Galactorrhea is defined as non-puerperal lactation and frequently occurs as an adverse drug reaction due to typical antipsychotics. Furthermore antidepressants, especially SSRIs, cause galactorrhea since the introduction of imipramine to psychiatry practice. Although galactorrhea ususally accompany increased prolactin levels, in some cases prolactin levels could be in normal range. To date there are two case reports of normoprolactinemic galactorrhea due to sertraline and here we report a patient who developed normoprolactinemic galactorrhea 1 month after initiating sertraline 50 mg/day.

Communication deficits resulting from aphasia can negatively impact stroke survivors’ social life. It has been reported that patients with severe non-fluent aphasia are better at singing lyrics than speaking the same words. Based on lesion studies, it is generally proposed that the right hemisphere is dominant especially for melody production. We present a 28-year-old woman with non-fluent aphasia as the result of a left hemisphere ischemic stroke involving mainly the superior division of the middle cerebral artery, and classified as having Broca’s aphasia. She was taken into melodic intonation therapy with speech therapy. Singing is accessible and enjoyable for many people with aphasia and melodic intonation therapies may facilitate recovery in such non-fluent aphasic patients.

Objective: To demonstrate the efficacy of EMDR in complex multiple psychological trauma after failed drug treatment from selective serotonin reuptake inhibitor (SSRI) in a diagnosed case of post traumatic stress disorder (PTSD). Material and method: Single participant of this case study, a sitting session judge of judicial governmental scaffold reported to this mental health tertiary care facility at his own accord with features of intense anxiety, depression, maladjustment issues and posttraumatic stress for a duration of several months. As a partial responder to full trial of SSRI he was enrolled for EMDR therapy to address his symptoms of intense anxiety, panic attacks, being overwhelmingly fearful, depressed, low self-esteem, inappropriate feelings of guilt, flashbacks, avoidance, nightmares, hyper-arousal and inability to perform as a judicial head in active war stricken area of northern Pakistan. Complete psychiatric evaluation was carried out and after the discontinuation of SSRIs he was scored on Impact of Event Scale (IES). He fulfilled the diagnostic criteria for PTSD as evaluated by the English version of the PTSD module of the Structured Clinical Interview for DSM-IV administered once before commencement of EMDR. Safe place of the client was established and 8 staged protocol of EMDR was started with him. Multiple EMDR sessions were conducted. Result: The case presented in this paper had multiple psychological trauma forms and failed drug treatment and yet it was observed that EMDR provided marked improvement in all the domains of his deficits and this was at a prompt speed as compared to cognitive behavioural therapy (CBT) which usually takes longer duration of therapy to achieve similar results. Conclusion: EMDR provides marked improvement in all domains of complex mental trauma and traumatic memories. Improvement attained was prompt and enduring as compared to other forms of established therapies and drug treatment indicating permanent changes happening at neurobiological levels of brain.

Peripheric edema could be caused by various medical conditions as well as pharmacologic agents such as antihypertensives, nonsteroidal antiinflamatory drugs, endocrine agents and immunotherapies. Olanzapine is an atypical antipsychotic that is widely prescribed for the treatment of schizophrenia and bipolar affective disorder. Most common adverse reactions of olanzapine are weight gain, postural hypotension, constipation, dizziness, akathisia, sedation. Peripheral edema was reported as an infrequent side effect, which affected 3% of the olanzapine treated patients. In this report, we aim to draw attention of psychiatrists on this rare adverse effect by presenting a 56-year-old case, who applied to our hospital with severe depressive and obsessive-compulsive symptoms and hospitalized because of suicide risk. Before psychiatric admission, he wasn’t taking any medication. He was diagnosed as major depression with psychotic features and obsessive-compulsive disorder. He was started on olanzapine 10 mg/day, quetiapine 300 mg/day and fluoxetine 40 mg/day. Two weeks after initiation of olanzapine, he was found to have bilateral pedal edema without ulceration and temperature change but minimal redness was observed. He had no history suggestive of cardiac, renal and liver dysfunction or allergic reaction against to any drug that could explain his existing edema. Possible medical conditions which may cause edema were ruled out by laboratory tests and physical examination. Olanzapine was stopped immediately and the therapy was modified to risperidone 1 mg/day. After discontinuation of olanzapine, edema was gradually resolved within two weeks. Because olanzapine associated edema has been seen rarely, it could be overlooked by psychiatrists in comparison to its more common side effects. Although it shows self-limited and benign course, patients may feel discomfort and their compliance to treatment may decrease. Also, it may interfere with differential diagnosis of other medical conditions which may cause edema. In conclusion, we suggest that patients should be observed carefully for edema during olanzapine treatment.

Rabies is a tropical zoonotic disease, transmitted to human being by carnivorous animals. Majority of human rabies cases were reported from Asia and African countries. India recorded more deaths from rabies than any other country in the world. There is no effective treatment for rabies; it can only be prevented by vaccination. It needs multiple levels of interventions at human and animal level. World Health Organization’s target is to eliminate the disease by 2020 in endemic South-East Asian countries which include India. Key challenges in control of rabies in India are lack of intersectoral coordination, weak surveillance system on rabies, inadequate rabies research and lack of sustainability. To conclude, breaking the rabies cycle in a sustained manner is necessary to eliminate rabies from this part of the world.

Clinical lycanthropy is defined as a rare psychiatric syndrome that involves a delusion that the affected person can transform into, has transformed into, or is a non-human animal. Its name is connected to the mythical supranatural stories of lycanthropy, in which humans are said to physically shape shift into wolves. According to suggested diagnostic criteria for lycanthropy, either a delusional belief in current or past transformation or behavior that suggests a person thinks of himself as transformed is considered evidence of clinical lycanthropy. Hereby we present a case of clinical lycanthropy in a male patient reporting moments of feeling himself as a wolf and behaving in a manner that resembles wolf behavior, for example howling and growling.

Patients with anxiety spectrum disorders are a highly heterogeneous group, requiring new therapeutic strategies and individualized treatment monitoring. Today, there is a growing interest for implementing biological approaches to clinical practice in psychiatry. Quantitative EEG is an excellent tool in this regard, though it has been widely underestimated when compared to recent neuroimaging techniques. In this case series, we presented four cases with a different diagnosis of anxiety spectrum disorder and evaluated their qEEG changes before and after the treatment. In addition, we also calculated the so-called EEG cordance values as an index of cerebral perfusion and cingulate cortex activity. According to the results, there appears to be an increase in the frontal beta and theta band in our cases, which has responded to treatment. In regards to the cordance values, we found that there was a reduction in the prefrontal regions up to %38 percent following the treatment. Based on previous studies, this may also indirectly suggest reduction in the cingulate cortex activity. The possible implications of these findings were discussed. Taken together, this case series highlighted the potential use of qEEG power values, normative z-scores and cordance values in treatment response monitoring of anxiety spectrum disorders.

Creutzfeldt Jakob Disease is an incurable and invariably fatal degenerative brain disease. Sporadic and variant forms of the disease can be observed among patients. We report on a patient for calling attention to clinical features and laboratory findings of CreutzfeldtJakob Disease and the psychiatric prodromal symptoms. This case demonstrates that psychiatric symptoms may also be a presenting symptom of Creutzfeldt-Jakob Disease and this diagnosis should be considered when rapid deterioration in cognition is observed with presence of psychiatric and neurological symptoms.

Trichotillomania is a psychiatric disorder that involves repetitive hair pulling to the point of apparent loss. No approved treatment algorithm is available for trichotillomania. We present a case report of a 28-year-old female diagnosed as trichotillomania, with complaints of recurrent hair pulling resulting in noticeable hair loss. She was treated with Habit Reversal Training and a selective serotonin reuptake inhibitor (sertraline) over a period of 6 weeks. Habit reversal training includes self-monitoring, awareness training, competing response training, and homework assignments. The aim of this case report is to provide a brief description of habit reversal training, which is unfamiliar to many professionals.