an ongoing study. The main limitations of this study were the small sample size and the absence of follow up assessment. Overall, the results suggest that the modified program had a positive impact in decreasing the psychopathological and psychosomatic symptoms of patients with BPD, and it led to an improvement of everyday problem-solving strategies as well as self-concept. Therefore, the present program could be viewed as an alternative therapy for outpatients with BPD in an hospital setting and can also be seen as the result of the first step towards a better investment in BPD study and specialized treatment in Portugal.

IntroductionDelusional misidentification syndromes are divided into Capgras Syndrome, Fregoli Syndrome, Double Subjective Syndrome and Intermetamorphosis Syndrome. The main feature is an error in the identification of self and / or others. These entities are relatively rare and etiologically heterogeneous, occurring mainly in the setting of schizophrenic disorder, affective disorders and organic diseases.ObjectivesAbout a clinical case of paranoid schizophrenia as a base, the authors revise and discuss the etiology and psychopathology of delusional misidentification syndromes presented by the patient.MethodsClinical interview with the patient during psychiatric hospitalization. Psychological assessment (test of intellectual performance, neurocognitive rating). Revision of selected literature about delusional misidentification syndromes and paranoid schizophrenia.ResultsThe neurobiological research on these syndromes indicates lesions both frontal lobes and / or right hemispheres.The coexistence of three of the four existing Delusional misidentification syndromes is very rare. Based on the available literature, it appears that the described case is the only reported about the coexistence presented by same patient of Capgras Syndrome, Fregoli Syndrome, Double Subjective Syndrome and Intermetamorphosis Syndrome. Furthermore, the presentation is not typical due to the absence of previous psychiatric disorders, substance use or organic diseases.ConclusionsThe delusional misidentification syndromes seems to be under-diagnosed entities and poorly understood. Active research may allow a better understanding of clinical conditions like stated on the previous clinical case.

Based on a case of an acute and transient psychotic disorder with full recovery between recurrences, the authors remind the concept of cycloid psychoses. This diagnosis has been neglected in modern psychiatry and in the current nosological systems. However, the cycloid psychoses concept may offer an alternative diagnosis for some psychotic disorders in spite of the need of more studies to improve the understanding of its etiology and treatment.Ferreira MC et al. / Arch Clin Psychiatry. 2015;42(3):79-80

Delirium is an increasingly common multifactorial condition, especially in elderly and debilitated patients often undiagnosed and therefore untreated properly. It is a medical emergency with significant mortality rates. Objectives: Clarification about what delirium is and how to act upon suspicions of this clinical condition. Methods: A non-systematic literature review was performed in PubMed (1990-2014), using the keyword "delirium" in combination with one other major search term to review areas including the Following: "epidemiology", "clinical features", "pathogenesis" and "evaluation". Only original articles in english language were included. Results: The clinical presentation of delirium is variable but can be classified broadly into three subtypes-hypoactive, hyperactive and mixed. Risk factors for delirium are presented. The diagnosis of delirium is made on the basis of clinical history, behavioral observation and cognitive assessment. In view of the fact that cognitive impairment can be missed during routine examination, a brief cognitive assessment should be included in the physical examination of patients at risk of delirium. An algorithm of action in case of suspicions of delirium is proposed in this study. Conclusion: Delirium is a serious cause and complication of hospitalization in elderly patients and should be considered to be a medical emergency until proven otherwise. Irrespective of the specific etiology, this condition has the potential to markedly affect the overall outcome and prognosis of severely ill patients, as well as substantially increasing health-care utilization and costs. For these reasons, prevention, early recognition and effective treatment of delirium are essential.

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