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Introduction: Patients with thyroid disorders are more prone to develop depressive symptoms and conversely depression may be accompanied by various subtle thyroid abnormalities. The aim of the study was to estimate the prevalence of thyroid dysfunction in depression. Methods: This is a descriptive cross-sectional study conducted at Devdaha Medical College and Research Institute employing a simple random sampling technique during the period of August 2019-January 2020. The research was approved by the Ethical Committee of the Institutional Review Board of Devdaha Medical College and Research Institute. The protocol approval number is 009/019. Data analysis was done in Statistical Package for the Social Sciences (Version 23). Results were presented as frequencies and percentages where required. Results: Among 263 patients with depression, 69 (26.2%) had abnormal thyroid status with most common being subclinical hypothyroidism 32 (12.2%), 13 (4.9%) overt hypothyroidism and 7 (2.7%) overt hyperthyroidism. Conclusions: The prevalence of thyroid dysfunction is high among patients with depression. We recommend to conduct routine thyroid function tests for all the patients with depression.

Objective: There has been increasing interest in the physical health, mental wellbeing and burnout afflicting medical students over recent years. This paper describes the overall results from phase two of an international study including a further nine countries across the world. Methods: We sampled large groups of medical students in nine countries at the same time and with exactly the same method in order to aid direct comparison of demographics, burnout and mental wellbeing through validated instruments. Results: A total of 4,942 medical students from these countries participated in this study. Around 68% of respondents screened positive for mild psychiatric illness using the General Health Questionnaire-12. Around 81% and 78% of respondents were found to be disengaged or exhausted respectively using the Oldenburg Burnout Inventory. Around 10% were found to be CAGE positive and 14% reported cannabis use. The main source of stress reported by medical students was their academic studies, followed by relationships, financial difficulties and housing issues. Conclusion: Cultural, religious and socioeconomic factors within each country are important and understanding their effects is fundamental in developing successful local, regional and national initiatives. Further quantitative and qualitative research is required to confirm our results, clarify their causes and to develop appropriate preventative strategies.

Introduction: Headache is a common neurological disorder and psychiatric comorbidity is very common in primary headache in which anxiety and depression is more common. Data of patients presenting with primary headache and psychiatric comorbidity is scanty in Nepal. The aim of the study was to study the socio-demographic and clinical profile of patients with primary headache, and to study the frequency and pattern of anxiety and depression as comorbidities among these patients.Material and Method: The study was done at the headache clinic in the Department of Psychiatry at Devdaha Medical College and Research Institute, Rupandehi, Nepal. All out-patients attending our clinic over a period of six months (January 2017-June 2017) with a diagnosis of primary headache were included in the present study. Demographic and clinical profiles of these patients were noted in a specially designed socio-demographic and clinical data sheets prepared for the present study.Results: Among the total patients (N=150), 86 (57.3%) were in the age group 20-39 years. Majority 118 (78.7%) cases were female while 32 (21.3%) cases were male patients. 69.3% cases had migraine headache and 28.7%cases had tension type headache. Comorbid psychiatric illness was present in 80 (53.33%) cases among which Anxiety disorder was the most common diagnostic category (31.3%) followed by depressive disorders (22.0%).Conclusion: Anxiety and depression (53.3%) as comorbid disorder is prevalent among those presenting with primary headache and anxiety spectrum disorder was more than depressive disorder.J Psychiatrists’ Association of Nepal Vol. 6, No. 2, 2017

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.