Broken Heart Syndrome, also known as Takotsubo Syndrome (TS), is sudden and transient dysfunction of the left and/or right ventricle which often mimics Acute Coronary Syndrome (ACS). Japan was the first country to describe this syndrome in the 1990s, and since then it has received a lot of attention from researchers all around the world. Although TS was once thought to be a harmless condition, recent evidence suggests that it may be linked to serious complications and mortality on par with Acute Coronary Syndrome (ACS). The understanding of TS has evolved over the past few years. However, its exact etiology is still poorly understood. It can be classified into two main types: Primary and Secondary TS. Primary TS occurs when the symptoms of myocardial damage, which is typically preceded by emotional stress, are the reason for hospitalization. Secondary TS is seen in patients hospitalized for some other medical, surgical, obstetric, anesthetic, or psychiatric conditions, and the dysfunction develops as a secondary complication due to the activation of the sympathetic nervous system and the release of catecholamines. The etiopathogenesis is now proposed to include adrenergic hormones/stress, decreased estrogen levels, altered microcirculation, endothelial dysfunction, altered inflammatory response via cardiac macrophages, and disturbances in the brain-heart axis. The role of genetics in disease progression is becoming the focus of several upcoming studies. This review focuses on potential pathophysiological mechanisms for reversible myocardial dysfunction observed in TS, and comprehensively describes its epidemiology, clinical presentation, novel diagnostic biomarkers, and evolving principles of management. We advocate for more research into molecular mechanisms and promote the application of current evidence for precise individualized treatment.

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Background and objectiveThe coronavirus disease 2019 (COVID-19) pandemic has highlighted the shortcomings worldwide in terms of preparedness protocols related to epidemics. A key area of research that is evidently overlooked across the globe is the mental health of family caregivers taking care of patients with COVID-19. In light of this, this study aimed to engage in a comparative analysis between the two worst affected countries, India and the United States of America (USA), which differ considerably in their demography, socio-epidemiological factors, and health system efficiency. MethodsA cross-sectional study was conducted among 1,250 family caregivers of patients with COVID-19 in India and the USA to assess their stress, anxiety, and sleep disturbance levels using the 10-item Perceived Stress Scale (PSS-10), the 7-item Generalized Anxiety Disorder (GAD-7) scale, and the Pittsburgh Sleep Quality Index (PSQI), respectively. Psychological assessment questionnaires were administered through online mode, which gathered demographic information and responses on several self-reporting scales. The main outcome measures were self-reported ratings on PSS, GAD-7 scale, and PSQI. ResultsWe found that 75.4% of the family members of COVID-19 patients suffered from mental health issues. The scores of all three scales were higher in caregivers from the USA than in India, more evident and pronounced in caregivers of hospitalized patients. The test scores were statistically significant (p<0.05) indicating a negative impact of having a dependent member in the family, being married, being of younger age, and having a longer duration of COVID-19 infection. Vaccines were found to have a life-enhancing effect. ConclusionOur findings highlight that the mental health of family caregivers is an ignored aspect and must be addressed. We recommend the implementation of well-researched and appropriate legislation, treatment programs, and health policies that involve not only the patients but also their families.

The past few decades have seen a significant rise in pornography consumption. This has brought into existence a new behavioral addiction, addiction to internet pornography, which impacts the psycho-somatic health of the individuals and people around them. The accessibility, affordability, and anonymity of online pornography have fed the growing popularity of online pornography. The International Classification of Diseases (ICD-11) has included pornography in Compulsive Sexual Behavior Disorder with it being categorized as an impulse control disorder and not necessarily an addictive disorder. However, the recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) does not recognize a diagnosis of sexual addiction/compulsion (including internet pornography). Psychiatry remains an ever-evolving branch, and as the understanding evolves, the schools of thought change as well. The constantly evolving literature on behavioral addictions has helped the understanding that any source capable of stimulating the reward circuitry in an individual can become addictive. The stigma associated with behavioral addictions, particularly pornographic addiction, as well as a lack of awareness, contribute to under-reporting, making the reported cases just the tip of the iceberg. Addictions have been associated with various complications and other psychiatric phenomena. We describe a case of a 28-year-old male with mild features of obsessive-compulsive disorder (OCD) that took major shape with the advent of pornographic addiction. The patient was a known case of exam anxiety, panic attacks, auditory hallucinations, and mild obsessive and compulsive symptoms. However, with the death of his girlfriend's father, a breakup with his girlfriend, and coronavirus disease 2019 (COVID-19), he indulged in porn consumption which soon shifted to religious pornographic content leading to guilt with a fair insight. This later culminated in the aggravation of his OCD with repetitive cleaning activities. The patient was started on pharmacological and behavioral therapy and has responded well in follow-ups. In light of the special presentation of this case, we strongly recommend better reporting of such complications aiding in broadening the understanding of the spectrum of possible psychiatric impacts of pornographic consumption.

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