Elderly patients pose a challenge in clinical practice. These patients may present symptoms that can be due to age-related cognitive impairment or may be due to other pathologies such as late psychosis, delusional disorder or manic episode with psychotic symptoms. It is for this reason that it is important to perform complementary tests and make a good differential diagnosis, with the aim of early treatment and improve evolution and prognosis.

The objective is to perform a literature review based on a case of an elderly patient.

To perform a literature review based on a case of an elderly patient.

Case: 70-year-old woman who lives with her husband and has two daughters. Currently retired. The patient has been in psychiatric consultations for approximately 30 years with a diagnosis of recurrent depressive disorder and under sertraline treatment. She goes to the emergency room with her daughter, as they have noticed a change in her behaviour over the last few days. The daughter reports that she is expansive, irritable, aggressive, who says that the neighbors are envious and watch him, performs many activities, etc. She comments that before her mother was the opposite, whiny and unwilling to do anything. The patient reports that her neighbors are envious of her and want to annoy her with great emotional repercussion and that she is aggressive with her husband because they do not get along. Hospital admission for clinical stabilization.

Examination and complementary tests: A neuropsychological evaluation of cognitive impairment was carried out, which resulted in the onset of cognitive impairment. Test of the watch with alterations and MOCA 25/30.

Evolution: During hospitalization, the patient is initially more expansive, irritable towards the family and with ideas of prejudice and self-referential to neighbors. She also has memory failures. Treatment with oral risperidone is adjusted with good tolerance, after which delirium symptoms are remitting.

The onset of cognitive decline may be accompanied or preceded by delusional symptomatology. It is recommended to perform differential diagnosis with mania, delirious disorder or onset of cognitive decline. Treatment with risperidone or quetiapine is useful.

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Charles Bonnet Syndrome (CBS) is characterized by the presence of complex visual hallucinations, such as objects or people, triggered by vision deprivation in the absence of cerebral, psychiatric, pharmacological, or systemic disorders. It is believed to result from brain escape phenomena due to cerebral deafferentation. Most affected patients are elderly individuals, although cases have also been described in various age groups. It occurs in 15% of individuals with visual loss, with a predominance in females around 80 years of age.

This case aims to analyze the clinical presentation in a patient with a suspected diagnosis of Charles Bonnet Syndrome.

A thorough review of the literature on CBS and the psychiatric symptoms that could complicate its diagnosis has been carried out to support the presentation of the case.

We present the case of an 84-year-old woman with a long history of psychiatric illness due to persistent depressive disorder was recently diagnosed with mild cognitive impairment. She has no ophthalmological history beyond age-related changes. She presented to the Emergency Department with visual hallucinations in the form of “famous television presenters,” which she partially criticizes while being mostly aware of their unreality. The hallucinations are not accompanied by significant somatic anxiety or affective impact. Delirium, substance intoxication, or medications causing the symptoms have been ruled out. She is currently under follow-up to exclude other causes. No pharmacological treatment has been administered.

The diagnosis of CBS is made by exclusion and is particularly challenging, as hallucinatory episodes can vary in content, duration, and frequency, even within the same patient, necessitating a multidisciplinary approach involving neurologists, psychiatrists, and ophthalmologists to avoid misdiagnosis. Differential diagnosis should include conditions such as delirium, Lewy body dementia, toxic substance intoxication, Parkinson’s disease, endocrine-metabolic disorders, and migrainous aura, among others. It is important to involve the family in managing the syndrome to reinforce the recognition of the unreality of the hallucinations in patients. Antipsychotic treatment may be effective only if the condition causes significant distress.

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A 74-year-old male with chronic anxiety and a previous brief depressive episode presents with persistent major depression, severe anxiety, and cognitive complaints including memory and attention difficulties worsened by benzodiazepine use. He reports insomnia, anhedonia, and difficulty managing daily activities. Despite treatment with high-dose SSRIs and benzodiazepines, symptoms and functional impairment persist. No clear psychosocial triggers are identified. Family reports sedation, confusion, and a recent fall linked to benzodiazepines. The patient remains independent in basic activities of daily living.

His medical history includes controlled hypertension, dyslipidemia, anticoagulated atrial fibrillation, and knee osteoarthritis. He denies substance use and has no known drug allergies or family psychiatric history. Comprehensive workup including labs, hormonal profile, urine toxicology, and brain CT is unremarkable.

To evaluate the discontinuation of benzodiazepines and the initiation of alternative pharmacological strategies with a more favorable safety and tolerability profile in the elderly population, such as tianeptine.

The patient was alert, oriented, and cooperative, exhibiting sad, blunted affect and psychomotor retardation. Speech was coherent, monotone, and slowed. He demonstrated depressed, apathetic mood with anhedonia, hopelessness, and severe mixed anxiety. Attention and concentration were impaired; memory and orientation intact. No suicidal ideation. Insomnia, adequate oral intake, and social withdrawal were present. Intellectual function and judgment remained intact.

The clinical diagnosis was moderate depressive episode (ICD-10 F32.1) with severe anxiety and cognitive impairment secondary to benzodiazepine use; due to age and comorbidities, tianeptine 12.5 mg twice daily was initiated, benzodiazepines were gradually discontinued, the SSRI was stopped, a non-benzodiazepine hypnotic was prescribed nocturnally, and supportive psychotherapy with cognitive remediation was implemented.

After four weeks, the patient showed improved mood, less anxiety, better sleep, and enhanced attention and memory. These improvements continued at six weeks. The family reported reduced anxiety without side effects like drowsiness or confusion seen with previous benzodiazepines. By two and a half months, the patient resumed social activities such as golf and socializing, with no major side effects or cognitive decline. The patient continues both medication and psychological therapy.

Tianeptine is an effective treatment for elderly patients with comorbid depression and anxiety, especially when benzodiazepines are poorly tolerated. It provides strong anxiolytic effects without sedation or cognitive impairment. Its glutamatergic action improves mood, anxiety, and cognition with minimal side effects. Tianeptine can be a first-line option in this population.

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Multidomain interventions for dementia prevention have shown consistent benefits and have been standardized through the FINGERS model, with the cognitive dimension being particularly relevant. Computerized cognitive training is increasingly used, but its feasibility in Portugal – where many older adults have low educational levels and limited digital literacy – remains underexplored. This study analyses the cognitive component of DemenPrev, a Portuguese feasibility study adopting the FINGER model.

To evaluate (1) adherence to the computerized cognitive training program; (2) usability and satisfaction; (3) progression across cognitive domains; and (4) differences between initial and final platform assessments.

Twenty older adults with the mean age of 71.9 (SD=3.6) at risk for dementia participated. Seventeen participants were women (85%), and three were man (15%). The mean years of education were 9.7 (SD=4.0). Baseline assessment was conducted using three computerized exercises: Mind Bender (executive functions), Target Tracker and Double Decision (attention). Based on these results, individualized training plans were generated. Participants attended two 45–50 minute sessions per week over 12 weeks. Post-intervention, the same exercises were repeated for reassessment.

Adherence was very high (95.2%), and participants expressed strong willingness to continue. Significant improvements were observed in executive functions (Mind Mender, p=0.006) and attention (Target Tracker, p=0.004; Double Decision, p<0.001). Satisfaction parameters (motivation, engagement, demand, time, clarity) were rated from moderately to extremely satisfactory. Usability was highly rated by the group. (M=71.63).

Preliminary findings suggest that computerized cognitive training can improve executive functions and attention, with excellent adherence and high satisfaction among Portuguese older adults. While causality cannot be established without randomized controlled trials, these results support its potential as a promising non-pharmacological component of dementia prevention strategies.

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Diogenes Syndrome (DS) is a behavioral disorder typically seen in the elderly, marked by rejection of social norms, progressive isolation and profound self-neglect (Czarnota-Kuczyńska J et al. J Educ Health Sport 2024; 58:210–24).

Through a clinical case, we aim to explore DS, with particular emphasis on associated comorbidities and multidisciplinary therapeutic approaches.

Case description supported by a review of the literature.

An 83-year-old woman, living alone, was referred to Psychiatry due to cognitive decline. The case was reported by neighbors after repeated refusal of medical care, placing herself and others at risk. She presented behavioral disorganization, unsanitary living conditions, neglect of hygiene, poor treatment adherence and refusal of psychosocial interventions. Laboratory tests revealed vitamin deficiencies, thyroid dysfunction and urinary tract infection. She was admitted for stabilization and social assessment. Clinical improvement was achieved with low-dose antipsychotic therapy and management of comorbidities. She was discharged to a residential care facility with stable condition.

DS is a growing social and public health concern. This case highlights the complex interplay between psychiatric symptoms, medical comorbidities, and social determinants in DS. Detection often relies on neighbors or relatives, as lack of insight leads to refusal of care, complicating intervention. This subject is particularly relevant due to the inherent challenges in diagnosis and treatment, compounded by multiple ethical and legal implications (such as access to the home, environmental interventions and the involvement of public health authorities) (Sacchi L et al. BJPsych Open 2021; 7:e43). The fundamental challenge is to reconcile individual autonomy with the responsibility to safeguard both the person concerned and society at large. No standardized pharmacological treatment exists, as DS is not formally recognized as a distinct clinical entity (Proctor C et al. Case Rep Psychiatry 2021; 2021:2810137). Management must be individualized, addressing comorbidities and integrating social services. Continuous professional training, strengthened support networks and community awareness are crucial for effective intervention.

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Preliminary results of the identification, and treatment of DV (index episode specifier, longitudinal course specifier and diurnal variation) in established TRD in older adults showed 95% responded to this approach. These results justify the establishment of apriori hypothesis that this approach must be exhausted prior to labelling older adult patients as TRD. The results of a much larger sample size are presented to affirm this hypothesis.

I hypothesize that identification, and treatment of the DV is the key to increasing the probability of response in established TRD in older adults. The principles governing the project design were derived from the observational case study design under the evaluative framework of the Continuous Quality Improvement governance structure. Results of CQI project on a Program for Older Adults (POA), a tertiary mood disorders program at Homewood Health, Guelph, Ontario, are presented to support this a priori hypothesis.

The principles governing the project design were derived from the observational case study design under the evaluative framework of the Continuous Quality Improvement governance structure. Results of CQI project on a Program for Older Adults, a tertiary mood disorders program at Homewood Health, Guelph, Ontario, were included in this project. Each patient was evaluated using Geriatric Depression Scale (GDS)] and Becks Depressions Inventory (BDI), on admission and at discharge. T-tests was used to establish statistical significance. The approach to identify DV was presented in an earlier abstract. Pharmacology was tailored to the identified DV in each patient while they engaged in evidence informed psychotherapies.

a random sample of 181 patients were evaluated. Average BDI scores on admission were 28.13 and average discharge scores were 8.59 (p<0.0000000000000000000000000000000000000000000000000000000311). Average GDS scores on admission were 21.06 and average discharge scores were 8.27 (p<0.00000000000000000000000000000000000000000000000000000189). Co-efficient of correlation between BDI and GDS for the same patients was 0.8279870037.

Identification, and treatment of DV from a larger sample offers more strength of their role in older adults getting labelled TRD. It is reasonable to suggest that identification and treatment of DV needs to be included in the definitions prior to labelling older adults with TRD.

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Population ageing heightens the relevance of self-relating processes for mental health. Self-criticism is linked to anxiety/depression, whereas self-reassurance may be protective. Evidence on the measurement of these constructs in Portuguese older adults remains limited.

To examine the psychometric properties of the Portuguese Portuguese Forms of Self-Criticizing/Attacking and Self-Reassuring Scale for use with older adults (FSCRS-OA), focusing on factor structure, internal consistency, and convergent evidence.

We conducted a cross-sectional study with community-dwelling and social-care participants aged ≥65 years (N = 211; M = 80.9, SD = 7.6). Protocols included sociodemographics, FSCRS, Geriatric Anxiety Inventory, 8-item Geriatric Depression Scale, and WHOQOL-BREF. We tested latent structure and reliability and evaluated associations with anxiety, depression, quality of life and perceived health.

Analyses supported a correlated two-factor representation (self-criticism; self-reassurance) with satisfactory model fit. Internal consistency estimates were acceptable for both factors. Convergent patterns were theory-consistent: higher self-criticism aligned with greater anxiety/depressive symptoms, whereas self-reassurance related to fewer depressive symptoms and better quality of life/perceived health.

Findings provide initial psychometric support for using the Portuguese FSCRS-OA in community-dwelling and social-care settings. Sample composition and the cross-sectional design are noted limitations. Broader and longitudinal samples are recommended to extend generalisability and temporal validity.

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Aging as a stage of the life cycle can proceed differently depending on the individual, psychological and social characteristics of a person. In recent decades increasing attention has been paid to the types of behavioral adaptation in old age, in particular to the difference between active and passive aging. The sociodemographic situation in the world, along with the development of the health-saving technologies, makes successful aging not only possible, but also necessary for the elderly with a high degree of their involvement in the public life.

To identify negative consequences of passive aging both for the elderly person and for society.

The primary method employed is bibliographic analysis.

Active aging implies maintaining activity in different spheres of life, including physical, social, cognitive, and emotional domains, and is a well-studied construct.

In contrast, passive aging has been studied less. Research shows that it is accompanied with decreased activity, social isolation and closeness.

Passive aging often leads to emotional difficulties: increased anxiety, depression, and feeling of loneliness. Passive aging can be caused by external circumstances (illness, loss of loved ones, unfavourable conditions) or internal factors, such as negative image of aging, low self-esteem, and attitude towards inevitable deterioration.

It is important to emphasize that the boundary between active and passive aging is not always rigid. The same person can exhibit different types of behavior depending on the situation, level of support, and personal resources.

There can be identified the following consequences of passive aging:

• - physiological (deterioration of health due to physical inactivity, increased risk of disease development, decreased life expectancy).

• - psychological (loss of meaning in life, lack of self-importance, disappointment in how life has been lived, decrease of cognitive processes).

• - social (a person’s separation from society, a decline in social activity, loss of significant social status).

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Since the second half of the 20th century, the problems of active/effective/successful aging, quality of life have been actively studied and methods for their diagnostics have been developed

To conduct a comparative analysis of methods for diagnosing successful aging and quality of life in the elderly using a Russian sample.

A pilot study was conducted. Four methods were used in this study: APQ (Attitudes to Ageing Questionnaire) (M. Barker, 2007, adoption M.D. Petrash М, O. Yu. Strizhitskaya, 2024); LSITA-SF (Life Satisfaction Index for the Third Age – Short Form) (A. Barrett, 2009, adoption A.A. Zolotaryova et al., 2022); WHOQOL-100 (World Health Organization Quality of Life Assessment) (WHO, 1998); SF-36 (Short Form-36 Health Survey) (Ware, Sherbourne, 1992, adoption A.B. Leonova, 2014).

The study sample consists of 60 elderly people from 52 to 70 years of age (M = 59,5). Among them women accounted for 58,3% (n=35), men 41,7 % (n=25).

Here is a short description of each of the methods with their comparison on the main characteristics. 1. APQ: This methodology is based on the assumption that perception of ageing is a significant predictor of psychological well-being in older adults. It identifies how an individual interprets age-related changes – as a loss or as a source of new opportunities. The instrument includes several scales reflecting different aspects of attitudes towards ageing. This self-report questionnaire consists of 31 items (~11 min). 2. LSITA-SF: This methodology is designed to assess the subjective feeling of life satisfaction among older adults, particularly relevant in studies of quality of life, psychoemotional state, and successful ageing. The short form of the index contains 12 statements (~2 min). 3. WHOQOL-100: In this questionnaire, quality of life is defined as an individual’s subjective perception of their position in life within the context of their culture, value system, goals, and expectations. A comprehensive assessment of quality of life is conducted across six domains. It includes 100 items across 6 domains and 24 facets (~18 min). 4. SF-36: This tool provides a concise yet informative overview of physical and mental health, including health-related quality of life. It comprises 36 items grouped into 8 scales (~7 min).

The methods used have the following advantages and limitations.

APQ covers both positive and negative attitudes but does not measure physical or social functioning. LSITA-SF allows for a quick and easy assessment of subjective well-being, but provides only a general assessment without a breakdown into scales. WHOQOL-100. Pros: multi-faceted, high precision. Cons: difficult for the elderly to perform. SF-36 convenient, short, valid for mass research, but does not consider the spiritual-existential sphere. The pilot study showed a high degree of agreement between these methods.

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Benign prostatic hyperplasia (BPH) is a common urological condition in aging men, often causing lower urinary tract symptoms (LUTS). LUTS are linked not only to impaired quality of life but also to psychiatric disorders, sleep disturbances, and cognitive decline. While surgical treatment is widely used to relieve bladder outlet obstruction, its long-term impact on psychiatric and cognitive outcomes remains unclear.

To evaluate whether surgical treatment for BPH is associated with reduced risks of psychiatric disorders, sleep disturbances, cognitive decline, and persistent LUTS.

A retrospective cohort study was conducted using the TriNetX Global Collaborative Network (155 healthcare organizations). Male patients aged ≥18 years with BPH (2015–2024) were included. Patients with baseline psychiatric disorders were excluded. The study population was divided into surgical (n = 20,328) and non-surgical (n = 1,659,904) cohorts. After 1:1 propensity score matching, 20,323 patients remained in each group. Outcomes within three years included depression, anxiety, insomnia, dementia, delirium, and LUTS. Hazard ratios (HR) and p-values were calculated. Subgroup analyses were performed by age and BPH medication use.

Surgical patients had lower risks of persistent LUTS (HR 0.917, p < 0.001), depression (HR 0.616, p < 0.001), anxiety (HR 0.551, p < 0.001), insomnia (HR 0.645, p < 0.001), dementia (HR 0.705, p = 0.013), and delirium (HR 0.694, p = 0.007). Benefits were more pronounced in men aged 18–70 for LUTS, depression, anxiety, and insomnia, whereas men >70 mainly benefited for depression, anxiety, and dementia. Protective effects were stronger in patients not taking medications.Table 1.

Risk of Psychiatric Disorders and LUTS in BPH Patients Undergoing Surgery versus Non-Surgical Controls (BPH = Benign Prostatic Hyperplasia; LUTS = Lower Urinary Tract Symptoms; HR = Hazard Ratio; CI = Confidence Interval; * p < 0.05; *** p < 0.001)

Image 1. Kaplan–Meier Curve of Psychiatric Disorder Risk in BPH Patients Undergoing Surgery versus Non-Surgical Controls (BPH = Benign Prostatic Hyperplasia)

Image 2 & 3. Subgroup Analysis Forest Plot of Outcomes After Surgery versus Controls (BPH = Benign Prostatic Hyperplasia; LUTS = Lower Urinary Tract Symptoms; HR = Hazard Ratio; CI = Confidence Interval)Image 1:

Surgical treatment for BPH is associated with reduced risks of psychiatric disorders. Beyond relieving urinary obstruction, surgery may confer broader mental health and cognitive benefits.

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Multidomain programs have demonstrated efficacy in preventing cognitive decline and dementia. Additionally, technological solutions show potential for cognitive interventions and the promotion of healthy aging. This study investigated the implementation of an innovative multidomain program in a Portuguese community setting, inspired by international multidomain models and supported by technological interventions.

To evaluate the effect of a multidomain program on adherence, satisfaction, and outcomes in cognitive, affective, social, and quality of life domains.

The program consisted of 26 sessions, held twice per week, combining robot-assisted therapy, augmented reality, computerized cognitive training, and psychoeducational sessions. Sociodemographic data and adherence records were collected, and a multidimensional assessment battery was administered before and after the intervention, along with a satisfaction questionnaire.

The study included 504 older adults (mean age = 76 ± 9.47 years), mostly women (80.36%). Significant improvements were observed in all assessed domains (p < 0.001): cognitive (+2.6 points ACE-R), affective (–1.1 points GDS-15), social (+3.9 points ESSS), and quality of life (+1.2 points WHOQOL-BREF). Adherence was 89%, and satisfaction was 98%.

The program was effective, as evidenced by the multidimensional health gains achieved. The integration of innovative technological interventions, combined with a multidomain approach, appears promising for the prevention of cognitive decline. Future studies with control groups could strengthen the robustness and sustainability of these results.

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The transition to retirement, far from being a mere cessation of work, is a major life and psychosocial transition that can negatively affect mental health. Social isolation and depression are well-established risks during this period. Understanding their determinants is essential for developing effective preventive measures.

This literature review aims to identify the key risk factors for deterioration of mental health after retirement and to synthesize validated strategies for prevention.

A review of the literature was conducted using PubMed, Scopus, and Google Scholar for publications between 2014 and 2024. Keywords included “retirement”, “mental health”, “depression”, “social isolation”, “risk factors”, “preventive strategies”. Included studies were meta-analyses, systematic reviews, and longitudinal studies that assessed predictors of depression or isolation in recent retirees, as well as the effectiveness of preventive interventions.

The literature consistently identifies several major risk factors. Individuals most vulnerable to depression and social isolation after retirement are those with:

• - Involuntary retirement: Leaving work due to health problems or financial necessity.

• - Poor preparation: Lack of anticipation and absence of a post-professional life plan.

• - Strong professional identity: Work being the main source of social status and interpersonal interactions.

• - Limited social network: Few meaningful connections outside the workplace.

Effective preventive strategies target these factors and include multidimensional retirement preparation programs, support for social and volunteer engagement, and early identification and intervention by healthcare professionals.

Prevention of post-retirement psychological distress requires a dual approach: early identification of risk factors and implementation of targeted preventive strategies. Proactive interventions before and during the transition to retirement can transform this potentially vulnerable period into a rewarding phase of life. Occupational physicians upstream and attending physicians downstream play critical roles in this preventive continuum.

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Physical exercise can be helpful for a range of psychiatric conditions. In the inpatient environment offering exercise can be difficult, particularly for detained patients who are at risk of absconsion. Indoor gymnasiums build into the hospital can offer a useful opportunity for exercise.

It is commonly advised that before patient’s start an exercise programme that they consult a physician. In the inpatient setting this involves a resident doctor reviewing the patient. However, this raises the question “how should resident doctors assess the older adult inpatient’s readiness for a new exercise programme?”

To develop a practical approach to older adult inpatients who want to start a new exercise programme

A group of resident doctors reviewed the literature and guidance in order to develop a pre-exercise assessment tool. This literature was then amalgamated through discussion to develop a flow chart of assessments to be undertaken prior to using the gym.

The assessment brings together a range of tools that look at the cardiac, respiratory and musculoskeletal health to assess the patient’s readiness for a new exercise programme. If the tool identified significant barrier to exercise then as an integrated mental health and acute trust we can access specialist advice on a case by case basis.

We have created a practical and easy to use approach which can be used in any mental health inpatient setting to ensure that patients are fit to engage in a new exercise programme.

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Manic episodes arising de novo in late life are rare and often indicate underlying organic pathology. Diagnosis is further complicated by overlapping psychiatric symptoms, neurodegeneration, and psychosocial stress. This report presents a first manic episode in a 66-year-old woman with a 25-year history of depression, recently diagnosed with Alzheimer’s disease and exposed to major psychosocial stress. The case highlights the challenge of distinguishing primary psychiatric illness from organic, iatrogenic, or reactive causes in geriatric psychiatry.

- To present a case of late-onset mania in a patient with Alzheimer’s disease and a longstanding depressive disorder

• - To explore potential etiological factors contributing to the manic episode

• - To highlight the diagnostic challenges related to Alzheimer’s disease, depression, mania, and personality disorders, and emphasizes the importance of a holistic approach in understanding complex psychiatric cases

A descriptive case report method was used, gathering data through clinical interviews, psychiatric evaluation, neurological assessments, imaging, and collateral information from family and medical records. Mental status examinations were conducted throughout the inpatient stay.

The patient, born in 1959, was hospitalized for a first manic episode marked by elevated mood, psychomotor acceleration, reduced need for sleep, and pressured speech. She had no previous manic or hypomanic episodes but had received outpatient treatment for multiple depressive episodes for over 25 years, starting after her son’s suicide attempt. About four months before admission, her son suffered a serious work injury that left him unable to work—an event she found highly distressing. The manic symptoms began around the same time, suggesting a possible temporal link. She was also diagnosed with Alzheimer’s disease following cognitive decline and neurological assessment; donepezil treatment started shortly before the manic episode. During hospitalization, based on anamnesis and her interpersonal relationships, combined with marked emotional reactivity and longstanding affective instability, a clinical suspicion of underlying personality pathology was raised.

This case illustrates the multifactorial origin of late-onset mania in a patient with Alzheimer’s and chronic depression. Contributing factors include the potential manic effects of donepezil, acute stress from her son’s injury, and cumulative psychological and interpersonal trauma. Diagnosing mania in older adults with neurodegenerative disease requires careful consideration of iatrogenic, psychosocial, and biological factors. This case highlights the need for interdisciplinary assessment of behavioral changes in the elderly, and for heightened awareness of possible mood destabilization following cholinesterase inhibitor treatment.

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Positive Dementia Caregiving in 30 Days (PDC30) is self-guided, fully automated online psychoeducational intervention for dementia caregivers. In a global trial involving 274 caregivers from 43 lower-middle to high income countries, the intervention was found to lower depression and burden, and increase positive gains, compared with 1-month waitlist control. However, the therapeutic mechanism is unclear.

To investigate whether self-efficacy beliefs and positive reappraisal coping mediated the intervention effects.

The inclusion criteria were providing ≥10 hours of care per week, scoring ≥5 on Patient Health Questionnaire-9 (PHQ-9), and passing a simple English comprehension test. Self-efficacy in obtaining respite (SE-OR), self-efficacy in responding to disruptive behaviors (SE-RDB) and self-efficacy in controlling upsetting thoughts (SE-CUT) were measured using the Revised Scale for Caregiving Self-Efficacy. Reappraisal coping was measured using Brief Cope, Positive Reappraisal Subscale (BC-PR). Primary outcome was depression (Patient Health Questionnaire-9 [PHQ-9]) and secondary outcomes were anxiety (brief Profile of Mood States-Anxiety Subscale [POMS-A]), burden (brief Zarit Burden Interview [ZBI]), and positive gains (brief Positive Aspects of Caregiving Scale [PACS]). Following baseline measurement, mediating and outcome variables were re-assessed at 3 weeks and 1 month respectively. 43 individuals having no post-baseline data were excluded, leaving 231 for the mediation analyses. SE-OR and POMS-A were dropped analysis as they were not influenced by the intervention. The general path model PDC30 → mediator (week 3 controlled for baseline) → outcome (1 month controlled for baseline) was estimated using full-information-maximum-likelihood. All mediators and outcomes were tested simultaneously in one integrated model. Indirect effects and confidence intervals were estimated using 5,000 bootstrapped samples. The study was registered with ClinicalTrials.gov, NCT06409455.

The intervention effect on PHQ-9 was mediated by SE-CUT (B = -0.306, 95% CI = -0.624 to -0.106; β = -0.047) and BC-PR (B = -0.477, 95% CI = -0.858 to -0.221; β = -0.074), whereas the effect on burden was mediated by SE-CUT (B = -0.495, 95% CI = -0.965 to -0.192; β = -0.060) and SE-RDB (B = -0.231, 95% CI = -0.574 to -0.034; β = -0.028). On the other hand, the increase in PACS was mediated by BC-PR only (B = 0.402, 95% CI = 0.100 to 0.793; β = 0.053). A full path diagram will be presented at the conference.

The pattern of results suggests that while improved self-efficacy in handling challenging behaviours was partly responsible for PDC30’s effect on caregiver burden, the main drivers of the intervention effects on mood, positive gains, and even burden, were increased use of positive reappraisal and a strengthened belief in one’s ability to avoid negative thoughts.

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Though psychoeducation with embedded psychotherapeutic components is beneficial for dementia caregivers, interventions tend to be regimented, without accommodating individual needs and preferences. As population ages and demand for accessible, personalised support grows, especially where in-person services are limited, the potential of web-based, self-guided programmes remains unclear.

Positive Dementia Caregiving in 30 Days (PDC30), the first fully automated, self-guided online intervention for dementia caregivers, was developed to be globally accessible and adaptable to diverse user needs. This study evaluated PDC30’s effectiveness in an international sample.

Family dementia caregivers having been in the role for ≥3 months, providing ≥10 weekly care hours, scoring ≥5 on Patient Health Questionnaire-9 (PHQ-9), and passing a simple English comprehension test, were recruited via the internet. 274 eligible participants from 43 countries were allocated to treatment and 1-month waitlist-control using computer-generated simple randomisation. The intervention provided information on dementia care, interactive psychotherapeutic skill-building applications, and a generative artificial intelligence chatbot for personalised advice. Primary (depression) and secondary outcomes (anxiety, burden, and positive gains) were assessed via online questionnaires (PHQ-9, brief Profile of Mood States-Anxiety Subscale [POMS-A], brief Zarit Burden Interview [ZBI], and brief Positive Aspects of Caregiving Scale [PACS], respectively) at baseline and monthly intervals over three months. Intent-to-treat analysis was conducted using mixed-effects regression to examine trajectory changes in the outcome variables due to treatment. This completed trial was registered with ClinicalTrials.gov, NCT06409455.

At 1-month follow-up, coinciding with exclusive access to PDC30, intervention caregivers showed significant improvements in PHQ-9 (adjusted mean difference = ‑1.79, 95% CI = ‑2.93 to ‑0.64, p = 0.002, d = ‑0.37), ZBI (adjusted mean difference = ‑1.59, 95% CI = ‑2.69 to ‑0.49, p = 0.005, d = ‑0.34), and PACS (adjusted mean difference = 2.21, 95% CI = 1.33 to 3.10, p < 0.001, d = 0.59). Further bolstering the evidence, the differences generally disappeared after control participants gained access to the intervention, while improvements in both groups were sustained thereafter. No effect was observed for POMS-A. Participants reported using the website several times weekly, were generally satisfied with it, and found the chatbot most helpful.

The findings demonstrate the feasibility, acceptability, and potential public health impact of PDC30, and support more developments of web-based, automated intervention for caregivers, especially in communities where conventional services are limited or inaccessible.

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Pseudodementia denotes potentially reversible cognitive impairment secondary to depression and may overlap with neurodegenerative presentations in late life. Beyond mood, psychodynamic, relational, and broader emotional processes can shape the salience and reporting of cognitive symptoms, treatment engagement, and functional impact.

To describe a longitudinal single-case of late-life depression with a pseudodementia presentation, examining temporal co-variation between mood and mnestic complaints, and exploring how psychodynamic/relational/emotional processes observed during routine follow-up may relate to symptom expression and treatment engagement.

Observational case report in community psychiatry (April 2024–September 2025). Baseline neuropsychology was consistent with amnestic Mild Cognitive Impairment (MoCA 28/30; impaired verbal learning/recall; preserved visual memory; executive inefficiencies; activities of daily living intact). Pharmacological management included a switch from escitalopram to vortioxetine with dose optimization. Psychiatric follow-up adopted a psychodynamic stance that explicitly considered emotional meaning and the patient’s relational context, with couple participation as clinically indicated. Cognitive rehabilitation was recommended. Outcomes were tracked through serial clinical interviews and session process notes.

Optimization of vortioxetine was associated with progressive mood improvement and a parallel reduction in memory failures. Fluctuations in cognitive complaints tended to cluster around emotionally salient or relationally tense contexts; this pattern emerged as a clinical impression and warrants systematic study. Work that addressed emotional meanings, acceptance of limitations, and patterns of relating coincided with better tolerance of errors and greater use of compensatory strategies. In contrast, adherence to cognitive rehabilitation was poor because the patient did not perceive benefit, whereas motivation and engagement were higher for psychodynamic/relational work. Transient autonomic symptoms occurred during emotionally intensive sessions (brief dizziness with normal blood pressure). Despite clinical gains, the neuropsychological profile remained compatible with amnestic MCI; daily functioning was preserved. Symptoms have not remitted, and the patient remains in active treatment.

In late-life depression with a pseudodementia phenotype, antidepressant treatment improved mood, but integrating a psychodynamic-informed clinical stance and attention to the relational/emotional context was associated with additional benefits in subjective cognition and behavior. The observed links between affective–relational processes and cognitive complaints are hypothesis-generating and should be evaluated in controlled studies to delineate mechanisms and identify who benefits most from this integrative approach.

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Bipolar disorder typically has its onset before age 40. Late-onset cases—defined as first manic episodes after age 50—are rare, representing fewer than 10% of new diagnoses after 50 and less than 5% after 60. In parallel to considerable progress in understanding and treatment of bipolarity, and despite growing interest in old age psychiatry, Late-onset bipolar disorder has remained relatively understudied, probably because of its complexity.

To report a clinical case of new-onset bipolar disorder in a 65-year-old man and discuss diagnostic, therapeutic, and pathophysiological considerations specific to late-onset presentations.

We report a clinical case based on medical records from the Department G of Psychiatry at RAZI Hospital.

A 65-year-old man with no prior psychiatric history presented with recurrent manic episodes. Investigations, including neuropsychological testing, laboratory studies, and neuroimaging, excluded organic causes, including dementias and metabolic or structural brain pathology.

He was initially treated with sodium valproate but developed severe refractory thrombocytopenia, preventing continued use. Carbamazepine was also contraindicated. Risperidone was initiated, with partial improvement at 4 mg/day, and clinical stabilization achieved only at 6 mg/day, highlighting the challenges of managing bipolar I disorder in older adults.

Late-onset bipolar disorder is likely a heterogeneous entity. Early- and late-onset cases share clinical symptoms, but different vulnerabilities and etiologies may exist. Understanding the aetiopathogenesis, including the influence of age-related changes is critical for management and prognosis.

Late-onset bipolar disorder, while rare, should be considered once secondary causes are excluded. Management in older adults is challenging due to comorbidities, treatment intolerance, and variable response, necessitating individualized pharmacological strategies, careful titration, and close monitoring. Further studies are required to clarify pathophysiology and optimize treatment.

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Sleep quality, depression, and quality of life (QoL) are closely interconnected, especially in the elderly population, where these factors significantly impact health and well-being.

Our study aimed to investigate the potential relationships between sleep quality, depression, and quality of life (QoL) in an elderly population.

Our study was a cross-sectional, descriptive, and analytical design conducted over a period of five months from July 2024 to November 2024. It included patients aged 65 and older who consulted general practitioners at two local clinics in the Sfax region. Data collection was carried out using a pre-established form. Sleep disorders were assessed using the validated Arabic version of the Pittsburgh Sleep Quality Index (PSQI) and the Arabic version of the Epworth Sleepiness Scale (ESS). Depression was assessed using the Geriatric Depression Scale (GDS-15). QoL was assessed using the SF-12 scale in its validated Arabic version.

Sixty patients participated in our study. The median age was 70 years [IQR (67-76.5)]. The sex ratio (M/F) was 0.7. The median overall PSQI score was 13 [11-15]. Sleep quality was poor in 65% of participants. An ESS score >10 was found in 90% of patients. The median ESS score was 13 [IQR (11-14)]. The prevalence of depression was 35%. The median GDS-15 score was 9 [IQR (6-13)]. The median physical health dimension score was 24.01 [IQR (21.3-28.46)] and the mental health dimension score was 44.54 [IQR (29.34-51.77)]. The overall PSQI score was correlated with the Epworth sleep score (p=0.040), the depression score (p=0.02, r=0.389), and the physical health dimension of the QoL scale (p=0.0001, r=-0.511). Depression was also associated with impaired mental health (p=0.0001, r=-0.653).

This study highlights significant correlations between poor sleep quality, depression, and impaired QoL in older adults. These findings underscore the importance of comprehensive care that includes screening and treatment for sleep disorders and depression to improve the well-being of seniors.

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The number of older adults in our society is increasing. Additionally, their medical and mental health problems. Considering the senile evolution of their health, specific care should be taken in order to help them age in a healthy way, in order to keep them independent.

To evaluate the relationship between depression and functional autonomy in older adults.

This cross-sectional, descriptive, and analytical study was conducted in two clinics in the governorate of Sfax between November 1, 2024, and January 31, 2025. Participants included patients aged 60 years or older at the time of the survey, lucid subjects without neurocognitive impairment, and those who provided their free and informed verbal consent. We opted for the Geriatric depression scale (GDS) to assess depression and the Activities of Daily Living (ADL, or the Katz scale) to evaluate a person’s functional autonomy.

Our study included 270 participants. The mean age was 67.33 ± 7.07 years. The sex ratio (M/F) was 0.8. The majority of participants had an educational level not exceeding high school. Married participants represented 73% (n=197). The socioeconomic status was low in 28.9% of cases (n=78). Among the participants, 68.9% (n=186) had a history of chronic somatic condition. Twenty-nine participants (10.7%) had definite depression. The mean ADL score was 5.49 ± 1.08, with extremes ranging from 0 to 6. Thirteen-point three percent were in a situation of mild dependence, 13.3% in a situation of moderate dependence, and 0.4% in a situation of severe dependence. The GDS scale score was significantly higher in subjects with loss of functional autonomy (5.15 vs. 4.15; p=0.046).

Maintaining a functional autonomy in daily activity was associated with lower scores on the depression scale in older adults, which can be a protective factor against depression. For the matter, promoting better health can help older adults to maintain a healthier style of life and therefore keep functional autonomy.

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