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Guest Editorial

Guest Editorial

Carving the foremost developments in neurosonology and cerebral hemodynamics from an inspiring meeting - read full article

By: Elsa Azevedo

In May 2013 the international experts on neurosonology and cerebral hemodynamics pooled their knowledge and expertise to produce an historical and fertile scientific meeting. It took the form of a joint meeting between the European Society of Neurosonology and Cerebral Hemodynamics (ESNCH) and the Cerebral Autoregulation Network (CARNet). The meeting hosted over 400 participants from 47 countries of the five continents in over 30 hours of active discussion and major updates in these fields. Following on the success of the reunion, the organizing and scientific committees felt compelled to assemble the major breakthroughs of the event in a publication meant to carve these developments for future reference. The present issue of the International Journal of Clinical Neurosciences and Mental Health began to take shape compiling the various lectures presented throughout the meeting and tutorials, articles with original contributions of innovative findings and exciting case reports.

International Journal of Clinical Neurosciences and Mental Health 2014; 1(Suppl. 1):S01

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Guest Editorial

State-of-the-art and new perspectives in Neurosonology - read full article

By: László Csiba

The neurosonological techniques play an important role in the vascular and non-vascular (degenerative, peripheral nervous system diseases) neurological diseases. The neurosonological methods proved their strength, not only in the prevention and diagnosis of vascular diseases, but also at intensive care unit monitoring and in therapeutic intervention (e.g. sonothrombolysis and gene therapy) in central nervous system diseases. The neurosonological methods detect and follow the early impairment of endothelium function and changes of cerebral hemodynamics before and after pharmacological interventions. This edition summarizes the recent advances of neurosonology, based on the most outstanding presentations of the European Society of Neurosonology and Cerebral Hemodynamics conference organised in Porto, 2013.

International Journal of Clinical Neurosciences and Mental Health 2014; 1(Suppl. 1):S02

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Guest Editorial

Global mental health – EFPT Porto Forum 2015 - read full article

By: Mariana Pinto da Costa, Cátia Moreira, Fernando Ochoa, João Caseiro, Joana Silva, Mariana Andrade, Sara Carneiro, Sarah Oliveira, Sérgio Saraiva, Tânia Abreu, Tiago Costa, and Vítor Pimenta

The European Federation of Psychiatric Trainees (EFPT) is the independent federation of psychiatric trainees associations of more than 30 countries, representing and supporting thousands of junior doctors training in psychiatry in Europe, and it has been the first international organization of trainees specialized in any branch of medicine. Since its inception in 1992, EFPT has grown playing a major role in the improvement of psychiatric training across Europe. The 23rd EFPT Forum, taking place in 2015 in Porto, has “Global mental health” as motto, and is receiving for the first time participants from different regions of the world further than Europe, facilitating the opportunity to develop collaborative projects, nationally and internationally, and being an excellent occasion to exchange experiences and share good practices. This Scientific Programme has been open to all junior doctors, medical students and mental health professionals beyond Portugal, interested in participating and contributing for this multidisciplinary discussion with colleagues from other specialties and other fields. Global mental health is needful of the support and advocacy of all professionals aiming to address health inequalities, which is such an important goal nowadays of the health systems worldwide; while at the same time, promoting the positive image of psychiatry not only for medical students, but more broadly to the different players of the society. We are delighted that so many world-renowned professionals have travelled from different regions of the world to Porto to contribute to this Scientific Programme of our EFPT Forum, which we are very proud of. Likewise, we are grateful to all the institutions and individual people that have by different means supported our efforts. Collaboration implies equal partners to work together, envisioning common goals: to share knowledge, to learn and to build consensus; with a strong determination to reach an identical objective: the endeavour of hosting the EFPT Porto Forum 2015. In fact, the Local Organising Committee of the EFPT Porto Forum 2015, is itself composed by a diverse group of elements, from different cities in Portugal: psychiatry trainees, both from adult psychiatry and child and adolescent psychiatry, trainees from other areas, as well as medical students, bringing a perspective of different backgrounds and stages of one’s career. International collaboration and partnerships between people, seem to have contributed throughout time to what we now call modern globalization, referred as a global interconnected system with dominant factors: economical, political, technological, cultural and environmental. According to its definition “Global mental health is the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide”1. This Special Issue about the Scientific Programme of the EFPT Porto Forum 2015 at the International Journal of Clinical Neurosciences and Mental Health gathers the symposiums, courses and workshops presentations by invited speakers, with the contributions of the selected abstracts for the e-posters and oral presentations by participants. We believe that this Special Issue translates the foremost developments in Global mental health during the latest years, covering central topics as: psychiatry and society; workforce and human resources; cooperation in psychiatry; providing health care; social breakthroughs; the profile of a psychiatrist; child and adolescent psychiatry; the psychiatric interview; psychotherapy; suicide prevention; complaints, litigation and malpractice, and statistical methods in psychiatric research. We look forward that this Special Issue is useful to bring this dialogue live and to generate further discussions, reproducing the memory of an exciting and interesting encounter, involving hundreds of people across the world.

From the 23rd EFPT Forum, Porto, Portugal. 22–27 June 2015.

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):1

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Guest Editorial

Advances on the diagnosis of idiopathic inflammatory demyelinating diseases of the central nervous system - read full article

By: Joana Guimarães

Diagnosis of acquired demyelinating syndromes can sometimes be delayed due to lack of awareness for these group of pathologies among clinicians, consequently, treatment opportunities may be missed. Multiple sclerosis (MS) is the most frequent disease of this group of acquired demyelinating syndromes and diagnosis is usually based on proof of disease dissemination in space and time, after exclusion of other disorders. With the advent of new drug therapies and the evidence that early treatment has significant long term benefits, it is extremely important to make an early, accurate diagnosis of MS; additionally, several MS mimics may require alternative treatments for best long-term outcome. In this Special Issue we present an overview of the recent advances on diagnosis of idiopathic inflammatory demyelinating diseases of the CNS and also case reports that illustrate real clinical practice, hoping that these will be useful for clinicians caring for patients with demyelinating syndromes. In the last selected paper, the inflammatory perspective of depression in the context of chronic immune-mediated diseases, will be discussed.

Special Issue on Inflammatory Demyelinating Diseases of the Central Nervous System

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 3):S01
DOI: http://dx.doi.org/10.21035/ijcnmh.2016.3(Suppl.3).S01

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Guest Editorial

Educating healthcare professionals about stroke: a 20-year milestone - read full article

By: Ricardo Soares-dos-Reis, Marta Carvalho, and Elsa Azevedo

Stroke is the leading cause of death in Portugal, greatly surpassing ischaemic heart disease. Largely ignored in the past, stroke has been the subject of intense research in the last decades, which led to the development of integrated care pathways with great impact on patients’ mortality and morbidity. Raising awareness for acute and chronic management of stroke has been one of the focuses of the Cerebrovascular Diseases Study Group of the Faculty of Medicine of Porto and Hospital de São João. This group has regularly organised courses to discuss recent developments in stroke management and, in 2016, celebrates its 20th anniversary with the publication of this supplement. It also joyfully celebrates the first year the meeting bears the name of the recently created Porto University Centre of Medicine. This joint venture of the Faculty of Medicine of Porto and Hospital de São João will certainly help further our goals of fostering research, education and improved care in the area of stroke. Mainly intended for General Practitioners, Internists, Neurologists and Physiatrists, the course also welcomes all healthcare professionals whose scope of care inevitably includes stroke patients. With a remarkably practical approach, it covers most aspects of the preventive and therapeutic management of cerebrovascular disorders. In this supplement, you will find the abstracts from the lectures and also from the oral presentations of young physicians who elected to discuss their work during the course, and whose interest in the area of stroke we applaud.

Special Issue on Stroke. From the Porto University Center of Medicine Stroke Update Course, Porto, Portugal. 7–8 June 2016.

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 2):S1

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Guest Editorial

CONy 2016: Controversies in Neurology were ignited in Lisbon and acknowledged in the International Journal of Clinical Neurosciences and Mental Health - read full article

By: Elsa Azevedo and Amos D. Korczyn

Controversy was ignited in Lisbon during March 2016 by one of the most important meetings in clinical neurology worldwide. The 10th Meeting of Controversies in Neurology (CONy) took shape along four days of intense debate and rich scientific overview. Leading experts from all subspecialties of clinical neurology and neuroscience coming from all corners of the world got together to challenge paradigms, update knowledges and identify the boundaries of current clinical reasoning. The program was organized across seven main areas of debate (Multiple Sclerosis, Stroke, Dementia, Headache, Movement disorders, Epilepsy and Neuromuscular), predated by discussions on the locally identified Machado-Joseph’s Disease and Portuguese amyloid neuropathy, followed by insights on the Neurology beyond the horizon. The present special issue of the International Journal of Clinical Neurosciences and Mental Health devoted to the 10th Meeting on Controversies in Neurology includes the abstracts of all the invited lectures and free communications of this meeting, as well as full articles proceeding from CONy 2016, as reviews, original research, viewpoints or case reports. It is a tribute to this event, allowing it to remain immortalized in an international academic journal. We look forward for more debates and enlightening discussions in CONy 11th, which will take place shortly (March 23-26, 2017) in Athens, Greece (www.comtecmed.com/cony).

Special Issue on Controversies in Neurology. From the 10th World Congress on Controversies in Neurology (CONy), Lisbon, Portugal. 17–20 March 2016.

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 1):S01 

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Guest Editorial

Stroke Care 2.0: updating and moving beyond hyperacute stroke care - read full article

By: Ana Aires, Ricardo Soares-dos-Reis, Marta Carvalho, and Elsa Azevedo

In an era of constant significant changes in stroke therapy, where medical treatments continue to be optimized and multiple large randomised controlled clinical trials support mechanical thrombectomy, we also must focus on patients best medical and social care once they are discharged from the stroke unit. We believe continuity of care impacts health outcomes in this patient population. Inpatient and outpatient care should be part of the same integrated stroke care pathway, with contributions from Neurologists, Internists, Primary Care Physicians, Physical Medicine and Rehabilitation, Public Health Physicians, Nurses, Physical and Speech Therapists, Neuropsychologists, Social Service professionals, etc. Our goal is to foster this view of integrated stroke care. Thus, in our annual course, we bring together those healthcare professionals so we can align our views and contribute to a consistently high level of quality in stroke care. In this process, rehabilitation assumes a prominent role. We feel it should begin as soon as possible and that treatment plans should be regularly reviewed, lest we lose the health gains brought by the acute therapies. In this issue, we focus on primary and secondary prevention of stroke, namely new antiplatelet drugs, anticoagulation after stroke and novel data regarding intracranial atherosclerosis. We also highlight the importance of an organized stroke care infrastructure to achieve better results. An update on endovascular treatment will be followed by interesting interventions approaching several themes, such as intracerebral haemorrhage and special populations. The relevance of an early rehabilitation will be put in the spotlight. Its role in spasticity, the importance of music therapy in language disorders and the several tools available during the period of hospitalization, including dysphagia screening and treatment, will deserve special consideration. Last, but certainly not least, we would like to give a warm welcome to the presence, for the first time, of patient associations in this course. It is definitely a further step in the right direction for truly providing a continuum of care.

From the Porto University Center of Medicine Stroke Update Course, Porto, Portugal. 20–21 June 2017.

International Journal of Clinical Neurosciences and Mental Health 2017; 4(Suppl. 2):S1

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Guest Editorial

Neurobiology of mental illness: from reductionism to integration - read full article

By: António Ferreira de Macedo

From its inception until now, psychiatry has continually searched for knowledge of brain-behavior relationships and the neurobiological underpinnings of psychopathology. The tendency to view mental illnesses as brain diseases is not new and goes back to Hippocrates, being dominant in the nineteenth century. This theoretical tradition was interrupted during the first decades of the twentieth century by a predominant psychological vision, embodied in different theories such as psychoanalysis, and a range of behavioural, humanistic and cognitive perspectives. However, in the last forty years the tendency to view psychiatric patients as individuals who have some kind of brain disorder has grown to the point of being an almost indisputable truth. In the second edition of Biological Psychiatry, Michael Trimble [1] said that biological psychiatry has a long past—which establishes its respectability—but a short history—which establishes its scientificity. Indeed, this part of the story is relatively short and researchers all over the world continue to struggle for discovering the neuronal and neurochemical bases of psychiatric symptoms. The corollary of this brain-centered vision, which is now firmly rooted in the mind of most psychiatrists, and is at the core of the contemporary neuroscience thinking, is that the mind is simply what the brain does. Consequently, mental pathology is merely the behavioral consequence of identifiable neuromolecular abnormalities. However, we must dispute this kind of simplistic brain-centered reductionisms, emphasizing that this view must be tempered with the notion that mental illness is multidetermined. This awareness should reminds us the great density of causal factors involved in mental illness and prevent us from falling into a simplistic and linear causal thinking. The explanation of this complex causality, including inside and outside-the skin factors is now well addressed within disciplines such as critical neuroscience and social neuroscience.

Special Issue on the Neurobiology of Mental Illness

International Journal of Clinical Neurosciences and Mental Health 2017; 4(Suppl. 3):S01
DOI: https://doi.org/10.21035/ijcnmh.2017.4(Suppl.3).S01

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Guest Editorial

Lisbon Stroke Summit 2018—deep into the stroke patient management decisions - read full article

By: Ana Paiva Nunes and Elsa Azevedo

After the success of its first edition, Lisbon Stroke Summit 2018 focus again in the stroke patient management decisions. Along with the pros and cons debate of unsolved issues, difficult clinical cases are discussed by the stroke experts of this international forum. In a world of clinical trials where we try to prove the benefits of an intervention in a big sample, sometimes we forget that patients are all different, and we need to come back to the old meetings discussing them individually. Our patient might have features not compatible with the strict inclusion and exclusion criteria of the trials, and therefore our concern is the patients who do not fit the guidelines. This meeting aims to join vascular clinicians, internists and neurologists, as well as neurointerventionalists, from different countries and with different perspectives, but having in common the experience of treating patients with stroke. All the knowledge gathered in this meeting will certainly help all the participants to better understand and manage the most challenging clinical cases of their practice. We believe that this perspective of returning to the basics in medicine, to the individual patient, is needed and should be stimulated because it is the core of clinical practice.

From the Lisbon Stroke Summit, Lisbon, Portugal. 6–7 April 2018.

International Journal of Clinical Neurosciences and Mental Health 2018; 5(Suppl. 1):S1

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Guest Editorial

Comprehensive stroke management: a new window of opportunity - read full article

By: Luís Braz, Ricardo Soares-dos-Reis, Marta Carvalho, and Elsa Azevedo

Cerebrovascular disease is one of the major contributors for global mortality and morbidity and the leading cause of mortality in Portugal. Education for patients and healthcare professionals in this area cannot be overemphasized and it is the key to reduce disease burden in future years. This is the moto of this course: from ischaemic to haemorrhagic stroke, from hyperacute to chronic management, from physician to patient, our aim is to provide an overview of comprehensive stroke management. Recent breakthroughs in selection of patients for hyperacute therapy of ischaemic stroke have shifted the concept of a time-based window to an individualized one, while keeping the general “time is brain” concept. Furthermore, primary and secondary prevention approaches for ischaemic cerebrovascular disease have witnessed advances towards a more tailored approach (e.g. dual antiplatelet therapy, prolonged cardiac monitoring, and diversified anticoagulation regimens). Since cerebrovascular disease care is considerably more than its acute management, we also focus on the continuum of care that goes beyond the stroke unit, with perspectives from acute to chronic rehabilitation, nursing and palliative care specialists. Multidisciplinary care impacts health outcomes in stroke patients. Therefore, we bring together diverse healthcare professionals from different institutions so we can align our views, with expert contributions from Neurology, Family, Internal, Intensive Care and Rehabilitation Medicine, Neurointervention, Neurosurgery, Cardiology and Imunohemotherapy. Furthermore, in this years’ course we continue to welcome the Portuguese stroke support association as part of the integrated stroke care management. In keeping with the moto of education, we provide four different workshops touching different facets of stroke patient’s management, from critical patient monitoring to endovascular stroke treatment. Highlights from the “Action Plan for Stroke in Europe 2018-2030” will be presented to include and motivate all participants in a common goal for the forthcoming years. In this year’s course, we have also expanded the time available for oral presentations and case discussion. We feel honoured by the quality, quantity and diversity of submitted presentations, a sign that stroke healthcare professionals share our enthusiasm in this era of great changes but also great opportunities to improve stroke care.

From the Porto University Center of Medicine Stroke Update Course, Porto, Portugal. 26–27 June 2018.

International Journal of Clinical Neurosciences and Mental Health 2018; 5(Suppl. 2):S1

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