Fatal Suicidal Attempt by Deliberate Ingestion of Nicotine-containing Solution in Childhood-onset Depression Mediated through Internet Suicide Guideline: A Case Report.

Nicotine is one of the most easily accessible, commonly abused drugs worldwide and if taken in overdose can cause serious clinical presentation, including cardiac arrhythmias and neurotoxicity mediated through oxidative stress. Its toxicity though rare can cause sudden deaths by cardiovascular arrest, respiratory muscle paralysis, and/or central respiratory failure. Here, we describe a case of intentional fatal ingestion of nicotine sulfate decoction used as a mean for fatal suicidal attempt by a 15-year-old adolescent male who was suffering from childhood-onset depression since about 3 months. He developed drooling of saliva, syncopal attacks, paroxysmal episodes of hematemesis, abdominal pain, signs and symptoms of hypoxia, nonfatal atrial tachycardia, and encephalopathy after ingestion of heavy dose of nicotine-containing concoction; however, he recovered successfully within 24-48 hours without any significant cardiac, respiratory, or neurological deficits (except short-term verbal memory). Authors discussed the details of management and reasons behind the reversible encephalopathy and molecular mechanism of nicotine toxicity. HOW TO CITE THIS ARTICLE: Kamble A, Khairkar P, Kalantri SP, Babhulkar S. Fatal Suicidal Attempt by Deliberate Ingestion of Nicotine-containing Solution in Childhood-onset Depression Mediated through Internet Suicide Guideline: A Case Report. Indian J Crit Care Med 2020;24(8):719-721.

Impact of Spectral Severity of Alcoholism on Visual-Evoked Potentials: A Neuropsychiatric Perspective.

BACKGROUND: The deleterious effects of alcohol on the brain are replete in literature. Only a few neurophysiologic measures can pick up the neuronal dysfunctions, one of them being visual-evoked potential (VEP). A very limited amount of data exists on the progression of neural abnormalities related to the spectral severity of alcoholism. AIM OF THE STUDY: To evaluate the impact of spectral severity of alcoholism through VEP and to understand the emergence of any specific pattern or morphometric abnormalities related to alcohol-induced neuropsychiatric presentations. METHODOLOGY: A total of 90 cases were recruited in addition to 180 age- and sex-matched controls using purposive and random sampling. The Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version and Campbell Neuropsychiatric Inventory were used to evaluate alcohol disorders and its neuropsychiatric complications apart from the mandatory consultant-specific clinical evaluations of all the cases. Of 90 cases of alcohol dependence, 15 patients were currently abstinent for >6 months, 15 had alcohol intoxication, 15 had signs of alcohol withdrawal, 15 had physical complications, 15 had psychiatric comorbidity, and 15 had neurological complications such as epilepsy. VEP recordings were taken using an Evoked Potential Recorder (RMS EMG. EP MARK II) where the stimulus configuration consisted of transient pattern-reversal method in which a black and white checkerboard was generated full field. RESULTS: Mean age of cases was 37.71 ± 11.49 years compared to 39.43 ± 10.67 years in controls (range 18-65 years). VEP abnormalities comprising of prolonged latencies (62.5%) with a statistically significant difference (P < 0.001) from the healthy controls was observed in cases of alcohol withdrawal syndrome. Predominant amplitude reduction with normal latency was obtained in 37.5% cases of withdrawal. Severe VEP abnormalities, i.e., both latency delay and amplitude reduction, were found in 75% patients with psychiatric comorbidity, 66.67% patients with neurological complications, i.e., epilepsy, and 33.34% patients with physical complications. An explicit finding of prominent interocular differences was a prominent feature present in 25% of patients with complications.

Atypical waveform morphology in schizophrenia-visual evoked potential as a promising endophenotype.

BACKGROUND: Electrophysiological research has provided measures of dysfunction of visual pathway in schizophrenia through the use of visual evoked potential (VEP) as the neurophysiologic tool. OBJECTIVE: The main objective of this study is to examine the morphology and topography of VEP responses in schizophrenic patients and to explore the potentiality of VEP as an endophenotype. MATERIALS AND METHODS: The study included 20 patients of schizophrenia who were recruited from the outpatient and inpatient department of psychiatry of a tertiary care rural hospital. The patients were assessed by tools such as Positive and Negative Symptoms Assessment Scale and Clinical Global Impression Scale for Severity. Transient Pattern Reversal VEP recordings were taken using an Evoked Potential Recorder (RMS EMG EP MARK II), and it was a cross-sectional study. RESULTS: The mean age of patients was 45.95 ± 10.14 years in the range of 35-60 years. Qualitative analysis of VEP waveforms in people with schizophrenia was performed. Abnormal waveform morphology was observed in 14/20 (70%) of the study population and all of them were the chronic and severe cases. Six out of 15 (40%) showed lack of differentiation of the evoked complex so that the three waves (negative-positive-negative [NPN] complex) could not be identified. In 5 of 15 (33.33%) VEP records, a distinct altered waveform with extinguished second negative component of NPN complex was obtained. CONCLUSION: Qualitative morphometric findings of this study in terms of pattern-reversal VEP waveform abnormalities emerged as a tool to provide evidence of relationship for emerging as first potential biomarker for diagnosing schizophrenia.