Pulmonary regurgitation is the most common complication in repaired tetralogy of Fallot patients. Severe chronic pulmonary regurgitation can be tolerated for decades, but if not treated, it can progress to symptomatic, irreversible right ventricular dilatation and dysfunction. We investigated clinical associations with pulmonary valve replacement among patients with significative pulmonary regurgitation and how interventional developments can change their management.

All adult patients with repaired tetralogy of Fallot who were followed at an adult CHD Clinic at a single centre from 1980 to 2022 were included on their first outpatient visit. Follow-up was estimated from the time of correction surgery until one of the following events occurred first: pulmonary valve replacement, death, loss to follow-up or conclusion of the study.

We included 221 patients (116 males) with a median age of 19 (18–25). At a median age of 33 (10) years old, 114 (51%) patients presented significant pulmonary regurgitation. Among patients with significant pulmonary regurgitation, pulmonary valve replacement was associated with male gender, older age at surgical repair, and longer QRS duration in adulthood. Pulmonary valve replacement was performed in 50 patients, including four transcatheter pulmonary valve implantations, at a median age of 34 (14) years.

Pulmonary regurgitation affects a large percentage of tetralogy of Fallot adult patients, requiring a long-term clinical and imaging follow-up. Sex, age at surgical repair and longer QRS are associated with the need of PVR among patients with significative pulmonary regurgitation. Clinical practice and current literature support TPVI as the future gold standard intervention.

The Profile of Mood States is one of the most widely used instruments to assess mood states. It is a rapid and economic method of assessing transient affective states (McNair et al. 2003) and it has been translated and validated to several languages including Portuguese. In our country we have several versions, with different factorial structures and number of items. The scale presents a list of feelings and emotions (adjectives) that people commonly experience.

With university students, we have used a version composed of 36 items that evaluates three factors, with good validity and reliability: Depression, Anxiety/Hostility and Positive Affect (Amaral et al. 2013).

However, to be included in digital apps that in addition to ecological momentary assessment parameters require a weekly or even daily assessment of mood states, this version has little usability.

To develop a shorter version of the POMS-36 based on Exploratory Factor Analysis and to analyse its construct validity using Confirmatory Factor Analysis in a sample of Portuguese college students.

765 students (69.2% females; mean age=22.09±2.433; range: 17-26) fill in the POMS-36 and the Perceived Stress Scale (Amaral et al. 2014). The total sample was randomly divided in two sub-samples. Sample A (N=380) was used to EFA and sample B (N=385) was used to CFA.

Through EFA (with varimax rotation and extracting three factors), the four items with the highest loadings in their respective factor were selected. Then, the CFA, carried out with the AMOS, revealed that this three-factor model, with two pairs of correlated errors, indicated a good fit (X2/df= 4.6010; CFI =.9561; GFI =.9406; TLI=.9559; RMSEA=.0687, p[rmsea=0.04]. The internal consistency analysis resulted in α (Cronbach alphas) <.75 for the three factors. Pearson correlations of the three factors - Depression, Anxiety/Hostility, Amability/Vigour – with Perceived stress were all significantly (p<.01) and moderate, respectively: .533, .614 and -.461.

Although much shorter, the new POMS-12 has good validity (construct and divergent-convergent) and reliability, being more suitable in studies that require frequent and rapid self-monitoring of affective states, such as ISABELA (“IoT Student Advisor and Best Lifestyle Analyser”), an app targeting student mental health and well-being in which we have been working.

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For people with mental illness, internalized stigma, also referred to as self-stigma, is characterized by a subjective perception of devaluation, marginalization, secrecy, shame, and withdrawal. It has many adverse effects on individual’s psychological well-being and clinical outcomes. The iatrogenic effects it has during psychotherapeutic treatment can significantly reduce utilization of mental health care services, reduce quality of life and increase avoidant coping. Overall, internalized stigma is considered a risk factor for poorer mental health prognosis. Although some interventions have recently been developed to specifically intervene on this target as part of psychological recovery goals over the course of treatment, most clinicians are not yet aware or empowered to correctly address this.

Description of a clinical case illustrating the relevance on addressing internalized mental illness related stigma during the recovery process.

Clinical case report and review of the literature on the subject.

We present the case of a 47-year-old female patient, C.S., single, graduated in social work (currently unemployed), who was admitted at the Psychiatry Day Hospital, where she was referred by her Psychiatry Assistant because of abulia, social withdrawal and isolation, depressed mood, thoughts of shame, guilt and self-devaluation and work incapacity. She had been admitted in the Psychiatry ward one year earlier for a first psychotic breakthrough, presenting persecutory and grandiose delusions and auditory hallucinations. After three weeks of inpatient treatment with antipsychotics, a full remission of the symptoms was achieved, without any posterior relapse. Before that first psychotic episode, the patient had been taking anti-depressive medication (escitalopram 20 mg id) for many years, prescribed by her General Practitioner, for mild to moderate depressive symptoms. After being discharged from the Psychiatry ward, C. kept following an outpatient treatment with anti-depressives and behavioural activation-based psychotherapy. She started to believe she was mentally ill and therefore weak, uncapable, and less deserving than her peers or her previous self. These self-stigmatizing ideas were enhanced by the lack of family support and the beliefs that were fostered by her mother, with whom she started to live after the hospitalization. These factors led to a dysfunctional internalization of an illness behaviour, jeopardizing the patient’s ability to reach full recovery.

This case reinforces the importance of targeting mental illness related stigma during the recovery process. Also, involving the family is of extreme importance to achieve support and address shared beliefs and the interchange between social and internalized stigma.

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Besides the traditionally studied group of young females, disordered eating occurs in all age groups (Eedena, Hoekena, and Hoek 2021). In recent years, there has been an increase in the prevalence of eating disorders and symptoms in middle-aged and older women (40 years old and over) (Mangweth-Matzek and Hoek 2017).

Experts in eating psychopathology in special groups such as Samuels, Maine and Taltillo (2019) suggest the use of the Screen for Disordered Eating (SDE; Magen et al. 2018) in the psychometric assessment of women in middle age and older. The SDE was developed to allow the Eating Disorders (ED) screening in Primary Health Care in people of all ages and without excluding Binge Eating Disorder (BED).

The SDE is composed of five items (yes or no answers), extracted from other validated self-reported questionnaires for the assessment of eating psychopathology.

To analyze the psychometric properties of the Portuguese Version of the Screen for Disordered Eating in a sample of women from the general population aged 40 and over.

Participants were 516 women with a mean age of 50.28 of years old (± 8.063; range: 40-80). They answered an online survey including the preliminary Portuguese version of the SDE and the Portuguese version of the Eating Disorder Examination – Questionnaire (EDE-Q-7; Pereira et al. 2021).

Confirmatory Factor Analysis showed that the unidimensional model presented good fit indexes (χ2/df=1.502; RMSEA=.0311, p<.001; CFI=.987 TLI=.995, GFI=.965). The Cronbach’s alfa was .762. All the items contributed to the internal consistency, as they presented item-total correlations above .40 and the exclusion of each one would decrease the alpha. Pearson correlations between SDE and the EDE-Q-7 were significant (p<.01), positive and moderate/high, as follows: .516 with the total score and .318, .503 and .536 respectively with the dimensional scores of Dietary restraint, Shape/weight overvaluation and Body dissatisfaction.

As observed with the original English-language scale, the Portuguese version of the SDE has shown good validity (construct and concurrent) and internal consistency. As such, the SDE might be a useful tool to investigate disordered eating psychopathology in older women. In the near future we will determine the SDE cut-offs with the best combination of sensitivity and specificity to screen for eating disorders in this populational group.

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During the COVID-19 pandemic outbreak, psychological distress, anxiety and depression reached new highs associated with a number of variables such as pandemic related-stress and sleep difficulties. These later two are known to be the precipitant and risk factors for psychological distress/mental disorders, respectively, and negative cognitive emotion regulation strategies can also have a key role on psychological/mental health problems generation and maintenance.

To study stress, sleep difficulties and the use of cognitive emotion regulation strategies by groups of students with different levels of psychological distress during the COVID-19 pandemic.

496 university students (mean age ± SD=20.99 years ± 2.27; 78.6% women) completed an online questionnaire between January and April, 2021, which included the Mental Health Inventory, the Perceived Stress Scale (PSS) and the Cognitive Emotion Regulation Questionnaire, as well as three questions from the Insomnia Scale to evaluate Difficulties in Initiating Sleep (DIS), Maintaining Sleep (DMS) and Early Morning Awakening (EMA). A Sleep Difficulties Index (SDI) was calculated by summing the scores of these three items.

18.3% of the students showed high levels of psychological distress (group 1; scores 1 SD =/< Mean), 62.7% average levels (group 2), and 19% low levels (group 3; Scores 1SD =/>Mean). The group 1, compared with group 3, showed higher levels of sleeping difficulties (DIS, DMS, EMA and SDI), greater stress levels and an increased use of negative emotion regulation strategies, as well as a lesser use of positive emotion regulation strategies. Furthermore, the group 2, with average levels of psychological distress is significantly distinct from the group with better mental health when comparing these same variables.

Almost one fifth of the Portuguese university students report elevated levels of psychological distress during the COVID-19 pandemic. Clinical interventions to promote psychological/mental health in this population should focus on reducing stress, promoting adequate sleep habits, reducing the use of negative cognitive emotion regulation strategies and increasing the use of positive ones.

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The relationship between narcissism and burnout has been explored in the literature with somewhat inconsistent findings. Though most studies have found a positive correlation between Narcissism and Burnout, some have failed to establish a significant link between the two, while others have even reported a protective role of narcissism against burnout.

In our previous work regarding the link between perfectionism and student burnout, we found that when using the Big Three model of Perfectionism, Narcissistic Perfectionism had only a weak connection to burnout, requiring full mediation by low-self compassion.

We hypothesized that this might be due to an exaggerated sense of Academic Efficacy in Narcissistic Perfectionists, which would compensate for some of the emotional exhaustion and depersonalization brought upon by their efforts to gain the admiration of others.

To investigate the link between Narcissistic Perfectionism and Academic Efficacy, and its impact on burnout levels.

A sample of 1080 students from healthcare-related courses (80,7% females; mean age=21.13±3.023; range: 17-41) filled in an online questionnaire including, among others, the Portuguese Version of BIG3-SF and MBI-SS. Correlational analysis was performed.

Contrary to our initial theory, Narcissistic Perfectionism did not significantly correlate with Academic Efficacy (r=0.011, p=0.728), although it had significant correlations with the other burnout dimensions and total burnout score.

This work disproved our initial hypothesis, suggesting that narcissistic perfectionism may be associated with other nefarious dimensions that cancel out the effects of grandiosity and inflated self-esteem on the perception of academic efficacy. This negative finding could possibly be further explored by using a psychometric instrument that differentiates between maladaptive and adaptive facets of narcissism.

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The Portuguese version of the Big Three Perfectionism Scale (BTPS), a 45-item self-report measure of rigid, self-critical, and narcissistic perfectionism, presented good reliability, construct and concurrent validity both in a sample of university students (Lino, Pereira et al. 2018) and of adults from the general population (Oliveira, Pereira et al. 2021).

To develop and validate a Portuguese brief version of the BTPS, the Big Three Perfectionism Scale–Short Form (BTPS-SF) in a sample of university students.

The procedure followed to select items for the short version was based on the 45-items BTPS confirmatory factorial analysis (Lino, Pereira et al. 2018). Following Feher et al. (2020) strategy, with Canadian university students, we retained between one and two from each of the 10 perfectionism facets in the BTPS, 16 items in total. The 16 items selected had loadings ranging from .63 to .88 (Lino, Pereira et al. 2018), thus meeting the suggested requirement of high loadings being above .60 in magnitude (Afifi et al. 2011).

Participants were 633 Portuguese students (medicine, dentistry and health technologies; 82.1% girls; mean age=21.25±3.115); they answered an online survey including the BTPS and the Depression Anxiety and Stress Scale (DASS; Xavier et al. 2017).

Confirmatory Factor Analysis showed that both the first (χ2/df=3.074; RMSEA=.0573, p<.001; CFI=.9591; TLI=.9478, GFI=.9465) and the second order (χ2/df=3.714; RMSEA=.0655, p<.001; CFI=.9482; TLI=.9317, GFI=.9318) models presented good fit indexes. The Cronbach’s alfas were: a=.865 for the total and .855, .829 and .750, respectively for F1 (rigid perfectionism), F2 (self-critical perfectionism) and F3 (narcissistic perfectionism). Pearson coefficient correlations with DASS total score were significant (p<.01), positive and moderate for the total 16-items- BTPS (r=.375), F1 (r=.285), F2 (r=.465) and low for F3 (r=.177). Correlation coefficients with Depression, Anxiety and Stress sub-scales presented the same pattern and magnitude.

Due to its good validity and reliability, the Portuguese BTPS–SF is an efficient and useful alternative to the 55-item version. When it is not necessary to measure the ten facets, the BTPS-SF has the advantages of conciseness, brevity and ease of filling.

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Postpartum depression, refers to depressive symptoms within a 12-month period after the birth of an infant in a new father or mother. It’s have been a growing mental health concern, as it is one of the leading causes of poor familial and infant health outcomes. Despite the growing attention being given to fathers’ depression, including in Portugal, prevalence data and its possible correlates are still scarce compared to depression in mothers, especially during the COVID-19 pandemic.

To explore and compare levels of depressive symptomatology and to analyze potential correlates for postpartum depression in Portuguese new mothers and fathers during the COVID-19 pandemic.

153 men and 187 women (mean age: 36.61± 4.99 vs. 32.98 ±5.00 years, respectively) were recruited in the perinatal period (7.29±3.22 vs 8.58± 0.97 months post-partum) and answered to an online survey that included questions related to sociodemographic and psychosocial variables and validated questionnaires: Perinatal Depression Screening Scale (PDSS), Perseverative Thinking Questionnaire (for Repetitive Negative Thinking/RNT) and Dysfunctional Beliefs Towards Motherhood/Fatherhood Scale (DBTM/F). Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS Version 26 for Mac).

New-mothers had significantly higher levels of depressive symptoms than new-fathers (41.89±16.94 VS. 33.95±14.99, p<.001). Based on the PDSS’ cutoff point the prevalence of clinically relevant depressive symptoms in male and female progenitors was 21.6% and 39.6%, respectively (p<.001).

DBTF were significantly higher compared to DBTM (p<.05). Male and female progenitors did not differ regarding levels of RNT.

DBT-M/F (r».40) and RNT (r>.55) significantly and positively correlated with PDSS scores.

In both genders, DBT-M/F and RNT significantly (p<.01) predicted PDSS scores explaining 33.8% (Beta: DBT=.136, p=.050; RNT=.538, p<.01) of its variance in fathers and 50.4% in mothers (Beta: DBT=.218, p=.001; RNT=.565, p<.01).

During the COVID-19 pandemic, Portuguese recent mothers had higher levels of depressive symptoms when compared to recent fathers. However, in both new mothers and fathers, depressive symptoms’ prevalence and severity were higher than the figures found in samples of new parents outside of the pandemic period and of samples from the general population. Addressing DBT-M/F, as well as RNT, in recent parents, could be relevant in preventing/improving their depressive symptoms.

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Mental pathology is relatively prevalent in the women, and there is often a need for treatment with psychotropic drugs, with an impact on women’s reproductive health. The use of contraception is widely spread among this population and the choice between these methods must be considered carefully.

This review aims to present the main interactions between contraceptive methods and psychotropic therapy and its impact on psychiatric disorders, in addition to the precautions to be taken in their choice.

Literature review of relevant articles on Pubmed. Query: Contraceptive+(psychiatric disorder, depression, anxiety, schizophrenia, bipolar disorder, psychotropic drugs).

Based on current evidence, no statistically significant differences regarding unplanned pregnancy rates or the psychotropic treatment outcomes were found when using combined oral contraceptives and antidepressants, benzodiazepines or atypical antipsychotics (being clozapine the exception). The impact of contraceptive methods on mood was unclear, as some articles showed an association between contraceptive use and a higher risk of beginning antidepressants and others showing no differences or even as a protective factor. Although the interactions of the aforementioned drugs are infrequent, there are cases where important interactions occur, such as clozapine, valproic acid, lamotrigine and carbamazepine, as some herbal products as the St.John’s wort. With clozapine, there is an increased serum concentrations, while the opposite occurs in the case of valproate and lamotrigine with a decrease of 32.6% and 23.4%, respectively. Treatment with valproic acid in women of childbearing age has been discouraged because of its association with polycystic ovary syndrome, elevated testosterone concentrations and menstrual irregularities, in addition to the risk of fetal malformations. In cases where this drug is prescribed, it is recommended to use highly effective methods such as subcutaneous implants or intrauterine devices. Lamotrigine and carbamazepine reduce the effectiveness of some contraceptive methods, such as oral contraceptives, transdermal patch and vaginal ring, in which case the placement of a subcutaneous implant or intrauterine device is indicated.

The magnitude of the impact between contraceptives, regarding depressive disorders, is unclear. The evidence shows that some women report the appearance and recrudescence of depressive symptoms, evidencing the need of further studies to identify the risk factors in these cases. The importance of clear and simple information and a shared decision on which contraception to choose is crucial, as clarification about their interactions with psychiatric treatment. The clinician must also be aware of the implications for reproductive health, in order to reduce the risks and side effects associated with some drugs.

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A number of studies have compared Alzheimer’s disease (AD), the commonest form of dementia, based on their age of onset, i.e. before the age of 65 years (early-onset AD, EO-AD) to those developing after 65 years of age (late-onset AD, LO-AD), but the differences are not clear. We performed a systematic review and meta-analysis to compare clinical characteristics between EO-AD and LO-AD.

Medline, Embase, PsycINFO, and CINAHL databases were systematically searched for studies comparing time to diagnosis, cognitive scores, annual cognitive decline, activities of daily living (ADLs), neuropsychiatric symptoms (NPS), quality of life (QoL), and survival time for EO-AD and LO-AD patients.

Forty-two studies were included (EO-AD participants n = 5,544; LO-AD participants n = 16,042). An inverse variance method with random effects models was used to calculate overall effect estimates for each outcome. People with EO-AD had significantly poorer baseline cognitive performance and faster cognitive decline but longer survival times than people with LO-AD. There was no evidence that EO-AD patients differ from people with LO-AD in terms of symptom onset to diagnosis time, ADLs, and NPS. There were insufficient data to estimate overall effects of differences in QoL in EO-AD compared to LO-AD.

Our findings suggest that EO-AD differs from LO-AD in baseline cognition, cognitive decline, and survival time but otherwise has similar clinical characteristics to LO-AD. Larger studies using standardized questionnaires focusing on the clinical presentations are needed to better understand the impact of age of onset in AD.

Data are scarce regarding hospital infection control committees and compliance with infection prevention and control (IPC) recommendations in Brazil, a country of continental dimensions. We assessed the main characteristics of infection control committees (ICCs) on healthcare-associated infections (HAIs) in Brazilian hospitals.

This cross-sectional study was conducted in ICCs of public and private hospitals distributed across all Brazilian regions. Data were collected directly from the ICC staff by completing an online questionnaire and during on-site visits through face-to-face interviews.

In total, 53 Brazilian hospitals were evaluated from October 2019 to December 2020. All hospitals had implemented the IPC core components in their programs. All centers had protocols for the prevention and control of ventilator-associated pneumonia as well as bloodstream, surgical site, and catheter-associated urinary tract infections. Most hospitals (80%) had no budget specifically allocated to the IPC program; 34% of the laundry staff had received specific IPC training; and only 7.5% of hospitals reported occupational infections in healthcare workers.

In this sample, most ICCs complied with the minimum requirements for IPC programs. The main limitation regarding ICCs was the lack of financial support. The findings of this survey support the development of strategic plans to improve IPCs in Brazilian hospitals.