Several studies have asserted the existence of a strong and complex genetic component

in the determination of psychotic disorders. However, the genetic architecture of these disorders remains poorly understood. GWAS studies conducted over the past decade lead to the identification of only a few low effect associations, and the major part of this heritability remains unexplained, thus calling questioning the hypothesis of «common disease - common variants » for a model involving a large number of rare variants.

Here, we studied a multigenerational multiplex family in which co-exist psychotic and mental retardation disorders and a high rate of consanguinity, located in the northwest of Algeria. This study aims to identify inherited rare variants of schizophrenia and mental retardation.

This family have received complete clinical (DIGS, DSM-IV creteria) and genealogical investigations and whole exomique sequencing WES (by GAIIx Illumina / HiSeq 2000) that were performed in the departement of genetics in the university hospital of Geneva.

07 individus (02 parents and 05 siblings) has been analyzed. The parents were healthy. In siblings, 02 individus had schizophrenia diagnosis, 01 individu had mental retrdation, 01 had both schizophrenia and mental retardation diagnosis and 01 was healthy. Recessive model was retained in this family. For schizophrenia, WES have identified new rare mutations in known genes: rs17057255 (EPHX2), MAF=3%, rs35337118 (SPZ1), MAF=10%, rs2259633 (CCDC67), MAF=17%.

In total, these highly informative family have identified new genetic variants of schizophrenia. The search for these mutations in contol population in north west of algeria and a wider population of affected individuals with schizophrenia would be useful to validate these data.

Chromosome 22 microdeletion correlates with different phenotypes. Prevalence is estimated between 1/2000-1/4000 newborns. Deletion arise di novo in almost 90% of the cases and the pattern of transmission is autosomal dominant. The most frequently described features are: orofacial abnormalities, heart defects, inmunological alterations, intelectual disabilities, attention deficit and psychiatric problems.

The prognosis is variable. The mortality rate is relatively low in infants (around 4%), however in adults it is higher than the rest of adult population.

To show, through the follow-up of a case report, the diagnostic difficulties when mental disorder and intellectual disability coexist.

Case report of a patient followed up in an ambulatory mental health clinic after discharge of an acute psychiatric unit.

An accurate diagnosis of primary mental disorders in a person with intellectual disability requires knowledge of the degree of intellectual disability, as well as knowledge of his verbal and communicative skills and comorbid medical diseases.

A combination of multiple dysmorphic features, anatomical abnormalities (primarily cardiac and gastrointestinal), stunting, endocrine problems and intellectual disability suggest chromosomal abnormalities.

Behavioral phenotypes are cognition and behavior patterns that are more likely to appear in a specific disease. They give us clues about the complex nature of interactions between genes and behavior.

Mental patients are at more risk of being under polypharmacy in compare to other medical disorders. Elderly patients are more at risk of using polypharmacy.

This research was designed to observe the benefits of replacing polypharmacy with a single medication in elderly patients with chronic schizophrenia.

Antipsychotic polypharmacy in elderly results in higher rate of interactions, side effects and cost. Polypharmacy would escalate medical risks which ends to decrease patients' quality of life.

A survey was performed at the long stay public and academic Tehran Razi Mental Hospital. From the initial 157 conveniently access patients, 59 cases were selected based on inclusion and exclusion criteria. Before intervention, 7 patients did not participate in the study due to their newly occurred medical conditions. 52 cases entered and completed the 36 weeks of research time period. Systematically, the patients' multiple antipsychotics were switched to a single medication, Risperidone. Their clinical assessments applied weekly for 36 weeks. Evaluations achieved by using validated and reliable tools of Brief Psychotic Rating Scale (BPRS), Global Assessment of Functions (GAF) and Extra-Pyramidal Syndrome (EPS) tools.

Wilcoxon signed ranks test and Friedman test revealed a significant difference in post intervention for positive, negative and general schizophrenic symptoms. Functional improvements and lower incidence of EPS, showed a significant difference statistically.

Risperidone may be safety used instead of other multiple antipsychotics in elderly patients with typical chronic schizophrenia. This replacement possibly will result in more clinical benefits, obvious cost reduction and less side effects.

A focus in a balanced time perception is linked to higher levels of life satisfaction in senior years.

To investigate latent constructs that can act as major determinants in age representation (AR) and subjective age (SA) and to explore associations between AR and SA, in an older adults’ cross-national population.

Measures were completed using a variety of culturally appropriate methods, including demographics and interviews. All variables had less than 1% missing values and complete information on 231 older adults aged between 74-102 years (M=83.1; SD = 6.692) from four different nationalities, was available. The data was subjected to content analysis. Representation of the associations and latent constructs were analyzed by a Multiple Correspondence Analysis (MCA). Standardized instruments measured regular cognitive abilities.

Findings showed a model for each pre-category. A three-dimension model formed by ‘past-oriented’, ‘present-oriented’ and ‘future-oriented’ was indicated as a best-fit solution for AR. SA was explained by a two-factor model: ‘age-cautious’ and ‘young-at-heart’. AR is shown to bear associations with individuals’ SA, in a model composed by ‘enjoyers’, ‘engaged’ and ‘conciliated’.

AR and SA are strongly explained by underlying constructs provided by the participants. AR is related to SA in older adults. Enhancing AR on shared perceptions of SA might be an important target to improve older adults’ interventions’ outcomes and aging well.

Older adults experience varying challenges that occur from late adulthood to extreme old age.

This study aims at exploring the indicators of adjustment to aging (AtA) reported by old and oldest old adults and at examining the potential explanatory mechanisms of a model for AtA for these two age groups.

This qualitative study comprised demographics and semi-structured interviews. Complete information on 152 older adults aged between 76-102 years (M=83.76; SD = 6.458) Data was subjected to content analysis. The correlational structure and latent constructs of indicators of AtA were analyzed by a Multiple Correspondence Analysis (MCA).

‘Occupation and achievement’ was the most mentioned indicator of AtA by the old participants (17.7%), whilst, ‘existential meaning and spirituality’ was the most verbalized indicator of AtA for the oldest old participants (16.9%). AtA was explained by a three-factor model for each age group. For the old participants, the largest factor ‘occupational and social focus’ accounted for 33.6% of total variance, whereas for the oldest old participants, ‘spirituality and health focus’ represented 33.5% of total variance.

The outcomes presented in this paper stressed the varied perspectives concerning AtA, contoured in two different models, for the old and the oldest old, and the need of considering these when designing and implementing programs in health care for these two age groups.

Diverse factors may predict the adjustment to aging (AtA) of the younger-old and oldest-old adults’

To build a structural model for exploring whether socio-demographic, health and lifestyle-related variables are predictors of AtA for both groups.

Research encompassed a community-dwelling sample, of 447 older adults aged 75 years and above (M = 86.27; SD = 6.78; range 75-100). Measures included demographics (sex, marital status, education, household, adult children, family‘s annual income, and self-reported spirituality), lifestyle and health-related characteristics (perceived health, recent disease, physical activity and leisure), and the Adjustment to Aging Scale. Structural equation modeling was used to investigate a structural model of the self-reported AtA, encompassing all the above variables.

Significant predictors for the younger-old are perceived health (β= .425; p< .001), leisure (β = .324; p< .001), professional status (β = .243; p< .001). Significant predictors for the oldest-old are self-reported spirituality (β = .816; p< .001), perceived health (β = .232; p< .001), and income (β = .233; p= .035). The variables explained respectively 64.5% and 61.6% of the variability of AtA, respectively.

Perceived health is the strongest predictor of AtA for the younger-old participants whilst self-reported spirituality is the strongest predictor of AtA for the oldest-old adults.

The aging of the world population implies challenges in the area of early diagnosis in geriatric psychiatry as well as in general medical practice. Researchers found that the screening tool developed by Saint Louis University detects early cognitive problems, specifically mild cognitive impairments (MCI), missed by other screening tools.

To compare the Polish version of SLUMS as a screening instrument with other screening tests mostly used in Poland such as: MMSE or STMS.

The cross-sectional descriptive study was conducted. The total sample included 58 nursing home residents with the mean age of 81.74 (± 8.6). According to CDR 32.8% (n=19) of participants fulfill the criteria of dementia, 27.6% (n=16) of MCI and 39.7% (n=23) were considered as healthy.

The internal consistencies (Crohnbach's a) of the SLUMS test was 0.7031. The average of total SLUMS score were 23.3 in healthy participants, 19.3 in MCI and 13.1 in demented residents. The statistical analysis illustrated that SLUMS differentiate the dementia residents from those considered as MCI (p=0.01), as well as from healthy participant (p=0.0001). Furthermore, it is also useful in conducting the differential diagnosis between MCI and healthy participants (p=0.017), where MMSE does not offer such a possibility (MCI vs healthy, p=0.51)

It seems that the SLUMS is not just another screening tool that can complement the range of existing cognitive tests in Polish clinical practice. Preliminary statistical analysis demonstrated its superior capabilities in the screening diagnosis compared to most famous test in Poland, MMSE.

Clinical guidelines indicate that treatment with haloperidol, the most widely used antipsychotic drug, may be associated with increased cardiovascular mortality in patients with dementia.

To determine the cause of unexpected death in patients with dementia treated with haloperidol.

From January 1, 1989 through December 31, 2013, 1,219 patients with a primary diagnosis of dementia with behavioral disturbance were admitted to a 120-bed, free standing, psychiatric hospital. Sixty-five patients (5.3%) died unexpectedly. Complete post-mortem examinations after the unexpected death were performed in 55 patients, of whom 27 were treated with haloperidol, while the other received no antipsychotic drugs.

The leading causes of death were myocardial infarction (25.5% of patients), pneumonia (23.6%) and stroke (10.9%). Other causes of death were myocarditis (3.6%), airway obstruction (1.8%) and upper gastrointestinal bleeding (1.8%). The cause of death could not be established at autopsy in 18 (32.7%) patients, of whom 16 had significant myocardial fibrosis and 2 had metastatic malignancies. Compared with patients not treated with antipsychotics, the group receiving haloperidol comprised more patients who were 80 years of age or older (p=0.010) and/or had psychotic features (p=0.0095). The cardiovascular causes of death (i.e., myocardial infarction, stroke and myocarditis) was more common in the group not treated with haloperidol (p=0.034). All of the other autopsy findings were similar in the two groups.

Based on autopsy findings, treatment with haloperidol for dementia does not appear to be associated with increased risk of unexpected, lethal cardiovascular events.

Mild cognitive impairment is the pathological case in which the individual is between dementia and healthy. Therefore, especially in the protection, it is necessary to maintain and protect the cognitive functions. The physical activities exercised by the old people are crucial in increasing the cognitive functions or in maintenance of the present condition.

The aim is to analyse the effects of the physical activities on the cognitive functions of the old people with mild cognitive impairment.

The research was organized within the order of pretest-posttest design as experimental type using control groups. For the experiment,25 old people with mild cognitive impairment who were convenient for physical activities were selected with regard to the doctors’ advice. For the control group, a group of old people with mild cognitive impairment was listed. For the old people in the experimental group, a physical activity programme was applied including 30min. walk and 30min. regular exercise three days in a week which had continued for four weeks. Standardized Mini Mental Test Examination(SMMTE) was applied on the old people both before and after the activity.

The average SMMTE point of the old people in the experimental group before the activity(20.6±2.4) increased considerably after the activity(24.3±3.6) and the difference is significant statistically(p<0.05). When the SMMTE points of the experimental and control group was compared after the activity, it was found out that the experimental group has higher points compared to the experimental group and the difference is significant(p<0.05).

Regular and a three-day week physical activity program improved the cognitive functions of the old people with mild cognitive impairment.

The older population has been growing at an unprecedented rate. The First World Assembly on Ageing estimated that there were 378 million people in the world at aged of 60 years or above. That figure has risen to 759 million over the past three decades and is projected to jump to two billion by 2050.

the purpose of this study was to investigate the psychological and social wellbeing of older persons in Jordan. The main objectives were: To describe the psychological and social wellbeing of older population in Jordan, and to investigate relationship between physical, psychological and social wellbeing of older population in Jordan.

A cross-sectional explorative design used to recruit 1270 Jordanian persons at age 60 years or above. Information collected in regards to depression, psychological; distress, coping, life satisfaction sleep disturbances, social support, and somatic symptoms.

in process.

Studies have shown the Clock Drawing Test (CDT) to be useful as a screening test between normal, elderly populations and those diagnosed with dementia. However, the results of studies which have looked at the utility of the CDT to help differentiate Alzheimer's dementia

(AD) and other dementias have been conflicting. The purpose of this study was to explore the utility of the CDT in discriminating between patients with AD and other dementias.

A review was conducted using MEDLINE, PsycINFO and Embase. Search terms included clock drawing or CLOX and dementia or Parkinson's Disease or Alzheimer's Disease or Dementia with Lewy Bodies (DLB) or Vascular Dementia (VaD) or Semantic Dementia.

20 studies were selected. In most of the studies included, no significant differences were found in CDT scores between AD and VaD, DLB, and Parkinson's disease dementia (PDD) patients. Frontotemporal dementia (FTD) patients consistently scored higher in the CDT than AD patients. Qualitative analyses of the type of errors seem to suggest a difference between AD and the other types of dementias.

Overall, the CDT score may be useful in distinguishing between AD and FTD patients, but shows limited value in differentiating between AD and VaD, DLB and PDD. Qualitative analysis of the type of CDT errors may be a useful adjunct in the differential diagnosis of the types of dementias.

Three controlled trials with similar study design [Graessel et al. (2011) BMC Medicine 9:129; Pickel et al. (2011) Psychiatrische Praxis 38:389-396; Stemmer et al., in preparation] on non-pharmacological therapies for people with degenerative dementia were recently carried out.

• - Capacities to perform activities of daily living can be stabilised at baseline level for at least 12 months (Cohen’s d = 0.69 for people with mild to moderate dementia) – both by means of unimodal interventions (occupational therapy) or multimodal group therapy (MAKS: motor stimulation, practice in activities of daily living and cognitive stimulation). We therefore suggest that these therapies be called 'Ressource Maintaining Therapies”.

• - A specific form of cognitive stimulation is required to maintain cognitive performance. If it is 'applied” almost daily the effect can be achieved. Further research is needed to establish exactly where the effectiveness threshold is.

• - The effect of the therapy shows a trend towards sustainability for the capacity to perform activities of daily living, but less so for cognitive abilities.

• - Multimodal treatment is definitely superior to unimodal treatment. This is evidenced by the fact that in persons with dementia the behavioural component only shows a clear improve-ment following multimodal treatment. This is not observed following unimodal interventions.

The intervention should begin early in the clinical course of degenerative dementia in order to be able to sustain the person’s abilities at as high a level as possible for as long as possible. This is a chance for the future!

Catatonia is a neuropsychiatric syndrome described in a variety of medical and psychiatric conditions. Its association with frontotemporal dementia (FTD) has been sparsely described.

We reported two patients with FTD that present a catatonic state.

Case reports

Literature review through Pubmed and report of a clinical cases.

Case 1: Frontotemporal dementia, behavioral variant.

65 year old female who was hospitalized after losing weight due to his active refusal to eat and subsequently was undergone a gastrostomy. Once stabilized physically was derived to psychogeriatric ward where the patient was stuporous, mute, with mannerisms and rigidity. Continued with refusal to take food. On examination she had staring, posturing, echophenomena, automatic obedience, Gegenhalten, ambitendency and perseveration. It featured 12 of 23 symptoms of Bush and Francis Catatonia Rating Scale (BFCRS), scoring 32. She improved completely her catatonic state within one week with lorazepam 2.5 mg /day and zolpidem 10mg/day. Perseverative behavior and mannerisms was maintained.

Case 2: Frontotemporal dementia, primary progressive aphasia

67 years old male who was admitted to psychogeriatric ward because had aggressivity and negativism. On examination immobility, mutism, staring, echolalia, rigidity, negativism, withdrawal, perseveration, Gegenhalten, impulsiveness and combativeness were observed. It featured 11 of 23 symptoms of BFCRS, scoring 22. He was treated with lorazepam 10mg/day and valproic acid 900 mg/day. Catatonic symptoms disappeared a month later. Negativism and impulsiveness persisted slightly.

The catatonic syndrome may occur in patients with FTD. In both conditions symptoms overlap. The response to GABAergic drugs was optimal.

Depression in older adults is often under-diagnosed and consequently under-treated, despite association with higher rates of morbidity and mortality, increased healthcare utilisation and greater economic cost compared to younger populations. Better identification will be imperative in the future because of the estimated growth in the older adult population. Screening could improve identification; a well-known screening tool tis the Geriatric Depression Scale (GDS).

To evaluate the diagnostic accuracy of the brief GDS-15 and ultra-brief versions in the detection of major depression.

Seven electronic databases and unpublished literature were searched, using predefined criteria, from 1982 to April 2014. Primary study quality was assessed using the QUADAS-2. Pooled diagnostic performance data was calculated using bivariate meta-analysis. Subgroup and sensitivity analyses were pre-planned. Heterogeneity was explored through meta-regression.

Of 6635 records identified 32 studies were included. Meta-analyses were possible for the GDS-1, GDS-4 and GDS-15. For the GDS-15, at the recommended cut-off score of 5, the diagnostic odds ratio was highest in a community setting and for older adults aged ≤69 years. A cut-off score of 4, however, provided better diagnostic accuracy. Diagnostic data was less favourable when depression prevalence was ≥10%. Better diagnostic properties were found in non-Western countries. Meta-regression revealed country and language were predictive of diagnostic accuracy.

Further research is needed to explore diagnostic properties of ultra-brief GDS versions. GDS-15 findings suggest selective reporting of cut-off scores, which requires cautious interpretation and a need for greater methodological rigor in primary studies.

The role of APOE in Alzheimer’s disease and other dementias has been intensively investigated. However APOE in delirium has only recently been investigated in studies with small samples. There is evidence that APOE relates to delirium by one or more of the following pathophysiological mechanism: a) inhibition of inflammation in the CNS during acute illness, with release of inflammatory mediators, b) modification of inflammatory responses in an isoform-specific manner, c) by blocking both nicotine and acetylcholine receptors causing the anticholinergic effect which is assumed in delirium.

A meta-analysis of the published pooled data seems timely to establish any relationship between APOE and delirium, and to determine further direction of research in this topic.

To find out if there is any direct relationship between the APOE epsilon 4 and the occurrence of delirium.

Pubmed, MEDLINE, EBSCOhost and Google Scholar have been searched with the relevant keywords, and from the references of relevant papers. Nine papers were found which examined the relationship between APOE and delirium. Data were extracted from 8 of them and were pooled for meta-analysis using random effects with R software.

Data from 1762 participants showed no heterogeneity (Q=13.55, df:7, p=0.06). The possession of the APOE epsilon 4 allele has a small (OR:1.17, CI:0.77-1.80), non-significant (p=0.45) effect in the presence of delirium.

There is no association between APOE and the occurrence of delirium. Confirmation and clarification in larger studies could have important clinical implications for predicting prognosis and for treatment of delirium.

Delirium is associated with poor outcomes and high mortality. Current research shows conflicting results regarding mortality rates in patients with delirium.

The aim was to examine the hazard risk associated with delirium in elderly medically ill patients at 1 year follow-up, controlling for baseline risk factors and interaction effects.

This was a prospective, observational, longitudinal study carried out in the medical wards of Sligo Regional Hospital. All acute medical admissions of patients 70 years old and over were approached. Each patient was assessed twice weekly for 2 weeks or until discharge. The following scales were used: CAM, DRS-98R, MoCA, Barthel Index, APACHE II. Primary outcome was time of death during 1 year. Cox proportional hazards were estimated and compared across patients who had delirium during hospitalisation and those who did not.

Two hundred patients agreed to take part in the study. The mean age of the studied sample was 81.13 (SD = 6.45; minimum 70 and maximum 100 years old) with 100 (50%) females. One hundred fifty four (77%) patients never developed delirium during hospitalization. Thirty four (17%) had delirium at admission and 12 (6%) developed prevalence delirium while inpatients. A total of 55 (27.5%) patients died during the one year follow-up. Significant risk factors for 1 year mortality were length of hospital staying, severity of illness (APACHE II), and cognition (MoCA).

Delirium was not found as an independent risk factor for 1 year mortality after controlling for other confounder variables.