Progressive nonfluent aphasia is a slowly progressive degenerative disease characterized by atrophy in left hemisphere particularly frontotemporal. It is one of three subtypes of frontotemporal lobar degeneration (frontotemporal dementia). Unlike Alzheimer’s disease it begins between 45-65 years of age and occurs equally in both sexes usually. The reported youngest case was 21 years old. Atrophy is seen in the left hemisphere more in temporal lobe on magnetic resonance imaging. Approximately half of the cases have family history. In early it might confuse with depression and therefore diagnosis may be delayed. Brain magnetic resonance imaging is important for verification of diagnosis. In this paper, a case who early onset progressive nonfluent aphasia was mentioned.

In this report, we present a 51 year old postmenopausal woman with clinical presentation of “delusional disorder-somatic type” and also facial hirsutism and subclinical hypothyroidism. Blood tests revealed thyroid gland dysfunction with high TSH and anti-TPO levels but other blood tests and radiological investments were found to be normal. The relationship between thyroid dysfunction, hirsutism and psychosis is discussed in the context of this particular case. In presence of limited case reports in literature indicating a relationship with subclinical hypothyroidism and psychotic symptoms, we think that our case is important for reminding clinicians to consider endocrine disorders providing a basis for psychiatric disorders and to investigate thyroid function deficiency not only in patients with depression but with other psychiatric presentations like psychosis.

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 usually accompanies increased prolactin levels, in some cases prolactin levels could be within the 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.

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.