Tessituras da adolescência na pandemia: demandas psicossociais de um CAPSi / Adolescence structures in the pandemic: psychosocial demands of a CAPSi Center / Tesituras de la adolescencia en la pandemia: demandas psicosociales de un CAPS

A pandemia da Covid-19 afetou, drasticamente, o campo social. O público adolescente, por apresentar um caráter específico do desenvolvimento, também é atravessado na pandemia. O objetivo desta pesquisa foi identificar e descrever quais as demandas de atenção psicossocial que emergiram nos acolhimentos em um CAPSi de um município do interior do estado do Rio Grande do Sul na pandemia no período da adolescência. O método utilizado foi o modelo quali-quantitativo, de caráter descritivo e exploratório. Os resultados das demandas psicossociais que mais apareceram foram: comportamento suicida, ansiedade, heteroagressividade, autoagressividade, conflitos familiares e dificuldades de aprendizagem. Através do estudo pode-se perceber os atravessamentos que a pandemia da Covid-19 reverberou no público adolescente acolhido neste CAPSi, e o que essas demandas mostram sobre as questões de saúde mental no cenário pandêmico. (AU)

The Covid-19 pandemic has drastically affected the social field. Adolescents, as they present a specific character of development, are also affected by the pandemic. The objective of this research was to identify and to describe the psychosocial care demands that emerged in the receptions at a CAPSi, a Child and Youth Psychosocial Care Center, in a municipality in the interior of the state of Rio Grande do Sul, in the pandemic, during the adolescence period. The method used was the qualitative-quantitative model, with a descriptive and exploratory character. The results of the psychosocial demands that appeared the most were: suicidal behavior, anxiety, heteroaggression, self-aggression, family conflicts and learning difficulties. Through the study, it is possible to perceive the crossings that the Covid-19 pandemic reverberated in the adolescent public hosted in this CAPSi, and what these demands show about mental health issues in the pandemic scenario. (AU)

La pandemia del Covid-19 afectó, drásticamente, al campo social. El público adolescente, por presentar un carácter específico del desarrollo, también se ve afectado en la pandemia. El objetivo de esta investigación fue identificar y describir cuales las demandas de atención psicosocial que surgieron en las acogidas en un CAPSi de un municipio del interior del estado de Rio Grande do Sul en la pandemia en el periodo de la adolescencia. El método utilizado fue el modelo cuali-cuantitativo, de carácter descriptivo y exploratorio. Los resultados de las demandas psicosociales que más aparecieron fueron: comportamiento suicida, ansiedad, heteroagresividad,auto agresividad,conflictos familiares y dificuldates de aprendizaje. A través del estudio se puede percibir los atravesamientos que la pandemia del Covid-19 reverberó en el público adolescente acogido en este CAPSi, y lo que esas demandas muestran sobre las cuestiones de salud mental en el escenario pandémico. (AU)

Indicadores qualitativos de processo e resultado no Acompanhamento Terapêutico

Este estudo é voltado à construção de indicadores qualitativos de processo e resultado para a prática do Acompanhamento Terapêutico (AT). O artigo inicia apresentando a conceitualização e os fundamentos da prática do Acompanhamento Terapêutico e seu papel na clínica e nas políticas públicas em saúde mental. Revisa a literatura acerca dos métodos de avaliação de processo e resultado de psicoterapias e das metodologias de construção de indicadores qualitativos em saúde. Por fim, discute a possibilidade de formular indicadores qualitativos para a avaliação da prática do Acompanhamento Terapêutico com base no estado da arte do conhecimento sobre este dispositivo e propõe alguns indicadores clinicamente e teoricamente relevantes.

Mental health in Europe during the COVID-19 pandemic: a systematic review.

The COVID-19 pandemic caused immediate and far-reaching disruption to society, the economy, and health-care services. We synthesised evidence on the effect of the pandemic on mental health and mental health care in high-income European countries. We included 177 longitudinal and repeated cross-sectional studies comparing prevalence or incidence of mental health problems, mental health symptom severity in people with pre-existing mental health conditions, or mental health service use before versus during the pandemic, or between different timepoints of the pandemic. We found that epidemiological studies reported higher prevalence of some mental health problems during the pandemic compared with before it, but that in most cases this increase reduced over time. Conversely, studies of health records showed reduced incidence of new diagnoses at the start of the pandemic, which further declined during 2020. Mental health service use also declined at the onset of the pandemic but increased later in 2020 and through 2021, although rates of use did not return to pre-pandemic levels for some services. We found mixed patterns of effects of the pandemic on mental health and social outcome for adults already living with mental health conditions.

Effects of ethnic density on the risk of compulsory psychiatric admission for individuals attending secondary care mental health services: evidence from a large-scale study in England.

BACKGROUND: Black, Asian and minority ethnicity groups may experience better health outcomes when living in areas of high own-group ethnic density - the so-called 'ethnic density' hypothesis. We tested this hypothesis for the treatment outcome of compulsory admission. METHODS: Data from the 2010-2011 Mental Health Minimum Dataset (N = 1 053 617) was linked to the 2011 Census and 2010 Index of Multiple Deprivation. Own-group ethnic density was calculated by dividing the number of residents per ethnic group for each lower layer super output area (LSOA) in the Census by the LSOA total population. Multilevel modelling estimated the effect of own-group ethnic density on the risk of compulsory admission by ethnic group (White British, White other, Black, Asian and mixed), accounting for patient characteristics (age and gender), area-level deprivation and population density. RESULTS: Asian and White British patients experienced a reduced risk of compulsory admission when living in the areas of high own-group ethnic density [odds ratios (OR) 0.97, 95% credible interval (CI) 0.95-0.99 and 0.94, 95% CI 0.93-0.95, respectively], whereas White minority patients were at increased risk when living in neighbourhoods of higher own-group ethnic concentration (OR 1.18, 95% CI 1.11-1.26). Higher levels of own-group ethnic density were associated with an increased risk of compulsory admission for mixed-ethnicity patients, but only when deprivation and population density were excluded from the model. Neighbourhood-level concentration of own-group ethnicity for Black patients did not influence the risk of compulsory admission. CONCLUSIONS: We found only minimal support for the ethnic density hypothesis for the treatment outcome of compulsory admission to under the Mental Health Act.

Initial testing of components of the cultural determinants of trauma recovery (CDTR) theory amongst American Gender-Based violence survivors: Structural equation modelling.

AIM: We tested key hypotheses derived from the Cultural Determinants of Trauma Recovery Theory (CDTR) with an American sample. DESIGN: A cross-sectional study using anonymous online surveys. METHODS: This study was conducted with 225 American survivors of gender-based violence (GBV) between August to November 2019. Demographics, distress (depression: PHQ8; PTSD: PCL-5), mental health service utilization (counselling and medication), sense of coherence (SOC), internal barriers to help-seeking (shame, frozen and problem management subscales: BHS-TR Internal) and the GBV healing (GBV-Heal) were used. Structural equation modelling (SEM) was conducted to test the hypotheses. RESULTS: The final SEM model showed that the relationship between distress and mental health service utilization was not mediated by internal help-seeking barriers; the relationship between distress and trauma healing was partially mediated by internal help-seeking barriers; the relationship between internal help-seeking barriers and trauma healing was partially mediated by SOC; mental health service utilization was not significantly associated with trauma healing. Overall, the relationship between distress and trauma healing was partially mediated by internal help-seeking barriers and SOC. CONCLUSIONS: This study confirmed some hypothetical pathways between distress and trauma healing. Further research with larger and international samples should be necessary to test the overall CDTR and compare groups. IMPACT: This study can help us focus on psychological interventions that enhance meaning and mitigate internal help-seeking barriers to promote holistic trauma recovery. Public and public contribution: The sample was gathered from a clinical population registry that alerts patients of potential research opportunities.

Associations between violence, self-harm and acute psychiatric service use: Implications for inpatient care.

WHAT IS KNOWN ON THE SUBJECT?: Service users who behave violently may suffer. This is because violence can lead to unnecessary medication, seclusion on the ward and strained relationships with other people. It can also affect a service user's self-esteem and lead to feelings of shame. Service users who behave violently can also make life frightening and unpredictable for members of staff, and other service users on the ward. It is important to gain a sound understanding of violence in order to help reduce it. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Previous research has shown that having a past history of violence, being admitted to PICU and being admitted to hospital under section is associated with violent behaviour on the ward. We identified several new factors associated with violent behaviour, such as engaging in self-harm, being the target of another person's violence and being referred to a Psychiatric Liaison Team. IMPLICATIONS FOR PRACTICE: For some service users, behaving violently may be a response to previous trauma and an expression of distress. It is therefore important that mental health nurses are supported by their employers to work with service users in a trauma-informed manner. Nurses employed across a range of psychiatric settings could benefit from direct interventions such as comprehensive trauma-informed care training and psychological debrief spaces, or systemic interventions to address staff shortages and improve ward conditions. ABSTRACT: INTRODUCTION: Instances of violence in acute psychiatric settings are frequent, can be devastating for service users and staff, and are costly. Such settings would benefit from a greater understanding of violence. AIM: We analysed the association between current and historical variables and rates of inpatient violence. To address gaps in current research, we included instances of self-harm and being the target of violence. We also included seldom used service metrics. METHOD: Data were extracted on admissions to acute adult wards and PICUs 2017-2020 within South London and Maudsley NHS Foundation Trust. A zero-inflated negative binomial regression mixed model was used to analyse the impact of variables on rates of violence. RESULTS: Variables associated with an increased rate of violence were as follows: an increased number of violent incidents in the year before admission, being admitted on MHA section, being admitted to PICU, instances of self-harm, being the target of violence and referral to a Psychiatric Liaison Team. DISCUSSION: The novel associations found between enacting violence, self-harm and being the target of violence indicate trauma-informed care is crucial to reduce violent presentations of distress. IMPLICATIONS FOR PRACTICE: System level interventions are crucial to ensure mental health nurses are supported to provide trauma-informed care.

Tracking demands for seeking psychological help before and during the COVID-19 pandemic: a quanti-qualitative study

Abstract The COVID-19 pandemic has placed unprecedented burdens on individuals and communities around the world. The isolation, fear, and uncertainty caused by the virus has led to increased rates of anxiety, depression, and other mental health issues. The pandemic has also had a disproportionate impact on individuals and communities with low income and socioeconomic status. Objective To shed light on the consequences of the pandemic on individuals from minorities and low-income areas, we investigate the main reasons that led patients who were referred to a social clinic of a private university in Rio de Janeiro to seek psychological treatment before (2019) and during the pandemic (2020 and 2021). Methods We conducted a quanti-qualitative study with a lexical analysis that evaluated 549 complaint forms of patients seeking treatment in these two distinct periods. Our analyses included descending hierarchical analysis (DHA) and correspondence factor analysis (CFA). Results Family dynamics and communication factors play a dominant role in the reason for seeking therapy and psychological treatment. Additionally, our study suggested an increase in anxiety and panic attacks among other mental health issues associated with griefand losses during the pandemic years. Conclusion Based on these analyses, we can begin to identify a few changes in the main demand and redirection of complaints of patients during the period of COVID-19.

Características clínicas e sociodemográficas dos usuários de um centro de atenção psicossocial infantojuvenil em Porto Alegre a partir do Sistema de Gerenciamento de Consultas (GERCON) / Clinical and sociodemographic characteristics of users of centro de atenção psicossocial infantojuvenil in Porto Alegre since the implementation of Sistema de Gerenciamento de Consultas (GERCON)

Introdução: Desde maio de 2019, o acesso aos serviços especializados de saúde mental infantojuvenil do município de Porto Alegre ocorre através da regulação assistencial por intermédio do sistema Gerenciamento de Consultas (GERCON). O objetivo deste estudo foi caracterizar o perfil clínico e sociodemográfico dos usuários encaminhados para um Centro de Atenção Psicossocial Infantojuvenil (CAPSi) nos dois primeiros anos do GERCON. Métodos: Estudo transversal em que foram resgatados dados dos prontuários eletrônicos de crianças e adolescentes encaminhados para primeira consulta em um CAPSi de Porto Alegre, capital do estado do Rio Grande do Sul, no período de maio de 2019 a abril de 2021. Resultados: A maioria dos 134 usuários era do sexo masculino (59,8%), autodeclarados brancos (69,7%), naturais de Porto Alegre (87,9%) e com hipótese diagnóstica inicial de Retardo mental (28,9%), Transtornos emocionais e de comportamento com início usualmente ocorrendo na infância e adolescência (24,2%) e Transtornos do humor (20,3%). A média de idade foi 13,4 anos e a mediana 15 anos. A taxa de absenteísmo na primeira consulta foi de 24,7%. Conclusão: A maioria dos usuários encaminhados para o CAPSi HCPA era do sexo masculino, adolescente, natural de Porto Alegre e com a hipótese diagnóstica inicial de transtornos do neurodesenvolvimento. Há uma elevada taxa de absenteísmo. Ao planejar intervenções para crianças e adolescentes que necessitam de atendimento em CAPSi é importante considerar o perfil nosológico e as características sociodemográficas dos usuários, assim como pensar em estratégias para diminuir o absenteísmo.

Introduction: Since May 2019, access to child and adolescent mental health services in the city of Porto Alegre has been managed through a regulatory system called sistema de regulação assistencial (GERCON). The aim of this study is to describe the clinical and sociodemographic characteristics of users referred to a Child and Adolescent Psychosocial Care Center (Centro de Atenção Psicossocial Infantojuvenil [CAPSi]) in the first two years of GERCON. Methods: This is a cross-sectional study. Data were retrieved from electronic medical records of children and adolescents referred for their first consultation at a CAPSi in Porto Alegre, capital of the state of Rio Grande do Sul, from May 2019 to April 2021. Results: Most of the 134 users were male (59.8%), self declared white (69.7%), from Porto Alegre (87,9%) and with an initial diagnostic hypothesis of Mental retardation (28,9%), Behavioral and emotional disorders with onset usually occurring in childhood and adolescence (24,2%) e Mood disorders (20,3%). The mean age was 13.4 years and the median was 15 years. The rate of absenteeism in the first appointment was 24.7%. Conclusion: Most users referred to the CAPSi HCPA were male, teenagers, born in Porto Alegre and with the initial diagnostic hypothesis of neurodevelopmental disorders. There is a high rate of absenteeism. When planning interventions for children and adolescents who need CAPSi care, it is important to consider the nosological profile and sociodemographic characteristics, as well as thinking about strategies to reduce absenteeism.

Percursos de cuidado na atenção à saúde mental de crianças / Paths of care in children's mental health care / Caminos de cuidado en la atención mental de los niños

Os Centros de Atenção Psicossocial para a Infância e Adolescência (CAPSi) são locais que ofertam serviços na atenção secundária, sob a perspectiva da reforma psiquiátrica e seguindo as diretrizes do Sistema Único de Saúde (SUS). O presente trabalho apresenta os resultados de uma pesquisa qualitativa, desenvolvida a partir de um estudo de casos múltiplos, cujo objetivo foi compreender como se estabelece o percurso do cuidado na saúde mental da criança em contexto da atenção secundária. A coleta de dados ocorreu a partir de análise documental e entrevista semiestruturada, e as informações obtidas passaram por análise de conteúdo. Foram identificadas dificuldades na comunicação e no compartilhamento dos casos entre os diferentes níveis de atenção e na construção de um Plano Terapêutico Singular (PTS). Com relação ao desligamento das crianças, observou-se mais encaminhamentos e desistências que processos de alta, resultado que necessita problematização tendo-se em vista a possibilidade de cronificação dos casos. (AU)

Psychosocial Care Centers for Children and Adolescents offer services in secondary health care, under the perspective of psychiatric reform and by following Brazil's Unified Health System guidelines. This paper presents the results of a qualitative research that was developed through a multiple case study, in order to understand how the path is established in the context of secondary health care for children. Data were collected through documental analysis and semi-structured interview, then the informationwere processed by content analysis. There were identified difficulties in communication, in the process of sharing cases between different levels of health care as well as in the development of Singular Therapeutic Project. Regarding the disengagement of children from the service, there were more referrals and wavers than discharge processes, which needs to be problematized given the risk of chronification of the cases. (AU)

Los Centros de Atención Psicosocial para Niños y Adolescentes son lugares que ofrecen servicios de atención secundaria en salud, desde la perspectiva de la reforma psiquiátrica y siguiendo las pautas del Sistema Único de Salud en Brasil. El presente trabajo presenta los resultados de una investigación cualitativa, desarrollada a partir de un estudio de casos multiples, con el objetivo de comprender cómo se establece el camino de la atención en la salud mental del niños en este contexto de atención secundaria. La recopilación de datos se basó en análisis de documentos y entrevistas semiestructuradas, y la información obtenida pasó por un análisis de contenido. Se identificaron dificultades en la comunicación y el intercambio de casos entre los niveles de atención y la construcción de un Proyecto Terapéutico Singular. Con respecto a desvinculación de los niños, hubo más encaminamientos y abandonos que procesos de alta, un resultado que debe ser problematizado en vista de la posibilidad de cronificación de los casos en el servicio de salud mental. (AU)

Use of Acute Mental Health Care in U.S. Children's Hospitals Before and After Statewide COVID-19 School Closure Orders.

Objective: This study aimed to examine changes in child emergency department (ED) discharges and hospitalizations for primary general medical (GM) and primary psychiatric disorders; prevalence of psychiatric disorders among acute care encounters; and change in acute mental health (MH) care encounters by disorder type and, within these categories, by child sociodemographic characteristics before and after statewide COVID-19­related school closure orders. Methods: This retrospective, cross-sectional cohort study used the Pediatric Health Information System database to assess percent changes in ED discharges and hospitalizations (N=2,658,474 total encounters) among children ages 3­17 years in 44 U.S. children's hospitals in 2020 compared with 2019, by using matched data for 36- and 12-calendar-week intervals. Results: Decline in MH ED discharges accounted for about half of the decline in ED discharges and hospitalizations for primary GM disorders (−24.8% vs. −49.1%), and MH hospitalizations declined 3.4 times less (−8.0% vs. −26.8%) in 2020. Suicide attempt or self-injury and depressive disorders accounted for >50% of acute MH care encounters before and after the statewide school closures. The increase in both ED discharges and hospitalizations for suicide attempt or self-injury was 5.1 percentage points (p<0.001). By fall 2020, MH hospitalizations for suicide attempt or self-injury rose by 41.7%, with a 43.8% and 49.2% rise among adolescents and girls, respectively. Conclusions: Suicide or self-injury and depressive disorders drove acute MH care encounters in 44 U.S. children's hospitals after COVID-19­related school closures. Research is needed to identify continuing risk indicators (e.g., sociodemographic characteristics, psychiatric disorder types, and social determinants of health) of acute child MH care.

Use of mental health services by children and youth in Ontario military families compared with the general population: a retrospective cohort study.

BACKGROUND: In Canada, more than 64 000 children are growing up with 1 or both parents in the military. We compared mental health service use by children and youth in military families versus the general population, to understand potential mental health service gaps. METHODS: This was a matched retrospective cohort study of children and youth (aged < 20 yr) of members of the Canadian Armed Forces posted to Ontario between Apr. 1, 2008, and Mar. 31, 2013, with follow-up to Mar. 31, 2017, using provincial administrative health data at ICES. We created a comparison group of children and youth in the general population, matched 4:1 by age, sex and geography. We compared the use and frequency of mental health-related physician visits, emergency department visits and hospital admissions, and the time to first service use, using regression models. RESULTS: This study included 5478 children and youth in military families and a matched cohort of 21 912 children and youth in the general population. For visits and admissions for mental health reasons, children and youth in military families were more likely to see a family physician (adjusted relative risk [RR] 1.25, 95% confidence interval [CI] 1.17 to 1.34), less likely to see a pediatrician (adjusted RR 0.87, 95% CI 0.79 to 0.96), equally likely to see a psychiatrist, and as likely to visit an emergency department or be admitted to hospital as the matched cohort. Children and youth in military families had the same frequency of use of outpatient mental health services. The time to first visit for mental health reasons was shorter to see a family physician (adjusted days difference [DD] -57, 95% CI -80 to -33) and longer to see a psychiatrist (adjusted DD 103, 95% CI 43 to 163) for children and youth in military families. INTERPRETATION: Children and youth in military families use mental health services differently from those in the general population. Provincial policies aimed at increasing access to mental health specialists for children and youth in military families, alongside targeted federal services and programming through military organizations, are needed.

Social and occupational outcomes for young people who attend early intervention mental health services: a longitudinal study.

OBJECTIVE: To identify trajectories of social and occupational functioning in young people during the two years after presenting for early intervention mental health care; to identify demographic and clinical factors that influence these trajectories. DESIGN: Longitudinal, observational study of young people presenting for mental health care. SETTING: Two primary care-based early intervention mental health services at the Brain and Mind Centre (University of Sydney), 1 June 2008 - 31 July 2018. PARTICIPANTS: 1510 people aged 12-25 years who had presented with anxiety, mood, or psychotic disorders, for whom two years' follow-up data were available for analysis. MAIN OUTCOME MEASURES: Latent class trajectories of social and occupational functioning based on growth mixture modelling of Social and Occupational Assessment Scale (SOFAS) scores. RESULTS: We identified four trajectories of functioning during the first two years of care: deteriorating and volatile (733 participants, 49%); persistent impairment (237, 16%); stable good functioning (291, 19%); and improving, but late recurrence (249, 16%). The less favourable trajectories (deteriorating and volatile; persistent impairment) were associated with physical comorbidity, not being in education, employment, or training, having substance-related disorders, having been hospitalised, and having a childhood onset mental disorder, psychosis-like experiences, or a history of self-harm or suicidality. CONCLUSIONS: Two in three young people with emerging mental disorders did not experience meaningful improvement in social and occupational functioning during two years of early intervention care. Most functional trajectories were also quite volatile, indicating the need for dynamic service models that emphasise multidisciplinary interventions and measurement-based care.

Trends in Health Care Use and Spending for Young Children With Neurologic Impairment.

BACKGROUND AND OBJECTIVES: Children with neurologic impairment (NI) are a growing subset of children who frequently use health care. We examined health care use and spending trends across services for children with NI during their first 5 years of life. METHODS: This was a retrospective study of 13 947 children with NI in the multistate IBM Medicaid MarketScan Database (2009-2017). We established birth cohorts of children with NI and analyzed claims from birth to 5 years. NI, identified by using International Classification of Diseases, 9th Revision, diagnosis codes, was defined as ≥1 neurologic diagnosis that was associated with functional and/or intellectual impairment. We measured annual health care use and per-member-per-year spending by inpatient, emergency department (ED), and outpatient services. Population trends in use and spending were assessed with logistic and linear regression, respectively. RESULTS: During their first versus fifth year, 66.8% vs 5.8% of children with NI used inpatient services, and 67.8% vs 44.4% used ED services. Annual use in both categories decreased over 0-5 years (inpatient odds ratio: 0.35, 95% confidence interval: 0.34 to 0.36; ED odds ratio: 0.78, 95% confidence interval: 0.77 to 0.79). The use of outpatient services (primary care, specialty care, home health) decreased gradually. Per-member-per-year spending on inpatient services remained the largest spending category: $83 352 (90.2% of annual spending) in the first year and $1944 (25.5%) in the fifth year. CONCLUSIONS: For children with early-onset NI from 0-5 years, use and spending on inpatient services decreased dramatically; ED and outpatient service use decreased more gradually. These findings may help systems, clinicians, and families optimize care by anticipating and adjusting for shifting use of health care services.

Prevalence of Neuropsychiatric Lupus in Psychosis Patients Who Have Tested Positive for Antinuclear Antibodies.

OBJECTIVE: Psychosis is a rare manifestation of neuropsychiatric systemic lupus erythematosus (NPSLE). Current guidelines do not make a recommendation regarding the use of antinuclear antibody (ANA) testing in the assessment of patients with psychosis. The present study was undertaken to determine the prevalence of NPSLE in patients with psychosis who were positive for ANAs. METHODS: A retrospective review of patients who were admitted to the mental health service of 2 metropolitan tertiary referral centers with a diagnosis of psychosis and had been tested for ANAs was conducted. A diagnosis of SLE was made when the 2019 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria were fulfilled. Attribution of psychosis-related events to NPSLE were made according to validated criteria. RESULTS: There were 10,205 mental health admissions with diagnoses of psychosis representing 4,766 individual patients, 911 patients (19%) were tested for ANAs, 135 (15%) of those tests returned a positive result with a titer of ≥1:160. The mean ± SD follow-up time was 47 ± 26 months. At discharge, there were 4 patients who met 2019 ACR/EULAR criteria for SLE, 2 of whom met criteria for NPSLE (2 patients had other manifestations of SLE), yielding an NPSLE prevalence of 1.5% (2 of 135) among patients who were positive for ANAs, and 0.2% (2 of 911) among all patients who underwent testing for ANAs. CONCLUSION: The prevalence of NPSLE in patients with psychosis who were positive for ANAs was low, at 1.5%. The low rate of clinically significant positive results would argue against routine testing for ANAs in patients with psychosis.

Analisis de la satisfaccion con los servicios prestados y la calidad de vida subjetiva durante la pandemia por covid-19 en recursos de rehabilitacion psicosocial / Analysis of satisfaction with services borrowed and subjective quality of life during the covid-19 pandemic in resources of psychosocial rehabilitation

El primer obetivo del presente estudio pasó por analizar los valores medios y ver las posibles diferencias entre la puntuación total y los tres factores que integran una escala de valoración acerca de la satisfacción con los servicios prestados, creada ad hoc para el mismo y que cuenta con una versión para recursos diurnos y otra para recursos residenciales, habiendo de hacerse la valoración de los ítems que la componen tanto durante el periodo de confinamiento por COVID-19 como durante la adaptación a la nueva normalidad. Por su parte, el segundo objetivo tuvo que ver con el análisis de los valores medios en calidad de vida subjetiva, valiéndose de una escala validada para población con Trastorno Mental Grave, tras la declaración de la pandemia en 2020 y comparar los mismos con los obtenidos en el año anterior. Dichos cuestionarios fueron aplicados entre los meses de diciembre y enero de 2020 a todos los usuarios de recursos diurnos y residenciales de la Línea de Rehabilitación Psicosocial de la entidad Hermanas Hospitalarias que cumplieran con los criterios de inclusión. Tras la recogida de datos y posteriores análisis, se encuentra que la valoración media en cuanto a la satisfacción con los servicios prestados está en torno al 6, lo que correspondería a “bastante satisfecho”, en el caso de la puntuación total y de los tres factores, tanto en recursos residenciales como diurnos. Si bien, solo se localizan diferencias estadísticamente significativas en el caso de los recursos diurnos entre el periodo de confinamiento y adaptación a la nueva normalidad, algo que ocurre en la puntuación total y en dos de los tres factores (AU)

The first objective of this study was to analyze the average values and see the possible differences between the total score and the three factors that make up a rating scale about satisfaction with the services provided, created ad hoc for it and that has a version for day resources and another for residential resources, having to make the assessment of the items that compose it both during the period of confinement by COVID-19 and during the adaptation to the new normal. For its part, the second objective had to do with the analysis of the average values as subjective quality of life, using a validated scale for population with Severe Mental Disorder, after the declaration of the pandemic in 2020 and compare them with those obtained in the previous year. These questionnaires were applied between the months of December and January 2020 to all users of day and residential resources of the Línea de Rehabilitación Psicosocial of the entity Hermanas Hospitalarias who met the inclusion criteria. After the collection of data and subsequent analysis, it is found that the average assessment in terms of satisfaction with the services provided is around 6, which would correspond to "quite satisfied", in the case of the total score and the three factors, both in residential and day resources (AU)

Suicide preceded by health services contact - A whole-of-population study in New Zealand 2013-2015.

New Zealand's rate of suicide persistently exceeds the global average. The burden of suicide in New Zealand is disproportionately borne by youth, males and Maori (NZ indigenous people). While the demographic characteristics of suicide decedents are established, there is a need to identify potential points of contact with health services where preventative action could take place. This paper aims to determine if suicide deaths in New Zealand were likely to be preceded by contact with health services, and the type and time frame in which these contacts took place. This study utilised a whole-of-population-cohort of all individuals age 15 years and over, who were alive on March 5th 2013, followed up to December 2015. Associations between the odds of suicide, demographic factors, area-based deprivation, and the timing of last contact with primary, secondary, and tertiary services were analysed using univariate and multivariate logistic regression. Contact with a health service in the 6 Months prior to death was associated with the highest odds of suicide. Over half of the suicide decedent population (59.4%) had contacted primary health services during this period. Large proportions of the suicide decedent population contacted secondary and tertiary services in the 6 Months prior to death, 46.5% and 30.4% respectively. Contact with primary, secondary and tertiary services in the prior 6 Months, were associated with an increased odds of suicide of 2.51 times [95% CI 2.19-2.88], 4.45 times [95% CI 3.69-4.66] and 6.57 times [95% CI 5.84-7.38], respectively, compared to those who had no health services contact.

Saúde mental: análise da rede de atenção psicossocial em Goiás / Mental health: analysis of the psychosocial care network in Goiás

A evolução das ferramentas terapêuticas e modelos de atenção em saúde mental deve ser analisada sob a ótica da história da Psiquiatria como especialidade, suas possibilidades e adequação ao contexto sociocultural vigente. O modelo asilar, ultrapassado nos dias de hoje diante dos avanços da psicofarmacologia e da psiquiatria comunitária, já representou, no passado, um progresso; numa época em que as pessoas portadoras de transtornos mentais eram marginalizadas da sociedade e literalmente abandonadas a própria sorte, por exemplo, em navios à deriva nos rios europeus, descritos como "Nau dos loucos" por Michel Foucault em "A história da Loucura" (FERREIRA, 2001)

The evolution of therapeutic tools and models of mental health care must be analyzed from the perspective of the history of Psychiatry as a specialty, its possibilities and adequacy to the current sociocultural context. The asylum model, outdated nowadays in the face of advances in psychopharmacology and community psychiatry, has already represented, in the past, a progress; at a time when people with mental disorders were marginalized from society and literally abandoned to their fate, for example, on ships adrift on European rivers, described as "Nau dos lunas" by Michel Foucault in "The History of Madness" ( FERREIRA, 2001)