Ouvidores de vozes de um serviço de saúde mental: características das vozes e estratégias de enfrentamento / Los que oyen voces en un servicio de salud mental: características de las voces y estrategias de enfrentamiento / Voice hearers of a mental health service: voice characteristics and coping strategies

Resumo Objetivou-se compreender a experiência de ouvir vozes a partir das características e conteúdos das vozes, e das estratégias utilizadas por dezesseis ouvidores usuários de um Centro de Atenção Psicossocial do Sul do Brasil. Trata-se de uma pesquisa qualitativa de caráter exploratório. Se deu através de entrevistas semiestruturadas e análise de conteúdo. Evidenciou-se que as características e conteúdos das vozes podem ser determinantes das reações emocionais dos ouvidores frente à experiência, sendo mais difícil lidar com ela quando os conteúdos são negativos. Através das estratégias utilizadas pelos ouvidores, percebeu-se uma resistência ao modelo biomédico, mesmo dentro de um serviço de saúde mental. Conclui-se que há uma necessidade de se pensar outras possibilidades de recuperação para as pessoas que ouvem vozes, que deem conta da complexidade da experiência e que sejam condizentes com o modelo de atenção psicossocial.

Resumen El estudio objetivó comprender la experiencia de oír voces a partir de las características y contenidos de las voces y las estrategias utilizadas por dieciséis oyentes que utilizan un Centro de Atención Psicosocial en el sur de Brasil. Esta es una investigación exploratoria cualitativa. Se llevó a cabo mediante entrevistas semiestructuradas y análisis de contenido. Se destacó que características y contenidos de las voces pueden ser determinantes de reacciones emocionales de los oidores delante la experiencia, siendo más difícil ocuparse de ella cuando los contenidos son negativos. A través de estrategias utilizadas por los oidores, se notó una resistencia al modelo biomédico, aunque dentro de un servicio de salud mental. Se concluye que hay una necesidad de pensar otras posibilidades de recuperación para las personas que oyen voces, que aporten la complejidad de la experiencia y que sean compatibles con el modelo de atención psicosocial.

Abstract The study aimed to understand the experience of hearing voices from the analysis of the characteristics and contents of the voices, and of the strategies used by sixteen voice hearers who use a Psychosocial Care Center in Southern Brazil. This is a qualitative exploratory research, conducted through semi-structured interviews and content analysis. It was evidenced that the characteristics and contents of the voices can be determinant of the hearer's emotional reactions to the experience, being more difficult to deal with when those are negative. By analyzing the strategies used by the hearers, resistance to the biomedical model was perceived even within a mental health service. It was concluded that there is a need to think about other possibilities of recovery for people who hear voices, possibilities that take into account the complexity of the experience and that are consistent with the psychosocial care model.

Psicoeducación (PE) en psicosis: evidencias y experiencia de 13 años / Psychoeducation (PE) in psychosis: evidence and experience of 13 years

La esquizofrenia es una prioridad sanitaria de primer orden, debido a su alta frecuencia en relación con otras enfermedades mentales. Patologías que, por sus propias características y curso evolutivo, ponen más a prueba la solidez y consistencia de las pautas de intervención que sobre ellas se realizan. Además un porcentaje alto de familias sienten estrés y dificultades que afectan de manera significativa su funcionamiento. Desde la década de los noventa se ha postulado que aplicar intervenciones integrales, farmacológicas, psicológicas y psicosociales, en una etapa precoz de la enfermedad, sería una estrategia beneficiosa para los pacientes, logrando con ello mejores resultados en cuanto a la evolución de la enfermedad a largo plazo. Entre ellas está la Psicoeducación (PE), que también tiene la función de contribuir a la no estigmatización de los trastornos psicológicos y disminuir las barreras para el tratamiento. En este trabajo presentamos un estudio en Chile de Psicoeducación con familiares de pacientes en primer episodio de esquizofrenia, aplicada por el sector 1 del Instituto Psiquiátrico Dr. José Horwitz Barak. Los contenidos de éste se basan en las Guías Clínicas GES (2016), y se enmarcan en las políticas públicas de salud promovidas por el Ministerio de Salud.

Schizophrenia should be a health priority because of its high frequency in relation to other mental illnesses. Pathologies that, due to their own characteristics and evolutionary course, put more to the test the solidity and consistency of the intervention guidelines that are carried out on them. In addition, a high percentage of families feel stress and difficulties that significantly affect their functioning. Since the nineties it has been postulated that applying comprehensive, pharmacological, psychological and psychosocial interventions, at an early stage of the disease, would be a beneficial strategy for patients, thereby achieving better results in the evolution of the disease in the long term. Among them is Psychoeducation (PE), which also has the function of contributing to the non-stigmatization of psychological disorders and reducing barriers to treatment. In this paper we present a study in Chile of sychoeducation with family members of patients in the first episode of schizophrenia, applied by sector 1 of the Dr. José Horwitz Barak Psychiatric Institute. The contents are based on the GES Clinical Guidelines (2016), and are framed in public health policies promoted by the Ministry of Health.

Influencia del estigma social en la rehabilitación y reinserción social de personas esquizofrénicas / Influence of social stigma on the rehabilitation and social reintegration of schizophrenic people

Introducción: El estigma es un constructo social que incluye actitudes, sentimientos, creencias y comportamiento que está configurado como prejuicio y trae como consecuencias discriminatorias hacia la persona estigmatizada. Las personas que padecen algún trastorno mental son uno de los grupos más estigmatizados de nuestra sociedad, especialmente las que padecen esquizofrenia. Objetivo: Fundamentar cómo el estigma social influye de manera negativa en la rehabilitación y reinserción social de las personas que padecen Esquizofrenia. Material y Métodos: Se realizó una revisión bibliográfica en fuentes de información disponibles en la Biblioteca Virtual de Salud de la red telemática Infomed, entre ellas, las bases de datos SciELO, Pubmed/Medline, Cumed, Lilacs, así como el Google académico. Finalmente se seleccionaron para nuestro estudio un total de 38 referencias. Desarrollo: El estigma se considera un constructo social y está asociado a numerosos factores psicológicos, sociológicos, históricos, así como a la representación social que se tenga de la causa de la estigmatización. Puede clasificarse de varias maneras y su abordaje resulta sumamente complejo, especialmente en lo relacionado con la Esquizofrenia. Conclusiones: El estigma social, unido a la representación que sobre la Esquizofrenia persiste en nuestro medio, son fenómenos que impiden una adecuada reinserción social en este tipo de pacientes. Urge el desarrollo de estrategias que modifiquen los falsos conceptos que sobre a enfermedad mental, persisten en nuestra sociedad(AU)

Introduction: Stigma is a social construct that includes attitudes, feelings, beliefs, and behavior that is configured as prejudice and brings about discriminatory consequences toward the stigmatized person. People who suffer from a mental disorder are recognized as one of the most stigmatized groups in our society, especially those who suffer from Schizophrenia. Objective: To establish how social stigma has a negative influence on the rehabilitation and social reintegration of people suffering from Schizophrenia. Material and Methods: A bibliographic review was made through the search of information in sources available from the Cuban National Health Care Network and Portal (INFOMED), among them, databases such as SciELO, Pubmed / Medline, Cumed, Lilacs, as well as Google Scholar. Finally, a total of 38 references were selected for our study. Development: Stigma is considered a social construct and is associated with many psychological, sociological, and historical factors, as well as the social representation of the cause of stigmatization. It can be classified in several ways. Its approach is extremely complex, especially when it is related to Schizophrenia. Conclusions: The social stigma, together with the representation in Schizophrenia that persists in our environment, are phenomena that prevent an adequate social reintegration in these patients. The development of strategies that modify the false concepts that persist over mental illness in our society is an urgent concern(AU)

La rehabilitación cognitiva para pacientes con esquizofrenia de larga data: un desafío para los equipos de salud / The cognitive rehabilitation of patients with long-standing schizophrenia: a challenge for health teams

Introduction: The differences in the scores observed in the attention, memory and executive functions regarding the use of a cognitive rehabilitation program in patients with long-standing schizophrenia are analysed. Method: The participants were selected through a nonprobability sampling with a purposive sample ofcritical cases (n = 31). It is a causal research, which considers a quasi-experimental design of two groups (experimental and control) with pre and postintervention measures. To measure the variables, the TMTA & B, WAIS, ROCF and the Stroop P & C tests were administered. Results: The intervention had a clinically significant impact on the domains of visual spatial attention and the executive function (speed of verbal information processing), given by the differences caused by the post-intervention means. There were only statistically significant differences of means in the post-test scores for the Rey-Osterrieth complex figure test, in the Memory-Time variable, whose treatment has a low impact and false negative rates higher than initially expected. At the same time, regarding the variability of the scores, there were not statistically significant differences for any of the variables analysed. Conclusions: Training the identification of symbols, using memories of details of projected images and simple words association, in a group-competition context with playful elements, have a clinically relevant impact on the rehabilitation of the visual spatial attention and the speed of verbal information processing of patients with long-standing schizophrenia. The statistically significant differences of means require to be considered with care.

Introducción: Se analizan las diferencias en las puntuaciones observadas en atención, memoria y función ejecutiva en función de un programa de rehabilitación cognitiva en pacientes con esquizofrenia de larga data. Método: Los participantes fueron seleccionados mediante un muestreo noprobabilístico con una muestra intencional de casos críticos (n = 31). Investigación explicativa, con diseño cuasi experimental de dos grupos (experimental y control) y medidas pre y post intervención. Para medir las variables se administraron los test TMT A y B, WAIS, F.C. de Rey, STROOP P y C. Resultados: La intervención tuvo un impacto clínicamente significativo en el Dominio de la Atención focalizada visual y en el Dominio Ejecutivo (velocidad de procesamiento de información verbal) dado por las diferencias de medias post intervención. Sólo existieron diferencias de medias estadísticamente significativas en los puntajes post test para la Figura Compleja de Rey en la variable Memoria-Tiempo, cuyo tratamiento tiene un impacto bajo y tasas de falsos negativos superiores a las esperadas. A su vez, respecto a la variabilidad de las puntuaciones, no se observaron diferencias estadísticamente significativas para ninguna de las variables analizadas. Conclusiones: Entrenar identificando símbolos, recuerdos de detalles de imágenes proyectadas, asociación de palabras simples, en contextos de competición entre grupo con elementos lúdicos, tiene un impacto clínicamente relevante en la rehabilitación de la atención focalizada visual y en la velocidad de procesamiento de información verbal en sujetos con esquizofrenia de larga data. Las diferencias de medias estadísticamente significativas detectadas requerirían ser consideradas con precaución.

A 20-week program of resistance or concurrent exercise improves symptoms of schizophrenia: results of a blind, randomized controlled trial

Objective: To evaluate the effects of 20 weeks of resistance and concurrent training on psychotic and depressive symptoms, quality of life outcomes, and serum IGF-1, IGFBP-3, and brain-derived neurotrophic factor (BDNF) concentrations in patients with schizophrenia. Methods: In this blind, randomized controlled clinical trial, 34 patients with schizophrenia were assigned to one of three groups: control (CTRL, n=13), resistance exercise (RESEX, n=12), or concurrent exercise (CONCEX, n=9). Symptoms, quality of life, strength, and other variables were assessed. Results: A significant time-by-group interaction was found for the RESEX and CONCEX groups on the Positive and Negative Syndrome Scale (PANSS) total score for disease symptoms (p = 0.007), positive symptoms (p = 0.003), and on the arm extension one-repetition maximum (1RM) test (p = 0.016). In addition, significant improvements on negative symptoms (p = 0.027), on the role-physical domain of the Short Form-36 Health Survey (p = 0.019), and on the chest press 1RM test (p = 0.040) were observed in the RESEX group. No changes were observed for the other variables investigated. Conclusions: In this sample of patients with schizophrenia, 20 weeks of resistance or concurrent exercise program improved disease symptoms, strength, and quality of life. ClinicalTrials.gov: NCT01674543.

Use of identification wristbands among patients receiving inpatient treatment in a teaching hospital / Uso de pulseiras de identificação em pacientes internados em um hospital universitário / Uso de pulseras de identificación en pacientes internados en un hospital universitario

OBJECTIVE: to evaluate the use of identification wristbands among patients hospitalized in inpatient units. METHOD: quantitative, descriptive and transversal research, with a sample of 385 patients. Data collection occurred through the observational method through the filling out of a structured questionnaire which aimed to check the presence of the identification wristband and the identifiers used. Descriptive statistics with absolute and relative frequencies was used for analysis. RESULTS: it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands. CONCLUSION: the study demonstrated the professionals' engagement in the process of patient identification, evidencing a high rate of conformity of the wristbands. Furthermore, it contributed to identify elements in the use of wristbands which may be improved for a safe identification process. .

OBJETIVO: avaliar o uso da pulseira de identificação em pacientes hospitalizados em unidades de internação. MÉTODO: pesquisa quantitativa, descritiva e transversal, com amostra de 385 pacientes. A coleta de dados ocorreu por método observacional, mediante preenchimento de um formulário estruturado, visando a conferência da pulseira de identificação e os identificadores utilizados. Para análise foi utilizada estatística descritiva com frequências absolutas e relativas. RESULTADOS: 83,9% dos pacientes encontravam-se com a pulseira corretamente identificada, 11,9% possuíam a pulseira de identificação com erros e 4,2% dos pacientes estavam sem a pulseira. As principais inconformidades encontradas nas pulseiras de identificação foram nomes incompletos, números de registros diferentes, ilegibilidade dos dados e problemas na integridade. CONCLUSÃO: o estudo mostrou o engajamento dos profissionais no processo de identificação dos pacientes, evidenciando alta taxa de conformidade das pulseiras. Além disso, contribuiu ao identificar elementos no uso de pulseiras que podem ser aprimorados para o seguro processo de identificação. .

OBJETIVO: evaluar el uso de la pulsera de identificación en pacientes hospitalizados en unidades de internación. MÉTODO: investigación cuantitativa, descriptiva y transversal, con una muestra de 385 pacientes. La recolección de datos se realizó por el método observacional mediante el llenado de un formulario estructurado que objetivaba constatar la presencia de pulseras identificativas e reconocer los identificadores utilizados. En el análisis fue utilizada la estadística descriptiva con frecuencias absolutas y relativas. RESULTADOS: se obtuvo que 83,9% de los pacientes se encontraban con la pulsera correctamente identificada, 11,9% poseían la pulsera de identificación con errores y 4,2% de los pacientes estaban sin la pulsera. Las principales inconformidades encontradas en las pulseras de identificación fueron: nombre incompleto, números de los registros diferentes, ilegibilidad de los datos y problemas en la integridad de las pulseras. CONCLUSIÓN: el estudio demostró el compromiso de los profesionales con el proceso de identificación de los pacientes, evidenciando una alta tasa de conformidad de las pulseras. Además de esto, contribuyó para identificar elementos utilizados en las pulseras que pueden ser mejorados para obtener un proceso seguro de identificación. .

Contribuição de grupos de atividades de terapia ocupacional na evoluçãode pessoas com diagnóstico de esquizofrenia refratária usuárias declozapina / Contribution of occupational therapy activity groups to the evolution ofpeople with diagnosis of refractory schizophrenia using clozapine

A esquizofrenia é um transtorno mental e a utilização de estratégias que combinam tratamento com psicofármacos e psicossocial aumentam as chances de seu controle. O objetivodeste estudo foi avaliar a evolução de pessoas com diagnóstico de esquizofrenia refratária, medicadas com clozapina, participantes de grupos de atividades de terapia ocupacional. Pesquisa exploratória de caráter quantitativo com participação de oitopessoas com diagnóstico de esquizofrenia refratária, medicadascom clozapina, pertencentes a um Grupo de pacientes em uso deAntipsicóticos avaliados pela Escala de Observação Interativa de Terapia Ocupacional. Os resultados, avaliados estatisticamente, mostraram que o grupo de atividades permitiu um suporte à prática das habilidades sociais e estimulação da exploração de idéias esentimentos, visto que pessoas com diagnóstico de transtorno mental apresentam comprometimento em seu desempenho ocupacional. A aplicabilidade da escala mostrou-se adequada, visto que possibilitou avaliar as intervenções terapêuticas ocupacionais junto ao tratamento farmacológico e sua importância no processo de reabilitação psicossocial...

Schizophrenia is a mental disorder and the use of strategies that combine treatment with psychotropic drugsincrease the chances of their psychosocial control. This study aimed to assess the evolution of people diagnosed with refractory schizophrenia, medicated with clozapine, participants from groupsof activities in occupational therapy. Exploratory research of quantitative character with participation of eight people diagnosed with refractory schizophrenia, medicated with clozapine, belonging to a Group of patients using Antipsychotics assessedby Interactive Observation Scale of Occupational Therapy. The results, evaluated statistically, showed that the group of activities allowed a social skills practice support and stimulating exploration of ideas and feelings, whereas people with a diagnosis of mental disorder have commitment in your occupational performance. The applicability of scale proved to be adequate, since it made it possible to evaluate the occupational therapeutic interventions along to pharmacological treatment and its importance in theprocess of psychosocial rehabilitation...

La actividad física debe ser parte de la rehabilitación psicosocial en las personas afectadas de esquizofrenia / Physical activity should be part of psychosocial rehabilitation of people affected in schizophrenia

La esquizofrenia es una enfermedad que se asocia a un mayor riesgo de patología cardiovascular, por una serie de factores. Es por ello que es sumamente importante tener en cuenta esta comorbilidad asociada y considerar el fomento de hábitos de vida saludable y muy especialmente el ejercicio físico, como uno de los pilares fundamental del tratamiento individualizado. En este ensayo se discute la importancia del ejercicio físico, las recomendaciones de la literatura internacional en este aspecto y cómo utilizar los recursos disponibles en un equipo de psiquiatría organizado de acuerdo al modelo comunitario de atención, articulado de manera eficiente con la atención primaria, buscando la mejoría de los hábitos de vida en los usuarios que atendemos, portadores de esquizofrenia.

Schizophrenia is a disease associated with a increased risk of a cardiovascular pathology by a number of factors. That is why it is extremely important to note this and consider comorbidity promoting healthy lifestyles and especially exercise, as one of the key pillars of individualized treatment. This paper discusses the importance of exercise, the recommendations of the international literature in this area and how to use available resources in a psychiatric team organized according to community care model, articulated efficiently with primary care, looking to improve healthy lifestyle habits in users we serve, affected by schizophrenia.

Disability in persons with Schizophrenia correlated to family burden and family distress among their caregivers.

Background: Families are the main support system or primary care givers for persons with Schizophrenia in India. Family burden and distress is a concern one should get acquainted about the disability of the client in relation to the accompanying world. Aim: To correlate the disability in persons with schizophrenia and family burden and distress among their caregivers. Objectives: (1) To assess the disability of persons with schizophrenia. (2) To assess the family burden among the caregivers of persons with schizophrenia. (3) To assess the family distress among the caregivers of persons with schizophrenia. (4) To correlate the disability of persons with schizophrenia and the family burden and family distress among their caregivers. Method: One hundred individuals diagnosed to be suffering from schizophrenia as per DSM IV or ICD – 10 criteria and hundred primary care givers were taken up for the study with their consent to participate after the intake screening. The data collected were primarily by interviewing & administering validated Indian research instruments Indian Disability Evaluation Assessment Schedule (IDEAS), Schedule for Assessment of Family Burden (SAFB), Schedule for Assessment of Family Distress (SAFD) to the client and the significant key relative or caregiver. Results: Among the participants 83% of clients found with mild to moderate disability. Majority (96%) of the key relatives had moderate to severe burden with a mean score of 1.27 + 0.863, and 46 percent had minimal distress and 50 percent had moderate to marked distress with mean score of 5.22 + 3.265. Conclusion: Level of disability does not affect the intensity or the severity of the family burden or distress experienced among their care givers. Hence psychosocial interventions are mandatory for reducing burden and distress among the primary care givers while intervening to reduce the level of the disability.

Inserción sociolaboral de personas diagnosticadas con esquizofrenia: articulación entre roles sociales y participación en redes como elemento primario en el proceso / Labor insertion of individuals with schizophrenia

El presente artículo muestra los de un estudio exploratorio en el cual se afirma, desde el punto de vista de los usuarios de servicios y agrupaciones de salud mental, que la relación entre los roles sociales y la participación en redes sociales es un elemento fundamental en la inserción social o laboral de personas diagnosticadas con esquizofrenia, puesto que la internalización de roles activos y pasivos de los entornos sociales en los cuales se desenvuelven, aumenta o reduce el potencial de desarrollo de redes sociales, promoviendo o limitando el proceso de inserción social o laboral del individuo. En el análisis teórico se ha desarrollado el concepto el concepto de G.H.Mead denominado self, aplicado en el torno a la adopción de roles sociales; en el ámbito de las redes sociales se desarrollan los conceptos de Toldorsf, Solokovsky, Barnes y Cohen. Los resultados son presentados en tres aspectos fundamentales: Internalización y desarrollo de de roles sociales; construcción funcionalidad de redes sociales primarias y secundarias; y finalmente, la relación entre la adopción de roles sociales y el potencial de construcción de redes sociales por parte de las personas diagnosticadas con esquizofrenia. En este estudio la metodología cualitativa y el análisis de contenido son las herramientas fundamentales en el análisis teórico sociológico. Esta investigación proporciona una base para investigaciones más profundas, como el desarrollo de rehabilitación basada en la comunidad y el uso de redes sociales de salud mental para la intervención e inserción de personas con esquizofrenia y otras discapacidades psíquicas análogas.

The present article shows the results of an exploratory study which affirms, from the users of mental health services and group perspectives, the relationship between social roles end participation in social networks is a primary element in social o labor insertion of individuals with schizophrenia, since internalization of passive roles as a product of the social environment on which the individual is involved, turns into a reduction of the potential social network development, therefore, limiting or reducing the capabilities of a full social or labor insertion of the individual. The theoretical framework is based on Mead's Self theory on social roles, and social networking theoretical approach from Toldorsf, Solokovsky, Barnes and Cohen. The results are shown in three fundamental aspects: internalization of social roles, passive and active social roles on social and labor insertion; construction and functionality of primary and secondary social networks; and finally, the relationship between adoption of social roles and the construction potential of social networks of individuals with schizophrenia. This study provides a community-based rehabilitation and mental health social networks, for intervention and insertion of people with schizophrenia and other psychiatric disabilities.

efficacy of group cognitive-remediation therapy for patients with schizophrenia with longitudinal course

The present research investigates the efficacy of Group Cognitive-Remediation Therapy [GCRT] in decreasing clinical symptoms and enhancing cognitive performance among patients with schizophrenia. Forty subjects were randomly selected from inpatients with at Razi Psychiatry Schizophrenia Hospital, and were assigned to one experimental and one control group, each one comprising 20 subjects. Both groups received drug therapy, and the experimental group received 16 sessions of GCRT in addition. Subjects were examined before, during and after intervention, using measures for assessing positive and negative symptoms, neuro-behavioral and cognitive examination, and nurse observation. Data were analyzed using multivariate repeated measures. GCRT had decreased positive and negative symptoms in patients in the experimental group, and enhanced their cognitive performance. However, it had no effect on behavioral performance. Treatment of patients with schizophrenia requires a multifaceted program, which takes cognitive disorders into consideration. GCRT, which is based upon the Iranian socio-cultural situation, could be effective for improving cognitive disorders and decreasing clinical symptoms

Acolhimento e tratamento de portadores de esquizofrenia na Atenção Básica: a visão dos gestores, terapeutas, familiares e pacientes / Acceptance and treatment of schizophrenics under Primary Health Care as seen by managers, therapists, relatives and patients

O estudo investigou as possibilidades e impasses do acolhimento e do tratamento de pacientes esquizofrênicos na Atenção Básica. Como pressupostos, admitiu-se que a Atenção Básica emerge como locus importante para as práticas de Saúde Mental e que seus técnicos vêm incorporando novas práticas aos seus currículos. Uma revisão da literatura abrangeu os principais marcos teóricos e conceituais das políticas de saúde, da Reforma Psiquiátrica e dos modelos em atenção à Saúde Mental, bem como considerações acerca da esquizofrenia e do estigma nos transtornos mentais. O estudo adotou um desenho de metodologia quali-quantitativa e trabalhou com um universo de significados, motivos, aspirações, crenças, valores e atitudes dos sujeitos envolvidos. A amostra foi composta por gestores, terapeutas, familiares e pacientes, atores sociais identificados na Atenção Básica com significativa vinculação com o problema trabalhado. Foram realizadas 38 entrevistas com gestores e terapeutas, aplicando-se às falas a metodologia do Discurso do Sujeito Coletivo. Dados fornecidos por familiares e pacientes, coletados em três entrevistas em profundidade realizadas em seus domicílios, permitiram a compreensão, entre outros aspectos, dos vínculos parentais, aspectos sociofamiliares, educacionais, história e tratamentos da doença pregressa e atual. As informações foram analisadas, dispostas numa narrativa cronológica e receberam tratamento de relatos de casos. Resultados: dentre os discursos de maior densidade observa-se que a maneira pela qual o paciente seria tratado - compreendendo acolhimento de qualidade, humanização da atenção, promoção da reinserção, atenção integral incluindo medicamentos e atitudes sem preconceito, interessava mais que o lugar onde a atenção ao doente mental grave fosse dispensada. De maneira reiterada, não se considera que os terapeutas da 7 Atenção Básica estejam capacitados para acolher e tratar de portadores de esquizofrenia, talvez casos leves ou compensados...

Predictors of psychiatric readmissions in the short- and long-term: a population-based study in Taiwan

OBJECTIVES: To explore the risks and rates of readmission and their predictors 14 days, one year, and five years after discharge for the psychiatric population in Taiwan. METHODS: This was a prospective study based on claims from 44,237 first-time hospitalized psychiatric patients discharged in 2000, who were followed for up to five years after discharge. The cumulative incidence and incidence density of readmission were calculated for various follow-up periods after discharge, and Cox proportional hazard models were generated to identify the significant predictors for psychiatric readmission. RESULTS: The less than 14-day, one-year, and five-year cumulative incidences were estimated at 6.1 percent, 22.3 percent, and 37.8 percent, respectively. The corresponding figures for incidence density were 4.58, 1.04, and 0.69 per 1,000 person-days, respectively. Certain factors were significantly associated with increased risk of readmission irrespective of the length of follow-up, including male gender, length of hospital stay >15 days, economic poverty, a leading discharge diagnosis of schizophrenia/affective disorders, and residence in less-urbanized regions. Compared to children/adolescents, young adults (20-39 years) were significantly associated with increased risks of

El concepto de cronicidad y su impacto en la clínica / The impact on clinical practice of the concept of chronicity

Los estudios de mayor nivel de evidencia nos muestran que la clínica de enfermedades crónicas, como la esquizofrenia o el trastorno bipolar, no es cristalizada y es pasible de ser modificada, positivamente, por intervenciones farmacológicas y psicosociales. Sostener el concepto de cronicidad como clínica inmodificable, al no estar sustentado en la evidencia científica, se ubica en el campo de las creencias o los prejuicios. Pensar las patologías crónicas sin posibilidad de ser mejoradas por las intervenciones terapéuticas podría resultar en no ofrecer alternativas de tratamiento. Podríamos estar frente a una cronicidad que se genera en la mente de los colegas y no en las posibilidades de la clínica de los pacientes. Las creencias y prejuicios de los profesionales del campo de la Salud Mental tienen un efecto estigmatizador similar al de la población general. Es necesaria una intensa actividad anti-estigma no sólo en el público en general sino también dentro de los colegas de nuestro campo. El esclarecimiento sobre el concepto de cronicidad se ubica en esta línea.

Studies of higher level of evidence show that the clinic of chronic diseases such as schizophrenia or bipolar disorder is not crystallized and is liable to be changed positively by pharmacological and psychosocial interventions. Supporting the concept of chronicity or "clinical unchangeable", not being supported by scientific evidence, lies in the way of belief or prejudice. Thinking that chronic diseases can t be improved by therapeutic interventions may result in not offering treatment options. We could be facing a chronicity generated in the minds of colleagues and not in the scope of the clinical patients. The beliefs and prejudices of professionals in the mental health field might have a stigmatizing effect similar to that of the general population. Intense antistigma activity is needed not only in the general public but also within our field. The c1arification of the concept of chronicity is located on this line.

Guía clínica para el tratamiento de personas desde primer episodio de esquizofrenia / Clinical guidelines for the treatment of people from first episode of schizophrenia

Se denomina esquizofrenia a un conjunto de trastornos mentales, caracterizados por alteraciones sustanciales y específicas de la percepción, del pensamiento y de las emociones, que comprometen las funciones esenciales que dan a la persona normal la vivencia de su individualidad, singularidad y dominio de sí misma y suelen, por tanto alterar de forma muy importante la vida de las personas que las padecen y también la de sus familiares y amigos. Los estudios epidemiológicos a nivel mundial han mostrado que las tasas de incidencia de la esquizofrenia son comparativamente bajas, aproximadamente 15,2 por 100.000 habitantes al año. A pesar de ello, es uno de los problemas de salud que más contribuye a la carga global de enfermedades producto tanto de su inicio a edades tempranas como del alto porcentaje de personas afectadas que mantienen alguna sintomatología a lo largo de su vida. El Estudio Multicéntrico patrocinado por la OMS en 10 países, mostró una incidencia anual de entre 16 a 40 por 100.000, al utilizar los criterios diagnósticos de la CIE-9 y de 7 a 14 por 100.000 usando criterios más rigidos (CATEGO class S+ identifying nuclear schizophrenia). El riesgo para desarrollar esquizofrenia alguna vez en la vida se estima en un rango de 0,3 a 2,0 por ciento, con una media aproximada de 0,7 por ciento.

A twelve-week randomized controlled study of the cognitive-behavioral Integrated Psychological Therapy program: positive effect on the social functioning of schizophrenic patients

OBJECTIVES: The present study was designed to evaluate the effect of twelve weekly sessions of the cognitive-behavioral program originally known as the Integriertes Psychologisches Therapieprogramm für Schizophrene Patienten, designated the Integrated Psychological Therapy (IPT) program in English, on cognition, social adjustment and quality of life in schizophrenic outpatients, comparing it to the effect of treating such patients as usual. METHOD: Fifty-six adult outpatients (from 18 to 65 years of age) with ICD-10-based diagnoses of schizophrenia were randomly assigned to two different groups: active intervention (IPT group); and treatment as usual (control group). Outcome measures were quality of life (as determined using the WHOQOL-Bref), cognition (Mini-Mental State Examination and Word Recall Test), global functioning (DSM-IV Global Assessment of Functioning Scale), social functioning (Social and Occupational Functioning Assessment Scale) and social adjustment (Social Adjustment Scale). RESULTS: The findings suggest that, in comparison with treatment as usual (control group), the twelve-session IPT program had a positive effect on several outcome measures: cognition in the domains of spatiotemporal orientation (p = 0.051) and memory (p = 0.031); overall social adjustment (p = 0.037), leisure/social life (p = 0.051) and family relations (p = 0.008); overall functioning (p = 0.000); social-occupational functioning (p = 0.000); and quality of life in the psychological domain (p = 0.021). CONCLUSIONS: The twelve-session cognitive-behavioral IPT intervention demonstrated superiority over treatment as usual in its effects on cognition, social adjustment and quality of life. Studies involving larger samples, longer follow-up periods and additional outcome measures are needed in order to assess the specific effects on dimensions of social functioning, cognitive functioning and quality of life in patients with schizophrenia.

OBJETIVOS: O presente estudo foi designado para avaliar o efeito de 12 sessões semanais do programa cognitivo-comportamental IPT (Integrated Psychological Therapy - Integriertes psychologisches Therapieprogramm für schizophrene Patienten - Terapia Psicológica Integrada), comparado ao tratamento usual sobre o funcionamento cognitivo, ajustamento social e qualidade de vida em pacientes ambulatoriais com esquizofrenia. MÉTODO: Cinqüenta e seis pacientes ambulatoriais adultos (idade entre 18 e 65 anos) com diagnóstico de esquizofrenia pela CID-10, foram aleatoriamente designados para dois grupos: intervenção ativa (IPT) e tratamento usual (grupo controle). As diferenças de medidas de resultados foram em qualidade de vida (WHOQOL-bref), cognição (Mini-Mental State Examination e word-span), funcionamento global (Global Assessment of Functioning-DMS-IV), funcionamento social (Social and Occupational Functioning Assessment Scale-DSM-IV) e ajustamento social (Social Adjustment Scale). RESULTADOS: Os achados sugerem que 12 sessões do programa IPT mostraram um efeito positivo sobre várias medidas de resultado comparado ao grupo controle (tratamento usual): cognição nos domínios de orientação no tempo e no espaço (p = 0,045) e memória (p = 0,031); ajustamento social geral (p = 0,037), lazer e vida social (p = 0,051), relações familiares (p = 0,008); funcionamento global (p = 0,000); funcionamento sócio-ocupacional (p = 0,000); e qualidade de vida no domínio psicológico (p = 0,021). CONCLUSÃO: A intervenção cognitivo-comportamental de 12 sessões do IPT demonstrou superioridade de efeito sobre cognição, ajustamento social e qualidade de vida comparado ao tratamento usual. Estudos com amostras maiores, maior tempo de seguimento (follow-up) e medidas adicionais de desfechos são necessários para avaliar efeitos específicos sobre dimensões de funcionamento cognitivo, social e qualidade de vida em esquizofrênicos.

Avaliação do comprometimento funcional na esquizofrenia / Functioning disability assessment in schizophrenia

CONTEXTO: A necessidade de avaliar o comprometimento de aspectos funcionais em transtornos psiquiátricos tem assumido crescente importância, particularmente no que se refere ao estudo da esquizofrenia. O funcionamento social deficiente é considerado na atualidade um importante sintoma da esquizofrenia. Vários instrumentos de mensuração para o acompanhamento da reabilitação desses pacientes foram desenvolvidos até o momento. OBJETIVO: Este artigo discute a avaliação do comprometimento do funcionamento social na esquizofrenia. MÉTODO: Resultados de recentes revisões da literatura são resumidos e discutidos. RESULTADOS: Vários estudos têm abordado a importância da análise da performance social e pessoal na esquizofrenia. Essa avaliação tem se mostrado uma medida de desfecho confiável em estudos clínicos e programas de reabilitação. CONCLUSÃO: O DSM-III apresentou uma proposta inovadora com a divisão diagnóstica multiaxial, onde foi incluído o eixo V com o objetivo de avaliar o funcionamento global de pacientes com transtorno mental. Atualmente, encontramos esse eixo atualizado no DSM IV com a proposta do uso de escalas mais precisas para a prática clínica. A escala de Performance Social e Pessoal (PSP) desenvolvida por Morosini et al. (2000) é considerada útil e prática e tem servido como instrumento de mensuração no processo de reabilitação e os resultados das intervenções farmacológicas de pacientes com esquizofrenia.

BACKGROUND: The assessment of functioning disability in patients with mental disorders and mainly in schizophrenia has increased in the last years. The social function impairment is nowadays recognized as an important symptom of schizophrenia. Many tools to measure social function impairment have been developed. OBJECTIVE: This article discusses the assessment of functioning disability in schizophrenic patients. METHOD: The results of recently reported reviews of the literature are summarized and commented. RESULTS: Several studies have evaluated the importance of Personal and Social Performance assessments in schizophrenia. These assessments have been shown as a reliable outcome measure in clinical trials and rehabilitation programs. CONCLUSION: Axis V has been inserted to the multiaxial system in DSM-III for assessing global function in mental disorders. DSM-IV has brought axis V up to date with improvements of accurate scales for clinical practice. Personal and Social Performance scale (PSP) was developed by Morosini et al. (2000). PSP is a useful and practical scale for assessing rehabilitation and pharmacology interventions in schizophrenic patients.

Alterações cognitivas na esquizofrenia: conseqüências funcionais e abordagens terapêuticas / Cognitive deficits in schizophrenia: functional consequences and therapeutic approaches

CONTEXTO: Muitos pacientes com esquizofrenia apresentam prejuízos cognitivos significativos, especialmente em relação à memória, à atenção e ao funcionamento executivo. Esses prejuízos inevitavelmente têm um importante impacto sobre a conseqüência funcional da doença. OBJETIVO: Este artigo tem como foco os aspectos do funcionamento cognitivo na esquizofrenia, sua relação com as conseqüências funcionais e o efeito das medicações antipsicóticas sobre a cognição. MÉTODO: pesquisa de base de dados Medline/PubMed e Lilacs utilizando os termos esquizofrenia, cognição, neuropsicologia, desfecho, funcionamento, tratamento. RESULTADOS: Apesar de um grande número de pesquisas descrever alterações cognitivas na esquizofrenia, ainda não há uma concordância em relação ao padrão desses déficits. Contudo, alterações cognitivas têm apresentado correlação significante com o nível de prejuízo funcional. Os antipsicóticos de segunda geração parecem ter um impacto positivo na cognição, entretanto, o significado dessa melhora cognitiva no desempenho funcional e social dos pacientes ainda não é claro. Os resultados na área de reabilitação neuropsicológica, apesar de discretos, mostram-se promissores. CONCLUSÃO: A habilidade dos antipsicóticos de segunda geração de melhorar domínios específicos da cognição varia com o padrão de alterações apresentado por esses pacientes. Assim, estratégias para melhorar a cognição de pacientes com esquizofrenia incluem o uso dos antipsicóticos de segunda geração em associação com as abordagens de reabilitação neuropsicológica.

BACKGROUND: Many patients with schizophrenia have severe impairments in cognitive functions, especially in memory, attention and executive functions. These impairments inevitably have an important impact on the functional outcome of the disorder. OBJECTIVE: This article focuses on aspects of cognitive function in schizophrenia, their relationship to functional outcome and the effect of antipsychotics on cognition. METHOD: Research on databases such as Medline/PubMed and Lilacs using the terms schizophrenia, cognition, neuropsychology, outcome, functioning, treatment. RESULTS: Even though a great number of studies report cognitive impairments in schizophrenia, there is no agreement in relation to the pattern of these deficits. Nevertheless, cognitive impairments have a significant correlation with functional handicaps. Second generation antipsychotics seem to have a positive impact in cognition, although the meaning of this improvement on social and functional performance of the patients is not clear. Neuropsychological rehabilitation shows discrete, though promising, results. CONCLUSION: The ability of second generation antipsychotics to improve specific domains of cognition vary as does the pattern of deficits of the patients. Thus, strategies to improve cognition in schizophrenia include the use of second generation antipsychotics associated with neuropsychological rehabilitation.

Evaluación de integración sensorial en adultos con esquizofrenia / Sensory integration evaluation in adults with schizophrenia

En la actualidad, los avances en salud y el concepto de relación entre mente y cuerpo han exigido investigar y proponer estrategias cada vez más integrales para abarcar enfermedades tan complejas como la Esquizofrenia. Entre ellas, aparece la Integración Sensorial como una propuesta para explicar algunos de los déficits y proponer intervenciones. El Modelo de Integración Sensorial, ha sido tradicionalmente usado por los Terapeutas Ocupacionales en niños. En nuestro país no existen publicaciones acerca de la utilización del Modelo de Integración Sensorial en personas adultas con diagnóstico de Esquizofrenia, tampoco existen herramientas que evalúen el procesamiento sensorial en esta población. El objetivo de esta publicación, es revisar los estudios internacionales existentes en relación al tema y realizar una propuesta a los Terapeutas Ocupacionales para evaluar las posibles alteraciones de Integración Sensorial en personas adultas con diagnóstico de Esquizofrenia y cómo éstas alteraciones influyen en el desempeño ocupacional.

In recent times, the advances in health science and the concept of mind and body have pushed for further investigation and the proposal of even more integral strategies to treat complex illnesses like Schizophrenia. Among these, the Sensory Integration approach appears as a new focus that may explain some of the deficits and propose alternatives for treatment. The Sensory Integration framework has been traditionally used by Occupational Therapists in work with children. In our country there are no publications regarding the use of Sensory Integration in adults diagnosed with Schizophrenia, there is also a lack of tools to evaluate sensory processing among this population. The aim of this publication is to review existing international studies on this topic and to develop a proposal for Occupational Therapists to assess possible Sensory Integration dysfunction in adults diagnosed with Schizophrenia and how these alterations may influence their occupational performance.

Esquizo-ocupação: uma ferramenta de análise da instituição Terapia Ocupacional / The Schizo-occupation: a tool for the analysis of the institution Occupational Therapy

O presente artigo propõe o conceito-exercício 'esquizo-ocupação' como uma ferramenta de análise para problematizar a instituição 'Terapia Ocupacional'. Inspirada na esquizoanálise e na análise de como a instituição 'terapia ocupacional' vem se constituindo enquanto um campo de saber, o conceito-exercício...