Opium Withdrawal Delirium: Two Case Reports

Two patients with opium dependence developed delirium during abstinence. The delirium resolved completely within 48-58 hours of appropriate treatment. Caution needs to be exercised during opioid detoxification in timely detecting and treating potentially life-threatening condition like delirium.

Topiramate induced pruritus in a patient with alcohol dependence

Topiramate is an antiepileptic medication frequently used for the management of alcohol dependence and in other psychiatric disorders. Though cutaneous side effects are known to occur with it, isolated pure pruritus is rarely reported with topiramate in the literature. We wish to report a case of pruritus associated with topiramate use in a male with alcohol dependence syndrome.

A probable association of acute dystonia with gemifloxacin administration

Gemifloxacin is a recently introduced fluoroquinolone antibiotic frequently used for its broad spectrum and once-daily dosing. Fluoroquinolones are associated with various neuropsychiatric side effects, such as seizures, insomnia, confusion, lightheadedness, psychosis, paranoia and hallucinations. We report a case of a 36-year-old woman given gemifloxacin for an upper respiratory tract infection who developed acute dystonia on the third day following therapy initiation. The clinical implications are discussed.

First episode mania at 75 years of age

Late onset psychiatric disorders are often associated with organic factors, either medical or neurological. Mania occurring for the first time in the elderly population is rarely reported. We hereby report a patient with first episode mania who was investigated in detail, but no organic factors were found. He was diagnosed as first episode mania and was managed with divalproex and olanzapine.

Mutism as the presenting symptom: three case reports and selective review of literature

Mutism, defined as an inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output, is a common clinical symptom seen in psychiatric as well as neurology outpatient department. It rarely presents as an isolated disability and often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. It is often a focus of clinical attention, both for the physician and the relatives. Mutism occurs in a number of conditions, both functional and organic, and a proper diagnosis is important for the management. We hereby present three cases, who presented with mutism as the presenting symptom and the differential diagnosis and management issues related to these cases are discussed. The authors also selectively reviewed the literature on mutism, including psychiatric, neurologic, toxic-metabolic, and drug-induced causes.

Amisulpride for clozapine induced sialorrhea

Clozapine is an atypical and novel antipsychotic medication useful for patients with schizophrenia who are refractory to treatment. Its use is often associated with troublesome side effects like sialorrhea, sedation, weight gain, enuresis, dizziness, besides life threatening side effects like agranulocytosis. Drug treatments used for Clozapine induced sialorrhea (CIS) like anticholinergic drugs and alpha 2 receptor antagonists have their own added side effects. A case of CIS responding to low dose of Amisulpride is reported.

Starvation in obsessive-compulsive disorder due to scrupulosity

This report describes an unusual presentation of obsessive-compulsive disorder (OCD) with predominant religious obsessions and compulsions (scrupulosity) in which the patient starved himself by keeping fast excessively to the extent of emaciation and extreme weakness even in walking and became bedridden.

Neurocysticercosis presenting with psychosis

Cysticercosis consists of infection with the small bladder-like larvae of the pork tapeworm Taenia solium. The life cycle of parasite is maintained between man and pig infected with cysticerci. Epilepsy is the most common presentation of neurocysticercosis; focal signs, headache, involuntary movements and global mental deterioration are other symptoms. Psychosis is a rare presentation and may be seen in up to 5% of patients. We present a 25 years old male, who had been under treatment from psychiatry OPD for psychosis for one year, developed generalized tonic-clonic seizures. CT scan of brain revealed multiple calcified and hypodense lesions with surrounding oedema. Histopathological examination of subcutaneous nodule confirmed the diagnosis of neurocysticercosis.