The coronavirus disease 2019 (COVID-19) pandemic is an unprecedent public health crisis, transforming many aspects of our daily life. Protection measures, such as social distancing, nationwide lockdowns, and restrictions on hospital visits and funerals have a serious impact on how people mourn their loved ones. The grieving process during childhood and adolescence evolves along the developmental stages and is a dynamic, non-linear process that needs time. Parental death increases the risk for psychopathology in the short and long term. We present a case of an 11-year-old girl referred to child psychiatry-liaison service by her neurologist due to peer relationship problems and sadness. Fifteen days before her first psychiatric consultation, her father suffered a myocardial infarction complicated with hypoxic ischemic encephalopathy, and he was hospitalized in the intensive care unit. Positive coping mechanisms and adaptive emotional expression strategies were explored during her consultations. Her father died 2 weeks after emergency state and nationwide lockdown was declared in Portugal, during the first COVID-19 outbreak. The family did not have the opportunity for a proper farewell, the funeral obeyed strict rules, and the patient and her family were at home, due to social distancing and school closure policies. Consultations were maintained by telephone calls and, less frequently, by face-to-face appointments. Adaptive and helpful strategies to grieve were shared with the patient and her mother. Intervention with the mother alone was also helpful. Death circumstances related to COVID-19, confinement policies, and social–economical stressors can intensify the grief experience, increasing the risk for complicated grief. Although psychiatric teleconsultation is essential during COVID-19 pandemic, it poses various limitations. Non-verbal communication clues may not be totally apprehended; it may represent a problem in the therapeutic relationship, and access to technology can be difficult for psychiatric patients and clinicians. COVID-19 pandemic policies should include mental health protection measures, which should facilitate adjusted grief responses for those who lose a loved one during this pandemic.
Several studies indicate that over 25% of child and adolescent inpatients were readmitted within one year of discharge. Several risk factors for psychiatric readmissions have been reported in the literature, but the history of repeated readmissions is the most consistent risk factor. Our aim is to calculate the readmission rates at 30 days and 12 months after discharge and to identify associated risk factors. Material and Methods:The authors consulted the clinical files of patients admitted to the Inpatient Unit between 2010 and 2013, in order to calculate the readmission rates at 30 days and at 12 months. The demographic and clinical characteristics of the readmitted patients were analyzed and compared with a second group of patients with no hospital readmissions, in order to investigate possible predictors of readmission. Results: A total of 445 patients were admitted to our inpatient unit between 2010 and 2013. Six adolescents were readmitted in a 30 days period (1.3%) and 52 were readmitted in a 12 month period after discharge (11.5%). Duration of the hospitalization and the previous number of mental health admissions were significant predictors of future hospital readmissions (p = 0.04 e p = 0.014). Discussion: The low readmission rates may reflect the positive clinical and sociofamilial support being provided after discharge. Conclusion: Rehospitalisation is considered a fundamental target for intervention concerning prevention and intervention in mental healthcare. Thus, knowledge regarding their minimisation is crucial. Keywords: Adolescent; Hospitalization; Mental Disorders; Patient Readmission; Portugal; Psychiatric Department, Hospital; Risk Factors INTRODUÇÃOA maioria das perturbações mentais tem uma evolução crónica, marcada por várias recaídas, pelo que alguns reinternamentos psiquiátricos são inevitáveis.1 Vários estudos indicam que mais de 25% das crianças e adolescentes internados foram readmitidos dentro de um ano após a alta.
Caffeine is the most commonly used psychoactive substance worldwide, being daily consumed by approximately 80% of the world's population. It may be found not only in the form of beverages and food but also as pharmacologic preparations. Caffeine's consumption is implied in many psychiatric manifestations, from anxiety bursts to psychosis. This symptomatic variation is not only dose-dependent but also affected by various individual factors. Caffeine is a methylxanthine that exerts its primary action in the Central Nervous System (CNS) as an antagonist of the adenosine receptors A 1 and A 2A , altering the release of neurotransmitters such as dopamine and glutamate. It also interferes with olanzapine and clozapine's hepatic metabolism, increasing its seric levels. Caffeinism is considered when the daily dosage of caffeine consumed is 600-750 mg. Some studies report that dosages above 750 mg/daily may precipitate or exacerbate psychotic symptoms, as well as increase the resistance to neuroleptic treatment. Moreover, it has been demonstrated that patients diagnosed with schizophrenia have significantly larger consumptions of caffeine than other diagnostic groups. Different factors may sustain this, as the relief of side effects due to neuroleptic medication and as a social facilitator.
Introduction: Corticosteroids have been widely prescribed in routine clinical practice and physicians have long known their many side effects. These include metabolic syndrome, osteoporosis, glaucoma, cataracts, peptic ulcers and psychiatric symptoms. Psychiatric side effects from corticosteroids include mania, depression and mood disturbances. Objectives: Description of a 75 year old female patient's case study, without previous psychiatric history, diagnosed with bronchopneumonia and requiring treatment with prednisone 40mg daily. Since the first week of treatment she reported behaviour changes such as episodes of elevated and irritable mood, pressured speech, insomnia, jealousy and megalomania delusions. These symptoms worsened, leading to admission in a psychiatric hospital. Methods: Revision of the scientific literature through Pubmed, using search terms including corticosteroids, mania, depression, psychosis and mood. The research was complemented with information from Uptodate. Results: Prednisone was suspended and the patient began treatment with Olanzapine, starting with a dosage of 5 mg daily at night, reaching a maximum of 10mg. The patient recovered complete euthymic mood and reverted to normal functioning. These results support the theory that this psychopathologic state was induced by the corticotherapy administered previously. Conclusions: Corticosteroids are usually associated with psychiatric disorders and cognitive symptoms. Mania symptoms are the most important manifestations of corticosteroids-induced psychiatric toxicity. It usually occurs within the first two weeks of therapy and it seems to be dose-related. Clinicians should be aware of these facts and carefully monitor patients for psychiatric and cognitive side effects of corticosteroid use.
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