Exploring the clinical features of postpartum obsessive-compulsive disorder- a systematic review

Background and objectives The postpartum period appears to be a vulnerable period for the development of obsessive-compulsive disorder in parents; yet it is often overlooked. This work aims to synthesize clinical data available on Postpartum Obsessive-Compulsive Disorder (PP-OCD) and to highlight its psychopathological significance and implications in clinical practice using a systematic approach. Methods We conducted a systematic research according to PRISMA guidelines in three databases – MEDLINE, Scopus and Web of Science. The references obtained were then screened and scanned for eligibility by two investigators. Risk of bias was assessed for each study with NIH tools. Results The found prevalence of postpartum OCD ranged from 2.43 %-9 % among women and 1,7 % among men. Other epidemiological and clinical data were reviewed including particular symptomatology, characterized by a swift onset of primarily aggressive and contamination obsessions, as well as situational avoidance. Conclusion It is a clinical entity frequently underdiagnosed, which perinatal health practitioners should be familiar with, as it can interfere with parent-infant bonding if left untreated. Mothers with an history of depression, anxiety, insomnia, obsessive compulsive, and avoidant personality disorder or presenting inappropriate interpretation of infant related intrusive thoughts are particularly at risk of developing OCD in the postpartum period. These mothers should be informed about the nature of their infant centered obsessions and could be a target of prevention programs. (AU)

Manic Episode Induced by Lamotrigine in Rapid Cycling Bipolar Disorder.

Bipolar disorder is characterized by persistent and/or recurrent mood changes between depressive and manic poles. Rapid cycling is a frequent, although underrecognized, condition in bipolar disorder, and it is known to worsen the prognosis of the disease. With regard to the treatment of bipolar depression, there is a shortage of evidence-supported treatment choices, and the literature on the subject includes few references to cases of manic switch induced by lamotrigine. The authors describe a case of a rapid cycling bipolar patient who presented manic symptoms after initiating treatment with lamotrigine.

Psychotic disorders hospitalizations associated with cannabis abuse or dependence: A nationwide big data analysis.

OBJECTIVES: We aimed to describe and correlate the hospital panorama of psychotic disorders (PD) with cannabis use (CU) trends in all Portuguese public hospitals. METHODS: We conducted a retrospective observational study that analysed all hospitalizations that occurred in Portuguese public hospitals from 2000 to 2015. Hospitalizations with a primary diagnosis of PD or schizophrenia were selected based on Clinical Classification Software diagnostic single-level 659. Episodes associated with CU were identified by the International Classification of Diseases Version 9, Clinical Modification code 304.3/305.2 that correspond to cannabis dependence/cannabis abuse. RESULTS: The number of hospitalizations with a primary diagnosis of PD and schizophrenia associated with CU rose 29.4 times during the study period, from 20 to 588 hospitalizations yearly (2000 and 2015, respectively) with a total of 3,233 hospitalizations and an average episode cost of €3,500. Male patients represented 89.8% of all episodes, and the mean/median age at discharge were 30.66/29.00 years, respectively. From all hospitalizations with a primary diagnosis of PD or schizophrenia, the ones with a secondary diagnosis of CU rose from 0.87% in 2000 to 10.60% in 2015. CONCLUSIONS: The increase on secondary diagnosis coding and the change on cannabis patterns of consumption in Portuguese population with an increasing frequency of moderate/high dosage cannabis consumers may explain the rise on PD hospitalizations.

Quality of Sleep and Depression in College Students: A Systematic Review.

BACKGROUND: Nowadays, sleep-related problems are a prevalent occurrence among university students. Poor sleep quality is one of the most studied aspects of sleep complaints, affecting from 10% to 50% of this population. Poor sleep quality consequences are many and have a profound impact in the student's psychobiological health. University students live through a period of psychological challenge and adaptation, since the transition from high school to professional life. Abrupt autonomy challenges students to deal with many choices, from their academic and social life to their intimate habits. Frequently, sleep hygiene is neglected, or they are unable to use proper coping mechanisms, resulting in disturbing consequences that could impact their lives as adults. Research has found a significant association between sleep quality and depression or depressive symptoms, but this relationship is still somewhat difficult to interpret. OBJECTIVE: The objective of this review is to appraise the current knowledge around the relationship of sleep with depression in this group of young adults. Data Source: Articles included in Medline database. METHODS: After a careful search, the articles selected aimed mainly college students. The studies had sleep quality and depression objectively assessed, focused in the relationship between both, and addressed possible influencing factors. RESULTS: The current literature still supports a bidirectional relationship between sleep and depression, however, the importance of sleep quality is becoming a very relevant variable. CONCLUSION: Education and the application of policies regarding sleep hygiene may prevent, in some cases, the development of depression and improve the quality of sleep in other cases. Future research should clarify the relationship between sleep problems and depression in a way they could be prevented or, at least, minimalized with effective and achievable interventions.

Parafrenia tardía, un diagnóstico revisado: reporte de caso y revisión de la literatura / Late paraphrenia, a revisited diagnosis: case report and literature review

No disponible

[HIV associated neurocognitive disorders]. / Trastornos neurocognitivos asociados con la infección por el VIH.

With the development of new antiretroviral therapies, there has been significant developments in the understanding of the neuropathogenesis of HIV-associated brain disease and the effects of these drugs in the CNS. This fact originated a substantial improvement in the survival of patients and influenced the course of cognitive impairment associated with HIV infection. This review intends to be an update on the epidemiological, etiopathogenic, clinical and therapeutic aspects related to neurodeterioration. A key challenge for the clinician working in this area is to diagnose, as early as possible, the cognitive deficits ocuring in the primary stages of the disease, to determine the prognosis (according to clinical, laboratory and neuropsychological findings) and establish a therapeutic approach. So the neuropsychological assessment should be included in the routine evaluation of these patients. This would have an important impact on their quality of life and improve, the antiretroviral therapy compliance.

Trastornos neurocognitivos asociados con la infección por el VIH / HIV associated neurocognitive disorders

Con el desarrollo de las nuevas terapias antirretrovirales, se han producido importantes avances en el conocimiento de la neuropatogenia de la encefalopatía asociada con la infección por el VIH y de los efectos que estos fármacos tienen en SNC. Los nuevos tratamientos antirretrovirales, además, han dado lugar a una mejora sustancial en la supervivencia de los pacientes seropositivos para el VIH y han influido de forma decisiva en el curso del deterioro cognitivo asociado con la infección por el VIH. Esta revisión pretende ser una actualización de los aspectos epidemiológicos, etiopatogénicos, clínicos y terapéuticos relacionados con el deterioro neurocognitivo. Un reto de enorme importancia para los médicos y neuropsicólogos que trabajan con estos pacientes es del de diagnosticar lo antes posible los déficits cognitivos que se observan en la primeras fases de la infección con el fin de establecer el pronóstico de acuerdo con los resultados de las pruebas neuropsicológica y de laboratorio e instituirla estrategia terapéutica más adecuada. Por esta razón, la evaluación neuropsicológica debe incluirse en la práctica clínica diaria con estos pacientes. Esto contribuirá a mejorar su calidad de vida y el cumplimiento terapéutico del tratamiento antirretroviral (AU)

With the development of new antiretroviral therapies, there has been significant developments in the understanding of the neuropathogenesis of HIV-associated brain disease and the effects of these drugs in the CNS. This fact originated a substantial improvement in the survival of patients and influenced the course of cognitive impairment associated with HIV infection. This review intends to be an update on the epidemiological, etiopathogenic, clinical and therapeutic aspects related to neurodeterioration. A key challenge for the clinician working in this area is to diagnose, as early as possible, the cognitive deficits ocuring in the primary stages of the disease, to determine the prognosis (according to clinical, laboratory and neuropsychological findings) and establish a therapeutic approach. So the neuropsychological assessment should be included in the routine evaluation of these patients. This would have an important impact on their quality of life and improve, the antiretroviral therapy compliance (AU)

Depression and neurocognitive performance in Portuguese patients infected with HIV.

This study focused on neurocognitive disorders associated with HIV infection, characterizes the most affected neuropsychological domains and their potential as factors related with depression. 130 HIV-positive individuals with CD4 >200 cells/mm(3), undetectable viral load, treated with HAART and with all kinds of risk behaviors were included. A structured interview composed by seven sections was used and relevant clinical and laboratory data was assessed. For the neuropsychological and depression assessment the HIV Neurobehavioral Research Center (HNRC) Battery and Hamilton Rating Scale for Depression (HAM-D) were chosen. Univariate nonparametric statistics and multivariate regression model were performed. Among 34% of depressed subjects, 20.7% had attempted suicide, 45.4% were under psychiatric medication and only 19% had no diagnostic criteria for HIV Associated Neurocognitive Disorders (HAND). The effect of depression on cognitive function revealed a significant deterioration in five of the eight measures. In the multivariate analysis, five variables significantly determined depression: sex, social class, antidepressant medication, history of suicide attempt and Dexterity and motor speed (neuropsychological test battery). Despite good patient adherence to treatment (HAART and antidepressive) and good immune status, the prevalence of HAND and depression are high and suggest a significant relation between severity of depression and cognitive functioning.