Psychiatric morbidity in elderly patients attending OPD of tertiary care centre in western region of Nepal

Progressive multifocal leukoencephalopathy in the background of chlorambucil treated chronic lymphocytic leukemia: a case report from Nepal

Introduction

Progressive multifocal leukoencephalopathy is a rare manifestation in itself. Although many immunosuppressive states are associated with the disease, its occurrence in the setting of chronic lymphocytic leukaemia treated with chemotherapy is seldom reported to date.

Case presentation

A 67-year-old woman with known chronic lymphocytic leukaemia who was previously receiving chlorambucil treatment was identified as having progressive multifocal leukoencephalopathy; her prognosis is currently good.

Clinical discussion

Although a rare disease in an immunocompromised setting, progressive multifocal leukoencephalopathy often leads to a grave outcome. However, the authors describe a case with a good prognosis to date.

Conclusion

Progressive multifocal leukoencephalopathy should be in differentials in immunocompromised patients with dementia. Given that the later prognosis of the disease is unpredictable, an earlier diagnosis would be better for immunological reconstitution.

Depression among older adults: a systematic review of South Asian countries

The world's population has been evolving rapidly; every country in the world is facing this drastic progression in the number and the percentage of the elderly in their net population. As the chronological age advances, physiological and psychosocial decline will be evident among all older adults. The potentially relevant literature was identified using appropriate search terms in electronic databases such as PubMed MEDLINE, Scopus, ProQuest, Web of Science, CINAHL, IndMed, and Google Scholar. Articles published from 2006 to 2019, reported the prevalence and the risk factors for depression among older adults living in the community, old age homes, or hospitals of the South Asian countries. Articles were published in the languages other than English and those reporting the categorised or mean depressive scores were excluded from the review. After quality check for all the retrieved articles from different databases, 120 articles were included for the meta-analysis. The data were extracted based on a validated data extraction form, and the reviewer contacted the authors for clarification of the missing data whenever required. The estimates were pooled using the random effect model for meta-analyses. Sub-group and sensitivity analyses were also performed. The overall pooled estimate (random effect models) of the prevalence of depression among the elderly was 42.0% (95% CI: 0.38-0.46), Chi-squared P-value <0.001, and I² 99.14%. The pooled estimate of the prevalence was higher in the community settings than the old age homes (44.0%; 95% CI: 39.0-49.0 vs. 42.0%; 95% CI: 34.0-49.0). Depression is a common problem among the elderly population and the pooled estimate of depression would give directions to the healthcare providers, policymakers, and future researchers to plan some measures (either pharmacological or non-pharmacological interventions) to effectively tackle the burden of geriatric depression in the future.

Psychiatric Morbidities of Elderly Out-patients Attending Various Outreach Clinics in Gandaki Province of Nepal: A Descriptive Cross-sectional Study

Introduction:

Dramatic growth of the aging population resulted in an increased number of mental disorders and such data are limited in Nepal. The objective is to find out the psychiatric morbidities of elderly out-patients attending Baglung, Kusma, Walling, and Dumre out-reach clinics in Gandaki Province of Nepal.

Methods:

This was a descriptive cross-sectional study conducted in 392 patients attending out-reach clinics of Baglung, Kusma, Walling, and Dumre of Gandaki Province for one year with the convenient sampling method. Ethical approval was taken from the Institutional Review Committee of Manipal College of Medical Sciences, Pokhara. The diagnosis was done according to the International Classification of Disease-10 guidelines. Epi-info 7 was used and point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data and the analysis was done.

Results:

The prevalence of neurotic, stress-related, and somatoform disorders 145 (37.0%) was maximum followed by mood disorders 111 (28.3%). Maximum cases were in between 66 and 75 years, Brahmin and Chhetri caste, females, married, and from an extended nuclear family. There is more prevalence of female gender in all psychiatric diagnoses except in mental and behavioral disorders due to psychoactive substance use. There is more prevalence of age groups of patients less than or equal to 75 years in all the psychiatric diagnosis.

Conclusions:

Neurotic, stress-related, and somatoform disorders were the most common diagnosis. The risk of development of certain disorders based on gender and age group of the patients would be helpful for case identification.