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- CHARACTERIZATION OF THE POPULATION OF PREGNANT WOMEN ATTENDING A MENTAL HEALTH SERVICEPublication . Ferreira, T; Dehanov, S; Oliveira, C; Castro, S; Ribeiro, R; Maia, TIntroduction: Psychopathological symptoms are common during pregnancy and their detection and referral to specialized care is often suboptimal. The aim of this study was to perform a descriptive analysis of sociodemographic, mental health, and obstetric features of a population of pregnant women followed at Psychiatry consultation. Methodology: This was a cross-sectional, descriptive study of women followed both at Gynecology/Obstetrics and Psychiatry consultations of Hospital Prof. Doutor Fernando Fonseca between 2014 and 2016. A total of 76 women were included, for whom pre-defined features associated in the literature with risk of developing psychopathological symptoms during pregnancy were collected. Results and Discussion: Risk factors identified in the development of depressive symptoms included absence of an affective relationship during pregnancy (n=11; 14.5%), being first-generation immigrant (n=17; 22.4%), and substance use before (n=18; 23.7%) or during (n=10; 13.1%) pregnancy. Sample was divided into women with previous Psychiatry follow-up who became pregnant (n=44; 57.9%) and women referred to Psychiatry consultation during pregnancy (n=32; 42.1%). In the second group, 18.8% (n=6) of referrals were from primary health care, being relevant to understand whether this represents an under-referral. Prescription of 21 risk category D drugs was identified, alerting to the need of caution in pharmacological prescription and of considering non-pharmacological options (e.g., cognitive-behavioral therapy) for management of these cases. Conclusions: Risk factors identified in this study represent an opportunity to optimize clinical practice and improve these patients’ follow-up
- Wernicke-Korsakoff Syndrome: A Case Series in Liaison Psychiatry.Publication . Barata, PC; Serrano, R; Afonso, H; Luís, A; Maia, TWernicke-Korsakoff syndrome (WKS) is a life-threatening and underdiagnosed neuropsychiatric condition caused by thiamine deficiency that comprises Wernicke encephalopathy and Korsakoff syndrome. Although mainly associated with chronic alcoholism, WKS can arise from other circumstances. This report describes a series of cases of WKS that were clinically evaluated by liaison psychiatrists on a nonpsychiatric inpatient unit. The cases illustrate a deficit in the recognition and adequate treatment of WKS, demonstrating its clinical complexity and the need to improve physicians' knowledge
- The Impact of the Semente Program on the Family-Focused Practice of Mental Health Professionals in Portugal.Publication . van Doesum, K; Maia, T; Pereira, C; Loureiro, M; Marau, J; Toscano, L, et al.Background: Children of parents with mental illness (COPMI) are a high-risk group. There is a strong association between parents' psychiatric disorders and the incidence of psychopathology in their children. These children need to be identified and supported by mental health workers early, and hence, clinical practice in adult mental health services needs to change from a focus on individual patients to a more systemic family focus. "Semente," a mental health promotion program developed by the Psychiatry Service of Fernando Fonseca hospital (Lisbon, Portugal), had been established to identify these children and families and promote their mental health, by decreasing the impact of risk factors and promoting protective factors. The program included preventive COPMI interventions and implementation of activities offered to families with children in the mental health care. The aim of the present study was to evaluate changes in mental health care after the training in "Child Talks" intervention (two to three psycho-educational meetings with parents and children) and implementation of the "Semente" program. Methods: Participants (N = 51) were all professionals from Psychiatric Service of Fernando Fonseca Hospital who received Child Talks training. The Family-Focused Mental Health Practice Questionnaire (FFMPQ) was used to measure change in professionals' attitudes, knowledge, confidence, and organizational structure in working with these families. All participants filled in the questionnaire before training and 10 months later. Results: The results showed that, from pre- to post-measurement, the professionals changed clinical practice significantly. The largest changes were visible in the improved provision of support at the workplace for family-focused practice and the clarity and availability of the policies and procedures. Furthermore, the skill and knowledge of the mental health workers showed significant improvement at posttest. Conclusion: The positive results of this study were not unexpected; the training, implementation of routines, and procedures as well as workplace support were aims of the "Semente" program. Interpretation of the results should be taken with caution because of the small sample and the lower reliability of some of scales of the FFMPQ. The results indicate that professionals moved from patient focus to family focus during the implementation of the "Semente" program.
- Olanzapine-Induced Hyperprolactinemia: Two Case ReportsPublication . Barata, P; Santos, MJ; Melo, JC; Maia, TBackground: Hyperprolactinemia is a common consequence of treatment with antipsychotics. It is usually defined by a sustained prolactin level above the laboratory upper level of normal in conditions other than that where physiologic hyperprolactinemia is expected. Normal prolactin levels vary significantly among different laboratories and studies. Several studies indicate that olanzapine does not significantly affect serum prolactin levels in the long term, although this statement has been challenged. Aims: Our aim is to report two olanzapine-induced hyperprolactinemia cases observed in psychiatric consultations. Methods: Medical records of the patients who developed this clinical situation observed in psychiatric consultations in the Psychiatry Department of the Prof. Dr. Fernando Fonseca Hospital during the year of 2017 were analyzed, complemented with a non-systematic review of the literature. Results: The case reports consider two women who developed prolactin-related symptoms after the initiation of olanzapine. No baseline prolactinemia was obtained, and prolactin serum levels were only evaluated after prolactin-related symptoms developed: at the time of its measurement, both patients had been taking olanzapine for more than 24 weeks. Hyperprolactinemia was found to be present in Case 2, whereas Case 1 (a 49-year-old woman) had "normal" serum prolactin levels for premenopausal and prolactin levels slightly above the maximum levels for postmenopausal women. Both patients underwent similar pharmacological adjustments, which comprised switches from olanzapine to aripiprazole. After all pharmacological changes, prolactin serum levels decreased to normal range values and prolactin-related symptoms disappeared. Discussion/Conclusions: Laboratorial and literature prolactinemia values variability and discrepancies may make the management of borderline hyperprolactinemia clinical situations difficult. Baseline prolactin levels should have been obtained, as they help in the management of patients who develop neuroleptic-induced hyperprolactinemia. Prolactin-related symptoms can occur with borderline or normal standardized prolactinemia values. Olanzapine-induced hyperprolactinemia is a rare but possible event. Aripiprazole was used as a suitable alternative for olanzapine-induced hyperprolactinemia.
- The Benefits of Mindfulness-Based Interventions on Burnout Among Health Professionals: A Systematic ReviewPublication . Klein, A; Taieb, O; Xavier, S; Baubet, T; Reyre, AObjective: Healthcare professional burnout affects performance and has a negative impact on healthcare as a whole. Mindfulness-based Interventions (MIs), developed over the last 30 years, are increasingly used by healthcare professionals to reduce the risk of burnout. Yet the impact of MIs on burnout remains to be clarified. This review aimed to summarize and evaluate the existing literature on the potential benefits of MIs to minimize burnout risk. Methods: We conducted a systematic review of the literature, reporting according to the PRISMA standards. PubMed, Psychinfo, Web of Science and Science Direct databases were screened for original articles. Articles in English assessing an MI in combination with burnout measures were included up to September 2018. Results: Thirty-four articles were included. Only four randomised controlled trials concluded to burnout improvement after several weeks of MIs (11,8%). In the remaining five randomised controlled trials, results did not reach statistical significance. Of the four controlled, non-randomised studies, three showed significant improvements on burnout. Twenty-one studies did not report a controlled trial design. Overall the results appeared to be widely heterogeneous and several methodological concerns arose from the review. Conclusion: This review shows the overall insufficient level of evidence offered by the literature assessing the effects of MIs on burnout in health professional populations. However, some studies have reported promising results and future research should address methodological issues and define more precise contexts of interventions and target populations that could benefit from MIs.
- Olanzapine-Induced Hyperprolactinemia: Two Case Reports.Publication . Barata, P; Santos, MJ; Melo, JC; Maia, TBackground: Hyperprolactinemia is a common consequence of treatment with antipsychotics. It is usually defined by a sustained prolactin level above the laboratory upper level of normal in conditions other than that where physiologic hyperprolactinemia is expected. Normal prolactin levels vary significantly among different laboratories and studies. Several studies indicate that olanzapine does not significantly affect serum prolactin levels in the long term, although this statement has been challenged. Aims: Our aim is to report two olanzapine-induced hyperprolactinemia cases observed in psychiatric consultations. Methods: Medical records of the patients who developed this clinical situation observed in psychiatric consultations in the Psychiatry Department of the Prof. Dr. Fernando Fonseca Hospital during the year of 2017 were analyzed, complemented with a non-systematic review of the literature. Results: The case reports consider two women who developed prolactin-related symptoms after the initiation of olanzapine. No baseline prolactinemia was obtained, and prolactin serum levels were only evaluated after prolactin-related symptoms developed: at the time of its measurement, both patients had been taking olanzapine for more than 24 weeks. Hyperprolactinemia was found to be present in Case 2, whereas Case 1 (a 49-year-old woman) had "normal" serum prolactin levels for premenopausal and prolactin levels slightly above the maximum levels for postmenopausal women. Both patients underwent similar pharmacological adjustments, which comprised switches from olanzapine to aripiprazole. After all pharmacological changes, prolactin serum levels decreased to normal range values and prolactin-related symptoms disappeared. Discussion/Conclusions: Laboratorial and literature prolactinemia values variability and discrepancies may make the management of borderline hyperprolactinemia clinical situations difficult. Baseline prolactin levels should have been obtained, as they help in the management of patients who develop neuroleptic-induced hyperprolactinemia. Prolactin-related symptoms can occur with borderline or normal standardized prolactinemia values. Olanzapine-induced hyperprolactinemia is a rare but possible event. Aripiprazole was used as a suitable alternative for olanzapine-induced hyperprolactinemia.
- Translation and cross-cultural adaptation of the Arizona Sexual Scale (ASEX) into Portuguese.Publication . Ribeiro, H; Figueiredo, I; Vitória-Silva, J; Barata, P; Fernandes, E; Marques, TINTRODUCTION: Sexual dysfunction is common in individuals with psychiatric disorders and under psychotropic medication such as antidepressants and antipsychotics. Several scales have been developed to assess sexual function in these patients. The Arizona Sexual Scale (ASEX) is a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. We describe the translation and cross-cultural adaptation of the ASEX into the Portuguese language, with the goal of contributing to the assessment of sexual function in Portuguese-speaking psychiatric patients under treatment with psychotropic drugs. METHODS: The translation and cross-cultural adaptation process thoroughly followed the steps recommended by the Task Force of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), namely: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing, finalization, proofreading, and final version. RESULTS: The process was successfully completed and no major differences were found between the translation, reconciliation and back-translation phases, with only small adjustments being made. CONCLUSION: The translation of the ASEX was completed successfully, following international reference guidelines. The use of these guidelines is a guarantee of a Portuguese version that is qualitatively and semantically equivalent to the original scale. This availability of this new scale version will enable studies evaluating the sexual function of Portuguese-speaking psychiatric patients. Future studies may assess the validity of the scale for Portuguese-speaking populations.
- Empathy as related to motivations for medicine in a sample of first-year medical students.Publication . Gonçalves-Pereira, M; Trancas, B; Loureiro, J; Papoila, A; Caldas-de-Almeida, JMProfessionalism and empathy are crucial in clinical settings. An association would be expected between empathic attitudes and altruistic motivations for a medical education. However, data is scarce in first-year students, and a previous small-scale study did not fully confirm the hypothesis that person-oriented motives would have a strong relationship to empathy. The present study tested this association in a larger sample. 202 first-year medical students (M age = 19.0 yr., SD = 2.7; 67.3% women) were assessed cross-sectionally, using the Vaglum and colleagues' indexes on motives for choosing medicine (security/status, person-orientation, and interest in the natural sciences) and the Jefferson Scale of Physician Empathy for students. There was a weak association between empathy and person-orientation, but the evidence regarding links between empathy and the three motivation scores was low overall. In this Portuguese sample there was not a clear-cut association between empathy and motivations for medical school.
- Cinema, aesthetics and narrative: Cinema as therapy in substance use disordersPublication . Correia, AF; Barbosa, SThe use of cinema as a mediator in therapeutic settings has been considered advantageous; however, few works have been published regarding this subject (Dermer & Hutchings, 2000; Egeci & Gencoz, 2017; Hesley & Hesley, 1998; Poltrum, 2009; Schulenberg, 2003; Wolz, 2005). The aim of this work was to explore the therapeutic potential of cinema, especially when applied to the treatment of substance use disorders, and to study the hypothesis that the narrative and aesthetic dimensions of cinema are primordial to its therapeutic properties. The authors first describe their clinical experience with a therapeutic activity specifically conceived to use cinema and its narrative and aesthetic dimensions in a therapeutic way, and then explore the proposed hypothesis by analysing and discussing its results. The authors found that cinema appears as a language of possibilities in the psychotherapeutic setting: not only the movies appeal to the patients' inner world and to the reflection on their previous life experiences, but also provide a safe and creative space for change. Also, movies take the patients to talk and elaborate on their thoughts, feelings and life stories, allowing a different look at the future, acting as inductors of hope. This work may be seen as an innovative contribution to further discussion about the clinical benefits of cinematographic art as a therapeutic mediator.
- Sexuality, emotionality, healthy responsibility: take care of yourself A sexual education projectPublication . Vilelas, J; Sousa, J; Baltar, P; Rodrigues, LINTRODUCTION. Adolescence is a period of doubt and discovery, during which the biggest problems related to the discovery of sexuality arise. Portugal is part of the European countries with the largest number of teenage mothers. Despite the rising availability of information in this area, this phenomenon still occurs with all the negative consequences involved. This project intends to develop and implement a Sexual Education project named "Sexuality, Emotionality, Responsibility: Take Care of Yourself", which aims at promoting healthy behaviours on an individual and group level (prevention, self-protection and protection of others). METHODS. This is an action research project. During first phase, a questionnaire will be applied to teenagers (10 to 18 years of age), who attend a group of schools in Lisbon area. Subsequently, "Love Workshops" will be implemented, aiming at progressively developing self-responsibilization, promoting physical, psychological, and social health. In schools, dialogue and discussion areas between students, parents, teachers and, eventually, other professionals will be created. Peer education will be one of the used strategies because prevention messages will thus be adapted to different values and needs of each peer group, mediated by "Affection Ambassadors", facilitating behavioural change. At the final phase, people involved will assess the intervention process. CONCLUSIONS. We hope to be able to promote prioritization of sexual education as a determinant of health, contributing to empowerment and emotional development of teenagers, aiming at healthy and responsible sexuality, through nursing interventions that use dynamic methods focused on the teenager and the group.