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43 Legal proceedings continued In October 2006, the Group reached a settlement agreement with Dr. Reddy's which provides that Dr. Reddy's may exclusively distribute authorised generic versions of sumatriptan tablets in the USA with an expected launch date late in the fourth quarter of 2008. In November 2006, the Group reached a settlement with Cobalt which provides that Cobalt may distribute a generic version of sumatriptan tablets in the USA with an expected launch date early in the first quarter of 2009. In December 2006, the Group reached a settlement with Spectrum which provides that Spectrum may exclusively distribute authorised versions of certain sumatriptan injection products in the USA with an expected launch during the Group's sumatriptan paediatric exclusivity period which begins in August 2008, with such launch occurring not later than early November 2008. Lamictal In August 2002, the Group commenced an action in the US District Court for the District of New Jersey against Teva Pharmaceuticals USA Inc., alleging infringement of the Group's compound patent for lamotrigine, the active ingredient in Lamictal oral tablets. That patent affords protection through January 2009 after giving effect to a grant of paediatric exclusivity by the FDA. Teva had filed an ANDA with the FDA with a certification of invalidity of the Group's patent. The parties reached a settlement agreement pursuant to which the Group has granted Teva an exclusive royalty-bearing license to distribute in the USA a generic version of lamotrigine chewable tablets. In addition, Teva was granted the exclusive right to manufacture and sell Teva's own generic version of lamotrigine tablets in the USA with an expected launch date in 2008. Paxil Seroxat In the USA a number of distributors of generic drugs filed applications with the FDA to market generic versions of Paxil Seroxat paroxetine hydrochloride ; prior to the expiration in 2007 of the Group's patent on paroxetine hyrdrochloride hemihydrate. Other distributors sought to bring to market anhydrate or other versions of paroxetine hydrochloride and in one case paroxetine mesylate. In response the Group filed actions against all those distributors for infringement of various of the Group's patents on the basis that the generic anhydrate and other versions infringe because they contain and or convert to the hemihydrate form and or infringe other Group patents. In July 1998, the Group filed an action against Apotex in the US District Court for the Northern District of Illinois for infringement of the Group's patent for paroxetine hydrochloride hemihydrate. Apotex had filed an ANDA with the FDA seeking approval to introduce a generic form of Paxil. Following a trial in February 2003, the judge ruled the Group's patent valid but not infringed by Apotex's product. On the Group's appeal to the US Court of Appeals for the Federal Circuit CAFC ; , which hears all appeals from US District Courts on patent matters, the CAFC ruled that the Group's patent was infringed but invalid based upon `public use' in clinical trials prior to the filing date in the USA. The Group filed a petition to the CAFC for rehearing on its appeal by the full court and in April 2005 the full CAFC vacated that judgement and remanded the matter to the same panel. Concurrently with entry of that decision, the panel issued a new opinion ruling the same patent invalid under an alternative theory. Because of the potential for adverse reactions from lamotrigine in nursing infants, breast-feeding while taking this medication is not recommended.

North American Antiepileptic Drug AED ; Pregnancy Registry The North American Antiepileptic Drug NAAED ; Pregnancy Registry is an ongoing prospective, observational study. Women are recruited directly into the Registry when they call a toll free number that is advertised through healthcare providers, teratology counselors, epilepsy support foundations, and the lay and scientific press. Upon enrollment, women participate in a telephone interview to collect information on material demographic and socio-economic characteristics, AED exposure during pregnancy therapy type, timing, and dosage ; , medical and prescription history, and details of the pregnancy. A further interview to confirm exposure information takes place at 7 months gestation and the health of the infant is established through an interview 4-8 weeks after the expected delivery date. Consent is also sought to access medical records to confirm details of the infant's health. All malformation descriptions are reviewed by two dsymorphologists blinded to maternal exposure. The findings in the NAAED Pregnancy Registry on the frequency of major malformations in infants exposed to lamotrigine as monotherapy will be made available once the sample size is adequate for assessing statistically significant differences from expected baseline rates. The AED Pregnancy Registry has enrolled over 3000 women. The Advisory Committee has determined that in order to detect a 2-3 fold increase in major birth defects, over 300 monotherapy exposures are needed for each medication. Patients enroll themselves into this Registry. Contact information is provided at the end of this Report. As of March 2006, data were available for 564 infants exposed to lamotrigine monotherapy in the first trimester of pregnancy. Of these, 15 infants had a major malformation detected between birth and five days, a prevalence of 2.7% 95% Confidence Interval: 1.5%-4.3% ; . Five of the reported malformations were isolated oral clefts 8.9 1000 ; : three isolated cleft palates and two isolated cleft lips Holmes et al, 2006 ; . This represents a significantly increased risk compared to the general population comparator group used by NAAED the Brigham and Women's Hospital surveillance program reporting a background rate of 0.6 1000 for isolated oral clefts ; and is higher than the range reported in the published literature 0.5-2.2 1000 ; Bille et al, 2005, Christensen 1999, Croen et al, 1998, Das et al, 1995, DeRoo et al, 2003, Hashmi et al, 2005, Kallen 2003, Menegotto et al, 1991, Tolarova et al, 1998, VallinoNapoli et al, 2004 ; Data from other registries are currently being monitored to better understand the significance of this finding. European Registry of Anti-Epileptic Drug Use in Europe EURAP ; EURAP is an ongoing multi-AED pregnancy registry that was established in 2002. Recruitment was initially in Europe, but the registry has since expanded to recruit women from countries in Asia, Oceania, and Latin America. Networks of reporting physicians within the participating countries record, with patient permission, details of AED exposure and maternal risk factors maternal demographics, maternal health, timings of AED treatment during pregnancy, history of maternal epilepsy, frequency of seizures during pregnancy, family history of epilepsy and other congenital and inherited conditions ; . The registry only includes pregnancies registered before the fetal outcome is known prospective ; and within the first 16 weeks of gestation for comparative risk assessments against other AEDs ; . The infant outcome is.
Senaida Salgado, Jason Nixon, Michael Alan Koris, Luis Jose Galvan and a handful of others used gang members to help carry out an elaborate insurance fraud scam that involved staging fake accidents and filing false claims for repairs and medical treatment that was never needed. Sources say police stumbled across the fake accident ring working a murder for hire case. Documents show the suspects made claims between $100, 000 $200, 000. All four suspects are currently in a Texas jail, for instance, lamotrigine pregnancy.

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Senate committee on health and human services pain relief and drug misuse. These include such medications as carbamazepine tegretol ; , lamotrigine lamictal ; , topiramate topamax ; , and valproic acid depakote and levothyroxine. BREAST CANCER EXECUTIVE SUMMARY THE FACTS What is BC and How Does it Affect Patients? Figure 21: Schematic of the Breast2 Risk Factors Diagnosis Stages of the Disease Table 21: TMN Classification in BC PATIENT STATISTICS Incidence, diagnosis rates & treatment; now and in the future Table 22: US prevalence of BC Figure 22: Cancer Incidence Rates and Cancer Death Rates for Women in the US Table 23: European prevalence of BC Table 24: Japanese prevalence of BC PATIENT MODEL The prevalence of people living with BC will increase by 20% by 2012 Figure 23: BC Market Opportunities Table 25: Summary of Patient Population Forecasts in the Top 7 Countries 2005-2012E ; DRUG GROWTH DRIVERS Figure 24: Impact of biomarker identification on BC patients Figure 25: Impact of biomarker identification on dose selection studies in BC patients DRUG GROWTH RISKS DAMPENERS THE MARKET GLOBAL CANCER MARKET Figure 26: Global Cancer Drug Sales including Supportive Care ; in 2006 US$472 billion ; Figure 27: Global Cancer Sales Forecasts 2004-2012 THE BREAST CANCER MARKET GLOBAL BC SALES SPLIT Figure 28: Global Sales Split 2006 ; Figure 29: Global BC Market by Therapy Class 2006 ; Figure 210: Global BC Market by Region 2012E ; Figure 211: Global BC Market by Therapy Class 2012E ; US market Figure 212: BC US Drugs Sales Split 2006 ; European market Figure 213: BC European Drugs Sales Split 2006 ; Japanese market Figure 214: BC Japanese Drugs Sales Split 2006 ; 19. Lamotrigine is well absorbed orally and is extensively metabolized by the liver 16 and lithobid.

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Tion treatment were defined as either 1 ; any patient discharged from the rehabilitation facility or 2 ; any patient discharged from one of the acute care general hospitals with a principal diagnosis of "Care involving use of rehabilitation procedures" ICD-9-CM code V57 ; . The analysis included all such discharges during the twelve-month period from October 1, 1999, through September 30, 2000, corresponding to hospital fiscal year 2000. Information on the medical condition underlying the patient's need for rehabilitation was drawn from the reported diagnosis codes. For patients of the inpatient rehabilitation facility, the information was drawn from the principal diagnosis; for patients of the acute-care general hospitals, the information was drawn from the first-listed additional diagnosis, as the principal "diagnosis" for those patients was the need for rehabilitative care. For the purpose of computing average lengths of hospital stays, patients not staying overnight were counted as having a stay of one day, per industry practice. In addition, lamotrigine is used to help prevent the manic and or depressive phases of bipolar disorder and lithium.

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Tients; and placebo, 70 patients ; . Both lamotrigine and lithium were superior to placebo at prolonging the time to intervention for any mood episode lamotrigine vs placebo, P .02; lithium vs placebo, P .006 ; . Lamotrrigine was superior to placebo at prolonging the time to a depressive episode P .02 ; . Lithium was superior to placebo at prolonging the time to a manic, hypomanic, or mixed episode P .006 ; . The most common adverse event reported for lamotrigine was headache.

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Valproate may exacerbate seizures and cause fatal encephalopathy in patients with defects of nitrogen metabolism such as ornithine transcarbamylase deficiency. Other cases of paradoxical increased seizures may not have a clear explanation. If a clinician is not aware of this possibility, they may attribute an increase in seizures to the patient's underlying condition, and further increase the dose of the offending medication. Case History 10 A 33-year-old man suffered poorly controlled temporal lobe epilepsy. His neurologist started lamotrigine and he developed a new pattern of drop attacks. Concerned about the deterioration in his seizures, an increased dose was prescribed and the drop attacks worsened. Following withdrawal of lamotrigine the drop attacks ceased and he returned to his previous pattern of focal seizures and loxitane.
PHARMACOTHERAPY OF POSTTRAUMATIC STRESS DISORDER Lukasz Struzik * , Lisa L. Vivian, Joanna C. McBride, Monica Vermani, Martin A. Katzman Centre for Addiction and Mental Health Clarke Site Introduction: Post traumatic stress disorder PTSD ; is a common but difficult disorder to treat associated with significant morbidity, mortality and societal burden. This literature review presents the current pharmacologic management of PTSD with reference to evidence from double-blind, placebo-controlled studies and open trials. The purpose of this paper is to encourage early detection and treatment of PTSD at the primary-care level to limit the consequences of trauma. Methods: The data were obtained using a Medline search with keywords: posttraumatic stress disorder, pharmacology, management, general practitioner. Results: Based on the evidence, the recommended first-line treatments for monotherapy are the selective serotonin reuptake inhibitors SSRIs ; , sertraline, paroxetine and fluoxetine. Other potential options include monotherapies of venlafaxine, mirtazapine, TCAs, MAOIs, as well as adjunctive usage of typical antipsychotics, lamotrigine, trazadone, and clonidine. To aid the family practitioner, a pharmacotherapy treatment algorithm is proposed. Conclusions: It is not suggested that simple drug monotherapy targeting specific symptoms will give good treatment outcomes in isolation; recognizing the PTSD symptomatology in the general practitioner's office and initiating treatment is the foundation to proper management.

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GENE EXPRESSION CHANGES IN CARDIAC HYPERTROPHY Dr. Sara Arab, Dr. Fayez Dawood, Eva Cukerman, Kevin Ong * , Dr. Peter Liu Max Bell Research Centre, Toronto General Hospital, Univrsity Health Network Heart failure arises from abnormal cardiac function that decreases the heart's ability to maintain cardiac output to meet the metabolic demands of the body's tissues and organs. Numerous heterogeneous disorders can lead to heart failure. For example, aortic stenosis can lead to maladaptive hypertrophy of the heart. However, exercise can improve the symptoms of heart failure by stimulating physiologic hypertrophy but the underlying mechanism is still not fully understood. A microarray technology, which provides a global view of gene expression patterns, can help to elucidate the gene expression profile of the heart in different conditions. This study was designed to assess the changes in cardiac hypertrophy and gene expression induced by a daily routine of exercise in aorta-banded AB ; mice vs controls SH ; . Initially, p57 black mice 8-10 wks old were randomly designated to one of the following four groups: 1. AB mice exercise 2. AB mice no exercise 3. SH mice control ; exercise 4. SH mice control ; no exercise. The ascending aortas of p57 black mice 8-10 wks old were banded to induce left ventricle pressure-overload-induced cardiac hypertrophy. The sham mice also underwent a similar operation except a ligature was not placed. Mice assigned to groups 1 and 3 were swum for 35 minutes each day for 1wk, 2wks, 4wks, or 8wks. Thus, four groups 14 ; were established for each time period 1, 2, 4, ; . At each time point, the four groups of mice were sacrificed and the heart was extracted for weight measurements. The ratio of heart weight HW ; to body weight BW ; was used as a marker of hypertrophy. Ratio increases were observed in SH mice exercised for 4 and 8 weeks versus those not exercised for 4 and 8 weeks. There is a large increase in the ratio of AB mice as compared to SH mice. However, the HW: BW ratio of AB mice exercised for 4 and 8 weeks was slightly lower than that of their AB counterparts at the equivalent time points. This might suggest a beneficial effect of exercise in the AB mice. Affymetrix microarray analyses are in process on the heart samples of mice from each group and loxapine. There were no significant changes in the BMI of patients after treatment 27.55.2 kg m2 before versus 27.25.2 kg m2 after treatment ; . The results of the first spirometery were normal in 4 patients 13% ; . Mild restrictive abnormality was found in 16 patients 53% ; and moderate restrictions were detected in the remaining 10 patients 34% ; . After treatment with levothyroxin 12 patients 40% ; was normal, 14 patients 47% ; had mild and 4 patients 13% ; showed moderate restrictive abnormalities in their spirometery Table 1, for example, lamotrignie oral.

Shift in bipolar prescribing toward anticonvulsants in the U.S. at the expense of lithium ; "more closely reflects marketing and continuing medical education CME ; discrepancies than it does differences in effectiveness." Baldessarini et al. 22 ; state that, "No other treatment has performed as well as lithium in as many aspects of longterm care of bipolar disorder patients, and despite some risks and limitations, lithium remains the standard against which all proposed alternatives are compared." Add to these observations the rather convincing evidence that lithium reduces suicidal behavior in bipolar patients 23 ; , and it becomes difficult to accept that many residents are completing training without sufficient knowledge and experience to feel comfortable using this drug. There is no question that lithium is now considered an old drug, even in the U.S., where it was first approved for the treatment of acute mania in 1970 and for maintenance therapy in 1974. There is also no question that other medications have well-established roles in the treatment of bipolar disorder [Food and Drug Administration FDA ; approval of divalproex for mania in 1995; olanzapine for mania in 2000; lamot4igine for maintenance in 2003; and still more recently aripiprazole, quetiapine, risperidone, ziprasidone, and extended-release carbamazepine for mania; olanzapine and aripiprazole for maintenance; and olanzapine fluoxetine combination for bipolar depression]. In addition, a vast amount of clinical experience as well as anecdotal reports and case series strongly support benefits from divalproex beyond acute mania. Nonetheless, there is no rational explanation for the apparent fade of lithium into the background of bipolar prescribing practices in the U.S. Less than reasonable explanations include: its unjust portrayal as an extremely dangerous, neurotoxic, nephrotoxic substance; its generic availability and, hence, its lack of marketing muscle; the premature glorification of the newest of the new based only on case reports and anecdotal experience remember that writing and publication biases favor articles with positive outcomes and the general tendency of the young to view the old with distrust. The final areas to address with regard to "old versus new: how much should be taught" have to do with the total amount of time a training program devotes to formal psychopharmacology teaching and the availability of postgraduate education. A training program that minimizes the value of psychopharmacology will direct its minimization at older drugs. A training program trapped by today's financial incentives to see more and more patients in less time will find it difficult to devote sufficient didactic teaching to psychopharmacology in general and to older drugs and lyrica. Lamotrigine lam0trigine is an anticonvulsant that may also be used in australia for the prevention of bipolar depressive episodes.

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A01 depression drugs to carry a warning; fda orders notice of risks for youths by shankar vedantam the federal government ordered yesterday that all antidepressant drugs carry a prominent black box warning to alert doctors that the medications increase the risk of suicidal thoughts and behavior among children and adolescents and pregabalin. Scientific Advisor: Donald B. Hunninghake, MD, Professor, Department of Medicine and Pharmacology; Director, Heart Disease Prevention Clinic, University of Minnesota, Minneapolis, Minnesota. L. de Pontual, V. Hollebecque, Z. Bessa, O. Camard, E. Lachassine, M. H. Muller, and J. Gaudelus. Childhood tuberculosis in a low-income Paris suburb: lessons from a resurgence brought under control. International Journal of Tuberculosis & Lung Disease 8 ; : 976-981, 2004. * Non-analytic study retrospective ; 3The stated aim of this study conducted in France was to evaluate the diagnosis and treatment of childhood TB in a low-income suburb of Paris. This was done by conducting a survey of all children aged under 15 seen between September 1996 and December 1997 as in- or outpatients in the hospitals and health prevention and screening centres that served the paediatric population of SeineSaint-Denis, and who received at least one anti-TB drug. A questionnaire was completed for each patient, and information collected included method of detection, viz., contact tracing, routine TST screening, or evaluation of symptoms suggestive of TB. N 92 The main characteristics of the 92 child participants were reported and are presented below. Female: N 50 54.3% ; Male: N 42 45.7% ; Aged under 1: N 5 5.4% ; Aged 1-4: N 33 35.9% ; Aged 5-9: N 23 25% ; Aged 10-14: N 31 33.7% ; Place of birth: France: N 64 80% ; North Africa: N 4 5% ; Sub-Saharan Africa: N 9 11.3% ; Latin America: N 2 2.5% ; Other: N 1 1.3% ; Unknown: N 12 and labetalol.

Taking oral contraceptives23 and suggests the need to increase the dose of estradiol from 35 g to enzyme-inducing antiepileptic drug is given. Midcycle bleeding may indicate that estrogen levels are too low to block ovulation. Drugs that do not increase the risk of oral contraceptive failure include valproate, lamotrigine and gabapentin. Oral contraceptives do not impair seizure control.
Data sources: citations obtained from medline searches 1985-september 2001 ; using lamotrigine as a text word, articles identified in reference lists of pertinent articles, abstracts presented at conferences, and research data from glaxosmithkline and lercanidipine and lamotrigine.
110. Sykes PA, Quarrie J, Alexander FW: Lithium carbonate and breast-feeding. Br Med J 1976; 2: 1299 Schou M, Amdisen A: Lithium and pregnancy, III: lithium ingestion by children breastfed by women on lithium treatment. Br Med J 1973; 2: 138 Tunnessen WW, Hert CG: Toxic effects of lithium in newborn infants: a commentary. J Pediatr 1972; 81: 804807 Weinstein MR, Goldfield M: Lithium carbonate treatment during pregnancy. Dis Nerv Syst 1969; 30: 828832 Fries H: Lithium in pregnancy. Lancet 1970; 1: 1233 Skausig OB, Schou M: [Breast-feeding during lithium therapy.] Ugeskr Laeger 1977; 139: 400401 Danish ; 116. Tomson T, Ohman I, Vitols S: Lammotrigine in pregnancy and lactation: a case report. Epilepsia 1997; 38: 10391041 Rambeck B, Kurlemann G, Stodieck S, May T, Jurgens U: Concentrations of lamotrigine in a mother on lamotrigine treatment and her newborn child. Eur J Clin Pharmacol 1997; 51: 481484 Ohman I, Tomson T, Vitols S: Lamotrihine levels in plasma and breast milk in nursing women and their infants abstract ; . Epilepsia 1998; 39 suppl 2 ; : 21 119. Wisner KL, Perel JM, Findling RL: Antidepressant treatment during breast-feeding. J Psychiatry 1996; 153: 11321137 Epperson CN, Anderson GM, McDougle CJ: Sertraline and breast-feeding. N Engl J Med 1997; 336: 11891190 Dreifuss FE, Santilli N, Langer DH, Sweeney KP, Moline KA, Menander KB: Valproic acid hepatic fatalities: a retrospective review. Neurology 1987; 37: 379385 Trimble MR: Anticonvulsants in children and adolescents. J Child Adolesc Psychopharmacol 1990; 1: 107124 Ananth J: Side effects in the neonate from psychotropic agents excreted through breast-feeding. J Psychiatry 1978; 135: 801805 American Academy of Pediatrics Committee on Drugs: Transfer of drugs and other chemicals into human milk. Pediatrics 1989; 84: 924936.
Anticonvulsants have been commonly used to treat PDN. Their mechanism of pain-relieving action is not definitely known but is thought to be related to suppression of neurotransmitters in the central nervous system. In a quantitative systematic review, Collins et al40 reported favorable PDN treatment results with anticonvulsants. In the included studies, all having a crossover design, an average of 63% of the participants reported at least 50% pain relief during anticonvulsant treatment compared with 39% during the placebo phase. Many anticonvulsants have been used to treat PDN, but the 2 that are currently most prescribed are gabapentin and lamotrigine. Findings from several studies using gabapentin dosages ranging from 900 to 3600 mg d suggest that gabapentin is superior to placebo52 and equivalent to and prinzide. Step 3 1 Fill each column from 1 to 10 the microtitration plate with 100 mL from each of the tubes containing the corresponding concentration. Thus, ll column 1 from the tube containing 16 mg L, column 2 from the tube containing 8 mg L, and so on until column 10 is lled from the tube containing 0.03 mg L. 2 Each well of column 11 and 12 should be lled with 100 mL of RPMI 2% glucose double strength. 3 Thus, each well in columns 110 will contain 100 mL of twice the nal antifungal drug concentrations in double-strength RPMI 2% G with 1% DMSO. Columns 11 and 12 will contain RPMI 2% G Figure 3a ; . 4 Alternatively, use a multichannel pipette to ll the microtitration plate from the 12-well pipette reservoir Figure 3b. Table 1 Drugs that induce liver enzymes and relevant associated drugs that do not induce liver enzymes Type of drug Anti-epileptic Liver enzyme induction Carbamazepine Oxcarbazepine Phenytoin Phenobarbital Primidone Topiramate Rifampicin Rifabutin Griseofulvin Effect Reduction in ethinylestradiol EE ; and progestogens2831 No liver enzyme induction Ethosuximide Gabapentin Lamo6rigine Levetiracetam Valproate Vigabatrin All other antibiotics narrow- and broadspectrum Fluconazole Itraconazole Ketoconazole Antiretroviral Protease inhibitors Amprenavir Atazanavir Nelfinavir Lopinavir Saquinavir Ritonavir Non-nucleoside reverse transcriptase inhibitors Efavirenz Nevirapine Reduction in EE and progestogen. Additional or alternative contraceptive methods advised with hormonal contraception79 Reduction in EE and progestogen but additional or alternative contraceptive methods advised with hormonal contraception79 Protease inhibitors Indinavir No clinically significant interaction79 Effect No reduction in EE or progestogens3236.

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Parable, and considerably greater than that from the parental cells. This was not a consequence of different initial intracellular concentrations, as all three cell lines were loaded to the same extent approximately 300 pmol 106 cells ; . The inset shows the relative rates of efflux mediated by MRP4 and MRP5 cells after subtraction of efflux from the parental line. The influence of various inhibitors at subtoxic concentrations ; on PMEA efflux is shown in Fig. 5, and the concentrations inhibiting MRP4 and MRP5 by 50% IC50 values ; are summarized in Table 3. Of the commonly used inhibitors of organic anion transport, probenecid inhibited PMEA efflux by MRP5 at much lower concentrations IC50, 200 M ; than those needed to inhibit MRP4 IC50, 2300 M ; , as did sulfinpyrazone to a lesser extent relative IC50 values 300 and 420 M, respectively ; , whereas benzbromarone inhibited both transporters equally Fig. 5A ; . In contrast, MK571 readily.
Exploration besides stomach perforation a large trichobezoar was removed form the stomach of the patient the tail of which was extended to the duodenum, a rare presentation of trichobezoar called Rapunzel syndrome. Peritonitis is very uncommon complication of trichotellomania reported so for in the literature as most of the cases which have been reported as a consequence of trichotellomania are with intestinal obstruction, dyspepsia or with malabsorption. After recovery from surgery her psychiatric exploration has been done. G. B. initially has denied about her habit of trichotellomania and trichopahgia. However when the rapport has been established she admitted her habit of eating her own hairs while she was below 8 years. She was having a sedentary trichotellomania and trichophagia with no compulsive element. She had childhood neurotic traits like nail biting and bed witting till age 7 years. On this psychiatric consultation she was found to be having Moderate Depressive Disorder for the last 2 years, instigated after her marriage. Significant psychosocial stressors were found to pave way for her depression. She has been started with Escitalopram10mg along with cognitive behavioral psychotherapy. On her follow up visits she is significantly improved in her depressive symptoms. She is advised to come regularly for follow ups. The multidisciplinary approach, psychiatric profile and discussion regarding management of trichotellomania have been discussed in this case. YFCC.6 Lamotr8gine Induced Hypomania Ayfle Baflterzi Mersin University Medical Faculty Psychiatry Department, Mersin, Turkey Lamotrigine has been evaluated as acute and maintenance therapy for bipolar disorder in a number of clinical trials. This case report highlights lamotrigine-induced hypomania and suggests hypomania as a genuine side-effect of lamotrigine. Ms. SB is a years-old married woman. Her main complaints were fatigue, feeling depressed and increased need for sleep for the past three weeks. She also complained of increased appetite, lack of energy, heaviness in her arms and decreased libido. In 1999, she experienced her first manic episode after the delivery of her son. She was treated with lithium during this episode, which she is still using as 900 mg daily. So far, she experienced two depressive and one hypomanic episode until this last depressive episode. Lamotrigine 25 mg day was added to her ongoing treatment and titrated to 50 mg day at second week. After one week at 50 mg day, she noted an elevation in mood, increased energy, decreased sleep 24 hours per night ; , distractibility, mood lability and increased spending. This clinical picture was fulfilling ICD-10 criteria for hypomania. Lamotrigine was then stopped and olanzapin 10 mg daily was added to lithium. After two weeks, symptoms of hypomania subsided. Our patient's hypomanic switch after lamotrigine addition is an evidence for lamotrigine's potential antidepressant properties, likely through its ability to decrease glutamate release 2 ; . It should be kept in mind that lamotrigine, a drug increasingly used in the treatment of bipolar depression, may induce hypomanic manic switch in patients with bipolar disorder. YFCC.7 A Case of ' Doctor Shopping' Syeda Ruksheda Mumbai, India Diagnostic dilemmas have often plagued psychiatrists the world over. I present and discuss a case with the onset of depressive symptoms that developed psychotic features within three weeks!
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