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Abstract of Medical school's graduation thesis. Supervisor: Liliana Lorettu, M.D. Psychiatrist.

DEPRESSION AND DEMENTIA Introduction Depression and dementia are both very common diseases in geriatric population. Epidemiological researches show that depression affects 30% of the population after 65 age and is three times more common in geriatric population compared to all other age groups. The prevalence of dementia is estimated to be 5 % after age 65, and doubles about every 5 years of age between age 65 and 85. In elderly patients these diseases may coexist (up to 25% in over 85) and manifest with overlapping onset symptoms. In fact , depression in the elderly patient may present with cognitive impairment, short-term and long-term memory loss, difficulties in concentration and distractibility. Likewise, dementia can start with depressive symptoms. In regard of comorbidity between depression and dementia it is difficult to find out affective symptoms because of the considerable overlap between the two disorders: for example apathy and emotional lability are common to both disorders. Materials and methods The sample consisted of 25 individuals after age 50, randomly recruited at the Psychiatric Clinic, Medical Clinic and Neurological Clinic of the University of Sassari. The clinical evaluation has been made by clinical interviews and administration of the following scales: Hamilton Depression Rating Scale which quantifies the depressive symptomatology investigating various aspects such as depressed mood, guilt, thoughts of suicide, insomnia, agitation, anxiety; Yousef Pseudodementia Scale, consisting of 18 items: 5 designed to emphasize the presence of depressive disorders or cognitive impairments, 7 designed to assess the symptoms of dementia, 4 designed to assess the awareness of illness and finally the last 2 items to assess the performance during the test administration. Objectives The objective of this study is to evaluate symptomatologic and diagnostic association of depression and dementia in order to improve the differential diagnosis between these two disorders. Results The sample consisted of 25 subjects, 28% of which were male and 72% female. 52% of them had depression, 40% had dementia and 8% had both diseases. Among patients with depression, 22% had major cognitive impairments and 78 % had a mild cognitive impairment. Among patients with dementia, 20% had significant depressive symptoms and 80% had less serious depressive symptoms. By evaluating them with the Hamilton Depression Scale, among subjects affected with depression 80% had mild depression and 20% had moderate depression. Between subjects affected with dementia, 10% had severe depression, 30% had moderate depression, 30% had mild depression, and finally the remaining 30% had depressed mood not classifiable as depressive disorder. Conclusions The data collected revealed that the majority of patients presented symptoms attributable to both diseases, but while in most cases the underlying disease is well recognized (patients with depression and mild cognitive impairment or dementia patients with mild depression), the rest of the sample confirms our hypothesis and shows a significant overlap of symptoms requiring a careful differential diagnosis. We must remember that the diagnosis must also be accompanied by a follow up period because depression is a risk factor for dementia. In fact, a diagnosis of depression can change in a period of five years thus revealing the presence of dementia. Finally, the gold standard for differential diagnosis between depression and dementia is the final psychiatric diagnosis made after an adequate follow-up period between 12 to 14 months.

Abstract of Graduate Course Psychiatry Residency Program's ( Psychiatry Specialist ) graduation thesis. Supervisor: Liliana Lorettu, M.D. Psychiatrist. MENTAL ILLNESS AND VIOLENT BEHAVIOR : AN OBSERVATIONAL STUDY ON RISK FACTORS Introduction As the scientific literature indicates, the presence of a serious mental disorder, particularly schizophrenia, increases the risk of violence. Furthermore, the schizophrenic author of violent behavior may recur in his criminal act. Evaluating the dangerousness of a patient with mental disorder is complex and bounded to a rigorous, systematic analysis of risk factors for aggressive behaviour. According to some authors the most important predictor for violent behavior is the criminal antecedent and every single antecedent of violence. We indicate several risk factors for aggressive behavior such as the state of mind of the subject: delusions and hallucinations are in fact reported as a statistically significant risk factor; age: studies show that young adults are more violent compared to the rest of the general population, and with regard to mental disorders the risk appears higher in patients younger than 40 year-old; marital status: celibacy represents a higher risk than being married or cohabitating; abuse of drugs and alcohol: scientific literature clearly indicates this as the most important risk factor for general population and it is also important for mental disorder sufferers. Materials and methods We will report 9 case reports of Schizophrenic patients selected by reason of the presence of specific risk factors for violent behavior. Data were collected through files and medical records at the Institute PhilippePinel de Montral, a maximum security psychiatric institution for patients with both psychiatric and judicial problem. Objectives Through a transversal observational screening, the present study aims to collect and display clinicaldescriptive data in a selected sample of schizophrenic patients that exhibited violent behavior. We will describe the cases reports of 9 patients hospitalized by a court order of imprisonment or sent from other hospitals due to difficulties in managing their aggressive behavior. The main objective of this study is to point out the diagnostic complexities related to the violent psychiatric patient as well as to identify and evaluate the most important clinical and socio-demographic risk factors associated with violent behavior. This factors can help the clinician in assessing the social dangerousness of the patient and quantifying the risk of future violent behavior after discharge. Conclusions In the present study were pointed out major risk factors for violent behaviour such as substance abuse, acute psychotic symptoms, first psychosis episode, impulsivity, previous violent behaviour, conduct disorders in adolescence, personality traits or disorders, bad adherence to treatment, extreme violence. As seen, violent behavior in patients with schizophrenia is not a rare event. It is therefore essential to evaluate the specific contexts in which there may be a violent assault. This is important in order to allow the clinician to better understand and manage the schizophrenic patient who turned violent and to prevent the repetition of the same behaviour. Therefore, the hazard assessment requires a qualitative and longitudinal evaluation for risk of violence. It is a complex process in which the evaluator must take into account all the facts documented.