Vol 3, No 1 (2022)


Mental Health of Older Adults: an Agenda for Action

Javed A.


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.

Consortium Psychiatricum. 2022;3(1):6-7
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The Evolution of Diagnostic Boundaries of Alzheimer’s Disease and Novel Therapeutic Options

Gavrilova S.


Over the past three decades, the definition and diagnostic boundaries of Alzheimer’s disease (AD) have been repeatedly revised due to significant progress in understanding of the pathogenesis of neurodegeneration associated with Alzheimer’s disease and in the development of high-tech diagnostic methods. The current approach to AD diagnostics relies on the detection of biomarkers that reflect two main neuropathological processes involved in the primary neurodegeneration that underlies AD: abnormal amyloidogenesis, and neuronal degeneration. The currently available diagnostic tools are limited to the detection of cerebrospinal biomarkers and/or assessment of the abnormal amyloid and tau protein burden in the brain via amyloid and tau positron emission tomography (PET) ligands. Practical implementation (mostly in the research field) of the biological model of AD diagnosis has led to a significant expansion of its diagnostic boundaries with the inclusion of predementia AD stages: asymptomatic and symptomatic, the latter is clinically corresponding to amnestic mild cognitive impairment (aMCI-amnestic mild cognitive impairment). On the one hand, this approach significantly expands the possibilities to study and use preventive technologies aiming to avert or delay the progression of predementia cognitive impairment to dementia but, on the other, it is associated with a number of negative implications from both the clinical and ethical points of view. A significant limitation of purely biological diagnosis of AD based on biomarker levels is due to the low prognostic value of biomarkers, which can cause diagnostic confusion in certain circumstances. Moreover, since the future evolution of the asymptomatic stage is not yet clear and there are still no reliable ways to prevent the cognitive and behavioral symptoms associated with AD, disclosure of stressful information about this “terrifying” diagnosis to patients can cause irreversible damage by triggering depressive disorder, which is a risk factor of AD itself.

The current knowledge about AD prognosis in amyloid-positive cognitively unimpaired patients is insufficient.The most adequate approach to early AD diagnostics appears to be the clinical and biological model, as recommended by the International Working Group (IWG 2021), which requires a combination of the clinical AD phenotype and the detection of biomarkers specific to this disease.

The article discusses the potential directions for the development of biological diagnostic methods, including those based on the so-called peripheral (serum) biomarker technologies and promising directions for the development of biological methods of secondary AD prevention.

Consortium Psychiatricum. 2022;3(1):8-15
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Towards a WPA Position Document on the Human Rights of Older Adults with Mental Health Conditions

Lima C.A.


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.

Consortium Psychiatricum. 2022;3(1):16-21
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Mental Health Promotion and Risk Reduction Strategies for Mental Disorders in Older Persons: Why Should Governments and Policymakers Care?

Rabheru K.


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.

Consortium Psychiatricum. 2022;3(1):22-28
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Loneliness Among the Elderly: a Mini Review

Grover S.


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.

Consortium Psychiatricum. 2022;3(1):30-36
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Technology-based Neurocognitive Assessment of the Elderly: a Mini Review

Sahoo S., Grover S.


Neurocognitive disorders in the elderly are on the rise all over the world. Neuropsychological assessment is vital to monitoring the progress of cognitive deficits. Over the years, there has been significant development in neuropsychological assessment to predict the development and progression of MCI and dementia. One such area of recent advancement in the field of neuropsychology is technology-based assessment. There are several types of technology-based assessments available based on the type of usage, site of the assessment, type of administration, type of device used for assessment, etc. Virtual reality-based assessments and digital assessments of neurocognitions for early identification of subtle cognitive deficits in patients with mild cognitive impairment (MCI) and major neurocognitive disorders (MND) represent two newly developed technologies. A few studies have demonstrated their efficacy; however, there remain several limitations and drawbacks to their usage within the elderly population. In this review, we have briefly discussed technology-based neuropsychological assessment, along with their usage and limitations.

Consortium Psychiatricum. 2022;3(1):37-44
pages 37-44 views

Symptomatic Profile of Cariprazine in the Context of ICD-11 Domains for Schizophrenia: Review of Clinically Oriented Studies

Pavlichenko A.V., Gubina A.S.


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".

Consortium Psychiatricum. 2022;3(1):45-61
pages 45-61 views


“Love in the Later Years…”: Perceptions of Sex and Sexuality in Older Indian Adults — a Qualitative Exploration

Banerjee D., Rao T.


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.

Consortium Psychiatricum. 2022;3(1):62-75
pages 62-75 views

A Comparison of Regional Brain Volumes in Older Adults With and Without History of COVID-19

Syunyakov T.S., Sharaev M.G., Savilov V.B., Karpenko O.A., Kurmyshev M.V., Yarkin V.E., Ushakov V.L., Bibyaev A.N., Soloveva K.P., Andruschenko A.V.


BACKGROUND: Recent studies have shown that SARS-CoV-2 can have neuropsychiatric consequences and has the ability to penetrate the blood-brain barrier. If SARS-CoV-2 has a specific route of entry into the brain, it may leave imprints in the form of specific changes in brain morphology. Older individuals are most vulnerable to the neuropsychiatric COVID-19 complications. This study aims to compare regional brain volumes in older adults individuals with and without COVID-19 history (COVID+ and COVID-, respectively).

METHODS: Individuals over 65 years old who applied for treatment to the Memory Clinic (Mental-Health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia) were assessed between October 2020 and April 2021. Their COVID-19 history was determined by the self-report and COVID-19 certificate. Individuals with severe neuropsychiatric or acute or severe chronic somatic or infectious disease and those taking medications potentially affecting cognitive functioning were excluded. All participants underwent MRI examinations followed by image segmentation and morphometric quantitative analysis. Regional brain volumes were compared in COVID+ and COVID- people.

RESULTS: 207 participants were included in the study. The COVID+ group consisted of 24 participants. The comparison between groups revealed statistically significant differences in left amygdala area (median 1199.3 mm3 in COVID+ vs. 1263.7 mm3 in COVID-) and right postcentral gyrus volumes (median 8055.5 mm3 in COVID+ vs. 8434.0 mm3 in COVID-). Then case-control analysis was performed in individuals matched for gender, age and common somatic causes of structural brain changes (hypertension and/or diabetes mellitus type 2) for 22 subjects in each group. Statistically significant differences in regional brain volumes between groups were absent.

CONCLUSION: We did not find strong evidence for any regional brain volumes changes in people older than 65 years with a history of COVID-19 in comparison to those without history of COVID-19. Though, given study limitations, these results cannot be generalized to other people who recovered from COVID-19.

Consortium Psychiatricum. 2022;3(1):76-87
pages 76-87 views


Healthy Longevity Among the LGBTQIA+ Population: From Neglect to Meeting Their Needs

Pereira H., Banerjee D.


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’.

Consortium Psychiatricum. 2022;3(1):88-91
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The WPA-IPS-SPF-AFPA Joint Panel Discussion Organized by the IPA: Voices from South Asia Regarding Older People’s Mental Health Advocacy and Services

Banerjee D., Javed A., Rao G., Saha G., Pradhan S.


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 6th, 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.

Consortium Psychiatricum. 2022;3(1):92-97
pages 92-97 views


Outpatient Services for People with Mental Disorders in the Kyrgyz Republic: What Is Next?

Molchanova E.S., Kosterina E.V., Yarova O.V., Panteleeva L.Y.


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.

Consortium Psychiatricum. 2022;3(1):98-105
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Community-Based Mental Health Services in Azerbaijan: a Course Toward Development

Ismayilov F.N.


Community mental health care in Azerbaijan was established in 2011 in the line with the country’s mental health reform. The main directions of the reform, as described in the National Mental Health Strategy, were deinstitutionalization, improving quality of care, integration of mental health into primary healthcare, and implementation of modern community-based services. Over the last decade, the number of beds in psychiatric hospitals has significantly decreased, and many psychiatrists and psychiatric nurses have been transferred to primary care facilities. At the same time, programs focusing on comprehensive care have been implemented in different regions of the country.

Community mental health services currently employ various kinds of mental health professional including psychiatrists, clinical psychologists, social workers, occupational therapists, and nurses to ensure a multidisciplinary approach to care provision. Team-based care may focus on crisis resolution, psychosocial rehabilitation, case management, family support, and early intervention for psychosis.

Among the barriers preventing development of community mental health services, one should note, in particular, stigma belittling the priority of mental healthcare, uncertainty in distribution of authority between the Ministry of Health and the State Agency for Mandatory Health Insurance, and a general scarcity of human resources, especially in the rural regions. Nevertheless, the mental health care in Azerbaijan is continuing its transition from an institutional model to community-based services.

Consortium Psychiatricum. 2022;3(1):106-112
pages 106-112 views

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