Journal of Psychiatrists' Association of Nepal

Fronto-temporal Lobe Epilepsy Presenting as Intermittent Outburst of Anger: A Case Report from Eastern Nepal

2022-10-20T12:58:45+00:00

Episodes of rage and anger with violent outbursts are common manifestations of various psychiatric and behavioral disorders. Though rare, it can be a manifestation of fronto-temporal lobe epilepsy which is often misdiagnosed. Here we present a case of 20 years male having intermittent episodes of anger and violent outburst for three years who was later diagnosed as a case of fronto-temporal lobe epilepsy.

Hypothyroidism Induced Mania: A Case Report

2022-10-20T13:06:56+00:00

Hypothyroidism is associated with myriad of medical, neurological as well as psychiatric symptoms. There is classic association of depression with hypothyroidism and of mania occurring with hypothyroidism. Only few cases of mania associated with hypothyroidism are reported. This is the first case of mania associated with hypothyroidism in Nepalese patient. We report a case of 30-year-old female with symptoms of mania induced by primary hypothyroidism. She had no previous history of psychiatric disorder but her father was diagnosed depression. Psychosocial factors contributed to noncompliance of Tablet. Levo thyroxine. She was successfully managed with Tablet. Aripiprazole, thyroxine replacement, family therapy and psycho education sessions. Therefore, clinicians should be aware to assess thyroid function in patients presenting with mania, especially females with first episode. We should also evaluate for mania symptoms in cases of hypothyroidism. Psycho education of patient and family play vital role in the treatment process.

Koro Like Syndrome with Genital Retraction Fear in Two Nepalese Men: A Case Series

2022-10-20T13:19:46+00:00

Koro is a culture bound syndrome exclusive to the South Chinese and Malay Archipelago, although similar cases have been reported outside its boundaries. The hallmark of the classic koro syndrome entails grave fear of penile shrinkage along with its disappearance into the abdomen by retracting inwards and inevitable death upon complete retraction. Absence of this triad of symptoms, or if the syndrome is encountered outside the geographical confines of South-East Asia or China, it is referred to as “koro-like” or “atypical koro”. Here, we report two cases with features of Koro, who presented to the Lagankhel Mental Hospital OPD.

Knowledge on Learning Disabilities Among Primary School Teachers of Selected Schools in Municipality of Morang

2022-10-19T15:02:45+00:00

INTRODUCTION Educational performance of children with learning disabilities are impressively not satisfactory as what is expected from them, ultimately that has a lifelong impact on the children affecting academic performances, interpersonal relationships, prospects for employment, marital life in later stage etc. Primary school teachers play a very important role in early recognition of learning disabilities, and contribute in the promotion of mental health of children. The objectives of the study are to assess knowledge on learning disabilities among primary school teachers of Letang Municipality, Morang and to find out the association between level of knowledge and selected demographic variables.

METHODOLOGY Descriptive cross-sectional study among primary school teachers was carried out in selected government and private schools of Letang Municipality, Morang. Study populations for the study were primary school teachers, both male and female, who were teaching up to grade five. Proportionate sampling technique was used to select participants from both public and private schools. Self-administered, structured questionnaire was used for data collection. Analysis was done in SPSS version 20.0. Descriptive statistics and inferential statistics (chi-square test) used to find the association between level of knowledge and selected demographic variables.

RESULT Among 120 respondents, more than half 65.8% had moderately adequate knowledge, 32.5% had inadequate knowledge and only 1.7% had adequate knowledge on learning disabilities and there was no association between teacher's level of knowledge on learning disabilities and demographic variables.

CONCLUSION The study concluded that more than half of the respondents have average knowledge on learning disabilities. There was no association between age, sex, teaching experience, types of school and training.

The Psychological Impact of Covid-19 Pandemic on Medical Undergraduates: A Study from BPKIHS, Dharan

2022-10-20T09:11:21+00:00

INTRODUCTION Since the start of the COVID-19 pandemic, the impact that it can have on mental health has been consistently highlighted. Subsequently there have been calls for universities to monitor the mental health of their students considering the unique set of stressors faced by them. This study is an attempt to understand how our students are doing and to plan appropriate psychological interventions to help them

METHODOLOGY Online questionnaires of Depression, Anxiety, Stress Scale (DASS-21) and Impact of Event Scale (IES) were distributed to the students currently pursuing MBBS and BDS in BP Koirala Institute of Health Sciences.

RESULT 409 students responded to the questionnaires. The prevalence of depression, anxiety and stress among the respondents were 39.1%, 35.7% and 35.0% respectively. All three were more common in first and second year students and in those with past history of mental illness (p<0.05). 68.5% students were impacted by the pandemic with moderate to severe impact present in 33.2%. Students from first and second years were more impacted than others. (p<0.01).

CONCLUSION Students from our institute were suffering from considerable amount of distress. Those in early years of medical schooling and those with past history of mental illness were doing particularly worse than others. It is important that we give due importance to their mental health and develop interventions to help them.

Mental Health Status of Children in Home Confinement in Nepal During Covid-19 Pandemic

2022-10-20T10:28:48+00:00

INTRODUCTION Since the declaration of COVID-19 as a pandemic there has been many public health strategies implemented to decrease it's extraordinarily adverse consequences. On March 18 2020, an estimated 107 countries around the world implemented national school closures and the Government of Nepal followed sooth on March 19. Children across European countries felt isolated due to the lockdown according to Save the Children, with increasing levels of feeling psychological distress. The effects of COVID-19 may be assumed to exert more negative life outcomes (depression, anxiety, domestic violence and loneliness) for children as it was more severe, unknown and fatal. This study is designed with a to assess the perspective of the child's mental health condition.

METHODOLOGY A descriptive cross-sectional online survey was done among children from two selected schools of Kathmandu, Nepal. Emails were sent to the children via the parents, following permission taken from schools, which contained a semi-structured pro-forma and Revised Child Anxiety and Depression Scale 25, along with and informed assent form.

RESULT In the study 29.3% of the respondents were of age 14 years, maximum age of 18 (1.1%) and minimum age 12 (8.7%) with mean age of 14.4 and sd ±1.41. More than half 58.7% of respondents were girls. Similarly, most of the respondents (35.3%) were studying in grade 10. Likewise,73.4% of respondents were living in nuclear family. Moreover, less than half 48.9 of the respondents belong to the Lower Middle Class and only 1.1% belong to the upper class of socio-economic status. The maximum number of respondents have scored between 0-64 which means that majority of the respondents were in low severity in respect to depression and anxiety.

CONCLUSIONS We found an increase in the levels of anxiety and depression in Nepali children and adolescent compared to pre-pandemic study. Policy makers should be alerted to this fact and judicious use of technology and strength of existing communities should be used to mitigate this in the future.

Utilization of EEG in A Teaching Hospital: A Descriptive Cross-Sectional Study

2022-10-20T10:38:53+00:00

INTRODUCTION Electroencephalography is a safe, convenient, non-invasive, and inexpensive technique that allows assessment of cerebral function and detects physiological manifestations of abnormal cortical excitability. Published literature about its utilization and application is sparse from this part of the world.

METHODOLOGY It is a descriptive, cross-sectional study conducted in Nepalgunj Medical College, Kohalpur, Nepal. All the subjects referred for EEG evaluation from January 2019 to December 2020 (two years) were enrolled and EEG was performed. A self-designed proforma was used to record different variables and data was analyzed using Statistical Package for the Social Sciences version 21.0 for Windows.

RESULT Of total 246 subjects, 53.3% were male and 58.9% of the subjects were 20 years or younger by age. Maximum (35.8%) number of referrals came from the department of psychiatry. Generalized seizure discharge was the most common EEG diagnosis and presence of seizure activity was noted in 37%of patients.

CONCLUSION EEG is utilized by different specialities commonly for seizure disorder, psychiatric disorders and headaches.

Depression, Anxiety and Stress Among Frontline Doctors of Covid Hospital in Eastern Nepal

2022-10-20T10:50:22+00:00

INTRODUCTION The COVID-19 pandemic has caused several mental health problems including depression, anxiety, and stress. In BPKIHS, junior resident doctors are one of the frontline health care professionals and are vulnerable to mental health problems. This study was undertaken to find out depression, anxiety, and stress in the frontline junior resident doctors (FJRD).

METHODOLOGY A web-based cross-sectional study among FJRD was done from 29 August to 28 September 2020 using Depression, Anxiety, and Stress Scale (DASS-21).

RESULT Among 168 FJRD, 144(85.7%) responded, and the mean age was 29.6±1.9 years. They were mostly male (56.9%), unmarried (60. 4%), living alone (77.1%), first-year junior residents (43.1%), and had last duty more than 2 weeks(56.9%). Anxiety was seen in 50%; followed by Depression in 38.1%; and Stress in 27.7%. The moderate type of Depression, Anxiety, and Stress was common which were 19.6%, 24.3% and 15.2% respectively. Depression, Anxiety and Stress was more in male (55 to 61.1%), unmarried (60-64%), living alone (76-85%) and first-year residents (37.5-43.6%) but not statistically significant. Depression, Anxiety and Stress were more in those whose last duty more than 2 weeks but statistically significant with Anxiety (p=0.03) only. There was a strong correlation among each other of depression, anxiety and stress (p=<0.05).

CONCLUSION Depression, anxiety, and stress were greater in FJRD. The most common being anxiety, followed by depression and stress. In severity grading moderate was common. It shows the need for early intervention and management.

Sexual Behaviour Among Adolescents Studying in Grade Eight to Ten of Government Schools in Kathmandu

2022-10-20T12:05:21+00:00

INTRODUCTION Risky sexual behaviour among adolescents has been a major concern around the globe. In developing countries like Nepal such behaviours have cost a lot in terms of major social issues. The main objective of this study was to explore risky sexual behaviour among school students studying in grade eight to ten of government school in Kathmandu district.

METHODOLOGY A descriptive cross-sectional study was carried out among school students studying in grade eight to ten in government school. Data were collected using self-designed semi-structured proforma and Youth Risk Behaviour Surveillance survey (YRBSS) developed by Centre for Disease Control (CDC) in 1990. Three Government schools randomly selected from two Resource centres were taken for the study. Among 620 students selected altogether,532 completed questionnaires were collected.

RESULT The percentage of participants who had sexual intercourse during their lifetime was 15.0%. Among them 20.5% male and 9.9% female had sexual intercourse during their lifetime (p-value 0.001). At the age of 13, 4.3% had sexual intercourse and 4.9% had sexual intercourse with two people during their lifetime. During the past 3 months, 2.8% had sexual intercourse with at least one person.

CONCLUSION This study showed the burden of risky sexual behaviours among school students. Proper interventional programs should be started promptly to address such issues by concerned authority and related stake-holders of this field.

Prevalence and Characteristics of Patients With Delirium Tremens: A Cross Sectional Study

2022-10-20T12:18:49+00:00

INTRODUCTION Delirium tremens (DT) is a severe form of alcohol withdrawal with high mortality. This study aims to estimate the prevalence of DT and describe its characteristics among patients presenting with alcohol withdrawal syndrome in a tertiary care teaching hospital.

METHODOLOGY This was a descriptive cross-sectional study on the consecutive patients with alcohol withdrawal syndrome admitted in the Department of Psychiatry of a tertiary care teaching hospital in Nepal from June 2016 to May 2017. DT was diagnosed according to the International Classification of Mental and Behavioural Disorders 10. Data on the demographic characteristics, alcohol use history, and associated features were collected and analyzed with Microsoft Excel 365. The numerical variables were summarized as the median and inter-quartile range (IQR) and the categorical variables as proportion.

RESULT Of the 105 patients admitted during the study period, 73(69.52%) patients experienced DT. The majority were male (71, 97.26%), married (69, 94.52%), illiterate (28, 38.36%), and manual labourer (40, 54.79%). The median age was 42 years (IQR 34-48). The median duration of hospital stay was 11 days (IQR 8-16). The median age of commencement of alcohol consumption was 18 years (IQR 15 -20) and the duration of consumption of alcohol was 22 years (IQR 12-30). The majority consumed homemade alcohol (65, 89.04%) in a continuous pattern (66, 90.41%). The median duration of the last drink was 3 days before admission (IQR 1-8.2). Withdrawal seizure, history of complicated withdrawal, and history of DT were present in 45 (61.64%), 15 (20.55%), and 8 (10.96%) patients respectively. Medical rather than psychiatric comorbidities were more frequently observed. The most common reason for drinking alcohol was socio cultural (43, 58.90%).

CONCLUSION The prevalence of DT was high and predominantly seen in middle-aged illiterate males working as manual laborers. Homemade alcohol was consumed in a continuous pattern mostly because of socio cultural reasons. Medical comorbidities and withdrawal seizures were common.

Presentations and Psychiatric Diagnosis in A Psychiatric Out-Patient Clinic of Tertiary Care Hospital in Eastern Nepal

2022-10-20T12:29:43+00:00

INTRODUCTION This study aimed to see common presenting complaints and psychiatric diagnoses among the patients visiting for the first time to the Psychiatric Out-patient Department (OPD) of a tertiary care hospital in Eastern Nepal.

METHODOLOGY A cross-sectional study was conducted in the OPD of B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal during the study period of 3 weeks after the institute ethical approval. Patients were selected via convenience sampling technique. Face to face interview was conducted to collect socio-demographic data and the presenting complains (up to 5) according to the patients and their attendants. Psychiatric diagnoses were recorded as per the clinician.

RESULT Among the first contact psychiatry out-patients; various physical/ somatic, anxiety and mood related symptoms were the commonest presenting complaints, as per the patients, attendants and clinicians. Behavioural symptoms were others mostly observed and reported. The commonest diagnoses were: Depression, Recurrent Depressive Disorder, Dysthymia (18.6%); Phobia, Other Anxiety and Obsessive Compulsive Disorder (17.9%); Schizophrenia, schizotypal and delusional disorders (13.8%) and Mental and Behavioural disorders due to Substance use (8.3%). Deliberate self harm and seizures were present in 7% each.

CONCLUSION The commonest presenting complaint in psychiatry outpatient clinic was related to physical and somatic symptoms, followed by anxiety and mood related ones. Common diagnoses were Depression, Anxiety, Schizophrenia and Substance use/ related disorders.

Time to Review and Revise the Peer Review Process: A Critique

2022-10-20T12:42:00+00:00

Biomedical publishing is valuable as it is the process of disseminating novel and valuable scientific information. The publication of an article relies mainly on the peer review process that has been regarded as a gold standard for a long time. Despite being successful, the process has had a fair share of criticism. There is a need for considering some reforms in terms of transparency, accountability, and quality for this process. In this review, we aim to bring forward some criticism and provide recommendations for improvement of the peer-review process.

Pregabalin Abuse: an Area of Concern in Nepal

2022-10-19T14:45:34+00:00

No abstract available.