Major depressive disorder (MDD) becomes difficult to treat when the patient has a comorbid personality disorder. For such patients, even a combination of psychotherapy and pharmacotherapy has been ineffective. Electroconvulsive therapy (ECT) has been the first line of therapy for the treatment-resistant depression. We used this mode of therapy for a patient who had MDD along with borderline personality disorder and had failed trials of multiple medications and psychotherapy. ECT was very successful in our patient.

Electroconvulsive therapy (ECT) is an effective but underutilized modality for the treatment of depression unresponsive to antidepressants. Mild to moderate cognitive impairment is a commonly encountered adverse effect but it normally resolves within hours. We report a case of post-ECT delirium lasting over a course of 14 days with succeeding sessions. Modification of ECT protocol by spacing the intervals of subsequent sessions and switching from bilateral brief pulse to unilateral ultra-brief pulse was found to be effective in reducing the confusion.

The war in Syria has entered the seventh year, with no sign of resolution. It is often referred as "the greatest human tragedy" since World War 2. Because of limited health facilities, we propose telepsychiatric interventions for the provision of mental healthcare services in Syria and in refugee camps to treat post-trauma patients.

contribute to the development of suicidal predilections. Due to a similarity of presentation, BDD can be misdiagnosed as major depressive disorder (MDD) or obsessive-compulsive disorder (OCD) leading to wrong treatment strategies (9). This review aims to provide an overall picture of BDD, its symptoms, diagnostic criteria, its effect on daily life, and management. SYMPTOMS OF BODY DYSMORPHIC DISORDERThere are four main symptoms of BDD, which manifest in different ways (4). The symptoms are as following: preoccupation with the perceived or concerned; repetitive behaviors such as checking their appearance on a reflective surface, application of various products to hide the defect, skin picking, obsessive dietary habits, and thoughts of getting cosmetic surgery to rectify the defect; delusional beliefs such that people are mocking their appearance based on the defect. Consequential symptoms such as low self-confidence, avoidance of public places due to a fear of being judged, anxiety, and depressive symptoms where suicidal thoughts may be seen as well (4). DIAGNOSTIC CRITERIABody dysmorphic disorder remains an under-diagnosed and inadequately treated disorder, despite being a common mental illness (10,11). The timely diagnosis of BDD is crucial for the proper management of the disorder. The ICD-10 lists BDD under the category of somatoform disorders (2). The diagnosis of BDD is commonly based on the DSM-5 criteria. It is being used in classifying as well as a diagnostic tool. It is published by the APA and serves as the principal authority for the diagnosis of psychiatric disorders.

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