Fonoaudiologia e Saúde Mental: passos e impasses / Speech Therapy and Mental Health: paths and impasses / Fonoaudiología y Salud Mental: pasos y impasses

Introdução: O Sistema Único de Saúde foi consolidado a partir da promulgação da Constituição Federal de 1988. Nas décadas de 70 e 80, o fonoaudiólogo começa a ser inserido nos serviços públicos, movimento que ganha força após a consolidação do SUS. O fonoaudiólogo é inserido no campo da Saúde Mental na década de 90, quando é instituída sua presença nas equipes multiprofissionais de ambulatórios especializados, e em 2002 na composição da equipe de Centros de Atenção Psicossocial infanto-juvenil. Desse modo, a atuação do fonoaudiólogo no campo da Saúde Mental é ainda "novidade" e pouco discutida no âmbito da Fonoaudiologia. Objetivo: refletir sobre o lugar do fonoaudiólogo na Saúde Mental no campo da Saúde Coletiva. A partir da questão: quais os passos e impasses para solidificar o lugar do fonoaudiólogo nos serviços da Atenção Psicossocial Especializada? Método: revisão bibliográfica não-sistemática. A seleção dos artigos foi realizada através de busca automática nas seguintes bases de dados: SCIELO, LILACS e PUBMED. Discussão: ao serem inseridos em um serviço do Sistema Único de Saúde da Rede de Atenção Psicossocial, os fonoaudiólogos se deparam com os preceitos da Reforma Psiquiátrica, que apontam um outro modo de clinicar, o que faz necessária uma mudança em seu fazer. Considerações finais: Para solidificar o lugar do fonoaudiólogo no campo da Saúde Mental é preciso subverter a lógica de cuidado e estabelecer o raciocínio da clínica da Atenção Psicossocial e preceitos da Reforma Psiquiátrica. A especificidade do fonoaudiólogo neste campo se dá através de uma teorização consistente sobre linguagem/comunicação que o autoriza a assumir uma posição frente aos sujeitos em sofrimento psíquico. (AU)

Introduction: The Unified Health System was consolidated from the promulgation of the Federal Constitution of 1988. In the 70s and 80s, the speech therapist began to be inserted in public services, a movement that gained strength after the consolidation of the SUS. The Speech-Language Pathologist is inserted in the field of Mental Health in the 1990s, when his presence in the multidisciplinary teams of specialized outpatient clinics was established and in 2002 in the composition of the Children's Psychosocial Care Center team. Thus, the role of the speech therapist in the field of Mental Health is still "new" and less discussed in the scope of Speech Therapy. Objective: reflect on the place of the speech therapist in Mental Health in the field of Collective Health. From the question: what are the paths and impasses to solidify the place of the speech therapist in the Specialized Psychosocial Care services? Method: non-systematic bibliographic review. The selection of articles was performed through automatic search in the following databases: SCIELO, LILACS and PUBMED. Discussion: when inserted in a service of the Unified Health System in the Psychosocial Care Network, speech therapists are faced with the precepts of the Psychiatric Reform, which point to another way of practicing, which makes a change in the speech therapist's practice necessary. Conclusion: To solidify the role of the speech therapist in the field of Mental Health, it is necessary to invert the logic of care and establish the rationale of the Psychosocial Care clinic and the precepts of the Psychiatric Reform. The specificity of the speech therapist in this field is through a consistent theorization about language/communication that authorizes him to assume a position in relation to subjects in psychological distress. (AU)

Introducción: El Sistema Único de Salud se consolidó a partir de la promulgación de la Constitución Federal de 1988. En los años 70 y 80, el logopeda comenzó a insertarse en los servicios públicos, movimiento que cobró fuerza tras la consolidación del SUS. El Patólogo del Habla y el Lenguaje se inserta en el campo de la Salud Mental en la década de los 90, cuando se estableció su presencia en los equipos multidisciplinarios de consultas externas especializadas y en 2002 en la composición del equipo de Centros de Atención Psicosocial Infantil. Por tanto, el papel del logopeda en el campo de la Salud Mental es todavía "nuevo" y poco discutido en el ámbito de la Logopedia. Objetivo: reflexionar sobre el lugar del logopeda en Salud Mental en el campo de la Salud Colectiva. A partir de la pregunta: ¿cuáles son los pasos y los impasses para solidificar el lugar del logopeda en los servicios de Atención Psicosocial Especializada? Método: revisión bibliográfica no sistemática. La selección de artículos se realizó mediante búsqueda automática en las siguientes bases de datos: SCIELO, LILACS y PUBMED. Discusión: al insertarse en un servicio del Sistema Único de Salud de la Red de Atención Psicosocial, los logopedas se enfrentan a los preceptos de la Reforma Psiquiátrica, que apuntan a otra forma de practicar, lo que hace necesario un cambio en su práctica. Conclusión: Para solidificar el rol del logopeda en el campo de la Salud Mental, es necesario subvertir la lógica del cuidado y establecer la lógica de la clínica de Atención Psicosocial y los preceptos de la Reforma Psiquiátrica. La especificidad del logopeda en este campo es a través de una teorización consistente sobre el lenguaje/comunicación que lo autoriza a asumir una posición en relación con sujetos en distrés psicológico. (AU)

Síndrome de burnout em profissionais da área de saúde mental / Burnout syndrome in mental health professionals / Síndrome de burnout en profesionales de salud mental

Introdução: Os profissionais da saúde responsáveis pelo cuidado profissional dos usuários possuem uma rotina de trabalho permeada por elevada sobrecarga física e mental, em função das próprias características do seu exercício profissional, mas que também podem se agravadas pelas condições de trabalho. Não é incomum a presença de jornadas de trabalho extensas, baixa remuneração, condições de trabalho insuficientes, desgaste pelo sofrimento do paciente, falta de suporte emocional e baixo reconhecimento profissional, cenário que favorece adoecimento. Objetivo: O presente estudo teve por objetivo caracterizar a prevalência de burnout em profissionais da área da saúde. Metodologia: Participaram da pesquisa 44 profissionais da área da saúde que trabalham em sete serviços da Rede de Atenção Psicossocial de dois municípios do interior paulista. Foram utilizados dois instrumentos: o Questionário Sociodemográfico e o Inventário da Síndrome de Burnout ­ ISB. Resultados: Verificou-se que 25,9% dos profissionais estavam sintomáticos para Síndrome de Burnout, sendo: 47,7% com comprometimentos nas dimensões Distanciamento Emocional, 25,0% em Exaustão Emocional, 20,4% em Desumanização e 6,8% em Realização Profissional, revelando dificuldade destes para lidar com as próprias demandas e a dos pacientes. Conclusão: Os resultados revelam a necessidade de gestores ficarem atentos às demandas dos trabalhadores da saúde, tendo em vista que o burnout além de afetar a saúde dos profissionais, pela característica relacional do trabalho, pode também interferir na qualidade da prestação da assistência ao usuário.

Introduction: The health professionals responsible for the professional care of users have a work routine permeated by high physical and mental overload, due to the characteristics of their professional practice, but which can also be aggravated by working conditions. It is not uncommon the presence of long working hours, low pay, insufficient working conditions, exhaustion due to the patient's suffering, lack of emotional support and low professional recognition, a scenario that favors illness. Objective: The present study aimed to characterize the prevalence of burnout in health professional. Methodology: Participated in the research 44 health professionals who work in 07 services of the Psychosocial Care Network of two municipalities in the interior of São Paulo. Two instruments were used: the Sociodemographic Questionnaire and the Burnout Syndrome Inventory ­ ISB. Results: It was found that 25.9% of the professionals were symptomatic for Burnout Syndrome, being: 47.7% with impairments in the dimensions Emotional Distancing, 25.0% in Emotional Exhaustion, 20.4% in Dehumanization and 6.8% in Professional Achievement, revealing difficulties to deal with their own demands and that of the patients. Conclusion: The results reveal the need for managers to be attentive to the demands of health workers, considering that burnout in addition to affecting the health of professionals, due to the relational characteristic of work, can also interfere in the quality of care delivery to users.

Introducción: Los profesionales sanitarios responsables de la atención profesional a los usuarios tienen una rutina de trabajo impregnada de una elevada sobrecarga física y mental, debido a las características de su ejercicio profesional, pero que también puede verse agravada por las condiciones de trabajo. No es infrecuente la presencia de largas jornadas de trabajo, baja remuneración, condiciones laborales insuficientes, agotamiento por el sufrimiento del paciente, falta de apoyo emocional y bajo reconocimiento profesional, escenario que favorece la enfermedad. Objetivo: El presente estudio tuvo como objetivo caracterizar la prevalencia del burnout en el profesional de salud. Metodología: Participaron de la investigación 44 profesionales de salud que actúan en 07 servicios de la Red de Atención Psicosocial de dos municipios del interior de São Paulo. Fueron utilizados dos instrumentos: el Cuestionario Sociodemográfico y el Inventario del Síndrome de Burnout - ISB. Resultados: Se encontró que 25,9% de los profesionales presentaban síntomas del Síndrome de Burnout, siendo: 47,7% con deficiencias en las dimensiones Distanciamiento Emocional, 25,0% en Agotamiento Emocional, 20,4% en Deshumanización y 6,8% en Realización Profesional, revelando dificultades para lidiar con sus propias demandas y las de los pacientes. Conclusiones: Los resultados revelan la necesidad de que los gestores estén atentos a las demandas de los trabajadores de salud, considerando que el burnout además de afectar la salud de los profesionales, debido a la característica relacional del trabajo, también puede interferir en la calidad de la prestación de cuidados a los usuarios.

Caracterización de pacientes con esquizofrenia en el Hospital Psiquiátrico Provincial de Sancti Spíritus

Introducción: Existe falta de consenso entre los expertos sobre la clínica y conceptualización de la esquizofrenia. La esquizofrenia es un trastorno mental severo que afecta al pensamiento, las emociones y el comportamiento. La causa de la enfermedad no está bien definida. Objetivo: Caracterizar los pacientes adultos esquizofrénicos internados en la institución. Métodos: Se realizó un estudio descriptivo para la caracterización del adulto con esquizofrenia hospitalizado se tuvo en cuenta, edad y sexo, independencia física, conducta, cognición, afectividad, síntomas positivos, negativos y nivel de rehabilitación. Se trabajó con una muestra intencional constituida por los adultos con diagnóstico de esquizofrenia ingresados en el hospital, en el periodo de 2018 al 2022, con un mínimo de seis meses de estadía hospitalaria, n=64. Resultados: El sexo predominante resultó el masculino 62,5 %, independencia física mínimo dependiente con un 51,57 %, la cognición estaba afectada en el 100 % de los estudiados, se destaca la desorganización del pensamiento y el embotamiento afectivo con el 100 y el 87,69 % respectivamente, con nivel de rehabilitación más preponderante el nivel cuatro para un 29,23 %. Conclusiones: La adecuada caracterización de los pacientes con esquizofrenia hospitalizados en el Hospital Psiquiátrico Docente Provincial de Sancti Spíritus, facilita el trabajo encaminado al fomento de las relaciones sociales a través de acciones que mejoran su estado de salud. Uno de cada siete pacientes con esquizofrenia puede alcanzar la recuperación funcional si dispone de una adecuada rehabilitación integral.

Introduction: There is a lack of consensus among experts on the clinical symptoms and conceptualization of schizophrenia. Schizophrenia is a severe mental disorder that affects thinking, emotions, and behavior. The etiology of the disease is not well defined. Objective: To characterize adult schizophrenic patients admitted to the institution. Methods: Descriptive study was carried out for characterization of the hospitalized adult with schizophrenia taking into account age and sex, physical independence, behavior, cognition, affectivity, positive and negative symptoms and level of rehabilitation. It was worked with an intentional sample consisting of adults diagnosed with schizophrenia admitted to the hospital, in the period from 2018 to 2022, with a minimum of six months of hospital stay, n = 64. Results: The predominant sex was male 62.5%, minimum dependent physical independence with 51.57%, affected exponent with greater representativeness was cognition in 100%, disorganization of thought and affective blunting stand out with 100 and 87.69% respectively, with the most preponderant rehabilitation level being level 4 for 29.23%. Conclusions: The proper characterization of patients with schizophrenia hospitalized in the Provincial Teaching Psychiatric Hospital of Sancti Spíritus, facilitates the work aimed at promoting social relationships through actions that improve their health status. One in seven patients with schizophrenia can achieve functional recovery if adequate comprehensive rehabilitation is available.

Standards for psychosocial care in pediatric cancer: adapted proposal for Latin American and Caribbean countries / Normas para la atención psicosocial en el cáncer pediátrico: una propuesta adaptada para los países de América Latina y el Caribe / Padrões de atendimento psicossocial em câncer pediátrico: proposta adaptada para países da América Latina e do Caribe

ABSTRACT Objective. To highlight the objectives, achievements, challenges, and next steps for the World Health Organization's Global Initiative for Childhood Cancer (GICC) framework, a project designed to improve psychosocial care (PSC) in pediatric cancer centers across Latin America and the Caribbean (LAC). Methods. The project was launched in Peru, the first GICC focal country, in November 2020. The diagnosis phase included a survey and a semistructured interview with health professionals to assess PSC practices in institutions, and a needs assessment survey for caregivers. In the second phase, a strategic plan was developed to address the identified needs, including the adaptation of PSC standards, the establishment of multicenter working groups, the expansion of the proposal, and the development of materials. Results. The study found that PSC was not being adequately provided in accordance with international standards. Six adapted standards were proposed and validated, and more than 50 regional health professionals participated in online activities to support the project. The implementation process is currently ongoing, with the establishment of five multidisciplinary working groups, one regional committee, and the production of 16 technical outputs. Conclusion. This project represents a substantial step forward to improve PSC for pediatric patients with cancer and their families in LAC countries. The establishment of working groups and evidence-based interventions strengthen the proposal and its implementation. Development of health policies that include PSC according to standards is needed to achieve sustainable results in the quality of life of children with cancer and their families.

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RESUMO Objetivo. Destacar os objetivos, as conquistas, os desafios e as próximas etapas da Iniciativa Global para o Câncer Infantil (GICC), um projeto criado pela Organização Mundial da Saúde para melhorar a atenção psicossocial em centros de câncer pediátrico na América Latina e no Caribe. Métodos. O projeto foi lançado no Peru, o primeiro país focal da GICC, em novembro de 2020. A fase de diagnóstico incluiu uma pesquisa e uma entrevista semiestruturada com profissionais de saúde para avaliar as práticas de atenção psicossocial nas instituições, bem como uma pesquisa para avaliar as necessidades dos cuidadores. Na segunda fase, foi desenvolvido um plano estratégico para atender às necessidades identificadas, incluindo uma adaptação de padrões de atenção psicossocial, o estabelecimento de grupos de trabalho multicêntricos, a expansão da proposta e o desenvolvimento de materiais. Resultados. O estudo constatou que, de acordo com padrões internacionais, a atenção psicossocial não estava sendo adequadamente oferecida. Seis padrões adaptados foram propostos e validados, e mais de 50 profissionais de saúde da região participaram de atividades on-line para apoiar o projeto. O processo de implementação está em andamento, com a formação de cinco grupos de trabalho multidisciplinares e um comitê regional e a produção de 16 relatórios técnicos. Conclusão. Este projeto representa um avanço substancial para melhorar a atenção psicossocial para pacientes pediátricos com câncer e suas famílias nos países da América Latina e do Caribe. A criação de grupos de trabalho e intervenções baseadas em evidências fortalecem a proposta e sua implementação. É preciso desenvolver políticas de saúde que incluam atenção psicossocial segundo padrões estabelecidos para alcançar resultados sustentáveis na qualidade de vida das crianças com câncer e de suas famílias.

COVID-19 pandemic effects on the care of people with psychosocial disabilities: workers' perspective / Efectos de la pandemia por covid-19 en la atención de personas con discapacidad psicosocial: perspectiva de trabajadores

RESUMEN INTRODUCCIÓN La pandemia de COVID-19 alteró el funcionamiento de los sistemas de salud y, particularmente, la provisión de servicios destinados a personas con discapacidad psicosocial de un modo pendiente de análisis en Argentina. El objetivo fue caracterizar los efectos de la pandemia de COVID-19 en los servicios de atención dirigidos a personas con discapacidad psicosocial en Rosario (Santa Fe), Resistencia (Chaco) y el Área Metropolitana de Buenos Aires desde la perspectiva de sus trabajadores durante 2020-2021 MÉTODOS Se realizó un estudio exploratorio y descriptivo a partir de entrevistas a 53 trabajadores de tres tipos de servicios de rehabilitación (orientados a dar apoyo para la socialización, el trabajo o la vivienda), en dos momentos (fin de 2020 y mediados de 2021). Se calcularon frecuencias y se realizó un análisis temático RESULTADOS Hubo una afectación amplia y duradera de los servicios, que se tornaron menos accesibles y eficaces para contribuir a la rehabilitación. Se observaron aspectos comunes, como la adaptación para seguir funcionando, la centralidad de la tecnología y el impacto subjetivo en los trabajadores, marcado por el cansancio. Al año de la pandemia, dos tercios de los servicios orientados a la socialización estaban muy afectados o cerrados DISCUSIÓN A partir de la descripción y análisis de cómo se vieron afectados los servicios de rehabilitación, se abre el interrogante respecto de su futuro y el rumbo que tomará la reforma en salud mental. ^s+

ABSTRACT INTRODUCTION The COVID-19 pandemic produced a reorganization of health systems and, in particular, affected the provision of services for people with psychosocial disabilities in a way that was pending an analysis in Argentina. The objective was to characterize the effects of the COVID-19 pandemic on services aimed at people with psychosocial disabilities in the cities of Rosario (Santa Fe), Resistencia (Chaco) and the Metropolitan Area of Buenos Aires from the perspective of their workers during 2020-2021 METHODS An exploratory and descriptive study was carried out by interviewing 53 workers from three types of rehabilitation services (aimed at providing support for socialization, for work or for housing) in two moments (November-December 2020 and April-June 2021). Frequencies were calculated and a thematic analysis was performed RESULTS The impact on services was broad and long-lasting, they became less accessible and effective in contributing to rehabilitation. Common aspects such as the new centrality of technology, massive adaptations and deep subjective impact on workers marked by fatigue were observed. Within a year of the pandemic, two-thirds of socialization-oriented services were still severely affected or closed DISCUSSION From the description and analysis of how the rehabilitation services were affected, the question remains regarding their future and how the mental health reform will unfold.

Potencialidades e desafios do Centro de Atenção Psicossocial na voz dos trabalhadores da saúde / Potencialidades y desafíos de los Centros de Atención Psicosocial en la voz de los trabajadores de la salud / Potentials and challenges of Psychosocial Care Centers in the voice of health workers

Objetivo: conhecer a percepção dos trabalhadores de saúde sobre as potencialidades e desafios do Centro de Atenção Psicossocial (CAPS). Método: estudo qualitativo realizado com 24 trabalhadores de saúde de um CAPS localizado no Sul do Brasil. Os dados foram produzidos entre agosto e outubro de 2018 por meio da entrevista aberta e submetidos à análise temática de conteúdo. Resultados: os trabalhadores identificaram potencialidades do serviço como estruturação, efetividade, qualidade de atendimento e entrosamento da equipe, que geram satisfação. No entanto, relataram desarticulações entre o serviço e a Rede de Atenção Psicossocial à Saúde (RAPS), além da diminuição dos investimentos públicos e interferência da conjuntura política na gestão dos serviços, o que acarretava, por vezes, adoecimento laboral. Conclusão: os trabalhadores de saúde perceberam o CAPS como um serviço potente e efetivo; porém, identificaram fragilidades em nível de RAPS que culminavam em sobrecarga do serviço e adoecimento dos trabalhadores.

Objective: to know the perception of health workers about the potentialities and challenges of the Psychosocial Care Center (CAPS). Method: qualitative study carried out with 24 health workers from a CAPS located in southern Brazil. The data were produced between August and October 2018 through an open interview and submitted to thematic content analysis. Results: the workers identified potentialities of the service such as structuring, effectiveness, quality of care and team interaction, which generate satisfaction. However, they reported disarticulations between the service and the Psychosocial Health Care Network (RAPS), in addition to the decrease in public investments and interference of the political environment in the management of services, which sometimes led to occupational illness. Conclusion: the health workers perceived the CAPS as a powerful and effective service; however, they identified weaknesses at the level of RAPS that culminated in overload of the service and illness of the workers.

Objetivo: conocer la percepción de los trabajadores de la salud sobre las potencialidades y desafíos del Centro de Atención Psicosocial (CAPS). Método: estudio cualitativo realizado con 24 trabajadores de salud de un CAPS ubicado en el sur de Brasil. Los datos fueron producidos entre agosto y octubre de 2018 a través de entrevistas abiertas y sometidos a análisis de contenido temático. Resultados: los trabajadores identificaron potencialidades del servicio como estructuración, eficacia, calidad de la atención e integración del equipo que generan satisfacción. Sin embargo, relataron desarticulaciones entre el servicio y la Red de Atención Psicosocial en Salud (RAPS), además de la disminución de las inversiones públicas y la interferencia de la coyuntura política en la gestión de los servicios, que en ocasiones derivaron en enfermedades laborales. Conclusión: los trabajadores de la salud percibieron el CAPS como un servicio poderoso y eficaz; sin embargo, identificaron debilidades a nivel de RAPS que culminaron en sobrecarga del servicio y enfermedad de los trabajadores.

Analysis on mental-insanity and cessation-of-dangerousness examinations in three Brazilian custodial institutions: a retrospective cross-sectional study

ABSTRACT BACKGROUND: In Brazil, the right to healthcare and the incorporation of best scientific evidence in public health are universally guaranteed by law. However, the treatment offered to patients with mental disorders in custodial hospitals in this country has not been rigorously evaluated. OBJECTIVES: To analyze the psychiatric diagnoses and treatments implemented in three Brazilian custodial institutions. DESIGN AND SETTING: This was a retrospective, cross-sectional and descriptive study on patients held in custody in three Brazilian institutions, as judicially-determined safety measures due to their mental disorders, and the tools used in diagnoses and treatments. These institutions are in Rio de Janeiro and the Federal District. METHODS: The data from medical and judicial records that were made available were assessed regarding the diagnoses that were made and the instruments that were used. RESULTS: None of these inpatients were evaluated using validated tools, and only a few medical records presented clear descriptions of the cases. No patient with substance involvement had undergone laboratory toxicological assays. It was not possible to verify the adequacy of treatments because the procedures were inadequately described in the records. CONCLUSIONS: No standardized protocols or instruments for diagnosing mental health disorders or assessing use of psychoactive substances had been applied among the inpatients at these custodial institutions in Rio de Janeiro and the Federal District. The treatments that were prescribed to these inpatients consisted mainly of drugs.

La rehabilitación psicosocial de víctimas del conflicto armado: encuentros entre salud pública y psicología social / Psychosocial rehabilitation of victims of the armed conflict: approaches between public health and social psychology

RESUMEN Este escrito se fundamenta en la necesidad de explicitar el aporte que hace la psicología social a la comprensión de un proceso de reparación a las víctimas de violaciones a los derechos humanos e infracciones al derecho internacional humanitario. Para dar cuenta de este aporte, se inicia argumentando por qué la reparación psicosocial es competencia de la salud pública a partir de la revisión del Plan Decenal de Salud Pública 2011-2021; luego se describen cuatro elementos que la psicología social comunitaria aporta a la salud pública para poder realizar procesos de rehabilitación psicosocial más consistentes y apropiados a las necesidades de las personas participantes en ellos.

ABSTRACT This essay is based on the need to make explicit contribution that community social psychology makes to the understanding of a process of reparation for victims of human rights violations and infractions of the international humanitarian law. To account for this contribution, it begins recognizing why psychosocial reparation could be an asset for public health based on the review of the Public Health Plan 20011-2021, pro-posed by Ministry of Health in Colombia. After those four elements that social psychology contributes to public health are described to carry out psychosocial rehabilitation processes that are more consistent and appropriate to the needs of the people participating in them.

Construction of mental health care based on the experiences of a nursing student / Construcción de la atención en salud mental a partir de las experiencias de un estudiante de enfermería / Construção do cuidado em saúde mental a partir das vivências de um estudante de enfermagem

ABSTRACT Objective: to report the experience of a nursing student with mental health care during a clinical internship. Method: an experience report based on data from a Singular Therapeutic Project developed by a nursing student during 16 days of practice in a Day Hospital as part of an undergraduate course. The findings were analyzed based on the theory of interpersonal relationships and psychosocial rehabilitation. Results: the care process was organized between the weeks and phases of the relationship in: 1) from the unknown to relationship of trust; 2) reflections and reframing as a care proposal; 3) from limitation to leading role; 4) from care resolution to mutual transformations. Final considerations: it was concluded that despite the limitations of the practice context, the student was able to conduct psychosocial interventions in mental health in line with the expected goals and produce meanings in both involved.

RESUMEN Objetivo: informar la experiencia de un estudiante de enfermería con atención de salud mental durante una pasantía clínica. Método: un informe de experiencia basado en datos de un proyecto terapéutico único desarrollado por un estudiante de enfermería durante 16 días de práctica en un Hospital Día como parte de un curso de pregrado. Los hallazgos fueron analizados en base a la teoría de las relaciones interpersonales y la rehabilitación psicosocial. Resultados: el proceso de cuidado se organizó entre las semanas y fases de la relación en: 1) de lo desconocido a la relación de confianza; 2) reflexiones y reencuadres como propuesta de cuidado; 3) de la limitación al protagonismo; 4) de la resolución del cuidado a las mutuas transformaciones. Consideraciones finales: se concluyó que, a pesar de las limitaciones del contexto de práctica, el alumno fue capaz de realizar intervenciones psicosociales en salud mental en línea con las metas esperadas y producir significados en ambos involucrados.

RESUMO Objetivo: relatar a vivência de um estudante de enfermagem com o cuidado em saúde mental durante um estágio clínico. Método: relato de experiência realizado com base nos dados de um Projeto Terapêutico Singular desenvolvido por um estudante de enfermagem durante 16 dias de prática em um Hospital Dia como parte de uma disciplina de graduação. Os achados foram analisados com base na teoria do relacionamento interpessoal e na reabilitação psicossocial. Resultados: o processo de cuidar se organizou entre as semanas e as fases do relacionamento em: 1) do desconhecido à relação de confiança; 2) reflexões e ressignificações como proposta de cuidado; 3) da limitação ao protagonismo; 4) da resolução do cuidado às mútuas transformações. Considerações finais: concluiu-se que, apesar das limitações do contexto de prática, o estudante foi capaz de conduzir intervenções psicossociais em saúde mental alinhadas aos objetivos esperados e produzir significados, em ambos os envolvidos.

Factors related to psychological impairment and quality of life in patients with schizophrenia / Factores relacionados con el deterioro psicológico y la calidad de vida en pacientes con esquizofrenia / Fatores relacionados ao comprometimento psíquico e qualidade de vida de portadores de esquizofrenia

ABSTRACT Objective: to describe the factors related to psychological impairment and quality of life (QoL) of patients with schizophrenia. Method: a cross-sectional, descriptive and correlational study, carried out with 119 schizophrenics. A questionnaire of sociodemographic and clinical variables was applied, plus BPRS-A and QLS-BR scales. Chi-square test and Spearman's correlation were used, Results: seventy-seven were male and 44 were using typical medications. The "Number of times they were hospitalized" related to "Time of illness" that patients live with schizophrenia showed significance (p=0.266); 91.7% had a severe occupational level (n=109); 34.5% (n=41) had moderate impairment. Conclusion: the greater the degree of psychological impairment, the worse the QoL, this worsening may be related to several factors, as well as disease symptoms.

RESUMEN Objetivo: describir los factores relacionados con el deterioro psíquico y la calidad de vida (CV) en pacientes con esquizofrenia. Método: se aplicó un estudio transversal, descriptivo y correlacional realizado con 119 esquizofrénicos, a un cuestionario de variables sociodemográficas y clínicas, más las escalas BPRS-A y QLS-BR. Se utilizaron la prueba de Chi-cuadrado y la prueba de correlación de Spearman. Resultados: 77 eran hombres, (n=44) usando medicamentos típicos. El "Número de veces hospitalizado" relacionado con el "Tiempo de enfermedad" que el paciente vive con esquizofrenia fue significativo (p=0,266). El 91.7% tenía un nivel ocupacional severo (n=109). El 34,5% (n=41) tuvo un deterioro moderado. Conclusión: cuanto mayor es el grado de deterioro psíquico, peor es la calidad de vida, este empeoramiento puede estar relacionado con varios factores, así como con los síntomas de la enfermedad.

RESUMO Objetivo: descrever os fatores relacionados ao comprometimento psíquico e qualidade de vida (QV) de portadores de esquizofrenia. Método: estudo transversal, descritivo e correlacional, realizado com 119 esquizofrênicos. Foi aplicado um questionário de variáveis sociodemográficas e clínicas, mais as escalas BPRS-A e QLS-BR. Foram utilizados o Teste Qui-Quadrado e Correlação de Spearman, Resultados: 77 eram do sexo masculino e 44 faziam uso de medicações típicas. O "Número de vezes que ficou internado" relacionado com o "Tempo de doença" que o paciente convive com esquizofrenia apresentou significância (p=0,266). 91,7% apresentaram Nível Ocupacional grave (n=109). 34,5% (n=41) apresentavam comprometimento moderado. Conclusão: quanto maior o grau de comprometimento psíquico, pior a QV, essa piora pode estar relacionada a diversos fatores, assim como os sintomas da doença.

El modelo de recuperación de la salud mental y su importancia para la enfermería colombiana

El objetivo es describir el modelo de recuperación de la salud mental (Recovery), el modelo de la marea en la recuperación de la salud mental (Tidal Model) y su relevancia hacia la implementación dentro de la práctica de la enfermería colombiana. Algunos conceptos sobre la recuperación de la salud mental y el modelo teórico propuesto por Phil Barker se presentan en el texto, y se analizan con los desafíos del profesional de enfermería para mejorar la atención de la salud mental, teniendo en cuenta el contexto actual de la práctica asistencial. Los principios propuestos con el modelo de recuperación ayudan a centrar los cuidados en la persona y no en los síntomas de la enfermedad, entendiendo que la persona tiene diversas dimensiones que le permiten explorar su propio camino hacia la recuperación. Se puede concluir que, a través de la teoría, pueden desarrollarse intervenciones y actividades de enfermería que contribuyan a mejorar la calidad de vida de las personas diagnosticadas de alguna enfermedad mental modificando los modelos tradicionales de atención sanitaria.

The article aims to describe the Mental Health Recovery Model, the Tidal Model in Mental Health Recovery and their relevance to implementation within the practice of Colombian nursing. Some concepts about mental health recovery and the theoretical model proposed by Phil Barker are presented in the text, analysing these with the challenges of the nursing professional to improve mental health care, taking into account the current context of care practice. The principles proposed with the Recovery model help to focus care on the person and not on the symptomatology of the illness, understanding that the person has different dimensions which make it possible for him/her to explore his/her own path to recovery. We can conclude that, through the theory, we can develop interventions and nursing activities that contribute to improving the quality of life of people who have been diagnosed with a mental illness, modifying the traditional healthcare models.

A Gestão Autônoma da Medicação em Centros de Atenção Psicossocial de Curitiba (PR) / Autonomous Medication Management in Psychosocial Care Centers of Curitiba (PR)

RESUMO No contexto do 'recovery' surgiu, em 1993, a Gestão Autônoma da Medicação, uma estratégia que visa garantir, aos usuários de psicotrópicos, participação nas decisões relativas aos seus tratamentos, via diálogo e troca de informações entre os envolvidos nos tratamentos em saúde mental com trabalhos nacionais, que demonstram esses efeitos. O objetivo do presente estudo foi fomentar e avaliar qualitativamente a realização da estratégia Gestão Autônoma da Medicação nos Centros de Atenção Psicossocial de Curitiba (PR). Foi feita uma pesquisa qualitativa, com implantação de grupos Gestão Autônoma da Medicação e de entrevistas semiestruturadas. Participaram usuários, trabalhadores dos Centros de Atenção Psicossocial e estudantes de medicina, totalizando 18 entrevistados. O material foi transcrito integralmente e as percepções dos participantes foram avaliadas baseando-se na hermenêutica gadameriana, extraindo-se, assim, núcleos argumentais, os quais foram agrupados em categorias e analisados posteriormente. Demonstrou-se que o grupo Gestão Autônoma da Medicação auxiliou os usuários no processo de conhecimento e tomada de decisão sobre seus tratamentos, bem como no conhecimento dos seus direitos. A intervenção também se mostrou relevante para os profissionais e estudantes, reforçando conceitos como a importância de valorizar a fala, as experiências e a autonomia do usuário.

ABSTRACT In the context of 'recovery', in 1993, the Autonomous Management of Medication emerged, a strategy that aims to ensure that psychotropic users participate in decisions regarding their treatments, through dialogue and information exchange among those involved in mental health treatments with national studies, that demonstrate these effects. The aim of the study was to promote and qualitatively evaluate the implementation of the Autonomous Medication Management strategy at the Psychosocial Care Center of Curitiba (PR). Qualitative research was carried out, with the implementation of Autonomous Medication Management groups and semi-structured interviews. Users, Psychosocial Care Centers workers and medical students participated, totaling 18 respondents. The material was fully transcribed and the participants' perceptions were evaluated based on Gadamerian hermeneutics, thus extracting argument nuclei, which were grouped into categories and analyzed later. It has been shown that the Autonomous Medication Management group assisted users in the process of knowledge and decision making about their treatments, as well as knowledge of their rights. The intervention was also relevant for professionals and students, reinforcing concepts such as the importance of valuing speech, experiences and user autonomy.

Quinze anos depois: serviços residenciais terapêuticos frente à portaria 106/2000 / Quince años después: servicios residenciales terapéuticos ante la ordenanza 106/2000 / Fifteen years on: residential treatment services and ordinance 106/2000

RESUMO Introdução: os serviços residenciais terapêuticos (SRTs), instituídos pela Portaria 106/2000, oferecem moradia a egressos de hospitais psiquiátricos no processo de desinstitucionalização e devem seguir as determinações legais, com o objetivo de promover a reabilitação psicossocial. Objetivo: descrever e analisar 11 SRTs do estado de São Paulo, Brasil, a partir da portaria/GM nº 106 de 11 de fevereiro de 2000. Método: estudo quantitativo-descritivo que utilizou como instrumento de coleta um questionário autopreenchido por um profissional-chave de cada serviço. Os dados foram organizados de acordo com os núcleos de informação e analisados de forma estatístico-descritiva. Resultados: os SRTs estudados cumprem a maior parte das determinações nos aspectos relacionados ao funcionamento e organização, como: serem de natureza pública, cadastrados no SUS, integrados à rede de saúde mental e número de moradores por casa; por outro lado, quanto às visitas de acompanhamento estaduais e municipais, o estado realizava pouco mais da metade e os municípios, abaixo disso; mais da metade das casas situava-se fora da comunidade; muitos não recebiam auxílio financeiro a que tinham direito. Discussão: os SRTs precisam de mais acompanhamento das autoridades estaduais e municipais, oportunizando melhorias de funcionamento para os serviços; as casas fora da comunidade dificultam o convívio comunitário e o objetivo de reabilitação psicossocial; o BPC-LOAS pode ser recebido por todos os usuários, fomentando mais autonomia financeira. Conclusão: a adequação dos aspectos que ainda não correspondem aos instituídos pela portaria pode aprimorar os serviços, principalmente na busca pela reabilitação psicossocial.

RESUMEN INTRODUCCIÓN: los servicios residenciales terapéuticos (SRT), instituidos por la Ordenanza 106/2000, en el proceso de desinstitucionalización y con el objetivo de promover la rehabilitación psicosocial, ofrecen alojamiento a pacientes que recibieron alta de internación psiquiátrica. Esos servicios deben cumplir con los requisitos legales. Objetivo: describir y analizar 11 SRT en el estado de São Paulo, Brasil, ante la Ordenanza / GM No. 106 del 11 de febrero de 2000. Método: estudio cuantitativo-descriptivo con datos recogidos a través de un cuestionario autoadministrado por un profesional clave de cada servicio. Los datos se organizaron de acuerdo con los núcleos de información y se analizaron de forma estadísticamente descriptiva. Resultados: los SRT analizados cumplen con la mayoría de las determinaciones en aspectos relacionados con el funcionamiento y la organización, tales como: ser de carácter público, registrado en el SUS , integrado en la red de salud mental y cantidad de residentes por hogar; por otro lado, con respecto a las visitas de seguimiento estatales y municipales, el estado realizó algo más de la mitad y los municipios por debajo de eso; más del 50% de las casas estaba fuera de la comunidad; muchos no recibían la ayuda financiera a la que tenían derecho. Discusión: los SRT necesitan más monitoreo por parte de las autoridades estatales y municipales, con miras a brindar oportunidades de mejora en el funcionamiento de los servicios; las casas fuera de la comunidad obstaculizan la vida comunitaria y el objetivo de la rehabilitación psicosocial; el beneficio BPC de la ley LOAS puede ser recibido por todos los usuarios, promoviendo mayor autonomía financiera. Conclusión: la adecuación de aspectos que aún no se corresponden con los establecidos por la ordenanza podría mejorar los servicios, especialmente en la búsqueda de rehabilitación psicosocial.

ABSTRACT Introduction: Residential treatment services (RTSs), instituted by Ordinance 106/2000, offer housing to those discharged from psychiatric hospitals in the process of deinstitutionalization and must follow certain legal requirements, with the aim of promoting psychosocial rehabilitation. Objective: describe and analyze 11 RTSs in the state of São Paulo, Brazil, based on Ordinance/GM (Minister's office) No. 106 of February 11, 2000. Method: quantitative-descriptive study using a self-administered questionnaire to collect data from a key professional from each service. The data were organized according to information core and analyzed using descriptive statistics. Results: the RTSs studied comply with most of the determinations in aspects related to functioning and organization, such as: being public in nature, registered with the SUS, part of the mental health network and number of residents per household; on the other hand, regarding state and municipal monitoring visits, the state carried out just over half and municipalities, fewer than that; more than half of the houses were outside the community; many did not receive financial aid to which they were entitled. Discussion: the RTSs require more monitoring by state and municipal authorities, providing opportunities for improvements to the functioning of the services; houses outside the community hinder community living - the aim of psychosocial rehabilitation; all users are entitled to BPC-LOAS (Social Care Benefits), promoting greater financial autonomy. Conclusion: adjusting aspects that still do not comply with the ordinance could improve services, especially in the search for psychosocial rehabilitation.

Impact of brief intervention and art therapy for alcohol users / Impacto de la intervención breve y de la arteterapia en usuarios de alcohol / Impacto da intervenção breve e arteterapia para usuários de álcool

ABSTRACT Objective: To identify the impact of brief intervention paired with art therapy in patients who use alcohol. Method: This study presents intra-group design, with 11 alcoholics in the city of Tamarana-PR, Brazil, between 2015 and 2016. A test to identify the alcohol consumption level was used at the beginning/end of the actions. Cohen's effect size and paired t-test were used to identify the impact of the actions on the reduction of alcohol intake. Results: Six participants ceased alcohol consumption, four showed high level of consumption and one presented average consumption. The paired t-test result suggested statistically significant difference between the initial and final scores, as well as 0.76 effect size. Conclusion: The brief intervention associated with the art therapy resulted in significant impact in reducing alcohol consumption. Investing in the continuous training of primary health care professionals is crucial to consolidate the improvements achieved.

RESUMEN Objetivo: Evaluar el impacto de la intervención breve junto con la arteterapia en usuarios que consumen alcohol. Método: Diseño intragrupo, siendo realizado entre 2015 y 2016, con la participación de 11 alcohólicos de la ciudad de Tamarana (PR, Brasil). Se realizó una prueba para identificar el nivel de consumo de alcohol antes y después de las acciones, y se calcularon el tamaño del efecto de Cohen y la prueba t pareada para evaluar el impacto de las acciones en la reducción del consumo de alcohol. Resultados: Seis dejaron de consumir alcohol, cuatro presentaron un alto consumo y uno presentó un consumo mediano. El resultado de la prueba t pareada reveló una diferencia estadísticamente significativa entre los puntajes inicial y final, así como en el tamaño del efecto con un 0,76. Conclusión: La intervención breve asociada a la arteterapia tuvo un gran impacto en la disminuición del consumo de alcohol. Es fundamental invertir en la educación continuada de los profesionales de la atención primaria de salud para consolidar las mejoras obtenidas.

RESUMO Objetivo: Identificar o impacto da intervenção breve em conjunto com a arteterapia em usuários que consomem álcool. Método: Delineamento intragrupo, com 11 alcoolistas na cidade de Tamarana-PR, entre 2015 e 2016. Foi utilizado um teste para identificação do nível de consumo de álcool ao início/término das ações e calculada a medida de efeito de Cohen e teste t pareado, para identificar o impacto das ações na redução do consumo de álcool. Resultados: Houve seis cessares do consumo de álcool, quatro apresentaram nível elevado de consumo e um apresentou consumo mediano. O resultado do teste t pareado sugeriu diferença estatisticamente significativa entre os escores iniciais e finais, assim como a medida de efeito de 0,76. Conclusão: A intervenção breve associada à arteterapia resultaram em grande impacto para a redução do consumo de álcool. É fundamental investir na educação continuada dos profissionais da atenção primária em saúde para consolidar as melhorias obtidas.

Academic sayings from the past and the present about the Nursing Role in the Process and Routine of Deinstitutionalization / Ditos acadêmicos do ontem e do hoje acerca do papel da enfermagem no processo e rotina da desinstitucionalização / Eses Académicos del pasado y del presente sobre el Papel de la Enfermería en el Proceso y Rutina de la Desinstitucionalización

This Integrative Review aims to explore the Brazilian scientific production of psychiatric nursing about psychosocial rehabilitation from 1992 to 2014. The analysis of the surveyed articles results in five thematic categories: nursing and Psychiatric Reform, tools and strategies that provide psychosocial rehabilitation, family background in psychosocial rehabilitation, Psychosocial Care Centers and other spaces as facilitators of psychosocial rehabilitation and mental health in primary care. According to our conclusions greater investment in the nurses’ professional training is necessary in order to fulfill the demands of care to the people with mental illness presented by the Psychiatric Reform, which has been slowly consolidating with inclusion strategies that seem appropriate, but still insufficient.

Esta Revisão Integrativa objetiva explorar a produção científica nacional de enfermagem psiquiátrica sobre a reabilitação psicossocial no período de 1992 a 2014. A análise dos artigos levantados, resulta cinco categorias temáticas: enfermagem e a Reforma Psiquiátrica, ferramentas e estratégias que possibilitam a reabilitação psicossocial, o contexto familiar na reabilitação psicossocial, CAPS e outros espaços como facilitadores da reabilitação psicossocial e saúde mental na atenção básica. Nossas conclusões consideram a necessidade de um investimento maior na capacitação profissional do enfermeiro para compatibilizar com as demandas de cuidados aos doentes mentais apresentadas pela Reforma Psiquiátrica, que vem se consolidando paulatinamente com estratégias de inclusão que parecem adequadas, porém ainda insuficientes.

Esta Revisión de integración objetiva explorar la producción científica nacional de enfermería psiquiátrica sobre la rehabilitación psicossocial en el período de 1992 a 2014. El análisis de los artículos levantados, resulta cinco categorías temáticas: enfermería y la Reforma Psiquiátrica, herramientas y estrategias que posibilitan la rehabilitación psicossocial, el contexto familiar en la rehabilitación psicossocial, CAPS y otros espacios como facilitadores de la rehabilitación psicossocial y salud mental en la atención básica. Nuestras conclusiones consideran la necesidad de una inversión mayor en la capacitación profesional del enfermero para compatibilizar con las demandas de atenciones a los enfermos mentales presentadas por la Reforma Psiquiátrica, que viene consolidándose de manera progresiva con estrategias de inclusión que parecen adecuadas, sin embargo aún insuficientes.

Effects of Repetitive Transcranial Magnetic Stimulation with Theta Burst Stimulation Paradigm on Executive Function in Patients with Chronic Schizophrenia / 中国康复理论与实践

Objective To explore the effect of theta burst stimulation (TBS) paradigm of repetitive transcranial magnetic stimulation (rT-MS) on executive function in patients with chronic schizophrenia. Methods 60 patients meeting DSM-IV for chronic schizophrenia disor-ders criteria were enrolled. They were randomly divided into TBS group (n=30) and sham intervention group (n=30). They were assessed with digit span performance, space span performance and Wisconsin Card Sorting Test (WCST) before and 4 weeks after intervention. Re-sults After intervention, the forward score of digit span performance, the total score and forward score of space span performance increased (P0.05). There was significant difference in all the items be-tween 2 groups after intervention (P<0.05). Conclusion TBS paradigm of rTMS could improve the executive function in schizophrenic pa-tients.

Alternativas a la hospitalización crónica / Alternatives to chronic hospitalization in mental health

No es posible ocuparse de alternativas a la hospitalización crónica sin tomar en cuenta una reforma del sistema de atención en salud mental. Desde el inicio del proceso de deshospitalización en la década de 1960, en los EE.UU. y en los países europeos, se ha acumulado mucha experiencia y se han hallado muchos problemas que aún no se han resuelto. Buscando el cierre de los hospitales psiquiátricos monovalentes se puso el énfasis en el sitio físico de tratamiento y no siempre en la calidad de la atención brindada ni en las necesidades reales de los individuos afectados. Se hace un repaso de la experiencia acumulada y se señalan pautas para evitar algunos de los principales errores y problemas que se presentaron. Para una reforma de la atención psiquiátrica exitosa son fundamentales la decisión política, la consulta a profesionales con experiencia, "un presupuesto adecuado y estable, la modificación de las leyes, la creación de las instituciones necesarias acordes con las necesidades de los pacientes antes de mudados, la formación de postgrado en rehabilitación, flexibilidad y creatividad con bases empíricas y científicas sólidas.

It is not possible to work on alternatives to chronic institutionalization without taking into account a reform of the mental health care system. A great deal of experience has been accumulated and a lot of unsolved problems have arisen since the beginning of the deinstitutionalization in USA and Europe in the 60s. The aim was the closing of psychiatric hospitals, and so the accent was put on the physical place of treatment instead on the quality of the treatment or on the actual needs of the people involved. A review of the experiences is made and some clues are given to avoid the major problems and errors that have presented. Political decisions, experienced professionals, a stable and sufficient budget, modification of some laws, the creation of community institutions that fulfill the patient's needs before moving them, postgraduate training in rehabilitation, flexibility and creativity with empirical and scientific grounds are needed for a successful reform of the mental health care system.

Training skills for illness self-management in the rehabilitation of schizophrenia: A Family-assisted Program for Latinos in California / La capacitación de habilidades para el autocontrol de la enfermedad en la rehabilitación de la esquizofrenia: Un programa de asistencia a la familia para la comunidad latina en California

This study evaluated the effectiveness of a skills training program designed to teach disease management to Latinos with schizophrenia treated at a community mental health center. Ninety-two Latino outpatients with schizophrenia and their designated relatives were randomly assigned to three months of skills training (ST) versus customary outpatient care (CC) and followed for a total of nine months. The skills training approach was culturally adapted by including the active participation of key relatives to facilitate the acquisition and generalization of disease management skills into the patients' natural environment. There was a significant advantage for the ST group over the CC group on several symptom measures, skill acquisition and generalization, level of functioning and rates of rehospitalization. There were no significant differences between the groups on quality of life or caregiver burden. Skills training had a direct effect on skill acquisition and generalization and utilization of disease management skills led to decreased rates of rehospitalization. Incorporating an intensive, culturally relevant generalization effort into skills training for Latinos with schizophrenia and their families was effective in teaching disease management and viable in a community mental health center.

La rehabilitación integral del paciente esquizofrénico en México: el modelo del Instituto Nacional de Psiquiatría Ramón de la Fuente, Grupo III

resumen está disponible en el texto completo

Summary In this manuscript we describe results obtained for Group III of the Integral Rehabilitation Program for Outpatient Schizophrenic Patients (IRPS III) at the National Institute of Psychiatry Ramón de la Fuente. This program was created for Mexican schizo-phrenic patients as a refined alternative for the treatment, rehabilitation and integration to a productive life within society. It is interdisciplinary and integral in nature; both patients and their relatives are involved in the treatment and rehabilitation. It includes admission, stabilization of clinical symptoms, and application of strategies for rehabilitation for one year (pharmacological treatment, group psychotherapy, labor -vocation induction therapy, music therapy, psychosocial psychotherapy, occupational therapy, artistic painting, drawing, and Hata-Yoga workshops, psycho-educational workshops for relatives, group dynamics therapy with responsible relatives, and unifamilial psychotherapy); there were assessments at the beginning and at end of the study. Objective To evaluate the efficacy of an interdisciplinary and integral program in these patients, with respect to a control group that received the usual medical-psychiatric treatment. Evaluation was carried out according to: a) Severity of psychiatric symptoms, b) Treatment compliance, c) Everyday performance, d) Psychosocial functioning, e) Global activity, f) Home occupational activities, g) Expressed emotion and attribution of the illness, and h) Patterns of communication and relationship within the family. The goals of this program were to reduce the disabilities and to profit from the conserved functions, as well as to develop other skills in order to increase the quality of life of patients. Methods This was a quasi-experimental pretest-postest prospective study where an experimental group and a control group were compared. The control group (n=39) received the usual psychiatric management, while the experimental group (n=39), participated in addition to this management, in a one-year integral rehabilitation program at the outpatient service of the institute. The sample was obtained in a non-probabilistic and sequential way, according to the established inclusion and exclusion criteria. Variables:Efficacy was evaluated through: a) Severity of psychiatric symptoms; b) Treatment compliance; c) Everyday functioning; d) Psychosocial functioning; e) Occupational activities at home; f) Expressed emotion; g) Patterns of communication and relationship within the family. Instruments: Composite International Diagnostic Interview (CIDI), Positive and Negative Syndrome Scale (PANNS), Clinical Interview and File, Everyday Unemployment Scale, Psychosocial Functioning Scale, Global Assessment Scale, Assessment and Follow-up Questionnaire, Patient Labor Performance Scale, Social Behavior Assessment Schedule (SBAS), Five Minute Speech Sample (FMSS), Verification of the Performance in Occupational Activities for Schizophrenic Patients, Extrapyramidal Symptom Scale. Procedures: a) Incorporation of patients and relatives to the study; b) Stabilization of clinical symptoms; c) Initial assessment; d) Program application; e) Final assessment. Results Demographic data: There were 47 subjects in the final sample, 25 in the experimental group, and 22 controls. There were more males than females in both groups (76% in the experimental group and 63.6% in controls). Being single was the most frequent marital status among patients (88% in the experimental group and 91% in controls). Education was slightly higher in the experimental group, were 40% had a bachelor´s degree as opposed to 27.2% in controls. Treatment compliance: The program had a final efficiency of 64% for the experimental group and 56% for controls. Some of the experimental subject's characteristics at the beginning of the program were related with treatment compliance: age, years of illness history, and number of different diagnoses. It was determined that 62% of the patients who completed the program were less than 30 years old, and in 80% of the cases the onset of the illness was less than 10 years ago. Regarding the number of diagnoses per patient, 60% of those who completed the study had one diagnosis, 40% had two or more. On the contrary, 30% of the patients who abandoned the study had one diagnosis and 70% had two or more. In other words, almost three fourths of the sub-sample that abandoned the Program had more than one diagnosis: 31% had two, 31% had three, and 10% had four or more. Clinical area: In the clinical area, there were no significant differences between groups. However, patients in the experimen-tal group had a higher level of clinical adaptation and treatment compliance. Everyday performance: The everyday performance was improved in patients from the experimental group, with statistically significant changes in 71.5% of the pretest-postest evaluated areas, with emphasis on self-care, family and interpersonal relationships, and remunerated work. In the control group, there was an improvement only in 28.5% of the areas. Psychosocial functioning: Global and by-area psychosocial functioning showed statistically significant differences in the experimental group in all functioning areas; there was an improvement from three to two, the latter number meaning feeling satisfied. This was not the case in the control group. Behavior at home: In the experimental group, the perception in families was that occupational behavior at home was improved, according to the final score. Family assessment: Relatives in the experimental group attributed the problems they had with the patient to personality characteristics. These problems were diminished at the end of the study, but not in the control group. When relatives attributed problems to the way of being and attitudes of patients, there was a decrease of problems from 31.6% to 26.3%. Emotional Expression in relatives from the experimental group was observed in 79.2% at the beginning of the treatment program, which decreased to 33.3% at the end of the study, with a significant difference of p <0.006, as opposed to relatives in the control group, who did not show statistically significant differences. Clinical assessment of families: At the beginning of the program, this group established reiterative communication patterns. The patient showed rejection to communication. Relatives blamed schizophrenia for the lack of communication. At the end of the program, patterns of communication had importantly improved. Conclusions Demographic data in our sample are similar to those described in previous reports for male:female ratio, marital status, and education. Some characteristics of the patients, in particular age, years from onset of illness, and psychiatric comorbidity assessed at recruitment were associated with completing or not the program. At the end of the study it was clear the program reached its goals of reducing the patients' disabilities and profiting of conserved functions: 64% of the patients in the experimental group were more stable in clinical terms, and treatment compliance was better. Also, everyday performance was notably improved. In the experimental group there were pretest-postest statistically significant differences in 71.5% of the studied area, especially in self-care and interpersonal relationships. In the control group there were significant changes only in 28.5% of the areas. One level of improvement was observed in global and by-area psychosocial functioning in the experimental group, but not in controls. Patients at the end of the study had switched from a score of three (neutral, unconcerned) to level two (satisfied with their own functioning). In the control group there were no statistically significant differences. Emotional expression in relatives in the experimental group significantly decreased at the end of the study (p< .006), but not in the control group, given that the latter did not show statistically significant differences. Occupational activities at home were also improved in the experimental group, with better scores at the end of the study. Regarding the assessment of occupational therapy, there were significant differences in four areas. Other areas with positive changes were: disease attribution to the patient, and patterns of communication in the family. The areas with better results were self-care, socialization, and family dynamics, which are frequently altered in schizophrenic patients. These results showed the efficacy of the program in its integral version (pluridimensional). Once the proposed objectives are reached, we propose to continue this program with important modifications of the method, which will be described in future publications.

The Effects of Medication and Symptom Management Education Program Based on Self Efficacy Theory for the Psychiatric Patients / 간호학회지

PROPOSE: An effective rehabilitation program had been developed for psychiatric patients' self management of medication and symptoms in Korea. The rehabilitation program was designed to allow the patients to understand their illness, cope with their medical regimen, and prevent a relapse by recognizing any of the symptoms when they recur. METHODS: The developed program utilizes the self efficacy method reported by Bandura, it includes manuals and videotapes focusing on real life situations, small group discussions, and telephone coaching. This study investigated the effects of this program with respect to various predictable variables in psychiatric rehabilitation. Thirty eight patients were selected for this study, 18 in the experimental program and 20 as controls. RESULTS: The results showed that the subjects who attended this educational program reported significantly more improvement in attitude toward medication compliance (p=0.033), and significantly less relapse warning symptom scores (p=0.000) than the controls. CONCLUSION: This program may be a useful psychoeducational resource for professionals in the field of clinical practice in psychiatry.