Although global knowledge on paediatric cardiomyopathies has advanced, prospective cohort studies from Brazil, particularly those integrating clinical and genetic data, remain limited.

To describe the clinical and genetic characteristics of paediatric cardiomyopathy patients and identify mortality predictors in a metropolitan region of Brazil.

Prospective observational study of paediatric patients with cardiomyopathies. Clinical data, genetic findings, and survival were analysed using Kaplan–Meier curves.

A total of 45 cases, male predominance (55.6%), and mean age at diagnosis of 6.5 years. Dilated and hypertrophic cardiomyopathy were the most common (33.3%). The main reason for diagnosis was the investigation of cardiovascular symptoms (60.9%). Genetic investigation occurred in 66.6%, a positivity rate of 60%. Multi-organ/system involvement was significantly associated with a positive genetic result (77.7%, p = 0.017). Mortality was 11.1%; survival was significantly lower in the following conditions: ejection fraction < 30% (p < 0.0001), functional class III/IV (p < 0.0001), heart failure (p = 0.0091), use of three or more cardiovascular medications (p < 0.001), N-Terminal Pro-B-Type natriuretic peptide >1000pg/mL (p = 0.004), and heart transplant indication (p < 0.001).

These findings provide novel data in Brazil, highlight a high rate of positive genetic test, particularly among patients with systemic involvement and identify key clinical predictors of mortality to guide risk stratification and care.

The widespread use of mobile devices, particularly among young people, extends beyond entertainment to education and professional purposes. However, excessive smartphone use has led to health issues such as headaches, poor concentration, sleep problems, and anxiety. A condition called nomophobia, or the fear of being without a mobile phone, has emerged, though it’s not officially recognized as a psychiatric disorder. In adults, 20% experience mild nomophobia, 50% moderate, and 20% severe symptoms, which can be measured using the Nomophobia Questionnaire (NMP-Q). Smartphone overuse is also linked to psychopathological issues like insomnia and anxiety.

The aim of this study is to evaluate the impact of nomophobia in insomnia and anxiety.

Non-systematic review of the literature regarding nomophobia and anxiety and insomnia. The research was carried out through the PubMed® database, using the terms “nomophobia”, “nomophobia and anxiety” and “nomophobia and insomnia”.

The included studies highlight that nomophobia is associated with higher anxiety levels in most individuals as well as a substantial correlation between nomophobia symptoms and insomnia.

Nomophobia is increasing due to technological advancements and widespread access. Overuse of mobile phones is linked to psychopathologic symptoms, like anxiety and insomnia. Raising awareness and helping young adults manage their phone use is essential for promoting health and well-being as digital technologies become an integral part of daily life.

None Declared

Dialectical Behavior Therapy (DBT) is a comprehensive evidence-based psychotherapy that focuses on teaching skills regarding the acceptance of circumstances and coping with emotional responses.

The objective of this study is to perform a systematic review and meta-analysis to investigate the efficacy of DBT in patients diagnosed with Bipolar Disorder (BD) in order to ascertain whether it improves the recurrence of manic and depressive symptoms.

A systematic search of the PubMed (MEDLINE), Embase, Web of Science, and Cochrane Library databases was conducted to identify studies that had applied DBT to patients with a diagnosis of BD.

A total of 343 patients were included in the study, comprising participants from eight randomized and non-randomized trials. Of whom, 196 patients (57.1%) underwent DBT and pharmacological treatment, while 147 patients (42.9%) were treated with alternative interventions. A total of 12 to 36 sessions of DBT were conducted across all trials, with a follow-up period ranging from three to 15 months. The age range of the participants was 15.8 to 49.3 years. All studies included patients diagnosed with BD type I (n=175), five articles included patients with BD type II (n=100), and two included patients with BD-NOS (Not Otherwise Specified) (n=68). The primary endpoint analyzed was the mean change in the Beck Depression Inventory-II (BDI-II), as reported by three of the included studies. The meta-analysis yielded no statistically significant results, with a mean difference of -4.49 (95% CI: -11.75, 2.76; I² = 6%; p = 0.22) (Figure 2). The analysis of the Young Mania Rating Scale (YMRS) revealed a mean of 5.96 in a total of 72 patients (95% CI: 0.29-11.64; I² = 97.39%; p < 0.001) (Figure 3).

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The DBT was observed to have a beneficial impact on mood episodes and symptomatic manifestations among adolescents and adults diagnosed with BD. Therefore, it may be postulated that the DBT could be employed in conjunction with pharmacological agents to mitigate the severity of symptoms and enhance the overall quality of life in patients with such a diagnosis.

None Declared

Postpartum depression (PPD) is one of the most prevalent mental disorders, with the potential to precipitate complications in childbearing. The estimated prevalence of PPD ranges from 7% to 13% in developed countries and exceeds 20% in underdeveloped countries. Near 20% of women presenting with symptoms of PPD experience suicidal ideation. Prompt detection and management of this patient group is of particular importance. The use of esketamine has shown to reduce the incidence of PPD in previous studies, but its widespread use has been hampered by its side effects and the need for hospitalisation.

We aimed to review the available literature on the efficacy and safety of peripartum esketamine use.

A narrative literature review was carried out in the PubMed, Cochrane and Embase databases, selecting only the articles published in the last 10 years, using the following keywords: pregnancy, esketamine, postpartum depression.

After childbirth 6 week is a high-risk period for PPD, specially the first week. The incidence of PPD is higher in C/S than in normal births. Compared with pregnant women who underwent C/S without the use of esketamine, those who used esketamine in the perioperative period had a 48% reduced risk of developing postpartum depression and a 1.43 point reduction in the Edinburgh Postnatal Depression Scale (EPDS). The optimal dose of esketamine for PPD is unknown; most studies consider high doses above 0.5 mg/kg and low doses inferior. These favourable effects were observed at both short and long-term follow-up and in low and high doses. Compared to intranasal esketamine, intravenous esketamine has a higher bioavailability and is more convenient to dose control. Route of administration and dose of esketamine did not affect the prophylactic effect of esketamine on PPD, but they differ in their adverse effect profiles. The incidence of immediate adverse reactions to intraoperative pumped esketamine is extremely high, particularly during the intraoperative period when more patients receiving esketamine developed neurological or psychiatric symptoms (97.7%). Other common immediate intraoperative maternal adverse events were nausea and vomiting, dizziness and hallucinations, but had no significant effect on postoperative adverse. Adverse reactions to esketamine are usually transient and are more common when single intravenous injection is used (continuous infusion is preferable), with faster and higher doses.

PPD has potentially serious consequences for mothers and their children, and there is an urgent need for safe, effective and accessible treatments. As the use of esketamine has progressed, concerns have arisen about adverse effects, particularly long-term efficacy, addiction and suicide risk. Current evidence suggests that although it may have a good preventive effect, a long research trail is needed to prove and confirm the efficacy and safety of esketamine.

None Declared

Schizophrenia is one of the most disabling mental disorders, affecting around 1% of the population. Although most patients respond to antipsychotic treatment, one third have a limited response to antipsychotic medication, being considered treatment resistant schizophrenia (TRS). Clozapine is the only effective medication for TRS, but 30-40% of TRS patients do not respond to it. Patients with schizophrenia who do not respond to clozapine experience more severe disability, persistent symptoms, a lower quality of life and incur higher economic costs compared to those who respond to treatment.

The aim of the present study is to review evidence for therapeutic strategies for patients with treatment-resistant schizophrenia not responding to clozapine.

Review of the literature regarding treatment-resistant schizophrenia not responding to clozapine. The research was carried out through the PubMed® database, using the terms “treatment resistant schizophrenia”, “schizophrenia resistant to clozapine” and “clozapine augmentation”.

For patients with treatment-resistant schizophrenia who do not respond to clozapine, several therapeutic strategies have been explored. These include pharmacological approaches, non-pharmacological interventions and brain stimulation procedures [Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS)]. However, the evidence is weak and the reported benefits were modest.

The current evidence is weak for efficacy of pharmacological augmentation strategies to clozapine. There are contradictory data regarding ECT and clozapine augmentation. More studies are necessary to clarify the potential of these strategies in order to manage these complex patients.

None Declared

Individuals with mental health disorders often lack access to appropriate care, including psychosocial rehabilitation programs, which are considered essential for their recovery. In 2019, as part of the intervention by the Community and Mental Health Service, at Hospital de Magalhães Lemos, we initiated a psychoeducational group for patients with psychotic spectrum disorders, with the purpose of providing our patients with comprehensive information about their condition and effective management strategies. Our 8-week program consisted of 16 sessions, including icebreaker activities, discussion of certain themes, sharing of experiences and practice of stress management techniques.

The aim of this study was to assess and quantify the impact of our 2023 program.

Out of a total of 20 patients interviewed for our program in 2023, 16 began the program and 12 completed it. The program’s evaluation was based on several assessment tools, including a sociodemographic questionnaire, a knowledge assessment questionnaire, the Positive and Negative Syndrome Scale (PANSS), the Insight and Treatment Attitudes Questionnaire (ITAC), the World Health Organization Quality of Life (WHOQOL), and the Medication Adherence Rating Scale (MARS). We also created a health agenda to organize an individual plan of care.

Our findings indicated an improvement in insight and attitudes towards treatment by 8.6%, an enhancement in treatment adherence by 5%, and an increase in knowledge by 11.9%. In terms of quality of life, we observed a slight improvement in the psychological domain by 0.6% and in the social domain by 1.2%. Regarding the impact on psychotic symptomatology, there was an average decrease in 4 points in the negative subscale and in 3 points in the general psychopathology subscale, whereas the positive subscale remained unchanged. None of the patients required hospitalization during this period.

Our study revealed some improvement in nearly all the evaluated parameters. There was an improvement of the therapeutic relationship, which we believe has contributed to lower scores in the negative symptoms and general psychopathology subscale. As for the study limitations, we acknowledge that we will need to expand our sample through additional programs in the next years, to include it in early intervention psychosis programs and to re-evaluate our patients’ outcomes after a more extended follow-up period, particularly if they continue to participate in our monthly mutual support group. Additionally, we must consider potential study biases, including the subjectivity of PANSS evaluations and the influence of other confounding factors, such as changes in treatment regimens during the program.

None Declared

Alcohol and illicit drug use are highly prevalent among the homeless population. Religiosity and spirituality (RS) have been widely associated with lower substance use. However, evidence of this relationship among the homeless is still scarce.

To assess the association between RS and the use of alcohol and illicit drugs among the homeless population of a large Brazilian urban center.

This cross-sectional study was conducted in São Paulo, Brazil. Aspects such as spirituality (FACIT-Sp12), religiosity (P-DUREL), religious-spiritual coping (Brief-RCOPE), and self-applied questions about current substance use (alcohol and illicit drugs) were evaluated. Adjusted Logistic Regression models were performed.

A total of 456 homeless individuals were included, with an average age of 44.5 (SD=12.6) years. More than half of the participants used alcohol (55.7%) weekly and 34.2% used illicit drugs weekly. The adjusted Logistic Regression models identified that aspects of RS were associated with a lower propensity for alcohol and illicit drug use, whereas negative religious-spiritual coping strategies were associated with a higher propensity for the use of both.

The prevalence of alcohol and illicit drug use among participants was high. Positive RS and religious-spiritual coping were significant protective factors against the use of these substances. Conversely, negative religious-spiritual coping strategies were associated with risk factors.

None Declared

Individuals experiencing psychotic symptoms often lack insight into their conditions, especially in first psychotic episodes. According to the Portuguese Mental Health Law, involuntary hospitalization may be necessary in cases of severe mental disorder, involving a threat to the patient or his/her legal assets, when there is a refusal of the necessary treatment.

The aim of our study was to characterize patients admitted involuntarily for first psychotic episode and to compare them with the patients undergoing inpatient voluntary treatment.

Out of a total of 87 patients diagnosed with first psychotic episode, hospitalized between 2020 and 2022 in our service, at Hospital Magalhães Lemos, 65 were included in the study. Exclusion criteria included patients from other residential areas. 40 patients were admitted under involuntary treatment, whereas 25 were hospitalized voluntarily. For both groups, we calculated the duration of untreated psychosis, the prevalence of psychoactive substance abuse, the type of treatment provided and the number of re-hospitalizations.

Patients in involuntary treatment had longer duration of untreated psychosis (71 vs 38 weeks). Among these patients, 53% had comorbid psychoactive substance abuse, in contrast with only 36% of voluntarily treated patients. Upon discharge, 58% of patients in involuntary treatment were prescribed depot antipsychotic medication, whereas only 12% of the ones in voluntary treatment. Out of 40 patients admitted involuntarily, 11 were re-hospitalized, but only 4 of the 25 patients in voluntary treatment (28 vs 16%).

Patients in involuntary treatment probably suffered from more severe disease, as seen for the higher duration of untreated psychosis and frequent comorbid substance abuse. Injectable medication was the preferred choice at the time of discharge for this group. Additionally, they experienced higher rates of re-hospitalizations. Recent changes in Portuguese Mental Health Law, that aims to safeguard the rights and responsibilities of individuals with mental health care needs, motivated this study.

None Declared

Immersive technologies have the potential to control cognitive and behavioural symptoms in people with dementia. A safe environment can be designed through a specific interactive scenario, according to the preferences and experiences of each user.

Mapping neuro-emotional responses during the interactive scenario therapy experience in a case study, with dementia, using electroencephalography (EEG).

A participant, 78 years old and diagnosed with moderate to severe Alzheimer's disease (female; Mini Mental State Examination score of 17 points; frontal assessment battery score of 8 points), underwent EEG analysis (EMOTIV EPOC X) using a protocol with interactive scenarios tailored to the participant's needs and preferences, the scenarios were designed from reminiscence strategies. The protocol included a stimulus that alternated between motor and cognitive activities (3 minutes), and breath-centered relaxation (1 minute). The scenarios used in this study were: setting up a living room; composing a cake recipe; shopping in the market to make a cake; looking for objects in the park; organizing a birthday party. These variables are provided, on a scale of 0 to 100, after processing by the algorithms of the EmotivPRO v3.0 software.

The values found in the EEG analysis will be described without stimulus and with stimulus respectively. Thus, engagement (68.57 to 71.86); arousal (57.86 to 49.86), focus (61.57 to 57.00), interest (54.86 to 49.57), relaxation (33.86 to 30.86), and stress (53.71 to 43.00). The EEG data showed an increase in engagement when the patient was stimulated (68.57 to 71.86). Relaxation also increased (30.86 to 33.86) when the stimulus was removed. The stress level, as analysed by the EEG, was also higher in the period without stimulus and reduced in the period with the stimulus (53.71 to 43).

During a stimulus period in interactive therapy, there was an increase in engagement, which was related to an increasing focus during the stimulus. Lower values were observed compared to the period without stimulus, indicating a period of recovery after a period of concentration/arousal. Therefore, therapy with an interactive and familiar scenario, using a circuit of stimulus-breathing exercises, promotes a positive and adequate neuro-emotional response in a person with dementia.

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

Data are scarce regarding hospital infection control committees and compliance with infection prevention and control (IPC) recommendations in Brazil, a country of continental dimensions. We assessed the main characteristics of infection control committees (ICCs) on healthcare-associated infections (HAIs) in Brazilian hospitals.

This cross-sectional study was conducted in ICCs of public and private hospitals distributed across all Brazilian regions. Data were collected directly from the ICC staff by completing an online questionnaire and during on-site visits through face-to-face interviews.

In total, 53 Brazilian hospitals were evaluated from October 2019 to December 2020. All hospitals had implemented the IPC core components in their programs. All centers had protocols for the prevention and control of ventilator-associated pneumonia as well as bloodstream, surgical site, and catheter-associated urinary tract infections. Most hospitals (80%) had no budget specifically allocated to the IPC program; 34% of the laundry staff had received specific IPC training; and only 7.5% of hospitals reported occupational infections in healthcare workers.

In this sample, most ICCs complied with the minimum requirements for IPC programs. The main limitation regarding ICCs was the lack of financial support. The findings of this survey support the development of strategic plans to improve IPCs in Brazilian hospitals.