Journal Articles

Coronavirus disease 2019, known as COVID-19, caused by the SARS-CoV-2 virus, is a highly contagious respiratory disease was first identified in Wuhan, China, in December 2019 and has become a major public health concern in Bangladesh. Health care workers (HCWs) are indispensable part of the battle against this deadly virus. There is evidence that their wellbeing has been compromised during this pandemic and they are exhibiting higher rates of mental disorders than general population and normal time. Multisectoral and integrated strategies are required to ensure their wellbeing.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: The National Institute of Mental Health (NIMH) is a 200-bed tertiary psychiatric hospital located in Sher-E-Bangla Nagar, Dhaka, Bangladesh. It has been maintaining a computer database to keep records of the indoor patients since 2020, based on which this study was carried out.
Objectives: To explore the proportion of patients with psychiatric disorders of inpatient departments of NIMH, with different clinical diagnosis according to ICD-10-4-digit code and the socio-demographic and other relevant profile of those patients.
Methods: It was a retrospective medical record review conducted utilizing the computer database containing the data regarding clinical diagnosis and other relevant variables of the indoor patients of the NIMH, which were plotted there by the assigned office staff on a weekly basis, over the period from January 2021 to December 2021, from the records of the structured indoor patient data sheet, that was prepared by the teachers of NIMH. The data sheet was filled out daily before each patient’s discharge by the duty doctors of the respective departments. Patients were diagnosed according to the ICD-10 4-digit code by the Professors, Associate Professors and Assistant Professors of the respective departments.
Results: In this study, the recorded data of 797 patients were analysed. Among them, (51.4%) of the patients were male and (48.6%) female. The patients’ Mean age (±SD) was 28.6±12.16 years. Thirty-five types of different clinical diagnoses were found. Schizophrenia (39%) and bipolar affective disorder (29.4%) were the most common diagnoses.
Conclusions: Findings of this study will act as an eye-opener for psychiatrists regarding a wide range of psychiatric diagnoses and future research."

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: People with obsessive compulsive disorder (OCD) are likely to be more susceptible to the mental health impact of COVID-19.
Objective: We aimed to investigate the socio-demographic and other factors of OCD and relation of its occurrence with COVID-19.
Methods: This was a cross-sectional study carried out among the persons diagnosed as a case of OCD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5) and attended at private chambers of psychiatrists during April 2022 – June, 2022. All the persons diagnosed with OCD, irrespective of gender and aged more than 18 years, were approached for the research. After having their consent, sociodemographic and other information were collected through face-to-face interview of the respondents. Completed data of 153 respondents were analyzed using Statistical Package for Social Sciences (SPSS), version 25. Ethical issues were addressed properly throughout the study.
Results: Mean age of the respondents were 29.3±12 years. More than half (54.9%) of the respondents were unmarried. About one-fifth (18.3%) of the respondents suffered from OCD symptoms for the first time after COVID pandemic occurred in Bangladesh. Among the respondents diagnosed as OCD prior to pandemic, more than one-third (36.8%) had treatment for the disorder. About one-fourth (23.5%) had family history of OCD. One-fifth (20.3%) had history of substance abuse. Suicidal attempt was reported by 19% of respondents. More than half (54.9%) had co-morbid physical illness.
Conclusion: A significant proportion of persons with OCD experienced their symptoms first time during COVID outbreak."

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: Behavioral and mental disorders accounted 12% of global burden of disease (GBD). Treatments for all these disorders are as available as efficacious. However, these disorders are remarkably undertreated worldwide.
Objectives: To find out the pattern of psychiatric morbidity of patients attending at the psychiatry outpatient department.
Methods: This was a cross sectional study carried out in the Department of Psychiatry at Combined Military Hospital (CMH), Chattogram from January 2022 to June 2022. For this purpose, 1297 respondents attending in psychiatry outpatient department of CMH Chattogram were enrolled in the study by using convenient sampling technique. Psychiatric diagnoses of the patients were assigned by the consultant psychiatrist as per Diagnostic and Statistical Manual of Mental Disorders-5 (DSM)-5 criteria. Structured questionnaire was used to collect socio-demographic data. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). The quantitative observations were indicated by frequencies and percentages. Ethical issues were maintained all through the study.
Results: The most common psychiatric morbidity among the respondents was depressive disorder (36.9%) followed by anxiety disorders (19.8%), obsessive-compulsive & related disorder (16.3%) and somatic symptom and related disorder (11.3%). The results showed that majority (26.6%) were from the age group of 31-40 years with female preponderance (59.1%). More than half of the patients were referred from different branches of Medicine (65%). Referral from Internal Medicine was 25.2%, Cardiology 13%, Gastroenterology 12.3%, Nephrology 10.6% and Physical Medicine 3.3%, respectively. The rest were from branches of Dermatology and Venereology, Surgery, Orthopaedics, Paediatrics and Gynaecology and Obstetrics.
Conclusions: Neurotic cases were predominant in psychiatric outpatient department. Referrals patients of psychiatric disorders came mainly from Medicine and allied branches. Results of this study may help in the planning for better mental health service integrated with primary healthcare system of our country.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: A significant number of patients are referred in Forensic Psychiatry Department for civil and criminal law related reasons. Knowing their reasons for referral can help in improving service delivery.
Objectives: To estimate the proportion of different psychiatric disorders along with reasons for referrals in persons attending the Forensic Psychiatry Department of National Institute of Mental Health, Dhaka.
Methods: A cross-sectional study was conducted in National Institute of Mental Health, Dhaka in between July 2017 and December 2018. By convenient sampling technique 127 participants aged 18 and more were enrolled in the study. Sociodemographic data and reasons for referrals were collected and psychiatric disorders were diagnosed according to International Classification of Diseases (ICD) 10th edition.
Results: Of the total 127 participants, 80 (63%) were civilians seeking forensic psychiatry services; common reasons were psychiatric assessment followed by getting certificate (20.5%), getting fitness certificate (15.7%), eligibility for getting pension (11.8%) and treatment for psychiatric disorders (11%). Of the 47 (37%) participants who had criminal charges against them were referred for getting court report (20.5%), psychiatric treatment (11%), fitness to plead (3.1%) and for both court report and treatment (2.4%). In the study population, schizophrenia was the most common diagnosis (34.6%), followed by bipolar affective disorders (18.1%) and mental retardation (15%). About 5.5% of the referred participants had no psychiatric disorders.
Conclusions: Nine out of ten patients referred to Forensic Psychiatry Department received a psychiatric diagnosis.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: The use of psychotropic medicines is stigmatized, which makes it difficult for the clinicians to treat children and adolescents in a suitable and efficient manner.
Objectives: To find out parents’ attitudes, knowledge and beliefs about the use and adverse effects of psychotropic medication on child and adolescents with psychiatric disorders.
Methods: A cross-sectional descriptive study was conducted from January 2018 to December 2019, in a private chamber of a psychiatrist, Bangladesh among 80 parents of children and adolescents with psychiatric disorders whose minimum level of education was up to secondary level were selected purposively. A structured, self-administered questionnaire in English for socio-demographic variables and items related to parents' attitudes, knowledge and beliefs about the use and adverse effects of psychotropic medications was applied. Data were collected by face-to-face interview.
Results: 80 parents with children and adolescents with psychiatric disorders participated in the study. Mean (±SD) age of the parents was 34.4 (±8.44) years. Among the respondents, 25% preferred use of medicines, 62.5% preferred medicine use as the last alternative, 31.25% knew that psychiatrists unnecessarily use high doses of medicines, 60% believed that psychotropics might have brain damaging effects, 62.50% believed that psychotropics might cause dependence, 7.50% believed that psychotropics might cause damage to physical health, 15% believed that psychotropics might affect learning abilities and 41.20% knew that psychotropic drugs are dangerous.
Conclusions: Parents must be educated about the potential risks and benefits of psychotropic medications on children and adolescents in order to reduce the stigma associated with this.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: Sexual dysfunctions is commonly experienced as having a devastating effect on familial, vocational, psychological, or social lives of sufferers. Irrespective of high prevalence of sexual dysfunction, only a little number of patients seeks psychiatric consultation. Some patients are ambivalent over getting professional help because of attached social stigma that leads to delayed or negating consultation. However, there is a paucity of studies investigating the prevalence of PSD, particularly in the Indian context.
Objectives: To determine the prevalence and pattern of sexual dysfunctions.
Materials and Methods: This was a cross-sectional analytical study carried out in the Outpatient Department of Psychiatry, Khwaja Yunus Ali Medical College, Sirajgonj from October 2019 to September 2020. Data were collected through face-to-face interviews using a semi-structured questionnaire. After collection, all data were checked thoroughly for consistency and completeness. Data were cleaned, edited and verified daily to exclude any error or inconsistency before coding and entering them into a database. Statistical analysis was performed using compatible computer software.
Results: This study observed erectile dysfunction (31%), premature ejaculation (25%), dhat syndrome (18%), and erectile dysfunction with premature ejaculation (17%) as the common sexual dysfunctions.
Conclusions: This study shows the common sexual dysfunctions were erectile dysfunction (ED), premature ejaculation (PME), dhat syndrome (DS) and ED with PME.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: Telemedicine has been gaining worldwide popularity lately. Bangladesh is also a part of this venture. Effective service planning depends on knowing the trends of service use.
Objective: To identify the trends in using telepsychiatry service at a tertiary level psychiatric hospital.
Methods: This was a retrospective study in which data were collected from telepsychiatry service patient records of a tertiary psychiatric hospital. Between 2018 and 2021, 270 patients took the service. All were included and the record contained their name, age, gender, diagnosis and treatment.
Results: Mean age of the patients was 31.6±14.5 years with a range between 4 and 75 years, and around 50% of the patients were in the 20–40 years age group. Male patients constituted 46.5% of the sample. Majority of the patients took services for neurotic, stress-related and somatoform disorders. Sertraline and benzodiazepines were found to be the most commonly used medications.
Conclusions: The study showed that the majority of patients taking telepsychiatry care had neurotic, stress-related and somatoform disorders. Pharmacotherapy was the main way of treating patients.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Blepharospasm is an abnormal uncontrolled contraction of eyelid muscles and can be a presenting motor symptom of conversion disorder. Here is a case of a 40-year-old Muslim housewife from a rural background presenting with the complaints of difficulty in opening her eyes for 6 months and pseudo-seizures for 2 months. Her symptoms could not be explained by any known medical condition. Both psychological and pharmacological interventions were given for the management of the patient.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Autism spectrum disorder (ASD) is a category of neurodevelopmental disorders, the prevalence of which has increased over time. Since 2008, the United Nations has celebrated 2nd April as World Autism Awareness Day each year to raise awareness. Like previous years, World Autism Awareness Day was observed worldwide in 2022. This year's theme was “Inclusive Quality Education for All.” It was observed through various activities at home and abroad. The Government of Bangladesh is giving priority to Autism and Neurodevelopmental Disorders in many areas, including protection of rights, inclusiveness, service and education.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: As part of continuity, the prevalence of autism spectrum disorder (ASD) in adults is nearly the same as in children and is associated with other comorbid psychiatric disorders that have a substantial impact on their lives and complicate intervention.
Objectives: This study was aimed to examine psychiatric co-morbidity in referred adult ASD patients compared to non-ASD psychiatric patients.
Methods: In total, 36 adult ASD patients from a psychiatric consultation center in Dhaka city were included in the study consecutively who were referred for psychiatric consultation during the period of 2019. An equal number of age- and sex-matched non-ASD psychiatric patients were selected for comparison. Socio-demographic information was collected and clinical assessment-based DSM-5 diagnosis of the cases was made.
Results: Patients’ age ranged from 18 to 41 years with a mean of 26.72±6.5 years. The male-to-female ratio was 1.6:1. The mean number of psychiatric disorders was 1.92 in patients with ASD and 1.67 in patients without ASD, and the difference was significant (P=0.04). The three most frequent co-morbidities among ASD patients were obsessive-compulsive disorder (27.8%), major depressive disorder (25%) and specific phobia (19.4%). All these disorders were significantly higher in ASD patients than in non-ASD psychiatric patients. Conversely, major depressive disorder (30.6%), bipolar disorder (19.4%), schizophrenia, generalized anxiety disorder and substance-related disorder (13.9% each) were higher among non-ASD patients.
Conclusions: Subsequent broad-based studies using extensive measures of psychopathology are required to confirm these preliminary findings. Greater understanding of the presence of other psychiatric disorders in ASD patients will turn this awareness into action.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: Intellectual Disability (ID) is a life-long disability which has a major impact on the lives of the children who suffer and their caregivers. Caring for those who are intellectually disabled is often itself stressful as caregiving affects several aspects of the caregiver’s life negatively, including poor physical and emotional state. Caregivers experience depression, burden, lack of social support and coping resources more than non-caregivers. However, little attention is given to the health of the caregivers or families of these children.
Objectives: To find out the level of burden experienced by the caregivers and study their sociodemographic profiles.
Methods: A descriptive, cross-sectional study was conducted among the caregivers of intellectually disabled children attending the Child Guidance Clinic in the outpatient department of the National Institute of Mental Health (NIMH), Sher-e-Bangla Nagar, Dhaka. The Bangla version of the Zarit Burden Interview (ZBI-B) scale was applied to measure the level of burden experienced by the caregivers of the intellectually disabled children whose diagnoses were already confirmed by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). A semi-structured questionnaire was used to find out the sociodemographic variables. Data analysis was done using the Statistical Package for Social Sciences (SPSS) version 24.0. Ethical clearance was taken from the authority of NIMH, Dhaka.
Results: The level of burden measured using the ZBI-B scale among the 66 caregivers of intellectually disabled children showed that 41 (62.1%) respondents experienced severe burden and 25 (37.9%) experienced moderate to severe burden. Among them, 50% were in the age group of 31–40 years, 83.3% were females who were mostly mothers of the children (80.3%), 16.7% were fathers and 3% were siblings of the intellectually disabled children. The respondents attending the outpatient department of NIMH were mostly from urban areas (72.2%) and more than half were unemployed or housewives (59.1%). It was also found that with increasing age, the level of burden increased, while caregivers living in joint families experienced comparatively less burden. Only 6 (9.1%) respondents reported having respite care provision, whereas the remaining 60 (90.9%) had no respite care.
Conclusions: All caregivers experience burden while taking care of intellectually disabled children. Therefore, education about the child’s condition, encouragement, family support, counselling services and regular screening of mothers should be included in the management protocol for ID. Community-based approaches will help in reaching people who are not even aware of hospital settings for intellectually disabled children.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: Suicide is highly prevalent in patients with obsessive-compulsive disorder (OCD) and an estimated 6 to 51.7% of patients attempt suicide. Early determination of risk factors can provide an opportunity for prevention and intervention.
Objectives: To estimate the prevalence of suicidal ideation in OCD patients and assess the association between sociodemographic factors and the presence of suicidal ideation.
Methods: A cross-sectional study was conducted in the OCD Clinic, Outpatient and Inpatient settings at the Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU), between 2019 and 2021. By convenient sampling technique, 60 OCD patients were enrolled in the study. They were interviewed using a semi-structured sociodemographic questionnaire along with the Bangla version of the Modified Scale for Suicidal Ideation (MSSI).
Results: Out of the total 60 patients, 18 (30%) reported having suicidal ideation during the two days prior to the interview. Suicidal ideation was more common among females (p=0.018). Across age groups, educational status, occupational status, family type, marital status, residence, family history of mental illness and substance use pattern, the presence or absence of suicidal ideation did not vary significantly.
Conclusions: One-third of OCD patients reported suicidal ideation. Female gender appeared to be a risk factor.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: Chronic kidney disease (CKD) is an important contributor to the global disease burden, and the presence of anxiety in CKD is associated with poor quality of life and increased mortality. The relationship of anxiety symptoms with kidney function and sociodemographic factors remains poorly investigated.
Objectives: To assess the relationship between anxiety with sociodemographic factors as well as some clinical biomarkers in patients with CKD.
Methods: A cross-sectional study was conducted in the Nephrology Department of a medical college hospital in 2021. By convenient sampling technique, 103 CKD patients of stages 3–5D were enrolled in the study. Sociodemographic and clinical data including CRP, hemoglobin, serum albumin, serum iPTH and blood urea were recorded from patients’ clinical notes and interviews. CKD staging was done according to KDIGO 2012 criteria. Severity of anxiety symptoms was assessed by the Generalized Anxiety Disorder Scale-7 (GAD-7).
Results: Among the patients, 53 (51.5%) were in CKD stages 3–5 and 50 (48.5%) were receiving hemodialysis. A significant number of patients (28.1%) showed moderate to severe anxiety. CKD patients’ age showed a negative correlation with anxiety score (r = -0.400, p = 0.000). No significant correlation was found between GAD-7 score and urea reduction ratio, serum creatinine level, eGFR, hsCRP, blood hemoglobin or serum parathyroid hormone level.
Conclusions: Anxiety symptoms are highly prevalent in CKD patients. However, no significant association with sociodemographic factors or biochemical parameters was observed.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: Prisoners have high levels of mental illness and drug or alcohol dependence. The prison environment is highly stressful and often predisposes prisoners to develop mental disorders which go undetected and untreated.
Objectives: To find out the prevalence of psychiatric morbidity among prisoners as well as to identify some socioeconomic and demographic parameters in relation to psychiatric morbidity.
Methods: It was a cross-sectional study conducted in Dhaka Central Jail, Keraniganj. The duration of the study was six months, from 01 May 2018 to 31 October 2018. All Bangladeshi male prisoners aged 18 years and above who were willing to participate were included in the study. Informed written consent was obtained from the respondents. Those who refused to give consent and those with severe cognitive impairment were excluded. Ethical issues were maintained throughout the study. A total of 438 prisoners were randomly selected, out of whom 276 cases were identified as having psychiatric morbidity through screening for common psychiatric disorders using the General Health Questionnaire-12 (GHQ-12). Sociodemographic data were collected through face-to-face interviews using a semi-structured questionnaire. Psychiatric diagnoses were assigned by consultant psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Statistical analyses were carried out using the Statistical Package for Social Sciences (SPSS) version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Mean values were calculated for continuous variables, and quantitative observations were presented as frequencies and percentages.
Results: The age of the prisoners ranged from 19 to 65 years, with a mean age of 32.5±9.3 years. Nearly two-thirds (63.0%) of the prisoners had psychiatric disorders, 60.5% came from rural backgrounds, 50.4% belonged to low economic groups, and 60.14% were charged with drug-related offences.
Conclusions: Psychiatric morbidity among prisoners is very common. A high rate of mental health problems exists in prisons, including substance-related disorders, anxiety disorders, adjustment disorders, antisocial personality disorder, depressive disorders and schizophrenia. To improve the overall healthcare service for prisoners, psychiatric evaluation and treatment remain fundamental. Proper diagnosis and timely intervention for mental health problems, including substance-related disorders, may help reduce the occurrence or repetition of some offences.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Background: Depression is the most common form of mental disorder in Bangladesh.
Objectives: To determine the sociodemographic characteristics of depressive patients attending the Medical Outpatient Department of Combined Military Hospital (CMH), Dhaka Cantonment, Bangladesh.
Methods: It was a cross-sectional study conducted in the Internal Medicine Outpatient Department of CMH, Dhaka. Considering the inclusion and exclusion criteria, 444 samples were selected purposively who were 18 years and above, irrespective of sex. The duration of the study was six months, from September 2018 to February 2019. Sociodemographic data were collected through face-to-face interviews using a semi-structured questionnaire. The Patient Health Questionnaire-9 (PHQ-9) score ≥5 (five or more) was applied to screen positive cases. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 22.
Results: The overall prevalence of depression in the study was 21.8%. The prevalence of depression was higher among the young age group of 18–40 years (75.2%). The majority of respondents were females (57.7%), came from rural backgrounds (71.1%) and had education up to the primary level (38.1%). This study also found that the majority of participants (43.3%) were unemployed (i.e., housewives), 53.6% were other than married (i.e., single, widowed, separated or divorced), and 42.3% belonged to the low-income group.
Conclusion: More than one-fifth of the participants showed depression among medical outpatients.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2022

Abstract
Clinical guidelines have been developed and practiced for decades in many developed countries. The potential benefit of using guidelines is to improve overall health outcomes by providing more consistent care to patients, improving their quality of life and reducing overall mortality and morbidity. Healthcare professionals also benefit by making quality clinical decisions, especially when they are uncertain about how to proceed, and by gaining reassurance about the appropriateness of their treatment approach. Healthcare organizations and government bodies also find clinical guidelines effective in providing standardized care and optimizing value for money. However, there are certain limitations to guidelines, especially when they are flawed due to a lack of proper scientific evidence, are misleading, or are influenced by the opinions and experiences of the group developing the guideline. Nevertheless, with sufficient resources, expert clinicians, systematic reviews of evidence and experienced group process leaders, flexible, valid and usable clinical guidelines can be developed.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: Increased availability of internet services and the COVID-19 pandemic have produced a surge in online learning activities. Undergraduate medical students, who are the future physicians, are the core of any health system, and their training is traditionally delivered in a face-to-face learning format. Exploring the advantages and limitations of online learning for undergraduate medical students will help in designing effective teaching and learning approaches.
Objectives: To explore the perceptions of teachers and students regarding the advantages and limitations of online learning and to formulate recommendations for increasing its effectiveness.
Methods: This narrative review was conducted using available literature after a meticulous search of Medline, Google, Google Scholar and PubMed with relevant search keywords. No time limit was imposed. We also searched the literature for studies exploring the perceptions of teachers and students regarding the advantages and disadvantages of online medical classes during the COVID-19 pandemic.
Results: One of the biggest difficulties of online learning is the lack of access to the internet and related technologies, especially in underdeveloped and developing countries. Feelings of isolation may affect learners. We also found several advantages, including the elimination of costs associated with student transportation, meals and accommodation.
Conclusions: It is not possible to avoid this challenging but very real situation, and we have to cope with this practical issue while continuing educational activities. There is a need to train faculty members in the use of online teaching modalities and to develop lesson plans with reduced cognitive load and increased interactivity.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: Apart from suffering from coronavirus disease 2019 (COVID-19) itself, this pandemic has been associated with mental health challenges related to the fear of being infected with the virus, the relative insufficiency of the healthcare system and the mitigating measures.
Objectives: We aimed to assess the types of psychiatric disorders among individuals who faced the consequences of COVID-19 and attended the outpatient department of the National Institute of Mental Health (NIMH).
Methods: This was a cross-sectional study carried out during September 2020–December 2020. Individuals whose psychiatric symptoms were noticed for the first time after 8 March 2020 were included in the study. A convenient sampling technique was applied. Data were collected through face-to-face interviews using a semi-structured questionnaire. Psychiatric diagnoses were assigned by psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Completed data from 288 respondents were analyzed using the Statistical Package for Social Sciences (SPSS), version 16.
Results: Among the respondents, 3.5% had suffered from COVID-19, while 27.1% were affected by COVID-19-related financial or job loss. Relatives of 4.9% of respondents were infected, and 1.7% had lost relatives due to COVID-19. Among respondents directly or indirectly affected by COVID-19, 33.3% had COVID-19-related anxiety. The majority of respondents were diagnosed with schizophrenia spectrum and other psychotic disorders (27.4%), followed by bipolar and related disorders (22.9%), somatic symptom and related disorders (13.2%), anxiety disorders (10.8%) and depressive disorders (10.8%). The proportions of anxiety disorders and depressive disorders were higher among respondents who had COVID-19-related anxiety than among those without COVID-19-related anxiety (18.8% vs. 6.8% and 12.5% vs. 9.9%, respectively).
Conclusions: The most common psychiatric diagnosis among outpatients at NIMH during the COVID-19 pandemic was schizophrenia spectrum and other psychotic disorders. The pattern of psychiatric disorders presented by outpatients at NIMH during the COVID-19 situation was not markedly different from the pre-pandemic era.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: The possible influence of an immunological process resulting in inflammation on the pathogenesis of schizophrenia has long been neglected, although inflammatory processes have been implicated in the etiology of schizophrenia. If inflammation is a factor in schizophrenia, then it presents a potential target for treatment.
Objectives: To estimate the C-reactive protein (CRP) levels in patients with schizophrenia attending the hospital and evaluate their association with different demographic and clinical factors.
Methods: It was a cross-sectional observational study conducted at the National Institute of Mental Health (NIMH), Dhaka, in 2019. A total of 48 patients with schizophrenia were enrolled in the study. Following enrollment, data on sociodemographic and other relevant variables were collected using a semi-structured questionnaire. CRP levels were estimated in the NIMH laboratory. The CRP levels were then interpreted and compared with different variables.
Results: Most of the respondents (66.7%) had normal C-reactive protein levels (<6.00 mg/L). However, 16 patients had CRP levels greater than 6.00 mg/L, accounting for 33.3% of the study population. The mean CRP level of the 48 participants was 7.70 mg/L (95% CI: 5.42–9.99). The study assessed the association between gender and CRP level (p=0.414), family history of psychiatric illness and CRP level (p=0.001), previous treatment history and CRP level (p=0.117), drug non-compliance and CRP level (p=0.036), and duration of illness with elevated versus non-elevated CRP levels (t=4.44, p=0.001).
Conclusions: CRP blood levels were found to be higher among patients with schizophrenia, suggesting a possible role of inflammation in the pathogenesis of schizophrenia. Further studies are needed to better understand whether CRP may be considered a biomarker for schizophrenia.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: Brain changes, circulatory and electrolyte imbalances are the main complications of transurethral resection of the prostate (TURP) surgery, known as transurethral resection (TUR) syndrome, which results from excessive absorption of irrigating fluid. For this surgical procedure, 1.5% glycine and 5% glucose are commonly used as irrigants.
Objectives: To observe the changes in serum electrolytes and the occurrence of transurethral resection (TUR) syndrome with 1.5% glycine and 5% glucose as irrigants.
Methods: Between June 2008 and May 2010, 120 patients were included in a prospective randomized comparative trial comparing 1.5% glycine with 5% glucose irrigation fluids. We measured blood loss, fluid absorption, biochemical parameters including serum electrolytes, random blood sugar (RBS), and peri-operative symptoms. Blood samples were taken before, immediately after, and 24 hours after TURP. Irrigating fluid absorption during TURP was measured by serum sodium level. Operative details were recorded, including the type of anaesthesia (with or without sedation), resection time and weight of resected tissue. Peri-operative symptoms were documented prospectively. TUR syndrome was defined as a serum sodium level of ≤125 mmol/L with two or more associated symptoms or signs of TUR syndrome.
Results: Two (1.67%) patients developed TUR syndrome; both were irrigated with glycine, although this difference was not statistically significant (p=0.10). There was no significant difference between the groups in serum sodium, potassium, urea, creatinine levels or peri-operative blood loss.
Conclusions: Both irrigants were associated with low peri-operative morbidity, including TUR syndrome. Except for transient postoperative hyperglycemia in the glucose group, both irrigants were found to be nearly equivalent and safe.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: In adults with chronic kidney disease (CKD), depression is highly prevalent and associated with poor quality of life and increased mortality. The relationship of depressive symptoms with kidney function and sociodemographic factors remains poorly investigated.
Objectives: To assess the relationship between depression with sociodemographic factors as well as some inflammatory biomarkers in patients with CKD.
Methods: A cross-sectional study was conducted in the Nephrology Department of a non-government hospital in 2021. By convenient sampling technique, 103 CKD patients of stages 3–5D were enrolled in the study. Sociodemographic and clinical data, including CRP, hemoglobin, serum albumin, serum iPTH and blood urea, were recorded from patients’ clinical notes and interviews. CKD staging was done according to KDIGO 2012 criteria. Severity of depressive symptoms was assessed using the Patient Health Questionnaire-9 (PHQ-9).
Results: Among the patients, 53 (51.5%) were in CKD stages 3–5 and 50 (48.5%) were receiving hemodialysis. A significant proportion of patients (35%) had moderately severe to severe depression. Patients with education below SSC level, rural residence, monthly expenditure below 10 thousand and above 31 thousand BDT, businessmen and those dependent on others’ income showed higher levels of depression. There were positive correlations between age (r=0.34, p=0.000), serum creatinine level (r=0.64, p=0.000), serum parathyroid hormone level (r=0.52, p=0.000) and depression severity; and negative correlations between urea reduction rate (r=-0.80, p=0.001), serum albumin (r=-0.71, p=0.000) and hemoglobin level (r=-0.71, p=0.000) with depression severity.
Conclusions: Depressive symptoms are highly prevalent in CKD patients, and several biochemical parameters correlate with depression severity.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: Patients with cancer often face psychological issues. Some nations have incorporated psychological assessments into cancer care; however, Bangladesh has minimal exposure to this discipline.
Objectives: To examine the prevalence and associated factors of anxiety and depression among cancer patients attending a private referral hospital in Bangladesh.
Methods: The Hospital Anxiety and Depression Scale (HADS) was used to evaluate cancer patients in a cross-sectional study. Eighty patients were recruited using a purposive sampling strategy. Descriptive statistics and chi-square tests were used to investigate the association of variables with anxiety and depression.
Results: The majority of cancer patients had moderate to severe depression (56.2%) and moderate to severe anxiety (42.5%). Anxiety was significantly associated with marital status (p=0.020) and the financial status of the patient (p=0.003).
Conclusions: The prevalence of anxiety and depression among cancer patients was high, indicating the necessity of screening and counselling to help patients cope with these conditions and improve their mental well-being.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: Substance use disorders (SUDs) constitute a major public health problem and are associated with extensive psychiatric comorbidity. Clinical studies have demonstrated a high prevalence of personality disorders (PDs) among SUD patients, which leads to poor psychosocial functioning and unfavorable clinical outcomes.
Objectives: The study was aimed at assessing personality disorders in patients with substance use disorders.
Methods: This was a cross-sectional descriptive study carried out in the Department of Psychiatry, Sylhet MAG Osmani Medical College, during the period from 1st September 2017 to 31st August 2019. A purposive sample was taken, and the diagnosis of SUD was made by consultant psychiatrists according to DSM-IV criteria. Sociodemographic variables were collected using a predesigned semi-structured questionnaire, and the Structured Clinical Interview for Diagnosis (SCID-II) was applied for screening personality disorders. Data analysis was performed using SPSS version 22.
Results: Among the 168 patients with SUD, 50.6% had a personality disorder. The majority of the participants had Cluster B personality disorders, comprising 39.3% of the patients. The most frequently diagnosed personality disorder was antisocial personality disorder (20.8%), followed by borderline personality disorder (13.1%), while each of the remaining personality disorders accounted for less than 5%. Regarding the association between sociodemographic variables and personality disorders, occupational status (p=0.027) and age at initiation of substance use (p=0.001) showed significant associations.
Conclusions: This study revealed a significantly high frequency of personality disorders among patients with substance use disorders. It is important to assess personality disorders in all SUD patients to design more effective management strategies for this underemphasized problem and improve treatment outcomes.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Sheehan’s syndrome (SS) refers to the occurrence of varying degrees of hypopituitarism after childbirth. Nowadays, it is a rare cause of hypopituitarism in developed countries due to advancements in obstetric care. However, underdeveloped and developing countries still have a higher number of SS cases because of poor healthcare services and inadequate obstetric management. SS may present during the postpartum period or several years after delivery. Reports of SS with psychotic manifestations are rare. This is a case report of a 36-year-old woman who presented with psychotic features after childbirth. She had a history of postpartum hemorrhage. Antipsychotic medications were administered, but there was no improvement. Treatment with thyroxine and glucocorticoids resulted in complete remission, with the patient returning to her normal level of functioning.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Naturally, comorbidity exists in psychiatry and is expected in nearly half of the cases across age, gender and time. The main reasons for comorbidity are shared biological and environmental risk factors that create complex psychopathology. Low reliability and validity of some disorders, as well as other artefacts, can be additional reasons for the increased rate of comorbid diagnoses. Despite these limitations and controversies, considering comorbidity is one of the key issues in clinical psychiatry for adequate intervention to minimize the multiplied distress and impairment.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Background: In medical practice, knowledge of psychiatry, mental health and behavioural science is essential. For this reason, training in psychiatry for undergraduate students is very important. However, medical students often have a neutral or negative attitude toward psychiatry.
Objectives: To identify the reasons behind the current attitude toward psychiatry and propose an action plan to make psychiatry more interesting and improve teaching techniques at the undergraduate level.
Methods: This narrative review was conducted using available English-language literature after a meticulous search of Medline, PsycINFO, Google, Google Scholar and PubMed with relevant search keywords. No time limit was imposed. We also searched PubMed for studies assessing knowledge, skills and attitudes regarding undergraduate medical education.
Results: This review revealed that several factors contribute to the negative attitude toward psychiatry among undergraduate medical students. We also found that psychiatry as a career choice has been viewed negatively and is often not prioritized for postgraduate training. Students are not adequately aware of the psychiatrist’s role in the multidisciplinary team in the context of patient management as well as health policy implementation.
Conclusions: There is a need to address psychiatry curricula and introduce novel teaching and training strategies in undergraduate medical education. Simulated and standardized patients are useful and appropriate for teaching and assessment and are well accepted at the undergraduate level. Further situation analysis and research are needed regarding the implementation of different simulation technologies in psychiatry.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: Dementia patients need assistance and supervision in their daily life activities, and this often places a major burden on their caregivers, thereby putting them at a great risk of mental and physical health problems. Identifying the severity and factors related to caregiver burden will facilitate the care of dementia patients.
Objectives: To assess the proportion, severity and factors associated with caregiver burden among caregivers of dementia patients.
Methods: It was a cross-sectional observational study conducted at the National Institute of Mental Health (NIMH), Dhaka, in 2019. Eighty caregivers of dementia patients were enrolled using a convenient sampling technique. Following enrollment, sociodemographic and relevant data including age, sex, education, income, marital status, residence, duration of caregiving, time spent in caregiving and provision of respite care were collected. The Mini-Mental State Examination (MMSE) score of each patient and the Zarit Burden Interview (ZBI-B) score of each caregiver were then recorded. Between-group comparisons were performed using the t-test and ANOVA. Associations between continuous variables were assessed using Pearson’s correlation test. A p-value of <0.05 was considered statistically significant.
Results: All 80 participants experienced different levels of caregiver burden. Among them, 35% reported mild to moderate burden, 51.2% reported moderate to severe burden and 13.8% reported severe burden. Caregivers’ age (r=0.118, p=0.297), sex (t=1.41, p=0.160), marital status (t=-1.41, p=0.149), educational status (F=1.13, p=0.342), number of family members in the household (r=0.134, p=0.237), relationship with the patient (F=1.12, p=0.149), duration of caregiving (r=0.096, p=0.397), patients’ age (r=0.198, p=0.079) and patients’ sex (t=-1.68, p=0.096) had no statistically significant association with caregiver burden. Caregivers with lower family income (r=-0.133, p=0.238), those not living with the patients (t=-4.04, p<0.001), those without respite care (t=-3.32, p=0.001), and those who spent more time caregiving (B=0.244, p=0.001) reported significantly higher burden. Furthermore, caregiver burden increased significantly with worsening cognitive function of dementia patients as measured by MMSE (B=-1.22, p=0.001).
Conclusions: All caregivers experienced varying levels of burden while caring for their relatives with dementia. Increased caregiving time and greater cognitive impairment markedly increased caregiver burden. Provision of respite care and adequate social support can reduce the perceived burden of caregivers.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: Major depressive disorder (MDD) is one of the most common psychiatric disorders. Sexual dysfunction is common in MDD and is an important cause of poor quality of life, as a satisfying sexual experience is an essential part of a healthy life.
Objectives: The study was undertaken to assess the pattern and frequency of sexual dysfunctions in male patients with MDD; to determine whether there is any correlation between the severity of depression and sexual dysfunction; and to examine the relationship between sexual dysfunction and the sociodemographic variables of patients suffering from MDD.
Methods: It was a cross-sectional observational study conducted in the Department of Psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet, during the period from September 2017 to August 2019. A total of 68 male patients with MDD were enrolled in the study. MDD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria. Sociodemographic information was obtained using a semi-structured questionnaire. Severity of depression was assessed using the Bangla version of the Depression Anxiety and Stress Scale (DASS-21). The Arizona Sexual Experience Scale (ASEX) was used to assess sexual dysfunction.
Results: The majority of the patients (70.5%) with MDD had sexual dysfunction. Low sexual drive and orgasmic difficulty were the most commonly reported sexual problems (35.3%). Problems with orgasmic satisfaction were present in 33.8% of patients, 23.5% had difficulty with erection and 16.2% had low arousal. The study found a statistically significant correlation between sexual dysfunction and the severity of depression, but no statistically significant correlation between the duration of MDD and sexual dysfunction. Similarly, neither the severity of depression nor sexual dysfunction was correlated with the duration of MDD.
Conclusions: This study revealed a significantly high frequency of sexual dysfunction among patients with MDD. All domains of sexual functioning were affected. These findings emphasize the need for greater awareness and routine enquiry about sexual dysfunction in patients with MDD.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: Pregnancy, childbirth and parenthood are major life events that have been associated with increased vulnerability to the development of obsessive-compulsive disorder (OCD).
Objectives: To explore the sociodemographic and clinical factors found in postpartum mothers with OCD.
Methods: A total of 126 mothers presenting with OCD during the postpartum period and attending the EPI Clinic of Bangabandhu Sheikh Mujib Medical University, Dhaka, were conveniently enrolled in the study. OCD was diagnosed using the Mini International Neuropsychiatric Interview (MINI) Scale-7. Sociodemographic and relevant clinical data were collected using a semi-structured questionnaire.
Results: The majority of the participants belonged to the 21–30 years age group. One-fifth had a family history of mental illness, and almost half of the participants had a past history of OCD. A significant number of participants had medical comorbidity, and the majority had depressive symptoms.
Conclusions: A past history of OCD is associated with OCD symptomatology in postpartum mothers. The majority of the mothers also had depressive symptoms.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: Migraine afflicts approximately 8–10% of the general population and is associated with considerable psychiatric morbidity.
Objectives: To explore the sociodemographic characteristics and psychiatric morbidities of patients with migraine.
Methods: It was a cross-sectional observational study carried out in 2020 at the Department of Psychiatry and the Department of Neurology of Combined Military Hospital (CMH), Dhaka, Bangladesh. Using a convenient sampling technique, 400 patients with migraine were recruited. A semi-structured questionnaire for sociodemographic and relevant information, along with the General Health Questionnaire-12 (GHQ-12), was used for data collection. Psychiatric diagnoses were made by psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria.
Results: Among the 400 patients with migraine, 148 (37%) had psychiatric comorbidity. The majority (45.9%) were diagnosed with major depressive disorder, followed by obsessive-compulsive disorder (37.9%), anxiety disorders (13.5%) and other psychiatric disorders (2.7%).
Conclusions: Psychiatric morbidity was highly prevalent among patients with migraine. Among the psychiatric disorders, mood and anxiety disorders were the most common.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: Depression is one of the most common forms of mental disorders. It frequently goes unrecognized and unmanaged in outpatient departments.
Objectives: To determine the prevalence of depression among patients attending the Medicine Outpatient Department.
Methods: This cross-sectional study was conducted in the Internal Medicine Outpatient Department of Combined Military Hospital (CMH), Dhaka. Considering the inclusion and exclusion criteria, 444 participants aged 18 years and above were selected purposively. The study was conducted over six months from September 2018 to February 2019. Sociodemographic data were collected through face-to-face interviews using a semi-structured questionnaire. A Patient Health Questionnaire-9 (PHQ-9) score of ≥5 (five or more) was used to identify positive cases. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 22.
Results: The prevalence of depression in the study was 21.8%. The majority of respondents were females (57.7%), came from rural backgrounds (71.1%), had education up to the primary level (38.1%), were unemployed (43.3%), were unmarried (53.6%), and belonged to the low-income group (42.3%).
Conclusions: More than one-fifth of the participants seeking medical outpatient services showed signs of depression.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Background: Domestic violence is increasingly cited as a risk factor for adverse physical and mental health outcomes. It is associated with an increased risk of psychoactive substance use, anxiety, depression, suicidality and post-traumatic stress disorder symptoms. It is also related to a higher risk of developing severe mental illnesses such as schizophrenia and bipolar disorder.
Objectives: To estimate the prevalence of domestic violence and the factors associated with it among psychiatric patients.
Methods: It was a cross-sectional descriptive study in which a convenient sample of 200 married adult psychiatric patients was included. Domestic violence was assessed using the Bangla version of the HITS (Hurt-Insult-Threaten-Scream) Scale.
Results: Out of the 200 married adult psychiatric patients, 21% had experienced domestic violence. Among males, 13% were victims of domestic violence, whereas among females the proportion was 27.8%. Victims of domestic violence most commonly suffered from depressive disorders (47.6%) and trauma- and stress-related disorders (19%).
Conclusions: A significant number of individuals with mental illnesses experienced domestic violence. Screening for domestic violence and providing information about safety plans can improve quality of life and reduce violence-related injuries.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Trichotillomania (TTM), or hair-pulling disorder, is a debilitating psychiatric condition characterized by a recurrent, irresistible urge to pull out one’s own hair, leading to hair loss and marked functional impairment. This is a case report of a 21-year-old female from an urban background who presented with the complaint of repeated hair pulling for the last 4 years. On mental state examination, she revealed obsessive thoughts about hair pulling and a compulsive act of pulling out hair from the scalp region. Other medical causes of this condition were excluded. Both pharmacological and psychological interventions were provided for the management of the patient.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2021

Abstract
Telepsychiatry is an innovative practice in healthcare that applies telemedicine in the field of psychiatry. Telepsychiatry is also called tele-mental health or e-mental health. It is the use of information and communication technology (ICT) to provide psychiatric services across distances. Using information and communication technologies, mental health professionals can deliver their expert services to remote and underserved areas.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2020

Abstract
Background: Insomnia is a condition of unsatisfactory quality and/or quantity of sleep, characterized by difficulty falling asleep, remaining asleep, or waking early and being unable to return to sleep. Transient insomnia occurs during periods of stress but frequently accompanies various medical and psychiatric conditions and is often associated with substance misuse. Insomnia affects one-third of adults occasionally and 9–12% on a chronic basis.
Objectives: To develop a better understanding of insomnia, including its different subtypes and various treatment modalities for the effective management of patients with insomnia.
Methods: A search was carried out using Google Scholar, Medline, HINARI and several other web portals for English-language articles containing the keywords: sleep, insomnia, epidemiology of insomnia, etiology of insomnia, pathology of insomnia, presentation of insomnia and treatment of insomnia. Relevant chapters from authoritative textbooks were also consulted.
Results: Insomnia is more common in women, the elderly, shift workers and patients with medical and psychiatric conditions. For the diagnosis of insomnia disorder, DSM-5 requires insomnia to be present for at least three nights per week for three months and to cause clinically significant distress or functional impairment. The insomnia should not be better explained by another sleep or mental disorder and should not be attributable to the effects of a substance or medical condition. Both pharmacological and non-pharmacological approaches can be used to treat insomnia. Among pharmacological agents, short- and intermediate-acting benzodiazepines and benzodiazepine receptor agonists remain the mainstay. Non-pharmacological interventions include a range of cognitive and behavioral techniques, including sleep hygiene. Although hypnotic drugs were widely prescribed in the past, non-pharmacological approaches are now recommended as the first-line treatment.
Conclusions: Sleep disturbance is common in the general population, and insomnia is the most prevalent type of sleep disorder. Individuals of any age can develop insomnia as a primary sleep disorder, as part of another mental disorder or as a complication of a medical illness. The clinical presentation differs among patients, and so does the choice of appropriate treatment modality. Nevertheless, most patients benefit significantly from appropriate therapeutic interventions.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2020

Abstract
Background: Frequent comorbidity among patients with neurodevelopmental disorders impairs the management process. Premature mortality and disability could be reduced if there were a greater focus on comorbidity. Holistic and cost-effective services for persons with neurodevelopmental disorders are of utmost importance.
Objectives: The objective of the study was to determine the prevalence and types of comorbidities among individuals diagnosed with neurodevelopmental disorders.
Methods: A hospital-based cross-sectional study was conducted among 346 children aged 10 to 18 years with neurodevelopmental disorders (NDDs) attending the Child Guidance Clinic of the National Institute of Mental Health, Dhaka, during the period from September 2017 to June 2018. Neurodevelopmental disorders were diagnosed by research psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria. Physical comorbidities were diagnosed through history, physical examination, relevant investigations and consultation with specialists from the respective disciplines. A research psychiatrist, statistician, medicine specialists and other specialists as required participated in the study. Coordination meetings involving all members were held before data collection. Microsoft Excel 2003 and SPSS version 18 were used for data analysis.
Results: A total of 346 children were approached for interview, and 311 respondents completed the full data collection procedure. Among the respondents, 61.7% were boys and 38.3% were girls. Intellectual disability was the most common type of neurodevelopmental disorder, followed by attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Among children with NDDs, 32.2% had physical comorbidities. Epilepsy (14.2%) was the most common comorbid physical disorder, followed by diabetes mellitus (2.6%) and cerebral palsy. Other physical comorbidities included infectious and parasitic diseases, thyroid disorders, hypertension, obesity, respiratory tract diseases, urinary tract diseases, skin diseases, and diseases of the ear, nose and throat.
Conclusions: Treatment of coexisting physical illnesses is essential for the proper management of patients with neurodevelopmental disorders. An integrative approach involving pediatrics and related disciplines is needed for the comprehensive management of these children.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2020

Abstract
Background: Obsessive-compulsive disorder (OCD) is a debilitating and heterogeneous psychiatric disorder that is often comorbid with other psychiatric disorders.
Objectives: To identify the psychiatric comorbidities among patients with OCD.
Methods: This cross-sectional study was based on a survey of 105 patients diagnosed with OCD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The participants were older than 18 years and were enrolled from the Inpatient and Outpatient Departments of Psychiatry at the National Institute of Mental Health (NIMH) and Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, between December 2018 and December 2019. Psychiatric comorbidities and the severity of OCD were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-I CV) and the Dhaka University Obsessive-Compulsive Scale (DUOCS). Data were analyzed using SPSS version 25.
Results: The study observed that 92.4% of the respondents had at least one psychiatric comorbidity, with a mean DUOCS score of 42.3. A larger proportion of patients had comorbid panic disorder, generalized anxiety disorder and hypoactive sexual desire disorder, each affecting around 40% of the participants. Approximately one-third of the patients had social phobia, secondary insomnia, dysthymic disorder, undifferentiated somatoform disorder, agoraphobia and major depressive disorder. Fewer than 20% of the patients had comorbid conditions such as hypochondriasis, tic disorder, body dysmorphic disorder, hypomania, bipolar II disorder, non-alcohol substance use disorder, dhat syndrome and acrophobia.
Conclusions: This study provides important information regarding the prevalence of psychiatric comorbidities among patients with OCD. Psychiatric comorbidities should be taken into consideration while planning the management of patients with OCD.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2020

Abstract
Background: Various studies have revealed that sexual side effects are common among patients with psychotic disorders treated with antipsychotic medications. Although these adverse effects negatively impact treatment adherence, information regarding the factors associated with antipsychotic-related sexual side effects remains limited.
Objectives: To evaluate the factors associated with sexual side effects of antipsychotic medications in patients with psychotic disorders.
Methods: A single-center, cross-sectional, naturalistic study was conducted among 146 patients diagnosed with different psychotic disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Sexual functioning was assessed using the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX). Demographic characteristics, medication history and relevant clinical information were also recorded.
Results: Among the participants, 52.1% exhibited sexual dysfunction according to the PRSexDQ assessment. Sexual dysfunction was common in both sexes, with a higher prevalence among males (58.5%) than females (43.8%). The incidence of sexual dysfunction increased significantly in male patients (χ²=3.14, p=0.050), among those receiving risperidone or typical antipsychotics (χ²=10.5, p=0.030), with higher medication doses (t=15.1, p=0.001), longer duration of treatment (t=8.2, p=0.001), longer duration of illness (t=14.7, p=0.001), older age (t=39.5, p=0.001), and in patients diagnosed with schizophrenia (χ²=50.8, p=0.000). However, the route of medication administration (χ²=0.535, p=0.380) and antipsychotic polypharmacy (χ²=0.955, p=0.220) were not significantly associated with sexual dysfunction.
Conclusions: Sexual side effects were common among patients receiving antipsychotic medications. Careful selection of antipsychotic therapy is important to minimize sexual adverse effects and improve treatment adherence.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2020

Abstract
Background: Sociodemographic status and the utilization of diagnostic healthcare facilities are important parameters to consider for ensuring the equitable distribution of healthcare services.
Objectives: To assess the sociodemographic characteristics and referral pattern of patients who underwent CT scans at the National Institute of Mental Health & Hospital (NIMH), Dhaka.
Methods: This observational study was conducted from March 2019 to September 2019. A total of 475 clients were consecutively enrolled. Sociodemographic and other relevant data were collected using a semi-structured questionnaire.
Results: The mean age of the participants was 40.3±16 years; 42.5% were female and 57.5% were male. The majority of requests were for brain CT scans (47.6%), followed by CT KUB (23.8%), whole abdomen CT (19.0%) and CT urogram (9.5%). Among the referred patients, 50.1% were referred from NIMH, 42.5% from NIKDU, 4.8% were referred directly by physicians and 2.5% were referred from BSMMU. Patients from urban areas accounted for 47.5%, while 52.4% came from rural areas. The majority of the patients were married (77.4%), and more than half (60%) were not involved in any income-generating activity.
Conclusions: This study describes important sociodemographic characteristics of patients undergoing CT scans, along with their referral patterns. Further research and continuous monitoring are required to achieve a better understanding of the current utilization pattern of CT scanning.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2020

Abstract
Background: Substance abuse is becoming a serious problem among the younger generation and requires a substantial amount of time and money for treatment and recovery from drug addiction.
Objectives: To explore the patterns of service utilization among substance abusers living in Dhaka city.
Methods: The study population consisted of 36 parents and 48 recovering substance users selected from Dhaka city using a random sampling table. Data were collected through face-to-face interviews using a semi-structured questionnaire.
Results: Half of the recovering substance users were in their thirties or forties. Two-thirds of the participants had used methamphetamine. Most had been addicted for 6 to 20 years. The cost of counseling was within BDT 20,000 for half of the participants and between BDT 20,001 and 40,000 for one-third. Treatment costs ranged between BDT 20,001 and 40,000 for half of the participants, while one-fourth spent within BDT 20,000. More than half of the recovering users required 2 to 5 years to achieve complete recovery.
Conclusions: Substance abusers invest considerable time and financial resources in counseling and treatment for recovery from addiction.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2020

Abstract
Background: Depression is a common mental illness worldwide, affecting more than 264 million people. It is more prevalent among doctors than in the general population. Physicians are particularly vulnerable because of high levels of occupational stress and workload, which adversely affect the quality of healthcare, increase medical errors and impair professional performance. Many physicians remain unaware of their mental health problems or are reluctant to seek treatment due to fear of social stigma and concerns about confidentiality. Consequently, the risk of suicidal behavior is increased among physicians. Therefore, maintaining the psychological well-being of doctors is essential for ensuring quality healthcare for the general population.
Objectives: To estimate the prevalence of depression among doctors who participated in an online survey and to examine its association with their demographic characteristics.
Methods: A cross-sectional online survey was conducted among doctors working in government and private hospitals across Bangladesh from June 2019 to December 2019. A predesigned questionnaire, along with the standardized Patient Health Questionnaire-9 (PHQ-9), was distributed via the internet. Demographic characteristics were recorded as independent variables, while depression scores were considered the outcome variables. Data were analyzed using SPSS version 23.
Results: During the study period, 502 doctors participated and completed the online questionnaire. Minimal depression was found in 3.1% of respondents, mild depression in 5.5%, moderate depression in 32.5%, moderately severe depression in 27.2% and severe depression in 31.8%. Only 39 (8.6%) respondents had no or only mild depression. The association between sex and PHQ-9 depression stages was statistically significant (χ²=21.30, p<0.001), with males being less likely to experience depression than females. Significant associations were also observed between depression and place of employment as well as history of physical assault. However, age group, marital status, having children, distance to the workplace and living with family showed no significant association with depression.
Conclusions: Depression is highly prevalent among doctors in Bangladesh. Routine screening and timely mental health interventions should be implemented in all medical institutions.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2020

Abstract
Background: Domestic violence is a global public health issue that can result in both short- and long-term physical and mental health problems. The HITS (Hurt–Insult–Threaten–Scream) Scale was developed as a brief instrument for screening domestic violence.
Objectives: To adapt and validate the Bangla version of the HITS Scale.
Methods: Cultural and linguistic adaptation into Bangla was carried out through translation, back translation, expert committee review, pretesting and revision of the scale. The reliability of the Bangla version of the HITS Scale was evaluated using parallel-form reliability, test-retest reliability and Cronbach’s alpha to assess internal consistency. Parallel-form reliability was determined by administering both the Bangla and English versions to 30 healthy medical professionals. Test-retest reliability of the Bangla version was assessed at a two-week interval. Subsequently, the Bangla HITS Scale was administered to 24 participants with self-reported domestic violence and the results were compared with those of 30 healthy non-clinical medical professionals.
Results: The Cronbach’s alpha value was 0.75, indicating acceptable internal consistency. For parallel-form reliability, the Pearson correlation coefficient between the Bangla and English versions was 0.647. The test-retest reliability over a two-week interval showed a correlation coefficient of 0.797. The mean HITS scores for the healthy medical professionals (n=30) and the self-identified victims of domestic violence (n=24) were 7.30 and 14.17, respectively. The difference between the two groups was statistically significant (t=14.4, p=0.000).
Conclusions: The Bangla version of the HITS Scale is a reliable instrument for assessing domestic violence among both male and female participants. It successfully differentiates between clinical and non-clinical populations.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2020

Abstract
Hematohidrosis is a rare and mysterious disorder characterized by one or more episodes of spontaneous bloody sweating from intact skin and/or mucous membranes. The exact pathophysiology of this condition remains unclear, although activation of the sympathetic nervous system has been suggested as a possible mechanism. This is a case report of a 13-year-old girl who presented with recurrent bleeding from the right nostril, right ear and right eye for 1.5 months. She had symptoms of depression and an anxious personality trait prior to the onset of these episodes. She was referred to the National Institute of Mental Health as a suspected case of factitious disorder. The patient was distressed by the significance of her symptoms and feared that she had developed a serious illness. Complete remission of the bleeding episodes was achieved with pharmacotherapy and psychotherapy.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2020

Abstract
The COVID-19 pandemic has had alarming implications for individual and collective health, as well as emotional and social functioning. This pandemic has highlighted the important role of mental health care providers in delivering psychosocial support to patients, healthcare providers and the general public. It has also reinforced the need for renewed efforts to reduce and eliminate the stigma associated with mental health.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2019

Abstract
Background: Cognitive deficits in schizophrenia are profound and affect the majority of patients.
Objectives: To review recent advancements and findings related to cognitive impairment in schizophrenia.
Methods: This narrative review was conducted using available literature after a meticulous search of PubMed, PubMed Central, Google and Google Scholar with relevant search keywords.
Results: The most prominent cognitive deficits in schizophrenia involve memory, attention, working memory, problem-solving ability, processing speed and social cognition. These impairments are present before the initiation of antipsychotic treatment and are not caused by psychotic symptoms in patients who are able to complete cognitive assessments, which includes most patients. Various cognitive deficits in schizophrenia have been associated with functional outcomes such as difficulties in community functioning, impairment in instrumental and problem-solving skills, reduced success in psychosocial rehabilitation programs and inability to maintain successful employment.
Conclusions: Cognitive deficits are better predictors of important functional outcomes, such as work performance and independent living, compared with positive or negative symptoms of schizophrenia.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2019

Abstract
Background: Studies from different parts of the world indicate that a significant proportion of people with mental disorders have physical comorbidities, which can impair the management process. Premature mortality and disability could be reduced if greater attention were given to comorbidity. However, nationwide data regarding the prevalence and pattern of this problem in Bangladesh are limited.
Objectives: The study was conducted to investigate the prevalence and types of physical comorbidities, including substance use, among individuals with severe mental illness (SMI).
Methods: A hospital-based cross-sectional study was conducted among 2,200 individuals with severe mental illness (SMI) at two specialized psychiatric hospitals, the psychiatry department of Bangabandhu Sheikh Mujib Medical University (BSMMU), the psychiatry department of Combined Military Hospital (CMH), and psychiatry departments of eight medical college hospitals across Bangladesh from September 2017 to June 2018. Individuals with severe mental illnesses who had been attending inpatient and outpatient departments for 10 years or more were included. Severe mental illnesses included major depressive disorder, schizophrenia, schizoaffective disorder, bipolar disorder and organic psychotic disorders diagnosed by research psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria. Physical comorbidities were diagnosed through history, physical examination, relevant investigations and consultation with specialists. A pretested questionnaire was used for sociodemographic and clinical variables. Data entry and analysis were performed using MS Excel 2003 and SPSS version 18, respectively.
Results: Among the estimated 2,200 participants from different study sites, 1,648 respondents provided complete information. Among them, 93.57% were aged 18 years or older, 45.63% were female and 54.36% were male. Overall, 42.0% of respondents with severe mental illness had physical comorbidities. Diabetes mellitus (28.47%) was the most common comorbidity, followed by hypertension (26.45%), obesity (6.06%), respiratory tract diseases (4.91%), dyslipidemia (4.04%), thyroid disorders (3.46%), blood disorders mainly anemia (3.32%), urinary tract infection (2.89%), digestive system diseases (2.60%), musculoskeletal disorders (2.45%) and ischemic heart disease (2.31%). Other physical comorbidities included infectious and parasitic diseases (2.16%), skin diseases (1.73%), genitourinary system diseases (1.44%), epilepsy (0.86%), chronic kidney disease (0.86%) and underweight (0.72%). Additionally, 7.77% of respondents had comorbid substance-related and addictive disorders. Among the substances used, cannabis was the most frequently abused substance (63.28%), followed by amphetamine (18.75%), alcohol (14.06%) and other drugs (3.90%).
Conclusions: Physical comorbidities, including substance use disorders, are common among patients with severe mental illness in Bangladesh and may lead to adverse outcomes. Proper management requires treatment of both physical and mental health conditions. An integrated healthcare approach involving multiple disciplines is necessary for managing individuals with severe mental illnesses.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2019

Abstract
Background: Headache is one of the most common complaints in outpatient departments and is known to have significant impact on different areas of functioning. The co-existence of psychiatric disorders with headache is an established fact.
Objectives: This study was aimed to explore the impact of headache, estimate the psychiatric comorbidity among headache patients and to see the possible association between them.
Methods: This cross-sectional study was conducted among 51 primary headache patients at Neurology Outpatient Department of Bangabandhu Sheikh Mujib Medical University in 2015. International Classification of Head- ache Disorders (ICHD-3) and Mini International Neuropsychiatric Interview (MINI) were used as diagnostic tools. Age range was 16-65 years.
Results: 62.7% had at least one psychiatric disorder. Severe impact on educational or occupational life was reported by 43.1% patients but association was not found with having psychiatric disorder. Severe impact on family/personal life and social life was reported by 15.7% and 6% individuals and it was significantly associated with psychiatric comorbidity (p=0.02 & 0.001). There was female preponderance and all types of headache were more prevalent among women. Prevalence of headache increased with age, peaked at 26-45 years and declined after that. Tension type headache was the commonest type of headache (60.8%) and highly prevalent among all age groups.
Conclusions: This small study shows the need of larger research in this area and also points out the importance of psychiatric intervention for headache patients.

Abstract
Background: Almost all physical illnesses have some psychological component and psychiatric disorders often present with physical symptoms; so psychiatric referral is especially important for the proper management of a patient.
Objectives: The purpose of the present study was to find out the referral pattern of patients to psychiatry department from other disciplines of “Monno Medical College & Hospital” and to come to diagnoses of those referred patients.
Methods: This descriptive cross-sectional study was performed in the department of psychiatry at a tertiary level multidisciplinary teaching hospital from June 2019 to December 2019. Patients referred from outpatient and inpatient departments of different disciplines were taken as study subjects. Psychiatric diagnoses of the patients were conferred by the consultant psychiatrist according to “The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)” diagnostic criteria. A semi-structured questionnaire was used to collect socio-demo- graphic information. The patients were analyzed based on important sociodemographic variables, source of referral, and diagnoses conferred. Ethical issues were maintained throughout the study.
Results: A total of 224 patients were referred to the Department of Psychiatry during the study period. Three fourths of the referred patients (171, 76%) were from outpatient departments of different disciplines and one fourth (53, 24%) from inpatient departments of the same. Majority of the patients were referred from the medicine and allied disciplines (194, 86.6%); the most referring departments were gastroenterology (63, 28%), medicine (51, 22%), dermatology (28, 12.5%), neuromedicine (24, 10.7%) and endocrinology (21, 9.4%) respectively. The referrals from the departments of surgery (17, 7.6%) and gynecology (3, 1.3%) constituted a minority (20, 9%). Common psychiatric diagnoses of the referred patients were generalized anxiety disorder (72, 32%), somatic symptom disorder (44, 19.6%) and major depressive disorder (30, 13.4%).
Conclusions: Patients with psychiatric symptoms and comorbidity come to the outpatient and inpatient departments of mainly medicine and allied disciplines, other than psychiatry itself. We need to increase interaction among psychiatry and rest of the medicine allied departments to enhance overall patient management.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2019

Abstract
Background: Sexual performance related side effects of antipsychotic medications are important causes of non-compliance to medications.
Objectives: To estimate sexual dysfunction (SD) in patients taking antipsychotic medications.
Methods: A total of 146 participants taking antipsychotic medications attending the inpatient and outpatient units of National Institute of Mental Health (NIMH), Dhaka were recruited for the study. Bangla adapted version of Psychotropic Related Sexual Dysfunction Questionnaire (PRSexDQ) was used to determine SD along with a semi-structured questionnaire for collecting sociodemographic and relevant clinical information.
Results: Among the 146 participants, 52.1% exhibited SD and males exhibited higher prevalence of SD (58.5%) than females (43.8%). Among the sufferers, 63.2% had shown problems in all three domains of SD, that were desire, arousal and orgasm; 23.7% in desire and arousal; 5.3% in desire and orgasm; 5.3% in arousal and orgasm; and 2.6% solely in desire domain.
Conclusions: More than half of the participants showed SD and it usually affected multiple domains of sexual performance.

Declaration of Interest: None.

Copyright: Archives of NIMH © 2020

Abstract
Summary: Stevens-Johnson syndrome (SJS) is an immune–complex mediated hypersensitivity reaction and has been linked as an adverse reaction to many drugs that predominantly involves the skin and the mucous membranes. In most of the cases, drugs are clearly the main causative factor. Lamotrigine, an anticonvulsant is recently being used as a mood stabilizer in many psychiatric disorders. Association between SJS and Lamotrigine is very rare in psychiatric settings in our country. A 19-year-old female with borderline personality disorder who developed Stevens- Johnson syndrome 3 weeks after starting of Lamotrigine reflects an important but rare side effect.

Summary
The presence of physical illness in psychiatric patients not only creates difficulties in diagnosis and treatment but also complicates the course of both conditions. The aim of this study was to determine the proportion of physical illnesses among patients attending the psychiatric outpatient department of Zainul Haque Sikder Women’s Medical College and Hospital. This descriptive cross-sectional study evaluated 345 respondents over a period of two years. Participants, aged between 18 and 60 years, were purposively selected and fulfilled the diagnostic criteria for psychiatric disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). Respondents of both sexes and from all socioeconomic and educational backgrounds were included. All participants underwent detailed history taking, physical examination and psychiatric assessment, while appropriate laboratory investigations were performed when indicated. The study found that 41.74% of psychiatric patients had coexisting physical illnesses. Generalized anxiety disorder was the psychiatric condition with the highest proportion of physical comorbidity (79.16%). Hypertension was the most common physical illness (17.6%). Notably, 37.5% of the physical illnesses were diagnosed for the first time during psychiatric consultation. The findings indicate that physical comorbidities are common among psychiatric patients, emphasizing the importance of early detection and appropriate management to improve their overall health outcomes.

Summary
The presence of a family member with schizophrenia, particularly following deinstitutionalization, can have a profound impact on the work and social lives of caregivers. This cross-sectional study was conducted in the Department of Psychiatry at North Bengal Medical College Hospital (NBMCH), Sirajganj, Bangladesh, from January 2016 to June 2017 to evaluate depression among caregivers of patients with schizophrenia. A total of 50 primary caregivers of patients attending the Psychiatry Outpatient Department (OPD) were purposively selected for the study. The mean age of the respondents was 38.98±12.42 years. The majority were aged 41–50 years (28%), followed by 31–40 years (24%). Among the respondents, 58% were female and 42% were male. Most were married (72%), Muslim (74%), had completed primary education (32%), were housewives (46%) and came from rural areas (70%). The study found that 44% of the caregivers suffered from major depressive disorder. These findings indicate a high prevalence of depression among caregivers of patients with schizophrenia and emphasize the need to provide mental health support not only to patients but also to those who care for them.

Summary Chronic and debilitating diseases like chronic kidney disease have numerous psychiatric consequences and strongly affect the mental health status of patients. The objectives of this study were to assess and quantify Depressive Disorders among End Stage Renal Disease (ESRD) patients, waiting for renal transplantation and 3 months after Renal Transplantation. It was a descriptive and analytical, follow up study which was conducted in the department of Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU) from July, 2013 to September, 2014. Cases were taken from department of Nephrology, BSMMU and Center for Kidney Diseases & Urological (CKDU) Hospital, Shyamoly, Dhaka. Adult ESRD patients waiting for Renal Transplantation of either sex were included. A total of 45 patients were taken and SCID-I CV (Clinician Version) was applied for diagnosis of Depressive Disorder. Severity was assessed by Bangla version of short-form of the Depression Anxiety Stress Scale-21 (DASS-21-BV). Depressive Disorders were found among 51.1% of patients before renal transplantation and 28.9% of patients after transplantation. Severity scoring of Depression revealed, 8.7% had extremely severe, 21.7%, 39.1% and 30.4% had severe, moderate and mild level of Depression respectively before renal transplantation. After renal transplantation 13.1%, 21.7%, 21.7% of patients had severe, moderate and mild level of Depression respectively. Frequency of Depressive Disorders were significantly more before renal transplantation (p2 value=4.63, p=0.03). Severity also significantly reduced 3 months after renal transplantation (χ² value=13.98, p=0.007). Depressive Disorders are highly prevalent among ESRD patients. So, strong consultation-liaison psychiatric services are needed to provide proper treatment to this group of patients.

Summary Premature Ejaculation (PE) has been considered as the most common male sexual dysfunction having significant adverse effects on the quality of life of the men and their sexual partners. The objective of the study was to determine the proportion of PE among men attending in the sex clinic of National Institute of Mental Health (NIMH), Dhaka, Bangladesh. This was a descriptive cross-sectional study conducted from August 2017 to June 2018 among the purposively selected 280 patients. The patients were of 18 to 60 year, and sexually active during at least the past 6 months. A semi-structured self-administered questionnaire, containing socio-demographic and clinical variables and Bangla version of Premature Ejaculation and Diagnostic Tool (PEDT) were used to assess PE. Results showed that mean (±SD) age of the respondents was 38.8 (±8.44) years. 26.4% of the respondents were found to have Premature Ejaculation. Among the PE subtypes, lifelong PE, acquired PE, natural variant PE, and premature-like ejaculatory dysfunction, was 20.3%, 24.3%, 25.7% and 29.7% respectively. Presence of PE was slightly higher among the younger age (aged 20–40 years) group (51.1%) than the older age (aged 41–60 years) group (48.9%). Intra-vaginal ejaculatory latency time (IELT) of 51.1% of men was >3 minutes, 38.2% of men in the range of 2–3 minutes and that of 10.7% men was (<) 1 minute. The high prevalence and adverse consequences illustrate the need for promoting awareness and standardized methods of PE diagnosis, assessment and treatment.

Summary Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with impairments in social communication and interaction, restricted interests, and repetitive behaviors. According to a recent study, ASD occurs in approximately sixteen out of every 1,000 children. Children with ASD often suffer from mental retardation, seizure disorder, and psychiatric disorders such as depression and anxiety. Early detection and intervention of this condition can significantly improve outcome, with about one third of persons with ASD achieving some degree of independent living. Current research links autism spectrum disorder to biological or neurological differences in the brain. Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) scans show abnormalities in the structure of the brain, with significant differences within the cerebellum, including the size and number of Purkinje cells. In some families there appears to be a pattern of autism or related disabilities, which suggests there may be a genetic basis to the disorder, although at this time no one gene has been directly linked to autism. There are three large categories of treatment for this disorder: behavioral modification and communication approaches, dietary and nutritional approaches, and complementary approaches. This review paper discusses all of these broad categories and the sub-categories associated with them.

Abstract
Ice use is becoming increasingly common in Bangladesh. This is a case report of a young woman in her mid-twenties from an urban background whose family reported that she used to take ice, although she denied any history of substance use. On mental state examination, her mood was euthymic; however, she exhibited delusions of grandiosity, control, persecution and systematized delusions. Magnetic Resonance Imaging (MRI) of the brain revealed no abnormal findings. A history of ice use should be carefully assessed when young or early adult individuals present with symptoms of psychosis.

Abstract
Care giving and care receiving can occur at any point in the life course and is typically associated with chronic illness or disabilities which result in losses of independence and functioning. Families are an integral part of the care system for persons with a chronic mental illness such as schizophrenia. The aim of this study was to assess the characteristics of the caregivers of schizophrenia patients. This descriptive cross-sectional study was done among the caregivers of all consecutive schizophrenia patients in outpatient and inpatient department of National Institute of Mental Health (NIMH), Dhaka, Bangladesh from September 2010 to February 2011. Diagnosis of schizophrenia was done by consultant psychiatrist following DSM-IV criteria. A semi-structured questionnaire was applied to the caregivers of schizophrenia patients who fulfilled the inclusion criteria. Ethical issues were maintained accordingly. Out of 272 caregivers of schizophrenia patients most were female (86.03%), housewife (72.43%), of rural area (56.25%). Most of the respondents (80.52%) belonged to the age range of 21 to 50 years. Regarding educational status more than 43% completed secondary level. Among the caregivers 81.25% lived with non-nuclear family. Female members of the family specially mothers (45.22%) and wives 33.09%) were the highest group among the caregivers of schizophrenia patients. Significant proportions of the caregiver of schizophrenic patients were the female members of the family. Information about other characteristics of the caregivers will help further broad-based study regarding this issue and burden of the caregivers of schizophrenia patients.

Abstract
A burn injury is a traumatic experience, with tremendous social, physical, and psychological consequences. But care and research in burn patients has focused on medical issues rather than on psychological predictors. So, this study was done to know the psychiatric consequences of burn patients. The general objective of this study was to find out the prevalence and pattern of psychiatric morbidity in burn patients in Shaheed Suhrawardy Medical College Hospital, Dhaka. It was a descriptive cross-sectional study done among thirty-two patients admitted in the burn unit of Shaheed Suhrawardy Medical College Hospital. After taking the written informed consent a semi structured questionnaire was applied to the respondents to know the socio- demographic characteristics. Screening for psychiatric illness was done by applying Bangla version of self-re- porting questionnaire (SRQ-20), which has been developed by World Health Organization (WHO) to screen for psychiatric illness. Diagnosis of psychiatric illness was confirmed by applying the Clinician Version of the Structured Clinical Interview for DSM-IV for Axis I mental disorders (SCID-CV). Data were analyzed using Statistical Packages of Social Sciences (SPSS) version 17 for windows. Most of the respondents had a diagnosis of psychiatric illness (56.3%). Among the nine positive cases four had a diagnosis of post-traumatic stress disorder; two were suffering from major depressive disorder, one from schizophrenia, one from somatoform disorder and one from adjustment disorder. Psychiatric illness is common among the burn patients. So, psychiatric aspect should be given more priority in the management of burn patients.

Abstract
Stroke is a common neurological disorder with high mortality and disability rates worldwide. The burden of psychiatric co-morbidity is not well documented in developing countries like Bangladesh. The objective of the study was to examine the frequency and pattern of common psychiatric disorders present in stroke survivors in a medical college hospital of Dhaka, Bangladesh. A cross-sectional study was conducted from October 2017 to April 2018 in the Neuro-science Department in Z H Sikder Women’s Medical College Hospital, Dhaka. A total of 50 patients with stroke were evaluated to study the frequency and characteristics of psychiatric morbidities. The participants were interviewed by experienced neurologists and psychiatrists. Informed consent as well as socio-demographic data was obtained and each patient was evaluated for psychiatric morbidity using the Mini International Neuropsychiatric Interview (MINI). Mean age of the respondents was 58.28 (+12.61) years, age ranging from 41 to 82 years. Out of 50 respondents, 80% were male, 44% had educational qualification below SSC, 54% had multiple risk factors of stroke. The results further showed that 20% respondents developed anxiety disorders, 70% developed major depressive disorder and 10% developed stress disorder. There is a significant burden of psychiatric co-morbidity found in stroke survivors in Bangladesh. This may go unnoticed, if not actively screened for by clinicians and could impact negatively on management outcomes if not attended appropriately.

Abstract
Suicide is a preventable public health problem which is under researched in Bangladesh. This review aimed to discuss the risk factors of suicide in Bangladesh based on readily available literatures. Current study was conducted with available literatures after adequate search in PubMed, PubMed Central, Google, Google Scholar, BanglaJOL with the searching keywords. Different studies revealed somewhat similar risk factors in Bangladesh. Majority of suicides were found to be linked with emotional events such as marital discord and family quarrel. Other reported risk factors were also related with strong emotions such as sexual harassment, failed in exam, not fulfilling immediate demand such as motor bike, bicycle, special dress in ceremonial occasions, special television channel watching etc., extra-marital relationship issue, early marriage, death of partner, death of children, and verbal abuse by teacher, love affair related complicacy, domestic violence, and divorce. Psychiatric illness as a risk factor of suicide is under focused and has not been considering as import- ant risk factor in the country. Risk factors of suicide in Bangladesh have been found different in regards to the other parts of the world and mostly related with emotionally charged events. Culturally appropriate prevention strategies should be considered to address the issue.

Abstract
Obsessive-compulsive disorder (OCD) is a chronic and debilitating neurotic illness; however, phenomenological aspects of childhood OCD are not extensively studied in Bangladesh. The article aimed to review symptom pattern of OCD among the children and adolescents of Bangladesh. This narrative review was conducted with available literature after meticulous search in PubMed, PubMed Central, Google, Google Scholar, BanglaJOL with the searching keywords. Prevalence of OCD among children and adolescents was found from 1.3%-2.5% with male predominance. Dirt and contamination was found as the commonest obsessions and cleaning/washing was found as the commonest compulsion among the child and adolescents of Bangladesh.

Abstract
Tuberous sclerosis or Bourneville’s disease is a rare multi-system genetic disease, which is clinically characterized by classical Voget’s clinical triad such as adenoma sebaceum, low intelligence and epilepsy. It is a Mandelian monogenic disorder which is inherited as autosomal dominant fashion with prevalence rate is approximately I in 6000 live births. In this disease specific genetic abnormality causes benign tumor to grow in brain, kidneys, heart, liver, eye, lungs and skin, which gradually cause significant functional impairment of those organs either in isolation or in combination. This is a case report of 22 years old young man present with aggression with significant behavioral impairment for last 3 years who has history of epilepsy as well as multiple cutaneous manifestations such as adenoma sebaceum, Shagreen patch, peri and subungual fibroma. His IQ was extremely low measured by Wechsler Abbreviated Scale of Intelligence. According to that scale his total IQ score was 53. On systemic enquiry by both clinical and laboratory means we found that he had multiple renal cysts with chronic kidney disease. According to that finding we advised antipsychotics and referred him to National Institute of Kidney Diseases and Urology (NIKDU) for better nephrological evaluation and treatment. Two weeks later on a follow up session we found that he was quiet and calm. His aggression and violence was subsided.

Abstract
Substance abuse has become a major public health concern in Bangladesh. The present study was designed to assess the pattern of substance abuse and factors related to it among the patients attending government facilities. This was a descriptive cross-sectional study conducted during November, 2013 to April, 2014 among patients with substance use disorder. A total of 175 patients with substance use disorder (SUD) were selected using convenient sampling technique from both the inpatient and outpatient departments of Central Drug Addiction Treatment Center (CTC), Dhaka and National Institute of Mental Health (NIMH), Dhaka. Data were collected through face-to-face interview using a semi-structured questionnaire designed by the researcher containing socio-demographic and other variables. The mean age of the respondents was 29.53(+8.10) years. More than one third of the respondents (37.1%) were included in the age group of 21-30 years. More than half (54.3%) of the respondents used amphetamine (Yaba) as their main substance of abuse which was followed by cannabis (15.4%) and pethedine (9.1%). Most of the respondents (58.3%) started to use substance when they were in between 16 to 20 years of age. Majority of the abusers (72.0%) took substance through smoking. Relapse rate (86.3%) was found high. This study provides information about recent pattern of different types of substance use among the abusers receiving services from government facilities. Amphetamine was found the main substance of abuse. An alarming proportion of respondents started to use substance before or at the age of 20.

Abstract
Juvenile offenders are generally vulnerable to psychiatric illness. The objectives of the study were to deter- mine the prevalence and types of psychiatric disorders among male juvenile offenders in Bangladesh. This was a cross-sectional study conducted in Juvenile Development Center (Boys’), Bangladesh. All the male offenders of 9-18 years were included in the study during January 2011 – June 2011. Total respondents were 138. Validated Bangla version of the Development and Well-Being Assessment (DAWBA) was used to deter- mine psychiatric disorders which were assigned based on ICD-10 diagnostic criteria. Information regarding socio-demography and other factors were collected through face-to-face interview using a semi-structured questionnaire and from the case-notes. Data analysis was done by SPSS for windows 15 version. The mean (+SD) age of the respondents was 14.2 (+1.7) years. Majority of them were from urban area (73.9%), were Muslims (94.2%), unmarried (97.1%), completed primary level of education (41.7%), lived in nuclear family (77.11%) having monthly family income of less than 10,000 Tk (89.1%). Most (26.8%) inmates were charged with murder. Psychiatric disorders were diagnosed in 57.2% of the respondents. Rate of emotional disorders (48.1%) was higher than behavioural disorders (38.4%). Regarding specific disorders, conduct disorder (46.8%) and major depressive disorder (43.0%) were the most common diagnoses. It can be concluded that there was considerable rate of psychiatric disorders among the male juvenile offenders in the development centre. Broad-based replication study could confirm these findings.

Abstract
Mood disorders impose a significant burden on a personal, medical and socioeconomic level of the caregivers. It is observed in our country that in almost all sort of patient with psychiatric illness including mood disorders depend on the care of their family members. The objectives of this study were to determine the level of burden of caregivers of patients with mood disorders attended in a tertiary care hospital and to identify the possible association of duration, type of mood disorders, and the socio demographic variables on the burden of caregivers. This was a cross sectional study, sample size were 95 and SCID-I applied on the subjects and they diagnosed mood disorders and caregiver‘s burden was assessed by using the Zarit Burden Interview (ZBI). It was found the positive relationship with the disease duration and caregiver burden level (p=0.000). The duration of providing care also significant (p=0.000) with the higher level of burden. Among the subjects 44.2% diagnosed Major Depressive Disorder, 43.1% Bipolar Mood Disorder (Manic), 7.4% Bipolar Mood Disorder (Depressive) and 5.3% were diagnosed Dysthymic Disorder. The caregiver from nuclear family (74.7%) felt higher degree burden than caregivers from joint family (24.3%). The family type and burden level bound significant relationship (p=0.013). Regarding the burden level 54.8% caregiver possessed severe burden, 24.2% moderate to severe burden, 18.9% mild to moderate burden and 2.1% possessed little or no burden. To provide a total care to the patients with mood disorders it is necessary to mitigate the caregiver‘s burden. For this reason clinicians need to review periodically the status of caregiver‘s burden.

Abstract
Hematidrosis or hematohidrosis or hemidrosis is a very rare condition in which a human being sweats blood. Physical and psychological stresses are found to be the most frequent causes among other causes such as systemic diseases and vicarious menstruation. This is a case report of 16-year-old girl with oozing of blood from intact skin of forehead, scalp, ears, eyes and nose. Physical exertion, long journey, intense fear secondary to psychosocial stressors and academic examination were identified as precipitants in this case she was provisionally diagnosed as mixed anxiety and depressive disorder. Pharmacotherapy and psychotherapy were followed by complete remission; it is inferred from the experience that hematidrosis is a treatable condition if the underlying cause is correctly identified.

Abstract
In Psychiatry insight refers to the conscious awareness and understanding of one‘s own psychodynamics and symptoms of maladaptive behavior, highly important in effecting changes in the personality and behavior of a person. Impaired insight into illness is common. It has direct or indirect impacts on almost all phases of the diagnosis and treatment protocols. Not surprisingly, there is scarcity of summarized outline of evidence-based importance of insight in psychiatry. This article aimed at fulfilling this scarcity. For this purpose, thirty articles were selected through searching internet and reviewed. This article reviews recent research related to impaired insight in major mental illness and its consequences for cognitive, behavioral, legal, and treatment compliance issues affecting this population. It discusses efforts to find the neurobiological basis for lack of insight and the various structures or circuits of the brain that have been implicated in schizophrenia. In the search for a more reliable and valid measure of insight for treatment decisions, the development of various assessment instruments is summarized. Impaired insight is shown to be related to a poorer course of the illness and noncompliance with necessary treatment in schizophrenia. The implications of these findings for treatment decisions, legal interventions, and ongoing treatment monitoring are discussed.

Abstract
Tuberous sclerosis or Bourneville’s disease is a rare multi-system genetic disease, which is clinically characterized by classical Voget’s clinical triad such as adenoma sebaceum, low intelligence and epilepsy. It is a Mandelian monogenic disorder which is inherited as autosomal dominant fashion with prevalence rate is approximately I in 6000 live births. In this disease specific genetic abnormality causes benign tumor to grow in brain, kidneys, heart, liver, eye, lungs and skin, which gradually cause significant functional impairment of those organs either in isolation or in combination. This is a case report of 22 years old young man present with aggression with significant behavioral impairment for last 3 years who has history of epilepsy as well as multiple cutaneous manifestations such as adenoma sebaceum, Shagreen patch, peri and subungual fibroma. His IQ was extremely low measured by Wechsler Abbreviated Scale of Intelligence. According to that scale his total IQ score was 53. On systemic enquiry by both clinical and laboratory means we found that he had multiple renal cysts with chronic kidney disease. According to that finding we advised antipsychotics and referred him to National Institute of Kidney Diseases and Urology (NIKDU) for better nephrological evaluation and treatment. Two weeks later on a follow up session we found that he was quiet and calm. His aggression and violence was subsided.