Clinical Features, Psychiatric Assessment, and Longitudinal Outcome of Suicide Attempters Admitted to a Tertiary Emergency Hospital.

The objective of this study was to characterize admissions to an emergency hospital due to suicide attempts and verify outcomes in 2 years. Data were collected from medical records and were analyzed using descriptive statistics and logistic regression. The sample consisted of 412 patients (58.7% women; mean age = 32.6 years old, SD = 14.3). Self-poisoning was the most frequent method (84.0%), and they were diagnosed mainly as depressive (40.3%) and borderline personality disorders (19.1%). Previous suicide attempts and current psychiatric treatment were reported by, respectively, 32.0% and 28.4%. Fifteen patients (3.6%, 9 males) died during hospitalization. At discharge, 79.3% were referred to community-based psychiatric services. Being male (OR = 2.11; 95% CI = 1.25-3.55), using violent methods (i.e., hanging, firearms, and knives) (OR = 1.96; 95% CI = 1.02-3.75) and psychiatric treatment history (OR = 2.58; 95% CI = 1.53-4.36) were predictors for psychiatric hospitalization. Of 258 patients followed for 2 years, 10 (3.9%) died (3 suicide), and 24 (9.3%) undertook new suicide attempts. Patients with a history of psychiatric treatment had higher risks of new suicide attempts (OR = 2.46, 95% CI = 1.07-5.65). Suicide attempters admitted to emergency hospitals exhibit severe psychiatric disorders, and despite interventions, they continue to present high risks for suicide attempts and death.

Direct and indirect cost of attempted suicide in a general hospital: cost-of-illness study.

CONTEXT AND OBJECTIVE: Knowledge of socioeconomic impact of attempted suicide may sensitize managers regarding prevention strategies. There are no published data on this in Brazil. The aim here was to describe the direct and indirect costs of care of hospitalized cases of attempted suicide and compare these with the costs of acute coronary syndrome cases. DESIGN AND SETTING: Cost-of-illness study at a public university hospital in Brazil. METHOD: The costs of care of 17 patients hospitalized due to attempted suicide were compared with those of 17 acute coronary syndrome cases at the same hospital, over the same period. The direct costs were the summation of the hospital and out-of-hospital costs resulting from the event, determined from the medical records. The indirect costs were estimated through the human capital lost. The Mann-Whitney test and analysis of covariance (ANCOVA) with transformation adjusted for age were used for comparisons. RESULTS: The average costs per episode of attempted suicide were: direct cost, US$ 6168.65; indirect cost, US$ 688.08; and total cost, US$ 7163.75. Comparative analysis showed a difference between the indirect costs to family members, with significantly higher costs in the attempted suicide group (P = 0.0022). CONCLUSION: The cost of care relating to attempted suicide is high and the indirect cost to family members reinforces the idea that suicidal behavior not only affects the individual but also his social environment.

Direct and indirect cost of attempted suicide in a general hospital: cost-of-illness study / Custo direto e indireto de tentativas de suicídio em um hospital geral: estudo de custo de doença

CONTEXT AND OBJECTIVE: Knowledge of socioeconomic impact of attempted suicide may sensitize managers regarding prevention strategies. There are no published data on this in Brazil. The aim here was to describe the direct and indirect costs of care of hospitalized cases of attempted suicide and compare these with the costs of acute coronary syndrome cases. DESIGN AND SETTING: Cost-of-illness study at a public university hospital in Brazil. METHOD: The costs of care of 17 patients hospitalized due to attempted suicide were compared with those of 17 acute coronary syndrome cases at the same hospital, over the same period. The direct costs were the summation of the hospital and out-of-hospital costs resulting from the event, determined from the medical records. The indirect costs were estimated through the human capital lost. The Mann-Whitney test and analysis of covariance (ANCOVA) with transformation adjusted for age were used for comparisons. RESULTS: The average costs per episode of attempted suicide were: direct cost, US$ 6168.65; indirect cost, US$ 688.08; and total cost, US$ 7163.75. Comparative analysis showed a difference between the indirect costs to family members, with significantly higher costs in the attempted suicide group (P = 0.0022). CONCLUSION: The cost of care relating to attempted suicide is high and the indirect cost to family members reinforces the idea that suicidal behavior not only affects the individual but also his social environment. .

CONTEXTO E OBJETIVO: O conhecimento do impacto socioeconômico das tentativas de suicídio pode sensibilizar gestores para programas de prevenção. No Brasil, não há dados publicados a esse respeito. O objetivo foi descrever os custos direto e indireto dos cuidados com as tentativas de suicídio de pacientes internados no hospital de uma universidade pública, e compará-los aos custos de casos de síndrome coronariana aguda. TIPO DE ESTUDO E LOCAL: Estudo de custo de doença em hospital universitário público no Brasil. MÉTODO: Os custos dos cuidados de 17 pacientes hospitalizados por tentativas de suicídio foram comparados aos custos de 17 síndromes coronarianas agudas de pacientes internados no mesmo hospital, no mesmo período. Os custos diretos foram o somatório de custos hospitalares e extra-hospitalares decorrentes do evento, determinados por registro hospitalar. Os custos indiretos foram estimados através da perda de capital humano. Teste de Mann-Whitney e análise da covariância (ANCOVA) com transformação por idade foram utilizados para comparação. RESULTADOS: As médias de custos por episódio de tentativa de suicídio foram: custo direto individual, US$ 6168,65; custo indireto individual, US$ 688,08; e custo total, US$ 7163,75. A análise comparativa indica diferença entre os custos indiretos a familiares dos dois fenômenos, com custos significativamente mais elevados no grupo de tentativas de suicídio (P = 0,0022). CONCLUSÃO: O custo dos cuidados com tentativa de suicídio é elevado e o custo indireto a familiares reforça a ideia de que o comportamento suicida não afeta apenas o indivíduo, mas também seu ambiente social. .

Comportamento suicida: epidemiologia / Suicidal behavior: Epidemiology / Le comportement suicidaire: épidémiologie / La conducta suicida: epidemiología

O Brasil encontra-se entre os dez países que registram os maiores números absolutos de suicídios, com 9.852 mortes em 2011. O coeficiente médio para o período 2004-2010 foi de 5,7%. Esse índice aumentou 29,5% nas duas últimas décadas e é mais elevado em homens, idosos, indígenas e em cidades de pequeno e de médio porte populacional. Transtornos mentais encontram-se presentes na maioria dos casos de suicídio, principalmente depressão, transtorno do humor bipolar e dependência de álcool e de outras drogas psicoativas. Um estudo populacional revelou que, ao longo da vida, 17,1% das pessoas tiveram ideação suicida, 4,8% chegaram a elaborar um plano para tanto, e 2,8% efetivamente tentaram o suicídio. Dar especial atenção à pessoa que tentou se suicidar é uma das principais estratégias de prevenção do suicídio...

Brazil is among the ten countries that record the highest absolute numbers of suicides, with 9,852 deaths in 2011. The average coefficient for the period of 2004-2010 was 5.7%. This figure increased 29.5% in the last two decades and is higher for men, elders, indigenous and small and mid-sized population towns. Mental disorders are present in most cases of suicide, especially depression, bipolar disorder, and dependence of alcohol and other psychoactive drugs. A population study revealed that, throughout life, 17.1% of people had suicidal ideation, 4.8% developed a suicide plan, and 2.8% actually attempted it. Giving particular attention to a person who has ttempted suicide is a major prevention strategy...

Le Brésil fait partie des dix pays qui enregistrent le plus grand nombre absolu de suicides, avec 9.852 décès en 2011. Le coefficient moyen pour la période 2004-2010 était de 5,7. Ce chiffre a augmenté de 29,5 % au cours des deux dernières décennies et est plus élevé chez les hommes, les personnes âgées, des autochtones et des petites et moyennes populations. Un trouble mental est présent dans la plupart des cas de suicide, en particulier la dépression, le trouble bipolaire, dépendance de l’alcool et d’autres drogues psychoactives. Une étude de population a révélé que 17,1 % tout au long de la vie ont eu des idées suicidaires, de 4,8 % avait un plan suicide, et 2,8 % ont effectivement tenté...

El Brasil está entre los diez países que registran las cifras absolutas más elevadas de suicidios, con 9.852 muertes en 2011. El coeficiente promedio para el período 2004-2010 fue de 5,7%. Esa cifra aumentó 29,5% en las dos últimas décadas, y es mayor en los hombres, los ancianos, los pueblos indígenas y ciudades con población de tamaños pequeño y medio. Un trastorno mental está presente en la mayoría de los casos de suicidio, especialmente la depresión, el trastorno bipolar, el alcohol y otras drogas psicoactivas. Un estudio poblacional reveló que a lo largo de la vida, el 17,1% de las personas tenían ideas suicidas, 4,8% tenían un plan para el suicidio, y 2,8% en realidad un intento de suicidio. Prestar especial atención a una persona que ha intentado suicidarse es una estrategia importante para la prevención del suicidio...

[Common mental disorders among elderly individuals: a population-based study in Campinas, São Paulo State, Brazil]. / Transtorno mental comum na população idosa: pesquisa de base populacional no Município de Campinas, São Paulo, Brasil.

This study analyzed common mental disorders in the elderly according to demographic and socioeconomic characteristics, health-related behavior, and disease history. This was a cross-sectional, population-based study with a cluster sample using data from a health survey conducted in Campinas, São Paulo State, Brazil, in 2008. SRQ-20 was used to evaluate common mental disorders. Adjusted prevalence ratios were estimated using multiple Poisson regression. Prevalence of common mental disorders was 29.7%, and higher rates were associated with female gender, age 80 years or older, lower income, not working, sedentary lifestyle, poor self-rated health, and greater number of chronic diseases. Prevalence ratios were higher in the subscale of depressive thinking. The results provide direct backing for planning interventions focused on health of the elderly, with an emphasis on elderly that work and follow healthy lifestyles. The study highlights the need for attention by health professionals to depressive disorder in the elderly.

Transtorno mental comum na população idosa: pesquisa de base populacional no Município de Campinas, São Paulo, Brasil / Common mental disorders among elderly individuals: a population-based study in Campinas, São Paulo State, Brazil / Trastornos mentales más frecuentes entre las personas de edad avanzada: un estudio basado en la población en Campinas, São Paulo, Brasil

Analisou-se o transtorno mental comum em idosos segundo variáveis demográficas, socioeconômicas, de comportamentos relacionados à saúde e morbidades. Trata-se de estudo transversal de base populacional, com amostra por conglomerados. A pesquisa utilizou dados de inquérito de saúde realizado em Campinas, São Paulo, Brasil, em 2008. Foi usado o questionário SRQ-20 para avaliar o transtorno mental comum. Foram estimadas razões de prevalências ajustadas por meio de regressão múltipla de Poisson. A prevalência de transtorno mental comum foi 29,7% e significativamente mais elevada no sexo feminino, nos idosos com 80 anos ou mais, menor renda, que não trabalhavam, sedentários, que avaliaram sua saúde como ruim/muito ruim e com maior número de doenças crônicas. Maiores razões de prevalências foram detectadas na subescala de pensamentos depressivos. Os resultados trazem subsídios para o planejamento de intervenções voltadas à saúde dos idosos, com ênfase nos idosos que trabalham e com hábitos de vida saudáveis. Apontam a necessidade de atenção dos profissionais para o quadro depressivo na terceira idade.

This study analyzed common mental disorders in the elderly according to demographic and socioeconomic characteristics, health-related behavior, and disease history. This was a cross-sectional, population-based study with a cluster sample using data from a health survey conducted in Campinas, São Paulo State, Brazil, in 2008. SRQ-20 was used to evaluate common mental disorders. Adjusted prevalence ratios were estimated using multiple Poisson regression. Prevalence of common mental disorders was 29.7%, and higher rates were associated with female gender, age 80 years or older, lower income, not working, sedentary lifestyle, poor self-rated health, and greater number of chronic diseases. Prevalence ratios were higher in the subscale of depressive thinking. The results provide direct backing for planning interventions focused on health of the elderly, with an emphasis on elderly that work and follow healthy lifestyles. The study highlights the need for attention by health professionals to depressive disorder in the elderly.

Se analizaron los trastornos mentales comunes en ancianos, de acuerdo con los comportamientos demográficos, socioeconómicos, de salud y morbilidad. Se realizó un estudio transversal, basado en la población de muestreo por conglomerados de los datos de una encuesta de salud realizada en Campinas, São Paulo, Brasil, en 2008. Se utilizó el SRQ-20 para evaluar la trastornos mentales comunes. Calculamos razones de prevalencia ajustadas por regresión de Poisson múltiple. La prevalencia de trastornos mentales comunes fue de 29,7%, significativamente mayor en las mujeres, las personas mayores de 80 años, de bajos ingresos, que no trabajan, sedentarias, que calificaron su salud como mala/muy mala y con más enfermedades crónicas. Mayores tasas de prevalencia fueron encontradas en las subescalas de trastornos depresivos. Proporcionan información para la planificación de intervenciones centradas en la salud de las personas mayores, con énfasis en las personas y el trabajo con hábitos de vida saludables. Indican la necesidad de atención profesional para los trastornos depresivos en ancianos.

Twenty years of electroconvulsive therapy in a psychiatric unit at a university general hospital.

OBJECTIVE: To describe the sociodemographic and clinical profile of patients who underwent electroconvulsive therapy (ECT) at a university general hospital. METHOD: In this retrospective study, records from all patients undergoing ECT between January 1988 and January 2008 at the psychiatric unit of the general hospital of Universidade Estadual de Campinas (UNICAMP) were reviewed. Telephone contact was made with patients/relatives to collect follow-up data. RESULTS: A total of 200 charts were reviewed. The majority of patients were women, with a mean age of 39 years, and history of psychiatric hospitalization. The main indications for ECT were depression and catatonia. Complications were observed in less than half of the cases, and most were temporary and not severe. There was a good psychiatric outcome for 89.7% of the patients, especially for catatonic patients (100%, p = 0.02). Thirty-four percent of the cases were later contacted by telephone calls, at a mean of 8.5 years between the procedure and the contact. Among these, three (1.5%) reported persistent memory disorders and 73% considered ECT a good treatment. CONCLUSION: ECT has been performed according to international guidelines. In the vast majority of cases, undesirable effects were temporary and not severe. Response to ECT was positive in most cases, particularly in catatonic patients.

Twenty years of electroconvulsive therapy in a psychiatric unit at a university general hospital / Vinte anos de eletroconvulsoterapia em enfermaria psiquiátrica de hospital geral universitário

Objective: To describe the sociodemographic and clinical profile of patients who underwent electroconvulsive therapy (ECT) at a university general hospital. Method: In this retrospective study, records from all patients undergoing ECT between January 1988 and January 2008 at the psychiatric unit of the general hospital of Universidade Estadual de Campinas (UNICAMP) were reviewed. Telephone contact was made with patients/relatives to collect follow-up data. Results: A total of 200 charts were reviewed. The majority of patients were women, with a mean age of 39 years, and history of psychiatric hospitalization. The main indications for ECT were depression and catatonia. Complications were observed in less than half of the cases, and most were temporary and not severe. There was a good psychiatric outcome for 89.7% of the patients, especially for catatonic patients (100%, p = 0.02). Thirty-four percent of the cases were later contacted by telephone calls, at a mean of 8.5 years between the procedure and the contact. Among these, three (1.5%) reported persistent memory disorders and 73% considered ECT a good treatment. Conclusion: ECT has been performed according to international guidelines. In the vast majority of cases, undesirable effects were temporary and not severe. Response to ECT was positive in most cases, particularly in catatonic patients.

Objetivo: Descrever o perfil sociodemográfico e clínico de pacientes submetidos a eletroconvulsoterapia (ECT) em um hospital geral universitário. Método: Neste estudo retrospectivo, foram revisados os prontuários de todos os pacientes submetidos a ECT entre janeiro de 1988 e janeiro de 2008 na unidade psiquiátrica do hospital geral da Universidade Estadual de Campinas (UNICAMP). Os pacientes/familiares foram contatados por telefone para a coleta de dados de seguimento. Resultados: Um total de 200 prontuários foram revisados. A maioria dos pacientes era do sexo feminino, com uma idade média de 39 anos e história de hospitalização psiquiátrica prévia. As principais indicações para ECT foram depressão e catatonia. Complicações foram observadas em menos de metade dos casos, e a maioria delas teve caráter temporário e não grave. Houve resultado psiquiátrico favorável em 89,7% dos pacientes, especialmente os catatônicos (100%, p = 0,02). Trinta e nove por cento dos casos foram contatados por telefone, a uma média de 8,5 anos decorridos entre o procedimento e o contato. Entre estes, três (1,5%) relataram transtornos amnésticos persistentes e 73% consideraram a ECT um bom tratamento. Conclusão: A ECT foi realizada de acordo com diretrizes internacionais. Na grande maioria dos casos, efeitos indesejáveis foram temporários e não graves. A resposta à ECT foi positiva na maioria dos casos, especialmente em pacientes catatônicos.

Suicide in Brazil, 2004 - 2010:the importance of small counties / Suicidios en el Brasil, 2004 - 2010: la importancia de los municipios pequeños

Objective. To describe suicide rates by county size in the five geopolitical areas of Brazil. Methods. This was an ecological, descriptive study of suicide deaths in Brazil that occurred among the population 10 years of age and older in 2004–2010. Data were obtained from the National Mortality Information System of Brazil. Counties were defined by size as: very large (200 000+), large (< 200 000–100 000), medium (< 100 000–50 000), small (< 50 000– 20 000), very small (< 20 000–10 000, and micro (< 10 000). Age-adjusted suicide rates were calculated for all counties and for population-size groups in each geopolitical area. Rate ratio and 95% confidence interval were used to compare suicide risk between groups and the reference. Results. The national, average suicide mortality rate was 5.7 deaths/100 000 inhabitants. Except in the North and North-East, suicide mortality rates increased from the very large (> 200 000) to the micro counties (< 10 000 population). Very high rates were scattered in the North and Mid-West among the indigenous peoples (> 30 deaths per 100 000). At highest risk were micro counties in the South (13.6 deaths per 100 000), with elderly males (60+ years, 31.4) and males 40–59 years (31.3) being the sex/age group with the highest rates. Conclusions. To reduce suicide mortality in Brazil, public health authorities must support mental health training in small cities and multi-professional interventions among the indigenous peoples. In addition, the causes behind underreporting of suicide deaths must be resolved in several areas.

Objetivo. Describir las tasas de suicidio según el tamaño del municipio en las cinco áreas geopolíticas del Brasil. Métodos. Estudio ecológico y descriptivo de las defunciones por suicidio en el Brasil ocurridas en la población de 10 años de edad y mayores en el período del 2004 al 2010. Se obtuvieron datos del Sistema Nacional de Información sobre Mortalidad del Brasil. Los municipios fueron definidos según su tamaño como: muy grandes (200 000 o más habitantes), grandes (de 100 000 a menos de 200 000), medios (de 50 000 a menos de 100 000), pequeños (de 20 000 a menos de 50 000), muy pequeños (de 10 000 a menos de 20 000) y micromunicipios (menos de 10 000). Se calcularon las tasas de suicidio ajustadas por edad para todos los municipios y según el tamaño de la población en cada área geopolítica. Se utilizaron la razón de tasas y el intervalo de confianza de 95% para comparar el riesgo de suicidio entre los distintos grupos y el grupo de referencia. Resultados. La tasa nacional promedio de mortalidad por suicidio fue de 5,7 defunciones/ 100 000 habitantes. Excepto en el norte y en el noreste las tasas de mortalidad por suicidio aumentaron entre los municipios muy grandes (más de 200 000) y los micromunicipios (menos de 10 000 habitantes). Se observaron tasas muy elevadas dispersas en el norte y el centro oeste entre las personas indígenas (más de 30 defunciones por 100 000). El mayor riesgo fue observado en los micromunicipios del Sur (13,6 defunciones por 100 000), donde los varones ancianos de más de 60 años (31,4) y los de 40 a 59 años (31,3) fueron los grupos de edad y sexo que presentaron las tasas más elevadas. Conclusiones. Para reducir la mortalidad por suicidio en el Brasil, las autoridades de salud pública deben abordar la capacitación en materia de salud mental en las pequeñas ciudades y promover las intervenciones interdisciplinarias en los pueblos indígenas. Además, en varias zonas se deben resolver las causas que provocan la insuficiente notificación de las defunciones por suicidio.

Suicide in Brazil, 2004-2010: the importance of small counties.

OBJECTIVE: To describe suicide rates by county size in the five geopolitical areas of Brazil. METHODS: This was an ecological, descriptive study of suicide deaths in Brazil that occurred among the population 10 years of age and older in 2004-2010. Data were obtained from the National Mortality Information System of Brazil. Counties were defined by size as: very large (200,000+), large (< 200,000-100,000), medium (< 100,000-50,000), small (< 50,000-20,000), very small (< 20,000-10,000, and micro (< 10,000). Age-adjusted suicide rates were calculated for all counties and for population-size groups in each geopolitical area. Rate ratio and 95% confidence interval were used to compare suicide risk between groups and the reference. RESULTS: The national, average suicide mortality rate was 5.7 deaths/100,000 inhabitants. Except in the North and North-East, suicide mortality rates increased from the very large (> 200,000) to the micro counties (< 10,000 population). Very high rates were scattered in the North and Mid-West among the indigenous peoples (> 30 deaths per 100,000). At highest risk were micro counties in the South (13.6 deaths per 100,000), with elderly males (60+ years, 31.4) and males 40-59 years (31.3) being the sex/age group with the highest rates. CONCLUSIONS: To reduce suicide mortality in Brazil, public health authorities must support mental health training in small cities and multi-professional interventions among the indigenous peoples. In addition, the causes behind underreporting of suicide deaths must be resolved in several areas.

Prática psiquiátrica no hospital geral: interconsulta e emergência / Psychiatric practice in general hospital: referral and emergency

Dez anos após seu lançamento, Prática psiquiátrica no hospital geral: interconsulta e emergência chega à sua terceira edição ampliado e atualizado, abordando tanto elementos da psicologia médica como da psiquiatria. Nos últimos anos, o reconhecimento e o interesse pela psiquiatria como área cada vez mais integrada a outras especialidades da saúde aumentou consideravelmente, assim como o conhecimento a ser dominado pelo psiquiatra de hospital geral. Em decorrência dessa nova realidade, nesta edição, os autores, destacados profissionais brasileiros e estrangeiros da área da saúde, tiveram o cuidadoso trabalho de atualização e de inclusão de novos temas.

Prevenção do suicídio

Manual dirigido a profissionais das equipes de saúde mental. Aborda várias questões relacionadas como depressão, esquizofrenia, abuso do álcool, atenção ao paciente, centros de atenção psicossocial etc. A publicação faz parte da Estratégia Nacional de Prevenção do Suicídio e teve a colaboração da OPAS, UNICAMP e Ministério da Saúde.

Suicide prevention training for professionals in the public health network in a large Brazilian city.

The objective of this study was to improve health professionals' knowledge and attitudes toward suicide prevention. A suicide prevention training of 18 hours duration was conducted with 270 health professionals, mainly primary care workers, who were routinely involved with patients at high risk for suicide. Questionnaires were used to assess changes in attitudes and knowledge. The score in the knowledge questionnaire, with 21 points as maximum value, increased from 8.9 to 13 points (p < .001, significance level of 95%). Of the 25 questionnaire items representing attitudes, 18 showed significant change after the training. This training model has enhanced knowledge and attitudes toward suicide prevention in healthcare workers.

Depression and anxiety in a community sample with epilepsy in Brazil.

OBJECTIVE: To estimate the frequency of depression/anxiety and to establish the social, epilepsy and psychiatric characteristics in individuals with epilepsy. METHOD: A cross-sectional study was employed to evaluate 153 subjects with epilepsy who were identified in a previous community-based survey. First, a structured interview was conducted, followed by a psychiatric evaluation. Subjects with depression were compared to those without, and subjects with anxiety were compared to those without. RESULTS: The prevalence of anxiety and depression was 39.4 and 24.4%, respectively. Both were associated with low schooling (OR 3.8, 95% CI 1.6 to 9.0 and OR 2.8, 95% CI 1.2 to 6.5 for depression and anxiety, respectively), lifetime suicidal thoughts (OR 4.4, 95% CI 1.9 to 10.3 and OR 3.6, 95% CI 1.7 to 7.7) and lifetime suicide attempts (OR 9.3, 95% CI 2.6 to 32.8 and OR 6.9, 95% CI 1.8 to 26.4). CONCLUSION: The high rates of depression and anxiety reinforced the need for recognition and treatment of mental disorders in epilepsy.

Atendimento de crise no Ambulatório de Psiquiatria do Hospital de Clínicas da Unicamp / Crisis care in the Psychiatric Clinic of the Hospital de Clínicas Unicamp

O artigo descreve a história do ensino da psicoterapia na Residência Médicaem Psiquiatria da Faculdade de Ciências Medicas da Universidade Estadualde Campinas (UNICAMP). Inicialmente baseado no referencial psicanalítico, oensino da psicoterapia acabou perdendo espaço, devido à crescente demandaassistencial, ao agravamento do perfil clínico dos pacientes e a uma práticaclínica mais descritiva e pautada em tratamento farmacológico, juntamentea aposentadoria da primeira geração de professores psicanalistas na décadade 1990. Nesse contexto surgiu a proposta de um atendimento de criseque incluísse os aspectos psicoterápicos na assistência ao paciente como umaprimeira tentativa de sanar essa deficiência. A experiência está em pleno andamento. O programa atual do Atendimento de crise no Ambulatório de Psiquiatria do Hospital de Clínicas da Unicamp é apresentado, bem como seus os pontos fortes e os perigos inerentes e cuidados a serem tomados nessetipo de atendimento.

[Detecting suicide risk at psychiatric emergency services]. / Detecção do risco de suicídio nos serviços de emergência psiquiátrica.

OBJECTIVE: Guide the health professional to identify risk factors and forms of protection, together with handling such patient throughout a clinical interview within the emergency service context. METHOD: Selected literature revision so as to identify relevant and illustrative key cases. RESULTS: The clinical interview is the best method to evaluate the suicidal risk and has two different aims: 1) emotional support and creation of a bond; 2) collecting information. There is a substantial amount of information to be collected during the clinical interview, such as: risk factors and protection, epidemiologic data, act characterization, psychical dynamics aspects, personal and familial historic patterns, identification models, data on physical wealth and social net support. Difficulties are to emerge throughout the clinical interview, but a trained and informed professional will be able to approach and adequately add the patient. Although several scales have been proposed, none of them have been efficient to deter the suicidal risk. CONCLUSION: There is no method to predict who is to commit suicide, nevertheless, it is possible to evaluate the individual risk of each patient with regards to a detailed and empathic clinical interview. Prevent the patient to commit suicide is the preliminary and fundamental rule.

General hospital admission as an opportunity for smoking-cessation strategies: a clinical trial in Brazil.

OBJECTIVE: To compare the results of 6-month follow-ups for hospitalized patients who were divided into two groups of low- and high-intensity treatments for smoking cessation and compared to the results of standard hospital treatment. METHODS: A total of 2414 patients were screened. Two hundred thirty-seven current smokers were randomly assigned to high-intensity intervention (HII; 30-min motivational interview plus seven routine telephone calls after hospital discharge) or to low-intensity intervention (LII; 15-min counseling about the benefits of quitting) and 80 comprised the usual care (UC) group. Six months after hospital discharge, all participants were contacted by phone. The main outcome measure was smoking cessation. RESULTS: The smoking-cessation rates were 44.9%, 41.7% and 26.3% for the HII, LII and UC groups, respectively (P = .03). The multivariable analysis identified the following variables which are associated with the failure to stop smoking: the absence of a tobacco-related disease (TRD), younger age and a low motivation for cessation at the initial contact. CONCLUSIONS: There was a great difference between intervention and nonintervention. The LII had an impact similar to the HII. The variables associated with no smoking cessation demonstrate the need for more personalized interventions for smokers who present lower indexes of motivation, are younger and do not have smoking-related diseases.

Detecção do risco de suicídio nos serviços de emergência psiquiátrica / Detecting suicide risk at psychiatric emergency services

OBJETIVO: Auxiliar o profissional de saúde na identificação dos fatores de risco e de proteção, e no manejo de pacientes com risco de suicídio, por meio de entrevista clinica, no contexto de emergência médica. MÉTODO: Revisão seletiva da literatura para identificar achados clínicos relevantes e ilustrativos. RESULTADO: A entrevista clinica é o melhor método para avaliar o risco suicida e tem dois objetivos: 1) apoio emocional e de estabelecimento de vínculo; 2) coleta de informações. Existe um número considerável de informações a serem coletadas durante a entrevista: fatores de risco e proteção (predisponentes e precipitantes), dados epidemiológicos, caracterização do ato, aspectos psicodinâmicos, antecedentes pessoais e familiares, modelos de identificação, dados sobre saúde física e rede de apoio social. Dificuldades ao longo da entrevista serão encontradas, mas com conhecimento e treinamento adequado, o profissional poderá abordar e ajudar adequadamente o paciente. Embora várias escalas tenham sido propostas, nenhuma delas demonstrou eficiência para a detecção de risco de suicídio. CONCLUSÃO: Não há como prever quem cometerá suicídio, mas é possível avaliar o risco individual que cada paciente apresenta, tendo em vista a investigação detalhada e empática da entrevista clinica. Impedir que o paciente venha a se matar é regra preliminar e fundamental.

OBJECTIVE: Guide the health professional to identify risk factors and forms of protection, together with handling such patient throughout a clinical interview within the emergency service context. METHOD: Selected literature revision so as to identify relevant and illustrative key cases. RESULTS: The clinical interview is the best method to evaluate the suicidal risk and has two different aims: 1) emotional support and creation of a bond; 2) collecting information. There is a substantial amount of information to be collected during the clinical interview, such as: risk factors and protection, epidemiologic data, act characterization, psychical dynamics aspects, personal and familial historic patterns, identification models, data on physical wealth and social net support. Difficulties are to emerge throughout the clinical interview, but a trained and informed professional will be able to approach and adequately add the patient. Although several scales have been proposed, none of them have been efficient to deter the suicidal risk. CONCLUSION: There is no method to predict who is to commit suicide, nevertheless, it is possible to evaluate the individual risk of each patient with regards to a detailed and empathic clinical interview. Prevent the patient to commit suicide is the preliminary and fundamental rule.

Depression, alcohol use disorders and nicotine dependence among patients at a general hospital / Depressão, transtornos decorrentes do uso de álcool e dependência de nicotina no hospital geral

OBJECTIVE: To determine prevalence rates and identify patient characteristics associated with depression, alcohol use disorders and nicotine dependence among individuals admitted to a general teaching hospital. METHOD: Using the Hospital Anxiety and Depression Scale and Alcohol Use Disorder Identification Test, we assessed 4,352 consecutive medical and surgical patients admitted over a 13-month period. The patients were also asked to report their daily cigarette smoking habits during the last month. Multiple logistic regression analyses were performed, and odds ratios (ORs) were calculated. RESULTS: The mean age of the sample was 49.3 years, and 56.6 percent were male. Prevalence rates of depression, alcohol use disorders and nicotine dependence were, respectively, 14 percent, 9.8 percent and 16.9 percent. In the multivariate analysis, depression was associated with previous suicide attempts (OR = 8.7), lower level of education (OR = 3.6), prior use of psychotropic medications (OR = 3.1), cancer (OR = 1.7) and pain (OR = 1.7). Alcohol use disorders were associated with male sex (OR = 6.3), smoking (OR = 3.5), admission for an external cause of injury, such as a traffic accident (OR = 2.4), and previous suicide attempts (OR = 2.3). Nicotine dependence was associated with alcohol use disorders (OR = 3.4), young adulthood (OR = 2.3), widowhood (OR = 2.2) and previous suicide attempts (OR = 1.8). CONCLUSION: This is the largest sample of medical and surgical patients ever surveyed with standardized screening instruments in a general hospital in Brazil. The high prevalence rates of psychiatric disorders and the profiles of the patients evaluated in this study underscore the need to develop methods that are more effective for detecting and managing such disorders. Hospital admission should be considered a major opportunity for the detection of psychiatric disorders and the subsequent implementation of the appropriate specific treatment strategies.

OBJETIVO: Identificar taxas de prevalência e perfis de pacientes associados a depressão, transtornos por uso de álcool e dependência de nicotina em indivíduos internados em um hospital geral universitário. MÉTODO: 4.352 pacientes internados consecutivamente foram avaliados pelas escalas Hospital Anxiety and Depression e Alcohol use Disorder Identification Test. Eles também foram questionados sobre uso diário de cigarros ao longo do último mês. Análises de regressão logística múltipla foram realizadas. RESULTADOS: 56,6 por cento eram de sexo masculino, e a média de idade foi de 49,3 anos. As taxas de prevalência de depressão, transtornos por uso de álcool e dependência de nicotina foram, respectivamente, 14 por cento, 9,8 por cento e 16,9 por cento. Na análise multivariada, depressão associou-se a tentativa prévia de suicídio (OR = 8,7), menor escolaridade (3,6), uso prévio de psicofármacos (3,1), câncer (1,7) e dor (1,7). Transtornos por uso de álcool associaram-se a sexo masculino (OR = 6,3), tabagismo (3,5), internação por uma causa externa (2,4), notadamente acidentes automobilísticos, e tentativa prévia de suicídio (2,3). A dependência de nicotina associou-se a transtornos por uso de álcool (OR = 3,4), idade adulta jovem (2,3), viuvez (2,2) e tentativa prévia de suicídio (1,8). CONCLUSÃO: Esta é a maior amostra de pacientes clínicos e cirúrgicos, internados num hospital geral brasileiro, avaliados com instrumentos padronizados. Houve considerável prevalência de transtornos mentais, e os respectivos perfis dos pacientes enfatizam a necessidade de se desenvolver métodos mais eficientes de detecção e de manejo desses transtornos. A internação hospitalar deveria ser tomada como um marco na vida de uma pessoa, a partir do qual se detecta um transtorno psiquiátrico e estratégias específicas de tratamento são implementadas.

Avaliação psicológica dos cuidadores de mulheres com câncer pelo General Comfort Questionnaire / Psychological assessment of the caregivers of women with cancer through the General Comfort Questionnaire / Evaluación psicologica de los cuidadores de mujeres con cáncer según el General Comfort Questionnaire

Este estudo avaliou o bem-estar global de 133 cuidadores de mulheres com câncer genital ou de mama, na fase avançada da doença, pelo General Comfort Questionnaire (GCQ) e analisou a associação com ansiedade, depressão, variáveis sociodemográficas e encargos do cuidador. Foi aplicada a Escala Hospitalar de Ansiedade e Depressão, o GCQ e uma entrevista semi-estruturada. Foram utilizadas a análise de variância (ANOVA), Tukey e a regressão linear múltipla em stepwise para determinar correlações entre as características do cuidador e bem-estar. O Alpha de Cronbach foi 0,8315. Segundo os resultados, quanto maior a idade do cuidador melhor o bem-estar (p<0,01). Cuidadores do sexo masculino apresentaram grau de bem-estar significativamente maior do que cuidadores do sexo feminino (p=0,01). Maridos apresentaram grau de bem-estar significativamente maior do que todos os outros cuidadores (p<0,001). Ansiedade (p<0,01), depressão (p=0,02) e ser mulher (p=0,01) foram fortemente relacionadas com menor bem-estar. O GCQ mostrou-se eficiente para realizar uma avaliação abrangente e multidimensional do cuidador.

This study evaluated global well-being of 133 caregivers of women with genital or breast cancer in the advanced stage of disease through the General Comfort Questionnaire (GCQ) and evaluates the association with anxiety, depression, sociodemographic characteristics; and incumbencies of the main caregivers. The Hospital Anxiety and Depression Scale was completed, followed by the GCQ and an interview semi-structured. To assess the effects of the caregivers characteristics on GCQ scores, analysis of variance followed by Tukey were applied. Stepwise multiple linear regressions were used. The Cronbachs Alpha coefficient was 0.8315. Older caregiver presented better comfort (p<0.01). Caregivers male presented degree of well-being significantly higher than female caregivers. Patients spouses showed significantly greater GCQ scores than other caregivers (p<0.001). Anxiety (p<0.01), depression (p=0.02), and being woman (p=0.01) were strongly associated with lower well-being. The GCQ was efficient to conduct a comprehensive and multidimensional assessment of the caregiver.

Este estudio evaluó el bienestar global de 133 cuidadores de mujeres con cáncer genital o de mama en etapas avanzadas de la enfermedad según el General Comfort Questionnaire (GCQ) y analizó la asociación con la ansiedad, depresión, variables sociodemográficas y responsabilidades del cuidador. Fue aplicada la Escala Hospitalaria de Ansiedad y Depresión, el GCQ y una entrevista semi-estructurada. Fueron utilizados el análisis de variación (ANOVA), Tukey y la regresión linear múltiple para determinar correlaciones posibles entre las características del cuidador y el bienestar. El Alpha de Cronbach fue 0.8315. Cuanto mayor la edad, mejor es el bienestar del cuidador (p<0.01). Cuidadores del sexo masculino mostraron mejor bienestar que cuidadores del sexo femenino (p=0.01). Los maridos presentaron grado de bienestar perceptiblemente mayor que los de todos los otros cuidadores (p<0.001). La ansiedad (p<0.01), la depresión (p=0.02) y cuidadores del sexo femenino (p=0.01) estaban fuertemente relacionadas con poco bienestar. El GCQ reveló eficiencia para una evaluación global y multidimensional del cuidador.