Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.857
Filtrar
1.
Medicine (Baltimore) ; 100(12): e25248, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761720

RESUMO

INTRODUCTION: Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia and an elevated level of serum parathyroid hormone (PTH). PHPT presents with a complex set of renal, skeletal, and neuropsychological symptoms. Parathyroidectomy (PTX) is a radical treatment that is recommended for all physically symptomatic patients with PHPT. However, psychiatric symptoms are not considered as an indication for surgery. There remains an important issue from the view of perioperative management of whether PTX should be performed with the presence of uncontrolled psychiatric symptoms or deferred until severe psychiatric symptoms have been controlled. We report a case of mild hypercalcemia that caused severe psychosis in PHPT, which improved dramatically following PTX and resulted in successful postoperative management. PATIENT CONCERN: Our patient was a 68-year-old Japanese woman. She was diagnosed with PHPT, which was triggered by mild hypercalcemia. She was due to receive an operation for osteoporosis and kidney stones. She had severe psychosis, despite medication. Blood examinations revealed mild hypercalcemia (10.4 mg/dL, 8.8-10.1 mg/dL) and elevated serum levels of intact PTH (184.0 pg/mL, 10-65 pg/mL). DIAGNOSIS: She was diagnosed with severe psychosis caused by mild hypercalcemia in PHPT. INTERVENTIONS: Although she was treated with 37.5 mg quetiapine and 2 mg risperidone daily, she was excessively sedated and rejected oral treatment. Therefore, we decided to perform the operation. OUTCOMES: Immediately following surgery, serum levels of calcium, and intact PTH were normalized. Her psychotic symptoms ceased completely 5 days after surgery. CONCLUSION: We emphasize that PHPT presents with various severe psychiatric symptoms, even in mild hypercalcemia. Psychiatric symptoms may be the only salient symptoms in PHPT, and thus clinicians should suspect PHPT in patients with psychiatric symptoms and mild hypercalcemia. Furthermore, PTX is recommended for PHPT-even in the presence of severe uncontrolled psychiatric symptoms, which carries risks for postoperative management-because psychiatric symptoms are expected to improve and good postoperative management is possible.


Assuntos
Hipercalcemia , Hiperparatireoidismo Primário , Paratireoidectomia/métodos , Transtornos Psicóticos , Fumarato de Quetiapina/uso terapêutico , Risperidona/uso terapêutico , Idoso , Antipsicóticos/uso terapêutico , Feminino , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Hipercalcemia/psicologia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/psicologia , Hiperparatireoidismo Primário/cirurgia , Hormônio Paratireóideo/sangue , Cooperação do Paciente/psicologia , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/terapia , Índice de Gravidade de Doença , Resultado do Tratamento
2.
Curr Opin Psychiatry ; 34(3): 203-210, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33587494

RESUMO

PURPOSE OF REVIEW: The coronavirus disease 19 (COVID-19) pandemic is having a critical impact on healthcare systems across the world, as well as on mental health in the general population; however, evidence regarding the impact of the COVID-19 pandemic on people living with schizophrenia and on the onset of psychotic symptoms is currently emerging. RECENT FINDINGS: People living with schizophrenia are at an increased risk of COVID-19 and present worse COVID-19-related outcomes, including mortality. They show low levels of information and of concern regarding the possibility of contagion and infection but presented substantially stable levels of psychotic symptoms and even increased subjective well being during the pandemic. SARS-CoV-2, as well as the prolonged social isolation and the spread of misinformation, appear to be responsible in some cases for the onset of psychotic symptoms. SUMMARY: Clinicians should inform and educate their patients on the risks related to SARS-CoV-2 infection and COVID-19 and on the precautions that they should adopt to avoid contagion. Particular attention should be devoted to maintaining the continuity of care, especially in frail patients. Telemedicine might represent a valid support, but face-to-face visits in some cases remain essential. The hypothesis of a direct role of viral infection on the onset of psychotic disorders is currently debated, as viral involvement of central nervous system appears to be rather infrequent in COVID-19.


Assuntos
Continuidade da Assistência ao Paciente , Transtornos Psicóticos , Esquizofrenia , Telemedicina , /prevenção & controle , Humanos , Transtornos Psicóticos/terapia , Esquizofrenia/terapia
3.
Psychiatry Res ; 298: 113802, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33592401

RESUMO

The ongoing Corona Virus Disease 2019 (COVID-19) pandemic appears to increase risk for mental illness, either directly due to inflammation caused by the virus or indirectly due to related psychosocial stress, resulting in the development of both anxious-depressive and psychotic symptoms. The purpose of the present study was to assess the frequency and characteristics of all patients with First Episodes Psychosis (FEP) without COVID-19 infection hospitalized in the first four months since lockdown in Milan. We recruited sixty-two patients hospitalized between March 8 to July 8, 2020 versus those first  hospitalized in the same period in 2019. The two subgroups were compared for sociodemographic variables and clinical characteristics of the episodes. Patients with FEP in 2020 were significantly older than patients with FEP in 2021, and presented with significantly less substances abuse. Interestingly, patients presenting with FEP in 2020 were significantly older than patients with FEP in 2019. These data are compatible with the greater vulnerability to stressful factors during the pandemic, as well as with the greater concern regarding a possible COVID-19 infection producing brain damage causing the FEP.


Assuntos
Controle de Doenças Transmissíveis , Hospitalização , Transtornos Psicóticos , Adulto , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/terapia
4.
Curr Opin Psychiatry ; 34(3): 211-215, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33605621

RESUMO

PURPOSE OF REVIEW: The aim of this study is to review the recent literature on disasters' impact on the course of psychotic spectrum disorders (PSDs) and how people with PSD fare during a disaster, including the effects of COVID-19. RECENT FINDINGS: Several, but not all, studies examining disasters including earthquake-affected communities and refugee populations have found increased incidence of PSDs. Studies have been inconsistent regarding psychosis incidence in COVID-19 patients. Meanwhile, patients with PSD have been found to cope poorly in recent disasters including flooding and a nuclear accident. Patients with schizophrenia appear to be at particular risk during COVID-19 due to such issues as poor awareness of health precautions and the psychiatric impact of lockdown. However, novel methods including telepsychiatry have allowed care of this population to remain consistent during COVID-19. SUMMARY: There is conflicting evidence as to the association between disasters and onset of PSD, and further study is needed to elucidate this link. Patients with PSDs are more likely to fare worse during disasters. Novel approaches to delivery of care have helped offset the psychiatric risks to PSD patients during the COVID-19 pandemic. These approaches may be applicable to other disaster scenarios or to general outpatient care.


Assuntos
Desastres , Transtornos Psicóticos , Esquizofrenia , Telemedicina , Humanos , Transtornos Psicóticos/terapia , Esquizofrenia/terapia
5.
BMC Psychol ; 9(1): 29, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579387

RESUMO

BACKGROUND: Psychotic illnesses can have a major impact on those who experience them. Timely treatment for psychosis is important and friends, family members and the public can be a facilitating factor in social support and professional help-seeking. Expert consensus guidelines on how to provide mental health first aid to a person experiencing psychosis were developed in 2008. This Delphi study aimed to redevelop the guidelines to reflect current evidence. METHODS: The Delphi consensus method was used to determine which helping strategies should be included in the redeveloped guidelines. A systematic search of grey and academic literature was undertaken to identify strategies on how a member of the public can assist someone experiencing psychosis. These strategies were organised into questionnaire statements. Two expert panels-one comprising people with lived experience (Carers and Consumers) and one of professionals-completed three consecutive rounds of online survey questionnaires to rate the importance of each helping statement for inclusion in the guidelines. Statements were included in the guidelines if they were endorsed by at least 80% of each panel. RESULTS: The expert panels rated 515 statements across three rounds of surveys, with 325 statements meeting the criteria for inclusion in the redeveloped guidelines. 59 panel participants completed all three surveys. CONCLUSIONS: The redeveloped guidelines outline a general set of strategies for providing initial assistance to a person who is experiencing psychosis. Compared to the original guidelines, these redeveloped guidelines provide more detailed instruction for members of the public on how to provide mental health first aid to assist a person experiencing psychosis. The guidelines are available to the public and will be used to update the Mental Health First Aid courses.


Assuntos
Primeiros Socorros , Transtornos Psicóticos , Técnica Delfos , Amigos , Humanos , Saúde Mental , Transtornos Psicóticos/terapia , Inquéritos e Questionários
6.
Epidemiol Psychiatr Sci ; 30: e12, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33543688

RESUMO

AIMS: Persistent inequalities exist in how individuals from minority ethnic groups access mental health care. A failure to investigate how these inequalities are experienced and what they mean to people with psychosis has privileged professional narratives and hindered our understanding of how they are sustained and what could be done to reduce them. The aim of this study was to investigate the long-term experience of living with psychosis and navigating mental health services within different ethnic groups. METHOD: Our approach was informed by work on narrative analysis and prioritised the meaning that mental health services held for participants. In-depth interviews with 17 black Caribbean, 15 white British and 3 non-British white people with psychosis as part of AESOP-10, a 10-year follow-up of an ethnically diverse cohort of individuals with first-episode psychosis in the UK. Thematic narrative analysis was used to examine experiences at the personal level within and then across the individual accounts. RESULTS: Service users shared many defining experiences and narratives frequently returned to individuals' first contact with mental health services, first hospital admission, the experience of impatient wards, and the meaning of medication and diagnosis in their lives. We found that experiences of powerlessness punctuated the journey through mental health services and this appeared to dominate the accounts of black Caribbean, and to a lesser extent, white British participants. The findings reveal how negative expectations and experiences of mental health services are compounded over time, creating a vicious cycle of disempowerment and mistrust that manifests for many in resistance to - or at the best passive acceptance of - intervention by mental health services. High levels of need, coupled with alienation from services, contributed to negative patterns of service use among black Caribbean participants. White participants recounted substantial, though fewer, experiences of disempowerment and more instances of shared decision making that for some helped protect positive aspects of their lives. CONCLUSIONS: Against a background of entrenched social and economic disempowerment, services were experienced as disempowering by many black Caribbean people, compounding and perpetuating a sense of alienation. Concerted efforts by services to more systematically target social needs and to share power through partnership working may reduce the mistrust that many with psychosis feel when entering services and in turn reduce persistent inequalities across ethnic groups.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Serviços de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Transtornos Psicóticos/etnologia , Adulto , Região do Caribe , Progressão da Doença , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Navegação de Pacientes , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Pesquisa Qualitativa , Classe Social , Reino Unido
7.
Isr J Health Policy Res ; 10(1): 2, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33451324

RESUMO

Measles is a highly contagious disease. A 24 years old patient, recently exposed to measles (unvaccinated), presented in the emergency department with severe agitation, compatible with an acute psychotic episode, during the measles epidemic which spread in Israel in 2018-2019. Upon hospital admission, strict isolation was instructed, yet, without compliance, probably due to the patient's status. Measles diagnosis was promptly confirmed. As measles transmission was eminent, public health measures were employed through immediate implementation of the section 15 of the Public Health Ordinance, allowing for compulsory short-term isolation. The patient's condition improved within a few days and the measures were no longer necessary. This measles case occurred in the pre-Coronavirus disease 2019 (COVID-19) epidemic when use of a Public Health Ordinance was considered an extreme measure. This is in contrast to the current global use of Public Health laws to enforce strict quarantine and isolation on persons infected or potentially exposed to COVID-19. Nevertheless, minimizing infectious diseases transmission is a core function of public health law. Utilizing legal enforcement in circumstances of immediate public health hazard, such as nosocomial measles transmission, necessitates careful consideration. The integrative clinical and public health approach and prompt measures employed in this exceptional case, led to prevention of further infection spread.


Assuntos
Infecção Hospitalar/prevenção & controle , Sarampo/prevenção & controle , Isolamento de Pacientes/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência , Doença Aguda , Serviço Hospitalar de Emergência , Hospitalização , Humanos , Israel/epidemiologia , Masculino , Sarampo/complicações , Sarampo/epidemiologia , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/terapia , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-33327452

RESUMO

Facilitated self-help and problem-solving strategies can empower and support family carers to cope with caregiving for people with severe mental illnesses. This single-blind multi-site randomised controlled trial examined the effects of a five-month family-facilitated problem-solving based self-learning program (PBSP in addition to usual care), versus a family psychoeducation group program and usual psychiatric care only in recent-onset psychosis, with a six-month follow-up. In each of three study sites (integrated community centres for mental wellness), 114 people with early psychosis (≤5 years illness onset) and their family carers were randomly selected and allocated to one of three study groups (n = 38). Caregiving burden (primary outcome) and patients' and carers' health conditions were assessed at recruitment, and one-month and six-months post-intervention. Overall, 106 (94.7%) participants completed the assigned intervention and ≥1 post-test. Generalised estimating equations and subsequent contrast tests indicated that the PBSP participants showed significantly greater improvements in carers' burden, caregiving experiences and problem-solving ability, and patients' psychotic symptoms, recovery, and duration of re-hospitalisations over the six-month follow-up, compared with the other two groups (moderate to large effect size, η2 = 0.12-0.24). Family-assisted problem-solving based self-learning programs were found to be effective to improve both psychotic patients' and their carers' psychosocial health over a medium term, thus reducing patients' risk of relapse.


Assuntos
Cuidadores , Resolução de Problemas , Instruções Programadas como Assunto , Transtornos Psicóticos , Adaptação Psicológica , Adolescente , Adulto , Cuidadores/educação , Cuidadores/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Instruções Programadas como Assunto/normas , Transtornos Psicóticos/terapia , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
9.
BMJ Open ; 10(12): e034913, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323425

RESUMO

OBJECTIVES: (1) To explore the role of ethnicity in receiving cognitive-behavioural therapy (CBT) for people with psychosis or bipolar disorder while adjusting for differences in risk profiles and symptom severity. (2) To assess whether context of treatment (inpatient vs community) impacts on the relationship between ethnicity and access to CBT. DESIGN: Cohort study of case register data from one catchment area (January 2007-July 2017). SETTING: A large secondary care provider serving an ethnically diverse population in London. PARTICIPANTS: Data extracted for 30 497 records of people who had diagnoses of bipolar disorder (International Classification of Diseases (ICD) code F30-1) or psychosis (F20-F29 excluding F21). Exclusion criteria were: <15 years old, missing data and not self-defining as belonging to one of the larger ethnic groups. The sample (n=20 010) comprised the following ethnic groups: white British: n=10 393; Black Caribbean: n=5481; Black African: n=2817; Irish: n=570; and 'South Asian' people (consisting of Indian, Pakistani and Bangladeshi people): n=749. OUTCOME ASSESSMENTS: ORs for receipt of CBT (single session or full course) as determined via multivariable logistic regression analyses. RESULTS: In models adjusted for risk and severity variables, in comparison with White British people; Black African people were less likely to receive a single session of CBT (OR 0.73, 95% CI 0.66 to 0.82, p<0.001); Black Caribbean people were less likely to receive a minimum of 16-sessions of CBT (OR 0.83, 95% CI 0.71 to 0.98, p=0.03); Black African and Black Caribbean people were significantly less likely to receive CBT while inpatients (respectively, OR 0.76, 95% CI 0.65 to 0.89, p=0.001; OR 0.83, 95% CI 0.73 to 0.94, p=0.003). CONCLUSIONS: This study highlights disparity in receipt of CBT from a large provider of secondary care in London for Black African and Caribbean people and that the context of therapy (inpatient vs community settings) has a relationship with disparity in access to treatment.


Assuntos
Transtorno Bipolar , Terapia Cognitivo-Comportamental , Transtornos Psicóticos , Adolescente , África/etnologia , Transtorno Bipolar/etnologia , Transtorno Bipolar/terapia , Região do Caribe/etnologia , Estudos de Coortes , Grupos Étnicos , Feminino , Humanos , Londres , Masculino , Transtornos Psicóticos/etnologia , Transtornos Psicóticos/terapia , Adulto Jovem
11.
Br J Clin Psychol ; 59(4): 524-551, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32944971

RESUMO

OBJECTIVE: Psychological interventions reduce the impact of psychosis, but widescale implementation is problematic. We tested the feasibility of group acceptance and commitment therapy for Psychosis (G-ACTp), delivered by frontline staff, and co-facilitated by service-user experts-by-experience (SU-EbyE), for service-users and informal caregivers (ISRCTN: 68540929). We estimated recruitment/retention rates and outcome variability for future evaluation. METHODS: Staff and SU-EbyE facilitators completed 1-day workshops, then delivered closely supervised G-ACTp, comprising four sessions (weeks 1-4) and two boosters (10 and 12 weeks). Participants recruited from adult community psychosis services were randomized to receive G-ACTp immediately or after 12 weeks, completing outcome assessments at 0, 4, and 12 weeks. Service-use/month was calculated for 1-year pre-randomization, weeks 0-12, and 5-year uncontrolled follow-up. RESULTS: Of 41 facilitators trained (29 staff, 12 SU-EbyE), 29 (71%; 17 staff, 12 SU-EbyE) delivered 18 G-ACTp courses. Participant refusal rates were low (9% of service-users [10/112]; 5% of caregivers [4/79]); 60% of those invited to participate attended ≥1 G-ACTp session (64% of service-users [39/61]; 56% of caregivers [35/63]). Randomization of facilitators and participants proved problematic and participant follow-up was incomplete (78% [66/85]; 82% of service-users [36/44]; 73% of caregivers [30/41]). Effect sizes ranged from very small to large mostly favouring treatment. Service-use reductions require cautious interpretation, as very few participants incurred costs. CONCLUSIONS: Implementation appears feasible for service-users; for caregivers, retention needs improving. Outcome variability indicated n = 100-300/arm followed up (α = 0.05, 90% power). Methodological limitations' mean replication is needed: identified sources of potential bias may be reduced in a cluster randomized design with sessional outcome completion. PRACTITIONER POINTS: Group acceptance and commitment therapy can be successfully adapted for people with psychosis and their caregivers. Implementation (training and delivery) is possible in routine community mental health care settings. Clinical and economic outcomes are promising, but replication is needed. Recommendations are made for future studies.


Assuntos
Terapia de Aceitação e Compromisso , Cuidadores/psicologia , Transtornos Psicóticos/terapia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia de Grupo , Transtornos Psicóticos/psicologia , Resultado do Tratamento
12.
Psychiatr Danub ; 32(Suppl 1): 21-23, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890356

RESUMO

BACKGROUND: Tobacco use is one of the major causes of morbidity and mortality amoung patients suffering from psychotic disorders. The association between severe COVID-19 and tobacco use is still debated. The aim of this paper is to enhance the importance of providing up to date informations about nicotine and tobacco use in connection with the SARS-CoV-2-related conditions. METHODS: We present 3 cases of sudden tobacco use cessation in 3 long-term heavy smokers receiving mental health care for chronic psychotic disorders. Fear of severe form of COVID-19 was their principal motivation. Nicotine replacement therapy and quitline counseling were provided and no major withdrawal symptoms were declared. RESULTS: As mass media later wrongly presented tobacco use as a protective factor regarding COVID-19, all three patients resumed smoking. Rigorous counseling took advantage of psychotic symptoms to correct false informations and finally promote tobacco use cessation. CONCLUSIONS: The COVID-19 pandemic might paradoxically represent a great motivational factor to quit smoking, espacially when considering patients suffering from severe mental health disorders. Beyond the terrible suffering it causes, we illustrate with a case serie that this opportunity must be exploited by mental health professionals to improve quality and life expectancy of their patients.


Assuntos
Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Transtornos Psicóticos/terapia , Abandono do Uso de Tabaco/psicologia , Betacoronavirus , Aconselhamento , Humanos , Motivação , Pandemias , Dispositivos para o Abandono do Uso de Tabaco
13.
Inf. psiquiátr ; (241): 9-13, jul.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-197440

RESUMO

En el año 2017, el Plan director de Salud Mental y Adicciones de Catalunya, puso en marcha el Programa PAE-TPI (Programa de Atención Específica al Trastorno Psicótico Incipiente) después de unos años de corroborar la eficacia de los programas pilotos implementados desde el año 2007 en el territorio catalán. Este programa, es la propuesta de un método organizativo y de un proceso activo de gestión de la psicosis focalizada en la comunidad. Se basa en la detección precoz y la atención individualizada en la que, el vínculo, es uno de los puntos fuertes. Este artículo recoge la puesta en marcha y la preparación previa así como el tipo de intervención propuesta y realizada. También se aportarán datos descriptivos derivados del primer año de asistencia clínica. El programa abarca el área geográfica de Terrassa y Sant Cugat del Vallés


In 2017, the Master Plan for Mental Health and Addictions of Catalonia, launched the PAE-TPI Program (Program for Specific Attention to Incipient Psychotic Disorder) after a few years of corroborating the effectiveness of the pilot programs implemented since 2007 in the Catalan territory. This program is the proposal of an organizational method and a process active management of community-focused psychosis. Is based on the early detection and individualized attention in which the reliance is one of the strengths. This article includes the start-up and previous preparation as well as the type of intervention proposed and carried out. Descriptive data derived from the first year of clinical care will also be provided. The program covers the geographical area of Terrassa and Sant Cugat del Vallés


Assuntos
Humanos , Serviços de Saúde Mental/organização & administração , Transtornos Psicóticos/terapia , Implementação de Plano de Saúde , Intervenção Médica Precoce/organização & administração , Transtornos Psicóticos/diagnóstico , Continuidade da Assistência ao Paciente/organização & administração , Qualidade de Vida
14.
Inf. psiquiátr ; (241): 15-33, jul.-sept. 2020. mapas, graf
Artigo em Espanhol | IBECS | ID: ibc-197441

RESUMO

La atención a las personas que han desarrollado o pueden llegar a desarrollar una psicosis incipiente debe realizarse de forma precoz. Por ello, la detección es el paso fundamental, seguida del diagnóstico, tratamiento y recuperación de la persona. Todas estas intervenciones transversales son realizadas por diferentes profesionales sanitarios y no sanitarios ubicados en dispositivos diferentes y de entidades proveedoras dispares, lo cual requiere la creación de alianzas y trabajo en red bajo el paraguas de una Unidad Funcional que permita situar a la persona en el centro para que pueda recibir la atención más necesaria en cada momento siguiendo su proyecto vital. Dicha Unidad Funcional debe ser territorial, transversal y comunitaria. En este artículo mostramos el proceso que se ha seguido en la creación de las unidades funcionales del Programa de Atención Específica al Trastorno Psicótico Incipiente (PAE- TPI), así como las comisiones de seguimiento y los resultados preliminares para cada uno de los sectores de referencia de Benito Menni CASM (L'Hospitalet, Sant Boi y Vallès Oriental)


Attention to people who have developed or may develop an incipient psychosis should be done early. Therefore, detection is the fundamental step, followed by diagnosis, treatment and recovery of the person. All these cross-cutting interventions are carried out by different health and non-health professionals, who work in different services and from different providers. The creation of a Functional Unit have two main aims: to reach a professional networking as well as to offer a personalized intervention and a long term monitoring to the target patients of the program. This Functional Unit must be territorial, transversal and community based. In this article we show the process that has been followed in order to create the functional units and the monitoring work commissions of the "Program of Specific Attention to the Incipient Psychotic Disorder", as well as inform about the preliminary results of the three reference population areas assisted by Benito Menni CASM (L'Hospitalet, Sant Boi and Vallès Oriental)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Assistência Centrada no Paciente/organização & administração , Intervenção Médica Precoce/organização & administração , Transtornos Psicóticos/terapia , Serviços de Saúde Mental/normas , Estratégias , Intervenção Médica Precoce/métodos , Transtornos Psicóticos/diagnóstico , Pessoal de Saúde/organização & administração , Nível de Saúde , Prestação Integrada de Cuidados de Saúde/organização & administração , Psicometria
15.
Inf. psiquiátr ; (241): 63-83, jul.-sept. 2020.
Artigo em Espanhol | IBECS | ID: ibc-197444

RESUMO

La psicoterapia multifamiliar es un modelo de terapia grupal compleja, rica e integradora, que permite incluir en un mismo lugar a pacientes, familias y equipo terapéutico. Las primeras experiencias en grupos multifamiliares se inician en Estados Unidos durante los años cincuenta, en entornos hospitalarios, para el tratamiento de los trastornos psicóticos como la esquizofrenia. Con el tiempo, el modelo multifamiliar se expande por el mundo y se ha venido implementando en distintos dispositivos asistenciales como hospitales de día o programas comunitarios, así como en una gran diversidad de poblaciones clínicas. En febrero de 2018, en el Equipo de Intervención Precoz en Psicosis (EIPP) del área del Baix Empordà, de la red de salud mental pública de la provincia de Girona, se crea un Grupo Multifamiliar (GMF) para jóvenes que han sufrido un Primer Episodio Psicótico (PEP) o bien tienen riesgo de padecerlo, los llamados Estados Mentales de Alto Riesgo (EMAR). En el equipo se construye un escenario terapéutico grupal con el objetivo de vincular, contener y dar continuidad de tratamiento al paciente y a su familia. Nuestro enfoque multifamiliar se ha inspirado en las ideas de Jaakko Seikkula y su modelo psicoterapéutico de Diálogo Abierto (Open Dialogue), y en las aportaciones de Irvin Yalom sobre la eficacia de los Factores Terapéuticos Grupales. Hemos hecho especial hincapié en los elementos a tener en cuenta en la gestión del clima emocional del grupo, que como sabemos es una de las variables de cambio psíquico más importantes. Nuestro GMF tiene como característica particular, la conducción terapéutica interdisciplinar. El presente artículo muestra el proceso de implementación e integración del GMF en un programa comunitario de intervención precoz de los trastornos psicóticos incipientes


Multifamily psychotherapy is a complex, rich and inclusive group therapy model that allows patients, families and a therapeutic team to be included in the same place. The first experiences in multi-family groups began in the United States during the 1950s, in hospital settings, for the treatment of psychotic disorders such as schizophrenia. Over time, the multi-family model has been spread throughout the world and has been implemented in different healthcare services such as day hospitals or community programs as well as in a wide variety of clinical populations. In February 2018, in the Early Intervention Team in Psychosis (EIPP) of the Baix Empordà area, of the public mental health network of the province of Girona, a Multifamily Group (MFG) is created for young people who have suffered from a First Psychotic Episode (FPE) or they are at risk of suffering it, the so-called High Risk Mental States (HRMS). The team builds a group therapeutic scenario with the aim of linking, controlling and giving continuity of treatment to the patient and their family. Our multifamily approach has been inspired by Jaakko Seikkula's ideas and his Open Dialogue psychotherapeutic model, and by the contributions of Irvin Yalom on the efficacy of Group Therapeutic Factors. We have placed special emphasis on the elements to be taken into account when managing the emotional climate of the group, which is known as one of the most important variables of psychic change. Our GMF has as its particular characteristic, Interdisciplinary Therapeutic Management. This article shows the process of implementation and integration of the GMF in an incipient psychotic disorders early intervention community program


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Transtornos Psicóticos/terapia , Intervenção Médica Precoce/organização & administração , Psicoterapia de Grupo/métodos , Equipe de Assistência ao Paciente , Psicoterapia de Grupo/instrumentação , Transtornos Mentais/terapia , Relações Mãe-Filho/psicologia , Terapia Familiar/métodos
16.
Inf. psiquiátr ; (241): 85-97, jul.-sept. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-197445

RESUMO

La intervención precoz en psicosis se inicia en los años 80 en Australia con la creación del primer programa de recuperación, desde entonces han sido muchos los países que han seguido a Australia. A pesar de la evidencia científica que avala la efectividad de la intervención en el primer episodio psicótico, los programas siguen siendo escasos y muy heterogéneos en un mismo territorio. En 2017 se pone en marcha la implantación de los programas de atención específica para el trastorno psicótico incipiente en Cataluña, el objetivo principal de este artículo es contextualizar la situación actual del programa PAE-TPI y realizar un análisis descriptivo de la población atendida en los dos años iniciales del programa en el distrito de Gracia en Barcelona


Early intervention in psychosis begins in the 80s in Australia, they created the first recovery program in psychosis, from that moment on several countries had also established new programs of intervention. Despite the scientific evidence about the effectiveness of first episode psychosis intervention, this kind of programs is limited and very heterogeneous in the same territory. In 2017 specific programs for the early intervention in psychosis are created in Catalonia. The main objective of this article is to resume the actual situation of PAETPI program and to perform a descriptive analysis of the two first years of implementation in Gracia neighborhood, Barcelona


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Transtornos Psicóticos/prevenção & controle , Implementação de Plano de Saúde , Intervenção Médica Precoce/métodos , Resultado do Tratamento , Transtornos Psicóticos/terapia , Espanha , Consenso , Intervenção Médica Precoce/normas
17.
Lancet ; 396(10251): 612-622, 2020 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-32861306

RESUMO

BACKGROUND: Traditional and faith healers (TFH) provide care to a large number of people with psychosis in many sub-Saharan African countries but they practise outside the formal mental health system. We aimed to assess the effectiveness and cost-effectiveness of a collaborative shared care model for psychosis delivered by TFH and primary health-care providers (PHCW). METHODS: In this cluster-randomised trial in Kumasi, Ghana and Ibadan, Nigeria, we randomly allocated clusters (a primary care clinic and neighbouring TFH facilities) 1:1, stratified by size and country, to an intervention group or enhanced care as usual. The intervention included a manualised collaborative shared care delivered by trained TFH and PHCW. Eligible participants were adults (aged ≥18 years) newly admitted to TFH facilities with active psychotic symptoms (positive and negative syndrome scale [PANSS] score ≥60). The primary outcome, by masked assessments at 6 months, was the difference in psychotic symptom improvement as measured with the PANSS in patients in follow-up at 3 and 6 months. Patients exposure to harmful treatment practices, such as shackling, were also assessed at 3 and 6 months. Care costs were assessed at baseline, 3-month and 6-month follow-up, and for the entire 6 months of follow-up. This trial was registered with the National Institutes of Health Clinical Trial registry, NCT02895269. FINDINGS: Between Sept 1, 2016, and May 3, 2017, 51 clusters were randomly allocated (26 intervention, 25 control) with 307 patients enrolled (166 [54%] in the intervention group and 141 [46%] in the control group). 190 (62%) of participants were men. Baseline mean PANSS score was 107·3 (SD 17·5) for the intervention group and 108·9 (18·3) for the control group. 286 (93%) completed the 6-month follow-up at which the mean total PANSS score for intervention group was 53·4 (19·9) compared with 67·6 (23·3) for the control group (adjusted mean difference -15·01 (95% CI -21·17 to -8·84; 0·0001). Harmful practices decreased from 94 (57%) of 166 patients at baseline to 13 (9%) of 152 at 6 months in the intervention group (-0·48 [-0·60 to -0·37] p<0·001) and from 59 (42%) of 141 patients to 13 (10%) of 134 in the control group (-0·33 [-0·45 to -0·21] p<0·001), with no significant difference between the two groups. Greater reductions in overall care costs were seen in the intervention group than in the control group. At the 6 month assessment, greater reductions in total health service and time costs were seen in the intervention group; however, cumulative costs over this period were higher (US $627 per patient vs $526 in the control group). Five patients in the intervention group had mild extrapyramidal side effects. INTERPRETATION: A collaborative shared care delivered by TFH and conventional health-care providers for people with psychosis was effective and cost-effective. The model of care offers the prospect of scaling up improved care to this vulnerable population in settings with low resources. FUNDING: US National Institute of Mental Health.


Assuntos
Cura pela Fé/organização & administração , Medicina Tradicional Africana , Atenção Primária à Saúde/organização & administração , Transtornos Psicóticos/terapia , Adulto , Análise por Conglomerados , Análise Custo-Benefício , Feminino , Gana , Humanos , Colaboração Intersetorial , Masculino , Pessoa de Meia-Idade , Nigéria , Resultado do Tratamento , Adulto Jovem
18.
Lancet Psychiatry ; 7(9): 788-800, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32649925

RESUMO

BACKGROUND: Evidence for the effectiveness of treatments in early-onset psychosis is sparse. Current guidance for the treatment of early-onset psychosis is mostly extrapolated from trials in adult populations. The UK National Institute for Health and Care Excellence has recommended evaluation of the clinical effectiveness and cost-effectiveness of antipsychotic drugs versus psychological intervention (cognitive behavioural therapy [CBT] and family intervention) versus the combination of these treatments for early-onset psychosis. The aim of this study was to establish the feasibility of a randomised controlled trial of antipsychotic monotherapy, psychological intervention monotherapy, and antipsychotics plus psychological intervention in adolescents with first-episode psychosis. METHODS: We did a multicentre pilot and feasibility trial according to a randomised, single-blind, three-arm, controlled design. We recruited participants from seven UK National Health Service Trust sites. Participants were aged 14-18 years; help-seeking; had presented with first-episode psychosis in the past year; were under the care of a psychiatrist; were showing current psychotic symptoms; and met ICD-10 criteria for schizophrenia, schizoaffective disorder, or delusional disorder, or met the entry criteria for an early intervention for psychosis service. Participants were assigned (1:1:1) to antipsychotics, psychological intervention (CBT with optional family intervention), or antipsychotics plus psychological intervention. Randomisation was via a web-based randomisation system, with permuted blocks of random size, stratified by centre and family contact. CBT incorporated up to 26 sessions over 6 months plus up to four booster sessions, and family intervention incorporated up to six sessions over 6 months. Choice and dose of antipsychotic were at the discretion of the treating consultant psychiatrist. Participants were followed up for a maximum of 12 months. The primary outcome was feasibility (ie, data on trial referral and recruitment, session attendance or medication adherence, retention, and treatment acceptability) and the proposed primary efficacy outcome was total score on the Positive and Negative Syndrome Scale (PANSS) at 6 months. Primary outcomes were analysed by intention to treat. Safety outcomes were reported according to as-treated status, for all patients who had received at least one session of CBT or family intervention, or at least one dose of antipsychotics. The study was prospectively registered with ISRCTN, ISRCTN80567433. FINDINGS: Of 101 patients referred to the study, 61 patients (mean age 16·3 years [SD 1·3]) were recruited from April 10, 2017, to Oct 31, 2018, 18 of whom were randomly assigned to psychological intervention, 22 to antipsychotics, and 21 to antipsychotics plus psychological intervention. The trial recruitment rate was 68% of our target sample size of 90 participants. The study had a low referral to recruitment ratio (around 2:1), a high rate of retention (51 [84%] participants retained at the 6-month primary endpoint), a high rate of adherence to psychological intervention (defined as six or more sessions of CBT; in 32 [82%] of 39 participants in the monotherapy and combined groups), and a moderate rate of adherence to antipsychotic medication (defined as at least 6 consecutive weeks of exposure to antipsychotics; in 28 [65%] of 43 participants in the monotherapy and combined groups). Mean scores for PANSS total at the 6-month primary endpoint were 68·6 (SD 17·3) for antipsychotic monotherapy (6·2 points lower than at randomisation), 59·8 (13·7) for psychological intervention (13·1 points lower than at randomisation), and 62·0 (15·9) for antipsychotics plus psychological intervention (13·9 points lower than at randomisation). A good clinical response at 6 months (defined as ≥50% improvement in PANSS total score) was achieved in four (22%) of 18 patients receiving antipsychotic monotherapy, five (31%) of 16 receiving psychological intervention, and five (29%) of 17 receiving antipsychotics plus psychological intervention. In as-treated groups, serious adverse events occurred in eight [35%] of 23 patients in the combined group, two [13%] of 15 in the antipsychotics group, four [24%] of 17 in the psychological intervention group, and four [80%] of five who did not receive any treatment. No serious adverse events were considered to be related to participation in the trial. INTERPRETATION: This trial is the first to show that a head-to-head clinical trial comparing psychological intervention, antipsychotics, and their combination is safe in young people with first-episode psychosis. However, the feasibility of a larger trial is unclear because of site-specific recruitment challenges, and amendments to trial design would be needed for an adequately powered clinical and cost-effectiveness trial that provides robust evidence. FUNDING: National Institute for Health Research.


Assuntos
Antipsicóticos/uso terapêutico , Terapia Cognitivo-Comportamental/métodos , Transtornos Psicóticos/terapia , Adolescente , Estudos de Viabilidade , Feminino , Humanos , Masculino , Projetos Piloto , Escalas de Graduação Psiquiátrica , Esquizofrenia , Esquizofrenia Paranoide/tratamento farmacológico , Método Simples-Cego , Resultado do Tratamento , Reino Unido
19.
J Clin Psychiatry ; 81(5)2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32726001

RESUMO

OBJECTIVE: The Affordable Care Act (ACA) of 2010 was fully implemented in 2014, expanding access to outpatient mental health services and potentially reducing reliance on emergency (ED) services. This study examined trends and correlates of ED visits for mental health conditions from 2007 to 2016, with attention to changes in ED use after 2014. METHODS: Nationally representative samples of ED visits in the United States were assessed using a repeated cross-sectional analysis of National Hospital Ambulatory Medical Care Survey data. This study used diagnoses associated with each ED visit to identify changes in proportions in mental health diagnostic categories (psychiatric diagnoses only, substance use-related diagnoses only, or both, based on ICD-9-CM or ICD-10-CM criteria). These trends were further examined by age, sex, race/ethnicity, and insurance status. The statistical significance of temporal patterns was evaluated with multivariate logistic regression analyses. RESULTS: Between 2007 and 2016, about 8.4 million (8.3%) of 100.9 million ED visits nationwide were for psychiatric or substance use-related diagnoses. Over the 10-year study period, the proportion of ED visits for mental health diagnoses increased from 6.6% to 10.9% (P < .001). Visits for alcohol and "other" substance use and psychiatric diagnoses classified as "other" accounted for an increasing portion of mental health-related ED visits during this time (P < .001). ED visits in which Medicaid was the primary source of insurance coverage showed the largest increase, nearly doubling from 27.2% in 2007-2008 to 42.8% in 2015-2016 (adjusted odds ratio for linear trends = 1.71; 95% CI, 1.36-2.15). CONCLUSIONS: ED utilization for mental health conditions-and especially substance use conditions-significantly increased in the last decade. The increasing use of EDs by patients with mental health conditions may indicate suboptimal delivery of effective or acceptable outpatient mental health care, particularly for substance use-related conditions.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Transtornos Mentais/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/terapia , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Transtornos do Humor/epidemiologia , Transtornos do Humor/terapia , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/terapia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Tentativa de Suicídio/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
20.
Soins Psychiatr ; 41(327): 35-38, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32718461

RESUMO

Patients with psychosis are known to dislike change or being hurried. Their relationship with time must therefore be taken into account, all the more so given that today's society leads us to believe that immediate satisfaction takes priority. Constant switching and addiction upset the stability which supports these patients with difficulty. The case of a patient visited at home shows that the team's decision to adapt to that one time will favour her subjectivation and the consolidation of her equilibrium.


Assuntos
Visita Domiciliar , Relações Profissional-Paciente , Transtornos Psicóticos/terapia , Feminino , Humanos , Transtornos Psicóticos/psicologia , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...