Neuropsychiatric manifestations in General Paralysis of Insane (GPI).

General paralysis of insane is a form of neurosyphilis which brings parenchymatous changes in the central nervous system. Its manifestations include a variety of neuropsychiatric symptoms ranging from cognitive impairment to overt psychosis. Clinicians face difficulties in proper diagnosis as variety of symptoms changes from one form to other within a short period of time. Rarity of the disease at this modern era of penicillin is also another factor in timely diagnosis and management of such cases. Here we present a case of general paralysis of insane who presented with variety of neuropsychiatric symptoms and have had great difficulties to reach into the diagnosis.

Cognitive Dysfunctions in Patients with Alcohol Dependence Syndrome in a Tertiary Hospital in Kathmandu.

INTRODUCTION: Alcohol dependence is a chronic disorder, accompanied by neuropsychological deficits. Patients with alcohol dependence were evaluated to identify the cognitive dysfunctions. METHODS: The study followed descriptive design and recruited participants (N=62) from inpatient services of the Department of Psychiatry and Mental Health by convenient sampling. Participants were evaluated with the Severity of Alcohol Dependence Questionnaire, Frontal Assessment Battery and PGI Memory Scale for the severity of alcohol dependence, executive impairments and memory dysfunctions respectively once they had completed alcohol detoxification. RESULTS: Total duration of alcohol consumption was 13.93 ± 8.74 years, period of dependence was 2.97 ± 2.23 years and 56.5% had moderate level of dependence. 33.9% of the participants had executive impairments particularly in conceptualization, programming and mental flexibility. 38% of variance in executive dysfunction was explained by illness variables, where period of alcohol dependence and education were significant predictors. 54.8% had significant memory dysfunction particularly in visual retention, remote memory, verbal retention of dissimilar pairs and delayed recall. Memory dysfunction differed significantly among the age groups (F=10.22, p<0.01) and age was a significant predictor (ß=.542, p<0.001). 19% variance in memory dysfunction was explained by illness variables, where duration of alcohol consumption was a significant predictor (ß = .485, p<0.01). CONCLUSION: Findings indicate that cognitive dysfunctions are prevalent among patients with alcohol dependence. Hence, routine neuropsychological assessment is of particular importance for early detection and remediation of underlying deficits, which completes the treatment of alcohol dependence.

Association of thyroid dysfunction with depression in a teaching hospital.

BACKGROUND: Thyroid dysfunction is common in patients with depression and depression is also common in patients with thyroid dysfunction. The purpose of this study was to estimate the prevalence of thyroid dysfunction in newly diagnosed depressed patients attending Psychiatry outpatient department of Tribhuvan University Teaching Hospital, Nepal and to find the correlation between the two. METHODS: The study population comprised of 70 patients aged more than 15 years selected by simple random sampling technique who attended the Psychiatry OPD of Tribhuvan University Teaching Hospital, Kathmandu, Nepal and were diagnosed with first episode depression. A self- designed semi structured proforma was devised to obtain the socio- demographic characteristics of the study population. These patients were diagnosed as depression as per the ICD-10 DCR Criteria and HDRS scale was used at the same interview to verify it objectively. RESULTS: Fifteen patients (21%) were found to have thyroid dysfunction, the most common being sub-clinical hypothyroidism, seen in 8 (11%). Thyroid dysfunction also showed positive correlation with depression severity. The diagnosis of depression by ICD- 10 DCR Criteria had positive correlation with HDRS grading of depression, though no significant association was found between different socio- demographic variables and depression. CONCLUSIONS: This study concluded that thyroid dysfunction is common in depressed patients and larger studies are required in this field before TFTs are considered as an integral part of evaluation of these patients.

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.