Obsessive Compulsive Disorder as a Rare Manifestation of Wilson’s Disease

Wilson’s disease is a rare autosomal recessive disorder of copper metabolism, that causes an impairment of cellular copper transport. An individual’s inability to excrete excess copper in bile leads to accumulation of copper in organs like the brain, liver and cornea. It can manifest with symptoms of hepatic impairment and liver failure. It can also present with neurological symptoms like rigidity, gait disturbances, dystonia, dysarthria and chorea. Frequently certain psychiatric manifestations have been reported like mood changes, personality changes, cognitive impairment, phobias, psychosis, anxiety, impulsive and compulsive behaviours . It’s rare for a Wilson’s disease patient to present with only Obsessive Compulsive Disorder (OCD). In the present case report, a 15-year-old male presented in the Outpatient Department with complaints of repetitive intrusive thoughts that he was unable to voluntarily control and compulsions of washing and preoccupation with checking and symmetrical organising with a deteriorating scholastic performance. The only positive findings were Kayser-Fleischer rings, low serum ceruloplasmin and mild cerebellar atrophy. The patient started showing symptomatic improvement with pharmacological treatment comprising of zinc, D-penicillamine, and fluoxetine and diet modification

An interesting case of serotonin syndrome precipitated by escitalopram

Serotonin syndrome is a known entity, which occurs with multiple drugs acting on serotonergic receptors. A 73-year-old lady presented with a history of agitation, altered sensorium, and autonomic hyperactivity after starting escitalopram on therapeutic dosage for her depressive syndrome who was on selegiline for her parkinsonism. This syndrome with therapeutic dose escitalopram warrants the careful and judicious use of the drug especially with other serotonergic drugs, so that this serious medical complication can be avoided

A case of corpus callosum agenesis presenting with recurrent brief depression

Agenesis of corpus callosum can have various neuropsychiatric manifestations. Following case report highlights the case of a young man presenting with features of recurrent brief depressive disorder, each lasting for about 3 to 7 days, for over a year. He had history of occasional headache and episodes of swooning attack in between, usually precipitated by emotional events. His neuroimaging revealed agenesis of corpus callosum. He was experiencing swooning attacks as he became aware that some ′unusual′ findings were present in his reports. Recurrent brief depression can be a manifestation of this congenital anomaly, and conversion disorder can be present as comorbid diagnosis perhaps due to ignorance and fear of this apparently innocuous congenital malformation

The folding of dimeric cytoplasmic malate dehydrogenase

Porcine heart cytoplasmic malate dehydrogenase (s-MDH) is a dimeric protein (2 × 35 kDa). We have studied equilibrium unfolding and refolding of s-MDH using activity assay, fluorescence, far-UV and near-UV circular dichroism (CD) spectroscopy, hydrophobic probe-1-anilino-8-napthalene sulfonic acid binding, dynamic lightscattering, and chromatographic (HPLC) techniques. The unfolding and refolding transitions are reversible andshow the presence of two equilibrium intermediate states. The first one is a compact monomer (M<SUB>C</SUB>) formed immediately after subunit dissociation and the second oneis an expanded monomer (M<SUB>E</SUB>), which is little less compact than the native monomer and has most of thecharacteristic features of a 'molten globule' state. Theequilibrium transition is fitted in the model: 2U⇆2M<SUB>E</SUB>⇆2M<SUB>C</SUB>⇆D. The time course of kinetics of self- refolding of s-MDH revealed two parallel folding pathways [Rudolph, R., Fuchs, I. &amp; Jaenicke, R. (1986) Biochemistry25, 1662-1669]. The major pathway (70%) is 2U→2M*→ 2M→D, the rate limiting step being the isomerization of the monomers (K<SUB>1</SUB> = 1.7 × 10<SUP>-3</SUP> s<SUP>-1</SUP>). The minor pathway (30%) involves an association step leading to the incorrectly folding dimers, prior to the very slow D*→D folding step. In this study, we have characterized the folding-assembly pathway of dimeric s-MDH. Our kinetic and equilibrium experiments indicate that the folding of s-MDH involves the formation of two folding intermediates. However, whether the equilibrium intermediates are equivalent to the kinetic ones is beyond the scope of this study

A Study of Cluster Behavioral Abnormalities in Down Syndrome

Background :The behavioral phenotype in Down syndrome follows a characteristic pattern. Aims: To find the incidence of behavioral abnormalities in Down syndrome, to compare these findings with other causes of intellectual disability and normal population and to cluster these abnormalities. Settings :One hundred forty mentally challenged people attending at tertiary care set up and from various non-governmental organizations were included in the study. Patients from both rural and urban set up participated in the study. The age-matched group from normal population was also studied for comparison. Design :The study design is a cross-sectional survey done independently by four observers. Materials and Methods :A semi-structured proforma for demographic profile has been used. The behavioral abnormalities are assessed by using DASH II (Diagnostic Assessment for the Severely Handicapped second modified version) scale. Statistical Analysis :Demographic comparison has been done by analysis of variance. Correlation matrix has been run to identify correlation between individual items. Principal component analysis has been used for grouping the behavioral pattern. Results :Behavioral abnormalities as expected are more common in people having intellectual disability than the normal population. The Down syndrome group unlike other causes of intellectual disability shows higher scores in Stereotypy. Impulse control and Mania subscales. Factor analysis yields five characteristic factor structures, namely, hyperactive-impulsive, biological functions, affective, neurotic and organic-pervasive developmental disorder clusters. Conclusions :Contrary to the conventional belief of docile-fun and music loving prototype, individuals diagnosed with Down syndrome show clusters of behavioral abnormalities and management can vary depending on these target symptoms

Perception, Working Experience and Psychiatric Morbidity among Information Technology Professionals during COVID-19 Lockdown: A Cross-sectional Survey

Introduction: In the year 2020, the functioning of the world changed in a big way. For a large part of the year, the world stayed locked indoor, due to the novel Coronavirus Disease -2019 (COVID-19). The need for Information Technology (IT) has reached a new height, and this is certain to persist. Though the IT professionals were mostly working indoors in 'work from home' mode, work pressure and boredom increased according to few studies. Work from home also has different set of employees’ expectations and organisational responsibilities. Aim: To assess the psychiatric morbidity working experience and related perspectives of the new normal, as perceived by IT professionals. Materials and Methods: This cross-sectional survey was conducted in Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India, between May 2020 and August 2020. A Google form-based survey was done which aimed to reach throughout the country. Consent was included as the first question of the form. An ethical clearance was taken from Institutional Ethical Committee of IPGME&R, Kolkata in convenience sampling of IT professionals. For the survey, a semistructured questionnaire was developed and Brief Resilience Coping Scale (BRCS), Ten Items Personality Inventory (TIPI), and K6 psychiatric morbidity screener were used to measure the psychiatric morbidity. Snow ball sampling methods was used to get the sample through free sharing of google forms over the internet. Relevant statistical tests were used to analyse the data, where p<0.05 had been considered significant. Results: Total 72 IT professionals responded to the survey but only 71 were included due lack of informed consent. About 20 (28.2%) showed a high risk of losing their job as per their perception and 35 (49.29%) were highly worried about having COVID-19, while 44 (61.9%) were highly worried about bringing the infection home. 78.9% (n=71) showed screener positive psychiatric morbidity. Psychiatric morbidity was only dependent on “emotional stability” as a personality trait and “risk of Job loss” by regression analysis. Total 67 people were working from home, 37 (55.22%) felt the family time had increased, 28 (41.79%) felt family was happier due to work from home. Conclusion: This study showed the psychiatric morbidity of IT professionals was quite high and it was not related to their resilience level and own perception of morbidity. Psychiatric morbidity was determined by emotional stability, and the threat of losing jobs. It also shed light on disease perception and state of work perception of IT professionals. Though work from home mode may compromise the work quality slightly but it was good for the families and personal stress levels of the employees