The authors present the case of a 68-year-old lady with a 35-year history of bipolar affective disorder (BPAD) type I, who developed frontotemporal dementia (FTD). Description of the psychopathology is illustrated with examples of patient's writings in order to demonstrate cognitive abilities at different stages. The diagnosis is supported by MRI and SPECT scans. The authors discuss the difficulties in differentiating the clinical presentation of chronic BPAD and FTD and examine the evidence for two important questions: Is there a relationship between BPAD and FTD and is there a relationship between lithium and risk of dementia? This is, to the best of our knowledge, the first reported SPECT scan finding in a case of frontotemporal dementia following chronic bipolar affective disorder.

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IntroductionMental illness remains highly stigmatized in society. Cinematography is a potent source of psychiatric images. Research has concentrated on mental illness portrayals in Hollywood; neglecting European cinematic perspectives.Objectives, aims, methodologyWe systematically examined European cinematic depictions of psychiatric illness and treatment. Award-winning European films were screened for psychiatric content using the International Movie Database. Two assessors independently viewed shortlisted films and compared findings. Stigma markers were derived from Link. Attributes, affective responses, attitudes and behaviours towards designated mentally-ill characters were identified through content and dramatic character analysis.Results40 films between 1964 and 2009 were identified. Psychopathologies included schizophrenia, delusional disorder, epileptiform psychosis, depression, somnambulism, learning difficulties, autism, sado-masochism and transsexualism. Frequent attributions were ‘odd’, ‘inappropriate’, ‘dangerous’, ‘unstable’, ‘frightening’ or ‘perverted’. Core affective responses comprised a cluster of ‘shame’, ‘pity’, ‘disgust’ and ‘fear’. Attitudes and corresponding behaviours occurred on a spectrum of ‘benevolent’, ‘ambivalent’, ‘distant’ and ‘hostile’. Stigmatisation of psychiatric treatment included portraying home treatment within traditional societies as misguided; institutional confinement as common; and medication as dominating daily routine. Religious dimensions to psychiatric illness and care were depicted positively and negatively. Anti-stigma themes included redemptive sacrifice or artistic genius in madness; madness as a natural manifestation of industrial alienation; and madness as unjust political labelling. Stigmatising reactions were depicted as cruel; even driving sufferers to gain sympathy through faking suicide. Psychiatrists were often characterized as empathic. One film charted humane Italian psychiatric reforms.ConclusionEuropean cinematic psychiatric perspectives are complex; both propagating and deconstructing stigmatising stereotypes.