The impact of workplace violence on the mental health of health care workers during the COVID-19 pandemic.

Introduction: The COVID-19 pandemic introduced a new set ofwork-related stressors for health care workers. Objectives: This study aimed to investigate the associations between exposure to violence and common mental disorders among health care workers in emergency care settings during COVID-19 in the city of São Paulo, Brazil. Methods: We randomly selected two emergency care units. The 12-item General Health Questionnaire was used to assess common mental disorders among emergency health care workers (n = 100). We examined the relationships between common mental disorders and COVID-19 pandemic-related variables, including availability of personal protective equipment, exposure to violence, discrimination, harassment, and confidence in the workplace to handle the pandemic. We used multivariate Poisson regression with robust variance to estimate prevalence ratios for common mental disorders. Results: Overall, 50% (95%CI 39.8-60.1) of participants had a common mental disorder. In addition, 71% reported being victims of at least one type of violence during the COVID-19 pandemic. Higher risks ofcommon mental disorders were found among those who reported lacking personal protective equipment, being victims of discrimination, violence, or harassment, and reporting less confidence in the workplace to handle the pandemic. Participants exposed to two types of violence and three types of violence had higher prevalence ratios, with prevalence ratios of 2.28 (95%CI 1.23-4.21) and 3.14 (95%CI 1.62-6.08), respectively. Conclusions: Promoting access to personal protective equipment, addressing mistreatment of health workers as well as promoting their well-being at work, and building confidence in the workplace to deal with the pandemic are critical.

Introdução: A pandemia de covid-19 trouxe uma nova gama de estressores relacionados ao trabalho para os profissionais de saúde. Objetivos: Este estudo examina as associações entre a exposição à violência e os transtornos mentais comuns entre os profissionais de saúde durante as situações de emergência na pandemia de covid-19 em São Paulo, Brasil. Métodos: Selecionamos aleatoriamente dois serviços de emergência. O Questionário Geral de Saúde 12 foi utilizado para avaliar os transtornos mentais comuns entre os trabalhadores de saúde de urgência (n = 100). Investigamos as relações entre transtornos mentais comuns e variáveis relacionadas com a pandemia: disponibilidade de equipamento de proteção pessoal, exposição à violência/discriminação/assédio e nível de confiança no local de trabalho para lidar com a pandemia. Realizamos uma regressão multivariada de Poisson com uma variação robusta para estimar as razões de prevalência para transtornos mentais comuns. Resultados: Entre os participantes, 50% (intervalo de confiança de 95% [IC95%] 39,8-60,1) apresentaram transtornos mentais comuns e 71% relataram ter sido vítimas de pelo menos um tipo de violência durante a pandemia de covid-19. Foi encontrado maior risco de transtornos mentais comuns entre aqueles que reportaram falta de equipamento de proteção pessoal, sendo vítimas de discriminação, violência ou assédio; e que reportaram menor confiança no local de trabalho para lidar com a pandemia. Os participantes expostos a dois tipos e a três tipos de violência apresentaram razão de prevalência 2,28 (IC95% 1,23-4,21) e razão de prevalência 3,14 (IC95% 1,62-6,08) mais elevados, respectivamente. Os resultados indicam domínios que podem ser cruciais para mitigar os transtornos mentais comuns entre os trabalhadores da saúde. Conclusões: É crucial promover o acesso a equipamento de proteção pessoal, combater os maus tratos e promover o bem-estar e confiança no local de trabalho para lidar com a pandemia.

Minimum required information for Psychiatric History Taking: a scoping textbook review / Informações básicas para anamnese Psiquiátrica: Uma revisão sistematizada de livros texto

ABSTRACT Objective In psychiatry, History Taking(HT) and Mental Status Examination are the only information source for diagnosis, resulting in reliability and validity issues. Standard Diagnostic Interviews(SDI) were prescribed as a solution for diagnostic unreliability but not used in clinical practice. Our objective is to describe and consolidate the "must be collected data" in psychiatric HT, and reasons why some information must be collected for an adequate diagnostic hypothesis generation. Methods Researchers and lecturers from different countries were consulted about Textbooks of Clinical Psychiatry, as a privileged source of consolidated HT information in psychiatric training, using a snowball methodology, complemented by references review and most sold textbooks. Data were systematically extracted by two authors, and then comprehensively synthesized. Results Twenty-five textbooks, from sixteen different countries, were accessed. We did not find a standard model, nor clear reasons for why HT components were chosen, but the manual's information grossly overlaps, suggesting a "validated by tradition" model in psychiatry. Conclusion The "must be collected data" are both risk factors and prototype building blocks for mental disorders, with different anti-bias strategies. HT content suggested by textbooks is different from what is addressed by SDI, and a consensual "minimum information" for diagnostic reasoning was described.

RESUMO Objetivo Em psiquiatria, a anamnese e o Exame Psíquico são as únicas fontes de informação para o diagnóstico, resultando em problemas de confiabilidade e validade. As entrevistas diagnósticas padronizadas (SDI) foram prescritas como uma solução para a falta de confiabilidade diagnóstica, mas não são utilizadas na clínica. Nosso objetivo é descrever e consolidar os "dados mínimos que devem ser coletados" na anamnese psiquiátrica, e as razões pelas quais estes dados devem ser coletados para a geração de hipóteses diagnósticas. Métodos Pesquisadores e professores de psiquiatria de diferentes países foram consultados sobre os livros didáticos de Psiquiatria Clínica usados em seus países. Usando uma metodologia de bola de neve, complementada por revisões de referências e os livros didáticos mais vendidos, selecionamos os livros texto como fontes de informação consolidada para o treinamento de anamnese em psiquiatria. Os dados foram sistematicamente extraídos por dois autores, e depois sistematizados e comentados. Resultados Vinte e cinco livros didáticos, de dezesseis países diferentes, foram acessados. Não encontramos um modelo padrão, nem razões claras para a escolha dos componentes da anamnese, mas as informações clínicas dos livros se sobrepõem consistentemente, sugerindo um modelo "validado pela tradição" em psiquiatria. Conclusões Os "dados mínimos que devem ser coletados" são tanto fatores de risco como blocos de construção de protótipos para distúrbios mentais, com diferentes estratégias anti-viés. O conteúdo da anamnese sugerido pelos manuais é diferente do abordado pelas SDIs, e a "informação mínima" para o raciocínio diagnóstico foi descrita.

A Recovery-Oriented Intervention for People With Psychosis: A Pilot Randomized Controlled Trial.

OBJECTIVE: This pilot randomized controlled trial evaluated the effectiveness of critical time intervention-task shifting (CTI-TS) for people with psychosis in Santiago, Chile, and Rio de Janeiro. CTI-TS is a 9-month intervention involving peer support workers and is designed to maintain treatment effects up to 18 months. METHODS: A total of 110 people with psychosis were recruited when they enrolled in community mental health clinics (Santiago, N=60; Rio de Janeiro, N=50). Participants within each city were randomly assigned to either CTI-TS or usual care for 9 months. Primary outcomes were quality of life, measured with the World Health Organization Quality of Life Assessment-Brief Version (WHOQOL-BREF), and unmet needs, measured with the Camberwell Assessment of Need (CAN), at 18-month follow-up. Results were analyzed according to intention-to-treat guidelines. Generalized estimating equations, with observations clustered within cities, and multiple imputation for missing data were used. RESULTS: At 18 months, both groups showed improved primary outcomes. In both unadjusted and fully adjusted analyses, no significant differences between CTI-TS and usual care (WHOQOL-BREF question on quality of life and CAN mean number of unmet needs) were found. CONCLUSIONS: Three factors might explain the lack of difference between CTI-TS and usual care: first-contact enrollment precluded rapport prior to randomization, a minority of patients were uncomfortable with peers being on the treatment team, and primary outcome measures may not have been sensitive enough to capture the effects of a recovery-oriented intervention. The results have implications for the design of transitional services for people with psychosis, especially in Latin America.

Patients and physician's self-assessment regarding clinical stability in severe mental disorders: a cross-sectional study / Autoavaliação de pacientes e médicos em relação à estabilidade clínica em transtornos mentais graves: um estudo transversal

OBJECTIVE: This study explores the relationship between patients' self-assessment and physicians' evaluation regarding clinical stability. METHODS: This cross-sectional study was carried out at the general outpatient clinic of the Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) in a large sample (1,447) of outpatients, of which 67.9% were patients with severe mental disorders (SMD). We collected information using a structured questionnaire developed for this purpose, filled in by the patient's physician. Clinical stability was assessed by means of five psychiatric instability criteria and by the physician's global clinical impression over the six previous months. The patients' self-assessment was based on a question about how they evaluated their health status: stable/better, worse, does not know. For the analyses, patients' self-evaluation was considered as our standard. RESULTS: The sample was composed of 824 (57%) women with an average age of 49 years. The most prevalent diagnoses within the SMD category corresponded to 937 patients, of whom 846 (90.3%) assessed themselves as stable/better. The physicians' evaluations agreed more with patients with bipolar disorders and less with schizophrenics regarding stability. As for patients with depressive disorder, physicians agreed more with them regarding instability. CONCLUSION: The data analysis confirms our hypothesis that the self- -assessment made by patients with SMD was accurate regarding their health condition, and that the self- -assessment made by patients who considered themselves stable agree with the physicians' evaluation.

OBJETIVO: Este estudo explora a relação entre a autoavaliação dos pacientes e a avaliação dos médicos quanto à estabilidade clínica. MÉTODOS: Trata-se de um estudo transversal realizado no ambulatório do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) em uma ampla amostra de pacientes (1.447), dos quais 67,9% eram portadores de transtornos mentais graves (TMG). Coletamos informações por meio de um questionário estruturado desenvolvido para esse fim, preenchido pelo médico assistente. A estabilidade clínica foi avaliada por meio de cinco critérios de instabilidade psiquiátrica e pela impressão clínica global do médico, nos seis meses anteriores. A autoavaliação dos pacientes baseou-se em uma pergunta sobre como eles avaliavam seu estado de saúde: estável/melhor, pior, não sabe. Para as análises, a autoavaliação dos pacientes foi considerada como nosso padrão. RESULTADOS: A amostra foi composta por 824 (57%) mulheres, com idade média de 49 anos. Os diagnósticos mais prevalentes na categoria TMG corresponderam a 937 pacientes, dos quais 846 (90,3%) se avaliaram como estáveis/melhores. As avaliações dos médicos concordaram mais com pacientes portadores de transtorno bipolar e menos com esquizofrênicos em relação à estabilidade. Quanto aos pacientes com transtorno depressivo, os médicos concordaram mais com eles em relação à instabilidade. CONCLUSÃO: A análise dos dados confirma nossa hipótese de que a autoavaliação feita por pacientes com TMG foi precisa quanto à sua condição de saúde e que a autoavaliação feita por pacientes que se consideravam estáveis concorda com a avaliação dos médicos.

COVID-19 Pandemic Factors and Depressive Symptoms Among Primary Care Workers in São Paulo, Brazil, October and November 2020.

Objectives. To investigate associations between COVID-19-related factors and depressive symptoms among primary care workers (PCWs) in São Paulo, Brazil, and to compare the prevalence of probable depression among PCWs before and during the pandemic. Methods. In a random sample of primary care clinics, we examined 6 pandemic-related factors among 828 PCWs. We used multivariate Poisson regression with robust variance to estimate prevalence ratios for probable depression. We assessed the prevalence of probable depression in PCWs before and during the pandemic in 2 comparable studies. Results. Adjusted prevalence ratios were substantial for insufficient personal protective equipment; experiences of discrimination, violence, or harassment; and lack of family support. Comparisons between PCWs before and during the pandemic showed that the prevalence of probable depression among physicians, nurses, and nursing assistants was higher during the pandemic and that the prevalence among community health workers was higher before the pandemic. Conclusions. Our findings indicate domains that may be crucial to mitigating depression among PCWs but that, with the exception of personal protective equipment, have not previously been examined in this population. It is crucial that governments and communities address discriminatory behaviors against PCWs, promote their well-being at work, and foster family support. (Am J Public Health. 2022;112(5):786-794. https://doi.org/10.2105/AJPH.2022.306723).

Cultural adaptation of psychological interventions for people with mental disorders delivered by lay health workers in Africa: scoping review and expert consultation.

BACKGROUND: Lay Health Workers (LHW) are important providers of community mental health services and help mitigate access and treatment gaps in Africa. However, there is a paucity of knowledge about the role and performance of these workers, as well as about the extent to which the interventions delivered are culturally adapted to the African context. AIMS: This scoping review aimed to explore the content and aspects concerning the cultural adaptation and sustainability of psychological interventions delivered by LHW to people with mental disorders in Africa. METHODS: We conducted a scoping review of the peer-reviewed literature published from January 2000 to December 2018 to identify psychological interventions delivered by LHW for people with mental disorders in Africa. We systematically searched PubMed, Google scholar and Hinari to select relevant publications. The articles were evaluated for risk of bias according to study design with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools. Expert consultation was performed according to Arksey & O'Malley framework and cultural adaptation analysis was performed according to Bernal framework. RESULTS: Out of 14,549 retrieved records, we identified ten peer-reviewed articles conducted in Zimbabwe, Uganda, South Africa and Zambia describing four distinct interventions. Six were randomized controlled trials; none addressed implementation outcomes. Group-based interpersonal therapy (n = 5), trauma-focused cognitive behaviour therapy (n = 1), problem solving therapy (n = 3) and narrative exposure therapy (n = 1) emerged as psychological interventions delivered by LHW for people with depression, anxiety, trauma and suicidal behavior. Psychological interventions delivered by LHW in Africa were all culturally adapted to meet the competence of LHW. All the interventions were associated with symptom improvement, but the quality of this evidence varied widely with study design. CONCLUSION: Task-shifting psychological interventions delivered by LHW after appropriate cultural adaptation show promise for addressing unmet mental health care needs in Africa. More effectiveness and implementation evidence is needed, especially with regard to psychological interventions delivered by LHW for adolescence, older people and those with severe mental disorders and suicidal behaviors.

The Weekly Study Meeting in Psychiatry of the Institute of Psychiatry - Federal University of Rio de Janeiro: 70-years of culture and scientific dissemination / O Encontro Semanal do Centro de Estudos do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro: 70 anos de divulgação cultural e científica

OBJECTIVE: To describe the history of creation, development, and topics covered by the Study Center of the Institute of Psychiatry of the Federal University of Rio de Janeiro (CE ­ IPUB/UFRJ) over its 70 years. METHODS: Research in newspapers of the Hemeroteca Brasileira Digital, internal documents of IPUB/UFRJ, and interviews with eyewitnesses of the functioning of the CE. RESULTS: The Study Center has been operating on an uninterrupted basis for 70 years, every week. 472 events have been identified since the founding of the CE, but numerous other meetings have taken place. The findings were described in three major groups: 1. Academic meetings in the first half of the 20th century and insertion of the CE in the history of IPUB; 2. Topics discussed and presentations; 3. Changes in periodicity and format. CONCLUSIONS: The CE produces cultural and scientific dissemination continuously since its foundation. The type and format of events have changed over time, adapting to the needs of their community, but always serving as an important beacon for the training of specialists in mental health, dissemination of research, and tendencies about psychiatry worldwide, Latin America, and Brazil.

OBJETIVO: Descrever a história da criação e do desenvolvimento e os temas abordados pelo Centro de Estudos do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (CE ­ IPUB/UFRJ) ao longo de seus 70 anos. MÉTODOS: Pesquisa em jornais da Hemeroteca Brasileira Digital, documentos internos do IPUB/UFRJ e entrevistas com testemunhas oculares do funcionamento do CE. RESULTADOS: O Centro de Estudos funciona de maneira ininterrupta há 70 anos, semanalmente. Desde sua fundação, 472 eventos foram identificados, mas outros inúmeros encontros ocorreram. Os achados foram divididos e descritos em três grandes grupos: 1. Encontros acadêmicos na primeira metade do século XX e inserção do CE na história do IPUB; 2. Temas debatidos e apresentações; 3. Mudanças de periodicidade e formato. CONCLUSÕES: O CE produz divulgação cultural e científica continuamente desde sua fundação. O tipo e o formato dos eventos mudaram ao longo do tempo, adaptando-se às necessidades de sua comunidade, mas sempre servindo como um importante farol para a formação de especialistas em saúde mental e divulgação de pesquisas, apresentando as tendências da psiquiatria mundial, latino-americana e brasileira.

Student's confidence in mental health practice before and after psychiatry rotation: a follow up study / Autoconfiança dos alunos para a prática em saúde mental antes e depois do internato em psiquiatria: um estudo de seguimento

ABSTRACT Objectives The primary objective was to measure the effect of psychiatry rotation in students self-confidence (SC) for managing mental health (MH) issues. Methods An eighteen questions version of "Preparation for Hospital Practice Questionnaire" (PHPQ) adapted for MH was applied before, after and six months later the psychiatry rotation. Sociodemographic and experience with mental illness was measured as confounding factors. Results Hundred and ten students were recruited and four factors were identified: "Diagnosis elaboration and basic care" (F1), "Crisis management and prevention" (F2), "External sickness determinants" (F3) and "Personal distress with clinics" (F4). Cronbach Alpha ranged from 0.71 to 0.90. Previous MH training were not frequent (9.09%), and associated with better SC in F2 (after p < 0.05, 6m p = 0.03). Previous mental disorder was frequent (42.16%), and associated with more SC on F2 (p < 0.01) and F3 (p = 0.03) before course, but only on F3 after (p < 0.01) and not 6 months later. Male gender had more SC in F4 (p < 0.01) before course, but after course and 6m later female gender became more SC in F1 (after p = 0.02, 6m p = 0.01) and equivalent in F4. All factors had higher scores after and 6 months later (p < 0.001). The class considered that an interview script is very important for their SC, and improves assistance (mean > 9.0/10.0). Conclusion Obligatory rotation in MH improved SC in students. Previous training and gender were related with long lasting effects in SC.

RESUMO Objetivos Avaliar os efeitos de empoderamento do internato em saúde mental (SM) na autoconfiança (AC) dos alunos de Medicina. Métodos Uma versão adaptada para a saúde mental do "Questionário de Preparação para Prática Hospitalar" foi aplicada antes, depois e seis meses após o internato. Resultados Cento e dez alunos participaram e quatro fatores foram extraídos: "Elaboração diagnóstica e cuidados básicos" (F1), "Gestão e prevenção de crise" (F2), "Determinantes externos de adoecimento" (F3) e "Sofrimento pessoal com a clínica" (F4). Treinamento prévio em SM é incomum (9,09%), mas foi associado com pontuações mais altas em F2 (p = 0,05 e 6m p = 0,03). Tratamento prévio em SM (42,16% dos alunos) foi associado a valores mais altos em F2 (p < 0,01) e F3 (p = 0,03) antes, mas apenas em F3 (p < 0,01) após o curso. O gênero masculino apresentou valores mais positivos que o feminino em F4 (p < 0,01) antes, mas não após o curso, quando apresentaram valores mais baixos em F1 (após p = 0,02, 6m p = 0,01). Todos os fatores apresentaram valores mais altos após o curso (p < 0,001). Os alunos consideraram o uso de uma entrevista estruturada muito importante para sua autoconfiança e qualidade da assistência (média > 9,0/10,0). Conclusão O internato em SM aumentou a AC nos alunos. Treinamento prévio e gênero estiveram associados com efeitos duradouros na AC.

Implementation of a pilot community-based psychosocial intervention for patients with psychoses in Chile and Brazil: a comparative analysis of users' perspectives.

BACKGROUND: Few studies provide clear rationale for and the reception of adaptations of evidence-based interventions. To address this gap, we describe the context-dependent adaptations in critical time intervention-task shifting (CTI-TS), a manualized recovery program for individuals with psychosis in Rio de Janeiro, Brazil and Santiago, Chile. Implications of the adaptations - incorporating a task-shifting approach and modifying the mode of community-based service delivery - are examined from users' perspectives. METHODS: A secondary analysis of in-depth interviews with CTI-TS users (n = 9 in Brazil; n = 15 in Chile) was conducted. Using the framework method, we thematically compared how participants from each site perceived the main adapted components of CTI-TS. RESULTS: Users of both sites appreciated the task-shifting worker pair to provide personalized, flexible, and relatable support. They wanted CTI-TS to be longer and experienced difficulty maintaining intervention benefits in the long-term. In Chile, stigma and a perceived professional hierarchy toward the task-shifting providers were more profound than in Brazil. Engagement with community-based services delivery in homes and neighborhoods (Chile), and at community mental health centers (Brazil) were influenced by various personal, familial, financial, and social factors. Uniquely, community violence was a significant barrier to engagement in Brazil. CONCLUSION: CTI-TS' major adaptations were informed by the distinct mental health systems and social context of Santiago and Rio. Evaluation of user experiences with these adaptations provides insights into implementing and scaling-up task-shifting and community-oriented interventions in the region through the creation of specialized roles for the worker pair, targeting sustained intervention effects, and addressing socio-cultural barriers.

[The impact of territorial care in the treatment of people diagnosed with schizophrenia and delusional disorders in a Rio de Janeiro community]. / El impacto del cuidado territorial en el tratamiento de personas diagnosticadas con esquizofrenia y trastornos delirantes en una comunidad en Río de Janeiro.

Care for people diagnosed with schizophrenia and delusional disorders involves many challenges, especially in territorial contexts of pronounced social vulnerability. In Rio de Janeiro, the two decades after the passing of Federal Law 10,216 on Psychiatric Reform in 2001 have been characterized by the transition from a hospital-centered model to one based on community services. Taking the case of a community in Rio de Janeiro, data was extracted from the medical records of 94 patients diagnosed with schizophrenia, schizotypal disorders, and delusional disorders (ICD-10 codes F20 to F29) in five public health services. Covering the period from 2003 to 2016, indicators of the quality of treatment provided were analyzed. As a result of this transition, psychiatric hospitals have all but emptied and a low number of currently untreated patients can be observed. In addition, crisis care and long-term hospitalizations have been replaced by territorial care, and clinical comorbidities are monitored and treated at Family Health Units.

El cuidado de personas diagnosticadas con trastornos esquizofrénicos y delirantes representa un desafío, especialmente, en territorios de gran vulnerabilidad social. En Río de Janeiro, con la promulgación de la Ley Federal 10216 de 2001 sobre la Reforma Psiquiátrica, las últimas dos décadas se han caracterizado por la transición del modelo centrado en el hospital al modelo basado en los servicios comunitarios. Utilizando el caso de una comunidad de Río de Janeiro, se seleccionaron cinco servicios de salud pública y se extrajeron datos de los registros médicos de 94 pacientes con diagnósticos de esquizofrenia, trastornos esquizotípicos y trastornos delirantes (codificados en la Clasificación Internacional de Enfermedades 10 edición entre los códigos F20 a F29) y se analizaron indicadores de calidad del tratamiento ofrecido en el período 2003-2016. Como resultado de la transición se observa que los hospitales psiquiátricos quedaron casi vacíos con un bajo número de pacientes actualmente desatendidos. Además, la atención a la crisis y las hospitalizaciones a largo plazo se reemplazaron por la atención territorial y las comorbilidades clínicas se monitorean y se tratan en unidades de salud familiar.

El impacto del cuidado territorial en el tratamiento de personas diagnosticadas con esquizofrenia y trastornos delirantes en una comunidad en Río de Janeiro / The impact of territorial care in the treatment of people diagnosed with schizophrenia and delusional disorders in a Rio de Janeiro community

RESUMEN El cuidado de personas diagnosticadas con trastornos esquizofrénicos y delirantes representa un desafío, especialmente, en territorios de gran vulnerabilidad social. En Río de Janeiro, con la promulgación de la Ley Federal 10216 de 2001 sobre la Reforma Psiquiátrica, las últimas dos décadas se han caracterizado por la transición del modelo centrado en el hospital al modelo basado en los servicios comunitarios. Utilizando el caso de una comunidad de Río de Janeiro, se seleccionaron cinco servicios de salud pública y se extrajeron datos de los registros médicos de 94 pacientes con diagnósticos de esquizofrenia, trastornos esquizotípicos y trastornos delirantes (codificados en la Clasificación Internacional de Enfermedades 10 edición entre los códigos F20 a F29) y se analizaron indicadores de calidad del tratamiento ofrecido en el período 2003-2016. Como resultado de la transición se observa que los hospitales psiquiátricos quedaron casi vacíos con un bajo número de pacientes actualmente desatendidos. Además, la atención a la crisis y las hospitalizaciones a largo plazo se reemplazaron por la atención territorial y las comorbilidades clínicas se monitorean y se tratan en unidades de salud familiar.

ABSTRACT Care for people diagnosed with schizophrenia and delusional disorders involves many challenges, especially in territorial contexts of pronounced social vulnerability. In Rio de Janeiro, the two decades after the passing of Federal Law 10,216 on Psychiatric Reform in 2001 have been characterized by the transition from a hospital-centered model to one based on community services. Taking the case of a community in Rio de Janeiro, data was extracted from the medical records of 94 patients diagnosed with schizophrenia, schizotypal disorders, and delusional disorders (ICD-10 codes F20 to F29) in five public health services. Covering the period from 2003 to 2016, indicators of the quality of treatment provided were analyzed. As a result of this transition, psychiatric hospitals have all but emptied and a low number of currently untreated patients can be observed. In addition, crisis care and long-term hospitalizations have been replaced by territorial care, and clinical comorbidities are monitored and treated at Family Health Units.

Internato de Saúde Mental para alunos de Medicina: qual o melhor cenário de formação? / Internado de Salud Mental para alumnos de Medicina: ¿ cuál es el mejor escenario de formación? / Mental Health Internship for Medical students: which is the best training setting?

As Diretrizes Curriculares do curso de graduação em Medicina de 2014 incluem a Saúde Mental (SM) como uma das áreas obrigatórias do internato. O objetivo deste trabalho é apresentar o internato integrado de SM e de Medicina de Família e Comunidade (MFC) da Universidade Federal do Rio de Janeiro (UFRJ) e a fundamentação da escolha da Atenção Primária à Saúde (APS) como cenário de formação dos internos. Trata-se do relato da experiência do internato integrado de SM e MFC da UFRJ e da discussão de seus marcos teóricos. A alta prevalência de sofrimento psíquico e transtornos mentais na APS, o fato de ela ser a porta de entrada do Sistema Único de Saúde (SUS) e o fato de que a faculdade de Medicina deve formar médicos generalistas fazem deste cenário lócus privilegiado para o treinamento dos internos de Medicina em SM.(AU)

Las Directrices Curriculares del Curso de Graduación en Medicina de Curso de 2014 incluyen la salud mental (SM) como una de las áreas obligatorias del internado. El objetivo de este trabajo es presentar el internado integrado de SM y Medicina de Familia y Comunidad (MFC) de la UFRJ y la fundamentación de la Escuela de Atención Primaria de la Salud (APS) como escenario de formación de los internos. Se trata del relato del internado integrado de SM y MFC de la UFRJ y de la discusión de sus marcos teóricos. La alta prevalencia de sufrimiento psíquico y trastornos mentales en la APS, el hecho de que la APS es la puerta de entrada del sistema único de salud (SUS) y el hecho de que la facultad de medicina debe formar a médicos generalistas, hace que este escenario sea un locus privilegiado para el entrenamiento de los internos de medicina en salud mental.(AU)

The 2014 Curricular Guidelines of the medical undergraduate courses include Mental Health (MH) as one of the required areas of internship. The objective of this paper is to present the integrated internship for MH and Family and Community Medicine (FCM) of UFRJ, as well as the rationale for choosing Primary Health Care (PHC) as the setting for the internship training. It presents a report of the experience of the integrated internship for MH and FCM of UFRJ and the discussion of its theoretical frameworks. The high prevalence of psychological distress and mental disorders in PHC, the fact that PHC is the gateway to the unified national health system (SUS) and the fact that the medical school must train general practitioners, make PHC a privileged locus for the training of medical interns in mental health.(AU)

Um estudo longitudinal sobre a influência do internato em saúde mental na redução de atitudes negativas de estudantes de Medicina em relação a portadores de transtornos mentais / A longitudinal study on the impact of mental health internship in reducing negative attitudes of medical students towards people with mental disorders

RESUMO Objetivo Avaliar o efeito do internato em saúde mental nas atitudes dos alunos de medicina quanto ao portador de transtorno mental (PTM). Métodos Atitudes foram avaliadas por questionário antes e depois do internato, por meio dos fatores: "aceitação social de PTM" (F1), "não acreditar em causas sobrenaturais para doença mental" (F2), "papéis sociais comuns para PTM" (F3), "acreditar em causas psicossociais para doença mental" (F4), "intimidade" (F5). Diferenças foram avaliadas por meio de testes t, fatores confundidores por ANOVA e correlações entre expectativa de melhora e fatores por Pearson. Resultados 74 de 85 alunos responderam ao questionário. Houve redução significativa em quatro fatores avaliados (F1, p < 0,001, F2, p = 0,002, F3, p = 0,04, F5, p < 0,001). Uma associação entre ter um amigo PTM e F3 foi identificada antes do curso (p = 0,04), porém não após (p = 0,13). Houve correlação positiva entre crenças de melhora e atitudes negativas com o F2 antes do curso (p = 0,01), mas não após. F5 esteve relacionado com a expectativa de melhora (p < 0,001) após o curso, indicando melhores atitudes quando melhor expectativa. Observou-se a melhora da expectativa quanto a resposta ao tratamento da esquizofrenia (p = 0,02), transtorno bipolar (p = 0,03) e transtorno de ansiedade (p = 0,03). Conclusões O internato esteve associado à redução de atitudes negativas com relação aos PTMs. O contato direto com o paciente parece ter influência direta nessa redução. Acreditamos que, mais importante do que possíveis efeitos de esclarecimento sobre causas do adoecimento, a desconstrução do mito sobre o louco violento é essencial para a melhora das atitudes. Estudos com populações de outras regiões do Brasil e voltadas para avaliação do medo de violência são necessários para a confirmação dessa hipótese e do efeito do internato sobre os alunos.

ABSTRACT Objective To evaluate and measure the effects of mental health internship on Medicine Students (MS) attitudes towards people with mental illness (PMI). Methods MS was submitted to an attitude questionnaire previously and after the mental health internship. Their attitudes were measured inside five factors: (F1) "social acceptance of PMI", (F2) "normalizing roles for PMI", (F3) "non-belief in supernatural causes for mental illness", (F4) "belief in bio-psychosocial causes for mental illness," and (F5) "near contact with PTM". T-tests were used to evaluate factor differences, confounding factor were analyzed by ANOVA and correlations through Pearson's correlation test. Results 74 of 85 students responded. There were a significant reduction in four factors (F1, p < 0.001, F2, p = 0.002, F3, p = 0.04, F5, p < 0.001). An association between having a PMI friend and F3 was identified before the course (p = 0.04), but not after (p = 0.13). A positive correlation was identified between belief in disease improvement and negative F2 attitudes before course (p = 0.01), but not after (0.40). F5 was related with disease improvement after course (p < 0.001), suggesting positive attitudes when improvement is expected. There were an increase in improvement expectations after course for schizophrenia (p = 0.02), bipolar disorder (p = 0.03) and anxiety (p = 0.03). Conclusions Mental health internship was related to a decrease in negative attitudes towards PMI. Personal contact seems to influence this improvement. We believe that the reduction of fear toward PMI is more powerful to reduce stigma than the acquisition of knowledge about its natural causes. More studies with a regionally distinct population in Brazil and aimed to measure the impact of fear are necessary to confirm this hypothesis.

Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities.

Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.