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BackgroundBrain tumors may present with multiple psychiatric symptoms (> 50%) and in 80% of the cases tumors are located in the frontal or limbic regions. Neuropsychiatric symptoms may be the first clinical indication of a brain tumor in 18% of the patients.Brain metastatic tumors may be associated with a greater incidence of mental symptoms and are probably due to the tumors being scattered throughout the brain substance.The authors report a case of a patient where the severe psychiatric symptoms, secondary to a metastatic brain tumor, were the initial presentation of a primary lung tumor.MethodsA comprehensive review of the literature was conducted for reports of brain tumors and psychiatric symptoms, through PubMed, between Jan 1970 and Out 2010.We also reviewed the patient medical records and computed tomography (CT) scans in detail.ResultsNeither tumor location nor type is associated with specific psychiatric symptoms.Mood symptoms may be a harbinger to an evolving brain tumor.There is a statistically significant correlation of anorexia, without disturbance of body image perception, with hypothalamic tumors.ConclusionWe conclude that brain tumors can be neurologically silent and only present with psychiatric symptoms. The diagnosis and treatment in the early phase of the disease are determinant for the survival and quality of life of patients with brain tumors.Neuroimaging (CT and MRI scan) should be considered in patients with new-onset psychosis, recurrence of previously well-controlled psychiatric symptoms, occurrence of atypical symptoms and in patient's refractory to psychiatric treatment.

IntroductionThe treatment of first-episode psychosis patients is different from those with multiple-episode schizophrenia: the response to antipsychotics is better, the required doses are lower and the sensitivity to side-effects is higher. As such, current guidelines recommend a “start slow, go slow” strategy and an active avoidance of side-effects.Objectives/aimsTo know the patterns of antipsychotic prescription in first-episode psychosis patients of our inpatient unit.MethodsWe retrospectively reviewed the clinical data of all non-affective first-episode psychosis patients admitted to the Inpatient Unit C of Hospital de Magalhães Lemos during 2015. The antipsychotics prescribed at admission and discharge were recorded, as well as the doses.ResultsA total of 29 patients were identified. The mean age was 36.6 and 65.5% were man. At admission, all patients were medicated with second-generation antipsychotics: 62.1% with risperidone, 27.6% with olanzapine, 6.9% with paliperidone and 3.4% with aripiprazol. The mean dose of risperidone was 3.5 mg/day. By the time of discharge, 34.5% of patients were prescribed a depot antipsychotic, half of them risperidone. Among those with oral medication only, 55.5% were prescribed risperidone, 22.2% paliperidone and the remainder 22.3% other antipsychotics (aripiprazol, olanzapine or quetiapine). The mean dose of risperidone was 3.7 mg/day.ConclusionsSecond-generation antipsychotics are clearly preferred. The mean dose by the time of discharge is similar to that used in clinical trials. However, antipsychotics are initiated at doses above the minimum effective dose. On discharge, an important proportion of patients are prescribed depot antipsychotics, which are known to improve medication adherence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionThe prevalence of severe mental illness (SMI) is estimated to be 4%. There are increased risk factors for cancer in SMI patients. People with SMI have deficient access and referral to routine cancer screening and psychiatric illness is often associated to late oncological diagnosis.ObjectivesCharacterize the population of SMI patients that undergoes oncological treatment; establish a comparison with the general population in terms of stage at the time of diagnosis and the type of follow-up that ensued; characterize the psychiatric care available to these patients; propose the necessary changes to ensure adequate healthcare for SMI patients.AimsTo assess and improve the quality of oncological care for SMI patients in our hospital.MethodsWe analyzed the data from SMI patients suffering from SMI observed by our group during a 12 month period.ResultsLow percentage of SMI patients being treated in our center regarding general rates; surprisingly high referral time to psychiatry unity; good compliance with treatments and appointments; have mostly been submitted to the standard oncological protocols of treatment.ConclusionIn spite of serious psychiatric co-morbidity and psychosocial deficits, our SMI patients are able for standard cancer treatment and present sufficient compliance. We value the help of family members and social workers. We have to insist in educational sessions and psychiatric screening procedures for oncological teams. It is also fundamental to implement educational programs for mental health centers in Lisbon in order to sensitize for cancer risks among SMI and alert for the pivotal role of mental health staff, namely the psychiatrists.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Dysfagia and gastroesophageal reflux disease (GERD): TCAs, by causing xerostomia (anticholinergic and antihistaminic effects) and inhibiting smooth muscle function, may contribute to dysphagia. Anticholinergic effects may also cause physiological impairment to the lower oesophageal sphincter resulting in or aggravating GERD. GI bleeding: AD with serotonergic action deplete platelet serotonin, leading to a reduced ability to form clots and a subsequent increase in the risk of bleeding. SSRIs and, with limited evidence, mirtazapine and bupropion, are associated with a similar GI bleeding risk, mostly of the upper GI tract. Microscopic colitis: May be iatrogenic -Nonsteroidal anti-inflammatory drug (NSAIDS) and SSRIs (particularly sertraline) most implicated.