Aim:To assess the incidence of cutaneous lesion in bipolar affective disorder (BPAD) patients on lithium therapy. To evaluate the relationship between duration of lithium therapy, dosage of lithium, serum lithium level, and cutaneous lesions. To assess whether reduction/stoppage of dose of lithium has any change in the course of cutaneous side effects. To look for a relationship between addition of isotretinoin and the course of mood disorder.Methodology:We retrospectively collected hospital case records of 125 consecutive BPAD patients initiated lithium therapy, assessed with inclusion and exclusion criteria. We follow up them for 2½ years for the assessment of above said aims.Results:The prevalence of skin reaction in BPAD patients with lithium therapy was 19.8%. Among patients on lithium therapy, cutaneous lesion emerged in initial 6 months and later after 1 year of treatment. Nearly 55% of patients on higher doses of lithium (1200 mg) had a cutaneous lesion. Patient on therapeutic serum level of lithium had a higher incidence of skin lesion. Out of six patients in whom dosage of lithium was reduced, three of them had reduced lesions (P = 0.6), in two patients, skin lesion increased, and one patient had no change. Among 11 patients treated with isotretinoin, only two patients had emergence of depressive symptoms.Conclusion:Lithium continues to increase the incidence of multiple cutaneous lesions among BPAD patients on lithium therapy. Incidence of cutaneous side effects directly correlates with the dose of lithium and therapeutic range of serum lithium level. Altering the dose of lithium does not statistically influence the cutaneous lesion.

Psychiatric disorders are common consequences of traumatic brain injury (TBI). But organic bipolar disorder is a rare entity when compared with other disorders. Here, we report this 49 year old patient with bipolar affective disorder following traumatic brain injury, its presentation and management. Though the pathophysiology of this disorder involves the interaction of factors that precede trauma (eg, genetic vulnerability and previous psychiatric history), factors that pertain to the traumatic injury itself (eg, type, extent, and location of brain damage), in our patient it showed an atypical presentation.

Background: Hypothyroidism is one the etiology of emerging psychiatric illness. The present study is an attempt to find out the incidence of psychiatric morbidity in drug-naïve hypothyroid patients and to find the correlation between patient’s sociodemographic variable, symptom duration, varying thyroid profile, subtype of hypothyroidism and psychiatric morbidity. Materials and Methods: This is a case-control study. The sample in this study consists of 75 hypothyroid patient and 75 euthyroid patients from Endocrinology out-patient department, matched for age and sex, after obtaining informed consent. Results: There was no statistical difference between cases and controls, with regard to sociodemographic variables. The psychiatric morbidity in hypothyroid patients is higher than euthyroid population (χ2 =32.9, p=0.001). The incidence and severity of depression (I – χ2=7.29, p=0.004), (severity- χ2 =10.42, p=0.02), anxiety (I- χ2 =3.84, p=0.05), (severity- χ2 =4.81, p=0.03) and cognitive impairment (I- χ2 =10..9, p=0.001), (severity- χ2 =13.04, p=0.001) are higher in hypothyroid patient when compared with controls. But the incidence of Psychosis is not statistically significant between groups. Among hypothyroid patients various parameters like symptom duration, varying thyroid profile and subtype of hypothyroidism did not reveal any significant statistical difference between patients with and without psychiatric morbidity. Conclusion: Incidence and severity of psychiatric morbidity in hypothyroid patients is higher than euthyroid population in our study. Hypothyroidism is one of the reversible etiologies of psychiatry disorder which is most often overlooked. Early diagnosis and treatment of hypothyroidism may alter the course of psychiatric illness and reduce the morbidity of these illnesses among patients.

Objective: To study the correlation between severity of depression and the quality of sleep disturbances in patients with non psychotic depression. Method: A cross-sectional study of a cohort of 30 outpatient sample with non psychotic depression were recruited for the study. Controls were the accompanying relatives of the patients. Study was conducted at a government hospital in Tamil Nadu, South India. Inclusion criteria in the study group required fulfillment of ICD 10 criteria for major depressive disorder. Patients who were 18yrs of age and above and both male and female genders were included in the study. Both study and control groups were administered the Pittsburg Sleep Quality Index (PSQI) and the Epworth sleepiness scale to measure the quality of sleep disturbances in the sample. Correlation between HAMD depression severity and the PSQI sleep quality scores and the Epworth sleepiness scale scores in the depressive patients and the correlation between nocturnal sleep disturbances and day-time sleepiness among depressed patients were analyzed using Pearson correlation coefficient. Results: Analysis revealed significant inverse correlation between the severity of depression and components of quality of sleep such as subjective sleep quality, total sleep duration and habitual sleep efficiency and positive correlation with sleep latency. Conclusions: Study shows that as the severity of depression increases the severity of sleep disturbances also increases which also was significant when compared with the various components of sleep quality on the PSQI scale.