Estratégias de intervenção precoce, estigma e práticas orientadas ao recovery na atenção ao primeiro episódio psicótico: uma comparação entre Centros de Atenção Psicossocial e Ambulatório Universitário Especializado
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Data
2023-12-21
Autores
Soeiro, Pâmela Pilar Molino [UNIFESP]
Orientadores
Noto, Cristiano de Souza [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
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Introdução: No âmbito do Sistema Único de Saúde (SUS), a Rede de Atenção Psicossocial (RAPS) fica responsável pela oferta da assistência à saúde mental pública no Brasil, tendo o Centro de Atenção Psicossocial (CAPS) como ponto estratégico no gerenciamento do cuidado. Por essas diretrizes, observou-se que, a literatura existente demonstra os benefícios da intervenção precoce nas psicoses iniciais; entretanto, pôde-se também notar que, barreiras como o estigma e a baixa perspectiva de recuperação podem impactar nos serviços oferecidos por essas organizações de atendimentos especializados. Materiais e Métodos: Este estudo de observação transversal comparou as estratégias de intervenção precoce nas psicoses experienciadas entre o CAPS adulto, o CAPS infantojuvenil e um ambulatório universitário especializado em primeiro episódio psicótico (Grupo de Apoio às Psicoses Iniciais - GAPi) da cidade de São Paulo. A princípio, a escala FEPS-FS (First Episode Psychosis Services Fidelity Scale) foi utilizada para identificar as estratégias de intervenção precoce às psicoses nas unidades de saúde mental. Secundariamente, a percepção da equipe em relação as práticas orientadas ao recovery dos serviços, também foi avaliada. Para isso, usou-se a escala RSA-R (Recovery Self-Assessment) e o nível de estigma dos profissionais das equipes, através do Questionário de Estigma. Resultados: Os resultados obtidos por esse processo mostraram os seguintes efeitos: 1). Que a escala FEPS tem um ponto de corte de 124 para resultados satisfatórios; enquanto, o GAPi pontuou 123. Uma estimativa que indica a necessidade de melhorias em estratégias de intervenção precoce. 2). Que as pontuações dos CAPS na escala FEPS variaram de 81 a 99. Uma estimativa que sinaliza práticas abaixo do esperado para os programas de intervenção precoce (com o CAPS infantojuvenil pontuando um nível mais alto do que o CAPS adulto). 3). Que há uma correlação negativa e significativa entre as escalas FEPS-FS e RSA-R, que indica quando o resultado de um instrumento pode aumentar e o outro diminuir nos locais estudados. Além disso, não houve diferenças significativas na presença de estigma entre o CAPS e o GAPi. Conclusões: Foi constatado que, programas e estratégias de intervenção precoce podem ampliar o acesso, ao passo que, a integração no SUS e seus impactos, ainda necessitam de estudos futuros. Nisto, o desenvolvimento de estudos sobre a integração destes programas nos CAPS demonstrou ser crucial para o entendimento de seu impacto na triagem, no recovery e no combate ao estigma.
Introduction: Within in the scope of the Brazil’s Unified Health System (SUS), the Psychosocial Care Network (RAPS) is responsible for providing public mental health care in Brazil, with the Psychosocial Care Center (CAPS) serving as a strategic point in care management. Through these guidelines, it was observed that, existing literature demonstrates the benefits of early intervention in early psychoses; however, it was also noted that, Barriers such as stigma and low prospects for recovery can impact the services offered by these specialized care organizations. Materials and Methods: This observational, crosssectional study compared the early intervention strategies for psychoses experienced between the adult CAPS, the teenager/chield CAPS and a university outpatient clinic specializing in firstepisode psychosis, the Group of Support for Early Psychoses (GAPi) in the city of São Paulo. First, the First Episode Psychosis Services Fidelity Scale (FEPSFS) was used to identify early intervention strategies for psychosis in mental health units. Secondarily, the team's perception regarding practices aimed at service recovery was also evaluated. For this, the Recovery SelfAssessment (RSAR) scale was used, and the level of stigma of team professionals was used through the Stigma Questionnaire. Results: The results obtained by this process showed the following effects: 1). That the FEPS scale has a cutoff point of 124 for satisfactory results; while, GAPi scored 123. An estimate that indicates the need for improvements in early intervention strategies. 2). That CAPS scores on the FEPS scale ranged from 81 to 99. An estimate that signals practices below expectations for early intervention programs (with the teenager/chield CAPS scoring at a higher level than the adult CAPS). 3). That there is a negative and significant correlation between the FEPSFS and RSAR scales, which indicates when the result of one instrument may increase and the other may decrease in the locations studied. Furthermore, there were no significant differences in the presence of stigma between CAPS and GAPi. Conclusions: It was found that, early intervention programs and strategies can expand access, whereas, integration into the SUS and its impacts still require future studies. In this sense, the development of studies on the integration of these programs in CAPS proved to be crucial for understanding its impact on screening, recovery and combating stigma.
Introduction: Within in the scope of the Brazil’s Unified Health System (SUS), the Psychosocial Care Network (RAPS) is responsible for providing public mental health care in Brazil, with the Psychosocial Care Center (CAPS) serving as a strategic point in care management. Through these guidelines, it was observed that, existing literature demonstrates the benefits of early intervention in early psychoses; however, it was also noted that, Barriers such as stigma and low prospects for recovery can impact the services offered by these specialized care organizations. Materials and Methods: This observational, crosssectional study compared the early intervention strategies for psychoses experienced between the adult CAPS, the teenager/chield CAPS and a university outpatient clinic specializing in firstepisode psychosis, the Group of Support for Early Psychoses (GAPi) in the city of São Paulo. First, the First Episode Psychosis Services Fidelity Scale (FEPSFS) was used to identify early intervention strategies for psychosis in mental health units. Secondarily, the team's perception regarding practices aimed at service recovery was also evaluated. For this, the Recovery SelfAssessment (RSAR) scale was used, and the level of stigma of team professionals was used through the Stigma Questionnaire. Results: The results obtained by this process showed the following effects: 1). That the FEPS scale has a cutoff point of 124 for satisfactory results; while, GAPi scored 123. An estimate that indicates the need for improvements in early intervention strategies. 2). That CAPS scores on the FEPS scale ranged from 81 to 99. An estimate that signals practices below expectations for early intervention programs (with the teenager/chield CAPS scoring at a higher level than the adult CAPS). 3). That there is a negative and significant correlation between the FEPSFS and RSAR scales, which indicates when the result of one instrument may increase and the other may decrease in the locations studied. Furthermore, there were no significant differences in the presence of stigma between CAPS and GAPi. Conclusions: It was found that, early intervention programs and strategies can expand access, whereas, integration into the SUS and its impacts still require future studies. In this sense, the development of studies on the integration of these programs in CAPS proved to be crucial for understanding its impact on screening, recovery and combating stigma.
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Citação
PILAR, Pâmela. Estratégias de intervenção precoce, estigma e práticas orientadas ao recovery na atenção ao primeiro episódio psicótico: uma comparação entre Centros de Atenção Psicossocial e Ambulatório Universitário Especializado. 2023. 129 f. Dissertação (Mestrado em Psiquiatria e Psicologia Médica) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.