S. Morais

Melanoma brain metastases presenting as delirium: a case report

Metastatic tumours sometimes present with neuropsychiatric symptoms, however psychiatric symptoms as rarely the first clinical manifestation. Cutaneous melanoma is the third most common cause of brain metastasis, with known risk factors increasing the chance of such central nervous system metastization. Objectives We present a clinical report of delirium as the first clinical manifestation of melanoma brain metastases, illustrating the relevance of an adequate and early differential diagnosis. Methods In addition to describing the clinical case, searches were undertaken in PubMed and other databases using keywords such as “brain metastasis”, “melanoma”, “agitation”, “psychiatric” and “delirium”. Results We here report the case of a 52-year-old female patient evaluated by Liaison Psychiatry after sudden onset of delirium while admitted at the Gastroenterology Department to study a hypothesis of pancreatitis. A head CT scan identified brain metastases, and after further examination, including brain biopsy, melanoma brain metastization was confirmed. Discussion Some of the diagnostic challenges of psychiatric symptoms associated with secondary brain tumours are discussed, underlining the importance of an adequate differential diagnosis when working in Psychiatry Liaison

The effects of perceptual load in processing emotional facial expression in psychotic disorders

Psychotic disorders are some of the most severe psychiatric conditions. Patients have difficulties in identifying facial expressions and appear to be highly sensitive to the presence of emotional distractors. Yet, no study has investigated whether perceptual load modulates the interference of emotional distractors. Our goal was to test whether psychotic patients were more sensitive to irrelevant emotional stimulus, even when the task demands a high amount of attentional resources. Twenty-two participants with schizophrenia or schizoaffective disorder and twenty-two healthy controls, performed a target letter discrimination task with emotional task-irrelevant stimulus (angry, happy and neutral facial expressions). Target-letters were presented among distrator-letters, which could be similar (low perceptual load) or different (high load); participants should discriminate the target-letter and ignore the facial expression. Results showed that patients were more prone to distraction by task-irrelevant stimulus, especially under high load, suggesting difficulties in attention control. Moreover, in psychotic patients, happy faces caused higher interference with the task, whereas neutral and angry faces resulted in less interference. These findings could provide innovative approaches regarding attentional deficits on social contexts in patients with schizophrenia spectrum disorders.

Relationship between self-reported and clinician-rated psychopathology in youth psychiatric outpatients

Introduction Psychopathology rating scales have been widely used. Studies evaluating the congruence between self and observer-reported ratings show inconsistent results. Objectives or aims Determine whether there was consistency between psychopathology as assessed by patients and clinicians’ assessment in outpatients observed in the Young Adult Unit of our Psychiatry Department (Coimbra Hospital and University Centre-Portugal). Methods Socio-demographic characterization was undertaken with young adult outpatients observed during nineteen months (1st January 2015–31st July 2016). Brief Symptom Inventory–53 items (BSI-53) and Brief Psychiatric Rating Scale (BPRS) were applied at the first clinical evaluation. Spearman correlation coefficient between General Severity Index (GSI) of BSI-53 and BPRS total score was calculated. Results During the mentioned interval 255 outpatients were observed: 64.3% females and 35.7% males; aged between 17 and 39 years old (average: 20.56; median: 20). Fifty percent were diagnosed with neurotic, stress-related and somatoform disorders (ICD-10 F40-48) and 14.1% with mood disorders (ICD-10 F30-39). BPRS and BSI-53 rating scales were administered to 55 patients: 72.5% females and 27.5% males; average age 21.2. A statistical significant correlation was found between BPRS total and GSI score. Conclusions Several factors can determine the accuracy of psychopathology self-assessment, including diagnosis and severity of illness. In fact, studies show strong correlation between self and observer assessment of depressive and anxious psychopathology, but no correlation in psychotic psychopathological dimensions. Therefore, the correlation found in this population can be explained by the fact that the majority of patients were diagnosed with neurotic, stress-related and somatoform and mood disorders.