Terapia Cognitivo‐Comportamental no Tratamento dos Sintomas Neurológicos Funcionais/Dissociativos: Estado da Arte

Introdução: Os sintomas neurológicos funcionais/dissociativos (SNF/D) geram incapacidade, diminuição de produtividade e da qualidade de vida. A abordagem terapêutica é ainda pouco clara; a terapia cognitivo-comportamental (TCC) parece apresentar resultados positivos. Esta revisão pretende sumarizar evidência sobre eficácia da TCC no tratamento dos SNF/D. Métodos: Revisão não sistemática da literatura: pesquisa na base de dados PubMed/Medline, utilizando guidelines PRISMA para scoping reviews, com termos relacionados com SNF/D e TCC. Resultados: Vários estudos descrevem vantagens da TCC no tratamento de tremor funcional; tontura postural-perceptiva persistente; crises não-epilépticas psicogénicas; várias perturbações funcionais do movimento; e SNF/D no geral, com melhoria nos outcomes primários (redução de sintomas físicos) e secundários (nível de funcionamento, qualidade de vida, estado mental, ansiedade/depressão, utilização de serviços). Alguns estudos analisaram intervenções psicológicas no geral, e não TCC especificamente. Uma revisão sobre neuromodulação no tratamento dos SNF/D refere que a sua eficácia não está provada; especula que a combinação com TCC pode ser promissora. Discussão: Estudos recentes referem que no geral, existe pouca evidência de elevada qualidade; consideram que alguns estudos têm elevado risco de viés e não têm análise de qualidade de evidência apropriada. Foram encontradas algumas contradições entre estudos, por exemplo em relação à melhoria do nível de funcionamento e à redução do número de convulsões. No entanto, a maioria dos estudos reporta alguma evidência sobre a eficácia da TCC no tratamento de diferentes SNF/D, quer a nível de outcomes primários como secundários, alguns em conjunto com fisioterapia e outras modalidades psicoterapêuticas, reforçando a importância de abordagem multidisciplinar. Conclusão: Os estudos realizados até à data apresentam problemas metodológicos importantes, com baixo número de doentes incluídos, e heterogeneidade dos doentes, o que dificulta a comparação entre estudos e obtenção de estudos de elevada qualidade metodológica. Apesar de não existir um consenso sobre a melhor abordagem terapêutica, e da baixa qualidade metodológica existente até à data, a TCC é a que tem demonstrado melhores resultados (em outcomes primários e secundários) no tratamento dos SNF/D. São necessários mais estudos, com rigor metodológico, que permitam validar os resultados positivos obtidos até ao momento

Urbanicity and Psychosis: Is there a Connection? A Comparative Study between an Urban and Rural Area in Portugal

Introduction: Studies about urbanicity and psychosis show contradictory results. In northern European countries and China there is a positive relationship; in southern European and underdeveloped countries, a significant difference between rural and urban rates of psychosis has not been found. Methods: We carried out a 5‐year retrospective observational study, with patients admitted to two inpatient units for first‐episode psychosis (FEP), in a rural area (Évora) and an urban area (Lisbon). We excluded affective or organic psychosis. Socio‐demographic and clinical data were extracted and analyzed. Results: The prevalence of FEP was the same for both areas (42/100 000 inhabitants), with a predominance of unemployed (63%) and lonesome individuals (81% in Évora versus 72% in Lisbon). The mean age was similar (Évora 43.4 years old; Lisbon 41.4 years old). Lisbon had a greater diversity of nationalities (16.3% vs 4.6%) and a higher rate of psychotic disturbance due to substance use (26.5% vs 21.6%). The most prevalent diagnosis in the Lisbon was unspecified psychotic disorder (UPD) (34.7%), while in Évora it was delusional disorder (DD) (21.5%) and acute andtransient psychotic disorder (21.5%). DD was a prevalent diagnosis in both areas, affecting mainly women and those with a higher median age. Duration of untreated psychosis (DUP) of less than 1 month was higher in Lisbon (24.5% vs 4.5%), but there was a high prevalence of DUP of more than 2 years in both samples (20.4% vs 23.1%). Discussion: The mean age of FEP was higher than in other studies, which may translate a significant prevalence of DD or reflect a higher DUP. A reduced DUP of less than 1 month in the rural area can be explained by greater isolation of the population, lower health literacy or better integration of patients in the community. The prevalence of UPD was higher in the urban area, possibly due to different forms of registration or a lower DUP. Conclusion: Our results are in line with studies reported in southern European countries, where no association was found between psychosis and urbanicity, and further studies are needed to elucidate this issue

Plasma lathosterol measures rates of cholesterol synthesis and efficiency of dietary phytosterols in reducing the plasma cholesterol concentration

Objectives: Because the plasma campesterol/cholesterol ratio does not differ between groups that absorb different amounts of cholesterol, the authors investigated whether the plasma Phytosterols (PS) relate to the body's cholesterol synthesis rate measured as non-cholesterol sterol precursors (lathosterol). Method: The authors studied 38 non-obese volunteers (58±12 years; Low-Density Lipoprotein Cholesterol ‒ LDL-C ≥ 130 mg/dL) randomly assigned to consume 400 mL/day of soy milk (Control phase) or soy milk + PS (1.6 g/day) for four weeks in a double-blind, cross-over study. PS and lathosterol were measured in plasma by gas chromatography coupled to mass spectrophotometry. Results: PS treatment reduced plasma total cholesterol concentration (-5.5%, p < 0.001), LDL-C (-7.6%, p < 0.001), triglycerides (-13.6%, p < 0.0085), and apolipoprotein B (apo B) (-6.3%, p < 0.008), without changing high density lipoprotein cholesterol (HDL-C concentration), but plasma lathosterol, campesterol and sitosterol expressed per plasma cholesterol increased. Conclusions: The lathosterol-to-cholesterol plasma ratio predicted the plasma cholesterol response to PS feeding. The highest plasma lathosterol concentration during the control phase was associated with a lack of response of plasma cholesterol during the PS treatment period. Consequently, cholesterol synthesis in non-responders to dietary PS being elevated in the control phase indicates these cases resist to further synthesis rise, whereas responders to dietary PS, having in the control phase synthesis values lower than non-responders, expand synthesis on alimentary PS. Responders absorb more PS than non-responders, likely resulting from responders delivering into the intestinal lumen less endogenous cholesterol than non-responders do, thus facilitating greater intestinal absorption of PS shown as increased plasma PS concentration

Unidade de Internamento Psiquiátrico para Jovens dos 15 aos 25 Anos: Um Estudo de Follow-up

Introduction: Adolescence and early adulthood are life stages characterized by significant physical, psychological, and social transformations. The transitional age, between 15 and 25 years old, is considered a high-risk period for the development of psychopathology, representing a critical period of opportunities and challenges for mental health intervention. Our objective was to do 4-year follow-up study was conducted on young individuals who were hospitalized during the year 2018 in the acute psychiatric inpatient unit Unidade Partilhada, dedicated to individuals aged 15 to 25 years old. The aim was to assess the sociodemographic and clinical characteristics of the sample, inpatient characteristics, rehospitalization rate, psychopathological status, quality of life, satisfaction with the provided care, and maintenance of follow-up appointments; establishing relationships between the mentioned variables. Methods: Standardized telephone interviews were conducted using the reduced version of the Mental Health Inventory (MHI) and the World Health Organization’s Abbreviated Instrument for Quality of Life Assessment. Clinical records were also consulted. Results: There was a higher percentage of female patients (52.1%). The discharge diagnosis of mood disorders (54.3%) was significantly higher in females, while psychotic disorders (23.4%) were significantly higher in males (Fisher = 40; p<0.001). The duration of hospitalization (average=16.1 days; SD=13.6 days) was significantly longer for psychotic disorders compared to mood disorders (p=0.009). A percentage of 41.5% of young individuals were readmitted, with 6.3% readmitted within 30 days and 35.2% readmitted within 365 days. At the time of the follow-up interview, 80.9% considered themselves “better,” and 62.7% reported being “satisfied” or “very satisfied” with their lives. A percentage of 74.5% continued to receive outpatient care, with significantly lower MHI scores observed among individuals without current follow‐up. A percentage of 37.2% reported being “very satisfied” or “extremely satisfied” with the care provided. Conclusion: Obtaining knowledge and data that allow for the characterization of psychiatric hospitalization during the transitional age is fundamental for the planning, organization, and optimization of care provided to this population. Valuing patient opinions and fostering closer relationships between healthcare professionals and young patients promotes treatment adherence.Introdução: A adolescência e início da idade adulta, são fases do ciclo de vida marcadas por grandes transformações físicas, psicológicas e sociais. A faixa etária de transição, entre os15 e 25 anos, é considerada uma idade de risco para o desenvolvimento de psicopatologia, representando um período crítico de oportunidades e desafios para a intervenção em saúde mental. O nosso objetivo foi realizar um estudo de follow-up a 4 anos dos jovens internados durante o ano de 2018 na unidade de internamento agudo psiquiátrico Unidade Partilhada, destinado a jovens dos 15 aos 25anos de idade; pretendeu‐se avaliar as características sociodemográficas e clínicas da amostra, as características do internamento, a taxa de reinternamento, o estado psicopatológico, qualidade de vida, grau de satisfação com os cuidados prestados e manutenção do seguimento em consulta; estabelecendo relações entre as variáveis mencionadasMétodos: Entrevista telefónica padronizada, com aplicação da versão reduzida do Mental Health Inventory (MHI) e o Instrumento Abreviado de Avaliação da Qualidade de Vida da Organização Mundial de Saúde; consulta de processo clínico.Resultados: Há uma maior percentagem de doentes do sexo feminino (52,1%). O diagnóstico de alta de perturbaçãodo humor (54,3%) foi significativamente superior no sexo feminino e o de perturbação psicótica (23,4%) foi significativamente superior no sexo masculino (Fisher= 40; p<0,001). A duração do internamento (média=16,1 dias; DP=13,6 dias) foi significativamente superior para as perturbações psicóticas em comparação com as perturbações do humor (p=0,009). Dos jovens, 41,5% foram readmitidos, 6,3% num período inferior a 30 dias e 35,2% num período inferior a 365 dias. À data da entrevista de follow-up, 80,9% consideram estar “melhor”; e 62,7% estar “satisfeitos”ou “muito satisfeitos” com a sua vida. Mantêm acompanhamento em consulta 74,5%, sendo a pontuação do MHI significativamente inferior nos jovens sem seguimento atual. Referem estar “muito satisfeitos” ou “mais que muito” com o atendimento prestado, 37,2%.Conclusão: O conhecimento e obtenção de dados que permitam a caracterização do internamento psiquiátrico em idade de transição é fundamental para a planificação, organização e otimização dos cuidados prestados a esta população. A valorização da opinião do doente e a aproximação entre profissionais de saúde e doentes jovens, favorece a adesão ao tratamento

Relatório Estágio Profissional

Relatório final do estágio profissionalizante do 6.º an

Phytosterols Supplementation Reduces Endothelin-1 Plasma Concentration in Moderately Hypercholesterolemic Individuals Independently of Their Cholesterol-Lowering Properties

Experimental and clinical studies have demonstrated the effect of phytosterols (PS) on reducing plasma levels of cholesterol and LDL-c, but the effects of plant sterols beyond cholesterol-lowering are still questionable. Since inflammation and endothelial dysfunction are involved in the pathogenesis of atherosclerosis, this study aims to evaluate the effect of PS on biomarkers involved in atherosclerosis progression and whether these effects are independent of alterations in plasma LDL-c levels. Thirty-eight moderately hypercholesterolemic volunteers (58 ± 12 years; LDL-c ≥ 130 mg/dL) were randomly assigned to consume 400 mL/day of soy milk or soy milk + PS (1.6 g/day) for 4 weeks in a double-blind, placebo-controlled, cross-over study. Blood samples were collected and lipid profiles and biomarkers for inflammation and endothelial dysfunction determined. The results showed that PS treatment reduced endothelin-1 plasma concentration by 11% (p = 0.02) independently of variations in plasma levels of LDL-c. No alterations were observed regarding fibrinogen, IL-6, hs-CRP, SAA, TNFα, or VCAM-1 between placebo and PS-treated groups. Furthermore, PS reduced total plasma cholesterol concentration (−5,5%, p < 0.001), LDL-c (−6.4%, p < 0.05), triglycerides (−8.3%, p < 0.05), and apo B (−5.3%, p < 0.05), without changing HDL-c concentration (p > 0.05). Therefore, PS supplementation effectively lowers endothelin-1 independently of the reductions in plasma levels of LDL-c, contributing to the comprehension of the effect of plant sterols on endothelial function and prevention of cardiovascular diseases