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Open J Psychiatry Allied Sci ; 12(2): 144-147, 2021.
Article in English | MEDLINE | ID: covidwho-1835583


Mental health professionals across the globe foresaw the mental health impact of the coronavirus disease 2019 (COVID-19) pandemic. They have faced scarcity of trained professionals, rising morbidities, lack of protective gear, shortage of psychotropic drugs, and poor rapport building due to masking and social distancing. Amidst all, they have responded with approaches that focus on continuing mental health services to the patients already in care, education of the vulnerable people to help them cope with these stressors, and provide counselling services to patients and families affected by the pandemic.

Int J Ment Health Syst ; 15(1): 85, 2021 Dec 20.
Article in English | MEDLINE | ID: covidwho-1632918


BACKGROUND: Pathways to care studies are feasible and tested means of finding the actual routes taken by patients before reaching proper care. In view of the predominance of nonprofessional service providers and the lack of previous large studies on pathways in Nepal, this multicenter study is needed. The aim of the study was to trace the various pathways and carers involved in mental health care; assess clinical variables such as the duration of untreated illness, clinical presentation and treatment; and compare geographically and culturally diverse landscapes. METHODS: This was a cross-sectional, convenience sampling study performed at 14 centers where new cases were being taken. The World Health Organization Study of the Pathways-to-Care Schedule was applied. The Nepali version of the encounter form was used. The data were collected between 17 September and 16 October 2020 and were analyzed using the Statistical Package for the Social Sciences (SPSS). Additionally, perspectives from local investigators were collected and discussed. RESULTS: Most of the first carers were native/religious faith healers (28.2%), followed by psychiatrists (26%). The median duration for the first psychiatric consultation was 3 weeks. The duration of untreated illness was 30.72 ± 80.34 (median: 4) weeks, and the time taken for this journey was 94.99 ± 274.58 (median: 30) min. The longest delay from the onset of illness to psychiatric care was for epilepsy {90.0 ± 199.0 (median: 25.5)} weeks, followed by neurotic illness {22.89 ± 73.45 (median: 2)} and psychotic illness {10.54 ± 18.28 (median: 2)} weeks. Overall, most patients with severe mental illnesses (SMIs) had their first contact with faithhealers (49%), then met with medical doctors (13%) or psychiatrists (28%). Marked differences in clinical presentation surfaced when hilly centers were compared with the Terai belt. CONCLUSIONS: Faith healers, general practitioners and hospital doctors are major carers, and the means of educating them for proper referral can be considered. The investigators see several hindrances and opportunities in the studied pathways. The employment of more mental health professionals and better mental health advocacy, public awareness programs and school education are suggested strategies to improve proper mental health care.

Journal of Affective Disorders Reports ; : 100219, 2021.
Article in English | ScienceDirect | ID: covidwho-1401562


Background TikTok is a recent type of video-sharing and lip-syncing online platform that is influencing adolescents rapidly and is likely to surge in view of increased use of smart-phones, internet use, ‘Lockdown’ period due to COVID-19pandemic and increasing online transactions, teachings and daily affairs worldwide. Case presentation Two teenaged girls from southern Nepal brought by their parents with problematic use of TikTok and behavioural problems that followed .They were engrossed in the mobile application that resulted in impairment at a personal, social, educational and family functioning.In addition to that, parents did not accept it on cultural grounds. However, patients did not consider it problematic .Gradually, they developed symptoms of depression, conduct disorder and oppositional defiant disorder but did not fulfill criteria of any disorder. The provisional diagnosis of Behavioural addiction was considered and Cognitive behavioural therapy planned. These cases posed diagnostic dilemma, challenging treatment sessions and partial success. Conclusions The line between normal and abnormal use of such mobile application is hazy in context of its social acceptability and growing use. The conflict appeared between traditional values and modern means of entertainment poses therapeutic challenge. Authors advise parental involvement, psychotherapeutic means, behavioral therapy and a collaborative approach with adolescents rather than pharmacotherapy for comprehensive treatment.