A partir de Janeiro de 2014, a Revista de Psiquiatria Clínica aceitará apenas submissões de manuscritos em INGLÊS!
Universidade de São Paulo. Faculdade de Medicina. Instituto de Psiquiatria
Uma vez aceito para publicação, torna-se o trabalho propriedade permanente da Revista de Psiquiatria Clinica, que reserva todos os direitos autorais corresponde aos direitos exclusivos e ilimitados de reproduzir e distribuir os trabalhos aceitos em qualquer forma de publicação (impressa, mídia eletrônica ou outra forma qualquer) no Brasil e no exterior.
Comparison of Metacognitive Beliefs Between Patients with Unipolar Depression and Bipolar Depression
Objective: The aim of this article is to compare differences in metacognitive beliefs between bipolar disorder type I depressed (BPD1) patients with Unipolar Depression (UPD) patients, and a control group; and to discuss the relationship between metacognitive beliefs and depression parameters. Methods: Sixty six consecutive outpatients with a diagnosis of depressed BPD1, 70 patients with UPD and 70 healthy controls were enrolled in the study. Following assessment with the Sociodemographic Data Form, Structured Clinical Interview for DSM-IV (SCID-I), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scales (HAM-A), Young Mania Evaluation Scale, and the Metacognition Questionnaire-30 (MCQ-30). Results: UPD and BPD1 patients included in the study had higher scores in metacognitive beliefs other than positive beliefs compared with healthy controls (p<0.05), but no significant difference was found between the BPD1 and UPD groups (p>0.05). A statistically significant positive correlation was observed between the HAM-A, HAM-D scores and MCQ-30 scores in UPD group (p<0.05) but not in BPD1 group (p>0.05). Discussion: The metacogitive structures of UPD and BPD1, may be helpful in identifying and choosing the right treatment modality. We think that our results may have implications for the metacognitive approaches in the treatment of BPD1.
Direitos autorais (c) 2021 Archives of Clinical Psychiatry https://creativecommons.org/licenses/by-nc/4.0
City birth trauma scale-updates to the Portuguese version
Online challenges that emerge as a public health issue for adolescents: Assessment of psychiatric comorbidity and the importance of parenting
Background: Online Challenge is neither an application nor an internet-based game; instead, users receive a link to it via chat groups on social media. Our aim is to identify the potential differences between the normal population and youth drawn to online challenges. These potential differences are the examining the parenting skills of parents of children who participate in the challenges and determining underlying psychopathologies through structured clinical interviews. Method: A questionnaire-based cross-sectional study was used to obtain further in-depth information on the comorbid psychopathology of children who play the BWC and on the parenting skills. The Development and Well Being Assessment and Alabama Parenting Questionnaire was applied to the children and their families in both the control and case groups. Results: Two groups of children and parents were recruited: a clinical sample (case) group (n = 34) and a community sample (control) group (n = 141). Attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), specific phobia and CD (conduct disorder) were significantly more frequent in the clinical sample than in the community sample. The median scores for the Alabama Parenting Questionnaire (APQ) parental involvement, positive parenting, and poor monitoring/supervision subscales were significantly lower in the clinical sample than in the community sample. Conclusion: As far as we know, this study is the first to examine comorbid psychopathologies of online challenge-style games and parenting skills. We believe that as research into these subject increases, it will assist mental health professionals to develop prevention strategies and to manage cases resulting from the Blue Whale Challenge (BWC) and other online challenges that pose a serious threat to mental health and that have driven many young people to suicide worldwide.
Association of screen time-based sedentary behavior and the risk of depression in children and adolescents: Dose-response meta-analysis
Purpose: We aimed to find the association between screen time (ST)-based sedentary behavior and depression in children and adolescents. Methods: PubMed, Embase, and Web of science database were searched to find eligible studies until April 25, 2021. Data extraction was conducted by two investigators independently, followed by quality assessment for included studies. Odd ration (OR) and 95% confidence intervals (CI) were regarded as effect size index. Heterogeneity test was conducted using Cochran’ s Q test and I 2 test. Least squares trend estimation method was used for dose-response meta analysis. All statistical analyses were conducted using Stata12.0 software. Results: Totally 22 articles containing 197,673 cases were included. The pooled results displayed that there was a significant positive correlation between ST and depression [OR (95%CI) = 1.24 (1.11, 1.38), P < 0.001]. Similar results were observed for watching television (TV), computer use (CU), computer game (CG)/video game (VG) and internet use (IU)/mobile phone (MP) time. Dose-response meta-analysis showed that take 1 hour/day as control, the risk of depression went down and then went up as sedentary time increased for ST (P > 0.05). The risk of depression was significantly increased when TV time beyond 4.5 hours/day (P < 0.05), or CU time beyond 0.5 hours/day (P < 0.05), or CG/VG time beyond 2 hours/day (P < 0.05), or IU MP time beyond 0.5 hours/day (P < 0.05). Conclusions: ST-based sedentary behavior was associated with the risk of depression in a non-linear dose–response manner for children and adolescents.
Suicide during COVID-19 infection – Case report and literature review
The COVID-19 pandemic has a global effect on people’s mental health. The SARS-CoV-2 infection is a new source of anxiety, depression, and psycho-emotional changes in people without morbid conditions, with even more important impact on patients with associated diseases. We present the case of a previously diagnosed patient with COVID-19, in which the psychological effects accumulated during hospitalization triggered an autolytic behaviour. The case presented by us and the review of the literature show that serious diseases are frequently associated with depression and emotional disorders, and SARS-CoV-2 infection is no exception.
Perampanel-Induced Psychotic Disorder: a case report
Absence of an association between serum interleukin-6 and brain-derived neurotrophic factor in drug-naïve first-episode major depression
Peripheral and central cytokine interleukin-6 (IL-6) levels play an important role in the pathophysiology of major depression (MD). We investigated the association between serum levels of IL-6 and brain-derived neurotrophic factor (BDNF) in drug-naïve, first-episode patients with MD. This study included 28 patients (male/female: 11/17; mean [standard deviation] age, 46.7 [11.9] years) who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for MD without any physical diseases. We evaluated the severity of depression using the Hamilton Rating Scale for Depression. No associations were found between serum levels of IL-6 and BDNF (r=-0.102, P =0.605). These results suggest that IL-6 does not influence BDNF and vice versa, but both act in a peripheral manner.
The impact of biohacking on psychiatric care - a case report
The prevalence and risk factors for anxiety in frontline nurses under COVID-19 pandemic based on a large cross-sectional study using the propensity score-matched method
We determined the prevalence of anxiety and the associated risk factors in frontline nurses under COVID-19 pandemic. Methods: This cross-sectional study was conducted from February 20, 2020, to March 20, 2020, and involved 562 frontline nurses. The effective response rate was 87.68%. After propensity score matched, there were 532 participants left. Extensive characteristics, including demographics, dietary habits, life-related factors, work-related factors, and psychological factors were collected based on a self-reported questionnaire. Specific scales measured the levels of sleep quality, physical activity, anxiety, perceived organization support and psychological capital. Adjusted odds ratios and 95% confidence intervals were determined by binary paired logistic regression. Results: Of the nurses enrolled in the study, 33.60% had anxiety. Five independent risk factors were identified for anxiety: poor sleep quality (OR=1.235), experienced major events (OR=1.653), lower resilience and optimism of psychological capital (OR=0.906, and OR=0.909) and no visiting friend constantly (OR=0.629). Conclusions: This study revealed a considerable high prevalence of anxiety in frontline nurses during the COVID-19 outbreak, and identified five risk factors, which were poor sleep quality, experienced major events, lower resilience and optimism of psychological capital, and no visiting friend constantly. Protecting mental health of nurses is important for COVID-19 pandemic control and their wellbeing. These findings enrich the existing theoretical model of anxiety and demonstrated a critical need for additional strategies that could address the mental health in frontline nurses for policymakers.
High prevalence of indicators of social anxiety in children and adolescents from Maceió, Alagoas, Brazil
The Relation between Behavioral, Emotional and Cognitive Apathy and Everyday Executive Dysfunction in Alcoholic Korsakoff’s Syndrome
Background: Apathy is an important neuropsychiatric symptom in alcohol-related cognitive impairment in general, and Korsakoff ’s syndrome in specific. However, research in patients with Korsakoff ’s syndrome on the multifaceted nature of apathy is lacking. Objective: Aim of the current study was to examine behavioral, cognitive and emotional apathy in alcoholic Korsakoff patients, also investigating the association with overall cognitive and executive dysfunction. Methods: We studied 43 patients with Korsakoff ’s syndrome (mean age 60.9, SD=6.5, range 38-70) using the Apathy Evaluation Scale – Informant Version (AES-I) and also administered the Montreal Cognitive Assessment and the Behavior Rating Inventory of Executive Function – Adult Version (BRIEF-A) as a measure of daily executive problems. Results: In our sample, 76% of the Korsakoff patients were classified as being apathetic. AES-I scores correlated with overall cognitive function and were related to observer-rated daily executive problems. Discussion: Apathy is highly prevalent in Korsakoff patients and related to overall cognitive dysfunction and everyday executive problems. Our results stress the need to further examine underlying mechanisms of apathy in Korsakoff patients and the need for interventions aimed at reducing apathy.
Relationship between oxytocin receptor (OXTR) gene polymorphism and obsessive compulsive disorder in Chinese Han
Recent research has shown that genetic variations in the oxytocin receptor (OXTR) may be related to variations in subtypes of obsessive-compulsive disorder (OCD). We aimed to explore the relationship between different subtypes of OCD and the genetic variation between rs1316193 and rs4686301 of the OXTR. In this case-control study, 92 OCD patients and 92 healthy controls were included in the OCD and control groups, respectively. The Y-BOCS scale was used to assess the severity of the OCD symptoms. The fasting peripheral blood samples were collected to extract DNA. rs4686301 and rs13316193 were genotyped using restriction fragment length polymorphism analysis techniques. Whether the gene frequency of the locus and the distribution of allele frequency were related to OCD were further study by TaqMan allele typing. The rs4686301 locus differed significantly between behavior and control groups. The genotype frequency and allele frequency at the rs4686301 locus were statistically significant between behavior and control groups (P<0.05). There was significant difference in the genotype frequency at the rs13316193 locus between behavior and control groups (P<0.05). The rs4686301 polymorphism of the OXTR may affect the clinical subtype of OCD. The rs13316193 polymorphism of the OXTR may be a risk factor for obsessive-compulsive behavior.
Explore functional brain changes in bipolar disorder: a whole brain ALE meta-analysis
Background: Previous functional magnetic resonance imaging (fMRI) studies showed inconsistent results for comparison between bipolar disorder (BD) and healthy controls (HC). Methods: An anatomic likelihood estimation (ALE) meta-analysis was used to explore the key regions of brain pathology in BD with different current mood states. Results: Depressed BD patients showed reduced regional homogeneity (ReHo) in the left claustrum and the left middle frontal gyrus (MFG), compared to HC. BD patients with mixed mood status showed decreased fractional amplitude of low frequency fluctuations (fALFF) in the right cerebellar tonsil, the bilateral MFG and the right superior frontal gyrus, compared to HC. Additionally, BD patients with mixed mood status showed increased fALFF in the right inferior occipital gyrus, the right culmen and the left lentiform nucleus, compared to HC. BD patients with mixed mood status showed decreased functional connectivity (FC) in the bilateral cerebellar tonsil, compared to HC. Conclusion: In the present study, key regions undergoing functional deficits in BD patients with different current mood states were obtained with the ALE meta-analysis. In addition, deficits in these regions in fMRI studies might work as biomarkers for early diagnosis of BD.
The Influence of Mothers on the Development of Their Daughter’s Eating Disorders: An Integrative Review
Background: Eating disorders (ED) are characterized by changes in eating behavior, whose aetiology is multifactorial with an emphasis on family relations, especially in the mother-daughter relationship Objective: To analyse the national and international scientific literature about the influence of mothers on the development of their daughter's ED. Methods: Integrative review based on the search of publications from 2012 to 2019 through PubMed, LILACS and SciELO electronic databases. Results: It was found 181 articles, from which 26 were selectec (21 in English, four in Portuguese and one in French) to comprise the research corpus. In addition, 155 were removed from the review due to the exclusion criteria, which included narrative review articles, theses, dissertations, monographs, editorial letters and responses to the editor. Discussion: The analyzed articles offer evidence that the type of influence exercised by the mother depends on her personality profile, the mother’s eating behaviour and body attitudes, the bond between mother and daughter and the type of communication that is established between the dyad. Conclusion: Health promotion actions in the population are necessary to prevent ED. In addition, interventions for families, and especially for mothers, are recommended, in order to favour more effective therapeutic and prognostic results.
Comparative Assessment of Burnout Syndrome in Medical and Dental Senior Undergraduate Students
Background: Burnout is observed when there is chronic exposure to work-related stress. This is commonly seen in physicians and undergraduate medical students. Thus, the study assessed and compared the severity of burnout among medical and dental senior undergraduate students in Abha, Saudi Arabia. Materials and method: 517 medical and dental senior undergraduate students were evaluated using a well-designed and formulated questionnaire. Different levels of burnout were evaluated with the related scores of burnout categories. Data collected was evaluated using SPSS version 25.0. Results: A total of 772 medical and dental senior undergraduate students were included in the study, out of which 517 responded to the questionnaire, with a response rate of t 67%. Demographic parameters like age, gender, marital status, and the course were assessed. The mean scores of Personal Accomplishment (PA), Emotional Exhaustion (EE), and Depersonalization (DP) for all study subjects were recorded, showing an insignificant difference (p-value > 0.05) between both the groups in all the three categories. Considering Personal Accomplishment, the lowest mean values were observed with subjects aged 23 years old, female participants, and unmarried students, with insignificant correlation, observed statistically. Conclusion: Moderate to high levels of burnout with no significant difference was observed between medical and dental students in all three burnout categories.
Relationship between paternal postnatal depression and its predictors factors among Iranian fathers
Background: Paternal postnatal depression (PPND) is widely overlooked despite being the most common mental health disorder among fathers in the postpartum period, and it affects all aspects of family life, particularly the relationship with the spouse and children. Objective: To determine the predictor factors of PPND. Methods: A descriptive-analytical study was performed on 400 fathers of children aged six weeks to one-year referring to the healthcare centers. Data were collected using a demographic characteristics form and the Edinburgh Postnatal Depression Scale (EPDS). Data analysis was performed using SPSS software version 22. Results: The mean EPDS score was 6/54± 4.3, the mean age of the studied fathers was 35 ± 5.4, and 57.7% had experienced more than one pregnancy with their spouses. There was a significant relationship (P>0.05) between the education level and the EPDS score. According to linear regression, the most influential factors on EPDS score included satisfaction with life and general health, as well as an unwanted pregnancy amongst maternal fertility characteristics. Conclusion: Determining the predictor/related factors with paternal postnatal depression helped us to identify at risk fathers promptly, to manage earlier, and to prevent the adverse effects of PPND on family health and relationship.
Voluntary and Automatic Orienting of Attention in Children with Attention Deficit Hyperactivity Disorder
Objective: Voluntary and automatic orienting of attention enable proper processing of environmental information. Few studies have assessed how this process varies during development in children with attention deficit hyperactivity disorder (ADHD). Methods: This study analyzed voluntary and automatic orienting in 30 children with ADHD and 30 age and sex matched controls (Control group-CG). Two experiments assessed voluntary and automatic orienting by recording reaction times (RT) to conditions in relation to temporal interval, spatial position, cue validity and age. The RT medians calculated for each condition and participant were analyzed using ANOVA to compare ADHD and CG. Results: Children with ADHD exhibited globally higher RT than the CG group. They also showed prejudices during the reorienting process and demonstrated adequate voluntary orienting for shorter intervals. In automatic task, there was no group interaction, expressing early facilitation, but not inhibition of return. Conclusion: These results identify correlations of ADHD and the children’s age in relation to voluntary and automatic orienting of attention.
Attention deficit hyperactivity disorder
The Relationship Between Cognitive Impairment And Functionality In Euthymic Bipolar Patients: A Case Controlled Study
Objective: We sought to compare differences in cognitive function between patients with bipolar disorder type 1 (BPD-1) and healthy controls (HC) and to investigate the relationship between cognitive functions and functional areas of patients with BPD-1. Methods: This study included 93 euthymic patients with BPD-1 and 64 healthy age- and sex-matched individuals. All participants completed a sociodemographic form; took the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Montreal Cognitive Assessment Scale (MoCA) assessments; and underwent a neuropsychometric battery. Results pertaining to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth revision Axis I Disorders (SCID-I), Young Mania Rating Scale score, and Bipolar Disorder Functioning Questionnaire score were obtained for the patients; the HC group was investigated using the SCID nonpatient version. Results: All of the cognitive domain scores were significantly lower in the BPD-1group than in the HC group (p < 0.05). A statistically significant positive correlation was observed between the neurocognitive domains of attention, verbal memory, visual memory, and BPD-1 total functioning (p < 0.05). Discussion: Impairments in verbal memory, visual memory, and attention among euthymic patients with BPD-1 may cause impaired functionality.
The Relationship between Cognition and Asymmetric Dimethyl Arginine, Symmetric Dimethyl Arginine, Nitric Oxide Levels and Total Antioxidant Capacity in Euthymic Bipolar Disorder Patients
Objective: This study investigates the relationship between serum nitric oxide, asymmetrical dimethylarginine and symmetrical dimethylarginine levels and Total Antioxidant Capacity, and cognitive function in patients with bipolar disorder. Method: The study included 42 bipolar patients, diagnosed and assessed according to the DSM-V criteria, and 30 healthy controls. The Sociodemographic Questionnaire was used for the collection of data, and a bivariate Pearson correlation analysis was carried out. Results: The patient scores from a Rey Auditory Verbal Learning Test (RAVLT), Auditory Consonant Trigram (ACT), Digit Span Test (DST), Wisconsin Card Sorting Test (WCST), Trail Making-B (TMT-B) and Stroop Tests (ST) were found to be impaired in patients with BD when compared to the healthy controls. The SDMA level of the patient group was significantly higher in the control group, while the ADMA level was lower. The SDMA value was found to be positively correlated with ST-1,2,5 duration; and the NO value was positively correlated with ST-3 duration. Conclusions: The presence of neurobiological markers may serve to predict the severity of neurocognitive deficits, and can provide information about the progress of the disease.
Impact of duration of untreated psychosis on remission in first-episode schizophrenia in Thailand: a cohort study
Background: To scale up the services for first-episode schizophrenia in Thailand, it is essential to understand to what extent health care-seeking is delayed, and how much the delay affects the treatment outcome. Objectives: To investigate the duration of untreated psychosis (DUP) and its impact on remission in first-episode schizophrenia across the country. Methods: 276 outpatients with a first-episode schizophrenia were followed for 6 months and assessed whether they fulfilled the criteria for remission at the follow-up. The proportion of those achieving remission was compared by the DUP. The impact of DUP on remission was estimated in multivariate analyses. Results: At the follow-up, 83% (71/86) of patients who had met the criteria for symptomatic remission at the baseline achieved enduring remission, whereas 63% (119/190) of patients who had not met the criteria for symptomatic remission at baseline met it at the follow-up. The shorter the DUP, the higher the proportion of those who achieved symptomatic or enduring remission at the follow-up. The impact of DUP on symptomatic remission appeared to be significant after controlling for other factors influencing remission. Conclusion: Since the DUP would influence remission of patients with schizophrenia, early detection and intervention services should be provided in Thailand
Associations between depressive and anxiety levels and allergic rhinitis in children: a cross-sectional study
Objective: To investigate the associations between the depressive and anxiety levels and allergic rhinitis (AR) in children. Methods: Children less than 15 years old admitted to our hospital from April 2017 to December 2019 were enrolled in this study, including 692 AR children in the patient group and 713 normal individuals in the control group. The Screen for Child Anxiety Related Emotional Disorders (SCARED) was used to detect their depressive and anxiety levels, and the Middle Childhood Temperament Questionnaire (MCTQ) was used to evaluate their dominant affective temperaments. The comparisons of scale scores between these groups, and the correlation analysis between SCARED scores and MCTQ scores were conducted. Results: The mean SCARED scores of the patient group were significantly higher than the control group (P < 0.05). The patient group also had more AR children with the depressive temperament and anxious temperament than the control group (P<0.01). Strong correlations were found between the SCARED scores and MCTQ scores. Conclusion: The AR children had obvious depressive and anxious trends than non-allergic children. Screening the temperaments and detecting the depression and anxiety symptoms were imperative for AR children, especially for those with depression and anxious moods.
Association between circulating concentrations of vitamin D and risk of antenatal, postnatal depression: a meta-analysis
Background: Previous studies showed consistent results for associations between circulating concentrations of vitamin D and risk of antenatal, postnatal depression. Methods: Articles published in English before November 2020 were searched in databases as follows: PubMed, EMBASE, Web of Science, Medline, Google Scholar and Cochrane. These articles explored associations between circulating concentrations of vitamin D and risk of antenatal, postnatal depression.The present meta-analysis was conducted using STATA 12.0 software. Odds ratios (ORs) and 95% confidence intervals (CIs) extracted from included studies were computed using a random effects model or a fixed effects model according to heterogeneities between included studies. Q test and I2 were used to explore heterogeneities between included studies. Results: 7 cohort studies (including 1567 depression cases and 5254 controls) and 3 case-control studies (including 995 depression cases and 1265 controls) were included in the present study. The study showed that low circulating levels of 25-hydroxy (OH) vitamin D is significantly associated with a higher risk of antenatal and postnatal depression (OR = 1.02, 95% CI 1.01 to 1.04, I2 = 90.7%, p < 0.001). Conclusion: Our results have shown that the low level of vitamin D may be an adverse factor of antenatal and postnatal depression.
Social Physique Anxiety Scale: a psychometric investigation of the factorial model in Brazilian adults
Background: Due to the different factorial models available for the Social Physique Anxiety Scale (SPAS), a psychometric study is needed to identify the most appropriate structure of the scale for a Brazilian sample. Objectives: to estimate the psychometric properties of the SPAS when applied to a sample of Brazilian adults and to explore a factorial model for the instrument. Methods: First, the original SPAS single-factor model was assessed for the total sample through confirmatory factor analysis (CFA). The total sample was randomly divided into two groups. Exploratory factor analysis was carried out in one of the subsamples to identify underlying factors. The new structure was submitted to CFA using the other subsample. Estimates of convergent validity, discriminant validity, and reliability were also calculated. Results: 979 adults with a mean age of 26.09 (SD = 6.37) years participated in the study, 70.5% of whom were women. A two-factor model was found in the exploratory analysis with adequate validity indexes and good reliability. Discussion/Conclusion: A two-factor model of the SPAS presented good indicators of validity and reliability for young Brazilian adults.
Claustrophobia in an oncologic patient: a life-saving treatment
Direitos autorais (c) 2020 Archives of Clinical Psychiatry https://creativecommons.org/licenses/by-nc/4.0
Neurosyphilis in a middle-aged woman with rapid cognitive decline and psychosis: A case report
Vortioxetine improved olfactory reference syndrome in a patient with major depressive disorder: A case report
Depressive disorder following withdrawal pregabalin: a case report
Bruxism as a clinical indicator of mental ilness: lessons from the COVID-19 to the future!
Psychological impacts on patients with COVID-19 in a Thai field hospital
Objective: This study investigates the psychological impacts and their associated factors on patients with COVID-19 at a Thai field hospital. Methods: All eligible patients confirmed to have COVID-19 at Thammasat University field hospital completed an online self-reported mental health screening questionnaire which collected sociodemographic data, their clinical characteristics, and used the depression, anxiety, and stress scale (DASS-21). Results: A total of 40 patients participated in the study. The depression rate was found to be 22.5%, while the anxiety rate was 30%, and the stress rate was 20%. Having a history of psychiatric disorder alone was significantly associated with a higher DASS-21 score (p = 0.001). Meanwhile, gender, age, level of education, occupation, living status, severity of COVID-19, and the number of days admitted to hospital prior to the field hospital were not found to be associated with the DASS-21 scores (P > 0.05). Conclusion: The depression, anxiety, and stress symptoms in patients with COVID-19 at the field hospital were common. Patients with a history of psychiatric disorder should undergo specific evaluation during the isolation phase.
Is All Psychiatry Forensic? Association between Mental Disorders and Legal Proceedings
Background: Psychiatric disorders cause significant impact to the individual, leading to lack of productivity and involvement with the legal system. Objectives: The present study aims to determine the association of mental disorders and an individuals’ odds of involvement with the legal system Methods: Through a descriptive cross-sectional study, 126 patients selected according to convenience sampling were interviewed for the study on their appointment days at University of São Paulo School of Medicine hospital. They were divided into a case group (n = 63) with patients from the outpatient clinic of the Department of Psychiatry and a control group (n = 63), with patients from the outpatient clinic of Department of Internal Medicine. These patients were asked to answer a questionnaire on sociodemographic information, age, medical diagnosis, and legal proceedings as related to their diagnoses. Results: We found high difference between the groups, in longer absences 57.10% of psychiatric patients, with only 33.3% in clinical group. This difference also appears in the requirement for forensic medical exams - 65.1% of psychiatric patients versus 44.4% of clinical patients. Discussion: This data clearly shows that involvement of psychiatric patients in legal matters is quite common, and therefore it is increasingly important for psychiatrists to be aware of legal implications when evaluating their patients.