Schizophrenia is characterized by long hospitalizations and a recurrent use of chronic and acute psychiatric care.

The aim of this study was to analyze schizophrenia related hospitalizations in Portugal.

A retrospective observational study was conducted using a nationwide hospitalization database containing all hospitalizations registered in Portuguese public hospitals from 2008 to 2015.Hospitalizations with a primary diagnosis of schizophrenia were selected and schizophrenia subtypes were grouped using the International Classification of Diseases version 9, Clinical Modification(ICD-9-CM) codes of diagnosis 295.xx.

There was a total of 25,385 hospitalizations in public hospitals of Portugal between 2008 and 2015 with a primary diagnosis of Schizophrenia or other psychotic disorders. A total of 14,279 patients were hospitalized during the study period with an average of 1,78 hospitalizations episodes per patient in the 8-year interval(0.22 hospitalizations/patient/year). 68.0% of the hospitalizations occurred in male patients and the median length of stay was 18.0 days. Mean hospitalization charges were 3,509.7€ per hospitalization, summed to a total charge of 89.1M€. Throughout the study period there was a significant linear decrease in the number of hospitalizations (r = 0.940; B= -47.488; p = 0.001). The last year of the study(2015) had the lowest number of hospitalizations with a total of 2,958 (vs. 3,314 in 2008). When adjusted for the yearly population, there was also a decrease of the number of hospitalizations per 100,000 inhabitants from 31.39 to 28.56 hospitalizations per 100,000 inhabitants between 2008 and 2015, respectively.

We found differences in hospitalization characteristics by gender, age and primary diagnosis.

No significant relationships.

Delusional parasitosis (DP), also know as Ekbom syndrome and in some cases as Morgellons, was first described in the late 17th century in France. It is an obsessive phobic state in which the patient believes that the is infested by parasites. In the hallucinatory state, they frequently remove parts of the skin, identifying them as parasites. The cause of DP is unknown. Evidence supporting the dopamine theory defend that the inhibition of dopamine reuptake (for example cocaine and amphetamines) induce symptoms such as formication.

Through the description of the following clinical case, we emphasize its clinical features and complexities.

Review of DP in light of a clinical case

A 48-year-old woman was brought to the psychiatric emergency due to psychotic symptoms following cocaine use. She had a history of drug abuse. She was apparently asymptomatic until October 2019, when, in the background of vague sensation of something crawling under his skin, she developed a sudden onset belief that she had been infested by insects that crawled under his skin. Previous medical observation found no reason for a skin infection or infestation. Skin examination revealed itch marks and skin excoriations in the abdomen. Mental status examination revealed anxious and depressive affect, delusion of parasitosis, tactile hallucination and impaired insight. Routine hemogram and urinalysis was unremarkable, except for the detection of cocaine.

Delusional parasitosis often presents to nonpsychiatric medical professionals. An awareness of such ilness, with an early recognition and timely referral are management cornerstones in order to successfully diagnose and treat patients.

No significant relationships.

Despite being one of the oldest treatments in the field of Psychiatry, Electroconvulsive therapy (ECT) is used worldwide for various severe and treatment-resistant psychiatric disorders, establishing itself as one of the fastest and most effective treatments.

The primary aim of this study was to describe a nationwide epidemiological perspective of the use of ECT in hospitalized psychiatric patients. The secondary aims were to characterize clinical and sociodemographic trends of hospitalized patients who needed ECT.

A retrospective-observational study was conducted using an administrative database which gathered all hospitalizations registered in Portuguese public hospitals from 2008 to 2015. We selected all hospitalizations with a procedure code 94.27 - Other electroshock therapy defined by the International Classification of Diseases version-9, Clinical Modification.The variables included in the study were birth date, sex, residence address, primary and secondary diagnoses, admission date, discharge date, length of stay (LoS), discharge status from each single hospitalization episode.

There were a total of 879 hospitalizations with ECT during the 8-year period of the study. Most of the hospitalizations occurred in female patients (53.4 vs 46.6%), belonging to the age group of 51-70 years old, with a mean age of 50.5 years old. The median LoS was 43.0 days with an IQR of 27.0-68.0 days. The specific primary diagnosis most frequent in all hospitalizations was Major depressive disorder, recurrent episode representing 19.6% of all ECT related hospitalizations.

In Portugal most of the patients who received ECT were women above middle age, and depressive disorders were the most common indication.

Bipolar Disorder (BD) is a mental disorder characterized by long hospitalizations and frequent need for acute psychiatric care. Hospitalizations represent a valuable quality of care indicator in BD.

The aim of this study was to describe a nationwide perspective of BD related hospitalizations and to use a BigData based approach in mental health research.

We performed a retrospective observational study using a nationwide hospitalization database containing all hospitalizations registered in Portuguese public hospitals from 2008 to 2015. Hospitalizations with a primary diagnosis of BD were selected based on International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 296.xx (excluding 296.2x; 296.3x and 296.9x).

A total of 20,807 hospitalizations were registered belonging to 13,300 patients. 33.4% of the hospitalizations occurred in male patients and the median LoS was 16.0 days. Mean age was 47.9 years and male patients were younger(46.6 vs. 48.6; p< 0.001). 59 hospitalizations had a deadly outcome (0.3%). The most common cause of hospitalization in BD was the diagnosis code 296.4x (Bipolar I disorder, most recent episode (or current) manic) representing 34.3% of all hospitalizations, followed by the code 296.5x (Bipolar I disorder, most recent episode (or current) depressed) with 21.4%. The mean hospitalization charges were 3,508.5€ per episode, with a total charge of 73M€ in the 8-year period of this study.

This is a nationwide study using BigData analysis giving a broad perspective of BD hospitalization panorama at a nationwide level. We found differences in hospitalization characteristics by gender, age and primary diagnosis.

No significant relationships.

Administrative databases (AD) are repositories of administrative and clinical data related to patient contact episodes with all sorts of health facilities (primary care, hospitals, pharmacies,…).The large number of patients/contact episodes with pharmaceutical facilities available, the systematic and broad register and the fact that AD provides Real-world data are some of the pros in using AD data.

To perform a narrative review on the role of Big Data pharmaceutical registries in Mental Health research.

We conducted a narrative review using MEDLINE and Google Scholar databases in order to analyse current literature regarding the role of BigData pharmaceutical registries in Mental Health Research.

Administrative variables like drug names and prices may be used and linked to other clinical variables such as patients disease, in-hospital mortality, length of stay,(…). The use of electronic medical records may also contribute to systematic surveillance approaches like local or national pharmacovigilance strategies, identification of patients at risk of developing complications and software pop-up warnings related to medication dosage, duplication and lateral effects. The use of Big Data pharmaceutical registries allows to create predictive epidemiological models regarding drugs lateral effects or interactions and may help to perform pharmacovigilance phase 4 clinical trials. Its use may be applied to the optimization of clinical decision, monitoring of drug adverse events, drug cost and administrative monitoring and as surrogate measures of quality care indicators.

Big Data use in pharmaceutical registries allows to collect large and important clinical and administrative data that may be later used in Mental Health care and research.

No significant relationships.

Éric Satie was a French classical music composer born in May of 1866. He composed several music pieces that did not fit the contemporaneous musical standard once he did not follow the orthodox rules of composition and harmonic expression.

To analyse Erik Satie personality traits and possible psychopathological findings.

A narrative review was performed using Google Scholar database.

His music, as it occurs in most musical composers, was said to translate his own personality and state of mind at the time. He was described as an eccentric with multiple descriptions demonstrating unstable and explosive personality traits of pride, determination, perfectionism and a hatred for convention that would put him near a Cluster A type of personality.

Although some authors conclude that Satie could be diagnosed with Asperger Syndrome I believe that his specificities represent more of personality traits than pathological findings.

No significant relationships.

The psychiatric care paradigm has shifted towards community-centered models. Yet, prolonged hospitalizations are still a reality, with debated impact at healthcare systems and patients.

This work aims to describe prolonged hospitalizations in acute psychiatric wards through patients’ sociodemographic and clinical data.

We analyzed a national hospitalization database that contained all hospitalization episodes registered in Portuguese public hospitals from 2008 to 2015. All episodes with a primary diagnosis of mental disorder defined as ICD-9-CM codes 290.x-319.x were included. Prolonged hospitalizations were defined as having a LoS ≥ P97.5; LOS ≥180 days or LOS ≥1 year. Age, sex, lengh of stay, in-hospital mortality were analysed.

The LoS ≥ P97.5(≥62 days) group comprised 3911 hospitalizations (2.3% of all psychiatric hospitalizations) and 1755 patients. The median LOS was 81 days and the mean age was 51 years. Sex was equally distributed, though a higher frequency of male patients was found on the ≥180 days (n=364) and ≥ 1 year (n=121) groups. Psychotic disorders were the main diagnosis at discharge (n= 1769, 45.2%), followed by mood disorders (n=1057, 27.0%) and dementia (n=451, 11.5%). In-hospital mortality increased in the higher LoS groups (1.1%; 4.4%; 9.1%, respectively).

Overall, middle aged patients with psychotic disorders represent most of the prolonged hospitalizations occurring in acute psychiatric wards. Community-based programs require further development to meet the existing needs.

No significant relationships.

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

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

An observational, cross-sectional study.

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

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

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

Sexual dysfunction is the inability to perform satisfactory sexual activity. It is estimated that 80% of men have erectile dysfunction in dialysis and 55% of women, difficulty in sexual arousal. Men may have decreased libido, erectile dysfunction and difficulty reaching orgasm. Women have difficulty in sexual arousal, decreased vaginal lubrication, dyspareunia, and difficulty achieving orgasm.

Assess sexual dysfunction in hemodialysis patients.

A Cross-sectional analysis conducted with a randomized sample of 100 subjects from a total of 521 hemodialysis patients (20%) of both genders. Data were collected through Kidney Disease Quality of Life - Short Form (KDQOL-SF).

Most patients were female (52%), mean age 55 ± 14 years. After KDQOL-SF, the most common complaint was lack of sexual activity (82.81%). Most patients are dissatisfied with sexual performance (59%). Among them, the more dissatisfied were women, 61% (36/59), p < 0.02, and patients under 65 years, 61% (36/59) p < 0.007. Among those who report being sexually satisfied, the majority were male (58.33%). We found that sexual dissatisfaction is more common in women. Among 52 female patients, 37 were dissatisfied (71.15%), whereas among men, we have 56.25% (27/48) of sexual dissatisfaction.

There is evidence of high prevalence of dissatisfaction in the hemodialysis patients sexual performances. Further studies are needed on their sexual function, as well as therapeutic interventions that may offer improvement in this negative scenario.

Depression is a common, recurrent, often underdiagnosed and undertreated disorder in older people. 10-15% of the elderly present depressive symptoms and 3% of that same population meet criteria for a major depressive episode.

Several factors, such as psychosocial changes, may be related to the onset of depressive episodes. Retirement (often accompanied with feelings of loss of status, both in the family and in the society), the decrease of social contacts with a tendency to isolation, and the difficulties to adapt to new activities and routines, all lead to feelings of inadequacy, worthlessness and a poor self-esteem.

The aim of this poster is to show and discuss the importance in recognizing some psychosocial factors that can predict the onset of depressive symptoms in the elderly.

We report a case of a 66-year-old man, without previous psychiatric history, who presented a major depressive episode with psychotic features, after an important life event (retirement).

Depression in older people has severe consequences, afflicting not only patients but also the caregivers. The amplification of previous disabilities associated with medical and cognitive disorders, the increased rate of mortality by suicide and the increased costs to the health care system are common consequences.

To reduce such threats we propose a clinical and social approach that evaluates and regards the different stages of the life cycle and valorize the achieved experiences of older patients.

Anxiety disorders have been historically described as a feature of Bipolar Disorder (BD), and Obsessive-compulsive-bipolar disorder (OCBD) comorbidity has been referred in literature. A survey reports that 55,8% of obsessive-compulsive patients may develop BD in their lifetime. Another survey estimates it at 21%. Mania in Obsessive-Compulsive Disorder (OCD) can occur either as an independent comorbidity or as a result of an antidepressant-induced switch in a patient in anti-OCD drugs.

The aim of this poster is to describe and discuss some aspects of this psychiatric comorbidity, with emphasis on its diagnosis and management, based on a case report.

This case report describes a 38-years-old married male with 5 years history of OCD treated with an antidepressant, admitted at our psychiatric ward due to a manic episode. Its management and therapeutic approach are described.

A baseline of “neurosis” (versus “psychosis”) in some BD presentations has emerged from recent scientific evidence, which prompts its better understanding. As a complex comorbidity, OCBD represents a diagnostic and therapeutic challenge implying further systematic exploration.

To assess quality of life through self-administered KDQOL-sf (Kidney Disease Quality of Life - short form) by patients on hemodialysis (HD) classified according to age.

We randomly 159 hemodialysis patients and applied the KDQOL-sf between February/10 and March/11. We evaluated the quality of life based on scores below or above 50, on all scales, according to age < 60 years (n = 85) and ≥ 60 years (n = 74).

In patients < 60 years, the scales in which they had poorer quality of life were: physical function 47/85 (55.3%), Chronic Kidney Disease (CKD) burden 46/85 (54.1%), professional role 57/85 (67.1%) and sexual function 47/85 (55.3%). In patients ≥ 60 years, the scales with poorer quality of life were: physical functioning 47/74 (62.2%), physical function 51/74 (68.9%), general health 38/74 (51.3%), energy / fatigue 45/74 (60.8%), CKD burden 56/74 (75.7%), professional role 49/74 (66.2%) and sexual function 60/74 (81.1%).

While patients younger than 60 years have a quality of life decrease in 4 scales, patients with more than 60 years have worsened in 7 scales, with significant worsening of sexual function. We conclude that the quality of life is more impaired in the elderly undergoing HD.

The occurrence of a depressive disorder after a neurological disease is a condition classified in the International Classification of Diseases (ICD-10) as an Organic mood [affective] disorders [F06.3], and in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as a Mood disorder due to a general medical condition [298.83]. Cerebrovascular disease is associated with an increased risk for depression, with incidence rates of 30-40%. Frequency of post-stroke depression is highest during the first month after the ischemic event, but remains high for several years.

The aim of this poster is to show and discuss some troublesome and complex issues on diagnosing and managing patients with post-stroke depression, based on a case report.

Herein we report a case of a 46-year-old woman, without significant prior psychiatric history, who presented with depressive symptoms after left middle cerebral artery stroke (with cardioembolic source) and right hemiplegia/hemiparesis and motor aphasia sequelae.

Depression has shown to be the most common psychiatric post-stroke complication, and the one associated with a worse poorer functional prognosis. It may be difficult to accurately diagnose a post-stroke depression, particularly in patients with aphasia, anosognosia and other cognitive dysfunctions.

Psychiatric symptoms occur quite often in epilepsy and are an important prognostic factor in quality of life of patients with this neurological condition. The psychotic disorders occurring in epilepsy are classified according to their chronological relationship with the seizures. The peri-ictal psychoses occur before (pre-ictal), during (ictal) or after (postictal) the emergence of a seizure. Inter-ictal psychoses occur independently of seizures. Postictal psychosis (PP) episodes are typically of short duration.

Our aim is to show the great importance of seizures control as a way to prevent the onset of psychotic symptoms, thereby improving patient’s prognosis and quality of life.

In this paper we describe a case of a 44-year-old man, with post-traumatic epilepsy and postictal psychotic symptoms.

The search and the recognition of psychiatric symptoms in epilepsy allow a better understanding of the overall clinical case and, therefore, a more effective treatment.