Tunisia has experienced a considerable increase in degenerative diseases associated with aging including in particular dementia and Alzheimer's disease.

To evaluate the diagnostic procedures of cognitive impairments in general medicine and to identify obstacles concerning the early diagnosis of dementia in these patients.

An email questionnaire was sent to a sample of general practitioners (GPs) working in the Sfax region, Tunisia.

We received 55 answers. When facing a mnesic complaint, 20% of GPs perform a screening of cognitive disorders. Among reasons leading to early identification, memory complaints (76.4%) was the most mentioned by GPs surveyed. the Mini Mental State was the most used (34.5%) by general practitioners. Twenty-nine point one percent (29.1%) of physicians conducted a comparative assessment 6 to 12 months later if the initial evaluation was normal and 83.6% send the patient to a specialist in case of a detected disorder. For GPs, in 58.2% of the cases, the major impediment is the lack of time, in 32.7% of the cases it is patient's and family's denial and in 23.6% of the cases it is the absence of effective medical treatment. A cross analysis shows that GPs who have had further training in geriatrics have a better approach.

Our study shows a lack in the early identification of cognitive impairment in the elderly by GPs. Develop simple cognitive tests, reinforce training of doctors and promote research to develop new drugs would improve early diagnosis and management of dementia.

The authors have not supplied their declaration of competing interest.

Antipsychotic medication use may be associated with prolongation of the QTc interval, increasing the risk of potentially fatal arrhythmias [1]. This is particularly pertinent in the elderly due to comorbid cardiovascular disease and polypharmacy. Attention to the ECG and co-prescribed medications is essential to minimise cardiac risk when prescribing antipsychotics.

On 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified as part of a hospital-wide survey. Data was collected from medical and electronic patient notes and medication kardexes.

Complete data was obtained for 36 patients aged over 65 who were newly-prescribed an antipsychotic or had their antipsychotic changed. Of these, 39%(n = 13) had a cardiac history. One quarter did not have an ECG in the 12 months preceding antipsychotic initiation. Of the 28 patients with an ECG, 57% (n = 16) had a QTc > 450ms before starting antipsychotic treatment. Only 11% (n = 4) had an ECG within 24 hours of starting the antipsychotic. The average change of the QTc interval in those with a repeat ECG was 30msecs. 42% (n = 15) were co-prescribed another QTc-prolonging medication.

Current monitoring of QTc interval in an elderly population newly prescribed antipsychotic medications is inadequate and a cause for significant safety concerns. Education and clear guidance is warranted to improve safety and minimise risk in this population.

The authors have not supplied their declaration of competing interest.

A 71 year old gentleman presented with two discrete episodes of delirium with prominent psychotic features and catatonia, over a 3-year period. Symptomatically, he was suffering from fluctuating consciousness, paranoid ideation and both auditory and visual hallucinations. He went on to develop catatonia, demonstrating negativism and mutism and he also exhibited pseudoseizures. His symptoms resolved entirely after three weeks. He re-presented 3 years later with profound psychosis and hyponatraemia. On this occasion, he exhibited catalepsy, negativism, echolalia and mutism, which resolved when his sodium was corrected.

To illustrate 2 episodes of acute catatonia temporally associated with hyponatraemia in an otherwise healthy elderly gentleman.

This is a case study. Consent was sought from the patient to write up his case and distribute it for educational purposes. His medical inpatient notes, psychiatric inpatient notes, correspondence and bloods pertaining to both admissions were reviewed and analysed. A literature review was carried out using Pubmed.

Low sodium levels were a common factor in his presentations and normal sodium levels were associated with a return to normal consciousness.

While medical issues confounded his first presentation of hyponatraemia associated catatonia, his second presentation was directly related to hyponatraemia. Given the coincidence of hyponatraemia during his first admission, it would strongly suggest that low sodium levels were an important factor in this gentleman's presentation. Importantly, this is the first case in the literature to demonstrate catatonia related to hyponatraemia on two separate occasions in the same individual.

The authors have not supplied their declaration of competing interest.

Falls of the elderly to a degree been associated with poor mental health, poor social support and poor physical health.

To investigate the falls of elderly people in relation to their mental and physical healthy.

To compare the effects of falls in the elderly in the areas of mental and physical health.

The current study used purposive sampling compromised from 48 people that visited the emergency department at the Patras University Hospital in 2016. The inclusion criterion for participation was age (> 65 years). Data was collected using WHO's questionnaire, the WHOQUOL-BREF. Finally, data was analyzed using the test t test for independent samples.

The sample constituted by 39.6% of male and 61.4% of female. The average age of the sample was M = 75.89 years. In relation to mental health, the average of the elderly with a history of falls found M = 57.26 (SD = ± 22.87), while the other was found M = 74.45 (SD = ± 15.81). The difference between the two groups was statistically significant (P < 0.05), while physical health although again the first group found to have a smaller average (M = 56.65, SD = ± 22.13) relative to the second group (M = 63.78, SD = ± 12.59) no statistical difference was observed.

These results demonstrates that falls beyond the physical damage that are immediately visible can as well create significant issues in the psychological state of the elderly exacerbating anxiety, fear and social isolation, which has been associated with depression event.

The authors have not supplied their declaration of competing interest.

The author has not supplied his/her declaration of competing interest.

Benzodiazepines (BZD) are the most consumed psychotropic drugs by the elders. This prescription can lead to the dependence which is a major public health problem particularly in this population.

To study the prevalence of dependence of the (BZD) in elderly subjects followed as outpatients and to identify the factors associated with it.

It was a cross-sectional study of 60 patients aged 65 years and older followed at the psychiatric consultation of the UH Hédi Chaker of Sfax; for 3 months. We used:

– Questionnaire containing demographic and clinical data.

– The cognitive scale of attachment to benzodiazepines (ECAB), a score ≥ 6 indicates dependence.

The average age of patients was 67.78 years, with a sex-ratio M/W = 0.46. They were smoking in 58.3% of cases. The most frequent psychiatric disorders were mood disorders (40%) followed by anxiety disorders (13.3%). The absence of diagnosis was observed in 23.3% of cases. A psychotropic drugs were associated with BZD in 86.7%. The most prescripted BZD was lorazépam (90%). Withdrawal signs were present in 90% of cases. The prevalence of BZD dependence has been estimated at 80%.

BZD dependence was significantly correlated with smoking (P = 0.00), with psychotropics association (P = 0.04) and with signs of withdrawal (P = 0.001).

It appears from our study the importance of BZD dependence in the elderly what it is a source of withdrawal difficulty. So we need make more effort to comply with recommendations regarding the prescription of these molecules.

The authors have not supplied their declaration of competing interest.

The limbic system is primarily responsible for modulating behaviour, emotions and neuro-endocrine functions. Limbic encephalopathy involves this part of the brain and is characterised by the acute or sub-acute onset of seizures, recent memory loss, confusion and psychiatric symptoms. Here we describe an unusual presentation of a well-functioning elderly man, who presented with sudden onset of confusion, cognitive impairment, treatment resistant hyponatremia, seizures and psychiatric symptoms.

This 79 year old gentleman, previously well and independent was admitted to the acute hospital with a 3 week history of sudden onset of confusion, odd behaviour and weight loss. On admission he was hyponatremic (Na-118), developed treatment resistant seizures and progressive cognitive impairment. He was referred to the Liaison Psychiatry team with increasing paranoia, agitation and persecutory delusions.

MRI and CT brain remained normal. Lumbar puncture revealed a positive VGKC antibody and his blood titres for VGKC was more than 3000. His hyponatremia and seizures remained chronic, but improved with plasmapheresis, oral corticosteroids and cyclophosphamide. He was commenced on aripiprazole for psychiatric symptoms, but was transferred to the acute psychiatric unit after being detained under section 2 of the MHA due to risks of aggression and absconsion.

Psychiatric symptoms related to this form of encephalitis have not been emphasised in literature. His aggression improved over time on aripiprazole, but was transferred to a residential care home setting due to persisting cognitive deficits and social care needs This case highlights the importance of recognising multimorbidity, joint working and more research required in the area.

The authors have not supplied their declaration of competing interest.

Alzheimer's disease (AD) is one of the pressing social problems as the negative effects of the disease often manifest on patients’ relatives. Relatives of AD patients experience physical and psychological burden during the care.

To clarify what kind of views on euthanasia are more common among relatives of patients with AD.

The study involved 23 AD patients’ relatives (mean age 60, SD = 2). There were 5 men (22%) and 18 women (78%). All participants were directly involved in caring for their relatives with AD. A 19-item structured questionnaire (E. Nikolaev, 2016) was used for measuring medical, legal, ethical, socio-cultural, spiritual and personal aspects of attitudes to euthanasia.

The respondents were less likely to see euthanasia as medical issue. They also referred it to kind of ethical and legal problems. Legal aspects were determined by greater consent to its legalization and by awareness of imperfections of legal basis for its immediate implementation. Ethical issues according to which euthanasia practice was related to the development of humanity complemented this vision. These settings were in conflict with socio-cultural perceptions of euthanasia. Respondents were convinced in possibility of various forms of abuse during euthanasia. Supporting the ideas of euthanasia in general, many respondents on a personal level were not ready to apply them to their relatives with AD in practice.

Attitudes to euthanasia in AD patients’ relatives was contradictory. It was determined by divergent ideas about euthanasia in field of legal, social, cultural, spiritual and personal issues of this interdisciplinary phenomenon.

The author has not supplied his/her declaration of competing interest.

Although not recommended as a first-line treatment for old patients with depressive, anxiety or somatic symptom disorders, we continue seeing tricyclic antidepressants being frequently prescribed.

To estimate the prevalence and to assess the implementation of safety measures related to the prescription of such molecules in the elderly. To explain their choice as a first-line treatment.

We included all new patients aged 65 years or over between 1st January 2011 and 31st December 2015 whom, were prescribed an antidepressant. Recommendations of the Canadian coalition for seniors’ mental health, of the world federation of societies of biological psychiatry and of the national institute for health and care excellence were our evaluation tools. We compared tricyclic receivers to those having newer antidepressants to try to understand the choice of tricyclics as a first-line treatment.

Eighty patients were included. Mean age was of 75 years. 46% were prescribed a tricyclic as a first line treatment. Depressive disorders were the most diagnosed ones (79%) followed by anxiety disorders (14%) and somatic symptom disorders (7%). An electrocardiogram was not performed to all patients prior to the initiation of the tricyclic nor at anytime later. 11% continued being prescribed tricyclics in spite of contraindications. Only a low economic level was significantly related to their choice as a first-line treatment (P = 0.001).

Tricyclics’ prescribing rate was high. Safety measures were not applied for all patients. Regular availability of newer antidepressants in public health structures and a better awareness of antidepressants prescribing guidelines in the elderly are mandatory.

The authors have not supplied their declaration of competing interest.

The delirium of the elderly is defined as an acute confusional state, with variation during the day, characterized by impaired consciousness, orientation, memory, thinking, attention and behavior.

The purpose of this research is to investigate whether the organic psychosyndrome of the elderly is a valid indicator of mortality after one year.

It was used material from patients with organic psychosyndrome older than 60 years, who were hospitalized in pathological clinics of the Hospital of Corfu and was diagnosed by the linker portion of the psychiatric clinic.

The patients diagnosed with organic psychosyndrome neither suffered from a psychiatric disorder psychotic type in the past, nor previously preceded anaesthesia in the context of physical disease. For the recognition and the criteria of ICD-10 to the exclusion of another psychiatric condition, it was used the delirium rating scale method.

According to the analysis of the data, 8% of patients died during hospitalisation, in the first 3 months after diagnosis, the 28% of the initially hospitalised patients, in 6 months the 42%, while during the year the 48% of the initial total patients died and in the next 12 months only one death was reported.

The analysis of the survey results shows that while the instrument psychosyndrome could be considered as a poor diagnostic marker for the first 12 months, 48% mortality, in the long run it seems to lose its prognostic value with the mortality approaching the mortality index of the hellenic statistical authority for 2015 at ages 60+ (1.2%).

The authors have not supplied their declaration of competing interest.

Psychotic symptoms are the most important non-motoric symptoms of the Parkinson disease (PD). The quality of life of those patients can be significantly improved with an appropriate therapy. In this article we provide evidence about the etiology, differential diagnosis and therapeutic possibilities with a work-up for the clinics.

To provide a case report of patient with PD who developed a paranoid psychosis after administration of levodopa/carbidopa, followed by a literature review on psychotic symptoms evoked by psychotropic medication by patients with PD.

An English-language literature search was conducted using Pubmed, EMBASE searching for case reports and observational studies reporting iatrogenic psychotic symptoms by patients with PD.

Ms. C. was a 65-year old woman with PD who was observed in a polyclinic setting and who used a levodopa/carbidopa combination. She developed paranoid psychosis with a following admission to the psychiatric ward. We have gradually lowered the dose of anti-Parkinson medication. Subsequently, treatment with clozapine was initiated and the psychotic symptoms resolved within five months.

Parkinson psychosis is due to a complex interaction of neurodegenerative changes and pharmacological therapy. Therefore, the role of iatrogenic factors must be always carefully assessed. Psychosis inducting agents should be lowered or stopped before the treatment with antipsychotic medication.

The authors have not supplied their declaration of competing interest.

The author has not supplied his/her declaration of competing interest.

The author has not supplied his/her declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Psychotic symptoms arise commonly in the context of behavioural and psychological symptoms of dementia (BPSD) in the elderly. While non-pharmacological interventions are preferable to manage such symptoms, antipsychotic medications are frequently used. This is largely unlicensed and associated with significant risks, particularly in dementia (1).

To examine antipsychotic prescribing practices in SJH.

On 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified. Demographic and medical data were collected from medical and electronic notes and medication kardexes.

Complete data were available for 53 of 59 identified cases. The cohort had a mean age of 80 (range 65–99) and 62% were male. Seventy-four percent (n = 39) had documented cognitive impairment or dementia. Fifty-eight percent (n = 31) were newly prescribed an antipsychotic following admission. The commonest indications for antipsychotics were: delirium (53%) and BPSD (25%). Haloperidol (56%), quetiapine (19%) and risperidone (8%) were prescribed most frequently. Non-pharmacological interventions were documented in 50% however in many cases it is not clear what these interventions were. Antipsychotic use was discussed with patients and/or next of kin in less than 25% of cases. Adverse effects were noted in 6/36 (17%) with equal incidence of falls, EPSEs and ECG changes.

Positive and negative aspects of current antipsychotic prescribing practices are highlighted. Antipsychotics were prescribed for a small number of patients for appropriate indications. However, there was poor consideration of non-pharmacological interventions and a lack of consultation with the patient/NOK. This may reflect, in part, inadequate medical documentation. A guideline needs to specifically address these areas of concern to improve safety and promote best practice.

The authors have not supplied their declaration of competing interest.

Major depressive disorder (MDD) in the older adults is correlated with a significant decline in daily physical activity, consequently resulting in chronically impaired quality of life and an increased exposure to falls-risk.

Establishing whether geriatric depression Scale (GDS) scores, found correlated with dual motor tasks (TUGTMAN), are also correlated under the cognitive test constraints (TUGCOG).

The study aimed to analyse the relationship of MDD symptoms, the number of depressive episodes and hospitalisations, with the efficiency of gait in single and dual task conditions, motor and cognitive, functional capabilities.

The study was conducted in the outpatient clinic, university hospital, department of psychiatry, Krakow, on 30 patients over 60 years of age presenting recurrent MDD. The assessment consisted of GDS, MMSE, TUGT, TUGMAN, TUGCOG, 30sChS, SLS. Spearman rho rank correlation was applied to determine the relationship between the variables.

Statistical analysis showed a significant association between the intensity of depressive symptoms expressed in the GDS and the number of completed episodes and depression and TUGT. The number of hospitalisations was associated with gait under motor (TUGMAN) and cognitive (TUGCOG) constraints.

Duration of the disorder and the number of hospital admissions are related to the functional efficiency of the single and dual-task performance in the persons suffering from this disorder for at least 10 years. Aged persons should effectively be encouraged to undertake physical activities.

The authors have not supplied their declaration of competing interest.

Even though it is not the most common type of dementia, frontotemporal dementia (FTD) is a major health problem. It affects people younger than 65 with similar frequency as Alzheimer's dementia (AD) and has a progressive course that leads to inevitable deterioration in functioning. Still, FTD is not a unique entity in ICD- 10 classification.

To investigate the diagnostic and treatment difficulties in FTD.

To show very rapid and progressive deterioration in people with early onset FTD.

We will present a series of cases showing progressive cognitive deterioration and prominent personality changes in patients with FTD hospitalised at University Psychiatric Hospital Vrapce since 2013 to 2015. Collected data included anamnestic and heteroanamnestic information, blood tests and neroimaging.

Our findings showed a significance of early onset FTD, with subtle, untypical symptoms at the beginning, and galloping deterioration during the course of illness.

Presented patients with FTD showed rapid and progressive nature of disease with infaust prognosis. Even though early onset patients make 20% of overall number of patients with FTD, we consider that it is necessary to separate them from late onset patients in future classification systems.

The authors have not supplied their declaration of competing interest.

While research is illuminating characteristics of elderly that are associated with mistreatment, far less research has investigated characteristics of the perpetrator that are involved in elder mistreatment cases.

To address the characteristics of elder mistreatment's perpetrators in a population of community-dwelling elders.

A cross-sectional study was conducted, including 80 subjects aged 65 years and older, with sufficient cognitive ability to complete the interview. Elderly were asked about several characteristics of mistreatment's perpetrators. Indicators of Abuse Screen (IOA) was used to evaluate abuse.

Findings show that 13.8% of the participants suffered from elder mistreatment, with a mean IOA's score of 8.35. According to subtypes, 10% reported psychological, 2.5% physical and 1.3% financial abuse. Abuse was recurrent and the victim's reactions were passive in all cases.

Perpetrators were family members in all cases, with being a partner in 63.6%, a child in 18.2%, a sibling in 9.1% and a stepdaughter in 9.1% of cases. They were men in 72.7% of cases and their mean-age was 64.09 years. Financial difficulties and psychological problems were reported in 54.5% and 36.4% of perpetrators, respectively. Perpetrators were most likely living with the victims (P = 0.009). Partners were the perpetrators of half of the psychological abuse, and the totality of the physical and financial abuse. Abusive marital relationships were significantly associated with the perpetrator (P = 0.04).

Our findings suggest that the cause of elder abuse is rarely unique, and that this phenomenon is consequent to many pre-existing underlying problems affecting both elderly and perpetrators.

The authors have not supplied their declaration of competing interest.

Elderly who live in settings other than their own homes or those of relatives have received little attention from researchers in Tunisia.

To compare sociodemographic and clinical factors associated with elder abuse between community-dwelling elders and those residing in nursing home.

A comparative study was conducted, including 50 subjects aged 65 years and older living in the community and 20 age- and sex-matched subjects living in a nursing home. Cognitive status, depressive symptoms and autonomy were assessed using mini-mental state examination (MMSE), geriatric depression scale (GDS) and activities of daily living scale (ADL). Elder abuse was evaluated with Indicators of Abuse Screen (IOA).

Elder abuse was more prevalent in elderly residing in nursing home (P = 0.009) with a prevalence of 35% and 8% and a mean IOA score of 12.75 and 7.74. Psychological, physical, financial abuse and neglect were reported by elderly residing in nursing home. Those living in community reported exclusively psychological abuse. The victim's reactions were passive in all cases.

Elders living in nursing home were more single or divorced (0.000) and financially independent (0.003). They had lower scores of MMSE (0.002) and ADL (0.014), and higher scores of GDS (0.022). A binary logistic regression confirmed that elder abuse was significantly more prevalent in nursing home after eliminating these confounding variables: age, gender, MMSE, GDS and ADL scores (P = 0.018).

Our results confirm that elderly who live in long-term care facilities are at particular risk for abuse and neglect.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.