Cross-cultural adaptation of Nepalese literacy and stigma of suicide scales (LOSS-SF-Nep and SOSS-SF-Nep) among Nepalese medical and nursing students

INTRODUCTION

Nepal is a country in South-east Asia with high suicide. There is ongoing trend of emerging research on suicide from Nepal but there is lack of validated scale in measuring literacy or stigma. In the view of poor media reporting and large treatment gap, this study was conducted. All previous validation studies were done in non-Hindu populations.

METHODS

A cross-sectional study was planned where the short forms of Nepalese literacy of suicide scale (LOSS-SF-Nep) and Stigma of Suicide Scale (SOSS-SF-Nep) were validated using standard procedure at a medical college in southern Nepal. Medical and nursing students of all batches were approached offline after successful pretesting. The psychometric properties of the scales were tested, and the statuses of literacy and stigma were assessed. Patient Health Questionnaire-9 and General Anxiety Disorder Scale-7 were used for revealing depression and generalized anxiety.

RESULTS

Three hundred and nineteen Nepalese students participated and most of them were males, belonged to nuclear family, upper-middle socioeconomic status and represented 46 out of 77 districts of Nepal. The mean score of LOSS-SF-Nep was 6.36 ± 1.92 and literacy ranged from 37.9% to 89.7%. The deeper exposure to suicidal patients was associated with better literacy. Factor analysis of SOSS-SF-Nep revealed three subscales: stigmatization, isolation/depression, and normalization/glorification and had acceptable psychometric properties. Gender, occupation of head of the family, region and years of education, using mental health services, and depression were associated with variable literacy or stigma.

CONCLUSION

Literacy and stigma scales were validated in Nepali, and SOSS factor structures were revealed with modified descriptors. The literacy and stigma levels in medical students were calculated for the first time in Nepal and Hindu majority population.

Protocol for the systematic review and meta-analysis of factors associated with non-adherence to antidepressants in depressive disorders in those more than 18 years of age

OBJECTIVE

We have developed a protocol for the systematic review and meta-analysis of the factors associated with nonadherence to antidepressants in depressive patients more than 18 years of age.

METHODS

We will search articles with the databases PubMed- Medline, Scopus, Embase and PsychINFO. All the published literature reporting factors associated with nonadherence to antidepressants in depressive disorders in patients more than 18 years of age and fulfilling all the eligibility criteria till October 2022 will be included. The data will then be extracted and examined to be included in the systematic review. Finally, we will conduct meta-analysis for factors associated with non-adherence.

CONCLUSION

We will do extensive search on the proposed topic within the available literature and come up with a robust review of factors associated with nonadherence to antidepressants in patients age more than 18 years globally. The evidence generated would assist in designing interventions to address non-adherence in this group of patients leading to better productivity and quality of life.

Prevalence of Sexual Dysfunction in Women With Depressive Disorder at a Tertiary Hospital

Background:

Sexual dysfunction in female with depressive disorder is highly prevalent and strikingly understudied. Epidemiological and clinical studies have shown association between depression and impairments of sexual function. Despite high prevalence, there are limited studies regarding the prevalence of sexual dysfunction among female with depressive disorder in Nepal.

Aims:

This study was conducted to find out the prevalence of sexual dysfunction in female with depressive disorder in Nepal, their association with treatment status, and the level of psychological distress caused by it.

Methods:

A descriptive cross-sectional study was carried out among female with depression at Tribhuvan University Teaching Hospital, Nepal. The participants were grouped as drug naïve and under medication. Data were collected using semi-structured proforma, Beck Depression Inventory, Kessler 6+ Psychological Distress Scale, and Female Sexual Function Index. Data were tabulated and analyzed using Statistical Package for Social Sciences version 23.

Results:

The prevalence of sexual dysfunction was 58.82%, being 60.78% in drug-naïve cases and 56.86% in females suffering from depression and receiving medications. This study showed statistically significant association between sexual dysfunction and psychological distress but not with age, duration of marriage, number of children, occupational, and financial status.

Conclusions:

The study reported high prevalence of sexual dysfunction among female with depression. All domains of sexual function were affected and showed significant association with psychological distress. Therefore, assessment of sexual dysfunction in every female with depression is required to address the problem timely and efficiently.

Internalized stigma in patients with schizophrenia: A hospital-based cross-sectional study from Nepal

Introduction

The aim of this study was to examine the internalized stigma of mental illness in patients with schizophrenia visiting psychiatry outpatient in a tertiary level hospital in Kathmandu, Nepal, and to explore the associated sociodemographic and clinical factors.

Methods

This was a cross-sectional study, where participants were selected by purposive sampling from the outpatient department of psychiatry in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. One hundred and fourteen patients were selected and given the Internalized Stigma of Mental Illness scale to complete to assess the level of stigma. A semi-structured sociodemographic form was used to get information on sociodemographic and clinical factors. Simple descriptive analysis was done followed by multivariate analysis to explore the sociodemographic and clinical correlates of stigma in these patients.

Results

A total of 114 patients were included in the study. Moderate to high levels of internalized stigma was reported in almost 90% of patients with schizophrenia. The subscale with the highest mean score was stereotype endorsement and that with the lowest mean score was stigma resistance. Duration of illness was the only clinical variable associated with stigma while occupation was the only sociodemographic variable related to stigma.

Conclusion

Moderate to high levels of internalized stigma were reported across all subscales of stigma in patients with schizophrenia and the prevalence was high. Further, duration of illness was associated with stigma. Stigma reduction should therefore be a component of the overall management of patients diagnosed with schizophrenia.

Pathways to mental health care in Nepal: a 14-center nationwide study

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.

Comparison of Disulfiram and Naltrexone in Cases of Alcohol Dependence Syndrome

BACKGROUND

Relapse prevention in alcoholism is recognised as an important component of management. Use of pharmacotherapies to prevent relapse in combination to psychological intervention is emerging. Disulfiram and Naltrexone are two of three FDA approved drugs for pharmacotherapy. The aim of the study is to compare the effectiveness of these two drugs in preventing relapse in alcohol dependence syndrome cases.

METHODS

A prospective crossectional study was conducted to compare disulfiram and naltrexone in alcohol dependent patients in tertiary institution. Cases of alcohol dependence syndrome were diagnosed based on ICD-10 DCR presenting to psychiatry department of Tribhuvan University Teaching Hospital, over the period of 6 months. After detoxification and fulfillment of inclusion criteria, semi structured proforma, Severity of alcohol dependence questionnaire, Stages of change readiness and treatment eagerness scale, Obsessive compulsive drinking scale were applied. Drug allocation was based on simple random method and on subsequent follow ups done at 2nd, 4th, 8th, 12th week semi structured proforma, Obsessive Compulsive Drinking Scale were completed and psychological intervention continued. After data collection, analysis and final results were computed.

RESULTS

Both drugs reduced craving and amount of alcohol intake(p less than 0.001). Relapse was more in naltrexone group but was not statistically significant (p>0.05). Side effects were more with disulfiram(p less than 0.001) whereas dropout was more in naltrexone group,(p less than 0.01).

CONCLUSIONS

Disulfiram and Naltrexone were equally effective in reducing craving, reducing amount of alcohol intake, and preventing relapse in 12 weeks follow up period. Naltrexone was found to be better in tolerability whereas disulfiram was better in terms of dropout from treatment.

Neuropsychiatric manifestations in General Paralysis of Insane (GPI)

General paralysis of insane is a form of neurosyphilis which brings parenchymatous changes in the central nervous system. Its manifestations include a variety of neuropsychiatric symptoms ranging from cognitive impairment to overt psychosis. Clinicians face difficulties in proper diagnosis as variety of symptoms changes from one form to other within a short period of time. Rarity of the disease at this modern era of penicillin is also another factor in timely diagnosis and management of such cases. Here we present a case of general paralysis of insane who presented with variety of neuropsychiatric symptoms and have had great difficulties to reach into the diagnosis.

Validating the Edinburgh Postnatal Depression Scale as a screening tool for postpartum depression in Kathmandu, Nepal

BACKGROUND

Edinburgh Postnatal Depression Scale (EPDS) is considered well accepted screening tool for postpartum depression (PPD). The objective of the study was to validate the EPDS as a screening tool for postpartum depression in Kathmandu, Nepal.

METHODS

A hospital based cross sectional study using EPDS was conducted among 346 mothers between 4 and 14 weeks of postpartum period. All the participants were examined by psychiatrist for possible clinical PPD diagnosis using International Classification of Disease tenth revision (ICD-10). Sensitivity, specificity, positive predictive value and negative predictive value were calculated for validation of EPDS. The best cut off point for Nepalese version of EPDS was identified and area of the receiver operating characteristics curve was calculated.

RESULTS

The overall prevalence of PPD was 17.1 %.The sensitivity, specificity, positive predictive value and negative predictive value of the Nepalese version EPDS was found to be 92, 95.6, 77 and 99.3 % respectively. The best cut-off point of EPDS for screening of PPD was found to be 12/13 and the area of the curve was 0.98 (95 % CI 0.970-0.994, p = 0.001).

CONCLUSIONS

The prevalence of PPD is not that far from the previous studies of Nepal. Nepali version of EPDS was acceptable and the study demonstrates good validity, thus EPDS can be used as valid screening tool for PPD for early detection, prompt treatment and to prevent possible consequences.

A Study Of Psychiatric Morbidty Amongst Children Attending A Child Guidance Clinic At A Tertiary Level Teaching Hospital In Nepal

Background: Mental health and its related problems are growing concerns over the world. The early onset of emotional and behavioral problem in the young children is related to a variety of health and behavior problems in adolescence. It is a challenging all over the world to determine the epidemiology of childhood mental disorders. Objective: The aim of this study is to sort out the prevalence and predominance of mental illness and their onset of age and sex among the child and adolescent who attended in the child guidance clinic in TUTH. Methodology: A retrospective study of a total of 539 consecutive cases of child and adolescent attended in Child Guidance Clinic TUTH. Diagnosis was made according to the criteria of Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision. Result: The cases from the age of 0.4 year to 21 years with mean age 8.85±4.08 years. Significantly majority were boys (n=343, 63.6%) and most of from out of the Kathmandu valley (n=300, 53.2%). Significantly most case referred from ENT OPD of TUTH (n=97, 18%) and mental retardation was the commonest (n=81, 15%) followed by conversion disorder (n=77, 14.3%) and anxiety spectrum disorder (n=63, 11.7%) Conclusion: Boys are common in mental illness among child and adolescents. The common diagnoses among child and adolescent are mental retardation, conversion disorder, anxiety spectrum disorders and Autism spectrum disorder. Journal of Nobel Medical College Vol. 2, No.1 Issue 3 Nov.-April 2013 Page 55-63 DOI: http://dx.doi.org/10.3126/jonmc.v2i1.7677