Aims: Unmet needs for mental health treatment are large and widespread, and periods of economic crisis may increase the need for care and the treatment gap, with serious consequences for individuals and society. The aim of this systematic review was to summarise the empirical evidence on the association between periods of economic crisis and the use of mental health care. Methods: Following the PRISMA statement, MEDLINE, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications, published between 1990 and 2018, from inception to June 2018. Search terms included (1) economic crisis, (2) use of mental health services and (3) mental health problems. Study selection, data extraction and the assessment of study quality were performed in duplicate. Results: Seventeen studies from different countries met the inclusion criteria. The results from the included articles suggest that periods of economic crisis might be linked to an increase of general help sought for mental health problems, with conflicting results regarding the changes in the use of specialised psychiatric care. The evidence on the use of mental health care specifically due to suicide behaviour is mixed. The results also suggest that economic crises might be associated with a higher use of prescription drugs and an increase in hospital admissions for mental disorders. Conclusions: Research on the impact of economic crises on the use of mental health care is scarce, and methodologies of the included papers are prone to substantial bias. More empirical and long-term studies on this topic are needed, in order to adapt mental health care systems to the specific needs of the population in times of economic crisis.

Background: Common mental disorders are highly prevalent and disabling, leading to substantial individual and societal costs. This study aims to characterize the association between disability and common mental disorders in Portugal, using epidemiological data from the World Mental Health Survey Initiative.Methods: Twelve-month common mental disorders were assessed with the CIDI 3.0. Disability was evaluated with the modified WMHS WHODAS-II. Logistic regression models were used to assess the association between disability and each disorder or diagnostic category (mood or anxiety disorders).Results: Among people with a common mental disorder, 14.6% reported disability. The specific diagnoses significantly associated with disability were post-traumatic stress disorder (OR: 6.69; 95% CI: 3.20, 14.01), major depressive disorder (OR: 3.49; 95% CI: 2.13, 5.72), bipolar disorder (OR: 3.41; 95% CI: 1.04, 11.12) and generalized anxiety disorder (OR: 3.14; 95% CI: 1.43, 6.90). Both categories of anxiety and mood disorders were significantly associated with disability (OR: 1.88; 95% CI: 1.23, 2.86 and OR: 3.94; 95% CI: 2.45, 6.34 respectively).Conclusions: The results of this study add to the current knowledge in this area by assessing the disability associated with common mental disorders using a multi-dimensional instrument, which may contribute to mental health policy efforts in the development of interventions to reduce the burden of disability associated with common mental disorders.

Traumatic brain injury (TBI) can result in serious and disabling neuropsychiatric disorders. The authors report a case of a 51-year old male, admitted to the psychiatric ward for acute psychosis and suicidal ideation, probably associated with TBI. After a temporal head trauma he initiated auditory/verbal hallucinations and subsequently developed paranoid delusions. The electroencephalography showed slow bilateral temporal activity and the neuropsychological testing showed several impairments. The patient improved with olanzapine at a dosage of 20 mg daily. This case shows the difficulty of differential diagnosis between schizophrenia and psychotic disorder due to traumatic brain injury. The authors conducted a revision of literature about the diagnosis, epidemiology, clinical aspects, laboratory and structural investigations and the treatment of this condition. Based on this revision work, the authors sketch some recommendations about the work-up that should be done when faced with this diagnostic hypothesis.

Background: Identifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012. Methods: Data from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors. Results: An increment of involuntary hospitalizations was associated with male gender [exp( $$\widehat{\upbeta }$$β ^ ) = 1.31; 95%CI 1.06–1.62, p < 0.05], having secondary and higher education [exp( $$\widehat{\upbeta }$$β ^ ) = 1.45; 95%CI 1.05–2.01, p < 0.05, and exp( $$\widehat{\upbeta }$$β ^ ) = 1.89; 95%CI 1.38–2.60, p < 0.001, respectively], a psychiatric diagnosis of psychosis [exp( $$\widehat{\upbeta }$$β ^ ) = 2.02; 95%CI 1.59–2.59, p < 0.001], and being admitted in 2007 and in 2012 [exp( $$\widehat{\upbeta }$$β ^ ) = 1.61; 95%CI 1.21–2.16, p < 0.01, and exp( $$\widehat{\upbeta }$$β ^ ) = 1.73; 95%CI 1.31–2.32, p < 0.001, respectively]. A decrease in involuntary hospitalizations was associated with being married/cohabitating [exp( $$\widehat{\upbeta }$$β ^ ) = 0.74; 95%CI 0.56–0.99, p < 0.05], having experienced a suicide attempt [exp( $$\widehat{\upbeta }$$β ^ ) = 0.26; 95%CI 0.15–0.42, p < 0.001], and belonging to the catchment area of three of the psychiatric services evaluated [exp( $$\widehat{\upbeta }$$β ^ ) = 0.65; 95%CI 0.49–0.86, p < 0.01, exp( $$\widehat{\upbeta }$$β ^ ) = 0.67; 95%CI 0.49–0.90, p < 0.01, and exp( $$\widehat{\upbeta }$$β ^ ) = 0.67; 95%CI 0.46–0.96, p < 0.05 for Hospital de Magalhães Lemos, Centro Hospitalar Psiquiátrico de Lisboa and Unidade Local de Saúde do Baixo Alentejo, respectively]. Conclusions: The findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with several sociodemographic, clinical, and contextual factors. This information may help identify high-risk patients and inform the development of better-targeted preventive interventions to reduce these hospitalizations.