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Objective: To evaluate the usefulness and degree of perfusion abnormalities in pediatric head injury patients by using computed tomography perfusion (CTP) and to assess its co-relation with neurologic outcome based on Glasgow Outcome Scale Extended Pediatric revision (GOSE-P)., Methods: Prospective evaluation of pediatric head injury patients who were taken for CTP after admission and then on discharge. We evaluated 5 regions of interest: orbitofrontal cortex, internal capsule, thalamus, caudate nucleus, and sensorimotor cortex for cerebral blood perfusion. The patient's clinical and radiologic findings were analyzed, correlated with cerebral blood flow (CBF) and MTT (mean transient time), and the outcome assessed using the GOSE-P scale on 3-month follow-up., Results: Both CBF and MTT showed a correlation with the GOSE-P scale. In mild head injury patients, the Pearson correlation of GOSE-P with mean CBF and mean MTT was -0.11 and 0.56, respectively (P < 0.05) in the sensorimotor cortex; in moderate head injury patients the Pearson correlation of GOSE-P with mean CBF in the caudate nucleus and mean MTT in the internal capsule was -0.32 and 0.36, respectively (P < 0.05); and in severe head injury patients, the Pearson correlation of GOSE-P with mean CBF and mean MTT was -0.78 and 0.56, respectively (P < 0.05) in the caudate nucleus, which had the highest Pearson co-relation among the regions studied., Conclusions: We conclude that CBF and MTT are 2 important radiologic parameters that can be used as prognostic indicators in pediatric head injury patients., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The concept of "absence of grief" in children has been embedded in psychoanalytic literature since its beginning. The clinical phenomenon of grief in a toddler is rarely described or analysed in the psychiatric literature. Early theorists felt that grieving does not occur until adolescence due to a younger child's psychological structure, including poor object-relations development. However, data on grief reaction in preschool children has mostly been under-reported or neglected, especially since most of the studies on childhood grief have been conducted on school-age children. We present a two-and-a-half-year-old girl, whose emotional and behavioural reactions to the loss of her grandfather became a focus of clinical attention. This report shows that even toddlers can mourn for their loved ones, although the expression and process of grief differ from that of older children and may occasionally draw clinical attention. Suggestions on how to investigate this phenomenon more closely and how to avoid it in socio-cultural contexts are proposed.

Anorexia nervosa is a condition thought to be associated with the western culture. However, the recent publication of a case series from Asia suggests that it is a syndrome related to a changing culture. We present a detailed clinical form of this syndrome based on descriptive analysis of 2 cases of anorexia nervosa. Both these patients were adolescent, school-going girls from middle socioeconomic class of urban background. They were pre-morbidly non-obese and did not have any pressures to pursue slimness for beauty. However, there was an identifiable psychosocial stressor as a precipitant in both of them. Both the patients had symptoms of refusal to eat followed by weight loss. We could not identify any risk factor in our patients for anorexia nervosa. Our report illustrates the differences in developmental and psychodynamic issues related to the development of anorexia nervosa, though the clinical symptoms may be similar.

Atomoxetine is the only FDA-approved non-stimulant to treat ADHD. We report a case of Atomoxetine-related exacerbation of nocturnal bruxism in a 12-yr old boy with ADHD, subsiding on discontinuing the drug, but re-worsening with retrial, finally subsiding upon adding Buspirone. This is the first report of its kind showing such an association, not included in any pre- or post-marketing data. Clinical implications and possible mechanisms are discussed.

There is very limited information available on the use of psychotropic drugs in consecutive pregnancies. The authors report a case of a woman with schizophrenia wherein risperidone was used successfully in two consecutive pregnancies. This is only the second known report in the existing literature in which atypical antipsychotic was used successfully in two successive pregnancies.

Poor outcome hebephrenic schizophrenia patients are clinically challenging. In this report, we demonstrate the usefulness of pimozide add-on thereapy to ongoing clozapine regime in a case who poorly reponded to clozapine, ECT and adequate trials with at least two conventional antipsychotics.