IntroductionRecent estimates suggest Bipolar disorder (BD) affects approximately 1% of the population, with diagnosis often made during late adolescence and early adulthood, and that it is lower in the elderly (up to 0.1%). The initial onset of BD generally presents with depressive episode, but an initial maniac episode is not uncommon, although it becomes less likely with increasing age. In spite of the fact that elderly is a growing population in developed countries there are only few studies on late-onset BD (LOBD). Its etiopathogenesis and heterogeneity are complex, sharing several commonalities with organic brain diseases, which is denoted on frequent neuroimaging white matter hyperintensities, and involves higher medical and neurological burden.Objectives and aimsTo provide a comprehensive review reporting prevalence, features, course and comorbidity on LOBD. Additionally to report one selected case, intending to better understand this patient's subgroup.MethodsThe literature was systematically reviewed by searching on PubMed and reference psychogeriatric textbooks. We have selected one case of an elderly woman with LOBD with inaugural acute mania episode associated with previous diagnosis of Parkinson disease.ResultsDistinguishing older adults with BD by early or late age at onset have limited clinical usefulness, although LOBD patients are more likely to have an organic mental disorder superimposed and more extensive and severe cognitive impairments, as well as vulnerability to extrapyramidal symptoms.ConclusionsThis case-report and literature review suggests that LOBD as a distinct diagnostic entity by its different presentation and etiology, and consequently different treatment, needs further investigation.

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IntroductionSystemic lupus erythematous (SLE) is the paradigm of chronic systemic diseases. It has a strong impact regarding patient’s quality of life and the ability to work, which carries high direct and indirect costs. Intervention strategies promoting appropriate coping seem to have an important positive effect on quality of life. Neuropsychiatric symptoms are common.Objectives and aimsTo review the literature on psychosocial impact of SLE, understand which coping strategies are more often used, and to know what are the most common SLE neuropsychiatric manifestations.MethodsThe authors have conducted an online search in PubMed with the terms “SLE + Psychiatry” and “SLE + Mental health” from 1995 until 2012. From the outcome were collected, analyzed and summarized the articles considered to be relevant.ResultsIndirect costs represents 2/3 of the total cost associated with SLE. Inability to work is common (23%) and it is related to multiple factors. Patients with SLE tend to use coping skills that are generally adopted for events perceived as nonmodifiable. The immune system might play a role in the aetiopathogenesis of psychiatric diseases. Neuropsychiatric SLE symptoms are frequent (20-75%), especially depression (10.8-39.6%) and cognitive deficits (>40%).ConclusionsSLE is a chronic systemic disease with a high psychosocial impact. Using active coping strategies seems to improve patient’s quality of life. Neuropsychiatric manifestations are common. A detailed study on disease impact will probably allow an earlier screening that lead to a more accurate diagnosis and treatment, promoting better mental health and prognosis in SLE patients

Introduction: Folie à deux or induced psychotic disorder is a rare psychiatric illness and was first described in the 19th century. The essential feature is a psychotic disorder shared by two emotionally close persons, usually a blood relative or spouse, while living in relative isolation. The disorder is characterized by a primary psychotic person, usually older, more intelligent and better educated who gradually imposes her delusional beliefs on the other person, who is often dependent on or submissive to the person with the psychotic disorder. The disorder usually resolves in the more passive person when the two are separated. Objectives/aims: To describe two case studies of two couples who shared psychotic illness and make a review of the literature. Methods: Search in the PubMed/MedLine and Medscape databases with the following key words: folie à deux; shared psychosis; shared delusion. Results/conclusions: Even though Folie a deux is rare to diagnose, clinicians should be aware of this condition, since it is tremendously important to treat properly both people involved.