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Background Weight loss, malnutrition and dehydration are common problems for people with dementia. Environmental modifications such as, change of routine, context or ambience at mealtimes, or behavioural modifications, such as education or training of people with dementia or caregivers, may be considered to try to improve food and fluid intake and nutritional status of people with dementia. Objectives Primary: To assess the effects of environmental or behavioural modifications on food and fluid intake and nutritional status in people with dementia. Secondary: To assess the effects of environmental or behavioural modifications in connection with nutrition on mealtime behaviour, cognitive and functional outcomes and quality of life, in specific settings (i.e. home care, residential care and nursing home care) for different stages of dementia. To assess the adverse consequences or effects of the included interventions. Search methods We searched the Specialized Register of Cochrane Dementia and Cognitive Improvement (ALOIS), MEDLINE, Eembase, PsycINFO, CINAHL, ClinicalTrials.gov and the World Health Organization (WHO) portal/ICTRP on 17 January 2018. We scanned reference lists of other reviews and of included articles. Selection criteria We included randomised controlled trials (RCTs) investigating interventions designed to modify the mealtime environment of people with dementia, to modify the mealtime behaviour of people with dementia or their caregivers, or both, with the intention of improving food and fluid intake. We included people with any common dementia subtype. Data collection and analysis Two review authors independently selected studies, extracted data and assessed the risk of bias of included trials. We assessed the quality of evidence for each outcome using the GRADE approach. Main results We included nine studies, investigating 1502 people. Three studies explicitly investigated participants with Alzheimer's disease; six did not specify the type of dementia. Five studies provided clear measures to identify the severity of dementia at baseline, and overall very mild to severe stages were covered. The interventions and outcome measures were diverse. The overall quality of evidence was mainly low to very low. One study implemented environmental as well as behavioural modifications by providing additional food items between meals and personal encouragement to consume them. The control group received no intervention. Differences between groups were very small and the quality of the evidence from this study was very low, so we are very uncertain of any effect of this intervention. The remaining eight studies implemented behavioural modifications. Three studies provided nutritional education and nutrition promotion programmes. Control groups did not receive these programmes. After 12 months, the intervention group showed slightly higher protein intake per day (mean difference (MD) 0.11 g/kg, 95% confidence interval (CI) -0.01 to 0.23; n = 78, 1 study; low-quality evidence), but there was no clear evidence of a difference in nutritional status assessed with body mass index (BMI) (MD -0.26 kg/m² favouring control, 95% CI -0.70 to 0.19; n = 734, 2 studies; moderate-quality evidence), body weight (MD -1.60 kg favouring control, 95% CI -3.47 to 0.27; n = 656, 1 study; moderate-quality evidence), or score on Mini Nutritional Assessment (MNA) (MD -0.10 favouring control, 95% CI -0.67 to 0.47; n = 656, 1 study; low-quality evidence). After six months, the intervention group in one study had slightly lower BMI (MD -1.79 kg/m² favouring control, 95% CI -1.28 to -2.30; n = 52, 1 study; moderate-quality evidence) and body weight (MD -8.11 kg favouring control, 95% CI -2.06 to -12.56; n = 52, 1 study; moderate-quality evidence). This type of intervention may have a small positive effect on food intake, but little or no effect, or a negative effect, on nutritional status. Two studies compared self-feeding skills training programmes. In one study, the control group received no training and in the other study the control group received a different self-feeding skills training programme. For both comparisons the quality of the evidence was very low and we are very uncertain whether these interventions have any effect. One study investigated general training of nurses to impart knowledge on how to feed people with dementia and improve attitudes towards people with dementia. Again, the quality of the evidence was very low so that we cannot be certain of any effect. Two studies investigated vocal or tactile positive feedback provided by caregivers while feeding participants. After three weeks, the intervention group showed an increase in calories consumed per meal (MD 200 kcal, 95% CI 119.81 to 280.19; n = 42, 1 study; low-quality evidence) and protein consumed per meal (MD 15g, 95% CI 7.74 to 22.26; n = 42, 1 study; low-quality evidence). This intervention may increase the intake of food and liquids slightly; nutritional status was not assessed. Authors' conclusions Due to the quantity and quality of the evidence currently available, we cannot identify any specific environmental or behavioural modifications for improving food and fluid intake in people with dementia.

Background Schizophrenia is a serious psychiatric disorder of multifactorial genesis, which can be associated with serious limitations in everyday life. In addition to environmental factors, genetic factors play a crucial etiological role. In 2014, the Psychiatric Genomics Consortium (PGC) carried out the largest GWAS to date. Significant associations between schizophrenia and 128 linkage-disequilibrium-independent Single-Nucleotide Polymorphisms (SNP) were found in 108 conservatively defined loci (Ripke et al. 2014). A neuropsychological deficit of schizophrenia, which has been widely described in the literature, is a disturbance of verbal fluency. The aim of this study was to examine schizophrenia-associated SNPs for their association with verbal fluency. Methods The PAGES sample includes 1000 schizophrenia patients who were diagnosed according to DSM IV, and 3000 randomly selected psychiatrically healthy controls that performed a multi-stage selection procedure. Verbal fluency was assessed by Regensburg word fluency test (RWT) in a subset of 361 cases and 559 controls. Association analysis was performed applying linear regression using an additive model corrected for affection status, age, education and gender. Results Several SNPs showed nominal significant association with verbal fluency measured with RWT. rs11191419 (BLOC-1 related complex subunit 7, BORCS7) was associated with all tested domains (words, words switch, categories, categories switch), association of rs111294930 (LINC01470) was restricted to categories and categories switch, for both SNPs association was reflected in the same direction of effect in cases and controls. Association in cases only could be detected for rs7523273 (MIR29B2) (all domains) and rs9636107 (transcription factor 4, TCF4) (categories, categories switch), whereas association of rs3849046 (eukaryotic translation termination factor 1, ETF1) (all domains) and rs12826178 (mitochondrial serine hydroxymethyltransferase, SHMT2) (categories and word switch) were restricted to controls. Discussion Though no association survived multiple testing, the nominal associated variations are localized in or near genes showing interesting features. Most genes are involved in regulatory processes either on the transcriptional or translational level: Long non coding RNAs (i.e. LINC01470) and micro RNAs (i.e. MIR29B2) are known to be involved in transcriptional and post-transcriptional regulation of gene expression, ETF1 is involved in termination of mRNA translation and nonsense mediated RNA decay. TCF4 activates transcription. This gene also plays a role in the initiation of neuronal differentiation. Another hit, BORCS7 has been shown to be upregulated during human stem cell differentiation toward neuronal fates in early brain development. The results indicate an influence of schizophrenia risk variants on verbal fluency performance in healthy subjects, thereby implicating an underlying mechanism which might be involved in such deficits in schizophrenia. Functional relevance of the associated SNPs as well as replication in independent samples remains to be determined.

Background Omega-3 polyunsaturated fatty acids (omega-3 PUFAs) from fish and plant sources are commonly considered as a promising non-medical alternative to improve brain functions and slow down the progression of dementia. This assumption is mostly based on findings of preclinical studies and epidemiological research. Resulting explanatory models aim at the role omega-3 PUFAs play in the development and integrity of the brain's neurons, their protective antioxidative effect on cell membranes and potential neurochemical mechanisms directly related to Alzheimer-specific pathology. Epidemiological research also found evidence of malnutrition in people with dementia. Considering this and the fact that omega-3 PUFA cannot be synthesised by humans, omega-3 PUFAs might be a promising treatment option for dementia. Objectives To assess the efficacy and safety of omega-3 polyunsaturated fatty acid (PUFA) supplementation for the treatment of people with dementia. Search methods We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (ALOIS), MEDLINE, EMBASE, PsycINFO, CINAHL, ClinicalTrials.gov and the World Health Organization (WHO) portal/ICTRP on 10 December 2015. We contacted manufacturers of omega-3 supplements and scanned reference lists of landmark papers and included articles. Selection criteria We included randomised controlled trials (RCTs) in which omega-3 PUFA in the form of supplements or enriched diets were administered to people with Alzheimer's disease (AD), vascular dementia (VaD), dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD) or frontotemporal dementia (FTD). Data collection and analysis The primary outcome measures of interest were changes in global and specific cognitive functions, functional performance, dementia severity and adverse effects. Two review authors independently selected studies, extracted data and assessed the quality of trials according to the Cochrane Handbook for Systematic Reviews of Interventions. We rated the quality of the evidence using the GRADE approach. We received unpublished data from the trial authors and collected adverse effects information from the published articles. We conducted meta-analyses for available outcome measures at six months. Main results We included three comparable randomised, placebo-controlled trials investigating omega-3 PUFA supplements in 632 participants with mild to moderate AD over six, 12 and 18 months. We found no studies investigating other types of dementia. All trials were of high methodological quality. The overall quality of evidence for most of the outcomes was high. There was no evidence of a benefit from omega-3 PUFAs on cognitive function when measured at six months with the Alzheimer's Disease Assessment Scale - Cognitive subscale (standardised mean difference (SMD) -0.02, 95% confidence interval (CI) -0.19 to 0.15; 566 participants; 3 studies; high quality evidence) or Mini-Mental State Examination (mean difference (MD) 0.18, 95% CI -1.05 to 1.41; 202 participants; 2 studies; high quality evidence) or on activities of daily living (SMD -0.02, 95% CI -0.19 to 0.16; 544 participants; 2 studies; high quality evidence). There was also no effect at six months of treatment on severity of dementia measured with the Clinical Dementia Rating - Sum of Boxes (MD -0.00, 95% CI -0.58 to 0.57; 542 participants; 2 studies; high quality evidence) or on quality of life measured with the Quality of Life Alzheimer's Disease scale (MD -0.10, 95% CI -1.28 to 1.08; 322 participants; 1 study; high quality evidence). There was no difference at six months on mental health measured with the Montgomery-Asberg Depression Rating Scale (MD -0.10, 95% CI -0.74 to 0.54; 178 participants: 1 study; high quality of evidence) or the Neuropsychiatric Inventory (SMD 0.10, 95% CI -0.07 to 0.27; 543 participants; 2 studies; high quality of evidence). One very small study showed a benefit for omega-3 PUFAs in instrumental activities of daily living after 12 months of treatment (MD -3.50, 95% CI -4.30 to -2.70; 22 participants; moderate quality evidence). The included studies did not measure specific cognitive function. The studies did not report adverse events well. Two studies stated that all adverse events were mild and that they did not differ in overall frequency between omega-3 PUFA and placebo groups. Data from one study showed no difference between groups in frequency of any adverse event (risk ratio (RR) 1.02, 95% CI 0.95 to 1.10; 402 participants; 1 study; moderate quality evidence) or any serious adverse event (RR 1.05, 95% CI 0.78 to 1.41; 402 participants; 1 study; high quality evidence) at 18 months of treatment. Authors' conclusions We found no convincing evidence for the efficacy of omega-3 PUFA supplements in the treatment of mild to moderate AD. This result was consistent for all outcomes relevant for people with dementia. Adverse effects of omega-3 PUFAs seemed to be low, but based on the evidence synthesised in this review, we cannot make a final statement on tolerability. The effects on other populations remain unclear.

Aim: The aim of this work is to investigate differences between two non-schizophrenic, non-organic psychotic disorders, namely persistent delusional disorders (PDD) and acute and transient psychotic disorders (ATPD) according to ICD-10. Method: In a prospective and longitudinal study, we compared all 43 inpatients with PDD who were treated at Halle-Wittenberg University Hospital during a 14-year period to a previously investigated cohort of 41 patients with ATPD in regard to demography, long-term symptomatic outcome, and social consequences. Sociobiographical data were collected using a semi-structured interview. Follow-up investigations were performed at a mean of 10–12 years after the onset of the disorder using standardized instruments. Results: With the exception of the duration of the psychotic symptoms, the PDD patients were significantly different from the ATPD patients on various levels, such as sex ratio (female predominance only in ATPD), age at onset (older in PDD), the number of preceding stressful life-events in the index hospitalization (more frequent in ATPD), richness and variety of symptoms (higher in ATPD), and persistence of positive psychotic symptoms (in PDD). Patients with PDD had significantly less re-hospitalizations during the course of their illness. Long-term outcome was marked by chronicity of delusional symptoms and lower global functioning in PDD than in ATPD, while negative symptoms and loss of independence were infrequent in both conditions. Conclusions: PDD differs from ATPD not only in the duration of the psychotic symptoms, but also in a variety of significant variables. They appear to be two separate entities within a psychotic spectrum.

This paper presents gender-related features of Delusional Disorder. It is part of the Halle Delusional Syndromes Study (HADES-Study). All inpatients fulfilling the DSM-IV/ICD-10 criteria of Delusional Disorder/Persistent Delusional Disorder (DD) during a 14-year period were included and followed up for an average of 10.8 years. Gender distribution was almost equal, women became ill significantly later than men, and almost all women had a stable diagnosis-in contrast to men. The great majority of women, at the end of the follow-up period, had an unremitted DD. Women more frequently had low social functioning at admission, but then were more compliant and received more frequently pharmacological medication. There were no differences in the delusional topic and no differences regarding long-term disability and autarky. In spite of previous reports, the HADES-Study found no gender difference in the frequency of DD. However, men tended more frequently to change into schizophrenia and schizoaffective disorder. In these cases, the DD might have been a prodrome of schizophrenia or schizoaffective disorder, which manifests later in life. Although in both female and male DD patients, the majority remained unremitted, almost none of them lost their autarky (independent living). While women more frequently received psychopharmacological medication, their DD was usually found to be unremitted.

OBJECTIVE Turner syndrome encompasses several chromosomal abnormalities and includes a typical clinical manifestation. While common somatic symptoms are often described, neuropsychiatric alterations are rare and not frequently mentioned in the literature. METHOD In this paper, we report on a subject with Turner syndrome who also showed psychotic symptoms. CONCLUSIONS The theoretical background and the relevance of this observation are discussed. Furthermore, this article briefly reviews existing reports on Turner syndrome and psychosis and presents neuropsychiatric changes in patients with Turner syndrome.

OBJECTIVE In comparison to metabolic syndrome, edema seems to be a rare occurrence in antipsychotic treatment. METHOD In this paper, we report on two subjects with psychotic disorders who were found to have peripheral edema during olanzapine therapy. DISCUSSION The theoretical background and the relevance of this observation are examined. Furthermore, edema as a side effect of antipsychotic treatment is reviewed. In particular, the importance of olanzapine, a commonly used neuroleptic drug, as a possible causative substance is evaluated.

OBJECTIVE Palinacousis seems to be a rare phenomenon in mental disorders. METHODS In this paper, we report on a subject with alcohol hallucinosis who displayed one episode with palinacousis after remission from the typical acoustic hallucinations according to the disorder. DISCUSSION The theoretical background and the relevance of this observation are discussed.

Objective: Reactive delusional disorder (DD) (with a precipitating factor) has been postulated to differ clinically from nonreactive DD and to show a better prognosis. Our study tests this hypothesis in a sample of patients with persistent DD (International Classification of Diseases, 10th Revision) or DD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) followed during a period of more than 10 years. Method: As part of a long-term study on DD, 19 patients with DD and a stressful life event preceding the onset of the disorder were compared with 24 DD patients without such a life event. Diagnoses, social and biographical data, life events, and outcome were assessed by a semistructured interview and validated rating scales. Personality features were assessed by the NEO Five-Factor Inventory and by the Inventory of Clinical Personality Accentuations. Results: Patients with reactive DD tended to be somewhat younger but showed otherwise little differences to patients with nonreactive DD. In particular, there were no differences in the course of the disorder. However, patients with reactive DD were significantly more often in a stable relationship and showed higher values on neuroticism and more pronounced dependent and borderline personality accentuations in dimensional personality measures. Conclusions: Reactive DD was not found to have a better prognosis than nonreactive DD. However, the results suggest an increased vulnerability for interpersonal conflicts in these patients. Objectif : Le trouble delirant (TD) reactionnel (avec un facteur declenchant) est postule differer cliniquement du TD non reactionnel et presenter un meilleur pronostic. Notre etude verifie cette hypothese chez un echantillon de patients souffrant de TD persistant (Classification internationale des maladies, 10e revision) ou de TD (Manuel diagnostique et statistique des troubles mentaux, 4e edition) suivis durant une periode de plus de 10 ans. Methode : Dans le cadre d'une etude a long terme sur le TD, 19 patients souffrant de TD et ayant vecu un evenement stressant de la vie avant l'apparition du trouble ont ete compares avec 24 patients du TD sans un tel evenement stressant. Les diagnostics, donnees sociales et biographiques, evenements de la vie, et resultats ont ete evalues par une entrevue semi-structuree et des echelles de cotation validees. Les traits de personnalite ont ete evalues par l'inventaire NEO des 5 facteurs et par l'inventaire des accentuations de la personnalite clinique. Resultats : Les patients souffrant de TD reactionnel tendaient a etre un peu plus jeunes mais ne presentaient autrement que de petites differences avec les patients souffrant de TD non reactionnel. En particulier, il n'y avait pas de differences dans l'evolution du trouble. Cependant, les patients souffrant de TD reactionnel etaient significativement plus souvent dans une relation stable et presentaient des valeurs plus elevees de nevrosisme et des accentuations plus prononcees de personnalite dependante et limite dans les mesures dimensionnelles de la personnalite. Conclusions : Nous n'avons pas observe que le TD reactionnel avait un meilleur pronostic que le TD non reactionnel. Toutefois, les resultats suggerent une vulnerabilite accrue aux conflits interpersonnels chez ces patients. Key Words: delusional disorder, life events, reactive psychosis, personality, NEO Five-Factor Inventory Received August 2011 , revised, and received September 2011. Abbreviations DO delusional disorder DSM Diagnostic and Statistical Manual of Mental Disorders GAF Global Assessment of Functioning HADES Halle Delusional Syndromes Study ICD International Classification of Diseases ICP Inventory of Clinical Personality Accentuations NEO-FFI NEO Five-Factor Inventory PANSS Positive and Negative Syndrome Scale Delusional disorders are characterized by the development and often chronic persistence of delusional ideas without other prominent psychotic symptoms and in the absence of major affective or cognitive abnormalities. …

The aim of this work is to investigate differences between two non-schizophrenic, non-organic psychotic disorders, namely persistent delusional disorders (PDD) and acute and transient psychotic disorders (ATPD) according to ICD-10.In a prospective and longitudinal study, we compared all 43 inpatients with PDD who were treated at Halle-Wittenberg University Hospital during a 14-year period to a previously investigated cohort of 41 patients with ATPD in regard to demography, long-term symptomatic outcome, and social consequences. Sociobiographical data were collected using a semi-structured interview. Follow-up investigations were performed at a mean of 10-12 years after the onset of the disorder using standardized instruments.With the exception of the duration of the psychotic symptoms, the PDD patients were significantly different from the ATPD patients on various levels, such as sex ratio (female predominance only in ATPD), age at onset (older in PDD), the number of preceding stressful life-events in the index hospitalization (more frequent in ATPD), richness and variety of symptoms (higher in ATPD), and persistence of positive psychotic symptoms (in PDD). Patients with PDD had significantly less re-hospitalizations during the course of their illness. Long-term outcome was marked by chronicity of delusional symptoms and lower global functioning in PDD than in ATPD, while negative symptoms and loss of independence were infrequent in both conditions.PDD differs from ATPD not only in the duration of the psychotic symptoms, but also in a variety of significant variables. They appear to be two separate entities within a psychotic spectrum.

Turner syndrome encompasses several chromosomal abnormalities and includes a typical clinical manifestation. While common somatic symptoms are often described, neuropsychiatric alterations are rare and not frequently mentioned in the literature.In this paper, we report on a subject with Turner syndrome who also showed psychotic symptoms.The theoretical background and the relevance of this observation are discussed. Furthermore, this article briefly reviews existing reports on Turner syndrome and psychosis and presents neuropsychiatric changes in patients with Turner syndrome.

In comparison to metabolic syndrome, edema seems to be a rare occurrence in antipsychotic treatment.In this paper, we report on two subjects with psychotic disorders who were found to have peripheral edema during olanzapine therapy.The theoretical background and the relevance of this observation are examined. Furthermore, edema as a side effect of antipsychotic treatment is reviewed. In particular, the importance of olanzapine, a commonly used neuroleptic drug, as a possible causative substance is evaluated.

Palinacousis seems to be a rare phenomenon in mental disorders.In this paper, we report on a subject with alcohol hallucinosis who displayed one episode with palinacousis after remission from the typical acoustic hallucinations according to the disorder.The theoretical background and the relevance of this observation are discussed.