IntroductionPsychological distress appears in the majority of people infected with HIV. Depression is the most important affection, the prevalence in comparison with general population arises to 37%. Psychotic symptoms in patients with HIV are a very frequent entity, in some cases, these symptoms are pre-existent in others the evolution of the infection or a medical cause related with the infection can cause its apparition. Psychosis and depression in patients with HIV have some clinical and therapeutical considerations. Antidepressants and antipsychotics have many pharmacological interactions with antiretroviral therapy.ObjectivesReview the efficacy and safety of antidepressants and antipsychotics in patients with HIV infection.MethodsPubMed was searched for articles published between 1966 and January 1, 2015, using the search terms HIV, AIDS, depression, phycosis, antipsychotics, antidepressants, antiretrovirals. We selected randomized placebo controlled or active comparator control trials.ResultsTwelve studies for depression treatment and 2 studies for psychosis treatment in patients with HIV infection. Selective serotonin reuptake inhibitors (SSRI) especially fluoxetine and tryciclic antidepressants are effective in treating depressive symptoms in patients with HIV infection. Testosterone and stimulants have been used in patients with mild depressive symptoms, however studies with these agents had a small sample size. Haloperidol and chlorpromazine were effective for AIDS delirium, there are not controlled trials with other antipsychotics.ConclusionsPsychiatrists must be concern about the clinical particularities of patients with HIV and depression or psychotic symptoms. The election of antidepressant or antipsychotic has to be made very carefully because of their side effects and interactions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionInsomnia is the most frequent sleep disorder in late life. Forty-two percent of elderly people in the United States often complain about difficulties to get or maintain sleep, or awakening too early. Insomnia is frequent in old people greatly due to frequency of concomitant medical illnesses and polypharmacy, rather than because of age.ObjectivesThe objective of our research was to revise the current state of knowledge about management of insomnia in people above 65 years of age.MethodologyFor that, a bibliographical search through PubMed.gov has been made. From the obtained results, the 14 which best suited for our goals were selected, 10 of them dealing with people above 65 years and the rest with people above 75 or 80 years of age.ResultsBased on the literature reviewed, the current options of management of late-life insomnia are based on behavioral or pharmacological therapy. The combination of behavioral therapies shows results and is currently considered as an option, especially given the possibility of medicine interaction and the secondary effects hypnotic and sedative medicines might produce. There is a paucity of long-term safety and efficacy data for the use of non-benzodiazepine sedative-hypnotics. There are no criteria for the use of antidepressant sedatives in elderly people without diagnosed depression, although they are still used in practice.ConclusionPossibility of using behavioral therapy as first option. In case of polymedicated or multi-pathological patients, pay special attention when starting a pharmacological treatment, choose the most suitable one and supervise it closely.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionSchizophrenia has traditionally been considered to strictly be an early-onset disorder. Current nosologies, including DSMV, are not restrictive with age of onset in schizophrenia and all patients that satisfy diagnostic criteria fall into the same category. Since 1998, International Late-Onset Schizophrenia Group consensus, patients after 60 are classified as very-late onset schizophrenia-like psychosis. Female overrepresentation, low prevalence of formal thought disorder, and a higher prevalence of visual hallucinations are associated with later age at onset. Atypical antipsychotics represent the election treatment because of the reduced likelihood of EPS and tardive dyskinesias, and should be started at very low doses, with slow increases.ObjectiveTo review the current knowledge about very late-onset schizophrenia through systematic review of the literature and the analysis of a case.MethodsCase Report. Review. Literature sources were obtained through electronic search in PubMed database of last fifteen years.ResultsWe present a case of a 86-year-old woman suffering from delusions and hallucinations, diagnosed with very late-onset schizophrenia-like psychosis, after differential diagnosis with other disorders. We analyze ethiology, epidemiology, clinical features and treatment in geriatric patients with schizophrenia.ConclusionsReluctance to diagnose schizophrenia in old people is still present today, probably in relation with the inconsistency in diagnostic systems and nomenclature, and consideration of medical conditions in the diagnosis. Identification of these patients is really important in order to start an appropriate treatment, which can lead to patient clinical stability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionConversion disorder (CD) is an uncommon but highly disabling condition. Affected children and adolescents are often severely impaired and at risk of serious long-term physical and psychosocial complications. Despite the enormous personal suffering and health resource implications of CD, little research has been done.ObjectivesTo update our knowledge about CD in adolescents, with a comprehensive review of the literature with special focus in prevalence, psychosocial factors, diagnosis, treatment and outcome.AimsTo present the most relevant data of our review with a clinical illustration that provides a practical vision of this disorder.MethodsA systematic literature review was performed in MEDLINE, with particular interest in papers published in the last 10 years. Clinical illustration is provided by a case selected from an outpatient child and adolescent mental health service.ResultsFew reliable prevalence data are available; the range goes from 0.2 in a German study to 31% in non-western clinical settings. Diagnosis is based on a constellation of features and treatment should involve several heath care professionals. CD has a favourable outcome in children and adolescents. However, mood and/or anxiety disorders are encountered at a considerable rate even after recovery from conversion symptoms. Long clinical follow-up seems appropriate.ConclusionsThe expression of emotional distress in the form of physical complaints is common in children. Nevertheless, the most severe presentation of physical symptoms is not a common topic in literature. More research should be done to improve our understanding of this disabling disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.