Aim of the study:The aim is to review the admission pattern, demographic prole and clinical characteristics of the patients admitted in Psychiatry ward during the lockdown phase following Covid-19 pandemic. Material and methods: A cross-sectional, observational study was undertaken in the Department of Psychiatry, Gauhati Medical College th rd Hospital, Guwahati, Assam, India for six months extending from 24 March 2020 to 23 September 2020. Data were collected retrospectively from case history sheet and a semi-structured proforma is used to collect the socio-demographic and clinical variables. Diagnosis was made using ICD-10. The analyses of data were done using descriptive statistics. Results:A total of 144 patients were admitted during the study period. Out of total admitted patients maximum were admitted on the third month and least in the month immediately following lockdown. Admission was more in young adults, men and in those from urban locality. More patients were diagnosed in the category F20-29 followed by F30-39, majority were admitted for relapse of previous symptoms and duration of hospital stay was less than 10days for half of the admitted patients. Conclusion:To tackle emergencies during a pandemic, the most crucial step is proper planning. Evaluation of data regarding inpatient admission in a psychiatry ward during pandemic will help in overcoming the discrepancies and guide in future planning for mental health care during any emergency situation.

IntroductionThe response to conventional antiparkinsonian medications is elusive in atypical parkinsonian disorders. Improvement in parkinsonian symptoms in atypical parkinsonian disorders has been reported with anecdotal use of Amantadine. The role of serotonergic control over the nigrostriatal pathway led to the use of Escitalopram.ObjectivesTo examine the efficacy of low dose Amantadine and Escitalopram combination treatment in atypical parkinsonian disorderMethodsA retrospective chart review of Atypical Parkinsonian disorder patients who received the combination of low dose Amantadine and Escitalopram and had follow up assessment available for a minimum of four months were studied. The primary outcome measure was change in Progressive Supranuclear Palsy rating scale, Unified Multiple System Atrophy rating scale score and Clinical Global Improvement Scale Change score in follow up visits.ResultsA total of 8 patients with a mean age of 68.5 years, 6 with a diagnosis of Progressive Supranuclear Palsy(PSP) and 2 with a diagnosis of Multiple System Atrophy(MSA) met the selection criteria for the study. Patients were treated with the dose of Amantadine 50mg twice daily and Escitalopram 5mg once daily. The symptom domain to respond first was autonomic symptoms followed by gait, mentation, limb and bulbar symptoms. Amantadine has unique dopaminergic and NMDA antagonist properties. Serotonin has a role in modulation of the autonomic functions and nigrostriatal circuitry. Thus, combining Escitalopram with Amantadine can help ameliorate the array of symptoms in atypical parkinsonian disorders.ConclusionsThe PSP and MSA patients responded to the combination of low dose Amantadine and Escitalopram as evidenced by objective rating scales and subjective clinician assessment. Further prospective trials for longer duration are needed to establish the effect size and stability of response.KEYWORDS: steele richardson olszewski disease, shy dragger syndrome, antidepressantsDisclosure of InterestNone Declared

Biomarkers of Alzheimer’s Disease (AD), and other neurodegenerative disorders are most exploring areas of clinical research in Geriatric Psychiatry. Presently neuroimaging, blood and CSF biomarkers are expensive and invasive to perform and are considered impractical for research purpose. The retinal presents a readily accessible tissue for monitoring the brain and could potentially be used in combination with or as a substitute for current AD and other neurodegenerative disease biomarkers. Data on retinal involvement in AD and neurodegenerative diseases have been controversial and inconsistent. So, we are reporting a case of Choroideremia with neuropsychiatric presentations and complications.

Constipation is one major complaint in elderly population. It may be due to physiological and anatomical reasons of aging, but it can be also due chronic medical and mental illnesses and due to use of multiple medications. Constipation itself is a precipitating factor for delirium. Drugs used for constipation can also be the culprit. A 64-year-old female who had a history of hypertension and chronic constipation presented with symptoms of confused and altered behavior, decreased oral intake, decreased sleep. On history taking it was known that she was using Herbal medication containing senna glycoside and other compounds since 8-9months. On examination she had signs of dehydration, disoriented and attention was impaired. On investigation her serum sodium was 122.6 mmol/ and other investigations were within normal limits. She was diagnosed as a case of Delirium according to ICD-10 criteria. Her dehydration was corrected by giving intravenous fluids and serum sodium level was corrected using salt capsules 2 tablets thrice daily. For disturbed sleep she was prescribed Tab Melatonin 10mg at bedtime and constipation was treated with per rectal enema and syrup lactulose 30ml at bedtime. Patient improved in 1 week time. Senna a herbal laxative used to treat constipation. It can alter intestinal electrolyte transportation and irritates intestinal mucosa. It is due to increased peristalsis and increased defecation and even diarrhea Prolonged use can cause dehydration, electrolyte imbalance and delirium. Senna, an over-the-counter laxative with FDA approval is a matter of concern in the current scenario. This case report warns into the judicious use of laxatives containing senna in elderly population. Key words: Delirium, Herbal Laxative, Senna, Constipation.