Repositório RCAAP

Culture‑bound syndromes (CBS) and cultural concepts of distress include syndromes or disease manifestations whose occurrence is related to particular cultural contexts. The term CBS is controversial, because ultimately all psychiatric and medical conditions are associated with culture. They constitute different points of view on mental health based on alternative explanatory models of mental distress. These idioms of distress have experienced a growing interest in Western countries either by an increase in the number of cases or the influence that transcultural psychiatry has come to conquer. This review describes clinical, epidemiological and contextual characteristics of most commonly reported CBS and briefly discusses the relationship between culture and psychiatric disorders. Modern societies are increasingly multi‑ethnic and multicultural and thus, discussion of these concepts remains relevant, aiming to integrate CBS in current classification systems or establishing criteria that best define them as legitimate nosological entities.

Perspective on the competence to give Informed Consent for electroconvulsive therapy in the presence of severe mental illness with indication for this treatment. 

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Introduction: Neurological soft signs (NSS) indicate non‑specific cerebral dysfunction, those have been extensively documented in the clinical course of schizophrenia and have been considered as valuable symptoms to monitor the disorder. The Brief Motor Scale (BMS) has been widely used to assess motor neurological soft signs in patients with schizophrenia, but the Portuguese version is still unavailable. The aim of this study is the investigation of the validity and reliability of the Portuguese version of the scale (BMS_pt). Material and Methods: The International guidelines for the cross‑cultural process adaptation were considered. Forty three adults, between 23 to 63 years (39.74±11.16), 38 males and 5 females, with a diagnosis of schizophrenia participated in this study. Results: Content validity indexes (> 0.75) pointed out the content validity of the BMS_pt with a moderate/strong agreement among experts. Internal consistency was confirmed, with Cronbach alphas ranging from 0.82 to 0.87. Pearson correlations ranged from 0.93 and 0.99 (p<0.01). Exploratory Factorial Analysis resulted in a two‑factor model that explained 58.91% of total variance Conclusion: Results showed that all BMS_pt items are relevant. BMS_pt seems to be a valid and reliable instrument to assess motor NSS in individuals with schizophrenia with the potential to be used in rehabilitation services.

   Introduction: Screen availability has been associated with negative effects. We intend to characterize and compare the “screen time” in children and adolescents from the Vila Nova de Gaia area, with and without psychopathology.  Material and Methods: Observational study, with a convenience sample and self‑questionnaires from October 1, 2018 to June 31, 2019 to patients followed in Primary Health Care and Child and Adolescent Psychiatry consultation.  Results: We obtained a sample of 223 participants, 184 with (82.5%) and 39 without (17.5%) psychopathology. The majority presented a “screen time” higher than recommended (71.4%), with a higher level in those with psychopathology (p = 0.006). We found the same regarding the use of devices to fall asleep or background TV (p = 0.024 and 0.008, respectively). Covisualization was more frequent in participants without psychopathology (p = 0.045). “Screen time” higher than recommended, background TV and visualization remained significant after logistic regression (p = 0.029, p = 0.024 and p = 0.013, and OR = 3.741 [CI 1.148‑12.194]; OR = 3.494 [CI 1.175 ‑10.392] and OR = 0.249 [CI 0.083‑0.750] respectively).  Discussion: The results are consistent with what is pointed out in other studies about a possible association between “screen time” and psychopathology. It will be important to assess the causal effect of this association.  Conclusion: “Screen time” is excessive and more frequent in participants with psychopathology. The standardization of recommendations and adaptation to the Portuguese reality are of increasing relevance nowadays. 

Delirium is a complex and multifactorial neuropsychiatric syndrome, highly prevalent in all palliative care settings, particularly among cancer patients. This article aims, based on the current literature, to revise the diagnostic criteria of delirium, its clinical manifestations; assessment tools; etiology and pathophysiology; and treatment strategies for this condition in this specific population. The review was conduct based on published articles in PubMed/Medline about delirium management in palliative care, between 1987 and 2020, using the keywords: delirium, cancer and palliative care. Although the global brain dysfunction associated with delirium is exhibited by neurocognitive or neuropsychiatric symptoms and signs, the fundamental characteristic of this syndrome is attention disorder. The etiology of delirium is considered multifactorial and its diagnosis is poorly recognized by health professionals. According to literature, diverse strategies are necessary to deal with delirium’s precipitant factors, pathophysiological mechanisms, subtypes and phenomenological differences. Although highly used in clinical practice, routinely use of antipsychotics in delirium management at palliative care is not an evidence‑based approach. In summary, the aim should always be to find and treat any reversible cause and enhance non‑pharmacological approaches, with antipsychotics reserved for severe, life‑threatening and refractory cases. Thus, the treatment approach to delirium in the context of palliative care, should consider the different subtypes of delirium, based on different etiologies, contexts and prognoses, with a need for more and better studies, both from the pharmacological point of view and in combined strategies, with clarification of results regarding efficacy in the resolution of the clinical syndrome and in the quality of life in this population.

Autism spectrum disorders encompass a wide range of clinical presentations, including obsessive‑compulsive symptoms. The comorbidity between these disorders is significant, and it has therapeutic and prognostic implications. While there are a few references on the approach of such comorbid presentations, the literature is even scarcer when this co‑occurrence is superimposed on individuals with intellectual disability. We present the case of a 43‑years‑old male patient with comorbid treatment refractory obsessive‑compulsive disorder, autism spectrum disorder and intellectual disability, exhibiting subacute symptomatic recurrence including hetero‑aggressive outbursts and contamination obsessions. The phenomenological features and therapeutic strategies are discussed, highlighting the centrality of a patient‑centered and methodologically pluralistic approach. Symptomatic remission was achieved employing high end doses of fluvoxamine and haloperidol, alongside daily psychotherapy involving both symptom‑directed behavioral therapy and supportive psychodynamic techniques. An integrative approach may be the best option in the stabilization of complex cases as the one presented.

The COVID‑19 pandemic implied the lockdown of the paediatric population at home, conditioning changes in academic and leisure activities and relations with peers and family. Children and young people with mental illness have specific vulnerabilities, which can be affected in a particular way. This study aims to evaluate the evolution of psychiatric symptoms ‑ in the domains of mood, anxiety and behavioral changes ‑ in a child and adolescent psychiatry (CAP) population during the lockdown due to COVID‑19. Data were collected through a telephone interview with the main caregiver of children/young people (for psychiatric symptoms and qualitative variables) and online filling of the Strengths and Difficulties Questionnaire (SDQ). Data were subsequently analyzed statistically in SPSS. The final sample consists of a total of 502 patients. There was a global increase in screen hours, along with changes in hours of physical activity and sleep. Additionally, there was an increase in symptoms of sadness, irritability, anxiety and behavior. It was demonstrated that these symptomatic variations were statistically correlated with the caregiver’s perception of the variation in the quality of the relationship during lockdown. With specific vulnerabilities, this population can be affected differently depending on the diagnosis and on the social and family context. Longitudinal studies are justified, as well as analyzes that identify risk and protective factors.

Gilles de la Tourette syndrome is a neuropsychiatric disease that affects about 1% of the population with frequent onset during childhood or early adolescence. Tics, the central manifestation, tend to decrease in frequency and severity throughout adolescence, even though a small percentage of cases progress to severe illness. We present a clinical case description of a 28‑year‑old patient late diagnosed at 18 years old, with severe disease and no response to treatment as well as a prognostic and maintenance factor exploration and surgical indication in pharmacological resistant cases. The pathophysiology is not well established and there is no approved treatment for all patients. There are alternatives when psychotropic drugs are not effective and a surgical intervention is considered in this case. We highlight the importance of a good co‑work and communication between Child and Adolescent Psychiatry, Psychiatry and Primary Care and early diagnosis. Further studies and evidence will be necessary to define and individualize resistant cases treatment.

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Lurasidone is an atypical antipsychotic approved in 2010 in Canada and in the USA for the treatment of adults with schizophrenia or bipolar type I disorder. In 2014 it was approved in the European Union for the treatment of patients with 13 years‑old or older, with schizophrenia. Lurasidone is a benzisothiazole derivative with a binding profile that makes it an antidepressant candidate with a low metabolic impact. In patients with bipolar disorder, depressive episodes tend to be present for the majority of the time and are difficult to treat, as shown in multiple surveys indicating that more than three quarters of patients with bipolar depression receive at least two pharmaceutical drugs and more than one third receive three or more. Some relevant international guidelines include different first‑line options in the treatment of bipolar depression, among which is lurasidone. Considering the difficulties in treating depressive episodes in bipolar disorder, the EU marketing authorization limiting the use of lurasidone in schizophrenia only and the expectable commercialization in Portugal by 2021, we aim to review the literature regarding the efficacy and advantages of lurasidone for depressive episodes of bipolar disorder and to discuss the usefulness of approving this medication as an alternative treatment approach.

Introduction: The World The World Health Organization declared the coronavirus outbreak a pandemic on March 11th 2020. Since then, the containment measures are leading to increasing mental health problems in the general population and worsening of some pre‑existing psychiatric conditions. To our knowledge, there are no studies characterizing the impact of the COVID‑19 pandemic on psychiatric hospitalizations across the world. We aim to compare the number and characteristics of the hospitalizations in the mental health department of a Portuguese psychiatric hospital from March 2nd 2019 to October 31st 2019 with those that occurred in the same period in 2020. Methods: We conducted a retrospective observational study including all patients admitted to hospital during these periods (n=805). Sociodemographic data, clinical characteristics and information about the context of hospitalization were collected. Statistical analysis was performed using t Student Test, Mann‑Whitney and Chi‑square. Results: In the pandemic period there was a marked reduction in the number of psychiatric hospitalizations. There was a statistically significant difference in the median length of stay and in the percentage of involuntary hospitalizations between the two periods. In 2019, the most frequent International Classification of Diseases (10th Revision) diagnostic categories were F30‑F39 (mood disorders) and in 2020 were F20‑F29 (schizophrenia, schizotypal and delusional disorders). Conclusion: The reorganization of services and the decrease in admissions through the emergency department may explain these results.

Introduction: Electroconvulsive therapy (ECT) is a safe and effective treatment for treatment resistant severe mental disorders. However, it has a high relapse rate, following the acute course (A‑ECT). Maintenance treatment is recommended to increase remission rate and duration. Maintenance ECT (M‑ECT) is an option, although under‑prescribed. The aim of this study was to assess M‑ECT effectiveness in reducing number and duration of hospital admissions, as well as associated costs, in patients with severe mental disorders. Mirror study comparing number and duration of hospital admissions before and after first M‑ECT. Methods: Information was gathered for demographic and technical data, and drug dosing. Mean cost before and after the initiation of M‑ECT was compared. All treatments were performed with a MECTA spECTrum 5000QÒ. Statistical analysis was performed using SPSS 22. Results: A total of 16 patients were enrolled. The mean number of M‑ECT treatments was 41.25 with a mean duration of 23 months. Treatment frequency was mainly once a month. A statistically significant decrease was found for number of admissions (Mdn=2.0 before and Mdn=0.0 after) and for total days in admission (Mdn=86.0 before and Mdn=14.5 after). Marginally significant results were found for antidepressive dosage, with higher dosages in the after initiation period. No significant results were found for antipsychotic dosage variation. The mean cost per patient, before and after initiation of M‑ECT, was respectively 10 621€ and 5 653€. Conclusão: In our sample, we found that M‑ECT significantly reduces number of admissions and days in admission. Initiating M‑ECT treatment decreased cost per patient by 47%.

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Introduction: When we talk about young adults we tend to consider them as a population in good health. However, in recent times, the transition from adolescence to adulthood has been the focus of attention to implement strategies for health promotion and disease prevention. The aim of this study was to understand the health status of a young adult population attending higher education and, in what way, the pandemic by COVID‐19 had an impact on the different dimensions of daily life, namely on well‐being and mental health. Methods: A questionnaire was applied and disseminated electronically by young people in university education and 149 responses were obtained. Results: The students showed some feelings of low personal fulfilment (28% say they feel unfulfilled), feelings of loneliness (26% say they feel alone), feelings of depression (42% say they feel depressed), lack of confidence in themselves (17%) and in some cases feel that their energy levels are low or extremely low (26%).The pandemic context brought several challenges to young adults who had difficulty making new friends (94%), the perception of feelings of nervousness, anxiety or tension during confinement was reported by 51% of students and the inability to control their concerns or emotions was reported by 43%. Conclusion: Several studies report mental changes that can develop or worsen after traumatic events such as a pandemic, and the results of our study are in line with this evidence. Feelings of nervousness, tension and anxiety, as well as difficulty in controlling emotions, emerged in association with the pandemic, emphasizing the need to develop health strategies that respond to these emerging needs.

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