O sofrimento psíquico em relatos de usuários de saúde mental / Psychic suffering in reports of mental health users / El sufrimiento psíquico en relatos de usuarios de salud mental

Na história da humanidade, a loucura foi concebida de diversas formas. Atualmente a Reforma Psiquiátrica propõe a construção de um novo lugar social para a loucura, concebendo-a como sofrimento psíquico. Para compreender como os usuários de saúde mental a concebem, fizemos uma pesquisa com o objetivo de analisar como essas pessoas produzem sentidos sobre o sofrimento psíquico em vídeos de domínio público. Para desenvolver esta pesquisa, adotamos a perspectiva teórico-metodológica da proposta de estudo da produção de sentidos a partir da análise das práticas discursivas. Trata-se de uma investigação de natureza qualitativa, com caráter exploratório, para cujo desenvolvimento foi feito uma pesquisa documental. Foram utilizados os videodocumentários 'A loucura entre nós' e 'Estamira' e a Conferência 'I am not a monster: schizophrenia'. Nos relatos analisados, os usuários referenciaram o sofrimento psíquico recorrendo ao discurso da Psiquiatria e à utilização de medicamentos, no entanto, alguns se posicionaram contrariamente a esse saber.

In the history of humanity, madness has been conceived in different ways. Currently, the Psychiatric Reform proposes the construction of a new social place for madness, conceiving it as psychic suffering. In order to understand how mental health users conceive it, we carried out a research with the aim of analyzing how these people produce meanings about psychic suffering in videos in the public domain. In order to carry out this researchwe dopted the theoretical-methodological perspective of the study proposal of the production of meanings from the analysis of discursive practices. This is a qualitative investigation with an exploratory approach for which a research of documents was carried out. The video documentaries "Madness among us", "Estamira" and the Conference "I am a monster: schizophrenia" were used, however, some of the subjects referred to psychic suffering using the internment Psychiatry jargon, mentioning the use of medicines. However, some of them took a position against this practice. (AU)

En la historia de la humanidad, la locura se ha concebido de diferentes maneras. Actualmente, la Reforma Psiquiátrica propone la construcción de un nuevo lugar social para la locura, concibiéndola como sufrimiento psíquico. Realizamos una investigación con el objetivo de analizar cómo los usuarios de salud mental producen sentidos sobre el sufrimiento psíquico en videos de dominio público. Para ello, adoptamos laperspectiva teórico-metodológica de la propuesta deestudio dela producción de sentidos a partir del análisis de las prácticas discursivas. Se trata de una investigación cualitativo, con carácter exploratorio, para cuyo desarrollo se realizó una pesquisa documental. Se utilizaron los video documentales: "A loucura entre nós", "Estamira"y la Conferencia "I am not a monster: schizophrenia". En los relatos analizados, los usuarios se refirieron al sufrimiento psíquico recurriendo al discurso de la Psiquiatría y a la utilización de medicamentos. No obstante, algunos tomaron posición contraria a ese conocimiento. (AU)

Abordar a la persona entre trayectorias alcohólicas y tratamientos / Approaching the person between alcoholic trajectories and treatments

Este artículo es un trabajo de investigación etnográfica en el campo sanitario. Sus objetivos son reconstruir trayectorias de personas con trastornos mentales y de comportamiento por uso de alcohol y visibilizar representaciones y prácticas en los tratamientos brindados en el Hospital Vilardebó (Uruguay), en torno a dichos itinerarios. Las narrativas de los pacientes estudiados dan cuenta de una ruptura biográfica ocurrida mayoritariamente en la adolescencia, cuando comienza un consumo problemático de alcohol que lleva a una reorganización de la identidad social de orden simbólico; refirieren también, la mayoría de ellos, estar disconformes con la asistencia que se les brinda, y reclaman ser más escuchados. Por otra parte, en lo referente a las representaciones formuladas por los funcionarios entrevistados, a mayor formación y experiencia de ejercicio profesional, hay mayores críticas a la atención que se brinda a estos usuarios. De ahí que la confluencia de Antropología y Salud, ensamblando cultura y cuidado, permite integrar a las dimensiones físicas los aspectos emocionales, familiares, culturales y sociales.

This article is carries out ethnographic research in the sanitary field. Its objectives are to reconstruct the trajectories of people with mental and behavioral disorders due to alcohol use and to make visible representations and practices in treatments provided at Hospital Vilardebó (Uruguay). Patients' narratives show a biographical rupture occurring mainly during adolescence. Problematic alcohol use begins soon after, leading to a reorganization of symbolic social identity. Most patients are not satisfied with care provided, and demand to be listened to more extensively. As for health care workers' representations, the greater the training and professional expertise, the greater the criticism of provided care. Hence, the confluence of Anthropology and Health, combining culture and care, makes possible the emotional, family, cultural and social aspects to be integrated into the physical ones.

Health risk behaviours among people with severe mental ill health during the COVID-19 pandemic: Analysis of linked cohort data.

BACKGROUND: People with severe mental ill health (SMI) experience a mortality gap of 15-20 years. COVID-19 has amplified population health inequalities, and there is concern that people with SMI will be disproportionately affected. Understanding how health risk behaviours have changed during the pandemic is important when developing strategies to mitigate future increases in health inequalities. METHODS: We sampled from an existing cohort of people with SMI. Researchers contacted participants by phone or post to invite them to take part in a survey about how the pandemic had affected them. We asked people about their health risk behaviours and how these had changed during the pandemic. We created an index of changed behaviours, comprising dietary factors, smoking, lack of exercise, and drinking patterns. By creating data linkages, we compared their responses during pandemic restrictions to responses they gave prior to the pandemic. OUTCOMES: 367 people provided health risk data. The mean age of the participants was 50.5 (range = 20 to 86, SD ± 15.69) with 51.0% male and 77.4% white British. 47.5% of participants reported taking less physical activity during the pandemic and of those who smoke 54.5% reported smoking more heavily. Self-reported deterioration in physical health was significantly associated with an increase in health risk behaviours (adjusted OR for physical health 1.59, 95%CI 1.22-2.07; adjusted OR for Age 0.99, 95%CI 0.98-1.00). INTERPRETATION: COVID-19 is likely to amplify health inequalities for people with SMI. Health services should target health risk behaviours for people with SMI to mitigate the immediate and long lasting impacts of the COVID-19 pandemic.

Histórias de vida e estigma de trabalhadores com transtornos mentais acompanhados em ambulatório especializado / Life stories and social stigma of workers with mental disorders followed up in a specialize outpatient clinic in Campinas, Brazil

Este estudo de abordagem qualitativa teve como objetivo conhecer, analisar e compreender como a retirada de direitos sociais e trabalhistas interferiu na vida e no trabalho de pessoas com transtornos mentais graves. Foram realizadas entrevistas em profundidade com 11 participantes, oito homens e três mulheres, atendidos(as) em um ambulatório de Psiquiatria de um hospital universitário, com uso de roteiro semiestruturado, e realizou-se análise de conteúdo. Os resultados indicam que a trajetória de trabalho dos(as) participantes iniciou-se na infância e adolescência, de modo que todos exerciam atividades de trabalho quando receberam o diagnóstico. A necessidade de afastamento, as dificuldades relacionadas ao retorno e a retirada de parte das pessoas do mundo do trabalho foram evidenciadas. Em face disso, foram discutidos os prejuízos sociais e trabalhistas após o diagnóstico de transtorno mental relatados pelos participantes. O processo de estigmatização apareceu no ambiente de trabalho, familiar e comunitário e contribuiu para o declínio da carreira e remuneração ou para a saída dos trabalhadores de suas atividades.

This qualitative approach study aimed to know, analyze, and understand how the withdrawal of social and labor rights interfered in the life and work of people with severe mental disorders. In-depth interviews with eleven participants, eight men and three women who were assisted at a psychiatric outpatient clinic of a university hospital, were performed. Semi-structured script interviews were conducted and content analysis was performed. The results indicate that the work trajectory of the participants began in childhood and adolescence, so that all performed work activities when they received diagnosis. The study highlighted the need for medical leave, the difficulties related to the return, and the withdrawal from work environment of part of the people interviewed. In view of this, the social and labor losses after the diagnosis of mental disorder reported by the participants were discussed. The stigmatization process manifested in their work, family and community environments and contributed to the decline in career and remuneration or to the withdrawal from their activities.

Construindo um dispositivo coletivo em oficinas na Saúde Mental / Building a collective device in Mental Health workshops / Construyendo un dispositivo colectivo en oficinas en la Salud Mental

Este texto é um relato de experiência profissional em que se construiu coletivamente um dispositivo denominado "Planilha da Vida Ocupacional" para acompanhar e analisar a produção de trabalho de pessoas com transtornos mentais em oficinas de geração de trabalho e renda do Núcleo de Oficinas e Trabalho. Optou-se pelo percurso metodológico cartográfico para narrar essa experiência. No processo de responder a um questionamento sobre a missão do equipamento de saúde, além de refletir sobre o progresso dos oficineiros, a equipe de profissionais também produziu sentidos para o seu próprio trabalho. São apontados como frutos dessa construção a visibilidade dada ao cuidado ampliado ao oficineiro, a possibilidade de reflexão sobre o próprio trabalho, a perspectiva interdisciplinar de atuação e o amadurecimento da equipe. As discussões pretendem contribuir com a Reforma Psiquiátrica brasileira.

This article presents an account of professional experience in which a device called "Occupational Life Worksheet" was collectively developed to monitor and analyze the work and health production of people with mental disorders during their work on employment and income generation workshops in Núcleo de Oficinas de Trabalho. To narrate this experience we opted for the cartographic method. During the process of responding to a questioning about the mission of health equipment, in addition to reflecting on the progress of the patients, the team of professionals also produced meanings for their own work. The possibility for the professional team to think about their own work, the perspective of interdisciplinary actions, the improvement of professional team and the visibility given to the patients care are results of the development process of this worksheet. The discussions aim to contribute to the Brazilian Psychiatric Reform.

Este artículo presenta un relato de experiencia profesional en lo cual se construyó colectivamente un dispositivo denominado "Planilha da Vida Ocupacional" (Hoja de Cálculo de la Vida Ocupacional) para acompañar y analizar la producción de trabajo y salud de personas con trastornos mentales en talleres de generación de trabajo e ingresos del "Núcleo de Oficinas e Trabalho" (Núcleo de Talleres y Trabajo). Se optó por el recorrido metodológico cartográfico para narrar esa experiencia. En el proceso de contestar un cuestionamiento sobre la misión del equipamiento de salud, además de reflexionar sobre el progreso de los alumnos, el equipo de profesionales también produjo sentidos para su proprio trabajo. Son señalados como fruto de esa construcción la visibilidad destinada al cuidado ampliado al alumno, la posibilidad de reflexionar acerca del proprio trabajo, la perspectiva interdisciplinar de actuación y la maduración del equipo. Las discusiones tienen como objetivo contribuir con la Reforma Psiquiátrica brasileña.

Perfil social y económico de los pacientes diagnosticados con trastornos del humor del Hospital Departamental Psiquiátrico Universitario del Valle, Cali / Social and economic profile of patients diagnosed with Mood disorders at the hospital Departamental psiquiátrico Universitario del Valle-Cali"

El objetivo de este artículo consiste en dar a conocer un perfil social, económico y demográfico de la población registrada con SISBÉN en el Hospital Departamental Psiquiátrico Universitario del Valle (HDPUV) entre el 2009 y el 2018, cuyo diagnóstico se encuentra dentro del grupo de los trastornos del humor (correspondiente al espectro de códigos del CIE-10 que va desde F30 a F39, episodio maníaco, trastorno bipolar, episodio depresivo, trastorno depresivo recurrente, trastorno del humor persistente, otros trastornos del humor, trastorno del humor sin especificación). Se optó por un trabajo en el que se complementó la información entre las bases de datos del SISBÉN de Cali y la del HDPUV para profundizar en datos sobre pobreza y vulnerabilidad de las personas que son potenciales beneficiarios de programas sociales estatales. Se identificaron 5.280 pacientes diagnosticados con trastornos del humor, en su mayoría mujeres (70,4 %) en condiciones de vulnerabilidad económicas, sociales y de acceso a servicios de salud, que representan otro factor más de riesgo para su salud mental.

The aim of this article is to provide a social, economic and demographic profile of the population registered with SISBÉN at the Hospital Departamental Psiquiátrico Universitario del Valle (HDPUV) between 2009 and 2018, whose diagnosis is within the group of mood disorders, (corresponding to the spectrum of ICD- 10 codes ranging from F30 to F39, manic episode, bipolar disorder, depressive episode, recurrent depressive disorder, persistent mood disorder, other mood disorders, mood disorder without specification). We opted for a study in which we complemented the information between the Cali SISBÉN and HDPUV databases to deepen in data on poverty and vulnerability of people who are potential beneficiaries of state social programs. We identified 5,280 patients diagnosed with mood disorders, mostly women (70.4%) in conditions of economic, social and access to health services vulnerability, which represent yet another risk factor for their mental health.

Challenges and opportunities in the science of research to practice: lessons learned from a randomized controlled trial of a sexual risk-reduction intervention for psychiatric patients in a public mental health system

Objective: Human immunodeficiency virus (HIV) prevention efficacy trials with psychiatric patients have been conducted in research settings in high-resourced countries, establishing short-term efficacy for reducing sexual risk behavior. None has been implemented within systems of care. In the last decade, overcoming this research-to-practice gap has become a focus of implementation science. This paper describes the first and only HIV Prevention intervention trial for psychiatric patients conducted in real-world outpatient psychiatric settings facilitated by trained clinic-based providers. Methods: The HIV Prevention intervention, which uses the Information-Motivation-Behavioral Skills model to achieve sexual risk-reduction, was rigorously adapted to the local context and clinic services' needs. Participants from eight clinics were randomized to HIV Prevention or Health Promotion conditions. Results: HIV Prevention participants showed significant improvement in Information-Motivation-Behavioral domains; in this group, behavioral intentions were associated with significantly fewer unprotected sex occasions, but reduction of unprotected sex occasions was similar in both conditions. Conclusion: Our trial was conducted before implementation studies became widely funded. Transporting an intervention to a new culture or into real-world practice settings may require adaptations. Our results demonstrate that clear guidelines are needed regarding whether to conduct efficacy, effectiveness, and/or implementation research as the most appropriate next step. Clinical trial registration: NCT00881699

Presencia de lesiones orales en pacientes con afecciones psicológicas, atendidos en una institución de salud / Presence of oral lesions in a group of patients with psychological disorders attending a health institution

Introducción: El liquen plano oral, la estomatitis aftosa recurrente y el síndrome boca urente constituyen entidades patológicas bucales que presentan relación con afecciones psicológicas. Objetivo: Describir la presencia de liquen plano oral, estomatitis aftosa recurrente y síndrome de boca urente en pacientes con afecciones psicológicas atendidos en una institución de salud. Métodos: Se realizó un estudio descriptivo de corte transversal, obteniéndose una población de 35 pacientes seleccionados mediante un muestreo no probabilístico por criterio de 26 pacientes aquellos que fueron remitidos del área de psicología (bajo un test de diagnóstico psicológico) al servicio de estomatología, con lesiones orales antes descritas. Bajo la firma de un consentimiento informado fueron tratadas y evolucionadas en un periodo de 16 meses. Se tuvieron en cuenta las consideraciones éticas basadas en la resolución 008430 de 1993, tratado de Helsinki. Resultados: En cuanto a la frecuencia, la lesión bucal que más se presentó fue la estomatitis aftosa recurrente en un 65,3 por ciento, las aftas mayores en un 38,4 por ciento, seguido de un tipo aftas menores en un 26,9 por ciento, entre otras lesiones en menor frecuencia. Los diagnósticos psicológicos evidenciados fueron estrés, depresión y ansiedad, en diferentes proporciones, mostrándose como lesión más frecuente dentro de estas entidades psicológicas, la estomatitis aftosa recurrente. No existió asociación estadística entre las variables orales y las psicológicas por mostrar valores de p >0,005. Conclusiones: Existió la presencia de liquen plano oral, la estomatitis aftosa recurrente y el síndrome boca urente en alteraciones psicológicas como estrés, ansiedad y depresión, con mayor frecuencia la estomatitis aftosa recurrente(AU)

Introduction: Oral lichen planus, recurrent aphthous stomatitis and burning mouth syndrome are oral conditions related to psychological disorders. Objective: Describe the presence of oral lichen planus, recurrent aphthous stomatitis and burning mouth syndrome in patients with psychological disorders attending a health institution. Methods: A descriptive cross-sectional study was conducted of a population of 35 patients, of whom 26 were selected by criterion nonprobability sampling and referred from the psychology service (based on a psychological diagnosis test) to the dental care service due to the presence of the aforementioned oral lesions. Upon granting their informed consent, the patients were treated and followed up for 16 months. Ethical provisions from Resolution 008430 of 1993, the Helsinki Declaration, were complied with. Results: In terms of frequency, the most common oral lesion was recurrent aphthous stomatitis with 65.3 percent. Major aphthas represented 38.4 percent. and aphthas of a minor type 26.9 percent.; other lesions had a lower frequency. The psychological diagnoses achieved were stress, depression and anxiety to various degrees, and the most common lesion for these psychological disorders was recurrent aphthous stomatitis. No statistical association was found between oral and psychological variables, for they showed values of p >0.005. Conclusions: The presence of oral lichen planus, recurrent aphthous stomatitis and burning mouth syndrome was determined in psychological disorders such as stress, anxiety and depression. Of these oral lesions, recurrent aphthous stomatitis was the most common(AU)

Gestão autônoma da medicação: saberes e visibilidades de usuários de saúde mental em universidades no interior do RS / Autonomous medication management: knowledge and visibilities of mental health users at universities in the countryside of RS/Brazil / Gestión autónoma de la medicación: saberes y visibilidades de usuarios de la salud mental en universidades en el interior del RS/Brasil

Este artigo abordou os efeitos de uma pesquisa da estratégia da Gestão Autônoma da Medicação em usuárias(os) da saúde mental que passam a ocupar o lugar de palestrantes em ambientes acadêmicos no interior do RS. Por objetivo geral pretendeu analisar como se constituíram esses investimentos e visibilidades no saber das(os) usuárias(os) para frequentarem essas universidades. Também intentou-se descrever as relações de saber e poder e os limites da prática de autonomia nas salas de aula. Por uma abordagem de inspiração foucaultiana, mapeouse o campo estratégico produzido pela pesquisa e os enunciados 'saber no corpo' e 'autonomia' pela experiência de seis participações dessas pessoas como palestrantes. Discute-se a produção de um corpo que encontra outras possibilidades além da relação com o medicamento e a loucura, assim como um processo de autonomia temporária no jogo de forças da ação de uns sobre os outros.

Este artículo abordó los efectos de una investigación de la estrategia de la Gestión Autónoma de la Medicación en usuarias(os) de la salud mental que pasan a ocupar el lugar de oradores en ambientes académicos en una ciudad interiorana del RS, Brasil. Por objetivo general pretendió analizar cómo se constituyeron esas inversiones y visibilidades en el saber de las usuarias(os) para frecuentar esas universidades. También se intentó describir las relaciones de saber y poder y los límites de la práctica de autonomía en las aulas. Por un enfoque de inspiración foucaultiana, se mapeó el campo estratégico producido por la investigación y los enunciados 'saber en el cuerpo' y 'autonomía' por la experiencia de seis participaciones de esas personas como oradores. Se discute la producción de un cuerpo que encuentra otras posibilidades además de la relación con el medicamento y la locura, así como un proceso de autonomía temporal en el juego de fuerzas de la acción de unos sobre otros.

This apper deals with the effects of a research on the strategy of Autonomous Medication Management in mental health users who are now taking the place of lecturers in academic settings in the countrtyside of the district of RS, Brazil. The purpose of the general objective was to analyze how these investments and visibilities were constituted in the knowledge of the users to attend these universities. We also attempted to describe the relations of knowledge and power and the limits of the practice of autonomy in classrooms. Through a Foucauldian-inspired approach, the strategic field produced by the research and the statements 'knowing in the body' and 'autonomy' were mapped by the experience of six participation of these people as lecturers. It discusses the production of a body that finds other possibilities beyond the relation with medicine and madness, as well as a process of temporary autonomy in the role of forces of the action of one on the other.

(Con) viver com a loucura: por um cuidado extramuros / (Co) existing with the madness: for a care outside the walls / (Con) vivir con la locura: Por un cuidado extramuros

O presente texto pretende refletir sobre o dispositivo do Centro de Convivência como uma ferramenta de empoderamento, de auxílio na construção de maior autonomia e promoção da cidadania da pessoa em sofrimento mental. Procura-se pensar a contribuição desse serviço para a efetivação da dimensão sociocultural da Reforma Psiquiátrica brasileira, auxiliando na inserção social do louco, a partir do fomento de atividades laborativas e artísticas e da articulação com diversos setores da sociedade. Assim, por meio da revisão de literatura de legislações sobre o tema, artigos científicos e textos de Conferências e Fóruns da Saúde Mental, busca-se analisar os desafios postos a esse serviço da Rede de Atenção Psicossocial frente a discursos e práticas homogeneizantes em nossa sociedade. Desse modo, verifica-se que, mesmo após grandes avanços da luta antimanicomial para a sensibilização da sociedade sobre a loucura, ainda persiste um imaginário social intolerante à diferença, ao louco. (AU)

The present article intends to reflect how the health mechanism of the Center of Coexistence can be a tool of empowerment, of help in the construction of greater autonomy and promotion of citizenship of the people in mental suffering. It is sought to think about the contribution of this service to the effectiveness at the socio-cultural dimension of the Brazilian Psychiatric Reform, contributing to the social insertion of the people in mental suffering, through the promotion of work and artistic activities and the articulation with various sectors of society. Thus, through the literature review of scientific articles and texts of Mental Health Conferences and Forums we seek to analyze the challenges imposed to this service of Primary Health Care, which works as an open and community space, face to speeches and practices homogenizers in our society. In this way, it is verified that even after great advances of the antimanicomial fight for the awareness of the society on the madness, still persists a social imaginary which is intolerant to the difference, to the madman. (AU)

El presente trabajo se propone reflexionar sobre el dispositivo del Centro de Convivencia como una herramienta de empoderamiento, de ayuda en la construcción de mayor autonomía y promoción de la ciudadanía de la persona en sufrimiento mental. Así, se busca pensar la contribución de ese servicio para la efectividad de la dimensión sociocultural de la Reforma Psiquiátrica brasileña, ayudando en la inserción social del loco, a partir del fomento de actividades laborativas y artísticas y de la articulación con diversos sectores de la sociedad. Por lo tanto, por medio de la revisión de literatura de legislaciones sobre el tema, artículos científicos y textos de Conferencias y Foros de la Salud Mental, se busca analizar los desafíos puestos a ese servicio de la Red de Atención Psicosocial frente a discursos y prácticas homogeneizantes en nuestra sociedad. De ese modo, se verifica que, incluso después de grandes avances de la lucha antimanicomial para la sensibilización de la sociedad sobre la locura, todavía persiste un imaginario social intolerante a la diferencia, al loco. (AU)

Prevalencia del consumo de sustancias psicoactivas y la aparición de la enfermedad mental en adolescentes / Prevalence of psychoactive substance use and mental illness in adolescents / Prevalência de uso de substâncias psicoativas e doenças mentais em adolescentes

Resumen El objetivo de este trabajo es presentar los resultados de una investigación secundaria acerca de la prevalencia del consumo de sustancias psicoactivas (SPA) en la población adolescente con enfermedad mental en comparación con los adolescentes que no padecen enfermedad mental. Se formuló una pregunta según el acrónimo"PICO" (pacientes, intervención, comparación, resultados); posteriormente, se buscó información en distintas bases de datos sugeridas en el curso de Práctica Clínica Basada en la Evidencia, impartido por el Programa de Colaboración para la Investigación de Enfermería Basada en la Evidencia de Costa Rica (CIEBE-CR). Para la búsqueda de información se efectuó una revisión de artículos científicos en Medline Plus, PudMed y EBSCO Host, con el fin de recuperar la mayor cantidad de información. Después de establecer los criterios de inclusión y exclusión y realizar un análisis crítico, se seleccionó cuatro documentos que dieron respuesta a la pregunta planteada. Se detectó 58 documentos relacionados con el tema de los cuales solo cuatro cumplían criterios de calidad que establece el Critical Appraisal Skills Programme español (CASPe) para responder a la pregunta clínica. Se evidencia cómo en la niñez la psicopatología se reconoce cada vez más como un factor de riesgo en cuanto al uso de sustancias psicoactivas. Se concluye que los adolescentes con patología mental tienen una mayor prevalencia al uso de sustancias psicoactivas en comparación con los adolescentes que no padecen enfermedad mental.

Abstract The objective of this paper is to present the results of secondary research on the prevalence of psychoactive substance use (PSA) in the adolescent population with mental illness compared to adolescents who do not suffer from mental illness. A question was formulated according to the acronym "PICO" (patients, intervention, comparison, results); Subsequently, information was sought in different databases suggested in the Clinical Practice Based on Evidence course, taught by the Collaboration Program for Nursing Research Based on the Evidence of Costa Rica (CIEBE-CR). For the search of information, a review of scientific articles was carried out in Medline Plus, PudMed and EBSCO Host, in order to recover the greatest amount of information. After establishing the inclusion and exclusion criteria and performing a critical analysis, four documents that answered the question posed were selected. It was detected 58 documents related to the topic of which only four met quality criteria established by the Spanish Critical Appraisal Skills Program (CASPe) to answer the clinical question. It is evidenced how, in childhood, psychopathology is increasingly recognized as a risk factor in the use of psychoactive substances. It is concluded that adolescents with mental pathology have a higher prevalence of the use of psychoactive substances in comparison with adolescents who do not suffer from mental illness.

Resumo O objetivo deste trabalho é apresentar os resultados da pesquisa secundária sobre a prevalência do uso de substâncias psicoativas (PSA) na população adolescente com doença mental em comparação com adolescentes que não sofrem de doença mental. Uma pergunta foi formulada de acordo com a sigla "PICO" (pacientes, intervenção, comparação, resultados); Posteriormente, a informação foi buscada em diferentes bancos de dados sugeridos no curso de Prática Clínica Baseada na Evidência, ministrado pelo Programa de Colaboração para Pesquisa de Enfermagem com base na Evidência da Costa Rica (CIEBE-CR). Para a busca de informações, foi realizada uma revisão de artigos científicos no Medline Plus, PudMed e EBSCO Host, a fim de recuperar a maior quantidade de informações. Depois de estabelecer os critérios de inclusão e exclusão e realizar uma análise crítica, foram selecionados quatro documentos que responderam à pergunta colocada. Foram detectados 58 documentos relacionados ao tema, dos quais apenas quatro critérios de qualidade estabelecidos pelo Programa Espanhol de Competências de Avaliação Crítica (CASPe) para responder à questão clínica. É evidenciado como, na infância, a psicopatologia é cada vez mais reconhecida como fator de risco no uso de substâncias psicoativas. Conclui-se que os adolescentes com patologia mental têm maior prevalência do uso de substâncias psicoativas em comparação com adolescentes que não sofrem de doença mental.

Adapting, Pilot Testing and Evaluating the Kick.it App to Support Smoking Cessation for Smokers with Severe Mental Illness: A Study Protocol.

(1) Background: While the prevalence of tobacco smoking in the general population has declined, it remains exceptionally high for smokers with severe mental illness (SMI), despite significant public health measures. This project aims to adapt, pilot test and evaluate a novel e-health smoking cessation intervention to assist relapse prevention and encourage sustained smoking cessation for young adults (aged 18⁻29 years) with SMI. (2) Methods: Using co-design principles, the researchers will adapt the Kick.it smartphone App in collaboration with a small sample of current and ex-smokers with SMI. In-depth interviews with smokers with SMI who have attempted to quit in the past 12 months and ex-smokers (i.e., those having not smoked in the past seven days) will explore their perceptions of smoking cessation support options that have been of value to them. Focus group participants will then give their feedback on the existing Kick.it App and any adaptations needed. The adapted App will then be pilot-tested with a small sample of young adult smokers with SMI interested in attempting to cut down or quit smoking, measuring utility, feasibility, acceptability, and preliminary outcomes in supporting their quit efforts. (3) Conclusions: This pilot work will inform a larger definitive trial. Dependent on recruitment success, the project may extend to also include smokers with SMI who are aged 30 years or more.

The clinical impact of a positive family history of psychosis or mental illness in psychotic and non-psychotic mentally ill adolescents.

BACKGROUND: A family history of psychosis is associated with negative clinical characteristics of psychosis. AIM: We aimed to determine the relationship between a family history (in first-degree relatives) of psychosis (FHP) or of any mental illness (FHM), and the clinical features (including cannabis use) of first episode early onset psychosis (EOP). METHOD: Forty-five adolescents with first episode EOP presenting to psychiatric services were assessed by clinical interview with the following tools: socio-demographic questionnaire, Positive and Negative Syndrome Scale (PANSS), Symptom Onset in Schizophrenia (SOS) inventory, and the World Health Organisation's (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) for cannabis misuse. Forty-five gender and age matched controls with incident non-psychotic mental illness were recruited from the same clinical sites. RESULTS: While there was evidence of trend associations, EOP adolescents and controls did not differ in terms of either FHP or FHM. However, adolescents with a non-psychotic mental illness (controls) were significantly more likely to have a family history of non-psychotic mental illness (EOP = 13%; controls = 47%, p = 0.001). In EOP adolescents, a positive FHP was associated with a significantly lower mean PANSS positive score (p = 0.009), but not with other clinical features. CONCLUSION: FHP may be a diagnostic clue in adolescents and is not necessarily associated with negative clinical characteristics at disease onset in EOP. However, this requires further research.

Medidas coercitivas desde el punto de vista psicológico del paciente / Coercive measures from patients' psychological point of view

Introducción: se han hallado dos herramientas de evaluación fiables y válidas que miden las repercusiones psíquicas que las técnicas coercitivas tienen sobre los pacientes mentales. La existencia de estas herramientas habilita la continuidad en la investigación sobre la temática. Objetivo: revisar las preferencias de los pacientes de las instituciones de salud ante las distintas medidas coercitivas. Métodos: se realizó una búsqueda bibliográfica sistemática en bases de datos digitales y otras fuentes. Se realizó revisión por pares de los trabajos, utilizando como criterio temático de inclusión, la pertinencia en los temas a tratar. Tras el examen del resumen, cuerpo y conclusiones, se seleccionaron aquellos cuyo contenido se refería a: (1) las vivencias de los pacientes y personal cuando se aplicaban las medidas coercitivas; (2) preferencias de los pacientes sobre estas; (3) medidas preventivas; y (4) cuidados necesarios. Desarrollo: Los estudios revisados apuntan al peligro ético que desarrolla el uso o la mala aplicación de estos protocolos coercitivos. Se debe tener en cuenta que la integridad física del personal sanitario también corre peligro en el tratamiento de pacientes psiquiátricos. En esta disyuntiva entre preservación de la dignidad del paciente y seguridad del personal, han sido propuestas diversas medidas tanto accesorias/compensatorias como sustitutivas de estas técnicas perjudiciales para la salud mental de los pacientes. Conclusiones: La comunicación entre el personal que implementa estas medidas y el paciente que las recibe, es esencial para una buena alianza terapéutica y el correcto desarrollo del tratamiento(AU)

Introduction: Two reliable and valid assessment tools have been found that measure the psychic impact of coercive techniques on mental patients. The existence of these tools enables continuity in research on the subject. Objective: This paper reviews the preferences of the patients of the health institutions about different coercive measures. Methods: A systematic bibliographic search was carried out in digital databases and other sources. Peer review of the works was carried out, using as a thematic criterion of inclusion, the relevance in the topics to be treated. After examining the summary, body and conclusions, those whose content referred to were selected: (1) the experiences of the patients and staff when the coercive measures were applied; (2) patients' preferences about these; (3) preventive measures; and (4) necessary care.. Body: The studies reviewed point to the ethical danger that leads to the use or misapplication of these coercive protocols. It should be taken into account that the physical integrity of health personnel is also at risk in the treatment of psychiatric patients. In this dilemma between the preservation of the patient's dignity and the safety of the personnel, various measures have been proposed, both ancillary and compensatory, as well as substitute for these techniques that are detrimental to the mental health of patients. The purpose of these measures is to avoid the use of these coercive techniques. Conclusion: communication between the personnel implementing these measures and the patient receiving them is essential for a good therapeutic alliance and the correct development of the treatment(AU)

[Smoking policy in mental health care]. / Rookbeleid in de ggz; documentonderzoek en enquête.

BACKGROUND: People with mental illnesses tend to smoke more often and more heavily than other members of the public and their addiction to tobacco also has harmful effects on their physical health. So far, however, limited priority was given to smoking cessation in mental health care settings. AIM: To provide insight into the formal and informal smoking policies of Dutch mental health care organisations and into the nature and extent of the smoking cessation support they offer, and, additionally, to look at the opportunities for improvement in clinical settings. METHOD: Document research on formal policies of 61 mental health care facilities, interviews with workers directly involved (n = 10), and a survey on policy implementation among staff members of treatment facilities (n = 600). RESULTS: One-third of the facilities did not have a formalised smoking policy document, and there was a marked difference between the smoking policies at the rest of the facilities. Treatment provision was limited, strongly dependent on the individual staff member, and was often not the most effective form of care (like medication). CONCLUSION: Many mental health patients really do want to give up smoking and often respond well to treatment. Psychiatrists play a key role in integrating and implementing an anti-smoking policy which will benefit their patients.

Barriers and Facilitators to Smoking Cessation Among People With Severe Mental Illness: A Critical Appraisal of Qualitative Studies.

BACKGROUND: People with severe mental illness (PWSMI) die 15-20 years earlier than people in the general population and this is often due to preventable smoking-related health conditions. Studies that identify barriers and facilitators to smoking cessation are crucial for policy makers and health care professionals. AIMS: This appraisal aims to identify and critically appraise qualitative studies which explore smoking experiences and barriers to smoking cessation among PWSMI. METHOD: Articles were retrieved from electronic health related databases including Web of Science, Scopus, PubMed, Sage, Biomed, Medline, Embase, and electronic hand searches of bibliographies from key articles. RESULTS: Eleven papers were identified. Although the overall quality of studies were sufficient, most had limited information relating to trustworthiness and sociodemographic details. Cost savings and health benefits were frequently cited as facilitators to quitting, however may be of limited impact as smoking for existential purposes, social inclusion, and mental health management appear to be considered highly important among PWSMI. CONCLUSIONS: Findings were restricted to predominantly individual barriers to smoking cessation which may be more resistant to change as service users rely on smoking to manage their mental health and smoking is embedded in the culture of mental health settings. IMPLICATIONS: This critical appraisal identifies qualitative evidence regarding which factors facilitate or prevent individuals with severe mental illness from engaging with smoking cessation. Healthcare professionals and policy makers should address external barriers to quitting smoking as this may increase participation in intervention studies, inform policy and assist in the development of a feasible and acceptable smoking cessation intervention among PWSMI. Methodological considerations highlight that future research should include sociodemographic and contextual factors to improve utility and applicability of findings.

Educación inclusiva en contextos inéditos: la implementación de la Pedagogía Hospitalaria / Inclusive education in new contexts: the implementation of Hospital Pedagogy / Educação inclusiva em novos contextos: a implemantação da Pedagogia Hospitalar

El objetivo de este trabajo es analizar los beneficios de la Pedagogía Hospitalaria en las Unidades de Salud Mental que reciben pacientes en edad escolar que permanecen largos períodos ingresados. Esto los aparta del sistema escolar ordinario. Esta investigación la hemos desarrollado durante diez años con una metodología mixta. En la contextualización del marco teórico, estudiamos la evolución de esta disciplina y los factores que intervienen. Destacamos que el alumnado valora positivamente superar su curso académico con éxito, la enseñanza personalizada de los docentes del Aula Hospitalaria, y la posibilidad de evadirse del medio hospitalario. Estas conclusiones demandan una mayor implicación y formación del profesorado para un trabajo coordinado, y el uso de las TIC en conexión con los centros educativos, para propiciar una educación inclusiva.

The aim of this study is to analyze the benefits of hospital pedagogy in mental health units that treat long‒term school‒age patients, causing them to miss a samount of time in the regular education system. The research took place over a period of ten years and is eclectic in its approach. As part of the contextualization of the theoretical framework, the development of this discipline and various intervening factors are studied. The results show that students view successful completion of their academic level, the personalized teaching from hospital school teachers and the ability to get away from the hospital environment in a positive light. These conclusions demonstrate the need for a greater level of teacher involvement and training that will result in work that is more coordinated between high schools and the hospital school and the use of ICT in education centers to promote inclusive education

O objetivo deste trabalho é analisar os benefícios da Pedagogia Hospitalar em Unidades de Saúde Mental que tratam de pacientes de longa permanência em idade escolar,os afastando do sistema de ensino regular. A pesquisa se desenvolve durante um período de dez anos e é eclética em sua abordagem. Na contextualização do quadro teórico, é estudada a evolução dessa disciplina e os diversos fatores intervenientes. Destaca‒se que os alunos acreditam que irão concluir de maneira bem‒sucedida seu ano acadêmico, valorizam o ensino personalizado por professores da escola do hospital e, assim, poderão sair do ambiente hospitalar. Essas conclusões exigem um maior nível de envolvimento e da formação do professor, para que haja um trabalho mais coordenado de IES/Sala de Aula Hospitalar e o uso das TIC em conexão com os centros de educação, de forma a promover a educação inclusiva

Estudio descriptivo de pacientes con reingreso múltiple anual en el Hospital Vilardebó (2013-2014) / Descriptive study of patients with annual multiple re-entry at the Vilardebó Hospital (2013-2014)

El reingreso frecuente al hospital psiquiátrico ha sido estudiado a lo largo de décadas en diferentes países. Se lo considera un fenómeno vinculado a los procesos de desinstitucionalización. Se define al paciente con reingresos frecuentes como aquel que cuenta con tres o más hospitalizaciones en un año. Se realizó un estudio exploratorio descriptivo de dicha población en el Hospital psiquiátrico Vilardebó (período 2013-2014). Se describieron sus características sociodemográficas, psicopatológicas, asistenciales y de sostén social. Se realizó una comparación con el resto de los pacientes hospitalizados en el mismo período. Los pacientes con reingresos frecuentes son una población joven, con un predominio femenino. Se subdividen fundamentalmente en tres categorías diagnósticas: trastornos de personalidad, trastorno bipolar y esquizofrenia. El trastorno bipolar y los trastornos de la personalidad se encuentran sobre rrepresentados en el grupo de los pacientes con reingresos frecuentes. Asimismo, se destacó la presencia de consumo de sustancias y trastornos de conducta.

The frequent re-entry to the psychiatric hospital has been studied over decades in different countries. It is considered a phenomenon linked to de institutionalization processes. The patient with frequent readmissions is defined as one who has three or more hospitalizations in a year. An exploratory descriptive study of this population was conducted in the Vilardebó psychiatric hospital (2013-2014 period). Their sociodemographic, psychopathological, welfare and social support characteristics were described. A comparison was made with the rest of the patients hospitalized in the same period. Patients with frequent readmissions are a young population, with a female predominance. They are basically subdivided into three diagnostic categories: personality disorders, bipolar disorder and schizophrenia. Bipolar disorder and personality disorders are overrepresented in the group of patients with frequent readmissions. Likewise, the presence of substance use and behavioral disorders was highlighted.