A Questionnaire-Based study to assess Health Care Providers' knowledge, attitudes, and practices regarding Oral Health and Oral Care for Hospitalized patients at St Giles Psychiatric Hospital in Fiji

@#A mental disorder is a pattern of behavior or thought that causes severe suffering or impairs one's ability to function. Due to their inability to lead a regular life, mentally challenged people have been found to have poor oral health. The aim of this study was to assess health care providers’ knowledge, attitudes, and practices regarding oral health care of hospitalized patients at St Giles Psychiatric Hospital in Fiji. A cross-sectional survey design was employed in which 29 health care providers completed a questionnaire that collected socio-demographic information, knowledge, attitude and practices regarding oral health maintenance and care of psychiatric patients. Results revealed that all participants (100%), had knowledge on oral health and oral hygiene practices. However, only 9 nurses (50%) and 5 ward orderlies (63%) reported practicing oral hygiene for in – patients. In fact, 5 (17%) respondents did not view oral hygiene as an important aspect in their patients’ health. All participants (100%) reported unavailability of oral hygiene aids and absence of frequent dental visits, as a key barrier in the oral health care of patients. The results emphasize on the need for a formal training program for health care providers, and clear policies and guidelines about oral health care of hospitalized patients must be instituted.

Oral health status of female hospitalized psychiatric patients in Jazan: A Case-control study / Estado de saúde bucal de pacientes psiquiátricas hospitalizadas em Jazan: Um Estudo de caso-controle

Objectives: Poor oral health is an important determinant of general health in patients with mental illnesses. The present study was conducted to evaluate the dental and periodontal status of hospitalized female psychiatric patients in Jazan city, Saudi Arabia. Material and Methods: This study included 82 subjects: 37 psychiatric female patients, and 45 age- and gender- matched healthy controls. Dental caries experience (decayed, missing, and filled teeth index ( DMFT ) and periodontal health status were recorded. SPSS version 21 was used for data analysis, and p-value < 0.05 was considered statistically significant. Results: The mean ages were comparable among the two groups. Psychiatric patients showed poor oral hygiene practices, with only 56.6% reported regularly brushing their teeth as compared with 82.2% of controls (P < 0.05). Control subjects had significantly higher DMFT mean scores than psychiatric female patients. However, psychiatric patients had significantly higher mean scores of missing teeth (M component) and lower restored teeth (F component) as compared with controls. Moreover, the mean attachment loss scores were significantly higher in the psychiatric group (0.76±1.58) compared with controls (0.23; 0.44 p < 0.01). Conclusion: Psychiatric patients showed poor oral hygiene practices and a high prevalence of untreated dental caries and periodontal diseases. Effective oral health promotion strategies need to be implemented to improve the oral health and oral health practices of this group of people. (AU)

Objetivo: A má saúde bucal é um importante determinante da saúde geral em pacientes com doenças mentais. O presente estudo foi realizado para avaliar o estado dentário e periodontal de pacientes psiquiátricos do sexo feminino hospitalizados na cidade de Jazan, Arábia Saudita. Material e Métodos: Este estudo incluiu 82 indivíduos: 37 pacientes psiquiátricas do sexo feminino e 45 controles saudáveis pareados por idade e gênero. A experiência de cárie dentária (índice de dentes cariados, perdidos e obturados (CPOD) e o estado de saúde periodontal foram registrados. O progama SPSS versão 21 foi usado para a análise dos dados, e o valor de p <0,05 foi considerado estatisticamente significativo. Resultados: As médias das idades foram comparáveis entre os dois grupos. Pacientes psiquiátricos mostraram práticas de higiene bucal precárias, sendo que apenas 56,6% relataram escovar os dentes regularmente, em comparação com 82,2% dos controles (P <0,05). Os indivíduos controle tiveram pontuações médias de CPOD significativamente mais altas do que as pacientes psiquiátricas. Os pacientes tiveram escores médios significativamente maiores de dentes perdidos (componente P) e dentes restaurados menores (componente O) em comparação com os controles. Além disso, os escores médios de perda de inserção foram significativamente maiores no grupo psiquiátrico (0,76 ± 1,58) em comparação com os controles (0,23 ± 0,44;p <0,01). Conclusão: Pacientes psiquiátricos apresentaram práticas inadequadas de higiene bucal e uma alta prevalência de cárie dentária e doença periodontal não tratada. Estratégias eficazes de promoção da saúde bucal precisam ser implementadas para melhorar a saúde bucal e as práticas de saúde bucal desse grupo de pessoas (AU)

Relationships Between Causes of Psychiatric Readmission and To Validate Psychoeducational Module

Background: Readmission rate can provide an importantindicator of the global functioning of the health system such as,the articulation between inpatient treatment and communityinterventions. It provides an important tool in planning mentalhealth services. The present study highlights the causes ofreadmissions for psychiatric patients with a view to preparepsychoeducational module. It has scope in various fields likemedical and paramedical. It will help to prevent relapse andreadmissions in psychiatric patients and to the nurses inproviding psychoeducation to the patient and family.Materials and Methods: The study was conducted 100psychiatric patients who were re-admitted in 2 selectedinpatient mental health setups in Pune, Maharashtra. Semistructured questionnaire based on causes of psychiatricreadmissions was used which consisted of 30 questions withmultiple options. Descriptive and inferential statistics wereplanned to analyze the data obtained through interviews.Findings of previous functional pattern of readmitted patients–It was analyzed by mean, median, mode, standard deviationand mean %. The relationship between causes of psychiatricreadmissions and selected demographic variables were foundout by using Chi Square test.Results: The data presented in the table 2, figure 1 showsthat highest affected functional pattern in previous 3 months isself activity (35.07%) followed by dietary pattern (36.5%),health promotional activities (42.3%), relation with family(49.1%), social adjustment (52.7%) and self care (61.6%). Themost non affected functional pattern is economical adjustment(69.11%).Conclusion: Schizophrenia is the common condition of whichmaximum readmissions are found. With the help ofpsychoeducational module, the staff nurses, student nursescan provide psychoeducation to the patients and caregiversabout the comprehensive care of psychiatric patients at thehome including the psychosocial rehabilitation. Thus, therelapse and readmission of psychiatric patients can beprevented in mental health setups

Sobrecarga de familiares cuidadores de pacientes psiquiátricos: relação com a resiliência / Burden of family caregivers of psychiatric patients: relation with resilience

Com a desinstitucionalização psiquiátrica, intensificou-se o papel da família no cuidado cotidiano dos pacientes, resultando em sentimento de sobrecarga. O modelo teórico da sobrecarga prediz que ela poderia ser diminuída por fatores moduladores, como a resiliência, definida como a habilidade para enfrentar adversidades, ajustando-se de forma positiva. Este estudo investigou a relação entre o nível de resiliência e o grau de sobrecarga desses cuidadores. Foram entrevistados 76 familiares de pacientes atendidos em três serviços de saúde mental de duas cidades de Minas Gerais. Foram obtidas correlações significativas entre o nível de resiliência e dois domínios da sobrecarga (assistência na vida cotidiana e supervisão dos comportamentos problemáticos), mas não em relação às preocupações com o paciente, ou o escore global de sobrecarga. Foram identificados os principais fatores associados à sobrecarga, características dos pacientes e dos familiares. Conclui-se pela necessidade de intervenções psicoeducativas dos serviços de saúde mental junto a esses cuidadores.

Since psychiatric deinstitutionalization, patients' family members became responsable for their daily care, resulting in caregiver' burden. The theoretical model of burden predicts that it could be reduced by modulating factors, such as caregivers' resilience, defined as the ability to face adversity and adapt positively to it. This study investigated the relationship between resilience and caregivers' burden. We interviewed 76 family members of psychiatric patients attending three mental health services in two middle size cities of the state of Minas Gerais. Significant correlations were found between the level of caregivers' resilience and two domains of burden (assistance in daily life and supervision of problematic behaviors), but not in relation to the domain of concerns about the patient, or the overall burden score. Burden associated factors were identified, among the variables of patients and caregivers characteristics. The results confirmed that psychoeducational interventions should be provided by the mental health services for these caregivers.

Intestinal Parasitic Infections among Patients of Psychiatric Hospital Rumuigbo, Rivers State, Nigeria

This study was carried out to determine the prevalence of intestinal parasitic infections among patients of psychiatric hospital Rumuigbo, Rivers State, Nigeria between June to September, 2017. Stool specimen were collected and analyzed from 203 patients for ova, larvae or cysts of intestinal parasites using direct wet mount and formol-ether concentration techniques. Of these, 78 (38.4%) were infected. Five parasitic infections were identified of which Ascaris lumbricoides had the highest prevalence (39.7%). Others included hookworm (8.4%), T.trichuria (4.4%) and 2 protozoans: Entamoeba histolytica (7.4%) and G. lamblia (3.0%). The occurrence of these parasites varied significantly (p< 0.05). Patients suffering from Schizophrenia had the highest prevalence of infection 33 (78.6%) followed by patients with Substance Abuse Disorder 11(37.9%), while the least prevalence was found among patients suffering from Anxiety disorder. Parasitic infection was most frequent among patients aged 18-27 years and higher among males 45 (47.9%) than the females 33 (30.3%).Prevalence of these parasitic infections varied significantly among sexes and age groups. This study has documented a higher prevalence of intestinal parasite amongst the mentally challenged in our society, re-emphasizing the need for intermittent de-worming among all the patients. Original Research Article

Changes in thyroid function status of suicidal patients

Abstract Background This study was carried out at Punjab Institute of Mental Health and Centre for Nuclear Medicine Mayo Hospital, Lahore. It is aimed at the possible association of thyroid malfunctioning with suicide attempts of patients. Objective Determination of thyroid function status of suicidal psychiatric patients and their comparison with psychiatric patients without suicide attempt or ideation. Methods Total 54 patients with either past history of suicide attempt or current suicidal ideation were selected for analysis of their thyroid function status (age 15-55 years). Age matched 50 non-suicide psychiatric patients were included for comparison. Results Two patients with suicide attempt had overt thyroid dysfunction. Remaining patients had serum FT4, FT3 and TSH level within normal range. Suicide attempter patients had lower FT4 but increased FT3 and TSH levels compared to suicidal ideation patients. Serum FT4 and TSH levels in suicidal patients were not different from psychiatric patients. Serum FT3 in suicidal patients was lower than psychiatric patients (3.7 ± 0.8 vs. 4.3 ± 0.5; p < 0.05). Female suicidal patients had lower FT3 levels compared to male patients (3.4 ± 0.6 vs. 3.9 ± 0.8 pmol/L; p < 0.05). Discussion Local suicidal patients have higher incidence of overt thyroid disorder and lower FT3 levels compared to non-suicidal psychiatric patients.

Factors for inhibition of early discharge from the psychiatric emergency ward for elderly patients

BACKGROUND@#As society is aging, the number of elderly patients with psychiatric disorder, such as dementia, is increasing. The hospitalization period of elderly patients in psychiatric wards tends to be prolonged. In this study, we have determined the factors that inhibit early discharge from the psychiatric emergency ward for elderly patients in Japan.@*METHODS@#The information was collected from patients admitted to our hospital's emergency ward for elderly patients with psychiatric disorders between May 2015 and April 2016. We compared various factors between the early discharge group and the non-early discharge group. In addition, we used a multiple logistic regression model to clarify the risk factors for non-early discharge.@*RESULTS@#Of the 208 elderly patients, body mass index (BMI) and serum albumin level were significantly lower in the non-early discharge group. In addition, we also showed that higher serum C-reactive protein (CRP) (> 0.5 mg/dL) and use of seclusion or physical restraint significantly inhibited the early discharge of patients. The results of multiple logistic analysis showed that the BMI ≤ 17.5 kg/m (OR, 2.41 [95% confidence interval (CI) 1.06-5.46]), serum albumin level ≤ 30 g/L (OR, 3.78 [95% CI 1.28-11.16]), and use of seclusion or physical restraint (OR 3.78 [95% CI 1.53-9.37]) are particularly important explanatory factors.@*CONCLUSIONS@#Hypoalbuminemia, low BMI, and the use of seclusion or physical restraint were identified as the factors that inhibit early discharge from the psychiatric emergency ward for elderly patients. These factors reflect malnutrition and extremely serious psychiatric symptoms.

Care for Psychiatric Patients that Use Drugs: Management and Perceptions of Professionals / Uso de Drogas por Pessoas em Tratamento Psiquiátrico: Manejo e Percepção dos Profissionais / Uso de Drogas por Personas en Tratamiento Psiquiátrico: Percepción y Acompañamiento de los Profesionales

Abstract There is a high prevalence of drug use among psychiatric patients, favoring worse prognosis and situations of vulnerability. The aim of this study was to understand the perception and management of mental health professionals related to the use of drugs among people receiving psychiatric care. Semi-structured interviews were conducted with 16 professionals. Through thematic analysis, three categories were constructed: (1) Identification of drug use, performed with some difficulty through self-reports, collected by doctors and nursing assistants, being the essential link; (2) Actions taken to manage drug use situations, focusing on abstinence counseling and many referrals; (3) Presence of moral discourses in the care offered. The team reports difficulties in dealing with situations of drug use among patients, from identification to management. The different ways of dealing with consumption were related to how the professional understands the use of drugs.

Resumo Há alta prevalência de consumo de drogas entre pacientes psiquiátricos, favorecendo pior prognóstico e situações de vulnerabilidade. O objetivo deste estudo é compreender a percepção e o manejo de profissionais de saúde mental sobre o uso de drogas entre pessoas em tratamento psiquiátrico. Foram realizadas entrevistas semiestruturadas com 16 profissionais. Foram construídas três categorias a partir de análise temática: (1) Identificação do uso de drogas, realizada com certa dificuldade por meio de autorrelato colhido por médicos e auxiliares de enfermagem, destacando-se o vínculo como essencial; (2) Ações realizadas para manejar situações de uso de drogas, focadas na orientação para abstinência e resultando em muitos encaminhamentos; (3) Presença de discursos morais no cuidado oferecido. A equipe relata dificuldades para lidar com situações de consumo de drogas relatadas pelos pacientes, desde a identificação até o manejo. As diferentes formas de lidar com o consumo mostram-se relacionadas ao modo como o profissional de saúde mental compreende o uso de drogas.

Resumen Hay alta prevalencia de consumo de drogas entre pacientes psiquiátricos, favoreciendo peor pronóstico y situaciones de vulnerabilidad. El objetivo de este estudio es comprender la percepción y el manejo de profesionales de salud mental sobre el uso de drogas entre personas en tratamiento psiquiátrico. Se realizaron entrevistas semiestructuradas con 16 profesionales. Con análisis temático se construyeron tres categorías: (1) Identificación del uso de drogas, realizada con cierta dificultad por medio de autorrelato recogido por médicos y auxiliares de enfermería, destacándose el vínculo como esencial; (2) Acciones realizadas para manejar situaciones de uso de drogas, siendo éstas enfocadas en la orientación hacia abstinencia y ocurriendo muchos encaminamientos; (3) Presencia de los discursos morales en el cuidado ofrecido. El equipo relata dificultades para lidiar con situaciones de consumo de drogas entre los pacientes, desde la identificación hasta el manejo. Las diferentes formas de lidiar con el consumo se muestran relacionadas con el modo en que el profesional de salud mental comprende el uso de drogas.

Discussion on Ethical Issues in the Diagnosis and Treatment of Vagrant Psychiatric Patients / 中国医学伦理学

As one of special groups in social groups,vagrant psychiatric patients have uniqueness.There are many ethical issues in their diagnosis and treatment,such as voluntary principles and involuntary medical treatment,protective constraints,patient's privacy protection,personalized treatment,fairness and so on.Therefore,to protect the fights and interests of psychiatric patients,it should strictly follow the standard of involuntary hospitalization and four principles of medical ethics when they are admitted to hospital;it should give protective constraints and make the diagnosis of mental disorder when they exist impulses and negative risks involved themselves or others.Meanwhile,it should give psychological counseling,take minimum limit to patient as principle,develop personalized treatment plan,provide humanity service,pay attention to the protection of privacy rights and promote early recovery of patient.

Fatores associados à assertividade de familiares cuidadores de pacientes psiquiátricos / Factors associated to the assertiveness of family caregivers of psychiatric patients / Factores asociados con la asertividad de los cuidadores familiares de pacientes psiquiátricos

O objetivo do estudo foi avaliar os fatores sociodemográficos associados à assertividade de familiares cuidadores de pacientes psiquiátricos. A amostra foi composta por 53 familiares que cuidavam de pacientes atendidos em um Centro de Atenção Psicossocial (CAPS) de uma cidade de porte médio de Minas Gerais. Os instrumentos de medida utilizados foram a Escala de Assertividade Rathus (RAS), que avalia um fator geral de inibição e três fatores específicos de timidez, agressividade e assertividade no sentido de fazer valer seus direitos, e um questionário sociodemográfico e clínico. Os resultados mostraram que ter menor grau de escolaridade e viver sozinho foram fatores preditores de maior grau de inibição e timidez, assim como menor agressividade e assertividade, e possuir um trabalho foi preditor de maior agressividade. Estes resultados apontam para subgrupos de familiares que necessitam de maior apoio e orientação para desenvolver as habilidades necessárias ao relacionamento com os pacientes, no desempenho do papel de cuidadores. Um melhor repertório de assertividade dos familiares, para saber lidar com os comportamentos dos pacientes, poderá contribuir para que eles tenham um menor grau de sobrecarga e melhores condições de prestar cuidados cotidianos aos pacientes. Intervenções psicoeducacionais em serviços de saúde mental poderão desenvolver estas habilidades. (AU)

The aim of the study was to evaluate the association between sociodemographic factors and the assertiveness of family caregivers of psychiatric patients. The sample consisted of 53 family caregivers of patients attended at a Community Mental Health Center (CAPS) in a midsize city of Minas Gerais. The instruments used were the Rathus Assertiveness Scale (RAS), which evaluates a general inhibition factor and three specific factors of shyness, aggressiveness and assertiveness in assuring personal rights, and a sociodemographic and clinical questionnaire. The results showed that lower educational level and living alone were predictors of higher degree of inhibition and shyness as well as lower aggressiveness and assertiveness, and having a job was a predictor of higher aggressiveness. These results point to subgroups of families who need to receive more support and guidance in order to develop the necessary relationship skills for the performance of patients' caregivers role. A better family assertiveness repertoire in dealing with patients' behavior can contribute to a lower degree of family burden and better condition for them to provide daily care to patients. Psychoeducational interventions in mental health services can develop these skills. (AU)

El objetivo del estudio fue evaluar los factores sociodemográficos predictivos de la asertividad de los cuidadores familiares de pacientes psiquiátricos. La muestra estuvo conformada por 53 familiares asistidos en un CAPS de una ciudad de tamaño mediano de Minas Gerais, Brasil. Los instrumentos de medida utilizados fueron la Escala Rathus Asertividad (RAS), que evalúa un factor de inhibición general y tres factores específicos de la timidez, agresividad y asertividad para tener la valoración de sus derechos, además de un cuestionario sociodemográfico y clínico. Los resultados mostraron que tener menos educación y vivir solo fueron predictores de mayor grado de inhibición y timidez, y menos agresividad y asertividad, y tener un trabajo era un factor predictivo de aumento de la agresividad. Estos resultados indican subgrupos de familias que necesitan más apoyo y orientación para desarrollar las habilidades relacionales necesarias para o desempeño de la función de cuidador. Un mejor repertorio de la asertividad de los familiares, para saber cómo lidiar con el comportamiento de los pacientes puede contribuir para que tengan un menor grado de sobrecarga y sean más capaces de proporcionar atención diaria a los pacientes. Las intervenciones psicoeducativas en los servicios de salud mental pueden desarrollar estas habilidades. (AU)

Form Quality in Rorschach Comprehensive System and R-PAS: Sample of Psychiatric Cases / Qualidade Formal do Rorschach Sistema Compreensivo e R-PAS: Amostra de Casos Psiquiátricos / Calidad Formal del Sistema Comprehensivo de Rorschach y R-PAS: Muestra de Casos Psiquiátricos

The creation of the Rorschach Performance Assessment System (R-PAS) requires research that allows its use in the Brazilian population. The Formal Quality (FQ) category is essential both for clinic and research. The aim of this study was to compare form quality variables in Rorschach protocols from psychiatric patients and ratings coded in the Comprehensive System (CS) and R-PAS. The sample comprised 206 Rorschach protocols from adult patients in psychiatric treatment, who were also assessed by SCID-I and SCID-II. Most protocols were administered in the CS and recoded according to the R-PAS. The kappa coefficient was calculated, and we compared the means of these variables in both systems. The kappa results varied from almost perfect to substantial consistency for all variables, however, the descriptive statistics confirmed that the R-PAS elicits more FQ Ordinary coding while the CS elicits more FQ minus coding...

A criação do Sistema de Avaliação de Desempenho do Rorschach (R-PAS) requer estudos que possibilitem o uso na população brasileira. A qualidade formal (FQ) é uma categoria imprescindível na clínica e na pesquisa. O objetivo deste trabalho foi comparar variáveis de FQ de protocolos de Rorschach de pacientes psiquiátricos codificados pelo Sistema Compreensivo (SC) e pelo R-PAS. A amostra foi de 206 protocolos de Rorschach de pacientes adultos em tratamento psiquiátrico, que foram avaliados também pela SCID-I e SCID-II. A maioria dos protocolos foi aplicada pelo SC e recodificados de acordo com o R-PAS. O coeficiente kappa foi calculado, e foram comparadas as médias dessas variáveis nos dois sistemas. Os resultados do kappa variaram de concordância quase perfeita até consistência substancial para todas as variáveis, no entanto, as estatísticas descritivas confirmaram que o R-PAS provoca mais codificação de FQ ordinária e, o SC, de FQ menos...

La creación del Sistema de Evaluación del Desempeño de Rorschach (R-PAS) requiere estudios para su uso en la población brasileña. La calidad formal (FQ) es una categoría esencial en la clínica y la investigación. El objetivo del estudio fue comparar variables de FQ de protocolos de Rorschach codificados por el Sistema Comprehensivo y R-PAS. La muestra consistió de 206 protocolos de Rorschach de pacientes adultos en tratamiento psiquiátrico, que también fueron evaluados por la SCID-I y SCID-II. La mayoría de los protocolos fue aplicada en el SC y re-codificados de acuerdo con el R-PAS. Se calculó el coeficiente kappa y se comparó el promedio de estas variables en los dos sistemas. Los resultados de kappa se variaron desde concordancia casi perfecta hasta consistencia considerable para todas las variables, pero las estadísticas descriptivas confirmaron que el R-PAS provoca más codificación de FQ ordinaria y el SC de FQ menos...

Adverse effects including sexual problems associated with the use of selective serotonin reuptake inhibitors in a tertiary care center of Eastern Nepal.

Background: Selective serotonin reuptake inhibitors (SSRIs) use has been associated with various adverse drug events, including sexual problems in recent literature. Methods: After written informed consent, remitted psychiatric patients were enrolled if they were taking an SSRI. The remitted state was ascertained by clinical assessment of a psychiatrist and reassessed with the use of self-response screening questionnaires (Beck Anxiety Inventory for anxiety, Beck Depression Inventory for depression). The self-response questionnaire “adverse drug effect (ADE) tool” was used to assess ADEs and the Arizona Sexual Experience Scale to assess sexual problems. Results: The total of 200 subjects was enrolled with 63% females. Commonly used SSRIs were escitalopram, fluoxetine, and sertraline for the common diagnosis of depression, recurrent depressive disorder, and panic disorder in this institute. The average duration of remission during the enrollment was 11.99 months (standard deviation: 12.269). The overall prevalence of adverse effects was 91.5%. The incidence of adverse effect and sexual problem were: weight gain (57%), dryness of mouth (32.5%), headache (30%), dizziness (28.5%), paresthesia (24.5%), confusion (23.5%), tremors (21.5%), irritation (20.5%) sexual dysfunction (SD) (17.2%), increase in anxiety (17%), akathisia (16%), nausea (14.5%), itchiness (14.5%), excessive sweating, (14.5%), difficulty in sleeping (10%), weight loss (6%), rash (6%), diarrhea (4%), vomiting (3%), and others (3%). Conclusion: Adverse effect (irrespective of severity) was commonly seen with SSRI use. Common adverse effects seen among remitted subjects were weight gain, dryness of mouth, headache, dizziness, paresthesia, etc. SD was other important side effect.

Estratégias de enfrentamentos e sobrecarga dos familiares cuidadores de pacientes psiquiátricos: revisão de literatura / Coping and burden from family caregivers of psychiatric patients: literature review

A desinstitucionalização psiquiátrica resultou em maior responsabilidade dos familiares no cuidado informal dos pacientes, o que pode resultar em elevada sobrecarga para estes cuidadores. Essa sobrecarga pode ser diminuída com o uso de estratégias eficazes de enfrentamento, segundo o modelo teórico da sobrecarga. Foi realizada uma busca sistemática nos indexadores SciELO, LILACS, Pubmed, Web of Science e PsycINFO, sendo encontrados 36 estudos internacionais que avaliaram a relação entre coping e sobrecarga dos familiares cuidadores. Os resultados indicaram que os familiares utilizam uma diversidade de estratégias de enfrentamento, mas, em geral, elas não estão associadas a um menor grau de sobrecarga. As estratégias de evitação e de resignação estão claramente associadas a um maior grau de sobrecarga, devendo, portanto, ser evitadas.

Psychiatric deinstitutionalization has resulted in greater responsibility for family members in the informal care of patients, which may result in high degree of burden for these caregivers. Burden may be reduced by the utilization of effective coping strategies, according to the theoretical model of burden. A systematic search was conducted in SciELO, LILACS, Pubmed, Web of Science and PsycINFO databases, where were found 36 international studies evaluating the relationship between coping and burden of family caregivers. Results indicate that family members use several types of coping strategies, but these strategies in general are not associated with a lower degree of burden. Two strategies, avoidance and resignation, were clearly associated with a higher level of burden and should, therefore, be avoided.

Prevalência da infecção pelo hiv em pacientes psiquiátricosque fazem uso de um serviço público de saúde mental / The prevalence of hiv infection in psychiatric patients who make use of a public mentalhealth service

Verificar a prevalência da infecção pelo HIV em pacientes psiquiátricos que fazem uso de um serviço público de saúde. Métodos: foram inspecionadas informações referentes a 222 prontuários que compõem a população do Centro de Atenção Psicossocial (Caps) do município de Assis (SP). Foi utilizada a análise estatística descritiva,o teste de correlação de Pearson e o teste de associações do qui-quadrado – com correção de Yates, quando necessário– para verificar correlações e associações entre as variáveis trabalhadas. Resultados: 51,3% da população eram do sexo feminino e 48,7%, do sexo masculino. A idade variou entre 20 e 73 anos, com média de 45 anos. Os graus de escolaridade e os índices de qualificação profissional foram baixos. O tempo de tratamento na instituição variou de três meses a 28 anos. Em relação ao HIV, somente 12 indivíduos (5,4%) foram testados, e todos resultaram em sorologia negativa. Conclusão: o fato de que somente 12 usuários foram submetidos à testagem e que em 94,6% dos prontuários não foi encontrada nenhuma informação que dissesse respeito à sorologia para o HIV expressa a carência de ações em testagem na instituição e a falta de efetividade nas ações de cuidado...

The aim of this paper is to verify the prevalence of HIV infection in psychiatric patients who make use of a public mental health service. Methods: In this research, 222 medical records that make up the population of the Center for Psychosocial Care (CAPS) were inspected. The institution is located in the city of Assis. We used descriptive statistics, the Pearson Correlation Test and the Chi-Square Test of Associations – with Yates correction when necessary – to investigate correlations and associations between the variables used. Results: 51.3% of the population were female and 48.7% were male. The age ranged from 20 to 73 years old, with an average of 45 years old. The education degrees and professional qualification levels were low. The treatment time in the institution ranged from three months to 28 years. Regarding HIV, only 12 individuals (5.4%) were tested and all resulted in negative serology. Conclusion: The fact that only 12 patients were submitted to testing and that no information was found as to HIV status in 94.6% of the medical records shows the deficiency of the testing actions inside the institution and the lack of effectiveness when it comes to care actions...

Habilidades sociais de familiares cuidadores de pacientes psiquiátricos / Social skills of family caregivers of psychiatric patients

Com a desinstitucionalização psiquiátrica, as famílias passaram a ter papel fundamental na reinserção social dos pacientes, bem como um sentimento de sobrecarga com esse papel. Um bom relacionamento entre familiares e pacientes constitui um importante fator modulador que pode diminuir a sobrecarga. Entretanto, poucos estudos avaliaram as habilidades sociais dos familiares cuidadores, embora elas sejam necessárias para o desenvolvimento de um bom relacionamento com o paciente. O objetivo desta pesquisa foi avaliar essas habilidades. Foram entrevistados 53 familiares, com aplicação dos instrumentos: Inventário de Habilidades Sociais, Rathus Assertiveness Schedule e questionário sociodemográfico. Os resultados mostraram porcentagem elevada de familiares com baixos escores de habilidades sociais e da subclasse de assertividade. Esses resultados sugerem a necessidade de serem implantados programas de treinamento de habilidades sociais nos serviços de saúde mental, para que os familiares cuidadores desenvolvam um melhor relacionamento com o paciente, potencializando a prestação de cuidados mais adequados...

Psychiatric deinstitutionalization has resulted in the greater involvement of family caregivers in patients' social reinsertion as well as the feeling of being overburdened. A good relationship between caregivers and patients is considered to be an important moderating factor that can reduce the burden on families. However, few studies have evaluated the repertoire of caregivers' social skills even though they are the basis for the development of a good relationship. The aim of the present study was to evaluate these skills. Data were collected from 53 caregivers, with the application of the following instruments: Inventory of Social Skills, Rathus Assertiveness Schedule and a sociodemographic questionnaire. Results showed a high percentage of family caregivers with low scores in social skills as well as in assertiveness. These results pointed to the need for implementing social skills training programs in mental health services, so that caregivers can develop a better relationship with patients and consequently be able to provide a better quality of care...

Sobrecarga de familiares cuidadores em relação ao diagnóstico de pacientes psiquiátricos / Family caregivers? burden as a function of psychiatric patients diagnostics

Objetivo Comparar os graus das sobrecargas objetiva e subjetiva sentidas por familiares cuidadores de pacientes com esquizofrenia e por familiares cuidadores de pacientes com depressão maior, bem como os fatores associados e as dimensões mais afetadas em cada grupo. Métodos Participaram desta pesquisa 50 cuidadores de pacientes com esquizofrenia e 50 cuidadores de pacientes com depressão maior. Esses familiares participaram de uma entrevista estruturada, na qual foram aplicados dois instrumentos: a escala de sobrecarga FBIS-BR e um questionário. Resultados Os resultados indicaram que os dois grupos apresentavam diferenças significativas quanto ao grau de sobrecarga, na análise detalhada dos itens da escala. Os familiares cuidadores de pacientes com esquizofrenia apresentaram sobrecarga objetiva significativamente mais elevada ao assistir o paciente na tomada de medicamentos e na administração do dinheiro e apresentaram maior sentimento de peso financeiro resultante do papel de cuidador. Os cuidadores de pacientes com depressão maior apresentaram maior frequência de supervisão de comportamentos autoagressivos, mais preocupação com a vida social dos pacientes e maior sentimento de incômodo nas tarefas de assistência na vida cotidiana. Não foram encontrados dados significativos referentes aos escores globais da escala de sobrecarga. Conclusão As diferenças encontradas nesta pesquisa apontam para a necessidade de os serviços de saúde mental planejarem intervenções específicas para cada grupo de cuidadores. .

Objective This study aimed to compare the degree of objective and subjective burden felt by family caregivers of patients with schizophrenia and by family caregivers of patients with major depression, as well as the associated factors and life dimensions most affected in each group. Methods Participated in this study 50 family caregivers of patients with schizophrenia and 50 family caregivers of patients with major depression. These subjects participated in a structured interview for the application of the FBIS-BR burden scale and a sociodemographic and clinical questionnaire. Results The results indicated significant differences in the degree of burden of the two family caregivers groups, in the analysis of specific scale items. The family caregivers of patients with schizophrenia showed significantly higher objective burden in the subscale “Assistance in Everyday Life”, particularly in the tasks related to medication administration and financial management, and they also had more feeling of financial burden. Caregivers of patients with major depression had a higher frequency of self-injurious behaviors supervision, more concern with the social life of patients and a greater feeling of discomfort in the service tasks in everyday life. No difference was observed between groups regarding the scale global scores. Conclusion The differences found in this study pointed out the need for mental health services to plan specific interventions for each group of family caregivers. .

Burden on relatives of people with psychic disorder: levels and associated factors / Sobrecarga de familiares de pessoas com transtorno psíquico: níveis e fatoresassociados

Background Studies have shown that overburden with care of psychotic patients is associated with a significant reduction of quality of life and causes harm to the caregiver’s health. Objective In order to compare factors associated with levels of burden of caregivers with the psychopathology of the patient, we conducted a cross-sectional study with 435 primary caregivers of patients of Centers for Psychosocial Care (CAPS) from Pelotas, RS. Methods The patients were identified through medical records and their caregivers were interviewed in their homes. To evaluate the burden we used Zarit Burden Interview (ZBI). Results Caregivers of dependent users of alcohol and drugs had the highest average of burden, 52.2 points (sd = 20.4), followed by the caregivers of patients with suicide risk, 48.5 points (sd = 0.7). In adjusted analysis, women had 8.2 (95% CI: 4.6, 11.8) points higher on average than men in ZBI scale. Caregivers with less education had 1.6 (95% CI: -3.1, -1.0) points lower on average of burden compared to those with higher educational level. Caregivers with some health problem had 6.7 (95% CI: 3.3, 10.0) points higher in the middle of the ZBI when compared to those without disease. Discussion Several factors overload clearly indicate the need to develop interventions such as psychoeducation which may give some support to the family responsible for care.

Contexto Estudos têm mostrado que a sobrecarga gerada no cuidado de pacientes psicóticos está associada com uma redução importante na qualidade de vida, trazendo danos à saúde do cuidador. Objetivo Com objetivo de verificar fatores associados e comparar níveis de sobrecarga de cuidadores com a psicopatologia do paciente, foi realizado um estudo transversal com 435 cuidadores principais de usuários de Centros de Atenção Psicossocial (CAPS) da cidade de Pelotas, RS. Métodos Os usuários foram identificados por meio de prontuários e seus familiares foram entrevistados posteriormente em suas residências. Para avaliar a sobrecarga, foi utilizada a Zarit Burden Interview (ZBI). Resultados Cuidadores de usuários dependentes de álcool e drogas apresentaram as médias mais altas de sobrecarga, 52,2 pontos (dp = 20,4), seguidos dos cuidadores com risco de suicídio, 48,5 pontos (dp = 0,7). Na análise ajustada, mulheres tiveram 8,2 (IC 95%: 4,6, 11,8) pontos a mais na média do ZBI do que os homens. Cuidadores com menor escolaridade apresentaram 1,6 (IC 95%: -3,1, -1,0) pontos a menos na média de sobrecarga comparados aos com maior grau de instrução. Cuidadores com algum problema de saúde tiveram 6,7 (IC 95%: 3,3, 10,0) pontos a mais na média do ZBI comparado àqueles sem nenhuma doença. Conclusões Vários fatores de sobrecarga indicam claramente a necessidade de se desenvolverem intervenções, como a psicoeducação, que possam dar algum tipo de apoio ao familiar responsável pelo cuidado.

Impact and barriers for the restriction of smoking during psychiatric hospitalization: an integrative review / Impacto e barreiras da restrição ao tabagismo na internação psiquiátrica: revisão integrativa / Impacto y barreras de la restricción al tabaquismo en la internación psiquiátrica: revisión integradora

The aim was to identify the barriers for implementing the restriction on smoking in psychiatric hospitalization services, its impact on the hospitalized smokers, and the positioning of the professionals. Integrative review of 19 articles published (1989-2011) in MEDLINE and SCOPUS. Descriptive analysis was carried out. The studies revealed that the main barriers for the implementation of the restriction were: beliefs in the patients’ increased aggressiveness, damage to the professional-patient relationship, and lack of preparation to address the theme. After the implementation, the restrictions showed a positive impact: reduction of cigarettes smoked, increased motivation to quit smoking, and more attempts to stop smoking. The professionals who smoked and those who did not believe that quitting smoking benefits mental health patients were those that least supported the implementation of the restrictions. In conclusion, the restriction on smoking is effective in psychiatric hospitalization, as it provokes an attitude of change in mental health patients...

Objetivou-se identificar as barreiras para a implantação da restrição ao tabagismo nos serviços de internação psiquiátrica, seu impacto nos tabagistas internados e o posicionamento dos profissionais. Revisão integrativa de 19 artigos publicados (1989-2011) no MEDLINE e na SCOPUS. Foi realizada análise descritiva. Os estudos revelam as principais barreiras para a implantação da restrição: crenças sobre o aumento da agressividade dos pacientes, prejuízo da relação profissional-paciente e falta de preparo para abordar o assunto. Após implantação, a restrição apresenta impacto positivo: redução do número de cigarros fumados, aumento da motivação para deixar de fumar e do número de tentativas de parar de fumar. Os profissionais tabagistas e aqueles que não acreditam que o abandono do tabagismo traga benefícios ao portador de transtorno mental são os que menos apoiam a implantação das restrições. Conclui-se que a restrição ao tabagismo é eficaz na internação psiquiátrica, pois provoca mudanças de atitudes nos portadores de transtornos mentais...

Se objetivó identificar las barreras para la implantación de la restricción al tabaquismo en los servicios de internación psiquiátrica, su impacto en los tabaquistas internados y el posicionamiento de los profesionales. Revisión integradora de 19 artículos publicados (1989-2011) en MEDLINE y SCOPUS. Análisis descriptivo. Los estudios muestran las principales barreras para la implantación de la restricción: creencia sobre aumento de la agresividad del paciente, perjuicio de la relación profesional–paciente y falta de preparo para discutir el asunto. Después de la implantación, la restricción presenta impacto positivo: reducción de cigarrillos fumados, aumento de la motivación para dejar de fumar. Los profesionales tabaquistas y aquellos que no creen que dejar de fumar puede traer beneficios al portador de trastorno mental son los que menos apoyan la implantación de las restricciones. Se concluye que la restricción al tabaquismo es eficaz en la internación psiquiátrica, pues provoca cambios de actitudes en los portadores de trastornos mentales...

Sexually transmitted diseases among psychiatric patients in Brazil

Sexually transmitted diseases are still highly prevalent worldwide and represent an important public health problem. Psychiatric patients are at increased risk of sexually transmitted diseases but there are scarce published studies with representative data of this population. We sought to estimate the prevalence and correlates of self-reported sexually transmitted diseases among patients with mental illnesses under care in a national representative sample in Brazil (n = 2145). More than one quarter of the sample (25.8%) reported a lifetime history of sexually transmitted disease. Multivariate analyses showed that patients with a lifetime sexually transmitted disease history were older, had history of homelessness, used more alcohol and illicit drugs, suffered violence, perceived themselves to be at greater risk for HIV and had high risk sexual behavioral: practised unprotected sex, started sexual life earlier, had more than ten sexual partners, exchanged money and/or drugs for sex and had a partner that refused to use condom. Our findings indicate a high prevalence of self-reported sexually transmitted diseases among psychiatric patients in Brazil, and emphasize the need for implementing sexually transmitted diseases prevention programs in psychiatric settings, including screening, treatment, and behavioral modification interventions.

Outcome predictors of smoking cessation treatment provided by an addiction care unit between 2007 and 2010

Objective: To analyze the predictors of smoking cessation treatment outcomes in a sample with a high rate of medical and psychiatric disorders and addictions. Methods: Analysis of predictors of success of a 6-week treatment provided by an addiction care unit (CAPS-AD) to 367 smokers in Brazil from 2007 to 2010. Forty variables were collected at baseline. Success was defined as abstinence from smoking for a period of at least 14 consecutive days, including the last day of treatment. Twenty variables were selected for the logistic regression model. Results: The only condition correlated with successful treatment after logistic regression was smoking one's first cigarette 5 minutes or more after waking (beta = 1.85, 95% confidence interval [95%CI] = 1.11-3.10, p = 0.018). Subjects with hypertension and alcohol use disorders and those who were undergoing psychiatric treatment showed success rates comparable to or greater than the average success rate of the sample (34.2-44.4%). Conclusions: These findings support the importance of the variable time to first cigarette in treatment outcomes for a sample with a high rate of clinical and psychiatric disorders. Good success rates were observed for pharmacological treatment, which was combined with group therapy based on cognitive-behavioral concepts and integrated into ongoing treatment of other addictions and psychiatric disorders. .