Topiramate-induced bilateral acute angle closure glaucoma and myopic shift

Topiramate (TPM) shows idiosyncratic adverse reaction of peripheral ciliochoroidal effusion leading to acute angle closure glaucoma (AACG), which should be diagnosed and managed at the earliest to prevent irreversible visual loss. We report, a case of TPM-induced bilateral AACG and myopic shift, which was reversed by omitting TPM and administering antiglaucoma medications.

Lamotrigine in treatment of Writer’s cramp (Focal dystonia) in unspecified bipolar and related disorder

Writer’s cramp is a focal dystonia and its non-response to a standard treatment regimen prompts review of the diagnosis as unspecified bipolar and related disorder. Mr. X, aged 44 years male, showed a symptom of writer’s cramp and his condition worsened on augmentation with antidepressant and antipsychotic drugs. The diagnosis of unspecified bipolar and related disorder is applied when it clinically impairs social, occupational, or other important areas of functioning that do not meet the full criteria for any of the disorders in bipolar class or when a clinician chooses not to specify the reason that the criteria are not met, and there is insufficient information to make the specific diagnosis. In our case, lamotrigine has shown effectiveness in unraveling writer’s cramp and is suggested as an alternate treatment in unmet need for bipolar disorders because of its pleiotropic actions on the nervous system, e.g., membrane stabilizing, neuronal plasticity, and inhibition of glutamate release

Acute psychosis induced by topiramate

Topiramate (TPM) is a new potent antiepileptic drug (AED) used as add-on therapy for generalized and partial seizures that are resistant to the other AEDs; or as a mood stabilizer, and for reducing weight gain associated with olanzapine and clozapine in patients with bipolar disorder or schizophrenia. However, there is a higher risk of psychosis with TPM in patients with a past history of psychiatric disorder. This case report highlights emergence of psychosis that was related to TPM which resolved on discontinuation

Steroid induced central serous retinopathy following follicular unit extraction in androgenic alopecia

Dermatologists for various conditions and procedures commonly use corticosteroids worldwide. The development of central serous retinopathy is a lesser known complication occurring in <10% of the cases with steroid use. This case report highlights the development of central serous retinopathy after prescribing low dose of prednisolone 20 mg per day for androgenic alopecia during post-surgical follicular unit extraction (FUE) surgery follow-up that recovered spontaneously after gradual withdrawal of steroids. Therefore, awareness is required for its early detection and management as it has a potential of causing irreversible visual impairment

Antidepressants-a possibly risk factor for cataract development: a cross-sectional study

Background: Few studies have reported the role of antidepressants as cataractogenic in humans.Methods: It’s a hospital based descriptive, cross-sectional study. 45 Patients were screened for antidepressant use and diminution of vision, 6 were dropped out. 39 patients with 78 eyes were finally enrolled. They were divided into two goups i.e., Group-I, with cataract (N=53) and Group-II, without cataract (N=25). Three clusters of antidepressants were assessed e.g., SSRI, SNRI and TCA with therapeutic dose (TD) and non-therapeutic dose (NTD) range. Psychiatric illness was diagnosed on DSM-5 and severity of depression on HAM-D. Best corrected visual acuity (BCVA) was converted from Snellen units to logarithm of minimal angle of resolution (log MAR) for statistical analysis. Cataract changes in eyes were seen on slit-lamp and classified on Lens opacities classification system-III (LOCS-III) criteria.Results: A total 78 eyes of thirty-nine (39) patients were evaluated. Thirty (38.46%) and forty-eight (61.53%) eyes belonged to males and females, respectively. Mean age of males (n=7) was 41.8±2.3 years and females (n=32) 40.2±1.0 years. In Group-I, out of (N=53) eyes that developed cataract 33 were females (62.26%) as compared to males 20 (37.7%). Group -II, out of (N=25) eyes, females without cataract were 15 (60%) as compared to males 10 (40%).  Therapeutic dose (TD) of antidepressants (AD) in Group-I had more cataract 37 (69.81%) as compared to non-therapeutic dose (NTD) 16 (30.1%). Most of the eyes with cataract 35 (66.03%) had AD exposure of more than 1 year that was possibly associated with increased risk of cataract development (OR 2.10; 95% CI, 0.79-5.55). Amongst users of antidepressants, SSRI was associated with increased risk of cataract development (OR 2.4; 95% CI, 0.72–7.94) with a female preponderance (OR 1.1; 95% CI, 0.41–2.91). Maximum number of eyes 34 (64.15%) that developed cataract had BCVA of ≥6/12 and minimum of 2 (3.77%) eyes had BCVA of ≤6/36. LOCS-III revealed 38 (71.69%) eyes (71.69%) having peripheral cortical cataract and 15 (28.30%) posterior sub-capsular cataract.Conclusions: There is a possible risk of association of cataract amongst user of antidepressants. The AD use of more than 1 year or longer had increased risk for development of cataract with a female preponderance. The highest risk was observed in the users of SSRI as compared to SNRI and TCA. Treatment exposure with antidepressant was longer for mild depression having more than two episodes

Psychiatric morbidity in newly diagnosed carcinoma cervix and its comparison with benign condition

Background: To study the psychiatric morbidity among newly diagnosed carcinoma cervix and its comparison with benign gynaecological diseases of cervix. Cervical cancer is the second most common cancer in the world and ranked first in India. It is mainly caused by sexually transmitted infection (STI) of human papilloma virus (HPV).Methods: It was an open labeled, cross-sectional and extended phase study that screened 158 patients in the age group of 18-70 years who fulfilled both inclusion and exclusion criteria and screened positive on liquid based cytology (LBC), as per guidelines of Bathesda system in Government Medical College, Patiala. 13 patients dropped out of study and finally 145 patients were enrolled. They were further divided after biopsy into two groups as per histopathological examination (HPE) i.e., Group-1, N=47 women HPE positive for cervical intraepithelial neoplasia (CIN) as Cases and Group-2, N=98 HPE negative as Control Hospital Anxiety Depression Scale (HADS) was used to screen psychiatric morbidity for depression and anxiety. Whereas, severity was assessed on Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A).Results: Mean age of Group-1 was 38.45±11.22 SD years and Group-2 was 36.67±8.54 SD years. Psychiatric morbidity in Group-1 was 65.95% whereas Group-2 was 21.42%. P value obtained on comparing HADS score of two groups was significant (p <0.050). After active intervention there was a significant reduction in psychiatric morbidity of two groups (72% in Group-1 and 81.3% in Group-2).Conclusions: The study revealed that the breaking of bad news has a significant psycho-social impact on patients suffering from carcinoma cervix than benign group

Pramipexole with leuprolide: a treatment strategy for PGAD

Persistent genital arousal disorder (PGAD) is described as the spontaneous, intrusive, and unwanted genital arousal in the absence of sexual interest and desire. Whether, its etiology is central or peripheral neurovascular in nature, it is still unclear. However, patient presents with symptoms of persistent engorgement of genital erectile and vascular tissue. The majority of women report PGAD as distressing. The symptoms usually occur in females in the age group 25-58 years especially in perimenopausal phase. The case is reported of PGAD in 19-year old female who was treated successfully with Pramipexole and Leuprolide

Venlafaxine induced hepatotoxicity in a carcinoma of breast survivor with co-morbid depression

Drug Induced Liver Injury (DILI) is one of the leading causes of liver damage worldwide and raises concerns about its prescription in lieu of the limited drug options available for the depression. Venlafaxine (VEN) is an antidepressant with dual neurotransmitter receptor modulations i.e., serotonin and norepinephrine reuptake inhibitor (SNRI) and having an additional benefit in management of vasomotor symptoms especially in menopausal patients where hormone replacement therapy (HRT) is contraindicated. VEN induced hepatotoxicity have been reported to occur in less than 1% of patients. Until now, less than 11 cases of VEN-related liver injuries have been reported in literature. We hereby, report a rare case of VEN induced liver injury in a 40-year-old breast cancer survivor with co-morbid depression

Carneous mole in a depressed patient: a diagnostic dilemma

Carneous mole is a pathological variant of missed abortion of a fetus less than 12 weeks. It’s medically managed by giving repeated doses of misoprostol with or without dilatation and curettage. Due to ambiguity in diagnosis and misleading clinical examination and investigations, surgical exploration was considered as the best approach. The case of carneous mole with depression is reported because of its rarity; as in this case, ammenorrhea was the only presenting complaint and all other laboratory tests, investigations and radiological report failed to detect carneous mole, which was diagnosed incidentally on exploratory laparotomy

Recurrent hydatidiform mole transformed into invasive mole with co-morbid depression- a rare case report

The gestational trophoblastic disease is a group of interrelated lesions that arise from abnormal proliferation of placental trophoblast. It comprises of hydatidiform mole (partial or complete), invasive mole, placental site trophoblastic tumor and choriocarcinoma. The occurrence of hydatidiform mole in more than two conceptions is known as recurrent hydatidiform mole. Although, its incidence is less than 2% but it may progress to invasive mole or choriocarcinoma. The case of 26-year old female is reported; she had five consecutive molar pregnancies and the sixth one developed into invasive mole with co-morbid depression that was managed by methotrexate chemotherapy, antidepressant and psychotherapy.