendencies towards
The Child Learning and Behavior Clinic, providing a comprehensive
forensic psychology.
assessment and management plan for children with ADHD,
Behavior Disorders, Autism, and other psychiatric disorders, is up
and running, manned by Dr Tania Nadeem, Munira Rasheed, Nargis Nadia Karim,
Asad, and our speech and occupational therapists.
Head nurse of
Do keep an ear and eye out for our upcoming school based Psychiatry. She holds keen interest in
programs, CME related to substance abuse led by Dr Mahmood the practical implications of Psychiatry.
Rehman and newer initiatives with the pediatric oncology
department. It looks to be a promising few months ahead as we
gear up to deliver in service, education and research.
.
“Not everything that is faced can be changed, but nothing can be changed until it is faced.”
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Pages 4 – 5
Pages 5 – 6
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Mental Health Week
Events & Highlights
Interview with Dr Saad Shafqat
Your schizophrenic child by Dr Hena Jawaid
Epilogue & guidelines for submission
James Baldwin
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MENTAL HEALTH WEEK
Celebrating dignity in mental health: November 10 – 13, 2015
HIGHLIGHTS
Tuesday, 10th November: an educational
camp for sleep hygiene and relaxation
techniques organised in the hospital
courtyard was highly successful and over 50
members of the visiting public (patients,
families) stopped by our stall to receive
informational pamphlets, a stress symptoms
checklist and sleep hygiene flyers. The
activity was run by Dr Sana Younus, Dr
Hena Jawaid, Waliyah Mughis, Nadia Karim
and many helpful nursing student
volunteers.
Thursday, 12th December: A series of
CME lectures by Dr Quratulain Khan, Dr
Mahmood Rehman and Dr Shameel Khan
was held in Lecture Hall 3.
SPIG also celebrated Mental Health Week
with the theme of artistic expression. An art
board was set up in the medical college quad
for 4 days. It displayed art entries such as
paintings, drawings and poetry sent in by
various students and doctors relating to the
theme of dignity in mental health.
An art activity "Stamp out the Stigma"
was also set up by SPIG in which students
made different finger printed greeting and
good-wish cards for the psychiatry patients
and received free brownies in return! It was
heart-warming to see everyone participate
with great enthusiasm.
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An occupational therapy stall was also
placed in the hospital and college
courtyards, where handiwork and crafts
(jewelry, paintings, sculptures) made by
Psychiatry patients were sold for over
PKR20,000 over the course of the week.
EVENTS & HIGHLIGHTS
Lectures, presentations & workshops:
Research & publications:

16th December: Dr Ayesha Mian was featured in
Media@AKU (Geo News - Report Card, and in an interview with
The Express Tribune) for discussing the impacts of the Army
Public School attack on mental health. [link to ET interview]

16th December: Dr Tania Nadeem was featured in
Media@AKU for her appearance on a live radio show
“Mukammal Ghar” on FM107 to discuss the impact of the APS
attack on mental health.

28th October: Dr Tania Nadeem was interviewed for
Newsline Magazine on bipolar affective disorder. [link to article
„Between Two Extremes‟]

Dr Tania Nadeem presented at the Karachi Grammar School
Career Fair and also conducted a discussion with O’ and A’ Level
students at KGS on ‘Stress in Adolescence’.
What we’re looking forward to:
January 2016: Dr Hena Jawaid and Waliyah Mughis
conducted a workshop on anxiety and stress management, CBT
and counselling at the School of Nursing. The workshop was
organized and facilitated by nursing students Sarmad
Mohammad Soomar and Umair Bachlani, in collaboration with
the Mind & Brain service line & Rho Delta Chapter SONAM.
February 2016: The Student Psychiatry
Interest Group will be hosting a session on
euthanasia, assisted dying, DNR and doctors’
dilemmas in an event titled „On Death,
Dignity and Choice‟. Date and time to be
confirmed.
January 2016: An article on
reproductive psychiatry by Dr Hena
Jawaid & Waliyah Mughis was
published in Acta Medica
International: Jawaid H, & Mughis
W. Insights in to Reproductive
Psychiatry: A Literature Review. Acta
Medica International. 2016;3(1):181184.

January 2016: Dr Qurat Khan,
co-author of "Evaluating pathogenic
dementia variants in posterior cortical
atrophy", was published in
Neurobiology of Aging, 37; 38-44.
4th year residents’ farewell
A farewell breakfast hosted by Dr Ayesha Mian and the
Psychiatry department for the final year residents (Drs
Sana Younus, Aisha Sanober, Ayesha Noor & Yusra
Hanif) and resident medical offer (Dr Syed
Mohammad Ali) was held in the Tea Garden at the
Sports Centre on 2nd December, 2015. All faculty, nurses
and staff members attended; cards, gifts and warm wishes
were exchanged, and the residents shared their stories and
experiences about their growth and learning at the AKUH
Department of Psychiatry.
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In the coming year, Dr Sana Younus will be pursuing a
Fellowship in Psychiatry at AKUH. Dr Ayesha Noor will be
assuming the position of an Instructor in Psychiatry at
AKUH. Dr Yusra Hanif will return to Multan. Dr Aisha
Sanober will assume the position of a Student Counselor
and Dr Syed Mohammad Ali will pursue his residency. We
wish them all the best in all their future endeavours.
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

INTERVIEW with DR. SAAD SHAFQAT
By Waliyah Mughis
Int: Dr Saad, what fascinated you or drew you in to the field of neurology?
Dr SS: So I was interested in neurology from very early on. The neuroscience part of the basic sciences course
started in the second year of university and when I started studying the brain along with my other classmates as a
second year medical student, I just was struck – it was almost like an epiphany, like a lightning bolt struck me. It
was just such a fascinating revelation, that this is ultimately the aim of everything we are trying to do: to
understand the brain. The ultimatum of scholarship, medicine, everything. There is a saying in medicine, “The
purpose of all medical practice is to save the brain.” All the specialists – ultimately their aim is to save the
brain, the king of all organs, the seat of consciousness. So I was just so drawn to studying the brain, and then of
course, in third and fourth year you have to decide if you want to be a procedural person or – let me use the word
‘cerebral’ person – so I felt more drawn to this aspect, I wasn’t inclined towards procedural/OR, so neurology was
the most natural thing for me to follow. To be honest, I didn’t toy with Psychiatry, because I also wanted to be very
much in critical illness, acuity, dealing with medical issues, so I fit in with Neurology in every way.
Int: What is your leadership approach towards the Mind and Brain service line?
Dr SS: So the service line concept was introduced by our CEO, Hans Kedzierski, to increase efficiency,
accountability, sense of ownership and ultimately improve patient service. I think it’s a successful model, and
the way it succeeds is that you create ownership of the physicians on the patient-care side of things. This new
approach is not unique to AKUH, it’s happening more and more internationally, that the academic side is being led
by a separate individual and the service chief is appointed as a separate individual. Our Mind & Brain service line
(consisting of Neurology, Neurosurgery and Psychiatry) has very talented faculty and excellent residents, and the
people working on the front lines, such as the nursing staff, technicians, URs are also very dedicated, committed
and working very hard under difficult circumstances.
Int: What went through your mind when you first heard about the idea of the service lines, and what made
you want to lead it, or what drew you to the challenges of leading the Mind and Brain SL?
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As for what drew me to the challenges of leading the M&B SL, personally speaking, I’ve been heading the section of
Neurology for a while, and I was thinking about the next opportunity for career growth. Of course, chairmanship is
one aspect, as opposed to governance and medical directorship. When the SL concept came up, I was attracted to it
primarily because this is purely neuro – brain and mind. To bring all the brain and mind and spine and nervous
system related matters, patient-related issues and diseases under one platform or framework.
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Dr SS: Interesting question. The first time I heard this idea, it was confusing to me, because I had not come across it
before. But the more I thought about it, an analogy came to my mind: (some of my colleagues don’t like me using
this analogy, but it clarifies things for me) – the evolution of Western society involved a separation of church and
state. The theocratic, religious element of church was separated from the finance and governance of the state’s
economy. This unlocked the potential of Western society, and you can see where Western society is today. This is
not meant to minimize or criticize religion in any way, but the point is that things have now advanced so much in
medicine as a field that you have to start dividing roles. It is no longer a one-man job. In this division of roles,
the separation of academia and service strikes me in the same way as separation of church and state.
Int: It seems that this was a necessary division between academic and administrative and clinical matters,
but to also comprehensively bring all the different services together within the Mind & Brain service line
must have been challenging.
Dr SS: Of course. Once you separate the academic and service issues, how do we organize the service? The most
natural thing to do is to organize it according to the organ system. For example, general surgery usually involves
abdominal surgery, so that gets teamed up with Gastroenterology. Cardiac surgery gets teamed up with Cardiology.
The brain is such a complicated organ. There is no equivalent of the mind with any other organ. Traditionally,
neurology and neurosurgery have worked very closely. But we have a third element, too – Psychiatry. This is a
fairly unique concept to our practice, and an excellent opportunity to bring mental health into the fold of
neurology.
Int: So what are the main objectives you wish to see the service line achieve in this year (2016)?
Dr SS: Well, the main objectives are to see greater patient satisfaction and to improve efficiency. So four main
goals: (1) increased patient volume, (2) increased patient satisfaction, (3) increased efficiency and (4) improved
quality of service.
Int: What keeps you driven in the practice of medicine?
Dr SS: I think it’s just what’s true for all practitioners – doctors, nurses, healthcare staff – just the opportunity to
help another human being.
Int: So you’re one of the alumni to return to AKUH to practice medicine. Would you like to share your
reasons for returning to Pakistan, to AKUH?
Dr SS: That’s an interesting question.My reason for returning was that I just wanted to be at home, to put it very
simply. I felt very comfortable in Pakistani society, I love being in Karachi, I grew up in Karachi, and also felt very
connected to AKU. I thought, what am I going to do in an American hospital, in an American suburb, in American
society, while AKU was back home? It was very natural for me to return to Karachi – it was a ‘no-brainer’ for me!
I’d also like to add here that many people say they return for family – of course they do, but the fact is, that
everyone has family, but only a small percentage returns home. So there is something different in us, the ones
who come back. It’s hard to describe, it’s difficult to quantify. I think it’s just a longing for home.
Int: Great. That wraps it up. Thanks very much for your time and the opportunity to interview you.
Dr SS: You’re welcome.
Your child might be suffering from Schizophrenia: how easy is it to
confront facts?
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“Even at this point”… he looked down and raised his head after a long pause. “You are controlling my mind and
even the staff has grouped up with CIA against me”. After a long and adequate trial of mood stabilizers, I have
added antipsychotics. But despite optimum and required trials of two antipsychotics, my patient continued to
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By Dr Hena Jawaid
speak in the aforementioned, suspicious manner.
I sadly started writing notes, quite disappointed. I looked at my resident and called for a family meeting, to let the
family know about my two months’ assessment…an assessment that was unfortunately not very promising or
positive. The course of illness started with affective (mood) symptoms; with medications mood symptoms
remitted. However, psychotic symptoms did not settle instead increased gradually. And now after two months,
there are only psychotic symptoms. I am filled with dread. Am I dealing with schizophrenia?
An illness that has high prevalence but low incidence, which carries significant care burden for families. There is
reportedly poor prognosis with early onset and long duration. A di-benzodiazepine called Clozapine is the
suggested choice giving the perspective of “Treatment – resistant schizophrenia”.
Whatever the biological reason is there, being in a profession of psychology and while dealing with emotional
turmoil, we try to foresee the consequential behaviors after any significant event. Here I was concerned about this
young boy’s parents. How would they see this aspect or receive this news? “My child is suffering from
schizophrenia? What does it mean? What about prognosis? What are the options? Is it episodic or continuous?”
Thousands of apprehensions and then comes the Stigma of chronic mental illness. This aspect of illness is crucial in
improving 1) functionality 2) quality of life 3) stability and 4) relapse. The presence of supportive behaviors and
understanding of an illness reduce the impact of stigma and maintain activities of daily living.
Epilogue by Dr Hena Jawaid
Guidelines for future submissions
Our second issue is an encouraging continuation of  All submitted content must be original. If
a project that we have high aims for. The
material is quoted from elsewhere, the
assimilation of art, literature and science has
source needs to be mentioned either in text
produced diversity of thoughts, perspectives and
or in footnotes. Plagiarized material will not
also generated different hypotheses regarding
be published.
biological and psychological problems. The need for  Staff, nurses, residents and students from
humanity and compassion to be restored through
other departments (nursing, education,
writing is much desired today, in order to facilitate
biomedical) and service lines of AKUH are
an evolving essence of empathy among young
also invited to contribute.
physicians.
 For formatting and editing purposes, the
word count for submitted articles and
We would like to take this opportunity to apologize
essays should not exceed 500 words.
for an editorial oversight in our last issue – in the
Articles exceeding this word limit will be
table of contents, the author of ‘Non-compliance’
returned to the contributor.
was listed as Nadia Karim, when the author of the  Submissions or queries can be forwarded to
article was nurse Zohra Aijaz Ali, as mentioned on
[email protected]
page 4 of the article.
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Psych Times | Vol. 1, Issue 2 | February 2016
Department of Psychiatry at the Aga Khan University Hospital