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.
{"title":"Don't forget me: Pseudodementia associated with depression","authors":"D. Dua, S. Grover","doi":"10.4103/JGMH.JGMH_29_18","DOIUrl":"https://doi.org/10.4103/JGMH.JGMH_29_18","url":null,"abstract":"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.","PeriodicalId":16009,"journal":{"name":"Journal of Geriatric Mental Health","volume":"5 1","pages":"159 - 161"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49547346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benzodiazepines (BZDs) remain the mainstay in the management of withdrawal arising out of BZD use disorders. The choice of detoxifying agent is determined by the duration of action and also by the metabolic properties of the drug. Very rarely, we consider the chemical properties of the drug that we choose, though occasionally that may have profound clinical impact on the outcome. In this case report, we present the case of alprazolam withdrawal that was ineffectively managed by lorazepam and finally salvaged by the use of clonazepam. The chemical properties of the molecules involved and their clinical importance in the decision-making process have been subsequently reviewed.
{"title":"A case report of preferential effectiveness of clonazepam over lorazepam in the management of a case of alprazolam withdrawal","authors":"V. Saxena, Robin Victor, Arghya Pal","doi":"10.4103/JGMH.JGMH_25_18","DOIUrl":"https://doi.org/10.4103/JGMH.JGMH_25_18","url":null,"abstract":"Benzodiazepines (BZDs) remain the mainstay in the management of withdrawal arising out of BZD use disorders. The choice of detoxifying agent is determined by the duration of action and also by the metabolic properties of the drug. Very rarely, we consider the chemical properties of the drug that we choose, though occasionally that may have profound clinical impact on the outcome. In this case report, we present the case of alprazolam withdrawal that was ineffectively managed by lorazepam and finally salvaged by the use of clonazepam. The chemical properties of the molecules involved and their clinical importance in the decision-making process have been subsequently reviewed.","PeriodicalId":16009,"journal":{"name":"Journal of Geriatric Mental Health","volume":"5 1","pages":"165 - 166"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45599218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Sujeetha, Jeenu Cheerian, Preethi Basavaraju, P. Moorthi, A. Anand
Neurodegenerative diseases are debilitating and incurable condition resulting in the progressive degeneration of nerve cells which causes problems with movement or mental functioning. Alzheimer's disease is the most common form of dementia and an irreversible neurodegenerative disorder. The mechanism of Alzheimer's disease is still unknown. The changes in the primary DNA sequence due to heritable alterations in the gene are known as epigenetics. The most studied epigenetic mechanisms are DNA methylation, histone modifications, and noncoding RNAs. Therefore, this change triggers the alterations in the transcriptional level of genes which are involved in the pathogenesis of Alzheimer's disease. Over the past decade, it is progressively clear that the epigenetic mechanisms play an important role in the pathogenesis of Alzheimer's disease. The literature search was performed on reviews addressing the topics in the databases PubMed and Google Scholar. This review focuses on the three major epigenetic mechanisms and their role in the pathogenesis of Alzheimer's disease.
{"title":"The role of epigenetics in Alzheimer's disease","authors":"P. Sujeetha, Jeenu Cheerian, Preethi Basavaraju, P. Moorthi, A. Anand","doi":"10.4103/JGMH.JGMH_33_17","DOIUrl":"https://doi.org/10.4103/JGMH.JGMH_33_17","url":null,"abstract":"Neurodegenerative diseases are debilitating and incurable condition resulting in the progressive degeneration of nerve cells which causes problems with movement or mental functioning. Alzheimer's disease is the most common form of dementia and an irreversible neurodegenerative disorder. The mechanism of Alzheimer's disease is still unknown. The changes in the primary DNA sequence due to heritable alterations in the gene are known as epigenetics. The most studied epigenetic mechanisms are DNA methylation, histone modifications, and noncoding RNAs. Therefore, this change triggers the alterations in the transcriptional level of genes which are involved in the pathogenesis of Alzheimer's disease. Over the past decade, it is progressively clear that the epigenetic mechanisms play an important role in the pathogenesis of Alzheimer's disease. The literature search was performed on reviews addressing the topics in the databases PubMed and Google Scholar. This review focuses on the three major epigenetic mechanisms and their role in the pathogenesis of Alzheimer's disease.","PeriodicalId":16009,"journal":{"name":"Journal of Geriatric Mental Health","volume":"5 1","pages":"94 - 98"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48985324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rishav Bansal, P. Chatterjee, A. Chakrawarty, Sujata Satpathy, Nand Kumar, S. Dwivedi, A. Dey
Background: Data on diabetes as a risk factor for mental health disorders in older population is limited. The health systems need to assess the burden on mental health disorders secondary to chronic diseases for better care provision. This study aims to assess the burden of depression, generalized anxiety disorder (GAD), and cognitive impairment among older patients with diabetes compared to age- and sex-matched nondiabetes and study the impact of diabetes on quality of life (QOL). Subjects and Methods: Cross-sectional comparative study was performed in Geriatric Medicine Outpatient Department (OPD) from November 2014 to June 2016. Ambulatory patients from OPD who provided informed consent were the participants of the study. They included 180 diabetic cases and 180 age- and sex-matched nondiabetic controls. The cases and controls were subjected to assessment for the presence of depression, GAD, and cognitive impairment using Geriatric Depression Scale, Mini International Neuropsychiatric Interview, and Montreal Cognitive Assessment, respectively. Health-related QOL was assessed with WHOQOL-BREF scale. They were also subjected to routine comprehensive geriatric assessment. McNemar's Chi-square test and Paired t-test was used for statistical analysis. Results: Older diabetics have significantly higher frequency of depression (35.6% vs. 16.7%), GAD (12.8% vs. 4.4%), and cognitive impairment (53.9% vs. 27.2%) compared to nondiabetics. In addition, they also report poorer health-related QOL. Conclusions: Diabetes in old age is associated with increased risk of mental health disorders and an accompanying poor health-related QOL in all domains. Thus, patients with diabetes require access to mental health support in addition to management of metabolic abnormalities. Future research to assess the impact of screening of mental health disorders on outcomes such as glycemic control, morbidity, and mortality is required.
{"title":"Diabetes: A risk factor for poor mental health in aging population","authors":"Rishav Bansal, P. Chatterjee, A. Chakrawarty, Sujata Satpathy, Nand Kumar, S. Dwivedi, A. Dey","doi":"10.4103/JGMH.JGMH_5_18","DOIUrl":"https://doi.org/10.4103/JGMH.JGMH_5_18","url":null,"abstract":"Background: Data on diabetes as a risk factor for mental health disorders in older population is limited. The health systems need to assess the burden on mental health disorders secondary to chronic diseases for better care provision. This study aims to assess the burden of depression, generalized anxiety disorder (GAD), and cognitive impairment among older patients with diabetes compared to age- and sex-matched nondiabetes and study the impact of diabetes on quality of life (QOL). Subjects and Methods: Cross-sectional comparative study was performed in Geriatric Medicine Outpatient Department (OPD) from November 2014 to June 2016. Ambulatory patients from OPD who provided informed consent were the participants of the study. They included 180 diabetic cases and 180 age- and sex-matched nondiabetic controls. The cases and controls were subjected to assessment for the presence of depression, GAD, and cognitive impairment using Geriatric Depression Scale, Mini International Neuropsychiatric Interview, and Montreal Cognitive Assessment, respectively. Health-related QOL was assessed with WHOQOL-BREF scale. They were also subjected to routine comprehensive geriatric assessment. McNemar's Chi-square test and Paired t-test was used for statistical analysis. Results: Older diabetics have significantly higher frequency of depression (35.6% vs. 16.7%), GAD (12.8% vs. 4.4%), and cognitive impairment (53.9% vs. 27.2%) compared to nondiabetics. In addition, they also report poorer health-related QOL. Conclusions: Diabetes in old age is associated with increased risk of mental health disorders and an accompanying poor health-related QOL in all domains. Thus, patients with diabetes require access to mental health support in addition to management of metabolic abnormalities. Future research to assess the impact of screening of mental health disorders on outcomes such as glycemic control, morbidity, and mortality is required.","PeriodicalId":16009,"journal":{"name":"Journal of Geriatric Mental Health","volume":"5 1","pages":"152 - 158"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46109014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shiva Shanker Reddy Mukku, Manjula Simiyon, Umamaheswari Vanamoorthy, S. Loganathan, M. Varghese
Bipolar illness and Frontotemporal dementia (FTD) share many common features. The clinical features of mania such as excessive cheerfulness, hyper-sexuality and overspending can mimic impaired judgement and loss of inhibition seen in FTD. The depressive features such as anhedonia, decreased social interaction can mimic apathy associated with FTD. Among the FTD subtypes the behavioural variant of FTD (bv-FTD) can mimic a bipolar disorder, especially when it occurs in late life. Initially, patients with behavioural variant of FTD generally have behavioural changes with relatively preserved memory thus presenting a diagnostic challenge. The literature on bipolar disorder converting or progressing to FTD is limited to case reports and case series. In this case report we describe about an elderly gentleman with prior bipolar illness who later evolved into FTD. The diagnostic as well as management challenges have been discussed.
{"title":"Red herrings in the diagnosis of frontotemporal dementia: A case of probable bipolar disorder evolving into frontotemporal dementia","authors":"Shiva Shanker Reddy Mukku, Manjula Simiyon, Umamaheswari Vanamoorthy, S. Loganathan, M. Varghese","doi":"10.4103/JGMH.JGMH_1_18","DOIUrl":"https://doi.org/10.4103/JGMH.JGMH_1_18","url":null,"abstract":"Bipolar illness and Frontotemporal dementia (FTD) share many common features. The clinical features of mania such as excessive cheerfulness, hyper-sexuality and overspending can mimic impaired judgement and loss of inhibition seen in FTD. The depressive features such as anhedonia, decreased social interaction can mimic apathy associated with FTD. Among the FTD subtypes the behavioural variant of FTD (bv-FTD) can mimic a bipolar disorder, especially when it occurs in late life. Initially, patients with behavioural variant of FTD generally have behavioural changes with relatively preserved memory thus presenting a diagnostic challenge. The literature on bipolar disorder converting or progressing to FTD is limited to case reports and case series. In this case report we describe about an elderly gentleman with prior bipolar illness who later evolved into FTD. The diagnostic as well as management challenges have been discussed.","PeriodicalId":16009,"journal":{"name":"Journal of Geriatric Mental Health","volume":"5 1","pages":"71 - 74"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48651140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Role of Vitamin D in schizophrenia in elderly patient","authors":"J. Siddiqui, S. Qureshi, Yousef Ahmed Shawosh","doi":"10.4103/jgmh.jgmh_22_17","DOIUrl":"https://doi.org/10.4103/jgmh.jgmh_22_17","url":null,"abstract":"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.","PeriodicalId":16009,"journal":{"name":"Journal of Geriatric Mental Health","volume":"5 1","pages":"65 - 67"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46333027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steroids are known to have mood-elevating effects and are commonly used by quacks for various medical ailments. In this report, we present two cases, who were started on corticosteroids for somatic symptoms, who continued to abuse the steroids and became dependent on the same because of the mood-elevating effect and feeling of general well-being with these medications.
{"title":"Methylprednisolone abuse: Report of two cases and review of literature","authors":"A. Mehra, S. Grover","doi":"10.4103/jgmh.jgmh_13_17","DOIUrl":"https://doi.org/10.4103/jgmh.jgmh_13_17","url":null,"abstract":"Steroids are known to have mood-elevating effects and are commonly used by quacks for various medical ailments. In this report, we present two cases, who were started on corticosteroids for somatic symptoms, who continued to abuse the steroids and became dependent on the same because of the mood-elevating effect and feeling of general well-being with these medications.","PeriodicalId":16009,"journal":{"name":"Journal of Geriatric Mental Health","volume":"5 1","pages":"55 - 57"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70794087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Quantification of dementia: Are we there yet?","authors":"A. De Sousa","doi":"10.4103/jgmh.jgmh_24_17","DOIUrl":"https://doi.org/10.4103/jgmh.jgmh_24_17","url":null,"abstract":"","PeriodicalId":16009,"journal":{"name":"Journal of Geriatric Mental Health","volume":"5 1","pages":"79 - 80"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70794180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Grover, V. Natarajan, S. Rani, S. Reddy, A. Bhalla, A. Avasthi
Background: Geriatric population is on a steady rise since the past decade especially in densely populated countries like India. Elderly form a significant proportion of patients presenting to the medical emergency department and they warrant more attention in terms of mental health conditions as they are more predisposed to conditions such as delirium and cognitive impairment. Aim of this Study: This study aimed to evaluate the prevalence of psychiatric morbidity including substance use disorders among elderly (age ≥60 years) presenting to emergency medical outpatient services. Methodology: A total of 300 patients aged 60 years and above attending the medical emergency department of tertiary care hospital were approached, out of which, 232 participated. All the patients were assessed by Confusion Assessment Method, Modified Mini Screen and Alcohol, Smoking, and Substance Involvement Screening Test. Those found positive on any of the screening instrument were further evaluated on International Classification of Diseases-10 criteria, by a semi-structured interview to confirm the psychiatric diagnosis. Results: At least, one psychiatric diagnosis, i.e., either axis-I psychiatric disorder or substance dependence disorder was seen in 62% of cases. Nearly, half of the patients (47.4%) fulfilled at least one axis-I psychiatric diagnosis other than the substance dependence disorder at the time of assessment, with delirium being the most common, seen in about one-third (34.1%) of the participants. Other psychiatric diagnoses in the study sample included dementia (9.5%), depressive disorders (8.2%), adjustment disorder (3%), and anxiety (not otherwise specified) disorder in 3.4% of participants. About one-third (31%) of the participants had tobacco dependence, currently, using and one-fifth (19.8%) of patients had alcohol dependence syndrome currently using. Higher prevalence of delirium and dementia was noted among patients who were aged ≥70 years. Conclusion: The present study shows that elderly patients presenting to medical emergency department have a high prevalence of psychiatry morbidity. Accordingly, there is a need to reorganize psychiatric services and training to improve the identification and management of mental disorders among elderly patients presenting to emergency.
{"title":"Psychiatric morbidity among elderly presenting to emergency medical department: A study from tertiary hospital in North India","authors":"S. Grover, V. Natarajan, S. Rani, S. Reddy, A. Bhalla, A. Avasthi","doi":"10.4103/jgmh.jgmh_28_17","DOIUrl":"https://doi.org/10.4103/jgmh.jgmh_28_17","url":null,"abstract":"Background: Geriatric population is on a steady rise since the past decade especially in densely populated countries like India. Elderly form a significant proportion of patients presenting to the medical emergency department and they warrant more attention in terms of mental health conditions as they are more predisposed to conditions such as delirium and cognitive impairment. Aim of this Study: This study aimed to evaluate the prevalence of psychiatric morbidity including substance use disorders among elderly (age ≥60 years) presenting to emergency medical outpatient services. Methodology: A total of 300 patients aged 60 years and above attending the medical emergency department of tertiary care hospital were approached, out of which, 232 participated. All the patients were assessed by Confusion Assessment Method, Modified Mini Screen and Alcohol, Smoking, and Substance Involvement Screening Test. Those found positive on any of the screening instrument were further evaluated on International Classification of Diseases-10 criteria, by a semi-structured interview to confirm the psychiatric diagnosis. Results: At least, one psychiatric diagnosis, i.e., either axis-I psychiatric disorder or substance dependence disorder was seen in 62% of cases. Nearly, half of the patients (47.4%) fulfilled at least one axis-I psychiatric diagnosis other than the substance dependence disorder at the time of assessment, with delirium being the most common, seen in about one-third (34.1%) of the participants. Other psychiatric diagnoses in the study sample included dementia (9.5%), depressive disorders (8.2%), adjustment disorder (3%), and anxiety (not otherwise specified) disorder in 3.4% of participants. About one-third (31%) of the participants had tobacco dependence, currently, using and one-fifth (19.8%) of patients had alcohol dependence syndrome currently using. Higher prevalence of delirium and dementia was noted among patients who were aged ≥70 years. Conclusion: The present study shows that elderly patients presenting to medical emergency department have a high prevalence of psychiatry morbidity. Accordingly, there is a need to reorganize psychiatric services and training to improve the identification and management of mental disorders among elderly patients presenting to emergency.","PeriodicalId":16009,"journal":{"name":"Journal of Geriatric Mental Health","volume":"5 1","pages":"49 - 54"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43807856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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