Introduction: Mental illness accounts for 14% of all disability adjusted life years (DALYs) lost worldwide and is one of the major contributors to the global burden of disease. In spite of this much of burden and disability there is a huge gap between the treatment and help seeking behavior. Though, the mental illness is a common problem, due to stigma and lack of knowledge they prefer to visit alternative sources like faith healers, traditional practitioners and quacks. Very few of them seek psychiatrists help. So, this pathway to care study aims to provide some descriptive insight into the pathways to care among the psychiatric patients attending the tertiary care hospital in Kathmandu valley. Material and Method: A cross-sectional study among 66 patients seeking psychiatric outpatient services in Kist medical College, Imadole, Lalitpur, Nepal which is a Teriatry hospital from the period of 1st August – 31st October, 2018. Semi structured proforma developed by department of Psychiatry which covered the socio-demographic profile and WHO (1987) collaborative “pathway study” encounter form as a guiding tool was used to collect the data. Results: Out of 66 enrolled patients, 60.6% were in the age group of 21-40. Almost equal proportion of male (51.5%) and female (48.5%) visited psychiatric services. Majority of the patients were married (81.8%), Chhetri (25.8%) by caste and Hindu (81.8%) by religion. Majority of the patients were from outside valley (51.5), educated upto primary level (31.8%) and housewife by occupation (28.8%). The most common diagnosis was Depression (16.7%) and Alcohol Dependence syndrome (16.7%). Majority (45.5 %) of the patients had visited faith healer before visiting to Psychiatrists. 57.6 % patient visited psychiatrists within 2.5 months duration and majority of them were initiated to visit psychiatrists by family members/ relatives. Conclusion: Faith healers were the most common first contact for psychiatric patients. Despite of that majority of the patients had visited psychiatrists within 2.5 months duration. In most of the cases family members/ relatives were the one to initiate for psychiatric consultation.

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.

Masturbation is common in all societies. Despite being common, it is admonished culturally and almost all religions prohibit masturbation and consider it an act of immorality. The prohibition for masturbation leads to a lot of cultural beliefs, including certain myths, which influence sexual behavior of the person. The impact of these common cultural myths associated with masturbation, are clinically understood as Dhat syndrome and masturbatory guilt. Although there is a reasonable literature on Dhat syndrome, there is limited literature with regard to masturbatory guilt especially linking the same with axis-I psychopathology. In this case series, three cases of masturbatory guilt are presented in whom masturbatory guilt was associated with manifestation of severe psychopathology. This report suggests that masturbatory guilt must be enquired for in patients presenting with severe mental disorder.

Introduction: Nepal entered into a lockdown mode since 24th March 2020 to control the spread of COVID-19 infection. Our aim was to evaluate the mental and behavioural impact of lockdown due to COVID-19 pandemic on the general public of Nepal in terms of the point prevalence of sadness, anxiety, feelings and relationship issues due to lockdown. Material And Method: It was a web-based cross-sectional survey conducted by using the Survey Monkey platform during 8th April 2020 and 29th April 2020. The link generated was circulated on Whatsapp platforms. Self-designed clinical profile was made to assess different feelings, leisure activities and relationship changes with family members that are not assessed using scale. The survey link was circulated starting from 8th April 2020 and was closed on 29th April 2020. Results: Of the 142 participants about 35.9% reported being sad, 28.2% had anxiety and about 46.5% of the participants felt lonely. Fear of death (60.6%) and getting infected with corona (52.1%) were the most common stress. Most of them were involved in sexual activities (67.6%) and reading books (42.3%) during lockdown. Some (14.8% and 18.3%) reported marked improvement in relationships with parents and children respectively. Conclusion: The present survey suggests that substantial proportion of the population do not report change in relationship despite reporting sadness, loneliness and change in daily activities. Therefore, social relationship and brotherhood need to be advised in addition to minimising emotional distancing during awareness programs related to COVID-19.

Introduction: Substance use and Substance Use Disorders (SUDs) have been shown to contribute substantially to the global burden of disease. However health workers belief system and attitude towards understanding and conceptualizing addiction makes the difference in the approach and treatment of the condition. This study tries to focus on the understanding and belief system of medical interns, and to see and contrast if their use of substance and their training about addiction during MBBS makes any difference in understanding and approaching addiction related cases. Material And Method: This is a cross- sectional, onetime assessment of medical interns working in KIST medical college and teaching hospital based on questionnaires and likert scale assessing addiction belief strength from time frame of April 2019 to 15th of May 2019. The sampling method will be convenient sampling method and finding will be evaluated further. Results: Out of 61 participants, 69% had completed psychiatry posting and were satisfied with their approach to patients with addiction related issues. Majority of them believed in disease model and their use of substance didn’t negatively influence the approach to patient care. Conclusion: Good exposure, training and skills given to students during MBBS years on addiction related diagnosis and treatment does help to understand addiction issues better and treat it as a biological model.