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Objective To characterize medical interns’ experience regarding communication skills education and to explore potential associations with preparedness for practice. Methods Two hundred sixty-six medical interns answered an original questionnaire specifically developed to explore how well they feel their undergraduate training had prepared them in key aspects of medical communication. Instrument’s psychometric properties were tested. Medical schools’ curricula were considered and associations explored using non-parametric tests. Results The questionnaire reliability was high, with Cronbach’s alphas ranging from 0.89 to 0.94 on all the factors. Core communication skills were highly rated. Perceived preparedness was lower in aspects concerning dealing with emotion, breaking bad news and communicating with speech impaired patients. Better preparedness was associated with a longitudinal integration of communication skills throughout the curriculum, simulation with standardized patients and real patient interviewing with feedback on communication skills. Conclusions Integrated programs, standing on a strong experimental component, particularly combining patient-simulation strategies with continuous supervision and learner centred feedback, were associated with higher preparedness. These results support the expansion of an educational model based on simulation strategies and structured longitudinally throughout the undergraduate medical curriculum. Practice implications This study intends to inform educational background and to support further development of communication skills curricula.

Tem como objetivo analisar as propriedades psicometricas da Escala de Medo da COVID-19 no periodo perinatal, constituida por dois itens adicionais para o periodo perinatal A pesquisa foi registrada no CONEP 204 gestantes com idade media de 30 12 anos (±5 45) e idade gestacional media de 25 17 (±6 553) responderam aos questionarios atraves das redes sociais no Brasil Foi utilizado o SPSS Statistics, foram usados para medidas parametricas, o coeficiente de Pearson e o T de Student e nao-parametrica – U de Mann Whitney e para magnitude dos coeficientes de correlacao com sintomatologia ansiosa e depressiva perinatais, os criterios de Cohen Usou-se o AMOS 26 0, para a analise fatorial confirmatoria Para consistencia interna, o alfa de Cronbach Os resultados indicam que a EMC-19-9 e um construto unidimensional, possui qualidades psicometricas robustas, consistencia interna do questionario muito boa e mostra ter validade convergente, apresenta correlacao moderada e significativa com a ansiedade perinatal e correlacao significativa, apesar de ligeira, com a depressao perinatal As pontuacoes totais foram comparaveis em todas as idades, o que sugere ser um bom instrumento psicometrico para ser usado na avaliacao de medos de COVID-19 entre gravidas Brasileiras Estudos futuros tambem devem avaliar associacao com condicoes medicas subjacentes associadas a um maior medo Alternate abstract: It aims to analyze the psychometric properties of the COVID-19 Fear Scale in the perinatal period, consisting of two additional items for the perinatal period The research was registered with CONEP 204 pregnant women with an average age of 30 12 years (± 5 45) and an average gestational age of 25 17 (± 6,553) answered the questionnaires through social networks in Brazil We used SPSS Statistics, used for parametric measurements, Pearson's coefficient and Student's non-parametric T - Mann Whitney U and for the magnitude of the correlation coefficients with perinatal anxiety and depressive symptoms, Cohen's criteria AMOS 26 0 was used for confirmatory factor analysis For internal consistency, Cronbach's alpha The results indicate that EMC-19-9 is a one-dimensional construct, has robust psychometric qualities, very good internal consistency of the questionnaire and shows convergent validity, has a moderate and significant correlation with perinatal anxiety and a significant, albeit slight, correlation with perinatal depression The total scores were comparable at all ages, which suggests that it is a good psychometric instrument to be used in assessing COVID-19 fears among pregnant women in Brazil Future studies should also assess association with underlying medical conditions associated with greater fear

Background: Although obsessive-compulsive (OC) symptoms are common in the perinatal period, measures to comprehensively assess their presence, frequency, interference and severity are lacking. The Perinatal Obsessive–Compulsive Scale (POCS) is the only self-report questionnaire with context-specific items. It includes items to assess perinatal-specific obsessions and compulsions, a severity scale and an interference scale. Objectives: (1) to analyze the validity and reliability of the Portuguese version of the POCS; (2) to find Obsessive–Compulsive Disorder (OCD) prevalence in postpartum and determine the POCS cut-off scores and its accuracy (sensitivity, specificity and predictive values) in screening for OCD according to DSM-5 criteria; (3) to describe the prevalence, content, severity, interference and onset of OC symptoms in the postpartum. Methods: 212 women in postpartum filled in a booklet, including the POCS Portuguese preliminary version, the Perinatal Anxiety Screening Scale and the Postpartum Depression Screening Scale; they were interviewed with the Diagnostic Interview for Psychological Distress—Postpartum. Results: Confirmatory Factor Analysis revealed that POCS presented acceptable fit indexes (χ2/df = 2.2971; CFI= 0.9319; GFI = 0.8574; TLI = 0.9127; RMSEA = 0.860, p < 0.001). The Cronbach’s alphas were all > 0.800. The POCS cut-off point that maximized the Youden Index (J = 0.86, 95% CI [0.94–0.99]) was 20, corresponding to an Area Under the Curve of 0.970 (p < 0.001; Standard Error = 0.031; 95% CI: 0.937 to 0.988). The prevalence of postpartum OCD was 3.30%. The severity of thoughts and behaviors was moderate to severe for approximately 15% of women. For thirty-five percent of women, the onset of symptoms was in the first three months postpartum. Conclusions: The Portuguese version of POCS has good validity, reliability and accuracy and may be considered ready for use in both clinic and research fields. POCS provides specific information regarding symptoms and individual patterns experienced by each woman, which allows normalization, destigmatization and personalized intervention.

Background: Women in the postpartum period may be particularly vulnerable to the psychological effects of the COVID-19 pandemic. The aim of our study was to evaluate the impact of the coronavirus pandemic on postpartum depression and anxiety levels and the role of the fear of COVID-19 in its development. Methods: Women who delivered at the Bissaya Barreto Maternity Hospital, between 16 March and 16 June 2020 (Group 1: Birth in COVID-19 period, n = 207), recruited in the postpartum period, filled in a set of self-reported validated questionnaires: Perinatal Depression Screening Scale, Perinatal Anxiety Screening Scale, Profile of Mood States, Perseverative Thinking Questionnaire, Dysfunctional Beliefs Towards Maternity Scale, and the Fear of COVID-19 Scale. Levels of depressive and anxious symptomatology, negative affect, negative repetitive thinking, and the dysfunctional beliefs towards motherhood of these women were compared with data from samples of previous studies that included women whose delivery had occurred at the same Maternity Hospital before the COVID-19 pandemic period (Group 2: Birth before the COVID-19 period, n = 212). Results: Based on the cutoff points of the screening scales, the prevalence of clinically relevant depressive and anxious symptoms in Group 1 was 40.1% and 36.2%, respectively. Women in Group 1 had significantly higher levels of anxious and depressive symptoms, negative affect, negative repetitive thinking, and dysfunctional beliefs towards motherhood than women in Group 2 (p < 0.05). Fear of COVID-19 in the postpartum period was a predictor of depressive (ß = 0.262) and anxious (ß = 0.371) symptoms, explaining 6.9% and 13.7% of their variability, respectively (p < 0.001). Conclusion: During the COVID-19 pandemic, women in the postpartum period present greater depressive and anxious symptomatology, as well as increased risk factors.

Recent studies have documented the high prevalence of burnout among medicine and dentistry students, with potentially catastrophic consequences for both students and patients. Both environmental and personality factors play a part in burnout; perfectionism, a common trait in medicine students’ personalities, has been linked to psychological distress and increasing students’ vulnerability to burnout. Self-compassion, i.e., treating oneself kindly through hardship, has recently emerged as a buffer between perfectionism and psychological distress. While using a novel three-factor conceptualization of perfectionism (BIG3), this study aims to analyze if self-compassion has a protective role in the relationship between perfectionism and burnout, in a sample of medicine and dentistry students, through mediation analysis. We found that self-compassion significantly mediated the relationship between all three forms of perfectionism and burnout: as a partial mediator in self-critical and rigid perfectionism, as well as a full mediator in narcissistic perfectionism. Our findings underline self-compassion’s relevance in burnout prevention and management, supporting its use as an intervention target in burnout reduction programs and strategies.

INTRODUÇÃO: A avaliação sistemática das experiências das mulheres durante o parto representa uma importante estratégia para viabilizar melhorias na atenção à saúde materna e neonatal. OBJETIVOS: Adaptar o Childbirth Experience Questionnaire (CEQ) para o contexto brasileiro e determinar as propriedades psicométricas da versão em português (do Brasil), denominada CEQ-2BR. MÉTODOS: Estudo transversal com 225 puérperas recrutadas através das redes sociais. Após o consentimento informado, as participantes preencheram um formulário eletrônico, que incluía a versão preliminar da CEQ-2BR. O tratamento dos dados foi realizado através dos pacotes estatísticos SPSS e AMOS 26. A confiabilidade do CEQ-2BR foi avaliada usando o coeficiente alfa de Cronbach. Para medidas paramétricas utilizou-se o Qui-quadrado de Pearson e o T de Student e, nas medidas não-paramétricas, U de Mann Whitney. A magnitude dos coeficientes de correlação foi classificada segundo os critérios de Cohen. RESULTADOS: O CEQ-2BR demonstrou boa consistência interna para “autocapacidade”, “suporte profissional”, “segurança percebida” e “participação”, tendo sido verificado que a avaliação negativa da experiência de parto aumenta em 1,9% e 2,1%, a sintomatologia ansiosa e depressiva pós-parto, respectivamente. CONCLUSÃO: O CEQ-2BR é uma medida válida e confiável sobre experiência de parto na população brasileira, apresenta propriedades psicométricas satisfatórias, sendo recomendado inclusive para multíparas. Houve correlação entre níveis altos de ansiedade pré-natal com experiência negativa de parto. A experiência negativa de parto explica parte das sintomatologias de ansiedade e depressão pós-parto.

Background The patient-centeredness (PC) is particularly challenging for the deaf population, mainly due to communication barriers. We compared the perception of PC, regarding the last medical appointment, satisfaction with the consult, adherence and health perception among a group of deaf adults and a group of adults from the general population; and analyzed the relation between these variables in adult's deaf group. Methods Adults from the general population (n = 1335) and deaf adults (n = 36) from different national associations completed the validated Portuguese version of a self-reported questionnaire (PPCD-16) and answered questions on satisfaction, adherence and health perception. The deaf group subsample watched a video with the translation of the questionnaire to Portuguese Sign Language. Results The two subsamples didn’t differ significantly in the PPCD-16 total and dimensional scores; only in 5 items, related to the perception of the consult motive and to the doctor’s concern for the patient, did the deaf group subsample show significantly lower scores. The same was verified for the satisfaction, adherence, and physical and psychological health perceptions. The PPCD-16 total and dimensional scores presented a significant, positive and moderate- high correlation with satisfaction and adherence. Total PPCD-16 and the dimensional score of Empathy were significant predictors of satisfaction and adherence. Conclusions There wereńt significant differences between the two groups in the PPCD-16 scores, but deaf participants consider that ‘many times’, they cańt understand and be understood by the physician. These factors may contribute to their lower satisfaction and adherence. More studies will be necessary to show the relevance of Portuguese Sign Language interpreters.

It is widely known that stress reactivity and social functioning impairment are important difficulties in people with psychosis. However, the specific impact of stress reactivity on social functioning and its underlying mechanisms are still less explored. Social rank variables, such as shame and self-criticism, have been pointed out as relevant in the development, maintenance of several types of psychosocial suffering and, specifically, in psychotic disorders. This study's aim was to explore the associations between external shame, self-criticism, social stress reactivity, and social functioning difficulties and understand the mediator role of shame and self-criticism in the relationship between social stress reactivity and social functioning. Seventy-seven participants with a psychotic disorder filled in self-reported measures of stress reactivity, shame, and self-criticism and were clinically evaluated for social functioning. To study the associations between variables in the study, Spearman correlation coefficients were used. The PROCESS macro was used to test the sequential mediation analyses. All variables under study were associated with each other, and social stress reactivity predicted social functioning difficulties through external shame, whereas self-criticism was not a significant mediator. The present study highlights the role of external shame in the pathway from stress reactivity to social impairment. These results inform recovery-oriented interventions and reinforce the relevance of considering social competitive mentality when working with people with psychosis. Further research is needed to clarify the role of self-to-self relationship in social impairment and to identify other mechanisms aimed at dealing with shame used by people with psychosis.

The objective of the present study was to develop and assess the validity of a short form of the Child–Adolescent Perfectionism Scale (CAPS). Two Portuguese samples composed of 756 adolescents were used to cross-validate the factorial structure of a nine-item Child–Adolescent Perfectionism Scale—Short Form (CAPS–SF). The CAPS–SF consists of a four-item self-oriented perfectionism subscale and a five-item socially prescribed perfectionism subscale. Both subscales demonstrated adequate internal consistency. Confirmatory factor analysis (CFA) of the CAPS–SF supported the same two-factor structure and represented a very good fit to the data for both groups. Other analyses found that the brief measure of socially prescribed perfectionism was associated with measures of distress and forms of self-criticism. The CAPS–SF appears to represent a reliable and valid alternative to the original CAPS. Overall, the CAPS-SF is considerably briefer than the original CAPS and it offers an economical and valid alternative when measuring perfectionism in children and adolescents.

Premenstrual dysphoric disorder (PMDD) affects 1.2 to 5% of women of reproductive age. Besides significant suffering and social, occupational, and interpersonal impairment, it has been suggested that this syndrome is associated with other affective disorders, in different reproductive phases, such as pregnancy and the postpartum period. However, the literature on this association is scarce and presents great variability in terms of adopted methodology and mixed results. To analyze the relationship between PMDD and other affective disorders, aiming to contribute to the clarification of whether PMDD can be considered a risk factor for perinatal depression (PND). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive literature search in PubMed, EMBASE, CINAHL, PsycINFO databases. Seven original studies were included. Only one study linked PMDD with depression during pregnancy, with evidence of a positive association between PMDD and PND. This and five other studies show a positive relationship between PMDD and postpartum depression (PPD), assessed in periods ranging from 2 to 4 days to 1 year after birth. Only one study found no significant association between PMDD and PPD, assessed at 4 weeks postpartum. There seems to be a positive and significant association between PMDD and the development of perinatal depression, particularly postpartum depression. This review supports the relevance of health professionals systematically evaluating the presence of premenstrual dysphoric disorder, when monitoring women throughout the perinatal period.

Stigma is associated with poor prognosis of illness and reduced help-seeking behavior, self-esteem and treatment compliance. The aims of this study were to study the reliability and construct validity of the King's et al Stigma Scale, and its association with Illness and Help-Seeking Behaviors scale (IHSBS) scores.One hundred and forty mental health patients filled out the Stigma scale and the Illness and Help-Seeking Behaviors scale. The exploratory factor analysis of the stigma scale was performed, and its reliability studied. The correlation analysis was used and mean differences in Stigma Scale scores among IHSBS groups were explored.The exploratory factor analysis indicated four factors (F): F1-Disclosure, F2-Discrimination, F3-Acceptance and F4-Personal Growth, which showed acceptable/good internal consistency (α from 0.70 to 0.91). Help-seeking behaviors were not associated with stigma. The levels of Discrimination were high in the group with global high-IHSB and in patients with medium/high illness behavior (IB) and health-related worries (HW). Additionally, Disclosure and overall stigma levels were higher in groups with high-HW and with medium-IB scores (when compared with the group with low-IB). The group with low-IB also had lower levels of Acceptance and Personal Growth when compared with the groups with medium-IB and high-IB, respectively.The Stigma Scale (27 items) is a valid, reliable instrument and useful tool to assess stigma in mental health patients.Introdução: O estigma está associado a pior prognóstico de doença e redução da procura de ajuda, autoestima e adesão ao tratamento. Os objetivos deste estudo foram estudar a fidedignidade a validade de construto da Escala de Estigma de King et al e a sua associação com as pontuações da Escala de Comportamento de Procura de Ajuda e de Doença (ECPAD). Material e Métodos: Cento e quarenta doentes psiquiátricos preencheram a Escala de Estigma e a ECPAD. Foi realizada a análise fatorial exploratória da escala de estigma e a sua fidelidade estudada. Foram realizadas análises de correlação e exploradas as diferenças nas médias das pontuações da escala de estigma nos grupos de ECPAD. Resultados: A análise fatorial exploratória indicou quatro fatores (F): F1-Divulgação, F2-Discriminação, F3-Aceitação e F4-Crescimento Pessoal (α de 0.70 a 0.91). Os comportamentos de procura de ajuda não se associaram ao estigma. Os níveis de Discriminação foram altos no grupo com CPAD total-elevado e nos grupos com comportamentos de doença (CD) e com preocupações com a saúde (PS) médios/elevados. Adicionalmente, os níveis de Divulgação e Estigma total foram superiores no grupo com PS-elevado e no grupo com CD-médio (quando comparado com o grupo CD-baixo). O grupo com CD-baixo também revelou níveis inferiores de Aceitação e Crescimento Pessoal em comparação com os grupos com CD-médio e CD-elevado, respectivamente. Conclusão: A escala de estigma (27 itens) é um instrumento válido, fidedigno e útil para avaliar o estigma em doentes psiquiátricos.

This study examined the moderator role of gender in the relationship between negative affect and eating psychopathology as well as gender differences in these variables. A community sample of 285 students (61.8% females), aged 13–25, was recruited in middle and high schools and universities. They filled instruments that assess negative affect and eating disordered symptoms (restraint, eating concern, shape concern, weight concern, and global scale). Females scored higher both in all subscales and the global scale of eating psychopathology. The restraint subscale was the only subscale showing non-significant differences between females and males. Controlling for BMI, moderation analyses revealed that gender moderated the relationship between negative affect and eating psychopathology, except for restraint behavior. To deal with negative affect, females engage in more cognitive symptoms associated with disordered eating than males, but both endorse equally in eating restraint. These findings suggest that interventions focused on emotion regulation could help to reduce eating disordered symptoms among females and males. Level V, cross-sectional descriptive study.

Acceptance and Commitment Therapy and related constructs (experiential avoidance, cognitive defusion and committed action) have recently been applied to psychosis. However, with a few exceptions, this application has not resulted in symptom-specific assessment instruments. The current work intends to develop a measure for assessing experiential acceptance regarding delusions (the Willingness and Acceptance for Delusions Scale) and to conduct a preliminary study of its psychometric properties in a sample of 91 patients with a psychotic disorder, mostly male (87%), single (86%), unemployed (44%), presenting with a schizophrenia diagnosis (71%), and currently with delusions (last week – 52%). Exploratory factor analysis yielded a three-factor structure (Acceptance and Action, Non-entanglement and Non-struggling), which adequately fitted the data and reflected the intended constructs within an Acceptance and Commitment Therapy framework. Scores from all factors achieved adequate reliability and were associated with mindfulness and satisfaction with life. These early findings point to the internal and construct validity and reliability of the scores of the WADS. Although further research into the scale’s psychometric properties, particularly construct validity, is needed, its use in research and clinical practice with psychosis populations seems substantiated.

Psychological reactions to pandemics and their constraints depend heavily on personality. Although perfectionism is consistently associated to depression, anxiety and stress, its role in the pandemics' psychological impact has not been yet empirically studied. Our aim was to analyze the role of perfectionism in psychological distress during the pandemic of COVID-19, testing whether it is mediated by fear of COVID-19 and repetitive negative thinking/RNT. Participants (N = 413 adults; 269.2% women) were recruited from September until December 2020, via social networks. They completed self-report validated questionnaires to evaluate perfectionism dimensions (self-critical, rigid and narcissistic perfectionism), fear of COVID-19, RNT and psychological distress (sum of anxiety, depression and stress symptoms). As women had significantly higher levels of self-critical perfectionism, RNT, fear of COVID-19 and psychological distress, gender was controlled in mediation analysis. The three perfectionism dimensions correlated with RNT, fear of COVID-19 and psychological distress. The effect of self-critical perfectionism on psychological distress was partially mediated by fear of COVID-19 and RNT whereas the effect of rigid and narcissistic perfectionism was fully mediated. Perfectionism influences emotional and cognitive responses to the COVID-19 and therefore should be considered both in the prevention and psychological consequences of the pandemic.

IntroductionResearch on the association between internet use and concerns about body image is still scarce.ObjectivesTo explore the associations between generalized problematic internet use, number of social networks, and appearance schemas.Methods216 Portuguese late adolescents (89.3% females), with a mean age of 18.62 years old (SD = .488, range: 18-19) filled in an internet patterns of use questionnaire, the Generalized Problematic Interne Use Scale 2 (GPIUS2) and The Appearance Schemas Inventory-Revised (ASI-R).ResultsA total of 99.6% of the students use social networks. Subjects were divided into three groups (group1: 1-2 social networks; group 2: 3 social networks, and group 3: >3 social networks). There was a statistically difference in Motivational Salience scores (ASI-R) for the three groups [F (2, 503) = 6.0, p = .003]. Post-hoc comparisons indicated that the mean score for group 3 (M = 28.29, SD = 4.95) was significantly different from group 1 (M = 26.69, SD =4.55), and from group 2, (M = 26.87, SD =4.95). Generalized problematic internet subscales (Mood Regulation, Self-Deficient Regulation, and Negative Consequences) and total score were significantly correlated with both dimensions of ASI-R: Self-Evaluation Salience (coefficients varied from r = .31** to r = .47**) and Motivational Salience (from r = .14*, to r = .31**).ConclusionsGeneralized problematic internet use and the number of social networks are associated with adolescent’s cognitive-behavioural investment in one’s own appearance. Study carried out under the strategic project of the Centre for Philosophical and Humanistic Studies (CEFH) UID/FIL/00683/2019, funded by the FCT.

Recent studies proposed that maladaptive cognitive emotion regulation (CER) is associated with negative dimensions of perfectionism and mediates the relationship between this trait and negative affect dimensions. In the present longitudinal study, our aim was to examine whether and which perfectionism cognitions and CER strategies would mediate the relationship between perfectionism traits and psychological distress, controlling for perceived stress, social support and outcome measure at one year before. At T0 and after approximately one year (T1), 258 college students (79.8% female) filled in the Portuguese validated versions of self-report questionnaires to evaluate perfectionism trait dimensions (perfectionistic concerns and perfectionistic strivings), perfectionism cognitions, CER dimensions, perceived stress, social support and psychological distress (depression, hostility-anxiety, and amiability-vigor). We found that higher perfectionistic concerns at T0 contribute significantly, after one year, to maladaptive perfectionism cognitions, which in turn are associated with higher levels of catastrophizing and rumination, and altogether will ultimately contribute to greater anxiety/hostility (total indirect effect: 0.03; 95% CI: 0.01 to 0.07) and depression (total indirect effect: 0.06; 95% CI: 0.02 to 0.13). In this cognitive setting, perfectionist individuals may benefit from psychological interventions to reduce their tendency to use maladaptive CER strategies.

Abstract. Considering several etiologic, therapeutic, and comorbidity-related factors, a psychosis continuum model has been proposed for the understanding and treatment of psychotic disorders. Within the new emerging treatment approaches, Contextual Cognitive-Behavioral Therapies (CCBT) seem to hold promise for the psychosis continuum. However, considering their novelty for this specific population, the quality of efficacy evidence remains unclear. Objective: To examine, critically analyze, and summarize the results from studies based on therapeutic models within the CCBT approach (Mindfulness and Acceptance-based interventions, Compassion-Focused Therapy, Dialectical Behavior Therapy, and Metacognitive Therapy) for patients with a diagnosis within the psychosis continuum (schizophrenia, schizoaffective disorder, bipolar disorder). Methods: Three leading electronic databases (MEDLINE/PUBMED; PsycINFO; Cochrane Library), a grey literature database (OpenGrey), and registered clinical trials (ClinicalTrials.Gov) were searched using combinations of key terms regarding the CCBT models and the diagnosis considered. Reference lists of the relevant studies and reviews were searched. Only Randomized Controlled Trials (RCTs) were included. The “Cochrane Risk of Bias Assessment Tool” was used for quality assessment. Results: A total of 17 articles were included. This review was based on a majority of unclear or low risk of bias studies. Benefits regarding clinical variables such as psychotic symptoms, anxiety and depression, functioning or quality of life were found. Conclusion: Overall the studies supported some benefits of CCBT approaches for the psychosis continuum. The conceptual perspective on treatment has changed, nevertheless the outcomes assessed are still symptom-focused and there is still need for improvement. Methodological considerations and future directions are presented.

During pregnancy, obsessive-compulsive (OC) symptoms and disorder are underdiagnosed and undertreated. The Prenatal Obsessive-Compulsive Scale (PreOCS; Lord, Rieder, Hall, Soares, & Steiner, 2011) is the only self-report questionnaire that evaluates the severity and interference of specific pregnancy-related obsessions and compulsions. We aimed to analyze the validity and reliability of the PreOCS Portuguese version and to describe the prevalence, content, severity, interference, and onset of OC symptoms in pregnancy. Three hundred fifty-five pregnant women completed the PreOCS and other self-report instruments to evaluate perinatal anxiety and depression. Exploratory and confirmatory factor analyses revealed that a second-order model presented an acceptable fit. Cronbach's alphas were ≥.75 for the Severity and the Interference subscales and both were moderately correlated with depression and anxiety measures. Nearly 10% of the women presented OC symptoms with relevant severity. Co-occurrence of obsessions and compulsions (44.4%) was associated with significantly higher PreOCS scores. Obsessions about contamination, harm to the baby, others' judgment and baby's health presented the highest prevalence and increased the odds of having at least one compulsion. Searching for information, asking for reassurance, checking, and cleaning were the most reported compulsions. The Portuguese version of PreOCS has good psychometric properties, presenting itself as a valid and reliable instrument.

The Halstead Category Test (HCT) is a neuropsychological test that measures a person's ability to formulate and apply abstract principles. Performance must be adjusted based on feedback after each trial and errors are common until the underlying rules are discovered. Event-related potential (ERP) studies associated with the HCT are lacking. This paper demonstrates the use of a methodology inspired on Singular Spectrum Analysis (SSA) applied to EEG signals, to remove high amplitude ocular and movement artifacts during performance on the test. This filtering technique introduces no phase or latency distortions, with minimum loss of relevant EEG information. Importantly, the test was applied in its original clinical format, without introducing adaptations to ERP recordings. After signal treatment, the feedback-related negativity (FRN) wave, which is related to error-processing, was identified. This component peaked around 250ms, after feedback, in fronto-central electrodes. As expected, errors elicited more negative amplitudes than correct responses. Results are discussed in terms of the increased clinical potential that coupling ERP information with behavioral performance data can bring to the specificity of the HCT in diagnosing different types of impairment in frontal brain function.

Antipsychotic medication non-adherence is a complex and multifaceted problem that may hinder recovery in psychosis-spectrum disorders. Therefore, it warrants an early and comprehensive assessment. Current self-report measures focus entirely on behavioral and attitudinal barriers to adherence, failing to provide insight about key psychosocial drivers such as shame and stigma that may also account for non-adherence. This study's main goals were to develop a brief scale for measuring antipsychotic (non)-adherence and associated intra and interpersonal barriers (Antipsychotic Medication Beliefs and Attitudes Scale - AMBAS), and explore its psychometric properties. One hundred and seventy participants with a psychosis-spectrum disorder were recruited and filled in a battery of self-report measures. Exploratory factor analysis supported a two-factor solution, with one factor tapping the influence of different barriers to medication adherence and other factor encompassing perceived positive effects of medication. The scale presented good reliability and convergent validity as evidenced by significant moderate associations with the Medication Adherence Rating Scale. Although in need for further study, AMBAS seems a valid and reliable measure to assess antipsychotic (non)-adherence and underlying behavioral and psychosocial drivers. With replication, AMBAS might be a useful measure that could be used in different clinical and research settings.

Described as a contextual behavioural approach, Compassion-focused Therapy (CFT) aims at helping people develop compassionate relationships both with others and with the self. CFT has been used to promote recovery in psychosis with promising results. The development process of the Compassionate Approach to Schizophrenia and Schizoaffective Disorder (COMPASS) builds upon the available research on contextual behavioural approaches for psychosis. Its main framework is the affect regulation system's model and the compassion-focused therapy rationale as it was adapted for psychosis. Other theoretical and empirical influences are presented and innovations regarding CFT protocols for psychosis are highlighted. COMPASS is already being studied and details on the pilot study are provided. With further study and continuing improvement COMPASS has the potential to help foster recovery in psychosis.

Brief Introduction–Perinatal mental illness–diagnosis, etiology, treatment options, dilemas, case report presentation Perinatal mental illness is a significant complication of pregnancy and the postpartum period. These disorders include depression, anxiety disorders and postpartum psychosis. Perinatal depression and anxiety are the most common. Their occurrence has complex psychological, environmental and biological underpinnings. Perinatal psychiatric disorders impair a woman's function and are associated with suboptimal development of her offspring. Currently available treatment options have many limitations regarding safety and efficacy. There is a need to establish new treatment tools in this special group of patients. Efficacy of repetitive transcranial magnetic stimulation (rTMS) in decreasing postnatal depression symptoms: a systematic review. Non-pharmacological interventions, such as repetitive Transcranial Magnetic Stimulation (rTMS; a non-invasive brain stimulation technique), are attractive options for women concerned with infant exposure to medication during the breastfeeding period, combining efficacy with low risk. rTMS is an approved treatment for Major Depression Disorder by the Food and Drug Administration (USA), and previous systematic reviews support its efficacy as a stand-alone or add-on procedure to accelerate responsiveness to SSRI's (Wang, 2017), suggesting the scale-up of this intervention to the Postnatal depression disorder (PND). As of now, results concerning its application in postnatal depression come from two open label, one Randomized Controlled Trail (RCT) and one case report. Reliable evidence concerning whether rTMS is indeed effective in treating postnatal depression is lacking. Here, we will present a systematic review that gathers the available information concerning rTMS clinical significance in treating postnatal depression, and establish the direction for needed future studies. Transcranial direct current stimulation for treatment of depression during pregnancy Six pregnant women (mean 32 years) with major depressive disorder (mean HAMD 22.5, mean BDI 26 at baseline) were treated with a two-step tDCS regimen: Two weeks of twice daily tDCS (30 min, 2 mA, anode F3–cathode F4 electrode position) and an optional elongation phase of two weeks with one stimulation per day. Four patients completed the whole study, two patients quitted after two weeks. All patients showed a marked improvement of depression. After two weeks of treatment, patients (n = 6) showed a mean HAMD reduction of 9 points or 37%, including two patients fulfilling response criteria. For BDI ratings, patients showed a mean reduction of 15 points or 54%, 3 achieved response, and one achieved remission. Patients who completed the whole study (n = 4) had a mean HAMD reduction of 17 points or 76%, three achieved response, and one achieved remission. In BDI ratings these patients showed a mean reduction of 17 points or 60%, two achieved response, and one achieved remission. TDCS was well tolerated and there were no adverse effects or serious events related to stimulation. Prevalence and incidence of perinatal depression, anxiety and obsessive-compulsive disorder in Portuguese women Following a categorical and dimensional approach, we will present new epidemiological data on perinatal depression, anxiety and obsessive-compulsive disorders in a population-based cohort of Portuguese women (mean age = 32.75 ± 4.721). The sample sizes range from 300 to 600 subjects depending on the diagnostic/screening instruments used at different stages of this study. Specifically, we will present: – estimates of prevalence of postpartum major depression (n = 475), anxiety disorders (n = 350) and OCD (n = 350) according to the DSM-5 diagnostic criteria, using the Diagnostic Interview for Psychological Distress-Postpartum (DIPD-PP); – proportions of caseness (prevalence and incidence) of clinical significant depressive (n = 600), anxiety (n = 300) and OC symptoms (n = 300) in the second trimester of pregnancy and in the 3rd to 6th months postpartum, according to their scores on the Portuguese versions of the Postpartum/Perinatal Depression Screening Scale, Perinatal Anxiety Screening Scale and Perinatal Obsessive Compulsive Scale. New psychometric and operative parameters of these screening questionnaires will also be presented, as well as relevant correlates and risk-factors of the psychological distress variables measured by these instruments. Perinatal OCD–can rTMS be an answer? A growing body of literature suggests that obsessive-compulsive disorder (OCD) is common in pregnancy and puerperium with risks of persisting consequences for both the mother and her child if untreated. Moreover, OCD is challenging to treat especially in the perinatal period. The extreme responsibility that characterizes OCD patients leads women in the perinatal period, often experiencing obsessions involving the safety of the foetus to a preference of non-pharmacological approaches. However, cognitive-behavioural psychotherapy drop-out rate is high due to time management difficulties especially in exposure and response prevention tasks involving family members or in family environment. One potential treatment alternative to antidepressants for pregnant and postpartum women with OCD is repetitive transcranial magnetic stimulation (rTMS). rTMS has proven to be effective in OCD symptoms and the its non-pharmacologic nature eliminates concerns about foetal exposure to the potential risks of psychotropic medications. However, the absolute number of pregnancies exposed to TMS remains small and evidence regarding its efficacy in women with perinatal OCD is limited. In this presentation we will discuss treatment challenges of perinatal OCD, the potential benefits of a rTMS based approach and present a rTMS protocol designed to treat OCD in the perinatal period.

Our objective was to analyze the relationships between Repetitive negative thinking (RNT), perfectionism and psychological distress. Specifically we wanted to test if RNT mediates the relationship between perfectionism and psychological distress. 788 college students completed self-report questionnaires to evaluate perfectionism trait dimensions [Evaluative concerns (EC) and Positive strivings (PS)], RNT dimensions [Repetitive thinking (RT) and Cognitive interference and unproductivity (CIU)], perceived stress, and perceived support. Psychological distress was measured with the Profile of Mood States subscales: Depression (D), Tension–anxiety (TA), Anger–hostility (AH), Fatigue–inertia (FI) and Vigor–anxiety (VA). After controlling for perceived stress and support, perfectionism dimensions and RNT (particularly CIU) remained a significant predictors of psychological distress. CIU was a partial mediator of the relationship between EC and D, TA, AH, FI and VA and a full mediator of the relationship of PS with D and FI. Whereas the effect of negative perfectionism on emotional disturbances was potentiated by RNT, PS was only associated to it when high levels of RNT were also present. Showing that Positive striving effects on psychological distress may be a function of specific mediators, these results contribute to a better understanding of the nature of positive perfectionism.

Eating disorders (ED) are a significant source of physical and psychosocial impairment, mainly amongst women in adolescence and early adulthood. The development and progression of ED are influenced by a large set of environmental and social factors, but it has also been recognized that ED have important biological and psychological determinants. This article reviews the literature on ED concerning defensive emotion and psychological processes involved in the development and maintenance of ED, but also their neuroimaging/electrophysiological correlates. Furthermore, it also reviews treatment approaches that focused on the improvement of ED patients’ symptomatology. An extensive literature exists regarding neuroimaging/electrophysiological studies associated with clinical features of ED patients in terms of body image and food processing and reward/inhibition processes. However, studies addressing the neural correlates of psychological processes, such as rumination, experiential avoidance, cognitive fusion and self-criticism, and the defensive emotion of shame, which are key components for the development and maintenance of ED, are still scarce if not lacking. In the context of this cognitive set, cognitive-contextual approaches for ED patients, such as mindfulness, acceptance- and compassion-based interventions are promising to change the way individuals relate to their aversive experiences, but still requires a deeper understanding of the mechanisms by which it operates and further testing of its therapeutic efficacy. This review highlights the lack of neuroimaging/electrophysiological studies in ED patients in which concerns shame and other relevant psychological processes, but also the scarce evidence in terms of brain modifications associated with therapeutic efficacy of cognitive-contextual approaches that help to change the way individuals relate to their body, weight and food concerns, reduce maladaptive emotion regulation strategies and improve well-being in patients suffering from ED.

Objective To explore 1) if perfectionism, perceived distress/coping, and cognitive emotion regulation (CER) are associated with and predictive of negative/positive affect (NA/PA); and 2) if CER and perceived distress/coping are associated with perfectionism and if they mediate the perfectionism-NA/PA associations. There is a distinction between maladaptive and adaptive perfectionism in its association with NA/PA. CER and perceived distress/coping may mediate the maladaptive/adaptive perfectionism and NA/PA associations. Methods 344 students (68.4% girls) completed the Hewitt & Flett and the Frost Multidimensional Perfectionism Scales, the Composite Multidimensional Perfectionism Scale, the Profile of Mood States, the Perceived Stress Scale, and the Cognitive Emotion Regulation Questionnaire. Results NA predictors were maladaptive/adaptive perfectionism, maladaptive CER and perceived distress (positively), positive reappraisal and planning, and perceived coping (negatively). PA predictors were maladaptive/adaptive perfectionism and perceived distress (negatively), positive reappraisal and planning, positive refocusing and perceived coping (positively). The association between maladaptive perfectionism and NA was mediated by maladaptive CER/low adaptive CER, perceived distress/low coping. Maladaptive perfectionism and low PA association was mediated by perceived distress. High PA was determined by low maladaptive perfectionism and this association was mediated by adaptive REC and coping. Adaptive perfectionism and NA association was mediated by maladaptive CER and perceived distress. Conclusion CER and perceived distress/coping are associated and mediate the perfectionism-NA/PA associations. Resumo Objetivo Explorar 1) se o perfeccionismo, o estresse/copingpercebidos e a regulação emocional cognitiva (REC) estão associadas e predizem o afeto negativo/positivo (AN/AP); e 2) se a REC e o estresse/copingestão associados e mediam a relação perfeccionismo-AN/AP. Existe uma distinção entre o perfeccionismo mal-adaptativo/adaptativo na associação com o AN/AP. A REC e o estresse/copingpoderão mediar as associações entre o perfeccionismo mal-adaptativo/adaptativo-AN/AP. Métodos 344 estudantes (68.4% do sexo feminino) completaram as Escalas Multidimensionais do Perfeccionismo de Hewitt & Flett e de Frost, a Escala Multidimensional de Perfeccionismo Compósita, o Perfil dos Estados de Humor, a Escala de Estresse Percebido e o Questionário da Regulação Emocional Cognitiva. Resultados Os preditores do AN foram o perfeccionismo adaptativo/mal-adaptativo, a REC mal-adaptativa e o estresse percebido (positivamente), a reavaliação positiva e planeamento e o coping(negativamente). Os preditores do AP foram o perfeccionismo adaptativo/mal-adaptativo e o estresse percebido (negativamente), a reavaliação positiva e planeamento, a refocalização positiva e o copingpercebido (positivamente). A associação entre o perfeccionismo mal-adaptativo e o AN foi mediada pela REC mal-adaptativa/baixa REC adaptativa, pelo estresse/baixo copingpercebidos. A associação entre o perfeccionismo mal-adaptativo/adaptativo e baixo AP foi mediada pelo estresse percebido. O elevado AP foi determinado pelo baixo perfeccionismo mal-adaptativo e esta associação foi mediada pela REC adaptativa e pelo coping. A associação entre o perfeccionismo adaptativo e o AN foi mediada pela REC mal-adaptativa e pelo estresse percebido. Conclusão A REC e o estresse/copingpercebidos estão associados e medeiam as associações entre o perfeccionismo e AN/AP.