Resumen El uso clínico del mindfulness adaptado a la psicosis ha sido rechazado por algunos profesionales de la Salud Mental debido a prejuicios y falta de información. Sin embargo, la evidencia actual ha demostrado que las Intervenciones Basadas en Mindfulness (MBI) son seguras y tienen numerosos beneficios en los trastornos del espectro psicótico. Las MBI son adaptables a diferentes contextos y situaciones clínicas, incluido el deterioro cognitivo, y aunque no constituye su objetivo principal, pueden facilitar la reducción de la sintomatología negativa en la psicosis. Las MBI permiten a las personas con psicosis enfrentar las experiencias alucinatorias desde una perspectiva diferente, fomentando la flexibilidad, la regulación emocional y la aceptación. Es importante adaptar las intervenciones a las características de la psicosis, así como distinguir entre los diferentes tipos de prácticas, para aplicarlas de manera diferencial según la sintomatología específica y las características de la persona.

Abstract The clinical use of psychosis-adapted mindfulness has been rejected by some mental health professionals due to biases and lack of information. However, current evidence has demonstrated the safety and numerous benefits of mindfulness-based interventions (MBIs) in psychotic spectrum disorders. MBIs are adaptable to diverse clinical contexts and situations, including cognitive impairment, and although it is not their primary objective, they can facilitate the reduction of negative symptomatology in psychosis. MBIs enable individuals with psychosis to approach hallucinatory experiences from an alternative perspective, fostering flexibility, emotional regulation, and acceptance. It is crucial to tailor interventions to the characteristics of the psychosis, as well as to differentiate between the different types of practices, in order to apply them differentially depending on the specific symptoms and characteristics of the individual.

ABSTRACT Serotonin syndrome is a set of signs and symptoms caused by serotonergic hyperactivity, primarily characterized by alterations in the central nervous system. Historically, traditional medicine has used herbal remedies for healing and religious purposes, which could affect the serotonergic system, dopamine, glutamate, and noradrenaline receptors. In this context, ayahuasca or «yagé» is mentioned as a brew with psychoactive potential that is generally associated with psychotic symptoms. Here, we present a clinical case of a patient with serotonin syndrome following her first-time consumption of ayahuasca in an indigenous ritual. The patient is a 31-year-old female who ingested an unknown quantity of yagé over two consecutive days in Cachipay, Cundinamarca. Given her clinical symptoms, she was considered to have serotonin syndrome and received treatment with adequate control of her condition. Multiple reports in the literature discuss psychotic disorders especially from DMT use in ayahuasca preparation; however, the occurrence of prolonged psychotic symptoms beyond 48 hours is considered exceptional and has been described in patients with personal and family histories of psychosis, mania, hypomania, or abuse of psychoactive substances.

RESUMEN El síndrome serotoninérgico es un conjunto de signos y síntomas generados por hiperactividad serotoninérgica, caracterizado principalmente por alteración del sistema nervioso central. La medicina tradicional, históricamente utiliza herbales con fines curativos y religiosos que podrían tener efectos sobre el sistema serotoninérgico, receptores de dopamina, glutamato y noradrenalina, en este contexto se menciona la ayahuasca o "yagé" como un brebaje con potencial psicoactivo que por lo general se relaciona con síntomas psicóticos. En esta ocasión presentamos un caso clínico de una paciente con síndrome serotoninérgico posterior al consumo por primera vez de ayahuasca en un ritual indígena. Se trata de una paciente femenina de 31 años quien por primera vez ingirió yagé y en cantidad desconocida durante dos días consecutivos en el municipio de Cachipay, Cundinamarca, por sus síntomas clínicos se consideró que cursaba con un síndrome serotoninérgico, recibió tratamiento con adecuado control de su cuadro. Existen múltiples reportes bibliográficos sobre trastornos psicóticos derivados especialmente del uso de DMT en preparación de ayahuasca, sin embargo, la ocurrencia de síntomas psicóticos prolongados, más allá de 48 horas, se considera excepcional; se han descrito en pacientes con antecedentes personales y familiares de psicosis, manía, hipomanía o abuso de sustancias psicoactivas.

RESUMO Alucinações musicais e obsessões musicais são fenômenos distintos. O primeiro é compreendido como uma manifestação da Síndrome do Ouvido Musical, a qual produz alucinações auditivas por desaferentação, enquanto o último é um sintoma obsessivo dos transtornos obsessivo-compulsivos. Ambos os sintomas são frequentemente pouco compreendidos e confundidos entre si ou com sinais de transtornos psicóticos. Nós relatamos dois casos, um caracterizado por alucinações musicais e o outro por obsessões musicais, ambos com deficiência auditiva comórbida, a qual é o principal fator confundidor no diagnóstico diferencial. Nós comparamos criticamente os dois casos e suas características-chave, permitindo um diagnóstico diferencial e um tratamento direcionado. distintos Musical desaferentação obsessivocompulsivos. obsessivocompulsivos compulsivos. compulsivos obsessivo-compulsivos psicóticos comórbida característicaschave, característicaschave características chave, chave características-chave direcionado

ABSTRACT Musical hallucinations and musical obsessions are distinct phenomena. The first can be understood as a manifestation of the musical ear syndrome, which produces deafferentation auditory hallucinations, while the latter is an obsessive symptom of obsessive-compulsive disorders. Both symptoms are often poorly understood and mistaken for one another or for signs of psychotic disorders. We report two cases, one characterized by musical hallucinations and the other by musical obsessions, both with comorbid hearing impairment, which is the main confounding factor in their differential diagnosis. We critically compare the two cases and their key features, allowing diagnostic differentiation and a targeted therapeutic approach. phenomena syndrome obsessivecompulsive compulsive disorders impairment diagnosis features approach

BACKGROUND: Trauma experiences, particularly in childhood, have been associated with criminality and mental illness. There is a paucity of research into the crime of murder, trauma and mental illness. AIM: This research study focused on state patients charged with murder and sought to determine associations with prior trauma experiences, and specific types of traumas (sexual, physical and emotional) SETTING: The study was conducted at a forensic psychiatric hospital in Johannesburg, South Africa. METHODS: The records of state patients admitted over a 21-year period on a charge of murder were reviewed and analysed with respect to sociodemographic variables, clinical profiles, trauma experience and victim characteristics RESULTS: Experience of trauma in this population, with a much higher number of males compared with females, was lower than previous studies. Neurocognitive disorder was significantly associated with physical trauma. Physical trauma was found to have a significantly negative association with psychotic disorders, compared with other mental disorders. CONCLUSION: Although trauma is common in psychiatric patients, the study's findings are lower than previous studies. Noting the male bias in state patients that commit murder, greater sample sizes are needed to adequately address issues of specific types of traumas, the development of mental illness and murder. CONTRIBUTION: Exploring and managing prior trauma in state patients who commit murder is important while considering rehabilitation efforts, such that reintegration into the community and non-recidivism are encouraged.

BACKGROUND: Women charged with violent offences may be referred by courts for forensic psychiatric assessment to determine whether mental disorder or intellectual disability impacts their fitness to stand trial and/or criminal responsibility. The profile of these women is a poorly researched area in South Africa. AIM: This study examined the socio-demographic, offence-related, and clinical profile of South African women charged with violent offences referred for forensic assessment. SETTING: Fort England Hospital (FEH), a forensic psychiatric institution in the Eastern Cape. METHODS: The clinical records of 173 women referred by courts for forensic psychiatric evaluation over a 24-year period (1993-2017) to FEH were systematically reviewed. RESULTS: Most women were single, black mothers with dependent children, who were unemployed and socio-economically impoverished. Many had backgrounds of pre-offence mental illness, alcohol use and alleged abuse. The majority were first-time offenders whose victims were known to them. Most child victims were biological children killed by their mothers. Likely primary motives for violence were related to psychopathology in half of cases, and interpersonal conflict in a third. Forensic assessment most frequently confirmed psychotic disorders and dual diagnoses. Half the cases were fit to stand trial and under half were criminally responsible. CONCLUSION: Violent female offending occurs within a gendered context, with high rates of prior trauma, alcohol use and psychosocial distress in perpetrators. An emphasis on gender-sensitive psychosocial interventions is required. CONTRIBUTION: This study highlights the nature and context of violent offending by women referred for forensic psychiatric assessment in South Africa.

BACKGROUND: Globally, crime is highly masculinised and research into female criminality is scarce. In South Africa, no research specifically investigating the characteristics of female observandi referred for non-violent crimes has been published. AIMS: The study aimed to describe the socio-demographic, clinical, and forensic correlates in women referred to Sterkfontein Hospital for forensic psychiatric observation following a non-violent criminal charge between 2010 and 2019. It also sought to establish the relationship between the correlates and fitness to stand trial and criminal responsibility, as well as the relationship between the socio-demographic characteristics and the different non-violent criminal charges. SETTING: Sterkfontein Hospital. METHODS: A retrospective record review of all cases referred to Sterkfontein Hospital for a single observation over 10 years was conducted. RESULTS: Sixty-five cases were included in the study. Most observandi referred for non-violent crimes were found to be single (84.6%), unemployed (67.7%), reported abuse (55.4%), and had a high prevalence of mental illness (90.8%). Non-adherence to treatment was identified in 59.1% and substance use was identified in 72.2% of the study sample. The most common charge was theft (64.6%). The majority of the sample was found fit and responsible (57%). Bipolar (21%) and Primary Psychotic Disorders (35.7%) were associated with statistically significant outcomes of trial incompetence (p = 0.005) and lack of responsibility (p = 0.028 CONCLUSION: It is recommended that prospective studies are conducted which include comparisons with male counterparts and females referred for violent crimes. CONTRIBUTION: The study identified correlates that should be included in the standard of care in forensic assessments of female observandi.

BACKGROUND: Anecdotal evidence indicates that the prevalence of long-term benzodiazepine prescription is high and not in accordance with accepted prescribing guidelines AIM: To determine the prevalence of long-term prescriptions of benzodiazepines and associations thereof in community psychiatry clinics SETTING: Of the 27 community psychiatry clinics, 5 were randomly selected METHODS: A descriptive, retrospective, and cross-sectional record review of files of 126 adult patients was conducted, to obtain sociodemographic and clinical characteristics. Descriptive statistics were presented as proportions and percentages. Fisher's exact test was used to determine any associations between long-term benzodiazepines use and demographic and clinical variables. Regression analyses were performed to determine the significance of any such associations RESULTS: Approximately one out of every four patients were prescribed benzodiazepines. Most of the patients were males aged between 18 and 50 years, single and unemployed. The most common psychiatric diagnoses were bipolar disorders and psychotic disorders, and the majority had no comorbid medical illnesses or substance use. Ninety-three per cent of the patients were prescribed long-term (more than 180 days) benzodiazepines. There were no statistically significant associations between prescribing patterns and any sociodemographic and clinical characteristics (p > 0.05 CONCLUSION: This study found that nearly all the benzodiazepine prescriptions were long-term (over 180 days) and no statistically significant associations between this practice and any sociodemographic and clinical characteristics could be established CONTRIBUTION: There is high prevalence rate of long-term benzodiazepine prescription in community psychiatry clinics, and as such clinical monitoring systems need to be established and enforced

BACKGROUND: The average length of stay is often used to indicate health system efficiency; shorter stays are associated with reduced costs. In South Africa, mental healthcare expenditure is spent on inpatient care AIM: To identify factors associated with a long stay in an acute psychiatric unit SETTING: A tertiary hospital METHODS: A case-control study review of inpatients diagnosed with psychotic symptoms was used. Sample was divided into two groups, length of stay (LOS) (LOS greater than 21 days, LOS less than 14 days). Total of 82 patients were divided into short stay group (SSG, n = 23) and long stay group (LSG) (n = 59). A comparison of demographic, clinical and system variables was conducted RESULTS: In demographics, LSG had fewer men compared to SSG (78.3%) and differed statistically from LSG with p = 0.05. Long stay groups were older in comparison to SSG with a p = 0.02. Illicit substance use in LSG was 44.1% and statistically less than SSG (73.91%; p = 0.02). A high proportion of LSG had medical or surgical and psychiatric comorbidities (67.8%) compared to SSG (43.5%) (p = 0.04). A total of 95% patients in SSG had family support CONCLUSION: Longer stay was found to be associated with older females with primary psychotic disorders. Comorbidities with less availability of family support were associated with younger males presenting with psychotic symptoms that may be related to illicit substances that respond to rapid stabilisation CONTRIBUTION: Active surveillance of medical comorbidities amongst older female patients is necessary for early liaison services to reduce their length of stay

ABSTRACT Background: Two out of the three forms in which intracranial anterior midline cysts present are: These usually disappear after birth; if they persist, they are often asymptomatic, but may also be associated with obstructive manifestations, psychotic disorders or neurodevelopmental disorders that require clinical follow up. Objective: To report a case of a 6-month-old patient with persistence of embryonic period structures in possible association with psychomotor developmental retardation. Case presentation: Because of how infrequent it is in practice, a case of a 6-month-old patient with a persistent cavum septum pellucidum and cavum vergae is reported in which the possible association of neurodevelopmental delay with the persistence of these structures is pointed out. The diagnosis was made in an early manner and it was timely intervened. Conclusions: The case presentation provided epidemiological evidences that encourage the possible association among the persistence of these embryonic structures and psychomotor developmental retardation.

RESUMEN Fundamento: Dos de las tres formas en que se presentan los quistes intracraneales de la línea media anterior son: cavum septum pellucidum y cavum vergae; estos normalmente desaparecen después del nacimiento, de persistir suelen ser asintomáticos, pero también pueden estar asociados a manifestaciones obstructivas, trastornos psicóticos o alteraciones del neurodesarrollo que demandan de un seguimiento clínico. Objetivo: Reportar el caso de un paciente de 6 meses con persistencia de estructuras del periodo embrionario en posible asociación con retraso del desarrollo psicomotor. Presentación de caso: Por lo infrecuente que resulta en la práctica, se informa el caso de un paciente de 6 meses con una persistencia del cavum septum pellucidum y cavum vergae en el que se destaca la posible asociación del retraso del neurodesarrollo a la persistencia de estas estructuras. El diagnóstico se realizó de forma precoz y se intervino oportunamente. Conclusiones: La presentación del caso aportó evidencias epidemiológicas que favorecen la posible asociación entre la persistencia de estas estructuras embrionarias y el retraso del desarrollo psicomotor.

Abstract Neuropsychiatric or behavioral symptoms of dementia encompass a series of disorders, such as anxiety, depression, apathy, psychosis, and agitation, all commonly present in individuals living with dementia. While they are not required for the diagnosis of Alzheimer's disease (AD), they are ubiquitously present in all stages of the disease, contributing to negative clinical outcomes, including cognitive decline, functional disability, and caregiver burden. Neuropsychiatric symptoms have been conceptualized not only as risk factors but as clinical markers of decline along the AD spectrum. The concept of “mild behavioral impairment”, the behavioral correlate of mild cognitive impairment, has been proposed within this framework. The first steps in the management of behavioral symptoms in AD involve defining the target and investigating potential causes and/or aggravating factors. Once these factors are addressed, non-pharmacological approaches are preferred as first-line interventions. Following the optimization of anticholinesterase treatments, specific pharmacological approaches (e.g., antidepressants, antipsychotics) can be considered weighing potential side effects. disorders anxiety depression apathy psychosis agitation Alzheimers Alzheimer s AD, , (AD) outcomes disability burden spectrum impairment impairment” framework andor addressed nonpharmacological non firstline line interventions treatments e.g., eg e g (e.g. antidepressants antipsychotics effects (AD e.g. (e.g e.g

Resumo Sintomas neuropsiquiátricos ou comportamentais de demência envolvem uma série de condições, como ansiedade, depressão, apatia, psicose e agitação, frequentemente observadas em indivíduos com demência. Embora esses sintomas não sejam necessários para o diagnóstico da doença de Alzheimer, estão presentes em todas as fases ou estágios da doença, contribuindo negativamente para o declínio cognitivo, comprometimento funcional e sobrecarga do cuidador. Os sintomas neuropsiquiátricos têm sido conceituados não apenas como fatores de risco, mas também como marcadores clínicos de progressão da doença de Alzheimer. O construto “comprometimento comportamental leve”, correlato comportamental do comprometimento cognitive leve, tem sido proposto nesse contexto. Os primeiros passos na abordagem dos sintomas comportamentais da doença de Alzheimer envolvem definir os alvos-terapêuticos e investigar potenciais causas ou fatores agravantes. Após intervir nesses fatores, abordagens não farmacológicas constituem a primeira linha de intervenção. Depois da otimização do tratamento anticolinesterásico, terapias farmacológicas específicas (por exemplo, antidepressivos, antipsicóticos) podem ser consideradas, levando-se em conta potencias efeitos colaterais. condições ansiedade depressão apatia agitação cognitivo cuidador risco leve , leve” contexto alvosterapêuticos alvos terapêuticos agravantes intervenção anticolinesterásico por exemplo antidepressivos antipsicóticos consideradas levandose levando se colaterais

Abstract Background: Psychosis is characterized by distortions of thinking and perception, as well as inappropriate emotions. In forensic settings, psychiatric mental health nurses are responsible for preventing violent behaviors through psychotherapeutic interventions. Objective: To characterize participants’ clinical situation based on the following variables: social performance, socially useful activities, personal and social relationships, disturbing and aggressive behavior, assertiveness, and early signs of aggression; and To assess the effectiveness of an intervention program for training social skills and reducing predictors of violence. Methodology: Pre-experimental study with a one-group pretest-posttest design. The sample consisted of 15 patients admitted to forensic psychiatric wards. Results: The intervention proved effective, with statistically significant changes in personal relationships, disturbing and aggressive behaviors, and early signs of aggression. Conclusion: Training social skills and self-control improved participants’ clinical indicators and psychosocial rehabilitation and contributed to better (re)integrating them into their families and communities.

Resumen Marco contextual: La psicosis se caracteriza por distorsiones del pensamiento, de la percepción y de las emociones inapropiadas. En el contexto forense, es responsabilidad del enfermero especialista en salud mental y psiquiátrica prevenir las conductas violentas mediante intervenciones psicoterapéuticas. Objetivo: Caracterizar la situación clínica de los participantes en cuanto a las siguientes variables: funcionamiento social, actividades socialmente útiles, relaciones personales y sociales, comportamiento disruptivo y agresivo, asertividad y signos tempranos de agresión. Evaluar la eficacia de un programa de intervención para entrenar las competencias sociales y reducir los predictores de violencia. Metodología: Estudio preexperimental, con diseño antes y después de la prueba con un único grupo, cuya muestra estaba compuesta por 15 pacientes ingresados en los servicios de psiquiatría forense. Resultados: El programa demostró ser eficaz y se observaron cambios estadísticamente significativos en las relaciones personales, el comportamiento disruptivo y agresivo, y los primeros signos de agresión. Conclusión: El entrenamiento de las competencias sociales y del autocontrol se tradujo en la mejora de los indicadores clínicos y en la rehabilitación psicosocial de los participantes, lo que contribuyó a una mejor (re)integración en la familia y la comunidad.

Resumo Enquadramento: As psicoses são caraterizadas por distorções do pensamento, da perceção e emoções inadequadas. Em contexto forense, cabe ao enfermeiro especialista em saúde mental e psiquiátrica prevenir comportamentos violentos através de intervenções psicoterapêuticas. Objetivo: Caraterizar a situação clínica dos participantes relativamente às variáveis: funcionamento social, atividades socialmente úteis, relações pessoais e sociais, comportamento perturbador e agressivo, assertividade e sinais precoces de agressão; avaliar a eficácia de um programa de intervenção para treino de competências sociais e diminuição de preditores de violência. Metodologia: Estudo pré-experimental, com delineamento de pré e pós-teste com grupo único, cuja amostra foram 15 doentes internados em serviços de psiquiatria forense. Resultados: O programa demonstrou-se eficaz, observando-se mudanças estatisticamente significativas a nível das relações pessoais, dos comportamentos perturbadores e agressivos e dos sinais precoces de agressão. Conclusão: O treino de habilidades sociais e de autocontrolo traduziu-se na melhoria dos indicadores clínicos e na reabilitação psicossocial dos participantes, contribuindo para uma melhor (re)integração na família e na comunidade.

RESUMEN Introducción: Los trastornos mentales comunes se refieren a una variedad de afecciones de salud mental no psicóticas, como la depresión, ansiedad y manifestaciones somáticas, que son reconocidas en la actualidad como un problema de salud pública debido a las repercusiones en la salud de las personas que lo padecen. Objetivo: Estimar la prevalencia de los trastornos mentales comunes en estudiantes de la carrera profesional de Enfermería de una universidad pública. Método: El enfoque de investigación fue cuantitativo, el diseño no experimental de tipo descriptivo-comparativo de corte transversal. La población estuvo conformada por 321 estudiantes y la muestra por 175 estudiantes, quienes respondieron al Self Reporting Questionnaire-SRQ 20, instrumento con adecuados niveles de validez y confiabilidad. Los datos se procesaron a través del software SPSS versión 25. Para el análisis se utilizó la estadística descriptiva y para determinar si los trastornos mentales comunes se asociaban a las variables sociodemográficas propuestas, se recurrió a la prueba no paramétrica ji cuadrado. Resultados: La prevalencia general de los trastornos mentales comunes fue del 39,4 %. Asimismo, se determinó que la prevalencia se asociaba de manera significativa al sexo y al nivel de consumo de bebidas alcohólicas (p< 0,05). Conclusiones: Existe una prevalencia moderada de los trastornos mentales comunes en los estudiantes peruanos de Enfermería.

ABSTRACT Introduction: Common mental disorders refer to a variety of non-psychotic mental health conditions, such as depression, anxiety, and somatic manifestations that are currently recognized as a public health problem due to the repercussions on the health of the people who suffer from them. Objective: To estimate the prevalence of common mental disorders among Nursing students at a public university in the Peruvian Amazon. Method: The research approach was quantitative, the design, non-experimental and the type, descriptive-comparative cross-sectional. The population consisted of 321 students and the sample by 175 students who responded to the Self Reporting Questionnaire-SRQ 20, an instrument with adequate levels of validity and reliability. The data was processed through the SPSS version 25 software. For the analysis, descriptive statistics were used and to determine if the common mental disorders were associated with the proposed sociodemographic variables, the non-parametric Chi-Square test was used. Results: The overall prevalence of common mental disorders was found to be 39.4%. Likewise, it was determined that the prevalence was significantly associated with gender and the level of consumption of alcoholic beverages (p< 0.05). Conclusions: There is a moderate prevalence of common mental disorders in Peruvian Nursing students.

Abstract Introduction: Primary health care (PHC) workers are responsible for diagnosing and treating psychiatric disorders, as well as referring some instances to secondary care. The Mental Health Law (Law no. 36/98) sets out the principles for mental health policy and regulates the involuntary hospitalization of people with mental illness. It is the responsibility of the family physician to identify such situations and activate the “emergency assessment warrant”. Case description: The case concerns a 50-year-old female patient with a history of attempted suicide and followed up in psychiatry. In a scheduled psychiatry appointment, the patient reported anxiety and night-time agitation, and therapeutic adjustment was made with subsequent reevaluation. Due to persistent symptoms, the therapeutic plan was adjusted again. Later, she sought care from her family physician reporting noncompliance with treatment and worsening symptoms of irritability and auditory hallucinations in the form of a single voice with instructions for self- and hetero-aggressive acts. The patient was referred to the emergency department, evaluated, and received a new therapeutic adjustment and a recommendation for an earlier psychiatry appointment for reassessment. In a subsequent appointment with the family physician, it was identified suicidal ideation, self- and hetero-aggression, and acoustic-verbal pseudo hallucinations, and a new visit to the emergency department was proposed, which the patient refused. Given the context, the family physician activated the “Mandado de Condução à Urgência” which the patient understood and accepted. During hospitalization, a new therapeutic plan was implemented, resulting in remission of self and hetero-aggressive ideation and auditory pseudo hallucinations, as well as improvement in mood and reduction of anhedonia and depressive cognitions. Comments: This clinical case represents shared management of patients with psychiatric illness between PHC and psychiatry, as well as the importance of monitoring therapeutic response, reinforcing the need for improved coordination among various levels of care to ensure more effective information sharing and better care for patients with psychiatric disorders.

Resumo Introdução: Os cuidados de saúde primários (CSP) são responsáveis pela resposta a situações de diagnóstico e tratamento de patologias do foro psiquiátrico bem como a referenciação de determinados casos para nível hospitalar. A Lei da Saúde Mental (Lei n.º 36/98) determina os princípios da política de saúde mental e regulamenta o internamento compulsivo de pessoas com doença mental, sendo da responsabilidade do médico de família a identificação dessas situações e a ativação do Mandado de Condução ao Serviço de Urgência. Descrição do caso: O caso refere-se a uma utente do sexo feminino, de 50 anos de idade, com antecedentes psiquiátricos de tentativa de suicídio e seguida em consulta de psiquiatria. Em consulta programada de psiquiatria a utente refere quadro de ansiedade e agitação noturna, tendo sido realizado ajuste terapêutico com reavaliação posterior. Por manter queixas é novamente realizada alteração do plano terapêutico. Posteriormente recorre aos CSP em consulta do dia com a médica de família, onde refere incumprimento terapêutico bem como agravamento sintomático associado a irritabilidade e alucinações auditivas na forma de voz única com instruções para realizar atos de auto e hetero-agressividade; fora encaminhada e avaliada no serviço de urgência, com novo ajuste terapêutico e indicação para antecipação de consulta de psiquiatria para reavaliação do quadro. Em consulta subsequente com a médica de família apura-se ideação suicida, auto e hetero-agressividade associadas a pseudo-alucinações acústico-verbais, tendo sido proposta nova ida a SU, que a utente recusou. Pelo contexto, a médica de família aciona o Mandado de Condução que a utente compreende e aceita. Durante o internamento foi realizado novo plano terapêutico, observando-se remissão da ideação auto e hetero-agressiva e das pseudo-alucinações auditivas, bem como eutimização do humor e redução da anedonia e cognições de cariz depressivo. Comentário: Este caso clínico representa a gestão partilhada de utentes com patologia psiquiátrica entre os CSP e a psiquiatria e ainda a importância da vigilância da resposta terapêutica, reforçando a necessidade de aperfeiçoamento na articulação entre os diversos níveis de cuidados com o objetivo de garantir partilha de informação mais eficaz e a melhor prestação de cuidados aos utentes de foro psiquiátrico.