Elderly people are likely to have inadequate storage of vitamin D. Physical consequences may include pain, loss of bone tissue, decrease of muscle power, increase of fall risk and fractures. Also, among women an association of low vitamin D levels and a higher incidence of mood disorders has been reported.Prevalence of vitamin D deficiency is highest among institutionalized elderly. Elderly psychiatric patients could be at increased risk because of inadequate diet, polypharmacy, diseases that interfere with vitamin D metabolism and less exposure to sunlight due to homeboundness.In July 2008 we started a study on a clinical department of geriatricpsychiatry ward with the aim to establish the nutritional and vitamin status (including vitamin D) at and during admission.

All patients admitted to the clinical department of geriatric psychiatry of De Gelderse Roos Mental Health Care Institute (Arnhem, The Netherlands) were included.

During six months (July 2008-January 2009) the vitamin D level was established in 50 patients. At admission a vitamin D deficiency was found in 40 patients (80%).

Because vitamin D deficiency could have serious implications, both physical and psychiatric, we recommend routine assessment of vitamin D levels at psychiatric admission. If found too low, supplementation needs to be considered. In further research we will establish whether there is an association between vitamin D deficiency and the occurrence of psychiatric disorders. Also we will investigate if non-deficient patients at admission develop deficiency during admission.

Even Emil Kraepelin's description of dementia praecox emphasized the change in cognition and the long-term deteriorating course of schizophrenic patients, opposed to the ones having manic-depressive psychosis or paranoia.

Currently, neurocognitive impairment is considered a core component of schizophrenia, particularly affecting the domains of attention, executive-frontal lobe function, working memory, and episodic memory. The dorsolateral prefrontal cortex has been implicated in cognitive disorganization and current therapeutic options have only a modest effect on this chronic disability. Although these impairments cannot function as diagnostic tools, they are strongly related to the functional outcome of the illness, and have significant prognostic value.

Negative symptoms, such as poverty of speech or blunted affect, are among the most chronic symptoms of schizophrenia. They respond poorly to antipsychotics, and are widely suspected to reflect a dorsolateral frontal lobe dysfunction, as well. This negative dimension is associated with a poor long-term cognitive outcome and may be closely related to the primary cognitive deficit in schizophrenia.

Objectives and methods: The authors aim to provide an overview of the existing literature regarding these dimensions of schizophrenia, and the hypotheses of a possible association between schizophrenia and dementia.

Given the prognostic value of mild cognitive impairment, and regardless of the evidence of frontal lobe dysfunction in schizophrenia, few studies have examined the longitudinal relationship between psychosis and the development of (frontotemporal) dementia. This theoretical association raises the possibility that these distinct entities could result from a common neurodegenerative pathway.

To estimate the prevalence and severity of neuropsychiatric symptoms in patients with dementia in nursing homes, assessing their association with certain factors that may promote or prevent its occurrence.

A cross-sectional study was carried out. We included all elderly diagnosed with degenerative, vascular, or mixed dementia, stage 4 to 7 of the GDS, and residents in 6 nursing homes in the province of Ourense (Spain). The assessment of symptoms was performed using the Neuropsychiatric Inventory - Nursing Home (NPI-NH) test. A sample size of 120 individuals was determined to be necessary.

We included 212 cases, with an average age of 85.7 (SD = 6.7) years. The prevalence of neuropsychiatric symptoms was 84.4%. The most common symptom was apathy, followed by agitation and delirium, the least frequent were euphoria and hallucinations. The symptom that produced most occupational disruption was agitation. Multivariate analysis showed that a higher score on the NPI-NH was associated with the use of neuroleptics, both typical and atypical, and with a higher score on the Reisberg Scale. Negative association was demonstrated with the number of days of institutionalization and the diagnosis of vascular dementia.

Patients with dementia in nursing homes in our area have a high frequency of neuropsychiatric symptoms that are associated with neuroleptic use and decreases as the patient remains institutionalized for longer. Patients diagnosed with vascular dementia have lower scores on the NPI-NH test.

Behavioral and psychological symptoms in dementia are known to increase caregiver stress and proceed admission to a nursing home. We studied caregiver stress due to the impact of sleep disturbances in different types of mild dementia.

A sample of 151 persons with mild dementia from the Norwegian DEMWEST- cohort and their caregivers. Sleep problems in dementia were studied with the Mayo Sleep Questionnaire and the Neuropsychiatric Inventory. Caregiver stress was studied with the Relative's Stress Scale.

Caring for a person with mild dementia with any sleep disturbance significantly increased caregiver stress as compared to caring for a person with mild dementia without any sleep disturbances. (18.2 vs. 13.0, p=0.017) Caregivers to patients diagnosed as having mild Dementia with Lewybodies with any sleep disturbance reported significantly more stress as compared to caregivers to person with mild Alzheimer's Disease with any sleep disturbance. (14.7 vs. 21.7 p=0.010).

Sleep disturbances in mild dementia significantly impact on caregiver stress, more so in DLB as compared to AD.

Time until nursing home admission (NHA) in different types of dementia is not known. Few studies in Alzheimer's disease (AD) have been reported previously and focused on demographic, socioeconomic, behavioral and psychiatric symptoms as predictors for NHA.

We use data from the Norwegian DEMVEST-cohort to calculate time until NHA applying Kaplan-Meier survival analysis comparing the Lewy body dementias (LBD) (Dementia with Lewy Bodies (DLB) and Parkinson's Disease Dementia (PDD)) to non-LBD patients. Associated factors were studied with a Cox proportional hazard model.

190 cases with the same degree of mild dementia at baseline were followed for on average 880 ± 397 days 95% CI (823, 937), 56 (29.5%) individuals were placed in a nursing home during follow up and mean time until institutionalization was 1204 days 95% CI(1130, 1279) for all included, 987 days 95% CI (823, 1151) for LBD patients and 1263 days 95% CI (1184, 1342) for non-LBD patients. p=0.007 (Log-Rank test) Chi-square= 7.330 df=1. Mean time until NHA for DLB patients is 985days 95%CI (801, 1169) and for AD patients 1264days 95% CI (1180, 1347) p=0.013 (Log-Rank test) Chi square=6.194 df=1

After controlling for age and duration at baseline we find that having a LBD diagnosis (DLB or PDD) increases the risk for nursing home placement during follow-up, hazard ratio =1.9 95%CI (1.1, 3.4) p= 0.030.

We find that a LBD diagnosis significantly shortens time until NHP controlling for age and duration at baseline compared to non-LBD patients.

To report a case of diagnosis and progression of Semantic Dementia.

Case report data were obtained through three years’ follow-up, review of records, neuropsychological and imagiological studies.

The 66 year old female patient presented with depressive complaints after the loss of her partner. With the remission of the depressive symptoms, the patient kept complaining of “forgetting words”. Her progressive verbal semantic memory impairment through the years and detailed examinations have revealed a naming and comprehension deficit. Scan pattern has shown progression of the left temporal-lobe variant of frontotemporal dementia.

The meagre psychopharmachological approach (SSRI) colud ot avoid the major disturbances in the patient's quality of life. Directive community and social support may be seen as the most powerfull tool available.

The authors describe and compare two cases of sudden onset cognitive impairment in middle-aged women.

Review of clinical records, laboratorial data, neuropsychological and imagiological studies.

Two women in the sixth decade of life with a similar background and pre-illness state were admitted in the Day Unit for evaluation. They both presented sudden onset of bizarre behaviours, mood swings, unspecific speech disorder, and appetite and sleep pattern deviation, accompanying mild cognitive impairment (MCI) on neuropsychological evaluation. Both cases were submitted to intensive studies. Data and long-term follow-up revealed a frontotemporal dementia in one of the cases, and the second woman was shown to have a conversive pseudodementia.

Cognition's progressive deterioration is considered a major marker of dementia, but mild cognitive impairment is a heterogeneous clinical syndrome without criteria on current classifications of disease and limited prognostic value.

Needs of the elderly are complex and difficult to identify since connected with many different dimensions. The aim was to identify met and unmet needs of patients referred to old age rehabilitation services in Poland (Wroclaw-Wr) and Germany (Hamburg-Ha).

Patients (n=80) over the age of 60 were assessed using the Camberwell Assessment of Need for the Elderly (CANE), Mini Mental State Examination (MMSE), Global Deterioration Scale (GDS), Good Milieu Index (GMI) and Activities of Daily Living Scale (ADL). Patients were at least 2 weeks under rehabilitation due to orthopedic or neurologic reasons.

Both groups were similar concerning age, gender, education and marital status. Satisfaction of the ward was the same. Wr-patients were significantly more demented (25.1 vs.26.8; p=0.011), depressed (4.12 vs 3.0; p=0.033) and disabled (24.88 vs 76.62; p< 0.0001).

The mean number of total, unmet and met needs before rehabilitation was similar in both centers. However, significantly more needs in accommodation, eyesight /hearing /communication and benefits were reported in Wr, whereas psychological distress and food in Ha.

During rehabilitation program over twice more unmet needs were reported in Wr vs. Ha (1.38 vs. 0.57; p =0,0029) in the areas of eyesight /hearing /communication and benefits, continence, money.

Ha received twice more formal assistance than Wr before (0,0027), but Wr twice more during rehabilitation (p< 0,0001).

Assessing individuals needs may help in creating individual complete rehabilitation program within continuing care post discharge and improve quality of life.

Delirium is a Acute Confusional State caused by physiological consequences of a medical disease, and is a predictive index of severity disease and survival time.

In this Study we valued, on random pool of 123 patients, the populations of older over 90yr aged recovered (29 patients) in the care of a RSA (Residential Sanitary Assisted in Italy or Nursing Home), compared with population younger afferent in RSA.

In the populations recovered in RSA studied is evident the prevalence of Delirium in the population over 90 year aged is most common compared to other population studied (44% vs 17%), as major seem to be the Incidence of Delirium in over 90 year population (33,3% vs 12,76%).

This data confirm the existence of biological frailty in the very old over 90 year aged.

Moreover this data demonstrate reduction of rates Delirium's Incidence compared with prevalence's rates in a Setting of Care focused elderly needs as RSA as other Non Geriatric Acute Setting. The 3-Months Mortality is major in the 90 year old compared to non 90 year old population (33,3% vs 18%) confirming a predictive role of Delirium.

This study showed Delirium is a Marker of Biological Frailty and it is an index predictive inauspicious about the survival of patient. Moreover is marked the RSA - Territorial Structures High Psycho-Geriatrics Contents - performs important role of delirium's prevention by means of removal of the risk factor avoidable and a careful control of causes.

There are many screening instruments available for the detection of dementia. However, they were not tested in very old age and often not in the primary care setting for which they are developed.

We condensed a screening battery of all elements of common tests (MMSE, TFDD, DEMTECT, Clock Test…). Nine primary care practices took part in the study. The practice assistants were trained to approach all patients over 75y visiting the practice. Only patients with already diagnosed dementia, severe hearing or vision disability or communication deficits were excluded. After informed consent they applied the screening. Within the next days a second independent neuropsychological examination was arranged in the memory clinic of the University of Goettingen. This included established neuropsychological tests (CERAD-NP, WMS-R, TMT.) and further scales were applied (NPI, CDR..). All patients with CDR=0.5 were approached 1.5y later for a follow-up by phone.

N=90 patients (25M, 65F) took part in the initial evaluation. From N=54 with CDR=0.5 only N=14 could be reached for follow-up. None of them returned to CDR=0, most progressed up to CDR=4. There were some correlations to education and dementia severity. All available screenings showed a good effect size of >0.70 (MMSE, DEMTECT, TFDD, RDST).

Elements for an optimal screening of the oldest old are discussed.

At least at the larger hospitals specialised gero-psychiatric units have been introduced, usually taking care of those at age 65y and higher. The advantages of this approach have been discussed and examined. The patients’ view has only rarely been investigated and mostly only from a single perspective (e.g. patient satisfaction on gero-psychiatric wards).

We performed semistructured qualitative interviews in our hospital in a balanced sample of (n=14) patients at 18-40y, (n=10) patients at 41-60y, (n=16) patients at 61-75y, (n=8) patients over 75y. There were (n=) 24 male and (n=) 24 female patients. 12 patients hat been treated exclusively in old age psychiatry, and 10 patients had been treated in old age psychiatry after their 65th birthday.

The majorities of the patients saw advantages in mixed sex and age care for the younger and for the older patients. Disadvantages where not seen for younger patients, however for the elderly the view was ambivalent (26 yes versus 22 no). Female and higher age patients and those with multiple hospitalisations tended to expect more disadvantages. While a mixed ward would be regarded as more (stimulating), disadvantages could be the combination of aggressive young and frail elderly patients as well as the overburdening of the staff.

This is the first investigation on patient view on the segregation of old age psychiatric patients. Further studies should lead to a consumer guided care provision allowing specialisation as well as defending ageism.

We present a 43 years old men discharged from an internal medical service where the diagnosis of liver cirrhosis was refuted and confirmed the hepatitis C disease.

Onset is 6 months ago with cognitive deterioration and behavioral problems, confusional episodes, importamte memory disorders. Symptomatology was exacerbated in the last two months.

CT Moderate cerebral atrophy

EEG revealed generalized arrhythmic slow activity;

Laboratory tests : VSH 36-mm/1h,WBC 13.6-10-3/mm 3.

HIV test negative.

VDRL quantitative 1/1- ++++, 1/2- ++++, 1 / 4 ++++, 1 / 8 /++++, 1/16- + + +, 1/32- +

THPA (positive reaction) -dil-1/80;

VDRL in CSF positive + + + +

Patient was treated with a high dose of penicillin G intramuscularly. The clinical symptoms improved significantly in 2 weeks and MMSE increased from12 to 22.

Syphilis and its complications must be still in medical attention. If there is cognitive dysfunction or brain atrophy of unknown cause, neurosyphilis should be considered. Treponema infection should be part of the differential diagnosis of each patient showing cognitive deterioration and behavior disturbances.

The objective of the present study was to explore the intestinal endotoxemia (IETM) in the cell apoptosis of Alzheimer disease's rats which were established by D-galactose and aluminum trichloride (AlCl3).

Adult wistar rats were subjected to 90 days of intraperitoneal injection with D-galactose and AlCl3 to establish the Alzheimer disease's model. After the administration, the study and memory ability of the Alzheimer disease's rats were observed by Morris water maze; The level of Lipopolysaccharide (LPS) in the sera of Alzheimer disease's rats was determined by tachypleus amebocyte lysate method; The level of tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1) in the sera of Alzheimer disease's rats were determined by radioimmunity method; The apoptotic neuron was detected by TdT-mediated dUTP Nick End Labeling (TUNEL).

Compared with the normal control, the level of LPS, TNF-αin the sera and PD in the brine of Alzheimer disease's rats were markedly increased (P< 0.01).

The level of LPS, TNF-αin the sera and PD in the brine of Alzheimer disease's rats were markedly increased, IETM maybe an important reason of the apoptotic in Alzheimer disease.

Epidemiological issues have an special interest among gerontopsychiaty, because of the high prevalence of mental disorders and the increasing average age of the population. According to the National Statistic Institute in Spain, in 2002 almost 7 million of the people were over 65 years old and in 2020 there is expected to be 8 million of elder people. This question associated with the decrease of birthrate, will bring about a rise in the absolut number of elder people with a mental disorder.

Our main objective in this work is to study the sociodemographil profile of inpatients over 60years old in a short stay unit.

This is a prospective, descriptive study. We have collected sociodemographical and clinical characteristics of people over 60 years old that entered short stay units of two hospitals in Vizcaya, Spain, during one year. Patients with dementia were excluded.

60 patients entered the units. The average age was 71,2 (7,26). Education; illiterate 6,6%; just read and write 46,6%; primary/elementary education 38,3%; secondary education 3,33% and higher education 5%. Marital status: single 10%; married 51,6%; divorced 8,3%; widow/er 30%. Family life: 31,6% alone; 28,33% with a paretner; 21,66% with a partner and some else; 13,33%, with their children with a partner; 3,33% old people's home.Social relationship: 5% without any relation; 25% family and neighbours; 31,6% family, neigbours and frienda; 3,33% people in the old people's home.

It is assumed to be important to know the characteristics of this people to guarantee an optimum assistance.

Manic Thought Disorder (MTD) is a characteristic clinical feature of mania. In the past, explanations of its pathogenesis have ranged from hypotheses of a disordered lexicon, to the side effects of a fatuous affect. We previously modeled thought disorder in schizophrenia using the notion of threads of thought.

To examine the nature of MTD to see if it is consistent with the theory of a disordered lexicon alone.

To simulate the mental lexicon and thought generation and examine if computational lesioning experiments could simulate various aspects of MTD.

We modeled the mental lexicon as a semantic network using the programming language Mathematica®. Thought generation was modeled as a walk along this directed graph. Semantic priming was implemented as assigned weights; these weights in turn determined assignment of salience to threads scanning the network.

Assignment of weights to the vertices and/or edges of the graph allows us to simulate the flow and trajectory of speech permitting the replication of features of MTD including pressure of speech, clang associations and flight-of-ideas.

Our model of MTD allows us to propose that thought disorder in mania occurs due to an inappropriate assignment of salience to threads scanning the semantic network. Reduction of inappropriate thread salience by antipsychotics must result in a disappearance of MTD. While MTD is interesting to listen to, for anyone, it betrays the underlying mental computational processes involved in the generation of normal thought and MTD and hence very important for psychiatrists and cognitive scientists.

To extensively describe three patients including one child with catatonia anonymously in terms of etiology, management and outcome.

Uncovering environmental factors and crude observations. All patients receive a low EE, low activity structured programmed.

Mark an adolescent with mild learning disabilities and autism developed catatonic features, coinciding with anorectic behavior and ‘tears behind his eyes’. He has remained refractory for medication. At admission under the above named regime he discloses sexually abuse, which coincides with resolvement of the catatonic features and anorexiaPeter a male in his late twenties has a diagnosis of schizophrenia due to recurrent catatonic features. An extensive developmental history reveals a childhood onset dysexecutive syndrome. He has remained refractory to medication, even when compliant. Following marked changes in his life, a relapse catatonia is treated in the community as above with visual augmentation and regular tutorials on events. A few months later he accepts medication and continues to incidentally experience a few days of mild catatonic features.Martha, a thirty year old with a tendency to concrete thinking and echolalia develops sudden catatonic features following a relationship break up. She is admitted under the mental health act and undergoes the described programme. She is also put on Citalopram 10mg, which coincides with resolvement of catatonia in five days.

Cognitive impairment, particularly a dysexecutive syndrome is susceptibility for catatonia at a time of cognitive overload and trauma. An ongoing low EE low activity structured programme is key to recovery in milder cases.

The aim of our study is to assess the degree of apathetic dimension in healthy subjects and its correlation with the cognitive-executive functioning.

Healthy subjects of both sex (n=50) were evaluated with Wisconsin Card SortingTest (WCST), Stroop Color/Word InterferenceTest and AB-AC Test for the neurocognitive assessment; the Apathy Evaluation Scale (AES) was used to quantify the degree of apathy.

Positive correlation between the degree of apathy and the number of WCST perseverations were observed (ρ=0.022), no correlations between the Stroop Test (ρ=0.702) and the AB-AC Test (ρ=0.448) with Apathy Evaluation Scale were observed.

Our study demonstrated that apathy is related to widespread prefrontal cortex functioning in healthy subjects, but not with specific areas of prefrontal cortex.

During last few years psychiatric research focused her attention on early psychotic disorders, Ultra High Risk subjects, at risk mental states (ARMS) etc in order to determine clinical criteria of prodromal illness states.

At the state of the art there is no evidence-based-approved scale for early diagnosis and the studies are for the most part dedicated to schizophrenia spectrum disorders.

All the patients clinically remitted, suffered from a psychotic disorder during last 12 months (including schizophrenia spectrum, brief psychoses, psychotic bipolar illness) and high-risk subjects will be recruited and re-interviewed by expert clinicians. Psychometric classic scales (CGI, PANSS, BCIS, GAF) will be administered at the start of the study and after 2 years.

During the interviews two psychopatological scales will be also administered to all subjects ; a phenomenologically oriented one, EASE scale (Parnas et al 2003) and CAARMS (McGorry, Barnaby Nelson 2006).

During the 2 years observation, clinicians are requested to follow-up the patients and describe clinical and psychopathological modifications.

The preliminary results will be presented at the congress.

This study focuses attention on psychotic illness dimension in order to better comprehend and grasp psychotic patients’ experience. A relationship between CAARMS-EASE score and clinical outcome is expected and will be discussed; thus could reinforce diagnostic and prognostic inference of early-diagnosis psychopatological scales. Limits of our study are the small sample and the brief temporal observation but are typical real-world conditions.