Primary adrenal insufficiency rarely occurs due to infections, which consequently involves destruction or dysfunction of both adrenal cortices. Tuberculous adrenalitis is still a frequent cause of adrenal insufficiency in developing countries. We present the case of origin of multiple delusions along with recurrent spells of vomiting and giddiness in a patient with pulmonary tuberculosis (TB). A thorough medical history combined with a panel of biochemical and endocrine investigations revealed disseminated TB with choroid tubercles and adrenal infiltration leading to primary adrenal insufficiency. A diagnosis of organic delusional disorder secondary to disseminated TB-associated adrenal insufficiency was considered. The patient was managed with risperidone and antitubercular drugs. The psychosis improved and the patient was stable during the follow-up. The present case report adds to the literature on diagnostic challenges associated with psychosis due to adrenal insufficiency secondary to disseminated TB.

Resilience is considered an important factor in managing psychological adversities during pandemics. The recent COVID-19 pandemic has proven to be a test for the population, especially health-care workers (HCWs), for their resilience in coping with the pandemic situation. Multiple factors influence resilience among people, including the HCWs who have endured the pandemic, such as stress, social support, and burnout. The review involved a search for original articles assessing resilience and the impact of COVID-19 on resilience among general population and HCWs. Among the general population, resilience mediated the severity of depression, stress, and anxiety. A greater resilience was associated with increased physical activity, perceived social support, better sleep quality, quality of life, hopeful, and prayer-related activities. Further, being male, older, without mental health issues, having subjective well-being, and high identification with all humanity were associated with higher resilience. Apart from the general factors affecting resilience, the female gender, trainee doctors, those involved in treating COVID-19, prolonged working hours, and limited access to information in management have significantly impacted the resilience among HCWs. Physicians of clinical specialties, especially emergency medicine, experienced lower resilience levels. Similar to doctors, the female gender, long working hours, lack of social support, lack of adequate training and knowledge, and those involved in managing COVID-19 patients were found to impair resilience among nurses. Deficiencies in core training of medical trainees, academic pressure, preclinical training, female gender, testing positive for COVID-19, or having a family member with COVID-19 were associated with lower resilience among medical students. Higher levels of perceived self-efficacy, self-esteem, and involvement in frontline medical services positively effect on medical students. Among the coping strategies, increased physical activity, better sleep quality, and activities promoting self-awareness were found to improve resilience. Involving a mental health professional, using mindfulness-based therapies, availability of peer consultation and support groups, and enabling independent decision making among frontline HCWs can alleviate mental distress. Effective screening strategies and interventions to build resilience are warranted, especially in HCWs.

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