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.

30-60% patients with skin disorder estimated to have psychiatry comorbidity. Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous follicles with global prevalence around 70-80%. To assess stress, anxiety and depression in patients of acne and their correlation with acne severity. Patients who received diagnoses of acne vulgaris from Dermatology OPD and willing to participate in study where included. Acne severity was assessed using Global Acne Grading System. (GAGS). Patients were assessed for psychiatry morbidity using Hindi version of Depression Anxiety Stress Scale- 21 item (DASS 21). Statistical analysis was done by SPSS version 20.0. Out of 46 patients included in study, 23 (50%) patients reported having mild stress, 7 (15.2%) had moderate and 2 (4.3%) had severe stress. 14 (26.1%) patients reported having mild anxiety and 8 (21.7%) had moderate anxiety. Depression was found in 9 (19.5%) patients as 7 (15.2%) had mild and 2 (4.3%) had moderate depression. As per GAGS, 19 patients had mild acne, 16 had moderate, 8 had severe and 3 had very severe acne. Significantly high proportion of patients with acne had stress, anxiety and depression and psychiatry morbidity significantly associated with acne severity. Anxiety and depression were also corelated significantly with acne duration. The relationship between stress, psychiatry morbidity and acne are worth exploring as possible behaviour intervention can be useful in patients.

No abstract

Introduction: Adult attention deficit hyperactivity disorder (ADHD) has a prevalence of 4.4% worldwide. Adults with ADHD are more prone to risk taking behaviours, behavioural addictions and substance abuse. Studies have shown that adults with ADHD are more likely to develop internet addiction (IA). Aim of the study: To determine scoring of medical students on an adult ADHD scale and internet addiction scale and to compare it. To compare the scoring in context to demographic characteristics and substance use. Material and methods: Medical students from two medical colleges from Gujarat participated in the study. Students filled in a semi-structured proforma which included sociodemographic details and details regarding internet use. Students completed self-report scales such as the Adult ADHD Self Report Scale (ASRS) and Young Internet Addiction Scale (IAS). Descriptive analysis was done using SPSS 20.0. Results: Out of 427 subjects, 233 (54.6%) were male and 194 (45.4%) were female. On IAS, 359 (84.15%) were found to be average online users (no addiction), 64 (15%) had frequent problems with internet use (possibly addicted) and only 4 (0.9%) students had excessive internet use (severely addicted). In screening for adult ADHD, 84 (19.7%) were found to be positive. Adult ADHD was found to be significantly associated with IA and substance use. Discussion: Deficiency in inhibitory control, reward deficiency syndrome and cognitive and motivational dysfunction have been observed in ADHD, which makes subjects with ADHD at risk of developing IA and substance use. Conclusions: Being positive on the Adult ADHD Scale was found to be significantly associated with IA and substance use.

Pramipexole is a dopamine agonist with higher affinity for D3 receptors. Treatment with pramipexole in clinical conditions such as restless legs syndrome, fibromyalgia, and parkinsonism has been found to significantly improve measures of pain and sleep along with the other symptoms. There is no research data available that explores the usefulness of pramipexole in somatoform/functional pain syndromes. We report a case of a 65-year-old male with bilateral functional shoulder pain associated with insomnia and zolpidem dependence effectively treated with pramipexole.