Survivors of critical illness stay frequently experience long-term mental health morbidity, suggesting that many critically ill patients with COVID-19 may also show a high prevalence of psychiatric conditions.

To describe depression in COVID-19 survivors 4-months post-hospital discharge and to examine its association with health-related quality of life (HRQoL).

This pilot study involved COVID-19 adult patients admitted in Intensive Care Medicine Service (ICMS) of a University Hospital. Exclusion criteria were: ICMS length of stay (LoS)≤24h, terminal illness, major sensory loss and inability to communicate at the time of assessment. All participants were evaluated at ICMS scheduled telephone follow-up appointment, with Patient Health Questionnaire (PHQ-9) (depression) and EQ-5D-5L (HRQoL). Critical-illness severity was assessed with APACHE-II and SAPS-II.

Twenty patients were included with a median age of 62(range: 24-77) y.o., the majority male (75%) and married (70%). Median (range) APACHE-II and SAPS-II was 17 (5-34) and 32.5 (7-77), respectively, and LoS was 18 (4-58) days. Overall, 25% patients presented depression symptoms and most reported problems on EQ-5D-5L domains of pain/discomfort (65%), anxiety/depression (55%) and mobility (50%). Depression scores were higher in patients with problems in EQ-5D-5L domains of usual activities (median 4 vs 1.5; p=0.046), pain/discomfort (median 0 vs 4; p=0.004) and anxiety/depression (median 4 vs 0;p<0.001).

These preliminary findings show that depression is frequent in COVID-19 survivors and it is associated with worse HRQoL. This pilot study highlights the importance of psychological assessment and treatment of COVID-19 survivors, in order to minimize its negative impact on HRQoL, optimizing their recovery.

Pisa Syndrome or pleurothotonus is a form of dystonia and often can arise as a side effect of antipsychotic treatment conditioning high morbidity and limiting management options. Despite the fact that the precise mechanism remains unclear, a neurochemical imbalance in dopaminergic and cholinergic transmission but also in serotoninergic and noradrenergic transmission can be a possible pathophysiologic mechanism, which can lead to changes in the axial axis with abnormal posture and marked lateral trunk flexion and abnormal gait.

Regarding a clinical case, the authors intend to review the relevant and current literature on the relationship between psychotropic drugs and Pisa Syndrome.

Description of a clinical case by consulting databases of current and scientifically relevant articles.

The clinical case reports a 48-year-old woman with a history of HIV and Substance Use Disorder, hospitalized for unspecific behavioral changes, characterized by mood changes, self-referential, persecutory and somatic delusional ideas, and delusions of the control of thought. She was medicated with antipsychotics and mood stabilizers, with subsequent development of an acute-onset dystonic condition, characterizing the Pisa Syndrome. In this context, the dose of antipsychotics was lowered and anticholinergics were introduced, with progressive improvement of the clinical picture.

Pisa Syndrome, previously seen as a rare adverse effect, can occur as a dystonic reaction related to the use of psychotropic drugs, so its use should be judicious. Further studies are needed to understand the extent of this association and its pathophysiological mechanisms in order to guide more rigorous therapeutic lines.

No significant relationships.

Substance use disorders in adolescents are a growing problem worldwide. These disorders are often unrecognised, unvalued by families, society and clinicians and as a result underdiagnosed, with serious future consequences if improperly addressed.

Updated review of the recent literature on this topic.

Unsystematic review of the most recent and relevant literature.

Review of neurobiology, risk factors, co-morbidity, differential diagnosis, diagnostic criteria, evaluation and treatment of substance use disorders in adolescence.

Substance use disorder in adolescence includes a variety of behaviours related to the use of alcohol and/or drugs, for instance, inability to control substance use, impairment of function at school, home or work, interpersonal problems and hazardous use of substance. Further knowledge in identifying, early diagnosing and adequate intervention in adolescents’ substance use disorder may have paramount prognostic features.

No significant relationships.

Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are omega-3 polyunsaturated fatty acids (ω-3 PUFAs) involved in the structure and function of cell membranes in the brain. Because both compounds must be obtained from diet, by eating oily fish or fish oil, the consumption of fish or supplements of omega-3 could be correlated with neuropsychiatric disorders, as depression disorder.

Search of relevant studies in Scirus database.

Epidemiological studies suggest that populations with high consumption of fish have low annual prevalence of major depression. Laboratorial research verified that major depression in acute coronary syndrome patients is associated with significantly lower plasma levels of ω-3 PUFAs, in particular of DHA; red blood cells membrane levels of total ω-3 PUFAs and of DHA are significantly lower in depressive patients; low plasma concentrations of DHA predict low concentrations of 5-hydroxyindolacetic acid, a marker of brain serotonin turnover, which, in turn, is strongly associated with depression and suicide. Clinical trials demonstrated the efficiency of EPA in the alleviating the symptoms of major depression in adults, childhood depression and postpartum depression.

Although the depression appears to be related with low levels of DHA in plasma and blood cells, controlled trials have found no effect of DHA supplementation in depression. On the contrry, EPA might have an adjunctive therapeutic value in the treatment of depression disorder. Much research is required to compare the effectiveness of the different fatty acids in the treatment of depressive disorder, as well as the relevant dose-response curves.

Results show that participants in the exercise group improved their quality of life parameters, suggesting that exercise could be an effective therapeutic adjuvant for non-remitted MDD patients.

In recent years, physical exercise has shown some promising results as an adjuvant therapy for several psychological disorders, helping to improve not only depression parameters but also quality of life. However, and due to the different populations, settings and exercise programs, not all studies have shown a positive association.

To assess the effect of a moderate intensity 12 week exercise program on the quality of life of a population sample of patients with non-remitted Major Depressive Disorder (MDD).

Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with MDD according to DSM-IV criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). Study protocol Exercise group: moderate intensity exercise program for 12 weeks, in addition to their usual pharmacological therapy. Control group: regular daily activities and their usual pharmacological therapy. Instruments WHOQOL-Bref and SF-36, two validated instruments to assess quality of life.

At the end of the exercise program, participants in the exercise group showed improvement on the physical domain of SF-36 and on the social domain of WHOQOL-Bref (p < 0.05).

Results suggest that exercise could help improve some aspects of the quality of life in non-remitted MDD patients.

In recent years, physical exercise has shown some promising results as an adjuvant therapy for several psychological disorders. However, and due to the different populations, settings and exercise programs, not all studies have shown a positive association.

To assess the effect of a moderate intensity 12 week exercise program on depression and functional parameters in a population sample of patients with non-remitted Major Depressive Disorder (MDD).

Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with MDD according to DSM-IV criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). Study protocol Exercise group: moderate intensity exercise program for 12 weeks, in addition to their usual pharmacological therapy. Control group: regular daily activities and their usual pharmacological therapy. Assessed parameters HAMD17, Beck Depression Inventory (BDI), Global Assessment of Functioning (GAF), Clinical Global Impression Scale - Severity (CGI-S).

Participants in the exercise group showed better depression and functional parameters at the end of the study, both compared to the beginning of the study and compared to the control group (lower HAMD17, BDI and CGI-S and higher GAF, p < 0.05).

Results suggest that exercise could be an effective adjuvant therapy for non-remitted MDD patients.

To compare patterns of temperament and character and the prevalence of Obsessive-Compulsive Personality Disorder (OCPD) and OCPD traits in parents of children with OCD and parents of healthy controls.

TCI and SCID-II were administered to 63 parents of 32 children with OCD and 63 parents of age- and sex-matched controls with no psychiatric diagnosis. Interviewers were not blind to proband status. Personality dimension scores and frequencies of OCPD criteria in both groups were compared after excluding parents with a diagnosis of OCD. Relationships between TCI dimensions and OCPD symptoms in parents and the clinical characteristics of OCD children were also studied.

Parents of OCD children presented significantly higher scores in harm avoidance and lower scores in self-directedness, cooperativeness and reward dependence than parents of healthy children. A higher incidence of OCPD was found in parents of probands (p < 0.02). Hoarding, perfectionism and preoccupation with details were significantly more frequent in parents of OCD children. Counting, ordering and cleaning compulsions in OCD children predicted elevated odds of perfectionism and rigidity in their parents.

The existence of the dimensional personality profile associated with OCD in parents of children with OCD and the higher number of OCPD criteria in these parents in comparison to parents of healthy children highlight the importance of the role of personality factors in familial OCD.

Physical exercise has shown promising results as an adjuvant therapy for depression. However, most studies rely on self-reported measures, which are subject to bias.

To assess, using accelerometer data, compliance to a moderate intensity 12 week exercise program, exercise patterns and relationship between exercise dose and response to treatment, in a population sample of patients with treatment-resistant MDD.

Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with treatment-resistant MDD were initially screened. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). All participants maintained their usual pharmacotherapy. Study protocol Exercise group: moderate intensity exercise program for 12 weeks. Control group: regular daily activities. All participants wore an ActiGraph® GT1M LLC accelerometer during the 12 weeks. Assessed parameters Moderate plus vigorous physical activity (MVPA), HAMD17, BDI, GAF, CGI-S.

The exercise group showed better depression and functional parameters at the end of the study compared to the control group (lower HAMD17, BDI, CGI-S; higher GAF, p < 0.05). Compliance was 97% based on accelerometer data and 91% based on self-reports. Participants showed preference for exercising on weekdays and on specific periods of the day.

Although not statistically significant, there was a trend for increasing MVPA from no response to response and remission. MVPA showed significant favourable correlations with all depression and functioning parameters.

Future implementation of effective exercise augmentation therapy programs should consider exercise dose and objective measures that will allow the quantification of that dose.

Physical exercise has shown promising results as an adjuvant therapy for depression. However, follow-up information assessing its long-term effects after the exercise program is suspended, is scarce.

To assess depression and functional parameters at follow-up, 6 months after a population sample of patients with treatment-resistant Major Depressive Disorder (MDD) finished a moderate intensity 12 week exercise program.

Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with treatment-resistant MDD were initially screened. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). All participants maintained their usual pharmacotherapy. Study protocol Exercise group: moderate intensity exercise program for 12 weeks. Control group: regular daily activities. Follow-up After 12 weeks the exercise program was suspended, and patients were assessed after 3 and 6 months. Assessed parameters HAMD17, BDI, GAF, CGI-S.

47% of participants in the exercise group continued to exercise at follow-up. Those who continued to exercise at follow-up maintained the same depression and functional parameters they showed after the 12 week exercise program, which were all improved compared to the initial values (lower HAMD17, BDI and CGI-S and higher GAF, p < 0.05). Those who did not continue to exercise showed worse HAMD17, GAF and CGI-S (p < 0.05) at 6 months follow-up than at the end of the exercise program.

Results suggest that positive effects of exercise as an adjuvant therapy for treatment-resistant MDD patients only persist if the exercise is continued over time.

The growth of the older population worldwide has been followed by an increase of mental illness, an important cause of morbidity. In the elderly, the coexistence of disability, physical and mental illness and social problems means that older people often have complex needs, which require comprehensive and systematic assessment.

To identify met and unmet needs and their relationship with cognition and functionality.

Elderly patients (≥ 65 years old), with mental disorders (ICD-9), were recruited consecutively from ULSAM, in Portugal.

All patients were assessed with the Camberwell Assessment of Need for the Elderly/CANE, Mini Mental State Examination/MMSE, Clock Draw Test/CDT, Geriatric Depression Scale/GDS, Zung Anxiety Scale/ZAS, Barthel Index/BI and Lawton & Brody Index/LI.

In this sample (n=306), the most frequent unmet needs were daytime activities (46.7%), psychological distress (25.8%), memory (13.4%), social benefits (11.4%) and company (8.2%).

A significant relation between global needs - CANE (met and unmet) and psychiatric diagnoses (F=12,888, p=.000) was found. Patients with dementia had a higher number of global needs and lower functionality.

The global needs correlated negatively with MMSE (r=−.666, p=.000), CDT (r=−.512, p=.000), BI (r =−.541, p=.000) and LI (r =−.854, p=.000), and positively with GDS (r =.385, p=.000).

Cognitive deficits, higher depression and lower functionality were associated with a greater number of needs. These results also suggest that dementia is an important determinant of the functional status and needs.

The aim of this randomized clinical trial follow-up at three months was to evaluate the effectiveness of an educational intervention with a focus on diet and physical activity (PA) to change the amount of PA, body mass index (BMI) and the waist circumference (WC) in patients with severe mental illness.

We recruited 332 outpatients with severe mental disorders undergoing treatment with antipsychotic medication from Mental Healthcare Centers of Barcelona. They were randomly assigned to an intervention or a control group. The patients in the intervention group participated in a group PA and diet educational program. The blinded measurements at 0 and 3 months were: the level of PA (IPAQ questionnaire), BMI, WC, blood pressure, dietary habits (PREDIMED questionnaire), quality of life (SF-36 questionnaire) and laboratory parameters (cholesterol, triglycerides, glucose).

The average age was 46.7 years and 55% were males. Schizophrenia had been diagnosed in 67.1% of them. At 3 months, the average weekly walking METs rose significantly in the IG 266.05 METs (95%CI: 16.86 to 515.25; P = 0.036). The total MET average also rose although not significantly: 191.38 METs (95%CI: 1.38 to 381.38; P = 0.086). However, the BMI decreased significantly more in the CG, by 0.26 kg/m2 (95%CI: 0.02 to 0.51; P = 0.038), than in the IG. There were no significant differences in the WC.

The short-term results suggest that the intervention increases the level of PA, but does not improve physical or laboratory parameters.

Clinicaltrials.gov NCT01729650 (effectiveness of a physical activity and diet program in patients with psychotic disorder [CAPiCOR]).