GENERAL AND SPECIALTY SERVICES
GENERAL AND SPECIALTY SERVICES
Department of psychiatry plays vital role for the management of psychiatric cases in Chitwan Medical College from beginning. Majority of patients come from different parts of the country of Nepal like Chitwan district itself, Gorkha, Lamjung, Tanahun, Nawalparasi and Baglung districts. The patients are also come from western development region, mid –western development region and eastern development region of Nepal. The Bharatpur town is becoming medical city of Nepal. Because of locating in the central part of Nepal and attached with east- west highway, its catchment is increasing day by day. Department of Psychiatry also does academic activities. Different programs like MD psychiatry, MN psychiatry, B.N-Psychiatric Nursing, MBBS and other program are already lunched.
The staff of department of Psychiatry of Chitwan Medical College comprised 4 consultant Psychiatrists, 4 Master in Psychiatry Nurses, one nursing staff with bachelor in psychatric nursing, and five staff nurses.
1. Organic Psychiatric disorders in many occasions are associated with visual hallucination and alteration of sensorium in day and night. Symptoms worse at night.
2. History taking is usually not sufficient with people taking alcohol or drugs. In many occasions get wrong history from patient. They take more quantity but give history of less quantity.
3. In Nepal there is many unqualified drug rehabilitation center opened with absence of medical person. They bring different medicine from market illegally and give to patient which is very dangerous. In many occasions alcoholic patients give history of fainting attack rather than alcohol abuse. Many alcoholic patients hear voices as schizophrenia.
4. Taking cannabis is danger for health. It increases the risk of schizophrenia. Habit of use of drugs and alcohols leads to other psychiatric disorder like anxiety disorder, depression etc.
5. Schizophrenia is most severe types of Mental illness need to treat long duration minimum 2 year, sometimes 5 year and longer than that.
6. Depressive disorder is commonest psychiatric disorder, life time prevalence 15-25℅, almost double on female than male. Two third of patients with depressive disorder difficult to diagnose many more different clinic & hospital to get rid of their problems & finally reach to psychiatrist. In the context if Nepal depression in female is due to poor relationship in between couple (husband & wife).On many occasion husband is alcoholic and wife develops depression.
7. In many occasion patients with mania become violent need to take precaution while taking history & examination & management.
8. In many occasion patients with anxiety disorder reach to cardiologist thinking that they have heart problem
9. Patients with conversion disorder show episodic interesting signs & symptoms. They may show attention seeking behavior. For management need to discourage it (cut off secondary gain). Many patients with conversion disorder refuse that they have stress, however we get stress factor on background. In context of Nepal many conversion disorder patients later fulfill the diagnosis of depression
10. In many occasion patients with somatoform disorder shows symptoms of acid peptic disease (ulcer). They change many doctors not better after taking medicine for ulcer. They do medical shopping behavior.
11. It is very difficult to treat dementia and Mental retardation. In fact only 10℅ are cured & other patients need supportive treatment because of danger for self & other. Treating these patients dose of drugs need to be decreased.
12. In many occasion person with psychosexual disorder don’t go to hospital & they think it is normal behavior and fear to give history.
13. Many children with depression show physical symptoms for long time like headache, pain abdomen, body ache difficulty to make diagnosis need leading question need to add history from patients and teachers.
14. Treating mentally ill person is difficult and challenging. Just giving drugs is no meaning. We should provide good counseling & psychotherapy for complete management.
15. In fact many patients with mental illness go to traditional healer (Dhami, Jhankri’s) thinking that it cures their problem than going to hospital. It is necessary to give basic training about mental illness for traditional healers.
16. Suicidal thinking is dangerous sign of any types of mental illness. We shouldn’t forget to check it with mentally ill patients. If a patient is suicidal, patients should refer to hospital immediately.
• OPD patients check-up services
• 24 hour emergency services
• Indoor patient’s treatments services
• Electroconvulsive therapy (ECT) services
• Counseling/Psychotherapy including behavior therapy, Meditation, play therapy, Art therapy and other recreational activities.
• Electroencephalography (EEG)
• Academic activities including seminars , journal clubs, case conferences, grand rounds, tutorials , theory class ,practical class
• Research activities
• Consultation/liaisons services
1. Pharmacotherapy(Treating by Drugs)
3. ECT (Electro convulsive Therapy
Most of the psychiatric patients need more than single therapy for example Pharmacotherapy with Psychotherapy, ECT with Pharmacotherapy etc. Some patients need all three therapies.
A new measure DALY (Disability Adjusted Life Years) has been developed by WHO to clarify the burden of mental illness. For mental health, the 'DALY' has brought a critical reality to light and shows that the psychiatric disorders are the most important contributors to the global burden of disease.
• Five of the ten leading causes of disability are mental disorders - namely Depressive Disorder, Schizophrenia, Mental Retardation, Epilepsy, Alzheimer's disease and Alcohol & Drug dependence.
• Mental disorders are projected to increase to 15% of the global disease burden and major depression could become the second leading causes in the disease burden after ischemic heart disease.
• Mental disorder causes extensive disabilities in rich and poor countries alike and is increasing. The global burden of study, has therefore, been an eye opener and mind opener for public health.
• Mental disorders are common affecting more than 25% of all people at some time during their lives.
• 0-9 Organic Psychiatric disorder
• 10-19 L Drug and Alcohol related disorder
• 20-29 Schizophrenia related disorder
• 30-39 Mood disorder (Depression, Mania, BPAD)
• 40-49 Neurotic stress related disorder
• 50-59 Sleep disorder, Eating disorder and sexual disorder
• 60-69 Personality disorder
• 70-79 Mental Retardation
• 80-89 Psychological development disorder
• 90-100 Child psychiatric disorder
Depressive disorder is commonest psychiatric disorder. Two third (2/3) of the depressive disorder presented with Somatic Symptoms have difficulty to diagnosis. They moves to different doctors and finally came to Psychiatric department for treatment The bipolar affective disorder (BPAD), schizophrenia, anxiety disorder, somatoform disorder, alcohol and drug related problems are also common psychiatric diagnosis in Chitwan medical college.
Psychiatric patients are treating with pharmacotherapy (drugs) and Electroconvulsive therapy (ECT). Department of Psychiatry also gives emphasis to Psychotherapy. They include cognitive behavior therapy, behavior therapy, Meditation, play therapy, Art therapy and other recreational activities, which is very helpful to many psychiatric patients.