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Background Our goal was to identify the demographic profile of the people living homeless with mental illness in Lisboa, Portugal, and their relationship with the national healthcare system. We also tried to understand which factors contribute to the number and duration of psychiatric admissions among these homeless people. Methods We used a cross-sectional design, collecting data for 4 years among homeless people, in Lisboa, Portugal, that were referred as possible psychiatric patients to Centro Hospitalar Psiquiátrico de Lisboa (CHPL). In total, we collected data from 500 homeless people, then crosschecked these people in our CHPL hospital electronic database and obtained 467 patient matches. Results The most common psychiatric diagnosis in our sample was drug abuse (34%), followed by alcohol abuse (33%), personality disorder (24%), and acute stress reaction (23%). Sixty-two percent of our patients had multiple diagnoses, a subgroup with longer follow-ups, more psychiatric hospitalizations, and longer psychiatric hospitalizations. The prevalence of psychotic disorders was high: organic psychosis (17%), schizophrenia (15%), psychosis not otherwise specified (14%), and schizoaffective disorder (11%), that combined altogether were present in more than half (57%) of our homeless patients. Conclusion The people living homeless with multiple diagnoses have higher mental health needs and worse determinants of general health. An ongoing effort is needed to identify and address this subgroup of homeless people with mental illness to improve their treatment and outcomes.

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Background: Homeless people present high rates of psychopathology, including personality disorders. Given the link between personality disorders and attachment, and the potential importance of these two traits for understanding homeless populations. Aims: Our aim was to review all studies focusing on attachment and on the full assessment of personality disorders in the homeless. Method: Overall, 213 studies were screened through title and abstract. Of these, 63 articles were chosen for full-text assessment. Results: A total of 14 articles met eligibility criteria and were included in the present review. Six studies evaluated personality disorders and eight studies assessed attachment in the homeless. In general, reports suggested that personality disorders are highly common in the homeless, with frequencies ranging between 64% and 79% for any personality disorder. The most common personality diagnoses were paranoid (14%–74%), borderline (6%–62%), avoidant (14%–63%), and antisocial (4%–57%) personality disorders. Attachment reports differed in the methods used and presented diverse results and correlates. Even so, insecure types of attachment dominated in the homeless, accounting for 62% to 100% of the samples. Conclusions: The high prevalence of personality disorders and insecure types of attachment in the homeless may impact intervention strategies for these people. The available literature evaluating attachment and the full assessment of personality disorders in the homeless is scarce, which supports the need for more research on these two topics.

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.