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.

Cognitive Dysfunctions in Patients with Alcohol Dependence Syndrome in a Tertiary Hospital in Kathmandu

INTRODUCTION

Alcohol dependence is a chronic disorder, accompanied by neuropsychological deficits. Patients with alcohol dependence were evaluated to identify the cognitive dysfunctions.

METHODS

The study followed descriptive design and recruited participants (N=62) from inpatient services of the Department of Psychiatry and Mental Health by convenient sampling. Participants were evaluated with the Severity of Alcohol Dependence Questionnaire, Frontal Assessment Battery and PGI Memory Scale for the severity of alcohol dependence, executive impairments and memory dysfunctions respectively once they had completed alcohol detoxification.

RESULTS

Total duration of alcohol consumption was 13.93 ± 8.74 years, period of dependence was 2.97 ± 2.23 years and 56.5% had moderate level of dependence. 33.9% of the participants had executive impairments particularly in conceptualization, programming and mental flexibility. 38% of variance in executive dysfunction was explained by illness variables, where period of alcohol dependence and education were significant predictors. 54.8% had significant memory dysfunction particularly in visual retention, remote memory, verbal retention of dissimilar pairs and delayed recall. Memory dysfunction differed significantly among the age groups (F=10.22, p<0.01) and age was a significant predictor (β=.542, p<0.001). 19% variance in memory dysfunction was explained by illness variables, where duration of alcohol consumption was a significant predictor (β = .485, p<0.01).

CONCLUSION

Findings indicate that cognitive dysfunctions are prevalent among patients with alcohol dependence. Hence, routine neuropsychological assessment is of particular importance for early detection and remediation of underlying deficits, which completes the treatment of alcohol dependence.

Association of thyroid dysfunction with depression in a teaching hospital

BACKGROUND

Thyroid dysfunction is common in patients with depression and depression is also common in patients with thyroid dysfunction. The purpose of this study was to estimate the prevalence of thyroid dysfunction in newly diagnosed depressed patients attending Psychiatry outpatient department of Tribhuvan University Teaching Hospital, Nepal and to find the correlation between the two.

METHODS

The study population comprised of 70 patients aged more than 15 years selected by simple random sampling technique who attended the Psychiatry OPD of Tribhuvan University Teaching Hospital, Kathmandu, Nepal and were diagnosed with first episode depression. A self- designed semi structured proforma was devised to obtain the socio- demographic characteristics of the study population. These patients were diagnosed as depression as per the ICD-10 DCR Criteria and HDRS scale was used at the same interview to verify it objectively.

RESULTS

Fifteen patients (21%) were found to have thyroid dysfunction, the most common being sub-clinical hypothyroidism, seen in 8 (11%). Thyroid dysfunction also showed positive correlation with depression severity. The diagnosis of depression by ICD- 10 DCR Criteria had positive correlation with HDRS grading of depression, though no significant association was found between different socio- demographic variables and depression.

CONCLUSIONS

This study concluded that thyroid dysfunction is common in depressed patients and larger studies are required in this field before TFTs are considered as an integral part of evaluation of these patients.

A comparision of efficacy of risperidone and olanzapine in schizophrenia patients

Schizophrenia is a leading worldwide mental health problem. It is also one of the common and challenging problems in Nepal. Risperidone and olanzapine is one of the major antipsychotic drug used for schizophrenia patients, however their efficacy is not compared in Nepal.To assess the efficacy of risperidone and olanzapine in schizophrenia patients in Nepalese context. An open-label, randomized, comparative, prospective study was done for 6 weeks. Total of 63 patients attending Psychiatry OPD in Jan to July 2008 at TUTH who could be available for close follow up were enrolled with consent. Risperidone was given in dose of 3-6 mg and Olanzapine in the dose of 15-20 mg per day. Efficacy and tolerability was assessed using PANSS, CGI, and UKU side-effect checklist. Both groups showed improvement in the entire positive, negative and general psychopathology subscales without significant difference in the two groups. Regarding tolerability, olanzapine was found to have significant sedation, weight gain while with risperidone extrapyramidal side-effects, palpitations, sexual side-effects were significant. Risperidone and olanzapine both are efficacious in the treatment of schizophrenia. Both the drugs have their own side-effects. Long-term efficacy and tolerability needs to be studied. As it has been seen in the ongoing studies, long-term use and side-effect profile, drop-out rates and the increase in metabolic syndromes need more consideration.DOI: http://dx.doi.org/10.3126/jcmsn.v7i3.6706 Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-3, 29-35

Nepal mental health country profile

The Kingdom of Nepal is situated in the heart of Asia, between its two big neighbours China and India. Nepal is home to several ethnic groups. The majority of the 23 million population reside in the countryside. Although figures on many of the health and socio-economic indicators are non-existing, some existing ones show gradual improvement over the years. However the figures for illiteracy and infant mortality are still one of the highest in the world. As per GDP, and population living below the poverty line and per capita income, Nepal still remains one of the poorest countries in the world. Despite this, it provides shelter to thousands of Bhutanese refugees in its land. Frequent natural disasters and recent violent conflicts in Nepal have further added hardship to life. Less than 3% of the national budget is allocated to the health sector. Mental health receives insignificant attention. The Government spends about 1% of the health budget on mental health. There is no mental health act and the National Mental Health Policy formulated in 1997 is yet to be fully operational. Mental ill health is not much talked about because of the stigma attached. The roles of the legal and insurance systems are almost negligible. The financial burden rests upon the family. The traditional/religious healing methods still remain actively practiced, specifically in the field of mental health. The service, comprising little more than two-dozen psychiatrists along with a few psychiatric nurses and clinical psychologists (mainly practicing in modern health care facilities) has started showing its impact--however this is limited to specific urban areas. The majority of the modern health care facilities across the country are devoid of a mental health facility. The main contextual challenges for mental health in Nepal are the provision of adequate manpower, spreading the services across the country, increasing public awareness and formulating and implementing an adequate policy.

SYMPTOM PROFILE AND CO-MORBID PSYCHIATRIC DISORDERS IN MENTALLY RETARDED CHILDREN AND ADOLESCENTS

A retrospective study of 52 children and adolescent subjects suffering from mentalretardation who attended in the Child Guidance Clinic in the Department of PsychiatryOPD, Teaching Hospital, Katmandu, Nepal. They were brought to the OPD withvarious symptoms. It was found that the number of male patients were 35 comparedto 17 female with male female ratio of 2:1. The mean age of male patients was 9.19 +3.55 years where as the mean age of female patients was 9.91 + 9.99 years. GeneralPractitioner and Pediatrician referred majority of them. The commonest symptomwith which the patients presented to the hospital was aggressive behavior (28%) while14 patients (26.9%) presented with speech related problems. Of the 52 patients whopresented in Child Guidance Clinic, 11 patients had comorbid psychiatric problems.It was found that 4 patients had hyperkinetic disorders, 3 patients had disorders ofpsychological development, 1 patient each had post encephalitic sequel, depressivedisorder, somatization disorder and eating disorder.1. Department of Psychiatry, Institute of Medicine.2. Mental Hospital, Lagankhel.3. Clinical Psychologist, Kathmandu Medical College.Address for correspondence : Dr. Saroj Prasad Ojha, MD (Psychiatry),Department of Psychiatry, Institute of MedicineMaharajgunj, Kathmandu, Nepal.Key words: Mental retardation, Psychiatric disorder, Child Guidance Clinic