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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

Introduction: Non-compliance significantly influences the course and outcome of treatment. Non-compliance in Schizophrenia is common and a major challenge globally due to need of long duration of treatment and other related factors. The objective of study was to identify patients with treatment non-compliance and associated factors in schizophrenia from socio-cultural, familial and environmental perspective.Material and Method: This study identified non-compliance in schizophrenia among 80 patients attending outpatient department at department of psychiatry, Devdaha Medical College, Rupandehi, Nepal. The study was a descriptive cross section study and purposive sampling, a type of non-random sampling technique was utilized for study. Ethical consideration was done throughout the study and informed consent was taken prior to the study. The questionnaire was given to those patients who had insight into the illness and who were able to understand the questions in the pro forma. Informants of patients with poor insight were given questionnaire to complete.Results: Out of 80 participants, majorities (57.5%) were male and 42.5% were female in the ratio 1.35:1. The mean age of respondent was 30.2±11.6. Approximately one seventh (13.75%) of them were illiterate, more than half (61.25%) had family income less than Nepalese rupees 10,000 a month. A significant proportion (15%) of family members did not know the role of them and relatives, and majority (76.25%) said that people contribute negatively. The different factors contributing to non-compliance were belief as non treatable illness (20%), significant life events (2.5%), migration (3.75%), lack of access of treatment nearby (72.5%), forget doctor appointment (11.25%), cessation of medication as per advise of faith healer (10%), stop medicine due to social stigma (15%), not monitoring patient on medication (15%) and discontinuation of treatment on refusal (11.25%).Conclusion: The study explored noncompliance in Schizophrenia from socio-cultural, familial and environmental perspectives. Multiple factors were identified that contributed for non-compliance directly or indirectly. The non-compliance is a preventable condition that needs an emphasis from different perspectives.J Psychiatrists’ Association of Nepal Vol. 6, No. 2, 2017, Page: 22-27

Introduction: Psychoactive substance use is known since the origin of mankind and has been global problem that is influenced by social, economic, political and psychosocial factors. The menace of psychoactive substance abuse is that it is not only a socially unacceptable reality but in itself a disorder and is emerging as a major public health burden. Material and Method: A descriptive study was carried out with the view to find out the prevalence of psychoactive substance disorder in de-addiction unit at Centre for Mental Health (Chautari Nepal Health Foundation) in Rupandehi district of province-5, Nepal. All patients who were admitted during the study period with psychoactive substance use Disorder were interviewed by using semi structured performa for addiction. Total 387 patients with psychoactive substance dependence (according ICD-10) were enrolled in the study after providing written informed consent. The data was analyzed by using descriptive and inferential statistics with SPSS software version 16. Results: Among 387 psychoactive substance users, majority of them (34.1%) were in the age group 35 years and above, 57.1% were belonged to Brahmin/ Chhetri ethnic group. Greater proportion 44.4% of psychoactive substance abuser had started taking the drugs between the age of 16-20 years of age. Alcohol was most commonly used psychoactive substance as 47.5% were dependent to alcohol. Conclusion: Based on the study findings, it is concluded that addiction is a global burden. Youth is a vulnerable group. Therefore, special attention, Psycho education related to psychoactive substance should be started before adolescent.

Introduction: Dhat syndrome is generally believed to be a culture-bound which is characterized by excessive preoccupation with loss of "Dhat", which is generally taken to be representing semen. The study evaluated the symptoms of patient with Dhat syndrome visiting three mental health clinics of Rupandehi district.Material and Method This descriptive cross- sectional study was conducted in three different Psychiatry outpatient clinics at Rupandehi district of Nepal. Purposive sampling, a type of non-random sampling was utilized for the study. A total 50 patients with Dhat syndrome were enrolled in the study. A semi-structured Performa containing socio-demographic and Dhat syndrome symptoms related information was filled by respondents after providing written informed consent.Results: The patients were predominantly young adults, male with mean age of 23.1±4.6. Majority of them were in age group 18-25 years, hindu by religion, living in non-urban areas, family income of 5000-10000 per month, literate and unmarried. A range of psychological and somatic symptoms associated with Dhat syndrome were revealed. Most common symptoms found in the study were excessive worries (96%), tingling sensation of body (86%), weakness (80%), decrease interest (80%), fatigue (76%), depressed mood (74%), and generalized body ache (72%).Conclusion: Dhat syndrome presented with a range of psychological and somatic symptoms. Any male patient presenting with multiple somatic symptoms must be evaluated for Dhat syndrome and the physician must enquire about the semen loss and the associated beliefs.J Psychiatrists’ Association of Nepal Vol .6(1), 2017, p.33-37