RCAAP Repository

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Since the disease caused by the SARS‑CoV‑2 virus was declared a pandemic by the World Health Organization, countries around the globe adopted measures of social distancing to limit the spread of the virus. Although social distancing measures are essential preventive mechanisms, they can promote feelings of loneliness and influence the onset or exacerbation of psychiatric disorders. Current knowledge about the impact of COVID‑19 on mental health – and specifically on mental health of the geriatric population ‑ is still scarce. With this non‑systematic review of literature we intend to analyze the impact of COVID‑19 pandemic, especially the containment measures enacted, on elderly’s mental health; we also aim to review measures that can mitigate this impact. There will probably be an increase in mental disorders as a result of the pandemic witch may be particularly relevant in the elderly. Recommendations to maintain the physical and mental health of the elderly have been suggested, focusing on non‑pharmacological measures.

Introduction: COVID‐19 disease has been declared a pandemic since March 2020. Studies carried out in previous pandemic contexts demonstrate a negative impact on mental health. In the context of SARS‐CoV‐2 infection, data suggests that the infection itself may be a predisposing factor for the onset or worsening of psychiatric disease. Material and Methods: We studied users of a Primary Care Unit in Northern Portugal diagnosed with SARS‐CoV‐2 infection between March and October 2020, with at least one month of follow‐up after cure, as well as a randomized sample of controls (1:1 ratio), in a total of 218 subjects. Results: We did not find significant differences in the onset or worsening of mental illness in the presence of SARS‐ ‐CoV‐2 infection. In this group, the number of days of isolation and the place of treatment were not associated with the onset or worsening of mental illness. In the total sample, the practice of physical exercise was associated with lower odds of onset or worsening of mental illness (p=0.039), and the presence of a history of mental illness was associated with higher odds of onset or worsening of it (p=0.001). Discussion: although COVID‐19 was not associated with onset or worsening of mental health, factors such as the practice of physical exercise and a history of mental illness were shown to have an impact on the onset or worsening of this variable in a pandemic context. Conclusion: SARS-coV-2 infection does not seem to be a determining factor in the worsening of mental health, there are other factors that may be more decisive.

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A dissociative fugue occurs when an individual with dissociative amnesia wanders away from their familiar surroundings, maintaining self‑care and apparently normal behavior to observers, lasting from hours to months in a row. New identities can be assumed and even organized travel can occur. While dissociative amnesia by itself may have a prevalence of around 7.2%, dissociative fugue is a rare entity, with unknown prevalence, and there are few reports in the literature. In this article, we describe a case of dissociative fugue in a 34‑year old woman that lasted eight months. Dissociative amnesia with fugue remains an interesting topic for further research since it can present a diagnostic challenge, there are currently no evidence‑based pharmacological treatments and prognosis varies greatly between patients.

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Introduction: We aimed to understand how loneliness and empathy relate to home confinement/quarantine and to explore the relation between loneliness, anxiety traits and empathy. Methods: This is an observational cross‑sectional cohort study including 364 participants. We delivered an online questionnaire composed by UCLA Loneliness scale (assessing loneliness), STAI‑Y (assessing trait anxiety), and IRI (assessing empathy). For the statistical analysis we performed  descriptive and inferential statistics. When not‑otherwise specified, two‑tailed p<0.05 was considered significant. Results: The mean for IRI was 60.46 (SD: 10.88), for UCLA Loneliness scale was 32.70 (SD: 8.11) and for STAI‑Y was 42.01 (SD: 12.29). We found no statistically significant correlation between empathy and loneliness (p>0.05). Nonetheless, loneliness and anxiety traits were positively correlated (p<0.05), and psychiatric comorbidity was associated with higher levels of loneliness and anxiety traits (p<0.05). Conclusion: Our results suggest social cohesion, solidarity and continuous online contact may have played a significant role on preservation of empathy and feelings of loneliness. The fact that loneliness may be felt in a positive way (such tightening household relationships) can explain the non‑correlationbetween the last and empathy. Ultimately, the positive correlation between anxiety traits and loneliness underlines the vulnerability of previously anxious subjects, enhancing the importance of promoting mental health during the pandemic.

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Introduction: Children and adolescents with attention deficit and hyperactivity disorder (ADHD) could experience dis- turbances in their behaviour due to the COVID-19 pandemic and its consequences.On the other hand, the absence of classroom rules (good behaviour, timed tasks) at home might have led to symptomatic improvement. The main goal of our study was to evaluate the perception of the carers of children and adolescents with ADHD regarding the impact of the pandemic in their child’s behaviour, emotions, and routines Methods: We inquired 40 carers using the following instruments: Sociodemographic and Clinical data questionnaire; survey of evaluation of the impact of COVID-19 pandemic on carers and their children and Conners Parent Rating Scale Revised (CPRSR) – Short form. Results: Regarding the carer’s perception of the child’s behaviour changes, the majority noticed an improvement in agitation and instruction following and worsening in anxiety and frustration tolerance. As far as the carer’s own perception of impact of the lockdown on themselves is concerned, there was a significant wors- ening of parental stress and carer’s irritability and anxiety.We also evaluated the association between children’s behavioural worsening and the CPRSR dimensions. We highlight a positive and statistically significant association between child’s global worsening and the following dimensions: opposi- tion, motor activity and ADHD index. Regarding the difference between child’s global worsening considering the carer’s own perception of impact of the lockdown on themselves, we found that children and adolescents whose carers reported worsening of anxiety, sadness, parental stress, and family relationship difficulties, revealed more severe worsening in their behaviour. Conclusion: We consider that this study shows the importance of mental health services’ intervention in children and adolescents with ADHD amidst the COVID pandemic.

A síndrome de DRESS (drug reaction with eosinophilia and systemic symptoms) constitui uma forma rara de reação adversa medicamentosa grave com envolvimento sistémico. Descreve‑seo caso clínico de doente com diagnóstico demelanoma maligno, que se dirigiu ao serviço de urgência com quadro de exantema morbiliforme generalizado, edema facial e astenia. Encontrava‑sesob terapêutica com pembrolizumab desde há 5 meses e, no contexto de depressão bipolar,tinha iniciado lamotrigina 14 dias antes da admissão. Analiticamente destacava‑setrombocitopenia, eosinofilia, PCR elevada e alterações das provas hepáticas. Considerou‑seo diagnóstico de síndrome de DRESS a lamotrigina, tendo este fármaco sido suspenso e iniciada corticoterapia sistémica, com resolução completa do quadro em 30 dias. A suspensão do fármaco responsável constitui a medida mais importante na redução da morbilidade e mortalidade associadas à síndrome de DRESS. A identificação do agente causal em doentes polimedicados pode tornar‑seum verdadeiro desafio.

Intimate partner violence (IPV) perpetrated by men is a highly prevalent public health problem. IPV has long been asso- ciated to substance use disorder (SUD) in young women, namely alcohol-related problems. However, evidence on this link regarding late-adulthood onset is scarce. In this paper, we report the case of a 52-year-old female patient voluntarily seeking medical help for first‐time heroin use. She had previously been married into a thirty‐year‐long abusive relation- ship, following unintended teenage pregnancy. At 49 years-old, as the patient signs for divorce and puts an end to the abusive relationship, high-risk behaviors and SUD follow. Although a bidirectional association between IVP and SUD is described in young women, further investigation is needed to elucidate on how IPV-related trauma may impact on older women. It is paramount to promote specialized mental health care among this vulnerable population.

Psychotic disorders are clinical syndromes that are characterized by difficulty in distinguishing internal experience fromexternal reality, with emergence of delusions, hallucinations and/or psychomotor disorganization. These symptoms areoften distressing experiences for the patient. Although these pathologies have a heterogeneous course, most patientsexperience difficulties in psychosocial rehabilitation, with loss of self‑esteemand quality of life.Third‑wavecognitive‑behavioraltherapies, developed in the last thirty years, have been extensively studied, with scientificevidence proving their effectiveness in the treatment of various pathologies, such as depression, anxiety and chronicpain. Although interest in the application of these therapies in psychotic disorders has developed more recently, there arealready several studies that demonstrate their usefulness in reducing psychotic symptoms and improving the well‑beingof patients with psychosis.This review focuses on the contributions of mindfulness based therapies, acceptance and commitment therapy and compassionfocused therapy in the treatment of psychotic disorders.

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Introduction: Some specific groups seem to show a higher prevalence of depression when compared to the general popu‐ lation, and that seems to be the case within the LGBT medical students population. This study aims to find out if there are repercussions in students’ mental health according to their sexual orientation and to discover indications of depression in the participants according to their sexual orientation in the medicine course of the Federal University of Sergipe, in Aracaju. Methods: A quantitative study was carried out at the Federal University of Sergipe, in Aracaju, Sergipe with 310 medical students who answered four questionnaries: Demographic characteristics, Beck Depression Inventory, LGBT Campus Climate Scale and the Scale of Perception of Social Support. Results: About the stratification of depression according to sexual orientation, the prevalence of depression in LGBTI+ medical students were higher than that found in the heterosexuals students. Furthermore, both groups presented a lack of knowledge about specific public policies for this population. Conclusion: It is extremely important that there are discussions that address both themes, sexuality and mental health, aiming to offer psychosocial support to those who are suffering in both groups, however, to those in need, with particular focus in those who show higher depression rates.

With the emergence of eHealth and mHealth, information technologies and mobile devices are now part of the clinical reality and its future prospects. Within this scope, given its own characteristics, its use in mental health has been focused as especially opportune for advancing in the fight against inequalities in access to quality healthcare. However, this area also appears to be particularly sensitive, and its digital transition deserves a careful analysis from an ethical‐legal point of view. This article aims to review some technologies currently applied in psychiatry and their ethical and legalimplications, namely: 1) issues of access and effectiveness of these technologies; 2) artificial intelligence in psychiatry and its clinical, legal and ethical implications; 3) surveillance systems with geolocation and digital tablets; 4) digital phenotyping and use of big data in mental health. We conclude that, despite contributing evident benefits to mental health, the implementation of these technologies is not innocuous. Their development requires both a legal strengthening of the protection of the patient and a broadening of the ethical debate in an anticipatory perspective, as well as keeping up with the speed of their implementation.