Vol 3, No 1 (2022)

The world’s population is ageing rapidly. Estimates by the United Nations (UN) and World Health Organization (WHO) suggest that between 2015 and 2050, the proportion of the world's older adults will almost double from about 12% to 22% [1]. In absolute terms, this is an expected increase from 900 million to 2 billion people over the age of 60. Older people face unique physical and mental health challenges that need to be recognized. Mental health and well-being are particularly important in older age. While most have good mental health, many older adults are at high risk of developing mental and neurological disorders, as well as other medical conditions. Similarly, as people age, they are more likely to experience a number of conditions at the same time [2]. Besides, there are numerous social, psychological, and ecological factors that can impact the mental wellbeing of older people.

The increasing number of older adults in countries across the world is a huge challenge to those that are in charge of promoting, protecting, and implementing their human rights. This task is particularly difficult in the absence of a strong international framework addressing the principles required to guide the actions to combat all human rights violations. The existence of such a specific framework for older adults with mental health conditions is justified in view of the particular vulnerability of this section of the population by virtue of societal ageism, stigmatization, exclusion, as well as the disability and dependency which mental health conditions in old age may confer. The present article is a development of a previous statement by the International Psychogeriatric Association and the World Psychiatric Association Section of Old Age Psychiatry. As there is a call to all organizations to support efforts to combat Human Rights violations among older adults, a text will be submitted to the Executive Committee of the World Psychiatric Association to approve an official position statement on Human Rights of Older Persons with Mental Health Conditions.

There is no health without mental health. These are both indispensable human rights and are prerequisite to living one’s life with dignity. Unfortunately, mental health systems have been in crisis, with burden of mental illness being among the ten leading healthcare-related issues worldwide, with no measurable reduction in such for over 30 years. Concurrently, the demographic clock continues to tick. Toady’s 703 million people aged 65 or older are projected to reach 1.5 billion by the year 2050. Of these, 20% will suffer with serious mental health conditions. At the heart of the global crisis for older people is ageism, frequently intersecting with ableism, mentalism, sexism, and racism.

These biases result in the violation of older peoples’ human rights every day, with the resultant poor quality of life and premature death. They are compounded by major gaps in legislation, policies, and practices, rendering the central transformative promise of the UN’s 2030 Agenda to “Leave No One Behind” a very elusive goal. Evidence-based interventions designed to prevent or reduce the risk of common mental health conditions and psychosocial disability are already available. All governments and policymakers have a major role to play in the promotion of good mental health and the prevention of mental illness by integrating these into public health and general social policy.

This requires adopting, implementing, and scaling up of evidence-based, cost-effective interventions to reduce the risk of the development of mental disorders and providing access to adequate treatment when needed for older persons. All governments and policymakers also have a pivotal role to play in leading and supporting a UN convention on the human rights of older people. A UN convention would help combat ageism at the national and international levels by ensuring integration of monitoring and enforcement mechanisms to effectively implement policies and laws that could address discrimination, inequity, and the protection of human rights of older people, including their mental health.

Loneliness is understood as a painful negative emotion. Since its introduction into the psychiatric literature in 1959, the understanding of loneliness has improved considerably, and is now understood to be a distinct entity to such issues as social isolation, solitude, and depression. However, there is still a lack of consensus on the general definition of loneliness. Similarly, different dimensions of loneliness have been described in the literature. It is understood in terms of either transient versus situational versus chronic loneliness; state versus trait loneliness; and the concept of unidimensional versus multidimensional loneliness. The reported prevalence of loneliness varies considerably in the literature, with evidence from metanalysis suggesting the prevalence of moderate loneliness that ranges from 31 to 100% with a mean of 61%, and that of severe loneliness ranging from 9 to 81%, with a mean prevalence of 35% among the elderly. Loneliness among the elderly is associated with significant adverse mental and physical health outcomes in the form of cardiovascular diseases, stroke, diabetes mellitus, arthritis, depression, anxiety, dementia, and even problematic internet use. Over the years, different instruments [University of California Los Angeles Loneliness Scale (UCLA-LS), De Jong Gierveld Loneliness Scale, Single-Item direct measure of loneliness] have been designed to assess loneliness among the elderly. Some of the interventions suggest that persons experiencing loneliness could benefit from improved social skills, enhanced social support, increased opportunities for social contact, and addressing maladaptive social cognition.

INTRODUCTION: One of the innovations in the ICD-11grouping "Schizophrenia and Other Primary Psychotic Disorders" is the implementation of six symptom domains intended to improve diagnostics and treatment of these mental conditions in clinical practice. In this respect, evaluation of the effects of various psychotropic drugs, primarily antipsychotic agents, on the specified psychotic symptom domains is a critical task. The antipsychotic agent cariprazine, registered in many countries worldwide (including Russia) for schizophrenia treatment, was selected as the psychotropic drug model for the purposes of the present review.

METHODS: For the purposes of this review the MEDLINE, Cochrane Central Register of Controlled Trials, and PubMed databases were searched for randomized controlled trials comparing cariprazine with a placebo, or a placebo and one or several antipsychotic agents, and that was performed within the period from January 2014 to March 2021.

RESULTS: Cariprazine has proved its efficiency in relation to all symptom groups of the ICD-11 domain "Positive Symptoms'', and may be considered a front-line therapy for treatment of the first and multiple episodes of schizophrenia, disorganized thinking, and behavioral disorders in the form of aggressiveness and hostility. Cariprazine has the best evidential base for treatment of various symptoms within the ICD-11 domain "Negative Symptoms'' among all antipsychotic agents. The data with regard to the effects of cariprazine on the domain "Depressive Mood Symptoms'' are controversial. No data concerning the effects of cariprazine on the domain "Maniс Mood Symptoms'' are available, but the effectiveness of cariprazine monotherapy for manic episodes without any psychomotor agitation signs in the instance of bipolar disorder has been demonstrated. The effectiveness of cariprazine therapy for the ICD-11 domain "Psychomotor Symptoms" has not been investigated, either within the framework of monotherapy or in the course of adjuvant therapy. The effectiveness of cariprazine has been demonstrated in treatment of the domain "Cognitive Symptoms", and the pro-cognitive effect of the drug has developed regardless of its impact on any other schizophrenia symptoms. The drug’s capability to improve the functioning of patients with schizophrenia was demonstrated regardless of the impact on psychotic symptoms.

CONCLUSION: Cariprazine is the first-line drug for treatment of the domain "Negative Symptoms" as well as representing front-line therapy for the treatment of ICD-11 domains "Positive Symptoms" and "Cognitive Symptoms". Additional studies will be required in order to evaluate the effects of cariprazine on the ICD-11 domains "Maniс Mood Symptoms" and "Depressive Mood Symptoms".

BACKGROUND: The world faces global population ageing. With this demographic shift and increased life-expectancy, healthcare services are focused on healthy ageing. Sexual health is a vital yet neglected dimension of general health and wellbeing in older adults. This study aimed to explore sexual experiences and perceptions of sexuality among older people in India.

METHODS: A qualitative approach with social constructivist paradigm was used. 20 participants aged above 60 years were recruited through purposive sampling until thematic saturation was reached. In-person, in-depth interviews were conducted using a semi-structured guide after an initial pilot study. They were audio-recorded, transcribed, and translated verbatim. Thematic analysis was conducted, and rigor ensured through triangulation and respondent validation.

RESULTS: The overarching categories were “sexuality as a mode of resilience”, “emotional stability and intimacy as attributes of sexual pleasure”, and “lack of sexual rights awareness”. The main categories (themes) were sexual experiences (intimate touch, non-penile sex, personal meanings of sexuality), partner expectations (companionship, support, continuity of care, proximity), and barriers against sexual expression (social stereotypes, stigma, lack of audience in healthcare services). The older people were accepting of their sexual difficulties and coped through relationship dynamics. Participant voices are discussed with regard to the socio-cultural context.

CONCLUSION: Sexual wellbeing is connected with “ageing well”. Our findings suggest that older people retain sexual desires and fantasies through changed patterns and expectations. Healthcare services, policymakers and academia need to be informed about older people’s sexual needs and rights.

The world is facing rapid population aging. This is associated with an increase in the number of older people from the lesbian, gay, bisexual, trans, queer, intersex, or asexual (LGBTQIA+) community. This population faces unique challenges, including ageism, sexual identity stigma, and self-stigma. The older LGBTQIA+ population are neglected by, and invisible to, healthcare interventions, research, and policy changes. In light of the paradigm shift in healthcare towards a rights-based approach, healthy aging has become an important construct. Healthy aging, according to the World Health Organization (WHO), is a “continuous process of optimizing opportunities to maintain and improve physical and mental health, autonomy, and quality of life throughout the life course”. This commentary highlights the unique vulnerabilities of the aging LGBTQIA+ population, advocates the inclusion of their voices at all levels of the healthcare system, and discusses the way forward to enable their ‘healthy aging’.

Kicking off on 1 October with the United Nations’ International Day of Older Persons (UNIDOP) and concluding on 10 October in conjunction with World Mental Health Day, the OLDER ADULT MENTAL HEALTH AWARENESS WEEK was a brand-new ten-day initiative launched by the International Psychogeriatric Association (IPA). It was focused on raising awareness of the importance of Better Mental Health for Older People with virtual programs from all around the world on each of these ten days. As part of this Awareness Week, the IPA hosted a discussion entitled “Mental healthcare services and advocacy for the older people amidst COVID crisis: Voices from South Asia”, organized on October 6^th, 2021 in conjunction with the World Psychiatric Association (WPA), Indian Psychiatric Society (IPS), Indian Association of Geriatric Mental Health (IAGMH), SAARC Psychiatric Federation (SPF), and the Asian Federation of Psychiatric Associations (AFPA). This is the event report of the same panel discussion which highlights the unique challenges to old age mental healthcare among the SAARC nations, calls for urgent collaborative action, and focuses on human rights and dignity-based mental healthcare for older adults in these rapidly ageing countries.

The outpatient care service for patients with mental disorders in the Kyrgyz Republic is currently experiencing various difficulties. These are largely due to a number of organizational and socio-economic problems at the state level. Treatment of patients with mental disorders is still provided in state mental health centres, while psychosocial services at the community level are only now beginning to be developed. This article describes the directions of mental health care, as well as ongoing efforts to provide outpatient care for people with mental disorders. The actions of a few prolific nongovernmental organizations (NGOs) are proving insufficient to meet the needs of patients. There is currently a gradual and visible movement toward the development of the private sector in the field of mental healthcare. In order to overcome organizational difficulties, support from government structures and certain initiatives to create legislative grounds are needed.