Upper gastrointestinal bleeding in a patient with depression receiving selective serotonin reuptake inhibitor therapy.

BACKGROUND: Serotonin plays an important role in the normal clotting phenomenon and is released by platelets. Platelets are dependent on a serotonin transporter for the uptake of serotonin, as they cannot synthesize it themselves. Selective serotonin reuptake inhibitors (SSRIs) block the uptake of serotonin into platelets and can cause problems with clotting leading to bleeding. AIM: This case report highlights the occurrence of upper gastrointestinal bleeding in the index case on initiating SSRI therapy for depression and the prompt resolution of the same on its discontinuation on two separate occasions. CONCLUSION: SSRIs may cause upper gastrointestinal (GI) bleeding. Physicians should be aware of the same and should try to rule out previous episodes of upper GI bleed or the presence of other risk factors which might predispose to it before prescribing SSRIs; they should also warn the patients about this potential side effect. Also, the presence of thalassemia trait in the index patient deserves special attention and needs to be explored to see if it might in any way contribute in potentiating this side effect of SSRIs.

A study of problem drinkers in a general hospital.

349 new admissions in the wards of Medicine, General Surgery & Orthopedics in a general hospital were screened with MAST & AUDIT for problem use of alcohol. Problem drinking was present in 14.6% of the inpatients. The severity and the need for additional treatment were measured with Addiction Severity Index (ASI). Majority of the patients had problems in more than one ar?a. Nevertheless, only one fourth of the patients were referred for psychiatric treatment. The findings indicate the need to develop services towards the recognition and referrals of the problem drinkers in general hospitals.

Generalised dissociative amnesia.

A case of generalised dissociative amnesia is presented, which illustrates several characteristic features of this uncommon condition. The case showed poor response to thiopentone interviews and in vivo cueing. Amnesia had persisted at six months follow up.

Dysmorphophobia with bipolar affective disorder : a case report.

This case report describes the progression of dysmorphophobic symptoms in the dimension of intensity from a normal age related concern, to primary dysmorpliophobia, to a somatic delusion during depressive and manic phases of a bipolar affective disorder. The depressive episodes were resistant to drug treatment but responded to ECTs.

Pituitary - adrenal functioning in male alcoholics.

Serum adrenocorticotrophic hormone (ACTH) and Cortisol were assayed in 38 males alcoholics and 24 male control subjects using radioimmunoassay (RIA) techniques. Biochemical parameters of hepatic function, depressive symptoms and severity of withdrawal were also assessed. Thirteen percent and eleven percent of the patients and elevated serum ACTH and Cortisol levels respectively. Evidence of advance liver disease was scant and significant symptoms of depression was observed in only 14% of the patients. By and large withdrawal symptoms were mild. Two patients have clinical features suggestive ofpseudo Cushing's syndrome without hypercortisolaemia.

Pituitary gonadal functioning in male alcoholics in an Indian psychiatric hospital.

Serum levels of luteinizing hormone (LH), testosterone and hepatic functions were measured in 38 male alcoholics and in 24 male control subjects. Significant elevation of serum LH and a trend of low serum testosterone were noted with scant evidence of advanced liver disease. None of the alcoholics had clinical stigmata of hypogonadism and feminization.