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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Geriatric mental health has yet to receive its due recognition in India. Geriatric mental health is plagued by many challenges that prevent the development and progress of its services. The present article is a narrative review that looks at the various challenges faced by geriatric mental health in India. The article describes different specific and general unique challenges faced by geriatric mental health and discusses in detail the nature of each challenge and what must be done to overcome it. The challenges range from demography of Indian aging to sexual issues in the elderly, geriatric depression, dementia care, and the aging lesbian, gay, bisexual, and transgender community. Various issues related to policy and research that challenge geriatric mental health are also discussed. The need to incorporate geriatric mental health into primary health care along with the need to train primary care workers and preventive work aimed at suicide prevention in the elderly is stressed. The article addresses these challenges with the aim of positing before the clinician the various challenges faced by geriatric mental health in India in the current era.

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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.

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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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Aim of the Study: This study aimed to evaluate the prevalence of loneliness and its relationship with social connectedness and depression in elderly. Additional aims were to evaluate the demographic and clinical factors associated with loneliness and social connectedness in elderly patients with depression. Methodology: The study sample comprised 488 elderly patients (age ≥60 years) with depression recruited across 8 centers. These patients were evaluated on Geriatric Depression Scale (GDS-30), Generalized Anxiety Disorder-7 Scale (GAD-7), Patient Health Questionnaire-15 (PHQ-15) Scale, Columbia Suicide Severity Rating Scale, UCLA Loneliness Scale (LS), and Revised Social Connectedness Scale. Results: About three-fourth (77.3%) of the entire sample reported the presence of loneliness. With respect to specific loneliness symptom, 62.5% reported lack of companionship, 58.7% reported being left out in life, and 56.5% of the individuals reported felt isolated from others. No gender differences were noted in the prevalence of any loneliness symptom. Higher loneliness scores had significant positive correlation with severity of depression, anxiety, and somatic symptoms as assessed by GDS-30, PHQ-15, and GAD-7, respectively, in individuals of both the genders. Higher social connectedness was associated with higher level of anxiety and lower loneliness in females only. Being currently single, older age, longer duration of illness, presence of family history of mental illness, presence of comorbid physical illness, and absence of substance abuse were associated with higher loneliness. With regard to suicidality, higher loneliness was associated with nonspecific active suicidal thoughts, active suicidal ideations with and without intent, nonsuicidal behavior, and higher intensity of suicidal ideations. Conclusions: About three-fourth of the elderly patients with depression also have associated loneliness. Loneliness is associated with higher severity of depression, anxiety, and somatic symptoms. Severity of depression is associated with loneliness but not with social connectedness. Lower social connectedness among elderly females with depression is associated with higher loneliness, but this is not true for elderly males with depression.

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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.

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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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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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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.

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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.

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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.

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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.

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Pseudodementia is understood as a clinical state, which occurs in the background of psychiatric disorders and mimics dementia. These patients are often diagnosed and treated as dementia, while the underlying disorder remains unrecognized and untreated. In this report, we discuss a patient suffering from depressive pseudodementia, who was previously treated as suffering from dementia. Management of depression with venlafaxine and electroconvulsive therapy was associated with significant improvement in functioning and behavior.

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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.

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Natural opioids have been in use in the North Western part of India for a long time. We present the case of an octogenarian "doda" (poppy husk) user, who sought treatment with us due to unavailability of natural opiates. The patient was treated successfully with tramadol maintenance for over 8 months. This case suggests that tramadol can be used as a harm reduction approach, for maintenance of patients with opioid dependence.

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Background: The use of antidepressants among elderly is associated with dreaded side effect of hyponatremia. However, there is limited information about specific risk factors associated with developing hyponatremia in elderly. Aim of the Study: The aim of this study was to evaluate the clinical risk factors for the development of hyponatremia among elderly patients started on antidepressant medications. Methodology: Using retrospective study design, patients who developed hyponatremia (n = 35) and those who did not develop hyponatremia (n = 43) with use of antidepressants, were matched on sociodemographic parameters and were compared for various parameters such as physical illness, other medications, and dose and type of antidepressant drug. Results: Higher proportion of those who developed hyponatremia had history of comorbid hypertension, were receiving antihypertensive agents, and were receiving 2 antihypoglycemic agents concomitantly. Majority of the patients who developed hyponatremia were receiving mirtazapine, followed by sertraline and venlafaxine. There was no association of hyponatremia with concomitant use of psychotropics, presence of other physical illnesses, comorbid dementia, and comorbid substance use. Conclusion: Antidepressant-associated hyponatremia is more commonly seen in patients with comorbid hypertension, those receiving any antihypertensive agent and those on more than one hypoglycemic agent.

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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.

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