Cabergoline-induced Mania in a Patient of Pituitary Microadenoma.

Cabergoline, a dopamine agonist agent, is commonly used in the treatment of hyperprolactinemia, Parkinson's disease, restless leg syndrome, and antipsychotic-induced prolactin elevation. It is generally well tolerated as compared to other dopamine agonist agents due to its more selective D2 receptor agonistic effect. We present a case of a 25-year-old female who developed manic episode, following the use of cabergoline for treatment of pituitary microadenoma. We suggest that physicians should carefully screen patients before initiating cabergoline therapy and at-risk patients may benefit from more frequent monitoring and cessation of therapy at the earliest safe juncture.

Disulfiram Induced Psychosis.

Disulfiram is the commonly prescribed drug for the treatment of alcohol dependence. It's major metabolite (diethyldithiocarbamate) is an inhibitor of dopamine-betahydroxylase, an enzyme that catalyzes the metabolism of dopamine to norepinephrine resulting in psychosis. We recommend that disulfiram should be used at the lowest effective dose, possibly 250 mg daily and caution should be taken while prescribing disulfiram for patients with personal and familial antecedents of psychosis.

A Clinical Study of Opioid Substitution Therapy in a Tertiary Care Center of Eastern India.

BACKGROUND: Opioid substitution therapy (OST) is an evidence-based intervention for opiate-dependent persons that replaces illicit drug use with medically prescribed, orally administered opiates such as buprenorphine and methadone. OST reduces HIV risk behaviors and harms associated with injecting opioid. Most of the evidence for OST effectiveness has been generated in middle- and high-income countries where programs are mostly located in dedicated health-care settings; evidence regarding the outcomes of OST programs in low-income countries where OST is often provided in grassroots settings such as drop-in centers is limited. AIMS AND OBJECTIVES: To study the sociodemographic variables, HIV ELISA status, HIV risk behavior, comorbid substance use pattern, and required dose of buprenorphine used for treatment of injection drug users (IDUs) attending oral substitution therapy (OST) center at a tertiary health care center. METHODOLOGY: A total of IDUs aged 18-60 years who attended the OST center during 1-year period at a government medical college are included in the study. RESULTS: Majority of the IDUs are male with mean age of 32.8 years. The mean dose of buprenorphine used for the substitution was 4.6 mg/day at the start of therapy. Most of the IDUs are of lower educational status and educated up to primary or middle school. 32.50% of the participants who are unemployed are totally dependent on the family. Most common substance abuse among IDU users were tobacco (74.17%), followed by heroine (57.5%). High-risk behavior found among OST clients was unprotected sexual intercourse (19.17%), sharing needle (11.67%), and sexual intercourse with multiple partners (6.67%). HIV ELISA testing showed positive among 2 (1.67%). CONCLUSION: These findings have relevance to other parts of India and Asia, where injecting drug use is common and is a first step toward filling the gap in knowledge regarding the effectiveness of community-based OST programs delivered in resource-constrained settings.

Extrapyramidal side-effects of low-dose aripiprazole in an 11-year-old child.

Partial agonism of D2 and 5-HT1A receptors accounts for the low incidence of extrapyramidal side-effects of aripiprazole. Extrapyramidal symptoms (EPS) during treatment with therapeutical doses of aripiprazole have been reported in adults and children. To the best of our knowledge, no cases of EPS with low doses (5 mg) have been reported until now. In this article, we present an 11-year-old child who developed EPS on low doses (5 mg) aripiprazole. This case emphasizes the need for careful surveillance for the development of EPS in patients treated even with low doses of aripiprazole.

Successful Management of Tardive Dyskinesia with Quetiapine and Clonazepam in a Patient of Schizophrenia with Type 2 Diabetes Mellitus.

Tardive dyskinesia is one of the most significant side effects of antipsychotic medications. Antipsychotic treated schizophrenia patients with diabetes mellitus are more likely to develop tardive dyskinesia than those without diabetes. Clozapine is probably best supported for management of tardive dyskinesia. But clozapine has been strongly linked to hyperglycaemia and impaired glucose tolerance, so it is not preferred in patients with diabetes mellitus. We present a case of 35-year-old male with a diagnosis of schizophrenia and type 2 diabetes mellitus with tardive dyskinesia, who was successfully treated with quetiapine and clonazepam.

Atypical Presentation of Childhood Obsessive Compulsive Disorder.

Obsessive-compulsive disorder (OCD) is one of the most prevalent psychiatric disorders in children and adolescents. The phenomenology of OCD in children and adolescent is strikingly similar to that of adults. But at times, the presentation of OCD may be so atypical or unusual in children and adolescents that may lead to misdiagnosis or delay in diagnosis. We report a case of 10-year-old child who was initially misdiagnosed with schizophrenia, and treated with antipsychotic for 2 months. But once the core symptoms were recognized as obsessions and compulsions and appropriately treated in the line of OCD, the symptoms resolved significantly.

A Case of Schizophrenia Like Psychosis Due to Fahr's Disease.

Fahr's disease (FD) is a rare idiopathic degenerative neurological disorder, which can be present in different heterogeneous manifestations and characterized by bilateral symmetrical cerebral calcification. We present a case of a 55-year-old male who presented with the psychotic feature, bilateral tremors of hand and bilateral symmetrical calcification of basal ganglia. Hence our case suggests that psychiatrists should evaluate the cases of psychosis thoroughly when the age of presentation is atypical, and they should consider the diagnosis of FD when psychosis presents with motor abnormalities.

Childhood Disintegrative Disorder as a Complication of Chicken Pox.

Childhood disintegrative disorder (CDD) is characterized by late onset (>3 years of age) of developmental delays in language, social function and motor skills. Commonly there is no antecedent physical disorder leading to childhood disintegrative disorder. The present case report describes a child who developed childhood disintegrative disorder at the age of 6 years after an episode of chicken pox.

Self-injurious Behavior in a Young Child with Lesch-Nyhan Syndrome.

Lesch-Nyhan syndrome (LNS) is a rare inherited disorder caused by a deficiency of the enzyme hypoxanthine-guanine phosphoribosyl transferase-1. Few reports on behavioral aspects especially self-injurious behavior in LNS patients are available. We report a case of LNS in an 8-year-old male child, who presented with characteristic self-injurious behavior.

Behavioral and emotional manifestations in a child with Prader-Willi syndrome.

Prader-Willi syndrome is a neurodevelopmental disorder characterized by mental retardation and distinct physical, behavioral, and psychiatric features. Maladaptive behaviours, cognitive impairment, and impediments in speech and language seriously affect the early development and long-term functioning of individuals affected by the illness. We present a case of a 9-year-old child with Prader-Willi syndrome whose behavioural symptoms were treated with low-dose antipsychotic medications.

Lithium-Induced Motor Neuropathy: An Unusual Presentation.

Peripheral neuropathy secondary to lithium is under-recognized. Most cases of polyneuropathy were reported with lithium intoxication. However, very few cases were reported without lithium toxicity. We present a case of motor neuropathy due to the use of lithium in a 26-year-old male with a therapeutic lithium level.

Electroconvulsive Therapy in a Child Suffering from Acute and Transient Psychotic Disorder with Catatonic Features.

Electroconvulsive therapy (ECT) is a recognized and effective treatment in adults for several psychiatric disorders. However, the lack of knowledge and experience with the use of ECT among child and adolescent psychiatrists is an obstacle to its appropriate use. Treatment using ECT in children of prepubertal age has been less reported. We present a case of 10-year-old child with a diagnosis of acute and transient psychotic disorder with catatonic features, where we have used ECT successfully.

Mirtazapine withdrawal-induced mania.

Antidepressant withdrawal mania is not a commonly reported occurrence. To date, there is only one published report of hypomanic episode on withdrawal of mirtazapine. A case is presented herein of a patient who experienced manic episode on withdrawal of mirtazapine.

Disulfiram-induced neuropathy: a case report.

Disulfiram is widely used for aversive treatment of alcoholism. Neuropathy is one of the most severe side effects of disulfiram therapy. We report the case of a young man who developed a neuropathy following disulfiram administration, with a virtually complete recovery within 2 months.

Mania following organophosphate poisoning.

Organophosphate poisoning is the most common poisoning in developing countries. Although the acute muscarinic and nicotinic side-effects of organophosphate poisoning are well known and easily recognized, but neuropsychiatric changes are rarely reported. We are reporting a case of a 33-year-old female who developed manic episode following acute organophosphate poisoning.

A clinical study of anxiety disorders in children and adolescents from North Indian children and adolescents clinic.

BACKGROUND AND OBJECTIVES: Anxiety disorders are the most common group of psychiatric disorders in children and adolescents. But few studies on specific anxiety disorders in children and adolescents are available in India. Therefore, this study was planned to identify anxiety disorders in children and adolescents in an Indian psychiatry outpatient setting and elicit its phenomenology and co-morbidities. METHODS: 1465 persons were screened using screen for child anxiety related emotional disorders (SCARED) scale. The screen positive patients were assessed and diagnosis of anxiety disorders was established according to DSM-IV-TR. Detailed assessment of the phenomenology of anxiety disorders was done by K-SADS-PL. RESULTS: 42 (2.86%) patients had different anxiety disorders. Out of which 16 (38.1%) patients had obsessive compulsive disorder, 10 (23.81%) patients with specific phobias, 6 (14.29%) patients with generalized anxiety disorder, 4 (9.52%) patients with social anxiety disorder and 3 (7.14%) patients each with separation anxiety disorder and panic disorder. Co-morbidities were found in 54% of patients with anxiety disorders. Dissociative disorder, specific phobias and social anxiety disorder were the common co-morbidities. INTERPRETATION AND CONCLUSION: Anxiety disorders are less commonly found in clinic settings (2.86%). No case of posttraumatic stress disorder or acute stress reaction was found in this study.

Pediatric anxiety disorders.

Anxiety disorders are the most common group of psychiatric disorders in children and adolescents. Anxiety disorders in children and adolescents can be chronic and disabling, and they can increase the risk of comorbid disorders. Anxiety is associated with substantial negative effects on children's social, emotional and academic success. Identifying and treating children and adolescents with anxiety disorders would reduce the burden of this disorder and may help in better management of the co-morbid conditions in these patients.