Psychiatry Pitstop is a role-play-based program for medical students aimed to improve communication skills in the framework of mental health. The workshop involved amateur actors who simulated different clinical scenarios and psychiatry residents, who facilitated the sessions and provided constructive feedback following the Pendleton method. Psychiatry Pitstop was originally developed in the United Kingdom and it was expanded to Lisbon, Portugal, in 2019. The authors adapted the course to the Portuguese context, adjusting the number of sessions and altering the scenarios to match common clinical situations faced by junior doctors in Portugal. By now, we conducted four courses.

Our study aims to describe the Portuguese adaptation of the program and to learn insights from the students feedback.

The course was assessed using satisfaction questionnaires, completed by the students after each session. These included a Likert scale ranging from 1 to 5, with items pertaining to Future Importance, Overall Quality, Theoretical Quality, and Practical Quality. Quantitative data was analyzed using Excel and standard descriptive statistics to summarize the results. The open questions invited students to articulate the main positive aspects, suggestions for improvement and future topics. A Natural Language Processing (NLP) software was used to evaluate open-ended responses and extract the main concepts.

We obtained a total of 39 single-answers from 4 different courses. Evaluation results yielded a mean score of 4.7 for Future Importance, 4.9 for Overall Quality, 4.3 for Theoretical Teaching, and 4.9 for Practical Teaching. Notable positive aspects included students’ appreciation of the immersive interview environment, the dedication exhibited by actors and doctors, well-prepared case scenarios, and engaging interactions with participants. Suggestions for improvement encompass enhanced theoretical introductions, comprehensive topic coverage, universal participation in simulations, and expanded workshop days. Future prospects for the program include practicing interviews with other psychiatric diagnosis, addressing difficult patients, delivering bad news and covering topics related to sexuality, grief and moral dilemmas.

Our study shows that Psychiatry Pitstop adaptation to the Portuguese context was successful. Overall, the feedback from medical students has been consistently positive. Subsequent editions will draw upon the findings of this study to enhance overall program quality.

None Declared

According to the 2023 statistical report from the Portuguese Migration Observatory, Portugal has received over 72,000 refugees since 2015, with a significant number (56,041) being displaced citizens from Ukraine. This influx includes spontaneous asylum requests. The major countries of origin for refugees in Portugal are Afghanistan, India, Gambia, Pakistan, and Morocco. Notably, refugee populations exhibit elevated incidence rates of specific psychiatric disorders, including post-traumatic stress disorder and depressive disorders. These conditions are independent risk factors for substance use disorders. Furthermore, refugees face unique risks related to their migration journey, increasing their vulnerability to substance use disorders. The prevalence of substance use disorders, especially Alcohol Use Disorder, can reach up to 36% in this population. CAR 1 (Reception Center for Refugees) is a vital social facility in Portugal dedicated to enhancing the reception and integration of asylum seekers and refugees.

Our primary objective is to determine the prevalence of potential alcohol problems and unhealthy alcohol use within the Portuguese Refugee Center in Lisbon. Our secondary aim is to comprehensively characterize the migrant population. This includes gathering data regarding demographic information, legal status, country of origin, pre-migration alcohol-related issues, psychiatric diagnoses, history of psychiatric evaluations, self-initiated help-seeking behavior, and self-perceived alcohol-related problems.

All individuals currently residing in our refugee center (approximately 70 people) will be invited to participate in a comprehensive survey and screening process. Exclusion criteria will apply to individuals with acute psychiatric conditions unable to provide reliable responses. The survey includes the Alcohol Use Disorders Identification Test (AUDIT) and the CAGE questionnaire. Quantitative data obtained from the questionnaires will be analyzed using Microsoft Excel and IBM SPSS 29 software.

We anticipate a high prevalence of positive responses to the AUDIT due to potential alcohol-related issues but expect low responses to the CAGE questionnaire due to limited awareness of alcohol use disorder and a reduced perception of the need for help.

This study could help identify and validate the prevalence of alcohol use disorders among migrants, emphasizing the need for appropriate responses. By shedding light on these challenges, we hope to promote effective responses to alcohol use disorder and encourage the utilization of alcohol screening tests in refugee centers, emphasizing the importance of seeking consultation when needed.

None Declared

Cariprazine is one of the most recent innovations in neuropsychopharmacology, with evidence for its efficacy in affective and psychotic spectrum disorders.

To present a case that highlights cariprazine’s potential use outside the regulatory approved indications.

Case report using CARE guidelines and a narrative review.

We present the case of a 41-year-old male readmitted to a psychiatric inpatient unit due to three months of mutism and withdrawal. At admission, the patient did not communicate verbally or in writing, but he complied with simple orders, and his consciousness remained unimpaired. He scored 11 points on the Bush-Francis Catatonia Rating Scale (BFCRS), indicating immobility, mutism, staring, withdrawal, ambitendency, and automatic obedience. We observed psychomotor retardation and indirect signs of a depressive mood, including the omega sign. His medical history included ongoing psychiatric treatment since the age of 30, with two prior admissions to an acute inpatient unit. At the time of admission, he was treated with olanzapine 20 mg/day, lorazepam 2 mg/day (recently downtitrated), venlafaxine 150 mg/day, and bupropion 150 mg/day. At the start of the current episode, the patient’s diagnosis was uncertain, with previous descriptions of psychotic, affective, and catatonic features. Due to suspicion of catatonia, we administered a high dose of lorazepam (8 mg/day), resulting in a partial response with a 4-point reduction in the BFCRS. We discontinued bupropion, increased venlafaxine to 225 mg, and switched from olanzapine to cariprazine using a taper, washout, and switch strategy. Psychotic symptoms briefly appeared when the patient was not taking a dopamine D2-receptor modulatory drug. We identified mild possible adverse drug reactions, including akathisia, transient insomnia, and daytime sleepiness. At a dose of 6 mg/day of cariprazine, we observed complete remission of catatonia (BFCRS=0) and significant improvement in affective and psychotic symptoms. The patient was discharged home with diagnoses of catatonia and schizoaffective disorder, prescribed 6mg/day of cariprazine, 225mg/day of venlafaxine, and 2,5mg/day of lorazepam. At the 6-month follow-up, the patient continues to exhibit clinical stability.

This case emphasizes the safety and potential effectiveness of cariprazine in treating catatonia within the context of schizoaffective disorder. We consider that the partial agonist properties of cariprazine could theoretically reduce the risk of exacerbating catatonia, a risk typically associated with full D2-receptor antagonists. Other mechanisms of action, such as D3 partial agonism, may also contribute to the improvement or at least the non-aggravation of catatonic symptoms. Cariprazine’s mood-stabilizing properties make it a promising off-label choice for treating schizoaffective disorder, especially when catatonic features are present.

None Declared

Obsessive-compulsive symptoms (OCS) have been described in many neurological disorders, including dementia. A meta-analysis by the authors (2021) reported a prevalence of OCS in dementia of approx. 35.8%, and a higher percentage in frontotemporal dementia (FTD) (46.7%). The literature also points that obsessive-compulsive disorder with late-life onset is rare, but those cases are frequently associated with neurologic injury, and some authors suggest a role of cognitive disfunction.

Our main goal was to describe the neurobiologic and cognitive underpinnings of OCS in patients with dementia.

MEDLINE, CENTRAL and PsycNet databases were searched for articles about obsessive-compulsive symptoms in dementia. Search terms included “obsessive”, “compulsive”, “OCD”, “cognitive decline”, “cognitive dysfunction” and “dementia”. Titles, abstracts and full texts were screened independently by 2 reviewers.

Correlations between dysfunction / lesions in various circuits in the context of dementia and OCS were found, such as (1) frontal regions (specially the orbitofrontal cortex) and anterior cingulate cortex (2) fronto-striatal-thalamic circuits (3) temporal structures; (4) cerebellar structures; (5) serotoninergic, dopaminergic, and cholinergic neurotransmission. A high proportion of studies concerned FTD. Regarding cognitive mechanisms, there is a focus on the importance subjective concerns about cognitive functioning, which could exacerbate obsessional beliefs and maladaptive responses to intrusions.

The main brain circuits implicated in dementia, specially FTD, and OCS are those involving frontal regions and the fronto-striatal-thalamic circuits, with areas such as the temporal and cerebellar structures algo being studied. The correlation between dysfunctional circuits in dementia and OCS could give us new hints about OCD and its treatment.

No significant relationships.

COVID-19 raises serious concerns regarding its unknown consequences for health, including psychiatric long term outcomes. Historically, influenza virus has been responsible for pandemics associated with schizophrenia. Epidemiological studies showed increased risk for schizophrenia in children of mothers exposed to the 1957 influenza A2 pandemic. Controversy remains concerning the mechanisms of pathogenesis underlying this risk.

We aim to review the evidence for the association between influenza infection and schizophrenia risk, the possible pathogenic mechanisms underlying and correlate these findings with the schizophrenia hypothesis of neurodevelopment.

We reviewed literature regarding evidence from epidemiological, translational animal models and serological studies using medline database.

The biological mechanisms likely to be relevant account to the effects of infection-induced maternal immune activation, microglial activation, infection-induced neuronal autoimmunity, molecular mimicry of the influenza virus, neuronal surface autoantibodies and psychosis with potential infectious antecedents. Influenza infection may fit into the theory of the neurodevelopment of schizophrenia as a factor that alters the normal maturation processes of the brain (possible second or third hit).

Influenza infection has multiple pathogenic pathways in both pre and post natal processes that might increase the risk of schizophrenia or psychosis. The existing evidence regarding the relationship between influenza virus and psychosis might help us draw similar long-term concerns of COVID-19.

No significant relationships.

To describe the use and abuse of alcohol, cigarettes and street drugs in nursing degree students of Alfredo Pinto nursing school at federal university of state of Rio de Janeiro.

cross-sectional and descriptive data of first and final year students enrolled in a nursing degree course. One hundred and seventeen students took part in a questionnaire, providing sociodemographic information and completed the alcohol smoking and substance screening test (ASSIST). A double variant and chi-squared analysis and Fisher's exact test was performed.

One hundred and seventeen students participated. Of the first year students 82% (n = 73) were woman; 61% (n = 54); 18–20 years old; 43% (n = 38) were white and 40% (n = 36) had parents that identified as Roman-Catholic. The students in their last year: 89% (n = 25) woman; 54% (n = 15) aged between 21–23 years old; 70% (n = 20) are white and 71% (n = 20) have roman-catholic parents. That is a high prevalence of alcohol use: 84% (n = 75) in the first year and 78% in the last year had used alcohol. 24% (n = 21) had smoked during their first year and 18% (n = 5) during the last year. It was found that the consumption of street drugs during early years of university is correlated to the age (P = 0.033) and the religious orientation by parents (P = 0.047).

Universities responsibility towards their students, and students involvement with their learning process are factors that lead to changes in attitudes, beliefs and knowledge that are so important in maintaining healthy habits and lifestyle in line with what is taught in a nursing degree.

The authors have not supplied their declaration of competing interest.

The Wernicke-Korsakoff syndrome comprises a complex of symptoms including Wernicke's encephalopathy and the Korsakoff's syndrome. While the former is characterized by a classic clinical triad of ataxia, ophtalmoplegia and a global confusional state; the Korsakoff's syndrome is characterized by memory impairment and confabulation. These two entities are now considered as a clinical spectrum of a same disease caused by deficiency of thiamine (vitamin B1).

To describe a case of Wernicke-Korsakoff Syndrome with psychotic symptoms in a 13-year-old female patient with anorexia nervosa.

The patient and family were interviewed. Literature relevant to the case was reviewed.

A 13-year-old Caucasian female was admitted to the emergency department with bradycardia (38 bpm) and a two-month history of weight loss totaling 6 kg. This loss of weight was a result of dietary restriction and over-exercise because she “felt too fat”. On admission she has a body mass index of 12.17. She was diagnosed with anorexia nervosa and was hospitalized. On day 11 after hospitalization, patient initiated alteration in behavior, fluctuating mental state with periods of lucidity and periods of confusion, memory impairment and psychotic symptoms, with paranoid delusions and auditory hallucinations. The classic triad of Wernicke's encephalopathy was not present. The treatment with thiamine was initiated and the symptoms including psychotic symptoms improved.

Wernicke-Korsakoff syndrome should be considered in cases of anorexia nervosa with a confusional state and memory impairment even if the classic symptoms are not present.

The authors have not supplied their declaration of competing interest.

The occurrence of chronic diseases, motor limitation, cognitive impairment and social isolation could be related to late life depression.

To describe the pathologies related to elderly patients with depression. To study possible relationship between depression and others pathologies in elderly patients.

This retrospective study included 124 geriatric patients enrolled in a private long-term care institution with mean age of 86.2 ± 6.5 years old, mean weight of 60.28 ± 2.00 kg and mean period of hospitalisation of 4.4 ± 2.3 years. For data analysis, double-entry tables and tests of proportion Qui-square were used.

Cardiovascular, respiratory, endocrine metabolic, skeletal muscle, sense organs, hematological, digestive tract; neuropsychological and genitourinary, diseases were analyzed.

We observed a significant correlation between depression and endocrine-metabolic (P value of 0.0003), sense organs (P value of 9.298 E-5) and skeletal muscle pathologies (P value of 6.843 E-6)

We observed in that population that depression could be prevalent in elderly patients with endocrine-metabolic, sense organs and skeletal muscle pathologies.

The authors have not supplied their declaration of competing interest.

Hypothyroidism psychocognitive key features may include melancholia, memory impairment, depression and dementia which could be misdiagnosed as a psychiatric disorder.

To study the incidence of hypothyroidism in psychiatric patients.

This retrospective study included 232 psychiatric patients with mean age of 43.39 ± 10 years old weight mean of 79.81 ± 19.07 kg, BIM of 29.55 ± 6.83, enrolled in a public mental health service.

Twenty point twenty-one percent (39) patients presented hypothyroidism with thyroid-stimulating hormone (TSH) levels above 5 mIU/L and Free T4 levels below 0.7 ng/dl.

Comparing the incidence of hypothyroidism in Brazilian population estimated rate of until 10% [1] with this psychiatric patients population we observed a significant difference with p value of 2.28 E-6. Neuroleptics 92%(36), biperiden 62%(24) and benzodiazepines 38% (15) were the most frequent prescribed drugs for these hypothyroidism patients.

Significant difference in the incidence of hypothyroidism between general Brazilian population and the studied psychiatric patients was observed [2,3].

The authors have not supplied their declaration of competing interest.

Little is known about predictors of recovery from bipolar depression.

We investigated affective instability (a pattern of frequent and large mood shifts over time) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychosocial treatment for acute depression.

A total of 252 out-patients with DSM-IV bipolar I or II disorder and who were depressed enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and were randomised to one of three types of intensive psychotherapy for depression (n = 141) or a brief psychoeducational intervention (n = 111). All analyses were by intention-to-treat.

Degree of instability of symptoms of depression and mania predicted a lower likelihood of recovery and longer time until recovery, independent of the concurrent effects of symptom severity. Affective instability did not moderate the effects of psychosocial treatment on recovery from depression.

Affective instability may be a clinically relevant characteristic that influences the course of bipolar depression.

The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy.

Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments.

Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10–20 prior episodes of depression [number needed to treat (NNT) = 2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT = 32.0) or >20 (NNT = 9.0) depressive episodes.

Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.