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Tourette’s syndrome (TS) is a disorder characterized by repetitive, involuntary movements, and vocalizations known as tics. While there are existing treatment options, there is a growing need for novel pharmacological approaches to manage the symptoms of TS effectively. This study delves into the emerging field of using cannabinoids as a potential treatment for Tourette’s syndrome.
Objectives
The primary objectives of this review are to examine the current evidence base for the use of cannabinoids in the treatment of Tourette’s syndrome, to assess the biological rationale supporting the use of cannabinoids in managing tic severity, to provide insights into the results of existing clinical trials involving cannabinoids and Tourette’s syndrome, and to draw conclusions regarding the potential efficacy and safety of cannabinoid-based treatments for TS.
Methods
Narrative review of the available scientific literature.
Results
There is a strong biological rationale for how cannabinoids could impact tic severity. The endocannabinoid system plays a crucial role in regulating various physiological processes, including motor control and neurotransmitter release. Activation of cannabinoid receptors in the brain may modulate these processes, potentially reducing tics. While limited, two small randomized, placebo-controlled trials of THC have been conducted in TS patients. These trials suggested potential benefits of cannabis-derived agents in reducing tic frequency and severity. Self-report and examiner rating scales demonstrated significant improvements in tic symptoms. The trials indicated that THC treatment did not result in significant adverse effects in TS patients.
Conclusions
The exploration of cannabinoids as a treatment option for Tourette’s syndrome is promising but requires further investigation. The biological mechanisms through which cannabinoids may affect tic severity in TS are sound, suggesting their potential as a therapeutic option. Existing trials with THC have shown encouraging results, demonstrating a reduction in tics without significant adverse effects. However, the limited number of trials warrants caution in drawing definitive conclusions. Despite the promising findings, the overall efficacy and safety of cannabinoid-based treatments remain largely unknown. Further trials are essential to address dosing, active ingredients, optimal administration, and potential long-term effects. Clinical use should be approached with caution. While early evidence is encouraging, additional rigorous studies are needed to establish the safety and efficacy of cannabinoid-based treatments for this disorder.
A number of studies have demonstrated that hyperthyroidism increases the prevalence of psychiatric disorders and the likelihood of depressive symptoms, anxiety and hipomania. Apathetic hyperthyroidism is a syndrome, which presents with symptoms of depression, apathy, somnolence or pseudodementia in the absence of the usual symptoms and signs of hyperthyroidism. This condition is more common in the elderly although it has also been described in young adults and adolescents.
In the majority of cases, treatment of hyperthyroidism results in an improvement in neuropsychiatric manifestations in parallel with an improvement of psychical (somatic?) symptoms and psychotropic medication is deemed unnecessary.
Approximately one-third of patients with Graves’ hyperthyroidism are prescribed psychotropic drugs. Sometimes to treat mental symptoms like psychosis or severe agitation, sometimes to treat mental symptoms remaining after amelioration of hyperthyroidism, and sometimes when the diagnosis of Graves’ hyperthyroidism has been missed and the patient is treated as having a primary psychiatric disorder.
Objectives
To present a case of a patient with neuropsychiatric symptoms caused by thyroid dysfunction.
Methods
Case presentation and non-systematic review of existing literature on Pubmed using the following keywords: hyperthyroidism, psychiatric disorders, psychiatric symptoms, depression, psychosis.
Results
We report the case of a 21-year-old female without history of psychiatric illness who presented to the emergency department with somnolence, apathy, cognitive impairment (answering “I don’t know” to most questions), poverty of speech, abulia, perplexity and delusional belief of ruin, in addition to physical symptoms namely alopecia and weight loss. According to her father, she was very active and dynamic person until two days prior, when he started noticing growing apathy, leading to job absenteeism. Urine analysis for elicit drugs was negative.
Investigation for organic disease was undertaken and the blood analysis revealed overt hyperthyroidism.
She was initially treated with aripiprazol. After thyroid dysfunction was identified, she was evaluated by an endocrinologist and started treatment with tiamazol and propanolol, presenting gradual remission of the psychiatric changes. Aripiprazole was discontinued and she was reevaluated in psychiatry consultation after about a month, with complete remission of psychiatric manifestations and normalized thyroid function.
Conclusions
Neuropsychiatric manifestations of thyroid dysfunction are often misdiagnosed as a primary psychiatric disorder. It is necessary to optimize the medical management of these patients in whom the psychiatric symptoms masks a curable organic cause.
Irvin D. Yalom defines existential psychotherapy as a dynamic therapeutic approach that focuses on concerns rooted in existence with the four ultimate concerns being death, isolation, meaning in life, and freedom. Patients in advanced stages of cancer often experience elevated levels of psychological distress, encompassing conditions such as depression, anxiety, and a sense of spiritual hopelessness. Recently, interest in spiritual well-being has prompted a new wave of interventions that directly target this population, namely logotherapy and other existential interventions based on existential principles.
Objectives
In this review, the primary focus was to comprehend the current evidence on the application of existential psychotherapy for individuals coping with advanced cancer and give an overview of the therapy approaches used.
Methods
Narrative review of scientific literature using Pubmed search engine.
Results
Terao and Satoh identified nine types of existential psychotherapies which were investigated using randomized controlled trials for patients with advanced cancer or in terminal care: Meaning-Centered Group Psychotherapy (MCGP), Individual Meaning-Centered Psychotherapy (IMCP), Meaning-Making intervention (MMi), Meaning of Life Intervention, Managing Cancer and Living Meaningfully (CALM), Hope Intervention, Cognitive and Existential Intervention, Dignity Therapy, and Life-Review Interviews. All deal with the issues pointed by Yalom. Existential or spiritual well-being improvements were validated in MCGP, IMCP, Meaning of Life intervention, and Life-Review intervention.
Conclusions
Current evidence is still based on a very limited number of studies. Additional research is needed to delve into the impact of existential psychotherapy on individuals facing advanced cancer.
The Covid-19 pandemic has generated an unprecedented impact on multiple levels (health, occupational, economic, and social) which affected the general population and has been an enormous stress factor for individuals with obsessive-compulsive disorder (OCD), particularly for those with contamination symptoms. Many patients, as well as healthy individuals, experienced new obsessive-compulsive-like symptoms centered on COVID-19 during the pandemic. However, data on this population are still scarce.
Objectives
To present a case exemplifying the association between the Covid-19 pandemic and the onset of OCD.
Methods
Case presentation and non-systematic review of existing literature on Pubmed using the keywords: Covid-19, OCD, pandemic, depression.
Results
We report a case of a 30-year-old female who presented to the emergency department due to depressive mood and suicidal ideation associated with exacerbation of OCD symptoms, namely intense fear of being infected with Covid-19. These symptoms led to avoidance of touching objects, surfaces or even herself in addition to frequent and long rituals of hand-washing and showers. She was asymptomatic prior to being infected with Covid-19, when she started developing obsessive ideas of contamination. She sought psychiatric support and was medicated with fluoxetine, olanzapine and clonazepam. Due to insufficient symptom control, she was admitted to the psychiatry ward, where treatment was initiated with aripiprazol and fluvoxamine. After dose titration, gradual remission of OCD symptomatology and depressive mood was observed.
Conclusions
The present case illustrates the correlation between Covid-19 and the onset of OCD symptomatology. Existing studies demonstrate that the pandemic worsened the landscape of symptoms of OCD, both in diagnosed patients as well as in previously healthy individuals. However literature is still limited thus, multinational and cross-cultural, longitudinal studies are warranted to gain further insights on this topic.
A variety of peer support workers have been integrated in the mental health workforce in several countries. The effectiveness of this approach is still inconclusive. However, some data reveals promising results. Some projects have integrated peer support intervention in the treatment of psychosis. In fact, UK clinical guidelines for psychosis advise the inclusion of peer support within Early Intervention in Psychosis services.
Objectives
The current study aims to evaluate how peer support may assist the intervention in psychosis and highlight challenges ahead in this field.
Methods
Narrative review of the available scientific literature.
Results
Research suggests that consistent and frequent peer support enhances social support and boosts self-confidence and the overall quality of life for people going through psychosis. Individuals diagnosed with severe mental illnesses who receive peer support reportedly experience an increased sense of control, hopefulness, and empowerment, enabling them to initiate positive changes in their lives. People going through psychosis experience internalized stigma. Destigmatization of psychotic experiences is a central theme of intervention in psychosis. Participants viewed peer support as a valuable form of assistance that could offer advantages to both peers (service users) and peer support workers.
Conclusions
Peer support makes a strong contribution to destigmatising psychosis. The available date is promising and supports the effectiveness of peer support in such instances. As projects of peer support in psychosis continue to be implemented, further research should provide additional insight into the effectiveness and inherent challenges of this type of intervention.
Psychotherapy serves as the foundation of care for individuals with borderline personality disorder (BPD), with pharmacotherapy being regarded as a supplementary measure to be considered when necessary. In clinical practice, however, most of BPD patients receive medication.
A major problem in the treatment of BPD is the lack of compliance derived from the pathological impulsivity of BPD patients. The use of long-acting antipsychotics (LAI) may be an option.
Objectives
This work aims to address the use of long-acting injectables in borderline personality disorder.
Methods
Non-systematic review of literature using the PubMed ® database, based on terms “Borderline Personality Disorder” and “Long-acting antipsychotics”. Only six articles were found.
Results
Several studies have shown promising results in the treatment of Borderline Personality Disorder (BPD) with long-acting injectable (LAI) antipsychotics. A six-month study using IM risperidone demonstrated significant improvement, while LAI Aripiprazole also exhibited positive outcomes in individuals with BPD and Substance Abuse. Additionally, Palomares et al. (2015) found that palmitate paliperidone LAI reduced impulsive-disruptive behaviors and enhanced overall functioning in BPD patients. Carmona et al. (2021) compared oral and LAI antipsychotics and concluded that LAIs may have a role to play in the management of BPD.
Conclusions
Treatment with LAIs may play an important role in clinical and functional improvement in BPD patients.
Delusion of pregnancy (DP) is a heterogeneous symptom that can emerge from different neuropsychiatric syndromes, including schizophrenia, bipolar disorders, but also major neurocognitive disorder (MND). According to the Diagnostic and Statistical Manuel of Mental Disorders-5 (DSM-5), DP is an unspecified type of delusional disorder present in the spectrum of schizophrenia and other psychotic disorders This type of delusion, which can affect both sexes, may have numerous determinants to its genesis and may last decades to resolve.
Objectives
We aim to present a case and review of DP and its association with dementia/MND, hyperprolactinemia and galactorrhea.
Methods
Non-systematic literature review and case report, based on the search for titles and/or abstracts of articles that address both DP and dementia, and DP and hyperprolactinemia/galactorrhea, including articles published between 2010 and 2022 in English.
Results
A 71-year-old female patient was admitted to the Psychiatric unit due to a change in usual behavior in the past 6 months: insomnia, anterograde amnesia, delusions of ruin and persecutory and, for the past month, the belief of being pregnant with twins, supported by the galactorrhea she presented after starting Risperidone prescribed by her Family Doctor weeks prior. Shortly after admission, the patient also revealed hearing her fetuses’ voices. DP vanished briefly after admission due to the combination between the change of Risperidone to Aripiprazole (a prolactin-sparing antipsychotic) and psychotherapy to help deconstruct the patient’s cognitive misinterpretations. She was furthermore diagnosed with Alzheimer’s disease and Memantine was started.
Conclusions
This patient, according to Bera et al. (Bera et.al. Indian J Psychol Med 2015;37:131-7) is part of the 28.6% of patients more than 50 years of age who present DP, 6.0% that report having twins and 8.3% that report hearing voices of their fetuses. No data was found correlating DP and MND directly. Hyperprolactinemia and its consequent galactorrhea represent one of the many explanations behind DP, especially in suggestible demented patients that easily misinterpret somatic sensations, in which delusional thoughts are frequent and contribute to the morbidity.
UK guidelines advocate ‘one-stop’ neck lump assessment for cancer referrals. This paper reports the pilot of a novel pre-clinic ultrasound pathway, presents outcomes, and discusses strengths and limitations in the context of the coronavirus disease 2019 pandemic.
Methods
Two-week-wait cancer referral patients with a neck lump were allocated a pre-clinic ultrasound scan followed by a clinic appointment. Demographic, patient journey and outcome data were collected and analysed.
Results
Ninety-nine patients underwent ultrasound assessment with or without biopsy on average 8 days following referral. Patients were followed up on average 14.1 days (range, 2–26 days) after initial referral. At the first clinic appointment, 45 patients were discharged, 10 were scheduled for surgery, 12 were diagnosed with cancer, 6 were referred to another specialty and cancer was excluded in 19 patients. Retrospectively, four ultrasounds were performed unnecessarily.
Conclusion
Pre-clinic ultrasound scanning is an alternative to the one-stop neck lump pathway. This study demonstrates fewer clinic visits, faster diagnosis and a low proportion of unnecessary scans, whilst minimising face-to-face consultations and aerosol-generating procedures.
Kleptomania is characterized by recurrent failure to resist the impulse to steal items of little value despite the ego-dystonic impulse and awareness of the wrongfulness of the act. Its prevalence is considered to be 0.6–0.8% in the general population and it is mostly comorbid with other psychiatric disorders. Kleptomania is a disabling disorder since patients suffer from emotional distress and impaired functioning.
Objectives
Although there is no cure, treatment may help prevent Kleptomania worsening and its negative consequences. We propose a review of the therapeutic approach to this disease.
Methods
Non-systematic literature review.
Results
No effective treatment is available for Kleptomania. Better efficacy can be achieved by combining psychotherapy with pharmacotherapy. Different treatment interventions can be selected based on clinical similarities to other disorders, co-occurring conditions or behavioral core features. Patients with significant mood symptoms may benefit from mood stabilizers or antidepressants. For patients with shoplift cravings and/or family history of substance use disorders, Naltrexone may reduce symptoms. Stimulants may be useful for Kleptomania bassociated with Attention Deficit Hyperactivity Disorder impulsivity. Benzodiazepines are effective in tension relief when used as adjuvants, at the beginning of treatment. Electroconvulsive therapy should be reserved for patients with treatment-resistant symptoms and comorbid depression. Cognitive-behavioral therapy has replaced Psychoanalytic and Psychodynamic psychotherapies.
Conclusions
Treatment helps decrease disruption to the person’s life, preventing the intense shame, legal, social, family, and occupational repercussions of Kleptomania. Although pharmaceutical and psychosocial interventions are available, we still lack specific treatments for Kleptomania.
Epidemiological studies suggested that antidepressant usage amongst pregnant women increased by 3- to 7-fold in the past 2 decades and that up to 13% of fetuses are exposed to antidepressants. There are concerns regarding the impact of prenatal antidepressant use on the offspring.
Objectives
We aim to review more recent evidence of antidepressant use during pregnancy and the risk of autism spectrum disorder (ASD) in the offspring.
Methods
Non-systematic review based on the PubMed® database.
Results
A recent meta-analyses suggested children of mothers who used antidepressants during their pregnancy may be at a higher risk of ASD, compared to mothers who do not use these medications. Other suggested that the use of any antidepressants in the first 2 trimesters was related to significantly risk of developing ASD. Despite higher risks with the use of antidepressants, the absolute risk appears to be low. In addition, confounding factors should be considered while interpreting the results. Studies concluded that the comparator group selection strongly influences the observed antidepressant-ASD relationship. Associations derived from general population studies might have been mediated by unmeasured maternal psychiatric burden or transdiagnostic genetic liability. The observed increase in risk may also be associated with depression, not its treatment.
Conclusions
The findings of these studies have important implications, and often result in drug discontinuation with a significant impact on maternal and infant health. Future research should include investigation of the severity of depression in this association, assessment of antidepressant dose and use of antidepressants in pregnant women with other pathologies.
Delirium is characterized as a short-term consciousness and cognition disturbance which tends to fluctuate during the course of the day. It is a common and serious problem, mainly in hospitalized older adults, potentially avoidable and often poorly recognized.
Objectives
We propose an analysis on the theme through a work that evaluates the requests for psychiatric consultation made in a district hospital in Portugal during the course of 12 months.
Methods
We identified all patients on the requests for psychiatric consultation and obtained a demographic, clinical and consultation requests by medical specialties data and conducted statistical analysis using Excel.
Results
We identified 106 consultation requests, in which 41 cases were eventually diagnosed as delirium. Most (83%) were hyperactive delirium, 12% were hypoactive delirium and 5% were mixed delirium. Incidence was higher in males (59%) and in those aged between 66 and 80 years old (56.1%). Most consultation requests were made by Internal Medicine (46.3%), followed by General Surgery (26.8%), Pulmonology (14.6%), Orthopedics (9.8%) and Neurology (2.5%). Finally, we analyzed which symptoms mentioned in the request made physicians consider requesting a psychiatric evaluation. Approximately half of the cases (48.8%) reported psychomotor agitation, followed by temporal/spatial disorientation (41.5%) and aggressive behaviour (17.1%).
Conclusions
We highlight a still notorious lack of proper identification of delirium, resulting in symptoms being incorrectly interpreted as a psychiatric disorder. This may cause a delay in the adequate diagnosis and management of the condition, increasing the morbidity and mortality of patients.
The delusional misidentification syndromes (DMS) are uncommon but fascinating neuropsychiatric disorders. One particularly intriguing form of DMS is called the mirror sign or mirror delusional misidentification (MDM).
Objectives
We aim to present a case on MDM and a review on MDM and its correlation with neurological lesions.
Methods
Non-systematic review of the literature and case report.
Results
A 72 years old patient was admitted to the emergency department with disorientation, behavioral changes and persecutory delusional ideation. The patient was also unable to recognize his face in the mirror, claiming to be his son. On neuroimaging tests, the patient presented with moderate diffuse cortical-subcortical cerebral atrophy associated with mild diffuse cortical cerebellar atrophy, as well as atheromatous calcifications in carotid siphons. In the MDM, the patient treats the mirror image as separate from the self. It is commonly seen in patients with dementia. Unlike Capgras syndrome, MDM is typically associated with neurological illness, particularly with neurodegenerative conditions. Findings on neuroimaging have shown a pattern of right hemisphere cortical and subcortical lesions. the most common findings included the following: generalized or localized atrophy on Magnetic Resonance Imaging, ventricular dilatation on Computed Tomography scan, and slowing on Electroencephalography.
Conclusions
Mirror delusional misidentification differs from other forms of DMS as it is seen exclusively in patients with neurological disease. While right hemisphere dysfunction appears to be a requirement for MDM, patients with this condition do not show consistent enough neuroimaging findings to allow for a localization within the right hemisphere.
To evaluate the prevalence of diabetes mellitus type 2 in subjects with presbylarynx.
Method
A case–control, prospective study was carried out on consecutive subjects who presented to the otorhinolaryngology department.
Results
The study comprised 174 subjects (60 males and 114 females) with a mean age of 73.99 years (65–95 years). Presbylarynx was identified in 71 patients (41 per cent). Among patients with diabetes mellitus type 2, 20 patients (77 per cent) exhibited endoscopic signs of presbylarynx. A statistically significant difference was found between presbylarynx versus no presbylarynx concerning diabetes mellitus type 2 (p < 0.001). Subjects with diabetes mellitus type 2 were approximately eight times more likely to have presbylarynx compared to subjects without diabetes mellitus type 2.
Conclusion
In this study, 77 per cent of patients with diabetes mellitus type 2 had endoscopic signs of presbylarynx. A multivariable analysis, which took into account co-morbidities of the elderly, identified diabetes mellitus type 2 as a possible risk factor for presbylarynx. Many physiopathological mechanisms might explain this result, as diabetes mellitus type 2 is known to affect muscular, neurological and vascular systems.
Perinatal death includes losses such as ectopic pregnancies, miscarriages, stillbirths and neonatal deaths. Perinatal loss has well documented negative effects on the health of the bereaved parents. Early pregnancy loss (EPL) is the spontaneous death of a fetus within the first 20 weeks of gestation.
Objectives
To describe a clinical case of disenfranchised grief following EPL and to review the literature.
Methods
We reviewed the clinical file of a patient presenting to the psychiatry outpatient clinic with disenfranchised grief. We conducted a non-systematic review on PubMed and Google Scholar.
Results
A 29-years-old female patient presents to the outpatient clinic with depressive symptoms and thoughts of death. The symptoms had begun 4 months earlier, following the loss of pregnancy at 14 weeks. She felt her grief was not accepted by her family and social network. Progressively, her relationships deteriorated, and she felt more and more isolated. She experienced marked difficulty in caring for her older child. Compared to other types of mourning, the loss of a child is associated with grief experience that is particularly severe and complicated. Despite the high prevalence of EPL, many women suffer in silence due to the common belief these losses are insignificant and may develop complicated grief.
Conclusions
Perinatal loss of an infant has the potential to have a large impact on the mental health of the bereaved parents. Literature on the efficacy of different interventions is still scarce. Further studies are necessary on prevention strategies and interventions for parents already suffering from complicated grief or depressive disorders.
In early 2020, governments started to implement different forms of public health measures, from physical distancing recommendations, to stay-at-home orders, to limit the propagation of COVID-19. Here we report the case of a 41-year-old woman, with a diagnosis of panic disorder. During the end of the lockdown, the patient presented psychopathological worsening, from her fear of Covid-19 infection, stemming from a heart failure disease and concerns regarding the hygiene and safety measures of those around her.
Objectives
Presentation of a clinical vignette.
Methods
Selection and analisis of clinical case and review of the literature using PubMed database.
Results
The COVID-19 pandemic and the measures adopted to prevent the spread of the disease had a huge impact on a personal, social, and economic level for the world population. The rise of fear and anxiety among people due to uncertainty about the disease are coupled with essential yet disruptive measures such as lockdowns and quarantines. The chronically ill population are especially vulnerable during such circumstances and require addressing their physical health and any psychological difficulties they might experience, being at higher risk of suffering physically from the pandemic’s disease as well as psychologically from the implemented countermeasures.
Conclusions
This vignette provides a case where a person’s psychiatric conditions are worsened due to the end of a pandemic lockdown, rather than the lockdown itself. Additional work should aim at comparing the experiences of the different countries affected by the pandemic in order to understand the size of the psychological impact, the potential risk and protective factors.
Tourette’s syndrome is a neuropsychiatric disorder marked by motor and phonic tics frequently associated with psychiatric comorbidities, beginning in childhood. While most cases improve or resolve with age, some are refractory.
Objectives
To review new strategies for the management of Tourette’s Syndrome, following an outpatient clinical vignette.
Methods
We performed a review based on the PubMed® database.
Results
A 50-years-old female patient with a long-term outpatient psychiatric follow-up presented with motor tics appearing in adolescence, including winking and facial grimacing, as well as episodes of coprolalia. Over the years, she developed an anxiety disorder and social isolation. In addition to psychological therapy, pharmacological therapy had already been approached with the use alpha-adrenergic agonists and several antipsychotics, such as risperidone and aripiprazole, with the patient showing only partial response to pimozide. In Tourette’s syndrome, the therapy must be adequate to the patient’s individual needs. Emerging treatments for refractory cases, such as anticonvulsants, cannabinoids or antiglutamatergic drugs have been the target of several studies. Botulinum toxin injections are particularly effective in patients with focal motor tics and complex phonic tics. Non-pharmacological treatment options, such as electroconvulsive therapy and deep brain stimulation may prove effective in some cases.
Conclusions
A significant proportion of patients fail to respond to conventional strategies. Thus, new pharmacological and non-pharmacological therapies are on the horizon and may represent an important step in treatment algorithms for refractory cases in the future.
Rates of cannabis use among pregnant women have been increasing. Psychiatrists may be required to provide counselling regarding marijuana use in pregnancy for their patients.
Objectives
To produce an up-to-date review of cannabis effects on pregnancy and the offspring.
Methods
We performed a non-systematic review of the literature apropos a clinical case.
Results
A 31-years-old, 22-weeks pregnant woman presented with severe anxiety, panic attacks and insomnia which she managed solely with cannabis. She had been previously treated with antidepressants and benzodiazepines with symptom remission but had suspended before her pregnancy without medical advice. She believed medication was more harmful to the baby than her cannabis use. There is little perception of risk concerning cannabis use in pregnant woman. Information on cannabis use is less likely to be obtained from healthcare providers than from anecdotal experiences, Internet searching and advice from friends and family. Prenatal use of cannabis has been associated with anaemia in the mother, whereas in the offspring it is associated with reduction in birth weight and greater likelihood of placement in intensive care units. There is insufficient evidence to support an association between marijuana use and any specific congenital abnormality, but also to demonstrate its safety.
Conclusions
It is essential for psychiatrists to have up-to-date knowledge of the effects of cannabis on the pregnancy and the offspring to properly counsel their patients. However, the effects of cannabis on maternal and foetal outcomes remain generally unknown. With rising numbers of female users, there is urgent need for further research.
Coronavirus disease 2019 (COVID-19) pandemic has had a negative impact for mental health. ULS-Guarda in cooperation with Portugal National Health Service, provided the population of the district of Guarda with a mental health helpline (MHHL).
Objectives
Provide a descriptive data analysis of the MHHL calls received between April 1st and September 20th of 2020.
Methods
The data was obtained through the filling out of questionnaires. It included fields for gender, age, the type of service provided, relation to COVID-19, symptoms displayed and the number calls made per patient. For the statistical analysis, Microsoft Excel TM was utilized.
Results
MHHL received 191 calls. The largest volume was received during April, which saw 116 instances of patients seeking the MHHL. The number of calls then tapered progressively throughout the following months. The services provided were split between psychiatric assistance, psychologic assistance, and the renovation of medical prescriptions, in 44%, 31% and 19% of the cases, respectively. The 101 patients who resorted to the MHHL were unevenly distributed in gender, being 74 female and 27 male individuals. Their ages were mostly between 50 and 69 years old. The most common symptoms were anxiety, depressed humor and insomnia, in 35%, 16% and 11% of the cases, respectively.
Conclusions
The largest influx of calls coincides with the home confinement period, and decreased alongside the relaxation of the confinement measures held. The MHHL had enough adherence to warrant consideration of it being an alternative means of healthcare access, especially in situations where physical access to healthcare is restricted.
The mental health impact of the COVID-19 pandemic is well documented. Portugal entered the emergency state on 19th march due to rising numbers of infected patients. The emergency state introduced regulatory measures that restricted people’s movements, applied a curfew, and closed most non-essential spaces and activities, such as shops and religious celebrations.
Objectives
To evaluate the rates of suicides during the emergency state in Portugal.
Methods
We obtained the number of probable suicides during 19th march and 2nd may 2020, 2019 and 2018 from SICO/eVM (Real Time Mortality Electronic Surveillance). This system is used for health planning in Portugal and provides provisory data which is updated every 10 minutes. ExcelÒ was used for the statistical analysis.
Results
During the Emergency State in Portugal there were 57 probable suicides. Comparing to the same period in 2018 and 2019, there were 62 and 70 probable suicides, respectively. Social isolation, anxiety, fear of contagion, chronic stress, and economic difficulties may lead to the development or exacerbation of depressive, anxiety, substance use, and other psychiatric disorders. Literature on suicides due to COVID-19 mention not only fear of infection, but also social isolation and distancing and economic recession as causes for suicide attempts and completions.
Conclusions
During the emergency state there was not an increase of probable suicides, compared to previous years. The greater vigilance of people’s movements may have deterred many attempts. However, policymakers and health care providers must be alert as the current psychosocial predispose to an increase in suicide rates.
Electroconvulsive therapy (ECT) presents itself as a highly effective therapeutic approach in various psychiatric conditions, especially affective disorders and catatonia. Although obsessive-compulsive disorder (OCD) is not an established indication for ECT, there are several positive results that have been replicated, giving us an account of its potential applicability.
Objectives
To emphasize the importance of defining predictors of response to ECT in OCD.
Methods
The authors’ clinical experience is combined with the review of clinical cases, available in the literature, related to the application of ECT in OCD.
Results
Personal or family history of affective pathology and obsessions of sexual content were identified as potential predictors of response to ECT in patients with obsessive and compulsive symptoms.
Conclusions
Although preliminary and based solely on case reports, the replicability of results should promote special attention to situations in which OCD is marked by particular characteristics that favor the response to ECT. In this way, it would be possible to prevent the dragged consumption of health resources and minimize the expected chronicity associated with this clinical condition.