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IntroductionSmoking rate seems to be higher among patients with schizophrenia, comparing to other psychiatric entities, mainly in those who are on typical antipsychotics. Tobacco is known to have enzyme inducer properties, due to cytochrome P450 complex activity: CYP1A1, CYP1A2, CYP2E1 and CYP2D6. CYP2D6 and CYP1A2 play an important role in antipsychotics metabolism, mainly in the first generation ones, like haloperidol, despite its importance in risperidone metabolism.AimTo analyze the importance of tobacco smoking in patients taking long-action injections.ObjectivesTo investigate how sexual dysfunction varies with tobacco smoking, in patients taking long-action injections.MethodsIndividuals from both sexes, from 18 to 55 years old, taking antipsychotic long-action injections, answered the Arizona Sexual Experience Scale (ASEX).ResultsIn the studied population (n = 44), there were 20 individuals on haloperidol and 24 individuals on risperidone. In a total of 18 (40.9%) positive results for sexual dysfunction, 6 were on haloperidol (30%), 12 (50%) were on risperidone. Seventeen individuals of the 20 who were on haloperidol were smokers, but only 4 were considered to have sexual dysfunction, 35.3%; 12 of the 24 individuals who were on risperidone were smokers, but only 5 were considered to have sexual dysfunction, 41.7%.ConclusionsPatients treated with haloperidol smoke more, comparing to risperidone. Sexual dysfunction is more frequent in patients taking risperidone than in patients taking haloperidol. This data supports that CYP2D6-CYP1A2 induction by tobacco, mainly interacts with haloperidol, which may be helpful for patients to try less side effects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe association venlafaxine-mirtazapine is currently known as California Rocket Fuel (CRF). Studies show advantage in terms of efficacy and rapid control of depressive symptoms compared to other associations. Venlafaxine is a selective serotonin-noradrenalin reuptake inhibitor and mirtazapine is a noradrenergic-specific serotonergic antidepressant: the result is a potent noradrenergic and serotonergic effect. Studies say that CRF should be performed only for drug-resistant depression; however, there are case reports of its use as a first line treatment, in selected patients.ObjectivesTo summarize the latest literature about this field and to present a case report.AimTo explore and critically review the controversies of venlafaxine-mirtazapine association as a first line antidepressants strategy.MethodsA brief review of the latest literature was performed, using PubMed and the keywords “venlafaxine-mirtazapine association”. A case report about a depressed woman is presented.ResultsDespite most studies are referent to its utility in drug-resistant depression, there are recent pilot studies that recommend CRF as a first line option.M., a 64-year-old woman, had her first psychiatric consultation. She had been depressed for 2 years, she lost 10 kg, had total insomnia and suicidal thoughts. CRF was started up to 150/15 mg, daily. An improvement was noticed after two weeks of treatment and the stabilization of depressive symptoms were achieved by the fourth month.ConclusionsCRF seems to be effective and useful. Patients with insomnia and weight loss may benefit from CRF as a first line option. However, more studies are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionGiven the effectiveness and overall safety in several psychiatry conditions, electroconvulsive therapy remains a widely used procedure in current medical practice. Informed consent is still a requirement for the use of ECT both in voluntary and compulsory treatment; however, since severe mental illness can affect decision-making capacity and insight of the need for treatment, this requirement often constitutes an obstacle to its use. In addition, stigma around ECT still contributes to treatment refusal.ObjectivesTo summarize the most recent evidence published about ECT and discuss the ethical and legal implications of its use, enlightened by the empirical description of a clinical vignette.MethodsReview of literature on the ethical and legal issues involving the ECT use in patients on compulsory treatment, considering the efficacy, risks, the mental health legislation in Portugal, and several international directives.ResultsInformed consent is the basic tenet in the contemporary physician-patient relationship. In principle, ECT can only be administered to patients who prior consent to the treatment. In contemporary practice, providing the best medical assistance and respecting the patient’s autonomy are two fundamental principles. However, we often face an ethical dilemma, when severely ill patients, whose insight, the ability for self-determination and decision-making capacity may be impaired, refuse a potential beneficial treatment as ECT.ConclusionsThe use of ECT in severe mental illness is still hampered by legal and ethical constraints. A future revision of the law could protect patients from being excluded from a treatment that may change the course of the disease.DisclosureNo significant relationships.

IntroductionSevere traumatic brain injury (TBI) causes neuropsychiatric disturbances. Emotional and personality disturbances seem to cause much more seriously handicap than residual cognitive or physical disabilities. The prognosis may be poor associated with marked social impairment, so a multidisciplinary approach team is required in order to improve patient's quality of life and reintegration in family and society.ObjectivesTo summarize the latest literature about this field and to present a case report.AimTo explore and learn more about chronic psychiatric changes in severe post-traumatic brain injury and share with the scientific community how challenging the approach of this entity can be.MethodsA brief review of the latest literature was performed, using PubMed and the keywords “traumatic brain injury” and “psychiatric changes”. A case report is presented.ResultsAlthough SSRI, benzodiazepines, mood stabilizers and antipsychotics are commonly used, new options are reported such as methylphenidate and cholinesterase inhibitors. The presented patient, a 27-year-old male, began with neuropsychiatric disturbances after a work-related fall from 9 meters high: convulsions and alcohol compulsive drinking. Three years have passed and his changes are still difficult to approach. Besides other medication, such as benzodiazepines and mood stabilizers, flufenazine injections and naltrexone seemed to be determinant in his behaviour and mood stabilization. He is also on a long-term alcoholism programme.ConclusionsAlthough the understanding of TBI-associated neuropsychiatric disorders has improved in the last decade, further research is needed, such as randomized-controlled studies to study new pharmacological and non-pharmacological approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.