Deepti Anbarasan

Normal Pressure Hydrocephalus Presenting as Othello Syndrome: Case Presentation and Review of the Literature

Normal pressure hydrocephalus (NPH), an obstruction in the normal flow of CSF through the subarachnoid space, typically presents with a classic “triad” of cognitive impairment, a gait disturbance, and urinary incontinence (1). The etiology of NPH includes subarachnoid spaceoccupying lesion or hemorrhage, chronic meningoencephalitis, changes following acute bacterial meningitis or spinal anesthesia, and carcinomatosis of the meninges (2). Usually, the underlying cause cannot be identified. Idiopathic NPH is clinically diagnosed in most patients during the sixth or seventh decade of life (3). The cognitive impairment in NPH most often manifests as subcortical dementia, though psychiatric and mood symptoms, most often depression, have been described. Most observations of psychiatric sequelae of NPH have been limited to case reports and have included frontal lobe symptoms such as apathy and akinetic mutism, as well as reports of mania, aggression, mood cycling, and psychosis (4–8). In this article, we report a case of NPH presenting as paranoid psychosis with delusional jealousy, otherwise known as the “Othello syndrome.” Case Presentation

Teaching “Global Mental Health:” Psychiatry Residency Directors’ Attitudes and Practices Regarding International Opportunities for Psychiatry Residents

ObjectiveThe authors surveyed Psychiatry Residency Training Directors’ (RTDs’) attitudes about the role and feasibility of international rotations during residency training.MethodA 21-question survey was electronically distributed that explored RTDs’ beliefs about the value, use, and availability of international clinical and research experiences during residency.ResultsOf 171 RTDs, 59 (34.5%) completed the survey; 83% of respondents rated the importance of global mental health education as 3- or- above on a scale of 1 (least important) to 5 (most important), but only 42% indicated that such opportunities were made available. The value of such opportunities was thought to lie primarily in professional development and cultural exposure, less so for enhancing core knowledge competencies. Obstacles to such opportunities included lack of accreditation, financial resources, and faculty/administrative support and supervision.ConclusionRTD respondents endorsed the value of international experiences during residency, but their availability and educational impact are not fully supported.

Somatic and cognitive domains of depression in an underserved region of Ecuador: some cultural considerations

Not enough research efforts on depression have been carried out up to now in Latin America. The knowledge that has resulted from research activities in the United States or Europe offers limited generalizability to other regions of the world, including Latin America. In the Andean highlands of Ecuador, we found very high rates of moderate and severe depressive symptoms, a finding that must be interpreted within its cultural context. Somatic manifestations of depression predominated over cognitive manifestations, and higher education level was protective against depression. These findings call for an appreciation of culturally-specific manifestations of depression and the social factors that influence them. These factors must be further studied in order to give them the deserved priority, allocate resources appropriately, and formulate innovative psychosocial interventions.

Sociocultural domains of depression among indigenous populations in Latin America.

Not enough research has been carried out on depression up to now in Latin America. The knowledge that has resulted from research activities in the USA or Europe offers limited generalizability to other regions of the world, including Latin America. In the Andean highlands of Ecuador, we found very high rates of moderate and severe depressive symptoms, a finding that must be interpreted within its cultural context. Somatic manifestations of depression predominated over cognitive manifestations, and higher education level was protective against depression. These findings call for an appreciation of culturally specific manifestations of depression and the social factors that influence them. These factors must be further studied in order to give them the deserved priority, allocate resources appropriately, and formulate innovative psychosocial interventions.

Acute exacerbation of multiple sclerosis presenting with facial metamorphopsia and palinopsia.

We discuss the case of a patient with a known history of relapsing–remitting multiple sclerosis (MS) who presented with the isolated complaint of altered visual perception in the absence of abnormalities on ophthalmological examination. To the best of the authors’ knowledge, this is the first documented case of both facial metamorphopsia and palinopsia occurring as the symptoms of demyelinating brain lesions consistent with an acute MS exacerbation. These symptoms appear to be related to active demyelination that either involved the optic radiations in the visual pathway or the visual association area in the temporo-occipital region of the left hemisphere.

Drug-induced leukoencephalopathy presenting as catatonia

We discuss the case of a 35-year-old woman who presented with thought impoverishment, disorganized behavior, and echolalia. The patients condition progressed to treatment-refractory catatonia. She was started on oral Coenzyme Q10 after magnetic resonance imaging of the brain showed findings consistent with drug-induced leukoencephalopathy (DIL). Following improvement, she acknowledged cocaine use that suggested a diagnosis of cocaine-induced leukoencephalopathy (CIL). This case report seeks to elucidate radiological and clinical features of DIL.

Laser ablation is effective for temporal lobe epilepsy with and without mesial temporal sclerosis if hippocampal seizure onsets are localized by stereoelectroencephalography

Selective laser amygdalohippocampotomy (SLAH) using magnetic resonance–guided laser interstitial thermal therapy (MRgLITT) is emerging as a treatment option for drug‐resistant mesial temporal lobe epilepsy (MTLE). SLAH is less invasive than open resection, but there are limited series reporting its safety and efficacy, particularly in patients without clear evidence of mesial temporal sclerosis (MTS).

Anton syndrome as a result of MS exacerbation

Visual anosognosia is the lack of awareness and denial of ones blindness. It is often referred to as Anton syndrome (AS), after one of the physicians who described the phenomenon of lacking insight into ones sensory deficit. There are limited numbers of case reports documenting the condition and many refer to the phenomenon in association with bilateral occipital infarcts. We describe a patient who developed visual anosognosia as a result of multiple sclerosis (MS).