Introduction:Legal drugs are changing the standards of drug consumption. These substances, labelled ‘not for human consumption’ are sold as incense, bath salts or pills, tricking sanitary authorities and Food and Drug Administration. Despite the absence of clinical trials, they grant a feeling of safety by being freely sold over the internet and smart-shops, and by ending the fear of control, since medical analyzes do not detect them. This makes them appealing and their popularity is steadily growing.Objective:The authors aim to describe the results of analysis made to several legal drugs samples available online and its potential implications.Methods:Review of PubMed’ studies between 2010 e 2012, using as key-words: ‘legal drugs’ and ‘purchase online legal highs’.Results:Studies of substance labeling found a lack of information, since 81,9% of the analyzed products did not report side effects and 86,3% did not specify medical interactions. A study done six months after mephedrone's prohibition in the U.K., showed that 62,5% of products still presented this substance, as well as unlisted components. Three subsequent studies revealed that the majority of the drugs listed the active principle on the label, but a significant percentage also showed unlisted substances.Conclusions:In addition to the dangerous effects and interactions of the unlisted substances, consumers and sellers, misled by the nomenclature ‘legal’, may be committing an illegality when buying these drugs. Despite governmental efforts, the gap between the identification of a potentially harmful substance and its prohibition, makes difficult to prevent this potential flagellum.
Introduction:Hyperkeratosis is characterized by abnormal palmoplantar skin thickening. These lesions can extend to other organs and be associated with a multiplicity of pathologies.Objectives:This paper aims to describe the features of psychosocial maladjustment in a patient firstly diagnosed as having hyperkeratosis of unknown etiology.Methods:We describe a 14-year-old boy admitted to our outpatient clinic after verbalizing suicidal thoughts to his endocrinologist.Results:His medical condition had been evolving since he was six, when his palms and specially soles became grossly thickened and painful and he would be found awake at night clawing at his severely scaly and itchy lesions. He was seen by geneticists, dermatologists and plastic surgeons. However, the thickened patches continued to progress over the years, with almost no response to treatment. He was unable to keep up with his friends walking and had to give up on sports. Due to medication he has a reduced stature and low puberty development. On his first appointment he was reported to be unable to manage routine affairs or handle money matters and his scholastic performance was poor. During mental state examination one could assess restricted interests, social and communication defficits, tantrums, self and hetero aggressions and IQ below normal, despite an extraordinary visuo-spatial memory and no suicidal intent. He was medicated with risperidone and structural family therapy was applied, with good response.Conclusions:Helping individuals and families dealing with behavioural problems improves family dynamics and quality of life even in the presence of such incapacitating diseases.
IntroductionRegular physical activity should be encouraged given its major role in health maintenance and disease prevention. However, in excess, exercise has the potential to cause physical and psychological harm and can become addictive. Excessive exercise can be described in an obsessive-compulsive dimension but it is included among the behavioural addictions since it presents some of its typical characteristics such as mood modification, tolerance, withdrawal symptoms and relapse after periods of abstinence or control.ObjectiveThe authors aim to describe the concept of Exercise Addiction and the current understanding of its symptoms, diagnosis criteria, epidemiology, etiology and mechanisms.MethodsExhaustive review of the literature on Exercise Addiction and its symptoms, diagnosis criteria, epidemiology, etiology and mechanisms, using PubMed.ResultsThe most addictive type of exercise varies with countries. Studies show that physical exercise activates de dopamine reward system contributing to stress reduction and there is evidence of the association between running, endorphins and cannabinoids – explaining the’runner's high’ that can cause addiction. Genetic studies reveal that the same genes control preference for drugs and for naturally rewarding behaviours. Psychological approaches focus on reward, habituation, social support, stress-relief, avoidance of withdrawal and anxiety reduction.ConclusionsExercising regularly has several positive effects on physical and mental health but in excess, may have serious physiological and psychological consequences. There are several hypotheses for the mechanisms of exercise addiction including reward, stress reduction, the euphoric effect, mood regulation and sympathetic arousal. More studies are needed to improve our understanding of this behavioural addiction.
IntroductionSleep problems are common in childhood. Disturbed sleep behaviours are among the most common concerns that parents of young children bring to their physicians. Defining disordered sleep behaviour is difficult because of important differences in sleep patterns at different developmental stages. The sudden onset of a sleep disorder or problem can be due to physical, mental and/or environmental factors.ObjectivesTo present the case of a young boy admitted to the emergency department of the Pediatric Hospital of Coimbra due to a sudden inability to sleep.ResultsA 6-year-old boy with previous language delay and undergoing regular psychotherapy due to family distress issues presented with inability to sleep for more than 10–15 minutes. The disturbances started 2 weeks prior to presentation and occurred more than 10 times per night. Immediately after each event the patient was screaming, frightened, unable to communicate normally with his mother. Since the beginning of the episodes the patient's social performance had declined, he was easily irritated, aggressive and with dysphoric mood.The patient was admitted and evaluated by child psychiatry in the emergency department. An extensive psychiatric evaluation revealed familyrelated stressors, depression and anxiety symptoms. An electroencephalogram was performed which revealed frontal lobe epilepsy.After the diagnosis treatment sodium valproate was started (30mg/kg/day). The symptoms reversed.ConclusionsThis case highlights how psychiatric manifestations or comorbidity may interfere in the understanding of clinical manifestations of sleep disorders in children. In fact, as in this case, symptoms may be related to underlying conditions, namely epilepsy.
Results: Biographic, psychopathology, social and family aspects were analyzed. The response time throughout the process, the origin and nature of the request's and the type of process which originated the request were also assessed. The authors identified the involved professionals and whether they needed to go to court. When there were questions, they evaluated the capacity to answer them, the forensic difficulties and solutions found, and the presence of recommendations. Discussion: The obtained results met the clinical experience and literature regarding demography and psychopathology. As for the difficulties, there were a number of aspects which could be improved by both parts, aiming to ameliorate the articulation between Health and Justice. Conclusion: With this study it was possible to reflect on the authors forensic practice, in order to develop a closer partnership with the courts to promote the real 'best interests' of children/adolescents and their families.
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