Although its rarity, psychiatrists should be aware of this diagnosis in elderly. The report of this cases could contribute to a better identification of clinical characteristics and additional risk factors.

It is widely agreed that obsessive-compulsive disorder (OCD) is less common among the elderly. However, several studies suggest that a third peak of OCD onset may occur after the age of 65. The onset of OCD in the elderly is unusual and mostly related to nonpsychiatric diagnoses. Nonetheless, some reports have documented late-onset OCD in older adults with no detection of cerebral abnormalities. Such differences in age of onset may be associated with phenotypical differences in disease severity, comorbidity, and treatment response across patients. In this report, we describe the case of late-onset OCD in an 80-year old man with no specific focal brain structural abnormality. The report could improve awareness of the disorder in the elderly and contribute to a better identification of clinical characteristics and additional risk factors of OCD.

A atual pandemia veio exacerbar as fragilidades pré-existentes do Sistema Nacional de Saúde, onde o burnout dos seus profissionais era já uma realidade. O burnout é considerada uma síndroma relacionada com o trabalho, caracterizada por exaustão emocional, despersonalização e baixos níveis de realização pessoal. Existem vários fatores que contribuem para o burnout, mas a sobrecarga laboral excessiva é citada como um dos fatores mais associados ao burnout dos profissionais de saúde. Esta síndroma leva a uma redução no desempenho profissional, com maior probabilidade de erro, maiores taxas de absentismo, menor compromisso com o trabalho, menor satisfação laboral, aumento do uso de álcool e drogas, exaustão física e problemas conjugais e familiares. Vários estudos apontam para percentagens consideráveis de profissionais de saúde que reportaram níveis elevados de sintomas de burnout durante a pandemia. Torna-se, portanto, imperioso abordar estratégias de prevenção e tratamento, que consistem em intervenções dirigidas aos médicos e intervenções organizacionais/ estruturais, com foco no ambiente de trabalho. A implementação de intervenções eficazes para prevenir e gerir o burnout nos profissionais de saúde contribuirá para o desenvolvimento de profissionais mais saudáveis, capazes de melhores resultados clínicos, com menos erros e encargos financeiros, levando a um funcionamento mais eficiente do setor da saúde, ainda que em contexto de crise.

Individuals with dementia usually have multiple chronic illnesses, most of whom are medicated with five or more medications. However, as dementia progresses and the goal of care moves from prolonging life to optimizing quality of life, the risk of taking certain medications may outweigh its benefit. Therefore, it is necessary to reassess the medication over time.The objective of this work was to explore the barriers to optimising prescribing and deprescribing (withdrawing) of medications and the benefits of this procedure. Optimizing pharmacological treatment for people with dementia usually requires the prescription of inappropriate drugs and the initiation of other drugs. Several obstacles to the optimization of treatment have been identified in elderly people with multiple morbidities, related to the doctor, the health system, the patient and the caregiver, including: inadequate guidelines, incomplete medical history, prevention of negative consequences and established beliefs in the benefits and harms medication. Desprescribing older people with dementia is made even more difficult by the decrease in decision-making capacity, difficulties in understanding and communicating, increased involvement of caregivers and difficulties in setting goals.

Background:The practice of assisted dying is increasingly being discussed in a growing number of countries and is progressively regarded as a last-resort option for those suffering from severe and irreversible diseases. Recently, euthanasia in patients with psychiatric disorders and dementia has taken a prominent place in the public debate, since little is known about the prevalence and practice of euthanasia in these particular cases. Remaining a controversial subject, this study aims to describe the evolution and characteristics in reported euthanasia cases, focusing in dementia patients and the perspective from different countries regarding the nature of suffering, the voluntariness of the request and the role of the physician in the process.Methods:A non-systematic review was performed, searching Pubmed/MEDLINE and Google Scholar for articles using the keywords dementia, euthanasia and assisted dying. Resultant articles were cross-referenced for other relevant articles not identified in the initial search.Results:Physicians consider less likely to perform euthanasia in patients with dementia, compared to patients with a severe and life-limiting somatic illness such as cancer. Both physicians and members of the general public acknowledge difficulties in the assessment of the voluntariness of the request and the extent of suffering of patients with advanced dementia, considering that communication is compromised. While euthanasia on the grounds of unbearable suffering caused by dementia remains a comparatively limited practice, its prevalence has risen and is related to loss of dignity or the knowledge that the lasting memory of their loved ones will be of the decomposed version of oneself.Conclusions:It is likely that the number of euthanasia requests from patients suffering from dementia and/or accumulation of health problems related to old age will continue to grow. The question of how policy makers and care providers should respond to these requests is, therefore, highly relevant, as welll as the development of practice guidelines, if medical staff is to respond adequately to these delicate requests.