Journal of Psychiatrists' Association of Nepal

Clinical Applications of State Alcohol Biomarkers: An update

2023-08-16T07:08:51+00:00

Alcohol Use Disorder (AUD) is one of the most prevalent causes of global burden of disease. It is associated with significant physical and mental health problems as well as social and economic consequences. Alcohol consumption is considered to be one of the most important preventable risk factors for adverse health outcomes, hence proper assessment is must for alcohol use disorder. The assessment pattern of alcohol use based on self-report of patients may not be always reliable due to recall bias and minimization highlighting the need of accurate biomarkers. In this narrative review we discuss about the different state biomarkers of alcohol, their properties and their utility in different settings during patient care. Despite many limitations traditional state markers are still useful and we recommend clinicians to familiarize themselves to use them as additional outcome measures in clinical interventions for AUDs and associated medical complications.

Climate change in South Asia and impact on mental wellbeing

2023-08-13T02:10:02+00:00

No abstract available.

Motivation enhancement in a case of Alcohol dependence presented with Wernicke Encephalopathy: a Case Report

2023-08-16T07:14:02+00:00

Alcohol related complications are fairly common among the chronic users. Life threatening complication such as Wernicke encephalopathy does occur; we do encounter it as mental health professionals. Motivation to stop or change the drinking habit is very crucial in the management of cases of Alcohol use disorder. Such a condition with cognitive dysfunction in itself hinders the process in such a case.

This case report highlights the implication of Wernicke encephalopathy (WE) and the process of motivation to change in such a case of Alcohol dependence syndrome (ADS). A 38-year-old case presented in our Emergency department with ADS, later upon shift to Psychiatry ward, Wernicke encephalopathy was also diagnosed. His initial assessment revealed confusion and his motivation in pre-contemplation stage. During the ward stay, as the patient condition stabilized with high dose of Thiamine and other measures, motivation enhancement was done. Later on, his motivation gradually changed to decision phase. Patient, since then, has been abstinent in alcohol

Chlorpromazine Induced Cataract in a female patient: A Case Report

2023-08-16T07:19:49+00:00

Tablet Chlorpromazine is a commonly used, affordable antipsychotic in developing countries. Chlorpromazine induced cataract and corneal pigmentation was first described by Greiner & Berry in 1964 but in the context of Nepal, there is no available literature or cases reported to date. Despite having a myriad of side effects, it is still used frequently in developing countries due to its cost-effectiveness. In this light, we report a case of a 43-year-old female with a diagnosis of Schizophrenia who had been treated with Tab. Chlorpromazine for 25 years. She lost to follow-up and presented at the OPD with cataract in bilateral eyes.

Psychological Distress & Coping among Nurses working with COVID-19 patients in a tertiary care hospital in India: A cross-sectional study.

2023-08-14T12:10:55+00:00

Objective: This study aimed to understand the psychological impact of COVID-19 pandemic on Indian nursing professionals and their strategies of coping with it.

Method: This was a cross-sectional observational study conducted on nursing professionals (staff and students) of a tertiary care hospital, medical college and research centre in North India.

Results: Among 103 participants, most participants were females (84.5%), graduates, married and lived with families. Most participants and their families responded to COVID duty with anxiety, fear and stress. Physical discomfort and inadequate PPE supply were main challenges perceived while working. Depressive symptoms were seen in 41% participants, 55% reported anxiety and 35% reported clinically significant stress. Participants working in COVID duty reported significantly higher anxiety compared to those who were not. Those with positive personal and family reactions towards COVID duties reported lower anxiety and stress scores. Those who perceived work-related discrimination had higher depression, anxiety and stress scores. Majority of participants employed approach-based coping styles with acceptance as the most commonly used coping strategy. Acceptance and planning were significantly higher in participants who had done COVID-19 duties compared to those who had not.

Conclusion: Understanding adverse psychological impact of COVID-19 on nursing professionals is of utmost importance as it has a direct bearing on patient care. Efforts for promoting comfort in work environment, psychological, familial and social support and activities promoting healthy coping are recommended during challenging times.

Psychiatric morbidities among old people of a city of Eastern Nepal

2023-08-14T12:23:42+00:00

Introduction: The data regarding prevalence of overall and common psychiatric disorders among community elderly people are scarce in Nepalese context.

Objective: To measure the prevalence of mental problems among old people in a community setting.

Methodology: All people of age ≥ 60 years from ‘Urlabari’, a city in eastern Nepal, being members of a local old-age committee were called to participate in this study. A total of 140 old people attended a health-camp and with informed written consent and authority approval, the response to the GHQ-12 and demographic information were collected. The GHQ-12 score ≥2 was adopted for ‘psychiatric caseness’ analysis. However, people with scores ≥4 were assessed by a psychiatrist for further evaluation and management. Diagnoses were made according the ICD-10.

Results: Majority (87%) were in age groups of (61-70) and (71-80) years. Many (44%) had stressors, common being: dispute with family, illness and death of close person. Many old people had health complaints; mainly physical/ somatic, mood and anxiety symptoms. About 2/5th subjects 55 (39.29%) had GHQ-12 score ≥2 and 26.43% had ≥3; i.e. ‘psychiatric caseness’. Among the subjects with score ≥4 (23) assessed for psychiatric diagnosis, 21 (91.30%) had some ICD-10 diagnosis. Depression, adjustment and anxiety disorders were common diagnoses, and 2% had suicidality.

Conclusion: A remarkable proportion of old people had current ‘psychiatric caseness’. Common mental disorders were depression, adjustment and anxiety disorders among elder people.

Prevalence and characteristics of relapse in patients with Alcohol Dependence Syndrome

2023-08-14T12:28:48+00:00

Background: Relapse is an important but difficult phase of the management of alcohol dependence syndrome (ADS).

Objective: To study the prevalence and characteristics of relapse in patients with ADS.

Methods:This is a descriptive cross-sectional study on the patients with ADS presenting at the Department of Psychiatry, Patan Academy of Health Sciences, for the period of one year (June 2016 - May 2017). Data on the demographic and relapse characteristics were collected. Data were entered and analyzed in Microsoft Excel (MS Office 365, Microsoft Corporation, Washington, United States). Numerical variables were summarized with the median (Inter-Quartile Range [IQR]) and the categorical variables with proportions.

Results: Altogether, 105 patients with ADS were studied, among which 59 patients had a relapse (56.1%). All of them were male with a median age of 42 years (Interquartile range (IQR) 35 to 52). The majority were married (55, 93.22%), manual labor as an occupation (32, 54.24%), were Janjati by ethnicity (37, 62.71%), and had received secondary education (19, 32.20%). The median age of starting alcohol consumption was 18 years (IQR 15 to 20) and the median duration of consumption was 22 years (IQR 15 to 30). The most common reason for relapse was peer pressure (25, 42.37%). The majority had relapsed once before (26, 44.07%). Mostly relapsed after abstinence of 1 to 3 months (22, 37.29%) and abstinence maintained by self-motivation (30, 50.85%). Comorbidity and family history of substance use was present in higher proportions.

Conclusion: A high rate of relapse was found in our patients with peer pressure as the most common reason for the relapse.

A naturalistic study on side effects of selective serotonin reuptake inhibitors in psychiatric out-patient department

2023-08-14T12:34:57+00:00

Introduction: >Antidepressants are one of the most commonly prescribed psychotropic drugs. Six SSRIs are approved for various disorders. SSRIs have fewer side effects owing to its selective blocking the serotonin transporter. Nonetheless SSRI has several troublesome side effects, including nausea, diarrhoea, headache, dizziness, sexual side effects, tachycardia, or weight gain.

Methodology: This cross-sectional comprised of 200 patients who were divided into two groups. Group 1 had participants who had received SSRI for less than 6 weeks duration and group 2 had patients who had taken SSRI for more than 6 months. Side effects of medications were recorded using UKU side effect rating scale and causality was ascertained using Naranjo adverse drug reaction probability scale.

Results: Among the early side effect group consisting of 100 patients, 40% of patients reported at least one side effect. Tension/inner unrest, nausea and vomiting and orgastic dysfunction was the most common side effect reported. 30% of patients in late side effect group had at least one side effect. Orgastic dysfunction, decreased sexual desire and weight gain were the main side effects reported. All the reported side effects were probably associated due to the prescribed SSRI, as inferred from Naranjo causality scoring system.

Conclusion: Escitalopram was the most commonly prescribed SSRI among all the SSRIs. Paroxetine and fluvoxamine were the least prescribed SSRIs. Sertraline was found to cause maximum side effects in the early group and fluoxetine caused the most side effects in the late group. Tension/Inner unrest was the most commonly reported side effects followed by sexual side effects.

Extent, pattern and risk factors of alcohol and tobacco use among undergraduate students in a university in Kathmandu: A cross-sectional study

2023-08-14T12:38:56+00:00

Correction: Several tables were omitted from this article by mistake. The correct PDF was loaded on 23/08/2023.

Background: Alcohol and tobacco use disproportionately affect young people and can lead to significant morbidity and mortality. High-risk factors often begin during adolescence and there is a long interval between exposure and disease development. This study aims to examine the prevalence and patterns of alcohol and tobacco use among undergraduates and to identify the risk factors associated with their use.

Methods and Materials: A structured self-administered web-based questionnaire using a cross-sectional design and stratified proportionate sampling was conducted. The questionnaire was based on the World Health Organization’s (WHO) Stepwise approach to surveillance of risk factors. The data was analyzed using SPSS version 25.

Results: Proportion of male and female participants was nearly equal. One-tenth of the participants were current tobacco users with cigarettes being the most used tobacco product while more than one-fourth currently consumed alcohol. Males were associated with lifetime alcohol and tobacco use, as well as current tobacco use. Senior-year students had a significant association with lifetime alcohol use, while insufficient intake of fruits and vegetables was associated with current alcohol use. Additionally, non-medical campus and junior-year students were associated with current tobacco use.

Conclusion: Alcohol and tobacco use among undergraduate students in a Kathmandu university show serious concern. Health professionals, faculty, stakeholders, and policymakers should take note of these findings and design interventions to promote the mental and physical health of young people and prevent addictive disorders.

Awareness regarding suicide among adolescents in a school: a cross sectional study

2023-08-14T12:46:59+00:00

Introduction: Psychosocial problems are highly prevalent problems among children and adolescents and can severely interfere with their everyday functioning. It is crucial to raise awareness around mental health to reduce the negative beliefs and attitudes and provide professional help. This study is aimed to find out the level of awareness regarding suicide among adolescents.

Material and Methods: A cross-sectional study was conducted to find out awareness regarding suicide among 300 adolescents in a school of Rupandehi district by using enumerative technique. Pretested, validated by experts and self-administered structured questionnaire was used to collect the data and collected data were analyzed by using descriptive and inferential statistics with SPSS-16.

Results: The findings of the study revealed that among 300 respondents, 47.5% had high awareness regarding suicide. Respondents have high awareness regarding meaning, risk groups, consequences and immediate management of suicide but have low awareness regarding risk factors, methods, warning signs, prevention and long term management of suicide.

Conclusion: Based on the findings of the study, it is concluded that nearly half of the respondents have high awareness regarding suicide. Suicide has been recognized as a major public health priority and advocate for the development and implementation of comprehensive strategies, taking into special consideration youth and other vulnerable groups. It is necessary to conduct awareness program on suicide to increase awareness among adolescents.