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Background: Unrecognized bipolar spectrum disorder under cover diagnosis of major depression disorder leads to wrong medications (antidepressants in absence of mood stabilizer), which may switch to mania. Aim and Objectives: A study was to identify unrecognized bipolar disorder in patients of major depressive disorder taking antidepressants. Materials and Methods: This is an observational and cross-sectional study of 150 patients previously diagnosed as major depressive disorder taking antidepressants from tertiary care hospital. Patients were assessed by proforma containing demographic details, Questionnaire of mood disorder questionnaire (MDQ), and Hamilton depression rating scale (HAMD) followed by clinical interview according to DSM-5 to confirm diagnosis. Statistical analysis was done. Results: We found 6.67% depression patients screened positive on MDQ for bipolar disorder and diagnosis is confirmed by interview according to DSM-5. MDQ positive patients have early age of onset of depression(P=0.0109), long duration of depression(P=0.0478), presence of previous suicide attempt(P=0.0130), and family history of bipolar disorder(P=0.0361). No statistically significant difference was observed between mean HAMD score and severity of depression between MDQ positive and negative group. Conclusion: Among patients prescribed antidepressants for depression, there is a substantial proportion with unrecognized bipolar disorder and most of them had never received diagnosis of bipolar disorder. When seeing patients with depression disorder, clinicians should review the life history for screening of unrecognized bipolar disorder by looking for early age onset of depressive episode and long lifetime duration of depression, previous suicide attempt, and family history of bipolar disorder.

Objective: Social anxiety disorder (SAD), (also known as social phobia), is characterized by intense fear of social interaction and often associated with social avoidance and impairments. There is high risk for depression, substance use disorder, and suicide among them. Subjects and Methods: It is an observational, cross-sectional, single centered, questionnaire-based study assessing the frequency of SAD and depression and their possible association with quality of life among 290 consenting medical undergraduate students. Social Phobia Inventory (SPIN), Beck's Depression Inventory (BDI II), and the World Health Organization Quality of Life assessment scale (WHOQOL-BREF) were used to screen and assess severity of SAD, depression, and quality of life, respectively. The statistical analysis of proportions was done by Chi-square test, while the scores of SPIN, BDI II, and WHOQOL-BREF was compared using Mann–Whitney test or Kruskal–Wallis test followed by Dunn posttest multiple comparison, using GraphPad InStat version 3.06. Results: Frequency of SAD is 11.37%, and depression is 8.96%. Females are more likely to experience SAD. Participants with SAD are more likely to experience depression (P < 0.0001) and have poor quality of life (P = 0.01). Participants with depression have higher SPIN score (P < 0.0001) and poor quality of life (P < 0.0001). Females are more likely to experience social fear (P = 0.02). Participants staying away from their family are more likely to experience social anxiety in comparison to their peers (P = 0.01). Severity of depression is correlated with severity of social anxiety (Spearman r = 0.4423 [0.3416–0.5329], P < 0.0001). Conclusion: Participants with SAD are more likely to experience depressive symptoms and have poor quality of life and vice versa.

Neuroleptic malignant syndrome is an acute, life-threatening medical complication caused by antipsychotics. It is commonly seen with typical antipsychotics and very rare with atypicals. Cases have been reported with quetiapine also, but this case is of special interest because it occurred in patient who was stable on maintenance quetiapine 200 mg/day for last 5 years.