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Issue 2 (2015) – Supplement 1


Abstracts from the 23rd EFPT Forum

This supplemental issue comprises the abstracts from the 23rd forum of the European Federation of Psychiatric Trainees (EFPT).

Guest editors:
Mariana Pinto da Costa (Guest Editor-in-chief)
Cátia Moreira
Fernando Ochoa
João Caseiro
Joana Silva
Mariana Andrade
Sara Carneiro
Sarah Oliveira
Sérgio Saraiva
Tânia Abreu
Tiago Costa
Vítor Pimenta

Issue Nr:

2

|    Issue date: 2015-06-20

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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Lecture


What is Global mental health? - read full article

By: Samuel Okpaku

Global health and global mental health are shifts in paradigm that are in response to the globalization process. Meanwhile, there is a shift in the definition and portfolio of health to include for example human rights and climate change. Many rich nations are beginning to include health policies within their foreign policies. Many stakeholders share the international vision of equity to all. We are in this together. This presentation will give a history of global mental health. It will present a definition of global mental health along 5 criteria. This definition as will be useful for research and scholarship. The presentation will highlight what some of the rich countries are contributing to global health, and what more they can do. It will also highlight the reciprocal benefits not only in terms of cultural and friendship benefits, but also potential education, research, and training benefits. It will define global mental health as the range of activities concerned with health that meets five principal criteria: universal and trans universal criterion; public health criterion; stakeholder's criterion; problem ownership criterion; and team criterion. This definition distinguishes it from community mental health and it allows for us likely to facilitate scholarship and research. Global mental health like the overarching process of globalization is not without any criticism. There is a vocal group that challenges the westernization and over medicalization of mental health. The role of such group as a watch dog will also be presented.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L1

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How is health across borders? - read full article

By: Gustavo Carona

The personal perspective of a doctor who has worked in some of the worst areas in terms of humanitarian need of our days. Medicine assumes a completely different role, although the aim is the same no matter where: save lives and improve the quality of life. Our task as a doctor and as an human being should always be seen as citizens of the world, because health issues has no borders.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L2

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Lecture


What is global for medical students? - read full article

By: Alberto Silva

Medical students have a strong say on Mental Health globally. Mental Health still remains a neglected area of health worldwide. Although neuropsychiatric conditions constitute the highest cause of global disability, access to treatment is limited by the availability of services, affordability of services and treatment, and the stigma attached to mental health conditions. Medical students worldwide support their role as international advocates for mental health. This may be through undertaking overseas electives in psychiatry, championing the mental health needs of all patients in all clinical settings and involvement with mental health charities both at home and abroad. IFMSA considers the elimination of stigma towards neuropsychiatric disorders to be everybody’s business. Medical schools and student psychiatry societies must be instrumental in leading the way for their students by encouraging such activities.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L3

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Temperament and Creativity - read full article

By: M. Luísa Figueira

In the present communication we explored the relationships between temperament and creativity across bipolar disorder, with the specific goal of understanding which temperamental traits are most strongly related to creativity. The bipolar– creativity association may be related to temperamental differences, such as increased cyclothymia that contributes to enhance openness to experience, increase of consciousness, intense activity, heighten of perceptive skills and sensibility. We will focus our presentation in the musical and painting creativity taking as example several artists with excessive temperamental traits and will review prospective studies of non-eminent creativity in mood disorder patients. These are limited in size, scope, and number, but include findings complementing those in eminent creators, suggesting that some facets of bipolar disorder, but not the disorder itself, may confer advantages for creativity.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L4

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Lecture


The sexuality in dictatorship time - read full article

By: António P. Palha

The author analyses aspects of legislative, social and cultural nature which characterize the fascist period in Portugal, particularly in the decades 30, 40 and 50. The total dependence of girl and woman respectively on father and husband’s authority is evidenced. The virtues of that dependence, exalting the values of conservative femininity according to both catholic religious patterns and political ideals imprinted in legislation, are widely shown through texts, quotations and iconographic symbols.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L5

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Lecture


From ancient times to Technology - read full article

By: Luiz Gamito

The knowledge about human mind comes from Philosophy to Science through Psychiatry and Neurosciences. Last decades brought to us a marvellous new world of Technologies of Information and Communication (TIC), nowadays each more used on the diagnostic and treatment of mental diseases and dysfunctions. Virtual Reality is a good example about the possible linkage between the pathways of Technologies and Psychiatry in order to improve progress in Medicine. The author, according his self experience, introduces some principles of cyberdiagnose and cybertherapy and discuss concepts around clinical practice.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L6

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Lecture


Neuroscience based Nomenclature - read full article

By: Joseph Zohar

Current psychopharmacological nomenclature remains wedded to earlier period of scientific understanding, failing to reflect contemporary developments and knowledge, does not help clinicians to select the best medication for a given patient, and tending to confuse patients as they are being given a drug with a different name compared to their identified diagnosis (e.g. "Antipsychotic" for depression). Four major colleges of Neuropsychopharmacology (ECNP, ACNP, Asian CNP, and CINP together with IUPHAR) proposed a new pharmacologically-driven nomenclature focusing on Pharmacological Target and Mode of Action. It includes also 4 dimensions of additional information: 1—Approved Indications; 2—Efficacy and side effects; 3—Practical note; and 4—Neurobiology. Several surveys in four different continents were conducted in order to examine satisfaction with the current psychopharmacological nomenclature, as well as test the NbN. A significant proportion of the participants in the surveys were in favor of the proposed nomenclature. It seems that clinicians found the available nomenclature system dissatisfactory and many times confusing for them and the patients. The proposed nomenclature seeks to up-end current usage by placing Pharmacology and Mode of Action rather than indication as the primary driven force. In the session examples of using the NbN in key medications will be presented and discussed.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L7

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Lecture


A multidimensional approach to depression - read full article

By: Vicent Balanza

Major depressive disorder (MDD) is a prevalent condition associated with potential disability. Given that monoamine-based antidepressant therapies fail to address many important needs and associated side effects may be burdensome, more effective and safe interventions are needed. Omega-3 polyunsaturated fatty acids (PUFAs) may be one such option and there is growing interest for nutritional supplements worldwide. Several lines of evidence suggest that diminished omega-3 PUFA concentrations are associated with MDD. The shift away from traditional dietary patterns, including fish and seafood rich in omega-3 PUFAs, has been associated with increased rates of depression. Patients show lower levels of omega-3 PUFAs in body tissues. In addition, supplemental omega-3 PUFAs have shown efficacy to improve depressive symptoms and proven to be a very safe and well tolerated treatment. At the molecular level, Omega-3s have shown anti-inflammatory, antioxidant and neuroprotective effects, which are strikingly similar to those of conventional antidepressants, and might explain their clinical benefits in mood disorders. The active antidepressant component from omega-3 PUFAs is eicosapentaenoic acid (EPA). The reason why EPA is more effective than docosahexaenoic acid (DHA) in the treatment of MDD is not yet elucidated, but one of the mechanistic underpinnings may involve anti-inflammation. Increasing evidence suggests that inflammation plays an important role in the pathophysiology of MDD. For instance, elevated levels of pro-inflammatory cytokines have been consistently shown in MDD patients and the induction of a pro-inflammatory state facilitates ‘sickness behaviour’ resembling depressive symptoms. EPA has a stronger anti-inflammatory effect than DHA. This presentation will critically update the clinical evidence for the use of omega-3 PUFAs in MDD, with a focus on inflammation. The potential preventative and therapeutic efficacy of these compounds will be considered.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L8

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Lecture


EFPT International Brain Drain Study - read full article

By: M. Pinto da Costa and EFPT Brain Drain Research group

Introduction: Migration of mental health professionals is an important phenomenon influencing mental health services of host and donor countries. Data on medical migration in Europe is very limited, particularly in the field of young doctors and psychiatry. To research this hot topic, the European Federation of Psychiatric Trainees (EFPT) conducted the EFPT Brain Drain Survey.

Objectives: To identify the impact of previous international experiences on migration, and to understand the characteristics, patterns and reasons of migration, as well as what is an attractive job for psychiatry trainees and what needs to be improved in psychiatry.

Methods: In this cross-sectional European multicentre study, data were collected from 2281 psychiatric trainees across 33 countries. All participants answered to the EFPT Brain Drain Survey reporting their attitudes and experiences on migration.

Results: Two-thirds of the trainees had not had a short-mobility experience in their lifetime, but those that went abroad were satisfied with their experiences, reporting that these influenced their attitude towards migration positively. The majority of the trainees has considered leaving the country they currently live in. Flows showed that Switzerland and United Kingdom are within the main host countries, whereas countries as Romania highlights from the main donor countries. ''Pull factors'' were mostly personal reasons, whereas typically ''push factors'' were mainly financial reasons. Indeed, trainees that wanted to leave the country were significantly more dissatisfied with their income. There is nevertheless an atypical pattern of migration worth to be further analysed.

Discussion: The possibility to endorse this discussion in a symposium on workforce and human resources, presenting and discussing the findings from the EFPT Brain Drain study, may raise awareness on the current trends, help to elucidate the underlying issues and recommend possible systems of support.

Conclusions: Migration within psychiatry will probably to a certain extent continue, being therefore essential to enhance support to those who migrate, and actually influence the mental health care provided internationally.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L9

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Lecture


Views from donor countries - read full article

By: Ana Giurgiuca, M. Pinto da Costa, and EFPT Brain Drain Research group

Introduction: Migration of highly skilled professionals to a better working and living environment is widely referred to as 'brain drain'. This phenomenon is currently influencing the mental health care professionals living in Europe by leading them to relocate towards higher income countries within the EU. This work force migration highly influences the mental health services of donor countries..

Objectives and Methods: To identify migration attitudes and their underlying reasons among psychiatric trainees living in the donor countries in Europe, as identified in the Brain Drain research study, led by European Federation of Psychiatric Trainees in Albania, Bulgaria, Cyprus, Ireland, Latvia, Romania and Ukraine..

Methods: This presentation will focus on the Brain Drain results from the donor countries.

Results: Past mobility experiences of psychiatry trainees seem to influence their attitude in favor of migration and increase the chances to leave their country of origin in the future. The most significant push factor is the financial one, whilst personal reasons seem to influence most trainees towards remaining in their country of origin. Trainees that express their intension to leave are significantly less satisfied with their income. Specific characteristics, patterns and reasons for migration of psychiatric trainees will be compared between the 7 donor countries.

Conclusion: Psychiatry trainees from donor countries display a positive attitude towards migration and similar patterns can be identified regarding their motives. However, some reasons seem country specific and heterogeneity occurs regarding the push and pull factors for migration.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L10

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Lecture


Views from host countries - read full article

By: Kevin Holmes, M. Pinto da Costa, and EFPT Brain Drain Research group

The EFPT Brain Drain Project involved surveying psychiatry trainees within x countries across Europe to understand the attitudes to and experience of migration. Following analysis of the results it became clear that some countries appeared to be net donors whereas a few appeared as net hosts for psychiatry trainees. Our results showed that Sweden, Switzerland and the UK were all significant net hosts. One of the main contributors as a ‘pull’ factor, assessed through the Brain Drain results, was unsurprisingly salary. It is notable that all three host countries were within the top two highest wage brackets within our survey. The percentage of immigrants varies from 28% in the UK to 70% in Switzerland. Presented are the individual host country results, looking at common themes that appear to attract trainees to migrate to these countries. In addition, the attitudes and experiences of individual trainees are discussed to try to draw some conclusions from our survey sample. These results are then considered within the overall political and financial landscape to make some concluding remarks.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L11

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Lecture


Health workers for all - read full article

By: Giulia De Ponte

Mobility of is a right of every individual: like other professionals, health workers have the right to choose the place where they wish to live and work. In a public health perspective, however, health systems have also the duty to ensure that mobility of professionals does not translate into brain drain, and into inequality of access of citizens to health services. Which are the policies put in place at European and global level to ensure that both the right to mobility and the right to health are protected? The impact of austerity measures on mobility of health workers across Europe will be taken into account; cases of specific countries will be briefly presented; actions at European and local level will be illustrated.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L12

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Joint action on health workforce planning and forecasting - read full article

By: Eszter Kovács

Health workforce mobility is a crucial factor when considering long-term strategic health workforce monitoring, planning and forecasting activities. The increased movements of health professionals have been investigated in the last few decades, when the EU enlargement and the economic crisis as significant macro-factors fostered the migration and altered some trends. Data collection and analyses were performed in the Joint Action on European Health Workforce Planning and Forecasting (JA EUHWF 20122201) project. Quantitative and qualitative methods were employed to map available mobility data in EU Member States, and to reveal the different ways how mobility is considered in health workforce planning. The findings showed that the availability of mobility data is highly fragmented. Even the most advanced health workforce planning systems frequently experience the lack of reliable and valid quantitative data for mobility. Different mobility indicators, mostly proxy indicators or estimates are in use, thus the precise numbers are still vague. The minimum planning data requirements for health workforce planning should contain health professionals’ in- and outflows, based on a standardized formula. Qualitative data collections might support to overcome the gaps and to complete quantitative information. Several initiatives attempt to track mobility of health professionals, however an integrated approach is needed within Europe, international data collections - such as WHO, OECD, Eurostat – should focus more significantly on mobility data. Collecting data on licensed and practicing foreign health professionals and a strengthened, more automatic information exchange between Member States would facilitate having a deeper understanding and a more exact overview of the situation. Since some popular destination countries highly rely on foreign human resources in their domestic labor force, doubtlessly necessary to calculate their volume for the future. On the other hand, countries with significant shortages also need to gain clarity of the current and future trends in order to ensure the sustainability of their health systems. Not only the numbers, but also the skills – and skill-mix – of the future health workforce should be taken into account in planning, so mutual recognitions and equivalences in trainings, or continuous professional development might be monitored among the activities.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L13

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Lecture


European early career psychiatrists - read full article

By: O. Andlauer, N. Jovanovic, K. Koelkebeck, O. Kazakova, and M. Pinto Da Costa

The European Psychiatric Association has had a dedicated Early Career Psychiatrists Committee for more than 5 years. Its aim is to involve Early Career Psychiatrists (ECP) in the association, and develop training activities. Its four task forces focus on research, publications, associations and professional development. The dedicated scientific programme during the EPA Congress gathers ECPs from all around the world, and provides scholarship, travel grants, and social activities during the Congress and throughout the year. It contributes in creating an identity to European Psychiatry.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L14

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Lecture


Young Psychiatrists’ Network - read full article

By: Raphael Psaras

The Young Psychiatrists’ Network (YPN) - www.ypsnet.org - is a rapidly growing network of Early Career Psychiatrists and Psychiatric trainees. Its aims include, global development of psychiatry through close collaboration of Young psychiatrists worldwide, expanding knowledge and sharing experiences, and facilitating the evolution of YPs from different parts of the world and improvement of their knowledge, skills and abilities. The Young Psychiatrists’ Network was born in 2009 as ”Young Psychiatrists Eastern Europe” due to an initiative from the – no longer active - Swedish Eastern Europe Committee, and the 1st international meeting was organized in Vilnius, Lithuania in 2010. But the Network evolved, involving psychiatrists from more and more countries, and organizing three more very successful conferences, in Riga, Minsk, and Wroclav. Other projects of the YPN include Scientific collaboration, Research collaboration, and Regional meetings. The 5th Young Psychiatrists’ Network Meeting will take place between 30 September to 3 October 2015, in Porto Heli, Greece. The annual YPN Meeting always combines the exceptionally interesting scientific program with the rich daily social program and the rare opportunity of creating friendships with Young psychiatrists from more than 30 countries.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L15

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What patients want from Psychiatrists? - read full article

By: Pedro Montellano

Scientific knowledge has its own pace. It doesn’t happen when the scientists want and, in many occasions, when mankind most needs. The advances on mental health science that had a significant translation on patient’s care have been very rare in the last decades. It cannot be said that an innovative treatment or a new therapeutic approach has seen the light of the day. Some improvements have occurred in some psychiatric medicines but they still present several side effects that are responsible for dysfunction and are an obstacle to the patient’s integration in the community. Considering the document with the conclusions of the meeting of the EU Ministers of Health, in 2005, Helsinki, has Psychiatry, as a science and a treatment discipline, been able to provide to patients treatment outcomes that allow them to pursuit the vision expressed in the document, namely in what concerns the full integration in the society of people with mental health problems? Were the Psychiatrists in this past ten years opened to accept the changes of its papers and to promote the changes needed in the health care systems? What was the context for the Psychiatrists during this period? Considering that the complexity of the brain makes the improvements in Psychiatry science even more difficult than for the majority of sciences, the apparent disinterest of the pharmaceutical industry to develop new medicines for CNS and the limitations of health care systems, what can psychiatrists and patient do overtake this difficult situation?

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L16

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Is it a burden for families? - read full article

By: Filipa Palha

This presentation has two main objectives: 1) to introduce the European Federation of Families of People with Mental Illness (EUFAMI), a European non-profit organisation that primarily advocates on behalf of families and family carers. Founded in 1992 after a meeting where members from all over Europe "shared their experiences of helplessness and frustration when living with someone with severe mental illness"; 2) to present preliminary results of an international survey carried out in 2014 and 2015 in more than 20 counties to get a clearer picture of the experiences, well-being and needs of family caregivers for persons with a severe mental illness. This study focuses on family caregivers of people with schizophrenia in different Western countries. 431 family caregivers filled in a questionnaire about experiences, well-being, and needs, and data from 7 countries (Australia, Canada, France, Germany, Italy, Spain and United Kingdom) will be discussed.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L17

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Lecture


How is mental health in international missions? - read full article

By: Maria Palha

Many times when we talk about mental health our mind wrongly traps us with examples like “the angry neighbour that shouts to her kids”, “that friend who has awkward behaviour or committed suicide”, “The crazy ex boy Friend who was paranoid” or “the main Psychiatric ward”. In fact all this assumptions are included in the vast area of mental suffering and not mental health. If we stick to the concept of mental health we access a world of harmony and well being that all of us desire to achieve. Nowadays science and information are available about physical and mental health, but it seems we have favouritism for our Physical health and a prejudice when it comes to Mental health. Why? We know that a sedentary life has impact in the quality of our sleep; we know that the excess of sugar in a daily basis is not good and we also know that cholesterol can damage our health. Living in an on-going stressful context can affect our well-being; A diet with vitamins deficiency can influence our memory, concentration and the way we perceive others and the world that surrounds us. For this reasons I believe it’s urgent to integrate Mental and Physical health without favouritism. If we are aware of its advantage I think we shouldn’t do differently and especially because we have a holistic and integrated condition as human being. Once we are conscience about ourselves and the impact that reality has in us, we can become experts in adjusting and surviving to all contexts where we live. By developing and getting self-knowledge about the way the reality impacts us we will also be able to monitor and regulate our emotions adjusting our answers to reality and others. When it comes to crisis situations, like humanitarian crisis, wars, natural disasters or even a big change of life, once we know what can happen to our mental and physical health, we will be able to identify our general needs and we will also be able to react and reduce the impact of this unexpected situations, that requires a fast and adapted response. This is the main benefit of a mental health Intervention when it comes to a crisis situation. Mental health will not only prevent mental suffering and mental chronicle conditions, like depressions, generalized anxiety, schizophrenia or psychosis, but will also support the medical programme when it comes to community approach and understanding. Generally during crisis situations people get scared about the symptoms they began to express, like insomnias, angriness, emotions instability, confusion or hair loss. They also get more suspicious about each other and especially about foreign support. Many times people begging to think that they are getting crazy, tend to get angrier and isolate themselves, facts that will increase what is a normal stress reaction into a severe condition or a chronicle condition (like Post traumatic stress disorder for example). As soon as the population get the information about what services are available to support them as well what can be a normal stress reaction, will also understand what is going on with them and begin to learn how to take care of themselves, understanding what can be health and unhealthy ways of copping. Studies show that as soon as the population has information about their normal stress reactions they are resilient to recover by themselves in 80%, only 20% will need individual support. This will also prevent the medical services obstruction and contribute to a traumatic social recovery. Form this 20% only around 1% will require a long-term intervention, due to development of Pathologies. I must admit that I became excited with this studies, because is very good news when it comes to generational trauma in countries in war. With Efficient Mental health intervention we can interrupt the traumatic transgenerational cycle.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L18

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Lecture


Medical writing and publishing – Acta Médica Portuguesa - read full article

By: Rui T. Marinho

Medical editing and publishing is a key issue in medical activity. Is very important for the medical CV as well for the development of medical science. Is part of our preparation and task in order to give better care to our patients. To publish in a medical journal with good impact factor should be one of our most important goals to have in mind. Is good for us, for our Department, for our Hospital, University, Institute, country…. And for our patients and the modern society. So, it is very useful to know “How to Do”. Publish or Perish. Teaching of all the mechanisms to write, publish, review, etc must begin in early years of medical course. Is a difficult task with a lot of defeats. We must be prepared to be resilient. Never, never, never, never give up. In this presentation we present Acta Médica Portuguesa as a case study of a modern medical journal. Acta Médica Portuguesa is in the section of Internal Medicine and General in the position 132 in 150, of Web of Science. It is receiving around 1000 papers each year. We explain the flux of a paper, the process of review, how to use graphics and figures, how to convince the editor-in-chief, how to use facebook, twitter, www. Becoming an editor-in-chief is a specialized task, time consuming and certain times like a referee in soccer: we need them but we hate them all.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L19

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Medical writing and publishing – International Journal of Clinical Neurosciences and Mental Health - read full article

By: João Massano

Scientific writing and publishing is important at all stages of medical education, postgraduate training, and also throughout the professional career. Publications may be the product of original research or the critical evaluation of routine clinical activity, and any of these contribute to the improvement of critical thinking, scientific knowledge and, ultimately, clinical skills. Publications are also important indicators of academic and scientific achievement, which contribute decisively to secure grants and to career progression. Learning how to design, write and review a paper should be formally taught in medical schools, thus providing young medical students and doctors with the right tools to critically appraise and successfully write a scientific paper. The talk will approach the fundamental aspects of scientific writing and publishing, including basic authorship rules, and the trajectory of a paper submitted to a scientific journal. The audience will also be given a few tips and tricks for manuscript improvement, in order to increase the quality of papers and the chance of publication. Acknowledgments: talk given on behalf of the Editor-in-chief of the International Journal of Clinical Neurosciences and Mental Health.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L20

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Intervention in first-episode psychosis - read full article

By: Sofia Brissos

Early intervention in psychosis is based on the assumptions that psychosis is a (neuro)degenerative illness and that its progress can be arrested or reversed by treatment. These assumptions suggest that it may be possible to detect people who will develop psychotic illness in the future and prevent transition to psychosis (the ultra–high-risk paradigm), that reducing the duration of untreated psychosis in people with frank psychotic illness will improve outcomes (the duration of untreated psychosis paradigm), and that more intensive treatment starting at the time of detection of psychosis will improve outcomes (the early intervention paradigm). Around 20% of patients with a first psychotic episode will have no further episodes; this means, however, that symptoms do recur in the great majority of patients. Studies have demonstrated that individuals who receive early intervention including guidance on how to improve their adherence to treatment, insight into their illness and self-management and how to minimise substance use have a better course. Further, early intervention services with an outreach component may reduce hospital admission, relapse rates and symptom severity, and improve access to and engagement to treatment. This is of utmost importance, since non- or partial adherence to treatment is frequent in the critical period, and may have a profound impact on prognosis. In fact, the critical period of the disease (the first 5 years) is a relatively reliable indicator of the long-term course of the disease. In this sense, earlier detection is expected to lead to quicker access to the effective treatment that is necessary during the 'critical period' and is one of the main incentives for setting up early intervention in psychosis (EIP) services. Overall, it seems that interventions carried out as early as possible, namely psychosocial interventions adjunctive to pharmacotherapy, may contribute to symptomatic and functional recovery, and improve prognosis and quality of life in these patients.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L21

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The future of Social Psychiatry - read full article

By: Stefan Priebe

It has been suggested that psychiatry as an academic and medical discipline is in crisis. In many countries, it is difficult to recruit young psychiatrists, and the profession struggles to show what specific skills they have. For more than 30 years, there has been hardly any progress in developing more effective treatment methods. Subsequently there is a debate about the future of psychiatry with suggestions to focus on neurosciences. The presentation will argue that it is essential for psychiatry to embrace social psychiatry as central to its thinking and practice. This involves social values, social approaches to care, and a social perspective in research. Concepts of social psychiatry are not new. Yet, the future cannot be a mere reference to successful periods in the past. So, how can we build on what has been achieved and advance the field? What may be the new ideas and the new approaches? The presentation will argue that future social psychiatry may be guided by three general principles: 1) that mental distress is understood as a phenomenon on a continuum of potential behaviours in a given social context (rather than a dichotomous biomedical illness); 2) that changes to the social context, e.g. in families and communities, influence experience and behaviour; and 3) that personal and community resources are primarily available in social relationships. Pursuing these ideas may require a radically different description of mental distress and a new terminology. Risks and benefits will be outlined, and potential research approaches briefly discussed.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L22

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Integration of mental health into primary care - read full article

By: Tiago V. Pinto

As we all know, mental disorders affect hundreds of millions of people and, if left untreated, create an enormous toll of suffering, disability and economic loss. Despite the potential to successfully treat mental disorders, only a small minority of those in need receive even the most basic treatment. Mental health is central to the values and principles of the Alma Ata Declaration. So, it appears to be logical that integrating mental health services into primary care seems the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. But how to do this? For sure it is essential that primary care workers are adequately prepared and supported in their mental health work. In fact, certain skills and competencies are required to effectively assess, diagnose, treat, support and refer people with mental disorders. For this purpose, we need education and training on mental health care for all students and health professionals training to work in family health and other areas of community oriented primary care. From an European point of view, there is no single best practice model that can be followed by all countries. Rather, successes have been achieved through sensible local application of broad principles. Again, how? Well, it is a fact that integration is most successful when mental health is incorporated into health policy and legislative frameworks and supported by senior leadership, adequate resources, and ongoing governance. Numerous low- and middle-income countries are successfully making the transition to integrated primary care for mental health, such as United Kingdom, Netherlands, Sweden, France, Ireland, Estonia and Portugal. Others, like Italy, Belgium, Poland, Romania and Spain are still making their development mainly on secondary mental health care institutions. In this presentation we will do both the update and the broad perspective of the current situation of the integration of mental health into primary care in the different countries across Europe, with a deeper explanation of the state of the art in Portugal.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L23

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Community intervention on first psychotic episodes - read full article

By: Teresa Maia

The author will describe an Early Intervention Program in Psychosis (PSIC) community based and integrated in a general adult psychiatry service. Early Intervention in Psychosis Programs (EIP) seek to help people who are in the early stages of their psychotic illness, through the prompt provision of comprehensive phase-specific interventions, with focus on recovery, in order to improve outcome. This program has been developed since 2001. The main goals of the Programme are: (1) early diagnosis and treatment of Ultra High risk and first psychotic episode patients; (2) treatment of primary symptoms and reduction of secondary comorbidity; (2) decrease of the frequency and severity of relapses; (3) decrease in the number of drop-outs; (4) decrease of family burden; and (5) promotion of psychosocial integration and development. The PSIC´s protocol include: (1) psychopharmacological treatment; (2) a psychiatric consultation within 2 weeks after referral, (3) Family Intervention; (4) cognitive evaluation (ACECF) on admission; (5) cognitive remediation (including cognitive remediation treatment [paper and pencil cognitive exercises] and ReHACOM [computer based cognitive exercises]); (6) psychomotor therapy; (7) occupational therapy; (8) social Cognition training using SCIT; and (9) socio-professional rehabilitation.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L24

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Social Impact Initiative - read full article

By: Irena Stojadinovic

The Social Impact Initiative is the newest EFPSA team and the only team representing one of the main goals of EFPSA—using psychology knowledge to make a positive impact on society. The first project chosen to be the representative of this team and its vision is the ‘Mind the Mind—to Combat the Stigma of Mental Disorders’ campaign. After thorough research about this topic, it was decided to make an educative workshop for high school students and make a positive impact on society by changing the way they perceive mental disorders and the associated stigma. The first wave of the campaign started in October 2014 and will finish in June 2015. The campaign was carried out in 19 European countries/regions. In each country there were between one and three Local Coordinators, one trainer, approximately 20 volunteers and between 300 and 1500 participants that were high school students involved. Both the Local Coordinators and the volunteers provided feedback and an analysis of this showed great results. The volunteers’ experience in both training and workshop delivery was very positive, the overall impression of students’ interest and engagement was very high and the workshops were mainly estimated as successful. The most difficult challenges volunteers faced were time management and keeping participants focused throughout the workshop. The next steps in the campaign are: revision of all the materials according to the feedback analysis, the experts’ check of the workshop, ensuring some sort of professional support for the project and development of the questionnaire measuring the campaign’s impact. The second wave of the campaign will start in September 2015 with a great potential of having an even bigger impact on society. The future plans for Social Impact Initiative are finalising the ‘Mind the Mind’ package and producing a report on all of this work, reestablishing the partnership with IFMSA on the topic of Mental Health and approaching other similar organisations to initiate new partnerships, as well as starting new campaigns on other sensitive and highly relevant topics for society.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L25

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The real pathology of depression - read full article

By: André F. Joubert

Depression is described as a disorder rather than a disease. This notion gradually needs to be challenged as we try to demystify depression and bring it into the realms of biological medicine. Using some of the accepted biological mechanisms describing depression, one is able to demonstrate the “whole body” nature of depression as a disease. More specifically, there is a difference between the neurotransmitter deficits and the underlying core biological deficits in the pathology behind depression, including the inflammatory hypothesis, the role of BDNF and neurogenesis, and other biological hypotheses. The deficits that underscore the “real pathology” of depression may pose new implications for treatment and treatment response.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L26

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The Profile of a Psychiatrist - read full article

By: Marc Hermans

The UEMS published in 2005 “The Profile of a Psychiatrist”. Although declared due for revision in 2009, the document has never been subject to such a process. The EFPT, represented by its president, Mariana Pinto da Costa, has been volunteering to revise this document on one of its scientific meetings. A workshop open to all trainees interested, seemed to be the most appropriate format to work on this document. Attendants working on it are expected to have read the document. They shall have the opportunity to give their suggestions during this workshop in order to eliminate elements no longer relevant, to keep necessary elements in the existing document, and to add elements that might have gained interest during the last few years.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L27

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First and second generation of cognitive-behavioural therapies: why the third was needed? - read full article

By: Serafim Carvalho

The first generation of behaviour therapy, which can be dated as far back as the 1920s, sought to modify problematic behaviour by the application of basic principles of classical or respondent conditioning à la Pavlov; and/or operant conditioning, in which behavior change is linked to reinforcing consequences. The potential contribution that language and cognition played in initiation, maintenance, exacerbation and improvement of abnormal behaviour could be acknowledged, while at the same time it could be largely ignored. The need to somehow incorporate language-based processes within behaviour therapy become obvious. In the 1970s cognitive therapy emerged as a distinct approach in response to this challenge, along with related efforts to create cognitive behavioural modification/therapy hybrid by combining cognitively based processes and techniques (e.g., cognitive restructuring), with existing respondent and operant conditioning principles and strategies. Despite clear technical and some conceptual differences between the first and the second generation of behaviour therapy, they still shared a common objective of focusing on what can be regarded as a strategy of first-order change, that is, attempting to alter the form, the frequency, and or content of abnormal behaviour. By the start of the 2000s, empirical limitations as well as philosophical reservations about the second wave of behaviour therapy, gave rise to the third generation approaches emphasizing a second-order change agenda, in which focus is shifted from altering the form or content of abnormal behaviour to the context in which it occurs. It is not easy to change the contextual factors as they are socio-verbal (language) and ubiquitous. The third wave therapies focus on aspects such as how language affects our experience, the concept of mindfulness, self as context, acceptance, commitment to values, compassion and therapeutic relationship. Some of third generation therapies presented at this workshop were: Acceptance and Commitment Therapy, Compassion Focused Therapy, and Mindfulness. The third wave comes to make behaviour therapy more comprehensive, depth and concerned in establishing a relationship with human problems in a broader sense.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L28

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Training our minds in compassion: an introduction to compassion-focused exercises and mindfulness skills - read full article

By: Paula Castilho

This presentation offers an outline of a basic approach to thinking about the nature of, and value of, developing compassion in our lives. In the other hand, explores some exercises that we practice to try to stimulate our own compassionate mind. (Self)Compassion is the heart of mindfulness. It is warm-hearted, connected presence during difficult moments in our lives. Thus, compassion can be thought of as a skill that one can train in, with increasing evidence that focusing on and practicing compassion can influence neurophysiological and immune systems. Compassion-focused therapy refers to the underpinning theory and process of applying a compassion model to psychotherapy. It is an integrated and multimodal approach that draws from evolutionary, social, developmental and Buddhist psychology, and neuroscience. First, we will explore how our brains work and what we mean by compassion. We are going to start by looking at a couple of challenges that life presents us with and that we all experience. Second, we will examine how the therapist help the client experience safeness in their interactions with him, to tolerate and feel safe with what is explored in the therapy, and to replace self-criticism with self-kindness. Empirical research suggests that a specialized affect regulation system (or systems) underpins feelings of reassurance, safeness and well-being. Compassion-focused therapy focuses on the development of the social safeness system in the therapy through the training of compassion and mindfulness exercises.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L29

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Acceptance and commitment therapy: an overview - read full article

By: Inês Guimarães

Acceptance and Commitment Therapy (ACT), is described as a third wave cognitive-behavioural therapy that is based in Relational Frame Theory (RFT). ACT is a psychotherapeutic approach that emphasizes the learning of acceptance and mindfulness skills as means to intervene in the psychological processes that underlie psychopathology, such as cognitive fusion and experiential avoidance. The aim of this communication is to provide an overview of ACT, covering briefly its theoretical foundations (Functional Contextualism and Relational Frame Theory), and to explain the psychological flexibility model that underlies ACT in its conceptualization of human suffering and psychopathology. The core therapeutic processes of ACT (mindfulness, acceptance, cognitive defusion, self-as-context, values and commited action) will be described, and given the experiential nature of many of the ACT interventions, these will be illustrated through experiential exercises and metaphors.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L30

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Complaints, litigation and malpractice: how to survive as a psychiatrist - read full article

By: Julian Beezhold

This informal user-friendly highly interactive course is aimed at addressing the ever-increasing tide of complaints and litigation faced by psychiatrists in their daily clinical work. All content is designed for an international audience working in a variety of different legal and regulatory environments. The course will provide a broad overview of the context, including data on complaints and litigation. We will then examine in greater detail the areas of medical error, complaints, litigation and medical misconduct. Discussion will highlight the situations and actions that more commonly lead to concern. There will be a focus throughout on actual real-life cases. We will explore the theory and practice of the prevention and minimization of the number and severity of adverse events in psychiatry. This will include looking at practical tips for individual practice as well as the gains that can be achieved by a systems approach to reducing medical error. This course aims to help improve the confidence and skills of participants in dealing with adverse events such as complaints and litigation; and also enhance participant’s ability to prevent things going wrong in the first place.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L31

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Suicidal risk assessment - read full article

By: Marco Sachiapone

The World Health Organization estimates that approximately 1 million people die each year from suicide; during the 2012 annual global mortality rate was about 11.4 per 100,000 and it is estimated that 1,500,000 will die from suicide in 2020. The suicidal behaviour is a complex and multi-determined phenomenon, determined by the action of several bio-psycho-social factors. Due to its complexity, it is not possible to absolutely predict if and when a suicidal behaviour will take place, but it’s possible to take into account the presence of certain risk factors and especially their coexistence. The main risk factors for suicide include mental disorder (depression, anxiety, personality disorder, use/abuse substances, schizophrenia), personality traits (aggression/impulsivity), the presence of familiar history of suicide and childhood trauma, some physical illnesses (neurological disorders, cancer, HIV infection), some specific socio-cultural characteristic. Even if the early diagnosis and an adequate treatment are keys to suicide prevention to date, there are not tools that allow an overall assessment of these dimensions. During the CME Course the Suicide Risk factors Check – List will be illustrated. This Check-list can be administered by mental health professionals and aims to allow a prompt and early screening of person at risk for suicide, integrating psychometric and anamnestic data and creating a check-list of the presences of risk factors.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L32

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Treatment of suicidal patients - read full article

By: Vladimir Carli

The need to have valid and effective treatments of suicidal behavior is as important as the early screening of the individuals at risk. However, the treatment of suicidal behaviour is complicated by a series of factors, since there aren't shared pharmacological therapeutic strategy available; an environment characterized by high stress and anxiety; the need of multi-disciplinary therapeutic interventions. Despite these difficulties the professionals who work with people with suicidal risk, have the general principles to refer for the treatment of these cases. The treatment of suicidal behaviour is based on some main concepts, as the importance of adequate communication between doctor and patient and the integration of pharmacological, psychological and social treatment. During the Course, these concepts basics of treatment as well as the important issue of hospitalization of the patient at risk of suicide will be illustrated.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L33

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Psychiatric Interview – subjectivity in the diagnosis - read full article

By: Luis Madeira

The scope of psychopathology as a discipline and its ability to (1) shape what is disturbed or normal and (2) to be assessed in the mental state examination has always been central to Psychiatry. For more than a century the increase of clinical workload, strict insurance policies and the request of objectivity and reliability for research have enforced categorization and operationalization of psychopathological phenomena. This move has been blamed as having led psychopathology into a dead end, undermining research and clinical diagnosis. The search for objectivity was spearheaded by the belief that standardization would (1) help increase its ever-low reliability, (2) diminish the exposure of Psychiatry to scientific criticism and most of all (3) restore the reputation of psychiatrists for they were reckoned as lacking scientific validity. Yet psychiatry seem to have dismissed the relational proxies of meaning (overlooking the conversational structure of the inquiry) accepting checklists of symptoms as proxies of patient’s rapport even if performed by untrained interviews, in uncanny settings (e.g. telephone or email). The clinical impression together with all pre-reflexive appraisal inputs was lost in the operationalization. The nature of phenomena we are accessing and studying are different from the symbols we learnt in psychopathology. Moreover the validity of the symbols we are learning have for long been overlooked as we are short of conceptual research . The quality of the rapport is contingent to the type of relation established and the acquaintance with intricateness of psychopathological symbols. Making such training a relevant feature of medical education might increase the quality of assessments and therefore improve diagnosis and research.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L34

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Statistical methods in psychiatric research - read full article

By: Corália Vicente

This course aims to present and discuss statistical methods in order to create a proper database, select appropriate statistical methods in the analysis of Psychiatric Research studies, use different types of designs having in account the pros and cons of each of them, present findings of a statistical analysis in a clear, concise and understandable way, identify the strengths and weaknesses of a research study and assess the usefulness and validity of the research findings. To attain these objectives case studies will be debated. After the course the participants will be able to appreciate the role of statistical methods in epidemiology, develop skills in presenting quantitative data, appreciate the sampling variation and the role of statistical methods in quantifying variation and testing hypotheses, use appropriate statistical methods in the analysis of datasets, interpret outputs and present findings from the statistical analysis. This will be a course intended for students with just a basic knowledge of the common statistical methods used in medical research. Previous computing experience is not required although it would be helpful.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L35

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Past and future of Training, Investigation and Intervention in CAP - read full article

By: Pedro Monteiro

Child and Adolescent Psychiatry is among the most fascinating fields of medicine. One of the most attractive factors in the rewards of working with children and families is the satisfaction of helping them to return to a healthier developmental stability. Mental health problems are expected to increase and psychiatrists are at the forefront of helping society to engage in best solutions. As we are at the front line of many problems and pathologies of children and adolescents we are in a unique position for intervention. According to this I have selected two main topics to discuss: (1) The early identification of children and adolescents at risk for schizophrenia and the Duration of Untreated Psychosis (DUP); (2) The psychotherapies. Progress in Child and Adolescent Psychiatry is based on the developments of psychology and neuroscience in a way that involves non-confrontational integration of biomedical and biopsychosocial models. This uses a combined practice of psychotherapy and psychopharmacology; we must continue to distinguish our practice from that of a “neurobiological prescriber” so as to prevent our discipline from merging with neurology.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L36

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The role of Child and Adolescence Psychiatry in Paediatric Oncology - read full article

By: Zulmira Correia

Children in oncology units face death. Many adults have the wrong idea that children don´t think about their own death. The most difficult moment is that of a relapse when a child thinks he is being punished . The role of child and adolescent psychiatrist concerns children, parents, siblings and other professionals involved in treatment. Mostly how to communicate bad news, but also how to return to normal life. When there is nothing we can do there is always something to do.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L37

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Health planning in Portugal - read full article

By: F. Parra da Silva

The Joint Action on Health Workforce Planning and Forecasting is working towards: (1) better understanding of terminology; (2) better monitoring of the HWF by access to timely data; (3) updated information on mobility and migration trends in the EU; (4) guidelines on quantitative and qualitative HWF planning methodology; (5) increased quantitative and qualitative planning capacity; (6) estimation of future skills and competencies needed in the health workforce; (7) a platform of cooperation to find possible solutions on the expected shortage of HWF; and (8) a higher impact of HWF planning and forecasts on policy decision making. 
Portugal, with this project, aims to: (1) improve the planning of medical specialists; (2) improve planning of HWF in less attractive and more needed areas; and (3) improve the methodology for identifying the needs of health professionals.
Portugal has already a database characterizing the existing stock of health professionals in the NHS. We are trying to complete the database with information from the private sector (a specific law has already been approved in general, in the Parliament, and is now being in specialty analysis).
For doctors and nurses we are trying to: (1) anticipate imbalances (supply vs demand) for medium and long term; (2) improve the knowledge on mobility of professionals within the EU; and (3) build tools that allow managing and adjusting the training capacity.
For dentists and pharmacists the scope of the pilot project considers measuring the current stock. 
This project considers the stakeholders within the Ministry of Health and the external ones, like others ministries, universities and professional associations.
About the involvement of stakeholders, we’ve had a first meeting, beginning 2014, and are planning a new one, next month. This aims at involving them in the planning process consistent with our own characteristics. 
And then, at the end of the pilot project (March 2016) we to measure the improvements in the period of the project.
The Pilot Study is working on a fixed term project to support national authorities in the implementation of models, procedures and tools, following the handbook produced in the framework of the Joint Action on Health Workforce Planning and Forecasting.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):L38


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Community psychiatry in Mozambique – a transcultural journey - read full article

By: Ana Guerra and Marta Croca

Introduction: Historically the psychiatric clinical practice in Mozambique evolved from an eminently reclusive care setting, during the colonial period, to a phase where the patients were rapidly deinstitutionalized into their communities, in the post-independence years. In 1990, in order to restructure the mental health care network, the National Mental Health Plan was approved. Its main goal was to promote a semi-open treatment setting, activating the community role in the rehabilitation and social reintegration of the psychiatric patient. Additionally, to cope with the scarcity of human resources, a three-year technical degree was created, training medical technicians in psychiatry. From 1990 to 1996 the network expanded from six sanitary units to twenty-four, covering the country’s eleven provinces, with ambulatory consultations functioning in some of the general hospitals and in all of the provincial hospitals. Presently, there are two specialized psychiatric hospitals, one in Maputo and another in Nampula.

Objectives and Methods: Through the description of our 3-month community psychiatry internship in Mozambique, we intend to depict the country’s mental health care reality.

Results: Our internship took place in São João de Deus Mental Health Centre, the psychiatric hospital located in Nampula, which is responsible for the country’s northern region. Besides offering in-patient and ambulatory treatment, it also aims to intervene at a community level by promoting educational talks, theatrical plays, radio and television discussions and the production of didactic material. The various components of our internship will be addressed, namely: the hospital’s community intervention project, the developed activities, the most commonly observed pathologies, the cross-cultural relevant aspects, as well as the challenges we had to face in an occasionally harsh environment.

Discussion and Conclusions: As one would expect, the social and medical realities we encountered were quite different from the ones we are used to, forcing us to adapt constantly in order to surpass challenges of a multiple nature. Nonetheless, these were also the circumstances that turned this experience into something unique, extremely enriching and certainly unrepeatable.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):O1

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Parental unemployment and post-traumatic stress disorder symptoms: a study through the fog of Greek financial crisis - read full article

By: A. Kanellopoulos, I. Beratis, E. Syngelaki, and A. C. Tsiantis

Introduction: The aim of the present study was to explore the impact of parental unemployment on the development in students of post traumatic stress disorder (PTSD) symptoms that are related to exposure to school bullying.

Methods: Participants were 2377 primary school students from Athens. The questionnaires were group-administered in each classroom by trained research staff.

Results: The findings showed that children that reside in families that both parents are unemployed have on average significantly higher PTSD scores related to exposure to school bullying. However, the greater PTSD scores in this group of students cannot be explained by the presence of a greater victimization rate, since the chi-square test for independence did not reveal a significant association between paternal employment status and bullying/victimization engagement. The greater PTSD scores in the group of students that experience paternal unemployment can be an outcome of severe economic stress in family life that influences their psychosocial development and reduces their capacity to overcome successfully adverse events, such as school bullying. The presence of various emotional problems that are more common in this group of students according to previous findings, maybe played a role in reducing the threshold for the development of PTSD symptoms.

Discussion and Conclusions: Properly designed interventions should provide support to students that experience economically stressful conditions, such as paternal unemployment.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):O2

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Psychiatric residents’ cultural competence training: could it contribute to commitment against Stigma and Inequality? - read full article

By: H. Esteves, Z. Gameiro, A. F. Freitas, and A. Bento

Introduction: Cultural competence has become an obligation in a society that highlights human rights and equity. Due to its colonial history Portugal has always been a multiracial country. This diversity has been further expanded due to the recent arrival of different migrant populations to Portugal. Psychiatric services reflects this diversity with growing admissions of foreigners with different cultural backgrounds which bring increasing difficulties in the management of this patients.

Objectives: To review the existent European residents’ training programs concerning cultural competence and to compare them with the ones delivered in Portugal.

Methods: EPA guidance on cultural competence training outlines was analysed. A literature review on cultural competence residency training programs was taken. PubMed search was done using with the following terms: psychiatric residency; cultural competence training programs and importance.

Results: Cultural competence is part of good clinical practice and comprises the process of how a clinician regards each patient in the context of the patient’s own culture as well as from the perspective of the clinician’s cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. Cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can improve the effectiveness of psychiatric treatment.

Discussion and Conclusions: Cultural competency and training are believed to be a positive value in psychiatric residents’ training. Furthermore, this training and the contact with diverse migrant populations could contribute to build a stronger awareness against stigma and inequality in future professionals.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):O3

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Occupational stress and burnout among physicians - read full article

By: Marco M. Oliveira, Ana S. Costa, Maria J. Peixoto, and Cassiano Santos

Introduction: Burnout has been defined as a psychological condition involving a continuous exposure to stressful work events leading to adverse consequences both in physical and mental health of workers. Among physicians, it is extremely hazardous given that it might affect their work and unintentionally harm the patients.

Objectives: The aim of this review was to collect data on the risk factors for burnout among physicians.

Methods: The review was based in articles published on PubMed database, using the following terms: “occupational stress”, “burnout”, “risk factors”, “predictive factors”, “healthcare professionals” and “physicians”.

Results: Studies showed that 25-60% of physicians reported symptoms or complaints related to burnout which also varies at different rates among different areas of specialty. Personal factors and workplace-related factors have been described and associated to burnout. As personal risk factors the studies describe higher levels of burnout in younger ages, unmarried status and, in women, being married with children. As workplace-related factors a positive association with burnout was found in physicians with less work experience, longer working hours, shift duty and working in higher-grade hospitals.

Discussion and Conclusions: Burnout has negative impact on physicians’ quality of life and for those who experience these symptoms there is a potentially increased risk for medical errors. This study highlights the importance of creating evaluation programmes for burnout in healthcare professionals, and the necessity to establish preventive protocols and specialized assistance.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):O4

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Human trafficking – are we ignoring modern-day slavery? - read full article

By: Marta Queirós

Objectives: Review available literature regarding Human Trafficking in Europe.

Methods: Non systematic review using PubMed database with the MeSH word "Human Trafficking". Review of the relevant international publications regarding "Human Trafficking".

Results: PubMed database found 46 results from which 10 were found relevant. Four international publications regarding the subject available online were also considered relevant.

Discussion: Although it is estimated that there are at least 2.4 million victims of human trafficking worldwide there is few available literature about this subject. According to the European Commission the number of people trafficked to or within the European Union amounts to several hundred thousands a year. The number of reported cases in 2012 was 10998, most of them are adults and about 80 percent are female. In Europe the most frequent purpose for human trafficking is sexual exploitation (69%) followed by labour exploitation (19%). The majority of them are European citizens. Health care professionals are not aware of this nor have been trained to recognize these victims and as a consequence, opportunities to identify this cases are missed.

Conclusions: Further research is needed to understand the causes, consequences and scope of human trafficking. Health care providers play a major role in identifying these victims. Educational programs concerning this subject should be offered to increase awareness, promote early detection and assure effective management of modern-day slavery

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):O5

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Innovative strategies for mental health education in low and middle income countries (LAMICs) - read full article

By: Asanga Fernando, Angharad Piette, Christopher Kowalski, Deborah Sebbane, Ashwini Rajan, Chrishanthi Rajasooriyar, and Walter Mangezi

Introduction: The improvement of mental health education in LAMICs has been highlighted as an imperative. Scarcity of resources necessitates innovative and creative approaches to this, such as human factors workshops and mental health simulation training. These have been little researched to date.

Objectives: To examine the feasibility and transferability of innovative mental health education strategies into low resource settings.

Methods: The authors comprise a collaboration spanning the UK, Zimbabwe, France and Sri Lanka, developing training courses for implementation in LAMICs, in collaboration with local partners. One involved multi-professional human factors workshops for mental health (and other healthcare) workers in Sri Lanka, whilst the other was a simulation-based training on the recognition and management of depression for medical students in Zimbabwe. We examined participants’ experiences, educational impact, feasibility and acceptability of these interventions in LAMICs.

Results: In Zimbabwe (n=27), student confidence scores in assessment and management of depression increased from mean 15.90 to 20.05 (95% CI = 2.58- 5.71) t (20) = 5.52, (p > 0.0001) following the simulation session. Feedback was positive overall with students commenting that it was “helpful”, “enjoyable” and “boosted confidence”. In Sri Lanka (n=196), descriptive data evaluation of ‘pre’ and ‘post’ course questionnaires demonstrated an identification of a knowledge deficit in areas covered by the workshops, and clear subsequent post course improvements in understanding .Furthermore, qualitative feedback demonstrated a high level of learner awareness, relevance, satisfaction and engagement.

Discussion and Conclusions: Work in Zimbabwe has demonstrated that simulation-based teaching is effective in improving student confidence and was enjoyable and acceptable. Local stakeholder input is essential in adapting materials to ensure culturally acceptability of interventions. Lack of funding for actors becomes an issue of sustainability. The workshops in Sri Lanka were, we believe the first multi-professional human factors workshops in the country. Evaluation has demonstrated that learners find this learning modality enjoyable, thought-provoking and relevant to improving patient safety across healthcare institutions in Sri Lanka. Innovative strategies for mental health education in LAMICs can be implemented in a cost-effective and effective manner. This implementation must be carefully considered locally in order to ensure cultural acceptability and sustainability.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):O6

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Psychiatry trainees’ experiences of providing training in the WHO’s mhGAP manual in Kashmir, India - read full article

By: H. Ryland, L. Potter, and P. Hughes

Introduction: Global mental health is an increasingly important component of training and is being integrated in to all specialty curricula in the UK.

Objectives: The Royal College of Psychiatrists Volunteer scheme allows psychiatrists, including trainees, to participate in volunteering opportunities abroad. This report outlines the experiences of psychiatry trainees who travelled to Kashmir in India to provide training in the World Health Organisation’s (WHO) mhGAP tool and reflects on volunteering as a mechanism for obtaining global health competencies.

Methods: The Kashmir project has run for two years, with the support of the Royal College of Psychiatrists’ Volunteer Scheme. Psychiatrists from the UK travelled to Kashmir to deliver training in the use of the WHO mhGAP tool, which has been specifically designed to support primary care workers to identify and treat common mental health problems in resource limited settings. Health professionals from across Kashmir and beyond were invited to attend the training, focusing on the pilot region of Gandabal. Trainees attended a two-day ‘train the trainer’ course in the UK to prepare them to use the mhGAP and were supported throughout the volunteering experience by consultant psychiatrists.

Results: Participation in the volunteering project in Kashmir provided trainees with real world experience of many of the key issues in global mental health, such as the influence of cultural factors, stigmatisation of mental illness and the varying resources and structure of health systems to respond to mental health needs. Trainees were also able to develop a number of generic competencies of relevance to their practice back in the UK. This included educational skills and the completion of work place based assessments.

Discussion: Global mental health is increasingly prominent on the training agenda, especially in countries with high numbers and diversity of immigrants, such as the UK. Volunteering schemes offer a mechanism whereby psychiatry trainees can gain hands-on experience of delivering training in Low and Middle Income Countries (LMIC).

Conclusions: As well as the opportunity to use skills to improve mental healthcare in LMIC, volunteering can enable psychiatric trainees to gain specific competencies in global mental health.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):O7

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A kangaroo on my couch: the mental health system and psychiatry training in Australia - read full article

By: Prashanth Puspanathan

Introduction: Due to its geographical isolation, cultural history and immigration policies, Australia possesses a population demographic rather unique to its borders. Heavily influenced by these factors is the resultant psychological landscape which presents itself to clinical eyes by the way it colours the spectrum of psychiatric manifestations.

Objective: Understanding the ramifications of national health policy which dictate the parameters by which the mental health system negotiates these hurdles. Exploring distinctly Australian travails: the mental health of the Indigenous Australian population, the Asylum Seeker Syndrome, the current Ice epidemic and the welfare state’s failings in the psychological realm.

Discussion: The impact of identified issues on psychiatric training and the role of trainees in the system.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):O8

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Investigating microglial activation in schizophrenia: post-mortem or in vivo? - read full article

By: L. De Picker, M. Morrens, D. Oche, and B. G. C. Sabbe

Background: Ensuing from the psychoneuroimmunology hypothesis, neuroinflammatory activation of microglial cells is explored as a hallmark of neurodegenerative and neurodevelopmental aberrations in schizophrenia. Because extrapolation of preclinical research results to the human brain - particularly in pathological conditions - is limited, investigation of microglial activation in schizophrenia is preferably done using immunohistochemistry on post-mortem brain tissue or with in vivo TSPO PET-CT nuclear imaging.

Objective: To compare immunohistochemistry and nuclear imaging methods for the study of microglial activation in schizophrenia.

Methods: We reviewed existing literature on microglial immunostaining and TSPO nuclear imaging in schizophrenia on PubMed.

Results: The scarcity of post-mortem tissue with sufficient clinical information, required for the careful selection of cases to minimize heterogeneity due to confounding variables such as cause of death, means few studies have examined microglial activation on post-mortem tissue in schizophrenia. In immunohistochemistry, the specificity of different microglial markers represents both a challenge and an asset, but currently only HLA-DP/DQ/DR and CD68 markers have been used in schizophrenia tissue. Also for TSPO nuclear imaging, different markers have been developed. Newer TSPO markers offer higher specificity but require genotyping of subjects for rs6971 polymorphism. Three studies have investigated microglial activation in schizophrenia patients with nuclear imaging.

Conclusion: Both immunohistochemistry with specific microglial phenotypic markers and TSPO PET imaging involve specific advantages and challenges, and the combination of both techniques offers the optimal chance to determine the role of microglial activation in the pathophysiology of schizophrenia.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):O9

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Autism parent support group - read full article

By: Beatriz Rosa, M. Pinto da Costa, Joana Jorge, Sara Cunha, Filipa Moreira, Fernando Ochoa, Daniela Rego, Camila Gesta, and Graça Fernandes

Introduction: Receiving a diagnosis of an autism spectrum disorder for one's child can be a painful experience for parents, that may require an adjustment of their beliefs, feelings, and expectations regarding the child so that they continue coping with raising their child. Because of the characteristics of autism spectrum disorders, parents' psychological adjustment can be especially challenging. Literature shows higher stress in parents of children with autism once compared to parents of children with other developmental disabilities. These findings must raise the clinicians awareness to improve methods of supporting families of children with autism.

Objectives: Provide information to parents about the characteristics of this disorder, advising them about the resources and interventions available and at the same time allowing them to share their concerns with other parents facing similar difficulties. These groups enable parents to increase their knowledge, skills and competencies needed to directly deal with their children, sometimes facing stressful events, which shows to increase the parent's self-confidence and self-assurance.

Methods: The authors with this work briefly present a parenting group model applied in the Child and Adolescent Psychiatry Department of Centro Hospitalar do Porto.

Results: Children's family with autism spectrum disorders participate in a group during 6 sessions (twice a month), that covers several topics, such as interventions, medication, social support, family stress, and counts with the contribution from the different elements of the multidisciplinary team involved in this intervention process (child psychiatrist, psychologist, paediatrician, social worker and occupational therapist).

Discussion: In-depth investigation in this area must be done to understand the best approach to the support of these high risk families. Randomized controlled trials of group intervention are required in order to confirm the effectiveness of these interventions.

Conclusions: Groups for parents of children with Autism can be an approach to the high stress levels of these families and therefore professionals should develop efforts to provide them the best support.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):O10

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Benzodiazepines in clinical practice: how to avoid and stop them? - read full article

By: Luisa Cabrita, Olivier Andlauer, Ozden Gokdemir, and Cristiano Figueiredo

Introduction: To manage anxiety and insomnia GPs and psychiatrists prescribe benzodiazepines, which have proven to be very helpful in the short term. However, in the longer term, their use can cause many difficulties. Memory problems or falls, especially in older adults, are a concern. In addition, misuse and dependency often appear after a few weeks/months. Clinicians and patients therefore end up with a prescription difficult to stop that doesn’t help any more with the initial complaint. There are other non-pharmacological ways to cope with anxiety and insomnia, and teaching these techniques to clinicians and patients has proven to be efficient.

Objectives: The aim of this workshop is to provide GPs and psychiatrists with skills to avoid prescribing benzodiazepines that can translate into their clinical practice, and to stop them in patients who have developed an addiction.

Methods: Using an interactive approach, presenters will alternate clinical vignettes and theoretical points to keep the workshop as close as possible to clinical practice. In addition, three group sessions using basic CBT (Cognitive and Behavioural Techniques) and motivational interviewing techniques will be held during the workshop to make participants practice with each other the techniques explained during the workshop.

Results: Basic CBT and motivational interviewing techniques will be taught to the participants and they will have the opportunity to practice them during the workshop. More general knowledge of the benefits and risks of benzodiazepines will help clinicians prescribe based on evidence.

Discussion and Conclusions: We believe the workshop was designed to suit early career doctors’ needs and will contribute to decrease unnecessary prescriptions of benzodiazepines both in the community and hospital. A balanced view of risks and benefits and a very practical approach will ensure the knowledge and skills learnt translate into clinical practice.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):O11

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On suicide – an integrative model of Stoicism and Scholasticism - read full article

By: Gustavo Santos

Introduction: Traditionally considered under the medical model, in psychiatry, the suicide remains a philosophical problem of laborious and complex approach.

Objectives and Methods: We confronted the philosophic perspective of suicide in two antagonistic times, the Ancient Age and the Middle Ages, analyzing the following works: Phaedo (Plato, 428 BC - 348 BC), Epistulae morales ad Lucilium (Seneca, 4 BC – 65 AD), The City of God (Saint Augustine, 354-430), The Summa Theologiae (Thomas Aquinas, 1225-1274) and Del Homicidio (Francisco de Vitoria, 1492-1546).

Results and Discussion: We argued that the demand of a worthy life with virtue, which for Stoics had the maximum moral value, was progressively replaced, during the Middle Ages, by the acceptance of suffering and misery of everyday life. The authors of the Ancient Age conceded a philosophical suicide, under particular conditions, while the Scholastic authors rejected suicide under any circumstances. The Stoic ethical paradigm “When is possible and desirable for a man to commit suicide?” was overridden by the Scholastic moral prohibition “Why the man should not commit suicide?”. We demonstrated how the theological standard overlapped the man’s ethical disposition, during the Middle Ages.

Conclusions: Finally, we propose an integrative model of these paradigms, which we believe may contribute to highlight the philosophical and medical discussion on suicide.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):O12

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Mental health of the deaf population – a review to an inclusive approach - read full article

By: Beatriz Martins

Introduction: The Deaf population is approximately 70 million worldwide; a large part integrates a community with a unique culture and language, which mental health professionals are not always aware of.

Objectives: The objective of this review is to list the characteristics and difficulties in the approach to mental disorders in deaf individuals.

Methods: The results of this review come from a search of the literature on psychiatric disorders in deaf people and it was conducted on the PubMed platform. Demographic data was consulted in Portuguese Association of the Deaf, World Association of the Deaf and European Union of the Deaf’s websites.

Results: Regarding the psychopathological evaluation of deaf patients, by their particular characteristics, the screening for psychotic symptoms must be open to a wide range of sensory phenomena and it includes the possibility of language deficits resulting from early language deprivation. These language deficits may emerge as a factor for confusion on the assessment of thought organization. For mood evaluation, doctors may observe the speed of the patient’s signing, but also admit other typical mood changes (on sleep, appetite, attention) for a correct diagnosis. Further, the deaf population has the same cluster of depressive symptoms experienced by hearing people. Mood disorders and suicide attempts are estimated as more prevalent in the deaf population; substance use disorders are similar to the general population. However, many methodological problems hamper conclusions on the prevalence of these and other psychiatric diagnoses in deaf patients. This was also verified: a frequent restriction and late access to a spoken or gestual language and its impact on one’s life; a linguistic and cultural barrier between clinicians and deaf patients; the role of certified interpreters that are not always trained to deal with mental health issues; the interpreter’s interference on doctor-patient relationship and on diagnostic interpretation.

Conclusions: No real conclusions can be derived about the expression of psychiatric disorders on the Deaf population, as there are no large scale population-based studies on the subject. Isolation and inequality of the deaf population are perpetuated by the persistence of social and educational deficiencies, including some deficiencies in the psychiatric training of young doctors.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P1

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From a mental health dispensary to ULS do Nordeste - read full article

By: Carina B. Rodrigues, Mariana N. Andrade, and Virgílio Palma

Introduction: Portuguese Legislation concerning Mental Health was first published in 1889. However, little changes have been made until 1945’s Law 2006. Only since then, many structures aimed to psychiatric care have been created and, lately, reorganized. Our present Department of Psychiatry and Mental Health is an example of how Psychiatric Care has evolved in a countryside district.

Objectives: Our aim was to understand which local and national changes were relevant to build and maintain a Mental Health Department operating since its creation to the present.

Methods: To display the major changes on the national scene, objective data was collected from Legislation and historical documents. Though, it was an essential part of this work to interview former and actual workers of this institution who shared their memories of the last decades.

Results: Our Department of Psychiatry and Mental Health started operating as a Mental Health Dispensary in 1964. It ensured, since then, ambulatory psychiatric care to the population of Bragança’s district. For many years, all patients hospitalized in a psychiatric hospital were transferred to a Psychiatric Hospital or Asylum, further than a five hours trip to their homes. Later, influenced by sectorial psychiatry, a local Mental Health Centre was created, including a Psychiatric Clinic permitting for the first time the hospitalization of patients in their home district. Recently, in 1992, all local Centres have been included in General Hospitals. Consequently, Psychiatric Departments have been influenced by the recent changes in Hospital Management. Today, our Department is part of the Unidade Local de Saúde do Nordeste, a public institution administered by a private entity, composed by three hospitals and fourteen healthcare centres.

Discussion and Conclusions: Parallel to the evolution of Psychiatry worldwide, also here the social, political, cultural and scientific changes had a relevant role. And so, we witnessed the same difficulties, and developments. Nowadays, however, the lack of financial and, particularly, human resources remains a major issue.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P2

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“Cabbage lice infestation” – how psychiatrists solved this, in the past 1500 days - read full article

By: Cátia Martins, Fábio da Silva, M. Pinto da Costa, and Serafim Carvalho

Introduction: Delusional parasitosis, also known as Ekbom’s syndrome, is a form of psychosis that people acquire a strong delusional belief of being infested with parasites, whereas in reality no such parasites are present. Patients affected by this psychiatric condition usually go to several doctors, as dermatologists, in the expectation to have their conviction of real infection confirmed and treated. They have indeed skin lesions, either self-inflicted by itching or by attempts to eliminate the presumed infection with abrasive products.

Methods: We present a case-study of a 68 years old female patient followed at the Psychiatry department in the past four years, after being referred by a dermatologist and how this case has been diagnosed and treated, and the improvements achieved.

Results: The patient had a delusional belief of being infested with cabbage lice, presenting skin lesions in both lower limbs, self-inflicted with pliers in an attempt to remove the supposed lice. This condition caused her serious dysfunction, interfering with her personal and social functioning at home, work, with her relationships, and hobbies. She was treated with haloperidol combined with a topical antihistamine. This treatment resulted in total remission of her symptoms.

Discussion: She kept being followed in the Psychiatry department in outpatient care regimen for the last four years, during which she remained without symptoms, believing we cured her infection. She gradually got back to her usual daily activities and her responsibilities at work, recovering her functionality.

Conclusions: This case illustrates the importance of the observation, diagnosis and treatment by Psychiatrists, and in this case the administration of antipsychotics as the proper treatment to disorders that have been first observed by other medical specialties, combined with a solid therapeutic alliance with patients and proper referrals between colleagues. This brings attention to the consequences of working closely with other medical specialties, as psychiatry and dermatology or any other medical specialty according to how the body is involved in the delusion, raising awareness to the importance of Liaison Psychiatry at the General Hospitals and in Primary Care.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P3

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Perfectionism, regret and psychological distress – preliminary study in college students - read full article

By: Daniela Borges, Ana T. Pereira, Joana Borges, A. Primo Cabral, and António Macedo

Introduction: Counterfactual thinking (CT) is defined as a set of mental representations of alternatives to the past actions and, when it focuses on personal decisions, the emotion that results is regret. Regret is defined as an aversive negative emotion, associated to specific cognitive contents and that can be functional or dysfunctional, particularly when associated with perseverative negative thinking (PNT) and certain personality traits, such as perfectionism.

Objectives: To study for the first time the relationship between regret, perfectionism, PNT and psychological distress in the form of negative affect (NA).

Methods: 87 college students (73.6% girls, mean age 22.74±4.828) completed Portuguese validated versions of the Hewitt & Flett Multidimensional Perfectionism Scale, the Multidimensional Perfectionism Cognitions Inventory (MPCI), the Perseverative Thinking Questionnaire (PTQ), the Profile of Mood States, the Perceived Stress Scale and the Regret Scale (RS).

Results: Regret trait was positively correlated with perfectionism, PNT, NA and stress perception; and inversely with positive affect (PA) and support perception. The comparison of the regret trait scores showed overlapping results to correlations. It was found that even perfectionism and PNT are predictors of regret trait and interference and unproductiveness (IU-PTQ) is a partial mediator of the relationship between personal standards (PS-MPCI) and RS. Regret trait proved to be a predictor of stress perception. The PNT (IU) provided a significant increment in explained variance for depression and NA, and together with PS to the variance of anxiety-hostility.

Discussion and Conclusions: In this study, using the Portuguese validated version of RS, a correlation between regret trait and perfectionism was shown. Additionally, and for the first time we demonstrated an association between regret and PNT, NA, PA, perception of stress and support. It was found that higher correlations between regret trait, perfectionism and PNT were experienced with their more maladaptive dimensions (Socially-Prescribed Perfectionism and IU). The PNT, especially its more maladaptive dimension (IU), is a mediator of the relationship between perfectionism and regret. Regret also proved to be a predictor of perception of stress. This preliminary study warrants further research of the relationship between regret, perfectionism, PNT and psychological distress.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P4

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Is forced therapy the solution for addiction? – addressing a global key health issue in times of the highest numbers of new psychoactive drugs - read full article

By: Franziska Baessler

Introduction: Addiction is one of the key global health problems. Worldwide there are approximately 149 to 271 million people who use amphetamine, cannabis, cocaine or opioids. Precise numbers on prevalence of addiction are difficult to obtain as measurements methods are indirect and surveys depend on information provided by consumers. To face that problem a variety of approaches have been implemented in Europe.

Objectives: The presentation takes into account the diversity and classification of addiction related disorders in Europe focusing on the most consumed legal drug alcohol and the most consumed illicit drug, cannabis.

Methods: Definitions, prevalence, evidence for the effectiveness of interventions and legal issues will be on focus and the audience will be updated on characteristics of the newest psychoactive substances.

Results: Around two new psychoactive substances are discovered per week in Europe as published by the EU drugs agency EMCDDA in March 2015. The figures are the highest measured showing an upward trend. Results show that semi-compulsory therapy in addiction for convicts are as effective as voluntary treatment. Especially regarding cannabis the European area has controversial approaches from a different legal point of view. Some countries differentiate “soft” drugs (such as cannabis) from “hard” drugs (such as heroin and cocaine). Softening or aggravation of penalties does not show a direct association with prevalence.

Discussion and Conclusions: The diversity in psychoactive substances increases to a frightening extent. On top of that new psychoactive substances are difficult to detect by traditionally drug tests. Despite of recent revisions there is an ongoing need for updating addiction related classification systems such as in DSM and ICD. Quasi-compulsory therapy shows effects. Harsher penalties do not show a unidirectional relationship with prevalence.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P5

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Prevalence and correlates of suicidal ideation in Portuguese and immigrant pregnant women - read full article

By: M. J. Soares, S. C. Bos, A. T. Pereira, M. Marques, B. Maia, A. P. Amaral, D. Mota, S. Morais, N. Madeira, V. Nogueira, M. Bajouco, J. Valente, C. Roque, L. Oliveira, and A. Macedo

Introduction: Due to the acculturation, immigrants may be exposed to additional sources of stress that may predispose them to psychological distress or psychiatric disease, including depression and suicidal ideation. Several studies, but not all, found higher rates of suicidal behaviors in immigrants than in the host populations. However, the literature on perinatal suicidality in immigrant women is scarce.

Objectives: To analyze the prevalence and correlates of suicidal ideation in Portuguese and immigrant pregnant women in Portugal.

Methods: 491 Portuguese (mean age=29.62 years; sd=4.51) and 77 immigrant pregnant women (mean age=31.08 years; sd=4.61) completed the Portuguese versions of the Postpartum Depression Screening Scale (PDSS), the Beck Depression Inventory II (BDI-II), the Profile of Mood States (PoMS) and a questionnaire to assess demographic and obstetric data, self-reported health, sleep difficulties, social support, quality of life, and stress. The suicidal ideation level was assessed with the PDSS suicidal ideation subscale and the prevalence was calculated based on the positive/indecision answers to this subscale items.

Results: Portuguese and immigrant pregnant women did not significantly differ in suicidal ideation scores (M=5.36±1.44 and M=5.48±1.45, respectively; p=.584) and prevalence (1.8% versus 3.9%, respectively). In both groups, immigrant and Portuguese women, suicidal ideation was significantly associated with lower education level, increased parity and number of child, lower professional levels, poor quality of life, sleep difficulties, and high levels of depression (PDSS). Only in Portuguese women, the suicidal ideation was associated with the status “not married”, lower social support, lifetime poor physical health, previous history of insomnia, hopelessness, helplessness, low positive affect, high negative affect, high levels of depression (BDI-II Total) and high levels of psychosomatic symptoms (PDSS - Appetite/Sleep). Only in immigrant women, the suicidal ideation was associated with abortion and stress.

Discussion: Suicidal ideation levels and prevalence did not differ significantly between Portuguese and immigrant pregnant women, but there were similarities and differences in the correlates of suicidal ideation.

Conclusions: The immigrant condition confers some specificity to the factors associated with suicidal ideation. The findings from this study might have clinical implications in perinatal mental health, including in clinical interventions with immigrant women.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P6

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Clues to an expectable attack to public figures by mentally disordered people - read full article

By: Maria J. Peixoto, Mota Oliveira, Catarina Novais, Filipe Pinto, and Sertório Timóteo

Introduction: Public figures are constantly besieged with unwanted attention from mentally disordered people. The studies of attacks on public figures emphasize the role of mental illness and the relationship between delusional fixations and subsequent attacks.

Objectives: To review literature on predictive factors for the threat-approach-attack escalation.

Methods: Papers about the association between mental illness and public figures attacks were searched through PubMed database, using the following terms: mentally disordered; approach behavior; public figures; pre-requisite to attack.

Results: In a review of mental disorder role in attacks on European politicians the authors found that a high proportion of the attackers were psychotic at the time of the event. In other review, 70% of those who approached were men with a mean age of 39 years, and the presence of mental illness ranged from 59.6% to near 84%, with grandiosity and delusional ideas being more frequent than persecutory beliefs. Those who approached celebrities were more likely to evidence an excessive sense of self-importance or uniqueness and had written a letter more than once (or used other forms of communication). Those who engaged in abnormal communications, employed multiple means of communications and were considered to be driven by motivations that concern a personal entitlement to the public figure, were more likely to approach physically the person of interest. On the other hand, angry and hostile themes on letters to public figures occurred more frequently in those who did not pursue an encounter.

Discussion and Conclusions: Approaches are a pre-requisite to attack, therefore, the prediction of approaches can assist in the prediction of attacks. Approach behavior appears to be associated with more intrusive forms of attempted communication with multiple means of interaction and a desire for face-to-face contact. The recognition of pre-attack signals like inappropriate communications and visits, statements to third parties of their intention to harm a public figure and physical approaches might predict who among the mentally disordered could commit an attack to a public figure. The high prevalence of mental illness indicates the relevance of psychiatric intervention.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P7

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Global mental health – going from HIC to LIC - read full article

By: M. Pinto da Costa and José M. C. Almeida

Introduction: A growing movement to High Income Countries (HIC) is increasing, being a signal of the current globalization. While facing these movement flows, it can be demanding to adapt the gained knowledge to the resource settings. Services in Low and Middle Income Countries (LMIC) are often poorly resourced, being frequent the struggle to provide care. Nevertheless, the original ways to overcome the challenges and constraints faced in these settings, can be examples of different means to treat or prevent mental illness from which we can learn.

Objectives: To promote the discussion on the challenges and opportunities of cooperation and professional medical mobility from HIC to LMIC.

Methods: To present the experience of a European junior doctor in an African setting in the capital city of Angola, Luanda.

Results: This inter-continental medical professional experience in an environment with different background and less resources to provide care, has been very challenging and enriching, also to establish comparisons with different health systems. When settings face constraints with increased levels of poverty and social deprivation, it is a challenge to deliver mental health care, being essential to advocate towards the engagement of policy-makers and planners. Developing and promoting professional medical cooperation between HIC and LMIC can be a strategy in this global world, while HIC society face crisis and certain LMIC rise financially. The effects of this medical professional mobility, promoting junior doctors to go across borders worldwide, are beyond the increased knowledge or the encouragement to joint projects, and can reach establishing durable cooperations.

Conclusions: The challenges faced on the ground in this experience encouraged me to advocate to further comparisons, and endorse critical thinking in regards to public health priorities and innovative responses to the burden of care.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P8

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“It's psychiatric!” – about stigma in general hospital - read full article

By: M. Silva, S. Nunes, P. Macedo, A. Figueiredo, A. Fornelos, and D. Maia

Introduction: Stigma can be defined as ‘the co-occurrence of labeling, stereotyping, separation, status loss, and discrimination in a situation where power is exercised” and during the last years the interest in the stigma of mental illness has increased considerably. In fact, evidence exists about the stigmatization of patients with mental illness and stigmatization of psychiatry and psychiatrists. Sometimes not only the general population stigmatise and discriminate mental illness but also the non-psychiatric healthcare professionals.

Objectives and Methods: Review of the literature using medline database to research some topics: (1) Stigma of mental health (patients, psychiatry and psychiatrists), (2) Stigmatization by non-psychiatrists healthcare professionals, (3) Repercussions in physical health of the patients, and (4) How to combat this stigma in general hospital.

Results: Many articles address the stigma of mental illness but most of them report the perspectives of patients, patient’s family and describes the discrimination behavior by general population. There are few studies that discuss this problematic in health professionals but enough to conclude that stigma of mental illness has been identified as a significant barrier to help-seeking and care. In recent decades it has become widely acknowledged that there are physical health disparities between patients with and without mental illness. For this situation contributes: poorer access to physical healthcare, diagnostic overshadowing and the notion that health professionals are not immune to the effects of stigma attached to mental illness, despite formal education in psychiatry. Although “often unintentional” such discrimination remains a major barrier to quality care, treatment and recovery.

Discussion and Conclusions: Stigma is a cruel reality in mental health care and this can negatively impact on physical health outcomes. As professionals, we must always be aware of how our own attitudes may affect our ability to provide appropriate, individualised care. Stigma reduction in healthcare students and professionals needs to be sustained over time if it is to result in positive changes for people living with mental illness. To achieve this, it is necessary education, inclusion of contact with people with mental illness and burnout reduction.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P9

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Job quality and mental health – the role of the economic crisis - read full article

By: Marta Queirós and Marlene Alves

Objectives: Review available literature concerning the impact of the Economic Crisis in Workplace Mental Health focusing mainly on European data.

Methods: Non systematic review using PubMed database with the Mesh words "Job Satisfaction" and "Mental Health". Review of the European Union (EU) Official Publications regarding this subject. Publications dating from 2007 to present were considered.

Results: PubMed database found 126 results from which 13 were considered relevant. Four EU Official Publications available online were also considered relevant.

Discussion: In recent years there has been a substantial change in European workplaces and an increasing concern about job-related mental health. Work-related stress occurs when workers are presented with work demands that are not matched with their knowledge, skills or abilities, and that challenge their ability to cope. The Financial crisis has accentuated some negative aspects of work that influence mental health, such as: workforce ageing, emergence of new forms of employment contracts, increased job insecurity, work intensification, and use of irregular and flexible working time. In 2012, about 20% of workers reported poor mental well-being. As a result, stress, depression and anxiety, were the second most frequently reported work-related health problems in Europe.

Conclusions: Psychosocial risks that negatively impact workers' mental health have been increasing due to the financial crisis. Work-related mental ill-health is a growing public health problem in Europe. Measures must be taken to improve job quality so that these health burdens decrease.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P10

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Implementation of Open Dialogue Approach in Polish mental health structures - read full article

By: Michal Klapcinski, Aleksandra Matuszek, and Renata Wojtynska

Introduction: In Poland since 2013 first one-year Open Dialogue Approach (ODA) courses has been carried out for mental health professionals (MDs, nurses, psychologists, psychotherapists, educators, social workers) ran by Polish Institute of Open Dialogue. Until now more than 50 people working in different professional backgrounds (stationary wards, ambulatory wards, daily clinics, mobile-crisis team, supportive housing facilities) have been trained and started to apply dialogical practices in their daily routine. First ODA practitioners report a significant change in communication patterns that occurs among professionals when dialogical practices are applied.

Objectives: The aim of this poster is to depict current state of ODA application in Polish psychiatric services and to discuss hardships as well as benefits that experience ODA practitioners.

Methods: 87 college students (73.6% girls, mean age 22.74±4.828) completed Portuguese validated versions of the Hewitt & Flett Multidimensional Perfectionism Scale, the Multidimensional Perfectionism Cognitions Inventory (MPCI), the Perseverative Thinking Questionnaire (PTQ), the Profile of Mood States, the Perceived Stress Scale and the Regret Scale (RS).

Discussion: ODA has been developed in Western Lapland [Finland] since early ‘90s. At the outset it was conceived as psychotherapeutically oriented, need-adapted treatment of schizophreniform psychosis. Willing to achieve “wide-range impact” it further evolved into comprehensive model of psychiatric service organization with challenging treatment outcomes (especially regarding sharp decrease in schizophrenia incidence in the catchment area). Meanwhile psychiatry in Poland, for years financially underestimated, leads a transformation, following the guidelines issued in Polish Mental Health Program, where considerable importance is attached to de-institutionalization of mental health structures and to foundation of community based facilities. Bottom-up patients’ family movement put effort into arranging first ODA workshops that where held in Wroclaw in 2012 with its architect Jaakko Seikkula and method’s practitioners. Meeting emphasized the need of further trainings led by experienced tutors. ODA due to its network- and need-adapted orientation may become an eligible standard for community psychiatry training, where shared decision making lie at the core of professionals’ everyday work, stressing the need for other than pharmacological interventions. Furthermore, being an attractive organizational solution it might satisfy demands drawn up by the mental health policy-makers. Well–design surveys that could undoubtedly support method’s replicable outcomes in different settings are required.

Conclusions: To summarize ODA provides a new perspective on mental health care, however multicenter, comparative (at best randomized clinical trials) studies are necessary to assess ODA impact on the long-term outcomes.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P11

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Psychopathology: is it still important for clinical practice? - read full article

By: Ana F. Freitas, A. Gameiro, and H. Esteves

Introduction: In the last years, psychiatry has given primarily importance to the construction of categorical classification systems (DSM and ICD), neglecting the importance of recognizing and describing the signs and symptoms of mental illnesses. On the other hand, the increasing use of scales and questionnaires has further undermine the semiotic investigation, acting as if psychopathology is a transparent instrument in which symptoms are seen as stable entities over time. This idea is wrong, as Jaspers has already postulated, considering psychopathology as a dynamic and continuously evolving entity.

Objectives: To provide a review to understand the importance of psychopathology in today’s psychiatric practice.

Methods: A literature review was taken using PubMed and Medscape databases with the following search terms: psychopathology, practice, importance.

Results: Psychopathology means the study of the diseases of the soul, spirit or mind. It appeared as an organized discipline, in the early XX century, with the publication of Karl Jaspers “Allgemaine Psychopathologie” (General Psychopathology). Psychopathology can be seen essentially from two perspectives: the phenomenological (Comprehensive or Descriptive Psychopathology) and the psychodynamic (Explanatory Psychopathology). In 1952, a categorical system (DSM) appeared with the purpose of facilitating diagnosis and treatment of soldiers. Since then, it has been an important tool, having been revised several times. Other tools appeared and are used currently – such as questionnaires and scales – trying to bring objectivity to clinical practice. In the last 20 years, neurosciences and genomics have also contributed to revolutionary changes in psychiatry. Yet, phenomenological psychopathology maintains a core role in clinical practice and could have an important place in the future growth of scientific psychiatry.

Discussion and Conclusions: Neuroscience and genetics contributions, the use of questionnaires and scales in the clinical evaluation and classification systems, are in fact relevant tools in clinical practice, which importance should not be neglected. However, they should be used with caution, never in a reductionist way, warning about the misunderstanding of pathology as simply check-lists. Instead, they must be understood in a dynamic/longitudinal perspective. In conclusion, it seems that psychopathology continues to be the main discipline in which psychiatric practice relies.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P12

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The EFPT psychoactive substances use disorders (PSUD) study - read full article

By: Duccio Papanti, Matis Martens, Andrew Putskys, Diego Quattrone, Irena R. Palavra, Franziska Baessler, Tomasz M. Gondek, Athanasios Kanellopoulos, M. Casanova Dias, M. Pinto da Costa, and Laura Orsolini

Introduction: Disorders due to psychoactive substance are considered by the World Health Organization as mental disorders, and therefore codified in ICD Classification of Mental and Behavioural Disorders. However, both the role of psychiatrists and trainees in the treatment of addiction and the practices used vary greatly among European Countries.

Objectives: We aim at understanding the attitude of psychiatric trainees towards people who use substances, the use of medications for treating patients with substance use disorders, if they feel confident and skilled to work in addiction psychiatry.

Methods: We drafted a 60 items questionnaire about: the attitude of trainees towards PSUD, PSUD pharmacologic treatment, best practices used, structuration and satisfaction about PSUD training; with the aim of having questionnaires filled out by 40 psychiatric trainees (both from General Adult and Child and Adolescent) per country, in about 20 EFPT partner countries (sample expected population of 800). One national coordinator per country will help in delivering the questionnaires and collect data on an online database.

Discussion and Conclusions: So far we enrolled national coordinators from: Italy, Croatia, Estonia, Lithuania, Portugal, United Kingdom, Germany, Greece and Poland. We still need to reach coordinators from other 11 EFPT partner countries to fulfil the above criteria and start the study. This survey will be the first to explore European psychiatric trainees attitudes and practices about PSUD. Findings from this independent and low-cost survey may serve in understanding the needs of trainees in the field of addiction psychiatry, and about the organization of such training across Europe.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P13

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EFPT health-seeking attitudes and existing support services for psychiatric trainees - read full article

By: Ema Conde, Alice Lomax, Telma Santos, Sonila Tomori, Thomas Pattyn, Celina Skjødt, Teelia Rolko, Laura Shtane, Sigita Rozanskiene, Sigita Rozanskiene, Egle Biliute, Liana Kobylinska, Branimir Radmanovic, Sonja Virag, Sara Meier, Bojana Rueegg, Romy Jost, and Deniz Ceylan

Introduction: Concern for medical doctors’ health has been widely recognized over the past ten years. EFPT is aware of the heterogeneity of support set up for doctors in distress and recognizes the need for further cross-Europe research. This project aims to gather information and carry out research in order to improve services for physician health Europe-wide.

Objectives: The “HELP Project” was designed to investigate psychiatry trainees’ perceptions of and attitudes towards health seeking at a Europe-wide scale. Furthermore, it aims to determine what services are available in Europe specifically to support physicians’ health.

Methods: This is a multinational, cross-sectional survey conducted in 14 European countries. Data collection was accomplished by an anonymous online or hard-copy questionnaire. Completion implied consent to participate.

Results: Of the respondent trainees, 98% said they would have surgery in the public sector, versus 42.3% who agree to get treatment there for an eating disorder, for depression (28.8%) or for addiction (17.3%). Trainees from developing economies were significantly less confident in using public sector help for mental health difficulties. Specific services for doctors only exist in the UK, Spain, The Netherlands and Switzerland.

Discussion and Conclusions: It was striking that for surgical and general medical problems, the majority of trainees would use public sector help, however, for psychiatric illness and substance use disorders, trainees tended to prefer the private sector or said they would not seek help or tell anyone at all. When asked for advice regarding the same problems in their fellow trainees, they said they would recommend public sector help, suggesting doctors may be reluctant to seek help in situations in which they would advise others to seek help. The EFPT believes specialised physician health services are needed to ensure doctors seek help when necessary, while avoiding feeling stigmatised or punished in doing so, particularly in mental health disorders.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P14

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The experience of psychiatry trainees who have participated in the Faculty of Medical Leadership’s National Medical Director’s Scheme in England - read full article

By: H. Ryland, L. Potter, M. Husain, and M. Casanova Dias

Introduction: Leadership is increasingly recognised as an important skill for junior psychiatrists to acquire in order to address the many challenges facing mental healthcare globally.

Objectives: This presentation will provide an insight from the perspective of psychiatry trainees who have participated in a high profile leadership-training scheme established by the UK Faculty of Medical Leadership and Management (FMLM). They will describe their experiences and tips to apply the learnt skills to improve global mental health.

Methods: In 2011 FMLM set up the National Medical Director’s Clinical Fellowship Scheme to provide experiential training for junior doctors from all specialties in a variety of national organisations. These have included NHS England, Health Education England, the National Institute for Health and Care Excellence, the General Medical Council, British Medical Journal and the Royal College of Psychiatrists. Fellowships last for a year and are full time. Each fellow works directly with one of the most senior leaders within the organisation on a range of activities including drafting policy, chairing meetings, developing strategy and liaising with external stakeholders.

Results: The scheme has proved to be hugely popular, with applications far exceeding places available each year. The scheme has expanded from 11 placements in the first year to 29 this year. Participants have reported a wide range of benefits, including exposure to high-level leaders, the opportunity to gain practical experience of national policy making and the benefits of being part of a multi-specialty cohort of their peers.

Discussion: There is an increasing emphasis on the need for psychiatrists across the world to develop leadership skills, but there has been much debate on how to most effectively deliver such training. The National Medical Director’s Clinical Fellowship Scheme provides an intensive and immersive model, which several junior psychiatrists have benefitted from in England. It has a particular focus on experiential learning and on the development of policy at a national or international level.

Conclusions: The FMLM National Medical Director’s Clinical Fellowship Scheme provides a highly successful model of leadership training, which may be of interest to other countries looking to develop similar opportunities.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P15

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Specialty programs in psychiatry in Poland - read full article

By: Irena Wojciechowska, Maja Krefft, Tomasz M. Gondek, and Michal Klapcinski

Introduction: Specialty training in psychiatry in Poland lasts for 5 years (60 months). During this time a trainee is obligated to attend certain internships and courses. In an attempt to prepare physicians to direct clinical work, recently the specialty training program has been updated.

Objectives: The main goals of the specialty training is to achieve theoretical and practical background to diagnose and cure patients according to the latest knowledge.

Methods: Specialty training ensures a robust and strong foundation to build specialist skills.

Results/Discussion: We have our doubts if the new curriculum is actually better. New specialty program consists of six courses and five internships. The most important and the longest among them is the internship on general ward for adults in a clinical ward and in a in-patient ward (40 months). Other internships include: neurology, child and adolescent psychiatry, neuroses treatment and addiction treatment. Compared with the new training program, the previous one consisted of seven obligatory courses and nine internships in: general psychiatry on hospital wards (22 months), the internship on daily ward, in mental health unit, internship in consultant psychiatry, neurology, child and adolescent psychiatry, neuroses treatment and addiction treatment. The last internship is devoted to deepen trainee's own interests in psychiatry. Specialist training in Poland does not contain psychotherapy course. Following successful completion of five years of training, a trainee will take the final exam. Once a trainee has passed the written and oral exam, he becomes a specialist in adult psychiatry.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P16

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Medfest 2015 – Global medicine & civilizations - read full article

By: Khurram Sadiq and Howard Ryland

Introduction: Medfest is an International medical film festival, in its fifth year of inception, this was pioneered by a Higher trainee based in London. Every year there is a specific theme selected for the festival and this year’s theme is Global Medicine & Civilization. Each year a Lead is selected through a strenuous interview process that then selects a team to the lead the events of the year. The committee then selects 6-9 movie clips, from documentaries, movies, news and other sources, relevant to the theme, once permissions are sought from the production houses, a DVD is created. Copies of the DVDs are then sent to the leads. The leads then select a 3-member panel, venue and start advertising the event.

Objectives: (1) To improve the outlook of psychiatry and (2) to help in recruitment of trainees to Psychiatry.

Methods: In 2015, A Medfest Committee was selected that included Local UK liaison, International liaison, European liaison and Medfest Arts & Music Leads. The UK Liaison links with the Psychiatric Society (Psychsocs) lead from the medical school to organize local events. This year, the theme was unanimously agreed by the leads and selected 9 clips in total for the DVD. The clips mainly consisted of documentaries from different regions of the world. Another initiative that is Medfest Music and Arts was finalized with a focus on patient participation for the event. There were two events finalized in Manchester & London and one final Gala event at the Royal College of Psychiatrists HQ London in June 2015.

Results and Conclusions: Medfest 2015 has been a big success with all the local UK events concluded and few International events to follow. We are anticipating an audience of 3000 combined for UK & International events. Most of the International events are in April & May 2015. India’s event has been a huge success with an attendance of around 200.



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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P17

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International experiences that shape professional identities in Hungary - read full article

By: Petra Ulbert, Luca Egervári, Hajnalka Nórándt-Pásztor, Nóra Horváth, Balázs Jeges, Anett Balázs, Attila Nagy, and Tibor Jáger

Introduction: Studying abroad during university or even short term foreign work experiences can have life altering effects by broadening one’s horizon on both personal and professional levels.

Objectives: Our aim was to assess the international experiences and their influences on the professional lives of the members of the Hungarian Association of Psychiatric Trainees (HAPT).

Methods: A survey was sent out to all HAPT members regarding previous international educational experiences and international scientific or clinical work experiences, and their influence on the participants’ professional identities.

Results: Erasmus experiences have been the most popular during university years, few of our members have tried the EFPT Exchange during the past year, some had the chance to attend international congresses and make a poster presentation or publish an article in an international scientific journal during their residency. All of the responders claimed that these experiences had a great effect on their choice of career, work style and their professional identities. However, the majority of the HAPT members have not yet had international experiences to affect their professional lives.

Discussion and Conclusions: Since HAPT was formed 1.5 years ago, we are still in the phase of recruitment, with a larger handful of members. Therefore, our sample was not representative, and our conclusions may not reflect the real conditions in Hungary. Consequently, further surveys will be necessary on this matter. However, we find it important that all responders highlighted the benefits and positive outcomes on their professional lives in relation with their international experiences. It seems that international educational, work or scientific experiences have a beneficial role in shaping professional identities. In the future, we would like to encourage and facilitate these experiences among HAPT members, thus contributing to the national psychiatric training system and our members’ professional identities.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P18

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Migration and brain drain: findings in Portugal - read full article

By: M. Pinto da Costa, Cátia Moreira, Mariana Andrade, Sara Carneiro, Sérgio Saraiva, and the EFPT research group

Introduction: The increasing migration of health professionals to affluent countries, a phenomenon known as “brain drain”, is not a recent phenomenon and has continued to fuel the huge inequities in global health. International professional mobility is inevitable when persons have skills they can put in the global marketplace.

Objectives: This work assessed junior doctors training in psychiatry in Portugal on their opinions and experiences of international migration, the migratory tendency of colleagues to migrate, the push and pull factors that pressure trainees to migrate in Portugal, the patterns of migration, as well as the features of an attractive job, and what should be improved in psychiatry in Portugal.

Methods: A cross-sectional survey was carried out in 33 countries. Hard-copy questionnaires or an online invitation link (surveymonkey) were circulated to junior doctors training in psychiatry in Portugal. The findings gathered through this pilot investigation were discussed based on a bibliographic search using PubMed/MedLine databse with the keywords “Migration” and “Brain Drain”.

Results: A total of 104 questionnaires were collected. From these findings, few respondents were immigrants, and impressively most of the trainees had a Portuguese citizenship. Almost two-thirds did not have a short-mobility experience, and the majority never migrated to another country. From those that did migrate, the majority has moved to neighbouring countries as Spain. Less than half consider staying in Portugal as a working perspective for the next years, and nearly four fifths have ever considered leaving the country. The majority of trainees earn between 1000-1499€, stating to be mostly dissatisfied with this income. Top reason to leave was financial, followed by work and academical. Working conditions ranked first as the priority condition to be improved in psychiatry in Portugal, followed by financial conditions. In fact, an attractive job for psychiatry trainees in Portugal must have as the most important feature a pleasant work environment.

Conclusions: An alarming percentage of psychiatry trainees in Portugal intend to migrate. Financial conditions, future perspectives of their career seem to have a lead role in the migratory tendency in Portugal, with trainees looking for better paid job opportunities and working conditions abroad.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P19

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Polish path to a National Psychiatric Trainees Association - read full article

By: Tomasz M. Gondek, Maja Krefft, Irena Wojciechowska, and Michal Klapcinski

Introduction: A few years ago there was an attempt to establish a national trainee association (NTA) in Poland. In the end, though, there was something lacking and the project was never brought to the close. When there appeared to be little hope to change this fact in the forseeable future, unexpectedly a group of new trainees from Poland attended the EFPT Forum for the first time in 2014. Armed with an uncanny motivation, they wanted to make their mark.

Objectives: Our objective is to establish the Polish Psychiatric Association in 2015, in order to soon become full members of the European Federation of Psychiatric Trainees (EFPT).

Methods: We joined various EFPT working groups, i.a. the ENTA Working Group and determined creating NTA in Poland one of our main goals. In December 2014 we participted in the International Congress of Psychiatry Medforum in Wisla, Poland, to promote EFPT and the idea of establishing the Polish NTA. We agreed to make it a section of the Polish Psychiatric Association (PTP) and received support from the organisation. Later on we promoted EFPT at local PTP meeting in Wroclaw as well as during specialization courses. In April 2015 we issued an official application to create a trainee section at PTP.

Results: Building network across Poland and getting support from decision makers: contact with over 200 trainees from various parts of Poland via e-mail, social networks groups or during psychiatry training courses. Support received from: Department of Psychiatry, Wroclaw Medical University; Lower-Silesian regional consultant in psychiatry; President of Wroclaw section of PTP; Secretary of the Polish Psychiatric Association and other influential members of PTP.

Discussion: We discuss future initiatives of our NTA that lie ahead: promoting EFPT during the conference in Katowice, representing EFPT at Congress in Wisla in 2015 (international societies session, young doctors session), creating a website of the Polish NTA which will include information relevant to trainees, building up further our network.

Conclusions: We discuss future initiatives of our NTA that lie ahead: promoting EFPT during the conference in Katowice, representing EFPT at Congress in Wisla in 2015 (international societies session, young doctors session), creating a website of the Polish NTA which will include information relevant to trainees, building up further our network.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P20

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European Federation of Psychiatry Trainees (EFPT) exchange programme – growing experience in Portugal - read full article

By: Vítor Pimenta, M. Pinto da Costa, Catarina Klut, Cátia Guerra, João C. Santos, Inês Fernandes, Fernando O. Leite, Cátia Moreira, Clara Feteanu, and Marina Fistonic

Introduction: The EFPT exchange programme was created in 2011 as the first exchange programme for Psychiatry Trainees in Europe. Its main goal has been to provide the possibility to undertake 2-6 weeks observational rotations in different countries.

Objectives: The authors intend to update, analyze and characterize the participation of Portugal in the EFPT exchange programme from its beginning up till now.

Methods: All the applications of trainees in Portugal who participated in the EFPT exchange were analyzed, as well as those of the other European colleagues that elected Portugal as their host country for the exchange and completed successfully the exchange in Portugal. The following variables were collected: sex, year of training, specific training programme and chosen city.

Results: Portugal has started the EFPT exchange programme since its inception, having progressively expanded the number of placements available in different cities across the country. Since the beginning, 19 applications for the exchange have been submitted in Portugal, having 18 trainees from Portugal proceeded effectively and participated in the EFPT exchange programme. The majority was female, with a median age of 28 years, and chose the United Kingdom as the preferred destination. Of the 17 applications received 11 foreign trainees came to Portugal to have their exchange. The majority was female, with a median age of 28 years, were at their 1st year of training, and most frequently came from Turkey. Moreover, Porto was the Portuguese city that received the higher number of candidates.

Discussion and Conclusions: The EFPT exchange programme provides to trainees the opportunity to contact with other mental health systems, getting contact with different intercultural aspects of psychiatry, both through clinical and research activities. The EFPT exchange programme in Portugal is having an important role in the improvement of training and psychiatric practice, supporting trainees and contributing to the expansion of the international network of professionals in this area. The increasing participation and increased programme options confirm the relevance and the prestige of this project within the Psychiatry training in Portugal, for which we want to acknowledge the associated Hospitals and Universities in Portugal that enable this.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P21

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Delusional disorder-jealous type: sleeping with the enemy - read full article

By: Adriana Carapucinha and Safira Hanemann

Introduction: Jealousy, the emotional state linked with the desire to preserve one's possession, is a common human response. It may present as the content of a psychopathological phenomenon such as delusions - delusional or morbid jealousy. These terms are sometimes used interchangeably with “Othello’s syndrome”, referring to a delusion characterized by the false absolute certainty of the infidelity of a partner. Delusional jealousy may be associated with several psychiatric and neurological disorders including Delusional Disorders (DD). DD are characterized by the presence of one or more nonbizarre delusions (jealousy, persecutory, somatic, erotomaniac or grandiose) and the relative absence of associated psychopathology. It is classically described that individuals suffering from delusional jealousy frequently harbor varying forms of hostility, posing medicolegal consequence.

Objectives: Concerning a clinical vignette of a patient with DD – jealous type, the purpose of this work is to make a critical review of literature on this disorder.

Methods: A search through electronic databases has been made for original research and review articles using the search terms 'Othello syndrome, morbid jealousy, pathological jealousy, delusional disorders, paranoia'. All literature in English or Spanish dated from twenty years ago onward was examined and 15 articles were selected.

Results: Among 398 patients with a jealousy disorder, only 4% met diagnostic criteria for DD-jealous type. Age at onset is usually middle or late adulthood and the jealous type corresponds to approximately 10% of DD. Depression is more frequent among the jealous and persecutory types. Speech comprehension, executive functioning, attention and verbal memory are functions which appear to be altered in DD. Erotomanic, jealous, and persecutory types might be associated with higher risk for violence.

Discussion: DD is not rare, but DSM criteria might not be inclusive enough to diagnose the jealous type of DD. Despite having some disabilities, “pure” DD seem to have preserved basic social cognitive abilities. Regarding therapeutics aspects, literature is confusing, but the last decade’s results suggest optimism about the potential for treatment effectiveness..

Conclusions: It is concluded that further exploration is required and greater epidemiologic, diagnostic and therapeutic attention needs to be given to Delusional Disorders

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P22

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Olfactory dysfunction in schizophrenia - read full article

By: M. Amélia Aleixo, Cátia Moreira, Gonçalo Sobreira, João Oliveira, and L. Carvalhão Gil

Introduction: The sense of smell and its relation to neurological and psychiatric diseases is a field of growing interest in clinical research. Like other neuropsychological measures, it provides the opportunity to assess brain function in a non-invasive way. Previous research has provided compelling support for olfactory dysfunction in schizophrenia patients, their first-degree relatives, and youth at-risk for psychosis.

Objectives: The authors’ aim is to describe and highlight the clinical and scientific relevance of olfactory dysfunction in schizophrenia patients, their first-degree relatives, and youth at-risk for psychosis.

Methods: A literature search was performed on PubMed database using the keywords olfactory, olfaction, dysfunction and schizophrenia and retrieved papers were selected according to their relevance.

Results: There are robust olfactory deficits in schizophrenia patients that include reduced odor identification, odor detection threshold sensitivity, odor discrimination, odor memory, and odor hedonic judgments. They have also been documented in ultra high-risk cohorts, nonpsychotic first-degree relatives of schizophrenia patients, and in individuals scoring high on psychometrically defined measures of schizotypal personality features. Structural and physiological abnormalities in the underlying neurocircuitry of the olfactory system have been documented, ranging from reduced volume in the olfactory bulbs, posterior nasal cavity, and olfactory eloquent brain regions to abnormal olfactory event related potentials and electro-olfactograms.

Discussion and Conclusions: These findings raise the possibility that these deficits represent a biobehavioral marker of vulnerability for the illness and olfactory measures may be a useful marker of schizophrenia risk status.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P23

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Late schizophrenia in a patient with previous opiate dependence? A clinical report - read full article

By: M. Amélia Aleixo, Cátia Moreira, Gonçalo Sobreira, João Oliveira, and L. Carvalhão Gil

Introduction: Schizophrenia is a severe psychiatric disorder that can cause long-standing impairments in several life domains. Substance abuse disorder (SUD) is very common in psychiatric patients and is associated with worse outcome. In fact, patients with schizophrenia and SUD, when compared to patients with a single diagnosis, have more severe (positive) symptoms, less treatment compliance, more re-hospitalizations, a higher degree of homelessness, and more legal, medical and social problems.

Objectives: The authors’ goal is to understand the complex role of substance abuse disorder in the patients with schizophrenia, more specifically opiate dependence. Additionally we present an illustrative clinical case.

Methods: A literature research was performed on PubMed database using the keywords schizophrenia, substance abuse, opiate dependence and retrieved papers were selected according to their relevance. The patient clinical record was reviewed.

Results: The authors report a case of a 51 year old woman with psychotic symptoms of persecutory and religious content for 4 years. She had tactile, somatic, auditory and command hallucinations. She has a history of cocaine and heroin abuse and she never felt symptoms while she was abusing of heroin or when she was in a methadone program.

Discussion and Conclusions: Despite the clinical presentation may lead us to the diagnosis of late schizophrenia, the opiate dependence may mask the symptoms. Because of that, in this clinical case the duration of the illness may have been longer than expected. It is important to access the history of substance abuse because it may lead to a different course of the disease, outcome and therapeutic approaches.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P24

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Schizophrenia and Fahr disease: a case report - read full article

By: Ana Barcelos and Magda Pereira

Introduction: Schizophrenia enfolds a variety of cognitive and emotional dysfunctions. Its diagnosis involves recognition of a constellation of signs and symptoms associated with functional impairment. Fahr disease, also knowns as idiopathic calcification of the basal ganglia, presents itself as a complex pathology that may arise in neurological and psychiatric context. In this line of concepts, we report a case of a patient presenting with Schizophrenia and Fahr disease.

Objectives: Our purpose is to analyze the process from diagnosis to treatment, of patients that present with psychotic symptoms.

Methods: Review of the literature, clinical interviews, as well as the consult of clinical records.

Results: This case highlights literature findings respecting the expression of symptoms, forcing us to admite that the distinction was not linear and the treatment presented to us as demanding.

Discussion and Conclusions: Both pathologies recognise perceptual distortions and delusions as symptoms. The challenges behind the neuro and psychopharmacological interventions emphasize the need of further research on this matter. This is required to improve the understanding of psychopathology, define incidence and prevalence rates, in order to improve the quality of patient's treatment.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P25

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Suicide among lesbian, gay, bisexual, and transgender individuals - read full article

By: Ana R. Figueiredo and Tânia Abreu

Introduction: Mental disorders constitute the most important risk factor for suicidal behaviour. Studies have found that LGBT (lesbian, gay, bisexual, and transgender) individuals are at increased risk for mental health problems, as a consequence of an hostile and stressful environment. There has been an historical pathologization of sexual orientation and gender identity; however, lately there have been significant changes in medical understanding about this theme.

Objectives: The authors aim to determine the possibility of increased suicidal ideation/suicidal behaviour among LGBT individuals.

Methods: Review of the literature using the terms LGBT, lesbian, gay, bisexual, transgender, sexual orientation, gender identity, suicide, suicidal ideation and suicidal behaviour.

Results: Studies provide evidence that individuals in a sexual or gender minority are at greater risk for suicidal thoughts and behaviours. There is evidence of elevated rates of reported suicide attempts in LGBT compared to heterosexual adolescents and adults, worldwide. Individuals reporting a bisexual orientation had an increased risk of suicide attempts and ideation compared with their homosexual and heterosexual peers.

Discussion and Conclusions: Mental disorders do not appear to entirely explain elevated rates of suicide attempts in these individuals. Social stigma, prejudice and discrimination associated with this individual are important factors. Health professionals should be aware to the higher risk of suicidal behaviour in lesbian, gay, bisexual and transgender people. Further research is needed in order to prevent suicide in these populations.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P26

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When wives are diagnosed with breast cancer – psychopathology in partners, a review - read full article

By: Ana R. Figueiredo, Susana Nunes, Mariana Silva, Pedro Macedo, and Antónia Fornelos

Introduction: Breast cancer is the most common malignant tumor in women. This diagnosis affects not only the patients, but also their partners. The development of physical and psychological symptoms of stress in breast cancer survivors is affected by the partners support and vice versa.

Objectives: Assessment of the eventual existence of psychopathology in the partners of patients with breast cancer.

Methods: Literature review using the terms breast cancer, partners, spouses, psychopathology, psychological/psychiatric symptoms, depression, anxiety.

Results: Partners of patients with breast cancer are the most involved family members in their support. In one article, these individuals reported feeling "in limbo". They may have difficulties in social, sexual and emotional adjustment and in marital relationship. While some studies show that a small proportion of partners present high levels of long term anxiety, others show that they are subjected to a higher stress level, psychiatric morbidity and increased risk of developing depression. They visit the physician more often for somatic and psychological symptoms, and are at greater risk of being hospitalized with affective disorder. The social support has influence in Depression, through various coping mechanisms.

Discussion and Conclusions: Facing a threatening event (diagnosis, consultation surveillance and results) can be seen as an interpersonal experience shared by the couple. Higher quality of relationship predicted better mental health in patients with breast cancer. Greater quality of their physical health predicted higher quality of mental and physical health in the partners. Further research is necessary, to identify and create assessment and assistance strategies to these partners with psychopathology.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P27

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“Psychogenic psychosis and the ongoing debate of the “third psychosis” - read full article

By: André Sousa, Corona Solana, Joana Gomes, Guida da Ponte, and António Paiva

Introduction: The existence of acute psychoses of short duration, often associated with an intense symptomatology, but also full remission, has always been described over the last two centuries. The concept of psychogenic psychosis was first published in 1916 by August Wimmer, and is widely used in scandinavian countries. According to Wimmer, psychogenic psychoses are etiologically defined as psychoses apparently caused by a mental trauma in predisposed individuals. The traumatic stress determines the content and the course of the psychotic reaction, which tend to remit in days to weeks.

Objectives: To make an historical review of the concept of psychogenic psychosis and discuss the debate over the classification and description of acute and transient psychosis.

Methods: A bibliographic review is made of the psychogenic psychosis, based on the data published in PubMed.

Results: The studies demonstrate a considerable prevalence of this clinical entity among all psychiatric admissions in scandinavian countries.

Discussion: After Emil Kraepelin’s division of the so-called endogenous or functional psychoses into a group of dementia praecox and manic-depressive insanity, some of the acute, brief, transient and good prognosis psychoses were classified as schizophrenia and some others as belonging to the affective category. However, the possibility of a "third psychosis”, apart from the Kraeppelin dychotomia system has always been debated since then. Such different concepts as the "bouffée delirante", "cycloid disorders", "atypical psychosis" and "reactive or psychogenic psychoses" have influenced this debate, lasting until our days. The concept of psychogenic psychosis through most of the 20th century has been widely used in the scandinavian countries for a major group of the so-called functional psychoses, separate from manic-depressive psychosis and schizophrenia. However, since Wimmer's works had not been translated from danish into any other language until recently, his contribution must surely be one of the least frequented in other countries.

Conclusions: The phenomenology and classification of acute and transient psychotic episodes with good prognosis has always been a matter of discussion in psychiatry. Thus, it is important to review and acknowledge this entity in order to strength the debate of the classification of the episodes mentioned above.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P28

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Delusion of pregnancy and pseudocyesis - read full article

By: Antónia Fornelos, Pedro Macedo, and Filipa Veríssimo

Introduction: Reports in delusion of pregnancy literature are rare and there are no specific epidemiological data on its prevalence. Although not being nosologically specific, these delusions can occur in several mental disorders. This mental illness has been reported in association with the use of antipsychotics, emotional conflicts, adverse life experiences and severe depressive symptoms. In what concerns to the differential diagnosis pseudocyesis should not be forgotten. This is understood as a form of hysterical neurosis, resembling in every aspect to a real pregnancy except, obviously, in the presence of the fetus.

Objectives: This research aims to clarify the notions of pseudocyesis and delusion of pregnancy and discuss their clinical implications and therapeutic approaches.

Methods: A literature review of scientific articles was conducted about this issue through the PubMed database.

Results: Despite the lack of specific epidemiological data, it is known that the delusion of pregnancy usually arises in developing countries. It can occur in schizoaffective and schizophrenic psychoses, epilepsy, depression and dementia. The reported cases in male appears as a percentage equal to or higher than females. The delusion of pregnancy has been reported in association with iatrogenic hyperprolactinemia. The emotional conflicts as the intense desire to become pregnant or fear that to happen, adverse life events and severe depressive/anxiety symptoms may be on it´s origin. Certain cultural beliefs, a sudden weight increase or social isolation can similarly take the patient to dysfunctional interpretations of body sensations. Delusion of pregnancy and pseudocyesis are related. The first one usually appears as a symptom of a psychotic disorder. However, this can precede the physical symptoms present in pseudocyesis. In the latter condition the woman believed to be pregnant, developing some of signs and symptoms of pregnancy such as abdominal enlargement, amenorrhea, feeling fetal movements, gastrointestinal discomfort and breast and/or genital changes.

Discussion/Conclusion: This study presents a brief survey of the literature on delusion of pregnancy and pseudocyesis. This aims to encourage a holistic and comprehensive approach to these disorders, taking into account the complex nature of pregnancy.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P29

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Kretschmer's syndrome of sensitive delusions - read full article

By: Catarina P. Ferreira, Maria J. Avelino, Susana Alves, José M. Jara, Ciro Oliveira, and José Salgado

Introduction: Kretschmer's syndrome of sensitive delusions is a self delusion that occurs in patients with sensitive Kretschmer character and develops after a triggering traumatic event in patient’s life, like a discussion or a humiliation. The delusion may be of several types, from persecutory, to guilt and/or ruin. Hallucinations may also be present. It is fundamental to establish an early diagnosis in order to improve the prognosis of this disease.

Methods: This work presents a systematic review about Kretschmer's syndrome of sensitive delusion and reports a real clinical case as an example, describing and explaining the so called sensitive personality that predisposes to that kind of delusion.

Results: Female, 50 years old patient, with obsessive and dependent traits of personality, history of sad mood and possibly depressive disorder since her father’s disease diagnosis in 2011. After a humiliating triggering event in patient’s life, psychotic symptoms developed, with auditory hallucinations as commentator voices and self-reference delusions. Besides that, the patient presents with major depressive symptoms, probably with suicide ideation (which the patient probably hides).

Discussion and Conclusions: Kretschmer sensitive delusions generally appear in subjects with a predisposing character named Kretschmer sensitive personality. These individuals are usually hypersensitive, demanding, with high moral principles and hardly deal with errors or frustrations. When a given triggering event happens they may have a psychotic development with escalation of their previous personality traits. A depressive disorder may precede or follow the delusion. Psychotic depression usually occurs in association with a pre-morbid sensitive Kretschmer character. In that case the patient develops the so called Kretschmer's syndrome of sensitive delusions. It is therefore fundamental to perform a complete clinical history, investigating the premorbid personality of the patient. An early and correct diagnosis allows an earlier institution of treatment and therefore a better outcome for the patient.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P30

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Circadian rhythm and affective disorders - read full article

By: Cátia A. Moreira, Gonçalo Sobreira, João M. Oliveira, M. Amélia Aleixo, and Ana Ramos

Introduction: The study of molecular clock mechanisms in psychiatric disorders is gaining significant interest due to data suggesting that a misalignment between the endogenous circadian system and the sleep-wake cycle might contribute to the clinical status of patients suffering from a variety of psychiatric disorders, including affective disorders.

Objectives: The aim of this study is to review scientific literature regarding the circadian rhythm and his effect on affective disorders.

Methods: A non-systematic review of English scientific literature was conducted, through research in the PubMed search engine, using the keywords "Circadian Rhythm" and "Affective Disorders".

Results: Mood disorders such as major depressive disorder and bipolar may be more prevalent in individuals that are born with an abnormally shifted or arrhythmic clock. Indeed, abnormal circadian rhythms in a variety of bodily functions (body temperature, plasma cortisol, norepinephrine, thyroid stimulating hormone, blood pressure, pulse, and melatonin) have been found in depressed and bipolar patients. Interestingly, these rhythms seem to return to normal with antidepressant or mood stabilizer treatment and patient recovery. Furthermore, genetic sleep disorders such as familial advanced phase sleep syndrome or delayed sleep phase syndrome are both highly co-morbid with depression and anxiety.

Discussion and Conclusions: The connection between mood disorders and circadian rhythms is becoming increasingly clear. Studies examining the biology behind this association and the clock’s influence on mood are now being conducted. These studies should provide valuable information in terms of our overall understanding of the development of mood disorders and the most appropriate ways to treat them.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P31

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First episode psychosis service – one year of experience - read full article

By: Cátia A. Moreira, Gustavo Jesus, Catarina Ferreira, Bernado C. Neves, Filipe Gomes, Marco Duarte, José Jara, Rita Mateiro, Maria J. Avelino, Ana Ramos, and José Salgado

Introduction: In the last few decades, substantial research has focused on the possibility of early detection and prevention of the first psychotic episode in young individuals at risk. Subtle motor, emotional, cognitive, and behavioral changes are often observed in young individuals who later develop schizophrenia, leading several authors to hypothesize that early detection and prevention strategies may provide an opportunity to reduce the incidence of an unfavorable outcome of the disease. The First Episode Psychosis Service of Centro Hospitalar Psiquiátrico de Lisboa (CHPL) was developed in 2014 and is an integrated and comprehensive inpatient service aimed at addressing the needs of people with emerging psychotic disorders.

Objectives: This study pretends to present the preliminary results from a descriptive analysis of patients admitted to the First Episode Psychosis Service of CHPL.

Methods: For obtaining clinical data, the authors reviewed a database containing all patients who had been admitted to first episode psychosis unit during the year of 2014. Statistical analysis was performed using SPSS®.

Results: A total of 91 patients were included in the study. Among these, 60.44% were male, 71,91% were single and 44,94% were unemployed. The average age of onset was higher in women. The mean of Duration of Untreated Psychosis (DUP/ weeks) was 26. The great majority of patients were treated with atypical antipsychotics and Olanzapine was the most used drug.

Discussion and Conclusions: The results of this study are in line with the literature. The type patient admitted to First Episode Psychoses Service is a single, unemployed and male patient without a psychiatric history and no drug use. This study represents the first step of a wider study being conducted in CHPL on the subject about first Psychosis episode in CHPL.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P32

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Suicide and Schizophrenia - read full article

By: Cátia A. Moreira, Inês Capeto, Margarida Bairrão, Leonor Queiroz, and Maria J. Carnot

Introduction: It is generally acknowledged that over 90% of those who commit suicide have a psychiatric diagnosis at the time of death. The presence of psychiatric illness is an important risk factor for suicide, and different risk profiles may emerge for different diagnoses. Among the various psychiatric illnesses, schizophrenia (19–46%) and mood disorders (28–62.4%) account for a high portion of suicide attempters/victims, and are known to be the most frequent risk factors for suicide. Patients with schizophrenia experience personal distress, socio-occupational dysfunction and reduced expectancy.

Objective: The aim of this study is to review scientific literature regarding suicide ideation among schizophrenic patients.

Methods: A non-systematic review of English scientific literature was conducted through research in the PubMed search engine, using the keywords “Suicide” and “schizophrenia”.

Results: The risk factors with a strong association with later suicide include: being young, male, and with a high level of education. Illness-related risk factors are important predictors, along with number of prior suicide attempts, depressive symptoms, active hallucinations and delusions, and the presence of insight all having a strong evidential basis. A family history of suicide and comorbid substance misuse is also positively associated with later suicide. The only consistent protective factor for suicide was delivery of and adherence to effective treatment.

Discussion and Conclusion: Prevention of suicide in schizophrenia relies on identifying those individuals at risk, and treating comorbid depression and substance misuse, as well as providing the best available treatment for psychotic symptoms.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P33

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She loves me, she loves me not: an atypical case of De Clèrambault syndrome - read full article

By: Célia Soares, Ricardo Ribeiro, and Natália Fernandes

Introduction: The De Clèrambault syndrome (DCS) or erotomania is a rare disorder characterized by a delusional conviction of being loved. Because of its rarity it is difficult to study and its classification as a nosological entity has been a matter of disagreement. According to the available knowledge the course of DCS is chronic and the prognosis is poor with severe impairments to the patients and families.

Objectives: The purpose of this work is to review the available literature about DCS published in the last decades and to present a case followed in our hospital.

Methods: A systematic review of DCS was carried out by searching the database Medline/PubMed comprising the articles published since the first description of this form of pathological love. An atypical case report is described and analyzed based on the reviewed literature.

Results: A 23-years-old man, with no previous history of psychiatric or medical history and no history of alcohol or substance abuse. He was admitted in our urgency for a psychiatric assessment because of a stalker behavior to a girl of the same social status that he believed to be loved by, despite the fact that she had done nothing to sustain that belief. No other psychiatric comorbidities were presented at admission or during the time of follow-up. The delusional system was intense and remained untouchable after 3 hospitalizations with psychotherapy and pharmacotherapy interventions. At the time of the last observation he was still symptomatic.

Discussion/Conclusions: This case shows an atypical presentation of the disorder and states the need for further studies in order to promote a better understanding of the disorder and to offer a satisfactory treatment for affected patients.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P34

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Bereavement and depression: a review concerning the DSM-5 - read full article

By: Filipa Novais and Luís C. Pestana

Introduction: One of the most significant decisions of the recent 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) of the American Psychiatric Association was the elimination of bereavement exclusion criteria in Major Depressive Disorder. Some authors have seen this change as a positive development in psychiatry allowing early diagnosis and appropriate treatment of depressive syndromes that are associated with bereavement as significant life event. Others relate this change with another attempt to classify as pathological the normal human reactions.

Objectives: This work aims to review the validity of elimination of bereavement exclusion criterion in major depression in the new classification of the DSM-5.

Methods: In this study, we performed a search on the Anglo-Saxon literature. The EMBASE, MEDLINE and PubMed were consulted retrospectively by the year 1960, using the following key words: "bereavement", "depression", "DSM 5","ICD""criteria","mood disorders". A total of 20 articles were considered relevant to this review, including original research papers and review articles.

Results: Studies attempting to establish whether there are differences between depression associated with grief or not related to this event found some differences between patients. In depression associated with bereavement there was a higher probability of late onset, African-American ethnicity, less problems in social functioning, fewer symptoms of fatigue, feelings of worthlessness and suicidal ideation than in individuals with depression not related with bereavement. However, the similarities, in most studies, outweigh the differences and there are no randomized controlled studies that distinguish depression associated with bereavement from depression associated with any other significant event.

Discussion and Conclusions: Most studies seem to support the decision of the elimination of bereavement as exclusion criterion. However, major depressive disorder as defined by DSM 5 has yet to be definitively validated.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P35

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Can we predict de novo psychopathology after refractory temporal epilepsy surgery? The role of predisposing and related factors - read full article

By: Filipa Novais, Ricardo Prata, and Luís C. Pestana

Introduction: The gold-standard treatment in refractory epilepsy is the surgical ablation of the epileptic focus. However, while most patients can be “cured” with dramatically improvement in their quality of life, others show de novo psychopathology and changes in behaviour and personality.

Objectives: We aimed to study de novo psychopathology after epilepsy surgery as well as predisposing and related factors.

Methods: We performed a search on the Anglo-Saxon literature, the EMBASE, MEDLINE and PubMed were consulted using the following key words: "epilepsy”, "psychopathology”, personality", “behaviour", “outcome” and "surgery".

Results: After temporal epilepsy surgery, 9,6 to 31% of patients may refer the onset of new psychiatric problems. On the other hand 15% to 54% report the resolution of previous psychiatric diagnoses. The most common reported de novo diagnoses were depression, anxiety, organic mood and personality disorders there are also reports of the emergence of psychosis possibly related to “forced normalization”. Psychiatric diagnoses appear to be more common in patients with right temporal lobe seizure focus, preoperative postictal psychosis, younger age at surgery, temporal lobe epilepsy, poor family adjustment to life after surgery, preoperative psychiatric history and ongoing seizures postoperatively. However these finding are not consistent across different studies and conflicting results have been reported. Beside psychological factors such as the burden of normality and disturbed family dynamics, biologically, the disruption of mesial temporal structures via mesial temporal lobe resection may contribute to the emergence of these side effects considering its role on mood and psychosis. On the other hand personality scales show improvement in some aspects such as a decrease in interpersonal sensitivity, irritability, and social introversion suggesting greater social desirability and self-control abilities.

Discussion and Conclusions: There is still little research on other kinds of surgery as well as what concerns the study of predictors of psychiatric side effects. This study emphasises the importance of pre and post psychiatric evaluation of patients submitted to epilepsy surgery.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P36

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When Sound is not of Music: psychotic depression in a nun with Parkinson’s Disease - read full article

By: Filipe F. Almeida, Joana A. Ribeiro, and Carlos Ramalheira

Introduction: Psychotic symptoms occur in 4% of patients with Parkinson’s Disease (PD) and its management remains a challenge. In this work, we report a case of psychotic depression in PD.

Objectives: To discuss an integrated approach toward treating psychiatric and motor symptoms in PD.

Methods: After admission for inpatient treatment, we interviewed and performed regular neurological examinations on R., a 59 year old nun, diagnosed with PD 10 years ago and treated with several dopaminergic agents (ropinirole, carbidopa+levodopa and entacapone). R. started developing delusions of guilt and auditory hallucinations two months before presenting to our hospital. At our first interview, she described hearing accusatory voices and had become convinced she had committed sins that would cause her to be expelled from her congregation. Furthermore, some traits of an obsessive personality became apparent and fellow nuns reported severe hoarding behaviour.

Results: After suspending ropinirole and entacapone, reducing the dose of carbidopa+levodopa and introducing clozapine, quetiapine and clomipramine, we observed a marked improvement in the patient’s condition. The hallucinations and delusions gradually stopped, mood and social behaviour improved greatly. Tremor increased slightly, but to a degree the patient was comfortable with.

Discussion: A predisposition toward obsessive ruminations seems to have, on the one hand, caused a negative view of PD in our patient, leading to an aggressive treatment with high doses of dopaminergic agents and, on the other hand, paved the way to a severe depression. We believe an interplay of both these factors was the key to the appearance and specific presentation of these psychotic symptoms. Conclusions: Considering the frequency of psychiatric symptoms in PD, there must be great care in taking a global approach. A careful interview and neurological examination, together with a strong knowledge of psychoactive and antiparkinsonic medication, are crucial.


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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P37

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Anxiety and depression: towards a CBT competencies model in children and adolescents - read full article

By: I. Peixoto, R. Velasco Rodrigues, and C. Marques

Introduction: There is a myriad of evidence-based and empirically supported cognitive behavioral treatments for child and adolescent anxiety and depressive disorders. However, there is now substantial research indicating that such interventions might be less effective when applied to clinical populations or with more complex psychopathology. A model of cognitive behavioral therapy (CBT) specific competencies in this population is thus crucial for the integration of the best available research with clinical expertise.

Objectives: Summarize and review pros and cons of the current interventions and the mounting efforts in the development of a CBT competencies model, providing data for innovative clinical training and the integration and implementation of psychotherapy skills in daily practice.

Methods: Selective review of the evidence was conducted with a computerized search on PubMed (MEDLINE). Review of empirically supported manuals in the treatment of child and adolescent internalizing disorders.

Results: Although there is consistent positive data regarding the outcomes of CBT interventions in children and adolescents with anxiety and depressive disorders, there is still little evidence concerning their translation into clinical practice particularly in adapting treatment sessions flexibly for child development and family factors. New approaches taking such aspects into account are growing, namely modular interventions and a set of generic, CBT, and of specific CBT therapeutic competencies model.

Discussion: The development of manualized CBT interventions allowed significant advances in the field of child and adolescent anxiety and depression study and treatment. However their weak dissemination potential, the substantial overlap between protocols and the encouragement of a categorical thinking of psychopathology dampen their consensual acceptance in clinical practice. A modular approach to treatment preserves the benefits of standardization inherentin manualized protocols while allowing flexibility through the use of a guiding algorithm for the application of individualized treatment techniques and might prove beneficial. The current development of a set of therapeutic competencies will probably overcome challenges while providing a solid training curriculum.

Conclusions: These integrative approaches will continue to provide a conceptual framework for operationalizing clinical competencies needed by therapists treating children and adolescents with internalizing disorders.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P38

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Boufée délirante in the contemporary psychiatric nosology - read full article

By: João Perestrelo, Ana Coutinho, and Georgina Lapa

Introduction: The French nosological concept of bouffée délirante (literally “delusional flush or rush”) may define a subgroup of non-affective, acute remitting psychoses with an especially favorable prognosis. To date, relatively little published literature is available about this entity.

Objectives: To discuss the concept, nosological status, diagnostic features and associated clinical characteristics of bouffée délirante.

Methods: A literature review of the theme is surveyed. Several articles were search on MEDLINE with the key-words: bouffée délirante, acute psychosis and acute paranoid reaction.

Results and Conclusions: Bouffée délirante is a historic French diagnostic term used in the past to describe a short-lived psychosis. It was termed differently in ICD-10 (described as acute and transient psychotic disorders) and DSM 5 (brief psychotic disorder). The key diagnostic features are acute, floridly psychotic symptoms with complete remission.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P39

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Hyponatremia and Psychosis: a case report with review - read full article

By: João Perestrelo, Ana Coutinho, and Georgina Lapa

Introduction: Hyponatraemia is known to occur as a rare but clinically important adverse reaction to treatment with different psychotropic drugs, including selective serotonin reuptake inhibitors and antiepileptic drugs. In past decades, reports have been published that describe the development of hyponatraemia in association with antipsychotic drug treatment. Our objective was to review the available evidence on antipsychotic-induced hyponatraemia.

Methods: The authors present a case report of a 56 years old woman with the diagnosis of Schizoaffective Disorder taking antipsychotics (clozapine and haloperidol). At the admission she had a serum sodium of 120 mEq/L without any symptomatology. The sodium was corrected with hypertonic solution with an improvement in psychotic symptoms. A literature review of the theme is surveyed.

Results and Conclusions: The incidence of hyponatraemia induced by antipsychotics may be much higher than is currently thought. Both the newer atypical antipsychotics and the older drugs have been associated with the development of hyponatraemia. Physicians, psychiatrists and other healthcare workers should be aware of the possibility of hyponatraemia associated with the use of antipsychotics. Further studies are required to establish the risks of and risk factors associated with antipsychotic-induced hyponatraemia.



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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P40

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Late-onset schizophrenia: a review - read full article

By: João Perestrelo, Ana Coutinho, and Georgina Lapa

Introduction: Although schizophrenia is generally regarded as an illness with onset in late adolescence or early adult life, a sizeable minority of patients first become ill in middle or old age. Inconsistencies in diagnostic systems and nomenclature have led to such cases occupying an ambiguous position in relation to schizophrenia.

Objectives: The concept, nosological status, diagnostic and associated clinical features involved in late-onset schizophrenia are reviewed.

Methods: A literature review of the theme is surveyed. Several articles were search on MEDLINE with the key-words: late-onset schizophrenia, very late-onset schizophrenia AND late-onset psychosis.

Results and Conclusions: In terms of epidemiology, symptom profile, and identified pathophysiology, the diagnosis of late-onset schizophrenia (illness onset after 40 years of age) has face validity and clinical utility. General adoption of this category will foster systematic investigation of such patients.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P41

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Relevance of allostatic load concept – the new notion describing course and outcome of schizophrenia - read full article

By: Maja Krefft, Dorota Frydecka, and Blazej Misiak

Introduction: Allostasis is the process that allows the achievement and maintenance of stability through physiological changes. The main mediators of allostasis are hypothalamic-pituitary-adrenal axis hormones, catecholamines, neurotrophins, cytokines and oxidative stress mediators. Allostatic load (AL) refers to variety of mechanisms that are activated in response to stress exposure. Permanent overactivation by chronic stress may lead to maladaptive disease outcomes and this process is called allostatic overload. Several physical health impairments such as obesity, hypertension, type 2 diabetes or cardiovascular diseases might be caused by overload of mechanisms that are responsible for maintaining homeostasis and by overproduction of stress mediators.

Objectives: The aim was to provide an evidence that schizophrenia can be perceived in terms of the AL concept with summarizing the current state of understanding on this topic, introducing the AL paradigm as a novel model to explain the course and outcome of this severe mental illness.

Methods: Authors, relying on previously published literature, provided a constructive analysis of the publications in a field of schizophrenia research and the AL paradigm, through description, specification, comparison and summary.

Results: The AL concept provides possible explanation for the causes, course and outcome of several mental disorders including affective disorders, post-traumatic stress disorder, substance use disorders and Alzheimer’s disease. Our group has provided evidence that schizophrenia might be another psychiatric disorder perceived in terms of the AL concept.

Discussion: Schizophrenia is a chronic mental disorder with multiple psychopathological domains including positive, negative and affective symptoms, as well as cognitive impairment. Importantly, schizophrenia has been linked to poor physical health status that contributes to excessive mortality. Above mentioned mediators of allostasis are increasingly recognized as core factors in the pathophysiology of schizophrenia.

Conclusions: Overwhelming evidence indicates that chronic exposure to stress represents an important etiological and prognostic factor in schizophrenia. This sheds a new light on the biological and clinical sequelae that occur throughout the course of schizophrenia. Therefore, this severe mental illness can be described in frame of the AL concept providing the consensus between neurodevelopmental and neuroprogressive models of schizophrenia conceptualization.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P42

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“Raro” – Conrad’s trema stage in a Spanish patient - read full article

By: Marco Duarte, Corona Solana, Filipe Gonçalves, Inês Capeto, and Rita Mateiro

Objectives: Increase the awareness about cycloid psychosis.

Methods: Case report of a patient with a cycloid psychosis that exhibits Conrad’s prodromal symptoms in a second psychotic episode. Review of literature about the subject.

Results: We present a case of 31 year old woman, Spanish resident admitted to the acute inpatient unit, after observation in the emergency service with a psychosis NOS diagnose (10th International Classification of Diseases (ICD 10) – F 29). Two weeks before, she started to feel “raro” (strange, different) and could not explain why. In the week before, she watched a talk show about a rare disease with a Portuguese doctor; she found similar cutaneous spots in her arm and the doctor nose, so she started thinking that everything made sense. She also thought that people in street started to call her “cerda” (hooker). Then she drove from Catalonia to a village near Lisbon. The next day she was taken to the emergency with an unspecific thoracic pain. Previously she had been admitted to psychiatric hospital in Spain around 2010 for another psychotic episode. After discharge, she gradually stopped the medication and consultations, returned to work, apparently with the same premorbid functioning. Treatment with a second generation antipsychotic was effective. In 6 days the delusions and hallucinations were no longer objectified. Two weeks, she was discharged and returned to Spain.

Discussion and Conclusions: The first publication of a psychopathological disorder characterized by sudden onset, polymorphous psychotic symptoms and recurrent course was made by Magnan in the 1880. Since then several studies addressed the nosological classification of this disorder, either as an independent diagnose, atypical variant of affective disorders or atypical form of schizophrenia, but no consensus was found. In the ICD 10 is found in the group F 23 - Acute and Transient Psychotic Disorders. In this patient, despite a previous psychotic episode, we can observe the different stages describe by Conrad in 1958 in the formation and maintenance of a primary delusion. The authors found no consensual guidelines regarding the treatment or the prevention of new psychotic episodes. Randomized studies are need to help to clarify this diagnose and treatment.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P43

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Pregnancy in bipolar disorder - read full article

By: Corona Solana, André Sousa, and Marco Duarte

Introduction: Bipolar disorder is a chronic psychiatric illnesses characterized by alternating episodes of mania/hypomania and major depression, or with mixed features. They represent a spectrum of illnesses characterized by frequent relapses, symptom recurrences, and persisting residual symptomatology. Both acute exacerbations and maintenance treatment with appropriate pharmacotherapy (e.g. mood stabilizers and antipsychotic) are mandatory. Long-term treatment with mood-stabilizing medications is typically required. Bipolar disorder has an estimated lifetime prevalence of 3%–7%. The incidence of bipolar disorders in women during the primary reproductive years is very high, raising the possibility of considerable bipolar illness burden during pregnancy and the postpartum period. Episodes of mania or depression are thought to occur in an estimated 25%–30% of women with bipolar disorder during pregnancy.

Objectives: Provide a clinically focused review of the available information on the effectiveness and safety of the different pharmacotherapies in the treatment of bipolar disorder during pregnancy.

Methods: A bibliographic review is made of the pregnancy in bipolar disorder, based on the data published in PubMed.

Results: The treatment of bipolar disorders during pregnancy presents numerous clinical challenges. Clinical decision making about the use of mood stabilizers and atypical antipsychotics by pregnant women can be conceptualized as balancing the competing risks imposed by withholding or stopping pharmacotherapeutic treatment (thus increasing the risk of maternal and fetal/neonatal harm from untreated illness or acute relapses) against that of continuing or initiating pharmacotherapy during pregnancy (thus introducing the possibility of fetal/neonatal harm associated with in utero medication exposure). Some of the most effective pharmacotherapies (such as valproate) have been associated with the occurrence of congenital malformations or other adverse neonatal effects in offspring. There is few information about the safety profile and clinical effectiveness of atypical antipsychotic drugs when used to treat bipolar disorder during pregnancy.

Discussion and Conclusions: Treating women with bipolar disorders during pregnancy is a challenge. There are no uniformly effective or risk-free treatment options. Fully informed decision making requires the review of the risks of both untreated maternal bipolar disorder and risks associated with each potential intervention, and the discussion of all reasonable treatment options.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P44

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Natural causes of death in persons with schizophrenia: review of European literature - read full article

By: Tomasz M. Gondek, Anna Królicka, Patryk Piotrowski, and Andrzej Kiejna

Introduction: Schizophrenia is a chronic mental disorder which, apart from being associated with a significantly higher suicide risk when compared with the general population, is characterised by an increased risk of developing a comorbid somatic disease. Elevated mortality rate from natural causes of death in persons with schizophrenia is currently one of the most important challenges for mental health policy in Europe.

Objectives: We reviewed the current literature on this subject to establish what are the most prevalent causes of death in persons with schizophrenia in Europe and what are the mortality ratios for the respective natural causes of death.

Methods: We searched PubMed database for articles in English, using MeSH (heading: schizophrenia with subheading: mortality; combined with heading: Europe). Publication years were limited to 2009-2014. The articles were then analyzed in order to find relevant data regarding the natural causes of death in patients with schizophrenia.

Results: Fifty articles met the search criteria. Eleven of them concerned somatic comorbidity and mortality from natural causes in schizophrenia. According to the current data, the majority of schizophrenia patients die due to natural causes, with cardiovascular diseases being prevalent among them. The patients are characterized by increased standardized mortality ratios for natural causes of death compared to general population, which contributes to the existence of mortality gap and reduced life expectancy.

Discussion: Compared to the data from the past decades, there were significant changes to the most frequent causes of death in persons with schizophrenia. Recent reviews of literature on this matter confirm our results: the leading causes of mortality in schizophrenia are currently natural causes, similar to those in general population.

Conclusions: Despite the elevated risk of suicide and other unnatural causes of death during the course of schizophrenia, the majority of persons with this diagnosis die due to natural causes, most frequently cardiovascular diseases. Despite the recent advances in treatment of psychotic disorders, there is still a siginificant mortality gap between the patients and general population, which is mainly a consequence of the excess mortality from natural causes. This issue warrants further attention from the researchers and health policy-makers.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P45

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Are people with schizophrenia more violent than the general population? – A look towards the stigma on mental illness - read full article

By: Zita Gameiro, Filipa Freitas, and H. Esteves

Introduction: Mental illness and mentally ill patients are surrounded by stigma and discrimination. Stigmatizing views about mental illness include the belief that psychotic patients, particularly those with schizophrenia, are violent persons. However, violent behaviour is quite uncommon among patients with schizophrenia. On the other hand, being object of society stigma and discrimination may increase the unemployment and the feeling of not being part of anything and decrease the social network, self-esteem and the financial income of patients. These findings have been related with violence in the general population.

Objectives: The author’s goal is to review the literature concerning the prevalence rates of violent behavior among schizophrenic patients in comparison with the same prevalence rates in general population. The authors also aim to understand whether there are grounds for the generic attribution of violence to these patients. Additionally we try to find which factors increase the risk of violence in schizophrenia patients.

Methods: A literature search was performed using the following key words schizophrenia, violent behaviour, violence prevalence and stigma and retrieved papers were selected according to their relevance.

Results: Patients diagnosed with schizophrenia are four to six times more likely to commit a violent crime than the general population. However, a significant amount of the excess risk appears to be mediated by substance abuse comorbidity. In fact, the risk of violence in schizophrenia patients with substance abuse is similar to that of substance abusers without psychosis. Due to the fact that schizophrenia is a disease with a prevalence of only 1%, even an increased risk of violent behaviour still remains a low absolute risk. In Western countries the homicide acts committed by schizophrenia patients are around 6%. Younger age, male sex, being single, lower socioeconomic status, refusing treatment, substance abuse and duration of illness were associated with the risk of violence in these patients.

Discussion and Conclusions: The vast majority of schizophrenia patients are not violent people so they don’t deserve the stigma of being considered potential murderers. However, the community and the mental health professionals in particular should reflect on the risk factors of violence and how to prevent them.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P46

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Attention deficit hyperactivity disorder (ADHD) and comorbid eating disorder - read full article

By: Cátia A. Moreira, Gonçalo Sobreira, João M. Oliveira, M. Amélia Aleixo, Gustavo Jesus, and Catarina Cotta

Introduction: The attention deficit hyperactivity disorder (ADHD) onsets during childhood and is characterized by symptoms of impulsivity, hyperactivity and lack of attention. According to studies of prevalence, up to 70% of the patients with ADHD have at least one psychiatric comorbidity, which leads to diagnostic and therapeutic difficulties as well as more severe functional impairment. Nonetheless, several studies have found positive associations between abnormal eating patterns and ADHD.

Objectives: The aim of this study is to review scientific literature regarding the attention deficit hyperactivity disorder and eating disorders comorbidityThe aim of this study is to review scientific literature regarding the attention deficit hyperactivity disorder and eating disorders comorbidity.

Methods: A non-systematic review of English scientific literature was conducted, through research in the PubMed search engine, using the keywords "ADHD" and "eating disorder".

Results: The three key features of ADHD – lack of attention, hyperactivity, and impulsivity – are often present in individuals with eating disorders. Core features of bulimia nervosa (BN) include binge eating and purging behaviours that can be described as impulsive. In fact, impulsiveness has been shown to be increased in subjects with eating disorders, particularly in those with binge eating behaviour, when compared to healthy controls. Subjects with anorexia nervosa (AN) or BN also showed significant attention impairment in neuropsychological testing when compared to healthy controls. Last but not least, excessive exercise, which is typical in AN patients, may be considered a restless or hyperactive behaviour.

Discussion and Conclusions: Binging or purging eating disorders subtypes have a high correlation with ADHD, which is also related with more severe eating patterns, general and personality psychopathology. The role of ADHD features for the development, maintenance and treatment of eating disorders seems to be intricate and requires further study.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P47

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“The Spirit Vine” - read full article

By: F. Leite, P. Carvalho, H. Salgado, C. Cochat, M. Queirós, and O. Campos

Introduction: Ayahuasca is a natural psychedelic brew prepared from Amazonian plants and rich in dimethyltryptamine and harmine. Throughout time, humans have used psychoactive plants and plant-derived products for spiritual, therapeutic and recreational purposes.

Objectives: To review the evidence regarding the use of ayahuasca for medical purposes.

Methods: Online search/review of the literature has been carried out, using Medline/Pubmed, concerning “ayahuasca”.

Results: Ayahuasca has been used as a pharmacological tool by therapists to treat mental conditions such as substance addiction.

Conclusions: There is little understanding of the neuroscience behind ayahuasca, however recent evidence suggests that its use can be beneficial under some circunstances.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P48

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How are you now? Follow-up study of the children who have attended an Early Childhood Unit consultation in 2008, 2009 and 2010 - read full article

By: P. Caldeira da Silva, S. Carmenates, T. Cartaxo, R. Cifuentes, M. L. Costa, T. Duque, J. Mesquita Reis; I. Moreira; J. Morgado; N. Pangaio, B. Pinto Ferreira; M. Pinto; L. Queiroga; C. Santos; and R. Teixeira

Introduction and Objective: “Unidade da Primeira Infância” (UPI) is a specialized unit in infant and early childhood mental health. Founded in March, 1983, it emerged as a place focused on the clinical study of babies’ behaviour, infant psychopathology and interaction between parents and babies. Nowadays, UPI provides intervention (preventive and therapeutic) for young children aged from zero to three and their parents or caregivers. The systematic research in this early age is still very limited and there is little information about the future impact of psychopathology diagnosed at this age. Thus, the aim of this study is to know, through five years follow-up, what is the evolution of the children whose first observation took place in this unit in 2008, 2009 and 2010.

Methods: The sample used in this study consists of children aged from zero to three years old whose first observation took place in UPI in 2008, 2009 and 2010. The data used to characterize our sample were obtained by consulting the clinical record. The following parameters were considered: Age at the time of the first psychiatric observation; gender; diagnosis according to DC 0-3R (Axis I and II); therapeutic intervention and duration of the intervention. An interview with the main caregivers was made, by telephone, which involved applying an appropriate follow-up questionnaire, which included completing the SDQ scale - version for parents.

Results: The results were submitted to a statistical analysis using SPSS. The rate of responders was approximately 64% from a total N of 301. Everyone that we were able to reach (n=192) agreed to participate in the study. From those, 91,6% are statisfied with the quality of the service provided and 85% refer to clinical improvement of the child. According to DC 0-3R, Relating and Communicating Disorders was the most common diagnosis on Axis I (19,3%), and Underinvolved relationship was the most frequent one in Axis II (18,8%). 31,8% had abnormal results on SDQ, and there was a significant association between Regulation Disorders of Sensory Processing and abnormal results on SDQ hyperactivity and behavior problems subscales. Learning disabilities are more common among those with more severe cases of Relating and Communicating Disorders.

Conclusion: Early and adequate intervention seems to have an important and positive impact in prognosis of the children referred to an early childhood psychiatry consultation. The children diagnosed with Regulation Disorders of Sensory Processing before the age of three seem to have more behaviour and hiperactivity relsted problems during school years, suggesting an associations between these disorders. Further investigation in early childhood psycopathology and its impact in the future of the child and family must be done.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P49

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Child and adolescent psychiatry in Poland – to improve is to change - read full article

By: Krefft Maja, Gondek Tomasz, Klapcinski Michal, and Wojciechowska Irena

Introduction: Last decades were very significant for the recognition of the wide range of mental disorders in children and adolescents as well as the availability and quality of undertaken interventions . Serious attention is given to the development of appropriate human resources for mental health care. These changes affect the guidelines contained in the specialty training in child and adolescent psychiatry (CAP). Integration of biological, psychological and social approach determine the core of the training curriculum.

Objectives: The aim was to assess the quality of the child and adolescent mental health care in Poland with a particular reference to the specialty training curriculum in Poland.

Methods: The authors analysed the legislation regarding the mental health care in Poland as well as the training programme for CAP and compared it with CAP training programmes in other European countries.

Results: In Poland certain steps were taken to ensure the best use of the available knowledge and train an increased number of CAP specialists in past few years. These include facilitated availability of the specialization, amenities provided to the CAP trainees related to the salaries and changes in training program adjusting it to the current research trends and requirements in the world. A new approach was proposed according to the current trends in the community care with the extension of the internship in the day-care ward and in the community treatment team. Also a holistic approach to young patient resulted in prolonged internships in pediatric neurology and general pediatric wards. Emphasis has been laid on the stronger separation of child and adolescent psychiatry from adult psychiatry resulting in shortening the internships in psychiatric wards for adults.

Discussion: Despite all the measures applied to improve the situation of Polish Child and Adolescent Psychiatry we are still struggling a fail to provide easier and faster access to health services specially in the provinces and smaller towns. Poland is a country with an average scale of the prevalence of mental disorders comparing to both Europe and the whole world with a slight upward trend.

Conclusion: Changes for the better are still made, but we will have to wait a few more years for their rewarding effects. Further work on improving the access to mental health care and on refining the training in CAP in Poland is necessary. To improve is to change; to be perfect is to change often.*
*Winston Churchill

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P50

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Psychopathology in pediatrics settings – case of Albania - read full article

By: Sonila Tomori, Agim Gjikopulli, Alma Babo, Aferdita Tako, Aida Bushati, Florida Dobi, and Eriona Shehu

Introduction: Mental disorders in children are quite common, occurring in about one-quarter of this age group in any given year. Mental illness are blamed for 10% of kids' hospitalizations. Mental health professionals consider the need for psychological help necessary and useful not only when diagnose is established or a co-morbidity is present, but in every phase of a diagnostic process in pediatric population at risk. Relatively little is known about children who present to emergency departments to stabilize acute emergencies related to behavioral disorders. In chronically ill children who are hospitalized for instance with cancer or renal or cardiac failure prolonged hospitalization and chemotherapy can lead to many mood changes and they result at higher risk for mood disorders in comparison with the ones of acute disorders.

Objectives: The aim of the study is to evaluate the effectiveness of mental health screening to identify psychiatric co morbidities in different units of general pediatric hospital (population at risk).

Methods: Analyzing data of 416 inpatient general pediatric hospital where SDQ, a brief screening questionnaire that investigates the presence of emotional and behavioral problems in children and adolescents, has been completed over a three years period, referred and hospitalized for neurological, endocrinological or gastroenterological diagnoses.

Results: High level of psychopathology in the entire study population, indicating high needs for therapeutic intervention. The more frequent psychiatric diagnoses result: ADHD 2,9%, Anxiety Disorders 13,2%, Somatisation Disorder 12%, Obsessive-compulsive disorder 5,7% and Conduct Disorder 2,9%.

Conclusions: The SDQ could be used by clinicians in a pediatric general hospital to detect psychopathology. These findings draw attention to the important role of screening for mental health problems in emergency situations especially in front of self-harm, depression and violent behaviors.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P51

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The impact of cannabis use on the outcome of psychosis - read full article

By: André Ponte, Henrique P. Ribeiro, L. Carvalhão Gil, Filipa Freitas, Bernardo Neves, Margarida Mota, Mariana Lázaro, and Catarina Ferreira

Introduction: The relationship between cannabis use and psychosis is complex and remains unclear. Although the common assumption is that cannabis use leads to worse outcomes in people with psychosis, it is uncertain whether research findings support this clinical opinion.

Objectives: To review the literature pertaining to whether cannabis use affects the outcome of psychotic disorders.

Methods: The authors have conducted an online search on PubMed, using keywords “cannabis use”, “outcome” and “psychosis”.

Results: Use of cannabis was associated with increased rehospitalisation and decreased adherence to treatment. Associations between cannabis and psychotic symptoms or other outcome measures were more inconsistent.

Discussion and Conclusions: There is still insufficient empirical evidence to satisfactorily establish whether cannabis use has detrimental effects on the outcome of psychotic disorders. More research is needed to understand which outcomes are particularly susceptible and to determine the pathways by which cannabis use influences the course of psychotic disorder.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P52

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A historical perspective of alcoholism – from sin and crime to disease - read full article

By: Beatriz Lourenço, Mónica Marinho, João C. Fernandes, and Teresa Mota

Introduction: Alcoholism concept, research and treatment underwent major changes in the previous century.

Objectives: The aim of this work is to review the historical evolution of this condition, its understanding and different concepts that are associated with it.

Methods: Review of selected literature on the subject.

Results: During the 19th century, the temperance and degeneration movements influenced the understanding of alcohol addiction, providing a theoretical platform for the implementation of alcohol prohibition the United States of America and also the compulsory sterilization of severe alcoholics during the Nazi Era. The conceptualization of alcoholics as patients with the right to medical treatment came out of the work of several researches such as E. Jellinek and self-organized groups as the Alcoholics Anonymous. It provided medical care and social support for these patients, but also raised the question about the influence of social constructs in the medicalization of deviants behaviors. Since the late 20th century, there has been a progressive understanding of the neurobiology of alcohol ingestion, dependence and withdrawal, as well as multiple attempts to describe subgroups of patients.

Discussion and Conclusions: The way that alcoholism is conceptualized through time reflects the influence of social and political movements and also the knowledge of the aetiopathology and the treatment options available at that time. Although there is still an open debate about ethic and stigma, the current valued research tries to integrate both neurobiological and psychosocial models, in order to provide tailored therapeutic projects to each individual.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P53

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Multiple substance use among alcohol dependents - read full article

By: Filipa Novais, Samuel Pombo, and Fátima Ismail

Introduction and Objectives: Relatively few studies have investigated the role of personality in the different patterns of multiple substance use among alcohol dependents. The authors assessed the association of several clinical, socio-demographic and personality predictors of nicotine and multiple substance use (MSU) in 178 patients receiving treatment for alcohol dependence.

Methods: The sample was divided into three groups: 60 only alcohol dependents, 78 tobacco and alcohol dependents and 40 alcohol dependants with multiple substance use..

Results: Regression and comparative analysis showed that age, educational background, occupational status, years of alcoholism and the personality trait of openness to experience were predictors of MSU in alcohol dependent outpatients. The results also showed significant differences on the NEO-PPI dimension openness to experience.

Conclusions: There are increasingly alcoholic polymorphic subtypes derived from the interactive complexity between genetic/family and psychosocial factors of civilization. Findings have implications for understanding differences between different profiles of alcohol dependents and for novel treatment opportunities in therapeutic settings.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P54

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Realities of pharmacogenetic testing in psychiatry - read full article

By: Gonçalo Sobreira, Cátia Moreira, João Oliveira, and Ana Ramos

Introduction: Pharmacogenomics has become increasingly significant in clinical practice, in several fields of Medicine. Psychiatric patients, in particular, may benefit from pharmacogenetic testing as many of the psychotropic medications prescribed may lead to varied response rates and a wide range of side effects. Thus, the use of pharmacogenetics may help tailor psychotropic treatment improving the likelihood of success. Several studies, have recently, tried to demonstrate the benefits of using genetic testing in order to improve patient outcomes and decrease healthcare costs.

Objectives: This brief review, aims to analyse the evidence supporting the present clinical utility and benefits of genetic testing in psychiatric patients.

Methods: A PubMed database review, using “pharmacogenomics”, “pharmacogenetics”, “psychiatry” as keywords.

Results: Response to psychotropic medication is a complex trait; the identification of key phenotypic measures for its definition is still a major issue in psychiatry. This is further increased by disparities of pharmacodynamics and pharmacokinetics across different ethnic groups, caused by genetic variations. In a study conducted, 57% of the papers examined, showed significant association between genetic variations and improved patient outcome. Clinical response and remission were significantly associated with variants within SLC6A4 and cytochrome P450 2D6 (CYP2D6), as well as serotonin receptor 2A (5HTR2A) and cytochrome P450 1A2 (CYP1A2). Adverse events were most associated with variations in CYP2D6, serotonin receptor subtype 2C, SLC6A4, and 5HTR2. These examples advocate the usefulness of genetic testing in psychiatry. However most of said test are not required to show their analytical validity and clinical utility, before being approved for marketing, something that the forthcoming FDA guidelines on laboratory-developed tests will likely encourage. Even though some studies have proven that tailored medicine has improved adherence and reduced cost of outpatients, the overall benefit have not been well established.

Discussion and Conclusions: Pharmacogenetic is a newly evolving field and is rapidly gaining wide acceptance. However to further substantiate the utility of genetic testing in psychiatry large randomized controlled and independent assessment of any genetic test would be ideal.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P55

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Antipsychotic induced sexual dysfunction - causes and management - read full article

By: Gonçalo Sobreira, Cátia Moreira, João Oliveira, M. Amelia Aleixo, and Ana Ramos

Introduction: Sexual dysfunction (SD) is a potential side effect of antipsychotic drugs. Until a few years ago, these side effects were neglected and received mild attention by research teams. This was mainly due to the fact that most studies were directed towards the effects of the underling disease on patient’s sexuality and that most patients, especially those suffering from schizophrenia, do not spontaneously report these side effects.

Objectives: This brief review, aims to analyse the current information concerning SD caused by antipsychotic treatment and the present management options.

Methods: A PubMed database review, using “antipsychotic”, “psychotropic drugs”, “sexual dysfunctions”, “sexual side effects” as keywords.

Results: The mechanism of action leading to sexual dysfunction is complex and sometimes multifactorial. Several studies agree that all antipsychotic can compromise, up to certain extent, all phases of the sexual response cycle. Different hypotheses have been formulated to explain these side effects (dopaminergic antagonist action, increased prolactin secondary to dopaminergic antagonist action, blockage of alpha-adrenergic receptor, blockage of acetylcholine receptors, serotonin antagonist action, histamine antagonist action and the different receptor affinities among antipsychotics). In addition to direct pharmacological effects and endocrine dysfunction (e.g. increased prolactin levels), other pharmacological side effects including sedation, extrapyramidal effects and weight gain, can indirectly reduce sexual desire and lead consequently to SD. In order to obviate the deleterious effect of antipsychotics on sexual function, several treatment options have been proposed like decreasing or switching to prolactin sparing antipsychotics (ariprazole, clozapine, olanzapine), the use of dopamine agonists or drugs with specific effects on sexual function such as phosphodiesterase inhibitors.

Discussion and Conclusions: It has been proven that SD can be a major cause for treatment noncompliance, and most studies agree that antipsychotic therapy may be responsible for SD. However, further research is needed to better understand the causes and factors linking antipsychotic use and sexual dysfunction. It is also important, to state the necessity, to enquire for SD symptoms and also to exclude other physical or psychiatric causes of SD in patients undertaking antipsychotic treatment.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P56

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Naturalistic study of a Long-Acting injectable antipsychotic drugs clinic - read full article

By: Gustavo Jesus, Cátia A. Moreira, João M. Oliveira, M. Amélia Aleixo, L. Carvalhão Gil, Marco Duarte, Corona Solana, and Rui Durval

Introduction: High rates of non adherence to antipsychotics are commonly seen in the treatment of schizophrenia and other psychotic disorders. Long acting injectable antipsychotics (LAIs) are a pharmacological option increasingly used for its potential to effectively treat symptoms. Simultaneously, they guarantee good therapeutic compliance therefore preventing relapses and improving prognosis. Several recent studies advocate early use of LAIs challenging the old perspective they should be reserved for non-compliant patients.

Objectives: The authors of the current study intend to evaluate the patterns of prescription of LAIs in patients attending an LAI clinic at Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal.

Methods: For obtaining clinical data, the authors reviewed a database containing all patients who had an LAI regularly administered between the years of 2009 and 2014. Statistical analysis was performed using SPSS®. Review of relevant literature obtained from online medical databases under the keywords “long acting antipsychotic” and “injectable antipsychotic”.

Results: A total of 1052 patients were included in the study. Among these, 64.3% (676) were male. All available LAIs (haloperidol, zuclopentixol, flupenthixol, fluphenazine, risperidone, and paliperidone) were used, more often in monotherapy, although there were patients where combination therapy was used. A great majority of patients were on typical LAIs. Two patients were found taking Olanzapine Palmoate although it is not available on the Portuguese market.

Discussion and Conclusion: This study uses a large sample which allows us to discuss several issues: patients under LAI were found to include not only patients with a diagnosis of schizophrenic disorder but also bipolar, schizoaffective, and delusional disorders, intellectual disability and Not Otherwise Specified Psychosis, which raises the question of off-label use of LAIs; frequency of relapse and the results of different drugs will be discussed with an emphasis on comparison between typical and atypical antipsychotics. This study represents the first step of a wider study being conducted about LAI use in mental disorders.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P57

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“Mathematically very complex problem” and corticosteroids - read full article

By: Joana Ferreira, Carla Araújo, Rita Gonçalves, Sara Pedroso, Sónia Silva, Manuel J. Brito, and Carla Pinho

Introduction: Over the years, exogenous corticosteroids have been used in the treatment of various medical illnesses and a number of adverse reactions have been established. About 6% of patients develop psychiatric disorders due to steroid therapy, although many more suffer from mild symptoms which do not fulfill a diagnosis. Evidence suggests that elevations in hypothalamic–pituitary–adrenal (HPA) axis activity have been implicated in the origins and exacerbation of mental disorders, as well as stress sensitivity and trauma, that can be related to chronic and disabling illnesses.

Objectives: To describe a case of substance-induced psychotic disorder in a patient diagnosed as having Hodgkin’s lymphoma, resulting from corticosteroids administration.

Methods: We describe a 16-year-old girl admitted to our liaison unit while she was as inpatient on paediatric oncology unit.

Results: After her second corticosteroid cycle she started being delusional with passivity experiences, showing psychomotor retardation and mannerisms, blunted affect, diminished spontaneous speech with higher latency, severe impairment of attention and concentration, time and space disorientation and flight of ideas. She was insightless and with poor judgment.

Discussion and Conclusions: Once starting Lorazepam 1mg + 1mg + 2mg; Olanzapine 5mg + 10mg; Haloperidol 5mg; Biperiden 4mg, she improved her condition, showing only psychomotor retardation. She improved whenever she was not in the interval period of the corticosteroids cycles, but her psychotic symptoms reappeared when approaching the end of the cycles. Currently she holds antipsychotic medication, with good response, and her main concern is returning to school, which is still postponed due to their organic condition. In management of physical illnesses with psychiatric features, we suggest that psychotic reaction should be taken into account as a possibility in all children and adolescents who develop behavioral changes during and after corticosteroid treatment. This study suggests that the biopsychosocial approach to health care and consultation-liaison psychiatry should be emphasized.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P58

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Baclofen-induced manic episode – a case report - read full article

By: Joana V. Silva, Joana Pinheiro, and Jorge Mota

Introduction: Baclofen is a gamma-aminobutyric acid type B receptor agonist usually prescribed for muscle spasticity, in a dosage that goes from 15 mg to 120 mg per day. The risk of psychiatric side effects associated with this medication is described as “frequent”, and psychiatric population are at an increased risk of relapse.

Objectives: Summarize the latest literature about manic episodes associated with baclofen prescription, with a case report.

Methods: Case report of a 43-year-old male who exhibited manic symptoms during treatment with baclofen for post stroke muscle spasticity. Literature review, using Pubmed and the keywords baclofen, mania.

Results: Mr. M. was admitted to Hospital de Magalhães Lemos, 1 week after discharge from an internal medicine ward where he was admitted for a stroke. During that week he was medicated with carvedilol 25 mg/day and losartan 20 mg/day for hypertension, oxazepam 80 mg/day, baclofen 30 mg/day, and haloperidol 4 mg/day. He had a previous history of drug and alcohol abuse. When admitted, he presented disinhibition, restlessness and pressured speech, with flight of ideas and delusions, decreased need for sleep, but no elated mood. The situation worsened in the first four days with haloperidol, so baclofen was suspended after a diagnosis review. The patient recovered adequate behavior and speech, with no delusions, and was discharged on the 10th day. 3 months later he is still stable, without antipsychotics, and on physiotherapy for the muscle spasticity.

Discussion and Conclusions: Despite its safety, baclofen has to be carefully considered in the psychiatric population, because of its side effects, even in a low dosage like 30 mg /day. Physichians need to be aware of this, but more studies are needed in order to clarify the underlying mechanisms of action of these side effects and how to prevent them.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P59

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Lithium neurotoxicity – a review - read full article

By: João M. Oliveira, M. Amélia Aleixo, Gonçalo Sobreira, and Cátia Moreira

Introduction: Lithium is commonly used in Psychiatry, either to treat Bipolar Disorder or as an add on treatment in Unipolar Depression; it has also been used as an off-label treatment in several other fields of Medicine. Side effects are usually gastrointestinal, weight gain and tremor; neurotoxicity is an uncommon but serious adverse reaction of lithium therapy.

Objectives: Brief review of literature concerning neurotoxicity of lithium with an emphasis on clinical syndrome and management.

Methods: A PubMed database review, using “lithium neurotoxicity” as a keyword.

Results: Lithium toxicity can be acute, chronic or acute-on-chronic. In acute toxicity neurological signs are delayed whereas in chronic toxicity they predominate. Lithium encephalopathy refers to a global neurological dysfunction attributed to lithium and which usually reverses upon cessation and treatment. Onset tends to be gradual and progress to coma and occasionally death. Symptoms do not correlate with lithium concentrations, and toxicity can occur with levels within the standard therapeutic window. In patients medicated with lithium attention must be paid to factors that may interfere with serum lithium levels, such as dehydration, drugs, or pre-exiting conditions. Aggressive treatment with fluid resuscitation and hemodialysis, sometimes requiring multiple sessions due to rebound, is the rule and should be undertaken based on clinical features and not serum lithium levels. Rarely, symptoms will persist beyond 2 months of lithium cessation, a condition known as syndrome of irreversible lithium-effectuated neurotoxicity.

Discussion and Conclusions: In any patient taking lithium who develops a clinical picture of neurotoxicity this possibility should be considered, regardless of serum lithium levels and prompt treatment should be initiated.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P60

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Alcohol misuse among older women – an under-recognized problem - read full article

By: Mariana Marinho, João Marques, and Miguel Bragança

Introduction: Population is aging quickly and there is an increasing number of older women misusing alcohol, which is of concern because the adverse health effects in this group are greater. Clinical research is beginning to explain the results of unrecognized alcohol abuse or dependence on elderly.

Objectives: To provide an overview of alcohol misuse among older women.

Methods: Literature review based on articles published on PubMed/MEDLINE, between January 2005 and January 2015, using the keywords “alcohol use”, “alcoholism”, “women”, “elderly”.

Results: The prevalence of alcohol misuse among older women ranges between less than 1% and 8%. Looking at the growing ageing population, effective prevention and intervention techniques and approaches targeted to older at–risk drinkers are essential. Elderly people suffer from many medical and psychiatric conditions influenced by alcohol consumption. However, alcohol problems in older women are less likely to recognize by health care providers, probably because this group generally drink less than older men or abstain from alcohol. Importantly, this population may be especially at risk for alcohol problems. They have social, psychological and physical risk factors that make them particularly susceptible. Comparing with men in same age group, elderly women are less likely to be financially independent and tend to live alone longer and to face other losses that can exacerbate depression and the use of alcohol. Furthermore, physiologically, women are at greater risk for negative effects of increased alcohol consumption as they age. Alcohol misuse is associated with adverse medical outcomes, including osteoporosis, cardiovascular disease and cancer. Also, it can lead to negative psychosocial effects (social isolation, legal problems, financial distress, and/or family or relationship problems). Crucially, physical and/or psychiatric comorbidity heightens the alcohol effects. Screening, brief intervention, and referral to treatment is the recommended approach for identifying persons engaged in at-risk alcohol use.

Discussion and Conclusions: Early detection by health care providers can reduce the prevalence of alcohol problems and improve overall health in older women. So, an increased effort on effective identification and subsequent treatment is warranted.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P61

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Khat and cathinones: from cultural use to drug of abuse - read full article

By: Pedro Macedo, Ana R. Figueiredo, Antónia Fornelos, Mariana Silva, and Filipa Veríssimo

Introduction: Among several communities around Saudi Arabia and East African countries, khat has played a major social role. The identification of cathinone as the main psychoactive compound led to the synthesis of several derivatives.

Objectives: The present work provides a review on khat and synthetic cathinones, concerning their historical background, prevalence, patterns of use, and their physiological and toxicological effects on humans.

Methods: The bibliographic research was concluded using the queries “cathinone” in the PubMed network.

Results/Discussion: In the mid-2000’s, synthetic cathinones emerged in the recreational drug markets as legal alternatives ("legal highs") to amphetamine, "ecstasy", or cocaine. Currently, they are sold as ‘bath salts’ or "plant food". Cathinone derivatives are available online or at "smartshops" and are much more affordable than the traditional illicit drugs. Available as powders, substituted cathinones are self-administered by snorting, oral injestion, or intravenous injection. They act as central nervous system stimulants through the release of catecholamines and by blocking their reuptake in the central and peripheral nervous system. Nevertheless, considerable differences have been found in the potencies of the different substituted cathinones in vitro. Desired effects reported by users include increased energy, empathy, and improved libido. Cardiovascular (tachycardia, hypertension) and psychiatric/neurological signs/symptoms (agitation, seizures, paranoia, and hallucinations) are the most common adverse effects reported. Severe toxicity signs compatible with excessive serotonin activity, such as hyperthermia, metabolic acidosis, and prolonged rhabdomyolysis, have also been observed. In case of overdose, no specific antidote exists and no curative treatment has been approved by health authorities. Therefore, management of acute toxic effects is mainly extrapolated from experience with cocaine/amphetamines.

Conclusion: Despite their now illegal status in many countries, substituted cathinones continue to be prevalent drugs of abuse. Routine toxicology screens may not detect the presence of these compounds and more specific methods are needed. Additionally, several new derivatives emerge in the recreational legal markets every year.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P62

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Suicide and forensic toxicology results: retrospective study of the cases from the south branch of national Institute of Legal Medicine and Forensic Sciences (2007 – 2012) - read full article

By: Susana Gonçalves, Joana Lucas, Tiago Costa, Luísa Eiras, and Jorge C. Santos

Introduction: Toxicological analyses are an important complementary exam for medico-legal autopsies, particularly in cases of suicide associated to substance use and dependency. Suicide sub-notification has been recognized worldwide as a serious public health issue, namely in fatal intoxication cases without enough circumstantial information for the differential diagnosis between accident and suicide.

Objectives: To characterize the forensic toxicology results in victims of suicide and violent deaths of undetermined intent, subjected to medico-legal autopsy in the South Branch of National Institute of Legal Medicine and Forensic Sciences, between 2007 and 2012.

Methods: A total of 996 medico-legal autopsy cases were identified, in which circumstantial information of suspected or probable suicide was registered at the corpse admission. We excluded 125 cases in which no toxicological exams were performed, ending up with a total sample of 871 cases.

Results: In 774 (90%) of these, the basic cause of death was certified as suicide, and in the remaining as undetermined intent. The direct cause of death resulted from intoxication in 108 (14%) of the suicide cases, and in 69 (71%) of the undetermined intent cases. Pharmaceutical drugs were surveyed in the forensic toxicology laboratory in 96% of the overall cases, and were found to be the cause of the majority of the intoxications: 60 (56%) of the suicide cases and 44 (64%) of the undetermined intent cases. In both groups, the most common pharmacological classes were benzodiazepines, antidepressants and antipsychotics.

Discussion: Our data shows a high prevalence of consumption of psychiatric medication, with obligatory medical prescription, among victims of suicide and intoxications of undetermined intent. Access to suicide methods is known to have a decisive influence on the direct causes of death of the victims, so it is relevant to discuss the patients’ access to toxic amounts of prescription drugs.

Conclusion: The analysis of this data might be an important contribution to a better definition of suicide prevention strategies, with a focus on medical drug prescription in psychiatric patients.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P63

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ADHD and drug abuse - read full article

By: Catarina Freitas, Tânia Abreu, Rita Figueiredo, and Sandra Queirós

Introduction: Several studies have shown a high prevalence of comorbidity between attention deficit hyperactivity disorder and drug abuse in adolescence and in adulthood. It is argued if ADHD is, in itself, a risk factor for drug abuse or if both are interconnected by conduct disorder, very common in individuals with ADHD.

Objectives and Methods: The authors proposed to conduct a literature review on the subject, trying to establish mechanisms, prevalence, onset and consumption patterns and associated factors.

Results: The prevalence of ADHD patients who abuse alcohol or illicit drug is estimated to be between 9 to 40%. Patients with ADHD appear to abuse earlier of alcohol and illicit drugs, with much more pronounced frequency and rate dependence. Approximately one third of patients with ADHD and substance use disorder abuse of the prescribed psychostimulant medication. However, there are disparate results regarding the influence of the pharmacological treatment of ADHD in risk of development drug addiction.

Discussion and Conclusions: Some theories relate the development of some symptoms with factors affecting cognitive processes that can also be associated with drug abuse. ADHD and substance abuse and dependence have similarities in terms of neurotransmission systems and anatomical structures, for example, the mesolimbic dopamine system.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P64

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Neuropsychiatric symptoms in frontotemporal dementia - read full article

By: Ana D. Amaral, Catarina Novais, Ana S. Costa, and Isabel Costa

Introduction: Frontotemporal dementia (FTD) comprises a heterogeneous group of clinical and pathological syndromes, with presenile onset and variable combinations of behavioural, executive, language or motor symptoms. FTD includes three main subtypes: behavioural variant, progressive non-fluent aphasia and semantic dementia.

Objectives: We aim to review and summarize the neuropsychiatric symptoms in behavioural variant.

Methods: Literature review up to 13th March 2015, using MeSH term frontotemporal dementias.

Results: Behavioural variant is the most common phenotype accounting for 50% of cases. Common symptoms can be either positive (disinhibition, hyperorality, stereotypies, compulsive and ritualistic behaviours) and negative (apathy, loss of empathy, social withdrawal and low self-care). These translate in to major personality changes from which we highlight social behaviour – patients lack tact and manners, use unacceptable physical contact, improper verbal or physical acts and are socially awkward. Compulsive and ritualistic behaviours may mimic obsessive-compulsive disorder. Disinhibition and mood elation can mimic a maniform state. Depression, as in other dementias, is common. However, its diagnosis is complicated by the negative symptoms overlap. Suicide attempts are not rare and are more likely in FTD patients as compared with controls. Prefrontal cortex malfunction and related impulsiveness may explain the increased risk of suicide. Curiously, risk is higher in patients with previous history of depression. Regarding the increased impulsiveness, there are at least five reported cases presenting as pathological gambling. One-third of the patients also exhibit excessive somatic complaints as headache and gastrointestinal, urogenital or musculoskeletal pain. The association between depression and somatic complaints is not well established in FTD. Sleep disturbances have also been reported with increased nocturnal activity and decreased morning activity, suggesting phase delay. Psychotic symptoms may occur in one third of FTD patients some time during the course of dementia: paranoid delusions and visual hallucinations are the most common, but auditory hallucinations may also occur. There seems to be a strong correlation between psychotic symptoms and predominantly right-sided degeneration.

Discussion and Conclusions: Neuropsychiatric symptoms in FTD may lead to misdiagnosis, most commonly with other neurodegenerative dementias, psychotic disorders or depression. We believe that if physicians are aware of their existence, diagnosis delay can be avoided.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P65

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Neuropsychiatric symptoms in Huntington’s disease - read full article

By: Ana S. Costa, Ana D. Amaral, Mota Oliveira, and Ricardo Moreira

Introduction: Huntington's disease (HD) is an autosomal dominant inherited disorder of the central nervous system with characteristic neurodegenerative alterations in the basal ganglia and cortex. HD is characterized by a triad of symptoms including motor disturbance, cognitive impairment and psychiatric features.

Objectives: Authors aim to review and summarize the neuropsychiatric symptoms associated with HD.

Methods: Literature review based on articles published on PubMed/MEDLINE using the keywords “Huntington’s Disease”, “neuropsychiatry” and “psychiatric aspects”.

Results: Psychiatric symptoms in HD may be associated with three different situations – they may be directly caused by the disease, may appear as a comorbid disorder or as a consequence of the pre-diagnosis of this disease. Approximately 40% of patients with HD present a mood disorder during the course of the disease – 30% major depression and 10% bipolar disorder, generally type II. In two thirds of cases, mood disorders may precede the movement disorders of HD in 2 to 20 years. Suicide rates among patients with HD are 4 to 6 times superior to the general population, and occur more frequently in patients between 50 and 69 years of age. Psychotic symptoms may appear in up to 30% of patients. A schizophrenia-like disorder, with paranoid delusions and auditory hallucinations, occurs in 4 to 12% of patients. Psychotic symptoms usually appear early in the disease course and become less common as cognitive decline progresses. Irritability and aggressive behaviour are also common, with the latter being a common cause for hospitalization. Other possible neuropsychiatric manifestations are apathy, obsessive-compulsive disorder, sexual disorders and sleep disorders. Authors provide a brief illustrative case report.

Discussion and Conclusions: Neuropsychiatric symptoms are prevalent in Huntington's disease and are relatively independent of cognitive and motor aspects of the disease. Psychiatric symptoms and behavioural changes together with a growing level of physical dependence make hospitalization frequent, requiring a multidisciplinary approach and specialized care.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P66

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Defensive pessimism: a hypothetical explanatory model - read full article

By: Ana Araújo, Maria J. Soares, Daniela Silva, Ana T. Pereira, and António Macedo

Introduction: Defensive Pessimism (DP) is a cognitive coping strategy that increases the feeling of control in anxious and perfectionist subjects, decreasing their anxiety previously to a task. It involves the setting of low expectations – Pessimism (Pess-DP) – and reflection about the possible negative/positive task outcomes – Reflectivity (Ref-DP). Perfectionism is associated with anxiety, and both traits are associated with poor mental health and vulnerability to psychopathology. DP effectively lowers anxiety leading to more successful performances, however it is associated with negative affect. Anxious subjects who use DP show significant increases in self-esteem over time, suggesting that, when used over time, DP constitutes a self-improvement strategy.

Objectives: To study a) if DP, anxiety and perfectionism are predictors of psychological health; b) if DP is a mediator between anxiety/perfectionism and psychological health; c) to present an hypothetical explanatory model of DP.

Methods: The Portuguese versions of the Revised Defensive Pessimism Questionnaire, State Trait Anxiety Inventory, two Multidimensional Perfectionism Scales (Hewitt & Flett, Frost et. al) and one item to measure perceived psychological health were administered to 192 university students (78.1% girls), aged 19,7±2,10 years. Correlation, regression and mediation analyses were performed.

Results: Anxiety (Beta=-.191), negative perfectionism (Beta=-.214), DP (Beta=-.171) and Pess-DP (Beta=-.245) (all p<.05) were independent negative predictors of psychological health. Ref-DP (Beta=.189/.201; p<.05) was a predictor of good psychological health only when both Pess-DP and anxiety/negative perfectionism were also included in regression model. Pess-DP was a full mediator between anxiety (95%CI=-.024;-.002) /negative perfectionism (-.006;-.001) and poor psychological health.

Discussion and Conclusions: Ref-PD/Pess-PD are associated with good/bad psychological health. Ref-PD may be the nuclear component and key for self-improvement (through self-awareness and emotional regulation), although Pess-PD remains a necessary condition, as it may be self-protective (“protective expectations”) despite its adverse outcomes.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P67

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Genetics of individual differences in chronotype and circadian rhythms - read full article

By: Ana Poças and Aníbal Fonte

Introduction: Chronotype refers to the behavioural manifestation of underlying circadian rhythms of various physical processes. We can describe it as a propensity to sleep at a particular time during a 24 hour period. 'Eveningness' (delayed sleep period) and 'morningness' (advanced sleep period) are the two extremes but most individuals have some flexibility in the timing of their sleep period. Interindividual differences in morningness–eveningness are believed to manifest into extreme cases classified as primary circadian rhythm sleep disorders, with altered phase relationships of the biological clock to the light–dark cycle, including alterations in sleep timing.

Objectives and Methods: By the review of the literature we tried to understand the knowledge about genetics of individual differences in chronotype and circadian rhythms and how it can be useful in our psychiatric patient’s future life. Sources of data: Pubmed; keywords: chronotype; circadian rhythms; clock genes.

Results: The causes and regulation of chronotypes aren’t clear but there are some candidate genes - clock genes - that exist in most cells of the body, referred to as the circadian system that regulate physiological phenomena. There are also important environmental cues (zeitgebers) include light, feeding, social behaviour and daily schedules that can influence it. Morningness–eveningness is estimated to be about 50% heritable. The genetic basis in the general population has been investigated by targetingseveral core circadian genes but the results are inconsistent. The 3111C allele of the clock gene 5'-UTR region has been associated with eveningness and delayed sleep timing in some studies, but not others. Also, the variable numbertandem repeat (VNTR) polymorphism in PERIOD3 (PER3), another core clock gene, has been linked to diurnal preference, but not consistently. Both the 111G polymorphism in the 5'-untranslated region of PERIOD2 (PER2) and the T2434C polymorphism of PERIOD1 have been associated with morning preference, though not consistently too.

Discussion and Conclusions: This area of research has promising implications to detect differential vulnerability to circadian disorders and lifestyles that adversely affect alertness, performance and sleep duration.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P68

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The endless dissatisfaction: association between body dysmorphic disorder and compulsive cosmetic surgery - read full article

By: Catarina Novais, Maria J. Peixoto, Ana D. Amaral, and Alexandra Côrte-Real

Introduction: Body dysmorphic disorder (BDD) is an under-recognized psychiatric condition which appears to be common in cosmetic settings. Its core symptom is an impairing worry about a nonexistent or slight defect in appearance.

Objectives: The aim of this study was to review the association between BDD and demand for cosmetic procedures among these patients.

Methods: Relevant literature from 2000 to March 2015 was identified by searching the PubMed, using the search terms body dysmorphic disorder, cosmetic surgery and compulsive cosmetic surgery.

Results and Discussion: BDD is a relatively common disorder with a prevalence of 0.7% to 2.4 % in community samples. Its course tends to be chronic and is one of the most common psychiatric conditions found in patients seeking cosmetic surgery, with a reported prevalence of 6% to 15% in these settings. Patients seek out psychiatric treatment after an average estimated delay of 10 to 15 years following onset of the disorder. Concerns about appearance may focus on any body area and are typically intrusive, unwanted, and usually difficult to resist or control. These worries trigger feelings of depression, anxiety or shame, which, in turn, trigger repetitive compulsive behaviors. Psychiatrists are often not aware of this diagnosis as patients turn to other specialists like cosmetic surgeons, even though patient should benefit from psychiatric approach alone. A surgical intervention, even if perfectly performed, may be unable to fix the psychological discomfort stemming from the supposed physical defect. Thus, the outcome of the procedure is very often disappointing, with the patient requesting further interventions for the same or other parts of the body. Most of the available data suggest that cosmetic treatment is almost never effective for BDD, can worsen symptoms, and can trigger legal action or even violent behavior.

Conclusions: BDD is usually chronic and associated with substantial morbidity and mortality if no appropriate treatment is provided. A significant number of patients seeking cosmetic treatment suffer from BDD, which may contraindicate it. Cosmetic surgeons should be aware of the clinical characteristics of BDD to identify and refer these patients to Psychiatry for a better treatment outcome.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P69

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Melatonin and Anxiety: from animal models to clinical practice - read full article

By: Filipa Novais and Sofia Paulino

Introduction: There has been a considerable amount of scientific literature focusing the role of circadian disturbances and sleep changes in depression, bipolar disorders and even in schizophrenia but few have explored the relationship between disruption of melatonin circadian release and anxiety symptoms. This association is frequent, for example, in shift work disorder with important implications on social and professional capacity and quality of life. Disruption in circadian rhythms has been related with low nighttime and 24h levels of melatonin, a neurohormone known to be involved in the regulation of anxiety. The underlying mechanism correlating disruption of circadian rhythms and melatonin levels to the emergence of anxiety is not well understood.

Objectives: This study aims to review the state of the art on the subject concerning pathophysiological mechanism, clinical findings and relevance as well as treatment options for anxiety.

Methods:A nonsystematic review of all English language PubMed articles published between 1991 and 2014 using the terms “anxiety”, “circadian”, “melatonin”, “treatment” and “sleep”.

Results: Chronic circadian disruption has been associated with higher levels of anxiety. Studies with animal models have been used to study the effects of internal and external melatonin on anxiety showing a correlation between melatonin levels and anxiety. In healthy subjects, anxiety levels were significantly and negatively correlated with melatonin production in summer and winter. This neurohormone is also known to have an anti-inflammatory activity in central nervous system, which is a general underlying mechanism in neuropsychiatric disorders. It has also been hypothesized that melatonin could be evolved in the immune-opioids network that mediate the return to baseline states after stressful events. The disruption in this system could be more specific in anxiety pathophysiology. Recently some melatonin receptor agonists like UCM765 and agomelatine have shown anti anxiety effects on animal models. Effects on clinical samples are yet to be determined.

Discussion and Conclusion: Chronic circadian disruption through could make neural systems less able to cope with stress and lead to the development of anxiety disorders. The interaction between opioid system and melatonin mechanism could provide a possible explanation for the pathophysiological mechanism underlying this symptomatology.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P70

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Personality and behaviour after Deep Brain Stimulation: do we know what happens next? - read full article

By: Filipa Novais, Ricardo Prata, and Luís C. Pestana

Introduction: Deep Brain Stimulation (DBS) is widely performed in advanced Parkinson Disease and other neurological diseases. However changes in behaviour and personality have been reported. Their implications on the quality of life for patients and their families are yet to be clarified.

Objectives: The aim of this work was to search for the most significant alterations in personality and behaviour in patients submitted to DBS.

Methods: We performed a search on the Anglo-Saxon literature, the EMBASE, MEDLINE and PubMed were consulted using the following key words: "deep brain stimulation", "personality", behaviour" and "ethical".

Results: The most common cognitive and psychiatric problems that have been reported concern a decline in word fluency and verbal memory, depression, increased suicide tendencies, anxiety, emotional hyperreactivity, hypomania, increased impulsivity, lack of premeditation and lower persistence. These changes in mood, behaviour and cognition may lead to changes in “personal identity” and eventually affect others.

Discussion and Conclusion: There are medical and ethical issues concerning such a dramatic change in some patient’s identity. The increasing use of DBS will lead to discussions concerning their responsibility for their actions and ability to make decisions. More research is need in order to clarify theses changes and to establish predictors and related factors.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P71

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Hysteria: the road to extinction? - read full article

By: Henrique Prata-Ribeiro and Ana Filipa Freitas

Introduction: Hysteria is undoubtedly one of the first mental disorders attributable to human beings. It has been accurately described since the second millennium BC. Nowadays, the psychiatric terminology distinguishes two types of disorders that were previously labelled “hysteria”: dissociative and conversion disorders.

Objectives: The aim of this study is to examine the population of the General and Transcultural Psychiatry Clinic of CHPL and characterize this disorder.

Methods: The retrospective study consisted in analyzing records from 3862 patients hospitalized in the Clinic since 2007 until 2015, using descriptive statistical analysis techniques.

Results: From the analyzed population sample (n = 3862) we found that only 18 hospitalized patients were diagnosed as “Hysteria”. Most of them were female (proportion female:male = 15:3), aged between 19 and 63 years. The majority (15) were natural from Portugal, 1 from Angola, 1 from Brazil and 1 from Cape Verde. Most of them had active work, recording only 5 retired and 1 unemployed. None of them had previous drugs consumption and just 1 have had alcohol consumption. 11 of them have been followed previously in Psychiatry (consultations and hospitalizations). The hospital admissions were mostly voluntary (17) and the main reasons were: Behavior alterations (6), hetero-aggressiveness (4), psychomotor agitation (2), suicidal ideation (4), aphonia (1) and mutism (1). At the admission, only 4 patients had the probable diagnosis of “hysteria”. We also found that the majority of the patients had an admission diagnosis of Mood Disorder.

Discussion and Conclusions: From the analyzed data we were able to characterize the population that would be classifiable as hysteric, finding that the diagnosis would still represent a minority of patients (0,39%), being 80% of these females. Cultural issues were not considered as the vast majority of the studied population was natural from Portugal.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P72

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Walking through the Portuguese Forensic System - read full article

By: Joana Melim, Rafael Araújo, Sofia Fonseca, and Susana Almeida

Introduction: Forensic psychiatry is becoming progressively, as time passes by, an essential area in psychiatry, having evolved from a lawless sector to an extremely over regulated process while maintaining some grey areas in need of attention.

Methods: Review of the Portuguese law published in Diário da Repúbica, applied to the mental health sector.

Results: The European law is by no means homogeneous and different forensic systems co-exists. This report intends to summarize the Portuguese legislation on mental health that have some specificities compared to other European systems.

Discussion and Conclusions: Having the awareness on different legislation across Europe, allows us not only to improve by learning from positive expediencies and outcomes, but also by realizing some disabilities and try to optimize them trough a structured and shared learning process.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P73

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Attachment, suicide attempts and borderline personality disorder: a review by a case report - read full article

By: Joana Ramos and Paula Valente

Introduction: Borderline personality disorder (BDP) is a common and severe psychiatric disorder. It’s characterized by severe functional impairments like a pervasive pattern of instability in affect regulation, impulse control and interpersonal relationships. Clinic may include impulsive aggression, repeated self-injury, and chronic suicidal tendencies. It leads to extensive use of treatment, and high costs to society. The etiology is not yet clear but has been a source of intense clinical interest. It seems that genetic factors and adverse life events during childhood seem to interact. Likewise Adler suggested as a failure of parental affection and bonding and also, Kernberg says that excessive early aggression leads young children to excessive frustration. Therefore, studies also suggest that the manifestation for suicide attempts has been described as arising from exposure to adverse childhood trauma.

Objectives: To describe the case of a central hospital psychiatric inpatient and it’s comparison with the international available literature.

Methods: Retrospective analysis of the clinical process. Review of the international available literature, using MedLine and PubMed.

Case Report: Woman, 38 years old, inpatient at Daily Hospital of a Central Psychiatry Hospital. It was admitted for behavioral changes with suicide ideation and impulsive behaviors. History of several internments in Psychiatric facilities and suicide attempts since she was 8 years-old.

Conclusion: Theories of suicidal behavior suggest that the desire to die can arise from disruption of interpersonal relationships. And those are also preponderant to clinical course of BDP. For that, when working with BDP patients, it should be considered the patterns of attachment.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P74

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Pharmacological management of challenging behavior in people with intellectual disability - read full article

By: João M. Oliveira, Cátia Moreira, Gonçalo Sobreira, Corona Solana, and M. Amélia Aleixo

Introduction: Challenging behavior (CB), which includes aggressive behavior, is the most common cause for psychiatric consultation in people with intellectual disability (ID). Recent developments in our knowledge about the neurobiology of aggression have allowed the investigation into more targeted drug therapy for CB.

Objectives: The authors aim to review the literature about pharmacological management of CB in people with ID.

Methods: A PubMed database review, using “intellectual disabity”, “challenging behavior”, “aggressive behavior”.

Results: Drugs are particularly useful when there is an identified psychiatric illness or as adjunctive treatment until other strategies are put in place. In general it is recommended that there should be periodic attempts at dose reduction. Antipsychotics are the drugs more commonly used for CB in ID. In the general population there is evidence for the use of atypical (but not typical) antipsychotics for aggression. Although initial studies provided no evidence for the use of antipsychotics in ID, more recent controlled studies have had positive results, particularly for risperidone, but also for clozapine, olanzapine, and quetiapine. SSRIs are also commonly used, on the basis that 5HT inhibits aggressive behavior, although in the last few years this idea has been challenged. Furthermore, there is no controlled study of the use of SSRIs in people with ID, and the few studies found provide conflicting results. The other main drug class used are anticonvulsants; in the general population they seem to decrease aggressiveness, however there are no methodologically solid studies for people with ID. Other drugs that may be useful are benzodiazepines, beta-blockers, lithium and methylphenidate (if comorbid ADHD).

Discussion and Conclusions: Management of CB in ID should always begin with the exclusion of an underlying medical or psychiatric condition as well as exploration of whether or not the behavior serves any functional utility. Drug therapy should take an adjunctive role to psychological management as it is unusual for the former to be sufficient. Unfortunately there is an overwhelming lack of evidence for the use of any drug other than risperidone, despite the large number of positive case reports. Future options may target oxytocin, vasopressin and other neurotransmitters.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P75

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Longitudinal diagnosis and comorbidity in Psychiatry – a clinical challenge - read full article

By: L. Carvalhão Gil, M. Amélia Aleixo, and André Ponte

Introduction: The longitudinal diagnosis is an important tool in Psychiatry. Mental disorders are complex and may have different courses, not showing the precise diagnosis at the beginning. This could imply different therapeutic approaches and diverse prognosis. The co-occurrence of different mental disorders in a patient is also frequent. It increases morbidity and may cause disability and makes management more challenging than in a single disorder.

Objectives: Clinical case report concerning a young female with a psychotic disorder and theme review on psychosis. The author’s aim is to highlight the relevance of clinical presentation over time and the need of modifying psychiatric diagnosis and its impact on the management of different mental disorders in a patient.

Methods: A literature search was performed on PubMed database using the key words psychosis, psychotic disorder, bipolar disorder, conversion and hysteria and retrieved papers were selected according to their relevance. The patient clinical record was reviewed.

Results: The authors report a case of a 25 year old female who presented a first episode of psychotic symptoms of religious content four years ago, in an apparent histrionic personality. At the time there was no previous psychiatric history. After two inpatient treatments under antipsychotic medication there was a fast and good therapeutic response. In the following two years there was complete remission with progressive reduction of the psychopharmacs. Two months later, without any medication, there was a single episode of agitation, euphoria and insomnia that ended in a defenestration of the 3rd floor. She became severely injured and is currently on mood stabilizer.

Discussion and Conclusions: The clinical presentation initially led to the diagnosis of brief psychotic disorder. After treated with an atypical antipsychotic, the patient remained apparently stable for two years but soon after the medication was stopped she developed severe symptoms of mania. The diagnosis was changed to bipolar disorder. This case illustrates the importance of following the course of the disease and reconsidering, occasionally, the disorder diagnosis, concerning therapeutic and prognostic implications.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P76

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Anorexia Nervosa in men: nuclear similarities and essential differences - read full article

By: M. Bernardo and E. Trigo

Introduction: For many decades the topic of eating disorders (ED) in males was largely neglected and there are actually very limited epidemiological data about this subject. Historical studies have examined Anorexia Nervosa (AN) from an almost entirely female focus, creating stigmatizing suppositions which have all failed to fully encapsulate the condition. The construction of AN as a woman’s illness has also been rooted in clinical practice, with the International Classification Diseases (ICD) 10 and DSM IV (up to 2013) including amenorrhea as a diagnostic criterion of AN. This view has fundamentally shaped the identity and status of male sufferers who bear the added burden of a feminised diagnosis.

Objectives: To study the male cases of AN as a way to enhance the knowledge on aetiology and patophisiology of this complex and multifactorial disease.

Methods: First, we will describe a clinical case of a young man with AN who was admitted to our Sara. Afterwards, we will briefly review the most current literature addressing the shared disease components in both genders, but also the crucial differences in male patients.

Results and Discussion: Men with AN are frequently underdiagnosed, less likely to receive treatment and treated for fewer days. Their first presentation is usually late in their illness trajectory, because they experience problems in recognizing that they may have AN as a result of the continuing cultural construction of this disease as uniquely female diagnosis. There is a lack of awareness also from health professionals, which contributes massively to the delayed diagnosis this patients have to face. At that time, the disease has already become well established and therefore, even more difficult to treat.

Conclusion: It’s imperative to decouple the experience of eating disorders from feminised cultural imagery, in order to break down the barriers men face between AN and the correct diagnosis and adequate treatment of this disease.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P77

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Perceived stress, repetitive negative thinking, and cognitive coping strategies as predictors of poor sleep - read full article

By: Ana P. Amaral, Maria J. Soares, Ana T. Pereira, Sandra C. Bos, Nuno Madeira, Carolina Roque, and António Macedo

Introduction: Stress is closely related to impaired sleep and can elicit profound and lasting effects on sleep. The cognitive representations of stressors need to be prolonged in order to extend their physiological concomitants. Elevated levels of repetitive negative thinking appear to be causally involved in the maintenance of emotional problems. An appropriate regulation of thoughts and emotions decreases the likelihood of pathogenic activation of stress response.

Objectives: To study the role of perceived stress, repetitive negative thinking, and cognitive coping strategies on sleep difficulties.

Methods: 549 students (80.1% females) from two Portuguese Universities filled in the Portuguese version of Perceived Stress Scale 10, Perseverative Thinking Questionnaire, Cognitive Emotional Regulation Questionnaire and three questions were used to access sleep difficulties (initiating sleep/DIS, sleep maintenance/DMS, and early morning awakening/EMA) and the Sleep Difficulties Index/SDI (sum of these questions scores).

Results: The significant predictors of SDI were Perceived Distress (Beta=.279); Repetitive Thought (Beta=.214), Cognitive Interference and Unproductiveness (Beta=-.198); and Rumination (Beta=.127). The predictor of reporting DIS was Perceived Distress (Beta=.144), the predictors of reporting DMS were Perceived Distress (Beta=.124), Repetitive Thought (Beta=.098) and Cognitive Interference and Unproductiveness (Beta=-.124), and the predictors of reporting EMA were Perceived Distress (Beta=.070) and Rumination (Beta=.067). The factors with significant impact on the likelihood of reporting good or poor sleep were Perceived Distress (Beta=.167), Repetitive Thought (Beta=.136); Cognitive Interference and Unproductiveness (Beta=-.106) and Positive Refocusing (Beta=-.083). The mediation analyses showed that rumination and repetitive thought partially mediated the association between perceived distress and global sleep difficulties/SDI.

Discussion and Conclusions: Perceived Distress, Repetitive Negative Thinking, Rumination and Positive Refocusing were the major predictors of poor sleep. These results may have clinical implications. They highlight the importance of cognitive-behavioral stress management interventions to promote a better sleep in students.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P78

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Chronic headaches – the hidden psychological factors - read full article

By: Mariana Marinho, Ana S. Costa, João Marques, Ricardo Moreira, and Miguel Bragança

Introduction: Chronic headaches are a group of diseases with variable prevalence and impact on patients quality of life. Until a few years ago most of the investigation and the attention on this theme was directed on the role of biological factors. Nevertheless, these are insufficient to explain all the aspects of these pathologies. Currently, chronic headaches are recognized as a group of biopsychosocial diseases in which biological, psychological and environmental/social processes are considered scientifically inseparable.

Objectives: The authors aim to summarize the influence of the psychological factors on the development, course and consequences of chronic headaches.

Methods: Literature review based on articles published on PubMed/MEDLINE, between January 2005 and January 2015, using the keywords “chronic headaches”, “psychological” and “risk factors”.

Results: Several psychological factors may significantly alter the development of headache episodes, the perception of pain severity, the disability, treatment adhesion and prognosis. However, these factors usually are only thought of on clinical situations associated with significant psychopathology. The main psychological factors are headache management locus of control beliefs, self-efficacy beliefs and negative affect/emotional states, mainly depression, anxiety and anger. The authors will describe the impact of each factor.

Discussion and Conclusions: On the management of “head pain”, the physician must be aware of this a real complaint. The biopsychosocial model turns chronic headaches on a clinical challenge and so it is crucial that the physicians are familiarized with the psychological factors involved. In fact, only then can they make a correct and early diagnosis to maximize the therapeutic benefits and to minimize the functional impact of chronic headaches.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P79

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(In)voluntary psychiatric hospitalization of geriatric patients with dementia in Portugal - read full article

By: M. Marinho, F. Vieira, and M. Cruz

Introduction: With the ageing of the population, dementia is becoming increasingly common in our communities and in health practice settings. 40-90% of patients will develop psychiatric symptoms at some point during their journey within these illnesses. Frequently, the psychiatrist is faced with clinical cases where patients with dementia exhibit behavioral symptoms and lack insight, which can lead to the refuse of treatments as hospitalization.

Objectives: To comment Portugal's state legislation, policy and practice implications.

Methods: Review of literature related with involuntary hospitalization (IH) and dementia and their legal and social consequences.

Results: In Portugal, all citizens have the right of liberty and security (Art.27). However, there are some exceptions as for involuntary placement in mental disorders. The IH is conducted by the Portuguese Mental Health Act (Law n.º 36/98), which foresees some conditions such as the presence of mental disorders that imply real danger to the patient or others, risk of further deterioration, of which the person is unaware. There are few national data about this matter.

Discussion: The only report about the reality in Portugal -Alzheimer Europe- declares that the IH of people with dementia is well regulated by the Portuguese Mental Health Act. However, Article 27 is frequently violated because the majority of them are residents in nursing homes without their consent. Nowadays, there is an increase of civil actions concerning this specific population that intend to nominate legal guardians. Conclusions: The aim of preserving and enhancing the autonomy of older adults is an important target in this specific population, often forgotten by others. More epidemiological data and research are needed, focusing the patterns, conditions and the types of diagnosis that are most commonly used in cases of IH in the elderly.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P80

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Borderline Personality Disorder: a treatable condition? - read full article

By: Sofia Marques and Daniel Barrocas

Introduction: Borderline personality disorder (BPD) is characterized by four facets of psychopathological symptoms: affective disturbance, impulsivity, disturbed cognition and intense unstable relationships. It is the most common personality disorder and has a major impact on health services consumption. APA guidelines recommend psychotherapy as the primary treatment for BPD.

Objectives: Evaluation of the efficacy of cognitive-behavioral treatment (CBT) in BPD.

Methods: A systematic review of literature was conducted, using MEDLINE and PUBMED. English-language studies published between 1991 and 2014 were included when a sample of adult patients diagnosed with BPD was present, a clear description of the cognitive behavioral intervention provided and the outcomes reported.

Results: Sixty-seven studies were included, which analyzed the efficacy of several psychotherapeutic interventions, namely dialectical behavioral therapy, cognitive behavioral therapy, schema-focused therapy, manual-assisted cognitive therapy, systems training emotional predictability and problem solving, and emotion regulation group treatment. All treatments showed beneficial effects in terms of reduction of BPD core pathology and associated general psychopathology. Some also showed reduction in the severity and frequency of self-harm behaviors, whereas others documented improvement in social and global adjustment. The effect size of CBT interventions differed among studies, but in some outcomes it was moderate to large. The psychotherapeutic interventions included in this revision have many differences, either in format, total duration, therapy structure or in strategies and techniques applied.

Discussion/Conclusions: Overall, the findings support a substantial role of cognitive-behavioral psychotherapy in the treatment of BPD. This work demystifies the idea that BPD is a chronic and intractable condition. However, none of the interventions has a very robust evidence base, since studies on effectiveness of psychotherapeutic interventions meet some special methodological restrictions inherent to psychotherapy research. In the future, more studies are needed to: 1) replicate the results submitted by independent researchers; 2) include male patients; 3) include patients with defined comorbidities; 4) compare various psychotherapeutic modalities.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P81

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From the uterus to the mind – the conceptual evolution of Hysteria - read full article

By: Tânia Abreu and Geraldo Oliveira

Introduction: The concept of Hysteria has been changing for four thousand years. Its inconstancy has been influenced by the socio-cultural context in each period of History.

Objectives: The authors aim to summarize the evolution of the concept of Hysteria from 1900 b.C. to the present.

Methods: Review of the literature.

Results: Egyptians initiated the descriptions about Hysteria, describing a uterus that wandered through the body causing the symptoms. The Wandering Womb Theory lasted for many centuries. Hippocrates spoke about the “suffocation of the womb” around 400 b.C.. In the second century, Galen refuted this theory, relating Hysteria to sexual dissatisfaction and a secretion of the uterus. In the Middle Age, Hysteria was associated with sin and demonic possession, being treated by exorcism and later leading to the execution of countless women by fire. In the 16th century, the Hippocrates and Galen’s ideas were resumed. The “Suffocation of the Mother” was caused by vapors arising from the uterus. By this time, emotional causes began to be considered, but the paradigm shifts started in the 17th century. Sydenham spoke of a common multifactorial chronic disease, determined by physical and psychological factors that could affect both sexes. In the 18th century, the uterus returned, this time associated with the theories of the cerebral and spinal irritation and reflex arcs. By the 19th century, Hysteria was epidemic and treated by genital massage. At the same time, it was starting to be considered a mental disorder with the works of Griesinger, Briquet and others. Charcot marked an important turn at the Salpêtrière Hospital, leading the way to his followers, like Freud and Janet, to explore Hysteria. Freud introduced the association to repressed child sexual conflict. Treatments were focused on hypnosis and, later, psychoanalysis. Currently, the concept of Hysteria is fragmented in different disorders: dissociative, somatic and histrionic personality disorder.

Discussion and Conclusions: After four millennia, there is no consensus about Hysteria. For some it is lost, for others it is still present, often with a negative connotation.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P82

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Paws for help animal-assisted therapy - read full article

By: Tânia Abreu and Ana R. Figueiredo

Introduction: Previous research indicates that pet ownership and animal assistance in therapy and education may have a multitude of positive effects in humans, providing physical, physiological and psychological health benefits for patients. Animal-assisted Therapy is a goal-directed intervention, led by a specialized professional, in which an animal that meets specific criteria is an integral part of the treatment process. There are specified goals and objectives for each individual and measured progress. Literature has been cementing the idea that animals’ presence, spontaneous behaviour and availability for interaction may facilitate therapy. It has been demonstrated that interactions with a friendly animal can result in reducing levels of cortisol and increasing oxytocin, dopamine, endorphins and phenethylamine.

Objectives: The authors aim to study Animal-Assisted Therapy regarding animal-human relation, characteristics of the animals, theoretical bases, definitions, types of therapies and results.

Methods: It was conducted a review of the literature about Animal-assisted Therapy.

Results: Recent research shows how interaction with animals can benefit individuals with a range of mental health issues, including affective disorders, anxiety, dementia, schizophrenia and trauma. Scientific evidence on the effects is far from being consistent. It is necessary to conduct rigorous studies to prove the efficacy of Animal-Assisted Therapy, so it could become an empirically supported treatment. It is also important to standardize terminology and methodologies.

Discussion and Conclusions: Overall, Animal-assisted Therapy is an emergent field in mental health, and it can potentially be a very useful complement for the treatment of mental disorders.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P83

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Malingering and self harm: a case study - read full article

By: Telma Santos, Ema Conde, R. Leite Almeida, João Alcafache, and Vitor Santos

Introduction: In clinical practice, malingering is not considered a form of mental illness or psychopathology, although it can occur in the context of other mental illnesses.

Objectives and Methods: The aim of this work is to expose a case study about malingering in a 44 years old female admitted in the Baixo Vouga Hospitalar Centre Psychiatric ward.

Results: She claimed being victim of several physical and pshychological attacks by neighbors and brothers which resulted in multiple burns injuries, most of all on the face. During the hospitalization she admitted the deliberate self-harm authorship. On an ongoing basis we found a severe personality disorder which conditioned all patient life.

Discussion and Conclusions: Despite of malingering is unfrequent clinicians should be aware of this possibility and be competent enough to identify it, tactfully and nonjudgmentally, presenting inconsistencies to the patient and offer a face-saving way out of the interaction.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P84

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Neurobiological aspects of personality - read full article

By: Catarina Freitas, Denis Gabriel, João Chaves, and Sandra Queirós

Introduction: Personality is an individual characteristic, result of the interaction of biological, psychological and social factors. In some circumstances during adulthood, it may occur deep and lasting personality changes, which may result from injury or organic brain disease, various psychiatric disorders or exceptionally severe stressful experience. The change most commonly perceived and reported by family members of patients with brain injury is the change in personality. The neurobiological aspects of personality have been subject of intense discussion, over time, in order to try to associate certain personality traits with areas and brain circuits, including, for example, studies with imaging exams.

Objectives and Methods: The authors propose to describe two cases of patients with lesions in the prefrontal cortex, trying to associate such lesions to characteristic personality traits of orbitofrontal dorsolateral syndromes.

Results: The frontal syndromes are associated with personality change, cognitive impairment, difficulties in interpersonal relations and social behavior and other neurological disorders.

Discussion and Conclusions: With the growing scientific advances and the high demand for neurological explanation for the personality, the question remains whether the personality changes are direct consequence of brain injury or due to other different processes such as the emotional reaction to the neurological damage.

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

International Journal of Clinical Neurosciences and Mental Health 2015; 2(Suppl. 1):P85

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