Background: The pandemic caused by the sars-cov2 coronavirus can be considered the biggest international public health crisis. Outbreaks of emerging diseases can trigger fear reactions. Strict adherence to the strategies can cause harmful consequences, particularly for people with pathology on the spectrum of obsessive-compulsive disorder. Case presentation: We describe the clinical case of a woman, with a history of anxiety disorder, who develops obsessive-compulsive symptoms, she started cognitive behavioral therapy and pharmacological therapy, with appropriate follow-up. Conclusions: The intense focus on the risk of contamination and the adoption of new hygienic behaviors can be internalized as normative and become an enhancing trigger for obsessive thinking and compulsive behaviors. It is an important focus on prevention, early intervention and adequate follow-up, through measures to promote mental health.

IntroductionThe patient readmission is commonly associated with the failure of the previous hospitalization/admission and is an important psychiatric and economic issue. Furthermore, it is still source of frustration to patients, their families and the teams treating them.MethodsThe authors propose a retrospective study investigating all the readmissions within 28 days of the last discharge in the general adult psychiatry ward of a portuguese hospital (Aveiro Hospital) from 2011 to 2013 in order to characterize the reasons and factors (social, demographic and clinical) involved.ResultsOver the total 1994 discharges, 88 were readmited, yielding a readmission rate of 4.4%. The main diagnose was Schizophrenia, schizotypal and delusional disorders, according to icd 10, and the main reasons for readmission were suicide and psychosis. Most previous hospitalizations have lasted less than the average length of stay during the considered period of time.ConclusionsEvaluating the characteristics of readmissions promotes a better understanding of the whole process in order to devise a strategy for prevention and improvement of mental health services.

Background Cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) is the most common hereditary subcortical vascular dementia, and it is caused by a broad spectrum of mutations in the NOTCH3 gene on chromosome 19. Aims The authors intend to review the clinical patterns of the condition and expose the variability of its radiological and genetic data. Furthermore, its diagnostic strategies and available treatments are also clarified. Methods Brief description of a clinical case and review of literature collected from online medical databases under the keywords 'CADASIL', 'dementia" and 'genetic". Results (including clinical vignette) The authors report a case of a 67-year-old woman with history of late onset migraine and polymorphic psychiatric and neurologic symptoms, which further evaluation confirmed the CADASIL diagnosis. The involutive course of her condition is also emphasized as well as its devastating social and familiar consequences. Literature on CADASIL is vast and confirm that its phenotype is variable between and within affected families, with new clinic features continually arising. Nevertheless, main pattern consists in migraine with aura (often atypical or isolated), strokes, cognitive decline/dementia and psychiatric symptoms. Diagnosis is confirmed either by identifying a pathogenic NOTCH3 mutation or by the demonstration of specific granular osmiophilic material in skin biopsies. So far, only symptomatic treatment is available. Conclusion CADASIL is notably underrecognized and underdiagnosed. Authors consider it deserves greater awareness from psychiatrists, since it brings great suffering for the patients and their families, as well as high demand for non-psychiatric care.

IntroductionHaloperidol is a high-potency first generation antipsychotic and one of the most frequently used antipsychotic medications. It is a potent central antagonist of type 2 dopamine receptors, with low alpha 1 adrenergic activity and has no antihistamine or anti-cholinergic activity. It is a widely used drug with proven efficacy. Angioedema is a very rare side effect, occurring in <1% of cases.ObjectivesCase report and reflection on its etiologyMethodsA Pubmed search was performed with the MeSH terms “haloperidol” and “Anaphylactic reactions”. Relevant articles obtained from the respective bibliographic references were also consulted.ResultsThe following case describes the development of angioedema in a patient with an acute confusional syndrome on the second haloperidol IM administration for symptomatic control of agitation. Angioedema has been reported as an adverse effect of various antipsychotics such as clozapine, risperidone, ziprazidone and chlorpromazine, however, resulting from haloperidol administration is rare.ConclusionsIn long-term formulations sensitization testing is especially important but a single prior administration is not sufficient, a second controlled administration is essential to avoid this kind of fatal reactions.

ObjectivesTo characterize the population with suicidal behaviour that uses the ER of the Hospital Infante D. Pedro. Elaborate a plan for prevention.MethodsObservational descriptive study of a single sample, transversal, including 102 individuals. All patients were assessed concerning socio-demographic, clinical and psychological items - IACLIDE (Depression Scale), 23QVS (Stress Vulnerability Scale) and Mini-Mult (Personality Scale).Results90.6% of women use pills as suicide method. 63.2% of men use drugs, 10.5% phlebotomy and 26.8% resorts to violent methods.Individuals with moderate or severe depression have a higher probability (91x) of suicidal risk compared with individuals with no depression or mild depression. Individuals vulnerable to stress have a higher probability (5.7X) of attempting suicide. Individuals with external influence suicidal behaviour have a higher likelihood of suicide risk (4x), compared to individuals without external influence. Individuals with personality disorder (particularly cluster B) have a higher probability (25x) for suicide risk in people without personality disorder.ConclusionThe para-suicidal prototype seems to be a 36 year old woman, low level of literacy, married, with previous para-suicidal gestures, from ingestion of drugs, at home, following an emotional conflict. The suicidal will probably be a 40 year old man, divorced, low financial resources, unemployed, having prepared a previous plan that consummated suicide by violent methods.The elaboration of a para-suicidal and suicidal profile, is an essential contribution to the determination of relative risk and to structure a prevention plan tailored to the perceived reality research.