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.

Intentional self-poisoning with medications: Occurrence, recurrence and suicide deaths.

This study aimed to identify the sociodemographic and clinical factors associated with the occurrence and recurrence of intentional self-poisoning with medications (ISP-M), and suicide deaths by ISP-M in the state of Mato Grosso, Brazil. In this cross-sectional analytical study, we used logistic regression models to analyze data obtained through health information systems. Factors associated with use of ISP-M as a method were female gender, white skin color, occurrence in urban areas and at home. The ISP-M as a method was less reported in people presumed under the influence of alcohol. Lower chance of death by suicide using ISP-M was found among young people and adults (under 60 years old).

Factors associated with suicide risk among Brazilian graduate students during the COVID-19 pandemic.

Though pandemic-related suicides are a concern, little is known about factors potentially linking graduate student life and suicide risk. This study identified factors associated with suicide risk among Brazilian graduate students (N = 5,344) during the COVID-19 pandemic. Utilizing the Mini International Neuropsychiatric Interview, this study revealed that 31.5% of participants presented some risk for suicide: 16.6% "low risk," 4.7% "moderate risk," and 10.2% "high risk." Higher income and religious affiliation were identified as protective factors. Identified risk factors encompass non-heterosexual orientation, a history of depression or posttraumatic stress or common mental disorders diagnoses, the use of medications-both general and psychopharmaceuticals-without medical prescription, antipsychotics use, alcohol consumption, lack of health insurance, and dissatisfaction with life as a result of accessing social media networks. The high vulnerability of graduate students to suicide risk highlights the need for institutional suicide prevention initiatives.

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.

Predictors of job stress and alcohol consumption amongst university professors.

The present study aimed to identify the predictors of job stress and alcohol consumption amongst 253 professors at a public university. Previous history of psychotropic drug use, as well as the Scale of Work Stress, the Alcohol Use Disorders Identification Test, and the Self-Report Questionnaire were used. Being female, younger than 40 years of age; of homosexual orientation; a workload of weekly classes of >10 h in total; and being positive for common mental disorders were identified as predictors of moderate or high work stress. The predictors of risky drinking or probable alcohol dependence were: male; younger than 40 years of age; tobacco use; health problems; teaching applied social sciences; and use of hypnotic medications. The findings could be used to develop strategies for the prevention or reduction of work stress and alcohol consumption amongst university professors.

The meaning of life after a suicide attempt.

INTRODUCTION: Understanding the meaning of life after a suicide attempt experience provides greater knowledge about the process of resignification, connections and commitment to life, which can be useful in different therapeutic approaches. OBJECTIVE: Understand the meaning of life after a suicide attempt. METHOD: Qualitative study with eight Brazilian adults assisted in mental health service. The data were collected in 2018 by semi-strutured interviews and group meetings that used artistic resources to facilitate expression.The Symbolic Interactionism was the theoretical reference used and the data were submitted to thematic analysis. RESULTS: Three themes were identified: "Searches in the affective, relational and spiritual field" (manifestations of affection, zeal, understanding and welcome and seemed to increase the link and commitment to life, as well as the openness to resignify it); "Life and the constancy of impermanence" (life as an alternation between weakness and strength, crisis and well-being, problems and overcoming); and "Discoveries and relationship with one's own self" (a self previously self-destructive could be resigned as capable of overcoming, resisting and developing resilience). CONCLUSIONS: The study provides important insights to be addressed in clinical practice, in the protocol design, institutional policies, as well as in the training of professionals.

Internalized Stigma in People With Mood Disorders: Predictors and Associated Factors.

To analyze the predictors of internalized stigma among people with mood disorders, we conducted an analytical observational cross-sectional study with 108 people with mood disorders in a public service setting in Sao Paulo, Brazil. We applied a sociodemographic and clinical questionnaire, the Internalized Stigma of Mental Illness Scale, the Medication Adherence Scale, the Brief Psychiatric Rating Scale-Anchored, and the Herth Hope Index. We analyzed the data using descriptive statistics, average comparison tests, a correlation test, and multiple linear regression. Internalized stigma was associated with symptomatology, history of aggressive behavior, psychiatric hospitalizations, suicide attempts, hopelessness, nonadherence to psychotropic medications, and unemployment. The predictors of internalized stigma were unemployment, more psychiatric symptoms, history of previous suicide attempts, and less hope. Clinical interventions and investigations for stigma reduction and psychosocial rehabilitation should incorporate the factors associated with self-stigma (aggressive behavior, history of psychiatric hospitalizations, suicide attempts, hopelessness, nonadherence to medication, and unemployment).

Meanings of suicidal behavior from the perspective of primary care professionals.

OBJECTIVE: To explore the meaning of suicidal behavior from the perspective of family health professionals. METHOD: A qualitative study developed during 2017-2018 with 18 primary care professionals from a Brazilian municipality. Grounded theory was used as the methodological framework. Semi-oriented interviews were conducted, transcribed, and analyzed by open, axial, and selective coding. FINDINGS: The professionals perceived themselves as unprepared, emotionally affected, and fearful to work in suicide prevention, prioritizing the referral of people to specialized services regardless of the severity of the situation. Suicide was represented as both a choice and a condition of vulnerability, being more reprehensible when associated with individual choice. CONCLUSION: We identified beliefs related to suicidal behavior that could affect the care of people at risk. Our findings reinforce the need for education and training in the prevention of suicidal behavior in primary care.

Factors associated with alcohol use and abuse in Brazilian primary health care settings.

The main goal of this study was to identify the prevalence of alcohol use and associations with selected variables among clients in a primary healthcare setting. A quantitative, cross-sectional study was carried out using structured questionnaires to measure the pattern of alcohol consumption, quality of life and common mental disorders. The results showed that men, people between 18 and 40 years old, with income between $300.00 and 1200.00 and smokers were at a higher risk of problematic alcohol use. Healthcare professionals should include alcohol screening questions to identify the hazardous consumption of alcohol at an early stage and prevent negative consequences.

The Social Support Buffering Effect in the Relationship Between Perceived Stress and Alcohol Use Among Brazilian Women.

This cross-sectional study interviewed Brazilian women regularly attending primary care to investigate whether the relationship between social support and alcohol use is direct or is mediated by stress, in order to support the development of recommendations related to health prevention and mental health promotion actions. The results suggest that social support affects the outcome alcohol use in the women studied by buffering the effect of stress. Based on these results, recommendations are made for amplifying the social support network that prevents stress-induced alcohol use.

Assistance related to suicidal behavior at a mobile emergency service: Sociodemographic and clinical associated factors.

It is important to investigate the care given to people with suicidal behavior, as it is an important predictor of future death by suicide and there is a lack of studies on this issue in Brazil. This study had the objective of investigating assistance related to suicidal behavior at a mobile emergency service and sociodemographic and clinical associated factors. This was a quantitative, cross-sectional study based on documental information. The data were collected through manual consultation of nursing records in which call-outs for suicidal behavior in the year 2014 were documented. The data were analyzed using descriptive statistics, Chi-squared test, Fisher's exact test, correlation tests, and comparison of means tests. In the 313 records analyzed there was a predominance of adult women with self-inflicted drug poisoning, attended to in their own residence and referred to pre-hospital emergency medical services. There was a lack of documentation on signs, symptoms, and grievances in most cases. The interventions most carried out by the nurses were related to monitoring of clinical parameters. There were differences related to the victim's sex and lethality, suicide attempt method, referral to emergency services, and semester of occurrence (January-June, July-December). Suicide attempts through self-poisoning or self-inflicted injuries differed in relation to time of call-out, waiting time, lethality, documentation on clinical assessment and interventions, and referral to emergency services. This study enabled the charting of factors linked with suicidal behavior and associated factors; it offers reflections on limitations and nursing care potential in the prevention of reoccurrence of suicidal behavior.

Factors associated with common mental disorders and use of psychiatric drugs in cancer outpatients.

BACKGROUND: Considering the high incidence of cancer in Brazil and worldwide, the high prevalence and relevance of Common Mental Disorders (CMD) in the treatment of cancer patients, and the use of psychiatric drugs without reliably proven effectiveness, studies that contemplate this topic are needed to understand and provide rationale for the treatment of CMD in these individuals. OBJECTIVES: This study identified prevalence and factors associated with Common Mental Disorders (CMD) and psychotropic use in cancer outpatients. METHOD: This is a cross-sectional study with descriptive correlational design. It was developed in the chemotherapy sector of a hospital specialized in cancer. The tools used were: Self Reporting Questionnaire (SRQ-20) and structured questionnaires. FINDINGS: Among 403 respondents, CMD prevalence was 31.5% and psychotropic use was 25.8%. CMD were associated with gender, education, family income, psychotropic use and cancer surgery. Psychotropic use was associated with gender, employment status, cancer surgery, treatment period and other physical health conditions. Logistic regressions showed CMD were associated with gender and other physical health conditions; psychotropic use was associated with gender, employment status and other conditions.

Depressive symptoms and factors associated with depression and suicidal behavior in substances user in treatment: Focus on suicidal behavior and psychological problems.

AIM: To investigate the prevalence of depressive symptoms, psychological problems, suicidal behaviour and their associations in substance users in treatment. METHODS: A cross-sectional study, with 307 substance users in an out-patient treatment facility, was undertaken. Socio-demographic data, psychoactive substances used, depressive symptoms, and suicide information were obtained. RESULTS: 70% of participants were depressed; of those, 8.1% were either under the influence of drugs or in withdrawal. Suicidal ideation was found to be present in those who had anxiety, were nervous, had depressive symptoms, or were under drug influence or in withdrawal. CONCLUSION: It is important to identify potential suicidal risk factors and implement the management of these conditions in substance users.

Physical and mechanical restraint in psychiatric units: Perceptions and experiences of nursing staff.

BACKGROUND: Physical restraint in psychiatric units is a common practice but extremely controversial and poorly evaluated by methodologically appropriate investigations. The cultural issues and professionals' perceptions and attitudes are substantial contributors to the frequency of restraint that tend to be elevated. Aim In this qualitative study, we aimed to understand the experiences and perceptions of nursing staff regarding physical restraint in psychiatric units. METHOD: Through theoretical sampling, 29 nurses from two Brazilian psychiatric units participated in the study. Data were collected from 2014 to 2016 from individual interviews and analyzed through thematic analysis, employing theoretical presuppositions of symbolic interactionism. RESULTS: Physical restraint was considered unpleasant, challenging, risky, and associated with dilemmas and conflicts. The nursing staff was often exposed to the risks and injuries related to restraint. Professionals sought strategies to reduce restraint-related damages, but still considered it necessary due to the lack of effective options to control aggressive behavior. CONCLUSIONS: This study provides additional perspectives about physical restraint and reveals the need for safer, humanized and appropriate methods for the care of aggressive patients that consider the real needs and rights of these patients.

Expressed emotion of family members and psychiatric relapses of patients with a diagnosis of schizophrenia. / Emoção expressa de familiares e recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia.

OBJECTIVE: Assess the relationship between psychiatric relapses of patients with a diagnosis of schizophrenia, the levels of expressed emotion among their relatives and related factors. METHOD: Prospective study carried out at a mental health outpatient clinic and two Psychosocial Care Centers, with patients and relatives responding to the Family Questionnaire - Brazilian Portuguese Version, a form containing socio-demographic and clinical variables and a structured script to assess relapses. A logistic regression model was used for the analysis. RESULTS: A total of 89 dyads participated in the study. Of the patients investigated, 31% presented relapses and, among the relatives, 68% presented elevated levels of expressed emotion. The relationship between expressed emotion and the relapses was not significant. The logistic regression analysis demonstrated that when there were a higher number of hospital admissions in the two years preceding the study, the chance of the patient relapsing in the 24-month period is 1.34. CONCLUSION: Expressed emotion was insufficient to predict relapses. Thus, a relapse should be understood as a multifactorial phenomenon. These results provide support for interventions and investigations on the multiple factors involved in the evolution of schizophrenia patients in follow-up at community-based health services.

Emergency Nursing Experiences in Assisting People With Suicidal Behavior: A Grounded Theory Study.

AIM: To understand emergency nursing experiences in assisting people with suicidal behavior. METHOD: Grounded theory study with symbolic interactionism conducted in 2015 to 2016 in Brazil with 19 nurses. RESULTS: Assistance for people with suicidal behavior is critical, challenging, evokes different feelings and requires knowledge, skills and emotional control. Nurses did not feel prepared or supported, and identified recurrent gaps and problems. Nurses occupied a limited role, restricted to attending to physical needs. They predominantly manifested opposition, judgments and incomprehension about patients. CONCLUSION: This study presents key elements to be addressed in interventions and investigations regarding nursing support, training and supervision.

Quality of Life in Brazil's Family Health Strategy: Common Mental Disorders, Use of Psychotropic Drugs and Sociodemographic Factors.

The aim of the study was to evaluate the patients' quality of life in Brazil's Family Health Strategy and its association with sociodemographic factors, presence of common mental disorders, and use of psychotropic drugs. Were interviewed 442 patients. Tools were: World Health Organization Quality of Life Assessment-Bref and Self Reporting Questionnaire. Male and low education were strongly associated with higher quality of life. Use of psychotropic drugs and the presence of CMD were strongly associated with poor quality of life. There is a pressing need for primary health care professionals to invest in tracking, and in holistic interventions that are able to cover the healthcare needs of these vulnerable groups.

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.

The Meaning of Stigma for People with Mental Disorders in Brazil.

OBJECTIVE: To understand the meaning of stigma for people with mental disorders. METHOD: A qualitative study with 46 Brazilian adults with mental disorders. Data were collected through semistructured interviews and nonparticipant observation and submitted for a thematic analysis with symbolic interactionism. RESULTS: Stigma was considered as an experience of incomprehension and suffering. The society has difficulty in empathizing, respecting differences and understanding the extent of the suffering of people with mental disorders. Participants recommended anti-stigma strategies that included promoting knowledge and respecting differences. CONCLUSIONS: The present study contributes new insights to be addressed in interventions to reduce the suffering and impact of stigma.

Factors Associated With Psychotropic Medication Use in Individuals in Brazilian Primary Health Care Units: A Descriptive, Cross-Sectional Study.

The current descriptive, cross-sectional study aimed to investigate the rate of psychotropic medication use and its association with sociodemographic factors, pharmacotherapy, health history, and presence of common mental disorders in individuals in Brazilian primary health care (PHC) units. A sample of 442 individuals was interviewed in 10 PHC units. Tools used included a structured questionnaire and the Self Reporting Questionnaire-20. The rate of psychotropic medication use was 38.7%. Demographic characteristics associated with psychotropic medication use were age 60 or older with common mental disorders and physical illness, a primary-level education or less, no occupation, and family income greater than three times the minimum wage. The strongest predictor of psychotropic medication use was monthly family income. The results highlight the need for interventions to improve patient outcomes. [Journal of Psychosocial Nursing and Mental Health Services, 55(3), 38-45.].