Indian Journal of Private Psychiatry

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Volume 18, Number 1, January-June 2024
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EDITORIAL

Prosenjit Ghosh

Mobile Apps in Psychiatry

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:3] [Pages No:1 - 3]

Keywords: Internet, Mobile app, Schizophrenia, Stigma, Technology

   DOI: 10.5005/jp-journals-10067-0170  |  Open Access |  How to cite  | 

Abstract

Technological advancement in the last 20 years has swept over psychiatry as multiple mHealth apps are available 24/7 on both Android and iOS-based smartphones. India is one of the leading countries in terms of smartphone ownership. Most of the apps are available for free or with minimal monetary subscription. The mHealth provides privacy and comfort to the user thus destigmatizing mental health and promoting help-seeking behavior as a part of modern lifestyle, thus demolishing previous conservative notions about psychiatry. Hurdles in the treatment of mental illness can be easily overcome by mHealth as it has 24-hour availability and provides anonymity therefore improving compliance. It also helps in accurately recording large data. However, limitations of mHealth apps primarily include that cognitively or functionally impaired patients may show diminished capacity to use technology and limited internet availability in certain geographical areas.

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Original Article

Julia Keisham, Vidya Sanapala, Niveditha Vasireddy, Ramya Spandana Tata, Srikrishna Nukala, Srinivas Singisetti, Abhilash Garapati

Association between Severity of Depression and CRP Level: A Cross-sectional Study

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:5] [Pages No:4 - 8]

Keywords: C-reactive protein, CRP, Cross-sectional observational, Depression, Inflammatory markers, Severity of depression, Suicidal ideation

   DOI: 10.5005/jp-journals-10067-0167  |  Open Access |  How to cite  | 

Abstract

Aim and background: Depression is a worldwide mental health issue. Depression is believed to result from multifaceted social, psychological, and biological interactions. Many recent studies have found elevated levels of pro-inflammatory cytokines in patients with depression and speculated on their involvement in the pathophysiology of depression. The autonomic nervous system (ANS) activity and hypothalamic (HPA) axis are linked to depression symptoms and C-reactive protein (CRP) production. So, this study aimed to study the severity of depression (SOD) and its correlation to serum CRP levels and identify the relationship between suicidal ideations and CRP levels. Materials and methods: This is a cross-sectional study, hospital-based on patients diagnosed with depression who attended the outpatient department, fulfilled the inclusion criteria, and gave consent. A semi-structured proforma for sociodemographic details and the Montgomery-Asberg Depression Rating Scale to assess the SOD were applied to the patients, after which serum C-reactive protein levels (CRP) were tested based on the particle-enhanced turbidimetric immunoassay (PETIA) technique. Results and conclusion: In our study, we found a statistically significant (p-value of 0.001) positive correlation between the SOD and serum CRP levels. A statistically significant (p-value = 0.001) association is found between the presence of suicidal ideations and an increase in CRP levels. In conclusion, with the SOD and the presence of suicidal ideations, higher CRP levels were observed. Clinical significance: These results indicate that CRP levels can be an essential marker for understanding the disease pathophysiology and may contribute to therapeutic management in the future.

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Original Article

Rizwan Ahmed, Manohar Kant Srivastava, Upendra Singh

Impact of Social Network Therapy on Family Resilience and Well-being among Spouses of Individuals with Alcohol-dependence Syndrome

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:4] [Pages No:9 - 12]

Keywords: Alcohol-dependence syndrome, Family resilience, Well-being

   DOI: 10.5005/jp-journals-10067-0161  |  Open Access |  How to cite  | 

Abstract

Background: Consumption of alcohol is associated with various psychological conditions, people with alcohol use faces negative consequences, like losing employment or destroying relationships with persons they love. Hazardous alcohol intake is also related to the low mental well-being of an individual or their family members. Aim: The current study was aimed to examine efficacy of social network therapy on family resilience and well-being among partners of male individuals with alcohol dependence syndrome. Methodology: Pre–post experimental research design with control group was used. Total 20 male participants diagnosed with alcohol dependence syndrome as per ICD-10 criteria were selected for the research; random allocation was done for in the control and experimental groups, with 10 participants in each group. Sample selection was done followed by purposive sampling technique. Socio-demographic and clinical data sheet, family resilience assessment scale (FRAS), and Postgraduate Institute (PGI) general well-being scale were applied to assess pre–post results. Results: The study reports network therapy does significant improvements in participants’ family resilience and helps in boosting well-being. Conclusion: Network therapy creates a positive aspect to change and reduce the chance of relapse among individuals with alcohol-dependence syndrome (ADS).

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Original Article

Rachit Sharma, Ankit Dangi, Markanday Sharma, Mohit Agrawal

Effectiveness of Quetiapine as a Mood Stabilizer: A Case Series

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:6] [Pages No:13 - 18]

Keywords: Bipolar disorder, Effectiveness, India, Maintenance phase treatment, Monotherapy, Quetiapine

   DOI: 10.5005/jp-journals-10067-0151  |  Open Access |  How to cite  | 

Abstract

Introduction: Bipolar affective disorder (BD) had a chronic episodic course with recurrent episodes of mania or depression, leading to socio-occupational dysfunction. Standard pharmacology is dependent on conventional mood stabilizers, such as lithium, divalproex sodium, and carbamazepine. The role of atypical antipsychotics is more as a first-line adjunct in manic episodes. Recently, the evidence in Europe and America is favoring for use of Quetiapine as a primary mood stabilizer for all phases and episodes of bipolar illness and has even been incorporated in clinical practice guidelines of some countries, including the recent Canadian Network for Mood and Anxiety Treatment 2018 guidelines (CANMAT). However, the prescribing pattern of Indian Psychiatrists weighs heavily on time-tested conventional mood stabilizers during acute episodes as well as during maintenance phases. Methodology: In order to understand and assess the effectiveness of quetiapine as a monotherapy in any phase of bipolar affective disorder without compromising the standard of care and as per clinical requirements, quetiapine was instituted/switched to 14 patients of BD in any phase of illness. Results: Two patients in manic episode, four patients in depressive episode, and one patient in mixed episode attained complete remission with quetiapine monotherapy. Medications of six patients were successfully switched from conventional mood stabilizers to quetiapine monotherapy without any signs of relapse. One patient already maintaining remission on a combination of quetiapine and valproate was continued on the same regimen due to patient preference. All patients, whether in the acute phase or maintenance phase, were noted to be in remission on maintenance dosages of 300 mg/day. Conclusion: Quetiapine monotherapy is effective in acute phases and long-term stabilization of BD and is a welcome drug for the Indian population also. But our findings differed from CANMAT 2018 guidelines in that, quetiapine as a mood stabilizer in monotherapy appears to be more promising in the maintenance phase of BD and only as an adjunct for acute phase management.

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Original Article

Kaveri Chougule, Ankit Halder, Prakash Behere, Nikhil Chougule

Prevalence, Patterns and Correlation of Behavioral and Emotional Disorders in School-going Children and Adolescents: A Cross-sectional Study

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:3] [Pages No:19 - 21]

Keywords: Adolescents, Behavioral and emotional problems, Screening, Youth self-report

   DOI: 10.5005/jp-journals-10067-0153  |  Open Access |  How to cite  | 

Abstract

Background: School-going early adolescent population are most vulnerable to psychiatric disorders. The study was undertaken to determine the prevalence, patterns, and correlation of behavioral and emotional disorders in school-going early adolescent children. Material and methods: The present study was conducted in Kolhapur district schools. A total of 376 students of age 6–16 years, without any diagnosed medical/surgical illnesses and known to teachers for at least 3 months were included in the study. The school teachers were then introduced to the screening tools such as the pediatric symptom checklist PSC for 6–12 years and youth self-report Y-PSE for ≥12 years. Results: The mean age of the children was 9.80 ± 1.85 years, ranging from 6 to 13 years. The majority of participants were male (52.92%). The incidence of behavioral and emotional disorders was found to be 46.67%. The prevalence of behavioral and emotional disorders was more in children of 10–11 years of age (34.07%), followed by 12–13 years (29.12%), 8–9 years (27.32%), and 6–7 years (9.34%). Whereas, prevalence in boys was more than in girls (53.30% vs 46.70%). The assessment of the pattern of emotional and behavioral problems in the children revealed that external problems were most common in children followed by attention problems and internalizing problems. A significant correlation was seen between academic performance and the presence of emotional and behavioral problems in children (p = 0.000). Conclusion: Alarming number of school-going early adolescent children are suffering from emotional and behavioral problems at the study site causing a significant impact on academic performance. These data suggest urgency in establishing a school-based mental health service.

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Original Article

Hina Bano, Kushagra Varma, Jai Singh, Mohammad Aleem Siddiqui, Abdul Qadir Jilani

Prevalence of Psychiatric Comorbidities in Patients with Migraine: A Cross-sectional Study

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:4] [Pages No:22 - 25]

Keywords: International classification of headache disorders, Migraine, Psychiatric comorbidity

   DOI: 10.5005/jp-journals-10067-0165  |  Open Access |  How to cite  | 

Abstract

Aim: To evaluate the prevalence of psychiatric comorbidity in migraine patients. Materials and methods: A total of 60 patients diagnosed with migraine according to the International Classification of Headache Disorders (ICHD-3) were included in the study and were interviewed for depression and mental disorders according to ICD-10 criteria. The migraine disability assessment (MIDAS) questionnaire was used to understand the impact of headaches on patients’ lives and the disruption of daily activities. Results: Migraine was more common in women, and while comorbid psychiatric disorders were detected in 42 patients (70%), dissociative disorder was the most common diagnosis (25%). Conclusion: The incidence of psychiatric comorbidities is higher in migraine patients. Dissociative disorders are the most common psychiatric disorders, followed by depression.

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Original Article

Anweshan Ghosh, Swadesh Kanti Mondal, Gulshan Narula, Prosenjit Ghosh

Prevalence of Substance Abuse in Patients Suffering from Schizophrenia: A Cross-sectional Study

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:5] [Pages No:26 - 30]

Keywords: Alcohol, Cannabis, Dual diagnosis, Opioids, Schizophrenia, Substance dependence

   DOI: 10.5005/jp-journals-10067-0145  |  Open Access |  How to cite  | 

Abstract

Background: Compared with non-abusing individuals who have schizophrenia, those with co-occurring schizophrenia and substance use have been found to have higher rates of homelessness, more unemployment, and poorer overall functioning. Various factors like genetic and environmental vulnerability, including family and social influences, early life trauma, and poor frontal lobe functioning, contribute to the development of psychiatric distress and drug abuse. Aims and objectives: This study aimed to assess the prevalence of substance dependence in cases of schizophrenia, and to check the correlation of severity of psychiatric symptoms in schizophrenia with severity of substance dependence. Materials and methods: This study was a cross-sectional non-interventional hospital-based study. Diagnosis of schizophrenia was made according to the International Classification of Diseases 10 (ICD-10). The severity of symptoms of schizophrenia was assessed using Brief Psychiatric Rating Scale (BPRS) and the severity of substance dependence was assessed using Severity of Dependence Scale (SDS). The data obtained were analyzed using SPSS version 26. Results: A total of 50 patients diagnosed with schizophrenia as per the ICD-10 criteria were recruited after their informed consent. Majority of the participants were young lower middle-class male; most of the participants were married (80%), homemakers or students by profession (22% each), belonging to a rural area (54%). Fifty-four percent of them (n = 27) reported having comorbid substance use disorder. The mean BPRS score was found to be 62.4 ± 22.36, while the mean SDS score was 5.3 ± 5.17. The BPRS score was found to be significantly correlated with the SDS score (r = 0.949, p < 0.001). Conclusion: A significant correlation was found between severity of psychiatric symptoms and severity of substance dependence.

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CASE REPORT

Robin Victor, Priyaranjan Avinash, Twinkle Sharma, Rohit Gondwal

Incubus Assaulting the Whole Family: A Case Report of Folie a Famille from North India

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:2] [Pages No:31 - 32]

Keywords: Case report, India, Psychotic disorder, Schizophrenia, Shared paranoid disorder

   DOI: 10.5005/jp-journals-10067-0158  |  Open Access |  How to cite  | 

Abstract

As per cultural beliefs, the incubus is a sex demon attempting to have intercourse with a female. Incubus syndrome has been described in patients either with schizophrenia or with delusional/psychotic disorders. Shared psychotic disorder (SPD) describes a phenomenon in which delusion/psychotic features are transferred from one member of the family to other susceptible family members who are in a close relationship. The majority of the literature about SPD describes shared delusion among two family members known as folie à deux. Few cases mention folie à famille in which more than two members have the same delusion/psychotic feature. Here, we report a case of incubus syndrome affecting the whole family. We highlight various factors playing a role in its etiopathogenesis and the approach we took for its management. Since both these disorders are quite rare hence an early acknowledgement and adequate intervention would help in the management of the cases.

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CASE REPORT

Rahul Bansal, Prerna Maheshwari

A Case of First Episode Psychosis Uncovering Encephalomalacia in a Young Female

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:2] [Pages No:33 - 34]

Keywords: Encephalomalacia, Gliosis, Psychosis

   DOI: 10.5005/jp-journals-10067-0142  |  Open Access |  How to cite  | 

Abstract

Aim and background: The diagnosis of organic psychosis is made when psychotic symptoms present after a specific neurological or organic event. One such dysfunction of brain structure is encephalomalacia, which refers to softening of brain tissue and can present with varying symptomatology. There is a dearth of cases reported showing quick recovery in patients with organic psychosis attributable to encephalomalacia. Case description: A 25-year-old female presented with acute onset aggressiveness, insomnia, social withdrawal, paranoid ideation, hallucinatory behavior, reduced appetite, and poor self-care. Routine investigations were normal. The computed tomography (CT) scan brain plain revealed encephalomalacia in the left parietal lobe. Organic psychosis was kept as a provisional diagnosis. There was a satisfactory outcome on low-dose antipsychotic on follow-up day 14. She came for follow-up till 3 months and was maintaining well. Conclusion: Encephalomalacia in left parietal lobe region can present with acute psychosis and relatively quick and satisfactory outcome can be seen.

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CASE REPORT

Rachit Sharma, Rishabh Singh

From Urinary Retention to Increased Urinary Frequency: A Case Report on Mirtazapine's Unusual Side Effect

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:2] [Pages No:35 - 36]

Keywords: Adverse drug reaction, Case report, Micturition frequency, Mirtazapine

   DOI: 10.5005/jp-journals-10067-0154  |  Open Access |  How to cite  | 

Abstract

Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA). It is used off-label for the treatment of insomnia, panic disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive–compulsive disorder (OCD), headaches, and migraines. The common side effects include sedation, increased appetite, weight gain, and dry mouth. Changes in urinary function are an uncommon side effect, predominantly as urinary retention and very rarely as an increase in urinary frequency. Here is a case of depressive episode in a middle-aged female, where mirtazapine precipitated a rapid and troublesome increase in micturition frequency.

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CASE REPORT

Soumitra Ghosh, Jyotirmoy Sarma, Debdutta Nayak, Tanveer Dabria

A Case Report on Rett's Syndrome

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:2] [Pages No:37 - 38]

Keywords: Autism spectrum disorder, Case report, Executive cognitive functioning deficits, Genetic

   DOI: 10.5005/jp-journals-10067-0163  |  Open Access |  How to cite  | 

Abstract

Introduction: Rett's syndrome is a neurodevelopmental disorder that occurs almost exclusively in females and has a typically deteriorating course that is mostly caused by an identifiable mutation of the MECP2 gene located in the X chromosome. The most characteristic features are loss of purposive hand movements and acquired fine motor-manipulative skills along with lack of language development, distinctive stereotyped movement, episodes of hyperventilation, etc. Case description: Here, we are presenting a case of Rett's syndrome in a girl of 4 years 10 months who had presented to the psychiatry OPD of Tezpur Medical College and Hospital on being referred from the Department of Pediatrics. There was a history of loss of hand skill and speech with purposeless stereotypic movement of hand, as a result of which she was unable to hold objects in her hand. She had broad-based gait with teeth grinding and a history of episodic hyperventilation. To our knowledge, this has been the second case of Rett's syndrome from the eastern zone of India. The first case was reported by Ghosh S et al. from a medical college in Assam. Conclusion: Rett's syndrome is a relatively rare disease with a deteriorating and progressing course without any specific treatment for it. Management plans should be focused on early detection and symptomatic treatment in the form of seizure control, behavior therapy, physiotherapy, etc., along with proper genetic counseling and parental counseling.

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CASE REPORT

Fannie Louis, Samir Yelwatkar, Harshal Sathe, Sagar Karia

Psychosis as Initial Clinical Presentation for Cerebral Venous Thrombosis: A Case Report

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:3] [Pages No:39 - 41]

Keywords: Case report, Cerebral venous thrombosis, Neuroimaging, Psychosis

   DOI: 10.5005/jp-journals-10067-0144  |  Open Access |  How to cite  | 

Abstract

Cerebral venous sinus thrombosis (CVT) is a rare cause of stroke affecting the venous circulation. It typically presents with the features of raised intracranial pressure (ICP) or cerebral edema caused by the thrombus obstructing the blood drainage from the brain. The presentation of CVT with behavioral change amounting to psychosis has rarely been reported. We aim to report the case of a young female, who presented and was admitted for the acute onset psychotic symptoms, and was later found to have CVT on brain imaging. The presentation, management and the outcome of the case have been discussed. We conclude that the physicians and psychiatrists must have a high index of suspicion for the organic lesion in the cases presenting with acute psychosis.

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CASE REPORT

Sucheta Saha, Sandhiya Loganathan

Psychosis as a Presenting Feature of Thyroid Storm: A Case Report

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:3] [Pages No:42 - 44]

Keywords: Case report, Hyperthyroidism, Nihilistic delusion, Psychosis, Thyroid storm, Toxic crisis

   DOI: 10.5005/jp-journals-10067-0156  |  Open Access |  How to cite  | 

Abstract

Aim and background: Hyperthyroidism is frequently associated with irritability, anxiety, restlessness, impairment in concentration, insomnia, and fatigue. Rarely such patients can also develop mania, depression, and even delirium. Psychosis is a rare complication of hyperthyroidism and has been reported in 1% of cases. A thyroid storm is a life-threatening endocrine emergency with an incidence rate of 1 to 2%. Hence, knowing the common and uncommon presentations of thyroid storm is important for its prompt diagnosis and treatment. In this article, we present an unusual case where psychosis was the manifesting symptom of thyroid storm. Case description: A 55-year-old woman presented to the psychiatry outpatient department with features of psychosis, agitation, and suicidality. Upon admission, the patient was started on antipsychotics but showed no improvement in restlessness and autonomic hyperactivity. Investigations in the upcoming days revealed hyperthyroid status, and a diagnosis of thyroid storm was considered. She was treated with methimazole and propranolol, which improved. Despite improvement in other domains, she continued having hallucinations and delusional ideas, for which antipsychotic treatment was continued. She achieved remission within six months and was reportedly euthyroid on regular medications. Conclusion: Recognition of organic causes of psychiatric presentations is crucial for successful treatment outcomes. Clinical significance: Psychosis can at times be the only presentation of a severely deranged thyroid profile. Hyperthyroidism leading to thyroid storm is an emergency and treatment of such patients should be multidisciplinary in approach. It poses a therapeutic challenge as delay or lack of appropriate medical treatment can result in significant morbidity and even mortality.

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CASE REPORT

Antara Kunwar, Jitendriya Biswal

Adrenoleukodystrophy: A Rare Clinical Scenario

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:3] [Pages No:45 - 47]

Keywords: ABCD1 gene, Adrenoleukodystrophy, Case report, Very long-chain fatty acids

   DOI: 10.5005/jp-journals-10067-0157  |  Open Access |  How to cite  | 

Abstract

Background: Adrenoleukodystrophy is a genetic disorder involving the peroxisomes, that leads to defects in beta-oxidation and collection of very long-chain fatty acids. Blaw, in the year 1970 for the first time introduced the term “adrenoleukodystrophy” as a distinct disease with X-linked inheritance and thought to be a metabolic disorder due to enzymes affecting both the adrenal cortex and cerebral white matter. Presently, it is known to be caused secondary to a defect in ABCD1gene on X q28 (ATP - binding cassette, subfamily D [ALD], member 1) gene that results in a defect in peroxisomal beta-oxidation. Aim: To highlight the rare clinical presentation of adrenoleukodystophy attending to psychiatry outpatient department (OPD). Methods: A thorough psychiatric history and clinical evaluation, a complete metabolic profiling, and genetic analysis by exome sequencing test to confirm the diagnosis, following MRI findings suggestive of leukodystrophy. Results: A 14-year-old boy presenting with behavioral abnormality, difficulty in motor coordination, and disinhibited behavior, for about 1 year, presenting to Psychiatry OPD, was found to have white matter hyperintensity suggestive of leukodystophy. A genetic study revealed a hemizygous, pathogenic variant in the ABCD1 gene, elevation of C26.0 levels, and an increased ratio of C24/22 and C26/22. Later his brother was reported to have behavioral abnormality and was found to have the same genetic findings. Conclusion: The clinical scenario of ALD can be diverse and confusing. Therefore, keeping in mind the rare possibility will provide genetic testing and further management promptly.

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CASE REPORT

Gagandeep Ahuja, Anupama Arora, Simran Gupta

Flunarizine-induced Depression: A Case Report with Review of Literature

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:3] [Pages No:48 - 50]

Keywords: Adverse drug reactions, Case report, Depression, Flunarizine

   DOI: 10.5005/jp-journals-10067-0164  |  Open Access |  How to cite  | 

Abstract

Aim and background: Flunarizine, a cerebro-selective calcium channel blocker, prescribed worldwide for migraine prophylaxis, has demonstrated efficacy and safety in different migraine types and patient populations, comparable to other first-line antimigraine drugs used for migraines such as propranolol, topiramate, amitriptyline, and valproate. Case description: A 35-year-old female primarily came to the outpatient department for treatment of headache and was started on Flunarizine 10 mg. Her headache significantly reduced but after 8 weeks she reported complaints of low mood, reduced sleep, reduced appetite, loss of interest in work, and crying spells. She was treated with adequate doses of Sertraline but showed no improvement in symptoms. Mental status examination revealed depressed affect, anhedonia, and negative cognition. After ruling out organic causes and medical work-up, drug-induced depression was considered, and flunarizine was stopped, and Sertraline was continued at the same dose. After she reported an improvement in depressive symptoms, the diagnosis was changed to drug-induced depression. Conclusion: Flunarizine may induce depressive symptoms in susceptible patients. Patients receiving long-term flunarizine should be regularly monitored for any signs of depression. If a patient develops symptoms indicative of depression after the initiation of a given agent; another agent should be considered. Clinical significance: As a clinician, we can never be too cautious of the adverse reactions of the prescribed drugs, hence, we should always be vigilant and prepared if the situation ever arrives.

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CASE REPORT

Jaafar Omer Ahmed, Koyar Sherko M Salih, Makwan Mohammed Abdulkareem

Mania Induced by a Low Dose of Citalopram: A Case Report

[Year:2024] [Month:January-June] [Volume:18] [Number:1] [Pages:4] [Pages No:51 - 54]

Keywords: Antidepressant-induced mania, Bipolar depression, Case report, Citalopram, Selective serotonin uptake inhibitors

   DOI: 10.5005/jp-journals-10067-0160  |  Open Access |  How to cite  | 

Abstract

Background: Antidepressant-induced mania is commonly observed in contemporary clinical practice. The problem in patients with unipolar depression has been evident since the introduction of the first antidepressants. Selective serotonin reuptake inhibitors (SSRIs), as new drugs, are one of those drugs that may lead to treatment-induced mania. The risk of inducing mania in bipolar patients with citalopram is comparable to the documented risk with other SSRIs. This case study elucidates the crucial factors for distinguishing key depressive episodes between bipolar and unipolar depression and provides recommendations regarding the use of antidepressants in high-risk patients. Case presentation: A 24-year-old Kurdish woman developed mania after self-administering a low dose of Citalopram for depression. Diana Azad (DA) is a 24-year-old single female. She was referred to the Mental Health Treatment Center by the police under a judicial order for psychiatric assessment and treatment. DA was irritable, aggressive, and restless. She showed disruptive behavior, including screaming in the wards and showing her will to leave the hospital. She was diagnosed with bipolar disorder I, a manic episode, and was admitted to the hospital with her mother's companion. Rapid tranquilizers were given at the start, and then mood stabilizers and antipsychotics were prescribed. Conclusion: We advocate the idea that caution must be taken in treating depression with citalopram in young populations, even in the absence of a family history of affective illness.

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