Bipolar disorder is commonly associated with early adulthood, although a substantial proportion of patients develops the condition in later life. the results of early investigations suggested that cases of bipolar disorder with onset in later life were more often associated with 'organic causes', and could potentially justify the distinction between early and late onset bipolar disorder.

Alert for organic causes of mania.

Review of relevant literature after the description of a clinical case.

Description of clinical case:

J.C. is a man of 80 years without psychiatric history that is admitted in a Oncology Service for dehydration. He has breast cancer since 2005, treated with neoadjuvant-chemotherapy, mastectomy and hormone-therapy with remission. in 2010 there was progression of the disease and he restart chemotherapy. He started odd behaviors and refusal to take medication and it was made the request for observation of liaison psychiatry. in the psychopathological observation is notorious a psychomotor agitation with sexual deshinibition, grandiosity ideas and dysphoric mood. It was placed the diagnostic hypothesis of mood disturbance due to cancer progression with manic characteristics that was supported by evidence in neuroimaging of metastization in frontal-parietal-occipital cranial bones. He started medication with halopheridol with remission of the psychiatric symptoms.

It is described a case of an old-age patient, without psychiatric background, with progression of his cancer disease, that suddenly starts manic symptoms. the manic states due to organic causes are more rare then other affective disorders and the clinician has to be alert.

Delirium involves an acute, transient disturbance in consciousness and cognition. When the delirium involves aggressive behavior it's termed excited delirium; when this is followed by sudden death, it's termed excited delirium syndrome. Typically, patients presented fever, a rapid pulse, agitation and anxiety, with increasing confusion, and a progressive deterioration over a course of weeks before dying.

Alert to the poor prognosis of excited delirium syndrome.

Review of relevant literature after the description of a clinical case.

Description of a clinical case:

A.R. is a man of 69 years, without psychiatric background, under neoadjuvant chemotherapy for metastatic bone disease. He has multiple comorbidity: chronic obstructive pulmonary disease, hypertension, diabetes and stomach cancer treated 15 years ago.

Three days before the hospitalization the patient began incoherent speech, and physically he was dehydrated; it was requested observation liaison psychiatry for psychomotor agitation. in the course of the interview, the patient was aggressive, very anxious, with jealousy and paranoid delusions, visual and auditory hallucinations, disoriented and with dispersed attention. It's placed the hypothesis of delirium by multiple etiologies and he was medicated with neuroleptics. It was necessary increased doses and physical restraint to control of agitation, which was not complete and lasted two weeks; meanwhile, he developed a respiratory infection. the patient eventually died of cardiopulmonary arrest.

It's described a typical case of excited delirium syndrome in a patient with psychomotor agitation that was difficult to control and lasted weeks, which culminated in cardiopulmonary arrest.

Even if obesity isn’t a psychiatric disorder included in the DSM IV-TR, it is associated with a high prevalence of psychopatological features. Mainly obese patients on a waiting list for bariatric surgery are affected by psychiatric disorders more often than non-obese individuals.

To estimate the prevalence of psychopatology in obese patients on a waiting list for weight loss surgery.

To demonstrate the importance of a multidisciplinary approach to bariatric surgery that includes a psychodiagnostic evaluation.

Forty-seven patients on a waiting list for bariatric surgery were assessed using the SCL-90-R.

In a high rate of patients (83%) was identified a significantly altered value at least in one of the SCL-90-R subscales. Mainly the 80.85% has expressed a psychological distress through physical symptoms (SOM), the 63.82% had a deflection of mood (DEP), the 61.7% had a higher ability to perceive both internal and external stimuli (IS); suspiciousness (PAR) occurred in 59.57% of patients (PAR).

Our results suggest a high rate of psychopatological alterations in patients on a waiting list for weight loss. These individuals try to manage their emotions through the relationship with food, and the body become a way to express themselves. Therefore the early detection and the treatment of the psychopatological features associated with obesity could have a role to improve the therapeutic outcome, and a multidisciplinary approach could represent an essential element to reach a global resolution of both clinical and mental features of patients.

To elucidete the relationship between post-operative delirium sumptons and sleep disturbance using Actiwatch(Respironics(R)).

12 esophagal cancer patients (male 10,female2, age mean 65.4y.o. ± 6.31) without dementia were assessed using the Delirium-rating scale -Revised-98(DRS-R98)after esophageal transection on post operative day 2 and 6. Actiwatch was placed on the the wrist of the patient's nondominant hand and lef in place from post operative day 1 to 6. the correlation between the point of DRS-R98 and sleep timeof daytime (8 h–22 h) was analysed.

All the patients had delirium and DRS-R98 was 2–12(mean 5.75) on day2 and 1–5 (mean 2.33) on day 6. Sleep-wake cycle abnormalities was the most frequent and the other symptoms were inattention, perceptual disturbances and hallucinations, visuospacial disorder and lability of affect. the mean value of DRS-R98 of dey 2 and day 6 was significantly correlated with the mean sleep time of daytime from postoperative day1 to day6.

Severity of post-operative delirium was correlated with abnormal wakefulness.

We describe a rare case antithyroid drug induced hypothyroidism leading to an acute psychotic episode.

A 39 year old woman complaining of anxiety was referred to our day hospital unit in september 2010. Her symptoms began a month earlier and she denied any past personal or family history of psychiatric disorders except for an acute psychotic episode in august 2010. She diagnosed with hyperthyroidism in june 2010 and was started on medication with 30 mg of methilmazole. Two weeks later she started to feel confused, and she developed auditory and visual hallucinations as well as persecutory delusionsn and she was hospitalized in a psychiatric facility. Upon admittance lab work indicated severe hypothyroidism (TSH 87 uI/L)and high total cholesterol. Antythiroid medication was suspended and the patient was started on antipsychotic medication with 10 mg of haloperidol.

Four days later the patient dysplayed a complete remission of symtpoms. She self discontinuated the antipsychotic medication one week after discharge and showed no sign of psychotic symptoms. Thyroid function was later revaluated and indicated mild hypethyroidism, for which methilmazole 10 mg was prescribed. in october 2010 the patient was evaluated in our unit and showed no sign of psychotic symptoms or anxiety.

Although very few cases of methilmazole induced psychosis are reported, based on the patient's history, on the doses of medication that were prescribed, on the lab work and on the onset, evolution and remission of her symptoms we hypothesize that the psychotic episode was drug induced.

Comparison of anxiety and depressive disorders (ADD) among persons with chronic CHD.

Patients (n = 301) with chronic CHD were: men 73% and women 27%. Age of women was 64,1 ± 9.9 years; men: 57.5 ± 9.9 years (p = 0,0000001). We used HADS, social adaptation and self-evaluation scales, and lipid range of blood. When anxiety and depression were more than 8 (HADS), diagnosis was verified by a psychiatrist (ICD-10).

In patients with CHD, anxiety (HADS) was 49.6%, and depression - 41.6%. Intensity of ADD among women was higher, than among men: anxiety level (HADS) was 9.3 ± 4.1 and 6.9 ± 3.6 respectively (p = 0,00005) and depression - 8.4 ± 3.4 and 6.6 ± 3.2 (p = 0,00009). Average score (social adaptation) was 34.9 ± 7.2. Frequency of ADD among inpatients with CHD was 42.6% (n = 130). Psychiatric diagnosis was: adaptation disorders 36.9% (n = 48), depressive episode 20% (n = 26), recursive depression 2.3% (n = 3), bipolar disorder 1% (n = 2), dysthymia 28.5% (n = 37), organic anxiety disorder 4.6% (n = 6), organic mood disorder 6.2% (n = 8). Women displayed more ADD than men: 40% (n = 32) vs. 22% (n = 49) (p = 0,05). Atypical depression was more often. Melancholic depression was less characteristic. Women displayed a higher total cholesterol than men: 6.4 ± 1.28 mmol/l and 5.4 ± 1.3 mmol/l respectively (p = 0,0000013) and low-density lipoprotein: 4.4 ± 1.11 mmol/l and 3.4 ± 1.1 mmol/l (p = 0,0007, respectively). 42.6% (n=130) of patients received medical correction of ADD. 97% of patients with chronic CHD on antidepressants, had stable rates of cardiovascular system.

We need integrated inter-institutional rehabilitation programs for patients with cardiovascular diseases and anxiety and depressive disorders taking into account their gender features.

Alopecia areata is a nonscarring hair disorder consisting in the sudden appearance of one or several circumscribed patches of hair loss. This often affects body image and carries a negative psychosocial impact for the patient. the pathogenesis of alopecia areata is not fully understood but psychosomatic factors such as emotional stress and specific personality traits have been suggested to play an important role in its development.

This study aims to understand the role of stressful events, attachment security, alexithymia and social support as factors triggering alopecia areata.

Participants were recruited from a psychiatric out-patient clinic of a general hospital (n = 7) and were assessed using Paykel's Interview for Recent Life Events, Experiences in Close Relationships Scale, 20-item Toronto Alexithymia Scale and Social Support Satisfaction Scale. all scales were adapted to the Portuguese population.

Alopecia areata tends to be associated with a low satisfaction in social support and high anxiety than avoidance in attachment relationships. Life events were important in 5 out of 7 patients studied and no association was found with alexithymia.

In our sample, poor social support, life events and anxious attachment were associated with Alopecia areata (in agreement with others previous studies), demonstrating the importance of psychosomatic factors in this disorder. Two patients that didn’t show a clear association with life events were under chronic stress situations (had mentally retarded children).

Delirium is a common neuropsychiatric syndrome associated with serious adverse healthcare outcomes. It is misdiagnosed in over 50% of cases across healthcare settings.

To document the point prevalence of delirium across an acute general hospital and identify factors associated with accurate detection by medical and nursing staff, as well as patient and carer recognition.

Adult in-patients in Cork University Hospital on 15.05.2010 were assessed for inattention, delirium symptoms with the Revised Delirium Rating Scale (DRS-R98) and the Confusion Assessment Method (CAM), and pre-existing cognitive impairment with the Informant Questionnaire for Cognitive Decline (IQCODE). Recognition by patients/carers and nursing staff was assessed through direct questioning, while recognition by the treating medical team was assessed through casenote review.

311 were recruited (87% of inpatients). 55(18%) had delirium. Pre-existing cognitive decline was detected in 28 delirious patients(51%). of those with delirium, 17 (31%) were aware of their own confusion, 35(64%) were recognised by nursing staff, and 24 (44%) had delirium documented in medical casenotes. Predictors of recognition in medical casenotes were the severity of inattention, short-term memory impairment and being managed by a medical rather than surgical team. for nurse recognition, predictors were severity of delusions, affective lability, inattention and long-term memory impairment. for patient self-recognition, acuity of onset and disorientation were predictors.

Delirium is present in approximately one in five hospitalised inpatients at any time. Under-detection is common. Factors linked to accurate detection can inform educational and other efforts to improve delirium recognition.

Burning Mouth Syndrome is an idiopathic condition seen commonly in patients especially in a Dental Hospital.It is characterized by a burning sensation of the mouth mucosa, localised to diferrent parts of the mouth. It is accompanied by gustatory disturbance and subjective xerostomia.

To determine the demographics and most common sites of burning sensation.

To identify the length of time from the onset to presentation together with association with any other pre-existing psychiatric comorbidities.

Analyse all the patient notes referred to the Psychiatric Liaison Dental Clinic between 2005 – 2011.

Burning Mouth Syndrome was found more frequent in women, with a previous diagnosis of Depression or Anxiety. the time between onset and presentation was on an average of 1year. Most common site of burning sensation was localised at the level of the tongue, lips, mouth roof, gums. Metalic taste and xerostomia were also associated. the age of onset was in patients over 50 year old, on an average. It had a gradual onset with a worsening of symptoms 6 months prior to presentation. Most cases were identified in Caucasians.

Over a period of 6 years only 24 cases of Burning Mouth Syndrome were identified

While many homeless persons are suffering from mental illnesses, they are often not able or willing to actively seek psychiatric treatment. in order to provide psychiatric help for mentally ill residents of facilities for the homeless in Vienna, a psychiatric liaison service for these facilities was implemented.

This study provides an overview of a six year period of psychiatric liaison services for the homeless: who was reached, which services were performed, and what support was given to staff.

Sociodemographic and diagnostic data were collected from all residents seen by the psychiatric liaison service. Liaison services provided to residents and staff were documented.

Within the six year period, liaison services were offered to 29 homeless shelters. A total of 1.808 homeless people were examined and 11.757 psychiatric services were performed. in addition to the services provided to residents, 1.471 case discussions, 1.187 supervisory services, and 857 information sessions were provided to staff. Among the examined residents, the majority were men without regular income who had been homeless for over five years. the most common diagnoses were substance-related disorders for male residents and schizophrenia for female residents. High rates of comorbidity and multimorbidity were observed. Severity of illness and low level of global functioning correlated positively with homelessness duration.

Because homeless persons rarely actively seek psychiatric treatment, the psychiatric liaison services are an important and necessary means to reach homeless persons who need psychiatric services.

Symptomatic neurosyphilis in immunocompetent patients is nowadays a rare diagnosis. Yet, if not properly diagnosed and treated, consequences for the patient's health are severe. Known as “the great imitator”, its detection involves both a high degree of suspicion and adequate diagnostic tests. Psychiatric symptoms are often the presenting symptoms of this illness.

The authors report four cases of neurosyphilis with psychiatric symptoms (general paresis) in immunocompetent patients. all four patients were initially referred for observation by a psychiatrist in the emergency room. Special diagnostic features of each case and potential diagnostic pitfalls are highlighted.

To raise awareness to the importance of this rare but highly disabling disease.

Review of clinical records and complementary exams.

All patients were male, two Caucasian and two African Black, with ages ranging from 41–56 years old. Clinical presentations were quite distinct, showing the symptomatic heterogeneity of paretic neurosyphilis. Blood VDRL test was negative in one case, CSF VDRL was negative in another case. TPHA was always positive in blood and CSF. White cell count and protein quantification in the CSF remains important to confirm diagnosis.

Current prevalence of symptomatic neurosyphilis in Western Europe is unknown. Atypical cases presenting with heterogeneous psychiatric and neurologic symptoms, with no previous history of mental illness, should undergo blood VDRL testing, and specific blood treponemal testing should be considered in specific situations. A high index of clinical suspicion is needed. Confirmation of diagnosis is only possible through further CSF analysis.

According to WHO reports, the risk of chronic noncommunicable diseases increases with raised body mass index and females have both obesity and depression rates higher.

To analyze the association obesity-psychiatric disorders in patients with diabetes and modified BMI, by gender.

We assessed emotional (HADS,PHQ,MADRS,HAM-A), cognitive (MMSE, clock test), and medical status in 50 consecutively admitted patients (March-June 2011), in our medical ward.

Sex ratio F/M:35 / 15; the mean duration of diabetes was lower in women: 9 vs. 15 years; at least two of diabetes complications have been noted in similar proportions, 62% vs. 66%; obesity / overweight ratio women =3:1/ men = 1:1; men being treated mostly with OAD (73.3% vs. 42.8%). Stressful life events, in the past year, have been reported mostly in men (60% vs. 40%).Anxiety (F/M - 22.8% / 20%), insomnia (F/M - 68% / 60%), and an average score of 27 in MMSE were similarly present in both sexes. Depression was strikingly more common in females (clinical depression F/M: 40% / 26.6%, subclinical depression F/M: 22.8% / 13.3%).

Untreated clinical and subclinical symptoms of depression in women with diabetes and modified body mass index is a rule, and the aspect appears to be chronic. in men unspecific anxious-depressive symptoms and insomnia could be a reaction to a stressful life event.the results raise the suspicion that depression is a hidden complicating factor in diabetic women with obesity. in this group, early specific psychiatric and psychological interventions may improve the multidisciplinary treatment team approach.

The presence of anxiety and depression has important implications for Inflammatory Bowel Diseases (IBD) management. the aims of our study were to examine the levels of anxiety and depression in IBD patients in remission and compared to those without IBD.

A total of 180 patients with IBD, 88 with Crohn's disease (CD) and 92 with ulcerative colitis (UC), in remission (defined by clinical criteria), aged 19–65, of both genders (96 males and 84 females), without known or evident psychiatric disorders, without other chronic disease or the history of surgical treatment, were enrolled in the study. the control group consisted of 180 subjects without IBD. the levels of anxiety and depression were obtained by the Hamilton Anxiety Rating Scale (HAMA-14) and Hamilton Depression Rating Scale (HAMD-21).

Among IBD patients 56.7% of them had no anxiety, 32.1% had mild anxiety and 11.2% had moderate anxiety. Without depression was 11.1% of patients, mild depression had a 55.6%, 32.2% had moderate depression and 1.1% had severe depression. There was a statistically significant difference in distribution of patients by categories of anxiety (P < 0.01) and by categories of depression (P < 0.01). in the control group, 94% were free of anxiety and 61.1% had no depression.

There was no statistically significant difference between CD and UC.

There was significant difference between control and IBD group by levels of anxiety and depression.

Delimited object of this study considers emotional meanings of stigma epilepsy related to the establishment / or the achievement of love relationships. Stigma brings potential adverse consequences to the quality of life for ill persons.

To discuss psychological and possible cultural meanings that patients with epilepsy, recognizing their stigma, attributed to issues experienced regarding to love relationships.

Qualitative method using of semidirected interviews and observing manifestations of respondents. Sample closed when informants' speech became repetitive.

Patients with epilepsy who are on their way there is less time-controlled are more emotional vulnerability, accompanied by the development of psychological distress. Some patients became during the treatment dependent on any kind of help of caregivers. There is an age difference between respondents who ranged from 20 to 40 years. There was that time with patient already dealing with illness and age at which symptoms began differentiate how vulnerable they feel.

Despite the condition of life at stake, they seemed not to feel emotionally or socially exposed. Those who were already in a stable relationship before the table of epilepsy, reported that over a life challenge to be faced by the couple and still had the vision of strengthening the relationship of certain complicity. Those who started a relationship that became permanent after the onset of epilepsy, faced uncertainty, fear of rejection and some embarrassment, at least initially. for those who find themselves loving relationship we find a profile of persons imprisoned the idea of not building links.