Obsessive-compulsive disorder (OCD) has a high prevalence and causes a significative reduction in functionality and quality of life.

First and second line treatment is ineffective in a variable percentage of patients. In such cases transcranial magnetic stimulation (TMS) may be considered.

The goal of this study is to evaluate the impact of TMS treatment on obsessive-compulsive, anxious and depressive symptomatology in patients with OCD.

A prospective observational study was conducted, including all patients diagnosed with OCD who underwent TMS in the Psychiatry department of Centro Hospitalar Universitário de São João since March 2023.

Symptomatology was assessed using the Yale Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D) before and after treatment.

Statistical analysis was performed using the SPSS-Statistics program. A significance level of 0.05 was considered.

As of October 31, 2023, nine individuals with OCD completed treatment with TMS, 33% male and with a median age of 40 years (range 33-57).

The median Y-BOCS score pre-TMS was 30 (range 20-33) and post-TMS 28 (range 16-34). The median difference was 2.5 (range -5-14) and was not statistically significant (p=0.128).

The median score on the HAM-A pre-TMS was 21 (range 9-41) and post-TMS 18 (range 11-24). The median difference was 0 points (range -4-21) and was not statistically significant (p=0.345).

The median HAM-D score pre-TMS was 26 (range 14-40) and post-TMS 19 (range 10-32). The median difference was 2.5 (range -3-20) and was not statistically significant (p=0.225).

Preliminary findings suggest that the impact of TMS on obsessive-compulsive, anxious, and depressive symptomatology in patients with OCD does not appear to be clinically or statistically significant.

Further results are necessary to confirm this trend.

None Declared

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.

None Declared

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.

None Declared

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.

None Declared

Eating disorders are potentially severe, complex, and life-threatening. Therefore, it is crucial to identify and treat all the comorbidities that could worsen the prognosis.

The aims of this work are to assess if substance use disorders are frequently comorbid in patients suffering from eating disorders, what are the problems associated with drug consumption among these individuals, and what are the best therapeutic strategies in this dual psychiatric diagnosis.

We carried out a narrative review, by searching on PubMed and Google Scholar databases, using the expression “eating disorders and substance use disorders”. We included all types of scientific articles published between 2018 and 2022, and information was extracted regarding the objectives of this review.

The prevalence rates of substance use in eating disorders are higher than in general population. For eating disorders in general, substance use disorder (SUD) is the third most prevalent psychiatric comorbidity. According to a meta-analysis published in 2019, the lifetime prevalence rate of a comorbid SUD was 21.9% (95% CI 16.7-28.0). SUDs were more frequently comorbid among individuals with the binge/purge type, which has a specific phenotype characterized by greater impulsivity, emotional dysregulation, and problems with executive control. Individuals with this dual diagnosis had a higher number of psychiatric comorbidities, were more likely to be prescribed mood stabilizers, and were more sensitive to reward.

Research suggests that eating disorders patients with co-occurring SUDs experience lower rates of treatment response, higher relapse rates, more severe medical complications, greater impairment, poorer long-term outcome, and are at higher risk of early mortality.

To date, there is limited information guiding the concurrent treatment of eating disorders and SUDs. Dialectical Behavior Therapy for SUDs seems to be a promising treatment, but more research on its efficacy will be essential for establishing treatment protocols for these patients.

SUDs have an impact on treatment response and increase mortality among people with eating disorders. The prevention and treatment of SUDs in this patient group is thus imperative to reduce mortality and increase the quality of life of these patients.

None Declared

Acute confusional state (ACS) or delirium is an acute neuropsychiatric syndrome due to an underlying organic pathological process. Despite its high prevalence, delirium can present a diagnostic challenge, particularly in paediatric patients. ACS can be defined as sudden impairment of mental status in a previously healthy child. The impairment varies; it may be global and severe or very specific and mild, such as impairment of short-term memory in “transient global amnesia.” The most common causes of ACS in the paediatric population are high fever, drugs, traumatic brain injury (TBI), and infection and inflammation of the nervous system. Traumatic brain injury is usually associated with some impairment of consciousness, although recovery can vary depending on the severity of the trauma.

The aim of this work is to revisit the diagnostic approach and management of ACS associated with traumatic brain injury in the paediatric population.

Case report of an acute confusional state, secondary to a TBI and a non-systematic review of the literature.

A 17-year-old female was admitted to the emergency department after being injured in a car accident. She was drowsy but easily awakened. She was conscious and partially oriented in time and space. She had amnesia for the episode. She spoke fluently and coherently but was hesitant regarding the hours before the accident, which was probably due to memory impairment. She exhibited sporadic hetero-aggressive behavior during the first few hours of the examination. She had no other thought or perceptual disorders. Head CT scan showed “a thin collection of blood from the frontal interhemispheric area and a discrete subarachnoid sulcal frontobasal hemorrhage, with no other significant changes.” Toxicology tests were positive for THC, cocaine, and MDMD and negative for blood alcohol. A forensic medical examination was required. After 48 hours of vigilance and improvement, she was discharged with a booked re-evaluation within a week. At the second evaluation, her mother described a change in her usual behavior with disorientation, drowsiness, difficulty managing daily life, and memory impairment. She had persecutory delusions regarding the physicians and was very agitated. She was admitted to a child and adolescent psychiatric hospital for further evaluation and stabilization. After 72 hours of inpatient stay, she fully recovered, receiving low-dose risperidone daily. She was discharged with the diagnosis of delirium due to another medical condition (TBI), acute, hyperactive. Since discharge, symptoms have not recurred even after discontinuation of antipsychotic medication.

Clinically, ACS can be divided into hypoactive, hyperactive, and mixed level of activity. Hyperactive forms may manifest as varying degrees of psychomotor agitation. With this case report, we’d like to raise awareness of ACS so that it’s diagnosed and treated correctly and in a timely manner.

None Declared

The clinical features of juvenile fibromyalgia were first described by Yunus & Masi in 1985. In the US, it is estimated that about 6% of adolescents between 15 and 19 years of age suffer from juvenile fibromyalgia. However, this entity remains “a poorly defined disorder”, being excluded from the main diagnostic classification systems.

The goal of our work is to present and discuss a case-based review of juvenile fibromyalgia.

We present a case of chronic pain in pediatric age, referred to a multidisciplinary chronic pain consultation. Through the analysis of this case, we review the concept of juvenile fibromyalgia and its pathophysiology, the risk factors, the diagnostic criteria, the recent evidence for the treatment of these cases and the prognosis of this disorder.

We describe the case of an 11-year-old female, who presented with widespread musculoskeletal pain, headaches, and sleep disturbances for a period over 3 months. At physical examination no significant alterations were found except for pain at palpation of the referred pain locations and at palpation of 11 typical fibromyalgia tender points. Complementary diagnostic exams were normal. The patient was referred to a multidisciplinary chronic pain consultation and was prescribed pharmacological therapy with antidepressants and a gabapentinoid and non-pharmacological therapy with a plan of physical exercises and psychotherapy.

This case report demonstrates the importance of considering juvenile fibromyalgia in the differential diagnosis of pain in pediatric age, showing also the complexity involved in the assessment and treatment of these cases. This case also highlights the importance of multidisciplinary collaboration in the management of chronic pain.

None Declared

Although a large number of studies have shown brain volumetric differences between men and women, only a few investigations to date have analyzed brain tissue volumes in representative samples of the general elderly population.

We investigated differences in gray matter (GM), white matter (WM) and intracranial volumes (ICVs) between sexes in individuals above 66 years old using structural magnetic resonance imaging (MRI).

Using FreeSurfer version 5.3, we automatically obtained the ICVs, GM and WM volumes from MRI datasets of 84 men and 92 women. To correct for interindividual variations in ICV, GM and WM volumes were adjusted with a method using the residuals of a least-square-derived linear regression between raw volumes and ICVs. We then performed an ANCOVA comparing men and woman including age and years of schooling as confounding factors.

Women had a lower socioeconomic status overall and fewer years of schooling than men. The comparison of unadjusted brain volumes showed larger GM and WM volumes in men. After the ICV correction, the adjusted volumes of GM and WM were larger in women.

After the ICV correction and taking into account differences in socioeconomic status and years of schooling, our results confirm previous findings of proportionally larger GM in women, as well as larger WM volumes. These results in an elderly population indicate that brain volumetric differences between sexes persist throughout the aging process. Additional studies combining MRI and other biomarkers are warranted to identify the hormonal and molecular bases influencing such differences.

To estimate the cost of metastatic prostate cancer (mPC) treatment using the time-driven activity-based costing (TDABC) method from the perspective of a philanthropic hospital in the Brazilian public health system (PHS) and to identify determinants of costs.

We used data from patients who received docetaxel chemotherapy in the Brazilian PHS from September 2012 to May 2017. Direct medical costs were estimated with the TDABC microcosting method, taking into account the multiple departments and services the patients interacted with during their oncological treatment.

The median overall survival of the forty-three patient sample was 1.8 years (95% CI 1.45–2.30), and the total cost of the sample was BRL 917.005 (USD 250,878). The median monthly cost per patient was BRL 20.201 (USD 5,526). The end-of-life cost per patient using the TDABC method was BRL 5.151 (USD 1,409). Patients who had received previous treatment at the center registered the lowest cost for hospitalizations and exams, suggesting an opportunity to better manage healthcare resources.

This is the first study on the economic burden of mPC in the Brazilian PHS using the TDABC costing evaluation method. Accurate cost information obtained with the TDABC can be helpful in guiding disease management to guarantee better use of ever-scarcer resources.