Body dysmorphic disorder (BDD) stands at the intersection of psychiatry and the silent language of the body, where the mirror reflects not reality but an unrelenting distortion. Patients often perceive themselves as disfigured or abnormal and sometimes have perceptions that brush into quasi-persecutory experiences, blurring the boundary with psychotic disorders. This sense of disfiguration can become magnified into an intolerable flaw, challenging clinicians to distinguish structural reality from psychopathological amplification.

Describe the case of a patient with an overwhelming preoccupation with mandibular retrognathism, who resorted to wearing a mask to hide what he perceived as unbearable deformity. Moreover, explore the diagnostic limbo between BDD and potential primary psychotic disorder.

Comprehensive psychiatric assessment, including family interviews and detailed mental state evaluation, with particular attention to the patient’s persecutory-like ideation—specifically, his conviction that others were staring at or commenting on his mandibular appearance. Diagnostic formulation carefully weighed BDD against the possibility of psychosis-spectrum pathology.

Initially, the patient arrived persistently wearing a mask, symbolizing self-protection and self-image issues. He exhibited depressed mood, anhedonia, restricted affect, and rigid attribution of blame toward his mother for his perceived mandibular retrognathism. Psychotic phenomena, including persecutory ideation and possibly auditory-verbal due to inappropriate head turns and facial expressions, could not be excluded. Family engagement illuminated premorbid personality traits, mannerisms and the evolution of the symptoms.

This case underscores the fragile threshold between BDD and psychotic-spectrum pathology, where distorted reflections of self manifest in both behavior and interpersonal relationships. Recognising such overlap is vital, as treatment relies on a multimodal intervention, integrating psychotherapy, pharmacotherapy, and family support are essential. The mask, rather than offering relief, symbolised the split between external concealment and internal torment.

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Introduction- Traumatic brain injury neuropsychiatric results are important causes of morbidity. Among of theme are the obsessive-compulsive disorders (OCD).

Aim-Aim of this study is to present cases with obsessive-compulsive disorders as a result of traumatic brain injuries in middle age people

Material-Methods-10 patients are presented.7 males (70%) and 3 females (30%) Range of age between 50-65 years old. All of theme (10-100%) were evaluated, with clinical and radiological exam(ct,mri) plus diagnostic tests for Obsessive-compulsive disorders

Results-Good results in 8 cases (80%) and moderate in 2 (20%). Collaboration between various medical disciplines is essential in order to achive optimal results and clarify the theory,the etiology, and treatment effectiveness.

Conclusion-Premorbid status can be obtained by structured psychiatric interviews, and traumatic brain lesions can be defined with advanced neuroimaging techniques

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Introduction- Cervical spine neuropsychiatric results are important causes of morbidity. Among of theme are the obsessive-compulsive disorders (OCD).

Aim-Aim of this study is to present cases with obsessive-compulsive disorders as a result of cervical spine injuries in geriatric patients

Material-Methods-10 patients are presented.9 males (90%) and 1 females (10%) Range of age between 70-80years old . All of theme (10-100%) were evaluated, with clinical and radiological exam(ct,mri) plus diagnostic tests for Obsessive-compulsive disorders

Results-Good results in 6 cases (60%) and moderate in 4 (40%). Collaboration between various medical disciplines is essential in order to achive optimal results and clarify the theory,the etiology, and treatment effectiveness..

Conlusions-Premorbid status can be obtained by structured psychiatric interviews, and traumatic brain lesions can be defined with advanced neuroimaging techniques.

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Cognitive models of obsessive-compulsive disorder (OCD) have indicated that perfectionism constitutes one of the dysfunctional cognitive patterns contributing to the disorder’s etiology. Perfectionism represents a multifaceted psychological construct that is frequently associated with childhood trauma.

The present study aimed to investigate the specific impact of childhood traumatic experiences and perfectionism tendencies on the severity of OCD symptoms.

This case–control study included 76 outpatients who presented to the Department of Mental Health and Diseases at Turgut Özal Medical Center and were diagnosed with OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. The control group consisted of 80 individuals with no prior history of psychiatric disorders, who were comparable to the patient group in terms of sociodemographic characteristics. Both groups completed a series of assessment instruments, including the Yale–Brown Obsessive–Compulsive Scale – Self-Report Form, the Frost Multidimensional Perfectionism Scale, and the Childhood Trauma Questionnaire.

When compared with the control group, the patient group demonstrated significantly higher scores in the perfectionism subdimensions of concern over mistakes, parental criticism, and doubt about actions, as well as in maladaptive perfectionism and total perfectionism scores. In addition, the patient group showed significantly higher scores in emotional abuse, emotional neglect, physical abuse, and total childhood trauma compared to the control group.A significant positive correlation was observed between the total childhood trauma score and the perfectionism subdimensions of concern over mistakes, parental criticism, and doubt about actions. Furthermore, OCD symptoms also demonstrated significant positive correlations with the same perfectionism subdimensions.In the organization subdimension, a non-significant negative correlation was observed, which appeared only within the patient group.

The observation that significant positive relationships among childhood trauma, OCD symptom severity, and specific perfectionism subdimensions were also present in the control group suggests that these associations may be more closely related to symptom severity rather than being disorder-specific. On the other hand, the non-significant negative correlation observed in the organization subdimension, which was present only in the patient group, appears to reflect an OCD-specific characteristic. This finding implies that the absence of adaptive perfectionism may play a role in the onset or maintenance of psychopathology in individuals with OCD. Overall, the study emphasizes the need for future research with larger samples and causal model testing to better elucidate the nature of these complex relationships.

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Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder characterized by obsessions and compulsions. The boundary between OCD and psychotic disorders has been debated, with certain subtypes demonstrating overlapping features. In cases where compulsions are excessively dominant, the persistent reinforcement of perceived threats may create fertile ground for paranoid ideation. This paper examines the contribution of compulsive dominance to paranoid cognition through neurobiological, cognitive, and psychodynamic perspectives, and discusses clinical observations and therapeutic strategies.

This article explores how excessive dominance of compulsive behaviors in obsessive-compulsive disorder (OCD) may contribute to the development of paranoid ideation.

Through literature review and clinical observations, the cognitive, neurobiological, and psychodynamic mechanisms linking compulsive symptoms with paranoia are examined.

Compulsive dominance in OCD may evolve into paranoid ideation, representing a distinct clinical subgroup. Serotonergic deficits, dopaminergic hyperactivity, CSTC dysfunction, and impaired reality testing all contribute to this transformation. Clinical observations support the progression from compulsive behaviors to paranoid beliefs.

In conclusion, compulsive-dominant OCD with paranoia requires tailored interventions. Pharmacological management should combine SSRIs with antipsychotic augmentation, while psychotherapeutic strategies must address both compulsive rituals and paranoid schemas within an integrated framework.

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Aging involves gradual changes in physical, cognitive, and emotional functions, often leading to social isolation, anxiety, and reduced life satisfaction. Positive memory therapy, or nostalgia, has emerged as a non-pharmacological intervention that reconnects older adults with meaningful past experiences, enhancing psychological well-being, social engagement, and emotional stability. Previous studies highlight nostalgia’s role in improving mood, social interaction, and sense of security.

This study aimed to

1. (1) assess the level of nostalgia among older adults in a Bethlehem nursing home,

2. (2) measure their sense of belonging and tranquility,

3. (3) examine nostalgia’s predictive capacity in enhancing belongingness and tranquility,

4. (4) explore differences by gender and length of stay.

A descriptive correlational design was used. The population included 70 older adults, with a random sample of 40 participants. Data were collected using a validated and reliable 46-item questionnaire covering nostalgia, belongingness, and tranquility. Responses were scored on a five-point Likert scale. SPSS was used for descriptive statistics, t-tests, and simple regression analyses.

Participants exhibited high levels of nostalgia (M = 4.56, SD = 0.31) and belongingness (M = 4.65, SD = 0.22). Nostalgia significantly predicted belongingness (R² = 0.116, p = 0.032) and tranquility (R² = 0.255, p < 0.001). No significant differences were observed based on gender or length of stay, indicating equal benefits of nostalgia therapy across demographic groups.

Nostalgia effectively enhances belongingness and tranquility among older adults. Recalling positive memories provides emotional support, strengthens social connections, and promotes psychosocial stability, making it a valuable intervention in nursing home settings.

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Physical activity has been consistently associated with improved cognitive functioning in older adults. However, the underlying biological and psychosocial mechanisms through which these benefits are realized remain only partially understood. Previous studies were limited by methodological shortcomings or an overreliance on experimental designs, thus constraining the generalizability of their findings to broader populations.

This systematic review aimed to critically evaluate and synthesize the existing literature on the mediating and moderating mechanisms that explain the relationship between physical activity and cognitive performance in adults aged 60 years and older.

A comprehensive search of PubMed and Scopus databases was conducted from their inception through April 2025. Eligible studies quantitatively assessed physical activity, reported cognitive outcomes, and included analyses of mediation and/or moderation effects. Study designs encompassed randomized controlled trials, longitudinal, cross-sectional, and experimental approaches. Data extraction was performed independently by two reviewers, and methodological quality was assessed based on seven established criteria.

Fifty-six studies met inclusion criteria: 44 examined mediation effects, 10 explored moderation, and 2 addressed both. Strong evidence identified depression and sleep quality as robust mediators of the PA–cognition relationship. In contrast, support for neurocognitive and physiological pathways ranged from limited to moderate. Moderating factors such as genetic predispositions (e.g., APOE genotype), age, comorbidities, and psychosocial context demonstrated inconsistent or weak evidence. Notably, 93% of the included studies were rated as high quality.

Physical activity influences cognitive functioning in older adults through multiple, interrelated mechanisms. Among these, depression and sleep quality emerged as particularly consistent mediators. Future research should prioritize integrative and longitudinal methodologies to unravel causal pathways and guide the development of targeted interventions aimed at preserving cognitive health in aging populations.

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Chronic use of benzodiazepines (BZD) among the elderly is a major public health concern due to the risk of dependence, cognitive decline, and psychiatric comorbidities.

We aimed to describe the consumption patterns and dependence profile of elderly psychiatric outpatients using BZD.

A cross-sectional study was conducted among patients aged 65 years and older attending outpatient psychiatric consultations. Data collected included benzodiazepine use, attempts at withdrawal, concomitant medications, and substance use. Psychometric assessments were performed using the Benzodiazepine Attachment Scale (ECAB), the Hospital Anxiety and Depression Scale (HADS-A and HADS-D), and the Mini-Mental State Examination (MMSE) to assess cognitive function.

Seventy-three patients were included (male/female ratio = 1.08). Psychoactive substance use was reported by 81% of patients, and polysubstance use by 41%. BZD consumption was found in 69% of cases (n = 51), with a mean duration of use of 23.3 years (range: 2–40 years). The most frequently used molecule was lorazepam, reported in 61% of cases. During the six months preceding the study, BZD use was daily in 92% of cases. Among the 51 BZD users, 31 patients (61%) had attempted withdrawal; among them, 27 (87%) reported failure. The main reasons for withdrawal failure were withdrawal syndrome (48%) and reappearance of initial symptoms (44%).

Among the 51 patients who used BZD, 41 (80%) met the criteria for dependence. A significant association was observed between BZD dependence and living in urban or semi-urban areas (p = 0.04). Clinically, dependence was significantly linked to the presence of personal somatic history (p = 0.021), depressive and bipolar disorders (p = 0.024), younger age at onset of psychiatric illness (p = 0.05), and longer illness duration (p = 0.035).

Regarding substance use, BZD dependence correlated with caffeine use (p = 0.021), stimulant use (p = 0.024), and polysubstance use (p = 0.038). Strong associations were also found with the duration (p < 0.001) and frequency (p = 0.021) of BZD use, as well as with failed withdrawal attempts (p < 0.001). On psychometric assessment, dependent patients showed significantly higher HADS-D (p = 0.001) and HADS-A (p = 0.005) scores, indicating more severe depressive and anxious symptomatology. Regarding cognitive performance, a negative correlation was observed between age (in years) and MMSE score among dependent patients (p = 0.001), while this association was less pronounced in non-dependent patients (p = 0.016).

BZD dependence in the elderly is associated with marked anxiety-depressive symptoms and cognitive decline. These findings highlight the importance of systematic assessment of dependence, mood, and cognitive function in elderly BZD users, to implement integrated, gradual, and tailored management strategies for this vulnerable population.

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Depression and anxiety are common in elderly psychiatric patients and are often associated with cognitive decline and behavioral dysregulation. Understanding the relationships between mood symptoms, impulsivity, and cognitive performance is crucial for tailored interventions in this vulnerable population.

We aimed to identify the associations between depressive and anxiety symptoms, impulsivity traits, and cognitive functioning in older adults receiving psychiatric care.

A cross-sectional study was conducted among patients aged 65 years and older attending outpatient psychiatric consultations. Psychometric assessments included the Hospital Anxiety and Depression Scale for anxiety (HADS-A) and depression (HADS-D), the Barratt Impulsiveness Scale – 11th version (BIS-11) for impulsivity, and the Mini-Mental State Examination (MMSE) for cognitive function. Correlations between mood symptoms, impulsivity, and cognitive performance were analyzed.

Seventy-three patients were included (male/female ratio = 1.08). The mean MMSE score was 22.63 (range: 11–30), indicating cognitive impairment in 42 patients (58%).

The median HADS-D score was 10/21 (IQR = [6–14]; range: 2–18), with depressive symptoms (HADS-D ≥ 11) observed in 39 patients (53%).

The median HADS-A score was 9/21 (IQR = [6.5–12]; range: 3–19), with anxiety symptoms (HADS-A ≥ 11) present in 49 patients (67%). The median BIS-11 score was 84 (IQR = [65.5–97.5]), with values ranging from 41 to 112.

Significant positive correlations were observed between depression scores (HADS-D) and impulsivity (BIS-11) (p = 0.005), as well as between anxiety scores (HADS-A) and impulsivity (BIS-11) (p < 0.01), indicating that higher levels of mood symptoms were associated with increased impulsivity. Additionally, depression (HADS-D) and anxiety (HADS-A) were negatively correlated with cognitive performance (MMSE) (p = 0.005 and p < 0.01, respectively), suggesting that higher mood symptom severity was linked to greater cognitive impairment.

In elderly psychiatric patients, depressive and anxious symptoms are associated with increased impulsivity and reduced cognitive function. These findings highlight the need for comprehensive assessment and integrated management of mood, behavior, and cognition in this population to improve clinical outcomes.

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Suicide in older adults is a growing public health concern, especially among those receiving psychiatric care. A comprehensive understanding of the clinical, psychosocial, and personality-related determinants of suicidal risk in this population is crucial for improving early detection and targeted prevention strategies.

This study aimed to identify the factors associated with increased suicidal risk among elderly psychiatric patients.

A cross-sectional study was conducted among patients aged ≥65 years attending psychiatric consultations. Clinical, familial, and psychosocial histories were also collected. Suicidal risk was assessed using the Ducher Suicide Risk Scale, while depression, anxiety, and impulsivity were measured using standardized scales: the Hospital Anxiety and Depression Scale – Depression subscale (HADS-D), the Hospital Anxiety and Depression Scale – Anxiety subscale (HADS-A), and the Barratt Impulsiveness Scale – 11th version (BIS-11).

Seventy-three patients were included (male/female ratio = 1.08). According to the Ducher Suicide Risk Scale, 60% of patients showed varying degrees of suicidal ideation, from transient thoughts to active intent.

Univariate analysis revealed that higher suicidal risk was significantly associated with depressive symptoms (HADS-D, p < 0.001), anxiety (HADS-A, p = 0.003) and impulsivity (BIS-11, p < 0.001). Other significant correlates included lack of religious practice (p = 0.03), history of violence (p = 0.01) or trauma (p = 0.001), legal history (p < 0.001), family history of psychiatric disorders (p = 0.025), suicide attempts (p = 0.002), or substance use (p = 0.017). Personality disorders (p < 0.001), previous suicide attempts (p < 0.001), absence of regret following a prior attempt (p = 0.001), and current suicidal ideation (p < 0.001) were also strongly associated with elevated suicidal risk.

In multivariate analysis, lack of religious practice (p = 0.029) and depressive symptoms (HADS-D, p = 0.018) emerged as independent predictors of suicidal risk.

Among elderly psychiatric patients, depressive symptoms and absence of religious practice are the strongest independent predictors of suicidal risk. The findings highlight the multifactorial nature of suicidality in late life, emphasizing the need for integrated screening of affective, psychosocial, and existential dimensions in geriatric psychiatric care.

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Prolonged benzodiazepine (BZD) use in elderly individuals has been associated with an increased risk of suicide.

This study aimed to investigate the relationship between BZD addiction and suicidal risk in older adults.

A cross-sectional study was conducted among patients aged 65 years and older attending outpatient psychiatric consultations. Data collected included benzodiazepine use and detailed assessment of suicidal history. Suicidal risk was assessed using the Ducher Suicidal Risk Scale, and benzodiazepine dependence was evaluated with the Benzodiazepine Attachment Scale (ECAB).

Seventy-three patients were included (male/female ratio = 1.08). Among the 51 patients who used benzodiazepines, 41 (80%) met the criteria for dependence. Nearly half of the patients (49%) reported a history of suicide attempts, with an average of 1.86 attempts (range: 1–4) and a mean interval of 24.9 years since the last episode (range: 2–43). Most attempts (58%) were described as impulsive rather than premeditated.

The most frequently reported motives were negative emotions (22%), family conflicts (19%), delusional ideas (17%), and hallucinations (11%). The most common method was intentional drug ingestion (28%), followed by strangulation (17%) and defenestration (17%); anxiolytics were involved in 60% of drug ingestions.

In 86% of cases, the act occurred when the patient was alone, most often at home (67%), predominantly during nighttime hours (20:00–04:00; 44%) and more frequently in autumn (39%). The suicidal act was mainly reactive in nature (44%).

According to the Ducher Suicide Risk Scale, 40% of patients expressed no death-related thoughts, whereas the remaining 60% presented a range from transient thoughts to active suicidal ideation.

BZD-dependent patients had significantly more frequent histories of suicide attempts (p = 0.01), a shorter duration between the last suicide attempt and the current evaluation (p = 0.03), and more frequent suicidal acts motivated by interpersonal conflicts or psychotic symptoms (delusions, hallucinations) (p = 0.045). They also presented suicidal ideation at the time of the interview (p = 0.045) and had higher scores on the Ducher scale compared to non-dependent patients (p = 0.005).

BZD addiction represents an independent risk factor for suicidality in the elderly. Systematic screening for suicidal risk iscommended in patients with chronic BZD use or dependence.

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Social isolation and feelings of loneliness are recognized as major contributors to suicidal behavior among the elderly.

We aimed to explore the relationship between perceived loneliness and suicidal risk in older adults followed in outpatient psychiatry.

A cross-sectional study was conducted among patients aged 65 years and older attending psychiatric consultations. Data collection included self-reported measures of loneliness, the 3-point Loneliness Scale and social isolation assessed through the Social Isolation Scale, which comprises a Social Link Index (ILS) quantifying social connections and a Close Relationship Index (IRE) evaluating the qualitative dimension of interpersonal bonds. Suicidal history and characteristics were explored in detail and complemented by the Ducher Suicide Risk Scale.

Seventy-three patients were included (male/female ratio = 1.08). A high prevalence of loneliness was observed, with 72% of participants reporting feeling lonely “often” or “sometimes.” More than half (51%) stated they had felt lonely during most of the past week, and 58% reported intensified loneliness during specific periods of the year, particularly in the evening (44%) and during summer holidays (23%).

The median score on the 3-point Loneliness Scale was 5 (IQR = 3–7). Regarding social isolation, 33% of participants were classified as socially isolated according to the ILS, while only 34% reported having close relationships (IRE).

According to the Ducher Suicide Risk Scale, 40% of patients expressed no death-related thoughts, whereas the remaining 60% showed varying degrees of suicidal ideation, from transient thoughts to active intent.

A significantly higher suicidal risk was correlated with greater subjective loneliness (p < 0.0001), higher scores on the 3-point Loneliness Scale (p < 0.0001), increased social isolation (p < 0.0001), and the absence of close relationships (p < 0.0001).

Loneliness was highly prevalent among elderly psychiatric outpatients and appeared closely intertwined with suicidal risk. The predominance of impulsive and reactive suicidal behaviors underscores the need for systematic screening of social isolation and emotional distress in this vulnerable population.

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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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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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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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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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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.

None Declared

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.

None Declared

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.

None Declared

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.

None Declared