The NEVERMIND e-health system in the treatment of depressive symptoms among patients with severe somatic conditions: A multicentre, pragmatic randomised controlled trial.

Background: This study assessed the effectiveness of the NEVERMIND e-health system, consisting of a smart shirt and a mobile application with lifestyle behavioural advice, mindfulness-based therapy, and cognitive behavioural therapy, in reducing depressive symptoms among patients diagnosed with severe somatic conditions. Our hypothesis was that the system would significantly decrease the level of depressive symptoms in the intervention group compared to the control group. Methods: This pragmatic, randomised controlled trial included 425 patients diagnosed with myocardial infarction, breast cancer, prostate cancer, kidney failure, or lower limb amputation. Participants were recruited from hospitals in Turin and Pisa (Italy), and Lisbon (Portugal), and were randomly assigned to either the NEVERMIND intervention or to the control group. Clinical interviews and structured questionnaires were administered at baseline, 12 weeks, and 24 weeks. The primary outcome was depressive symptoms at 12 weeks measured by the Beck Depression Inventory II (BDI-II). Intention-to-treat analyses included 425 participants, while the per-protocol analyses included 333 participants. This trial is registered in the German Clinical Trials Register, DRKS00013391. Findings: Patients were recruited between Dec 4, 2017, and Dec 31, 2019, with 213 assigned to the intervention and 212 to the control group. The sample had a mean age of 59·41 years (SD=10·70), with 44·24% women. Those who used the NEVERMIND system had statistically significant lower depressive symptoms at the 12-week follow-up (mean difference=-3·03, p<0·001; 95% CI -4·45 to -1·62) compared with controls, with a clinically relevant effect size (Cohen's d=0·39). Interpretation: The results of this study show that the NEVERMIND system is superior to standard care in reducing and preventing depressive symptoms among patients with the studied somatic conditions. Funding: The NEVERMIND project received funding from the European Union's Horizon 2020 Research and Innovation Programme under grant agreement No. 689691.

Meaning-centered group psychotherapy in Portuguese cancer patients: A pilot exploratory trial.

OBJECTIVE: To describe the feasibility of a meaning-centered group psychotherapy (MCGP) adaptation in a sample of Portuguese cancer patients. METHOD: The study was carried out according to four steps: 1st - Transcultural adaptation and validation (focus groups); 2nd - Preliminary study with MCGP original version (to test its feasibility); 3rd - Adaptation of MCGP original version to a 4-session version (and internal pilot study); and 4th - Pilot exploratory trial (MCGP-4 session version), implemented between January 1, 2018 and December 31, 2019. Inclusion criteria were >18 years, psychological complaints, and difficulty to adapt to cancer. Allocation was according to participants' preference: MCGP vs. care as usual (CAU). Primary outcomes were: MCGP adapted version improved quality of life (QoL) and spiritual well-being; secondary outcomes were improvement of depression, anxiety, and distress. Assessments were done at baseline (T1) and 1 month after (T2), with self-report socio-demographic and clinical questionnaires, Distress Thermometer (DT), McGill Quality of Life Questionnaire (MQOL), Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale (FACIT-Sp-12), Hospital Anxiety and Depression Scale, and its subscales (HADS - HADS-D, HADS-A). RESULTS: In the 1st step, and through focus groups, the manual was reformulated and tested. The preliminary study (2nd step) with MCGP original version showed a high number of dropouts which could jeopardize the study and, after reframing the sessions content, MCGP was adapted to a 4-session version, and its feasibility was tested by an internal pilot study (3rd step). The pilot exploratory trial (4th step) had 91 participants. Most socio-demographic and clinical characteristics between the groups (51: MCGP; 40: CAU) had no statistically significant differences. A comparison between the two groups at T2 showed that the MCGP group scored significantly higher in the general (U = 552.00, P < 0.001), and existential (U = 727.50, P = 0.018) domains and total score (U = 717.50, P = 0.015) of QoL, and CAU presented statistical higher levels in DT (U = 608.50, P = 0.001). Comparing the groups between T1 and T2, the MCGP group had a statistically significant improvement in the general (Z = -3.67, P < 0.001) and psychosocial (Z = -2.89, P = 0.004) domains and total score (Z = -2.71, P = 0.007) of QoL, and a statistically significant decrease in DT (Z = -2.40, P = 0.016). In terms of group effects, the MCGP group presented increased general (b = 1.42, P < 0.001, η2p = 0.179), and support (b = 0.80, P = 0.045, η2p = 0.048) domains and total score (b = 0.81, P = 0.013, η2p = 0.073) of QoL (small to elevated dimensions), and decreased levels of depression (b = -1.14, P = 0.044, η2p = 0.048), and distress (b = -1.38, P = 0.001, η2p = 0.127) (small to medium dimensions), compared with CAU. At T2, participants who attended ≥3 sessions (n = 38) had a statistically significant higher score in the general domain (U = 130.50, P = 0.009) of QoL, comparing with those who attended 1 or 2 sessions (n = 13). SIGNIFICANCE OF RESULTS: This study supports the benefits of an MCGP adapted version in improving QoL and psychologic well-being. More studies are necessary to address the limitations of this pilot exploratory trial, as its small sample size.

Schizophrenia-schizoaffective-bipolar spectra: an epistemological perspective.

For decades clinicians and researchers have been thinking and writing about the spectrum of schizophrenia disorders. Indeed both Kraepelin and Bleuler believed in schizophrenia as a spectrum, both in a clinical (individual) and hereditary (family) continuum, from just some exquisite personality traits to unquestionable chronic and debilitating psychosis. Other authors would put the schizophrenia spectrum disorders on different levels of continuum: developmental, psychofunctional, existential, and genetic. Here, we would like to present an historical chronology for the schizophrenia-schizoaffective-bipolar spectra plus a tridimensional model for these spectra: the first axis for categories (affective versus nonaffective psychoses), the second axis for dimensions (personality versus full blown psychosis), and a third axis for biomarkers (remission versus relapse). We believe that without the schizophrenia-schizoaffective-bipolar spectra concept in our minds all our efforts will keep failing one the hardest quest: searching for biomarkers in schizophrenia and related disorders.

Emotional dysregulation features and problem gambling in university students: a pilot study.

Undergraduate students typically cope with various changes in their lives and experience many stressors associated with academic issues. Distress can make them more vulnerable to particular behavioral patterns in order to cope with negative affect. The association of problematic gambling with particular emotion regulation characteristics-some of which are developmentally dependent-becomes a recent focus of research with clinical and preventive implications. We carried out a pilot study enrolling voluntarily young adults of a public university in the Lisbon area, and 117 Portuguese-speaking individuals were interviewed. Participants, mainly female (M = 20.6; SD = 3.9), were investigated taking into consideration their gambling practices, characteristics of impulsivity and alexithymia, along with the symptoms of depression and anxiety. Portuguese versions of the South Oaks Gambling Scale (SOGS) and Short-Version of Impulsive Behavior Scale (S-UPPSP) were prepared (i.e., translation and back-translation of the original versions were performed). The prevalence of gambling problems in this sample is modest, although they were associated with negative urgency and sensation-seeking, as well as with depression symptoms. Multiple correspondence analysis, a particular multivariate model associating gambling problems with socio-demographic and psychological variables, allowed identifying different profiles of individuals. Trace and state emotional dysregulation features are selectively associated with distinctive gambling patterns, according to some previous findings in studies with other groups. Results may address new findings in terms of morbidity, risk factors and the design of future preventive strategies among such individuals.

Correlation between emotional regulation and peripheral lymphocyte counts in colorectal cancer patients.

BACKGROUND: Colorectal cancer is one of the most common cancers worldwide. Psychological morbidity has an important impact on quality of life and major clinical outcomes. Several data have shown that the immune system may be a key player on the relation between psychological features and cancer outcomes. Natural Killer (NK) cells have been shown to be influenced by psychological factors. The aim of this investigation was to assess the impact of anxiety, depression, and anger state, trait, and expression on the immune response, particularly, their effect on NK cells and CD8+ T cells in surgical colorectal cancer patients. METHODS: We studied 54 surgical colorectal cancer patients and assessed patients pre-surgically, post-surgically, and 12 months after surgery (follow-up). We applied the Hospital Anxiety and Depression Scale and the State-Trait Anger Expression Inventory and measured peripheral T cells, CD8+ T cells, and NK cells. We did a cross-sectional analysis as well as a longitudinal assessment of the variables during the follow-up period. RESULTS: Pre-surgical assessment: Trait anger, angry reaction, and anger-out had a significant negative correlation with NK cells. The lymphocytes values were unaffected by the presence of clinical anxiety or depression. Post-surgical assessment: Patients without clinical anxiety had higher levels of T cells. Angry reaction was negatively correlated with NK cells. Lymphocytes values were unaffected by the presence of clinical depression. Follow-up assessment: Patients without clinical depression had higher T cell counts. Trait anger and angry reaction were negatively correlated with the levels of NK cells. The lymphocytes values were unaffected by the presence of clinical anxiety. Longitudinal assessment: Angry-temperament, anger expression, and anger-in reduced significantly from the first to the second assessment. Anxiety, state anger, and trait anger significantly diminished from the pre-surgical to the follow-up assessment. Depression levels did not alter during the follow-up period. The lymphocyte count, and particularly T cells and CD8+ T cells, was significantly higher in the follow-up when compared with the pre-surgical assessment. CONCLUSION: Our study suggests the existence of a relation between psychological response and immune response in colorectal cancer patients. We identified the importance of emotional regulation as a potential modulator for NK cell counts. Higher values of propensity to experience anger states and express them outwards seem to be associated with lower NK cell counts.

A protocol for a multicentre, parallel-group, pragmatic randomised controlled trial to evaluate the NEVERMIND system in preventing and treating depression in patients with severe somatic conditions.

BACKGROUND: Depressive symptoms are common in individuals suffering from severe somatic conditions. There is a lack of interventions and evidence-based interventions aiming to reduce depressive symptoms in patients with severe somatic conditions. The aim of the NEVERMIND project is to address these issues and provide evidence by testing the NEVERMIND system, designed to reduce and prevent depressive symptoms in comparison to treatment as usual. METHODS: The NEVERMIND study is a parallel-groups, pragmatic randomised controlled trial to assess the effectiveness of the NEVERMIND system in reducing depressive symptoms among individuals with severe somatic conditions. The NEVERMIND system comprises a smart shirt and a user interface, in the form of a mobile application. The system is a real-time decision support system, aiming to predict the severity and onset of depressive symptoms by modelling the well-being condition of patients based on physiological data, body movement, and the recurrence of social interactions. The study includes 330 patients who have a diagnosis of myocardial infarction, breast cancer, prostate cancer, kidney failure, or lower limb amputation. Participants are randomised in blocks of ten to either the NEVERMIND intervention or treatment as usual as the control group. Clinical interviews and structured questionnaires are administered at baseline, at 12 weeks, and 24 weeks to assess whether the NEVERMIND system is superior to treatment as usual. The endpoint of primary interest is Beck Depression Inventory II (BDI-II) at 12 weeks defined as (i) the severity of depressive symptoms as measured by the BDI-II. Secondary outcomes include prevention of the onset of depressive symptoms, changes in quality of life, perceived stigma, and self-efficacy. DISCUSSION: There is a lack of evidence-based interventions aiming to reduce and prevent depressive symptoms in patients with severe somatic conditions. If the NEVERMIND system is effective, it will provide healthcare systems with a novel and innovative method to attend to depressive symptoms in patients with severe somatic conditions. TRIAL REGISTRATION: DRKS00013391. Registered 23 November 2017.

Process of therapeutic changes in Meaning-Centered Group Psychotherapy adapted to the Portuguese language: A narrative analysis.

OBJECTIVE: The aim was to understand the processes of therapeutic changes in Meaning-Centered Group Psychotherapy (MCGP) in a Portuguese sample. METHOD: Adult cancer patients with distress motivated to participate in MCGP were identified; descriptive and narrative analyses were performed on the session content. RESULTS: The sample had 24 participants (mean age: 63.43 years); the majority were females (75%), with a median academic degree (54%). Breast cancer was most frequent (67%) at the localized stage (71%). The narrative analysis defined seven categories according to the MCGP themes. In "Moments with Meaning (MwM)," the most relevant dimensions were related to interpersonal relations, the moment of diagnosis, and personal achievements. This category established relations with almost all other categories, as did the category "historical sources of meaning (SoM)." The category "identity before and after cancer diagnosis" was only related to "attitudinal SoM" and "transitions." Historical SoM had two dimensions, "past" and "present and future" legacies, in which prominent topics related to family, childhood, achieved goals, and values to pass to others explored. Attitudinal SoM established relations only with the category "creative SoM," in which "courage" and "responsibility" were the main dimensions, which were also related to "MwM," "historical," and "attitudinal SoM." Experiential SoM, with the main dimension "love," was related to "MwM" and "historical SoM." Transitions only established relations with "historical SoM" and "identity before and after cancer." SIGNIFICANCE OF RESULTS: The findings that "MwM" and "historical SoM" were the categories which established a solid pattern of relations suggest that these are the main psychotherapy topics that can have more influence for the participants; one explanation is that these categories imply a concrete way of thinking, which is easier to understand. This process of therapeutic changes must be integrated in a cultural context, as it is well known to have an impact upon the "meaning" of life.

Clinical profile in schizophrenia and schizoaffective spectrum: relation with unconjugated bilirubin in a prospective and controlled study with psychopathological and psychosocial variables.

OBJECTIVE: Our objective was to assess unconjugated bilirubin (UCB) as biomarker for schizophrenia (SCZ) and schizoaffective (SAF) spectrums disorder (relapse vs. partial remission). METHODS: Eighty-eight psychotic patients completed first assessment during relapse at ward admission, half with SCZ and half with SAF disorder. Forty-four acute bipolar patients were used as controls. After 12-month follow-up, we collected longitudinal protocol (laboratory, psychopathological, and psychosocial data) from 60 patients, half with SCZ and half with SAF disorder. RESULTS: During psychotic relapse (N = 88), we found a statistically significant difference (analysis of variance [ANOVA]; p = .002), confirmed after post hoc multiple comparisons (Bonferroni) between SCZ (N = 44) and both SAF (N = 44; p = .05) and bipolar controls (N = 44; p = .05); a positive correlation (Pearson's r = .314) between UCB mean levels and Personal and Social Performance item (d) "disturbing and aggressive behaviors"; and a positive correlation (R2 = .223), with statistically significance (p = .008), between UCB mean levels and mean length of stay at the psychiatric ward in SAF patients who completed full protocol (N = 30). During partial remission (N = 60) we found: a statistically significant difference (ANOVA; p = .006), confirmed after post hoc multiple comparisons (Bonferroni) between SCZ (N = 30) and SAF (N = 30; p = .05); plus a negative correlation (Pearson's r = -.399) between UCB mean levels and Positive and Negative Syndrome Scale item G7 "psychomotor retardation." Comparing first and second assessments (paired samples t test) we found a statistically significant difference in UCB mean levels among SAF patients (p = .034). CONCLUSIONS: There is potential in the research of UCB as a biological marker for SCZ and SAF spectrums disorders during relapse and partial remission of both syndromes.

Hepatitis C Pretreatment Profile and Gender Differences: Cognition and Disease Severity Effects.

BACKGROUND: The hepatitis C virus (HCV) is known to infect the brain, however, the findings based on associated neuropsychiatric syndrome are controversial and the association itself remains unclear. Gender research in HCV infection is limited, failing to integrate the role of gender differences in neurocognitive syndrome. The aim of this study was to characterize psychological and neurocognitive profiles in HCV-infected patients before treatment and to explore gender differences in those profiles, as well as the impact of disease severity. METHODS: A total of 86 patients diagnosed with chronic hepatitis C were included. Depression and anxiety were assessed using Hamilton anxiety scale (HAM-A), Hamilton depression scale (HAM-D), Beck Depression Inventory (BDI). For cognition, a neuropsychological battery to measure attention, concentration and memory was used, and executive function components validated for the Portuguese population was also used before starting treatment. To identify the disease severity, platelet ratio index, and FibroScan® were used. RESULTS: A statistically significant gender effect was found on HAM-A (B = 0.64, CI: 0.17-1.11) and HAM-D (B = 0.62, CI: 0.14-1.09), with women scoring higher compared to men. Regarding neuropsychological scores, significant differences between gender were identified in executive functions measured by Trail Making Test (TMT B) (B = 0.48, CI: 0.02-0.97), TMT B-A (B = 0.26, CI: -39.2 to -3.7) and in digit span total (B = -0.52, CI: -1.0 to -0.04), with women performing worse than men. Controlling for years of substance dependence, TMT-B and TMT B-A showed significant gender differences. Regarding the presence or absence of substance dependence, only HAM-A and HAM-D remained significant. For categorical variables, Digit Span Total was also influenced by gender, with women being more likely to be impaired: odds ratio (OR) = 7.07, CI: 2.04-24.45), and a trend was observed for Digit Span Backward (OR = 3.57, CI: 1.31-9.75). No significant differences were found between disease severity and neurocognitive performance. CONCLUSION: Data suggest that gender has an influence on depression, anxiety and cognitive functions with women showing greater impairment compared with men. This effect seems to be influenced by substance dependence.

Unconjugated bilirubin and acute psychosis: a five years retrospective observational and controlled study in patients with schizophrenia, schizoaffective and bipolar disorders.

Introduction: Unconjugated bilirubin (UCB) high levels have been correlated with schizophrenia spectrum disorders.Methods: We searched for correlation between UCB mean levels, duration of psychiatric admission, and diagnosis in 255 individuals, including 56 healthy controls and 199 acute patients (namely 44 with schizophrenia, 99 with schizoaffective disorder and 56 with bipolar disorder).Results: We found a statistically significant difference between UCB mean levels of patients with schizophrenia versus patients with schizoaffective (0.41 mg/dL vs. 0.34 mg/dL; p < .03) and bipolar disorders (0,41 mg/dL vs. 0.29mg/dL; p < .0001). We also found a statistically significant difference between UCB mean levels of patients with schizoaffective disorder and bipolar disorder (0.34 mg/dL vs. 0.28; p < .04). We also found a significant difference (p < .001) between mean admission duration of schizophrenia (29 days) versus bipolar patients (16 days). Although in a non-significant manner, the schizoaffective group got a mean admission duration value (22 days) right in between the schizophrenia and the bipolar patients.Conclusions: Our results deserve further research to access the role UCB may have in the physiopathology of acute patients with schizophrenia/schizoaffective/bipolar spectrum disorders.KeypointsUnconjugated Bilirubin (UCB) high levels are correlated with acute psychosis.UCB high levels are correlated with duration of psychiatric admission.UCB mean levels of schizophrenic patients are higher than schizoaffective patients.UCB mean levels of schizoaffective patients are higher than bipolar patients.

Unconjugated bilirubin and schizophrenia: a systematic review.

Schizophrenia is a complex syndrome of unknown etiology and difficult to manage. Unconjugated bilirubin has been researched as a potential biological marker of this syndrome. The objective of this review article was to gather the studies published to date on the relationship between this molecule and schizophrenia. Broad inclusion criteria have been used (PRISMA) to include as many relevant studies as possible. Fourteen studies were selected: 3 analyzed the effects of unconjugated hyperbilirubinemia in animal models; 6 demonstrated an increased incidence of schizophrenia in patients with increased unconjugated bilirubin; 2 reported an increased incidence of the disease in patients with decreased unconjugated bilirubin; and 3 linked an increased incidence of schizophrenia with an increased excretion of the oxidative product of bilirubin, the so-called biopyrrins. Because of apparently contradictory reported results, the hypothesis that the relationship between schizophrenia and unconjugated bilirubin was not linear and that there was an inflammatory dysfunction explaining this was considered. The 2 most accepted models for the pathophysiology of schizophrenia are described, and the possible role of the molecule in each is clarified. The bilirubin buffer system and its role in antioxidant defense was explored. The average levels of unconjugated bilirubin in patients with schizophrenia, schizoaffective disorder, and bipolar disorder were also compared, having been hypothesized that these diseases could be different points of a same pathological spectrum. Finally, it was concluded that unconjugated bilirubin is a promising molecule that could be used as a possible biological marker for schizophrenia, and the necessity of subsequent efforts for its research was considered.

Depression and Obesity: Integrating the Role of Stress, Neuroendocrine Dysfunction and Inflammatory Pathways.

Literature on depression and obesity describes the relevance of the hypothalamic pituitary adrenal axis dysfunction, sympathetic nervous system (SNS) activation, and inflammatory processes as well as the interaction of genetic and environmental factors. Recent investigation in obesity highlights the involvement of several regulation systems, particularly in white adipose tissue. The hypothalamic pituitary adrenal axis, gonadal, growth hormone, leptin, sympathetic nervous system and adrenergic, dopaminergic, and serotoninergic central pathways, all seem interconnected and involved in obesity. From another perspective, the role of psychosocial chronic stressors, determining poor mental and physical health, is well documented. Empirical data can support biologically conceivable theories describing how perceptions of the external social environment are transduced into cellular inflammation and depression. Although in neurobiological models of depression, stress responses are associated with neuroendocrine and neuro-inflammatory processes, concerning similar pathways to those described in obesity, an integrating model is still lacking. The aim of this mini-review is to offer a reflexion on the interplay between the neuroendocrine dysfunctions related to chronic stress and the nature of the shared biologic mechanisms in the pathophysiology of both clinical entities, depression and obesity. We highlight dysfunctional answers of mind body systems that are usually activated to promote regulation and adaptation. Stress response, as a mediator between different level phenomena, may undertake the role of a plausible link between psychological and biological determinants of disease. Depression and obesity are major public health issues, urging for new insights and novel interventions and this discussion points to the need of a more in-depth approach.

Association of Anger Expression-Out with NK Cell Counts in Colorectal Cancer Patients.

INTRODUCTION: There is growing evidence describing the relation between psychological factors and the progression of colorectal cancer. Several mechanisms have been proposed but the one showing more promising evidence relies on the modulation of the antitumoral immune response by psychological factors, particularly through natural killer cells. We aimed to study the relation between natural killer cell count and anxiety, depression and anger state, trait and expression in 54 pre-surgical colorectal cancer patients. MATERIAL AND METHODS: We measured peripheral blood natural killer cell count and applied the State-Trait Anger Expression Inventory and the Hospital Anxiety and Depression Scale to 54 pre-surgical colorectal cancer patients. We used the Mann-Whitney U test and the Kruskal-Wallis test when appropriate to compare independent groups. RESULTS: Patients with higher Anger Expression-Out had lower natural killer cell numbers than patients with lower Anger Expression-Out (p value = 0.008). No relation was found between natural killer cell levels and Anger State, Anger Trait, or Anger Expression-In. No difference in natural killer cell count was found between patients with and without clinical anxiety or depression. DISCUSSION: These results suggest that, in colorectal cancer patients, natural killer cell counts are influenced by Anger Expression-Out, but not by clinical anxiety or depression. CONCLUSION: The unregulated emotional expression might be a conditioning factor of innate immunity. Additional studies are needed to further investigate this relation and to ascertain the clinical impact of therapeutic interventions regarding emotional regulation on the anti-tumoral immune response.

Introdução: Existe crescente evidência da relação entre fatores psicológicos e progressão do cancro colorrectal. Vários mecanismos têm sido propostos porém o mais promissor baseia-se na modulação da resposta imune anti-tumoral pelos fatores psicológicos, particularmente através das células natural killer. Esta investigação teve como objetivo o estudo da relação entre as células natural killer e a ansiedade, a depressão e o estado, traço e expressão da raiva num grupo de 54 doentes pré-cirúrgicos com cancro colorrectal. Material e Métodos: Medimos a contagem periférica de células natural killer e aplicámos o Inventário de Estado-Traço de Raiva e a Escala Hospitalar de Ansiedade e Depressão a 54 doentes pré-cirúrgicos com cancro colorrectal. Usámos o teste U de Mann-Whitney e o teste Kruskal-Wallis para amostras independentes. Resultados: Os doentes que apresentaram níveis mais elevados de Anger Expression-Out revelaram contagens inferiores de células natural killer (p value = 0,008). Não encontrámos relação entre os níveis de células natural killer e o Anger State, Trait ou Expression-In. Não identificámos diferenças nas contagens de células natural killer entre doentes com e sem ansiedade clínica ou com e sem depressão clínica. Discussão: Estes resultados sugerem que em doentes com cancro colorrectal a contagem de células natural killer é influenciada pela Anger Expression-Out, mas não pela depressão ou ansiedade clínica. Conclusão: A desregulação da expressão emocional pode ser um factor condicionante da imunidade inata. São necessários estudos adicionais para investigar mais aprofundadamente esta relação e para estabelecer o impacto clínico na resposta imune anti-tumoral das intervenções terapêuticas dirigidas à regulação emocional.

Psychosocial and Neurocognitive Factors Associated With Hepatitis C - Implications for Future Health and Wellbeing.

Background: Hepatitis C virus (HCV) infection involves changes not only from the point of view of physical health, but also emotional, and social that have a significant impact on the quality of life of these patients. According to the literature review, it seems that there is an important association between psychosocial factors, in particular on a cognitive level and disease progression. The aim of this mini-review is to summarize recent literature looking at the associations between psychosocial and neurocognitive factors and HCV. Methods: PubMed/Medline was systematically searched for psychosocial and neurocognitive factors associated with hepatitis C, treatment adherence, and patient wellbeing. Results: Patients present with a range of extrahepatic symptoms including fatigue, anxiety, depression, and neurocognitive dysfunction. HCV's impact on quality of life and wellbeing has serious clinical and social implications. Conclusion: Hepatitis C and its management continue to have a profound impact on health and psychologic wellbeing. Considering the serious extrahepatic implications for individuals, it is imperative that healthcare professionals pay close attention to psychosocial and neurocognitive factors. The focus on combined clinical approaches could enhance understanding about the health and social impacts of hepatitis C along the life course.

Teaching Psychology in Medicine: The Context, Methodologies and Doctor's Professional Identity.

INTRODUCTION: Teaching Psychology in medical curriculum has been the subject of numerous dissertations that focus on the relevance of this knowledge for doctors, at a general level. METHODS: A non-systematic review of the relevant literature, particularly from the last decade, as well as national and international recommendations addressing the need for integration of behavioural and social sciences in medical training, was performed. RESULTS: The literature supports the existence of preconceptions and negative attitudes towards the role of psychology in medical education, demonstrated by research in various european and american universities. The socio-cultural context, the different methodologies and barriers experienced by teachers in medical education are listed and provide the matrix for a more comprehensive discussion of the development of the doctor's identity. CONCLUSION: Revisiting the experience of many years of teaching Medical Psychology, it is considered that the process of integration of this curricular area should occur horizontally and vertically throughout the course, stressing the need for the pedagogical training of teachers. Concepts that arise from personal reflection, adjusted to the reality of our education and the basic principles that guide it, are elaborated in order to integrate the teaching of Psychology in Medicine, emphasizing its importance and utility in the competencies and abilities of future doctors.

Introdução: O ensino da Psicologia no currículo do curso de Medicina tem sido alvo de inúmeras reflexões que se debruçam sobre a importância destes conhecimentos, a um nível geral, para os médicos.Métodos: Procedeu-se a uma revisão não sistemática de literatura relevante, particularmente da última década e de recomendações nacionais e internacionais que se debruçam sobre a necessidade de integração das ciências sociais e do comportamento na formação médica.Resultados: A literatura suporta a existência de pré-conceitos e atitudes negativas face ao papel da Psicologia na formação médica, demonstrada pela investigação em várias universidades europeias e americanas. O contexto sociocultural, as diferentes metodologias e as barreiras sentidas face a este ensino são enumerados, fornecendo a matriz para uma discussão mais abrangente da formação da identidade do médico.Conclusão: Revisitando a experiência de muitos anos de ensino na Psicologia Médica, considera-se que o processo de integração desta área curricular deve ocorrer de forma transversal e vertical, ao longo de todo o curso, salientando-se a necessidade da formação pedagógica dos docentes. Procura-se, assim, elaborar conceitos que decorrem de uma reflexão pessoal e que se pretende ajustada à realidade do nosso ensino e aos princípios básicos que o norteiam, de forma a integrar o ensino da Psicologia no curso de Medicina, acentuando a sua importância e utilidade no desempenho de futuros médicos.