Introduction: The aim of the study is to assess the prevalence of anxiety and depressive symptoms in Portuguese medical students compared to students of other faculties, and the possible impact those symptoms have on academic performance.Material and Methods: A cross-sectional study was conducted in a sample of 750 students: 512 medical students and 238 nonmedical students. All students anonymously completed a socio-demographic survey and the Hospital Anxiety and Depression Scale (HADS). Statistical analysis was performed using the chi-square test, Mann-Whitney test, Spearman correlation coefficient or Kruskal-Wallis test.Results: We found a prevalence of 21.5% (n = 161) for anxiety symptoms and 3.7% (n = 28) for depressive symptoms. Being a medical student was more significantly associated with symptoms of anxiety (p = 0.034) compared with other students. Depressive symptoms were slightly associated with poor academic performance (p < 0.01). A percentage of 59.6% (n = 96) of students with anxiety symptoms and 46.4% (n = 13) of students with depressive symptoms did not seek medical or psychological care at that time.Discussion: Medical students in this sample seem to have more symptoms of anxiety, possibly explained by a higher number of female students in that sample. Depressive symptoms could be associated with poor academic performance in both groups, but an evident correlation was not established.Conclusion: Considering the high levels of anxiety symptoms, the possible impact of depressive symptoms in academic performance and the lack of psychiatric or psychological follow-up reported in this study, it is urgent to develop adequate means of support to improve students’ well-being and mental health.

The liver is the organ by which the majority of substances are metabolized, including psychotropic drugs. There are several pharmacokinetic changes in end-stage liver disease that can interfere with the metabolization of psychotropic drugs. This fact is particularly true in drugs with extensive first-pass metabolism, highly protein bound drugs and drugs depending on phase I hepatic metabolic reactions. Psychopharmacological agents are also associated with a risk of hepatotoxicity. The evidence is insufficient for definite conclusions regarding the prevalence and severity of psychiatric drug-induced liver injury. High-risk psychotropics are not advised when there is pre-existing liver disease, and after starting a psychotropic agent in a patient with hepatic impairment, frequent liver function/lesion monitoring is advised. The authors carefully review the pharmacokinetic disturbances induced by end-stage liver disease and the potential of psychopharmacological agents for liver toxicity.

Prior to the seventeenth century, the experiences we now name hallucinations were valued within a cultural context, they could bring meaning to the subject or the world. From mid-seventeenth to eighteenth centuries, they acquire a medical quality in mental and organic illnesses. However, the term was only fully integrated in psychiatry by Esquirol in the eighteenth–nineteenth centuries. By then, a controversy begins on whether hallucinations have a perceptual or intellectual origin. Esquirol favors the intellectual origin, describing them as an involuntary exercise of memory and imagination. By the twentieth century, some authors maintain that hallucinations are a form of delusion (Ey), while others describe them as a change in perception (Jaspers, Fish). More integrated perspectives like those proposed by Alonso Fernandez and Luque, highlights the heterogeneity of hallucinations and the multiplicity of their types and causes. The terms pseudohallucination, illusion, and hallucinosis are grafted into the concept of hallucination. Since its introduction the term pseudohallucination has been used with different meanings. The major characteristics that we found associated with pseudohallucinations were “lack of objectivity” and “presence of insight” (differing from hallucinations). Illusions are unanimously taken as distortions of real objects. Hallucinosis, first described in the context of alcohol consumption, is generally considered egodystonic, in which insight is preserved. These and other controversial aspects regarding the evolution of the term hallucination and all its derivative concepts are discussed in this paper.

Acne vulgaris, a condition that can affect people at any age, is the most common cause of referral to a dermatologist. Isotretinoin (ITT) is the most effective treatment available, but serious adverse effects, including a possible association with depression and suicide, limit its use. We review the current literature regarding the association of ITT with depression and suicide. Case reports and database studies show a clear association, and this association is biologically plausible. Although prospective studies have opposite results, limitations make them unsuitable to identify a subgroup of patients who may be at risk of developing depression or suicidal ideation with ITT. Overall, it seems some people might be at risk, particularly those with a personal or family history of mental disorder, but further studies are needed to identify those patients who would benefit from an early referral to a mental health professional when ITT is initiated. Currently, no conclusions can be drawn, and it seems appropriate to regularly screen all patients on ITT for depressive symptoms and suicidal ideation and promptly refer them to a mental health professional if any are found.