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The use of cerebroprotein hydrolysate in dementia: A case series of 25 cases seen in a tertiary general hospital
Mosam Phirke, Avinash Desousa, Nilesh Shah, Sushma Sonavane, Anup Bharati
July-December 2014, 1(2):106-109
Background: Cerebroprotein hydrolysate (Cerebrolysin) is a pharmacological and neurotrophic agent that has been used widely in the management of various forms of dementia. Purpose: The present paper presents a retrospective chart review of 25 patients with dementia visiting a tertiary general hospital psychiatry unit who received cerebroprotein hydrolysate as an add on treatment for dementia. Materials and Methods: Twenty-five patients were administered 20 doses of cerebroprotein hydrolysate intravenously at a dose of 60 mg in 250 ml normal saline over 1-2 h after a test dose on 20 consecutive days. The cognitive assessment was done before the first injection and after the last dose using the Adenbrook's Cognitive Examination-Revised (ACER) and the Mini Mental Status Examination (MMSE). Results: There was significant improvement in scores on the ACER and MMSE, although the final scores remained in the dementia range. None of the patients experienced any major side effects. Conclusions: Cerebroprotein thus is a useful pharmacological option in the management of dementia and warrants further study and exploration.
  23,116 611 -
Late-life psychosis: An overview
Naresh Nebhinani, Vrinda Pareek, Sandeep Grover
July-December 2014, 1(2):60-70
There could be multiple causes for late-life psychosis, such as chronic conditions, like early-onset schizophrenia, late-onset schizophrenia, delusional disorder, psychosis associated with various dementias, various neuropsychiatric disorders, delirium, and secondary to organic causes. This article will provide an overview of late-life psychosis by elaborating different types of psychotic disorders usually seen in the elderly population. Psychosis associated with dementia and delirium is usually accompanied by cognitive symptoms. Organic Psychosis is usually characterized by higher prevalence of visual hallucination. There are few well-designed randomized controlled evaluating the efficacy of atypical antipsychotics for management of various forms of psychosis in elderly and there is a black box warning for using atypical antipsychotics in elderly patients with dementia.
  11,687 1,545 -
Depression in elderly: A review of Indian research
Sandeep Grover, Nidhi Malhotra
January-June 2015, 2(1):4-15
To review the existing literature on depression among elderly arising from India. Search was carried out using PubMed, Google Scholar, Google, and Medknow search engines to identify the relevant studies. Most of the literatures that are available are in terms of prevalence of depression. Community-based studies involving 70 to 7,150 elderly subjects report prevalence rate varying from 8.9% to 62.16%. Clinic-based studies involving 50 to 5,260 participants report prevalence rates ranging from 42.4% to 72%. Studies have reported depression to be more common among females. Other demographic factors that have been associated with depression among elderly include being unmarried, divorced or widowed elderly, residing in rural locality, being illiterate, increasing age, lower socioeconomic status, and unemployment. Depression has also been shown to be associated with various psychosocial factors, lifestyle and dietary factors, and presence of chronic physical illness. There are limited data on various therapeutic interventions. Available data suggest usefulness of pranayam, cognitive behavior therapy, and electroconvulsive therapy. The review of data suggests that prevalence of depression among elderly in India is high. However, there is lack of data on symptom profile and limited data is available on various therapeutic interventions for the management of depression in elderly from India. There is urgent need to conduct large multicentric studies to fill this void in research.
  10,916 1,251 6
Reversible dementia in elderly: Really uncommon?
Damodar Chari, Ramjan Ali, Ravi Gupta
January-June 2015, 2(1):30-37
There has been a steady rise in the prevalence of dementia all over the world. Our understanding of the illness, as well as its etiopathology, has also improved. Dementias due to degenerative and vascular pathology form the most common types of dementias resulting in cognitive impairment. However, these conditions usually lead to irreversible impairment and cause significant morbidity and mortality among patients. On the other hand, there is a group of conditions among elderly, where dementia follow a reversible course provided these conditions are picked and managed early. Few common causes of reversible dementias are Vitamin B12 deficiency, normal pressure hydrocephalus, thyroid dysfunction, anticholinergic medications, depression, etc. This review will discuss all these conditions with reference to their presentation, diagnosis, and management.
  10,641 830 1
Late-life mania: A brief review
Priti Singh, Nisha Mani Pandey, Sarvada Chandra Tiwari
July-December 2015, 2(2):68-73
There is a relative lack of evidence relating to specific etiology and management of late-onset bipolar illness and first episode mania in the elderly. This is despite a significant number of older patients presenting with this condition and a potential increase in prevalence with steady growth of the elderly population all over the world. There are also several distinct features of late-life mania that distinguish it from the adult onset manic presentation. Also, clinical diagnosis of late life mania may be difficult to establish at times due to the presence of several comorbidities and the potential overlap of symptomotology with other common disorders such as delirium and dementia. This review attempts to summarize the current knowledge of bipolar affective disorder, specifically late onset mania in the elderly and consider important factors that need to be accounted for its diagnosis, investigation, and management.
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Hyponatremia and psychotropics
Swapnajeet Sahoo, Sandeep Grover
July-December 2016, 3(2):108-122
Psychotropic-induced hyponatremia is one of the most common electrolyte abnormalities seen in routine psychiatric practice and is especially common in elderly subjects. Recent evidence suggests that even mild hyponatremia is associated with several detrimental effects in elderly. However, practicing clinicians often overlook hyponatremia due to lack of awareness about the incidence, presentation, and risk factors of psychotropic-induced hyponatremia. Available evidence suggests that all classes of psychotropics, i.e., antidepressants, antipsychotics, mood stabilizers, and sedative/hypnotics can lead to hyponatremia. Maximum evidence is available for antidepressant-associated hyponatremia. Various risk factors for hyponatremia include increasing age, female gender, low body weight, history of hyponatremia, low baseline sodium levels, summer season, initial phase of antidepressant use, early-onset psychiatric illnesses, longer duration of psychiatric disorder, prolonged admission, presence of comorbid medical conditions, concomitant use of diuretics, antihypertensives, and cytochrome P450 inhibitors. Awareness about this potentially life-threatening side effect and taking appropriate, timely steps can help in prevention of psychotropic-associated hyponatremia.
  5,346 534 -
Klismaphilia like behavior in late life
Avinash De Sousa
January-June 2015, 2(1):60-62
Klismaphilia is a sexual disorder under the group of paraphilias where sexual gratification is obtained by the use of enemas. It is rare paraphilia though anecdotal case reports are abound in literature. Most paraphilias are lifelong enduring patterns of behavior while some may be transient in nature. We present herewith a case of 66-year-old man who began to feel a sexual arousal during an enema that was administered for medical reasons and then began to use enemas regularly by himself and partner for sexual gratification. He was psychoeducated and showed a good response.
  5,417 181 -
Study of loneliness, depression and coping mechanisms in elderly
Nitin B Raut, Shipra Singh, Alka A Subramanyam, Charles Pinto, Ravindra M Kamath, Sunitha Shanker
January-June 2014, 1(1):20-27
Aims and Objectives: To study loneliness, depression and coping mechanism and the relationship between these factors in depressed and non-depressed elderly. Materials and Methods: Cross sectional study was done on 46 depressed and 48 non-depressed elderly were assessed clinically and using Geriatric Depression Scale-Short form [GDS-SF], loneliness scale, and brief cope scale. Statistical analysis was done using SPSS 20 software. Result: Mean GDS scores, mean loneliness (emotional and social) scores of depressed patients were higher than that of non- depressed, and this difference was found to be statistically significant [GDS: t = 14.33, p<0.001, loneliness Score: t = 7.23, p<0.001]. Self-distraction (mal-adaptive-passive) was the most commonly used coping mechanism in depressed group, while in the non-depressed group active coping (adaptive) was most common coping mechanism. Loneliness (emotional as well as social subscale) was a significant predictor of depression in both depressed and non-depressed group (Beta = .714, p<0.001) and (Beta = .629, p<0.001) and predicted 51% and 39% variance in depression respectively. Loneliness appeared as a distinct factor which seems to have a temporal and synergistic relationship with depression. Use of more adaptive coping mechanisms is associated with decrease in loneliness and depression while use of maladaptive coping mechanism is associated with decreased depression and loneliness in elderly. Conclusion: Loneliness is an important distinct factor in predicting depression in elderly. Coping mechanisms used, also affects loneliness and depression significantly.
  4,886 583 2
Sexuality in older adults: Clinical and psychosocial dilemmas
Isha Dhingra, Avinash De Sousa, Sushma Sonavane
July-December 2016, 3(2):131-139
The present review aims to throw some light on the various aspects of sexuality in older adults and the challenges faced by medical professionals working in this area. Keyword searches using the terms "sexuality," "sexual dysfunction," "geriatric," "old age," and others in combination were carried out on PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews. Relevant clinical trials, case studies, and review papers were selected. This was further supplemented with the clinical experience of the authors, who work with older patients in a psychiatric outpatient setting with a dedicated sexual disorders clinic. Sexuality is a lifelong phenomenon and its expression a basic human right across all ages. However, the construct of normalcy for sex in aging is blurred, with agism playing a distinct role. Older adults face much stigma when expressing sexual desires or concerns, both from their own families and the health-care system. Sexual dysfunctions due to comorbid medical illnesses and medications are often treatable. Evidence-based treatments for sexual dysfunction in the elderly, lesbian, gay, bisexual, transgender, and queer, and other orientations are especially underrepresented in research; available research has several limitations. Sexuality in people with dementia and sexual rights in nursing homes are gray areas. Medical training, treatment guidelines, and health-care facilities all need to be stepped up in terms of awareness and quality of care provided to the elderly with concerns related to sexuality.
  4,876 539 2
Leukocytosis associated with clozapine in elderly patient
Javed Ather Siddiqui, Shazia Farheen Qureshi, Muhammed Hamdi, Abdullah Alzahrani
July-December 2016, 3(2):182-184
Clozapine is the second-generation antipsychotic which is approved by the US Food and Drug Administration for the treatment of refractory schizophrenia. Clozapine is unfortunately associated with number of adverse effects, one of the chief concerns is agranulocytosis and occasionally leukocytosis, i.e. elevation of white blood cell count. In some cases, the leukocytosis may be persistent. We report the case of a 65-year-old patient diagnosed with schizophrenia, who also fulfilled the criteria of treatment-resistant schizophrenia, treated with clozapine as patient experienced leukocytosis.
  4,292 291 -
Adverse drug reactions due to antipsychotics and sedative-hypnotics in the elderly
Natasha S Kate, Shalaka S Pawar, Shubhangi R Parkar, Neena S Sawant
January-June 2015, 2(1):16-29
Psychotropic drugs are commonly used to manage mental and behavioral problems in geriatric patients. This is, however, accompanied by the risk of developing adverse drug reactions (ADRs), impacting the safety with which the drug can be used. In this article, we provide an overview of the factors associated with the ADRs due to psychotropic medication in the elderly, and the ADRs associated with the use of antipsychotics and sedative-hypnotics in the geriatric population. For this, literature searches were conducted through MEDLINE, PubMed, and Google Scholar using keyword terms: Geriatric, elderly, safety, adverse events, ADRs, antipsychotic, names of individual antipsychotics, benzodiazepine, sedative, hypnotic, zolpidem, zaleplon, zopiclone. Research data indicate that antipsychotics are associated with an increased risk of metabolic syndrome, thromboembolism, cerebrovascular and cardiac events, pneumonia, fractures, and increased mortality. Among antipsychotics, aripiprazole seems to have fewer ADRs while other antipsychotics (typical and atypicals) have reports of troublesome side effect profiles. Sedative-hypnotics are associated with a risk of falls, fractures, cognitive impairment, and may increase the risk of developing dementia with long-term use. The risk of these complications is present with both benzodiazepines and medications such as zolpidem and zopiclone.
  3,880 438 1
Alcohol use among the elderly: Issues and considerations
Rakesh Lal, Raman Deep Pattanayak
January-June 2017, 4(1):4-10
Alcohol use typically begins in the adolescence and peaks over the adulthood. However, its abuse is not as uncommon among the elderly though it tends to be under.recognized. Certain age.related physiologic, biologic, and psychosocial issues pose unique challenges in the diagnosis as well as management of alcohol use disorders in the elderly. Indian studies. .. specifically focusing on elderly substance users. .. are few. Screening should be a crucial component during clinical encounters with elderly populations across a variety of settings. Depending on the extent, nature and pattern of use, the elderly persons may need less intensive, brief interventions to more intensive inpatient care for safety concerns. Emphasis should always be on age.specific treatments delivered by trained personnel using nonconfrontational approaches.
  3,776 413 2
Perception of old age and self: A comparative study of elderly females living in community and in old age home
Shipra Singh, Nitin B Raut, Alka A Subramanyam, Ravindra Kamath, Charles Pinto, Sunitha Shanker
January-June 2014, 1(1):32-37
Aims and Objectives: To study and compare the perception of old age and self in elderly women living in community and in old age homes. Materials and Methods: By using a cross sectional study design 60 elderly females (30 each from community and old age homes) were assessed using a semi-structured proforma and an interview questionnaire. Data was qualitatively analysed and frequency computation was done. Results: The elderly women living in community had more of an attitude of 'acceptance' towards old age and 'generativity' was a part of ageing for them. They were found to be more satisfied with life and had better emotional support, whereas elderly in old age home perceived better instrumental support. Conclusion: Both community living and living in an old age home, have certain positive aspects. From a perspective of future policies and outreach services, it would be interesting to note the same and use best of both the worlds to provide the best for the elder in either setting.
  3,798 323 1
Role of Vitamin D in schizophrenia in elderly patient
Javed Ather Siddiqui, Shazia Farheen Qureshi, Yousef Bin Ahmed Shawosh
January-June 2018, 5(1):65-67
Vitamin D deficiency is common in the patient with mental illness such as schizophrenia; several environmental risk factors for schizophrenia, such as season of birth, latitude, and migration, have been linked to Vitamin D deficiency. Recent studies have suggested a potential role of Vitamin D in the development of schizophrenia, for example, neonatal Vitamin D status is associated with the risk of developing schizophrenia in later life. Here, we report a case of Vitamin D deficiency presenting with schizophrenia. Vitamin D supplementation is promising treatment strategy to prevent relapse to improve psychotic symptoms, and physical health in patients with schizophrenia should be further explored in future studies.
  3,800 295 -
Steroid induced mania in an elderly patient
Sandeep Grover, Swapnajeet Sahoo, Sunil Dogra, Deepak Ghormode
July-December 2014, 1(2):115-117
In the present context, steroids are important therapeutic agents used in the management of various diseases. Existing literature suggests that various steroids are associated with psychiatric manifestations such as psychosis, depression, mania, dementia/cognitive impairment, delirium, etc. However, reports of such associations among elderly are limited. In this report, we present the case of an 80-year-old male who developed mania while taking dexamethasone and required management with olanzapine.
  3,724 224 -
Successful aging
Sandeep Grover
July-December 2016, 3(2):87-90
  1,685 2,132 -
Elder abuse: Need for awareness
Sandeep Grover
July-December 2015, 2(2):65-67
  1,331 2,406 -
Cognitive reserve: Concept, determinants, and promotion
Charles Pinto, Kirti Yeshwant Tandel
January-June 2016, 3(1):44-51
Maintenance of cognitive function in old age has become increasingly desirable to a human society with an aging population. Various studies have shown that there is major variation in the clinical manifestations and severity of cognitive aging as a result of neurodegenerative changes that are similar in nature and extent. These mismatches led to the emergence of the concept of cognitive reserve (CR), which focuses on the adaptability and the flexible strategies of the brain that allow some people to cope better than others in the circumstance of age-related or Alzheimer's disease (AD)-related pathology. It is believed that CR is mainly influenced by an individual's education, intellect, mental stimulation, participation in leisure activities, dietary preferences, and social stimulation. These determinants of CR help in slowing the rate of memory decline in the normal aging process and also reduce the risk of developing AD. The role of functional neuroimaging has recently gained importance in the context of understanding the neural basis of CR and its relationship to aging-related behavior changes. Future research in this field may enable earlier detection and thus reduction in the prevalence of age-related cognitive changes and AD. This article is a review of the neurobiology of CR, the concept of CR, and the promotion of preserving CR by analyzing its determinants along with their implementation against its deterioration toward cognitive loss and disorders.
  3,164 420 -
Differential diagnosis for cognitive decline in elderly
Om Prakash, Shailesh Jha
January-June 2016, 3(1):21-28
Cognitive decline has a spectrum of presentations, which manifest from normality as part of senility to the established form of various neurodegenerative illnesses causing dementia. Understanding these various differential diagnoses is of great clinical significance as they have different management and interventional strategies. The neuropsychological deficits which are identified should follow known neuropathological disease patterns that helps in distinguishing different types of cognitive impairment to established dementia. It is important to look at different cognitive impairment in elderly with core diagnostic sense to define severity, type of cognitive impairments, identifying patients need for accommodation or adaptation, associated risks, effectiveness of therapies and predict mortality. This would help clinicians to identify and plan management based on individual needs in cases with variable cognitive impairment.
  3,185 302 -
Substance use disorders in the elderly: A review
Siddharth Sarkar, Arpit Parmar, Biswadip Chatterjee
July-December 2015, 2(2):74-82
The population of elderly substance users is gradually increasing over the years in India due to the aging population and changing demographics. Hence, clinicians are likely to encounter a larger proportion of elderly substance users with time. This narrative review aims to provide an overview of the substance use disorders in the elderly with a focus on the Indian population. The epidemiology of substance use disorders in the elderly is discussed, as is the unique features of specific substances of use in this population. The overlay of medical comorbidities in the elderly substance users is highlighted. This is followed by the discussion of the key issues in the assessment and management of elderly substance users. The directions of future research in this field are subsequently highlighted.
  2,832 560 2
Delirium-most prevalent mental disorder: Still a clinical orphan?
Sandeep Grover
July-December 2014, 1(2):57-59
  1,175 2,164 -
Benzodiazepine abuse among the elderly
Shalini Singh, Siddharth Sarkar
July-December 2016, 3(2):123-130
Benzodiazepines belong to the hypnotic-sedative class of drugs which have anxiolytic, sedative, and hypnotic properties. These drugs have been in clinical use for at least half a century. The propensity for development of dependence, especially on prescription benzodiazepines, coupled with the risk of falls and cognitive impairment due to benzodiazepines makes the elderly population susceptible to adverse outcomes with the use of benzodiazepines, and hence, cautious use is desired in this population. This review discusses the various aspects pertaining to benzodiazepine abuse in the elderly including pharmacology, prevalence of abuse, adverse consequences of benzodiazepine abuse, and subsequently assessment and management of elderly patients with benzodiazepine abuse.
  2,849 340 2
Study of perceived and received social support in elderly depressed patients
Bhushan Patil, Neha Shetty, Alka Subramanyam, Henal Shah, Ravindra Kamath, Charles Pinto
January-June 2014, 1(1):28-31
Aims and Objectives: To determine the relationship between depression, perceived and received social support. Materials and methods: Forty elderly (age >60 yrs) subjects were assessed for depression and social support using Berlin Social Support Scale. Result: Significant negative correlation was seen between perceived social support and depression (r = −.413; P < 0.01). There was no significant correlation between depression and received social support. Conclusion: Perception of social support in elderly is affected by depression. Adequate treatment of depression which improves negative cognition would help in the perception of social support for elderly subjects who are depressed and aid in recovery.
  2,801 303 -
Mild cognitive decline: Concept, types, presentation, and management
Alka A Subramanyam, Shipra Singh
January-June 2016, 3(1):10-20
As advancements are being made in the medical field, the average life span is increasing and more complaints related to the elderly are coming into notice. Of these, mild cognitive decline (MCD) or mild cognitive impairment (MCI) is recently becoming an increasingly recognized entity that is often considered a precursor of dementia but is found to have other outcomes as well. It also has variations in presentations; it does not present only as memory complaint but also in the form of other cognitive or behavioral manifestations and has always been a point of controversy regarding the objectivity of the diagnosis. It is considered as the appropriate stage for intervention to prevent its progression to dementia and therefore, requires early identification for which various diagnostic modalities such as neuroimaging, neuropsychological tests, and biological markers are considered. Currently, there are no specific treatment guidelines for MCD. Drugs used in Alzheimer's disease (AD), lifestyle modifications, and other nonpharmacological approaches have shown some benefit in MCI but the results are variable; hence, the need for further research is warranted for effective preventive therapy. In this article, we will be discussing MCD as a clinical construct, evaluation of a person suspected of having MCD, and management of the same.
  2,694 406 -
Forbidden fruit in the golden years: Elderly sexuality
Telkar Srinivasa Sathyanarayana Rao
January-June 2014, 1(1):8-13
  2,704 211 -