To report a clinical case on neurosyphilis.

Clinical history, neuroimaging and lab investigations, and neuropsychological assessments.

A 66-year-old married man was admitted to an Old Age psychiatric ward presenting with a two-year history of desinhibited behaviour, hetero-aggression and a gradual loss of his ability cope with activities of daily living. His Mini Mental State Examination (MMSE) score was 20/30 on admission. The symptoms described above raised the working diagnosis of a frontotemporal dementia. Computerized axial tomography was normal. Laboratory and additional examinations were performed. Serological tests for syphilis were positive for both the Venereal Disease Research Laboratory test (VDRL) and Treponema pallidum hemaglutination test (TPHA). Cerebrospinal fluid (CSF) revealed a positive VDRL (cytology: 2 erythrocytes/μl, 30 leucocytes/μl with 24 mononuclear cells/ μl). Additional tests including human immunodeficiency virus (HIV) test were negative. Based on these findings the patient was treated for neurosyphilis according to the IUSTI 2008 European Guidelines on the management of Syphilis: Benzyl penicillin 18 million units i.v. daily, as 3 million units every four hours during 21 days. Two months later, he scored 28/30 at the MMSE but showing only slight improvement at the executive function battery.

Neurosyphilis remains a differential diagnosis for a wide variety of psychiatric syndromes, including dementia. However, the incidence of neurosyphilis presenting initially with frontotemporal impairment is unclear. High-risk groups such as patients with neuropsychiatric diseases should be routinely screened with serological tests in order to prevent morbidity and help to eliminate syphilis.

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.

To investigate associations between perfectionism dimensions and psychological distress 421 pregnant women (M=29.8, SD=4.48 years) completed measures of Self-Oriented Perfectionism (SOP), Socially-Prescribed Perfectionism (SPP) (MPS; Hewitt & Flett, 1991; Soares et al., 2003), mood (POMS; McNair et al., 1971; Azevedo et al., 1991) and depressive symptomatology (BDI-II; Beck et al., 1996; Coelho et al., 2002).

A 2-factor model of Perfectionism with SOP and SPP dimensions and a 3-factor model with SOP, SPP-Others’ High Standards and SPP-Conditional Acceptance factors were explored. Correlations and Linear Regressions were calculated between perfectionism factors and mood variables/depressive symptoms.

Higher levels of SPP factors were in general associated with increased Anxiety, Depression, Anger, Fatigue and Confusion, with decreased Vigour and with more severe depressive symptomatology. SPP dimension and both SPP sub-scales explained depressive symptoms.

Our results, in contrast with those from the study of Campbell and DiPaula (2002) did not confirm a preferential association between SPP-Conditional Acceptance and psychological distress (PD), revealing that both components of SPP were associated with PD.

Deficits in social functioning are a core feature of schizophrenia and are influenced by both symptomatic and neurocognitive variables.

In the present study we aimed to determine the reliability and validity of the Portuguese version of the Personal and Social Performance (PSP) scale, and possible correlations with measures of cognitive functioning.

One-hundred and four community and inpatients with schizophrenia were assessed using measures of social functioning and symptom severity alongside measures of executive function, processing speed and verbal memory.

The reliability of the PSP was found to be satisfactory, with a Cronbach's alpha coefficient of 0.789. Inter-rater reliability in the four domains of the PSP varied from 0.430 to 0.954. Low-functioning patients (PSP < 70) were older, had longer duration of illness, were more symptomatic and had worse cognitive performances, as compared to high-functioning patients (PSP ≥ 70). In a regression model, deficits in social functioning were strongly predicted both by symptomatic and neurocognitive variables; these together accounted for up to 62% of the variance.

The present study supports the reliability and validity of the Portuguese language version of the PSP and further supports the original measure. The co-administration of brief cognitive assessments with measures of functioning may lead to more focused interventions, possibly improving outcomes in this group.

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.

The literature recognizes differences in the prevalence, eating disorders (ED) symptoms and eating habits/behaviours by sex, but few studies in Portugal considered this subject.

To explore associations between sex, Body Mass Index (BMI), Eating Attitudes Test-25 (EAT-25) dimensions and items, the EAT-25 score dichotomized by the cutoff of 19 (a score equal/above 19 indicates “possible” ED) and, finally, some items about eating habits/behaviors; to verify possible associations between sociodemographic variables and items assessing eating habits/behaviours.

308 adolescents (M = 14,5 years; DP = 1,67; girls, n = 184, 59,7%) answered a sociodemographic questionnaire and the EAT-25.

There were no significant associations between sex, categorized and dimensional BMI, EAT-25 dimensions, categorized EAT-25 (cutoff of 19) and items assessing eating habits/behaviors. However, some items of the EAT-25 revealed a significant association with sex. Most adolescents from both sexes presented a score below the cutoff of 19. The frequency with which young people drink sodas and eat vegetables is associated with father's educational level. The frequency with which adolescents eat vegetables and fast food is associated with the school area they attend.

Eating habits/behaviours are not as much negative as documented in some literature. There does not seem to exist significant sex differences regarding eating attitudes, “possible” ED, BMI and eating habits/behaviours. However, there are sex differences regarding some of the specific symptoms of EAT-25. It is good to verify that both sexes reveal a low prevalence of “possible” eating behaviour disorder, although girls reveal a higher value.

Several studies associated Major Depressive Disorder (MDD) with an increased production of pro-inflammatory cytokines, such as interleukin 6 (IL-6). Serum IL-6 levels were found to be significantly increased in subjects with MDD and with Treatment Resistant Depression (TRD). Moreover, ketamine, a drug with fast-acting antidepressant properties, has proven to reduce IL-6 levels in rat prefrontal cortex and hippocampus. However, despite the clear influence of IL-6 in the pathophysiology of depression and in antidepressant response, studies evaluating the impact of IL-6 functional genetic polymorphisms on treatment response phenotypes are scarce.

We aim to evaluate the role of IL6-174G>C, IL6-6331T>C and IL6R D358A A>C functional polymorphisms in antidepressant treatment phenotypes, specifically remission, relapse and TRD.

We genotyped the referred polymorphisms in a subset of 80 MDD patients followed at Hospital Magalhães Lemos, Portugal, within a period of 18 months.

We found that patients carrying IL6-174 GG genotype are more prone to develop TRD (OR=4.125; 95%CI: [1.151-14.786]; p=0.038). We also observed that patients carrying IL6-6331 TC genotype have a higher risk of relapse (OR=3.988; 95%CI: [1.176-13.516]; p=0.022), and present a lower time to relapse, TC: 26 weeks vs. TT: 45 weeks (p=0.041, Log-rank test). No association was found between IL6R D358A genetic polymorphism and any of treatment phenotypes.

The IL6-174G>C and IL6-6331T>C polymorphisms influence antidepressant treatment response in our subset of MDD patients. These polymorphisms may possibly contribute to the elevated IL-6 levels found in patients with TRD. This research was partially supported by an AstraZeneca Grant

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.

Recent studies suggested that immune activation and cytokines might be involved in depression. The proinflammatory cytokine interleukin-18 (IL-18) is less reported in depression but is still relevant since it is expressed in the brain and serum levels of IL-18 have been found to be increased in patients with moderate to severe depression. Therefore, it seems reasonable that IL-18 promoter SNPs may have an effect in antidepressant response phenotypes.

We aim to evaluate the role of IL18-607C>A and IL18-137G>Cpromoter polymorphisms in antidepressant treatment phenotypes, specifically remission, relapse and treatment resistant depression (TRD).

We genotyped the referredpolymorphisms in a subset of 80 MDD patients followed at Hospital Magalhães Lemos, Portugal, within a period of 27 months.

We found that patients carrying IL18-607CA or AA genotypes are more prone to relapse after AD treatment (OR=4.145; 95%CI: [1.038-16.555]; p=0.043) and present a lower time to relapse than patients carrying CC genotype (69 vs 115 weeks, p=0.019, Log-rank test). We also observed that patients carrying IL18-137GC or CC genotypes have a higher risk of relapse (OR=3.988; 95%CI: [1.176-13.516]; p=0.022) and display relapse earlier than the ones carrying GG genotype (64 vs 112 weeks, p=0.006, Log-rank test). No association was found between the evaluated genetic polymorphisms and remission or TRD.

The IL18-607A>C and IL18-137G>Cpolymorphisms seems to influence relapse after antidepressant treatment in our subset of depressed patients. These polymorphisms may possibly contribute to the elevated IL-18 levels found in patients with moderate to severe depression.

Light-to-moderate alcohol consumption is associated with a reduced risk of overall dementia; however, moderate-to-heavy alcohol consumption is a risk factor for the development of dementia prior to age 65. Here we describe a case report of a 51-year-old man whose clinical presentation is consistent with dementia related to alcohol consumption.

To describe the clinical case of a patient with a probable diagnosis of dementia related to alcohol consumption.

This report aims to understand the role of alcohol consumption as a risk factor for dementia.

This report contains a case report and a literature review that was performed using Pubmed and Medscape.

Although a gradual improvement in cognitive ability with prolonged abstinence can occur, some cognitive impairments appeared to persist despite prolonged periods of abstinence. Thus, the avoidance of excessive alcohol consumption is crucial for the prevention of this disease.

Psychogenic excoriations are also called neurotic excoriations, dermatillomania or skin picking syndrome. Psychogenic excoriations are lesions caused by scratching, picking, lancing, rubbing or squeezing, usually, in areas that patient can easily reach (face, upper back and upper and lower extremities). They are initiated because an urge to excoriate an irregularity of the skin or by a disturbing sensation in the skin. The classic lesions are characterized by clean, linear erosions, scabs and scars that can be hypopigmented or hyperpigmented and are usually similar in size and shape. Association with psychiatric comorbidities are common, particularly mood and anxiety disorders. It is estimated to occur in 2% of dermatology clinic patients and is associated with functional impairment, medical complications (e.g. infection) or substantial distress. Psychotropic medications (e.g. SSRIs) and appropriate counseling can be effective treatments.

The purpose of the poster is to highlight the existence and characteristics of psychogenic excoriations. A

condition that can be chronic, causes significant impairment and is believed to be common but unreported.

Here we report the case of a 27 year-old woman, with a 10 years history of self-inflicted excoriations, associated to high anxiety levels, treated with an SSRI with good response.

Although it does not appear as a diagnostic category in DSM- IV, psycogenic excoriations is indeed a treatable condition that, isolated or associated with psychiatric comorbidity can cause marked distress, impairment and psychological suffering.

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.