ANCIPS – 2025 – E-POSTERS

Section 359

Col Virendra Vikram Singh 1 , Maj Parveen Kumar, Maj Sandeep HoD, Psychiatry Department, Base Hospital, Barrackpore Email: [email protected] Stroke is not often suspected in young patients. The prevalence of stroke in young adults aged 20 to 34 is 0.4%. Stroke is associated or followed by psychotic symptoms in some cases. However, stroke presenting without any physical symptoms but only psychosis is rare. We present a case of 34-year-old male who developed acute psychosis characterised by perplexed and fearful affect, delusion of persecution and reference, and transient third person auditory hallucinations. Evaluation revealed rt sided caudate infarct on CT scan of head. The infarct timeline matched with the onset of symptoms suggesting them to be related. Patient however did not have any physical symptoms related to stroke. The case report highlights importance of screening for organicity in acute psychosis and atypical presentation of stroke.

Section 361

Dr. Mohamed Hakkim, Dr. Nirmal S.R., Dr. Muralitharan. Dr. Jai Singh 1. Junior Resident 2. Prof and HOD 3. Professor, Dhanalakshmi Srinivasan Medical College Hospital, Siruvachur, Perambalur, Tamil Nadu Background: Persistent delusional disorder is a rare psychiatric condition characterized by the presence of fixed delusions lasting for an extended duration. Olfactory delusions, although uncommon, can significantly impair the quality of life. Case Report: 57-year-old male came with a 20-year history of delusions involving foul smell following an unusual and distressing experience. Collateral history was collected to corroborate the delusional beliefs and assess psychosocial impairments. The patient’s belief system, behaviour patterns, and duration of illness were analysed in the context of cultural influences and stigma. The patient attributed the foul smell originating from his nose and mouth to a long-standing infection following sexual interactions with a dog during his time in Saudi Arabia. He exhibited frequent mouth washing, social withdrawal, and preoccupation with his delusional beliefs. Despite no confirmatory medical findings of infection or physical abnormalities, the delusion persisted, significantly impairing his social and occupational functioning. Conclusion: This case underscores the interplay of culture, guilt, and stigma in the development and persistence of olfactory delusions. Early intervention and a culturally sensitive therapeutic approach are critical for improving outcomes in such cases. Key words: delusions, olfactory, culture

Body

Dr Anshuli Tiwari 1 , Dr Mazher Ali 2 , Dr Minhajzafar Nasirabadi 3 , Dr Bipin Sethi 4 , Dr Vinoothna Chowdary Athaluri 5 1. Post Graduate, Dept of Psychiatry, Deccan College of Medical Sciences 2. Assistant Professor, Dept Of Psychaitry, Neelima Institue of Medical Sciences 3. Professor and HOD, Dept of Psychiatry, Deccan College of Medical Sciences 4. Consultant Endocrinologist, Care Hospitals Email : [email protected] Background & Aims : Body Dysmorphic Disorder (BDD) is a mental health condition characterised by excessive concern over perceived physical flaws. Its prevalence among individuals with Type 1 Diabetes (T1D) remains largely unexplored. Considering the unique psychological and physical challenges faced by T1D patients, it is important to assess the potential impact of BDD within this group. Methods: This cross-sectional study was conducted among patients attending an endocrinology clinic. Participants were screened for BDD using the Body Image Disturbance Questionnaire (BIDQ), and clinical interviews were conducted to assess whether they met the DSM-V criteria for BDD. Results: Among the 140 participants, 57% expressed concerns about some aspect of their appearance. The prevalence of BDD, meeting DSM-V criteria, was 19%, notably higher than the 1.7–2.9% prevalence in the general USA population. Of those diagnosed, 52% were female and 48% male, with a mean age of 21 years. Females were primarily dissatisfied with their weight, hair, skin, thighs, and teeth, whereas males expressed concerns over tummy fat, muscle build, and eyes. Conclusion: This study reveals a significant prevalence of BDD in individuals with T1D, emphasising the need for targeted psychological support and interventions to address body image concerns in this population. Keywords: BDD, Type 1 Diabetes, BDIQ

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Dr. Tayade Harshali Junior Resident-2, Department of Psychiatry, BJGMC & Sassoon General Hospital, Pune Maharashtra, India. Email: [email protected] Background & Aims: Renal failure is associated with many subtle and several distinct alterations in neuropsychiatric function. Methods : 73-year-old male with sudden onset behavioural disturbances was admitted. He was started on low dose antipsychotics. After 2 days, his general medical condition worsened with abnormal LFT, RFT. USG (A+P) was s/o renal parenchymal disease and cystitis. Results: Psychotropics were withheld and the patient was transferred to the medicine ward where he was treated. Psychiatry review revealed improvement in his behavioural disturbances. Conclusion: A collaborative liaison between the nephrologist and psychiatrist is required to identify and treat the neuro psychiatric disturbances arising in a case of renal dysfunction. Key words: Acute kidney injury, sudden behavioural disturbances, renal failure.

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Dr. Sudeepti singh Department of Psychiatry, BJ government medical college, Pune. Email: [email protected] Introduction: Neurocysticercosis, a parasitic brain infection caused by Taenia solium, often presents with neurological symptoms, complicating diagnosis when psychiatric symptoms co-occur. Dissociative disorders can mimic neurological conditions, creating challenges in overlapping physical and psychological presentations. Case details: A 28-year-old married female presented with recurrent headaches and episodes of loss of consciousness following family conflict. A CT scan revealed a calcific nodule (9.8 mm x 7.4 mm) consistent with grade 4 neurocysticercosis. Her symptoms suggested stress-induced dissociative/conversion disorder. Amitriptyline improved her symptoms, and levetiracetam addressed potential seizure-like activity. She relapsed after another psychosocial stressor, raising questions about the primary cause. Discussion: This case highlights the complexity of diagnosing coexisting neurocysticercosis and dissociative disorder. Differentiating neurological from psychological origins is crucial for effective treatment. Conclusion: Neurocysticercosis with comorbid dissociative disorder requires a multidisciplinary approach for optimal management. Keywords: Neurocysticercosis, dissociative disorder, conversion disorder, psychosocial stress, multidisciplinary management.

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Dr Dyuthy R, Associate Specialist, Department of Psychiatry, TATA Main Hospital, Jamshedpur, Email: [email protected] Dr Devu R, Senior Resident, Department of Cardiology, Government Medical College, Thiruvananthapuram. Email: [email protected] Background: Cyclical migraine and depression significantly impact quality of life. This case report presents a unique 20-year history of a patient experiencing concurrent cyclical migraine and depression, complicated by familial stigma. Case: A 44-year-old lady presented with annual cyclical migraine and depressive episodes, occurring in October and November. Symptoms included severe migraine headaches, depressive episodes, and significant stress due to familial stigma. This stigma exacerbated her emotional distress and hindered effective treatment. Method: A comprehensive medical history, physical examination, investigations, and detailed evaluations of family dynamics were done to rule out other potential causes Result: Treatment involved preventative measures, breaking the cycle with Cap. Venlafaxine 150mg, Tab. Sodium Valproate(1000mg), Tab. Amitriptyline (50mg), and Tab. Propranolol (120mg), along with Tab. Frovatriptan (2.5mg) and Tab. Ibuprofen(400mg) as needed, and lifestyle modifications. Conclusion: This case highlights the complex interplay between cyclical migraine, depression, and familial stigma, emphasizing the need for comprehensive management strategies. Keywords : Cyclical Migraine, Cyclical Depression, Family Dynamics.

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Dr Nisha A George, Dr Sanath, Dr Peri Sowmya, Dr Anuraag Aedma, Brig (Dr.) P S Bhat (Retd) Dept of Psychiatry, Rural Medical College, Loni, Maharashtra. Email: [email protected] Background : Happiness, a subjective experience of joy and well-being, can be significantly affected by stress, which impacts the emotional health, productivity, and patient handling abilities of young doctors. Aim : To assess the happiness levels of medical interns at a rural tertiary care hospital in Maharashtra and correlate them with demographic variables and perceived stressors. Methodology : Interns were given the Oxford Happiness Questionnaire and a form addressing demographics and stressors. A sample of 150 was targeted, with data analyzed using statistical tools. Results : 120 responses were received, with an average age of 24.4 years. Females reported higher happiness than males. Major stressors included exams and career uncertainty, with movie watching as a common coping strategy. Conclusion : The primary stressors for young doctors were post-graduation exams and the uncertainty regarding their future careers. These factors significantly impacted their happiness and well-being. Keywords: Happiness, Interns.

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1 Dr Rachana Chandekar 2 Dr Avinash Shukla 1 Pt JNM Medical College Raipur, 2 District Hospital Raipur Email: [email protected] Background: Migraine is a common disorder that affects 12-15 percent of the general population. Affecting females more than males. Introduction: Retinal migraine is a rare condition that is characterized by repeated attacks of monocular scotoma or blindness lasting less than one hour followed by headache. Case Report: A 36-yr old female experienced episodic unilateral headaches starting from the left side gradually getting generalised which is preceded by partial loss of lateral field of vision lasting for half an hour, since age 16 with no known precipitating factor. Clinical Course: Annual episodes (2003-2005), followed by a 10-year remission. Postpartum recurrence (2015) led to comprehensive investigations (MRI, CT, EEG, ophthalmological evaluation), revealing no significant abnormality. Diagnosis and Management: Diagnosed with retinal migraine in 2021. Initial treatments (carbamazepine, valproate) were discontinued due to side effects. Topiramate (50 mg BD) provided stability. Conclusion: This case highlights challenges in diagnosing and managing retinal migraine, emphasizing thorough history-taking, normal investigative findings, and pharmacological management trials. Key words: Migraine, Retinal Migraine.

Cases

Abhimanyu Sinha 1 , Archana Javadekar 2 , Suprakash Chaudhury 3 1.Department of Psychiatry, Junior Resident, DY MEDICAL COLLEGE, Pune, Maharashtra. Email: [email protected] Background: Hyponatremia, defined as serum sodium <135 mEq/L, causes symptoms below 130 mEq/L, leading to severe complications if untreated. Psychiatric manifestations include confusion and mood fluctuations, though the latter is rare. Mood Disorders: Characterized by mood shifts, from depression to mania, requiring treatment with antidepressants, mood stabilizers, and antipsychotics, many of which can cause hyponatremia (e.g., SSRIs, antiepileptics, and antipsychotics). Case Series, Discussion and Conclusion: Patients with mood changes (depression or mania) linked to hyponatremia showed symptom improvement with sodium correction. Highlights the need for regular sodium level monitoring in mood disorder treatments. Key words: Hyponatremia, mood changes, mania, depression.

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Dr. Koustubh Bagul, Associate professor, MGM Medicial College And Mental Hospital, Indore. Email: [email protected] Background : Medical residency, particularly psychiatry, involves high stress due to workload and emotional challenges. Understanding stress and coping mechanisms among psychiatry residents in India is crucial for developing support strategies. Objective : To assess stress levels and coping mechanisms among psychiatry residents in Central India. Methods : Cross-sectional survey using structured questionnaire evaluating sociodemographic factors, work environment, Perceived Stress Scale, and coping strategies. Results : Most residents reported moderate to high stress, correlating with long work hours and insufficient support. Those using adaptive coping strategies showed lower stress compared to maladaptive mechanisms. Sleep quality and physical activity negatively correlated with stress. Conclusion : Findings emphasize need for targeted interventions promoting adaptive coping strategies and institutional support for resident well-being. Keywords : Psychiatry residents, stress, coping mechanisms, adaptive strategies, mental health, institutional support.

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Sharma S, Assistant Professor, Bajpai S, Sharma PK, Timothy A Army Medical College of Sciences & Base Hospital Delhi Cantt. Email: [email protected] Background : Adrenal insufficiency has been associated with psychiatric symptoms, including psychosis. Hormonal dysregulation impacts stress response and cognitive functioning, yet the link between adrenal insufficiency and psychosis remains underexplored. Aims : To highlight Addison’s disease with predominant psychiatric symptoms. Methods : A 24-year-old male presented with hyperpigmentation, weakness, weight loss, postural symptoms, irrelevant talk, and hallucinations. Investigations showed normal Cortisol, raised ACTH, decreased aldosterone-renin ratio, positive 21 Alpha hydroxylase antibody, and BPRS score of 45. Results : Neuropsychiatric symptoms, though rare, might be first manifestation, with good prognosis if diagnosed early. Conclusion : Adrenal insufficiency may significantly influence psychotic symptoms, particularly with cortisol deficiencies. Early detection could reduce psychosis risk, emphasizing need for interdisciplinary care. Key words: Adrenal Insufficiency, Psychosis.

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Dr Nayni Bajaj PG student, Dr Sanjay Gehlot, senior professor and Head of department, Department of psychiatry, Dr SNMC jodhpur Email: [email protected] Introduction: Pica involves compulsive consumption of non-food items, often linked to psychiatric disorders. Case Report: A rare case of sapophagia (soap eating) in a 22-year-old male with iron deficiency anemia. Consuming 2–4 soap bars weekly for two years, he experienced anxiety and unusual tongue sensations when unable to eat soap. Persistent anaemia despite iron therapy was attributed to the soap’s alkaline properties hindering absorption. Diagnosis and treatment: Diagnosed as part of the obsessive-compulsive spectrum, he was treated with Fluoxetine (20 mg/day), showing initial improvement but relapsing after discontinuation. Increasing the dose to 40 mg/day achieved remission within two months, sustained for six months with continued therapy. Conclusion: This case underscores pica’s dual role in anaemia and highlights serotonin’s role in compulsive behaviours. Effective interdisciplinary management and SSRI therapy are crucial for treating rare presentations like sapophagia. Keywords: Sapophagia, OCD spectrum, Anaemia.

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1Dr. Anwesha Pal 2Dr.M.K.Sahu, Pt. JNM Medical College, Raipur, Chhattisgarh Email: [email protected] Background: Non suicidal self-harm behaviour or non-suicidal self-injury refers to the deliberate damaging of one’s own body tissue without any suicidal intent. Lifetime prevalence accounts for around 5% of population. It includes behaviours like cutting, scratching, hitting oneself and intentional drug overdose. Aim: To assess prevalence of non-suicidal self-harm behaviour in a tertiary care hospital. Method: This study was conducted in dept of psychiatry, Pt. JNM College from September 2023 to sept 2024. All adult patients 18-60 years age group referred to psychiatry opd with suicidal attempts were included in study. Patients were assessed on CSSR-S (Columbia Suicide Severity Rating Scale). Result: Out of 140 subjects, 96 patients were finally included in study. Males were slightly over represented (58%). Most common method of self-harm was poisoning (78%). The most common reason was financial constraints followed by Interpersonal conflicts. Conclusion: Non-suicidal self-harm behavior is different from suicidal attempt and requires different approach for management. Differentiation of NSSI from suicidal behavior can help better utilization of mental health services. Keywords: Self-harm, Suicide.

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Dr Pamidimukkala Hasitha, Dr Sudarshan C Y, Dr Shantheri R Pai, Dr M N Prerana Prasad Department of Psychiatry, JJM Medical College, Davangere, Karnataka Email: [email protected] Background and Aims : Body image perception influenced by social media fuels dissatisfaction, leading to poor mental health. This study aims to explore relationship between body image satisfaction and socialmedia use Methods : This observational, cross-sectional survey included 90 medical students and interns in a medical college. Data about socio-demographics, social media usage, and Body Self-Image Questionnaire (BSIQ) were collected using Google forms. Those with medical or psychiatric illnesses and incomplete forms were excluded. Results : Median age of the sample was 26 years, 61.1% were females, and 48.9% postgraduate students. Everyone was using social media, 91% daily. Median time spent was 2.0 hours/day. 94.4% were using Instagram. Mean BSIQ score was 75.29, indicating 75.6% had body dissatisfaction. Significant association was found between type of content followed, self-comparison, replication of trends, and mood secondary to online activity with body self-image. Conclusion : Considerable influence of social media on body image perception was noted highlighting need for more body positive content on social media. Key Words : Body image perception, social media

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Maj (Dr.) Shradha Khatri Department of Psychiatry, 174 Military Hospital Email: [email protected] Introduction: A 29 yrs. old lady, construction labourer, educated till 8 th std, married, has 03 children, youngest 2 yrs old, hailing from a low socio-economic status joint family, with past h/o low back work-related injury presented with acute onset pain abdomen, nausea, explosive diarrhoea and flu-like symptoms. Initially, managed conservatively. After 08 hours of hospitalization, her breastfeeding child also developed similar symptoms and she was evaluated for substance use. Aims & Objective: To discuss a case of a young breast-feeding mother with presenting with Opioid withdrawal. Material & Method: She was referred by her treating physician for evaluation of substance use disorder. Results: She and her infant were diagnosed as a case of Opioid Dependence Syndrome. Initially, managed for withdrawal syndrome and then for de-addiction along with pain management. Conclusion: Identification and management of Opioid use disorder requires a high suspicion, close monitoring, longitudinal follow ups along with pharmacotherapy, socio-occupational supportive measures and an empathetic-holistic approach. Keywords : Opioid withdrawal, breast-feeding mother, Opioid Dependence Syndrome

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Dr. Jaivardhan 1 , Dr. Akshay Jadhav 2 , Dr. Anuraag Aedma 3 , Brig(Dr)P S Bhat(Retd) 4 Junior Resident 2 Assistant Professor 3 Associate Professor 4 Professor and HOD Department of Psychiatry, Rural Medical college, Loni, Maharashtra. Email: [email protected] Introduction Delusional Parasitosis (DP) is a condition in which patients believe they are infested with parasites despite no objective evidence. It can be primary or secondary to psychiatric disorders, drug abuse, or medical conditions. Dopamine dysregulation, including inhibition of dopamine reuptake, is thought to contribute to symptoms like formication. Psychiatric patients often experience more frequent pruritus than non-psychiatric individuals. Case Summary A 79-year-old woman developed dryness and itching three years ago, eventually using a handkerchief to “dust off” perceived insects. After partial improvement with psychiatric medication, she stopped treatment due to sedation. Symptoms recurred, and she began undressing to remove the insects. Diagnosed with Xerosis, she was referred to Psychiatry. Evaluation revealed a Delusion of Infestation and increased psychomotor activity. Treatment with Pimozide (1 mg/day) and Lorazepam (1 mg) resulted in improvement. Conclusion Xerosis likely contributed to the development of DP. Atypical antipsychotics like Olanzapine may offer safer treatment options. Keywords: Delusional Parasitosis (DP), Xerosis, Dopamine dysregulation.

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Dr. Nirali kathiriya 2nd Year Junior Resident Lokmanya Tilak Municipal And Medical Collage, Mumbai Email: [email protected] Background Brain tumors can present with psychiatric symptoms due to mass effects or neurochemical imbalances. Psychiatric manifestations may range from mood and psychotic symptoms to cognitive changes, depending on tumor location. Early neuroimaging is essential for patients with unusual psychiatric presentations to avoid misdiagnosis. Case Discussion A 29-year-old female presented with psychotic symptoms, delusions of persecution, auditory hallucinations, and behavioral changes. Over time, physical symptoms like imbalance, slurred speech, and drooling emerged. Neurological examination revealed absent gag reflex and left dysdiadochokinesia. MRI showed a large extra-axial lesion in the right cerebellopontine angle and temporal lobe, suggesting an epidermoid tumor. The patient was referred for neurosurgical evaluation and biopsy. Conclusion This case highlights the association between psychiatric symptoms and brain tumors. Early identification and management of tumors can improve psychiatric and physical symptoms, enhancing the patient’s quality of life. Keywords: Brain tumor, cerebellopontine angle, psychotic symptoms, neuroimaging, organic psychiatric disorder.

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Dr. Urbi Ghosh 1 , Dr. Shashidhar Bhat 2 , Dr. Anil Korade 3 , Brig. (Dr)P S Bhat (Retd) 4 1 Junior Resident 2 Junior Resident. 3 Associate Professor. 4 Professor and HOD Department of Psychiatry, Rural Medical College, Loni, Maharashtra. Email: [email protected] Introduction Parkinson’s disease (PD), the second most common neurodegenerative disorder, is marked by progressive motor symptoms like tremors, bradykinesia, rigidity, and postural impairment. These arise from dopaminergic nigrostriatal pathway degeneration, critical for movement control. Levodopa, the main PD treatment, can lead to levodopa-induced dyskinesia (LID), characterized by involuntary movements such as chorea and dystonia, typically after years but occasionally within months of use Case Summary A 59-year-old woman from Pravara Nagar, with osteoarthritis and planned for knee replacement, presented with a two-year history of tremors, gait difficulty, and stooped posture. Diagnosed with PD, she was treated with levodopa (500 mg) and carbidopa (125 mg). Her motor symptoms improved but she developed LID, including lip-smacking, tongue protrusion, and excessive salivation over six months. Discussion LID progression necessitates medication adjustments. Amantadine and clozapine offer relief, and emerging therapies targeting diverse pathways promise improved patient outcomes. Key words: Parkinson’s disease (PD), Levodopa-induced dyskinesia (LID), Bradykinesia, Chorea.

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Dr. Jaya Rama Rao Ponnamanda, Junior Resident KLES Prabhakar Kore Hospital/ JN Medical College Email: [email protected] Background Urinary retention (UR) is characterized by impaired bladder emptying and post-void residual urine. Medications with anticholinergic or noradrenergic properties, such as duloxetine and desvenlafaxine, can disrupt the micturition pathway, increasing urethral sphincter tone or impairing detrusor muscle contraction. Case Discussion A 24-year-old male with severe bodily distress disorder developed acute urinary retention (400 mL) two days after starting duloxetine 40 mg daily. Symptoms resolved after reducing the dose to 20 mg. In March 2023, he was readmitted with similar symptoms, and desvenlafaxine 100 mg daily was initiated, again causing recurrent UR. Uroflowmetry suggested functional retention with a delay time of 114 seconds and 20 mL residual urine. Switching to sertraline improved symptoms without recurrence. Conclusion This case highlights the need for careful medication selection and monitoring in patients with drug-induced UR. SSRIs like sertraline are safer alternatives for individuals with urinary side effects. Keywords: Urinary retention, drug-induced urinary side effects, duloxetine, desvenlafaxine, SSRIs, sertraline.

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Dr.. Athik Kumar Junior resident, Department of psychiatry, SNMC Jodhpur Phone no - 8860282632 Email id - [email protected] Background and aims: Typhoid fever, or enteric fever, is a potentially fatal multisystemic infection produced primarily by Salmonella enterica serotype typhi. It can present in unusual ways, potentially causing delays in diagnosis. Here we present a case of 15 year old male who presented with a rare manifestation of enteric fever Methods: A 15 year old male was admitted in psychiatry department of SNMC Jodhpur with history of disorganised and hallucinatory behavior along with aggressive outbursts since 2 days for which he was brought by concerned family members. After a detailed evaluation, MSE and Investigations, a diagnosis of Enteric Psychosis was made. Results: Patient was started on T. Olanzapine 10mg for the psychotic symptoms and for enteric fever, he was started on injection ceftriaxone 1gm iv BD. Patient responded well to the treatment and his symptoms improved within 1 week as shown by reduction in BPRS score from 54 to 18. Conclusion: This case highlights a rare presentation of typhoid fever as enteric psychosis. Initial psychiatric symptoms can obscure the diagnosis, necessitating thorough evaluation. Timely antibiotic treatment led to significant recovery, emphasizing the importance of considering infectious causes in psychiatric presentations, particularly in endemic areas. Key words: typhoid fever, psychotic disorders,

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Dr. Hima Thokala Pg Registrar Christian Medical College [email protected] Introduction Heat intolerance is a condition where individuals experience discomfort or illness in high temperatures, even in acclimatized individuals. Some people’s bodies warm up faster, making them more prone to heat intolerance. This case reports a person with severe heat intolerance due to a tricyclic antidepressant (TCA), which improved after switching to an SSRI. Case Report A 44-year-old male with anxiety disorder had been on Dosulepin (TCA) 50 mg for 3 years, showing good response but developing heat intolerance. He had to take frequent sick leaves and avoid outdoor activities in summer. Despite well-controlled type 2 diabetes and hypothyroidism, no other cause was found. After switching to Escitalopram 10 mg daily, he experienced immediate relief, which lasted for a year at the follow-up. Discussion and Conclusion Antidepressants, especially TCAs, are known to cause heat intolerance. Escitalopram, with higher serotonin transporter selectivity, may have contributed to relieving the symptoms, highlighting the need for careful medication choice in patients with heat intolerance. Keywords: Heat intolerance, Tricyclic antidepressants (TCA), Escitalopram, Dosulepin

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Dr Rajesh Ayyalasomayajula Consultant Psychiatrist, Retreat Hospital, Hyderabad Professor & HOD, Department of Psychiatry- SIMS, Siddipet, Telangana Dr Devika kosana Assistant Professor, Department of Psychiatry- SIMS, Siddipet, Telangana Food addiction (FA) involves excessive consumption of hyperpalatable, high-calorie foods and shares features with addictive and eating disorders like binge eating disorder and bulimia nervosa. Although not classified as a psychiatric disorder, it has gained attention due to its links with obesity. Etiological factors include brain–gut–microbiome changes, genetic polymorphisms (dopamine, opioid, leptin), and altered brain connectivity. Risk factors include depression, anxiety, emotional dysregulation, impulsivity, and stress-induced comfort eating. Management strategies encompass lifestyle changes, cognitive behavioral therapy, pharmacotherapy, cognitive training, psychobiotics, low-carb ketogenic diets, self-help groups, virtual reality, and neuromodulation techniques. Addressing FA is critical for sustainable obesity management. Preventive efforts should focus on early identification in at-risk adolescents, promoting healthy eating habits, and regulating access to hyperpalatable foods in youth settings. Responsibility lies with the food industry, governments, and society to implement measures curbing FA and its impact. Keywords: Addiction, binge eating disorder, bulimia nervosa, cognitive behavioral therapy, compulsive eating, eating addiction, eating disorder, food addiction, lifestyle modification, obesity, policy

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Dr Rachana Chandekar, 2nd year psychiatry PG, Dr Surbhi Dubey, MD Psychiatry, Associate Professor in Pt Jawaharlal Nehru Memorial Medical College, Raipur. Dr Arpit Agrawal, DM Neurology DKS Hospital, Raipur. Email: [email protected] Background Autoimmune encephalitis is a neurological disorder with a wide range of psychiatric and neurological symptoms, often mimicking acute psychiatric conditions. Its early detection is challenging, especially in young individuals with psychiatric presentations. Case Report A young female presented with symptoms resembling acute psychosis, including agitation, disorganized thinking, and altered mental status. After thorough clinical and laboratory investigations, autoimmune encephalitis was diagnosed as the underlying cause. Neuroimaging and cerebrospinal fluid analysis confirmed the diagnosis. The patient was started on immunotherapy, leading to significant improvement. Conclusion This case highlights the importance of considering autoimmune encephalitis in young patients with acute psychiatric symptoms. Early diagnosis and appropriate immunotherapy can improve outcomes and prevent long-term complications. Keywords: Autoimmune encephalitis, Acute psychosis , Immunotherapy

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Dr. Jessintha Petrus Junior Resident St Johns Medical College And Hospital, Bengaluru Email: [email protected] Introduction: Treacher Collins syndrome is a rare genetic condition which causes congenital craniofacial deformity occurring at a frequency of 1 in 50,000 live births. It is sometimes associated with conductive hearing loss. There is no developmental delay linked to this usually. Method A 26-year-old male with TCS, presenting with significant craniofacial abnormalities, deaf-mutism, and a history of tracheostomy and BAHA surgery, was evaluated for progressive symptoms of low mood, irritability, aggression, social withdrawal, and self-neglect. Assessment involved sign language for history-taking, detailed psychiatric evaluation, and medication trials tailored to symptom response. Conclusion This case underscores the complexities of managing psychiatric disorders in patients with TCS, given communication barriers and unique phenotypic challenges. It highlights the necessity of a multidisciplinary approach, cautious pharmacological management, and robust family support for sustained improvement. Keywords: Treacher Collins syndrome, craniofacial abnormalities.

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1 Gagan Hans, 2 Uma Sharma, 2 Tanmay Dey Sarkar, 4 Sakshi Panwar 1 Department of Psychiatry, AIIMS, New Delhi, 2 Department of NMR, AIIMS, New Delhi Email: [email protected] Background and aims: This study aims to elucidate the neurometabolic alterations in the anterior cingulate cortex (ACC) and hippocampus in Treatment resistant depression (TRD) patients, employing advanced Magnetic Resonance Spectroscopy (MRS). Methods: Participants included comprised 13 TRD patients and 9 healthy controls, underwent MRS using the PRESS sequence. Results: TRD patients exhibited a reduction in N-acetyl aspartate (NAA) levels in the right hippocampus (p=0.01) and total NAA levels (p=0.03). In the ACC, patients displayed decreased NAA levels at baseline (P=0.03) as compared to controls. Conclusions: The preliminary results show that there is a significant alteration in neuro-metabolite levels in ACC and hippocampus in patients with TRD compared to healthy controls. Keywords: anterior cingulate cortex, Treatment resistant depression, hippocampus

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Dr. Harshada Shakuntal Junior Resident B.J. Govt Medical College And Sassoon General Hospitals Pune Email: [email protected] Introduction Clozapine, an atypical antipsychotic, is effective in treating treatment-resistant schizophrenia. However, one of its rare and serious side effects is gastrointestinal hypomotility, which can lead to ileus or bowel obstruction. Case Details A 30-year-old female with moderate intellectual disability and hypothyroidism presented with abdominal pain, nausea, vomiting, and severe constipation. She had been on Valproate, Olanzapine, and Clozapine for Schizoaffective Disorder. Examination revealed abdominal tenderness, hypoactive bowel sounds, and no palpable masses. CT scan showed large dilated bowel loops with a diameter of 5.9 cm at the hepatic flexure. Management The patient was managed conservatively with NPO status, nasogastric tube decompression, and IV fluids. A psychiatric liaison was consulted, and it was determined that clozapine contributed to the gastrointestinal hypomotility. The clozapine dose was gradually reduced as part of the treatment. Conclusion This case highlights the importance of collaboration between specialties to manage complex clinical scenarios, improving patient care. Keywords: Clozapine , Gastrointestinal hypomotility , Schizoaffective disorder

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Dr. Shruthi Nandakumar Postgraduate Student Shri B M Patil Medical College Hospital and Research Centre, BLDE(DU) Email: [email protected] Introduction: Organic disorders often present with psychiatric symptoms, but brain metastasis as a first contact to psychiatrist is very rare. Neuroimaging is key for differentiating primary psychiatric conditions from secondary causes, especially with atypical onset. Material and Method: A 44-year-old woman with no prior psychiatric history presented with suspiciousness, irritability, social withdrawal and loss of appetite. Mental status examination showed delusions of infidelity and incoherent speech. Physical exam revealed no neurological deficits or signs of systemic illness. Routine chest X-ray incidentally found a right lung mass, confirmed as primary lung carcinoma on contrast enhanced CT. Brain CT revealed multiple metastases, indicating advanced malignancy with a poor prognosis. Conclusion: Early neuroimaging and thorough medical evaluation are essential for accurate diagnosis and management, potentially improving outcomes by identifying and treating the underlying cause of psychosis. Keywords: Brain metastasis, Neuroimaging, social withdrawal.

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Dr. Kajjapu Aarthi Chandra Department of Psychiatry, MediCiti institute of medical sciences, Hyderabad, telangana. Email: [email protected] Background and aim : Patients coming to psychiatry opd can have other comorbidities which are managed with medication, so it is important to check the interaction with these medications before starting a treatment. The current case aimed to present drug interaction leading to lithium toxicity Methods : Case presentation of lithium toxicity Results : Patient presented with signs of lithium toxicity with serum lithium levels- 2.1mEq/l after adding antihypertensive medication to the ongoing prescription leading to toxic levels of lithium Conclusion : Importance of drug-drug interaction during lithium treatment and the importance of high index of suspicion and adequate monitoring is needed Key words : lithium, drug interactions.

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Dr C Anushree Institute Of Child Health, Madras Medical College. Email: [email protected] Background: Myelin oligodendrocyte glycoprotein antibody associated encephalitis is an immune mediated demyelination disorder occurring both in children and adults. Apart from neurological symptoms, patients are rarely reported to be presenting with psychiatric complaints or behavioral disturbances. Objectives: To report a rare case of a 9 year old child diagnosed with Myelin Oligodendrocyte Glycoprotein antibody-associated EncephaloMyelitis (MOG-EM), presenting as recurrent diencephalic syndrome; the girl had neurological symptoms like headache and fever during each episode; but later developed behavioral disturbances like excessive talk, euphoria, impulsive stealing and lying, academic decline for the past 1 year; and new onset seizures once during the course. Results: Child was treated with steroids and IVIG therapies and the neurological symptoms subsided. For behavioral issues, she was started on mood stabilising anti-epileptics and anti-psychotics but only with partial response. Conclusion And Discussion : Psychiatric presentations are rare in MOG-antibody associated EncephaloMyelitis. In this case the girl has improved neurologically, but has persistent behavioral problems despite adequate treatment. Thus, it highlights the impact and organic underpinnings of psychiatric manifestations. Keywords: Recurrent Diencephalic Syndrome, Myelin Oligodendrocyte Glycoprotein antibody-associated EncephaloMyelitis (MOG-EM), IVIG therapies.

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Dr. Kush Goyal - Junior Resident Dr. Fiona Mahapatro (Professor And Hod) Dr. Ss Kale (Professor) Department of Psychiatry, D. Y. Patil School of Medicine, Navi Mumbai, India Email : [email protected] Background and Aims : Abdominal epilepsy is a rare form of temporal lobe epilepsy Methods : An eight year old boy was referred to Psychiatrist for an EEG, with complaints of recurrent episodes of abdominal pain in the periumlical region, nausea, weakness and drowsiness post episodes, 1-2 times/ day, over a period of 9 months. There was no history of any other medical or neurological illness. Results : Blood tests, stool examination and USG abdomen were normal. EEG recording revealed a background of delta activity and spikes over the bilateral centro-parietal and frontal regions, confirming the diagnosis of abdominal epilepsy. Paediatrician initiated treatment with Syp. Levetiracetam (200mg) BD. Patient responded with resolution of symptoms. Patient followed up a month later and was asymptomatic. Conclusion : Abdominal epilepsy should be considered as a differential diagnosis in children as well as adults presenting with gastrointestinal & CNS symptoms Key Words : Abdominal Epilepsy, Temporal Lobe Epilepsy, EEG

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Dr.Ankur chatterjee MD psychiatry, Burdwan medical college, West bengal Introduction: ADHD is mentioned withing the NDD in DSM 5 TR version and ICD 10 as hyperkinetic disorder, we can note similarity in Etiology prevails Aims and Objective: Treating the patient of concern of her symptoms that developed gradually 6months after resolve of the Kawasaki Disease. To follow up and report to Pediatric department of any organic cause or residual for the disease Materials and methods. Pediatric and Biochemistry department laboratory for inflammatory markers. Radiology department for MRI (magnetic resonance imaging) scan. Consultations from the concerned department. Consultations from the department of Psychiatry professors Results. Patient had dramatic improvement in features of ADHD (impulsivity, hyperactivity and inattentiveness). Patient had almost complete resolution in behavioral domain of ODD (oppositional defiant disorder) Conclusion : ADHD and conduct disorder being separate entities yet co-morbid values, need to be explored on its own. In this study, the patient was evaluated for aspects of behavioral change in sequelae post-Kawasaki disease where the child was seen to develop ADHD symptoms and features if CD. Implicabilities as heterogenous NDD in children with Kawasaki disease explored. Keywords : ADHD, Kawasaki disease

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Dr. Ribhav Gupta, Dr. Abhinav Agrawal, Dr. Sanya Sharma Department of Psychiatry, Government Medical College & Hospital (GMCH), Sector-32, Chandigarh (UT) - 160030 Background: Acute management of periodic catatonia involves administration of benzodiazepines but long-term management still remains uncertain. Methods: A 21-year-old male with 4 years history of recurrent catatonic symptoms followed by complete remission with progressive decrease in inter-episodic interval from 6 months to 15 days presented with acute catatonic symptoms for 7 days. The patient had 12-15 similar episodes in the past 4 years. Results: Patient was treated in inpatient setting. The patient was treated with parenteral Lorazepam on which significant improvement was observed over 2 weeks. Patient was started on Aripiprazole 5mg as a prophylactic agent for further episodes Conclusions: Periodic catatonia must be considered as a distinct subtype of catatonia which responded well to oral Aripiprazole as a prophylactic agent in the index case thus opening a way for further research in this area. Keywords: Periodic catatonia, Prophylactic management, Catatonia, Psychomotor abnormality

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Dr. Niharika, Dr. Abhinav Agrawal, Dr. Sanya Sharma Department of Psychiatry, Government Medical College and Hospital, Sector-32, Chandigarh Background : Catatonia, a psychomotor disorder, can result from both psychiatric and medical conditions. Methods : A 34-year-old male with a 10-year history of irritability, fearfulness, delusions of persecution, hallucinatory behavior, poor self-care, and socio-occupational decline presented with 15 days of disturbed sleep, psychomotor retardation, poor communication, prolonged staring, and odd postures. His medical history included disseminated tuberculosis in 2020 and two prior seizures. Result : MRI revealed tuberculoma in the right anterior lobe and basal cisterns. Neurological examination showed horizontal nystagmus and a BFCRS score of 19, indicating severe catatonia. The patient was treated with Anti-Tuberculosis Treatment (ATT), steroids, streptomycin, and Lorazepam, resulting in the resolution of catatonia. Conclusion : This case highlights the need to consider cerebral tuberculosis in the differential diagnosis of catatonia in psychiatric patients. Keywords : cerebral tuberculosis, schizophrenia

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Dr. Kommi Supriya Chowdary, Dr. Shivani Gusain, Dr. Varun S Mehta, Dr. Nishant Goyal Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand – 834006 Email: [email protected] Background& Aims: Leukodystrophy is a rare dysmyelinating disorder of nervous system with rare initial psychiatric presentation. Case Summary: A 10-year-old boy with 3-year history of seeing things others can’t see, irritability, self-smiling, academic decline, changing behavioural patterns, inattention, prolonged gazing, sibling conflicts, see Chota Bheem on trees, see lion facesover mother’s and progressively declining daily activities MRI Findings : T2-Flair hyperintensity seen in subcortical white matter in B/L frontal and parietal lobes, periventricular regions and right lentiform nucleuswith largest lesion in the frontal lobe showing no diffuse restriction suggestive of Alexander’s disease. Results &Conclusion: Leukodystrophy is considered from white matter changes in MRI, confirmed by genetic testing. Early subcortical and frontal involvement on T2/FLAIR imaging and absence of genetic predisposition suggests AD. Neuroimaging aids diagnosis, differentiating leukodystrophies and informing prognosis. Key Words : Leukodystrophy, Alexander’s disease, Psychosis

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Dr. Priyanka Bale ¹, Dr. Challa S.V.Krishna Vasan ², Dr. V. Vara Prasad ³, Dr. E. Ramachandra Rao ⁴. 1. Postgraduate, Department of Psychiatry, Rangaraya Medical College, Kakinada. [email protected]; 8096332311. 2.Child and Adolescent Psychiatrist, Anurag Hospitals, Kakinada. 3. Associate Professor, Department of Psychiatry, Rangaraya Medical College, Kakinada. 4. Professor and Head of the department, Department of Psychiatry, Rangaraya Medical College, Kakinada. Background : Mowat Wilson Syndrome is rare genetic disorder characterized by mixed features of facial dysmorphism and neuro developmental disorders[NDD]. Aim :To report and discuss a case of Mowat Wilson Syndrome. Method : Clinical, Psychiatric and Genetic examination of the subject and their correlation for management of the patient Results : A fifteen year old male with complaints of unresponsiveness, paroxysmal events, behavioral problems, abnormal movements. History and examination revealed delay in his milestones, temperament issues, dysmorphic features. On genetic testing, chromosomal alterations in ZEB-2 genewas noted. Conclusion : Genetic analysis helps in understanding, diagnosing, managing and prognosis of NDDs with mixed features. Keywords - ZEB2, Mowat-Wilson Syndrome, neurodevelopmental delay, intellectual disability, hyperactivity

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1. Dr Shahnaz Parveen PG Resident, Dept of Psychiatry, INHS Asvini. 2. Surg Lt CdrSargundeep Singh, Graded Specialist (Psychiatry) Background and aims: A recurrent hair pulling disorder Present in 1-2% of adolescents Very few cases have been reported in the age 30-40 age groups, therefore, we intend on reporting this case It is complicated by irreversible damage to hair growth and quality, trichobezoars. Methods: A 40 yrs old male who presented in psychiatry department with history of alcohol consumption and diagnosed with trichotillomania and ADS. The patient’s family observed him of being involved in a puzzling behaviour. Examination revealed irregular bald patches over the scalp. Dermatologic examination done. Trichoscopy revealed alopecic patch further highlighted random hair lengths with no exclamation mark hairs. The patient was started on Cap Fluoxetine along with behavioral therapy and was advised to continue follow ups. Results & conclusions: The diagnosis of our patient was established upon the history, clinical and dermatologic evaluation, and eventual elimination of the possible differential diagnosis. Keywords : tricotillomania, bald patches,

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Dr khushboo sahni – junior resident dr fiona mahapatro (professor and hod) dr ss kale (professor) D.Y. Patil School Of Medicine, Navi Mumbai Introduction: Montelukast is a leukotriene receptor antagonist used to treat chronic asthma and allergic rhinitis. It also crosses the blood brain barrier and blocks G protien coupled receptor on neurons and microglia contributing to neuropsychiatric symptoms. Methods: A 20 year old lady presented with symptoms of suspiciousness, fearfulness, irritability, angry outbursts and sleep disturbances since 5 yrs (on psychotropics) increased 2 months & worsened in 2 days, following which she was admitted. Patient discontinued the psychotropics, because of foul smelling left ear discharge and giddiness since 2 months. Result: After 8th day of admission, montelukast was added by the ENT surgeons, in addition to the existing antibiotics. Patient had responded well to psychotropics, however worsened after 3rd day of montelukast addition.Montelukast was administered for a week in total, and was stopped subsequently. Psychotic symptoms resolved after 3 days of omission of montelukast. Conclusion : Montelukast coincidentally caused exacerbation of psychotic symptoms in our patient. Keywords : montelukast, psychotic symptoms

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Dr.Bushra Batool, Department of psychiatry, Gandhi Medical College & hospital, Hyderabad, India . Email: [email protected] Introduction : Disulfiram is used in treatment of alcohol dependence syndrome(ADS).It has many side effects but rigidity is an uncommon side effect. Case : A 42 year old male diagnosed as ADS since 20 years was started on disulfiram 6 months back, during that he was abstinent from alcohol for 6months. Then, he presented with difficulty in walking with stiffness of both lower limbs. Examination revealed rigidity of bilateral lower limbs with brisk reflexes.He was not able to make any movements at ankle joint and toes. Routine blood investigations -normal. CT brain showed -normal study. After admission, disulfiram was withheld. And without any other significant intervention, symptoms improved with decreased stiffness in limbs. Conclusion : This will be case report describing appearance of rare side effect of dystonia while on disulfiram, as there was significant improvement in symptoms just after stopping of that drug. Keywords : alcohol, disulfiram, rigidity, dystonia

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Dr. Arpit Gupta Department of Psychiatry, Government Medical College, Aurangabad, India. Email: [email protected] Introduction : This study explores complex relationships between emotional intelligence (EI), comprising emotional awareness, management of emotions, social awareness, and management of relationship, personality traits, and perceived stress among 627 medical students. Results: Emotional intelligence, particularly emotional management, demonstrated a significant negative correlation with perceived stress levels. Personality traits, including extroversion, agreeableness, conscientiousness, and openness, exhibited negative correlations, while neuroticism showed a positive correlation with perceived stress. The study emphasized the importance of emotional regulation skills and individual differences in shaping stress responses. Conclusion: While the study provides valuable insights, its cross-sectional design limits causal inferences. The use of self-report measures introduces potential biases, suggesting the employment of objective assessments in prospective research. Overall, this study contributes a foundation for evidence-based interventions, shaping the well-being and resilience of medical students as they navigate the challenges of their academic and professional journeys. Key words : emotional intelligence (EI), personality, stress, medical students

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Dr. M Dinesh 1 , Dr. Dinesh Kataria 2 , Dr. Sunita Mondal 2 , Dr. Shiv Prasad 3 , Dr. Sajjadur Rehman 3 1 Department of Psychiatry &NDDTC, All India Institute of Medical Sciences, New Delhi, India 2,3 Lady Hardinge Medical College, New Delhi, India 1 Email: [email protected] Methods: Sixty schizophrenia (DSM 5)patients aged 18 to 65 years were recruited. Positive and Negative Syndrome Scale (PANSS) and Pittsburg Sleep Quality Index (PSQI)was used to assess the symptom severity and sleep quality. Results: Out of 60 subjects(34 male, mean age 35.03±10.48), 60% had poor sleep quality (PSQI score >5) and 40.0% had good sleep quality (PSQI score ≤ 5). Increased sleep latency and decreased sleep duration found in 95%and 61.7% of the participants.83.3 % had sleep disturbances and 30 % had decreased sleep efficiency. 66.7% was using some sleep medications and 43.3% had daytime dysfunction.96% in high PANSS group (total score ≥ 65) had poor sleep quality while only 34.3% in low PANSS group (total score <65) had poor sleep quality indicating a significant difference between the groups(p = <0.001). Conclusion: Our study being cross sectional and a subjective assessment of sleep quality have found poor sleep quality to be a frequent problem in schizophrenia. Key words: Sleepy quality, Symptom severity, Schizophrenia, PSQI, PANSS

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Dr. Kaustubh Bhor Department of Psychiatry, Dr. Panjabrao Deshmukh Memorial Medical College, Amravati, Maharashtra Email: [email protected] Methods: 94 postgraduate junior residents voluntarily filled a cross-sectional survey prepared in Google Forms and distributed online via social media. The form had a pretested self-administered questionnaire. Results: Junior residents of a variety of specialties took part in the survey. A significant proportion (75-95%) thought that recognizing and managing delirium was important. However, about 35-40% did not think that ‘reduced speech’ or ‘reduced motor activity’ could be clinical features of the condition, or that ‘increased noise’ and ‘pre-existing hypertension’ were risk factors for it. Only around one-third practised the use of hearing aids/glasses and ensured family visits as preventive methods. Conclusion: Residents’ attitudes regarding delirium are promising, with majority considering it important to identify and tackle. Most residents lacked experience with delirium screening tools. Key words: Knowledge, Practices; Delirium; Postgraduate junior residents

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Dr.Vrinda Purushottam junior resident, Department of psychiatry, King George’s medical university, Luknow, U.P. Introduction: Psychotropic medications have long been used in managing Irritable Bowel Syndrome (IBS), but Duloxetine has seen limited application. Methods: Patients presenting with IBS at the Medical Gastroenterology Outpatient Department (OPD) of a tertiary care hospital were screened and randomized into two groups: Study and Control. The Study group received Duloxetine as an add-on to treatment as usual, while the Control group received a placebo. Socio-demographic and clinical data were collected, and outcome variables IBS-Severity Scoring System(IBS-SSS) and IBS-Quality of Life (IBS-QOL) were assessed at baseline, 2, 4, and 8 weeks. Results: Duloxetine treatment resulted in significant reductions in IBS-SSS scores compared to placebo, with a mean score of 63.51 (SD=38.67) for Duloxetine versus 90.00 (SD=42.65) for placebo at 8 weeks (p=0.000). Additionally, IBS-QOL scores were notably higher with Duloxetine (mean=65.62, SD=10.01) compared to placebo (mean=57.92, SD=8.13), with a significant difference (p=0.001). Conclusion : Duloxetine as an add-on treatment significantly reduces IBS symptom severity and improves quality of life measures.

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Dr.Stuti Sharma Department of Psychiatry Jawaharlal Nehru Medical College, Belagavi, India. Email: [email protected] Methods: A 20-year-old female presented with complaints of episodes of alternating between identifying as a five-year-old girl and a grown man, with no recollection of these incidents. Further history revealed over the past yearshe had been under significant distress due to an ongoing stressor and had consulted multiple doctors and faith healers for various unexplained somatic complaints. Results: We took a longitudinal view of the patient’s conflicts, tracing their origins and behaviour in specific situations. Conclusion: The therapeutic approach involved a development through different life stages. The formulation linked all her presenting problems, offering insight into her likely combination of psychotherapy and pharmacotherapy. By developing a psychodynamic formulation, we were able to understand the major sources of conflict for our patient, which helped us choose among different possible interventions and aide in recovery. Key words: Trauma, Dissociative Identity Disorder, Somatoform, Psychodynamics formulation, India

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Dr Kiran Nath G Junior Resident, Department of Psychiatry, Pushpagiri Institute of Medical Sciences & Research Centre, Thiruvalla, Pathanamthitta, Kerala. Email ID: [email protected] Background : Paediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a complex neuropsychiatric disorder characterised by sudden onset of obsessive-compulsive disorder (OCD) symptoms or severe eating restriction, tic disorders, and other neuropsychiatric manifestations. It often follows a streptococcal infection. The Case History : A 5-year-old girl presented with a history of fever, cough, rhinitis, and vomiting, followed by acute-onset behavioural changes including demanding behaviour, aggression, hyperactivity, sleep disturbances, regression in speech and toileting, and poor handwriting. A detailed clinical evaluation was conducted, ruling out organic causes. Based on the clinical presentation, the child was diagnosed with PANS. Treatment with olanzapine and psychosocial management led to significant improvement in her symptoms. Conclusion : PANS can present with a wide range of neuropsychiatric symptoms, often following an infectious trigger. Early recognition and prompt intervention with appropriate pharmacological and psychological therapies are crucial for optimal outcomes. Key words: PANS, Regression, Antipsychotics, Psychosocial management.

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Dr. Medha pandey, junior resident, MGM Medical college, Bangala, Indore Background : Bipolar disorder (BPAD) is a chronic mood disorder marked by significant mood, energy, and behavior fluctuations. It impacts caregivers, affecting their physical and mental health, family dynamics, and overall well-being. Aim: To assess caregiver burden among BPAD caregivers using the Burden Assessment Schedule (BAS) and family functioning by Family Attitude Scale (FAS), and explore caregiver demographics. Method A cross-sectional study was conducted on 120 primary caregivers of BPAD patients attending a Psychiatry OPD at a tertiary care hospital in Central India. Results : Most caregivers were male (60%) and married (96.7%). The mean caregiver age was 40.76 ± 13.9 years, with a mean caregiving duration of 17.43 ± 9 years. The mean BAS score was 82.38 ± 7.2, indicating high burden. Significant correlations were found between caregiver burden and age (r = 0.311, p = 0.001) and caregiving years (r = 0.210, p = 0.022). FAS scores correlated with caregiver age (r = 0.404, p < 0.001) and cohabitation years (r = 0.239, p = 0.008). BAS and FAS scores showed a significant positive correlation (r = 0.423, p = 0.000). Conclusion: Caregivers of BPAD patients face high burdens influenced by age, caregiving duration, and family emotions. Keywords: BPAD, Care givers

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Dr Divyam Goswami, Second year resident Dept of Psychiatry, PDU Govt. medical college, Rajkot, Gujarat Dr.Gopi Gajera, Assistant Professor, Dept of Psychiatry, PDU Govt. medical college, Rajkot, Gujarat. Email id : [email protected] Background : A 17-year-old male who is a known case of OCD presented with symptoms of excessive handwashing, repetitive thoughts about cleanliness, decreased speed in daily activities, and social withdrawal. Patient had marked improvement in repeatitive thoughts of contamination, mental counting and repeated handwashing with fluoxetine (100 mg), clomipramine (225 mg), aripiprazole (30 mg) and Behaviour Therapy, but was having minimal improvement in obsessive slowness. Methods : Following initial evaluation reviewing past records, Tab. Lamotrigine 25 mg was started and gradually titrated upto 150 mg over 3 monthsin addition to above mentioned treatment. The patient’s progress was monitored through clinical observation and assessment of symptom severity. Conclusion : Lamotrigine appears to be a promising treatment for managing Obsessive Slowness in OCD. Keywords : Obsessive slowness, Lamotrigine, OCD

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Dr. Majoe Mathew Nellary, Dr. Devan S., Dr. Derrick Johnson, Dr. Joice Geo Department of Psychiatry, Pushpagiri Institute of Medical Sciences & Research Centre, Thiruvalla Email id: [email protected] Background : Zolpidem is a short acting, non benzodiazepine hypnotic, a member of the imidazopyridine class. Misuse is often self-medication of psychological symptoms in ways unauthorized by the prescriber. Case history: A 47 years old male, married, completed M. Tech and currently working as an Assistant Professor presented to us with disturbed sleep, increased tension and increased intake of Zolpidem for the past 3 months.3 years back he received treatment for depressive symptoms. There was history of ADS in brother. MSE revealed anxious mood. Conclusion : Over the last decade, Zolpidem, a non-BZD hypnotic, gained attention as a potential solution for insomnia. However, recent studies suggest otherwise. A systematic review of Medline data documented 36 cases of Zolpidem dependence, indicating that individuals of all ages & genders are equally affected. Keywords : Zolpidem, misuse, benzodiazepine, self-medication

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Dr.Mirunalini.I - Post Graduate, Department of Psychiatry, Institute of Mental Health [email protected] Dr.Poorna Chandrika - Professor, Institute Of Mental Health Madras Medical College, Chennai, Tamil Nadu Background and Aims: Joubert Syndrome (JS) is a rare autosomal recessive ciliopathy characterised by abnormal brain development that includes irritability and behavioural outbursts remain less explored, particularly in adult patients. Methods :This is a case of a 33-year-old male, born out of third degree consanguineous marriage with maternal history of use of abortificants in antenatal period. There was history of developmental delay since birth, and has ataxic gait, however there was no history of seizures. Patients developed persistent irritability and frequent episodes of sudden, intense uncontrollable emotional outbursts. Comprehensive clinical evaluation, including neuroimaging and genetic studies, confirmed the diagnosis of Joubert Syndrome. Conclusion :This case underscores the importance of addressing neuropsychiatric symptoms in Joubert Syndrome and highlights the need for further research into their prevalence of behavioural disturbance and underlying mechanisms in adults with ciliopathies. Key words : Joubert syndrome, neuropsychiatry, behavioural disturbance

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Dr. Ankit Janiani Dept. of Psychiatry, Dr. D.Y. Patil Medical College, Pune Email: [email protected] Background: Anxiety disorders are conditions that often present with physical symptoms, complicating their diagnosis and treatment. Case Details: A 64/M k/c/o GAD, maintaining well for 3 years on SSRI, admitted with symptoms suggestive of worsening anxiety for 1.5 months. Despite few days of treatment, no improvement reported. Initial liaison with neurology and general medicine diagnosed him with Parkinson’s disease and started on treatment. Despite a week of treatment, he showed no relief. After a liaison with cardiology, underwent coronary angiography and diagnosed to have coronary artery disease and initiated on medical treatment. Within a month of treatment, became symptom free. Conclusion: Cardiac conditions can be underdiagnosed in individuals with anxiety disorders due to overlapping symptoms. This highlights the importance of considering organic causes, even in patients with known psychiatric diagnoses, to prevent misdiagnosis. Key Words: Generalised anxiety disorder, Anxiety disorders, Coronary artery disease

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Dr Purbasha Sengupta, Junior Resident, Department of Psychiatry, Calcutta National Medical College & Hospital, Kolkata Email ID: [email protected] Background : Shared psychosis/Folie à Deux, is a rare psychiatric disorder characterized by the transference of delusional beliefs and behaviours from one primary patient (Dominant) to the secondary patient (Submissive). The Case History : Primary Patient (43 y) presented with DOP, DOR & believed that there was a cyber crime going on against them. Secondary Patient (48 y) also had the same delusions but to a far lesser degree and her symptoms started 6 months later. Upon Admission, A was diagnosed as having Paranoid Schizophrenia, B as Shared Delusion; Folie Imposee. They were managed by 300 mg & 100 mg of Amisulpride respectively. Conclusion : The paradox of the case lies in the fact that even though Primary Patient was more dominating and had a stronger conviction about her psychotic thoughts, she had lesser OC symptoms (lower YBOCS) with a better insight than the Secondary Patient, who even though was the submissive one had much worse OC symptoms with poor insight. (higher YBOCS) Key words : Shared Delusion, OCD, Amisulpride

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Dr. Nisha Karar, Dr. Surjit Prasad, Central Institute of Psychiatry, Ranchi-834006, Jharkhand, India Introduction : Suicide is one of the leading causes of death worldwide. Surprisingly, literature is very sparse regarding the neuropsychiatric sequelae of the survivors of the suicides. Methodology : A 26 years old married female presented with chief complaints of poor communication, inappropriate smiling and crying episodes, wandering tendency, difficulty in having activities of daily life for last 6 years with a history of an attempt to suicide by complete hanging 6 years back due to marital altercation followed by ICU admission in an unconscious state with amnesia till 15 days and mutism till 1 month followed by utterance of incomprehensible words. Investigations showed metabolic acidosis with normal neuroimaging study. No neurological deficits were evident behavioral symptoms emerged gradually with deteriorating progress. On MSE, inappropriate affect, incomprehensible speech, and increased psychomotor activity were noted. Conclusion: Multiple factors are implicated in the causation of death by hanging leads to sustained hypoxic ischemic injuries in the hippocampus, and cerebral cortex, which might cause neuropsychiatric sequelae in the survivors of suicidal hanging. Key words : Hanging, suicide, behavioral changes.

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Dr. S. Ajithkumar, Post Graduate, Department of Psychiatry, IMH, OMC, HYD. Dr. Ragini, Asst.professor, Dept of Psychiatry, IMH, OMC, HYD. Dr.Rajeevi, Asst. professor, Dept of Psychiatry, IMH, OMC, HYD. Introduction: Restless leg syndrome is a circadian disorder of sensorimotor integration due to dysregulation of iron and its impact on dopamine metabolism affecting 7 % population, Case report : A 50 yr old married female without any past or family history of medical or surgical illness, with no history of substance use disorders diagnosed as BPAD mania with psychosis started on T.Olanzapine on 5mg and dose increased to 10 mg gradually. within 4-5 days there was decrease in her aggression and she became cooperative for interviewing. Conclusion: Restless Leg Syndrome diagnosis was made Olanzapine was decreased to 5mg and oral risperidone 2mg and clonazepam upto 2 mg were added to treat sleep disturbances. Within 2 days severity score reduced to 12. Then Olanzapine was stopped and risperidone increased to 6mg.RLS symptoms did not recur following substitution of other antipsychotic drugs. Keywords: Restless leg syndrome, Olanzapine.

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Dr. Sanghe Doma Department of Psychiatry, ABVIMS & Dr RML Hospital, New Delhi, India Email: [email protected] Background: Corticosteroids are essential for managing systemic lupus erythematosus (SLE) flares but can induce psychosis in 4.8% of patients. Methods: A 29-year-old nursing student with SLE, diagnosed in 2019, experienced a disease flare in 2023 requiring high-dose corticosteroids. Shortly after initiation, she developed mood disturbances progressing to psychosis with hallucinations and delusions. Treatment included antipsychotics (haloperidol, amisulpride) and steroid tapering, leading to complete resolution of symptoms. Results: Diagnostic clues favoring steroid-induced psychosis included its temporal correlation with corticosteroid initiation, predominance of mood symptoms, and absence of SLE markers. Conclusion: Distinguishing steroid-induced psychosis from NPSLE is challenging but critical as the conditions require distinct management—tapering steroids versus increasing immunosuppression. This case underscores the importance of a systematic diagnostic approach, integrating clinical, laboratory, and imaging findings, for effective treatment. Keywords : neuropsychiatric lupus, steroid induced psychosis

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Dr.Nusrath K, Dr Arun, Dr Barath Department of Psychiatry, SMVMCH, Puducherry. Introduction: Frontal lobe ataxia is a rare condition characterized by gait disturbances and coordination defects that occurs due to damage to the frontocerebellar pathways. Case report: A 35-year-old male presented with complaints of aggressive behaviour, difficulty controlling impulses, inappropriate social conduct, and problem in motor coordination.. These symptoms began following a motorcycle accident four months prior, leading to traumatic brain injury with confirmed frontal lobe damage on CT imaging. Mental status examination revealed increased psychomotor activity, an irritable mood, accompanied by lack of coordinated movement, wide based gait and difficulty motor planning. The patient was started on antipsychotics and mood stabilisers following which symptoms improved. Conclusion: Frontal lobe ataxia associated with frontal lobe syndrome is a rare condition occurs due to damage to the frontal lobe. Keywords: frontal lobe syndrome, frontocerebellar pathways, aggressive

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Dr. Swetha Pakki Department of Psychiatry, Dr. D.Y. Patil Medical College, Pune, India. Email: [email protected] Background: Rheumatoid arthritis (RA) significantly impacts quality of life, often accompanied by anxiety and depression. People with chronic illness are in dynamic process to develop resilience. Aim: To assess anxiety, depression, resilience, and quality of life in RA patients. Methods: A cross-sectional study involving 30 RA patients assessed with a semi-structured proforma of socio-demographic data, anxiety & depression (HADS), resilience (CD-RISC), and quality of life (RAQOL) after obtaining their consent. Statistical analysis was done with SPSS version 22.0. Results: Severity of disease (DAS28-CRP) correlated with increased anxiety and depression. Resilience showed an inverse relationship with anxiety and depression. Quality of life was negatively impacted by anxiety and depression. Conclusion: Anxiety and depression are common in RA and significantly impact quality of life. Enhancing resilience may be crucial in improving outcomes for RA patients. Keywords: Rheumatoid Arthritis, Anxiety, Depression, Resilience, Quality of Life, Inflammation.

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*Dr. Chhavi Bharti **Dr. Lokesh Singh Shekhawat *Post Graduate Resident **Professor & Consultant ABVIMS & RML Hospital, New Delhi Email: [email protected] Background& Aims: Charles Bonnet Syndrome (CBS) involves complex visual hallucinations in individuals with significant vision loss, without any psychiatric disorder or consciousness impairment. It affects around 0.8% of those with low vision and 0.6% of the elderly, primarily aged 70-85 years, but often goes unrecognized, leading to misdiagnosis. Aim is to present a rare case of CBS in an elderly patient, highlighting diagnostic challenges. Method: A detailed clinical assessment was conducted, including psychiatric evaluation, neuroimaging, and ophthalmological examination. A 60-year-old female with vision loss from macular degeneration presented with 2-year history of distressing visual hallucinations with insight into their realities. There were no signs of dementia or other neurological / comorbid psychiatric disorders. Conclusion: CBS should be considered in elderly patients with visual impairment and hallucinations to ensure accurate diagnosis and effective management. Key words: Charles Bonnet Syndrome (CBS), Visual hallucinations, Vision loss, Elderly, Insight

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Dr. Vineet Kumar Lal Dept. of Psychiatry, IMHH Agra Email: [email protected] Background & Aim: Tactile hallucinations, though uncommon in schizophrenia, are distressing and often associated with severe delusions. Case Study: This case study highlights a 52-year-old male presenting with tactile hallucinations characterized by a pricking sensation and the perception of being physically attacked, alongside auditory hallucinations and delusions of persecution. The patient believed his neighbor conspired to harass him, causing significant impairment in daily functioning. Diagnostic evaluation confirmed schizophrenia per DSM-5 criteria. Initial treatment with Olanzapine (10–20 mg) showed minimal improvement, but a switch to Haloperidol (20 mg) led to significant clinical progress within six weeks. The patient was discharged with follow-up care. Result: This case underscores the importance of recognizing tactile hallucinations in schizophrenia, as they indicate greater delusional severity and may contribute to earlier disease onset. Conclusion: Clinicians should routinely assess for non-auditory hallucinations in schizophrenia to ensure comprehensive management and optimal therapeutic outcomes. Key Word: tactile hallucination, schizophrenia

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Dr. Pranshi Agrawal, Dr. Chirag Patel, Dr. Mallika Singh Department Of Psychiatry, Chirayu Medical College & Hospital, Bhopal Email: [email protected] Background : Levosulpiride is dopamine D2 receptor antagonist, widely used for gastrointestinal disorders, but can cause extrapyramidal symptoms (EPS), often misdiagnosed in non-psychiatric settings. Method : A young male, post-laparoscopic gastrojejunostomy, presented with involuntary teeth grinding. Initially diagnosed as bruxism by dentistry, he was referred to psychiatry. Normal lab reports and diagnostic investigations, ruled out dental or systemic causes. History revealed levosulpiride use, with a similar past episode resolving after drug discontinuation. Clinical and neurological assessment identified symptoms as rare manifestation of Oro-mandibular dyskinesia, secondary to levosulpiride Result : Stopping levosulpiride and initiating promethazine resolved symptoms. Conclusion:Levosulpiride is widely used in gastroenterology due to its prokinetic properties, but requires caution due to potential extrapyramidal side effects. This case highlights the diagnostic challenges of rare levosulpiride-induced EPS, emphasizing the need for interdisciplinary collaboration for timely identification and management. Key words : Bruxism, levosulpiride, EPS

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Dr Ritambhara Mandal, Junior Resident, IOP-COE, Kolkata Email: [email protected] Background &Aims: Valproate induced EPS is less common but important side effect. Current presentation aimed to review literature for studying rare side effect of valproate . Methods: 54year female admitted with aggressive behaviour, increased talk, increased energy, reduced sleep for 3 weeks. On MSE- there was raised motor activity, pressured speech, elevated affect& delusion of grandiosity. History of similar episode at past. She was diagnosed as Bipolar affective disorder current episode manic with psychotic symptoms. After initial stabilization with injectable she was started on Tab Olanzapine (10 mg), Valproate (600mg)&discharged in stable condition. She developed EPS (tremor, bradykinesia, bilateral symmetrical rigidity of upper limbs) so we stopped Olanzapine &Trihexyphenidyl (2mg) was started. Without any improvement of EPS on next visit, we changed Valproate to Lithium Carbonate and she improved drastically. Results: We identified this as Valproate induced EPS. Conclusion: High clinical awareness is required to diagnose Valproate induced EPS in elderly because of other comorbid conditions. Key words: Valproate, EPS

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Dr Suhash N L, Dr Sudarshan C Y Department of Psychiatry, JJM Medical College Davangere, Karnataka Email: [email protected] Background: Homosexuality is no longer considered an abnormality, and sexual reorientation therapies are legally prohibited. This paper discusses two cases. The Cases: 1: A 27-year-old unmarried male from an urban, upper socioeconomic background presented with anxiety about his future due to his homosexual practices. Despite knowing the legal ban on conversion therapy, he sought help with his father due to familial disapproval. Therapy focused on psychoeducation, reassurance, and coping with his sexual orientation. 2: A 20-year-old unmarried male from a rural, lower socioeconomic background experienced anxiety over his future marriage, distressed by his attraction to males. He sought therapy to change his sexual orientation, despite no prior homosexual encounters. He was diagnosed with adjustment disorder and given psychoeducation and medication. Conclusion: Individuals may seek help for distress related to their sexual orientation. Mental health professionals face ethical dilemmas in such cases, warranting further discussion. Key Words : Homosexuality, sexual reorientation therapy, legal, India.

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Dr Taniya Maji 1, Dr Supartho Barua 2, Dr Subhendu Datta 2, Dr Nitu Mallik 2 Department of Psychiatry, Medical College and Hospital, Kolkata. Material and methods : We report a case of a 31year old Hindu male patient visiting the psychosexual clinic, complaining that for the past 2 years, there was spontaneous and involuntary sensation around his penile area, occurring under any circumstances and persisting for a significant amount of time which he interpreted as genital arousal. It was excessively embarrassing and distressing to him — so much so that he started injuring himself in order to stop it. Clinical interview, mental state examination and standardized psychosis assessment scales like Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS) revealed him to have delusion of control and persecution and auditory and tactile hallucinations. He was started on tablet Risperidone 2mg with gradual increase up to 6mg, along with subsequent addition of tablet Trihexiphenidyl 2mg and thereafter followed up for a period of 6 weeks. Conclusion : This report features variability in the symptomatology of schizophrenia. It emphasizes the need for further integration of sexual functioning assessment into routine clinical care, to diagnose any rare manifestations of similar other medical or psychiatric illness. Keywords: schizophrenia, psychosexual clinic.

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Dr. Sadiya Saman, Resident, ESIMCH, Hyderabad Email: [email protected] Introduction Consultation-liaison psychiatry plays a vital role in bridging the gap between mental and physical health care. It fosters interdisciplinary collaboration, supporting holistic and patient-centered care in diverse inpatient settings. Inpatient psychiatry referrals from other departments often highlight the critical intersection between physical health and mental health. Aim This study aims to analyse the prevalence and types of psychiatry referrals from other inpatient departments, identify common reasons for referrals, and explore patterns that could inform better interdisciplinary collaboration and mental health care delivery. Methodology This retrospective observational study was conducted at a tertiary care hospital. Data was collected from psychiatry consultation records over a 3-month period. Inclusion criteria encompassed all psychiatry referrals made by inpatient departments. Each referral was categorized based on the referring department, reason for referral, and patient demographics. Results: Out of a total of 325 interdepartmental referrals to psychiatry department in a period of 3 months, we noticed that mean age of patients was 43 years with males more than females and majority of the referrals were found to be from department of General Medicine with most common reason for referral being Alcohol related disorder followed by delirium. Key words: Consultation liaison psychiatry, Referrals

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Dr. Sathish Kumar N, 1 Dr Arun Selvaraj, 2 Dr Souganyadevi V 3 Department of Psychiatry, SMVMCH, Puducherry. Second year PG, 1 Professor and Head, 2 Assistant Professor 3 BACKGROUND: Akathisia is a feeling of restlessness with an urge to move, usually occurs as a side-effect of antipsychotics. Prevalence of SSRI-induced akathisia is about 9.8%-45.1%, where escitalopram accounts for 0.46%. CASE REPORT: A 19-year-old male reported with sad mood, weeping spells, fearfulness, and reduced sleep for 1 week. A diagnosis of depression was made and was started on Escitalopram 5mg/day. After 3 days, he developed agitation and restlessness. An escitalopram-induced akathisia was suspected, and drug was stopped. Beta-blockers, benzodiazepines and Mirtazapine 7.5mg/day was started. The dose of Mirtazapine was gradually increased to 22.5mg/day. In view of persistent sad mood and aggressive behaviour, ketamine therapy was initiated under the supervision of anaesthetist. Patient showed significant improvement in akathisia after switching to mirtazapine. DISCUSSION: The probable mechanism underlying SSRI-induced akathisia is serotonin-induced dopaminergic inhibition. Ketamine modulates glutamate neurotransmission and promotes synaptic plasticity, though its exact mechanisms and long-term impacts remain under investigation. KEYWORDS: Restlessness in depression treatment, Escitalopram-related adverse effects, Ketamine therapy

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Dr Kamran Zuber, 1 st year PGT, Department of Psychiatry, Katihar Medical College, Katihar (Bihar). Dr Arati Shivhare, Associate Professor, Department of Psychiatry, Katihar Medical College, Katihar. E-mail – [email protected] BACKGROUND A genetic medical disorder that affects both adults and children is nocturnal enuresis. Rarely are occurrences of nocturnal enuresis documented. The majority of patients with nocturnal enuresis recover on their own, but in those who are resistant, the condition lasts until adulthood. Patients who experienced frequent bedwetting as children are more likely to experience symptoms that persist. METHODOLOGY Since childhood, the 25-year-old male who graduated presented with c/o bet wetting four to five times a week. The patient stated that he experiences more frequent bedwetting when he is under stress. absence of any birth abnormalities, accomplishments to date, psychosis, or depression. NE 6-7 extended family members’ family background. A urologist, a neurologist, and a psychiatrist had each evaluated him independently. RESULTS DSM-5 diagnosis = PNE. Patient and relative s counselling done, Oral medication has been started, progress noted. CONCLUSION Adult NE prevalence is 1%. The patient’s high drive during his initial psychiatric application and his adherence to behavioral therapy are linked to his positive response to treatment.

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Dr Pooja Bhatia 1 , Dr Savita Chahal 2 1.Senior Resident, Kalpana Chawla Government Medical College, Karnal, Haryana 2.Associate Professor, Kalpana Chawla Government Medical College, Karnal, Haryana Email: [email protected] Introduction - In the wake of improved access to the internet and health information, individuals with noticeable personal gains may malinger symptoms of various illnesses. Psychiatric disorders are usually very fascinating to the malingerers due to the subjective nature of complaints and lack of objectively demonstrable organic abnormalities. Aim- To discuss a case of malingering in clinical setting Case Description- A 37-year-old man undergoing trial under section 420 of IPC, referred by the judicial magistrate for medical board examination to determine his mental capacity to stand trial. He had been successful in duping the medical boards of psychiatrists at two different government hospitals into issuing him a medical certificate of diagnosis of schizophrenia with severe mental disability and declaring him unfit to stand trial. The authors, through this case report, intend to present how they picked up and developed further on several cues in the index patient leading to a diagnosis of malingering. Conclusion - Malingering is a diagnosis of exclusion. It is vital to consider malingering as a differential diagnosis in patients who present with atypical features, inconsistencies in history, and observed behavior and have clear external incentives for their behavior. Key words: Malingering, Schizophrenia

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Introduction : Psychosexual medicine is a burgeoning field that addresses the intricate relationship between mental health and sexual wellbeing. This module aims to investigate the bidirectional impact of mental health on sexual function and vice versa, shedding light on the complexities of this intersection. Objectives: 1. Undergraduate medical students and postgraduate psychiatry students lead research to Investigate the prevalence of sexual dysfunction in individuals with mental health conditions (e.g., anxiety, depression). 2. Undergraduate medical students and postgraduate psychiatry students led Examine the impact of mental health treatment on sexual function. 3. Undergraduate students and postgraduate psychiatry students led research to Explore the relationship between sexual wellbeing and mental health outcomes. Methods: 1. Mixed-methods approach: Surveys, interviews, and focus groups. 2. Participants: Adults (18-45) 3. Data analysis: Statistical analysis and thematic analysis. Expected outcomes : Module for Undergraduate Medical Students and Postgraduate Psychiatry Students that includes 1. Prevalence rates of sexual dysfunction in mental health populations. 2. Understanding of mental health treatment effects on sexual function. 3. Insights into the interplay between sexual wellbeing and mental health outcomes. Significance: This module will inform evidence-based teaching learning for students that enhance their ability to consider interventions, enhancing the sexual wellbeing and mental health of individuals. It will also contribute to the development of psychosexual medicine as a distinct aspect with the current curriculum. Keywords: mental health, sexual health

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Dr. Divya Gurunathan, Dr. Shivarama Varambally, Dr. Vijay kumar NIMHANS, Bangalore Email: [email protected] BACKGROUND: Schizophrenia, a chronic mental illness with a global lifetime prevalence of 4.0/1,000 and 0.2-0.3% in India. Cognitive insight is the ability to critically assess one’s beliefs. AIM: To study the correlation between cognitive insight and adherence to treatment. OBJECTIVES: To examine the relationship between cognitive insight and medication adherence in schizophrenia patients. METHODOLOGY: This prospective cohort study included 60 participants diagnosed with schizophrenia (DSM-V), illness duration under 5 years, and treatment duration under 4 weeks. PROCEDURE: Participants were recruited, and informed consent obtained. Baseline clinical assessments (SAPS, SANS, BCIS, VAGUS, BCATS) done, followed by 1 and 3-month follow-up evaluations, including medication adherence measured with BARS. RESULTS: The median age was 32. Regression analysis revealed that cognitive insight positively correlates with medication adherence even after controlling for other variables. A significant negative correlation was found between age, age of onset, and cognitive insight. CONCLUSION: This is one of the kind study showing that cognitive insight positively predicts medication adherence, suggesting its role in identifying individuals who could benefit from metacognitive therapy in Indian population. KEY WORDS: Schizophrenia, Cognitive insights

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Dr. Nithya, Junior resident- IMH, Chennai. Email: [email protected] Introduction: Tuberous sclerosis complex (TSC) is a rare genetic disorder with multisystem involvement and neuropsychiatric manifestations like psychosis, mood disturbances, and cognitive impairments. Case summary : A young female with TSC and seizure disorder presented with borderline intelligence, reduced psychomotor activity & appetite, staring gaze, irritability, and wandering behavior. Examination showed ash-leaf macules, shagreen patches, adenoma sebaceum, and multiple hypopigmented macules. MRI revealed cortical tubers. Family history indicated genetic predisposition. She was treated with risperidone (6 mg), sodium valproate (800 mg), topiramate (200 mg), lorazepam (4 mg), and thyroxine (25 µg) Conclusion: This patient presented with catatonic features on stopping her drugs. Importance of compliance and regular follow-up is emphasized. Key words: Tuberous sclerosis, seizures

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Dr Charulatha C S, Dr Mythili, Dr Shanthi Department of Psychiatry, Institute of Mental Health, Madras Medical college Email - [email protected] INTRODUCTION Early neurological events like strokes and seizures can lead to long-term cognitive and behavioral challenges, including ADHD and specific learning disabilities (SLD) significantly affecting academic performance. CASE REPORT A 11-year-old boy presented with poor academic performance, including difficulties in reading, writing, spelling and arithmetic for six years and hyperactivity, inattention, and impulsive behavior since age six. At age five, he had a transient ischemic attack (TIA) followed by a seizure and right hemiparesis. MRI revealed a left MCA infarct, EEG showed epileptic activity. After one year of antiepileptic treatment, he recovered without neurological deficits. ADHD was diagnosed using Vanderbilt and Conners rating scales, and SLD was confirmed with the NIMHANS SLD battery. Methylphenidate (20 mg/day) improved ADHD symptoms and cognitive remediation for SLD was recommended. DISCUSSION Early childhood strokes can disrupt brain regions involved in attention and executive functions, leading to ADHD and SLD. Early diagnosis and intervention with medication and educational support are critical for improving long-term outcomes. Key words ADHD, SLD, Childhood Stroke, TIA, Seizure Disorder

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Dr. Harshada Shakuntal Junior resident, Dr. Sachin Mahajan Dr. Niteen Abhivant B.j. Govt Medical College And Sassoon General Hospitals, Pune, Maharastra. Email: [email protected] Introduction: Geriatric patients presenting with psychiatric disorders can have associated neurological or metabolic co-morbidities which can influence or precipitate the psychiatric disorder itself. Late onset mood disorders, including mania, have generally been reported to be associated with vascular risk factors. Case Report: A 78-year-old Muslim male, presented with history of 25 days with complaints of decreased sleep, increased talkativeness and overfamiliarity, expansive talks, and increased activity and aggressive behaviour. MSE showed elated mood and ideas of grandiosity, Insight Grade I/V. His MMSE revealed a score of 26/30. CT Brain (Plain) : 1. Tiny old infarcts, A provisional diagnosis of First Episode Mania was kept and the patient was started on Tb. Divalproex along with Tb. Risperidone Tb. Quetiapine 25 mg per day for sleep, along with Tb. Trihexyphenidyl being added as 2mg over a period of 10 days. The patient showed improvement in his symptoms over a period of next 2 weeks and was subsequently discharged. Conclusion: Our patient fulfilled the criteria for manic episode as per ICD 11- 6E62.1 i.e Secondary Mood Syndrome, with manic symptoms. Keywords: Geriatric, Secondary mood syndrome

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Dr. Mehwish Imtiaz Senior Resident, Department of Psychiatry, GMC, Srinagar. Email: [email protected] INTRODUCTION: During the postpartum period, about 85% of women experience some type of mood disturbance. Most are mild and short-lived but 10 to 15% of women develop more significant symptoms of depression or anxiety. AIMS AND OBJECTIVES: To Identify the socio-demographic and obstetric risk factors associated with post-partum depression. METHODOLOGY: A cross-sectional study was conducted in the department of obstetrics and gynaecology at LD hospital, an associated hospital of GMC Srinagar. Post-partum women (within 6-12nweeks post-delivery), of age 18-45 years, delivered a live baby and those who provided informed consent were included in the study. They were assessed using Edinburgh postnatal depression scale. RESULTS: Among the total study patients, 15.2% had post-partum depression. Among obstetric factors, primipara who delivered by caesarean section, had complicated pregnancy, with NICU admission of the delivered baby and positive family history of psychiatric illness had greater risk for post-partum depression. CONCLUSION: Identification of risk factors associated with post-partum depression is imperative for early intervention and the prevention of mental health disorders. KEYWORDS: Post partum depression, Obstetric Risk Factors.

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Dr.Bhola Prasad Mahato 1 , Dr.Arka Adhvaryu 2 Post graduate Trainee 1 , Senior Resident 2 , Department of Psychiatry, R G Kar Medical College &Hospital Kolkata, West Bengal, India. Email: [email protected] Background & Aims: Dating apps are popular for meeting new people, but they can impact on mental health. This study aimed to find the motivations for using online dating apps and their impact on mental health Methods : An observational study conducted on 40 participants from Kolkata, aged 18-35 yrs. The purpose of the study was explained, and the questionnaires were completed using google forms. Dating App Motivation scale and Depression Anxiety Stress Scales 21 were used. Results : Participants motivated by casual sex and ease of communication on dating apps had high stress, anxiety, and depression, while those motivated by trendiness had lower stress and anxiety. Conclusion : The study found that using dating apps for casual sex and easy communication is linked to increased stress, anxiety, and depression. Key words : Stress, Anxiety, Depression

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Dr. Roshan F. Sutar Department of Psyhciatry, All India Institute of Medical Sciences, Bhopal (AIIMS Bhopal) Email: [email protected] Background and Aims: Transgender individuals in India face significant barriers to accessing gender-affirmative healthcare, with limited specialized services available. A multidisciplinary Transgender Clinic (TGC) has been operational for one year at a tertiary care hospital in central India, integrating expertise from Gynecology, Plastic Surgery, Urology, Psychiatry, and Endocrinology. This study evaluated the utilization of Gender Affirmative Medical and Surgical Therapies (GAMST) and patient clinical profiles at the TGC. Methods: A structured retrospective review of consultation data from February to November 2024 was conducted using patient records from the TGC. Results: Among 21 participants, 82.6% were unmarried, and 65.2% were biologically male. Significant knowledge gaps about GAMST were identified, with 13% reporting discrimination and 4.3% experiencing suicidal ideations. Internet platforms were the primary source of LGBT information (91.3%), and most consultations centered on gender-affirming treatments. Conclusion: The clinic addresses critical gaps in education, mental health, and gender-affirming care. Keywords: Gender dysphoria, transgender, GAMST, gender-affirmative care

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1 Dr. Amar Shinde, 2 Dr. Aanchal Miglani 1 Senior Consultant Psychiatrist, Jagruti Rehabilitation Centre, India 2 Junior Consultant Psychiatrist, Jagruti Rehabilitation Centre, India Email : [email protected] BACKGROUND: Alcohol Dependence Syndrome – A prevalent condition and a global health issue, a chronic disease in which a person is unable to control their urge to drink. CLINICAL FINDINGS: A case of liver transplant, consuming alcohol in dependence pattern with medical, social, personal complications, and lab findings of direct bilirubin – 0.5mg/dl, SGOT – 65 U/L, SGPT – 57 U/L, GGT – 120.37 U/L, Hb – 11.0 THERAPEUTIC INTERVENTIONS: T. Chlordiazepoxide 100mg, T. Levetriacetam 1000mg in divided doses, tapered off in 7 days, T. Thiamine 200mg, T. Pantoprazole 40mg, T. Acamprosate 1998mg RESULTS: Post – intervention results – mitigation of withdrawal severity – reduction in CIWA – Ar scores, reduction in craving, restoration of normal liver function tests and sustained abstinence. CONCLUSION: Emphasis on post – transplant management of alcohol dependence in liver transplant recipients: A comprehensive treatment approach KEY WORDS: post liver transplant, alcohol detoxification, deaddiction

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Dr Dean Manning Core Psychiatry Trainee Dr Shweta Mittal Consultant Psychiatrist Nottinghamshire Healthcare NHS Foundation Trust, UK Background: I am a Core Psychiatry trainee currently working in a Crisis Resolution and Home Treatment Team (CRHT) in which many patients are referred with suicidal ideation in the context of their Mental Health. Aim: To identify professional and organizational-related themes highlighted in Coroner’s PFDs reports in Mental Health related suicides.. Methods: We reviewed Coroner’s PFDs reports via the UK Judiciary website. We filtered reports by those which are both Mental Health related deaths and included the keyword ‘suicide’. 100 reports were reviewed starting with the most recent. Themes were identified and grouped into patient-related, professional-related, and organizational-related factors that may have contributed to the death by suicide. Results: Reports were reviewed from across the UK. The highest number of reports were from the Coroner area of Manchester South (12%). 61% of reports were of males. Analysis: The main professional-related factors identified from thematic analysis of the PFDs reports were; issues around risk assessment and management (45%), lack of interprofessional communication and collaboration (33%), inadequate clinical queries/assessments (25%), Conclusions and Recommendations: It is hoped by identifying common themes arising from PFDs reports in Mental Health related suicides we can identify areas for change in practice that could lead to reduction in death by suicides. Key words: Suicide, Corner’s prevention

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Dr Alicia Perti Department of Psychiatry, Dr. D.Y Patil Medical College, Pune, India. Email: [email protected] Background & Aims : Eating disorders in students are showing an increasing trend. The current study aims to evaluate and compare eating disorders and body shape perception in male and female medical students. Methods : A cross-sectional study was conducted among 319 undergraduate students in a medical college. Eating Attitudes-26, Body Shape Questionnaire-16B, The SCOFF Questionnaire, and Medical Students Well-Being Index were applied to all the participants. Results : 319 medical students were recruited for the study, of which 159 were males and 160 were females. The study found that male and female medical students are at an equal risk of developing eating disorders. More male students fell in the overweight and obese category of BMI. Increased risk of developing eating disorder was positively associated with elevation in BMI. Increased psychological distress was seen among students with higher body shape dissatisfaction. Conclusion : From the present study we could conclude that eating disorders are on the rise among males as much as females, thus providing an area that requires further research. Disordered eating habits and body image dissatisfaction are directly linked to increased weight and higher BMI. Keywords : Eating disorders, body shape, psychological distress

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Dr. Piyali mandal Additional professor, NDDTC, AIIMS, Delhi. Background: In the treatment of opioid dependence, naltrexone has tremendous potential. The major problem with naltrexone maintenance treatment is attrition and noncompliance. Aims & objectives: The current study aims to assess the effect family involvement on retention and compliance to naltrexone treatment. Material & Methods: A consecutive sample of 40 subjects were recruited as per selection criteria and randomized to either of the two-intervention arm (Treatment as usual= naltrexone and one session with family on need for supervision, TAU+ Significant other involvement, SOI) in the OPD setting for this randomized open label prospective study. In the TAU+SOI group, 3 family sessions based on Budney and Higgins (1998) manual for reciprocal relationship counselling were delivered. Assessment was done at every 2-3 weeks till 12 weeks. Results: The groups did not differ in demographic characteristics and substance use profile. Both the groups had comparable retention and compliance rates at every follow-up, abstinence rate at the end of 12 weeks. The family functioning was slightly better in the intervention group. Conclusion: The pilot study results highlight the need for further study involving family with more sample size and extended period. Key words: naltrexone, retention, family

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Dr.Mullaivendan, final year postgraduate Madras medical College, Chennai, India Case presentation: This case explores a 34 yr old software Engineer, who presented with unexplained fatigue, chronic headaches and irritability. Despite being successful at work, Mr. A battled feeling of emptiness, self-doubt and worthlessness for over a year. Clinical presentation: Symptoms: persistent low mood, loss of interest in hobbies, insomnia and poor concentration. Physical complaints including unexplained body aches, dismissed by Mr. A as “work stress”. Diagnostic challenges: Delayed diagnosis : Initial consultations focused on ruling out medical causes (thyroid disorders, vitamin deficiencies).Mr. A ability to mask symptoms and function well made clinicians suspect stress or burnout rather than depression Breakthrough: During a casual discussion, Mr. A disclosed feeling “like a fraud” despite accolades. This prompted a psychological evaluation. Treatment approaches CBT, lifestyle adjustments, low dose SSRI. Outcome With 6 months of low dose SSRI, CBT, lifestyle adjustments reported a significant reduction of symptoms and improved self-awareness, learned to set realistic goals and accept imperfections, which strengthened his resilience. Key words: Depression, High functioning depression.

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Dr. Rahul Mathur, Assistant Professor of Psychiatry Dr Varchasvi Mudgal Assistant Professor of Psychiatry MGM Medical College Indore. Background: Phagophobia, or the irrational fear of choking, is a rare and debilitating anxiety disorder. It often arises after a triggering event, leading to avoidance of solid foods, malnutrition, and social withdrawal. Case Presentation: A 26-year-old female presented with a three- year history of phagophobia following a mild choking incident involving a chickpea. Her condition progressively worsened, leading to complete avoidance of solid foods and a reliance on liquids or ground meals. She experienced significant weight loss (over 15 kg), menstrual irregularities, and marked social isolation. Treatment: A multidisciplinary treatment plan was implemented. Pharmacotherapy included high-dose fluoxetine (40 mg/day), augmented with aripiprazole (5 mg/day) and clonazepam (0.5 mg/day). Concurrently, she underwent cognitive-behavioral therapy (CBT), which included psychoeducation, cognitive restructuring, graded exposure to solid foods, and relaxation techniques. Outcome: After three months, the patient showed significant improvement, including reintroduction of solid foods, weight stabilization, normalization of her menstrual cycle, and resumption of social activities. Conclusion: This case underscores the chronic nature of phagophobia and its profound physical and psychosocial impacts. Key words: Phagophobia, Anxiety

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Dr. Keerthana Mynampally Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry. Email: [email protected] Introduction- Women engaged in commercial sex work face intertwined challenges stemming from socioeconomic hardship, stigma, and mental health issues. Substance dependence and unstable relationships increase their vulnerability to mental health disorders. Aims and Objectives- To present the case of a 25-year-old woman with substance dependence involved in commercial sex work. Case Report- A 25-year-old woman from a low socioeconomic background with nicotine and cannabis dependence engaged in commercial sex work to sustain her livelihood and substance use. She exhibited traits of borderline personality disorder (BPD), recurrent mood episodes, low mood, irritability, and anxiety about HIV. Treated initially with olanzapine and psychosocial support, she improved but was lost to follow-up. Returning a year later with similar symptoms triggered by stress, sertraline was added, and psychosocial strategies reinforced. Conclusion- This case highlights the need for long-term, integrated care combining psychotherapy, medication, and harm-reduction strategies to address the complexities faced by such women. Key words: Gender, Mental Health, female sex worker.

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Dr. Nishi Vishwanathan, Dr. Sagar Dattani, Dr. Sakshi Nagori, Dr. Delnaz Palsetia, Dr. Alka Subramanyam Department of Psychiatry, T.N.M.C. and B.Y.L. Nair Charitable Hospital, Mumbai, India Email: [email protected] Background : Autoimmune encephalitis (AE), caused by autoantibodies targeting neuronal or synaptic proteins, is a rare but significant cause of encephalitis, accounting for 20-30% of paediatric cases. Adolescents, particularly females (3:1 ratio), are disproportionately affected. Only 28% meet diagnostic criteria, emphasizing the importance of clinical judgment. Methodology : This case report examines a 13-year-old female presenting with AE at a tertiary centre in Mumbai, India. Results/Case Summary : The patient exhibited neuropsychiatric symptoms, including delusions and hallucinations, progressing to status epilepticus and a comatose state. EEG showed diffuse slowing, and MRI revealed fronto-temporal and parieto-occipital changes. Despite a negative NMDA receptor antibody test, clinical features indicated AE. She was treated with antiepileptics and referred to neurology for further care. Conclusion : This case highlights AE’s diagnostic challenges, stressing the need for clinical recognition despite inconclusive investigative findings. Key words : Autoimmune encephalitis, Adolescent psychiatry, Immune-mediated psychosis, Neuropsychiatric symptoms.

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Dr. Srikar chintala, Resident, Dr. Md. Adil Faizan, Resident, Dr. M. Raghuram, Professor, Dr. M Pramod Kumar Reddy, Professor & HOD, Department of psychiatry, Mamata Medical college, Khammam. Introduction: Folie à deux is defined as an identical or similar mental disorder affecting two or more individuals, usually the members of a close family. Case: One case report of two patients of this condition are presented with a brief review of the literature. Prompt recognition of this condition is an essential step in the management. Discussion: The majority of patients with folie à deux require multiple treatments including separation, antipsychotics, individual and group psychotherapy, and family therapy. Keywords: Folie à deux, folie imposé, induced delusional disorder, shared psychotic disorder

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Dr. Anindo Mitra 1 Dr. Ankita Chattopadhyay 2 Dr. Bandita Abhijita 3 Junior Resident 1 Assistant Professor 2 Senior Resident 3 Dept. Of Psychiatry, JIPMER, Puducherry, India Email: [email protected] Background and Aims: Deliberate foreign body ingestion (DFBI) is a repetitive, impulsive behaviour linked to psychiatric conditions such as borderline personality disorder (BPD). While commonly associated with psychosis, pica, or malingering, DFBI is rarely observed in substance use disorders (SUD). We aim to present a patient with multiple SUDs and BPD exhibiting DFBI, focusing on clinical management and outcomes. Methods: A 31-year-old male with polysubstance dependence, BPD, and adjustment disorder presented with abdominal pain after ingesting sharp objects. He reported a 17-year substance use history involving alcohol, cannabis, opioids, and recreational drugs. Early familial separation contributed to feelings of rejection, impulsivity, and substance use. Imaging revealed a metallic foreign body in the transverse colon, which passed spontaneously. Results: The patient was treated with naltrexone and weekly psychotherapy addressing emotion regulation and self-harm. Conclusion: Multidisciplinary approaches combining pharmacotherapy and psychotherapy effectively manage DFBI and related impulsivity in dual-diagnosis cases. Key words: Deliberate foreign body ingestion, Self Harm, Polysubstance Abuse, Addiction, India

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Dr. Swetha Pakki Department of Psychiatry, Dr. D.Y. Patil Medical College, hospital and research centre, Pune, India Email: [email protected] Background: Primary hypothyroidism is a result of autoimmunity, radiation surgery, radio iodine, drugs such as Iodine and Iodine containing drugs (Amiodarone), and Lithium. Lithium has dose and time dependant side effects on thyroid, parathyroid and kidneys. Case: A 40-year-old woman who is a known case of BPAD since 2004 and was on tab. Lithium 400mg BD. She developed hypothyroidism in 2020 and has been on thyroid replacement therapy since then but didn’t respond until her lithium was stopped. After which, at the same dose of thyroxine, her TSH normalised and is currently maintaining well. Conclusion: Lithium-induced hypothyroidism varies from 14.17% - 19.35% for overt and subclinical hypothyroidism. Hence it is important for a thyroid function test to be performed prior to the start of lithium therapy. A trial of lithium can be given along with thyroid replacement in such cases. Keywords: Bipolar Disorder, Lithium, Hypothyroidism, Mania.

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Dr. Debjani Baral, Junior resident, Institute of Psychiatry-COE, Kolkata Email: [email protected] INTRODUCTION - OCD is characterized by repetitive thoughts, impulses, doubts or images associated with or without compulsive behaviors. AIM- Aim of this presentation is to study the rare presentation of OCD. METHODS - A 17-year-old male presented to psychiatry ER with complaints of not speaking spontaneously in all situations (in home and other social situations) since past 7 days with occasional whispering or being stuck in one syllable for substantial period. On MSE- motor activity was reduced, no speech productivity, affect was anxious. Detailed history from family members revealed progressive slowness in daily activities, repeated checking, repeating same phrase over and again since past 3 months and washing hands for prolonged duration, spending much higher time than usual in washroom since past 2 months. Patient was started with tab fluoxetine 20mg, gradually increased up to 80mg over 4 weeks, tab lorazepam 4mg in divided doses. tab clomipramine 25 added at 4 th week. Patient started speaking gradually after 4 days of admission, YBOCS at 7 th day of admission was 26, YBOCS after 4 weeks was 15. RESULT - We identified that this sudden onset mutism was a rare presentation of undiagnosed obsessive-compulsive disorder in this patient. CONCLUSION - Obsessive compulsive disorder can present as variety of other psychiatric conditions, detailed history and early diagnosis can result in good prognosis of the disorder. KEY WORDS: OCD, Mutism

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Dr Sagi Lakshmi Neeharika 1 , Dr. K. Suresh Reddy, Dr. G. Surekha, Dr. C. Pradyumna Junior Resident, Dept. of Psychiatry, Malla Reddy Medical College for Women, Hyderabad. Introduction Huntington disease (HD), a neurodegenerative autosomal dominant disorder, is characterized by involuntary choreoathetotic movements with cognitive and behavioural disturbances. Accumulating evidence suggests that obsessive compulsive disorder (OCD) symptoms may precede the clinical onset of HD or emerge during the later stages of the disease. Case Report A 45 year old male patient was brought to the psychiatry OPD with the complains of involuntary body movements (upper, lower and trunk), abnormal facial movements, abnormal posturing, speech difficulty since 8 years. Repeated hand washing and excessive bath time since 3 years with positive family history of similar complaints in his daughter. Discussion Some patients with HD develop symptoms associated with OCD. Progressive and differential neuropathological changes in the ventromedial caudate nucleus and related neural circuits may underlie this association. Conclusion: Further testing is needed to determine the neurobiological mechanisms of these disorders. Key words: OCD, Huntington’s Disease.

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Dr. Sri Amrutha Lakshmi Kakarla Department of Psychiatry, Tirunelveli Medical college and Hospital, Tirunelveli, Tamil Nadu. Email: [email protected] Background: Emerging adulthood, typically defined as the age range of 18-29 years, represents a critical developmental period characterized by increased autonomy, exploration, and identity formation. Aim: To describe key psychological, social, and biological risk factors associated with substance use in emerging adulthood Methods: A cross-sectional study was conducted in Psychiatric department of Tirunelveli medical hospital among 80 patients aged 18 to 29 years who had substance use. The severity of Substance use is assessed by ASSIST (Alcohol, smoking and substance involvement screening test), Severity of dependence scale (SDS) and Personality risk factors are identified by The Substance Use Risk Profile Scale (SURPS) Results: The Study shows male predominance (98.6%) in substance use and significant association of p value showing 0.000 with first drink at adolescence, peer pressure, alcohol use in family members, easy availability of substance, family conflicts Conclusion: The above study is expected to reveal diverse risk factors for substance use in emerging adulthood which is essential for developing targeted prevention, intervention strategies and support individuals. Key words: substance use, ASSIST, risk factors, personality, prevention

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Dr. Akash Gorana(Junior Resident) Dr. Delnaz Palsetia (Assistant Professor) Dr. Jahnavi kedare (Additional Professor) Department of Psychiatry, Topiwala National Medical College and BYL Nair Charitable Hospital Email: [email protected]@gmail.com Background: Traumatic brain injury (TBI) is a global health concern with significant neuropsychiatric sequelae that can impair quality of life and functional independence. Cases: Case 1: A 32-year-old female developed seizures, compulsive behaviors, and personality changes after a road traffic accident in 2017. Misdiagnosed with obsessive-compulsive disorder, evaluation revealed frontal, temporal, and cerebellar lesions, managed with antipsychotics and anticonvulsants. Case 2: A 27-year-old male with temporal gliosis post-accident experienced irritability, insomnia, and interpersonal difficulties, diagnosed as post-concussion syndrome and treated with antidepressants. Case 3: A 67-year-old male transitioned from post-TBI depression to mania two years after a traumatic haemorrhage. Non-compliance with medications led to worsening symptoms, later managed with mood stabilizers and antipsychotics. Conclusion: TBI-induced psychiatric disorders are complex but manageable with early intervention, enhanced awareness, and collaborative care to improve outcomes. Keywords: Traumatic brain injury, neuropsychiatric sequelae

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Dr. Shubham Jadhav (Junior Resident) Dr. Delnaz Palsetia (Assistant Professor) Dr. Jahnavi Kedare (Additional Professor) Department of Psychiatry, Topiwala National Medical College and BYL Nair Charitable Hospital Email: [email protected] Background Female alcoholism is a growing public health concern influenced by unique psychosocial factors. Emotional distress, trauma, and relational difficulties often contribute to alcohol use disorders in women. Case 1 involved a 35-year-old woman whose alcoholism developed alongside her husband’s, fuelled by marital stress and emotional neglect. Case 2 focused on a 43-year-old woman who drank heavily due to depression from a dysfunctional family environment and abusive household. Case 3 described a 47-year-old woman whose alcoholism stemmed from work-related stress and isolation. Discussion : Women are more likely to develop alcohol dependence as a response to emotional stress and mental health issues. Conclusion : Effective treatment requires addressing both addiction and the psychosocial challenges unique to women. Keywords : Female alcoholism, Psychosocial factors

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Dr. Nikita Deopa*, Dr. Bhavika Rai, Dr. Chirag Saini GMC, Haldwani, Nainital, Uttarakhand Email: [email protected] Background : Trichotillomania is a psycho dermatological disorder characterized by an uncontrollable urge to pull one’s own hair and a sense of relief after the hair has been plucked. Case synopsis : A 10 year old male, presented with complaints of irresistible urge to pull his hair, resulting in obvious hair loss and distress, consistent with a diagnosis of trichotillomania. Flouxetine 10mg OD was initiated, with some improvement at 3 weeks. The dose was increased to 20mg for further improvement of the disease. However, he developed erythematous, itchy wheal like lesions all over the body. The patient was referred to Dermatology OPD for the management of urticaria. Discussion : It highlights the importance of monitoring patients closely for side effects when initiating pharmacotherapy for psychiatric disorders. Keyword: Trichotillomania, SSRI, Fluoxetine, Urticaria, Paediatric

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Dr. Manita Kumari, PG, DR. RML HOSPITAL, DELHI. , Dr. Nitin Kumar, Associate Professor, DR. RML HOSPITAL, DELHI. Email: [email protected] Introduction Delusional parasitosis, also known as Ekbom Syndrome, is a psychiatric condition characterized by the false belief of infestation with bugs or worms. Case Report A 57-year-old woman presented with tactile sensations of insects crawling under her skin for a year, accompanied by headaches and itching. She attempted to “kill” the imagined insects by pinching her skin and wanted surgical intervention to confirm the infestation. She experienced sleep disturbances due to intense itching. Results Initial treatment with Duloxetine showed no improvement. Subsequently, Aripiprazole (5 mg) and Lorazepam (2 mg, as needed) were prescribed, leading to symptom relief. Conclusion This case highlights the effectiveness of antipsychotics in managing Ekbom Syndrome, emphasizing the need for targeted therapies in treating delusional parasitosis. Keywords: Delusional parasitosis, Ekbom Syndrome, Antipsychotics

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Dr Mano Manoharan (Mony) FRCPsych 1 , Dr Greeshma Grish MRCPsych 2 , Miss Vinuthy Vijaykaandeepan 3 1 Consultant Perinatal Psychiatrist, South London and Maudsley NHS Trust 2 ST5, South London and Maudsley NHS Trust 3 Medical student, Kings College Hospital. Email: [email protected] Background and introduction: The COVID-19 pandemic disrupted perinatal mental health services, necessitating rapid adaptation by our Community Perinatal CMHT through a hybrid care model. This approach improved access via home visits, remote reviews, flexible clinic locations, and telepsychiatry, enabling caregiver-infant assessments, family involvement, and continuity of care through virtual consultations. Remote participation of multidisciplinary teams also enhanced pre-birth planning, while psychotherapy and couples therapy benefited from flexibility. Challenges included inconsistent internet access, lack of private spaces, risks of undetected domestic violence, and difficulties assessing mother-infant bonding remotely. Limited clinic space and reduced team cohesion hindered the return to face-to-face care, and the absence of partner support during high-risk pregnancies impacted maternal mental health. The pandemic experience highlighted the need for infrastructure investments, multidisciplinary collaboration, and innovative care models. Hybrid approaches hold promise for addressing perinatal mental health in the future. Keywords: Perinatal mental health, Hybrid care model, Telepsychiatry

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Dr Arnab Chakraborty MD psychiatry 3rd year JR, IPGMER and SSKM Hospital, Kolkata. Email : [email protected] Background: Clozapine is an effective antipsychotic for treatment-resistant schizophrenia, but eosinophilia, a rare non-dose dependent side effect, can occur. Defined as eosinophil count >600/mm3, it can be benign or indicate life-threatening conditions such as neutropenia, myocarditis, or pancreatitis. Methods: A 31-year-old male diagnosed with resistant schizophrenia was started on clozapine at 12.5 mg. Initial blood tests showed normal eosinophil levels (6%). After 4 weeks, the BPRS score was 36, and eosinophil count had decreased to 26%, with no signs of organ inflammation. By the 6th week, the eosinophil count normalized without treatment interruption. Conclusion: There are no established management protocols for clozapine-induced eosinophilia. Stopping clozapine can worsen psychotic symptoms, so clinicians should develop guidelines for early detection and management to improve patient outcomes. Keywords: eosinophilia, clozapine.

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Dr Mano Manoharan (Mony) FRCPsych 1 , Dr Greeshma Grish MRCPsych 2 , Miss Vinuthy Vijaykaandeepan 3 1 Consultant Perinatal Psychiatrist, South London and Maudsley NHS Trust 2 ST5, South London and Maudsley NHS Trust 3 Medical student, Kings College Hospital. Email: [email protected] Background Electroconvulsive therapy (ECT) is an effective treatment for severe mood disorders, occasionally used during the perinatal period. Neuromodulatory treatments like transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are emerging as alternatives for treatment-resistant perinatal mental health conditions, such as postpartum depression and obsessive-compulsive disorder (OCD). Findings Preliminary studies highlight the potential of TMS and tDCS. A pilot randomized controlled trial (RCT) of tDCS showed a 75% remission rate in postpartum depression compared to 12.5% in the sham group, with no serious adverse events. TMS studies also reported reduced depression scores without adverse fetal outcomes, though larger RCTs are required to validate these findings. Conclusion Non-invasive treatments like TMS and tDCS offer safe and effective options for managing maternal mental health, minimizing medication-related risks during pregnancy, and improving outcomes in treatment-resistant cases. Keywords: Neuromodulation, Perinatal mental health, Transcranial magnetic stimulation (TMS)

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Dr S Sagar Post Graduate Trainee, CAIMS, Karimnagar Email: [email protected] Introduction: Folie a trois translates from French to madness of three and refers to a rare psychiatric syndrome in which a delusional belief is shared among three individuals who are in close proximity or have a close relationship. It is usually classified under the broader category of shared psychotic disorder or related condition, F24 - Induced delusional disorder in ICD-10. Case A 30 year old male brought by informants with chief complaints of suspiciousness, sleep disturbances, refusing intake of food, since 6 months,, on MSE patient was found to have delusion of persecution, where he had a belief that someone is trying to harm him by mixing poison in his food, on further interview with the informants it was found that similar delusional belief was found in wife and mother in law, family history of psychiatric illness in mother, laboratory investigations done were found to be within normal limits, patient was advised for couple counselling and further lost follow up Conclusion This is a case report of shared delusion among the patient, patients wife and mother in law. Keywords: Folie a trois, Induced delusional disorder

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Deric Joseph*, Vignesh Kuppusamy, Nishtha Chawla, Raman Deep * Junior Resident, All India Institute Of Medical Sciences, New Delhi Email: [email protected] Background: Clozapine withdrawal-associated cholinergic-rebound syndrome (CWCRS) is a rare condition following abrupt clozapine cessation, presenting as cholinergic rebound, withdrawal psychosis, serotonin syndrome, or catatonia. Case Report A 55-year-old male with a 25-year history of treatment-resistant bipolar disorder developed CWCRS after clozapine (125 mg/day) was stopped due to neutropenia (ANC 920/μL). Within 48 hours, he experienced disorientation, altered sensorium, impaired attention, and reemergence of Oro-Bucco-facial dyskinetic movements. Comprehensive investigations were normal, and CWCRS was diagnosed. Clozapine was reintroduced at 25 mg/day after ANC recovery, leading to significant improvement by Day 3, with complete resolution at 50 mg/day. Conclusion This case highlights that CWCRS can occur even at low clozapine doses. A systematic approach and vigilant monitoring are crucial during abrupt cessation, especially in patients with a history of tardive dyskinesia. Key words: clozapine, withdrawal, delirium, bipolar disorder

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Dr. Sneha Gupta Psychiatrist, Sangath, Rewa. Email: [email protected] Background Adverse Childhood Experiences (ACEs) such as abuse, neglect, and dysfunctional households are linked to long-term negative health outcomes, including impaired emotional regulation and maladaptive coping strategies like substance use. Methods This cross-sectional study analysed baseline data from 500 participants enrolled in the NIMH-funded trial Optimized ( NCT05944926 ). Participants were assessed for ACEs (ACE score), AUD (AUDIT-C score), depression (PHQ9 score), anxiety (GAD7 score), and other factors like smoking history, resilience, impulsiveness, and socioeconomic variables. Multivariable logistic regression estimated the odds of AUD development in participants with higher ACE scores while adjusting for confounders. Conclusion The study revealed a significant association between ACEs and AUD. Routine ACE screening and trauma-informed care models are essential to mitigate the psychological impacts of early life adversity and provide targeted interventions for those at risk. Keywords: Adverse Childhood Experiences (ACEs), dysfunctional households, emotional regulation and maladaptive coping strategies.

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Dr. Rishabh Tiwari*, Dr. Sujita Kumar Kar** Junior Resident*, Additional Professor** Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India Email: [email protected] Background Cognitive deficits often persist in bipolar depression despite resolution of mood symptoms. This case explores the use of transcranial random noise stimulation (tRNS), a non-invasive neuromodulation technique, to address cognitive impairments. Methods A 36-year-old female with bipolar disorder exhibited deficits in attention, verbal fluency, and memory, as assessed by Addenbrooke’s Cognitive Examination-III (ACE-3). She underwent 12 tRNS sessions targeting the dorsolateral prefrontal cortex (DLPFC) bilaterally over six days. Cognitive assessments were conducted pre- and post-treatment, with a follow-up after one month. Conclusion The patient demonstrated sustained improvements in cognitive performance post-tRNS, indicating its potential as a therapeutic tool for cognitive deficits in bipolar depression. Further research is needed to establish its efficacy and optimize treatment protocols. Keywords: Transcranial random noise stimulation (tRNS), Bipolar depression, Cognitive deficits

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Dr Richa choudhary MD, Dr V S Pal Prof &Hod Mgm Medical College, Indore Email: [email protected] Introduction: Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome affecting 8% of Indian females. Suicidal ideation is rare in PMDD. Case Details: A 22-year-old female presented with anger, lethargy, and suicidal thoughts occurring one week before menstruation for six months. Symptoms included anxiety, bloating, and backache, impacting her personal and professional life. No psychiatric comorbidities were found. She was diagnosed with PMDD per DSM-5 criteria. Management Escitalopram 10 mg was prescribed for luteal-phase-only treatment (14 days before menstruation). The patient showed improvement in suicidal thoughts and other PMDD symptoms. Conclusion: Suicidality in PMDD may stem from cyclic hormonal changes influencing neurotransmitters like serotonin, GABA, and dopamine. This case highlights the importance of timely diagnosis and targeted treatment for improved outcomes. Keywords: Premenstrual Dysphoric Disorder (PMDD), Suicidal ideation, Selective Serotonin Reuptake Inhibitors (SSRIs)

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P. Jain, P.K. Sharma, A. Timothy Dr. Pranika Jain Pg Resident, Base Hospital, Delhi Cantt Roorkee Email: [email protected] Background : Gender dysphoria involves discomfort due to incongruence between a person’s assigned sex at birth and their gender identity. Obsessive-compulsive disorder (OCD) co-occurring with gender dysphoria in adolescents is rare and poorly documented. This case explores the management of such co-morbidity. Methods : A 16-year-old assigned female at birth presented with distress over a mismatch between assigned and expressed gender since age 6. Symptoms included intrusive self harm thoughts, guilt, and repetitive counting rituals. Evaluation included mental status examination (MSE), Yale-Brown Obsessive Compulsive Scale (YBOCS), and the Utrecht Gender Dysphoria Scale. Conclusion : This case highlights the importance of individualized, multidisciplinary care in addressing the dual burden of OCD and gender dysphoria. A tailored approach incorporating pharmacotherapy, psychotherapy, and gender-affirmative care can significantly improve outcomes in such complex presentation. Keywords : Gender dysphroia, OCD, Yale-Brown Obsessive Compulsive Scale (YBOCS),

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Dr. Rashmi Shukla Assistant Professor, Kgmu Medical College, Kanpur Email: [email protected] Introduction: Neurocysticercosis (NCC), caused by Taenia solium , is a common parasitic infection of the central nervous system, often presenting with seizures and neurological deficits. Psychiatric manifestations, though less common, can mimic other psychiatric disorders, complicating diagnosis. Case Report: A 20-year-old male presented with manic symptoms, including grandiosity, irritability, and sleep disturbances, lasting a month. He had no history of seizures or neurological deficits. Initial psychiatric treatment was ineffective. Neuroimaging revealed a cystic lesion in the right temporal lobe, confirming NCC. Treatment with albendazole, corticosteroids, and psychiatric support led to rapid symptom improvement. Conclusion: NCC is a significant but often overlooked cause of psychiatric symptoms, especially in endemic areas like India. Manic symptoms in patients without a prior history of NCC are rare, emphasizing the importance of considering NCC in unexplained psychiatric changes, particularly when symptoms resist treatment. Keywords: Neurocysticercosis, psychiatric manifestations, organic mania, neuroimaging.

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Dr. Apeksha kulkarni Senior resident, Department of Psychiatry, St john’s medical college, Bangalore. Email: [email protected] Background: Today’s psychiatry is involved in very, many spheres of our day today life. There is lot of interfaces between psychiatry and law. postgraduate psychiatry course should be modified to the extent that they should have proper forensic psychiatry training, exposure to certification, disability assessment, management of pocso cases and many more civil and criminal responsibilities as psychiatrist varies in different settings. Individual perspective : Some key experience points include 1.Managing violent patients and resources available for protection of psychiatrist. 2.reporting and managing patients who are in conflict with law 3.Issuing disability certification and tools used. 4.Emergency management of POCSO cases and challenges encountered. Conclusion the younger psychiatrist should be thorough in latest legislations such as mental health care act in the future. Which going to govern the practice of psychiatry. Keywords: forensic psychiatry, disability certification, POCSO.

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Dr. Muhammad Qasim Mujahid* Senior Clinical Fellow, Dr. Vinu Pemmaraju Consultant Child and Adolescent Psychiatrist Black Country Health Care NHS Foundation Trust, UK Email: [email protected] Background: Research shows that number of risk factors associated with diagnosis of autism spectrum disorder (ASD) and higher incidence in Males. Method: A retrospective cohort study of the 6-year data (January 2016 to February 2022) of 6-18-year-olds referred to our Autism Panel. Referrals to our Autism pathway are mostly from Pediatricians and CAMHS. The above-mentioned variables were analyzed. Descriptive statistics were used, followed by non-parametric one-sample binomial and Chi-square tests. Conclusion: Study confirms a significant association between ASD and all the above-mentioned variables. We hope to discuss these findings to wider ASD team. In future, with right approvals, would like to corroborate this data with Obstetric team’s notes locally. Keywords: Autism spectrum disorder, ASD, Delayed Milestones.

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Dr. Asmita Vashisht DM SR, All India Institute Of Medical Sciences, Dehradun Email: [email protected] Background Tics are involuntary, repetitive motor movements or vocalizations resulting from a dysfunction in the basal ganglia and frontal cortex, often linked to dopamine dysregulation. Sudden onset tics in the elderly are rare. Case Report A 68-year-old female presented with six months of sudden onset vocalizations (coprolalia) and repetitive right-hand tapping. The symptoms were involuntary, occurring without emotional context, and worsened after attempts at suppression. The tics caused significant distress, impairing her interactions with others. There was no history of childhood tics, stressors, or neurological conditions. Physical examination showed pallor, tachycardia, and lean build. Mental status examination revealed complex vocal tics and simple motor tics, along with depressive symptoms. Conclusion The Yale Global Tic Severity Scale (YGTSS) scores indicated a tic disorder with depressive symptoms. Blood tests revealed hyperthyroidism, and MRI showed age-related changes. Diagnosis was made as “Other Specified Tic Disorder.” The patient showed improvement after treatment with Haloperidol, Etizolam, and Carbimazole. Keywords: Tic disorder, Coprolalia, Hyperthyroidism

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Dr Sen Kallumpuram*, Dr Aravid CK, Dr Babafemi Ogunnaike, Dr Ashwani Kumar Kapila, Dr Aneeba Anwar and Dr CT Sudhir Kumar. Dr. Sen Kallumpuram Consultant Psychiatrist, East London NHS Foundation Trust, RICKMANSWORTH Email: [email protected] Background: The clinical correlation between stages of dementia and the Clinical Frailty Scale (CFS) provides insights into the progression of cognitive and physical decline in individuals with dementia. This relationship is crucial for assessing functional capacity, planning care, and managing interventions. Aims: Review the electronic case records to determine the clinical correlation of stages of dementia and Clinical Frailty Score in patients diagnosed in 2023-24. Methods: We analysed the data available for our dementia patients and looked at the correlation of the stages of dementia with their Clinical Frailty Score on the Rockwood Clinical Frailty Scale. Results: There was a good correlation between the various stages of dementia (mild, moderate and severe) with the scores on the Rockwood Frailty Scale. Keywords: Clinical Frailty Scale (CFS), Rockwood Frailty Scale, Dementia.

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Dr. M Jayalakshmi 1 , Dr. I Meenakshi 2 , Dr. S Neelakandan 3 , Dr. G Anbazhagan 4 . 1. Junior Resident, Department of Psychiatry, Thanjavur medical college hospital, Thanjavur. 2. Professor & HOD, Department of Psychiatry, Thanjavur medical college hospital, Thanjavur. 3. Associate Professor, Department of Psychiatry, Thanjavur medical college hospital, Thanjavur. 4. Assistant Professor & HOD, Department of Psychiatry, Thanjavur medical college hospital, Thanjavur. Email: [email protected] Background: Tuberous Sclerosis Complex (TSC) is a genetic disorder causing benign tumors across multiple organs and neurodevelopmental challenges. ADHD in TSC is often under-recognized, necessitating early detection and targeted support. Case Report: A 6-year-old male presented with inattentiveness, hyperactivity, self-injurious biting behavior, poor social interactions, and delayed speech development. Examination revealed skin lesions, including adenoma sebaceum, ash leaf macules, and shagreen patches. The Vanderbilt ADHD rating scale confirmed ADHD, combined type. He was started on T. Risperidone 0.5 mg HS and T. Trihexyphenidyl 0.5 mg OD. After developing seizures, he was initiated on T. Sodium Valproate 100 mg BD and T. Quetiapine 25 mg HS. MRI revealed Sub-ependymal Giant Cell Astrocytoma (SEGA) and multiple cortical tubers with bilateral retinal astrocytoma. Conclusion: This case underscores the importance of multidisciplinary care combining medical, behavioral, and educational interventions. Early diagnosis and psychoeducation of caregivers about TSC’s multisystem implications can enhance developmental outcomes. Regular follow-up is critical. Keywords: Tuberous sclerosis, ADHD.

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Dr Sukanto Sarkar 1 . 1. Additional Professor, Department of Psychiatry, AIIMS Kalyani. Email: [email protected] Background: Schizophrenia, a neurodegenerative disorder like Alzheimer’s and Parkinson’s, is linked to reduced retinal nerve fibre layer (RNFL) and macular thickness (MT), potential biomarkers of neurodegeneration. This study compares RNFL and MT in acute schizophrenic patients with age- and sex-matched healthy controls. Methods: Twenty acute schizophrenic patients and 20 matched controls underwent RNFL and MT measurement via spectral-domain Optical Coherence Tomography following clinical and ocular assessments. Patients with prior eye issues or non-cooperation were excluded. Results: Both groups were socio-demographically comparable. Average RNFL thickness was 102.11 ± 29.18 µm in patients versus 105.14 ± 27.35 µm in controls (p = 0.339). Central MT was significantly reduced in patients (181.12 ± 13.63 µm) compared to controls (234.58 ± 10.71 µm; p < 0.05). Conclusion: Macular thinning, rather than RNFL reduction, may serve as an early neurodegeneration biomarker in acute schizophrenia. Keywords: Schizophrenia, Neurodegeneration, Retinal biomarkers, Macular thinning

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Dr. Shreya Singha Mahapatra¹, Dr. Twishampati Naskar², Dr. Nirmal Kumar Bera³. 1. Junior Resident, Department of Psychiatry, North Bengal Medical College, Siliguri. 2. Consultant Psychiatrist, Brain and Pain Clinic, Siliguri. 3. Professor & HOD, Department of Psychiatry, North Bengal Medical College, Siliguri. Email: [email protected] Background: Caring for children with IDD can lead to significant caregiver burden, impacting parental mental health. This study assessed psychiatric morbidities among parents of IDD children, exploring sociodemographic and child-specific factors influencing parental mental health. Methods: A descriptive, cross-sectional study was conducted with 112 parents of IDD children (DSM-5 criteria) attending the Psychiatry OPD. Psychiatric comorbidities were assessed using MINI International Neuropsychiatric Interview 5.0.0, along with a semi-structured proforma for sociodemographic data. Results: 55.4% of parents had psychiatric morbidities, with Generalized Anxiety Disorder (52.7%) being the most common, followed by Major Depressive Disorder (22.3%). Mothers (68.4%) were significantly more affected than fathers (41.8%). Statistically significant associations were observed with birth order and degree of intellectual disability. Conclusion: The study highlights the need for early mental health interventions for parents of IDD children to support both caregiver well-being and child development. Keywords: Caregiver burden, Intellectual Disability, Parental mental health, Psychiatric comorbidities

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Dr. Sri Adhithya, Junior Resident, Dr. I Meenakshi², Professor & HOD, Dr. S Neelakandan³, Associate Professor, Dr. G Anbazhagan⁴, Assistant Professor, Department of Psychiatry, Thanjavur Medical College Hospital, Thanjavur. Email: [email protected] Background: Nutmeg (Myristica fragrans), a common spice, contains myristicin, a precursor to hallucinogenic compounds like MMDA. While acute nutmeg intoxication is known, flashbacks—recurrent re-experiencing of drug-induced effects—are rarely associated with nutmeg abuse. Case Report: A 33-year-old male presented with a 6-year history of recurrent episodes (5–10/month) of palpitations, dizziness, dry mouth, and sweating lasting 10–20 minutes. Symptoms began post-consumption of 3–4 nutmeg seeds daily for 10 days and persisted despite cessation. Elevated blood pressure and heart rate were noted during episodes. Routine investigations, imaging, and systemic evaluations were normal. Mental status examination revealed anxiety linked to these episodes. Chronic nicotine and alcohol use, along with altered neurotransmitter activity, may have exacerbated the flashback phenomenon. Conclusion: This case demonstrates nutmeg’s potential to induce prolonged psychoactive effects, emphasizing the importance of thorough substance use history in patients with unusual episodic symptoms. Keywords: Nutmeg, Flashbacks, Hallucinogens, Psychoactive effects

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Dr. Navneet Venugopal¹, Dr. Suriyakumar T², Dr. Karthick S³. 1. Junior Resident, Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Puducherry. 2. Assistant Professor, Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Puducherry. 3. Associate Professor, Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Puducherry. Email: [email protected] Background: Tapentadol, a dual-action analgesic acting as a mu-opioid receptor agonist and norepinephrine reuptake inhibitor, is widely used in pain management. Case Summary: A 38-year-old male developed dependence on tapentadol nasal spray after prescribed use for post-operative pain management. Initially prescribed 45 mg/day, he self-escalated the dose to 180–360 mg/day, exhibiting withdrawal symptoms such as anxiety, myalgia, palpitations, and insomnia. Despite no prior substance use or psychiatric history, the patient demonstrated features consistent with opioid use disorder (OUD), including intense cravings. Management involved oral clonidine, quetiapine, diazepam, promethazine, pregabalin, and psychosocial interventions, including craving management and coping skills training. Limited resources precluded opioid substitution therapy. Within one week of inpatient treatment, the patient showed significant improvement (COWS score reduced from 15 to 4) and maintained stability over three months with continued support. Conclusion: This case underscores the risk of tapentadol misuse even in individuals without prior substance use or psychiatric comorbidities. It highlights the need for early identification, cautious prescribing, and comprehensive strategies to manage OUD, especially in resource-limited settings. Keywords: Tapentadol, Opioid Use Disorder, Nasal Spray, Pain management

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Dr. Shintu Unnikrishnan 1 . Junior Resident, Department of Psychiatry, Government Medical College, Kottayam. Email: [email protected] Background: While numerous therapeutic agents are known to cause neuropsychiatric side effects, the risks associated with indigenous medications remain understudied and underdiagnosed, despite their widespread use. Case Report: A 50-year-old female with a history of hyperthyroidism managed with T. Neomercazole 10 mg presented with a 7-year history of hallucinatory behavior without prior psychiatric treatment. She developed reduced sleep, psychomotor agitation, and auditory hallucinations over three weeks following the intake of an indigenous thyroid medication. Laboratory investigations revealed low TSH levels and elevated T3 and T4 levels. The temporal association between her symptoms and the intake of indigenous medication suggests a potential adverse interaction exacerbating her thyroid dysfunction and psychiatric symptoms. Conclusion: This case underscores the potential neuropsychiatric risks of traditional remedies, particularly in individuals with preexisting medical conditions like hyperthyroidism. Integrating traditional treatments with evidence-based medical management must be approached cautiously to prevent adverse interactions. Keywords: Neuropsychiatric side effects, Traditional medicine, Hyperthyroidism, Indigenous medication, Adverse interaction.

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Dr. Khushboo Sahni¹, Dr. Fiona Mahapatro², Dr. S.S. Kale³ 1. Junior Resident, Department of Psychiatry, D.Y. Patil School of Medicine, Navi Mumbai. 2. Professor and HOD, Department of Psychiatry, D.Y. Patil School of Medicine, Navi Mumbai. 3. Professor, Department of Psychiatry, D.Y. Patil School of Medicine, Navi Mumbai. Email: [email protected] Background: Montelukast, a leukotriene receptor antagonist used to treat asthma and allergic rhinitis, crosses the blood-brain barrier and acts on neuronal and microglial G protein-coupled receptors, potentially causing neuropsychiatric symptoms. Case Report: A 20-year-old female with a 5-year history of psychotic symptoms (suspiciousness, fearfulness, irritability, angry outbursts, and sleep disturbances) presented with symptom exacerbation for 2 months and worsening over 2 days. The patient had discontinued psychotropics due to ear discharge and giddiness. On admission, montelukast was prescribed by ENT surgeons along with antibiotics. While initially stable on psychotropics, her psychotic symptoms worsened three days after initiating montelukast. The medication was discontinued after a week, leading to significant symptom resolution three days post-discontinuation. Conclusion: This case highlights a possible link between montelukast and exacerbation of psychotic symptoms. Previous studies also report similar neuropsychiatric side effects, emphasizing the need for cautious use of montelukast, especially in patients with psychiatric conditions. Keywords: Montelukast, Neuropsychiatric symptoms, Psychotic exacerbation

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Dr. Virinchi Thota¹, Ms. Sukanksha Sahni², Dr. Sunil Mittal³ 1. Consultant Psychiatrist, Cosmos Institute of Mental Health and Behavioural Sciences, Delhi. 2. Clinical Psychologist, Cosmos Institute of Mental Health and Behavioural Sciences, Delhi. 3. Director and Senior Consultant Psychiatrist, Cosmos Institute of Mental Health and Behavioural Sciences, Delhi. Email: [email protected] Background: Deep Transcranial Magnetic Stimulation (dTMS) is an emerging non-invasive neuromodulation technique for Major Depressive Disorder (MDD) and obsessive-compulsive disorder (OCD). Methods: This study aims to evaluate the comparative effectiveness of standardized dTMS protocols in MDD and OCD. Participants diagnosed with either MDD or OCD will undergo pre- and post-treatment assessments for symptom severity, functional impairment, and quality of life. Statistical analyses will compare symptom changes between groups, and predictors of treatment response will be explored. Conclusion: Findings may offer valuable insights into dTMS’s differential efficacy in MDD and OCD, aiding in the optimization of treatment protocols for these prevalent psychiatric conditions. Keywords: dTMS, Major Depressive Disorder, Obsessive-Compulsive Disorder, Neuromodulation.

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Dr. Sameer Qureshi 1 . 1. Junior Resident, Department of Psychiatry, MIMER Medical College, Chandrapur. Email: [email protected] Background: Neuroleptic Malignant Syndrome (NMS) is a rare, life-threatening condition linked to antipsychotic therapy. It manifests as hyperthermia, muscle rigidity, autonomic instability, and altered mental status. This case details an atypical progression of NMS. Case Report: A 33-year-old male with an eight-year history of paranoid schizophrenia presented with delusions of persecution, auditory hallucinations, and impaired biofunctions. He was admitted and treated with antipsychotics, electroconvulsive therapy (ECT), and supportive care. On Day 14, he developed fever, muscle rigidity, and autonomic instability. Elevated CRP levels confirmed NMS. Antipsychotics were promptly discontinued, and the patient was transferred to the ICU for intensive care, including antipyretics, antibiotics, IV fluids, and oxygen therapy. He stabilized after supportive treatment, and antipsychotics were cautiously reintroduced, leading to significant clinical improvement. Discussion: The early onset of severe autonomic symptoms in this patient emphasizes the need for vigilance and timely intervention. It reinforces the role of a multidisciplinary approach and clinician awareness in minimizing morbidity and mortality. Keywords: Neuroleptic Malignant Syndrome, Antipsychotics, Adverse drug reactions.

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Dr. Abhay Paliwal 1 . 1. Associate Professor, Department of Psychiatry, Mahatma Gandhi Memorial Medical College, Indore. Email: [email protected] Background: Alcohol dependence is a chronic disorder with significant physiological, behavioral, and social consequences. It impacts not only the individual but also their caregivers. Methodology and Results: A cross-sectional, hospital-based study was conducted in psychiatry outpatient departments of Mental Hospital and MY Hospital, Indore, involving 100 patients (meeting ICD-10 criteria for alcohol dependence) and their primary caregivers. The Severity of Alcohol Dependence Questionnaire (SADQ) assessed dependence severity, while the Burden Assessment Scale (BAS) measured caregiver burden. Statistical analysis was performed using Pearson’s correlation coefficient and chi-square tests. Most patients had mild alcohol dependence, followed by moderate and severe dependence. Caregiver burden was notably higher among caregivers of patients with moderate dependence compared to mild dependence. A statistically significant relationship was observed between alcohol dependence severity and caregiver burden (χ²(2) = 13.998, p = 0.001). Conclusion: This study reveals a significant association between the severity of alcohol dependence and caregiver burden. Keywords: Alcohol dependence, Caregiver burden, Family support

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Dr. Anil Kumar M Nagaraj¹, Dr. Savitha Soman², Dr. Samrudhi V 3 , Dr. Radhika Gupta 4 , Dr. Umesh Thonse 4 , Dr. Amrtavarshini R 4 . 1. Associate Professor, Department of Psychiatry, Kasturba Medical College, Manipal. 2. Professor & HOD, Department of Psychiatry, Kasturba Medical College, Manipal. 3. Senior Resident, Department of Psychiatry, Kasturba Medical College, Manipal. 4. Assistant Professor, Department of Psychiatry, Kasturba Medical College, Manipal. Email: [email protected] Background: Posttraumatic Stress Disorder (PTSD) has diverse and atypical presentations, including symptoms resembling ADHD, chronic pain syndromes, and even spontaneous ejaculation. Case Report: An 18-year-old boy, a grade 11 student, presented with recurrent, dramatic dry cough associated with chest pain for one year. Four years earlier, he had experienced headache, chest pain, and loss of consciousness, diagnosed as dissociative disorder mixed. Careful evaluation revealed the cough episodes were triggered by reliving his trauma of physical violence. He also exhibited avoidance behaviors and hypervigilance. Initial treatment with medications showed poor results, but significant improvement was observed after introducing repetitive Transcranial Magnetic Stimulation (rTMS). Conclusion: This case underlines the importance of thorough assessment in patients with dissociative symptoms, as atypical manifestations of PTSD, such as chronic cough, can easily be overlooked. It also emphasizes the need for evolving diagnostic criteria and innovative therapies like rTMS in managing treatment-resistant PTSD. Keywords: PTSD, Cough, unusual presentation, treatment challenges.

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Dr. Mansi Kothekar 1 , Dr. Shubhangi Parkar 2 . 1. Junior Resident, Department of psychiatry, Vedantaa Institute Of Medical Sciences, Dahanu. 2. Professor & HOD, Department of psychiatry, Vedantaa Institute Of Medical Sciences, Dahanu. Email: [email protected] Background: Multiple System Atrophy (MSA) is a rare, rapidly progressive neurodegenerative disorder with a prevalence of 4.6 per 100,000. Case Report: A 54-year-old tribal male presented with progressive gait disturbances, imbalance, and social withdrawal over one year, accompanied by recent urinary and bowel retention, visual hallucinations, and persecutory delusions. Clinical examination revealed parkinsonism (coarse tremors, short-stepped gait, reduced arm swing), cerebellar signs, and cognitive impairments. Mental status examination highlighted persecutory delusions, reduced psychomotor activity, and memory deficits. MRI findings were unremarkable for cerebello-pontine T2 hyperintensities, likely reflecting the rapid disease progression. Symptomatic management included antipsychotics and interventions for motor and autonomic dysfunction, providing temporary benefits without altering disease trajectory. Conclusion: This case emphasizes the diagnostic complexities of MSA Type C, particularly in resource-limited settings. Early recognition, multidisciplinary management, and improved healthcare access remain critical for enhancing quality of life. Keywords: Multiple System Atrophy, Cerebellar ataxia, Neurodegenerative disorders

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Dr. Sushan Pokharel 1 , Dr. Nikhil Kamal 1 , Dr. Sandeep Grover 2 . 1. Junior Resident, Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. 2. Professor, Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. Email: [email protected] Background: There is little information about management of treatment resistant psychosis in patients with Huntington’s Disease. Case Report: A 60-year-old female with a 13-year history of Huntington’s Disease presented with 10 years of psychotic symptoms characterized by fearfulness, persecutory delusions, muttering, and severe psychosocial dysfunction. The patient had undergone adequate but ineffective trials of olanzapine (up to 20 mg/day) and risperidone (up to 4 mg/day). Recently, her psychotic symptoms worsened, accompanied by significant gait and speech deterioration. The patient was started on clozapine, which was gradually titrated to 125 mg/day. This led to substantial improvement in her psychotic symptoms, as well as marked improvements in gait and speech. Conclusion: Clozapine use in patients with psychosis associated with Huntington’s Disease can result in significant clinical improvement and is a feasible option for managing treatment-resistant psychosis in such cases. Keywords: Huntington’s Disease, Treatment-resistant psychosis, Clozapine

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Dr. Guduru Sruthi 1 , Dr. S Shankar 2 , Dr. K S Ravishankar 3 . 1. Junior Resident, Department of Psychiatry, Government Mohan Kumaramangalam Medical College Hospital, Salem. 2. Assistant Professor, Department of Psychiatry, Government Mohan Kumaramangalam Medical College Hospital, Salem. 3. Professor, Department of Psychiatry, Government Mohan Kumaramangalam Medical College Hospital, Salem. Email: [email protected] Background: Internet Gaming Disorder (IGD) is a behavioral addiction marked by excessive gaming that disrupts mental health, social functioning, and daily life. IGD shares features with substance use disorders. Case Report: A 16-year-old boy with a two-year history of excessive gaming presented with irritability, school avoidance, obesity, diabetes, vitamin deficiencies, and sleep disturbances. Prior interventions, including psychotherapy, benzodiazepines, clonidine, and de-addiction center admissions, yielded minimal improvement. Naltrexone therapy was initiated at 50 mg daily and titrated to 150 mg over a week. Within two weeks, significant reductions in withdrawal symptoms, improved mood, and better academic engagement were observed. Over six months, the patient resumed schooling and successfully completed his 12th grade. Conclusion: IGD poses significant challenges, demanding early identification and tailored interventions. This case highlights the efficacy of naltrexone in treating resistant IGD cases, particularly when integrated with behavioral therapies. Keywords: Internet Gaming Disorder, Naltrexone, Behavioral addiction

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Dr. R Mohana Priya 1 , Dr. S Shankar 2 , Dr. M Mohamed Ilyas Rahamathulla 3 . 1. Junior Resident, Department of Psychiatry, Government Mohan Kumaramangalam Medical College Hospital, Salem. 2. Assistant Professor, Department of Psychiatry, Government Mohan Kumaramangalam Medical College Hospital, Salem. 3. Associate Professor, Department of Psychiatry, Government Mohan Kumaramangalam Medical College Hospital, Salem. Email: [email protected] Background: Schizo-obsessive disorder refers to the co-occurrence of obsessive-compulsive symptoms (OCD) and psychotic symptoms in schizophrenia, affecting approximately 15–30% of patients. Distinguishing between genuine schizo-obsessive symptoms and antipsychotic-induced behaviors is crucial for providing optimal care. Case Series: Three schizophrenia patients were treated with antipsychotic medications and developed obsessive-compulsive symptoms. In all three cases, obsessive symptoms persisted despite appropriate doses of anti-obsessional medications (SSRIs like fluoxetine, fluvoxamine, clomipramine) and switching antipsychotics. Conclusion: The distinction between schizo-obsessive disorder as an independent condition or a medication-induced phenomenon remains unresolved. Further research into its neurobiological underpinnings is necessary. Keywords: Schizo-obsessive disorder, Antipsychotics, Obsessive-compulsive symptoms

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Dr. Nayan Malviya 1 , Dr. Natasha Patel 2 , Prof. (Dr). Varun S Mehta 3 . 1. Junior Resident, Central Institute of Psychiatry, Ranchi. 2. Senior Resident, Central Institute of Psychiatry, Ranchi. 3. Professor, Central Institute of Psychiatry, Ranchi. Email: [email protected] Background: Depersonalization (DP) and derealization (DR) are perceptual disturbances affecting the sense of self and surroundings, with a prevalence of 30–80% in various mental disorders. Case Report: A 16-year-old male presented with a two-year history of low mood, one-year history of suicidal thoughts, and a suicide attempt. For seven months, he experienced persistent feelings of derealization (world seemed unreal), depersonalization, hopelessness, and positive autoscopy, alongside suicidal ideations. Physical examination was normal. Mental status examination confirmed DP, DR, and depressive features. A provisional diagnosis of “Other Depressive Episode” was made. After unsuccessful trials with olanzapine and risperidone, the patient was managed with lithium carbonate (up to 1050 mg), fluoxetine (up to 60 mg), and aripiprazole (up to 10 mg). Grounding techniques, particularly the “5 Senses Mindfulness” method, were incorporated into treatment. While depressive symptoms improved, DP/DR symptoms lingered but resolved over time. Conclusion: Early recognition and targeted interventions for these symptoms are critical to optimizing outcomes in depressive disorders. Keywords: Depersonalization, Derealization, Depression, Mindfulness

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Dr. Jesna Johnson 1 , Dr. S Shankar 2 , Dr. K S Ravishankar 3 . 1. Junior Resident, Department of Psychiatry, Government Mohan Kumaramangalam Medical College Hospital, Salem. 2. Assistant Professor, Department of Psychiatry, Government Mohan Kumaramangalam Medical College Hospital, Salem. 3. Professor, Department of Psychiatry, Government Mohan Kumaramangalam Medical College Hospital, Salem. Email: [email protected] Background: Arachnoid cysts are cerebrospinal fluid-filled sacs that are often discovered incidentally during neuroimaging. Although usually asymptomatic, their size and location can interfere with neural circuits, resulting in neuropsychiatric symptoms, including behavioral and cognitive disturbances. Case Report: A 17-year-old male with episodic behavioral changes mimicking acute psychosis was found to have an arachnoid cyst located in the right hippocampal region. Neuroimaging revealed the hippocampal cyst as the likely cause of his symptoms. He was treated with carbamazepine and divalproex, leading to rapid symptom resolution within a week. The patient was subsequently maintained on divalproex alone, achieving sustained symptomatic improvement over follow-ups. Conclusion: This case highlights the importance of distinguishing psychiatric presentations resulting from neurological abnormalities. The rapid resolution of symptoms with anticonvulsant therapy suggests neural network dysfunction rather than primary psychosis. Keywords: Arachnoid cyst, Psychosis, Anticonvulsants

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Dr. Vijay Seethapathy 1 . 1. Clinical Associate Professor, University of British Columbia, Canada. Email: [email protected] Background: Nicotine use disorder (NUD) is a rising public health concern, particularly among university students. Although traditional smoking rates have declined globally, increased vaping and alternative nicotine delivery systems present new addiction risks. Methods and Results : A scoping review was conducted by systematically searching peer-reviewed studies (2010–2023). Findings revealed declining smoking rates among students but a rise in vaping prevalence (exceeding 25% in some regions) and dual use of smoking and vaping. Contributing factors included stress, academic pressures, marketing, flavored products, and ease of access. High nicotine concentrations in vaping products correlated with increased NUD prevalence. Conclusion: Findings highlight the need for tailored public health strategies in university settings, including stricter regulations, targeted awareness campaigns, and evidence-based interventions, to curb nicotine addiction and improve long-term health outcomes. Keywords: Nicotine use disorder, Vaping, Public health strategies.

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Dr Amy Ida Singh 1 . 1. Junior Resident, Central Institute of Psychiatry, Ranchi Email: [email protected] Background: Impulsivity is a frequent comorbidity in Temporal Lobe Epilepsy (TLE), often associated with prefrontal cortex (PFC) dysfunction and low serotonin states, resulting in increased theta activity. Neurofeedback (NFB) has emerged as a promising, non-invasive tool for modulating brain activity to manage impulsivity. Case Report: An 11-year-old male with a six-year history of seizures and five months of irritability, anger outbursts, self-harm, and suicidal behavior was diagnosed with cryptogenic temporal lobe epilepsy and organic depressive disorder. Normal EEG and NCCT head. He was treated with Oxcarbazepine, Lacosamide, Risperidone, and Trihexyphenidyl. Neurofeedback (NFB) targeting beta activity in the left prefrontal cortex was administered over 20 sessions, leading to significant mood improvement and cessation of self-harm. The Barratt Impulsiveness Scale score improved from 80 to 67, sustaining at one-month follow-up. Conclusion: This case highlights the potential of beta neurofeedback as an adjunctive treatment for impulsivity in TLE, an area not widely explored. Keywords: TLE, PFC, neurofeedback, impulsivity, self-harm.

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Dr Nishant Sangwan 1 . 1. Junior Resident, Department of Psychiatry, Dr. Ram Manohar Lohia Hospital, New Delhi. Email: [email protected] Background: Sexual addiction, characterized by compulsive sexual behavior despite adverse consequences, presents significant diagnostic and treatment challenges. Categorized under habit and impulse control disorders, it remains underrecognized within clinical practice. Case Report: A 38-year-old male with a 25-year history of compulsive sexual behavior presented with persistent sexual urges, failed attempts to control them, guilt, interpersonal conflicts, and impaired social and occupational functioning. Organic causes were ruled out, and diagnosis was established through a thorough mental state examination. Treatment included Oxcarbazepine (300 mg), Aripiprazole (10 mg), Fluoxetine (40 mg), and interpersonal psychotherapy. This led to reduced compulsive behaviors and moderate improvement in functioning, though mild sexual urges persisted. Conclusion: This case underscores the complexity of diagnosing and managing sexual addiction. While pharmacotherapy and psychotherapy offer symptomatic relief, long-term management remains challenging. Further research is needed to optimize treatment strategies. Keywords: Sexual addiction, Compulsive behavior, Impulse control disorder, Psychotherapy, Pharmacotherapy.

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Dr. Megha 1 . 1. Junior Resident, Department of Psychiatry, Dr. Ram Manohar Lohia Hospital, New Delhi. Email: [email protected] Background: Postpartum mania is a severe condition requiring effective intervention. Case Report: A 24-year-old married female from a middle socioeconomic status presented with her third episode of recurrent episodic manic illness, four months postpartum. Symptoms included grandiosity, hypersexuality, hyper-religiosity, decreased need for sleep, and over-talkativeness, impairing her ability to care for her child. The patient was admitted with a Young Mania Rating Scale (YMRS) score of 35. Initial treatment with Quetiapine (100 mg) and Olanzapine (30 mg) showed minimal improvement. Endoxifen (8 mg) was added, leading to a rapid reduction in YMRS scores from 32 to 18 within 10 days. Subsequent adjustments, including Sodium Valproate (up to 1500 mg) and Haloperidol (10 mg), further reduced the YMRS score to 10 at discharge, reflecting significant symptom improvement. Conclusion: This case highlights the potential role of Endoxifen as an effective adjunctive treatment for postpartum mania. Keywords: Postpartum mania, Endoxifen, Treatment-resistant, YMRS, Adjunctive therapy.

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Dr. Rahul Krishna R 1 . 1. Junior Resident, Department of Psychiatry, Government Medical College, Kottayam. Email: [email protected] Background: Vestibular schwannomas, benign tumors of the eighth cranial nerve, account for 8% of all skull tumors. Commonly presenting with hearing loss, tinnitus, and vertigo, they can rarely manifest with psychiatric symptoms such as agitation, delusions, hallucinations, and sleep disturbances. Case Report: A 34-year-old male with a history of vestibular schwannoma resected 5 years ago presented with gait difficulties and left-sided hearing impairment. Neuroimaging revealed tumor recurrence. During hospitalization, the patient developed sleep disturbances, auditory hallucinations, and agitation. Psychiatry consultation was sought, and the patient was started on Olanzapine, resulting in symptom resolution within a week. Conclusion: This case underscores the importance of considering neuropsychiatric syndromes in patients with new or recurrent brain lesions. Keywords: Vestibular schwannoma, Neuropsychiatric symptoms, Auditory hallucinations, Brain tumors, Multidisciplinary approach.

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Dr. Ritika Modi 1 1. Junior Resident, Department of Psychiatry, K S Hegde Medical Academy, Mangalore. Email: [email protected] Background: The intersection of substance use, sexual identity, and health challenges poses unique hurdles for LGBTQ+ individuals. Case Report: A 30-year-old homosexual male with a family history of OCD presented with a 2-year history of intravenous MDMA use, dependence, and persecutory ideas, alongside delusions of misidentification and auditory hallucinations. He developed these symptoms after using MDMA to enhance sexual performance, later requiring sildenafil. In-patient evaluation revealed amphetamine withdrawal, HIV positivity, and syphilis serology. Treatment included Olanzapine, Methylphenidate, ART, and Motivational Enhancement Therapy. His struggles with coming out as queer were discussed, and familial involvement was facilitated at his request. Ethical concerns regarding confidentiality were addressed as he was counseled about informing his partner of his HIV status. Conclusion: Culturally sensitive, integrated mental health and substance use treatment are essential to reduce stigma and improve health outcomes for LGBTQ+ individuals. Keywords: LGBTQ+, MDMA, Homosexual, Sexuality, HIV, Ethics, Confidentiality

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Dr. Medha Pandey 1 . 1. Junior Resident, Department of Psychiatry, MGM Medical College, Indore. Email: [email protected] Background: Amisulpride is an atypical antipsychotic used to treat schizophrenia, primarily by antagonizing dopamine D2 and D3 receptors. While common side effects include prolactin elevation, EPS, and metabolic disturbances, rare adverse reactions like Toxic Epidermal Necrolysis (TEN) can occur. Case Report: A 26-year-old female with chronic schizophrenia on Haloperidol 15 mg was prescribed and Amisulpride for negative symptoms. Two days later, she developed facial lesions and skin peeling, which progressed to widespread erythematous, fluid-filled lesions and skin desquamation by day seven. Dermatological evaluation confirmed TEN. Amisulpride, identified as the causative agent, was discontinued and substituted with Olanzapine. The patient received ICU-based care, including corticosteroids, antihistamines, and dermatological support, resulting in significant improvement and lesion resolution Conclusion: This case highlights the need for vigilance regarding severe dermatological reactions to antipsychotics. Early identification, prompt discontinuation, and multidisciplinary management are critical. Keywords: Amisulpride, Toxic Epidermal Necrolysis, Schizophrenia, Adverse drug reaction, Dermatological emergency.

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Yogitha Ashok*, G. Swarnameenaa, Vaishnavi K. Madhavan, Nithyashri Hariharan, Dr. Lakshmi Venkatraman Schizophrenia research foundation, Anna Nagar, Chennai, India. E-mail: [email protected] Background: The COVID-19 pandemic led to a global shift in internet usage, particularly in healthcare services. For individuals with serious mental illness (SMI), barriers to internet access persist, yet how these evolved post-pandemic remains underexplored. Methods: A longitudinal study at a tertiary mental health center in South India included 78 participants with SMI. Data on internet access and usage were collected through self-structured surveys in 2018 (pre-pandemic) and 2022 (post-pandemic). Changes were analyzed using descriptive statistics and the McNemar test. Results: Internet access increased significantly, with 44.4% of previously non-users gaining access by 2022. Key uses included entertainment, social networking, news, and general information. However, barriers to using technology for mental health services persisted, limiting participation in internet-based healthcare. Conclusion: While internet usage rose among individuals with SMI post-pandemic, barriers to accessing online mental health services remain significant. Addressing these barriers is essential to promote engagement in digital healthcare. Keywords: Serious mental illness, Internet access, COVID-19, Digital healthcare, Mental health services.

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Dr. Mridula Kaul 1 , Dr. Shrinivasa Bhat 2 . 1.Junior Resident, Department of Psychiatry, K S Hegde Medical Academy, Mangalore. 2.Professor & HOD, Department of Psychiatry, K S Hegde Medical Academy, Mangalore. Email: [email protected] Background: Hot water epilepsy (HWE) or bathing epilepsy is a rare reflex epilepsy triggered by hot water exposure, often linked to complex tactile and temperature-dependent stimuli or temporal lobe lesions. Case Report: 24-year-old male with a history of alcohol dependence in the last 6 years, presented with recurrent seizures during showers since childhood. Upon detailed history, diagnosis of hot water epilepsy was made. Patient experienced generalized-tonic-clonic-seizures, leading to injuries and increased alcohol consumption to cope up with the same. Investigations were done, alcohol withdrawal was monitored using appropriate scales. Motivational enhancement therapy and anti-craving drugs were initiated for alcohol dependence, anti-epileptics for seizure and advised to avoid the seizure precipitators. Conclusion: Dual diagnosis necessitates an integrated, multidisciplinary strategy for treating both seizures and addiction in order to improve health outcomes and quality of life. Keywords: Hot water epilepsy, Reflex epilepsy, Alcohol dependence

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B Nisha*, Subhashini Gopal, Pratiksha Venkatasubramanian, Jothilakshmi Durairaj, Yogitha Ashok, Elsa Joseph, S Amritha, Sonia Sims, Suvarna Jyothi Kantipudi, Lakshmi Venkatraman, Padmavati Ramachandran Schizophrenia Research Foundation (SCARF), Annanagar, Chennai, India. Email: [email protected] Background: Digital interventions are promising for enhancing mental health care but face user engagement challenges, especially in low-and-middle-income countries. Identifying factors driving engagement is crucial for designing interventions that improve adherence and outcomes for chronic schizophrenia. Methods: Data from an ongoing trial of a virtual cognitive intervention in Tamil was analyzed. Forty-eight participants with chronic schizophrenia were randomized into a cognitive intervention or active control group for six weeks. Baseline sociodemographic, cognition, and socio-occupational functioning were assessed. Participant engagement was logged, and statistical tests (Mann-Whitney U, Kruskal-Wallis, Spearman’s correlation) analyzed engagement across variables. Results: Nineteen percent of participants dropped out. Higher engagement was observed in sessions attended from separate, disturbance-free spaces. Conclusion: Minimizing external distractions in a conducive setting significantly enhances engagement in online psychosocial interventions. Keywords: Psychosocial intervention, Chronic Schizophrenia, Digital mental health.

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Dr. Ravjot Kaur 1 , Dr. Sushmita Bhattacharya 2 . 1. Junior Resident, Department of Psychiatry, Government Medical College and Hospital, Chandigarh. 2. Assistant Professor, Department of Psychiatry, Government Medical College and Hospital, Chandigarh. Email: [email protected] Background: Narcolepsy, a chronic sleep disorder characterized by REM sleep dysregulation, presents with excessive daytime sleepiness (EDS), hallucinations, sleep paralysis, and cataplexy. Case Report: A 25-year-old male presented with EDS, sleep fragmentation, hypnagogic hallucinations, suicidal ideation, and sudden loss of muscle tone, causing frequent falls and socio-functional decline. Misdiagnosed and treated with antipsychotics without improvement, a detailed clinical evaluation raised suspicion of narcolepsy. High scores on the Epworth Sleepiness Scale (ESS) and Hamilton Depression Rating Scale (HDRS) indicated EDS and moderate depressive symptoms. MRI findings were normal. The patient was treated with lifestyle modifications, Venlafaxine (150 mg/day), and Melatonin (3 mg/day), leading to significant clinical improvement and decreased HDRS and ESS scores. Conclusion: This case underscores the importance of considering narcolepsy in young patients with psychosis-like symptoms, especially when conventional psychiatric treatments fail. Keywords: Narcolepsy, Psychosis, Excessive daytime sleepiness, REM sleep dysregulation, Misdiagnosis.

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Dr. Vijay Ishwardutt 1 . 1. Junior Resident, Department of Psychiatry, DR. SCGMC, Nanded. Email: [email protected] Background: Art therapy provides a non-verbal outlet for emotional release, promoting self-awareness, relaxation, and a sense of control. For the student, balancing academic pressure with personal struggles, art becomes an ultimate coping mechanism, fostering resilience and enhancing her emotional well-being. Case Report: A 23-year-old female medical student was diagnosed with anxiety disorder. Initially, she was managed on Paroxetine and Etizolam, followed by reassurance. During follow up, she revealed that she used her art as a means of alleviating stress and reducing the severity of her anxiety. Qualitative feedback revealed that the student found the art-making process to be calming and therapeutic, often using the activity to process and express emotions that were difficult to verbalize. Notable themes in the art included visual representations of internal conflict, stress, and emotional release. The student also described an improved sense of emotional awareness and self-reflection. Conclusion: This case study suggests that art can be a valuable tool for individuals with anxiety disorders, providing a means of emotional expression and a method for stress relief. Keywords: art therapy, anxiety, stress relief

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Dr. Shreya Mishra 1 , Dr. Kiran Kumar K 2 , Dr. Sudharshan R 3 . 1. Junior Resident, Department of Psychiatry, VIMS & RC, Bengaluru. 2. Professor & HOD, Department of Psychiatry, VIMS & RC, Bengaluru. 3. Senior Resident, Department of Psychiatry, VIMS & RC, Bengaluru. Email: [email protected] Background: Postictal psychosis with catatonia is a rare complication of chronic epilepsy, manifesting during the postictal period with debilitating neuropsychiatric symptoms that persist beyond the resolution of seizures. Case Report: A 31-year-old male with a 14-year history of myoclonic epilepsy and 9 years of hypothyroidism presented with behavioral disturbances, suspiciousness, disturbed sleep, reduced verbal communication, slowness of movement, and decreased food intake. MSE revealed dysphoric affect, delusions of persecution and reference, loosening of associations, auditory hallucinations, and catatonic features. MRI suggested lissencephaly-pachygyria spectrum with T2W/FLAIR hyperintensities in periventricular white matter, while EEG indicated a lowered epileptic threshold and liability to generalized seizures. Conclusion: Postictal psychosis is a common but underrecognized psychiatric complication of chronic epilepsy. Timely diagnosis and management are crucial to reducing morbidity and mortality associated with this condition. Keywords: Epilepsy, Postictal psychosis, Catatonia, Myoclonic epilepsy.

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Dr. Balaji Annaluru 1 . 1. Consultant Psychiatrist, Asha Neuromodulation Clinics, Hyderabad. Email: [email protected] Background: Tardive dyskinesia (TD), as a potentially long-standing hyperkinetic movement disorder, is usually known to occur after months or years of taking psychotropic drugs. Case Report: This report highlights the case of a 44-year-old male, k/c/o schizophrenia for 15 years, who developed TD was treated with dTMS along with Clozapine 200mg/day, after 6 months of treatment with titrating doses of Clozapine and Tetrabenazine. Each session involved Low Frequency Stimulation with 1 Hz, over bilateral motor cortex using H4 coil at 90% of resting motor threshold, lasted for 15 minutes administering 900 pulses. The total dosage was 9000 pulses over 10 sessions. Baseline and post dTMS, AIMS scores showed the significant change. He maintained the AIMS score at 3 months and 6 months follow-up. Conclusion: For a disabling condition like TD, a combined approach in the management of disease would prove to be beneficial. Further research is warranted to explore the long-term efficacy and optimal treatment protocols for dTMS in managing TD. Keywords: Tardive dyskinesia, dTMS, neuromodulation

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Dr. Haj Jancy 1 , Dr. Siddeswara B L 2 , Dr. Juhi Gupta 3 , Dr. Neha B Kulkarni 3 , Dr. Vidur Makkar 4 . 1. Junior Resident, Department of Psychiatry, LGBRIMH, Tezpur. 2. Associate Professor, Department of Psychiatry, LGBRIMH, Tezpur. 3. Assistant Professor, Department of Psychiatry, LGBRIMH, Tezpur. 4. Senior Resident, Department of Psychiatry, LGBRIMH, Tezpur. Email: [email protected] Background: Hunter Syndrome (Mucopolysaccharidosis II) is a rare X-linked lysosomal storage disorder characterized by progressive multisystem involvement. Managing ADHD symptoms in these patients poses clinical challenges due to their comorbidities. Case Report: A 7-year-old boy diagnosed with Hunter Syndrome presented with delayed speech, hyperactivity, decreased sleep, and defiant behavior after referral for behavioral disturbances. Physical examination revealed typical features of Hunter Syndrome, including coarse facial features, skeletal deformities, hepatosplenomegaly, and cardiac anomalies. The patient was managed with Methylphenidate, titrated up to 20 mg/day under cardiology supervision, and behavioral interventions. Due to partial improvement, Clonidine was added and titrated to 0.075 mg/day, resulting in notable symptom reduction Conclusion: This case underscores the importance of early recognition and tailored management of ADHD symptoms in children with Hunter Syndrome. Keywords: Hunter Syndrome, ADHD, Behavioral intervention.

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Dr. Sneha M 1 , Dr. Archana G 2 . 1. Junior Resident, Department of Psychiatry, BMCRI, Bangalore. 2. Assistant Professor, Department of Psychiatry, BMCRI, Bangalore. Email: [email protected] Background: Risky sexual behaviors are a significant public health concern due to their association with sexually transmitted infections, unintended pregnancies, and adverse maternal and infant outcomes, Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) may be at an increased risk for RSB. Methods: Data from 15 adolescents presenting under POCSO Act, attending the OPD/IPD of Psychiatry Department is included in the study. ADHD- RS IV, Barratt Impulsiveness scale applied. ADHD and impulsivity were assessed in the study group. Results: Out of 15 patients, ADHD and Impulsivity was not significantly found in the study population and was not associated with each other. Conclusion: There is no significant association between ADHD and impulsivity among adolescents presenting under POCSO Act. Keywords: ADHD, Impulsivity, POCSO, Adolescents

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Dr. Surabhi G 1 , Dr. Shankar K 2 . 1. Junior Resident, Department of Psychiatry, BMCRI, Bangalore. 2. Associate Professor, Department of Psychiatry, BMCRI, Bangalore. Email: [email protected] Background: ADHD affects 5-8% of children globally, often continuing into adulthood. Despite effective medication and behavioral therapy, stigma and access issues remain. Digital tools like the GenBlend app enhance attention and executive functioning through tailored activities and progress tracking. Methods: This pilot trial involved 20 children aged 6–10 years with ADHD, stable on medications. They were randomized into two groups: one used the GenBlend app daily with standard treatment, while the other received only standard treatment, with assessments at baseline and post-intervention. Results: The intervention group using the GenBlend app showed improvements in ADHD Rating Scale-IV compared to the control group. Conclusion: The GenBlend app shows potential as an effective addition to ADHD treatment in children, but larger studies are needed for confirmation. Keywords: ADHD, GenBlend, Child Psychiatry.

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Dr. Kiran R 1 , Dr. Shankar K 2 . 1. Junior Resident, Department of Psychiatry, BMCRI, Bangalore. 2. Associate Professor, Department of Psychiatry, BMCRI, Bangalore. Email: [email protected] Background: Cognitive dysfunction is a significant comorbidity of diabetes, impacting QOL. Its association with early-onset T2DM is unclear, though elevated HbA1c and OSA increase cognitive impairment risk. Methods: 50 patients aged 18 to 60 with young-onset type 2 diabetes were enrolled in the study. Demographic data and blood tests, were collected, while cognitive function and QOL were assessed using various standardized tests and questionnaires. Results: 84% of participants exhibited significant cognitive impairment. Severity of impairment correlated positively with age, age of onset, and duration. Individual cognitive assessment domains were correlated with CRP, and cognitive impairment incidence was higher in those at risk for OSA. Conclusion: Regular cognitive assessments and targeted interventions for inflammation and sleep apnoea are essential for managing cognitive health in early-onset type-2 diabetes patients. Keywords: Cognitive Dysfunction, DM-2, OSA, Inflammation

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Dr. Vijay Krishna 1 , Dr. Sushmita Bhattacharya 2 , Dr. Gurneet Kaur 3 . 1. Junior Resident, Department of Psychiatry, Government Medical College and Hospital, Chandigarh. 2. Assistant Professor, Department of Psychiatry, Government Medical College and Hospital, Chandigarh. 3. Senior Resident, Department of Psychiatry, Government Medical College and Hospital, Chandigarh. Email: [email protected] Background: Cariprazine is a novel antipsychotic approved for schizophrenia, effective for both positive and negative symptoms due to its partial agonist action at dopamine and serotonin receptors, often used in supramaximal doses for refractory cases of schizophrenia. Methods: A 44-year-old female with 24 years of schizophrenia, characterized by delusions and hallucinations, was treated for erratic compliance. After poor responses to multiple medications and developing cardiomyopathy from Clozapine, Cariprazine was up-titrated to 7.5 mg under strict monitoring. Results: Response was observed and BPRS scores decreased from 32 to 22. Patient is currently functioning well post discharge with no adverse effects. Conclusion: Cariprazine is well tolerated even at supramaximal doses, making it a viable option for treatment-resistant schizophrenia when conventional antipsychotics are contraindicated, warranting further research into its use when Clozapine is not suitable. Keywords: Cariprazine, Schizophrenia, Supra-optimal Doses.

Methods

Dr. Pushpa Bhuarya 1 . 1. Junior Resident, Department of Psychiatry, Pt. JNM Medical College, Raipur. Email: [email protected] Background: Sickle cell disease is a chronic clinical illness, that is considered to be one of the major public health problems in Central India due to its incidence. Neurological events are considered the most complex clinical manifestation of sickle cell disease and are frequently associated with cognitive impairment. Methods: This cross-sectional analytical study will involve 128 participants aged 11 to 16 years, divided into two groups: 64 children with sickle cell disease (Group 1) and 64 without (Group 2). Cognitive function will be assessed using the Bhatia battery of intelligence tests and the Bender visual motor gestalt test. Conclusion: This study will shed light on the effect of sickle cell disease on the cognitive function of young children. Keywords: Sickle cell disease, Cognitive function, Children

Sharper

Dr. Mohamed Hakkim 1 , Dr. Nirmal S.R. 2 , Dr. Muralitharan 2 , Dr. Jai Singh 3 1. Junior Resident, Dhanalakshmi Srinivasan Medical College Hospital, Siruvachur, Perambalur, Tamil Nadu, India 2. Professor and HOD, Dhanalakshmi Srinivasan Medical College Hospital, Siruvachur, Perambalur, Tamil Nadu, India 3. Professor, Dhanalakshmi Srinivasan Medical College Hospital, Siruvachur, Perambalur, Tamil Nadu, India Background: Persistent delusional disorder is a rare psychiatric condition characterized by the presence of fixed delusions lasting for an extended duration. Olfactory delusions, although uncommon, can significantly impair the quality of life. Case Report: 57-year-old male came with a 20-year history of delusions involving foul smell following an unusual and distressing experience. Collateral history was collected to corroborate the delusional beliefs and assess psychosocial impairments. The patient’s belief system, behaviour patterns, and duration of illness were analysed in the context of cultural influences and stigma. The patient attributed the foul smell originating from his nose and mouth to a long-standing infection following sexual interactions with a dog during his time in Saudi Arabia. He exhibited frequent mouth washing, social withdrawal, and preoccupation with his delusional beliefs. Despite no confirmatory medical findings of infection or physical abnormalities, the delusion persisted, significantly impairing his social and occupational functioning. Conclusion: This case underscores the interplay of culture, guilt, and stigma in the development and persistence of olfactory delusions. Early intervention and a culturally sensitive therapeutic approach are critical for improving outcomes in such cases. Key words: delusions, olfactory, culture

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Ms. Aardhraya Nair & Dr. Shabbir Amanullah Queen’s University, Kingston Ontario, Canada. Email: [email protected] & [email protected] Background & Aims: Autism spectrum disorder (ASD) shows sex-based disparities, with males diagnosed 3-4 times more often than females. The “Female Protective Effect” (FPE) suggests that females may require a higher genetic load to exhibit ASD symptoms. This study investigates how genetic factors, FPE, and fear expression impact ASD in females, aiming to support more accurate, sex-specific diagnostics. Methods: A literature search across PubMed and OMNI identified genetic and behavioral studies. A scoping review approach was used to integrate findings on ASD-related genetic variants in females. Results: FPE is supported, with key genetic variants in neurodevelopment and synaptic function playing a role in the protective mechanism. FPE is associated with reduced fear responses, suggesting that genetic protection may influence emotional regulation and modify ASD symptoms. Conclusion: These findings emphasize FPE’s role in shaping ASD’s genetic and behavioral profile in females. Key words: Female Protective Effect (FPE), Genetic Factors, Autism Spectrum Disorder (ASD), Fear Expression, Sex Differences

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Katherine Rachel Hoffer Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada. Email: [email protected] Background & Aims: Findings in research over the past decade have shown significant sex differences in autism spectrum disorder (ASD). The recognition of gender discrepancies raises concerns about ASD assessment tools, which were developed based on the typical male autism phenotype, and whether these are actually sex-friendly gold-standard tools. This study addresses this literature gap by discussing a graduate’s perspective of the ADOS-II, focusing on the hurdles the ADOS-II presents to female diagnosis. Methods: To find relevant articles to compare with the graduate’s ideas, a literature search was conducted on two databases, Omni and PubMed. To be included, the articles needed to present perspectives on autism diagnostic tools concerning barriers to female diagnosis. With few articles meeting this criterion, papers discussing diagnostic tools more generally were included, even if the ADOS-II was not explicitly referenced. Results: The search yielded 240 results; 192 results after removing duplicates. After reviewing titles and abstracts, 65 full-text articles were considered, identifying six suitable articles. Conclusion: The graduate’s perspective will be compared to these articles. Overarching themes and ideas for future research will also be discussed. Key words: Autism Spectrum Disorder, ADOS-2, Gender bias, Diagnostic barriers, Autism in females

Subjects

Karan Sud, Tanmay Agarwal, Armed forces medical services. Alcohol Dependence Syndrome (ADS), a complex dynamic process is a serious public health problem and a central concept in the World Health Organization classification of alcoholism. This syndrome involves physical signs in addition to psychological symptoms that contribute to distress and psychological discomfort. Several neurobiological and environmental factors influence motivation to drink leading to an altered relationship between the person and his/her way of drinking, which becomes a feedback behaviour comprising much more than tolerance and abstinence. Various cognitive, personality and situational factors have been found to be related to impulsivity and aggression. Additionally, it is well established that aggression and impulsivity are more likely to occur in the context of alcohol use. Impulsivity is defined as acting without forethought, lack of concern about the consequence of one’s own behaviour, unable to control, lacking willpower to give up his or her temptation. The discussion has also been verified: impulsivity as measured in prospective studies has been shown to envisage the development of alcohol use disorders. There are well-established links between impulsivity and alcohol use in humans and other model organisms; though, the etiological nature of these associations remains unclear. Additionally, there is prosperity of research about the links connecting alcohol use and executive functioning (EF) - higher-order cognitive constructs, concerned with the self-regulation of goal-directed behavior which is therefore highly relevant for the avoidance of maladaptive behaviors. Research has suggested a potential role for social problem solving as a mediator between impulsivity and aggression. Hence, the purpose and implication of this study is to understand the role of impulsivity and executive functioning associated with Alcohol dependence and likely areas of intervention.

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Dr. Parth Nigam Department of Psychiatry, Dr. Sampoornanand Medical College, Jodhpur, India Email: [email protected] Introduction: Brucellosis is a zoonotic infectious disease caused by the Gram-negative bacteria Brucella sp. Central nervous system involvement is rare but may cause serious clinical manifestations. Case report: A 24-year-old female patient Mrs. M was admitted to the Female Psychiatry Ward, after having complaints of Acute agitation, hostile behaviour, Irrelevant talk, suspiciousness and disturbed sleep, associated with high grade fever since the last 12 days. Patient had also given birth, via NVD, to a healthy male baby, 1.5 months ago. Patient was started on psychotropic medications, on the provisional diagnosis of ATPD (with peri-partum onset) (according to ICD-11). IV Antibiotics were started to manage the infection. Blood Investigations and NCCT-Head was done, which showed no abnormality. Further investigations revealed IgM positive for Brucella sp. With the given treatment, patient’s agitation subsided, but her general condition did not improve. CSF Culture returned positive for Brucella sp. and Injection Doxycycline was started. Improvement in the patient’s condition was seen by 3 rd day of starting Doxycycline, including reduction in fever. Following proper work-up and investigations, patient was discharged after 2 days, on antibiotics. Discussion: Out of all the patients of Brucellosis, Neurobrucellosis occurs in < 5% of patients. Most common symptoms include Meningo-encephalitis. Psychosis occurs as an even rarer complication. Key words: Neurobrucellosis, Psychosis.

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Dr. Nivedita Mondal Department of Psychiatry, LGBRIMH, Tezpur, Assam Email: [email protected] Background & Aims: Delusional parasitosis (DP) is characterized by steadfast belief that one is infested with living organisms or inanimate material in the absence of objective proof, without any accompanying medical disorder. This report aims to present a case of DP treated with high dose SSRI and low dose antipsychotic. Method: A 69-year-old male, presented with complains of sensation of insects crawling underneath the skin, for a total duration of 1 year. He had a strong conviction that he was infested with insects, and had constant desire to prick and pull it out. Diagnosed with Delusional Parasitosis, patient was initially treated with adequate trial of Tab. Olanzapine, but showed no response. It was then changed to Tab Fluoxetine 20 mg, and increased up to 60 mg, along with Tab. Risperidone 2mg. Results: Patient reported decrease in symptoms after a month, and achieved complete remission within 3-4 months Conclusion: Given the history of preoccupation with thoughts of being infested with insects, and his compulsive scratching and pricking the skin, patient’s illness can be conceptualized as OCD with poor insight, rather than classifying it as a Delusional disorder. This case highlights SSRIs as a novel treatment for Delusional Parasitosis Keywords: Obsessive-Compulsive Disorder, Delusional Parasitosis, SSRI

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Dr Sumeesha Jaswal1, Dr Dinesh Dutt Sharma2, Dr Shivani Sandal2* 1 Senior Resident, Department of Psychiatry, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India 2 Professor, Department of Psychiatry, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India 3 Junior Resident, Department of Psychiatry, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India: Background: Many children world over end up having tussles with the legal systems and coming under their purview results in them facing challenges which negatively impact their psyche. Materials and methods: It was a retrospective study carried out over a period of 10 months, from 1st January 2024 to 31st October 2024. Results: A total of 11 children were included in the study out of which 10 were males of age range 13-17 years with an average age of 16.09 years. 36.4% children had studied till middle grade. 36.3% were employed as skilled worker. 54.45% belonged to lower socioeconomic status. 5 out of them belonged to single parent family with 72.7% had either parent suffering from alcoholism and 90.9 % reported witnessing domestic violence at home. 54.54% were migrants. 45.45% were diagnosed with adjustment disorder after getting in contact with the legal system with the symptoms lasting for less than 6 months. 3 of the children had illness preceding the contact with the legal system. 72.7% had comorbid substance use with tobacco use being the most common. Sleep disturbance and depressive symptoms were reported in 54.54%. All were involved in criminal cases with 2 of them having been incarcerated for a period of 2 years. 36.36% were under trial for 302 IPC while 3 were being tried under the POCSO Act. Worries pertaining to duration of case (72.7%) and implications of case (100%) were reported. Conclusion : Adolescent boys with low educational achievement, belonging to lower socioeconomic status, migrant and disrupted families were identified as risk factors for children getting in conflict with law. Key words: Indian Penal System, POCSO Act

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Dr. Ankur Chatterjee Department of Psychiatry, Burdwan Medical College and Hospital, Purba Barddhaman, India Email: [email protected] Background & Aims: Studies are sparse relative to complications developing after Kawasaki disease. Risks for developing ADHD, autism, epilepsy is mentioned in literature. Methods : Presenting to Psychiatry OPD, a girl aged 9years, referred from the Paediatrics department with complaints of behavioral changes for past 6 months. Evaluation of the ADHD traits done by the DSM 5 TR version and severity by the Conners rating scale. Patient followed up to the Paediatrics department for any medical complications of the Kawasaki disease. Results: Improvement in the symptomatology after treatment with syrup Risperidone and Syrup Phenergan. Conclusion: Behavioural problems resolved with treatment, although aetiology could not be determined. Other investigations had non yielding results as well. Key words: Kawasaki disease, ADHD, behavioural changes

Cases|Subjects

Dr. Pooja Hazare 1 . 1. Junior Resident, Department of Psychiatry, PDMMC, Amravati. Email: [email protected] Background: Catatonia is a neuropsychiatric syndrome characterized by a range of motor, behavioral, and autonomic disturbances. It is associated with various psychiatric and medical conditions, yet it remains under-recognized, leading to delays in treatment. Case Series: Three patients diagnosed with catatonia based on DSM-5 criteria were reported. Comprehensive clinical assessments were conducted, including history taking, physical and neurological examinations, and laboratory investigations to determine underlying causes. Case 1: A 30-year-old male with schizophrenia presented with mutism, posturing, stereotypy and waxy flexibility. Initial treatment with lorazepam led to partial symptom resolution, necessitating ECT for complete remission which took 10 days of time. Case 2: A 48-year-old male with substance induced psychosis presented with catatonia marked by stupor, posturing, mutism, grimacing. Lorazepam was administered, leading to rapid symptom improvement and he fully recovered within minutes. Case 3: A 14-year-old female with brief psychotic disorder presented with stupor, mutism and negativism. She responded rapidly to lorazepam, with full symptom resolution within 48 hours. Conclusion: This case series illustrates the diverse presentations and treatment responses in catatonia. Timely diagnosis and individualized treatment are crucial. Keywords: catatonia, benzodiazepines, ECT