Obssesive Compulsive Disorder (OCD) is characterized by impaired neuropsychological functions that are also influenced by clinical variables and aging.

According to the literature, several of these neuropsychological deficits could be potential endophenotype markers.

The present study aimed to study what kind of cognitive deficits OCD patients have and how aging and clinical course modify their cognitive profiles campared with general population.

This study examined a sample of 60 adult outpatients with OCD diagnosis, who were matched with 70 healthy controls (HC). Cognitive performance in both groups was assessed using a neuropsychological battery including Rey-Osterrieth complex Figure (ROCF) and Digit Span Test (DGS). Based on previous research on neuropsychology of OCD, it was specified that these neuropsychological measures could be divided in two composites. The first composite, Executive function, includes Total Digit Span and the domain of organization of ROCF. The second composite, Non-Verbal Memory, includes the copy of ROCF, immediate recall, delayed recall and recognition of ROCF.

Severity of OCD symptoms was assessed by YBOCS and HDRS was used for symptoms of depression.

Both cognitive performance and clinical data were documented before and after a follow-up of 11 years.

During analysis, group differences between patients with OCD and HC regarding demographic and clinical characteristics at baseline and follow-up were calculated with independent t-tests and Pearson tests.

The main analysis tested if the change in cognitive function over time differed between patients and controls. To this end, a linear mixed model was used, examining the interaction between age, gender and time in both groups.

Older age, in patients with OCD and HC, was associated with poorer performance on executive function and nonverbal memory. Executive function was influenced by severity of OCD, and non-verbal memory by depressive symptoms at baseline. While, after the follow-up, as obsessive and affective symptoms improve along de follow-up, there is no significant change in the neuropsychological pattern.

At baseline, patients with OCD showed a poorer performance than HC in areas of nonverbal memory and executive function. After de follow-up, there is a poorer performance in the cognitive function in both groups, as they get older. However, there is no significant difference in this change between patients and HC.

Results suggest that OCD is characterized by the existence of dysfunction in several neuropsychological areas that are influenced by time and clinical variables.

Nevertheless, this alteration is no solely attributable to these factors, as they remain stable through time compared to the general population. Therefore, certain neuropsychological functions might be endophenotype traits of the disorder.

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Obsessive-compulsive disorder (OCD) is a chronic disorder with a wide range of manifestations but primarily intrusive thoughts (obsessions) and/or ritualized actions (compulsions) that can cause a huge distress in patients’ life. First-line treatment for OCD are selective serotonin reuptake inhibitors (SSRIs). Tricyclic antidepressants are used as second-line treatment due to secondary effects. Also antipsychotics such as aripiprazole are approved for treating OCD. Vortioxetine is has 5-HT3, 5-HT7 and 5-HT1D antagonists, 5-HT1B partial agonist and a 5-HT1A agonist and serotonin transporter inhibitor property. It is used in major depressive and anxiety disorders. A male 48 years old patient with an OCD diagnosis since he was 21, was reffered to psychiatry department. Previously, he had no response with SSRIs at full dosage and clomipramine 75mg was effective. At 46 years old, he had an acute myocardial infarction. He also admited not taking the medication regularly due to sexual disfunction and having affective symptoms related to the distress caused by OCD.

To evaluate efficacy of vortioxetine in treating OCD in a patient with contraindications for tricyclic antidepressants and no response to SSRIs.

Clomipramine dose was reduced until discontinuation. After one week without treatment, basal scores for Hamilton Scale and Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) were collected. Same data was collected again after 10 weeks treatment.

The dosage of vortioxetine was progressively titrated until 20mg daily in 3 weeks lapse. Diazepam 5mg was added in case of insomnia or anxiety. Aripiprazole 5mg was added in the third week of treatment as adjunctive treatment due to the recurrence of some intrusive thoughts (discontinued by himself because of akathisia). Finally, the patient reported an improvement in affective and OCD symptoms in the sixth week of treatment that was sustained until the tenth week, when data was recollected. The patient did not refer sexual disfunction.

The pre and post results are summarized in tables 1 and 2.Table 1.

Hamilton Depresion Rating Scale (0-52)

Dimensional Y-BOCS (0-15)

Vortioxetine might be a promising molecule for treating OCD in patients with contraindications for first and second-line treatments.

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Excoriation disorder (ExD) is a pathology recognized by DSM-5, and it is considered a part of the obsessive-compulsive spectrum. ExD is associated with a high rate of psychiatric comorbidity (e.g., depression, ADHD, substance use disorders, etc.).

The main objective of this review was to explore the available evidence to support the diagnosis and treatment of skin picking in elderly population.

A literature review of the available sources reporting on ExD in elderly patients, realized by searching three electronic databases (PubMed, Cochrane, Clarivate/Web of Science) but also the grey literature. All papers published between January 1990 and July 2023, including the terms “excoriation disorder”, “compulsive skin picking”, “dermatillomania” and “elderly” or “old-age patients” were reviewed.

The information about ExD was extracted almost exclusively from reports on elderly patients with neurocognitive disorders. Tactile hallucinations, delusions of contamination, social isolation and focusing on own bodily sensations, and organic causes- dehydration, allergies, renal insufficiency, hepatic and pancreatic diseases, as well as toxic causes- e.g., adverse events of certain drugs should be investigated in elderly patients exhibiting signs of ExD. A differential diagnosis is very important in this population in order to find the most adequate treatment. Behavioral treatments, serotonergic antidepressants, and glutamatergic modulators have been explored in patients with ExD, although specific trials for elderly patients with this disorder are still lacking. However, case reports support the utility of several serotonergic antidepressants in the elderly.

ExD is a less explored disorder in the elderly, where an extensive differential diagnosis and screening for somatic/psychiatric comorbidities are needed. Trials exploring the potential treatments for ExD in old-age patients are also required for evidence-based case management.

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Obsessions and compulsions often focus on routine life actions such as consuming, bathing and living in public, so the disorder interferes with the social, family and occupational functioning of both the individual and their caregiver. In OCD, caregivers are often involved in the ritual behaviors of the individual, either by providing avoidance or by assisting in ritual behaviors. Individuals with OCD are often exposed to aggression from family members because of these behaviors. Research has shown that individuals with OCD may experience illness-related domestic violence. In the literature review on the subject, there were no qualitative studies examining the experiences of individuals diagnosed with OCD towards domestic violence caused by the symptoms of the disease. A mix-method study conducted by aimed to explore the illness-related domestic violence experiences of individuals diagnosed with OCD. The study utilized both quantitative and qualitative methods to gather data from individuals with OCD. The findings of the study revealed that a significant number of individuals with OCD reported experiencing domestic violence related to their illness. This study highlights the importance of addressing the issue of domestic violence in individuals with OCD and the need for appropriate interventions and support.

This study was planned to examine the experiences of individuals diagnosed with OCD regarding domestic violence caused by the symptoms of the disease in Turkey.

The sample of the study was determined by purposive sampling method. The study was conducted with individuals diagnosed with OCD who were being treated in the psychiatric clinics of two university hospitals. The study used mixed methods and was planned in two phases. In the first stage, Socio-Demographic Data Form and Yale-Brown Obsession Compulsion Scale were used. After reviewing the results of these scales, individual in-depth interviews were conducted with 20 patients who had a history of domestic violence and scored above 16 on the Yale Brown Obsessions and Compulsions Scale. Data saturation was deemed to have been reached and data collection was terminated.

The analysis of the data is still ongoing in detail by the researchers. The findings and relational implications of the study will be presented.

It is thought that the results of the study will provide a basis for further research and intervention programs and contribute to the literature by determining the types of violence experienced by individuals diagnosed with OCD from family members due to the disease, how patients feel in the face of the problems they experience and how they cope with it. In addition, the results of the study are expected to help intervention programs to be developed for families to strengthen treatment adherence.

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Alzheimer’s and Parkinson’s disease are neurodegenerative disorders with life limiting conditions. The symptomatic pharmacological therapeutic strategies unfortunately are also related to undesirable side effects. Acetylcholinesterase inhibitors administered to Alzheimer’s disease patients increase cholinergic transmission in cortex and hippocampus.

Antiparkinsonian drugs increase dopaminergic system activity, to compensate for dopaminergic neurons’ degeneration in corpus striatum, therefore supplying the imbalance of these neurotransmitters in these degenerative areas.But undesirable the increase of these neurotransmitters in other cerebral and peripheral areas brings us important side effects

To study Alzheimer’s cholinergic drugs and Parkinson’s dopaminergic drugs’ side effects

This retrospective study included 107 geriatric patients enrolled in a private long-term care institution. 79 patients with Alzheimer’s disease had mean age of 88.11 ± 5,78 years old, mean weight of 61.62 ± 13.10 kg. 28 patients with Parkinson’s disease had mean age of 84.93 ± 5.71 years old, weight mean 66.36 ± 2.83 kg.

Alzheimer’s disease patients 41.77% (33) received. Acetylcholinesterase inhibitors (Donepezil, galantamine and rivastigmine) Psychomotor agitation and aggressive behavior 63.666% and nausea (15%) were observed in the patients treated with these drugs. The association of L-DOPA and DOPA decarboxylase inhibitors (benserazide) were administered to 53%(15) of the Parkinson’s disease patients in doses between 2.0-19.0 mg/kg/day. L-DOPA associated to catechol-O-methyltransferase inhibitor (entacapone) 3 mg/kg/day were given to 7.14% (2) patients. Bromocriptine 0.04 mg/kg/day was given to 3.57% (1) patients. Mental confusion and hallucination side effects were observed in 53.33% (8) patients treated with L-DOPA associated with the DOPA decarboxylase inhibitor (benserazide).

The increase of cholinergic activity due to the acetylcholinesterase inhibitors in the Nigro- striatal pathway could be related to psychomotor agitation in Alzheimer’s disease patients in a similar way to akathisia induced by neuroleptics. The increase of dopamine levels due to the administration of L-DOPA, in corpus striatum improved Parkinson’s disease symptoms although the increase of dopaminergic activity at mesocortical pathways may be related to confusion and hallucination observed in these patients. Adjustments in dosage of these drugs could provide improvement in these patients’ daily life conditions.

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The ageing population presents complex clinical challenges, particularly in the realm of mental health among the elderly. The intersection of geriatric psychiatry and geriatrics plays a critical role in providing a holistic and comprehensive approach to addressing psychiatric issues in older adults. This abstract explores the integration of these two disciplines and their significance in elderly mental health care.

This study aims to underscore the benefits of collaboration between geriatric psychiatry and geriatrics while highlighting areas of intersection. These areas include the assessment of medical and psychiatric comorbidities, the management of neuropsychiatric disorders, and the promotion of healthy ageing, both physically and mentally.

We comprehensively reviewed the literature, encompassing research studies, case reports, clinical guidelines, and reports published in the last 10 years. The research was conducted on medical databases, including PubMed, Medline, and specialized sources in gerontology.

Effective integration between geriatric psychiatry and geriatrics provides a more comprehensive and patient-centred approach to addressing the mental health needs of the elderly. This includes enhanced assessment and treatment of a wide range of psychiatric conditions commonly found in older adults, such as cognitive disorders (including dementia and mild cognitive impairment), mood disorders (including depression and bipolar disorder), anxiety disorders, psychotic disorders, and substance use disorders. Additionally, the collaboration ensures a better understanding of the complex interplay between physical and mental health in the ageing population. The integration approach also encompasses the management of neuropsychiatric symptoms associated with various medical conditions common in older adults, such as delirium and behavioural disturbances in dementia. This coordinated care extends to the judicious use of psychotropic medications, considering the unique pharmacokinetics and pharmacodynamics in the elderly population, with a focus on minimizing adverse effects and drug-drug interactions. Furthermore, promoting emotional well-being and preventing mental illnesses emerge as critical areas of collaboration between these disciplines. Strategies for achieving this goal include psychoeducation, lifestyle interventions, and fostering a supportive environment for the elderly.

In summary, the collaboration between geriatric psychiatry and geriatrics is crucial for addressing the complex mental health needs of the elderly, providing patient-centred care, and optimizing resources. This integrated approach is essential in ensuring the well-being of older adults, emphasizing a holistic, multidisciplinary approach to mental health issues in this population.

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The elderly population is rapidly growing worldwide. Depression is an important public health concern among the elderly population in terms of its prevalence and the burdens of ill health in individual sufferers and families.

A considerable number of studies focusing on the prevalence, associated factors, and treatment of depression have been conducted in Western Europe and North America. However, this kind of research is relatively limited in Nepal.

- To find out and prevalence and its associated factors of depression among the elderly in sudur paschim province Nepal.

This community-based, cross-sectional, door-to-door survey was conducted in the two representative districts of Sudur-paschim Province, Nepal. Eligible participants were assessed for geriatric depression and quality of life. the sample size was calculated at 945.

Depression was found in 43.9% of the participants.

The association of different variables with WHOQOL-8 first question. Income was significantly associated with poor quality of life (p-value 0.04).

Furthermore, we have evaluated the association of different variables across four domains of the WHOQOL-8 scale and found statistically significant differences across age, sex, residence, occupation, income, history of smoking, history of alcohol use, comorbidities, and depression.

Depression is highly prevalent among the elderly in the Sudur-Paschim Province of Nepal. So policymakers should take this research outcome seriously and should keep the mental health of the elderly population a priority during the implementation of public health policies.

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Some studies have shown that late-life depression is related to faster cognitive decline and may increase the risk of dementia.

Identifying risk and protective factors for dementia is essential to develop preventive interventions. Some literature has suggested that mood disorders (namely depression) are potential modifiable risk factors for dementia.

Thus, it is important to know clinical presentation of depression that is associated to dementia, as a manifestation of subclinical dementia or as a risk factor for neurocognitive disorders.

We aim to identify clinical characteristics related to dementia of inpatients admitted for first time due to depressive episode after 55 years old.

Retrospective cohort study of inpatients admitted between January 1st 2010 and March 31st 2022 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0.

Our sample included 57 inpatients, 15,8% (n=9) with the diagnosis of dementia 5,2 (SD 5,6) years after admission. All of these patients presented a depressive episode with psychotic symptoms, namely delusion activity. In those with hallucinatory activity, no one developed dementia.

Interestingly, 33,3% of patients with dementia (n=3) presented with delusion of ruin, 55,6% (n=5) with delusion of prejudice/persecutory delusion and 66,7% (n=6) manifested delusion of ruin and/or prejudice.

We also found that 42,9% (n=3) of patients with dementia manifested Cotard delusion while this type of delusion was observed in 13,6% of patients without dementia (p=0,095).

Our study has several limitations because is based on results of only one hospital, with a small sample size.

However, since depressive symptoms are potentially modifiable risk factors for dementia, future studies are essential to understand the mechanisms that link depression to cognitive decline as well as clinical characteristics that may constitute predictors of dementia.

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BPSDs in patients with AD are present up to 90% and can cause serious complications in their overall health. A non-pharmacological approach and cognitive enhancers should be a priority in treatment in order to reduce the use of antipsychotics. In the pharmacological treatment of bpsd, additional therapy is inevitable in many cases

the need for adequat educatation of the medical staff in a geriatric center for the nonfarmacological approach in patients with bpsd in AD. Polypharmacy is common in farmacological treatment.

A cross-sectional study of 180 patients hospitalized at geriatric unit in period of January till May 2023 was conducted. 61(33.9%) were patients with AD, 44 or 72.1% were females and 17 or 27.9% were males, with mean age 78.6±5.6 years. 50 patients (82.0%) had potentiated BPSD in the first days of hospitalization and needed additional therapy

: 19 od 61pts (31.1%) were on dual therapy, full doses of donepezil and memantine. 17 (89.5%) needed additional therapy for BPSD; 13 (68.4%) a short-term antipsychotic and 4 (21.1%) patients antidepressant therapy. 22 patients (36.1%) were admitted with donepezil only. 18 (81,8%) needed additional therapy. The remaining 20 (32,8%) were solely on memantine. 15 (75.0%) needed additional therapy

Vast majority of patients AD (82.0%) manifested BPSD and needed additional therapy. Number of scientific papers it is found that cognitive stimulation in persons with moderate dementia has a benefit more than any pharmacological treatment. Education of caregivers of people with AD is inevitable.Opening of day care centers that will enable continuous support as well as individual access which would help delay institutionalization of people with BPSD at ADthe need

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Bipolar disorder (BD) in the elderly patient may present as the evolution of illness initiated earlier in life or as a new-onset entity. Therefore, two groups of patients are distinguished: “late onset” (LOBD) when the first mania occurs in old age and “early onset” in elderly patients with long-standing history. BD in elderly patients (≥60 years) constitutes 25% of all BD cases. Specific aspects of older age bipolar disorder (OABD) are somatic and psychiatric comorbidity, impaired cognition and age-related psychosocial functioning. The management of BD in the elderly is complex given the high sensitivity of these patients to pharmacological side effects, particularly of psychotropic drugs.

The case of a patient with LOBD is presented, followed by a theoretical review of the subject.

A case is presented with a bibliographic review.

A 76-year-old woman who had no prior history of mental health issues until March 2023 when she was initially admitted to a geriatric hospitalization unit for manifesting manic symptoms. She was readmitted in July 2023 due to worsening depressive symptoms that included a declining mood, passive thoughts of death, deterioration in self-care, weight loss, insomnia, constipation, and dry mouth despite recent changes in her medications. She was on treatment with escitalopram (which was gradually discontinued and replaced with mirtazapine), quetiapine, lormetazepam, and lorazepam. Imaging tests showed chronic ischemic lesions in her brain and a small meningioma, the rest of the test were normal.

The initial diagnostic hypothesis was a bipolar depressive episode, and her treatment was adjusted accordingly. She was started on lithium, and her quetiapine dosage was increased, along with the anxiolytic lorazepam. Due to the persistence of depressive symptoms, including low mood, anhedonia, apathy, and negative thoughts, she was also prescribed antidepressant medication (venlafaxine and mirtazapine). Her condition gradually improved, with better eating and sleep patterns, increased participation in activities, and reduced somatic complaints and anxiety.

As she continued to experience somnolence and decreased morning energy, her antipsychotic medication was switched from quetiapine to lurasidone. The dose of lithium was decreased due to tremors in her extremities, although they remained within the therapeutic range. Despite these adjustments, her mood significantly improved, and she showed no signs of worsening or psychotic symptoms, leading to her discharge.

Summarizing different studies, LOBD who develop mania for the first time at an advanced age (≥ 50 years) constitute 5-10% of all BD. It is important to perform a thorough differential diagnosis, as an organic substrate and diverse etiologies may be present. Current guidelines recommend that first-line treatment of OABD should be similar to that of BD in young patients, with careful use of psychotropic drugs.

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Impairment in mentalization, interpreting and perceiving social relevant information has been found to play a part in the development and maintenance of depression. Major depressive disorders showed significant impairment in social cognition and such impairment appears to be positively associated with the severity of depression. Self-referential gaze perception, as a measurement of mentalization, was predominantly measured in patients with psychosis but rarely examined in late-life depression (LLD).

To assess the effect of cognition on the interpretation bias of mentalization

This will be a cross-sectional case-controlled study on Chinese older adults with major depressive disorder recruited from outpatient departments of the public mental health service in Hong Kong. The same inclusion and exclusion criteria, with the exception of the history of major depressive disorder, will be used to recruit the control group. Assessments included sociodemographics, cognitive assessments and depressive symptoms. The primary experimental task was Gaze Perception Task using E- prime Professional 2.0. The stimuli of task are photographs of six Chinese models (3 men and 3 women) facing straight to camera with 13 different gaze directions (0°, 5°, 10°, 15°, 20°, 25° and 30° to the left and to the right, respectively). Participants shall be instructed to respond with a “yes” or a “no” to the question (for self-referential gaze): ‘Do you feel as if the person in the picture is looking at you?’.

41 patients and 41 healthy controls have been recruited. The group comparison in SRGP revealed that there was only significant difference in the unambiguous-SRGP (U=561.000, Z=-2.62, N=82, p=0.009). Patients had higher unambiguous self-referential gaze accuracy (Mean=0.16) than controls (Mean= 0.075). With a cut-off score of 22, patients with better HK-MoCA scores had better unambiguous SRGP scores than those with lower HK-MoCA scores (p=0.024). This difference was not observed in healthy controls. HK-MoCA could predict ambiguous SRGP rate F(1,80)=14.85, p<.001, R square=15.7%. and redict unambiguous SRGP rate F(1,80)=14.85, p<.001, R square=15.7%.

LLD subjects had a significant interpretation bias in the unambitious averted gaze (20°, 25° and 30°) interpretation compared with healthy controls. LLD subjects tend to have more self-referential perception of the clear averted gaze. This misinterpretation of the eye gaze is probably due to the interpretation bias in processing external information, which is commonly reported as mentalization impairment in depression (Weightman et al., 2014).

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The population ageing is a reality associated with an increase in prevalence of Dementia. The use of benzodiazepines is often postulated as a risk factor in these syndromes.

Contrary to recommendations for its short-time use, long-term and chronic use are common, with an estimated 8,7% of elderly people in the US taking benzodiazepines.

To clarify the most recent evidence on the use of benzodiazepines and the risk of developing dementia.

Non-systematic review of literature, using PubMed as database and filtering the results for meta-analysis.

Four articles were included in this review.

Zhong G et al. concluded that risk of dementia increased in consumers of benzodiazepines and it was associated with higher doses.

In turn, AlDawasari A et al., when trying to clarify the use of different sedative-hypnotic drugs, found and increased risk with the consumption of benzodiazepines. After exclusion of articles with confounders and adjustment for protopathic bias, the risk was not maintained.

Lucchetta RC et al. concluded that the risk exists but without inferring differences between doses or duration of action.

Finally, Penninkilampi R e Eslick GD investigated this association, after controlling for the protopathic bias, concluding, contrary to AlDawasari et al., that the association benzodiazepines consumption and dementia do not result from this bias.

We cannot draw robust and concrete conclusions between benzodiazepines consumption and the pathogenesis of dementia because not only is the literature limited, but results are also heterogeneous.

However, these prescriptions must be carried out cautiously, especially in the elderly, due to the known adverse effects associated with them.

None Declared

Dementia is a common diagnosis in service users seen by Psychiatry of Old Age (POA) Services. This clinical audit was conducted prior to the services engagement with a focus group, which aimed to explore the implementation of the “Appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia” (National Clinical Guideline No. 21) and identify additional resource requirements to be submitted for consideration by the HSE’s estimate process for 2023.

Its aims were to evaluate:

• • The prevalence of service users with a dementia diagnosis among those seen by the POA Service, from January 2018-June 2022

• • The prevalence of co-morbid psychiatric diagnoses among those with a dementia diagnosis.

• • The resources needed to manage currently active cases with a diagnosis of dementia, by evaluating MDT member involvement.

Data is routinely collected on service users treated by the POA service for service evaluation, including service users’ diagnoses, and current MDT member involvement. All service users seen by the POA service between Jan 2018 – June 2022 were included. The total number of service users, and service users with dementia and mild Cognitive impairment were counted, in order to evaluate the prevalence of dementia. We then evaluated the proportion of those with dementia who had co-morbid psychiatric diagnoses. We then looked at currently active cases with dementia, and evaluated how many MDT members were involved in their ongoing care.

392 service users were treated by the service from Jan 2018-June 2022. Of these 104 cases were still active with the service. 152 (39%) of these service users had a diagnosis of dementia. Of those with dementia, 45% (68, n=152) also had another psychiatric co-morbidity. Psychosis was the most common psychiatric co-morbidity, seen in 22% of those with dementia (33, n=152). 12% of active service users with a dementia diagnosis were only seen in outpatients clinics only, 60% were seeing one MDT member, 28% were seeing multiple MDT members (n=25).

Dementia was the most common diagnosis among service users seen by the POA service. 45% of service users with dementia being seen by the POA service also had another psychiatric co-morbidity. Such patients require significant MDT input.

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Deprivation is widely known in children and adolescents and means a lack of social, emotional, or sensory stimuli, due to disabilities such as deafness, but also social isolation and reduced parental care. It may cause developmental disorders such as impaired language, motoric and social development. Little is known of the impact of social deprivation in demented patients.Stimulus shielding, which is a widespread option for psychiatric symptoms of dementia such as agitation, vocalization and aggressive behavior may – if frequently used- have similar effects on demented patients.

We report the case of a 71-year-old patient with dementia caused by PSP (Progressive Supranuclear Palsy), who was in inpatient treatment due to continuous undirected vocalizations. She presented with inability to walk, dysarthria, aphasia, and hearing difficulties beside major mnestic impairment. In a prior hospitalization and in her residency, she was frequently isolated from other patients due to loud screaming and vocalizations in terms of stimulus shielding by suspected overstimulation. In order to that, for four months, she developed progressive difficulties to speak, hear, understand, as well as gait disorders. In addition, the vocalizations increased.

We rated the symptoms due to deprivation, triggered by lack of mobilization, social experiences, visual, tactile and acoustic stimuli following a vicious circle of anxiety, vocalizations and recurrent isolations. Therefore, a multimodal therapy assessment was implemented, including daily physical therapy, mobilization, basal stimulation, social reintegration and basal conversation training.

After a few days of high intensity treatment, speech reappeared in form of one- word sentences and proceeded to the ability to have short conversations. Mobility increased, starting from severe gait disorder, including the use of a wheelchair and emerged to the ability of walking up to 50 metres. Additionally, the undirected vocalizations improved and were reduced. In addition, hearing ability improved during the four-week treatment.

This case highlights the impact of deprivation in demented patients. Especially it shows that these symptoms can be reversible under a high intensity multimodal and multi- professional treatment within a few weeks. Therefore, stimulus shielding, should be carefully evaluated in order to prevent deprivation – and thus deterioration of the symptoms – in demented patients.

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Behavioral and psychological symptoms (BPS) of Alzheimer’s disease, known as neuropsychiatric symptoms, involve a range of symptoms that include agitation, psychosis (hallucinations, delusions), affective symptoms (depression and anxiety), apathy, and sleep disturbances. These behavioral and psychological symptoms harm the patients’ daily lives and significantly burden their families. Managing BPS of Alzheimer’s disease requires a targeted approach focused on each symptom to achieve a better therapeutic response.

Providing practice pharmacological recommendations targeted to each of the behavioral and psychological symptoms of Alzheimer’s disease.

A literature review was conducted using Medline via PubMed, Embase, PsycINFO, and Cochrane databases until September 2023.

There is a consensus in the literature that non-pharmacological approaches should be recommended as the first-line treatment for most behavioral and psychological symptoms of Alzheimer’s.

Second-generation antipsychotics (risperidone and olanzapine, with improved efficacy; aripiprazole and quetiapine, with better tolerance) are recommended for severe agitation states with a risk of self or hetero-aggression, as well as for persistent psychotic symptoms in Alzheimer’s disease. The benefit-risk balance of these agents must be assessed, with close monitoring of heart arrhythmias, metabolic risk, orthostatic hypotension, and extrapyramidal symptoms. The recommendations suggest tapering antipsychotics within the first three months of their prescription. Selective serotonin reuptake inhibitors (SSRIs) such as Escitalopram, Citalopram, and Sertraline can be considered a therapeutic option for persistent affective symptoms (depression and anxiety) with significant functional impairment or suicidal risk, severe apathy, or constant agitation. Minimum effective doses are recommended for Escitalopram and Citalopram due to the risk of QT interval prolongation. There is limited evidence regarding the effectiveness of benzodiazepines, mood stabilizers, cholinesterase inhibitors, and memantine for various behavioral and psychological symptoms; the benefit-risk ratio and therapeutic response do not support the prescription of these agents. Melatonin and Mirtazapine have limited benefits for sleep disturbances, while benzodiazepines, antihistamines, and antipsychotics should be avoided.

The pharmacological approach should target a thorough clinical assessment of the psychopathological dimensions of behavioral and psychological symptoms of Alzheimer’s disease. The prescription should be based on evaluating the benefit-risk balance and adherence to literature recommendations for patient safety.

None Declared

There are numerous organic causes that can be related to affective symptoms such as neurological, metabolic, infectious and pharmacological. Neurological conditions associated to affective symptoms include vascular lesions, tumors, infections, seizures and dementia. Within cognitive impairment conditions, depressive symptoms are more frequent in vascular dementia and Alzheimer disease, and behavioral or manic symptoms in frontotemporal dementia although we cannot rule out less common associations.

To review about organic mania due to dementia

We carry out a literature review about organic mania accompanied by a clinical description of one patient with manic symptoms and cognitive impairment.

A 80-year-old male was admitted to the short-term hospitalization unit from the emergency department due to maniform symptoms. He had believed for weeks that he was millionaire and capable to cure all the diseases in the world, reason for which he had given away many of his belongings and had tried to register the patent for his invent. He also had future plans to invest all the money he earned from the patent in the construction of roads in Latin America. He had not previous history of mental illness. Neurological study concluded a diagnosis of Alzheimer disease. It was treated as a manic episode with a mood stabilizer and antipsychotic, with partial resolution of the condition.

It is common to find depressive symptoms in cognitive disorders. Although manic symptoms are much more frequent in frontotemporal dementia or other organic disorders, we can also find them in patients with Alzheimer disease. Since there is no specific curative treatment for this disease, concomitant psychopharmacological treatment is recommended if manic symptoms appear.

None Declared

Dementia can present with psychiatric symptoms even before the cognitive impairment, which makes difficult to establish an adequate diagnosis. There have described symptoms of this type in vascular dementia, frontotemporal dementia, Alzheimer disease and Lewy bodies dementia. Frontotemporal dementia has a prevalence of 9-20% and it`s the third in frequency among degenerative dementia. It appears before the age of 65 years old and is more common in men. Two variants have been described, linguistic and behavioral. The behavioral one has usually an initial psychiatric presentation, with behavioral disorders, disinhibition and personality changes. Therefore it`s important to make an adequate differential diagnosis with late onset bipolar disorder.

To review about frontotemporal dementia and its differential diagnosis with late onset bipolar disorder.

We carry out a literature review about frontotemporal dementia and its differential diagnosis with late onset bipolar disorder, accompanied by a clinical description of one patient with behavioral disturbance and language disorder.

A 59-year-old female was admitted to the short-term hospitalization unit from the emergency department due to behavior disorder. She had no relevant personal or familiar psychiatric history up to two years before when she received diagnosis of bipolar disorder. She presented behavioral disorganization, psychomotor restlessness, verbal aggressiveness, verbiage, insomnia and decreased intake. Psychopathological examination became difficult due to her language disorder since she presented an incoherent speech with paraphasias and loss of the common thread. Neurological study guided diagnosis to frontotemporal dementia even though they left the psychopharmacological treatment to our discretion. Olanzapine 5 mg twice a day was initiated, and behavioral improvement was observed. However, the patient maintained a significant functional impairment.

Psychiatric presentation is frequent in dementia, even before cognitive failures which makes essential an exhaustive differential diagnosis. It`s important to consider the diagnosis of frontotemporal dementia in those patients who debut with behavioral disturbance in the 50s. Psychopharmacological treatment is only symptomatic so functional recovery should not be expected.

None Declared

Affective disorders are associated with cognitive deterioration, manifested by an increased risk of developing dementia. Late-onset bipolar disorder (BD) establishes a dynamic interaction between dementia and BD, considering its particular manifestations in old age.

Provide a comprehensive overview of the clinical and epidemiological attributes specific to late-onset BD, elucidating its interplay with dementia.

We conducted a literature search on PubMed in August 2023, using the following terms: late-onset bipolar disorder AND dementia. Only systematic reviews and meta-analysis were included with no year or language restrictions. Three articles were eligible for this review: two systematic reviews and one meta-analysis.

Late-onset BD can be defined as a secondary condition and may result from an expression of lower vulnerability to BD, when compared to early-onset BD. On the other hand, late-onset BD may be conceptualized as a subtype of pseudodementia, or even considered a risk factor for dementia. In fact, this particular association with dementia supports the existence of a specific class of BD, i.e. BD type VI. Such diagnostic overlap might be explained by common factors that have been associated with both BD and dementia, such as cardiovascular risk factors, systemic inflammation, stress and levels of baseline cognitive reserve. Despite the commonalities, other aspects, such as family history and prior history of a mood disorder, may help to make the differential diagnosis between late-onset BD and dementia.

There is a diagnostic challenge between dementia and the neurocognitive decline associated with BD, particularly in the case of a late-onset BD. Although the available evidence is limited, current evidence demonstrates that BD can indeed be seen as a risk factor for dementia. Therefore, cognitive impairment in individuals with BD should not be overlooked.

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Adverse effects (AEs) of psychotropic drugs are more frequent and potentially more dangerous in elderly subjects (ES), probably due to a greater frequency of somatic comorbidities, as well as polymedication.

The aims of this study were to determine the prevalence of AEs of psychotropic treatment among ES hospitalized in psychiatry, and to identify the associated sociodemographic and clinical factors.

We conducted a retrospective and descriptive study. It concerned male patients aged at least 60 years, hospitalized in the psychiatry B department at CHU Hedi Chaker (Sfax, Tunisia) between 2018 and 2022. We collected demographic and clinical data from their medical records using a pre-established form.

We included 30 patients. The average age was 64 years. Addictive behaviors were reported in 60%, and somatic histories were noted in 53.3% of patients. The three most frequent psychiatric diagnoses were schizophrenia (43.3%), bipolar disorder (33.3%) and depressive disorder (13.3%). Among our patients, 10% experienced adverse psychotropic drug reactions: orthostatic hypotension 6.7%; neurological AEs 3.3%. Univariate analysis showed no significant relationship between sociodemographic variables and psychotropic drug AEs. Patients with bipolar disorder were more likely to develop AEs of psychotropic treatment (p=0.04).

Our results suggest that special attention should be paid to avoiding psychotropic medication AEs in psychiatric inpatients ES. Indeed, extra precautions need to be taken in this population due to their reduced ability to report their symptoms.

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Dementia is a syndrome of high prevalence and health impact. The Montreal Cognitive Assessment (MoCA) questionnaire is a screening tool whose use has increased in recent years, especially in cases of mild cognitive impairment. Some studies suggest that its ability to detect cognitive impairment, especially in early or mild stages, seems to be greater than gold-standard instruments (Ciesielska et al., 2016).

We have performed a meta-analysis of reliability generalization to see if different adaptations and use in different contexts show consistent results.

We performed a literature search in PyscINFO and Medline with the terms “Cognitive impairment” AND “internal consistency” AND “Cronbach”, using the following inclusion criteria:

1. 1. Be a study in which the MoCA scale was applied to a population sample.

2. 2. Studies published in the last 10 years.

3. 3. Studies that provide the reliability coefficient or sufficient data to calculate them.

4. 4. Be written in English or Spanish.

We have limited our study to the last 10 years and the English language has given us a total of 19 results in Medline and 132 results in PsycINFO. Subsequently, we completed this search by snowball sampling.

A random effects model was assumed for the statistical calculations and the transformation of our values using the Hakstian and Whalen (1976) proposal. Statistical analysis was performed with the MAJOR package of the Janovi program, based on the R environment.

We obtained a mean reliability for the transformed test scores of 0.42 (95% CI: 0.38 - 0.45), as well as high heterogeneity measured by Cochran’s Q statistic and the I2 index, which is attributed after analysis of moderating variables to the geographical adaptation of the questionnaire and the type of patient on whom it is applied. Our Funnel Plot graph indicates that we do not appear to have committed a publication bias.

Our meta-analysis shows high heterogeneity, mainly explained by the population of origin, both geographically (continent) and clinically (presence of primary cognitive impairment or not), with special incidence in those with impairment secondary to other pathologies, mainly neurological. However, we should consider the high probability that we have not included important variables in our analysis that could increase the explanatory power of our model.

None Declared