Bipolar disorder associated with tuberous sclerosis: Chance association or aetiological relationship?

A Rare Presentation of Attention Deficit/Hyperactivity Disorder: A recommendation to be more alert!

We report the case of a 7 year-old Omani girl with tuberous sclerosis (TS), attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BD), at Sultan Qaboos University Hospital (SQUH), Oman. For a year she had been suffering from hyperactivity, aggression, over talkativeness, insomnia, risk-taking behaviour, distractibility, poor attention and seizures. This clinical picture evolved slowly, but was progressive in nature. Before the consultation at her local health centre, she was given four drugs without being properly investigated; she continued to deteriorate. In SQUH, she showed hyperactive-impulsive behaviour, elation, flight of ideas, preoccupation with self and high self-confidence. The physical examination revealed multiple hypomelanotic patches all over the body and a shagreen patch at the sacral area. The electroencephalogram showed generalised epileptic discharges, while brain imaging showed multiple parenchymal calcified foci in both cerebral hemispheres. Other investigations were normal. She was given valproate, and then a psychostimulant, methylphenidate, that controlled her state. Our aim in reporting this case is not only because it is unique, given its rare comorbidity (ADHD, TS and BD), but also to remind our junior colleagues to be alert to the possibility of an underlying neuropathology when performing clinical examinations and investigations of children presenting with neuropsychiatric symptoms.

An overview of Indian research in bipolar mood disorder

This review has been done after careful research of articles published in indian journal of psychiatry with the search words of manic depressive psychosis and bipolar mood disorder. Many articles in the following areas are included: 1) ETIOLOGY: genetic studies: 2) ETIOLOGY - neuro psychological impairment: 3) Adult bipolar disorder 4) Epidemological 5) Clinical picture - phenomenology: 6) Course of bipolar mood disorder: 7) Juvenile onset bipolar affective disorder 8) Secondary mania: 9) Clinical variables and mood disorders: 10) Disability: 11) Comorbidity: 12) TREATMENT: biological 13) Recent evidence: 14) Pharmacological evidence in special population. Though there seems to be significant contribution, there are still lot of areas which need careful intervention. The findings in various studies from the indian point of view are reviewed.

Bipolar disorder and tuberous sclerosis complex: is it a mere coincidence?

Tuberous sclerosis complex (TSC) is associated with significant psychiatric comorbidity mainly in the form of autistic disorders, hyperkinetic disorders, depression, and anxiety disorders. There are very few reports of bipolar disorder in TSC. The authors present the case of a patient with TSC having bipolar disorder manifesting as manic as well as depressive episodes. The diagnosis of TSC was based on the presence of facial angiofibromas, enamel pits, and shagreen patches on clinical examination, and the presence of cortical tubers and calcified subependymal nodules on neuroimaging. The patient presented during the manic phase of the illness and responded well to treatment with carbamazepine and haloperidol and became symptom free within 1 month. The patient's neuropsychological assessment revealed a borderline level of intellectual functioning and deficits in attention and concentration, recent memory, delayed and immediate recall, and visual retention. To our knowledge, this is the first report of TSC with bipolar disorder having both manic as well as depressive episodes. The nature of association between TSC and bipolar disorder, and its clinical implications are discussed.