The authors describe and compare two cases of sudden onset cognitive impairment in middle-aged women.

Review of clinical records, laboratorial data, neuropsychological and imagiological studies.

Two women in the sixth decade of life with a similar background and pre-illness state were admitted in the Day Unit for evaluation. They both presented sudden onset of bizarre behaviours, mood swings, unspecific speech disorder, and appetite and sleep pattern deviation, accompanying mild cognitive impairment (MCI) on neuropsychological evaluation. Both cases were submitted to intensive studies. Data and long-term follow-up revealed a frontotemporal dementia in one of the cases, and the second woman was shown to have a conversive pseudodementia.

Cognition's progressive deterioration is considered a major marker of dementia, but mild cognitive impairment is a heterogeneous clinical syndrome without criteria on current classifications of disease and limited prognostic value.

Needs of the elderly are complex and difficult to identify since connected with many different dimensions. The aim was to identify met and unmet needs of patients referred to old age rehabilitation services in Poland (Wroclaw-Wr) and Germany (Hamburg-Ha).

Patients (n=80) over the age of 60 were assessed using the Camberwell Assessment of Need for the Elderly (CANE), Mini Mental State Examination (MMSE), Global Deterioration Scale (GDS), Good Milieu Index (GMI) and Activities of Daily Living Scale (ADL). Patients were at least 2 weeks under rehabilitation due to orthopedic or neurologic reasons.

Both groups were similar concerning age, gender, education and marital status. Satisfaction of the ward was the same. Wr-patients were significantly more demented (25.1 vs.26.8; p=0.011), depressed (4.12 vs 3.0; p=0.033) and disabled (24.88 vs 76.62; p< 0.0001).

The mean number of total, unmet and met needs before rehabilitation was similar in both centers. However, significantly more needs in accommodation, eyesight /hearing /communication and benefits were reported in Wr, whereas psychological distress and food in Ha.

During rehabilitation program over twice more unmet needs were reported in Wr vs. Ha (1.38 vs. 0.57; p =0,0029) in the areas of eyesight /hearing /communication and benefits, continence, money.

Ha received twice more formal assistance than Wr before (0,0027), but Wr twice more during rehabilitation (p< 0,0001).

Assessing individuals needs may help in creating individual complete rehabilitation program within continuing care post discharge and improve quality of life.

Delirium is a Acute Confusional State caused by physiological consequences of a medical disease, and is a predictive index of severity disease and survival time.

In this Study we valued, on random pool of 123 patients, the populations of older over 90yr aged recovered (29 patients) in the care of a RSA (Residential Sanitary Assisted in Italy or Nursing Home), compared with population younger afferent in RSA.

In the populations recovered in RSA studied is evident the prevalence of Delirium in the population over 90 year aged is most common compared to other population studied (44% vs 17%), as major seem to be the Incidence of Delirium in over 90 year population (33,3% vs 12,76%).

This data confirm the existence of biological frailty in the very old over 90 year aged.

Moreover this data demonstrate reduction of rates Delirium's Incidence compared with prevalence's rates in a Setting of Care focused elderly needs as RSA as other Non Geriatric Acute Setting. The 3-Months Mortality is major in the 90 year old compared to non 90 year old population (33,3% vs 18%) confirming a predictive role of Delirium.

This study showed Delirium is a Marker of Biological Frailty and it is an index predictive inauspicious about the survival of patient. Moreover is marked the RSA - Territorial Structures High Psycho-Geriatrics Contents - performs important role of delirium's prevention by means of removal of the risk factor avoidable and a careful control of causes.

There are many screening instruments available for the detection of dementia. However, they were not tested in very old age and often not in the primary care setting for which they are developed.

We condensed a screening battery of all elements of common tests (MMSE, TFDD, DEMTECT, Clock Test…). Nine primary care practices took part in the study. The practice assistants were trained to approach all patients over 75y visiting the practice. Only patients with already diagnosed dementia, severe hearing or vision disability or communication deficits were excluded. After informed consent they applied the screening. Within the next days a second independent neuropsychological examination was arranged in the memory clinic of the University of Goettingen. This included established neuropsychological tests (CERAD-NP, WMS-R, TMT.) and further scales were applied (NPI, CDR..). All patients with CDR=0.5 were approached 1.5y later for a follow-up by phone.

N=90 patients (25M, 65F) took part in the initial evaluation. From N=54 with CDR=0.5 only N=14 could be reached for follow-up. None of them returned to CDR=0, most progressed up to CDR=4. There were some correlations to education and dementia severity. All available screenings showed a good effect size of >0.70 (MMSE, DEMTECT, TFDD, RDST).

Elements for an optimal screening of the oldest old are discussed.

At least at the larger hospitals specialised gero-psychiatric units have been introduced, usually taking care of those at age 65y and higher. The advantages of this approach have been discussed and examined. The patients’ view has only rarely been investigated and mostly only from a single perspective (e.g. patient satisfaction on gero-psychiatric wards).

We performed semistructured qualitative interviews in our hospital in a balanced sample of (n=14) patients at 18-40y, (n=10) patients at 41-60y, (n=16) patients at 61-75y, (n=8) patients over 75y. There were (n=) 24 male and (n=) 24 female patients. 12 patients hat been treated exclusively in old age psychiatry, and 10 patients had been treated in old age psychiatry after their 65th birthday.

The majorities of the patients saw advantages in mixed sex and age care for the younger and for the older patients. Disadvantages where not seen for younger patients, however for the elderly the view was ambivalent (26 yes versus 22 no). Female and higher age patients and those with multiple hospitalisations tended to expect more disadvantages. While a mixed ward would be regarded as more (stimulating), disadvantages could be the combination of aggressive young and frail elderly patients as well as the overburdening of the staff.

This is the first investigation on patient view on the segregation of old age psychiatric patients. Further studies should lead to a consumer guided care provision allowing specialisation as well as defending ageism.

We present a 43 years old men discharged from an internal medical service where the diagnosis of liver cirrhosis was refuted and confirmed the hepatitis C disease.

Onset is 6 months ago with cognitive deterioration and behavioral problems, confusional episodes, importamte memory disorders. Symptomatology was exacerbated in the last two months.

CT Moderate cerebral atrophy

EEG revealed generalized arrhythmic slow activity;

Laboratory tests : VSH 36-mm/1h,WBC 13.6-10-3/mm 3.

HIV test negative.

VDRL quantitative 1/1- ++++, 1/2- ++++, 1 / 4 ++++, 1 / 8 /++++, 1/16- + + +, 1/32- +

THPA (positive reaction) -dil-1/80;

VDRL in CSF positive + + + +

Patient was treated with a high dose of penicillin G intramuscularly. The clinical symptoms improved significantly in 2 weeks and MMSE increased from12 to 22.

Syphilis and its complications must be still in medical attention. If there is cognitive dysfunction or brain atrophy of unknown cause, neurosyphilis should be considered. Treponema infection should be part of the differential diagnosis of each patient showing cognitive deterioration and behavior disturbances.

The objective of the present study was to explore the intestinal endotoxemia (IETM) in the cell apoptosis of Alzheimer disease's rats which were established by D-galactose and aluminum trichloride (AlCl3).

Adult wistar rats were subjected to 90 days of intraperitoneal injection with D-galactose and AlCl3 to establish the Alzheimer disease's model. After the administration, the study and memory ability of the Alzheimer disease's rats were observed by Morris water maze; The level of Lipopolysaccharide (LPS) in the sera of Alzheimer disease's rats was determined by tachypleus amebocyte lysate method; The level of tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1) in the sera of Alzheimer disease's rats were determined by radioimmunity method; The apoptotic neuron was detected by TdT-mediated dUTP Nick End Labeling (TUNEL).

Compared with the normal control, the level of LPS, TNF-αin the sera and PD in the brine of Alzheimer disease's rats were markedly increased (P< 0.01).

The level of LPS, TNF-αin the sera and PD in the brine of Alzheimer disease's rats were markedly increased, IETM maybe an important reason of the apoptotic in Alzheimer disease.

Epidemiological issues have an special interest among gerontopsychiaty, because of the high prevalence of mental disorders and the increasing average age of the population. According to the National Statistic Institute in Spain, in 2002 almost 7 million of the people were over 65 years old and in 2020 there is expected to be 8 million of elder people. This question associated with the decrease of birthrate, will bring about a rise in the absolut number of elder people with a mental disorder.

Our main objective in this work is to study the sociodemographil profile of inpatients over 60years old in a short stay unit.

This is a prospective, descriptive study. We have collected sociodemographical and clinical characteristics of people over 60 years old that entered short stay units of two hospitals in Vizcaya, Spain, during one year. Patients with dementia were excluded.

60 patients entered the units. The average age was 71,2 (7,26). Education; illiterate 6,6%; just read and write 46,6%; primary/elementary education 38,3%; secondary education 3,33% and higher education 5%. Marital status: single 10%; married 51,6%; divorced 8,3%; widow/er 30%. Family life: 31,6% alone; 28,33% with a paretner; 21,66% with a partner and some else; 13,33%, with their children with a partner; 3,33% old people's home.Social relationship: 5% without any relation; 25% family and neighbours; 31,6% family, neigbours and frienda; 3,33% people in the old people's home.

It is assumed to be important to know the characteristics of this people to guarantee an optimum assistance.

Manic Thought Disorder (MTD) is a characteristic clinical feature of mania. In the past, explanations of its pathogenesis have ranged from hypotheses of a disordered lexicon, to the side effects of a fatuous affect. We previously modeled thought disorder in schizophrenia using the notion of threads of thought.

To examine the nature of MTD to see if it is consistent with the theory of a disordered lexicon alone.

To simulate the mental lexicon and thought generation and examine if computational lesioning experiments could simulate various aspects of MTD.

We modeled the mental lexicon as a semantic network using the programming language Mathematica®. Thought generation was modeled as a walk along this directed graph. Semantic priming was implemented as assigned weights; these weights in turn determined assignment of salience to threads scanning the network.

Assignment of weights to the vertices and/or edges of the graph allows us to simulate the flow and trajectory of speech permitting the replication of features of MTD including pressure of speech, clang associations and flight-of-ideas.

Our model of MTD allows us to propose that thought disorder in mania occurs due to an inappropriate assignment of salience to threads scanning the semantic network. Reduction of inappropriate thread salience by antipsychotics must result in a disappearance of MTD. While MTD is interesting to listen to, for anyone, it betrays the underlying mental computational processes involved in the generation of normal thought and MTD and hence very important for psychiatrists and cognitive scientists.

To extensively describe three patients including one child with catatonia anonymously in terms of etiology, management and outcome.

Uncovering environmental factors and crude observations. All patients receive a low EE, low activity structured programmed.

Mark an adolescent with mild learning disabilities and autism developed catatonic features, coinciding with anorectic behavior and ‘tears behind his eyes’. He has remained refractory for medication. At admission under the above named regime he discloses sexually abuse, which coincides with resolvement of the catatonic features and anorexiaPeter a male in his late twenties has a diagnosis of schizophrenia due to recurrent catatonic features. An extensive developmental history reveals a childhood onset dysexecutive syndrome. He has remained refractory to medication, even when compliant. Following marked changes in his life, a relapse catatonia is treated in the community as above with visual augmentation and regular tutorials on events. A few months later he accepts medication and continues to incidentally experience a few days of mild catatonic features.Martha, a thirty year old with a tendency to concrete thinking and echolalia develops sudden catatonic features following a relationship break up. She is admitted under the mental health act and undergoes the described programme. She is also put on Citalopram 10mg, which coincides with resolvement of catatonia in five days.

Cognitive impairment, particularly a dysexecutive syndrome is susceptibility for catatonia at a time of cognitive overload and trauma. An ongoing low EE low activity structured programme is key to recovery in milder cases.

The aim of our study is to assess the degree of apathetic dimension in healthy subjects and its correlation with the cognitive-executive functioning.

Healthy subjects of both sex (n=50) were evaluated with Wisconsin Card SortingTest (WCST), Stroop Color/Word InterferenceTest and AB-AC Test for the neurocognitive assessment; the Apathy Evaluation Scale (AES) was used to quantify the degree of apathy.

Positive correlation between the degree of apathy and the number of WCST perseverations were observed (ρ=0.022), no correlations between the Stroop Test (ρ=0.702) and the AB-AC Test (ρ=0.448) with Apathy Evaluation Scale were observed.

Our study demonstrated that apathy is related to widespread prefrontal cortex functioning in healthy subjects, but not with specific areas of prefrontal cortex.

During last few years psychiatric research focused her attention on early psychotic disorders, Ultra High Risk subjects, at risk mental states (ARMS) etc in order to determine clinical criteria of prodromal illness states.

At the state of the art there is no evidence-based-approved scale for early diagnosis and the studies are for the most part dedicated to schizophrenia spectrum disorders.

All the patients clinically remitted, suffered from a psychotic disorder during last 12 months (including schizophrenia spectrum, brief psychoses, psychotic bipolar illness) and high-risk subjects will be recruited and re-interviewed by expert clinicians. Psychometric classic scales (CGI, PANSS, BCIS, GAF) will be administered at the start of the study and after 2 years.

During the interviews two psychopatological scales will be also administered to all subjects ; a phenomenologically oriented one, EASE scale (Parnas et al 2003) and CAARMS (McGorry, Barnaby Nelson 2006).

During the 2 years observation, clinicians are requested to follow-up the patients and describe clinical and psychopathological modifications.

The preliminary results will be presented at the congress.

This study focuses attention on psychotic illness dimension in order to better comprehend and grasp psychotic patients’ experience. A relationship between CAARMS-EASE score and clinical outcome is expected and will be discussed; thus could reinforce diagnostic and prognostic inference of early-diagnosis psychopatological scales. Limits of our study are the small sample and the brief temporal observation but are typical real-world conditions.

Digital EEG pattern specific for Alzheimer disease has not studied yet.

Resting EEG (16 channels) was recorded by the use of “Brainscan” system in 150 persons: 50 healthy 20-55 year old volunteers, 50 healthy 55-75 year old volunteers, 50 patients with mild Alzheimer. Alpha rhythm frequency was checked after Furie's reversal transformation in periodmetric analysis for single “pure” alpha rhythm (8-13.5 Hz).

Significant distinction between a healthy subjects and Alzheimer patients has proved to be changed spatial - frequency alpha rhythm structure. High-frequency alpha rhythm is dominant in the occipital zone and low - in the frontal one of healthy subjects. Alzheimer patients show the opposite relationship. This phenomenon named the “inversion” can be revealed only by mean of digital EEG, visually - no, because the difference between frontal and occipital mean frequency may be less than 0.01 Hz.

The inversion discovered in 90% of Alzheimer patients, while among healthy persons of 20-55 years - in 2%, among healthy persons elder 55 - 7%.

CT investigation has not revealed any occipital or frontal lobe pathology. Therefore alpha inversion is stipulated by violations of thalamic rhythm generator's function. Inversion mean EEG quality decline and determined by disharmony between thalamic and anterior alpha generators.

For Alzheimer disease inversion may be considered as diagnostic sign revealing organic brain damage. Future studies should evaluate it's clinical usefulness in early differential diagnosis, disease staging and therapy monitoring.

Delusional disorder is characterized in current classifications by the development of one delusional thought or set of related delusional ideas that are usually permanent. Body dysmorphic disorder is sick preoccupation with appearance of the whole body or focused on particular areas of body, when the patient is convinced that there is a change of shape, structure or function.

We will present 36-year old patient who was sent to a psychiatry recommended by the otorinolaringology specialist, where he was treated three years for sore throat. The patient was very focused and concerned about the problems of the target organ.

Correct diagnosis is very important for choosing adequate therapy.

clinical interview, psychologic testing, EEG egzam.

He was treated with different combinations of drugs, but the combined therapy showed that the most effective were quetiapin, venlafaksin and valproat acid.

Individual access and knowledge of the pathophysiological background of patients with delusional body dysmorphic disorder is of great importance in choosing psycho pharmacotherapy.

5 subtypes of PNES emerged from the statistical analysis showing reproducibility of seizures in 61.54% of patients:

1. - brief crisis with automatisms and dystonia

2. - “pauci-kinetic”, sensitive crisis with preserved contact

3. - brief and brutal crisis with break contact and clonic jerks

4. - “major crisis” with extended axial spasms

5. - prolonged, fluctuating with hyperventilation preceded by prodrome.

The identification of a typology can move from a clinical based diagnosis to a real positive diagnosis. The reproducibility of the crisis allow to make common pathophysiological hypotheses. The history of psychological trauma query on a relationship between the management of neuro-psychological affects and PNES “dysfunction” of connections between the frontal lobe, the limbic system and the basal ganglia. Beyond the positive diagnosis, the fundamental and therapeutic perspectives are many.

Atypical and melancholic subtypes of depression based on the Diagnostic and Statistical Manual (DSM) IV are important concepts, especially for biological psychiatry. The aim of this study was to determine whether the symptoms used for the diagnoses of atypical and melancholic depression can distinguish these subtypes during pregnancy.

A modified version of the Structured Clinical Interview for DSM IV (SCID interview) was used that allowed assessment of all DSM IV symptoms of melancholic and atypical depression with depressed and non depressed women in pregnancy. A Swiss cohort of 449 women was interviewed. Four diagnostic groups were compared: women with melancholic, atypical, or non specified depression, and those without depression.

Seventeen per cent of the cohort met SCID criteria for a depressive episode of depression at least once in pregnancy, with melancholic depression 2.4%, atypical depression 4.4%, and non specified depression 10.2%. Many of the symptoms used to distinguish atypical and melancholic depression did not discriminate between these groups during pregnancy. However some, such as mood reactivity, distinct quality of mood and sleep pattern, did discriminate.

Differential diagnosis between melancholic and atypical depression in pregnancy needs to be based on pregnancy specific definitions. The possible therapeutic consequences and the neurobiological basis for these findings warrant further research.