Background:Nowadays, sleep-related problems are a prevalent occurrence among university students. Poor sleep quality is one of the most studied aspects of sleep complaints, affecting from 10% to 50% of this population. Poor sleep quality consequences are many and have a profound impact in the student's psychobiological health. University students live through a period of psychological challenge and adaptation, since the transition from high school to professional life. Abrupt autonomy challenges students to deal with many choices, from their academic and social life to their intimate habits. Frequently, sleep hygiene is neglected, or they are unable to use proper coping mechanisms, resulting in disturbing consequences that could impact their lives as adults. Research has found a significant association between sleep quality and depression or depressive symptoms, but this relationship is still somewhat difficult to interpret.Objective:The objective of this review is to appraise the current knowledge around the relationship of sleep with depression in this group of young adults. Data Source: Articles included in Medline database.Methods:After a careful search, the articles selected aimed mainly college students. The studies had sleep quality and depression objectively assessed, focused in the relationship between both, and addressed possible influencing factors.Results:The current literature still supports a bidirectional relationship between sleep and depression, however, the importance of sleep quality is becoming a very relevant variable.Conclusion:Education and the application of policies regarding sleep hygiene may prevent, in some cases, the development of depression and improve the quality of sleep in other cases. Future research should clarify the relationship between sleep problems and depression in a way they could be prevented or, at least, minimalized with effective and achievable interventions.

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This study focused on neurocognitive disorders associated with HIV infection, characterizes the most affected neuropsychological domains and their potential as factors related with depression. 130 HIV-positive individuals with CD4 [200 cells/mm 3 , undetectable viral load, treated with HAART and with all kinds of risk behaviors were included. A structured interview composed by seven sections was used and relevant clinical and laboratory data was assessed. For the neuropsychological and depression assessment the HIV Neurobehavioral Research Center (HNRC) Battery and Hamilton Rating Scale for Depression (HAM-D) were chosen. Univariate nonparametric statistics and multivariate regression model were performed. Among 34% of depressed subjects, 20.7% had attempted suicide, 45.4% were under psychiatric medication and only 19% had no diagnostic criteria for HIV Associated Neurocognitive Disorders (HAND). The effect of depression on cognitive function revealed a significant deterioration in five of the eight measures. In the multivariate analysis, five variables significantly determined depression: sex, social class, antidepressant medication, history of suicide attempt and Dexterity and motor speed (neuropsychological test battery). Despite good patient adherence to treatment (HAART and antidepressive) and good immune status, the prevalence of HAND and depression are high and suggest a significant relation between severity of depression and cognitive functioning.Resumen Este estudio se centra en los trastornos neurocognitivos asociados a la infección por el VIH, caracteriza los dominios neuropsicológicos más afectados y su potencial relación con la depresión. Fueron incluidos en el estudio 130 individuos VIH-positivos con CD4[200 células/mm 3 , carga viral indetectable, medicados con HAART abarcando todos los comportamientos de riesgo. Fue utilizada una entrevista estructurada compuesta por siete secciones y se evaluaron los datos clínicos y de laboratorio. Para la evaluación neuropsicológica y la depresión fueron elegidas la batería de lo HNRC (HIV Neurobehavioral Research Center) y la Escala de Hamilton para Depresión (HAM-D). Se utilizaran estadísticas univariantes no paramétricas y el modelo de regresión multivariante. Entre el 34% de los sujetos deprimidos, el 20,7% había intentado suicidarse, el 45,4% hacían medicación psiquiátrica, y sólo el 19% carecía de criterios para el diagnóstico trastornos neurocognitivos asociado al VIH (HAND). El efecto de la depresión sobre la función cognitiva revela un deterioro significativo en cinco de las ocho medidas. En el análisis multivariado, cinco variables se asocian significativamente con la depresión: el sexo, la clase social, los medicamentos antidepresivos, la historia de intentos de suicidio y la destreza y velocidad motora (batería neuropsicológica). A pesar de buena adherencia de los pacientes al tratamiento (HAART y antidepresivos) y del buen estado inmunológico, la prevalencia de HAND y depresión son altas y sugieren una relación significativa entre la gravedad de la...

Objectives We aimed to describe and correlate the hospital panorama of psychotic disorders (PD) with cannabis use (CU) trends in all Portuguese public hospitals. Methods We conducted a retrospective observational study that analysed all hospitalizations that occurred in Portuguese public hospitals from 2000 to 2015. Hospitalizations with a primary diagnosis of PD or schizophrenia were selected based on Clinical Classification Software diagnostic single‐level 659. Episodes associated with CU were identified by the International Classification of Diseases Version 9, Clinical Modification code 304.3/305.2 that correspond to cannabis dependence/cannabis abuse. Results The number of hospitalizations with a primary diagnosis of PD and schizophrenia associated with CU rose 29.4 times during the study period, from 20 to 588 hospitalizations yearly (2000 and 2015, respectively) with a total of 3,233 hospitalizations and an average episode cost of €3,500. Male patients represented 89.8% of all episodes, and the mean/median age at discharge were 30.66/29.00 years, respectively. From all hospitalizations with a primary diagnosis of PD or schizophrenia, the ones with a secondary diagnosis of CU rose from 0.87% in 2000 to 10.60% in 2015. Conclusions The increase on secondary diagnosis coding and the change on cannabis patterns of consumption in Portuguese population with an increasing frequency of moderate/high dosage cannabis consumers may explain the rise on PD hospitalizations.

The aim of our study was to evaluate the impact of coffee intake on cognitive function in persons living with HIV (PLWH). 130 PLWH with CD4 > 200 cells/mm(3), undetectable viral load, treated with HAART were included. A structured interview was applied and relevant clinical and laboratory data were assessed, including coffee intake. For neuropsychological assessment, the HIV Neurobehavioral Research Center Battery was chosen. Univariate nonparametric statistics and multivariate regression model were used. A significant association between espresso coffee use and a better cognitive function was verified in five of the eight psychometric measurements. In the multivariate analysis, after variable adjustment, linear regression analysis showed that coffee intake was a positive predictor for attention/working memory, executive functions and Global Deficit Score. Although the mechanisms behind the influence of caffeine on cognitive functioning are controversial, regular espresso coffee intake may have favourable effects on cognitive deterioration caused by HIV.

IntroductionManagement of HIV/AIDS “worried well” people is among the most complex and challenging psychiatric problems in HIV care.ObjectivesTo provide an overview of HIV/AIDS “worried well”.MethodsLiterature review based on PubMed/Medline, using the keywords “HIV” and “worried well”.ResultsThe HIV/AIDS “worried well” are those individuals who are intensely worried about being infected with HIV, despite overwhelming evidence to the contrary. Indeed, they will rapidly return with the renewed conviction that the physician has “got it wrong” or “missed something”. So, they tend to over-utilize health care services. Seven HIV/AIDS “worried well” sub-groups have been identified: those with past sex or drug use history; those with relationship problems; the partners/spouse of those at risk; couples in individual or family life transitions; past history of psychological problems; misunderstanding of health education material; and pseudo and factitious AIDS. These patients have several striking consistencies in their presenting phenomenology and background features and usually have psychiatric problems associated. The authors will analyze all these aspects. Currently there are no guidelines to deal with this clinical condition, however cognitive-behavioral therapy along with selective serotonin reuptake inhibitors has been an effective approach. It is also important to ensure follow-up discussion to these patients, especially where unresolved life issues may cause future vulnerability in absence of intervention.ConclusionsPatients may express their concerns about HIV infection by several ways, directly or indirectly, and psychiatrists need to be aware of this reality, which causes much suffering as well as severe monetary loss.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionEfavirenz, a non-nucleoside analogue inhibitor of the reverse transcriptase, has become commonly used in the treatment of HIV infection. Although highly effective, efavirenz is associated with causing neuropsychiatric side effects in approximately 50% of patients.ObjectivesTo provide an overview of efavirenz-induced neuropsychiatric effects.MethodsLiterature review based on PubMed/Medline.ResultsThe neuropsychiatric side effects of efavirenz usually begin quickly, commonly peak in the first two weeks after the start of therapy, and can include depression, anxiety, sleep disturbances, impaired concentration, aggressive behavior, paranoia, psychosis. Generally, these events are mild to moderate in severity and time limited, however, in a small number of cases, are late, persistent or intolerable. They are often associated with a negative impact on treatment adhesion. Some factors are known to increase the risk of neuropsychiatric effects in HIV-positive patients. The behavioral effects of efavirenz appear to be dose-dependent and mediated predominately by the 5-HT2A receptor, a primary site of action of lysergic acid diethylamine (LSD). Importantly, the efavirenz-induced neuropsychiatric effects may be difficult to distinguish from HIV-related neuropsychiatric symptoms, preexisting mental disorder or substance use. The neuropsychiatric effects should be treated with non-pharmacologic or pharmacologic interventions, according to severity. The psychiatric status of patients should be closely monitored for at least the first 6 to 12 months of treatment.ConclusionTaking into account the high rates of neuropsychiatric side effects, it is crucial that the physicians are familiar with this important subject, and the decision to initiate efavirenz in psychiatric patients is individualized.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionHIV infection is a chronic disease characterized by a great deal of uncertainty and unpredictability, being anxiety disorders a frequent psychiatric problem.ObjectiveTo provide an overview of anxiety in HIV-infected patients.MethodsLiterature review based on PubMed/Medline, using the keywords “HIV” and “anxiety disorders”.ResultsHIV-infected individuals can experience symptoms of anxiety across the spectrum of anxiety disorders. Adjustment disorder with anxious mood is the most common diagnosis, followed by generalized anxiety disorder and panic disorder. Some patients present with these disorders prior to notification, others develop them during the course of their illness, mainly at key moments. In HIV-infected patients, anxiety can be a manifestation of side effects of medication; a symptom of an illness associated with HIV disease; or, most commonly, the psychological response to the stressors of the illness. In fact, many issues are responsible for the anxiety experienced by people living with HIV. The authors will analyze them. Besides the distress of anxiety disorders, these lead to a decrease in adherence to antiretroviral treatments, resulting in adverse progression of HIV disease and increased risk of mortality. Importantly, however, appropriate psychiatric intervention can do it over.ConclusionsCareful diagnosis and treatment of anxiety disorders in the context of HIV disease is even important, given the serious effects if untreated. Thus, anxiety should never be seen simply as a natural reaction to a life-threatening illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.