Dr. Navendu Gaur

INTRODUCTION The average life span in many parts of the world has increased over the past century beginning with new challenges. In India those above the age of 60 years form 6.4% of the country's population.This figure is likely to increase to 15% by 2025 A.D. Community based studies have shown higher prevalence of psychiatric disorders in the elderly. Ramchandran et al. (1982) reported 35% from a survey conducted in a suburban area near Chennai. Venkoba Rao and Madhavan(1982) reported 8.9% from theThiruppuvanam survey. A retrospective study of geriatric patients attending tertiary care psychiatric hospital (IPHB) at Goa revealed psychotic illness in > 70% of geriatric patients attending the outpatient department foi ;ne first time (Yvonne da Silva perira et al. 2002). A single institutional retrospective study of 3 years to assess socio-demographic characteristics and pattern in elderly outpatients revealed 48.07% mood disorders, 15.47% neurotic and stress related disorders...

Elderly subjects have initial insomnia, wake up earlier than usual, have higher time spent in bed, have nighttime awakenings, nap more, and have decreased total sleep as compared to younger adults. With increasing age lighter stages of sleep becomes more, whereas, REM and slow-wave sleep reduce; up to 6 years of age there is 2% decrease in slow-wave sleep every decade. Slow-wave sleep does not change much from 60 to 90 years of age. However, sleep efficiency, i.e. the duration of sleep relative to total time in bed, continue to decrease over time. Sleep in the elderly is fragmented, lighter and is characterized by episodes of arousals and awakenings.

The Z-category hypnotics are promoted for their relative safety. However, this view is challenged by the emerging clinical evidence in the form of zolpidem related intoxication delirium and seizures, and dependence and complicated withdrawal. We report the case of a zolpidem-naive alcohol-dependent inpatient that, while undergoing alcohol de-addiction, was prescribed zolpidem for insomnia and developed delirium during taper-off. He was successfully detoxified for alcohol, treated for delirium and put on disulfiram prophylaxis. The case highlights the need for being cautious while using zolpidem for insomnia in alcohol dependent subjects.

1. World J Biol Psychiatry. 2010 Mar;11(2):156-7. Factors associated with weight gain with olanzapine. Gaur N, Grover S. Comment on: World J Biol Psychiatry. 2009;10(4 Pt 3):729-40. PMID: 20128715 [PubMed - indexed for MEDLINE]. Publication Types: Comment; Letter. ...

The long-term efficacy of psychological interventions for bipolar disorders has not been tested. This study assessed the efficacy of group psychoeducation to prevent recurrences and to reduce time spent ill for people with bipolar disorders. A randomised controlled trial with masked outcome assessment comparing group psychoeducation and non-structured group intervention during 5-year follow-up. One hundred and twenty people with bipolar disorders were included in the study and 99 completed 5-year follow-up. Time to any recurrence, number of recurrences, total number of days spent ill, frequency and length of hospitalisations were the main outcome measures. At the 5-year follow-up, time to any recurrence was longer for the psychoeducation group (log rank=9.953, P<0.002). The psychoeducation group had fewer recurrences (3.86 v. 8.37, F=23.6, P<0.0001) of any type and they spent less time acutely ill (154 v. 586 days, F=31.66, P=0.0001). The median number of days of hospitalisation per hospitalised participant was also lower for the psychoeducation group (45 v. 30, F=4.26, P=0.047). Six-month group psychoeducation has long-lasting prophylactic effects in individuals with bipolar disorders. Group psychoeducation is the first psychological intervention showing such a long-term maintained efficacy in people with bipolar disorders.