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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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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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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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 rising proportion of elderly in India exhibits concern for the well-being of this section of the population. It will be important to know what factors are responsible for elder abuse and also who commonly perpetuates abuse among elderly. Objectives and Aims: The objective of the study is to find out the prevalence of elder abuse and profile of abuser in Maharashtra. The study also tried to examine the differences in elder abuse cases by several socioeconomic characteristics, disability level, chronic conditions, and age cohorts. Materials and Methods: The data from the United Nations Population Fund survey named "Building Knowledge base of Population Ageing in India" was used. The sample size was 1435 respondents aged 60 and above. Cross-tabulation was done to assess the socioeconomic profile and elder abuse among elderly. Multivariate analysis named logistic regression was performed to know the important determinants of elder abuse and neglect. Results: Around 35% of elderly in Maharashtra had faced any abuse. The percentage of elderly who faced verbal abuse (30.1%) was highest, followed by economic abuse (22.5%) and physical abuse (18.0%). Neighbors (56.1%), sons (43.1%), relatives (38.6%), and daughter-in-law (31.9%) were involved in the majority of the abuse cases. Education, wealth quintile, living alone, and the presence of any disability and morbidity or injury were the important determinant of elder abuse. Conclusion: Elder abuse and neglect were quite high in Maharashtra. The policies and strategies need to form in order prevent abuse of elderly population in Maharashtra.

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Dementia is understood as a clinical syndrome characterized by impairment in memory impairment along with cognitive deficits in other domains. Over the years, understanding about the causes of dementias has improved. Broadly, dementias can be classified as irreversible degenerative dementias and reversible dementias. Alzheimer's disease is the prototype of degenerative dementias and is characterized by the accumulation of beta-amyloid protein (called as amyloid plaques) outside the neurons and accumulation of tau protein (called tau tangles) inside the neurons. Vascular dementias are characterized by cerebrovascular insults which lead to pathological brain changes that impair cognition. The pathological hallmark of Lewy body dementia is the presence of α-synuclein neuronal inclusions, also known as Lewy bodies, accompanied by neuronal loss. Frontotemporal dementias are characterized by abnormal deposits of the microtubule-associated protein tau, the trans-activation response TAR DNA-binding protein with molecular weight 43 kDa (TDP-43), and the fused in sarcoma protein. Reversible dementias are characterized by the primary illness and may not present with characteristic brain deposits as seen with many degenerative dementias.

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Context: Old age homes are on the rise in India. Older people staying in such institutions have specific psychosocial issues that may affect their cognitive performance and daily living. Materials and Methods: 71 older people, 39 institution based and 32 community-based were recruited with serial sampling after screening on mini-mental state examination and were evaluated with geriatric depression scale, University of California, Los Angeles scale, Lawton's instrumental activities of daily living scale and montreal cognitive assessment scale. Results: Prevalence of depression was significantly higher in older people who were institution based, widowers and females. The severity of perceived loneliness was higher in females, institution based and depressed older people. The severity of depression correlated with independence in daily activities, cognition, and perceived loneliness only in institution based older people. Discussion: Older people in institutions have a higher psychosocial burden than the community-based older people. Family support prevents the attrition effect of depression on cognition and independence in daily activities in the community-based older people.

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Background: The concepts of aging-related cognitive changes have appeared to be a major challenge in the society. In this context, the present study was planned to find out the functioning of aging population on different neurocognitive measures. Aims: The aim of the study was to find out the neurocognitive functioning, namely memory, verbal fluency, and response inhibition of normal aging population. Materials and Methods: Following purposive sampling technique, a total of 50 healthy subjects (30 males and 20 females) in the age range of 60-70 years were recruited from Jaipur city of Rajasthan. Mini-mental state Examination, PGI memory scale, animal names test, and Stroop test were administered. Results: The findings reveal dysfunction in almost all the domains of memory, namely mental balance, attention and concentration, delayed recall, verbal retention for dissimilar pairs, visual retention and recognition, immediate recall, verbal retention for similar pairs, and visual retention. In domain of verbal fluency, all subjects gave low responses on the animal names test. In domain of response inhibition, all the subjects took less time in color test as compared to color word test on the Stroop task. Conclusions: Findings suggest that there are dysfunction in the area of memory, verbal fluency, and response inhibition in persons aged 60-70 years. However, recent and remote memory were found to be intact.

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Sensory deprivation is understood as diminution or absence of perceptual experiences to the usual external stimuli. Sensory deprivation in elderly is reported to be associated with depression, anxiety, psychosis, dementia, etc. In this report, we present the case of an 84-year- elderly man who developed auditory hallucination and after 1 year of onset of hearing difficulties. He was managed with quetiapine, with which he showed significant improvement.

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Background: Depression in elderly is a public health problem. Aims and Objectives: To determine the prevalence of depression and its correlates among the elderly population. Materials and Methods: This cross-sectional study was conducted among elderly aged 60 years and above using two-stage cluster sampling technique among elderly residing in the rural and urban areas of Shimla district of Himachal Pradesh, India. A written consent was taken from each participant after explaining the purpose of the study. Results: Of the 800 subjects, 76 (9.5%) were found to be suffering from depression. The logistic regression analysis revealed that elderly having lower income, consuming tobacco, experiencing stressful life event in the past 1 year, having 3 or more chronic diseases, and lacking positive approach toward life and were found to be more depressed. Conclusion: The study conducted in Shimla district shows that one-tenth of the elderly residing in the study area suffering from depression. Elderly having lower income, residing in the urban area, experiencing significant life event, suffering from multimorbidity, and lacking positive approach toward life increase should be identified by screening. They should be focused on so as to reduce the probability of occurrence of depression.

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Antipsychotic drugs are widely used in the management of schizophrenia in the elderly. Extrapyramidal reactions to these drugs and tardive dyskinesia are a dreaded side effect of these drugs that may be seen in the elderly. We present herewith, a case of probable respiratory dyskinesia, a rare but important variant of tardive dyskinesia seen in an elderly patient with schizophrenia after the sudden stoppage of antipsychotic medication.

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Hyperammonemia is a rare side effect of valproate, diagnosis of which requires a high level of clinical suspicion. We describe a case of 57-year-old man, suffering from bipolar affective disorder, who had multiple physical comorbidities (diabetes mellitus, benign prostatic hyperplasia, hydroureteronephrosis, and chronic kidney disease) and was on sodium valproate 1500 mg/day along with risperidone 6 mg/day, who developed delirium when the dose of sodium valproate was increased from 1500 mg/day to 2000 mg/day. In view of use of high doses of valproate, hyperammonemia was suspected, and on investigations, patient was found to have high ammonia levels (159 μmol/l). He was managed conservatively with stoppage of valproate and syrup lactulose. To conclude this case depicts that use of high doses of valproate can lead to hyperammonemia, especially among those with chronic medical illnesses.

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Frontotemporal dementia (FTD) is a clinically and pathologically heterogeneous syndrome. It can be classified into three clinical syndromes depending on the early and predominant symptoms: A behavioral variant FTD and two language variants namely, semantic dementia, and progressive nonfluent aphasia (PNFA) which are very rare and elude diagnosis. We report the case of an elderly homemaker who came to our institute with features of cognitive decline and behavioral problems with language deficits in the form of nonfluent speech, impaired vocabulary to three pairs of words, agrammatism, and impaired single sentence comprehension with corroborative magnetic resonance imaging findings. PNFA is a rare clinical variant of FTD and often underdiagnosed. It should be considered in elderly patients who apart from having cognitive decline, behavioral problems, and absent insight also develop limited vocabulary, especially using a set of nouns to express themselves. Speech therapy and behavioral therapy in the initial stages can be of utility.

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