35 year old female presented with wrist Slash, telling some one told me to do so. she is married having two children.No significant stressors.History suggestive of psychotic illness for past four years which is episodic. Poor compliance with treatment.Premorbid personality well adjusted.No history of BPAD or MDD. when the patient reported she was on olanzepine 15 mg and sertraline 50 mg from a psychiatrist when she tried self harm now for first time.Mood depressed ,no depressive ideas ,percecutary and referential ideas present along with pseudohallucination commanding to commit suicide. Also complaints of palpitations,fear , running out behaviour in response to pseudohallucination. Olanzepine uptitrated to 25 mg, Sertraline changed to desvenlafaxine 50 mg along with bzd considering associated low mood which was persisting.Parient became euthymic suicidal ideation disappeared full improvement noticed in 20 days. Suddenly next day started pseudohallucination and running out behaviour,mood changes ,dsh ideation. Considering the primary diagnosis of Psychosis , possible worsening of psychotic features with SNRI desvenlafaxine stopped.Patient returned to premorbid level in one week and discharged on olanzepine 25 mg and bzd. Due to complaints of sedation bzd tapered down next visit and within two days patient attempted suicide telling commanding hallucination. How can be proceeded with the case . Please opine. @Dr. Shama Rathod @Dr. Sumi Aswin

IS LATE ONSET OF SCHIZOHRENIA IS PURE NEUROGENERATIVE PROCESS A lady 55 yeara with suspiciousness, Muttering to self, impaired biofunction irritability and agressive behavior.MSE revealed Third person auditory hallucination, Delusion of persecution and reference. Patient Initially put on Inj.Serenace 10 stat and 5mg bd for two days later on shift on Tab.Olanz 10mg hs and Tab.Valproate 500mg .Now she is improving with decrease Psychotic feature. Is late onset of schizohrenia or pschyosis is Neurogenerative as there is change in level of brain derived neurotrophic factor (BDNF) .@Curofy Expert Panel

abnormal behaviour .... schizophrenic like picture ... not responding to medication ... with h/o epilpesy in childhood .... ? treatment ? Management a young girl in her twenties came with the parents reporting sign n symptom of schizophrenia for 3 years - muttering ... laughing without reason - crying without reason - neglect of self care - like bathing justp utting water on body .. does not use soap ..... Treted with olanzapine by another psychiatrist with olanz - had side effect as exxcessive weight gain with excessive appetite on history n on inquiry - frequnet faith healer visit n Irregular intake of medicine ( as can be expected in the village ) came for the second opinion ... on inquiry n detail history noticed h/o epilepsy in the childhood ... 6 times in 4 years then stopped without medication .... so need your views n opinion regarding is there any or can there be any corealation - of abnormal behvior with h/o childhood epilepsy ... if yes then does any body has any experience or explanation ? pl share can this be treated or should be treated with the addition of Antiepileptic medicine even though there is not active seizures ? does supplementary or dietary support or psychotherapy support helps ? should we go for Imaging study ? like CT Scan Brain / MRI Brain with contrast ? or PET Scan Brain .... what do you advise n why ? what should we look for ? pl share your ideas

#CAP2020 DSM 5 CRITERIA FOR ADHD:- People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development: Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level: Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities. Often has trouble holding attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked). Often has trouble organizing tasks and activities. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework). Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). Is often easily distracted Is often forgetful in daily activities. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level: Often fidgets with or taps hands or feet, or squirms in seat. Often leaves seat in situations when remaining seated is expected. Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless). Often unable to play or take part in leisure activities quietly. Is often “on the go” acting as if “driven by a motor”. Often talks excessively. Often blurts out an answer before a question has been completed. Often has trouble waiting his/her turn. Often interrupts or intrudes on others (e.g., butts into conversations or games) In addition, the following conditions must be met: Several inattentive or hyperactive-impulsive symptoms were present before age 12 years. Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities). There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning. The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder). Based on the types of symptoms, three kinds (presentations) of ADHD can occur: Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months. Because symptoms can change over time, the presentation may change over time as well. REFERENCE(S) :- 1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32279-7/fulltext 2. https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_ADHD.pdf 3. https://www.ncbi.nlm.nih.gov/books/NBK223473/

A 72 y/o male came with the complaint of itchy blisters on his skin that have been present for 3 months. He has multiple medical conditions including diabetes, hypertension, and schizophrenia. Current medications include atenolol, atorvastatin, insulin, and haloperidol. Examination reveals multiple, tense blisters arising on normal-appearing skin as well as erythematous bases.