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Objectives: Explore the relationship of symptoms, mood episodes and course of the disease in women with bipolar disorder (BD) associated with reproductive cycle events, particularly during menopause.Background: Reproductive cycle events like menstrual cycle, pregnancy/postnatal period and menopause may impact the course of the ilness for women with BD. Times of reproductive hormonal transition are periods prone to increased risk of mood episodes. Every women with BD is expected to or has experienced menopause. Given the substancial societal burden for this population detecting and detailing clinical features in this time of risk is critical.Materials and Methods: Non-systematic review of the literature published between 2009 and 2019 using PubMed database, with the search terms: u201cmenopauseu201d and u201cbipolar disorderu201d. The articles found were selected by the authors according their scientific relevance for the present aim.Results and Conclusions: Studies report that around twenty percent of women with BD are at increased risk of mood episodes during menopause. Mood elevation is reported less frequently than depression. Women who experienced postnatal episodes were more likely to experience mood symptoms menopausally. Midlife women with major depression and symptomatic menopausal transition had an increased risk of subsequent BD compared to those with major depression alone. There is a scarcity of studies and remains largely under-explored the impact of menopause on BD. Reproductive cycle event-related worsening of mood was associated with a more severe lifetime course of the ilness. Further work is needed to raise awareness over this period of possible relapse and exacerbation of symptoms, crucial for tailored interventions in this population.

Diagnostic instability is a measure to which psychiatric diagnoses change over time in the same patient. Since psychiatric diagnostic categories are developed without biological markers, the diagnostic process is less reliable in Psychiatry than in other fields of Medicine. We aim to study the changes in psychiatric diagnoses and the factors involved. Methods: Nonsystematic review of the literature using the specific terms in this context. Results: The overall mobility of diagnoses ranged from 27 to 40%. For most studies, the diagnosis with greater instability was schizoaffective disorder, with some authors even defending its elimination from the diagnostic classification. On the other hand, the most stable diagnosis over time is schizophrenia (mean stability: 90%).Bipolar disorder (BD) revealed the most variable results depending on the study. In some, underdiagnosis is the issue, especially when the first episode is depressive or when psychotic symptoms are present. In fact, approximately 61,5% of bipolar patients with psychotic symptoms received a first diagnosis different from BD. BD may also be overdiagnosed, particularly in the presence of personality and substance use disorders. Discussion and Conclusions: In the absence of biological markers, longitudinal validation through a long-term follow-up is necessary for accurate diagnostic ascertainment. It is believed that family or genetic studies will become a more reliable tool in error detection as well.

Objectives:A non-systematic literature review focusing the gender differences among bereaved parents.Background:The rate of prolonged grief disorder (PGD) among bereaved parents varies between 10 and 94% depending on the childu2019s cause of death. Parental bereavement process might be associated with different risk factors and important modifications on both marital and sibling systems. The aim of this work is to highlight the gender differences among bereaved parents. Materials and Methods:The research strategy on Pubmed database considered the papers published between 2009 and 2019 with the combination of the keywords u201cgriefu201d, u201cbereavementu201d, and u201cparentu201d. Results and Conclusions:Literature suggests that the main differences of the bereaved process of parents after the death of a child are related to gender differences in reaction to stress and in socialization. Women show grief manifestations earlier than men and mothers generally have intense and prolonged grief reactions with higher levels of depression. Interestingly, fathers showed more prominent denial at the beginning, with their attention placed at work. They tend to prefer experiencing grief reactions solely and there is a tendency to manifest their suffering feelings later. The majority of studies focused on the bereavement process among bereaved mothers, with few highlighting the grief process in fathers. One of the implications associated with gender difference across parental bereavement is related to the adherence of parents to counselingu200b interventions, that seems to be lower in men. It is important to consider these differences when treating prolonged grief disorder in parents.

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016 Submitted by Biblioteca da Faculdade de Medicina da Universidade de Lisboa (repositorio@medicina.ulisboa.pt) on 2017-01-26T16:25:20Z No. of bitstreams: 1 BeatrizCorte-Real.pdf: 510164 bytes, checksum: a0f0d9130632cab8aebb78105bc8fc7d (MD5) Made available in DSpace on 2017-01-26T17:03:07Z (GMT). No. of bitstreams: 1 BeatrizCorte-Real.pdf: 510164 bytes, checksum: a0f0d9130632cab8aebb78105bc8fc7d (MD5) Previous issue date: 2016