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Manjri Singh,1 Parul Gupta,2 Richa Baronia,1 Priti Singh,1 Stalin Karuppiah,1 Rishi Shankar,3 Premendra D Dwivedi,2 Surinder P Singh1 1CSIR-National Physical Laboratory, New Delhi, 2CSIR-Indian Institute of Toxicology Research, Lucknow, Uttar Pradesh, 3Institute of Life Sciences, Ahmedabad University, Ahmedabad, Gujarat, India Abstract: We have synthesized graphene oxide (GO) nanosheets using modified Hummer’s method and conjugated it with doxorubicin (DOx), an anticancer drug. Drug release kinetics from GO–DOx conjugate indicated the drug release at acidic pH. MTT assay performed on FaDu hypopharyngeal cancer cell lines revealed that the GO–DOx nanoconjugate inhibited cell proliferation more efficiently compared with pure DOx. Preliminary results indicate the potential of designed GO–DOx drug conjugate for head and neck cancer. Keywords: graphene oxide, doxorubicin, nanomedicine, head and neck cancer

Richa Baronia,1 Manjri Singh,1 Rajat B Gupta,1 Stalin Karuppiah,1 Rajiv Kumar,2 Jodi Belz,2 Rishi Shanker,3 Srinivas Sridhar,2 Surinder P Singh1 1CSIR-National Physical Laboratory, Dr KS Krishnan Marg, New Delhi, India; 2Nanomedicine Science and Technology Center, Northeastern University, Boston, MA, USA; 3Institute of Life Sciences, Ahmedabad University, Ahmedabad, India Abstract: Gold nanoparticles, because of their high radiation absorption coefficient and efficient generation of secondary photoelectrons, have been predicted to enhance therapeutic efficacy in radiation therapy. However, high dose for effective treatment limits their use. We have synthesized multifunctional gold nanoclusters (GNCs) that can be used for imaging and radiation therapy. The designed GNCs have been characterized for their physicochemical properties, biocompatibility, and their radiation dose enhancement potential on PC3 cell lines. Keywords: gold nanoclusters, radiation therapy

Objective A well-established association exists between academic performance and levels of depression and anxiety among medical students. However, the effects of positive psychological factors on symptoms of depression and anxiety and academic performance have not been adequately studied. This study explores the relationship between the above variables and identifies positive psychological factors that can promote medical student wellbeing. Methods Medical students were surveyed at four time points during their first two years of medical education using Qualtrics. The surveys used a five-point Likert scale to assess students' levels of loneliness, religiosity, engaged living, life fulfillment, resilience, psychological wellbeing, and symptoms of depression and anxiety. Academic performance was measured using students' Comprehensive Basic Science Examination scores. Linear mixed effect models with maximum likelihood estimation were used to investigate the relationship between positive psychological factors and scores on depression and anxiety as well as the relationship between demographic and psychological factors and exam scores. Results Seventy-two students completed the study. A significant positive correlation was observed between loneliness and symptoms of depression and anxiety, while the same symptoms had significant negative correlations with engaged living. None of the positive psychological factors were significantly predictive of exam scores. Conclusion Our findings suggest that medical students who develop meaningful relationships and live engaged lives are less likely to develop symptoms of depression and anxiety. Our study lays the groundwork for future research focusing on identifying and implementing pre-clinical curriculum changes aiming to improve medical students' mental health., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Collins et al.)

Background: This study investigates the association between Methamphetamine (MA) intoxication and suicidal ideation/behavior in patients presenting to emergency departments. Amidst rising MA use and co-use with opioids, this "twin epidemic" has manifested in increasing admissions for MA intoxication, often accompanied by psychiatric symptoms that can escalate to suicidal behaviors., Method: This retrospective study utilized patient records and analyzed data from 629 patients admitted to a Texas emergency department in 2020, with MA intoxication confirmed via urine tests and patient interviews. The suicidal tendencies were assessed using the Columbia-Suicide Severity Scale. The 629 patients were divided into three groups for analysis: Group I ( n  = 188), MA positive with suicidal ideation (SI) (MA + SI+); Group II ( n  = 202), MA-positive without SI (MA + SI-); and Group III ( n  = 239), MA-negative with SI (MA- SI+). Multiple regression analysis was used to elicit clinical features predicting patients presenting to the emergency department with acute MA intoxication., Results: Results reveal that approximately half of patients with acute MA intoxication reported suicidal thoughts, indicating a significant association between MA use and suicidal tendencies. Females exhibited higher rates of suicidal thoughts, behavior, and subsequent medical attention compared to males. Sociodemographic characteristics and clinical features differed among MA-positive patients with and without SI. Multivariable regression analysis identified factors influencing MA use, including cannabis use, male gender, agitation, and an inverse association with alcohol use. Notably, the severity and potential lethality of suicidal behavior in MA-intoxicated patients paralleled those observed in psychiatric patients without MA use., Conclusion: These results underscore the urgent need for targeted interventions to address the complex interplay between MA use and suicidal risks in the emergency department setting, as well as broader public health strategies to combat the increasing prevalence of MA use.

Background: American youth are seriously impacted by depression and suicide. The Texas Youth Depression and Suicide Research Network (TX-YDSRN) Participant Registry Study was initiated in 2020 to develop predictive models for treatment outcomes in youth with depression and/or suicidality. This report presents the study rationale, design and baseline characteristics of the first 1000 participants., Methods: TX-YDSRN consists of the Network Hub (coordinating center), 12 medical school "Nodes" (manage/implement study), each with 1-5 primary care, inpatient, and/or outpatient Sub-Sites (recruitment, data collection). Participants are 8-20-year-olds who receive treatment or screen positive for depression and/or suicidality. Baseline data include mood and suicidality symptoms, associated comorbidities, treatment history, services used, and social determinants of health. Subsequent assessments occur every two months for 24 months., Results: Among 1000 participants, 68.7 % were 12-17 years, 24.6 % were ≥ 18 years, and 6.7 % were < 12. Overall, 36.8 % were non-Hispanic Caucasian, 73.4 % were female, and 79.9 % had a primary depressive disorder. Nearly half of the sample reported ≥1 suicide attempt, with rates similar in youth 12-17 years old (49.9 %) and those 18 years and older (45.5 %); 29.9 % of children <12 reported at least one suicide attempt. Depression and anxiety scores were in the moderate-severe range for all age groups (Patient Health Questionnaire for Adolescents [PHQ-A]: 12.9 ± 6.4; Generalized Anxiety Disorder [GAD-7]: 11.3 ± 5.9)., Limitations: The sample includes youth who are receiving depression care at enrollment and may not be representative of non-diagnosed, non-treatment seeking youth., Conclusions: The TX-YDSRN is one of the largest prospective longitudinal cohort registries designed to develop predictive models for outcome trajectories based on disorder heterogeneity, social determinants of health, and treatment availability., Competing Interests: Declaration of competing interest Dr. Trivedi has provided consulting services to Alkermes Inc., Axsome Therapeutics, Biogen MA Inc., Cerebral Inc., Circular Genomics Inc., Compass Pathfinder Limited, GH Research Limited, Heading Health Inc., Janssen, Legion Health Inc., Merck Sharp & Dohme Corp., Mind Medicine (MindMed) Inc., Merck Sharp & Dhome LLC, Naki Health, Ltd., Neurocrine Biosciences Inc., Noema Pharma AG, Orexo US Inc., Otsuka American Pharmaceutical Inc., Otsuka Canada Pharmaceutical Inc., Otsuka Pharmaceutical Development & Commercialization Inc., Praxis Precision Medicines Inc., SAGE Therapeutics, Sparian Biosciences Inc., Takeda Pharmaceutical Company Ltd., WebMD. He sits on the Scientific Advisory Board of Alto Neuroscience Inc., Cerebral Inc., Compass Pathfinder Limited, Heading Health, GreenLight VitalSign6 Inc., Legion Health Inc., Merck Sharp & Dohme Corp, Orexo US Inc., Signant Health. He holds stock in Alto Neuroscience Inc., Cerebral Inc., Circular Genomics Inc., GreenLight VitalSign6 Inc., Legion Health Inc. Additionally, he has received editorial compensation from American Psychiatric Association, and Oxford University Press. Dr. Blader reports having received consultant and speakers' honoraria from Supernus Pharmaceuticals. Dr. Brown has received consulting fees from Sage and Biogen Pharmaceuticals. Dr. Hughes reports receiving research funding to her institution from NIH and the American Foundation for Suicide Prevention (AFSP). She reports receiving support from the Society of Clinical Child and Adolescent Psychology, the Jed Foundation, and Mental Health in Mind, International AB, and consulting on quality improvement interventions for depression and suicidal/self-harm behavior. She receives book royalties from Guilford Press. Dr. Kennard receives royalties from Guilford, Press, Inc.; and serves on the board of trustees for the Jerry M. Lewis, III, MD Research Foundation. Dr. Soares has served as an advisor or consultant for Asofarma, Boehringer Ingelheim, Johnson & Johnson, Livanova, Pfizer, Pulvinar Neuro LLC, Relmada, Sanofi, and Sunovian. He has received research grants from Alkermes, Allergan, and Compass and holds less than U.S. $5000 in Atai Life Sciences stock. Dr. Soutullo reports for the period 2018–2022 non-personal research funds from Lundbeck and Janssen; is a consultant/advisory board member of Editorial Médica Panamericana, EUNETHYDIS (European Network on Hyperkinetic Disorder), NeuroTech Solutions Ltd. (Israel), Limbix Health DSMB (United States), MEDEA (Spain), Tech Innosphere Engineering LTD (Germany), and Shire/now part of Takeda (Spain); received speaker's bureau fees from Bial (Portugal), Cuquerella Medical Consulting (Spain), Medice (Germany), Rubio (Spain), Tecnofarma (Peru), and Shire/now part of Takeda (Spain), and royalties from Editorial Médica Panamericana (Spain). Dr. Storch reports receiving research funding to his institution from the Ream Foundation, International OCD Foundation, and NIH. He is a consultant for Brainsway and Biohaven Pharmaceuticals. He owns stock less than $5000 in NView. He receives book royalties from Elsevier, Wiley, Oxford, American Psychological Association, Guildford, Springer, and Jessica Kingsley. Dr. Wakefield serves as an Executive Committee Member of the Texas Child Mental Health Care Consortium. Drs. Minhajuddin, Slater, Baronia, DeFelippis, Farmer, Garza, Liberzon, Martin, and Mrs. Mayes have no declarations to report., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

In February 2020, the governing bodies of the United States Medical Licensing Examination (USMLE) announced the decision to change Step 1 score reporting from a three-digit system to pass/fail designation. Previous studies theorized that Step 2 Clinical Knowledge (CK) will become the numerical standard by which residency directors can quickly sort through program applicants. The goal of this study is to review prior research and identify significant factors associated with Step 2 CK outcomes. A systematic literature search on PubMed, Web of Science, Scopus, and ERIC that included articles published between 2005 and 2015 was conducted using the keywords "USMLE," "Step 2 CK," "score," "success," and "predictors." After screening the initial search yield of 3,239 articles, 52 articles were included for this review. Positively correlated factors included Step 1 score, clinical block grades, Comprehensive Clinical Science Self-Assessment (CCSSA), Comprehensive Clinical Science Examination (CCSE), and volunteerism. Factors such as clerkship sequence and pass/fail grading failed to correlate with Step 2 CK. Medical College Admission Test (MCAT) score (p < 0.01) and undergraduate grade point average (GPA) (p = 0.01) positively correlated, while age displayed a negative correlation. Additionally, females typically scored higher on Step 2 CK than their male peers. The study findings suggest that continuous learning and academic success throughout medical school positively influence eventual Step 2 CK scoring. Performance on USMLE practice examinations, Step 1, and clinical evaluations serve as positive predictors for Step 2 CK scores. Interestingly, changing answers and spending more time on each question during the examination were associated with higher scores., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Jacobparayil et al.)

This meta-analysis examined the efficacy of positive psychology interventions (PPIs) in treating depression in 11 articles. PubMed, Web of Science, and Clinical Key were used to identify papers published from 2010 to 2020 that utilized PPIs. Key terms were "positive psychology" and "treatment of depression." Studies on adults with (a) depressive symptoms or (b) diagnosed clinical depression were included. A random-effects model was used to compare PPIs and control groups on post- vs. pre-intervention differences in depression scores. Data analysis examined Beck Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), and Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) scores. Findings show PPIs are effective in treating depressive symptoms, with significant improvements in depression scores when compared to control groups in all but one study. This was true for both post- vs. pre-intervention (pooled Cohen's d = -0.44 (-0.77, -0.11)) and follow-up- vs. pre-intervention analyses (pooled Cohen's d = -0.46 (-1.02, 0.09)). PPIs can improve the accessibility and affordability of depression treatments., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Pan et al.)

In the development of direct methanol fuel cell (DMFC) the fabrication of an anode comprising of a Pt or Pt-based bi or tri-metallic alloys nanoparticles on a suitable support material having higher stability, higher surface area, electrical conductivity and strong interaction is very important. In the present work we have solved this problem by using a nanocomposite of reduced graphene oxide (rGO) and graphitic carbon nitride (g-C₃N₄) as the support material and deposited PtCo nanoparticles by in-situ chemical reduction. The electro-oxidation of methanol is carried out in an acidic medium. The electrochemical behaviour of as-synthesized PtCo/rGO-gC₃N₄ catalyst was found to be much superior to Pt/rGO-g-C₃N₄ catalysts towards electro-oxidation of methanol and is mainly due to the homogeneous dispersion of PtCo nanoparticles onto rGO-g-C₃N₄ nano composite, higher electrical conductivity and a strong interaction between metal nanoparticles and N group of the support material. By using the as-synthesized electro-catalyst the adsorption or poisoning of Pt due to CO is greatly reduced and more active Pt sites are created for the electro-oxidation of methanol. Thus, the as-synthesized electro-catalyst can be used as an efficient anode material in a direct methanol fuel cell.

Background: Antipsychotic drug use in children has doubled from 2001 to 2007 with concomitant increase in obesity. Second-generation antipsychotic (SGA) medication use is associated with weight gain, metabolic derangements, and blood sugar and lipid abnormalities in children. The American Psychiatric Association and the American Diabetes Association have recommended metabolic monitoring guidelines for patients using SGA., Study Question: The study objective was to investigate and compare metabolic monitoring for SGA medications in psychiatry (PSY), and pediatrics and family medicine [primary care providers (PCP)] outpatient clinics of a university medical center., Study Design: This is a retrospective study of 149 charts of patients newly prescribed with SGA, ages 5-18 years, from their initial visit in the outpatient clinics., Measures and Outcomes: Compliance with recommended metabolic monitoring was evaluated for initial and subsequent clinic visits. Parameters included body mass index, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile., Results: Of the 149 charts, 110 patients were in PSY and 39 in PCP. The parameter most regularly monitored was body mass index (baseline: PSY 88.3%, PCP 97.4%; 12 weeks: PSY 86.4%, PCP 85.0%; and 24 weeks: PSY 91.8%, PCP 100%). Fasting plasma glucose (baseline: PSY 18.9%, PCP 25.6% and 12 weeks: PSY 8.6%, PCP 10.0%) and fasting lipid profile (baseline: PSY 12.7%, PCP 25.6% and 12 weeks: PSY 7.0%, PCP 10.0%) had low completions rates. No difference was seen in metabolic monitoring by sex or ethnic group., Conclusions: Metabolic monitoring rate of child and adolescent patients on SGAs was low overall. No statistically significant differences were seen between psychiatry and PCP except a significantly higher rate of fasting plasma glucose level monitoring at baseline among PCP. Limitations to the study include the small sample size obtained for the period investigated and insufficient documentation in some electronic charts. Extending the period studied may increase the statistical significance of the data.

Plant-parasitic nematodes cause severe damage to the various agricultural crops, leading to economic losses for farmers. Therefore, identification and development of novel and environmentally benign nematicides is critically important. In this study, a silver nanoparticle (AgNP) formulation was synthesized, characterized, and investigated as a potential nematicide against rice root-knot nematode, Meloidogyne gramnicola , on rice ( Oryza sativa ). A series of lab assays (water and sand screening) and glasshouse experiments (using soilless system, autoclaved soil, and naturally infested soil) were conducted to examine the nematicidal effects of AgNP. The results from lab assays revealed 0.1 µg/ml as the minimum concentration for 100% irreversible nematode mortality after 12 hr in the water screening test. However, results from the sand screening test indicated 100% nematicidal effect of AgNP at 2 µg/ml after 24 hr of incubation. In glasshouse assays in soilless system of rice cultivation, 1 µg/ml concentration of AgNP applied directly to the trays achieved significant suppression of root gall formation. The effective dosage to kill nematodes in field soil assays was determined to be 3 µg/ml, which is lower than the value of 150 µg/ml reported in the literature. No visible adverse effect of AgNP was observed on seed germination or plant growth in all the experiments. The results indicate that AgNP has effective nematicidal activity against M. graminicola in rice., Plant-parasitic nematodes cause severe damage to the various agricultural crops, leading to economic losses for farmers. Therefore, identification and development of novel and environmentally benign nematicides is critically important. In this study, a silver nanoparticle (AgNP) formulation was synthesized, characterized, and investigated as a potential nematicide against rice root-knot nematode, Meloidogyne gramnicola , on rice ( Oryza sativa ). A series of lab assays (water and sand screening) and glasshouse experiments (using soilless system, autoclaved soil, and naturally infested soil) were conducted to examine the nematicidal effects of AgNP. The results from lab assays revealed 0.1 µg/ml as the minimum concentration for 100% irreversible nematode mortality after 12 hr in the water screening test. However, results from the sand screening test indicated 100% nematicidal effect of AgNP at 2 µg/ml after 24 hr of incubation. In glasshouse assays in soilless system of rice cultivation, 1 µg/ml concentration of AgNP applied directly to the trays achieved significant suppression of root gall formation. The effective dosage to kill nematodes in field soil assays was determined to be 3 µg/ml, which is lower than the value of 150 µg/ml reported in the literature. No visible adverse effect of AgNP was observed on seed germination or plant growth in all the experiments. The results indicate that AgNP has effective nematicidal activity against M. graminicola in rice.

Immigration and asylum-seeking are issues that have recently. warranted increased attention and significance. In the aftermath of terrorist attacks, people are more wary of asylum seekers who are usually held in detention centers after fleeing persecution and not for criminal or immigration charges. Asylum seekers may raise suspicions due to inconsistent statements and can be held in detention for the duration of the process and/or denied asylum. Inconsistencies may be influenced by psychiatric symptoms, cognitive abilities, the type of past trauma experienced, the questioning style of the interviewer, and are usually unrelated to dishonesty or malingering making psychiatric consult important in many of these evaluations., (Published by Elsevier Ltd.)

Justice-involved youth are at exceedingly high risk of trauma exposure, multisystem involvement, and mental health distress, including depression. Justice-involved youth carry with them both a high symptom burden and a high cost to society. Both could be reduced through evidence-based prevention and treatment strategies. Effective treatment of mental disorders may reduce future justice involvement, whereas lack of treatment increases likelihood of justice involvement into adulthood. Multiple effective programs exist to improve the lives of justice-involved youth and subsequently decrease the cost to society of detaining and adjudicating these youth within the juvenile justice system., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The higher methanol utilization efficiency in direct methanol fuel cell (DMFC) is one of the key parameter to show the performance of an anode catalyst. Here in, we have synthesized a highly efficient and stable PtCo anode nanocatalysts (2-4 nm size) supported on reduced graphene oxide (rGO) for the electro-oxidation of methanol in a DMFC. Three different compositions of anode catalysts PtCo (1:7)/rGO, PtCo (1:9)/rGO and PtCo (1:11)/rGO comprising of 20% metal loading by weight of rGO are being investigated for methanol electro-oxidation in acidic medium with different methanol concentration using cyclic voltammetry. The electrochemical response from three different catalysts revealed that the PtCo (1:9)/rGO catalyst has efficiently oxidized 5 M methanol in a half cell configuration. A peak anodic current density of 46.8 mA/cm² and a power density of 136.8 mW/cm² are achieved using PtCo (1:9)/rGO anode catalyst at 100 °C for DMFC with 5 M methanol supply with negligible amount of methanol crossover. About 34% Faradaic efficiency and 22% energy efficiency is attained using PtCo (1:9)/rGO anode catalyst for a DMFC. Further, the 3% methanol oxidation reaction (MOR) efficiency is attained as revealed by evaluating the MOR by-products i.e., formic acid and formaldehyde formation. The results indicate excellent catalytic behavior of PtCo (1:9)/rGO towards MOR and its potential application as anode catalyst in DMFC.

Incomplete methanol oxidation and rapid activity degradation of electro-catalysts are key barriers to successful commercialization of direct methanol fuel cell (DMFC). To address these problems, we report the synthesis of platinum-copper (PtCu) alloy nanoparticles supported on nitrogen doped reduced graphene oxide (N-rGO) as the anode catalyst for the efficient electro-oxidation of methanol. Catalysts with varying molar ratios of PtCu were fabricated using impregnation reduction method and their electrochemical performance was compared with the commercially available Pt/C (20 wt%) anode catalyst. The electro-catalytic activity of the synthesized PtCu (1:2)/N-rGO catalyst was found to be much higher to those that observed for Pt/N-rGO and Pt/C catalyst as revealed by cyclic voltammetry, electrochemical impedance spectroscopy and electron transfer measurements. The enhanced electrochemical activity of PtCu (1:2)/N-rGO catalyst is not only attributed to strong interfacial interaction between the nitrogen group of N-rGO and PtCu active metal phase but also to the altered electronic structure of Pt as a result of Cu alloying. This reduces the adsorption of CO and OH - species on Pt surface, thereby creating more Pt active sites for methanol electro-oxidation; thus faster kinetics is exhibited. These results indicate the potential application of PtCu/N-rGO catalyst as an anode material in a DMFC.

Objective: Wernicke's encephalopathy is caused by thiamine deficiency and occurs predominantly in alcohol-dependent individuals but also develops in those who are malnourished due to other reasons including medical and psychiatric disorders. This study examined the frequency rate and management of Wernicke's encephalopathy in alcohol-dependent and non-alcohol-dependent patients admitted to a psychiatric hospital., Methods: Data were retrospectively collected from electronic medical records of psychiatric inpatients admitted to a teaching hospital located in Texas between September 2013 and March 2014. The diagnostic criteria of Caine and colleagues and thiamine dosing strategies were used to identify cases of suboptimal management., Results: A total of 486 charts were reviewed. Nine patients (1.85%) had clinical signs of Wernicke's encephalopathy, and 36 (7%, n = 486) were at a high risk for developing the disorder. None of these patients received adequate doses of parenteral thiamine, and of those who were prescribed thiamine, the majority, including high-risk patients, were prescribed oral thiamine at the traditional dose of 100 mg/d., Conclusions: The findings suggest that Wernicke's encephalopathy is underdiagnosed and undertreated. Our study also highlights the need for clarifying diagnostic criteria, identifying the risk factors for thiamine deficiency, and improving awareness among physicians about diagnosis, prevention, and adequate treatment of Wernicke's encephalopathy in alcohol-dependent and non-alcohol-dependent patients., (© Copyright 2017 Physicians Postgraduate Press, Inc.)

Objective: The study collected data on the attitudes of residents toward religion and spirituality in their practice after taking part in a 3-year curriculum on spirituality during their residency., Methods: This is a descriptive, single-site study with psychiatry residents as subjects. A questionnaire was given to the residents at the end of their third year of residency (N = 12)., Results: The responses heavily endorsed the religiousness/spirituality curriculum to be helpful and meaningful. Residents consider addressing spiritual and religious needs of patients to be important (76.9%) and appropriate. For majority of the residents (69.2%), there is strong agreement in the management of addictions having spiritual dimensions. Residents also strongly agreed that treatment of suffering, depression, guilt, and complicated grief may require attention to spiritual concerns (92-100%)., Conclusion: Regardless of cultural or religious background, the residents endorsed the curriculum as a worthwhile experience and increased their appreciation of the place of spirituality in the holistic care of patients with psychiatric conditions.

This is a case of a 22-year-old Hispanic male with a history of bipolar disorder and methamphetamine dependence who was admitted after presenting with suicidal ideations by slashing his throat with a machete. The patient had been smoking and inhaling "processed" pyrethroid for about eight weeks as an inexpensive methamphetamine substitute. He reported experiencing a "rush" similar to methamphetamine after using pyrethroid from liquid insecticide that had been heated (electrocuted) or sprayed on hot metal sheets until it crystallized. The patient presented with no significant physical markings or findings but claimed to have his suicidal ideations precipitated by concerns of ill effects of pyrethroid on his health. He also had positive urine drug screen for methamphetamine, which he admitted to using on the day of admission. We conclude that it is important for physicians to maintain a high level of suspicion for alternate and uncommon substances of abuse as well as risks for suicidal tendencies in these patients.