A qualitative assessment of methadone maintenance therapy program in Nepal: evidence to scaling up at national level.

Methadone maintenance therapy is widely accepted form of substitution therapy in people with Opioid dependent client. It is a kind of harm reduction strategy which prevents the spread of HIV and hepatitis among injecting drug users. It also improves quality of life and help decrease crime and other social issues. The program has been in Nepal for few years. The clients are increasing more each day and the demand for the program is also increasing. There is an urgent need of scaling-up the program in Nepal to address the increasing number of clients and unreached clients. This is an attempt to assess qualitatively the methadone maintenance therapy program in Nepal to generate evidences as a support to existing programs and to scale up the program in unreached population. The qualitative study revealed that the clients had adequate knowledge on the program and the program is quite satisfactory. However, they have to wait for a long to get enrollment in the program, there is no counseling session and they were more concern about the quality of the drug. Despite many lacunae, the participants found the program very useful in terms of developing good relation with family members, decreasing the necessity of money, being able to attend social functions, health and economic benefits, time saving, easily getting job. On the other hand, they were experiencing adverse effect such as decreasing sexual performance, dental caries, nausea, social stigma due to misuse of the program by some clients which are not properly addressed by the program. The program can be improved by making it priority problem at national level by the government, improving it as one stop shopping such as providing counseling, medicine and skill development program at one place.

Assessment of characteristics of patient with delirium tremens.

Delirium tremens is the severe form of alcohol withdrawal. It carries a certain degree of mortality and there has been and advancement in the understanding of pathophysiology and risk factors for the development of the condition. This prospective study is carried out to study the characteristic of the patient of delirium tremens in our setting using ICD-10 diagnostic criteria. Thirty seven cases of delirium tremens with majority of males and of all hill origin people were identified. Patients with delirium tremens has been using alcohol for average of 24.8 years with an average intake of around 2.2 litres per day. Most of the patient has seizure and similar episodes in past and using alcohol from morning time.

Delirium at Nepal Medical College Teaching Hospital: reason for referral and subtypes.

The important neuropsychiatric disorder delirium is the most single important disorder in onsultation liaison psychiatry. There is a dearth of study in delirium. The purpose of this study was to find out the demographic profile, reason for referral, and subtypes of delirium. Thirty two consecutive cases of delirium diagnosed by psychiatrist in consultation liaison psychiatry were enrolled in the study. This is a descriptive study and diagnoses were made based upon 'The International Classification of Disease (ICD-10)'. The majority of cases were from age 70 and above, male sex being more common and most commononest reason for referral being disturbed behavior. The hyperactive subtype of delirium was the frequent finding. Medicine and ICU followed by surgery and post operative ward were the most referring departments.

Consultation liaison psychiatry at Nepal Medical College and Teaching Hospital.

The authors reviewed the all referral cases from different inpatient and outpatient department, in Nepal Medical College and Teaching Hospital. It was a descriptive study. There were 484 referred cases during the study period. Around half the referral were from department of medicine (49.8%), surgery (11.2%), Eye/ENT (10.3%). The referral rate was 1.4%, with an average three cases per day. Among the referral cases depression was diagnosed in 26.9%, anxiety in 15.5% and substance related problem in 14.5%. The consultation liaison psychiatry service is satisfactorily used. Depression, substance use problem, anxiety, deliberate self harm is the main diagnoses in liaison psychiatry.

Hepatitis B and C infection among drug abusers in Nepal.

Prevalence of hepatitis B and C virus infection amongst intravenous drug users (IDU) in Nepal is not known. To estimate such prevalence 72 IDU individuals were tested for HBV and HCV markers. About 80% of the drug abusers are both anti-HBc (59/72) and anti-HCV (58/72) sero-positive. However persistent infection with hepatitis B, as indicated by positive HBsAg, was detected in only 5.5% (n = 4). Active hepatitis C infection, as indicated by HCV RNA positivity, was documented in 74% (42/58) of those who were anti-HCV positive. Importance of awareness of this observation among the healthcare workers in the prevention of hepatitis C in the community is stressed.