Background Pathways to care studies are feasible and tested means of finding the actual routes taken by patients before reaching proper care. In view of the predominance of nonprofessional service providers and the lack of previous large studies on pathways in Nepal, this multicenter study is needed. The aim of the study was to trace the various pathways and carers involved in mental health care; assess clinical variables such as the duration of untreated illness, clinical presentation and treatment; and compare geographically and culturally diverse landscapes. Methods This was a cross-sectional, convenience sampling study performed at 14 centers where new cases were being taken. The World Health Organization Study of the Pathways-to-Care Schedule was applied. The Nepali version of the encounter form was used. The data were collected between 17 September and 16 October 2020 and were analyzed using the Statistical Package for the Social Sciences (SPSS). Additionally, perspectives from local investigators were collected and discussed. Results Most of the first carers were native/religious faith healers (28.2%), followed by psychiatrists (26%). The median duration for the first psychiatric consultation was 3 weeks. The duration of untreated illness was 30.72 ± 80.34 (median: 4) weeks, and the time taken for this journey was 94.99 ± 274.58 (median: 30) min. The longest delay from the onset of illness to psychiatric care was for epilepsy {90.0 ± 199.0 (median: 25.5)} weeks, followed by neurotic illness {22.89 ± 73.45 (median: 2)} and psychotic illness {10.54 ± 18.28 (median: 2)} weeks. Overall, most patients with severe mental illnesses (SMIs) had their first contact with faithhealers (49%), then met with medical doctors (13%) or psychiatrists (28%). Marked differences in clinical presentation surfaced when hilly centers were compared with the Terai belt. Conclusions Faith healers, general practitioners and hospital doctors are major carers, and the means of educating them for proper referral can be considered. The investigators see several hindrances and opportunities in the studied pathways. The employment of more mental health professionals and better mental health advocacy, public awareness programs and school education are suggested strategies to improve proper mental health care.

Introduction: The prevalence of Delirium tremens (DT) is around 5-12%. Very few studies have looked into the prevalence of DT in general population and has shown varying results. The study aims at finding the prevalence of delirium tremens among alcohol dependents (AD) and a comparison of profiles of alcohol withdrawal syndrome (AWS) with DT and AWS without DT. Material And Method: A case- control study was conducted in patients diagnosed as Alcohol dependent syndrome and admitted in Psychiatry in-patient ward for detoxification. Socio demographic and clinical variables were assessed and compared between alcohol dependents who developed DT and who did not developed DT. Results: 24% of the patients with AD had/developed delirium tremens. The multivariate regression analysis model shows variables like Age>50years (AOR= 75.7,95% C.I=7.8-730), Caste(Janjati: AOR=4.2, 95% C.I=1.329-13.23,) and unemployment(AOR=54.2, 95%C.I=3.8-765.254),longer length(years) of alcohol consumption >20 years(AOR= 305,95%CI=3.4-2711),presentation within 48-72 hrs since the last intake of alcohol (AOR=923,95%CI=38-22333),absence of nicotine consumption(AOR=40,95%C.I.=1.66-967) were significantly associated with development of delirium tremens. Similarly, those with educational status of higher secondary and above (AOR=0.7, 95% C.I =0.73-1.43), past history of absence of DT (AOR=0.013, 95% C.I=0.0002-0.77), less frequent intake of alcohol <3 times/week (AOR=0.001,95%C.I=0.001-0.07) had less likely developed DT. These significant variables were further assessed for their ability to predict the occurrence of delirium tremens in ROC and area under the curve for age, duration since last alcohol intake and years of intake of alcohol were respectively = 0.799, 0.843 and 0.765. Conclusion: Three features findings (older Age, more years of intake of alcohol, more hrs since last intake of alcohol) were more likely seen in delirium tremens patients.

INTRODUCTION: Healthcare providers (HCPs) though stood as front-liners during the crisis situation were not themselves immune to the psychological consequences due to COVID-19. The present study aimed to find the prevalence of perceived stress on COVID-19 pandemic and its associated factors among health care providers in Rupandehi district health institutions. MATERIAL AND METHODS: This  cross- sectional study was conducted among the HCPs in the institutions of Rupandehi district in Western  Nepal, from August to November, 2020. Total 126 subjects were included and probability sampling technique was applied for sample collection. After written consent from participants socio-demographic data were collected and Perceived Stress Scale (PSS-10) was applied. RESULTS: The study showed the prevalence of perceived stress in COVID-19 HCPs found to be 65.1% considering score 20 as cut-off. Age, work place, precaution measures taken and staying with family were statistically significant with the perceived stress level (p<0.05). Multivariate logistic regression showed perceived stress level had statistically significant association with precaution means and work place of HCPs. Healthcare providers who had unsatisfactory precaution means followed at work were 2.66 times more likely to have perceived stress as compared to satisfactory precaution means as adjusted odds ratio (AOR) = 2.66 (1.09-6.51). Healthcare providers who stayed with family members were 2.28 times more likely to have perceived stress level as AOR=2.28 (0.94-5.52). CONCLUSION: The study showed increased prevalence of perceived stress among HCPs during the initial stage of COVID‐19 pandemic in Nepal. Considering the findings, there is urgent need to develop and implement appropriate stress management and coping strategies to the target group.

It is great time to know the psychological consequences and know how hoteliers are coping to it because of Covid19 lockdown. Thus we tried to access prevalence of perceived stress and associated factors among hoteliers of Nepal. A hotel based quantitative descriptive cross-sectional study was done using a structured questionnaire cum interview schedule. The data was recorded in Microsoft Excel sheet, and was analyzed using Statistical Package for Social Sciences version 23. A descriptive analysis was done using mean, frequency, percentage and standard deviation. Bivariate analysis was done using Mann-whitney U test and Kruskal Wallis test as the data were non-normal. Significance level was observed at p-value less than 0.05. There was significant relation between stress score and variables like age, gender, marital status, smoking, alcohol, bread winner, sound sleep, family conflict, too many responsibilities, pay loans, pay rent of hotel, other source of income, paying salary, happy with government, lockdown only solution, economic problem and social problems. (p -value <0.05) Male had significantly higher stress than female. Similarly married participants showed significantly higher stress than unmarried. Stress level has been increased among the hoteliers of Nepal due to covid19 lockdown and has affected the tourism sector very badly.

Introduction: Anxiety during pregnancy is an important predictor of postpartum anxiety. Pregnancy is a time of increased vulnerability for the development of anxiety. Maternal anxiety may also have an impact on the developing fetus. The current study aims to estimate the prevalence and associated factors of anxiety during pregnancy. Material and Method: A descriptive cross-sectional study was conducted among 95 pregnant women during the antenatal period. A purposive sampling technique was used and data collection was done from November 15, 2019, to December 14, 2019. Ethical permission was obtained from the concerned authority. All pregnant women were interviewed during their antenatal visit and a semi-structured questionnaire was used to collect the data. Descriptive and inferential statistics were used to analyze and interpretation of the findings. Results: The prevalence of anxiety was 32.6%. Among them, 18.9% had borderline anxiety and 13.7% had abnormal anxiety. More than one-fifth (21.1%) of pregnant women were worried about the sex of the baby. Although, 68.4% of them had occasionally felt tense, and 75.8% had worried thoughts from time to time. Anxiety during pregnancy was significantly associated with gravida, history of abortion, maternal desire regarding the pregnancy and worry about the sex of a fetus (p<0.05). Conclusion: The status of anxiety was quite common during pregnancy and its occurrence is associated with the pregnant woman's gravida, history of abortion, intention of pregnancy and worried about the sex of a fetus. Antenatal screening for anxiety should be carried out early from the antenatal clinics for improving the psychological well-being of women.

Introduction: More than 700, 000 people die due to suicide every year. Suicide is the fourth leading cause of death among 15-29 year-olds. A total of 77% of global suicides occur in low- and middle-income countries. There is an increasing number of suicide all over the world. There is limited data regarding this issue. The available data are based on police reports or on specific populations. The aim of this study was to find out the prevalence of suicidal attempts among psychiatry patients presented to the Department of Emergency of a tertiary care centre. Methods: A Descriptive cross-sectional study was done in a tertiary care centre from January 2019 to July 2020 after taking Ethical approval from the same institute. Beck Suicide Intent Scale, MINI-7, IPDE and PLESS were used to assess suicidal intent, psychiatric comorbidities, personality disorder and life stress event scores respectively. Bronfenbrenner’s Social Ecological Model was used to access various stressors. Point estimate and 95% Confidence Interval were calculated. Results: The Prevalence of suicidal attempts among psychiatry patients in the emergency department was 265 (24.50%), (21.66-26.74, 95% Confidence Interval). The majority were females 135 (51%). The majority attempted at home 238 (89.81%). Poisoning was the most common mode of attempting suicide. Conclusions: The Prevalence of suicidal attempts among psychiatry patients was higher than in the other studies done in similar settings.

Introduction: Stress is the response of body to any change. The end stage of renal disease and the process of haemodialysis treatment are long-term stressors that alter patients’ well-being and everyday lifestyle. The aim of this study was to find out the prevalence of moderate stress levels among patients undergoing hemodialysis in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients undergoing hemodialysis from 1 October 2021 to 30 September 2022. Ethical clearance from the Institutional Review Committee. Patients undergoing maintenance haemodialysis for at least 3 months were included in the study. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 118 patients, 82 (69.49%) (61.18-77.80, 95% Confidence Interval) had moderate stress levels, out of which 51 (62.20%) were male and 31 (37.80%) were female. Conclusions: The prevalence of moderate stess level was found to be higher than other studies done in similar settings.