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.

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.

IntroductionEating disorders are characterized by a persistent disturbance of eating behaviour that results in altered consumption of food and that significantly impairs physical health or psychosocial functioning. Treatment of eating disorders is complex and challenging and sometimes patient's hospitalization is needed. The Santa Maria Hospital's Eating Disorders Unit is a specialized multidisciplinary team with long experience in the treatment of such disorders.ObjectivesTo present and discuss the results of the inpatient treatment program for patients with eating disorders held at the Santa Maria Hospital's Eating Disorders Unit.Methodsreview of clinical files of all patients hospitalised at Santa Maria Hospital's Eating Disorders Unit during a twelve month period and statistical analysis of data collected using SPSS program.ResultsThe sample included mainly female patients with anorexia nervosa with a significantly low body weight. In this presentation we show the results of the statistical analysis performed for sample characterization (both demographic and clinical variables), evaluation of patient's clinical outcome and features associated with good or poor prognosis.ConclusionsThe results of this study show the importance of inpatient care especially for patients with anorexia nervosa with a significantly low body weight.

IntroductionAnorexia nervosa is an uncommon but life threatening psychiatric disorder that is characterized by persistent energy intake restriction associated with intense fear of gaining weight and disturbance in self-perceived weight or shape. The nutritional compromise associated with anorexia nervosa affects most major organ systems, including the brain.ObjectivesTo present and discuss the case of a patient with restricting-type anorexia nervosa who presents brain cortical atrophy.Methodsinterview with the patient, analysis of patient's clinical file (including neuroimaging studies) and literature review on brain changes, especially focused on cortical atrophy, in restricting-type anorexia nervosa patients using the Pubmed/Medline databases.Resultsa 21 year-old female patient, with diagnosis of severe restricting-type anorexia (BMI < 15 Kg/m2), hospitalized for severe low body weight without any signs or symptoms besides memory complaints. The neurological exam was normal. Brain CT scan revealed generalized brain cortical atrophy.ConclusionsIn anorexia nervosa, long-term persistent energy intake restriction is associated with brain volume changes, particularly global gray matter reduction which can be reversed by normal eating and associated weight gain. Although most cases of brain cortical atrophy are reversible, some will still persist despite normal eating. This report presents a challenging patient with restricting-type anorexia nervosa with brain cortical atrophy whose successful clinical outcome will depend on anorexia's prompt and effective treatment.

Gangliogliomas are rare tumors, comprising less than 1% of all brain tumors, predominating in the early decades of life, with strong association with long term intractable epilepsy. In 90% of the cases they are located in the temporal lobe and overall a good prognosis is expected. With this poster the authors report a case of a 38-year-old male patient, clinically stabilized with psychotropic drugs, who was diagnosed for six years with undifferentiated schizophrenia. Recently, he started with seizures which lead to the diagnose of ganglioglioma. Due to the need of surgical resection the psychotropic drugs were suspended. Consequently, the psychotic symptoms reappeared with more intensity and resistance to the treatment.A retrospective and detailed analysis of the psychiatric and neurologic diagnosis conducts to a thorough discussion over the possible associations between these two entities without excluding an eventual causality. The authors aim to review and discuss the relevance of this topic, highlightening the racional use of imaging studies in order to exclude organic diseases in patients with first episode psychosis.