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Mindfullness-Based Interventions for Anxiety and Depression
- B. L. B. Mesquita, F. Ribeirinho Soares, M. Fraga, M. Albuquerque, J. Facucho, P. Espada, S. Paulino, P. Cintra
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S948
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Introduction
Mindfulness refers to a process that leads to a mental state characterized by non-judgmental awareness of the present moment experience, including one´s sensations, thoughts, bodily states, consciousness, and the environment, while encouraging openness, curiosity, and acceptance.
ObjectivesThe purpose of this paper is to review the ways in which cognitive and behavioural treatments for depression and anxiety have been advanced by the application of mindfulness practices.
MethodsBrief non-systematic literature on the topic.
ResultsMindfulness has spread rapidly in Western psychology research and practice, in large because of the success of standardized mindfulness-based interventions, consequently research on mindfulness based interventions (MBIs) has increased exponentially in the past decade. The most common include Mindfullness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), which incorporate the essence of Eastern mindfulness practices into the Western cognitive-behavioral practice. MBIs have showed efficacy in reducing the severity of anxiety and depressive symptoms in a broad range of treatment seeking individuals. MBIs have also been showed to perform with not so different results to cognitive-behavioral therapy (CBT).
ConclusionsMBIs have been showed to be important co-adjuvants to pharmacological treatment and psychotherapy of depression and anxiety. To prove this point without doubts and create adequate guidelines that include these forms of treatment more research needs to be done on the matter.
Disclosure of InterestNone Declared
How sexuality is affected and managed in patients under antipsychotic drugs
- F. Ribeirinho Soares, B. Mesquita, A. M. Fraga, M. Albuquerque, J. O. Facucho, P. E. Santos, D. E. Sousa, N. Moura, P. Cintra
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1057
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Introduction
Sexual dysfunction (SD) is a prevalent side effect of antipsychotic drugs (AP), and it impairs patients’ quality of life. Because of the distress caused by it, it should be borne in mind when prescribed since it is responsible for treatment nonadherence or discontinuation. SD affects about 45- 80% of males and 30-80% of females that take it. In SD, all phases of the sexual response cycle may be compromised.
ObjectivesThis non-systematic review of the literature aims to better understand the antipsychotic-induced SD and its management to better compliance of AP-treated patients without compromising their quality of life.
MethodsA semi-structured review on PubMed linking SD as a side effect of AP drugs.
ResultsAll AP drugs can cause SD. It seems related to their mechanism of activity at receptors D2, 5-HT2, α1, H1, and M, which are also involved in sexual function. They do it by diminishing arousal, decreasing libido by blocking motivation and reward system and orgasm indirectly, provoking erectile dysfunction by vasodilatation, and decreasing woman lubrification. Hyperprolactinemia is a significant cause of sexual dysfunctions. Haloperidol, Risperidone, and Amisulpride (prolactin elevating AP) are more likely to cause SD than Olanzapine, Clozapine, Quetiapine, and Aripiprazole (prolactin sparing AP). Although psychotic disorders (Schizophrenia and other psychotic disorders) can impact sexual functioning, according to evidence, there is no denying the role of AP in this issue. Aripiprazole, a D2 partial agonist, has been associated with lower rates of SD and seems to reduce the rates of SD in patients previously treated with other AP. Other AP with the same potential dopamine agonist activity, such as Cariprazine and Brexpiprazole, can probably have the same effect. The management of SD induced by AP drugs should include measuring serum prolactin and modifying risk factors like hypertension, smoking, hyperglycemia, and hypercholesterolemia. In that regard, waiting for spontaneous remission, reducing the dose of the AP prescribed, or switching to Aripiprazole are all viable strategies, if possible. Although the evidence supporting the addition of symptomatic therapies is weak, adding dopaminergic drugs (amantadine, bromocriptine, cabergoline) or drugs with specific effects on sexual functioning (such as phosphodiesterase inhibitors or yohimbine) may be helpful in selected cases.
ConclusionsAlthough all AP drugs can cause sexual dysfunction, it is difficult to determine its true prevalence accurately. AP-induced sexual dysfunction can adversely affect compliance and is one of the factors that must be considered when selecting treatment. In summarizing, Aripiprazole has shown to be the AP with the most favorable profile concerning SD. Cariprazine and Brexpiprazole, being also D2 partial agonists, may cause less SD.
Disclosure of InterestNone Declared
First episode psychosis: the depressive symptoms and suicidal behaviour that follow
- B. L. B. Mesquita, F. Ribeirinho Soares, M. Fraga, M. Albuquerque, J. Facucho, P. Espada, S. Paulino, P. Cintra
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1048
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Introduction
Depressive symptoms and suicidal behaviour are common among patients that suffered a first-episode psychosis. Depressive symptoms could occur in different phases of psychosis, including in post-psychotic period. Depression is a well-known risk factor for suicidal behaviour in psychosis with data showing that occurrence of depression in psychosis have a significant correlation with suicide risk.
ObjectivesThe purpose of this paper is todo a brief review on the relation of causality that existes between first episode psychosis and depressive symptoms as well as suicidal ideation.
MethodsBrief non-systematic literature review on the topic.
ResultsFirst episode psychosis is not uncommonly followed by depressive symptoms and suicidal thoughts. The rate of suicide attempt in psychotic patients range from 10 to 50%. Individuals with first episode psychosis have a greater risk of suicidal behavior compared with normal population and chronic disorders. In several studies, factors identified as being associated with depressive symptoms after first episode psychosis were anomalies of psychosocial development, poor premorbid childhood adjustment, greater level of continuing positive symptoms and longer duration of untreated psychosis. Suicidal behavior was associated with sexual abuse, previous suicide attempt, comorbid polysubstance use, lower baseline functioning, longer time in treatment, recent negative events, older patients, longer duration of untreated positive and negative psychotic symptoms, family history of severe mental disorder, depressive symptoms and cannabis use. Data also indicate that treatment and early intervention programs reduce depressive symptoms and suicidal behavior after first episode psychosis.
ConclusionsThere is convincing evidence that depressive symptoms and suicidal behaviour have high rates after first episode psychosis. The research for treatment of depressive symptoms and/or suicidal behaviour after first-episode psychosis is very limited, therefore this paper aims to bring to light the importance of more studies on the matter.
Disclosure of InterestNone Declared
Aripiprazol and Hypersexuality: when partial is to much
- P. Espada-Santos, J. Facucho-Oliveira, B. Mesquita, A. Fraga, M. Albuquerque, M. Costa, M. Marinho, P. Cintra
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S723
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Introduction
A growing number of published cases has showed that hypersexual behavior may arise with treatment with second-generation antipsychotics, including aripiprazole and olanzapine. Aripiprazole is a second-generation antipsychotic commonly used to treat schizophrenia and bipolar disorder. It has a unique pharmacologic profile acting as a partial agonist of the dopamine D2 receptor, as a partial agonist at the 5-HT1A receptor, and as an antagonist at the 5-HT2A receptor. Literature shows that medication with partial dopaminergic agonistic activity can cause compulsive behaviors, such as pathological gambling, compulsive eating, compulsive shopping, and hypersexuality. Although it is difficult to predict who would develop these behaviors, the literature suggests that patients at a higher risk of developing impulsive behaviors include those with a personal or family history of obsessive-compulsive disorder, impulse control disorder, bipolar disorder, impulsive personality, alcoholism, drug abuse, or other addictive behaviors.
ObjectivesHere, we present a case of a 32-year-old male who developed hypersexuality symptoms after receiving aripiprazole as treatment for bipolar disorder.
MethodsWe have done a literature review using the MeSH terms Aripiprazole and hypersexuality in the “PubMed”.
ResultsAfter switching Aripiprazole to Risperidone the hypersexuality symptoms started to decrease and got almost complete relief after 2 weeks.
ConclusionsThis case highlights the rare hypersexuality side effect that can arise in patients receiving aripiprazole for bipolar disorder treatment. Clinicians should be aware of the increased risk of hypersexuality and other impulsive behaviors as they can significantly impair a patient’s daily functioning.
DisclosureNo significant relationships.
Valproate-induced hypothyroidism in schizoaffective disorder
- J. Facucho-Oliveira, P. Espada-Santos, A. Fraga, N. Moura, C. Laginhas
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S722
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Introduction
Valproate is widely used in the treatment of maniac and mixed episodes and is well known to be safe with side effects being mostly related to hepatic disorders and psychomotor retardation.
ObjectivesRaising attention to valproate-induced hypothyroidism that despite the increasing evidence tends to be neglected.
MethodsHere, we report a case of a 55-year-old woman, with a previous diagnosis of schizophrenia, treated for many years with 200mg of zuclopenthixol triweekly and 2mg of risperidone daily. Patient developed a maniac episode characterized by elevated mood, sense of grandiosity, increased energy and psychomotor activity, disinhibition and insomnia. No laboratory abnormalities were detected and inpatient treatment was initiated with paliperidone up to 12mg/day and valproate 1000mg/day.
ResultsPatient showed progressive clinical recovery attaining full remission within 2 weeks. Despite the absence of clinical side effects and the valproate serum levels of 74.9μg/mL (range 50–100μg/mL), laboratory testing found progressive reduction F-T4 down to 0.45ng/dL (range 0.8–1.5 ng/dL) and a concomitant upregulation of TSH to 73.99mUI/L (range 0.55–4.8mUI/L). Thyroid autoantibodies and thyroid echography were negative. Considering that patient was previously medicated with risperidone, it was suspected that her hypothyroidism was caused by valproate. Normalization of thyroid function was observed after 21 days valproate withdrawal. Patient is currently being treated with 150 mg paliperidone (monthly) with no recurrence of mood or psychotic episodes and maintain normal thyroid function.
ConclusionsOur case emphasizes the need for extended laboratory testing upon prescription of new pharmacological medications as severe analytic alterations can take place in the absence of immediate clinical manifestation.
DisclosureNo significant relationships.
Behavioural Variant of Frontotemporal Dementia or Mood Disorder?
- B. Mesquita, S. Paulino, A. Fraga, J. Facucho-Oliveira, P. Espada-Santos, M. Albuquerque, M. Costa
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S453-S454
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Introduction
The behavioural variant of frontotemporal dementia (bvFTD) is a devastating neurodegenerative syndrome with its peak in the early sixties at about 13 per 100,00. The diagnosis of bvFTD relies on clinical assessment as patients present executive and behavioural deficits, like apathy, loss of motivation and personality changes. Current diagnosis criteria lack specificity and symptomatic overlap between bvFTD and primary psychiatric disorders (PPD) pose a diagnostic conundrum, with half of bvFTD patients previously receiving a psychiatric diagnosis.
ObjectivesThe goal is to discuss the syntomatic overlap of these two entities.
MethodsBrief non-systematic literature review on the topic, illustrated by a case-report presentation.
ResultsA 69 year old men, retired and single, is committed for thought and behavior disorganization and insomnia. He presented expansive mood but also temporal and spatial disorientation and periods of incongruous speech. This patient’s clinical presentation could both entice a diagnosis of bvFTD but also of an affective disorder, especially since it has been reported that neuropsychiatric presentations, like late-onset psychosis or mania, can be the initial presentation of this form of dementia, particularly in patients with C9orf72 mutations, who often display persecutory or grandiosity delusions.
ConclusionsThis clinical case exemplifies the difficulty that lies in differentiating cases of bvFTD from late-onset idiopathic mood or psychotic disorders. It is important to consider that on cognitive assessment patients with bvFTD score significantly worse on executive function tests that PPD patients No disease- modifying therapies are available for patients with bvFTD, therefore drug treatment should focus on the most disruptive or taggable behaviours.
DisclosureNo significant relationships.
Irritable Bowel Syndrome: The role of the Psychiatry
- A. Fraga, B. Mesquita, D. Esteves-Sousa, M. Albuquerque, J. Facucho-Oliveira, P. Espada-Santos, P. Cintra, A. Moutinho
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S480
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Introduction
Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder, affecting about 20% of people worldwide. This complex and multifaceted disorder has been proposed as a system disease involving not only individual systems including the nervous, endocrine, imune, digestive, microbiota and the environment but also the interactions of these systems. The aetiology of IBS is complex and incompletely understood and this disease are frequently associated with a comorbid psychiatric disease. Current treatment is symptom-directed, rather than based on underlying pathophysiological mechanisms.
ObjectivesThe authors elaborate a narrative literature review to identify the pathophysiology and therapeutic approach of IBS.
MethodsPubmed databased searched using the therms “psychiatry”, “irritable bowel syndrome” and “treatment”.
ResultsThe IBS is the most common and best described of the functional bowel disorders, which represents a considerable therapeutic challenge. Studies looked at the efficacy of fibre, antispasmodics and peppermint oil in the treatment of IBS found moderately effectiveness in the treatment of global symptoms. Elimination diets are helpful in improving IBS. There is evidence that a low-FODMAP diet can have a favorable impact on IBS symptoms, especially abdominal pain, bloating and diarrhea with improved irritable bowel syndrome symptoms and quality of life. Among the currently available classes of drugs for the treatment of IBS, antidepressants such as selective serotonin releasing inhibitors and tricyclic antidepressants are useful because of their analgesic properties, independent of their mood-improving effects.
ConclusionsEvidence suggest that antidepressants might be useful for treatment symptom of IBS however further investigation is required.
DisclosureNo significant relationships.
Ketamine and Electroconvulsive Therapy: Better Together?
- A. Fraga, B. Mesquita, J. Facucho-Oliveira, P. Espada-Santos, M. Albuquerque, R. Neves, A. Moutinho
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S564-S565
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Introduction
Major depressive disorder (MDD) is a highly prevalent clinical condition with a leading cause of disability worldwide. The currently available therapeutic agents have important limitations regarding side effects, partial or non-responsiveness. Patients are considered to have treatment-resistant depression (TRD) if there is no effect or minimal effectiveness after receiving adequate dose-duration use of antidepressants from two different categories. For this patients, electroconvulsive therapy (ECT) can be a treatment option and new therapies appear to tackle TRD like ketamine, a dissociative anesthetic and analgesic.
ObjectivesThe authors elaborate a narrative literature review to understand if ketamine might enhance the antidepressant efficacy of ECT.
MethodsPubMed database searched using the terms “Electroconvulsive therapy”, “ketamine” and “treatment-resistant depression”.
ResultsECT is currently recommended as an end-line therapy for TRD. Memory impairment after ECT could be a consequence of indiscriminate activation or saturation of glutamate receptors during the treatment, disrupting hippocampal plasticity involved in memory. Ketamine inhibits N-methyl-d-aspartate (NMDA) receptors, while stimulating glutamate release and was proposed as an ECT adjuvant, might reduce cognitive adverse effects, time until response/ remission and inclusively improve response rates to ECT.
However, response and remission rates of ketamine in ECT showed no significant difference from the comparator groups and was associated with higher rates of psychiatric and cardiovascular adverse events.
ConclusionsThe results did not support the use the combination of ketamine and propofol as anesthetic agents for ECT in patients with MDD. However, further studies are needed to investigate the beneficial clinical and cognitive effects of ketamine alone in ECT settings.
DisclosureNo significant relationships.
Transcranial magnetic stimulation and post-traumatic stress disorder
- N. Moura, A. Fraga, J. Facucho-Oliveira, F. Azevedo, C. Laginhas, D. Esteves-Sousa
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S674
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Introduction
Post-traumatic stress disorder (PTSD) is a psychiatric disorder characterized by symptoms from four clusters after exposure to a traumatic event: re-experiencing symptoms including flashbacks and nightmares, hyperarousal, avoidance of internal and external stimuli related to trauma, and negative alterations in mood and cognition. As a noninvasive intervention that uses induction of electromagnetic fields to modulate cortical circuitry, TMS has a substantial body of literature demonstrating safety, tolerability, and efficacy in depression and potentially PTSD.
ObjectivesOur aim is to perform a non-systematic review of the literature regarding TMS and PTSD
MethodsA semi-structured review was conducted on Pubmed concerning TMS and PTSD
ResultsThe majority of studies utilize repetitive TMS targeted to the right dorsolateral prefrontal cortex (DLPFC) at low frequency (1 Hz) or high frequency (10 or 20 Hz), however others have used alternative frequencies, targeted other regions, or trialed different stimulation protocols utilizing newer TMS modalities such as theta-burst TMS (TBS). It is encouraging that were positive outcomes have been shown, and often sustained for up to -3 months, nevertheless there is a paucity of long-term studies directly comparing available approaches.
ConclusionsTMS appears safe and effective for PTSD, although important steps are needed to operationalize optimal approaches for patients.
DisclosureNo significant relationships.
COVID-19 Psychiatric Inpatient Unit- experience and challenges
- B. Mesquita, A. Fraga, M. Albuquerque, P. Espada-Santos, J. Facucho-Oliveira, S. Paulino, M. Costa
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S520
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Introduction
On January 2021 the Department of Psychiatry became the only unit exclusively dedicated to COVID patients with severe mental illness in acute decompensation. Only patients in risk of rapid medical deterioration were excluded and forwarded to intensive care.
ObjectivesDiscussion of this unprecedented experience.
MethodsAnalysis of 28 patients hospitalized during 3 months with both an acute psychiatric disorder and an SARS-CoV-2 infection; description of the multidisciplinary intervention made.
ResultsOur sample was characterized by a majority of patients with an acute psychotic episode derived from a schizophrenia spectrum disorder (42%) or a bipolar affective disorder (21%). Only 3% of the patients had a diagnosis of severe major depressive disorder. And 10% of patients developed severe respiratory symptoms requiring oxygen or urgent transfer to COVID medical wards. Most patients presented periods of psychomotor agitation, lack of impulse control and self-aggression. Psychopharmacological and psychotherapeutic interventions had to be adapted to these unusual conditions. Most of them had already gone through a period of isolation in the buffer ward created to exclude false negatives, which promoted atypical deliriums and symptoms of post-traumatic stress. The psychiatric team was faced with the emergent need to adapt an intervention model based on trust to a model that had to prioritize physical safety.
ConclusionsThe pandemic experience was transformative for all who lived through it. From the challenge perspective, it may have been enriching. But the maintained confrontation with the antithesis of therapy, defined by “caring, supporting, communicating, approaching”, was devastating in ways that we consider essential to be debated.
DisclosureNo significant relationships.
Lithium: more than a mood stabilizier
- A. Fraga, B. Mesquita, J. Facucho-Oliveira, M. Albuquerque, P. Espada-Santos, P. Cintra, S. Paulino, A. Moutinho
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S405
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Introduction
Bipolar disorder (BD) is characterized by episodic changes in affect, motivation, cognition and behavior. This severe mental disorder has a prevalence of at least 1% and a high heritability of 60%-80%. The pathophysiology is still poorly understood but evidence indicate that the disorder relates to disturbances in front-limbic networks relevant for emotion processing and regulation. New techniques have been used to study BD and showed aberrante white matter (WM) microstructure in the corpus callosum and from-limbic pathways. However, lithium, a mood stabilizier, it looks like has celular and neuromodulatory effects.
ObjectivesThe authors elaborate a narrative literature review to identify the existing clinical evidence of lithium’s effect on the WM from BD patients.
MethodsPubmed databased searched using the therms “bipolar disorder”, “white matter” and “lithium”.
ResultsLithium is a bipolar medication that confers treatment and long-term prophylaxis and been reported as having neuroprotective effects.
Studies that used new techniques such diffusion tensor imaging measures to assess white matter integrity reported a positive effect of lithium on the integrity of WM of BD patients and suggest that response to lithium treatment in BD patients is associated with normalization of WM microstructure in regions associated with emotion processing.
ConclusionsLithium appears to positively influence the evolution of the white matter abnormalities described in BD patients however further investigation is required to strongly reinforce this potential and safety.
DisclosureNo significant relationships.
The Role of Vagus Nerve Stimulation in Depression: What We Know?
- A. Fraga, B. Mesquita, D. Esteves-Sousa, J. Facucho-Oliveira, M. Albuquerque, P. Espada-Santos, P. Cintra, A. Moutinho
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S566
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Introduction
Depression is a leading cause of disability affecting over 300 million indivuals worldwide. About 1/3 of patients with depression fail to achive remission despite treatment with multiple antidepressants and are considered to have treatment-resistant depression (TRD). In view of such facts, vagus nerve stimulation (VNS) therapy was approved as an adjunctive long-term treatment for TRD.
ObjectivesThe authors elaborate a narrative literature review about de effectiveness of VNS in treatment for TRD.
MethodsPubMed database searched using the terms “treatment-resistant depression”, “vagus nerve stimulation”
ResultsThe pathophysiology of depression is complex and includes social environmental stress factors, genetic and biological processes, inflammation, and disturbances in monoamine neurotransmission. The overdrive of the HPA axis is most consistently seen in subjects with more severe depression, when the cortisol feedback inhibitory mechanisms are impaired, contributing to cytokine oversecretion. It has been shown that chronic exposure to elevated inflammatory cytokines can lead to depression. The vagus nerve represents the main component of the parasympathetic nervous system, which oversees a vast array of crucial bodily functions, including control of mood and imune response. VNS therapy has a demonstrated anti-inflammatory effect which might be a significant reason for its efficacy in patients who did not respond to antidepressants. Treatments thar target the vagus nerve increase the vagal tone and inhibit cytokine production and the stimulation of vagal aferente fibers in the gut influences monaminergic brain systems.
ConclusionsThe mecanismos by which VNS may benefit patients nonresponsive to conventional antidepressants is unclear, with further research need to clarify this.
DisclosureNo significant relationships.
Effects of psilocybin-assisted therapy on treatment-resistant depression
- A. Fraga, D. Esteves-Sousa, J. Facucho-Oliveira, M. Albuquerque, M. Costa, P. Espada Dos Santos, N. Moura, A. Moutinho
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, pp. S693-S694
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Introduction
Major depressive disorder is a highly prevalent clinical condition, affecting more than 300 million individuals worldwide. About 1/3 of patients with MDD fail to achieve remission despite treatment with multiple antidepressants and are considered to have treatment-resistant depression (TRD). Novel antidepressants with rapid and sustained effects on mood and cognition could represent a breakthrough in the TRD and may potentially improve or save lives. Psilocybin, a classic hallucinogen, more commonly found in the Psilocybe mushrooms has a combined serotonergic and glutamatergic action. The preliminary evidence of antidepressant effects of psilocybin-assisted therapy indicates the potential of psilocybin-assisted therapy as a novel antidepressant intervention.
ObjectivesThe authors elaborate a narrative literature review about the effects of Psilocybin-based therapy on patients diagnosed with treatment-resistant depression.
MethodsPubMed database searched using the terms “Treatment-Resistant Depression AND Psilocybin” and targeting clinical trials. References of selected articles and review articles were also assessed.
Results2 articles evaluate psilocybin effects in 32 patients with TRD and showed that two doses of psilocybin alongside psychological support significantly reduces depressive symptoms. All patients presented some reduction in symptoms from baseline to one week after the second dose and reproduced immediate and substantial improvements in depression that ultimately could sustain up to 6 months.
ConclusionsPsilocybin-assisted therapy is a very appealing new possibility in the treatment of depression. However, due to the small populations of the existing trials, future studies are needed to prove this positive association and to fully understand Psilocybin’s mechanisms of actions and effects.
DisclosureNo significant relationships.
How to manage antipsychotic-induced akathisia
- N. Moura, D. Esteves-Sousa, J. Facucho-Oliveira, C. Laginhas, A. Quintão
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- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, pp. S481-S482
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Introduction
Akathisia is a relatively common adverse effect of antipsychotics although some second-generation antipsychotics are known to have a lower liability for the condition. The core feature of akathisia is mental unease characterized by a sense of agitation, usually accompanied by motor restlessness, which can cause patients to pace up and down and be unable to stay seated for more than a short time. An association between this discomfiting subjective experience and suicidal ideation has been postulated but remains uncertain.
ObjectivesOur aim is to perform a non-systematic review of the literature regarding the current understanding of antipsychotic-induced akathisia and its management.
MethodsA semi-structured review was conducted on Pubmed concerning the relationship between akathisia and antipsychotics.
ResultsAll antipsychotics drugs can cause akathisia. The management of antipsychotic-induced akathisia should include a dose reduction of the antipsychotic treatment or a switch to quetiapine or olanzapine. If ineffective, a trial with propranolol may be useful as well as the addition of a 5-HT2A antagonist like mirtazapine or mianserine. At last the inclusion of a benzodiazepine may be helpful albeit the risk of dependence and anticholinergics mainly when other extrapyramidal symptoms are present.
ConclusionsHigh‐dose antipsychotic medication, antipsychotic polypharmacy and rapid increase in antipsychotic dosage should be avoided to prevent akathisia. There is limited evidence for any pharmacological treatment for akathisia such as switching to an antipsychotic medication with a lower liability for the condition, or adding a beta‐adrenergic blocker, a 5‐HT2A antagonist or an anticholinergic agent although some patients may benefit from such interventions.
The role of intranasal esketamine in treatment-resistant depression
- A. Fraga, D. Esteves-Sousa, J. Facucho-Oliveira, M. Albuquerque, M. Costa, P. Espada-Santos, A. Moutinho
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, pp. S478-S479
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Introduction
Major depressive disorder (MDD) is a highly prevalent clinical condition with a leading cause of disability worldwide. Unfortunately, about 1/3 of patients with MDD fail to achieve remission despite treatment with multiple antidepressants and are considered to have treatment-resistant depression (TRD). Research showed abnormalities in glutamatergic transmission in neural circuits and antidepressant efficacy with the N-methyl-D-aspartate (NMDA) receptor antagonist, ketamine.
ObjectivesThe authors elaborate a narrative literature review on the intranasal esketamine as a new-class antidepressant.
MethodsPubMed database searched using the terms “treatment-resistant depression” and “esketamine”.
ResultsKetamine, synthetized from PCP, acts as an antagonist of NMDA receptor, reducing Central Nervous System excitability. One limitation of ketamine for treating depression is that requires intravenous administration, reducing its applicability in outpatient settings. Esketamine, the S-enantiomer of ketamine, developed as an intranasal formulation has a higher affinity for the NMDA receptor. The evidence of the rapid antidepressant effect of intranasal esketamine was first made by Lapidus et al, that demonstrated intranasal esketamine ability to reduce depressive symptomatology. However, some recent studies reported significant acute cardiovascular, psychotomimetic and neurological side-effects. Thus, drug formulation, delivery device, insufflation technique, and individual factors seem to contribute importantly to the tolerability and efficacy of the intranasal administration rote.
ConclusionsThere is the need to develop novel treatments providing effective, more rapid-acting, and sustained relief of depressive symptoms, especially in patients with TRD. Intranasal esketamine has shown antidepressant effects in patients with TRD but further investigation is required to strongly reinforce this potential and safety.
Mechanisms linking gut microbiota to depression
- A. Fraga, D. Esteves-Sousa, J. Facucho-Oliveira, M. Albuquerque, M. Costa, P. Espada-Santos, N. Moura, A. Moutinho
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S741
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Introduction
The gut microbiota constitute the largest and most diverse community in the body which is primarily responsible for the maintenance of the intestinal wall integrity and the protection against pathogens. Besides having an important role in the regulation of host energy metabolism, the gut microbiota can also influence neurodevelopment, modulate behavioral and might contribute to the development of psychiatry disorders.
ObjectivesThe authors elaborated a narrative literature review to understand how gut microbiota can influence depression.
MethodsUsing PubMed as the database, a research was conducted about how Gut Microbiota relates with Depression.
ResultsThe microbiota-gut-brain axis encompasses the strong bidirectional communication between the gut microbiota and the CNS. Multiple mechanisms may be involved in this bilateral communication, including immune, endocrine and neural pathways. Permutations in the gut microbiome composition trigger microbial lipopolysaccharides production that activates inflammatory responses. Cytokines send signals to the vagus nerve, which links the process to the hypothalamic-pituitary-adrenal axis that consequently causes behavioral effects. Beyond this, gut microbiota have the capacity to produce many neurotransmitters and neuromodulators such as serotonin and can induce the secretion of the brain-derived neurotrophic factor, an important plasticity-related protein that promotes neuronal growth, development and survival.
ConclusionsNeuroinflammatory processes like those that occur in depression are deeply modulated by peripheral inflammatory stimuli, especially those from the intestinal microbiota. However, the knowledge is currently limited and the information available is not enough to understand the exact mechanisms. Therefore, more studies are required to show how gut microbiota influences the human brain.
DisclosureNo significant relationships.
Neuropsychiatric symptoms of multiple sclerosis: A case report
- P. Espada Dos Santos, J. Facucho-Oliveira, D. Esteves-Sousa, M. Costa, M. Albuquerque, A. Fraga, M. Marinho, P. Cintra
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, pp. S473-S474
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- Article
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Introduction
Multiple Sclerosis (MS) is an immune-mediated inflammatory demyelinating disease of the central nervous system. Concomitant psychiatric diseases are frequent in MS, with depression and anxiety disorders constituting the majority. The presence of psychotic disorders with MS is rare. Several studies have reported that psychotic symptoms usually develop after the neurological signs of MS and they are mostly linked to the side effects of treatment with interferon or with corticosteroids.
ObjectivesThe authors report here the case of patient with MS without psychiatric history that developed psychotic symptoms.
MethodsBeside the medical record of the patient a non-systematic search of the literature was carried out in the databases Pubmed and Google Scholar with the terms “Multiple Sclerosis”, “Multiple Sclerosis treatment ”and“ Neuropsychiatric symptoms ”.
ResultsA 38 years old woman with MS, with no psychiatry history developed paranoid and reference delusions, several months after starting interferon beta-1a therapy. The inferferon therapy was stopped and the patient was started Risperidone 3 mg id with a rapid but only partial remission of the psychotic symptoms. The patient presented high blood levels of prolactine and the MRI showed a pituitary microadenome. The Risperidone was switched to Aripiprazol 15 mg also with partial remission of the psychtic symptons.
ConclusionsIt is not possible to attribute our patient’s psychotic symptoms entirely to his Interferon therapy or to MS lesion load, but the occurrence during treatment, no psychiatric history and the rapid but parcial resolution with discontinuing suggest that Interferon therapy was at least contributory to the clinical picture.
The role of Mediterranean Diet in mental health in pandemic times
- A. Fraga, D. Esteves-Sousa, J. Facucho-Oliveira, M. Albuquerque, M. Costa, N. Moura, P. Espada-Santos, A. Moutinho
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S674
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- Article
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- Open access
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Introduction
In late 2019, an epidemic outbreak emerges in China caused by a new coronavirus with high transmission and human infection potential which in March 2020, was characterized by WHO as a pandemic. The lockdown has repercussions on the population’s well-being, reflected in their food choices. There is a tendency to increase the consumption of energy dense food, rich in fat and carbohydrates, which are related to an increased risk of depression.
ObjectivesThe main goal of this non-systematic literature review was to understand the impact of the Mediterranean Diet on Mental Health promotion in SARSCoV-2 pandemic.
MethodsLiterature from Pubmed database were searched, with the following keywords: COVID-19, Depression, Anxiety, Mental Health and Mediterranean Diet.
ResultsStudies indicate that a diet based on the Mediterranean Diet is associated with a decreased risk of developing depressive symptoms, especially when there is moderate to high adherence to this dietary pattern. High consumption of plant and fish foods, reduced consumption of sugary products, processed and red meats and the use of olive oil as a fat source, are principles of the Mediterranean diet, associated with an improvement in endothelial function, increased levels of eicosanoids and serotonin synthesis and regulation of serotonin which seem to explain this protective effect.
ConclusionsIn addition to decreasing the risk of obesity, diabetes, and hypertension, comorbidities associated with the most serious disease of COVID-19, the Mediterranean Diet seems to play an important role in promoting mental health, with a decreased risk of developing depressive symptoms.
DisclosureNo significant relationships.