Psiquiatria
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- Consumo de Álcool na Perturbação de Hiperatividade e Défice de AtençãoPublication . Ramalheira, Filipa; Paulino, Luis; Vieira, Ana Sofia; Pereira, Madalena; Gonçalves, Filipe; Teixeira, JoanaA Perturbação de Hiperatividade e Défice de Atenção (PHDA) é uma doença do neurodesenvolvimento cujos sintomas e neurobiologia podem conferir risco aumentado de para o consumo abusivo de substâncias tóxicas incluindo o álcool. A Perturbação de Uso de Álcool (PUA) e PHDA partilham fatores de risco e vários mecanismos neurobiológicos, não sendo de admirar que surjam frequentemente em comorbilidade familiar e no mesmo indivíduo. Por isso, recomenda-se o screening de PHDA nos doentes que procuram ajuda por abuso de substâncias e mesmo PUA. Nos doentes com PHDA, a PUA inicia-se mais precocemente e associa-se a piores outcomes clínicos e de tratamento. O tratamento da PUA em comorbilidade com a PHDA deve englobar preferencialmente uma abordagem fármaco e psicoterapêutica dirigida a ambas as patologias
- An Exploration of Blood-Based Biomarkers of Negative Symptoms of Psychosis in Men.Publication . Rodrigues, Alexandra; Santos, Henrique Castro; Ferreira, Sara; Diogo, Vasco; Costa, Marco; Brissos, Sofia; Gama Marques, João; Prata, DianaNegative symptoms in the context of psychosis are still poorly understood and diagnosed, which impairs the treatment efficacy of current therapies and patient's integration in society. In this study, we aimed to test hypothesis-based and exploratory associations of negative symptom domains, as defined by the Brief Negative Symptom Scale (BNSS), with hormonal and hematological variables, and, complementarily, with standard psychological/cognitive and psychopathological measures. Fifty-one male patients diagnosed with a psychotic disorder underwent a structured interview and blood collection. Standard Spearmen bivariate correlations were used for data analysis. We obtained evidence of hypothesis-based associations between specific negative symptoms and oxytocin, thyroid stimulating hormone levels and neutrophil-to-lymphocyte ratio; as well as novel and hypothesis-free associations with erythrocyte and lymphocyte count, mean corpuscular volume and red cell distribution width. Complementarily, we also obtained some validation of previous associations of negative symptoms with illness resolution, cognitive symptom severity and social performance, and a novel association with anger contagion. We hope our results can generate new hypotheses in psychosis research. Our work suggests further avenues in research on erythrocytic, inflammatory, thyroid and oxytocin-related markers and abnormalities in psychosis, especially in regards to specific negative symptoms, towards more precise and comprehensive etiological, diagnostic and therapeutic models.
- Gender Dysphoria: Concepts, Diagnosis and Clinical ManagementPublication . Alves Rodrigues, C; Marguilho, M; Ferreira, B; Nascimento, S; Nascimento, M; Cardoso, S; Silva, M; Pablo, AC; Soares, C; Fernandes, C; Gonçalves, MGender dysphoria is defined as a condition characterized by mental suffering associated with the incongruence between one's experienced gender and their birth-assigned sex. Gender as a construct and gender dysphoria as a condition in need of multidisciplinary intervention have developed as swiftly as their visibility in society, making it mandatory to promote the literacy and education of all healthcare professionals in this area. This article aims to review information based on scientific evidence on people with gender dysphoria and its clinical approach, while contributing to a safe, inclusive, and non-discriminatory practice of healthcare.
- Homeless Outreach Psychiatric Engagement for Lisboa (HOPE 4 Lisboa): One Year of Marontology, and One John Doe Living with Diogenes SyndromePublication . Gama Marques, J; Chesi, D; Coelho, RO; Castanheira Costa, I; Santos Antão, C; Pedro, CA; Silva Santos, P; Xavier Diogo, JBackground: In Europe, psychiatric disorders seem to affect up to 50% of the homeless. In Portugal there were, at a certain time, circa 3,396 homeless people, half living in the capital city, Lisboa. Aims: The Homeless Outreach Psychiatric Engagement for Lisboa (HOPE 4 Lisboa) was created, in January 1st 2022, as a collaboration including staff from the local state asylum, medical school and town hall in Lisboa, Portugal, in order to provide better treatment for the super difficult cases of psychiatric patients living homeless in Lisboa. Method: During 2022, the HOPE 4 team made night rounds, every 15 days on Tuesday's night (20:30 to 23:30) trying to reach, at least, one dozen of homeless psychiatric patients, previously identified. Results: The HOPE 4 Lisboa interviewed 101 patients (53.4%) out of the 189 programed visits. From this group, 72 (72%) had already a previous psychiatric diagnosis. From those 101 patients, reports for 47 (47%) were sent for an eventual compulsory psychiatric assessment. From those 47 only 21 patients (21%) were admitted in the psychiatry ward. Finally we discuss the most super difficult patient we found, as a small case report: a John Doe living in complete Diogenes syndrome. Conclusions: there are still a few psychiatrists interested in treating homeless people completely or partially out of the classic mental health care systems. Some claim to be doing interstitial psychiatry, others street psychiatry, but we could also call it marontology.
- Instruments for Short-Term (24 h) Violence Risk Assessment and Strategies for Managing Violence Risk Among Adolescents With Risk for Violent Behaviour: A Systematic Review.Publication . Väätäinen, Laura; Björkqvist, Maiju; Li, Yan; Pelto-Piri, Veikko; Ferreira, António; Lantta, TellaShort-term (24 h) violence risk assessment and management can reduce violence in institutional settings, yet they remain understudied in adolescent populations. This systematic review aimed to identify instruments used for short-term violence risk assessment and strategies for managing violence risk among adolescents in institutional settings, as well as to evaluate related outcomes. PRISMA was used as an evidence-based minimum set of items for reporting systematic reviews. The literature search (March 2024 and March 2025) was conducted in PubMed, PsycINFO, Web of Science, CINAHL, The Cochrane Library and Scopus, and references from selected studies were reviewed. Data extraction and analysis were performed in Covidence. Nine studies met inclusion criteria describing six assessment instruments: DASA, DASA-YV, V-RISK-Y, Kennedy Axis V, Pedi-BEWS and BVC. No studies regarding strategies for short-term violence risk management were identified. DASA-YV, BVC and V-RISK-Y predicted violence among adolescents within 24 h (AUC = 0.70-0.95); DASA predicted violence moderately (AUC = 0.50-0.69). Pedi-BEWS (ICC = 0.83) and Kennedy Axis V (ICC = 0.79) demonstrated similar inter-rater reliability. Due to the lack of studies, firm conclusions on the best instrument for clinical practice in institutional settings remained elusive. Further research is necessary to ascertain if youth-specific instruments (e.g., DASA-YV, V-RISK-Y) predict violence more effectively than non-age-specific instruments (e.g., DASA). The lack of youth engagement in violence risk assessment stands out clearly. Scoring was done by the staff, mostly by nurses. Future studies should involve adolescents in the scoring or evaluation of assessment and management. There is a need for evidence-based recommendations for youth engagement.
- The Portuguese Version of the Self-Report Form of the DSM-5 Level of Personality Functioning Scale (LPFS-SR) in a Community and Clinical Sample.Publication . Pires, Rute; Henriques-Calado, Joana; Sousa Ferreira, Ana; Gama Marques, João; Ribeiro Moreira, Ana; Barata, Bernardo C; Paulino, Marco; Morey, Leslie; Gonçalves, Bruno; PlosThe Level of Personality Functioning Scale-Self-Report (LPFS-SR) operationalizes Criterion A of the DSM-5 Alternative Model for Personality Disorders. The current study aimed 1) to examine the internal consistency of the Portuguese version of the LPFS-SR in a community sample and a clinical sample, 2) to compare non-clinical participants (N = 282, Mage = 48.01, SD = 10.87) with two samples of clinical participants, one composed of patients with a personality disorder diagnosis (PD sample, n = 40, Mage = 46.18, SD = 13.59) and the other of patients with other psychiatric diagnoses (OD sample, n = 148, Mage = 49.49, SD = 11.88), with respect to LPFS-SR dimensions and total score, 3) to examine the capacity of the LPFS-SR to discriminate between samples through the ROC curve analyses, and 4) to examine the factor structure of the Portuguese version of the LPFS-SR. The Portuguese version of the LPFS-SR revealed adequate internal consistency results, akin to the original data, in the community and clinical samples. The community sample differed significantly from both clinical samples in all the LPFS-SR dimensions and total score. The ROC curve analysis indicated an optimal cut-off for the total score of 272.00, corresponding to a sensitivity of 75% and a specificity of 89%, in the PD vs. community samples. The LPFS-SR total score discriminative capacity between the PD and OD samples was lower, albeit also significant (area-under-the-curve of .63; p = .027; 95% CI: .52-.74). The current study provided evidence of the LPFS-SR's unidimensionality in both community and clinical samples. Although this study has limitations, its findings contribute to a deeper understanding of the LPFS-SR construct, as well as to its cross-cultural validation.
- Postictal Psychosis: Case Report and Literature ReviewPublication . Regala, J; Lourenço, J; Moniz-Pereira, F; Bento, APostictal psychosis (PIP) is one of the most common types of psychosis in epileptic patients. By virtue of the paucity of research on PIP, its pathophysiology remains not completely understood. Our case report describes a clinical picture of PIP, characterized by pleomorphic features, with neither Schneider's first-rank symptoms nor negative symptoms of schizophrenia, in a longstanding epileptic female patient with a history of nonadherence to antiepileptic treatment and poorly controlled seizures. Additionally, she had previous cognitive impairment and encephalomalacia in the right parietooccipital region as a sequela of a moderate-to-severe traumatic brain injury known to precede the emergence of the epilepsy. In light of our findings, we critically reviewed the current literature on postictal psychoses providing insight into its neurobiological underpinnings.
- The European Portuguese Version of the Brief Negative Symptom ScalePublication . Santos, HC; Rodrigues, A; Ferreira, S; Martins, JM; Baptista, T; Gama Marques, J; Kirkpatrick, B; Prata, DNegative symptoms reflect a currently much-untreated loss of normal functioning and are frequently found in psychotic disorders. We present the first translation of the Brief Negative Symptom Scale (BNSS) to European Portuguese and evaluate its validity in a sample of Portuguese male patients with a psychotic spectrum disorder. The Portuguese BNSS showed excellent internal consistency, high convergent validity (i.e., strong correlation with the PANSS negative factor), and high discriminant validity (i.e., a lack of association with the PANSS positive factor). In sum, the present European Portuguese BNSS has shown to be reliable, thus extending this instrument's clinical availability worldwide.
- When Paranoia Comes with the Treatment: Psychosis Associated with Tacrolimus UsePublication . Machado Nogueira, J; Freire, MJ; Vila Nova, V; Jesus, GTacrolimus is an immunosuppressive drug frequently used in solid organ transplant recipients. This drug has well-documented neuropsychiatric side effects in the literature, although emergence of psychotic symptoms is rare, being only described in a very few case reports. We present a case of a renal transplant recipient with no prior psychiatric history, who developed a severe psychosis secondary to supratherapeutic tacrolimus' blood concentrations. This case highlights the importance of clinical awareness to rare but severe neuropsychiatric effects due to tacrolimus use.