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Senescence as a manifestation of Mirror Autoprosopometamorphopsia
- S. Kalita, D. Birwatkar, A. Hirsch
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S689
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Introduction
Obligate autoscopic mirror hallucinations of senescence have not heretofore been described.
ObjectivesTo reveal that perception of looking older in the mirror may be the manifestation of Mirror Autoprosopometamorphopsia.
MethodsA 37 year old right handed female, with schizoaffective disorder, bipolar subtype She described that when she would gaze at herself in the mirror, she would not see her current face, but rather the visage of an “old person”. This would recur whenever she would directly look at herself in the mirror, and would avoid glancing at any mirrors because she was fearful of looking at her transform senescent countenance. She realised it was not another person but rather herself in the future, having become her geriartric self.
ResultsAbnormalities in Physical Examination: Mental Status Examination: Hyperverbal, grandiose with expansive affect, poor insight and judgment. Recalls 3 out of 4 objects in 3 minutes and all 4 with reinforcement. Proverb testing: correct abstraction. Neuropsychiatric Testing: The Patient Health Questionnaire 9:7 (mild depression). Other: Magnetic Resonance Imaging/ Magnetic Resonance Angiography of Brain with Infusion: Normal.
ConclusionsAutoscopic mirror hallucinations appearing only when embedded in a mirror are obligate autoscopic mirror hallucinations and suggest occipital and parietal lobe dysfunction (Virk, 2018). The inability to recognize the perception of another image or another person replacing the individual looking in the mirror, while defined as a mirror sign, may also be viewed as “a capgras syndrome for the mirror image” (Feinberg, 2005). Distortion of one’s own face only when viewed in a mirror is autoprosopometamorphopsia. With such distortion, this may be a misidentification of one’s own image. This phenomenon is classified as a form of delusional misidentification syndrome with inability to recognise one’s image in the mirror (Postal, 2005). Autoprosopometamorphopsia, obligate to mirror reflection, but metamorphosized to enhance perceived senescence, has not been specifically localized. Possibly a single lesion in the non dominant inferior parietal lobe may have caused this phenomenon. Somatoparaphrenia with somatosensory illusions involving body image are seen with parietal lobe dysfunction (Nightingale, 1982). In the general population, an individual’s focus on a mild facial imperfection often is associated with a negative view of their image. Exaggeration of this to involve the entire face, with projection of imperfection of aging, may be a somatic manifestation of such negative self image. It is possible that such senescent autoprospometamorphopsia may be prevalent, to a lesser degree, in the general population and may be a nidus for younger people seeking cosmetic and plastic surgical intervention of the face.
Disclosure of InterestNone Declared
To Sleep Perchance to Dream - Not; Nyctophobia From COVID-19 Induced Hyposmia
- S. Kalita, D. Birwatkar, R. Cosme, A. Hirsch
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S807
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Introduction
Fear of sleep (nyctophobia), has been attributed to myriad conditions ranging from benign nocturnal panic attacks and Morvan’s syndrome (Ekambaram, 2021). Positional dependent hyposmia as an origin of nyctophobia has not heretofore been described.
ObjectivesIncrease awareness for correlation between nyctophobia and hyposmia in individuals with COVID-19.
MethodsThis 52-year-old woman presented with sudden onset of loss of smell and taste with COVID-19, which returned to 85% of normal. Five months prior to presentation she was reinfected with COVID-19, and her smell and taste dropped to 20-50% of normal which improved. However, her symptoms worsened when she would lie down, to 30% of normal, but would improve with standing, moving and sitting. Even reclining for a short nap caused her sense of smell to drop, requiring her to stand for hours before her sense of smell would return leading to her nyctophobia that forced her to move around all the time. She altered her lifestyle and assiduously avoided lying down. When so overwhelmed by tiredness she would sleep sitting up. Prior to her chemosensory problems she slept well without any fear of lying down or sleeping.
ResultsPsychiatric exam: speech: coherent, relevant without circumstantiality, normal pace and volume. Mood: normal. Oriented x 3. Able to remember 7 digits forward and 5 backwards. Able to recall 3/4 objects without reinforcement. Interpretation of similarities: normal. Proverbs: normal. Calculation: normal. Neuropsychiatric testing: Clock Drawing Test: 4/4 (normal). Animal Fluency Test: 22 (normal).
ConclusionsNyctophobia, fear of positional dependent loss of smell, highlights the importance of smell to narcissistic perception of self. More than just one of senses, olfaction is important for mood regulation, memories and quality of life. Associated with chemosensory dysfunction, this is associated with 96% incidence of DSM-IIIR Axis I or II diagnoses, with the most common Axis I diagnosis being generalized anxiety disorder and dysthymia (Hirsch, 1996). This can be understood that the olfactory lobe is anatomically part of limbic system (MacLean, 1973). Smell fascilitates socialisation as well as maintaining interelationships; sexual dysfunctioning is seen in 17% of the population with olfactory loss (Hirsch, 1998). Deposition of memory engrams are facilitated as manifest with olfactory evoked nostalgia seen in 84% of the general population (Hirsch, 1992). Quality of life is reduced in 68% of patients who demonstrate smell loss (Deems, 1991). The importance of smell is thus intrinsic to an individual’s wellbeing, and the threat of loss of such sensation with change in position with sleep, was the precipitating event leading to nyctophobia in this subject. Assessing for fear of loss of smell in those with nyctophobia, especially with past COVID-19 infection, allows for increased understanding of etiology and indicates potential treatment approaches.
Disclosure of InterestNone Declared
Bluetooth Hyperosmia: Chemosensory Variant of Delusional Somatic Symptom Disorder
- S. Kalita, D. Birwatkar, A. Hirsch
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S689-S690
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Introduction
Subjective hyperosmia, as a manifestation of belief of exposure to Bluetooth transmission, with testing demonstrating the absence of true hyperosmia, has not heretofore been described.
ObjectivesCorrelation of Bluetooth transmission with subjective hyperosmia.
MethodsThis 53-year-old right-handed single woman presented with a 10-year history of increase in sensitivity to aroma and enhanced perception of smells upon exposure to Wi-Fi electromagnetic radiation. She noted an intensity-duration effect: with higher intensity and duration of Wi-Fi exposure, her sense of smell would escalate and persist: after a few hours of exposure, her smell would jump to a 190% of normal and last for two weeks. When she drives toward a metropolitan area, she can feel that the Wi-Fi is more intense and gets an electrical sensation like “I am an antenna”. Because of this, she refuses to use a cell phone or have Wi-Fi in her home.
ResultsMental Status Examination: Able to recall 3 out of 4 objects in 3 minutes without reinforcement. Chemosensory Testing: Olfaction: Brief Smell Identification Test: 9 (normosmia). Alcohol Sniff Test: 8 (hyposmia). Gustation: Waterless Emperical Taste Test: brothy: 4/8 (hypogeusia), total: 46 (normogeusia).
ConclusionsNidus for such hyperosmic delusions may be a primary olfactory system disorder, with induction of ephaptic transmissions, causing intermittent phantosmia or otherwise misperceived odor, misattributed to the ambient environment. Paradoxically, such perceived hyperosmia may be due to a specific or isolated hyposmia or anosmia, the olfactory equivalent to monochromatic color blindness. The assignment of the source of the hyperosmia to that of Bluetooth is consistent with the zeitgeist of mistrust and paranoia of higher technology. Thus, the subjective hyperosmia would only occur when the patient perceives there was a kippage of radiation/ Bluetooth/ electromagnetic waves present, independent of these actually being present. This may be a form of expectation effect due to visual evidence (high tower wires); suggestion combined with subcultural group dynamics with belief in harm of such electromagnetic/Bluetooth waves, with distorted information recall and misattribution. Such group dynamics and shared misperceptions may act to fuel such a delusion as in the Mandela effect (French, 2018). This may represent the chemosensory equivalent of somatosensory amplification due to external intensification (Brascher, 2017). Perchance, this case represents not delusional hyperosmia, due to a functional psychiatric disorder, but rather has a neuroanatomic basis. Those with subjective hyperosmia and hypersensitivity to aromas have demonstrated hypertrophied gray matter volume in the posterior subregion of the right hippocampus, left precuneus, left superior frontal gyrus, and right hypothalamus (Han, 2020). In those with subjective hyperosmia, neurological investigation is warranted.
Disclosure of InterestNone Declared
Management of subjects with Intermittent Explosive Disorder and Autism Spectrum Disorder with Lumateperone
- N. Mehdiratta, S. Kalita, D. Birwatkar, A. Hirsch
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S583
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Introduction
Use of lumateperone in reduction of aggression in patients with both autism spectrum disorder and intermittent explosive disorder has not heretofore been described.
ObjectivesExplore the impact of lumateperone treatment for intermittent explosive disorder in autism spectrum disorder.
MethodsCase A: An illiterate non-verbal 18-year-old male, presented with history of behavior problems, developmental and intellectual delays. He attended special education programs at school where he had difficulty interacting with peers and teachers. For three weeks prior to presentation, he has displayed more anger and aggression, biting his hands, pounding on the walls and furniture, and screaming.
Case B: This 18-year-old male, presented with a history of hypsarrhythmia, Lennox-Gastaut syndrome, severe developmental delay, deficit in socializing with lack of interaction with others and autism, presented with aggression, agitation, and hostility, banging on walls and furniture and throwing objects. Coincident with this was an increase in frequency of myoclonic seizures occurring up to twenty-five seizures per day followed by a postictal period of shouting and screaming.
ResultsCase A: Psychiatric examination: Nonverbal, intermittently grunting and screaming, eyes darting, not responding to verbal commands. Posturing of arms in the air, in a hostile stance. Ten days post starting nightly lumateperone 42 mg, patient was no longer banging furniture nor biting. He remained non-verbal but without screaming and hostile behavior.
Case B: Psychiatric examination: Non-verbal screaming, throwing furniture, hitting walls and uncooperative to verbal commands. One month post starting lumateperone 42 mg nightly, while the seizures persisted, patient’s violent attacks were not severe. Two months later, the aggression was much less severe, that he could attend school. Behavioral problems with aggression would recur an hour before the next evening’s lumateperone dose.
ConclusionsLumateperone modulates a variety of neurotransmitters including glutamate, functions as a presynaptic partial dopamine agonist and postsynaptic dopamine antagonist, and enhances N-methyl-d-aspartate, an inhibitor of serotonin reuptake (Reddy, 2020), input, on any of these, may be its mechanism of action (Vyas, 2020). Perchance, its action as a 5HT-2A receptor antagonist may be its method of reducing aggression, as has been posited for its anti aggression effect in schizophrenia (Vyas, 2020). Lumateperone impacts on neurotransmitters, including substance P, which modulate aggression (Gretchen, 2020). Alternativity ASD correlated with dysfunction of Area VIIIA of the right posterior cerebellum and its connection with the left frontal cortex (Heemkerk, 2021). Lumateperone may act to stabilize these areas and thus inhibit aggression (Heemkerk, 2021). In those with aggression associated with ASD and IED, a trial of lumateperone may be worthwhile.
Disclosure of InterestNone Declared
Too Sweet to Eat: Delusional Hypergeusia
- S. Kalita, D. Birwatkar, A. Sundar, A.R Hirsch
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- Journal:
- CNS Spectrums / Volume 28 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 14 April 2023, pp. 225-226
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Introduction
Delusional hypergeusia has not heretofore been reported.
Methods: Case reportA 62-year-old right-handed woman described a plethora of complaints after exposure to a solvent aroma, including headaches, diffuse weakness, fatigue, hallucinated smells and tastes, burning mouth syndrome, and panic attacks. The apogee of her symptoms was that salty taste was 800% of normal, making food taste disgustingly salty. She was unable to tolerate potato chips, pizza, spaghetti sauce, Coca Cola, root beer, Sprite, 7 Up, and even bottled water. Sugar was also too sweet, 600% of normal. Foods which were unbearably sweet included cookies, sugar, and breakfast cereals. Sour and bitter were normal.
ResultsAbnormalities in Neurological Examination: Mental Status Examination: hyperverbal, loud, overly inclusive, irritable with pressured speech; disheveled, racing thoughts, and tangential. Motor Examination: Drift Test: right pronator drift with right abductor digiti mini sign. Gait Examination: heel walking with bilateral decreased arm swing. Reflexes: bilateral quadriceps femoris 3+, positive left (L) Hoffman’s reflex. Chemosensory Testing: Olfaction: Brief Smell Identification Test: 12 (normosmia). Retronasal Olfactory Testing: Retronasal Smell Index: 1 (Anosmia). Gustatory Testing: Propylthiouracil Disc Taste Test: 10 (normogeusia). Waterless Empirical Taste Test: sweet: 4, sour: 3, salty: 7, bitter: 5, brothy: 0, total: 30 (ageusia to umami, otherwise normogeusia). Neuropsychiatric Testing: Go-No-Go Test: 2/6 (abnormal).
DiscussionPerhaps hypergeusia may not have been true hypergeusia but a misperception of retronasal smell associated hyperosmia with physiologic synesthesia manifested as taste. Peradventure, the perceived hypergeusia, is just one component of a generalized delusional paradigm, where many sensory perceptions are intensified. The perceived delusional hyperosmia may be intensification of the sensory misperception due to an underlying dysgeusia. This may represent a variant of the two-factor hypothesis of delusions whereby a distorted sensory perception is then misrepresented in a delusion. Dysfunction of the right hemisphere, which normally acts to censor the left, allows the delusion to manifest. While two different anatomical abnormalities (one left and one right hemisphere) have been postulated to be the foundation of such delusions, it is distinctly possible that a single lesion of the inferior parietal lobule may be sufficient for both sensory distortions to be produced as well as loss of inhibition of delusional interpretation of distorted sensation of the frontal lobe by the right parietal lobe, yclept the sensorialist hypothesis. In those who present with hypergeusia, search for delusional origin is warranted and in those who present with delusions, query as to perceived hypergeusia may be revealing.
FundingNo Funding
Careful, Women! Is Orgasm Worth the Cost of Your Cerebellum? Flibanserin-Induced Cerebellar Dysfunction
- D. Birwatkar, S. Kalita, A.R Hirsch
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- Journal:
- CNS Spectrums / Volume 28 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 14 April 2023, p. 225
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Introduction
Flibanserin, a serotonin antagonist currently indicated for treatment of female sexual dysfunction disorder, has not heretofore been described to worsen cerebellar function. Such a case is presented.
MethodsA 60-year-old woman, 8 months prior to presentation, had an acute onset of fainting and hitting her head into a wall without loss of consciousness. She could not stand up, had left-sided weakness, and vomiting, with garbled, slow speech and severe headache. Findings in the emergency room showed a left cerebellar parenchymal hemorrhage of 3.2 x 3.1 x 2 cm with the epicenter at the dentate nucleus, extending medially towards midline into the cerebellar vermis, with surrounding perilesional edema extending into the middle cerebellar peduncle. Also, 5.2 cm of the hemorrhage extended from the petrous of the tentorium to the cerebellar vermis. Moreover, a ventral left thalamic hemorrhage with subependymal clot at the foramen of Monroe extended into the dependent portion of lateral ventricles without midline shift. Post one month of physical therapy, speech, walking, and coordination improved but she continued to have delayed speech and trouble getting up, with a wide stance.
ResultsNeurologic Examination: Cranial Nerve (CN) Examination: CN XI: Sternocleidomastoid hypertrophy, horizontal titubation. Motor examination: Drift test: L pronator drift with L abductor digiti mini sign. Gait examination: heel walking, dystonic posture of L hand. Tandem gait: unstable, wide based. Cerebellar examination: Both (B) finger-to-nose dysmetria, Left > Right. Slow rapid alternating movements (RAM) L Upper Extremity (UE). Due to absent sexual desire she started 100 mg of flibanserin nightly. Maintaining this for 5 weeks, her coordination markedly worsened with poor balance and a need for a cane to ambulate. She would stumble, with a wider gait, and found climbing stairs challenging. Physical examination displayed worse cerebellar function: prominent horizontal titubation. Finger-to-nose—dysmetria L>R. Decreased RAM, L UE. Markedly positive Holmes Rebound phenomenon, Bilateral UE. Tandem gait: unstable. A week post stopping flibanserin, gait and cerebellar examination returned to baseline.
DiscussionThe temporal correlation between the use of flibanserin and transient worsening of cerebellar function strongly suggests that this is the causative agent. Since serotonin is essential in cerebellar function, including its action on the cerebellar cortex and deep cerebellar nuclei, it strongly suggests that its action as a serotonin antagonist is the mechanism whereby flibanserin is causing cerebellar symptoms. In those on flibanserin, investigation to detect the presence of cerebellar dysfunction is warranted. Assessment for the presence of cerebellar dysfunction in those who are on anti-serotonin drugs, such as cyproheptadine and methysergide, may be worthwhile.
FundingNo Funding
Effect of dust particle and magnetic field on EEPF and plasma oscillation
- D. Kalita, B. Kakati, S. S. Kausik, B. K. Saikia, M. Bandyopadhyay
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- Journal:
- Journal of Plasma Physics / Volume 85 / Issue 4 / August 2019
- Published online by Cambridge University Press:
- 08 July 2019, 905850402
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The significance of dust particles for the electron energy probability function (EEPF) and plasma oscillations is studied under varying magnetic field strength in a filamentary discharge hydrogen plasma. The experimental result shows that with an increase in dust density, the electron density decreases as a result of the charging of dust grains in the plasma background. A bi-Maxwellian EEPF is computed in both a pristine hydrogen plasma and a dust-containing plasma at different magnetic field strengths. We have observed that the increase in magnetic field decreases the lower energy electron population. The electron population of the lower energy range shows nearly identical results at magnetic field, $B\leqslant 3.7$ mT whereas the behaviour of the high-energy electron population becomes identical for a field strength $B\leqslant 5.8$ mT. From the observation, we have seen that the mid energy electron population slightly decreases and the high energy electron population slightly increases due to the presence of dust particles as compared to a pristine plasma. Further, very low energy electron population remains almost unchanged. With increase in dust density, the mid energy electron population further decreases whereas the high energy electron population slightly increases for different magnetic fields. But, no changes were observed for the very low energy electron population in the presence of dust particles. From the study of plasma oscillation, it is observed that the dominant frequency associated with the plasma oscillation is matched with the ion cyclotron frequency. The amplitude of the ion cyclotron frequency reduces with the increase of dust density which might be due to the decrease of plasma density.
Comparative performance of Khaki Campbell ducks, Desi ducks and their reciprocal crosses for certain economic traits in rural conditions
- N. Kalita, D. Sarma, J.K. Talukdar, N. Barua, N. Ahmed
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- Journal:
- World's Poultry Science Journal / Volume 60 / Issue 3 / September 2004
- Published online by Cambridge University Press:
- 18 September 2007, pp. 349-356
- Print publication:
- September 2004
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A comparative study was undertaken on the performance of Khaki Campbell, Desi ducks and their reciprocal crosses in the Darrang District of Assam (India). Four hundred and seventy ducks were studied for certain economic traits. Results of the study in respect of age at maturity, body weight, egg production, egg quality, mortality and economic performance from the flocks are highlighted.