PSIQ - Artigos publicados em revistas não indexadas
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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.
- A Aprendizagem segundo Karl Popper e Thomas KuhnPublication . Santos, NBApós uma breve introdução em que é apresentada a organização deste trabalho, o autor aborda o modelo popperiano da aprendizagem e as suas implicações nas ideias do filósofo austríaco, em relação à evolução científica. Seguidamente, é referido o modelo kuhniano com especial enfoque nos paradigmas e nas revoluções científicas. A concluir, são apresentadas, de forma resumida, as principais semelhanças e diferenças de pontos de vista, entre os dois filósofos, acerca da aprendizagem e evolução científica.
- 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.
- A brief diagnostic screening instrument for mental disturbances in general medical wardsPublication . Fink, P; Ørnbøl, E; Huyse, F; Jonge, P; Lobo, A; Herzog, T; Slaets, J; Arolt, V; Cardoso, G; Rigatelli, M; Hansen, MOBJECTIVE: Mental illness is prevalent among general hospital ward patients but often goes unrecognised. The aim of this study was to validate the SCL-8d as a brief questionnaire for mental disturbances for use in general hospitals. METHODS: The study included 2040 patients, 18 years or older, consecutively admitted to 11 general internal medicine wards in seven European countries. All patients were screened on admission by means of the SCL-8d questionnaire. The psychometric performance (i.e., the internal validity) of the SCL-8d scale was tested using modern item response theory (IRT) in the form of the Rasch model. RESULTS: Differences between sample characteristics were considerable. Even so, the SCL-8d scale showed a remarkable, statistically significant fit in terms of internal homogeneity (P>.01) in all individual settings, except in Spain and Germany where the item "Everything is an effort" had to be excluded to obtain a fit. When pooling data from all centres, an excellent statistical significance of fit (P>.05) was obtained by exclusion of the "Effort" item. The scale was homogeneous as to gender (P>.05), but not age as it performed better among young patients than among patients older than 60 years (P<.01). In these two patient groups both internal and external homogeneity (gender, median age) was achieved. The SCL-8d sum score showed a marked correlation with current and previous treatment for mental illness. CONCLUSION: Apart from the "Effort" item ranking differently on the latent severity dimension as to age, the SCL-8d seems very robust from a psychometric point of view. Besides being short, the SCL-8d scale contains only emotional symptoms. It would therefore seem to be an excellent diagnostic tool for use in medical settings.
- Care complexity in the general hospital: results from a European studyPublication . de Jonge, P; Huyse, F; Lobo, A; Slaets, J; Herzog, T; Lyons, J; Opmeer, B; Stein, B; Arolt, V; Balogh, N; Cardoso, GThere is increasing pressure to effectively treat patients with complex care needs from the moment of admission to the general hospital. In this study, the authors developed a measurement strategy for hospital-based care complexity. The authors' four-factor model describes the interrelations between complexity indicators, highlighting differences between length of stay (LOS), objective complexity (such as medications or consultations), complexity ratings by the nurse, and complexity ratings by the doctor. Their findings illustrate limitations in the use of LOS as a sole indicator for care complexity. The authors show how objective and subjective complexity indicators can be used for early and valid detection of patients needing interdisciplinary care.
- Um caso de mania crónica numa doente com diagnóstico duplo de doença bipolar tipo I e perturbação delirantePublication . Martins, M; Gracias, MJ; Melo, JOs autores descrevem o caso de uma doente de 62 anos, sem antecedentes psiquiátricos pessoais ou familiares até aos 52 anos, altura em que inicia ideias delirantes de conteúdo somático e hipocondríaco em que acredita ter ficado doente com um “problema na cabeça” após um pequeno traumatismo no local de trabalho. É internada pela primeira vez dois anos depois do referido traumatismo com o diagnóstico de perturbação delirante tipo somático, tendo tido alta com o delírio enquistado e sem crítica para o estado patológico. Inicia acompanhamento em consulta externa de psiquiatria, com má adesão terapêutica em ambulatório, com novo internamento cerca de 1 ano depois, por agravamento das ideias delirantes somáticas e hipocondríacas. Cerca de 3 anos depois, começa a manifestar sintomas maniformes de gravidade crescente (ideias sobrevalorizadas de grandiosidade, aumento da energia, taquipsiquia, aumento do débito do discurso, desinibição, elação de humor e redução da necessidade de sono); posteriormente o quadro agrava-se com o aparecimento de ideias delirantes persecutórias e alucinações auditivo-verbais, situação que motiva novo internamento, com um episódio maníaco franco. É feito o diagnóstico duplo de perturbação delirante e perturbação bipolar tipo I, numa doente com funcionamento pré-mórbido hipertímico. Desde então e durante cerca de 4 anos mantém-se com quadro clínico relativamente estável caracterizado por humor tendencialmente elevado, ideias de grandiosidade, discurso prolixo e de débito aumentado, aspecto externo por vezes excêntrico e sem crítica para o estado patológico. Os autores discutem a evolução e as implicações clínicas de uma forma particular e relativamente pouco frequente da doença bipolar, a mania crónica.
- Um caso de microdelecção em 22q11.2, numa doente com esquizofrenia, atraso mental e diabetesPublication . Santos, NB; Ferreira, B; Ribeiro, R; Carreira, H; Maia, TOs autores descrevem o caso de uma doente de 31 anos, do sexo feminino que, aos 26, iniciara um quadro de esquizofrenia, diagnosticada pela DSM-IV e ICD-10. Foi inicialmente tratada com haloperidol, mas após um segundo surto, já com 27 anos, foi-lhe prescrito risperidona. Aos 28 anos, foi-lhe diagnosticada uma diabetes tipo I. Por apresentar várias malformações - consistentes com o síndroma velo-cárdio-facial (SVCF) - os autores decidiram realizar uma análise do cromossoma 22, na região 22q11.2 que está associada ao SVCF e à esquizofrenia. Apurou-se a existência de uma microdeleção em 22q11.2. Os autores discutem implicações clínicas e genéticas deste achado, no que diz respeito à esquizofrenia, síndroma velo-cárdio-facial e diabetes mellitus .
- 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.