ObjectiveTo discuss the psychiatric symptoms that are associated with CADASIL syndrome Abstract Cerebral:Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a rare type of hereditary disease involving the small cerebral vessels. The clinical symptoms are various and include recurrent ischemic strokes, migraine with aura, seizures with epilepsy, psychiatric problems such as mood disturbances, and progressive cognitive decline leading to dementia. This disease needs awareness amongst the psychiatrists even though it is discussed much more in neurology literature. Psychiatric symptoms are seen in 20–41% of patients with CADASIL syndrome (1, 2). Psychiatric symptoms are actually the initial presentation in 15% of the cases. (3) The psychiatric disturbance most reported are mood disturbances (9–41%) especially depression. Here a 42-year-old African American female was brought to the hospital emergency room after she was found wandering in the streets. Psychiatry was consulted for altered mental status. Upon evaluation by the psychiatric consult service she was only oriented to person, depressed, anxious and complaining of headaches. Initial CT scan showed marked small vessel disease and old lacunar infarcts in the basal ganglia and right corona radiata. Magnetic Resonance Imaging (MRI) of the brain showed acute infarcts in the right posterior frontal and right parietal lobes along with old infarcts. Her symptoms and findings on imaging were consistent with CADASIL syndrome. Once the diagnosis was confirmed and prior records were obtained patient was resumed on an antidepressant and anxiolytic.ConclusionThe purpose of this case report was to discuss psychiatric symptoms associated with CADASIL syndrome. Although there has been research showing a relationship between vascular disease and depression, a review of the literature suggests that there needs to be more research done to explore other psychiatric disturbances that may be seen with this syndrome. Psychiatric symptoms that are untreated can have the potential to further impact the quality of life therefore psychiatrists need to be aware of this syndrome in order to treat these patients promptly.References1 https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0778-8 2 http://dx.doi.org/10.32474/OJNBD.2018.01.000101 3 https://pdfs.semanticscholar.org/47f6/5952ee3c5dcf2a61345f704914b17fa8dc0d.pdf

Sound health is considered a basic need of every individual. It allows a person to enjoy routine activities. Objective: To examine the impact of moderate intensity exercise on aerobic fitness. Methods: Participants of the study were voluntarily selected from the department of sports science and Physical Education, Gomal University, Dera Ismail Khan, KPK, Pakistan. In addition, the participants of the study were categorized as; control group (CG =20) and experimental groups (EG-20). A self-made exercise protocol of twelve weeks was applied on the selected subjects and thus for the assessment of aerobic fitness, Harvard Step Test, developed by Brouha et al., (1943) was used.  The collected data were tabulated and were analyzed by using appropriate statistical tools i.e. Percentage, Means, Standard Deviation, Paired Sample t-Test and ANOVA. Results: The study found significant difference were found between pre & post cardiovascular fitness of male subject i.e. t (9) = -21.433, sig. = .000 < a= .05. Similarly, significant difference was found between pre & post cardiovascular fitness of female subject i.e. t (9) = -25.249, sig = .000 < a= .05. According to the results of this research study, it may be recommended that the Physical education and exercise must be a necessary subject for all college, school and university level students or the student is necessary to take the subject of physical education and exercise for each year so that their cardiovascular fitness is maintained. Conclusions: The study concluded that moderate intensity exercise has significant impact on aerobic fitness of respondents.

Objective:To describe the presence of psychotic symptomatology in a patient with hyperthyroidismAbstract:Psychiatric-spectrum symptoms associated with thyrotoxicosis has been well reported in the past. However, psychosis in a patient with a thyroid nodule is a rare find. Here, the case of twenty four-year-old, single, unemployed, Albanian American male with self-reported history of Attention Deficit Disorder (ADD) and Cannabis use disorder was brought in to the Comprehensive Psychiatric Emergency Program (CPEP) due to new onset psychosis. Patient was paranoid, disorganized with labile mood. He had poor insight, judgement and impulse control. The event coincided with a period of unemployment in his life and new onset of hallucinations from past few days. He was brought in to the hospital after he was found pacing and having lack of sleep. Patient was treated with antipsychotic for acute psychosis. He was started on Risperidone initially to which he did not respond to. Blood work showed low TSH and elevated T4. Physical exam was noted for palpable thyroid nodule. Further labs resulted in high thyroid peroxidase antibody. Ultrasound of thyroid with color flow showed single nodule in the left lobe and iodine uptake activity localized to the left lobe. Patient was started on Methimazole 5 mg along with Haldol 5mg orally twice a day which improved his symptoms tremendously. Patient was stabilized and after 1 week was discharged on Haldol 5 mg by mouth two times a day for Psychosis, Cogentin 1 mg by mouth two times a day for extrapyramidal system (EPS), and Methimazole 5 mg by mouth daily for overactive thyroid nodule.Conclusion:Psychosis associated with thyroid nodule is rare but possible. The onset of psychotic syndrome is an important clinical element whose underlying medical cause must be promptly clarified. Psychosis can present in a number of ways and can have different causes. Apart from psychiatric causes, underlying medical causes should always be considered. In this case it was important to get a full clinical history of the patient as well as complete physical examination. The differential diagnosis of a psychotic disorder in light of a medical disease should always be considered in order to promptly diagnose and treat the underlying cause to reduce the morbidity and possibly the mortality associated with it.

The purpose of this analytical study was to synthesize existing evidence relating to the association of exercise or physical activity with academic burnout in students. Relevant articles were systematically and rigorously searched using ten research databases. Following screening for relevancy, ten studies (eight cross-sectional, one cohort, and one interventional) were selected to include for final synthesis. All of the cross-sectional studies had good or satisfactory quality ratings, and the cohort and interventional studies included in this review had moderate to strong quality ratings.  Six out of eight cross-sectional studies showed an inverse relationship of physical activity or exercise with academic burnout with the exception of two studies showed no significant associations. The cohort and interventional studies also demonstrated negative relationships of physical activity with academic burnout.  The findings are likely to provide some evidence that physical activity may be capable to reduce academic burnout in students.