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   Table of Contents - Current issue
January-June 2019
Volume 6 | Issue 1
Page Nos. 1-34

Online since Friday, August 16, 2019

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Loneliness: Does it need attention! p. 1
Sandeep Grover
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Mental health policy for elderly p. 4

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Reminiscence therapy in geriatric mental health care: A clinical review Highly accessed article p. 7
Pragya Lodha, Avinash De Sousa
Reminiscence therapy (RT) has been used over the past two decades extensively in the management of patients with dementia and geriatric depression. The following review study looks at the current role of RT in geriatric patients from a clinical perspective. The review elucidates the concept of reminiscence and looks at the historical aspects of RT. It also looks at the taxonomy and classification of the various types of reminiscences and RT techniques. The difference between reminiscence and life review is discussed. There are sections that look at the clinical role of RT in the management of patients with dementia and geriatric depression. The role of art therapy as a form of RT is discussed and elaborated. The existing literature on RT is reviewed, and certain recommendations for RT are made. There is also a slight deliberation on the need for RT in Indian settings. The role of RT as positive geriatric mental health intervention is also discussed.
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Identifying multiple domain memory impairment in high-risk group for Alzheimer's disorder p. 14
Susmita Halder, Akash Mahato
Introduction: Occasional lapses in memory in elderly people are often considered as normal aging process and not a warning sign of serious mental deterioration or Alzheimer's disease (AD). When memory loss becomes so pervasive and severe that it disrupts daily activities, it becomes a signal for early AD. As the disease is irreversible and progressive in nature, identification of persons with high risk of developing AD is becoming a priority. The objective of this study was to identify and characterize the deficits in the memory performance of patients who presented with memory difficulties, without any other significant cognitive decline, and identified with high risk. Subject and Methods: Consecutive patients of both sexes in the age range of 55–70 years, who presented with problem in memory, were screened on the Mini–Mental State Examination and further assessed on the Dementia Rating Scale. Patients identified with high risk for AD were assessed for their memory profile using the PGI Memory Scale and further compared with healthy controls. Results: The high-risk group performed significantly lower than controls in domains of recent memory, delayed recall, verbal retention for dissimilar pairs, visual retention, and recognition. Conclusion: Multiple memory domains are affected in high-risk group for AD. Although they did not qualify to be diagnosed with AD, their memory profile is distinct with healthy controls and may be indicative of proneness for the disease.
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Mild cognitive impairment – A hospital-based prospective study p. 19
Shiva Shanker Reddy Mukku, Mathew Varghese, Srikala Bharath, Keshav Janakiprasad Kumar
Background: Mild cognitive impairment (MCI) is regarded as a transitional state between normal aging and dementia. It may progress to dementia, remain same, or revert to normalcy. Most western studies report an annual conversion of 10%–15% of MCI to dementia. There is a paucity of literature on prospective studies on MCI in India. Objective: The objective is to prospectively study the cognitive status of MCI patients at least 1 year after their diagnosis. The other objective was to find the conversion among the MCI patients to Alzheimer's dementia. Methodology: We followed up persons with MCI above 50 years evaluated in the Geriatric Clinic of National Institute of Mental Health and Neurosciences (NIMHANS) between 2012 and 2014, reassessed their cognitive abilities (neuropsychological measures) 1 year later, and compared them with earlier assessment and the conversion rate among this sample. Hindi Mental Status Examination (HMSE), Everyday Abilities Scale for India (EASI), NIMHANS neuropsychological battery for Indian elderly, and Clinical Dementia Rating (CDR) scale instruments were used for assessment. Results: Twenty-seven persons with a diagnosis of MCI were contacted. Twenty-one participated and underwent repeat clinical and neuropsychological evaluations. The mean duration of follow-up was 1.43 (standard deviation: ± 0.46) years. Six participants (28.6%) had progressed to mild Alzheimer's disease (AD) based on EASI, CDR, and neuropsychological scores, 15 (71.4%) retained their MCI status, and none had reverted back to normal status. The mean age of converters (progressed to mild AD) was 72 ± 5.69 years and nonconverters (remained as MCI) was 72.6 ± 7.16 years. Multiple medical comorbidities were found in both the groups with hypertension being the higher in converters (P = 0.04). Among the converters compared to nonconverters, there was a significant decline in total word list learning (P = 0.006), design construction copy (P = 0.042), total figures canceled in figure cancellation test (P = 0.009), and total omissions on figure cancellation test (P = 0.02). Discussion and Conclusion: Scores on episodic memory, attention, and visuospatial skills were low in the MCI compared to normal controls to start with – there was a further significant decline in few of these parameters over the follow-up. The conversion rate in our study was 28.6% for 1.43 years, which is higher compared to the western studies. Executive function learning and memory were the domains predominantly affected in the converters compared to nonconverters. The study based on tertiary hospital and help seeking with a specialist by those who perceived/were perceived to worsen could be probable reason for this higher rate. Higher medical comorbidities, lower HMSE scores, and executive function and memory at baseline are found to increase the risk of progression to AD.
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Pregabalin misuse in a 75-year-old woman p. 26
Avinash De Sousa
Pregabalin is a drug that has been used in the management of partial epilepsy, generalized anxiety disorder, neuropathic pain, and fibromyalgia. Recently, it has found usefulness in the management of alcohol withdrawal. The use of pregabalin in the elderly is scarce, and data on the same are not easily available. We report herewith the case of pregabalin misuse in a 75-year-old woman with depression and anxiety.
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Risperidone-induced skin rash in an elderly female p. 28
Mansi Shah, Sagar Karia, Heena Merchant, Nilesh Shah, Avinash de Sousa
Skin reactions have been reported with various antipsychotic drugs in scientific literature. It is important that clinicians be watchful of skin reactions in the elderly with antipsychotic medication, which can be an uncommon occurrence. It has been documented that the elderly are more prone to skin reactions with various forms of medication. We herewith report a case of skin reaction with risperidone in an elderly female patient.
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Prognostic implications of late-onset primary tic disorder in an elderly male: A case report p. 31
Suyash Dwivedi, Sujita Kumar Kar
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Aripiprazole worsening visual hallucination in a patient with lewy body dementia p. 33
Sujita Kumar Kar, Suyash Dwivedi
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