Navigating Unique Diagnostic and Therapeutic Challenges in Premenstrual Dysphoric Disorder: A Case Report.

Premenstrual dysphoric disorder (PMDD) is a disabling form of premenstrual syndrome affecting females of reproductive age in the premenstrual period. The presentation may vary from severe mood lability to extreme attempts to end life, usually within a week before menstruation resulting in considerable stress, functional impairment, and interpersonal conflicts. We present an interesting case of a 19-year-old sexually active girl who presented with a polysubstance overdose owing to her cyclical episodes of severe mood symptoms including irritability and uncontrolled aggression. Detailed history and thorough examination raised suspicion of PMDD which was confirmed on prospective symptom charting for two menstrual cycles as described by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criterion. After the establishment of diagnosis, the patient was started on selective serotonin reuptake inhibitors to target PMDD symptoms along with oral contraceptive pills for birth control which showed marked improvement in her overall condition. We herein discuss multiple diagnostic and therapeutic challenges that limit correct diagnosis and timely management of PMDD, especially in the adolescent age group.

Deliberate Foreign Body Ingestion in a 35-Year-Old Woman With Borderline Personality Disorder and Several Psychiatric Comorbidities.

Deliberate foreign body ingestion (DFBI) is a rare psychopathological disorder that involves the swallowing of non-nutritive objects to cause self-harm. It is most commonly associated with borderline personality disorder (BPD). Very scant literature has been published on the psychopathological understanding or psychopharmacological interventions. Mostly, gastroenterological and surgical management regarding the removal of the foreign body has been discussed in the literature. DFBI can be very challenging in terms of the treatment of the patient and the morale of the health providers - it exhausts the patient and the family and evokes frustration among the medical staff due to its resistance to remission. By presenting the case of a patient in this article, we will discuss what is known about the poorly understood DFBI and the challenges and difficulties encountered while treating these patients. Further, we will discuss how a biopsychosocial approach can be used in treating these patients.

Treatment and Management of Sexual Disinhibition in Elderly Patients With Neurocognitive Disorders.

Sexual disinhibition is uncommon but challenging symptom to address in elderly patients with neurocognitive disorders. Due to the lack of large-scale studies, there is no gold standard treatment for sexual disinhibition, and treatment is largely left up to the discretion of the provider based on the severity and onset of the patient's symptoms. A review was conducted to investigate the non-pharmacological and pharmacological interventions for treating this condition. Articles that discussed treatments were screened for the type of treatment and possible side effects of medication if applicable. Thorough patient history should be taken prior to starting any drug therapy to rule out possible behavioral changes due to an existing medication side effect, delirium, or past mental or sexual health history. Non-pharmacological treatment has been generally recommended as first-line therapy over pharmacological treatment. Distraction/diversion of the patient when inappropriate sexual behaviors occur was the most common non-pharmacological intervention. Antidepressants were generally recommended as the first line of pharmacological treatment after attempting all possible non-pharmacological interventions. Several other categories of interventions are discussed as well in addition to the ethical implications of treating a patient for this condition.

Neurological sequelae of COVID-19: a review.

BACKGROUND: The COVID-19 pandemic has produced a myriad of challenges, including identifying and treating neurological sequelae. MAIN BODY: COVID-19 can cause olfactory and respiratory dysfunction with average recovery within 1 month and a minority of patients experiencing symptoms at 8-month follow-up. Headaches are also very common (up to 93%) amongst patients with persistent COVID-19 symptoms. COVID-19 illness may also affect cognition, although results are mixed. CONCLUSION: While many studies have focused on acute COVID-19 symptoms, more longitudinal studies will need to assess the neurological sequelae of the disease. Furthermore, care must be taken when attributing sequelae to COVID-19 illness and not an unrelated cause. Finally, there is concern that COVID-19 may be associated with secondary illnesses, such as Guillain-Barre, and may even contribute to the development of diseases, such as Alzheimer's.

Emerging Needs and Viability of Telepsychiatry During and Post COVID-19 Era: A Literature Review.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in nationwide stay-at-home orders in an effort to slow the spread severely impacting the healthcare sector. Telepsychiatry provides a platform bridging the gap through advanced technologies connecting mental health providers and patients who need their services, overcoming previous barriers of great distances, lack of transportation, and even time constraints. The most obvious benefit is increased accessibility to mental healthcare, especially in underserved and remote areas where there is no easy access for in-person care. It is important to note that benefits are not limited to patients, but also allow clinicians greater flexibility in scheduling and reduced practice overhead costs, both of which aid with physician burnout and burden. Telepsychiatry during COVID-19 provides its own unique advantages over in-person visits. The risk of exposure to healthcare workers and patients receiving care is reduced, allowing immunocompromised patients to receive much-needed psychiatric care. Without the need to meet in person, self-isolating psychiatrists can still provide care, decreasing strain on their co-workers. Although telepsychiatry is relatively new, it has already exhibited considerable success in its effectiveness at treating psychiatric conditions and widespread corollary benefits. Telepsychiatric consults may be carried out synchronously and asynchronously, each having benefits and setbacks. Different mobile application interventions have been explored, which are available for the purpose of both monitoring/assessing patients and/or providing treatment. The scope of conditions these applications address is broad, from anxiety disorders to schizophrenia to depression. As promising and beneficial telepsychiatry may seem, it is necessary to recognize that building the program can be challenging. It involves adapting to new methods in medicine. We highlighted barriers to general telepsychiatry, the most prominent being technological literacy of both physician and patient, and possible negative effects of eliminating the in-person patient-doctor interaction.