Electroconvulsive therapy is safe and effective in the treatment of depression in older individuals. Minor cognitive side effects of electroconvulsive therapy include acute postictal confusion and reversible short-term memory deficits. However, interictal delirium is uncommon in absence of risk factors. Herein, we report the case a depressed male patient without any known risk factors who developed interictal delirium 2 days after his sixth electroconvulsive therapy session. Interictal delirium improved with treatment within 1 week.

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ObjectiveRecreational use of nitrous oxide (N20) or ‘laughing gas’ inhalation is a common phenomenon in countries like UK and US where it is associated with music festivals and parties. However, as far as we know, recreational N20 use in Singapore has hitherto not been reported in the press or scientific journals. We report the first case of N20 use and addiction in a young Singaporean male who was introduced to it by a friend from a Western country where its use is prevalent.MethodsA 20-year-old Singaporean male with an existing psychiatric diagnosis of major depression, presented with a 3 year history of solitary regular N20 inhalation that escalated from infrequent low dose use to the current daily high-dose use which he was unable to control. He exhibited symptoms of dependence — including preoccupation, tolerance, withdrawal and difficulty in cutting down. No major adverse medical complications were noted so far.ResultsThe patient was assessed to have Nitrous Oxide Dependence; and is currently undergoing regular counselling sessions in an attempt to motivate him to cut down or stop his N20 use.ConclusionThis case is unique for 2 reasons:– extant literature suggests that only anectodal evidence exists for psychological dependence of N20 in Singapore; yet our patient clearly demonstrates psychological dependence;– this is the first reported case of N20 use disorder in Singapore; and perhaps ASEAN, with the unusual presentation in a young male whose use is solitary and private.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Obstructive sleep apnea is a major public health concern which is associated with cardiovascular and cerebrovascular comorbidities. Eventhough association of OSA with adverse fetomaternal outcomes is documented, screening for OSA in pregnancy is a challenging task. So the purpose of our study is to assess the risk of OSA in obese pregnant ladies by using established STOP BANG Questionnare for OSA. Materials and Methods: This cross sectional study on assessment of obstructive sleep apnea risk among the obese pregnant women was done in tertiary care centre in the rural population of Puducherry. Results: 21 obese pregnant women were included in our study. The mean age of our study population was 29.5 years. Most of the study subjects (85.7%) had history of snoring both reported by them and their bed partners. History of tiredness was reported by 14 patients (66.6%).Chocking or history of gasping was reported by only 4 patients (19%). Results of our study showed that 42.9% of the obese pregnant women had high risk, 42.9% had intermediate risk and 14.3% for OSA as per the STOP BANG scoring. Conclusion: Thus our study subjects were having higher risk of OSA which needed further evaluation with polysomnography. Thus the STOPBANG questionnaire can be used to screen for obstructive sleep apnea (OSA) in obese women during pregnancy.