Analysis of medical quality in psychiatric hospitals based on DRG evaluation / 中华医院管理杂志

Objective:To evaluate the medical service quality of psychiatric hospitals in Beijing based on diagnostic related group (DRG), analyze the evaluation effect, for refences to constructe a DRG performance evaluation system suitable for psychiatric hospitals.Methods:This study extracted data such as the number of DRG groups, etc. of hospitalized patients in 14 tertiary and secondary psychiatric hospitals in Beijing from 2018 to 2020 from the Beijing inpatient medical performance evaluation platform, and analyzed data on DRG performance evaluation indicators, as well as the average length of hospital stay and average cost of DRG enrolled cases. All data were analyzed using descriptive research methods, and inter group comparisons were conducted using the Mann Whitney U-test. Results:From 2018 to 2020, the average number of DRG groups in tertiary hospitals (28) was higher than that in secondary hospitals (10) ( P<0.05), and the average CMI values of both were the same(1.79); The average cost consumption index (1.15) of tertiary hospitals was higher than that of secondary hospitals (0.65) ( P<0.05), while the average time consumption index (1.11) was slightly lower than that of secondary hospitals (1.30); The mortality rate of the low-risk group in tertiary hospitals (0.01%) was generally lower than that in secondary hospitals (0.88%), and the average percentage of DRG admitted inpatients (82.8%) was significantly higher than that in secondary hospitals (27.3%) ( P>0.05). The average length of stay and cost per case for DRG enrolled inpatients in tertiary and secondary hospitals were lower than the overall hospital discharge cases ( P<0.05). Conclusions:The number of DRG groups, CMI value, and low-risk mortality rate could be used for evaluating the medical service capacity and safety of psychiatric hospitals, but the cost and time consumption index could not objectively reflect the efficiency of hospital medical services. DRG performance evaluation indicators are more suitable for evaluating short-term hospitalization of psychiatric patients. The proportion of DRG enrolled cases might be a potential indicator for evaluating the service quality of psychiatric hospitals.

Analysis of risk factors for delirium in critically ill patients in a psychiatric hospital： a retrospective study / 四川精神卫生

BackgroundThe incidence of delirium in critically ill psychiatric patients is high， and there are many factors affecting delirium occurrence. At present， epidemiological studies on delirium among critically ill patients in psychiatric hospitals are limited. ObjectiveTo explore the risk factors for delirium in critically ill patients in a psychiatric hospital， so as to guide the clinical management of delirium in psychiatric hospitals. MethodsThis retrospective study included 427 critically ill patients who were admitted to Shenzhen Kangning Hospital from January 1， 2019 to May 31， 2021. The delirium situation， gender， age， pre-admission course of illness （duration from the onset of acute mental state changes to in-patient registration at a psychiatric hospital）， history of mental illness， history of cognitive dysfunction， history of using psychoactive substances， history of using sedative and hypnotic drugs， number of combined chronic diseases， number of combined drugs and type of disease were examined as potential risk factors for delirium. Single Logistic regression was used to analyze the potential risk factors for delirium， and the potential risk factors were incorporated into the multi-factor Logistic regression analysis model so as to gradually screen out the risk factors for delirium in critically ill psychiatric patients. ResultsDelirium was present in 33.49% （143/427） of critically ill patients. Multi-factor Logistic regression analysis demonstrated that the presence of delirium was associated with mental and behavioral disorders caused by psychoactive substances （OR=8.949， P<0.01）， absent history of mental illness （OR=4.202， P<0.01）， number of combined chronic diseases （OR=1.249， P<0.01）， age （OR=1.031， P<0.01） and pre-admission course of illness （OR=0.942， P<0.01） . ConclusionDelirium was present in nearly 1/3 critically ill patients in the psychiatric hospital. The risk factors for delirium included short course of illness before admission， age， more combined chronic diseases， absent history of mental illness， mental and behavioral disorders caused by psychoactive substances. ［Funded by Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties （number， SZGSP013）］

Hospitais de Custódia e Tratamento Psiquiátrico no sistema prisional: a morte social decretada? / Custody and Psychiatric Treatment Hospitals in the prison system: A social death decreed?

Resumo Este texto apresenta uma discussão a respeito das pessoas com transtorno mental em conflito com a lei no Brasil e os Hospitais de Custódia e Tratamento Psiquiátrico, instituições inseridas no sistema prisional e consideradas híbridas entre a saúde e a justiça. Ao apresentarmos a realidade no contexto nacional, evidenciamos que a Reforma Psiquiátrica não alcançou essas instituições e esses indivíduos seguem estigmatizados, tendo os seus direitos humanos violados. Fundamentamos a necessidade de avançarmos o debate e trazemos alguns questionamentos na tentativa de fomentar a criação de novas saídas para o enfrentamento do problema, bem como a garantia de cuidado em saúde bem estruturado e baseado em evidências científicas.

Abstract This text discusses people with mental disorders in conflict with the law in Brazil and the Custody and Psychiatric Treatment Hospitals, institutions included in the prison system and considered a hybrid between health and justice. When we present the reality in the national context, we show that the Psychiatric Reform did not reach these institutions, and these individuals continue to be stigmatized, and their human rights are violated. We substantiate the need to advance the debate and raise some questions to establish new solutions to tackle the issue and ensure well-structured, scientific evidence-based health care.

Práticas profissionais em instituições psiquiátricas: desafios para o atendimento humanizado e integral / Professional practices in psychiatric hospitals: challenges for humanized and comprehensive care

Modelo de estudo: Estudo transversal de abordagem misto (quantitativa e qualitativa). Objetivo: Analisar as prá-ticas de profissionais em hospitais psiquiátricos no atendimento a pessoas com transtornos mentais, com vistas a contribuir para a abordagem humanizada e integral. Metodologia: Estudo realizado em dois hospitais psiquiátricos do Rio Grande do Norte, tendo como participantes 60 profissionais de saúde. Os dados quantitativos foram sub-metidos ao software estatísticoe analisados através de estatística bivariada; e nos dado qualitativos, recorreu-se ao tratamento do software Alceste e a técnica de análise de conteúdo. Resultados: Observou-se o predomínio de práticas profissionais associadas a intervenções tradicionais no contexto da abordagem realizada, reforçados nos dois temas centrais, oriundos dos achados qualitativos, a saber: Práticas profissionais no hospital psiquiátricos: cotidianos e políticas, e, Entraves e caminhos para o atendimento integral e humanizado em instituições psiquiá-tricas. Conclusão: As práticas profissionais desenvolvidas no âmbito das instituições psiquiátricas apontam para o enfoque terapêutico biológico e individual, tendo em vista os desafios de articular um atendimento integral e humanizado condizente com as diretrizes propostas pelo movimento de reforma psiquiátrica brasileiro. (AU)

Study model: cross-sectional study with a mixed approach (quantitative and qualitative). Objective: to analyze the practices of professionals in psychiatric hospitals in the care of people with mental disorders, with a view to contributing to a humanized and integral approach. Methodology: study carried out in two psychiatric hospitals in Rio Grande do Norte, with 60 health professionals as participants. The quantitative data were submitted to statis-tical software and analyzed through bivariate statistics; and in the qualitative data, the Alceste software treatment and the content analysis technique were used. Results: it was observed the predominance of professional practices associated with traditional interventions in the context of the approach performed, reinforced in the two central themes, arising from the qualitative findings, namely: Professional practices in the psychiatric hospital: daily life and policies, and, Barriers and paths to comprehensive and humanized care in psychiatric institutions. Conclusion:the professional practices developed within psychiatric institutions point to the biological and individual therapeutic focus, in view of the challenges of articulating a comprehensive and humanized care consistent with the guidelines proposed by the Brazilian psychiatric reform movement. (AU)

Support interventions for nurses working in acute psychiatric units: A systematic review

Diverse support interventions have been implemented to provide support for nurses working in acute psychiatric settings. These interventions aimed at modifying the psychological and social factors, as they either prevent stress responses or reduce its effects to improve the psychological well-being of staff. This study aimed to examine effective stress reduction interventions for nurses and to identify key elements of these successful interventions. Studies included in this review were conducted in acute psychiatric settings. A comprehensive search of electronic databases was conducted for support intervention studies between 2010 and 2021. The search yielded 315 studies that were reduced to seven studies after being reviewed by two independent reviewers. The studies were coded, and key elements were identified. Seven studies that were included consisted of a randomised controlled trial, quasi-experimental design and single-group design. Interventions included mindfulness-based stress reduction, burnout prevention programmes, communication skills, educational programme, group intervention, resilience training programme and stress management. Four key elements emerged from these interventions, namely, educational support, interpersonal skills, psychological support and adaptive coping. The findings highlighted the diverse interventions in supporting psychiatric nurses to cope with stress. However, there is a dearth of studies in acute psychiatric settings that were mostly done in emergency settings. Knowledge gained from this review may assist with practice improvement as managers can implement the identified interventions.

Current status of hospital infection management in psychiatric hospitals in the Ningxia Hui Autonomous Region / 四川精神卫生

ObjectiveTo investigate current status of hospital infection management in psychiatric hospitals in the Ningxia Hui Autonomous Region， so as to provide references for improving the level of hospital infection management of psychiatric hospitals. MethodsIn December 2020， on-site supervision was conducted on hospital infection management in all 9 psychiatric hospitals in the Ningxia Hui Autonomous Region， meantime， the self-compiled questionnaire on hospital infection management status was used for investigation. ResultsAmong the selected hospitals， nine （100.00%） psychiatric hospitals had the main hospital leaders in charge of hospital infection management， five （55.56%） hospitals had established a hospital infection management committee， six （66.67%） hospitals had established an independent hospital infection management department， and one （11.11%） hospital had developed all 13 systems mentioned in the questionnaire related to hospital infection management and job responsibilities. In terms of hospital infection management staff， there were 23 staff members in the nine psychiatric hospitals， including 3 in the specialty （13.04%） and 20 in the part-time setting （86.96%）. The score of the implementation of the basic system of hospital infection management in nine hospitals was （3.28±2.22）. ConclusionThe system specification related to hospital infection management in the Ningxia Hui Autonomous Region psychiatric hospitals needs to be improved and further strengthened， the professionalism of hospital infection management personnel needs to be improved.

A construção do Hospital de Custódia e Tratamento Psiquiátrico Henrique Roxo à luz da memória de Miguel Ângelo Roberto D'Elia / The construction of the Forensic Pychiatric Hospital Henrique Roxo in light of Miguel Ângelo Roberto D'Elia's memories / La construction de l'Hôpital Psychiatrique Pénitentiaire Henrique Roxo à la lumière des mémoires de Miguel Ângelo Roberto D'Elia / Construcción del Hospital de Custodia y Tratamiento Psiquiátrico Henrique Roxo a la luz de la memoria de Miguel Ângelo Roberto D'Elia

A partir da análise de uma postagem de Miguel Ângelo Roberto D'Elia, médico, ex-diretor da Divisão de Doenças Mentais do Estado do Rio de Janeiro na década de 1960, e idealizador da construção do Manicômio Judiciário Henrique Roxo em Niterói, este artigo investiga a memória do processo de construção dessa instituição. O corpus deste artigo é constituído pelo post publicado no Google+, de autoria D'Elia. No texto, de cunho autobiográfico, o autor descreve uma rede de alianças sociais e políticas efetivadas durante o seu período na gestão pública, bem como as ações por ele protagonizadas até a inauguração do referido estabelecimento fluminense.

Based on a post by Miguel Ângelo Roberto D'Elia, physician, former director of the Rio de Janeiro State Division for Mental Illnesses in the 1960s and the founder of the forensic psychiatric hospital Henrique Roxo in the city of Niterói, State of Rio de Janeiro, this article investigates the memory of the construction of that institution. A post on Google+ by D'Elia makes up the research corpus of this article. In his autobiographical text, D'Elia describes social and political networks at play during his tenure in public administration, as well as his initiatives until the opening of the institution.

Cet article analyse un post sur Internet de la part de Miguel Ângelo Roberto D'Elia, médecin et ancien directeur de la Division des Maladies Mentales de l'État de Rio de Janeiro dans les années 1960, réalisateur de la construction de l'Hôpital Psychiatrique Pénitentiaire Henrique Roxo de la ville de Niterói, État de Rio de Janeiro. On explore les mémoires de la construction de cet l'établissement à partir de ce post sur Google+ rédigé par D'Elia qui intègre donc le corpus de cette recherche. Ce texte autobiographique décrit le réseau d'alliances sociales et politiques pendant son poste au sein de la gestion publique, ainsi que les actions qu'il avait réalisées jusqu'à l'inauguration de l'établissement.

Basado en una publicación de Miguel Ângelo Roberto D'Elia, médico y exdirector de la División de Enfermedades Mentales del Estado de Río de Janeiro en la década de 1960, e idealizador de la construcción del Manicomio Judicial Henrique Roxo en la ciudad de Niterói, en el Estado de Rio de Janeiro, este trabajo estudia la memoria de la construcción de esta institución. Una publicación en Google+ del citado autor compone el corpus de la investigación. En el texto autobiográfico, el autor reconstruyó la red de alianzas sociales y políticas durante su periodo de gestión pública, así como las etapas transcurridas hasta la inauguración del hospital.

A cross-sectional study of attitude towards psychiatry among undergraduate medical students

Background: Psychiatric disorders are common, affecting millions of population worldwide. Patients with psychiatric disorders, psychiatrists as professionals, and psychiatry as a subject are seen in negative attitudes. Prejudices and negative attitudes exist among medical professionals as well. Aims: This study aims to know the attitude of undergraduate medical students towards psychiatry and compare the attitude among students with or without exposure to clinical psychiatry postings. Materials and methods: This is a descriptive, cross-sectional study conducted at a medical college, Karnataka, South India. Undergraduate students belonging to all phases and consenting for the study were the participants. They were considered into two groups, students not exposed to psychiatry clinical posting and students exposed to psychiatry clinical postings, respectively. Apart from collecting sociodemographic details, a self-administered Attitude Towards Psychiatry?30 items questionnaire was used and t-test, chi-square/Fisher’s exact test were used for statistical analyses. Result: The sample consisted of 484 students, of which 52.3% vs 47.7% of students were not exposed to psychiatry vs exposed to psychiatry clinical postings respectively. Overall students reported having a positive attitude towards psychiatry. We found 96.1% of students with clinical exposure to psychiatry have a better attitude compared to 86.9% of students not exposed to psychiatry clinical postings. Conclusion: A positive attitude towards psychiatry is necessary for better care of patients as well as to reduce stigma regarding mental illness. As clinical exposure improves the positive attitude, there is always a scope for improvements in the form of better psychiatry training at the undergraduate level.

Cartografia da saúde do homem em conflito com a lei / Cartography of the health of men in conflict with the law / Cartografía de la salud del hombre en conflicto con la ley

Neste estudo, apresentamos um recorte de uma pesquisa-intervenção realizada em um Hospital de Custódia e Tratamento Psiquiátrico, com o objetivo de cartografar processos de subjetivação da saúde do homem com transtorno mental em conflito com a lei. Para a produção das informações, utilizamos a cartografia e realizamos encontros com participantes da pesquisa por meio de práticas integrativas grupais e uso de objetos relacionais da arte. Para a discussão e os resultados, utilizamos a esquizoanálise, que aponta: a) as ações do cuidado em custódia são reduzidas à medicalização do confinamiento e à atenção de urgência e emergência, quando não é adiado ao máximo esse direito humano; b) a promoção da saúde do homem privado de liberdade é associada a ações de humanização e direitos humanos vinculados à determinação social. Conclui-se que os processos de subjetivação denunciam as instituições de violência e anunciam modos de desinstitucionalização da saúde mental custodiada.

In this study, we present a cutout of an intervention research performed in a Hospital of Custody and Psychiatric Treatment, with the objective of mapping subjectivation processes of the health of men with mental disorders in conflict with the law. For data production, we used cartography and held meetings with research participants through group integrative practices and the use of relational art objects. For discussion and results, we used schizoanalysis, which points out that: a) actions of care in custody are restricted to the medicalization of the confinement and the urgent and emergency attention, when this human right is not deferred to the maximum; b) the promotion of the health of men deprived of freedom is associated with humanization and human rights actions linked to social determination. We concluded that the subjectivation processes denounce institutional violence and announce ways of deinstitutionalizing mental health in custody.

En este estudio, presentamos un recorte de una investigación-intervención realizada en el Hospital de Custodia y Tratamiento Psiquiátrico, con el objetivo de mapear los procesos de subjetivación de la salud del hombre con trastorno mental en conflicto con la ley. Para la producción de información, utilizamos cartografía y realizamos reuniones con los participantes de la investigación a través de prácticas de integración grupal y el uso de objetos relacionales del arte. Para la discusión y los resultados, utilizamos el esquizoanálisis, que señala: a) las acciones de cuidado en custodia se reducen a la medicalización del encarcelamiento y a la atención de urgencia y emergencia, cuando este derecho humano no se extiende al máximo; b) la promoción de la salud del hombre privado de libertad está asociada a acciones de humanización y derechos humanos vinculadas a la determinación social. Se concluye que los procesos de subjetivación denuncian a las instituciones de violencia y anuncian formas de desinstitucionalización de la salud mental vigilada.

Me chama para conversar que eu gosto: análise de experiência clínico-institucional com a enfermagem de um hospital psiquiátrico / Call me for a conversation and I will enjoy it: analysis of a clinical-institutional experience with the nursing staff of a psychiatric hospital

Resumo As equipes que atuam em enfermarias psiquiátricas são herdeiras diretas de uma prática marcada pelo discurso institucionalizante, mas precisam dialogar com a clínica e o cuidado preconizados pela Reforma Psiquiátrica. O presente artigo tem por objetivo analisar como se dá o trabalho em saúde mental e quais as relações entre o modo de trabalhar e a saúde de trabalhadores de enfermagem de um hospital psiquiátrico universitário. O referencial teórico utilizado teve como base os conceitos de atividade e corpo-si trazidos por Schwartz e a dimensão da saúde estabelecida por Canguilhem, entendendo que o trabalho em saúde é também um trabalho de criação, de produção de saber e de uso de suas capacidades e saberes tácitos. A partir de "Conversas sobre o Trabalho e a Saúde" realizadas com as equipes das enfermarias do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ), abordamos temáticas específicas da enfermagem em saúde mental. Concluímos que existe um painel bastante heterogêneo de falas, que expressam a diversidade de formas de pensar e agir no trabalho da enfermagem, de modo que cada trabalhador traz à cena aquilo que acredita ser o melhor para o paciente e é em nome dessa ética no cuidar que orbitam as questões mais dramáticas dentro de uma enfermaria psiquiátrica.

Abstract The teams that work in psychiatric wards are direct heirs of a practice marked by the institutionalizing discourse but need to dialogue with the clinic and care advocated by the Psychiatric Reform. This article aims to analyze how mental health work occurs and what are the relationships between the way of working and the health of nursing workers of a university psychiatric hospital. The theoretical reference used was based on the concepts of activity and self body by Schwartz and the dimension of health established by Canguilhem, understanding that health work is also a work of creation, of production of knowledge and use of their capacities and tacit knowledge. BasedonConversations about Work and Health carried out with the nursing teams of the Institute of Psychiatry of Universidade Federal do Rio de Janeiro (IPUB/UFRJ), we address specific topicsrelated to nursing in mental health. We conclude that there is a very heterogeneous panel of speeches, which express the diversity of ways of thinking and acting in nursing work, so that each worker brings to the scene what they believe to be the best for the patient and it is in the name of that care ethicsthat the most dramatic issues revolvewithin a psychiatric ward.

O manicômio no cariri cearense: análise arquegenealógica de sua abertura e fechamento / The asylum in cariri cearense: arquegenealogical analysis of its opening and closing / El manicomio en el cariri cearense: análisis arque-genealógico de su apertura y cierre / L'asile au cariri dans l'état du ceará: analyse archéologique de son ouverture et de sa fermeture

Este artigo objetiva analisar as formações discursivas e não discursivas que possibilitaram a abertura de um hospital psiquiátrico na Região do Cariri cearense, entre os anos 1970 e 2016. Propõe o uso dos conceitos foucaultianos de arqueologia e genealogia enquanto método e estratégia de análise. A hipótese de pesquisa defendida é de que a abertura desse hospital faz parte de um processo amplo de instalação de hospitais psiquiátricos no Brasil e aponta para o internamento enquanto lógica massiva de intervenção em Saúde Mental no Brasil, que, embora segregacionista e excludente, se manteve até o final da década de 1980.

This article aims to analyze the discursive and non - discursive formations that allowed the opening of a psychiatric hospital in the Cariri region of Ceará between 1970 and 2016. It proposes the use of the Foucaultian concepts of archeology and genealogy as a method and strategy of analysis. The research hypothesis defended is that the opening of this hospital is part of a wide process of installation of psychiatric hospitals in Brazil, and points to the hospitalization as a massive logic of intervention in Mental Health in Brazil, which, although segregationist and excluding, has remained until the late 1980s.

Este trabajo tiene el objetivo de analizar las formaciones discursivas y no discursivas que permitieron la apertura de un hospital psiquiátrico en la Región del Cariri cearense, entre los años de 1970 y 2016. Propone los conceptos de Foucault de arqueología y genealogía mientras método y estrategia de análisis. La hipótesis de investigación defendida es la de que la apertura de este hospital haz parte de un proceso amplio de instalación de hospitales psiquiátricos en Brasil y apunta para el internamiento mientras lógica masiva de intervención en Salud Mental en Brasil, que, aunque segregacionista y excluyente, se mantuvo hasta el final de la década de 1980.

Cet article vise à analyser les formations discursives et non discursives qui ont permis l'ouverture d'un hôpital psychiatrique dans la région du Cariri dans l'état du Ceará entre 1970 et 2016. On utilise les concepts "archéologie" et "généalogie" de Foucault comme méthode et stratégie de l'analyse. Notre hypothèse de recherche est que l'ouverture de cet hôpital fait partie d'un vaste processus d'installation d'hôpitaux psychiatriques au Brésil. Cela suggère que l'hospitalisation a été une logique d'intervention massive en matière de santé mentale au Brésil qui, bien que ségrégationniste et excluant, a demeuré jusqu'à la fin des années 1980.

Nursing Strategy for Use of Seclusion and Restraint in Psychiatric Hospitals / 대한정신분열병학회지

Although seclusion and restraint are required for the treatment of mentally ill patients in psychiatric hospitals, these procedures involve potential violations of human rights and pose a potential risk to patients' physical condition. Nursing staffs in psychiatric hospitals often have to manage psychiatric patients who display aggressive, violent, or challenging behavior. However, the guidelines for the use of seclusion and restraint in Korea are too broad to apply in clinical situations. The guidelines in the United States, Australia, the United Kingdom, and New Zealand emphasize that patients' basic needs have to be met and stipulate that patient–staff interaction must be continued during seclusion and restraint procedures. Mental health workers in psychiatric hospitals should pay close attention to patients' verbal and non-verbal expressions while communicating with them. This study reviews the guidelines for seclusion and restraint used in foreign countries to improve current Korean guidelines and provides strategies of the nursing activities to be implemented when patients require seclusion and restraint.

Exploration of Service Objects Extension of Psychiatric Hospitals in Internet Era / 中国医院管理

The method of using internet to take advantages of tertiary psychiatric hospitals is explored.Tertiary psychiatric hospitals expand the service objects,improve the accessibility of mental health services,and realize the mental health care services extension and high-quality medical resources sinking by signing the technical guide agreement with primary health care institutions and internet plus,to explore a new type integrated management mode of mental diseases prevention,treatment and rehabilitation based on the psychiatric specialized hospitals.

Andando na contramão: o destino dos indivíduos com transtorno mental que cometem crimes no Brasil / Going Backwards: The fate of the individual with mental disorder that commit crimes in Brazil

Resumo A reforma psiquiátrica no Brasil possibilitou, entre outros benefícios, a substituição do modelo médico psiquiátrico pelo modelo de atenção psicossocial. A internação psiquiátrica passou a ser contraindicada, exceto nos casos em que os recursos extra-hospitalares forem insuficientes ou quando indicada judicialmente. Nesses casos, a assistência aos portadores de sofrimento mental autores de delito é realizada nos Estabelecimentos de Custódia e Tratamento Psiquiátrico (ECTP), onde esses indivíduos são internados para o cumprimento da medida de segurança imposta. Entre os anos de 2015 e 2016, o Mecanismo Nacional de Combate e Prevenção à Tortura (MNCPT) realizou a inspeção de unidades de privação de liberdade, divulgando relatórios através dos quais descreve sua atual realidade. Até o momento, foram visitados cinco estabelecimentos de custódia, nos estados do Pará, Paraíba, Rio Grande do Sul, Rondônia e São Paulo. Este artigo discute o direito à saúde no contexto dos ECTPs. Circulando entre os domínios do direito e da medicina, essa população tem seus direitos humanos violados e, apesar de distantes geograficamente, a opinião é unânime: os avanços na assistência em saúde mental não contemplaram os ECTPs, que ainda preservam características asilares.

Abstract Psychiatric reform in Brazil made it possible, among other benefits, to replace the psychiatric medical model with the psychosocial care model. Psychiatric hospitalization is now contraindicated, except in cases in which extra-hospital resources are inadequate or when judicially indicated. In such cases, assistance to mentally ill people who are perpetrators of crime is carried out in the Custody and Psychiatric Treatment Facilities (ECTP), where these individuals are hospitalized for compliance with the security measure imposed. Between 2015 and 2016, the National Mechanism for Combating and Preventing Torture (Mecanismo Nacional de Combate e Prevenção à Tortura - MNCPT, in Portuguese) carried out the inspection of detention units, releasing reports describing its current situation. To date, five custody establishments have been visited in the states of Pará, Paraíba, Rio Grande do Sul, Rondônia and São Paulo. This article discusses the right to health in the context of ECTPs. Circulating between the domains of law and medicine, this population has their human rights violated and, although geographically distant, it is unanimous that advances in mental health care have not addressed ECTPs, which still preserve asylum characteristics.

As análises de Hannah Arendt acerca dos campos de concentração e suas relações com o "holocausto brasileiro" / Analyses of Hannah Arendt about the concentration camps and its relations with the "brazilian holocaust" / Los Análisis de Hannah Arendt sobre los campos de concentración y sus relaciones con el "holocausto brasileño"

Este artigo centra-se na reflexão arendtiana acerca dos campos de concentração e suas relações com o "Holocausto Brasileiro". A pensadora Hannah Arendt buscou compreender os apelos da história política de seu tempo, marcada pelos totalitarismos nazista e stalinista e pelos acontecimentos que a eles se seguiram. Sua obra apresenta-se como de grande alcance e possui inúmeras repercussões nos dias de hoje. Em sua reflexão, a autora salienta que os campos de concentração são considerados a concretização do regime totalitário, no qual o objetivo é a consumação e o domínio total sobre o outro. A jornalista Daniela Arbex resgata a história da loucura e afirma, em sua obra Holocausto Brasileiro (2013), que Basaglia, um dos teóricos renomados da psiquiatria, lutou severamente para acabar com os manicômios e garantir a liberdade dos doentes mentais, tendo estado, inclusive, no Hospital Psiquiátrico Colônia, em Barbacena. Por essa razão, em seu relato, observamos que o teórico comparou a situação do Hospital à de um campo de concentração nazista. Percebemos que, diante do Hospital Psiquiátrico e dos campos nazistas, os seres humanos eram maltratados, desumanizados e degradados. Pessoas passavam a ser identificadas por números. Portanto, são essas afirmações que sustentam o objetivo do nosso trabalho, qual seja o de estabelecer paralelos entre os internos do Colônia e os judeus dos campos de concentração nazistas.

This paper aims to focus on Hannah Arendt's reflections on the concentration camps and their relations with the "Brazilian Holocaust". Arendt tried to understand the demands of the political history of her time, marked by the Nazis and Stalinist totalitarianisms and by the subsequent happenings. Her work presents itself with a great reach and has uncountable repercussions nowadays. In her reflection, the author emphasizes that the concentration camps are considered the achievement of the totalitarians regimes, in which the objective is the consolidation and the total domination over the other. The journalist Daniela Arbex recovers the history of madness in her book, Holocausto Brasileiro (2013). She stated that Basaglia, a well-known theorist of psychiatry, fought severely to put an end to the asylums and to guarantee the freedom of mentally ill people. Moreover, he has already been in the Colônia Psychiatric Hospital, in Barbacena. Because of this, in his report, we observe a comparison between the hospital's situation and the Nazis concentration camp. We realize that vis-à-vis the Psychiatric Hospital and the Nazis concentration camps, human beings used to be ill-treated, de-humanized and degraded. People became identified by numbers. Thus, these statements sustain the aim of this research, which is determining parallels between the patients of Colônia and the Jews from the Nazis concentration camps.

Ese artículo se centra en la reflexión arendtiana sobre los campos de concentración y sus relaciones con el "holocausto brasileño". La pensadora Hannah Arendt buscó comprender los ruegos de la historia política de su tiempo, marcada por los totalitarismos nazista y stalinista y por los acontecimientos que a ellos se siguieron. Su obra se presenta como de grande alcance y posee innumerables repercusiones en los días de hoy. En su reflexión, la autora destaca que los campos de concentración son considerados la concretización del régimen totalitario, en lo cual el objetivo es la consumación y el dominio total sobre el otro. La periodista Daniela Arbex rescata la historia de la locura y afirma, en su obra Holocausto Brasileiro (2013), que Basaglia, uno de los teóricos renombrados de la psiquiatría, luchó severamente para poner fin a los manicomios y garantizar la libertad de los enfermos mentales; estuvo, además, en el Hospital Psiquiátrico Colonia, en Barbacena. Por esa razón, en su relato, observamos que el teórico comparó la situación del hospital a la de un campo de concentración nazista. Percibimos que, ante el Hospital Psiquiátrico y los campos nazistas, los seres humanos eran maltratados, deshumanizados y degradados. Personas pasaban a ser identificadas por números. Por lo tanto, son esas afirmaciones que sustentan el objetivo de nuestro trabajo, es decir, establecer paralelos entre los internos del Colonia y los judíos de los campos de concentración nazistas.

Sociodemographic and clinical factors associated with dual disorders in a psychiatric hospital / Factores sociodemográficos y clínicos asociados a patología dual en un hospital psiquiátrico

Abstract: Introduction: Among patients with mental illness, dual disorders patients are characterized by a heterogeneous and more severe clinical presentation that is difficult to treat. Therefore, knowledge about the distribution of this disorder and the characteristics of these patients can be helpful to optimize and organize health resources. Objective: To explore the prevalence and socio-demographic and clinical factors associated with dual disorders patients who were hospitalized due to mental illness at a psychiatric unit in Colombia between January and June 2013; this data was collected and analyzed on the basis of the medical records of each patient. Method: Observational, quantitative, cross-sectional study of a secondary source. It included the analysis of 201 patients aged 18 to 65. Results: There were 201 patients analyzed; 45.3% had dual disorders, with a ratio of 2.24 men:women; there was a high frequency of single marital status (69.2%) and more than 90% had a low socioeconomic level. The factors significantly associated with dual disorders in order of importance were: age from 18 to 35 years (OR = 11.03; CI 95% [4.43, 27.46]), male (OR = 5.10, CI 95% [2.26, 11.50]), history of aggression (OR = 3.35; CI 95% [1.63, 6.91]), and readmission in the year after hospital discharge (OR = 2.23; CI 95% [1.08, 4.61]). Discussion and conclusion: Dual disorders prevalence in this study is similar to that found by other authors. The high prevalence of dual disorders requires specialized therapeutic programs for treatment. The more hospitals know about the associated variables in this study, the more they will be able to improve their approach to patients.

Resumen: Introducción: Dentro de los pacientes con trastornos mentales, el grupo con patología dual se caracteriza por una presentación clínica heterogénea, más grave y difícil de tratar, por lo que conocer la distribución de este trastorno y las características de estos sujetos puede ayudar a optimizar y organizar los recursos sanitarios. Objetivo: Explorar la prevalencia y los factores sociodemográficos y clínicos asociados a la patología dual en pacientes hospitalizados por trastorno mental en una unidad de psiquiatría general de Colombia entre enero a junio del 2013, analizando los datos recolectados a partir de las historias clínicas. Método: Estudio cuantitativo y observacional de corte transversal de fuente secundaria. Se incluyeron en el análisis 201 pacientes con edades entre los 18 a 65 años. Resultados: De los 201 pacientes analizados, el 45.3% presentaron patología dual, con una razón hombre-mujer de 2.24. La mayoría tenía como estado civil soltero (69.2%), y más del 90% presentaron un nivel socioeconómico bajo. Los factores que resultaron significativamente asociados a patología dual, por su orden de importancia, fueron la edad de 18 a 34 años (OR = 11.03; IC 95% [4.43, 27.46]), el sexo masculino (OR = 5.10; IC 95% [2.26, 11.50]), antecedente de heteroagresión (OR = 3.35; IC 95% [1.63, 6.91]) y la rehospitalización durante el año posterior al egreso (OR = 2.23; IC 95% [1.08, 4.61]). Discusión y conclusión: La prevalencia de patología dual en este estudio coincide con el rango encontrado por otros autores. Por la elevada prevalencia de la patología dual, es necesario disponer de programas terapéuticos especializados para su tratamiento. En la medida en que se conozcan las variables asociadas, el tratamiento de los pacientes mejorará considerablemente.

Análise arquegenealógica de mecanismos de segregação e exclusão no Cariri cearense / Archigenealogical analysis of segregation and exclusion mechanisms in Cariri metropolitan area, Ceará, Brazil / Análisis arquegenealógica de mecanismos de segregación y exclusión en el Cariri cearense

O presente artigo consiste na descrição e análise de três episódios ocorridos durante o século XX relacionados ao governo e gestão dos corpos de pessoas pobres do Cariri cearense. O campo de concentração do Buriti, o Caldeirão da Santa Cruz do Deserto e um hospital psiquiátrico são objetos da análise das relações de poder e governamentalidade relacionadas às pessoas pobres, migrantes da seca e loucos. Para tanto, foram utilizados os elementos das análises arqueológicas e genealógicas presentes na obra de Michel Foucault, sobretudo, o conceito de biopoder como estratégia geral de governo. Ademais, foi utilizada a perspectiva multidimensional de pobreza, uma vez que esses mecanismos foram aplicados aos corpos de pessoas pobres sob a justificativa de preservação e manutenção da vida de outras. Nosso objetivo é mostrar a importância do aprofundamento crítico-reflexivo no que diz respeito aos contextos nos quais os discursos e as práticas de exclusão social se inscrevem.

The present study is the description and analysis of three episodes that occurred during the twentieth century in the region of Cariri, Ceará State, Brazil: the Buriti concentration camp, the community Caldeirão da Santa Cruz do Deserto and a psychiatric hospital. They are objects for the analysis of the power relations and governmentality related to the poor, drought migrants and the mad. To that end, elements and concepts from the work of Michel Foucault are used, especially the concept of biopower as a general governmental strategy. In addition, the multidimensional perspective of poverty was used, since these mechanisms were applied to the bodies of poor people, justified by the preservation and maintenance of others' lives. This work aims to describe and analyze three events of the early twentieth century, relating them to the strategies of governance, control and power over the bodies of poor people. We highlight the importance of critical and reflexive apprehension in relation to the contexts in whichdiscourses and practices of exclusion are inscribed.

Este artículo es la descripción y el análisis de tres episodios que se produjeron durante el siglo XX en relación con los órganos de gobierno y de gestión de las personas pobres de Ceará Cariri. El campo de concentración de Buriti, el Caldeirão da Santa Cruz do Deserto y un hospital psiquiátrico son el análisis de los objetos de las relaciones de poder y la gobernabilidad relacionados con los pobres, los migrantes sequías y loco. Por lo tanto, se utilizaron los elementos de análisis arqueológico y genealógico presente en la obra de Michel Foucault, especialmente el concepto de biopoder como estrategia general del gobierno. Además, se utiliza la perspectiva multidimensional de la pobreza, ya que estos mecanismos se aplicaron a los cuerpos de las personas pobres en los terrenos de la preservación y el mantenimiento de la vida de los demás. Nuestro objetivo es mostrar la importancia de la profundización crítica y reflexiva en relación con los contextos en los que los discursos y las prácticas de exclusión socialcaen.

Psiquiatría y literatura en la España de la transición: los renglones torcidos de Dios (1979) / Psiquiatria e literatura na Espanha da transição: Los renglones torcidos de Dios / Psychiatry and literature in transition-era Spain: Los renglones torcidos de Dios / Psychiatrie et littérature dans l’Espagne de la Transition : Los renglones torcidos de Dios / Psychiatrie und Literatur zur Zeit der spanischen Transition: Los renglones torcidos de Dios

El objetivo de este trabajo es analizar los contenidos psiquiátricos de la novela de Torcuato Luca de Tena Los renglones torcidos de Dios (1979), con el fin de valorar de qué manera esta obra de ficción fue capaz de reflejar la realidad asistencial en la España de los años setenta en un contexto de profundos cambios culturales en torno a la locura. La novela refleja una posición conservadora de resistencia y critica a las novedades (el psicoanálisis, el movimiento antipsiquiátrico) que estaban propiciando un cambio de la “cultura psi” en la España de la Transición democrática.

O objetivo deste trabalho é analisar os conteúdos psiquiátricos do romance Los renglones torcidos de Dios [As linhas tortas de Deus] (1979), de Torcuato Luca de Tena, a fim de avaliar de que forma essa obra de ficção foi capaz de espelhar a realidade assistencial na Espanha dos anos 1970 em um contexto de profundas transformações culturais no âmbito da loucura. O romance reflete uma posição conservadora de resistência e critica as novidades (a psicanálise, o movimento antipsiquiátrico) que estavam a propiciar uma nova “cultura psi” na Espanha da transição democrática.

This paper analyses the psychiatric content of the novel Los Renglones Torcidos de Dios [The Twisted Lines of God] (1979), by Torcuato Luca de Tena, so as to assess in what way this was capable of reflecting the reality of care in 1970s Spain, within a context of deep cultural changes concerning the concept of madness. The novel reflects a conservative position of resistance and criticizes new developments (psychoanalysis, the anti-psychiatric movement) brought about by a new ‘psy culture’ in Spain during its transition to democracy.

L’article qui suit vise à analyser les contenus psychiatriques du roman de Torcuato Luca de Tena Los renglones torcidos de Dios [Les lignes tordues de Dieu] (1979) afin d’analyser de quelle façon cet ouvrage de fiction réussit à rapporter la réalité des services psychiatriques dans l’Espagne des années 1970, dans un contexte de profonds changements culturels dans le domaine de la folie. Le roman dénonce une position conservatrice de résistance et critique par rapport aux nouveautés (la pschanalyse, le mouvement antipsychiatrique) qui encourageaient une nouvelle «culture psy ¼ en Espagne pendant la transition démocratique.

Das Ziel dieser Arbeit besteht darin, die psychiatrischen Inhalte des 1979 von Torcuato Luca de Tena geschriebenen Romans Los renglones torcidos de Dios (Die schiefen Zeilen Gottes) zu analysieren, um zu beurteilen inwiefern es diesem Roman gelungen ist, die Situation des spanischen Gesundheitswesens in den siebziger Jahren widerzuspiegeln, dass zu dieser Zeit bedeutende kulturelle Veränderungen bezüglich des Wahnsinns erfuhr. Der Roman vertritt eine konservative Widerstandshaltung und kritisiert die Neuerungen (Psychoanalyse, Antipsychiatrie-Bewegung), welche die sogenannte „Psy-Kultur” während der demokratischen Transition in Spanien förderten.

Práticas corporais e desinstitucionalização em saúde mental: Desafios e possibilidades / Body practices and deinstitutionalization in mental health: Challenges and possibilities / Prácticas corporales y la desinstitucionalización en salud mental: Retos y possibilidades

O presente artigo trata do recorte de uma pesquisa que objetivou investigar as práticas voltadas para o processo de desinstitucionalização realizadas em um hospital psiquiátrico de uma cidade do nordeste brasileiro, focalizando no corpo e nas práticas corporais como recurso. Para tanto, foram realizadas 30 entrevistas e 07 oficinas de práticas corporais com profissionais envolvidos e foram analisadas como essas práticas corporais poderiam contribuir para o trabalho de desinstitucionalização dos moradores do hospital. Como resultados, evidencia-se e discute-se a importância de que sejam realizadas atividades intra e extramuros do hospital que considerem as marcas da institucionalização nos corpos, tanto dos moradores, como dos profissionais que os acompanham, de modo a potencializar a desinstitucionalização em sentido amplo e a construção da autonomia dos atores envolvidos e do cuidado em liberdade.

This article deals with the part of a research that investigated the practices aimed at the deinstitutionalization process held in a psychiatric hospital of a city in northeastern Brazil, focusing on the body and bodily practices as a resource. Therefore, we carried out 30 interviews and 07 workshops of corporal practices with professionals involved and it was analyzed how these bodily practices could contribute to the deinstitutionalization work with the hospital residents. As a result, it is evident and discusses the importance of intra and extramural activities of the hospital be held to consider the trademarks of institutionalization in the bodies of both the residents and the professionals who assist them, so enhance the deinstitutionalization broadly and the construction of autonomy of the actors involved and care free.

Este artículo se ocupa de la parte de una pesquisa que investigó las prácticas dirigidas a el proceso de desinstitucionalización que tuvo lugar en un hospital psiquiátrico de una ciudad en el nordeste de Brasil, centrado en el cuerpo y las prácticas corporales como recurso. Por lo tanto, llevamos a cabo 30 entrevistas y 07 talleres de prácticas corporales con los profesionales implicados y fueron analizadas como estas prácticas corporales podrían contribuir a el labor de desinstitucionalización de los residentes del hospital. Como resultado, es evidente y se analiza la importancia de las actividades intra y extramuros del hospital se celebrará para considerar las marcas registradas de institucionalización en los cuerpos de los residentes y de los profesionales que los asisten, con el fin de mejorar la desinstitucionalización en amplio sentido y la construcción de la autonomía de los actores involucrados y del cuidado en liberdad.

Violência relacionada ao trabalho na psiquiatria: percepção dos trabalhadores de enfermagem / Work-related violence in psychiatry in the perception of nursing workers / La violencia relacionada con el trabajo en psiquiatría en la percepción de los trabajadores de enfermería

Objetivou-se, neste estudo, analisar os tipos de violência relacionados ao trabalho em unidade de internação psiquiátrica, de acordo com a percepção dos trabalhadores de enfermagem, e discutir as repercussões para a saúde dos integrantes do grupo. Pesquisa qualitativa, descritiva, realizada em unidade de internação psiquiátrica de hospital universitário. Utilizou-se a técnica de entrevista semiestruturada, com 16 trabalhadores de enfermagem. Aplicada a análise de conteúdo aos depoimentos, identificou-se que tanto a violência psicológica quanto a institucional, decorrentes das condições inadequadas de trabalho, prejudicam os trabalhadores e a prática de enfermagem. Conclui-se, então, a importância de a instituição investir em ações preventivas no intuito de promover a saúde do grupo, bem como a qualidade do serviço ofertada.

The objective in this study was to analyze the types of violence related to the work at a psychiatric inpatient service as perceived by the nursing professionals and to discuss the repercussions for the group members' health. Qualitative and descriptive research, undertaken at a psychiatric inpatient service of a teaching hospital. The semistructured interview technique was used with 16 nursing workers. Content analysis was applied to the testimonies. It was identified that both psychological and institutional violence, deriving from the inappropriate work conditions, negatively affect the professionals and nursing practice. In conclusion, it is important for the institution to invest in preventive actions in order to promote the group's health and the quality of the service offered.

Este estudio tuvo como objetivo analizar los tipos de violencia relacionada con el trabajo en una unidad de internación psiquiátrica en la percepción del personal de enfermería y discutir las implicaciones para la salud del grupo. Investigación cualitativa, descriptiva, cumplida en una unidad de internación psiquiátrica de un hospital universitario. Se ha utilizado la técnica de entrevista semiestructurada con dieciséis trabajadores de enfermería. Aplicada el análisis de contenido a los testimonios, se identificó que la violencia psicológica y institucional resultante de las condiciones de trabajo inadecuadas causan daño a los trabajadores y la práctica de enfermería. La conclusión es la importancia de la institución invertir en acciones preventivas con el fin de promover la salud del grupo y la calidad del servicio.