Rare case report of Van Gogh syndrome in a patient with paranoid schizophrenia

Self-mutilation is often associated with psychiatric disorders.We describe here a 22-year-old male Indian with decreased sleep,aggressive behaviour,self-muttering,disorganised behaviour,frequent spitting,biting and selfmutilation;he bit off his right ring finger and left thumb(Van Gogh syndrome).Self-harm behaviour was frequently evidenced by family members resulting in various injuries.The patient was diagnosed with paranoid schizophrenia and was treated with anti-psychotics which resulted in a decrease in his behavioural disturbances along with treatment for his self-mutilation injuries.Here we discuss Van Gogh syndrome’s presentation of self-mutilation in paranoid schizophrenia and its implications.

Pattern/clinical and demographic profile of inpatient psychiatry referrals in a tertiary care teaching hospital:a descriptive study

Background Consultation liaison psychiatry(CLP)as a subspecialty is defined as the area of clinical psychiatry that encompasses clinical understanding,teaching and research activities of psychiatrists and allied health professionals in the non-psychiatric divisions of a general hospital.Psychiatric comorbidity of inpatients in tertiary care hospitals is huge.However,the amount of research in India in the field of consultation liaison is strikingly low.Aim To investigate the sociodemographic profile and psychiatric and physical subtypes of illness in patients admitted in other departments and referred to psychiatry department.Methods The study population comprised all consecutive inpatients referred for psychiatric consultation from other departments of a multispecialty tertiary care teaching hospital over 3 months.In a semistructured proforma,sociodemographic profile,referring departments,reasons for referral,referral rate,psychiatric diagnosis and physical illness diagnosis were recorded and analysed using descriptive statistics.Results 172 patients were included and assessed after referral from various departments,of which 56.4%were male and 43.6%were female.The mean age was about 33.95 years,with majority of the patients in the 21-30 years age group.The referral rate was 1.1%.The maximum referrals were from the medicine department,with abnormal behaviour(26.2%)being the most common reason for referral,followed by alleged suicide attempt or self-harm(24.4%),anxiety(10.5%),substance use(10%)and disorientation(7.6%).The most common psychiatric disorder among patients was depressive disorder(24.4%),followed by substance use disorder(19.7%),schizophrenia and psychotic disorder(9.3%),and stress and trauma-related disorder(8.1%).Conclusion There are very few psychiatry referrals and an alarmingly low referral rate,given the psychiatric morbidities in the medical setting.Psychiatry training should have more weightage across different medical specialties and liaison activities between psychiatry and other disciplines should be augmented,which can lead to a better understanding of psychiatric symptomatology,early symptom recognition,swift referral and ensuring follow-up,which,in turn,would be key to improving CLP services.

Acute oedema associated with risperidone use:a report

Risperidone acts by potent serotonergic,dopaminergic and alpha adrenergic receptor antagonism.The most common side effects reported are extrapyramidal symptoms,dizziness,sedation,insomnia,headache,anxiety,nausea,constipation and weight gain.Oedema associated with risperidone use is a rare side effect.Here we present a report on pedal oedema associated with use of oral risperidone 4 mg per day for acute-onset psychotic illness.Through this case report we want to make clinicians aware about this important side effect as it can affect patients*compliance and quality of life.