Ana Matos Pires

Background/Objectives: Anxiety disorders are the most prevalent mental illnesses worldwide and in Portugal, often resulting in chronicity and disability. The objective of this study is to evaluate the sociodemographic and health-related factors associated with anxiety in the Portuguese adult population. Methods: This study included participants aged 18 to 65 years from the nationwide, population-based EpiDoC cohort, who were followed from 2011 to 2021 (n = 2927). Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). A mixed logistic regression analysis was performed using a prospective analytical approach. Two strategies were used to adjust the mixed models: (i) model with only complete observations (n = 1950) and (ii) model with imputation of the category “No” in missing self-reported diseases (n = 2554). Results: The proportion of anxiety symptoms decreased from 2011–2013 to 2021 (12.5% vs. 8.5%). Experienced anxiety symptoms were positively associated (OR > 1, p < 0.05) with being female; having a high school, 2nd and 3rd cycle (6–9 years of studies), or primary/no education; being unemployed; seeking the first job; and not working or being temporarily unable to work. Additionally, anxiety symptoms were positively associated (OR > 1, p < 0.05) with smoking daily, lack of physical exercise, and medication use. Digestive diseases, multimorbidity, and region were also positively associated (OR > 1, p < 0.05) with anxiety symptoms. Moreover, age was negatively associated (OR < 1, p < 0.05) with experiencing anxiety symptoms. Conclusions: Some determinants are modifiable and preventable through economic, social, and health policies. Measures to promote healthy lifestyles, like physical exercise, reduce substance abuse, prevent chronic diseases, increase employability, and increase schooling and health literacy, are necessary to reduce the anxiety rate in Portugal.

Background/Objectives: Anxiety and depression result in a greater health burden; both can impact functionality and quality of life. This review aims to understand the association between anxiety, depression, functionality, and quality of life. Although three systematic reviews exist, one focuses on quality of life in depression and anxiety, while the others address functionality in depression and anxiety, with the former being more recent and the latter two being older. The association between these four variables will be explored. Methods: A literature search of MEDLINE with Full Text, CINHAL PLUS with Full Text, Psychology and Behavioral Sciences Collection, and Academic Search Complete was conducted from 1 January 2017 to 22 November 2022. Seven studies involving 2279 adults were included. Results: All studies analyzed the association between anxiety and/or depression with functionality and/or quality of life, in a population with a primary chronic condition. We found the higher functionality (return to work, no sedentary lifestyle, and no fatigue) and quality of life are, the lower the values of anxiety and depression will be. The HADS is a consensual instrument to access anxiety and depression, but the same cannot be said for assessing functionality and quality of life. Conclusions: The severity of the chronic disease and the loss of functionality and quality of life seem to increase psychological distress. This study highlights the importance of a multidisciplinary and holistic approach, focusing not only on clinical outcomes but also on overall well-being. Further longitudinal research is needed to support the association between these variables to draw more concrete conclusions with scientific evidence.

Introdução: Existem várias razões pelas quais a pandemia pode ter consequências na saúde mental. A criação de uma consulta de seguimento de doentes COVID teve como objetivo avaliar o seu estado clínico e aferir as necessidades de seguimento e terapêutica. Métodos: Foram referenciados doentes com mais de 18 anos, com COVID-19, da área de abrangência da ULSBA. As sequelas psiquiátricas foram avaliadas aplicando a Brief Symptom Inventory e a Clinical Global Impression. Aos doentes que apresentavam quadros sugestivos de declínio cognitivo foi ainda aplicado o Montreal Cognitive Assessment. Resultados: Foram identificados quatro outcomes: doentes sem história pregressa de doença mental, que não desenvolveram sequelas neuropsiquiátricas, pelo que tiveram alta; doentes com doença mental previamente identificada que não apresentam alterações, mantendo o seu seguimento habitual; doentes com história pregressa de doença mental em crise aguda ou sem seguimento recente devido à pandemia, que foram encaminhados para o seu acompanhamento psiquiátrico ambulatório habitual; e doentes sem história pregressa de doença mental que, na avaliação estandardizada apresentam psicopatologia, pelo que iniciaram acompanhamento psiquiátrico. Conclusão: Esta consulta permitiu monitorizar 98 doentes, com resultados satisfatórios na identificação precoce de sequelas neuropsiquiátricas. Sempre que necessário, foi feito o acompanhamento em consulta da especialidade.

BACKGROUND Spousal bereavement is both common in later life and often a major adverse life event. Despite frequently affecting their mental health, older adults, particularly in Portugal, encounter barriers in seeking mental health support during bereavement. This is mainly due to a scarcity of grief-specific support, and a tendency to dismiss the struggle as ‘natural’ and undeserving of specific support by the bereaved and other healthcare professionals. OBJECTIVE To evaluate the feasibility, acceptability, effectiveness and costs of the web-based self-help program (EuLuto), designed to address grief and mental health challenges in older adults experiencing spousal bereavement. METHODS In this before and after pilot study we assigned 30 Portuguese-speaking participants aged 55+ and experiencing spousal bereavement to use EuLuto, an web-based, asynchronous, self-help, and psychoeducational program for spousal bereavement for 10 weeks. The primary outcome was grief symptoms (Texas Revised Inventory of Grief (TRIG)), secondary outcomes were prolonged grief (PG-13), depression, and loneliness. Additionally, costs were estimated and a qualitative study on barriers and facilitators using a sub-sample of participants was conducted. RESULTS Prolonged grief (PG-13) and depression scores, but not grief (TRIG) and loneliness, showed a significant decrease after 10 weeks of intervention. The qualitative study demonstrated that main barriers and facilitators to the use of EuLuto were the motivation of users and psychological capability. CONCLUSIONS Despite preliminary positive effects and overall acceptability of EuLuto, due to limitations in design and sample size, the study could not establish effectiveness at this time. This paves the way for a randomized controlled trial with a larger sample. CLINICALTRIAL https://clinicaltrials.gov/study/NCT05156346 INTERNATIONAL REGISTERED REPORT RR2-10.2196/37827

Background: The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content. Objective: This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis will complement the study. Methods: The study includes 3 different randomized control trials. The trial in Switzerland comprises a waitlist control group and 2 active arms consisting of 2 delivery formats, standardized and self-tailored. In the Netherlands and in Portugal, the trials follow a 2-arm design that will be, respectively, complemented with focus groups on technology acceptance and cost-effectiveness analysis. The main target group will consist of adults aged >60 years from the general population in Switzerland (n≥85), the Netherlands (n≥40), and Portugal (n≥80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The trials will test the intervention’s clinical efficacy for reducing grief (primary outcome) and depression symptoms and loneliness (secondary outcomes) after the intervention. Measurements will take place at baseline (week 0), after the intervention (week 10), and at follow-up (week 20). Results: The trials started in March 2022 and are expected to end in December 2022 or when the needed sample size is achieved. The first results are expected by January 2023. Conclusions: The trials will provide insights into the efficacy and acceptance of a web-based self-help intervention among older adults who have recently lost a partner. Results will extend the knowledge on the role of self-tailoring, working alliance, and satisfaction in the effects of the intervention. Finally, the study will suggest adaptations to improve the acceptance of web-based self-help interventions for older mourners and explore the cost-effectiveness of this intervention. Limitations include a self-selective sample and the lack of cross-cultural comparisons. Trial Registration: Switzerland: ClinicalTrials.gov NCT05280041; https://clinicaltrials.gov/ct2/show/NCT05280041; Portugal: ClinicalTrials.gov NCT05156346; https://clinicaltrials.gov/ct2/show/NCT05156346 International Registered Report Identifier (IRRID): PRR1-10.2196/37827

Obsessive-compulsive disorder (OCD) encompasses a broad range of symptoms and is normally considered a heterogeneous disorder. Sometimes, OCD seems to be psychotic in nature, being complex in the differentiation between OCD and schizophrenia. This report describes a female adult patient who was diagnosed in her adolescence with schizophrenia due to her complains of “hearing voices “criticizing her. In response to team request for a second evaluation, she was admitted to the acute inpatient service. After a careful reassessment, the core symptom was recognized as obsession, and her diagnosis was revised to OCD; this allowed for a more direct treatment and management, with cognitive-behavior therapy and high doses of selective serotonin reuptake inhibitors, achieving a sustained clinical improvement over 2 years of follow-up. Currently, she is more functional, participates in social activities, and totally recognizes the egodystonic and intrusive thoughts. This case demonstrates the importance of eliciting psychopathology in greater detail for specific diagnosis and treatment decisions, especially in a complex clinical presentation.

Arriaga F, Paiva T, Matos‐Pires A, Cavaglia F, Lara E, Bastos L. The sleep of non‐depressed patients with panic disorder: a comparison with normal controls. Acta Psychiatr Scand 1996: 93: 191–194. © Munksgaard 1996.All‐night sleep EEG recordings were performed in non‐depressed patients with panic disorder, agoraphobia, and a group of age‐ and sex‐matched normal controls. Patients were selected according to DSM‐IV and all subjects were studied under drug‐free conditions. In addition to sleep continuity disturbances, patients with panic disorder have a reduced percentage of slow wave sleep, mainly due to diminished amounts of stage 4. REM sleep characteristics are identical in the two groups. When depressive co‐morbidity and non‐specific causes of insomnia are excluded, the sleep EEG of panic patients seems to be characterized by modest changes in sleep continuity and sleep architecture. These findings favour the existence of a neurophysiological frontier between anxiety disorders and depressive illness.