A sixty three year old man was admitted for the first time in a psychiatry unit.The patient did not presented history of mental disorder before.He was hospitalized with an important level of anxiety. Could not feed himself, because there was a belief that his throat was “closed”, losing ten kilograms in a year. He thought his intestines and bladder were paralyzed.It was presented by him also ideas of being already dead (nihilistic delusions), insomnia, thoughts that all was ruined.Family reported also symptoms such as impulsiveness, mood lability, psychomotor agitation.He was diagnosed as having a bipolar depression. His treatment was initially based on neuroleptic drugs and mood stabilizers - lithium and olanzapine. As the patient responded poorly was tried the introduction of antidepressants. Firstly a tricyclic drug - amitriptyline then a selective inhibitor reuptake - paroxetine. Both drugs were uneffective.After several attempts with no resolutive medications ECT was tried.The patient was submitted to seven sessions of ECT and showed remarkably improvement.He was discharged after one month of hospitalization with presenting no more psychotic symptoms and keeping a stable mood.Although there are strong evidences in favor of the efficacy and safety of ECT this procedure is still surrounded by a lot of prejudice.This patient was accompanied by his son in all ECT sessions. When parents are able to watch the procedure it gives the patient more confidence and security. As a result the prognosis gets better and the stigma is defeated by comprehension.

Schizophrenia is a serious mental disorder that affects 1% of the population.In childhood and adolescence it is an extremely rare disease.This case shows a comorbidity between Schizophrenia and Asperger Syndrome.A sixteen year old female was admitted in a psychiatry unit in order to prevent suicide.The girl was delusional about her appearance. She felt like did not have hips and would like to die.She was always complaining as well about her hair and nose. She did not recognize herself as a girl.Efforts were made in order to persuade the patient about the inveracity of her ideas but she insisted with the thoughts.When asked, she affirmed to hear voices that cursed her and controlled her actions.She was first treated with risperidone 4 mg day without good response. Then she was given olanzapine 10 mg day with partial response. The best response was achieved with clozapine 400 mg day.The patient presented childish behavior. Could be noticed difficulty in social interaction and repetitive movements as rocking, spinning and hand - flapping.She did not presented signs of mental reatardation.Nowadays the patient did not present delusional ideas, her behavior is more stable. She is finishing the first grade at school and under the use of clozapine.