Journal of Psychiatrists' Association of Nepal

Unilateral Ophthalmoplegia in Delirium Tremens Patient Due to Subdural Hematoma

Suren Limbu — 2022-12-31

Ophthalmoplegia or the paralysis of nerves supplying extraocular muscles can be due to numerous etiologies. In alcohol users, ophthalmoplegia might be due to Wernicke's encephalopathy. A high dose of thiamine should be used with a high index of suspicion in such cases, but at the same time, other life-threatening conditions should not be missed. Careful history taking, clinical features and neuro imaging can guide in identifying the likely aetiology. Here, we present a case of isolated unilateral oculomotor nerve palsy due to subdural hematoma in a patient with delirium tremens.

Rising Trend in Screen Time and Associated Autism-like Symptomsin the Digital Age of COVID-19 Pandemic

Sherina Moktan — 2022-12-31

The COVID-19 pandemic came with stay-at-home orders, virtual classrooms, online family and social interactions, with consequential rise in preference of spending time on digital devices rather than in social interaction and outdoor play activities. This trend has brought challenges to today's parenting with repercussions on social communication development of children resulting in an increase in the number of children presenting with symptoms of autism. The postulated mechanism could be the screen-based developed neuroplasticity adversely affecting social salience neuronal pathways. Other contributing factors could be the hindrance of screen overuse on social learning, parent-child interaction and child's interests on off-screen activities. Positive parenting with structured routine of settng screen-free time and zones, behavioral modeling and substitution along with virtual access to child psychiatry services and interventions can mitigate the surging risk of associated autism-like features in today's children.

Human Sexuality, Sexual Medicine and Psychiatry

Reet Poudel — 2022-06-30

No abstract available.

Mental and Behavioral Problems in Medical Students of a Health Science Institute in Eastern Nepal

Dhana Ratna Shakya — 2022-06-30

Introduction: Literature shows a high prevalence of mental disorders among medical students. Psychiatric morbidity data help enhance all levels of management. We have limited data about 'mental and behavioural problems' in medical students.

Objective: To see and sort out psychiatric problems among medical students of BP Koirala Institute of Health Sciences (BPKIHS), Nepal.

Methodology: It is an institute based prevalence study. Twenty percentages of all medical students of all programs (1125) of academic year of 2008/9 were (systematic) randomly selected. After informed written consent, the subjects were enrolled. A semi-structured proforma was used to record socio-demographic and clinical profiles. The 'Structured clinical interview for DSM-IV Axis I disorders' (SCID-I) was used to diagnose major psychiatric disorders.

Result: Out of the total sample students, 219 students were enrolled. Among the enrolled subjects, life time diagnosis of psychiatric problem (till the time of the study) was about 55%. At the time of the study, approximately 30% had psychiatric problem. During BPKIHS stay inclusive of current problem, slightly more than 40% had mental problems. The most common diagnosis was adjustment disorder.

Conclusion: A great proportion of medical students suffer from mental and behavioural problems.

Stressful Life Events Severity in Patients with Depressive Disorder: A Cross-Sectional Study

Riju Niroula — 2022-06-30

Introduction: Stress and stressful life events are believed to precipitate depressive disorders but the areas of stress and types of stressful life events found in depression vary by socio-cultural contexts. So this study was conducted to assess the contribution of the number and severity of recent stressful life events on the prevalence of depressive disorder in a tertiary hospital in Nepal.

Methodology: 237 consecutive patients with ICD-10 diagnosis of a depressive disorder were included in the study. The Beck Depression Inventory (BDI) was applied to rate the severity of depressive disorder and The Social Readjustment Rating Scale (SRRS) was applied to assess for the severity of stressful life events.

Result: 65.8% patients had experienced low severity of Stressful life events SLEs while 13.5% patients suffered from medium severity of SLEs and 20.6% suffered from severe SLEs. Severity of depression assessed with BDI revealed the 62.8% patients suffered from moderate depression while 22.7% suffers from severe depression. The Chi square statistics showed statistically significant difference on age, marital status, educational status and socioeconomic status. Also the severity of depression was found to be statistically significant with severity of SLEs experienced.

Conclusion: Significant correlation was seen between severity of depressive disorder and stressful life events. Establishing their impact and addressing coping mechanisms should be done to make for a comprehensive management of any patient diagnosed with depressive disorder.

Relationship Between Screen Time and Behavioral Problems in Primary School Students

Manisha Chapagai — 2022-06-30

Introduction: Rampant use of electronic based devices like television, mobile phones, gaming consoles, computers, etc. disregarding the beneficial effects of physical activity, social interaction, sleep and academic performance result in deficit of psychological well-being of children. The aim of our study was about screen use in Nepalese children and the relationship of screen time with behavioral problems in primary school students. In this study we collected important information based on our objectives on primary school students in our context and to avail the information to clinicians, parents, guardians, educators, policy makers and all those involved.

Methodology: This study was done in Budhanilkantha municipality of Kathmandu district, Nepal. One community school and one private school were randomly selected from a list of schools. Data was collected from all primary school students of these schools with the help of questionnaires filled by parents. Screen _me and different socio demographic factors that might affect screen time was assessed with the help of questionnaires filled by parents. Behavioral problems were assessed using parent-filled Strength and Difficulties Questionnaire. Statistical analysis was done using SPSS version 24 for windows.

Result: Our study sample contained 314 primary school students. 52.5% of them were from private school and 47.5% from community school. The mean daily screen time was 1.96 hours, and more than one-fourth of the students had daily screen time of more than two hours per day. Higher number of televisions in the house, presence of computer in the house, more frequent screen use while having meals, higher frequency of screen use with parents, having father with university degree were the factors having statistically significant association with higher screen time of children. Students with daily screen time of more than two hours per day had higher internalizing problem score (8.93±3.453), higher externalizing problem score (9.28±3.885) and total problem score (18.21±6.253) compared to those with screen time of two hours or less (6.97±3.285, 6.10±3.398, 13.07±5.402 respectively). The difference between the groups were statistically significant on all three scales on Mann Whitney U-test (p<0.001, p<0.001, p<0.001 for internalizing, externalizing and total problem score respectively).

Conclusion: The higher screen time in children was significantly associated with higher behavioral problems. Our study findings re-emphasized the need to follow the guidelines and recommendations set by international regulatory bodies as well as develop guidelines on our own on limiting screen time in children for betterment of psychological wellbeing of children.

The Association Between Internet Addiction and Social Anxiety Among Adolescents: A cross sectional study from Dharan

Sanjeev Kumar Mishar — 2022-06-30

Introduction: Internet addiction is an increasingly prevalent phenomenon affecting both social and psychological aspects of an individual. Internet addiction is thought to be the result of cognitive distortions such as those seen in social anxiety. In light of this theory, this study is an attempt to see if there is an association between internet addiction and social anxiety.

Methodology: A cross sectional study was conducted among students from class 10-12 of a school in Dharan using convenient sampling method. The students were evaluated using the Young Internet Addiction Test (IAT) and the SPIN Inventory. Descriptive data was analysed using number and percentage. Association between IAT and SPIN was assessed using chi square test. Correlation between the IAT and SPIN scores was assessed using Pearson correlation.

Result: Of the 245 students, 52.7% were female and 38.4% were from class 10. 44.9% students had mild internet addiction 29.4% had moderate and 0.4% had severe level of internet addiction. 57.4% students had both internet addiction and social anxiety (p < 0.01). There was a small positive correlation between IAT and SPIN scores (r value 0.3, p value < 0.01).

Conclusion: Internet addiction and social anxiety are significantly associated with each other. Further studies need to be carried out to establish the cause-effect relationship.

Tobacco Use, Dependence and Psychiatric Comorbidity in the Community of Dharan

Suren Limbu — 2022-06-30

Introduction: Though there are studies in the past done to assess the prevalence of tobacco use in the country, little is known about the state of nicotine dependence among tobacco users and the co-occurrence of nicotine dependence and psychiatric disorders in Nepal.

Objectives: To estimate the prevalence of tobacco use, the level of nicotine dependence among the users and the psychiatric disorder-specific prevalence among tobacco users in a community settng.

Methodology A cross-sectional study was conducted in the community of Dharan. One hundred twenty-eight cases (size) were enrolled from different wards of Dharan using the Population proportionate random sampling technique. The Fagerström Test for Nicotine Dependence (FTND) was applied to assess the level of nicotine dependence and the Mini International Neuropsychiatric Interview (M.I.N.I.) was for the diagnosis of Psychiatric disorders.

Result: The prevalence of tobacco use was 41.4%. Tobacco use was more common among males and those with a family history of tobacco use and psychiatric illness (p-value< 0.05). The smoking form was more common than smokeless one. Most tobacco users had moderate nicotine dependence and started the use in their 20s. Among tobacco users, 23 cases had comorbid psychiatric diagnoses, common being alcohol and other substance, depression and anxiety disorders.

Conclusion: The prevalence of tobacco use was high in the community. Young persons in their 20s should be given special attention while conducting educational and awareness programs regarding tobacco prevention. Psychiatric comorbidities should be assessed routinely among tobacco users.

Coping in People Living with HIV/AIDS (PLWHA) and its Association with Depressive Disorder

S. Tiwari — 2022-06-30

Introduction: Among PLWHA, fewer studies have done to assess the coping and their role in increasing the morbidity and mortality among people living with HIV/AIDS (PLWHA).

Objective: This study aims to study coping among PLWHA and their association with depression.

Methodology: This study was conducted at the outpatient HIV clinic in a tertiary center (TUTH). All relevant information was noted in a semi structured proforma designed for the study. BDI-II and brief COPE were the tools used.

Result: Among the depressed and non-depressed groups, the mean scores on emotional support (and standard deviation), were found as 4.41 (1.104) and 5.32 (1.511) respectively. There is a negative correlation between depressive scores (BDI) and total score on brief COPE.

Conclusion: PLWHA with lower level of depression were to found to score more on brief COPE.

Mental Healthcare of Elderly Population of Bangladesh: Current Situation and Challenges

Shaorin Tanira — 2022-12-31

In Bangladesh, mental health of elderly people is often underestimated because of lack of awareness and perceived needs of medical care for physical health problems, whereas comorbid psychiatric conditions remain underdiagnosed among individuals in the country. Large numbers of older persons face challenges such as discrimination, negligence and abuse that severely restrict their human rights and their contribution to society. However, in recent times, NGOs, legislatives, and citizens argue that it is the high time that older persons should be identified as a distinct category deserving special care and attention under human rights law. In Bangladesh, about 14 million older adults live in the country, which is 7.7% of the total population; this ageing population has been projected to be 17.2 million by 2025. The Mental Health Act was passed by the National Parliament of Bangladesh in 2018. A multi-disciplinary working group with representatives from government Ministries, mental health professional organizations, and advocacy groups collaborated to draft a National Mental Health Policy, which was approved by the Ministry of Health in 2019 is currently awaiting endorsement by the Cabinet. The working group also drafted a National Mental Health Strategic Plan 2020- 2030, anticipating implementation over the next decade, through successive 5-year action plans. To date, neither the policy nor the strategic plan has been implemented. Adoption of the strategic plan within the MOHFW general health care plan is anticipated in 2020. Under the circumstances, this review paper aims to examine current situation and challenges in having access to mental health care for the elderly people as part of human rights and a public health concern, while the health system has already been overburdened with other public health challenges due to limited resources.

Relationship between Substance use and Endocrine Disorders: A Narrative Review

Pawan Sharma — 2022-12-31

Substance use disorder is one of the significant public health concerns and the co-morbidity with endocrine disorders has a potential to cause adverse outcomes. There is a definite link between substance use and dysregulation of endocrine system at a level of causation, association, management and drug interaction. It has been seen that the screening of substance use while managing endocrine disorders is a must. Also, integrated management of both of these chronic condition with collaborative care approach can not only help in effective management but also improve the outcomes in terms of mortality, cost effectiveness, stigma and financial burden. Though considered important this common area seems to be understudied. Hence we recommend that this co-occurrence of substance use and endocrine disorders should be studied and guidelines be developed for the effective management.