Background: Psychiatric morbidity is ubiquitous, affecting children, adolescents and adults. Age factorsplay a great role in pattern of morbidity profile. Psychiatric morbidity profile of children and adolescentsmay indicate different needs and priorities. Objective: This study aims to sort out referral pattern, attitudeabout psychiatric referral and morbidity profile among child and adolescent psychiatric out-patients in atertiary-care general hospital. Methodology: A total of 100 consecutive child and adolescent patientsin psychiatry OPD coming into contact with investigator psychiatrist were enrolled during the studyperiod. Diagnoses were made according to the ICD-10. Results: Fifty three of the subjects were female,majority of the cases (79) were of age between 13-18 years. Main ethnicity-caste groups seeking carewere Mongol, Brahmin, Chhetri and indigenous Terai tribes. People from semi-urban and urban settingspredominated in this study. Great majority (more than 80%) had reached this service in the 4th or in morethan the 4th step of their help seeking. Most of the subjects were comfortable and happy about psychiatricreferral. More than half had presented mainly with physical and somatic complaints. Major psychiatricdiagnoses encountered were mood (affective), anxiety, seizure, dissociative conversion disorders andmental retardation. Four percent of subjects had suicidal behaviours and 17% migraine headache.Conclusion: Common psychiatric diagnoses among these child and adolescent out-patients are mood,anxiety, seizure, dissociative conversion disorders and mental retardation.Key words: Attitude to psychiatric consultation; child and adolescent; out-patient; psychiatric morbidityDOI: 10.3126/jnps.v30i2.2604J. Nepal Paediatr. Soc. May-August, 2010 Vol 30(2) 79-84

AbstractsWith the rise in life expectancy, the elder population is increasing. Morbidity profiles of elderly people may indicate different needs and priorities. This study aims to sort out referral pattern, attitude about psychiatric referral and morbidity profile among elderly psychiatric outpatients in a general hospital.A total of 100 consecutive elderly (>55 years) out-patients in psychiatry OPD coming into contact of the investigator and giving informed consent were enrolled. Diagnoses were made according the ICD-10.More (54%) were female, mainly of age, 55-70 years (79%). Main ethnicity groups seeking care were Mongol (32%), Brahmin (25%), indigenous Terai tribes (14%) and Newar (11%). People from cities and semi-urban settings predominated the study. Referrals made most commonly by the departments were medicine, family medicine, surgery and ENT. More than a fourth (28%) were dissatisfied and questioned about the referral to psychiatric service. Greater proportions (71%) were comfortable and happy about psychiatry referral. Mood related and physical complaints each were presenting complaints in about half of subjects. Major psychiatric diagnoses were mood affective, anxiety, substance use and organic psychiatric disorders. Great majority had physical co-morbidity. Common mental disorders among elderly psychiatry out-patients were mood affective, anxiety and substance use disorders. A significant number of elderly psychiatry out patients had physical comorbidity.

Introduction: Suicide is a major public health concern and it is one of the commonest Psychiatric emergencies. Suicide rates are increasing and have become a global concern with more than 600,000 suicidal attempts every year in the United States, alone. There is no national data available for Nepal. This hospital based study may help in understanding about the cause and methods of suicide attempts. Objective: The aim of the present study was to assess the (i) methods and precipitating cause for attempted suicide (ii) to study the relationship between major socio-demographic variables and attempted suicide. This study may be helpful in formulating suicide prevention strategies at different levels. Methods: Cross-sectional study in a tertiary level hospital. Consecutive 100 cases of attempted suicide coming in contact to an investigating team were evaluated for methods opted for attempting suicide and underlying cause was explored. Demographic variables were recorded and analysed. Results: Majority of the suicide attempters (67%) were less than 35 years of age, and female outnumbered male. Sixty one percent of the subject belonged to rural background. Out of 100 suicide attempters 40% of them have completed SLC and majority of them were students. Fifty-four percent of the sample consumed pesticides and 25% of the cases used highly lethal means. Majority of the persons (58%) had psychiatric co morbidities in which depression was the commonest. Interpersonal conflict accounted for 18% of the cases followed by marital problems (13%) as triggering factors of attempted suicide. Conclusion: Majority of the suicide attempters were young and having psychiatric disorders. Most of the attempters were from rural areas. Keywords: Attempted suicide; psychiatric co morbidities; Interpersonal conflict. DOI: http://dx.doi.org/10.3126/hren.v9i3.5584   HR 2011; 9(3): 162-167

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Background Scrub typhus, an important cause of unexplained fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. The main aim of this study was to report on the clinical profile and complications of scrub typhus and its outcome in Nepalese children. Methods A prospective observational study was carried out in children aged 1–16 years, admitted to a tertiary care hospital of central Nepal in between July 2016- Aug 2017. Scrub typhus was diagnosed with IgM ELISA. Results All cases of scrub typhus (n = 76) presented with fever and commonly had other symptoms such as headache (75%), myalgia (68.4%), vomiting (64.5%), nausea (59.2%), abdominal pain (57.9%), cough (35.5%), shortness of breath (22.4%), altered sensorium (14.5%), rashes (13.2%) and seizures (11.8%). Important clinical signs noticed were lymphadenopathy (60.5%), hepatomegaly (47.4%), edema (26.3%), jaundice (26.3%), and splenomegaly (15.8%). About 12% (n = 9) had necrotic eschar. Similarly, thrombocytopenia, raised liver enzymes and raised creatinine values were seen in 36.9%, 34.2% and 65.8% respectively. The most common complications were myocarditis (72.4%), hypoalbuminemia (71.1%), severe thrombocytopenia (22.4%), renal impairment (65.8%), hyponatremia (48.7%) and hepatitis (34.2%). Over two-thirds (69.70%) of the cases were treated with doxycycline followed by combination with azithromycin in the remaining 18.4%. Overall, mortality rate in this group was 3.9%. Conclusions Scrub typhus should be considered as a differential in any community acquired acute undifferentiated febrile illness regardless of the presence of an eschar. Myocarditis and acute kidney injury are important complications which when addressed early can prevent mortality. Use of doxycycline showed a favorable outcome.

Corona virus disease-19 (COVID-19) is an acute highly infectious disease primarily involving the respiratory system. The World Health Organization (WHO) declared COVID-19 a global pandemic on March 11, 2020. No proven efficacious drug and no vaccine are available so far for treatment or prophylaxis of COVID-19. Social distancing has been one of the major measures adopted to prevent spread of the disease. Educational institutions have been shut down all over the world for the safety of both students and communities. Social distancing measures hamper students from assembling in learning labs, lecture halls, or small-group rooms and interacting in person. The major response to the pandemic has been to try to move both teaching-learning and assessment online. Schools have also tried to move clinical learning and teaching communication skills online using standardized patients and facilitators. Online education and assessment are not without their challenges, more so in South Asia. Online teaching learning has been a challenge for both faculty members and students, in varying extent. With online learning environments, supervision and support by the teacher may be less and students should have well developed self-regulated learning skills. These challenges have also offered several opportunities, some general to educators, some relatively specific to medical educators, some global in perspective and some local ones. The pandemic offers both educators and students the insight into: how health problems particularly infectious diseases can affect human life and livelihood; and understanding how people respond to it. The pandemic has forced changes in education methods, modality and process, which though may demand extra effort initially, provides teacher, faculty and facilitator the impetus to keep pace with current trends InTechnology. It has offered an opportunity to move to online learning and interaction and use virtual platforms for e-conference, webinars, podcasts, e-class/ e-lectures etc. Pandemic has brought very rapid changes in educational approaches in South Asia, which otherwise would have taken 5-10 years under normal circumstances.

People with psychiatric problems often visit a general hospital. Many of them require emergencyservice. B P Koirala Institute of Health Sciences (BPKIHS) is one of the few health institutes in Nepalproviding comprehensive 24-hour psychiatric emergency service. This study aims to document thepattern of psychiatric emergencies in a tertiary care hospital of Eastern Nepal.All psychiatric emergencies referred from different departments in 30 random days during a sixmonthperiod were enrolled. This is a descriptive study with convenience sampling method wherethe diagnoses were made based on the‘International Classifi cation of Disease and Infi rmity’ (ICD-10).One hundred twenty-nine cases were referred in the study period. The M:F ratio was 1.3:1. Theservice users were predominantly young adults. The majority of cases were seen in the emergencydepartment and medical ward. The most common causes for the consultation were behavioralproblems (39%), altered consciousness (32%) and somatic complaints (17%). Approximately 83%received the diagnosis of Category F of the ICD-10. Mental and behavioral disorder due to substanceuse (F10-19) was the most common disorder (30%), followed by mood/affective disorders (23%)and neurotic, stress-related anxiety disorders (16%). Roughly 46% had co-morbid physical illnessesand 8% received only a physical diagnosis. About 20% had attempted suicide using different means,poisoning being the most common.Emergency psychiatric consultation for mental problems is sought by almost all departments of ageneral hospital. These consultations are most commonly sought for substance use, mood or anxietydisorders.Key Words: Behavioral problems, psychiatric emergency, psychiatric disorders, substance abuse.

Alcohol abuse is common in eastern Nepal, rather reported remarkably high. Hence, various aspects of this problem have been the topic of search, study, survey and research in this part of the country, both in community and clinical settings. This article aims to review the journal articles published, research projects presented in scientific forum or conferences, thesis articles submitted and other research works related to alcohol from eastern Nepal coming into the knowledge of the author. The basis of this review were medical journals including Health Renaissance (HR), abstract books of various medical meets, internet search and personal communication with various departments of BP Koirala Institute of Health Sciences (BPKIHS), a prominent centre for the research projects carried out both by students and faculty members in this area. Overarching the objective would be to point out some important needs and areas for future research studies in next article. Health Renaissance, January-April 2013; Vol. 11 No.1; 74-82 DOI: http://dx.doi.org/10.3126/hren.v11i1.7607