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The article presents letter to the editor focuses on a case of Dhat syndrome presenting as a psychiatric emergency, highlighting the cultural context of the condition. Topics include the patient's psychological distress linked to perceived semen loss, the resulting suicidal and aggressive behaviors, and the importance of timely mental health intervention and psychoeducation for traditional healers.

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. [ABSTRACT FROM AUTHOR]

Background: Personality disorders (PDs) comprise deeply ingrained and enduring behavioral patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations. Our aim was to study sociodemographic profile and parental attitudes in patients with PDs and their comparison with healthy controls. Materials and Methods: It was an observational case-control study conducted in Department of Psychiatry, Government Medical College, Srinagar, J and K, India. A total of 41 cases and 163 controls were selected. Patients were diagnosed using Diagnostic and Statistical Manual-5 (DSM-5) criteria. Childhood Trauma Questionnaire was used for parental attitudes. Results: The mean age of patients and controls was 22.41 (standard deviation [SD] = 4.14) and 22.52 (SD = 4.15), respectively. Majority of the participants were females, single, were from nuclear families, and belonged to upper-middle socioeconomic class. Most of the patients were borderline PD (BPD), followed by histrionic PD. The frequency and inappropriateness of punishment by parents was more in patients than controls. Conclusion: A positive correlation was seen between PDs and inappropriate parental attitudes and rearing styles. Therefore, it is required to have a better understanding of PDs and to help parents to develop skills to handle their children with utmost care in distress. [ABSTRACT FROM AUTHOR]

Abstract Epistaxis is an important otorhinolaryngological emergency, which usually has an apparent etiology, frequently local trauma in children. Here we present a case report wherein the epistaxis was recalcitrant, and proved to have a psychiatric disorder as an underlying basis. The child was diagnosed with Attention Deficit/Hyperactivity Disorder, hyperactive type, which led to trauma to nasal mucosa due to frequent and uncontrolled nose picking. Treatment with atomoxetine controlled the patient's symptoms and led to a remission of epistaxis.

Abstract Introduction Tennis elbow is a common musculoskeletal disorder; management options include physiotherapeutic, medical, surgical, and other forms of intervention. Some patients remain symptomatic despite best efforts. We present two patients who did not respond to medical and surgical treatments, and whose symptoms were relieved with duloxetine. This is the first report on the use of duloxetine to treat tennis elbow. Case presentation Two mentally healthy young Asian women aged 32 and 27 years, each with tennis elbow of about 18 months duration continued to suffer pain despite treatment with analgesics, local steroid injections, physiotherapy, cryotherapy, ultrasound, and surgical release, among other interventions. Both showed substantial improvement within 4 to 6 weeks of receiving monotherapy with duloxetine 60 mg/day. Both were pain-free with continued treatment at a 6-month follow-up. Conclusion Duloxetine may be a useful treatment option in patients with chronic tennis elbow, even those who have failed conventional medical, physiotherapeutic, surgical, and other forms of management.

Abstract Cotard's syndrome is a rare syndrome, characterized by the presence of nihilistic delusions. The syndrome is typically related to depression and is mostly found in middle-aged or older people. A few cases have been reported in young people with 90% of these being females. We present a case of a young pregnant woman suffering from Cotard's syndrome. This is the first report of this syndrome in a pregnant woman. The case was diagnosed late, due to lack of awareness of psychiatric problems in primary care physicians resulting in undue suffering, loss of precious time and resources for the patient. Besides highlighting the rare combination of pregnancy and Cotard's syndrome this report delineates the difficulties faced by patients with such symptoms in a low resource setting.

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. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is a common chronic metabolic disorder characterized by hyperglycemia. Minimal attention has been paid toward the relationship between diabetes and depression in developing countries such as India, despite a number of studies in developed countries, exploring casual pathway between the two highly prevalent conditions. The aim of this study was to estimate the prevalence and severity of depression among patients of diabetes attending the endocrinology department of a tertiary care hospital of Kashmir. Methodology: A total of 527 patients having diabetes of ≥6 months with age ranging from 18 years to 60 years were screened for major depressive disorder (MDD) using Diagnostic and Statistical Manual IV-based criteria. Severity of depression was assessed by the Montgomery–Asberg Depression Rating Scale. Results: Depression was present in 39.65% of patients. Depression was more prevalent in the age group of 29–38 years, in females as compared to males, among literates and government employees. Prevalence of depression among Type 1 diabetic patients was 60%, while as in case of Type 2, it was 37.75%. Depressed patients had higher fasting blood glucose levels as compared to nondepressed diabetic patients. Conclusion: MDD is inordinately high among adult diabetic patients, and majority of the depressive patients have moderate intensity of MDD. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the improvement in neurological deficit following late decompression and stabilization of the fractured thoracolumbar spine., Methods: Between January 2001 and August 2004 neurological recovery in 120 thoracolumbar fractures was studied after posterior stabilization at the Hospital for Bone & Joint Surgery, Srinagar, India. There were 88 male and 32 female patients. Fall from a height, usually a tree, was the most common (90%) cause of injury. Seventy-six patients (63%) had neurologic deficit at the time of presentation. The unstable spine was fixed, between 4-18 days after trauma, by posterior short segment instrumentation (Steffee). Neurological recovery for the patients was recorded in the follow-up period. Frankel grade was used to assess the neurological status. The average follow-up period was 25 months (range 8-44 months), and average age was 34 years (18-54)., Results: There were 40 patients (30%) with an incomplete neurological deficit, namely, patients with Frankel grade B, C, and D. Two grades of improvement were found in 8 patients, and one grade improvement in 32 patients with incomplete lesion. Only one third of the patients with complete neuro deficit improved at the final follow-up. The overall result of the surgery for partial lesions was an improvement of at least one Frankel grade in all cases, but no improvement in most of the cases with complete lesion., Conclusion: This study demonstrates a clear relationship between the level of injury and Frankel grades, translational injuries are associated with a more severe neurologic grade, and surgical intervention appears to improve the neurological outcome, even when the intervention is inadvertently delayed (average 7.9 days).