Aims and Objectives: The sequence of contacts with individuals and organizations prompted by the distressed person's efforts, and those of his or her significant others, to seek help is known as the pathways to care. The study of the pathways to care provides the relevant information regarding the individual's health seeking and illness behaviour. A wide range of professionals including psychiatrists, psychologists, other doctors, faith-healers and religious healers cater to the needs of mentally ill patients. This study was carried out to identify the pathway to care of patients up to psychiatric care with no prior psychiatric treatment at GMCTH. Methodology: It is a cross-sectional, descriptive study conducted in GMCTH, Pokhara from Jan 2015 to Dec 2016. After ethical consideration, all new patients and those newly referred to the psychiatric services and agreed to participate were interviewed until the target 100 participants were recruited. ICD-10 was used for diagnosis. Data were computed and analyzed by using Microsoft excel and SPSS. Parametric & non parametric statistical technique was applied wherever appropriate. Results: Total of 100 patients (56 females, 44 males) was included in the study. Mean age of the entire study cohort was 37.17 years (SD 15.45). The mean no. of months to seek first help from a psychiatrist was 53.03 months (SD: 81.70). Conclusion: All the patients here eventually made treatment contact with psychiatrists. However, delay was pervasive. Delay in treatment has negative effect in the treatment outcome. The knowledge and recognition of psychological disorders by the traditional healers as well as other treatment providers in the community are crucial for early treatment of psychiatric patients.

Background: The referral rates of psychiatric patients in Nepal are very low, considering the higher rates of psychiatric morbidity in patients who attend various departments of a general hospital. Studying the pattern of psychiatric referrals may facilitate the management of the mentally ill in a comprehensive and holistic manner. Materials and methods: The study was conducted at Western Regional Hospital (WRH) over the period of one year. The patients referred from different departments were assessed by the consultant psychiatrists. Result: A total of 816 patients were referred for psychiatric consultation out of which majority was from department of medicine and the most common reason for referral was anxiety disorder. Conclusion: Multi-disciplinary interaction is beneficial to identify the psychiatric morbidity in the patients who attend general hospital.

Background: Opioid use is a serious global problem and the problem is increasing over years. Buprenorphine has been approved as a substitution therapy in Nepal, but there are few long-term studies of its effectiveness. Aim: This study aimed to assess the 1-year efficacy of buprenorphine and reasons for dropout. Materials and Methods: This study was conducted at Western Regional Hospital, Pokhara from 29th August 2016 to 31st August 2017. The Buprenorphine Maintenance Treatment Program (BMT) was started on 29th August 2016 and all the clients enrolled in the program within 1 year of starting BMT were included in the study. Results: 75% of the enrolled clients dropped out in 1-year period. Conclusion: Adherence to Buprenorphine was better in flexible dose adjustment group. Combination of buprenorphine and psychosocial treatment would have been related with better outcome.