Journal of Pakistan Psychiatric Society

The The Gut–Brain Axis in Consultation–Liaison Psychiatry: a biopsychosocial framework for assessment, formulation and management

Tayyeb A Tahir, Elizabeth Wickens, Jawed Akbar Dars, Alex J Mitchell — Tue, 29 Sep 2026 22:14:26 +0000

The gut–brain axis has become an important conceptual framework for understanding the bidirectional relationship between physical and mental health. Consultation‑Liaison Psychiatry is particularly well positioned to incorporate this emerging evidence into routine clinical practice.

This narrative synthesises evidence from liaison psychiatry, psychosomatic medicine, and the literature on disorders of gut–brain interaction (DGBI), and proposes a practical biopsychosocial framework for assessment, formulation, management, and training. We review foundational mechanistic studies, large human cohort data, faecal microbiota transplantation experiments, meta‑analyses of randomised controlled trials, and major reviews published between 2020 and 2026.Communication between the gut and brain is now well recognised, operating through neural, hormonal, immune, and microbial–metabolic pathways.

Role of Nanotechnology in Psychiatry

Muhammad Raza Shah — Tue, 29 Sep 2026 22:12:00 +0000

The field of psychiatry has undergone a rapid transformation in recent years due to continuous advancements across related fields, such as neuroscience, molecular biology, and digital health. These modern approaches often challenge the traditional symptom-based diagnostics that many psychiatrists have been using for decades. Several deficiencies have been evident in traditional psychiatric treatments, such as a lack of precise drug treatment, slow therapeutic development, drug side effects, a virtual absence of disease markers, and a limited understanding of variation in disease. With the continuous development of nanotechnology over the last two decades, researchers have developed new tools to address these issues, including precise and targeted drugs, enhanced diagnostic accuracy, and real-time monitoring. This editorial describes recent contributions and the role of nanotechnology in developing novel psychiatric treatments, including psychopharmacology, diagnosis, neuroprotection, and personalized medicine.

Living in the Grey Zone: Perceived Uncertainty, Coping Strategies, and Psychological Distress among Young Adults in Pakistan during the Indo-Pak Conflict 2025

Aiman Javed, Laiba Rizwan, Muhammad Hamza Haris — Wed, 30 Sep 2026 00:00:00 +0000

OBJECTIVE

To study how perceived uncertainty and the coping strategies adopted by young adults of Pakistan during the May 2025 Indo-Pak conflict affected their mental health.

STUDY DESIGN

Cross-sectional research.

PLACE AND DURATION OF STUDY

An online study was conducted in May 2025.

METHOD

Nine hundred young adults (201 men, 699 women), aged 18-30, studying at different universities of Pakistan were sampled using non-probability sampling. The data was collected through Demographic Information Questionnaire, Intolerance of Uncertainty Scale, Brief COPE, and Depression Anxiety Stress Scale.

RESULTS

The young adults of Pakistan experienced symptoms of depression (45%), anxiety (55.6%) and stress (46.3%). Exposure to war-related media was associated with increased uncertainty (r= .16) and psychological distress (r= .10). The presence of uncertainty and use of all three types of coping strategies i.e., problem-focused, emotion-focused and avoidant coping were related with higher levels of psychological distress (r= .59, .29, .36, and .61 respectively). Avoidant coping predicted greater levels of depression (β= .48), anxiety (β= .39), stress (β= .35) and psychological distress (β= .44), while problem-focused coping predicted lower levels of depression (β= -.10). The partial mediating role of avoidant coping was also established suggesting that uncertainty increases the use of avoidant coping which in turn exacerbate psychological distress.

CONCLUSION

The Indo-Pak conflict had a negative impact on the mental health of young adults of Pakistan, highlighting the need for targeted psychological interventions to improve their well-being and proactive measures to safeguard their mental health in the event of future conflict.

A Cross-Sectional Study to Determine the Association Between Family History of Depression and Depression Rates Among Caregivers of Patients with Intellectual Disability

kainat mirza — Wed, 30 Sep 2026 02:10:08 +0000

A mental illness characterized by low mood, low self- esteem and loss of interest in previously pleasurable activities is considered as depression. Intellectual disability is characterized by limitations in intellectual functioning and adaptive behavior that emerge prior to 18 years of age. The prevalence of mental retardation is 1-3% worldwide, according to World Health Organization. This study was conducted in Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi. It is a cross-sectional descriptive study to determine the association of family history of depression and depression rates in care-givers of intellectually disable individuals. Our study concluded that there is close association in family history of depression and depression in caregivers of intellectually disable patients.

The Role of Communication Skills and Empathy Workshop for Doctors, Resulting in Better Healthcare Delivery from the Patient’s Perspective

Farrukh Hayat Khan, Mehwish Sultan, Haseeba Rasheed — Wed, 30 Sep 2026 02:30:24 +0000

Objective

To compare the effectiveness of the communication skills workshop, empathy workshop, and a combined workshop of communication skills and empathy on patient satisfaction.

Methodology

The current study is a quasi-experimental research conducted at Hitec Institute of Medical Sciences, Taxila. Medical officers, postgraduate trainees, and physicians directly involved in patient care participated in the study. The doctors were divided into four groups. One group attended a workshop on empathy, the other on communication skills, one attended a combined workshop, and one served as a control group. The workshops included lectures, handouts, skills, and attitude training via videos and role play. Patient satisfaction was assessed using the Doctor Interpersonal Skills Questionnaire (DISQ) from patients (N=240) treated by physicians from each group following the workshop. The Group differences in patient satisfaction were analyzed using one-way analysis of variance (ANOVA).

Results

Patients reported higher satisfaction when treated by physicians who attended the combined workshop. Furthermore, patients managed by physicians who participated in the communication skills workshop reported higher satisfaction compared to those treated by physicians who attended the empathy workshop alone.

Conclusion

The findings of the current study highlight the importance of interpersonal skills of physicians in the medical field. These interpersonal skills are essential components of medical practice and play a crucial role in improving patient satisfaction. This ultimately contributes to improved clinical outcomes of patients and overall better healthcare delivery. Therefore, integrating these skills into undergraduate medical education is essential to equip students to use them successfully in clinical settings.

IMPACT OF FAMILY FUNCTIONING AND STRUCTURE ON CAREGIVER BURDEN AND PSYCHOLOGICAL DISTRESS IN PARENTS OF CHILDREN WITH ADHD

Aatir Rajput — Wed, 30 Sep 2026 02:03:36 +0000

Objective: To determine the impact of family functioning and family structure on caregiver burden and psychological distress (depression, anxiety, and stress) among parents of children with ADHD.

Methods: This analytical cross-sectional study was conducted at the Child Psychiatry Clinic of LUMHS from August 2024 to April 2025. A total of 73 parents or primary caregivers of children aged 6–13 years diagnosed with ADHD according to DSM-5 criteria were included using non-probability consecutive sampling. Data were collected using a structured proforma for sociodemographic and family variables. Family functioning was assessed using the Family Assessment Device (FAD), caregiver burden using the Zarit Burden Interview (ZBI), and psychological distress using the DASS-21. Data were analyzed using SPSS version 27.0. Correlation was performed, with p ≤ 0.05 considered statistically significant.

Results: Among 73 caregivers, 64.4% were female, and 56.2% belonged to joint families. Family dysfunction was observed in 75.3% of participants. High caregiver burden was reported in 53.4%, while moderate to severe levels of depression, anxiety, and stress were observed in 56.2%, 60.3%, and 53.4% of caregivers, respectively. Family functioning showed a significant positive correlation with caregiver burden (r = 0.61) and psychological distress (r = 0.57). Caregivers from joint families had significantly higher burden and distress scores compared to nuclear families (p < 0.05).

Conclusion: Family dysfunction and structure significantly influence caregiver burden and psychological distress among parents of children with ADHD. These findings highlight the need for family-centered interventions and caregiver support strategies in the management of ADHD.

Perceived Self-Stigma as a Barrier to Healthcare Service Utilization Among People with Substance Use Disorders

Wed, 30 Sep 2026 01:49:44 +0000

Objectives: To assess the frequency of perceived stigma and utilization of healthcare
services for detoxification or its medical complications among people with Substance Use
Disorder
Study Design: This is a descriptive, cross-sectional study and 131 patients with SUD were
included via non probability consecutive sampling technique.
Place and Duration of study: It was conducted at Jinnah Postgraduate Medical Center,
Department of Psychiatry and Behavioral Sciences from June 2024 to June 2025.
Methods: Informed consent was taken from the patients. Patients with known medical
comorbidities were excluded. A self-reported measure, ‘Perceived Stigma of Substance
Abuse Scale (PSAS)’ was utilized to assess perceived stigma. Healthcare utilization was self
reported. Data was analyzed using Statistical Package for the Social Sciences (SPSS Version
23). Linear regression analysis was used to determine associations.
Results: The mean age of the patients was 30.99±9.49 years. Most of the patients
112(85.5%) were male, and 47(35.9%) unemployed. Over half of the patients, 77(58.8%)
were poly-substance users. Mean PSAS score was 21.62±3.59. Prevalence of perceived
stigma among substance users was 93(71%). Patients with a history of utilizing healthcare
services reported relatively higher perceived stigma compared to those who had not utilized
healthcare services.
Conclusion: In conclusion, individuals with substance use disorders had a higher prevalence
71% of perceived stigma with notable differences across clinical and demographic
subgroups. On further evaluation, it was observed that patients with a history of utilizing
healthcare services reported relatively higher but insignificant perceived stigma compared
to those who had not utilized healthcare services.

Patterns of Narcissistic traits and its Association with Career Motivations among Medical Students: A Cross-Sectional Study in Pakistan

Minal Akbar — Wed, 30 Sep 2026 02:16:56 +0000

Background: Narcissism is a personality trait which influences behavior and motivations toward choosing a specific career in medical students. The objective of this study is to determine the distribution of narcissistic traits among medical students and its correlation with choices towards career motivations.

Methods: A cross-sectional study was conducted from April to October 2025 which involved medical undergraduates of four medical colleges of Pakistan. Using stratified sampling, a sample size of 370 students was selected. A valid questionnaire comprising three sections of questions: demographic, NPI-16, and items assessing motivations for career choices and was used for data collection. SPSS version-27 was employed to analyze the data.

Results: Of the total participants, 49.2% were male and 50.8% female, and mean age was 21.5 years. On analysis, 72.7% of the population were found to have normal level of narcissistic score, 24.6% were on borderline levels, and 2.7% have significantly high levels of narcissism score. Males were more narcissistic than females. Narcissism was strongly associated with factors like desire for well reputed social status, highly demanding career, independence, and enjoyment of professional activity. Altruism and science related motivations showed no significant association with narcissism.

Conclusion: Medical students showed borderline-to-high degree of narcissism, and were linked with status inspired career motivations rather than altruistic or scientific interests. These findings highlight the importance of addressing personality-driven motivations in medical education and career counseling.

Sleep Quality Among Type 2 Diabetes Patients: Role of Acceptance and commitment therapy

Sidra Tul Muntaha — Wed, 30 Sep 2026 02:20:41 +0000

ABSTRACT

OBJECTIVE

To examine the Role of Acceptance and Commitment Therapy in improving Sleep quality among patients with Type 2 Diabetes Mellitus patients

STUDY DESIGN

Quasi experimental pre and posttest design

PLACE AND DURATION

This study was conducted at Shekh Jana Hospital, Swabi, Pakistan from December to February 2026.

METHOD

Total number of Thirty-four (34) participants aged 30 to 65 years were recruited using purposive sampling. Over span of four weeks participants received eight therapy sessions. The Pittsburgh Sleep Quality Index (PSQI-U) was used to measure quality of sleep. For statistical analysis paired sample t-test was utilized.

RESULT

Paired-sample t-test results showed a large effect size (Cohen's d = 0.82) and a significant improvement in sleep quality after the intervention (pre: M = 14.09, SD = 4.73; post: M = 10.79, SD = 3.14, t(33) = 9.87, p < .001

CONCLUSION

The results suggest that ACT is found to be effective intervention in improving sleep quality in individuals with type 2 diabetes mellitus.

Key words

Sleep Quality, Acceptance and Commitment Therapy, Type 2 Diabetes Mellitus

Perceived Family Ecology and Criminal Tendency in Youth: A Correlational Study

Muhammad Sufyan SIDDIQUE — Wed, 30 Sep 2026 02:32:41 +0000

Abstract

Objective:
To examine the relationship between perceived family ecology and criminal tendency among youth.

Study Design:
Cross-sectional correlational study.

Place and Duration of Study:
Department of Psychology, University of Karachi, Pakistan. Data were collected between May and July 2025.

Method:
A total of 122 young adults (50 males, 72 females) aged 19–30 years (Mean age = 23.77 ± 2.94 years) were recruited using purposive sampling. Perceived family ecology was measured using the Family Ecology Questionnaire (Cronbach’s α = 0.748). Self-Report Delinquency Scale (Elliot, Huizinga, &Ageton, 1985) was assessed using the Criminal Tendency Scale (Cronbach’s α = 0.679). Descriptive statistics and Pearson product–moment correlation were computed using SPSS version 26. A p-value <0.05 was considered statistically significant.

Results:
The mean family ecology score was 83.40 ± 10.04, while the mean criminal tendency score was 25.17 ± 3.34. Pearson correlation revealed a weak and statistically non-significant association (r = 0.073, p = 0.812).

Conclusion:
Perceived family ecology was not significantly associated with criminal tendency among youth. Broader ecological determinants may exert stronger influence.

Suicide as a Mirror of Social Realities: Unveiling Structural Inequality and Distress in Sindh, Pakistan

Riaz Ahmed, Nida Shoaib, Jalil Ahmed, Muhammad Naeem — Wed, 30 Sep 2026 02:18:23 +0000

Suicide in Sindh is a forgotten but worrisome social crisis and neglect of people in Pakistan. Although the trend is on the rise in the region, it is shrouded in stigmatization, under-reporting, and ineffective response of the institutions. By explicitly connecting the social factors that contribute to suicide in the Sindh to poverty, unemployment, gender imbalance, caste sidelining, and environmental stress, this commentary critically examines the sociological aspects of suicide in the Sindh region through the lack of mental-health infrastructure and the lack of state-mediated prevention systems. According to the recent provincial police statistics, 1,287 suicides were registered in Sindh in January 2014-June 2019, where 586 were female victims and most (702) of them are of the 21-40 age bracket, especially in Mirpurkhas, Tharparkar, and Umerkot. All these characters underscore structural and cultural frailties that are beyond personal psychopathology. The commentary contends that Sindh needs a multidimensional strategy of economic protection, gender, empowerment, community-based, mental-health, and de-stigmatization efforts to put suicide in the contexts of a social-justice and a public-health imperative, but not a moral crime. It recommends evidence based, culturally based policy change within the provincial health systems of Pakistan by incorporating the findings of the sociology of health and disease.

NEUROCHECK PRO AND THE FUTURE OF DIGITAL NEURODEVELOPMENTAL ASSESSMENT: LESSONS FROM UK PRACTICE AND DIRECTIONS FOR COLLABORATION WITH LOW- AND MIDDLE-INCOME COUNTRIES

Tanha Tabassum, Arshad Ahmed — Tue, 29 Sep 2026 22:11:04 +0000

Timely, high-quality neurodevelopmental assessment remains out of reach for most people who need it, and the gap is widest in low- and middle-income countries. This article describes NeuroCheck Pro, a clinician-led digital platform delivering end-to-end assessment for autism and ADHD across the lifespan in line with National Institute for Health and Care Excellence guidance: validated multi-informant instruments, a computerised cognitive battery, automated threshold-based scoring, and a clinician-led video consultation culminating in a governed, clinician-authored report. Drawing on United Kingdom practice, it argues that the transferable asset for Pakistani collaborators is not the software alone but the structured, auditable pathway it encodes, which raises the consistency of specialist evaluation while reserving scarce clinical time for formulation. Remote structured assessment is already feasible and acceptable in Pakistan, and computerised testing reduces dependence on scarce psychometric resources; equity of access, connectivity, data governance, and local validation of instruments and norms remain the binding constraints. Three directions for collaboration follow: joint psychometric validation in Urdu and regional languages, pilot deployments in Pakistani institutions with local clinicians retaining diagnostic authority, and workforce development through supervised structured assessment. The invitation is to co-develop and scrutinise such platforms, not simply to adopt them.

Real Voices, Real Change

JPPS — Tue, 29 Sep 2026 22:08:48 +0000