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The characteristic symptoms of normal pressure hydrocephalus are dementia, urinary incontinence and gait disturbance. Psychiatric symptoms make their appearance usually after the characteristic symptoms. In some cases, however, prominent psychiatric symptoms are the presenting picture even before the cognitive decline is evident. A case of NPH is discussed which presented with psychotic depression along with urinary incontinence. CT scan showed dilated supratentonal ventricular system and normal fourth ventricle. There was slight widening of cortical sulci. The cognitive impairment set in later during the course of illness. The psychiatric symptoms responded fairly well to a course of ECT and antidepressant drugs.

The mentally retarded subjects show a much higher prevalence of full range of psychiatric disorders than the non-retarded population. Whereas the role of psychotropic drugs in such patients is well discussed, the reports on the use of ECT are scarce. Many psychiatrists dealing with the mentally retarded psychiatric patients are reluctant to consider ECT due to lack of adequate experience. We report five mentally retarded patients with different psychiatric disorders who were successfully treated with ECT after failing adequate trials of pharmacotherapy. No disproportionately higher adverse events on account of mental retardation were observed. ECT need to be favorably considered in mentally retarded persons with psychiatric morbidity especially when treatment with psychotropic drugs either fail or is intolerable.

Significant but subtle abnormalities in the thyroid functions in depressive patients, have been reported. Basal thyroid functions of 33 drug naive depressive patients having first episode of illness were compared with 31 healthy matched controls. The mean value of total thyroxin (T(3)) was significantly higher in depressives. Total triiodothyronine (T(3)) was lower in depressive patients but the difference was not significant. The mean value of thyroid stimulating hormone (TSH) was comparable in the two groups No significant difference was found with respect to total T(4) and total T(3) when depressive patients with various subtypes of depression were compared. But depressive patients with psychotic features had significantly higher mean value of TSH as compared to those without them. The findings are discussed in relation to the available literature.

With recent advances in molecular genetics, a new mechanism proposed for the inheritance of Bipolar Disorder is Genomic Imprinting or Parent of Origin Affect. In this study of 79 consecutive first episode manic patients, predominantly male, we failed to establish the phenomenon of imprinting. With other proposed non-Mendelian patterns of inheritance, it may be that bipolar disorder is genetically heterogenous.

Transsexualism is a rare disorder with an uncertain aetiology. Recently, biological factors have been considered to be important in its occurrence. The relationship of transsexualism with psychosis is not known; in most cases no specific relationship exists, though few cases of symptomatic transsexualism have been reported. In the following case, cross dressing and homosexual orientation was present from an early age, but gender dysphoria became manifest only after the onset of an acute psychotic episode. The implications of such a finding are discussed.