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   Table of Contents - Current issue
January-June 2020
Volume 7 | Issue 1
Page Nos. 1-66

Online since Monday, June 29, 2020

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COVID-19: A crisis for people with dementia p. 1
Aseem Mehra, Sandeep Grover
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Coronavirus disease 2019 and the elderly: Focus on psychosocial well-being, agism, and abuse prevention – An advocacy review Highly accessed article p. 4
Debanjan Banerjee, Migita Michael D’Cruz, TS Sathyanarayana Rao
Age and agism are significant vulnerabilities for the coronavirus disease 2019 (COVID-19). While the number of cases and fatalities rises throughout the globe, the elderly are prone both to the physiological and psychosocial aftermaths of the infection. As the focus on management is predominantly directed toward precautionary measures and searching for a biological cure, the mental well-being of this vulnerable population is unfortunately neglected. Besides being prone to isolation, loneliness, stress, grief, depression, and anxiety during the lockdown, the seniors are also victims of stigma, prejudice, and abuse, stemming from agism. Substance abuse-related complications and cognitive disorders are added concerns. Elder abuse in every form has particularly been concerning during the present pandemic. Especially those staying alone, those with sensory or cognitive impairment, and those institutionalized are at a greater risk. Considering the increasing number of aging population, such biological disasters can have notable acute and long-term consequences on overall health and well-being of the seniors, if not adequately cared for. A holistic care based on biopsychosocial model needs to be in force for elderly mental health care during the pandemics, supplemented by research to shape policies. Keeping this in background, the advocacy review glances at the unique challenges that the older adults face during COVID-19 with special focus on psychosocial well-being, agism, and abuse. It also highlights the important facets for elderly care and abuse prevention during such crises.
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Depression and somatic symptoms in dementia: A narrative review p. 11
Shiva Shanker Reddy Mukku, Geetha Desai, Santosh K Chaturvedi
Dementia is an irreversible progressive degenerative disease with cognitive impairment. Cognitive impairment eventually leads to impaired activities of daily living and premature mortality. Apart from cognitive symptoms, nearly two-thirds of dementia patients have behavioral problems commonly known as behavioral and psychological symptoms of dementia (BPSDs). Depression and dementia have a complex relationship. Depression is a risk factor, prodrome and as well as a BPSD symptom in dementia. Depression in dementia is known to cause decreased quality of life and poor outcomes. Depression though common in dementia it is often under-recognized and treated. Somatic symptoms are further less studied BPSD in dementia. With the changes in nosology and criteria for somatic symptoms disorders in the classificatory system, there is renewed interest in somatic symptoms in dementia. In this article, we discuss about depressive and somatic symptoms in patients with dementia along with assessment and management.
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Virtual reality and its therapeutic uses in the elderly: A narrative clinical review p. 21
Pragya Lodha, Avinash De Sousa, Sagar Karia
Virtual reality (VR) as a form of therapy has made rapid strides in the field of psychiatry and neurorehabilitation. This paper is a narrative clinical review that provides an overview of the use of VR therapy (VRT) in care for elderly. It covers various uses of VR in elderly care that span from dementia, neurorehabilitation, and stroke to role of VR in psychotherapeutic management for the elderly. The uses of VR as therapy for dementia and various areas that it focuses on such as executive function, cognition, memory, and visuospatial navigation are discussed. The role of VRT in cognitive training and motor rehabilitation after stroke along with exergames is analyzed as well. The paper also looks at VR as a part of the treatment for treatment-resistant hallucinations and geriatric depression. Using VR as an adjuvant to psychotherapy and in reminiscence therapy is also discussed. The article ends by discussing the advantages and disadvantages of VR in the elderly along with future research needs in the area.
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Identifying suicidal risk and its association with depression in the elderly population p. 29
Susmita Halder, Shreya Manot
Background: With increased life expectancy and improved health-care facilities, the number of elderly persons is on the rise worldwide. According to the population census 2011, there are nearly 104 million elderly persons in India, who face several physical and mental health challenges, suicide being one of them. Increased life expectancy, rapid urbanization, sociocultural factors, changing family setups, and lifestyle changes have led to an emergence of varied problems, the most alarming being suicide among the elderly, which often goes unnoticed due to inadequate expression. Further, the risk of suicide increases with depression, which tends to be common among elderly people. Many a times, the indicative signs of depression in the elderly are missed and attributed to usual complaints associated with aging. It has become important to understand the suicidal ideation and behaviors in the elderly, for identifying the risk factors and further facilitating prevention. The present study aims to explore suicidal ideation and behavior among the elderly population. Materials and Methods: A total of 110 individuals of both genders aged 60 years and above were included in the study. The General Health Questionnaire-12 was administered for screening, the Geriatric Depression Scale, and Suicidal Behaviors Questionnaire-R were administered to assess the presence of depression and suicidal behavior, respectively. Results: The results of the study show the presence of suicidal ideation and behavior in 42.72% of the individuals; it was also found to be more among males. Conclusions: Thus, these findings implicate that the elderly are at a considerable risk for suicidal behaviors, which warrants attention for early identification and subsequent psychosocial intervention.
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Comparison of depression among the elderly in a selected semiurban and rural community of Haryana, North India: A cross-sectional survey p. 33
Sudesh Kumari, Jaison Joseph
Background: Depression in the elderly is one of the most common rising mental health problems worldwide. The prevalence of geriatric depression is relatively sparse as per the epidemiological studies conducted in the Indian setting. Aim: The present study compares the depression among the elderly in a selected semiurban and rural community of North India. Materials and Methods: The present study was conducted among 400 elderly in a selected semiurban and rural community setting of North India. The participants were included as per the predetermined criteria using a convenient sampling method. Geriatric depression scale 15 Hindi version (GDS-15) was used for the assessment of depression. Results: The overall prevalence of geriatric depression (GDS-15 score >5) was found to be 10.5% (95% confidence interval [CI]: 7.8–13.8). Of the 400 individuals, the proportion of the elderly who were at risk of developing depression was higher in the rural area (46.19%; 95% CI: 39.5–52.9) as compared to the semiurban area (22.1%; 95% CI: 16.79–28.53). The presence of chronic illness had an independent association with depression in the elderly residing in the rural setup (adjusted OR: 3.584; 95% CI: 1.399–9.178). Conclusion: The study showed a significantly higher burden of depression in rural geriatric population as compared to the semiurban setting. Considering the rapidly increasing population of older aged people in India, epidemiological data regarding the prevalence of depression form the mainstay for proper health planning.
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Problems and strain of caregivers of urban older adults: An exploration p. 38
Rakesh Kumar Tripathi, Shailendra Mohan Tripathi, Nisha Mani Pandey, Bhupendra Singh, Sarvada Chandra Tiwari
Background: Due to the ever-changing psychosocial priorities and changes in family paradigms, care of older adults (aged 60 years and above) is often being experienced difficult. However, studies have hardly been done in this direction to elicit caregivers' experiences. The present article explores the problems and strain faced by the caregivers of urban older adults and discusses the basic differences faced during care of the healthy (elderly with no discernable illness) and unhealthy (elderly with single or multiple morbidity[ies]) older adults. Methods: The data were extracted from an extramural ad hoc research project sponsored by the Indian Council of Medical Research. It was a cross-sectional study, in which 1163 caregivers, aged 18 years or more, were interviewed. They were asked to share experiences for caring their elderly. It was revealed that around 57% (n = 661) of caregivers were taking care of unhealthy (elderly with psychiatric disorders, physical diseases, organic disorders, or two or more morbidities) older adults, whereas 43% (n = 502) of caregivers were taking care of healthy older adults. The Problem Checklist and Strain Scale was administered and the obtained data were analyzed applying percentages, mean, standard deviation, and χ2 test. Results: The mean age of caregivers was 43.64 ± 13.8 years for males and 44.57 ± 12.42 for females; females outnumbered males (59.4%) as primary caregivers. Irrespective of health conditions, majority of the caregivers reported that they experienced problems (73.86%) and strain (70.59%) due to their caregiving responsibilities. The pertinent issues have been analyzed and discussed. Conclusion: Majority of the caregivers of older adults experience problems and strain, which is an alarming situation. This may further negatively affect the well-being and quality of life of the elderly. Therefore, there is a need to thoroughly study the caregivers' aspects and introduce remedial strategies so that the elderly and caregivers both can lead a better life.
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Cognitive impairment among Hindi mental state examination positive community-dwelling rural older adults p. 45
Nisha Mani Pandey, Rakesh Kumar Tripathi, Shailendra Mohan Tripathi, Bhupendra Singh, Sarvada C Tiwari
Background: Cognitive impairment is emerging as one of the greatest mental health challenges in older adults. Its proper screening is required primarily. This article aimed to determine the usefulness of cognitive screening and assessment tools for ascertaining cognitive impairments among community-dwelling rural older adults. Methods: Lucknow rural elderly project was funded by the Indian Council of Medical Research, carried out in randomly selected rural areas of Lucknow district. The present article is based on the archived data of the same project. We have analyzed 1243 patients' data, who participated in the referred study. Data related to sociodemographic details, Hindi Mental State Examination (HMSE), were extracted. There were 81 patients who screened as HMSE positives (scored ≤23). These patients were then assessed using the Cambridge Examination for Mental Disorders of the Elderly-Revised to reach to a diagnostic category as per the International Classification of Diseases-10th Revision DCR criteria. Further, a triad of Brief Cognitive Rating Scale (BCRS), Functional Assessment Staging (FAST), and Global Deterioration Scale (GDS) administered on the cognitively impaired patients. The data were analyzed by employing SPSS version 15. Results: Among HMSE positives, 81.5% (66) had a diagnosable cognitive impairment and 18.5% (15) non-cases. FAST, BCRS, and GDS had concordant findings and were found to be effective instruments for the assessment of severity of cognitive decline. Conclusion: HMSE is a useful cognitive screening tool for rural older adults. A triad of BCRS, and GDS is found to be useful in determining the severity of cognitive impairment.
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Clinical profile of older adults presenting to psychiatric emergency services: A retrospective study from South India p. 51
Shiva Shanker Reddy Mukku, Suchandra Hari Hara, Palanimuthu Thangaraju Sivakumar, Krishna Prasad Muliyala, V Senthil Kumar Reddi, Mathew Varghese
Background: Older adults constitute an important subgroup among those presenting to psychiatric emergency services. Psychiatric emergencies in older adults are particularly understudied in India. Objective: The objective was to study the clinical profile of older adults presenting to psychiatric emergency services. Method: All case records of older adults (60 years and above) presenting to Emergency psychiatry and Acute care (EPAC) in a tertiary care Neuropsychiatric institute from July 2018 to December 2018 were reviewed. The details pertaining to sociodemography, clinical profile, medical comorbidity and clinical management were reviewed and analyzed. Results: 230 older adults were seen in EPAC during the study period. This constituted 6.7% of the 4200 patients of all age groups seen in EPAC during this period. The mean age of the study group was 68.77 years (standard deviation-7.23) with 61.30% males and 38.69% females. The frequency of individuals with at least one co-morbid medical illness was 62.6%. The common diagnosis was mood disorders (30.87%), followed by dementia (16.52%) and delirium (10.43%. Agitation/aggression (46.52%), confusion (31.74%), and risk of self-harm (13.47%) were the most frequent reasons for presentation to EPAC. Neuropsychiatric disorders (31.30%) and mood disorders (30.87%) constituted the most common diagnosis in the group. Among those who required parenteral sedation, lorazepam (18.7%) was the most preferred agent followed by haloperidol (16.1%). Discussion and Conclusion: Older adults in our study predominantly had depression, behavioral and psychological symptoms of dementia and delirium although the proportion of delirium is smaller when compared to western studies. The most common reason for older adults' visit to emergency was agitation/aggression which is in agreement to other similar studies. Nearly half were managed without emergency sedation. However, smaller proportion of patients received sedation with haloperidol and lorazepam. The study was done in a primary psychiatry setup where general medical emergency is not available. This could be the probable reason for lower prevalence of delirium in our study compared to previous studies which is a limitation.
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Delusional parasitosis in a 69-year-old male in relation to COVID-19 p. 58
Avinash De Sousa
Delusional parasitosis (DP) is a type of delusional disorder which poses a challenge to psychiatrists worldwide. We present a case report of a patient who was diagnosed with DP and was treated and had recovered and developed a re-emergence of symptoms with causation blamed on COVID-19. The patient responded well to risperidone.
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Sleep paralysis in a 76-year-old male p. 60
Avinash Desousa, Sagar Karia
We present herewith a case of sleep paralysis (SP) which entails a transient, generalized inability to move or speak and that usually seen during the patient's transitions between sleep and wakefulness. We report a case of a 76-year-old man with recurrent SP in the absence of any other psychiatric disorder. The patient sought help after over 2 years of symptoms as he thought that the symptoms were part of dreaming during sleep. SP is seen in conjunction with multiple psychiatric disorders, and the symptoms may mimic them, thereby confounding the diagnosis. SP with onset in old age is rare and is the highlight of this case report.
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Hyponatremia-associated catatonia in an elderly male: A case report and review of literature p. 62
Aseem Mehra, Sandeep Grover
Catatonia is a condition characterized by abnormal behavior and reported to occur in various psychiatric as well as in medical illnesses. The association of hyponatremia and catatonia in the absence of confounding factors is a matter of debate. There are few case reports that found the association between hyponatremia and catatonia, but none of them reported in the absence of confounding factors. We report a case of an elderly male presented with catatonia in association with hyponatremia. Complete resolution of symptoms was associated with normalization of sodium and the use of a low dose of lorazepam. It is suggested that the evaluation of serum electrolyte levels should be an essential part of the evaluation of an older adult with catatonia.
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Dementia and driving fitness: Critical clinical issues p. 65
Avinash De Sousa
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