Although not the most prevalent clinical presentation, obsessive compulsive (OC) symptoms have been reported after TBI. Post-TBI OC disorder (OCD) cases are rare, so that OC symptoms in this setting are frequently described as OC personality disorders (OCPD).

Generally, the clinical features of post-TBI OCD are thought to be similar to those observed in idiopathic OCD, assuming the probable involvement of structures such as the orbitofrontal cortex, basal ganglia, limbic and thalamic systems in its pathophysiology, although no anatomical location clearly associated with post-TBI OCD being recognized.

Brief systematic review of OCD post-TBI and case report.

Bibliographic research using Pubmed. Clinical interviews and file consultation, with patient informed consent.

We present a case of a 63-year-old patient referred to the Psychiatry Consultation due to obsessive thoughts of dirt and contamination, accompanied by compulsive cleaning and sanitizing behaviors with at least 3 years of evolution with a history of TBI and right frontopolar hemorrhage 5 years ago. These behaviors significantly impaired his functionality (cleaning objects on average 300 to 700 times a day, spending hours in the shower). The patient had insight for the excessive behaviors and its daily impairment.

Psychopathology in the post-TBI context is not infrequent, however reported cases of post-TBI OCD are described as rare in the current literature. The short description of this phenomenon implies the need for more studies focused on the study of the phenomenology of post-TBI OCD. For example, while OCD and obsessive-compulsive symptoms tend to be recognizable psychiatric phenomena, neurobehavioral sequelae in a post-TBI context can present multiple manifestations and resemble OC phenomena, without actually constituting OCD.

None Declared

Medications currently recommended for the treatment of Obsessive-Compulsive Disorder (OCD) usually decrease the severity of the symptoms by 20–30%; however, 40–60% of OCD patients do not achieve a satisfactory response. Our main objective was to investigate the effectiveness of memantine, a non-competitive N-Methyl-D-aspartate (NMDA) receptor antagonist, as an adjunct therapy to sertraline, a selective serotonin reuptake inhibitor (SSRI), to improve severity of symptoms and executive function among patients with obsessive-compulsive disorder.

Our main objective was to investigate the effectiveness of memantine, a non-competitive N-Methyl-D-aspartate (NMDA) receptor antagonist, as an adjunct therapy to sertraline, a selective serotonin reuptake inhibitor (SSRI), to improve severity of symptoms and executive function among patients with obsessive-compulsive disorder.

Seventy patients with OCD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) criteria, and a Yale-Brown obsessive compulsive scale (Y-BOCS) score of more than 21 were recruited to the study. They received sertraline (100 mg daily initially followed by 200 mg daily after week 4) and either memantine (10 mg twice daily) or placebo in a placebo controlled, double-blinded, parallel-group, clinical trial of 12 weeks. The primary outcome was OCD symptoms measured by the Y-BOCS. Moreover, executive function of participants was measured by the Wisconsin Card Sorting Test (WCST).

The total score, and obsession and compulsion subscales of Y-BOCS significantly dropped in both groups with no significant difference between the two groups. However, memantine group showed a greater response in the number of completed categories subscale of the WCST (p value<0.001). We did not observe any major adverse effects in any of the groups.

Image:

Image 2:

Image 3:

Memantine has an acceptable safety and tolerability in patients with OCD and might have a positive effect on their executive function. Nevertheless, the current results don`t42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 support the efficacy of memantine as an adjunctive agent to sertraline for symptoms in patients with OCD.

Memantine has an acceptable safety and tolerability in patients with OCD and might have a positive effect on their executive function. Nevertheless, the current results don`t support the efficacy of memantine as an adjunctive agent to sertraline for symptoms in patients with OCD.

None Declared

Obsessive-compulsive disorder (OCD) is a clinical syndrome whose hallmarks are excessive, anxiety-evoking thoughts and compulsive behaviours that are generally recognized as unreasonable, but which cause significant distress and impairment. OCD may also occur in the context of other neuropsychiatric disorders, most commonly other anxiety and mood disorders. The question remains as to whether these combinations of disorders should be regarded as independent, cooccurring disorders or as different manifestations of an incompletely understood constellation of OCD spectrum disorders with a common aetiology.

To review critically whether there is a robust basis for the concept of an obsessive–compulsive (OC) spectrum of disorders, and if so, which disorders should be included.

Literature review performed on PubMed and Google Scholar databases, using the keywords “obsessive–compulsive disorder”, “obsessive–compulsive spectrum”, “body dysmorphic disorder”, “hypochondriasis”, “trichotillomania”, “psychiatry”.

Obsessive–compulsive disorder (OCD) itself is a heterogeneous condition or group of conditions, and this needs to be appreciated in any articulation of a ‘spectrum’ of OC disorders. The basis for ‘membership’ of the spectrum is inconsistent and varied, with varying level of support for inclusion in the putative spectrum.

A more fruitful approach may be to consider behaviours and dimensions in OCD and OC spectrum disorders, and that this should be encompassed in further developments of the OC spectrum model.

None Declared

DSM-5’s framing of Obsessive-Compulsive and Related Disorders (OCRDs) paved the way for the increasingly structured definition of obsessive-compulsive spectrum disorders. The spectrum would include, among others, body dysmorphia, hair-pulling, skin-picking, obsessional jealousy, and olfactory reference syndrome (ORS). ORS – i.e., persistent concern about emitting a foul or offensive body odor – causes clinically significant distress or impairment in several areas of functioning.

This study aimed to investigate the relationship between obsessive traits and self-odor concern in a clinical sample that did not meet the diagnostic criteria for either OCRDs or ORS.

In a sample of 220 adults referring to an outpatient Mental Health Service in Bologna, Northern Italy, we measured (1) self-odor concern through two specific items – sweat hatred (SH) and body odor hatred (BOH) – on the Body Uneasiness Test (BUT) and (2) obsessive traits through the total score of the Obsessive-Compulsive Inventory-Revised (OCI-R). Therefore, we performed correlation and regression analysis to examine the relationship between obsessive-compulsive traits and self-odor concern.

We found a positive correlation between OCI-R and SH scores (r = 0.330) and OCI-R and BOH scores (r = 0.188). Linear regression analysis demonstrated that OCI-R score significantly predicted SH score [F(1, 218) = 26.455, R2 = 0.109, p < 0.001] and BOH score [F(1, 218) = 8.017, R2 = 0.035, p = 0.005], highlighting that obsessive-compulsive traits predict both sweat and body odor hatred.

These results demonstrate that obsessive traits and self-odor concern are strictly connected. This knowledge may allow us, even in the absence of an overt diagnosis of OCRDs or ORS, to better identify an at-risk population before it suffers impairment in functioning. Overall, further research is needed to help characterize obsessive-compulsive spectrum disorders before symptom exacerbation.

None Declared

Increased life expectancy, increased prevalence of neurocognitive disorders, various aspects of the concept of “age” and pathogenic the influence of late age on the formation of cognitive deficit was the basis for this study. Bi-directional communication between the brain and the intestine is continuous and supported by the mechanisms that carry out the work of the axis “brain-gut”. Increased life expectancy, increased prevalence of neurocognitive disorders,various aspects of the concept of “age” and pathogenicthe influence of late age on the formation of cognitive deficit was the basis for this study. Bi-directional communicationbetween the brain and the intestine is continuous and supported by the mechanisms that carry out the work of the axis“brain-gut”

Studied relationships between microbiota of the gastrointestinal tract and CNS diverse and dynamic, including in relation to to age and the aging process. Studied relationships betweenmicrobiota of the gastrointestinal tract and CNSdiverse and dynamic, including in relation toto age and the aging process.

Microbiotic a person’s profile is age-specific. Changes in microbial middle age increase mental, cognitive problems in the elderly and senile age.

Dysbiosis of the intestinal microbiota in AD triggers neuroinflammation, which contributes to the accumulation of Aβ in brain structures and pathological cleavage of the tau protein, which leads to disruption of the functions of microglia, hippocampus, and synaptic transmission. The emergence of a two-way connection through the vagus nerve system between the formations of the digestive tract containing microbiota and the CNS with the formation of a “vicious circle” with the development of age-related pathological processes in the CNS. The diverse and multilevel process of aging in its pathological form embraced the active participation of mental adaptation.

Involvement of the microbiota in the pathogenesis of the disease Alzheimer’s suggests that the correction intestinal microflora may have potential value for the prevention of cognitive damage and / or be included in the therapeutic complex, which requires further study and analysis. Involvement of the microbiota in the pathogenesis of the diseaseAlzheimer’s suggests that the correctionintestinal microflora may have potentialvalue for the prevention of cognitive damage and / or be included in the therapeutic complex, whichrequires further study and analysis

None Declared

Frontotemporal dementia (FTD) is a devastating neurodegenerative condition with several clinical presentations for which there is currently no effective treatment. Although much less common than Alzheimer’s disease, the impact of FTD is high thanks to its relatively early onset and high heritability. This subtype of brain atrophy production decided the frontal and temporal lobes.

Clinical heterogeneity and overlap with other neurodegenerative and psychiatric syndromes complicate diagnosis. Three different subtypes are recognized: behavioral variant, non-fluent aphasia, and progressive semantic dementia.

Clinical review of frontotemporal dementia including the clinics, determination of diagnosis, treatment, and prognosis with a clinical case report.

Bibliographic research with the terms dementia, frontotemporal dementia.

The current clinical case follows a patient in her fifties, born in Brazil, who has a child and a poor social support network. No significant history, celebrating at least two years marked by an evolution framework of progressive change in verbal memory, increase in verbal influence, change in executive functions, namely, and definition of verbal decision.

In general terms, behavioral and language alterations are the dominant aspects of this type of dementia and as characteristics common to the various subgroups of FTD.

FTD is a catastrophic clinical entity thanks to its beginning, the exuberance of the clinical picture, and mainly the lack of treatment with guidance aimed at relieving symptoms and improving the patient’s quality of life.

None Declared

A descriptive study is presented on three cases in which the adjustment of antipsychotic treatment has led to an improvement in the patients’ quality of life.

The objective is the description of the process of treatment optimization in elderly people, with the secondary improvement in the quality of life.

These are three female patients, with an average age of 73 years, institutionalized in the ORPEA Puerta de Hierro Specialized Mental Health Center for the Elderly. Two of them have a diagnosis of paranoid schizophrenia, and the third has a diagnosis of delusional disorder. The average age at the onset of symptoms was 21 years old.

All three were receiving treatment with biweekly zuclopenthixol, 200mg DMD together with haloperidol at a mean dose of 7.5mg of haloperidol. For the extrapyramidal side effects presented they were on treatment with biperiden 4mg DMD.

In addition to psychopathological examinations and subjective impressions, previous and current status were compared with the Barthel Scale, GDS and family satisfaction scale.

The treatment of the three patients was modified, in a period of three months, replacing the treatment with zuclopenthixol 200mg DMD to paliperidone extended release 150mg every 21 days, as well as with oral paliperidone, at an average dose of 10mg DMD. Also, biperiden treatment could be completely withdrawn and the dose of haloperidol could be reduced to 2.25mg.

In addition to the reduction of polypharmacy doses, an overall improvement is observed in relation to psychotic symptoms, without presenting exacerbations and improvement in the control of chronic psychotic symptoms. Likewise, they have improved at the affective level, presenting less negative symptoms, improvement of the affective flattening, being more resonant in the interaction with peers and with increased participation in joint activities. On the other hand, at a cognitive level, a significant improvement has been observed.

First generation antipsychotics produce a high rate of side effects, such as prolactin increase, affective blunting and extrapyramidal symptoms. In contrast, second-generation antipsychotics, in addition, act as 5HT2A antagonists, thus reducing the rates of unwanted effects.

Some studies have shown that paliperidone increases prolactin to a lesser extent than risperidone and causes fewer extrapyramidal and cognitive effects. Furthermore, because of its safety profile, paliperiona may be a first-choice strategy in psychosis in the elderly, even in its intramuscular extended-release form in nonadherent patients.

In conclusion, the elderly are a vulnerable population and to a greater extent when they suffer from a severe mental disorder. The aim of any treatment must be directed not only to control positive symptoms, but also to slow down the deterioration of the disease itself, as well as to improve quality of life and functionality.

None Declared

The psychopathological observation of the behavioral and psychological symptoms in dementia (bpsd) and a study of the environment in which they arise, especially during a framework of mild cognitive impairment, must make us reflect on the consumption of resources for families and health or social services. The bpsd contribute 30% to the overall costs of dementia. In particular bpsd accelerate the institutionalization, temporary and definitive, of suffering elderly.

On the basis of some experiences, it is possible to use the health budget tool as part of the project budget, in the field of bpsd, moving from the practice of consumed cost to generated cost, that is the investment of resources that produces social value. The goal is to describe some concrete examples of this application, highlighting strenghts and weakness.

The psychosocial interventions recommended to prevent the risk of onset of bpsd from a public health perspective are analyzed, in Italy and in other countries, in the light of the evolution of welfare theories and practices in community psychiatry.

The methodology of the health budget, in public health system, calls family members and users to a commitment of co-responsibility and administrators of financial resources in terms of accountability. The psychogeriatric elderly with mild cognitive impairment and bpsd, can also be a resource and not just a cost, if we consider the possible performance (dividend of longevity) and not the consumption of economic resources.

A reconceptualization of the bpsd is necessary, which integrates the bio-medical dimension with psychosocial approach within the new welfare systems that must be rethought in function of the increase of the elderly population and respect to demographic trends. The onset of mild cognitive impairment and the reversibility of this pre-clinical occurrence should stimulate early recourse to appropriate psychosocial interventions to counter the social marginalization of many citizens.

None Declared

Depression is a very prevalent mental disorder among older people. Exercise and physical activity may have beneficial effects on depressive symptoms that are comparable to those of antidepressant treatments.

The purpose of the present study was to estimate the role that physical activity plays in wellbeing of older people, as well as its association with depression.

A cross-sectional study was conducted among 101 people over the age of 60, who are active members of the Open Day Care Centers (K.A.P.I) of the municipality of Serres, North Greece. An anonymous questionnaire was created to record the basic demographic data of the studied population. The Greek version of the Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms in the elderly, and the (IPAQ) short edition - 7 items, was applied to evaluate the physical activity of the participants. Statistical analysis was performed with a SPSS 21.

According to our results, as the age of the participants increases, so does the severity of the depression according to GDS-15. In addition, depressive symptoms were associated with marital status, widows in comparison to divorced, with participants living in urban areas and with illiterates and high school graduates. Furthermore, older adults with monthly income of 1000 to 2000 Euros presented to suffer more from depression than those who had a monthly income of up to 2000 Euros (p <0.05).On the other hand, physical activity based on IPAQ was strongly associated with age, married compared to not, high level of education, living in rural areas and depression (p <0.05).

The results of the present study may contribute to further interventions in Primary Health Care for the prevention and detection of depression among older people. Furthermore, physical exercise may be an alternative or adjunct to traditional forms of treatment in mild to moderate forms of depression later in life.

None Declared

Major Depressive Disorder is a common psychiatric diagnosis among elderly patients with cancer. More than 10% of cancer patients suffer from Depression, which negatively impacts their quality of life. Mood symptoms are treated pharmacologically with antidepressant medications, while psychotic symptoms are treated with antipsychotic medications. Electroconvulsive Therapy may be initiated early for psychotic depression.

The objective of this case is to present a patient with Major Depressive Disorder, who developed psychotic symptoms after a diagnosis of malignancy, and to suggest early initiation of Electroconvulsive Therapy for treatment.

Ms G is a 68-year-old female who presented with low mood, worries, poor sleep, anhedonia and suicidal ideation. She complained of abdominal bloatedness and was reviewed by Gynaecology, who discovered a large ovarian mass, likely malignant in nature. Within days of the diagnosis, the patient developed nihilistic delusions, believing that her body was decaying and filled with poison. She was distressed and worried that the poison would spread to others around her. Risperidone was initiated and uptitrated, with limited improvement. As early surgical removal of the ovarian tumour was advised, it was essential that the patient’s mental state be quickly stabilised. She was hence initiated on Electroconvulsive Therapy (ECT). The patient underwent a total of 11 sessions of ECT. She was initially started on daily sessions, and the frequency gradually tapered.

The patient’s mental state improved. She was then continued on oral medications, and discharged home well to proceed with her Gynaecological surgery.

This is a case of Major Depressive Disorder with psychotic symptoms that emerged after a diagnosis of malignancy. This case illustrates the importance of routine screening for psychotic symptoms, including nihilistic delusions, in elderly patients with Major Depressive Disorder who are newly diagnosed with cancer. It may be beneficial to consider early Electroconvulsive Therapy when treating such patients.

None Declared

Reduplicative paramnesia (RP) is a very rare content-specific delusional misidentification syndrome (DMS). RP entails the delusion that a place, an object, or an event has been duplicated or exists in two different places at the same time. RP is thought to result from an organic rather than psychiatric cause distinguishing it from other DMS. It has been suggested that damage to the right frontal and temporal lobe plays a crucial role, although other areas involved in visuospatial processing have also been reported.

The aim of this study is to review the literature and report a clinical case of RP.

We describe a case of an 81 year old woman admitted in a Neurology ward, with a 2 week clinical presentation of temporo-spatial disorientation, behavioural changes, persecutory delusions and reduplicative paramnesia phenomena concerning her house. She had previous history of a stroke 3 years prior to admission and, about one year before, the patient also started to present cognitive decline in the context of Parkinson’s dementia. One month before admission, treatment with Rotigotine was started and later suspended when the aforementioned clinical manifestations started. Upon admission it was diagnosed an urinary tract infection and treatment with antibiotics was started. Two days afterwards, the patient recovered orientation and her usual behaviour, but persecutory delusions and RP persisted. She then started treatment with low dose Olanzapine. Following 2 weeks of treatment the psychotic symptoms fully remitted, including RP.

We underline CT-scan and EEG relevant findings upon admission. In the CT-scan sequelar lesions in left frontoparietal junction, right posterior frontal cortex, left inferior occipital cortex, bilateral cerebellar hemispheres, left caudate nucleae and thalamus were identified. The EEG showed a preserved posterior alpha rhythm associated with slow discontinuous right temporal and mainly left parieto-temporo-occipital activity, indicating dysfunction in these locations.

In line with literature our patient had lesions in the right frontal and temporal lobe. She also presented lesions in other areas involved with visuospatial processing. Particularly the involvement of the left hemisphere reported in our case seems to be an exception. Other factors potentially played a role triggering this episode, namely the cognitive compromise due to dementia interposed with infectious disease, and the rotigotine treatment as well. Another aspect worth mentioning in our case was the remission of symptoms with the use of Olanzapine, even though only a few cases in literature have fully remitted with treatment with antipsychotics.

None Declared

The term paraphrenia, as classically described by Kraepelin, characterizes a disorder that fits into the complex group of late onset psychoses and resembles schizophrenia, but with better preservation of affect and volition and less deterioration of personality. Over the last few decades, the concept has suffered several setbacks and is not currently recognised by the main manuals of mental disorders. However, there are several authors who argue that the diagnosis of paraphrenia has not lost its usefulness. In 1999, Munro and colleagues proposed a set of criteria to identify this entity and delimit it from the diagnoses of schizophrenia and delusional disorder.

Based on a clinical case, we intend to discuss the applicability of the criteria proposed by Munro and the usefulness of the concept of paraphrenia nowadays.

Case report.

A 71-year-old woman was taken to the emergency department for presenting a first psychotic episode characterized by auditory hallucinations, persecutory delusional ideation and Capgras delirium. The delirium was well structured and very dynamic, interfering in the patient’s social and family spheres. Affects were preserved and adequate and no volitional alterations, thought forms or cognitive deficits were found. Organic pathology was also excluded. Thus, it was possible to make the diagnosis of paraphrenia in light of Munro’s criteria.

The description of this case illustrates the definition and identification of paraphrenia, highlighting the usefulness of the proposed criteria and the importance of giving greater recognition to this entity in order to stimulate future research.

None Declared

Depression is a common pathology in the elderly, often unrecognized and mostly affiliated to the consequences of aging,especially in front-line services. It induces somatic and functional impact and even a suicidal risk.

When unrecognized or neglected, depression can reduce life expectancy and increases the use of healthcare and the institutionalization.

-Determine the point-prevalence of depression in the elderly in a front-line heath service in Tunis.

• - Identify risk factors of depression in the elderly.

A descriptive and evaluative cross-sectional study on a sample of patients aged 65 or more, in a tunisian front-line service of general health care regardless of the medical reason.

Sociodemographic and clinical forms along with the PHQ-9 scale (Patient health questionnaire-9)

• - validated in tunisian dialect- were used.

Thirty patients have participated in our study (21 men and 9 women). The average age was 73.23 years. Chronic pathologies were found in 96.66% of cases.

The found risk factors are: female sex in 70% of cases, loneliness and isolation in 10% of cases, widowhood in 50% of cases, grieving in 6.6% of cases and somatic comorbidity in 96 .66% of cases.

The overall prevalence of depressive symptoms was 53.33%. This is correlated with advanced age and female sex (57.14% in women vs 33.33% in men).

The depressive symptomatology found, was mild in 18.5% of cases, average in 62.5% of cases and moderately severe in 18.5% of cases.

Depression is a frequent pathology in the elderly with multiple risk factors. The aging of the Tunisian population on one hand and the change of the social model (family nucleus) on the other, encourage the early detection of depression in the elderly and the training of the health professionals in order to limit its prevalence.

None Declared

Approximately 40% of people with dementia have some sleep disorder, and in as many as 20% this disorder is of clinically relevant severity. The risk of sleep disorders is especially high in people who have been hospitalized for a long time due to dementia. However, sleep disorders are also common in people hospitalized for a long time for the treatment of other mental disorders, so it is unclear to what extent the described risk for sleep disorders is related to dementia and to what extent to living in an institution. In order to answer that question, a control group of persons without dementia who are permanently housed in institutions is necessary. Given that the risk of sleep disorders is related to age and that people with dementia are older on average, a proper control population should be comparable in terms of age. The optimal control population therefore consists of persons without diagnosed dementia, i.e. preserved cognitive functions, permanently residing in homes for the elderly.

The aim of this research was to examine whether there are differences in sleep difficulties between hospitalized patients with moderate dementia and people with preserved cognitive functions living in homes for the elderly.

Cross-sectional research at the Clinic for Psychiatry “Sveti Ivan”, Zagreb and five homes for the elderly in Zagreb. Sleep problems were measured using the Pittsburgh Sleep Quality Index. The hypothesis was tested using linear regression analysis with adjustment for age, sex, education and body mass index. The subjects were 60 patients diagnosed with moderate dementia, aged 60-90 years, who were treated for at least one month in a psychiatric hospital in the dementia department, and the control group was 60 people living in homes for the elderly.

The two groups were well matched in terms of age and sex, but there were large differences in the level of education and body mass index. After adjustment for the mentioned covariates, the total PSQI score was not statistically significantly different between the two groups (p = 0.839). The only statistically significant difference was that patients with dementia slept longer on average during the night (p = 0.003).

Moderate dementia in hospitalized patients does not seem to be an independent risk factor for sleep difficulties.

None Declared

Data are scarce regarding the clinical factors associated with utilization of long-term care facilities among older adults with schizophrenia.

In this multicenter study, we sought to examine potential clinical differences between older adults with schizophrenia who are living in a long-term care facility and their community-dwelling counterparts.

We used data from the French Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia (N = 353).

We used data from the French Cohort of individuals with Schizophrenia Aged 55-years or more (CSA)study, a large multicenter sample of older adults with schizophrenia (N = 353).

Results from the multivariable binary logistic regression analysis including all variables that had a significant association in univariate analyses (i.e., p < 0.05) revealed that older age (Adjusted odds ratio (AOR) [95%CI]=1.08 [1.03–1.13]), depression (AOR [95%CI]=1.97 [1.06–3.64]), lower MMSE (AOR [95%CI]=0.94 [0.88–0.99]) and GAF scores (AOR [95%CI]=0.97 [0.95–0.99]), living in an area comprising more than 1000 inhabitants per km2 (AOR [95%CI]=2.81 [1.37–5.80]), having consulted a general practitioner in the past year (AOR [95%CI]=0.28 [0.0.14–0.56]), and a greater lifetime number of hospitalizations in a psychiatric department (AOR [95%CI]=2.30 [1.18–4.50]) were significantly and independently associated with long-term care utilization among older adults with schizophrenia . In the multivariable logistic regression model, the variance inflation factor (VIF) and tolerance values of each predictor variable were respectively lower than 2.5 and higher than 0.2, supporting that multicollinearity was not a concern in our analysis.

In a multicenter sample of 353 older adults with schizophrenia, we found that ong-term care utilization was significantly and independently associated with depression, lower cognitive and global functioning, greater lifetime number of hospitalizations in a psychiatric department, not having consulted a general practitioner in the past year, urbanicity and older age. Patients living in a long-term care facility appear to belong to a distinct group, marked by a more severe course of illness with higher level of depression and more severe cognitive deficits.

Despite its limitations, this study contributes to gain more specific knowledge about this specific understudied population. Our study highlights the need of early assessment and management of depression and cognitive deficits in this population and the importance of monitoring closely this vulnerable population.

None Declared

Charles-Bonnet syndrome was described in 1760 by the Swiss philosopher Charles-Bonnet, who reported that his grandfather’s visual hallucinations were due to eye disease rather than mental illness.

It is characterized by the presence of visual hallucinations, which are usually complex and structured, in elderly patients with preserved cognitive status, significant deterioration in visual acuity and no evidence of associated psychiatric or neurological disease.

The objective of this poster is to contribute a case to the existing series, and thus get closer to the knowledge of this clinical entity.

To review the case, a search was made in Pubmed with the terms hallucinations and Charles Bonnet’s Syndrome.

This is a 76-year-old man, in follow-up by the ophthalmology service in the context of bilateral cataract, which causes severe visual disturbance. He went to our hospital, accompanied by his wife, reporting that for some months he has had complex visual hallucinations of various animals, colors in space, as well as children playing around him. All this generates a lot of anxiety, although the patient makes adequate criticism of them.

The neurological examination performed was normal. The CT scan and laboratory tests were also within normal limits. Cognitive impairment was explored using the MMSE scale, which did not show any alteration. In addition, after a psychiatric evaluation, the patient does not meet the criteria for any disorder included in the DSM V. After reviewing the literature and taking into account the clinical picture described, the case is framed within a Charles-Bonnet syndrome.

Regarding the therapeutic plan carried out, it was decided to start treatment with Gabapentin up to a maximum dose of 900 mg/day, with a considerable improvement in the hallucinatory symptoms. In addition, given the repercussion at the affective level, especially with a predominance of anxious symptoms, it was decided to start sertraline at a dose of 50 mg/day, with an adequate therapeutic response.

Charles-Bonnet syndrome refers to hallucinosis, generally of a visual nature, that appear in patients with a sensory deficit associated with the type of sensory-perceptive alteration. It is important to take it into account in the differential diagnosis of the elderly patient with hallucinosis. There is no established treatment, although neuroleptics, benzodiazepines, antidepressants and antiepileptics are used.

None Declared

age-related macular degeneration (AMD) is an ocular disease involving central vision. It is one of the mainreasons of vision loss in people over 50. Seeing non-existing faces or shapes are described in AMD. Symtoms of visualhallucinations that occur as a result of vision loss is known as Charles Bonnet syndrome (CBS). These patients haveintact cognition, do not have hallucinations in any other sensory modalities, and retain insight into the unreal nature oftheir hallucinations.

the aim of this work is analizing ethiology, demographic characteristics, clinica features and treatment inpatients with AMD and visual hallucinations

a literature search using electronic manuscripts available in PubMed database published during the last ten years with further description and discussion of a single-patient clinical case.

in different studies in patients diagnosed with AMD, the reported prevalence ranges between 15 up to 39percent. Patients with more significant vision loss may be more likely to experience visual hallucinations. In large caseseries, mean age is 70 to 85 years. Hallucinations can last few minutes or several hours. On average, people experiencethese hallucinations on and off for about 3 years. Those who experience hallucinations tend to see multiple types ofimages, particularly people and faces.The diagnosis of CBS is made when visual hallucinations occur in patients withvision loss in the absence of psychosis, delirium, or other causes.

There is no specific treatment for CBS: optimal ocular care, education and differents techniques to manage hallucinations(changing your lighting conditions and environment, blinking frequently or moving your eyes side-to-side rapidly whilekeeping your head still…). Antidepressants, anticonvulsants, anxiolytics and low-dose of antipsychotics have been used for CBS with positiveeffects in previous reports, but the efficacy of these drugs in the treatment is somewhat questionable and should bereserved for those who exhibit high levels of distress and have not responded to conventional intervention.

Case report: 80-years old woman who presented with a 4 month history of hallucinations and legally blind from AMD. Aworkup for other pathological causes of visual hallucinations was negative.

CBS is an under-recognized and under-reported disorder that involves visual hallucinations in visuallyimpaired individuals. It requires a multidisciplinary approach from neurologists, psychiatrists, general practitioners andophthalmologists. New studies are needed in order to understand its clinical presentation and to improve its management.

None Declared

Dementia - one of the most common diseases in old age - is often only diagnosed at a late stage. Therefore patients with dementia have often a 1.4 to 3.6 times greater risk of treatment as an inpatient. Consequently it is highly relevant within the caring system to identify and treat the onset of dementia at the earliest possible opportunity.

Part of a new treatment center, a psychiatric clinic in the Hanover area (Wahrendorff) has concentrated on treating patients with a mild or moderate form of Alzheimer’s disease as early as possible on an outpatient basis. The method of transcranial pulse stimulation (TPS®) is used. Acoustic pulses generated outside the body are introduced specifically into the brain regions requiring treatment. The aim being the release of growth factors and an improvement in cerebral blood flow, as a means to maintaining and promoting cognitive performance for as long as possible. The poster contribution shows reports from clinicians, patients and relatives, using TPS®. The development of cognitive performance in the course of treatment is also considered.

The data collection for the quantitative study design will take place at the clinic in the period from 06/2021 to 10/2022 (N planned = 60). Cognitive performance is recorded using the Montreal Cognitive Assessment (MoCA test) and the experience reports via interview.

Results of repeated measurement and analysis of the variance in terms of cognitive performance (MoCA test, baseline and follow-up measures) are presented. Field reports are considered and the suitability of TPS® as a method for treating the symptoms of dementia in Alzheimer’s disease is discussed in the form of a best-practice example.

Field reports are considered and the suitability of TPS® as a method for treating the symptoms of dementia in Alzheimer’s disease is discussed in the form of a best-practice example.

None Declared

Subjective memory complaints remain a relevant aspect to be considered in patients with mild cognitive impairment. Likewise, their association with depressive symptoms, quality of life and cognitive performance is also an objective to be studied in such patients.

Our clinical case represents just one opportunity to study how memory complaints are related to depressive states and how they affect the quality of life of patients with mild cognitive impairment.

We conducted a bibliographical review by searching for articles in Pubmed.

PERSONAL HISTORY: Male, 73 years old, separated, residing alone in Valladolid. He has home help, a person comes to help him with the household chores. Little social and family circle.

He has a history of an admission in 2013 to this Short Hospitalization Unit for ethanol detoxification. Since then, he has been followed up in the Mental Health Unit. According to the reports, he has been diagnosed with depressive disorder and cluster B personality disorder.

Current psychopharmacological treatment: diazepam, olanzapine, duloxetine 60 mg, quetiapine.

Toxic habits: history of chronic ethanol consumption. Smoker. He denies other toxic habits.

The patient presents a worsening of his mood of 15 days of evolution, coinciding with a voluntary decrease of his psychopharmacological treatment that the patient has carried out on his own. He walks with the aid of a crutch. Hypomimic facies. Slowed language, circumstantial, with speech focused on current discomfort.

On assessment, he reports initial improvement after reducing his medication, but in recent days he has experienced a decrease in initiative accompanied by feelings of emptiness, sadness and loneliness. He refers to memory complaints for which he is awaiting evaluation by Neurology. The patient explains that at other times in his life he has presented self-harming ideas that he has been controlling. At this time he expresses desire for improvement and adequate future plans, and accepts plans to attend a memory workshop. He also reports visual hallucinations with no affective repercussions and preserved judgment of reality.

Treatment adjustment: Duloxetine 60 mg, 2cp/day. The patient is recommended to lead an active lifestyle and attend a day center or memory workshop.

In numerous patients with mild cognitive impairment, we have observed that memory complaints are closely related to depressive symptoms and to the patient’s functioning in daily life.

In one study memory complaints were a negative predictor of quality of life in these patients.

Therefore, in addition to considering the importance of treating depressive symptoms, it is also important to address quality of life in patients with mild cognitive impairment.

None Declared

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor and nonmotor symptoms, the latter contributing significantly to morbidity, mortality, nursing home placement and quality of life.

We present a literature review about the impact of psychosis on PD’s prognosis.

A literature review is performed on PUBMED, using the next keywords: "Parkinson’s disease”, “psychosis” and “prognosis”. We focused on data from systematic reviews, clinical trials and meta-analysis published in English on last 10 years.

Psychosis is a common feature of Parkinson’s disease, occurring in up to 30% of PD patients treated chronically with antiparkinsonian drugs. Visual hallucinations are the most common psychotic symptom observed, delusions being considerably less common and affecting only 5% of treated patients.

Positive symptoms in PD vary across its course: early in the disease, passage hallucinations, illusions and presence hallucinations occur; later, complete visual hallucinations, initially with good insight, then without insight.

Psychosis spectrum symptoms in early PD predict a decline in cognitive function at 2 years, especially visual hallucinations. There is an association between visual hallucinations and the subsequent emergence of dementia.

Current evidence highlights the role of PD psychosis as a clinical biomarker of disease stage, distribution and future progression. Early recognition and treatment of psychotic symptoms improves disease’s outcomes.

None Declared