Mirtazapine, a commonly used antidepressant, has a relatively safe side effect profile and is commonly used in the elderly for treatment of depression. It has been proposed as being particularly suitable for patients with depression associated with insomnia and weight loss. Although mental status changes and perceptual abnormalities secondary to its use are rare, special care needs to be taken, especially while starting treatment or while increasing the dose. We report three cases of auditory, musical and visual hallucinations associated with the use of mirtazapine.

Alzheimer's disease (AD) is the major form of age-related dementia worldwide, accounting for more than two-thirds of all dementia cases. The disease is characterized by a progressive loss of cognitive and intellectual functioning (Gilman, 1997). A number of risk factors for AD have been identified. The prevalence of AD increases with age, diabetes, depression, family history of Parkinson's disease and following head injury or exposure to solvents (Jorm et al., 1991; van Duijn et al., 1991; Ott et al., 1995; Yoshitake et al., 1995; Devanand et al., 1996). Published research further suggests that low education levels are associated with increased prevalence of clinical AD (Gatz et al., 2001; Qiu et al., 2001; Ravaglia et al., 2002). Women also have a higher risk for developing the disease than men, with the risk being markedly increased following menopause (Sherwin, 2002; Sherwin 2003). Additionally, slightly more severe cognitive deficits have been reported in AD in women compared to men (Buckwalter et al., 1993, Henderson and Buckwalter, 1994). These epidemiological trends may be a consequence of reproductive hormonal changes. Specifically, menopause results in a marked diminution in gonadal estrogen production in women (see Sherwin, 2003, for a review). Estrogen plays a pivotal role in the maintenance and function of neuronal circuits in the brain and in resistance to neuronal damage (McEwen, 2001). The neuroprotective properties of estrogen are thought to be mediated at least in part by anti-amyloidogenic, anti-oxidative and ant-inflammatory mechanisms (reviewed in Barron et al., 2006a). However, limited and somewhat mixed data exist regarding the association between endogenous levels of estrogen and cognitive decline (Manly et al., 2000; Schupf et al., 2003). Based on some of our own findings, we here consider the factors that may be useful in predicting memory decline as a risk factor for Alzheimer's disease in older post-menopausal women.

Older adult psychiatric inpatients may have impaired balance and have an increased risk of falling for many reasons (Pellfolk et al., 2009; Ko et al., 2009). This population may be on psychotropic medication, which is in itself an independent risk factor for falls (Stubbs et al., 2009). This is a group that may also be at elevated risk of osteoporosis and osteopenia; should they fall, they are more susceptible to osteoporotic fractures which are associated with high morbidity and mortality (Stubbs et al., 2009). To counteract this risk, older adult psychiatric services should seek to adopt the strategies identified as being “gold standard” in general older adult rehabilitation settings, such as a multifactorial falls intervention program (Gillespie et al., 2009). This would typically include a review of medication; environmental falls risk assessments, the provision of walking aids and strength and balance training (Gillespie et al., 2009).

Modernization is a social and economic process consisting of three interrelated processes of industrialization, urbanization and secularization. The process of industrialization may provide greater economic opportunities in urban areas and facilitate migration of people from rural to urban areas. This process of urbanization may lead to a weakening of ties with family, friends, local religious institutions and original place of residence. Difficulties in adjusting to the new urban environment may increase the risk of suicide and see a rise in suicide rates (Stack, 2000).

It is believed that a better understanding of the methods used by older people for suicide may lead to the development of targeted preventative strategies, which are expected to meet the challenge of sustaining this observed decline in suicide rates among older people over time in England and Wales (Lindesay, 1991; Dennis and Lindesay, 1995).

There is little literature on older adults with borderline personality disorder during neuropsychological assessment. Here we report on a 59-year-old woman with borderline personality disorder who referred herself for assessment because she feared the onset of dementia. Results showed an above average level of intelligence, with scores on memory tests that ranged from well below to well above average in a pattern that was not consistent with a dementia or with common forms of neurologically based memory impairments. A test of memory malingering was within normal limits. Results are discussed in terms of somatization within this personality disorder.

I respect and like Dan Blazer more than (or at least as much as) any other psychiatrist I've met. He is a world expert on late life depression and a pre-eminent researcher and teacher – but that is why statements made by him in a recent guest editorial in this journal (Blazer, 2010) must not be left unchallenged.

A curvilinear (U-shaped) relationship between population growth rates and elderly suicide rates fitting the quadratic equation y = a + bx + cx2 (where y is the elderly suicide rate, x is the population growth rate and a, b and c are constants) has been reported (Shah, 2009a). A theoretical model with three sequential stages incorporating population growth, elderly population size, the proportion of elderly in the general population, life expectancy and birth rates has been proposed to explain the findings (Shah, 2009a).

Electroconvulsive therapy (ECT) has been reported to have efficacy in the treatment of depressive illness, mania and catatonia (U.K. ECT Review Group, 2003; National Institute for Clinical Excellence, 2003; Scott, 2004). The Royal College of Psychiatrists in the U.K. continues to support the use of ECT within the framework of its guidance on the use of ECT (Scott, 2004) and has developed an ECT accreditation service for clincal services that use ECT. In May 2003, the National Institute of Clinical Excellence (NICE) issued a technical appraisal on the use of ECT in England (NICE, 2003). This is essentially guidance on the use of ECT which clinicians are required to follow in their clinical practice.

A recent cross-national study demonstrated that the relationship between elderly suicide rates and educational attainment is curvilinear (U-shaped curve) (Shah and Chatterjee, 2008). That study used only one-year data on suicide rates for the latest available year. These findings may have been spurious as suicide rates can randomly fluctuate year on year (Shah and Coupe, 2009). Therefore, this curvilinear relationship was examined using a one-year average of five-year data on elderly suicide rates to establish the accuracy of the earlier findings.