Context:There is a paucity of published telepsychiatry results in India.Aims:This study was conducted to assess the feasibility of asynchronous telepsychiatry and to study the referral patterns.Settings and Design:This study was conducted in the telemedicine unit of a tertiary care center and design was retrospective analysis of 94 cases, which were diagnosed and treated by telepsychiatry.Materials and Methods:All 94 patients who were referred between January 2007 and August 2013 for telepsychiatry consultations were retrospectively analyzed to assess the referral pattern and feasibility.Statistical Analysis Used:Comparisons between demographic parameters and psychiatric diagnosis was done using Chi-square test.Results:In 89 out of 94 (95%) patients it was possible to make a definitive diagnosis and recommend appropriate treatment only on the basis of data received from the primary care physician by telepsychiatry. This indicates the feasibility of telepsychiatry. The most common problems for which referrals were made included schizophrenia and other psychotic disorders, mood disorders and substance related disorders.Conclusions:This study demonstrates the feasibility of Asynchronous telepsychiatry. Additional Indian studies should be conducted to build the evidence base for the best use of asynchronous telepsychiatry.

Objective: Alzheimer's disease (AD) is characterised by progressive cognitive decline due to neurodegeneration. Over activation of the hypothalamic–pituitary–adrenal axis, oxidative stress and inflammation potentially damage the neuronal system, affecting cognition. Aim: This study aimed to assess the relationship between serum cortisol, Interleukin-6 (IL-6) and homocysteine (Hcy) levels in AD. Methods: Case-Control observational study consisting of 71 patients with AD and 70 healthy controls above 60 years of age. Serum samples were analysed for cortisol, IL-6 and Hcy levels using chemiluminescence immunoassay (Immulite 1000) technique. Cognitive functions were measured using the Mini-Mental State Examination (MMSE) Score. AD subjects were categorised based on the modified Kuppuswamy socioeconomic status scale. Statistical evaluation was conducted using SPSS Statistics software. Group data were analysed using a two-tailed Student's t-test, analysis of variance (ANOVA), the Mann–Whitney U test and Pearson's correlation test. Results: Serum cortisol, IL-6 and Hcy levels were significantly increased (p < 0.01) in AD (cortisol: 19.69 ± 8.96 ug/dl; IL-6: 10.27 ± 2.76 pg/ml; Hcy: 23.29 ± 3.81 μmol/l), as compared with the controls (cortisol: 13.37 ± 5.59 ug/dl; IL-6: 3.37 ± 0.79 pg/ml; Hcy: 8.25 ± 2.36 μmol/l). MMSE scores in AD were negatively correlated with cortisol, IL-6 and Hcy levels. Conclusions: Serum cortisol, IL-6 and Hcy levels are independent biomarkers for AD progression. Hypercortisolaemia, hyperhomocysteinemia and inflammation play important roles in AD-related cognitive dysfunction and are interlinked.

Aims: The aim of this study was to investigate thyroid status in Alzheimer’s Disease (AD) patients and its response to donepezil and vitamin B12 supplement therapy for 6 months. Design: Case-Control Observational study. Place and Duration: Department of Biochemistry, GGMC & Sir J. J. Group of Hospitals, Mumbai, India between March 2017 and July 2019. Methodology: Case-Control study comprised of 71 AD patients and 70 healthy controls above 60 years of age.  Blood serum samples were analyzed for thyroid hormones levels by the chemiluminescence method. AD patients were treated with donepezil (5 mg/day) and vitamin B12 supplement (1.5 mg/day) and thyroid profile was observed at intervals of 3 and 6 months. Statistical evaluation was done by using IMB SPSS statistics version 25. Results: Serum levels of thyroid hormones were low in euthyroid AD patients when compared with controls at the baseline level [T3 (120.64 ± 20.64 vs 127.8 ± 17.29), T4 (7.71 ± 2.34 vs 7.54 ± 1.85), FT3 (1.2 ± 0.13 vs 2.26 ± 0.63) and FT4 (0.79 ± 0.08 vs 1.29 ± 0.27)] except TSH which was increased in AD [TSH (2.71 ± 1.19 vs 2.34 ± 0.65)]. During follow-ups at 3 and 6 months, there was a slight decrease in TSH levels in response to the therapy. Conclusion: The AD patients were euthyroid with low T3, FT3 and FT4 serum levels and high TSH serum levels. Thyroid hormones might play a role as markers for disease progression. Donepezil and vitamin B12 therapy could not benefit restore the normal thyroid functioning in a period of 6 months. Further longitudinal research with larger cohort might help in elucidating thyroid dysfunction in AD and develop novel therapeutic strategies.

Letter to the Editor days of treatment, the mother reported improvement in reassurance-seeking behavior, and after one month of treatment, the patient reported improvement in the repetitive doubts. In three months, he was found to sustain the improvement and had improvement in socio-occupational functioning. Also, his Y-BOCS score decreased to 6, and his BABS score reduced to zero with good insight. There were no adverse effects reported. After recovery, he was thankful and attributed the symptoms to stress after reading and watching videos about dog bites.