Emociones, creencias y actitudes del personal asistencial hacia habitantes de calle que usan drogas en Medellín, Colombia / Emotions, beliefs and attitudes of healthcare workers towards homeless who use drugs in Medellín, Colombia / Emoções, crenças e atitudes do pessoal de assistência social com os moradores de rua que usam drogas em Medellín, Colômbia

Resumen Objetivo: Identificar algunos aspectos relacionados con el estigma de personal asistencial hacia habitantes de calle consumidores de sustancias psicoactivas. Metodología: Para lograr este objetivo, se llevó a cabo un estudio cualitativo, con enfoque hermenéutico y de alcance descriptivo, mediante el análisis categorial de las transcripciones de las grabaciones de los discursos de dos grupos focales con 32 participantes, miembros del Sistema de Atención al Habitante de Calle Adulto de Medellín, Colombia. La sistematización y la codificación del análisis se hicieron en un archivo de Excel®, destacándose la emergencia de las categorías: "emociones", "creencias" y "actitudes". Resultados: En los discursos de los participantes, se reiteran contenidos ambivalentes de los estigmas hacia esta población. Por una parte, la frustración en su trabajo, como principal emoción que coincide con las creencias de desconfianza y actitudes evasivas hacia ellos; y, por otro, los sentimientos de gratificación por la labor realizada, acordes con posturas más protectoras y pacientes durante el acompañamiento, pero que no se alejan de un ideal moralista de cero consumos. Conclusión: Reconocer y discutir abiertamente sobre el estigma podría orientar otras formas más humanizadas en la labor con este tipo de población, en tanto se devela que el rol profesional no nos exime del prejuicio, el estereotipo y la discriminación.

Abstract Objective: To identify some aspects related to the stigma of healthcare workers towards the homeless who consume psychoactive substances. Methodology: To achieve this objective, a qualitative study with a hermeneutic approach and descriptive scope was carried out, through the categorical analysis of transcriptions of recorded speeches from two focus groups comprised of 32 participants, members of the System of Attention to the Homeless Adult in Medellín, Colombia. Systematization and analysis encoding were performed in an Excel ® file, highlighting the presence of categories: "emotions", "beliefs" and "attitudes". Results: Ambivalent contents of the stigma towards this population are frequent in participant's speeches. On the one hand, the frustration about healthcare work, as the main emotion that coincides with the beliefs of distrust and evasive attitudes towards the homeless. On the other hand, the feelings of gratification for the work done and the presence of more protective and forbearing attitudes, but that do not alienate from the moralistic ideal of zero consumption. Conclusion: Recognizing and openly discussing stigma could guide more humanized ways of working with this type of population, as it is showed that the healthcare role does not exempt them from prejudice, stereotype and discrimination.

Resumo Objetivo: Identificar alguns aspectos relacionados ao estigma do pessoal de assistência social com os moradores de rua consumidores de substâncias psicoativas. Metodologia: Para alcançar este objetivo, foi realizado um estudo qualitativo, com abordagem hermenêutica e âmbito descritivo, através da análise categorial das transcrições das gravações dos discursos de dois grupos focais com 32 participantes, membros do Sistema de Atenção ao Morador de Rua Adulto de Medellín, Colômbia. A sistematização e a codificação da análise foram feitas num arquivo Excel®, destacando-se a emergência das categorias: "emoções", "crenças" e "atitudes". Resultados: Os participantes reiteraram em suas falas, conteúdos ambivalentes dos estigmas dessa população. Por um lado, a frustração em seu trabalho, com emoção principal que coincide com as crenças de desconfiança e atitudes evasivas com eles; e por outro, os sentimentos de gratidão pelo trabalho realizado, de acordo com posturas mais protetoras e pacientes durante o acompanhamento, mas que não se distanciam de um ideal moralista de consumo zero. Conclusão: Reconhecer e discutir abertamente o estigma poderia orientar outras formas mais humanizadas no trabalho com este tipo de população, e ao mesmo tempo se revela que o compromisso profissional não os exime do preconceito, o estereótipo e a discriminação.

Beliefs of parents of children with mental disorders in a university hospital out-patient clinic in Colombia.

OBJECTIVE: Describe the beliefs of parents about the mental disorders of their children who attended a paediatric outpatient clinic at a university hospital. METHODS: This was a descriptive study with parents of children with mental disorders seen from January to May of 2018 at a high complexity hospital in Medellin, Colombia. Ninety-eight (98) parents of children and adolescents attending their first outpatient consultation with Paediatric Psychiatry were studied. An instrument designed by the investigators was applied to obtain demographic variables and beliefs about the origin of their child's mental disorder, treatment and adjuvants. RESULTS: 49.9% of the 98 parents believed that their child had a mental disorder. 43.9% believed the disorder was inherited and 41.8% believed its cause was organic. 95.9% of the parents believed the child needed treatment, including psychotherapy (90.4%) and medication (58.51%). Among the alternative treatments the parents believed the child needed, healing was the most commonly cited by 27.5% of the parents. Of the adjuvant methods, the most commonly cited were reinforcing positive behaviour (82.7%) and correcting with words and setting a good example (72.4%). CONCLUSIONS: Nearly half of the parents believed their child had a mental disorder, the treatment that was most commonly considered was psychotherapy above medication, and the best adjuvant methods cited by parents were reinforcing positive behaviour, correcting with words and setting a good example.

Creencias de los padres acerca de los trastornos mentales de sus hijos en una consulta universitaria en Colombia / Beliefs of parents of children with mental disorders in a university hospital out-patient clinic in Colombia

RESUMEN Objetivo: Describir las creencias de los padres acerca de los trastornos mentales de sus hijos que asistieron a consulta externa infantil en una clínica universitaria. Métodos: Estudio descriptivo transversal realizado en padres de niños con trastornos mentales de una clínica de cuarto nivel de Medellín, Colombia, durante el periodo comprendido entre enero y mayo del 2018. Se estudió a 98 padres de niños y adolescentes que consultaron por primera vez a Psiquiatría Infantil. Se aplicó un instrumento elaborado por los investigadores con variables demográficas y de creencias sobre: el origen del trastorno mental, del tratamiento y sus coadyuvantes. Resultados: El 49,9% de los 98 padres evaluados creyeron que su hijo tenía un trastorno mental; en cuanto al origen de este, el 43,9% creía que era heredado y 41,8% por causas orgánicas. El 95,9% de los padres creía que sus hijos necesitaban tratamiento, de ellos, el 90,4% estimó la psicoterapia y el 58,51%, la medicación. Entre los tratamientos alternativos el más frecuente fue la sanación, con un 27,5%. De los métodos coadyuvantes en el tratamiento, los más frecuentes fueron estimular comportamientos positivos con el 82,7%, y corregir con palabras y dar buen ejemplo con el 72,4%. Conclusiones: En este estudio casi la mitad de los padres pensaba que sus hijos tenían una enfermedad mental. El tratamiento más considerado por los participantes fue la psicoterapia, por encima del uso de psicofármacos. En cuanto a los métodos coadyuvantes, los padres consideraron principalmente el estimular comportamientos positivos, corregir con palabras y dar buen ejemplo.

ABSTRACT Objective: Describe the beliefs of parents about the mental disorders of their children who attended a paediatric outpatient clinic at a university hospital. Methods: This was a descriptive study with parents of children with mental disorders seen from January to May of 2018 at a high complexity hospital in Medellin, Colombia. Ninety-eight (98) parents of children and adolescents attending their first outpatient consultation with Paediatric Psychiatry were studied. An instrument designed by the investigators was applied to obtain demographic variables and beliefs about the origin of their child's mental disorder, treatment and adjuvants. Results: 49.9% of the 98 parents believed that their child had a mental disorder. 43.9% believed the disorder was inherited and 41.8% believed its cause was organic. 95.9% of the parents believed the child needed treatment, including psychotherapy (90.4%) and medication (58.51%). Among the alternative treatments the parents believed the child needed, healing was the most commonly cited by 27.5% of the parents. Of the adjuvant methods, the most commonly cited were reinforcing positive behaviour (82.7%) and correcting with words and setting a good example (72.4%). Conclusions: Nearly half of the parents believed their child had a mental disorder, the treatment that was most commonly considered was psychotherapy above medication, and the best adjuvant methods cited by parents were reinforcing positive behaviour, correcting with words and setting a good example.

Beliefs of parents of children with mental disorders in a university hospital out-patient clinic in Colombia. / Creencias de los padres acerca de los trastornos mentales de sus hijos en una consulta universitaria en Colombia.

OBJECTIVE: Describe the beliefs of parents about the mental disorders of their children who attended a paediatric outpatient clinic at a university hospital. METHODS: This was a descriptive study with parents of children with mental disorders seen from January to May of 2018 at a high complexity hospital in Medellin, Colombia. Ninety-eight (98) parents of children and adolescents attending their first outpatient consultation with Paediatric Psychiatry were studied. An instrument designed by the investigators was applied to obtain demographic variables and beliefs about the origin of their child's mental disorder, treatment and adjuvants. RESULTS: 49.9% of the 98 parents believed that their child had a mental disorder. 43.9% believed the disorder was inherited and 41.8% believed its cause was organic. 95.9% of the parents believed the child needed treatment, including psychotherapy (90.4%) and medication (58.51%). Among the alternative treatments the parents believed the child needed, healing was the most commonly cited by 27.5% of the parents. Of the adjuvant methods, the most commonly cited were reinforcing positive behaviour (82.7%) and correcting with words and setting a good example (72.4%). CONCLUSIONS: Nearly half of the parents believed their child had a mental disorder, the treatment that was most commonly considered was psychotherapy above medication, and the best adjuvant methods cited by parents were reinforcing positive behaviour, correcting with words and setting a good example.

Discriminant Performance of Dysexecutive and Frontal Release Signs for Delirium in Patients With High Dementia Prevalence: Implications for Neural Network Impairment.

BACKGROUND: Prevalence of signs of abnormal executive function (EF) and primitive reflexes (PR) with delirium in older hospitalized patients with or without comorbid dementia has not been reported. OBJECTIVE: To describe prevalence of signs of EF deficits and PR in older inpatients and their discriminant value for delirium while accounting for dementia. METHODS: Participants were evaluated for delirium using the Diagnostic and Statistical Manual of Mental Disorders 5th edition and the Delirium Rating Scale Revised-98, dementia using Informant Questionnaire on Cognitive Decline in the Elderly, and signs of PR (n = 5) and EF deficits (n = 3) using bedside neuropsychiatric examination. Three indices (PR, EF, and Combined) and 4 diagnostic groups were created for correlational and discriminant analyses. RESULTS: Correlations of indices were higher with the Delirium Rating Scale Revised-98 than with the Informant Questionnaire on Cognitive Decline in the Elderly and even higher in those with dementia, especially the Combined index (Delirium Frontal Index). Among individual signs, glabellar and Simple Luria Hand Sequence were most common in delirium and the best for delirium discrimination irrespective of dementia status. The Combined index had about 80% sensitivity and specificity at the ≥2 cutoff in the whole cohort (positive and negative predictive values and likelihood ratios: PPV 50.0%, NPV 93.8%, +LR 3.82, -LR 0.25). The Combined index also had the best performance on discriminating delirium in dementia patients at the ≥3 cutoff, with about 80% for both sensitivity and specificity. CONCLUSIONS: PR and EF deficit signs are consistent with reduced neural network integration during delirium, even worse in those with dementia whose baseline structural injury impairs network connectivity with frontal regions. We recommend simple bedside assessment of PR and EF signs to help assess for delirium as an indicator of cerebral cortical neural network impairment in older persons.

The Mental Health Recovery Model and Its Importance for Colombian Nursing. / El modelo de recuperación de la salud mental y su importancia para la enfermería colombiana.

The article aims to describe the Mental Health Recovery Model, the Tidal Model in Mental Health Recovery and their relevance to implementation within the practice of Colombian nursing. Some concepts about mental health recovery and the theoretical model proposed by Phil Barker are presented in the text, analysing these with the challenges of the nursing professional to improve mental health care, taking into account the current context of care practice. The principles proposed with the Recovery model help to focus care on the person and not on the symptomatology of the illness, understanding that the person has different dimensions which make it possible for him/her to explore his/her own path to recovery. We can conclude that, through the theory, we can develop interventions and nursing activities that contribute to improving the quality of life of people who have been diagnosed with a mental illness, modifying the traditional healthcare models.

El modelo de recuperación de la salud mental y su importancia para la enfermería colombiana

El objetivo es describir el modelo de recuperación de la salud mental (Recovery), el modelo de la marea en la recuperación de la salud mental (Tidal Model) y su relevancia hacia la implementación dentro de la práctica de la enfermería colombiana. Algunos conceptos sobre la recuperación de la salud mental y el modelo teórico propuesto por Phil Barker se presentan en el texto, y se analizan con los desafíos del profesional de enfermería para mejorar la atención de la salud mental, teniendo en cuenta el contexto actual de la práctica asistencial. Los principios propuestos con el modelo de recuperación ayudan a centrar los cuidados en la persona y no en los síntomas de la enfermedad, entendiendo que la persona tiene diversas dimensiones que le permiten explorar su propio camino hacia la recuperación. Se puede concluir que, a través de la teoría, pueden desarrollarse intervenciones y actividades de enfermería que contribuyan a mejorar la calidad de vida de las personas diagnosticadas de alguna enfermedad mental modificando los modelos tradicionales de atención sanitaria.

The article aims to describe the Mental Health Recovery Model, the Tidal Model in Mental Health Recovery and their relevance to implementation within the practice of Colombian nursing. Some concepts about mental health recovery and the theoretical model proposed by Phil Barker are presented in the text, analysing these with the challenges of the nursing professional to improve mental health care, taking into account the current context of care practice. The principles proposed with the Recovery model help to focus care on the person and not on the symptomatology of the illness, understanding that the person has different dimensions which make it possible for him/her to explore his/her own path to recovery. We can conclude that, through the theory, we can develop interventions and nursing activities that contribute to improving the quality of life of people who have been diagnosed with a mental illness, modifying the traditional healthcare models.

Encerrado a oscuras: significado de vivir con esquizofrenia para diagnosticados y sus cuidadores, Medellín-Colombia / Locked in Darkness: What Living with Schizophrenia Means to Diagnosed Patients and their Caregivers. Medellín - Colombia / Envolto na escuridão: significado de viver com esquizofrenia para os diagnosticados e seus cuidadores, Medellín, Colômbia

RESUMEN Vivir con esquizofrenia representa un enigma para todas aquellas personas que no presentan la enfermedad o conviven con alguien que la padece. Objetivo: comprender el significado de vivir con esquizofrenia para personas que presentan la enfermedad y sus familiares, quienes acudieron a una institución estatal para la atención de problemas de salud mental de alta complejidad en Colombia durante el 2014 y 2015. Materiales y método: se utilizó un enfoque cualitativo y la información fue analizada por medio del método de la teoría fundamentada. Las técnicas de recolección de información fueron ocho entrevistas a profundidad y dos grupos focales, con una participación de 21 personas diagnosticadas y sus cuidadores. Resultados: por medio de la codificación, el muestreo teórico, la comparación constante y los memos analíticos, se llegó a la categoría "Vivir con esquizofrenia es vivir encerrado, a oscuras y con los sueños truncados". Conclusiones: para los pacientes, la familia y para los cuidadores, vivir con esquizofrenia conlleva una sensación de encerramiento que afecta el proyecto de vida de unos y otros.

ABSTRACT Living with schizophrenia is an enigma to all who do not have the disease or live with someone who does. Objective: The purpose of the study was to understand what living with schizophrenia means for people with the disease and their relatives, specifically in the case of patients who sought help during 2014 and 2015 at a state institution in Colombia that is dedicated to handling highly complex mental health problems. Materials and method: A qualitative approach was employed and the grounded theory methodology was used to analyze the information, which was gathered through eight in-depth interviews and two focus groups. Twenty-one individuals took part, including xx diagnosed with schizophrenia and their caregivers. Results: Through coding, theoretical sampling, constant comparison and analytical memos, a category was established; namely, "Living with schizophrenia is living locked up and in the dark, with curtailed dreams". Conclusions: For patients, their families and caregivers, living with schizophrenia leads to a sense of confinement that affects all their lives.

RESUMO Viver com esquizofrenia representa um enigma para todas aquelas pessoas que não apresentam a doença ou convivem com alguém que a padece. Objetivo: compreender o significado de viver com esquizofrenia para pessoas que apresentam a doença e seus familiares, que recorriam a uma instituição estatal para o atendimento de problemas de saúde mental de alta complexidade na Colômbia durante 2014 e 2015. Métodos: foi utilizada uma abordagem qualitativa, e a informação foi analisada por meio do método da teoria fundamentada. As técnicas de coleta de informação foram oito entrevistas a profundidade e dois grupos focais, com a participação de 21 pessoas diagnosticadas e seus cuidadores. Resultados: por meio da codificação, da amostragem teórica, da comparação constante e dos relatórios analíticos, chegou-se à categoria Viver com esquizofrenia é viver preso, às escuras, e com os sonhos interrompidos. Conclusões: para os pacientes, para a família e para os cuidadores, viver com esquizofrenia implica uma sensação de encerramento que afeta o projeto de vida de todos.

El valor de los apoyos para el bienestar subjetivo al vivir con esquizofrenia / The value of supports for subjective well-being to live with schizophrenia

Este artículo es el resultado de una investigación cualitativa que se realizó con la participación de un grupo de personas con esquizofrenia y sus familiares, en Medellín (Colombia). El objetivo fue comprender los aspectos que promueven la salud mental en las personas con esquizofrenia y sus familias, teniendo en cuenta su experiencia subjetiva. Se realizaron ocho entrevistas en profundidad y dos grupos focales para la recolección de la información, la cual se analizó bajo los planteamientos de la Teoría Fundamentada de Strauss y Corbin. La categoría interpretativa que surgió durante el análisis fue «El valor de los apoyos, un punto subjetivo en la experiencia de vivir con esquizofrenia», la cual revela la importancia que tiene, para quienes viven y conviven con la enfermedad, el fortalecimiento de los apoyos personales, familiares y sociales disponibles, pues estos favorecen la sensación de bienestar y el camino hacia la recuperación

This article is a result of a qualitative research that was conducted with participation of a group of people with schizophrenia and their families in Medellín (Colombia). The objective was to understand aspects that promote mental health in people with schizophrenia and their families, considering their subjective experiences. Eight in-depth interviews and two focus groups were conducted to collect information, which was analyzed under the approach of Strauss and Corbin's Grounded Theory. The interpretive category that emerged during the analysis was «The value of supports, a subjective point in the experience of living with schizophrenia», that reveals as different supports are valued by who are living with this disease and their families, and as these favor well-being sense and their road to recovery

Towards a community mental health care for people with schizophrenia in Colombia. / Hacia una atención comunitaria en salud mental para personas con esquizofrenia en Colombia.

Mental health care based on the community has shown to be effective and successful for the health care service to people with severe mental disorders such as schizophrenia, evidence that is less clear in the health care system in Colombia, where weaknesses are present, both for prevention and rehabilitation, although national guidelines give importance to the social context in relation to the disease. As a contribution to the discussion on providing care for people living with schizophrenia, a topic review was conducted with the aim of identifying experiences in community mental health care services, in relation to their relevance to these people at the national level. Articles were searched on Scientific Electronic Library Online (SciELO) Medline with Full text, Science Direct and documents of the World Health Organization, Pan American Health Organization and the Colombian Ministry of Health and Social Protection. Few experiences in community care for people with schizophrenia in Colombia were found and given its importance to public health worldwide, a call for attention is made towards the construction and implementation of these models in the Colombian context.

Hacia una atención comunitaria en salud mental para personas con esquizofrenia en Colombia / Towards a community mental health care for people with schizophrenia in Colombia

Resumen La atención en salud mental con base en la comunidad ha mostrado ser eficaz y acertada para el servicio de salud a personas con trastornos mentales severos como la esquizofrenia, evidencia que es menos clara en el sistema de salud de Colombia, donde se presentan debilidades, tanto en la prevención como en la rehabilitación, a pesar de que directrices nacionales le dan importancia al contexto social con relación a la enfermedad. Como aporte a la discusión sobre la atención para personas que viven con esquizofrenia, se realizó una revisión de tema con el objetivo de identificar experiencias en servicios de salud mental comunitaria, en relación con su pertinencia para estas personas en el ámbito nacional. Se buscaron artículos en Scientific Electronic Library Online (SciELO), Medline with Full text, Science Direct y documentos de la Organización Mundial de la Salud, Organización Panamericana de la Salud y Ministerio de Salud y Protección Social. Se hallaron pocas experiencias en atención comunitaria para personas con esquizofrenia en Colombia y teniendo en cuenta su importancia para la salud pública a nivel mundial, se realiza un llamado de atención hacia la construcción e implementación de estos modelos en el contexto colombiano.

Abstract Mental health care based on the community has shown to be effective and successful for the health care service to people with severe mental disorders such as schizophrenia, evidence that is less clear in the health care system in Colombia, where weaknesses are present, both for prevention and rehabilitation, although national guidelines give importance to the social context in relation to the disease. As a contribution to the discussion on providing care for people living with schizophrenia, a topic review was conducted with the aim of identifying experiences in community mental health care services, in relation to their relevance to these people at the national level. Articles were searched on Scientific Electronic Library Online (SciELO) Medline with Full text, Science Direct and documents of the World Health Organization, Pan American Health Organization and the Colombian Ministry of Health and Social Protection. Few experiences in community care for people with schizophrenia in Colombia were found and given its importance to public health worldwide, a call for attention is made towards the construction and implementation of these models in the Colombian context.