Psychotic relapses from the perspective of patients and family members.

This qualitative study was carried out with 10 dyads of patients-family members to explore their perception about psychotic relapses. Data were collected through a semi-structured interview from April to August 2019, in Brazil, and analyzed using the thematic analysis proposed by Braun & Clark. Four main themes emerged from the interviews: (1) defining and describing the psychotic relapses; (2) risk factors for psychotic relapse; (3) protective factors for psychotic relapse; and (4) early warning signs: identification of an episode of psychotic relapse. Exploring the perception of patients with psychotic disorders and their families about relapse is fundamental for the development of relapse risk assessment tools and to guide further research on this topic.

Family Nursing Practice Scale: Portuguese Language Translation, Cross-Cultural Adaptation, and Validation.

Studies of family nursing interventions have shown positive results for the health of individuals and families. To increase the availability of instruments that evaluate the practice of family nursing, this research adapted and validated the Family Nursing Practice Scale (FNPS) for use in Brazil with a sample of 144 hospital nurses using a cross-sectional design. The adaptation process involved back-translation, validation by a committee of experts, and semantic analysis. Content validity was analyzed through the content validity coefficient (CVC); construct validity was analyzed by exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and convergent and discriminant validation through average variance extracted (AVE). The reliability of the measure was evaluated using Cronbach's alpha index and composite reliability (CR). The results indicate that the adapted version of FNPS is recommended for family nursing research, education, or clinical practice with Brazilian nurses.

Predictors of Expressed Emotion in First Episode Psychosis.

This article evaluated the predictors of EE and its components, EOI and CC, in relatives of first episode psychosis patients (FEP) in Brazil. Cross-sectional observational study conducted with 82 dyads of FEP patients and their relatives. Data collection instruments: sociodemographic and clinical data questionnaire, Family Questionnaire, Zarit Burden Interview and Morisky Medication Adherence Scale. Logistic and linear regression models were used. Our results indicate that patient's age, relative's sex, daily time spent together, and family burden were predictors of EE and its components. Our findings may be helpful in planning nursing interventions to reduce EE and prevent psychotic relapses.

Family experiences in the identification of the first-episode psychosis in young patients.

The study aimed to understand the family experience in the identification of the first-episode psychosis in young family members. Qualitative research using symbolic interactionism and narrative. Data were collected through depth interview with 13 relatives of 11 young patients treated for the first-episode psychosis. The families showed behavior consistent with the meanings they gave to the disease process of the young relatives, represented by categories: "waiting move: trying to justify the behavior of the adolescent", "not understanding the psychosis", and "seeking help". This research fostered the understanding of how families decided to seek help in the healthcare system. The nursing interventions with these families could contribute to early detection and beginning of treatment.

Expressed emotion of family members and psychiatric relapses of patients with a diagnosis of schizophrenia. / Emoção expressa de familiares e recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia.

OBJECTIVE: Assess the relationship between psychiatric relapses of patients with a diagnosis of schizophrenia, the levels of expressed emotion among their relatives and related factors. METHOD: Prospective study carried out at a mental health outpatient clinic and two Psychosocial Care Centers, with patients and relatives responding to the Family Questionnaire - Brazilian Portuguese Version, a form containing socio-demographic and clinical variables and a structured script to assess relapses. A logistic regression model was used for the analysis. RESULTS: A total of 89 dyads participated in the study. Of the patients investigated, 31% presented relapses and, among the relatives, 68% presented elevated levels of expressed emotion. The relationship between expressed emotion and the relapses was not significant. The logistic regression analysis demonstrated that when there were a higher number of hospital admissions in the two years preceding the study, the chance of the patient relapsing in the 24-month period is 1.34. CONCLUSION: Expressed emotion was insufficient to predict relapses. Thus, a relapse should be understood as a multifactorial phenomenon. These results provide support for interventions and investigations on the multiple factors involved in the evolution of schizophrenia patients in follow-up at community-based health services.

Assistance to families of children with Autism Spectrum Disorders: Perceptions of the multiprofessional team.

OBJECTIVE: to synthesize the care provided by health professionals, at different care levels, to the families of children with Autism Spectrum Disorders. METHOD: a qualitative study, based on the Family-Centered Care philosophical theoretical framework and developed with 22 professionals from three multidisciplinary teams from the Health Care Network of a municipality in the state of Mato Grosso do Sul, Brazil. The data were collected through two focus groups with each team, organized with the support of the Atlas.ti 8 Qualitative Data Analysis® software and submitted to Thematic Content Analysis. RESULTS: the findings show actions centered on specific situations, especially on the demands and needs arising from the child's care and atypical behavior. Influencing factors for family care, such as work overload and little professional experience, show the weakness of multiprofessional care and the invisibility of the family as a care unit. CONCLUSION: the need is highlighted to review functioning of the network for the multiprofessional care of children and their families and how such network is organized. It is recommended to offer permanent education actions that contribute to the qualification of multiprofessional teams in the care of families of children in the autism spectrum.

[Psychiatric hospitalization and maintaining the treatment outside the hospital]. / Internação psiquiátrica e a manutenção do tratamento extra-hospitalar.

The objective of this study was to identify common features between people that have been recently discharged from psychiatric hospitalization. A quantitative exploratory study was performed at an outpatient mental health service center. The sample was comprised by patients who had recently been discharged. A questionnaire was used and the study was approved by the Review Board. Interviews were performed with 48 patients who were in average 39 years old. Diagnosis for Schizophrenia and Schyzotypal Disorders were prevalent for 33.3% of the sample. An average 13 patients were discharged from psychiatric hospitalization every month, 62.5% of which had been previously hospitalized. In the studied period, 12.5% of the sample required rehospitalization. Psychiatric hospitalization proved to be a necessary resource in crisis episodes and as part of the psychiatric treatment, especially of severe mental disorders. It is evinced that there is a need for adequate treatment maintenance in community health care services to avoid the need of rehospitalizations.

[Mental health care today]. / O cuidado em saúde mental na atualidade.

The objective of this study was to identify the sociodemographic characteristics of caregivers to people who have been discharged from psychiatric hospitalization. A quantitative exploratory study was performed at an outpatient clinic of a mental health service. The sample consisted of patients who had been discharged and their caregivers. A questionnaire was used, and the study was approved by the local research ethics committee. Of the 48 discharged patients, 21 had a caregiver. All the identified caregivers were relatives of the patients, and their average age was 46.6 years. In 38% of cases, the patient's mother was the caregiver. In terms of marital status, 61.9% of the caregivers were married or living in common-law relationships, and only one caregiver did not have children. The main source of income for 28.6% of the participants was temporary keeping eventual jobs. By knowing who is the caregiver of a patient discharged from psychiatric hospitalization it is possible to identify the characteristics that may help to determine the best treatment and professional support for that population.

[Schizophrenia: adherence to treatment and beliefs about the disorder and the drug treatment]. / Esquizofrenia: adesão ao tratamento e crenças sobre o transtorno e terapêutica medicamentosa.

This study verified the adherence of people with schizophrenia to the medication, identified and compared their beliefs about the disorder and the drug among patients who adhered and those who did not. Participants were 14 patients of a psychiatric outpatient clinic. Semi-structured interviews and the Morisky-Green test were performed. The data was analyzed using a quali-quantitative approach. Results showed that 64.3% of patients do not adhere to treatment. Most participants considered the drug capable of reducing the seriousness and severity of the disorder. However, the drawbacks for patients that did not adhere to the treatment were more expressive. Side effects were the cause for interrupting the treatment for 80% of patients who intentionally did not adhere to treatment. It was observed there is insufficient knowledge about schizophrenia and the drug treatment. Patients referred to faith as a strategy to cope with the process they were experiencing. This study points at the need for strategies directed towards the promotion of drug treatment adherence among people with schizophrenia.

Meaning of aging for caregivers of senile elderly people.

OBJECTIVES: to understand the meaning of aging for caregivers of senile elderly people. METHODS: qualitative study carried out with 12 caregivers of elderly people registered in the Home Care Service, adopting the Explanatory Model of Kleinman's Disease as a theoretical framework. Data were collected from April to June 2019, through semi-structured, audio-recorded interviews, carried out at home and submitted to content analysis. RESULTS: taking care of senile elderly people triggers reflections on aging that sometimes lead to a new meaning of this process, besides stimulating the recognition of the factors that influence it, with emphasis on the life history, occupation and deleterious behaviors adopted throughout life. FINAL CONSIDERATIONS: the care experience influences the meaning attributed to aging, favoring: the identification of modifiable and non-modifiable aspects and behaviors that make it healthy; reflection on aging itself, with a new meaning of habits and behaviors to be adopted.

Family resilience: perception of family members of psychoactive substance dependents.

OBJECTIVE: to understand the perception of family members of psychoactive substance dependents on the elements of the functioning of their family in family resilience. METHOD: a qualitative approach study, based on the theoretical interpretive framework of family resilience from a systemic perspective. The participants were eleven family members of psychoactive substance dependents from a Psychosocial Care Center - Alcohol and Drugs, from a city in the state of São Paulo. For data collection, semi-structured interview, genogram and ecomap were used. Data analysis was based on the Content Analysis technique, thematic category. RESULTS: from the interviews, three thematic categories were formulated: mobilization in search of support and social support; positive perspectives that would strengthen the family, and assertive communication. These categories point to references to the mobilization and unity of the family in search of social support in the intra-family, extended family and extra-family contexts and positive perspectives, such as persistence, perseverance, hope, faith and religiousness. CONCLUSION: the situation of having a psychoactive substance dependent in the family seemed to mobilize coping devices and attempts to overcome them through the resilience forces. The results may favor the daily clinical reasoning of the health professionals, helping them to recognize and value the identified resilience attributes.

[Care for family caregivers living with alcoholics through the problem solving technique]. / Assistência ao familiar cuidador em convívio com o alcoolista, por meio da técnica de solução de problemas.

The aim of this study was to offer training to family caregivers of alcoholic patients through the problem solving technique. This was a descriptive study, in which eight family caregivers participated. Three meetings were held, which addressed themes such as: behavioral changes and exhaustion of those giving care. From these meetings, feelings emerged which were mobilized by the situation of behavioral changes; self care of the caregiver by sharing responsibilities with relatives and other people and the search for specialized care. Study participants considered the proposed intervention as positive, since it allowed them to reflect on their experiences and their potential to cope with difficulties. It is believed that nurses trained for care delivery to family caregivers should explore this area.

[Assessment of alcohol use in families of the suburbs of Guayaquil City, Ecuador, by nursing students]. / Evaluación del uso de alcohol por familias de la periferia de Guayaquil en Ecuador, por estudiantes de enfermería.

The aim of this study was to present the demographic and alcohol use profiles of families assessed by nursing students during the Community and Family Nursing Program. This is a case study using The family assessment questionnaire as its data source, which was applied by nursing students to assess family health conditions, during their practical training. Family selection was by convenience according to risk indicators and poverty, assessed from the outside condition of the dwelling or from public health services records of the area. A questionnaire correlated with the one that students applied was prepared to obtain data. This instrument obtained information about the socioeconomic profile, family environment and alcohol consumption. The Alcohol Use Disorder Identification Test (AUDIT) was applied to families that reported alcohol use. Of the 128 families evaluated by students we found 47 families who reported alcohol consumption, these families answered AUDIT, the average total score was 10.66 which equates to risk level 2. The suggested intervention for this level of risk is simple counseling that can be offered by nurses in the primary health care.

Family experiences in discovering Autism Spectrum Disorder: implications for family nursing.

OBJECTIVES: to describe the family's experience in the process of discovering the diagnosis and initiation of treatment of children with Autism Spectrum Disorder. METHODS: this qualitative and descriptive study interviewed nine relatives of eight children on autism spectrum. They were inserted in health services, public education, and Association of Parents and Friends of The Exceptional of cities in the countryside of the Center-West. Data were collected through open interviews from July to September 2017. Data was submitted to thematic analysis. RESULTS: at the beginning, the family was difficult to perceive the first atypical signs presented by the children. Families experience situations of vulnerability, since support networks are insufficient. The school played a significant role in recognizing unexpected behaviors. FINAL CONSIDERATIONS: support, offered by nurses, health professionals, school and social support devices, is important to family and children in this trajectory.

Brazilian transgender children and adolescents: Attributes associated with quality of life.

OBJECTIVE: to describe attributes associated with the Quality of Life of Brazilian transgender children and adolescents according to their own perception. METHOD: descriptive study conducted with 32 participants between eight and 18 years old, who were either interviewed or participated in focus groups. The statements were transcribed, grouped with the aid of the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software, version 0.7 alpha 2 and described according to the definition of Quality of Life by the World Health Organization concerning to the mental, physical, and social dimensions. RESULTS: it was possible to identify the family nucleus as the main social support for transgender children and adolescents. However, the experience of prejudice and discrimination were negative attributes associated with Quality of Life. CONCLUSION: the statements indicate that lives of transgender children and adolescents are impacted by social, physical, and mental factors due to the stigma and discrimination experienced. It is expected to contribute to the formulation of public policies related to transgender children and adolescents and expand the discussion on the citizens' duties and rights in relation to transsexuality.

Contexts of vulnerabilities experienced by adolescents: challenges to public policies.

OBJECTIVES: to understand the context of vulnerability experienced by adolescents from the perspective of health professionals from the Family Health Strategy. METHODS: a descriptive-exploratory qualitative study developed with 80 Family Health Strategy professionals in the Midwest region of Brazil. Data collection was developed from July to September 2018 through a focus group, and submitted to Thematic Analysis. RESULTS: it was understood that the vulnerability experienced by adolescents is not an exposure to something isolated, but is linked to risk and protection factors, socioeconomic and cultural contexts, public and health policies. FINAL CONSIDERATIONS: there are still gaps in public policies for this population, which impacts on the access and development of promotion actions by health professionals.

[Mental patients and their profile of compliance with psychopharmacological treatment]. / Doentes mentais e seu perfil de adesão ao tratamento psicofarmacológico.

Non-compliance with drug-based treatment is a complex and universal phenomenon that develops gradually during psychiatric treatments, and is related to disease aggravation. The purpose of this study was to describe the profile of using a given medication in the clientele of a community mental healthcare service and its characteristics. We performed a retrospective study in the medical records of patients who used Haloperidol Decanoate in a period of 1 year and 8 months. 167 medical records were analyzed. 60% of the patients presented irregular use of medication, which reflects in high risks of relapse and re-hospitalizations. This profile configures low compliance with the prescribed drug treatment, leading to reflections about which factors influence this behavior and which measures could be implemented in the maintenance of extra-hospital treatment for these patients.

[The use of the Calgary Model for assessment of families of the aged in clinical practice]. / Aplicação do Modelo Calgary para avaliação de famílias de isodos na prática clínica.

This qualitative study has as objective to present the experience to assessment of the families of dependent aged under the systemic approach. The Calgary Model was used as theoretical framework and as methodological strategy the case study. The data had been collected with five families of dependent older person, from September of December of 2005, by means of the instrument elaborated previously. The application of this model allowed doing the familiar analysis raising the main aspects of its structure, development and functioning. We believe that the nurse must search endorsement in the scientific literature and adopts pertinent instruments to contribute for the development of its abilities to do the familiar approach.

Caregiver burden and stress in psychiatric hospital admission.

OBJECTIVE: to evaluate the relation between sociodemographics factors, stress and burden of care of family caregivers of patients at a psychiatric hospital admission. METHOD: quantitative study, with a cross-sectional correlation design. A total of 112 family caregivers participated, older than 18, in a Brazilian psychiatric hospital. A sociodemographic questionnaire was used to collect data, the Zarit Burden Interview and LIPP Adult Stress Symptom Inventory. RESULTS: burden of care in family caregivers at a psychiatric hospital admission was significantly associated with stress (p=0.000). The psychological symptoms of stress predicted severe burden. Most caregivers presented a moderate or severe burden, with 52.7% in the resistance phase of stress; 66.1% presented psychological symptoms. CONCLUSION: results show the alarming situation of caregivers of patients from a psychiatric hospital, evidencing their own vulnerability to illness. Indeed, the during admission in a psychiatric hospital, not only patients need care, but also their caregivers.