No abstract

Following seizure control with antiepileptic drugs and normalization of electroencephalogram, behavioral problem may appear for the first time in an epileptic patient. This phenomenon has been termed ‘alternative psychosis’. However, it remains poorly understood in absence of any definite diagnostic criteria, and there are no specific guidelines to treat the condition. Here we report a case of an untreated patient of epilepsy of 13 years duration, who had onset of first episode non-specific aggressive behavior within 1 week after starting treatment with sodium valproate, which responded adequately to a short course of low dose risperidone. We conclude that alternative psychosis may have a variable clinical presentation and may respond favorably to antipsychotic drugs.

Myxedema madness is a very rare but established entity. A psychotic patient having hypothyroid features should always be evaluated regarding same. A 30-year-old female without known significant past medical history had, for the past one and half year, continuous persecutory and referential delusions; second and third person auditory hallucinations, facial puffiness and Brief Psychiatric Rating Scale (BPRS) score of 41 on admission. Her thyroid profile was: Thyroid stimulating hormone - 63.71 mIU/L, Free tri iodo threonine (FT3) - 2.1 pg/ml, free tetra iodo thyronine (FT4) - 0.6 ng/ml with normal ultrasound-thyroid. Patient was started on thyroxin 100 μg with a low dose risperidone 2 mg. Risperidone was withdrawn over a week and the patient was discharged on thyroxin alone with BPRS score of 8 and absence of delusions and hallucinations.

This chapter focuses on ADHD in the adult population. The authors of this chapter incorporate new developments in existing understanding of the disorder. This chapter includes journey of ‘ADHD diagnosis in adults' to current practice. Understanding of newer aspect of etiological research and its application in identification of adult ADHD is given utmost importance in this chapter. Core parts of the disorder like clinical features, diagnosis, comorbidity, and management are discussed in detail, keeping in mind disease progression from childhood to adulthood. Finally, the authors discussed a lacunae in current scenario and possible future interventions that can improve overall outcome of functional impairments in adults.