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Abstract Background There is a growing recognition that staff attitudes toward coercion in mental health care may influence its application. This study presents the psychometric properties of the Portuguese version of the Staff Attitudes towards Coercion Scale (SACS) and describes mental health professionals’ attitudes towards coercion in Portugal. Methods Mental health professionals working in five Portuguese mental health services in urban and rural regions of Portugal were invited to complete a questionnaire comprising the SACS and a socio-demographic form. Psychometric analyses including construct validity and internal consistency were carried out using R software. Results A total of 91 out of 119 questionnaires completed were valid for analysis. Fifty-seven (62.64%) respondents were female, with an age range of 24 to 69 years (M = 39.33; SD = 11.09). More than half of them were nurses (52.75%, n = 48), and a third were psychiatrists (36.26%, n = 33). A three-factor structure was confirmed and showed the best fit compared to previously proposed models with a cumulative explained variance of 59%. The Portuguese SACS exhibited adequate internal consistency for both the full-scale and subscales. The highest mean score was in the pragmatic attitude domain (20.60; SD = 3.37). A negative correlation was observed between the critical attitude domain and both age and years of experience (p

Introduction: Few studies analysed the impact of COVID-19 on supported accommodations (SAs) for people with serious mental disorders. This study aimed to analyse staff’s assessments of work challenges in SAs during COVID-19, the impact of the pandemic on staff, their perception of the impact on residents, and associated factors. Methods: To assess work challenges and the impact of the pandemic on staff and their perception of the impact on residents, a questionnaire was administered to the staff of SAs. Multilevel logistic regression analyses were conducted, involving work challenges and staff’s sociodemographic characteristics, and impact on staff. Results: In total, 117 staff from 32 SAs responded. A challenging environment was felt by most participants (68.4%). There were significant differences in work challenges experienced by staff, namely, according to profession and years working in mental health. A negative impact of COVID-19 was reported by 26.5% of staff, which was associated with their feeling that residents were no longer getting an acceptable service (OR = 7.04, 95% CI [1.43, 34.65], p = 0.016) and with staff feeling at risk of infection at work (OR = 7.99, 95% CI [1.39, 45.86], p = 0.020). Relapse and deterioration of residents’ mental health were perceived by 43.6% of staff. Conclusions: Several work challenges occurred in SAs during COVID-19, which had a negative impact on staff and reportedly on residents. Implications range from the organisational to the clinical levels and may apply internationally and in similarly challenging situations.

Cultural factors play a significant role in shaping the perception of coercion during psychiatric admissions. The present study aimed to assess the psychometric properties of the Portuguese Admission Experience Survey(P-AES).The study employed a cross-sectional approach in five psychiatric departments in three regions of Portugal. A total of 208 patients participated in the survey. Reliability was assessed through internal consistency and test-retest procedures. Internal validity was analyzed using a two-parameter logistic item response model, exploring three models, including a bifactor model. Convergent validity was determined by correlating AES scores with the Coercion Ladder (CL), Client Assessment of Satisfaction (CAT), and Global Assessment of Functioning (GAF) scale. Discriminatory power was assessed by comparing scores between patients with voluntary and involuntary admission status.The P-AES demonstrated satisfactory internal consistency and test-retest reliability. The bifactor model exhibited superior fit compared to the one-factor and three-factor models. Correlations between P-AES and CL, as well as CAT scores, indicated good convergent validity. Additionally, P-AES scores were notably higher in patients with compulsory psychiatric hospital admission compared to those admitted voluntarily, confirming its discriminatory power.The bifactor model suggests that all three domains of the AES should be used to measure the subjective experience of coercion.

Abstract Background Posttraumatic stress disorder (PTSD) is associated with significant morbidity, but efficacious pharmacotherapy and psychotherapy are available. Data from the World Mental Health Surveys were used to investigate extent and predictors of treatment coverage for PTSD in high-income countries (HICs) as well as in low- and middle-income countries (LMICs). Methods Seventeen surveys were conducted across 15 countries (9 HICs, 6 LMICs) by the World Health Organization (WHO) World Mental Health Surveys. Of 35,012 respondents, 914 met DSM-IV criteria for 12-month PTSD. Components of treatment coverage analyzed were: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) effective treatment coverage. Regression models investigated predictors of treatment coverage. Results 12-month PTSD prevalence in trauma exposed individuals was 1.49 (S.E., 0.08). A total of 43.0% (S.E., 2.2) received any mental health services, with fewer receiving adequate pharmacotherapy (13.5%), adequate psychotherapy (17.2%), or effective treatment coverage (14.4%), and with all components of treatment coverage lower in LMICs than HICs. In a multivariable model having insurance (OR = 2.31, 95 CI 1.17, 4.57) and severity of symptoms (OR = .35, 95% CI 0.18, 0.70) were predictive of effective treatment coverage. Conclusion There is a clear need to improve pharmacotherapy and psychotherapy coverage for PTSD, particularly in those with mild symptoms, and especially in LMICs. Universal health care insurance can be expected to increase effective treatment coverage and therefore improve outcomes.

Abstract Background People with mental health problems are more vulnerable to a broad range of coercive practices and human rights abuses. There is a global campaign to eliminate, or at the very least decrease, the use of coercion in mental health care. The use of coercion in psychiatric hospitals in developing countries is poorly documented. The primary aim of this study was to explore service users’ perceptions and experiences of coercion in psychiatric hospitals in Nigeria. Methods Four focus group discussions were carried out among 30 service users on admission in two major psychiatric hospitals in Nigeria. The audio recordings were transcribed verbatim and then analyzed thematically with the aid of MAXQDA software. Results The Focus group participants included 19 males and 11 females with a mean age of 34.67 ± 9.54. Schizophrenia was the most common diagnosis (40%, n = 12) and had a secondary school education (60%, n = 18). The focus group participants perceived coercion to be a necessary evil in severe cases but anti-therapeutic to their own recovery, an extension of stigma and a vicious cycle of abuse. The experience of involuntary admission revolved mainly around deception, maltreatment, and disdain. Participants in both study sites narrated experiences of being flogged for refusing medication. Mechanical restraint with chains was a common experience for reasons including refusing medications, to prevent absconding and in other cases, punitively. The use of chains was viewed by participants as dehumanizing and excruciatingly painful. Conclusion The experiences of coercion by participants in this study confirm that human rights violations occur in large psychiatric hospitals and underscore the need for mental health services reform. The use of coercion in this context reflects agelong underinvestment in the mental health care system in the country and obsolete mental health legislation that does not protect the rights of people with mental health problems. The study findings highlight an urgent need to address issues of human rights violations in psychiatric hospitals in the country.

Western societies have witnessed a sharp aging of their population in recent decades. This paradigm shift is reflected in the health care provided to the community, with a growing need to adapt to the aging of the population. The purpose of this article is to understand how the greater number of elderly people affect clinical practice in primary health care and to highlight the tools and mechanisms to be used in the (in)appropriate prescription and prevention of iatrogenesis in this group. Knowing that adverse drug reactions are one of the main reasons for morbidity and mortality in the older population, strategies should be adopted, by prescribing clinicians, to protect these patients who are already debilitated. A systematic approach, when introducing a new therapy, or reviewing it, and the use of prescription support tools, should be some of the practices that should be implemented in clinical practice in primary health care.

Variations in the rates of involuntary admission (IA) reflect the influence of unexplained contextual variables that are typically too heterogeneous to be included in systematic reviews. This paper attempts to gather and analyze factors unrelated to the patients that have been linked to IA. The articles included in this review were selected by iteratively searching four electronic databases (PubMed, PsychINFO, EMBASE, and Web of Science). A total of 54 studies from 19 different countries and regions, including 14 European countries, the United States, Canada, China, Vietnam, and Taiwan, were selected. The factors were categorized as service-related factors, impactful events, seasonal and temporal factors, mental health legislation, staff factors, and public attitudes. The factors rarely act in isolation but rather interact and reinforce each other, causing a greater influence on IA. This paper explains how these factors present opportunities for robust and sustainable interventions to reduce IAs. The paper also identifies future directions for research, such as examining the effects of economic recessions. Enhancing global reporting standards is essential to validate future research and support further in-depth studies. The complexity of the factors influencing IA and the implicit role of society suggest that resolving it will require social change.

IntroductionTreatment-Resistant Depression (TRD) and Major Depression with Suicide Risk (MDSR) are types of depression with relevant effects on the health of the population and a potentially significant economic impact. This study estimates the burden of disease and the costs of illness attributed to Treatment-Resistant Depression and Major Depression with Suicide Risk in Portugal.MethodsThe disease burden for adults was quantified in 2017 using the Disability-Adjusted Life Years (DALYs) lost. Direct costs related to the health care system and indirect costs were estimated for 2017, with indirect costs resulting from the reduction in productivity. Estimates were based on multiple sources of information, including the National Epidemiological Study on Mental Health, the Hospital Morbidity Database, data from the Portuguese National Statistics Institute on population and causes of death, official data on wages, statistics on the pharmaceutical market, and qualified opinions of experts.ResultsThe estimated prevalence of TRD, MDSR, and both types of depression combined was 79.4 thousand, 52.5 thousand, and 11.3 thousand patients, respectively. The disease burden (DALY) due to the disability generated by TRD alone, MDSR alone, and the joint prevalence was 25.2 thousand, 21 thousand, and 4.5 thousand, respectively, totaling 50.7 thousand DALYs. The disease burden due to premature death by suicide was 15.6 thousand DALYs. The estimated total disease burden was 66.3 thousand DALYs. In 2017, the annual direct costs with TRD and MDSR were estimated at € 30.8 million, with the most important components being medical appointments and medication. The estimated indirect costs were much higher than the direct costs. Adding work productivity losses due to reduced employment, absenteeism, presenteeism, and premature death, a total cost of € 1.1 billion was obtained.ConclusionsAlthough TRD and MDSR represent relatively small direct costs for the health system, they have a relevant disease burden and extremely substantial productivity costs for the Portuguese economy and society, making TRD and MDSR priority areas for achieving health gains.

Abstract Background Identifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012. Methods Data from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors. Results An increment of involuntary hospitalizations was associated with male gender [exp( $$\widehat{\upbeta }$$ β ^ ) = 1.31; 95%CI 1.06–1.62, p

ABSTRACT Objective: To gain a better understanding of how long-acting injectable antipsychotic (LAI) therapy is perceived by patients. Methods: A search for qualitative studies has been carried out on PubMed, Google Scholar, PsycINFO and PsycArticles, yielding 11 studies suitable for a review of qualitative studies. The reporting approach chosen was meta-ethnography, following the ENTREQ statement recommendations. Key concepts common to the different studies were extrapolated and then analysed in a systematic and comparative way. Results: Some recurrent issues were associated with LAIs, such as fear of coercion, fear of needles and lack of knowledge about depot therapy. These topics are linked to each other and the patients most concerned about the disadvantages of LAIs are those who are less informed about them, or who have experienced coercion and trauma during hospitalisation. On the other hand, patients who had already received LAIs, and those who had a good therapeutic relationship with their healthcare providers expressed satisfaction with this form of treatment and its continuation. Conclusion: Long-acting injectable antipsychotics are a tool in the management of mental disorders, and a viable alternative to oral medication. Patients show curiosity towards this method of administration, but lack of knowledge is a common finding. Shared decision making about the use of LAIs antipsychotics requires that patients receive accurate information and support for their decision regarding medication.

Abstract Background Research suggests that economic recessions might be associated with a higher use of psychotropic drugs, but literature is scarce and contradictory in identifying the most vulnerable groups. This study aims to assess possible changes in the use of psychotropic drugs due to the economic recession in Portugal, by comparing self-reported consumption in 2008/09 and 2015/16. Methods Data from the World Mental Health Survey Initiative Portugal (2008/09) and the National Mental Health Survey Follow-Up (2015/16) were used (n = 911). McNemar’s tests were performed to estimate changes in consumption of any psychotropic drug and of antidepressants, anxiolytics, and hypnotics/sedatives. Multiple Generalised Estimating Equations models with interaction effects were used to estimate the population odds of consuming psychotropic drugs according to year, gender and age. Results An increase of 6.74% was estimated in the consumption of psychotropic drugs from 2008/09 to 2015/16. Population odds of consuming any psychotropic drugs in 2015/16 were estimated to be 1.5 times higher than in 2008/09 (OR = 1.50;95%CI:1.13–2.01), particularly for hypnotics/sedatives (OR = 1.60;95%CI:1.14–2.25). Women and older individuals presented higher odds of consuming any psychotropic drugs (OR = 2.79;95%CI:2.03–3.84, and OR = 1.80;95%CI:1.28–2.54), after adjusting for year of assessment and education. However, when evaluating the interaction effect of the year with gender and age, men and younger individuals reported higher odds of consuming any psychotropic drugs in 2015/16, when compared to 2008/09 (OR = 1.85;95%CI:1.08–3.17, and OR = 1.95;95%CI:1.32–2.90, respectively). Conclusions The findings indicate that the period of economic recession was associated with an increased risk of psychotropic drugs use in Portugal. Consumption of psychotropic drugs remained higher among women and older individuals, but the results suggest that the economic crisis had a disproportionate impact on men and younger individuals. This identification of the most vulnerable population groups is useful to design effective and targeted public health interventions aimed at alleviating the effects of economic recessions.

Objective: Childhood adversities have been linked to poor health outcomes in adults, including both mood and general medical disorders. Here we tested the hypothesis that childhood adversities specifically increase the risk of comorbidity between mood and general medical disorders, rather than increasing the risk of either one independently. Methods: Mood disorders (DSM-IV major depressive, dysthymic and bipolar disorders), childhood adversities and general medical disorders were assessed in 2060 adults in the WHO World Mental Health Survey Portugal. Discrete-time survival analyses were used to investigate the association between mood disorders and subsequent first-onset general medical disorders and between general medical disorders and subsequent first-onset mood disorders, in adults. Discrete-time survival and multinomial regression analyses were used to test the influence of childhood adversities on the comorbidity between mood disorders and general medical disorders. Anxiety disorders were used as a psychiatric control. Results: Adult-onset mood disorders were found to precede the onset of diabetes (OR:1.8; 95% CI:1.2–2.9), arthritis (OR:1.6; 95% CI:1.1–2.3) and seasonal allergies (OR:1.6; 95% CI:1.1–2.5) while adult-onset hypertension was found to precede the onset of mood disorders (OR:1.7; 95% CI:1.2–2.6). Maladaptive family functioning (abuse, neglect and parental maladjustment), was associated with mood disorders (OR:1.5; 95% CI:1.2–1.9), hypertension (OR:1.4; 95% CI:1.1–1.7), arthritis (OR:1.3; 95% CI:1.0–1.6) and seasonal allergies (OR:1.5; 95% CI:1.1–2.0) in adulthood. Finally, the effect of maladaptive family functioning in predicting comorbid mood disorders and arthritis significantly differed from its effect in predicting only arthritis (p ​= ​0.01), which was not observed for other comorbidities. Maladaptive family functioning further predicted comorbid anxiety disorders and hypertension. Conclusion: Childhood adversities may be a specific risk factor for comorbid mood disorders and arthritis in adults.

Abstract Background Mental disorders are a major cause of disability with impacts on daily functioning and quality of life, which has been associated with socioeconomic disadvantage. The present study aims to assess how socioeconomic position is related to the disability reported by people with mental disorders, using data from the World Mental Health Survey (WMHS) Initiative Portugal. Methods Using data from the Portuguese Mental Health Survey, a nationally representative cross-sectional study (n = 3849), several logistic regression models with interaction terms were performed to evaluate the effect of different indicators of socioeconomic position on the disability reported by people with any mental disorder (any 12-month mood or anxiety disorder). Odds ratios were estimated at the specific values of the main effects and interaction terms between the presence of any mental disorder and education, employment status, self-perceived financial deprivation and subjective social status. Results The prevalence rate of any mood or anxiety disorder was 21.0% (n = 788), among which 14.7% (n = 115) reported disability. The results show that among people with any 12-month mental disorder, those in the employment category of “retired or others” had two times higher odds of reporting disability (OR = 2.19; 95%CI: 1.06–4.48) when compared to participants categorized as “working”. Likewise, individuals with financial deprivation had two times higher odds of reporting disability when compared to those non-financially deprived (OR = 2.36; 95%CI: 1.31–4.24). The odds ratios obtained for the specific years of education evaluated were not statistically significant but seem to suggest an educational gradient. Conclusions The findings of this study indicate that the disability reported by people with mental disorders varies according to socioeconomic position and draw attention to the need to develop policies to address these inequalities.

Background One important aspect of the societal burden of mental disorders is the extent to which these problems cause disability. Aims To assess days out of role associated with commonly occurring mental disorders in comparison with physical disorders in Portugal. Method National cross-sectional survey, with home interviews carried out with 3849 adult (aged 18+) respondents (57.3% response rate). Results Twelve-month prevalence for any mental disorder was 21.8%, any physical disorder 55.1% and any disorder 63.1%, with an average of 2.3 disorders per respondent with a disorder. Close to one out of every 10 respondents (9.2%) reported at least one day totally out of role in the past month (median of 6.4 days/any). The 18 conditions accounted for 78.2% of all days out of role, with 20.2% because of mental disorders and 59.2% because of physical disorders. Conclusions Mental disorders account for a substantial proportion of all role disability in the Portuguese population. Early detection and intervention would have a positive societal effect. Owing to highly frequent comorbidity, simultaneous management of mental and physical disorder comorbidities is advised for greater effect.

Background: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their ‘worst.’ Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD. Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the ‘worst’ lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview. Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk. Conclusions: Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized.

Introduction. Mixed states represent a frequent presentation of bipolar disorder, associated with higher resistance to psychopharmacology. Limited evidence supports the use of ECT in these patients. We aim to report our experience on treating bipolar mixed states with ECT. Methods. Retrospective data were collected from all bipolar patients submitted to acute ECT treatment, between June 2006 and June 2011. Three groups were created in terms of affective polarity of the episode. CGI rating was used to establish clinical remission and demographic and clinical variables were compared among groups. Long-term outcome was assessed through readmission measures, considering the use of continuation or maintenance ECT. Results. During the study time frame, a total of 50 ECT course treatments were performed on 41 bipolar patients. All affective episodes, except one mixed state, showed a positive clinical response. Patients with mixed state presentation tended to be younger and have an earlier first hospitalization than depressed patients. No differences were found in terms of ECT sessions performed, length of hospital admission, referral to continuation ECT treatment, number of readmissions, and time until next readmission. Conclusions. Our results support the effectiveness of ECT in patients experiencing a mixed affective state.

The Psychiatric Department of the Hospital Fernando Fonseca (HFF) was the first service in Portugal based on the general hospital to develop an integrated model of mental health care in the community, oriented towards the needs of the population and supported by multidisciplinary teams. This model is based on continuity of care by the same team, assertive follow-up of patients in the community, in conjunction with primary health care and a wide range of interventions. The activity of the Service occurs at both hospital and community levels, maintaining a close articulation between the different units that constitute it, to ensure the necessary continuity of care. The Community Teams of Amadora, Brandoa, Damaia and Queluz constitute the Functional Community Intervention Unit and are based in the Health Centers of the area where they operate. This work aims to characterize the active population followed by the Brandoa Community Team in December 2008, at socio-demographic and clinical levels and from the data obtained to do a brief reflection in order to question the activities undertaken and to improve care practices in the future.

O Serviço de Psiquiatria do Hospital Prof. Doutor Fernando Fonseca, EPE (HFF) foi o primeiro serviço em Portugal com base no hospital geral a desenvolver um modelo integrado de cuidados de saúde mental na comunidade, orientado para as necessidades da população e apoiado em equipas multidisciplinares. Este modelo assenta na continuidade de cuidados pela mesma equipa, no seguimento assertivo dos doentes na comunidade, na articulação com os cuidados de saúde primários e numa grande diversidade de intervenções. A actividade do Serviço decorre a nível hospitalar e comunitário, mantendo‐se uma estreita articulação entre as várias unidades que o constituem, de forma a garantir a indispensável continuidade de cuidados. A nível comunitário, as Equipas da Amadora, Brandoa, Damaia e Queluz constituem a Unidade Funcional Comunitária e estão sediadas nos Centros de Saúde da área onde desenvolvem a sua actividade. O presente trabalho tem como objectivos caracterizar a população activa seguida pela Equipa Comunitária da Brandoa em Dezembro de 2008, em termos socio‐demográficos e clínicos e a partir dos dados obtidos, fazer uma breve reflexão no sentido de questionar a actividade desenvolvida e melhorar as práticas assistenciais no futuro.

BackgroundThe Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care.MethodAt least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit's therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables.Results1750/2495 (70%) users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users' autonomy and experiences of care. Associations between QuIRC ratings and service users' ratings of their quality of life and the unit's therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning). A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy.ConclusionsRatings of the quality of longer term mental health facilities made by service managers were positively associated with service users' autonomy and experiences of care. Interventions that improve quality of care in these settings may promote service users' autonomy.

As alucinações musicais são um tipo de alucinações auditivas complexas. Trata‐se de um fenómeno relativamente raro e etiologicamente heterogéneo. Como principais etiologias, têm sido apontadas a hipoacúsia, a patologia cerebral orgânica, a epilepsia, e as doenças psiquiátricas, incluindo a esquizofrenia. A propósito de um caso clínico, os autores revêem e discutem a etiologia e a psicopatologia das alucinações musicais. Parece tratar‐se de um fenómeno subdiagnosticado, cuja pesquisa activa poderá permitir uma compreensão mais completa do quadro clínico apresentado pelo doente.

A síndrome takotsubo é uma síndrome cardíaca aguda de bom prognóstico que ocorre mais frequentemente em mulheres pós‐menopausa e que, geralmente, é precedida por stress psicológico ou físico. Os autores recolheram dados demográficos e clínicos e avaliaram aspectos psiquiátricos e psicológicos numa amostra de sete doentes com este diagnóstico. Foram aplicadoso Questionário de Saúde do Doente e o Inventário Multifásico de Personalidade de Minnesota (Minnesota Multiphasic Personality Inventory–MMPI). Verificou‐se que duas das participantes apresentavam uma perturbação depressiva e quatro se encontravam medicadas com psicofármacos. Os resultados da aplicação do MMPI revelaram características de psicopatia e paranóia nas doentes avaliadas.

Oncologic diseases currently have a high prevalence and present as one of the leading causes of death in the western world. Clinical depression and emotional distress are often the outcome of the threat these diseases present to individual existence. Although its precise determination is hampered by methodological problems, up to 50% of cancer patients may become clinically depressed and experience intense personal distress. We performed a literature review on screening and evaluating clinical depression in cancer patients (risk factors, instruments and strategies) and its treatment (psychotherapy, drug treatment and care management).Non-systematic literature review. The search was performed on Pubmed with the following keywords in title/abstract fields: cancer, oncology, depression, psychiatry, morbidity, screening, treatment, psychotherapy, psychiatric status rating scales, with no time restriction. Articles written in Portuguese, English and Castilian were included. A cross-reference search yielded additional included articles.Several risk factors for an increased likelihood of clinical depression in oncologic diseases have been identified which, together with screening strategies, including validated scales such as Hospital Anxiety and Depression Scale (HADS), may enhance our ability to detect cases. While not having, for the moment, the highest possible evidence for effectiveness from randomized trials, the treatment strategies for clinical depression in this population should be available and make use of multidisciplinary interventions, including psychopharmacological and psychotherapeutic options. The need for health care workers to spend adequate time with patients is underscored. This not only enhances their ability to detect and treat depression cases but also allows for an empathic and understanding relationship, validating the existence and suffering of the patient.

As autoras descrevem o contexto que precedeu o planeamento, implementação e desenvolvimento do Serviço de Psiquiatria do Hospital Fernando Fonseca, enfatizando os valores e princípios gerais orientadores de um Serviço marcadamente comunitário. Realçam a forma como se foram estreitando laços com os cuidados de saúde primários e outras estruturas de saúde e sociais existentes na comunidade. Descrevem a organização actual do serviço, os projectos em desenvolvimento e, finalmente, abordam os projectos e as linhas gerais de orientação para o futuro.

A doença oncológica é acompanhada de mar‐ cado sofrimento psicológico que atinge o doente e a família. O doente enfrenta, a partir do momento do diagnóstico, um conjunto de mecanismos e de tarefas de adaptação à doença e suas circunstâncias. A grande prevalência de quadros de ansiedade e depressão no seu decurso é mais acentuada na fase terminal. Destes factos decorre a necessidade de um plano terapêutico global integrando os cui‐ dados somáticos e psicológicos/psiquiátricos em todos os estadios da doença oncológica. Os profissionais de saúde também estão sujeitos a reacções emocionais face ao sofrimento que presenciam, pelo que, é importante estarem atentos aos aspectos emocionais e desenvolverem formação que lhes permita intervir de forma adequada junto do doente e da família. A articulação de oncologistas e profissionais de cuidados paliativos com as equipas de saúde mental pode ter um papel importante para a prestação de cuidados de qualidade a doentes oncológicos.

The development of consultation liaison psychiatry is linked to the integration of mental health services in the general health services. Its beginning occurred simultaneously in North America and in Europe, although following paths that differed in each country, and were related with the organization of health services. Nowadays, consultation liaison psychiatry's importance and development are fully established. Among the different challenges it currently faces, the need for a better articulation between hospital and primary care services, is the most preeminent.

Opening address of the WPA regional meeting workshop "Return to Kraepelin"

Comunicação de abertura do II Simpósio do Serviço de Psiquiatria, dedicada ao tema "Psicoses Agudas e Transitórias"

Uma extensa revisão da literatura mostra que as perturbações psiquiátricas são muito prevalentes nos serviços não psiquiátricos e nas consultas externas do hospital geral, atingindo taxas muito superiores às encontradas na população geral. As perturbações depressivas são as mais prevalentes, seguidas das ansiosas e das cognitivas, mas a sua distribuição difere entre serviços e populações estudadas. Tais factos permitem concluir que é mandatória a criação de equipas de Psiquiatria de Ligação que possam, não apenas diagnosticar e tratar as situações psicopatológicas, mas também aumentar a capacidade da sua detecção e tratamen- to pelas equipas médicas.

A Psiquiatria de Ligação como área da psiquiatria clinica e situada no seu contexto histórico e evolutivo, a partir do seu início na década de 30 nos EUA. Explicitam-se os principais modelos organizativos, bem como as suas funções e objectivos. Descrevem-se os desenvolvimentos mais importantes desta especialidade em Portugal, a experiencia do Núcleo de Psiquiatria de Ligacao (N.P.L.) do H.S.M. e os principais indicadores utilizados para referenciar a sua actividade. Salienta-se a análise dos resultados de um inquérito dirigido a médicos e enfermeiros do H.S.M. (n = 358) com a finalidade de levantar necessidades, caracterizar atitudes e identificar expectativas dos profissionais de saúde em relação ao atendimento psiquiátrico dos doentes internados. Apesar de os resultados evidenciarem perfis diferentes para os serviços de medicina, cirurgia, especialidades e unidades de cuidados intensivos, conclui-se: 1. da relevância dos problemas de saúde mental na prática clinica do hospital; 2. da sensibilidade dos profissionais de saúde para este tipo de problemas; 3. da boa receptividade para aquisição de maior treino em saúde mental; 4. de um pedido de personalização dos cuidados com a responsabilização de um psiquiatra por cada serviço hospitalar. Com base nos indicadores analisados define-se o modelo organizativo do N.P. L. e descrevem--se os seus objectivos principais.