BackgroundGeneralized anxiety disorder has a strong impact on health-related quality of life. For this reason, it seems relevant to develop strategies allowing early diagnoses in order to promote appropriate treatments. The objective of this study was to culturally adapt and validate the GAD-7 for the Portuguese patients with generalized anxiety disorder.MethodsFor the cultural adaptation of the Portuguese version of the GAD-7 scale we started with a previous translation made by Mapi Institute and decided to perform a clinical review followed by a cognitive debriefing with patients. Once piloted, this version was then tested in a larger sample for feasibility and reliability (1-week test-retest). Construct validity was assessed by the relationship between GAD-7 and socio-demographic and clinical variables. Its unidimensionality was tested by principal component factor analysis. Criterion validity was assessed by comparing GAD-7 scores with those obtained by HADS, and EQ-5D. STAI was mainly used as a screening indicator for patient inclusion.ResultsGAD-7 was considered feasible with a mean completion time of 2.3 minutes and no major floor or ceiling effects. We found an excellent Cronbach’s alpha internal consistency score (0.880) and the test-retest and interclass correlation coefficients were also very good. Regarding the construct validity, younger patients, those with higher education, employed and without anxiety symptoms revealed lower GAD-7 scores, meaning better health. The unidimensionality of GAD-7 index was also confirmed by principal component factor analysis. At last, GAD-7 was significantly correlated with other health outcome indices and the classification levels created by it and by HADS showed to be dependent.ConclusionThe excellent metric properties confirmed the cultural adaptation and validity of GAD-7 into Portuguese population, allowing the clinicians an early detection and treatment of these patients.

IntroductionDue to recent aviation accidents, like German Wings flight 9525, aviation related mental health disorders have recently received much attention. Several psychological disorders have been associated with aviation ever since its beginning, both in passengers and aviation professionals. A clinical case is revised of a 33 years old air hostess, without previous psychiatric history, who was admitted twice in a manic state, and a third time abroad in Nice, France, after prolonged sleep privation due to consecutive transatlantic flights.ObjectivesScientific revision of psychological disorders in passengers (flight related psychological stress, flight phobia, post-traumatic stress disorders after plane crashes…), aviation professionals (mood changes, sexual function disorders, jet lag, sleep disorders), ground staff, and populations living within close distance to airports (burnout, circadian rhythms disorders due to high noise levels…).MethodsResearch in Pubmed, Medscape, scientific literature and other publications, with the following research terms: aviation related mental health disorders, flight related psychological disorders, flight phobia, aerophobia, aviophobia, flight related anxiety, flight related mood disorders, flight induced mania, psychological stress and air travel; articles in English, Portuguese and Spanish.ResultsFifty-eight articles, one book and four publications were considered relevant; the case of the patient is thoroughly described with data retrieved from the clinical file.ConclusionsSeveral important issues concerning both mental and physical health are highlighted by this clinical case, yet, surprisingly, scientific knowledge has progressed at a rather slow pace and mental health professionals have not given much attention to this issue.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Among the delusional misidentification syndromes, Capgras is the most common delusional disorder. Is characterized by the belief that a person, usually related to the patient, has been replaced by an impostor. In a more rare presentation, delusion affects the recognition of the self, either his physical or his psychological identity. In this paper, the authors aim to describe a clinical case of false recognition of the patient's own physical identity. The patient was diagnosed with a Schizoaffective Disorder. The authors also describe summarily the different misidentification syndromes.