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Abstract Background Deficits in executive function (EF) are consistently reported in autism spectrum disorders (ASD). Tailored cognitive training tools, such as neurofeedback, focused on executive function enhancement might have a significant impact on the daily life functioning of individuals with ASD. We report the first real-time fMRI neurofeedback (rt-fMRI NF) study targeting the left dorsolateral prefrontal cortex (DLPFC) in ASD. Methods Thirteen individuals with autism without intellectual disability and seventeen neurotypical individuals completed a rt-fMRI working memory NF paradigm, consisting of subvocal backward recitation of self-generated numeric sequences. We performed a region-of-interest analysis of the DLPFC, whole-brain comparisons between groups and, DLPFC-based functional connectivity. Results The ASD and control groups were able to modulate DLPFC activity in 84% and 98% of the runs. Activity in the target region was persistently lower in the ASD group, particularly in runs without neurofeedback. Moreover, the ASD group showed lower activity in premotor/motor areas during pre-neurofeedback run than controls, but not in transfer runs, where it was seemingly balanced by higher connectivity between the DLPFC and the motor cortex. Group comparison in the transfer run also showed significant differences in DLPFC-based connectivity between groups, including higher connectivity with areas integrated into the multidemand network (MDN) and the visual cortex. Conclusions Neurofeedback seems to induce a higher between-group similarity of the whole-brain activity levels (including the target ROI) which might be promoted by changes in connectivity between the DLPFC and both high and low-level areas, including motor, visual and MDN regions.

Abstract Inhibition is implicated across virtually all human experiences. As a trade-off of being very efficient, this executive function is also prone to many errors. Rodent and computational studies show that midbrain regions play crucial roles during errors by sending dopaminergic learning signals to the basal ganglia for behavioural adjustment. However, the parallels between animal and human neural anatomy and function are not determined. We scanned human adults while they performed an fMRI inhibitory task requiring trial-and-error learning. Guided by an actor-critic model, our results implicate the dorsal striatum and the ventral tegmental area as the actor and the critic, respectively. Using a multilevel and dimensional approach, we also demonstrate a link between midbrain and striatum circuit activity, inhibitory performance, and self-reported autistic and obsessive–compulsive subclinical traits.

Background and Objectives: Observational studies with data from real-world clinical practice with patients with difficult-to-treat depression (DTD) are rare. This study aims to collect observational data from the real-world clinical practice of a Portuguese community mental health team (CMHT) on the prevalence of DTD and to explore differences between DTD and non-DTD groups. Materials and Methods: We conducted a retrospective chart review study using data from Electronic Health Records (EHRs) of adult patients with psychiatric disorders followed by a CMHT from the Department of Psychiatry of the Coimbra Local Health Unit (between 1 December 2020–31 December 2022). The Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD) was used to assess the degree of treatment resistance and the Charlson Comorbidity Index (CCI) to measure medical comorbidity. Results: A quantity of 473 patients were referred to Cantanhede CMHT for a first assessment. Of these, 219 patients met the criteria for a primary diagnosis of any depressive disorder. Assistant psychiatrists identified 57 patients with DTD during follow-up (approximately 26%). The DTD group had higher rates of depressive episodes, greater depression severity, increased service use, higher DM-TRD scores, and a higher prevalence of comorbid anxiety symptoms, personality disorders, and severe medical comorbidities. The DTD group also had a higher prescription rate of antidepressants. Differences were observed in the use of antidepressant augmentation strategies and in the prescription of anticoagulant/antiplatelet drugs and analgesics, with higher prescription rates in the DTD group. We found correlations between DM-TRD and CCI scores, and between DM-TRD scores and all service use variables. Conclusions: Our results are consistent with a similar study in the United Kingdom, highlighting the need for a different approach to the management of DTD patients, who continue to live with a significant burden despite usual pharmacological and non-pharmacological treatments.

The profile of executive function (EF) in adults with Schizophrenia (SCZ) and autism spectrum disorder (ASD) remains unclear. This study aims to ascertain if distinct EF patterns can be identified between each clinical condition by comparing the neuropsychological profile of adults with SCZ and ASD, for whom the differential diagnosis is still highly challenging. Forty-five individuals (15 SCZ, 15 ASD, 15 controls) matched for age, sex, education level, and handedness underwent intelligence evaluation and neuropsychological testing for working memory, inhibition, planning and set-shifting, and verbal fluency subdomains. Principal component analysis (2D-PCA) using variables representing 4 domains was employed to identify patterns in neuropsychological profiles. The ASD group had lower scores on the Digits Forward subtest compared to the SCZ group (7.2 ± 2.1 vs. 9.3 ± 1.9, p = 0.003; Cohen’s d: 1.05). ASD also performed significantly worse on the Stroop Word Test compared to the control group (77.7± 17.9 vs. 98.0 ± 12.7, p = 0.009; Cohen’s d: 1.31). No significant differences were observed between ASD and SCZ on other EF measures. The larger contributors for the dimensions in 2D-PCA were the Digits Forward subtest and Stroop Word Test. Still, there was substantial overlap between the clinical groups. This study suggests a high degree of similarity of EF between SCZ and ASD. Through four EF measures, the discrimination of low and high-functioning EF groups spanning both diagnostic categories may help to identify the individuals who could better benefit from cognitive rehabilitation strategies.

Introduction: The paradigm in mental health care is progressively moving towards a recovery-focused perspective. Thus, there is a need for validated instruments to measure recovery in bipolar disorder (BD). The Bipolar Recovery Questionnaire (BRQ) is the most used instrument to assess it. The aim of this study was to translate and perform a cross-cultural adaptation of the BRQ to European Portuguese (PT-PT) and to explore further associations of recovery with sociodemographic and emotional regulation, as well as recovery predictors to inform future research and clinical practice. Methods: The BRQ was forward-translated and back-translated until a consensus version was found, and a test-retest design was used to assess temporal stability. Participants were recruited in public hospitals and organizations supporting people with BD, either referred by their psychiatrists or psychologists or through self-referral. Eighty-eight individuals diagnosed with BD were recruited to complete a battery of Portuguese-validated self-report questionnaires to assess recovery (BRQ), clinical mood symptoms (Hospital Anxiety and Depression Scale), affect (Positive and Negative Affect Scale), well-being (brief Quality of Life for Bipolar Disorder; Satisfaction with Life Scale) and emotion regulation (Difficulties in Emotion Regulation Scale). Results: The BRQ showed excellent internal consistency with a Cronbach alpha of 0.92, and test-retest exhibited good reliability (r = 0.88). Construct validity was confirmed through/by positive and moderate correlations with quality of life (QoL; r = 0.58) and positive affect (r = 0.52), and negative moderate correlations with depression (r = -0.64), and negative affect (r = -0.55). Both satisfaction with life (β = 0.38, p = 0.010) and recovery (β = 0.34, p = 0.022) impacted quality of life, supporting the BRQ’s incremental validity. Depressive symptoms and emotion dysregulation accounted for 51% of its variance. Conclusion: The BRQ is a valid and reliable instrument to measure recovery in people with BD in the Portuguese population and is suitable for both clinical and research contexts.

Executive functions and motivation have been established as key aspects for neurofeedback success. However, task-specific influence of cognitive strategies is scarcely explored. In this study, we test the ability to modulate the dorsolateral prefrontal cortex, a strong candidate for clinical application of neurofeedback in several disorders with dysexecutive syndrome, and investigate how feedback contributes to better performance in a single session. Participants of both neurofeedback (n = 17) and sham-control (n = 10) groups were able to modulate DLPFC in most runs (with or without feedback) while performing a working memory imagery task. However, activity in the target area was higher and more sustained in the active group when receiving feedback. Furthermore, we found increased activity in the nucleus accumbens in the active group, compared with a predominantly negative response along the block in participants receiving sham feedback. Moreover, they acknowledged the non-contingency between imagery and feedback, reflecting the impact on motivation. This study reinforces DLPFC as a robust target for neurofeedback clinical implementations and enhances the critical influence of the ventral striatum, both poised to achieve success in the self-regulation of brain activity.

Introduction: Stigma is associated with poor prognosis of illness and reduced help-seeking behavior, self-esteem and treatment compliance. The aims of this study were to study the reliability and construct validity of the King’s et al Stigma Scale, and its association with Illness and Help-Seeking Behaviors scale (IHSBS) scores. Material and Methods: One hundred and forty mental health patients filled out the Stigma scale and the Illness and Help-Seeking Behaviors scale. The exploratory factor analysis of the stigma scale was performed, and its reliability studied. The correlation analysis was used and mean differences in Stigma Scale scores among IHSBS groups were explored. Results: The exploratory factor analysis indicated four factors (F): F1-Disclosure, F2-Discrimination, F3-Acceptance and F4-Personal Growth, which showed acceptable/good internal consistency (α from 0.70 to 0.91). Help-seeking behaviors were not associated with stigma. The levels of Discrimination were high in the group with global high-IHSB and in patients with medium/high illness behavior (IB) and health-related worries (HW). Additionally, Disclosure and overall stigma levels were higher in groups with high-HW and with medium-IB scores (when compared with the group with low-IB). The group with low-IB also had lower levels of Acceptance and Personal Growth when compared with the groups with medium-IB and high-IB, respectively. Conclusion: The Stigma Scale (27 items) is a valid, reliable instrument and useful tool to assess stigma in mental health patients.

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Background: Social cognition impairment is a key phenomenon in serious mental disorders such as schizophrenia (SCZ) and bipolar disorder (BPD). Although genetic and neurobiological studies have suggested common neural correlates, here we hypothesized that a fundamental dissociation of social processing occurs at an early level in these conditions. Methods: Based on the hypothesis that key structures in the social brain, namely the temporoparietal junction, should present distinctive features in SCZ and BPD during low-level social judgment, we conducted a case-control study in SCZ (n = 20) and BPD (n = 20) patients and controls (n = 20), using task-based fMRI during a Theory of Mind (ToM) visual paradigm leading to interpretation of social meaning based on simple geometric figures. Results: We found opposite neural responses in two core ToM regions: SCZ patients showed social content-related deactivation (relative to controls and BPD) of the right supramarginal gyrus, while the opposite pattern was found in BPD; reverse patterns, relative to controls and SCZ, were found in the left posterior superior temporal gyrus, a region involved in inferring other’s intentions. Receiver-operating-characteristic curve analysis showed 88% accuracy in discriminating the two clinical groups based on these neural responses. Conclusions: These contrasting activation patterns of the temporoparietal junction in SCZ and BPD represent mechanistic differences of social cognitive dysfunction that may be explored as biomarkers or therapeutic targets.

Introduction: Obtaining the best possible medication history is the crucial step in medication reconciliation. Our aim was to evaluate the potential contributions of the main data sources available – patient/caregiver, hospital medical records, and shared electronic health records – to obtain an accurate ‘best possible medication history’. Material and Methods: An observational cross-sectional study was conducted. Adult patients taking at least one medicine were included. Patient interview was performed upon admission and this information was reconciled with hospital medical records and shared electronic health records, assessed retrospectively. Concordance between sources was assessed. In the shared electronic health records, information was collected for four time-periods: the preceding three, six, nine and 12-months. The proportion of omitted data between time-periods was analysed. Results: A total of 148 patients were admitted, with a mean age of 54.6 ± 16.3 years. A total of 1639 medicines were retrieved. Only 29% were collected simultaneously in the three sources of information, 40% were only obtained in shared electronic health records and only 5% were obtained exclusively from patients. The total number of medicines gathered in shared electronic health records considering the different time frames were 778 (three-months), 1397 (six-months), 1748 (nine-months), and 1933 (12-months). Discussion: The use of shared electronic health records provides data that were omitted in the other data sources available and retrieving the information at six months is the most efficient procedure to establish the basis of the best possible medication history. Conclusion: Shared electronic health records should be the preferred source of information to supplement the patient or caregiver interview in order to increase the accuracy of best possible medication history of the patient, particularly if collected within the prior six months.

Schizophrenia is believed to be a neurodevelopmental disease with high heritability. Differential diagnosis is often challenging, especially in early phases, namely with other psychotic disorders or even mood disorders. such as bipolar disorder with psychotic symptoms. Key pathophysiological changes separating these two classical psychoses remain poorly understood, and current evidence favors a more dimensional than categorical differentiation between schizophrenia and bipolar disorder. While established biomarkers like cortical thickness and grey matter volume are heavily influenced by post-onset changes and thus provide limited possibility of accessing early pathologies, gyrification is assumed to be more specifically determined by genetic and early developmental factors. The aim of our study was to compare both classical and novel morphometric features in these two archetypal psychiatric disorders. We included 20 schizophrenia patients, 20 bipolar disorder patients and 20 age- and gender-matched healthy controls. Data analyses were performed with CAT12/SPM12 applying general linear models for four morphometric measures: gyrification and cortical thickness (surface-based morphometry), and whole-brain grey matter/grey matter volume (voxel-based morphometry - VBM). Group effects were tested using age and gender as covariates (and total intracranial volume for VBM). Voxel-based morphometry analysis revealed a schizophrenia vs. control group effect on regional grey matter volume (p

Sarco/endoplasmic reticulum Ca2+ ATPase (SERCA) is a crucial component of the cellular machinery responsible for Ca2+ homeostasis. The selective inhibition of SERCA by thapsigargin (TG) leads to perturbations in Ca2+ signaling, which can trigger endoplasmic reticulum (ER) stress. The unfolded protein response (UPR) pathway is activated in response to ER stress and induces an adaptive response to preserve cell survival or committee cells to programmed death, depending on stress duration and/or level. Early stages of ER stress stimulate mitochondrial metabolism to preserve survival but under chronic ER stress conditions, mitochondrial dysfunction is induced, which, in turn, can enhance inflammation through NLRP3 inflammasome activation. This study was aimed at investigating the role of SERCA inhibition on NLRP3 inflammasome activation in human monocytes, which was evaluated in primary monocytes isolated from healthy individuals and in the THP-1 human monocytic cell line. Findings obtained in both THP-1 and primary monocytes demonstrate that SERCA inhibition triggered by TG does not activate the NLRP3 inflammasome in these innate immune cells since IL-1β secretion was not affected. Results from THP-1 monocytes showing that SERCA inhibition increases mitochondrial Ca2+ content and fusion, in the absence of changes in ROS levels and membrane potential, support the view that human monocytes counteract ER stress that arises from inhibition of SERCA through modulation of mitochondrial morphology towards mitochondria fusion, thus preventing NLRP3 inflammasome activation. Overall, this work contributes to a better understanding of the molecular mechanisms that modulate the activity of the NLRP3 inflammasome leading to sterile inflammation, which are still poorly understood.

This study aims to evaluate whether mitochondrial changes occur in the early stages of bipolar disorder (BD). Using fibroblasts derived from BD patients and matched controls, the levels of proteins involved in mitochondrial biogenesis and dynamics (fission and fusion) were evaluated by Western Blot analysis. Mitochondrial membrane potential (MMP) was studied using the fluorescent probe TMRE. Mitochondrial morphology was analyzed with the probe Mitotracker Green and mitophagy was evaluated by quantifying the co-localization of HSP60 (mitochondria marker) and LC3B (autophagosome marker) by immunofluorescence. Furthermore, the activity of the mitochondrial respiratory chain and the glycolytic capacity of controls and BD patients-derived cells were also studied using the Seahorse technology. BD patient-derived fibroblasts exhibit fragmented mitochondria concomitantly with changes in mitochondrial dynamics and biogenesis in comparison with controls. Moreover, a decrease in the MMP and increased mitophagy was observed in fibroblasts obtained from BD patients when compared with control cells. Impaired energetic metabolism due to inhibition of the mitochondrial electron transport chain (ETC) and subsequent ATP depletion, associated with glycolysis stimulation, was also a feature of BD fibroblasts. Overall, these results support the fact that mitochondrial disturbance is an early event implicated in BD pathophysiology that might trigger neuronal changes and modification of brain circuitry.

According to recent models of recovery in psychosis, the patients’ perspectives about their own difficulties, symptoms and goals (health-related and in other areas) are of major importance in intervention. Self-report measures have been increasingly studied and several authors have pointed out their validity, reliability and clinical utility in people with psychotic-disorders. The present study sought to review and critically analyse the available self-report instruments for assessing delusions. Four instruments met the inclusion criteria: Characteristics of Delusions Rating Scale; Beliefs Rating Scale; Peters Delusions Inventory; and Conviction of Delusional Beliefs Scale. All scales assess delusions in a multidimensional perspective and present adequate psychometric properties, although with high variability within studies. Refining the psychometric studies of the existing instruments (mainly confirmatory factor analysis, reliability and diagnostic accuracy analyses) and developing new instruments focused on coping are future areas of research interest.

The aim of this study was to analyze the psychometric properties of the Portuguese version of the Child and Adolescent Perfectionism Scale (CAPS). Method: 971 Portuguese high school students (572 girls and 399 boys) answered the CAPS. The test-retest reliability was obtained with 206 participants from the total sample. Results: Internal consistency (α= .809) and test-retest reliability (r= .691) were satisfactory. Main components of factorial analysis yielded two factors, accounting for 41.44% of the total variance. Factor structure was similar to the original version. Factors were labelled as "Socially Prescribed Perfectionism" and "Self-Oriented Perfectionism". Discussion: The Portuguese version of the CAPS is a valid and useful instrument for the evaluation of perfectionism among Portuguese adolescents.

OBJECTIVE: To investigate the predictive/protective role of negative affect/positive affect in late pregnancy on the outcome of postpartum depression. METHODS: A total of 491 pregnant women participated in the study. The participants were asked to fill out a series of questionnaires, which included the Profile of Mood States, the Beck Depression Inventory-II, psychosocial variables and socio-demographic characteristics and were asked to participate in a psychiatric interview. After delivery, 272 mothers participated again in the study and filled out a similar series of questionnaires. RESULTS: Negative affect was associated with more intense depressive symptomatology, more self-perceived stress, lower self-reported social support, lower quality of life and perception of having a more difficult infant. By contrast, positive affect was negatively associated with these variables. Negative affect in late pregnancy increased the likelihood of experiencing postpartum depression (DSM-IV/OR = 2.1, 95%CI = 1.3-3.4, p = .003; ICD-10/OR = 2.1, 95%CI = 1.5-3.0, p < .001), while positive affect increased the odds of not having this condition (DSM-IV/OR = 2.0, 95%CI = 1.5-2.7, p = .042). CONCLUSION: In pregnancy, negative affect was a predictor of postpartum depression, whereas positive affect showed a protective role. Future studies are required to explore whether psychotherapeutic strategies focusing on decreasing negative affect and enhancing positive affect in the last trimester of pregnancy can reduce the risk of postpartum depression.

OBJECTIVE: To evaluate the degree of absolute change, relative stability and state dependence of trait perfectionism in sleep disturbances in a sample of university students. METHOD: Participants completed the Multidimensional Perfectionism Scale and two items concerning sleep difficulties. The mean age at T0 (baseline) was 19.59 years (SD = 1.61, range = 17-25) and 62.5% of the sample were female. RESULTS: Absolute changes in self-oriented and socially-prescribed perfectionism were found. Relative stability was found for all perfectionism dimensions. Prior and concurrent sleep disturbances explained a significant amount of variance in perfectionism. Controlling for the effects of sleep measures, prior self-oriented perfectionism and other-oriented perfectionism were the only significant predictors of subsequent self-oriented perfectionism and other-oriented perfectionism, at T1 and T2. Difficulties falling asleep at T1 and socially-prescribed perfectionism at T0 were significant predictors of socially-prescribed perfectionism at T1. CONCLUSION: Despite significant changes in perfectionism mean scores over the follow-up, the correlation analyses demonstrated that participants remained quite stable in regard to their relative levels of perfectionism. As concurrent difficulties initiating sleep also predicted concurrent socially-prescribed perfectionism, this seems to be one dimension of perfectionism with trait-state characteristics.OBJETIVOS: Avaliar o grau de mudança absoluta, de estabilidade relativa e dependência do estado do perfeccionismo nas perturbações de sono numa amostra de estudantes universitários. MÉTODO: Os sujeitos completaram a Escala Multidimensional do Perfeccionismo e dois itens sobre dificuldades em dormir. Os dados foram recolhidos em três momentos de avaliação, separados por um intervalo de um ano acadêmico. A idade média dos sujeitos no T0 era de 19,59 anos (DP = 1,61, variação = 17-25); 62,5% eram mulheres. RESULTADOS: Foram encontradas ao longo do follow-up mudanças absolutas para o perfeccionismo auto-orientado e para o perfeccionismo socialmente prescrito. Foi encontrada estabilidade relativa para todas as dimensões do perfeccionismo. As dificuldades de sono prévias e concorrentes explicaram significativamente a variância do perfeccionismo. Controlando o efeito das dificuldades em dormir, o perfeccionismo auto-orientado e o perfeccionismo orientado para o outro prévios foram os únicos preditores significativos de perfeccionismo auto-orientado e perfeccionismo orientado para o outro (T1 e T2). As dificuldades em iniciar o sono no T1 e o perfeccionismo socialmente prescrito prévio (T0) revelaram-se preditores significativos de perfeccionismo socialmente prescrito no T1. CONCLUSÃO: Apesar das mudanças significativas nas pontuações médias de perfeccionismo ao longo do follow-up, as análises de correlação demonstraram que os participantes permaneceram relativamente estáveis nos seus níveis de perfeccionismo. Uma vez que as dificuldades em iniciar o sono concorrentes se revelaram um preditor significativo de perfeccionismo socialmente prescrito, esta é a dimensão do perfeccionismo que possui características traço-estado.

OBJECTIVE: The main aims of this article are twofold. First, to assess perfectionism dimensions in obsessive-compulsive disorder and eating disorders in comparison with psychiatric control (depression/anxiety) and non-clinical control groups. Second, to examine if perfectionism is specifically related to these different clinical conditions. METHOD: Thirty-nine outpatients with obsessive-compulsive disorder, 24 outpatients with eating disorders, 65 outpatients with a diagnosis of depression and/or anxiety, and 70 non-clinical participants completed the Portuguese version of the Multidimensional Perfectionism Scale. RESULTS: Compared to non-clinical subjects, individuals of all clinical samples had significantly higher scores on Multidimensional Perfectionism Scale total score, Self-Oriented and Socially-Prescribed Perfectionism. There were no significantly differences in Self-Oriented Perfectionism and Multidimensional Perfectionism Scale total score in all the three clinical samples. Subjects from the eating disorders sample had significantly higher scores of Socially-Prescribed Perfectionism in comparison to obsessive-compulsive disorder and psychiatric control samples. CONCLUSION: Perfectionism showed to be related with this broad range of psychopathologies. However, the differences between eating disorders versus obsessive-compulsive disorder and psychiatric control on Socially-Prescribed Perfectionism warrant further investigation in order to clarify the specificity of this perfectionism dimension in eating disorders.OBJETIVO: Este estudo tem dois objetivos principais. Primeiro, avaliar as dimensões do perfeccionismo no transtorno obsessivo-compulsivo e nos transtornos alimentares em comparação com duas amostras controle: psiquiátrica (depressão/ansiedade) e não clínica. Segundo, avaliar se o perfeccionismo é um traço de personalidade especificamente relacionado com estas diferentes condições clínicas. MÉTODO: 39 pacientes com transtorno obsessivo-compulsivo, 24 com transtornos alimentares, 65 com um diagnóstico de depressão e/ou ansiedade (todos estes pacientes encontravam-se em regime de ambulatório) e 70 controles não clínicos completaram a versão portuguesa da Multidimensional Perfectionism Scale. RESULTADOS: Comparativamente à amostra não clínica, todas as amostras clínicas apresentaram níveis significativamente mais elevados na Multidimensional Perfectionism Scale total, no Perfeccionismo Auto-Orientado e no Perfeccionismo-Socialmente-Prescrito. Não houve diferenças estatisticamente significativas no Perfeccionismo-Auto-Orientado e na Multidimensional Perfectionism Scale total nas três amostras clínicas. No entanto, a amostra com transtornos alimentares apresentou níveis significativamente mais elevados de Perfeccionismo-Socialmente-Prescrito, comparativamente à transtornos alimentares e à amostra psiquiátrica (depressão/ansiedade). CONCLUSÃO: O perfeccionismo revelou estar associado a uma grande variedade de condições psicopatológicas. Contudo, as diferenças encontradas entre a amostra de transtornos alimentares, de transtorno obsessivo-compulsivo e a psiquiátrica no Perfeccionismo-Socialmente-Prescrito necessitam de investigação subsequente no sentido de clarificar a especificidade desta dimensão com os transtornos alimentares.

OBJECTIVE: To examine the factor structure of the Rutter Teacher Questionnaire in Portuguese primary school children. METHOD: The Rutter Teacher Questionnaire, a 26-item scale covering a variety of behavioral problems, was completed by teachers of 877 children, aged 6 to 11 years. Data were subjected to factor analysis using the principal components solution with varimax rotation. RESULTS: The factorial analysis in total sample revealed three factors explaining 38.88% of the total variance. The factors contained items representing hyperactivity/conduct (Factor 1), anxious/depressive (Factor 2) and truancy/stealing (Factor 3). The highest correlations between factors scores were for Factor 1 and Factor 3. These Factors scores were higher in boys than girls and correlated with lower social class. All three Factors scores correlated with school performance. The comparison between separate factorial structures for the samples of boys and girls revealed a considerable overlap. CONCLUSIONS: The pattern of the items contained on Factor 1 appears to be related with the category of hyperkinetic conduct disorder used by the International Classification of Diseases-10. Results suggest that the Portuguese language version of the Rutter Teacher Questionnaire possesses good psychometric properties and may be considered a useful instrument for measuring children's behavior problems.OBJETIVO: Analisar a estrutura fatorial do Questionário de Rutter para Professores numa amostra de crianças portuguesas do 1º Ciclo do Ensino Básico. MÉTODO: O questionário, constituído por 26 itens que avaliam problemas do comportamento, foi preenchido pelos professores de 877 crianças (6-11 anos). As respostas foram sujeitas a uma análise fatorial, por meio do método de componentes principais com rotação ortogonal varimax. RESULTADOS: Na amostra total, a estrutura fatorial resultou em três fatores que explicam 38,88% da variância total e que foram denominados: problemas de hiperatividade/conduta (Fator 1), ansiedade/depressão (Fator 2) e vadiagem/furto (Fator 3). A correlação entre os fatores 1 e 3 foi a mais elevada. As pontuações fatoriais foram significativamente mais elevadas nos rapazes do que nas raparigas e apresentaram uma relação inversa com a classe social e com o rendimento escolar. As estruturas fatoriais realizadas separadamente para rapazes e raparigas revelaram grandes similitudes. CONCLUSÕES: Os itens do Factor 1 parecem relacionar-se com o distúrbio hipercinético da conduta proposto pela Classificação Internacional de Doenças-10. Os resultados sugerem que a versão portuguesa do Questionário de Rutter para Professores apresenta parâmetros psicométricos adequados, podendo ser útil na avaliação dos problemas de comportamento das crianças.

Thyroid hormones are crucial during development and in the adult brain. Of interest, fluctuations in the levels of thyroid hormones at various times during development and throughout life can impact on psychiatric disease manifestation and response to treatment. Here we review research on thyroid function assessment in schizophrenia, relating interrelations between the pituitary-thyroid axis and major neurosignaling systems involved in schizophrenia’s pathophysiology. These include the serotonergic, dopaminergic, glutamatergic, and GABAergic networks, as well as myelination and inflammatory processes. The available evidence supports that thyroid hormones deregulation is a common feature in schizophrenia and that the implications of thyroid hormones homeostasis in the fine-tuning of crucial brain networks warrants further research.

The aim of the present study was to estimate depressive disorder and symptomatology prevalence and incidence in perinatal period in a population-based sample. Three-hundred and eighty six Portuguese women (mean age=30.08 years, SD=4.21) were interviewed with the Diagnostic Interview for Genetic Studies and completed Beck Depression Inventory-II/BDI-II and Postpartum Depression Screening Scale/PDSS, in pregnancy and postpartum. OPCRIT polydiagnostic system generated ICD-10 and DSM-IV diagnoses. One-month prevalence in pregnancy was of 2.3%/ICD-10 and 1.3%/DSM-IV; in postpartum it was of 16.6% and 11.7%. Pregnancy incidence was of 0%/ICD-10 and .3%/DSM-IV and in postpartum of 7.5%/ ICD-10 and 4.9%/DSM-IV. Depression pregnancy point-prevalence found with BDI-II cutoffs ranged from 13.7% to 19.4% in pregnancy and from .8% to 13.0% in postpartum and with PDSS from 14.2% to 17.9% in pregnancy and from 3.9% to 12.7% in postpartum. In the same sample, different diagnostic systems generated different prevalence and incidence rates. Higher prevalence rates were found using self-reported questionnaires. ICD-10 generated higher prevalence and incidence rates than DSM-IV.

EMPATIA EM MEDICINA GERAL E FAMILIAR OBJECTIVO: A empatia é essencial nas relações terapêuticas. Uma relação empática tem vários resultados positivos: melhoria da relação médico-doente,aumento da satisfação e da capacidade de diagnóstico, e um melhor empowerment do doente. Este estudo pretende avaliar a empatia dos Médicos de Família (MF) num Centro de Saúde(CS) português e verificar a relação entre o grau de empatia de médico para doente e as características sócio-demográficas do utente. DESENHO: estudo transversal LOCALIZAÇÃO: CS da Senhora da Hora, Matosinhos PARTICIPANTES: utentes do CS Senhora da Hora, que efectuaram um contacto presencial com o seu MF durante o mês de Junho de 2009 MÉTODOS: O valor de empatia foi medido através do questionário Consultation and Relational Empathy (CARE). As associações entre variáveis foram testadas com testes não paramétricos (Mann-Whitney, Kruskal-Wallis) e correlação de Pearson. O nível de significância adoptado foi de 0,05. RESULTADOS: Foi obtida uma amostra de 353 questionários. O valor médio de empatia global entre os MF incluídos foi de 41,1 pontos, numa escala de 1-50 (IC 95%, 40,1-42,2). A única associação estatisticamente significativa foi com a escolaridade (p=0,02). Pacientes com baixo nível de escolaridade atribuíram pontuações mais baixas de empatia no seu MF. CONCLUSÃO: Os utentes deste CS pontuaram um elevado grau de empatia aos seus MF. Pacientes com baixo nível de escolaridade atribuíram menor pontuação, uma associação que não foi encontrada noutros estudos.

Iron deficiency anemia is the micronutrient deficiency most prevalent in the world primarily affecting young children and pregnant or puerperal women. It is also associated with an increase in perinatal and maternal morbidity and mortality. Increasing iron demands in pregnancy are common knowledge, however the evidence of a clinical effect of routine iron supplementation in uncomplicated pregnancy is controversial.To determine if routine iron supplementation in uncomplicated pregnancy has clinical effects for the mother or newborn.A systematic review was conducted in the electronic databases Medline, Cochrane Library, Medscape, DARE, United States Preventive Services Task Force and National Guideline Clearinghouse using the keywords iron and pregnancy. Articles published until August 2008 were chosen for the review. The Strength of Recommendation Taxonomy (SORT) was used to grade the level of evidence.Routine iron supplementation in uncomplicated pregnancy increases or maintains the levels of blood iron and ferritin and results in a substantial reduction of women with low hemoglobin. However, this supplementation does not have detectable effects in any of the important clinical outcomes (p.e. preterm labor, duration of pregnancy, cesarean rate, birthweight, perinatal mortality or Apgar at birth). Iron supplementation is also responsible for some undesired effects.The evidence seems to show that there are no clinical improvements to recommend routine iron supplementation in all pregnancies. Women who show signs or symptoms of anemia at any time during pregnancy should be evaluated.

It is thought that in the XXI century cardiovascular disease will become the main cause of disability ant death in the world. Cardiac complaints are very common in clinical practice and the high prevalence of coronary disease and its sequels puts the family doctor in the frontline of the struggle against this pathology. This review pretends to inform about the presentation, diagnosis and urgent approach of the acute coronary syndrome as well as the need of continuity of care and secondary prevention.Coronary disease can appear as a myocardial infarction and occurs predominantly in a population susceptible to atherogenesis due to various risk factors. Acute thoracic discomfort is the most usual clinical presentation and the initial evaluation intends to determine its cause through a brief clinical history, physical exam, electrocardiogram and dosing of markers of cardiac necrosis. After confirmation of the diagnosis the patient is submitted to urgent treatment that depends on the form of presentation of the acute coronary syndrome. It usually involves study of coronary anatomy by coronariography and revascularization. After the acute event the coronary patient must initiate a medical therapy with drugs that reduce mortality (antiplatelet therapy, beta-blockers, angiotensin converting enzyme inhibitors and statins) and aggressively control the modifiable risk factors.The family doctor has a primordial role in continuing care initiated at the hospital and in implementing aggressive secondary prevention measures. By knowing and putting them into practice, the family doctor takes his part in reducing the burden of cardiovascular diseases and in controlling this epidemic.

Objectivos: Com este estudo pretendeu-se determinar a prevalência de pé em risco aumentado de ulceração em doentes diabéticos tipo 2 no concelho de Matosinhos, utilizando a classificação do International Working Group Diabetic Foot (IWGDF) e sua correlação com algumas variáveis da população. Tipo de Estudo: observacional analítico transversal. Local: Três centros de saúde (CS) do Concelho de Matosinhos. População: Doentes com Diabetes Mellitus tipo 2, portadores de Guia do Diabético e residentes em Portugal. Métodos: Obtiveram-se 237 participantes pela técnica de amostragem aleatória simples com reposição. Os dados foram obtidos por entrevista presencial, exame objectivo e análise de processos. Colheram-se dados gerais da amostra bem como Índice de Massa Corporal, período desde diagnóstico e controlo glicémico. Foi avaliada presença de vasculopatia e neuropatia periférica, de modo a agrupar os doentes pela classificação do IWGDF. Resultados: Dos 237 participantes, 46% eram do sexo masculino com média de idades de 63 anos. A prevalência de pé em risco aumentado de ulceração encontrada foi de 18,1% encontrando-se associação com a situação de reformado. Conclusões: Este estudo revelou que a prevalência de diabéticos com risco aumentado de ulceração a nível dos Cuidados de Saúde Primários é significativa, realçando a necessidade de uma detecção precoce das alterações no pé e investimento na educação dos diabéticos sobre os cuidados a ter com os pés.

Dizziness is a non specific and incapacitating symptom. Its classification is based on the patient complaints and categorized in pre-syncope, disequilibrium, lightheadness and vertigo. Vertigo is the most prevalent cause of dizziness. This article pretends to review the management of vertigo, its causes, differential diagnosis and treatment.The articles used in this review were obtained from a Medline search with the keywords vertigo and dizziness, from publications from the past 5 years in the English, Spanish and Portuguese languages.Vertigo is the most prevalent cause of dizziness in primary care. It is caused by an asymmetric involvement in the basal activity of the central and peripheric vestibular pathways. It occurs in episodes and the intensity of this symptom diminishes as the causative factor dissipates or compensation occurs. The clinical evaluation is bases on the clinical history and physical examination. The first step in the differential diagnosis is to differentiate central vertigo from peripheral vertigo. Knowing the duration of symptoms, precipitating factors and associated symptoms and performing the Dix-Hallpike manoeuvre is important in achieving this. The treatment of vertigo must be specific and oriented to the cause, and the use of symptomatic therapy must be reserved to the acute episodes. The definite treatment are rehabilitation exercises.

In Portugal, the medical school selection process relies exclusively on past academic results, involving the most stringent criteria of all courses, with no attention given to the personality traits of the students. In a competitive context, perfectionism dimensions may be relevant to consider. Socially Prescribed Perfectionism (SPP) has been correlated with Neuroticism, while Self-Oriented Perfectionism (SOP) is strongly associated with Conscientiousness. These domains of personality have been linked (lower levels of Neuroticism and higher levels of Conscientiousness) to academic and professional success in Medicine. The premedical syndrome describes premedical students as overachieving, excessively competitive, cynical, dehumanized, overspecialized and narrow. Our main objective was to compare SPP and SOP levels between Medical and Humanities students, as they may be possible indicators of the premedical syndrome among Portuguese medical students.The Portuguese version of the Multidimensional Perfectionism Scale was administered to 908 undergraduate students from Medicine and Humanities courses of Coimbra University. The sample covered students from the 1st to the 5th year of the courses but most of the students were from the 1st year (n=436).With respect to SPP, significant statistical differences were found, with Medicine students showing lower levels (mean 48.60+/-11.02; p=0.023) than Humanities students (mean 50.00+/-9.56). No significant differences were found in SOP.Our results are reassuring, suggesting the lack of a negative impact of the medical school selection process in the personality traits of the students and the probable absence of the premedical syndrome.

Objectivos: A diabetes mellitus tipo 2 (DM2) é um problema de saúde associado a aumento da morbimortalidade e custos. É frequentemente precedida por estados metabólicos alterados, alteração da glicemia em jejum (AGJ) e diminuição da tolerância à glicose (DTG). Está demonstrado que alterações do estilo de vida em doentes com DTG diminuem a sua incidência. O uso de alguns fármacos parece prevenir ou atrasar a progressão da doença, mas existem dúvidas sobre o seu real benefício. Pretende-se determinar a evidência de benefícios para o doente com a terapia farmacológica nos estados pré-diabéticos. Fontes de dados: Foi realizada uma pesquisa sistemática, na National Guideline Clearinghouse, Bandolier, DARE, NHS e Medline, de artigos publicados entre Janeiro de 1998 e Setembro de 2008, em língua portuguesa, inglesa e espanhola, usando as palavras «prediabetic state», «prediabetes» e «therapeutics». Métodos de revisão: Obtiveram-se 103 artigos que comparavam a intervenção farmacológica com placebo ou alterações de estilo de vida em doentes pré-diabéticos. Utilizou-se a classificação SORT para atribuição do nível de evidência e força de recomendação. Resultados: Foram incluídos 9 artigos: 4 normas de orientação clínica, 1 meta-análise, 3 revisões sistemáticas e 1 ensaio controlado aleatorizado. Alguns antidiabéticos orais (metformina, acarbose e glitazonas) e o orlistat mostraram uma redução no risco de desenvolvimento de diabetes em doentes pré-diabéticos, ficando por esclarecer se esse benefício se mantém após a sua suspensão. A acarbose mostrou diminuir a progressão do espessamento da íntima das carótidas. Conclusões: Apesar de alguns antidiabéticos orais e o orlistat terem demonstrado diminuir o risco de desenvolvimento de diabetes em doentes pré-diabéticos, não há evidência que demonstre haver benefícios orientados para o doente na sua utilização, uma vez que nenhum dos estudos avaliou como endpoint primário a morbimortalidade e seu custo-eficácia. Encontram-se em curso alguns estudos que pretendem esclarecer estes pontos.

Introdução: A linfadenopatia periférica apresenta,muitas vezes, dificuldades diagnósticas ao médico de família. O caso a seguir relatado pretende demonstrar a abordagem da linfadenopatia cervical em cuidados primários, a importância da história clínica e do exame físico e a relevância da coordenação com os cuidados secundários. Descrição do caso: Mulher de 43 anos de idade, empregada de limpeza no desemprego, com antecedentes de rinite alérgica, sinusite, varicectomia e depressão reactiva. Fumadora e com antecedentes familiares de tuberculose pulmonar em familiares do primeiro grau. Recorre à sua médica de família com tumefacção dolorosa no triângulo posterior do pescoço direito com 1 ano de evolução. O estudo ecográfico mostra adenomegalia com características suspeitas de doença de Hodgkin e a doente é referenciada aos cuidados secundários, onde é submetida a excisão ganglionar, cuja análise histológica e posterior cultura confirma o diagnóstico de linfadenite tuberculosa, sendo referenciada ao Centro de Diagnóstico Pneumológico para tratamento. Comentário: Este relato demonstra a importância da avaliação sistemática de uma adenomegalia e a relevância da tuberculose como problema prevalente em Portugal, para o qual o médico de família deve estar alerta. É evidenciada a função fulcral do médico de família como gestor dos cuidados de saúde à população e o seu papel na conexão entre os diferentes níveis de prestação de cuidados.

Objectivos:Avaliar a qualidade da prescrição da vacina anti-pneumocócica (PPV) pelos Médicos de Família (MF), aos idosos inscritos no Centro de Saúde (CS) da Senhora da Hora. Tipo de estudo: Avaliação da qualidade. Estudo retrospectivo. Local: Centro de Saúde da Senhora da Hora, Matosinhos. População: 10% dos idosos inscritos nas listas de todos os MF do CS da Senhora da Hora, com idade ³ a 65 anos a 31 de Dezembro de 2007. Metodologia: Foi avaliada retrospectivamente (no período compreendido entre 1 de Janeiro de 2003 e 30 de Setembro de 2008) a qualidade técnico-científica da prescrição da PPV pelos 23 MF do CS do estudo, numa amostra de 10% dos idosos inscritos nas listas de todos os MF, com idade ³ a 65 anos a 31 de Dezembro de 2007, seleccionados aleatoriamente com reposição. Foram consultados dados do processo clínico e SAM®. Utilizaram-se como padrão de qualidade para a prescrição os seguintes critérios: Muito Insuficiente se taxa de prescrição

Introdução: A vacinação anual é o principal método de prevenção e controlo da infecção gripal sazonal e das suas complicações, devendo ser dirigida aos grupos populacionais de alto risco, como os idosos (idade ³65 anos). Os médicos de família (MF) têm um papel importante no controlo desta doença no sentido de promover a vacinação. Objectivo: Avaliar e garantir a qualidade do aconselhamento e/ou prescrição da vacina anti-gripal pelos MF nos idosos. Tipo de estudo: Descritivo e transversal. Local: Cinco centros de saúde (CS) da Região Norte. População: Todos os idosos inscritos nos CS estudados. Métodos: Dimensão estudada: qualidade técnico-científica. Unidade de estudo: 375 utentes inscritos nas listas de MF dos CS avaliados, que completaram 65 anos até 30 de Setembro de 2006. Foram avaliados cinco médicos de família em cada CS no período de 1 de Setembro de 2006 e 28 de Fevereiro de 2007. Base de estudo: amostra aleatória sistemática de 375 utentes, de base institucional.Tipo de dados: de processo. Fonte de dados: processos clínicos e SAM.Tipo de avaliação: interna. Critérios: Registo do aconselhamento ou prescrição da vacina anti-gripal no período em estudo aos utentes idosos. Avaliação temporal: retrospectiva. Tipo de intervenção prevista: estrutural e educacional. Resultados: Em 49,3% dos casos não foi encontrado nenhum registo de aconselhamento e/ou prescrição da vacina da gripe no grupo alvo. Em 50,7% dos processos a vacina tinha sido aconselhada (5,1%) ou prescrita (45,6%), permitindo alcançar o padrão de qualidade suficiente. Entre as diferentes unidades de saúde a taxa de aconselhamento/prescrição variou entre 36% (insuficiente) e 68% (suficiente). Conclusões: É necessária uma melhoria contínua da qualidade da prescrição da vacina da gripe nos grupos de risco. Propõe-se a formação de um grupo de trabalho para o Desenvolvimento Contínuo da Qualidade nesta área em cada Centro de Saúde.

Abstract Objective To explore 1) if perfectionism, perceived distress/coping, and cognitive emotion regulation (CER) are associated with and predictive of negative/positive affect (NA/PA); and 2) if CER and perceived distress/coping are associated with perfectionism and if they mediate the perfectionism-NA/PA associations. There is a distinction between maladaptive and adaptive perfectionism in its association with NA/PA. CER and perceived distress/coping may mediate the maladaptive/adaptive perfectionism and NA/PA associations. Methods 344 students (68.4% girls) completed the Hewitt & Flett and the Frost Multidimensional Perfectionism Scales, the Composite Multidimensional Perfectionism Scale, the Profile of Mood States, the Perceived Stress Scale, and the Cognitive Emotion Regulation Questionnaire. Results NA predictors were maladaptive/adaptive perfectionism, maladaptive CER and perceived distress (positively), positive reappraisal and planning, and perceived coping (negatively). PA predictors were maladaptive/adaptive perfectionism and perceived distress (negatively), positive reappraisal and planning, positive refocusing and perceived coping (positively). The association between maladaptive perfectionism and NA was mediated by maladaptive CER/low adaptive CER, perceived distress/low coping. Maladaptive perfectionism and low PA association was mediated by perceived distress. High PA was determined by low maladaptive perfectionism and this association was mediated by adaptive REC and coping. Adaptive perfectionism and NA association was mediated by maladaptive CER and perceived distress. Conclusion CER and perceived distress/coping are associated and mediate the perfectionism-NA/PA associations.