The presence of elderly people is more and more common in developed countries. Unlike other medical conditions, late onset psychosis includes organic and mental precipitants in its differential diagnosis.

To present a case of late onset schizophrenia.

Medline search and review of the clinical history and the related literature.

We present the case of a 71-year-old woman with organic medical history of rectum adenocarcinoma in 2008 that underwent radiotherapy, chemotherapy and surgical resection with successful results. According to the psychiatric history, this patient has needed two admissions to the psychiatry ward, the first of them in 2012, (when the delusional symptoms started), due to deregulated behaviour in relation to persecutory delusions and auditory pseudo-hallucinations. In 2012, she was diagnosed with late onset schizophrenia. Blood tests (hemograme, biochemistry) and brain image were normal. Despite treatment with oral amisulpride and oral paliperidone and due to low compliance, delusional symptoms have remained. We started treatment with long-acting injectable papliperidone 75 mg/28 days having reached clinical stability.

Late onset psychosis is due to a wide range of clinical conditions. In this case, our patient had no organic precipitants. The evolution and presentation of delusional symptoms in this patient made us think of late onset schizophrenia as main diagnosis.

The authors have not supplied their declaration of competing interest.

The proportion of elderly people and affective syndromes are more and more common in developed countries. Elderly people have physiological conditions that may limit our intervention.

To present a case of a major depressive disorder with psychotic symptoms in a 72-year-old woman.

Medline search and review of the clinical history and the related literature.

We present the case of a 72-year-old woman with psychiatric history of a major depressive disorder 14 years ago with ad integrum restitution after pharmacological treatment. In 2015, our patient was admitted to the psychiatry ward due to major depressive symptomatology (apathy, anhedonia, global insomnia, weight loss) that associated mood-congruent delusions (nihilistic, ruin, guilt, catastrophic) with deregulated behaviour. The patient was resistant to combined pharmacological treatment with aripiprazole, desvenlafaxine, mirtazapine and lorazepam, therefore, we decided to administer ECT, with successful results after 5 sessions. Brain tomography, blood and urine tests were normal. Clinical signs of dementia were not present.

Inpatients with deregulated behaviour; it is important to rule out organic causes, especially in elderly, in whom dementia, brain tumors or metabolic disturbances may simulate psychiatric syndromes.

The authors have not supplied their declaration of competing interest.

Jealousy is a complex emotional state and some degree is considered normal in mature love, but when does it become destructive in a relationship? There's a thin line between what is normal and what is pathologic. Pathological jealousy differs from normal by its intensity and irrationality. Obsessive and delusional jealousies are different types of pathological jealousy, difficult to distinguish, which is important, since they have different treatment. Despite the differences, both result in significant distress and carry the risk of homicide/suicide, so it's a matter deserving the psychiatrists’ attention.

Explore the psychopathological differences between obsessive and delusional jealousy and list the characteristics and difficulties in the approach to pathological jealousy.

The results were obtained searching literature included on the PubMed and Google Scholar platforms.

Delusional jealousy is characterized by strong and false beliefs that the partner is unfaithful. Individuals with obsessive jealousy suffer from unpleasant and irrational jealous ruminations that the partner could be unfaithful, accompanied by compulsive checking of partners’ behavior. This jealousy resembles obsessive-compulsive phenomenology and should be treated with SSRIs and cognitive-behavioral therapy. Delusional jealousy is a psychotic disorder and should be treated with antipsychotics.

The common issue in pathological jealousy is the problem of adherence to treatment and bad prognosis. In order to achieve better treatment outcomes, we should follow-up the patient regularly. One key factor is to explore the psychopathology and motivate the sufferer for the proper pharmacological and psychotherapeutic interventions, trying to reduce the suffering caused by ideas of unfaithfulness.

The authors have not supplied their declaration of competing interest.

Anomalies of bodily experience have for long been described as relevant features of schizophrenia and major depression, yet such experiences are usually neglected in clinical examination. Bodily experience is the implicit background of our experiences against which we develop a coherent sense of self as a unified, bounded entity, naturally immersed in a social world of meaningful others. Such tacit experiential background is often perturbed in schizophrenia and major depression. Empirical research shows that patients with schizophrenia and major depression frequently present many different kinds of anomalies of bodily experience in the course of their illness.

To characterize the abnormal bodily phenomena in both schizophrenia and major depression.

To improve differential diagnosis based on the identification of typical features of abnormal bodily experiences in persons affected by schizophrenia and major depression and to provide supplementary diagnostic criteria.

Analysis of empirical and theoretical research published in the last 25 years.

Ongoing bodily feelings of disintegration/violation and nothingness/mechanization (e.g. one's body experienced as a object-like mechanism) are the most typical experiences in people with schizophrenia whereas major depressives are not able to detach themselves from the experience of bodily failure or chrematization (from chrema = corpse, i.e., feeling like a corpse) and therefore, feel worthless, guilty, or decaying. They feel chrematized in their very self.

These experiences might be considered as specific and they can contribute to differential diagnosis of somatic complaints in schizophrenia and in major depression.

The authors have not supplied their declaration of competing interest.

Using a clinical case as illustration, the present work engages the different psychopathologic alterations that blindness patients could present.

The presentation and discussion of a clinical case of psychosis in a blind patient are addressed. The scientific documentation used as support was obtained from PubMed/Medline search engines using as keywords blindness and psychosis.

A 43-years-old male patient, with a medical history of arterial hypertension, heroine dependence (presently with methadone schema) and bilateral blindness caused by a bilateral retinal detachment 20 years ago, was admitted in the psychiatric ward. The patient's historical record includes a previous personality with paranoid characteristics, as well as a hospitalization due to persecutory and auto-reference ideas and kinaesthetic hallucinations with 1 month of evolution, coincident with address changes. Lab tests revealed the following results: haemoglobin 13.8; Leucocytosis 13,400; CRP: 6.2; ALT > AST. Positive results were obtained in the drug tests for cannabinoids, as well as for the anti-HCV antibody (IgG). Finally, the patient was medicated with an antipsychotic and humour stabilizer, achieving a significant improvement after 10 days of hospitalization.

Although studies reveal that mental and behavioural disorders, especially those with symptoms of psychosis and mental retardation, are common among people with congenital blindness, more knowledge of the prevalence and aetiology of mental and behavioural disorders among people suffering from blindness is needed.

The authors have not supplied their declaration of competing interest.

Episodes of time-limited acute psychosis, with full recovery in between, are categorized as acute polymorphic psychotic or brief psychotic disorders. Leonhard described the three forms of cycloid psychosis (CP). Perry considers it a separate entity.

We report the case of a 54-year-old male, with a 9-year history of brief psychotic disorders. He was admitted to an inpatient unit after a 4-day episode of persecutory delusion, leading to high emotional repercussions and isolation at home. Euthymia was present. Previous admissions, 9 and 5 years before, presented similar clinical pictures. Treatment with low dose paliperidone during 6-month periods had led to the complete resolution of the episodes (restitutio ad integrum: no psychotic manifestations and the ability to run his business). In this episode, 8 days after the reintroduction of 12 mg of paliperidone per day, cessation of the symptoms took place. Careful reconstruction of the clinical history showed no stressors or drug consumption. And immediately previous 5-day phase of insomnia, hyperactivity and expenditure was described by the patient's wife.

Three inpatient admissions, a careful clinical history and a thorough review of the evidence regarding Perris criteria led to a diagnosis of CP.

CP, a classical nosological approach, is helpful in a clinical setting, as it might imply different prognosis and treatment. Recognition of CP, not included as an entity by the major diagnostic systems, requires a high index of suspicion.

The authors have not supplied their declaration of competing interest.

Cryptococcal meningitis is a frequently observed opportunistic infection in patients with late-stage HIV-infection, especially among people living in South-East Asia and Central Africa. The worldwide incidence is estimated at one million cases. The worldwide mortality of HIV-associated cryptococcal meningitis remains high (10–30%), due to the inadequacy of antifungal treatments and complications of increased intracranial pressure. Clinical symptoms of cryptococcal meningitis are fever, headache, vomiting, and altered mental status. Neck stiffness, papiledema, and focal neurological symptoms are sometimes present.

We describe the case of a patient who first developed a delirium, and a few months later an acute-onset psychosis, after a past cryptococcal infection.

To report a case-study describing acute-onset psychosis as a neuropsychiatric consequence of HIV-infection.

A case-study is presented and discussed, followed by a literature review.

A 49-year-old African-born male was admitted to hospital with an acute psychosis. He had been treated by an internist after being found to have HIV. As a result of non-compliance over a period of about four months, his cd4-count had dropped to 40. Six months earlier he had developed cryptococcal meningitis, which left him a number of neurological and psychiatric symptoms. During his stay in hospital, there had to be good collaboration with the specialist in internal medicine whose dual task was to manage the patient's dramatically low cd4-count as well as his psychosis.

Cryptococcal meningitis is a risk factor for psychiatric disorders and mortality in HIV-infected persons.

The authors have not supplied their declaration of competing interest.

Meditation is frequently applied in Western as well as non-Western countries for different purposes; we know little about adverse events. The symptomatology of a meditation-related psychosis appears to show similarities with that we call “bouffée delirante”.

A female patient is described who developed an acute and transient psychosis with polymorphic symptomatology after meditating (Bikram-yoga). We made a literature search for psychotic states related to meditation.

There are some case reports of psychosis disorder induced by meditation. Some cultural syndromes like Qi-gong appear on DSM-IV as psychotic reaction. In this case, the syndrome is not culture bound.

Meditation can act as a stressor in vulnerable patients who may develop a transient psychosis with polymorphic symptomatology (confusion, pananxiety, mood swings and mood dystonic psychotic symptoms) with a short duration.

The authors have not supplied their declaration of competing interest.

Erotomania (also known as De Clerambault's syndrome) is usually described as a rare delusional syndrome characteristically involving an individual who believes that another person, typically of higher social, economic or political status, is in love with the individual. De Clerambault's syndrome remains a ubiquitous nosological psychiatric entity with uncertain prognosis that remains recognised as a subtype of delusional disorder in DSM 5.

To review the history of Erotomania as a nosological psychiatric entity, its clinical characteristics and course. Also to report some selected clinical cases.

The authors have conducted an online search on PubMed with MeSH words“erotomania”, “erotomaniac delusion” and “Clerambault” and systematically reviewed some case reports.

Erotomania is a relatively uncommon and misunderstood disorder characterised by the presence of a persistent erotic delusion. The individual (usually described as a woman) has had little or no contact with the other person who is perceived as watching over, protecting or following the individual. Despite various authors have described and named this syndrome, it was Clérambault who first classed the symptoms into the disorder he referred to as “psychose Passionelli” (1942). There are numerous theories as to the aetiology of this illness that is not uniquely associated with any specific disorder. We reviewed some clinical cases.

Erotomania is a relatively uncommon psychiatric disorder. An increased awareness and understanding of this illness will assist in the recognition of patients affected, opening doors for future progress on its aetiology and, therefore, the development of new treatment options.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The classical authors associate the insanity with delusions, without delusions there was not insanity. This axiom has changed nowadays, and it's also accepted that insanity can exist without delusions.

We aim to know and describe which factors are involved in the development of the delusion. Use these conclusions to drive the patient to the comprehension and acceptance of the reality.

(a) Unravel the mechanism of delusion, (b) seek the causes, (c) find out an explanation about the origin and development of the delusional thematic.

Clinical biographic review, carried on in 2 steps: (a) review the delusions store in the Hermanas Hospitalarias Spanish hospitals (17 centres), (b) choose one of them, (c) use the inductive method for analyzing the details and for making conclusions in order to be apply in the delusional process.

(a) Understand the internal dynamic of delusion and how the delusion becomes the main axis of the patient life. (b) The patient finds on the delusion a life motive, which did not exist before.

Paraphrasing Dr.Castilla del Pino, “the delusion is a necessary mistake”. From the emotional point of view, it can be said “the delusion is a cry of a captured heart”.

The authors have not supplied their declaration of competing interest.

This is a doctrinal movement that seeks to analyze mental illness without reductionism and seeks to grasp the nearest as possible to the reality of the patient.

This is the analysis of an event, a concept, a feeling, trying to grasp as it is lived by the subject and in the direction you may have for him.

Review of literature.

It was the first approach to the knowledge of the pathological experience and was the first scientific model to characterize the mental pathology. It was the central doctrine of psychiatry until the end of World War II, when the hegemony of the German psychiatric science gave way to the views that are primarily developed in Anglo-Saxon countries (psychoanalysis and behavioral psychology), although some European countries such as Germany and Spain continued growing until the 1980s, when it culminated in the publication of the DSM-III (1980).

These approaches are “old fashioned” but are essential to understand and know the reality of human sick, “mentally ill man.”

The author has not supplied his/her declaration of competing interest.

This study was conducted to examine the psychological characteristics of the schizophrenia (n = 20), bipolar disorder (n = 20) and depressive disorder (n = 13) patients on MMPI-2 and Rorschach responses.

MMPI-2 and Rorschach was individually administered to all patients, and their Rorschach responses were scored by Exner's comprehensive scoring system. The means of T scores of MMPI-2 subscales and Rorschach scores were compared among the three groups.

The schizophrenic and bipolar disorder groups showed significantly higher scores on the MMPI-2 K scale than the depressive group, while the depressive group showed significantly higher score on MMPI-2 Si scale than the schizophrenic and bipolar groups. In Rorschach responses, the bipolar and depressive groups obtained significantly higher scores on two variables (FM + m, m) than the schizophrenic group. The bipolar group obtained significantly higher scores on three variables (es, CP, a), suggesting hyperactivity and mood dysregulation.

These results suggested that patients with depressive disorder might subjectively suffer from more severe emotional and social discomfort than patients with the schizophrenia and bipolar disorder, while patients with bipolar disorder and schizophrenia would be more defensive than the depressive patients.

The author has not supplied his/her declaration of competing interest.

There are few reported cases relating visual acuity and psychosis. The Spanish psychiatrist Sanchís-Banús focused on two patients who became blind and who, due to stress developed paranoid and jealousy delusional ideas. He called it “Sanchís-Banús syndrome” (SBS) that is mentioned in the psychiatry literature.

A case report. We present a case of “paranoid delusion of the blind” (SBS), quite similar in its clinical characteristics to those of the original patients of the valencian psychiatrist Sanchís-Banús. In our case, we met a 46-years-old woman, who worked as a lottery seller because she had a visual problem: retinitis pigmentosa. She had had her first psychotic decompensation when the blindness started. In spite of having achieved good social and work performance with quetiapine 400 mg/daily, laboral conflicts and stress caused her delusional ideas again. She began to think that her mother was not her real mother (Capgras syndrome) and that she was being persecuted. She also did not eat the meal and did not drink water because she thought that they were contaminated.

We started treatment with clozapine at doses of 300 mg every day (50-50-200) combined with aripiprazole15 mg/day tolerating the medication without notable effects. After this adjustment of medication, remission and good criticism of hallucinatory and delusional clinical course. The nosological, clinical, and prognostic features of SBS are discussed in light of the current literature.

The authors have not supplied their declaration of competing interest.

Adjustment disorder (AD) is a common diagnosis, but there are relatively few studies, in part because the current definition is still poorly specified, inadequate and controversial. Some clinicians and researchers have pointed out that a psychiatric diagnosis should present a clinical description, as well as date based on psychological, biological and/or sociofamiliar studies, and follow-up investigation about outcome and prognosis, to increase the reliability and validity diagnosis and permits exclusion of other possible disorders and normality. There is much empirical evidence to indicate that AD is a transient disorder with a tendency to spontaneous remission. However, some studies have shown that patients with AD often develop major psychiatric disorders, presenting a higher rate of psychiatric morbidity, e.g., higher suicide rates.

The aim of this study was to analyze the clinical and sociodemographic characteristics, as well as some possible personal vulnerability factors in patients with AD.

This longitudinal study was carried out on 80 outpatients diagnoses with AD at a Mental Health Unit, who were followed up for 3 years. It was analyzed different clinical and sociodemographic characteristics.

Significant differences between groups were found in some of the variables considered.

The results add empirical evidence to a controversial and little-researched diagnostic category and provide guidelines for assessment and intervention. They also may contribute to improve diagnostic classifications.

The authors have not supplied their declaration of competing interest.

Neurological soft signs (NSS) refer to a group of neurological deficits with no apparent pathognomonic supstrate and comprise phenomena such as disorders of simple motor coordination, sensory integration, as well as disinhibition sings. Schizophrenia and other neuropsychiatric disorders are associated with a higher prevalence of NSS.

A 21-year-old male presented to our hospital with symptoms including anxiety, delusions, mood alterations, insomnia, and hypomania. Neurological assessment revealed presence of soft neurological signs. Personal history was positive for hypoxic birth injury and psychiatric heredity. During his stay, the patient showed not only partial response to treatment during several months, but also extrapyramidal symptomatology (limb hypertonia, decreased associated movements during walking, arm dropping, and rigidity of the neck, as well as elevated blood levels of CK, CRP, and high body temperature). There was no progression of NSS. The addition of valproate to antipsychotic treatment led to mild improvement. An MRI exam indicated presence of lesions in the white mass.

Although NSS have been more frequently associated with schizophrenia, especially in patients with dominant negative symptoms, there are findings, which suggest their presence in schizoaffective and bipolar disorders. Their presence is often an indicator of poor outcome, they can resemble EPS, and their association with frequency and severity of EPS is unclear.

The presence of NSS is not enough to discriminate schizoaffective disorder, a “vague” diagnosis from others in what is considered the psychotic spectrum.

The authors have not supplied their declaration of competing interest.

It is difficult to establish whether a patient has late onset schizophrenia or frontotemporal dementia. The object of the following case report is to point out the difficulty of making a differential diagnosis between these two entities.

A 49-year-old female patient was admitted to our hospital after presenting with auditory and visual hallucinations, formal thought disorder, persecutory delusions, ideas of reference, insomnia. Memory, executive function and attentional tasks were severely compromised. Computerized tomography showed incipient frontal lobe atrophy. There were no significant abnormalities found in blood and urine samples or physical and neurological examinations. After showing no response to olanzapine, and extrapyramidal side effects to fluphenazine, risperidone was initiated which subsequently led to complete withdrawal of positive symptoms.

Patients presenting with psychotic symptoms after the age of 40 presented a diagnostic quandary, as they were less likely to present with negative symptoms, formal thought disorder or affective blunting, and more likely to have systematised delusions and visual hallucinations. Frontotemporal dementia is a disorder that can present itself with cognitive decline and a large range of psychiatric symptoms. The risk of late onset schizophrenia is greater in women, possibly implicating a causative role of female sex hormones. Atypical antipsychotics risperidone and olanzapine seem to be an adequate treatment.

Schizophrenia is a heterogeneous disease with a large variety of clinical manifestations. Special care should be given to patients with age over 40, including neurocognitive assessment, laboratory and hormone tests, and a long-term follow-up.

The authors have not supplied their declaration of competing interest.

Some kinds of hallucinations are misdiagnosed due to primary psychotic disorders. Hallucinations can be classified into 3 categories: true hallucinations, pseudo-hallucinations and hallucinosis. True hallucinations are different from the others due to incapacity of insight of the unreal and pathologic character of the phenomenon.

This study reports a case initially diagnosed as psychotic depression that after a rigorous psychopathologic investigation revealed to be an unspecified dissociative disorder.

Twenty-four-year-old female, with a past of psychiatric treatment since 18-years-old, reports brief dysphoric episodes associated with visions of bleeding clowns and skulls that were always connected to a psychosocial stressor. At the interview she asserts that she understands those symptoms as pathological and caused by her mind, and associate them with external stressors. These episodes were brief and remitted spontaneously. The mental state examination did not show any psychopathological disturbance. The reduction and suspension of antipsychotics did not result in worsening of these symptoms.

The psychopathological disturbances reported by the patient did not represent a true hallucination. The presence of insight, the evolution and duration of the symptoms, and the association with psychosocial stressors has shown that the phenomena and symptoms are associated to a dissociative disorder. Therefore, the prescription of antipsychotics involves unnecessary pharmacological and clinical risks for this patient at the moment.

Despite the use of psychopathology is considered by some as outdated, it is still an important semiological instrument for an accurate diagnosis and planning therapeutic conduct.

The authors have not supplied their declaration of competing interest.

The diagnosis of a primary psychiatric disorder requires the exclusion of an organic etiology. However, Brazilian public hospitals commonly lack resources. Diagnostic precision requires also the congruence of the clinical history and the natural history of the investigated disorder.

This study reports a rare case of hallucinations and retrograde amnesia, due to organic brain lesion but without other cognitive impairments.

Fifty-three-years-old male Brazilian, was evaluated after one year in Brazil after being missing for 25 years in USA. Encountering his family, he did not recognize his mother, did not remember his life in Brazil, including his infancy, nationality and mother language. He was found as a homeless in poor hygiene. In the exam, he only presented retrograde amnesia, without any disturbances of fixation memory, intelligence, formal thought, affect or psychomotor function. Patient reported hallucinations. Blood tests showed no abnormalities. EEG showed diffuse slow rhythms. Brain MRI showed cortical and hippocampal atrophy. After weekly evaluations for 5 months, he remained stable despite lack of prescription. Some weeks after MRI, patient reported frequent alcohol and inhalant use when missing. No hints of secondary gain were found until present.

Organic etiology was suspected due to atypical presentation: hallucinations, evocative amnesia, with no further cognitive and affect disturbances. This is not compatible with schizophrenia, dementia or dissociative disorder. The brain abnormalities and recent data highly suggest this etiological hypothesis.

Since this clinical presentation does not fit into any specific psychiatric category, the case will continue to be studied.

The authors have not supplied their declaration of competing interest.

Recent studies suggest that aripiprazole (ARP) shows a better profile in terms of mental state and extrapyramidal symptoms (EPS) in psychosis. However, other studies consider that a combination of atypical antipsychotics (AAP) may also be an option for some refractory patients. We present a case of a schizoaffective disorder, manic type (SAFM) (F25.0, ICD-10 criteria) that improved in terms of EPS adverse effects after switching from long-term fluphenazine (LTF) to Long-acting injectable aripiprazole (LAIA) but showed relapse symptoms.

We present a clinical case of SAFM that improved clinically in our outpatient clinic after 1 month of bi-therapy with low doses of oral risperidone and standard dose of LAIA. We study oral AAP-LAIA drug combination utility in this clinical setting.

To study “oral AAP-LAIA combo” benefits in refractory SAFM cases.

Our patient is a 68-year-old female diagnosed of SAFM clinically stable with a combination of lithium and LTF. She presented severe cogwheel stiffness in the upper limbs and postural tremor. We switched from long-term fluphenazine to LAIA and 4 weeks later, she showed discrete cogwheel stiffness but also persecutory delusions and dysphoria.

We maintained LAIA (400 mg/28 days) and lithium (800 mg/day) doses and added-on risperidone 1 mg/day. She presented clinical relapse 1 month later. She kept her better EPS tolerance as she only had discrete cogwheel in upper limbs only by using attention distraction techniques.

Oral risperidone-LAIA drug combination appears as an effective and well-tolerated treatment in refractory SAFM cases.

The authors have not supplied their declaration of competing interest.