ABSTRACT
Um dos mais preocupantes problemas no contexto da Reforma Psiquiátrica são os moradores dos hospitais psiquiátricos (pacientes institucionalizados por um ano ou mais). As longas internações evidenciam a situação de abandono e podem descompensar transtornos psiquiátricos. O objetivo deste artigo é traçar o perfil sociodemográfico e clínico da população dos moradores de hospitais psiquiátricos do Estado do Ceará. Trata- se de um estudo transversal, baseado em revisões de prontuários, entrevistas e aplicação de escalas (índice de Katz e PANSS). Dos 39 participantes, a maioria era homem, solteiro e em idade economicamente ativa. Da maioria não se dispõe dados sobre a escolaridade (69,2%) e a religião (66,7%); e 12,8% têm o estado civil ignorado. Cerca de ¾ não recebiam visitas de amigos ou familiares. Dois terços mantêm independência total para a realização de AVD (Atividades de Vida Diária). A maioria estava internada por transtorno psicótico primário (76,8%). Nesses pacientes, destacava-se a exuberância de sintomas negativos, configurando uma síndrome negativa em 96,7% dos casos. O estudo destaca a situação de abandono e perda de cidadania dos pacientes cronicamente institucionalizados. Questiona-se até que ponto os hospitais estão preparados para oferecer-lhes a devida assistência.
One of the most vexing problems in the context of psychiatric reform are the inmates of psychiatric hospitals institutionalized for one year or more. The long periods of hospitalization indicate that these inmates have been abandoned, which can aggravate their psychiatric disorders. This article seeks to trace a socio-demographic and clinical profile of the inmates of psychiatric hospitals in the State of Ceará, Brazil. It is a cross-sectional study, based on reviews of medical registers, interviews and application of two scales: the Katz Index and the PANSS. Most of the 39 participants were men, single and of an economically active age. Information on education (69.2%) and religion (66.7%) were not known and for 12.8%, their marital status was unknown. Nearly 75% received no visits from friends or relatives. Two thirds maintained total independence to perform ADLs (Activities of Daily Living). The majority were admitted for primary psychotic disorder (76.8%). These manifested a marked negative syndrome in 96.7% of cases. The study highlights the situation of abandonment and loss of citizenship experienced by chronically institutionalized patients. It is questionable to what extent hospitals are prepared to offer the assistance that this population needs.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Institutionalization , Mental Disorders/diagnosis , Mental Disorders/psychology , Brazil , Cross-Sectional Studies , Hospitals, PsychiatricABSTRACT
OBJECTIVE: To determine the impact of delirium on post-discharge mortality in hospitalized older patients. INTRODUCTION: Delirium is frequent in hospitalized older patients and correlates with high hospital mortality. There are only a few studies about its impact on post-discharge mortality. METHODS: This is a prospective study of patients over 60 years old who were hospitalized in the Geriatric Unit at Hospital das Clínicas of São Paulo between May 2006 and March 2007. Upon admission, demographics, comorbidities, number of drugs taken, and serum albumin concentration were evaluated for each patient. Delirium was diagnosed according to the DSM-IV criteria. Patients were divided into group A (with delirium) and group B (without delirium). One year after discharge, the patients or their caregivers were contacted to assess days of survival. RESULTS: The sample included 199 patients, 66 (33 percent) of whom developed delirium (Group A). After one year, 33 (50 percent) group A patients had died, and 45 (33.8 percent) group B patients had died (p = 0.03). There was a significant statistical difference in average age (p = 0.001) and immobility (p <0.001) between groups A and B. There were no statistically significant differences between groups A and B in number of drugs taken greater than four (p = 0.62), sex (p = 0.54) and number of diagnoses greater than four (p = 0.21). According to a multivariate analysis, delirium was not an independent predictor of post-discharge mortality. The predictors of post-discharge mortality were age > 80 years (p = 0.029), albumin concentration < 3.5 g/dl (p = 0.001) and immobility (p = 0.007). CONCLUSION: Delirium is associated with higher post-discharge mortality as a dependent predictor.