Depressive Disorder Related Hospitalizations in Portugal Between 2008-2015: a Nationwide Observational Study.

Depression is a prevalent disease, being one of the most relevant contributors of disability in the overall global burden of diseases. Hospitalization episodes are important quality indicators in psychiatric care. The primary aim of this study is to analyse depressive disorder related hospitalizations in Portuguese public hospitals and to detail clinical and sociodemographic differences among various subtypes of depression. Admissions with a primary diagnosis of depression in adult patients(> = 18 years) were selected from a national mainland hospitalization database. ICD-9-CM codes were used to select the diagnoses of interest: 296.2 × to 296.3x (Major depressive disorder), 300.4 (Dysthymic disorder) and 311 (Depressive disorder, not elsewhere classified). Birth date, sex, residence address, primary and secondary diagnoses, admission date, discharge date, length of stay (LoS), discharge status, and hospital estimated charges were obtained. A total of 28,569 hospitalizations (22,387 patients) with a primary diagnosis of depression were analysed. In the 8-year period of the study, 19.1% of all hospitalizations with a primary diagnosis of psychiatric disorder were linked to Depression. Major Depressive episodes were the most common (n = 15,384; 53.8%), followed by Depression unspecified episodes (n = 6,793; 23.8%), and Dysthymia (n = 6,392; 22.4%). Most episodes occurred in female patients (70.2%; n = 20,052), with a mean age of 50.6 years, and 37.0% (n = 10,564) of the episodes were associated to other psychiatric comorbidities. Depressive disorders are one of the leading causes of hospitalization in Portuguese psychiatric departments, being responsible for approximately 1 in 5 hospitalizations with a psychiatric diagnosis.

Bipolar Disorder Related Hospitalizations - a Descriptive Nationwide Study Using a Big Data Approach.

Bipolar Disorder (BD) is a mental disorder which frequently requires long hospitalizations and need for acute psychiatric care. The aim of this study was to describe a nationwide perspective of BD related hospitalizations and to use a BigData based approach in mental health research. We performed a retrospective observational study using a nationwide hospitalization database containing all hospitalizations registered in Portuguese public hospitals from 2008-2015. Hospitalizations with a primary diagnosis of BD were selected based on International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 296.xx (excluding 296.2x; 296.3x and 296.9x). From 20,807 hospitalizations belonging to 13,300 patients, around 33.4% occurred in male patients with a median length of stay of 16.0 days and a mean age of 47.9 years. The most common hospitalization diagnosis in BD has the code 296.4x (manic episode) representing 34.3% of all hospitalizations, followed by the code 296.5x (depressed episode) with 21.4%. The mean estimated hospitalization charge was 3,508.5€ per episode, with a total charge of 73M€ in the 8-year period of this study.This is a nationwide study giving a broad perspective of the BD hospitalization panorama at a national level. We found important differences in hospitalization characteristics by sex, age and primary diagnosis.

Electroconvulsive Therapy Use in Psychiatric Hospitalizations in Portugal: A Nationwide Descriptive Study.

OBJECTIVES: The primary aim of this study was to describe a Portuguese nationwide epidemiological perspective on the use of electroconvulsive therapy (ECT) in hospitalized psychiatric patients. The secondary aims of the study were to characterize clinical and sociodemographic trends of hospitalized patients treated with ECT. METHODS: A retrospective-observational study was conducted using an administrative database gathering every registered Portuguese public hospital hospitalizations from 2008 to 2015. We selected all hospitalizations with a procedure code 94.27 (Other electroshock therapy) defined by the International Classification of Diseases version 9, Clinical Modification. Variables included birth date, sex, address, primary and secondary diagnoses, admission/discharge date, length of stay, and discharge status from each single hospitalization episode. We also calculated Portugal's inpatient ECT prevalence rate (iP%). RESULTS: There were a total of 879 registered hospitalizations with ECT within the 8-year period of this study. Most occurred in female patients (53.4%), belonging to the age group of 51 to 70 years old, with a mean age of 50.5 years. The median length of stay was 43.0 days with an interquartile range of 27.0 to 68.0. The most frequent primary diagnosis was major depressive disorder, recurrent episode, representing 19.6% of all hospitalizations. The iP% for the study period was 0.71%. CONCLUSIONS: In Portugal, most of the patients who received ECT were women above middle age, and depressive disorders were the most common indication. Portugal's iP% represents a low rate when compared with other European countries, which might indicate an underutilization of ECT in Portuguese psychiatric hospitals.

Schizophrenia Related Hospitalizations - a Big Data Analysis of a National Hospitalization Database.

Schizophrenia is a mental disorder characterized by long hospitalizations and frequent need for chronic/acute psychiatric care. Hospitalizations represent a valuable quality of care indicator in schizophrenia patients. The aim of this study was to describe a nationwide perspective of schizophrenia related hospitalizations. We performed a retrospective observational study using a nationwide hospitalization database containing all hospitalizations registered in Portuguese public hospitals from 2008 to 2015. Hospitalizations with a primary diagnosis of schizophrenia were selected based on the definition by CCS - Clinical Classification Software diagnostic single-level 659. Schizophrenia subtypes were identified based on International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 295.xx. A total of 25,385 hospitalizations were registered belonging to 14,279 patients. 68.0% of the hospitalizations occurred in male patients and the median length of stay was 18.0 days. In male patients' hospitalizations, the most frequent age group was 31-50 years followed by the age group of 18-30 years (55.9 and 24.0% respectively). For female patients, the most frequent age group was 31-50 years followed by 51-70 years (54.1 and 22.6%, respectively). There were 73 hospitalization with a deadly outcome (0.29%). Paranoid type was the most frequent subtype of schizophrenia (50.5%). The mean hospitalization charges were 3509.7€ per episode, with a total charge of 89.1 M€ in the 8-year period. This is a nationwide study using Big Data analysis giving a broad perspective of schizophrenia hospitalization panorama at a nationwide level. We found differences in hospitalization characteristics according to patients' gender, age and primary diagnosis.

Prediction of Survival after 48 Hours of Intensive Unit Care following Repair of Ruptured Abdominal Aortic Aneurysm-Multicentric Study for External Validation of a New Prediction Score for 30-Day Mortality.

BACKGROUND: Ruptured abdominal aortic aneurysm (rAAA) remains a critical life-threatening condition. We aimed to evaluate rAAA management in our center focusing on predictors of mortality at 48 hr of intensive care unit (ICU) and to develop a new mortality prediction score considering data at 48 hr postprocedure. External validation of the modified score with patient data from independent vascular surgery centers was subsequently pursued. METHODS: Clinical data of all patients admitted in our center from January 2010 to December 2017 with the diagnosis of rAAA were retrospectively reviewed for the development of the mortality prediction score. Subsequently, clinical data from patients admitted at independent centers from January 2010 to December 2017 were reviewed for external validation of the score. Statistical analysis was performed with SPSS Version 25. RESULTS: A total of 78 patients were included in the first part of the study: 21 endovascular aneurysm repairs (EVARs), 56 open repairs (ORs), and 1 case of conservative management. Intraoperative mortality in EVAR and OR groups was 0% vs. 24.6%, respectively (P = 0.012). Thirty-day mortality reached 50% and 33% in the OR and EVAR groups. For patients alive at 48 hr, 30-day mortality diminished to 27.6%. Several preoperative predictors of outcome were identified: smoking (P = 0.004), hemodynamic instability(P = 0.004), and elevated international normalized ratio (P < 0.0001). Dutch Aneurysm Score and Vascular Study Group of New England Score (VSGNE) were also significant predictors of outcome (area under the receiver operating characteristic curve [ROC AUC] 0.89 and 0.79, respectively; P < 0.0001). At 48 hr of ICU stay, high lactate level, high Sequential Organ Failure Assessment score, need for hemodyalitic technique, and hemodynamic instability were significant risk predictors for 30-day mortality (P < 0.05). VSGNE score was modified with the inclusion of 2 variables: hemodynamic instability and lactate level at 48 hr and a new score was attained-Postoperative Aneurysm Score (PAS). Comparing AUC for VSGNE and PAS for patients alive at 48 hr, the latter was significantly better (AUC 0.775 vs. 0.852, P = 0.039). The PAS was applied and validated in 3 independent vascular surgery centers (AUC VSGNE 0.782 vs. AUC PAS 0.820, P = 0.027). CONCLUSIONS: Despite recent evidence on preoperative predictors of survival in an era when both EVAR and OR are available, emergent decision to withhold life-saving treatment will always be extremely difficult. Therefore, the policy in our department is to try surgical repair in all cases. It remains important, however, to identify whether late deaths can be predicted, so that unnecessary prolonged treatment can be avoided. A PAS was delineated predicting 30-day mortality significantly better in patients alive at 48 hr. The score was externally applied and validated in independent centers, corroborating the score's usefulness.

Herculano Sá de Figueiredo (1911-74): a sculptor in the Conde de Ferreira Hospital, Portugal.

Herculano Sá de Figueiredo's sculptures remained anonymous inside the Conde de Ferreira Hospital of Oporto (Portugal) for over 30 years. The accidental discovery of the patient's clinical file enabled the authors of this paper to establish the link between the man, his work and his psychiatric pathology. The artwork kept in the hospital was not previously known in academic and artistic circles. Studying and recovering Figueiredo's work is important because a considerable part of his oeuvre was produced from 1955 to 1973, when he was a patient in the Conde de Ferreira Hospital. The models represented in his sculptures were technicians and patients at the institution.

Psychiatric Comorbidities in Neurologic Hospitalizations in Portugal: A Nationwide Retrospective Observational Study.

INTRODUCTION: Psychiatric comorbidities have a significant impact on patients' quality of life and often go undetected in neurologic practice. The aim of this study was to describe and characterize psychiatric comorbidities among patients hospitalized due to a neurologic disorder in mainland Portugal. METHODS: A retrospective observational study was performed by analyzing hospitalization with a primary diagnosis of neurologic disorder defined as categories 76, 77, 79 - 85, 95, 109 of the Clinical Classification Software for International Classification of Diseases, Ninth Revision, Clinical Modification, occurring between 2008 and 2015 in adult patients (≥ 18 years of age). Psychiatric comorbidities were determined as the presence of a secondary diagnosis belonging to the Clinical Classification Software categories 650 to 670. RESULTS: A total of 294 806 hospitalization episodes with a primary diagnosis of a neurologic disorder were recorded in adult patients between 2008 - 2015 in Portuguese public hospitals. Approximately 26.9% (n = 79 442) of the episodes had a recorded psychiatric comorbidity (22.1%; 32.2%, female versus male hospitalizations). Patients with registered psychiatric comorbidities were younger (66.2 ± 16.2 vs 68.6 ± 17.2 with no psychiatric comorbidities, p < 0.001), presented lower all-cause in-hospital mortality rates, and significantly longer mean hospital stays. 'Delirium, dementia, amnestic and other cognitive disorders' were recorded in 7.4% (n = 21 965) of the hospitalizations, followed by alcohol-related disorders in 6.5% (n = 19 302) and mood disorders in 6.1% (n = 18 079). Epilepsy/seizures were the neurologic disorders with the highest proportion of recorded psychiatric comorbidities (39.9%). CONCLUSION: Psychiatric comorbidities were recorded in more than a quarter of the hospitalizations with a primary diagnosis of a Neurologic disorder. Psychiatric comorbidities varied among neurological disorders and were associated with different demographic and clinical features.

Synergistic Antigenotoxic and Antioxidant Action of Gum Arabic and Eugenol in Rat Liver Following Induction of Colorectal Carcinogenesis.

OBJECTIVE: Much research has been conducted to identify natural antioxidant and antimutagenic compounds capable of preventing, reverting or treating conditions caused by oxidative stress and genotoxicity. In this study we evaluated the effects of 10% gum arabic (GA) and eugenol (EUG) on hepatic oxidative stress and genotoxicity induced by dimethylhydrazine (DMH) in rats. METHODS: The prevention arm of the study included 4 control groups and 4 experimental groups. Once a week for 20 weeks, the controls received saline s.c. while the experimental groups received DMH at 20 mg/kg s.c. During the same period and for an additional 9 weeks, the animals received either water, 10% GA , EUG or 10% GA + EUG  by gavage. The treatment arm of the study included 4 control groups and 4 experimental groups. Once a week for 20 weeks, the controls received saline s.c. while the experimental groups received DMH at 20 mg/kg s.c. During the subsequent 9 weeks, the animals received either water, 10% GA, EUG or 10% GA + EUG  by gavage. Finally, the livers were harvested for histopathological study with HE, measurement of genotoxicity and oxidative stress. RESULT: Genotoxicity and oxidative stress were found to be significantly lower in Group XII (animals treated concomitantly with GA and EUG). This is the first study to observe the synergistic action of GA and EUG administered concomitantly in this scenario. CONCLUSION: Indicating a synergistic antigenotoxic and antioxidant effect on liver cells in rats with DMH-induced colorectal carcinogenesis.

São Paulo's atmospheric pollution reduction and its social isolation effect, Brazil.

Since January 2020, studies report reductions in air pollution among several countries due to social isolation measures, which have been adopted in order to contain the coronavirus outbreak progress (COVID-19). This study aims to evaluate the change in the atmospheric pollution levels by NO and NO2 in São Paulo City for the social isolation period. The NO and NO2 hourly concentrations were obtained through air quality monitoring stations from CETESB, from January 14, 2020 to April 12, 2020. Mann-Kendall and the Pettitt tests were performed in the air pollutant time series. We observed an overall negative trend in all stations, indicating a decreasing temporal pattern in concentrations. Regarding NO, the highest absolute decrease rates were observed in the Congonhas (- 6.39 µg m-3 month-1) and Marginal Tietê (- 6.19 µg m-3 month-1) stations; regarding NO2, the highest rates were observed in the Marginal Tietê (- 4.45 µg m-3 month-1) and Cerqueira César (- 4.34 µg m-3 month-1) stations. In addition, we identified a turning point in the NO and NO2 series trends that occurred close to the start date of the social isolation period (March 20, 2020). Moreover, from statistical analysis, it was found that NO2 is a suitable surrogate for monitoring economic activities during social isolation periods. Thus, we concluded that social isolation measures implemented on March 20, 2020 caused significant changes in the air pollutant concentrations in the city of São Paulo (as high as - 200% in NO2 levels).

Spontaneous seizures after ECT in a patient medicated with bupropion, sertraline and risperidone.

OBJECTIVE:: To report a case of post-electroconvulsive therapy spontaneous seizures in a patient medicated with sertraline, bupropion and risperidone. CASE DESCRIPTION:: A 53-year-old woman with recurrent major depression was admitted to our psychiatry department for a major depressive episode of 6 weeks' duration, with psychotic symptoms. She was already on 200 mg/day of sertraline and 2 mg/day of risperidone. After 8 weeks on 200 mg/day of sertraline, 4 mg/day of risperidone and slow release bupropion (titrated to 300 mg/day), with no objective improvements, the decision was taken to initiate a course of 8-10 electroconvulsive therapy (ECT) sessions. Two days after the first treatment, three generalized tonic-clonic seizures occurred within 6 hours. Phenytoin and sodium valproate were added to the patient's daily medication and no further spontaneous seizures were observed. After neurologic assessment and discussion of the case, phenytoin and bupropion were withdrawn at once (two days after the spontaneous seizures) and the decision was taken to resume the ECT treatment. No further spontaneous seizures occurred and, at discharge, the patient exhibited significant improvements and was free from major depressive symptoms. COMMENTS:: This report illustrates a case of post-ECT spontaneous seizures that might have been due to a specific pharmacological etiological pathway, namely, bupropion's proconvulsive properties, although both sertraline and risperidone also lower the convulsive threshold.

Multiple imputation to deal with missing objectively-measured physical activity data: findings from two cohorts / Imputação múltipla para lidar com dados faltantes em acelerometria: resultados de duas coortes

The objective of this article was to describe patterns of losses of information regarding accelerometer data and to assess the use of multiple imputation to generate physical activity estimates for individu-als without accelerometry data. Two birth cohort studies from Pelotas (Brazil) with participants aged 22 and 11-years old assessed objectively measured physical activity differences between complete and imputed cases. Mean values of overall physical activity for complete cases (n1993 = 2,985 and n2004 = 3,348) and for complete cases plus imputed cases (n1993 = 760 and n2004 = 79) were described accord-ing to predictors. Male individuals, participants with black skin color, and less schooled individuals presented higher averages of overall physical activity than their counterparts. Almost all imputed estimates were comparable to the complete cases, and the highest difference found was 0.7 mg for the first quintile of socioeconomic status of the 1993 birth cohort. Multiple imputation is a positive technique to deal with missing data from objectively measured physical activity. It provides a set of relevant variables to be used in order to efficiently predict accelerometer data

O objetivo desse artigo foi descrever os padrões de perda de informação em dados de acelerometria, além de avaliar o processo de imputação múltipla para estimar o nível de atividade física para indivíduos sem dados de acelerometria. Participantes de duas coortes de nascimentos de Pelotas (Brasil) com 22 e 11 anos participaram do estudo e diferenças entre casos completos e imputados foram avaliadas. A média geral de atividade física para os casos completos (n1993 = 2.985 e n2004 = 3.348) e para casos completos mais imputados (n1993 = 760 e n2004 = 79) foi descrita de acordo com os preditores. Indivíduos do sexo masculino, de cor da pele preta e com menor escolaridade apresentaram maiores médias de atividade física geral. Quase todas as estimativas imputadas foram comparáveis com os valores de casos completos, e a maior diferença encontrada foi 0,7 mg para o primeiro quintil de renda na coorte de 1993. Imputação múltipla é uma boa técnica para lidar com dados faltantes de atividade física medida por acelerometria. Essa técnica fornece um gama relevante de variáveis para serem usadas a fim de predizer valores de acelerometria eficientemente

"Um insuportável vazio" - falso self e a organização borderline da personalidade, a partir de um caso clínico / "An unbearable void" - false self and the borderline organization of personality, from a clinical case

Partindo das noções de verdadeiro e falso self de Winnicott, os autores propõem-se a uma revisão desses conceitos na literatura psicanalítica contemporânea, relacionando-os com a perspectiva atual sobre o funcionamento psíquico dos pacientes com uma estrutura borderline da personalidade. Uma vinheta clínica é utilizada como ilustração e análise dessa relação.(AU)

Based on Winnicott's conceptualizations of true self and false self, the authors propose to review the notions in contemporary psychoanalytic literature, relating them to the current perspective on the psychological functioning of patients with a borderline personality structure. A clinical vignette is used as illustration and analysis of this relationship.(AU)

Spontaneous seizures after ECT in a patient medicated with bupropion, sertraline and risperidone / Convulsões espontâneas após ECT em doente medicada com bupropiona, sertralina e risperidona

Abstract Objective: To report a case of post-electroconvulsive therapy spontaneous seizures in a patient medicated with sertraline, bupropion and risperidone. Case description: A 53-year-old woman with recurrent major depression was admitted to our psychiatry department for a major depressive episode of 6 weeks' duration, with psychotic symptoms. She was already on 200 mg/day of sertraline and 2 mg/day of risperidone. After 8 weeks on 200 mg/day of sertraline, 4 mg/day of risperidone and slow release bupropion (titrated to 300 mg/day), with no objective improvements, the decision was taken to initiate a course of 8-10 electroconvulsive therapy (ECT) sessions. Two days after the first treatment, three generalized tonic-clonic seizures occurred within 6 hours. Phenytoin and sodium valproate were added to the patient's daily medication and no further spontaneous seizures were observed. After neurologic assessment and discussion of the case, phenytoin and bupropion were withdrawn at once (two days after the spontaneous seizures) and the decision was taken to resume the ECT treatment. No further spontaneous seizures occurred and, at discharge, the patient exhibited significant improvements and was free from major depressive symptoms. Comments: This report illustrates a case of post-ECT spontaneous seizures that might have been due to a specific pharmacological etiological pathway, namely, bupropion's proconvulsive properties, although both sertraline and risperidone also lower the convulsive threshold.

Resumo Objetivo: Descrever o caso de uma paciente medicada com sertralina, bupropiona e risperidona que apresentou três crises tônico-clônico generalizadas espontâneas após eletroconvulsoterapia (ECT). Descrição do caso: Uma mulher de 53 anos com antecedentes de perturbação depressiva maior recorrente foi internada em nosso serviço devido a novo episódio depressivo maior com sintomas psicóticos e 6 semanas de evolução. Ela já estava medicada com 200 mg/dia de sertralina e 2 mg/dia de risperidona. Após 8 semanas usando 200 mg/dia de sertralina, 4 mg/dia de risperidona e bupropiona de liberação lenta (titulada até 300 mg/dia), sem melhoras objetivas, decidiu-se iniciar 8-10 sessões de ECT. Dois dias após a primeira sessão, ocorreram três crises tônico-clônico generalizadas num espaço de 6 horas. Foram introduzidos fenitoína e valproato de sódio no esquema terapêutico da paciente, e não ocorreram mais crises. Após avaliação neurológica e discussão do caso, optou-se por suspender a fenitoína e a bupropiona (2 dias após as crises espontâneas) e retomar a ECT. No restante do tratamento não ocorreram mais crises convulsivas espontâneas e, até data da alta, a paciente apresentava melhorias significativas e estava livre de transtorno depressivo maior. Comentários: Este relato ilustra a ocorrência de crises convulsivas espontâneas após a ECT, as quais parecem ter sido causadas por mecanismos farmacológicos etiológicos específicos, a saber, as propriedades pró-convulsivantes da bupropiona, mesmo com o uso de sertralina e risperidona, que baixam o limiar convulsivante.

A skin-picking disorder case report: a psychopathological explanation / Um caso clínico sobre skin-picking disorder: uma explicação psicopatológica

We describe the case of a 44-year-old woman, without known previous psychiatric history, hospitalized after a significant hemorrhage caused by self-inflicted deep facial dermal lesions (with muscle exposition). Psychopathological possible explanations of this case, as in similar reviewed ones, are related to frustration, aggression, and impulsivity.

Descrevemos um caso clínico de uma senhora de 44 anos de idade, sem antecedentes psiquiátricos prévios, internada após hemorragia significante causada por uma lesão facial autoinfligida (com exposição de músculo). Possíveis explicações psicopatológicas deste caso, tal como em casos similares, relacionam-se com frustração, agressividade e impulsividade.