Corticosteroids have been in use since the past five decades as anti-inflammatory and immunosuppressive drugs for the treatment of several pathologies such as asthma, allergy, rheumatoid arthritis, and dermatological disorders. Adverse effects include growth retardation in children, immunosuppression, hypertension, hyperglycemia, inhibition of wound repair, osteoporosis, metabolic disturbances, glaucoma, and cataracts. The psychiatric effects of steroids are due to the wide expression of Glucocorticoid Receptors in the brain, and their long-term modulation can lead to functional and anatomical alterations along with hippocampal dysfunction. In most cases, the psychiatric symptoms disappear on cessation of steroid therapy; others may require some form of therapeutic management. A search was conducted for clinically relevant articles from 1971 to 2016 by including the terms corticosteroids, mania, depression, psychosis and cognitive defects. About one-fifth of patients receiving high doses of corticosteroids develop psychiatric symptoms. These symptoms are observed to be dose-dependent and generally occur during the first few weeks of therapy. Lithium has a preventive as well as therapeutic role, while antipsychotics are reserved for high risk cases with predominant psychotic symptoms. Psychiatric effects of long term steroid therapy have become increasingly common nowadays due to long duration of treatment of many chronic respiratory and orthopedic illnesses. Reduction in the dose or complete discontinuation of steroid therapy has been proven beneficial in many patients. Among the therapeutic options, lithium has a definitive role, both in the prevention as well as treatment of psychiatric symptoms. Better co-ordination between the physician and psychiatrist can go a long way to improve the quality of life in these patients.
Cerebral malaria (CM) represents a deadly neurological complication associated with Plasmodium falciparum infection. It is defined as an unarousable coma or a deep level of unconsciousness in the presence of a P. falciparum parasitemia, the diagnosis confirmed after exclusion of other common causes of coma such as hypoglycemia, septicemia, metabolic derangements and bacterial and viral meningitis/encephalopathies. Mortality is high and some surviving patients sustain neuronal injury which manifests as long-term neuro-cognitive impairments. Microscopy of Giemsa-stained blood smears remains the gold standard for confirmation of malaria diagnosis. The purpose of this review was to summarize the updated knowledge on the disease, its presentation, complications and neurological sequelae and the presently available newer and experimental adjuvant therapies. For this review, a PubMed search was conducted for articles and case reports from 1968 to 2020 containing the keywords cerebral malaria, P. falciparum, neurological impairment, neurocognitive defects and artesunate combination therapy. The treatment includes specific antimalarial therapy, supportive therapy for multi-organ dysfunction and management of associated complications. Prompt and rapid stabilization of the patient, adequate fluid supplementation and correction of electrolyte imbalance remain the most vital supplementary interventions in these cases, along with early induction of primary parenteral antimalarial therapy in the form of artemisinin based combination therapy (ACT) or quinine. Neurological sequelae including seizures are frequently observed in many treated and recovered cases, with some patients having to endure long term neurocognitive defects.
Bipolar disorder is a mental illness that causes serious disabilities in both social and work function. The occurrence of this disorder in children and adolescent age group has gained the attention of research workers since the 20th century. The varied clinical presentation of this disorder in comparison to the adult population, as well as the management approaches have been a matter of debate for ages. The aim of the study was to put forward the diagnostic and treatment approaches of bipolar disorder in children and adolescent.
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