Tasa de egreso hospitalario por episodio depresivo recurrente en los años 2018-2021 en Chile / Hospital discharge rate due to recurrent depressive episode in the years 2018-2021 in Chile

Introducción: La depresión es un trastorno del ánimo frecuente, cuya recurrencia altera su manejo y pronóstico. El objetivo del trabajo es describir la tasa de egreso hospitalario (TEH) por episodio depresivo recurrente (EDR) entre 2018-2021 en Chile, según sexo, edad y gravedad. Materiales y métodos: Estudio observacional y transversal que considera los egresos hospitalarios por EDR en el período 2018-2021 en Chile (N=1551). Se utilizaron las bases de datos del Departamento de Estadísticas e Información de Salud y el Instituto Nacional de Estadística. Las variables estudiadas fueron sexo, grupo etario y gravedad. No requirió aprobación de comité de ética. Resultados: Se observó la menor TEH en 2020 con 1,91 egresos por cada 100.000 habitantes. Las mujeres sobresalieron durante todo el período con una TEH de 3,68 egresos por cada 100.000 habitantes. Destacó el grupo de 15 a 19 años con la mayor TEH en ambos sexos con 5,3 egresos por cada 100.000 habitantes. Respecto a gravedad, las hospitalizaciones se concentraron en pacientes de diagnóstico no especificado. Discusión: La pandemia de COVID 19 podría explicar la disminución de la TEH en 2020, al reducirse el diagnóstico y hospitalización por EDR; presumiblemente debido al fenómeno de reconversión de camas. La TEH es mayor en el sexo femenino, lo cual es concordante con la literatura. El predominio del grupo de 15 a 19 años discrepa de la evidencia, la cual indica que suele concentrarse en individuos de 25 a 64 años. Conclusión: Las TEH por EDR se concentraron en mujeres jóvenes. Es relevante conocer la epidemiología local para focalizar los recursos en la detección oportuna de factores de riesgo, para evitar episodios graves y disminuir su recurrencia.

Introduction: Depression is a common mood disorder, whose recurrence alters its management and prognosis. The aim of the paper is to describe the hospital discharge rate (HED) for recurrent depressive episode (RDE) between 2018-2021 in Chile, according to sex, age and severity. Materials and methods: Observational and cross-sectional study considering hospital discharges due to DRE in the period 2018-2021 in Chile (N=1551). The databases of the Department of Health Statistics and Information and the National Institute of Statistics were used. The variables studied were sex, age group and severity. Ethics committee approval was not required. Results: The lowest HTE was observed in 2020 with 1.91 discharges per 100,000 inhabitants. Females stood out during the entire period with an HTE of 3.68 discharges per 100,000 population. The 15-19 years age group stood out with the highest HTE in both sexes with 5.3 admissions per 100,000 inhabitants. In terms of severity, hospitalizations were concentrated in patients with unspecified diagnosis. Discussion: The COVID 19 pandemic could explain the decrease in HTE in 2020, with a reduction in diagnosis and hospitalization for RDE, presumably due to the bed conversion phenomenon. HTE is higher in the female sex, which is consistent with the literature. The predominance of the 15 to 19 years age group disagrees with the evidence, which indicates that it tends to be concentrated in individuals aged 25 to 64 years. Conclusion: HTE due to DRE was concentrated in young women. It is important to know the local epidemiology in order to focus resources on the timely detection of risk factors to avoid serious episodes and reduce their recurrence.

Trabalho da educação física na internação psiquiátrica: a percepção da equipe de profissionais de saúde / Work of physical education in psychiatric hospitalization: the perception of the team of health professionals / Trabajo de educación física en la interna psiquiátrica: la percepción del equipo de profesionales de salud

O estudo analisou a percepção da equipe multiprofissional sobre o trabalho da Educação Física em uma unidade de internação psiquiátrica. Esta é uma pesquisa de abordagem qualitativa, com entrevistas realizadas com 09 trabalhadores de diferentes categorias profissionais na unidade de internação. Os resultados sugerem que os demais profissionais identificam a atuação da Educação Física na psiquiatria, porém apontam dificuldades para entender o trabalho destes e suas funções. Concluiu-se que o trabalho do profissional de Educação Física é importante e, ao mesmo tempo, reconhecido e desconhecido pelos demais profissionais atuantes na internação psiquiátrica(AU).

The study analyzed the perception of the multiprofessional team about the work of Physical Education in a psychiatric hospitaliza-tion unit. Qualitative research, with interviews with 09 workers from dif-ferent professional categories in the inpatient unit. The results suggest that the other professionals identify the role of the Physical Education in psychiatric, but point out difficulties in understanding their work and their functions. It was concluded that the work of the Physical Education professional is important and at the same time recognized and unknown by the other professionals working in psychiatric hospitalization (AU).

El estudio analizó la percepción del equipo multiprofesional sobre el trabajo de la Educación Física en una unidad de internación psiquiátrica. Investigación cualitativa, con entrevistas con 09 trabajadores de diferentes categorias profesionales em la unidad de internación. Los resultados sugieren que los demás profesionales identifican el papel de la Educación Física en la psiquiatría, pero señalan dificultades para comprender su trabajo y sus funciones. Se concluyó que el trabajo del profesional de Educación Física es importante y al mismo tempo reconocido y desconocido por los demás profesionales que trabajan en la internación psiquiátrica

Calidad de la atención de servicios de internación psiquiátrica en hospitales generales de Argentina, 2018 / Quality of psychiatric hospitalization services in general hospitals in Argentina, 2018

RESUMEN Objetivo: evaluar la calidad de atención en servicios de internación psiquiátrica de hospitales generales desde los enfoques de derechos y comunitario. Métodos: estudio multicéntrico, observacional descriptivo. Se seleccionaron cuatro servicios de internación psiquiátrica de hospitales generales ubicados en centros urbanos de distinta población en Argentina. En cada uno de ellos se analizaron los registros estadísticos, se realizaron observaciones no participantes y se entrevistó a gestores, trabajadores y usuarios. La guía de observación y entrevista se elaboró a partir de la revisión de instrumentos de la OMS y del proyecto Idea. Los resultados se analizaron a partir de las categorías de enfoque de derechos y orientación comunitaria de los servicios. Resultados: respecto del enfoque de derechos se observa que el que requiere mayor desarrollo es el de capacidad jurídica. En relación a la orientación comunitaria, se observa un mayor desarrollo de esta perspectiva a través de la implementación de diversas estrategias y el trabajo con las familias como la más común. Conclusiones: en términos de procesos y resultados de la atención se observan algunas diferencias entre los servicios que cuentan con sala especializada y los que no, y que estos últimos requieren de otros estudios para poder ser analizados.

ABSTRACT Objective: To evaluate, based on the human rights and community care frameworks, the quality of hospitalization psychiatric services in general hospitals. Methods: Multisite, descriptive observational study. There were analyzed four psychiatric hospitalization services, located in general hospitals of urban districts with different sizes in Argentina. Data collection included analysis of statistical records, non-participant observations of services, and interviews with service managers, service staff and users. The observation and interview guides were based on two international tools: Idea project interview guide, and QRTK of the WHO. Results were analyzed using two main categories: human rights-based care approach and community orientation of care delivery. Results: Regarding human rights-based care, legal capacity is the right that requires more improvement in services. About community orientation of care, different strategies were observed, with the work with the families as the most common. Conclusions: One aspect that requires further research is the specific type of psychiatric hospitalization service in the general hospital, given the fact that some differences in process and results were observed between general and specialized wards.

Trabalho da educação física na internação psiquiátrica: a percepção da equipe de profissionais de saúde / Work of physical education in psychiatric hospitalization: the perception of the team of health professionals / Trabajo de educación física en la interna psiquiátrica: la percepción del equipo de profesionales de salud

O estudo analisou a percepção da equipe multiprofissional so-bre o trabalho da Educação Física em uma unidade de internação psi-quiátrica. Esta é uma pesquisa de abordagem qualitativa, com entrevistas realizadas com 09 trabalhadores de diferentes categorias profissionais na unidade de internação. Os resultados sugerem que os demais profis-sionais identificam a atuação da Educação Física na psiquiatria, porém apontam dificuldades para entender o trabalho destes e suas funções. Concluiu-se que o trabalho do profissional de Educação Física é importante e, ao mesmo tempo, reconhecido e desconhecido pelos demais profissionais atuantes na internação psiquiátrica.

The study analyzed the perception of the multiprofessional team about the work of Physical Education in a psychiatric hospitaliza-tion unit. Qualitative research, with interviews with 09 workers from dif-ferent professional categories in the inpatient unit. The results suggest that the other professionals identify the role of the Physical Education in psychiatric, but point out difficulties in understanding their work and their functions. It was concluded that the work of the Physical Education professional is important and at the same time recognized and unknown by the other professionals working in psychiatric hospitalization.

El estudio analizó la percepción del equipo multiprofesional sobre el trabajo de la Educación Física en una unidad de internación psiquiátrica. Investigación cualitativa, con entrevistas con 09 trabajadores de diferentes categorias profesionales em la unidad de internación. Los resultados sugieren que los demás profesionales identifican el papel de la Educación Física en la psiquiatría, pero señalan dificultades para comprender su trabajo y sus funciones. Se concluyó que el trabajo del profesional de Educación Física es importante y al mismo tempo reconocido y desconocido por los demás profesionales que trabajan en la internación psiquiátrica.

Effectiveness of Milieu Therapy in reducing conflicts and containment rates among schizophrenia patients.

OBJECTIVES: To evaluate effectiveness of Milieu Therapy in reduction of conflict and containment rates among schizophrenia patients. METHODS: This study utilized quasi experimental non-equivalent control group pre-post design. One hundred schizophrenia patients admitted in acute psychiatric wards were non-randomly assigned to either of the experimental (n=50) or control group (n=50). The experimental group received both milieu therapy and routine hospital treatment. The Milieu Therapy intervention Included environmental modification and structuring ward activities, establishing effective interaction with patient, and teaching caregivers on managing conflict behavior of patient. The control group received only routine treatment in the hospital. Outcome measures on conflict and containment rates were evaluated for both the groups at baseline and at 2nd, 3rd and 15th day. The Patient-Staff Conflict Checklist Shift Report (PCC-SR) was used to collect information about rates of conflict and containment. RESULTS: Compared with control group, the experimental group participants showed decrease in aggressive behavior, self-harm behavior and general rule breaking behavior at baseline and 2nd, 3rd and 15th day (F=4.61, p < 0.004, η2=0.04; F=11.92, p < 0.001, η2=0.11; F=6.94, p < 0.001, η2=0.06) over seven days interval. CONCLUSIONS: The present study findings provided evidence for the effectiveness of integrating Milieu Therapy in psychiatric acute wards in reducing conflict behaviors among schizophrenia patients. Milieu therapy should be considered as an integral part of psychiatric care settings in these patients.

Propiedades psicométricas de la escala EMUN-AR determinadas mediante el análisis de Rasch / Psychometric variables of the EMUN-AR scale using Rasch analysis

Resumen Introducción. Las escalas de autorreporte se han considerado útiles para evaluar y vigilar los síntomas de la enfermedad maníaco-depresiva. Uno de estos instrumentos, la escala de medición de la enfermedad maníaco-depresiva mediante autorreporte (EMUN-AR), no se ha validado aún. Objetivo. Validar la escala EMUN-AR usando el modelo de Rasch. Materiales y métodos. La escala EMUN-AR mide 26 ítems que evalúan por dimensiones los síntomas de la enfermedad maníaco-depresiva en tres categorías: frecuencia, intensidad y grado de molestia causada. Para evaluar las propiedades psicométricas de la escala, se efectuaron análisis factoriales exploratorios con el fin de tener una aproximación de su estructura latente, y se usaron modelos de Rasch que incluyeron la 'unidimensionalidad', la confiabilidad, el ajuste de ítems, el ordenamiento de umbrales, y los mapas de personas e ítems. Resultados. Se seleccionó una muestra de 267 pacientes hospitalizados, 204 de los cuales había sufrido un episodio maníaco (76,4 %) y estaba recibiendo tratamiento farmacológico. Se encontró una estructura factorial que puede resumirse en cuatro dominios: activación, inhibición, ideas depresivas e inadaptación. El análisis de Rasch evidenció la unidimensionalidad en los factores, adecuados valores de confiabilidad, buen ajuste de los 26 ítems en general (excepto en el ítem que mide las ideas de muerte o suicidio), un funcionamiento deficiente del sistema de calificación de los ítems y un cubrimiento limitado de los síntomas de la enfermedad correspondientes a las formas atenuadas. Conclusión. Se modificó la escala original en dos aspectos: se ajustó un ítem cuyos indicadores marginales tenían mal ajuste y se redujo el número de categorías. En su forma actual, el instrumento es apropiado para medir las formas graves de la enfermedad maníaco-depresiva, mas no así las atenuadas.

Abstract Introduction: Self-report scales have been considered to be useful for evaluating and monitoring symptoms of manic-depressive illnesses. The EMUN-AR scale is one of such scales but it has not been validated. Objective: To validate the EMUN-AR scale using Rasch models. Materials and methods: The EMUN-AR scale measures 26 items to assess comprehensively symptoms of manic-depressive illnesses in three domains: Frequency, severity, and level of disturbance caused by the symptoms. To test the psychometric properties of this scale, we used the exploratory factorial and Rasch analyses. The Rasch analysis included unidimensionality, reliability, item fit, threshold ordering, and person-item maps. Results: The study included 267 hospitalized patients, most of them with a manic episode diagnosis (n=204, 76.4%), and receiving pharmacological treatment. The factor structure was summarized in four domains: Activation, inhibition, depressive ideation, and maladaptive behavior. The Rasch analysis supported unidimensionality of the EMUN-AR factors, satisfactory levels of reliability, and appropriate item fit, except for one of the items measuring death or suicidal thoughts. However, the scale did not measure adequately the mild forms of the illness given its redundant and unordered thresholds. Conclusion: The EMUN-AR was modified in two aspects: An item whose marginal indicators were poorly adjusted and the reduction in the number of categories. In its current form, the EMUN-AR is appropriate for measuring severe forms of the illnesses, but it does not adequately measure the mild forms of manic-depressive illnesses.

Percepção, satisfação e resistências relatadas por profissionais de enfermagem na atuação em psiquiatria / Perception, satisfaction and resistance reported by nursing professionals working in psychiatry

Objetivo: identificar a percepção, a satisfação e as resistências dos profissionais de enfermagem na atuação profissional em psiquiatria. Método: realizado estudo exploratório com 16 profissionais de enfermagem de uma unidade de internação psiquiátrica do interior paulista. Entrevistas com questões norteadoras sobre o início da carreira em psiquiatria e como se sentem, atualmente, trabalhando na área. Análise temática de conteúdo. Resultados: dos 16 profissionais participantes, 68,8% eram mulheres com média etária 35,7 anos. 87,5% dos profissionais resistiram em trabalhar em psiquiatria. Os motivos da resistência foram a falta de preparo (100%), preconceito (43,7%), receio de desenvolver transtornos mentais (30%). Hoje, 50% sentem medo dos pacientes, porém não gostariam de mudar de setor. Estão satisfeitos com seu trabalho porque se sentem importantes para a recuperação dos pacientes. Conclusão: muitos profissionais de enfermagem começaram a trabalhar em psiquiatria devido à falta de oportunidades para seu primeiro emprego. O preconceito em relação à psiquiatria, o ensino insuficiente de enfermagem psiquiátrica e o receio de desenvolverem transtornos mentais predispõem esses profissionais a considerarem negativamente a carreira de enfermagem psiquiátrica(AU)

Objective: to identify nursing professionals' perception, satisfaction and resistance to work in psychiatry. Methods: this is a exploratory study with 16 nursing professionals of psychiatric hospitalization unit of the State of São Paulo. Interviews with guiding questions about the beginning of their career and how they feel nowadays working in this area. Content thematic analysis. Results: of the 16 professionals, 68.8% women, mean age 35.7 years old. 87.5% of the professionals have resisted to work in psychiatry. The resistance reasons were lack of preparation (100%), preconception (43.7%), scare of developing mental disorders (30%). Nowadays 50% are scared of aggressive patients, but they do not like to work in other area. They are satisfied with their work because they feel important to the patients' recovery. Conclusion: many nursing professionals began working in psychiatry due the lack of opportunities for their first job. Preconception regarding psychiatry, insufficient teaching of psychiatric nursing and the fear of developing mental disorders predispose these professionals to consider the psychiatric nursing career negatively(AU)

[Readmission to an Adolescent Psychiatry Inpatient Unit: Readmission Rates and Risk Factors]. / Reinternamentos Hospitalares num Serviço de Pedopsiquiatria: Taxa de Readmissão e Fatores de Risco.

INTRODUCTION: Most mental disorders have a chronic evolution and therefore a certain amount of psychiatric readmissions are inevitable. Several studies indicate that over 25% of child and adolescent inpatients were readmitted within one year of discharge. Several risk factors for psychiatric readmissions have been reported in the literature, but the history of repeated readmissions is the most consistent risk factor. Our aim is to calculate the readmission rates at 30 days and 12 months after discharge and to identify associated risk factors. MATERIAL AND METHODS: The authors consulted the clinical files of patients admitted to the Inpatient Unit between 2010 and 2013, in order to calculate the readmission rates at 30 days and at 12 months. The demographic and clinical characteristics of the readmitted patients were analyzed and compared with a second group of patients with no hospital readmissions, in order to investigate possible predictors of readmission. RESULTS: A total of 445 patients were admitted to our inpatient unit between 2010 and 2013. Six adolescents were readmitted in a 30 days period (1.3%) and 52 were readmitted in a 12 month period after discharge (11.5%). Duration of the hospitalization and the previous number of mental health admissions were significant predictors of future hospital readmissions (p = 0.04 and p = 0.014). DISCUSSION: The low readmission rates may reflect the positive clinical and sociofamilial support being provided after discharge. CONCLUSION: Rehospitalisation is considered a fundamental target for intervention concerning prevention and intervention in mental healthcare. Thus, knowledge regarding their minimisation is crucial.

Introdução: A maioria das perturbações mentais tem uma evolução crónica pelo que certos reinternamentos são inevitáveis. Vários estudos indicam taxas de reinternamento pedopsiquiátrico superiores a 25%. O nosso objetivo é calcular as taxas de readmissão no internamento pedopsiquiátrico do Centro Hospitalar do Porto a 30 dias e um ano após a alta, e identificar os fatores de risco associados. Material e Métodos: A metodologia consistiu na consulta dos processos clínicos dos doentes internados na Unidade de Internamento do Centro Hospitalar do Porto entre 2010 e 2013, a fim de calcular as taxas de readmissão. Foram também recolhidas as características demográficas e clínicas dos doentes readmitidos. Finalmente, os resultados do grupo de doentes reinternados foram comparados com um segundo grupo de doentes selecionados aleatoriamente e sem readmissões hospitalares, a fim de investigar possíveis fatores de risco para reinternamentos. Resultados: Um total de 445 doentes foi admitido entre 2010 e 2013. Seis adolescentes foram readmitidos no período de 30 dias (1,3%) e 52 foram readmitidos nos 12 meses após a alta (11,5%). A análise comparativa revelou que a duração do internamento e o número de internamentos anteriores são preditores significativos (p = 0,04 e p = 0,014) para reinternamento.D iscussão: As baixas taxas de readmissão podem refletir não só a eficácia da intervenção terapêutica durante o internamento como também um bom suporte clínico e sociofamiliar após a alta. Conclusão: Os reinternamentos são considerados um alvo fundamental quanto à prevenção e intervenção nos cuidados de saúde mental. Assim, o conhecimento sobre a sua minimização é crucial.

Internações e reinternações psiquiátricas em um hospital geral de Porto Alegre: características sociodemográficas, clínicas e do uso da Rede de Atenção Psicossocial / Psychiatric admission and readmission in a general hospital of Porto Alegre: sociodemographic, clinic, and use of Network for Psychosocial Care characteristics

RESUMO: Introdução: O fenômeno da porta giratória é caracterizado por repetidas e frequentes reinternações psiquiátricas. Objetivo: Investigar as características sociodemográficas, clínicas e de acompanhamento em serviços da Rede de Atenção Psicossocial (RAPS) associadas às internações e às reinternações psiquiátricas de usuários de um hospital geral de Porto Alegre. Métodos: Estudo transversal realizado com uma amostra de 96 participantes. Resultados: Mais da metade da amostra (53,1%) era do sexo feminino, 51% eram solteiros e a idade média foi de 44,33 anos. Dos dados clínicos, 36,5% (n = 35) dos usuários estavam em sua primeira internação e 36,5% (n = 35) preencheram o critério para reinternação frequente. Os resultados mostraram que usuários com reinternações frequentes referiam um número significativamente menor de pessoas com as quais consideravam que poderiam contar. Já os usuários de primeira internação viviam com um número significativamente maior de pessoas que o restante da amostra e possuíam, com menor frequência, vínculo com serviço de saúde, utilizando o hospital como porta de entrada para o cuidado em saúde mental. Em relação ao acompanhamento na rede, 34,4% da amostra não frequentava nenhum serviço da RAPS antes da internação à época do estudo e somente 4,1% fazia uso de serviços de reabilitação psicossocial. Conclusão: Destacamos a importância do hospital como ponto articulador da rede e estratégico para realizar a ponte com os serviços da RAPS. Apesar de a literatura internacional investigar e registrar o fenômeno da porta giratória, percebe-se que esse é um campo que necessita de maiores investigações no território brasileiro.

ABSTRACT: Introduction: The revolving door phenomenon is characterized by repeated and frequent psychiatric readmissions. Objective: We aim to investigate sociodemographic, clinic, and follow-up characteristics in health services associated to psychiatric admissions and readmissions of inpatients in a general hospital of Porto Alegre. Methods: It is a cross-sectional study with a sample of 96 participants. Results: More than half of the sample (53.1%) were female, 51% were single, and the average age was 44.3 years old. From clinic data, 36% (n = 35) of the users were in their first admission, and 36% (n = 35) met the criteria for frequent readmission. The results show that users with frequent readmissions significantly mentioned fewer people on whom they could rely. Alternatively, users in first admission lived with a significant larger number of people than the rest of the sample and had, with less frequency, bond with health services other than hospitals, using hospitals as an entrance door to mental health care. Regarding follow-up in the network, 34.4% of the sample did not visit often NPC services before admission, and only 4.1% used psychosocial rehabilitation services. Conclusion: We highlight the importance of hospitals as an articulation point in the network, and as strategic to connect with NPC services. In spite of international literature investigation and registration of the frequent psychiatric readmission phenomenon, we notice it is a field that needs greater investigation in Brazil.

Effectiveness of a clinical practice change intervention in increasing the provision of nicotine dependence treatment in inpatient psychiatric facilities: an implementation trial.

BACKGROUND: Despite clinical practice guidelines recommending the routine provision of nicotine dependence treatment to smokers in inpatient psychiatric facilities, the prevalence of such treatment provision is low. The aim of this study was to examine the effectiveness of a clinical practice change intervention in increasing clinician recorded provision of nicotine dependence treatment to patients in inpatient psychiatric facilities. METHODS: We undertook an interrupted time series analysis of nicotine dependence treatment provision before, during and after a clinical practice change intervention to increase clinician recorded provision of nicotine dependence treatment for all hospital discharges (aged >18 years, N = 4175) over a 19 month period in two inpatient adult psychiatric facilities in New South Wales, Australia. The clinical practice change intervention comprised six key strategies: leadership and consensus, enabling systems and procedures, training and education, information and resources, audit and feedback and an on-site practice change support officer. Systematic medical record audit and segmented logistic regression was used to determine differences in proportions for each nicotine dependence treatment outcome measure between the 'pre', 'during' and 'post-intervention' periods. RESULTS: The prevalence of all five outcome measures increased significantly between the pre and post-intervention periods, including clinician recorded: assessment of patient smoking status (36.43 to 51.95%; adjusted odds ratio [AOR] = 2.39, 99% Confidence Interval [CI]: 1.23 to 4.66); assessment of patient nicotine dependence status (4.74 to 11.04%; AOR = 109.67, 99% CI: 35.35 to 340.22); provision of brief advice to quit (0.85 to 8.81%; AOR = 97.43, 99% CI: 31.03 to 306.30); provision of nicotine replacement therapy (8.06 to 26.25%; AOR = 19.59, 99% CI: 8.17 to 46.94); and provision of nicotine dependence treatment on discharge (8.82 to 13.45%, AOR = 12.36; 99% CI: 6.08 to 25.14). CONCLUSIONS: This is the first study to provide evidence that a clinical practice change intervention may increase clinician recorded provision of nicotine dependence treatment in inpatient psychiatric settings. The intervention offers a mechanism for psychiatric facilities to increase the provision of nicotine dependence treatment in accordance with clinical guidelines.

Emergências psiquiátricas: manejo de agitação psicomotora e avaliação de risco suicida / Psychiatric emergencies: psychomotor agitation management and suicide risk assessment

O objetivo deste artigo é a apresentação de diretrizes e protocolos de avaliação de condições frequentemente observadas em contexto de emergências psiquiátricas, a saber; manejo de agitação psicomotora e avaliação de risco suicida. As peculiaridades da interação entre serviços de emergências psiquiá- tricas e rede de saúde mental e do diagnóstico diferencial de primeiro episódio psicótico também são brevemente discutidas. Com base em evidências científicas associadas à experiência clínica dos autores, são apresentadas as habilidades e competências necessárias para o manejo de emergências em psiquiatria, com ênfase em técnicas de entrevista psiquiátrica, abordagem atitudinal/comportamental e intervenções farmacológicas. (AU)

The objective of this article is to present guidelines and assessment protocols of frequently observed conditions in the context of psychiatric emergencies, namely, management of agitation and evaluation of suicide risk. The peculiarities of the interaction between psychiatric emergency and mental health services and the differential diagnosis of first-episode psychosis are briefly presented. Based on scientific evidence associated with our clinical experience, we discuss the skills and competencies needed for the management of emergencies in psychiatry, with emphasis on psychiatric interview techniques, attitudinal/ behavioral approach and pharmacological interventions. (AU)

Construction of sensitive index evaluation system of psychiatric nursing quality in Henan / 中华护理杂志

Objective To construct sensitive,scientific,targeted index evaluation system of psychiatric nursing quality and provide basis for evaluation and surveillance of psychiatric nursing quality.Methods Based on 3-di-mension quality construction theory,literature analysis and experts group discussion were adopted to preliminarily screen indexes and compile inquiry questionnaire.Two rounds of expert consultation were performed using Delphi technique,and sensitive index evaluation system of psychiatric nursing quality was revised and finalized.Results Positive coefficients of two rounds of expert consultation were 90.63％ and 96.55％,authority coefficients were 0.81 and 0.83,and coordination coefficients were 0.136-0.335;the constructed sensitive index evaluation system of psychiatric nursing quality included 3 first-class indicators and 18 second-class indicators.Conclusion The constructed sensitive index evaluation system of psychiatric nursing quality has psychiatric characteristics.Its effects on nursing quality control and evaluation can be verified from clinical practices,then effective data sharing can be gradually realized.

Redução do número de cigarros durante internação psiquiátrica: intervenção ou punição? / Reducción del número de cigarrillos durante la hospitalización psiquiátrica: ¿intervención o sanción? / The decreasing number of cigarettes during psychiatric hospitalization: intervention or punishment?

A restrição do fumo durante internação psiquiátrica provoca mudanças pessoais e institucionais. Objetivo: Identificar a percepção dos portadores de transtorno mental, fumantes, sobre a redução do número de cigarros durante a internação psiquiátrica. Método: Estudo exploratório com 96 portadores de transtorno mental, fumantes, internados em hospital geral: G1 (34 sujeitos quando permitido um cigarro/hora) e G2 (62 sujeitos quando reduzido para oito cigarros/dia). Questionário semiestruturado. Análise temática do conteúdo. Resultados: O G1 declarou-se satisfeito com a restrição – fumo na internação como direito. O G2 resiste à mudança da restrição que ocorreu sem diálogo ou apoio. Apesar das dificuldades, constataram-se algumas mudanças de atitudes sobre o cigarro tais como aumento responsabilidade, descoberta de capacidade em reduzir o fumo e ressignificação do seu papel. Conclusão: Alguns sujeitos entendem a mudança na política de saúde do tabagismo como punição, enquanto outros como oportunidade de repensar o papel do cigarro em sua vida. .

La restricción al tabaquismo durante la hospitalización psiquiátrica promueve cambios personales e institucionales. Objetivo: Identificar la percepción de portadores de trastorno mental, fumadores, sobre la reducción del número de cigarrillos durante la internación psiquiátrica. Método: Estudio exploratorio con 96 portadores de trastorno mental, tabaquistas, internados en hospital general: GI (34 sujetos cuando permitido un cigarrillo/hora) y G2 (62 sujetos cuando reducido para ocho cigarrillo/día). Cuestionario semi-estructurado. Análisis temática del contenido. Resultados: El GI se declaró satisfecho con la restricción – tabaco en la hospitalización como directo. El G2 resiste al cambio de la restricción que ocurrió sin dialogo o ayuda. Aunque las dificultades, se constató algunos cambios de actitudes sobre el tabaco como el aumento de responsabilidad, descubierta de la capacidad de reducir el fumo y re-significación de su papel. Conclusión: Algunos de los sujetos comprenden el cambio en la política de salud del tabaquismo como sanción, mientras otros como una oportunidad de replantear el papel del cigarrillo en su vida. .

The smoking ban during psychiatric hospitalization provokes personal and institutional changes. Objective: To identify the mental disorders carriers’ perception, the smokers ones, about the decreasing number of cigarettes during psychiatric hospitalization. Method: Exploratory study with 96 hospitalized carriers of mental disorders who are smokers: G1 (34 subjects hospitalized when was allowed one cigarette by hour) and G2 (62 subjects hospitalized when it was reduced to eight cigarette by day). Semi-structured questionnaire. Thematic content analysis. Results: The G1 admitted satisfaction with the restriction – smoking during hospitalization as entitlement. The G2 resists the restriction change occurred without dialogue or support. In spite of the difficulties, some attitude changes about the cigarette were noticed such as increase of the responsibility, discovery of the ability to reduce smoking and the meaning of its role. Conclusion: Some subjects understand the smoking health policy change as punishment, while others as opportunity to think about the role of cigarette in their life. .

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.

Viabilidade de unidades psiquiátricas em hospitais gerais no Brasil / Viabilidad de unidades psiquiátricas en hospitales generales en Brasil / Feasibility of general hospitals psychiatric units in Brazil

OBJETIVO: Compreender o estigma voltado aos portadores de transtornos mentais na cultura de hospitais gerais enquanto fator limitante para a implantação de unidades psiquiátricas em hospitais gerais no Brasil. PROCEDIMENTOS METODOLÓGICOS: Foi delineada uma pesquisa social, de natureza qualitativa. Adotou-se como estratégia a pesquisa-ação para a implantação de uma unidade psiquiátrica em um hospital geral em Taubaté, SP, 2005-2006. As evidências foram obtidas por meio de entrevistas, observação participante e palestras sobre o projeto da unidade psiquiátrica para o corpo clínico do hospital. RESULTADOS: O investimento do órgão gestor possibilitou que as concepções estigmatizantes presentes na cultura do hospital estudado (violência, fraqueza moral e intratabilidade) fossem ressignificadas por meio de discussões clínicas e sanitárias, viabilizando a implantação da unidade psiquiátrica. A análise mostrou que essas concepções eram reatualizadas pelo contexto assistencial, no qual o acesso dos portadores de transtornos mentais era restrito. CONCLUSÕES: A postura assumida pelo órgão gestor, que decidiu pelo financiamento adequado da unidade psiquiátrica e exerceu sua ascendência sobre o hospital prestador, foi decisiva para o desfecho do caso. A principal dificuldade para a implantação das unidades psiquiátricas não é o estigma presente na cultura dos hospitais gerais, mas uma limitação de ordem estratégica: a falta de uma política afirmativa para essas unidades.

OBJECTIVE: To comprehend the stigma against people with mental disorders still persists in the culture of general hospitals and acts as a limiting factor in the implementation of psychiatric units in general hospitals in Brazil. METHODOLOGICAL PROCEDURES: A qualitative social survey was outlined based on action research strategy as of the agreement to adopt a psychiatric unit in a general hospital in Taubaté, Southeastern Brazil. Data was obtained through interviews, participant observation and talks on the psychiatric unit project given to the hospital's clinical staff. RESULTS: The investment made by the healthcare authority enabled the stigmatizing conceptions (violence, moral weakness and untreatability) present in the hospital culture in question to be resignified by means of clinical and sanitary discussions, which enabled the implementation of the psychiatric unit. The analysis showed that these concepts persist in this context because of a healthcare system that limits the access of people with mental disorders. CONCLUSIONS: The attitude of the healthcare authority, who decided to adequately fund the general hospital's psychiatric unit and exerted his influence over the hospital, was decisive for the outcome of the case. The main difficulty in implementing psychiatric units at general hospitals is not the overcoming the existing stigma in the culture of general hospitals, but rather a difficulty which is strategic in nature: the lack of an affirmative policy for these units.

OBJETIVO: Comprender el estigma dirigido a los portadores de trastornos mentales en la cultura de hospitales generales con relación al factor limitante para la implantación de unidades psiquiátricas en hospitales generales en Brasil. PROCEDIMIENTOS METODOLÓGICOS: Fue delineada una pesquisa social, de naturaleza cualitativa. Se adoptó como estrategia la pesquisa-acción para la implantación de una unidad psiquiátrica en un hospital general en Taubate (Sureste de Brasil), 2005-2006. Las evidencias fueron obtenidas por medio de entrevistas, observación participante y palestras sobre el proyecto de la unidad psiquiátrica para el cuerpo clínico del hospital. RESULTADOS: La inversión del órgano gestor posibilitó que las concepciones estigmatizantes presentes en la cultura del hospital estudiado (violencia, debilidad moral e intratabilidad) fueran resignificadas por medio de discusiones clínicas y sanitarias, viabilizando la implantación de la unidad psiquiátrica. El análisis mostró que esas concepciones eran reactualizadas por el contexto asistencial, en el cual el acceso de los portadores de trastornos mentales era restringido. CONCLUSIONES: La postura asumida por el órgano gestor, que decidió por el financiamiento adecuado de la unidad psiquiátrica y ejerció su ascendencia sobre el hospital prestador, fue decisiva para el desenlace del caso. La principal dificultad para la implantación de las unidades psiquiátricas no es el estigma presente en la cultura de los hospitales generales, pero una limitación de orden estratégica: la falta de una política afirmativa para esas unidades.

A controlled study on identification for depression and effectiveness of its treatment in psychiatric clinics of general hospitals / 中华全科医师杂志

Objective The study is designed to evaluate the difference in identification for depression and clinical effectiveness of its treatment between psychiatrists and non-psychiatric Dhysieians at out-patient departments of general hospitals and to analyze its related factors.Methods Totally,680 patients who visited psychiatric clinics in nine general hospitals of Shanghai at first time were screened by psychiatrists using Composite International Diagnostic Interview(CIDI)for depression and the screening resuhs were compared to the diagnosis made by non-psychiatric physicians as goal-keepers there.Altogether 297 patients with depression were recruited and assessed using Hamilton Depression Rating Scale(HAMD)and Hamilton Anxiety Rating Scale(HAMA).A self-made questionnaire for basic information was used to assess the ability for identification of depression in non-psychiatric physicians of general hospitals.Results Psychiatrists identified depression correctly in 337 of 680 patients who visited psychiatric clinics in general hospitals at their first visit,but non-psychiatric physicians only identified 216 patients,with statistically significant difference(χ2=30.73,P=0.000).A consistent agreement on depression diagnosis between the findings by psychiatrists and by CIDI was reached with Kappa of 0.774,but Kappa for that between the findings by non-psychiatric physicians and CIDI was 0.439.Effectiveness of treatment for depression by psychiatrists was better than that by non-psychiatric physicians,with higher total score and scores for each item of HAMD four,eight and 12 weeks after treatment,respectively(P＜0.05 or P＜0.01).Length of professional work of non-psychiatric physicians and annual time for professional training in management of mental disorders associated with their ability of identification for depression(P＜0.05).Conclusion Ability of non-psychiatric physicians to identify alQd cope with depression in the psychiatric department of general hospitals was insufficient,suggesting that more importance should be attached to the management of service quality at psychiatric department of general hospitals.

Psychiatric inpatients' satisfaction with services: A pilot study.

INTRODUCTION: Fifty-three patients admitted to a psychiatric inpatient unit in South London were interviewed to ascertain their satisfaction with services provided for them. METHOD: The level of satisfaction with various aspects of treatment was evaluated using a 45-item questionnaire. RESULTS: Results showed that patients were generally satisfied with the staff attitudes and care, although two-thirds felt that they had not been sufficiently involved in their own treatment planning. Younger patients reported more frequent difficulties in the relationship with staff. Patients were generally satisfied with the physical environment. Patients with a higher number of previous admissions were more satisfied with the planning of care, and they were less often in conflict with the staff. Patients admitted compulsorily were less satisfied than voluntary patients with the overall quality of the help received and said they would rarely re-contact the service in the future. There was virtually no effect of ethnicity on the levels of satisfaction in different aspects of care. The only worry expressed more frequently by African-Caribbean patients was about re-contacting the service in the future, even though they felt the help received in planning their discharge was good. CONCLUSION: It would be useful to carry out such surveys more often.