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Basal cell carcinoma masquerading as panic disorder Aabid Parvaiz, Abdul Majid SKIMS MCH, Srinagar, Jammu and Kashmir, India Background: Panic disorder is a common anxiety disorder that typically responds to pharmacological and psychotherapeutic interventions. In cases where symptoms are resistant to treatment, it is essential to reassess the diagnosis and evaluate for underlying medical or organic causes that may contribute to psychiatric manifestations. Case Description: A 45-year-old male smoker, normo-tensive, non-diabetic, and euthyroid, presented with a two-year history of recurrent panic attacks. Despite adequate trials of standard psychotropic medications, the patient showed no significant clinical improvement. Laboratory evaluation revealed elevated hemoglobin levels (17 g/dL), for which therapeutic phlebotomy was performed considering secondary polycythemia. However, this intervention did not alleviate his panic symptoms. During physical examination, a lesion was noted on the dorsum of the nose. A skin punch biopsy of the lesion confirmed basal cell carcinoma. The patient underwent wide local excision of the lesion. Outcome: Following surgical excision, the patient exhibited a drastic and immediate improvement in panic attacks, with marked reduction in both frequency and severity. Conclusion: This case highlights a possible association between basal cell carcinoma and treatment-resistant panic disorder, with complete resolution of symptoms following tumor excision. It underscores the importance of evaluating underlying medical conditions in refractory psychiatric presentations. Organic mood disorder secondary to frontal lobe infarct: A diagnostic challenge Aanchal Gupta NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India Background: Frontal lobe lesions may present with prominent disturbances in affect, speech, and behavior, often resembling primary psychiatric disorders. Right frontal lobe infarcts are particularly associated with apathy, reduced verbal output, impaired initiation, and mood changes. Recognizing such neuropsychiatric presentations is important for timely differentiation between organic and functional psychiatric conditions. Case Description: A 55-year-old male with poorly controlled diabetes mellitus presented with an abrupt episode of unawareness of his surroundings 15 days prior to evaluation. This was followed by persistent behavioral changes, including markedly decreased speech, low mood, reduced social interaction, diminished appetite, and prolonged periods of mutism. There was no previous psychiatric history. Mental status examination revealed apathy, blunted affect, psychomotor slowing, and deficits on frontal lobe tests such as impaired verbal fluency and difficulty in abstract thinking, while no focal motor deficits were observed. MRI brain demonstrated a subacute-on-chronic right frontal lobe infarct, consistent with his clinical presentation. Stroke management was initiated with antiplatelet therapy, statins, and glycemic optimization. A low-dose antidepressant was introduced along with psychoeducation. Gradual improvement in speech initiation and affective symptoms was noted on follow-up. Conclusion: This case underscores the importance of considering frontal lobe pathology in patients presenting with sudden-onset mutism, apathy, and depressive symptoms, particularly among individuals with vascular risk factors. Neuroimaging plays a crucial role in distinguishing organic neuropsychiatric syndromes from primary psychiatric disorders, enabling timely and appropriate management. Psychiatric sequelae of pituitary insufficiency: A case of psychosis in sheehan’s syndrome Aastha Priyadarshi, Shinjini Choudhury, Rajeev Ranjan AIIMS, Patna, Bihar, India Background: Sheehan’s syndrome, resulting from ischemic pituitary necrosis following severe postpartum haemorrhage, typically presents with features of hypopituitarism such as lactation failure, amenorrhea, hair loss, and generalized asthenia. Although endocrine and metabolic complications are well recognized, psychiatric manifestations, particularly psychosis, are rare and underreported. Case Report: This is a case of 35-year-old woman with no prior psychiatric history who developed amenorrhea and lactation failure after severe postpartum haemorrhage 15 years ago. Over time, she became socially withdrawn, suspicious that her husband was in an adulterous relationship, and develop persecution toward family members, with auditory hallucinations and somatic passivity experiences. She was later diagnosed with Sheehan’s syndrome but remained poorly adherent to hormone replacement therapy due to suspiciousness. Her psychotic symptoms progressively worsened, accompanied by generalized weakness, hair loss, edema, and recurrent hypoglycaemia. Previous trials of risperidone without concurrent hormone replacement yielded limited benefit. On current admission, she was restarted on both hormone replacement therapy and antipsychotics, leading to significant improvement in psychiatric and medical symptoms. Conclusion: This case underscores the complex interplay between endocrine and psychiatric manifestations in Sheehan’s syndrome. Psychosis may persist or worsen when hormone replacement and antipsychotics are given sequentially rather than concurrently, as seen in our patient. The progressive course may also be influenced by autoimmune mechanisms. Improvement following combined treatment highlights the importance of multidisciplinary approach for optimal outcomes. Key words: Hormone replacement therapy, hypopituitarism, postpartum haemorrhage, psychosis, Sheehan’s syndrome A case of temporal lobe epilepsy misdiagnosed as dementia – Insights from a complex clinical presentation Abhay Bazaz Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India Background: Temporal lobe epilepsy (TLE) is the most common focal epilepsy and often presents with cognitive, behavioural, and psychiatric symptoms that overlap with neurodegenerative disorders such as dementia. Atypical features such as deja vu, hallucinations, episodic confusion, and memory disturbance can complicate diagnosis and lead to misclassification as dementia. Aims: To highlight the diagnostic challenges in distinguishing TLE from dementia and to describe a case where episodic neurological and psychiatric symptoms initially attributed to dementia were more consistent with temporal lobe epilepsy. Methods: A detailed clinical evaluation and symptom analysis were performed on a 64 year old male with a prior diagnosis of dementia who presented with progressive forgetfulness, episodic confusion, sensory auras, transient loss of consciousness, and vivid dream-like experiences. The history and functional assessments were reviewed to differentiate between epileptic and neurodegenerative etiologies. Results: The patient exhibited recurrent, stereotyped episodes characterized by disorientation, repetitive questioning, brief unresponsiveness, which were preceded by a left-sided head sensation, which is more suggestive of focal seizures. Preservation of daily living skills and task sequencing argued against a dementia process. Psychiatric symptoms, including vivid hallucination-like dreams and suicidal ideation, further complicated the clinical picture but were consistent with TLE-associated behavioural disturbances. Conclusion: This case demonstrates how TLE can closely mimic dementia due to overlapping cognitive and behavioural symptoms. It highlights how these phenomena may be misdiagnosed in an OPD setting. A thorough, multidisciplinary approach is essential for accurate differentiation, preventing misdiagnosis, and ensuring appropriate management and patient safety. When pregnancy triggers psychosis: A case of first-trimester psychosis with somatic symptoms Abhay Bazaz Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, India Background: Psychosis arising in early pregnancy is uncommon and can be overlooked, particularly when accompanied by prominent somatic symptoms. Such presentations diagnostic challenges and can leading to pregnancy psychosis significant clinical Aims: To describe a case of first-trimester psychosis associated with severe somatic in a woman with psychiatric manifestations, and to highlight the importance of early and multidisciplinary Methods: A detailed clinical evaluation was for a presenting in her with somatic and psychotic symptoms. Medical psychiatric and of prior pregnancy were to the clinical and Results: to of the patient accompanied by auditory hallucinations, thinking, and impaired Medical and surgical no organic for her or psychiatric symptoms. revealed previous following first-trimester psychiatric Her somatic and psychotic consistent with a of psychiatric Conclusion: This case the complex between early somatic symptom and psychosis first-trimester psychiatric manifestations, in individuals with a history of is essential for timely risk and multidisciplinary of this presentation intervention and to psychiatric of in psychosis in patients to A Medical College and Hospital, India Background: psychosis in patients to symptoms often a where antipsychotics risk motor a a that this To evaluate the of in psychotic symptoms in patients risk of or Methods: A was in the of with psychotic disorders and were assessments and to assessments were were or tests to Results: the demonstrated improvement in psychotic and showed no significant and or were observed. Conclusion: showed but for of the particularly to improvement was not the and it may as a for patients in antipsychotics controlled are to of and these hallucinations in impaired Medical India Background: is characterized by complex hallucinations in individuals with significant hallucinations are the presentations sensory hallucinations and are but particularly in Such presentations lead to diagnostic with primary psychiatric or neurodegenerative disorders. Aims: To describe and presentations of in impaired individuals and to highlight associated diagnostic and therapeutic Methods: This case patients with significant secondary to pathology who presented with clinical evaluation neurological examination, where and cognitive Psychiatric on the of hallucinations, of and of were followed after initiation of Results: patients demonstrated cognitive with no of primary psychiatric or neurological patients exhibited complex hallucinations, while presented with auditory hallucinations following patient developed prominent Neuroimaging and neurological were in with low-dose risperidone in significant improvement and resolution of hallucinations, with no following Conclusion: cases the clinical of by and presentations. of such manifestations is crucial to and and clinical of metabolic syndrome in patients with anxiety A from India Medical India Background: disorders are psychiatric conditions associated with that may individuals to metabolic syndrome on this association in the To the of metabolic syndrome and clinical among patients with anxiety disorders in Methods: This was the of and Medical College and Hospital, from to A of diagnosed with anxiety disorders as were was the syndrome was diagnosed with and were and Results: The of was with syndrome was present in of while metabolic and later of and anxiety showed significant with Conclusion: A of patients with anxiety disorders metabolic syndrome or early metabolic metabolic and psychiatric metabolic are essential to outcomes. are to underlying and evaluate treatment When treatment the A rare case of psychosis of and India Background: and is a for Although it is to and with psychiatric cases of psychosis associated with in the of metabolic brain or prior psychiatric history. of the in in To highlight a case of psychosis and to diagnostic therapeutic Case A male patient with was initiated on exhibited speech, and The patient did not or neurological no psychiatric or history. Laboratory assessments were and MRI was were with low-dose the treatment psychiatric manifestations with the patient remained with no psychotic symptoms in the of The of symptoms after symptom resolution with antipsychotics, and symptom a significant The transient of the symptoms an organic Conclusion: This case highlights the psychiatric of and the for psychiatric evaluation in When A rare to in an patient with Medical India in individuals with presents diagnostic and therapeutic challenges due to symptom and limited the case of a woman with who presented with a two-year history of persistent and marked loss, in a of Following clinical a diagnosis of was of her was initiated to loss, and mood symptoms. days of treatment initiation, the patient developed a the and confirmed a of The manifestations with and the patient was with low-dose and resulting in and in without further This case underscores the importance of for rare in and highlights the for pharmacological when disorders in patients with syndrome in A neuropsychiatric AIIMS, India Background: syndrome is a rare but severe neuropsychiatric of replacement therapy in is and often misdiagnosed as a primary mood disorder, disorder, or This the and underscores to neuropsychiatric Aims: To a of and on the clinical risk and management of syndrome. Methods: A approach was were and were to The was from to Results: presents with of to and a marked by and Psychiatric manifestations psychosis, and with disorders. of male of of and prior psychiatric or history. of and impaired an is to and are and with Conclusion: an in with significant psychiatric is essential to misdiagnosis, and multidisciplinary management. behavioural and cognitive primary psychiatric disorder Medical Hospital, India Background: and in patients of epilepsy may be as primary psychiatric in who are can contribute to behavioural and cognitive leading to challenges in diagnosis and Case Description: A was for behavioural and a a year disorder with history episodes of for which on which were and the remained for years after and were therapy and task were in the and his to showed of to cognitive with history of a which showed in the of of were after which and with improvement. This case that contribute to behavioural disturbances and may be associated with cognitive in the of epilepsy. the of behavioural symptoms, cognitive deficits the of epileptic in the A case of Medical College and Madhya Pradesh, India and Aims: is the syndrome after a of who a of psychosis his A rare case of a male is who auditory hallucinations which to his The patient was diagnosed with On status examination, the patient was of of persecution and Methods: Psychiatric was to of and to against the of affective disorder or Conclusion: A diagnosis of was the of and given for the to of the was to the of was The patient was on and On the for the symptoms and were Key words: syndrome and the Santosh Medical Hospital, and India Background: is a in mood, and anxiety disorders. It is to low symptom risk due to low and However, rare cases of low particularly in patients on Aims: To a rare case of by low-dose in a patient on an and to underlying pharmacological and clinical Methods: describe a case a male with disorder who for year on and was for and Results: days after initiation, developed by and revealed with no neurological was and was resulting in complete symptom resolution The patient remained as the Conclusion: low-dose can transient by may further this when in patients on early and and treatment complete misdiagnosed as Medical India is a rare psychotic It is also syndrome. It can as a primary or be secondary to psychiatric or medical conditions. Case Report: A 55-year-old from the with of and on his that an was present his brain and that it from to time, symptoms were his daily and the patient a and was diagnosed with was but was no improvement. of was later to the Mental status examination showed a of Conclusion: is often diagnosed as skin or to by medical is important to diagnosis and in between and and in A of Mental and India Background: is of the most for disorder, but is limited by of and on of to and This the association between and and in and the with that of a Methods: This medical of years with disorder with for on concurrent medications, and Hormone and as well as or were were with an was to of and Results: In the risk of both and in both and reduced association with risk in the and but not in the Conclusion: patients exhibited risk for and when to the for with on in and levels in among with to of Medical India is crucial to is and underreported. loss of and which of A in due to The to and association in with Methods: This was a among with the of a psychiatric was the of and were standard in and in The were for Results: the was by impaired by impaired by by and by and were Conclusion: The highlights significant in among with and is a for skills among to it early for Key words: the of a case Medical College and India Background: is a and that presents diagnostic particularly when neuropsychiatric symptoms early in the Case A from presented with a history of progressive behavioral changes, cognitive hallucinations, and motor including and psychiatric evaluation to a diagnosis of psychotic However, the and of motor neurological evaluation. MRI revealed basal with showed and analysis demonstrated elevated with the diagnosis of Despite including the patient progressive neurological and cognitive consistent with the course of was initiated Conclusion: This case highlights the importance of clinical for in patients presenting with progressive dementia accompanied by neuropsychiatric and motor symptoms. diagnostic evaluation clinical and is crucial for accurate diagnosis and appropriate diagnostic and interventions. and in – A case analysis Santosh Medical College and Ghaziabad, Uttar Pradesh, Hospital, India Background: to between an and severe and functional In of and limited to and leading to This case the clinical of and in the and a of a patient. Case A as presented with and depressive symptoms with suicidal the of for the to family patient a male 15 years but by for after which most of her family evaluation confirmed for with severe and generalized the patient demonstrated marked improvement in mood, reduced and following but to a Conclusion: This case highlights how a of of by and of psychiatric symptoms. It also that early family and for individuals with in presentation of in a patient with a affective and to highlight the diagnostic challenges and to therapeutic Medical College and Hospital, Uttar Pradesh, India Background: is an psychomotor syndrome with and is characterized by motor and behavioural disturbances. To describe an presentation of in a patient with a affective and to highlight the diagnostic challenges and to therapeutic interventions. Case A male presented with history of recurrent with the current episode for following decreased motor repetitive speech, appetite, to episodes were consistent with with psychotic symptoms, to antipsychotics, mood and showed but not psychomotor decreased time, speech, and with and disturbances including and of was The patient was on Improvement in and motor and patient is on and with improvement. Conclusion: is an uncommon presentation and may complicate diagnosis and management. most patients to low-dose cases may improvement or therapy and treatment are crucial to of cognitive the cognitive in individuals with disorder treatment and Background: is associated with cognitive but are not well treatment and To the and of cognitive in severe disorder and to and Methods: male with severe underwent the after of and were no medical Results: was in and were most remained in possible syndrome. risk showed with in years cognitive deficits are common in severe particularly in and in and are to and from persistent Key words: disorder, cognitive cognitive cognitive A case on and episode psychosis in of India Background: disorders often from the of with is a that and psychiatric This is in for may for skills and as psychotic symptoms. To describe cases of psychosis following the role of limited social and in symptom and Methods: cases were in a and was and with on social and treatment Results: patients were male and without prior psychiatric or history. developed psychotic symptoms such as of and behavior, days of and on for of and Improvement on was and symptom Conclusion: This case underscores that with limited social and as a A approach including and family is disorder presenting as after Medical Uttar Pradesh, India Background: neurological symptom disorder can mimic particularly in where neurological deficits interventions. after for causes also be to Case following an a the and was in of During the such as weakness, a and were MRI of the brain and were and revealed and elevated anxiety were by the history. disorder was diagnosed on the clinical and the of the of brief and the patient in This case the importance of distinguishing functional neurological symptoms from in the setting. and anxiety can as neurological and early can surgical or diagnostic interventions. Conclusion: disorder be in the diagnosis of following when are with between and diagnostic and clinical outcomes. and A case in of of and of of Medical and Hospital, India an that and the between skin disorders and conditions can an while can or This to the complex interplay between and psychiatric conditions a of case the importance of an treatment case are a were to the underlying to the symptoms. Case A years old diagnosed with disorder exhibited improvement in symptoms with Case A with disorder showed with a of and behavioural Case A with significant improvement a of and behavioural The case underscores the importance of a multidisciplinary approach in conditions. and psychiatric can patient by both physical and on for these complex conditions and the of treatment The of Hospital, India Background: are rare but from in and In often symptoms are and may due to or of in this may a behavioural for underlying psychiatric or such as or where repetitive and impaired are timely may leading to and Case A presented with and a history of including and were psychiatric revealed with A multidisciplinary approach therapy, and further management. Case A presented with severe and confirmed a surgical Psychiatric evaluation with with and significant improvement in and Conclusion: cases highlight how somatic presentations may underlying psychiatric or conditions. is without psychiatric multidisciplinary and are essential to and Key words: A case with significant from concurrent of Medical Uttar Pradesh, India are to most is most is and a possible but can also diagnostic when both are To present cases of associated with and how concurrent Case Case A woman on developed progressive Case A on and developed to to complete resolution in Case A on and developed that after to Case A male on and developed was Case A on and developed were cases showed a temporal between initiation and Improvement after in patients a possible However, concurrent in most cases a and limited further Conclusion: is but not due to significant from for and assessments in patients When the frontal sequelae of of Medical Uttar Pradesh, India is to and functional brain changes, particularly the frontal leading to significant in and brain in psychiatric clinical Case Description: the case of a years male with a history of who presented with progressive behavioral including social and episodic depressive symptoms. Neuroimaging revealed frontal without focal a in and demonstrated deficits in and abstract This case highlights the neuropsychiatric of the of frontal brain to The behavioral and mood with the role of in the evaluation of and affective in including disorders and dementia are along with the for early and Conclusion: Frontal lobe due to can with prominent behavioral and mood disturbances. of in psychiatric can timely diagnosis and patient outcomes. The the Medical India This is the case of an from a She and presented with recurrent episodes of and for the She treatment from a primary surgical and medical and a She was to our and to with previous of disorder, and possible She with detailed and MRI and A detailed history and status examination revealed that she recurrent associated with depressive symptoms and She was on in the in the and The patient showed significant improvement a days and episodes of depressive symptoms, and disturbances. The patient the for the and no of or Her decreased from to Her and markedly This case highlights the importance of considering and in presenting with recurrent and and appropriate treatment with and are essential for of of in postpartum with diabetes mellitus – A Medical India Background: is a common metabolic disorder pregnancy and to particularly Despite clinical on among with To the of postpartum among diagnosed with and to associated and clinical Methods: A was among postpartum with confirmed after from a in and were a was with the a analysis tests and with Results: The of postpartum among with was family and a family history of diabetes were associated with confirmed these as of did not significant Conclusion: is a among with in limited reduced family and family history of diabetes and be postpartum for syndrome of hormone Medical India Background: is the most common and of patients with of the causes of a in patients when presenting with the the is rare and well with of is the common in and is To highlight with the case Case case of with with was on was days after initiation of the patient developed and with was was was were was status on and not on or brain was and to and Conclusion: The of was as is as an to antidepressant evaluation and be in patients with risk factors. The in – A of Medical Uttar Pradesh, India Background: is a with for and without cognitive or psychomotor It is as an for particularly in individuals To clinical of in and Methods: A was and for to and and A of were which were in the which as primary Results: clinical consistent and significant in and and and with limited in or and while showed significant to is Conclusion: to be a for and is with to and are Psychiatric manifestations of A case of Medical India are and disorders that are characterized by the common of in the may present with neuropsychiatric and behavioral symptoms, and lead to dementia. and This presents an case and diagnostic and clinical Case Description: a year old who was diagnosed with presented with low mood for the along with loss of in reduced to decreased severe in and She also history of psychotic in the Case There were severe depressive features in this patient that an diagnosis along with an MRI in of The patient was with therapy, behavioral and management on motor symptom cognitive and family daily Conclusion: with can be to a the of diagnosis that can be on a for the psychiatric manifestations, which the of treatment for such A case of presentation of Medical College and Hospital, Uttar Pradesh, India Background: is characterized by and symptoms, while are associated with are rare and To describe a rare presentation of recurrent generalized Case A male with a history of presented with symptoms including and along with a generalized on the of episodes previous on the of There was no history of head or neurological Laboratory including and tests were for elevated MRI brain and were not be performed due to The patient was with and and later initiated on and was in a Conclusion: Although can as a of particularly in of this uncommon presentation is essential to timely diagnosis and appropriate management and to to primary disorders or metabolic and of in analysis of a evaluation the India