Low and middle-income countries (LMICs) hold the majority of disease burden attributed to major depressive disorder (MDD). Despite this, there remains a substantial gap for access to evidence-based treatments for MDD in LMICs like Pakistan. Measurement-based care (MBC) incorporates systematic administration of validated outcome measures to guide treatment decision making and is considered a low-cost approach to optimise better clinical outcomes for individuals with MDD but there is a paucity of evidence on the efficacy of MBC in LMICs.

This protocol highlights a randomized trial which will include Pakistani outpatients with moderate to severe major depression.

Participants will be randomised to either MBC (guided by schedule), or standard treatment (guided by clinicians’ judgement), and will be prescribed with paroxetine (10–60mg/day) or mirtazapine (7.5–45mg/day) for 24 weeks. Outcomes will be evaluated by raters blind to study protocol and treatment.

National Bioethics Committee (NBC) of Pakistan has given full ethics approval. The trial is being conducted and reported as per recommendation of the CONSORT statement for RCTs.

With increasing evidence from high-income settings supporting the effectiveness of MBC for MDD, it is now necessary to explore its feasibility, utility. and efficacy in low-resource settings. The results of the proposed trial could inform the development of a low-cost and scalable approach to efficiently optimise outcomes for individuals with MDD in Pakistan.

None Declared

Depression is a global public health problem with highest rates in women in low income countries including Pakistan. Paediatricians may be a resource to help with maternal depression. Little is known in low income countries about the prevalence of depression and its social correlates in mothers of children attending paediatric clinics.

Using cross-sectional design consecutive women attending the paediatric clinic were screened using the Edinburgh Postnatal Depression Scale (n=185). Women scoring 12 or more (n=70) and a random sample of low scorers (n=16) were interviewed using the Clinical Interview Schedule Revised (CIS-R) to confirm the diagnosis of depression, the Oslo scale was used to measure social stress and EQ-5D for health related quality of life.

The prevalence of maternal depression was 51%. The mean age of the sample was 26 years. Depressed mothers were more likely to be living in a joint family household, they were less educated and they and their husbands were less likely to be employed. The depressed mothers had more financial difficulties and they were more likely to sleep hungry during the last month due to financial problems. The depressed mothers had less social support and poorer quality of life compared to non depressed mothers.

Maternal depression in this health care setting is high and it is associated with social stress and poor social support. Paediatric appointments may be an opportunity for care and care delivery for maternal depression.

Female patients tend to be more often diagnosed with ADHD inattentive subtype. Many of these females deny an earlier childhood history of hyperactivity or disruptive behaviours and hence may have been clinically overlooked in childhood, while their male counterparts may have presented with ADHD combined subtype which tends to be more easily identified and diagnosed.

Participants will learn about gender differences in ADHD diagnosis and epidemiology.

To examine gender differences in the age of first diagnosis of ADHD in a clinical population.

The study sample consisted of 118 males and 61 females (ages 17–69). Each patient was evaluated and diagnosed by an experienced psychiatrist. Clinical measures (administered by a trained psychometrist) included the CAARS (self and observer versions), BRIEF (self and informant versions), CAADID (history and structured interview), ASRS, CPT, Beck Anxiety and Beck Depression Inventories. Patients were referred by family physicians to a large out-patient metropolitan psychiatry program specializing in ADHD. Information regarding childhood diagnosis was collected retrospectively during the clinical interview.

In this study the mean age of diagnosis (ADHD) for males was 31.2 years versus 32.1 for females. Neither t-test (p = 0.44) nor non-parametric testing using Mann-Whitney U Test (p = 0.67) showed any statistical differences between the two groups.

In the present study there were no difference in the mean age of first diagnosis between male and female subjects. In the present study Further studies are needed to clarify this question. Selection factor may have been a factor in these results.

Cognitive Behavioral and related psychotherapies such as Meta-Cognitive Psychotherapy are the most commonly cited and researched psychotherapy modalities in treating Adult Attention Deficit Hyperactivity Disorder (ADHD). The structure and goals of these therapies can be directly adapted to address ADHD symptoms. However, Psychodynamic Psychotherapy is not generally thought of as a common treatment alternative in ADHD. Indeed, psychoanalytically derived psychotherapies are not regularly utilized in the treatment of neurobiological disorders/ADHD. Adults with ADHD have commonalities in psychological developments due to secondary effects ADHD may have on the infant-caregiver interactions and the formation of later psychological structures. Research in the treatment of Adult ADHD demonstrates how patients share common defensive configurations secondary to common sequelae of ADHD such as underachievement and social maladjustment.

The purpose of this abstract is to examine how the application of psychodynamic theory can be successfully utilized in several ways as a beneficial adjunct treatment of ADHD. Case examples of psychodynamic treatments of adults with ADHD will be presented as will common clinical issues in ADHD treatment.

This poster will present 4 case studies selected from a clinical population of a large metropolitan ADHD in Toronto, Canada and will discuss how psychotherapeutic techniques were utilized in conjunction with psychopharmacological agents to treat the symptoms of Adult ADHD.

The use and application of psychodynamic theory can be successfully utilized in significant ways as a beneficial adjunct treatment of ADHD as part of an integrative treatment approach which utilizes both psychotherapeutic and psychopharmacological approaches.

The goal of this poster is to discuss a brief pilot study in which mindfulness – and yoga-based practices were utilized with a group of adult ADHD patients.

A sample of 10 adults participated in a pilot group which utilized the use mindfulness-based and yoga practices to address ADHD. This group was a single 2 hour session which was a pilot for a future 6-week psycho-educational group. The participants completed the following questionnaires: the Cognitive and Affective Mindfulness Scale (CAMS-R), the Freiburg mindfulness inventory and the Mindful Attention Awareness Scale (MAAS) in addition to a survey regarding levels of knowledge of yoga and mindfulness prior to the beginning of the session. The participants completed a survey at the end of the session.

In our small sample group, all respondents reported that they found the session helpful (43% strongly agreed; 57% agreed). When asked if the participants were likely to explore and learn more about ADHD and meditation on their own based on what they learned in the session, most indicated that they were likely to (43% strongly agreed; 43% agreed and 14% were neutral).

The use of treatment modalities involving the use of meditation and mindfulness-based techniques in a group setting are thought to be helpful in addressing some of the target symptoms of ADHD. Based on the preliminary data collected in our small pilot study, our group intends to further explore the efficacy of meditation-based groups in the form of a 6-week training program in 2017.

The authors have not supplied their declaration of competing interest.

There is strong association between depression and mortality rates among patients with CHF. Despite the massive burden of cardiac disease as well as that of depression in Pakistan, there is limited data regarding the prevalence of depression in patients suffering from CHF. The aim of this study was to assess prevalence of depression in patients with CHF and to compare the health related quality of life of depressed and non-depressed patients with CHF.

A total of 1009 patients diagnosed with CHF were recruited from different public hospitals in Karachi, Pakistan. Depression was assessed at baseline using the Beck Depression Inventory (BDI) and health related quality of life was assessed using Euro Qol (EQ-5D).

Of the 1009 participants recruited to the study, 66.4% (n = 670) met the threshold for depression using the BDI measure. Of the depressed patients, 66.7% (n = 447) were male. Preliminary results indicate that participants who were depressed at baseline had poorer health related quality of life on EQ-5D measures as compared to those who were non-depressed (mean EQ-5D descriptive score 10.45 in depressed patients vs 7.37 in non-depressed patients and mean EQ-5D visual scale score 35.09 in depressed patients vs 52.19 in non-depressed patients).

Considering the high prevalence of depression and its serious negative impact on quality of life of patients suffering from chronic physical illness, it is important to design and test culturally adapted psychosocial interventions to reduce depression and improve quality of life for these patients.

The authors have not supplied their declaration of competing interest.

Poor auditory speech perception in geriatrics is attributable to neural de-synchronisation due to structural and degenerative changes of ageing auditory pathways. The speech-evoked auditory brainstem response may be useful for detecting alterations that cause loss of speech discrimination. Therefore, this study aimed to compare the speech-evoked auditory brainstem response in adult and geriatric populations with normal hearing.

The auditory brainstem responses to click sounds and to a 40 ms speech sound (the Hindi phoneme |da|) were compared in 25 young adults and 25 geriatric people with normal hearing. The latencies and amplitudes of transient peaks representing neural responses to the onset, offset and sustained portions of the speech stimulus in quiet and noisy conditions were recorded.

The older group had significantly smaller amplitudes and longer latencies for the onset and offset responses to |da| in noisy conditions. Stimulus-to-response times were longer and the spectral amplitude of the sustained portion of the stimulus was reduced. The overall stimulus level caused significant shifts in latency across the entire speech-evoked auditory brainstem response in the older group.

The reduction in neural speech processing in older adults suggests diminished subcortical responsiveness to acoustically dynamic spectral cues. However, further investigations are needed to encode temporal cues at the brainstem level and determine their relationship to speech perception for developing a routine tool for clinical decision-making.

This study aimed to compare the interpretations of temporal bone computed tomography scans by an otologist and a radiologist with a special interest in temporal bone imaging. It also aimed to determine the usefulness of this imaging modality.

A head and neck radiologist and an otologist separately reported pre-operative computed tomography images using a structured proforma. The reports were then compared with operative findings to determine their accuracy and differences in interpretations.

Forty-eight patients who underwent pre-operative computed tomography scans in a 30-month period were identified. Six patients were excluded because complete operative findings had not been recorded. Positive and negative predictive values and accuracy of the anatomical and pathological findings were calculated for 42 patients by both reporters. The accuracy was found to be less than 80 per cent, except for identification of the tegmen and lateral semicircular canal erosion. Overall, there was no significant difference in interpretations of computed tomography scans between reporters. There was a slight difference in interpretation for tympanic membrane retraction, facial canal erosion and lateral semicircular canal fistula and/or erosion.

Pre-operative computed tomography scanning of the temporal bone is useful for predicting anatomy for surgical planning in patients with chronic otitis media, but its reliability remains questionable.

There has been a surge in the popularity of loom bands amongst children in recent months. These small rubber bands, which can be woven together to make colourful bracelets and necklaces, have become the world's most popular toy. Foreign bodies in paediatric nasal and aural cavities are a common presentation to ENT units across the country. Whilst most are removed without incident, foreign bodies in nasal passages represent a potential risk for inhalation, leading to airway obstruction.

This paper reports a case series of four paediatric patients who presented with a loom band associated foreign body in the nose over a 7-day period at a district general hospital in Scotland.

Although the four cases presented were resolved without the need for general anaesthetic, the ever-soaring prevalence and popularity of loom bands necessitates a degree of caution and vigilance from parents, retailers and manufacturers alike. We believe there is an urgent need for greater public awareness of their potential hazards.