Los Servicios de Salud Públicos de la Región Metropolitana (RM) cuentan con 9 camas psiquiátricas de corta estadía por 100.000 habitantes mayores de 18 años, insuficiente para la necesidad actual / The Public Health Services at the Metropolitan Region (MR) of Chile have nine acute psychiatric beds per 100,000 over 18 years old inhabitants, insufficient for current need Alfonso González1 2

INTRODUCCIÓN: Los Servicios de Salud Públicos de la Región Metropolitana (RM) cuentan con 9 camas psiquiátricas de corta estadía por 100.000 habitantes adultos, por debajo de las recomendaciones internacionales. OBJETIVO: El presente estudio evaluará la capacidad de resolución del principal Servicio de Urgencias Psiquiátricas de la RM lo que puede ser de utilidad para evaluar el impacto de la disponibilidad de camas de corta estadía en la RM. MATERIALES Y MÉTODO: Se realizó un estudio observacional retrospectivo de todas las atenciones realizadas en el Servicio de Urgencias del Instituto Psiquiátrico "Dr. José Horwitz B." entre los años 2017 y 2020 y las indicaciones de hospitalización y su resolución. Se obtuvieron Razones de Tasas de Incidencia crudas y ajustadas para la indicación de hospitalización, las efectuadas y aquellas rechazadas por falta de vacantes. RESULTADOS: Se realizaron 90.464 atenciones a 41.541 usuarios y se indicó la hospitalización al 12,5% de ellas. La hospitalización se efectúa en el 59,5% de las atenciones y 35,9% no se pueden realizar por falta de vacantes. Al comparar las Tasas de Incidencia ajustadas se observó solamente una mayor tasa de hospitalización efectuada para los usuarios de regiones (IRR = 1,27; IC95%: 1,11-1,44; valor-p < 0,001) y durante el primer semestre de 2020 (IRR = 1,49; IC95%: 1,35-1,65; valor-p < 0,001). CONCLUSIONES: La evidente demanda por las hospitalizaciones psiquiátricas y la baja disponibilidad de camas de corta estadía en la Región Metropolitana probablemente tiene consecuencias insospechadas. Su abordaje es un desafío que requiere de una planificación multinivel entre todos los actores involucrados.

BACKGROUND: The Public Health Services at the Metropolitan Region (MR) of Chile have nine acute psychiatric beds per 100,000 inhabitants, under international recommendations. AIM: The present study will evaluate the resolution capacity of the main MR Psychiatric Emergency Room (PER), which may help assess the impact of the availability of acute beds in the MR. MATERIAL AND METHODS: A retrospective observational study of electronic patient records for all adult patients attending PER of the Psychiatric Institute "Dr. José Horwitz B." between 2017 and 2020 was analyzed. Crude and adjusted Incidence Rate Ratios were obtained for the indication of hospitalization, admissions, and those rejected due to lack of acute psychiatric beds. RESULTS: 90,464 attendances were evaluated on 41,541 patients, and hospitalization was indicated for 12.5% of them. Admissions were carried out in 59.5%, and 35.9% did not occur due to a lack of acute psychiatric beds. When comparing the adjusted Incidence Rates, only a higher hospitalization rate was observed for users from regions (IRR = 1,267; 95% CI: 1,11-1,44; p-value < 0.001) and during the first half of 2020 (IRR = 1.49; CI95%: 1.35-1.65; p-value < 0.001). CONCLUSIONS: The demand for psychiatric hospitalizations and the low availability of acute psychiatric beds in the MR probably have unsuspected consequences. The solution requires multilevel planning among all the actors involved.

Factors Associated With Physical Restraints in a Psychiatric Unit in Japan: a Retrospective Study.

OBJECTIVE: To identify factors associated with the use and duration of physical restraint (PR) in a psychiatric unit in Japan. METHODS: Medical records of 1308 patients admitted first time to the psychiatric emergency unit of Showa University Northern Yokohama Hospital between 1 January 2014 and 31 December 2021 were retrospectively reviewed. Data collected included patient age, sex, outpatient treatment, living arrangements, disability pension status, diagnosis (based on ICD-10), and psychotropic medication use at admission (chlorpromazine equivalent dose, imipramine equivalent dose, diazepam equivalent dose, and number of mood stabilisers administered). Logistic regression analysis and multiple regression analysis were used to identify factors associated with the use and duration of PR, respectively. RESULTS: Of 1308 patients, 399 (30.5%) were subjected to PR and 909 (69.5%) were not. Among the 399 patients subjected to PR, 54 were excluded from the multiple regression analysis for duration of PR as they remained subject to PR on the day of discharge. The remaining 345 patients were subject to PR for a median of 10 days. PR utilisation was associated with male sex (odds ratio [OR] = 1.420), treatment at our hospital (OR = 0.260), treatment at other hospitals (OR = 0.645), F3 diagnosis (depression) [OR = 0.290], F4-9 diagnosis (OR = 0.309), and imipramine equivalent dose at admission (unit OR = 0.994). The log-transformed duration of PR was independently associated with the age group of 50 to 69 years (ß = 0.248), the age group of ≥70 years (ß = 0.274), receiving a disability pension (ß = 0.153), an F1 diagnosis (ß = -0.187), an F4-9 diagnosis (ß = -0.182), chlorpromazine equivalent dose at admission (ß = 0.0004), and number of mood stabilisers administered at admission (ß = -0.270). CONCLUSION: Identifying factors associated with the use and duration of PR may lead to reduction in the use and duration of PR.

Reasonable or Random: 72-Hour Limits to Psychiatric Holds.

Across the United States, state laws most commonly limit the duration of emergency psychiatric holds to 72 hours. Estimates suggest that more than 1 million emergency psychiatric holds are placed in the United States each year, and this 72-hour limit can shape the lives of patients, clinicians, law enforcement officials, and others in the community. Yet, from where did this time frame originate, and why is it so prevalent in psychiatric care? The author examines the evolution of 72-hour limits on psychiatric holds in the United States, as well as the evidence for or against use of this specific time frame in emergency psychiatric care. Given limited research into policies that affect millions of people, the author concludes that further study is needed to understand how these time limits influence outcomes related to psychiatric care and to strengthen the evidence base for civil commitment practices.

Psychiatric emergency service in Federal District: interdisciplinarity, pioneering spirit and innovation / Servicio de emergencia psiquiátrica en Distrito Federal: interdisciplinariedad, espíritu pionero e innovación / Serviço de emergência psiquiátrica no Distrito Federal: interdisciplinaridade, pioneirismo e inovação

ABSTRACT Objective: This study aims to discuss the care for people in psychic crises conducted by the team of the Mental Health Center of the Mobile Emergency Care Service of the Federal District - Brazil (NUSAM/SAMU/DF/BRAZIL), describing the dynamics of care, since the regulation from cases to follow-up. Methods: Qualitative, exploratory, descriptive study, with data collected through data collection in the information system of the Health Department of the Federal District (SES/DF), participant observation activities and interviews, over a period of three months, with professionals from NUSAM/SAMU/DF. The qualitative analysis consisted of Bardin's content analysis. Results: NUSAM/SAMU/DF showed its ability to offer care in a humanized and resolving way to urgencies and emergencies of a psychosocial nature, considering the resources it has. Final considerations: The service's pioneering spirit regarding the prehospital approach to people in psychic crises is highlighted, characterized by the singularized, humanized and resolutive service.

RESUMEN Objetivo: Debatir la atención a personas en crisis psíquicas realizado por equipo del Núcleo de Salud Mental del Servicio de Atención Móvil de Urgencia del Distrito Federal - Brasil (NUSAM/SAMU/DF/BRASIL), describiendo dinámica de atención, desde la regulación de los casos hasta el follow-up. Métodos: Estudio cualitativo exploratorio, descriptivo, con datos recogidos por medio del levantamiento de datos en sistema de informaciones de la Secretaría de Salud del Distrito Federal (SES/DF), actividades de observación participante y entrevistas, en el período de tres meses, con profesionales del NUSAM/SAMU/DF. Análisis cualitativo consistió en el análisis de contenido de Bardin. Resultados: El NUSAM/SAMU/DF evidenció su capacidad de ofertar atención de forma humanizada y resolutiva a las urgencias y emergencias de naturaleza psicosocial, considerando los recursos de que dispone. Consideraciones finales: Destaca el pionerismo del servicio en que se refiere al abordaje prehospitalario a personas en crisis psíquicas, caracterizada por la atención singularizada, humanizada y resolutiva.

RESUMO Objetivo: Este estudo objetiva debater o atendimento a pessoas em crises psíquicas realizado pela equipe do Núcleo de Saúde Mental do Serviço de Atendimento Móvel de Urgência do Distrito Federal - Brasil (NUSAM/SAMU/DF/BRASIL), descrevendo a dinâmica de atendimento, desde a regulação dos casos até o follow-up. Métodos: Estudo qualitativo exploratório, descritivo, com dados coletados por meio do levantamento de dados no sistema de informações da Secretaria de Saúde do Distrito Federal (SES/DF), atividades de observação participante e entrevistas, no período de três meses, com profissionais do NUSAM/SAMU/DF. A análise qualitativa consistiu na análise de conteúdo de Bardin. Resultados: O NUSAM/SAMU/DF evidenciou sua capacidade de ofertar atendimento de forma humanizada e resolutiva às urgências e emergências de natureza psicossocial, considerando os recursos de que dispõe. Considerações finais: Destaca-se o pioneirismo do serviço no que se refere à abordagem pré-hospitalar a pessoas em crises psíquicas, caracterizada pelo atendimento singularizado, humanizado e resolutivo.

[Is the orientation of patients suffering from depressive disorder to the psychiatric emergencies by a general practitioner associated with the decision to hospitalize?] / L'orientation des patients souffrant d'un trouble dépressif aux urgences psychiatriques par le médecin traitant est-elle associée à la décision d'hospitalisation : étude observationnelle.

INTRODUCTION: Depressive disorders affect nearly 350 million people worldwide and are the world's leading cause of incapacity. Patients who are depressed preferentially approach their general practitioner (GP), who is their first point of contact, in 50-60% of cases. The aim of our study is to assess whether the orientation of patients suffering from anxiety-depressive disorder towards a GP in a general emergency is a factor associated with hospitalization when compared to patients who present themselves spontaneously for the same disorders. Our secondary objective was to identify the different profiles of patients who were hospitalized for these disorders as an emergency. MATERIALS AND METHODS: We conducted a cross-sectional study for the year 2015, targeting patients who presented as general emergencies at the centre hospitalier de Troyes and who had received a psychiatric diagnosis in the context of an anxiety or depressive disorder. RESULTS: Five hundred and twenty four patients were included. A univariate analysis showed that referral by the attending physician was associated with hospitalization in 57.9% vs. 42.1% cases (P=0.007), at an odds ratio at 1.98 [1.22-3.21] by multivariate analysis. Analysis by ascending hierarchical classification made it possible to identify 3 profiles for hospitalized patients: 1) patients with a known psychiatric history, a history of past or current follow-ups directed by a psychiatrist, with at least one psychotropic treatment, the presence of psychotic symptoms and a low suicidal risk compared to the rest of the study population; 2) patients without a psychiatric history, or a history of past or ongoing psychiatric follow-up and the absence of ongoing psychotropic treatment. These patients were referred by a GP (67% vs 23%, P<0.001) and their suicidal risk was higher (59% vs 26%, P<0.001); 3) patients about whom the psychiatrist had little information at the time of the emergency consultation. CONCLUSIONS: The relevance of GPs in orientation towards emergencies pleads in favor of a partnership and an early exchange between treating physicians and the psychiatrists.

Presentations to NSW emergency departments with self-harm, suicidal ideation, or intentional poisoning, 2010-2014.

OBJECTIVE: To evaluate population trends in presentations for mental health problems presenting to emergency departments (EDs) in New South Wales during 2010-2014, particularly patients presenting with suicidal ideation, self-harm, or intentional poisoning. DESIGN, SETTING AND PARTICIPANTS: This was a retrospective, descriptive analysis of linked Emergency Department Data Collection registry data for presentations to NSW public hospital EDs over five calendar years, 2010-2014. Patients were included if they had presented to an ED and a mental health-related diagnosis was recorded as the principal diagnosis. MAIN OUTCOME MEASURES: Rates of mental health-related presentations to EDs by age group and calendar year, both overall and for the subgroups of self-harm, suicidal ideation and behaviour, and intentional poisoning presentations. RESULTS: 331 493 mental health-related presentations to 115 NSW EDs during 2010-2014 were analysed. The presentation rate was highest for 15-19-year-old patients (2014: 2167 per 100 000 population), but had grown most rapidly for 10-14-year-old children (13.8% per year). The combined number of presentations for suicidal ideation, self-harm, or intentional poisoning increased in all age groups, other than those aged 0-9 years; the greatest increase was for the 10-19-year-old age group (27% per year). CONCLUSIONS: The rate of mental health presentations to EDs increased significantly in NSW between 2010 and 2014, particularly presentations by adolescents. Urgent action is needed to provide better access to adolescent mental health services in the community and to enhance ED models of mental health care. The underlying drivers of this trend should be investigated to improve mental health care.

Paediatric mental and physical health presentations to emergency departments, Victoria, 2008-15.

OBJECTIVES: To identify trends in presentations to Victorian emergency departments (EDs) by children and adolescents for mental and physical health problems; to determine patient characteristics associated with these presentations; to assess the relative clinical burdens of mental and physical health presentations. DESIGN: Secondary analysis of Victorian Emergency Minimum Dataset (VEMD) data. Participants, setting: Children and young people, 0-19 years, who presented to public EDs in Victoria, 2008-09 to 2014-15. MAIN OUTCOME MEASURES: Absolute numbers and proportions of mental and physical health presentations; types of mental health diagnoses; patient and clinical characteristics associated with mental and physical health presentations. RESULTS: Between 2008-09 and 2014-15, the number of mental health presentations increased by 6.5% per year, that of physical health presentations by 2.1% per year; the proportion of mental health presentations rose from 1.7% to 2.2%. Self-harm accounted for 22.5% of mental health presentations (11 770 presentations) and psychoactive substance use for 22.3% (11 694 presentations); stress-related, mood, and behavioural and emotional disorders together accounted for 40.3% (21 127 presentations). The rates of presentations for self-harm, stress-related, mood, and behavioural and emotional disorders each increased markedly over the study period. Patients presenting with mental health problems were more likely than those with physical health problems to be triaged as urgent (2014-15: 66% v 40%), present outside business hours (36% v 20%), stay longer in the ED (65% v 82% met the National Emergency Access Target), and be admitted to hospital (24% v 18%). CONCLUSIONS: The number of children who presented to Victorian public hospital EDs for mental health problems increased during 2008-2015, particularly for self-harm, depression, and behavioural disorders.

Compreendendo a dinâmica assistencial do serviço de emergência psiquiátrica utilizando a avaliação de quarta geração / Understanding the assistance dynamic of the psychiatric emergency service using the fourth generation assessment

Estudo que objetivou compreender as reivindicações, preocupações e questões construídas por profissionais acerca da dinâmica assistencial de um serviço de emergência psiquiátrica. Para tanto, foi realizado um estudo de caso, por meio da avaliação de Quarta Geração, com 15 participantes. A coleta de dados ocorreu por meio de análise documental, entrevista semiestruturada e observação, e a análise pelo método comparativo constante. Assim emergiram dois eixos temáticos: a) Compreendendo a dinâmica assistencial do serviço de emergência Psiquiátrica e; b) A desarticulação da rede de atenção psicossocial como entrave para a satisfação sobre a assistência na emergência psiquiátrica. Considera-se que a dinâmica assistencial na Emergência Psiquiátrica extrapola o mero caráter de unidade de estabilização de pacientes com quadros de agudização do transtorno mental, uma vez que esta direciona o fluxo de usuários para o tratamento adequado na rede de atenção psicossocial.

A study to comprehend the requests, concerns, and questions of professionals about the assistance dynamic of a psychiatric emergency service. We conducted a case study, using the Fourth Generation assessment method, with 15 participants. We collected data using documental analysis, semi-structured interview and observation and, we used the constant comparative method for analysis. Therefore, two thematic axes arose: a) Comprehending the assistance dynamic of the Psychiatric emergency service and, b) The disarticulation of the psychosocial attention network as a barrier to satisfaction with the assistance in the psychiatric emergency. We considered that the assistance dynamic in the Psychiatric Emergency extrapolated the simple, unique character of stabilizing patients with acute mental disorders, once it directs the user's flow to the adequate treatment in the psychosocial attention network.

NURSING PRACTICE AT A PSYCHIATRIC EMERGENCY SERVICE: EVALUATION USING FOURTH GENERATION ASSESSMENT / PRÁCTICA DE ENFERMERÍA DE URGENCIAS DE PSIQUIATRÍA: MÉTODO DE EVALUACIÓN DE CUARTA GENERACIÓN / ATUAÇÃO DO ENFERMEIRO NO SERVIÇO DE EMERGÊNCIA PSIQUIÁTRICA: AVALIAÇÃO PELO MÉTODO DE QUARTA GERAÇÃO

Qualitative study that used the framework of Fourth Generation Assessment and aimed to apprehend the perception of professionals, users and family members, about the nurse's practice at a psychiatric emergency service. Data were collected from February to June 2014, involving with 15 professionals, nine users and six family members. In the data collection, non-participant observation, participant observation and individual interviews were held, using hermeneutic-dialectic circle, with analysis by the constant comparative method. The results were grouped into two main themes: The nurse as a facilitator of multidisciplinary and humanized care and; activity accumulation: limitation for nurses to work at the psychiatric emergency service. It was concluded that the use of Fourth Generation Assessment reveals the empowerment of stakeholders as protagonists of change and that the nurse's practice is essential for the humanization of care and the dynamics of multidisciplinary work.

Estudio cualitativo que utilizó el marco de Evaluación de la Cuarta Generación y que tuvo como objetivo aprehender la percepción de los profesionales, usuarios y familiares, sobre la actuación del enfermero en un servicio de urgencias psiquiátricas. Los datos fueron recolectados de febrero a junio de 2014, junto con 15 profesionales, nueve usuarios y seis miembros de la familia. En la recogida de datos se llevó a cabo la observación de no participantes, la observación de participantes y las entrevistas individuales, a través del círculo hermenéutico-dialéctico, con análisis por el método comparativo constante. Los resultados se agruparon en dos temas principales: El enfermero como facilitador del cuidado multidisciplinario y humanizado; Acumulación de Actividades: limitación para los enfermeros trabajaren en el servicio de urgencias de psiquiatría. Se concluyó que uso del método Cuarta Evaluación Generación pone de manifiesto el empoderamiento de los actores como protagonistas del cambio y la actuación del enfermero es esencial para la humanización del cuidado y la dinámica del trabajo multidisciplinario.

Estudo qualitativo que utilizou o referencial da Avaliação de Quarta Geração e que teve como objetivo apreender a percepção de profissionais, usuários e familiares, acerca da atuação do enfermeiro em um serviço de emergência psiquiátrica. Os dados foram coletados no período de fevereiro a junho de 2014, junto a 15 profissionais, nove usuários e seis familiares. Realizou-se observação não participante, observação participante e entrevista individual, por meio do círculo hermenêutico-dialético, com análise pelo método comparativo constante. Os resultados foram agrupados em dois eixos temáticos: O enfermeiro como facilitador do cuidado multidisciplinar e humanizado e; Acúmulo de atividades: limitação para o enfermeiro atuar no serviço de emergência psiquiátrica. Concluiu-se a que a utilização do método de Avaliação de Quarta Geração faz emergir o empoderamento dos grupos de interesse como protagonistas das transformações e que a atuação do enfermeiro é essencial para a humanização do cuidado e à dinâmica de trabalho multidisciplinar.

Concepção de profissionais de saúde que atuam em emergência de saúde mental / Conception of health professionals who work in emergency mental health / Concepción de profesionales de la salud que actúan en urgencias de los servicios de salud mental

O presente estudo comparou as concepções sobre doença mental de profissionais administrativos, de enfermagem e médicos dos serviços de saúde de urgência no município de Londrina-PR. O delineamento foi transversal, utilizando a escala OpinionsAbout Mental Illness (OMI) com uma amostra aleatória de 30% dos profissionais, totalizando 96 sujeitos no período de 2010 a 2011. Os dados foram submetidos à análise estatística pelo StatisticalPackage for Social Sciences (SPSS). Para dois fatores da escala ODM e com os enfermeiros, há normalidade na distribuição amostral. O teste de Kruskall-Wallis indicou que há diferença significativa com relação a quatro dos sete fatores componentes da ODM (p<0,05). Os profissionais que atuam nesses serviços necessitam de capacitação na área de saúde mental, bem como há a necessidade de novos estudos sobre o tema, com um maior número de sujeitos.(AU)

This study compared the conceptions about mental illness of administrative professionals, nurses and doctors of emergency health services in the city of Londrina, PR. The design was cross-sectional, using the Opinions about Mental Illness (OMI) scale with a random sample of 30% of the professionals, totaling 96 subjects in the period 2010 to 2011. The data was statistically analyzed by the Statistical Package for Social Sciences (SPSS); with two factors of the OMI scale and nurses, there was normality in the sampling distribution. The Kruskall-Wallis test indicated a significant variation with respect to four of the seven factor components of the OMI (p <0.05). The professionals that work in emergency health services require training in the area of mental health, and there is a need for further studies on this topic, with a larger number of subjects.(AU)

El presente estudio comparó las concepciones sobre enfermedad mental de profesionales administrativos, de enfermería y médicos de los servicios de salud de urgencias en el municipio de Londrina-PR. O delineamiento fue transversal, utilizando la escala OpinionsAbout Mental Illness (OMI) con una muestra aleatoria del 30% de los profesionales, totalizando 96 sujetos en el período de 2010 a 2011. Los datos fueron sometidos al análisis estadístico por el StatisticalPackage for Social Sciences (SPSS). Para dos factores de la escala ODM y con los enfermeros, hay normalidad en la distribución muestral. El test de Kruskall-Wallis indicó que hay diferencia significativa con relación a cuatro de los siete factores componentes de la ODM (p<0,05). Los profesionales que actúan en esos servicios necesitan de capacitación en el área de salud mental, al igual que existe la necesidad de nuevos estudios sobre el tema, con un mayor número de sujetos.(AU)

Concepção de profissionais de saúde que atuam em emergência de saúde mental / Conception of health professionals who work in emergency mental health / Concepción de profesionales de la salud que actúan en urgencias de los servicios de salud mental

O presente estudo comparou as concepções sobre doença mental de profissionais administrativos, de enfermagem e médicos dos serviços de saúde de urgência no município de Londrina-PR. O delineamento foi transversal, utilizando a escala OpinionsAbout Mental Illness (OMI) com uma amostra aleatória de 30% dos profissionais, totalizando 96 sujeitos no período de 2010 a 2011. Os dados foram submetidos à análise estatística pelo StatisticalPackage for Social Sciences (SPSS). Para dois fatores da escala ODM e com os enfermeiros, há normalidade na distribuição amostral. O teste de Kruskall-Wallis indicou que há diferença significativa com relação a quatro dos sete fatores componentes da ODM (p<0,05). Os profissionais que atuam nesses serviços necessitam de capacitação na área de saúde mental, bem como há a necessidade de novos estudos sobre o tema, com um maior número de sujeitos.

This study compared the conceptions about mental illness of administrative professionals, nurses and doctors of emergency health services in the city of Londrina, PR. The design was cross-sectional, using the Opinions about Mental Illness (OMI) scale with a random sample of 30% of the professionals, totaling 96 subjects in the period 2010 to 2011. The data was statistically analyzed by the Statistical Package for Social Sciences (SPSS); with two factors of the OMI scale and nurses, there was normality in the sampling distribution. The Kruskall-Wallis test indicated a significant variation with respect to four of the seven factor components of the OMI (p <0.05). The professionals that work in emergency health services require training in the area of mental health, and there is a need for further studies on this topic, with a larger number of subjects.

El presente estudio comparó las concepciones sobre enfermedad mental de profesionales administrativos, de enfermería y médicos de los servicios de salud de urgencias en el municipio de Londrina-PR. O delineamiento fue transversal, utilizando la escala OpinionsAbout Mental Illness (OMI) con una muestra aleatoria del 30% de los profesionales, totalizando 96 sujetos en el período de 2010 a 2011. Los datos fueron sometidos al análisis estadístico por el StatisticalPackage for Social Sciences (SPSS). Para dos factores de la escala ODM y con los enfermeros, hay normalidad en la distribución muestral. El test de Kruskall-Wallis indicó que hay diferencia significativa con relación a cuatro de los siete factores componentes de la ODM (p<0,05). Los profesionales que actúan en esos servicios necesitan de capacitación en el área de salud mental, al igual que existe la necesidad de nuevos estudios sobre el tema, con un mayor número de sujetos.

A concepção dos enfermeiros de serviços de urgência e emergência sobre o processo saúde-doença na assistência aos usuários de substâncias psicoativas / The understanding of ER nurses about the health-disease process in assisting drug users

Este estudo qualitativo objetivou identificar as concepções de enfermeiros sobre o processo saúde-doença na assistência emergencial a usuários de álcool e outras drogas. Realizou-se a pesquisa de campo por meio de entrevista semiestruturada com 14 enfermeiros. Analisaram-se os dados segundo os pressupostos da hermenêutica dialética, dando origem à categoria 'processo saúde-doença em álcool e outras drogas'. Os resultados mostraram que os enfermeiros compreendem o abuso de substâncias psicoativas como uma patologia, pautando-se nos modelos biomédico e moral, que desconsideram as várias faces da problemática. Conclui-se que a teoria do processo saúde-doença ainda está associada ao modelo da multicausalidade, constituindo-se no principal desafio a ser superado quando se considera o modelo psicossocial de atenção.

This qualitative study aimed to identify the nurses understanding about the health-disease process in the emergency assistance to drug users. The field research was carried out by means of semi-structured interviews with fourteen nurses. Data were analyzed following the assumptions of Hermeneutical Dialectic, giving rise to the category 'health-disease process in drugs'. Results showed that nurses understand the abuse of psychoactive substances as pathology, and focus on biomedical and moral models that disregard the many faces of the disease. It concludes that the theory of health-disease process is still associated with the model of multiple causes, constituting the main challenge to be overcome when a psychosocial model of attention is concerned.

Predictors of frequent visits to a psychiatric emergency room: a large-scale register study combined with a small-scale interview study.

BACKGROUND: The role of the psychiatric emergency services has undergone extensive changes following a significant downsizing of the number of psychiatric hospital beds during the past decades. A relatively small number of "frequent visitors" accounts for a disproportionately large amount of visits to psychiatric emergency services. OBJECTIVES: To identify predictors of frequent use of a psychiatric emergency room at a Danish University Psychiatric Hospital through a 12-year period (1995-2007) and to speculate on how changes in the mental healthcare services affect predictors of frequent use through time. DESIGN: A large-scale register based logistic regression analysis combined with a small-scale explorative, interpretative interview study. Register data were drawn from the Danish Central Psychiatric Research Register. Four-year cohorts (1995, 1998, 2001 and 2004) of patients with at least one visit to the psychiatric emergency room were followed for 3 years to identify general trends of predictors throughout the period. A purposeful sample of 15 frequent visitors were interviewed about their personal motives for visiting the psychiatric emergency room, their pathways to care, and their social network and social support. RESULTS: The study identified two overall trends of predictors of frequent use of the psychiatric emergency room. High use of psychiatric services: ≥5 visits to the psychiatric emergency room, ≥3 admissions or ≥60 bed days during the year, was and continued to be predictive of high use of the psychiatric emergency room throughout the whole period. Furthermore, the emergence and continual presence of the predictors: severe mental illness (1999-onwards), substance abuse (2002-onwards) and sheltered housing (2002-2003-2005-onwards) indicated changes in the general profile of frequent visitors to the psychiatric emergency room, where predictors related to illness behaviour were supplemented by predictors related to disease. CONCLUSION: The changing profile of the conditions predicting frequent visits at the psychiatric emergency room was most probably related to the adverse effects of the continuous deinstitutionalising of the Danish mental health services and a radical health care reform. A basic multiplicative model was designed for the early detection of individual frequent visitors.

Profile of patients attended as psychiatric emergencies at a university general hospital / Caracterizacao de pacientes atendidos em emergencia psiquiatrica de hospital geral universitario

CONTEXT AND OBJECTIVE: The prevalence of psychiatric conditions in clinical settings is high, particularly in emergency services. This is a challenge for healthcare professionals and an essential element in the functioning of the mental health network. The objective here was to describe the sociodemographic and clinical profile and the practices among patients treated psychiatrically in the Emergency Unit. DESIGN AND SETTING: Descriptive and quantitative study, conducted at Hospital das Clínicas (HC), Universidade Estadual de Campinas (Unicamp). METHODS: Sociodemographic data, reasons for attendance, diagnostic hypotheses and practices were analyzed. RESULTS: Psychiatric staff attended 1,835 cases over the study period, corresponding to 1465 patients. The patients were predominantly women (53.7%) and white (79.6%); their mean age was 37 years and 41.3% lived with their parents. The commonest reasons for attendance were depressive symptoms (28.1%), agitation (23.6%) and problems with psychoactive substances (19.5%). The commonest diagnoses were psychoactive substance-related disorders (23%) and depressive disorders (18.5%). 31.6% of the patients were referred to healthcare centers and 29.2% to specialized outpatient clinics, while 8.2% were hospitalized. CONCLUSIONS: This study emphasizes that it is important for professionals working in emergency service to have information about the patients' profile and the main reasons that lead them to seek psychiatric care, and to establish a diagnosis that will allow proper management at the emergency service and case referral. .

CONTEXTO E OBJETIVO: A prevalência de quadros psiquiátricos em contextos clínicos é elevada, particularmente em serviços de emergência, representando um desafio para os profissionais da saúde e um elemento essencial no funcionamento da rede de saúde mental. Objetivou-se descrever o perfil sócio-demográfico, clínico e condutas para pacientes atendidos pela psiquiatria na Unidade de Emergência. TIPO DE ESTUDO E LOCAL: Estudo descritivo e quantitativo, conduzido no Hospital das Clínicas (HC), Universidade Estadual de Campinas (Unicamp). MÉTODOS: Foram analisados dados sócio-demográficos, motivos de atendimento, hipóteses diagnósticas e condutas. RESULTADOS: Houve 1.835 atendimentos pela Psiquiatria no período, correspondendo a 1.465 pacientes. Encontrou-se predomínio de mulheres (53,7%), idade média de 37 anos, maioria branca (79,6%); 41,3% moravam com os pais. Os motivos mais frequentes de atendimento foram sintomas depressivos (28,1%), agitação (23,6%) e problemas com substâncias psicoativas (SPA) (19,5%). Os diagnósticos mais frequentes foram transtornos relacionados a SPA (23%) e transtornos depressivos (18,5%). 31,6% dos pacientes foram encaminhados para centros de saúde, 29,2% para ambulatórios especializados e 8,2% foram internados. CONCLUSÃO: O estudo reforça a importância de que profissionais que atuem em serviços de emergência tenham informações sobre o perfil, os principais motivos que levam os pacientes a procurar atendimento psiquiátrico, além do estabelecimento de uma hipótese diagnóstica que permita uma adequada conduta no serviço e o seu encaminhamento. .

Serviços de emergência psiquiátrica e suas relações com a rede de saúde mental Brasileira / Psychiatric emergency services and their relationships with mental health network in Brazil

OBJETIVO: Revisão de dados da literatura relativos ao papel e à inserção de serviços de emergências psiquiátricas em redes de saúde mental. MÉTODO: Foi realizada uma busca em banco de dados (PubMed e SciELO) de artigos empíricos e revisões sobre serviços de emergências psiquiátricas e rede de serviços de saúde mental. RESULTADOS: Serviços de emergências psiquiátricas constituem unidade central para o funcionamento adequado de redes de saúde mental, tanto pelo manejo de situações de emergências, como pela regulação da rede em que se insere. Os serviços de emergências psiquiátricas relacionam-se com todos os serviços hospitalares e extra-hospitalares, possibilitando a organização do fluxo das internações e evitando sobrecarga da rede de saúde mental. As funções dos serviços de emergências psiquiátricas são amplas e extrapolam o simples encaminhamento para internação integral, pois estabilização clínica e suporte psicossocial podem ser alcançados em serviços de emergências psiquiátricas bem estruturados. No Brasil, estas funções foram ampliadas após a Reforma da Assistência à Saúde Mental e a sobrecarga das redes de saúde mental provocadas pelas dificuldades e limitações dos serviços hospitalares e extra-hospitalares. CONCLUSÃO: Serviços de emergências psiquiátricas devem ser valorizados e ampliados, principalmente aqueles localizados em hospitais gerais. Recomenda-se que o investimento em emergências psiquiátricas seja prioridade das políticas de saúde pública brasileiras para o aprimoramento da atenção na saúde mental.

OBJECTIVE: To review the literature concerning the role and the inclusion of emergency psychiatric services in mental health networks. METHOD: We performed a search in online databases (PubMed and SciELO) of empirical articles and reviews about emergency psychiatric services and networks of mental health services. RESULTS: Emergency psychiatric services are a core unit for a proper functioning of mental health networks, by both the management of emergencies itself, and the regulation of the network where it belongs. The emergency psychiatric services relate to all inpatient and outpatient services, allowing the organization of the flow of admissions and avoiding the overload of the network of mental health.The functions of emergency psychiatric services are broad and go beyond the simple referral for hospitalization, since clinical stabilization and psychosocial support can be reached in well structured emergency psychiatric services. In Brazil, these functions were expanded after the mental health reform and the burden of mental health network caused by difficulties and limitations of inpatient and outpatient services. CONCLUSION: Emergency psychiatric services should be recovered and expanded; especially those located in general hospitals. It is suggested that investment in psychiatric emergencies should be a priority of the Brazilian public health policies for improving the mental health care.

Diagnóstico diferencial de primeiro episódio psicótico: importância da abordagem otimizada nas emergências psiquiátricas / Differential diagnosis of first episode psychosis: importance of optimal approach in psychiatric emergencies

OBJETIVO: Revisar dados da literatura relativos ao diagnóstico de primeiro episódio psicótico no contexto das emergências psiquiátricas. MÉTODO: Revisão de artigos empíricos e de revisão selecionados por meio de busca eletrônica no indexador PubMed. RESULTADOS: Características específicas de atendimento de emergência - avaliação única e breve, em corte transversal e com poucas informações disponíveis - podem dificultar o processo diagnóstico. Essas limitações podem ser contornadas por meio da aplicação adequada de critérios diagnósticos operacionais, do uso de escalas e entrevistas diagnósticas padronizadas e de um tempo mínimo de observação de 24 a 72 horas. Diagnósticosdetranstornobipolar,esquizofrenia,depressãopsicóticaetranstorno delirante elaborados em contexto de emergência apresentam boa estabilidade temporal, não ocorrendo o mesmo com diagnósticos de transtorno psicótico breve, transtorno esquizofreniforme e transtorno esquizoafetivo. Primeiro episódio psicótico pode ocorrer na vigência do uso de substâncias psicoativas, sendo relativamente frequente a manutenção do quadro psicótico mesmo após cessação do uso. A utilização racional de exames complementares pode ajudar no diagnóstico diferencial com episódios psicóticos devido a condições médicas gerais. CONCLUSÃO: Diagnósticos de primeiro episódio psicótico podem ser adequadamente realizados durante emergências psiquiátricas, desde que sejam implementadas rotinas baseadas em evidências científicas.

OBJECTIVE: To review the literature regarding the diagnosis of first episode psychosis in the context of emergency psychiatry. METHOD: Review of empirical and review articles selected by electronic search in the database PubMed. RESULTS: Specific features of emergency care - single, brief and cross section assessment, and with little information - may jeopardize the diagnostic process. These limitations can be circumvented by application of operational diagnostic criteria, the use of scales and structured interviews and a short period of observation, between 24-72 hours. Diagnoses of bipolar disorder, schizophrenia, psychotic depression and delusional disorder developed in the context of emergency have good stability, but not the diagnoses of brief psychotic disorder, schizophreniform disorder and schizoaffective disorder. First episode psychosis can occur in the course of the use of psychoactive substances, with relatively frequent maintenance of psychotic symptoms even after cessation of the use of the substance. The rational use of subsidiary tests may help the differential diagnosis of psychotic episodes due to general medical conditions. CONCLUSION: Diagnoses of first psychotic episode can be adequately performed during psychiatric emergencies, if routines are implemented based on scientific evidence.