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Introduction: Muscular dysmorphia (DM) is a subtype of body dysmorphic disorder, which occurs in individuals who, despite having a muscularly developed physique, consider themselves thin and weak. Currently, it is assumed that the use of androgen‑anabolic steroids (AAS) may be a perpetuating factor in this disorder, but also that DM may predispose to the use of AAS, drugs frequently used for their effects on body composition, namely the increase in muscle mass body composition, but with vast side effects. This systematic review aimed to explore the current evidence about the association between DM and the use of AAS. Methods: Systematic review of recent literature, including articles published between June 2009 and January 2019. Results: Twelve articles were included, with the majority of studies establishing an association between these two variables, the results oscillating between the absence of statistically significant differences and a strong association, the latter being the most frequently found. Conclusion: The existing evidence of the association between DM and the use of AAS is still not very consistent, which may be due to the heterogeneity of the tools used to compare the same variables. Thus, it is important to establish an optimal model for collecting more sensitive information, and to establish better validated DM assessment scales, so that data collection and analysis can be as accurate as possible.

Shiftwork is a key characteristic of the working environment of the XXI century. We can define this type of work schedule as any work that takes place outside the usual working hours with the goal of providing a continuity of services. Healthcare constitutes a sector where shiftwork is particularly necessary. The aim of this study is to review the current literature on the influence of shiftwork in the development of sleep and mental disturbances. The literature found on PubMed/MEDLINE from 1984 to 2017, with full text available written in English that assessed the effects of shiftwork on mental health and sleep was reviewed by searching on the keywords: shiftwork, mental health, sleep disorders, circadian rhythm. This study found that shiftwork produces important effects regarding sleep and mental health. Concerning sleep, this type of work increases excessive somnolence and insomnia. As to mental health, depression, suicide ideation, cognitive impairment and substance abuse are greatly influenced by shiftwork. Shiftwork has a significative impact in workers’ mental health, cognitive function and sleep patterns. Considering this, it is crucial to know how to identify this toll to adopt the necessary measures to minimize the effects of shiftwork on workers’ health, especially in those who are most vulnerable, as it happens in the healthcare system.

Marchiafava‑Bignami disease is a rare condition associated with chronic alcohol consumption and/or malnutrition, characterized by demyelination of the corpus callosum, generally attributed to a deficiency in B complex vitamins. We report the case of a 34‑year‑old male with a 10‑year history of alcohol dependence who was admitted to the hospital, after having been found lying on the floor of his house, malnourished and with pressure ulcers on his chest and knees. On clinical observation he was found to be alert but mute. He followed some simple orders. Generalized spastic hypertonia was present. Magnetic resonance imaging showed demyelination of the corpus callosum, suggesting the diagnosis of Marchiafava‑Bignami disease. He was admitted to the Psychiatry Inpatient Unit and evaluated by a multidisciplinary team. He received thiamine, corticosteroids and rehabilitation. After a week, his speech was slurred but comprehensible and he could walk with aid; magnetic resonance imaging findings had improved. After three months in a Convalescence Unit, he was discharged with total autonomy.

Delusional parasitosis, also known as delusional infestation or Ekbom syndrome, is a somatic type of delusional disorder, usually mono‑symptomatic, in which patients are convinced they are being infested with animal parasites while no objective evidence to support their belief exists. Complaints are usually about skin infestation, but involvement of the gastrointestinal tract has also been described. We describe a case of a 59‑year‑old woman with delusional parasitosis claiming to be infected with Strongyloides stercoralis.

Evidence has been suggesting that neurochemical and behavioral adaptations emerging during one addictive behavior may enable a subsequent, different, addiction, even when the first one has ended. Such association seems remarkably accurate to fat bingeing and ethanol consumption, which constitute a relevant example of addictive patterns sequential association, particularly in adolescence. Therefore, the main purpose of the following review is to comprehend if adolescents who have engaged on fat bingeing escalated their ethanol consumption, after fat bingeing terminus, and secondly, in a positive scenario, to highlight why such association may happen. After searching databases such as MEDLINE (PubMed) and Clarivate Analytics Web of Science, all articles focused on adolescent humans or adolescent rats or adolescent mice, that included topics on fat bingeing and consequent ethanol consumption, were considered. Gathered results strengthened the referred hypothesis. Reports stating that adolescent fat bingers engage on escalated ethanol consumption were fundamentally supported by a prevalent fast food and ethanol cultures, bingers ‘shared personality traits, adolescence ‘susceptibilities for addictive behaviors and neurochemical and behavioral craving installment after fat bingeing cessation. Given that adolescence is a key structural and functional phase of human development, and that fat and ethanol consumption are linked to harmful physiological and social effects, priority must be given to multidisciplinary interventions aiming to challenge addictions, both pharmacologically and psychotherapeutically.

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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.