One hypothesis proposed to underlie formal thought disorder (FTD), the incoherent speech is seen in some patients with schizophrenia, is that it reflects impairment in frontal/executive function. While this proposal has received support in neuropsychological studies, it has been relatively little tested using functional imaging. This study aimed to examine brain activations associated with FTD, and its two main factor-analytically derived subsyndromes, during the performance of a working memory task.

Seventy patients with schizophrenia showing a full range of FTD scores and 70 matched healthy controls underwent fMRI during the performance of the 2-back version of the n-back task. Whole-brain corrected, voxel-based correlations with FTD scores were examined in the patient group.

During 2-back performance the patients showed clusters of significant inverse correlation with FTD scores in the inferior frontal cortex and dorsolateral prefrontal cortex bilaterally, the left temporal cortex and subcortically in the basal ganglia and thalamus. Further analysis revealed that these correlations reflected an association only with ‘alogia’ (poverty of speech, poverty of content of speech and perseveration) and not with the ‘fluent disorganization’ component of FTD.

This study provides functional imaging support for the view that FTD in schizophrenia may involve impaired executive/frontal function. However, the relationship appears to be exclusively with alogia and not with the variables contributing to fluent disorganization.

Functional brain activity has been only studied marginally in schizoaffective disorder (SAD), a disorder whose nosological status is controversial. The present study investigated the prefrontal cortex (PFC) activity of schizomanic patients during performance of a working memory task.

13 schizoaffective patients, with current schizomanic episode (Young> 18); and 26 sex- and age-matched healthy controls underwent functional magnetic resonance imaging (fMRI) while performing baseline, 1-back and 2-back versions of the n-back task. Linear models were used to obtain maps of activations and deactivations in the groups.

During performance of the n-back task, controls showed activation in a cluster of frontal areas and de-activation in the medial orbitofrontal and anterior cingulate cortex. The SAD patients showed significantly less activation in prefrontal areas than the controls. They also showed a marked failure to de-activate in medial frontal cortex. The SAD patients’ impaired task performance was associated with both reduced activation of the dorsolateral PFC and reduced de-activation of the medial frontal areas.

Schizomanic patients show failure of activation in a network of cortical regions, and also a failure to de-activate the ventromedial PFC and anterior cingulate cortex. This latter area corresponds to the one of the components of the 'default mode network´. This pattern of abnormality is similar to that found by our group to characterise schizophrenia (failure to activate and failure to de-activate), but different from that which characterises manic patients (failure to de-activate only).

To describe validation process of the new apathy scale for institutionalized dementia patients (APADEM-NH).

100 elderly, institutionalized patients with diagnosis of probable Alzheimer Disease (AD) (57%), possible AD (13%), AD with cerebral vascular disease (CVD) (17%), Lewy Bodies Dementia (11%) and Parkinson associated to dementia (PDD) (2%). All stages of the disease severity according to the Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR) were assessed. The Apathy Inventory (AI), Neuropsychiatric Inventory (NPI), Cornell scale for depression, and the tested scale were applied. Re-test and inter-rater reliability was carried out in 50 patients. The feasibility and acceptability, reliability, validity, and measurement precision were analyzed.

APADEM-NH final version consists of 26 items and 3 dimensions: Deficit of Thinking and Self-Generated behaviors (DT): 13 items, Emotional Blunting (EB): 7 items, and Cognitive Inertia (CI): 6 items. Mean application time was 9.56 minutes and 74% of applications were fully computable. All subscales showed floor and ceiling effect lower than 15%. Internal consistency was excellent for each dimension (Cronbach’s α DT = 0.88, α EB = 0.83, α CI= 0.88);Test-retest reliability for the items was kW=0,48-0,92; Inter-rater reliability reached kW values 0.84-1.00; The APADEM-NH total score showed a low/moderate correlation with apathy scales (Spearman ρ, AI =0.33; NPI-Apathy= 0,31), no correlation with depression scales (NPI-Dementia = -0.003; Cornell= 0,10), and high internal validity (ρ =0.69 0.80).

APADEM-NH is a brief, psychometrically acceptable, and valid scale to assess apathy in patients from mild to severe dementia and discerning between apathy and depression.

In Portugal, after the integration, in 1992, of the Mental Health Services in General Hospitals and, later, with the publication of the Mental Health Act in 1998, there was a clear choice, in terms of health policy, for the deinstitutionalization of the mentally ill and for promoting the integration into their communities. In 1977, at the time called Mental Health Center of Viseu, inspired by the avant-garde currents of French sector psychiatry, pioneered through the creation of their Community Service, immediately reducing its capacity from 120 inpatients to 44.

To conduct a descriptive analysis of the patient population monitored by the team of the Community Service of Centro Hospitalar Tondela-Viseu.

An observational, cross-sectional study.

Descriptive analysis. Data collected from the clinical files and the database built by this service team, analyzed in the program EXCEL ® 2010.

The Community Service currently integrates 562 patients, about half of which are aged between 30 and 49 years. Most patients are male and the main diagnosis is schizophrenic psychosis.

The Community Services have progressively assumed a more relevant importance in the monitoring of individuals with mental illness, allowing their deinstitutionalization to happen and contributing to a more harmonious reintegration of these patients in their community.

Previous studies suggest a relationship between decreased serum cholesterollevels and impulsive/aggressive behaviors [1]; howeverwe found just one study in the literature based in eating disorder [2].

To investigate the potentialrelationship between lipid profile (cholesterol, HDL, LDL, triglycerides) andmeasures of impulsivity, aggression or suicidal behavior in a sample of nevertreated patient whit Eating disorder and healthy controls.

The first episode of eatingdisorders group consisted of 199 (age range 14-60) subjects included in DETECTAprogram of Cantabria, Spain, from 2011 to 2013. Other group of 199healthy controls were initially recruited from the community and matched by ageand gender. Socio-demographic information was collected for each subject. Clinicalcharacteristics were ascertained either from clinical charts or by directquestioning the study participants. Lifetime diagnosis of impulse control wasassessed with questionnaires developed ad hoc. Impulsivity was evaluated using self-administered questionnaires, EatingDisorder Inventory and Cloninger's Temperament and Character Inventory.

Differences found betweensubgroups did not differ from those shown in the literature, with higher levelsof impulsivity in the group of Bulimia. However in the partial correlation we did not find a relationship betweencholesterol levels and Impulsivity. We neither found this relationshipbetween suicide attempts, pathological gambling, compulsive buying disorder, self-harm or kleptomania.

Although the biological mechanism between plasma hypocholesterolemia andimpulsive behavior has not been fully elucidated this relationship has beenestablished in others pathologies [3], howeverin eating disorders so far, this theory has not been proved.

Anorexia nervosa is a disorder of eating behavior that is a major health problem on our society. It is characterized by three main criteria: self-induced starvation, desire for thinness or fear of obesity, and the presence of medical signs and symptoms due to improper feeding. This work is focused on its treatment. The biopsychosocial approach allows the design and application of effective therapeutic strategies and a multidisciplinary team collaboration is essential.

Research of current pharmacological and psychotherapy treatments options of the disease.

Literature review based on articles and publications on this topic.

In anorexia nervosa, it is necessary to establish a therapeutic alliance between doctor and patient. Patient usually feels no motivation to improve. The different treatments options to combine, in terms of the patient status, are: nutritional rehabilitation, cognitive-behavioral, family and interpersonal psychotherapies and pharmacological treatment. It can be carried out at the ambulatory, at the day-hospital or by medical stay, even beyond patient will.

Nowadays, the nutritional rehabilitation is the best treatment established and it is the core treatment. About the psychotherapies, the cognitive-behavioral is the most used because it has exposed better results in all different studies proved and in clinical practices, followed by the family therapy which is the responsible of the patient family's treatment. Pharmacological treatment should not be used systematically and its exclusive use is not enough to resolve anorexia nervosa as there are needed also other treatments combined.

The authors have not supplied their declaration of competing interest.

Almost 50 years after the mental health reform in Europe and the deinstitutionalization of the mentally ill, there seems to be a slow change in the social concept of mental disorder. However, in the case of mental retardation, little progress has been made, since the social approach to these patients does not seem to involve the promotion of their autonomy. This is a reality with implications in medical, social and forensic psychiatry settings.

We will present a statistical analysis on interdiction/inhabilitation processes in two districts of Portugal followed by a comparative analysis between Portuguese and other European countries’ civil law concerning the regulation of legal capacity.

Critical analysis of the means by which the concept of legal incapacity has been applied in the Portuguese social setting.

Descriptive and retrospective analyses of 500 expert reports in the districts of Coimbra and Viseu regarding interdiction/disqualification processes. Research on Pubmed and legal databases; keywords used: mental disability, mental retardation, civil law, mental incapacity, legal incapacity, legal capacity, interdiction, curator.

The number of forensic psychiatric examinations has suffered a significant increase in the last years. The majority of these expertise concern interdiction/inhabilitation processes. Mental retardation is the more prevalent diagnosis, and the great majority of the cases were interdicted.

In Portugal, the law has been applied in order to safeguard the economic assets of mentally retarded individuals, but not in order to promote their social integration and autonomy.

The authors have not supplied their declaration of competing interest.

We have done a descriptive study of 34 patients hospitalized in psychiatry between January and July 2015 for psychotic active clinic who started treatment with PP or the previous dose was increased.

91.2% of patients admitted for acute exacerbation of their usual pathology and 8.8% for a first episode psychosis. In the CGI scale, all the patients admitted scored as severe or markedly ill; going mostly mildly ill at discharge. For 55.9% of patients, the treatment was changed to PP, 29.4% of the dose was increased PP and 14.7% antipsychotic treatment was started with PP. Among patients change treatment, the main reason was non-adherence (47.4%). 70.6% of our patients were discharged with PP as only antipsychotic and 29.4% which was discharged with another antipsychotic, the most frequent association was of PP with Quetiapine (80%).

PP is a highly effective medicament in the treatment of the schizophrenia that improves the adherence to the treatment, so in our experience and we consider it a medicament to be considered in the early stages of the disease. According to our experience and there are patients who can benefit from better control of symptoms adjusting the dose individually.

The authors have not supplied their declaration of competing interest.

Hyperthyroidism may lead to high anxiety status, emotional lability, irritability, overactivity, exaggerated sensitivity to noise, and fluctuating mood, insomnia and hyporexia. in extreme cases, they may appear delusions and hallucinations as psychiatric symptoms.

we report the case of a 53-year-old female who was diagnosed of hyperthyroidism and generalized anxiety disorder. The patient went to emergency department because of high levels of anxiety, with heart palpitations, trembling, shortness of breath and nausea. She was presenting auditory hallucinations and delusions as psychiatric symptoms. an urgent thyroid profile was made and it was observed the next results: TSH < 0.005; T4:4; T3:21. Due to a severe thyroid malfunction, the patient was admitted and treated with antithyroid agent, improving the psychiatric and somatic symptoms.

in this case, a patient diagnosed of hyperthyroidism and generalized anxiety disorder presented very severe psychiatric symptoms, with hallucinations and delusions. These symptoms may be produced by primary psychiatric disorders, but is very important to look for thyroid alterations, because if they are the cause, the acute treatment of thyroid malfunction is the correct management of the patient.

Hyperthyroidism is very common in general population, being infradiagnosed most of times. in patient with anxiety or other psychiatric symptoms, it is very important to make a thyroid function tests before the diagnosis of a psychiatric disorder. in extreme cases, hyperthyroidism status may lead to severe psychiatric and somatic complications.

The authors have not supplied their declaration of competing interest.

Various jurisdictions have legalized cannabis for medical purposes. As with all psychoactive medications, medical cannabis carries a risk of diversion and accidental ingestion. These risks may be particularly high among long-term medical cannabis patients as safety practices may become less salient to patients once the treatment becomes part of everyday life. The current study examines whether patients who have used medical cannabis for longer periods differ from those who have used for shorter periods in terms of sociodemographic background and other key aspects of medical cannabis use. Furthermore, the study examines the relationship between length of medical cannabis treatment and risk factors related to storage and diversion. Finally, the study examines the extent to which oncologists provide information to their patients about safe storage and disposal.

One hundred twenty-one medical cannabis oncology patients were interviewed face-to-face and 55 oncologists participated in a survey about safe storage and disposal practices related to medical cannabis.

Length of medical cannabis treatment was related to administration by smoking and using higher monthly dosages. In terms of risk for unsafe storage and diversion, length of medical cannabis was positively associated with using cannabis outside the home and having been asked to give away medical cannabis. Physicians did not report providing information to patients regarding safe storage and disposal practices in a regular manner.

Results suggest that there is an ongoing risk of unsafe storage and diversion over the course of medical cannabis treatment. Oncologists may need to give more consistent and continued training in safe storage and disposal practices, especially among long-term medical cannabis patients.

Major depressive disorder (MDD) is a multifactorial syndrome with significant interactions between genetic and environmental factors. This study specifically investigates the association between family history of alcohol problems (FHAP) and family history of depression (FHD), and how these relate to different clusters of depressive symptoms.

Correlations between FHAP and FHD and different clusters of the Beck Depression Inventory (BDI) were studied. We sampled 333 employees from a general hospital who had been receiving a psychiatric consultation between 2005 and 2012. Analysis of variance (ANOVA) and Analysis of covariance (ANCOVA) models were conducted to explore these correlations.

There was a significant positive correlation between FHAP and BDI affective score. This result remained significant even after the adjustment for other variables considered as important factors for MDD, such as gender, age, marital status, education, ethnic group and FHD. More specifically, FHAP was correlated with dissatisfaction and episodes of crying among the affective symptoms. FHAP showed no statistical difference in any of the other clusters score or in the BDI total score. Moreover, as expected, we found a correlation between FHD and BDI total score and Somatic and Cognitive clusters.

FHAP should be routinely investigated in individuals presenting with depressive symptoms. This is especially important in cases presenting with dissatisfaction and episodes of crying in patients who do not endorse criteria for MDD. Due to study limitations, the findings require replication by neurobiological, epidemiological and clinical studies.

Although mild to moderate major depressive disorder (MDD) is one of the main reasons for consulting a general practitioner (GP), there is still no international consensus on the most appropriate therapeutic approach.

The aim of this study is to evaluate the clinical effectiveness of watchful waiting (WW) compared with the use of antidepressants (ADs) for the treatment of mild to moderate depressive symptoms in 263 primary care (PC) usual-practice patients in a 12-month pragmatic non-randomised controlled trial. Both longitudinal and per-protocol analyses were performed, through a multilevel longitudinal analysis and a sensitivity analysis.

We observed a statistically significant time x treatment interaction in the severity of depression (Patient Health Questionnaire, PHQ-9) and disability (World Health Organization Disability Assessment Schedule, WHODAS) in favour of the AD group at 6 months but not at 12 months. The effect size of this difference was small. No statistically significant differences were observed between groups in severity of anxiety (Beck Anxiety Inventory, BAI) or health-related quality-of-life (EuroQol-5D, EQ-5D). Sensitivity analysis and per-protocol analysis showed no differences between the two groups in any of the evaluated scales.

Superiority of either treatment (WW and AD) was not demonstrated in patients treated for depression in PC after one year of follow-up.

Palivizumab is the standard immunoprophylaxis against serious disease due to respiratory syncytial virus infection. Current evidence-based prophylaxis guidelines may not address certain children with CHD within specific high-risk groups or clinical/management settings.

An international steering committee of clinicians with expertise in paediatric heart disease identified key questions concerning palivizumab administration; in collaboration with an additional international expert faculty, evidence-based recommendations were formulated using a quasi-Delphi consensus methodology.

Palivizumab prophylaxis was recommended for children with the following conditions: <2 years with unoperated haemodynamically significant CHD, who are cyanotic, who have pulmonary hypertension, or symptomatic airway abnormalities; <1 year with cardiomyopathies requiring treatment; in the 1st year of life with surgically operated CHD with haemodynamically significant residual problems or aged 1–2 years up to 6 months postoperatively; and on heart transplant waiting lists or in their 1st year after heart transplant. Unanimous consensus was not reached for use of immunoprophylaxis in children with asymptomatic CHD and other co-morbid factors such as arrhythmias, Down syndrome, or immunodeficiency, or during a nosocomial outbreak. Challenges to effective immunoprophylaxis included the following: multidisciplinary variations in identifying candidates with CHD and prophylaxis compliance; limited awareness of severe disease risks/burden; and limited knowledge of respiratory syncytial virus seasonal patterns in subtropical/tropical regions.

Evidence-based immunoprophylaxis recommendations were formulated for subgroups of children with CHD, but more data are needed to guide use in tropical/subtropical countries and in children with certain co-morbidities.