IntroductionThe diagnosis of psychosis is based on the presence or absence of characteristic symptoms. The presence of such symptoms varies during the course and treatment, raising the question of diagnostic stability after a first psychotic episode.Aims and objectivesThe aim of this study is to evaluate the diagnostic stability after a first psychotic episode in the long term (five years after the first inpatient admission).MethodologyA retrospective study that included patients with first psychotic episode between 2007 and 2011 admitted to the inpatient unit of the psychiatry and mental health clinic of São João hospital center, Oporto, Portugal and re-evaluation of the diagnosis after five years.ResultsWe included 60 patients with a first psychosis episode, 22 of which were drop-outs after five years. Of the 38 patients evaluated, it was possible to see that after 5 years 68.4% (n = 26) maintained the same diagnosis during follow-up. In particular, the diagnosis of schizophrenia was kept in 83.3% of patients after 5 years (n = 15, 18 patients with the diagnosis of schizophrenia after first admission). Diagnosis of acute and transient psychotic disorder and psychosis not otherwise specified were the least stable diagnosis after 5 years.ConclusionsThe diagnosis after a first psychotic episode has important therapeutic and prognostic implications. The presence of characteristic symptomatology, with periods of partial or total remission between subsequent episodes emphasizes the need for regular monitoring, since this group of patients appears to be more vulnerable to changes in diagnosis over time.Disclosure of interestThe authors have not supplied their declaration of competing interest.
IntroductionThe clinic of psychiatry and mental health of São João hospital centre (Oporto, Portugal) has implemented a psychiatric consultation to support college students since 2007. This consultation is open to all of the universities in the metropolitan area of Oporto.Aims/objectivesThis specific consultation aims to detect and intervene early in the treatment of psychiatric illness and to promote mental health in this specific population.MethodsRetrospective study conducted in the São João hospital centre, Oporto, Portugal. Patients attending university student's specific consultation between January 1st 2011 and March 31st 2016 were included. Data collection included sociodemographic variables, clinical diagnosis (ICD-10, WHO, 1992) and psychological scales (WAIS-III, BSI, HADS, SF-36 and NEO-PI-R). SPSS® software (v. 20.0, 2011) was used for statistical analysis.ResultsIn this study, 139 patients were included (66.2% female, medium age 23.1 years old). The majority of patients were medical, engineering or nursing students (respectively 20.9%, 18.0% and 17.9%). The most frequent diagnosis was adjustment disorders, anxiety disorders, mood disorders and personality disorders. 54.6% completed all the psychological scales.ConclusionsThe number of students with mental health issues is increasing. Early detection and treatment of these pathologies may allow improvements on the educational, economic and social levels, as well as in the quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.
IntroductionHIV-infection is a very stigmatized, chronic disease with increased rates of psychiatric disorders, being major depression the most common.ObjectiveTo review the recent research related to depression in HIV-infected patients.MethodsLiterature review based on PubMed/Medline, using the keywords “HIV” and “depression”.ResultsHIV-infected patients have a chance 2-7 times higher of developing major depression, around the time of diagnosis or during the course of their illness. However, only fewer than 50% of the cases are recognized clinically. Several factors contribute to its under-recognition and under-treatment, such as the overlap between the neurovegetative symptoms of depression, the somatic symptoms of HIV disease, and the effects of comorbid diseases; the mistaken belief that depressive symptoms are expected in this group; the neuropsychiatric side effects associated with some antiretrovirals. Besides, major depression presents important diagnostic challenges due to biological, psychological, and social components associated with the infection. The authors will analyze the clinical presentation.Depression has been associated with a negative impact on quality of life, poorer HAART adherence, faster HIV disease progression and increased mortality risk. Importantly, however, appropriate psychiatric intervention can do it over. In fact, studies suggest that patients receiving SSRI treatments for depression have rates of adherence and CD4+ T-cell counts similar to non-depressed patients receiving HAART.ConclusionsThe high prevalence of major depression in HIV-positive individuals and its serious consequences if untreated, increase even further the importance of its effective identification and subsequent treatment in this group of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Background: For Bleuler, late-onset schizophrenia (LOS) was characterized by onset after age 40, symptoms similar to the classic form and absence of signs of organic brain disease. We aim to describe the current aetiology, diagnosis and treatment of LOS, emphasizing the differences between LOS and classic schizophrenia.Methods: Non-systematic review of original articles and systematic reviews regarding late-onset schizophrenia aetiology, diagnosis and treatment indexed to Pubmed, ISI -Web of Knowledge, Scopus and EBSCO published between January 1980 and December 2017, using the MeSH query: schizophrenia AND late onset disorders. Altogether, 62 articles were deemed relevant by two independent reviewers and included in the final selection.Results: 23% of the cases of schizophrenia have late-(> 40 years) or very late-onset (> 60 years), with higher incidence in females. Genetic factors, menopause, sensory deficits, vascular and neurodegenerative lesions, and age per se are risk factors. Higher educational levels and marital rates and greater cognitive reserve stand out. Well systematized persecutory and jealousy delusions and auditory hallucinations are common. On the contrary, negative symptoms are uncommon. Cognitive functions are well preserved in the first year, but high rates of dementia are described after fiveyear follow-up. Due to the protective effect of oestrogen, LOS appears to have a worse prognosis in postmenopausal women. Despite the anti-psychotic drugs available, most patients remain symptomatic. Conclusion:There is a significant overlap between early-onset schizophrenia and LOS/very-late onset schizophrenia-like psychosis (VLOSLP), but there are important differences mainly regarding risk factors and symptoms that cannot be overlooked. Seventy-five years after the first description, it is necessary to better define LOS/VLOSLP as a debate identity.
INTRODUCTION: Eating disorders with cutaneous manifestations are common, but scurvy is an extremely rare complication of anorexia nervosa. Human body is not able to produce vitamin C, so he must obtain it from dietary intake. Clinical manifestations occur after vitamin C has been eliminated from the diet for 2-3 months and when the body pool is below 350 mg. OBJECTIVES: To report a clinical case of scurvy in a female patient with restricting type of anorexia nervosa and emphasize the risk of poor vitamin C intake in developing a disease that might have a fatal outcome. METHODS: Case report and systematic review of literature. Case Report: We report a clinical case of a 21 year-old woman with restricting type of anorexia nervosa, who developed ecchymosis and petechiae on the torso and legs, pedal edema, anemia normocytic normochromic and symptoms such as fatigue, weakness. The diagnosis of scurvy is usually based on clinical findings and dietary history, with therapeutic evidence as soon as vitamin C supplementation begins. After two weeks of treatment the cutaneous signs fully disappeared. RESULTS: When scurvy is diagnosed early, the condition can be readily treated, so we should be aware of this disease in anorexia nervosa, so that we can intervene quickly and ameliorate the clinical status. CONCLUSIONS: Although scurvy is regarded by many as a disease from the past we should be conscious of its existence in developed countries as a nutritional consequence of poor intake in anorexia nervosa.
IntroductionLyme disease, caused by the spirochete Borrelia burgdorferri as recognized as a possible cause of multisystemic signals and symptoms, including symptomatology of the central as well as the peripheral nervous system.ObjectivesIdentification of neuropsychiatric symptoms associated with Lyme disease.MethodsLiterature review in the light of researched articles published in Pubmed/Medline as well as related bibliography.ResultsSince the identification of the etiology of syphilis in the early twentieth century, mental health professionals consider the fact that serious psychiatric symptoms can be caused by infections of the central nervous system and that early antibiotic treatment can prevent permanent neurological/psychiatric damage. Syphilis was known as “the great imitator” because its multiple manifestations mimic other known diseases. In recent years, a new epidemic, also with multiple manifestations emerged–Lyme disease, also known as the “new great imitator”. Like syphilis, Lyme disease may be associated with neuropsychiatric symptoms, which means that often these cases are initially referred for psychiatric services, before another diagnosis is made. The incorrect assessment of these patients as individuals with functional psychiatric disease can result in a delay in the start of antibiotic treatment and may cause serious neurological and psychiatric damage.ConclusionsAccording to the review, the authors propose that in the evaluation of acute psychiatric disease or atypical chronic disease, with poor therapeutic response, Lyme disease should be considered and ruled out, especially if there is epidemiological context and absence of psychiatric family antecedents.Disclosure of interestThe authors have not supplied their declaration of competing interest.
IntroductionThe Psychiatry consultation is a collaborative approach between primary health care services and community mental health teams. Our clinic provides support to three Oporto areas (Bonfim/Paranhos, Campanhã and Maia/Valongo) corresponding to a population of 350,000 inhabitants.ObjectivesTo analyze and collect Psychiatry consultation data of the first semester of 2015 in Maia/Valongo region. We aim to describe our population's sociodemographic characteristics, the most common referral motive, diagnosis and therapeutics, and orientation.MethodsPsychiatry consultation data of the first semester of 2015 were collected and analyzed using SPSS software (version 20).ResultsOne hundred and sixty-one patients were evaluated. A total of 26.09% were male and 73.91% were female. The mean age was 51.61 years old. The most frequent referral motives were depressive (47.82%) and anxiety (23.60%) symptoms. The two most common diagnostic groups according to the International Classification of Diseases (version 10) were F30-F39–Mood affective disorders (57.76%) and F40-F48–Neurotic, stress-related and somatoform disorders (18.63%). 22.36% of the patients were referred without medication, but only four were discharged drug-free, corresponding to bereavement situations. 34.16% of our population were previously prescribed two or more psychotropic drugs, increasing to 63.98% after assessment. Only 18.63% met criteria to hospital referral.ConclusionsThe Psychiatry consultation selects the most severe patients and allows a faster evaluation of mentally ill patients awaiting hospital consultation, thus preventing unnecessary access to the emergency room. Authors consider that all the patients referred to a hospital consultation should be previously evaluated by a consultant psychiatrist on a primary health care setting.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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