To alert to manic like symptoms in frontotemporal dementia (FTD).

Review of literature relevant in medline database.

Frontotemporal dementia (FTD) is a behavioural syndrome caused by generation of the frontal and anterior temporal lobes.

Bipolar disorder in dementia and the temporal relation between the two conditions have rarely been studied. There is a increased probability of developing a manic episode in patients with dementia.

Those with temporal FTD have impairments in emotional processing and hypomania like behavior. Moria (childish excitement or tendency to joke) or frivolous excitement are common presenting symptoms, and is difficult to distinguish to features in bipolar disease.

The correlation between mania like symptoms and FTD can be make with the help of informations of the family and computed tomography imaging. Those with temporal involvement are particularly at risk of developing deficits in emotional processing secondary to atrophy in the amygdale, anterior temporal cortex, and adjacent orbitofrontal cortex.

Early temporal involvement in FTD is associated with frivolous behavior and right temporal involvement is associated with emotional disturbances.

Moria or frivolous behavior are common presenting symptoms of FTD and the differential diagnosis is made with the help of informant's reports and computed tomography imaging.

To alert to apathy as a sub-syndrome in the spectrum dementia-depression.

Review of literature relevant in medline database.

The modern concept of apathy implies a reduced volition. Apathy may occur in depression and dementia and the differential diagnosis is difficult. Symptoms of apathy may constitute a sub-syndrome in the spectrum depression-dementia, that are characterized by lack of interest, psychomotor retardation, loss of energy and loss of appetite. Apathy may occur in dementia without depression and is significantly associated with more severe cognitive deficits. In dementia, depression may primarily result from a combination of symptoms of anxiety and apathy. Most patients with dementia and apathy had concomitant depression, but less depressed patients had concomitant apathy. The key to diagnosis may be the mood symptoms: dysthymia could be a negative emotional reaction to the progressive cognitive decline in dementia, whereas major depression could more strongly related to biological factors.

The nosological position of apathy remains obscure, with some studies suggesting that apathy and depression are independent constructs, and other studies showing a significant overlap between apathy and depression. The major interest to the type of syndrome has therapeutics implications.

Acute psychosis can represent a diagnosis challenge. Several disorders can be implicated, and some representing a life threatening condition. We report a rare case of acute psychosis with persistent soft neurological signs as a primary presentation of a central nervous system vasculitis.

A 23 year old man, with antecedent of depression, previous history of cocaine and marijuana abuse, admitted to an acute psychiatric ward with three days evolution of disturbed behavior, mainly isolation and immobility. On the psychiatric ward he appeared vague, with negativism, inattentiveness, and elementary and incoherent speech. He had unsystematised delusions. His neurological examination revealed a slight ataxic gait and discoordination, and signs of frontal lobe release. Initial extensive complementary study, including brain CT, EEG, and urine toxicology were negative. He began treatment with risperidone and clomipramine, with improvement of his mental condition, and by the second week he was able maintain a coherent speech. The neurological signs did not improve, and frequent falls appeared. We performed a brain MRI who revealed lesions compatible with vasculitis. The extensive liquor study was negative, with exception of proteins levels (56 md/dl). He was transferred to an internal medicine ward, treated with corticoesteroid. His condition improved in the following weeks and on discharge from Hospital he had recovered his mental status and was autonomous.

Psychosis is an uncommon presentation of central nervous system vasculitis. In cases of persistence or progression of the soft neurological signs, further complementary study is essential to exclude organic pathology.

PPA is characterized by progressive language dissolution, with remarkable spare of other cognitive domains for at least two years, and should be considered in the differential diagnosis of dementia.

A 56-year-old previously healthy man was seen for speech difficulties. He studied Portuguese for 4 years, and then went to live in France, where he learned French for 3 years. He returned definitely to Portugal when he was 42. Since early adolescence he was fluent on speaking, reading and writing in both languages. In the last 12 years he spoke French mainly when visiting his family. Three years ago he started showing disintegration of his second language preceding that of his native one. Upon examination he had laborious, effortful, nonfluent and agrammatic speech, with severe anomia and some repetition and complex-command comprehension difficulties. He could not name, understand or write any French word. The remaining neurological examination was near-normal to age and education level (MMSE - 25/30). Brain MRI showed left-side predominant frontotemporal cortical atrophy. PET scan revealed hypometabolism in the same area and the temporal lobe, anterior cynguli and dorsolateral frontal cortex.

Our patient has nonfluent variant of PPA. Cases like this can give further insight into the neural network subserving language acquisition and dissolution. In proficient bilinguals, the main point on language dissolution in PPA seems to be the recency of use. The best way to confirm this would be to systematically characterize PPA patients on secondary language usage, attained proficiency and disintegration sequence.

Previous studies concerning early experiences in childhood show that these play a crucial role in the individuals’ development and may lead to a decrease in the vulnerability to show psychological problems. Mindfulness skills and feelings of hope seem to function as mechanisms that promote adjustment and psychological well-being.

The aim of this study was to explore the relationship between early positive emotional memories, hope, and mindfulness skills, as well as their role in the psychological well-being.

A sample of 402 adolescents with ages ranging from 12 to 18 years old completed four self-report instruments: the Early Memories of Warmth and Safeness Scale, the Children and Adolescent Mindfulness Measure, the Children Hope Scale and the Positive and Negative Affect Schedule.

Girls exhibited more negative affect when compared to boys. Age and years of education were not correlated with any of the study variables. Students with no school disapprovals showed more positive emotional memories and more hope. Mindfulness skills, hope, warmth and safety memories, and positive and negative affect were significantly correlated in an expected way. The set of variables that better predicted positive affect was: hope, early warmth and safety memories, and mindfulness skills. For negative affect, mindfulness was the best predictor followed by hope and lastly by positive emotional memories.

The current study heightened the role of positive emotional memories, mindfulness, and hope in affective states, suggesting that they may be addressed in intervention programs for the adjustment or the psychological well-being of the adolescents.

Somatic comorbidities are common among elderly patients with mental health problems, namely dementia and depression. Quite often, somatic problems are associated with a substantial impairment in daily routines, as well as to a worse outcome of the neuropsychiatric condition.

to investigate the level of impairment due to comorbid somatic problems in the elderly, as part of the implementation of the 10/66- Dementia Research Group Population-based Research Protocol in Portuguese settings.

A cross-sectional survey was implemented of all residents aged 65 in a semi-rural area in Southern Portugal. Evaluation included a cognitive module and the Geriatric Mental State-AGECAT (GDS). Training of the field researchers was conducted with the supervision of the 10/66-DRG coordinators (CF, MP).

703 elderly participants were evaluated. Interference with daily activities was present in every area assessed, with moderate to severe impact in the following areas: Arthritis or rheumatism (36,9%), eyesight problems (19,8%), hypertension (10,5%) and gastro-intestinal conditions (10,4%). 48,9% of the participants had at least one contact with a primary care health centre in the last three months, and 22,5% had at least one contact with a doctor in a general hospital.

Results showed a relevant degree of impairment due to somatic conditions, and a high use of services, namely at primary care level. The significant prevalence of comorbid somatic conditions should be taken into account regarding the organization of services directed to older patients with mental health problems, that has been considered a priority in the Portuguese Mental Health Plan 2007–2016.

Chronic alcoholism is associated with impaired cognitive functioning. Over 75% of autopsied chronic alcoholics have significant brain damage and over 50% of detoxified alcoholics display some degree of learning and memory impairment. In clinical practice, it could be difficult to differentiate between the various syndromes associated with chronic alcohol use.

The authors present the various syndromes associated with cognitive impairment induced by chronic alcohol use.

Review of the most recent literature with the following key words: alcoholism, differential diagnosis, cognitive impairment and dementia.

Chronic alcohol use can cause dementia such as chronic subdural hematoma after head injury, hepatocerebral degeneration by cirrhosis and nutritional deficiencies. The thiamine deficiency can originate Wernicke-Korsakoff syndrome. If not properly treated, it can develop as a chronic amnesic syndrome known as Korsakoff's syndrome. It is characterized by episodic memory deficit with confabulations, involvement of semantic memory, nistagmus and ataxic gait. The Machiafava- Bignami disease is rare and usually diagnosed in alcoholics. The symptoms include dementia, muscle stiffness, seizures, dysphagia and less often coma. Finally, diagnostic criteria for alcoholic dementia include dementia diagnosis made at least 60 days after the last exposure to alcohol; minimum of 35 standard doses for men and 28 for women per week for more than 5 years and, ethanol abuse mean within 3 years after the onset of cognitive decline.

Although various syndromes present similarities, the clinicians should be aware of the different symptoms as the treatment may vary according to the pathology.

Delirium involves an acute, transient disturbance in consciousness and cognition. When the delirium involves aggressive behavior it's termed excited delirium; when this is followed by sudden death, it's termed excited delirium syndrome. Typically, patients presented fever, a rapid pulse, agitation and anxiety, with increasing confusion, and a progressive deterioration over a course of weeks before dying.

Alert to the poor prognosis of excited delirium syndrome.

Review of relevant literature after the description of a clinical case.

Description of a clinical case:

A.R. is a man of 69 years, without psychiatric background, under neoadjuvant chemotherapy for metastatic bone disease. He has multiple comorbidity: chronic obstructive pulmonary disease, hypertension, diabetes and stomach cancer treated 15 years ago.

Three days before the hospitalization the patient began incoherent speech, and physically he was dehydrated; it was requested observation liaison psychiatry for psychomotor agitation. in the course of the interview, the patient was aggressive, very anxious, with jealousy and paranoid delusions, visual and auditory hallucinations, disoriented and with dispersed attention. It's placed the hypothesis of delirium by multiple etiologies and he was medicated with neuroleptics. It was necessary increased doses and physical restraint to control of agitation, which was not complete and lasted two weeks; meanwhile, he developed a respiratory infection. the patient eventually died of cardiopulmonary arrest.

It's described a typical case of excited delirium syndrome in a patient with psychomotor agitation that was difficult to control and lasted weeks, which culminated in cardiopulmonary arrest.

Above 60 years, prevalence rates of neuropsychiatric disorders double with every 5.1 years of age (from 0.7% at 60-65 years to 23.6% for those aged 85 or older). As aged people are dramatically increasing in Portugal, a Country under a serious financial crisis, it is important to understand whether health services are being used appropriately.

to characterize the use of health services among the elderly, as part of the implementation of the 10/66-Dementia Research Group Population-based Research Protocol in Portugal.

A cross-sectional survey was implemented of all residents aged 65 or more in a semi-rural area in Southern Portugal. Core evaluation included a cognitive module and the Geriatric Mental State-AGECAT (GDS). A structured questionnaire assessed the use of services, including health care providers (public, private), inpatient episodes, medication and costs.

703 participants were evaluated. Almost half of the participants (48,9%) were in contact with public primary care facilities, but only 22,5% had a contact with a hospital service. In both settings, nurses and other non-doctor professionals were rarely involved (6,4%) as principal care providers. 11,8% had at least one contact with a private doctor. Inpatient episodes in the last 3 months were very infrequent (3%). The National Health Service covered most costs.

Previous research strongly suggests that health services are not provided equitably to people with mental disorders, namely the elderly. Reliable and cross-culturally comparable information about patterns of care may guide the implementation of adequate management in this area in Portugal.

The concept of delirium has developed historically from the prototype of acute confusion with psychomotor agitation. While the modern view of delirium recognizes four core features (disturbance of consciousness, disturbance of cognition, limited course and external causation), their operationalization can produce a misleading picture of the most common manifestations of delirium in elderly people.

Alert to the diagnosis of delirium in elderly patients.

Review of relevant literature.

Delirium is a multifactorial syndrome, involving the interrelationship between patient vulnerability, predisposing factors at admission, and the noxious insults and aggravating factors during hospitalization. A significant proportion of elderly patients are either delirious on admission to hospital, or develop delirium at some point during their hospital stay. The clinic needs to be alert to the predisposing and precipitating factors, which have the potential to identify those at risk of delirium and to prevent it occurring, like age, sex, dementia, psychiatric disorders and physical illness. Another important phase of assessment is the differential diagnosis that includes most other organic and functional psychiatric disorders (but it's necessary to remember that their presence does not exclude the possibility that the subject is delirious as well), especially depression, dementia or dysphasia due to a cerebrovascular accident.

Complications arising from the delirious state in elderly patients prolong hospital admission and contribute to adverse functional outcomes, notably increased dependency and higher rates of institutionalization.