Somdet Chaopraya Institute of Psychiatry (also known as Somdet Chao Phraya Hospital) is a psychiatric hospital in Khlong San District of Bangkok, Thailand. Established as a mental asylum, the original building was designed by a British architect and supervised by the British physician Dr. Morden Carthew. As the first psychiatric hospital and the second oldest hospital in Thailand, the hospital became well known for being the pioneer in the country for the humane treatment of mentally ill patients.
Medical simulation has emerged as a transformative approach in toxicology education. By providing immersive, hands-on experience, simulation enhances learner engagement, critical thinking, and long-term knowledge retention while offering a safe environment to practice clinical decision-making without jeopardizing patient safety. Despite these advantages, the integration of simulation-based training remains limited in low- and middle-income countries (LMICs) due to resource constraints, lack of standardized curricula, and limited access to high-fidelity simulators. Additionally, little research has explored its optimal application in these settings. This review explores available evidence regarding the effectiveness of medical simulation in the diagnosis and treatment of toxicological emergencies in LMICs. Our findings suggest that while traditional lecture-based instruction may provide immediate knowledge gains, several studies suggest simulation-based training may enhance long-term retention and practical skills, particularly in resource-limited environments. This review highlights the need for further research to develop cost-effective, scalable simulation models tailored to LMICs and evaluate their impact on clinical outcomes in toxicology education.
BACKGROUND:Violence exposure is a major public health concern among adolescents. Yet, evidence on socio-demographic and familial risk factors in adolescent psychiatric populations in Nepal and other low- and middle-income countries is limited. OBJECTIVES:To identify risk factors associated with different forms of violence exposure among adolescents attending a child and adolescent psychiatric unit in Nepal. METHODS:A total of 810 adolescents aged 11-15 years (392 boys, 418 girls) at Kanti Children's Hospital in Kathmandu, were included. Adolescents reported past-year exposure to violence using adapted PedHITSS and ICAST-C items, while parents provided socio-demographic and family data. Associations were examined using ordinal and logistic regression analyses in SPSS 29. RESULTS:Physical abuse was more frequent among adolescents from the Dalit caste (OR 1.86, 95% CI 1.03-3.34, p = 0.04), whereas neglect and domestic violence were more frequent among Indigenous/minority groups compared with Brahmin/Chhetri castes (OR 1.72, 95% CI 1.17-2.52, p = 0.006; OR 1.63, 95% CI 1.17-2.27, p = 0.004). Compared with urban areas, emotional abuse was less frequent in rural (OR 0.52, 95% CI 0.34-0.80, p = 0.003) and semi-urban areas (OR 0.60, 95% CI 0.41-0.85, p = 0.005), while sexual abuse and neglect were less frequent in semi-urban areas (OR 0.40, 95% CI 0.21-0.77, p = 0.01; OR 0.35, 95% CI 0.20-0.60, p < 0.001). Emotional abuse, sexual abuse, and neglect were more frequent among females (OR 1.59, 95% CI 1.19-2.13, p = 0.002; OR 3.70, 95% CI 2.27-6.06, p < 0.001; OR 1.75, 95% CI 1.22-2.50, p = 0.002). Increasing maternal age was associated with lower odds of emotional abuse (OR 0.97, 95% CI 0.95-1.00, p = 0.02). Emotional abuse and domestic violence were more frequent in single-parent families compared with extended families (OR 1.98, 95% CI 1.04-3.78, p = 0.04; OR 2.84, 95% CI 1.04-7.78, p = 0.001), and parental illiteracy was linked to increased domestic violence compared with university-level education (OR 2.93, 95% CI 1.15-7.49, p = 0.03). CONCLUSION:Violence exposure was more frequent among Dalit and Indigenous/minority groups, females, urban residents, was associated with younger maternal age, single-parent households, and parental illiteracy reflecting need for culturally informed, trauma-focused prevention and intervention.
Abstract Introduction Psychosis is a heterogeneous psychiatric disorder that may present with predominantly somatic symptoms. Such presentations are challenging to diagnose, particularly in resource-limited settings where stigma, low mental health literacy, and fragmented referral systems delay care. Case description A 33-year-old female from remote Nepal presented with a five-year history of persistent and worsening somatic complaints, fixed bodily beliefs, and marked functional decline. She consulted multiple health facilities, cross-border hospitals, and traditional healers, undergoing extensive investigations with no relief, delaying psychiatric referral, and increasing morbidity. On presentation, she exhibited persecutory and somatic delusions, somatic hallucinations, depressive cognitions, and poor insight. She was diagnosed with schizophrenia and treated with antipsychotics, nutritional rehabilitation, and family psychoeducation, resulting in notable clinical improvement. Discussion This case illustrates how biological, psychological, and social factors can delay recognition of psychosis presenting with predominant somatic symptoms. Early identification and intervention require integrated, longitudinal care addressing all biopsychosocial dimensions to ensure timely diagnosis and reduce morbidity. Learning points •Biological, psychological and social barriers can interact to delay recognition and treatment of psychosis. •Predominant somatic symptoms may obscure psychotic disorders, complicating diagnosis in primary and secondary care settings. •Geographic isolation, limited referral systems and financial constraints can prolong untreated illness and increase functional impairment. •Integrated, longitudinal care addressing biopsychosocial dimensions is essential for timely diagnosis, effective management and reduction of morbidity.
Substance use disorder (SUD) is an increasingly serious public health issue in Nepal, associated with significant psychological consequences. This study aimed to assess perceived family support, levels of depression, severity of drug-related problems and commonly abused substances among individuals with SUD in rehabilitation centers in Bagamati Province. A quantitative cross-sectional descriptive study was conducted among 263 participants aged ≥ 18 years. Ethical approval was obtained from the Institutional Review Committee of Madan Bhandari Academy of Health Sciences. Data were collected using a structured questionnaire incorporating the Family Support Scale, Beck Depression Inventory (BDI-Ia), and Drug Abuse Screening Test (DAST-20) and analyzed using SPSS version 16. Most participants were male (92.8%) and aged 25–50 years (62.0%), with a mean initiation age of 17.74 years. Alcohol (80.6%) was the most commonly abused substances. Nearly half (49.8%) reported high perceived family support, 41.8% experiencing moderate level of depression. Gender was significantly associated with depression (p = 0.027). Most participants had substantial (46.0%) or severe (33.5%) drug abuse severity. Severity was significantly associated with age (p = 0.003), education (p = 0.038), and family support (p = 0.003). Participants aged 18–50 years had lower odds of severe drug abuse (OR = 0.29; 95% CI: 0.13–0.66), while illiterate individuals had higher odds (OR = 4.78; 95% CI: 2.07–11.07). Low family support showed borderline association (OR = 2.68; 95% CI: 0.99–7.28). The findings highlight a high burden of substance use severity and comorbid depression, emphasizing the need for integrated, family-centered interventions.
