Objective: The commonest age of onset for Trichotillomania is between 9 to 13 years of age and at times triggered by Depression and stress. According to literature, the best treatment is a combination of clomipramine and Cognitive Behaviour Therapy. The objective of this index case is to present a patient with an older age of onset, and with co-morbid intellectual disability and the challenges faced during treatment because of the comorbidity. Methods: A case of Intellectual disability who presented with Trichotillomania, and Trichophagia was chosen and followed up for a period of three years. Results: The hair-pulling behaviour in the index case was due to a strong urge, which was relieved by the behaviour and was not secondary to other symptoms. The course of trichotillomania was independent of the course of aggression as improvement in aggressive symptoms was not accompanied by improvement in hair-pulling behaviour, which responded to administration of Imipramine, though it did not improve with clomipramine and citalopram, which are the medications of choice. Conclusion: The index case suggests customizing treatment according to individual suitability, and choosing a medication that the patient is comfortable with, is important. It also suggests true comorbidity between Intellectual Disability and Trichotillomania, as the symptom of trichotillomania was not secondary to the aggressive behaviour exhibited by the patient.

Schizophrenia is a complex, heterogeneous, and disabling psychiatric disorder that impairs cognitive, perceptual, emotional, and behavioural functioning. It has a worldwide prevalence rate of about 1%. There are a number of physical and mental illnesses which are co-morbid with schizophrenia and this article will include a brief description and management of some of the commoner ones. Similarly, it can be mimicked by several mental and physical illnesses and accurate diagnosis is important to reduce the disability associated with the illness. Morbidity and mortality is elevated in patients in Schizophrenia as compared to the general population. More than 50% of patients with schizophrenia have co-morbid psychiatric or medical conditions including impairment of cognitive function, depression, obsessive-compulsive behaviour, substance abuse, and aggressive behaviour, and these reflect on prognosis of both acute as well chronic schizophrenia.

Objective: The objective of these 4 case reports is to highlight that psychotic symptom can occur due to the consumption of sibutramine. The psychosis is usually self-remitting, once its consumption is stopped. Methods: All cases with first episode psychosis presenting to a tertiary mental health Institute in Singapore were screened and 4 consecutive sibutramine-induced psychoses cases are reported. Results: All the 4 cases that were diagnosed with Sibutramine induced psychoses, had history of consumption of the substance in the tablet form or in substances like slimming tea or slimming powders. In 2 out of the 4 cases, no antipsychotics were started. In the 2 cases that received antipsychotics, they were for short duration. There was a temporal association between the consumption of sibutramine containing substances and the onset of psychotic symptoms. All patients were on follow up for two years and in 2 patients, there were no recurrence of psychotic symptoms. In 2 patient recurrent psychotic symptoms were temporally related with consumption of sibutramine and symptoms remitted when the consumption was stopped. Conclusions: Despite sibutramine being banned in several countries, it can still be purchased from countries allowing its sale and from online stores. Labeling a patient having schizophrenia can be avoided if detailed history, specifically enquiring about the consumption of sibutramine is obtained.

INTRODUCTION: Few studies have investigated the factors that affect the relationship between body image dissatisfaction and disordered eating locally. Our study aimed to investigate the moderating effects of depression and anxiety levels on the body dissatisfaction-disordered eating link in Singapore. METHODS: A total of 329 participants completed a set of questionnaires that included various scales pertaining to eating behaviours, body image, psychological distress and quality of life. RESULTS: Participants were diagnosed with schizophrenia (47.4%), depression (46.8%) and substance use disorders (5.8%). Moderation analyses revealed that depression (F [9, 251] = 18.50, p < 0.001, R CONCLUSION Greater effort should be dedicated to the screening of disordered eating behaviours in psychiatric outpatients presenting with greater psychological distress.