Published Research

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Attempted suicide is a serious problem requiring mental health interventions, but it continues to be treated as a criminal offence under the section 309 of Indian Penal Code. The article reviews the international legal perspective across various regions of the world, discusses the unintended consequences of section 309 IPC and highlights the need for decriminalization of attempted suicide in India. The Mental Health Care Bill, 2013, still under consideration in the Rajya Sabha (upper house), has proposed that attempted suicide should not be criminally prosecuted. Decriminalization of suicidal attempt will serve to cut down the undue stigma and avoid punishment in the aftermath of incident, and lead to a more accurate collection of suicide-related statistics. From a policy perspective, it will further emphasize the urgent need to develop a framework to deliver mental health services to all those who attempt suicide.

Keywords: Borderline Personality Disorder, Polycystic Ovarian Syndrome, Tourette syndrome

Background: Polycystic Ovarian Syndrome (PCOS) is a complex disorder characterized by infertility, hirsutism, obesity, metabolic syndrome and various menstrual disturbances due to elevated androgen levels. Borderline Personality Disorder patients are also known to have highercomorbid obesity, metabolic syndrome and disturbed androgen metabolism. To our knowledge, only one case control study has found association between Polycystic Ovarian Syndrome and Borderline Personality Disorder. So, there is intense need to report such association to have better understanding of etiopathogenesis of Borderline Personality Disorder. We report a case of Borderline Personality Disorder with a comorbid diagnosis of Polycystic Ovarian Syndrome and Tourette syndrome.

Methods: A 30 year old married female with history of menstrual irregularity at onset of puberty and subsequently diagnosed as PCOS at age 12. Later, she developed simple motor tics at 19 years of age and progressed to multiple motor tics and vocal tic by age of 24 years. She developed a pervasive pattern of instability of interpersonal relationships, self-image distortion, affect dysregulation and marked impulsivity by 22 years of age. She had recurrent gestures, threats, self-mutilating behavior, difficulty in controlling anger and transient anxiety spells. The patient was on regular OCP for PCOD. She was maintained on low dose of Aripiprazole and Fluoxetine for Tics and Anxiety spells. She was evaluated by MCMI3 and found to have higher scores for Borderline Personality Disorder. She responded well to regular behavior therapy. Her socio-occupational functioning markedly improved with the treatment in subsequent follow up.

Results: Elevated androgens in women with polycystic ovaries might have an impact on psychopathology leading to Borderline Personality Disorder. Relevant literature pertaining to association between Borderline Personality Disorder and Polycystic Ovarian Syndrome are reviewed and discussed in the report.

Conclusion: The present case report supports the clinical evidence of association between Borderline Personality Disorder and Polycystic Ovarian Syndrome.

Objectives: Low frequency (1 Hz) rTMS has been shown to inhibit cortical excitability and has been investigated as a potential therapeutic tool in tic disorders. Mixed results have been obtained in different studies with some studies showing promising results, whereas other studies have found no therapeutic effect. Here we report a young female who failed to have any beneficial effect.

Methods: A 12 year old female has developed motor tics since last two years. On evaluation her Yale Global Tic Severity Scale (YGTSS) score came out to be (46/100) and patient had received adequate trials of risperidone and pimozide and haloperidol. She was found to be also suffering from anxiety disorder. There was family H/O tic disorder in father and sister and OCD in cousin brother who was receiving treatment. All secondary causes of Tic disorders were ruled out.It was decided to be given a trial of low frequency rTMS after discussing all the treatment options with parents and after taking informed consent. The protocol designed was 1Hz, 110%MT, 900 pulses/session, total 20 sessions over 4 weeks to be given B/L over supplementary motor area. Assessment was done using YGTSS after 5 and 20 sessions. Side effects are routinely monitored with a check list as a treatment protocol.

Results: There was no significant improvement in the symptoms, the scores on YGTSS showed slight decline, with the final score being 40 without any significant side effect. Relevant clinical issues, related to our case and its failure to show therapeutic effect with low frequency rTMS are reviewed and discussed in the report.

Conclusion: rTMS is a non invasive brain stimulation technique which has shown some promise in treating patients with tic disorder but in our patient’s we failed to have any beneficial effect.

Objectives: Age-of-onset for Obsessive Compulsive disorderis not a unimodal phenomena. There are two distinguishable groups; early and late onset. Repetitive transcranial magnetic stimulation (rTMS) targeting the supplementary motor area seems to be efficacious for treating OCD, however little information is available about difference in efficacy in these two groups. Treatment of late onset OCD with Low-frequency rTMS has rarely been reported.

Methods: Here we report a case of 44 years old male with OC symptoms since last 4 years. The patient was treated with anti obsessional drugs in last 2 years with partial improvement but developed prominent side effects as constipation and postural hypotension which were tried to be managed but patient became non compliant to medication. From last year patient developed motor tics and phonic tic. The patient was tried on low dose antipsychotics with no improvement in either OC symptoms or Tics and had developed sedation as side effect. Secondary causes of OCD and Tic disorder was ruled out. It was decided to give a trial of rTMS. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 28/40 and Yale Global Tic Severity Score (YGTSS) was 42/100. The protocol designed was 1Hz, 110%MT, 900 pulses/session, total 20 sessions over 4 weeks to be given B/L over supplementary motor area.

Results: The patient reported improvement in both OC symptoms and decrease in TICS within a week of therapy and by the end of 20 sessions, YBOCS score was 14/40 and YGTSS score was 16/100. The patient was further followed up for another 3 months in which he maintained the improvement with addition of Fluoxetine. Low frequency rTMS normalize overactive motor cortical regions and thereby improve symptoms.

Conclusion: Low-frequency rTMS over the SMA appears to be effective treatment modality in late onset Obsessive compulsive disorder.

To read the file of this research, you can request a copy directly from the authors.

To read the file of this research, you can request a copy directly from the authors.

Meditation is believed to have many health benefits apart from enhancing spiritual health. However, there is evidence that meditation may even lead to psychosis or worsen it in some cases. The aim of this paper is to present a case and discuss the role of meditation as a precipitating factor to psychosis. A 27-year-old male presented with psychotic symptoms with a temporal correlation with meditation. He was then successfully treated with antipsychotic medication and is maintaining well. This case report highlights the possibility that intense meditation could precipitate psychosis in vulnerable individuals. However, there are several beneficial effects of meditation in patients with psychosis if practiced with caution.

To read the full-text of this research, you can request a copy directly from the authors.

To read the full-text of this research, you can request a copy directly from the authors.

To read the full-text of this research, you can request a copy directly from the authors.