No abstract

Background:Inpatient institution-based geropsychiatric study reports are rare in the world psychiatric literature.Aims:To study the pattern of neuropsychiatric illnesses seen in older age group population and to study how the advancing age influences the pattern of physical and neuropsychiatric illnesses in these geriatric people.Materials and Methods:This was a retrospective review of the charts of all patients of age 60 years and above, during a specified period of 3.5 years. The present study reports the findings of 138 patients (83 males and 55 females) admitted during the said period. For comparison purpose, 194 patients, in the age range of 50-59 years, who were admitted during the same period, were taken up specially to study the changing pattern of diagnosis, if any, as well as to study the significance of increased rate of physical illness in the geriatric study group.Results:Our geriatric inpatients (138) formed only 3.73% of the total patient population (3698) admitted during the said period, which is in sharp contrast to 23-44% geriatric inpatients, the range that has been usually reported in the western literature. Common clinical diagnoses amongst male geriatric patients were alcohol dependence with or without various complications (27.7%), followed by mood disorder-mania (18.1%), organic mental disorders (18.1%), psychosis (16.9%), and mood disorder-depression (14.5%). Common clinical diagnoses amongst geriatric females were mood disorder-depression (36.4%) and psychosis (25.5%). Comorbid physical illness was seen to be present at a very high percentage (61.4%) in geriatric male patient population than in female patients (40%). Alcohol dependence in male and depressive disorder in female stood out as distinctive illness in patients above 50 years of age (including both study and comparative groups). In sharp contrast to elderly comparison group's 14.9% cases of comorbid physical illness, geriatric study population had a staggering 52.9% cases of additional burden of physical illness diagnosis.Conclusions:Being elder by a decade poses a significant threat in developing an additional physical illness to an already existing psychiatric illness in the geriatric community. Though the prevalence of mental illness in the geriatric age group is similar in developed and developing countries, poor inpatient attendance of geriatric neuropsychiatric patients probably indicates a poor delivery of healthcare facilities to our senior citizens.

Background:Although buprenorphine abusers are a common clinical entity, literature on them is rare in Nepal.Aim:To assess whether injectable opioid abusers are any different a subgroup vis-a-vis brown sugar abusers in relation to their demographic and clinical profiles.Materials and Methods:Seventy-six opioid abusers, who were admitted over a period of one year, in our de-addiction center, were included in the present study. They were divided into two groups based on the history of the presence or absence of buprenorphine injection abuse in them. The demographic and clinical profiles of these two groups were studied and compared.Results:The most characteristic opioid abuse pattern was the abuse of brown sugar through inhalation (chasing). A total of 32 (42.1%) among them had a history of injectable drug abuse (IDU). Most characteristic buprenorphine abuse pattern seen was an evolution from injectable buprenorphine to triple injection to brown sugar abuse (Reverse Transition). Injection buprenorphine abusers, who attended our clinic, were older in age and had a history of a longer duration of abuse than their counterparts who abused opioid drugs through the inhalational route only. Their lifetime diagnosis revealed a polysubstance abuse pattern. They were more unstable, impulsive, and disorganized in their behavior pattern, suggestive of the presence of inadequate personality traits. There were high instances of injection-related side effects in the form of the presence of thrombophlebitis, HIV positivity, and clinical AIDS in them.Conclusion:Findings of the current research indicate the presence of a subgroup of patient population among opioid abusers with a history of injectable buprenorphine abuse, with characteristic personality traits, pattern of drug abuse, and associated physical complications resulting from it.

Introduction: The prevalence of pre-operative anxiety among patients undergoing various surgeries is as high as 60% to 90%. The pre-operative anxiety have serious outcomes and can increase the risk of post-operative complications like pain, prolonged recovery, and longer hospitalization. Pre-operative anxiety may be transient or chronic and can lead to aggressive reactions and undue stress as well. Material And Method: A descriptive study was designed to assess the level and contributing factors to anxiety among preoperative patients. Non-probability purposive sampling technique was used to select the patients from Devdaha Medical College and Research Institute, Bhaluhi and Mercy City Hospital, Butwal, Rupendehi district. Semi-structured interview schedule and Beck Anxiety Inventory Scale (BAI) were used to collect data. The collected data were analyzed by using descriptive and inferential statistics with Statistical Package for Social Sciences (SPSS) software version 16. Results: Among 150 respondents 57.3%, 26.6%, and 16% respondents had severe, moderate and low anxiety levels respectively. The contributing factors for pre-operative anxiety were respondents having no history of previous surgery (20.7%), less number of days of hospital admission (44% and 44%), had major surgery(48.7%). Respondents felt fear about the pain due to surgery in 91.3% cases, death in 36% and blood transfusion in 13.3% cases. 62.7% respondents had no any doubt regarding competency of health personnel. Conclusion: Based on the study findings, there are varying levels of anxieties among preoperative patients. It is recommended to surgeon and other health personnel that information needs to be provided related to surgery before surgery to reduce pre-operative anxiety.

Introduction: Headache is a common neurological disorder and psychiatric comorbidity is very common in primary headache in which anxiety and depression is more common. Data of patients presenting with primary headache and psychiatric comorbidity is scanty in Nepal. The aim of the study was to study the socio-demographic and clinical profile of patients with primary headache, and to study the frequency and pattern of anxiety and depression as comorbidities among these patients.Material and Method: The study was done at the headache clinic in the Department of Psychiatry at Devdaha Medical College and Research Institute, Rupandehi, Nepal. All out-patients attending our clinic over a period of six months (January 2017-June 2017) with a diagnosis of primary headache were included in the present study. Demographic and clinical profiles of these patients were noted in a specially designed socio-demographic and clinical data sheets prepared for the present study.Results: Among the total patients (N=150), 86 (57.3%) were in the age group 20-39 years. Majority 118 (78.7%) cases were female while 32 (21.3%) cases were male patients. 69.3% cases had migraine headache and 28.7%cases had tension type headache. Comorbid psychiatric illness was present in 80 (53.33%) cases among which Anxiety disorder was the most common diagnostic category (31.3%) followed by depressive disorders (22.0%).Conclusion: Anxiety and depression (53.3%) as comorbid disorder is prevalent among those presenting with primary headache and anxiety spectrum disorder was more than depressive disorder.J Psychiatrists’ Association of Nepal Vol. 6, No. 2, 2017