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Introduction: Rape trauma is particularly traumatic when compared to other forms of trauma. PTSD is one of the most frequent mental disorders found in assault victims. The lifetime prevalence of sexual-assault-related PTSD (SAR-PTSD) can be as high as 50% among victims and its profile has been under recent study. Objectives: We aim to present the main characteristics of SARPTSD, including differences between gender, severity of symptoms and comorbid disorders. Methods: A selective literature review was conducted using the PubMed and ResearchGate databases, using combinations of the following keywords: "sexual assault", "rape", "PTSD" and "sexual related PTSD". Results: Sex and gender: The majority of the victims are women while the perpetrators are usually male. Sexual assault predicts SAR-PTSD for both genders. Women have a higher risk of developing SAR-PTSD than men, but men are generally less likely to disclose being raped. Symptoms Severity: Factors like completed rape, physical injury and life threat interact synergistically in predicting SAR-PTSD risk. Less education, greater perceived life threat, and receipt of more negative social reactions (stigma) upon disclosing assault were related to greater symptom severity. Perceived control over trauma recovery is related to fewer SAR-PTSD symptoms. Comorbid Findings: Patients with SAR-PTSD are at greater risk of developing a comorbid substance use disorder and show higher symptom severity and poorer treatment outcomes compared to patients with either disorder alone. Conclusions: The distressingly high rate of SAR-PTSD in survivors of sexual assault is a clear indication for further support to these patients. Future studies with sexual assault male victims are a pressing necessity. [ABSTRACT FROM AUTHOR]

Introduction: The pharmacological treatment of sexual offenders - and of those predisposing to these behaviors - aims to inhibit or reduce sexual arousal and recidivism. Pharmacological approaches are not widely used for all patients and are often selected for paraphilias or specific patterns of sexual arousal. Objectives: We aim to present the most common pharmacological treatment options used in clinical pratice for sexual offenders. Methods: A selective literature review was conducted using the PubMed and ResearchGate databases, using the following key words "sexual offenders", "pharmacological intervention", "pharmacological treatment", "paraphilia treatment". Results: Hormonal agents (antiandrogens) target a reduction in testosterone and sexual drive. Research shows that antiandrogens treatment presents lower rates of detected sexual recidivism and decreased sexual arousal in response to offense specific stimuli. Both side effects and negative/punitive connotations of these drugs make them reserved for paraphilic and high risk patients. SSRI are mostly used in cases where there is marked sexual rumination or preoccupation, a compulsive aspect to the sexual behavior or an association with low mood. Their efficacy is the result of a reduction in the intensity of sexual rumination/urges, enhancement of mood, decreased impulsivity, lessening of libido, sexual anhedonia or a combination of these. Although commonly causing loss of libido and erectile difficulties, the antipshychotics' impact is inconsistent and unreliable. Research doesn't provide the evidence for using mood stabilizers, anxiolytics or naltrexone. Conclusions: Due to the lack of studies and the evanescing interest in studying perpetrators, current evidence is far more supporting than robust making the need for guidelines a pressing matter. [ABSTRACT FROM AUTHOR]

Historically the psychiatric clinical practice in Mozambique evolved from an eminently reclusive care setting (colonial period) to a phase where the patients were rapidly deinstitutionalized into their communities (post-independence years). In 1990, in order to restructure the mental health care network, the National Mental Health Plan was approved. Its main goal was to promote a semi-open treatment setting, activating the community role in the rehabilitation and social reintegration of the psychiatric patient. To cope with the scarcity of human resources, a three-year technical degree was created, training medical technicians in psychiatry. Presently, there are two specialized psychiatric hospitals, one in Maputo and another in Nampula. Through the description of our 3-month community psychiatry internship in Mozambique, we intend to depict the country's mental health care reality. Our internship took place in São João de Deus Mental Health Centre, the psychiatric hospital located in Nampula, which is responsible for the country's northern region. Besides offering in-patient and ambulatory treatment, it also aims to intervene at a community level. We will address the hospital's community intervention project, the developed activities, the most commonly observed pathologies, the cross-cultural relevant aspects, as well as the challenges we had to face in a harsh environment. As one would expect, the social and medical realities we encountered were quite different from the ones we are used to, forcing us to adapt constantly in order to surpass challenges of a multiple nature. Nonetheless, these were also the circumstances that turned this experience into something unique, extremely enriching and certainly unrepeatable. [ABSTRACT FROM AUTHOR]

We explored the adherence to a home-delivered, computer-based, cognitive remediation protocol in a first-episode psychosis outpatient cohort. Seventeen patients underwent a cognitive training protocol for 6 months using an online platform accessible from their home under the supervision of a qualified neuropsychologist. Neuropsychological, psychopathological, and functional data were collected at baseline and postintervention, whereas qualitative appraisal of the intervention was assessed monthly. Overall, participants' evaluation of the program was positive. This was reflected in a good adherence rate with 12 (70%) of 17 patients completing 80% of the prescribed sessions. Exploratory analysis revealed significant improvements in sustained attention (p = 0.020) and verbal memory (p = 0.018). A decrease in negative symptoms and an improvement on the Clinical Global Impression were also found (p = 0.009). We believe these are encouraging results to further explore the adopted delivery approach, which could facilitate access to cognitive training earlier and to a larger group of patients.

Theory of Mind (ToM) is compromised in schizophrenia, and responsible for social disability. We aim to study the correlation between ToM deficits and Executive Functions (EF), using the Faux Pas Test (FPT) for ToM evaluation, Behavioral Assessment of the Dysexecutive Syndrome (BADS) and Wisconsin Card Sorting Test (WCST) for EF assessment. Two groups of patients with schizophrenia were included: 22 young (18-35 years-old) and 18 middle-aged (>50 years-old) Patients, compared to age-matched Controls. We found worst FPT performances in both groups of patients, but with a more generalized pattern of dysfunction in the middle-aged patient group. This group had worse EF scores than both controls and younger patients. The association of EF with FPT items was uneven. In young patients only empathy (Q6) remained significant after controlling for EF and level of education, while in middle-aged patients faux pas explanation (Q4), false belief (Q5) and total scores remained significant. In young patients only affective TOM was impaired. No correlation was found with clinical symptoms, nor age at onset of the disease. We conclude that ToM deficit arises early during the course of the illness (already present in young patients), increases in middle-aged patients, and relates only partially with EF., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Impaired manual dexterity is commonly observed in schizophrenia. However, a quantitative description of key sensorimotor components contributing to impaired dexterity is lacking. Whether the key components of dexterity are differentially affected and how they relate to clinical characteristics also remains unclear. We quantified the degree of dexterity in 35 stabilized patients with schizophrenia and in 20 age-matched control subjects using four visuomotor tasks: (i) force tracking to quantify visuomotor precision, (ii) sequential finger tapping to measure motor sequence recall, (iii) single-finger tapping to assess temporal regularity, and (iv) multi-finger tapping to measure independence of finger movements. Diverse clinical and neuropsychological tests were also applied. A patient subgroup ( N  = 15) participated in a 14-week cognitive remediation protocol and was assessed before and after remediation. Compared to control subjects, patients with schizophrenia showed greater error in force tracking, poorer recall of tapping sequences, decreased tapping regularity, and reduced degree of finger individuation. A composite performance measure discriminated patients from controls with sensitivity = 0.79 and specificity = 0.9. Aside from force-tracking error, no other dexterity components correlated with antipsychotic medication. In patients, some dexterity components correlated with neurological soft signs, Positive and Negative Syndrome Scale (PANSS), or neuropsychological scores. This suggests differential cognitive contributions to these components. Cognitive remediation lead to significant improvement in PANSS, tracking error, and sequence recall (without change in medication). These findings show that multiple aspects of sensorimotor control contribute to impaired manual dexterity in schizophrenia. Only visuomotor precision was related to antipsychotic medication. Good diagnostic accuracy and responsiveness to treatment suggest that manual dexterity may represent a useful clinical marker in schizophrenia.