Contribitions from Forensic Psychology and Psychiatry

Neonaticide is the homicide of a child by a parent during the first 24 hours of life. The goal of this paper is to characterize cases of neonaticide that have occurred in the Great Lisbon area. The clinical files of all neonaticide cases that were studied at the Delegação do Sul, Instituto Nacional de Medicina Legal e Ciências Forenses (INMLCF, IP), between January, 1st 2001 and December 31st 2010 were reviewed and analyzed. Five cases of neonaticide were identified (2.96 per 100000 live births), perpetrated by five mothers with an average age of 25 years, whose main motivation was unwanted pregnancy. The pregnancies were concealed, no pre-natal care was obtained and delivery was unassisted and occurred at home. There were no cases of mental disorders that could justify, under a medico-legal point of view, a decision of not guilty by reason of insanity. Although rare, neonaticide cases affect societies and raise forensic questions. Due to its lower association with major psychopathology, low careseeking behavior, opportunities for prevention are reduced. Therefore, the early detection of pregnancy in women of fertile age may provide a valuable chance to offer the required support.info:eu-repo/semantics/publishedVersio

Mental health stigma: where do we stand?

O estigma da doença mental tem sido alvo de crescente atenção nos últimos anos, com um aumento exponencial de publicações sobre o tema. Este fenómeno constitui para os doen- tes uma fonte de sofrimento, representando um obstáculo à concretização de projectos pessoais e à integração social plena, objectivo principal da prática psiquiátrica actual. Neste artigo, os autores fazem uma revisão selectiva do tema do estigma da doença mental, abor- dando as suas definições, origens, repercus- sões, vivências dos doentes e abordagens para o combater. A literatura revela tratar-se de um fenómeno complexo, cujas definições provêm de diferentes campos do conhecimento (socio- logia, psicologia e psiquiatria). O seu impacto na vida das pessoas com doença mental é evi- dente, condicionando perda de oportunidades, prejuízo da auto-estima e auto-conceito, quali- dade de vida, suporte social e empowerment e actuando como uma barreira ao desempenho dos papéis sociais habituais. O estigma pare- ce ainda comprometer o acesso a cuidados de saúde, não apenas ao tratamento psiquiátrico, mas também a cuidados médicos gerais, com aumento da morbilidade e mortalidade desta população vulnerável. Tem sido dedicado um considerável esforço à compreensão deste fe- nómeno e ao delinear de estratégias anti-estig- ma, que passam também pela sensibilização dos profissionais de saúde para o tema, tendo em vista a melhoria da prática clínica e qualidade dos cuidados prestados

Musical hallucinations and schizophrenia: case report

As alucinações musicais são um tipo de alucinações auditivas complexas. Trata-se de um fenómeno relativamente raro e etiologicamente heterogéneo. Como principais etiologias, têm sido apontadas a hipoacúsia, a patologia cerebral orgânica, a epilepsia, e as doenças psiquiátricas, incluindo a esquizofrenia. A propósito de um caso clínico, os autores revêem e discutem a etiologia e a psicopatologia das alucinações musicais. Parece tratar-se de um fenómeno sub-diagnosticado, cuja pesquisa activa poderá permitir uma compreensão mais completa do quadro clínico apresentado pelo doente

Contributos da psicologia e psiquiatria

O neonaticídio corresponde ao homicídio de uma criança durante as primeiras 24 horas de vida. Neste trabalho procurou-se caracterizar casos de neonaticídio ocorridos na área da Grande Lisboa, através de um estudo retrospetivo de todos os processos investigados na Delegação do Sul do Instituto Nacional de Medicina Legal e Ciências Forenses, I.P. (INMLCF), entre 1 de janeiro de 2001 e 31 de dezembro de 2010. Identificaram-se cinco casos de neonaticídio (2.96 por 100000 nados-vivos), atribuíveis a cinco mães com uma idade média de 25 anos, cuja principal motivação foi a gravidez indesejada. Em todos os casos, a gravidez foi ocultada, evoluiu sem cuidados médicos pré-natais e o parto ocorreu em casa, sem assistência. Não foi identificada qualquer perturbação mental que verificasse os requisitos normativos de inimputabilidade para o crime. Embora raros, os casos de neonaticídio causam particular alarme social e levantam diversas questões jurídicas e médicolegais. O facto de se encontrarem associados à ocultação da gravidez e à ausência de perturbação mental evidente das suas autoras, dificulta a adoção de medidas preventivas, destacando-se a importância de um diagnóstico precoce de gravidez em mulheres em idade fértil.info:eu-repo/semantics/publishedVersio

Psychoeducation for bipolar disorders’ patients: the “Porta Aberta” programme

Psychoeducation is currently considered to be a fundamental intervention in the management of bipolar disorders. A psychoeducation group programme for patients with bipolar disorders, aimed at euthymic patients just prior to their discharge from the acute psychiatric inpatient unit, named “Porta Aberta” (Open Door), has been implemented since 2007 at the day-hospital of our psychiatric department (Amadora, Portugal). In this article, the authors provide a brief review of the relevant literature on this subject and also assess the effectiveness of the “Porta Aberta” programme in reducing the average number and duration of readmissions; they determine whether individual characteristics (gender, marital status and disorder subtype) may influence outcome

Characteristics of frequent users of an acute psychiatric inpatient unit: a five-year study in Portugal.

OBJECTIVE: This study examined demographic and clinical characteristics of frequent users of a psychiatric inpatient unit in Portugal. METHODS: Data (2004-2008) for 1,348 consecutive psychiatric inpatients were reviewed. Frequent users (N=137), who had at least three admissions in the study period, were compared with nonfrequent users (N=1,211) on age, gender, race-ethnicity, diagnosis, and compulsory admissions. Data were analyzed with chi square and Student's t tests. RESULTS: Frequent users accounted for 29% of admissions. They were significantly younger than nonfrequent users (39±14 versus 44±17, p<.001), and a larger proportion had compulsory admissions (28% versus 14%, p<.001). The frequent user group also had significantly higher rates of bipolar disorder (61% versus 46%, p<.001) and schizophrenia (29% versus 18%, p<.003). CONCLUSIONS: Understanding characteristics of frequent users can inform development of appropriate services. Research should address other variables related to frequent admissions, including socioeconomic factors, general medical and psychiatric comorbidities, and treatment compliance

Activation of neutrophils within pulmonary microvessels of rabbits exposed to cigarette smoke.

Previous studies have shown that polymorphonuclear leukocytes (PMN) are delayed in the pulmonary capillaries by the presence of cigarette smoke. To determine if the PMN delayed by smoking are activated, we estimated the in vivo expression of CD11/CD18 and L-selectin on the surface of PMN in lungs and peripheral blood of rabbits because these molecules are known to be upregulated and downregulated, respectively, on the surface of activated PMN. New Zealand white rabbits (3.5 +/- 0.1 kg) were exposed to either air (n = 5) or cigarette smoke (n = 5), and we used an established protocol to measure pulmonary vascular blood flow, volume, and red blood cell (RBC) transit time in the left lung. The right lungs were then fixed in 0.025% glutaraldehyde and stored in liquid nitrogen. Ultrathin sections were immuno-labeled with either the anti-CD18 monoclonal antibody 60.3 or the anti-L-selectin antibody Dreg-200, followed by a secondary antibody conjugated to 10 nm colloidal gold. The target antigens were quantified by counting the number of gold particles per micron (G/microns) of PMN surface membrane. The data show that smoke exposure had no effect on pulmonary blood flow, volume, or RBC transit time. However, it increased the expression of CD11/CD18 on intravascular PMN in the upper region of the lung (control, 7.4 +/- 1.3 G/microns; smoke-exposed, 13.2 +/- 3.3 G/microns; P < 0.05) and decreased the expression of L-selectin on intravascular PMN in both the lower (control, 5.5 +/- 2.0 G/microns; smoke-exposed, 2.6 +/- 1.5 G/microns; P = 0.05) and the upper (control, 6.8 +/- 1.4 G/microns; smoke-exposed, 2.6 +/- 1.2 G/microns; P < 0.05) regions

An OCD patient presenting with a cerebellum venous variant in a family with a strong schizophrenia loading: a case report.

The role of cerebellar pathology in psychiatric symptoms has long been recognized. Cerebellar pathology has been associated with obsessive-compulsive disorder pathophysiology, particularly with compulsive hoarding. Likewise, some cerebellum abnormalities have been described in schizophrenia, as well as in comorbidity between obsessive-compulsive disorder and schizophrenia. The authors report the case of a 32-year-old woman with obsessive-compulsive disorder and a cerebellum development variant in a family with a strong schizophrenia loading. This case emphasizes the probable role of the cerebellum in the pathophysiology of both obsessive-compulsive disorder and schizophrenia, and reconsiders the existence of a so called schizo-obsessive subtype of schizophrenia

Suicide ideators and attempters : differences and risk factors for the use of violent methods at admission in a psychiatric ward

Copyrights belong to the Author(s). Suicidology Online (SOL) is a peer-reviewed open-access journal publishing under the Creative Commons Licence 3.0.OBJECTIVES: The study addressed two major issues: (1) how patients admitted to a psychiatric ward with suicide ideation differ from patients who attempted suicide in the last 24–48 hours and (2) which characteristics are associated with violent methods in the suicide attempt. METHODS: Data from all patients admitted for suicide ideation or attempt were collected, including sociodemographic and clinical variables (psychiatric diagnosis and history of substance use disorder, method utilized, precipitating factor, seasonality of the episode, length of inpatient stay, history of suicidal attempts and nonsuicidal self-injuries (NSSI), family history of suicide attempts). Results were calculated using chi-square with Fisher’s exact tests, independent sample t-test and multiple logistic regression analyses. RESULTS: A total of 106 admissions (58 ideators and 48 attempters) were identified. Attempters (compared to ideators) were significantly more frequently male, retired or unemployed, had more frequently a psychotic diagnosis and a history of drug use disorder and less frequently previous suicide attempts. Attempters who used violent methods (compared to those who used deliberate selfpoisoning) were significantly more often male, had a psychosis diagnosis and a superior length of inpatient stay but had less frequently previous NSSI. Independent risk factors for attempted suicide included psychosis diagnosis and history of drug use disorder. Female gender was protective. CONCLUSIONS: This study provides a characterization of suicide ideators and attempters in a sample of psychiatric inpatients. The identification of risk factors and its early recognition are crucial interventions for suicide prevention.info:eu-repo/semantics/publishedVersio