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This study is the first studying the association of plasma PNX level and cognitive complaints or decline. The knowledge about the role, interaction, and physiological functions of PNX is lacking. Lower plasma PNX level might be important in prodromal stages as MCI and the predictive role of PNX should be investigated in further studies.

Alexithymia might be an important searching domain of behavioral-psychological symptoms in people with cognitive problems beyond aging.

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We investigated trends over a decade in the prescription of lithium, antiepileptics, and antipsychotic agents at discharge for patients hospitalised for acute mania. We conducted a retrospective review of medical records for 165 inpatients with acute mania who had been hospitalised in Cerrahpaşa Faculty of Medicine, Department of Psychiatry during 2001-2002 and 2011-2012. Among 165 patients, prescription of olanzapine at discharge increased from 3 to 46 % (p < 0.001), while prescription of haloperidol decreased from 55 to 21 % (p < 0.001). Use of other atypical antipsychotics did not change significantly (risperidone decreased from 14 to 11 %, p = 0.5; quetiapine increased from 10 to 16 %, p = 0.2). Use of valproate, carbamazepine, and lithium did not change significantly. Use of electroconvulsive therapy in acute mania decreased by half from 27 to 13 % (p = 0.02). Typical antipsychotics alone or in combination with antiepileptics were the most common treatment regimen at discharge at 2001-2002; while 10 years later, they had been largely replaced by lithium or antiepileptics combined with second generation antipsychotics. Antipsychotic agents remained to be an important component of acute treatment of mania in our practice.

Dear Editor, Hyperostosis frontalis interna (HFI) is a well-described entity from ancient times that occurs in 24% of women and 5.2% of men. 1 Although meaningful association between HFI and neurological disorders has not been proven, HFI frequently accounts for neuropsychiatric symptoms including frontal executive dysfunctions, epilepsy, cognitive impairments, parkinsonism, and frontal headache. 2-4 Here, we present an HFI case involving a woman with symptoms of depression and parkinsonism. CASE PRESENTATIONA 78-year-old woman complained of excessive fatigue, decreased rate of speech, and motor behaviours over a period of five years. As a result, she was diagnosed with Parkinson's disease and was prescribed levodopa and levodopa/carbidopa/ entacapone in outpatient neurology clinics. Because of unresponsiveness to these treatments and the nonprogressive course, the patient was referred to geropsychiatric outpatient clinics. Her physical and mental examinations revealed excessively decreased rate of speech but not poverty of speech, hypophonia, and a thought rate in the normal range without delusion. Affect was limited, decrease in facial movements, and mood was dysthymic. The patient's spontaneous attention was impaired, but her memory was intact. Bradykinesia, bilateral +2 rigidity in the upper extremities, and gait with small steps but without tremor were noted. We performed cranial magnetic resonance imaging that revealed HFI (Fig. 1).The patient was assessed in a geriatrics consultation that aimed to exclude secondary causes of Figure 1 Brain computed tomography of the patient showing left frontal thickness (12.8 mm).bs_bs_banner

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