PPG - Psiquiatria e Psicologia Médica

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https://hdl.handle.net/11600/61164

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Navegando PPG - Psiquiatria e Psicologia Médica por Autor "Andrade, Mario Cesar Rezende [UNIFESP]"

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    Necessidades de pacientes com transtornos do espectro da esquizofrenia como indicador de resultado na avaliação de serviços comunitários de saúde mental
    (Universidade Federal de São Paulo (UNIFESP), 2017-02-15) Andrade, Mario Cesar Rezende [UNIFESP]; Andreoli, Sergio Baxter [UNIFESP]; Bandeira, Marina de Bittencourt; http://lattes.cnpq.br/5161981285689911; http://lattes.cnpq.br/3330444987520974; http://lattes.cnpq.br/0634812325568520; Universidade Federal de São Paulo (UNIFESP)
    Objective: To study the needs of patients with schizophrenia spectrum disorders treated at community mental health services and their association with service use, adjusted for individual variables. Methods: A cross-sectional study was carried out with a probabilistic sample of 401 patients who were attended at the five Psychosocial Care Centers of the city of Santos, in a period of one year prior to data collection. Needs assessment was performed using the Camberwell Assessment of Need, applied in a structured clinical interview. This instrument 22 clinical and social needs of patients with severe disorders. Its score is obtained through the sum of the number of total, met and unmet needs besides the possibility of analyzing whether there is a need and whether it is met or unmet. Symptoms were assessed by the Positive and Negative Symptom Scale and a questionnaire of history of the disease was adapted from the Life Chart Rating Form. Hierarchical multiple regression analyzes were performed to investigate the factors associated with numbers of total and unmet needs. Hierarchical logistic regression was applied to identify factors related to the following clinical needs: psychotic symptoms, information and psychological distress. Results: The average number of total needs (attended + unmet) was 5.85 (3.09) and the number of unmet needs was 2.91 (2.55). These numbers were shown to be associated only with sociodemographic and clinical indicators of severity, showing no association with the use of services. The presence of the need related to psychotic symptoms was associated with a higher level of positive symptoms and non-involvement of the family in the treatment, while na unmet need was again associated with a higher level of these symptoms and a dissatisfaction with the medication used. The presence of information need was associated with lower educational level, higher age at onset and monitoring of medication use by the family, while na unmet need was associated with noninvolvement of the family in the treatment, although this model was not statistically significant. The need related to psychological distress was associated with the presence of suicidal thoughts in the last year, greater general psychopathology, use of psychotherapy in the last year and absence of psychosocial rehabilitation activities, while an unmet need was again associated with a higher level of psychopathology and the lack of follow-up of the patient in the treatment by a family member. Conclusion: The present study pointed to the needs assessment as a possible outome measure in Brazilian mental health services, associated to the use of these services. This occurred mainly in the analysis of patients' specific clinical needs. The results also reinforced the role of family members in meeting patients' needs. These findings seem to contribute to the production of outcome measure which are relevant to mental health services in Brazil, where there is still no systematic and continuous evaluation of mental health care.