Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.

The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.

We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.

We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

Bipolar disease type I has an estimated prevalence of 1% in the general population. Approximately 50% of first episodes are of the manic type. In the last decades, there have been major advances in the understanding of the disease and its psychopharmacological treatment, namely through the usage of anti-psychotics (both typical and atypical), mood stabilizers and anxiolitics.

To study the farmacological treatment of acute mania in Hospital Miguel Bombarda over the last 20 years.

Data retrieval from the clinical files of the patients admitted for bipolar disease, manic type, and its sociodemografic caractherization. Study of the farmacotherapy used in a sample of the first 30 clinical admissions due to the illness over 20 years, with intervals of 5 years. (1986, 1991, 1996, 2006)

There has been an overall increasing rate of admissions due to bipolar disease, manic type over the last 20 years. This evolution is depicted graphically.

Anti-psychotics were the class of therapeutic agents most comonly used, especially haloperidol. In the last years, there has been a slow but steady increase in the usage of mood stabilizers; however, atypics lagged behind in the prescriptions habits for bipolar disease, manic type in the sample studied.

We present the case of a psychotic patient with a previous diagnosis of pellagra, admitted to an acute care unit of Miguel Bombarda Hospital, Lisbon. Pellagra is a systemic disease caused by niacin deficit; its clinical presentation is revised, taking into account psychiatric disease.

We will focus the following items:

1. - definition of pellagra and description of its main clinical symptoms

2. - historical issues of psychiatric symptoms of pellagra

3. - pellagra psychosis – evolution of classifications

4. - neuropsychiatric features of pellagra

5. - diagnosis, treatment and outcome of psychiatric illness of pellagra

Medline Research. Bibliography revision.

Clinical presentation of pellagra includes gastrointestinal, dermatological and neuropsychiatric symptoms.

The first description of pellagra dates back to 1863. In the beginning of the 20th century, approximately 30% of admissions in psychiatry were due to this disorder, which was included in the first classification of mental illness of the American Psychiatric Association.

Pellagra psychosis should be diagnosed in a patient with typical symptoms and signs of pellagra and psychotic symptoms which respond to treatment with niacin.

Pellagra is currently a rare disorder, but the diagnosis should be taken into account in alcoholic patients, undernourished, with anorexia nervosa or tuberculosis treated with isonyazid.

With proper treatment, there is a complete recovery.

blepharospasm is a focal dystonia of the orbicularis oculi muscles, provoking intermittent or sustained eye closure, sometimes severe enough to cause functional blindness. Basal ganglia connections seem to have a major role in its still largely unknown physiopathology. Though usually idiopathic, in the last decades many authors have been linking it to neuropsychiatric diseases, such as obsessive-compulsive disorder. Hemifacial spasm (HFS) consists in unilateral, sudden and intermittent contraction of muscles innervated by the facial nerve. Unlike blepharospasm, an identifiable etiology is frequent. Current best treatment for both diseases consists in botulinum neurotoxin type A application (BoNT/A).

to characterize psychological profile of patients with idiopathic blepharospasm or HFS and analyze significant differences.

consecutive patients diagnosed with one of the above mentioned diseases, visiting an outpatient clinic of BoNT/A application, were evaluated regarding the existence of stress, depression, and obsessive-compulsive behavior. Personality traits, quality of sleep and quality of life were also analyzed. Validated scales were used to assess these domains.

eighty patients were included, 43 with HFS and 37 with idiopathic blepharospasm. After explanation and agreement, demographic, social and clinical data was collected, in addition to questionnaires. Statistical analysis focuses on group differences and correlation with clinical and psychological parameters.

the proposed involvement of basal ganglia in motor and affective domains of blepharospasm must lead to a comprehensive approach of these patients, including a psychological evaluation and pharmacological treatment directed not only to motor spectrum, as it is currently usual, but also matching coincident psychopathology.