Assessment of neuropsychiatric symptoms is crucial to the management of dementia. In this context, the Neuropsychiatric Inventory (NPI) is the most widely used comprehensive tool, assessing twelve domains (delusions, hallucinations, dysphoria, anxiety, agitation/aggression, euphoria, disinhibition, irritability/lability, apathy, aberrant motor activity, night-time behaviour and appetite/eating abnormalities). NPI records severity, frequency and caregiver distress. It has been translated and validated into a number of languages and shown to be reliable in cross-cultural studies.

To present preliminary results of the NPI Portuguese validation study.

A cross-sectional study was conducted with a convenience sample of institutionalized elderly (≥ 60 years old) in three Nursing Homes in Portugal. All patients were also assessed with MMSE (cognition) and GDS (depression). NPI was administered to a formal caregiver, usually from the clinical staff. Inter-rater and test-retest reliability were assessed in a subsample of 25 randomly selected elderly.

The sample included 166 elderly, with a mean age of 80.9 (10.2sd). Three out of the NPI behavioural items had significant negative correlations with MMSE: delusions (r=−0.177, p=0.024), disinhibition (r=−0.174, p=0.026) and aberrant motor activity (r=−0.182, p=0.020). The NPI subsection of depression/dysphoria correlated positively with GDS total score (r=0.166, p=0.038). NPI showed good internal consistency (overall α=0.766; frequency α=0.737; severity α=0.734). The inter-rater reliability was excellent (ICC=1.00, CI95% 1.00–1.00), as well as test-retest reliability (ICC=0.91, CI95%0.80–0.96).

These results suggested that the Portuguese version is a valid and reliable instrument for the evaluation of neuropsychiatric symptoms in elderly people.

Major depressive disorder (MDD) is a complex disorder and recent research suggests that muliple genetic and environmental factors seem to underly MDD criteria as well as seem to influence brain structure and function.

Aim of the study was to investigate whether epigenetic regulation and mRNA expression of glucocorticoid inducible genes (SGK-1, GILZ) are associated with structural alterations in hippocampal subfields and functional brain changes. Moreover, we investigated whether there are interactive effects between the genetic variant of the BICC1 gene and ELA.

Patients with MDD and healthy controls were investigated using structural magnetic resonance imaging (MRI) and functional MRI with an emotion inhibition task. Analysis of a single nucleotide polymorphism in the BICC1-1 (rs999845) gene as well as mRNA expression and methylation of DNA was performed.

Hippocampal subfield volumes of dendate gyrus and CA2 were reduced in patients with MDD. These were associated with reduced mRNA expression of glucocorticoid inducible genes and with DNA methylation. Moreover, MDD patients with a history of ELA, who carry the protective T-allele, had smaller hippocampal head volumes compared to MDD patients without ELA. FMRI showed that patients and controls carrying the protective T-allele of BICC1 activate the emotion regulation system significantly more compared to those participants homozygous for the major C-allele (p<0.05, family wise error corrected).

These results are suggestive for environment x gene interactions in MDD and for the impact of epigenetic regulation on brain structure and function.

Spherocytosis is an inherited hemolytic anemia, most common on northern Europe, that causes variable degrees of anemia, jaundice, splenomegaly and in severe cases adolescents are transfusion-dependent prior to esplenectomy.

Chronic illnesses are known to provoke psychosocial dysfunction in affected children and their families. The risk of psychiatric disorder increases with the number of such family's adverse factors as marital discord, low social status and parental psychiatric disorders. It has been reported that children with two family risk factors have a fourfold increase in rate of disorder.

This paper aims to describe the features of psychiatric and psychosocial maladjustment in a patient firstly diagnosed as having sickle cell disease.

We describe a 16-year-old girl with homozygous hereditary spherocytosis admitted to the outpatient Child and Adolescent Psychiatry Department who developed progressive social isolation.

Her psychiatric condition had been evolving since fifth grade, when she started blood transfusions and stricter clinical surveillance. A favorable trend was observed after strategic family therapy and individual cognitive-behavioural therapy focusing on anxiety and shyness desensitization intending to overcome friendship difficulties and improve social assertiveness.

In psychosocial management of physical illnesses, assessment and care should include a focus on families besides the affected individual only. This study suggests that the bio psychosocial approach to health care and consultation-liaison psychiatry should be emphasized.

Major depression is a debilitating and recurrent disorder with a substantial lifetime risk and a high social cost.

1. - To establish the course of the first major depressive episode (MDE) in a population of students.

2. - To identify the various factors involved in this process.

Retrospective and descriptive study on 40 students followed in Psychopedagogie’ consultation in the department of Psychiatry B, Hedi chaker hospital in Sfax Tunisia from 2009 to 2013. The statistical analysis was performed by the SPSS (version 18).

The average age of the group was 22,8 years. Twenty-three women (57,5%) were included. All of patients were single. The socioeconomic level of the group was fair in 62,5% of cases. Twelve subjects had a family history of psychiatric illness. Prevalence of unipolar depression was 82,5%. Majority of patients were treated with only pharmacological means (77,5%). The general evolutif course in our subjects tends to improvement (37,5%). Six patients had a complete recovery. The persistence of residual symptoms was found in 12 patients. Deterioration in social and professional functioning was reported in12 patients. Six patients have had relapse. The recurrence of MDE was reported in 2 patients. Chronicity was founded in 4 patients. Two patients had a new suicide risk. One patient had an emergence of mood episode. No patient had spontaneous improvement. Nine patients have stopped the follow. The main reason of worsening was the emergence of an intercurrent stress factor (52,5%).

The negative impact of depression in our patients explains the necessity of a well adapted management.

We used British national survey data to test specific hypotheses that mood instability 1) is associated with psychosis and individual psychotic phenomena, 2) predicts the later emergence of auditory hallucinations and paranoid ideation, and 3) mediates the link between child sexual abuse and psychosis.

We analysed data from the 2000 and 2007 UK national surveys of psychiatric morbidity (N=8580 and 7403 respectively). The 2000 survey included an 18-month follow-up of a subsample (N=2406). Mood instability was assessed from the Structured Clinical Interview for DSMIV Axis II (SCID-II) questionnaire. Our dependent variables comprised auditory hallucinations, paranoid ideation, the presence of psychosis overall, and a 15-item paranoia scale

Mood Instability was strongly associated in cross-sectional analyses with psychosis (2000 OR: 7.5; 95% CI: I 4.1–13.8; 2007: OR 21.4; CI 9.7–41.2), paranoid ideation (2000: OR: 4.7; CI 4.1–5.4; 2007: OR 5.7; CI 4.9–6.7), auditory hallucinations (2000: OR: 3.4; CI 2.6–4.4; 2007: OR 3.5; CI 2.7–4.7) and paranoia total score (2000: Coefficient: 3.6;CI 3.3–3.9), remaining so after adjustment for current mood state. Baseline mood instability significantly predicted 18-month inceptions of paranoid ideation (OR: 2.3;CI 1.6–3.3) and of auditory hallucinations (OR: 2.6;CI 1.5–4.4). Finally it mediated a third of the total association of child sexual abuse with psychosis and persecutory ideation, and a quarter of that with auditory hallucinations.

Mood instability is a prominent feature of psychotic experience, and may have a role in its genesis. Targeting mood instability could lead to innovative treatments for psychosis.

Methylphenidate (MPH) abuse is well established especially among young people in USA. In France, MPH is indicated in treatment for attention deficit/hyperactivity disorder (ADHD) in children and narcolepsy in children and adults. Since its release onto the market, MPH abuse has been progressively increasing by individuals close to children treated with MPH and especially by patients to whom MPH is prescribed offlabel or obtained in black market.

We report the results of a national survey on abuse and off-label use of methylphenidate.

Assessment of data collected between 2000 and 2011 from the Nots, OPPIDUM and OPEMA databases (tools for monitoring psychoactive substance misuse).

MPH abuse and misuse were identified in 245 patients (168 in NotS, 68 in Oppidum and 9 in Opema). In NotS database, subjects were predominantly males (65%), aged between 12 and 74 years. When specified (122 cases), the sustained release form was used in 83% of cases and maximum daily MPH intake reached 2520 mg. MPH was injected (20%) or snorted (4%). Polydrug use was noted in 77% of cases. Regarding Oppidum and Opema databases, patients were exclusively adults and supported for drug addiction. In these cases, MPH was obtained by medical prescription (61%) and/or in black market (36%).

The medical practice of off-label prescription of MPH to treat ADHD or drug addiction in adults is the main problem in France. Another new aspect is that MPH is also diverted by teenagers, with or without ADH, for its stimulant and concentration-enhancing properties.

Cognitive impairment is often characterized as trait features of bipolar disorder.

To evaluate possible impairment of attention and executive function in bipolar patients.

Improving life quality of bipolar patients with cognitive deficits.

75bipolar (depressive: Hamilton Depression Rating Scale score>=17, manic/hippomanic: Young Mania Rating Scale score >=12, euthymic:6month of remission, HAMDscore<=8, YMRSscore<=6) patients (DSMIVTR). All the patients were free of psychotic symptoms at the moment of neurocognitive evaluation. Comparison group consisted of 25 healthy subjects without history of neurological and/or psychiatric disorder. Cognitive battery included standardized test of IQ, attention, working memory, visual memory, verbal memory and executive functioning. Demographic data, data about family history, information about psychiatric history, past and current treatment, history of psychosis, duration of illness, age of onset were collected. We analyzed statistically these data and evaluate impairment of attention and executive dysfunction.

Stable and lasting cognitive impairments involving attention and executive functioning (working memory, executive control, verbal fluency, mental manipulation and cognitive flexibility) are evident across all phases of illness. Longer durations of mood disturbance and higher number of hospitalization are negatively correlated with executive function.

Deterioration of executive functioning is related of hospitalization for mania. Attention and executive function are deteriorated by the recurrence of episodes. Sustained attention is impaired during mania, depression, euthymia. Selective attention deficits during acute episodes don’t normalize during euthymia.

Bipolar patients exhibit widespread neurocognitive dysfunctions during their lives, and attention and executive function are important impaired domains regardless illness phases.

Intimate partner violence (IPV) accounted for 62.4% of the total interpersonal violence burden in women. Various studies have identified the mental health consequences of intimate partner violence, with PTSD and depression as the most commonly identified disorders, but less have analysed the role of different type of violence.

The aim of this study was to assess the contributions of different forms of intimate partner violence (physical violence, sexual violence, psychological abuse, and stalking) on symptoms of posttraumatic stress disorder (PTSD) and depression.

In all 160 women consecutively receiving a protection order in the South of Italy were assessed by an external interviewer. Hierarchical regressions tested the unique effects of different types of intimate partner violence on PTSD and depression.

In terms of PTSD symptoms, more than half (68.2%) of the sample reported PTSD and 77.4% reported severe depression symptoms. Two types of intimate partner violence (physical and sexual) were significantly associated with depressive symptoms, while only psychological violence was moderately correlated with PTSD symptoms. Physical abuse contributed to the prediction of depression and psychological abuse to PTSD.

A significant number of women with protection orders suffer from PTSD and depression. The results confirm a relationship between severity of intimate partner violence and mental health problems (PTSD and depression). Assessment of intimate partner violence should incorporate the multiple dimensions that have been identified as contributing to poor mental health.

The special mental states such as hallucination and confusion in schizophrenia have been creating obstacles in research in spirituality in this population. Although primary treatment should focus on symptom management, psychosocial and spiritual care should not be neglected. This study aimed to understand spirituality from the perspectives of both the patients and the healthcare professionals and its role in different stages of disease and rehabilitation.

Schizophrenic patients (n=22) and healthcare professionals including psychiatric doctors, nurses, and social workers (n=19) were recruited from an out-patient clinic of a hospital and a mental health rehabilitation complex. Semi-structured interviews on the meaning and experiences of spirituality, and its role in rehabilitation were conducted, with follow-up interviews when further clarification was needed. Interviews were transcribed into verbatim and analyzed with the assistance of computer software based on Ground theory. Trustworthiness was assured through member checking and peer scrutiny.

Both patients and professionals regarded spirituality as an inherent part of the patients’ well-being. Spirituality could be a practice, a way of thinking, sense of peace and fulfillment, and connectedness towards oneself, others, and a higher power. Spiritual experiences were helpful in the rehabilitation phase. However, some patients considered spirituality as apparitional experiences, thus hindered their recovery.

This study demonstrated that the spirituality played a part in patients’ lives and rehabilitation. Findings suggest the importance of spiritual care in this population and provide insights and roadmap for developing spiritual assessments and holistic care in psychiatric context.

This study is supported by RGCGRF/HKU745511H.

Previous studies have presented different factorial structures using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). The core elements of burnout include emotional exhaustion, depersonalization, and a lack of personal accomplishment. The MBI-HSS is the most widely used questionnaire to evaluate burnout, and has been applied to various healthcare providers.

To investigate the factorial structure of a Portuguese version of the MBI-HSS for nurses in Portugal.

Secondary data analysis was implemented to explore the factor structure of MBI-HSS using exploratory factor analysis (EFA). Confirmatory factor analysis was then performed to verify the modified structure for nurses in Portugal. The data provided for this study were obtained from nurses (n = 146) from 15 surgical and medical units.

The EFA found that three factors explaining 59% of the variance were extracted, and 20 out of 22 items were retained. The goodness-of-fit test was the performed using the CFA approach, and verified that the modified version of MBI-HSS is a suitable instrument for measuring burnout for nurses in Portugal.

The results confirmed the factorial structure of MBI-HSS for nurses in Portugal with a three-dimension, 20-item assessment, and the variance was not diminished in this sample. These findings demonstrate that the modified version of MBI-HSS provides a suitable instrument for measuring burnout for Portuguese nurses. Similar to other cultures, our population retained each of the items based on the theoretical structure.

Globally there is apprehension about a nursing workforce shortage. To date, no studies have connected quality of work life with other contributing and co-existing factors such as depression, anxiety and stress.

This study explores the association of the quality of compassion fatigue and compassion satisfaction with anxiety, depression and stress and builds a portrait of nursing profiles to identify the factors/triggers that move a nurse from normally functioning, to at risk or very distressed levels.

Exploratory cross sectional survey of 112 registered nurses working in several departments of a Portuguese tertiary hospital using a self-report survey tool to collect data.

Burnout and secondary traumatic stress were significantly related to higher levels of anxiety and depression. Higher anxiety levels were correlated with nurses that were younger in age, working 40 h per week, and without a postgraduate qualification. Older and more experienced nurses exhibited higher levels of compassion satisfaction. Twenty percent had elevated levels of compassion fatigue, with 7.6% of the sample having a very distressed profile. At risk nurses stress and depression scores were significantly higher than nurses with higher compassion satisfaction scores.

In recognition of the importance of continuing professional education and in line with previous studies into burnout in preregistration nurses, educators should advocate including strategies in undergraduate and postgraduate nursing programs that facilitate students identifying and managing compassion fatigue and build personal resilience through the development of positive coping strategies.

Bipolar patients show broad cognitive deficits during entire course of the illness.

To evaluate a possible relationship between a severe course of illness and cognitive impairment in bipolars.

Improving life quality of bipolar patients with cognitive deficits.

75bipolar (depressive:Hamilton Depression Rating Scale score>=17, manic/hippomanic: Young Mania Rating Scale score>=12, euthymic:6month of remission, HAMDscore<=8, YMRSscore<=6) patients (DSMIVTR). All the patients were free of psychotic symptoms. Comparison group consisted of 25healthy subjects without history of neurological and/or psychiatric disorder. Cognitive battery included standardized test of IQ, attention, executive functioning, memory (working, visual, verbal). Demographic data, data about family history, psychiatric history, past/current treatment, psychosis history, duration of illness, age of onset were collected. We analyzed statistically these data and evaluate relationship between severe course of illness and cognitive impairment.

Cgnitive deficits are more frequent in bipolars with more severe course of illness, as indicated by: longer durations of mood disturbance (negatively correlated with executive function, psychomotor speed, attention, concentration and verbal memory-associated with a higher number of past manic episodes too), younger age at onset, history of multiple and frequent episodes (with manic episodes impacting neuropsychological impairment most extensively; attention and executive function deteriorated by the recurrence of episodes) and higher number of hospitalization (negatively correlated with visual and verbal memory, verbal fluency, spatial memory, psychomotor speed, executive function).

Svere course of illness influence cognitive status of bipolars. There's need for further clarification regarding the magnitude, clinical relevance and confounding variables of cognitive deficits in bipolars.

The annual global suicide mortality rate is 16 per 100,000 and suicide attempts are 20 times more frequent. We aimed at comparing patients referring to the emergency room (ER) for self-inflicted injury vs those needing psychiatric consultation for other reasons, in order to assess possible predictors of self-injury.

Determinants of ER psychiatric consultations were studied prospectively during the period 2008–2011 at the ‘Maggiore’ Hospital in Novara. A multivariate analysis was performed using a logistic regression in order to assess the potential predictors of self-injury behaviors. Results are expressed as Odds Ratio (OR) with 95% Confidence Intervals (95%CI). Statistical significance was set at p≤0.05.

In a sample of 1888 psychiatric consultations, 280 (14.8%) were due to self-inflicted injuries. Female gender (OR: 1.51; p=0.005) was found to positively correlate with attempted suicides, whereas unemployment (OR: 0.68; p=0.013) and being in the colder months of the year (OR: 0.75; p=0.043) were found to be negative correlated. A positive trend without statistical significance was observed for foreign nationality, being not married and living with parents/own family vs a negative trend was found for history of psychiatric disorders.

In accordance with other studies, we observed the female gender positively correlates with attempted suicides and sunlight may act as a trigger. In contrast with literature, individuals with a permanent job would be at higher risk of self-injury behaviours, whereas having a history of psychiatric disorders and being under the care of a psychiatrist might be a protective predictor.

Activation of microglial cells is currently explored in schizophrenia pathophysiology. Post-mortem immunohistochemistry remains the most accurate method to investigate microglial morphology and function, since high microglial plasticity limits extrapolation of in vitro and animal research results to the human brain.

To investigate microglial morphology and activation patterns, we performed immunohistochemistry with specific microglial markers: Iba1 (marker of resting and activated microglia), CD68 (marker of microglial lysosomes, indicative of phagocytic microglia) and CD64 (FcγRI, binds IgG) on formalin fixed paraffin embedded brain tissue from the Corsellis Collection (BRAIN UK), in 15 schizophrenia cases and 15 nonneurological controls. Immunostaining was quantified by image capture and analysis (Image J, NIH, US) to provide a measure of protein load. We also reviewed existing literature on microglial immunostaining in schizophrenia using Pubmed.

Few studies have examined post-mortem microglia in schizophrenia, mostly with HLA-DP/DQ/DR markers. Although frequently studied in neurological disorders Iba1, but also CD64 were never previously investigated in schizophrenia patients. Two studies explored CD68, but results were misinterpreted for resting state tissue macrophages. Our pilot study shows Iba1, CD68 and CD64 can detect microglial cells in schizophrenia brain tissue, but considerable heterogeneity exists both in patients and controls, probably due to confounding by clinical variables, e.g. age and cause of death.

Future research needs careful selection of cases and controls to minimize heterogeneity due to confounding clinical variables. Highly specific microglial markers such as Iba1, CD64 and CD68 are very useful and ought to be introduced into schizophrenia research.

Eating Disorders (EDs) are chronic illnesses requiring long-term care and significant involvement of carers. Expressed Emotion (EE) is a measure of the ‘emotional temperature’ of a family: an index of the relative's emotional answer in a certain situation. Literature suggests that EE scores are usually low in EDs families and the degree of family EE correlates with patients’ outcome.

To compare EE, life events and anxiety between patients with diagnosis of EDs and patients with other psychiatric diagnosis.

To measure the level of EE in EDs families in order to improve the quality of health care.

We administered the following tests to 20 patients with EDs and 20 patients with other psychiatric diagnosis: the Level of Expressed Emotion Scale (LEE) in two versions, one for patients and one for relatives with the purpose of evaluating intrusiveness, emotional response, attitude toward disease, tolerance and expectation; the Paykel's Interview for recent life events in which the subjects had to point out stressful events; STAI Y1 concerning state anxiety and STAI Y2 concerning trait anxiety. We also recruited co-habiting relatives and compared the relative's EE and the EE perceived by patients.

Statistical analyses are still in progress. Our preliminary results suggest that levels of EE are higher among the patients with a diagnosis of EDs, in contrast with results obtained by literature.

We expect that our results will help to shed light on the issue of EE correlates to EDs.

NGR3 substance is usually in the form of a white powder that is consumed by humans to create a legal high; feelings of euphoria and reduce tiredness. It is a GHB analogue and when consumed turns into GHB in the body. A 40year old male patient who ingested NRG3 was admitted thrice with symptoms of hearing voices, hyperactivity, agression and the inability to sleep.

To determine the probability of onset of psychotic symptoms as an effect of ingestion of NRG3.

To apply Naranjo's ADR probability scale and on the basis of the weighted questions of the scale, which examine factors such as temporal association of drug administration and event occurrence, alternative causes for the event, drug levels, dose-response relationships and previous patient experience with the substance NRG3.

Using the scale, the score indicated that there was a definite adverse drug reaction with NRG3.

A definite adverse drug reaction of psychotic symptoms did occur with the ingestion of NRG3.

Baseline values and early changes of emotional reactivity, cognitive speed, psychomotor function, motivation and sensory perception have been poorly studied in unipolar depression, although they could help to characterize different dimensions harder to capture by clinicians, give new insights on how patients are improved, and offer new markers depicting how early changes testify later treatment response.

1565 adult outpatients with MDD receiving agomelatine completed QIDS-C, CGI and MATHYS scales at inclusion, W2 and W6. The MATHYS includes 20-item self-rated visual analogue scales (from inhibition -0- to activation -10- with -5- representing the usual state) leading to five a priori dimensions (emotional reactivity, cognitive speed, psychomotor function, motivation and sensory perception).

All dimensions increased from inclusion to W2 and from W2 to W6 (p<10−3). Roughly, improvement was 2-point (out of 10) for motivation, 1.5 for psychomotor function and 0.5 for other dimensions.

Motivation: (1) had a trend as being more severe at inclusion in later non-responders (t=1.25, df=1563, p=0.10) (2) displayed the highest difference at W2 in later responders versus non-responders (t=7.98, df=1563, p<10–6) (3) correlated the highest with QIDS-C improvement (r=0.22, df=1563, p<10–6) (4) best predicted at W2 later treatment response as per the highest area under the ROC curve (AUC=0.606, 95%CI[0.588–0.643], p<0.001).

Motivation had the earliest capacity to be improved, the best predictive value for treatment response and the largest global margin of progress in depressed outpatients. Assessing self-reported motivation in MDD could offer an interesting paradigm shift while assessing linear changes of depressive symptoms.

Schizophrenia has genetic, epigenetic and environmental components. Recent reports showed that the IL3 gene, colony stimulating factor 2 receptor alpha (CSF2RA), beta (CSF2RB) and IL-3 receptor alpha (IL3RA), the IL-specific receptor subunits for CSF2 and IL3, respectively, are associated with schizophrenia.

Association analyses of rs6603272 variant of the IL3R gene and rs4129148 variant of CSFR2A gene with schizophrenia have been studied.

We had 166 schizophrenic patients and 246 healthy controls. In both case control studies, a PCR-RFLP method was used.

The genoype frequencies of the IL3R gene rs6603272 variant were TT, 54.8, TG, 40.4, GG, 4.8 % in cases, TT, 57.7, TG, 36.2 and GG, 6.1% in controls. The frequency of T allele in controls and cases was 76% and 75% respectively. Similarly, the genotype frequencies of the CSFR2A gene rs4129148 variant were GG, 44.6; GC,39.8; CC,15.7 % in cases and GG,43.9; GC,43.1; and CC, 13.0% in controls. The G allele frequency was 64% in cases and 65% in controls.

In our study, we did not find an association between the rs66033272 variant of IL3RA gene and schizophrenia (χ2=0.896; P=0.639). Nor did we find an association between the CSFR2A rs4129148 variant and schizophrenia (χ2= 0.770; P=0.681)

Alzheimer's disease (AD) is the most common form of dementia. What is less apparent to the casual observer are thepsychological costs borne by the caregiver. Their lives are marked with significant changes concerning family relationships and social life.

The purpose of this study was to define the correlation between the psychophysical functioning of the AD patient, the quality of caregiversufferer relations and the psychological costs borne (depression and burden) by the caregiver.

The design is a cross-sectional study. This study encompassed 292 caregivers. The following questionnaire methods were used: BDI, Caregiver Burden/Burnout Inventory, Emotional Bond Questionnaire (caregivers) and MMSE and ADL (patients).

The study indicated the greatest level of depression and caregiving-related burdens in the spouses group, and the least in the friends/others group. The most important predictor of the level of burden turned out to be the nature of the caregiver-patient relationship. The positive experiences with the AD patients from the pre-onset time are an important protective factor in all the groups of caregivers.

The fact that the group of spouses was found to be the most affected by the burden of care indicates the need to provide them with help. One of the most significant predictors of caregiving burnout in this group is a sense of loss and positive experiences. Therefore it seems reasonable to assume that refreshing and nurturing such memories could also enhance the caregiver's ability experiences and emotions predominate.