Delays in accessing treatment for psychosis and other severe mental disorders can reach 8–10 years. Inspired by McGorry’s Australian model, the Transition to Adulthood Program in Toledo applies a targeted and cost-effective screening strategy based on two risk markers: age (16–20 years) and substance use.

• - To describe the program design and clinical framework.

• - To evaluate its ability to detect severe psychopathology at early stages.

• - To analyze its impact on reducing treatment delays and improving service organization.

Open-access program (2015–2025) including 1,300 patients. Inclusion criteria: adolescents/young adults (16–20 years) and/or substance or behavioral addictions. Multidisciplinary intervention (psychiatrists, psychologists, mental health nurses, social workers). Combined individual, group, and family psychotherapy, with daily open consultation slots.

• - Two-thirds presented substance use; one-third met only age criteria.

• - Mean age: 16.8 years; 60% female.

• - 40% reported complex trauma history.

• - 15% showed psychotic symptoms at intake; ~50% progressed to schizophrenia or bipolar disorder.

• - ~400 patients treated annually; mean treatment duration: 18 months; 30% early dropout rate.

The program achieved cost-effective early detection in high-risk populations, reduced time-to-treatment, and provided flexible, accessible care. This model demonstrates both clinical and organizational utility and can be adapted to other public mental health contexts.

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Elderly patients pose a challenge in clinical practice. These patients may present symptoms that can be due to age-related cognitive impairment or may be due to other pathologies such as late psychosis, delusional disorder or manic episode with psychotic symptoms. It is for this reason that it is important to perform complementary tests and make a good differential diagnosis, with the aim of early treatment and improve evolution and prognosis.

The objective is to perform a literature review based on a case of an elderly patient.

To perform a literature review based on a case of an elderly patient.

Case: 70-year-old woman who lives with her husband and has two daughters. Currently retired. The patient has been in psychiatric consultations for approximately 30 years with a diagnosis of recurrent depressive disorder and under sertraline treatment. She goes to the emergency room with her daughter, as they have noticed a change in her behaviour over the last few days. The daughter reports that she is expansive, irritable, aggressive, who says that the neighbors are envious and watch him, performs many activities, etc. She comments that before her mother was the opposite, whiny and unwilling to do anything. The patient reports that her neighbors are envious of her and want to annoy her with great emotional repercussion and that she is aggressive with her husband because they do not get along. Hospital admission for clinical stabilization.

Examination and complementary tests: A neuropsychological evaluation of cognitive impairment was carried out, which resulted in the onset of cognitive impairment. Test of the watch with alterations and MOCA 25/30.

Evolution: During hospitalization, the patient is initially more expansive, irritable towards the family and with ideas of prejudice and self-referential to neighbors. She also has memory failures. Treatment with oral risperidone is adjusted with good tolerance, after which delirium symptoms are remitting.

The onset of cognitive decline may be accompanied or preceded by delusional symptomatology. It is recommended to perform differential diagnosis with mania, delirious disorder or onset of cognitive decline. Treatment with risperidone or quetiapine is useful.

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Despite strong evidence for group psychotherapy, its implementation in adolescent mental health services remains limited. Barriers include lack of professional training, insufficient supervision, and rigid adherence to specific theoretical schools.

• - To identify barriers in the training and implementation of adolescent group therapy.

• - To present insights from the Toledo Transition Program on overcoming these barriers.

• - To propose recommendations for professional development and service design.

Qualitative descriptive study based on clinical experience. Observation of group sessions, supervision dynamics, and training needs of psychiatry residents and staff were analyzed.

• - Residents were often relegated to observer roles in groups, limiting active learning.

• - Lack of supervision spaces hindered skill acquisition and confidence.

• - Rigid theoretical frameworks discouraged flexible, integrative approaches.

• - Program experience showed that transdisciplinary teamwork and integrative use of dynamic, systemic, and cognitive tools improved training outcomes.

Expanding group therapy training requires supervision, active participation, and theoretical flexibility. Addressing these gaps can strengthen workforce capacity and facilitate the integration of group interventions as a standard tool in adolescent psychiatry.

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An increasing number of adolescents present to mental health services with anxiety, depression, or self-harming behaviors. In a significant subset, these symptoms conceal undiagnosed neurodevelopmental conditions—such as borderline intellectual functioning (BIF), mild intellectual disability (ID), or autism spectrum disorder (ASD)—that were not identified during childhood. Many of these youths advanced academically and socially despite substantial effort, which delayed recognition by pediatricians and schools. Without acknowledging these hidden developmental profiles, clinicians risk applying symptom-focused therapies that are ill-suited to the adolescent’s cognitive and adaptive capacities.

(1) To highlight the impact of missed childhood diagnosis of BIF, mild ID, or ASD in adolescents presenting with emotional or behavioral symptoms. (2) To demonstrate how undetected neurodevelopmental conditions undermine standard psychotherapeutic approaches. (3)To propose systematic neurodevelopmental screening prior to intervention initiation in adolescent mental health care.

We conducted a narrative review (2023–2025) of recent meta-analyses on adapted psychotherapy in ASD and ID, conceptual reviews of BIF, and major international guidelines (NICE, NHS England). We analyzed recommendations on neurodevelopmental screening and psychotherapeutic adaptations for adolescents.

1. (1) Missed in childhood: Many adolescents with low IQ or autistic traits escaped earlier detection, progressing academically at the cost of hidden distress.

2. (2) Secondary presentations: In adolescence, they present with anxiety, depression, or self-harm, symptoms that overshadow the underlying condition.

3. (3) Therapy works—when adapted: Evidence supports the efficacy of adapted psychotherapies (simplified CBT, visual supports, structured pacing, family involvement) when neurodevelopmental conditions are recognized.

4. (4) Guideline gap: Although guidelines recommend adaptations, they rarely require clinicians to systematically rule out neurodevelopmental conditions prior to starting standard therapy.

The failure to detect neurodevelopmental disorders early partly explains why many adolescents show poor response to conventional, symptom-focused treatments. Unless mental health services incorporate routine cognitive and adaptive screening before pychotherapy or pharmacotherapy, treatments risk addressing symptoms while ignoring root causes. This raises a necessary debate: should adolescent mental health care continue to apply one-size-fits-all protocols, or move toward precision psychotherapy tailored to each individual’s neurodevelopmental profile?

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Vaping has gained popularity since its introduction in 2005, particularly among adolescents and young adults, due to its appealing flavors and perceived lower health risks compared to traditional smoking. Despite its widespread use, emerging evidence suggests that vaping may pose significant health risks, including respiratory and cardiovascular damage, and potential neurological effects.

This study aimed to explore the demographic and behavioral characteristics of individuals who vape, assess the perceived health risks associated with vaping, and examine the relationship between vaping and conventional tobacco use.

A cross-sectional exploratory design was employed. A non-probabilistic convenience sample of 230 individuals aged 18–40 was recruited via social media. Participants completed a questionnaire assessing vaping habits, substance types used, motivations, perceived risks, and tobacco use history.

Of the 230 participants, 97 (42.2%) reported having vaped at least once. Among them, 66.0% no longer vape, while 5.2% vape daily, 6.2% occasionally, and 22.7% sporadically. The primary motivations for initiating vaping were curiosity (60.8%) and social influence (15.5%), with fewer citing smoking cessation (11.3%) or stress reduction (2.1%).

A significant proportion (62.9%) perceived vaping as equally harmful as smoking, and 80.4% reported quitting due to health concerns. A positive correlation was found between risk perception and intention to quit (r = .372, p < .001).

Regarding substance use, 59.8% used nicotine-containing liquids, while 35.1% used nicotine-free variants. Only 5 participants reported using cannabis-derived substances. A significant association was found between nicotine vaping and tobacco use (χ2(1, N = 92) = 8.21, p = .004), with 77.8% of smokers using nicotine vapes compared to 48.9% of non-smokers (see Image 1).Image 1:

The findings indicate that while most individuals discontinue vaping, a notable minority continue the practice. Curiosity and peer influence are dominant initiation factors, contrasting with previous studies that emphasize stress relief and smoking cessation as primary motives. The high prevalence of nicotine use among non-smokers raises concerns about potential nicotine dependence in previously non-smoking populations.

Compared to earlier research suggesting vaping may aid in reducing cigarette consumption, this study highlights a more complex reality where vaping does not consistently serve as a cessation tool. Moreover, the perception of vaping as harmful appears to be a protective factor, suggesting that public health campaigns should emphasize risk awareness to reduce usage.

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Intellectual disability (ID) affects approximately one percent of the population. The relationship between ID and schizophrenia is complex. Individuals who later develop schizophrenia tend to exhibit lower intelligence quotient scores, with a further decline often occurring during the prodromal phase preceding illness onset. Moreover, offspring of individuals with schizophrenia have an increased risk of developing ID.

To synthesize current evidence on the prevalence, risk factors, diagnostic challenges, and prognostic outcomes of schizophrenia among individuals with ID.

Narrative literature review.

Schizophrenia is three times more prevalent in adults with ID than in the general population. This elevated prevalence may be attributed to shared genetic vulnerabilities and environmental factors, particularly obstetric complications. Accurate diagnosis of schizophrenia in individuals with ID poses significant challenges, as it requires a level of communicative ability that many lack. In those with severe or profound ID, the assessment of reality testing is often unreliable, rendering diagnosis particularly difficult. Core features such as disorganized thinking may be difficult to identify, and behaviours such as talking to oneself, interaction with inanimate objects, or abnormal postures can overlap with the behavioural phenotype of ID. Additionally, individuals with ID may experience visual rather than auditory hallucinations, potentially reflecting underlying neurobiological differences. Adults with comorbid ID and schizophrenia tend to exhibit more pronounced negative symptoms, higher rates of treatment resistance, and greater functional impairment compared to those with schizophrenia alone.

The increased prevalence of schizophrenia among individuals with ID carries significant implications for clinical practice. Diagnostic overshadowing, where behavioural disturbances are attributed solely to ID, leading to missed comorbid diagnoses, remains a major challenge in this population. As schizophrenia is a potentially treatable disorder, timely recognition and effective management are essential to alleviate distress and improve quality of life in individuals already burdened by substantial disability.

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Adolescent substance use is recognized as an early marker of vulnerability to severe mental illness, regardless of frequency or intensity. Detecting and addressing initial consumption provides a gateway for cost-effective preventive programs, avoiding the limitations of broad population screening.

• - To assess substance use as an entry point to early intervention.

• - To describe the Toledo program’s experience with adolescents presenting early substance use.

• - To analyze the role of brief group psychotherapy in improving outcomes.

Cohort of adolescents with cannabis, alcohol, polysubstance use, or behavioral addictions (mobile phones, video games, internet). Weekly brief group interventions based on Yalom’s Here and Now and Badaracco’s Healthy Virtuality, integrated with individual and family sessions.

• - Cannabis was the primary reason for referral.

• - Growing demand related to behavioral addictions (e.g., smartphones, gaming).

• - Over 70% had received prior, often fragmented, treatments.

• - Groups facilitated symbolization processes and improved adherence in resistant populations.

• - High prevalence of complex trauma and homo/heterotypic relapses (>70%).

Early substance use is a strong clinical and epidemiological marker for indicated prevention. Integrating group-based brief psychotherapies enables effective intervention, enhances adherence, and fosters early detection of psychosis, reducing long-term risk of chronic trajectories.

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Thyroid dysfunction can manifest through diverse neuropsychiatric symptoms, often resembling primary psychiatric disorders. Early identification of endocrine causes is essential to avoid misdiagnosis and ensure appropriate treatment.

To highlight the importance of thyroid evaluation in acute neuropsychiatric presentations.

Case report.

A 23-year-old Venezuelan man, recently emigrated to Portugal and with no psychiatric history, presented with a three-day history of psychomotor agitation, disinhibition, insomnia, disorganized thinking, and bizarre behavior. Examination revealed alertness with disorientation, distractibility, unkempt appearance, and poor cooperation. Initial laboratory testing showed undetectable TSH, elevated free T3 and T4, and positive thyroid antibodies (TRAb 17.87 IU/L; TgAb 17.5 IU/mL; TPOAb 313.1 IU/mL). Neuroimaging findings were unremarkable, and toxicology screening was negative. Based on these results, a diagnosis of Graves’ disease was established, and appropriate treatment was initiated. Despite achieving euthyroidism, agitation, confusion, and distractibility persisted. Further investigations, including electroencephalography, brain magnetic resonance imaging, and cerebrospinal fluid analysis, yielded unremarkable findings. No infectious, metabolic, or structural cause was found. Hashimoto’s encephalopathy was suspected. Corticosteroid therapy was initiated; however, it led to clinical worsening, with increased agitation and affective lability. Gradual tapering and discontinuation of corticosteroids resulted in behavioural improvement. Transient use of antipsychotic medication was required for agitation but was later withdrawn. At discharge, the patient showed partial improvement, with residual cognitive rigidity and continued need for supervision in daily activities.

This case illustrates the intricate relationship between thyroid dysfunction and neuropsychiatric manifestations. Thyrotoxicosis may precipitate cognitive and behavioural disturbances that closely mimic primary psychiatric disorders, while autoimmune thyroid disease can also be associated with encephalopathic processes of immune origin. The persistence of neuropsychiatric symptoms despite normalization of thyroid function emphasizes that thyroid-related brain dysfunction may have a multifactorial and prolonged course, extending beyond metabolic imbalance alone. Prompt recognition of reversible thyroid-related causes is crucial for timely, multidisciplinary management and better outcomes.

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The widespread recognition of Attention-Deficit/Hyperactivity Disorder (ADHD) has led to a simplified, predominantly symptomatic approach, often initiated by non-specialized mental health staff (e.g., educators, primary care physicians). However, recent research highlights the need for a more refined perspective, emphasizing neurobiological underpinnings—executive dysfunction, arousal dysregulation, delayed reward processing—and the differentiation between primary ADHD and secondary ADHD-like presentations stemming from complex trauma, attachment disturbances, or emotional dysregulation.

To analyze the main neurobiological hypotheses underlying ADHD (executive dysfunction, arousal regulation deficits, intolerance to reward delay), to explore the clinical overlap with trauma- and attachment-related disorders during childhood and adolescence, and to examine longitudinal outcomes and differential pharmacological responses in primary versus secondary ADHD.

A narrative synthesis of recent neurobiological and clinical findings was conducted, focusing on: (1) competing neurobiological models (fronto-striatal dysfunction, aberrant arousal regulation, and reward delay intolerance); (2) symptom overlap with trauma-related and attachment disorders in children and adolescents; (3) longitudinal outcomes across developmental stages; and (4) differential response to stimulant medication in primary versus secondary ADHD.

Evidence supports the heterogeneity of ADHD trajectories. Neurobiologically, individuals with impaired arousal regulation or delayed reward processing show distinct profiles compared to those with inhibitory deficits, suggesting that uniform pharmacological approaches may be insufficient. Longitudinal studies show that about one-third of girls and one-fourth of boys no longer meet ADHD criteria by adolescence without intervention, highlighting the role of maturational processes. Moreover, children diagnosed with ADHD often evolve into divergent adult diagnoses (e.g., mood, anxiety, substance use disorders), underscoring the nonspecificity of early symptoms. Importantly, stimulant response differs: primary ADHD typically shows robust benefit, whereas secondary ADHD-like presentations linked to trauma or relational disturbances present attenuated or paradoxical responses.Image 1:

Complex trauma in early development induces neuroadaptive changes in arousal and reward systems that may mimic ADHD phenotypes. Treating these cases solely with stimulants risks chronicity and progression to comorbidities such as addictions, mood, or anxiety disorders in adolescence. Therefore, a comprehensive assessment distinguishing between primary neurodevelopmental ADHD and secondary ADHD-like syndromes is crucial. Integrating trauma- and attachment-focused interventions alongside or instead of stimulants offers a more tailored, prognostically favorable approach.

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Cannabidiol (CBD), a non-psychoactive compound derived from Cannabis sativa, has gained popularity among young adults seeking natural alternatives for managing emotional and physical symptoms. Despite its increasing use, particularly without medical supervision, scientific evidence regarding its safety and efficacy remains limited.

This study aimed to:

• • Describe the demographic and clinical profile of CBD users.

• • Assess perceived effects of CBD on mental health and well-being.

• • Explore associations between CBD use, mental health history, and cannabis consumption.

A cross-sectional survey was conducted among 230 individuals aged 18–40, recruited via social media. Data collected included sociodemographic variables, mental health history, substance use, and perceptions of CBD efficacy.

Among the participants, 14.3% reported having used CBD. These individuals showed a higher prevalence of mental health care, depression, antidepressant use, and prior cannabis consumption compared to non-users (see Table 1</b>). The most common motivations for CBD use were stress/anxiety relief and peer recommendations. Notably, a large majority (81.8%) initiated CBD use without prior consultation with a healthcare professional.Table 1.

Mental Health and Substance Use Characteristics of CBD Users vs. Non-Users

Perceived efficacy varied by user profile. As shown in Image 1, 75% of cannabis users reported emotional improvement with CBD, while 73.3% of non-cannabis users did not perceive any benefit (p = .026). Similarly, participants with a history of depression were more likely to rate CBD as “very effective” (75%) compared to those without such history (25%), while 88.9% of those who found CBD ineffective had no depression history (p = .048).Image 1:

This study reveals a strong association between CBD use and mental health vulnerability, particularly among individuals with depressive symptoms or prior cannabis use. Compared to previous studies that emphasized insomnia or chronic pain as primary motivations, our findings highlight stress and anxiety relief as dominant factors. The high rate of unsupervised consumption underscores the need for regulatory oversight and public health education. These results align with prior research indicating increased self-medication behaviors among emotionally vulnerable populations and suggest that CBD may be perceived as a therapeutic alternative, especially by those already engaged in psychopharmacological treatment.

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Treatment-resistant depression (TRD) is one of the leading causes of global disability (1). This has spurred the search for more effective treatments for treatment-resistant depression (TRD), which is defined as a lack of response to two or more antidepressants and is associated with high morbidity and mortality, including suicide (2).

This has led to the search for more effective alternatives, especially intranasal esketamine. Esketamine has been shown to be more potent than ketamine for the NMDA receptor, allowing for lower doses and reducing dissociative effects. Approved intranasal esketamine has emerged as a promising option for TRD (1), although its high cost and the need for long-term follow-up are disadvantages.

To address an emerging treatment such as esketamine in a patient with TRD and consider its implications.

We conducted a literature review by searching for articles in PubMed.

Treatment with intranasal esketamine is discussed in a 77-year-old female patient with TRD. The patient had undergone several unsuccessful treatment attempts (antidepressants; augmentation strategies with quetiapine and aripiprazole; lithium; electroconvulsive therapy (ECT) was considered but was not feasible due to her implanted cardioverter defibrillator (ICD)).

The patient achieved significant improvement, with a reduction of more than 50% in MADR (Montgomery-Åsberg Depression Rating Scale) and HDRS (Hamilton Depression Rating Scale) scores after 24 weeks.

Clinical diagnosis: F33.2 Major depressive disorder, recurrent severe episode.

Plan:

• - Psychopharmacological treatment:

  • Desvenlafaxine 100 mg (1-0-0)

  • Desvenlafaxine 50 mg (1-0-0)

  • Lamotrigine 200 mg (1-0-0)

  • Mirtazapine 30 mg (0-0-1)

  • Clonazepam 0.5 mg (1/4-0-1/2)

• - Follow-up with your mental health team in psychiatric consultations.

Intranasal esketamine has been shown to be an effective and well-tolerated treatment with a remarkable rapid antisuicidal effect. Both ketamine and esketamine have been shown to be rapid and effective antisuicidal agents, making them useful in the management of patients in acute crisis (1).

However, their cost and need for long-term use require constant monitoring (2). In the case of our patient, this treatment has been effective for a period of 24 weeks.

Furthermore, although ECT remains a cost-effective option (3), in this case it could not be applied due to the presence of ICD in the patient (4). Preliminary evidence suggests that intravenous ketamine is non-inferior to ECT in its acute efficacy. The efficacy of intranasal esketamine versus ECT in TRD is still being evaluated (4).

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Multidomain interventions for dementia prevention have shown consistent benefits and have been standardized through the FINGERS model, with the cognitive dimension being particularly relevant. Computerized cognitive training is increasingly used, but its feasibility in Portugal – where many older adults have low educational levels and limited digital literacy – remains underexplored. This study analyses the cognitive component of DemenPrev, a Portuguese feasibility study adopting the FINGER model.

To evaluate (1) adherence to the computerized cognitive training program; (2) usability and satisfaction; (3) progression across cognitive domains; and (4) differences between initial and final platform assessments.

Twenty older adults with the mean age of 71.9 (SD=3.6) at risk for dementia participated. Seventeen participants were women (85%), and three were man (15%). The mean years of education were 9.7 (SD=4.0). Baseline assessment was conducted using three computerized exercises: Mind Bender (executive functions), Target Tracker and Double Decision (attention). Based on these results, individualized training plans were generated. Participants attended two 45–50 minute sessions per week over 12 weeks. Post-intervention, the same exercises were repeated for reassessment.

Adherence was very high (95.2%), and participants expressed strong willingness to continue. Significant improvements were observed in executive functions (Mind Mender, p=0.006) and attention (Target Tracker, p=0.004; Double Decision, p<0.001). Satisfaction parameters (motivation, engagement, demand, time, clarity) were rated from moderately to extremely satisfactory. Usability was highly rated by the group. (M=71.63).

Preliminary findings suggest that computerized cognitive training can improve executive functions and attention, with excellent adherence and high satisfaction among Portuguese older adults. While causality cannot be established without randomized controlled trials, these results support its potential as a promising non-pharmacological component of dementia prevention strategies.

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