Kluver-Bucy Syndrome in a Patient with Bipolar Affective Disorder

Introduction: Kluver and Bucy described a behavioral syndrome in rhesus monkeys following bilateral temporal lobectomy which included psychic blindness, hyperorality, hypermetamorphosis, hypersexuality, and emotional unresponsiveness. Case report: A 44 years old right handed male of Indo-aryan origin, blacksmith by profession, had presented in manic phase of bipolar illness. He had hypersexuality, hypermetamorphosis, hyperorality, and altered dietary habits along with amnesia and fleeting misrecognition of even his close relatives. MRI of the patient showed mild cerebral atrophy with right temporal lobe atrophy. The patient was treated with lithium and olanzapine along with benzodiazepines. The symptoms resolved gradually with resolution of the manic phase. Patient had similar features in the previous manic episode as well that resolved with resolution of mania. Conclusion: The symptoms of Kluver-Bucy syndrome like increased libido, increased activity might be confused with that of mania. Other features of Kluver-Bucy syndrome and the overt hypersexuality could help identify it even during manic phase of bipolar illness

Bullying, Depression and Anxiety among Secondary School Students of Illam, Nepal

Background: Bullying is an intentional act of hurt and frighten others, it is common in schools. Different kind of bullying student may include physical, verbal, emotional and cyber bullying in the school. Objectives: To assess bullying, depression and anxiety among students and to find out association between bullying, depression and anxiety. Materials and method: A descriptive cross-sectional study design was adopted with sample size of 306. Simple random sampling technique was used to select the sample. Bullying (physical, verbal, emotional, sexual and cyber bullying) questionnaire was developed on the basis of Olweus Bullying Profile, Depression and anxiety was assessed using Beck Depression Inventory (BDI II) and Beck Anxiety Inventory (BAI). Data were analyzed using descriptive and inferential statistics with SPSS version 16. Results: Present study found that 112 (37%) of respondents had experienced bullying among them physical bullying 41(36.6%), verbal bullying 40 (35.7%), emotional bullying 10 (8.92%), sexual bullying 11(9.82%), and cyber bullying 10 (8.92%). More than half (52.6%) of the respondents had minimal depression followed by mild depression 35.6%. More than two-third (69.9%) of the respondents had low anxiety. Conclusion: Bullying is common in schools. Minimal Depression and low anxiety were common in students which ultimately leads to suicidal ideation. There was significant association between physical, verbal, and sexual bullying with gender and obtained percentage in last year summative annual exam. Awareness program should be initiated to identify bullying and proper reporting which will ultimately improve the mental health of school students. Keywords: Anxiety, bullying, depressio

Health and socioeconomic resource provision for older people in South Asian countries: Bangladesh, India, Nepal, Pakistan and Sri Lanka evidence from NEESAMA

Background: The global population is ageing rapidly, with low- and middle-income countries (LMICs) undergoing a fast demographic transition. As the number of older adults in LMICs increases, services able to effectively address their physical and mental health needs will be increasingly important. Objective: We review the health and socioeconomic resources currently available for older people in South Asian countries, Bangladesh, India, Nepal, Pakistan and Sri Lanka, to identify gaps in available resources and assess areas for improvement. Methods: We conducted a search of grey and published literature via Google Search, Compendex, EBSCO, JSTOR, Medline, Ovid, ProQuest databases, Scopus and Web of Science. Data on population demographics, human resources, health funding and social protection for older people were extracted. Local informants were consulted to supplement and verify the data. Results: In the study countries, the number of health professionals with expertise in elderly care was largely unknown, with minimal postgraduate training programmes available in elderly medicine or psychiatry. Older adults are therefore cared for by general physicians, nurses and community health workers, all of whom are present in insufficient numbers per capita. Total average healthcare expenditure was 2.5–5.5% of GDP, with 48.1–72.0% of healthcare costs covered by out-of-pocket payments. Pakistan did not have a social pension; only India and Nepal offered financial assistance to people with dementia; and all countries had disproportionately low numbers of care elderly homes. Conclusions: Inadequate healthcare funding, a shortage of healthcare professionals and insufficient government pension and social security schemes are significant barriers to achieving universal health coverage in LMICs. Governing bodies must expand training pro-grammes for healthcare providers for older adults, alongside increasing social protection to improve access to those in need and to prevent catastrophic health expenditure

Dementia Assessment and Management Protocol for Doctors in Nepal

WHO Dementia Report published in 2012 highlighted the exponential rise of dementia in the elderly population worldwide, especially in low-and middle-income countries. There may be over 135,000 people with dementia in Nepal, but there are no formal arrangements for diagnosis and treatment or any care and support for their caregivers. WHO developed the Mental Health Gap Action Programme (mhGAP) Intervention Guide in 2010, for mental, neurological and substance use, including dementia in non-specialist health settings. This paper reviews the current dementia care provisions in Nepal and proposes a mhGAP-based dementia assessment and management protocol for Nepalese doctors in hospital/clinic settings. The protocol also outlines a post-diagnostic advice for dementia caregivers. The protocol would be discussed at various stakeholders meetings before recommending for routine clinical use. Keywords: caregiver burden; dementia; MCI; memory clinic; mhGAP-IG; protocol

Dementia Assessment and Management Protocol for Doctors in Nepal

WHO Dementia Report published in 2012 highlighted the exponential rise of dementia in the elderly population worldwide, especially in low-and middle-income countries. There may be over 135,000 people with dementia in Nepal, but there are no formal arrangements for diagnosis and treatment or any care and support for their caregivers. 
 WHO developed the Mental Health Gap Action Programme (mhGAP) Intervention Guide in 2010, for mental, neurological and substance use, including dementia in non-specialist health settings. This paper reviews the current dementia care provisions in Nepal and proposes a mhGAP-based dementia assessment and management protocol for Nepalese doctors in hospital/clinic settings. The protocol also outlines a post-diagnostic advice for dementia caregivers. The protocol would be discussed at various stakeholders meetings before recommending for routine clinical use. 
 Keywords: caregiver burden; dementia; MCI; memory clinic; mhGAP-IG; protocol

Length of Stay of Psychiatric Admissions in a Tertiary Care Hospital

Introduction: The length of stay among psychiatric in-patients is usually longer than that of others. In-patient management is costly and longer length of stay can lead to catastrophic costs. We conducted this study to explore about the length of stay of psychiatric admissions and factors affecting it. Methods: We collected the data of all the patients admitted to the psychiatric ward of B. P. Koirala Institute of Health Sciences from 1st January 2007 to 31st December 2016 from the database of the medical records section after ethical approval. The sociodemographic and clinical variables were analyzed using SPSS 20.0 version. Length of stay more than 3 weeks was considered as long stay. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with length of stay. Results: There were 3687 admissions during the study period. The average length of stay was 19.36 (±13.14) days. On logistic regression, the factors associated with shorter length of stay were: male gender (aOR= 0.79, 95%CI: 0.68-0.93), being self employed (aOR= 0.17, 95%CI: 0.12-0.22), homemakers (aOR= 0.18, 95%CI: 0.14-0.24), farmers (aOR= 0.20, 95%CI: 0.15-0.27) and students (aOR= 0.23, 95%CI:0.17-0.32). Similarly, factors associated with longer length of stay were: being from other Eastern Terai districts(aOR=1.37, 95%CI: 1.11-1.70), other Eastern Hill districts (aOR= 1.68; 95%CI: 1.29-2.20), diagnosis of schizophrenia and related disorders (aOR=4.01, 95%CI: 1.34-12.0), having medical co-morbidity (aOR= 3.47; 95%CI: 2.49-4.84) and being readmitted (aOR= 1.23, 95%CI: 1.03-1.47). Conclusions: There was significant association of length of stay with gender, age, address, occupation, diagnosis and readmissio

Delirious Mania in an Elderly, Challenges in Diagnosis and Treatment

Delirious mania is an acute neurobehavioral syndrome which can have the features of mania, delirium, psychosis and catatonia. There are no diagnostic and treatment guidelines of delirious mania which can lead to delayed treatment, increasing morbidity and mortality. The primary goal of this report is to raise awareness among healthcare professionals and improve patient outcomes for this potentially life-threatening condition. In this case report, we present an octogenarian female, a case of bipolar disorder, current episode manic, who had impaired orientation, delusion of persecution, and altered sleep–wake cycle. She was treated with a combination of mood stabilizer and antipsychotic and discharged after 24 days of admission

Psychiatric Comorbidities in Patients with Deliberate Self-Harm in a Tertiary Care Center

Introduction: Deliberate self-harm is one of the common psychiatric emergencies in medical practice. It has become a global health problem with rates increasing over time. This hospital based study may help in understanding the cause, methods and psychiatric comorbidities present in such patients. The aim of this study was to (i) study the relationship between major socio-demographic variables and deliberate self-harm (ii) evaluate methods and precipitating cause (iii) determine the nature and prevalence of psychiatric and personality disorders in deliberate-self harm patients. Methods: This retrospective observational study was performed on 200 cases of deliberate self-harm in a tertiary referral centre in Eastern Nepal by the data collected from the medical records of these patients. Various sociodemographic data and psychiatric comorbidities prevalent in them were analysed. Results: Majority of the suicide attempters (77%) were less than 35 years of age. The female-to-male ratio was 1.35:1. 76% of the patients had received formal education. Majority (73.5%) were married. By occupation, 38% were housewives and 25.5% were students. 72.5% of cases had consumed organophosphates/-chlorides. Interpersonal conflict (72%) was the major cause of DSH. ICD-10 psychiatric disorders were diagnosed in 37% of cases and premorbid personality problems were present in 20% of cases. The most common diagnosis was adjustment disorder (13.5%) followed by mood disorder (11%). Conclusions: Majority of DSH cases were of younger generation. Psychiatric disorders and comorbid personality problems are common in DSH patients. This has important implications for proper assessment and management. Keywords: Deliberate self-harm; Organophosphorous; Para suicide; Psychiatric co-morbidities

Magico-religious Beliefs in Schizophrenia: A study from Eastern part of Nepal

Background &amp; Objectives: Schizophrenia is one of the commonest psychiatric disorders which require immediate interventions. Magico-Religious beliefs may affect the expression of psychopathology as beliefs are entrenched into human psyche. Local and community beliefs in such phenomena appeared to be a factor in influencing the decision to seek magico-religious treatment. This study aimed (1) to determine attitude of patients and relatives with respect to magico-religious beliefs and its influence on psychopathology, and (2) to examine the relationship between psychopathology and major sociodemographic variables.Materials &amp; Methods: All 50 consecutive cases of schizophrenia attending psychiatric services during study period were thoroughly evaluated. All the cases were diagnosed as per ICD 10 DCR criteria. The supernatural attitude questionnaire was applied.Results: Fifty cases were studied. Among them, 48% belonged to the age-group of 25 to 34 years, the majority of them were male (62%), 82% were Hindus, and 64% married. Majority of the patients had undergone magico-religious treatment (n = 35). Among the sample, 68% consulted faith healer and 42% performed religious treatment during the illness period; 60% acknowledged personal belief in sorcery, 58% in ghosts, and 52% in spirit intrusion. Among them, 20% believed there was a link between sorcery and mental illness, and 20% believe spirit could cause mental illness. Among the samples, 38% found the link between sorcery and abnormal behaviour, 38% with evil spirit, and 22% due to planetary influences. Statistically significant association was noted in the belief that rituals can improve patient behaviour and local belief in supernatural influences.Conclusion: There is a common belief in the relationship between supernatural influences and mental illness among the relatives of the patients. Such beliefs and magicoreligious treatment do occur during the course of the illness.</p

Gender Differences in the Prevalence of Depression among the Working Population of Nepal

Objective. To estimate the prevalence of depression in the working population; to examine if any gender disparity prevails; and to determine the sociodemographic mediators of depression. Methods. Data from previous research was retrieved for this study. Only paid workers were selected (n=160). Sociodemographic variables including prevalence of moderate depression were compared between the genders using Chi square test. Significant variables were subject to logistic regression. Validated Nepali version of the Beck Depression Inventory scale (BDI-Ia) was used to determine depressive symptoms with a cutoff score of ≥20 considered as moderate depression. Result. The overall prevalence of moderate depression was 15%, with higher prevalence among working women compared to men [χ2 (df) = 6.7(1), P=0.01], those practicing religions other than Hinduism [χ2 (df) = 5.5(1), P=0.01], those educated up to primary school compared to other education criteria [χ2 (df) = 9.4(4), P=0.03], those having vitamin D deficiency compared to others [χ2 (df) = 8.5(3), P=0.03], and sedentary lifestyle compared to active lifestyle [χ2 (df) = 6.7(1), P=0.009]. The OR (95% CI) for moderate depression was significantly higher in women than in men [3.2 (1.1-9.6), P= 0.03] and sedentary lifestyle [2.9(1.1-8.2), P= 0.04] even after adjusting for confounding variables. Conclusion. Working women have increased odds of depression compared to men. Among various characteristics, sedentary lifestyle was the most important causative factor for depression among women