Munchausen Syndrome in the Context of Liaison Psychiatry: A Case Report and a Narrative Review.

Munchausen Syndrome (MS) has been widely recognized as a severe manifestation of factitious disorder, a condition where individuals intentionally fabricate or exaggerate symptoms for psychological gratification. It represents a complex diagnostic challenge due to its elusive nature and intricate relationship with various medical conditions. We present a clinical case of a 44-year-old woman observed in the context of Liaison Psychiatry, demonstrating the intricate interplay between chronic medical conditions, psychiatric factors, and the challenges in diagnosing and managing MS. The patient exhibited a history of recurrent hospitalizations, difficult-to-heal injuries, and a pronounced preference for surgical interventions. Despite diagnostic difficulties and poor therapeutic adherence, a multidisciplinary team approach involving plastic surgery, orthopedics, physical medicine, and rehabilitation, alongside Liaison Psychiatry, led to the diagnosis of MS with chronic osteomyelitis, ultimately necessitating a transtibial amputation. The case underscores the importance of early detection, a multidisciplinary approach, and the role of Liaison Psychiatry in managing MS. While early diagnosis may not alter the disease course, it can prevent unnecessary interventions and mitigate associated risks. The case also highlights the need for continuous psychiatric support and family involvement in addressing the recurrence of self-injurious behaviors. Further research is essential to enhance our understanding and develop effective treatment strategies for MS, contributing to improved diagnostic precision and overall management of this challenging psychiatric disorder.

Brief Report: Asexuality and Young Women on the Autism Spectrum.

Existing research suggests that people with Autism Spectrum Disorder (ASD) are more likely than those without ASD to self-identify as asexual, or as being on the asexual spectrum. This study contributes to the literature by exploring aspects of sexuality and well-being in a large, community-based sample of young women (18-30 years old) with ASD (N = 247) and comparing the experiences of those with asexual spectrum identities and those with other sexual orientations (e.g., gay, bisexual, heterosexual). In the present sample, asexual participants reported less sexual desire and fewer sexual behaviors than those with other sexual orientations, but greater sexual satisfaction. Being on the asexual spectrum also was associated with lower generalized anxiety symptoms. Clinical and research implications are discussed.

LGBTQ + and autism spectrum disorder: Experiences and challenges.

Background: Research focused on gender identity, autism spectrum disorder (ASD), and the experiences of those who identify as LGBTQ+, remains minimal. Initial findings have indicated that those on the autism spectrum may be more likely to identify as homosexual and experience more fluid gender identity. Insufficient consideration has been given to intersectionality around a disability status and gender identity, and few have focused this conversation specifically on the experiences of those with ASD. Aim: The aim of this study was to improve current understanding of the first-hand experiences of those on the autism spectrum who identify as LGBTQ+, particularly regarding challenges stemming from these dual identities. Method: A focus group was conducted with four participants with ASD who presented with a range of gender identities (as they defined them) including male, transgender; agender/nonbinary; agender; and queer. Results: Qualitative analysis of the focus group transcription identified key themes: (1) Effect of Dual Identities: experiencing dual identities, autism spectrum, and LGBTQ+; (2) Multiple Minority Stressors: challenges experienced by the participants, the impact of discrimination/misunderstanding, and holding minority statuses; (3) Isolation: barriers caused by lack of understanding; (4) Lack of Service Provision. Discussion: These preliminary findings underline the need for better support, understanding, and practices regarding sexuality and gender identity among those on the autism spectrum. The current study is important for giving voice to adults on the autism spectrum who identify as LGBTQ+, and has implications for the disability community more broadly.

Early identification and intervention on language deficits and behavioral difficulties in early childhood education / Identificação Precoce e Intervenção em Déficits de Linguagem e Dificuldades Comportamentais na Educação Infantil

Abstract This project had the aim of detecting and intervening in difficulties of language and behavior in children at the age of three and four. A hundred seventy-eight children were assessed in behavior, expressive and receptive vocabulary and in central auditory processing. 84 children constituted the experimental group and were engaged in an intervention for the development and refinement of language and management of behavior problems through activities developed in software used in tablets, concrete games and orientation provided to their parents and teachers by a professional team composed by speech therapists, psychologists and psycho pedagogues. Posttest analysis indicated significant difference between the vocabulary and language scores, suggesting that this model of early assessment and intervention can be a successful strategy in school environments.

RESUMO Esta pesquisa objetivou detectar e intervir nas dificuldades de linguagem e comportamento em crianças de três e quatro anos de idade. Foram avaliadas 178 crianças nas áreas de comportamento, vocabulário expressivo e receptivo e processamento auditivo central. O grupo experimental, com 84 crianças, foi submetido à intervenção para o desenvolvimento e aprimoramento de linguagem e manejo de comportamentos-problema por meio de atividades desenvolvidas em aplicativos usados em tablets, jogos concretos e orientações fornecidas a seus pais e professores por uma equipe de fonoaudiólogos, psicólogos e psicopedagogos. As análises do pós-teste indicaram diferença significativa entre os resultados dos testes de vocabulário e comportamento, sugerindo que esse modelo de avaliação e intervenção precoce pode ser uma estratégia bem-sucedida em ambiente escolar.

Supporting university students with autism spectrum disorder.

Increasing numbers of students with autism spectrum disorder are entering higher education. Their success can be jeopardized by organizational, social/emotional, and academic challenges if appropriate supports are not in place. Our objective was to evaluate the effectiveness of a support group model for university students with autism spectrum disorder in improving psychological and functional outcomes. A curriculum guided the weekly discussions and consisted of topics such as time and stress management, managing group work, and social communication. Efficacy was assessed through pre- and post self-report measures focused on self-esteem, loneliness, anxiety, and depression. Functional changes in academic and social skills were examined through qualitative analysis of focus groups. Findings from the self-report measures indicated significant reductions in feelings of loneliness and general anxiety, and a significant increase in self-esteem at the end of the program compared to the beginning. Five prominent themes were identified in the focus-group analysis and reflected how the program had positively impacted participants' skills and coping: executive functioning; goal setting; academics and resources; stress and anxiety; and social. Given the cost effectiveness of "in-house" interventions and the potential for improving academic outcomes and retention of students with autism spectrum disorder, further research examining similar program models is warranted.

Compulsory psychiatric treatment checklist: Instrument development and clinical application.

Instruments designed to evaluate the necessity of compulsory psychiatric treatment (CPT) are scarce to non-existent. We developed a 25-item Checklist (scoring 0 to 50) with four clusters (Legal, Danger, Historic and Cognitive), based on variables identified as relevant to compulsory treatment. The Compulsory Treatment Checklist (CTC) was filled with information on case (n=324) and control (n=251) subjects, evaluated under the Portuguese Mental Health Act (Law 36/98), in three hospitals. For internal validation, we used Confirmatory Factor Analysis (CFA), testing unidimensional and bifactor models. Multilevel logistic regression model (MLL) was used to predict the odds ratio (OR) for compulsory treatment based on the total scale score. Receiver Operating Characteristic analysis (ROC) was performed to predict compulsory treatment. CFA revealed the best fit indexes for the bifactor model, with all items loading on one General factor and the residual loading in the a priori predicted four specific factors. Reliability indexes were high for the General factor (88.4%), and low for specific factors (<5%), which demonstrate that CTC should not be performed in the subscales to access compulsory treatment. MLL reveals that for each item scored in the scale, it increases the OR by 1.26 for compulsory treatment (95%CI 1.21-1.31, p<0.001). Based on the total score, accuracy was 90%, and the best cut-off point of 23.5 detects compulsory treatment with a sensitivity of 75% and specificity of 93.6%. The CTC presents robust internal structure with a strong unidimensional characteristic, and a cut-off point for compulsory treatment of 23.5. The improved 20-item version of the CTC could represent an important instrument to improve clinical decision regarding CPT, and ultimately to improve mental health care of patients with severe psychiatric disorders.

Influence of music and its genres on respiratory rate and pupil diameter variations in cats under general anaesthesia: contribution to promoting patient safety.

OBJECTIVES: The aims of the study were to recognise if there is any auditory sensory stimuli processing in cats under general anaesthesia, and to evaluate changes in respiratory rate (RR) and pupillary diameter (PD) in anaesthetised patients exposed to different music genres, while relating this to the depth of anaesthesia. METHODS: A sample of 12 cats submitted for elective ovariohysterectomy was exposed to 2 min excerpts of three different music genres (classical [CM], pop [PM] and heavy metal [HM]) at three points during surgery (T1 = coeliotomy; T2 = ligature placement and transection of the ovarian pedicle; T3 = ligature placement and transection of the uterine body). A multiparametric medical monitor was used to measure the RR, and a digital calliper was used for PD measurement. Music was delivered through headphones, which fully covered the patient's ears. P values <0.05 were considered to be statistically significant. RESULTS: Statistically significant differences between stimuli conditions for all surgical points were obtained for RR (T1, P = 0.03; T2, P = 0.00; T3, P = 0.00) and for PD (T1, P = 0.03; T2, P = 0.04; T3, P = 0.00). Most individuals exhibited lower values for RR and PD when exposed to CM, intermediate values to PM and higher values to HM. CONCLUSIONS AND RELEVANCE: The results suggest that cats under general anaesthesia are likely to perform auditory sensory stimuli processing. The exposure to music induces RR and PD variations modulated by the genre of music and is associated with autonomic nervous system activity. The use of music in the surgical theatre may contribute to allowing a reduced anaesthetic dose, minimising undesirable side effects and thus promoting patient safety.

A pilot study exploring the effects of musical genres on the depth of general anaesthesia assessed by haemodynamic responses.

OBJECTIVES: This pilot study aimed to investigate whether and how music and musical genres may influence the depth of anaesthesia, as measured using changes in arterial blood pressure (ABP), including systolic blood pressure (SBP), and heart rate (HR) across three different surgical time points. METHODS: This work focused on a sample of 12 female cats (Felis catus) that were subjected to an elective ovariohysterectomy (OVH), and three different surgical time points were considered (T1, coeliotomy; T2, ligature placement and transection of the ovarian pedicle; and T3, ligature placement and transection of the uterine body). All of the cats were subjected to stimulation with 2 min segments of three music tracks from different genres (pop [PM], classical [CM] and heavy metal [HM]). At the same time, ABP and HR measurements were obtained using a multi-parametric monitor. For statistical analysis, P values <0.05 were considered significant. RESULTS: For all cats, music exposure induced statistically significant changes in the parameters under study; the same finding was observed for the genre of music. The majority of cats experienced the same variation pattern, with lower values when exposed to CM, intermediate values when exposed to PM and higher values when exposed to HM. CONCLUSIONS AND RELEVANCE: Our results indicate that the development of sensory processing of acoustic stimuli is maintained by cats under general anaesthesia and reveal the influence of music on the autonomous nervous system, as measured using HR and SBP.

Aplicativos para tablets sensíveis ao toque para melhorar vocabulário, processamento auditivo central e habilidades de interação social entre pré-escolares / Multitouch tablet applications for ennhancing vocabulary, central auditory processing and prosocial skills among preschoolers

Esta pesquisa objetivou detectar e intervir em dificuldades de linguagem e comportamento em crianças frequentando pré-escolas, para prevenir problemas futuros, como o baixo desempenho acadêmico. Foram avaliadas 195 crianças em diversos comportamentos, 193 em vocabulário expressivo e receptivo e 187 em processamento auditivo central. Assim, 88 delas constituem o grupo experimental e foram envolvidas em uma intervenção para o desenvolvimento e refinamento de linguagem e comportamento por meio de atividades desenvolvidas em aplicativos usados em tablets e orientação fornecida a seus pais e professores por uma equipe profissional de fonoaudiólogos, psicólogos e psicopedagogos. As outras 99 crianças constituem o grupo controle. A fase de pós-teste aconteceu no início de 2015. Para o desenvolvimento e refinamento de vocabulário, processamento auditivo central e habilidades pró-sociais, um conjunto de atividades baseadas em aplicações que funcionam em tablets foram usadas e categorizadas em jogos, livros interativos por meio do toque, personagens respondendo ou repetindo o discurso da criança, discriminando e classificando diferentes sons e tarefas para lidar com emoções e sentimentos. Durante a fase de intervenção, após cada sessão, as crianças forneceram devolutivas sobre os aplicativos usados. Seus pais também foram requisitados a comentar, por meio de um questionário semiestruturado, sobre mudanças possíveis ou melhora no que se refere à linguagem e às habilidades comportamentais. A devolutiva deles e nossa observação sugerem que essas atividades aumentaram os comportamentos pró-sociais, como colaboração e maior apreciação para atividades sociais, e forneceram às crianças formas novas de expressão, englobando habilidades de discriminação auditiva e vocabulário.

This research aimed to detect and intervene in difficulties of language and behavior in four-year old children, attending preschools to prevent future problems such as academic underachievement. 195 children were evaluated in behavior, 193 in expressive and receptive vocabulary and 187 in central auditory processing. So, 88 constitute the experimental group and were engaged in an intervention for the development and refinement of language and behavior through activities developed in software used in tablets and orientation provided to their parents and teachers by a professional team of speech therapists, psychologists and psycho pedagogues. The other 99 children constitute the control group. Post-test phase took place in the beginning of 2015. For the development and refinement of vocabulary, central auditory processing and pro-social behavior skills, a set of activities based on applications that run on multitouch tablets were used and categorized into games; interactive touch books; characters responding or repeating the children`s speech; discriminating and classifying different sounds and tasks on dealing with emotions and feelings. During the intervention phase, after each session, the children provided us with feedback on the applications used. Their parents were also asked to comment, through a semi-structured questionnaire, on possible changes or improvements regarding children's language and behavioral skills. So far, their feedback and our observations suggest these activities increased pro-social behaviors such as collaboration and augmented appreciation for social activities, and provided children with novel forms of expression encompassing vocabulary and auditory discrimination skills.

Aplicativos para tablets sensíveis ao toque para melhorar vocabulário, processamento auditivo central e habilidades de interação social entre pré-escolares / Multitouch tablet applications for ennhancing vocabulary, central auditory processing and prosocial skills among preschoolers

Esta pesquisa objetivou detectar e intervir em dificuldades de linguagem e comportamento em crianças frequentando pré-escolas, para prevenir problemas futuros, como o baixo desempenho acadêmico. Foram avaliadas 195 crianças em diversos comportamentos, 193 em vocabulário expressivo e receptivo e 187 em processamento auditivo central. Assim, 88 delas constituem o grupo experimental e foram envolvidas em uma intervenção para o desenvolvimento e refinamento de linguagem e comportamento por meio de atividades desenvolvidas em aplicativos usados em tablets e orientação fornecida a seus pais e professores por uma equipe profissional de fonoaudiólogos, psicólogos e psicopedagogos. As outras 99 crianças constituem o grupo controle. A fase de pós-teste aconteceu no início de 2015. Para o desenvolvimento e refinamento de vocabulário, processamento auditivo central e habilidades pró-sociais, um conjunto de atividades baseadas em aplicações que funcionam em tablets foram usadas e categorizadas em jogos, livros interativos por meio do toque, personagens respondendo ou repetindo o discurso da criança, discriminando e classificando diferentes sons e tarefas para lidar com emoções e sentimentos. Durante a fase de intervenção, após cada sessão, as crianças forneceram devolutivas sobre os aplicativos usados. Seus pais também foram requisitados a comentar, por meio de um questionário semiestruturado, sobre mudanças possíveis ou melhora no que se refere à linguagem e às habilidades comportamentais. A devolutiva deles e nossa observação sugerem que essas atividades aumentaram os comportamentos pró-sociais, como colaboração e maior apreciação para atividades sociais, e forneceram às crianças formas novas de expressão, englobando habilidades de discriminação auditiva e vocabulário.(AU)

This research aimed to detect and intervene in difficulties of language and behavior in four-year old children, attending preschools to prevent future problems such as academic underachievement. 195 children were evaluated in behavior, 193 in expressive and receptive vocabulary and 187 in central auditory processing. So, 88 constitute the experimental group and were engaged in an intervention for the development and refinement of language and behavior through activities developed in software used in tablets and orientation provided to their parents and teachers by a professional team of speech therapists, psychologists and psycho pedagogues. The other 99 children constitute the control group. Post-test phase took place in the beginning of 2015. For the development and refinement of vocabulary, central auditory processing and pro-social behavior skills, a set of activities based on applications that run on multitouch tablets were used and categorized into games; interactive touch books; characters responding or repeating the children`s speech; discriminating and classifying different sounds and tasks on dealing with emotions and feelings. During the intervention phase, after each session, the children provided us with feedback on the applications used. Their parents were also asked to comment, through a semi-structured questionnaire, on possible changes or improvements regarding children's language and behavioral skills. So far, their feedback and our observations suggest these activities increased pro-social behaviors such as collaboration and augmented appreciation for social activities, and provided children with novel forms of expression encompassing vocabulary and auditory discrimination skills.(AU)

[The use of herbal medicine therapies by cancer patients]. / O uso de terapêuticas à base de plantas por doentes oncológicos.

The use of herbal complementary and alternative medicines is growing among Portuguese cancer patients, contributing to a higher risk for unwanted interactions, especially due to the narrow therapeutic index of most oncolytic drugs. A literature review was carried out in order to determine which medicinal plants are most commonly used by cancer patients, in Europe and USA, and their risk of interaction with the multiple medications taken by those patients. The collected information reveals a high degree of herb-drug interaction suggesting that patients under antineoplastic treatments should avoid the concomitant use of herbal medicines. These findings show that it is extremely important to have a clear knowledge of the herbal complementary and alternative medicines used by Portuguese cancer patients and to assess healthcare professionals' familiarity and attitude towards its use by cancer patients.