RCAAP Repository

Body image, in the subsequence of bariatric surgery and the inherent fast and massive experience of weight loss, may suffer many changes such as dissatisfaction or distortion. This narrative review aims to explore the conception of body image in obese patients and the experience of their own body after bariatric surgery, as well as the reflection of this intervention in their mental health. Additionally, this study further clarifies the potential dissociation between the time of physical‑metabolic adaptation and psychological adaptation, the use of aesthetic correction procedures after bariatric surgery, as well as the motivations that sustain the choice for such surgical strategies.The acquisition of the bibliographic information was performed through a research on PubMed and SCOPUS platforms, starting from the following combination of terms: body image and bariatric surgery. Studies obtained in the last five years were analyzed, corresponding to investigations conducted or based on the obese population. Most of the studies corroborate the benefits of bariatric surgery in the conception of body image; however, the existence of unsatisfactory results, limited improvements in time or negative repercussions in the field of mental health have also been reported. The psychological transformation may even take a different pace of development from the fast and simultaneous physical‑metabolic transformation. The evidence of the benefit of having subsequent aesthetic corrective surgery, such as body lifting, has been increasingly consistent, associated with generalized psychosocial improvements.However, the motivations that underlie the use of bariatric surgery and body lifting remain unclear.The changes caused by bariatric surgery may expose the patient to stresses never experienced or projected before surgery, so that the long‑term follow‑up of the post‑bariatric patient by psychology or psychiatry is an essential step for the whole evaluation of the effect of this type of surgery.

Introduction: Suicidal behaviors lead unequivocally consequences both in society and in the family environment. These behaviors can be divided into suicidal acts (suicide attempts and completed suicide) and self‑injurious behaviors, which are important predictors of risk for suicide. This study is based on socio‑demographic characteristics of the hospitalized patient by suicide attempts and self‑injurious behaviors in a period of six years (2008‑2013), the comparison of these behaviors by gender and in assessing the evolution of admissions over these six years. Methods: It was used as a data source records of clinical processes. Results: During the study period the suicide attempts accounted for 13.1% of all admissions while self‑injurious behavior were the source of 0.9%. Most remains hospitalized for a relatively short period. Both predominantly females, aged between 31‑40 years and in Viana do Castelo. It appears that the majority of hospitalizations for suicide attempts occurs in February and spring, the result of a disturbance of adaptation. Self‑injurious behaviors occurs especially in April and October, in the summer, with most affective psychosis. In both cases, the poisoning is the predominant method, psychotropic agents being the most used. In 2013 recorded the highest number of admissions for suicide attempts without evidence of any hospitalization for self‑injurious behaviors. Conclusion: This study confirms the importance of suicide attempts and self‑injurious behaviors in public health.

Asperger’s syndrome is a disorder characterized by impaired social interaction and a pattern of stereotyped behaviors. These include repetitive behaviors, irritability, aggressiveness, hyperactivity and inattention. The treatment of behavioral symptoms is a challenge, with few studies on the effectiveness of different therapeutic approaches. This article is the first description of the successful use of monthly paliperidone palmitate in the treatment of behavioral symptoms in an adult with Asperger’s syndrome. 

Cannabis is the most cultivated and abused illicit drug worldwide. Paradoxically to the antiemetic properties attributed to cannabis, a relatively new cannabinoid hyperemesis syndrome (CHS) started to be recognized and is characterized by cyclic vomiting that are interspaced by asymptomatic phases. We present a case of a 36‑year‑old woman who repeatedly presented to the emergency room with cyclic vomiting that alleviated with hot showers. She was a long‑term cannabis user and the diagnosis was only established several years later after the onset of symptoms. The diagnostic work up was unremarkable, and the only effective treatment was cannabis cessation. Hot bathing behavior is a key characteristic of this syndrome. CHS is a new clinical condition that should be considered in a setting of recurrent and intractable vomiting in patients with a history of cannabis use.

Introdução: As pessoas com esquizofrenia têm um risco acrescido de mortalidade ao mesmo tempo que recebem menos cuidados paliativos, dos quais o planeamento antecipado de cuidados éum componente essencial. O objetivo desta revisão éreunir as provas disponíveis relativamente ao planeamento antecipado de cuidados em contexto paliativo em pessoas com esquizofrenia, os seus obstáculos e as boas práticas a serem seguidas.  Método: Revisão sistemática da literatura qualitativa ao longo dos últimos 20 anos relativamente à utilização de planeamento antecipado de cuidados em cuidados paliativos ou de fim de vida em pessoas com esquizofrenia.  Resultados: Sete artigos foram incluídos na revisão. Por análise temática foram identificados cinco temas, nomeadamente, a capacidade de decisão em doenças mentais graves, as particularidades do planeamento antecipado de cuidados na pessoa com esquizofrenia, as características da esquizofrenia que afetam o planeamento antecipado dos cuidados, comunicação e formação, e a multidisciplinaridade e continuidade de cuidados.  Conclusão: É urgentemente necessária mais investigação nesta área. Os pacientes enfrentam obstáculos relacionados com a sua doença mental, desconforto e dúvida por parte dos profissionais de saúde e falta de figuras de apoio. Uma abordagem multidisciplinar e colaborativa, a formação e o reconhecimento da capacidade inerente dos pacientes para fazerem escolhas e terem discussões eficazes sobre o seu estado de saúde, facilita o processo de planeamento antecipado de cuidados. 

   The COVID‑19 pandemic has been declared a global health emergency. It is estimated that it may lead to a high level of suffering, and the crisis period is expected to give rise to various challenges in the sphere of mental health, both in the general population and in people with a previous mental disorder. Psychological suffering and generalized anguish due to the immediate impact of the virus on health, but also the need to implement quarantine measures, physical isolation associated with loss in educational and work activities, predict the fear of the disease, the fear of death and uncertainty about the future. On the other hand, it is estimated that the COVID‑19 pandemic may disproportionately affect the most vulnerable populations, namely health professionals and those with a previous history of mental disorder.  Due to the threat of mental health problems that the general population may face and the possible worsening of the underlying condition in patients with previous mental disorders, it is important to assess the various emerging problems. Indeed, mental health services need structural adaptation to deal with the increased risk of psychiatric morbidities, developing and implementing screening and early intervention programs, aimed not only at acute effects but also long‑term or chronic effects of this pandemic.  The preparation of this review article aims to gather, in a rigorous manner, the information dispersed in various scientific sources currently existing on the impact of COVID‑19 infection on mental health, as well as clinical experience in the field. In this way, the authors reviewed the literature, through research through PubMed and Medscape using the keywords “Pandemic”, “COVID‑19”, “Mental Health”, “Mental Disorder”.  The article proposes to develop concisely and summarily some of the particular problems inherent to the pandemic COVID‑19 and mental health, proposing some strategies and interventions to face the situation of crisis experienced. However, the future need for continuous studies and evaluation of the practical experience must be considered, to reorient mental health intervention policies and measures. 

Avoidant restrictive food intake disorder (ARFID) is one of the least clearly understood feeding and eating disorders, and there are no guidelines for its treatment. Patients with ARFID often present comorbid psychiatric disorders. The feeding and eating disorders can present with pancytopenia associated with poor nutritional status. Our aim is to present a clinical case of pancytopenia in a patient with ARFID. The case concerns a 20‑year‑old man hospitalized with pancytopenia. It was diagnosed ARFID and comorbid generalized anxiety disorder. Cognitive behavior therapy was implemented, and after six months there was an improvement in the feeding behavior, with greater diversity of ingested food and remission of pancytopenia. This is the first documented case of ARFID with pancytopenia. A multidisciplinary approach is crucial not only for the correct diagnosis, but also for the effective treatment with relapse prevention.

Introduction: Trans people, who need specific medical, surgical and psychological healthcare due to their condition, are confronted with discrimination, prejudice and stigma thus limiting their access to health services. The present study aims to assess barriers in trans health in three distinct public services (emergency, primary care and surgery). Material and Methods: A non‑controlled cross‑sectional study was conducted, using interviews with 71 trans people, after their sexology consult. An interview model was elaborated by the authors, adapting questions from the Trans Pulse Project and the 2015 US Transgender Survey. Results: Half of the trans people who used the services studied perceived discrimination by a healthcare provider. The use of prejudiced language was the most frequent perceived episode of discrimination and the emergency department was the place where it occurred with higher frequency. We found an association between episodes of perceived discrimination in family medicine and the discomfort felt in addressing trans health with the family physician. Discussion: The perceived discrimination felt by trans people was similar to the literature data, in emergency and family medicine services. The lack of knowledge of standards of care by health providers may reinforce barriers to trans healthcare, as seen in the literature. Conclusion: We found the need to study the impact of trans discrimination, around the country, as welll as evaluate and promote trans healthcare amongst healthcare providers.

Introduction: Antipsychotic polypharmacy (APP) and high dose (APHD) remain a common practice in the treatment of severe mental illness, even though they are not supported by current international guidelines. Methods: We aimed to establish the prescribing patterns of antipsychotics in a community mental health service in a rural setting, to determine the prevalence of APP and APHD treatment and to identify associated factors. Results: We identified 284 patients. APP was present in 46.5% patients and was associated to younger age, single status, more previous psychiatric admissions, and anticholinergic prescription. Prescription of APHD was observed in 14.4% patients and was associated with previous inpatient admissions, being prescribed with a first generation long‑acting injectable antipsychotic and anticholinergics. We also found that APP and APHD were mutually associated. Conclusion: Despite current guidelines, we found prevalences of APP and APHD of 46.5% and 14.4%, respectively. Further studies are necessary to better evaluate the antipsychotic prescription patterns in Portugal.

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Major depressive disorder affects an estimate of 5% of the population with nearly 1‑third of patients failing to achieve remission with conventional pharmacological treatment. Esketamine, a novel rapid‑acting antidepressant, with a noncompetitive antagonism on N‑methyl‑D‑Aspartate receptor, have been recently approved by Food and Drug Administration (FDA) and European Medicines Agency (EMA) for treatment‑resistant depression. Here, we report a clinical case of a 42‑year‑old Caucasian woman who endured many years with severe depressive symptoms and high functional impairment. Previous treatments included cognitive behavioral therapy, numerous pharmacological trials with antidepressants and augmentation agents, and neurostimulation approaches. Upon treatment with esketamine, the patient presented remarkable clinical recovery. Psychometric assessments determined an acute reduction on the MADRS score after 1 week and progressive recovery of the depressive symptoms on the following weeks. Likewise, PHQ‑9 scale assessments, evaluating the relative frequency of depressive symptoms. and the Sheehan scale, assessing functional recovery, also determined a pronounced symptomatic relief.

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Anticholinergic medication abuse is common in patients with schizophrenia. The recreational use of anticholinergic plants for their euphoria inducing and hallucinogenic properties is a rising concern in America and Eastern Europe, but rare in Portugal. Anticholinergic misuse poses a challenge to Psychiatrists treating patients with dual pathology, for its addictive potential. In managing antipsychotic medication and its side effects in this population one must have in mind the potential for abuse of anticholinergics. We present a case report of a patient with schizophrenia and abuse of anticholinergic plants, after receiving biperiden to treat extrapyramidal symptoms. Later we discuss anticholinergic effects and potential for addiction and explore ways to prevent and treat drug misuse in this context.

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Since the pandemic was declared in March 2020 by World Health Organization, COVID‑19 has been responsible for a disruptive impact on health, economy, and interpersonal relationships, with significant repercussions on mental health and the eating habits. A bibliographic review was carried out through the PubMed database, which aimed to study the implications of COVID‑19 on the mental health and eating habits of individuals. The association between increased psychopathological symptoms and pandemics has been established throughout human history. During the COVID‑19 pandemic, studies that sought to assess the mental health of individuals who had been infected with SARS‑CoV‑2 and/or were in quarantine found an increased prevalence of psychopathological symptoms such as anxiety, sadness or fear. The duration of the quarantine, socioeconomic problems, false and/or inappropriate information and the neurotropism of the virus, were some of the risk factors pointed to the appearance of these symptoms. Likewise, the scientific community has also found a relationship between the quarantine period and depressive symptoms with increased consumption of comfort foods, with high energy density and low in nutrients. This not only increases the risk of developing chronic non‑communicable diseases, such as obesity and type 2 diabetes mellitus, but it also seems to influence the hypothalamic‑pituitary‑adrenal axis, with impairment of the immune system and an increase in mental illnesses such as depression. The immune response is, ultimately, the only way we have to overcome this pandemic. SARS‑CoV‑2 has had an important negative impact both on the mental health of the population and on their food choices, which conditions out immune response. Thus, more than only measures to prevent contamination, also to promote a healthy lifestyle seem to be the best strategies against COVID‑19, with a view to increase our “psychoneuroimmunity” to better overcome this pandemic.

Shared decision‑making supports users to experience greater empowerment, including a subjective sense of involvement in treatment, self‑efficacy and autonomy. Health care should be provided on the basis of need, with an intended goal of improving quality of life. It is known that the number of unmet needs has been directly implicated in a lower quality of life for people. The studies differ as to the level of agreement between the unmet needs identified by patients and technicians but the needs of a social and psychosocial nature corresponded to the majority of unmet needs identified. The needs assessment should be part of the psychiatric clinical practice and should not be used only for research. A policy of actively assessing and addressing patient‑rated unmet needs may lead to improved quality of life.

Introduction: Mental illness stigma studies demonstrate the presence of stigmatizing attitudes towards people with mental illness both by the public and health professionals. This study aimed to analyze the attitudes of professionals working at a Portuguese psychiatric hospital towards people with mental illness. Material and Methods: A cross‑sectional observational study was conducted to examine the attitudes of professionals through application of Mental Illness Clinician Attitude Scale (MICA) and collection of sociodemographic data. Results: Scores of MICA questionnaire were significantly lower than the cut‑off point for negative attitude in general and across professional categories suggesting that overall professionals seem to manifest a positive attitude towards people with mental illness. There was a trend of decrease in MICA scores throughout increasing years of professional experience although not statistically significant. Conclusion: Our results do not contradict the need to continue fighting stigma, but instead to better evaluate how these attitudes translate into practice, by including behavioral outcomes in future research.

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