Aim: To determine the prevalence, aetiology, and treatment profile of abnormal sexual behaviour in subjects with dementia in psychogeriatric practices. Methods: A retrospective cross sectional study was conducted in a long term care psychiatry consultation service, community based geriatric psychiatry service, and an inpatient dementia behavioural unit in Edmonton, Canada. Results: Forty one subjects (1.8%) had sexually inappropriate behaviour. Of those cognitively impaired subjects with sexually inappropriate behaviour, 20 (48.8%) were living in nursing homes and the rest, 21 (51.2%) in the community. Of these subjects, 53.7% had vascular dementia, 22% had Alzheimer's, and 9.8% had mild cognitive impairment. History of alcohol misuse and psychosis were reported in 14.6% and 9.8% of subjects respectively. Twenty seven (65.7%) had verbally inappropriate behaviour and 36 (87.8%) had physically inappropriate behaviour. In this study, verbally inappropriate behaviour was more commonly seen in the community sample (81%) than in the nursing home sample (50%) (p = 0.04). Behavioural treatment was also more commonly seen in the community sample (81%) than in the nursing home sample (45%) (p = 0.01). Conclusion: In this study sexually inappropriate behaviour was seen in all stages of dementia, more commonly associated with subjects of vascular aetiology, and is as commonly seen in community dwelling subjects with dementia as in nursing home subjects.

E lderly persons experience a complex array of physical, psychological, and social changes while they struggle to adjust to the aging process. As part of the psychosocial developmental task of aging, most people deal with existential issues, at some level, in their efforts to achieve integrity or coherence. In his theory of human development, Erik Erickson describes distinct developmental stages across the lifespan from birth to death (1). The eighth stage occurs in late adulthood and focuses on the dynamics between ego integrity and despair. Persons who achieve integrity can reflect on their 428

The case of a patient who developed a severe hypotensive reaction with a persistent hemianaesthesia following the addition of lithium carbonate to her treatment regimen is described. The patient had been receiving chlorpromazine therapy for the management of hypomania and the addition of lithium carbonate to the chlorpromazine produced a severe hypotensive episode which compromised her neurological functioning. Only three doses of lithium carbonate had actually been taken by the patient. This type of hypotensive response associated with the simultaneous use of chlorpromazine and lithium has not previously been noted in the literature.