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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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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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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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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Bilateral thalamic glioma is a rare type of primary thalamic tumor. It presents clinically with personality changes and dementia rather than mass effect or focal neurological deficit. Imaging findings are somewhat characteristic with the diffuse homogenous enlargement of bilateral thalami with altered attenuation or signal intensity on computerized tomography and magnetic resonance imaging, respectively. This tumor is refractory to radiotherapy and chemotherapy and survival beyond 2 years after diagnosis is rare. This report emphasizes the need of neuroimaging in a patient with dementia to identify this rare devastating tumor early.

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Background: Of the higher mental functions, certain deteriorate earlier than others. The relative deterioration of the different higher mental functions in dementia patients would be of interest to investigate. Aim: We intended to study the status of higher mental functioning in dementia patients. Materials and Methods: Household screening of a randomly selected ward, Musahebganj of urban Lucknow generated 1,216 elderly people aged >55 years. After taking the informed consent to participate in the study, all the subjects were screened using the Mini Mental Status Examination (MMSE) for cognitive disorders. Age and education specific cut-off criteria were used to find out MMSE positive subjects. MMSE positive subjects were assessed in detail using the Cambridge Examination for Mental disorder in the Elderly-Revised instrument. Result: Fifty patients were diagnosed to have dementia as per the international classification of diseases-10 criteria. The study demonstrated that the higher mental functioning especially visual reasoning, ideational fluency, and memory are maximally affected in dementia patients. Conclusions: The deterioration in higher functioning is usually seen in dementia. The mental functioning relates with each other and is interrelated, leading to overall deterioration.

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Corticobasal degeneration (CBD) rarely presents with rapidly progressive dementia (RPD). Its description primarily exists as case reports and case series only. This case report describes and discusses RPD as an initial manifestation of CBD for the benefit of clinician. A 75-year-old male who presented initially with complaints of difficulty in money handling, repetitive activities, irritability, and naming difficulty for 8 months. Later, he developed complaints of forgetfulness, navigational difficulty, dystonia, and rigidity in the right hand. This case demonstrates that patients who are presenting with RPD in geriatric mental health, motor symptoms must be evaluated to rule out corticobasal degeneration.

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Background: Depression in elderly is under diagnosed. This study was planned to find the prevalence of depression in the nonpsychiatric geriatric population, which often goes undiagnosed and untreated. Aims: The primary aim of the study was to find the sociodemographic profile and prevalence of depression among nonpsychiatric geriatric outpatients and the secondary aim was to find factors associated with depression. Settings and Design: By using purposive sampling, 100 patients aged more than 60 years attending various Out Patient Departments (OPDs) other than the Psychiatry OPD were recruited. Materials and Methods: Geriatric depression scale was used to diagnose depression. Results: 21% patients had mild depression and another 21% patients were severely depressed. 64% of the patients had one medical illness and 36% of the patients have more than 1 medical illness. Widow/widower patients had significantly more depressive symptom as compared to patients having a living spouse. Patients with two or more medical illnesses had significantly more depressive symptoms as compared to the patients with one medical illness. Conclusions: 42% of the nonpsychiatric geriatric patients were found to have depression. Depression was more common in geriatric patients who were widow/widower or had more than 1 medical illness.

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Pathological laughter and crying are episodes of either laughter or crying, which is intense and uncontrollable, usually lasting for brief periods and occurring in paroxysms. In the literature, pathological laughing and crying, emotionalism, pseudo-bulbar affect are synonymously used. Favorable evidences exist with regard to the use of antidepressants, mood stabilizers, and anti-glutaminergic agents for the management of pathological laughter and crying. In this case report, we highlight the clinical presentation of hypertensive bleed in the form of pathological laughter and its management with selective serotonin reuptake inhibitor - sertraline along with literature review regarding its neurobiological basis and pharmacological management.

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Self-medication is quite prevalent in South East Asia and particularly in India. However, little knowledge about the medicines often exposes the patients to the untoward side effects. There is a scanty literature on psychiatric side effects of these drugs and none in elderly population. Here, we report a case who presented with symptoms suggestive of bipolar affective disorder, which was found to be linked to his use of medicines available over-the-counter (OTC). His mental status improved with stoppage of OTC medications and use of low dose Quetiapine.

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