Browsing by Author "Trancas, B"
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- 48,XXYY in a general adult psychiatry departmentPublication . Santos, NB; Trancas, B; Pinto, P; Lopes, B; Gamito, A; Almeida, S; Ferreira, B; Luengo, A; Vieira, C; Martinho, J; Pereira, B; Cardoso, GThe 48,XXYY syndrome is a distinct clinical and genetic entity, with an incidence of 1:17,000 to 1:50,000 newborns. Patients often access mental healthcare services due to behavior problems, such as aggressiveness and impulsiveness, and are frequently intellectually disabled. We report a case of a patient with 48,XXYY syndrome treated in a general adult psychiatry department. A 23-year-old man was frequently admitted to our inpatient psychiatric unit (14 admissions in five years) due to disruptive behavior, including self harm, aggression to objects and animals, and fire-setting behavior, in a context of dysphoric mood and marked impulsivity. Upon observation, the patient had mild intellectual disability, with prominent impulsive and aggressive features and very low tolerance to frustration. His physical examination revealed hypertelorism, increased thickness of neck, acne, sparse body hair, triangular pubic hair distribution, fifth digit clinodactyly, small testicles and penis, and gynecoid pelvis. Laboratory analysis revealed endocrine abnormalities (low plasma testosterone and subclinical hypothyroidism). Cardiac Doppler sonogram was normal. Electroencephalogram revealed only a diffuse slowing electrogenesis, with no etiological specificity. Clinical suspicion of a chromosomal disorder was confirmed by a 48,XXYY karyotype. Subsequent magnetic resonance imaging detected discrete bilateral reduction of the hippocampal formations, possibly related to temporal dysgenesia. Psychopharmacological treatment options met moderate success, with lack of adherence. Other psychosocial treatment interventions ensued, including family therapy and psychoeducation. We underscore the need to be alert for chromosomal disorders, even in a general adult psychiatry department, as a minority of patients may reach adult care without proper diagnosis.
- An OCD patient presenting with a cerebellum venous variant in a family with a strong schizophrenia loading: a case report.Publication . Palma, M; Borja-Santos, N; Trancas, B; Klut, C; Cardoso, GThe role of cerebellar pathology in psychiatric symptoms has long been recognized. Cerebellar pathology has been associated with obsessive-compulsive disorder pathophysiology, particularly with compulsive hoarding. Likewise, some cerebellum abnormalities have been described in schizophrenia, as well as in comorbidity between obsessive-compulsive disorder and schizophrenia. The authors report the case of a 32-year-old woman with obsessive-compulsive disorder and a cerebellum development variant in a family with a strong schizophrenia loading. This case emphasizes the probable role of the cerebellum in the pathophysiology of both obsessive-compulsive disorder and schizophrenia, and reconsiders the existence of a so called schizo-obsessive subtype of schizophrenia.
- Aspectos psicológicos do doente oncológicoPublication . Cardoso, G; Luengo, A; Trancas, B; Vieira, C; Reis, DA doença oncológica é acompanhada de marcado 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 cuidados 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.
- Causes of Death in an Acute Psychiatric Inpatient Unit of a Portuguese General HospitalPublication . Barbosa, S; Sequeira, M; Castro, S; Manso, RT; Klut, C; Trancas, B; Santos, NB; Maia, TINTRODUCTION: Psychiatric patients are at increased risk of death from a number of natural and unnatural causes. This study examines the mortality causes of all psychiatric inpatients of an acute psychiatric unit at a general hospital in Portugal for sixteen years (1998 to 2013). MATERIAL AND METHODS: Twenty-one inpatients died at the inpatient unit between 1998 and 2013 (average 1.3 per year). A retrospective study through case-file review was carried to collect demographic characteristics, medical and psychiatry diagnosis. Patients transferred to other wards during their admission were not included. RESULTS: Circulatory system diseases were the most prevalent causes of death, occurring in 2/3 of patients and include pulmonary embolism (n = 6), acute stroke (n = 3), cardiac arrhythmia (n = 2), acute myocardial infarction (n = 1), abdominal aortic aneurysm rupture (n = 1) and heart failure (n = 1). Two patients died with pneumonia and in four cases the cause of death was undetermined. Only one case of suicide was registered. DISCUSSION: Circulatory conditions were the most frequent causes of death in our inpatient unit. Albeit a relatively rare event, inpatient suicide does occur and, in addition to its complex consequences on staff, family and patients should remain a focus for continued prevention. CONCLUSION: Mortality studies are important for determining quality of health care and to create recommendations for preventive measures.
- Characteristics of frequent users of an acute psychiatric inpatient unit: a five-year study in Portugal.Publication . Graça, J; Klut, C; Trancas, B; Borja-Santos, N; Cardoso, GOBJECTIVE: This study examined demographic and clinical characteristics of frequent users of a psychiatric inpatient unit in Portugal. METHODS: Data (2004-2008) for 1,348 consecutive psychiatric inpatients were reviewed. Frequent users (N=137), who had at least three admissions in the study period, were compared with nonfrequent users (N=1,211) on age, gender, race-ethnicity, diagnosis, and compulsory admissions. Data were analyzed with chi square and Student's t tests. RESULTS: Frequent users accounted for 29% of admissions. They were significantly younger than nonfrequent users (39±14 versus 44±17, p<.001), and a larger proportion had compulsory admissions (28% versus 14%, p<.001). The frequent user group also had significantly higher rates of bipolar disorder (61% versus 46%, p<.001) and schizophrenia (29% versus 18%, p<.003). CONCLUSIONS: Understanding characteristics of frequent users can inform development of appropriate services. Research should address other variables related to frequent admissions, including socioeconomic factors, general medical and psychiatric comorbidities, and treatment compliance.
- O Conceito de Normalidade: Uma Perspectiva da Psiquiatria ForensePublication . Trancas, BIntrodução: O conceito da normalidade tem merecido investigação filosófica, antropológica, médica, psicológica, estatística, entre outras, escapando a uma definição única, linear, estática e universal. O patológico surge em diálogo com a normalidade, interessando este debate à psiquiatria forense (PF). Objectivos: Perceber como a PF poderá ser chamada a ajudar a definir os limites e excepções (no Direito) a uma alegada “normalidade legal” e que tensões surgem nessa tarefa. Métodos: Procedeu-se a revisão selectiva da literatura, centrada quer na literatura filosófico-jurídica quer na literatura de psiquiatria forense. Resultados e Conclusões: Principiando por abordar tentativas de definição do normal, no âmbito da psiquiatria, através dos contributos de Alejandro Raitzin e de Daniel Offer e Melvin Sabshin, recomeçou-se esse esforço a partir do modelo do Homem implícito no Direito na perspectiva de Michael Moore: o comportamento humano é explicado pelo agir racional, autónomo, motivado por razões, caracterizado por intencionalidade e pressupondo existência de agência. No pressuposto vigente no Direito de que todos os cidadãos maiores possuem esta “normalidade legal”, sendo-lhes atribuídos direitos, capacidades e responsabilidades, a PF poderá ser chamada a investigar os pressupostos científicos às excepções a esta aludida “normalidade legal” (e.g. internamento compulsivo, inimputabilidade, interdição/inabilitação). Nesta tarefa a PF debate-se com áreas de tensão, onde há disputa de fronteiras, que se modificam por natureza (o normal é um conceito dinâmico) mas também por influência de agentes. São exploradas diversas áreas de tensão e analisados os casos exemplificativos da perturbação da personalidade (e.g. juízo médicos sobre pressupostos para inimputabilidade e para internamento compulsivo) e o problema das nosologias fabricadas (e.g. a alegada síndrome de alienação parental). Neste contexto a PF navega por um canal estreito entre concepções nem sempre sobreponíveis de dois sistemas para os quais tem especial incumbência de colocar em diálogo (Medicina e Direito). As fronteiras da “normalidade legal” devem ser vigiadas com zelo e ética, evitando a eventual instrumentalização da PF, sem esquecer o papel humanista da medicina (e da psiquiatria) no cuidar e tratar das pessoas, sejam criminosos doentes ou doentes criminosos.
- Contributos para a formação geral e especializada em psiquiatria forense em PortugalPublication . Vieira, F; Trancas, B; Santos, J
- Depressão no doente oncológico: considerações diagnósticas e terapeuticasPublication . Trancas, B; Cardoso, G; Luengo, A; Vieira, C; Reis, DContexto e Objectivos: A prevalência da doença oncológica é elevada, representando uma das principais causas de morte no mundo ocidental. A ameaça que exerce sobre a existência individual faz com que se acompanhe frequentemente de perturbações emocionais, incluindo depressão clínica. Embora a sua determinação não esteja isenta de problemas metodológicos, esta pode afectar até 50% dos doentes, cursando com intenso sofrimento pessoal. Os autores efectuam uma revisão centrada no rastreio e avaliação da depressão clínica em doentes com doença oncológica (factores de risco, instrumentos e estratégias) e no seu tratamento (psicoterapia, farmacoterapia e prestação de cuidados). Métodos: Revisão não sistemática da literatura. A pesquisa foi efectuada na base de dados Pubmed utilizando as seguintes palavras chave no campo title/abstract: cancer, oncology, depression, psychiatry, morbidity, screening, treatment, psychotherapy, psychiatric status rating scales, sem restrição temporal. Incluíram-se artigos redigidos em Português, Inglês ou Castelhano. Foram ainda pesquisadas e incluídas fontes bibliográficas citadas nos artigos encontrados. Conclusão: Têm sido isolados factores de risco para o aumento da probabilidade de depressão em contexto oncológico, o que pode, aliado a uma estratégia de rastreio, porventura utilizando instrumentos validados como a Hospital Anxiety and Depression Scale (HADS), permitir aumentar a capacidade de detecção de casos. A revisão das opções terapêuticas mostra que estas devem ser personalizadas e baseadas numa intervenção multidisciplinar, psicofarmacológica e psicoterapêutica, aindaque não recolham para já a melhor evidência baseada em ensaios clínicos aleatorizados. Sublinha-se a necessidade dos técnicos de saúde disporem de tempo para o doente, o que maximiza a sua capacidade de detecção da depressão clínica e subsequente tratamento e permite estabelecer uma relação compreensiva e empática, validando a existência e o sofrimento do doente.
- Depression and anxiety symptoms following cancer diagnosis: a cross-sectional study.Publication . Cardoso, G; Graça, J; Klut, C; Trancas, B; Papoila, AINTRODUCTION: The aims of the present study were to assess demographic and clinical characteristics of patients after receiving a cancer diagnosis, and to determine possible risk factors for anxiety and depression. METHODS: All consecutive patients aged 18 or above, were assessed before starting intravenous chemotherapy for the first time with the Hospital Anxiety and Depression Scale (HADS), the Distress Thermometer, and a Visual Analog Scale for pain. Demographic and clinical data were also collected. RESULTS: The patients assessed (n = 270) had a mean age of 59.4 (SD = 11.8) years, and 50.7% were women. Tumours were more frequently colorectal (27.2%), lung (18.8%) and breast (17.6%), and 68.9% were stages 3 or 4. A HADS Anxiety score ≥8 was present in 30% of the patients, a Depression score ≥8 in 24.1%, and a Distress score ≥4 in 44.4%. Independent risk factors for HADS Depression score ≥8 were being a woman (OR = 2.45; p = 0.004), being older (OR = 1.04; p = 0.005), and cancer stage 3-4 (OR = 2.24; p = 0.023) in the multivariable analysis; for Anxiety ≥8 they were being a woman (OR = 2.47; p = 0.002), having a past psychiatric consultation (OR = 2.83; p = 0.029), and cancer stage 3-4 (OR = 1.90; p = 0.047). CONCLUSION: These results suggest the need for greater awareness and a differentiated approach to patients at increased risk of anxiety and depression in the early stages of treatment and before starting chemotherapy.
- Efficacy of Electroconvulsive Therapy in Bipolar Disorder with Mixed Features.Publication . Palma, M; Ferreira, B; Borja-Santos, N; Trancas, B; Monteiro, C; Cardoso, GBACKGROUND: The aim of this study was to investigate the effectiveness of electroconvulsive therapy (ECT) in medication-nonresponsive patients with mixed mania and bipolar depression. METHOD: Forty-one patients with mixed mania (DSM-IV diagnosis of bipolar I disorder, most recent episode mixed) and 23 patients with bipolar depression (DSM-IV diagnosis of bipolar I disorder, most recent episode depressed) consecutively assigned to ECT treatment were included in this study. Subjects were evaluated using the Montgomery-Asberg Depression Rating Scale (MADRS), the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impressions-Severity of Illness scale (CGI-S). Assessments were carried out the day before starting ECT, 48 hours after completion of the third session (T1), and a week after the last session of ECT (T2). RESULTS: Both groups received an equal number of ECT sessions (mean +/- SD = 7.2 +/- 1.7 vs. 7.3 +/- 1.6). In both groups, within-group comparisons showed that there was a significant reduction in CGI-S score (mixed mania, p <.0001 at T1 and T2; bipolar depression, p < .01 at T1, p < .0001 at T2), MADRS total score (both groups, p < .0001 at T1 and T2), BPRS total score (mixed mania, p < .0001 at T1 and T2; bipolar depression, p < .001 at T1, p < .0001 at T2), and BPRS activation factor score (mixed mania, p < .0001 at T1 and T2; bipolar depression, NS at T1, p < .01 at T2). Between-group comparisons revealed that patients with mixed mania showed significantly greater decrease in MADRS score (p < .001) and a greater proportion of responders (CGI-S) than patients with bipolar depression at endpoint (56% [N = 23] vs. 26% [N = 6], p = .02). Patients with mixed mania showed a greater reduction in suicidality, as measured by MADRS score, than patients with bipolar depression (p < .02). CONCLUSION: In our study, ECT was associated with a substantial reduction in symptomatology, in both patients with mixed mania and those with bipolar depression. However, the mixed mania group exhibited a more rapid and marked response as well as a greater reduction in suicidal ideation. Response to ECT was not influenced by the presence of delusions.
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