Autoscopic phenomenon, a psychic illusionary duplication of one's own self, has been the subject of interest in the literature and science for years. It has been reported in various diseases of the central nervous system but with an unknown mechanism. Hallucinations are a common presentation in alcohol dependence syndrome during delirium tremens and as induced disorder. However, autoscopic hallucination has been rarely reported in the cases of alcohol dependence. We present a case of a 40-year-old man who experienced autoscopic hallucination during the withdrawal state of alcohol. He was successfully treated with detoxification and an antipsychotic medication and was doing well. The case highlights the need for strong suspicion and exploration of the autoscopic hallucination and autoscopic phenomenon in general in cases of alcohol dependence syndrome.

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.

Context:Deliberate self-injury, a fairly common condition is present across all culture. It is defined as intentional, direct injuring of body tissue without suicidal intent. We continue to lack a sufficient understanding of this behavior in the context of South East Asian region.Aims:This study aims to explore the characteristics of self-cutting, and gender differences in homologous group of youth applying for foreign employment in Nepal.Settings and Design:Cross-sectional, single interview method in an out-patient setting.Subjects and Methods:The youths applying for foreign employment were screened for self-harm attempt using single question. Screen positive individuals were applied with inclusion and exclusion criteria. The data were collected in a single interview by consultant psychiatrist.Results:Males were more than females and the mean age (standard deviation) at the time of act and current presentation were 16.52 (3.13) and 24.70 (5.54) years, respectively. Various methods were used in self-inflicting cut, and certain amount of stress was present in the majority of the participants. There was no significant difference between male and female in all descriptive characteristics except for mean age at the time of presentation.Conclusions:The descriptive results from Nepal are keeping with most of the published literature. The study is the first one from Nepal, and we expect that this will help in laying a good foundation for further studies with stronger methodologies.

Highlights Patients with drug-resistant tuberculosis (DR TB) are at high risk for depression. DR TB patients in Nepal were screened with Health Questionnaire 9 for depression. 81 out of 129 patients (62.7%) were found to have possible depressive disorder. Duration of illness was a significant risk factor for depression ( p < 0.001).

Meditation is regarded as a self-regulation approach to manage emotions. Meditation has a beneficial effect on mental health. Different kinds of meditation are practiced in many religions and cultures for the general wellbeing of an individual. However, meditation-related experiences and negative effects of meditation are not uncommon. Meditation-induced psychosis has been reported in the past. Here, we present a case of a 33-year-old male patient who developed acute and transient psychosis twice after meditation and discuss the role of meditation as a precipitating factor to psychosis.