BACKGROUND-The delusion of pregnancy is a condition where the person strongly believes that he/she is pregnant in spite of providing enough evidence to the contrary. Though previously it was considered rare, the number of such cases are gradually increasing in developing countries but the literature regarding this is very meagre in India particularly in the NorthEast. METHOD-In this article we report the unique case of a 60yrs old woman from rural Assam who developed delusion of pregnancy following her menopause thirteen years back, which has been continuing ever since. RESULT-A 60ys old woman presented in the OPD of Tertiary Care Hospital with feelings of movement of foetus in her womb. This was also associated with tremulousness of whole body, burning sensation of both lower limbs, palpitation, irritability and disturbed sleep for 13yrs with episodic exacerbation currently increased for 4-5months. She was a housewife, completed her family and lived with her husband and three children. She was apparently well 13yrs back when following her menopause at age 42yrs she started to doubt if she is pregnant or not. Multiple gynaecologists' opinion was taken but that did not convince her and she continued to believe she was pregnant and felt the movement of the baby inside her womb. CONCLUSION-Although these kinds of patient visit the obstetrician first but historically and clinically this type of delusion of pregnancy is clearly different from the phenomenon of pseudocyesis. Hence treatment approach of both are also different. We need further research to explore this rarely reported phenomenon.

Extra Pyramidal Symptoms (EPS) are a group of symptoms that include dystonia, bradykinesia, tremor, akathisia, and tardive dyskinesia. They are caused by the blockage of D2 receptors in the nigro-striatal pathway and the imbalanced acetyl choline activity that results in the basal ganglia. It most likely happens when first-generation antipsychotics taken in large doses and some second-generation antipsychotics. A few tricyclic antidepressants, including amitriptyline and clomipramine, monoamine oxidase (MAO) inhibitors, such as phenelzine, and SSRIs, such as fluoxetine, may also cause EPS. Antiemetics (domperidone), antiepileptic medications like phenytoin and carbamazepine, and anti-migraine medications like sumatriptan are a few additional causes of EPS. Schizophrenia patients who have never been prescribed medication may also exhibit similar movement problems. The tricyclic antidepressant (TCA) clomipramine is a tertiary amine that has potent D2 blocking and serotonin and norepinephrine reuptake inhibitor characteristics. Constipation, dry mouth, nausea, dizziness, drowsiness, tachycardia, sweating, arrhythmia, and seizures at high doses are common side effects associated with clomipramine. In this case series, three patients from different age groups are presented, the first one being a 38-year-old female with a diagnosis of paranoid schizophrenia, the second one was a 26-year-old male with the obsessive compulsive disorder (OCD)- washer type, and the third one was a 62-year-old female with dementia all of whom developed signs of EPS like dystonia, bradykinesia and tremors following the introduction of clomipramine. In all the patients, the drug was stopped and the patients were cured. This case series stresses that a clinician should be cautious about the possibility of extrapyramidal side effects while using the TCA Clomipramine which is commonly known for its anticholinergic side effects.

Wilsons Disease also known as hepatolenticular degeneration is a autosomal recessive disorder, characterized by abnormal copper deposition in the liver, brain, and other tissues caused by mutation in the copper transporting gene ATP7B. Patients presents with neurological and hepatic disorder. Psychiatric manifestation are common along with movement disorder but its association with paraphilic disorders like zoophilia is very rare and there is practically no literature regarding this in North-Eatern India. In this article we report the unique case of a 21 year old boy from rural Assam suffering from Wilson's disease with multiple neuropsychiatric manifestations among which zoophilia was noteworthy. This case report highlights a rare and atypical association between an adolescent patient of Wilson disease & zoophilia-a relatively rare paraphilic disorder. A 21 year old boy presented in the Psychiatry emergency department in a tertiary care hospital with aggressive, disorganized behavior with reported sexual act with a cow. Examination of the patient also revealed massive organomegaly and K-F ring which on further investigation confirmed the diagnosis of Wilsons Disease. The occurrence of zoophilic behavior in Wilsons disease is very rare and we have not come across any such report regarding this. To conclude, the association between copper deposition in specific brain areas due to Wilsons disease and zoophilic behaviour we need further studies with better investigative modalities, which will in turn help in drawing an individualise treatment plan.