Background: Medically ill elderly patients are more prone to develop depression. Faulty coping mechanisms increase the risk of developing depression. Spirituality is known to decrease this risk. Aim: This study was conducted to assess the prevalence of depression in medically ill elderly patients, coping strategies used and spirituality as a way of coping. A comparison was made between coping strategies used by depressed and nondepressed elderly patients with medical illnesses. Materials and Methods: This was a cross-sectional study carried out at a tertiary care hospital. A total of 100 consecutive patients were evaluated on Geriatric Depression Scale, Coping Inventory for Stressful Situations-21, and Spiritual Attitude Inventory. Results: Prevalence of depression was 72% among the medically ill elderly patients. Of those found to have depression, two third had mild depression and one-third had severe depression. On comparing coping and spirituality between depressed and nondepressed patients it was found that non depressed patients had better coping towards stressful situation, they used more of task oriented and avoidance based coping, whereas depressed patients used more of emotion oriented coping. Non-depressed patients were more spiritual when compared to depressed patients. Severity of depression positively correlated with emotion oriented coping mechanisms and it was negatively correlated with task and avoidance oriented coping mechanisms and spirituality in all four domains. Conclusion: The present study shows that 72% of medically ill elderly patients have depression and compared to those with one medical illness, the prevalence of depression is more among those who have 2 or more medical illnesses. Compared with those without depression, patients with depression more often used emotion based coping, less often used task and avoidance coping mechanisms and were less spiritual.

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Background: Increased life expectancy has increased many chronic illnesses in the elderly population, adding a phase of life affecting resilience, well-being, and perception of illness. Aims and Objectives: To assess resilience, well-being, and illness perception in the elderly and study the relation among them. Materials and Methods: A population of 90 (30 from the psycho-geriatric OPD, 30 from medical geriatric OPD and 30 normal elderly, accompanying patients in psycho geriatric OPD) patients age 60 years or more were taken, at a tertiary care center. Geriatric depression scale was applied and score <7 were selected for normal and rheumatoid arthritis. Patients with score >7 and fulfilling diagnostic and statistical manual-IV TR criteria were taken in depression group. Semi-structured proforma and scales (Connor Davidson resilience scale, Warwick Edinberg mental well-being scale, and brief illness perception scale) were applied, and statistical analysis was done using Statistical Package for the Social Sciences. Results: Results demonstrated resilience (P < 0.001) significantly differed in the three groups. Resilience was higher in normal (P < 0.001) than rheumatoid arthritis, which is higher (P < 0.02) than depression group. Well-being also significantly differ in all three group (P < 0.001), higher in normal elderly (P < 0.001) than affected elderly. We found strong positive correlation between resilience and well-being. Conclusion: Resilience is higher in those with a higher hardiness, optimism, purpose of life, and resourcefulness. Well-being gets significantly affected with mental and physical illness.

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Background: Electroconvulsive therapy (ECT) is quite often used in elderly patients with severe mental disorders. One of the important factors which determine the acceptance of ECT among patients is the knowledge and attitude toward ECT. Aim: The present study attempted to assess the knowledge about and attitude toward ECT among elderly patients with severe mental disorders who had never received ECT. Materials and Methods: Knowledge and attitudes regarding ECT were assessed using ECT knowledge and attitude questionnaires, among 102 clinically stable elderly patients with severe mental disorders. Results: Majority (n = 62; 60.8%) of the patients obtained information mostly from "general word of mouth" or media (n = 23; 22.6%). None of the patients had full knowledge about ECT. Majority of the patients were not aware of the basic facts about ECT. Except for the fact that ECT involves use of electric current and can be given by a doctor, more than two-third of the patients were unaware of the basic facts about the procedure of ECT. Less than half of the patients were aware of the need for informed consent. Knowledge about indications, efficacy, and side effects of ECT was also very poor. In terms of attitude toward ECT, on most (15 out of 16) of the items, positive attitudes toward ECT were found in less than half of the patients (8.8-44.1%). In addition, significant proportions of patients were uncertain about their attitudes to ECT (35.3-66.7%) or had a negative attitude toward ECT (4.9-32.4%). There was significant positive correlation between the total knowledge and attitude score, suggesting that higher knowledge was associated with more positive attitude and vice versa. There was no relationship of total knowledge and total attitude score with demographic and clinical variables. Conclusions: Elderly patients with severe mental disorders have poor knowledge, and a significant proportion of them have a negative attitude toward ECT. Accordingly, it is important that medical professionals should impart proper information about ECT to elderly patients to increase the acceptability of ECT in this age group who more often respond well to ECT.

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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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Everyone has the right to live with liberty; but, in India a person with any kind of mental illness often faces inhumane behavior. To avoid such conduct and protect human rights, amendments in legislation will be needed. Modifications have been made in mental health laws to harmonize it with the United Nations Convention for Rights of Persons with Disabilities and a new Mental Health Care Bill was introduced in Rajya Sabha in 2013. However, the bill lacks inclusion of mental capacity assessment related legislation, which is essentially required for welfare of the people with health problems especially in the case of mental health. Mental capacity related legislations advocate the provision of treatment in the patient's best interests and thus, is acknowledged in most of the developed countries of the world. In all spheres of life the mission of the country is to remain dedicated to the best interests of its citizens and so is the case for mental health care. It high time when the country needs concerted efforts of academicians, administration and policy makers to amend the prevailing legislation and introduce and pass an act in favor of human rights.

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Delirium is in general considered as an acute short lasting reversible neuropsychiatric syndrome. However, there is some evidence to suggest that in a small proportion of cases delirium may be a chronic or persistent condition. However, making this diagnosis requires clinical suspicion and ruling other differential diagnosis. In this report, we present a case of a 55-year-old man who had cognitive symptoms, psychotic symptoms and depressive symptoms along with persistent hypokalemia and glucose intolerance. He was seen by 3 psychiatrists with these symptoms and was initially diagnosed as having depressive disorder and later diagnosis of bipolar affective disorder (current episode mania), and psychosis were considered by the third psychiatrist. However, despite the presence of persistent neurocognitive deficits, evening worsening of symptoms, hypokalemia and glucose intolerance diagnosis of delirium was not suspected.

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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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Progressive supranuclear palsy is an unusual neurodegenerative disorder, which superficially resembles Parkinson's disease, and the initial manifestations are characterized by depression, akinesia and mild cognitive impairment. The motor symptoms often appear later. Here we describe a case in whom affective symptoms predated the onset of other symptoms.

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Intracranial tumors are increasingly common in the elderly population. They may present with varied symptoms, some of which may be psychiatric in nature. In patients with known psychiatric disorders, these symptoms may be misattributed resulting in a delay in diagnosis and management. We present a case of an elderly female with paranoid schizophrenia and new onset symptoms secondary to intracranial tumor, which were initially misdiagnosed.

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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.

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Background: Mini Mental State Examination (MMSE) has been used widely for screening of cognitive disorders. It has been validated and adapted in various languages. Corrections have been proposed to rule out the bias in the scoring of MMSE based on education and age. However association of MMSE scores with socioeconomic status (SES)has not been studied. Aim: This study was aimed at evaluating the association of SES and MMSE. Materials and Methods: SES and the MMSE scores of participants more than 55 years of age were determined by trained social workers and clinical psychologists. The SES was determined by SES scale. Education and age bias was corrected using specific cut-off criteria for education and age bias while applying MMSE. The data thus obtained was analyzed using Epi-Info software to find the differences in MMSE positive (cognitive impairment present for the educational status and age) and MMSE negative (cognitive impairment absent for the educational status and age) individuals across different SES. Results: The study included 2,283 participants of whom 652 (28.6%), 1326 (58.1%) and 305 (13.4%) belonged to lower socio economic status (LSES), middle socio economic status (MSES) and upper socio economic status (USES) respectively. The MMSE scores were also compared across the SES. Persons from MSES had higher cognitive impairment when compared with LSES and USES, respectively. Significant difference was found among the two genders on the MMSE scores (more females had cognitive impairment) in only the LSES and not in USES and MSES. Conclusion: The findings suggest putative relationship between cognitive functioning and SESsocioeconomic status amongst the elderly.

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Insomnia in life-life is a common clinical presentation and yet its appropriate assessment and management can be challenging. This is largely due to the complex interplay of various co-morbid factors like physical or mental disorders, poly-pharmacotherapy, primary sleep disorders, psycho-social and environmental factors. Despite several evidence-based effective treatments being available, inappropriate pharmacotherapy is common and frequently leads to poorer outcomes and considerable risks in this population group. Nonpharmacological treatments are effective, but remain largely under-funded and infrequently used. This paper reviews the important changes in classification of insomnia; normal age related changes of sleep; factors contributing to late-life insomnia and useful assessment tools and treatment strategies in the management of chronic insomnia.

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