Elevated Cortisol Levels and Manic Symptoms in a 16-Year-Old Female: A Case Report.

This case report presents the clinical presentation, diagnosis, and management of a 16-year-old female with elevated cortisol levels who was diagnosed with mania. The patient exhibited symptoms consistent with a manic episode, including extreme euphoria, decreased need for sleep, impulsivity, and heightened irritability. Laboratory investigations revealed an elevated morning cortisol level, prompting further psychiatric evaluation. A diagnosis of bipolar I disorder, manic episode, was made based on established criteria. The patient was initiated on mood stabilizers and antipsychotic medications alongside psychoeducation for the patient and her family. This case underscores the potential association between cortisol dysregulation and mood disorders, highlighting the importance of comprehensive assessment and personalized treatment approaches in adolescents with bipolar disorder. Further research is needed to elucidate the underlying mechanisms linking cortisol dysregulation and mood disturbances and explore novel therapeutic interventions targeting hypothalamic-pituitary-adrenal axis dysfunction.

Navigating the Shadows: A Comprehensive Review of Suicide in the Geriatric Population.

This review critically examines the complex landscape of suicide within the geriatric population, defined as individuals aged 65 and older. By synthesizing existing research, we elucidate critical findings related to the prevalence, risk factors, and challenges associated with suicide in this demographic. Social isolation, mental health issues, and the intricate psychosocial dimensions of ageing emerge as pivotal factors contributing to the vulnerability of older individuals. The conclusion underscores a compelling call to action, urging collaborative efforts from healthcare professionals, policymakers, and communities to implement targeted prevention strategies. Our vision for the future involves building a supportive and resilient community for the geriatric population, emphasizing age-friendly policies, robust social support networks, and destigmatizing mental health discussions. Through this comprehensive exploration, we aim to contribute to a deeper understanding of suicide in the geriatric population and inspire effective interventions that prioritize the well-being and dignity of older individuals.

Identifying Myoclonic Epilepsy Misdiagnosed as Psychogenic Nonepileptic Seizures: Challenges in Differential Diagnosis.

Psychogenic nonepileptic seizures (PNES) and epileptic seizures often present with similar clinical manifestations. This case report describes the diagnostic journey of a 24-year-old female initially diagnosed with PNES but later found to have myoclonic epilepsy upon comprehensive evaluation. The patient presented with recurrent episodes characterized by sudden loss of awareness, jerking movements, and urinary incontinence, often triggered by stressors. Initial assessment, including video-electroencephalography (EEG) monitoring, did not reveal epileptiform activity, leading to the provisional diagnosis of PNES. However, the persistence of symptoms and doubts regarding the diagnosis prompted further investigation, which uncovered generalized spike-and-wave discharges on repeat EEG studies. The diagnosis of myoclonic epilepsy was established based on these findings, and treatment with valproate resulted in a significant reduction in seizure frequency. This case underscores the importance of a thorough evaluation in distinguishing between seizure disorders and psychogenic manifestations, emphasizing the need for collaborations between neurology and psychology disciplines for accurate diagnosis and management.

Bridging the Gap: A Holistic View of Personality Factors in Individuals With and Without Alcohol Use.

This comprehensive review examines the intricate interplay between personality factors and alcohol use, shedding light on the dynamic relationship that shapes the initiation, progression, and outcomes of alcohol-related behaviors. The exploration encompasses vital personality traits such as sensation seeking, impulsivity, neuroticism, extroversion, agreeableness, conscientiousness, and openness to experience. The bidirectional nature of this association is underscored, emphasizing how personality influences and is influenced by alcohol consumption patterns. Protective personality factors, including resilience, emotional regulation, and social support, are identified as crucial elements in mitigating the risk of alcohol use disorders (AUDs). The implications for clinical practice advocate for tailored interventions that address individual personality profiles, while policy considerations highlight the need for targeted prevention efforts that acknowledge the diverse ways individuals respond to alcohol use. Furthermore, a call for future research emphasizes emerging perspectives, improved methodologies, and ongoing exploration of intervention strategies to advance our understanding of this complex relationship and refine approaches for prevention and treatment. As we navigate this evolving field, the insights gleaned hold promise for shaping more compelling and nuanced interventions to address the diverse needs of individuals affected by AUDs.

Journey of Marijuana From "Folk Tales" to "Doors of Justice": A Comprehensive Review.

This comprehensive review delves into the intricate journey of marijuana in India, tracing its historical and cultural significance from ancient times to the present day. Despite its deep-rooted presence in religious rituals, traditional medicine, and cultural festivities, marijuana faces stringent prohibition under the Narcotic Drugs and Psychotropic Substances Act 1985. This review critically examines the current legal framework, highlighting its societal impacts and limitations. Through an evidence-based analysis, it advocates for a reevaluation of marijuana laws to align with contemporary realities, promoting public health, social equity, and economic development. By envisioning a future of evidence-based regulation and innovation, India can unlock the full potential of marijuana as a "miracle crop" for the betterment of its people and society.

Exploring Body Image Dissatisfaction and Psychiatric Co-morbidities in Rural India: A Comprehensive Review.

This comprehensive review examines the intricate landscape of body image dissatisfaction (BID) in rural India, shedding light on the multifaceted factors influencing individual perceptions and societal expectations. Delving into cultural nuances, economic disparities, and gender-specific experiences, the study highlights the pervasive nature of BID across diverse age groups. Unveiling the complex interplay between BID and psychiatric co-morbidities, such as depression and anxiety, underscores the urgency of integrated mental health interventions. The review concludes with a resounding call to action for policymakers, healthcare professionals, and communities. It advocates for culturally sensitive mental health policies, targeted healthcare training, and community-driven initiatives to foster environments conducive to positive body image and mental well-being. By acknowledging these challenges and committing to collaborative solutions, this review aims to contribute to developing comprehensive strategies that address BID in rural India and pave the way for healthier and more resilient communities.

A Bird's-Eye Perspective: An Unusual Case of Very Late-Onset Schizophrenia-Like Psychosis With Visual Hallucinations Included in Its Manifestations Versus the Dementia Prodrome.

Very late-onset schizophrenia-like psychosis (VLOSLP) is still a paradox; certain characteristics such as episodic progression of psychosis including delusions and hallucinations involving various modalities, as well as the absence of negative symptoms, are strongly predictive of VLOSLP. We describe an interesting case of a 61-year-old male who presented with a second episode of psychosis along with mild to moderate cognitive impairment like having difficulty in buttoning for over eight months at our tertiary care hospital. Previously, during the first episode, he was treated by a private practitioner; adequate doses for an adequate duration of two atypical antipsychotics were given; and up to 25% global improvement was reported by the caregiver. During the current episode, he experienced delusions, in which he had a conviction that a "WIFI" was capable of "thought-making" functions. During the past four months, his delusions exacerbated and were accompanied by hallucinations of other modalities, like visual and kinesthetic hallucinations, which profoundly impacted his daily life. He used to hear voices. While listening to the voices, he also experienced voices coming out of his mouth. All these were experienced by him in clear consciousness daily for a few hours. All plausible medical causes of late-onset psychosis, such as neuroinflammatory/immunological disorders, were ruled out. Neuroimaging revealed T2-weighted image (T2WI)/fluid-attenuated inversion recovery (FLAIR) hyperintensity in bilateral subcortical and periventricular deep white matter, suggestive of small vessel ischemic changes in the brain. The diagnosis of VLOSLP is completely rationalized by evidence-based medicine. Hence, the role of cerebrovascular risk factors, as well as age-related neurobiological processes, in the pathogenesis of VLOSLP is discussed. Future research ought to emphasize identifying a particular biomarker that would be highly predictive for accurately diagnosing VLOSLP and giving it an identity to separate it from various overlapping clinical conditions such as dementia with Lewy bodies (DLB) and other types of dementia with psychosis so that the patient can be given specific treatment.

A Rare Presentation of Delusional Parasitosis With Koro-Like Syndrome.

Delusional parasitosis (DP) with Koro-like syndrome poses a complex clinical challenge, demanding a comprehensive and empathetic approach from healthcare professionals. This exceptional combination of fixed beliefs about infestation and experiences of genital retraction can profoundly impact patients' well-being and daily functioning. The associated stigma and misconceptions further compound the difficulties faced by individuals struggling with these co-occurring conditions. Given the rarity of encountering both conditions simultaneously, navigating the diagnosis and treatment of delusional parasitosis with Koro-like syndrome requires a thorough understanding of its multifaceted nature. Embracing a holistic strategy encompassing psychoeducation, psychotherapy, and pharmacological interventions is essential for effectively addressing these dual conditions.

Unexpected Cataract Formation Following Valproate Treatment: A Case Report.

Valproic acid (VPA), or sodium valproate, is a frequently prescribed medication for many psychiatric conditions, notably for the management of bipolar affective disorder. While its common side effects are well known and thoroughly documented in medical literature, the occurrence of cataracts as a side effect is exceedingly rare. There is evidence of cataract formation with long-term use of VPA in a few studies. Recognizing this potential adverse effect is crucial. It is important to recommend that patients undergo regular eye examinations if they experience any visual disturbances or as a preventative measure to ensure effective management. This case report examines the unusual occurrence of cataract development associated with valproate use.

Unraveling the Web of Delusional Parasitosis: A Case Report.

Delusional parasitosis (DP) is a psychiatric condition characterized by the false belief of skin infestation. However, the coexistence of medical conditions, such as iron deficiency anemia, may complicate the clinical presentation and treatment approach. The present case provides an overview of the challenges faced with the diagnosis and management of DP in a patient with a co-morbid medical condition. It highlights the importance of multidisciplinary collaboration in achieving a favorable outcome. Through this case, we shed light on the possible multifactorial origins of DP and emphasize the importance of a comprehensive approach to care for patients with this condition. It also underscores the need for timely recognition and appropriate treatment to improve the quality of life for individuals affected by this debilitating psychiatric condition.

Assessing the Behavioral and Personality Changes in Alcohol Dependence Syndrome in Wardha, Central India.

Background Alcohol dependence syndrome occurs when the consumption of alcohol is uncontrollable. Most of the alcohol drinkers are usually males. There is a rise in the incidence of road traffic accidents under the influence of alcohol due to locomotor and cerebral dysfunction. Alcohol is a significant cause and contributing factor for domestic violence, family disharmony, and displeasure in families. Research studies have shown that after the lockdown of COVID-19, the consumption of alcohol decreased in India. This study was conducted to assess the behavioral and personality changes in alcohol dependence syndrome. Methods This study was conducted at a rural tertiary care hospital in Wardha, Maharashtra, Central India. Sixty-two males participated in the study. Out of which, 56 were included in the study. There were urban and rural participants in the study. The study was conducted for a period of six months. The participants who were being treated for alcohol withdrawal and alcohol dependence syndrome were included in the study. The individuals unwilling to participate in the research and those admitted to the intensive care unit were excluded from this study. The primary outcome measure of the study was to assess the behavioral and personality changes in alcohol dependence syndrome. Participants were screened using the Cut-Down, Annoyed, Guilty, and Eye-Opener (CAGE) and the Alcohol Use Disorders Identification Test (AUDIT) questionnaires. The diagnosis of alcohol dependence syndrome was made according to the International Classification of Diseases, Tenth Revision, (ICD-10) criteria. The participants were assessed using a self-report questionnaire. The parameters of assessment were aggressive behavior, domestic violence, workplace violence, verbal abuse, and variables including the forensic aspects of alcohol consumption, such as road traffic accidents, etc. Previous research and similar studies on factors related to alcohol dependence syndrome were compared to establish a conclusion for the study. Results Participants reported to have decreased psychomotor function upon alcohol consumption compared to the time they were not under the influence of alcohol. Aggressive behavior associated with irritability and agitation was observed in 89.28% (50 out of 56) participants. A total of 76.78% (43 out of 56) had road traffic accidents at least once under the influence of alcohol. Of the sample, 85.71% (48 out of 56) committed verbal abuse at the workplace and home as a result of aggression under the influence of alcohol. And 69.64% (39 out of 56) of the sample had memory loss after consumption of alcohol. Conclusion There are several behavioral changes in individuals who are alcohol dependent, which may affect their day-to-day activities and cause poor performance in the workplace. Participants in the study showed a notable positive relation between alcohol dependence syndrome and aggressive behavior, verbal aggression, domestic violence, memory loss, and road traffic accidents under the influence of alcohol. Alcohol dependence syndrome can be linked with decreased quality of life due to problems faced in daily activities like psychomotor functions, sleeping, etc. During the treatment of alcohol dependence or withdrawal from alcohol, individuals experience socio-behavioral changes. Cognitive behavior therapy, including cognitive neuroscience, can help in managing these behavior and personality changes in alcohol dependence syndrome.

A Rare Presentation of Quadrigeminal Cistern (Tectal Plate) Lipoma With Visual Hallucinations in a Patient of Schizophrenia: A Case Report.

Intracranial lipomas are rare benign congenital tumours, consisting of <0.1% of all primary brain tumours. They are asymptomatic and are thus incidentally discovered whenever brain imaging is advised due to any other organic cause. These lipomas can rarely present with acute psychosis or schizophrenia-like symptoms characterised by abnormal perceptions, cognition, mood, and behaviour. One of the most frequent symptoms of schizophrenia is hallucination. In patients with schizophrenia, hallucinatory experiences can have an impact on any of the five senses; however, auditory hallucinations are the most common. Although tactile, olfactory, and gustatory hallucinations are uncommon, visual hallucinations are also frequently experienced; their existence should prompt a clinician to think about whether there may be an underlying medical or neurological condition that is the root of the entire syndrome. Thus, the presence of visual hallucinations in a patient with psychosis should not be neglected and brain imaging should be done to rule out any organic brain disease. Schizophrenia-like symptoms in a patient of quadrigeminal lipoma are rare and not many cases have been reported in this context. Quadrigeminal lipoma presenting with headache, seizure, loss of consciousness, and aggression has been reported but not with acute psychosis or schizophrenia. Hereby, we report a case of a 35-year-old female who presented with psychosis with predominant visual hallucinations, which suspected an underlying organic pathology and brain imaging showed the presence of quadrigeminal cistern lipoma. The idea behind choosing this case is to report a very rare condition with an even more atypical associated presentation.

Psychiatric morbidity in children of alcoholic parents.

CONTEXT: Children of alcoholics (COAs) are children who have grown up in families in which either one or both parents are alcoholic. The interplay of several factors such as environmental, cognitive, and genetic vulnerability has been linked to the psychopathology among COAs. AIMS: To assess psychiatric morbidity in COAs and to compare these children with the children of nonalcoholic parents. SETTING AND DESIGN: This cross-sectional study was conducted on children of outpatients and inpatients of a tertiary health-care center in Central India, for 18 months. SUBJECTS AND METHODS: A total of 100 children, fifty children of alcoholic parents and fifty children of nonalcoholic parents between the age groups of 4 and 14 years, were assessed using childhood psychopathology measurement schedule. STATISTICAL ANALYSIS USED: Statistical analysis was done by using descriptive and inferential statistics using Chi-square test and Student's unpaired t-test. SPSS version 22.0, were used for statistical analysis, and P < 0.05 was considered as level of significance. RESULTS: Most of the children were in the age group of 8-11 years. Depression and anxiety were found to be statistically significant (P < 0.05) in COAs than in children of nonalcoholics. Whereas, there was no difference (P > 0.05) for low intelligence and behavioral problems, conduct disorder, psychotic symptoms, special symptoms, physical illness, emotional problems, and somatization. CONCLUSIONS: Thus, there is a high need to address the stress to children of persons with substance abuse. Early detection of psychiatric morbidities in such children and appropriate intervention can produce beneficial changes in such children.

Spectrophotometric bioassay method for urokinase.

INTRODUCTION: Urokinase is a potent plasminogen activator. Present Bio assay methods of Urokinase are very tedious. So a new simple spectrophotometric Bio assay method was developed to estimate thrombolytic activity of Urokinase. METHODS AND RESULTS: This Bio assay is designed for the quantitative in vitro spectrophotometric determination of Urokinase activity by utilizing its thrombolytic activity to carry out the lysis of plasma clots. The initial concentration of the plasma clots was adjusted to 0.2+/-0.01 absorbance and the linear decrease in the absorbance by addition of Urokinase concentration from 200 to 1200 IU/ml at lambda(max) 530 nm was studied. The activity of sample Urokinase can be quantified by comparing the absorbance of sample Urokinase with Urokinase standard Bio assay calibration curve and predicted in IU. The r(2) value of standard calibration curve was found out to be 0.993. The repeatability of the Bio assay was studied by performing the experiment six times with fresh plasma samples and the results showed significant similarity. DISCUSSION: We can conclude that the novel Bio assay method was found to be simple, economical, reproducible and accurate than the present Bio assay methods.

Media optimization studies for Serratiopeptidase production from Serratia marcescens ATCC 13880.

Production of an anti-inflammatory enzyme serratiopeptidase by fermentation with Serratia marcescens ATCC 13880 was studied to ascertain optimal nutritional conditions for large scale production. To study biosynthesis and production of serratiopeptidase by Serratia marcescens ATCC 13880, different physicochemical parameters were studied and optimized. The optimized medium contain, (g/l) glycerine 10.0, maltose 10.0 as carbon source, peptone 10.0 as organic nitrogen source, ammonium sulphate 10.0 as inorganic nitrogen source, dihydrogen phosphate 10.0, sodium bicarbonate 10.0, sodium acetate 10.0 as inorganic salt source, ascorbic acid 10.0 as stabilizer, distilled water 1000 ml and the optimized fermentation conditions were pH 7.0, temperature 37 degrees C and duration 24 hr. The modified fermentation medium produced 27.36 IU/ml of serratiopeptidase compared to 17.97 IU/ml in basal medium and the molecular weight of the purified serratiopeptidase was found to be 52 kD.