Munir Hamirani
University of Karachi, Psychiatry, Faculty Member
Research Interests: Psychosis, Research Design, Schizophrenia, Cognition, Pakistan, and 15 moreBrazil, Medicine, Humans, Schizoaffective Disorder, Checklist, Clinical Sciences, Anti Inflammatory, Randomized Controlled Trial, Combination drug therapy, Ondansetron, Clinical Protocols, Psychiatric Status Rating Scales, Neuropsychological Tests, Antipsychotic agents, and Cardiovascular medicine and haematology
Objectives Immune mechanisms have been implicated in the pathogenesis of schizophrenia. This has lead to clinical trials of re-purposing drugs with off-target anti-inflammatory actions. They include the antibiotic minocycline and... more
Objectives Immune mechanisms have been implicated in the pathogenesis of schizophrenia. This has lead to clinical trials of re-purposing drugs with off-target anti-inflammatory actions. They include the antibiotic minocycline and simvastatin (HMP-Co reductase inhibitor), which decrease microglial activation, and ondansetron a 5-HT3-receptor antagonist that has limited effects on cytokine production. This presentation will address their efficacy and mechanism of action. Aims 1) Update on trials with minocycline including our own positive finding on negative symptoms (PMID: 16959472) 2) Present new results with ondansetron and simvastatin summarised below. Methods Ondansetron (8mg) and simvastatin (40mg) vs placebos in 2x2 design (PMID: 23782463). Patients aged 18-65, stable treatment, DSM IV schizophrenia-related diagnosis. PANSS and cognition at 0,3,6 months. Results The four cells of the 2x2 design contained 302 patients. The interaction between ondansetron and simvastatin was significant at p=.006 reflecting the lower scores in the 3 active treatment groups than in the P+P group. Ondansetron improved verbal (p=.007) and visual list learning (p=.02) with no other treatment effects on cognition. Conclusions Minocycline appears to benefit negative symptoms in early psychosis with a minor effect on cognition. Simvastatin had limited effects in our patients with established schizophrenia but its anti-inflammatory effects could be worth investigating in early psychosis. Ondansetron has a significant effect on new learning, which might be expected from its 5-HT3 antagonist properties. This may underlie a benefit on negative symptoms reported by others and us.
Research Interests:
Research Interests:
Schizophrenia is a chronic and disabling disease with poor long-term outcomes. The current antipsychotic medications, both first and second generation, are efficacious in alleviating the posi-tive symptoms. However, the evidence for... more
Schizophrenia is a chronic and disabling disease with poor long-term outcomes. The current antipsychotic medications, both first and second generation, are efficacious in alleviating the posi-tive symptoms. However, the evidence for accept-able outcomes on negative symptoms and cognitive decline, which have a marked impact on social integration of patients with schizophrenia, is still limited. There is some evidence that anti-inflammatory treatment may have beneficial effects in schizo-phrenia and major depression. Cox-2 inhibitors and aspirin have been tested in preliminary clini-cal trials for schizophrenia and depression, show-ing favourable effects compared with placebo [Müller and Schwarz, 2008; Laan et al. 2010]. Statins are widely used in schizophrenia suffer-ers, particularly those taking second-generation Add-on clinical effects of simvastatin and ondansetron in patients with schizophrenia stabilized on antipsychotic treatment: pilot study
Schizophrenia is a chronic and disabling disease with poor long-term outcomes. The current antipsychotic medications, both first and second generation, are efficacious in alleviating the posi-tive symptoms. However, the evidence for... more
Schizophrenia is a chronic and disabling disease with poor long-term outcomes. The current antipsychotic medications, both first and second generation, are efficacious in alleviating the posi-tive symptoms. However, the evidence for accept-able outcomes on negative symptoms and cognitive decline, which have a marked impact on social integration of patients with schizophrenia, is still limited. There is some evidence that anti-inflammatory treatment may have beneficial effects in schizo-phrenia and major depression. Cox-2 inhibitors and aspirin have been tested in preliminary clini-cal trials for schizophrenia and depression, show-ing favourable effects compared with placebo [Müller and Schwarz, 2008; Laan et al. 2010]. Statins are widely used in schizophrenia suffer-ers, particularly those taking second-generation Add-on clinical effects of simvastatin and ondansetron in patients with schizophrenia stabilized on antipsychotic treatment: pilot study
Research Interests: Medicine and Polypharmacy
Self-insertion of foreign bodies is a rare phenomenon, not commonly seen in clinical practice. We report a case of a young female who presented with pain and pricking sensation. On radiological investigations, self-insertion of multiple... more
Self-insertion of foreign bodies is a rare phenomenon, not commonly seen in clinical practice. We report a case of a young female who presented with pain and pricking sensation. On radiological investigations, self-insertion of multiple sewing needles in different parts of the body, under the effect of hallucinatory voices due to Schizophrenia, was found. Most of the needles were removed by surgical intervention but some are still there. The Schizophrenia is well settled by the initiation and compliance with antipsychotics and no subsequent act of self-insertion was reported. The patient is now being followed up in psychiatric outpatient clinic
OBJECTIVE: This study was aimed to see the frequency of anxiety, depression and stress in patients with dyspeptic symptoms referred for endoscopy. DESIGN: Cross sectional study. SETTING: Department of medicine & psychiatry Baqai Medical... more
OBJECTIVE: This study was aimed to see the frequency of anxiety, depression and stress in patients with dyspeptic symptoms referred for endoscopy. DESIGN: Cross sectional study. SETTING: Department of medicine & psychiatry Baqai Medical University, Fatima hospital, Gadap, Karachi. DURATION: The study was conducted from Jan 2011 to Jun 2011 METHOD: Patients referred from department of medicine with symptoms of dyspepsia were assessed at department of psychiatry Baqai University before endoscopy. A total of 40 patients, fulfilling the inclusion criteria were enrolled for the study and their demographic variables were obtained using a Performa specially designed for this purpose. Urdu version of DASS (Depression Anxiety Stress Scale) was administered to the selected sample to establish the presence of three emotional states--anxiety, depression and stress. The DASS is a 42-item self report instrument designed to measure the three inter-related negative emotional states of depression, a...
Research Interests:
Pak J Surg 2013; 29(1):36-40 Introduction: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is one of the commonest presentation and a... more
Pak J Surg 2013; 29(1):36-40 Introduction: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is one of the commonest presentation and a major concern for the patients in clinical practice and in many cases it remains a challenging problem for both patients and therapists. Pain is a major symptom in many medical conditions, and severe and chronic pain, if untreated, can signifi cantly interfere with a person’s quality of life and general functioning.1 Pain interferes with sleep, impairs activities of daily living and reduces the productivity which may lead to a poor quality of life. Pain also provokes an emotional response in the suff erers and one is expected to have irritability and agitation and if pain gets teasing and prolonged, the patient may feel constantly tense and stressed. Over the time, this constant stress can result in difAbstract Objective: Th is study was aimed to see t...
OBJECTIVE: To determine the prevalence of impulsivity in patients who attempted suicide presenting at a tertiary care hospital, Karachi. STUDY DESIGN: Cross sectional study. STUDY SETTING: Study was led in the Psychiatry Department,... more
OBJECTIVE: To determine the prevalence of impulsivity in patients who attempted suicide presenting at a tertiary care hospital, Karachi. STUDY DESIGN: Cross sectional study. STUDY SETTING: Study was led in the Psychiatry Department, Abbasi Shaheed Hospital, Karachi. DURATION OF STUDY:Six month after approval of synopsis. SUBJECTS AND METHODS: Data was prospectively collected from patients after taking verbal consent. Permission was taken from ethical review committee. 95 patients presenting to the Psychiatry Department who met the inclusion criteria were included. A brief history about suicide attempt and demographic data was taken from the patient and confirmed by an attendee. The researcher himself interviewed the patient in a conducive environment assuring the patient's confidentiality. The Barratt Impulsiveness Scale (BIS-11) which consists of 30 self administered questions, marked out of 120 and rated from 0-4 was used to measure impulsivity. Demographic data was presented ...
Research Interests:
Background: Since the emergence of the novel coronavirus, the front line soldiers during this pandemic are the healthcare professionals because of their direct association with COVID19 patients. In the management of such patients, nurses... more
Background: Since the emergence of the novel coronavirus, the front line soldiers during this pandemic are the healthcare professionals because of their direct association with COVID19 patients. In the management of such patients, nurses play a significant role through proper care and preventive measures. Due to its contagious nature, fatality, and no proper medicine, it is a risk to the health and life of nurses and has an impact on their psychological health. The aim of the current study was to assess the knowledge, attitude, practices, and anxiety levels of the frontline nurses. Methods: It was an online questionnaire-based cross-sectional survey targeting only those nurses involved in the management of COVID-19 patients from different hospitals of Karachi, Pakistan. SPSS 21 was used for data analysis. Descriptive analysis, Chi-Square, and t-tests were applied. P-value <0.05 was considered significant. Results: Data of 78 nurses were analyzed. We observed that nurses possess g...
Research Interests:
Since the emergence of the novel corona virus, the front line soldiers during this pandemic are the healthcare professionals because of their direct association with COVID19 patients. In the management of such patients, nurses play a... more
Since the emergence of the novel corona virus, the front line soldiers during this pandemic are the healthcare professionals because of their direct association with COVID19 patients. In the management of such patients, nurses play a significant role through proper care and preventive measures. Due to its contagious nature, fatality and no proper medicine, it is a risk to the health and life of nurses and has an impact on their psychological health.In the current study we assessed the knowledge, attitude, practices and anxiety levels of nurses who are directly involved in the management of COVID-19 patients.It was an online questionnaire based cross sectional survey targeting only those nurses involved in the management of COVID-19 patients from different hospitals of Karachi, Pakistan. SPSS 21 was used for data analysis. Descriptive analysis, Chi Square and t-tests were applied. P value < 0.05 was considered significant.Data of 78 nurses was analyzed. We observed that nurses pos...
Research Interests:
BackgroundA third of patients diagnosed with major depressive disorder (MDD) experience treatment-resistant depression (TRD). Relatively few pharmacological agents have established efficacy for TRD. Therefore, the evaluation of novel... more
BackgroundA third of patients diagnosed with major depressive disorder (MDD) experience treatment-resistant depression (TRD). Relatively few pharmacological agents have established efficacy for TRD. Therefore, the evaluation of novel treatments for TRD is a pressing priority. Statins are pleiotropic agents and preclinical studies as well as preliminary clinical trials have suggested that these drugs may have antidepressant properties.AimsTo report on a protocol for a 12-week, randomised, double-blind, placebo-controlled trial of add-on treatment with simvastatin for patients meeting DSM-5 criteria for MDD who have failed to respond to at least two adequate trials with approved antidepressants. The trial has been registered with Clinicaltrials.gov in (ClinicalTrials.gov identifier: NCT03435744).MethodAfter screening and randomisation to the two parallel arms of the trial, 75 patients will receive simvastatin and 75 patients will receive placebo as adjuncts to treatment as usual. The ...
Research Interests:
Evidence for efficacy of cognitive-behavioural therapy (CBT) in treatment of schizophrenia is growing. CBT is effective and cost efficient in treating positive and negative symptoms. To effectively meet the needs of diverse cultural... more
Evidence for efficacy of cognitive-behavioural therapy (CBT) in treatment of schizophrenia is growing. CBT is effective and cost efficient in treating positive and negative symptoms. To effectively meet the needs of diverse cultural groups, CBT needs to be adapted to the linguistic, cultural and socioeconomic context. We aimed to assess the feasibility, efficacy and acceptability of a culturally adapted CBT for treatment of psychosis (CaCBTp) in a low-income country. Rater-blind, randomised, controlled trial of the use of standard duration CBT in patients with psychosis from a low-income country. Participants with a ICD-10 diagnosis of psychosis were assessed using Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Psychotic Symptom Rating Scales (PSYRATS), and the Schedule for Assessment of Insight (SAI) (baseline, 3 months and 6 months). They were randomized into the intervention group (n = 18) and Treatment As Usual (TAU) group (n = 18). The intervention group receiv...
Research Interests: Schizophrenia, Pakistan, Developing Countries, Health Administration, Medicine, and 14 moreLibrary and Information Studies, Humans, Hallucinations, Female, Cognitive Therapy, Male, Adult, Public health systems and services research, Randomized Controlled Trial, Psychotic Disorders, Pilot Projects, Socioeconomic Factors, Psychiatric Status Rating Scales, and Culturally Competent Care
Research Interests:
Background Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder... more
Background Despite the use of maintenance medication, recurrence rates in bipolar affective disorder (BPAD) are high. To date, there are no clinical trials that have investigated the use of psychological interventions in bipolar disorder in Pakistan. Aim The purpose of the study was to assess the feasibility and acceptability of a culturally adapted bipolar psychoeducation programme (CaPE) in Pakistan. Methods Thirty-four euthymic bipolar I and II outpatients were randomized to either 12 weekly sessions of individual psychoeducation plus Treatment As Usual (Intervention) or Treatment As Usual (TAU) (Control). Outcomes were assessed using the Young Mania Rating Scale (YMRS), Beck Depression Inventory (BDI), EuroQoL (EQ-5D), Bipolar Knowledge and Attitudes and Questionnaire (BKAQ), and a self-reported measure of medication adherence (Morisky Medication Adherence Scale-4 items, MMAS-4). Effect sizes were derived from baseline adjusted standardized regression coefficients. Results Reten...
Research Interests:
Research Interests:
Research Interests:
Objectives There is some evidence that anti-inflammatory treatment may have beneficial effects in schizophrenia and major depression. Statins are cholesterol-lowering agents but have been found to be anti-inflammatory and also decrease... more
Objectives There is some evidence that anti-inflammatory treatment may have beneficial effects in schizophrenia and major depression. Statins are cholesterol-lowering agents but have been found to be anti-inflammatory and also decrease C-reactive protein (CRP). Ondansetron is a serotonin (5-HT3) receptor antagonist widely used to prevent nausea and vomiting in patients receiving chemotherapy for cancer. Small studies have suggested that adjunctive Ondansetron is efficacious against schizophrenia symptoms. We carried out a feasibility study in schizophrenia patients (within 5 years of first diagnosis) to explore the adjunctive use of simvastatin and ondansetron on positive, negative and general psychopathology. Methods This was a 12 week rater blind placebo controlled study. All to gather 36 patients with DSM-IV diagnosis of schizophrenia were recruited, 12 in each arm. Patients were assessed at baseline and at 12 weeks using PANSS, CGI, GAF and AIMS. Results Both simvastatin and ondansetron provide some evidence of a reduction in symptoms compared to treatment as usual (TAU) on PANSS total score, although, this was not statistically significant. In the secondary analyses, no significant differences were seen on CGI, GAF and AIMS. Conclusions Anti-inflammatory treatments have shown to have some beneficial effects in schizophrenia. Both simvastatin and ondansetron provide some evidence of a reduction in symptoms compared to treatment as usual. This study has led to a larger SMRI-funded, double blind, randomized control trial.
Research Interests:
Research Interests: Research Design, Pakistan, Treatment Outcome, Medicine, Humans, and 15 moreMajor Depressive Disorder, Clinical Sciences, Time Factors, Randomized Controlled Trial, Trials, Combination drug therapy, Pilot Projects, Minocycline, Severity of Illness Index, Psychiatric Status Rating Scales, Surveys and Questionnaires, Psychology and Cognitive Sciences, Medical and Health Sciences, Cardiovascular medicine and haematology, and Antidepressive agents
There is some evidence that anti-inflammatory treatment may have beneficial effects in schizophrenia and major depression. Statins are cholesterol-lowering agents but have been found to be anti-inflammatory and also decrease C-reactive... more
There is some evidence that anti-inflammatory treatment may have beneficial effects in schizophrenia and major depression. Statins are cholesterol-lowering agents but have been found to be anti-inflammatory and also decrease C-reactive protein (CRP). Ondansetron is a serotonin (5-HT3) receptor antagonist widely used to prevent nausea and vomiting in patients receiving chemotherapy for cancer. Small studies have suggested that adjunctive ondansetron is efficacious against schizophrenia symptoms. We carried out a feasibility study in schizophrenia patients (within 5 years of first diagnosis) to explore the adjunctive use of simvastatin and ondansetron on positive, negative and general psychopathology. This was a 12-week rater-blind placebo-controlled study. A total of 36 patients with DSM-IV diagnosis of schizophrenia were recruited, 12 in each arm. Patients were assessed at baseline and at 12 weeks using Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression (CGI) s...
Research Interests:
Research Interests:
BackgroundSelf-harm is a major risk factor for completed suicide.AimsTo determine the efficacy of a brief psychological intervention – culturally adapted manual-assisted problem-solving training (C-MAP) – delivered following an episode of... more
BackgroundSelf-harm is a major risk factor for completed suicide.AimsTo determine the efficacy of a brief psychological intervention – culturally adapted manual-assisted problem-solving training (C-MAP) – delivered following an episode of self-harm compared with treatment as usual (TAU).MethodThe study was a randomised controlled assessor-masked clinical trial (trial registration: ClinicalTrials.gov NCT01308151). All patients admitted after an episode of self-harm during the previous 7 days to the participating medical units of three university hospitals in Karachi, Pakistan, were included in the study. A total of 250 patients were screened and 221 were randomly allocated to C-MAP plus treatment as usual (TAU) or to TAU alone. All patients were assessed at baseline, at 3 months (end of intervention) and at 6 months after baseline. The primary outcome measure was reduction in suicidal ideation at 3 months. The secondary outcome measures included hopelessness, depression, coping resou...
Research Interests: Self Harm, Pakistan, Treatment Outcome, Adolescent, CBT, and 15 moreMedicine, Problem Solving, Humans, Female, Cognitive Therapy, Male, Young Adult, Follow-up studies, Randomised Controlled Trial, Middle Aged, Adult, Randomized Controlled Trial, Guidance and Counseling Intervention Programs, Psychology and Cognitive Sciences, and Medical and Health Sciences
The aim of this study was to determine rates and risks of Complicated Grief (CG) among psychiatric clinic patients in Karachi, Pakistan. The Inventory of Traumatic Grief, an early version of Inventory of Complicated Grief--Revised, was... more
The aim of this study was to determine rates and risks of Complicated Grief (CG) among psychiatric clinic patients in Karachi, Pakistan. The Inventory of Traumatic Grief, an early version of Inventory of Complicated Grief--Revised, was administered to 151 recently bereaved patients, with validated criteria applied to determine CG &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;caseness.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Thirty-four percent of the sample met criteria for CG. Although violent deaths did not pose a heightened CG risk, gender and kinship to the deceased did significantly increase the likelihood of meeting of criteria for CG.