Clonidine for ADHD with Comorbid Oppositional Defiant Disorder in a Patient with Congenital Long QT Syndrome

Amantadine-Responsive, Benzodiazepine-Resistant Catatonia in an Adolescent With Autism Spectrum Disorder.

BACKGROUND Catatonia is a severe neuropsychiatric syndrome increasingly recognized in autism spectrum disorder (ASD), where symptom overlap can delay diagnosis. In pediatric populations, it is associated with significant morbidity and requires prompt intervention. Benzodiazepines and electroconvulsive therapy (ECT) are first-line treatments; however, access to ECT may be limited due to legal or institutional constraints. Alternative pharmacological strategies, including N-methyl-D-aspartate (NMDA) receptor antagonists such as amantadine, have been proposed, although evidence remains limited. CASE PRESENTATION We report a 15-year-old male with ASD who developed progressive catatonia over 1 year, with psychomotor slowing, speech latency, staring, and functional decline requiring hospitalization. Symptoms emerged after using over-the-counter supplements and partially improved after discontinuation. Medical and neurological workup was unremarkable. A lorazepam challenge produced partial improvement, but high-dose benzodiazepines were insufficient. Due to lack of access to ECT, amantadine was initiated and titrated to 200 mg twice daily. Within days, the patient showed marked improvement, including increased speech output, improved psychomotor activity, and enhanced social engagement. Improvement was supported by clinical observations and caregiver reports. DISCUSSION Catatonia involves dysfunction in dopaminergic (DA), GABAergic, and glutamatergic systems within cortico-striato-thalamo-cortical circuits. In ASD, similar abnormalities in excitatory-inhibitory balance and connectivity have been reported, which may partly explain the overlap in presentation and the potential vulnerability to catatonia. Amantadine may help restore this imbalance through NMDA receptor antagonism and DA modulation. CONCLUSION Amantadine may be a viable adjunctive treatment for benzodiazepine-insufficient catatonia in adolescents with ASD when lorazepam is insufficient or poorly tolerated and ECT is unavailable. Further research is needed.

Role of Brahmi Ghrita in Attention-Deficit Hyperactivity Disorder (ADHD) - A case study

Background: Attention-deficit hyperactivity disorder (ADHD) is a neuro developmental disorder of childhood characterised by inattention, hyperactivity, and impulsivity, leading to significant academic and social impairment. Conventional treatments in this condition is sparse, which have led to growing interest in integrative therapeutic approaches. Based on symptomatology, ADHD may be correlated with Unmada described in classical Ayurveda texts. The objective focuses on evaluating the effect Brahmi Ghrita on hyperactivity and inattention in the present case. Case details: An 8-year-old boy came to outpatient department with complaints of inattention, hyperactivity, and impulsivity since early childhood was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Ayurveda assessment indicated predominance of Vata and Pitta Dosha (bodily humors). The child was managed with Brahmi Ghrita for 60 days along with dietary restrictions and parental counselling. Follow-up assessments were conducted on the 15th, 30th, 45th, and 60th day. Clinical outcomes were evaluated using SWAN Rating Scale for ADHD before and after treatment. Results: At baseline, SWAN Rating Scale  score was sum of 10-18 is 8 and after treatment 6 and the child fulfilled 6 out of 9 criteria in both the inattention and hyperactivity-impulsivity domains of DSM-5. After 60 days of treatment, marked improvement was observed in all previously present symptoms across both domains. Improvements were noted in attention span, impulse control, hyperactivity, and overall behaviour, with better academic and social functioning. No adverse effects were reported during the treatment period. Conclusion: This case report suggests that Ayurveda management with Brahmi Ghrita, along with dietary modification and parental counselling, may be beneficial in improving symptoms of inattention and hyperactivity in children with ADHD. The observed clinical improvement highlights the potential role of Medhya Rasayana formulations as a supportive and integrative approach in the holistic management of ADHD.

Possible Cognitive Dysfunction Associated With High‐Dose Fluoxetine in a Patient on Lithium

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, are widely prescribed medications. Fluoxetine is considered a first‐line pharmacological treatment for common psychiatric conditions such as anxiety, depression, and obsessive–compulsive disorder (OCD). In large clinical trials, fluoxetine has consistently demonstrated a strong safety and tolerability profile over the past 30 years. This case describes a 36‐year‐old Caucasian female with a history of autism spectrum disorder (ASD) and bipolar I disorder treated with lithium, who developed new‐onset cognitive dysfunction following the up‐titration of fluoxetine. Her fluoxetine dose was gradually titrated to 80 mg/day over several weeks, in accordance with dosing guidelines. At that dose, she began experiencing progressive memory loss and confusion, ultimately requiring hospitalization. Extensive evaluation ruled out other potential psychiatric or medical causes of cognitive decline. Upon discontinuation of fluoxetine and reduction of her longstanding lithium dose, her cognitive function improved after 2 weeks and returned to baseline within 4 weeks. While SSRIs are generally well‐tolerated compared to other antidepressant classes, isolated reports suggest fluoxetine may be associated with reversible memory impairment in certain populations. This is the first documented case of reversible memory loss requiring hospitalization associated with fluoxetine in a middle‐aged adult with complex comorbid psychiatric conditions—a demographic frequently prescribed this medication. When prescribing fluoxetine to patients with comorbid psychiatric conditions on lithium, clinicians may consider slow titration and proactive cognitive monitoring.

Three Adult Cases of ADHD With Comorbid Tic Symptoms Successfully Treated With Guanfacine Monotherapy

ABSTRACT Tic disorders typically begin in childhood and often improve by adulthood, but some individuals continue to experience tic symptoms into adult life. Tic disorders frequently co‐occur with Attention‐deficit/hyperactivity disorder (ADHD), and in such cases α2‐adrenergic agonists are recommended as a treatment as they can address both conditions. However, evidence in adults with ADHD and comorbid tic disorders is limited, as most studies have focused on pediatric populations. Here, we present three adult male patients with childhood‐onset ADHD and chronic tic symptoms who showed a rapid and significant improvement in tics with low‐dose extended‐release guanfacine (GXR) monotherapy. These cases suggest that GXR can effectively treat both ADHD and tic symptoms in adults—a finding that has not been well documented in prior adult studies.

Treatment of obesity with liraglutide in bipolar disorder: a case report

Bipolar disorder (BD) is a chronic, severe mental illness frequently complicated by metabolic disturbances such as obesity, insulin resistance and dyslipidaemia. We report the case of a 57-year-old man with Bipolar I Disorder and class III obesity (BMI 47.7 Kg/m²) whose mood episodes were tightly linked to weight fluctuations. patients’ psychiatric history began in 1986 with a manic episode and recurrent depressive and manic relapses over nearly four decades, often provoked by weight‐loss attempts. In February 2024, he was admitted for initiation of liraglutide under close psychiatric monitoring, given prior episodes of mania triggered by dietary interventions. At baseline, he exhibited moderate illness severity (CGI = 4), insulin resistance (HOMA-IR = 6.19), dyslipidaemia and sedentary habits. Liraglutide was titrated from 0.6 mg to 1.8 mg over three weeks. During the weight-loss intervention, and temporally after liraglutide titration to 1.8 mg/day, he developed a manic episode (YMRS = 30), prompting an increase in risperidone and addition of gabapentin alongside continuation of mood stabilizers. His manic symptoms remitted within one week, allowing discharge with liraglutide 1.8 mg, risperidone 3 mg, valproic acid and lamotrigine. Over subsequent outpatient follow-up at the target liraglutide dose (3 mg/day), he lost 6.5 kg more (total Δ weight = − 7 kg), his HOMA-IR improved to 5.78 and glycemic and lipid parameters stabilized without further mood destabilization. This case illustrates the bidirectional interplay between metabolic regulation and mood stability in BD, highlights the need for close psychiatric monitoring during structured weight-loss interventions in clinically vulnerable patients, and supports integrated multidisciplinary care when initiating anti-obesity treatments in patients with severe mental illness.

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