Browsing by Author "Pant, SB"
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Publication Clinical outcome of patients with psychiatric illness following Electroconvulsive therapy in a teaching hospital in Kathmandu(Institute of Medicine, 2018) Pant, SB; Upadhyaya, S; Ojha, SP; Chapagai, M; Tulachan, P; Dhungana, SAbstract Introduction: Electroconvulsive therapy (ECT) is a safe and effective procedure used for treatment of variety of psychiatric illness. In spite of its proven efficacy ECT is underutilized due to stigma and prejudice attached to it among patients, their families and even among mental health service providers. The purpose of the study was to evaluate the clinical outcome of patients diagnosed with psychiatric illness following electroconvulsive therapy. Methods: This is a retrospective hospital based study of patients who underwent electroconvulsive therapy at department of Psychiatry and Mental health, Tribhuvan University Teaching hospital during 1 year duration. Pre-ECT and Post-ECT BPRS and GAF were obtained and the data were analyzed subsequently. Results: A total of 39 patients underwent Electroconvulsive therapy during the study period. There were 16 males and 23 females. Among all cases receiving ECT, mean BPRS scores at the time of admission and discharge were 74.41±9.61 and 47.31±7.27 respectively whereas mean GAF scores at the time of admission and discharge were 20.21±6.03 and 57.95±11.05 respectively. The most common diagnosis for which ECT was used was Schizophrenia 14(35.89%). All patients showed statistically significant functional and symptomatic improvement except those with organic psychosis (GAF p<0.05 and BPRS p<0.05). Conclusions: ECT is found to be effective in the treatment of patient diagnosed with various psychiatric illnesses. Keywords: Brief Psychiatric Rating Scale, Electroconvulsive therapy, Global Assessment of FunctioningPublication Combination treatment with carbamazepine and clonidine in a case of epilepsy with ADHD(Institute of Medicine, 2017) Adhikari, S; Upadhyaya, S; Pant, SB; Dhungana, S; Tulachan, P; Chapagai, M; Ojha, SPAbstract In a child with epilepsy, Attention Deficit Hyperactivity Disorder (ADHD) is found to be more prevalent in comparison to general population. In western literature for the management of ADHD, stimulants like Methylphenidate and non-stimulant like Atomoxetine are considered the first line drugs. Although no any robust findings are found that support the use of such drugs in cases of epilepsy with ADHD, still they recommend using these drugs in such cases. In our scenario availability of such drugs is a major hindrance for which second line drugs like alpha agonists are the only options available to us. Here in this case report we have used Clonidine along with Carbamazepine in the management of a 12 years child presented in our centre with episodes of seizure and ADHD and had shown significant improvement with these medications. Keywords: ADHD, Carbamazepine, Clonidine, EpilepsyPublication Comorbid psychiatric illness and its association with glycemic control among adults with diabetes mellitus: a hospital based cross sectional study in Nepal(Institute of Medicine, 2016) Pant, SB; Ojha, SP; Chapagain, M; Tulachan, P; Dhungana, SAbstract Introduction: People diagnosed with diabetes are more likely than people without diabetes to have psychiatric illness, the management of which is important for the management of diabetes itself. The aim of the study was to estimate psychiatric illness among people with diabetes mellitus attending endocrinology outpatient department of Tribhuvan University Teaching Hospital. Methods: Patients with diabetes mellitus attending endocrinology OPD of Tribhuvan University Teaching Hospital were selected by simple random sampling technique. Patients were assessed using semi structured sociodemographic data form followed by General health questionnaire -12 (GHQ-12), which was used to screen psychiatric illness. Those with a score of three or more were considered as having psychiatric caseness which designated over all psychiatric illness. Results: Among 158 patients, 122 (77.2%) were cases of type 2 diabetes while 36 (22.8%) were type 1 diabetes and overall estimate of psychiatric illness among them was 48.7% (n = 77) Significant relationship was found between psychiatric caseness and meal plan (p = 0.007) psychiatric caseness and regular exercise (p = 0.031) psychiatric caseness and type of diabetes medication used (p < 0.001) . psychiatric caseness and diabetes medication doses missed per week (p < 0.001) psychiatric caseness and glycemic control. (p < 0.001) Conclusion: This study showed that comorbid psychiatric illness is common in patients with diabetes which affects overall glycemic control. Hence, screening for psychiatric illness is an indispensable component of diabetes management planPublication Depression and its association with glycemic control in Nepalese adults with diabetes mellitus(Institute of Medicine, 2016) Pant, SB; Ojha, SP; Chapagain, M; Tulachan, P; Dhungana, SAbstract Introduction: Depression is reported more common among people with diabetes mellitus which if not addressed, may lead to poor diabetes outcomes. The purpose of the study was to explore depression among people with diabetes mellitus attending endocrinology outpatient department of Tribhuvan University Teaching Hospital and to find its association with glycemic control. Methods: Patients with diabetes mellitus (n=158) attending endocrinology OPD of Tribhuvan University Teaching Hospital were chosen by simple random sampling technique. A self- designed semi structured proforma was devised to obtain the socio- demographic characteristics of the study population. 'General health questionnaire -12' was applied and those with a score of three or more considered as achieving 'psychiatric caseness and among them depression was diagnosed with ICD-10 DCR criteria and HAM-D scale was used to verify it objectively. Results: Among the patients, 122(77.2%) belonged to type 2 diabetes and 36 (22.8%) belonged to type 1 diabetes. Estimate of depression was found to be 29.11% (n=46) which was almost similar in both types of diabetes. The duration of diabetes were less than 5 years in 38% of patients. Level of depression showed significant associationand a positive correlation with glycemic control. Conclusion: This study concluded that depression is common in both type 1 and type 2 diabetes patients and calls the need for screening of depression for comprehensive diabetes management. Keywords: Depression, diabete smellitus, General Health Questionnaire-12, glycemic control, HAM-D, ICD-10 DCRPublication Depression in survivors of female trafficking in shelter homes of Kathmandu Valley(Institute of Medicine, 2017) Pradhan, G; Ojha, SP; Sharma, VD; Chapagain, M; Tulachan, P; Dhungana, S; Pant, SBAbstract Introduction: Human trafficking is the recruitment and movement of individuals most often by force, coercion, or deception for the purpose of exploitation. There is very limited evidence on the health consequences of human trafficking. This study were to find out the prevalence of depression among survivors of female trafficking in the shelter homes of Kathmandu valley and also to find out severity of depression (mild, moderate and severe) among the survivors of female trafficking. Methods: A cross- sectional design was implemented. A total of 67 participants was collected from 4 different NGOs working in the field by using probability proportion to size method and from each NGOs the participants were taken using purposive sampling. The consent was taken and strict inclusion and exclusion criteria were applied during participant's selection. The semi- structured proforma was filled with adequate information. Clinical diagnosis of depression was made according to ICD-10 classification of Mental and Behavioral Disorders-Diagnostic Criteria for Research (WHO-1992) in patients and Hamilton Rating Scale for Depression (HAM-D) was used to assess the severity of depression (mild, moderate and severe). Finally, information obtained from demographic profile, clinical features, and rating scale was analyzed by using suitable statistical tools. Results: The study showed out of all 67 female human trafficking victims interviewed from 4 major shelter homes in Kathmandu valley a majority were found to be from the 16 to 20 years age group during the time of interview. Most victims were found to be trafficked at a young age, 11-15 years. A majority of them were lured with job proposals mostly by their own family members. Victims were mostly lead to India for trafficking as sex workers. Based on ICD 10 DCR 61.2% of the victims were found to be suffering from depression among which according to HDRS 16.4% had severe and 4.5% had very severe depression. Conclusion: Despite a dramatic increase in the profile of human trafficking over the past decade, the evidence on trafficked people's experiences of violence and of depression and other mental health problems is extremely limited. Depression is quite common and more information is needed on trafficked people's health needs and experiences, including evidence on interventions to mitigate the physical and psychological damage associated with this global crime.Publication Neuropsychiatric presentation of Wilson's disease(Institute of Medicine, 2016) Dhungana, S; Ojha, SP; Chapagain, M; Tulachan, P; Pant, SBAbstract Wilson's disease is a rare autosomal inherited disorder with various manifestations. Initial manifestations could be hepatic, neurological or psychiatric and there is invariable delay coming to the correct diagnosis. Exact frequency of children and adolescents presenting with psychiatric complaint as the initial manifestation is not known. It is recommended that detailed medical evaluation be done in any child presenting with psychiatric complaints. We hereby present a case of an eight-year old girl who presented with anxiety and subsequently diagnosed to have Wilson's disease. Keywords: children, neuropsychiatric presentation, Wilson's diseasePublication Psychiatric mobility among repatriated Nepalese foreign labor migrants-a hospital based study(Institute of Medicine, 2017) Chapagai, M; Pant, SB; Tulachan, P; Dhungana, SAbstract Introduction: International migration for employment has burgeoned in Nepal in the recent decade, and now it is an important factor of social transformation across most societies all over the country. Various factor associated with migration and working in a foreign land can affect mental health of migrating individuals. The purpose of the study was to explore psychiatric morbidity among repatriated Nepalese foreign labor migrants who visited psychiatric services at a tertiary level hospital in Kathmandu. Methods: Repatriated Nepalese foreign labor migrants (n=51) having symptoms of mental illness at a foreign country, visiting psychiatric services at Tribhuvan University Teaching Hospital were enrolled in the study. A self- designed semi structured proforma was devised to obtain the socio- demographic characteristics of the study population and diagnosis was made using International Classification of Disease-10- Diagnostic criteria for research (ICD-10 DCR). Results: The age range of the repatriated population was 21-45 years. Most of the cases were males (n=46) and only five were female. Majority of the subjects were literate but only 27.45% had education level above secondary level. Greater number of respondents worked in the gulf countries (66.66%) followed by Asian countries (25.49%). The most common psychiatric morbidity among repatriated Nepalese foreign labor migrant was depressive disorders (29.41%) followed by Anxiety disorder (25.49%). Conclusion: There is a growing need to enhance our understanding about psychiatry co morbidity among repatriated Nepalese migrant workers so as to promote mental well-being at their working foreign country. A wide range of psychiatry morbidity, predominantly depression and anxiety was found among them which if addressed timely would prevent many migrant workers from returning back prematurely. Keywords: ICD-10 DCR, Nepal, psychiatric diagnosis, migrationPublication Psychiatric morbidity pattern in patient after earthquake at Tribhuvan University Teaching Hospital Nepal(Institute of Medicine, 2017) Chapagai, M; Tulachan, P; Shakya, S; Dhungana, S; Pant, SBAbstract Introduction: A trauma is an event that is not within the normal range of the common experience. It is perceived as overwhelming physically and/or emotionally and may involve a perceived threat to the individual or a loved one. The basic aim of this study is to evaluate sociodemographic characteristic and pattern of psychiatric morbidity in patient attending at Tribhuvan University Teaching Hospital after earthquake. Methods: A cross sectional study was carried out on patients attending psychiatric OPD services of Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, a tertiary care hospital, from April 2015 to mid Sep. 2015. Results: Among 1057 cases who visited the outpatient services at Department of Psychiatry during first four and half months after major earthquake on 25 April 2015, 108 were directly related to earthquake The most commonly diagnosed conditions were F 41.9 Anxiety Disorder Unspecified (15.7%), F43.2 Adjustment disorder (13.9%). F 43.1 Post-traumatic stress disorder (8.3%) and Moderate depressive episode (7.4%). Two cases were referred with incidence of deliberate self harm. Conclusion: This study has contributed in new knowledge regarding the psychological conditions aftermath of natural disasters in Nepal and also the need of research to determine the prevalence of post-disaster mental health conditions tike posttraumatic stress disorder (PTSD), anxiety and depressive disorders, resilience and factors associated with the impact of event among the survivors Keyword: Earthquake. PTSD, Psychiatric morbidity.Publication Self castration in trance and possession disorder: a case report(Institute of Medicine, 2017) Adhikari, S; Pant, SB; Ojha, SP; Chapagai, M; Tulachan, P; Dhungana, S; Upadhyaya, SAbstract Castration is a rare event that is commonly associated with psychotic disorders. However, such injuries have also been reported from non-psychotic patients as a result either from bizarre autoerotic acts. attempts at crude sex change operation by transsexuals or secondary to complex religious beliefs and delusions regarding sexual guilt. We report a case of 35 years male from rural Nepal with history of trance and possession spells for last 7 years and self-inflicted scrotal injury with amnesia for that period. After two days, surgical orchiectomy was done and postoperative outcome was uneventful. Such case of self castration in dissociative disorder is rarely reported and worth to bring in notice. Keywords: castration, dissociative disorder, psychotic, trance and possessionPublication Zolpidem dependence(Institute of Medicine, 2017) Tulachan, P; Pant, SB; Chapagai, M; Dhungana, S; Ojha, SPAbstract Recently, Zolpidem dependence is rising in clinical practice. It was once thought to have low addictive potential due to its selective affinity to α1-GABAA receptors. However, contemporary studies have shown that Zolpidem may lack selectivity when used at high dose for extended periods of time and may show addictive potential similar to that of the benzodiazepines. We hereby report a case of Zolpidem dependence in a physician with insomnia, which was successfully detoxified with Diazepam to emphasizethe caution while prescribing it. Keywords: Dependence, Zolpidem