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How much or how often? Examining the screening properties of the DSM cross-cutting symptom measure in a youth population-based sample
- João Pedro Gonçalves Pacheco, Christian Kieling, Pedro H. Manfro, Ana M. B. Menezes, Helen Gonçalves, Isabel O. Oliveira, Fernando C. Wehrmeister, Luis Augusto Rohde, Maurício Scopel Hoffmann
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- Psychological Medicine , First View
- Published online by Cambridge University Press:
- 19 April 2024, pp. 1-12
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Background
The DSM Level 1 Cross-Cutting Symptom Measure (DSM-XC) allows for assessing multiple psychopathological domains. However, its capability to screen for mental disorders in a population-based sample and the impact of adverbial framings (intensity and frequency) on its performance are unknown.
MethodsThe study was based on cross-sectional data from the 1993 Pelotas birth cohort in Brazil. Participants with completed DSM-XC and structured diagnostic interviews (n = 3578, aged 22, 53.6% females) were included. Sensitivity, specificity, positive (LR+), and negative (LR−) likelihood ratios for each of the 13 DSM-XC domains were estimated for detecting five internalizing disorders (bipolar, generalized anxiety, major depressive, post-traumatic stress, and social anxiety disorders) and three externalizing disorders (antisocial personality, attention-deficit/hyperactivity, and alcohol use disorders). Sensitivities and specificities >0.75, LR+ > 2 and LR− < 0.5 were considered meaningful. Values were calculated for the DSM-XC's original scoring and for adverbial framings.
ResultsSeveral DSM-XC domains demonstrated meaningful screening properties. The anxiety domain exhibited acceptable sensitivity and LR− values for all internalizing disorders. The suicidal ideation, psychosis, memory, repetitive thoughts and behaviors, and dissociation domains displayed acceptable specificity for all disorders. Domains also yielded small but meaningful LR+ values for internalizing disorders. However, LR+ and LR− values were not generally meaningful for externalizing disorders. Frequency-framed questions improved screening properties.
ConclusionsThe DSM-XC domains showed transdiagnostic screening properties, providing small but meaningful changes in the likelihood of internalizing disorders in the community, which can be improved by asking frequency of symptoms compared to intensity. The DSM-XC is currently lacking meaningful domains for externalizing disorders.
FC23: Dementia and Triadic (Doctor-Patient-Carer) Interactions in Primary Care
- C. Balsinha, F. Barreiros, M.J. Marques, S. Dias, S. Iliffe, M. Gonçalves-Pereira
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- Journal:
- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 84-85
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Objective:
Primary care visits of persons with dementia often bring together triads composed of patients, family carers and general practitioners (GPs), as previously discussed (1). Communication dynamics potentially affect dementia outcomes, not least because primary care is a health setting where these triad encounters often occur naturally. Our aim is to present further data from Portuguese primary care consultations with persons with dementia, their carers and GPs.
Methods:We refer to the conclusion of our study ‘Dementia in Primary Care: the Patient, the Carer and the Doctor in the Medical Encounter - Bayer Investigation Grant | NOVAsaúde Ageing 2018’ (1). Fieldwork was interrupted during the COVID-19 pandemic and resumed in 2022. Sixteen consultations with persons with dementia, their carers and GPs (purposive sampling) were audio- recorded and transcribed verbatim. Interactions were thematically analysed using NVIVO® software. The analytical framework combined codes derived from the transcripts with codes from the literature.
Results:Dementia-related content took up less than half of consultations’ time, despite their considerable length (as compared to the average in primary care). Most GPs assessments lacked breadth, although efforts towards positive attitudes were present. Themes specifically related to social health in dementia were not (or were poorly) covered. Frequently, carers facilitated GPs’ assessment of dementia consequences, but their own needs were neglected. Patients’ self-expression tended to be limited.
Discussion:Our findings suggest that doctor-patient interactions in many GPs’ consultations seemingly compromise patient-centred approaches. There are challenges regarding how to assess the biopsychosocial consequences of dementia in a context of fragmented care (2,3). Given the scarcity of evidence from live-recorded primary care consultations about triadic dynamics, our findings are important to guide further explorations.
P123: Cognitive Disorders and Impact on Caregivers: The COGCARE Study protocol
- M. Gonçalves-Pereira, B. Pedrosa, M. Braga, M.J. Marques, C. Balsinha, A. Verdelho, E. Albanese, for the COGCARE Study Group
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- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 252-253
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Introduction and objectives:
Dementia is associated with a high burden of disease, impacting patients, families and society. Nevertheless, related epidemiological data is becoming outdated, given the difficulties of implementing costly and laborious fieldwork surveys. Data is also difficult to retrieve from health and social services’ information systems. Overall, we must improve the feasibility and validity of case definition regarding dementia and the assessment of caregivers’ consequences. The 10/66 Dementia Research Group diagnostic algorithm is a cross-culturally valid method(1). A ‘short 10/66’ was also validated(2), but not in Portugal. We intend to assess its feasibility and validity in Portuguese samples, using REDcap (a browser-based, metadata-driven software) in mobile devices. Additionally, we aim to assess dementia family caregivers’ subjective burden and psychological distress, contrasting primary care and hospital outpatient settings.
Methods:A multicentre mixed-methods study will be conducted on fifty dyads of older people with dementia and their caregivers, plus 150 dyads of ‘controls’ and their close family members, as informants. The ‘short 10/66’ will be administered. Dementia caregivers’ assessments include the Zarit Burden Interview and Self-report Questionnaire. Quantitative analyses will estimate the sensitivity and specificity of the ‘short 10/66’ dementia case definition. Semi-structured qualitative interviews will be conducted with participants and research assistants, exploring their experiences with the assessment process; thematic analysis will then be used.
Implications:We expect this study to facilitate the diagnosis of dementia and data collection in health/social services on a routine basis, which will potentially improve the feasibility and decrease the costs of epidemiological surveys and allow for prevalence monitoring in Portugal.
Factors influencing subcanopy leaf and stolon exposure and associated absorption and translocation of herbicides in semidormant zoysiagrass
- Jordan M. Craft, Navdeep Godara, Clebson G. Gonçalves, Shawn D. Askew
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- Journal:
- Weed Science / Volume 72 / Issue 1 / January 2024
- Published online by Cambridge University Press:
- 17 November 2023, pp. 59-67
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Turfgrass managers are concerned about zoysiagrass (Zoysia japonica Steud.) injury from nonselective herbicide treatment during winter dormancy. Research was conducted to assess factors affecting spray penetration into semidormant ‘Meyer’ zoysiagrass canopies and to evaluate absorption and translocation of [14C]glyphosate and [14C]glufosinate into green leaves and subtending stolons. Absorption of [14C]glyphosate and [14C]glufosinate was up to four times greater in stolons than in leaves. Zoysiagrass leaves treated with [14C]glufosinate had more rapid 14C absorption than those treated with [14C]glyphosate. More 14C translocated out of the treated area following [14C]glyphosate treatment compared with [14C]glufosinate and moved more readily from stolon to leaves than from leaves to stolon. When extended-range, flat-fan spray tips (XR) were positioned 61 cm above zoysiagrass, 73% and 11% of recovered colorant was extracted from dormant vegetation in the upper and lower canopy levels. Turbo TeeJet® spray tips (TTI) deposited fewer droplets into the upper canopy and more droplets into the middle and lower canopy regardless of position above the turf surface. Increasing pressure from 103 to 414 kPa increased droplet velocities from XR and TTI nozzles and decreased droplet diameters of XR nozzles. Droplet diameters were also substantially increased when using TTI nozzles compared with XR nozzles. Droplet diameter and associated mass were more determinant of turfgrass canopy penetration than droplet velocity. At 60 L ha−1 of carrier volume, 23% of colorant reached the lower canopy level, and this quantity increased by 2.3% per additional 100 L ha−1. When carrier volume was reduced from 584 to 60 L ha−1, 48% less colorant was delivered to the lower canopy level. Given that subcanopy stolons are always present and absorb more glyphosate and glufosinate than leaves, practices such as avoiding induction-type nozzles, raising spray height, and reducing spray volume can reduce herbicide delivery and potential injury to semidormant zoysiagrass.
Tiny insects, big troubles: a review of BOLD's COI database for Thysanoptera (Insecta)
- Mariana F. Lindner, Leonardo T. Gonçalves, Filipe M. Bianchi, Augusto Ferrari, Adriano Cavalleri
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- Bulletin of Entomological Research / Volume 113 / Issue 5 / October 2023
- Published online by Cambridge University Press:
- 24 August 2023, pp. 703-715
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DNA Barcoding is an important tool for disciplines such as taxonomy, phylogenetics and phylogeography, with Barcode of Life Data System (BOLD) being the largest database of partial cytochrome c oxidase subunit I (COI) sequences. We provide the first extensive revision of the information available in this database for the insect order Thysanoptera, to assess: how many COI sequences are available; how representative these sequences are for the order; and the current potential of BOLD as a reference library for specimen identification and species delimitation. The COI database at BOLD currently represents only about 5% of the over 6400 valid thrips species, with a heavy bias towards a few species of economic importance. Clear Barcode gaps were observed for 24 out of 33 genera evaluated, but many outliers were also observed. We suggest that the COI sequences available in BOLD as a reference would not allow for accurate identifications in about 30% of Thysanoptera species in this database, which rises to 40% of taxa within Thripidae, the most sampled family within the order. Thus, we call for caution and a critical evaluation in using BOLD as a reference library for thrips Barcodes, and future efforts should focus on improving the data quality of this database.
The impact of COVID-19 pandemic on inpatient admissions for bipolar disorder
- C. Portela, C. Oliveira, D. Areias, M. Gonçalves
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S781
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Introduction
In 2019, there were 39.5 million patients suffering from bipolar disorder worldwide, resulting in around 8.5 million disability-adjusted life years (DALYs) and in a significant economic burden. Bipolar disorder is known to be susceptible to factors that disrupt biological and social rhythms. The COVID-19 pandemic and the measures taken to control it, such as social distancing, home confinement and lockdowns, pose a risk to the stability of bipolar patients. Other factors, for example, reduced access to treatment and stress associated with the disease could also contribute to relapses. Studies have shown that, in 2020, more people with bipolar disorder were hospitalised compared to previous years, including patients without previous history of hospitalizations.
ObjectivesThis study aims to assess the impact of the COVID-19 pandemic on inpatient admissions for bipolar disorder.
MethodsSocio-demographic and clinical data were collected from electronic medical records. A retrospective observational study of patients who were admitted to a psychiatric ward between March 2019 and February 2021 was conducted. The characteristics of patients admitted before the pandemic (March 2019 to February 2020) and after (March 2020 to February 2021) were compared statistically.
ResultsA total of 850 patient admissions were obtained, 15% of which had a main diagnosis of bipolar disorder. The authors will analyze all the variables in the population admitted. The authors expect to find differences between patients hospitalized before and after the beginning of the pandemic, both in clinical presentation (manic, depressive or mixed episode), psychiatric history, comorbidities, suicide attempts and socio-demographic factors.
ConclusionsThe COVID-19 pandemic had a significant impact on mental health on a global level, plenty of which is still unknown. The findings of this study will likely show the effects of this crisis on bipolar disorder patients.
Disclosure of InterestNone Declared
Online pornography use during the COVID-19 pandemic: a review
- C. Portela, R. Dionísio, S. M. Sousa, M. Gonçalves
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S782
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Introduction
The Coronavirus (COVID-19) pandemic and the regulations enforced to control it caused significant alterations in daily routines worldwide. Lockdowns, remote working and schooling favoured virtual interactions and increased “free-time”, with the internet posing as a preferential means of distraction. Statistics from pornographic websites have shown a rise in traffic during lockdown periods, with problematic use of pornography (POPU) emerging as a potential mental health concern.
ObjectivesThe authors aim to summarize current knowledge on the effects of the COVID-19 pandemic on online pornography use.
MethodsNarrative review of articles referenced on PubMed and Google Scholar.
ResultsThe increased exposure to the internet during the pandemic, combined with psychosocial factors such as social isolation, diminished physical contact and intimacy may have contributed to the reported surge in online pornography use. Other associated factors include emotional distress and less availability of other addictive substances and behaviours during confinement periods. Besides the spike in pornography consumption, other aspects were also affected, such as time of usage, search keywords and type of content, with an increase in engagement in illegal pornography. In susceptible individuals, these circumstances may lead to the development of POPU, characterized by impaired control, excessive time spent and perceived negative consequences. Currently, there is a lack of consensual diagnostic criteria for POPU, hindering the detection of these patients and timely management.
ConclusionsBehavioural addictions are an emerging mental health problem, particularly the ones related to internet use. In the aftermath of the pandemic, considering the reported rise in online pornography use, an increase in POPU prevalence is expected. Therefore, more accurate and consensual diagnostic criteria are required, as well as a greater amount of evidence on the treatment of this disorder, in order to improve the approach to these patients.
Disclosure of InterestNone Declared
LATE ONSET PSYCHOSIS AND VERY LATE ONSET PSYCHOSIS: WHAT ARE THE POSSIBLE ETHIOLOGIES?
- A. C. Ramos, S. C. Martins, T. M. Afonso, N. B. Santos, P. Gonçalves, T. Maia
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1039
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Introduction
Psychotic symptoms have long been known to show up earlier in life, typically during adolescence and early adulthood. Late Onset Psychosis (LOP), in which symptoms start between 40 and 60 years of age, and Very Late Onset Psychosis (VLOP), in which onset of symptoms happens after 60 years of age, although classically rare, have had a growing prevalence in the last decades.
ObjectivesTo access the definition and main etiologies of LOP and VLOP, based on the current literature.
MethodsNon-systematic review of literature using the terms “late onset psychosis” and “very late onset psychosis”. Case report of a patient who was admitted and treated in our inward patient field.
Results51-year-old female patient. She is divorced (two previous marriages) and has two daughters (26 and 16, respectively). She was brought by police officers because of behavior problems at the shelter where she was living. She was evicted from the house she was living in because of delay in paying the rent. On observation, she verbalizes persecutory and prejudicial delusions and auditory hallucinations on the 2nd and 3rd person (commenting voices) with at least 5 years of duration. She was hospitalized for almost 3 months, with slow but progressive clinical improvement on haloperidol 7,5mg/day. At the date of discharge, she did not spontaneously verbalize her symptoms, although she did not recognize them as delusional. Recent studies have shown that the prevalence of Schizophrenia in the typical age range is 75-80%, which means that an important proportion of diagnosis is made after that age span. Primary causes of LOP and VLOP are schizophrenia (of late onset), schizophrenia-like very late onset psychosis, delusion disorder, unipolar depression with psychotic symptoms and bipolar disorder. Secondary causes should also be considered, such as delirium, dementia (Alzheimer’s, Lewi bodies and vascular), and substances abuse; even more rare, other conditions should be considered, as cerebrovascular accident, encephalitis, epilepsy, and multiple sclerosis.
ConclusionsLOP and VLOP have been a growing diagnosis in the past decades. In the assessment of these patients, we must consider the importance of secondary etiologies besides the primary psychiatric ones. Primary psychosis is a diagnosis of exclusion, and the clinician must rule out secondary causes. Recent data point out these symptoms as markers for an increased risk of dementia in these patients. Further research involving individuals with LOP and VLOPs is required to increase the evidence base for treatment and improve outcomes of care.
Disclosure of InterestNone Declared
E-tool for mental health coping: usability and effectiveness study of a biofeedback approach on a digitized diaphragmatic breathing strategy
- R. Maçorano, F. Canais, A. Perdigão, I. Gonçalves, M. Parreira, M. Ribas, H. A. Ferreira
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S860-S861
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Introduction
One of the most common somatic responses of the human body to a mental health issue consists of alterations of the breathing rate. Typically, when an individual is under stress, tends to have a more rapid shallow breathing - instead of resorting to the diaphragm to help the air in and out the lungs, ends up conducting a thoracic breathing, leading to extended fatigue or dizziness.
ObjectivesThe aim of this project is to assess the accuracy and efficacy of measuring the breathing rate through abdominal breathing movements, via the smartphone’s sensors, and applying it to personalize a digitized diaphragmatic breathing strategy. The main hypothesis under testing is that the digitization of this strategy with the personalization to the subject’s own response is efficient as a valuable tool for mental health coping.
MethodsA tool was developed and integrated with a mobile app that aggregates mental health coping strategies, based on the digitalization of positive psychology techniques. The tool included the diaphragmatic breathing exercise and the personalization to the user through biofeedback. Such biofeedback was based on the user’s abdominal movements and directly impacted the course of the strategy. The tool is under testing, counting so far with 25 subjects resident in Portugal.
ResultsThe usability and effectiveness metrics of the solution will be assessed on the first contact of the subject with the app, and segmented by different subject profiles. Mental health metrics will also be assessed, namely anxiety levels - using the smartphone sensors and standard psychiatric scales. The results will be compared with a control group, in which the subjects will only perform the self-assessment, without using the breathing exercise.
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ConclusionsWe have yet to draw conclusions from the project; however, we aim to achieve the first results in due time.
Disclosure of InterestNone Declared
Late diagnosis of attention deficit hyperactivity disorder and cocaine abuse
- C. De Andrés Lobo, C. Vallecillo Adame, T. Jiménez Aparicio, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramírez, M. Fernández Lozano, N. Navarro Barriga, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Calvo Valcárcel, M. Andreo Vidal, M. P. Pando Fernández, P. Martínez Gimeno, I. D. L. M. Santos Carrasco, J. I. Gonçalves Cerejeira, A. Rodríguez Campos
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S335-S336
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Introduction
Adult ADHD diagnosis sometimes represents a challenge for the clinician, due to the comorbid psychiatric diseases that are often associated and which complicate de recognition of the primary symptoms of ADHD. The prevalence of ADHD in adult populations is 2’5% and it is a relevant cause of functional impairment.
ObjectivesPresentation of a clinical case of a male cocaine user diagnosed with adult ADHD.
MethodsLiterature review on adult ADHD and comorbid substance abuse.
ResultsA 43-year-old male who consulted in the Emergency Department due to auditory hallucinosis in the context of an increase in his daily cocaine use. There were not delusional symptoms associated and judgment of reality was preserved. Treatment with olanzapine was started and the patient was referred for consultation. In psychiatry consultations, he did not refer sensory-perceptual alterations anymore, nor appeared any signals to suspect so, and he was willing to abandon cocaine use after a few appointments. He expressed some work concerns, highlighting that in recent months, in the context of a greater workload, he had been given several traffic tickets for “distractions.” His wife explained that he had always been a inattentive person (he forgets important dates or appointments) and impulsive, sometimes interrupting conversations. In the Barkley Adult ADHD Rating Scale he scored 32 points.
He was diagnosed with adult ADHD and treatment with extended-release methylphenidate was started with good tolerance and evolution, with improvement in adaptation to his job and social environment. Since then, the patient has moderately reduced the consumption of drugs, although he continues to use cocaine very sporadically.
ConclusionsEarly detection of ADHD and its comorbidities has the potential to change the course of the disorder and the morbidity that will occur later in adults. Comorbidity in adult ADHD is rather the norm than the exception, and it renders diagnosis more difficult. The most frequent comorbidities are usually mood disorders, substance use disorders, and personality disorders. Treatment of adult ADHD consists mainly of pharmacotherapy supported by behavioral interventions. When ADHD coexists with another disorder, the one that most compromises functionality will be treated first and they can be treated simultaneously. The individual characteristics of each patient must be taken into account to choose the optimal treatment.
Disclosure of InterestNone Declared
Specific treatment for alcohol use disorder reduces relapse after psichiatric hospitalization
- O. Martin-Santiago, J. I. Goncalves-Cerejeira, G. Guerra-Valera, M. Calvo-Valcarcel, P. Martinez-Gimeno
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S565
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Introduction
Patients with an alcohol use disorder frequently relapse after various efforts to quit. Admission to hospital units is a possible start to stop drinking alcohol and reach abstinence. Among the pharmacological strategies to quit this addiction are specific drugs, such as disulfiram or namelfen, which are widely studied. Hospitalized patients frequently initiate these medications to control addiction, but little is known about their efficacy after discharge in this group.
ObjectivesThe aim is to determine whether the initiation of treatment with specific drugs for alcohol use disorder could help to maintain alcohol abstinence after admission to a General Hospital Psychiatric Ward. In addition, we want to check those factors associated with a higher rate of relapse in consumption.
MethodsWe conducted a retrospective cross-sectional study of a group of patients admitted in 2018 to a psychiatric hospitalization ward due to alcohol use disorder and who expressed their desire to stop drinking. At the time of admission, we recorded sociodemographic data, consumption of other substances and alcohol family history. Patients initialized specific treatments to reduce and control alcohol consumption if they wanted. Twenty-four months after discharge, we acquired the number of relapses through new admissions, emergency room visits or outpatient follow-up data.
ResultsA sample of 36 patients (28 men) admitted to a psychiatric hospitalization ward was analyzed. At discharge, 17 accepted specific pharmacological treatments to reduce alcohol consumption. After a follow-up period of 24 months, 70.8% relapsed compared to 94.7% who did not accept treatment (χ2=4.001, DF=1, p=0.045, OR=0.13). There were no differences between the two groups in age, gender, amount of alcohol consumed, follow-up modality at discharge or if it was their first detoxification attempt. However, those who did not accept the specific pharmacological treatment consumed other drugs (41.1% vs 5.8%, χ2= 5.888, DF=1, p=0.015), had other history of mental disorder (64.7% vs 23.5%, χ2= 5.845, FD=1, p=0.015) and a higher proportion of relatives with alcohol consumption (81.8% vs 42.8%, χ2= 3.896, FD=1, p=0.048) more frequently. The time (in days) to relapse was faster in this group of patients (200.8 vs 402.7 , Z=-2.5413, p=0.005).
ConclusionsAccepting drug-specific treatment for alcohol use can be helpful for many patients who want to achieve alcohol abstinence. Among the factors that prevent the acceptance of this treatment is the consumption of other substances, comorbidity with another mental pathology and family history, which may involve genetic factors that favour addiction. This group of patients could benefit from a specific pharmacological treatment, although other psychosocial factors may also help.
Disclosure of InterestNone Declared
Chronic obstructive pulmonary disease and comorbid psychiatric disorders: preliminary results of an 8-year retrospective study using real data
- G. Santos, A. R. Ferreira, M. Gonçalves-Pinho, A. Freitas, L. Fernandes
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S513-S514
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Introduction
Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. In Portugal, it is estimated to afflict 14.2% of the population over the age of 45 and is one of the most common causes of morbidity, with a significant social impact and excessive expenses. Moreover, COPD is associated with high levels of psychological distress and diverse psychiatric disorders that heighten the disease burden as they are associated with increased risk of exacerbations and frequent hospitalizations. Despite this overview, psychiatric conditions remain understudied compared to comorbid general medical conditions, and few studies have assessed their effect on COPD hospitalization outcomes.
ObjectivesThis study aimed to describe the occurrence of a vast array of psychiatric comorbid diagnoses in COPD hospitalizations and to understand their impact on hospitalization outcomes.
MethodsA retrospective observational study was conducted. All inpatient episodes from 2008 to 2015 of patients with at least 40 years and a primary diagnosis of COPD (ICD-9-CM codes 491.x, 492.x and 496) were selected from a national administrative database that included all hospitalizations in mainland public hospitals. From these sampled episodes, secondary psychiatric diagnoses were identified (ICD-9-CM codes 290.x-319.x). Age at hospitalization, sex, psychiatric comorbidities, length of stay (LoS) in days, admission type and date, destination after discharge, in-hospital mortality and hospital charges were analyzed.
ResultsFrom a total of 66,661 COPD hospitalizations, 17,652 (26.5%) corresponded to episodes with a secondary psychiatric diagnosis. Patients with a comorbid psychiatric diagnosis were on average younger at admission (70.3 vs. 75.9 years, p<0.001), had a longer median LoS (9.89 vs. 9.33 days, p<0.001) and higher urgent admission rates (96.2% vs. 95.7%, p=0.009). There was also a significant association between discharge destination and psychiatric diagnoses (p<0.001).
ConclusionsThese findings suggest that mental disorders have an adverse and quantifiable impact on COPD hospitalization outcomes. With this in mind, to provide optimal treatment for patients with both conditions, psychiatric disorders should become a matter of routine evaluation and follow-up.
Disclosure of InterestNone Declared
COVID-19 pandemic and involuntary admitted patients in a Psychiatric Service
- C. Portela, C. Oliveira, M. Gonçalves
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S781-S782
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Introduction
The COVID-19 pandemic had a major impact on mental health globally, resulting in a need for adaptation of mental health services. The psychosocial consequences of this crisis, such as psychological stress, reduction of community care and social support, are known factors that increase the risk of psychiatric decompensation. Compulsory admission is the last line of intervention in individuals who suffer from severe mental disorders and refuse treatment, based on the principles of therapeutic need and social protection. In Portugal, the last law regulating the compulsory admission is in forme since 2004 (Law 36/98 of 24 July), and configures this measure as a hospitalization by court order, happening the same in other European countries. The literature shows that in 2020 there was a significant increase in the proportion of involuntary inpatient admissions for all psychiatric diagnosis.
ObjectivesThis study aims to assess the impact of the COVID-19 pandemic on involuntary admissions to an acute psychiatric service.
MethodsSocio-demographic and clinical data were collected from electronic medical records. A retrospective observational study of patients who were admitted in a General Psychiatric Unit of Hospital Magalhães Lemos between March 2019 and February 2021 was conducted. The characteristics of patients admitted before the pandemic (March 2019 to February 2020) and after (March 2020 to February 2021) were compared statistically.
ResultsA total of 850 patient admissions were obtained, of which 28% were involuntary. The authors expect to find differences between involuntary inpatient admissions before and after the COVID-19 pandemic in proportion of patients, socio-demographic and clinical factors.
ConclusionsThe findings of this study will likely show an increase in involuntary admissions during the pandemic, in agreement with current knowledge. More studies are needed to assess the long-term impact of the pandemic on mental health.
Disclosure of InterestNone Declared
Prescription drug abuse in migrants from Middle Eastern and North African countries: a review
- C. Portela, C. Oliveira, M. Gonçalves
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S658-S659
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Introduction
In recent years, there has been a rise in misuse of low-cost prescription pills across Middle Eastern and North African (MENA) countries. In Algeria, Tunisia and Morocco, for example, the consumption of prescription medications has dramatically increased, particularly amongst young and marginalized groups. Drugs such as clonazepam and pregabalin are extremely popular in these regions, as they are relatively inexpensive and perceived as safe. With the migration of MENA citizens to Europe, it is likely that mental health services will come across substance use disorders related to these medications.
ObjectivesThe authors aim to analyse prescription medication misuse reports from MENA countries, specifically pregabalin and clonazepam, and review the pharmacological, neurobiological and social factors that contribute to their potential for abuse.
MethodsNarrative review of articles referenced on PubMed and Google Scholar.
ResultsPregabalin and clonazepam are widely used in psychiatry and neurology. Pregabalin is an alpha 2 omega ligand with supposed GABA-mimetic properties. Anecdotal reports suggest that pregabalin, used recreationally in amounts up to 3-20 times the therapeutic doses, possesses both sedative and psychedelic effects. Experimenters are mainly individuals with a history of recreational polydrug use, who are aware that pregabalin is not included in standard drug monitoring tests, with this molecule being used in some instances as a legal substitute of common illegal drugs. Clonazepam is a benzodiazepine that combines high potency and a long duration of action and is said to cause euphoria at doses over 8mg. It is very popular and affordable, placing consistently in the top three of benzodiazepines sales across the globe. Clonazepam has potential for tolerance build up and severe withdrawal symptoms. These medications are frequently used together and in combination with other substances such as alcohol and opiates, increasing the risk for respiratory failure and death.
ConclusionsPrescription medications such as pregabalin and clonazepam are extremely accessible, inexpensive and highly addictive substances, whose abuse is well disseminated across MENA countries. With migratory flows from this region, the prevalence of misuse of these drugs in Europe is expected to increase. Therefore, physicians should be aware of their potential for abuse and carefully evaluate patients’ previous history before prescribing these medications.
Disclosure of InterestNone Declared
“The cat and the calcium”. A case of delirium secondary to hypercalcaemia.
- T. Jiménez Aparicio, C. Vallecillo Adame, C. de Andrés Lobo, G. Medina Ojeda, M. Queipo de Llano de la Viuda, A. A. Gonzaga Ramírez, G. Guerra Valera, M. Fernández Lozano, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, N. Navarro Barriga, M. A. Andreo Vidal, M. Calvo Valcárcel, P. Martínez Gimeno, M. P. Pando Fernández, I. D. L. M. Santos Carrasco, J. I. Gonçalves Cerejeira
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S946-S947
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Introduction
Interconsultation with the psychiatry service is frequently requested from other specialties for the assessment and treatment of patients who present neuropsychiatric symptoms secondary to organic alterations. On the other hand (and in relation to this case), within the possible causes for the elevation of calcaemia figures, the most frequent are hyperparathyroidism and neoplasms, representing between these two entities 90% of cases (1).
Among the organic mental disorders, Delirium stands out, with an approximate prevalence between 1 and 2% (general population), which increases in hospitalized and elderly patients (2).
ObjectivesPresentation of a clinical case about a patient with delirium secondary to hypercalcemia, with hallucinations and behavioral disturbance.
MethodsBibliographic review including the latest articles in Pubmed about delirium (causes and treatment) and hypercalcaemia secondary to neoplasms.
ResultsWe present a 52-year-old male patient, who went to the emergency room accompanied by his wife, due to behavioral alteration. Two days before, he had been evaluated by Neurology, after a first epileptic crisis (with no previous history) that resolved spontaneously. At that time, it was decided not to start antiepileptic treatment.
The patient reported that he had left his house at midnight, looking for a cat. As he explained, this cat had appeared in his house and had left his entire bed full of insects. His wife denied that this had really happened, and when she told the patient to go to the emergency room, he had become very upset.
As background, the patient used to consume alcohol regularly, so the first hypothesis was that this was a withdrawal syndrome. However, although the consumption was daily, in recent months it was not very high, and at that time no other symptoms compatible with alcohol withdrawal were observed (tremor, tachycardia, sweating, hypertension…).
We requested a general blood test and a brain scan. The only relevant finding was hypercalcaemia 12.9mg/dL (which could also be the origin of the previous seizure). It was decided to start treatment with Diazepam and Tiapride in the emergency room, with serum perfusion, and keep under observation. After several hours, the patient felt better, the hallucinations disappeared, and calcium had dropped to 10.2mg/dL. A preferential consultation was scheduled, due to suspicion that the hypercalcaemia could be secondary to a tumor process.
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ConclusionsIt is important to rule out an organic alteration in those patients who present acute psychiatric symptoms. Hypercalcaemia is frequently associated with tumor processes (1) due to secretion of PTH-like peptide (4), so a complete study should be carried out in these cases.
Delirium has a prevalence between 1 and 2% in the general population (2).
Psychopharmacological treatment is used symptomatically, with antipsychotics (3). For the episode to fully resolve, the underlying cause must be treated.
Disclosure of InterestNone Declared
Epilepsy hospitalizations and psychiatric comorbidities: a study protocol for a nationwide inpatient analysis
- M. Silva, M. Gonçalves-Pinho, A. Rita Ferreira, M. Seabra, A. Freitas, L. Fernandes
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1037
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Introduction
Psychiatric comorbidities are highly frequent in patients with epilepsy and are associated with negative outcomes. These comorbid conditions can lower the seizure threshold, increase the risk of treatment-resistant epilepsy, and reduce function and quality of life. Additionally, patients with epilepsy have an increased risk of premature mortality, including due to suicide. In this context, although hospitalizations are common in patients with epilepsy, little information on healthcare utilization associated with comorbid psychopathology is available.
ObjectivesTo characterize psychiatric comorbidities among all hospitalizations with a primary diagnosis of epilepsy and to analyze their association with key-hospitalization outcomes, including length of stay, in-hospital mortality, estimated hospital charges, and readmissions.
MethodsAn observational retrospective study will be performed using an administrative database that comprises de-identified routinely collected hospitalization data from all Portuguese mainland public hospitals. All episodes of inpatients, discharged between 2008-2015, with a primary diagnosis of epilepsy (ICD-9-CM code 345.X) will be selected. Psychiatric comorbidities as secondary diagnoses will be identified, grouped into broader categories as defined by the Clinical Classifications Software for ICD-9-CM, and computed into binary variables. Descriptive, univariate, and multivariate analyses will be used.
ResultsDescriptive and analytical statistics will be conducted to describe and characterize this sample of hospitalizations. Sociodemographic variables such as age at admission, sex, and place of residence will be characterized. Multivariate models will be used to quantify the association between psychiatric comorbidities and hospitalization outcomes, and results will be presented as crude and adjusted odds ratios.
ConclusionsWith this nationwide analysis, we expect to better understand the additional burden of psychiatric comorbidities on epilepsy-related hospitalizations, including psychiatric diagnoses that have not been extensively investigated.
Disclosure of InterestNone Declared
Hospitalization readmission rates in patients with schizophrenia: A nationwide analysis
- M. Gonçalves Pinho, J. P. Ribeiro, L. Fernandes, A. Freitas
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S128
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Introduction
Schizophrenia is a chronic severe mental disorder characterized by acute decompensation episodes that may lead to hospitalization. In Portugal a previous study found a total of 25,385 hospitalizations in an 8-year period, being one of the most burdensome serious mental disorders in Portugal.Rehospitalizations (hospitalization occurring after a previous discharge due to Schizophrenia) are one of the quality-of-care indicators of schizophrenia treatment.
ObjectivesThis project aims to describe and quantify hospitalization readmission rates in patients with schizophrenia in Portuguese public hospitals
MethodsA descriptive study was designed according to the RECORD guidelines, using a nationwide hospitalization administrative database that contains all hospitalizations registered in Portuguese mainland public hospitals. All episodes with discharges occurring between 2008 and 2015 with a primary diagnosis of Schizophrenia were selected according to the International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 295.xx. Readmission rates were estimated using a methodological approach developed by the authors that identified patients who have been rehospitalized in <=5; <=30; <=90 and <=365 days from a previous hospitalization episode during the study period. Individual patients were identified (crosschecking three variables: birthdate; sex and place of residence). The time between discharges was calculated using the difference between an index hospitalization and the next registered hospitalization from the same patient.
ResultsA total of 14,279 patients were anonymously identified in order to calculate readmission rates per patient from a total of 25,385 hospitalization episodes. The mean hospitalization per patient ratio was 1.78. A total of 367 patients (2.6%) had a readmission in <=5 days after discharge. The readmission rate at <=30 days was 8.6% (n=1224); 14.1% (n=2013) at <= 90 days and 23.7% (n=3378) at <=365 days. Readmission rates were higher in male sex patients. Shorter periods of time between readmissions were increasingly frequent in male patients (3.1% vs. 1.6% of all male vs. all female patients in <=5days readmissions; 9.6% vs. 6.5% in <=30 days readmissions; 15.7% vs. 11.0% in <=90days readmissions and 25.3% vs. 20.4% in <=365days readmissions).
ConclusionsRehospitalizations arise as one of the indicators of treatment failure and quality of care in patients with a diagnosis of schizophrenia. Our study is the first to measure and assess readmission rates in patients with Schizophrenia in Portuguese public hospitals at a nationwide level. Portugal presents lower 30-day readmission values when compared to other countries. The 30-day readmission rate in patients with Schizophrenia in Portuguese Public Hospitals is 8.6% and male patients have higher readmission rates when compared to female patients.
Disclosure of InterestNone Declared
Flagella are an important virulence factor in the subclinical persistence of Escherichia coli in bovine mammary gland
- Maysa Serpa Gonçalves, Jamila PJ Faria, Juliana R Silva, Dircéia AC Custódio, João B Ribeiro, Alessandro de S Guimarães, Elaine MS Dorneles, Geraldo M Costa
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- Journal:
- Journal of Dairy Research / Volume 90 / Issue 2 / May 2023
- Published online by Cambridge University Press:
- 16 June 2023, pp. 146-151
- Print publication:
- May 2023
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We compared the virulence profile and REP-PCR genotypes of Escherichia coli strains isolated from subclinical and clinical mastitis cases and dairy farm environments in Minas Gerais State, Brazil, to determine virulence factors and genotypes potentially associated with subclinical persistence in the udder. The virulence profile was obtained by the search for three virulence genes: lpfA (long polar fimbriae), fliC (flagella), and escN (type III secretion system). Subclinical isolates exhibited mainly the fliC gene (33.33%) and fliC + escN genes (30.30%). Clinical isolates exhibited mainly fliC + escN genes (50%) and environmental isolates the lpfA + escN genes (58.04%). Strains isolated from subclinical mastitis showed 6.75 times more positivity to fliC than environmental isolates. Thirty-four genotypes were observed in the REP-PCR analysis, and clinical mastitis isolates indicated more genetic proximity to dairy farm environment isolates than subclinical mastitis isolates. In conclusion, the results suggested that flagella may be an important virulence factor for mammary persistent E. coli infection in cattle, however, none of the E. coli REP-PCR genotypes were associated with subclinical infection.
Paraffin gauze bolus as tissue compensator in photon irradiation for mycosis fungoides – regarding a case study
- André M. Pires, Fátima Borges, Anabela G. Dias, Lencart Joana, Marisa Matos, Joana Gonçalves
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- Journal:
- Journal of Radiotherapy in Practice / Volume 22 / 2023
- Published online by Cambridge University Press:
- 28 February 2023, e82
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Introduction:
Total skin electron beam therapy is a treatment option in patients with mycosis fungoides (MF) affecting a significant amount of the body surface. For patients with involvement of soles and interdigital folds, however, this approach is ineffective, requiring alternatives such as localised radiotherapy (RT). Although electron beams are well suited for superficial lesions, on irregular surfaces it provides inadequate tumour coverage and excess dose variance, requiring photon irradiation with tissue compensation.
Methods:We present the case of a patient with extensive cutaneous MF with skin lesions spread over both lower limbs and treated on these affected areas with photon beam RT. Long sheets of paraffin gauze dressings were used to create a 0·5-cm-thick bolus. The patient received a single fraction of 8 Gy. In vivo dosimetry using Gafchromic films was performed.
Results:After 3 months, a complete response was achieved. In this case, paraffin gauze bolus proved to be an inexpensive, convenient, effective and flexible method for irregular superficial cancer irradiations.
Conclusion:Paraffin gauze bolus is a suitable option for irregular contours.
Comparing human to electronic observers to monitor hand hygiene compliance in an intensive care unit
- Eduardo Casaroto, Jose R. Generoso, Jr, Ary Serpa Neto, Marcelo Prado, Guilherme M. Gagliardi, Fernando Gatti de Menezes, Priscila Gonçalves, Fábio Barlem Hohmann, Guilherme Benfatti Olivato, Gustavo Potratz Gonçalves, Nathalia Xavier, Marcelo Fernandes Miguel, Michael B. Edmond, Alexandre R. Marra
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue 1 / 2022
- Published online by Cambridge University Press:
- 29 September 2022, e161
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Objective:
We sought to determine whether an electronic hand hygiene (HH) system could monitor HH compliance at similar rates to direct human observation.
Methods:This 4-year proof-of-concept study was conducted in an intensive care unit (ICU) of a private tertiary-care hospital in São Paulo, Brazil, where electronic HH systems were installed in 2 rooms. HH compliance was reported respectively using direct observation and electronic counter devices with an infrared system for detecting HH opportunities.
Results:In phase 1, HH compliance by human observers was 56.3% (564 of 1,001 opportunities), while HH compliance detected by the electronic observer was 51.0% (515 of 1,010 opportunities). In phase 2, human observers registered 484 HH opportunities with a HH compliance rate of 64.7% (313 of 484) versus 70.6% (346 of 490) simultaneously detected by the electronic system. In addition, an enhanced HH electronic system monitored activity 24 hours per day and HH compliance without the presence of a human observer was 40.3% (10,642 of 26,421 opportunities), providing evidence for the Hawthorne effect.
Conclusions:The electronic HH monitoring system had good correlation with human HH observation, but compliance was remarkably lower when human observers were not present due to the Hawthorne effect (25%–30% absolute difference). Electronic monitoring systems can replace direct observation and can markedly reduce the Hawthorne effect.