Premenstrual dysphoric disorder

A 20 y/o female admitted for suicidal ideation. Denies ingestion of anything. History of Mobitz II. HR 45-60 dropping to the 30s when sleeping. BPs on the lower end of normal. Patient’s only complaint is dizzy spells a few times a week without syncope and occasional fatigue. All other vitals within normal limits, labs and physical assessment unremarkable. Diagnosis based on ECG was complete heart block. Dual chamber pacemaker placement pending. Any other thoughts on this ECG reading?

30 years male Papulosqamous patches Severe itch and tenderness History of same illness. Recurrent episodes . Mentally depressed . Not responding to any treatment . He is not diabetic, not hypertensive Normal blood picture. No family history . Married. And he tried 2 times for suicidal attempts in the past. Consulted Allopathic , Homeo, Ayurvedic and Siddha. But no use. How to manage. And what suggestions recommended in this case. Any other modality of treatment .

35 year old female presented with wrist Slash, telling some one told me to do so. she is married having two children.No significant stressors.History suggestive of psychotic illness for past four years which is episodic. Poor compliance with treatment.Premorbid personality well adjusted.No history of BPAD or MDD. when the patient reported she was on olanzepine 15 mg and sertraline 50 mg from a psychiatrist when she tried self harm now for first time.Mood depressed ,no depressive ideas ,percecutary and referential ideas present along with pseudohallucination commanding to commit suicide. Also complaints of palpitations,fear , running out behaviour in response to pseudohallucination. Olanzepine uptitrated to 25 mg, Sertraline changed to desvenlafaxine 50 mg along with bzd considering associated low mood which was persisting.Parient became euthymic suicidal ideation disappeared full improvement noticed in 20 days. Suddenly next day started pseudohallucination and running out behaviour,mood changes ,dsh ideation. Considering the primary diagnosis of Psychosis , possible worsening of psychotic features with SNRI desvenlafaxine stopped.Patient returned to premorbid level in one week and discharged on olanzepine 25 mg and bzd. Due to complaints of sedation bzd tapered down next visit and within two days patient attempted suicide telling commanding hallucination. How can be proceeded with the case . Please opine. @Dr. Shama Rathod @Dr. Sumi Aswin

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 ?

Diagnose the condition 22/male Came to OPD with self injuries over the left forearm after having a fight at home H/o similar injuries in the past