No abstract

Trichotillomania is a psychodermatological disorder characterized by an uncontrollable urge to pull one's own hair. It is often associated with depression and obsessive–compulsive disorder. We report five cases, a young male and four females, who presented with an increased desire to pluck out their hair, leading to large patches of baldness. Despite distinct forms of presentations and different comorbidities, the management more or less remained the same.

Aim: The aim is to study the quality of life (QoL) and disability in persons with alcohol dependence syndrome (ADS). Materials and Methods: This cross-sectional, analytical, case–control study in a tertiary hospital in a suburb of Maharashtra included 100 cases of ADS and equal number of age- and sex-matched healthy controls fulfilling the various inclusion and exclusion criteria. Results: The study revealed that individuals commonly initiate drinking alcohol between 20 and 30 years and first present to the hospital for seeking medical attention in the age group of 30–40 years after 10–12 years of drinking when they are moderately or severely dependent on alcohol. Alcohol dependence is associated with lower educational levels and lower levels of employment. Many have problems in their marital and intimate relations, making it difficult for them to stay in long-term relationships. As a consequence of their frequent aggressive and violent behaviors, they are more commonly involved in legal matters. Having a positive family history of alcohol dependence and familial psychiatric disorders makes them have a higher chance of developing alcohol dependence. As the number of years of drinking increases, so does the dependency level. Conclusion: Alcohol dependence is associated with lower QoL and higher levels of disability levels. The severity of alcohol dependence is inversely proportional to the QoL experienced by them and directly proportional to their disabilities.

Geophagia, a form of pica, is often associated with iron and zinc deficiency. However, a number of environmental, cultural, and psychological factors are also implicated. Pica in children is common with those having intellectual disability. In adults, it is most commonly associated with pregnancy. No specific screening tests for pica exist, but many nutritional and psychological complications can be avoided by accurate and timely diagnosis. Even when pica is diagnosed, no proven treatments exist. Two patients who reported to the psychiatry outpatient department with habit of eating nonnutritive substances for a prolonged period associated with apprehension and decreased appetite are reported. Both the patients were diagnosed with adult pica and were treated with selective serotonin-reuptake inhibitors and psychotherapy with considerable improvement.

Hepatic encephalopathy (HE) is an important and potentially life threatening complication in alcoholic patients with decompensated liver function that develop even as they continue drinking. Delirium tremens, on the other hand, is an acute condition resulting from alcohol abstinence in a person dependent on alcohol, making it a life threatening diagnosis that requires intensive care and successful management of the withdrawal. Often in medical wards, these two conditions are mistaken and so is the management plan confused with each other. Making the right diagnosis early on during the hospital course is extremely important in these critical conditions so as to make an appropriate schedule for treatment and a better outcome for the same. A case series of patients who presented with a diagnostic dilemma is reported. Clinical examinations, diagnostic tools to measure the levels of ammonia and liver function tests and hemogram, West Haven criteria and Child–Pugh grading, and clinical scales of these patients are reported. Increased levels of ammonia were present in all the cases. The subtle similarities in the presentation of the two conditions often make it confusing for the clinician to distinguish between them. Using a simple test of measuring ammonia levels in the blood helps in such situations. The detection of raised levels of ammonia in cases of chronic liver disease helps in not just the diagnosis but also is an important prognostic indicator for development of HE.