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Multiple studies have been done in the past to understand the relationship between seizure and psychosis, still no conclusive point has been found yet. The mechanism behind the relationship is unknown. Seizures may cause brain damage, increasing the chance of schizophrenia and psychosis, or the two illnesses may share etiological elements. We present a case of a 45-year-old male with a prior history of viral meningoencephalitis, axonal motor polyneuropathy, encephalopathy, and well-controlled generalized tonic–clonic seizures. However, the patient presented to us with a new onset of behavioral disturbances in the form of severe aggression, disinhibition, homicidality, and suicidality during treatment with multiple antiepileptics drugs but with no response to multiple antipsychotics. This patient had an adequate response to clozapine and modified electroconvulsive therapy. No such case has been reported in literature, till date. During the phase of forced normalization, the patient may experience behavioral issues following the management of their seizures with antiepileptic medications and the normalization of their electroencephalography. Any unusual behavior observed in epilepsy patients following the initiation of therapy and seizure control should alert clinicians to the likelihood of this condition.

Ethambutol is the primary commonly used antitubercular drug for the treatment of tuberculosis and atypical mycobacterial infection. Central nervous system toxicity other than optic neuropathy is not widely reported. We describe a case of a 46-year-old female with abdominal tuberculosis who developed mania after the commencement of ethambutol, and symptoms fully resolved with its cessation. She was prescribed rifampicin, pyrazinamide, isoniazid, and ofloxacin and has no further manic symptoms. This case supports that the patients being treated with ethambutol can develop mania which improves quickly within days of stopping it. A trial of antimanic drugs is needed for short-term rapid improvement of manic symptoms, whereas other anti-tubercular medications can be continued safely.

Cyproheptadine hydrochloride(CH)- and dexamethasone-induced obsessive-compulsive symptomatology with suicide is extremely rare. We describe the case of a 20-year-old lean male who developed obsessive-compulsive symptoms and suicidality within a week of the use of CH and dexamethasone. There was complete resolution of symptoms after stopping the offending agent. Ashort trial of selective serotonin reuptake inhibitor was given for the rapid improvement of symptoms.

Background: Although lithium is known to cause thyroid dysfunction and increased thyroid gland volume, clinical examination and biochemical assessment are fundamental to thyroid workup of patients on lithium treatment. We aimed to determine thyroid gland volume and the Thyroid hormone levels of patients who have been receiving lithium treatment for affective disorders in comparison to voluntary healthy controls. Methods: This was a cross-sectional, hospital-based observational study which was performed in 43 patients on long-term lithium treatment for bipolar disorder, major depressive and schizoaffective disorders. Patients with documented continuous and adequate serum lithium levels for more than or equal to 6 months recruited consecutively underwent the ultrasonographic examination of the thyroid gland. Ultrasonographic examinations were also done in all gender- and age-matched healthy controls. All cases and controls underwent biochemical thyroid function tests. Results: There were no statistically significant differences in gender (P = 0.198; Chi-square = 1.654) of cases and controls. Most of the cases were married, maximum number of them unemployed and belonged to the lower socioeconomic status. Total thyroid volume was significantly greater in the lithium-treated group than the controls (9.40 ± 1.41 vs. 4.79 ± 0.45). Clinical inspection and palpation only detected goiter in six (n = 6, 13.95%) of patients on lithium and none among controls. The mean triiodothyronine, mean thyroxine, and mean scores for thyroid-stimulating hormone were significantly increased in patients receiving lithium therapy as compared to controls. Conclusion: It would seem wise from a clinical point of view to include ultrasonographic examination of the thyroid gland as part of the standard thyroid workup before initiating lithium treatment.

Background: Although lithium is known to cause thyroid dysfunction and increased thyroid gland volume, clinical examination and biochemical assessment are fundamental to thyroid workup of patients on lithium treatment. We aimed to determine the thyroid gland volume and the thyroid hormone levels of patients who have been receiving lithium treatment for affective disorders in comparison to voluntary healthy controls. Materials and Methods: This was a cross-sectional, hospital-based observational study, performed in 43 patients on long-term lithium treatment for bipolar disorder, major depressive disorder, and schizoaffective disorder. Patients with documented continuous and adequate serum lithium levels for more than or equal to 6 months recruited consecutively underwent ultrasonographic examination of the thyroid gland. Ultrasonographic examinations were also done in all gender- and age-matched healthy controls. All cases and controls underwent biochemical thyroid function tests. Results: There were no statistically significant differences in gender (P = 0.198; χ2 = 1.654) of cases and controls. Most of the cases were married; maximum number of them unemployed and belonged to the lower socioeconomic status. Total thyroid volume was significantly greater in the lithium-treated group than the control group (9.40 ± 1.41 vs. 4.79 ± 0.45). Clinical inspection and palpation only detected goiter in six (n = 6, 13.95%) of patients on lithium and none among controls. The mean triiodothyronine (T3), mean thyroxine (T4), and mean scores for thyroid-stimulating hormone were significantly increased in patients receiving lithium therapy as compared to controls. Conclusion: It would seem wise from a clinical point of view to include ultrasonographic examination of the thyroid gland as part of the standard thyroid workup before initiating lithium treatment.

Background: Menopausal transition (MT) is the period of irregular menstrual activity which directly precedes menopause and is characterized by widely fluctuating hormone levels and reproductive, metabolic, and psychological disturbances. We aimed to study the prevalence of psychiatric comorbidity among ambulatory women in MT. Materials and Methods: One hundred consecutive ambulatory women in MT were assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria by means of the Mini-International Neuropsychiatric Interview, English version 5.0.0. The diagnosis of MT was made according to the Stages of Reproductive Aging Workshop. Results: About 28% of the cases had major depressive disorder (MDD), 14% had anxiety disorders, and 7% had anxiety with depression. A statistically significant difference in psychiatric comorbidity was found between the age groups of 45–50 years and 51–55 years. There was a statistically significant difference between onset of menarche and psychiatric comorbidity. Women in the late MT had statistically significant sleep disturbances. Conclusion: A high prevalence of mental disorders was observed which included MDD and other anxiety disorders. The results suggested that screening and appropriate management for psychiatric disorders should be part of the routine evaluation that would help in early recognition of symptoms and reduction in discomfort of these symptoms.

Introduction: Hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infection among IDUs is an emerging trend. Opioid substitution therapy (OST) is an evidence-based treatment for opiate-dependent clients that replaces illicit drug use with medically prescribed, orally administered opiates such as buprenorphine. The objective of this study was to determine the sociodemographic variables; seroprevalence of HIV, hepatitis B, and hepatitis C; associated risk behaviors; comorbid substance use pattern; and psychiatric comorbidity among injection drug users (IDUs). Methods: A total of 57 IDUs aged between 18 and 60 years who attended the OST center during 4 months period of a government medical college in North India were included in the study. Results: All of the IDUs were males with a mean age of 26.55 ± 7.26 years. The mean dose of buprenorphine used for the substitution was 6.24 ± 2.4/day at the start of the therapy. Most of the patients were unemployed, with a maximum of them studied up to high school level. The most common substance abuse among IDU users was tobacco 47 (82.46%), followed by Cannabis 23 (40.35%). High-risk behavior found among OST clients was sharing needles (29.82%), unprotected sexual intercourse (12.28%), and sexual intercourse with multiple partners (3.51%). HCV testing showed positive among 9 (15.78%) clients. Conclusion: Oral substitution with buprenorphine is an effective harm reduction strategy for preventing HCV, HBV, and HIV among IDUs. Buprenorphine is a safe compound, with minimal side effects and minimal chances of overdoses.

Background: Frontline healthcare workers (FHCWs) are at an increased risk of contracting COVID-19. We aimed to assess the stress and psychological impact of the COVID-19 pandemic among FHCWs. Methods: This was an exploratory hospital-based study. A semistructured e-questionnaire was developed and shared through emails, WhatsApp groups, Facebook, and Twitter. The study instruments used were stress questionnaire and the impact of event scale—revised. Results: We received 133 valid responses. A total of 81 (61.4%) of the respondents were single, 74 (55.6) were male, 70 (52.6%) were between 20 and 29 years of age, and 91 (68.4%) were from urban background. A total of 83 (62.4%) of respondents were doctors and 28 (21.1%) were registered nurses. A total of 36 (27.1%) were posted in emergency and 34 (25.6%) were in the in-patient department. Feeling sad and pessimistic, feeling of being avoided by others, the burden of change in the quality of work, and worrying whether the family will be cared for in their absence were significantly more in nurses as compared to the doctors. Stress due to burden in an increase in the quantity of work was seen more in FHCWs working in the swab collection center as compared to those working in the in-patient department, emergency, or theaters. Severe psychological impact was seen in 81 (60.9%) of FHCWs. The psychological impact was significantly more in males and in those who were married. It was also significantly related to the place of posting. Conclusion: More than half of the FHCWs had a severe psychological impact owing to COVID-19. The psychological impact was more in males and those who were married, and it was related to the place of posting of the FHCWs. Nurses had significantly higher stress as compared to doctors.

Background and Aims: Globus is the physical sensation of a lump in the throat presenting as difficulty in swallowing. Since there is a paucity of literature regarding the psychiatric comorbidity in globus, we aimed to study the psychiatric comorbidities in these patients visiting a tertiary care center in Kashmir. Materials and Methods: It was a noncontrolled, noninterventional, cross-sectional, hospital-based study carried out from August 2014 to July 2015 among the patients with a diagnosis of globus. Patients were selected from the outpatient unit, visiting the Institute of Mental Health and Neurosciences Kashmir. About 51 patients with globus who fulfilled the inclusion criteria and gave written informed consent were selected as study cases. For diagnosing psychiatric comorbidities, we used the Mini-International Neuropsychiatric Interview. Results: The mean age of our cases was 39.58 years. Females outnumbered males in cases by a ratio of 3:1 approximately. Psychiatric disorders were seen in 70.588% of globus patients. Major psychiatric disorders seen in our patients were major depressive episode (23.53%) and generalized anxiety disorders (11.76%). Conclusions: Majority of patients with globus who present to a tertiary care center have comorbid psychiatric disorders. We need to screen these patients for such comorbidities and develop a holistic approach for better outcome in such cases.

[This corrects the article DOI: 10.1371/journal.pone.0240152.].

BackgroundCoronavirus disease-19 (COVID-19) has not only spawned a lot of stigma and discrimination towards its survivors but also to their corpses. We aimed to assess the magnitude and correlates of stigma in these survivors, on return to their communities.MethodsThis was a cross-sectional, hospital-based, exploratory study conducted by the postgraduate department of psychiatry, in collaboration with the postgraduate department of chest medicine, Govt. medical college, Srinagar. The study was performed among COVID-19 survivors, who attended the outpatient department after their discharge from the hospital. Socio-demographic characteristics were recorded through semi-structured proforma. Stigma was measured by the stigma questionnaire. Data was analyzed using descriptive statistics and regression analysis.ResultsA total of 91 survivors consented to participate in the study. Almost half (46.2%) of them were in the age group of 30-49 years and close to two-thirds (68.1%) were males. About three-fourths (74.7%) were from the urban background. The mean time from hospital discharge to study entry was 11.7±5.1 [Range(R) = 7-21] days. 98% of survivors provided at least one stigma endorsing response and the total mean stigma score was 28.5±7.1[R = 6-39]. The mean stigma sub-scores were highest for enacted stigma (7.6±1.8) [R = 2-9] and externalized stigma (15.0±4.1) [R = 1-20]. Enacted stigma was significantly high in males as compared to females. Enacted stigma and internalized stigma were both associated with education. Enacted stigma, externalized stigma, disclosure concerns, and total stigma was significantly associated with the occupation. Being unemployed and time since discharge were identified as independent predictors of total stigma.ConclusionOur study results showed high levels of enacted and externalized stigma among COVID-19 survivors. Enacted stigma was more among males and in those who were highly educated. Survivor centered and community-driven anti-stigma programs are the need of the hour to promote the recovery and community re-integration of these survivors.