Palliative care is an integrated approach that promotes the quality of life of patients and families who are confronted with the physical, psychosocial and spiritual problems associated with a life-threatening illness. 1 The palliative patient is not necessarily a terminal patient (estimated prognosis of 3-6 months), or a moribund or agonising patient (estimated prognosis of days or hours). 1 According to the World Health Organization (WHO) and the National Plan of Palliative Care, palliative care: affi rms life and accepts death as a natural process, without trying to delay the process; constitutes a global and holistic approach to the patients suffering from a physical, psychological, social and spiritual point of view; seeks the wellbeing and quality of life of the patient; is centered on the needs of patients and their families, life and death; should not be restricted to terminally ill and agonised patients; and, should be addressed by a multidisciplinary team. 1,2 The person with a life-threatening illness feels in total pain. 1 Patients with an advanced life-limiting illness experience great suffering, a complex negative state of malaise (bodily, affective, cognitive, spiritual) characterised by feeling threatened and destroyed in the integrity or continuity of their existence, a sensation of powerlessness to face this threat and an exhaustion of their personal and psychosocial resources. 1 The main sources of suffering in palliative care patients are poorly controlled symptoms, loss of autonomy and dependence on others, alterations in body image, loss of social roles and status, impairment in interpersonal relationships, feelings of abandonment, changes in expectations and future plans, and loss of dignity and meaning of life. 1 In most cases, palliative patients have severe functional and cognitive limitations requiring support in basic needs, such as hygiene, food, money, medication and mobility, relying on others for daily life activities, with increasing dysfunctionality and psychological repercussions. 2 According to number 7 of the Administrative Rule 66/2018 in Diário da República (Portugal), 3 a palliative care unit must ensure: permanent medical and nursing care; psychological intervention for patients, relatives and professionals; social intervention and support; support and intervention in mourning; spiritual intervention; complementary examinations; prescription and administration of drugs contained in the National Formulary of Medicines; hygiene, comfort and food; conviviality and leisure; training in palliative care; and, assistance in the area of palliative care for health professionals, namely primary, hospital and continuing healthcare. 3 Psychosocial rehabilitation can be understood as, 'a comprehensive and continuous process that provides individuals with disability due to mental illness the opportunity to achieve the greatest possible functioning potential (in the Palliative care is an approach to incurable and/or severe disease with limited prognosis, aiming to relieve the suffering a...
IntroductionStuttering is a speech disorder characterized by involuntary repetition, prolongation or cessation of a sound. This dysfluency may be developmental or acquired. Acquired dysfluency can be classified as neurogenic or psychogenic.ObjectivesThis case report aims to describe and discuss a case of psychogenic stuttering, providing an updated review on this disorder.MethodsIn and outpatient interviews were performed by Neurology and Psychiatry. Investigation to exclude organic causes included lab exams, electrocardiogram, electroencephalography, computed tomography scan and magnetic resonance imaging. A literature review in Science Direct database, with the keywords “psychogenic stuttering”, was also conducted.ResultsA 63-year-old man was admitted to the Beatriz Ângelo Hospital with an acute stuttering. Speech was characterized by the repetition of initial or stressed syllables, little affected by reading out loud or singing. Comprehension, syntaxes and semantic were not compromised, as weren’t sensory and motor abilities. During admission, stuttering characteristics changed. Multiple somatic complaints and stress prior to the onset and bizarre secondary behaviors were also detected. Work-up didn’t show an organic etiology for that sudden change. An iatrogenic etiology was considered, as sertraline and topiramate were started for depression 1 month before. However, the stuttering pattern, the negative results, the psychological and the social life events suggested a psychogenic etiology.ConclusionsPsychogenic stuttering finds its origin in psychological or emotional problems. It is best classified as a conversion reaction. The differential diagnosis between psychogenic and neurological stuttering can be challenging.Disclosure of interestThe authors have not supplied their declaration of competing interest.
IntroductionPatients with psychiatric disorders are admitted to psychiatric units for evaluation and treatment in the acute phase of illness.AimsTo perform a descriptive analysis of psychiatric hospitalization characteristics before (phase1) and after (phase2) the inclusion of the Rehabilitation Unit for Alcoholic Patients (RUAP).MethodsA retrospective study with clinical and statistical data analysis of patients admitted to a general Psychiatric Hospital twelve months before and after the inclusion of RUAP.ResultsThe sample had 741 patients (376 males, 365 females). Hospitalization characteristics data is presented in table1.[Hospitalization characteristics of phase 1 and 2]ConclusionSample demographic characteristics were similar in both phases. Although mood disorders were the more prevalent diagnosis, after inclusion of RUAP, Alcoholic Dependence Syndrome became the most frequently assigned diagnosis. It is also relevant the higher mean occupancy rate and the higher number of patients admitted to the service. Patients social characteristics in phase 1 and 2 need further investigation.
IntroductionErotomania (“Clérambault's syndrome”) is a rare syndrome characterized by a delusional belief of being loved by another person, usually of higher social status.ObjectiveThis case report aims to describe and discuss a case of erotomania, providing an updated review on this disorder.MethodsRegular clinical interviews were performed during admission period to collect information about the clinical case and to promote an intervention approach to the patient. A literature review in Science Direct database, with the keyword “erotomania”, was also conducted.ResultsA 51-year-old woman was admitted in Beatriz Ângelo Hospital psychiatric ward with delusional beliefs of being loved by the ex-boss. Positive misperceptions and persecutory delusions regarding her husband as the obstacle for the love were manifested. The lack of insight for the situation and the necessity of treatment created some difficulties. A clinical report and a bibliographic review were made to allow a better understanding about the case and to orient the case evidence based.ConclusionsDespite the evidence about the good response of atypical antipsychotics (e.g. risperidone) in erotomania, in our case study, the partial remission was only achieved with high dose of the old typical antipsychotic, pimozide.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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