A psychiatrist is a physician who specializes in psychiatry . Psychiatrists are physicians who evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly mental issues. Sometimes a psychiatrist works within a multi-disciplinary team, which may comprise clinical psychologists , social workers , occupational therapists , and nursing staff . Psychiatrists have broad training in a biopsychosocial approach to the assessment and management of mental illness.
147-496: As part of the clinical assessment process, psychiatrists may employ a mental status examination ; a physical examination ; brain imaging such as a computerized tomography , magnetic resonance imaging , or positron emission tomography scan; and blood testing . Psychiatrists use pharmacologic , psychotherapeutic , and/or interventional approaches to treat mental disorders. The field of psychiatry has many subspecialties that require additional ( fellowship ) training, which, in
294-450: A Pew Research Center (PEW) poll, favor Sharia law as the official law, and 94 percent of them identify more with religion than nationality compared to Muslims in other nations. Pakistan, a federal parliamentary republic , consists of four provinces : Punjab, Khyber Pakhtunkhwa, Sindh, and Balochistan, along with three territories : Islamabad Capital Territory , Gilgit-Baltistan , and Azad Kashmir . The Government of Pakistan governs
441-548: A military coup in 1977 against the leftist PPP, which saw General Zia-ul-Haq become the president in 1978. From 1977 to 1988, President Zia's corporatisation and economic Islamisation initiatives led to Pakistan becoming one of the fastest-growing economies in South Asia. While building up the country's nuclear program , increasing Islamisation , and the rise of a homegrown conservative philosophy, Pakistan helped subsidise and distribute US resources to factions of
588-409: A nine-month-long civil war . In the following four decades, Pakistan has been ruled by governments whose descriptions, although complex, commonly alternated between civilian and military, democratic and authoritarian, relatively secular and Islamist. Pakistan is considered a middle power nation, with the world's sixth-largest standing armed forces . It is a declared nuclear-weapons state , and
735-774: A supermajority in elections in 1997, Nawaz Sharif authorised nuclear testings , as a retaliation to the second nuclear tests conducted by India in May 1998. Military tension between the two countries in the Kargil district led to the Kargil War of 1999, and turmoil in civil-military relations allowed General Pervez Musharraf to take over through a bloodless coup d'état . Musharraf governed Pakistan as chief executive from 1999 to 2002 and as president from 2001 to 2008 —a period of enlightenment , social liberalism , extensive economic reforms , and direct involvement in
882-481: A 2019 Forest Landscape Integrity Index mean score of 7.42/10, ranking 41st globally out of 172 countries. Pakistan operates as a democratic parliamentary federal republic , with Islam designated as the state religion . Initially adopting a constitution in 1956 , Pakistan saw it suspended by Ayub Khan in 1958, replaced by a second constitution in 1962. A comprehensive constitution emerged in 1973, suspended by Zia-ul-Haq in 1977 but reinstated in 1985, shaping
1029-530: A bland affect when describing a very distressing experience would be described as showing incongruent affect, which might suggest schizophrenia. The intensity of the affect may be described as normal, blunted affect , exaggerated , flat, heightened or overly dramatic. A flat or blunted affect is associated with schizophrenia, depression or post-traumatic stress disorder ; heightened affect might suggest mania, and an overly dramatic or exaggerated affect might suggest certain personality disorders . Mobility refers to
1176-408: A blend of socialism , conservatism , and the third way , with the three main political parties being the conservative PML (N), socialist PPP, and centrist PTI. Constitutional amendments in 2010 curtailed presidential powers, enhancing the role of the prime minister. Pakistan, the only country established in the name of Islam, had overwhelming support among Muslims, especially in provinces like
1323-465: A brief neuropsychiatric examination in some situations. Frontal lobe pathology is suggested if the person cannot repetitively execute a motor sequence (e.g. "paper-scissors-rock"). The posterior columns are assessed by the person's ability to feel the vibrations of a tuning fork on the wrists and ankles. The parietal lobe can be assessed by the person's ability to identify objects by touch alone and with eyes closed. A cerebellar disorder may be present if
1470-574: A cool, dry winter from December through February; a hot, dry spring from March through May; the summer rainy season, or southwest monsoon period, from June through September; and the retreating monsoon period of October and November. Rainfall varies greatly from year to year, with patterns of alternate flooding and drought common. The diverse landscape and climate in Pakistan support a wide range of trees and plants. From coniferous alpine and subalpine trees like spruce , pine , and deodar cedar in
1617-580: A delusion in that the patient is aware that the fear is irrational. A phobia is usually highly specific to certain situations and will usually be reported by the patient rather than being observed by the clinician in the assessment interview. Preoccupations are thoughts which are not fixed, false or intrusive, but have an undue prominence in the person's mind. Clinically significant preoccupations would include thoughts of suicide , homicidal thoughts , suspicious or fearful beliefs associated with certain personality disorders, depressive beliefs (for example that one
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#17327657977371764-516: A depressive disorder, physical illness, anorexia nervosa or chronic anxiety. Attitude, also known as rapport or cooperation, refers to the patient's approach to the interview process and the quality of information obtained during the assessment. Observations of attitude include whether the patient is cooperative, hostile, open or secretive. Abnormalities of behavior, also called abnormalities of activity, include observations of specific abnormal movements , as well as more general observations of
1911-632: A devastating cyclone in East Pakistan resulting in 500,000 deaths. In 1970, Pakistan conducted its first democratic elections since independence, intending to transition from military rule to democracy. However, after the East Pakistani Awami League emerged victorious over the Pakistan Peoples Party (PPP), Yahya Khan and the military refused to transfer power. This led to Operation Searchlight ,
2058-574: A diagnosis of schizophrenia. Delusions of guilt, delusions of poverty, and nihilistic delusions (belief that one has no mind or is already dead) are typical of depressive psychosis . An overvalued idea is an emotionally charged belief that may be held with sufficient conviction to make believer emotionally charged or aggressive but that fails to possess all three characteristics of delusion—most importantly, incongruity with cultural norms. Therefore, any strong, fixed, false, but culturally normative belief can be considered an "overvalued idea". Hypochondriasis
2205-467: A disintegration of personality and a failure to cope with work, relationships, or education. Other features differentiate diseases with delusions as well. Delusions may be described as mood- congruent (the delusional content in keeping with the mood), typical of manic or depressive psychosis , or mood-incongruent (delusional content not in keeping with the mood) which are more typical of schizophrenia. Delusions of control, or passivity experiences (in which
2352-490: A distortion of the patient's sense of time, for example déjà vu , or a distortion of the sense of self ( depersonalization ) or sense of reality ( derealization ). Hallucinations can occur in any of the five senses, although auditory and visual hallucinations are encountered more frequently than tactile (touch), olfactory (smell) or gustatory (taste) hallucinations. Auditory hallucinations are typical of psychoses : third-person hallucinations (i.e. voices talking about
2499-763: A final attempt to prevent partition, they proposed the Cabinet Mission Plan . As the Cabinet Mission failed, the British announced their intention to end rule by June 1948. Following rigorous discussions involving Viceroy of India , Lord Mountbatten of Burma , Muhammad Ali Jinnah of the All-India Muslim League , and Jawaharlal Nehru of Congress, the formal declaration to partition British India into two independent dominions—namely Pakistan and India—was issued by Mountbatten on
2646-743: A majority of the regional population to Islam. Upon the defeat of the Turk and Hindu Shahi dynasties which governed the Kabul Valley , Gandhara (present-day Khyber Pakhtunkhwa), and western Punjab in the 7th to 11th centuries CE, several successive Muslim empires ruled over the region, including the Ghaznavid Empire (975–1187 CE), the Ghorid Kingdom, and the Delhi Sultanate (1206–1526 CE). The Lodi dynasty ,
2793-524: A medical doctor. After a strict selection program, one can specialize for 4.5-years in psychiatry. During this specialization, the resident has to do a 6-month residency in the field of social psychiatry, a 12-month residency in a field of their own choice (which can be child psychiatry, forensic psychiatry, somatic medicine, or medical research). To become an adolescent psychiatrist, one has to do an extra specialization period of 2 more years. In short, this means that it takes at least 10.5 years of study to become
2940-729: A military crackdown, and eventually sparked the war of liberation by Bengali Mukti Bahini forces in East Pakistan, described in West Pakistan as a civil war rather than a liberation struggle. Independent researchers estimate that between 300,000 and 500,000 civilians died during this period while the Bangladesh government puts the number of dead at three million, a figure that is now nearly universally regarded as excessively inflated. Some academics such as Rudolph Rummel and Rounaq Jahan say both sides committed genocide; others such as Richard Sisson and Leo E. Rose believe there
3087-536: A minimum of two months of neurology during their first year of residency, referred to as an "internship". After completing their training, psychiatrists are eligible to take a specialty board examination to become board-certified. The total amount of time required to complete educational and training requirements in the field of psychiatry in the United States is twelve years after high school. Subspecialists in child and adolescent psychiatry are required to complete
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#17327657977373234-455: A pamphlet Now or Never , using it as an acronym . Rahmat Ali explained: "It is composed of letters taken from the names of all our homelands, Indian and Asian, P anjab , A fghania , K ashmir , S indh , and Baluchis tan ." He added, "Pakistan is both a Persian and Urdu word... It means the land of the Paks, the spiritually pure and clean." Etymologists note that پاک pāk ,
3381-570: A particular subculture, body modifications , or clothing not typical of the patient's gender, might give clues to personality . Observations of physical appearance might include the physical features of alcoholism or drug abuse , such as signs of malnutrition , nicotine stains, dental erosion, a rash around the mouth from inhalant abuse , or needle track marks from intravenous drug abuse. Observations can also include any odor which might suggest poor personal hygiene due to extreme self-neglect, or alcohol intoxication . Weight loss could also signify
3528-463: A preamble to the constitutions of 1956, 1962, and 1973. Democracy faced setbacks due to the martial law imposed by President Iskander Mirza , who was succeeded by General Ayub Khan . After adopting a presidential system in 1962, Pakistan witnessed significant growth until the second war with India in 1965, resulting in an economic downturn and widespread public discontent in 1967. In 1969, President Yahya Khan consolidated control, but faced
3675-589: A prolonged speech latency and speak in a slow, quiet and hesitant manner. Thought process in the MSE refers to the quantity, tempo (rate of flow) and form (or logical coherence) of thought. Thought process cannot be directly observed but can only be described by the patient, or inferred from a patient's speech. Form of the thought is captured in this category. One should describe the thought form as thought directed A→B (normal), versus formal thought disorders. A pattern of interruption or disorganization of thought processes
3822-579: A psychiatrist which can go up to 12.5 years if one becomes a children's and adolescent psychiatrist. In Pakistan , one must complete basic medical education, an MBBS, then get registered with the Pakistan Medical and Dental Council (PMDC) as a general practitioner after a one-year mandatory internship, house job. After registration with PMDC, one has to take the FCPS-I exam. After that, they pursue four additional years of training in psychiatry at
3969-470: A republic. The creation of Pakistan was never fully accepted by many British leaders including Lord Mountbatten . Mountbatten expressed his lack of support and faith in the Muslim League's idea of Pakistan. Jinnah refused Mountbatten's offer to serve as Governor-General of Pakistan. When Mountbatten was asked by Collins and Lapierre if he would have sabotaged Pakistan had he known that Jinnah
4116-484: A respected Deobandi alim (scholar) who held the position of Shaykh al-Islam in Pakistan in 1949, and Maulana Mawdudi of Jamaat-i-Islami played key roles in advocating for an Islamic constitution. Mawdudi insisted that the Constituent Assembly declare the "supreme sovereignty of God" and the supremacy of the shariah in Pakistan. The efforts of Jamaat-i-Islami and the ulama led to the passage of
4263-463: A result of a coalition between PML (N) and PPPP. Pakistan's diverse geography and climate host a wide array of wildlife . Covering 881,913 km (340,509 sq mi), Pakistan's size is comparable to France and the UK combined. It ranks as the 33rd-largest nation by total area , but this varies based on Kashmir's disputed status. Pakistan boasts a 1,046 km (650 mi) coastline along
4410-412: A side effect of antipsychotic medication. Similarly, a global decrease in arousal and movement (described as psychomotor retardation , akinesia or stupor ) might indicate depression or a medical condition such as Parkinson's disease , dementia or delirium. The examiner would also comment on eye movements (repeatedly glancing to one side can suggest that the patient is experiencing hallucinations), and
4557-566: A simple structured cognitive assessment which is in widespread use as a component of the MSE. Mild impairment of attention and concentration may occur in any mental illness where people are anxious and distractible (including psychotic states), but more extensive cognitive abnormalities are likely to indicate a gross disturbance of brain functioning such as delirium, dementia or intoxication . Specific language abnormalities may be associated with pathology in Wernicke's area or Broca's area of
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4704-696: A symptom of Tourette's syndrome . There are a range of abnormalities of movement which are typical of catatonia , such as echopraxia , catalepsy , waxy flexibility and paratonia (or gegenhalten ). Stereotypies (repetitive purposeless movements such as rocking or head banging) or mannerisms (repetitive quasi-purposeful abnormal movements such as a gesture or abnormal gait) may be a feature of chronic schizophrenia or autism . More global behavioural abnormalities may be noted, such as an increase in arousal and movement (described as psychomotor agitation or hyperactivity ) which might reflect mania or delirium . An inability to sit still might represent akathisia ,
4851-443: A two-year fellowship program, the first year of which can run concurrently with the fourth year of the general psychiatry residency program. This adds one to two years of training. The average compensation for psychiatrists in the U.S. in 2023 was $ 309,000. Mental status examination The mental status examination ( MSE ) is an important part of the clinical assessment process in neurological and psychiatric practice. It
4998-820: A united Islamic bloc, called Islamistan, wasn't supported by other Muslim governments, though figures like the Grand Mufti of Palestine, Al-Haj Amin al-Husseini , and leaders of the Muslim Brotherhood were drawn to the country. Pakistan's desire for an international organization of Muslim countries was fulfilled in the 1970s when the Organization of Islamic Conference (OIC) was formed. East Pakistan's Bengali Muslims, opposed to an Islamist state, clashed with West Pakistanis who leaned towards Islamic identity. The Islamist party Jamaat-e-Islami backed an Islamic state and opposed Bengali nationalism . After
5145-437: A wide variety of settings. Some are full-time medical researchers , many see patients in private medical practices, and consult liaison psychiatrists see patients in hospital settings where psychiatric and other medical conditions interact. While requirements to become a psychiatric physician differ from country to country, all require a medical degree . In India , a Bachelor of Medicine, Bachelor of Surgery (MBBS) degree
5292-754: Is 'pure' in Persian and Pashto and the Persian suffix ـستان -stan means 'land' or 'place of'. Rahmat Ali's concept of Pakistan only related to the northwestern area of the Indian subcontinent . He also proposed the name "Banglastan" for the Muslim areas of Bengal and "Osmanistan" for Hyderabad State , as well as a political federation between the three. Some of the earliest ancient human civilisations in South Asia originated from areas encompassing present-day Pakistan. The earliest known inhabitants in
5439-407: Is a global reduction in the quantity of thought and one of the negative symptoms of schizophrenia. It can also be a feature of severe depression or dementia . A patient with dementia might also experience thought perseveration. Thought perseveration refers to a pattern where a person keeps returning to the same limited set of ideas. A description of thought content would be the largest section of
5586-992: Is a member of the United Nations, the Shanghai Cooperation Organisation , the Organisation of Islamic Cooperation , the Commonwealth of Nations , the South Asian Association for Regional Cooperation , and the Islamic Military Counter-Terrorism Coalition , and is designated as a major non-NATO ally by the United States. The name Pakistan was coined by Choudhry Rahmat Ali , a Pakistan Movement activist, who in January 1933 first published it (originally as "Pakstan") in
5733-402: Is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude , behavior, mood and affect, speech, thought process , thought content, perception , cognition , insight, and judgment . There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains. The purpose of
5880-630: Is an overvalued idea that one has an illness, dysmorphophobia that a part of one's body is abnormal, and anorexia nervosa that one is overweight or fat. An obsession is an "undesired, unpleasant, intrusive thought that cannot be suppressed through the patient's volition", but unlike passivity experiences described above, they are not experienced as imposed from outside the patient's mind. Obsessions are typically intrusive thoughts of violence, injury, dirt or sex, or obsessive ruminations on intellectual themes. A person can also describe obsessional doubt, with intrusive worries about whether they have made
6027-497: Is assessed by asking the patient where he or she is (for example what building, town and state) and what time it is (time, day, date). Attention and concentration are assessed by several tests, commonly serial sevens test subtracting 7 from 100 and subtracting 7 from the difference 5 times. Alternatively: spelling a five-letter word backwards, saying the months or days of the week in reverse order, serial threes (subtract three from twenty five times), and by testing digit span . Memory
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6174-417: Is assessed in terms of immediate registration (repeating a set of words), short-term memory (recalling the set of words after an interval, or recalling a short paragraph), and long-term memory (recollection of well known historical or geographical facts). Visuospatial functioning can be assessed by the ability to copy a diagram, draw a clock face, or draw a map of the consulting room. Language is assessed through
6321-514: Is broadly referred to as formal thought disorder , and might be described more specifically as thought blocking, fusion, loosening of associations, tangential thinking, derailment of thought, knight's move thinking. Thought may be described as 'circumstantial' when a patient includes a great deal of irrelevant detail and makes frequent diversions, but remains focused on the broad topic. Circumstantial thinking might be observed in anxiety disorders or certain kinds of personality disorders . Regarding
6468-422: Is carried out in the manner of an informal enquiry, using a combination of open and closed questions, supplemented by structured tests to assess cognition. The MSE can also be considered part of the comprehensive physical examination performed by physicians and nurses although it may be performed in a cursory and abbreviated way in non-mental-health settings. Information is usually recorded as free-form text using
6615-678: Is divided into three major geographic areas: the northern highlands, the Indus River plain, and the Balochistan Plateau. The northern highlands feature the Karakoram , Hindu Kush , and Pamir mountain ranges, hosting some of the world's highest peaks, including five of the fourteen eight-thousanders (mountain peaks over 8,000 metres or 26,250 feet), notably K2 (8,611 m or 28,251 ft) and Nanga Parbat (8,126 m or 26,660 ft). The Balochistan Plateau lies in
6762-459: Is experienced in external or objective space (i.e. experienced by the subject as real). An illusion is defined as a false sensory perception in the presence of an external stimulus, in other words a distortion of a sensory experience, and may be recognized as such by the subject. A pseudohallucination is experienced in internal or subjective space (for example as "voices in my head") and is regarded as akin to fantasy. Other sensory abnormalities include
6909-407: Is incompatible with the original meaning which was concerned with comprehending a patient's subjective experience. The mental status examination is a core skill of qualified (mental) health personnel. It is a key part of the initial psychiatric assessment in an outpatient or psychiatric hospital setting. It is a systematic collection of data based on observation of the patient's behavior while
7056-449: Is open to both neurologists and psychiatrists. Some psychiatrists specialize in helping certain age groups. Pediatric psychiatry is the area of the profession working with children in addressing psychological problems. Psychiatrists specializing in geriatric psychiatry work with the elderly and are called geriatric psychiatrists or geropsychiatrists. Those who practice psychiatry in the workplace are called occupational psychiatrists in
7203-830: Is out of keeping with the patient's educational, cultural and social background (2) ... held with extraordinary conviction and subjective certainty (3)", and is a core feature of psychotic disorders. For instance an alliance to a particular political party, or sports team would not be considered a delusion in some societies. The patient's delusions may be described within the SEGUE PM mnemonic as: somatic, erotomanic delusions, grandiose delusions , unspecified delusions, envious delusions (c.f. delusional jealousy ), persecutory or paranoid delusions , or multifactorial delusions. There are several other forms of delusions, these include descriptions such as: delusions of reference , or delusional misidentification , or delusional memories (e.g., "I
7350-523: Is ranked amongst the emerging and growth-leading economies, with a large and rapidly growing middle class. Pakistan's political history since independence has been characterized by periods of significant economic and military growth as well as those of political and economic instability. It is an ethnically and linguistically diverse country, with similarly diverse geography and wildlife . The country continues to face challenges, including poverty , illiteracy , corruption , and terrorism . Pakistan
7497-473: Is the basic qualification needed to do psychiatry. After completing an MBBS (including an internship), they can attend various PG medical entrance exams and get a Doctor of Medicine (M.D.) in psychiatry, which is a 3-year course. Diploma course in psychiatry or DNB psychiatry can also be taken to become a psychiatrist. In the Netherlands , one must complete medical school after which one is certified as
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#17327657977377644-868: Is the only animal found in significant numbers in Cholistan , with a few nilgai along the Pakistan–India border and in some parts of Cholistan. Rare animals include the snow leopard and the blind Indus river dolphin , of which there are believed to be about 1,816 remaining, protected at the Indus Dolphin Reserve in Sindh. In total, 174 species of mammals, 177 species of reptiles, 22 species of amphibians, 198 species of freshwater fish, 668 species of birds, over 5,000 species of insects, and over 5,700 species of plants have been recorded in Pakistan. Pakistan faces deforestation, hunting, and pollution, with
7791-663: Is today Pakistan. During this period, the Vedas , the oldest scriptures of Hinduism , were composed. The western regions of Pakistan became part of Achaemenid Empire around 517 BCE. In 326 BCE, Alexander the Great conquered the region by defeating various local rulers, most notably, the King Porus , at Jhelum . It was followed by the Maurya Empire , founded by Chandragupta Maurya and extended by Ashoka
7938-455: Is unable to experience any pleasure may have anhedonia . Affect is described by labelling the apparent emotion conveyed by the person's nonverbal behavior (anxious, sad etc.), and also by using the parameters of appropriateness, intensity, range, reactivity and mobility. Affect may be described as appropriate or inappropriate to the current situation, and as congruent or incongruent with their thought content. For example, someone who shows
8085-633: Is unloved or a failure), or the cognitive distortions of anxiety and depression. The MSE contributes to clinical risk assessment by including a thorough exploration of any suicidal or hostile thought content. Assessment of suicide risk includes detailed questioning about the nature of the person's suicidal thoughts, belief about death, reasons for living, and whether the person has made any specific plans to end his or her life. The most important questions to ask are: Do you have suicidal feeling now; have you ever attempted suicide (highly correlated with future suicide attempts); do you have plans to commit suicide in
8232-694: The British Indian Empire , and remained so until independence in 1947. Under British rule, modern Pakistan was primarily divided into the Sind Division , Punjab Province , and the Baluchistan Agency . The region also included various princely states , with the largest being Bahawalpur . The major armed struggle against the British in the region was the rebellion known as the Sepoy Mutiny in 1857. Divergence in
8379-624: The College of Physicians and Surgeons Pakistan . Training includes rotations in general medicine, neurology, and clinical psychology for three months each, during the first two years. There is a mid-exam intermediate module and a final exam after four years. In the Hong Kong Special Administrative Region (HKSAR), psychiatrists are required to obtain a medical degree, followed by a minimum of six years of specialized training. Then, they must achieve fellowship at
8526-781: The East India Company , and later, after the post- Sepoy Mutiny (1857–1858), direct rule by Queen Victoria of the British Empire , acquired most of the region. Key conflicts included those against the Baloch Talpur dynasty , resolved by the Battle of Miani (1843) in Sindh, the Anglo-Sikh Wars (1845–1849), and the Anglo-Afghan Wars (1839–1919). By 1893, all modern Pakistan was part of
8673-1039: The Hindu Shahis , the Ghaznavids , the Delhi Sultanate , the Samma , the Shah Miris , the Mughals , the Durranis , the Sikhs and most recently, the British Raj from 1858 to 1947. Spurred by the Pakistan Movement , which sought a homeland for the Muslims of British India , and election victories in 1946 by the All-India Muslim League , Pakistan gained independence in 1947 after the Partition of
8820-626: The Indian pangolin , the jungle cat , and the sand cat . Indus is home to mugger crocodiles , while surrounding areas host wild boars , deer, and porcupines . Central Pakistan's sandy scrublands shelter Asiatic jackals, striped hyenas , wildcats, and leopards . The mountainous north hosts a variety of animals like the Marco Polo sheep , urial , markhor goat, ibex goat, Asian black bear , and Himalayan brown bear . The lack of vegetative cover, severe climate, and grazing impact on deserts have endangered wild animals. The chinkara
8967-594: The Islamic Republic of Pakistan , is a country in South Asia . It is the fifth-most populous country , with a population of over 241.5 million, having the second-largest Muslim population as of 2023. Islamabad is the nation's capital, while Karachi is its largest city and financial centre . Pakistan is the 33rd-largest country by area . Bounded by the Arabian Sea on the south, the Gulf of Oman on
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#17327657977379114-633: The Nehru Report , Muhammad Ali Jinnah , the founder of Pakistan, issued his fourteen points , which included proposals to safeguard the interests of the Muslim minority in a united India. These proposals were rejected. In his December 29, 1930 address, Allama Iqbal advocated the amalgamation of Muslim-majority states in North-West India, including Punjab , North-West Frontier Province , Sind , and Baluchistan . The perception that Congress-led British provincial governments neglected
9261-592: The Objectives Resolution in March 1949. This resolution, described by Liaquat Ali Khan as the second most significant step in Pakistan's history, affirmed that "sovereignty over the entire universe belongs to God Almighty alone and the authority which He has delegated to the State of Pakistan through its people for being exercised within the limits prescribed by Him is a sacred trust". It was later included as
9408-535: The United Provinces , where Muslims were a minority. This idea, articulated by the Muslim League, the Islamic clergy , and Jinnah, envisioned an Islamic state . Jinnah, closely associated with the ulama , was described upon his death by Maulana Shabbir Ahmad Usmani as the greatest Muslim after Aurangzeb , aspiring to unite Muslims worldwide under Islam. The Objectives Resolution of March 1949 marked
9555-678: The most votes in the elections of 2008, appointing party member Yusuf Raza Gilani as Prime Minister. Threatened with impeachment , President Musharraf resigned on 18 August 2008, and was succeeded by Asif Ali Zardari . Clashes with the judicature prompted Gilani's disqualification from the Parliament and as the Prime Minister in June 2012. The general election held in 2013 saw the PML (N) achieve victory, following which Nawaz Sharif
9702-450: The mujahideen against the USSR 's intervention in communist Afghanistan . Pakistan's North-West Frontier Province became a base for the anti-Soviet Afghan fighters, with the province's influential Deobandi ulama playing a significant role in encouraging and organising the 'jihad'. President Zia died in a plane crash in 1988, and Benazir Bhutto , daughter of Zulfikar Ali Bhutto,
9849-429: The posterior fossa can be detected by asking the patient to roll his or her eyes upwards ( Parinaud's syndrome ). Focal neurological signs such as these might reflect the effects of some prescribed psychiatric medications, chronic drug or alcohol use, head injuries , tumors or other brain disorders. The person's understanding of his or her mental illness is evaluated by exploring his or her explanatory account of
9996-572: The relationship between Hinduism and Islam resulted in significant tension in British India , leading to religious violence. The language controversy further exacerbated tensions between Hindus and Muslims. A Muslim intellectual movement , led by Sir Syed Ahmed Khan to counter the Hindu renaissance , advocated for the two-nation theory and led to the establishment of the All-India Muslim League in 1906. In March 1929, in response to
10143-712: The 1970 general elections, the Parliament crafted the 1973 Constitution . It declared Pakistan an Islamic Republic, with Islam as the state religion, and mandated laws to comply with Islamic teachings laid down in the Quran and Sunnah and that no law repugnant to such injunctions could be enacted. Additionally, it established institutions like the Shariat Court and the Council of Islamic Ideology to interpret and apply Islam. Zulfikar Ali Bhutto faced opposition under
10290-443: The 6th century BCE. The ancient university was documented by the invading forces of Alexander the Great and was also recorded by Chinese pilgrims in the 4th or 5th century CE. At its zenith, the Rai dynasty (489–632 CE) ruled Sindh and the surrounding territories. The Arab conqueror Muhammad ibn Qasim conquered Sindh and some regions of Punjab in 711 CE. The Pakistan government's official chronology claims this as
10437-437: The 8,500-year-old Neolithic site of Mehrgarh in Balochistan , the Indus Valley Civilisation of the Bronze Age , and the ancient Gandhara civilisation . The regions that compose the modern state of Pakistan were the realm of multiple empires and dynasties, including the Gandhāra , the Achaemenid , the Maurya , the Kushan , the Parthian , the Paratarajas , the Gupta ; the Umayyad Caliphate in its southern regions,
10584-601: The Arabian Sea and the Gulf of Oman, and shares land borders totaling 6,774 km (4,209 mi), including 2,430 km (1,510 mi) with Afghanistan, 523 km (325 mi) with China, 2,912 km (1,809 mi) with India, and 909 km (565 mi) with Iran. It has a maritime border with Oman, and shares a border with Tajikistan via the Wakhan Corridor . Situated at the crossroads of South Asia,
10731-554: The British Indian Empire , which awarded separate statehood to its Muslim-majority regions and was accompanied by an unparalleled mass migration and loss of life. Initially a Dominion of the British Commonwealth , Pakistan officially drafted its constitution in 1956, and emerged as a declared Islamic republic . In 1971, the exclave of East Pakistan seceded as the new country of Bangladesh after
10878-477: The Great , until 185 BCE. The Indo-Greek Kingdom founded by Demetrius of Bactria (180–165 BCE) included Gandhara and Punjab and reached its greatest extent under Menander (165–150 BCE), prospering the Greco-Buddhist culture in the region. Taxila had one of the earliest universities and centres of higher education in the world, which was established during the late Vedic period in
11025-615: The Hong Kong College of Psychiatrists and attain the qualification of 'specialist in psychiatry' from the Medical Council. Certified psychiatrists are included in the registry. The fees charged by specialist psychiatrists vary. In private clinics, the cost of a consultation starts from HK$ 1,500. Compared to private clinics, the fees for specialist outpatient services of the Hospital Authority are lower, but
11172-470: The MSE covers the patient's level of alertness , orientation , attention , memory , visuospatial functioning, language functions and executive functions . Unlike other sections of the MSE, use is made of structured tests in addition to unstructured observation. Alertness is a global observation of level of consciousness , i.e. awareness of and responsiveness to the environment, and this might be described as alert, clouded, drowsy, or stuporous. Orientation
11319-469: The MSE is applied in a cross-cultural context, when the clinician and patient are from different cultural backgrounds. For example, the patient's culture might have different norms for appearance, behavior and display of emotions. Culturally normative spiritual and religious beliefs need to be distinguished from delusions and hallucinations — these may seem similar to one who does not understand that they have different roots. Cognitive assessment must also take
11466-439: The MSE is to obtain a comprehensive cross-sectional description of the patient's mental state , which, when combined with the biographical and historical information of the psychiatric history , allows the clinician to make an accurate diagnosis and formulation , which are required for coherent treatment planning. The data are collected through a combination of direct and indirect means: unstructured observation while obtaining
11613-461: The MSE report. It would describe a patient's suicidal thoughts, depressed cognition, delusions , overvalued ideas, obsessions, phobias and preoccupations. One should separate the thought content into pathological thought, versus non-pathological thought. Importantly one should specify suicidal thoughts as either intrusive, unwanted, and not able to translate in the capacity to act on these thoughts ( mens rea ), versus suicidal thoughts that may lead to
11760-856: The Middle East, and Central Asia, Pakistan's location is geopolitically significant. Geologically, Pakistan straddles the Indus–Tsangpo Suture Zone and the Indian tectonic plate in Sindh and Punjab, while Balochistan and most of Khyber Pakhtunkhwa sit on the Eurasian Plate , primarily on the Iranian plateau . Gilgit-Baltistan and Azad Kashmir, along the Indian plate's edge, are susceptible to powerful earthquakes . Pakistan's landscapes vary from coastal plains to glaciated mountains, offering deserts, forests, hills, and plateaus. Pakistan
11907-612: The Muslim League from 1937 to 1939 motivated Jinnah and other Muslim League leaders to embrace the two-nation theory. This led to the adoption of the Lahore Resolution of 1940, presented by Sher-e-Bangla A.K. Fazlul Haque , also known as the Pakistan Resolution. By 1942, Britain faced considerable strain during World War II , with India directly threatened by Japanese forces. Britain had pledged voluntary independence for India in exchange for support during
12054-511: The Muslim League, became Pakistan's first Governor-General and the first President-Speaker of the Parliament , but he succumbed to tuberculosis on 11 September 1948. Meanwhile, Pakistan's founding fathers agreed to appoint Liaquat Ali Khan , the secretary-general of the party , the nation's first Prime Minister . From 1947 to 1956, Pakistan was a monarchy within the Commonwealth of Nations, and had two monarchs before it became
12201-607: The Republic of Ireland to achieve registration as a basic medical practitioner. Training in psychiatry can then begin and it is taken in two parts: three years of basic specialist training culminating in the MRCPsych exam, followed by three years of higher specialist training referred to as "ST4-6" in the UK and "Senior Registrar Training" in the Republic of Ireland. Candidates with MRCPsych degree and complete basic training must reinterview for higher specialist training. At this stage,
12348-582: The Trzepacz and Baker (1993) definitions, with mood regarded as a current subjective state as described by the patient, and affect as the examiner's inferences of the quality of the patient's emotional state based on objective observation. Mood is described using the patient's own words, and can also be described in summary terms such as neutral, euthymic , dysphoric , euphoric , angry , anxious or apathetic . Alexithymic individuals may be unable to describe their subjective mood state. An individual who
12495-545: The US or Canada and frequently takes around 8–9 years following graduation from medical school. Those with a CC(S)T will be able to apply for consultant posts. Those with training from outside the EU/EEA should consult local/native medical boards to review their qualifications and eligibility for equivalence recognition (for example, those with a US residency and ABPN qualification). In the United States and Canada, one must first attain
12642-491: The US, are certified by the American Board of Psychiatry and Neurology (ABPN) and require Maintenance of Certification Program to continue. These include the following: Further, other specialties that exist include: The United Council for Neurologic Subspecialties in the United States offers certification and fellowship program accreditation in the subspecialties of behavioral neurology and neuropsychiatry , which
12789-513: The US-led war on terrorism . By its own financial calculations, Pakistan's involvement in the war on terrorism has cost up to $ 118 billion, over eighty one thousand casualties , and more than 1.8 million displaced civilians. The National Assembly historically completed its first full five-year term on 15 November 2007. After the assassination of Benazir Bhutto in 2007, the PPP secured
12936-937: The United States and occupational psychology is the name used for the most similar discipline in the UK. Psychiatrists working in the courtroom and reporting to the judge and jury, in both criminal and civil court cases, are called forensic psychiatrists , who also treat mentally disordered offenders and other patients whose condition is such that they have to be treated in secure units. Other psychiatrists may also specialize in psychopharmacology , psychotherapy , psychiatric genetics , neuroimaging , dementia -related disorders such as Alzheimer's disease , attention deficit hyperactivity disorder , sleep medicine , pain medicine , palliative medicine , eating disorders , sexual disorders , women's health , global mental health , early psychosis intervention , mood disorders and anxiety disorders such as obsessive–compulsive disorder and post-traumatic stress disorder . Psychiatrists work in
13083-401: The ability to name objects, repeat phrases, and by observing the individual's spontaneous speech and response to instructions. Executive functioning can be screened for by asking the "similarities" questions ("what do x and y have in common?") and by means of a verbal fluency task (e.g. "list as many words as you can starting with the letter F, in one minute"). The mini-mental state examination is
13230-515: The act of suicide ( actus reus ). Abnormalities of thought content are established by exploring individuals' thoughts in an open-ended conversational manner with regard to their intensity, salience, the emotions associated with the thoughts, the extent to which the thoughts are experienced as one's own and under one's control, and the degree of belief or conviction associated with the thoughts. A delusion has three essential qualities: it can be defined as "a false, unshakeable idea or belief (1) which
13377-420: The age of onset for delusional disorders being older with a more complete and unaffected personality, where the delusion may only partially impact their life and be fairly encapsulated off from the rest of their formed personality—for example, believing that a spider lives in their hair, but this belief not affecting their work, relationships, or education. Whereas schizophrenia typically arises earlier in life with
13524-563: The banner of Nizam-e-Mustafa ("Rule of the Prophet "), advocating an Islamic state. Bhutto conceded to some Islamist demands before being ousted in a coup. General Zia-ul-Haq, after seizing power, committed to establishing an Islamic state and enforcing sharia law. He instituted Shariat judicial courts, and court benches, to adjudicate using Islamic doctrine. Zia aligned with Deobandi institutions, exacerbating sectarian tensions with anti-Shia policies. Most Pakistanis, according to
13671-416: The biographical and social information, focused questions about current symptoms, and formalised psychological tests . The MSE is not to be confused with the mini–mental state examination (MMSE), which is a brief neuropsychological screening test for dementia . The MSE derives from an approach to psychiatry known as descriptive psychopathology or descriptive phenomenology , which developed from
13818-511: The brain. In Korsakoff's syndrome there is dramatic memory impairment with relative preservation of other cognitive functions. Visuospatial or constructional abnormalities here may be associated with parietal lobe pathology, and abnormalities in executive functioning tests may indicate frontal lobe pathology. This kind of brief cognitive testing is regarded as a screening process only, and any abnormalities are more carefully assessed using formal neuropsychological testing . The MSE may include
13965-476: The country worked towards promulgating its constitution and putting the country on the road to democracy. In 1972 Pakistan embarked on an ambitious plan to develop its nuclear deterrence capability with the goal of preventing any foreign invasion ; the country's first nuclear power plant was inaugurated in that same year. India's first nuclear test in 1974 gave Pakistan additional justification to accelerate its nuclear program . Democracy ended with
14112-523: The country's governance. The military's influence in mainstream politics has been significant throughout Pakistan's history. The eras of 1958–1971, 1977–1988 , and 1999–2008 witnessed military coups , leading to martial law and military leaders governing de facto as presidents. Presently, Pakistan operates a multi-party parliamentary system , with distinct checks and balances among government branches. The first successful democratic transition occurred in May 2013. Pakistani politics revolves around
14259-623: The decline of the Indus valley civilization, Indo-Aryan tribes moved into the Punjab from Central Asia in several waves of migration in the Vedic period (1500–500 BCE), bringing with them their distinctive religious traditions and practices which fused with local culture. The Indo-Aryans religious beliefs and practices from the Bactria–Margiana culture and the native Harappan Indus beliefs of
14406-633: The degree of M.D. or Doctor of Osteopathic Medicine , followed by practice as a psychiatric resident for another four years (five years in Canada). This extended period involves comprehensive training in psychiatric diagnosis, psychopharmacology, medical care issues, and psychotherapies. All accredited psychiatry residencies in the United States require proficiency in cognitive behavioral, brief , psychodynamic , and supportive psychotherapies . Psychiatry residents are required to complete at least four post-graduate months of internal medicine or pediatrics, plus
14553-428: The development of special interests such as forensic or child/adolescent takes place. At the end of 3 years of higher specialist training, candidates are awarded a Certificate of Completion of (Specialist) Training (CC(S)T). At this stage, the psychiatrist can register as a specialist, and the qualification of CC(S)T is recognized in all EU/EEA states. As such, training in the UK and Ireland is considerably longer than in
14700-520: The domains of the MSE: Clinicians assess the physical aspects such as the appearance of a patient, including apparent age, height, weight, and manner of dress and grooming. Colorful or bizarre clothing might suggest mania , while unkempt, dirty clothes might suggest schizophrenia or depression . If the patient appears much older than his or her chronological age this can suggest chronic poor self-care or ill-health. Clothing and accessories of
14847-794: The early 16th century, the region remained under the Mughal Empire . In the 18th century, the slow disintegration of the Mughal Empire was hastened by the emergence of the rival powers of the Maratha Confederacy and later the Sikh Empire , as well as invasions by Nader Shah from Iran in 1739 and the Durrani Empire of Afghanistan in 1759. The growing political power of the British in Bengal had not yet reached
14994-429: The evening of 3 June 1947. In Mountbatten's oval office, the prime ministers of around a dozen major princely states gathered to receive their copies of the plan before its worldwide broadcast. At 7:00 P.M., All India Radio transmitted the public announcement, starting with the viceroy's address, followed by individual speeches from Nehru, and Jinnah. The founder of Pakistan Muhammad Ali Jinnah concluded his address with
15141-418: The extent to which affect changes during the interview: the affect may be described as fixed, mobile, immobile, constricted/restricted or labile . The person may show a full range of affect, in other words a wide range of emotional expression during the assessment, or may be described as having restricted affect. The affect may also be described as reactive, in other words changing flexibly and appropriately with
15288-406: The flow of conversation, or as unreactive. A bland lack of concern for one's disability may be described as showing la belle indifférence , a feature of conversion disorder , which is historically termed " hysteria " in older texts. Speech is assessed by observing the patient's spontaneous speech, and also by using structured tests of specific language functions. This heading is concerned with
15435-473: The former Indus Valley civilization eventually gave rise to Vedic culture and tribes. Most notable among them was Gandhara civilization , which flourished at the crossroads of India, Central Asia, and the Middle East, connecting trade routes and absorbing cultural influences from diverse civilizations. The initial early Vedic culture was a tribal, pastoral society centered in the Indus Valley, of what
15582-504: The functions or domains that are normal versus impaired (e.g., poor judgement is isolated to petty theft, able to function in relationships, work, academics). Traditionally, the MSE included the use of standard hypothetical questions such as "what would you do if you found a stamped, addressed envelope lying in the street?"; however contemporary practice is to inquire about how the patient has responded or would respond to real-life challenges and contingencies. Assessment would take into account
15729-429: The future; and, do you have any deadlines where you may commit suicide (e.g., numerology calculation, doomsday belief, Mother's Day, anniversary, Christmas). A perception in this context is any sensory experience, and the three broad types of perceptual disturbance are hallucinations , pseudohallucinations and illusions . A hallucination is defined as a sensory perception in the absence of any external stimulus, and
15876-419: The individual has the experience of the mind or body being under the influence or control of some kind of external force or agency), are typical of schizophrenia. Examples of this include experiences of thought withdrawal , thought insertion , thought broadcasting , and somatic passivity. Schneiderian first rank symptoms are a set of delusions and hallucinations which have been said to be highly suggestive of
16023-440: The individual's executive system capacity in terms of impulsiveness, social cognition , self-awareness and planning ability. Impaired judgment is not specific to any diagnosis but may be a prominent feature of disorders affecting the frontal lobe of the brain. If a person's judgment is impaired due to mental illness, there might be implications for the person's safety or the safety of others. There are potential problems when
16170-455: The individual's use of words to describe mood, thought content or perceptions, as words may be used idiosyncratically with a different meaning from that assumed by the examiner. In this group, tools such as play materials, puppets, art materials or diagrams (for instance with multiple choices of facial expressions depicting emotions) may be used to facilitate recall and explanation of experiences. Pakistan Pakistan , officially
16317-469: The initial step towards this goal, affirming God as the sole sovereign. Muslim League leader Chaudhry Khaliquzzaman asserted that Pakistan could only truly become an Islamic state after bringing all believers of Islam into a single political unit. Keith Callard observed that Pakistanis believed in the essential unity of purpose and outlook in the Muslim world, expecting similar views on religion and nationality from Muslims worldwide. Pakistan's desire for
16464-526: The last of the Delhi Sultanate, was replaced by the Mughal Empire (1526–1857 CE). The Mughals introduced Persian literature and high culture, establishing the roots of Indo-Persian culture in the region. In the region of modern-day Pakistan, key cities during the Mughal period were Multan , Lahore , Peshawar and Thatta , which were chosen as the site of impressive Mughal buildings . In
16611-798: The northern mountains to deciduous trees like shisham in the Sulaiman Mountains , and palms such as coconut and date in the southern regions. The western hills boast juniper , tamarisk , coarse grasses, and scrub plants. Mangrove forests dominate the coastal wetlands in the south. Coniferous forests span altitudes from 1,000 to 4,000 metres (3,300 to 13,100 feet) in most northern and northwestern highlands. In Balochistan's xeric regions, date palms and Ephedra are prevalent. In Punjab and Sindh's Indus plains, tropical and subtropical dry and moist broadleaf forests as well as tropical and xeric shrublands thrive. Approximately 4.8% or 36,845.6 square kilometres (3,684,560 ha) of Pakistan
16758-423: The patient is in the clinician's view during the interview. The purpose is to obtain evidence of symptoms and signs of mental disorders, including danger to self and others, that are present at the time of the interview. Further, information on the patient's insight, judgment, and capacity for abstract reasoning is used to inform decisions about treatment strategy and the choice of an appropriate treatment setting. It
16905-405: The patient is unaware, such as defense mechanisms or unconscious drives. In practice, the MSE is a blend of empathic descriptive phenomenology and empirical clinical observation. It has been argued that the term phenomenology has become corrupted in clinical psychiatry: current usage, as a set of supposedly objective descriptions of a psychiatric patient (a synonym for signs and symptoms ),
17052-811: The patient to name objects, repeat short sentences, or produce as many words as possible from a certain category in a set time. Simple language tests also form part of the mini-mental state examination . In practice, the structured assessment of receptive and expressive language is often reported under Cognition (see below ). Language assessment will allow the recognition of medical conditions presenting with aphonia or dysarthria , neurological conditions such as stroke or dementia presenting with aphasia , and specific language disorders such as stuttering , cluttering or mutism . People with autism spectrum disorders may have abnormalities in paralinguistic and pragmatic aspects of their speech. Echolalia (repetition of another person's words) and palilalia (repetition of
17199-497: The patient's explanatory account descriptively. Impaired insight is characteristic of psychosis and dementia, and is an important consideration in treatment planning and in assessing the capacity to consent to treatment. Anosognosia is the clinical term for the condition in which the patient is unaware of their neurological deficit or psychiatric condition. Judgment refers to the patient's capacity to make sound, reasoned and responsible decisions. One should frame judgement to
17346-580: The patient's language and educational background into account. Clinician's racial bias is another potential confounder. Consultation with cultural leaders in community or clinicians when working with Aboriginal people can help guide if any cultural phenomena has been considered when completing an MSE with Aboriginal patients and things to consider from a cross-cultural context. There are particular challenges in carrying out an MSE with young children and others with limited language such as people with intellectual impairment . The examiner would explore and clarify
17493-449: The patient's level of activity and arousal, and observations of the patient's eye contact and gait . Abnormal movements, for example choreiform , athetoid or choreoathetoid movements may indicate a neurological disorder. A tremor or dystonia may indicate a neurological condition or the side effects of antipsychotic medication. The patient may have tics (involuntary but quasi-purposeful movements or vocalizations) which may be
17640-563: The patient) and hearing one's thoughts spoken aloud ( gedankenlautwerden or écho de la pensée ) are among the Schneiderian first rank symptoms indicative of schizophrenia, whereas second-person hallucinations (voices talking to the patient) threatening or insulting or telling them to commit suicide, may be a feature of psychotic depression or schizophrenia. Visual hallucinations are generally suggestive of organic conditions such as epilepsy , drug intoxication or drug withdrawal. Many of
17787-440: The person cannot stand with arms extended, feet touching and eyes closed without swaying (Romberg's sign); if there is a tremor when the person reaches for an object; or if he or she is unable to touch a fixed point, close the eyes and touch the same point again. Pathology in the basal ganglia may be indicated by rigidity and resistance to movement of the limbs, and by the presence of characteristic involuntary movements. A lesion in
17934-677: The possibility of establishing a Muslim nation. The 1946 elections saw the Muslim League secure 90 percent of the Muslim seats, supported by the landowners of Sindh and Punjab. This forced the Indian National Congress, initially skeptical of the League's representation of Indian Muslims, to acknowledge its significance. Jinnah's emergence as the voice of the Indian Muslims, compelled the British to consider their stance, despite their reluctance to partition India . In
18081-414: The problem, and understanding of the treatment options. In this context, insight can be said to have three components: recognition that one has a mental illness, compliance with treatment, and the ability to re-label unusual mental events (such as delusions and hallucinations) as pathological. As insight is on a continuum, the clinician should not describe it as simply present or absent, but should report
18228-580: The production of speech rather than the content of speech, which is addressed under thought process and thought content (see below). When observing the patient's spontaneous speech, the interviewer will note and comment on paralinguistic features such as the loudness, rhythm, prosody , intonation , pitch, phonation , articulation , quantity, rate, spontaneity and latency of speech. Many acoustic features have been shown to be significantly altered in mental health disorders. A structured assessment of speech includes an assessment of expressive language by asking
18375-571: The provinces of Balochistan , East Bengal , the North-West Frontier Province , West Punjab , and Sindh. In the riots that accompanied the partition in Punjab Province, between 200,000 and 2,000,000 people were killed in what some have described as a retributive genocide between the religions. Around 50,000 Muslim women were abducted and raped by Hindu and Sikh men, while 33,000 Hindu and Sikh women experienced
18522-594: The quality of eye contact (which can provide clues to the patient's emotional state). Lack of eye contact may suggest depression or autism. The distinction between mood and affect in the MSE is subject to some disagreement. For example, Trzepacz and Baker (1993) describe affect as "the external and dynamic manifestations of a person's internal emotional state" and mood as "a person's predominant internal state at any one time", whereas Sims (1995) refers to affect as "differentiated specific feelings" and mood as "a more prolonged state or disposition". This article will use
18669-740: The region were Soanian during the Lower Paleolithic , of whom artefacts have been found in the Soan Valley of Punjab . The Indus region , which covers most of the present-day Pakistan, was the site of several successive ancient cultures including the Neolithic (7000–4300 BCE ) site of Mehrgarh , and the 5,000-year history of urban life in South Asia to the various sites of the Indus Valley Civilisation , including Mohenjo-daro and Harappa . Following
18816-534: The same fate at the hands of Muslims. Around 6.5 million Muslims moved from India to West Pakistan and 4.7 million Hindus and Sikhs moved from West Pakistan to India. It was the largest mass migration in human history. A subsequent dispute over the princely state of Jammu and Kashmir eventually sparked the Indo-Pakistani War of 1947–1948 . After independence in 1947, Jinnah, the President of
18963-619: The slogan Pakistan Zindabad (Long Live Pakistan). As the United Kingdom agreed to the partitioning of India , the modern state of Pakistan was established on 14 August 1947 (27th of Ramadan in 1366 of the Islamic Calendar , considered to be the most blessed date from an Islamic perspective) . This new nation amalgamated the Muslim-majority eastern and northwestern regions of British India , comprising
19110-467: The southwest, and the Sir Creek on the southeast, it shares land borders with India to the east ; Afghanistan to the west ; Iran to the southwest ; and China to the northeast . It shares a maritime border with Oman in the Gulf of Oman, and is separated from Tajikistan in the northwest by Afghanistan's narrow Wakhan Corridor . Pakistan is the site of several ancient cultures , including
19257-408: The standard headings, but brief MSE checklists are available for use in emergency situations, for example, by paramedics or emergency department staff. The information obtained in the MSE is used, together with the biographical and social information of the psychiatric history, to generate a diagnosis, a psychiatric formulation and a treatment plan. The mnemonic ASEPTIC can be used to remember
19404-443: The subject's own words) can be heard with patients with autism , schizophrenia or Alzheimer's disease . A person with schizophrenia might use neologisms , which are made-up words which have a specific meaning to the person using them. Speech assessment also contributes to assessment of mood, for example people with mania or anxiety may have rapid, loud and pressured speech ; on the other hand depressed patients will typically have
19551-600: The tempo of thought, some people may experience 'flight of ideas' (a manic symptom), when their thoughts are so rapid that their speech seems incoherent, although in flight of ideas a careful observer can discern a chain of poetic, syllabic, rhyming associations in the patient's speech (i.e., "I love to eat peaches, beach beaches, sand castles fall in the waves, braves are going to the finals, fee fi fo fum. Golden egg."). Alternatively an individual may be described as having retarded or inhibited thinking, in which thoughts seem to progress slowly with few associations. Poverty of thought
19698-489: The territories of modern Pakistan. None of modern Pakistan was under British rule until 1839 when Karachi , a small fishing village governed by Talpurs of Sindh with a mud fort guarding the harbour, was taken , and used as an enclave with a port and military base for the First Afghan War that ensued. The remainder of Sindh was acquired in 1843, and subsequently, through a series of wars and treaties,
19845-411: The time when the foundation of Pakistan was laid. The Early Medieval period (642–1219 CE) witnessed the spread of Islam in the region. Before the arrival of Islam beginning in the 8th century, the region of Pakistan was home to a diverse plethora of faiths, including Hinduism , Buddhism , Jainism and Zoroastrianism . During this period, Sufi missionaries played a pivotal role in converting
19992-443: The visual effects of hallucinogenic drugs are more correctly described as visual illusions or visual pseudohallucinations, as they are distortions of sensory experiences, and are not experienced as existing in objective reality. Auditory pseudohallucinations are suggestive of dissociative disorders . Déjà vu, derealization and depersonalization are associated with temporal lobe epilepsy and dissociative disorders. This section of
20139-484: The waiting time can be as long as two years. For Eligible Persons, the first consultation fee is HK$ 135, and each subsequent consultation fee is HK$ 80. Additionally, the cost for each type of medication is HK$ 15. In the United Kingdom , psychiatrists must hold a medical degree. Following this, the individual will work as a foundation house officer for two additional years in the UK, or one year as an intern in
20286-545: The war. However, this pledge included a clause stating that no part of British India would be compelled to join the resulting dominion, which could be interpreted as support for an independent Muslim nation. Congress under the leadership of Mahatma Gandhi launched the Quit India Movement , demanding an immediate end to British rule. In contrast, the Muslim League chose to support the UK's war efforts , thereby nurturing
20433-616: The west and the Thar Desert in the east. The 1,609 km (1,000 mi) Indus River and its tributaries traverse the nation from Kashmir to the Arabian Sea, sustaining alluvial plains along the Punjab and Sindh regions. The climate varies from tropical to temperate, with arid conditions in the coastal south. There is a monsoon season with frequent flooding due to heavy rainfall, and a dry season with significantly less rainfall or none at all. Pakistan experiences four distinct seasons:
20580-399: The work of the philosopher and psychiatrist Karl Jaspers . From Jaspers' perspective it was assumed that the only way to comprehend a patient's experience is through his or her own description (through an approach of empathic and non-theoretical enquiry), as distinct from an interpretive or psychoanalytic approach which assumes the analyst might understand experiences or processes of which
20727-409: The wrong decision, or forgotten to do something, for example turn off the gas or lock the house. In obsessive-compulsive disorder , the individual experiences obsessions with or without compulsions (a sense of having to carry out certain ritualized and senseless actions against their wishes). A phobia is "a dread of an object or situation that does not in reality pose any threat", and is distinct from
20874-673: Was a goat last year") among others. Delusional symptoms can be reported as on a continuum from: full symptoms (with no insight), partial symptoms (where they may start questioning these delusions), nil symptoms (where symptoms are resolved), or after complete treatment there are still delusional symptoms or ideas that could develop into delusions you can characterize this as residual symptoms. Delusions can suggest several diseases such as schizophrenia , schizophreniform disorder , brief psychotic disorder , mania , depression with psychotic features, or delusional disorders . One can differentiate delusional disorders from schizophrenia for example by
21021-435: Was dying of tuberculosis, he replied 'most probably'. "You are free; you are free to go to your temples, you are free to go to your mosques or to any other place of worship in this State of Pakistan. You may belong to any religion or caste or creed – that has nothing to do with the business of the State." — Muhammad Ali Jinnah 's first speech to the Constituent Assembly of Pakistan. Maulana Shabbir Ahmad Usmani ,
21168-400: Was elected as Prime Minister for the third time. In 2018, PTI won the general election and Imran Khan became the 22nd Prime Minister. In April 2022, Shehbaz Sharif was elected as prime minister, after Imran Khan lost a no-confidence vote. During 2024 general election , PTI-backed independents became the largest bloc, but Shehbaz Sharif was elected prime minister for a second term, as
21315-446: Was elected as the country's first female Prime Minister. The PPP was followed by conservative Pakistan Muslim League (N) (PML (N)), and over the next decade the leaders of the two parties fought for power, alternating in office. This period is marked by prolonged stagflation , political instability, corruption , misgovernment, geopolitical rivalry with India, and the clash of left wing - right wing ideologies. As PML (N) secured
21462-466: Was forested in 2021. Pakistan's fauna mirrors its diverse climate. The country boasts around 668 bird species, including crows , sparrows , mynas , hawks , falcons , and eagles . Palas, Kohistan , is home to the western tragopan , with many migratory birds visiting from Europe, Central Asia, and India. The southern plains harbor mongooses , small Indian civet , hares, the Asiatic jackal ,
21609-402: Was no genocide. In response to India's support for the insurgency in East Pakistan, preemptive strikes on India by Pakistan's air force , navy , and marines sparked a conventional war in 1971 that resulted in an Indian victory and East Pakistan gaining independence as Bangladesh . With Pakistan surrendering in the war, Yahya Khan was replaced by Zulfikar Ali Bhutto as president;
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