Being diagnosed with dementia can be a hectic and critical period. While severe dementia may act as a shield when it comes to suicidal risk, mild and early dementia stages may still preserve cognitive functions to elaborate a suicidal plan. Having insight may lead to feelings of despair and sadness that patients find unbearable to deal with. The aim of this article is to review the current literature regarding suicidal risk after a dementia diagnosis.

Review of the most recent literature regarding the risk of suicide among patients with a recent dementia diagnosis. The research was carried out through the PubMed and UptoDate databases, using the terms “dementia”, “diagnosis” and “suicidal risk”.

Previous research showed inconclusive findings, with some authors suggesting a higher risk of an early suicide attempt in patients recently diagnosed with dementia, and others suggesting otherwise. Nowadays, the literature mainly reports that older adults with recent dementia diagnoses are at increased risk of endeavoring suicide. There is an important requirement to offer appropriate support to patients and their families, at the time, or as soon as possible, when a dementia diagnosis is made, to diminish the risk of suicide attempts in these patients.

Patients with recent diagnosis of dementia, or diagnosed at an earlier age, seem to have higher suicidal risk. The period immediately after diagnosis is when individuals need greater support, so these results demand for better assistance for those experiencing such intellectual decline.

The amyloid hypothesis suggests that errors in production, accumulation, or disposal of beta-amyloid are the primary causes of Alzheimer's disease (AD). Since this was hypothesized, there has been significant effort in developing treatments that prevent the build-up of amyloid beta (Aβ) plaques in the brain. A disease modifying therapy (DMT) changes the clinical progression of AD by interfering in its pathophysiological mechanisms.

The aim of this article is to review the current literature regarding the role of new DMTs for Alzheimer’s dementia and assess the preparedness of health care systems to implement these treatment options.

Review of the most recent literature regarding the role of new DMTs for Alzheimer’s dementia and the challenges faced by the health care system to implement these treatment options. The research was carried out through the PubMed and UptoDate databases, using the terms “amyloid hypothesis”, “Alzheimer”, “disease modifying treatments” and “dementia”.

Research has been focusing on developing monoclonal antibodies as potential DMTs that target Aβ. Aducanumab, a human antibody, or immunotherapy, is the only disease-modifying medication currently approved to treat AD. It targets the Aβ protein and helps to reduce amyloid plaques and is currently the only FDA approved medication to slow the progression of AD. Lecanemab, a humanized IgG1 monoclonal antibody, binds to Aβ soluble protofibrils with high affinity. Even though there is considerable optimism about its potential, lecanemab will probably be more useful to patients on early stages of the disease.

DMTs administration obeys to certain needs such as a vacancy in Day Hospital for infusion and regular monitorization and for lumbar punction. It demands a complex network involving general practitioner, neurologist, psychiatrist, psychologist, and social services. It also involves a genetic study and complementary diagnosis exams such as PET (Positron emission tomography) scans and MRIs (Magnetic resonance imaging), which are expensive. There is an emerging need to develop enhanced and safer treatments.

Psychotic disorders are not infrequent in late life and involve massive costs to society, affecting individuals and their caregivers. The epidemiology of late-life psychosis remains imprecise and despite its high prevalence, it remains a diagnostic and treatment dilemma. The aim of this article is to review the current literature regarding late-onset psychosis and whether it is recognized as a clinical entity on itself, differing from early-onset psychosis.

Review of the most recent literature regarding late-onset psychosis its clinical and epidemiological particularities. The research was carried out through the PubMed and UptoDate databases, using the terms “late-onset psychosis”, “late-life psychosis”, “dementia” and “elderly”.

Late-life psychotic disorders may originate in an intricate interaction between several biological, psychological, social, and environmental factors. These may include functional status, other physical diseases, hospitalizations, physical activity, and stability of care. Some authors refer that older age, and the presence of suicidal ideation were associated with incident late-life psychosis. Assuming the significant load associated with psychotic disorders in late life, their assessment should identify the potential causes and distinguish predictive factors. Treatment should include a combination of nonpharmacological approaches and psychotropic medications, used cautiously.

Late-life psychosis differs from early-onset psychosis on several characteristics. The treatment must be directed towards the cause and adapted to each individual. Non-pharmacologic interventions are frequently used as first line treatment, and pharmacotherapy must be used carefully. The crescent number of senior population must alert to this entity and the specificity of its approach.

Data regarding mental health problems in the prelingual deaf population is scarce. There is evidence that factors related to minority stress can contribute to mental illness in that population. In psychiatry, communication is key, however, most clinicians are not trained to communicate with the Deaf. Moreover, psychiatrists are often not aware of particularities in the psychopathology of these patients.

We aim to review important aspects of psychiatric evaluation of prelingual Deaf patients.

Non-systematic review of recent literature regarding Deaf mental health and mental illness.

Data regarding prevalence of mental illness in the Deaf population is mostly obtained from small studies and suggest an increased burden of mental illness and significant barriers to mental health care. Psychiatry research regarding Deaf patients is about 40 years behind research on the hearing population. While communicating with a Deaf patient, clinicians should consider the preferred communication modality. Sign-language interpreters should have specific mental health training, although that is not the case for many countries. Clinicians should keep communication simple, use short sentences, concrete examples and visual aids.

The mental status examination will have particularities, such as: 1) facial expressions have a specific role in sign languages and may not relate to affect; 2) There is a need to distinguish between language dysfluency and thought disorder 3) voice hallucinations may manifest as somatic or visual hallucinations; the occurrence of pure auditory hallucination in the prelingual Deaf is controversial. 4) the Deaf have little access to health information and are likely to demonstrate poor literacy on mental health matters.

More studies regarding the mental health issues of the Deaf population should be conducted. Raising awareness among clinicians about the needs of Deaf population is an important step to improve their access to help and treatment.

None Declared

Obsessive-Compulsive Disorder (OCD) is a chronic disabling condition, with considerable lifetime prevalence. There are interindividual differences regarding personality dimensions and how they affect obsessive- compulsive (OC) symptomatology. Furthermore, there is a connection between OC symptoms and the use of maladaptive emotion regulation strategies (expressive suppression) instead of using more cognitive reappraisal.

Explore the relationship between personality, emotion regulation strategies and OC symptoms by testing a path analytic model in a sample of healthy participants and in a sample of OCD patients.

Two samples of participants were utilized. Sample 1 consists of 787 healthy participants from the general Portuguese population. Sample 2 is composed of 33 OCD patients and 32 Healthy Controls (HC). Participants completed different scales: Emotion Regulation Questionnaire (ERQ), Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI) and Obsessive-Compulsive Inventory-Revised (OCI-R), through online surveys (sample 1) or a clinical interview (sample 2). These questionnaires were then analyzed with a path-analytic approach.

In sample 2, we found significant differences between OCD patients and HC in every OCI-R subscale, except Hoarding and Neutralizing. In the NEO-FFI, OCD patients scored higher on Neuroticism and lower on Extraversion. No significant differences were found regarding the ERQ. Relatively to sample 1: path analysis results showed that 13,4% of the variance of OC symptoms was explained by the best-fitting model. Only Neuroticism and Extraversion were directly associated with higher OCI-R Total scores, whereas Agreeableness predicted less OC symptoms. The use of Expressive Suppression was associated with more OC symptomology, but no significant connection was found with Cognitive Reappraisal. Regarding sample 2, no model was found, showing no modifying effect of emotion regulation strategies on OC Symptoms.

There is a deep-rooted interconnection between personality and emotion regulation regarding OC symptomatology in a sample of healthy participants but no effect of emotion regulation was seen regarding OCD patients.

To sum up, promising results were obtained and it could be an important field for the OCD in terms of diagnostic, severity and treatment.

None Declared

The COVID-19 outbreak imposed several periods of lockdown to stop the pandemic, with a determinant impact on access to mental health services. In Portugal, the first State of Emergency was declared on the 18th of March 2020, with the obligation of mandatory confinement and circulation restriction. Restrictive measures were alleviated on the 2nd of May 2020.

We aimed to investigate the impact of the first confinement on the maintenance or loss of psychiatric and psychological follow-up. Also, we aimed to explore the outcomes in the mental health of losing psychiatric or psychological consultations.

We conducted an online survey among the Portuguese population to evaluate demographic, clinical and mental health variables (STAI, DASS-21, PHQ, OCI-R, Quality of Life [QoL] and PSS). Individuals were invited to answer the survey at two timepoints: third week of March 2020 and third week of May 2020. Concerning the first timepoint, we used independent t-tests to compare the mental health variables in the individuals who loss and who did not lose consultations. Then, we evaluated the impact of losing consultations across time in those individuals who continued responding in the second timepoint, through a Linear Fixed Model. All the analyses were performed using JASP software.

From the total sample (n=2040), 334 individuals (84.4% female gender) had psychiatric and/or psychological consultations previously to the confinement. In March 2020, the individuals who maintained the consultations (35.0%) showed best mental health indicators in the QoL Self Evaluation (p=0.002), QoL Satisfaction (p=0.037), STAI State (p<0.001), DASS-21 (p=0.001), PHQ (p<0.001), OCI-R (p=0.002) and PSS (p<0.001). Among the matched individuals who answered the survey in May 2020 (n=93), we found that the group who maintained follow-up (n=24) did not improve significantly more than the other group (n=69) for any of the mental health variables in study.

The results indicate that stopping psychiatric and psychological follow-up represented worse mental health outcomes at the beginning of the first confinement. However, anxiety feelings improved at the end of the first confinement, which happened independently of psychiatric/ psychological follow-up.

None Declared

Posttraumatic stress disorder (PTSD) is a psychiatric condition which can be developed following traumatic experience. Treatment guidelines have long considered psychotherapy as a first line treatment. Despite that, PTSD remains an illness with high rates of comorbidity. Therefore, exploring novel therapies is of utmost importance.

Clarifying methylenedioxymethamphetamine (MDMA)-assisted psychotherapy efficacy in symptom relief in people with PTSD. Explaining clinical MDMA mechanism of action. Assessing safety of MDMA clinical use.

PubMed database search, with “MDMA for PTSD” keyword expression. 12 Articles published in the last ten years were selected among the 112 best matches. Reference lists of articles were reviewed to identify additional articles.

Mithoefer et al. (2010) carried out the first controlled clinical study with MDMA-assisted psychotherapy in people with PTSD. Twenty patients with treatment-resistant PTSD were selected. They were given either placebo or two or three sessions of MDMA. 83% of the experimental group no longer met the criteria for PTSD (mean remission lasted 45 months without further MDMA doses) compared with 25% of the placebo group. Further studies were also suggestive of improvements in treatment-resistant PTSD patients undergoing MDMA-assisted psychotherapy. MDMA may increase exposure therapy effectiveness, allowing patients to stay emotionally involved while revisiting past traumas without being overwhelmed by anxiety and fear.

To date, MDMA-assisted psychotherapy studies demonstrated consistently positive results. However, they have been carried out with small groups of individuals. Therefore, larger trials should be conducted to assess MDMA’s efficacy and safety for it to become a licensed medicine.

No significant relationships.

The word couvade originated from the French verb couver, meaning to hatch, nest, or brood. Custom of Couvade or Couvade Syndrome (CS) is a poorly understood phenomenon observed since ancient times, in which the expectant father experiences somatic and psychological symptoms of pregnancy.

Defining what is CS. Identifying possible origin. Hypothesizing causes. Identifying CS frequency.

PubMed database search, with “Couvade syndrome” keyword expression. Seven articles were selected among the best matches. Reference lists of articles were reviewed to identify additional articles.

Currently, there are several views on this phenomenon, including religious, cultural, medical, psychoanalytic, and psychological. CS is used in Psychiatry to describe somatic symptoms resembling pregnancy and/or childbirth in expecting fathers, such as weight gain, diarrhea or constipation, toothache, and headache. Lipkin and Lamb (1982) studied 300 couples from New York: they diagnosed Couvade Syndrome in 22,5% of fathers. Nevertheless, Brennan et al. (2007) found different incidence rates of CS diagnose in different areas of the world: 20% in Sweden; 25–97% in United States; 61% in Thailand; 68% in China; 35% in Russia.

Whether CS constitutes a disease entity, or it should be considered a ritual or custom remains a matter of debate. Different rates of CS around the globe may indicate that culture plays an important role. It may be a way for fathers-to-be to cope with changes imposed by pregnancy in the mother and in the couple. Overall, it is a fascinating intersection between the physiological and psychological realms.

No significant relationships.

Microorganisms distributed in our tissues and fluids make up the human microbiota. During our lifetime, gastrointestinal microbiota acts as an important modulator of brain development and, in turn, adult behavior and health. Immune response may be triggered by gut microbiota, releasing mediators that penetrate the blood-brain barrier (BBB).

Understanding if gut microbiota can influence schizophrenia pathogenesis. Clarifying how gut microbiota can influence schizophrenia treatment, and vice-versa.

PubMed database search, with “gut microbiota and schizophrenia” keyword expression. Eight articles published in the last ten years were selected among the most recent best match results. Reference lists of articles were reviewed to identify additional articles.

There could be an association between the development of gut microbiota starting during pregnancy and schizophrenia pathogenesis, through an immune-mediated process. Schwarz et al. (2018) investigated the differences in faecal microbiota between individuals with first-episode psychosis and controls. They found psychotic patients to have an increased amount of Lactobacillus bacteria. Yuan et al. (2018) studied microbiota changes in patients with schizophrenia, before and after treatment. Individuals diagnosed with schizophrenia had less faecal Bifidobacterium, Escherichia coli and Lactobacillus. After treatment with risperidone, there was a significant increase in the amount of fecal Bifidobacterium and E. Coli.

Microorganisms living inside our gastrointestinal tract are vital for proper central nervous system (CNS) development. Patients with schizophrenia have anomalies in the composition of the microbiota. It remains unclear if microbiota changes after treatment further influence the course of the disease.

No significant relationships.

Clozapine is the first atypical antipsychotic. It is used in refractory schizophrenia. It has a heavy side effect burden, including weight gain, dizziness, blurred vision, and sialorrhea. Not only is sialorrhea bothersome, but it can also have with serious consequences, such us aspiration pneumonia, neutropenia, agranulocytosis, myocarditis, and may be responsible for low self-esteem, leading to low treatment compliance and discontinuation.

Identifying the mechanism behind clozapine-induced sialorrhea. Finding how frequent clozapine-induced sialorrhea is compared to other antipsychotics. Finding effective ways to prevent clozapine-induced sialorrhea.

PubMed database search, with “clozapine sialorrhea” keyword expression. 12 Articles published in the last ten years were selected among the 112 best matches. Reference lists of articles were reviewed to identify additional articles.

Clozapine is a muscarinic M1-5 receptor antagonist, explaining its anticholinergic effects. Due to its strong anticholinergic action, sialorrhea is a paradoxical side effect. To prevent it, several drugs can be used, such us scopolamine, pirenzepine, sublingual atropine solutions, clonidine, botulinum neurotoxin, and others. Sialorrhea was relatively more frequently reported in clozapine (1.1%) compared with other antipsychotics (0.31%). Mubaslat and Lambert (2020) found that drops of atropine reduce the rate of saliva secretion significantly better than placebo. Uzun, et al. (2019) observed the adjunction of N‐acetylcysteine allowed a significant decrease of the severity of sialorrhea and was well tolerated.

Although effective in refractory schizophrenia, clozapine side effects, namely sialorrhea, can be bothersome and may affect treatment adherence. Fortunately, we have tools at our disposal to help patients better handle it.

No significant relationships.

N-acetylcysteine is known for its uses in non-psychiatric conditions, such as paracetamol overdose and as a mucolytic. The rationale for its administration in psychiatric conditions is based on its ability reducing synaptic glutamate release, which was found to be increased in the cerebrospinal fluid of OCD patients.

Evaluating N-acetylcysteine efficacy in OCD symptoms. Studying mechanisms underlying its action. Identifying the frequency of side effects.

PubMed database search, with the “N-acetylcysteine obsessive compulsive” keyword expression. The search was restricted to English-only articles, published in the last ten years. Twenty-five results among the best match correspondence were selected. Reference lists of articles were reviewed to identify additional articles.

Oliver et al. found that a daily dose of 2.400 to 3.000 milligrams of N-acetylcysteine reduced the severity of obsessive-compulsive symptoms with minimal side effects; Smith et al. found inconclusive evidence on its efficacy. A clinical trial from Ghazinadeh et al. revealed N-acetylcysteine to be effective as an add-on to citalopram, reducing the score of resistance/control to obsessions after supplementing with N-acetylcysteine. Costa et al. found out it was superior to placebo in anxiety control as a secondary outcome.

The potential efficacy of N-acetylcysteine in the treatment of psychiatric disorders attracted interest. Mixed evidence was found that N-acetylcysteine may have some benefits controlling compulsions, both as an adjunctive as and as monotherapy. Thus, larger and more robust studies are required to further investigate the clinical effectiveness of N-acetylcysteine in this area.

No significant relationships.

Previous studies concerning early experiences in childhood show that these play a crucial role in the individuals’ development and may lead to a decrease in the vulnerability to show psychological problems. Mindfulness skills and feelings of hope seem to function as mechanisms that promote adjustment and psychological well-being.

The aim of this study was to explore the relationship between early positive emotional memories, hope, and mindfulness skills, as well as their role in the psychological well-being.

A sample of 402 adolescents with ages ranging from 12 to 18 years old completed four self-report instruments: the Early Memories of Warmth and Safeness Scale, the Children and Adolescent Mindfulness Measure, the Children Hope Scale and the Positive and Negative Affect Schedule.

Girls exhibited more negative affect when compared to boys. Age and years of education were not correlated with any of the study variables. Students with no school disapprovals showed more positive emotional memories and more hope. Mindfulness skills, hope, warmth and safety memories, and positive and negative affect were significantly correlated in an expected way. The set of variables that better predicted positive affect was: hope, early warmth and safety memories, and mindfulness skills. For negative affect, mindfulness was the best predictor followed by hope and lastly by positive emotional memories.

The current study heightened the role of positive emotional memories, mindfulness, and hope in affective states, suggesting that they may be addressed in intervention programs for the adjustment or the psychological well-being of the adolescents.

Quality of Life (QoL) plays a remarkable role in practice and public health policy. However, research on QoL among children and adolescents is still scarce and it seems crucial to develop and validate assessment tools for measuring health-related QoL.

The current study aims to analyse the psychometric properties and validate the Portuguese version of the Youth Quality of Life Instrument (YQOL-R; Patrick et al., 2002). In addition, the convergent and divergent validities are examined with related constructs.

Participants were 507 adolescents, with ages between 12 and 19 years old, attending middle and high schools. Together with YQOL-R, participants also filled out the Kidscreen-27 (Gaspar & Matos, 2008) and the Depression Anxiety and Stress Scales (Pais-Ribeiro, Honrado & Leal, 2004).

The Portuguese version of YQOL-R showed a four-factor structure (dimensions: Self, Relationships, Environment, General Quality of Life), similar to the original version. This instrument also revealed a good internal reliability and adequate temporal stability. YQOL-R showed positive correlations with health-related quality of life and negative associations with depression, anxiety and stress symptoms. There were significant gender differences regarding quality of life, with boys reporting higher levels of perceived quality of life than girls.

Future studies should be conducted to ensure these findings among clinical samples or physical conditions. Nevertheless, this study contributes to the set of available instruments for the assessment of QoL among children and adolescents, suggesting that the YQOL-R may be a useful tool for research and health practices in community samples.

The impact of the diagnosis of an oncologic disease is well-known in terms of psychological adjustment and quality of life. On the other hand it is known that depressive symptoms may also overlap the physical symptoms of cancer and cancer treatment, which may interfere in their detection and appropriate treatment approach.

The aim of the current study was to explore the relationship between psychological adjustment to lung cancer, self-compassion, social support and emotional negative states in patients with lung cancer.

Fifty-five patients diagnosed with lung cancer (38 men and 17 women) with ages ranging from 44 to 87 years old participated in the study. A set of self-report instruments was used: the Mini Mental Adjustment to Cancer Scale (MiniMac), the Self-compassion Scale (SCS; Neff, 2003), the Social Support Satisfaction Scale (SSSS) and the Depression, Anxiety and Stress Scale (DASS-21).

Significant correlations were found between psychological adjustment and emotion regulation strategies (self-compassion), social support and psychopathology. The predictive model for depressive symptomatology and psychological adjustment (as assessed by the helpless/hopeless dimension) includes mindfulness as a significant predictor. Regarding the predictive model for stress, the satisfaction level with support from friends revealed to be an important element.

Our findings suggest that these patients may benefit, in their therapeutic approach, from the development of this kind of strategies (new ways of relating themselves with their emotional experiences and quality of their social networks) in order to promote a better psychological adjustment to their clinical condition.

Social relationships (e.g. family, friendships and romantic relationships) are fundamental to human development and well-being.

The current study aimed to explore the psychometric properties of the Social Values Questionnaire (SVS; Blackledge & Ciarrochi, 2006) in a sample of Portuguese adolescents. Furthermore we sought to understand motives for and commitment to social values and how these elements are associated with well-being across age and gender.

The sample included 268 adolescents (150 girls and 118 boys) with ages ranging from 14 to 18 years old, attending high school. Participants completed a set of self-report measures: the SVS, the Positive and Negative Affect Schedule (PANAS-C; Sadin, 1997), the Students’ Life Satisfaction Scale (SLSS;Huebner 1991) and the Children's Hope Scale (CHS; Snyder, Hoza, Pelham, Rapoff, Ware, Danovsky, Highberger, Rubinstein & Stahl, 1997).

The Portuguese version of the SVS showed high internal consistency: Intrinsic motivation (α=0,91), extrinsic motivation (α=0,90), commitment (α=0,79). It also showed adequate test retest reliability. Gender revealed a relevant role with girls presenting more intrinsic motivation, less extrinsic motivation and a higher degree of commitment when compared with boys. Age was positively correlated with intrinsic motivation and commitment. Significant and expected relationships were also found between SVS subscales and positive and negative affect, life satisfaction, and hope.

The SVS seems to be a valid and reliable instrument for the assessment of social values in adolescents. This construct is an important one in the context of mindfulness and acceptance based therapies and thus its assessment is pertinent.

Social anxiety refers to the discomfort felt in situations of social interaction or performance and may be an especially intense emotion in adolescence due to characteristics and developmental tasks of this age group. Although it is a common emotion and has an adaptive function, it can also develop as a negative experience raising serious difficulties in school and social life of young people.

This study analyses the contribution of childhood negative memories and fear of compassion in social anxiety in adolescence.

Three hundred and twenty adolescents (186 boys and 134 girls) with ages ranging from 12 to 19 years old took part in the study. Participants completed the following self-report measures: Early Life Experiences Scale for Adolescents, Fear of Compassion Scale (FCS-A) and the Social Anxiety Scale for Adolescents (SAS-A).

Significant gender differences were found regarding social anxiety, empathy and early unvalued experiences within the family. Age was only correlated with social anxiety. Social anxiety showed a significant and expected correlation with the study variables. The model including fear of compassionate feelings (from other and from oneself) and early unvalued experiences showed to be the best predictor of social anxiety.

This study integrates the contribution of less explored variables, as the fear of compassion and early negative memories, in the understanding of social anxiety in adolescents. Results suggest that these variables may have an important role and should be incorporated in psychological interventions for social anxiety in adolescence.

Centro Hospitalar Lisboa Norte's Psychiatric Day Care Hospital (CHLN-PDC) offers a psychotherapeutic oriented program.

To characterize the CHLN-PDC population and to determine if the subjects' HSM-PDC treatment leads to variation in the number of re-admissions to psychiatric wards.

Retrospective analysis of all patients admitted to the CHLN-PDC between July 1, 2008 and June 30, 2011, assessing for gender, age, diagnoses, time of admittance, and number of re-admissions in psychiatric wards, three years before and three years after the program.

During this period, 71 patients were admitted (17 males, 54 females), with an average age of 33 years old (no difference between genders). Mean duration of the program was 267 days (260 for females, 291 for males). The most frequent diagnoses were Depressive Episode (N=30), Personality Disorder (N=29, in general co-morbid to other diagnoses), Obsessive Compulsive Disorder (N=5), Generalized Anxiety Disorder (N=5), Schizophrenia (N=3) and Schizoaffective Disorder (N=3).

The number of admissions to psychiatric wards reduced from 86 before to 36 after the program. The reduction was more evident for patients with Bipolar Disorder and Personality Disorder. Patients who completed the full program remained in average 303 days, but re-admissions were reduced greatly when compared to those who did not complete the full program (increase of re-admissions).

The majority of patients were women, with no difference of age between genders. Most common diagnoses were Depressive Episode and Personality Disorder. The program, when completed to its fullest extent, lead to a decrease in the number of re-admissions.