Patient hear abnormal voices

14 year old girl brought with complaints of absent interactions with peers and teachers in school .Sitting eyes apparently closed inside class room .Not making eye contact with anyone. Deterioration in academic functioning also noticed. Decline started since four years which is gradual and interest in extracurricular activities is also coming down and absent now. Inside family atmosphere she functions well and takes initiatives to do outside trip to play areas,parks, cinemas. Irritability and occasional destructive behaviour also present inside house ,no change in biological functioning reported. Whenever her school mates visited her house she was in distress and there was irritability.Recently she seems to wear a scarf over head when she goes to outside house where there is likely to meet her school mates.Some excessive concern about cleanliness also noticed. Family history of depression in mother delusional disorder in father and suicide and substance use disorder in second degree relatives.Interpersonal issues between parents present. MSE revealed Poor but possible rapport, Slightly reduced range of affect, slightly reduced reactivity, low mood , sibling rivalry,no egodystonic distress regarding her problems also noticed.No hallucinations or delusion .No depressive or suicidal ideation. Unable to self appreciate fully her dysfunctions and unable to elaborate on reasons. physical examination nil significant.No history of abuse reported. How you proceed with the case ?

Manasamitra Vatakam is an ayurvedic formulation that is prepared from very effective herbs and salts. This herbal formulation is very efficient to treat the mental illness and disorders. Ingredients Juice of Trayamana – Gentiana kurroo WATER DECOCTION OF: Shankhapushpi – Clitorea ternateaVacha – Acorus calamusSariva – Hemidesmus indicusLakshmana – Ipomoea sepiariaBilva – Aegle marmelosBala – Sida cordifoliaGoksheera – Cow milkJiraka – Cumin – Cuminum cyminumSomavalli – Sarcostemma acidumStanya – Breast milk OTHER INGREDIENTS: Nagabala – Grewia populifoliaBilva – Aegle marmelosShravani – Sphaeranthus indicusBhunimba – Andrographis paniculataPrishniparni – Uraria pictaShankhapushpi – Clitorea ternateaTamrachuda PadikaBala – Sida cordifoliaPushkaramoola – Inula racemosaVacha – Acorus calamusChandana – Santalum albumRaktachandana – Pterocarpus santalinusMadhuka – Glycyrrhiza glabraTwak – Cinnamomum zeylanicumMagadhi – Piper longumKarpoora – Cinnamomum camphoraAileya – Prunus cerasusVishala – Citrullus cholocynthisArkaraga - Onosma echioidesNirgundi – Vitex negundoPlava – Nyctanthes arborRasna – Vanda roxburghiShilajatu – AsphaltumGojihva – Onosma bracteatumPadmakeshara – Nelumbium speciosumJivaka – Malaxis acuminataRishabhaka – Mimusoops hexandraKakoli – Fritillaria royleiKshira Kakoli – Roscoea purpureaBrihati – Solanum indicumKantakari – Solanum xanthcarpumKritamala – Cassia fistulaParushaka – Grewia asiaticaHaritaki – Terminalia chebulaVibhitaki – Terminalia belliricaAmalaki – Emblica officinalisAmruta – Tinospora cordifoliaShweta – Hemidesmus indicusJivanti – Leptadenia reticulataSomavalli – Sarcostemma acidumAshwagandha – Withania somniferaNisha – Curcuma longaUsheera – Vetiveria zizanioidesDraksha – Vitis viniferaYashti – Glycyrrhiza glabraRiddhi – Vigna cylindricaDurva – Cynodon dactylonHamsapadi – Adiantum philippenseBhadra – Sida cordifoliaLavanga – Syzigium aromaticumTulasi – Ocimum sanctumKumkuma – Crocus sativusKasturi – MuskPravala pishti – CoralRajata Bhasma – Bhasma of silverSwarna Bhasma – gold calyxMrigashringa Bhasma – Bhasma made of deer hornMukta Pishti – Paste prepared from PearlLoha Bhasma – Bhasma prepared from IronMakshika Bhasma – Bhasma of Copper-Iron Pyrite Method Of Preparation Take all the ingredients up to 10 grams.Powder all the ingredients individually and mix all together later.Triturate this powder mixture with the liquids (the juice and water decoction) and make its paste.Make the pills from this paste. Medicinal Properties Manasamitra Vatakam is an effective Ayurvedic formulation that helps to keep the Vata, Pitta and Kapha dosha balanced, potent in Neuro Protective, Anti-Stress, Anxiolytic and Anti-Depressant Anti-Inflammatory, Antioxidant etc. properties. It is very useful Ayurvedic medicine for psychiatric conditions, improves blood circulation and oxygen supply to brain cells, thereby helps to expand intelligence, improve brain functions, and enhance memory and concentration as well as boost retention power. It is helpful in depression too, promotes calmness and feeling of peace in the mind. It is even useful to decreases anxiety and prevent repeated occurrences of anxiety disorders. It lessens the feeling of restlessness, tiredness, and nervousness. It is beneficial in epilepsy, seizures and mania, reducing their frequency of occurrence. It is beneficial in insomnia too, helps to induces sleep calms the mind, and improves the quality of sleep and lessens the sleep disturbances. It is even useful in Alzheimer’s disease ad Schizophrenia. It is suitable in improving speech problems. It is even useful in children for diseases like autism. It is also helpful in poisonous condition. Indications Mental illnessTo enhance memoryDepressionPsychosisGAD (generalized anxiety disorder)EpilepsySeizuresStress busterImproves concentrationPre-menstrual tensionInsomniaMigraineAlzheimer’s disease Dose Two tablets two times a day, before or after meals

Mr. E is 68 years old and married with two children. His wife reports changes in his memory and behavior over the last 9 years. She reports that he frequently forgets his keys, goes into the house to get something and then forgets what he wants, and that he has changed from an outgoing pleasant person, to one who avoids conversation. She says that he seems hostile at times for no apparent reason. Mr. E is in good general health, taking no medications, and his alcohol consumption is limited to two to three beers a day. EEG as shown in image. what is the most likely diagnosis other than dementia for Mr. E? A. Major depression B. Chronic paranoid schizophrenia C. Normal aging D. Delirium E. Factitious disorder

Ginkgo biloba has many health benefits. It’s often used to treat mental health conditions, Alzheimer’s disease , and fatigue . It’s been used in traditional Chinese medicine for about 1,000 years. It came on the Western culture scene a few centuries ago, but has enjoyed a surge of popularity over the last few decades. ADVERTISEMENT USES Uses of ginkgo biloba Ginkgo is used as an herbal remedy to treat many conditions. It may be best known as a treatment for dementia , Alzheimer’s disease, and fatigue. Other conditions it’s used to treat are: • anxiety and depression • schizophrenia • insufficient blood flow to the brain • blood pressure problems • altitude sickness • erectile dysfunction • asthma • neuropathy • cancer • premenstrual syndrome • attention deficit hyperactivity disorder (ADHD) • macular degeneration Like many natural remedies, ginkgo isn’t well-studied for many of the conditions it’s used for. HEALTH BENEFITS Health benefits of ginkgo biloba Ginkgo’s health benefits are thought to come from its high antioxidant and anti-inflammatory properties. It may also increase blood flow and play a role in how neurotransmitters in the brain operate. Some studies support the effectiveness of ginkgo. Other research is mixed or inconclusive. In 2008, results of the Ginkgo Evaluation of Memory (GEM) study were released. The study sought to find out if ginkgo would reduce the occurrence of all types of dementia, including Alzheimer’s disease. It also looked at ginkgo’s impact on: • overall cognitive decline • blood pressure • incidence of cardiovascular disease and stroke • overall mortality • functional disability The GEM study, the largest of its kind to date, followed 3,069 people age 75 or older for 6 to 7 years. Researchers found no effect for preventing dementia and Alzheimer’s disease in study participants who either took ginkgo or a placebo. And a 2012 meta-analysis found ginkgo had no positive effects on cognitive function in healthy people. Still, a 2014 study showed ginkgo supplementation may benefit people who already have Alzheimer’s and take cholinesterase inhibitors, common medications used to treat the condition. The GEM study also found ginkgo didn’t reduce high blood pressure . There was also no evidence ginkgo decreases the risk of heart attack or stroke. It may, however, reduce the risk of peripheral artery disease caused by poor blood circulation. According to a 2013 systematic review , ginkgo can be considered an adjuvant therapy for schizophrenia. Researchers found ginkgo seemed “to exert a beneficial effect on positive psychotic symptoms” in people with chronic schizophrenia who take antipsychotic medication. Researchers in that study also found positive study results for ADHD, autism, and generalized anxiety disorder, but indicated more research is needed. According to an older review of evidence study, ginkgo may improve erectile dysfunction caused by antidepressant medications. Researchers believe ginkgo increases the availability of nitric oxide gas which plays a role in increasing blood flow to the penis. Ginkgo may help relieve premenstrual syndrome (PMS) symptoms, according to a 2009 study . During the study, participants taking either ginkgo or a placebo experienced a reduction in symptoms. Those taking ginkgo had significantly more relief. ADVERTISEMENT RISKS Ginkgo biloba risks Ginkgo is generally safe for healthy people to use in moderation for up to six months. Severe side effects are rare. Still, the Food and Drug Administration (FDA) doesn’t regulate ginkgo and other over-the-counter herbal supplements as strictly as other drugs. This means it’s hard to know exactly what’s in the ginkgo you buy. Only buy a brand of supplement you trust. Ginkgo may cause an allergic reaction in some people. Your risk may be higher if you’re allergic to urushiols, an oily resin found in poison ivy, sumac, poison oak, and mango rind. Ginkgo may increase bleeding. Don’t use ginkgo if you have a bleeding disorder or take medications or use other herbs that may increase your risk of bleeding. To limit your bleeding risk, stop taking ginkgo at least two weeks before undergoing a surgical procedure. Don’t take ginkgo if you’re on any medications that alter clotting. Don’t take it if you’re taking NSAIDS like ibuprofen, too. Ginkgo can have serious side effects. If you’re on any medication, let your doctor know the dose you plan on taking. Ginkgo may lower blood sugar. Use with caution if you have diabetes or hypoglycemia or if you take other medications or herbs that also lower blood sugar. Don’t eat ginkgo seeds or unprocessed ginkgo leaves; they’re toxic. Due to the potential bleeding risk, don’t use ginkgo if you’re pregnant. Ginkgo hasn’t been studied for use in pregnant women, breastfeeding women, or children. Other potential side effects of ginkgo are: • headache • vomiting • diarrhea • nausea • heart palpitations • dizziness • rash TAKEAWAY Takeaway There was a time ginkgo seemed like a magic bullet for preventing age-related memory loss and other health conditions. But research to date doesn’t support much of the enthusiasm. Most evidence for ginkgo is anecdotal or decades old. Still, research has shown ginkgo may slow the progression of Alzheimer’s disease, help treat some common mental health conditions, improve sexual function, and improve blood flow to the peripheral arteries. Don’t replace a current medication with ginkgo or start taking ginkgo to treat a serious condition without consulting you

male patient 26yr btech student came with complaints of Auditory Hallucinations, k/c/o - Ankylosing spondylitis HLA B27 +Ve CCP -ve RA -ve X-ray pelvis (attachment) - shows Sacro iliatis old case of Tubercular Sacro iliatis is on medication for Ankylosing spondylitis (attachment) Question is - is these drugs can cause these psychiatric symptoms. please guide me... and if, then want will be the approach ..