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.

Introduction: Gender dysphoria is a new diagnostic class in DSM-5 that reflects a new conceptualization of the disorder emphasizing the phenomenon of 'gender incongruence". It refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. Hormone and/or surgery are treatment options available. There is some clinical evidence that patients under gonadotropin-releasing hormone (GnRH) agonists may develop symptoms consistent with various psychiatric disorders with and without psychotic features. Objectives and Aims: To review new DSM-5 conceptualization of gender dysphoria and psychiatric sideeffects of ovocyte stimulation drugs. Also to report one selected clinical case of psychosis after FSH and LH stimulation in a patient under female to male sex reassignment process. Methods: The authors have conducted an online search on PubMed on psychosis after ovocytes stimulation and gender dysphoria and systematically reviewed a case report. Results: There is little evidence of psychiatric side-effects of GnRH agonist. Case report: 22 years old male with diagnosis of gender dysphoria under female to male sex reassignment process with FSH and LH stimulation to ovocyte preservation that acutely developed psychiatry symptoms of bizarre behaviour, irritability, flight of ideas, soliloquies and erotomaniac delusions that remit on antipsychotic drugs. Conclusions: Gender dysphoria is a new diagnostic class in DSM-5. There are multiple hormone and/or surgery treatments options. There is little evidence hormone treatments are associated with psychiatric side-effects, namely psychosis. To conduct a well-designed clinical trial on psychiatric symptoms related with hormone treatment in gender dysphoria patients is needed.

IntroductionErotomania (also known as De Clerambault's syndrome) is usually described as a rare delusional syndrome characteristically involving an individual who believes that another person, typically of higher social, economic or political status, is in love with the individual. De Clerambault's syndrome remains a ubiquitous nosological psychiatric entity with uncertain prognosis that remains recognised as a subtype of delusional disorder in DSM 5.Objectives and aimsTo review the history of Erotomania as a nosological psychiatric entity, its clinical characteristics and course. Also to report some selected clinical cases.MethodsThe authors have conducted an online search on PubMed with MeSH words“erotomania”, “erotomaniac delusion” and “Clerambault” and systematically reviewed some case reports.ResultsErotomania is a relatively uncommon and misunderstood disorder characterised by the presence of a persistent erotic delusion. The individual (usually described as a woman) has had little or no contact with the other person who is perceived as watching over, protecting or following the individual. Despite various authors have described and named this syndrome, it was Clérambault who first classed the symptoms into the disorder he referred to as “psychose Passionelli” (1942). There are numerous theories as to the aetiology of this illness that is not uniquely associated with any specific disorder. We reviewed some clinical cases.ConclusionsErotomania is a relatively uncommon psychiatric disorder. An increased awareness and understanding of this illness will assist in the recognition of patients affected, opening doors for future progress on its aetiology and, therefore, the development of new treatment options.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionAnti-psychotics constitute a class of psychotropic drugs used for the treatment and prophylaxis of several disorders, including schizophrenia, bipolar disorder and psychotic depression. Frequently, clinicians are asked by their patients to withdraw this medication. In some cases, that may be related to notable side effects. However, it may actually indicate an inadequate control of the psychiatric disorder with poor insight.AimsThe goal of this work is to systematically review the scientific literature in order to understand if there are consistent data that support anti-psychotics withdraw in specific clinical situations.MethodsThe literature was reviewed by online searching using PubMed®. The authors selected scientific papers with the words “anti-psychotics” and “withdraw” in the title and/or abstract, published in English.Results and discussionAnti-psychotics improve prognosis and enhance patients’ quality of life. There are few data in the literature regarding recommendations that support anti-psychotic withdraw in psychiatric patients. Very specific conditions must exist for withdrawing anti-psychotics, like neuroleptic malignant syndrome, cardiac side effects, and change of diagnosis or prolonged remission after a first and single psychotic event. When that decision is made, it should be done slowly and carefully and both the patient and his family should be involved.ConclusionsThere is no evidence in the literature that supports withdraw of anti-psychotics for the majority of psychiatric situations. When specific conditions are present that possibility must then be considered, however, with careful consideration and after discussion with the patient and parties involved in patient's care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionBorderline personality disorder (BPD) is a disabling heterogeneous psychiatric disorder characterized by poor affect regulation and impulse control, with a high reactivity and vulnerability to stress. It has been hypothesized that these patients may have a dysregulation of the neuroendocrine system.AimsThe goal of this work is to systematically review the scientific knowledge regarding the role of the neuroendocrine system in the physiopathology of BPD.MethodsThe literature was reviewed by online searching using PubMed®. The authors selected scientific papers with the words “borderline personality disorder” and “neuroendocrine”/“endocrine” in the title and/or abstract, published in English.Results and discussionThere is scientific evidence for an enhanced cortisol release and HPA axis hyperactivity in BPD. The dexamethasone suppression test has been used in BPD, finding high rates of non-suppressors in that sample. There also seems to be a reduced volume of the amygdala and anterior cingulate cortex, suggesting an involvement of those regions in the emotional disturbances in BPD. Symptoms of impulsivity, aggression and suicidal behavior seem to be strongly mediated by the serotonergic system. The available research suggests a serotoninergic dysfunction in BPD, with lower levels of serotonin in those patients.ConclusionsThere seems to be several neuroendocrine changes related to BPD, namely a hyperactivity of the HPA axis with stimulated cortisol release together with disturbances of the serotonergic system. Also some brain structural alterations in BPD are scientifically depicted. Further studies are needed to clarify the neurobiology of BPD improving both psychotherapeutic and psychopharmacological treatment in these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.