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    Abstract
    Introduction
    Epilogue
    References

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REVIEW ARTICLE Table of Contents   
Year : 2010  |  Volume : 52  |  Issue : 7  |  Page : 76-79
Contribution of Indian psychiatry in the development of psychiatry in Nepal


Universal College of Medical Sciences, Bhairahawa, Nepal

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Date of Web Publication15-Sep-2010
 

   Abstract 

Psychiatric services remained virtually unknown in Nepal until 1961. The first psychiatric outpatient service was started in 1961, at Bir Hospital, Kathmandu. In 1984, the Psychiatry Department at Bir Hospital was separated and a mental hospital was created, which was later shifted to its current location at Lagankhel, Patan, in Kathmandu valley, in 1985. It is the only mental hospital in Nepal with a current bed strength of 50 beds. The new era in medical learning and teaching was ushered in Nepal with the establishment of the Institute of Medicine (IOM) under the Tribhuban University and the 400-bed Tribhuban University-Teaching Hospital (TU-Teaching Hospital), in the year 1983. BP Koirala Institute of Health Sciences (BPKIHS) at Dharan was established in 1993, as a part of the joint Indo-Nepal collaboration on developing an international standard teaching, training, and research-oriented medical institute similar to AIIMS, New Delhi. During the last one-and-half decades a number of privately run medical colleges have come up in Nepal. Outpatient and inpatient Psychiatry Departments have been established in most of these government as well as private medical institutes. At present, the postgraduate course (MD) in psychiatry has been running in two government-run institutes as well as three privately run medical colleges. Indian psychiatrists have played and are still playing significant roles in establishing as well as maintaining Psychiatry Departments, especially in the private sector medical colleges. They have also contributed to the growth of psychiatry research and postgraduate teaching in psychiatry, in Nepal.

Keywords: India, Nepal, psychiatry

How to cite this article:
Aich TK. Contribution of Indian psychiatry in the development of psychiatry in Nepal. Indian J Psychiatry 2010;52, Suppl S3:76-9

How to cite this URL:
Aich TK. Contribution of Indian psychiatry in the development of psychiatry in Nepal. Indian J Psychiatry [serial online] 2010 [cited 2019 Aug 24];52, Suppl S3:76-9. Available from: http://www.indianjpsychiatry.org/text.asp?2010/52/7/76/69216



   Introduction Top


Few milestones in the development of mental health services in Nepal [1]

Psychiatric services remained virtually unknown in Nepal till 1961. Unlike other places where mental asylums first made their presence for the care of the mentally ill, mental health services started in a general hospital setting in Nepal. The first psychiatric outpatient service was started in 1961, at Bir Hospital, Kathmandu, by Dr. Bisnu Prasad Sharma, when he came back to Nepal with a DPM degree from Great Britain. A five-bed inpatient unit was established in the same hospital in 1965, which was further strengthened to 12 beds in 1971. In 1984, the Psychiatry Department at Bir Hospital was separated and a mental hospital was created, which was later shifted to its current location at Lagankhel, Patan, in Kathmandu valley, in 1985. It is the only mental hospital in Nepal, with the current strength of 50 beds. In addition to the mental hospital, in 1972, a 10-bed neuro-psychiatric unit was established in the Royal Army Hospital in Kathmandu.

Establishment of the department of psychiatry, institute of medicine, Kathmandu [2]

A new era in medical learning and teaching was ushered in Nepal with the establishment of the Institute of Medicine (IOM) under the Tribhuban University, as also a 400-bed Tribhuban University-Teaching Hospital (TU-Teaching Hospital), in the year 1983. At the TU-Teaching Hospital, the Psychiatric Out-Patient Service was started in February 1986, followed by the addition of a 12-bed psychiatric inpatient unit in December 1987. Later, an eight-bed de-addiction unit was added to the Psychiatric Inpatient setup, thus totaling a current strength of 20 beds in the department. Clinical psychological services were offered from 1997 onward.

The Institute of Medicine was established with a view to increase the trained manpower in Nepal in the field of medicine and related fields, both at the undergraduate and postgraduate levels. Before the establishment of IOM, students from Nepal, aspiring to become doctors, had to go either to India or to the erstwhile USSR, to pursue their medical course. Postgraduate training in psychiatry was started at IOM in the year 1997, with the intake of two students for a three-year residency scheme. Subsequently, a two-year M Phil course in Clinical Psychology was started in 1998, and Bachelor of Psychiatric Nursing was started in 1999, in the same center. Indian faculties from AIIMS, New Delhi, and other PG institutes actively collaborated with their counterpart in the Department of Psychiatry, IOM, during the initial years of MD training, teaching, and examination programs.

Establishment of the department of psychiatry, BP Koirala institute of health sciences, Dharan [3]

BP Koirala Institute of Health Sciences (BPKIHS) at Dharan was established in 1993, as a part of the joint Indo-Nepal collaboration on developing an international standard of teaching and training, and a research-oriented medical institute, similar to AIIMS, New Delhi. Outpatient psychiatric service at BPKIHS was started in 1995, after Dr. HP Jhingan and Dr. SK Khandelwal joined the institute on a short-term deputation from AIIMS, New Delhi. A 20-bed psychiatric ward was started in February 2000. The department started an MD course in Psychiatry in the same year, with the enrollment of one PG resident. Since the beginning of the PG course, visiting faculties from India and other countries formed an integral part in imparting teaching and training to PG residents in psychiatry. Some of the noted visiting faculties from India were Dr. BM Tripathy, Dr. Rakesh Lal, Dr. Indira Sharma, Dr. Avneet Sharma, Dr. RK Chadda, Dr. KMR Prasad, and Dr. Biswojit Sen. At present, every year, two to three students enrol in the MD psychiatry course.

Establishment of the department of psychiatry in various private medical colleges in Nepal

During the last one-and-half decades a number of privately run medical colleges have come up in Nepal. With functioning teaching hospitals attached to each of these medical institutes, the In- and Outpatient Departments of Psychiatry were also established in most of them. Of late, a postgraduate course (MD) in psychiatry has been started in three private medical institutes. These institutes are, the Manipal College of Medical Sciences, Pokhara, the Universal College of Medical Sciences, Bhairahawa, and the National Medical College, Birganj.

Contribution of Indian psychiatrists in the development of psychiatry in Nepal

As has already been stated, both the government sector medical institutes IOM, Kathmandu, and BPKIHS, Dharan, have received active assistance from eminent Indian faculty members in establishing and developing postgraduate Psychiatry Departments in both these premier teaching institutes in Nepal.

Similar cases are seen in the establishment of Psychiatry Departments in private medical colleges. Manipal College of Medical Sciences (MCMS), Pokhara, has Col. K Ramesh and Brig. PK Chakraborty on their faculty lists of the Department of Psychiatry. Both of them are eminent teachers from AFMC, Pune, and have joined the department after retirement from their service in the army. Both of them have long years of postgraduate teaching experience behind them. Brig. PK Chakraborty was the director of RINPAS, Ranchi, before joining MCMS, Pokhara as the medical director and professor of psychiatry. Thus, it came as no surprise that shortly after joining the department Brig. Chakraborty was able to start MD psychiatry in his institute, with affiliation from the Kathmandu University and the Nepal Medical Council.

The medical college in Birganj has Dr. JN Vyas, another well-known and reputed academician in the field of psychiatry in India, as head of the Department of Psychiatry. During his tenure in Nepal he helped to start a PG course in psychiatry at the Birganj Medical College. He also utilized his time in Nepal in editing and publishing the first multi-authored post-graduate psychiatry text book from India.

The present author, after completing his DPM and MD psychiatry from the Central Institute of Psychiatry (CIP), Ranchi, took the challenge of establishing a new department in another private medical college in Nepal. Present author started the outpatient service in psychiatry by January 2001, at the Universal College of Medical Sciences (UCMS), Bhairahawa. Within one year the Inpatient Department was started, with a 30-bed separate ward for psychiatry. Currently we have a 60-bed Inpatient Department (20 each for male, female, and the de-addiction center) of Psychiatry, the largest of its kind in Nepal. Our patient turnover has increased gradually over the last nine years. We attended to more than 14,000 patients at our outpatient clinic during the last one year and approximately 1200 patients were admitted and treated in our inpatient ward during the same period. These statistics are probably the highest in comparison with the performance of a Department of Psychiatry attached to a general hospital setup in Nepal. Besides the present author, the department was enriched by the presence of Dr. R Muthuswamy from Salem, India, a student of late Professor Venkoba Rao and a very popular teacher among undergraduate students here. We have started PG in psychiatry from the last academic year, with permission from the Nepal Medical Council to take one MD resident per year.

Psychiatry research in Nepal in the new millennium

In the new millennium, research works of Nepali psychiatrists as well as Indian psychiatrists working in Nepal are published in different national and international journals. Epidemiological surveys, though in a limited scale, have been reported on psychiatric morbidity [4] , alcohol dependence [5] , epilepsy [6] and drugs of abuse. [7] Psychiatric morbidity studies are reported on the profiles of referred psychiatry OPD patients [8] and hospitalized medical patients [9] . There are OPD based studies [10] , inpatient study reports, [9],[11],[12] studies on emergency psychiatry, [13] as well as study reports are available based on consultation-liaison psychiatry. [14],[15],[16]

Significant works have been published in relation to alcohol and drug abuse during the last one decade. There are prevalence studies on alcohol dependence, [4] psychopathology in alcohol exposed children, [16] alcohol abuse among women in Nepal, [17],[18] alcohol and other substance abuse among junior doctors and medical students, [19] risk factors for drug abuse, [7] profiles of inpatient drug and alcohol abusers [12] , cannabis abusers [20] , injection drug abusers [21],[22] and family burden in opioid dependence patients. [23]

Published literature are available on diverse topics like co-morbidity in psychiatric illnesses, [24],[25] quality of life, [26] Nepali adaptation of international guidelines and rating scales, [27],[28] headache [29] , HIV [30] and depression during pregnancy [31].

The Indian Psychiatric Society (IPS) always encouraged research article presentations by psychiatrists from Nepal during its annual national conferences (ANCIPS). [4],[10] The Indian Journal of Psychiatry (IJP) also encouraged publications of research articles received from Nepal. [14],[32],[33]

Two research articles of the present author were published in IJP, while working in Nepal, in the year 2004 and 2005, although the study was carried out in India. [24],[25] Two more articles of the present author, based on the research study done in Nepal, have been accepted for publication recently. [11],[22]


   Epilogue Top


This is a humble effort to outline the growth of modern psychiatry in Nepal and the contribution from Indian psychiatrists in its development. Some important references might have been missed, in an attempt to write this article within a very short time frame.

This article would remain incomplete if I did not mention the name of Professor Mahendra Kumar Nepal, an alumnus of the Agra Medical College and MD psychiatry from AIIMS, New Delhi. He was the key person in establishing the Department of Psychiatry in IOM, Kathmandu. A person with vision, great leadership quality, and a tireless worker, he was able to influence the decision-makers in the Tribhuban University and Nepal Medical Council to introduce a separate clinical examination for final MBBS students, which included presenting a long case before the examiner and appearing for a viva in psychiatry and related subjects. Undergraduate psychiatry teaching and learning in the Institute of Medicine, Kathmandu, includes 40 hours of theory classes and 160 hours of clinical exposure for the final year MBBS students. This is where, probably, psychiatry in Nepal outscored India in terms of the undergraduate psychiatry curriculum followed and the pattern of examination conducted.

Professor Mahendra Kumar Nepal was the main driving force behind the start of the Nepalese Journal of Psychiatry in the year 1999, although its publication was stopped after a few years. It was upon his personal effort that Nepal successfully conducted the second SAARC Psychiatric Conference in Kathmandu, in November 2006. 'Brain drain' in psychiatry also affected Nepal, with at least three psychiatrists leaving the country in search of greener pastures abroad. Probably the bigger loss to psychiatry in Nepal was when Dr. MK Nepal also decided to join the Australian Government service a few years back! Hopefully newer, younger, and competent leaders like Professor VD Sharma of IOM, Kathmandu and Professor PM Shyangwa of BPKIHS, Dharan, will ably fill up the vacant place left by Professor MK Nepal and will take psychiatry in Nepal to newer heights in the coming decade.

 
   References Top

1.Upadhyaya KD. Current situation of mental health service in Nepal and some priorities to improve it. In Souvenir: 15 years of PAN: Past, present and future, 3 rd National Conference of Psychiatrist Association of Nepal; 2006. p. 13-23.  Back to cited text no. 1      
2.Editorial. Mental health in Nepal. Nepalese J Psychiatry 1999;1:3-4.  Back to cited text no. 2      
3.Shyangwa PM. Department of Psychiatry, BPKIHS: an overview. Souvenir: National CME of Psychiatrist Association of Nepal 2007. p. 1-3.  Back to cited text no. 3      
4.Jhingan HP, Sharma A, Shyangwan P. A community survey for psychiatric morbidity in Dharan: finding from GHQ. Indian J Psychiatry 2002;42:42-3.  Back to cited text no. 4      
5.Jhingan HP, Shyangwan P. Prevalence of alcohol dependence in a town as assessed by CAGE questionnaire. Addiction 2003;98:339-43.  Back to cited text no. 5      
6.Rajbhandari KC. Epilepsy in Nepal. Neurol J Southeast Asia 2003;8:1-4.  Back to cited text no. 6      
7.Niraula SR, Chhetry DB, Singh GK, Nagesh S, Shyangwa PM. Risk factor for drug abuse among nepalese samples selected from a town of eastern Nepal. Int J Ment Health Addict 2009;7:430-40.  Back to cited text no. 7      
8.Shakya DR, Pandey AK, Shyangwa PM, Shakya R. Psychiatric morbidity profiles of referred psychiatry OPD patients in a general hospital. Indian Med J 2009;103:407-11.  Back to cited text no. 8      
9.Khandelwal SK, Karki P, Deo BK, Ansari JA. Study of psychiatric morbidity in hospitalized medical patients of a general hospital in Nepal. Nepalese J Psychiatry 1999;1:20-5.  Back to cited text no. 9      
10.Khandelwal SK, Deo BK, Shyangwa PM. A clinical and demographic characteristics of patients attending psychiatric OPD at BPKIHS. Indian J Psychiatry 2002;42:85-6.  Back to cited text no. 10      
11.Aich TK, Dhungana M, Muthuswamy R. Pattern of neuro-psychiatric illnesses in older age group population: an inpatient study report from Nepal. Indian J Psychiatry 2010. [In Press].  Back to cited text no. 11      
12.Ojha SP, Pokhrel A, Koirala NR, Sharma VD, Pradhan SN, Nepal MK. Profile of first 100 inpatients in deaddiction ward of TU-Teaching hospital, Nepal. J Nepal Med Assoc 2003;42:32-5.   Back to cited text no. 12      
13.Shakya DR, Shyangwa PM, Shakya R. Psychiatric emergency in a tertiary care hospital. J Nepal Med Assoc 2008;47:28-33.  Back to cited text no. 13      
14.Jhingan HP. Profile of consultation-liasion psychiatry cases in a new medical college hospital in Nepal. Indian J Psychiatry 1997;39:40-3.  Back to cited text no. 14      
15.Chapasgain G, Rajbhandari KC, Chandra K, Sharma VD. A study of symptom profile of depression following myocardial infarction. J Nepal Med Assoc 2003;5:92-4.  Back to cited text no. 15      
16.Sharma A, Khandelwal SK, Kalra OP. Psychopathology in alcohol exposed children: A report from Nepal. Neuropsychopharmacology 2000;23:148-9.  Back to cited text no. 16      
17.Niraula SR, Shyangwa PM, Jha N, Paudel RK, Pokharel PK. Alcohol use among women in a town of eastern Nepal. J Nepal Med Assoc 2004;43:244-9.  Back to cited text no. 17      
18.Sharma A, Khandelwal SK. Women with alcohol related problems in Nepal. Addiction 2000;95:1105-6.  Back to cited text no. 18  [PUBMED]  [FULLTEXT]  
19.Shyangwa PM, Joshi D, Lal R. Alcohol and other substance use/abuse among junior doctors and medical students in a teaching institute. J Nepal Med Assoc 2007;46:126-9.   Back to cited text no. 19      
20.Upadhyaya KD. Cannabis abuse and psychiatric morbidity. J Nepal Med Assoc 2004;43:91-3.  Back to cited text no. 20      
21.Ojha SP, Pokhrel P, Acharya RP, Pandey KR, Bhusal CL, Marhatta MN. Socio-psychological study among injectable drug users in Kathmandu valley. J Nepal Med Assoc 2002;41:235-40.  Back to cited text no. 21      
22.Aich TK, Dhungana M, Khanal R. Pattern of buprenorphine abuse amongst opioid abusers in Nepal. Indian J Psychiatry 2010 [In Press].   Back to cited text no. 22      
23.Shyangwa PM, Tripathy BM, Lal R. Family burden in opioid dependence syndrome in tertiary care center. J Nepal Med Assoc 2008;47:113.  Back to cited text no. 23      
24.Aich TK, Sinha VK, Khess CRJ, Singh S. Demographic and clinical correlates of substance abuse comorbidity in schizophrenia. Indian J Psychiatry 2004;46:135-9.   Back to cited text no. 24    Medknow Journal  
25.Aich TK, Sinha VK, Khess CRJ, Singh S. Course and outcome of substance abuse comorbidity in schizophrenia: An intensive inpatient study report. Indian J Psychiatry 2005;47:33-8.   Back to cited text no. 25    Medknow Journal  
26.Shrestha S, Ghotekar LR, Sharma SK, Shyangwa PM, Karki P. Assessment of quality of life in patients of end stage renal disease on different modalities of treatment. J Nepal Med Assoc 2008;47:1-6.  Back to cited text no. 26      
27.Jordans M, Upadhaya N, Tol W, Shrestha P, Doucet J, Gurung R, et al. Introducing the IASC mental health and psychosocial support guidelines in emergencies in Nepal. Intervention 2010;8:52-63.   Back to cited text no. 27      
28.Koirala NR, Regmi S, Sharma VD, Khalid A, Nepal MK. Sensitivity and validity of the General Health Questionnaire-12 (GHQ-12) in a rural community setting in Nepal. Nepalese J Paychiatry 1999;1:34-40.  Back to cited text no. 28      
29.Khalid A, Regmi S, Nepal MK, Pokhrel A, Rana M. A socio-demographic study of patients with headache attending a general hospital psychiatry OPD. Nepalese J Psychiatry 2000;2:125-8.  Back to cited text no. 29      
30.Aich TK, Dhungana M, Kumar A, Pawha VK. Demographic and clinical profiles of HIV positive cases: a two-year study report from a tertiary teaching hospital. J Nepal Med Assoc 2004;43:125-9.   Back to cited text no. 30      
31.Shakya R, Situla S, Shyangwa PM. Depression during pregnancy in a tertiary care center of eastern Nepal. J Nepal Med Assoc 2008;47:128-31.  Back to cited text no. 31      
32.Mishra PB, Shyangwa PM, Khandelwal SK, Kalra OP. Factitious disorder with Oligoanuria: a case report. Indian J Psychiatry 1999;41:374-6.   Back to cited text no. 32    Medknow Journal  
33.Chadda RK, Singh MM. Awareness about psychiatry in undergraduate medical students in Nepal. Indian J Psychiatry 1999;41:211-6.  Back to cited text no. 33    Medknow Journal  

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Correspondence Address:
Tapas Kumar Aich
Universal College of Medical Sciences, Bhairahawa
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.69216

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