Premature Ejaculation after Lithium Treatment in a Patient with Bipolar Disorder.

Lithium has proven its efficacy in treating bipolar disorder. Severe side effects caused by lithium, including renal and endocrine outcomes, have already been amply documented. The impact of lithium on sexual function, however, is less well known. A 33-year-old man, with no past medical history, diagnosed with bipolar disorder, developed premature ejaculation after short-term use of lithium. The dose of lithium was reduced, leading to a rapid clinical resolution. Retrospectively, lithium-induced premature ejaculation was deemed the most likely diagnosis. Premature ejaculation is a rare side effect of lithium. Changing the time of medication administration and lowering dose could be considered as alternatives. Given lithium's pharmacological profile, it is likely that the pathophysiologic mechanism behind premature ejaculation is altered levels or altered serotonin receptor sensitivity in the ejaculatory modulating centers of the central nervous system. Given the reluctance to spontaneously report sexual adverse effects, clinicians should be aware of this possible side effect.

The impact of the second wave of COVID-19 on liaison psychiatry: a comparative retrospective study with the homologous non-pandemic period.

OBJECTIVE: To determine the impact of COVID-19 pandemic (COVID-19-P) on clinical and health organisational variables of patients evaluated by Liaison Psychiatry (LP). METHODS: Revision of all collaboration requests (CR) to LP for patients hospitalised in a Portuguese General Hospital during the second wave of COVID-19-P, from 1 October to 31 December of 2020. Medical charts were analysed and selected variables were compared with those of the homologous non-pandemic period. Data were statistically analysed. RESULTS: There was a 22.3% decrease in the number of CR in 2020. The most frequently given reasons for CR were depressive symptoms, psychomotor agitation, and difficulties in adapting to the disease in both years. However, 5.9% more patients reported suicidal ideation in 2020. The hospitalisation length before CR was smaller in 2020 than in 2019 (9 vs 11). There was a higher proportion of patients followed in a psychiatric consultation and previously taking psychotropic medication before hospitalisation in 2020 than in 2019. After the assessment, the trend was that both groups did not meet diagnostic criteria for any disorder and no pharmacological adjustment was needed. CONCLUSION: This study highlights the need to better characterise the indirect repercussion of COVID-19-P, and focus on the prevention and treatment of mental illness particularly in adverse contexts.Key PointsFewer collaboration requests to liaison psychiatry during the second wave of COVID-19;Collaboration requests were made earlier in the hospitalisation;For patients with more medical comorbidities, psychiatric history, and psychotropic medication;Most because of depressive symptoms and more with suicidal ideation;Fewer collaboration requests to liaison psychiatry during COVID-19;Made earlier in the hospitalisation;For patients with more medical comorbidities, psychiatric history, and medication;Most because of depressive symptoms and more with suicidal ideation.

A 10-year mirror-image study of effectiveness and cost of long-acting paliperidone palmitate injectable in patients with schizophrenia or schizoaffective disorder.

Acute episodes of Schizophrenia and Schizoaffective Disorder often require hospitalizations and/or psychiatry emergency room (PER) visits, with significant economic burden. Long-acting injectables (LAI), such as the once-monthly Palmitate Paliperidone LAI (1MPP) are effective in suppressing symptoms and raise treatment adherence. This study is the first aimed at evaluating long-term efficacy of initiation of 1MPP. This was a mirror-image study with a total 10 year observational length. Sample was divided into five different groups according to time span of observation: 2,4,6,8, and 10 years. Number of participants per group was 162, 129, 95, 77 and 35, respectively. Main outcomes were number and length of hospitalizations and number of PER visit. Significant reductions in these outcomes after initiation of 1MPP were found in all groups. Subgroups consisting only of patients with full adherence were evaluated, and these had better outcomes. A cost evaluation was also performed, which demonstrated decreases every year, for all main outcomes. Sensitivity analysis in the 2-year group showed results in this time-frame are independent of gender, diagnosis, previous LAI or 1MPP initiation setting. Initiation of 1MPP reduces number and length of hospitalizations up to 5 years, decreasing associated costs. This study increases evidence supporting use of 1MPP in patients with Schizophrenia or Schizoaffective disorder.

Maternal depression and anxiety and fetal-neonatal growth / Depressão e ansiedade maternal e crescimento fetal-neonatal

Abstract Objective: Maternal depression and anxiety have been found to negatively affect fetal and neonatal growth. However, the independent effects of maternal depression and anxiety on fetal-neonatal growth outcomes and trajectories remain unclear. This study aimed to analyze simultaneously the effects of maternal prenatal depression and anxiety on (1) neonatal growth outcomes, and (2), on fetal-neonatal growth trajectories, from the 2nd trimester of pregnancy to childbirth. Methods: A sample of 172 women was recruited and completed self-reported measures of depression and anxiety during the 2nd and 3rd trimesters of pregnancy, and at childbirth. Fetal and neonatal biometrical data were collected from clinical reports at the same assessment moments. Results: Neonates of prenatally anxious mothers showed lower weight (p = 0.006), length (p = 0.025), and ponderal index (p = 0.049) at birth than neonates of prenatally non-anxious mothers. Moreover, fetuses-neonates of high-anxiety mothers showed a lower increase of weight from the 2nd trimester of pregnancy to childbirth than fetuses-neonates of low-anxiety mothers (p < 0.001). Considering maternal depression and anxiety simultaneously, only the effect of maternal anxiety was found on these markers of fetal-neonatal growth outcomes and trajectories. Conclusion: This study demonstrates the independent longitudinal effect of maternal anxiety on major markers of fetal-neonatal growth outcomes and trajectories, simultaneously considering the effect of maternal depression and anxiety.

Resumo Objetivo: Foi constatado que a depressão e ansiedade materna afetam negativamente o crescimento fetal e neonatal. Contudo, o efeito independente da depressão e ansiedade materna sobre os resultados e as trajetórias de crescimento fetal e neonatal continua incerto. Este estudo visou a analisar simultaneamente o efeito da depressão e ansiedade materna pré-natal (1) sobre os resultados de crescimento neonatal e (2) sobre as trajetórias do crescimento fetal-neonatal a partir do 2° trimestre de gravidez até o parto. Métodos: Uma amostra de 172 mulheres foi recrutada e elas relataram graus de depressão e ansiedade no 2° e 3° trimestre de gravidez e parto. Os dados biométricos fetais e neonatais foram coletados dos prontuários clínicos nas mesmas ondas de avaliação. Resultados: Os neonatos de mães ansiosas no período pré-natal mostraram menor peso (p = 0,006), comprimento (p = 0,025) e índice ponderal (p = 0,049) no nascimento do que os neonatos de mães não ansiosas no período pré-natal. Além disso, os neonatos de mães muito ansiosas mostraram um menor aumento de peso do 2° trimestre de gravidez até o parto que os fetos-neonatos de mães pouco ansiosas (p < 0,001). Considerando simultaneamente a depressão e a ansiedade maternal, apenas o efeito da ansiedade materna foi constatado nesses marcadores de resultados e trajetórias de crescimento fetal-neonatal. Conclusão: Este estudo demonstra o efeito longitudinal independente da ansiedade materna sobre os principais marcadores de resultados e trajetórias de crescimento fetal-neonatal, considerando simultaneamente o efeito da depressão e ansiedade materna.

Maternal depression and anxiety and fetal-neonatal growth.

OBJECTIVE: Maternal depression and anxiety have been found to negatively affect fetal and neonatal growth. However, the independent effects of maternal depression and anxiety on fetal-neonatal growth outcomes and trajectories remain unclear. This study aimed to analyze simultaneously the effects of maternal prenatal depression and anxiety on (1) neonatal growth outcomes, and (2), on fetal-neonatal growth trajectories, from the 2nd trimester of pregnancy to childbirth. METHODS: A sample of 172 women was recruited and completed self-reported measures of depression and anxiety during the 2nd and 3rd trimesters of pregnancy, and at childbirth. Fetal and neonatal biometrical data were collected from clinical reports at the same assessment moments. RESULTS: Neonates of prenatally anxious mothers showed lower weight (p=0.006), length (p=0.025), and ponderal index (p=0.049) at birth than neonates of prenatally non-anxious mothers. Moreover, fetuses-neonates of high-anxiety mothers showed a lower increase of weight from the 2nd trimester of pregnancy to childbirth than fetuses-neonates of low-anxiety mothers (p<0.001). Considering maternal depression and anxiety simultaneously, only the effect of maternal anxiety was found on these markers of fetal-neonatal growth outcomes and trajectories. CONCLUSION: This study demonstrates the independent longitudinal effect of maternal anxiety on major markers of fetal-neonatal growth outcomes and trajectories, simultaneously considering the effect of maternal depression and anxiety.