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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 8 | Issue 1
Page Nos. 1-59

Online since Thursday, August 5, 2021

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EDITORIAL  

COVID-19 and cognitive impairment: A new challenge for the elderly Highly accessed article p. 1
Sandeep Grover
DOI:10.4103/jgmh.jgmh_31_21  
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CURRENT THEMES Top

Relevance of the Indian telemedicine guidelines 2020 in psychogeriatric care: A critical appraisal p. 3
Sanchari Mukhopadhyay, Debanjan Banerjee
DOI:10.4103/jgmh.jgmh_24_21  
Older people with psychiatric illnesses face unique challenges in terms of clinical, sociocultural, and environmental factors. The Ministry of Health and Family Welfare, Government of India (MoHFw, GOI), has released telemedicine guidelines in April 2020, closely followed by a telepsychiatry operational guidelines as a collaborative effort of the National Institute of Mental Health and Neurosciences, Bengaluru, and the MoHFw, GOI. The current article presents a critical analysis of the provisions in these guidelines relevant to psychogeriatric care. The gray areas in the existing protocols which may hamper their applicability and accessibility in older adults include digital connectivity, continuity of care, patient autonomy and capacity assessment, medical comorbidities, evaluation of dementia, confidentiality, and teleconsultations in the institutionalized elderly. Preexisting challenges are seen to be compounded by the coronavirus disease 2019 pandemic, in addition to the onset of newer psychosocial and clinical adversities. The article also highlights certain recommendations for possible modifications of the guidelines in future. The telepsychiatry guidelines provide a paradigm shift in mental health care. However, the lacunae involved in the care of vulnerable groups such as the geriatric population based on these guidelines need to be reconsidered by all levels of stakeholders supported by evidence-based research.
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SERVICE DEVELOPMENT Top

Establishment of a geriatric clinic in psychiatry outpatient setting of a tertiary care hospital: Impact on care of elderly and training p. 11
Sandeep Grover, Chandrima Naskar, Subho Chakrabarti, Aseem Mehra, Ritu Nehra
DOI:10.4103/jgmh.jgmh_17_21  
Although there is a rapid increase in the elderly population in India, there is a lack of geriatric mental health services across the country. In India, although the postgraduation psychiatry program is available across many centers, little attention is paid to the subspecialty of geriatric psychiatry during the postgraduation training. There are very few courses (in the form of doctorate of medicine and fellowship programs) available in the subspecialty of geriatric psychiatry in the country. In this background, this paper focuses on the experience of establishing a geriatric clinic in a postgraduation psychiatry department and the impact of the same on patient care, research, and training in the area of geriatric psychiatry. The patient care data suggest that with the establishment of the geriatric clinic, there is an increase in the number of elderly patients admitted to the inpatient setting and those receiving electroconvulsive therapy. Further, there is an increase in the research in the area of geriatric psychiatry.
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ORIGINAL ARTICLES Top

A comparative study of caregiver burden and stigma among the caregivers of patients with dementia and schizophrenia p. 15
Shaheena Parveen, Aseem Mehra, Krishan Kumar, Sandeep Grover
DOI:10.4103/jgmh.jgmh_10_21  
Aim: This study aimed to assess the level of stigma faced by the caregivers of patients with dementia. The secondary objective was to evaluate the association of stigma faced by the caregivers with caregiver burden and compare the stigma and caregiver burden encountered by the caregivers of patients with dementia and schizophrenia. Methodology: This was a cross-sectional study, 50 patients with dementia and their caregivers and 50 patients with schizophrenia and their caregivers. Diagnosis of both the disorders was made as per the Diagnostic and Statistical Manual, Fifth Revision. The study participants were assessed on the Stigma Scale for caregivers of people with mental illness and family burden interview schedule. Results: Caregivers of patients with schizophrenia had been in the caregiver role for a longer duration and were not on paid employment. Caregivers of patients with dementia were more often children of the patients. Caregivers of patients with dementia reported a significantly lower level of stigma in all the domains as well as reported lower total stigma score. The significant difference persisted even after controlling for demographic and caregiving variables. Similarly, caregivers of patients with schizophrenia reported a significantly higher level of burden on all the domains, except for effect on the domain of mental health of others which persisted even after controlling for demographic and caregiving variables. Conclusion: Caregivers of patients with dementia experience a lower level of stigma and caregiver burden, compared to patients with schizophrenia even after controlling for different confounding variables.
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Prevalence of metabolic syndrome in elderly patients with depression p. 20
Sandeep Grover, Rahul Chakravarty, Aseem Mehra, Subho Chakrabarti
DOI:10.4103/jgmh.jgmh_8_21  
Aim: To assess the prevalence of metabolic syndrome (MetS) in elderly patients with depressive disorder. Methodology: By using retrospective study design, the treatment records of all the elderly patients (aged ≥60 years) diagnosed with depressive disorders diagnosed as per the International Classification of Diseases, 10th Revision, were reviewed and data of patients for fasting blood glucose levels, lipid profile, and anthropometry (height, weight, waist circumference, and blood pressure [BP]) were extracted. The diagnosis of MetS was made as per the consensus criteria. Results: Data of 93 patients were included in the study. The mean age of the study participants was 65.65 (standard deviation [SD]: 5.61) years and the mean number of years of education was 8.33 (SD: 6.65) years. The mean duration of illness was 70.93 (SD: 107.39) months, with the mean duration of the current episode at the time of collection of data as 5.38 (SD: 3.54) months. More than half (57%) of the patients fulfilled the criteria for MetS. Besides more than half of the patients fulfilling the criteria for MetS, about one-tenth (9.7%) fulfilled one criterion, and one-third (32.3%) fulfilled 2 criteria for the MetS. The most common criteria of MetS which was fulfilled included abnormal waist circumference, followed by raised blood pressure, abnormal triglyceride levels, and abnormal high-density lipoprotein. Fasting blood glucose level was the least common abnormality. The presence of MetS was associated with a higher level of education, higher income, and presence of physical comorbidity. Conclusions: Considering that more than half of elderly patients with depressive illness also suffer from MetS, it is important to monitor elderly with depression for MetS, to reduce the risk of future cardiovascular morbidity and mortality.
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A study of cerebrovascular risk factors in depressive patients in old age p. 26
Pyare Lal Bhalothia, Paramjeet Singh, Banwari Lal Mawlia, Sahiba Singh, Priyank Jain
DOI:10.4103/jgmh.jgmh_34_18  
Context: Depression in late life is more likely to be associated with multiple medical comorbidities and cognitive impairment. In old-age hypertension, hyperlipidemia and obesity have been associated with cognitive impairment and vascular depression. The severity of vascular burden has a positive correlation with the severity of depression. Aims: This study aimed to find the association between cerebrovascular risk factors (CVRFs) and depression in old age. Methodology: A cross-sectional observational study was carried out at the outpatient department (OPD) of psychiatric center, SMS Medical College and Hospital, Jaipur. The patients from the OPD who provided informed consent were the participants in this study. Two hundred cases of depressive episode or recurrent depressive episode (unipolar depression) were included in the study. The diagnosis was made as per the International Classification of Diseases-10 criteria by two psychiatrists independently. Framingham CVRF prediction tool was applied to assess vascular burden. This was followed by statistical analysis. Results: The mean age of participants were 68.53 years, the mean score of Hamilton Depression Rating Scale (HAM-D) was 19.10 and the mean score of CVRFs was 13.13. HAM-D score positively correlates with CVRFs score (r = 0.188 and P = 0.008). Conclusions: Our study contributes to the growing literature elucidating the relationship of CVRFs in depressed older adults confirming that greater vascular burden can contribute to the severity of depression in geriatric depression.
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A retrospective chart analysis of 34 cases with the use of oral cerebroprotein hydrolysate in dementia in a tertiary general hospital p. 30
Sagar Karia, Avinash Desousa, Nilesh Shah
DOI:10.4103/jgmh.jgmh_10_20  
Background: Cerebroprotein hydrolysate (cerebrolysin) is a nootropic and neurotrophic drug used widely in the management of various forms of dementia, stroke and head injury. A number of case series and anecdotal case reports on its efficacy exist. This study is a retrospective chart review of 34 patients with dementia treated at a tertiary general hospital psychiatry department that were given oral cerebroprotein as add on to their existing treatment for dementia. Methodology: 34 patients were administered twice daily oral cerebroprotein 90 mg tablets for 90 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: Changes on cognitive assessment were minimal and no major improvements were seen though isolated areas of improvement were reported by many patients. The scores on the ACER and MMSE remained in the dementia range though improvement in scores were noted. None of the patients experienced any major side effects with the drug. Conclusions: Oral cerebroprotein is a useful agent in the management of dementia and must be tried as an add-on to regular dementia treatment. Larger studies in prospective cohorts with further stringent assessments warrant exploration.
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Improving depression and well-being in older adults using selection, optimization, and compensation model: A case series p. 34
Narendra Nath Samantaray, Nilamadhab Kar
DOI:10.4103/jgmh.jgmh_7_21  
Background: There is a need to study age-sensitive psychological management for improving the clinical and overall health outcome for elderly adults. Hence, we intended to evaluate the effects of selection, optimization, and compensation (SOC) model, usually studied in nonmental health settings predominantly, in managing depression and well-being of the elderly in a clinical mental health setting in an Indian context. Methods: A pre–postintervention with a 2-month-follow-up approach was adopted. We delivered six sessions over 4–5 months. An independent rater assessed participants using the Beck Depression Inventory-II and World Health Organization's Well-Being Index (WHO-5) at baseline, postintervention, and a 2-month follow-up. Results: There was a clinically significant improvement in depression severity and well-being of participants at the postintervention and 2-month follow-up. Conclusions: SOC-based intervention has potential therapeutic effects in improving depression severity and well-being of elderly individuals in clinical settings. We recommend the current protocol to be studied in a randomized design study with a larger sample size and a longer follow-up period.
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Association of of noncommunicable diseases on cognitive functioning: A comparative study p. 39
Aseem Mehra, Seema Rani, Swapnajeet Sahoo, Ritu Nehra, Sandeep Grover
DOI:10.4103/jgmh.jgmh_9_21  
Aim: To compare the level of cognitive functioning among those with and without noncommunicable diseases (NCDs). Methodology: Using a cross-sectional study design, 104 patients attending the NCD clinic of a community rural health center and 101 elderly participants attending the hospital as caregivers of patients coming to the same community clinic with different ailments, were assessed on Hindi Mental State Examination (HMSE), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) scale. Results: Those with NCD performed poorly on all the domains of HMSE except orientation and registration. When the HMSE score of <25 was used to categorize the sample into those with and without cognitive impairment (CI), it was seen that the prevalence of CI was more among those with NCDs. The significant difference between the two groups persisted, even after controlling for age, gender, the income of the family, number of years of education, type of family, socioeconomic status, mean score of PHQ-9, and mean score of GAD-7. Conclusion: NCDs are negatively associated with cognitive functioning even after controlling for age, gender, the income of the family, number of years of education, type of family, socioeconomic status, mean score of PHQ-9, and mean score of GAD-7.
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Research on delirium: A scientometric assessment of publications from India during 2001 to 2020 p. 45
Sandeep Grover, BM Gupta, Ghouse Modin Mamdapur
DOI:10.4103/jgmh.jgmh_26_21  
Aim: To analyze the publication growth, international collaboration, funding support, citation impact, and distribution of publications on delirium with one of the authors from India, indexed in Scopus database, published during 2001–2020. Methodology: The Scopus database (http://www.scopus.com) was searched for publications on delirium during 2001–2020 with one of the authors from India. The publications were identified and retrieved. Results: The initial search, which involved locating the global publication output, yielded 22,929 records. When the search was limited to research originating from India, it yielded 478 Indian records. Researchers from India contributed to 2.08% of the world's delirium research, and overall, the research output from India, ranked twelfth in the world. Of the research originating from India, only 12.97% of publications involved international collaboration. The number of publications on delirium with one of the authors from India increased from 1 in the year 2001 to 47 in the year 2020, accounting for 33.61% annual average growth rate, higher than 9.5% of publication growth rate on the topic for the worldwide publications. The 10-year cumulative publications increased from 84 during 2001–2010 to 394 during 2011–2020, registering 369% absolute growth, which was much higher than 107.52% of the world publications. Conclusion: To conclude, this study suggests that only 2% of the world's delirium research emerges from India and overall based on this research output, India stands at the 12th position in delirium research. However, over the last few years, the research on delirium from India has increased.
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CASE REPORT Top

Elderly male with late-onset heroin dependence p. 51
Akansha Bhardwaj, Sidharth Arya, Sunila Rathee, Rajiv Gupta
DOI:10.4103/jgmh.jgmh_12_21  
Substance use disorders usually have their onset during the adolescent period. However, in rare cases environmental and psychosocial factors can contribute toward a later onset. We describe a case of an elderly male who initiated his heroin use for the first time at 65 years of age and eventually developed dependence. This late-onset of heroin use was mediated by contextual factors such as loneliness, boredom, and easy access to heroin while craving and withdrawal symptoms served as maintaining factors. He responded well to a combination of opioid antagonist and nonpharmacological approaches focusing on activity scheduling and social support. As the demographic transition and societal changes take place, the elderly population with substance use problems will increase. There is an urgent need to upgrade substance abuse treatment services to meet the specific needs of the elderly using supportive and nonconfrontational approaches with special focus on improving social support access.
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LETTERS TO THE EDITOR Top

I wish she had dementia: Pandemic, lockdown, elderly with personality traits, and stress on families p. 54
Srikala Bharath
DOI:10.4103/jgmh.jgmh_14_21  
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Recurrent idiopathic catatonia in an elderly patient with successful weaning off lorazepam p. 56
Tushar Kanta Panda, Jitender Aneja
DOI:10.4103/jgmh.jgmh_18_21  
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Vortioxetine-induced switch - New drug with emerging old problems p. 58
Shiva Shanker Reddy Mukku, Ravi Kumar Nadella
DOI:10.4103/jgmh.jgmh_27_21  
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