Charles Pinto

Sexuality: Desire, activity and intimacy in the elderly

Background: Sexual function and activity in old age have been inadequately studied world over. It is important to know that aging processes are not confined to persons beyond the age of 60 years; many changes in elderly have their antecedents in the middle age. Aims: This study sought to determine the patterns of sexual activity and function in individuals over 50 years of age. It also sought to discuss barriers such as chronic illness that may interfere with sexual function. Materials and Methods: We conducted a study of subjects above the age of 50 years in various outpatient departments (OPDs) of a teaching municipal hospital in Mumbai, by interviewing 60 individuals who attended the OPDs, after taking their informed consent. Socio-demographic and other information on their sexual function and activities were obtained. Data was analyzed using statistical package for social sciences v15. Results: 72% individuals below 60 were sexually active, while only 57% above 60 were active. Others had become completely abstinent at some time in their lives. Statistical analysis revealed significant gender, health and educational status based differences in the sample. Conclusion: Our study showed significant presence of sexual desire, activity and function even after the age of 50 years; a decline by the age of 60 and above was a finding that reflected more in women. Chronic illness did affect sexual function and desire.

Marchiafawa bignami disease possibly related to consumption of a locally brewed alcoholic beverage: Report of two cases

Marchiafava Bignami disease is a rare toxic disease seen mostly in chronic alcoholics, resulting in progressive demyelination and necrosis of the corpus callosum. Initially it was thought to be specific to individuals in central Italy, consuming large amounts of Chianti red wine; however, alcoholic beverages worldwide are presently implicated. In our case series of two cases, locally made “illicit” liquor (Mahuwa Alcohol) could be the causative factor. In radiological point of view typically the corpus callosum is affected, with involvement of the body, genu, and splenium in order of occurrence. Occasionally the entire callosum may be also involved. Clinical presentation varies from case to case.

Neuropsychiatric symptoms in mild cognitive impairment: An analysis and its impact on caregiving

Background: Neuropsychiatric impairments play a significant role throughout the course of cognitive decline. Many psychological and behavioral symptoms are present in patients of mild cognitive impairment (MCI) similar to that seen in individuals with dementia. Aims and Objectives: To study the relevance of neuropsychiatric symptoms of MCI and the impact it has on caregivers of these patients. Materials and Methods: This cross-sectional study was done on 90 patients (30 MCI, 30 dementia and 30 controls) above the age of 50 years. The scales used were Hindi–Mental Status Examination, Global deterioration scale and Neuropsychiatric inventory (NPI). Statistical analysis was done using SPSS 16 software. Results: 73.33% (22) of the subjects in MCI group, 90% (27) of subjects in dementia group and 53.33% (16) of subjects having normal cognition had neuropsychiatric complaints. 73.33% (22) relatives of subjects in the MCI group, 90% (27) relatives of subjects in dementia group and 46.67% (14) relatives of subjects in the normal group (i.e. control group) experienced some distress. The differences in the mean NPI severity, frequency, distress and total scores of the three groups were statistically significant. Severity and frequency of neuropsychiatric symptoms significantly predicted the caregivers distress. Conclusions: Neuropsychiatric symptoms increase both in frequency and severity with increasing cognitive decline, and they cause distress both to the patient as well as the caregiver; and hence their early recognition is a must. The NPI appears to be a useful tool in that regard.

Study of loneliness, depression and coping mechanisms in elderly

Aims and Objectives: To study loneliness, depression and coping mechanism and the relationship between these factors in depressed and non-depressed elderly. Materials and Methods: Cross sectional study was done on 46 depressed and 48 non-depressed elderly were assessed clinically and using Geriatric Depression Scale-Short form [GDS-SF], loneliness scale, and brief cope scale. Statistical analysis was done using SPSS 20 software. Result: Mean GDS scores, mean loneliness (emotional and social) scores of depressed patients were higher than that of non- depressed, and this difference was found to be statistically significant [GDS: t = 14.33, p Conclusion: Loneliness is an important distinct factor in predicting depression in elderly. Coping mechanisms used, also affects loneliness and depression significantly.

Indian Research on Acute Organic Brain Syndrome: Delirium

Delirium, though quite often referred to psychiatrists for management, does not find many takers for analysis, research and publications. Acute in onset, multiplicity of etiology and manifestations, high risk of mortality delirium is very rewarding in proper management and outcome. Delirium has a limited agenda on teaching programs, research protocols and therapeutic strategies. There is a dearth of Indian studies both in international and national scientific literature. This annotation is based on a Medline search for “delirium India” on Pubmed, which resulted in 54 articles. A search in Indian Journal of Psychiatry for “delirium” resulted in 38 published articles, “delirium tremens” showed up only five articles. The articles are primarily from the Indian Journal of Psychiatry with cross reference to articles on Pubmed or Google search on Indian studies and a few international studies

Study of suicidal ideations, hopelessness and impulsivity in elderly

Aims and Objectives: This study aimed to assess the suicidal ideations, hopelessness and impulsivity in depressed and non-depressed elderly and to study the relationship of suicidal ideations with hopelessness and impulsivity in them. Materials and Methods: This cross sectional study was done on 60 elderly patients (30 cases and 30 controls) above the age of 60 years. The scales used were Geriatric Suicide Ideation Scale, Beck Hopelessness Scale, Barrats Impulsiveness Scale, Geriatric Depression Scale. Results: Mean Geriatric Suicide Ideations Scale scores, mean Beck Hopelessness Scale scores and mean Barrats Impulsiveness Scale and scores of depressed elderly were higher than that of elderly who were not depressed and these differences were statistically significant. Hopelessness was a significant predictor of suicidal ideation in the entire sample as well as in the depressed and non-depressed elderly when the two groups were considered separately. Impulsivity when considered alone was a significant predictor of suicidal ideations in the entire sample. Conclusion: Hopelessness and impulsivity both by themselves are significant predictors for suicidal ideations in the elderly and when both are considered together hopelessness is a better predictor of suicidal ideations than impulsivity.

Clinical practice guidelines for geriatric anxiety disorders

Anxiety is one of the most common symptoms seen in the elderly. Sub-syndromal anxiety is more prevalent than depression and cognitive disorders. The commonest anxiety disorder seen in the clinical practice is Generalised Anxiety Disorder(GAD)(7.3%) followed by phobias(3.1%), the panic disorder(1%) and Obsessive Compulsive Disorder(OCD)(0.6%). Two relatively recent Indian studies have demonstrated an overall prevalence of anxiety disorders to be10.8% and 10.7%, respectively. Thus anxiety is quite common in the elder, among all the disorders of the geriatric population.

Neuropathology in Neuropsychiatric Disorders Secondary to Alcohol Misuse

Chronic alcohol use can result in structural and functional abnormalities in the brain. These changes are aggravated with nutritional deficiencies like thiamine deficiency. Advances in neuroimaging and quantitative studies have contributed significantly to the understanding of these neuropathological mechanisms underlying brain damage. This chapter focuses on the relationship between alcohol misuse and neuropsychiatric disorders. In addition, emphasis is given to the effects of alcohol on neurotransmitters and neuroregulatory hormones. Common syndromes discussed are Wernicke encephalopathy, Korsakoff syndrome, and alcohol withdrawal syndrome. Other disorders are alcohol-related dementia, alcoholic cerebellar degeneration, and alcoholic hallucinosis. Rarer diseases like Marchiafava–Bignami disease and central pontine myelinolysis have also been described. Early identification of potentially reversible pathological changes with studies on risk factors are tools that can be incorporated into public education programs. More research in preventive approaches is needed to help reduce the morbidity and mortality associated with this global health problem.

Cognitive reserve: Concept, determinants, and promotion

Maintenance of cognitive function in old age has become increasingly desirable to a human society with an aging population. Various studies have shown that there is major variation in the clinical manifestations and severity of cognitive aging as a result of neurodegenerative changes that are similar in nature and extent. These mismatches led to the emergence of the concept of cognitive reserve (CR), which focuses on the adaptability and the flexible strategies of the brain that allow some people to cope better than others in the circumstance of age-related or Alzheimer′s disease (AD)-related pathology. It is believed that CR is mainly influenced by an individual′s education, intellect, mental stimulation, participation in leisure activities, dietary preferences, and social stimulation. These determinants of CR help in slowing the rate of memory decline in the normal aging process and also reduce the risk of developing AD. The role of functional neuroimaging has recently gained importance in the context of understanding the neural basis of CR and its relationship to aging-related behavior changes. Future research in this field may enable earlier detection and thus reduction in the prevalence of age-related cognitive changes and AD. This article is a review of the neurobiology of CR, the concept of CR, and the promotion of preserving CR by analyzing its determinants along with their implementation against its deterioration toward cognitive loss and disorders.

Private Sector Psychiatry: What it has to Offer to Mentally Ill Persons in South Asia?

Private Sector Psychiatry has a lot to offer in the region of South Asia. South Asia is a densely populated region with disproportionate skilled personnel for Mental Health and a scarcity of government resources to manage the Mental Health issues of the populace. There are some countries in this region which have Mental Health Legislation and National Mental Health Programs, and some who have no separate Mental Health laws, guidelines and programs. Private sector services range from single doctor clinics to multispecialty hospitals, and individual initiatives. The private sector in many small areas is the initial and the most important source of care provision. Though costly, private services are accessible, prompt, of reasonably good quality, and mostly evidence based. Private Practitioners want to provide the best possible services to their patients and for that purpose collaboration with the Public Sector is vital. Issues that are of concern are costs necessary to set up services, expensive medication & investigations, and lack of health insurance & reimbursement. The Private Sector can function as a zone of transition between services when the need may arise. Private Sector multispecialty hospitals are increasingly involved in research in various forms.