The Eating Disorder Examination Questionnaire short version (EDE-Q7) presented better psychometric properties than the Fairburn’s 28-items original version, not only in girls (Machado et al. 2018), but also in older women (Pereira et al. 2021; Pereira et al. 2022). It comprises 7 items in three subscales: Dietary Restraint/DR; Shape and Weight Overvaluation/SWO and Body Dissatisfaction/BD. In a more recent clinical study in men (Laskowski et al. 2023) the factors associated with body concerns and dissatisfaction weren’t fully represented in the questionnaire, possibly indicating differences in body ideals, specially relating to musculature.

We aimed to analyze the psychometric properties of the Portuguese version of EDE-Q7 in males.

Participants were 227 male individuals with a mean age of 30.41 years (±13.96; range: 14-73 years). They answered an online survey including the Portuguese versions of the Screen for Disordered Eating/SDE; the Body Image Concern Inventory/BICI and the Muscle Dysmorphia subscale of the Eating Disorder Assessment for Men/DM-EDAM.

Confirmatory Factor Analysis showed that the second order model presented good fit (χ2/df=2.437; RMSEA=.0794; CFI=.986 TLI=.974, GFI=.967). Cronbach’s alpha was .856 for the total, .876 for DR and .917 for SWO and .900 for BD. All items contributed to internal consistency and presented high internal validity. Pearson’s correlations of EDE-Q7 with BICI (.465), DM-EDAM (.384) and SDE (.361) were significant (p<.001) and moderate.

Also in men, the Portuguese version of EDE-Q7 demonstrates good validity (construct and convergent) and reliability.

None Declared

Some studies have shown that late-life depression is related to faster cognitive decline and may increase the risk of dementia.

Identifying risk and protective factors for dementia is essential to develop preventive interventions. Some literature has suggested that mood disorders (namely depression) are potential modifiable risk factors for dementia.

Thus, it is important to know clinical presentation of depression that is associated to dementia, as a manifestation of subclinical dementia or as a risk factor for neurocognitive disorders.

We aim to identify clinical characteristics related to dementia of inpatients admitted for first time due to depressive episode after 55 years old.

Retrospective cohort study of inpatients admitted between January 1st 2010 and March 31st 2022 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0.

Our sample included 57 inpatients, 15,8% (n=9) with the diagnosis of dementia 5,2 (SD 5,6) years after admission. All of these patients presented a depressive episode with psychotic symptoms, namely delusion activity. In those with hallucinatory activity, no one developed dementia.

Interestingly, 33,3% of patients with dementia (n=3) presented with delusion of ruin, 55,6% (n=5) with delusion of prejudice/persecutory delusion and 66,7% (n=6) manifested delusion of ruin and/or prejudice.

We also found that 42,9% (n=3) of patients with dementia manifested Cotard delusion while this type of delusion was observed in 13,6% of patients without dementia (p=0,095).

Our study has several limitations because is based on results of only one hospital, with a small sample size.

However, since depressive symptoms are potentially modifiable risk factors for dementia, future studies are essential to understand the mechanisms that link depression to cognitive decline as well as clinical characteristics that may constitute predictors of dementia.

None Declared

Lithium is one of the main drugs used in Bipolar Affective Disorder. However, it has a narrow therapeutic window, which requires close monitoring and progressive dose adjustment, according to serum levels, clinical response and the appearance of side effects. The term ‘SILENT’ explains descriptively persistent neurological sequelae related to lithium salt intoxication when symptoms persist for more than 2 months after stopping treatment. SILENT Syndrome is more common in females, at ages ranging from 21 to 77 years and is characterized mainly by avermian-type cerebellar disorder, persistent extrapyramidal syndrome, brainstem dysfunction and dementia of varying severity. It can also result in apraxia of the body, changes in the coordination and balance, dysarthria, as well as intentional and kinetic cerebellar tremor, involuntary movements of orofacial dyskinesias or resting tremor.

The authors intend to review the relevant and current literature in order to extend the knowledge about this condition and find the best conducts for clinical practice.

Non-systematic literature review.

Complications from the use of lithium known in the medical literature include mainly nephrotoxicity, endocrine alterations and neurotoxicity. The neurotoxic effects of lithium usually occur at high serum concentrations. However, they can also occur with lithium in the therapeutic range, and memory, attention and ataxia impairment may be some of the permanent sequelae. The etiopathogenesis is unclear, but demyelination has been detected in multiple brain regions, mainly in the cerebellum. The mechanism of lithium-induced cerebellar injury is believed to be mediated by the entry of calcium into the cells of this organ. The main factors that predispose to greater side effects and risk of toxicity are patients with decreased renal function, advanced age, use of diuretics, dementia, pregnancy, low sodium intake and physical illness with vomiting and/or diarrhea.

Lithium is a drug used mostly in affective disorders and given the narrow therapeutic window, it requires close monitoring in order to avoid side effects that can be permanent. In this way, it is important to review the factors that increase the lithium toxicity and make recommendations about it.

None Declared

Depression is one of the most prevalent and incapacitating disease in current times and depressive symptoms have important global functioning implications.

The serotonergic and glutamatergic systems are involved in the pathophysiology and treatment of depression. Ketamine is an N-methyl-d-aspartic acid (NMDA) receptor antagonist that has demonstrated an important role on depressive symptoms, but its use is restricted due to its dissociative effects and other possible adverse effects.

Memantine is a noncompetitive antagonist of the NMDA receptor that modulates glutamate transmission. Memantine is used for the treatment of moderate to severe Alzheimer’s disease.

In this review, we aim to investigate, organize and synthetize the current data about the use of memantine for depressive symptoms.

Our literature research focused on some of the most significative articles published in the last decade, including meta-analysis and systematic reviews.

Most of the relevant literature suggests that memantine may effectively reduce depressive symptoms in patients with mood disorders.

The literature also supports that memantine’s glutamatergic mechanism of action could reduce apathy and treat depression comorbid with alcohol abuse.

Memantine affects brain-derived neurotrophic factor(BDNF) production suggesting that glutamate assumes an essential role in the pathology and etiology of depression. Also, the relationship between depression and the NMDA receptor is further supported by the fact that people with major depressive disorder demonstrate higher glutamate levels in the brain and blood.

Moreover, current studies demonstrate that treatment with memantine as adjunct to selective serotonin reuptake inhibitors (namely sertraline) manifested a favourable safety and efficacy profile in patients with major depressive disorder.

Memantine may have a wide therapeutic use beyond its utility in neurodegenerative diseases.

More studies should be performed, especially larger controlled studies of longer duration focusing on long-term safety and efficacy.

None Declared

The United States of America are currently facing a public health crisis characterized by the abuse of synthetic opioids, notably Fentanyl, and the veterinary sedative Xylazine. While each of these substances has been associated with significant risks, their current misuse presents a formidable challenge to healthcare professionals, law enforcement agencies and policymakers. While the opioid epidemic has long held the nation in its grip, the emergence of Xylazine as complementary agent in substance abuse has added a disturbing layer of complexity to an already terrible situation, due to its cost-cutting, an increase in its addictive properties and its ability to extend the duration of the opioid with which it is combined.

The authors intend to review the relevant and current literature in order to extend the knowledge about this condition and find the best conducts for clinical practice.

Non-systematic literature review

Various regions of the United States are facing a troubling surge in the co-abuse of Fentanyl, a potent synthetic opioid many times more potent than morphine, and Xylazine, a veterinary sedative and muscle relaxant, particularly in urban areas. The motivations for this combination appear to vary, ranging from the enhanced euphoria to cost-saving measures, further fueling its prevalence. However, the consequences are devastating. Both substances depress the central nervous system, with a sharp increase in overdose deaths and emergency medical services are strained to their limits in responding to these crises. Law enforcement agencies are facing a daunting task in curtailing the distribution of these substances, often grappling with clandestine networks that exploit the accessibility of these drugs.

The concurrent abuse of Fentanyl and Xylazine represents a critical public health challenge in the United States of America, demanding immediate attention and a multidisciplinary response. Failure to address this issue comprehensively will have profound implications for the well-being of individuals, families and communities across the nation. It is imperative to mobilize resources, foster interdisciplinary collaboration and develop evidence-based policies to combat this dual-threat crisis. Novel intervention strategies, including community education programs, targeted outreach efforts, and supervised consumption facilities, are urgently needed to address this complex issue.

None Declared

Obsessive-compulsive disorder (OCD) is a chronic condition characterized by time-consuming and distressing obsessions and/or compulsions, often accompanied by avoidance behaviours. It is a highly prevalent and incident disorder that results in considerable disability and quality of life reduction.

Current pharmacological treatments are hindered by their delayed onset and the limited evidence on how to approach first and second line treatment-resistant patients.

Recent research showcased the involvement of glutamatergic pathways in the pathophysiology of OCD prompting research into the potential therapeutic use of ketamine, which binds to the N-methyl-D-aspartic acid receptor and acts as a non-competitive antagonist of glutamate.

The aim of this study is to conduct a literature review on the use of ketamine and its enantiomers as a treatment for OCD and report a clinical case involving an OCD patient who experienced significant improvement following ketamine use.

A search was performed on PubMed using a combination of keywords and Medical Subject Headings terms, including “Ketamine”, “Esketamine” and “Obsessive-Compulsive Disorder”. Only studies that involved patients with OCD aged ≥18 years who had received ketamine or its enantiomers as an intervention and that reported treatment response using a validated scale were included.

Nine studies were included, 4 case reports, 3 open-label trials and 2 randomized controlled trials, totalling 71 patients. Ketamine was administered intravenously in 7 studies and intranasally in the remaining 2. The results were heterogeneous, with some studies reporting no effect on obsessive-compulsive (OC) symptoms and others demonstrating significant and rapid improvement, albeit some only transitorily.

We present the case of a 42-year-old man who experienced OC symptoms since the age of 20 but was only formally diagnosed with OCD 3 years ago. During his first consultation, the patient described obsessive thoughts related to contamination and dirtiness, accompanied by handwashing rituals and avoidance behaviours (e.g., avoiding touching handles and switches). His Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 29. Escitalopram was initiated with a progressive dose titration, resulting in partial improvement (Y-BOCS 23). In a follow-up appointment, the patient disclosed that he had purchased and self-administered a single intravenous dose of 2g of ketamine 2 months earlier for recreational use. This led to an immediate and significant improvement of his OC symptoms. Subsequent re-evaluation 4 months later confirmed that he remained asymptomatic (Y-BOCS 2).

Ketamine may be a therapeutic alternative for OCD patients who are treatment resistant due to its rapid anti-obsessional effect. Further studies with improved designs and larger sample sizes are warranted to better assess the efficacy of ketamine in OCD treatment.

None Declared

The phenomenon of suicide and self-harm is one of the most intriguing and disturbing human behaviours. Suicide is global public health problem, with multiple and complex contributing factors. Global trend show a stabilizing or descending curves in the last years. The Portuguese atlantic archipelago of Azores has had an opposite trend that together with regional proctective and risk factors ought to be addressed for further tailored interventions.

Review of the up-to-date literature on this topic and present the recent suicide-related data in the Azores.

Unsystematic review of the most recent and relevant literature.

Epidemiology, risk and protective factors, preventive and treatment measures were described.

The Azores region has a ascending trend in the suicide mortality rate, opposing the portuguese trend. The azorean suicide mortality rate has a bimodal distribution and has higher values in every age group, except for the +75yo, when compared with the portuguese rates.

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Multiple complex factors contribute to the suicide phenomenon. Suicide protective and risk factors mostly overlap with mental disorders’ factors and those of other health and socio-economic conditions.

Azorean suicide rates are growing against the global and national descending trends.

Prevention and treatment strategies to be implemented regionally must be fine tailored, accounting for the most relevant factors in place, in order to be most effective.

None Declared

Lithium is one of the main drugs used in Bipolar Affective Disorder. However, it has a narrow therapeutic window, which requires close monitoring and progressive dose adjustment, according to serum levels, clinical response and the appearance of side effects. The term ‘SILENT’ explains descriptively persistent neurological sequelae related to lithium salt intoxication when symptoms persist for more than 2 months after stopping treatment.

SILENT Syndrome is more common in females, at ages ranging from 21 to 77 years and is characterized mainly by avermian-type cerebellar disorder, persistent extrapyramidal syndrome, brainstem dysfunction and dementia of varying severity. It can also result in apraxia of the body, changes in the coordination and balance, dysarthria, as well as intentional and kinetic cerebellar tremor, involuntary movements of orofacial dyskinesias or resting tremor.

The authors intend to review the relevant and current literature in order to extend the knowledge about this condition and find the best conducts for clinical practice.

Non-systematic literature review.

Complications from the use of lithium known in the medical literature include mainly nephrotoxicity, endocrine alterations and neurotoxicity.

The neurotoxic effects of lithium usually occur at high serum concentrations. However, they can also occur with lithium in the therapeutic range, and memory, attention and ataxia impairment may be some of the permanent sequelae.

The etiopathogenesis is unclear, but demyelination has been detected in multiple brain regions, mainly in the cerebellum. The mechanism of lithium-induced cerebellar injury is believed to be mediated by the entry of calcium into the cells of this organ.

The main factors that predispose to greater side effects and risk of toxicity are patients with decreased renal function, advanced age, use of diuretics, dementia, pregnancy, low sodium intake and physical illness with vomiting and/or diarrhea.

Lithium is a drug used mostly in affective disorders and given the narrow therapeutic window, it requires close monitoring in order to avoid side effects that can be permanent. In this way, it is important to review the factors that increase the lithium toxicity and make recommendations about it.

None Declared

The emergence of new psychoactive substances (NPS) has had a substantial impact worldwide. NPS mimic the effect of “existing” drugs and are specifically manufactured so that the new substances fall out of regulatory frameworks. Although the structural changes might be minimal, NPS often have marked differences in potency and subsequent harm.

The population of the Azores archipelago has been particularly affected by the rapid growing and changing nature of this phenomenon, mainly caused by the introduction and spread of the “newly” synthetic cathinones as a inexpensive and easily available street drug.

Before any educational, public health and socioeconomic policy changes be proposed to accurately tackle the problem, the basic step of knowing how these substances have been affecting their users, specially their neuropsychiatric effects, must be taken.

This project aims to characterize the neuropsychiatric side effects caused by the acute intoxication of NPS with a psychostimulant profile, namely synthetic cathinones.

Description of the neuropsychiatric symptoms of intoxicated users of stimulant NPS that present to non-governmental organizations specialized in addictions and also to the psychiatry emergency department in Sao Miguel - Azores.

Review of the forensic records of the deaths by suicide in 2021 in Sao Miguel, looking for evidence of recent abuse of NPS or previous history of “NPS use disorder”.

Non-systematic review of the recent and relevant scientific literature on this topic.

The desired effects are increased energy, mood enhancement, euphoria, mental clarity, improved concentration, improved sociability, increased talkativeness, empathy inducing effects, amplification of sound and colour and prosexual effects. Nevertheless, in the case of intoxication, the frequent neuropsychiatric side effects tend to be agitation, agressiveness, irritability, altered consciousness, brief psychosis with paranoid delusion, visual and auditive hallucinations, transient mania, enhanced sensorial experiences, headaches, dizzyness, seizures, confusion and amnesia. Usually, the acjute intoxication period tend to be followed by a “crash” with depression, craving, anxiety, panic, suicidal ideation and behaviours. A third of the deaths by suicides in Sao Miguel Island in 2021, 7 out of 21, were in stimulant NPS active or recent users.

Review of the neuropsychiatric effects of New Psychoactive Substances with a psychostimulant profile. Further studies of this population of synthetic cathinone users in the Azores are due, namely studying their socioeconomic background, looking for risk and protective factors, and also the long-term side effects.

None Declared

Research on life stress in bipolar disorder largely fails to account for the possibility of a dynamic relationship between psychosocial stress and episode initiation. The kindling hypothesis states that over the course of recurrent affective disorders, there is a weakening temporal relationship between major life stress and episode initiation that could reflect either a progressive sensitization or progressive autonomy to life stress.

To explore the concept of the Kindling model applied to bipolar disorder and to present a clinical case of a bipolar patient whose latter mood episodes were caused by adverse life events.

We performed a non-systematic literature review using the most relevant papers found on the database PubMed with the keywords “kindling effect”, “allostatic load”, “bipolar disorder” and “prevention”. Description of the clinical case report.

The phenomenon of kindling was first discovered by Goddard in 1967 who described it in epilepsy. Later, Post applied it to the bipolar disorder, arguing that the initial episodes of both unipolar and bipolar affective disorders are often precipitated by psychosocial stressors, but after multiple recurrences, not only do precipitated episodes continue to occur, but so do spontaneous ones as well. We present the case report of a 62 years old woman, divorced, diagnosed with type 1 bipolar disorder since she was 20 years old. She always have had poor adherence to her medication and follow-up with Psychiatry consultation, with a non-containing sociofamily environment that does not promote clinical stability. Over the time, her admissions on the Psychiatry ward were more frequent and precipitated by adverse life events, mainly caused by the deteriorated relationship with her children.

The kindling model clarifies aspects of the longitudinal course of episode development, recurrence, and progression to spontaneity, as well as further conceptual and theoretical rationales for intervention in order to prevent illness progression.

None Declared

Recent studies reported substantive clinical differences in those with a bipolar disorder who evidence elevated or irritable mood during a manic episode, which may have treatment and prognosis implications.

We aim to compare sociodemographic and clinical characteristics of inpatients admitted for bipolar mania with elevated vs. irritable mood.

Retrospective observational study of inpatients admitted between January 1st 2018 and July 31st 2022 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0.

Our sample included 143 inpatients, 39,9% (n=57) with elevated mood. When compared with those with irritable mood, euphoric patients had 2.765 more odds of having previous psychiatric hospitalizations (x2(1, N = 143) = 4.93; p = 0.026). Interestingly, 78.4% of inaugural manic episodes (n=19) presented with irritable mood (x2(1, N = 143) = 3.447; p = 0.063). We also found that a patient with euphoric mood has 2.575 greater odds of being under a mood stabilizer (x2(1, N = 143) = 5.026; p = 0.025) before admission. More specifically, there is a significantly higher proportion of euphoric patients that were prescribed with valproic acid as mood stabilizer (57.9% vs 37.2%; x2(1, N = 143) = 5.016; p = 0.015). This association was not found with lithium. We found no statistically significant differences regarding the sociodemographic characteristics, previous long acting injectable antipsychotic or antidepressant treatment and psychotic symptoms during manic episode between the two groups.

Patients with elevated mood are more likely to have a previous bipolar disorder diagnosis, which may reflect an observer bias due to the fact that diagnosis is already known.

The use of valproic acid as mood stabilizer may be a protective factor to irritable mood, since it’s currently prescribed in those with bipolar disorder who have more depressive or mixed instead of manic episodes. However, future studies are essential to understand the impact of mood stabilizer on these two contrasting phenotypic expressions.

Differences related to disease severity or sociodemographic characteristics were not found.

None Declared

Covid-19 does not only have repercussions on the physical level, representing a new way of life, both individually and in society. The pandemic results in invisible consequences for the population’s mental health.

This study aimed to explore the consequences of Covid-19 on mental health in Portugal with a view to understanding and promoting the well-being and happiness of the Portuguese.

The study included 111 young people and adults, aged between 18 and 58 years (M= 21.81, SD= 5.34), with 43.7% males and 52.7% females. A sociodemographic questionnaire was applied to all participants, as well as the Échelle de Mesure des Manifestations du Bien-Être Psychologique (ÈMMBEP; Massé et al., 1998 - Portuguese translation by Monteiro, Tavares & Pereira, 2012) which translates into a response scale 5-point Likert type, with five subscales, including happiness. In addition, a semistructured interview with data collection instruments was administered.

The results obtained demonstrate the negative impact of Covid-19 on the level of well-being, regardless of the participant’s gender or age.

The data presented point to the need to sensitize individuals to the risk of the pandemic in terms of mental health, thus increasing society’s awareness of the psychological effects of this new global disease. Therefore, coping mechanisms are essential to promote well-being and successfully overcome the pandemic.

No significant relationships.

There is a current trend towards an increase in the number of elderly prisoners due to the increase in life expectancy and the change in the attitude of society and the judicial system. The cut-off for “older offender” is defined from the age of 50, due to the lifestyle previous to prision and premature ageing.

The authors intend to understand the challenges of aging in prison and forensic services, highlighting the psychiatric comorbidities of inmates and how these services can adapt to the needs of this population.

Non-systematic review of the literature.

Studies of elderly in prisons and elderly forensic psychiatric patients are limited. Prisoners have increased physical and psychiatric morbidity and early mortality as they are more exposed to risk factors and more likely to have at least one health problem compared to older adults in the community. Compared to older people in the community, older prisoners are at higher risk for most psychiatric disorders including depression, psychosis, bipolar disorder, cognitive impairment, personality disorder and anxiety. Suicide rates are also higher among elderly prisoners. The inadequacy of the prison system to respond to the unique needs of elderly prisoners has a detrimental impact on their overall experience of incarceration. The development of specific services for elderly prisoners or the adaptation of mixed units for the elderly population is proposed.

The elderly population in prisons is growing and has higher risk of psychiatric pathology compared to community elders. Prison services with difficulties in identifying and meeting these needs.

No significant relationships.

There is no consensus in the literature regarding the relationship between high-resolution computed tomography findings and hearing thresholds in pure-tone audiometry in otosclerosis. This study evaluated the association between high-resolution computed tomography findings and pure-tone audiometry in otosclerosis in the spongiotic phase.

A cross-sectional study was conducted of 57 ears with surgically confirmed stapes fixation and tomographic findings. Air conduction and bone conduction thresholds on audiometry, and air–bone gap, were analysed.

There were no correlations between sites affected by otospongiosis and air conduction threshold, bone conduction threshold or air–bone gap in the analysed tomographic images, but the diameter of the otospongiotic focus was greater in the presence of extension of the otospongiotic foci to the cochlear endosteum.

There were no relevant associations between high-resolution computed tomography findings and pure-tone audiometric measurements. However, the diameter of the otospongiotic focus was greater in the presence of extension of the otospongiotic foci to the cochlear endosteum.