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Aripiprazole worsening visual hallucination in a patient with lewy body dementia 阿立哌唑加重路易体痴呆患者的视幻觉
Pub Date : 2019-01-01 DOI: 10.4103/jgmh.jgmh_31_18
Sujita Kumar Kar, Suyash Dwivedi
33 Sir, Lewy body dementia is the most common degenerative form of dementia, next to Alzheimer’s disease.[1] Patients with Lewy body dementia often experience psychotic symptoms such as delusions and hallucinations. In Lewy body dementia, hallucinations are the most common psychotic symptoms.[2] Evidence suggest the association of visual hallucinations, misidentifications, and delusions with dysfunctions of parieto‐occipital cortex, limbic–paralimbic cortex, and frontal lobe, respectively.[3] A recent systematic review and meta‐analysis on pharmacological treatments of Lewy body dementia highlights about the inadequacy of high‐level evidence‐based pharmacological interventions.[4] Donepezil and rivastigmine can improve cognitive and psychiatric symptoms in Lewy body dementia. Antipsychotic agents that may be of some use for the management of psychotic symptoms in Lewy body dementia are – quetiapine, clozapine, olanzapine, and risperidone.[4] High neuroleptic sensitivity is a challenge which limits the use of antipsychotic agents to treat psychotic symptoms associated with Lewy body dementia. We present here a case (after obtaining informed consent) of Lewy body dementia, who reported worsening of visual hallucinations with aripiprazole.
先生,路易体痴呆是最常见的退行性痴呆,仅次于阿尔茨海默病路易体痴呆患者通常会出现妄想和幻觉等精神病症状。在路易体痴呆中,幻觉是最常见的精神病症状有证据表明,视幻觉、误认和妄想分别与顶枕皮质、边缘-旁缘皮质和额叶功能障碍有关最近一项关于路易体痴呆药物治疗的系统综述和荟萃分析强调了基于高水平证据的药物干预的不足多奈哌齐和利瓦斯汀可改善路易体痴呆患者的认知和精神症状。可能对路易体痴呆的精神病症状有一定作用的抗精神病药物有奎硫平、氯氮平、奥氮平和利培酮高抗精神病药敏感性是一个挑战,限制使用抗精神病药物治疗与路易体痴呆相关的精神病症状。我们在这里提出一个病例(在获得知情同意后)路易体痴呆,谁报告恶化的视觉幻觉与阿立哌唑。
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引用次数: 0
Mental health policy for elderly 老年人心理健康政策
Pub Date : 2019-01-01 DOI: 10.4103/jgmh.jgmh_26_19
The population of elderly has been increasing globally with a more rapid increase in the developing countries like India. The increase in life expectancy has contributed to the increase in elderly population, particularly the older old (above 80 years’ age). Unlike some of the developed countries, the change in demography in developing countries has started even before the adequate improvement in the health‐care system to manage the challenges in health care of elderly. The burden due to noncommunicable diseases (NCD) is high in elderly as they have a high prevalence of comorbid general medical and mental health problems. The health system in India is less prepared for the management of NCD in elderly that requires an approach of chronic care. The facilities for the treatment of mental health problems even in young adults in India are not adequate, and Mental Health Care Act, 2017 highlights this issue, and there is a need for prompt action to improve this situation. Elderly being a vulnerable population have more risk factors and also have more barriers in access to treatment. The National Programme For Health Care of the Elderly launched few years back to promote active and healthy aging in elderly has not yet been implemented actively. Therefore, there is an urgent need for policies and geriatric mental health services to focus toward this neglected population.
全球老年人口一直在增加,其中印度等发展中国家的增长速度更快。预期寿命的增加导致老年人口增加,特别是老年人口(80岁以上)。与一些发达国家不同,发展中国家的人口变化甚至在卫生保健系统得到充分改善以应对老年人卫生保健方面的挑战之前就开始了。非传染性疾病在老年人中造成的负担很高,因为他们普遍存在一般医疗和精神健康问题。印度的卫生系统在管理老年人非传染性疾病方面准备不足,这需要一种慢性护理方法。在印度,治疗精神健康问题的设施甚至在年轻人中也不充分,《2017年精神保健法》突出了这一问题,需要迅速采取行动改善这一状况。老年人是弱势群体,有更多的风险因素,在获得治疗方面也有更多障碍。几年前为促进老年人积极健康老龄化而启动的《国家老年人保健方案》尚未得到积极实施。因此,迫切需要政策和老年心理健康服务来关注这一被忽视的人群。
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引用次数: 2
Prognostic implications of late-onset primary tic disorder in an elderly male: A case report 老年男性迟发性原发性抽动障碍的预后意义:1例报告
Pub Date : 2019-01-01 DOI: 10.4103/JGMH.JGMH_19_19
Suyash Dwivedi, Sujita Kumar Kar
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引用次数: 0
Risperidone-induced skin rash in an elderly female 利培酮致老年女性皮疹1例
Pub Date : 2019-01-01 DOI: 10.4103/JGMH.JGMH_7_19
M. Shah, S. Karia, Heena Merchant, N. Shah, A. Sousa
Skin reactions have been reported with various antipsychotic drugs in scientific literature. It is important that clinicians be watchful of skin reactions in the elderly with antipsychotic medication, which can be an uncommon occurrence. It has been documented that the elderly are more prone to skin reactions with various forms of medication. We herewith report a case of skin reaction with risperidone in an elderly female patient.
在科学文献中已经报道了各种抗精神病药物的皮肤反应。重要的是,临床医生要注意皮肤反应在老年人与抗精神病药物,这可能是一个罕见的发生。有文献表明,老年人更容易对各种形式的药物产生皮肤反应。我们在此报告一例皮肤反应与利培酮在一个老年女性患者。
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引用次数: 1
Identifying multiple domain memory impairment in high-risk group for Alzheimer's disorder 阿尔茨海默病高危人群多区域记忆障碍的鉴定
Pub Date : 2019-01-01 DOI: 10.4103/jgmh.jgmh_4_19
Susmita Halder, A. Mahato
Introduction: Occasional lapses in memory in elderly people are often considered as normal aging process and not a warning sign of serious mental deterioration or Alzheimer's disease (AD). When memory loss becomes so pervasive and severe that it disrupts daily activities, it becomes a signal for early AD. As the disease is irreversible and progressive in nature, identification of persons with high risk of developing AD is becoming a priority. The objective of this study was to identify and characterize the deficits in the memory performance of patients who presented with memory difficulties, without any other significant cognitive decline, and identified with high risk. Subject and Methods: Consecutive patients of both sexes in the age range of 55–70 years, who presented with problem in memory, were screened on the Mini–Mental State Examination and further assessed on the Dementia Rating Scale. Patients identified with high risk for AD were assessed for their memory profile using the PGI Memory Scale and further compared with healthy controls. Results: The high-risk group performed significantly lower than controls in domains of recent memory, delayed recall, verbal retention for dissimilar pairs, visual retention, and recognition. Conclusion: Multiple memory domains are affected in high-risk group for AD. Although they did not qualify to be diagnosed with AD, their memory profile is distinct with healthy controls and may be indicative of proneness for the disease.
老年人偶尔的记忆衰退通常被认为是正常的衰老过程,而不是严重的精神退化或阿尔茨海默病(AD)的警告信号。当记忆丧失变得如此普遍和严重,以至于它扰乱了日常活动时,它就成为了早期阿尔茨海默病的信号。由于阿尔茨海默病具有不可逆性和进行性,因此识别阿尔茨海默病高危人群正成为一个优先事项。本研究的目的是识别和描述出现记忆困难的患者的记忆表现缺陷,没有任何其他显著的认知能力下降,并确定为高风险。对象与方法:对年龄在55 ~ 70岁、连续出现记忆问题的男女患者进行小精神状态检查和痴呆评定量表的筛选。使用PGI记忆量表评估AD高风险患者的记忆概况,并进一步与健康对照进行比较。结果:高危组在近期记忆、延迟回忆、对不相似词的言语保留、视觉保留和识别方面的表现明显低于对照组。结论:AD高危人群多记忆域受到影响。虽然他们没有资格被诊断为阿尔茨海默病,但他们的记忆概况与健康对照者不同,可能表明易患该疾病。
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引用次数: 1
Mild cognitive impairment – A hospital-based prospective study 轻度认知障碍——一项基于医院的前瞻性研究
Pub Date : 2019-01-01 DOI: 10.4103/jgmh.jgmh_30_18
Shiva Shanker Reddy Mukku, M. Varghese, S. Bharath, Keshav J. Kumar
Background: Mild cognitive impairment (MCI) is regarded as a transitional state between normal aging and dementia. It may progress to dementia, remain same, or revert to normalcy. Most western studies report an annual conversion of 10%–15% of MCI to dementia. There is a paucity of literature on prospective studies on MCI in India. Objective: The objective is to prospectively study the cognitive status of MCI patients at least 1 year after their diagnosis. The other objective was to find the conversion among the MCI patients to Alzheimer's dementia. Methodology: We followed up persons with MCI above 50 years evaluated in the Geriatric Clinic of National Institute of Mental Health and Neurosciences (NIMHANS) between 2012 and 2014, reassessed their cognitive abilities (neuropsychological measures) 1 year later, and compared them with earlier assessment and the conversion rate among this sample. Hindi Mental Status Examination (HMSE), Everyday Abilities Scale for India (EASI), NIMHANS neuropsychological battery for Indian elderly, and Clinical Dementia Rating (CDR) scale instruments were used for assessment. Results: Twenty-seven persons with a diagnosis of MCI were contacted. Twenty-one participated and underwent repeat clinical and neuropsychological evaluations. The mean duration of follow-up was 1.43 (standard deviation: ± 0.46) years. Six participants (28.6%) had progressed to mild Alzheimer's disease (AD) based on EASI, CDR, and neuropsychological scores, 15 (71.4%) retained their MCI status, and none had reverted back to normal status. The mean age of converters (progressed to mild AD) was 72 ± 5.69 years and nonconverters (remained as MCI) was 72.6 ± 7.16 years. Multiple medical comorbidities were found in both the groups with hypertension being the higher in converters (P = 0.04). Among the converters compared to nonconverters, there was a significant decline in total word list learning (P = 0.006), design construction copy (P = 0.042), total figures canceled in figure cancellation test (P = 0.009), and total omissions on figure cancellation test (P = 0.02). Discussion and Conclusion: Scores on episodic memory, attention, and visuospatial skills were low in the MCI compared to normal controls to start with – there was a further significant decline in few of these parameters over the follow-up. The conversion rate in our study was 28.6% for 1.43 years, which is higher compared to the western studies. Executive function learning and memory were the domains predominantly affected in the converters compared to nonconverters. The study based on tertiary hospital and help seeking with a specialist by those who perceived/were perceived to worsen could be probable reason for this higher rate. Higher medical comorbidities, lower HMSE scores, and executive function and memory at baseline are found to increase the risk of progression to AD.
背景:轻度认知障碍(Mild cognitive impairment, MCI)被认为是介于正常衰老和痴呆之间的过渡状态。它可能发展为痴呆,保持不变,或恢复正常。大多数西方研究报告称,每年有10%-15%的轻度认知损伤转化为痴呆。在印度,关于MCI的前瞻性研究文献很少。目的:前瞻性研究MCI患者诊断后至少1年的认知状况。另一个目标是发现MCI患者向阿尔茨海默氏痴呆症的转变。方法:我们对2012 - 2014年在美国国家心理健康与神经科学研究所(NIMHANS)老年临床评估的50岁以上轻度认知障碍患者进行随访,1年后对其认知能力(神经心理学测量)进行重新评估,并与早期评估和该样本的转换率进行比较。采用印地语精神状态检查(HMSE)、印度日常能力量表(EASI)、印度老年人NIMHANS神经心理测试和临床痴呆评分(CDR)量表进行评估。结果:联系了27例诊断为轻度认知损伤的患者。21人参与并接受了重复的临床和神经心理学评估。平均随访时间为1.43年(标准差:±0.46)。根据EASI、CDR和神经心理学评分,6名参与者(28.6%)进展为轻度阿尔茨海默病(AD), 15名参与者(71.4%)保持MCI状态,没有人恢复到正常状态。转换者(进展为轻度AD)的平均年龄为72±5.69岁,非转换者(仍为MCI)的平均年龄为72.6±7.16岁。两组患者均有多种合并症,其中高血压患者较多(P = 0.04)。与非转换者相比,转换者在单词表学习总量(P = 0.006)、设计结构拷贝量(P = 0.042)、图形消除测试中取消的图形总数(P = 0.009)和图形消除测试中遗漏的图形总数(P = 0.02)均显著下降。讨论与结论:与正常对照相比,MCI患者的情景记忆、注意力和视觉空间技能得分较低——在随访过程中,这些参数中有几个进一步显著下降。在我们的研究中,1.43年的转化率为28.6%,高于西方的研究。与非转换者相比,转换者的执行功能、学习和记忆是受影响最大的领域。基于三级医院的研究和那些认为/被认为病情恶化的人向专家寻求帮助可能是这一较高比率的原因。较高的医疗合并症、较低的HMSE评分以及基线时的执行功能和记忆增加了进展为AD的风险。
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引用次数: 3
Pregabalin misuse in a 75-year-old woman 一名75岁妇女滥用普瑞巴林
Pub Date : 2019-01-01 DOI: 10.4103/jgmh.jgmh_35_18
A. Sousa
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引用次数: 0
Inpatient treatment outcomes of aged substance-using patients admitted to a tertiary care center 入住三级护理中心的老年药物使用患者的住院治疗结果
Pub Date : 2018-07-01 DOI: 10.4103/JGMH.JGMH_9_18
P. Kathiresan, S. Sarkar, Y. S. Singh Balhara
Background and Aims: Studies on aged substance users are few from the Indian subcontinent, though they are likely to represent a subgroup of patients with distinct clinical needs. This study aimed to present the inpatient treatment outcomes of such aged substance-using patients admitted to a tertiary care treatment facility in India. Methodology: This descriptive, retrospective chart-based study presents data of aged patients (age 50 years and above) admitted between January and December 2014 at the National Drug Dependence Treatment Centre, Ghaziabad. Results: A total of 72 aged patients were admitted during this period out of total 953 admissions (7.6% of the sample). All of them were male. Forty patients (55.6%) had a diagnosis of alcohol dependence and 32 (44.4%) had a diagnosis of opioid dependence. The mean duration of stay was 12.9 (±9.6) days. Of these 72 patients, treatment could be completed for 57 patients (79.2%), while seven patients left against medical advice, four were discharged on disciplinary grounds, three were shifted to another facility (two due to medical reasons), and one absconded. Treatment completion rate was least among aged patients with only opioid dependence (25.65%). Conclusion: Medical issues may be a consideration of premature discharge among aged patients admitted for the treatment of substance use disorders. Furthermore, treatment noncompletion is more among aged patients with opioid use disorder than among alcohol use disorder. Further studies are needed with prospective methodology for the assessment of various factors associated with treatment completion, which can help to address the treatment needs of aged patients with substance use disorders, which in turn can lead to better treatment outcomes for them.
背景和目的:印度次大陆对老年药物使用者的研究很少,尽管它们可能代表了具有不同临床需求的患者亚组。本研究旨在利用印度三级护理治疗机构收治的患者,介绍此类老年物质的住院治疗结果。方法:这项基于图表的描述性回顾性研究提供了2014年1月至12月在加齐阿巴德国家药物依赖治疗中心入院的老年患者(年龄50岁及以上)的数据。结果:在此期间,共有953名老年患者入院(占样本的7.6%),共有72名老年患者住院。他们都是男性。40名患者(55.6%)被诊断为酒精依赖,32名患者(44.4%)被诊断出阿片类药物依赖。平均住院时间为12.9(±9.6)天。在这72名患者中,57名患者(79.2%)可以完成治疗,7名患者不听医嘱离开,4名患者因纪律原因出院,3名患者被转移到另一个机构(2名患者因医疗原因),1名患者潜逃。只有阿片类药物依赖的老年患者的治疗完成率最低(25.65%)。结论:在接受药物使用障碍治疗的老年患者中,医疗问题可能是提前出院的一个考虑因素。此外,与酒精使用障碍相比,阿片类药物使用障碍的老年患者治疗不完全的情况更多。需要采用前瞻性方法进行进一步研究,以评估与治疗完成相关的各种因素,这有助于满足患有药物使用障碍的老年患者的治疗需求,进而为他们带来更好的治疗结果。
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引用次数: 0
Insomnia in elderly: A neglected epidemic 老年人失眠:一种被忽视的流行病
Pub Date : 2018-07-01 DOI: 10.4103/JGMH.JGMH_15_18
Shiva Shanker Reddy Mukku, V. Harbishettar, P. Sivakumar
Sleep is an important vital function. Sleep promotes many functions such as restoration of body, repair of tissues, immune regulation, and consolidation of memory. Insomnia is one of the most common complaints in patients with mental health problems. The prevalence of insomnia is higher in elderly than in general population. The reasons could be due to physiological changes in sleep architecture with aging, high medical morbidity, multiple medication, loneliness, and environmental factors causing sleep disturbances. Although insomnia is a common troubling problem in the elderly, only minority seek professional help. Some elderly self-medicate with over-the-counter medications for their sleep problems. These practices lead to serious adverse effects over the long term. There are many myths related to insomnia in elderly. Thus, insomnia in elderly is often under-recognized and under-treated problem. In this article, we review the literature on sleep problems in the elderly and discuss the systematic evaluation of insomnia in the elderly.
睡眠是一项重要的生命功能。睡眠促进许多功能,如身体的恢复,组织的修复,免疫调节,巩固记忆。失眠是心理健康问题患者最常见的主诉之一。失眠症在老年人中的发病率高于一般人群。原因可能是随着年龄增长,睡眠结构的生理变化,高发病率,多种药物治疗,孤独感以及导致睡眠障碍的环境因素。尽管失眠是困扰老年人的常见问题,但只有少数人寻求专业帮助。一些老年人使用非处方药物自行治疗睡眠问题。长期来看,这些做法会导致严重的不良影响。关于老年人失眠有很多误区。因此,老年人失眠往往是一个未被充分认识和治疗的问题。在本文中,我们回顾了有关老年人睡眠问题的文献,并讨论了老年人失眠的系统评估。
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引用次数: 6
An old man who spit pearls-A case discussion 一个吐珍珠的老人——一个案例讨论
Pub Date : 2018-07-01 DOI: 10.4103/jgmh.jgmh_19_18
S. Agarwal, Apoorva Yadav, A. Tyagi, Arpit Koolwal, S. Choudhary
In the history of psychiatry, the contents of delusions have always interested the community of mental health professionals. We came across a 65-year-old patient with a peculiar delusion of spitting pearls. This study purports to discuss, first, the late age of onset of the delusions in the absence of any cognitive deficits along with unique delusional content and, second, the possible role of environment in the formulation of delusional content.
在精神病学史上,妄想的内容一直引起心理健康专业人士的兴趣。我们遇到了一位65岁的病人,他有一种吐珍珠的奇特错觉。这项研究旨在讨论,首先,在没有任何认知缺陷的情况下,妄想症的发病年龄较晚,以及独特的妄想内容,其次,环境在妄想内容形成中的可能作用。
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引用次数: 0
期刊
Journal of Geriatric Mental Health
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