Recurrent mass hysteria in schoolchildren in Western Nepal.

AIM: The aim was to study the clinical presentation and factors contributing to "recurrent mass hysteria" among rural schoolgoing children. MATERIALS AND METHODS: A visit to a school in a remote hilly district of Puythan, Nepal, was carried out to assess students experiencing mass dissociative/conversion symptoms over a short period of time. There was a second incidence of "mass hysteria" on the day of visit. Regular follow-up of these students was done telephonically for the next 1 year. RESULTS: The total number of child victim of "mass hysteria" was 47, with majority of them being girl students. Historically, at least two more attacks of "mass hysteria" were noted in the schoolchildren in the preceding years. Follow-up study revealed no further attacks of similar "mass attacks" over the following 1 year. CONCLUSION: Supporting, assuring, counseling, and educating these children, their parents and teachers and conducting public awareness programs are the mainstay of treatment of mass hysteria.

Mix headache: A valid clinical entity?

BACKGROUND: Chronic daily headache (CDH) patients respond better with a combination of anti-migraine and anti-stress medications, irrespective of clinical diagnosis of chronic migraine (CM) or chronic tension-type headache (CTTH). HYPOTHESIS: "CDH: Mix headache" type is a valid clinical entity. MATERIALS AND METHODS: A total of 70 participants fulfilling the diagnosis of "primary CDH", aged between 15 and 55 years were taken up for the present study. All these patients were subdivided into either CM or CTTH, based on the predominance of symptom profiles in these patients, in confirmation with the International Headache Society guidelines (International Classification of Headache Disorders-2, 2004). Schedules for clinical assessment in neuropsychiatry (SCAN) were applied to these patients to collect information about any mental or behavioral symptoms present at the time of the study. Psychiatric comorbidity was confirmed according to the International Classification of Diseases (ICD)-10. RESULTS: Forty-eight (68.6%) patients could be differentiated into CM and rest 22 (31.4%) patients were given a diagnosis of CTTH. SCAN and ICD-10 diagnosis revealed the presence of comorbid anxiety and depressive illness in 47 (67.2%) patients. Thirty-four of them belonged to CM (MH) group and the rest 13 had CTTH. DISCUSSION: We propose that these 47 (67.2%) patients of CDH form our special category of "CDH - mix headache" subtype. Thus, 14 (20%) patients constitute "CDH - migraine" subtype and rest 9 (12.8%) patients have a diagnosis of "CDH - tension headache" subtype. CONCLUSION: Findings of the present study validate the concept of "mix headache" and explains the clinical observation that chronic daily headache (CDH) patients responds better with a combination of anti-migraine and anti-stress medications.

Central Institute of Psychiatry: A fictional journey to past in a time machine.

A fictional journey was planned and carried out in a time machine, to know and understand the glorious past of Central Institute of Psychiatry (CIP), Ranchi. As Dr. Anand, the protagonist, went through different periods in the history of CIP, he narrated his experiences while meeting different peoples in different clinical settings. In this journey, he met Lt. Col Berkeley-Hill at European Mental Hospital, as it was in the 1930s. He tried to understand the relevance of Professor Mapother's report and its essence in relation to European and Indian psychiatric scenario during inter-war period, the significance of Moore-Taylor's report, and the direction of psychiatric training and teaching during postindependence era under Major RB Davis as the superintendent of Hospital for Mental Diseases (HMD). Here, Dr. Anand met the great rebel poet of Bengal (and the national poet of Bangladesh later), Kazi Nazrul Islam, who was here for a short period, before being shifted to Europe for further treatment. Dr. Anand also met other superintendents/directors of CIP during postindependence period and tried to understand the significance of those periods in the total journey of CIP till today. The journey started in the present and went back in time. Finally, a brief comparative analysis has been made regarding the status of CIP vis-à -vis other important psychiatric institutes/hospitals in the past and present.

A factor analytical study report on mania from Nepal.

BACKGROUND AND OBJECTIVES: Phenomenological studies on mood disorder are rare in Nepal which prompted us to undertake the current factor analytical study of mania. MATERIALS AND METHODS: It was a cross-sectional descriptive study for which we did purposive sampling technique according to certain inclusion and exclusion criteria. The study sample consists of fifty patients, who fulfilled the International Classification of Diseases, Tenth Edition (ICD-10) diagnostic criteria for Manic Episode and/or Bipolar Affective Disorder-current episode mania. Tools used were ICD-10 Diagnostic Criteria for Research, Young's Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). Principal component factor analysis was applied to the 35 symptoms taken from YMRS and BPRS. RESULTS: Factor analysis revealed the presence of four main factors, which explained 51.082% of the total variance. These are "pure mania" which isolated 11 manic symptoms, "dysphoric mania" which isolated five depressive symptoms, "hostile mania" which isolated six symptoms, and the fourth factor, we called it "delirious mania," isolated four symptoms. CONCLUSION: The identified factors and subtypes are a useful conceptualization of atypical features among patients with acute mania. Further validation studies are required to determine whether the identified subtypes are of clinical and theoretical importance.

Wisconsin Card Sorting Test performance impairment in schizophrenia: An Indian study report.

AIM: The present study attempted to find out the relationship between positive and negative clinical symptoms and Wisconsin Card Sorting Test (WCST) performance in a group of schizophrenia patients. METHODOLOGY: Fifty schizophrenia patients were assessed using the Positive and Negative Syndrome Scale (PANSS) by a trained psychiatrist (TKA) and two groups, each of 25 positive symptom and 25 negative symptom schizophrenia patients were formed. On these fifty patients with schizophrenia and 15 normal control groups, WCST measures were applied by a clinical psychologist (SS) who remained blind to the PANSS score. RESULTS: Schizophrenia diagnosis significantly affects WCST performances. One-way analysis of variance (ANOVA) revealed schizophrenia patients showed a significant impairment on all WCST indices compared with normal subjects except versus total number of correct responses. Post hoc comparison (Tukey HSD Test) between means revealed that negative schizophrenia patients showed significantly worse performance on most WCST performance parameters: percent errors, perseverative responses, percent perseverative responses, perseverative errors, percent perseverative errors, and conceptual level responses. CONCLUSIONS: Both positive and negative symptom schizophrenia patients have some distinct WCST measures deficits.

Use of ECT in Nepal: A One Year Study From the Country's Largest Psychiatric Facility.

INTRODUCTION: Electro-Convulsive Therapy (ECT) refers to the electrical stimulation of the brain to produce seizures for therapeutic purpose. Since the development of ECT, it's use has been consistent. Inspite of the common use, data pertaining to the use of ECT in Nepal is lacking. AIM: This study was undertaken with the aim of exploring the clinico-demographic profile of patients treated with ECT in the largest psychiatry facility in the country. MATERIALS AND METHODS: It is a retrospective descriptive study of patients who were treated with ECT after admission in the inpatient psychiatry unit of Universal College of Medical Sciences Teaching Hospital, Bhairahawa, Nepal during a period of one year (August 2012 to July 2013). RESULTS: Out of 1095 patients admitted during the specified period, 81 (7.39%) patients received ECT. About 44.44% of the patients belonged to 20-29 years age group. Female patients constituted more than half of the subjects (55.56%). Review of diagnostic profile showed that majority of patients receiving ECT were suffering from Schizophrenia (44.4%), followed by Bipolar Affective Disorder/Mania (29.6%), Depressive disorder (11.1%), Acute and Transient Psychotic Disorder (6.2%), Post-partum Psychosis (3.7%) and substance induced mood/psychotic disorders (3.7%). A significant majority of subjects (75.3%) received about 5-7 ECT treatments. The mean seizure duration after ECT treatment was 31.13±5.79 seconds. No any major complications were noted during ECT treatment. CONCLUSION: This study suggests that ECT, use, as a treatment modality is common in young adults and females with Schizophrenia being the most common indication. Direct ECT is safe when used judiciously.

Absent posterior alpha rhythm: An indirect indicator of seizure disorder?

HYPOTHESIS: Absence of normal posterior alpha rhythm is an indirect indicator of seizure disorder. MATERIALS AND METHODS: Study group consists of 116 child and adolescent patients in the age range of 5-17 years, with established history of seizure disorder. Follow-up cases of seizure disorder formed first comparison group, patients with a history of pseudo-seizures formed second comparison group and patients with a history of headache formed the third comparison group. RESULTS: In significant 48.3% (56) patients within the study group there was no visible alpha rhythm. Whereas, this absent alpha rhythm criteria was seen in only 11.2% (4) patients in first and 15% (8) patients in second and in only 6.1% (2) patients in third comparison groups. DISCUSSION: Absent alpha rhythm- a criterion seems to have a certain amount of specificity for electroencephalograms (EEGs) with seizure disorder patients. Presence of seizure activity and absence of alpha activity in EEG significantly correlated to each other (Significant at < 0.01 level). Absent alpha rhythm appears to be a state marker rather than a trait marker of seizure disorder.

Buddha philosophy and western psychology.

Four noble truths as preached by Buddha are that the life is full of suffering (Duhkha), that there is a cause of this suffering (Duhkha-samudaya), it is possible to stop suffering (Duhkha-nirodha), and there is a way to extinguish suffering (Duhkha-nirodha-marga). Eight fold Path (astangika-marga) as advocated by Buddha as a way to extinguish the sufferings are right views, right resolve/aspiration, right speech, right action/conduct, right livelihood, right effort right mindfulness and right concentration. Mid-twentieth century saw the collaborations between many psychoanalysts and Buddhist scholars as a meeting between "two of the most powerful forces" operating in the Western mind. Buddhism and Western Psychology overlap in theory and in practice. Over the last century, experts have written on many commonalities between Buddhism and various branches of modern western psychology like phenomenological psychology, psychoanalytical psychotherapy, humanistic psychology, cognitive psychology and existential psychology. Orientalist Alan Watts wrote 'if we look deeply into such ways of life as Buddhism, we do not find either philosophy or religion as these are understood in the West. We find something more nearly resembling psychotherapy'. Buddha was a unique psychotherapist. His therapeutic methods helped millions of people throughout the centuries. This essay is just an expression of what little the current author has understood on Buddha philosophy and an opportunity to offer his deep tribute to one of the greatest psychotherapists the world has ever produced!

Pattern of neuropsychiatric illnesses in older age group population: an inpatient study report from Nepal.

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.

Pattern of buprenorphine abuse among opioid abusers in Nepal.

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.

Contribution of Indian psychiatry in the development of psychiatry in Nepal.

Psychiatric services remained virtually unknown in Nepal until 1961. The first psychiatric outpatient service was started in 1961, at Bir Hospital, Kathmandu. In 1984, the Psychiatry Department at Bir Hospital was separated and a mental hospital was created, which was later shifted to its current location at Lagankhel, Patan, in Kathmandu valley, in 1985. It is the only mental hospital in Nepal with a current bed strength of 50 beds. The new era in medical learning and teaching was ushered in Nepal with the establishment of the Institute of Medicine (IOM) under the Tribhuban University and the 400-bed Tribhuban University-Teaching Hospital (TU-Teaching Hospital), in the year 1983. BP Koirala Institute of Health Sciences (BPKIHS) at Dharan was established in 1993, as a part of the joint Indo-Nepal collaboration on developing an international standard teaching, training, and research-oriented medical institute similar to AIIMS, New Delhi. During the last one-and-half decades a number of privately run medical colleges have come up in Nepal. Outpatient and inpatient Psychiatry Departments have been established in most of these government as well as private medical institutes. At present, the postgraduate course (MD) in psychiatry has been running in two government-run institutes as well as three privately run medical colleges. Indian psychiatrists have played and are still playing significant roles in establishing as well as maintaining Psychiatry Departments, especially in the private sector medical colleges. They have also contributed to the growth of psychiatry research and postgraduate teaching in psychiatry, in Nepal.