Folie a deux, also known as shared psychotic disorder or induced delusional disorder, is a rare mental disorder that was first described in France in the late 19th century and was referred to delusions shared between two individuals in close relationship. The concept has evolved and according to ICD-10 the following criteria for the diagnosis is phenomenology-based only.

To describe a clinical case and review the existing evidence on folie a deux.

Clinical case and non-systematic review of the literature, from the last 15 years, on folie a deux. For this research, the keywords “folie a deux”, “shared psychotic disorder” and “induced delusional disorder” were used in the MEDLINE/PubMed database.

The clinical case presented refers to a 56-year-old female patient with no known psychiatric history. The patient stated that 5 years ago when his mother died, neighbors began to persecute her and her sister. She was medicated with a second-generation antipsychotic without total remission of symptoms. Generally, in folie a deux there is a close and prolonged relationship between the inducer and the receptor, as described in this case. We considered that the sister is the active subject. The delusion is persecutory, the most common in this disorder. The patient kept her job until she was hospitalized and as described in the literature patients with folie a deux maintain their functionality, which is responsible for the underdiagnosis of this disorder. The fact that the current evidence is based on case reports reflects the underdiagnosis and rarity of this disorder.

This clinical case highlights the challenging diagnosis and difficulty in treating this condition. Patients can be diagnosed many years after the onset of symptoms, which may not resolve with treatment. Much information, as prevalence, natural history, and optimal treatment, is lacking on folie a deux, and the etiology remains unknown. As such, prospective studies should be carried out to help understand this disorder.

None Declared

Suicide presents itself as a serious public health problem, with universal characteristics. Though world rates dropped between 2010 and 2016, they are still very high and in regions like the Americas there has been a raise in the same period in Brazil, contrary to the word trend and surpassing the avarage of the Americas (6%), the rate of suicides in each 100 thousand inhabitants has raised in about 7% in the period (WHO, 2019).

Considering the relevance of these aspects, this study presents the results of actions for treatment and prevention of suicidal behavior, developed by a psychiatry and chemical dependency inpatient service in the city of Rio de Janeiro.

This showed the necessity of the creation of a specific program of suicidal treatment and prevention and the Institution established the following actions of intervention to hospitalized patients: permanent watching , reduction of access to instruments and methods to commit suicide, strengthening of the Life Appreciation Group (LAG) and the Cognitive Behavioral Therapy group, art therapy and physical activities.

It was observed that among the 370 patients hospitalized in the Institution in the period of the study, 137 presented suicidal behavior and only 2 died. From these two cases, one abandoned treatment and the other ocurred during the period of treatment.

The developed program reached positive results in the intervention of the cases and the actions of prevention had expressive reach in the number of people, especially because the press promoted wide dissemination of information for immediate help.

None Declared

The Portuguese Plan for Mental Health envisaged the development of teams dedicated to the support of “difficult” patients. However, it was not clarified who these patients were, nor in which dimensions they could be supported. In this regard, there is a need for an objective and pragmatic definition to understand who these patients are.

To characterize the “difficult” patient with Schizophrenia.

Through the hospital’s IT services, all acute inpatient episodes at Centro Hospitalar Psiquiátrico de Lisboa were collected since 2017, with the diagnosis of Schizophrenia (ICD10: F20 – n: 1448). Cluster analysis was performed, regarding number of previous admissions (PA) and days of admission. Descriptive analysis of these patients was made, regarding age, gender, destination at discharge, and to the “difficult to treat” patients, whether they attend a medical consultation prior to admission, if they were complying with the therapy and if they were using psychoactive substances.

Cluster analysis identified 3 clusters: (G1) a larger, uncharacteristic one; (G2) one of users with many PA; and one with a high number of days of admission (G3).

The average age is similar (46 years old), as well as gender (male). Regarding hospitalization days, G1 and G2 presented similar average values (16 days), higher for G3 (60 days). Comparing PA in G2, 47% of patients have between 6 and 10 PA and 25% have between 11 and 20 PA. For the same intervals, G3 has values of 10% and 2% respectively. About the destination after discharge, about 2/3 of both groups were referred for follow-up consultation; in G2, 5% were discharged by abandonment and in G3, 5% were referred to a Rehabilitation service and 6% integrated in Residential homes. Approximately 2/3 of the patients in G2 and G3 did not go to a medical consultation in the three months prior to their admission. Regarding the therapeutic plan, in G2 73% were not following it and in G3 this rate was 66%. Only 5% of G2 and 2% of G3 were in involuntary treatment. Injectable medication was used by 42% of patients in G2 and 23% in G3. Regarding substance use, alcohol was present in 9% of G2 and in 6% of G3; cannabinoids in 18% of G2 and in 11% of G3; and other psychoactive substances were present in 8% of G2 and in 4% of G3.

The findings of this study allow us to outline two profiles of “difficult to treat” patients with Schizophrenia. On the one hand those with multiple relapses (G2), on the other those with prolonged hospitalizations (G3). Both have poor adherence to consultations and are erratic in therapeutic compliance. Injectable medication, although present in G2 and in a lower percentage in G3, and the infrequent involuntary treatment in both, may be considered as possible intervention points. An assertive multidisciplinary approach, focused on current treatment and relapse prevention (including social structures and rehabilitation centers), will be the key to their treatment.

None Declared

Oncological and palliative care patients face unique stressors which increase their risk of developing depression and anxiety. Cognitive behavioural therapy (CBT) and mindfulness has established success in improving this population’s mental health. Traditional face-to-face psychotherapy is costly, has long wait lists, often lacks accessibility, and has strict scheduling, each of which can make attending psychotherapy physically, mentally, and financially out of reach for oncological and palliative patients. Web-based CBT (e-CBT) is a promising alternative that has shown efficacy in this and other patient populations.

To quantify the efficacy of online CBT and mindfulness therapy in oncological and palliative patients experiencing depression and anxiety symptoms.

Participants with depression or anxiety related to their diagnosis were recruited from care settings in Kingston, Ontario, and randomly assigned to 8 weekly e-CBT/mindfulness modules (N= 25) or treatment as usual (TAU; N=24). Modules consisted of CBT concepts, problem-solving, mindfulness, homework, and personalised feedback from their therapist through a secure platform (Online Psychotherapy Tool- OPTT) Participants completed PHQ-9 and GAD-7 in weeks 1, 4, and 8. (NCT04664270: REB# 6031471).

Significant decreases in PHQ-9 and GAD-7 scores within individuals support the hypothesis of efficacy. At this time, 10 e-CBT/mindfulness and 12 TAU have completed the study. Decreases in PHQ-9 and GAD-7 scores within e-CBT group support the hypothesis of efficacy. Specifically, PHQ-9 scores decreased over the 3 repeated measures (ANOVA, 2 groups, 3 repeated measures and the decrease in GAD-7 scores was similarly large)

As hypothesized, the results suggest that e-CBT/mindfulness therapy is an affordable, accessible, and efficacious mental health treatment for this population. The virtual, asynchronous delivery format is particularly appropriate given the unique barriers.

N. Alavi Shareolder of: OPTT inc, Grant / Research support from: department psychiatry Queen’s University, M. Omrani Shareolder of: OPTT inc, A. Shirazi: None Declared, G. Layzell: None Declared, J. Eadie: None Declared, J. Jagayat: None Declared, C. Stephenson: None Declared, D. Kain: None Declared, C. Soares: None Declared, M. Yang: None Declared

Childbirth can be experienced as distressing or even traumatic for some women and her partners, which could cause psychological distress, intense fear or helplessness and increases the risk of anxiety, depression and even post-traumatic stress disorder (PTSD). The reported prevalence of post-traumatic stress disorder after childbirth ranges from 1.5% to 6%.

The current study aimed to elaborate a narrative literature review to identify predictors associated development of PTSD in women and the partners.

PubMed database searched using the terms “post-traumatic stress disorder” and “childbirth” and “trauma”. Only research conducted in the past 20 years was considered for inclusion.

Several variables were associated with risk to development PTSD after childbirth, including negative experiences and severe fear of childbirth, subjetive distress, previous abortion, psychological difficulties in pregnancy, previous psychiatric problems, history of PTSD and trauma. Futhermore, obstretic and birth-related factors such as pregnancy complications, type of birth could also contribute to PTSD in women and her partners. Additionally, diferent environmental factors like poor interaction between provider and mother, low social support during labour and birth are associated with development of PTSD.

Clinicians should be aware that many women and her parterns have a risk to development PTSD following childbirth. We need to research risk factors in routine clinical practice and carefully monitored the patients with high risk.

None Declared

Monoaminergic neurotransmitters affect motor control, emotions and cognitive functions. Their relative abundance depends on the action of monoamine oxidase A (MAOA) which catalyses their degradation into inactive metabolites. Brunner syndrome is a rare chromosome X-linked recessive inheritance genetic disorder, which causes loss of function of the MAOA gene, leading to a relative increase in monoamines in affected individuals (typically males). It manifests with moderate intellectual developmental disturbance associated with maladaptive externalising behaviours, low frustration tolerance and marked impulsivity.

To present a clinical case of patient diagnosed with Brunner Syndrome presenting with suicidal and homicidal ideation and to discuss it based on a non-systematic review of the literature.

Case report and non-systematic review of the literature.

Male born with neonatal asphyxia that consequently presented developmental retardation characterised by learning difficulties and emotional dysregulation. At 18 years of age, he began follow-up in Psychiatry due to self-injurious behaviours and several reactive suicide attempts (SA), being diagnosed with Intellectual Disability. At 22, he was hospitalised due to reactive depression, being discharged doing well with valproate, fluoxetine and olanzapine. Shortly after, he was arrested (aged 23-28) for attempted murder followed by SA. During imprisonment, he was diagnosed with Brunner’s Syndrome after his younger brother diagnosis. At 31, he was hospitalised for suicidal and homicidal ideation, revealing high impulsiveness and low frustration tolerance, and was discharged with compulsory psychiatric treatment. Three weeks later he was again hospitalised for symptoms recurrence having improved on Sertraline 50mg and Aripiprazole 400mg monthly.

Although scarce, the available evidence suggests that dietary modifications and the use of selective serotonin reuptake inhibitors may improve behaviour, reduce serotoninergic symptoms and possibly reverse some neurochemical abnormalities.

Brunner syndrome is a rare genetic disorder with neuropsychiatric manifestations, whose course, treatment and prognosis are currently poorly known. Thus, the current treatment is empirical and further studies are needed.

None Declared

Multiple definitions for “difficult to treat” patients (DTP) were given throughout the years. While most authors focus on diagnoses, others focus on clinical, social and demographic factors, which should be regarded as factors of bad prognosis and elevated costs for the healthcare systems.

To identify and haracterize DTP patients admitted in acute ward, based on practical criteria.

Through the hospital’s IT services, all acute inpatient episodes at Centro Hospitalar Psiquiátrico de Lisboa were collected, since 2017. Cluster analysis was performed, regarding number of previous admissions (PA) and days of admission. Descriptive and comparative statistics (with multiple comparisons) for the different clusters, regarding age, gender, diagnosis at discharge (according to ICD10), and, to the DTP, previous medical following, compliance to medication, and substance use at admission.

Three clusters were identified: (C1, n=5861) a larger, uncharacteristic one; (C2, n=1168) with a higher number of PA (average of 8, versus less than 2 on the others); and (C3, n=1462) with higher number of days of admissions (58 versus less than 16). Statistical significance was found regarding age (higher in C3), gender (more men in C2), nationality (C1 with more foreigners). Regarding diagnosis at discharge, statistical difference was found between the 3 groups: C1 has significantly less patients with Schizophrenia (11% versus 30% in the others), but more depressive (21% versus 6% in C2 and 12% in C3) and neurotic disorders. C2 presented less dementias (0,5% versus 3% in C1 and 10% in C3) and delusional disorders, but more bipolar disorders (24% versus 15% in C1 and C3); C3 represented less episodes due to substance abuse (alcohol or others) and personality disorders. In both C2 and C3, no psychiatric consultation happened in the 3 months prior admission to around 40% of episodes, and 50% had stopped medication. The majority had only oral medication. Almost 24% of C2 tested positive for cannabinoids, with no differences regarding other substances.

These findings allow the definition of 2 kinds of DTP, which present unique characteristics but some common features (namely poor adherence to consultations and are in therapeutic compliance). An assertive multidisciplinary approach, focused on current treatment and relapse prevention (including social structures, more frequent clinical follow-up, and rehabilitation centers), will be the key to their treatment.

None Declared

Deep brain stimulation (DBS) of brain circuits involved in mood regulation is a novel tool that is being investigated as a potential treatment for some of the most severe patients with mood disorders. At UTHealth Houston, we have had an ongoing clinical trial with DBS of the medial forebrain bundle (MFB).

Our preliminary results suggest effects in alleviating depressive symptoms in this very severe, refractory patient group.

In this presentation, we will review our latest findings, and will also discuss the potential effects of the MFB stimulation on measures of suicidality in this patient population.

None Declared

The Portuguese shortest version of the Perinatal Depression Screening Scale/PDSS-7 proved to be valid and reliable, in Portugal and Brazil, but it is essential to analyze its operational characteristics before using it for screening purposes.

To determine PDSS-7 cut-off points and associated conditional probabilities to screen for major depression, according to the DSM-5.

he pregnancy sample was composed of 259 women in the second trimester (Mean gestation weeks=17.83±4.750). The postpartum sample consisted of 241 women assessed between the 2nd-6thmonths postpartum(M=17.99±4.689 weeks postpartum). All women completed the PDSS-7 and were interviewed with the Diagnostic Interview for Psychological Distress(Pereira et al., 2017), a semi-structured clinical interview to assess the most prevalent psychiatric disorders in the perinatal period according to the DSM-5 criteria. MedCalc was used to perform ROC analysis.

During pregnancy, the major depression prevalence was of 4.6%(n=12). The cut-off point that maximizes the Youden Index(J=.98, 95%CI: .97-.99; AUC=.99; se=.004; p<.001) was of 18(95%CI:17-19), which resulted in a sensitivity of 100%(71.5%-100%), a specificity of 97.98%(95.3%-99.3%), a positive predictive value/+PP of 68.8%(48.0%-84.0%) and a negative predictive value/-PP of 100%. In the postpartum, the major depression prevalence was of 10.4%(n=25). The cut-off point(J=.79, 95%CI: .63-.82; AUC=.89; se=.036; p<.001) was of 14(95%CI: 12-16), with a sensitivity of 85.0%(69.3%-93.2%), a specificity of 85.0%(69.3%-93.2%), a +PP of 56.5%(46.1%-67.3%) and a -PP of 97.5%(94.6%-98.8%).

The Portuguese version of PDSS-7 presents good combinations of sensitivity and specificity, being accurate and usable to screen for depression during pregnancy and in the postpartum both in research and primary health care.

No significant relationships.

Parkinson’s disease (PD) is a neurologic degenerative condition with complex neuropsychiatric manifestations which can be challenging to manage and greatly impact quality of life and prognosis.

The description of this case aims to highlight the complex interaction between PD, drug-abuse and impulse control disorder (ICD).

Clinical information was obtained through patient interviewing and medical records consulting. A literature review on the topic was conducted.

We report the case of a 52-years-old male with PD diagnosed at the age of 45, presenting with rigidity of right limbs and freezing of gait. He had a history of multiple substance-abuse: hashish, heroin and cocaine, with cessation of all substances by the age of 40. The patient responded well to antiparkinsonian medication initially, but needed frequent adjustments and developed ICD secondary to dopamine agonists, presenting pathological gambling and hypersexuality. At 47 he restarted using cocaine stating that it diminished the motor symptoms. Motor symptoms worsened and became partially responsive to medication. Pharmacologic options were limited due to ICD. He developed dopamine dysregulation syndrome, abusing dopaminergic drugs and requesting multiple prescriptions. Deep brain stimulation surgery was proposed, but the patient was deemed unfit for the procedure after two separate psychiatric evaluations, mainly because of behaviour and social problems in relation to sustained cocaine abuse and personality disorder. Attempts to stop drug abuse were unsuccessful despite several interventions by addiction psychiatry.

Co-occurrence of PD, substance-abuse and personality disorder poses as a therapeutic challenge conditioned by pharmacological iatrogenesis and behavioural disturbances, requiring a multidisciplinary and individualized approach.

No significant relationships.

Prediction of treatment outcomes is a key step in improving the treatment of major depressive disorder (MDD). The Canadian Biomarker Integration Network in Depression (CAN-BIND) aims to predict antidepressant treatment outcomes through analyses of clinical assessment, neuroimaging, and blood biomarkers.

In the CAN-BIND-1 dataset of 192 adults with MDD and outcomes of treatment with escitalopram, we applied machine learning models in a nested cross-validation framework. Across 210 analyses, we examined combinations of predictive variables from three modalities, measured at baseline and after 2 weeks of treatment, and five machine learning methods with and without feature selection. To optimize the predictors-to-observations ratio, we followed a tiered approach with 134 and 1152 variables in tier 1 and tier 2 respectively.

A combination of baseline tier 1 clinical, neuroimaging, and molecular variables predicted response with a mean balanced accuracy of 0.57 (best model mean 0.62) compared to 0.54 (best model mean 0.61) in single modality models. Adding week 2 predictors improved the prediction of response to a mean balanced accuracy of 0.59 (best model mean 0.66). Adding tier 2 features did not improve prediction.

A combination of clinical, neuroimaging, and molecular data improves the prediction of treatment outcomes over single modality measurement. The addition of measurements from the early stages of treatment adds precision. Present results are limited by lack of external validation. To achieve clinically meaningful prediction, the multimodal measurement should be scaled up to larger samples and the robustness of prediction tested in an external validation dataset.

Multiple treatments are effective for major depressive disorder (MDD), but the outcomes of each treatment vary broadly among individuals. Accurate prediction of outcomes is needed to help select a treatment that is likely to work for a given person. We aim to examine the performance of machine learning methods in delivering replicable predictions of treatment outcomes.

Of 7732 non-duplicate records identified through literature search, we retained 59 eligible reports and extracted data on sample, treatment, predictors, machine learning method, and treatment outcome prediction. A minimum sample size of 100 and an adequate validation method were used to identify adequate-quality studies. The effects of study features on prediction accuracy were tested with mixed-effects models. Fifty-four of the studies provided accuracy estimates or other estimates that allowed calculation of balanced accuracy of predicting outcomes of treatment.

Eight adequate-quality studies reported a mean accuracy of 0.63 [95% confidence interval (CI) 0.56–0.71], which was significantly lower than a mean accuracy of 0.75 (95% CI 0.72–0.78) in the other 46 studies. Among the adequate-quality studies, accuracies were higher when predicting treatment resistance (0.69) and lower when predicting remission (0.60) or response (0.56). The choice of machine learning method, feature selection, and the ratio of features to individuals were not associated with reported accuracy.

The negative relationship between study quality and prediction accuracy, combined with a lack of independent replication, invites caution when evaluating the potential of machine learning applications for personalizing the treatment of depression.

The modality of assessment used at a University Clinical Practice in Brazil is interventive psychodiagnosis in which the active participation of children and families is considered. Orientation is given following the input provided by children and their parents.

Evaluating the use of an electronic form to be fulfilled during the observation of a child’s play in psychological session.

A child at the age of 5yrs 4m was brought for psychological assessment with the complaint of aggressiveness and irritability. His parents answered the Child Behavior Checklist (CBCL -1 1/12 5 yrs) and the Psychology interns had to observe the child’s play and fulfill an electronic form in which the choice of toys and plays, motricity, creativity, symbolic abilities, frustration tolerance, adequation with reality were verified.

The results of CBCL indicated that the child was within the clinical range regarding anxiety and depression along with somatic complaints. The indicators observed in the electronic form such as rigidity in the modality of play, the lack of adequate ability of impersonating in role-playing, the difficulty of using creativity during play unless he was guided by peers or the Psychology interns and the constant anguish of separating himself from his parents were crucial for parents’ orientation. The psychological treatment lasted five months and benefited from the information obtained through the form once the symptoms of irritability and aggressiveness were reduced.

This modality of assessment can be instructional for parents and may also reduce financial and time costs once provides specific indicators to observe during play.

Postpartum depression (PPD) is the commonest postpartum psychiatric condition, with prevalence rates around 20%1. PPD is associated with a range of adverse outcomes for both the mother and infant2. Therefore, identifying modifiable risk factors for perinatal depression is an important public health issue3.

To explore the role of dysfunctional attitudes towards motherhood in postpartum depressive symptoms and disorder.

247 women were evaluated in the third (12.08±4.25 weeks) and sixth months (31.52± 7.16 weeks) postpartum with the Attitudes Towards Motherhood Scale4, the Postpartum Depression Screening Scale5 and the Diagnostic Interview for Psychological Distress-Postpartum6. Correlation analysis was performed followed by linear/logistic regression analysis when the coefficients proved significant (p<.05), using SPSS.

Dysfunctional beliefs towards motherhood concerning judgement by others and maternal responsibility positively correlated with depressive symptoms at the third (.528; .406) and the sixth months (.506; .492) postpartum. Those dysfunctional beliefs were predictors of depressive symptoms at the third (ß=.440; ß=.151) and sixth months (ß=.322; ß.241) explaining 29.4% and 30.2% of its variance, respectively. Having dysfunctional beliefs at the third month significantly increase the likelihood of being diagnosed with Major Depression (DSM5) both in the third (Wald=9.992, OR=1.169; Wald=16.729, OR=1.231) and sixth months (Wald=5.638, OR=1.203; Wald=7.638, OR=1.301) (all p<.01).

Cognitive distortions should be included in the assessment of risk factors for PPD. Early identification of women presenting motherhood-specific cognitive biases may be crucial for implementing preventive interventions favoring a more positive and healthier motherhood experience.

No significant relationships.

Motherhood-related beliefs are characterized by themes of failure and maternal role idealization. Recent studies found that postpartum depression/PPD is both predicted and a predictor by/for dysfunctional beliefs/DB. Additionally, it is possible that when contextual factors (eg. lack of social support) are present, women may anticipate the parenting experience as being of isolation, which in turn can lead to more dysfunctional attitudes.

To explore psychosocial risk factors for motherhood-DB.

233 women were evaluated in the second trimester (17.05±4.82 weeks) of pregnancy and in the third month (12.08±4.25 weeks) postpartum sociodemographically and psychosocially (years of education, previous children and social support) and the Portuguese validated self-report questionnaires to assess: perinatal depression; perinatal anxiety; perfectionism; negative affect; self-compassion; and repetitive negative thinking (all in T0). The Attitudes Towards Motherhood Scale was administered in the postpartum. When Pearson/Spearmen correlation coefficients proved significant (p<.05), linear/logistic (hierarchic) regression analysis were performed.

Motherhood-DB correlated significantly with all the variables, except for years of education, Other-oriented-Perfectionism and Common-Humanity. Motherhood-DB were significantly higher in women without previous children (p<.05). The final regression model was statistically significant (p<.001) explaining 15% of the Motherhood-DB variance, with Socially-Prescribed-Perfectionism and social support being the only statistically significant predictors. Hierarchic regression showed that even after controlling for social support, SSP significantly incremented the variance in 9%.

Our results highlight the need for preventive approaches to help women understand the origins of their dysfunctional beliefs (perfectionism, the myths of perfect motherhood) and for the promotion of positive cognitions.

No significant relationships.

The main purpose of the present study was to evaluate whether complications related to surgery for exostoses are associated with a decrease in patients’ quality of life.

This was a retrospective study for which the following information was collected: sex, age, pre- and post-operative symptoms, pre- and post-operative audiological evaluation results, surgical approach, instruments used, complications, and Glasgow Benefit Inventory score.

The study included 67 patients (94 ears). The three main complaints reported were wax retention, otitis externa and hearing loss. Surgical complications occurred in 14.9 per cent of patients. Patients experienced a significant benefit from surgery, especially in relation to somatic state, with a global Glasgow Benefit Inventory score of + 44.3. No significant difference was found between the global Glasgow Benefit Inventory changes and surgery-related complications (p = 0.093).

After surgery for exostoses, the vast majority of patients showed improvement. Complications related to surgery in general do not seem to influence patients’ satisfaction with surgery.

Insight and treatment adherence in serious mental illness, namely psychotic disorders, are well recognized as strong predictors of prognosis; several psychometric instruments have been developed for their evaluation.

To analyze the relation between self and hetero-evaluated insight and treatment attitudes in a clinical sample of psychiatric patients, besides assessing it's clinical correlates and relevance.

60 patients with serious mental illness (schizophrenia and bipolar disorder with psychotic features) were assessed using the Portuguese versions of the ‘Insight Scale' (IS), ‘Medication Adherence Rating Scale’ (MARS) and ‘Insight and Treatment Attitudes Questionnaire’ (ITAQ). General psychopathology and functioning scales were also applied, such as the BPRS, BDI-II and FAST. Relevant sociodemographic and clinical variables were also obtained. Statistical analysis was conducted using SPSS version 19.

Self-reported insight using the IS was not correlated with the insight subscale of the ITAQ, a hetero-evaluation instrument. Similarly, we found no correlation regarding attitudes to treatment when comparing self-report (MARS) and hetero- evaluation (treatment attitudes subscale of the ITAQ). Nonetheless, patients with a history of medication non-compliance and worse clinical outcomes had significantly lower (p< .05) scores in hetero-evaluation measures of insight and treatment attitudes (ITAQ), yet exhibited no differences in the self-evaluation measures of those dimensions.

Insight and treatment attitudes assessments can be valuable in clinical practice, contributing to decisions in both in- and outpatient settings involving treatment planning and level of monitoring. Clinician-rated instruments are probably more reliable, with clearer prognostic relevance.

To investigate in non-depressed perinatal women, whichBeck Depression Inventory-II (BDI-II) and Postpartum Postpartum DepressionScreening Scale (PDSS) scores and proportions of symptomatic items significantlydiffer through the perinatal period.

273 women were assessed with the Diagnostic Interviewfor Genetic Studies, BDI-II and the PDSS at the third trimester of pregnancy/T0(mean age =29.42±7.159 years; mean weeks gestation=32.6±3.61),three/T1, six/T2 and twelve/T3 months postpartum.

Significantlyhigher scores in T0 than in T1/T2/T3 and in T1 than in T2/T3 were found for: Total PDSS, Sleeping-Eating Disturbances, Emotional Liability, Total BDI-II andits dimension Somatic-Anxiety. Only T0 and T1/T2 didnot significantly differ in Anxiety/Insecurity, Mental Confusion, and Loss of Self. In Guilty/Shame only T1 was significantly higher than T3. Suicidalthoughts were significantly higher in T0 than T1 and lower in T1 than T2/T3.

Theproportions of symptomatic items systematically and significantly decreased fromT0 to T3 in changes of sleep, loss of interest in sex, feeling overwhelmed. Significantlyhigher symptomatic proportions in T0 than in all post-partum moments were foundfor: loss of energy, irritability, fatigue, changes in appetite, crying, indecisiveness and worthlessness (these last three also higher in T1 than inT3). Agitation was significantly higherin T1 than in T0. All the cognitive-affective symptoms from BDI-II and PDSSdid not differ.

From pregnancy to the twelfth month postpartum the depressivesymptomatology, particularly somatic-affective symptoms, significantlydecreased. However even for the women who are not clinically depressed, theperinatal period requires considerable psychological adjustment.

Factors associated with postpartum/PPT anxiety have been insufficiently investigated.

To identify correlates of PPT anxiety.

201 3-months postpartum women completed the Portuguese versions of Postpartum Depression Screening Scale (PDSS), Beck Depression Inventory/BDI-II, Profile of Mood States, Difficult Infant Temperament Questionnaire/DITQ, Multidimensional Perfectionism Scale and questions on sociodemographic variables, Lifetime history of insomnia/LTHD, Lifetime history of depressive symptomatology/LTHDS, Current insomnia, Health perception/HP, Stress perception/SP, Perceived social support/PSS, Quality of life/QOL, Health problem/complication postpartum, Sensibility to hormonal fluctuations, Type of delivery and Type of feeding. Postpartum anxiety was measured with the Anxiety/Insecurity (AI) subscale of the PDSS.

AI significantly correlated with LTHDS (rS=.32), LHI (rS=.18), Current insomnia (rS=.32), BDI-II (r=.76), SP (rS=.38), PSS (rS=.25), Perceived QOL (rS=.37), Health perception (rS=.29), Health problem in the postpartum (rS=.26), Negative Affect/NA (r=.66), Positive Affect/PA (r=.58), Conditional Acceptance/CA (r=.29) and DIT (r=.38) (all p< .01). Mean comparisons revealed that women with vs. without LHDS, with vs. without LTHI, good sleepers vs. with insomnia syndrome, high vs. low SP, low vs. high PSS, bad/very bad vs. good/very good QOL, bad/very bad vs. good/very good HP, high (< M+1DP) vs. low (>M-1DP) DIT, CA, NA and low vs. high PA had significantly higher mean scores in AI (all p< .01). Linear regression model composed of all correlated variables explained 53.7% of AI variance and showed that NA, PA and DIT are significant (p< .05) predictors of AI.

Our findings are in accordance with previous research and contribute to the progress on this topic.