Ornithine transcarbamylase (OTC) deficiency is the most frequent congenital defect among the urea cycle enzymatic disorders, due to mutations a!ecting the OTC gen (Xp21.1) that are inherited with an X-linked pattern. As it happens with sex-linked genetic disorders, late-onset OTC deficiency is more prevalent among women, so that females may be asymptomatic over the years and manifest symptoms only when they are submitted under severe metabolic stress, such as pregnancy, infections or new medications. The enzymatic defect involves a blockage a!ecting the main biochemical route that converts ammonia into urea. This leads to analytic hyperammonemia and the outburst of gastrointestinal, neurological and psychiatric symptoms with variable severity.

Expounding the importance of inborn errors of metabolism as possible causes of a psychotic episode.

Describing the case, supporting our data with a bibliographic research made on PubMed.

We describe a psychiatric adult-onset OTC deficiency in a 37-year-old woman with borderline intellectual functioning and a psychotic episode in the context of an infection that was wrongly diagnosed at first as schizophrenia, until the genetic study was carried out. The woman’s familiar history shown an OTC deficiency among some family members, a mutation- carrier sister and at least two male children death by the first month of life.

Organic psychosis can be caused by a large number of medical diseases. A di!erential diagnosis of possible cerebral, toxic or metabolic causes of psychosis is necessary to avoid mistakes in diagnosis.

No significant relationships.

CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is an inherited disease caused by mutations in the Notch3 gene in chromosome 19.The clinical features are primarily neurological, which include recurrent transient ischaemic attacks, strokes, and migraines.However, psychiatric manifestations such as severe depression, psychosis, changes in behavior and personality have also been reported in CADASIL. Symptoms and disease onset vary widely, with signs typically appearing in the mid-30s.Some individuals may not show signs of the disease until later in life.

In this case report, we present a possible case of CADASIL, a 67-year old female patient diagnosed with schizophrenia fifteen years ago to discuss the co-occurrence of these conditions in the light of the literature.

Hospitalization records of the patient viewed.

Our patient suffered from sleep disturbances, hearing religious voices and in psychiatric examination resistant to treatment psychotic symptoms such as blunted affect, mystic, persecutory delusions, auditory hallucinations were present.Cranial magnetic resonance imaging scan was performed and revealed leukoencephalopathy, high-signal intensity lesions in the periventricular white matter consistent with a diagnosis of CADASIL.Atypical antipsychotics found to be effective in treating psychotic symptoms in our case.

Persistent psychotic symptoms despite adequate antipsychotic treatment in patients diagnosed with schizophrenia, also with pathological findings in MRI an organic cause such as CADASIL must be considered. Further studies are needed to better understand the exact impacts of cerebral tissue lesions and psychiatric symptoms in CADASIL patients.

No significant relationships.

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.

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 cross-checked these people in our CHPL hospital electronic database and obtained 467 patient matches.

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.

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.