Anorexia nervosa: An Indian perspective.

Anorexia nervosa is a condition thought to be associated with the western culture. However, the recent publication of a case series from Asia suggests that it is a syndrome related to a changing culture. We present a detailed clinical form of this syndrome based on descriptive analysis of 2 cases of anorexia nervosa. Both these patients were adolescent, school-going girls from middle socioeconomic class of urban background. They were pre-morbidly non-obese and did not have any pressures to pursue slimness for beauty. However, there was an identifiable psychosocial stressor as a precipitant in both of them. Both the patients had symptoms of refusal to eat followed by weight loss. We could not identify any risk factor in our patients for anorexia nervosa. Our report illustrates the differences in developmental and psychodynamic issues related to the development of anorexia nervosa, though the clinical symptoms may be similar.

Recurrent postictal depression with Cotard delusion.

Depression is a common occurrence among epileptic patients and constitutes, along with anxiety disorders, the most frequent psychiatric condition in these patients. However, little work is done in the area of post-ictal depression especially in children with epilepsy. Here, the authors report an adolescent boy who developed recurrent depression associated with Cotard's delusion following complex partial seizure at the age of 7 years. Trial of antidepressant drug and lithium worsened the clinical picture but ultimately he responded well to carbamazepine. This case is unique in its presentation due to recurrent depression itself is rare at this age and secondly rarity of onset of Cotard delusion in prepubertal phase. This case also showed that post-ictal depression is biological process rather than psychological and social reaction. Prompt identification and management of underlying cause would definitely prevent further complication and would also prevent the child from exposing unnecessary with various pharmacological treatments.

Bulimia nervosa.

Although there is a lot of information coming up to explain the pathogenesis of anorexia nervosa, yet little is know about bulimia nervosa in Indian literature. This case report highlights the typical presentation of a case of bulimia nervosa in an adolescent girl, where bulimia symptoms were preceded by anorexic behavior. Our case showed clinical similarity with the diagnostic criteria of the available classification system. The absence of self-evaluation for body weight and shape in this case be explained on the basis of cultural factors. To some extent, initial anorexic behavior could have played a role in etiopathogenesis of bulimia nervosa.