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.

Social disablement among residents of hostels for the homeless in Rio de Janeiro, Brazil.

BACKGROUND: Knowledge of the extent of social disablement among homeless people is very useful for policy-makers and mental health professionals who are involved in the delivery of community-based care. As there are few studies of this issue in Brazil or other developing countries, a cross-sectional study was carried out among homeless people from the Rio de Janeiro (RJ) metropolitan area. METHOD: Data were collected on a random sample of 330 residents in the five public hostels using the 21-items Social Behaviour Scale (SBS) and the Composite International Development Interview (CIDI). RESULTS: The mean age of the 330 people in the sample was 44.8, 75.8% of them were men, 78.9% were single, 79.2% unemployed. Ten percent of the 330 residents had more than five social behaviour problems, but 39.4% of them had no problem. Some 26.7% were scored as under-active, 23.0% with poor self-care, 13.3% with slowness, 12.7% with restlessness and 11.8% inappropriate social mixing. Those with schizophrenia were reported to have many more disabilities in almost all of the SBS areas. On the other hand, depression and hostility were more frequent in those with diagnoses of depression and substance abuse disorders. Women were more likely to be reported as having disablement than men, explained by their greater prevalence rate of schizophrenia. CONCLUSIONS: In this population, social disablement was largely explained by those with schizophrenia. Active treatment strategies are needed for this group. Other residents had few behaviour problems, their most pressing problems come from their poor social circumstances.

Questöes da bioética no contexto da reforma psiquiátrica / Bioethical issues in the psychiatric reform

Os autores discutem algumas questöes éticas que envolvem o atendimento a usuários dos serviços de saúde mental e a reforma psiquiátrica. Quatro questöes säo consideradas fundamentais: O consentimento informado e a internaçäo involuntária; Direito ao tratamento mais indicado; Família x usuário x profissional; O tratamento do doente crônico na comunidade. Concluem que a bioética surge como uma diretriz na difícil tarefa de decidir entre açöes que afetam interesses distintos e como fonte de conhecimentos que certamente tem muito a contribuir no desenrolar da reforma psiquiátrica no Brasil

Questoes da bioetica no contexto da reforma psiquiatrica

Os autores discutem algumas questoes eticas que envolvem o atendimento a usuarios dos servicos de saude mental e a reforma psiquiatrica. Quatro questoes sao consideradas fundamentais. O consentimento informado e a internacao involuntaria; Direito ao tratamento mais indicado; Familia x usuario x profissional; O tratamento do doente cronico na comunidade. Concluem que a bioetica surge como uma diretriz na dificil tarefa de decidir entre acoes que afetam interesses distintos e como uma fonte de conhecimentos que certamente tem muito a contribuir no desenrolar da reforma psiquiatrica no Brasil.