Brazil – one of the world's largest biocultural diversities – faces high rates of habitat loss, social inequality, and land conflicts impacting indigenous and local peoples. To challenge that, Brazilian sustainability science and education needs to be strengthened. We searched for elements in ongoing bottom-up sustainability social movements that can help serve that purpose. We found values, contents, and attitudes that, if incorporated into Brazilian sustainability science and education, can assist its transformative potential by reflecting local voices and critically engaging with (often-hegemonic) northern concepts.

In Brazil, a strong sustainability science and education is required to confront ‘glocal’ issues such as zoonotic pandemics and climate change, which are worsened by rampant ecosystem loss and social vulnerability. However, a largely disciplinary university system has been slow to meet these urgent needs. To address if and how dialogical processes with non-academics can prompt integration between distinct types of knowledge, we analyze four bottom-up sustainability initiatives that promote dialogues between science, the arts, religion, youth, and indigenous and local knowledge, and reflect on lessons learnt with movement organizers, scientists, and educators – the authors of this paper. Although sustainability science produced in dialogue with other forms of knowledge is still emerging in Brazil, we find that bottom-up initiatives outside academia can inspire science and education to approach sustainability as wholeness – a state of balance to be fulfilled when reached individually, collectively, and cosmically. We discuss how to approach a transdisciplinary and reflexive attitude in Brazilian sustainability science and education, and highlight its unique contribution to frontier topics in global sustainability debates.

Social movements’ values, contents, and attitudes can inspire transformative Brazilian sustainability science and education.

Sustained alcohol intake, when combined with incomplete treatment, can result in chronic structural changes in the Central Nervous System, including generalized cortical and cerebellar atrophy, amnesic syndromes like Korsakoff’s syndrome, and white matter disorders such as Central Pontine Myelinolysis and Marchiafava-Bignami syndrome. It is crucial to prevent these complications due to their potential for irreversible and debilitating consequences. For Wernicke-Korsakoff syndrome, early recognition and thiamine administration for prevention are paramount, as it arises from thiamine deficiency due to malnutrition caused by persistent alcohol use. In the case of Central Pontine Myelinolysis, which is caused by abrupt fluctuations in serum osmolality, controlled sodium correction is essential.

Through a clinical case and a review of published literature, this study aims to reflect on the importance of preventing neurological injuries associated with chronic alcohol consumption, specifically Wernicke-Korsakoff Syndrome and Central Pontine Myelinolysis.

A literature review was conducted by searching for articles on PubMed using the terms “Alcohol Use Disorder,” “Wernicke-Korsakoff syndrome,” and “Central pontine myelinolysis.” A clinical case is presented, featuring a 50-year-old patient with alcohol use disorder who developed Wernicke-Korsakoff syndrome and Central Pontine Myelinolysis. Considering this case, we reflect on the primary approaches that could have been beneficial in preventing these complications and propose a straightforward method for doing so.

A 50-year-old patient presented with poor general condition, characterized by low weight, significant loss of strength in the limbs and arms, and incoherent speech with anterograde amnesia and confabulation. This condition had progressed to a point where the patient could no longer walk, perform basic self-care tasks such as bathing, dressing, and eating independently, underscoring the severity of his condition. The diagnoses of Wernicke-Korsakoff syndrome and Central Pontine Myelinolysis were established based on clinical manifestations and the presence of hyperintense lesions observed in the central pons on T2/FLAIR axial MRI scans. This clinical case highlights the importance of proper and precocious prevention of complications in patients with alcohol use disorder. The foremost step in preventing these complications is to treat alcohol dependence effectively, even when faced with patient resistance. It’s vital to remain vigilant about potential complications and implement suitable prophylactic measures.

The devastating effects of complications arising from Alcohol Use Disorder, such as Wernicke-Korsakoff syndrome and Central Pontine Myelinolysis, underscore the importance of enhanced attention that clinicians should provide when approaching these patients at all clinical interactions.

None Declared

Involuntary admission rates differ between gender across various countries. In several European Union countries, men are more frequently involuntarily admitted, while an opposite trend, associating women with involuntary care, has been observed in countries like Switzerland, Brazil, and China.

Considering the contradictory evidence about gender and involuntary care in the literature, we aim to analyze the gender patterns of involuntary care in Centro Hospitalar Médio Tejo’s Psychiatric Acute Unit, exploring the gender differences in diagnosis among involuntary patients.

We stored and analyzed the data using Microsoft Excel and IBM SPSS Statistics. We studied psychiatry admissions at Centro Hospitalar Médio Tejo, Portugal over 2 years. The Acute Psychiatric Unit, located within a general hospital, has 24 beds, and offers acute mental healthcare services to adults aged 18 and above, serving a coverage area of approximately 251,000 residents. As part of our data collection process for all admissions to the Acute Psychiatry Unit, we recorded information such as gender, age, diagnosis at discharge, treatment type (voluntary or involuntary), and length of stay.

From January 1, 2021, to December 31, 2022, there were 686 psychiatry admissions at Centro Hospitalar Médio Tejo, of which 125 (18,2%) were involuntary. The admission rates were approximately 136.6 per 100,000 people annually, with 24.9 being involuntary admissions per 100,000 people annually. In our analysis of involuntary admissions, women had a lower rate of such admissions, making up 6.4%, while men had a higher rate at 11.8%. No other gender identity was mentioned. Schizophrenia-related disorders were the primary cause for involuntary admissions for both genders, with 67.9% for men and 50% for women. Mood disorders were the second most common reason for involuntary admission, accounting for around 40.9% of cases for women and a significantly lower 16% for men. Involuntarily hospitalized patients exhibited longer lengths of stay independently of the gender. Men hospitalized involuntarily tended to be younger, whereas for women, involuntary hospitalizations were associated with older ages.

In conclusion, our study reveals gender differences in psychiatric involuntary admissions, with more men being involuntarily admitted than women. Schizophrenia group disorders were the most common diagnoses among male and female involuntary patients. Furthermore, all hospitalized women exhibited a higher prevalence of mood disorders, a trend that was more pronounced among those admitted involuntarily. These gender trends match the overall patterns seen in the epidemiology of schizophrenia and mood disorders. Additionally, women with schizophrenia generally exhibit better social functioning than men, which may explain the lower needs of involuntary hospitalization.

None Declared

Multiple Sclerosis (MS) is an inflammatory disease affecting primarily the central nervous system, characterized by focal lesions of white-matter demyelination. It can present with a variety of neurological symptoms, including monocular vision loss, sensory loss, paresthesias, limb weakness, ataxia and bladder dysfunction, and has a typically chronic and progressive course. Neuropsychiatric manifestations including depressive or manic symptoms, anxiety disorders and psychosis, are also frequently observed, and are of particular importance to mental health practitioners.

To describe a case of a 45-year-old female patient with a history of suspected MS presenting with manic symptoms, and to discuss the possible neuropsychiatric manifestations of Multiple Sclerosis.

Clinical case report and literature review.

A 45-year-old woman was brought to the emergency department presenting with severe acute agitation, irritable mood, rapid speech and persecutory delusions. She had no prior history of neuropsychiatric symptoms, but her medical history was notable for a suspected diagnosis of MS, having suffered an episode of optic neuritis 16 years before the present episode. Magnetic Ressonance Imaging performed 3 months before emergency admission documented non-specific white-matter lesions presenting as hyper-intense in long TR sequences, as well as a cervical lesion of atypical characteristics, representing possible spondylotic myelopathy or demyelination. A head CT performed at emergency admission did not reveal relevant acute findings. The patient was hospitalized and initiated risperidone and valproic acid therapy. She responded favorably to medication, with progressive stabilization of mood and remission of delusional ideas over three weeks.

Neuropsychiatric symptoms are a common and concerning manifestation of Multiple Sclerosis. The present case illustrates that clinicians should be on alert for signs of mood and psychotic symptoms in patients with suspected or confirmed MS, as these can manifest at any point during the disease course.

None Declared

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

Cannabis use has been reported to cause a myriad of acute adverse reactions, including those linked to anxiety disorders, such as panic attacks and derealization. Notably, in the emergency department, anxiety makes up a significant proportion of the complaints related to cannabinoid consumption. Several reports show these symptoms can persist after the cessation of cannabis consumption. Consequently, some questions have arisen regarding the role of cannabinoids as precipitators for anxiety disorders in vulnerable individuals. Alternatively, it has been hypothesized that patients with anxiety disorders are more prone to using cannabis.

We aim to understand whether there is an established relationship between anxiety disorders and cannabis use. Moreover, we intend to identify what are the factors which make an individual more likely to experience anxiety following cannabis consumption.

A search was conducted in the PubMed database using the MeSH terms “cannabis”, “panic disorder”, “anxiety”, “panic” and “generalized anxiety disorder”. Articles published in the last ten years were considered. Publications were selected after careful reading of their abstract. A non-systematic review of the selected articles was performed.

Eight articles were included in this review. While a majority of these publications did not find a significant association between cannabis use and anxiety disorders, a small subset of analyzed articles found that cannabis use may increase anxiety severity in general, devoid of specific diagnostic association. Individuals who presented to the emergency department with anxiety complaints after cannabis use were likely to be young and to have ingested edible cannabis. History of psychiatric disease, especially substance use disorder, was common in this population.

Most available data suggest cannabis use is not clearly linked to anxiety disorders. However, information around this topic is scarce and heterogenous. Further research is needed focusing on the natural evolution of acute anxiety after cannabis use. Factors such as young age, presence of psychiatric comorbidities and consumption of edible cannabis appear to contribute to a significantly increased risk of experiencing acute anxiety after cannabis use.

None Declared

Early-onset dementia (EOD) is defined as any type of dementia with an onset before the age of 65. Despite its profound impact on patients and their families, EOD has garnered less attention when compared to late-onset dementia (LOD), often resulting in its underestimation. In comparison to LOD, EOD commonly manifests with atypical and heterogeneous symptoms, encompassing mainly non-memory problems, ranging from language and executive impairments to behavioral-led dysfunction. Despite the importance of accurate data to organize appropriate healthcare, evidence regarding EOD patients in Portugal is lacking.

The primary aims of this study include identifying the causes for hospitalization in EOD patients, diagnosed with dementia either as a primary or secondary diagnosis, and comparing them with inpatients aged 65 and older (LOD). Additionally, the study aims to analyze key hospitalization outcomes for both groups, including length of stay, in-hospital mortality, and readmissions. As a secondary aim, this study seeks to describe subtypes of EOD.

A retrospective observational study will be conducted following the RECORD statement. Data will be retrieved from an administrative database that gathers de-identified routinely collected hospitalization data from all Portuguese mainland public hospitals. Hospitalization episodes of inpatients younger than 65 years old, with a primary or secondary diagnosis of dementia (ascertained by ICD-9-CM codes 290.0-290.4, 294.0-294.2, 331.0, 331.1, and 331.82), will be extracted. Comparison patients will be selected by propensity score-matching from inpatients over 65 years with a dementia ICD-9-CM code (in any position), matched for Charlson Comorbidity Index (CCI).

Descriptive and analytical statistics will be conducted to describe and characterize both group of inpatients. Variables such as age at admission, sex, place of residence, causes and type of admission, psychiatric comorbidities, length of stay (LoS), destination after discharge, readmissions, in-hospital mortality and hospital charges will be analyzed.

With this nationwide analysis of EOD hospitalizations, we aim to reveal critical aspects of this condition, including common causes of admission, diagnostic features and health outcomes, allowing for appropriate medical interventions and support tailored to the specific needs of this clinical group.

None Declared

Psychiatry training programs vary in the degree to which they offer trainees with an opportunity to get involved in research. Exposure to research during the training period is critical, as this is usually when trainees start their own scientific research projects and gain their first experiences in academic publishing.

We present the European Journal of Psychiatric Trainees (EJPT) (ejpt.scholasticahq.com), the official journal of the European Federation of Psychiatric Trainees (EFPT), including its scope, mission and vision and practical considerations.

Reflecting on the foundation and operation of the European Journal of Psychiatric Trainees.

The European Journal of Psychiatric Trainees is an Open Access, double blind peer-reviewed journal which aims to publish original and innovative research as well as clinical, theory, perspective and policy articles, and reviews in the field of psychiatric training, psychiatry and mental health. Its mission is to encourage research on psychiatric training and inspire scientific engagement by psychiatric trainees. Work conducted by psychiatric trainees and studies of training in psychiatry are prioritized. The journal is open to submissions, and while articles from psychiatric trainees are prioritized, submissions within scope from others are also encouraged. The article processing fee is very low and waivable. It is planned to publish two issues yearly.

The first article was published in July 2022, titled “Fluoxetine misuse by snorting in a teenager: a case report” and it received 218 views as of 17 October 2022, which confirms the journal’s potential for visibility.

The European Journal of Psychiatric Trainees is a non-profit initiative designed to offer psychiatric trainees a platform to publish and gain experience in publishing. Thanks to its robust double blind peer reviewing system, it has the potential to contribute to scientific excellence.

None Declared

Neurocognitive deficits amongst patients with schizophrenia are considered one of schizophrenia’s central features. These deficits appear to be present from the first episode of psychosis (FEP) and certain cognitive impairments could be components of a genetic vulnerability to schizophrenia. Regarding research on cannabis and cognition in schizophrenia, different studies have assessed neurocognitive functions: memory, attention/vigilance, processing speed, verbal learning, executive functions, and verbal fluency.

The aim is to do a review of recent findings concerning the association of cannabis use with cognition in schizophrenia.

A literature review was conducted using the PubMed search database.

Patients with schizophrenia and concomitant cannabis use are associated with worse performance in immediate verbal learning, and in some studies with worse working memory performance. There is an improvement of verbal memory when they cease the cannabis’ consumption. Regarding attention capacity and memory types assessed, the results are controversial. In FEP, heavy cannabis use during the previous year correlates with slower processing speed. Also, FEP-patients with cannabis use but no family history of psychosis perform worse in executive functions, while those with a family history of psychosis perform better.

The studies of psychosis, cannabis and cognition differ in relevant aspects, which might be connected to the result variability. Therefore, before solid conclusions can be reached, it is important to carry out longitudinal studies to understand the changes in the cognitive variables, which can depend on the pattern of cannabis’ use (concurrent or prior to the FEP). Possible confounding variables that might be present should be acknowledged.

No significant relationships.

Uterine cancer is the most common gynecologic malignant neoplasm in developed countries. While depression is up to 3-5 times more common in patients with cancer than in the general population, literature is still limited regarding the relation between Endometrial Cancer and depression.

To analyze Depression among Endometrial Cancer hospitalizations in mainland Portuguese public hospitals (2008-2015).

A retrospective observational study was conducted using administrative data from all hospitalizations in Portuguese mainland public hospitals between 2008-2015. All women’s hospitalizations(≥18 years) with a primary diagnosis of Endometrial Cancer (ICD-9-CM 182.x) were selected. Secondary diagnosis of depression was identified with ICD-9-CM 296.2x, 296.3x and 311x codes. Surgical procedures codes 68.4x, 65.6x, 40.3x, 40.5x, 68.6x, 68.9x and 68.8x were used to divide the hospitalizations into surgical vs non-surgical. Groups were compared with Pearson Chi-square test and crude odds ratio(OR) was used to estimate the association between surgery and depression.

From 10227 hospitalizations with a primary diagnosis of Endometrial Cancer, 533 had a registry of depression(5.2%). Annual depression frequency rose from 2.0% (2008) to 8.3% (2015). Among patients with a record of depression, 73.2% had surgery. Women who had surgery were significantly more likely to have registered depression (p<0.001). The OR for depression in surgical vs non-surgical patients was 1.73 (95%IC:1.42-2.10).

Patients hospitalized due to Endometrial Cancer and submitted to surgery had almost two-fold more risk of having a registry of depression. This trend reinforces the importance of early depression screening of these patients, enabling the implementation of timely therapeutic strategies before and after surgery.

No significant relationships.

Autism Spectrum Disorder (ASD), is a neurodevelopmental disorder, characterized by inabilities in communication and social interaction. ¹ Childhood Apraxia of Speech (CAS) is a neurological disorder in which the consistency and precision of speech movements are impaired, in the absence of neuromuscular deficits.2 Research indicates that children with ASD do not have a higher prevalence of CAS.3 It is suggested that comorbid ASD and CAS would be expected to be extremely rare.

Verify the occurrence of CAS in children with ASD.

The study included 22 children diagnosed with ASD aged between 4 and 8 years, who were undergoing speech therapy at a specialized health service and their therapists. The test was applied by the therapists Differential Assessment of Autism and Other Developmental Disorders (DAADD)4, divides into six areas of development: language, pragmatic, sensory, motor, physical and behavioral to differentiate and diagnose disorders of neurological origin.

Among the 22 children participating in the research, 20 did not score the item apraxia. Only two children were referred with apraxia and twelve had receptive language and pre-academic skills proportional to their age. Of 22 participants, only three were overly excited for verbal productions.

The analyzes of data suggests that the occurrence of CAS in children with ASD is low and underlying the disorder.

Previous studies have demonstrated that night-shift work is associated with adverse effects impacting physical and psychological health, including the Shift Work Disorder (SWD). SWD is a circadian rhythm disorder characterized by sleepiness and insomnia, resulting from working a shift other than the traditional daytime-shift. Armodafinil, a modafinil longer-lasting R-isomer, is approved for SWD treatment. Due to its pharmacodynamic profile, it may result in more sustained wakefulness during night-shifts than Modafinil.

To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the efficacy of Armodafinil vs Modafinil and/or placebo on reducing SWD excessive sleepiness.

Will follow PRISMA guidelines. A systematic search will be conducted on PubMed, Web of Science, Scopus and ClinicalTrials.gov databases. RCTs comparing Armodafinil with Modafinil and/or Placebo for SWD treatment will be included. No language nor date restrictions will be applied. Outcomes of interest are prespecified as follows: the primary endpoint will be objective sleepiness; secondary endpoints will include subjective sleepiness, adverse effects, awareness, reaction time, memory and cognition. Retrieved studies will be independently screened for eligibility by two reviewers. Disagreements will be solved by consensus or by a third reviewer. Primary studies methodological quality will be assessed and data extracted independently using a standardized extraction-form.

Data will be described and reported as narrative text and summary tables. Heterogeneity of the included studies will be assessed and, if possible, a meta-analysis will be conducted.

It is expected that this systematic review and meta-analysis favours Armodafinil over Modafinil and placebo in the treatment of SWD.

No significant relationships.

Heart failure (HF) is a worldwide public health problem and the main cause of morbidity and mortality in older people. Previous studies have demonstrated that psychological symptoms are associated with worse cardiovascular outcomes. Nevertheless, the research regarding the association between anxiety and HF is still scarce.

To analyse the levels of anxiety in HF patients and its association with New York Heart Association (NYHA) class in HF patients.

This study takes part of a wider project named Deus Ex-Machina project (NORTE-01-0145-FEDER-00026). HF patients were recruited from an outpatient clinic at a University Hospital. Patient with inability to communicate, with severe visual impairment or with NYHA class IV were excluded. Sociodemographic data and NYHA class were recorded. Anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7).

Overall, 136 patients were included, with a mean age of 57(±13) years old. Most of them were men (66%) and married (76%), with mean education of 8 years (±4). Regarding NYHA class, 36%, 49% and 15% were at class I, II and III, respectively. The mean GAD-7 total score was 6.4 (±5.2) and 32% of patients showed moderate to severe anxiety symptoms. No association between the NYHA functional class and anxiety was found (p=0.106).

The results reveal that anxiety is frequent among HF patients. However, as found in previous studies, it was not associated with more severe HF symptoms. The coexistence of HF and anxiety deserves further studies, in order to build a better understanding of this association.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that can cause social and professional harm in an individual. Many teachers are unprepared to receive students with ASD. They find it difficult to communicate with other professionals or to comfort the family. And parents often do not feel that their children at school benefit socially and in their academic skills.

To know the point of view and expectations of parents with children with Autism Spectrum Disorder about the academic future and professional life.

An online questionnaire was applied with 38 multiple choice questions about the future academic perspectives and expectations of their children, the job market and about school adaptations and the school year during the COVID-19 pandemic.

So far, 16 parents of a Speech-Language Pathology laboratory in which they assist children with Autism Spectrum Disorder (ASD) have answered the questionnaire. When asked if there were teachers who work with TEA individuals, nine guardians 56.3% answered that they did not, 50% of the guardians said they had received adapted material during the COVID-19 pandemic, 100% of the guardians believe that their child will finish high school, 93.8% of those in charge do not believe that the job market is prepared for individuals with ASD.

Parents are dissatisfied with the education their children receive and most of them did not get adequate support during the COVID-19 pandemic. There are also low expectations for the future in the job market.