The Structured Clinical Interview for DSM- IV (SCID-IV) is a semi-structured interview tool used to conduct major psychiatric diagnoses according to the criteria established in the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM). It is typically administered by a clinician or mental health professional who is familiar with the DSM criteria.

Schedule for Assessment of Insight (SAI) is a semi-structured interview which measures the patient’s insight across 3 domains; awareness of the illness, recognition for need of treatment and ability to see that the psychotic symptoms (hallucinations/delusions) are a result of the illness.

The Schizophrenia Proneness Instrument, Adult Version (SPI-A) examines basic symptoms that are self-experienced disturbances in thinking, perception, speech and motor functioning. These typically appear before the onset, during or after the onset of a psychotic episode.The Schizophrenia Proneness Instrument, Adult Version (SPI-A) examines basic symptoms that are self-experienced disturbances in thinking, perception, speech and motor functioning. These typically appear before the onset, during or after the onset of a psychotic episode.

The Schizotypal Personality Questionnaire (SPQ) is 74-item self-report measure developed to assess schizotypal personality. The questionnaire is divided across 9 subscales such as Odd beliefs or Magical thinking, Unusual perceptual experiences, Ideas of reference, Paranoid ideation/suspiciousness, Excessive social anxiety, No close friends, Constricted affect, Odd or eccentric behavior, and Odd speech.

The PANSS is a widely used structured clinical interview to examine the severity of positive and negative symptoms for individuals with schizophrenia. About 30 items – from which seven are positive symptoms, seven are negative symptoms, and 16 are general psychopathology symptoms – of schizophrenia are assessed of the most recent week.

The Montgomery–Asberg Depression Rating Scale (MADRS) is a clinician-rated scale, 10-item scale which tests the severity of core depressive symptoms. Nine of the questions are patient-rated while one question is observer-rated. The scale examines mood symptoms like sadness, tension, lassitude, pessimistic thoughts, and suicidal thoughts.

PSYRATS is a clinical scale developed to assess and quantify the severity of hallucinations and delusions, commonly used in research for patients with schizophrenia and psychosis. It contains two different subscales for auditory hallucinations (11 items) and delusions (6 items).

The Global Assessment of Function scale is widely used by mental health clinicians to test the severity of mental health illnesses. It uses interviews and questionnaires to examine how symptoms may impact the psychological, social and occupational wellbeing or functioning of an individual and ultimately their ability to perform daily activities.

The CGI is devised to offer a brief assessment of the patient’s global functioning before and after administering a study medication. It covers information such as knowledge of the patient’s history, psychosocial circumstances, symptoms, behavior, and the impact of the symptoms on the patient’s ability to function. CGI measures illness severity (CGIS), global improvement or change (CGIC) and therapeutic response.

The Abnormal Involuntary Movement Scale (AIMS) is a 12-item scale rated by clinicians to measure the severity of dyskinesias which are involuntary movements often observed in patients taking antipsychotic medication.

The SFS is a 76-item measure designed to assess the social skills and functioning for individuals with schizophrenia. It has 7 subscales including social engagement/withdrawal, interpersonal behaviour, pro-social activities, recreation, independence-competence, independence-performance, and employment/occupation.

This self-rated questionnaire includes a visual analogue scale and provides an overview of an individual’s health status across 5 dimensions; mobility, self-care, usual activities, pain/discomfort and anxiety/depression.

SOFA is a scale that is derived from the Global Assessment of Functioning and measures the social and occupational performance of an individual which is independent to the severity of an individual’s psychological symptoms. Other extraneous or environmental factors are usually not considered as an influence.

ECI is a self-rated 66-item questionnaire that assesses the impact of caregiving for carers of individuals who suffer from psychotic illnesses.

The Brief IPQ is a 9-item measure to evaluate a patient’s perception or representation of their illness across domains like cognitive illness representation, emotional representations, and causal representations.

The Herth Hope Index is a 12-item assessment tool to clinically examine the construct of hope as theorized by Dufault and Martochhio. The three domains assessed are inner sense of temporality and future, inner positive readiness and expectancy, and interconnectedness with self and others.

CANTAB accurately measures cognitive function, identifies levels of performance and impairment, and quantifies the effectiveness of treatments in the brain. CANTAB tests have demonstrated sensitivity to detecting changes in neuropsychological performance and include tests of working memory, learning and executive function; visual, verbal and episodic memory; attention, information processing and reaction time; social and emotion recognition, decision making and response control.

Wechsler Adult Intelligence Scale is an IQ test designed to measure intelligence and cognitive ability in adults and older adolescents. The test contains numerous scales (Indices) assessing qualitatively different types of intellectual functioning. It scores four main indices; Verbal Comprehension, Working Memory, Perceptual Reasoning, and Processing Speed. WAIS measures intellectual performance as a multidimensional construct.

SCWT is a neuropsychological test that is used to assess the Stroop Effect. The Stroop effect is the delay in reaction time between automatic and controlled processing of information, in which the names of words interfere with the ability to name the color of ink used to print the words. It is used for both experimental and clinical purposes. This test can be used to measure a person’s selective attention capacity and skills, processing speed, automaticity, and cognitive flexibility.

The verbal fluency task (VFT) is a short screening test that evaluates cognitive function. Verbal fluency tasks are widely used to assess verbal functioning in clinical and research settings. This is because the tasks have compelling face validity: A person with a serious deficit in executive control abilities or both will perform poorly in the tasks. It can be used to screen for Alzheimer’s disease or another type of dementia.

Psychosis is one of the leading causes of disability affecting 29 million people worldwide and the First Episode Psychosis (FEP) occuring between ages 15–35 years is thought to be a critical period, influencing the long-term course of the disorder. Cognitive Behavioural Therapy (CBT) has been proven to be highly effective for the treatment of psychosis and culturally adapted CBT interventions are known to generate positive outcomes for patients with schizophrenia in low-middle-income countries. Mobile Health (mHealth) is a growing approach where cellular phones and smartphones can be used to facilitate healthcare provision, when time or distance-related challenges create barriers to mental health care access. This research on the feasibility of the TechCare app showed that most participants were able to get the “right help” when using the app for managing symptoms and gaining comprehensive insights about the illness.

Suicide accounts for around 800,000 deaths globally per annum and 78% of all deaths by suicide occur in low and middle-income countries (LMIC). An under-researched population in LMIC are individuals at high risk of developing a psychotic disorder; a population referred to as Ultra-High Risk psychosis (UHRp) or At Risk Mental State (ARMS). The aim of this study is to evaluate the prevalence, over a 5 year follow-up period, of suicide, suicidal ideation, and self-harm in individuals vulnerable to developing psychosis.

MAC study

MAC is an acronym used for the research study Minocycline Augmentation of Clozapine for Treatment Resistant Schizophrenia: A Multicentre randomised double-blind placebo-controlled trial. MAC trial. Treatment resistant schizophrenia (TRS), thus has become a major public health concern especially in low income countries such as Pakistan. Clozapine, an atypical antipsychotic is best alternative for such resistant patients but still 70% of the patients treated with Clozapine, respond only partially and continue to have debilitating symptoms (Chakos, Lieberman, Hoffman, Bradford, & Sheitman, 2001). The aim is to determine the beneficial effects of minocycline augmentation to clozapine in Treatment Resistant Schizophrenia (TRS). This would be the first such study in the Pakistan. The study was caried out over the period 12 weeks as a randomized placebo controoled trial on 2 treatment arms one arm receiving TAU with minocycline and the other TAU with placebo. This study was conducted in Rawalpindi, Lahore, Karachi, Peshawar, Quetta and Hyderabad in major psychiatric teaching and non-teaching hospitals/departments. The patients was assessed on clinical, neuropsychological, physical and haematological assessments on baseline and follow-up visits (2, 4, and 8 weeks) and outcome assessment were carried out in the 12th week. The total of 18 patients, who are on clozapine treatment for a minimum of 3 months, were randomized in the trial. The analysis of the study is in progress.

At-risk mental state (ARMS) individuals are those who have a high likelihood of developing psychosis but are not clinically diagnosed with the illness. Unfortunately, there is no specific course of treatment for individuals with ARMS especially in low-middle-income countries like Pakistan. This research trial attempted to examine the efficacy of minocycline and omega-3 fatty acids as treatment interventions for individuals with ARMS. Such evidence can contribute to growing literature for ARMS treatment options as minocycline and omega-3 fatty acids are low-cost interventions and previous evidence has shown their ability to delay or prevent the onset of full psychosis.

A Culturally adapted Family Intervention (CulFI) was developed through a scientific framework for the treatment of schizophrenia in Pakistan. Compared to treatment as usual, CulFI had greater acceptability as it was highly rated by participants. The significant treatment gap in low-middle-income countries for providing care to schizophrenic patients warrants the need to conduct a full-scale trial of this study and create pathways to develop psychosocial interventions for schizophrenia in Pakistan.

This feasibility study aimed to assess the efficacy of the immune-suppressant drug methotrexate to treat individuals with schizophrenia. Methotrexate is typically used in the treatment systemic autoimmune disorders. A total of ninety-two participants who had been diagnosed with schizophrenia in the last five years were recruited from various healthcare facilities in Karachi, Pakistan. This was the first evidence reported of testing methotrexate in patients with schizophrenia and whether such a drug would be effective in managing psychotic symptoms.