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AimsElectroconvulsive 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.MethodA 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.ResultThe 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).ConclusionSeveral 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.

BACKGROUND: Patients with schizophrenia go through several non-medical and non-psychiatric pathways before reaching proper psychiatric treatment in Nepal. It also includes faith healer and spiritual leaders. Supernatural beliefs about causation of mental illness have shown to affect their behavior in studies from India. However, there is no study from Nepal. METHODS: This study is a part of ongoing teaching hospital survey since August 2018. Seventy-one participants were mainly from Terai belt (plains) of Nepal (Parsa, Bara, Rautahat and Siraha districts). Clinic attending patients who were diagnosed schizophrenia as per ICD 10 criteria were approached. Patients and family members who gave consent for participation were assessed after ruling out medical comorbidity. This was a cross sectional assessment of pathways to care from beginning till current health service. A semi-structured questionnaire was designed and was used along with Supernatural Attitude Questionnaire (SAQ). SAQ has been validated scale in local language. They have been used in previous study from India. Important clinical details were also assessed along with sociodemographic profile. RESULTS: The mean duration of untreated psychosis was more in females (8.86±20.64 months) than in males (5.89±14.47 months). The average number of help sought was 6.68±6.68 service providers which contained faith healers, physicians, paramedics and psychiatrists. However, the mean number of help sought before reaching a psychiatrist was 3.11±5.22. Most of the first contacts i.e. 76.1% were non-psychiatrists. Forty five percent of the patients had faith healers as first contact of treatment. Sixty percent of the family members believed in black magic and 56.3% of them believed that faith healing can improve their patients’ behavior. However, 83.1% of the patients were taken to faith healer and 88.7% performed rituals or worship during current episode of illness. There was significant association between belief in black magic, ghosts, curse of Gods/Goddesses, celestial influence, unsatisfied spirit in causation and recent visit to faith healer (Pearson Chi-Square p0.001, 0.016, 0.001, 0.046 and 0.023 respectively). Sixty two percent of the patients took concomitant faith healing along with psychiatric treatment. The mean score of supernatural Attitude Questionnaire (SAQ) was higher in male (9.21±3.59) than in females (6.30±4.95) (Independent T-test significance 0.006). Similarly, males had significantly more belief in black magic (p0.01), heavenly influence (p0.018), God/Goddess’s curse (p0.028), and wrong deeds of previous life (p0.002) as causation of mental illness. Family members of male patients believed that faith healing can improve their behavior in comparison to those of female patients (p0.043). Visits to faith healers and performing rituals were significantly more for male patients than female (p0.001 and 0.006). DISCUSSION: Supernatural factors as the causes and faith healing as help seeking means were very common in patients of schizophrenia in our region. Despite of psychiatric treatment, people are likely to seek concomitant faith healing in desperation to ‘cure’ their patients. Females suffering from schizophrenia remain the neglected group either for medical treatment or for faith healing. This is the time when faith healers can be incorporated in governmental health policy to guide patients for proper treatment. This is also a call for nationwide study.

AimsThe 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.BackgroundHealth 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.MethodIt 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.ResultA 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).ConclusionWhile 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.