[Effectiveness of psychotherapy on dissociative symptoms in adult populations: A PRISMA systematic review]. / Efficacité des psychothérapies sur les symptômes dissociatifs en population adulte : une revue de la littérature PRISMA.

INTRODUCTION: Dissociation is a psychological process in reaction to threat which can be found in many psychiatric conditions. Dissociative symptoms can become very disabling, whether in daily life or in care. Nevertheless, few studies seem to have examined the efficacy of psychotherapy on the latter and its relevance as a therapeutic target. METHOD: A systematic review of the literature (PRISMA) on the efficacy of psychotherapy on dissociative symptoms in adults with mental disorders was conducted. Effectiveness was considered in terms of reduction in dissociative symptomatology. The search was conducted on Scopus, PubMed and PsycInfo. Overall, 50 full-text articles were evaluated. RESULTS: Fourteen studies were included in the review. In all, 711 adult subjects with post-traumatic stress disorder, borderline personality disorder or dissociative disorder were included. Overall, this systematic review reports a reduction in dissociative symptoms associated with a variety of psychotherapeutic interventions, without allowing any conclusions to be drawn on the superiority of one psychotherapy over another. DISCUSSION: The conclusions of this work highlight three possible therapeutic orientations for reducing dissociative symptoms: (i) by reintegrating the dynamic subsystems, (ii) by treating the cognitive processes underlying dissociation, and (iii) by acting on the processes identified as common to the effectiveness of psychotherapy.

Association of high-sensitivity C-reactive protein with susceptibility to Schizophrenia in Tunisian population.

The pathogenic mechanisms underlying Schizophrenia (SZ), one of the most frequent mental disorders, are complex and poorly understood. Several evidences suggest that inflammatory processes may underpin some of its neurobiological correlates. The aim of this study was: (i) to analyze the potential association between circulating levels of the C-reactive protein (CRP), a crucial inflammatory marker, and Schizophrenia in Tunisian patients and healthy controls (HC) cohorts; (ii) to investigate the genetic diversity of three CRP variants (rs1417938, rs1130864 and rs1205) and; (iii) to analyze a potential relationship between expression and genetic data and clinical and socio demographical characteristics. CRP polymorphisms were exanimated for 155 patients and 203 HC by taqMan5'-nuclease. High-sensitivity CRP (hs-CRP) serum level was measured in 128 clinically stable out-patient SZ patients and 63 HC subjects via an automated biochemical analyzer. We found that hs-CRP levels were significantly higher in SZ patients as compared to HC. No significant differences were found when the proportions of CRP variants were compared in patients and HC. Further analysis according to clinical and socio demographical characteristics revealed a positive association with age and hypertension. Our data on an original Tunisian sample confirm the previous finding in others population groups.

[Network analyses: Are we moving toward a new conceptualization and treatment of mental disorder?] / Les analyses par réseau : vers une nouvelle conceptualisation et prise en charge des troubles mentaux ?

In a break with categorical and dimensional approaches and thus the classical medical model, the network approach applied to psychopathology constitutes a holistic approach to mental disorders. In this approach, mental disorders are conceived as an interconnected system of symptoms in which symptoms are the cause of each other. It is suggested that the interaction between the different symptoms would result in a feedback loop that leads to the installation and maintenance of these symptoms/disorders. In addition, this approach proposes that co-morbidities are the result of symptom-symptom interactions that cross the diagnostic boundary and interact with symptoms from other psychiatric disorders. A growing number of studies have applied the network approach to elucidate causal interactions within the symptoms of depression, post-traumatic stress disorder, schizophrenia, or anxiety disorders. The overall objective of this review is to raise awareness among researchers and clinicians in psychiatry and clinical psychology of the network approach applied to psychopathology. To do this, we present the main concepts and principles of the network approach and its application in post-traumatic stress disorder. We also discuss recent criticisms of this approach and its clinical applications.

[Is the court-ordered treatment indication by the expert based on a medical diagnosis?]. / L'indication d'injonction de soins repose-t-elle sur un diagnostic médical ?

UNLABELLED: Court-ordered treatment was created in 1998, as part of a law against sexual offense recidivism. The creation of court-ordered treatment is based on the premise that many offenders have psychiatric disorders. If the court-ordered treatment is appraised as an effective way to prevent recidivism by the lawmaker, the preeminent role of psychiatry, in the prevention of recidivism has generated controversy in the psychiatric community. Few studies have been conducted on court-ordered treatment in France, and have concerned epidemiological measures. Court-ordered treatment leads to an extension of the expert's mission. In order to prevent recidivism, the interest of a treatment is a new part of the expert's mission. PURPOSE: The main purpose of this study was to assess the kind of diagnosis reported by the forensic psychiatrist who considered the court-ordered treatment as appropriate. METHOD: We led a descriptive and retrospective study among the experts' reports of 68 subjects followed by three psychiatrists. We categorized each diagnosis found in the experts' reports in reference to DSM-IV-TR axis I and axis II. As the expert has no obligation to refer to the DSM-IV-TR, we also considered the "no DSM-IV-TR categorized disorder" as a category. The primary outcome was the proportion of each diagnosis category in experts' reports, in which the forensic psychiatrist agreed with the indication of a court-ordered treatment. RESULTS: We analysed 123 experts' reports in which the mission was to diagnose a mental disorder and to assess the need for a court-ordered treatment. The expert agreed with the need for a court-ordered treatment in 112 reports. In those reports the diagnosis was "no disorder" in 27% of them, "no DSM-IV-TR categorized disorder" in 26% of them, "axis II disorder" in 24% of them, "axis I disorder" in 19% of them, and "association of an axis I and an axis II disorder" in 4% of them. DISCUSSION: The diagnoses were heterogeneous. Their associations with the need for a court-ordered treatment seem to be contradictory when considering the association between "no mental disorder" and "need for a court-ordered treatment" found in 27% of the reports. These paradoxical results led us to question the meaning of mental disorder and treatment.

[Practices and interventions related to the work integration of people with a severe mental illness: work outcomes and avenues of research]. / Pratiques et interventions de soutien à l'insertion professionnelle des personnes présentant des troubles mentaux graves : résultats et pistes de recherche.

Sustained work integration for people with a severe mental illness or handicap psychique in French (e.g., schizophrenia) is an important issue in our society today. Indeed, work is not only an essential factor in people's social integration but is also a stepping-stone toward recovery for this clientele. Well-defined programs and services related to work integration were developed and studied over the last three decades. Although the work integration of people with severe mental illness has been studied extensively in the Anglo-Saxon literature, the impact of these studies on the traditional beliefs and services in France remains uncertain. In terms of the scope of the studies so far, there has been an initial interest lasting over many years to uncover individual characteristics of people with severe mental illness which would best predict job tenure. Since, studies have been increasingly investigating various supports in order to facilitate the work integration process. These supports can be illustrated as direct supports or accommodations offered in the workplace, as needed, particularly when people with severe mental illness choose to disclose their mental disorder in the workplace. This awareness of the impact of the workplace environment on the work integration of people with a severe mental illness increases the need to find solutions and develop environmentally sensitive clinical strategies to overcome difficulties during the work integration. To illustrate this thematic, in this special issue, we have gathered together studies conducted in different countries but who share the focus on work integration of people with a severe mental illness. To reflect the advancement in this domain, this special issue is divided in three parts. The first part consists of the presentation of different types of vocational programs: supported employment programs, social firms, and hybrid models. Supported employment programs are very well documented in the specialised literature and are recognized as an evidence-based practice across the world to help people get competitive employment. Social firms is an another alternative model for facilitating the work integration of people with severe mental illness but has to date scarcely been studied empirically. Other hybrid vocational programs implemented in Québec (Canada) and France and inspired by supported employment programs and social firms' principles, are also described. The second part of this special issue is related to the presentation of two adjunct clinical interventions for helping people with a severe mental illness in their work integration, and more particularly for increasing job tenure: cognitive remediation and group cognitive behavioral therapy. Cognitive remediation was developed to reduce the impact of cognitive deficits, such as memory or attention, in people with a severe mental illness whereas group cognitive behavioral therapy was developed to change the dysfunctional beliefs and behaviours that might hinder job tenure in people receiving supported employment services. Finally, the third part of this special issue presents two papers on the influence of the workplace, of stakeholders from the organization (e.g., employers, supervisors) and of the work environment on the work integration of people with severe mental illness. The first paper discusses disclosure of the mental illness in the workplace and its positive and negative consequences such as receiving work accommodations and experiencing stigma, respectively. In the last paper, psychological processes during the hiring process are presented to better understand the elements related to discrimination and stigma during the work integration of people with severe mental illness.

[Disclosure of a mental disorder in the workplace and work accommodations: two factors associated with job tenure of people with severe mental disorders]. / La divulgation du trouble mental et les mesures d'accommodements de travail : deux facteurs du maintien en emploi des personnes aux prises avec un trouble mental grave.

Job tenure for people with severe mental disorders (e.g., schizophrenia) remains a stumbling-block to their work integration. However, the length of job tenure can vary according to the workplace (e.g., provided resources) and the work context (e.g., regular market, social firms). This gap can be explained in part by diverse organisational components, particularly the implementation of work accommodations, which is related to the disclosure of the mental disorder in the workplace. Indeed, in the scientific literature, the principal reason associated with disclosure is in regards to requesting work accommodations. The main objective of this paper is to increase our understanding of the relationships between these three concepts - disclosure of a mental disorder, work accommodations and natural supports, and job tenure - by reviewing the specialized literature and presenting the work of the authors of this paper. To do so, the authors will address the following questions: How do we define 'disclosure' of a mental disorder in the workplace and what are the strategies to consider before disclosing? What is the decision-making process related to disclosure in the workplace? How are the three concepts - disclosure of the mental disorder in the workplace, work accommodations and job tenure - intertwined? Finally, how can employment specialists facilitate the work integration of people with severe mental disorders by considering the three concepts mentioned above? Results from a review of the literature show that disclosure of a mental disorder is a dialectical process that goes beyond the question: to tell or not to tell? In fact, it is not a single binary decision. Several components are associated with the disclosure concept, and can be summarized by the questions: What, how, when and to whom to disclose his/her mental condition? Reasons for disclosing his/her mental disorder in the workplace are numerous, characterized by personal, interpersonal and work environmental factors, on one hand. On the other hand, disclosure has potential consequences, both positive (e.g., to obtain work accommodations) and negative (e.g., stigma). A decision-making process takes place when people with a severe mental disorder think about the possibility of disclosing their mental condition in the workplace - a complex decisional process involving the need to evaluate different aspects (i.e. individual, interpersonal and work environmental factors). Also, the literature supports the fact that requiring work accommodations is often related to the disclosure of the mental disorder, when natural supports in the workplace are not available. The literature is scarce regarding the correlations between the concepts of disclosure, implementation of work accommodations and job tenure; however, a more recent study demonstrated this significant relationship, in which the supervisor and co-worker supports are crucial. Employment specialists or counselors recognise the importance of planned disclosure as a means to obtain access to work adjustments in the workplace and to prevent stigma. The employment specialist working in supported employment programs for instance, could adopt with his/her clients a plan for managing the pros and cons of disclosure of the mental disorder in the workplace; this plan is entitled: Managing personal information. It consists of several steps - for example, to collect details of any sensitive information such as diagnosis, to identify work restrictions with the client, to have a common agreement (employment specialists and clients together) on terms to describe work restrictions - to help clients feel empowered and more confident as productive and valued workers. This plan allows employment specialists to work through the disclosure concept, often negatively connoted, and to adopt a more normalising strategy. Furthermore, additional tools for supporting the management of personal information plan could be used such as the Decision-Making About Disclosure Scale, the Barriers to Employment and Coping Efficacy Scale, and the Work Accommodation and Natural Support Scale, to name a few. To conclude, job tenure for people with severe mental disorders is not a pious vow, several pragmatic ingredients for intervening on this issue are now available.

[Social care for patients hospitalised in units for difficult patients]. / Prise en charge sociale des patients hospitalisés en unité pour malades difficiles.

The units for difficult patients are secure psychiatric wards that receive mentally ill people who could have committed or have committed dangerous acts. As part of the overall care of these patients, the treatment of their social problems by social workers plays an essential role. These interventions provide the psychosocial benefits necessary for the stabilisation and evolution of these subjects.

[Working as a resilience mentor aside victims of domestic violence]. / Devenir tuteur de résilience auprès de victimes de violence conjugale.

Domestic violence has numerous consequences on the victims' health. Supporting these victims means firstly being able to recognise the warning signs. Tools exist to facilitate the role of health professionals on the front line to screen for domestic violence and identify with the victims the gravity of their situation. Depending on the risks involved, it is sometimes important to let them make their own enlightened choices to help them regain confidence and independence.

Neoliberalism: Unpacking Limited Employment Success for Persons with SMI.

BACKGROUND.: A mixed-methods case study exploring access to competitive employment for persons with serious mental illness (SMI) revealed limited access to work and low employment success across two northern communities. PURPOSE.: To explore possible explanations for why low employment rates persist despite existing employment services and supports. METHODS.: A total of 46 individual or group interviews were conducted with persons with SMI, vocational providers, and decision-makers regarding access to competitive employment in the case communities. Data were systematically analysed for dominant ideas, interests and institutions using a neo-institutional framework. FINDINGS.: Participants described access to employment to be constrained by provider competition, limited supports, and a lack of consideration of difference-ideas and interests associated with neoliberal influences within provincial employment supports policy. IMPLICATIONS.: Enabling participation in meaningful employment for people with SMI will require occupational therapists to appreciate and contest the oppressive nature of neoliberal policies on local programs and services.

Stakeholder Perspectives on IPS for Employment: A Scoping Review.

BACKGROUND.: Individual Placement and Support (IPS) has demonstrated effectiveness in achieving competitive employment for people with severe mental illness. Yet limited efforts have been made to synthesize the literature pertaining to the experiences and perspectives of key stakeholders regarding IPS, which could be helpful for occupational therapists, given their role in vocational rehabilitation. PURPOSE.: To synthesize qualitative literature to understand how stakeholders (including occupational therapists) experience and perceive IPS and consider the implications for future occupational therapy practice and research. METHOD.: A scoping review methodology guided our review. We conducted an electronic search of qualitative and mixed-method studies on IPS. FINDINGS.: Twenty-six articles were retrieved. Most studies sought clients' perspectives (n = 15), followed by practitioners (mostly employment specialists; n = 10) and only one with employers. IMPLICATIONS.: There is a need for research targeting practitioners and employers which will help improve the nature of the collaboration between mental health teams, vocational teams, and employers.

[A Patient´s Personality: A Frequently Ignored but Important Component in General Medical Practice]. / Die Persönlichkeit des Patienten: Eine oft vernachlässigte aber bedeutsame Komponente in der allgemeinmedizinischen Praxis.

A Patient´s Personality: A Frequently Ignored but Important Component in General Medical Practice Abstract. In general medical practice, a patient's personality is hardly considered and assessed. In this mini-review the author summarises how a comprehensive personality assessment may provide valuable patient information. Prospective effects of personality traits on general lifestyle as well as mental and physical health are presented. In addition, original research is introduced that shows meaningful associations between personality traits, clinical disease markers, and all-cause mortality. These findings are discussed with respect to selected etiological models. The studies illustrate that a personality assessment could be a useful aid for diagnosis, prognosis, and treatment planning.

O delírio além do sintoma: reflexões a partir da teoria da subjetividade / The delusion beyond the symptom: reflections from subjectivity theory / El delirio más allá del síntoma: reflexiones a partir de la teoría de la subjetividad / Le délire au-delà du symptôme: réflexions de la théorie de la subjectivité

Este artigo parte de uma crítica ao conceito de delírio na perspectiva psiquiátrica hegemônica, de modo a propor sua definição a partir de uma base teórico-conceitual diversa: a teoria da subjetividade na perspectiva cultural-histórica de González Rey. A partir dessa perspectiva teórica, torna-se possível desconstruir o conceito de patologia e avançar na compreensão do transtorno mental como configuração subjetiva de um conflito, social e historicamente situado. Nesse sentido, esse referencial teórico permite gerar inteligibilidade sobre processos singulares individuais e sociais que se articulam no delírio, de forma a legitimá-lo enquanto fonte de conhecimento científico e como dimensão a ser considerada nos processos de atenção à saúde mental. Tal compreensão abre a possibilidade para considerar a dimensão potencialmente criativa do delírio, constituindo-se em produção possivelmente articulada a processos de desenvolvimento subjetivo, para além de um déficit comportamental relativo a uma suposta norma idealizada.

This article starts with a critique of the delirium concept in the hegemonic psychiatric perspective, to propose its definition from a different theoretical-conceptual basis: the theory of subjectivity in González Rey's cultural-historical perspective. It becomes possible to deconstruct the concept of pathology and advance the understanding of the mental disorder as a subjective configuration of a socially and historically situated conflict. In this sense, this theoretical framework allows us to generate intelligibility about individual and social singular processes that articulate in delirium, to legitimize it as a source of scientific knowledge and as a dimension to be considered in mental health care processes. Such understanding opens the possibility to consider the potentially creative dimension of delirium, constituting a production possibly linked to processes of subjective development, beyond a behavioral deficit relative to a supposed idealized norm.

Este trabajo viene de una crítica al concepto del delirio en la perspectiva psiquiátrica hegemónica, de modo a proponer su definición a partir de una base teórico-conceptual diversa: la teoría de la subjetividad en la perspectiva cultural-histórica de González Rey. A partir de esta perspectiva teórica, es posible derrumbar el concepto de patología y avanzar en la comprensión del trastorno mental como configuración subjetiva de un conflicto, social e históricamente ubicado. En este sentido, ese referencial teórico permite generar inteligibilidad sobre procesos singulares individuales y sociales que articúlense en el delirio, de forma a legitimarlo mientras fuente de conocimiento científico y como dimensión a ser considerada en los procesos de atención a la salud mental. Tal comprensión abre la posibilidad para considerar la dimensión potencialmente creativa del delirio, constituyéndose en producción posiblemente articulada a procesos de desarrollo subjetivo, para más allá de un déficit de comportamiento relativo a una supuesta norma idealizada.

Cet article part d'une critique du concept de délire dans la perspective psychiatrique hégémonique, afin de proposer sa définition à partir d'une base théorique-conceptuelle différente: la théorie de la subjectivité dans la perspective historico-culturelle de González Rey. Dans cette perspective théorique, il devient possible de déconstruire le concept de pathologie et de faire progresser la compréhension du trouble mental en tant que configuration subjective d'un conflit socialement et historiquement situé. En ce sens, ce cadre théorique permet de générer une intelligibilité sur les processus singuliers individuels et sociaux qui s'articulent dans le délire, ce qui le légitime comme source de connaissance scientifiques et aussi comme dimension à prendre en compte dans les processus de soins de la santé mentale. Une telle compréhension ouvre la possibilité de considérer la dimension potentiellement créative du délire. Ce-ci se constitue, donc, dans une production probablement liée à des processus de développement subjectif, au-delà d'un déficit comportemental par rapport à une norme supposément idéalisée.

O estupor revisitado / Stupor revisited / La stupeur revisitée / El estupor revisitado

O estupor é uma síndrome negligenciada. Isso pode ser devido à sua baixa incidência, complexidade intrínseca e boa resposta à ECT. A pobreza do material clínico não tem permitido análises estatísticas e científicas adequadas e, portanto, sua fenomenologia e neurofisiologia permanecem não esclarecidas. Questões importantes são: 1) se o estupor constitui uma forma estável de comportamento chegando a ser uma“síndrome complexa”; 2) se ele representa um comportamento pré--programado ou vestigial que pode ser desencadeado por noxa severa,seja psicogênica ou orgânica; 3) se a personalidade e causa subjacente desempenham um papel modulador e 4) se os estupores orgânicos efuncionais compartilham mecanismos subjacentes similares ou,alternativamente, se referem a estados clínicos não relacionados.Um ponto de vista evolucionário deveria integrar os estupo resneurológicos e orgânicos e justificar o uso da resposta de“congelamento” ou cataléptica ao estresse em animais como um modelode pesquisa. Isso deveria, por sua vez, sugerir predições farmacológicas de interesse para o manejo do estupor humano.

Stupor is a neglected syndrome. This may be due to its low incidence, intrinsiccomplexity and good response to ECT. Paucity of clinical material has not allowed foradequate statistical and scientific analysis and therefore its phenomenology andneurophysiology remain unclear. Important questions are whether: (1) stuporconstitutes a stable form of behavior amounting to a “symptom complex”; (2) itrepresents a preprogrammed or vestigial behavior which may be triggered off by severenoxae, whether psychogenic or organic; (3) personality and underlying cause play amodulating role and; (4) organic and functional stupors share similar underlyingmechanisms or, alternatively, refer to unrelated clinical states. An evolutionary viewshould integrate neurological and organic stupors and justify the use of the “freezing”or cataleptic response to stress in animals as a research model. This should in turnsuggest pharmacological predictions of interest for the management of human stupor.

El estupor es un síndrome negligenciado. Eso puede deberse a su baja incidencia,a la complejidad intrínseca y a la buena respuesta al ECT. La pobreza del materialclínico no ha permitido análisis estadísticas y científicas adecuadas y, por tanto, sufenomenología y neurofisiología permanecen no esclarecidas. Cuestiones importantesson: 1) saber si el estupor constituye una forma estable de comportamiento llegandoa ser un “síndrome complexo”; 2) si él representa una conducta preprogramado o unvestigio que puede ser desencadenado por una noxa severa, sea ésta psicogénica oorgánica; 3) si la personalidad y la causa subyacente desempeñan un papel moduladore 4) saber si os estupores orgánicos y funcionales comparten mecanismos subyacentessimilares o, alternativamente, se refieren a estados clínicos no relacionados.Un ponto de vista evolutivo debería integrar los estupores neurológicos eorgánicos y justificar el uso de la respuesta de “congelamiento” o cataléptica al estrésen animales como un modelo de investigación. Eso debería al mismo tiempo, sugerirpredicciones farmacológicas de interés para el manejo del estupor humano.

La stupeur est un syndrome négligé. Cela peut être dû à sa faible incidence, à sacomplexité intrinsèque et à sa bonne réponse à l’ECT. Le manque de matériel clinique ne permet pas d’effectuer des analyses statistiques et scientifiques adéquates et parconséquent sa phénoménologie et sa neurophysiologie restent floues. Il s’agit dedécouvrir si: (1) la stupeur constitue une forme stable de comportement équivalant àun ®syndrome complexe¼; (2) elle représente un comportement préprogrammé ourésiduel qui peut être déclenché par un mal sévère, soit psychogène, soit organique;(3) la personnalité et une cause sous-jacente jouent un rôle modulateur et (4) si lesstupeurs organiques et fonctionnelles partagent des mécanismes sous-jacents similairesou, à défaut, renvoient à des états cliniques indépendants. Un point de vueévolutionnaire devrait intégrer les stupeurs neurologiques et biologiques et justifier laréponse de la ®congélation¼ ou cataleptique au stress chez les animaux comme modèlede recherche. Cela devrait en revanche produire des prédictions pharmacologiquesd’intérêt pour la gestion de la stupeur humaine.

Comportamento violento, gênero e psicopatologia / Violent behavior, gender and psychopathology / Comportement violent, sexes et psychopathologie / Comportamiento violento, género e psicopatología

A violência cometida por indivíduos com transtornos mentais graves tem se tornado um foco crescente de interesse entre profissionais de saúde, autoridades policiais e outros segmentos da sociedade. Na população geral, os homens são mais agressivos do que as mulheres. Entretanto, tem sido encontrado que a diferença de gênero em relação ao comportamento violento é menor entre os indivíduos que apresentam transtornos mentais, comparados àqueles que não apresentam estes transtornos.

Violence committed by individuals with severe mental disorders has come under considerable scrutiny recently by mental health professionals, police authorities and other segments of society. Men are more aggressive than women among the general population. In contrast, however, it has been found that the difference between the genders in terms of violence is smaller among individuals with mental disorders than among people in general.

Les actes de violence commis par des personnes atteintes de graves troubles mentaux attirent de plus en plus l'intérêt des professionnels de santé, des autorités policières et d'autres segments de la société. Dans la population normale, les hommes sont d'habitude plus agressifs que les femmes. Cependant, on observe que le décalage entre les sexes par rapport au comportement violent est moins prononcé parmi les individus porteurs de troubles mentaux que dans la population normale.

La violencia cometida por los individuos con trastornos mentales graves ha despertado el interés creciente de los profesionales de la salud, autoridades policiales y otros estratos de la sociedad. Si bien que en la población común, los hombres son más agresivos que las mujeres, se ha encontrado que las diferencias de género relacionadas al comportamiento violento son menores entre individuos que presentan trastornos mentales que de aquellos que no presentan esos trastornos.

Mortalidade por transtornos mentais e comportamentais e a reforma psiquiátrica no Brasil contemporâneo / Mortalidad por los trastornos mentales y del comportamiento y la reforma psiquiátrica en el Brasil contemporáneo / La mortalité par trouble mental et comportemental et la réforme psychiatrique au Brésil contemporain / Death resulting from mental and behavioral disorders, and psychiatric reform in contemporary Brazil

A mortalidade por transtornos mentais e comportamentais têm aumentado no Brasil com a redução progressiva das internações hospitalares. A reforma psiquiátrica do governo aparentemente está contribuindo para este cenário preocupante, com sua política de desospitalização.

La mortalidad por trastornos mentales y del comportamiento ha aumentado en Brasil con la reducción gradual de las internaciones hospitalarias. La reforma psiquiátrica del gobierno aparentemente, está contribuyendo para ese escenario preocupante con su política de deshospitalización.

La mortalité par trouble mental et comportemental a augmenté au Brésil avec la réduction progressive des hospitalisations. La réforme psychiatrique du gouvernement contribue apparemment à ce cadre inquiétant, avec sa politique de deshospitalisation.

Death due to mental and behavioral disorders has increased in Brazil with the gradual reduction in the numbers of hospitalized mental patients. The federal government's psychiatric reform, based largely on closing down mental hospitals, is apparently contributing to this phenomenon.