A pandemia COVID‑19 foi declarada uma emergência de saúde mundial. Estima‑se que poderá originar um elevado nível de sofrimento, prevendo‑se que o período de crise origine variados desafios na esfera da saúde mental, tanto na população geral como nas pessoas com perturbação mental prévia. O sofrimento psicológico e angústia generalizada devido ao impacto imediato do vírus na saúde, mas também a necessidade de implementar medidas de quarentena, de isolamento físico associado à perda nas atividades educativas e laborais, adivinham o medo da doença, o receio da morte e incerteza quanto ao futuro. Por outro lado, estima‑se que a pandemia COVID‑19 poderá afetar de modo desproporcional populações mais vulneráveis, nomeadamente os profissionais de saúde e aqueles com antecedentes prévios de perturbação mental.  Pela ameaça de problemas da saúde mental que a população em geral pode enfrentar e a possível agudização da condição de base nos doentes com perturbação mental prévia éimportante uma avaliação dos vários problemas emergentes. Com efeito, os serviços de saúde mental necessitam de uma adaptação estrutural de modo a lidar com o risco acrescido das morbidades psiquiátricas, desenvolvendo e implementando programas de rastreio e intervenção precoce, que visem não apenas os efeitos agudos, mas também os efeitos a longo prazo ou crónicos desta pandemia.  A elaboração deste artigo de revisão tem por objetivo reunir, de forma rigorosa, a informação dispersa em variadas fontes científicas atualmente existentes sobre o impacto da infeção por COVID‑19 na saúde mental, assim como a experiência clínica no terreno. Deste modo, os autores realizaram uma revisão da literatura, pela pesquisa através da PubMed e Medscape usando as palavras‑chave “Pandemic”, “COVID‑19”, “Mental Health”, “Mental Disorder”.  O artigo propõe‑se a desenvolver de forma concisa e sumária algumas das problemáticas particulares inerentes à pandemia COVID‑19 e saúde mental, propondo ainda algumas estratégias e intervenções para fazer face à situação de crise vivida. Considera‑se, no entanto, a necessidade futura da contínua realização de estudos e avaliação da experiência prática, de modo a reorientar as políticas e medidas de intervenção na saúde mental.

Background: to understand if patients seen at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) live in geographical clusters or randomly throughout the city, as well as determine their access to the psychiatric hospital and primary care facilities (PCF). Methods: spatial autocorrelation statistics were performed (queen criterion of contiguity), regarding all patients observed at CHPL in 2017 (at the census subsection level), and considering not only their overall number but also main diagnosis, and admission to the psychiatric ward-voluntary or compulsory. Distance to the hospital and to the closest PCF was measured (for each patient and the variables cited above), and the mean values were compared. Finally, the total number of patients around each PCF was counted, considering specified radius sizes of 656 and 1000 m. Results: All 5161 patients (509 psychiatric admissions) were geolocated, and statistical significance regarding patient clustering was found for the total number (p-0.0001) and specific group of disorders, namely Schizophrenia and related disorders (p-0.007) and depressive disorders (p-0.0002). Patients who were admitted in a psychiatric ward live farther away from the hospital (p-0.002), with the compulsory admissions (versus voluntary ones) living even farther (p-0.004). Furthermore, defining a radius of 1000 m for each PCF allowed the identification of two PCF with more than 1000 patients, and two others with more than 800. Conclusions: as patients seem to live in geographical clusters (and considering PCFs with the highest number of them), possible locations for the development of programs regarding mental health treatment and prevention can now be identified.

Schizophrenia most commonly presents early in life, but at least 20% of patients have onset after the age of 40 years. The Diagnostic and Statistical Manuel of Mental Disorders (DSM)-5 states that "late-onset cases can meet the diagnostic criteria for schizophrenia", but it is not clear whether this is the same condition as schizophrenic early-life, as well as, schizophrenia like psychosis >65 years. In the late 1990s, an international conference of experts reviewed the available evidence concluding -onset of symptoms between 40 and 60 years should be conceptualized as a subtype of schizophrenia, termed Late-onset schizophrenia (LOS). They also concluded that schizophrenia-like symptoms arising >60 years, when the risk of primary neurodegenerative dementias is greater, are more likely to have a distinct underlying (i.e., degenerative rather than neurodevelopmental) pathology. The name very-late-onset-schizophrenia-like-psychosis (VLOSLS) was recommended to describe this group (Maglione et al, 2014) LOS has a 0.1% lifetime prevalence and VLOSLS >65 years 0.3% respectively. Ms. A., a 71-year-old divorced women, was brought by her son to the hospital with change in behavior and suspiciousness. No significant past history. Mental status examination revealed no thought or affective disorders. Patient had well organized paranoid/referential/persecutory delusions, often directed toward family, also partition delusions, believing that nurses could enter the room and could observed, harmed, stolen from her, also described the experience of being sexually assaulted. Auditory, olfactory, and tactile hallucinations were present, and somatic and will passivity. Neuropsychiatric examination revealed no abnormality. Mini-mental status examination (MMSE) score was 30/30, Addenbrooke's Cognitive Examination Revised (ACE-R) was 100/100. Magnetic resonance imaging (MRI) brain showed age related cortical atrophy. A trial of dose gradually titrated up to 6 mg oral risperidone was initiated, with no response, so clozapine was added until 200mg with satisfactory response.Diagnosis of psychosis in older populations is essential, to provide accurate treatment strategies and new neuroimaging and molecular studies to possible identifying differences in the underlying biology of early, late and very late-onset schizophrenia. A multi-modal treatment involving individual care planning, judicious prescribing of antipsychotic medication, psychological support, education, and family and community resources is essential.

Introduction: Mental illness stigma studies demonstrate the presence of stigmatizing attitudes towards people with mental illness both by the public and health professionals. This study aimed to analyze the attitudes of professionals working at a Portuguese psychiatric hospital towards people with mental illness. Material and Methods: A cross‑sectional observational study was conducted to examine the attitudes of professionals through application of Mental Illness Clinician Attitude Scale (MICA) and collection of sociodemographic data. Results: Scores of MICA questionnaire were significantly lower than the cut‑off point for negative attitude in general and across professional categories suggesting that overall professionals seem to manifest a positive attitude towards people with mental illness. There was a trend of decrease in MICA scores throughout increasing years of professional experience although not statistically significant. Conclusion: Our results do not contradict the need to continue fighting stigma, but instead to better evaluate how these attitudes translate into practice, by including behavioral outcomes in future research.

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