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Perinatal death includes losses such as ectopic pregnancies, miscarriages, stillbirths and neonatal deaths. Perinatal loss has well documented negative effects on the health of the bereaved parents. Early pregnancy loss (EPL) is the spontaneous death of a fetus within the first 20 weeks of gestation.
To describe a clinical case of disenfranchised grief following EPL and to review the literature.
We reviewed the clinical file of a patient presenting to the psychiatry outpatient clinic with disenfranchised grief. We conducted a non-systematic review on PubMed and Google Scholar.
A 29-years-old female patient presents to the outpatient clinic with depressive symptoms and thoughts of death. The symptoms had begun 4 months earlier, following the loss of pregnancy at 14 weeks. She felt her grief was not accepted by her family and social network. Progressively, her relationships deteriorated, and she felt more and more isolated. She experienced marked difficulty in caring for her older child. Compared to other types of mourning, the loss of a child is associated with grief experience that is particularly severe and complicated. Despite the high prevalence of EPL, many women suffer in silence due to the common belief these losses are insignificant and may develop complicated grief.
Perinatal loss of an infant has the potential to have a large impact on the mental health of the bereaved parents. Literature on the efficacy of different interventions is still scarce. Further studies are necessary on prevention strategies and interventions for parents already suffering from complicated grief or depressive disorders.
In early 2020, governments started to implement different forms of public health measures, from physical distancing recommendations, to stay-at-home orders, to limit the propagation of COVID-19. Here we report the case of a 41-year-old woman, with a diagnosis of panic disorder. During the end of the lockdown, the patient presented psychopathological worsening, from her fear of Covid-19 infection, stemming from a heart failure disease and concerns regarding the hygiene and safety measures of those around her.
Presentation of a clinical vignette.
Selection and analisis of clinical case and review of the literature using PubMed database.
The COVID-19 pandemic and the measures adopted to prevent the spread of the disease had a huge impact on a personal, social, and economic level for the world population. The rise of fear and anxiety among people due to uncertainty about the disease are coupled with essential yet disruptive measures such as lockdowns and quarantines. The chronically ill population are especially vulnerable during such circumstances and require addressing their physical health and any psychological difficulties they might experience, being at higher risk of suffering physically from the pandemic’s disease as well as psychologically from the implemented countermeasures.
This vignette provides a case where a person’s psychiatric conditions are worsened due to the end of a pandemic lockdown, rather than the lockdown itself. Additional work should aim at comparing the experiences of the different countries affected by the pandemic in order to understand the size of the psychological impact, the potential risk and protective factors.
Rates of cannabis use among pregnant women have been increasing. Psychiatrists may be required to provide counselling regarding marijuana use in pregnancy for their patients.
To produce an up-to-date review of cannabis effects on pregnancy and the offspring.
We performed a non-systematic review of the literature apropos a clinical case.
A 31-years-old, 22-weeks pregnant woman presented with severe anxiety, panic attacks and insomnia which she managed solely with cannabis. She had been previously treated with antidepressants and benzodiazepines with symptom remission but had suspended before her pregnancy without medical advice. She believed medication was more harmful to the baby than her cannabis use. There is little perception of risk concerning cannabis use in pregnant woman. Information on cannabis use is less likely to be obtained from healthcare providers than from anecdotal experiences, Internet searching and advice from friends and family. Prenatal use of cannabis has been associated with anaemia in the mother, whereas in the offspring it is associated with reduction in birth weight and greater likelihood of placement in intensive care units. There is insufficient evidence to support an association between marijuana use and any specific congenital abnormality, but also to demonstrate its safety.
It is essential for psychiatrists to have up-to-date knowledge of the effects of cannabis on the pregnancy and the offspring to properly counsel their patients. However, the effects of cannabis on maternal and foetal outcomes remain generally unknown. With rising numbers of female users, there is urgent need for further research.
Coronavirus disease 2019 (COVID-19) pandemic has had a negative impact for mental health. ULS-Guarda in cooperation with Portugal National Health Service, provided the population of the district of Guarda with a mental health helpline (MHHL).
Provide a descriptive data analysis of the MHHL calls received between April 1st and September 20th of 2020.
The data was obtained through the filling out of questionnaires. It included fields for gender, age, the type of service provided, relation to COVID-19, symptoms displayed and the number calls made per patient. For the statistical analysis, Microsoft Excel TM was utilized.
MHHL received 191 calls. The largest volume was received during April, which saw 116 instances of patients seeking the MHHL. The number of calls then tapered progressively throughout the following months. The services provided were split between psychiatric assistance, psychologic assistance, and the renovation of medical prescriptions, in 44%, 31% and 19% of the cases, respectively. The 101 patients who resorted to the MHHL were unevenly distributed in gender, being 74 female and 27 male individuals. Their ages were mostly between 50 and 69 years old. The most common symptoms were anxiety, depressed humor and insomnia, in 35%, 16% and 11% of the cases, respectively.
The largest influx of calls coincides with the home confinement period, and decreased alongside the relaxation of the confinement measures held. The MHHL had enough adherence to warrant consideration of it being an alternative means of healthcare access, especially in situations where physical access to healthcare is restricted.
The mental health impact of the COVID-19 pandemic is well documented. Portugal entered the emergency state on 19th march due to rising numbers of infected patients. The emergency state introduced regulatory measures that restricted people’s movements, applied a curfew, and closed most non-essential spaces and activities, such as shops and religious celebrations.
To evaluate the rates of suicides during the emergency state in Portugal.
We obtained the number of probable suicides during 19th march and 2nd may 2020, 2019 and 2018 from SICO/eVM (Real Time Mortality Electronic Surveillance). This system is used for health planning in Portugal and provides provisory data which is updated every 10 minutes. ExcelÒ was used for the statistical analysis.
During the Emergency State in Portugal there were 57 probable suicides. Comparing to the same period in 2018 and 2019, there were 62 and 70 probable suicides, respectively. Social isolation, anxiety, fear of contagion, chronic stress, and economic difficulties may lead to the development or exacerbation of depressive, anxiety, substance use, and other psychiatric disorders. Literature on suicides due to COVID-19 mention not only fear of infection, but also social isolation and distancing and economic recession as causes for suicide attempts and completions.
During the emergency state there was not an increase of probable suicides, compared to previous years. The greater vigilance of people’s movements may have deterred many attempts. However, policymakers and health care providers must be alert as the current psychosocial predispose to an increase in suicide rates.
Electroconvulsive therapy (ECT) presents itself as a highly effective therapeutic approach in various psychiatric conditions, especially affective disorders and catatonia. Although obsessive-compulsive disorder (OCD) is not an established indication for ECT, there are several positive results that have been replicated, giving us an account of its potential applicability.
To emphasize the importance of defining predictors of response to ECT in OCD.
The authors’ clinical experience is combined with the review of clinical cases, available in the literature, related to the application of ECT in OCD.
Personal or family history of affective pathology and obsessions of sexual content were identified as potential predictors of response to ECT in patients with obsessive and compulsive symptoms.
Although preliminary and based solely on case reports, the replicability of results should promote special attention to situations in which OCD is marked by particular characteristics that favor the response to ECT. In this way, it would be possible to prevent the dragged consumption of health resources and minimize the expected chronicity associated with this clinical condition.
The development of an extrapyramidal syndrome (EPS) is assumed to be a potential and important consequence of organophosphate poisoning (OP). Even though its causal relationship is firmly established, the information available in the literature regarding the orientation to be given is scarce, and its approach remains shrouded in a significant degree of uncertainty. Catatonia, as a neuropsychiatric condition, may present a marked overlap with the set of extrapyramidal symptoms developed after OP. Does the overlap between the symptoms seen in catatonia and in EPS make differential diagnosis fundamental or does it have no relevance in relation to the approach to be established?
To discuss the therapeutic approach to be implemented in the extrapyramidal symptoms resulting from OP and reflect on the overlap between catatonia and EPS.
Presentation of a clinical case and review of the literature.
A 50-year-old woman with major depressive disorder developed a condition marked by exuberant extrapyramidal symptoms 3 weeks after OP. Significant stiffness, tremor, dysphagia and facial hypomimia were some of the symptoms observed. Therapy was started with amantadine 100mg daily, with complete resolution of the symptoms after 5 days. Follow-up revealed reversal of extrapyramidal symptoms, in the absence of any neuroimaging changes or any other neuropsychiatric manifestations.
The possible overlap between catatonia and EPS is remarkable. The two conditions, regardless of their differentiation, may benefit from an identical approach using dopaminergic drugs. The use of amantadine, even in low doses, may be an option in the rapid reversal of extrapyramidal symptoms resulting from OP.
Now-a-days, obesity and other cardiovascular risk factors (CVRF) became a matter of concern in Schizophrenia, due to their potential relation with atipical antypsychotics. The high prevalence of CVRF in schizophrenic patients is a consensual issue, but there are only a few studies in Portugal.
This is an observational transversal study thats aims to evaluate the presence of CVRF, and to establish the relationship between these ones and anthropometric measurements evaluating global and regional adiposity, in a population of schizophrenic patients.
Material and Methods:
The authors studied a population of 25 schizophrenic patients followed at our Department of Psychiatry. These instruments were used: PANSS (Positive and Negative Symptoms Scale), and a semi-structured interview, with sociodemografic data, and information about life style, medication and schizophrenia. These informations were completed according to the clinical process. The following measurements were recorded: weight, height, abdominal circunference, lipidic and glicemic values, and blood pressure.
The high frequency of CVRF in the population of this study confirms the importance of regular medical evaluations, in every patients with Schizophrenia, to allow early diagnosis/monitorization of CVRF. However, our results dont confirm the benefit of anthropometric measurements as screening methods, possibly due to our small sample. Curiously, we found a week correlation bettween CVRF and environment factors (as medication or life style), what can reforce the hold ideia of Schizophrenic susceptibility to CVRF.