These findings are in some degree analogous to those in other studies and suggest that the DES is a reliable and valid screen for the Portuguese population.

A psicose puerperal (PP) é um quadro clínico exuberante, com uma frequência estimada de 1 caso por cada 1.000 puerpérios, e que tem sido associado com maior consistência ao espectro bipolar. A evidência científica disponível é escassa, nomeadamente no respeitante à orientação terapêutica. Os autores apresentam o caso clínico de uma mulher primípara de 28 anos, sem antecedentes psiquiátricos, que iniciou nas primeiras semanas de puerpério um quadro psicótico florido, composto por agitação psicomotora, confusão, desorganização do pensamento e comportamento, sintomatologia psicótica e insônia grave. Por ausência de resposta ao tratamento farmacológico, houve recurso à eletroconvulsoterapia (ECT), com melhoria clínica rápida e evidente. Nesse contexto, os autores realizaram uma apreciação da literatura e evidência referentes ao uso de ECT na psicose puerperal. aBstractPuerperal psychosis (PP) is an exuberant clinical syndrome with an estimated frequency of 1 case per 1,000 childbirths that has been most consistently associated with the bipolar disorders spectrum. Available evidence is scarce, namely regarding management and treatment. The authors present the clinical case of a 28 year-old first-time mother, with no psychiatric history, who developed a florid psychotic syndrome in the first weeks of puerperium. Due to lack of improvement following pharmacological treatment, electroconvulsive therapy (ECT) was applied, with substantial and quick response. In this context, the authors reviewed current literature on the use of ECT for the treatment of puerperal psychosis.

Starting from atypical psychosis as a model of a psychotic entity typically associated with states of altered consciousness, and having as organic and physiological comparative models epileptic psychosis and dream, respectively, the authors seek to establish a fundamental condition for these phenomena. Then, assuming a phenomenological perspective, we analyze the latest neuroscientific findings in the field of psychosis, including schizophrenia, trying to extrapolate the findings obtained in atypical psychoses to all forms of psychosis, achieving a defining principle of psychosis. We conclude that psychosis consists in a disturbance of consciousness, namely, of a pre-reflective consciousness. This will be dependent on a complex neural system which, starting from a primordial feeling of Self, differentiates and branches out through higher brain structures along the ontogenetic development. A significant interference on the connectivity of this system leads to a commitment of effective intentionality in the psychotic individual, with a discontinuity in the search for meaning, and interaction of individuals in the world, where the regulation of primitive emotional tendencies for higher cognitive components is lost.

Children with Gender Identity Disorder (GID) show a strong preference for sex-typed behaviors more characteristic of the opposite sex and a rejection or avoidance of sex-typed behaviors more characteristic of one's own sex. There are also signs of distress and discomfort about one's status as a boy or a girl, including verbal expressions of dislike or disgust about one's genital anatomy. The behaviors that characterize GID in children occur in concert, not in isolation. It is this behavioral patterning that is of clinical significance, and recognition of the patterning is extremely important in conducting a diagnostic assessment. The authors describe the case of a 6-year-old boy with GID. The clinical referral occurred 3 years after the onset of the condition, at the age of 6, when his parents begin to feel that the pattern of behavior was no longer a "phase" and worried about the implications of his symptoms in his academic and social life. This case illustrates some of the problems of the diagnosis, assessment, associated psychopathologies, developmental trajectories and therapeutic strategies for childhood GID, including parental considerations.

The imprecise status of Psychiatry may be due to Cartesian dualism and the mind / body assumption. We can clarify this status resorting to an alternative ontology. Popper's Worlds 1, 2 and 3, and the corresponding concepts of matter, energy and information, from Von Bertalanffy and his General Systems Theory, are candidates for a new ontology. Applying them to the history and present structure of Western Medicine, we can assume that General Surgery is the branch of medicine which deals with bodily matter, Internal Medicine deals with energy and Psychiatry is the branch which deals with information. The respective basic disciplines are Anatomy, Physiology and Psychology. None of them is a medical specialty, because specialties, such as Neurology, Urology and Cardiology, deal with a sub-system of the organism and may have a surgical, medical or even psychiatric emphasis. In the same way that the body / mind problem seemed important for Cartesian dualism, this triadic structure of Medicine may also inform a new ontology. The recent history of Philosophy may be interpreted as an attempt of looking for it.