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The history of psychiatry as a discipline in Nepal has been poorly studied. We have attempted to summarise historical landmarks to explore how it began and its evolution over time in relation to contemporary political events. Although Nepal has achieved several milestones, from establishing a psychiatric out-patient department with one psychiatrist in 1961 to having more than 500 psychiatric in-patient beds with 200 psychiatrists by 2020, the pace, commitment and dedication seem to be slower than necessary: the current national mental health policy dates back to 1996 and has not been updated since; there is no Mental Health Act; the number of psychiatric nurses and in-patient psychiatric beds has increased only slowly; and there is a dearth of professional supervision in rehabilitation centres. Thus, despite making significant progress, much more is required, at greater intensity and speed, and with wide collaboration and political commitment in order to improve the mental health of all Nepali citizens, including those living in rural areas and or in deprived conditions.
The study aims to compare the attitude of early clinical year medical students towards people with mental illness at the beginning and the end of their psychiatry teaching schedule. It hypothesizes that long exposure to psychiatry lectures can help to reduce the negative attitude.
Background
Health professionals are also known to harbour negative attitude towards people with mental illness. Reducing stigma among medical students is crucial to shape the attitude of future health professionals towards people with mental illness. However, the effect of Psychiatry training on the attitude of the medical students shows mixed results.
Method
It was a prospective longitudinal study conducted among fourth year medical students affiliated with a teaching hospital in Southern Nepal as an initiative to improve quality of Psychiatry training for medical students. The students who gave their consent for participation were assessed for their attitude at the beginning, after the first two introductory lectures and at the end of the Psychiatry lecture-based teaching schedule (36 two weekly lectures in 5 month period), using self-administered 16-item Mental Illness Clinician's Attitudes Scale (MICA-2) ‘medical students version’ questionnaire in English language. Permission was taken from the author of the study to use the scale. IRB approval was taken prior to the study.
Result
A total of 95 (approx. 67%) students participated in the study. At the first follow-up i.e. second week, (n = 85), there was no significant difference in negative attitude as assessed by MICA score (p = 0.47). However, at six months follow-up (n = 82), the negative attitude significantly differed compared to the baseline (p < 0.001).
Conclusion
While brief lectures about mental illness can provide some knowledge about mental illness, long term exposure to psychiatry lectures can reduce attitude of medical students on people with mental illness. Hence, it is also crucial to incorporate academic contents that reduce negative attitude about people with mental illness.
Financial declaration: The study was self-funded by the department of Psychiatry at National Medical College and Teaching Hospital, Parsa, Nepal.
Electroconvulsive Therapy (ECT) is an important modality of treatment for treatment resistant psychiatric disorders. Young medical students like general public might harbor several misconceptions about ECT. In this pilot survey, we explored the knowledge and attitude about ECT amongst young medical students training in a medical college affiliated to a teaching hospital in Southern Nepal.
Method
A 23-item questionnaire in English language with either ‘True’ or ‘False’ response as outcome was developed by reviewing findings from previous studies. Brief information was also taken to record familiarity of medical students with ECT as a treatment procedure. The study was conducted as a departmental pilot survey for quality improvement of Psychiatry Undergraduate Training. A total of 128 medical students in early clinical year enrolled in MBBS curriculum at a teaching hospital in Southern Nepal participated in the survey. The students were not exposed to any specific teaching regarding ECT while participating in the study.
Result
The students were aged between 21 and 28 years with almost equal gender distribution. Among them, 89.1% had heard about ECT before whereas 15.6% knew someone who has received ECT. Although 90.6 % of students believed ECT can be lifesaving many times, a substantial number of students had misconception about ECT such as assuming it as a painful procedure (71.9%). Almost half of them believed ECT can have severe consequences like death or permanent brain damage. Around one fourth to one third believed ECT is inhumane, without scientific proof or a form of punishment for violent angry patients. Surprisingly, a significant higher percentage of male students believed that ‘ECT leads to permanent loss of memory’ (11/34 vs. 3/30, p = 0.04) and ‘ECT is given as a punishment to violent/angry patients’ (15/34 vs. 4/30, p = 0.01).
Conclusion
Several misconceptions about ECT are prevalent in medical students that need to be adequately addressed during their training to develop a positive attitude and basic knowledge about the treatment.
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