Bipolar Affective Disorder Research Articles

Hair cortisol concentrations in pregnant women with bipolar, depressive, or schizophrenic spectrum disorders

PurposeMaternal cortisol levels in pregnancy may support the growth of or adversely affect fetal organs, including the brain. While moderate cortisol levels are essential for fetal development, excessive or prolonged elevations may have negative health consequences for both the mother and the offspring. Little is known about predictors of altered hypothalamic–pituitary–adrenal (HPA) axis activity during pregnancy. This study examined maternal hair cortisol concentration (HCC) in the 3rd trimester of pregnancy in relation to severe psychopathology.MethodsHair samples were collected from 69 women, 32 with a lifetime diagnosis of severe mental disorders (bipolar I or II disorder, moderate or severe depressive disorder, schizophrenic spectrum disorder), and 37 non-clinical controls. Hair samples were collected during the 3rd trimester, and liquid chromatography tandem mass spectrometry was used for cortisol assessment. Psychiatric diagnosis and current level of symptomatic functioning were assessed using the structured clinical interview from the DSM-5 and the global assessment of functioning scale.ResultsWomen with a lifetime diagnosis of severe mental illness had significantly elevated HCC compared to controls. Poorer current symptomatic functioning was also significantly associated with elevated HCC in pregnancy.ConclusionsThe implications of alterations in HCC on both maternal and infant health need further study.

Psychiatric Onset in Wilson's Disease: A Case Report

Wilson's disease is a rare autosomal recessive disorder resulting from a loss of function of adenosine triphosphatase secondary to a mutation. This leads to a decrease or absence of copper transport in the bile and its accumulation in organs, particularly the brain. It can manifest initially as hepatic, neurological, or psychiatric disorders in at least 90% of patients. Cases appearing beyond the age of 50 are rare. In some patients, central nervous system involvement can be predominant, presenting as behavioral disorders, depression, or psychosis indistinguishable from schizophrenia or manic-depressive psychosis. Diagnostic criteria include low ceruloplasmin, Kayser-Fleischer ring, low serum copper, and high urinary copper. Genetic testing can be done through familial linkage analysis or direct genotypic diagnosis. We present an original clinical case where the onset of Wilson's disease presents as a late-onset psychotic episode. Although rare, Wilson's disease is crucial in psychiatry, as psychiatric manifestations may precede somatic symptoms, aiding in early diagnosis. Early diagnosis is vital, as the disease is fatal without specific treatment.

Kleine-Levin syndrome and bipolar affective disorder: a case report

Kleine-Levin syndrome and bipolar affective disorder: a case report

Utilization of Cultural Formulation Interview to understand the factors affecting treatment adherence and help-seeking in mood disorders: A qualitative study from Western India

Introduction: Treatment adherence rates among patients of affective disorders remain sub-par across the world. Sociocultural factors affecting the same remain poorly understood. The current study aimed to explore and conceptualize the same. Methodology: The study utilized a qualitative grounded and phenomenological approach study design. The patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders – Fifth edition (DSM-5) criteria of unipolar depression or bipolar affective disorder, and were presently under our treatment for at least three months and currently in remission, aged 18-60 years, and were able to understand Hindi or English, scored less than 6 on the Medication Adherence Rating Scale were included. Furthermore, key caregivers were also included in the study. Using purposive sampling and data saturation, a total of 30 participants were recruited. In-depth interviews were conducted using the cultural formulation interview as given in DSM-5, which was used as the interview tool. Thematic analysis of data was performed using Atlas.ti version 8.4.3. Results: A total of 14 themes (deductive and inductive) emerging from 171 codes were identified. Some of the important inductive themes included cultural and societal attitude toward illness and treatment-seeking, trust, experience, and expectations from available health care, faith healing-related practices and beliefs. The implicit themes such as cultural understanding of the problem and cultural factors affecting help-seeking, also showed prudent findings. Conclusion: The study findings demonstrate the various features of the sociocultural milieu and identity of an individual and family that have an influence on treatment-seeking behavior.

Longitudinal dynamics between anxiety and depression in bipolar spectrum disorders.

Anxiety and depression are common among individuals with bipolar spectrum disorders (BSDs), with anxiety being a risk factor for depression and vice versa. While the harmful effects of these symptoms are well recognized, their temporal dynamics have not been fully tested. To address this gap, our study investigated bidirectional relationships between anxiety and depression in individuals with BSDs using data from the Prechter Longitudinal Study of Bipolar Disorder, collected over an average of 11 years. We included 651 participants with various BSD subtypes (BD I, BD II, BD not otherwise specified, and schizoaffective bipolar type), with at least 5 years' data for adequate statistical power in detecting temporal dynamics. Bimonthly measurements of anxiety and depression were analyzed using dynamic structural equation modeling. Beyond assessing autoregressive and cross-lagged effects, this study also investigated whether temporal dynamics differed based on demographic characteristics and the use of psychiatric medication. Our findings revealed that individuals with BSDs experienced significant fluctuations in anxiety and depression over time. In addition, we found significant autoregressive and cross-lagged effects of anxiety and depression. Comparison of the cross-lagged effects demonstrated that anxiety had a greater effect on subsequent depression than vice versa. Age and marital status impacted cross-lagged and autoregressive effects. Specifically, older participants had stronger temporal associations between depression and subsequent anxiety, while widowed participants exhibited a heightened impact of depression on subsequent depression. These results underscore the importance of early identification and integrative interventions aimed at addressing both anxiety and depression to mitigate subsequent symptoms in BSDs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evolution of Concepts of Differential Diagnostics in Frontotemporal Dementia

Background: frontotemporal dementia (FTD) is a group of neurodegenerative diseases, with onset usually in presenile age, the clinical picture is manifested by behavioral disorders and relatively intact cognitive features in the initial disease. In the early stages of FTD, it is difficult to differentiate this type from other dementias or other mental diseases. The aim was to analyse recent scientific publications on the problem of differential diagnostics of frontotemporal dementia. Material and methods: using the keywords “frontotemporal dementia”, “frontotemporal lobar degeneration”, “differential diagnosis of frontotemporal dementia”, “behavioral variant of frontotemporal dementia”, selected and analyze publications for the last two decades. Results: the behavioral variant of FTD (bv-FTD) is the most common form of FTD, accounting for 50% of all cases of FTD, and especially in cases with early onset. Predominantly, this variant of FTD presents diagnostic difficulties, due to the limited accuracy of neuroimaging examinations and the lack of specific biomarkers. The clinical symptoms of bv-FTD are characterized by considerable overlap with symptoms of neurodegenerative diseases and mental diseases, such as schizophrenia, bipolar affective disorder, obsessive-compulsive disorder, and personality disorders. Conclusion: the diagnosis of FTD at the initial stage of the disease is problematic and difficult, the sensitivity and specificity of almost all diagnostic methods increase as the disease progresses. This literature review highlights some of the diagnostic methods that can be used in suspected cases of FTD and informs about the differential diagnostics recommendations that have been developed to improve the accuracy of FTD diagnosis.

A Scoping Review: Is Yoga an Effective Intervention for Erectile Dysfunction and Premature Ejaculation?

There is increasing concern among both healthcare professionals and the general public about the long-term effectiveness and possible adverse effects of medicines used to treat premature ejaculation (PE) and erectile dysfunction (ED). There is also a growing recognition of the advantages of incorporating alternative or traditional approaches into healthcare systems. Yoga is gaining popularity globally and has emerged as a viable adjunct and alternative to add value to patient care and prevention of illnesses, which requires further investigation. This scoping review aimed to explore the effects of yoga as an independent or adjunct intervention in treating ED and PE. In this review study, researchers conducted a systematic literature review from 2000 to 2023 as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases of Scopus, Google Scholar, Web of Science, and PubMed were used for literature searches. Studies published in the English language on male individuals with ED and PE and those with comorbid stress, anxiety, and depression were also included. Studies on these sexual dysfunctions, comorbid with HIV/AIDS, and severe psychiatric conditions, i.e., schizophrenia, bipolar affective disorders, and substance dependence, except alcohol, were excluded. Ten studies out of the 2016 selected articles met the inclusion criteria and were included in the final analysis. The findings of this scoping review revealed that yoga interventions are more effective in managing PE and ED, with a greater emphasis on the former. Yoga is an effective, safe, and affordable approach recommended for managing erectile functions and PE. Men can improve their quality of life and regain confidence in sexual functioning by incorporating yoga into their routines. The study shows the potential benefits of yoga for both conditions, indicating the need for further robust studiesin this area. Researchers advocate practising yoga under professional supervision for optimal safety and guidance.

KAJIAN PENGGUNAAN DAN EFEK SAMPING RISPERIDONE DI RUMAH SAKIT JIWA GRHASIA YOGYAKARTA

Risperidone is an atypical antipsychotic indicated for acute and chronic schizophrenia and mania. A study found that the use of risperidone as a therapy for acute schizophrenia was 25.32%. Side effects of risperidone include insomnia, anxiety, headache, and extrapyramidal symptoms. With the high use of risperidone and the many possible side effects, it is necessary to study the drug. This study aims to describe the use and side effects of risperidone at the Ghrasia Mental Hospital Yogyakarta. This research is non-experimental research using a descriptive design. Data were collected retrospectively from medical records of a patient who received risperidone prescriptions at the Grhasia Mental Hospital Yogyakarta January-December 2019. Sampling used the purposive sampling technique, and 360 samples were obtained. The incidence of side effects was analyzed using the Naranjo algorithm. The use of risperidone at the Ghrasia Mental Hospital Yogyakarta showed that patients improved 25.83%, patients improved but had to control 71.17%. The incidence of side effects was 15% of the total 360 patients taking risperidone. The most common side effects were tremor (4.72%), insomnia 2.50%, nausea 1.67%, and vomiting 1.39%. Side effects were treated with 65% additional therapy, 22% no additional therapy, and 13% drug discontinuation. Conclusion: The use of risperidone at Ghrasia Hospital Yogyakarta shows good effectiveness with a 15% incidence of side effects that are handled properly

Social cognition across the schizophrenia–bipolar disorder spectrum

Social cognition across the schizophrenia–bipolar disorder spectrum

Occurrence of postpartum manic or mixed episodes in women with bipolar I disorder: A systematic review and meta-analysis.

Accurate information on the frequency and prevalence of manic or mixed episodes is important for therapeutic, prognostic, and safety concerns. We aimed to estimate the risk of relapse of manic and mixed episodes after delivery in women with bipolar I disorder or schizoaffective disorder-bipolar type. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search in PubMed, PsycINFO, Embase, and Cochrane databases was carried out on November 17, 2022, using the terms ((bipolar disorder) OR (manic depressive illness)) AND (mania)) AND (postpartum)) AND (recurrence)) AND (relapse). The search was updated on March 29, 2023. Case studies and qualitative analyses were excluded. Twelve studies reporting on 3595 deliveries in 2183 women were included in the quantitative analysis. The overall pooled estimate of postpartum relapse risk was 39% (95% CI = 29, 49; Q(11) = 211.08, p < 0.001; I2 = 96.31%). Among those who had a relapse, the pooled estimate of risk for manic and mixed episodes was 38% (95% CI = 28, 50; Q(11) = 101.17, p < 0.001; I2 = 91.06%). Using data from the nine studies that reported the percentage of medication use during pregnancy, we estimated a meta-regression model with the percent medication use as a continuous explanatory variable. The estimated prevalence of relapse was 58.1% (95% CI, 9.6 to 39.3 to 76.8) for studies with no medication use and 25.9% (95% CI, 10.5-41.3) for studies with 100% medication use. The difference between the two prevalence estimates was statistically significant, z = -2.099, p = 0.0359. Our findings suggest an overall pooled estimate of postpartum relapse risk of 39%, while the pooled estimate of risk for manic and mixed episodes was 38%. These findings highlight the need to educate patients with bipolar I disorder, and their healthcare professionals about the high risk of relapse of manic or mixed episodes after delivery.

Qualification and predictors of the development of affective disorders in multiple sclerosi

Affective disorders occupy one of the leading places in the structure of comorbidity in multiple sclerosis, but the questions concerning etiopathogenesis, qualification, diagnosis, and prediction of these disorders remain controversial. The most important consequences of affective disorders in MS include a decrease in the patient's quality of life, adherence to treatment, and their daily activities, and an increased risk of suicide and death from cardiovascular diseases. In this regard, the need for early detection and prediction of the development of depression in patients with MS is obvious. The following factors are considered among the predictors of the development of emotional distress and affective disorders: social, psychological, demographic, neurocognitive, and treatment-related factors, neuroimaging data, lifestyle features, comorbidities, characteristics of multiple sclerosis and its social implications. Specifically, younger age at the time of diagnosis, the presence of dyssomnia, fatigue, consumption of dairy products, atrophy of cortical areas in the frontal lobes, and decreased white matter volume of the uncinate fasciculus predict the development of depression. This article reviews the features of depressive and bipolar spectrum disorders in patients with MS.

Dissociation, “OCD IN REVERSE” and unfulfilled schizophrenia. Case of Alsu B.

The article describes a rare clinical case of severe histrionic personality disorder featuring manifestations of an atypical obsessive-compulsive disorder (“obsessive-compulsive disorder in reverse”), which led to an erroneous diagnosis of schizophrenia and classification of the patient as disabled. Over an eight-year period of psychiatric observation, the girl was given many different diagnoses in leading Russian and foreign clinics — from somatoform, hypochondriac and obsessive-compulsive disorder to schizophreniform disorder, bipolar affective disorder and paranoid schizophrenia with an emotional and volitional defect. The article substantiates the diagnosis of histrionic personality disorder and the incorrectness of other diagnoses. The article also provides a brief review of the literature regarding the comorbidity of dissociative and obsessive-compulsive disorders.

Hypothalamic Subunit Volumes in Schizophrenia and Bipolar Spectrum Disorders.

The hypothalamus is central to many hormonal and autonomous nervous system pathways. Emerging evidence indicates that these pathways may be disrupted in schizophrenia and bipolar disorder. Yet, few studies have examined the volumes of hypothalamic subunits in these patient groups. We compared hypothalamic subunit volumes in individuals with psychotic disorders to healthy controls. We included 344 patients with schizophrenia spectrum disorders (SCZ), 340 patients with bipolar disorders (BPD), and 684 age- and-sex-matched healthy controls (CTR). Total hypothalamus and five hypothalamic subunit volumes were extracted from T1-weighted magnetic resonance imaging (MRI) using an automated Bayesian segmentation method. Regression models, corrected for age, age2, sex, and segmentation-based intracranial volume (sbTIV), were used to examine diagnostic group differences, interactions with sex, and associations with clinical symptoms, antipsychotic medication, antidepressants and mood stabilizers. SCZ had larger volumes in the left inferior tubular subunit and smaller right anterior-inferior, right anterior-superior, and right posterior hypothalamic subunits compared to CTR. BPD did not differ significantly from CTR for any hypothalamic subunit volume, however, there was a significant sex-by-diagnosis interaction. Analyses stratified by sex showed smaller right hypothalamus and right posterior subunit volumes in male patients, but not female patients, relative to same-sex controls. There was a significant association between BPD currently taking antipsychotic medication and the left inferior tubular subunits volumes. Our results show regional-specific alterations in hypothalamus subunit volumes in individuals with SCZ, with relevance to HPA-axis dysregulation, circadian rhythm disruption, and cognition impairment.

Prevalence and Sociodemographic Correlates of Psychotic and Mood Disorders among the Population in Bungoma County, Kenya

Mental, neurological, and substance use disorders (MNS) pose a significant global health challenge, affecting a quarter of the world's population and contributing to a substantial portion of the global disease burden. Access to essential treatment remains challenging, particularly in low and middle-income countries (LMICs). This study focuses on the scarcity of mental health resources in Kenya, particularly in Bungoma County, where community-level perspectives are often overlooked. The research aims to bridge this gap by investigating the prevalence and sociodemographic correlates of psychosis and mood disorders in the region, aligning with the World Health Organization's call for holistic mental health services. The study was conducted in Bungoma County, Kenya, and employed a descriptive cross-sectional design. The study population was 1,670,570 as per the Kenya census 2019. The sampling strategies used were purposive, stratified and simple random sampling with a sample size of 762 respondents. A stratified random sampling method ensured representation from each sub-county, maintaining proportionality based on population size. The study utilized the MINI International Neuropsychiatric Interview (MINI) for screening, a structured diagnostic psychiatric interview, and conducted structured interviews with trained research assistants. Statistical analyses, including descriptive, bivariate, and multivariate analyses were performed to determine prevalence and sociodemographic correlates. Among 762 respondents, 78.2% met the lifetime criteria for at least one of the four screened mental health conditions. Depression was the most prevalent (73.8%), followed by bipolar mood disorder (13.8%) and psychosis (1.8%). Sociodemographic factors significantly associated with these disorders included marital status, employment status, and income. Male persons were at a higher risk of experiencing psychosis and mood disorder (odds 1.37); the odds of youths having psychosis and mood disorder was higher (odds 1.42); low-income earners of less were 1.685 times likely to experience psychosis and mood disorder and people who lived alone were 1.641 times more likely to suffer psychosis and mood disorder. This study underscores the urgent need for targeted mental health interventions in Bungoma County, Kenya. It emphasizes the prevalence of mental health conditions and the sociodemographic factors influencing them. The findings highlight the importance of considering the local context in mental health interventions, aligning with global calls for holistic, community-driven mental health services.

Assessing Quality of Life: A Comparative Study among Patients with Schizophrenia, Bipolar Affective Disorder, and Healthy Control in a South Indian Tertiary Care Setting

Aim: To assess and compare the quality of life (QOL) of patients with schizophrenia, bipolar affective disorder (BPAD) patients and healthy control.&#x0D; Methods: This is an observational study carried out in MVJ Medical College and Research Hospital, Bengaluru, India. The WHOQOL-BREF questionnaire was administered to 139 patients with schizophrenia and 139 patients with BPAD that were diagnosed according to the ICD-10 diagnostic criteria, as well as 139 healthy subjects all of whom gave their informed consent. The data were analyzed using SAS 9.2 software.&#x0D; Results: On comparing the three groups, the schizophrenia group scored the least in the physical (53.51±19.36), psychological (51.32±21.37) and environmental health domains (55.59±17.78). The QOL of the BPAD group was comparable to that of the healthy control group and significantly better as compared to that of the schizophrenia group (P&lt;0.0001).&#x0D; Conclusion: The study shows that patients with schizophrenia had significantly lower QOL than patients with BPAD and healthy subjects. Our study emphasizes the significance of addressing psychiatric patients' overall health and QOL in addition to symptom management.

Depressive disorder, bipolar disorder, and associated factors among adults, in the Eastern part of Ethiopia

BackgroundDepressive disorder is one of the severe and common mental illnesses in the general population. Bipolar disorder is a severe, persistent mental illness associated with significant morbidity and mortality. However, there is a paucity of data on the prevalence of depressive disorder, and bipolar disorder in our study area.ObjectiveThis study aimed to assess the prevalence of depressive and bipolar disorders among adults in Kersa, Haramaya, and Harar Health and Demographic Surveillance Sites in Eastern Ethiopia.MethodsA community-based cross-sectional study was conducted among 1,416 participants. A multi-stage sampling was employed to select the participants. DSM-5 diagnostic criteria was used to assess depressive disorder and bipolar disorder. Data was collected using a standard questionnaire. Data were entered into Epi-Data 3.1 and analyzed using SPSS version 26. Both binary and multivariate logistic regression analyses were done. Those with a p-value < 0.05 in the final model were considered statistically significant.ResultsThe overall prevalence of depressive and bipolar disorders among our study participants was 6.7% (95% CI: 5.40, 8.20) and 2.1% (95% CI: (1.40, 3.00), respectively. The independent predictors of depressive disorder included a family history of mental illness, chronic medical illnesses, unemployment, low educational status, divorced or widowed, poor social support, and current alcohol use or khat chewing. Single, males, divorced or widowed, and current consumers of alcohol were independent predictors for bipolar disorder.Conclusions and recommendationThe results of our investigation showed that bipolar illness and depression were significant public health issues. It was shown that although bipolar disorder is highly prevalent in the society, depression is a widespread concern. As a result, it is imperative that the relevant body grow and enhance the provision of mental health services. Furthermore, research on the effects and burdens of bipolar disorder in the community is required.

The prevalence and associated characteristics of Bipolar Disorder diagnosis among admitted patients at three tertiary psychiatric hospitals in Zimbabwe: A cross sectional study.

Bipolar Affective Disorder (BD) is a serious condition that affects more than 1% of the world's population. If not treated can cause disability, yet its prevalence in Zimbabwe is not known. This study explores the burden of Bipolar Disorder and its associated factors in Zimbabwe. A cross sectional study with a sample of 272 participants was carried out at three tertiary hospitals in Zimbabwe. Data was collected using an interviewer administered questionnaire and the Mini International Neuropsychiatric Interview (M.I.N.I). The study shows the prevalence and factors associated with Bipolar Disorder at tertiary psychiatric hospitals. Data analysis was done using STATA S/E 13.0 for data management. The prevalence of BD in the sample was 39.3%. Factors associated with BD were, being formally employed (AOR = 3.69, 95%CI: 1.55-8.79), a history of defaulting medications (AOR = 1.90, 95%CI: 1.02-3.57) and a reported previous diagnosis of BD (AOR = 5.66, 95%CI: 2.72-11.8). The prevalence of BD among admitted participants in tertiary psychiatric hospitals in Zimbabwe is high. It is comparable to that from African studies done in clinical settings. There is need for in-service training for clinicians to be more vigilant in diagnosing BD.

Contextualizing Late Holocene Subsistence Change on California’s Northern Channel Islands: A Middle Period Case Study from Santa Cruz Island

ABSTRACT The complex relationship between sociopolitical complexity, natural climatic change, and subsistence strategies on California’s Northern Channel Islands has long been a topic of archaeological inquiry. One period of particular interest to researchers is the Middle-to-Late Period Transition (MLT, 800–650 cal BP), during which Chumash hierarchical sociopolitical organization is thought to have solidified. Multiple models of sociopolitical change have been proposed, all of which acknowledge the relationship between growing populations, shifting dietary patterns, climatic events, and sociopolitical structure. Considerable debate remains, with some pointing to the importance of events during the late Middle Period (∼1,500–800 cal BP) or earlier. While these models partly rely on dietary data from late Middle, MLT, and Late Period (650 cal BP–AD 1542) archaeological sites, research at late Middle Period sites has often been more limited than work at later sites, leaving an imbalance in our understanding of subsistence shifts and changing cultural and environmental dynamics. Here, we present faunal and dietary data from two well-dated Middle Period sites on Limuw (Santa Cruz Island) that document an intensification of finfishing in the Middle Period, supporting models that see the evolution of Island Chumash complexity as a more gradual phenomenon.

Bipolar affective disorder occurring with psychopharmacotherapy-induced manic phases

To analyze the stages of development of the problem, identify the evolution of views and the main directions of current research in the field of bipolar affective disorder, which occurs with psychopharmacotherapy-induced manic phases, the search for publications by keywords «pharmaco-induced mania»", «bipolar affective disorder» was carried out in the PubMed/MEDLINE, Russian Citation index and other sources from the mid-19th century to the present. The issue of adequate treatment of bipolar depression became relevant back in the 20th century; numerous observations indicated the presence of associated risks when using antidepressants in patients with bipolar affective disorder, namely, the likelihood of affect inversion and aggravation of the course of the disease (accelerated cyclicity, continuum). In recent years, due to the expansion of research capabilities and the introduction of biological psychiatry, works have appeared that consider this problem from both clinical and pharmacodynamic, genetic and neurophysiological aspects, which opens up the prospect of developing advanced methods of personalized medicine for the diagnosis and treatment of bipolar disorder, taking into account the need to minimize iatrogenic effects.

New onset gender dysphoria in bipolar affective disorder - A case series

Gender confusion in the context of mania is very less frequently described in the literature. The actuality of a primary psychiatric condition in gender identity complaint has significant bearing on the applicable operation and prognostic. This case series describes cases of bipolar affective complaint presenting in a manic occasion whose mania was marked by hypersexuality and the desire to be of opposite gender. Both of these symptoms resolved with treatment of the manic occasion. Case 1 describes a 17-year-old male presenting with an episodic illness, with current manic episode. He is currently interested in boys and has started enjoying feminine activities. Upon treatment, his symptoms showed improvement. Case 2 describes a 22-year-old gay male, with a total duration of 7 years, current episode mania. Now, he is considering himself a lesbian and feels he is mentally a modern female. After 4 months of treatment, there was significant improvement in his complaints and he stopped cross-dressing as a female. Case 3 shows a 21-year-old female, with manic episode. After 1 month, the patient began acting and speaking more like a boy. The patient has shown improvement while taking lithium 900 mg, divalproex sodium 1000 mg, risperidone 6 mg, and chlorpromazine 150 mg. Gender dysphoria occurring along with a psychotic episode and resolving with management of the primary psychiatric disorder are rarely recorded. The central issue in similar cases is a proper workup and diagnosis. Psychiatrists should be aware of this scenario so that proper treatment strategies for gender incongruence can be planned and not be brushed aside as “just another symptom.”