First rank symptoms (FRS) are considered to be pathognomic for schizophrenia. However, FRS is not distinctive feature of schizophrenia. It has also been noticed in affective disorder, albeit not inclusive in diagnostic criteria. Its existence in the first episode of bipolar disorder may be predictor of poor short-term outcome and decompensating course of illness.ObjectiveTo determine the frequency of first rank symptoms in manic patients.MethodThe cross sectional study was done at psychiatric services of Aga Khan University Hospital, Karachi, Pakistan. One hundred and twenty manic patients were recruited from November 2014 to May 2015.FRS was assessed by administration of validated Urdu version of Present State Examination (PSE) tool.ResultThe mean age of the patients was 37.62 + 12.51. The mean number of previous manic episode was 2.17 + 2.23. In total, 11.2% males and 30.6% females had FRS. This association of first rank symptoms with gender in patients of mania was found to be significant with a P value of 0.008. All-inclusive, 19.2% exhibited FRS in their course of illness, 43.5% had thought broadcasting, made feeling, impulses, action and somatic passivity, 39.1% had thought insertion, 30.4% had auditory perceptual distortion, and 17.4% had thought withdrawal. However, none displayed delusional perception.ConclusionThe study confirms the presence of FRS in mania in both male and female, irrespective of the duration of current manic illness or previous number of manic episodes. A substantial difference was established between both the genders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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AimsTo compare the practice in a PICU setting against the standard practicing guidelines before commencing antipsychotics with regards to: 1.Physical examination2.ECG3.Baseline blood investigations4.Physical health conditions5.Family history of medical conditions.MethodData were collected from the PICU, Black Country Healthcare NHS Foundation Trust which covers four different hospital sites. 37 patients were admitted in PICU from 1st March 2020 to 30th September 2020, out of which 30 were included. 6 case notes were not available and one patient was admitted twice, thus case notes for only one admission was included in data collection.The standard guidelines for PICU outline that each admitted patient should have physical examination, vitals monitoring and baseline investigations including routine blood tests and ECG within first 24 hours. The data were collected as per standards retrospectively within two weeks from case notes in health records. Investigations were accessed through electronic information system for current inpatient admission and 12 months prior to the admission to the PICU.ResultMean age of the sample (n = 30) was 34.26 years. 37% of patients had physical comorbidities and a family history of medical conditions was documented for only 3% of cases. A large proportion of inpatients (53%) refused to have blood investigations before treatment and only 13% of blood investigations were completed before commencing treatment. Only 7% of patients consented to an ECG prior to commencing treatment. 27% of patients had a physical examination, including vitals, before starting treatment, a further 37% had just their vitals taken within 24 hours of admission and 20% refused any form of physical examination during their inpatient admission. 7% of cases had complications due to a lack of investigation.ConclusionAlthough there are standard guidelines for the PICU setting, it has been noted that these guidelines aren't always implemented. Multiple factors have a role to play such as: non-consenting patients, inaccessibility of previous records, initial assessment forms being incomplete including assessment of mental capacity and lack of follow-up with physical investigations by both primary care and secondary mental health services. As per findings, a few recommendations were proposed to meet the standards.

Marriage is one of the principal facets when it comes to interpersonal context of depression. There is evidence supporting bidirectional casual effect between depression and marital satisfaction. However the phenomenon of marital adjustment and its related variable has not been given much attention in the Pakistan.ObjectiveTo determine the frequency of marital adjustment in patients with depression.MethodDepressed patients, who were aged between 15–65 were included. Patients who had documented co morbid of substance use or any unstable serious general medical condition were excluded. The severity of depression was evaluated by using Urdu validated Hamilton Depression Rating Scale. Marital adjustment is determined by using Urdu validated version of Kansas Marital Satisfaction Scale.ResultOnly 8.6% were well adjusted in their marital life, and all were females. The association of marital adjustment and severity of depression and difference in both genders on KANSAS was insignificant. The longer duration of illness was positively interrelated to the marital adjustment with odd ratio of 7.6. Being employed and above 30 years of age were inversely related to marital satisfaction with odd ratio of 6.1 and 5.4 respectively. However, the correlation between other independent variables and marital adjustment were insignificant in both genders.ConclusionThis study confirms the presence of high frequency i.e. 91.4% of marital dissatisfaction in depression in both male and females, irrespective of their severity of depression.Disclosure of interestThe author has not supplied their declaration of competing interest.

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