IntroductionLate-onset psychoses are a heterogeneous group of disorders whose nosology has been controversial throughout history. Several methodological limitations have made difficult the comparison among studies and, as a consequence, the research interest has been little, leading to the absence of late-onset schizophrenia and paraphrenia in current official classifications.Aims and methodologyTo highlight the specific symptoms of late-onset schizophrenia as well as its differences with other psychoses though the study of a case report.ResultsA 70-year-old woman developed psychotic symptoms during the last seven years, consisting of auditory and olfactory hallucinations, telepathic phenomena and injury delusions, erotomania and thought control, with a high level of systematization and fantasy. She was admitted in an inpatient unit. She was treated with risperidone and the psychotic symptoms got better. At the time of hospital discharge, hallucinations and delusional thoughts had disappeared and no behavioral or emotional disorder was observed. Some weeks later, risperidone had to be substituted by paliperidone due to side effects, such as tremor, sialorrhea and parkinsonism.ConclusionsLate-onset schizophrenic psychosis is not as exceptional as it has been traditionally considered. One of the main problems is that current classifications do not include specific diagnostic categories for cases of late or very-late-onset psychoses. It would be necessary that future ICD-11 and DSM-V classifications will include different-age criteria when diagnosing mental disorders.

Introduction: Delusional parasitosis, also known as Ekbom syndrome, is the most frequent among the somatic delusions. It may occur at any age but is more common in the elderly, particularly in females. It is a syndrome in which the patient has the false belief that he is infested by some type of insects, lice, worms or other invertebrates, and that they live or grow under their skin or inside their body. Psychiatric interventions are usually rejected by these patients and long-term treatments are frequently abandoned. Objectives and method: A clinical case was followed and reviewed to illustrate the links between somatic delusions, hypochondriasis, somatization and obsessive disorders. Results: A 58-year-old female presents delusions of infestation. She has a long history of somatization and hypochondria, which can be interpreted as a continuum in the onset of the delusional syndrome. In this case, delusions of infestation are projected onto a third person. Psychophramacological treatment with long acting injectable risperidone was then introduced, as an alternative to drugs previously used. Conclusions: The effectiveness of pimozide and risperidone for the Ekbom syndrome has been documented in the literature. In our case, we decided to introduce long acting injectable risperidone after several rejections or long-term discontinuation in oral treatments.

Introduction: Progressive hepatolenticular degeneration or Wilson's disease is a rare autosomal recessive genetic disorder of copper metabolism, which is characterised of hepatic and neurological disorders due to the accumulation of copper in organs such as the liver or the basal ganglia. The manifestations of Wilson's disease are multiple and sometimes insidious, which makes the diagnosis very complicated. Objective and method: A clinical case was followed and reviewed to illustrate the psychiatric symptoms in Wilson's disease. Results: A 23-year-old male came to the emergency room presenting insomnia, logorrhea, euphoria, irritability and a slight tremor in the upper limbs. Symptoms started two weeks before. The previous year, he was diagnosed of bipolar disorder after a manic episode which required inpatient treatment with risperidone and lithium. During the actual hospitalization, the tremor increased progressively and affected all four limbs and his head. He was then examined by neurology and an ophthalmology service, who ordered some specific complementary exams. Low levels of ceruloplasmin and serum copper and high levels of urinary copper confirmed the diagnosis of Wilson's disease. Treatment with copper chelants was introduced and the psychiatric symptoms and the analyses got better in several weeks. Conclusions: Even a typical presentation of a psychiatric syndrome can be part of the spectrum of an organic illness. So an organic etiology should always be considered in the differential diagnosis, as sometimes it is possible to be treated.

IntroductionThere is a growing interest in establishing a relationship between several mental disorders and traumatic life events in childhood and adolescence.It has been seen a high prevalence of these traumatic events when reviewing the clinical history of patients with mental illness.AimsMeasuring the prevalence of traumatic events in a sample of patients with a diagnosis of psychotic disorder.MethodologyA retrospective descriptive study was made. The sample comprised 50 patients admitted to our psychiatric inpatient unit. These patients were separated into different categories according to clinical diagnosis and demographic variables. Data was obtained through clinical interview before their hospital discharge. We tried to detect the presence or absence of real or imaginary memories of traumatic events during their childhood or adolescence.Results52% of patients had a diagnosis of paranoid schizophrenia. 64% reported a history of substance abuse in their family. 20% referred the experience of having suffered sexual abuse by a member of their family, and up to 44% of them by someone other than family. 22% reported having suffered some kind of physical abuse by their parents, and more than 70% reported having suffered some type of traumatic event in the school environment.ConclusionsThere is an important amount of traumatic events in childhood and adolescence in this sample of patients. However, concluding that such traumatic events could eventually produce severe psychiatric disorders is still quite controversial. In order to understand better the association between childhood trauma and severe mental illnesses more research is needed.

IntroductionObsessive compulsive disorder (OCD) in childhood was first described by Legrand du Saulle in late XIX century, however, a systematic study in pediatric population was not made until 1986, by Rapoport. It is has been documented in scientific literature that younger patients usually hide their symptoms because of shame or that they do not find their obsessions and compulsions excessive, so that they feel them in an egosyntonic way, delaying diagnosis until several years after their first symptoms.Aims and methodologyTo highlight the specific symptoms in Pediatric OCD and review its treatment and approach through the study of a case report.ResultsA 11-year-old boy was referred by his paediatrician to a child mental outpatient service for behavioural disturbances in the last few months. For the last three years, he had been performing rituals of cleaning, order and checking, increasingly complex and with a significant impact on his life, to the point of not being able to go to school and have other members of his family involved. He also had religious and catastrophic obsessions that generated him important distress. He was treated with high doses of sertraline and low doses of risperidone, and cognitive-behavioral psychotherapy with exposure response prevention and training in relaxation techniques were associated to the treatment. The patient improved partially.ConclusionsThis case illustrates the delay in the diagnosis of Pediatric OCD itself as well as the complexity when treating this disorder.