Psychosocial aspects of pregnant women living with diabetes.

A pregnant woman is exposed to a number of stress factors that can affect the pregnancy, maternal health and well-being of the foetus. Among these are the biological, social/environmental and psychological factors. The biological factors include medical condition of the pregnant woman, most notable is the gestational diabetes. The increased glucose levels can cause detrimental effect on the foetus and also cause maternal distress. This factor becomes more complicated if the woman is exposed to environmental stressors. The result is evident in the form of complications during pregnancy and psychological effects like depression and anxiety. Appropriate steps are important to address these issues in order to maintain the mother and prospective child\'s well-being.

Psychosis with Huntington's disease: role of antipsychotic medications.

This is a case of a 60-year-old man who presented with a 6-month history of increasing agitation and emotional volatility. His family brought him to the emergency room as they were concerned about his threatening and aggressive behaviour. The patient was initially incoherent and uncooperative. During the interview, the patient's family revealed that he had a previous diagnosis of Huntington's disease; there was also a family history of personality changes preceding Huntington's chorea. The patient was admitted to the psychiatric inpatient unit and started on low-dose risperidone. Consequently, there was marked improvement in his symptoms. Subsequent cognitive tests revealed deficits in multiple domains. After a month, the patient was discharged to a community home in stable state.

Acute psychosis with attention-deficit/hyperactivity disorder and oppositional-defiant disorder comorbidities.

This is a case of an 18-year-old boy who presented with his mother in the emergency room with a 1-week history of paranoia and bizarre behaviour. His comorbidities included attention-deficit/hyperactivity disorder, oppositional-defiant disorder and mild intellectual delay. At the emergency room he was incoherent, agitated and uncooperative. He was admitted to the psychiatric inpatient unit and treated with low-dose risperidone. The patient's symptoms improved markedly over a few days, although he remained restless and had episodes of agitation. Nursing staff was concerned about his behaviour and found him difficult to manage. However, after speaking to the patient's family, this was felt to be his baseline. After 11 days the patient was discharged home in stable state.

School refusal in adolescent young man: could this be an idiopathic amotivational syndrome?

This is the case of a 17-year-old male student who presented to an outpatient clinic with a 3-year episode of increasing anxiety and amotivation related to attending school. Initially affecting only his school work and attendance, the amotivation grew to affect his activities of daily living such as personal hygiene maintenance. There were no discernible psychosocial stressors. The patient did not report any bullying at school or any sort of abuse. At the time of presentation, there were also some depressive symptoms and visual perceptual abnormalities; both appeared subsequent to the amotivation. Escitalopram treated the depressive symptoms and risperidone minimised the perceptual disturbances; methylphenidate was not effective for this patient. The medications did not improve the patient's motivation. At the time of writing, the patient remained in stable state in terms of mood but unable to return to school.

Delusion or obsession: clinical dilemma.

BACKGROUND: A 52-year old lady presented for admission with severe depression characterised by suicidal ideation and delusional belief. CASE PRESENTATION: Her treatment regime was reviewed and modified. The dilemma was whether she suffered from a psychotic depression with delusion or an obsessional disorder. She responded well to change of antipsychotic medication. CONCLUSIONS: Her depression went in remission and her delusional belief decreased in intensity. She also gained reasonable insight into her problem. She is currently being followed up in the psychiatric outpatient clinic.

Efficacy of ECT in severe obsessive-compulsive disorder with Parkinson's disease.

A man in his 60's was admitted following a serious suicide attempt secondary to severe obsession with bowel movements and severe depression. He had multiple previous admissions with similar presentations and responded partially to psychotropic medications. It was transpired that obsessive compulsive disorder preceded depression and being overwhelmed with this obsession related to bowel movement, he decided to end his life. Electro-convulsive therapy was commenced with good results. His obsessive-compulsive disorder came under control to a greater extent and there was an improvement in his mood.

Obsessive compulsive disorder with psychosis NOS, in an asexual male: a diagnostic challenge.

A 28-year-old asexual Malaysian male presented for emergency assessment with suicidal thoughts, paranoid delusions and increasing time spent on ritualistic behaviours that included hand washing, door checking and religious chanting. His obsessions were primarily related to counting, perfectionism, contamination and chanting. The patient found himself compelled to complete numerous rituals including chanting religiously to 1000, having to restart in the event of an error during such and also described delusions of being followed by a woman who was analysing his life pattern in order to steal from him. He then started to proclaim himself to be Buddha as he believed this would keep his dead grandmother away from him, thus avoiding supposed persecution from her. Following optimisation of both escitalpram and olanzapine, a slight reduction in the patient's ritualistic behaviour and psychotic phenomenon were witnessed.

Karo-kari: a form of honour killing in pakistan.

Karo-Kari is a type of premeditated honour killing, which originated in rural and tribal areas of Sindh, Pakistan. The homicidal acts are primarily committed against women who are thought to have brought dishonour to their family by engaging in illicit pre-marital or extra-marital relations. In order to restore this honour, a male family member must kill the female in question. We conducted a systematic review of the published literature other sources on karo-kari and related forms of honour killing or violence against women. Media and non-governmental organization reports were utilized for case studies and analysis. Although legally proscribed, socio-cultural factors and gender role expectations have given legitimacy to karo-kari within some tribal communities. In addition to its persistence in areas of Pakistan, there is evidence that karo-kari may be increasing in incidence in other parts of the world in association with migration. Moreover, perpetrators of ;honour killings' often have motives outside of female adultery. Analysis of the socio-cultural and psycho-pathological factors associated with the practice of karo-kari can guide the development of prevention strategies.