Despite increasing social acceptance over the past two decades, lesbian, gay, bisexual, and transgender (LGBT) individuals continue to face unequal treatment in society (Institute of Medicine, 2011; Caceres et al., 2020). Elderly LGBT adults include the population of sexual and gender minorities over the age of 50 (Choi et al., 2016).They continue their lives under the shadow of negative societal stereotypes and assumptions about their physical and mental health, sexuality, sexual lives, and ability to contribute to society, as well as their family and societal values. When individuals find themselves at the intersection of being elderly and LGBT, they encounter a combined situation that leads to an increased risk of discrimination, social exclusion, and violence.Over time, this can lead to high levels of depression, anxiety, loneliness, and other mental health issues. When they are not accepted by social circles, it often results in social isolation and loneliness. (Geneva, 2023)

The aim of this study is to examine the challenges faced by elderly LGBT individuals by addressing issues of discrimination and elder abuse. By evaluating the extent to which current services meet the needs of these individuals, it aims to propose solutions from the perspective of social equality and human rights.

The study was conducted between December 2024 and February 2025 using the keywords “elderly,” “elderly LGBT individuals,” and “LGBT discrimination” “elder abuse” in databases (PubMed, Scopus, Springer, etc.). These databases have been preferred because they contain a significant amount of evidence-based literature in the field of psychology. Studies conducted between 2000 and 2024, with full texts accessible and written in Turkish and English, have been included in the study

As of November 2024, 28 national and international research articles related to the subject have been reached. The literature review is ongoing. When the literature review is completed, all the study results will be presented together.

The human rights violations, discrimination, social exclusion, and risk of violence faced by elderly LGBT individuals are not only individual but also societal issues.Developing policies that are sensitive to the needs of elderly LGBT individuals in social services, healthcare services, and the legal system is an important step toward improving their physical, mental, and social health.Awareness-raising activities need to be expanded to reduce stigma and discrimination against elderly LGBT individuals in society. Additionally, establishing LGBT-friendly elderly care centers and strengthening social support networks are crucial to preventing social isolation.In conclusion, achieving a more inclusive, equal, and fair society is only possible by respecting the rights of every individual.

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Violent, abusive, and harmful behavior enacted by older adults upon their caregivers represents a distressing and frequently disregarded facet within the domain of caregiving.

This qualitative study aims to 1) explore family caregivers’ experiences of violent, abusive, and harmful behavior by the older person and 2) explore how violent, abusive, and harmful behavior by the older person affects family caregivers’ mental health.

This qualitative study encompassed 307 participants, with a diverse age range spanning from 65 to 87 years. All the interviews went through the process of content analysis.

For the first objective, findings indicated six emerging themes: Persistent and intense verbal abuse (79.1%); Subjugation and manipulation by older adults (72.5%); Unexpected illicit activities initiated by older adults (62.1%); Financial exploitation by older adults (39.8%); Physical abuse (31.5.%); and Sexual abuse (30.7%). The second objective highlighted four themes: High levels of anxiety and depression (87.9%), Intense rage (79.4%), Feelings of moral isolation (77.4%), and Intense explosions (63.6%). Brazilian participants mainly experienced persistent and intense verbal abuse (64.1%). Moreover, higher levels of depression and anxiety were mainly verbalized by English participants (81.8%).

These findings underscore the significant toll that older individuals’ violent, abusive, and harmful behavior can have on the mental well-being of family caregivers. This study sheds light on the complex experiences faced by family caregivers and emphasizes the urgent need for targeted interventions to foster healthier caregiving environments.

Keywords: Carers; family caregivers; mental health; older adults; violent, abusive and harmful behavior.

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Pet companionship plays a pivotal role in the lives of older couples, significantly influencing their intimate relationships, by fostering deeper connections and enhancing mental well-being.

This study has two aims: (1) to explore the impact of pet companionship on the intimacy of older couples; and (2) to examine its influence on their mental health.

This study included 223 older couples aged between 65 and 94 years. To explore the multifaceted role of pets in their relationship, content analysis was conducted on all interviews.

Their experiences shed light on the significance of this bond for promoting healthy and fulfilling intimate relationships, with the following themes: (1) contributing to emotional well-being (87.3%), (2) improving mental health in later life (83.1%), (3) fostering a deep relationship between couples (78.7%), (4) facilitating the formation of new emotional connections with others (72.1%), and (5) boosting physical and sensory functions (67.2%).

The findings emphasize the diverse advantages of pet companionship among older adults. These include enhancing emotional well-being, bolstering mental health, fostering interpersonal bonds, and improving physical capacities. These insights underscore the potential for integrating pet interventions into comprehensive strategies aimed at promoting the overall quality of life for older individuals.

Keywords: Pet companionship; intimate relationships; mental health; older couples; well-being.

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Discriminatory and abusive behaviors may strongly affect older LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more) adults, and poorer health is linked to discriminating practices. Shame is associated with ageism and sexual orientation-based discrimination and may be a significant impediment to aging well by undermining older adults’ sense of agency, health, and well-being. However, little is still known about older LGBTQIA+ adults who encounter double stigmatization.

This study aims to explore the dimensions of shame and double stigmatization of older LGBTQIA+ adults.

The significant psychological challenges and relevant themes experienced by older LGBTQIA+ adults, as related to shame and double stigmatization, were illustrated by semi-structured interviews with 329 older adults in a qualitative study through content analysis.

The results highlight four themes of shame and double stigmatization among older LGBTQIA+ adults, encompassing (1) ageism (86.5%), (2) sexual orientation-based discrimination (81.1%), (3) stereotyping (76.8%), and (4) social exclusion (72.3%).

The study reveals the profound negative effects of shame and double stigmatization on older LGBTQIA+ adults, emphasizing the need for inclusive policies and interventions to address multiple forms of discrimination and promote equitable treatment in aging populations.

Keywords: Shame; Ageism; double stigmatization; LGBTQIA+; multiple discrimination; older adults.

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Lyme borreliosis is one of the most common vector diseases transmitted by tick bites; it is caused by Borrelia burgdorferi. Mostly it manifests on the skin, in the nervous system or joints. It involves the nervous system in 10-15% of cases, of which 2-4 % affect the central nervous system. The most common manifestation is encephalitis, which has a diverse clinical picture.

We aim to describe a rare case and discuss the diagnostic challenges of a rapidly progressive disease.

A detailed description of the patient based on our interview and clinical findings, including blood work, imaging, microbiological testing, lumbar puncture, and treatment.

A 67-year old female patient came to the psychiatric emergency room in March 2024, because of persistent anxiety and unexplained somatic disorders, including weight loss, tremor and unstable gait, which began a few months ago. She had some somatic diagnostic procedures done, with no abnormal findings. 2 weeks before being admitted she was sent to the emergency neurological unit because of fatigue and tremor. They excluded focal neurological signs and concluded that she had an adjustment disorder and suggested psychiatric treatment. In March 2024 she was admitted to the geriatric psychiatry ward, where at first our main differential diagnosis was pseudodementia. In the next few days her condition worsened. She appeared psychotic, with ideas of persecution and reference. On the psychological exam she had moderate cognitive decline with a focus on impaired attention, memory and executive systems, misinterpretations of past and current events, misidentifications of people and possible complex visual hallucinations. At that time we suspected she might have prolonged delirium. Because of an uncommon clinical picture, we pursued further diagnostics. The lumbar puncture showed cerebral spinal fluid (CSF) pleocytosis, which confirmed the diagnosis of encephalitis. Blood tested for multiple infectious causes was positive for Lyme borreliosis. The brain CT scan showed an inflammatory or infiltrative process in both cerebral hemispheres. We then transferred her to the infectious disease clinic where she had a brain MRI with contrast and her CSF was tested for Borrelia and other possible causes. On the MRI they suspected she had rhombencephalitis with leptomeningitis. After the diagnosis of neuroborreliosis was confirmed, she received a 4-week parenteral treatment with ceftriaxone. Two months after completing the treatment she has fully recovered.

When faced with a patient with rapidly progressive dementia a wider range of possible diagnoses has to be considered. We have to be aware of the importance of recognising the cause of the disease sooner, as the patient may have a treatable condition.

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Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia and is clinically characterised by progressive behavioural changes, executive dysfunction and language difficulties. FTD is often confused with Alzheimer’s disease and other psychiatric disorders. Clinical features of FTD include personality changes, agitation, loss of inhibition, apathy, social withdrawal and impulsivity. In some cases, the disease is accompanied by mood or psychotic symptoms, resulting in the diagnosis of an additional psychiatric disorder. (Gliebus G.(2014). SAGE open medical case reports,2, 2050313X13519977.). This article presents the case of a middle-aged woman who was diagnosed with an anxiety spectrum disorder before developing and being diagnosed with FTD.

A 57-years-old right handed female with previous history of anxiety disorder admitted to psychiatry clinic with restlessness, decreased sleep, and complain of constant non-purpose walking. Physical examination revealed bradymimia and grabellar reflex. Additionally in her psychiatric evaluation she had short-term memory impairment, disinhibition and verbal perseverations. She had been given multiple combinations of medications by outpatient providers and her restlessness only increased. At the time of admission she was taking mirtazapine,olanzapine and clonazepam. The initial impression was that she had akathisia, and her medications were tapered. She was then started on propanolol and lorazepam. After several days her symptoms had not changed.

In routine biochemical and hematological tests, electroencephalogram (EEG) were within normal limits. 18F-FDG PET/MRI revealed hypometabolism in the bilateral temporal-frontoparietal region, more pronounced in the frontal region which is consistent with FTD.

Trazodone was started to control behavioural symptoms and the dose was gradually increased to 150 mg/day. The dose of propranolol was increased to 80 mg/day, and lorazepam was tapered and discontinued. During the follow up with this treatment, there was an improvement in her restlessness and anxiety symptoms, but her memory problems were persistent.

Frontotemporal dementia may overlap and be confused with other psychiatric disorders. Therefore, a comprehensive history, physical and neurological examination are required to differentiate each clinical entity (Khan I, De Jesus O. (2023).Frontotemporal Lobe Dementia. In: StatPearls ). Additionally, the use of functional neuroimaging, such as 18F-FDG PET/MRI, enables the different distribution of pathology in dementing disorders to be highlighted, as can be seen in our case. This case report highlights the importance of re-evaluating patients with psychiatric diseases, especially when symptoms are resistant to treatment.

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Loneliness is widely recognized as a significant risk factor for psychosomatic issues in older adults, potentially impacting various aspects of health, including oral health.

This study aims to investigate the relationship between loneliness and oral health in older adults.

This cross-sectional study was conducted with a sample of 84 older adults (41 females and 42 males), aged between 65 and 94 years (mean age: 74.1 years, SD = 8.1). Participants completed a sociodemographic questionnaire, the 12-item Geriatric Oral Health Assessment Index (GOHAI), and the Emotional and Social Loneliness Scale. Multivariate analysis was used to assess the impact of loneliness on oral health outcomes.

The analysis revealed that emotional and social loneliness had a significant negative impact on oral health. Furthermore, the overall loneliness score was strongly associated with poorer oral health quality, independent of marital status or the presence of children. In other words, the relationship between loneliness and oral health was not moderated by these demographic factors.

As loneliness increases in older adults, their susceptibility to poor oral health rises, which can have significant implications for their psychological well-being. This study underscores the need to consider oral health as an integral component of overall well-being, particularly in the context of mental health in older populations.

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Artificial Intelligence (AI) is increasingly recognized as a powerful tool for customizing learning experiences, fundamentally transforming traditional teaching methods.

This systematic review aims to evaluate and synthesize current research on AI learning tools and their role in enhancing educational experiences for older adults, as well as in promoting intergenerational learning and engagement.

Following PRISMA guidelines, a comprehensive review of both quantitative and qualitative data was conducted. Electronic databases such as PubMed, Scopus, and ERIC were searched up to October 20, 2024. The reference lists of included studies and relevant review articles were also thoroughly examined. The quality of the eligible studies was assessed using the Mixed Methods Appraisal Tool (MMAT).

Nine studies met the inclusion criteria. Findings indicate that personalized education for older adults can be delivered through various approaches, including interactive, user-friendly learning environments, training via virtual conversation agents and digital assistants, and automatic adjustments of pace and content to meet user needs (Figure 1). These approaches also facilitate and promote intergenerational learning (Figure 2).

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Personalized education through artificial intelligence can significantly enhance older adults’ quality of life by promoting autonomy, expanding knowledge, supporting psychosocial well-being, and fostering intergenerational connections.

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Previous research suggests that individuals with lower socioeconomic status are frequently exposed to more health risks and emotionally stressful conditions compared to those with higher status. There is a clear link between income and poor quality of life, with disadvantaged older adults lacking key resources. This study explores the relationship between the economic profile of older individuals and their psychosomatic health within the Greek population. It continues a previous investigation on the impact of socioeconomic status on health, offering a deeper understanding of long-term effects.

This study investigates how socioeconomic status affects the physical and mental health of older adults in Greece, focusing on income levels’ influence on health quality and disparities in health outcomes.

This cross-sectional study was conducted among 516 Greek participants (214 men, 302 women, average age 73.47 ± 7.72). The participants’ average monthly income was €796.72 ± 621.82 (p=0.002). Psychosomatic health was evaluated using the Other As Shamer Scale (OAS), Experience of Shame Scale (ESS), and Cardiac Anxiety Questionnaire (CAQ). A one-way MANOVA analyzed the impact of income on health quality, focusing on both physical and mental health using the 36-Item Short Form Health Survey (SF-36).

Our findings revealed that individuals with a monthly income above €1,500 reported significantly higher quality of life scores. In contrast, those with lower economic profiles exhibited increased levels of shame (measured by OAS and ESS), anxiety about their heart health (measured by CAQ), and a tendency to somatize stress. The analysis indicated that for every additional €100 of monthly income, physical health quality increased by 4.4 points on the SF-36 Physical Health Scale, and mental health quality improved by 2.9 points on the SF-36 Mental Health Scale. These results underscore the statistically significant impact of monthly income on overall physical and mental health scores.

The study highlights a strong link between lower economic status and poorer physical and mental health among older Greek adults. Addressing these effects requires political and societal efforts, with mental health policies that focus on economically vulnerable populations to mitigate the health impacts of low income and improve overall well-being.

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Research has shown that staff working in clinical environments caring for frail, elderly or dying patients often must deal with high levels of emotional distress and psychological pain. Psychological defences are necessary and are part of our normal coping mechanism to deal with grief and losses but if they are not understood and recognized, may impact on staff and organizations in unhelpful and destructive ways. In resilient caregiving organizations, emotions are respected and attending to these emotions allow staff to create relationships which will help them cope with their work better.

Through interprofessional education with a reflective group, it was hoped that the improved understanding of emotions and experiences of staff and patients could directly influence clinical practice.

Participants were invited to monthly meetings of 60 minutes for 12 months. A psychodynamic perspective addressed the unconscious processes in clinical encounters. Participants were encouraged to describe how they felt and the meanings of their behaviour rather than just focusing on what happened. Group size was capped at 12 with 2 psychodynamically-oriented facilitators. Semi-structured interviews were conducted and a qualitative approach with content analysis of the transcribed interviews was adopted.

Interdisciplinary staff included nurses, psychologists, social workers, junior and senior clinicians. Our findings showed that staff in dementia care encountered significant levels of emotional distress. The major themes emerged included:

1. 1. Universality of emotions

2. 2. Psychologically safe space

3. 3. Enhancement of reflective capacity

4. 4. Sense-making in the clinical environment

The experiential group discussions allowed staff to better understand and recognize their vulnerability by providing a safe space for directed catharsis. The enhancement of reflective capacity through mirroring and universality in groups allowed members to create relationships which helped them cope with their work better. Through critical inquiry and dialogue, there was better awareness of the social, cultural, economic and political forces at work as staff were encouraged to think and respond honestly to day to day clinical and organizational pressures.

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Sarcopenia is a syndrome described as generalized and progressive loss of muscle mass, strength and function, leading to an increased risk of falls, fractures, disability and mortality. Recent studies have shown that sarcopenia is more common in patients with long-standing psychiatric illnesses compared to the general population, particularly in those with depression and dementia. There have also been reports of higher prevalence in patients with schizophrenia and bipolar disorder.

Our study aims to determine the prevalence of sarcopenia and the factors associated with the syndrome among the geriatric psychiatric population diagnosed with Alzheimer’s disease, depression, bipolar disorder, or schizophrenia in the central Slovenian region.

A single-centre cross-sectional study will be conducted over 3 months at the Department of Geriatric Psychiatry of the University Psychiatric Clinic Ljubljana. Admitted patients aged 65 years or older with a diagnosis of Alzheimer’s, depression, bipolar disorder, or schizophrenia will be eligible (50 patients per each diagnosis). The SARC-F (Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls) and the MSRA (Mini Sarcopenia Risk Assessment) questionnaires will be used as screening tools to identify sarcopenic patients. Additionally, calf circumference and handgrip strength will be measured. The patients’ cognitive functioning will be assessed using the Mini‐Mental State Evaluation (MMSE).

We expect to detect higher rates of sarcopenia among inpatients with mental illness. Subgroups will be analyzed according to different demographic and disease parameters.

This study is the first to evaluate sarcopenia among elderly Slovenian inpatients with a mental health illness. We believe that sarcopenia is an important yet underdiagnosed parameter of functional health in the elderly struggling with a chronic mental health illness and should be regularly screened for. Further research is required to identify sarcopenia in this vulnerable population, especially at an early stage, to counteract the progression of the disease.

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Neurobiological mechanisms of late depression include abnormal regulation and interaction of multiple biological processes, as well as abnormalities of brain structures and organs.

literature analysis

general scientific method

The results of the study show that the SASP index as an integral indicator of changes in proteins associated with the cellular aging secretory phenotype is significantly higher in patients with late depression. A high SASP index correlates with older age and age-related diseases. A high SASP index correlates with low cognitive function (low executive function, information processing speed), and high gray matter atrophy. According to the authors, this indicates a connection between late depression and the molecular picture caused by structural and phenotypes of brain aging. Postmortem studies of patients with late depression revealed a coincidence of abnormal gene expression with genes whose expression is regulated by age. Proteomic studies show that late-onset depression associated with cognitive impairment is associated with abnormal regulation of biological pathways related to immune inflammation control, proteostasis, cellular communication and signaling, and oxidative stress. These biological pathways were downregulated during aging, suggesting that depression is associated with lifelong biological abnormalities, limitations with aging. Studies have shown that some of the biomarkers associated with inflammation, growth factors, and cell surface proteins are abnormally regulated in late-onset depression (e.g., elevated sTNFR2 levels) or are associated with certain clinical characteristics such as cognitive impairment (e.g., angiogenin, IGFBP-6). The biological effects of SASP proteins are mediated by p53, p38MAPK, and NFκB signaling pathways. The SASP index correlates with poor executive function and information processing speed. Patients with late-onset depression associated with cognitive decline have been shown to have profound neurobiological abnormalities and significantly reduced BDNF levels, which is consistent with an enhanced molecular profile of aging. SASP proteins can be produced and secreted by senescent glial cells and activate neuronal intracellular cascades associated with nutrition, metabolic control, cell growth, and apoptosis.

Key to understanding the neurobiology of late-onset depression is how it interacts with brain and systemic biological changes associated with aging.

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The psychogeriatric wards are managed by a specialized multidisciplinary team and are designed to provide a safe, comfortable, and therapeutically appropriate environment for patients with psychiatric issues, where, due to advanced age, pre-existing medical conditions, polypharmacy, cognitive impairments, and fragile physical conditions often coexist.

The elderly population, which is admitted in psychiatric ward in the absence of psychogeriatric wards, appears to be rather heterogeneous and in continuous grow. There are few studies in the literature that investigate the outcomes of hospitalization for these often fragile and vulnerable individuals in environments specific for the intensive management of acute psychopathological conditions.

This retrospective observational study aims to evaluate the effectiveness of clinical interventions in patients aged over 65 who are hospitalized in acute phases in the psychiatric ward at the Bufalini Hospital in Cesena.

At the beginning and end of hospitalization, psychopathological symptoms were measured using the Brief Psychiatric Rating Scale (BPRS). Social and relational functioning was evaluated with the Health of the Nation Outcome Scales (HoNOS), while global cognitive performance was assessed through the Mini-Mental State Examination (MMSE) and the Clock Drawing Test (CDT).

The sample included 166 patients (91 F), with an average age of 71.2 years (SD 5.7). Among these, 128 (77.1%) completed tests. Patients were hospitalized for Bipolar Disorder (46), Psychotic symptoms (16), Major Depression (58), and Dementia (8).

From the general linear model for repeated measures, it emerged that the treatment administered during hospitalization led to a significant improvement in outcomes regardless of the admission diagnosis, for psychopathological symptoms, for socio-relational functioning, and for general cognitive functionality (MMSE and marginally p<0,05 CDT). There were no statistically significant differences related to diagnostic category, age, or gender.

The present study provided important insights regarding the effectiveness of clinical interventions applied to patients over 65. The relevance of these results is particularly pronounced considering the increasing heterogeneity of the elderly population with psychiatric issues and the complexity of the treatments needed to address coexisting conditions and polypharmacy.

Further studies are needed to monitor clinical outcomes in the field of psychogeriatrics to further improve the quality of care, while also exploring the challenges related to the early differential diagnosis between psychiatric and dementia-related disorders, in order to ensure increasingly effective and personalized care.

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We present the case of an 88-year-old woman with severe hearing loss and a history of hypertension, non-valvular atrial fibrillation (AF), hypothyroidism, and depressive episodes, admitted following a medication overdose in a context of depressive ideation. The patient reported auditory hallucinations, hearing the voice of her deceased mother; however, she did not exhibit delusional interpretations regarding these experiences, suggesting auditory Charles Bonnet syndrome. This rare phenomenon is primarily described in older patients without psychotic disorder and requires an interdisciplinary approach for appropriate management.

To describe the clinical progression of a probable case of auditory Charles Bonnet syndrome and analyze the importance of a multidisciplinary approach, particularly in coordination with neurology, to achieve optimal diagnosis and treatment in a geriatric context.

The case was addressed through a detailed psychiatric evaluation focused on psychopathological assessment and structured interviews to evaluate affective, cognitive, and behavioral symptoms. Neuropsychological assessment included the Phototest and Clock Drawing Test to rule out advanced cognitive impairment, as well as a cranial CT scan, which showed no significant abnormalities. The neurology consultation evaluated cognitive status, hearing loss, and its impact on the patient’s psychological state, while also ruling out other neurological disorders.

The patient showed favorable progress during admission, with mood stabilization and reduced anxiety. She exhibited long-standing depressive symptoms, including feelings of guilt and burden on her family. She acknowledged hearing her mother’s voice calling her and was able to critically assess the unreal nature of these hallucinations. The neurology consultation confirmed significant hearing loss, which contributed to her isolation and, possibly, to the development of auditory hallucinations (due to the lack of sensory input). No signs of advanced cognitive impairment were found.

This case highlights the importance of a multidisciplinary approach in managing elderly patients with unusual hallucinatory phenomena. Once psychotic symptoms were ruled out by psychiatry, the neurology consultation was essential to exclude cognitive impairment and contextualize the auditory hallucinations in relation to the patient’s hearing loss and emotional burden. The integrated intervention with her family facilitated a more comprehensive approach, including family support and psychoeducation, adjustments in psychopharmacological treatment, and recommendations to improve quality of life (including emphasizing the use of hearing aids) and social support; demonstrating the effectiveness of collaboration between psychiatry and neurology.

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This case of a 79-year-old patient with inferred past exposure to toluene and persistent paranoid delusions illustrates the potential neuropsychiatric consequences of solvent exposure. The patient’s work as a car painter (1990-1992) aligns with literature highlighting the neurotoxic effects of organic solvents. Despite no direct evidence of exposure, treatment with Zuclopentixol 200 mg Depot every two weeks led to symptom improvement, reflecting findings on toluene-related neuropsychiatric disorders such as psychosis.

• - Present a potential case of toluene-induced psychosis.

• - Review the etiopathogenesis and treatment.

• - Assess evidence linking chronic solvent exposure with neuropsychiatric disorders.

A literature search using PubMed databases was conducted with keywords: (toluene OR xylene OR volatile organic compounds OR organic solvents) AND (psychosis OR schizophrenia OR mental disorders). Case series and observational studies were reviewed. No randomized clinical trials on antipsychotic treatment for toluene-induced psychosis were found.

The patient’s exposure to toluene was inferred based on work history, without direct evidence such as biomarkers or occupational assessments. As most studies are case series, results must be interpreted with caution. There is a lack of randomized controlled trials exploring antipsychotic treatments in solvent-induced psychosis.

Chronic exposure to toluene is associated with cognitive impairment, memory deficits, personality changes, and psychosis. Neuroimaging often reveals white matter alterations and cerebral atrophy in chronic users. Rare cases of irreversible schizophreniform psychosis have been documented. Treatment with atypical antipsychotics like risperidone shows variable efficacy, but outcomes differ between patients. In this case, Zuclopentixol 200 mg Depot every two weeks led to significant symptom reduction.

Chronic toluene exposure can result in severe neuropsychiatric disorders, including psychosis, as demonstrated by this 79-year-old patient. Neuroimaging showed cerebral atrophy and white matter changes in long-term exposure cases. Treatment with Zuclopentixol effectively reduced symptoms, despite the limited literature, which is mostly based on case series. Randomized clinical trials are needed to develop standardized treatment protocols. Additionally, occupational safety measures are critical to preventing adverse effects from solvent exposure.

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A 64-year-old male with diabetes-related blindness was admitted with anxiety, low mood, and passive suicidal ideation. Despite no psychiatric history, he experienced visual hallucinations, which he recognized as “optical illusions.” A CT scan ruled out organic causes, and retinal detachment with irreversible vision loss was confirmed. Diagnosed with Charles Bonnet Syndrome (CBS), he developed delusional interpretations and auditory hallucinations. Initially treated with Venlafaxine 150 mg/day, his psychotic symptoms persisted until Risperidone was increased to 6 mg/day, which resolved the hallucinations. Lithium was then added, allowing a reduction in Risperidone without relapse.

This review, based on a case study, focuses on the challenges of treating Charles Bonnet Syndrome (CBS), early diagnosis, and the lack of clear diagnostic criteria. It explores the connection between CBS and visual loss, the emergence of psychotic symptoms, and the role of antipsychotics in managing them.

Literature was reviewed using the following keywords: (Charles Bonnet syndrome) AND (visual hallucinations OR hallucinations) AND (treatment OR management OR therapy OR pharmacotherapy). Databases such as PubMed were used to gather relevant studies.

There are several challenges in diagnosing and treating CBS. Underdiagnosis is common, leading to misdiagnoses such psychosis (Voit et al., 2021; Stojanov, 2016). Non-pharmacological approaches, including improving vision aids, have shown effectiveness in reducing hallucinations (Yacoub & Ferrucci, 2011; Pang, 2016).However, pharmacological treatments, including antipsychotics and SSRIs, have shown inconsistent results (Voit et al., 2021; Rojas & Gurnani, 2023). Differentiating CBS from psychiatric disorders is crucial, as patients typically retain awareness of the unreal nature of their hallucinations (Stojanov, 2016). Emerging research on CBS neurobiology suggests potential for future targeted therapies (Weil & Lees, 2021; Collerton et al., 2023).

Charles Bonnet Syndrome (CBS) is frequently underdiagnosed due to limited awareness and patient underreporting. Non-pharmacological approaches, such as improving vision and social support, help alleviate symptoms, though no standardized pharmacological treatments exist. This case underscores the importance of distinguishing CBS from psychiatric disorders, especially when psychotic features are present. A multidisciplinary approach, involving ophthalmologists, psychiatrists, and neurologists, is essential for effective management, as seen in this case. Early diagnosis and ongoing research are crucial for developing more targeted treatments for CBS.

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Delusions and hallucinations can appear in various psychiatric and neurological pathologies. When these psychotic symptoms are of late onset, in geriatric age, it may be necessary to make a differential diagnosis between dementia or other psychiatric disorders.

To describe the differential diagnosis between dementia and delusional disorder.

Review of the scientific literature based on a relevant clinical case.

70-year-old woman who lives with her husband. She has two independent daughters. History of a depressive episode in her youth related to her husband’s gambling addiction. She attended the emergency department due to behavioural alteration at home with verbal heteroaggressiveness towards her sister and several neighbours. At the hospital she was approachable, with some psychomotor restlessness, reporting that a neighbour wanted to harm her and spoke of her, making delirious interpretations of harm and referring to visual hallucinations in the form of animals in the courtyard of her house. A brain CAT scan was performed, with normal results.

Her family reports that for about a year she has been saying incoherent things on occasions and behaving strangely. It was decided to admit her to the acute care unit.

During hospitalisation she didn’t present behavioural alterations. Treatment with risperidone was introduced with adequate tolerance and response, with distancing of the delusional ideation of harm. MOCA test was performed: 23/30 (suggestive of cognitive impairment), so PET-CT was requested with results not suggestive of neurodegenerative disease and neurodiagnostic tests (SCIP-S and BCSE); the results indicate heterogeneous cognitive performance, and no global cognitive impairment could be observed at the present time and a repeat assessment was recommended in one year’s time. Due to the results of the tests and the decrease in positive symptomatology with antipsychotic treatment, a diagnosis of delusional disorder was made upon discharge.

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The concept “mild cognitive impairment” (MCI) means a decline in executive functions (such as memory, attention, language or thought) that does not correspond to what is expected for a person’s age group. It is estimated that this diagnosis may affect a fifth of the population over 65 years and 50-80% of them will develop dementia. This pathology is related to a loss of autonomy and an increase in dependence. In addition, there are therapeutic limitations, so it is a flagrant health and social problem. In this context of difficulties, various non-pharmacological therapies are emerging with the aim of improving various aspects of this disease, among which we can found music therapy (MT).

The aim of this study is to review the most recent findings of the scientific community regarding the validity of MT as an intervention in patients with MCI. Specifically, its efficacy on cognition and its power to stop the progression of dementia are evaluated, as well as its effects on other areas of the patient.

A systematic review was carried out in the “WOS-Web of Science”, “Scopus” and “Psycoinfo” databases following PRISMA guidelines. The keywords were “MT” and “MCI”. We included clinical trials, systematic reviews and meta-analyses in english or spanish whose study population had MCI, excluding those published before 2017.

15 studies were selected, all with high quality evidence designs measured by Scotish Intercollegiate Guidelines Network scale. Among all the types of MT evaluated, various studies agree that Active MT (which includes activities that involve active participation of the patient such as singing or dancing) stands out as one of the best options, showing post-intervention improvements in MMEE scores and, secondarily, in emotional well-being (specially depression and anxiety). Instrumental practice has an important protective effect on cognitive function. On the other hand, MT with movement, in addition to being effective on cognition (it increases activity in prefrontal cortex), also causes an improvement in physical conditions. However, musical reminiscence (which consists of listening to music with an emotional component for patients with simultaneus display of images to favor memories), although it shows postive effects in several articles, these are not statistically significant. Finally, multimodal therapy (which is a combination of training and cognitive stimulations based on reminiscence and MT) did not show statistically significant changes in either mood or executive functions.

MT is a valid intervention to improve cognitive function, some neuropsychiatric symptoms and the quality of life of patients with MCI. If we also take into account its economic accessibility, the organizational simplicity and null adverse effects, it is easily concluded to be one of the most attractive therapeutic options for treating MCI today.

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Even mild forms of dementia have a detrimental effect on memory and activities of daily living, and cause distress to patients and their families. As the disease progresses, the impairment of patients and the burden on their carers increases over time. Thus, there is a need for effective, safe and well-tolerated treatments that can be initiated at the earliest stages.

A meta-analysis of pooled patient subgroup data from randomised clinical trials was conducted to assess the treatment effects of Ginkgo biloba extract EGb 761 in patients with mild dementia.

The studies included in this meta-analysis were selected from a previous systematic review (von Gunten et al. World J Biol Psychiatry 2016, 17(8),622-633). They enrolled patients with mild dementia (total score 9-15 on the SKT Short Cognitive Performance Test, SKT) (Lehfeld and Erzigkeit, Int Psychogeriatr 1997, 9(Suppl 1), 115-21) with probable Alzheimer’s disease, probable vascular dementia, or possible Alzheimer’s disease with cerebrovascular disease, respectively. Outcome measures were cognition, activities of daily living, global clinical assessment and quality of life.

From four eligible trials data of 782 patients with mild dementia were included in the meta-analysis. The analysis demonstrated that treatment with 240 mg EGb 761 daily was significantly superior to placebo in cognition (p=0.04), global assessment (p=0.01), activities of daily living (p=0.01) and quality of life (p=0.02) with medium to large standardised effects. Adverse events were similarly frequent in patients treated with EGb 761 and placebo (p=0.66).

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The meta-analysis shows that EGb 761 has beneficial effects on cognition, activities of daily living, global assessment and quality of life in patients with mild dementia.

M. Riepe Speakers bureau of: Dr. Willmar Schwabe GmbH & Co. KG, M. Burkart Employee of: Dr. Schwabe Holding SE & Co. KG

Recent research highlights the importance of technological solutions in delaying cognitive decline and improving life quality for at-risk individuals, emphasizing the need for innovative, tech-based approaches in dementia prevention (Johnson et al.,2023; Smith et al.,2023). Exercogs® is an innovative tool designed to tackle the global challenge of dementia by addressing modifiable risk factors (Livingston et al.,2020). Developed through a clinic-academia partnership, it integrates physical exercise, cognitive skills, and social interaction into a single activity for dementia prevention programs.

This scientific study aims to: 1) Creating and validating 4 Exercogs® (using gamification) for an augmented reality platform; 2) Validating a dementia prevention program that generates health benefits using Exercogs®.

1. 1. Research and Planning: assessment of seniors’ needs; survey of market solutions;

2. 2. Ideation and Concept Development: definition of therapeutic objectives; selection of stimulus types; idealization of game scenarios, cognitive, and motor areas;

3. 3. Design and Prototyping: programming video games; implementation of gamification techniques;

4. 4. Testing and Evaluation: testing the prototypes and interaction mechanics with a group of users; usability testing.;

5. 5. Scientific Validation: experimental study with pre and post-test assessment, with a sample of 204 subjects aged ≥ 65 years old.

6. 6. Maintenance and Improvement: the solution is being used in pilot studies in different institutions in Portugal for evaluation and continuous improvement.

Exercogs® consists of 4 games that target key areas of healthy and pathological ageing, focusing on cognitive (attention, memory, executive functions), physical (mobility, coordination, balance) and social (general social skills) domains. Each game adapts to users’ abilities with different difficulty levels and is designed for group play to enhance social interaction, crucial for mental health. Utilizing gamification and augmented reality for engagement, scientific validation showed significant improvements in cognitive, affective, social, functional domains, and quality of life, with marked statistical significance in all areas assessed.

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Notable health benefits were observed among users, particularly in cognitive function and quality of life. These findings indicate the potential effectiveness of Exercogs® in dementia prevention programs. The alliance between the clinic and academia is crucial for solving the challenges of longevity and creating technological solutions that respond to new health needs. The use of technologies in health intervention generates high levels of adherence and motivation among older adults, as well as among health professionals. Exercogs® are a promising technological solution that uses gamification with clinical support to prevent dementia!

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