Repositório Institucional - Unifesp :: Navegando por Palavras-chave "Mental disorders"

Navegando por Palavras-chave "Mental disorders"

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Acesso aberto (Open Access)
Abuso de cannabis em pacientes com transtornos psiquiátricos: atualização para uma antiga evidência
(Assoc Brasileira Psiquiatria, 2010-05-01) Diehl, Alessandra [UNIFESP]; Cordeiro, Daniel Cruz [UNIFESP]; Laranjeira, Ronaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Objective: To perform an update on cannabis abuse by patients with psychiatric disorders Method: A search was performed in the electronic databases Medline, The Cochrane Library Database, Lilacs, PubMed, and SciELO, using the keyword 'marijuana abuse, 'cannabis abuse, 'psychiatric disorders, and 'mental disorders' Articles published until December 2009, dealing with cannabis abuse and dependence in association with other psychiatric disorders were included Results: Cannabis abuse was found to be associated with increased risk for the onset of schizophrenia and chronic psychotic symptoms, although these findings require confirmation from additional research. Cannabis seems to be one of the drugs of choice of individuals with bipolar disorder, despite evidence that manic states can be induced by its use Cannabis abuse also occurs frequently in individuals with anxiety disorders, but the relationship between the chronic nature of these conditions and the use of marijuana remains uncertain In respect to depression, there is no clear evidence to date that depressive patients use can nab's as a form of self-medication In individuals wall psychiatric disorders, the use of cannabis has been associated with Increased positive symptoms, additional negative symptoms in the course of illness, impaired treatment compliance, and more hospitalizations Conclusion: The abuse of cannabis by patients with psychiatric disorders such as schizophrenia and mood and anxious disorders has a negative impact both in the acute and advanced stages of these conditions, although further investigation on this association is still necessary
Acesso aberto (Open Access)
Access, equity and social cohesion: evaluation of intersectoral strategies for people experiencing homelessness
(Universidade de São Paulo, Escola de Enfermagem, 2014-12-01) Borysow, Igor Da Costa; Furtado, Juarez Pereira [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
Objective To understand and evaluate the work of intersectoral assistance on the insertion and the flow of people in situation of street with severe mental illness in public services of Mental Health. Method A case study developed from ten visits to a night shelter between March and April 2012. For data collection, the participant observation and semi-structured interviews were carried out with four sheltered individuals, as well as non-directive group interviews with five technicians of the social-assistance services. Results Were analyzed using Content Analysis and developing a Logic Model validated with the professionals involved. Conclusion The social assistance services are the main entry of this clientele in the public network of assistance services, and the Mental Health services have difficulty in responding to the specificities of the same clientele and in establishing intersectoral work. 
Acesso aberto (Open Access)
Adaptation of the Barriers to Access to Care Evaluation (BACE) scale to the Brazilian social and cultural context
(Associação de Psiquiatria do Rio Grande do Sul, 2013-12-01) Silva, Leticia [UNIFESP]; Silva, Paula Freitas Ramalho da [UNIFESP]; Gadelha, Ary [UNIFESP]; Clement, Sarah; Thornicroft, Graham; Mari, Jair de Jesus [UNIFESP]; Brietzke, Elisa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); King's College Institute of Psychiatry Health Services and Population Research Department
INTRODUCTION:A significant gap between the number of individuals who need mental health care and the ones who actually have access to it has been consistently demonstrated in studies conducted in different countries. Recognizing the barriers to care and their contributions to delaying or preventing access to mental health services is a key step to improve the management of mental health care. The Barriers to Access to Care Evaluation (BACE) scale is a 30-item self-report instrument conceived to evaluate obstacles to proper mental health care. The main constraint in the investigation of these barriers in Brazil is the lack of a reliable instrument to be used in the Brazilian social and cultural context.OBJECTIVE:To describe the translation and adaptation process of the BACE scale to the Brazilian social and cultural context.METHOD:The translation and adaptation process comprised the following steps: 1) translation from English to Brazilian Portuguese by two authors who are Brazilian Portuguese native speakers, one of whom is a psychiatrist; 2) evaluation, comparison and matching of the two preliminary versions by an expert committee; 3) back-translation to English by a sworn translator who is an English native speaker; 4) correction of the back-translated version by the authors of the original scale; 5) modifications and final adjustment of the Brazilian Portuguese version.RESULTS AND CONCLUSION:The processes of translation and adaptation described in this study were performed by the authors and resulted in the Brazilian version of a scale to evaluate barriers to access to mental health care.
Acesso aberto (Open Access)
Association between mental disorders and adherence to antiretroviral treatment in health facilities in two Mozambican provinces in 2018: a cross-sectional study
(Anao Zhang, 2023-04-20) Mandlate, Flavio Machado [UNIFESP]; Greene, M. Claire; Pereira, Luis F.; Gouveia,Maria Lidia [UNIFESP]; Mari, Jair Jesus [UNIFESP]; Cournos, Francine; Duarte, Cristiane S.; Oquendo, Maria A.; Mello, Marcelo Feijó [UNIFESP]; Wainberg, Milton L.; http://lattes.cnpq.br/8530143179652631
Introduction: Lower adherence to antiretroviral treatment (ART) has been found among people with HIV (PWH) who have comorbid mental disorders like depression and alcohol use in Sub-Saharan African. However, there has been less exploration with regards to other mental disorders. Methods: This study assessed the association of multiple mental disorders and adherence to ART based on the data from primary/tertiary health care facilities in Maputo and Nampula, Mozambique. We administered a sociodemographic questionnaire, Mini International Neuropsychiatric Interview (MINI) Plus 4.0.0 adapted for use in Mozambique to assess mental conditions, and a 3-item self-report to measure ART adherence. Results: 395 HIV-positive (self-report) participants on ART, with an average age of 36.7 years (SD = 9.8), and 30.4% were male. The most common mental disorders were major depressive disorder (27.34%) followed by psychosis (22.03%), suicidal ideation/behavior (15.44%), and alcohol-use disorder (8.35%). Higher odds of missing at least one dose in the last 30 days (OR = 1.45, 95% CI: 1.01, 2.10) were found in participants with any mental disorder compared to those without a mental disorder. The highest levels of non-adherence were observed among those with drug use disorders and panic disorder. Conclusions: In Mozambique, PWH with any co-occurring mental conditions had a lower probability of ART adherence. Integrating comprehensive mental health assessment and treatment and ART adherence interventions tailored to PWH with co-occurring mental disorders is necessary to attain optimal ART adherence and reach the UNAIDS ART target.
Somente Metadadados
Brief report: prevalence of psychiatric disorders in pregnant teenagers
(Elsevier B.V., 2009-06-01) Mitsuhiro, Sandro Sendin [UNIFESP]; Chalem, Elisa [UNIFESP]; Moraes Barros, Marina Carvalho [UNIFESP]; Guinsburg, Ruth [UNIFESP]; Laranjeira, Ronaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Purpose: To evaluate the prevalence of ICD-10 psychiatric disorders in a population of pregnant teenage women from a Brazilian public hospital.Method: 1000 pregnant teenage women were evaluated using the Composite International Diagnostic Interview, a Structured interview which establishes diagnoses according to the International Classification of Diseases.Results: 325 of the 1000 patients were found to have at least one psychiatric disorder; 33.2% of them had a second psychiatric diagnosis. the most prevalent, disorders were depression (12.9%), post-traumatic stress disorder (10%), and tobacco dependence/harmful use (10.30%). the most prevalent co-morbidity was ICD-10 Affective Disorders versus Neurotic, Stress-related, and Somatoform Disorders. Substance-related disorders are significantly correlated with all of the ICD-10 psychiatric diagnoses but Psychotic Disorders.Conclusion: the prevalence of psychiatric disorders in this Population is high, and one third of them had co-morbidities, a condition usually associated with a more serious course of illness. This finding has important implications for clinical management and prognosis, and demands preventive public policies. (C) 2008 Published by Elsevier Ltd on behalf of the Association for Professionals in Services for Adolescents.
Acesso aberto (Open Access)
Common mental disorders in Petrópolis-RJ: a challenge to integrate mental health into primary care strategies
(Associação Brasileira de Psiquiatria - ABP, 2011-06-01) Fortes, Sandra; Lopes, Claudia de Souza; Villano, Luiz Augusto Brites [UNIFESP]; Campos, Mônica Rodrigues [UNIFESP]; Gonçalves, Daniel Almeida [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Universidade do Estado do Rio de Janeiro School of Medical Science; Universidade do Estado do Rio de Janeiro Institute of Social Medicine; Public Health National School; Universidade Federal de São Paulo (UNIFESP); University of London King's College Institute of Psychiatry
OBJECTIVE: Common mental disorders are present in more than 50% of patients attending primary care clinics. The main objectives of this study were to detect whether there is any special group of patients within the Family Health Strategy that should be considered to be in greater risk for common mental disorders and to recommend alternative interventions to aid these patients. METHOD: In 2002, a cross-sectional study on common mental disorders seen at Family Health Strategy centers was conducted in Petrópolis, State of Rio de Janeiro. RESULTS: Common mental disorders were associated with women (OR = 2.90; 95% CI 1.82-4.32), younger than 45 years of age (OR = 1.43; 95% CI 1.02-2.01), with a monthly per capita family income of less than US$40.00 (OR = 1.68; 95% CI 1.20-2.39), and without a partner (OR = 1.71; 95% CI 1.22-2.39). Illiteracy was associated with common mental disorders among patients who were not extremely poor. Social support networks such as going often to church (OR = 0.62; 95% CI 0.43-0.89); participating in artistic and sporting activities (OR = 0.42; 95% CI 0.26-0.70) and having at least four trusted relatives or friends (OR = 0.53; 95% CI 0.31-0.91) was inversely associated with common mental disorders. DISCUSSION: Poor women with little social support represent a special group at risk for common mental disorders in the primary care setting. Some countries have developed special interventions to treat patients with common mental disorders in primary care. CONCLUSION: Mental health care programs could include evidence-based psychosocial interventions to assist women in overcoming the vicious circle of poverty and dealing with their mental disorders.
Acesso aberto (Open Access)
O consumo de etanol entre universitários e sua relação com transtornos ansiosos e desempenho acadêmico
(Universidade Federal de São Paulo, 2022-01-20) Lima, Ana Paula Oliveira de [UNIFESP]; Garcia, Raphael Caio Tamborelli [UNIFESP]; Wagner, Gabriela Arantes [UNIFESP]; http://lattes.cnpq.br/2359496498484717; http://lattes.cnpq.br/7921656182943609
Os transtornos mentais (TM) estão ganhando cada vez mais visibilidade nos dias atuais e, consequentemente, são cada vez mais estudados. Os transtornos de ansiedade são a classe de distúrbios mentais de maior prevalência, sendo estimado a 6ª maior causa de incapacitação mundial. Caracterizado por medo, pavor e inquietação como resposta ao estresse, é considerado patológico quando essa resposta passa a ser excessiva e persistente. Muitos pacientes acabam fazendo o uso de etanol como uma forma de amenizar os problemas diários, aumentando o risco de desenvolver alcoolismo. Sabe-se que a idade com a maior prevalência de consumo de álcool é no início da vida adulta, entre 18 e 22 anos, mesma idade em que normalmente se ingressa na universidade, adquirindo maiores responsabilidades e, assim, maiores preocupações com problemas do dia a dia. O objetivo deste estudo foi avaliar o consumo de etanol e o aparecimento de crises de ansiedade em estudantes universitários com idades entre 18 e 29 anos, correlacionando com o desempenho acadêmico dos mesmos, utilizando o instrumento de pesquisa do Google Formulários, respondido pelo próprio estudante. Notou-se que a prevalência de transtornos de ansiedade na amostra está acima da média da população brasileira, e houve um aumento de crises após a entrada na universidade. Um dos fatores de risco para a ansiedade é o período em que o aluno está matriculado, sendo mais presente no início e no final da formação – ambas épocas de importantes decisões de vida. Com relação ao consumo de etanol, observamos que as mulheres consumiram mais nos últimos 12 meses, o que pode estar relacionado ao fato de ser o gênero mais acometido pelos TM. Conclui-se que o contexto universitário pode ser um agravante para transtornos de ansiedade e, portanto, maiores investimentos e recursos na área da saúde mental precisam ser destinados para o bem-estar dos estudantes.
Acesso aberto (Open Access)
A contribuição dos estudos transculturais dos países latino-americanos e caribenhos para a revisão da CID-10: resultados preliminares
(Associação Brasileira de Psiquiatria - ABP, 2011-05-01) Razzouk, Denise [UNIFESP]; Nogueira, Bruno [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: This review aims to verify the scientific evidences for the inclusion of culture bound syndromes in the International Classification of Diseases towards its 11th edition based on studies from Latin American and Caribbean countries. METHOD: Studies were identified in Medline, LILACS and EMBASE databases for the period between 1992 and 2008, and then classified according to the type of study, to the mental disorder, country and number of publications per year. RESULTS: 163 studies were selected and classified: 33 in MedlLne, 90 in EMBASE e 40 in LILACS. The percentage of culture bound-syndrome corresponded to 9% in Medline, 12% in EMBASE e 2.5% in LILACS. Among fifteen studies on cultural bound syndromes, two were about nervios and ataque de nervios, two about susto, four about the relationship between religion beliefs, witchery, trance and mental disorders, one with a proposal for new diagnostic category, three about theoretic issues and three about the pathoplasty of mental disorders. CONCLUSION: The scarcity of studies on culture bound syndromes might be due to the indexation problems hindering the screening of studies; lack of interest on publishing such studies in indexed journals (publication bias) and due to difficulty to access them. There is no robust evidence identified among cross-cultural studies to recommend changes for International Classification of Diseases-11th edition.
Acesso aberto (Open Access)
Detection of psychiatric morbidity in the primary medical care setting in Brazil
(Faculdade de Saúde Pública da Universidade de São Paulo, 1987-12-01) Mari, Jair de Jesus [UNIFESP]; Iacoponi, Eduardo [UNIFESP]; Williams, Paul [UNIFESP]; Simões, Oziris [UNIFESP]; Silva, João Batista Teodoro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The aims of this study were a) to assess the ability of primary care doctors to make accurate ratings of psychiatric disturbance and b) to evaluate the use of a case-finding questionnaire in the detection of psychiatric morbidity. The estudy took place in three primary care clinics in the city of São Paulo, Brazil, during a six-month survey. A time sample of consecutive adult attenders were asked to complete a case-finding questionnaire for psychiatric disorders (the Self Report Questionnaire - SRQ) and a subsample were selected for a semi-structured psychiatric interview (the Clinical Interview Schedule - CIS). At the end of the consultation the primary care doctors were asked to assess, in a standardized way, the presence or absence of psychiatric disorder; these assessments were then compared with that ratings obtained in the psychiatric interview. A considerable proportion of minor psychiatric morbidity remained undetected by the three primary care doctors: the hidden morbidity ranged from 22% to 79%. When these were compared to those of the case-finding questionnaire, they were consistently lower, indicating that the use of these instruments can enhance the recognition of psychiatric disorders in primary care settings. Four strategies for adopting the questionnaire are described, and some of the clinical consequences of its use are discussed.
Restrito
Educação física e saúde mental no SUS: revisão bibliográfica
(Universidade Federal de São Paulo, 2021-08-18) Silveira, Marcos Isaias Conceição [UNIFESP]; Gomes, Ricardo José [UNIFESP]; http://lattes.cnpq.br/2738281530091229; http://lattes.cnpq.br/7121214104117231; Universidade Federal de São Paulo (UNIFESP)
A atuação do profissional de Educação Física (PEF) no apoio à saúde mental é regulamentada pelo governo federal desde 2001 e, embora não seja obrigatória, a inserção desses profissionais tem se tornado crescente no território nacional. Diante disso, o objetivo dessa pesquisa foi investigar a quantidade de publicações e as temáticas que estão sendo abordadas na literatura envolvendo o PEF e a sua atuação na saúde mental pública (CAPS, NAPS). Para o estudo, de caráter bibliográfico e abordagem quantitativa e qualitativa, foram pesquisados artigos publicados sobre o assunto entre os anos 2000 e 2020 nas plataformas Lillacs, Scielo, Biblioteca Virtual em Saúde (BVS), National Library of Medicine (PubMed) e Web of Science. Sendo assim, o trabalho consistiu em elencar e avaliar a quantidade e a temática dos estudos publicados que relacionem saúde mental e a atuação do PEF no SUS. Apesar da pouca literatura encontrada sobre o tema em duas décadas de regulamentação pelo governo federal — mesmo com o aumento nos últimos anos — foi possível identificar potencialidades e fragilidades na atuação do PEF na saúde mental pública, o que pode ajudar a orientar diretrizes para melhorar sua atuação, não apenas como profissional de Educação Física, mas como profissional da área da saúde mental.
Acesso aberto (Open Access)
The effectiveness of a non-pharmacological intervention for weight gain management in severe mental disorders: results from a national multicentric study
(Associação Brasileira de Psiquiatria - ABP, 2011-06-01) Attux, Cecília [UNIFESP]; Martini, Larissa Campagna [UNIFESP]; Araújo, Célia Maria de [UNIFESP]; Roma, Ana Maria [UNIFESP]; Reis, André Fernandes [UNIFESP]; Bressan, Rodrigo Affonseca [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: To evaluate the effectiveness of a non-pharmacological intervention for weight gain management in severe mental disorders. METHOD: An open, multicentre interventional study was conducted in 93 mental health services. Patients concerned with weight gain were included in this study and received a 12-week 1-hour group intervention focused on nutrition counseling, lifestyle, physical activity and self-esteem. Weight, waist circumference and blood pressure were measured before and after the intervention. RESULTS: 1,071 patients were enrolled in the study, and 73.9% completed the 12-week intervention. Significant weight loss (Mean difference: 0.41, CI 95%: 0.18 to 0.64, p = 0.001) and a significant BMI reduction (Mean difference: 0.13, CI 95%: 0.04 to 0.22, p = 0.006) were observed. During the intervention 37 (4.4%) patients lost > 7% of their initial weight, 780 (92.5%) maintained their weight, and 26 (3.1%) of the patients had a meaningful weight gain (> 7%). There was a significant increase in the proportion of patients undertaking physical activity after the intervention (70.8%, p < 0.001). CONCLUSION: In this 3-month open study we found a small weight and waist reduction, and increased physical activity practice, suggesting a trend towards anthropometric profile improvement. However, further randomized-controlled trials are necessary to evaluate the efficacy and clinical relevance of this psychosocial intervention for weight gain.
Acesso aberto (Open Access)
Exposição à violência e problemas de saúde mental em países em desenvolvimento: uma revisão da literatura
(Associação Brasileira de Psiquiatria - ABP, 2009-10-01) Ribeiro, Wagner S. [UNIFESP]; Andreoli, Sergio Baxter [UNIFESP]; Ferri, Cleusa Pinheiro [UNIFESP]; Prince, Martin; Mari, Jair de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); King's College London institute of Psychiatry Health Service and Population Research departament; Universidade Católica de Santos
OBJECTIVE: To study the epidemiological evidence on the prevalence of exposure to violence and its relationship with mental health problems in low and middle-income countries. METHOD: The search was based on cross-sectional and cohort studies available in electronic databases (Medline, Psycinfo, Embase, SciELO and Lilacs), through July 2009, using the key words: violence and mental disorders. RESULTS: The frequency of exposure to violence was shown to be very high and was significantly associated with mental health problems. Among children, the highest correlation was found to be of domestic violence with externalizing problems (OR = 9.5; 95% CI = 3.4-26.2), and suicidal ideation with sexual abuse (OR = 8.3; p < 0.05); among women, depression/anxiety symptoms correlated with intimate-partner psychological (OR = 3.2; 95% CI = 1.8-5.8) and sexual (OR = 9.7; 95% CI = 1.9-51.2) violence. In the general population, the highest prevalence rates of post-traumatic stress disorder were associated with sexual and domestic violence, kidnapping, and cumulative trauma exposure. Violence also correlated with common mental disorders. CONCLUSION: A substantial part of the mental health problems in low and middle-income countries can be attributed to violence. Thus, interventions directed to decrease violence in low and middle-income countries might have a major positive impact on the mental health of those living in these settings.
Acesso aberto (Open Access)
Fatores associados ao uso excessivo de medicação sintomática em pacientes com enxaqueca crônica
(Instituto Israelita de Ensino e Pesquisa Albert Einstein, 2012-09) Zukerman-Guendler, Vera [UNIFESP]; Mercante, Juliane Prieto Peres; Ribeiro, Reinaldo Teixeira [UNIFESP]; Zukerman, Eliova [UNIFESP]; Peres, Mario Fernando Prieto [UNIFESP]; Hospital Israelita Albert Einstein - HIAE; Universidade Federal de São Paulo - UNIFESP; Faculdade de Medicina do ABC - FMABC; Universidade de São Paulo - USP
OBJETIVO: Avaliar a prevalência de transtornos psiquiátricos em pacientes com diagnóstico de enxaqueca crônica com e sem uso excessivo de medicação sintomática. MÉTODOS: Setenta e dois voluntários foram recrutados a partir de um Programa de Saúde da Família da comunidade de Paraisópolis, na cidade de São Paulo (SP). Esses pacientes foram submetidos a exames clínico e neurológico. As seguintes variáveis foram analisadas: idade, gênero, nível educacional, índice de massa corporal, tipo de uso excessivo de medicação, características da cefaleia, consumo de cafeína, presença de ansiedade e distúrbios de humor. RESULTADOS: Dos 72 pacientes, 50 (69%) tinham cefaleia crônica, com uso exagerado de medicação, e 22 (31%) tinham cefaleia crônica, sem uso excessivo de medicação. Os fatores idade, gênero, nível educacional, índice de massa corporal, tipo de uso excessivo de medicação, características da cefaleia e consumo de cafeína não mostraram diferença significante entre os grupos estudados. Os diagnósticos de ansiedade e de distúrbios de humor ao longo da vida foram mais comuns nos pacientes com uso excessivo de medicação (p=0,003 e p=0,045, respectivamente). CONCLUSÃO: Este estudo mostrou uma associação significativa entre cefaleia crônica e uso excessivo de medicação nos pacientes avaliados, quanto ao diagnóstico de transtornos de ansiedade e de humor ao longo da vida. Não foi encontrada nenhuma associação com outros distúrbios psiquiátricos pesquisados.
Acesso aberto (Open Access)
The general practitioner and mental health problems: challenges and strategies for medical education
(Associação Paulista de Medicina - APM, 2005-03-01) Ballester, Dinarte Alexandre [UNIFESP]; Filippon, Ana Paula [UNIFESP]; Braga, Carla [UNIFESP]; Andreoli, Sergio Baxter [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
CONTEXT AND OBJECTIVE: Within the context of primary health care and mental disorders, our aim was to study the opinions of general practitioners regarding attendance of people with mental health problems. DESIGN AND SETTING: Qualitative focal group study among primary care services in the cities of Porto Alegre and Parobé, State of Rio Grande do Sul. METHODS: A deliberately selected sample of 41 general practitioners who were working in basic health services met in focal groups. Two videos were presented, which simulated consultations for patients with depression and psychoses. The discussions about the identification and handling of mental health problems were recorded and assessed via content analysis. RESULTS: The opinions related to the difficulties of diagnosing and treating mental problems, the involvement of relatives in caring for patients, the difficulty of compliance with the treatment, the uncertainty experienced by physicians and the difficulty of referring patients to specialized services. CONCLUSIONS: The general practitioners indicated that they perceived the mental health problems among their clientele, but the diagnosis and treatment of these problems are still seen as a task for specialists. The challenge of continuing education on mental health requires methods of interactive and critical teaching, such as the problem-based approach.
Acesso aberto (Open Access)
Identificação de casos psiquiátricos em estudos epidemiológicos multifásicos: métodos, problemas e aplicabilidade
(Faculdade de Saúde Pública da Universidade de São Paulo, 2000-10-01) Andreoli, Sergio Baxter [UNIFESP]; Almeida Filho, Naomar de; Coutinho, Evandro Sf; Mari, Jair de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal da Bahia Instituto de Saúde Coletiva; Escola Nacional de Saúde Pública Departamento de Epidemiologia
OBJECTIVE: To discuss methodological aspects of the two stages in the identification of psychiatric cases in epidemiological studies. METHODS: Analyze the methodology used in the Multicentric Psychiatric Morbidity Study, which was conducted in three Brazilian cities (São Paulo, Brasília and Porto Alegre). In the first stage of that study, a random sample (6,740 individuals) of the population was drawn and all the participants were screened with the Questionnaire of Psychiatric Morbidity of the Adult (QMPA). In the second stage, a sample (775 individuals) of this population was drawn and these individuals were submitted to the Inventory of Symptoms of DSM-III, carried out by psychiatrists and trained psychologists. RESULTS: The study procedure for estimating the prevalence is described in details, showing that though the screening scales are a weak tool, they don't interfere with the methodology. CONCLUSION: The advantage of this methodology is to correct any distortions caused by the current tools used in the identification of psychiatric cases.
Acesso aberto (Open Access)
Impact of psychiatric disorders on the quality of life of brazilian HCV-infected patients
(Brazilian Society of Infectious Diseases, 2009-02-01) Batista-Neves, Susana; Quarantini, Lucas de Castro [UNIFESP]; Almeida, Amanda Cristina Galvão Oliveira de [UNIFESP]; Cardeal, Maurício; Lacerda, Acioly Luiz Tavares de [UNIFESP]; Paraná, Raymundo; Reis De-Oliveira, Irismar; Bressan, Rodrigo Affonseca [UNIFESP]; Miranda-Scippa, Ângela Marisa de Aquino [UNIFESP]; Federal University of Bahia Hospital Universitário; Universidade Federal de São Paulo (UNIFESP)
The aim of our study was to determine the impact of psychiatric comorbidities on the health-related quality of life of HCV-infected patients. Assessment of clinical, socio-demographic and quality of life data of the patients followed up at a Hepatology unit was performed by using a standard questionnaire and the SF-36 instrument. Psychiatric diagnoses were confirmed by using the Mini International Neuropsychiatric Interview, Brazilian version 5.0.0 (MINI Plus). Evaluation using the MINI plus demonstrated that 46 (51%) patients did not have any psychiatric diagnosis, while 44 (49%) had at least one psychiatric diagnosis. Among patients with a psychiatric comorbidity, 26 (59.1%) had a current mental disorder, out of which 22 (84.6%) had not been previously diagnosed. Patients with psychiatric disorders had lower scores in all dimensions of the SF-36 when compared to those who had no psychiatric diagnosis. Scores of physical functioning and bodily pain domains were lower for those suffering from a current psychiatric disorder when compared to those who had had a psychiatric disorder in the past. Females had lower scores of bodily pain and mental health dimensions when compared to males. Scores for mental health dimension were also lower for patients with advanced fibrosis. The presence of a psychiatric comorbidity was the variable that was most associated with the different scores in the SF-36, compared to other variables such as age, gender, aminotransferase levels, and degree of fibrosis.
Acesso aberto (Open Access)
O impacto da exposição à violência e outros eventos traumáticos nos transtornos mentais dos adolescentes e adultos jovens na cidade de São Paulo
(Universidade Federal de São Paulo (UNIFESP), 2015-03-25) Jaen Varas, Denisse Claudia [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Ribeiro, Wagner Silva [UNIFESP]; http://lattes.cnpq.br/0879604363822969; http://lattes.cnpq.br/5783141369706484; http://lattes.cnpq.br/2456474709926289; Universidade Federal de São Paulo (UNIFESP)
Adolescentes e adultos jovens são mais vulneráveis e mais expostos à violência e eventos traumáticos do que os adultos, e esses fatores podem ser associados a transtornos mentais. Objectivo: O objectivo deste estudo é avaliar se os jovens são de fato mais expostos à violência e eventos traumáticos e comparar padrão de transtornos mentais com a população adulta. Métodos: Um estudo transversal com o Composite International Diagnostic Interview foi realizado entre 2007 e 2008 com uma amostra aleatória da população da cidade de São Paulo, Brasil: os participantes com idade 15 a 75 anos foram divididos em grupos de jovens adultos e adultos. Resultados: 2.536 indivíduos foram entrevistados e divididos em dois grupos: 1.096 (43,2%) jovens com idade entre 15-24, e 1.440 (56,8%) adultos com idade de 25 a 75. A exposição a eventos traumáticos nos 12 meses anteriores a entrevista foi significativamente maior entre os jovens (32,1% vs. 20,6%; p <0,001). A exposição à violência direta e intencional atingiu 13,4% dos jovens e 8,6% dos adultos (p = 0,012); 20,1% dos jovens e 13% dos adultos (p<0,001) relataram sofrer exposição a outros ferimentos ou eventos impactantes; notícia de doença grave ou morte repentina uma pessoa próxima foi declarada por 6,1% dos jovens e 3,2% dos adultos (p = 0,017). A prevalência de abuso de álcool foi significativamente maior entre os jovens (5,4% vs. 2,5%; P = 0,032), enquanto os transtornos depressivos foram significativamente mais comuns entre os adultos (9,0% vs. 4,7%; P = 0,004). Transtornos fóbico-ansiosos estiveram associados a outras lesões ou acontecimentos impactantes entre os jovens (OR = 3,51; p = 0,025). O transtorno depressivo maior foi associado à violência direta e intencional entre os jovens (OR = 3,13; p = 0,004) e adultos (OR = 1,66; p = 0,009). Conclusão: A exposição a todas as formas de violência e eventos traumáticos foi significativamente maior entre os jovens. O abuso de álcool, depressão e transtornos fóbico-ansiosos foram significativamente maior entre os jovens expostos a eventos traumáticos. Embora este seja um estudo transversal, a alta exposição à violência e eventos traumáticos nessa faixa etária pode ser um fator importante para desencadear transtornos mentais neste período vulnerável da vida.
Acesso aberto (Open Access)
Impacto do estigma no manejo clinico dos transtornos mentais na atenção primária
(Universidade Federal de São Paulo (UNIFESP), 2018-02-08) Rojas Vistorte, Angel Olider [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; http://lattes.cnpq.br/5783141369706484; http://lattes.cnpq.br/0507476619809231; Universidade Federal de São Paulo (UNIFESP)
Introdução: O tratamento de transtornos mentais comuns em unidades da atenção primária tem sido sugerido como estratégia prioritária para garantir que todos os portadores de transtornos mentais tenham acesso à abordagem terapêutica que necessitam. Porém, médicos da atenção primária enfrentam importantes obstáculos para o diagnóstico e tratamento de transtornos mentais, por não estarem capacitados para fazê-lo, ou por apresentarem atitudes estigmatizantes em relação a eles. Objetivo: Avaliar como o estigma relacionado aos transtornos mentais pode afetar os cuidados oferecidos aos pacientes com transtornos mentais comuns na atenção primária. Método: No primeiro artigo foi realizada uma revisão sistemática da literatura das atitudes estigmatizantes que apresentam os médicos da atenção primária com respeito às pessoas com transtornos mentais. No segundo artigo foi realizado o processo de tradução, adaptação e validação de um instrumento que avalia os níveis do estigma nos médicos da atenção primária. E no terceiro artigo foi realizado análises da associação entre as condutas clínicas e os níveis de estigma, assim como a identificação de potenciais fatores associados às atitudes estigmatizantes. Os artigos 2 e 3 foram baseados em uma amostra de médicos que trabalham em unidades de atenção primária no Brasil, Bolívia, Chile. Participaram 550 profissionais dos quatro países. As condutas clínicas dos médicos em relação aos transtornos mentais comuns foram investigadas por meio de vinhetas clínicas. As atitudes estigmatizantes foram avaliadas por meio do questionário Mental Illenss: Clinicians’ Attitudes Scale (MICA v4). Resultados: Após aplicar critérios de elegibilidade, onze artigos foram incluídos na revisão. Os médicos de atenção primária apresentaram atitudes estigmatizantes com respeito às pessoas com transtornos mentais, e mostraram atitudes mais negativas em relação aos pacientes com esquizofrenia do que com pessoas com depressão. Os dois modelos na validação do MICA v4 demonstraram uma boa confiabilidade e ajuste para as amostras em Espanhol e Português (Português: CFI=0.927; TLI=0.913; RMSEA= 0.066; Spanish: CFI=0.945; TLI=0.935; RMSEA= 0.068). 70% dos médicos que atuam na atenção primária reconhecem a presença de um transtorno mental nas vinhetas apresentadas, e 80.9% se sentem capacitados para diagnosticar e tratar pessoas com transtornos mentais comuns. Mais de 90% dos médicos da Bolívia, Cuba e Chile concordaram em tratar os pacientes apresentados nas três vinhetas. Não encontramos diferenças significativas entre os quatro países nas pontuações dos níveis de estigma no MICA v4 (M=36.1, SD=8.3). O gênero (p = .672), a idade (p = .171), os anos de experiência (p = 0,28) e treinamento (p = .673) não estão relacionados ao estigma. Aqueles médicos que não se sentem preparados para o diagnóstico e tratamento de transtornos mentais apresentam maiores níveis do estigma (t(385)=2.5, p<0.01). Médicos com níveis mais baixos de estigma apresentaram maior probabilidade de não encaminhar para um psiquiatra os pacientes com sintomas de depressão e somatoformes. Conclusões: As versões do MICA v4 em espanhol e português possuem boas propriedades psicométricas, boa consistência interna e são aplicáveis e aceitáveis para o contexto latino-americano. Há uma correlação entre níveis de estigma e habilidade do médico para cuidar adequadamente dos transtornos mentais na atenção primária. Atitudes estigmatizantes podem atuar como uma barreira importante para que os pacientes recebam o tratamento que eles precisam.
Acesso aberto (Open Access)
Mental health and psychiatry research in Brazil: scientific production from 1999 to 2003
(Faculdade de Saúde Pública da Universidade de São Paulo, 2006-08-01) Razzouk, Denise [UNIFESP]; Zorzetto, Ricardo [UNIFESP]; Dubugras, Maria Thereza Bonilha [UNIFESP]; Gerolin, Jerônimo [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: To assess the extent of mental health scientific production in Brazil from 1999 to 2003, and to identify the nature of the publications generated, their sources of finance and the ways of publicly disseminating the research findings. METHODS: Searches for publications were conducted in the Medline and PsychInfo databases for the period 1999-2003. A semi-structured questionnaire developed by an international team was applied to 626 mental health researchers, covering each interviewee's educational background, research experience, access to funding sources, public impact and research priorities. The sample was composed by 626 mental health researchers identified from 792 publications indexed on Medline and PsychInfo databases for the period above, and from a list of reviewers of Revista Brasileira de Psiquiatria. RESULTS: In Brazil, 792 publications were produced by 525 authors between 1999 and 2003 (441 indexed in Medline and 398 in the ISI database). The main topics were: depression (29.1%), substance misuse (14.6%), psychoses (10%), childhood disorders (7%) and dementia (6.7%). Among the 626 Brazilian mental health researchers, 329 answered the questionnaire. CONCLUSIONS: There were steadily increasing numbers of Brazilian articles on mental health published in foreign journals from 1999 to 2003: the number of articles in Medline tripled and it doubled in the ISI database. The content of these articles corresponded to the priorities within mental health, but there is a need for better interlinking between researchers and mental health policymakers.
Acesso aberto (Open Access)
The needs of members of the families of general hospital inpatients
(Associação Paulista de Medicina - APM, 2008-03-01) Lucchese, Ana Cecília [UNIFESP]; Citero, Vanessa de Albuquerque [UNIFESP]; De Marco, Mario Alfredo [UNIFESP]; Andreoli, Sergio Baxter [UNIFESP]; Nogueira-Martins, Luiz Antonio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
CONTEXT AND OBJECTIVE: The needs of members of the families of intensive care unit patients have been studied, but little is known about the needs of members of the families of general hospital inpatients, especially patients with chronic diseases. The aim of this study was to identify the needs of members of the families of general hospital inpatients and investigate associations between these needs and the patients' clinical and psychiatric profiles. DESIGN AND SETTING: Descriptive study, in a public teaching hospital. METHODS: A random sample of 47 patients and members of their families was studied. Family members' needs were investigated using the critical care family needs inventory and the patients' clinical profiles were investigated using the hospital anxiety and depression scale, confusion assessment method and Karnofsky performance status. The frequencies of family members' needs were described and the patients' clinical and psychiatric characteristics were correlated with the needs using the chi-squared test. RESULTS: Chronic patients predominated and the needs for reassurance and information were indicated as the most important by all members of their families. No associations were found between the patients' characteristics and the needs of members of their families during the hospitalization. CONCLUSIONS: The needs indicated by members of the families of general hospital inpatients were similar to those of members of the families of patients in intensive care units: they considered it very important to be reassured and kept informed throughout the hospitalization.

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