Adherence to treatment in collective multiprofessional activities and factors associated with adherence in a specialized center for psychosocial care

Abstract Introduction Specialized psychosocial care centers (Centros de Atenção Psicossocial [CAPS]) are mental health services focused on social rehabilitation and reducing hospitalization of patients with severe and persistent mental illness. Collective multiprofessional activities (CMPA) are the main therapeutic tools used at CAPS. This study aimed to determine rates of adherence to CMPA and identify factors associated with adherence. Methods This is a cross-sectional study in which 111 CAPS users were evaluated using questionnaires covering patient characteristics, clinical status, and treatment and incorporating the Functioning Assessment Short Test (FAST), the Clinical Global Impression - Severity scale (CGI-S), and the Clinical Global Impression - Improvement scale (CGI-I). Adherence was defined as attendance at 50% or more CMPA during the previous 3 months. Data were analyzed using descriptive statistics, bivariate analysis, and Poisson logistic regression with robust variance to estimate prevalence ratios. Results CPMA adherence was 43%. Having children aged 14 years or younger was significantly associated with non-adherence (71%, p = 0.001). Poor or partial adherence to psychotropic drugs tended to be associated (p = 0.066) with poor adherence (33% higher risk), as was the number of psychiatric hospitalizations during CAPS (p = 0.076), with a cumulative association of 5% non-adherence per hospitalization. Conclusions CMPA adherence was low in the study. It is necessary to consider the environment in which the individual lives and invest in support networks, providing patients and family members with explanations about the importance of CMPA to rehabilitation and attempting to tailor the care provided to each patient's needs. There was an association between greater number of psychiatric hospitalizations and non-adherence, suggesting that CAPS are fulfilling a preventive role.

Internal consistency and factor structure of the Portuguese version of the Liebowitz Social Anxiety Scale among alcoholic patients

OBJECTIVE: Liebowitz Social Anxiety Scale is an instrument used to evaluate the severity of social phobia. It has been widely used in different contexts and cultures, presenting variable psychometric properties. The objective of this article is to investigate the internal consistency and the factor structure of this scale. METHOD: In a sample of 300 alcoholic patients hospitalized in 3 mental clinics in Southern Brazil, 74 of them were social phobics (24.6 percent). The Structured Clinical Interview for DSM-IV-Axis I Disorders - Patient Edition, a semi-structured clinical interview based on DSM-IV, was used to check for the diagnosis of social phobia. The internal consistency was measured by Cronbach's alpha. Data were subjected to a factor analysis with the principal component method of parameter estimation. Questionnaire items loading at 0.35 or above were considered in the final factor solution. RESULTS: The coefficient of internal consistency was 0.95. All items showed corrected item-total correlation coefficient above 0.15, considered the minimum requested index. The factor analysis resulted in 5 dimensions which corresponded to 52.9 percent of the total variance. The five factors extracted were: factor I - speaking in a group, factor II - activity in public, factor III - social interaction with unknown person, factor IV - attitude of disagreement or disapproval and factor V - social interaction in leisure activity. CONCLUSIONS: The scale proved to be reliable and structurally valid instrument for use in a population of alcoholic patients. The possibility of screening for social phobia through the use of the instrument may be helpful in identifying probable cases of the disorder among alcoholics.

OBJETIVO: A Escala de Ansiedade Social de Liebowitz é um instrumento utilizado na avaliação da gravidade da fobia social. Tem sido amplamente usada em diferentes contextos e culturas, apresentando propriedades psicométricas variadas. O objetivo do artigo é investigar a consistência interna e a estrutura fatorial da escala. MÉTODO: A escala foi aplicada em uma amostra com 300 pacientes alcoolistas hospitalizados em três clínicas psiquiátricas na região Sul do Brasil, sendo 74 deles fóbicos sociais (24,6 por cento). O SCID-I/P, entrevista clínica semi-estruturada baseada no DSM-IV, foi usado para avaliação do diagnóstico de fobia social. A consistência interna foi medida pelo Alfa de Cronbach. Os dados foram submetidos à análise fatorial com estimativa de parâmetros por meio da análise do componente principal. Todos os itens do questionário de cargas fatoriais maiores ou iguais a 0,35 foram considerados na solução final da análise fatorial. RESULTADOS: O coeficiente de consistência interna foi de 0,95. Todos os itens mostraram coeficientes de correlação entre o item e a totalidade dos itens maiores do que 0,15, o menor índice aceitável. A análise fatorial resultou em cinco dimensões que correspondiam a 52,9 por cento da variância total. Os cinco fatores excluídos foram: fator I - falar em público; fator II - atividade em público; fator III - interação social com pessoa desconhecida; fator IV - atitude de discordância ou enfrentamento; e fator V - interação social em atividade de lazer. CONCLUSÕES: A escala mostrou-se confiável e estruturalmente válida quando utilizada em populações de pacientes alcoolistas. A possibilidade de rastreamento da fobia social através do uso do instrumento pode ser de grande utilidade na identificação de prováveis casos entre alcoolistas.