Study of personality factors in attempted suicide.

BACKGROUND: Suicidal attempt is becoming a major problem in the world, as it affects the person's career, life style, and family dynamics. Comorbid personality disorders are a risk factors for suicidal behavior. The aim of this study was to determine the various personality factors involved in attempted suicide. METHODS: This is a descriptive study. This study was carried out in the patients, who attempted suicide, who were admitted in the wards of Kathmandu Medical College Teaching Hospital during 1st January 2010 to 30th July 2010. The 16-PF scale was used in all the subjects. RESULTS: Total 46 cases were studied. Six (13%) subjects were seen as having "schizothymic" traits. Sixteen(34.8%) of the subjects were seen as having low intelligent traits. Total 14 (30.4%) were seen as having affected by feelings. Seven (15.2%)were seen as having humble traits. Fifteen (32.6%) were seen as having sober traits and there are no cases of happy-go-lucky. Three (6.5%) were seen as having expedient. Eight (17.4%) were seen as having shy traits and there are no cases seen of venturesome traits. Total 14 (30.4%) were seen as having tough-minded traits. Eight (17.4%) were seen as having suspicious personality traits while nine(19.6%) were seen as having practical personality traits. Ten (21.7%) were seen as having shrewd personality traits. Total 17 (37.0%) were seen as having apprehensive personality traits. Twelve (26.1%) were seen as having experimenting personality traits and 6 (13.0%) were seen having group dependent personality traits. Among the patients, 10 (21.7%) were seen having undisciplined personality traits. Seven (15.2%) were seen having relaxed personality traits. Total 12 (23.1%)were seen having extroversion traits. Six (13.0%) were seen having low anxiety traits. Ten (21.7%) were seen having tender-minded emotionality personality traits. Seven (15.2%) were seen having subduedness personality traits. CONCLUSIONS: Our study highlights the importance of personality factors in attempted suicide and these factors are at risk in attempting suicide, therefore, which can be implemented in prevention of suicide.

A study of severity of intention of suicide in various psychiatric diagnoses.

BACKGROUND: Suicidal intent has been described as the seriousness or intensity of the patient's wish to terminate his or her life. Suicide has become an important public health issue throughout the world. It is important to evaluate the intentions of suicide attempts and various psychiatric diagnostic perspectives to understand the multiple dimensions of suicide. AIMS: The aim of the work was to study the severity of suicidal intention among suicide attempters in different psychiatric diagnoses and different mode of attempted suicide. MATERIALS AND METHODS: This study was carried out in the patients, who attempted suicide, by various modes, who were admitted in the wards of KMCTH during 1st January 2007 to 30th December 2007. Suicide Intent Scale (SIS) was used in all the cases that had attempted suicide. RESULTS: Total numbers of patients was 43. Mean SIS was 13.88. The results have shown that majority of cases were female 69.8% (n=30) and male were 30.2% (n=13). The commonest mode of suicide was poisoning 83.7% (n=36) in which moderate suicide intent was 58.3% (n=21); mild suicide intent 33.3% (n=12) and severe suicide intent 8.3% (n=3) (p value < .004). Pesticide (organophosphorus) ingestion was the commonest mode of suicide 44.4% (n=16), followed by pharmacological drugs 33.3% (n=12) (p value < 0.267). The commonest psychiatric diagnosis was depressive disorders 62.9% (n=27), in which moderate suicide intent was found to be maximum 70.4% (n=19) followed by mild suicide intent 14.8% (n=4) and severe suicide intent 14.8% (n=4) (p value < 0.002). CONCLUSION: The increasing problem of pesticide poisoning and drug overdose demands strict legal scrutiny in the availability of common means of attempting suicide.

Modified Welsh regimen: a promising therapy for actinomycetoma.

BACKGROUND: Mycetoma has a worldwide geographical distribution which is extremely uneven; however, it is a common disease in India and responsible for causing significant morbidity. Treatment of this condition is often a challenge for the treating dermatologist. The authors report a promising therapy for patients of actinomycotic mycetoma. METHODS: This assessment series included 18 patients with a confirmed diagnosis of actinomycetoma, and who had shown a poor response to previous treatments. Patient received a combination therapy of the Welsh regimen (amikacin along with cotrimoxazole) to which rifampicin was added as a third drug. Clinical evaluation included radiology and laboratory investigations. RESULTS: Sixteen patients out of 18 completed the combination therapy, which lead to remission. Two patients were lost to follow-up. Of the 16 patients in remission, no recurrence was observed during a follow-up period of up to 18 months.

Diagnostic variability and therapeutic efficacy of ECT in Nepalese sample.

BACKGROUND: Though electroconvulsive therapy (ECT) has been used in Nepal for last twenty years, researches regarding its use, its efficacy and other data are non-existent. AIMS: The objective of this study was to know about diagnostic variability and therapeutic efficacy of the use of ECT in hospitalized patients. METHODS: This is a prospective comparative study between patients who received ECT and who did not using ICD-10 as diagnostic confirmation. Psychopathology was evaluated using Brief Psychiatric Research Scale (BPRS), Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS) between the groups at admission, at discharge, at 1st month, at 6th month and at 12th month. Functional assessment of patients was done using Global Assessment of Function (GAF). Modified ECT was performed using general anaesthetic agent. RESULTS: 47 patients received ECT as compared to 78 patients who were non-receivers. The patients with most common five diagnosis were paranoid schizophrenia (14.4%); psychotic depression (13.6%) ; undifferentiated schizophrenia (8.8%) ; bipolar mania (7.2% ) ;severe depression without psychosis (5.6%) . There was significant decrease in BPRS in ECT receiver as compared to non-receivers at discharge (p=0.0001), 1st month (p=0.0001), 6th month (p=0.0001) and 12th month (p=0.0001) ; in YMRS at discharge (p=.008), 1st month (p=.002) and at 12th month (p=.015) ; in HAMD-M at discharge (p=0.0001), at 1st month (p=0.0001), at 6th month (p=0.0001) and at 12th month (p=0.0001) ; in GAF at discharge (p=0.0001), at 6th month (p=0.0001) and at 12th month (p=0.0001). CONCLUSION: There was significant improvement in overall psychopathology of patients who received ECT as compared to non-receivers. The improvement was shown by decrement in scores in BPRS, YMRS, HDRS and GAF at the time of discharge, 1st month, 6th month and 12th month which were statistically significant. Day to day functional status of patients also improved as shown by GAF. The efficacy of ECT was very significantly shown in this study with all the psychiatric spectrum disorders.

Experiencing stigma: Nepalese perspectives.

BACKGROUND: Experiencing stigma by patients with mental illness in their day to day lives has substantial importance in treatment, compliance and quality of life. There is dearth of information and researches in experiences/ perceptions and coping of stigma in Nepal. AIMS: The objective of this study was to find out experiences/ perceptions and coping of stigma and stigmatizations among patients with mental illness. MATERIALS AND METHODS: This is a retrospective, cross sectional study of patients admitted in psychiatry ward. Patients were assessed using self-report questionnaire which focused on beliefs about discrimination against mental illness, rejection experiences, and ways of coping with stigma. Patient's socio demographic profiles were also assessed. RESULTS: Fifty three patients completed questionnaire concerning various constructs of stigma. There were 29 male patients and 24 female patients. Majority (N=45; 84.9%) were of Hindu religion but there were mixed numbers regarding caste. Most of the patients were aware of the stigma associated with mental illness. There were experiences of rejection by family members and colleagues (N=23; 43.4%) and health care professional (N=16; 30.2%). There were strong perceptions of stigmatization felt by patients in different social circumstances. Though maintaining secrecy and avoidance/withdrawal of stigma provoking scenario were not experienced much, there was a strong sense of advocacy whenever there was any negative view of mental illness. Some of the questionnaire items in "perception", "rejection" and "coping" showed statistical significance (p=0.001). CONCLUSION: People with mental illness experience stigma during their course of illness and treatment and it is an important determinant for the relapse of symptoms and non-compliance to treatment. Despite experiencing stigma, patients were generally treated fairly by other people. Patients develop various mechanisms to cope with stigma, mostly secrecy and avoidance. Advocacy and anti-stigma campaign along with positive attitudes of health professionals play important role in decreasing stigmatizing experiences in patients.

A prospective study of comorbidity of alcohol and depression.

OBJECTIVE: The aim of the work was to study the socio-demographic variables and their co-morbidity to alcohol consumption and presence of depressive symptomatology. DESIGN: This was a prospective cross-sectional study. MATERIALS AND METHODS: The study was carried out in 53 patients, who were admitted in the wards of Kathmandu Medical College Teaching Hospital (KMCTH) with the diagnosis of mental and behavioural disorder due to the use of alcohol according to ICD-10. The patients were taken from 1st February 2006 to 30th December 2006. All patients were rated using Hamilton Depression Rating Scale (HDRS). Comparison of alcohol intake, depressive symptomatology and their associations with various socio-demographic variables were done using standard statistical procedures. RESULTS: The present study has shown that more than 94.3% of the patients were suffering from depressive episode. Among all the patients, 11.3% were suffering from severe depressive episode. Alcohol intake was more significantly correlated (p = .002) with Brahmin and Chhetri caste. The other significant correlation of alcohol intake and sociodemographic variable was Nuclear family (p=.001). Among these patients the severity of depression was significantly (p= .001)associated with duration of alcohol intake. Marital status was another important factor affecting comorbidity of alcohol intake and presence of depressive symptoms (p =.002). Students of 10th to 12th grades of school were found to be using alcohol more often (45.3%). Middle socio-economic status (60.4%) was using alcohol more frequently than other socioeconomical classes. CONCLUSION: Severity of depression and alcohol intake was found to be significantly associated with various socio-demographic variables such as caste, family structure, marital status and educational status.

Encephalocraniocutaneous lipomatosis: a rare neurocutaneous syndrome.

Encephalocraniocutaneous lipomatosis is a congenital hamartomatous disorder with unique ocular, cutaneous and neurological features. A 13-year-old boy presented with history of mental retardation and delayed developmental milestones. Bulbar conjunctiva of left eye showed hypertrophy with a soft reddish limbal nodule encroaching on the cornea. Dermatological examination showed multiple patches of alopecia, soft papules in the left perioral and periorbital areas, soft masses over the right axilla, trunk and in the lumbosacral region suggestive of lipomas. The CT scan of the brain revealed well-defined, hypodense lesions in both the cerebellar hemispheres suggestive of lipomas. The constellation of these findings led us to a diagnosis of encephalocraniocutaneous lipomatosis.

Comparative study of esmolol and labetalol to attenuate haemodynamic responses after electroconvulsive therapy.

OBJECTIVE: The study was designed to evaluate the hemodynamic effects of Esmolol and labetalol in patients undergoing electroconvulsive therapy. MATERIALS AND METHODS: Ninety patients undergoing electroconvulsive therapy treatment were studied according to randomized, double blind placebo controlled protocol. Ninety patients were divided into three groups with thirty patients in each group. Patients received either Esmolol (1 mg/kg), Labetalol (0.25 mg/kg) or Normal Saline (placebo) intravenously just after induction with propofol. The baseline heart rate and blood pressure were recorded. Hemodynamic parameters before and after drug therapy and after the ECT current application, were recorded at different time intervals. RESULTS: It was found that Esmolol significantly attenuated the degree of tachycardia and hypertension after ECT in comparison with placebo in the first three minutes (p<0.05), whereas the rise in HR and blood pressure was significantly blunted in the labetalol group in comparison to placebo, from three minutes onward till ten minutes. (p<0.05). CONCLUSION: It was concluded that Esmolol is effective in blunting the hemodynamic response after ECT stimulus in the first three minutes after application of the electrical current, whereas Labetalol is effective after five minutes onwards till ten minutes.

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.

A study of the first 350 cases referred for EEG in Kathmandu Medical College Teaching Hospital.

UNLABELLED: Electroencephalography or EEG is a neurological test that uses an electronic monitoring device to measure and record electrical activity in the brain. Epilepsy is defined as a recurrent tendency to unprovoked seizure. About 0.5% to 2% of the population has epilepsy. MATERIAL AND METHODS: This is a retrospective study of the first 350 odd cases referred for EEG at Kathmandu Medical College Teaching Hospital, Kathmandu during period November 2002- September 2002 (Mangsir 2058- Bhadra 2059). RESULTS: Most patients fall in the age group of 11-20 years and more than 50% referred cases fall in the prime of life, i.e., 11-30) years. 16% of patients with the history of seizure did not use any AED and 32% who though had no history of seizures were actually using AED. It is seen that out of 149 reported normal, 57 (38%) had history of seizure; but out of 208 reported abnormal in EEG only 92 (42%) had history of seizure. DISCUSSION: EEG is not a very sensitive or a specific tool; however, in our study it was seen to be more sensitive than specific. It is till very useful in classifying seizure types, in locating epileptic focus prior to surgery or in some confusing situation when movement disorder may simulate seizure disorder or vice versa. CONCLUSION: Although EEG is not a very sensitive or specific investigation, it is more sensitive than specific.

Glycaemic index of conventional carbohydrate meals.

The glycaemic index (GI) and the triacylglycerol response were measured in thirty non-insulin-dependent diabetes mellitus patients given 50 g portions of five different conventional Indian meals containing semolina (Triticum aestivum) cooked by two different methods, or combinations of semolina and pulse (black gram dhal (Phaseolus mungo), green gram dhal (Phaseolus aureus) or Bengal gram dhal (Cicer arietum)). There were no significant differences among meals in mean GI except for meals based on roasted semolina or semolina-black gram dhal. Compared with the blood glucose response for a 50 g glucose load, only meals based on steam-cooked semolina and semolina-Bengal gram dhal elicited a significantly lower response at 1 h postprandially, and only meals based on semolina-black gram dhal at 2 h postprandially. No significant differences were found among the meals in the triacylglycerol-response.

Behavioral effects of ethanol inhalation in rats.

Behavioral effects of ethanol inhalation were studied on two fixed-ratio (FR) liquid-reinforced schedules and a continuous reinforcement (CRF) schedule intracranial self-stimulation (SS) in rats using the inhalational behavioral chamber designed in our laboratory. In the FR-24 schedule ethanol caused a decrease of reinforcement rate at 161 ppm and higher concentrations. In the FR-50 schedule decreases of the rate were observed at 102 ppm and 203 ppm. In the SS behavior ethanol produced a decrease in the rate of reinforcement at 603 ppm and higher concentrations. In rats of this schedule, blood ethanol concentrations were measured to be 393 micrograms/ml and 545 micrograms/ml after exposure to 600 ppm and 1200 ppm of ethanol respectively. Acute tolerance to ethanol was observed in these experiments, particularly in the FR-24 schedule. Thus ethanol inhalation could produce adequate blood concentrations so as to produce behavioral effects.

Effects of ethanol inhalation on EEG in rats.

Effects of ethanol on duration of stages of sleep-wake cycle and EEG power spectra were measured during a 2-h exposure in a dynamic inhalational chamber in rats. Rats were exposed to one of four graded concentrations (approx. 100, 400, 800 and 1600 ppm) of ethanol on different days. Ethanol was found to increase the duration of waking (W) with a decrease in duration of rapid eye movement (REM) sleep at 100 and 400 ppm. No effect was observed at 800 and 1600 ppm on the stages of sleep-wake cycle or at 100-1600 ppm on EEG power spectra from the somatosensory or visual cortices. Results indicate that ethanol administered by inhalation could produce arousal action at low doses, but did not have any effect on EEG power spectrum at the concentrations used.

Glycemic index of traditional Indian carbohydrate foods.

The glycemic index (GI) was determined in 36 non-insulin-dependent diabetes mellitus patients who were fed 50 g carbohydrate portions of six Indian conventional foods, including rice, a combination of rice-legume (Bengalgram, peas, and greengram), and a combination of rice-dal (greengram dal and redgram dal -- dal is dehusked and split legume). In addition to the GI, triglyceride (TG) responses of these foods were also determined. A higher GI was obtained for rice and for rice with peas; all other combinations yielded lower glycemic indices. However, all the foods produced significantly lower blood glucose response 2 hours postprandially as compared with blood glucose responses to a 50 g glucose load for the same group. No significant difference was observed for TG responses to the different foods.

Sensitivity of EEG in young rats to toluene exposure.

Effects of toluene on the electroencephalogram (EEG) and its power spectra were measured during a 2-hr exposure in a dynamic inhalational chamber in young rats (30-53 days old) and compared to those in adult rats (63-77 days old). Rats were exposed to one of the three concentrations [low (108-111 ppm), medium (160-163 ppm), and high (407-432 ppm)] of toluene on different days. In tests on sleep-wake cycle, in the young animals the duration of the wake stage (W) was increased with decreases of rapid eye movement (REM) and non-REM (NREM) sleep during hr 1 and hr 2 of exposure to the low concentration. These effects were marked at the medium and the high concentrations. In adult rats, at the low concentration the increase of W and the decrease of REM were observed only at hr 1; however, at medium and high concentrations these changes of W and REM sleep were marked along with a decrease of NREM. Comparison of the changes of duration of different states in rats of two age groups showed that there was a significant difference in the increase of W and the decrease of NREM sleep in young rats at hr 2 of exposure to low concentrations only compared to those in adult rats. Tested on power spectrum in young rats during REM sleep recorded from the visual cortex, the power of delta waves increased at the medium and high concentrations and that of theta wave decreased at the high concentration during hr 2 of exposure compared to the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of toluene exposure on the spontaneous cortical activity in rats.

Effects of toluene on the electroencephalogram (EEG) and its power spectra were measured during a 2-hr exposure in a dynamic inhalational chamber in rats. Rats were exposed to one of six graded concentrations (110.6, 162.5, 432, 676, 1558, 2730 ppm) of toluene on different days. It was found that the duration of waking (W) was increased with a decrease in duration of rapid eye movement (REM) sleep even at 110.6 ppm. Duration of nonrapid eye movement (NREM) sleep was decreased with an increase of W and a decrease of REM sleep at 162.5 ppm. Dose-related effects were noted in higher concentrations. The power of delta frequency band was increased with a decrease of theta frequency band power at hr 1 of exposure to 676 ppm during REM sleep recorded from the visual cortex. The power of theta frequency band was also decreased at hr 2 of exposure at 432 ppm. During W and NREM sleep power spectra were not changed significantly. Results indicate that the changes of EEG are a sensitive measure of the effects of toluene on the central nervous system (CNS).

Rebound increase of basal cAMP level in NG108-15 cells during chronic morphine treatment: effects of naloxone and chloramphenicol.

The effects of morphine on the basal cAMP level in the neuroblastoma X glioma NG108-15 hybrid cell line have been studied. Morphine (10 microM) added to the incubation media at hr 0 caused a rapid and significant decrease in the cAMP level up to hr 1; the level then slowly returned to the control at hr 6, and gradually increased to its peak at hr 36, returning to the control at hr 60. These results provide the first evidence for a delayed rebound increase of cAMP during morphine treatment. Naloxone (10 microM) added at hr 0 concomitantly with morphine blocked the morphine-induced decrease in cAMP level at hr 1 and attenuated its increase at hr 36. However, when naloxone was added at hr 5.5, the cAMP level significantly increased at hr 6, and at hr 36 the cAMP level increase was the same as in the case of morphine alone. Furthermore when naloxone was added 0.5 hr prior to harvesting the cells at hr 6, 12, 24 and 36, the cAMP level showed an immediate increase at each time point up to about the same level as observed with morphine alone at hr 36. Chloramphenicol, a protein synthesis inhibitor (100 microM) itself caused little or no change in the cAMP level. Added 30 min before morphine, chloramphenicol decreased the morphine-induced rebound increase at hr 36 in a concentration-dependent manner without any significant effect on cAMP decrease at hr 1. However when chloramphenicol was added at hr 5.5, the morphine-induced rebound increase at hr 36 was also attenuated, thereby suggesting an involvement of macromolecular synthesis in the rebound increase of cAMP which may be used as a model for the development of morphine dependence.

Effect of morphine on self-stimulation in rats and its modification by chloramphenicol.

The effect of morphine was studied on self-stimulation (SS) behavior in rats implanted with bipolar electrodes in the posterior hypothalamus. A single dose (10 mg/kg) of morphine decreased SS responding within 10-20 min, reaching a minimum level between 20-40 min after which the responding gradually returned to normal. The SS responding then increased above the control level at 120-180 min postdrug, then slowly returned to normal, thus showing a rebound effect. The combination treatment with morphine (10 mg/kg) and chloramphenicol (50 mg/kg) on SS behavior produced an accentuation of the initial decrease in responding, which was prolonged before gradually returning to the control levels without showing any rebound effect. The data suggest that alterations in protein synthesis may underlie the suppressed excitatory effect of a high dose of morphine on SS behavior.

Effect of inhalation of xylene on intracranial self-stimulation behavior in rat.

The effect of the inhalation of xylene on intracranial self-stimulation behavior was studied in rats in a flow-through (dynamic) inhalational behavioral chamber. Rats were exposed successively to four graded concentrations (102, 192, 419 and 623 ppm) of xylene vapor during 2-hr sessions on different days. The rate of lever-pressing showed a dose-dependent decrease during exposure to 192, 419 and 623 ppm of xylene. The 4-hr exposure to the smallest concentration (106 ppm) of xylene failed to show any effect on self-stimulation behavior. During a 5-day 2 hr/day exposure, the decrease in response observed on the 1st day was further accentuated with a nadir on the 3rd day; from the 4th day onwards, the depressant effect was attenuated showing the development of tolerance.

Effect of xylene inhalation on fixed-ratio responding in rats.

The effect of xylene inhalation was studied on operant behavior under a fixed-ratio (FR24) schedule in rats. Experiments were performed while rats were being exposed to xylene vapor in an inhalational (flow-through) behavioral chamber. Rats were exposed successively to three graded concentrations (113, 216 and 430 ppm) of xylene vapor each for 2 hr in range-finding studies during 6 1/4-hr sessions. The reinforcement rate which is correlated with FR responding was shown to be decreased at hr 1, hr 3 and hr 5. However at hr 2, hr 4 and hr 6 the reinforcement rate in rats increased approaching the control levels, thereby indicating development of tolerance. When rats were exposed to one of the three graded concentrations of xylene for 2 hr on separate days, they also showed a decrease in the reinforcement rate at hr 1; development of acute tolerance was also noted in this schedule. Exposure to the lowest (98.5 ppm) level of xylene used during 5-hr sessions caused no significant decrease in the reinforcement rate. This study thus attempts to identify a minimum effective concentration of xylene and indicates the development of acute tolerance to behavioral effect of xylene.