Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis

Objectives: To present evidence-based guidelines for clinical practice regarding religiosity and spirituality in mental health care in Brazil. Methods: A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS, and Cochrane databases. A summary of recommendations and their levels of evidence was produced in accordance with Oxford Centre for Evidence-Based Medicine guidelines. Results: The systematic review identified 6,609 articles, 41 of which satisfied all inclusion criteria. Taking a spiritual history was found to be an essential part of a compassionate and culturally sensitive approach to care. It represents a way of obtaining relevant information about the patient's religiosity/spirituality, potential conflicts that could impact treatment adherence, and improve patient satisfaction. Consistent evidence shows that reported perceptual experiences are unreliable for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful for distinguishing pathological and non-pathological anomalous experiences. Conclusion: Considering the importance of religiosity/spirituality for many patients, a spiritual history should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to differential diagnosis.

Guidelines for integrating spirituality into the prevention and treatment of alcohol and other substance use disorders

Alcohol and other substance use disorders are complex problems with multiple variables and determinants, requiring a multidimensional approach to prevention and treatment. A robust body of research shows that religiosity and spirituality (R/S) play a prominent role in these disorders; however, how to apply this knowledge remains unclear. We present practical guidelines on how to integrate R/S into substance use prevention and treatment in an ethical, evidence-based manner. These guidelines have been endorsed by prominent academic leaders in these topics and by health associations affiliated with the three major Brazilian religions. The integration of R/S is part of a respectful, person-centered, interdisciplinary approach, which imposes neither religious beliefs nor secular worldviews. The most critical interventions include collecting a history of spiritual and religious beliefs, practices, and experiences and evaluating how these may be used positively in treatment. It is also essential that health professionals are encouraged to value and respect the R/S of patients, and that religious groups recognize that professional and technical interventions can make a valuable contribution to preventing and treating these disorders.

Investigação dos conceitos de religiosidade e espiritualidade em amostra clínica e não clínica em contexto brasileiro: uma análise qualitativa

Introdução: Já é conhecido o papel (geralmente positivo) da religiosidade e espiritualidade (R/E) sobre a saúde física e mental dos indivíduos, porém, mesmo com evidências robustas, não existe um consenso científico com relação aos conceitos de R/E, podendo levar a: instrumentos não acurados, ampliação ou "redução" dos conceitos a outros constructos que não necessariamente são R/E. Objetivo: avaliar de forma qualitativa os principais atributos que os conceitos de R/E possuem em uma amostra clínica e não clínica do contexto brasileiro. Métodos: 14 sujeitos, pacientes e acompanhantes de 2 hospitais gerais de Juiz de Fora-MG foram sorteados a partir de uma amostra prévia (estudo quantitativo) e responderam a um questionário semi-estruturado (10 questões) sobre os conceitos de R/E. Análise de conteúdo foi utilizada para as interpretações. Resultados: percebe-se insegurança para a definição dos conceitos (especialmente o de espiritualidade), a palavra 'fé' presente em muitos discursos, a importância dos aspectos religiosos privados na vida dos respondentes, a associação que os alguns participantes fizeram entre espiritualidade e espiritismo e a maioria acreditar haver algo além do mundo material, especialmente após a morte. Conclusão: fé, religiosidade não organizacional, religiosidade intrínseca e coping religioso espiritual foram as principais dimensões associadas aos conceitos de R/E.

Introduction: The role of religiousness and spirituality (R/S) on the physical and mental health of individuals is already known (usually positive), but even with robust evidence among these associations, there is no scientific consensus regarding the concepts of R/S, a fact that leads to implications as: non-accurate measures, the extension, or "reduction" of the concepts to other constructs that are not necessarily R/S, besides clinical aspects that can confuse R/S with psychopathological aspects. Objective: to evaluate in a qualitative way, the main attributes that the concepts of religiousness and spirituality have in a clinical, and in a non-clinical sample of the Brazilian context. Methods: 14 subjects, patients and caregivers from 2 general hospitals of Juiz de Fora-MG were sorted out from a previous sample (quantitative study) and responded to a semi-structured questionnaire about the concepts of religiosity and spirituality. Content analysis was used for interpretations. Results: the definition of the concepts (especially of spirituality) was confuse, the word 'faith' was present in many discourses, the importance of private religious aspects in respondents' lives, the association of spirituality with spiritism, and to believe there is something beyond the material world was very frequent. Conclusion: faith, aspects of private religiousness (non-organizational religiousness), intrinsic religiosity and spiritual religious coping, were the main dimensions of R/S associated with the concepts of religiosity and spirituality.

Association between religiosity and happiness in patients with chronic kidney disease on hemodialysis / Associação entre religiosidade e felicidade em pacientes com doença renal crônica em hemodiálise

Abstract Objectives: Religiosity/spirituality (R/S) seems to be a relevant factor in chronic diseases adaptation, but there is a lack of studies involving chronic kidney disease (CKD). This study aimed to investigate the association between R/S and happiness among CKD patients on hemodialysis and whether Sense of Coherence (SC) mediates this possible association. Methods: This was a cross-sectional study in two renal replacement therapy centers in Brazil, involving 161 adults on hemodialysis. Linear regressions were performed to evaluate the association between R/S (predicting variable measured with Duke Religious Index - DUREL) and happiness (outcome variable), adjusted for sociodemographic, clinical, and some laboratory variables. Later, SC was added to the model to test the possible mediating effect. Results: Most patients (91.20%) reported some religious affiliation. Private Religiosity (PR) (β = 0.53; 95% CI = 0.01 a 1.06), Intrinsic Religiosity (IR) (β = 0.48; 95% CI = 0.18 a 0.79), and SC (β = 0.11; 95% CI = -0.09 a 0.15) correlated with higher levels of happiness, controlling for clinical and sociodemographic variables. When SC was included in the model, IR (β = 0.34; 95% CI = 0.07 to 0.60) and SC (β = 0.11; 95% CI = 0.08 to 0.14) remained significantly. No clinical or sociodemographic variable correlated with happiness. Conclusions: Patients on hemodialysis showed high levels of R/S, which correlated with higher happiness levels. Clinical and sociodemographic variables were not correlated with patients' happiness. Psychosocial variables such as R/S and SC are potential key targets for interventions to promote better survival quality among CKD patients.

Resumo Objetivos: Religiosidade/espiritualidade (R/E) parecem ser fatores relevantes na adaptação a doenças crônicas, mas faltam estudos nessa área envolvendo pacientes com doença renal crônica (DRC). O presente estudo teve como objetivo investigar a associação entre R/E e felicidade em pacientes com DRC em hemodiálise e se o senso de coerência (SC) faz a mediação dessa possível associação. Métodos: Estudo transversal realizado em dois centros de terapia renal substitutiva no Brasil com 161 adultos em hemodiálise. Regressões lineares foram utilizadas para avaliar a associação entre R/E (variável preditora medida pelo Índice de Religiosidade de Duke - DUREL) e felicidade (variável de desfecho), ajustadas para variáveis sociodemográficas, clínicas e algumas variáveis laboratoriais. Posteriormente, o SC foi acrescentado ao modelo para testar seu possível efeito mediador. Resultados: A maioria dos pacientes (91,20%) relatou alguma afiliação religiosa. Religiosidade Privada (RP) (β = 0,53; IC 95% = 0,01 a 1,06) e Religiosidade Intrínseca (RI) (β = 0,48; IC 95% = 0,18 a 0,79) e SC (β = 0,11; IC 95% = -0,09 a 0,15) foram correlacionadas a níveis mais elevados de felicidade após controle para variáveis clínicas e sociodemográficas. Quando SC foi incluído no modelo, IR (β = 0.34; 95% IC = 0.07 a 0.60) and SC (β = 0.11; 95% IC = 0.08 a 0.14) continuaram se correlacionando significativamente com felicidade. Nenhuma variável clínica ou sociodemográfica apresentou correlação com felicidade. Conclusões: Os pacientes em hemodiálise apresentaram altos níveis de R/E, que por sua vez foi correlacionada com elevados níveis de felicidade. As variáveis clínicas e sociodemográficas não exibiram correlação com a felicidade dos pacientes. Variáveis psicossociais como R/E e SC são possíveis alvos para intervenções destinadas a promover a melhora da qualidade de sobrevida dos pacientes com DRC.

Elderly caring for the elderly: spirituality as tensions relief / Ancianos que cuidan a los ancianos: la espiritualidad como alivio de las tensiones / Idosos cuidando de idosos: a espiritualidade como alívio das tensões

ABSTRACT Objective: To investigate the forms of coping used to relieve tensions by elderly caregivers of elderly relatives and to know the type of support they receive from the Primary Health Care service at home. Method: A qualitative study with a theoretical-methodological contribution of Grounded Theory, carried out with 10 elderly caregivers interviewed between August 2014 and January 2015. Results: Participants use primarily religious coping to deal with adverse situations that arise in their lives; they attribute to the sacred the strength to continue to age and care for another elderly person at home. Religiousness was the main coping strategy used by the participants, but little recognized by the health service. Final considerations: It is recommended that the Primary Health Care service provide greater support to these caregivers and be attentive to the spiritual dimension as an auxiliary element in the process of comprehensive and inclusive health care of these elderly caregivers.

RESUMEN Objetivo: Investigar las formas de enfrentamiento utilizadas para alivio de tensiones por cuidadores ancianos de familiares ancianos y conocer el tipo de apoyo que reciben del servicio de Atención Primaria a la Salud en el domicilio. Método: Estudio cualitativo, con aporte teórico-metodológico de la Grounded Theory, realizado con 10 cuidadores ancianos entrevistados, entre agosto de 2014 y enero de 2015. Resultados: Los participantes se utilizan prioritariamente del coping religioso para enfrentar situaciones adversas que surgen en sus vidas; atribuyen al sagrado la fuerza para continuar envejeciendo y cuidar de otro anciano en el domicilio. La religiosidad fue la principal estrategia de enfrentamiento utilizada por los participantes, pero poco reconocida por el servicio de salud. Consideraciones finales: Se recomienda que el servicio de Atención Primaria a la Salud proporcione mayor apoyo a esos cuidadores y que esté atento a la dimensión espiritual como elemento auxiliar en el proceso de asistencia integral e inclusiva a la salud de esos cuidadores ancianos.

RESUMO Objetivo: Investigar as formas de enfrentamento utilizadas para alívio de tensões por cuidadores idosos de familiares idosos e conhecer o tipo de apoio que recebem do serviço de Atenção Primária à Saúde no domicílio. Método: Estudo qualitativo, com aporte teórico-metodológico da Grounded Theory, realizado com 10 cuidadores idosos entrevistados, entre agosto de 2014 e janeiro de 2015. Resultados: Os participantes utilizam-se prioritariamente do coping religioso para enfrentar situações adversas que surjam em suas vidas; atribuem ao sagrado a força para continuar a envelhecer e cuidar de outro idoso no domicílio. A religiosidade foi a principal estratégia de enfrentamento utilizada pelos participantes, porém, pouco reconhecida pelo serviço de saúde. Considerações finais: Recomenda-se que o serviço de Atenção Primária à Saúde proporcione maior apoio a esses cuidadores e que esteja atento à dimensão espiritual como elemento auxiliar no processo de assistência integral e inclusiva à saúde desses cuidadores idosos.

Religiosity, depression, and quality of life in bipolar disorder: a two-year prospective study

Objective: Few quantitative studies have examined the effect of religious involvement on the course of bipolar disorder (BD). We investigated the effects of religious activity and coping behaviors on the course of depression, mania, and quality of life (QoL) in patients with BD. Methods: Two-year longitudinal study of 168 outpatients with BD. Linear regression was used to examine associations between religious predictors and outcome variables (manic symptoms, depression, QoL), controlling for sociodemographic variables. Results: Among the 158 patients reassessed after 2 years, positive religious coping at T1 predicted better QoL across all four domains: physical (β = 10.2, 95%CI 4.2 to 16.1), mental (β = 13.4, 95%CI 7.1 to 19.7), social (β = 10.5, 95%CI 3.6 to 17.33), and environmental (β = 11.1, 95%CI 6.2 to 16.1) at T2. Negative religious coping at T1 predicted worse mental (β = -28.1, 95%CI -52.06 to -4.2) and environmental (β = -20.4, 95%CI -39.3 to -1.6) QoL. Intrinsic religiosity at T1 predicted better environmental QoL (β = 9.56, 95%CI 2.76 to 16.36) at T2. Negative religious coping at T1 predicted manic symptoms (β = 4.1) at T2. Conclusion: Religiosity/spirituality (R/S) may influence the QoL of patients with BD over time, even among euthymic patients. Targeting R/S (especially positive and negative religious coping) in psychosocial interventions may enhance the quality of recovery in patients with BD.

The presentation of the mind-brain problem in leading psychiatry journals

Objective: The mind-brain problem (MBP) has marked implications for psychiatry, but has been poorly discussed in the psychiatric literature. This paper evaluates the presentation of the MBP in the three leading general psychiatry journals during the last 20 years. Methods: Systematic review of articles on the MBP published in the three general psychiatry journals with the highest impact factor from 1995 to 2015. The content of these articles was analyzed and discussed in the light of contemporary debates on the MBP. Results: Twenty-three papers, usually written by prestigious authors, explicitly discussed the MBP and received many citations (mean = 130). The two main categories were critiques of dualism and defenses of physicalism (mind as a brain product). These papers revealed several misrepresentations of theoretical positions and lacked relevant contemporary literature. Without further discussion or evidence, they presented the MBP as solved, dualism as an old-fashioned or superstitious idea, and physicalism as the only rational and empirically confirmed option. Conclusion: The MBP has not been properly presented and discussed in the three leading psychiatric journals in the last 20 years. The few articles on the topic have been highly cited, but reveal misrepresentations and lack of careful philosophical discussion, as well as a strong bias against dualism and toward a materialist/physicalist approach to psychiatry.

How to tell a happy from an unhappy schizotype: personality factors and mental health outcomes in individuals with psychotic experiences

Objective: It is unclear why some individuals reporting psychotic experiences have balanced lives while others go on to develop mental health problems. The objective of this study was to test if the personality traits of harm avoidance, self-directedness, and self-transcendence can be used as criteria to differentiate healthy from unhealthy schizotypal individuals. Methods: We interviewed 115 participants who reported a high frequency of psychotic experiences. The instruments used were the Temperament and Character Inventory (140), Structured Clinical Interview for DSM-IV, and the Oxford-Liverpool Inventory of Feelings and Experiences. Results: Harm avoidance predicted cognitive disorganization (β = 0.319; t = 2.94), while novelty seeking predicted bipolar disorder (β = 0.136, Exp [β] = 1.146) and impulsive non-conformity (β = 0.322; t = 3.55). Self-directedness predicted an overall decrease in schizotypy, most of all in cognitive disorganization (β = -0.356; t = -2.95) and in impulsive non-conformity (β = -0.313; t = -2.83). Finally, self-transcendence predicted unusual experiences (β = 0.256; t = 2.32). Conclusion: Personality features are important criteria to distinguish between pathology and mental health in individuals presenting high levels of anomalous experiences (AEs). While self-directedness is a protective factor, both harm avoidance and novelty seeking were predictors of negative mental health outcomes. We suggest that the impact of AEs on mental health is moderated by personality factors.

Cardiopulmonary resuscitation in an average brazilian intensive care unit: should we perform less or better?

Abstract Introduction: Few data can be found about cardiac arrest in the intensive care unit outside reference centers in third world countries. Objective: To study epidemiology and prognostic factors associated with cardiac arrest in the intensive care unit (ICU) in an average Brazilian center. Methods: Between June 2011 and July 2014, 302 cases of cardiac arrest in the intensive care unit were prospectively evaluated in 273 patients (age: 68.9 ± 15 years) admitted in three mixed units. Data regarding cardiac arrest and cardiopulmonary resuscitation were collected in an "Utstein style" form and epidemiologic data was prospectively obtained. Factors associated with do not resuscitate orders, return of spontaneous circulation and survival were studied using binary logistic regression. Statistical package software used was SPSS 19.0 (IBM Inc., USA). Results: Among 302 cardiac arrests, 230 (76.3%) had their initial rhythm recorded and 141 (61.3%) was in asystole, 62 (27%) in pulseless electric activity (PEA) and 27 had a shockable rhythm (11.7%). In 109 (36.1%) cases, cardiac arrest had a suspected reversible cause. Most frequent suspected cardiac arrest causes were hypotension (n=98; 32.5%), multiple (19.2%) and hypoxemia (17.5%). Sixty (19.9%) cardiac arrests had do not resuscitate orders. Prior left ventricle dysfunction was the only predictor of do not resuscitate order (OR: 3.1 [CI=1.03-9.4]; P=0.04). Among patients that received cardiopulmonary resuscitation, 59 (24.4%) achieved return of spontaneous circulation and 12 survived to discharge (5.6%). Initial shockable rhythm was the only return of spontaneous circulation predictor (OR: 24.9 (2.4-257); P=0.007) and survival (OR: 4.6 (1.4-15); P=0.01). Conclusion: Cardiopulmonary resuscitation rate was high considering ICU patients, so was mortality. Prior left ventricular dysfunction was a predictor of do not resuscitate order. Initial shockable rhythm was a predictor of return of spontaneous circulation and survival.

As investigações dos fenômenos psíquicos/espirituais no século XIX: sonambulismo e espiritualismo, 1811-1860 / Investigations of psychic/spiritual phenomena in the nineteenth century: somnambulism and spiritualism, 1811-1860

Resumo No início do século XIX, investigações sobre a natureza de fenômenos psíquicos/espirituais como transes e supostas aquisições de informações indisponíveis aos canais sensoriais normais geraram grande debate no meio científico. Este artigo discute as principais explicações oferecidas pelos pesquisadores dos fenômenos psíquicos entre 1811 e 1860, concentrando-se nos dois movimentos principais no período: sonambulismo magnético e espiritualismo moderno. As investigações desses fenômenos geraram diversas teorias, sem que se chegasse a consenso, mas trouxeram implicações para a compreensão da mente e de seus transtornos, notadamente na área do inconsciente e da dissociação, constituindo-se como parte importante da história da psicologia e da psiquiatria.

Abstract In the early nineteenth century, investigations into the nature of psychic/spiritual phenomena, like trances and the supposed acquisition of information unattainable using normal sensory channels, prompted much debate in the scientific arena. This article discusses the main explanations offered by the researchers of psychic phenomena reported between 1811 and 1860, concentrating on the two main movements in the period: magnetic somnambulism and modern spiritualism. While the investigations of these phenomena gave rise to multiple theories, they did not yield any consensus. However, they did have implications for the understanding of the mind and its disorders, especially in the areas of the unconscious and dissociation, constituting an important part of the history of psychology and psychiatry.

Brazilian scientific articles on "Spirituality, Religion and Health"

Abstract Background Studies on "Spirituality, religion and health"(R/S) have been increasing worldwide, including in Brazil. Mapping this production can help researchers to understand this field and also to identify gaps in the Brazilian R/S studies. Objective To analyze the Brazilian scientific articles on "Religion, Spirituality and Health&" available on the main electronic databases using a bibliometric approach. Methods A comprehensive review of four major databases (PubMed, Scopus, BVS and Web of Science) was conducted. Three reviewers performed the data analysis. Off-topic articles, articles from Portugal, books and thesis were excluded. Articles were then classified by: Publication year, journal, Central focus in R/S, Academic Area, Main topic and Study Type. Results From 3,963 articles found, 686 studies were included in the final analysis (320 had central focus on R/S). There was an increase of articles in the last decade (most observational), with predominance of mental health issues, and from journals in the field of psychiatry, public health and nursing. Discussion This study enabled us to widen our understanding about how the field of "spirituality, religion and health" has been established and how this field is increasing in Brazil. These findings can help in the development of future Brazilian studies.

O cérebro produz a mente? Um levantamento da opinião de psiquiatras / Does the brain produce the mind? A survey of psychiatrists’ opinions

Psychiatrists’ views on the mind-brain relationship (MBR) have marked clinical and research implications, but there is a lack of studies on this topic. Objectives: To evaluate psychiatrists’ opinions on the MBR, and whether they are amenable to change or not. Methods: We conducted a survey of psychiatrists’ views on the MBR just before and after a debate on the MBR at the Brazilian Congress of Psychiatry in 2014. Results: Initially, from more than 600 participants, 53% endorsed the view that “the mind (your “I”) is a product of brain activity”, while 47% disagreed. Moreover, 72% contested the view that “the universe is composed only of matter”. After the debate, 30% changed from a materialist to a non-materialist view of mind, while 17% changed in the opposite way. Discussion: Psychiatrists are interested in debates on the MBR, do not hold a monolithic view on the subject and their positions are open to reflection and change, suggesting the need for more in-depth studies and rigorous but open-minded debates on the subject...

Psychiatrists’ views on the mind-brain relationship (MBR) have marked clinical and research implications, but there is a lack of studies on this topic. Objectives: To evaluate psychiatrists’ opinions on the MBR, and whether they are amenable to change or not. Methods: We conducted a survey of psychiatrists’ views on the MBR just before and after a debate on the MBR at the Brazilian Congress of Psychiatry in 2014. Results: Initially, from more than 600 participants, 53% endorsed the view that “the mind (your “I”) is a product of brain activity”, while 47% disagreed. Moreover, 72% contested the view that “the universe is composed only of matter”. After the debate, 30% changed from a materialist to a non-materialist view of mind, while 17% changed in the opposite way. Discussion: Psychiatrists are interested in debates on the MBR, do not hold a monolithic view on the subject and their positions are open to reflection and change, suggesting the need for more in-depth studies and rigorous but open-minded debates on the subject...

Clinical implications of spirituality to mental health: review of evidence and practical guidelines

Objective: Despite empirical evidence of a relationship between religiosity/spirituality (R/S) and mental health and recommendations by professional associations that these research findings be integrated into clinical practice, application of this knowledge in the clinic remains a challenge. This paper reviews the current state of the evidence and provides evidence-based guidelines for spiritual assessment and for integration of R/S into mental health treatment. Methods: PubMed searches of relevant terms yielded 1,109 papers. We selected empirical studies and reviews that addressed assessment of R/S in clinical practice. Results: The most widely acknowledged and agreed-upon application of R/S to clinical practice is the need to take a spiritual history (SH), which may improve patient compliance, satisfaction with care, and health outcomes. We found 25 instruments for SH collection, several of which were validated and of good clinical utility. Conclusions: This paper provides practical guidelines for spiritual assessment and integration thereof into mental health treatment, as well as suggestions for future research on the topic. .

Explorando a relação mente-cérebro: reflexões e diretrizes / Exploring mind-brain relationship: reflections and guidelines

CONTEXTO: O avanço no entendimento da mente e sua relação com o cérebro tem sido prejudicado por equívocos filosóficos e metodológicos. OBJETIVO: Discutir brevemente e propor diretrizes epistemológicas e metodológicas para uma frutífera investigação da relação mente-cérebro. RESULTADOS: A relação mente-corpo ainda é um problema em aberto, não havendo evidências conclusivas de que a mente seja apenas um produto da atividade cerebral. Na exploração da mente, deve-se evitar a aceitação ou rejeição prematura de teorias, buscando não apenas evidências confirmatórias, mas também as falseadoras de uma teoria. Deve-se ampliar e diversificar a base empírica, buscando especialmente experiências humanas não usuais, tais como as chamadas experiências anômalas ou espirituais. A observação de fenômenos anômalos que não se encaixavam nos paradigmas estabelecidos foi essencial em revoluções científicas prévias. Tanto dados quantitativos quanto qualitativos devem ser valorizados. Para explicar a mente e suas múltiplas manifestações, é essencial haver abertura e rigor para criar, desenvolver e testar alternativas teóricas. Candidatos a paradigma de base tanto materialista quanto não materialista devem ter oportunidade de ser apresentados, aprimorados e testados. CONCLUSÃO: A ampliação e a diversificação da base empírica aliada a uma postura epistemológica e metodológica mais adequada são essenciais para o avanço da compreensão da relação mente-cérebro.

BACKGROUND: Philosophical and methodological misconceptions have hampered advances in the understanding of mind and its relationship with the brain.OBJECTIVE: To discuss and propose epistemological and methodological guidelines for a fruitful investigation of mind-brain relationship.RESULTS: Mind-brain problem is still an open quest, there is no conclusive evidence that mind is just a product of brain activity. In exploring mind one should avoid premature acceptance or rejection of theories, searching not only for confirmatory evidence, but also for the falsifying ones. It is needed enlarging and diversifying the empirical basis, looking especially for unusual human experiences such as those called anomalous and spiritual. Observation of anomalous phenomena, that did not fit established paradigms, was essential in early scientific revolutions. Both qualitative and quantitative data must be valued. In order to explain mind and its myriad of manifestations, it is essential to have openness and rigor to create, develop and test theoretical alternatives. Both, materialist and non-materialist paradigm candidates deserve the same opportunity of being presented, improved and tested.DISCUSSION: The broadening and diversification of the empirical base allied to a more fruitful epistemological and methodological stance are essential for the advancing of our understanding of mind-brain relationship.

Pesquisa em mediunidade e relação mente-cérebro: revisão das evidências / Scientific research on mediumship and mind-brain relationship: reviewing the evidence

CONTEXTO: Mediunidade, uma experiência humana disseminada pelas diversas sociedades ao longo da história, pode ser definida como uma experiência em que um indivíduo (chamado de médium) alega estar em comunicação com, ou sob influência de, uma personalidade falecida ou outro ser não material. Desde o século 19 há uma substancial mas negligenciada tradição de investigações científicas sobre mediunidade e suas implicações para a natureza da mente. OBJETIVO: Discutir a importância histórica e atual da mediunidade para o problema mente-cérebro, focando em estudos que investigam as origens e as fontes das comunicações mediúnicas. MÉTODOS: O artigo inicia-se com uma breve discussão filosófica sobre o que seria evidência para identidade pessoal e sua persistência além do cérebro, então apresenta e analisa as evidências proporcionadas por estudos em mediunidade, incluindo uma análise mais detalhada de dois médiuns muito produtivos: Leonora Piper e Chico Xavier. RESULTADOS: Estudos bem controlados, antigos e recentes, sugerem que médiuns podem exibir habilidades e conhecimentos compatíveis com personalidades falecidas e improváveis de terem sido obtidos por meios ordinários. CONCLUSÕES: O uso de métodos de pesquisa contemporâneos em experiências mediúnicas pode proporcionar a necessária ampliação e diversificação da base empírica para o avanço de nosso entendimento do problema mente-cérebro.

BACKGROUND: Mediumship, an experience widespread throughout human history, can be defined as an experience in which an individual (the so-called medium) purports to be in communication with, or under the control of, a deceased personality or other non-material being. Since the 19th Century there is a substantial, but neglected tradition of scientific research about mediumship and its implications for the nature of mind. OBJECTIVE: To discuss the historical and current importance of mediumship to the mind-brain problem, focusing on studies investigating the origins, the sources of mediumistic communications. METHODS: This paper starts discussing what would be evidence for personal identity and its persistence beyond the brain, then empirical evidence provided by studies on mediumship are presented and analyzed, including a more detailed analysis of two very productive mediums: Mrs. Leonora Piper and Chico Xavier. RESULTS: Old and recent well controlled studies suggest that mediums can exhibit skills and knowledge unlikely to have been acquired by ordinary means and compatible with deceased personalities. DISCUSSION: Applying contemporary research methods to mediumistic experiences may provide a badly needed broadening and diversification of the empirical basis needed to advance our understanding of the mind-body problem.

Personalidade, religiosidade e qualidade de vida em indivíduos que apresentam experiências anômalas em grupos religiosos / Personality, religiosity, and quality of life in individuals with anomalous experiences in religious groups

INTRODUÇÃO: Há alta prevalência de Experiências Anômalas (EAs), como as vivências chamadas de psicóticas, na população geral. Existe pouca informação a respeito das caraterísticas de pessoas que apresentam EAs de caráter não patológico e que buscam auxílio em instituições religiosas. OBJETIVOS: Investigar os perfis de personalidade, a qualidade de vida (QV) e a religiosidade em pessoas que apresentam EAs. MÉTODOS: Cento e quinze sujeitos que procuraram centros espíritas de Juiz de Fora/MG e que apresentavam EAs foram entrevistados: dados sociodemográficos; ITC-R (140) - (Inventário de Temperamento e Caráter, revisado e reduzido); DUREL-P (Duke University Religious Index, versão em português), e WHOQOL-BREF (Avaliação da Qualidade de Vida da Organização Mundial da Saúde - versão brasileira abreviada). RESULTADOS: Cooperatividade foi a dimensão de personalidade que obteve a maior média (77,0 ± 11,2); Religiosidade Não Organizacional obteve médias altas em 77% da amostra; 58,9% dos sujeitos eram Espíritas; QV psicológica obteve a média mais baixa (61,1 ± 19,4) e a mais alta foi QV física (67,1 ± 18,2). CONCLUSÕES: Os indivíduos com EAs que buscam auxílio parecem constituir uma população de risco para transtornos mentais ou problemas emocionais em geral, sendo preciso desenvolver abordagens adequadas e mais estudos sobre o tema.

INTRODUCTION: There is a high prevalence of Anomalous Experiences (AEs), as psychotic experiences, in the general population. There is little information about characteristics of people with non-pathological AEs seeking religious institutions. OBJECTIVES: To investigate personality profiles, quality of life (QoL) and religiosity in people with EAs. METHODS: One hundred and fifteen subjects who sought Spiritist Centers in Juiz de Fora/MG, Brazil, and who had AEs were interviewed: sociodemographic data; ITC-R (140) - (Temperament and Character Inventory, revised), Durel-P (Duke Religious Index, Portuguese version), and WHOQOL-BREF (Assessment of Quality of Life of the World Health Organization-Brazilian abbreviated version). RESULTS: Cooperativity was the personality dimension with the highest mean (77.0 ± 11.2). High non-organizational religiousness was reported by 77% of the sample; 58.9% were affiliated to Spiritism; psychological dimension of QoL had the lowest mean (61.1 ± 19.4) and physical domain the highest (67.1 ± 18.2). CONCLUSIONS: Individuals with AEs who seek help seem to be a population at risk for mental or emotional problems in general, being necessary to develop appropriate approaches and more studies about the topic.

Development and validation of the Intrinsic Religiousness Inventory (IRI) / Desenvolvimento e validação do Inventário de Religiosidade Intrínseca (IRI)

OBJECTIVE: The role of religious involvement in mental health has been increasingly investigated in psychiatric research; however, there is a shortage of scales on religiousness in Portuguese. The present study aimed to develop and validate a brief instrument to assess intrinsic religiosity (Intrinsic Religiousness Inventory - IRI) in two Brazilian samples. METHOD: The initial version was based on literature review and experts' suggestions. University students (sample 1; n = 323) and psychiatric patients (sample 2; n = 102) completed the Duke Religiosity Index (DUREL), the IRI, an instrument of spirituality measurement (WHOQOL-SRPB), as well as measurements of anxiety and depressive symptoms. RESULTS: The IRI showed adequate internal consistence reliability in sample 1 (Cronbach's α = 0.96; 95 percent CI; 0.95-0.97) and sample 2 (α = 0.96; 95 percent CI; 0.95-0.97). The IRI main component analyses indicated a single factor, which explained 73.7 percent and 74.9 percent of variance in samples 1 and 2, respectively. Strong correlations between IRI and intrinsic subscale of the DUREL were observed (Spearman's r ranging from 0.87 to 0.73 in samples 1 and 2, respectively, p < 0.001). The IRI showed good test-retest reliability (intraclass correlation coefficients > 0.70). CONCLUSION: These data indicate that the IRI is a valid instrument and may contribute to study intrinsic religiosity in Brazilian samples.

OBJETIVO: O papel da religiosidade em saúde mental vem sendo objeto de intensa investigação. Estudos devem ser executados em diferentes locais e culturas. O presente estudo objetiva desenvolver e validar um instrumento breve para mensurar religiosidade intrínseca (Inventário de Religiosidade Intrínseca - IRI) em duas amostras brasileiras. MÉTODO: A versão inicial foi baseada na revisão de literatura e em sugestões de especialistas. Estudantes universitários (amostra 1; n = 323) e pacientes psiquiátricos (amostra 2; n = 102) preencheram o Índice de Religiosidade de Duke (DUREL), o IRI, uma medida de espiritualidade (WHOQOL-SRPB), bem como medidas de sintomas ansiosos e depressivos. RESULTADOS: O IRI apresentou consistência interna adequada nas amostras 1 (α de Cronbach = 0,96; IC 95 por cento; 0,95-0,97) e 2 (α = 0,96; IC 95 por cento; 0,95-0,97). Análises de componentes principais indicaram um único fator que explicou 73,7 por cento e 74,9 por cento da variância nas amostras 1 e 2, respectivamente. Foram observadas fortes correlações entre o IRI e a subescala de religiosidade intrínseca da DUREL (r de Spearman de 0,87 a 0,73 nas amostras 1 e 2, respectivamente, p < 0,001). O IRI apresentou boa validade teste-reteste (coeficientes de correlação intraclasse > 0,70). CONCLUSÃO: Os dados indicam que o IRI é um instrumento válido e pode contribuir para estudar religiosidade intrínseca em amostras brasileiras.

Validação da versão brasileira da escala de religiosidade de Duke (DUREL) / Validity of the Brazilian version of the Duke Religious Index (DUREL)

CONTEXTO: Há escassez de instrumentos validados para o estudo da religiosidade em amostras brasileiras. Um recente estudo realizado em uma amostra comunitária sugeriu adequada validade para a versão em português brasileiro do índice de Religiosidade de Duke (P-DUREL). Entretanto, as propriedades psicométricas do P-DUREL não foram estudadas em amostras psiquiátricas e/ou de estudantes universitários. OBJETIVO: Determinar a consistência interna, a confiabilidade teste-reteste e a validade convergente-discriminante do P-DUREL em duas amostras distintas. MÉTODOS: Amostra 1: estudantes universitários (n = 323). Amostra 2: pacientes psiquiátricos (n = 102). Foram aplicados o P-DUREL e o Instrumento de Qualidade de Vida da Organização Mundial da Saúde - Módulo Espiritualidade, Religiosidade e Crenças Pessoais (WHOQOL-SRPB) em ambas as amostras; os sintomas psicológicos foram medidos por meio do Inventário Beck de Depressão (IDB) e do Inventário Beck de Ansiedade (IAB) na amostra 1 e da Escala Hospitalar de Ansiedade e Depressão (HADS) na amostra 2. RESULTADOS: O P-DUREL teve adequada consistência interna (α de Cronbach > 0,80) e confiabilidade teste-reteste (Coeficiente de Correlação Intraclasse > 0,90) em ambas as amostras. Correlações moderadas entre as subescalas da P-DUREL (0,58 < r < 0,71) foram observadas. Além disso, correlações significantes entre os escores do P-DUREL com o escore geral do WHOQOL-SRPB, bem como com medidas de sintomas psicológicos, foram observadas em ambas as amostras. CONCLUSÃO: O presente estudo abre perspectivas para o uso do P-DUREL para a investigação das dimensões da religiosidade em amostras brasileiras com características sociodemográficas diversas.

BACKGROUND: There is a shortage of validated instruments for the study of religiousness in Brazilian samples. A recent study in a community sample pointed to an adequate validity for the Brazilian Portuguese version of the Duke Religiosity Index (P-DUREL). Nevertheless, no study to date has investigated the psychometric properties of the P-DUREL in psychiatric and/or university student samples. OBJECTIVE: To determine the internal consistency, the test-retest reliability and the convergent-discriminant validity of the P-DUREL in two distinct samples. METHODS: Sample 1: university students (n = 323). Sample 2: psychiatric patients (n = 102). The P-DUREL and the World Health Organization's Quality of Life Instrument-Spirituality, Religion and Personal Beliefs module (WHOQOL-SRPB); psychological distress symptoms were measured by means the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) in sample 1, and the Hospital Anxiety and Depression Scale (HADS) in sample 2. RESULTS: The P-DUREL had adequate internal consistency (Cronbach's α > 0.80) and test-retest reliability (Intraclass Correlation Coefficient > 0.90) in both samples. Moderate correlations (0.58 < r < 0.71) between the P-DUREL subscales were observed. Furthermore, significant correlations between the P-DUREL scores with the general WHOQOL-SRPB scores as well as with psychological distress symptoms measures were observed in both samples. DISCUSSION: The present study opens perspective for the use of P-DUREL for the investigation of religiousness dimensions in Brazilian samples with diverse socio-demographic backgrounds.