The Strengths and Difficulties Questionnaire (SDQ) is a widely used assessment tool for measuring the psychological well-being of children and adolescents. It consists of 25 items that assess emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship difficulties, and prosocial behavior.

The present study aimed to investigate the relationship between parental perceptions of difficulties and the results obtained from the SDQ.

Participants were recruited from the initial consultation of Child and Adolescent Psychiatry (N=132). Parents completed a questionnaire assessing their subjective perceptions of their child’s difficulties in various domains (home, school, learning activities, relations with friends) on a 4-point scale ranging from “no notion of difficulties” to “very severe difficulties”. They also completed the SDQ scale. Data were analyzed using SPSS software.

In this study, 74% of participants had scores on the SDQ indicating potential psychological difficulties. Additionally, 17.4% of participants had scores on the borderline between normal and abnormal results. 47% of patients scored above the cut-line for problems on the hyperactivity/inattention subscale, indicating higher levels of difficulties in this area. Conversely, only 3% of participants scored problematic scores on the peer relationship difficulties subscale. There was no statistical difference between sexes in terms of SDQ scores. A correlation analysis revealed a significant positive correlation (p < 0.01) between parental perceptions of difficulties and higher SDQ scores and the mean score on the SDQ scale was found to be significantly higher in patients who were rescheduled for another consultation following the evaluation by doctors, compared to those patients who received clinical discharge from the initial consultation (p-value 0,040).

This study provides valuable insights into the concordance between parental perceptions and objective assessments of difficulties in children and adolescents. Parents who perceived their child to have more difficulties also reported higher levels of psychological difficulties on the SDQ. This study highlights the importance of using tools like the SDQ to assess psychological well-being in children and adolescents. It also emphasizes the practical utility of the SDQ as a time-efficient assessment tool for use during initial consultations in child and adolescent psychiatry.

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Cognitive dysfunction has been reported in acute psychiatric patients for a long time and has profound implications for the management of severe mental disorders. The Screen for Cognitive Impairment in Psychiatry (SCIP) is a scale developed for screening cognitive deficits. This tool is simple and easy to administer.

To translate and to validate to Portuguese the SCIP.

The accepted back-translation method is employed for translating from English into Portuguese. One-hundred individuals in good health were characterized using demographic questionnaires and a neuropsychological battery. Subsequently, the new version of the scale was administered on two distinct occasions with a minimum one-week gap between them.

High internal consistencies as well as strong correlations with comparable neuropsychological tests were obtained.

The results obtained from the Portuguese version of SCIP are in line with those from the English version. Effectively, SCIP serves as a key instrument for the initial assessment of cognitive function. Its characteristics, particularly its conciseness and independence from a technological platform, allow it to be integrated into clinical practice. Our aim is to use this version and apply it to different pathologies, comparing patients with controls. This will allow us to study different patients and apply it to our population.

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Sustained alcohol intake, when combined with incomplete treatment, can result in chronic structural changes in the Central Nervous System, including generalized cortical and cerebellar atrophy, amnesic syndromes like Korsakoff’s syndrome, and white matter disorders such as Central Pontine Myelinolysis and Marchiafava-Bignami syndrome. It is crucial to prevent these complications due to their potential for irreversible and debilitating consequences. For Wernicke-Korsakoff syndrome, early recognition and thiamine administration for prevention are paramount, as it arises from thiamine deficiency due to malnutrition caused by persistent alcohol use. In the case of Central Pontine Myelinolysis, which is caused by abrupt fluctuations in serum osmolality, controlled sodium correction is essential.

Through a clinical case and a review of published literature, this study aims to reflect on the importance of preventing neurological injuries associated with chronic alcohol consumption, specifically Wernicke-Korsakoff Syndrome and Central Pontine Myelinolysis.

A literature review was conducted by searching for articles on PubMed using the terms “Alcohol Use Disorder,” “Wernicke-Korsakoff syndrome,” and “Central pontine myelinolysis.” A clinical case is presented, featuring a 50-year-old patient with alcohol use disorder who developed Wernicke-Korsakoff syndrome and Central Pontine Myelinolysis. Considering this case, we reflect on the primary approaches that could have been beneficial in preventing these complications and propose a straightforward method for doing so.

A 50-year-old patient presented with poor general condition, characterized by low weight, significant loss of strength in the limbs and arms, and incoherent speech with anterograde amnesia and confabulation. This condition had progressed to a point where the patient could no longer walk, perform basic self-care tasks such as bathing, dressing, and eating independently, underscoring the severity of his condition. The diagnoses of Wernicke-Korsakoff syndrome and Central Pontine Myelinolysis were established based on clinical manifestations and the presence of hyperintense lesions observed in the central pons on T2/FLAIR axial MRI scans. This clinical case highlights the importance of proper and precocious prevention of complications in patients with alcohol use disorder. The foremost step in preventing these complications is to treat alcohol dependence effectively, even when faced with patient resistance. It’s vital to remain vigilant about potential complications and implement suitable prophylactic measures.

The devastating effects of complications arising from Alcohol Use Disorder, such as Wernicke-Korsakoff syndrome and Central Pontine Myelinolysis, underscore the importance of enhanced attention that clinicians should provide when approaching these patients at all clinical interactions.

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Involuntary admission rates differ between gender across various countries. In several European Union countries, men are more frequently involuntarily admitted, while an opposite trend, associating women with involuntary care, has been observed in countries like Switzerland, Brazil, and China.

Considering the contradictory evidence about gender and involuntary care in the literature, we aim to analyze the gender patterns of involuntary care in Centro Hospitalar Médio Tejo’s Psychiatric Acute Unit, exploring the gender differences in diagnosis among involuntary patients.

We stored and analyzed the data using Microsoft Excel and IBM SPSS Statistics. We studied psychiatry admissions at Centro Hospitalar Médio Tejo, Portugal over 2 years. The Acute Psychiatric Unit, located within a general hospital, has 24 beds, and offers acute mental healthcare services to adults aged 18 and above, serving a coverage area of approximately 251,000 residents. As part of our data collection process for all admissions to the Acute Psychiatry Unit, we recorded information such as gender, age, diagnosis at discharge, treatment type (voluntary or involuntary), and length of stay.

From January 1, 2021, to December 31, 2022, there were 686 psychiatry admissions at Centro Hospitalar Médio Tejo, of which 125 (18,2%) were involuntary. The admission rates were approximately 136.6 per 100,000 people annually, with 24.9 being involuntary admissions per 100,000 people annually. In our analysis of involuntary admissions, women had a lower rate of such admissions, making up 6.4%, while men had a higher rate at 11.8%. No other gender identity was mentioned. Schizophrenia-related disorders were the primary cause for involuntary admissions for both genders, with 67.9% for men and 50% for women. Mood disorders were the second most common reason for involuntary admission, accounting for around 40.9% of cases for women and a significantly lower 16% for men. Involuntarily hospitalized patients exhibited longer lengths of stay independently of the gender. Men hospitalized involuntarily tended to be younger, whereas for women, involuntary hospitalizations were associated with older ages.

In conclusion, our study reveals gender differences in psychiatric involuntary admissions, with more men being involuntarily admitted than women. Schizophrenia group disorders were the most common diagnoses among male and female involuntary patients. Furthermore, all hospitalized women exhibited a higher prevalence of mood disorders, a trend that was more pronounced among those admitted involuntarily. These gender trends match the overall patterns seen in the epidemiology of schizophrenia and mood disorders. Additionally, women with schizophrenia generally exhibit better social functioning than men, which may explain the lower needs of involuntary hospitalization.

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Epilepsy is one of the most common serious brain illness, with symptoms influenced by multiple risk factors and a strong genetic predisposition, rather than having a single expression and cause¹. Neuropsychiatric symptoms in epilepsy can encompass manifestations such as mood alterations, anxiety, sleep disturbances, psychosis, and behavioral disorders. While the motor and sensory manifestations of epileptic seizures are widely recognized, neuropsychiatric symptoms accompanying epilepsy are often underestimated. Therefore, it is essential to understand the most prevalent epidemiological profile of these patients to improve the diagnosis and management of these symptoms.

Our goal was to evaluate the neuropsychiatric behavior of epilepsy patients in Brazilian over the past 3 years through hospitalization data in order to outline an epidemiological and behavioral profile.

A cross-sectional, descriptive, retrospective, and quantitative study was conducted on hospitalizations of individuals simultaneously diagnosed with epilepsy, schizotypal and delusional disorders, and mood disorders in all five regions of Brazil (South, Southeast, Midwest, North, and Northeast) between February 2020 and December 2022. Data from January 2020 were not available. The data used were collected through the Department of Health Informatics of the Brazilian Unified Health System (DATASUS) in the “Hospital Information System of SUS” section, gathering information regarding the nature of care, age range, gender, and ethnicity of the patients.

The analysis covers the years 2020 to 2022, totaling 503,045 hospitalizations. In 2022, the highest number of cases occurred (≈ 37.55%), followed by 2021 (≈ 33.62%) and 2020 (≈ 28.81%). Urgent hospitalizations represented ≈ 90.85% of the total. The most affected age group was 30 to 39 years old (≈ 18.30%). Men were more affected than women (≈ 52.03% and ≈ 47.96%, respectively), and Caucasians accounted for ≈ 36.07% of the hospitalizations. The average length of stay was 19.1 days, and the mortality rate was 1.4%.

Thus, there is a gradual and annual increase in the number of hospitalizations during the observed period. While there is a minimal disparity between the affected genders, it is evident that the profile of male, caucasian, and adult patients is the most prevalent. Moreover, the predominantly urgent nature of hospitalizations points to an alarming scenario regarding this issue. From the analysis of the data obtained in the study, there is a clear need for interventions capable of reducing the prevalence of hospitalizations for neuropsychiatric symptoms in epilepsy patients in Brazil.

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Neuropsychiatric disorders are the leading cause of disability worldwide, as seen in cases such as depression, anxiety, bipolar mood disorder and schizophrenia, which can be developed or exacerbated by the use of psychoactive substances. Most mental disorders have an early onset, often leading to early and/or permanent disability, increasing the need and cost of healthcare. Therefore, it is necessary to improve the identification of the epidemiological profile of these cases in the South of Brazil in order to enhance the diagnosis and reduce the costs associated with managing these disorders.

The present study aimed to analyze statistical data regarding hospitalizations related to mental disorders caused by the use of psychoactive substances and alcohol in the southern region of Brazil, highlighting the pathological scenario and identifying the most prevalent profiles of these disorders in this region.

A cross-sectional, descriptive, retrospective, and quantitative study was conducted on hospitalizations of individuals diagnosed with mental and behavioral disorders due to the use of psychoactive substances and alcohol in the states of the Southern region of Brazil (Paraná, Santa Catarina, and Rio Grande do Sul) between February 2020 and December 2022. Data of January 2020 were not available. The data used were collected through the Department of Health Informatics of the Brazilian Unified Health System (DATASUS) in the “Hospital Information System of SUS” section, gathering information regarding the nature of the care, age range, gender, and ethnicity of the patients.

The study covers the years 2020 to 2022, indicating a total of 81,608 hospitalizations, with the year 2022 having the highest number of cases (≈ 37.13%), followed by 2021 (≈ 33.30%) and 2020 (≈ 29.55%). The states with the highest number of hospitalizations were Rio Grande do Sul (≈ 54.90%), Paraná (≈ 29.29%), and Santa Catarina (≈ 15.79%). Urgent hospitalizations accounted for ≈ 87.29% of the total. The most affected age group was 30 to 39 years old (≈ 25.61%). Men were more affected than women (≈ 81.70% and ≈ 18.28%, respectively). Caucasians accounted for ≈ 64.29% of the hospitalizations. The average length of stay was 20.8 days, and the mortality rate was 0.32%.

There is a clear increase in the number of hospitalizations related to mental disorders caused by the use of psychoactive substances in the period from 2020 to 2022 in the southern region of Brazil, with the highest number of cases in the state of Rio Grande do Sul. The most affected population consisted of Caucasian men aged 30 to 39 years old. Furthermore, these results may be related to the increasing trend of psychoactive substance use among the Brazilian population and also the COVID-19 pandemic, which led to a period of underreporting due to social isolation.

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In recent years, mental health has gained prominence in public health, prompting thorough investigations into psychiatric condition trends. This study conducts a comprehensive epidemiological analysis of hospitalizations for Schizophrenia, Schizotypal, and Delirium Disorders in Rio Grande do Sul (RS) over the past five years. By revealing these patterns, it enhances our understanding of regional mental health dynamics and offers insights for intervention strategies, resource planning, and improved mental healthcare. The ultimate goal is to advance more effective and accessible mental healthcare in RS and beyond.

This study aims to analyze the prevalence and epidemiological profile of hospitalizations due to psychiatric disorders to assist in the diagnosis and outcome of affected patients.

A cross-sectional, descriptive, retrospective, and quantitative study was conducted regarding hospitalizations for Schizophrenia, Schizotypal Disorders, and Delirium in the state of RS between January 2018 and November 2022. Data were collected from the Department of Informatics of the Brazilian Unified Health System (DATASUS) in the “Hospital Information System of SUS” section, focusing on the nature of care, age group, gender, and ethnicity of the patients. The information was aggregated over the five-year period based on the four mentioned descriptors and subsequently analyzed to establish a profile of hospitalizations during that period.

The analysis spans from 2018 to 2022, encompassing a total of 28,345 hospitalizations. In 2019, there was the highest number of cases (22.21%), followed by 2018 (21.08%). Urgent care admissions constituted 85.34% of the total. The age group most affected was 35 to 39 years (11.8%). Men were more affected than women (60.18%), and the majority of hospitalizations were among the Caucasian ethnicity (75.12%). The average length of stay was 23.7 days, and the mortality rate stood at 0.26%.

The increasing trend in hospitalizations, peaking in 2019, highlights the need for preventive measures. Urgent admissions (85.34%) underscore the demand for accessible mental health resources. Men in the 35 to 39 age group are disproportionately affected, suggesting specific risk factors. The predominance of Caucasian ethnicity emphasizes the need for culturally sensitive care. A longer average length of stay (23.7 days) underscores treatment complexity, while a low mortality rate (0.26%) signals effective medical care. In essence, these findings inform tailored mental health policies to enhance service quality and prioritize patient-centered approaches.

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It is well known that healthcare professionals, in a somewhat generalized manner, work in stressful contexts that embrace emotional overload, highly hierarchical environments, and not always sensitive to the vulnerabilities that arise. Chronic professional stress in institutions, associated with the perception of low control and emotional exhaustion, acts as a trigger for eminently deleterious consequences, significantly affecting the most dedicated and perfectionist professionals.

This work aims, through a non-systematic literature review, to analyze the psychosocial risks associated with the practice of healthcare professionals, as well as the mitigation strategies whose practical implementation may depend on and maintenance of a positive and protective occupational environment.

For the purpose of literature review, a search was conducted on search engines such as Google Scholar, Research Gate, and PubMed, with no date limitations, using the following terms (or combinations): “occupational psychiatry”; “psychosocial risks AND healthcare professionals”; “mitigation strategies”; “occupational risk management.”

Healthcare sector professionals are the ones reporting exposure to higher levels of workload intensity, including parameters related to work speed (under time pressure), combined with prominent emotional demands and psychological suffering. In addition to the most commonly analyzed occupational stressors (workload, job fatigue, particularly draining emotional interactions, marked cognitive demands, complex decision-making, conflicts of a deontological nature), other relevant contextual factors emerge. Among these, predisposing personality traits (such as neuroticism), a sense of personal sacrifice with neglect of self-care, vicarious trauma, which is intimately related to compassion fatigue in the face of frequent and prolonged exposure to traumatic experiences (of various kinds) of the patients they accompany, and occupational violence, which can manifest as verbal or behavioral threats, mobbing, physical harm, and/or sexual abuse based on a tendentially gender-based and deeply hierarchical structure.

Undeniable consequences such as job dissatisfaction, psychological distress, the development of anxiety, depression, burnout, and post-traumatic stress disorder translate into a loss of capacity to perform occupational functions, with a higher risk of medical/clinical errors, conferring risks that should never be neglected to the safety of the users of healthcare institutions. On the darker side of this panorama, and in the face of chronic depletion, occupational suicide emerges. It is therefore urgent to requalify the work environment, aiming at creating and maintaining a positive occupational environment, or alternatively, a preventive approach to the risk of mental health problems originating or exacerbated in the workplace.

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Over the past few years, Psychiatry has undergone a significant transformation with the integration of Artificial Intelligence (AI). This shift has been driven by the increasing demand for mental health services, as well as advances in AI technology. AI analyzes extensive datasets, including text, voice, and behavioral data, aiding in mental health diagnosis and treatment. Consequently, a range of AI-based interventions has been developed, including chatbots, virtual therapists and apps featuring cognitive-behavioral therapy (CBT) modules. Notably, chatbots, as conversational agents, have emerged as valuable tools, assisting users in monitoring emotions and providing evidence-based resources, well-being support, psychoeducation and adaptive coping strategies.

This study aims to investigate the impact of AI chatbots on improving mental health, evaluate their strengths and weaknesses and explore their potential for early detection and intervention in mental health issues.

A literature review was conducted through PubMed and Google Scholar databases, using keywords ‘artificial intelligence’, ‘chatbot’ and ‘mental health’. The selection focused on the most relevant articles published between January 2021 and September 2023.

Mental health chatbots are highly personalized, with a primary focus on addressing issues such as depression or anxiety within specific clinical population groups. Through the integration of Natural Language Processing (NLP) techniques and rule-based AI algorithms, these chatbots closely simulate human interactions and effectively instruct users in therapeutic techniques. While chatbots integrating CBT principles have gained widespread use and extensive research attention, some also incorporate alternative therapeutic approaches, including dialectical behavior therapy, motivational interviewing, acceptance and commitment therapy, positive psychology or mindfulness-based stress reduction. AI chatbots provide substantial advantages in terms of accessibility, cost-effectiveness and improved access to mental health support services. Nonetheless, they also exhibit limitations, including the absence of human connection, limited expertise, potential for misdiagnosis, privacy concerns, risk of bias and limitations in risk assessment accuracy.

AI-based chatbots hold the potential to enhance patient outcomes by enabling early detection and intervention in mental health issues. However, their implementation in mental health should be approached with caution. Further studies are essential to thoroughly evaluate their effectiveness and safety.

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We identify a set of essential recent advances in climate change research with high policy relevance, across natural and social sciences: (1) looming inevitability and implications of overshooting the 1.5°C warming limit, (2) urgent need for a rapid and managed fossil fuel phase-out, (3) challenges for scaling carbon dioxide removal, (4) uncertainties regarding the future contribution of natural carbon sinks, (5) intertwinedness of the crises of biodiversity loss and climate change, (6) compound events, (7) mountain glacier loss, (8) human immobility in the face of climate risks, (9) adaptation justice, and (10) just transitions in food systems.

The Intergovernmental Panel on Climate Change Assessment Reports provides the scientific foundation for international climate negotiations and constitutes an unmatched resource for researchers. However, the assessment cycles take multiple years. As a contribution to cross- and interdisciplinary understanding of climate change across diverse research communities, we have streamlined an annual process to identify and synthesize significant research advances. We collected input from experts on various fields using an online questionnaire and prioritized a set of 10 key research insights with high policy relevance. This year, we focus on: (1) the looming overshoot of the 1.5°C warming limit, (2) the urgency of fossil fuel phase-out, (3) challenges to scale-up carbon dioxide removal, (4) uncertainties regarding future natural carbon sinks, (5) the need for joint governance of biodiversity loss and climate change, (6) advances in understanding compound events, (7) accelerated mountain glacier loss, (8) human immobility amidst climate risks, (9) adaptation justice, and (10) just transitions in food systems. We present a succinct account of these insights, reflect on their policy implications, and offer an integrated set of policy-relevant messages. This science synthesis and science communication effort is also the basis for a policy report contributing to elevate climate science every year in time for the United Nations Climate Change Conference.

We highlight recent and policy-relevant advances in climate change research – with input from more than 200 experts.

Mental Illness Stigma is a barrier in access to healthcare. Stigma also influences population health outcomes by worsening, undermining adequate processes. The healthcare professionals show several stigmatising behavirous and cognitions, which may impair the adequate provision of care of this population with mental illness.

We aimed to measure mental health stigma in healthcare professionals at a portuguese hospital center.

A cross-sectional study of health profissionals was performed using a survey that included socio-economic and job related questions, personal and familiar questions regarding mental health, and Attribution Questionnaire 27 (AQ-27), a translated and validated stigma questionnaire with nine stigma sub-scales (Responsability, Pity, Anger, Dangerousness, Fear, Help, Coercion, Segregation and Avoidance).

The sample included a total of 388 participants. The majority of the respondants were female (82,5%). The age ranged from 22 to 69 (mean = 40,05). According to the job place distribution, we found statistically significant differences in various stigma subscales among several healthcare settings within our center. The inpatient unit professionals showed lesser stigmatising attitudes in anger, coercion, segregation and avoidance domains; and higher stigmatising attitudes in pity and help domains. However, professionals who work at surgery room showed higher stigmatising attitudes in danger and fear, but lesser levels of help domains. We also found differences in five stigma subscales among various health professions. The study didn’t show differences in stigma domains regarding personal or professional contact with mental illness, neither academic studies in mental health.

Our findings suggest that workplace environment and profession may impact mental ilness stigma levels in healthcare professionals. We propose that future studies could be done to investigate methods to mitigate mental illness stigma, tailored to address different stigma domains in different workplace settings.

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The entity of ‘pseudoneurotic schizophrenia’ was coined in 1949 by Hoch and Polatin to define emerging psychotic symptoms, namely formal thought disorder and emotional dysregulation, in patients previously presenting with neurotic functioning. Although currently considered to be outdated, the term paved way for the concept of ‘borderline disorders’, known for their difficult assessment.

To highlight the obstacles in diagnosing clinical presentations of overlapping psychotic and neurotic symptomatology.

We report a case of an adolescent admitted for presumed psychosis, later to display fast clinical improvement and significant neurotic personality traits.

A 17-year-old male with no previous psychiatric follow-up, except for brief psychotherapeutic intervention at the age of 11, following the death of his grandfather.

He presented with a sudden change in behavior and sleep since the week before, coincident with acknowledging the loss of his best friend in a car accident. Upon evaluation, he presented with unstable gait. He seemed fatigued but displayed inappropriate restricted affect. He reported perceiving bizarre, meaningful signs everywhere concerning his own death since the event. Additionally, he detailed feelings of lethargy and unexplained sadness, relying on the nihilistic delusional beliefs that he had been in deep sleep and he would die soon. At admission, he was prescribed with aripriprazol 5mg id.

Throughout his stay in the hospital, he maintained consistently adequate, calm behavior. During inpatient clinical interviews, he showed clear insight into the aforementioned behavior. He provided clear, logical information referring to his past grief process and remaining trauma, reporting coping mechanisms based on spiritual beliefs

Prescription medication was interrupted soon after admission, with no noticeable changes. At dismissal, despite remaining sad concerning the death of his friend, there was no signs of psychotic symptoms or other significant mental distress.

In this report, we emphasize the hazards of differential diagnosis between psychosis and emotional dysregulation with underlying neurotic traits. There is conflicting evidence on the concept of ‘pseudoneurotic’ presentations, specifically ‘pseudoneurotic schizophrenia’. Available information on distinguishing between overlapping psychotic and neurotic features in adolescents is even more scarce. To perform extended, multidisciplinary evaluations might be key in accurately assessing these patients.

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Paraphilias constitute a set of psychiatric conditions that are often chronic and require a combination of treatment approaches, such as pharmacotherapy and psychotherapy. Sexual interest toward prepubescents and pubescents (pedophilia and hebephilia) is frequently identified in criminal settings, within numerous child sexual abuse and child pornography offenses. The high prevalence rates and negative consequences of these acts, causing distress in multiple important areas of health and functioning, reveal the importance of preventing these offenses as a clinical and social matter. Secondary prevention programs, which provide treatment and support for those with paraphilia disorders before sexually abusive behaviors and legal system involvement, show as ethically and socially necessary.

We aim to discuss and bring insights into the knowledge on pedophilia and hebephilia treatments and prevention programs, in the fields of psychotherapy as well as pharmacologic strategies.

We present a non-systematic review of the updated literature on this subject from the data found on the PubMed and PsycInfo databases.

Preliminary results of recent works show that at-risk individuals with paraphilia disorders are often willing to seek treatment without external pressure from the legal system, and report benefits from early treatments. Most studies found that gonadotropin-releasing hormone agonists reduce the risk of child sexual abuse in men with pedophilia. An injectable form has shown to lower this risk 2 weeks after the initial injection, suggesting its use as a rapid-onset treatment option. Cyproterone acetate and medroxyprogesterone acetate are other anti-androgen drugs that inhibit hypersexual behavior, with important side effects to be considered. The combination of androgen deprivation treatment and psychotherapy has a greater effect on preventing fantasies, urges, and behaviours in paraphilic patients. Cognitive-behavioural psychotherapy shows the best results and should soon be initiated in all patients. Biomolecular studies revealed that serotonin and prolactin inhibit sexual arousal, being SSRIs used as first treatment in younger patients, particularly in less severe cases.

Evidence-based treatments from randomized clinical trials for paedophilic and hebephilic disorders are lacking. These current numbers reveal the need for widespread implementation of primary and secondary prevention initiatives, that go beyond the prevention of a repeated offense. There is a need for further research using controlled, randomized trials to examine the effectiveness of sexual offender treatment including psychotherapeutic and pharmacologic interventions. The development of more specific, more effective, and better-tolerated medications for these disorders should be recognized as a program worthy of greater support from government and pharmaceutical industry sources.

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Lithium, a mood stabilizer, is a commonly prescribed and effective treatment for bipolar affective disorder. It´s excreted almost exclusively by the kidneys with a half-life primarily determined by renal function. Chronic intoxication results from an insidious accumulation of lithium in a chronically medicated patient (due to a reduction in renal function secondary to volume depletion, a new medication, et cetera). Patients often present with neurologic findings, including tremor, ataxia, dysarthria, confusion and neuromuscular excitability.

The objective of this report is to describe a clinical case of lithium neurotoxicity (myoclonus and encephalopathy), along with a review of the literature on the topic.

We describe a case of lithium neurotoxicity, along with a brief non-systematic review of the literature on lithium toxicity. We conducted a PubMed bibliographic search using keywords such as “lithium intoxication”, “lithium neurotoxicity”, “lithium encephalopathy” and “lithium intoxication treatment”.

A women aged 81 was brought to the emergency department by her daughter following 1 week of asthenia, diarrhoea, periods of confused speech and involuntary movements. In the previous week, the patient had been diagnosed with COVID-19. Her past medical history is significant for bipolar affective disorder, hypertension, diabetes mellitus, dyslipidemia and asthma. The patient has been treated with following drugs: lithium carbonate (no recent change of dose and previous serum levels around 1mmol/L), quetiapine, lisinopril, metformin, simvastatin, formoterol and budesonide. On the first examination, she had an exuberant multifocal myoclonus. Posteriorly, she became somnolent, with language impairment (verbal perseveration, echolalia) and dysarthria. Investigations revealed renal impairment (creatinine 1,5 mg/dL, blood urea nitrogen 42 mg/dL) and supratherapeutic lithium levels (lithium serum level 1,7 mmol/L). Computed tomography scan of the brain was negative for acute injuries. The electroencephalogram showed triphasic waves (1-1,5 Hz). Encephalopathy secondary to lithium intoxication was diagnosed (probably in the context of acute kidney injury precipitated by hypovolaemia – diarrhoea). Lithium was stopped and intravenous isotonic fluids were given. After 1 week, her myoclonus resolved and over the following week the other signs resolved as well. The patient was later discharged to her daughter’s home, with follow-up neurology and psychiatry visits.

Both reversible and irreversible neurotoxicity related to lithium have been reported, specially occurring alongside chronic intoxication. If not addressed, impaired consciousness can lead to coma and death. A high clinical suspicion is needed for prompt diagnosis and treatment (intravenous fluids and sometimes haemodialysis are warranted).

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Suicide is a serious public health problem since it accounts for nearly 900,000 deaths each year worldwide. Globally in 2019, 10.7 persons out of 100,000 died by suicide. Psychiatric disorders are related to an overwhelming proportion of these cases. In the last years, several specific interventions and action plans for suicide prevention have been implemented in a number of European countries.

Our aim was to analyze recent epidemiologic trends of suicide mortality rates in Europe.

Annual national statistics of suicide mortality rates derived from Eurostat public databases from 2011 to 2019 were analyzed for 38 European countries. The suicide mortality rate was estimated per year/100,000 population. Linear regression models were used to study temporal trends of suicidal mortality. Analyses were performed using RStudio.

Available data show a statistically significant reduction in suicide mortality rates from 2011 to 2019 in 15 European countries, and a significant increase for Turkey (ES=0.32, SD=0.06, p=0.037) (Fig 1). The greatest significant decrease was reported in Lithuania (ES=-1.42, SD=0.02, p=0.02), followed by Hungary (ES=-1.13, SD=0.11, p=0.0007), Latvia (ES=-0.76, SD=0.11, p=0.007), and Poland (ES=-0.73, SD=0.10, p=0.001). Italy reported the lowest significant reduction in suicide mortality rates (ES=-0.13, SD=0.018, p=0.003). The remaining 16 countries showed no significant changes in suicide mortality trends.

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In the last years, Europe registered an overall reduction in reported suicide rates. However, more recent data (i.e., suicide rates after COVID-19 pandemic, age and sex-related effect on suicide rates) should be analyzed and used to implement future recommendations. Current and future suicide prevention strategies aim to contribute to a greater reduction of suicide rates in the different European countries.

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The coronavirus disease 2019 (COVID-19) pandemic has caused a global health crisis and may have affected healthcare-associated infection (HAI) prevention strategies. We evaluated the impact of the COVID-19 pandemic on HAI incidence in Brazilian intensive care units (ICUs).

In this ecological study, we compared adult patients admitted to the ICU from April through June 2020 (pandemic period) with the same period in 2019 (prepandemic period) in 21 Brazilian hospitals. We used the Wilcoxon signed rank-sum test in a pairwise analysis to compare the following differences between the pandemic and the prepandemic periods: microbiologically confirmed central-line–associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) incidence density (cases per 1,000 central line and ventilator days, respectively), the proportion of organisms that caused HAI, and antibiotic consumption (DDD).

We detected a significant increase in median CLABSI incidence during the pandemic: 1.60 (IQR, 0.44–4.20) vs 2.81 (IQR, 1.35–6.89) (P = .002). We did not detect a significant difference in VAP incidence between the 2 periods. In addition, we detected a significant increase in the proportion of CLABSI caused by Enterococcus faecalis and Candida spp during the pandemic, although only the latter retained statistical significance after correction for multiple comparisons. We did not detect a significant change in ceftriaxone, piperacillin–tazobactam, meropenem, or vancomycin consumption between the studied periods.

There was an increase in CLABSI incidence in Brazilian ICUs during the first months of COVID-19 pandemic. Additionally, we detected an increase in the proportion of CLABSI caused by E. faecalis and Candida spp during this period. CLABSI prevention strategies must be reinforced in ICUs during the COVID-19 pandemic.