The prevention and treatment of cognitive impairment in the elderly has assumed increasing importance in an aging population. This article presents a qualitative review of recent research on experimental interventions for the prevention and treatment of mild cognitive impairment and Alzheimer's disease in elderly subjects. Interventions addressed range from lifestyle measures to pharmacological treatments. Epidemiological studies suggest that dietary measures, physical exercise, and mental activity may reduce the risk of cognitive impairment and Alzheimer's disease in elderly subjects. Statins may protect against incident dementia, and lithium may convey similar benefits to bipolar patients. Ginkgo appears ineffective as a primary preventive measure. Donepezil but not Vitamin E may benefit persons with mild cognitive impairment. Experimental treatments potentially useful for Alzheimer's disease include dimebon, PBT2 and etanercept; the safety and efficacy of the Alzheimer's vaccine remains to be proven, and growth hormone secretagogue and tarenflurbil are likely ineffective. Herbal treatments merit study in elderly subjects with cognitive syndromes.

Women in childbearing age frequently suffer from mental illness. Maternal psychiatric disorders may have a devastating impact on the fetus and the newborn. Thus treating or preventing relapse of these disorders during pregnancy and puerperium is a clinical and ethical duty with the necessity to avoid or minimize fetal or neonatal drug exposure. Though there are many guidelines and comprehensive reviews regarding drug safety in pregnancy and lactation, the application of these recommendations into clinical practice appears to be complex. Hence, we present some clinical questions with answers considering the available literature on safety of psychotropics in pregnancy and lactation.

Background: Reporting of informed consent and ethical approval are important aspects of published papers which indicate the knowledge and sensitivity about ethical aspects of research by the researchers. Materials and Methods: This study reports description of informed consent and ethical approval in the published psychiatric research in the main journal of psychiatry in India. All original research articles (n=157) published in the Indian Journal of Psychiatry in the years 2000, 2003 to 2007 were included. Results: Informed consent was mentioned in 51% of studies in 2000, which gradually rose to 82% by the year 2007. Ethics committee approvals were mentioned in 2% of studies in 2000, and 25% of reports in 2007. Consent was reported to be written in only 40%, content of the consent forms was mentioned in 17%, and the language of consent form was reported in 3% of the studies where consent was reported. Conclusions: Regulation of ethical principles and formulation of necessary guidelines or rules for research as well as for publications are necessary and desirable to ensure the safety of participants and good quality of research.

Background : Behavioral disturbances are integral to the dementing process and contribute adversely to the quality of life of the patients and caregivers. Information regarding the nature of symptoms in Alzheimer's disease is limited in the Indian context. Aim: To study the nature of symptoms in Alzheimer's disease using the Malayalam adaptation of Behavioral Pathology in Alzheimer's disease Rating Scale (BEHAVE-AD). Materials and Methods: Forty patients diagnosed as having Alzheimer's disease as per DSM-IV criteria were studied using the Malayalam version of BEHAVE-AD. Results: Delusions and paranoid ideations were present in 53% of the sample studied and 33% had hallucinations. Activity disturbances were seen in 65%, aggressive symptoms in 75% and diurnal rhythm disturbances in 55%. Affective disturbances and anxiety symptoms were present in 37% and 43% respectively. Conclusion : The prevalence of behavioral and psychological symptoms of dementia was found to be high.

Background: There is a need to develop specialised dementia care services in developing countries. Materials and Methods: We used the existing infrastructure of a general hospital to start a weekly dementia clinic. Results: We were able to support home-based care, even in patients with advanced disease. This new service gave us opportunity to train clinicians and researchers interested in dementia. Conclusion: It is feasible to start weekly dementia clinics using existing infrastructure in developing countries. Networking of such centres can generate a database capable of guiding service development.

Background: Dementia care in developing countries will continue to be provided by co-resident caregivers at home. Behavioral and Psychological Symptoms of Dementia (BPSD) are difficult to manage at home.Interventions leading to reduction or remission of reduction or remission of BPSD will be of immense help in the management of these patients. Materials and Methods: The nature and prevalence of BPSD in a community sample of patients with dementia was assessed by a clinician .The impact of these symptoms on the caregiver was assessed by measures of burden of care and the psychological well being of the caregiver. Another rater carried out these assessments independently. Results: Prevalence of BPSD was very high and they were more common in patients with Alzheimer's Disease than patients with Vascular Dementia. They were rated as troubling to most caregivers. Caregiver burden was associated with adverse effects on the mental health of the carer. Conclusions: To be effective, dementia care services in developing countries need to focus on management of BPSD at home. Development of a low cost, effective and sustainable dementia care service should be given due importance by the policy makers in the developing world.

A Pilot study was Carried out to study the association of consanguinity marriage with depression. It was observed that the consanguinity of marriage was associated with depression. The odds ratio was 5.66 (CI: 2.42-13.54). The age and sex had an association with depression. The age and sex adjusted odds ratio of consanguinity marriage was 7.66 (CI: 3.93-19.45) indicating that it is independently associated with depression.

Bupropion is an antidepressant, which has recently been promoted for the treatment of bipolar depression, because of its lower potency to induced switch. However, due to its dopamine enhancing effect, it has been reported to induce psychosis and perceptual changes. Most of the literature, which is available in relation to development of psychosis while receiving bupropion, has been with the use of immediate release formulation. Some of the case report which have reported development of psychosis with sustained release Bupropion, it has been reported in the background history of over dosage or substance abuse. We present case in which use of bupropion led to development of frank psychosis, which responded to use of antipsychotic medication. However, when antipsychotics were stopped, psychosis again recurred and as a result diagnosis of patient was changed.

Alzheimer's disease (AD) is a devastating neurodegenerative disease, the most common among the dementing illnesses. The neuropathological hallmarks of AD include extracellular β-amyloid (amyloid precursor protein (APP) deposits, intracellular neurofibrillary tangles (NFT)), dystrophic neuritis and amyloid angiopathy. The mismetabolism of APP and the defective clearance of β amyloid generate a cascade of events including hyperphosphorylated tau (τ) mediated breakdown of microtubular assembly and resultant synaptic failure which results in AD. The exact aetiopathogenesis of AD is still obscure. The preeminent hypotheses of AD include amyloid cascade hypothesis and tau hyperphosphorylation. The amyloid hypothesis states that extracellular amyloid plaques formed by aggregates of Aβ peptide generated by the proteolytic cleavages of APP are central to AD pathology. Intracellular assembly states of the oligomeric and protofibrillar species may facilitate tau hyperphosphorylation, disruption of proteasome and mitochondria function, dysregulation of calcium homeostasis, synaptic failure, and cognitive dysfunction. The tau hypothesis states that excessive or abnormal phosphorylation of tau results in the transformation of normal adult tau into PHF-tau (paired helical filament) and NFTs. Vascular hypothesis is also proposed for AD and it concludes that advancing age and the presence of vascular risk factors create a Critically Attained Threshold of Cerebral Hypoperfusion (CATCH) which leads to cellular and subcellular pathology involving protein synthesis, development of plaques, inflammatory response, and synaptic damage leading to the manifestations of AD. Multiple other aetiological and pathogenetic hypotheses have been put forward including genetics, oxidative stress, dysfunctional calcium homeostasis, hormonal, inflammatory-immunologic, and cell cycle dysregulation with the resultant neurotransmitter dysfunctions and cognitive decline. The available therapeutic agents target only the neurotransmitter dysfunction in AD and agents specifically targeting the pathogenetic mechanisms like amyloid deposition and tau hyperphosphorylation might provide a definite therapeutic edge.

The nosology associated with transgender phenomena is undergoing rapid revisions. This phenomenon is mentioned in ancient cultures and the allusions to it are variously described in the Indian literatures. The trials and tribulations of the isolated segment of the human population are surmised from two autobiographical accounts of writers. The measures to improve the life of the transgender population are suggested.