Mundo de Pólus serious game for people with bipolar disorder.

BACKGROUND: Serious games are play-based technologies designed to teach users a wide range of concepts and skills applicable in the non-virtual environment. OBJECTIVES: This paper describes the process of developing a serious game for people with bipolar disorder to promote symptom recognition and the safe use of medications. METHODS: This study was based on the User-Centered Design methodological model and the theoretical framework for Participatory Design. We conducted interviews with health professionals and discussion circles with people with bipolar disorder and their family members in order to identify the learning needs related to symptom recognition and safe medication use. A categorical analysis was completed of the participants' reports and the scientific literature and formed the basis for the design of Mundo de Pólus. RESULTS: The game development process had three pillars (detailed in this manuscript): missions, simulation, and journal. The serious game focuses on the users' perceptions about their experience with the disorder, their interpersonal relationships, coping strategies, use of medications, and non-pharmacological treatments. CONCLUSIONS: These scientific and technological outcomes are useful to promote literacy and safety in medication therapy for people with bipolar disorder.

Evaluation of Quality of Life of Primary Health Care Patients in Brazil: Influence of Drug Interactions, Common Mental Disorders, and Use of Psychiatric Medication.

The objectives of this study were to identify the interaction between drug interaction risk, common mental disorders, use of psychiatric medication and quality of life in patients treated in primary health care settings in Brazil. In this quantitative research, 452 patients were interviewed in ten basic Brazilian health units. Sociodemographic and pharmacotherapeutic questionnaires, use of psychiatric medication, prevalence of common mental disorders, and quality of life were utilised. The structural equation model was used to evaluate the relationships among the variables. The prevalence of drug interaction risk was 66.59%. The variables associated with drug interaction risk were polypharmacy and income. The use of psychiatric medication was associated with diagnosis of common mental disorders, income and gender. The use of psychiatric medication and common mental disorders negatively influenced quality of life.

Factors Associated with Potential Drug-Drug Interactions in Patients Attended in Primary Health Care: A Focus on Mental Health.

There were no Brazilian studies regarding potential drug-drug interactions (DDIs) in primary health care (PHC) analysing common mental disorders (CMDs) and psychotropic medication. OBJECTIVES: To identify DDI prevalence in that setting; to classify DDI; to verify correlations with demographics, pharmacotherapeutics, psychotropic medication and CMDs. Among 430 patients interviewed 190 had more than two medications prescribed, 58.4% had DDI. Factors associated were age and number of medications. Nine types of severe DDI composed 28% patients' prescriptions, 71.9% involving psychotropic medication. Only the number of types of drugs contributed to the regression model. Results raise important aspects regarding patient safety in PHC units in Brazil are where patients with psychological complaints have to seek for health care firstly.

Predictors of drug-drug interactions of medications prescribed to patients admitted due to suicidal behavior.

INTRODUCTION: Drug-drug interactions among people with suicidal behavior is a challenging topic, considering the harm it poses for patients already vulnerable and the lack of literature on the thematic. This aspect must not be neglected in research and clinical practice, and thus requires thorough investigation. OBJECTIVE: to investigate predictors of drug-drug interaction of prescribed drugs and the prescription of two or more drugs for people admitted due to suicidal behavior in a psychiatric emergency department (short-stay hospital ward). METHOD: A cross-sectional study with retrospective approach, carried out in a Brazilian psychiatric emergency unit in 2015. Data about first and last medical prescriptions were collected from 127 patients' files. Descriptive statistics and the Zero Adjusted Logarithmic Distribution (ZALG) model were adopted, with the significance level α = 0.05. RESULTS: Potential drug-drug interactions were found in most of the first and last prescriptions. The sample majority were female, with previous suicide attempts, being discharged from the hospital with three drugs (or more) prescribed, and without referral to any health service. Age and comorbidities were predictors of more drug prescriptions and the amount of prescribed drugs was the most important predictor of drug-drug interactions (quantity and severity). CONCLUSIONS: the variables associated with drug-drug interactions and prescription of two or more drugs among people with suicidal behavior needs to be investigated in different contexts and addressed in interventions with the aim to promote patient safety.

An Integrative Review of Non-Pharmacological Therapeutic Interventions in Children with Mental Health Problems.

We provide an integrative review of non-pharmacological interventions for children with mental health problems. A total of 262 studies were found in three databases, of which 12 met the inclusion criteria, indicating a shortage of research on the subject. The most frequently used type of intervention was cognitive-behavioural therapy-based interventions, and attention deficit hyperactivity disorder was the most frequent problem. Non-pharmacological interventions help to improve the symptoms of childhood mental health problems, so there is a need to carry out further research on this issue in Brazil and the rest of Latin America.

Mundo de Pólus: serious game para auxiliar pessoas com Transtorno Bipolar no reconhecimento de sintomas e no uso seguro de medicamentos / World of Pollus: serious game to help people suffering from Bipolar Disorder in the recognition of symptoms and safe use of medications

A presente pesquisa teve como objetivo geral desenvolver e avaliar uma tecnologia digital serious game para auxiliar pessoas com diagnóstico de transtorno bipolar (TB) no reconhecimento de sintomas e uso seguro de medicamentos. Trata-se de pesquisa de implementação, exploratória e descritiva. Para desenvolvimento do serious game foi utilizado o modelo metodológico User-Centered Design, com as seguintes etapas: (1) definição do tema e fatores motivacionais do projeto; (2) análise das necessidades junto aos usuários, valendo-se de temas geradores; (3) seleção de soluções; (4) formulação de objetivos; (5) avaliação dos questionamentos; (6) desenvolvimento e prototipagem e (7) avaliação da usabilidade junto a especialistas da área da computação e da saúde mental. Utilizou-se como referencial teórico o Design Participativo. Foram participantes desta pesquisa pessoas com TB, terapeutas, familiares e profissionais da computação como stakeholders do processo de design e desenvolvimento do serious game. Para coleta dos dados foram realizados cinco círculos de discussão, com pessoas com TB e familiares, em cada um dos três serviços de saúde mental selecionados para o estudo, a saber: Ambulatório de Transtorno de Humor de um hospital geral, Centro de Atenção Psicossocial (CAPS) II e CAPS III. Participaram dos círculos, no total, 10 pessoas com TB e nove familiares. Todos os encontros grupais foram gravados, sendo posteriormente transcritos para análise. A leitura flutuante e análise categorial dos relatos de pessoas com TB e seus familiares, durante os círculos de discussão, resultaram em quatro categorias: A - Percepções sobre a vivência do TB; B- Percepções sobre o uso dos medicamentos; C- Percepções sobre relações interpessoais; D- Uso de estratégias terapêuticas não farmacológicas. Posteriormente, foram realizadas entrevistas gravadas, norteadas pela síntese obtida a partir dos círculos de discussão, com 36 profissionais de saúde envolvidos no tratamento das pessoas com TB. A análise obtida dos círculos de discussão e das entrevistas com os profissionais de saúde constituiu subsídio para desenvolvimento do serious game "Mundo de Pólus", com finalidade de auxiliar pessoas com TB no equilíbrio do humor e uso seguro de medicamentos. O serious game foi avaliado por 11 especialistas, incluindo profissionais das áreas da computação e da saúde mental, por meio do instrumento EGameFlow. Foram realizadas as alterações no serious game, considerando os aspectos relevantes indicados pelos especialistas. A presente pesquisa resultou em produção científica e tecnológica relevante para a promoção de reconhecimento de sintomas e segurança na terapêutica medicamentosa em pessoas com TB.

This research is aimed at developing and evaluating a serious game digital technology to help people diagnosed with bipolar disorder (BD) in the recognition of symptoms and safe use of medications. It is an implementation, exploratory and descriptive research. In order to develop the serious game, the methodological model known as User-Centered Design was used according to the following steps: (1) definition of the theme and motivational factors of the project; (2) analysis of users' needs using generative themes; (3) selection of solutions; (4) formulation of objectives; (5) assessment of questions; (6) development and prototyping; and (7) usability assessment by experts in the field of computing and mental health. Participatory Design was used as a theoretical framework. People suffering from BD, therapists, family members and computer professionals, such as stakeholders interested in the design and development process of the serious game, took part in the research. For data collection, five discussion circles were carried out with people suffering from DB and family members, in each of the three mental health services which had been selected for the study, namely: Mood Disorder Outpatient Clinic of a general hospital, Psychosocial Care Center (CAPS) II and CAPS III. A total of 10 people suffering from BD and nine family members participated in the circles. All group meetings were recorded and later transcribed for analysis. Text skimming and categorical data analysis of the reports of people suffering from BD and their families during the discussion circles resulted in four categories: A - Perceptions about the experience of BD; B- Perceptions about the use of medications; C- Perceptions about interpersonal relationships; D- Use of non-pharmacological therapeutic strategies. Subsequently, guided by the synthesis obtained from the discussion circles, recorded interviews were conducted with 36 health professionals involved in the treatment of people suffering from BD. The analysis obtained from the discussion circles and interviews with health professionals was a subsidy for the development of the serious game "World of Pollus", in order to help people suffering from BD balance their mood and use medications safely. The serious game was evaluated by 11 experts, including professionals from the areas of computing and mental health, using the EGameFlow instrument. Changes were made to the serious game, considering the relevant aspects indicated by the experts. The present research resulted in scientific and technological production that is relevant to the promotion of symptom recognition and safety considering drug therapy for people suffering from BD.

Interações medicamentosas potenciais em idosos institucionalizados em um Centro em Atenção Integral à Saúde / Potentially drug-drug interactions in institutionalized elderly in a Center of Comprehensive Health Care

O tratamento farmacológico em idosos representa grande desafio, principalmente relacionado às alterações no metabolismo, que resultam em modificações farmacocinéticas e farmacodinâmicas, aumentando a sensibilidade a muitos fármacos. Associado ao uso extensivo de medicamentos e a presença de comorbidades, o risco de interações medicamentosas aumenta substancialmente nesta população. Essa problemática destaca-se em idosos institucionalizados em hospitais psiquiátricos. Desse modo, esta pesquisa teve como objetivo geral analisar e classificar as interações medicamentosas (IM) potenciais do tipo fármaco-fármaco, em idosos institucionalizados em unidades de internação e lares abrigados de Centro de Atenção Integral à Saúde. Trata-se de estudo de delineamento não experimental, descritivo correlacional e transversal. O estudo foi realizado a partir de dados secundários contidos nos prontuários dos idosos com transtornos psiquiátricos e neuropsiquiátricos que foram internados em um Centro de Atenção Integral à Saúde estadual nos anos de 2005 a 2014. Foram verificados todos os medicamentos prescritos na admissão do paciente, na mediana da internação e na última prescrição. Para coleta de dados foi utilizado um instrumento adaptado de Reis (2009). Para análise dos dados, foi utilizada a análise descritiva e a regressão logística múltipla bruta e ajustada. A maioria dos idosos era do sexo feminino (61,7%), com idade de 60 a 69 anos (54,3%), com diagnóstico psiquiátrico e clínico concomitantes (72,3%) e em uso de 5 a 10 medicamentos (68,1%). Os fármacos utilizados para o Sistema Nervoso foram os mais prescritos. Verificou-se que 67,0%, 74,5% e 80,8% dos pacientes apresentaram IM potenciais na admissão, mediana da internação e última prescrição, respectivamente. Foi detectado um total de 1064 IM potenciais nos três momentos investigados e constatou-se a média de aproximadamente cinco IM potenciais nas prescrições por paciente. Houve elevada porcentagem de IM potenciais graves e contraindicadas. No modelo de regressão logística, realizado para identificar os preditores de IM, no momento da admissão dos idosos, contribuíram de forma significativa a idade de 60 a 69 anos (OR=7,9), a polifarmácia (OR=16,6) e o uso de medicamentos para o aparelho cardiovascular (OR=11,3) e para o aparelho respiratório (OR=16,4). Na mediana da internação, foram preditores de IM potenciais o uso de medicamentos que atuam no sistema nervoso (OR=7,4) e polifarmácia (OR=4,9). Na última prescrição, apenas a polifarmácia foi preditor para ocorrência de IM potencial (OR=30,1), indicando que a segurança do paciente no uso de medicamentos permaneceu comprometida. Os resultados desta investigação mostraram o comprometimento da segurança dos idosos no que se refere ao potencial para IM. Estratégias como a integração da equipe multidisciplinar, a reconciliação medicamentosa e a atuação do enfermeiro na avaliação do processo medicamentoso do idoso são necessárias para o cuidado seguro e de qualidade

Pharmacological treatment in elderly represents a great challenge, mainly related to changes in metabolism that result in pharmacokinetic and pharmacodynamic changes, increasing sensitivity to many medications. Associated with the extensive use of medication and the presence of comorbidities, the risk of drug interactions increases substantially in this population. This problem stands out in institutionalized elderly in psychiatric hospitals. Thus, this study aimed to analyze and classify potential drug-drug interactions (DDI), in institutionalized elderly in inpatient units and sheltered homes in a Center of Comprehensive Health Care. It's a not experimental, descriptive correlational and transversal study. The study was conducted from secondary data in the medical records of elderly patients with psychiatric and neuropsychiatric disorders that have been admitted to a Center of Comprehensive Health Care from the years 2005 to 2014. We checked all drugs prescription at the admission of hospitalization, at median of stay and at the last prescription. For data collection was used an adapted instrument of Reis (2009). For data analysis, we used the descriptive analysis and multiple logistic regression. The majority seniors were female (61.7%) aged from 60 to 69 years (54.3%), with psychiatric and clinical diagnosis concomitant (72.3%) and in use of 5 to 10 drugs (68.1%). The most prescribed drugs were those used to the nervous system. It was found that 67.0%, 74.5% and 80.8% of patients had potential DDI at admission, at median of stay and at the last prescription, respectively. It was detected a total of 1064 potential IM in the three investigated moments and found to average approximately five potential DI requirements for the patient. There was a high percentage of serious and contraindicated potencial DDI. In the logistic regression model, performed to identify predictors of DDI at the time of admission of the elderly, the age 60-69 years (OR=7.9), polypharmacy (OR=16.6) and use of drugs for the cardiovascular system (OR=11.3) and the respiratory system (OR=16.4) contributed significantly to potential DDI. At the median of stay were predictors of potential DDI the use of drugs that operate on the nervous system (OR=7.4) and polypharmacy (OR=4.9). In the last prescription, only polypharmacy was predictor of potential DDI occurrence (OR=30.1), indicating that patient safety in medication use remained compromised. The results of this investigation showed the impairment of the elderly safety regarding potential for drug interactions. Strategies such as the integration of the multidisciplinary team, the medication reconciliation and the work of nurses in assessing the elderly drug's process are necessary for a safe and a qualitied care