Journal of Psychiatrists' Association of Nepal

Embracing Diversity: Advancing Transgender Mental Health in Nepal

Reet Poudel — 2023-12-31

The understanding and recognition of transgender identities have evolved over time and reflected in changes to diagnostic classifications.

Navigating the intersection of Post-COVID olfactory dysfunction and mental Health: A biopsychosocial case study

Anvi Gupta — 2023-12-31

Background: Olfactory Dysfunction (OD) post-SARS-CoV-2 infection can manifest in various forms, including qualitative impairments such as parosmia. We describe a 26-year-old woman's trajectory from anosmia following COVID-19 infection to parosmia, which evolved into severe depression. This young woman from North India began perceiving a "garbage-like" odor from food items several months after recovering from COVID-19. Her distress from this condition, exacerbated by her family's lack of understanding, led to significant dietary restrictions, weight loss, and subsequent development of an episode of severe depression linked to the distress from her persistent olfactory dysfunction. A combination of escitalopram, olanzapine, and carbamazepine was initiated alongside psychoeducation sessions for the family. Over the following months, her depressive and olfactory symptoms showed significant improvement. This case illuminates the complex relationship between sensory dysfunction and mental health post-COVID-19, emphasizing the need for an integrated biopsychosocial treatment approach and the crucial role of familial understanding and support.

Tramadol use and seizure: A case report

Sachin Nepali — 2023-12-31

Opioids are commonly used and abused substance worldwide. Tramadol hydrochloride is a synthetic, centrally acting, opiate-like analgesic. Seizure is a rare side effect of tramadol. Tramadol-related seizures are short, tonic-clonic seizures that, like other drug-related seizures, are self-limiting. This epileptogenic effect of tramadol occurs at both low and high doses. We, herein, report the development of seizures after the use of tramadol with increasing dose. We report a 19-year-old man who had opioid dependence syndrome with regular use resulting into multiple episodes of seizures diagnosed as epilepsy for which Sodium valproate had been started.

Hospital based one-stop crisis management centre at patan academy of health sciences: New avenues for the mental health professionals

Sulochana Joshi — 2023-12-31

Gender-based violence (GBV) is a public health concern with high rates of mental disorders. One Stop Crisis Management Centre (OCMC) was established in 2010 in different hospitals throughout the nation for the management of gender-based violence (GBV) against women by the Government of Nepal. With establishment of OCMC throughout the nation to tackle and manage these GBV, the role of mental health professionals has been highlighted in many ways. OCMC is full of opportunities and challenges to improve mental health issues of patients with GBV as well as define and recognize the roles and responsibilities of mental health experts.

A study of sleep problems and its associated factors among patients presenting in psychiatry OPD at tertiary-level hospital in Nepal

Sreya Paudyal — 2023-12-31

Background: Sleep disturbances amongst those with psychiatric disorders are quite common and may occur as a primary disorder or in association with any psychiatric disorders. The aim of this study is to find out the prevalence of sleep disorders and its associated factors in psychiatric outpatients.

Material & Methods: This cross- sectional study was conducted among the patients presenting in the psychiatric opd, from 1st Feb 2022 to 30th July, 2022 in tertiary level hospital in Nepal. Total 217 samples were included and purposive sampling technique was applied for sample collection.

After written informed consent from participants socio-demographic data were collected. Athens Insomnia scale (ASI) and Screening symptoms of sleep disorder(s) were the tools applied to the participants to find out types of sleep disorders.

Results: In our study, sleep disorders were found in 66.8% of the patients presenting to psychiatric opd. Insomnia was the most common finding accounting for 59.4 % of the participants. Narcolepsy was found in 2.3% whereas parasomnia was found in 5.1 %; periodic limb movement disorder/Restless leg syndrome (PLMD/RLS) in 5.1%; disturbed circadian rhythm was found in 3.7% and Sleep Related Breathing Disorder was found in 5.1% of the participants. Patients diagnosed with mood disorder (80.4%) and primary headache disorders (82.9%) had more sleep problems compared to other diagnosis.

Conclusion: This study was the first in Nepal to assess the prevalence of sleep disorders in psychiatric outpatients. Our study emphasis importance of careful evaluation of sleep problems for proper management of the psychiatric patients.

Correlation between psychological diagnosis (Rorschach Psycho-diagnostics) and clinical diagnosis

Rajesh Kumar — 2023-12-31

Background: A wide acceptance of the Rorschach test is shown in clinical practice and clinicians choose the test not only as a diagnostic instrument but as a therapeutic practice also, sometimes variety of opinion comes from health professionals and the validity of the test result become more challenging. It creates a cognitive dilemma and the clinician has two options: either choice to accept or reject the diagnosis.

Material & Methods: A total 80 cases were selected from the psychiatry ward and written informed consent was taken. Socio-demographical data sheet was applied. Without knowing the history and other diagnostic variables, the Rorschach test was administered to make a psychological diagnosis by a qualified clinical psychologist and the clinical diagnosis was made through ICD-10 DCR criteria by the competent psychiatrist.

Results: Among the participants, 37.5% belonged to 29-39 years age group; 58.75% were male. Most of the study samples were married (71.25%), 32.5% were educated up to 6-10th standard. The majority (38.75%) of the participants were unemployed and 51.25% belonged to rural areas. A majority, ie: 47.5% were in the middle-income group (50-74K) and living in a nuclear family (83.75%). Schizophrenia was the most frequent diagnosis in both categories, 38.75% belonging to the Rorschach diagnosis and 33.75% in the clinical category followed by Depression, mania, anxiety, obsession, psychosis, organic, and conversion disorder. Overall, a high correlation was found between both diagnostic categories (X2 =4.1, P=0.75).

Conclusion: The findings of the study suggest that a high level of correlation was found between clinical diagnosis and Rorschach psycho-diagnosis.

Impact of brief psychological intervention on reducing the psychological symptoms after COVID-19 infection among healthcare workers (HCWs) in Nepal

Narmada Devkota — 2023-12-31

Background: Studies from various countries showed that HCWs suffered from psychological problems during the period of COVID-19 and psychosocial intervention to address the issues was found effective. This study aimed to find out the status of depression, anxiety, stress and post-traumatic stress disorder (PTSD) symptoms among HCWs after COVID-19 infection including determining the outcome of a brief psychosocial intervention protocol in reducing the symptoms.

Methods: Group-based pretest-posttest interventional design was adopted. A total of 380 HCWs, recovered from the COVID-19 infections were selected through a purposive sampling technique. The study period was from November 2020 to January 2021. The Nepalese-translated and validated version of the Depression, Anxiety and Stress Scale – 21(DASS-21) and Impact of Event Scale-Revised (IES-R) were used to assess the symptoms. A brief psychosocial intervention was done by a trained clinical psychologist and compared the differences in mean scores on the level of depression, anxiety, stress and PTSD symptoms before and after the intervention.

Results: This study found that about 11% HCWs had symptoms of depression, 31% had symptoms of anxiety, 3% had stress and 98.50% had symptoms of PTSD. The paired sample t-test showed a significant difference between the means for the IES-R before the intervention (M=47.94, SD=14.53) and after the intervention (M=43.63, SD=15.35); t = 5.003 and p=.000 as well as the DASS-21 mean score before (M=14.11, SD=11.74) and after (M=12.28, SD=10.81); t = 2.97 and p = .003 the intervention.

Conclusion: This study showed that this intervention protocol was found effective in reducing the symptoms of depression, anxiety, stress and PTSD symptoms of the participants. However, a longitudinal study is needed to confirm these findings

Depressive disorder among the end-stage renal disease patients undergoing maintenance hemodialysis at Chitwan medical college

Sabina Dahal — 2023-12-31

Background: Patients with End stage renal disease (ESRD) suffer from a variety of losses, including renal function, family role, work role, sexual function, as well as time and mobility, all of which have a substantial influence on their lives. Physical manifestation of the End-Stage Renal Disease patients receiving dialysis treatment may be obvious but studies have found that they are also at increased risk of clinical and subclinical Depressive Disorder for a variety of reasons; which might be overlooked in our routine clinical assessment. Depressive Disorder has been associated with impaired recovery and increased mortality in many diseases including End-Stage Renal Disease patients.

Objectives: To assess the magnitude of depressive disorder among the patients undergoing hemodialysis of duration >3 months at Chitwan Medical College Teaching Hospital (CMCTH) and to determine the association between explanatory variables with depressive disorder.

Methods: Patients undergoing maintenance hemodialysis at CMCTH after meeting inclusion criteria were enrolled by consecutive sampling technique. Diagnoses were assessed on the basis of the ICD-10 Classification of Mental and Behavioral Disorders- Diagnostic Criteria for Research (ICD-10 DCR). To stratify the severity of the Depression into mild, moderate and severe categories, we used Hamilton Depressive Disorder rating scale. Seventy-four (74) patients undergoing maintenance hemodialysis were assessed. Interviews with patients and informants were taken and filled in a self-designed demographic datasheet. Obtained data were analyzed by using descriptive and inferential statistics.

Results: The prevalence of the depressive disorder among patients undergoing maintenance hemodialysis was 75.70%. Positive correlations were found between depressive disorder and gender, age group and occupation(p<0.05).

Conclusion: The present study showed that the prevalence of depressive disorder was higher in ESRD patients compared to study done in Nepal where prevalence of depressive disorder in ESRD patients was 51.8%.

Morbidity Pattern in Psychiatry Ward in a Tertiary Care Hospital

Neena Rai — 2023-12-31

Background: Worldwide mental health conditions are in increasing trend. South Asian countries report the highest prevalence of common mental disorders globally, which accounts for 8.8% to 16.6% of the total burden of disease. In Nepal, the prevalence of mental disorders among adults and children is 13.2% and 11.2%, respectively. In Nepal, there is limited data on the pattern of morbidity in inpatient psychiatric wards. Hence, the need is felt to carry out this study to monitor the psychiatric morbidity patterns of patients admitted to the psychiatric ward.

Methods: This is a retrospective, cross- sectional study conducted in Kist Medical College. After ethical approval from Institutional Review committee, the data of all patients admitted to Psychiatry Ward of Kist Medical College Teaching Hospital from 14 th April, 2022 to 13 th April, 2023 were collected from Record section. We used ICD-10 and CDDG criteria for the diagnosis of mental and behavioral disorders. Data was analyzed using SPSS version 16.

Results: Out of 285 patients 70.40% patients belonged to age group 25-54 years .The mean age with standard deviation was 55.4±72.3 years. Most of the patients were Male (72.60%) and Janajati (44.80%). The most common diagnosis was Alcohol Dependence Syndrome. The duration of hospital stay of most (46.90%) of the patient was 1-2 weeks.

Conclusion: The most common diagnosis for which admission was made in Kist Medical College was Alcohol Dependence Syndrome. This indicate that the alcohol related disorder may have important implications for care and planning in the community. The overall outcome was satisfactory.

Depression and anxiety among patients with cardiovascular disease in a tertiary care centre

Mukti Acharya — 2023-12-31

Background: Years of investigation have unveiled numerous connections between cardiovascular diseases (CVDs) and anxiety and depression, and there is even a suggestion that they could mutually contribute to each other. Recent research is starting to reveal a significant occurrence of behavioral risk factors among individuals with anxiety and depression, which could potentially lead to the development of cardiovascular disease. A descriptive cross-sectional study was conducted with the aim of determining the occurrence of psychiatric coexisting conditions among individuals with cardiovascular diseases and identifying the behavioral risk factors among this group

Material and Methods: The study took place between May 17, 2022, and January 31, 2023, at Nobel Medical College Teaching Hospital in Biratnagar. To achieve this, a semi-structured questionnaire, which included the Self-Reporting Questionnaire (SRQ-20) developed by the World Health Organization, was employed to screen for psychiatric symptoms in a sample of 200 individuals who were purposefully selected for the study.

Results: Out of the 200 patients examined, 160 (which accounts for 80%) were found to be positive on the SRQ screening, with the majority of them being males, totaling 65.62% (n=105). A significant portion of these patients fell within the age range of 19 to 39 years 50% (n=80).

The behavioral risk factors include smoking at 76.25%, alcohol abuse at 73.75%, physical inactivity at 60%, and obesity at 70%. The distribution of cardiac conditions in the sample included ischemic heart disease in 54.50% of cases, heart failure in 10.50%, cardiomyopathy in 9.00%, rheumatic heart disease in 11.00%, and post-cardiac intervention in 15.00%. Among those with cardiac diseases, 51.25% were experiencing symptoms of depression, 48.75% had anxiety disorders.

Conclusion: There was a notable prevalence of depression and anxiety among patients with cardiovascular diseases.

Tobacco use and its associated factors among Bachelor’s level public health students of Koshi Province

Parth Guragain — 2023-12-31

Background: Tobacco is a pressing global public health issue, contributing significantly to widespread illness and mortality. All forms of tobacco consumption have adverse effects on well-being, resulting in millions of deaths each year. Whether through smoking, smokeless methods, or exposure to secondhand smoke, it is associated with various health complications, including cardiovascular diseases, respiratory disorders, diverse cancers, non-communicable diseases (NCDs), and more. The WHO Framework Convention on Tobacco Control underscores the pivotal role of healthcare practitioners like doctors, dentists, nurses, pharmacists, and optometrists in aiding individuals to quit or preventing tobacco usage through concise counseling or straightforward advice. Providing cessation training to aspiring health professionals could be a pivotal stride towards advancing tobacco control endeavors.

Methods: This study employed a descriptive, cross-sectional design to investigate the perspectives of public health students regarding global health issues. Bachelor’s level public health students of Koshi Province were administered the Global Health Professional Student Survey (GHPSS), a validated instrument designed to assess prevalence, attitudes, and behaviors related to tobacco use and control. Data collection took place over a specified time frame, with participants providing responses anonymously. Statistical analyses using SPSS 20 employed to derive meaningful insights into the tobacco consumption habits of public health students.

Results: Out of the participants, 14.1% were identified as current smokers. A significant portion (27.6%) had experimented with cigarettes at some point, with the majority initiating cigarette smoking between the ages of 11 and 19 years. In terms of current usage of alternative tobacco products, 8.2% reported ongoing use, while 9.4% had tried them at least once. Male respondents exhibited a 9.05 times higher likelihood of smoking compared to their female counterparts. Furthermore, individuals with friends who engaged in tobacco smoking were 4.02 times more inclined to smoke than those whose friends did not have this habit.

Conclusion: The research revealed a 14.1% prevalence of current smoking among bachelor level public health students in Koshi Province. As future leaders in health planning and administration, it is imperative for these students to grasp the comprehensive implications of smoking on physical, mental, and societal well-being. To achieve this, academia, healthcare, and policymaking sectors should work in tandem to create an environment that fosters enhanced learning for current public health students. This collaborative effort holds the potential to significantly reduce smoking rates in society.

Declining attendance at conferences locally and globally: How to combat in limited resource settings?

Rika Rijal — 2023-12-31

Nepal is hosting several national and international conferences. This trend is growing in the past few years. It is heartening to see academicians and researchers from all over Nepal are taking up the responsibility with big enthusiasm for hosting such events. This gives hope to new and potential conference venues for the future. Such events especially in the field of psychiatry help create awareness and decrease stigma among colleagues of other specialty as well.