Energy drinks can cause cardiovascular, gastrointestinal, and other health disorders. These effects are particularly pronounced in youth. The aim of this study was to systematically review the literature on the consumption of energy drinks in European countries.

A systematic bibliographic search was performed in November 2024 in EMBASE, MEDLINE (Ovid), Scopus and Cochrane databases with no restrictions on country, study period, study design and language.

Energy drinks are beverages high in caffeine, sugar, and other stimulants.

A total of 2008 studies were identified and reviewed by four researchers. Ninety-four met the inclusion criteria and were extracted in a table designed ad hoc.

The included studies showed differences regarding their design, definition of consumption, and time frame under study. The most studied frequency of energy drink consumption was weekly consumption, and the most studied population was school students. An increase in prevalence of consumption was observed when tracking energy drink consumption over time. Variables most related to consumption were low socioeconomic status, alcohol and tobacco consumption, physical activity, age, and sex.

It is difficult to have a clear picture of the extent of energy drink consumption in Europe, mainly due to differences in the design of the studies and the lack of periodicity of the estimates in different countries. However, given the health problems that have been associated with energy drink consumption, regulation of these beverages is essential, especially in youth.

Bipolar disorder (BD) and borderline personality disorder (BPD) appear as prevalent psychiatric conditions, with both being associated with increased morbidity and elevated suicide rates.

Borderline personality disorder is characterized by emotional instability and impulsivity, and patients are susceptible to dangerous behaviors such as unsafe sexual behavior, eating disorders and substance abuse. On the other hand, mania in BD patients contributes to impulsivity, hypersexuality and poor judgment, as well as a lack of inhibition. In both cases, individuals are at a higher risk of committing suicide due to emotional dysregulation and impulsive behaviours.

The symptomatic overlap in BPD and BD is prone to discussion and may lead to misdiagnosis. Some studies suggest that BPD and BD may lie on a spectrum, while others advocate them as separate entities that may coexist.

To explore the clinical challenges associated with both the differential diagnosis and the comorbidity of BD and BPD.

We performed a non-systematic review of the literature using the database PubMed and the following keywords: bipolar disorder borderline personality disorder comorbidity

Patients with borderline personality disorder seem to have significantly greater odds of a previous bipolar misdiagnosis, but no specific borderline criterion was shown unique in predicting this outcome.

Nonetheless, research studies have reported that approximately 20% of BPD were also diagnosed with BD and, similarly, 10% of people with BD I and 20% with BD II were diagnosed with BPD.

Comorbid BPD and BD are associated with marked psychosocial disability, with patients being more impulsive and aggressive than those with BPD and BD alone. They are also highly susceptible to anxiety disorders like obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and somatoform disorders. Studies have shown that comorbid BPD has a negative impact on the clinical course of Bipolar Disorder, as the patients have an unfavorable illness trajectory, with earlier onset of mood symptoms,higher likelihood of hospitalization, longer treatment duration and worse response to treatment. They are also at higher risk for depression and persistent unemployment, increased risk drug abuse, higher suicide risk, and greater utilization of ECT, compared to patients with BPD or BD alone.

A careful review of the patient’s history must be done to properly distinguish between BPD and BD and to make the right diagnosis. Further studies are needed to clarify the risk factors associated with the comorbidity between these two disorders, in order to develop effective clinical strategies for optimal outcomes for patients with both disorders, improve their clinical course and prevent the increased risk of suicidality.

None Declared

The Capgras syndrome, also known as the delusion of doubles, is a delusional misidentification syndrome, defined in 1923 by Joseph Capgras, who referred to it as “l’illusion des sosies”, which means “the illusion of look-alikes”. In this syndrome, people falsely believe that someone significant to them has been replaced by an identical-looking impostor.

To review the evolution of the conceptualization of Capgras syndrome and its relationship with neurological disorders, such as dementia.

Non-systematic review of the literature with selection of scientific articles published in the last 10 years, using PUBMED as database and the following keywords: «Capgras syndrome» and «dementia». 11 studies were included.

Originally, Capgras syndrome was seen exclusively as a psychiatric disorder: a delusional disorder, which can be associated to schizophrenia, bipolar or schizoaffective disorder. Since 1980, when organic brain lesions were identified in patients with Capgras syndrome, it started to be understood as a neuropsychiatric disorder. Previous studies revealed that in Capgras syndrome there is damage in the bifrontal, temporal cortex and the limbic system, structures that are involved in emotional arousal to familiar faces. In fact, Capgras Syndrome can be experienced in neurological conditions, including Alzheimer’s disease, dementia with Lewy body, Parkinson’s disease, epilepsy, cerebrovascular disease, subarachnoid hemorrhage, pituitary tumors and head injury. A 2014’s study showed that 73% of Capgras syndrome cases had comorbid diagnosis of schizophrenia, 26,4% had dementia and 16,7% had mood disorders. The prevalence of Capgras syndrome in neurodegenerative disorders is well known, and it is higher in dementia with Lewy body than in Alzheimer’s disease and frontotemporal dementia. In patients without a neurodegenerative disease, Capgras syndrome typically occurs at a younger age and is associated with psychiatric disease, cerebrovascular events, or illicit drug use. To date, it is unclear whether there are differences between Capgras syndrome as it occurs in neurodegenerative compared with non-neurodegenerative diseases.

Currently, it is believed that Capgras syndrome can be associated not only with psychiatric diseases (a delusional syndrome, when belief evaluation is affected) but also with neurological diseases, such as neurodegenerative disorders. Therefore, when addressing a Capgras syndrome it is necessary to rule out these neurological conditions. Also, correct early identification of the Capgras syndrome in dementia cases will improve the clinical management, outcome and quality of life of patients and caregivers.

None Declared

Knowing mental representations about the phenomenon of illness and medical care allows the clinical team to have better emotional handling of their patients, with gains in greater adherence to treatments. Graves’ Ophthalmopathy is an inflammatory disease with primary involvement of the extraocular muscles and orbit, being the most frequent extrathyroidal manifestation of Graves’ Disease. Many patients have psychological status changes even after successful treatment of hyperthyroidism, especially when the disfiguring signs of ophthalmopathy are predominant. An understanding of the symbolic aspects linked to this condition help doctors and nurses to have a relationship more harmonious with them.

To interpret emotional meanings in reports of patients with euthyroidism and with ophthalmopathy under follow-up at a specialized university endocrinology outpatient follow-up, discussing contradictions perceived between a stigmatized body and clinical-laboratory euthyroidism.

Clinical-Qualitative design of Turato. Data was collected using Semi-directed interviews with open-ended questions in-depth, carried out with patients at a university hospital specialized outpatient service in South-eastern Brazil. The interview material was audio-recorded and fully transcribed. The interviews were treated by Clinical-Qualitative Content Analysis described by Seven Steps’ Faria-Schützer. It is based on psychodynamic concepts from the Medical Psychology theoretical framework, whose main author is Michael Balint. The sample was closed by the Theoretical Saturation of Information studied by Fontanella and cols. The finding validation has occurred by peers at the Laboratory of Clinical-Qualitative Research, State University of Campinas, San Paolo.

The sample was composed by 10 patients. From the search of nuclei of meanings in the reports, four categories of analysis were constructed: 1) “No, this is not normal, I must have cancer”: psychodynamics of the doctor-patient relationship in Graves’ Disease; 2) Types of illness according to their manifestations and auto-perception: silent illness and non-silent ones; 3) “The eyes are everything”: the impacts of the disfiguring alterations of ophthalmopathy; 4) The contradiction perception between clinical and laboratory normality the stigmas of ophthalmopathy.

The patients with severe exophthalmos, maintained emotional distress despite being euthyroid, manifested by various emotional meanings reported in the interviews. The clinical-laboratory diagnosis of Graves’ Disease alone is not sufficiently capable of responding to the psychological demands of the patients. Proper listening to emotional symbolic meanings attributed by patients can help physicians and nurses in handling this setting

None Declared

Bipolar disorder is a serious mental disorder. Although bipolar disorder I (BDI) might seem to have a more complex evolution and severe prognosis than bipolar disorder II (BDII) because of cross-sectional symptom severity, BDII has a high episode frequency, high rates of psychiatric comorbidities and recurrent suicidal behaviours that impair functioning and quality of life.

To explore whether there are differences between patients with BDI and BDII concerning sociodemographic and clinical variables of interest.

A sample of 407 euthymic patients with bipolar disorder (307 BDI and 100 BDII) being age 18 or older was recruited from the Bipolar and Depressive Disorders Unit of the Hospital Clinic of Barcelona. Sociodemographic and clinical variables were collected through the administration of semi-structured interview and clinical scales. Differences between groups in these variables were analysed using the Mann-Whitney U and Chi-square tests, as appropriate. The level of significance was set at p <0.05.

We found statistically significant differences between both groups. Patients with BD II were older (p<0.001), presented a longer illness duration (p=0,001) and a greater subsyndromal depressive symptomatology (p=0,010). Patients with BDI had a higher number of previous hospitalizations (p<0,001) and higher rates of psychotic symptoms (p<0,001) even during the first episode (p<0,001).

Our data suggests that clinical differences exist between both bipolar subtypes. The episodes may be more serious, with a greater presence of a history of psychosis, and require more hospitalizations in BDI patients. In the BDII group, persistent subsyndromal symptoms may predominate, especially of the depressive pole.

No significant relationships.

A higher risk of mental health consequences in critical COVID-19 patients is expected due to several reasons, including prolonged mechanical ventilation with exposure to high sedation. In this context, post-discharge depression has been reported in previous COVID-19 studies, with a profound impact on patients’ health-related quality of life (HRQoL).

To identify depressive symptoms in COVID-19 survivors 1-year after hospital discharge and to analyse its association with HRQoL.

As part of the longitudinal MAPA project, this study enrolled critical COVID-19 patients admitted in the Intensive Care Medicine Department of a University Hospital (March-May 2020). Participants were assessed through telephone by an intensive care nurse and a psychologist, with the Patient Health Questionnaire (PHQ-9) (depressive symptoms), EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and EQ-Visual Analogue Scale (EQ-VAS) (global health status patient record).

A sample of 55 survivors (median age=66 years; 69% males) were included, with 20% showing depressive symptoms. Pain/discomfort (67%) and anxiety/depression (67%) were the most EQ-5D-5L domains reported. Survivors scoring for depression had more problems in all HRQoL areas (mobility:91%vs.48%, p=0.015; self-care:64%vs.27%, p=0.035; usual activities:91%vs.50%, p=0.017; pain/discomfort:100%vs.59%, p=0.010; anxiety/depression:100%vs.59%, p=0.010). Moreover, they had a lower EQ-VAS median, corresponding a worse self-perception of health status (50vs.80, p=0.010).

Even after 1-year, a significant proportion of survivors presented depressive symptoms with repercussions in all HRQoL dimensions and association with worse self-perception of global quality of life. Taking this in mind, early screening and treatment of depression in COVID-19 survivors will be crucial, minimizing its impact on quality of life.

No significant relationships.

Bipolar Disorder (BD) is a severe mental disorder with a high genetic load, in which is relevant to identify potential differences in affective temperaments between both diagnostic subtypes.

To find differences between BDI and BDII patients in affective temperaments evaluated by Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego TEMPS-A.

A sample of 407 euthymic patients with diagnosis of bipolar disorder type I (BDI= 307) or type II (BDII= 100) according to DSM-IV-TR criteria being age 18 or older was recruited from the Bipolar and Depressive Disorders Unit of the Hospital Clinic of Barcelona. Five affective temperaments were evaluated using the TEMPS-A. It was initially verified that the scores of these temperaments do not fulfil the assumption of normality by means of tests. Differences in means were estimated using Mann-Whitney U and Chi square tests (p <0.05) as appropriate, and ANCOVA controlling the effect of confounding variables.

Data revealed that patients with BD II had significantly higher scores in four affective temperaments: dysthymic, cyclothymic, irritable and anxious compared to BDI. After controlling the most relevant moderating variables, BDII patients continued to show higher scores in irritable temperament .

BDII patients present a more irritable temperament than BDI (p=0,037), which can affect the course and management of the disease. It could be suggested that presenting higher scores of these temperaments could be associated with BDII and further studies are needed to replicate this finding since it might help the clinicians in early phases to guide in the diagnostic process.

No significant relationships.

Severe COVID-19 survivors experience long-term neuropsychiatric morbidity, particularly those who developed delirium, with a negative impact on health-related quality of life (HRQoL).

To identify the cases of delirium in severe COVID-19 patients and to describe its association with post-hospital discharge HRQoL.

In the context of the longitudinal MAPA project, we included adult patients (≥ 18 years old) admitted with COVID-19 to the Intensive Care Medicine Department (ICMD) of a Portuguese University Hospital (October 2020-April 2021). Exclusion criteria were: ICMD length of stay ≤24h, terminal illness, major auditory loss, or inability to communicate at the time of assessment. Delirium during ICMD stay was ascertained based on patients’ clinical records. HRQoL was evaluated using the 5-Level EQ-5D questionnaire (EQ-5D-5L), at a scheduled telephone follow-up appointment on average 1-2 months after hospital discharge.

Overall, 124 patients were included with a median age of 62 (range: 24-86) years, being mostly male (65%). About 19% had delirium, 42% were deeply sedated and 43% required invasive mechanical ventilation. Most survivors reported problems on the EQ-5D-5L domains: usual activities (85%), mobility (73%) and anxiety/depression (65%). Patients with delirium reported more pain/discomfort (75%vs46%; p=0.011) and considerably anxiety/depression (83%vs60%; p=0.032).

These findings pointed that COVID-19 patients who experienced delirium reported worse HRQoL, regarding pain/discomfort and anxiety/depression. This study highlights the importance of not only prevention but also early screening of delirium during hospital stay, as well as the crucial role of the timely interventions at discharge, in order to minimize delirium long-term impacts.

No significant relationships.

Long-term neuropsychiatric consequences of critical illness are well known. Therefore, it is expected that critical COVID-19 patients might also present several psychiatric symptoms such as depression, with inevitable negative effect on health-related quality of life (HRQoL), commonly used as an indicator of illness and treatment impact.

To identify depressive symptoms in critical COVID-19 survivors and to examine its association with HRQoL domains.

This preliminary study involved critical COVID-19 patients admitted into the Intensive Care Medicine Department (ICMD) of a University Hospital, between October and December of 2020. Patients with an ICMD length of stay (LoS)≤24h, terminal illness, major auditory loss, or inability to communicate at the follow-up time were excluded. From 1-2 months after discharge, all participants were evaluated by telephone at follow-up appointment, with Patient Health Questionnaire (PHQ-9) (depression) and EuroQol 5-dimension 5-level EQ-5D-5L (HRQoL). This study is part of the longitudinal MAPA project.

Eighty-three patients were included with a median age of 63 years (range: 31-86) and the majority were male (63%). The most reported problems on EQ-5D-5L domains were usual activities (82%) and mobility (76%). About 27% presented depressive symptoms, and with more problems of self-care (68%vs41%; p=0.029), pain/discomfort (86%vs49%; p=0.002), and anxiety/depression (96%vs54%; p<0.001).

These preliminary results are in line in previous studies in critical COVID-19 survivors, with depression being associated with worse HRQoL. Bearing this in mind, follow-up approaches with an early screening and treatment of these psychiatric symptoms will be fundamental to optimize the recovery of these patients.

No significant relationships.

Evidence suggest that critically ill COVID-19 patients are at higher risk of developing anxiety symptoms, which may be related to or exacerbated by patients concerns regarding their health status and recovery.

To assess anxiety symptoms in critically ill COVID-19 survivors, 1-2 months after hospital discharge and to analyze its association with concerns reported by patients regarding their own health status and recovery.

In the framework of MAPA prospective research, this preliminary study included COVID-19 patients admitted in the Intensive Care Medicine Department (ICMD) of a University Hospital. Patients were excluded if they had an ICMD length of stay (LoS) ≤24h, terminal illness, major auditory impairment or inability to communicate at the evaluation time. Participants were assessed at a scheduled telephone follow-up appointment, with Generalized Anxiety Disorder Scale (GAD-7). Additional questions were asked to assess the survivors’ post-discharge concerns regarding discrimination against for COVID-19, infection of a family member, re-infection or sequelae related to COVID-19.

Eighty-three patients were included (median age=63 years; 63% male) and 24% had anxiety symptoms. Anxiety scores were higher in survivors who reported being afraid of being discriminated against for COVID-19 (30% vs 10%; p=0.034), being re-infected (100% vs 79%; p=0.032) and having sequelae (94% vs 44%; p<0.001).

These findings revealed that anxiety is common in COVID-19 survivors and is associated with post-discharge patients concerns that may limit patient daily living. This study emphasizes the importance of psychological assessment and follow-up of the COVID-19 survivors, in order to support these patients recovery.

No significant relationships.