IntroductionThe mental health impact of the COVID-19 pandemic is well documented. Portugal entered the emergency state on 19th march due to rising numbers of infected patients. The emergency state introduced regulatory measures that restricted people’s movements, applied a curfew, and closed most non-essential spaces and activities, such as shops and religious celebrations.ObjectivesTo evaluate the rates of suicides during the emergency state in Portugal.MethodsWe obtained the number of probable suicides during 19th march and 2nd may 2020, 2019 and 2018 from SICO/eVM (Real Time Mortality Electronic Surveillance). This system is used for health planning in Portugal and provides provisory data which is updated every 10 minutes. ExcelÒ was used for the statistical analysis.ResultsDuring the Emergency State in Portugal there were 57 probable suicides. Comparing to the same period in 2018 and 2019, there were 62 and 70 probable suicides, respectively. Social isolation, anxiety, fear of contagion, chronic stress, and economic difficulties may lead to the development or exacerbation of depressive, anxiety, substance use, and other psychiatric disorders. Literature on suicides due to COVID-19 mention not only fear of infection, but also social isolation and distancing and economic recession as causes for suicide attempts and completions.ConclusionsDuring the emergency state there was not an increase of probable suicides, compared to previous years. The greater vigilance of people’s movements may have deterred many attempts. However, policymakers and health care providers must be alert as the current psychosocial predispose to an increase in suicide rates.DisclosureNo significant relationships.

IntroductionTourette’s syndrome is a neuropsychiatric disorder marked by motor and phonic tics frequently associated with psychiatric comorbidities, beginning in childhood. While most cases improve or resolve with age, some are refractory.ObjectivesTo review new strategies for the management of Tourette’s Syndrome, following an outpatient clinical vignette.MethodsWe performed a review based on the PubMed® database.ResultsA 50-years-old female patient with a long-term outpatient psychiatric follow-up presented with motor tics appearing in adolescence, including winking and facial grimacing, as well as episodes of coprolalia. Over the years, she developed an anxiety disorder and social isolation. In addition to psychological therapy, pharmacological therapy had already been approached with the use alpha-adrenergic agonists and several antipsychotics, such as risperidone and aripiprazole, with the patient showing only partial response to pimozide. In Tourette’s syndrome, the therapy must be adequate to the patient’s individual needs. Emerging treatments for refractory cases, such as anticonvulsants, cannabinoids or antiglutamatergic drugs have been the target of several studies. Botulinum toxin injections are particularly effective in patients with focal motor tics and complex phonic tics. Non-pharmacological treatment options, such as electroconvulsive therapy and deep brain stimulation may prove effective in some cases.ConclusionsA significant proportion of patients fail to respond to conventional strategies. Thus, new pharmacological and non-pharmacological therapies are on the horizon and may represent an important step in treatment algorithms for refractory cases in the future.

IntroductionCoronavirus disease 2019 (COVID-19) pandemic has had a negative impact for mental health. ULS-Guarda in cooperation with Portugal National Health Service, provided the population of the district of Guarda with a mental health helpline (MHHL).ObjectivesProvide a descriptive data analysis of the MHHL calls received between April 1st and September 20th of 2020.MethodsThe data was obtained through the filling out of questionnaires. It included fields for gender, age, the type of service provided, relation to COVID-19, symptoms displayed and the number calls made per patient. For the statistical analysis, Microsoft Excel TM was utilized.ResultsMHHL received 191 calls. The largest volume was received during April, which saw 116 instances of patients seeking the MHHL. The number of calls then tapered progressively throughout the following months. The services provided were split between psychiatric assistance, psychologic assistance, and the renovation of medical prescriptions, in 44%, 31% and 19% of the cases, respectively. The 101 patients who resorted to the MHHL were unevenly distributed in gender, being 74 female and 27 male individuals. Their ages were mostly between 50 and 69 years old. The most common symptoms were anxiety, depressed humor and insomnia, in 35%, 16% and 11% of the cases, respectively.ConclusionsThe largest influx of calls coincides with the home confinement period, and decreased alongside the relaxation of the confinement measures held. The MHHL had enough adherence to warrant consideration of it being an alternative means of healthcare access, especially in situations where physical access to healthcare is restricted.

IntroductionIn early 2020, governments started to implement different forms of public health measures, from physical distancing recommendations, to stay-at-home orders, to limit the propagation of COVID-19. Here we report the case of a 41-year-old woman, with a diagnosis of panic disorder. During the end of the lockdown, the patient presented psychopathological worsening, from her fear of Covid-19 infection, stemming from a heart failure disease and concerns regarding the hygiene and safety measures of those around her.ObjectivesPresentation of a clinical vignette.MethodsSelection and analisis of clinical case and review of the literature using PubMed database.ResultsThe COVID-19 pandemic and the measures adopted to prevent the spread of the disease had a huge impact on a personal, social, and economic level for the world population. The rise of fear and anxiety among people due to uncertainty about the disease are coupled with essential yet disruptive measures such as lockdowns and quarantines. The chronically ill population are especially vulnerable during such circumstances and require addressing their physical health and any psychological difficulties they might experience, being at higher risk of suffering physically from the pandemic’s disease as well as psychologically from the implemented countermeasures.ConclusionsThis vignette provides a case where a person’s psychiatric conditions are worsened due to the end of a pandemic lockdown, rather than the lockdown itself. Additional work should aim at comparing the experiences of the different countries affected by the pandemic in order to understand the size of the psychological impact, the potential risk and protective factors.DisclosureNo significant relationships.

IntroductionElectroconvulsive therapy (ECT) presents itself as a highly effective therapeutic approach in various psychiatric conditions, especially affective disorders and catatonia. Although obsessive-compulsive disorder (OCD) is not an established indication for ECT, there are several positive results that have been replicated, giving us an account of its potential applicability.ObjectivesTo emphasize the importance of defining predictors of response to ECT in OCD.MethodsThe authors’ clinical experience is combined with the review of clinical cases, available in the literature, related to the application of ECT in OCD.ResultsPersonal or family history of affective pathology and obsessions of sexual content were identified as potential predictors of response to ECT in patients with obsessive and compulsive symptoms.ConclusionsAlthough preliminary and based solely on case reports, the replicability of results should promote special attention to situations in which OCD is marked by particular characteristics that favor the response to ECT. In this way, it would be possible to prevent the dragged consumption of health resources and minimize the expected chronicity associated with this clinical condition.