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Like Louis-Ferdinand Céline meets Larry David The nights were terrible, during the day we were occupied, but at night we got to thinking, picturing food, our houses, food again, painful memories from our childhoods--that abominable era--would mix with images of food and our torture would grow and grow, I recalled my impotence before the plate I was ordered to clean, the impossibility of choice in a world into which I had been thrust unwillingly, war was indeed an extension of the torture of being born . . . Set during the difficult era of the Great War, The Silence Devastation is the story of a captain in the Portuguese Expeditionary Corps who, with no documents showing his rank, finds himself in a German prison camp forced to share the circumstances of his poorer countrymen. He is hungry, constantly plagued by the sound of incessant detonations--and trying to finish his oral account of a strange story about a German scientist and voice recordings. In all this, he must seek meaning in his observations, his dreams, and, above all, silence.

Gambling and Bipolar disorderu2013 a case reportS. Nascimento1, I. Caldas1, J. Oliveira2, J. Reis21Psychiatry trainee at Centro Hospitalar Psiquiu00e1trico de Lisboa, Lisbon, Portugal2Psychiatrist at Centro Hospitalar Psiquiu00e1trico de Lisboa, Lisbon, PortugalBehavioral Addictions Ambulatory Team, CHPLIntroduction:Clinical and epidemiological research suggests that behavioral addictions and related disorders (BARD) have a relationship with bipolar disorder (BD); pathological gambling and kleptomania, in particular, seem to be the most prevalent among BD patients. These comorbid conditions were associated with a more severe course of illness, which is further complicated because treatment strategies for BD-BARD comorbidity are limited by the potential side effects of serotoninergic medication on BD.Objectives/Methods:Clinical report of a patient with BD-BARD, followed by a narrative review. The authors conducted an online search in PubMed and Medscape with the keywords u201cbipolar disorderu201d u201cbehavioral addictionu201d, u201cpathological gamblingu201c, from 2011 to 2018. After a review of the abstract, articles considered to be relevant were included. The aim of this work is to critically summarize the current available evidence regarding a possible association between BARD and BD and respective treatment strategies.Case report:Ms. A., a 61-year-old woman, retired, diagnosed with BD since the age of 24, characterized by mostly depressive episodes with psychotic symptoms, in remission with olanzapine 20mg id, lithium 400 id, valproate acid 1000 id. For the past 6 years, the patient developed a persistent and recurrent problematic gambling behavior (not associated with mood episodes of either polarity). The patient was referred to our outpatient team and a trial of naltrexone, gradually titrated to 50 mg, was initiated; the problematic behavior ceased after 1 month of treatment but cravings persisted. After developing a new depressive episode, the patient was started on bupropiom with further improvement..Conclusions:Impulse control is a dimension affected in both BD and BARD; routine screening and adequate assessment may be helpful in BD patients to identify individuals at risk for BARD and to exclude the association of impulsive behavior with manic or depressive episodes. Care must be taken because antidepressants, frequently used to treat BARD, should be avoided in BD and antipsychotics, sometimes used to treat BD, in particular aripiprazole, may be detrimental in BARD. Although there is not enough research to provide clear guidelines, we review common medication used to treat each disorder and its effects on BD-BARD.

Gaming disorders - u2013 How far have we came?S. Nascimento1, I. Caldas1, J. Oliveira2, J. Reis21Psychiatry traine at Centro Hospitalar Psiquiu00e1trico de Lisboa2Psychiatry at Centro Hospitalar Psiquiu00e1trico de LisboaIntroduction:Gaming disorders has greatly increased in popularity in recent years and are now recognized as a mental health disorder by the World Health Organization and included for the first time in draft of 11th revision the International Classification of Diseases (ICD-11).Methods:The authors have conducted an online research in PubMed and Medscape with the words u201cGaming disordersu201d u201cbehavioral addictionsu201d, u201cinternet gaming disorderu201d from 2011 until 2018, from the outcome, the articles considered to be relevant were collected and analyzed. Aims:The aim of this work is to summarize and evaluate the current available evidence regarding Gaming disorder, in this way, the objective is to demonstrate the Portuguese reality and our experience in our Behavioral Addictions Ambulatory Team.Results:Although the positive effects of healthy gaming, several studies indicated a potentially harmful effect that games can have on human health.Gaming disorder have features of potentially addictive properties, similarity to psychoactive substances and with gambling disorder, as well as functional neuroimaging with similar areas of the brain activated. Health agencies worldwide are seeking to address the effects of gaming, for preventive approaches to be developed. Conclusions:Although, there is some debate against the proposal to include Gaming Disorder as a new diagnostic category, highlighting the lack of consensus and the risk of a recreational activities be stigmatized. However, there are strong indications that Gaming Disorder is a relevant clinical entity worldwide, therefore its recognition is needed to facilitate not only further development, accessibility but also treatment strategies.

Sexually transmitted infections (STIs) are infections that are spread primarily through person to person sexual contact. There are more than 30 different sexually transmissible bacteria, viruses and parasites. STIs lead to high morbidity and complications. This book entitled as Sexually Transmitted Infections is not a text book but provides useful information for general reference work for physicians, researchers and students interested in the subject. Each chapter is abundant in tips useful to general readers as well. It also includes the Introductory chapter providing an overview with special emphasis on syndromic approach to the management of STIs in clinical setting.