ABSTRACT
Resumen Introducción: la resiliencia ha sido definida como la resistencia frente a experiencias psicosociales adversas. Tiene un rol importante en varios trastornos mentales, asociándose, por ejemplo, a la severidad en el trastorno depresivo mayor y a la calidad de vida en el trastorno afectivo bipolar. La esquizofrenia es un trastorno mental severo que destaca por producir dificultades en múltiples dominios de la vida y una alta morbimortalidad. El objetivo de esta revisión fue sintetizar la evidencia disponible acerca de la importancia de la resiliencia en la esquizofrenia. Métodos: se realizó una búsqueda en las bases de datos PubMed, LILACS y SciELO, seleccionando artículos en inglés y español, que incluyeran personas con esquizofrenia y midieran la resiliencia. Veinticinco artículos cumplieron los criterios de inclusión. Resultados: las personas con esquizofrenia tenían una menor resiliencia que sujetos sanos (9 estudios). El nivel de resiliencia se asoció inversamente con los síntomas negativos (3 estudios), síntomas positivos (1 estudio), depresión (4 estudios), desesperanza (3 estudios) y suicidio (1 estudio). Por otro lado, la resiliencia se asoció positivamente con la calidad de vida (5 estudios), funcionalidad (4 estudios) y salud física (2 estudios). En dos estudios se evaluaron intervenciones orientadas a potenciar la resiliencia de pacientes con esquizofrenia, mostrando resultados poco concluyentes. Discusión: es llamativa la escasa literatura que aborda el tema de la resiliencia en esquizofrenia. Los hallazgos de la presente revisión sitúan a la resiliencia como un factor determinante de la evolución y expresión clínica de esta enfermedad.
Introduction: resilience has been defined as the resistance to adverse psychosocial experiences. It has an important role in various mental disorders, being associated, for example, with the severity in major depressive disorder and the quality of life in bipolar affective disorder. Schizophrenia is a severe mental disorder that stands out for causing difficulties in multiple domains of life and high morbidity and mortality. The objective of this review was to synthesize the available evidence about the importance of resilience in schizophrenia. Methods: a search of the PubMed, LILACS and SciELO databases was performed, selecting articles in English and Spanish that included patients with schizophrenia and measured resilience. Twenty-five articles met the inclusion criteria. Results: patient with schizophrenia had less resilience than healthy subjects (9 studies). Resilience levels were inversely associated with negative symptoms (3 studies), positive symptoms (1 study), depression (4 studies), hopelessness (3 studies), and suicide (1 study). On the other hand, resilience was positively associated with quality of life (5 studies), functionality (4 studies) and physical health (2 studies). In two studies, interventions aimed at enhancing the resilience of patients with schizophrenia were evaluated, showing inconclusive results. Discussion: there is a striking limited literature that address the topic of resilience in schizophrenia. The findings of the present review place resilience as a determining factor in the evolution and clinical expression of this disease.
Subject(s)
Humans , Schizophrenic Psychology , Resilience, Psychological , Quality of Life , Qualitative ResearchABSTRACT
Resumen Este artículo apunta a ofrecer soluciones prácticas a los atolladeros más comunes que suelen presentarse al momento de utilizar los sueños en el psicoanálisis con psicóticos, como la indiferenciación entre sueño, realidad y delirio, la dificultad de algunos psicóticos para asociar y el avance de las pesadillas. Se toma posición a favor de la posibilidad de utilizar los sueños en la clínica de las psicosis y se describen los modos en que estos pueden colaborar en la dirección de la cura: poniendo en discurso experiencias inefables, permitiendo la historización y sustituyendo la asociación libre por el encadenamiento entre sueños. Se concluye que la vía onírica puede constituir un remedio eficaz contra el retorno en lo real y que es preferible interrogar los sueños con preguntas no muy amplias, orientadas a vincularlos con la vida del soñante y su posición subjetiva.
Resumo Este artigo tem como objetivo apontar soluções práticas aos impasses mais comuns que costumam aparecer quando se aborda os sonhos na psicanálise com psicóticos, como a indiferenciação entre sonho, realidade e delírio, a dificuldade de alguns psicóticos com a associação livre e o avanço dos pesadelos. Toma-se posição a favor da possibilidade de utilizar os sonhos na clínica das psicoses e se descrevem os modos em que estes podem colaborar com o tratamento, colocando em discurso experiências inefáveis, permitindo a historização e substituindo a associação livre pelo encadeamento dos sonhos. Conclui-se que a vida onírica pode constituir um remédio eficaz contra o retorno no real e que é preferível interrogar os sonhos com perguntas não muito amplas, orientadas a vinculá-los com a vida do sonhante e com a sua posição subjetiva.
Abstract This paper offers some practical solutions to the most usual predicaments that usually arises when exploring dreams in psychoanalysis with psychotic patients, such as the non-distinction between dream, reality and delirium, the difficulty with free association and the invasion of nightmares. It advocates for using dreams in psychosis clinic and describes how dreams can contribute to treatment, by turning ineffable experiences into discourse, allowing historization and replacing association with dream chaining. Dream life can be an effective remedy against the return to the real, being preferable to interrogate dreams with precise questions aimed to link them to the dreamer's life and their subjective position.
Résumé Cet article propose quelques solutions pratiques aux problèmes les plus courants qui se posent lors de l'exploration des rêves en psychanalyse avec les psychotiques, tels que la non-distinction entre rêve, réalité et délire, la difficulté de l'association libre et l'invasion des cauchemars. On plaide pour l'utilisation des rêves dans la clinique des psychoses et décrit comment ceux-ci peuvent contribuer au traitement, en mettant en discours les expériences ineffables, permettant l'historisation et remplaçant l'association par l'enchaînement des rêves. La vie onirique peut être un remède efficace contre le retour au réel, étant préférable d'interroger les rêves avec des questions plus précises visant à les relier à la vie du rêveur et à sa position subjective.
Subject(s)
Humans , Male , Female , Child , Adult , Paranoid Disorders/psychology , Psychotic Disorders/psychology , Schizophrenic Psychology , Dreams , Psychoanalysis , Unconscious, PsychologyABSTRACT
Awareness of perceptual and sensory changes that might occur in visual, auditory, proprioception, and other senses, in the early stages towards the First Episode Psychosis (FEP), and their subsequent sensorial evolution as the disturb progresses deeper into an acute episode, might be a key element for interrupting the process. In the present study, we investigated hearing discomfort/tolerance to 16 given sound streams. Sixteen people diagnosed with FEP, participated in the experiment. Sixteen frequency sweeps varying in modulation envelopes (sawtooth, sine), order (ascending, descending), duration (4s, 8s), and range (508000 Hz, 28 kHz) were presented randomly, but always in the same sequence, to FEP and healthy controls (HC). The level of discomfort was estimated by the participant by making a mark across a continuous line whose extremes read "nothing bad" (left) and "too bad" (right). Results showed that ascending sine pure frequency sweeps (p < 0.01) and descending sine pure frequencies sweeps (p < 0.01) caused the maximum discomfort in FEP. Other variables also showed differences between FEP and HC, and FEP were always more intolerant to such pure frequency sweeps than HC. We conclude that this might be useful for very early assessment of people at risk, people with FEP, and people with schizophrenia. (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Schizophrenic Psychology , Auditory Perception , Psychoacoustics , Psychotic DisordersABSTRACT
Objectives: A previous study has shown that schizophrenia (SCZ) is accompanied by lowered levels of trace/metal elements, including cesium. However, it is not clear whether changes in cesium, rubidium, and rhenium are associated with activated immune-inflammatory pathways, cognitive impairments, and the symptomatology of SCZ. Methods: This study measured cesium, rubidium, and rhenium, cognitive impairments (using the Brief Assessment of Cognition in Schizophrenia [BACS]), and the levels of cytokines/chemokines interleukin (IL)-1β, tumor necrosis factor (TNF)-α, and eotaxin (CCL11) in 120 patients with SCZ and 54 healthy controls. Severity of illness was assessed using the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), the Fibromyalgia and Chronic Fatigue Syndrome Rating (FF) Scale, and the Hamilton Depression Rating Scale (HAM-D). Results: Serum cesium was significantly lower in patients with SCZ as compared with controls. Further, serum cesium was significantly and inversely associated with CCL11 and TNF-α, but not IL-1β, in patients with SCZ; significant inverse associations were also noted between serum cesium levels and BPRS, FF, HAM-D, and SANS scores. Finally, cesium was positively correlated with neurocognitive probe results including the Tower of London, Symbol Coding, Controlled Word Association, Category Instances, Digit Sequencing Task, and List Learning tests. Conclusion: The results suggest that lowered serum cesium levels may play a role in the pathophysiology of SCZ, contributing to specific symptom domains including negative, depressive and fatigue symptoms, neurocognitive impairments (spatial working, episodic, and semantic memory and executive functions), and neuroimmune pathways.
Subject(s)
Humans , Schizophrenia , Cognitive Dysfunction , Schizophrenic Psychology , Biomarkers , Cesium , LondonABSTRACT
Objective: The purpose of this study was to investigate the lifetime suicide attempt rate, clinical characteristics and cognitive function of Chinese patients with chronic schizophrenia who had attempted suicide. Methods: We collected data from 908 schizophrenia inpatients about suicide attempts through interviews with the patients and their families, as well as through medical records. All patients were assessed with the Positive and Negative Syndrome Scale, the Rating Scale for Extrapyramidal Side Effects, the Abnormal Involuntary Movement Scale, and the Repeated Battery for the Assessment of Neuropsychological Status. Results: Of this sample, 97 (10.68%) had attempted suicide. Patients who had attempted suicide were younger, had longer illness duration, and more severe general psychopathology and depressive symptoms than those who had not. Logistic regression analysis confirmed that suicide attempts were correlated with age, smoking, and depression. No cognitive performance differences were observed between patients who had and had not attempted suicide. Conclusions: In China, patients with chronic schizophrenia may have a higher prevalence of lifetime suicide attempts than the general population. Some demographic and clinical variables were related to suicide attempts in patients with chronic schizophrenia.
Subject(s)
Humans , Schizophrenia/epidemiology , Suicide, Attempted , Psychiatric Status Rating Scales , Schizophrenic Psychology , China/epidemiology , Risk Factors , CognitionABSTRACT
In this study, we compared visual pictorial size perception between healthy volunteers (CG) and an experimental group (EG) of people diagnosed with schizophrenia. We have been using paintings by Salvador Dalí and Rorschach plates to estimate visual pictorial size perception. In this transversal, ex post facto, and quasi-experimental study, we observed differences between EG and CG. Schizophrenic in-patients perceived sizes about 1.3-fold greater than healthy volunteers (p=0.006), implying that pictorial size perception is altered in some way in schizophrenia. Considering the present and previous results, this measurement of diameter size of first pictorial perception may be a useful estimate of some aspects of perceptual alterations that may be associated with psychotic symptoms in prodromal and acute schizophrenic episodes and other related mental states. Eventually, this may help in preventing people from evolving to acute episodes.
Subject(s)
Humans , Male , Female , Adult , Paintings/psychology , Schizophrenia , Schizophrenic Psychology , Visual Perception/physiology , Size Perception/physiologyABSTRACT
Objective: To analyze the association between severe mental illnesses and health behaviors among Brazilian adults. Methods: We used data from the Brazilian National Health Survey, a large nationally representative cross-sectional study conducted in 2013 among 60,202 adults (≥ 18 years). Clinical diagnoses (major depressive disorder, bipolar disorder and schizophrenia), lifestyle behaviors (leisure-time physical activity, TV viewing, tobacco use and the consumption of alcohol, sweets, and soft drinks) and potential confounders (chronological age, race, educational and employment status) were self-reported. Logistic regression models were used to examine the associations between severe mental illness and lifestyle behaviors, adjusting for confounders. Results: Schizophrenia (n=41) was associated with lower odds of physical activity (OR 0.08 [95%CI 0.01-0.58]). Major depressive disorder (n=4,014) was associated with higher odds of TV viewing (OR 1.34 [95%CI 1.12-1.61]), tobacco use (OR 1.37 (95%CI 1.18-1.58]), consumption of sweets (OR 1.34 (95%CI 1.15-1.55]) and consumption of soft drinks (OR 1.24 (95%CI 1.06-1.45]). There were no significant associations between bipolar disorder (n=47) and any lifestyle behaviors. Conclusions: Schizophrenia was associated with lower physical activity, while major depressive disorder was associated with increased TV viewing, tobacco use, and consumption of sweets and soft drinks. These findings reinforce the need for prevention and treatment interventions that focus on people with severe mental illness in Brazil.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Schizophrenic Psychology , Bipolar Disorder/psychology , Health Behavior , Depressive Disorder, Major/psychology , Life Style , Socioeconomic Factors , Time Factors , Brazil , Exercise/psychology , Case-Control Studies , Logistic Models , Cross-Sectional Studies , Self Report , Leisure Activities/psychology , Middle AgedSubject(s)
Humans , Male , Female , Adult , Aged , Young Adult , Psychotic Disorders/psychology , Schizophrenic Psychology , Sexual Behavior/psychology , Mood Disorders/psychology , Social Stigma , Emotional Regulation , Anxiety/psychology , Psychiatric Status Rating Scales , Pilot Projects , Surveys and Questionnaires , Depression/psychology , Middle AgedABSTRACT
Schizophrenia is a common disease characterized by thinking obstructions and accompanied by cognitive, emotional and behavioral disorders. Under the control of psychiatric symptoms, patients with schizophrenia may self-injure or impulsively wound others, resulting in public risk and increase in the burden of family and society. In recent years, many studies have shown that the violent behavior of patients with schizophrenia is related to genetic factors. This article reviews the research progress on the relationship between genetic polymorphism and violent behavior of patients with schizophrenia, analyzes the possible mechanism of the correlation between the two, puts forward the limitations of current research and the directions of future research, and provides scientific basis for risk assessment and prevention of violent behavior of patients with schizophrenia.
Subject(s)
Humans , Aggression , Polymorphism, Genetic , Risk Assessment , Schizophrenia/genetics , Schizophrenic Psychology , ViolenceABSTRACT
Resumo Objetivou-se compreender a experiência de ouvir vozes a partir das características e conteúdos das vozes, e das estratégias utilizadas por dezesseis ouvidores usuários de um Centro de Atenção Psicossocial do Sul do Brasil. Trata-se de uma pesquisa qualitativa de caráter exploratório. Se deu através de entrevistas semiestruturadas e análise de conteúdo. Evidenciou-se que as características e conteúdos das vozes podem ser determinantes das reações emocionais dos ouvidores frente à experiência, sendo mais difícil lidar com ela quando os conteúdos são negativos. Através das estratégias utilizadas pelos ouvidores, percebeu-se uma resistência ao modelo biomédico, mesmo dentro de um serviço de saúde mental. Conclui-se que há uma necessidade de se pensar outras possibilidades de recuperação para as pessoas que ouvem vozes, que deem conta da complexidade da experiência e que sejam condizentes com o modelo de atenção psicossocial.
Resumen El estudio objetivó comprender la experiencia de oír voces a partir de las características y contenidos de las voces y las estrategias utilizadas por dieciséis oyentes que utilizan un Centro de Atención Psicosocial en el sur de Brasil. Esta es una investigación exploratoria cualitativa. Se llevó a cabo mediante entrevistas semiestructuradas y análisis de contenido. Se destacó que características y contenidos de las voces pueden ser determinantes de reacciones emocionales de los oidores delante la experiencia, siendo más difícil ocuparse de ella cuando los contenidos son negativos. A través de estrategias utilizadas por los oidores, se notó una resistencia al modelo biomédico, aunque dentro de un servicio de salud mental. Se concluye que hay una necesidad de pensar otras posibilidades de recuperación para las personas que oyen voces, que aporten la complejidad de la experiencia y que sean compatibles con el modelo de atención psicosocial.
Abstract The study aimed to understand the experience of hearing voices from the analysis of the characteristics and contents of the voices, and of the strategies used by sixteen voice hearers who use a Psychosocial Care Center in Southern Brazil. This is a qualitative exploratory research, conducted through semi-structured interviews and content analysis. It was evidenced that the characteristics and contents of the voices can be determinant of the hearer's emotional reactions to the experience, being more difficult to deal with when those are negative. By analyzing the strategies used by the hearers, resistance to the biomedical model was perceived even within a mental health service. It was concluded that there is a need to think about other possibilities of recovery for people who hear voices, possibilities that take into account the complexity of the experience and that are consistent with the psychosocial care model.
Subject(s)
Schizophrenia/rehabilitation , Health Strategies , Deinstitutionalization/methods , Mental Health Services , Schizophrenic Psychology , Psychiatric RehabilitationABSTRACT
La presente investigación corresponde a un estudio no experimental, transversal y correlacional, cuyo objetivo fue identificar si existe relación entre funcionamiento social (FS) y cognitivo (FC) en pacientes con esquizofrenia, mediante la evaluación del funcionamiento social (SFS) y deterioro cognitivo (MoCA y SCIP-S) en una muestra de 12 pacientes (11 hombres y 1 mujer) entre los 22 y 70 años, de Medellín (Colombia), mediante muestreo no probabilístico por conveniencia. Se encontró que más de la mitad (n = 7) presenta un nivel superior de FS y casi el total de la muestra presenta deterioro cognitivo. Al correlacionar FS y FC se encontró que sólo SFS y MoCA se relacionan significativamente, mientras que la SCIP-S no presenta relación con SFS ni con MoCA. Aunque estos hallazgos no pueden ser concluyentes ni generalizables debido a limitaciones metodológicas, pueden ser usados como antecedente para futuros estudios.
A non-experimental, cross-sectional and correlational study was made, whose objective was to identify if there is a relationship between social functioning (SF) and cognitive functioning (CF) in patients with schizophrenia, through the evaluation of social functioning (SFS) and cognitive impairment (MoCA and SCIPS) in a sample of 12 patients (11 men and 1 woman) between 22 and 70 years old, from Medellín (Colombia), selected by non-probabilistic sampling for convenience. It was found that more than half of the participants (n = 7) present a higher level of SF and almost the total of the sample presents cognitive impairment. When correlating SF and CF it was found that only SFS and MoCA are significantly related, whereas SCIP-S has no relation with SFS or with MoCA. Although these findings cannot be conclusive or generalizable due to methodological limitations, they can be used as a background for future studies.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Schizophrenia/physiopathology , Schizophrenic Psychology , Cross-Sectional StudiesABSTRACT
ABSTRACT Objectives: To explore the relationship between severe/serious mental illness (SMI) and the behavioral variant of frontotemporal dementia (bvFTD), as the patterns of symptoms and cognitive performance that characterize both disorders share similarities. Methods: We performed a systematic review investigating what has already been published regarding the relationship between bvFTD and SMI. Studies were selected from PubMed and LILACS databases, including those published up to February 12, 2018. The search strategy included the following terms: "frontotemporal dementia" plus "bipolar", OR "frontotemporal dementia" plus "schizophrenia", OR "frontotemporal dementia" plus "schizoaffective". Publications without abstracts, case reports with absent genetic or histopathological confirmation, reviews and non-English language papers were excluded across the search process. Results: The search on PubMed retrieved 186 articles, of which 42 met eligibility criteria. On the LILACS database, none met the requirements. Generally, three major research aims were identified: 1) to look for frontotemporal lobar degeneration-associated genetic abnormalities in patients with prior SMI; 2) to compare the cognitive profile between patients affected by neurodegenerative disorders and schizophrenic patients; 3) to highlight the association between bvFTD and preceding psychiatric conditions and/or distinguish them both. The investigated mutations were found infrequently in the studied SMI samples. Cross-sectional studies comparing cognitive performance between bvFTD and psychiatric disorders mostly found no remarkable differences. There were only a few case reports identifying definite frontotemporal lobar degeneration in patients with previous psychiatric diagnoses. Conclusions: The available evidence demonstrates how fragile the current understanding is regarding the association between bvFTD and prior SMI.
RESUMO Objetivos: Explorar a relação entre doença mental grave (DMG) e a variante comportamental da demência frontotemporal (DFTvc), uma vez que os padrões de sintomas e de desempenho cognitivo que caracterizam ambos os transtornos compartilham semelhanças. Métodos: Revisão sistemática investigando estudos publicados sobre a relação entre DFTvc e DMG. Os estudos foram selecionados nas bases de dados PubMed e LILACS, incluindo aqueles publicados até 12 de fevereiro de 2018. A estratégia de busca incluiu os seguintes termos: "demência frontotemporal" e "bipolar", OU "demência frontotemporal" e "esquizofrenia" OU "demência frontotemporal" e "esquizoafetivo". Publicações sem resumos, relatos de casos sem confirmação genética ou histopatológica, revisões e artigos escritos em idiomas que não fossem o inglês não foram selecionados na busca sistemática. Resultados: A pesquisa no PubMed encontrou 186 artigos, dos quais 42 alcançaram critérios de elegibilidade. Na base de dados LILACS, nenhum dos nove artigos identificados atendeu aos requisitos. Foram identificados três objetivos de pesquisa principais: buscar anormalidades genéticas associadas à degeneração lobar frontotemporal (DLFT) em pacientes com SMI prévia; comparar o perfil cognitivo entre pacientes acometidos por doenças neurodegenerativos e esquizofrênicos; destacar a associação entre DFTvc e condições psiquiátricas precedentes e/ou distinguir ambos. As mutações investigadas foram encontradas infrequentemente nas amostras estudadas. Os estudos transversais comparando o desempenho cognitivo entre DFTvc e os transtornos psiquiátricos não encontraram diferença, e houve apenas relatos de casos confirmando de DLFT em pacientes com diagnósticos psiquiátricos prévios. Conclusões: A evidência disponível demonstra quão frágil é o entendimento atual sobre a associação entre DFTvc e DMG.
Subject(s)
Humans , Male , Female , Frontotemporal Dementia/psychology , Mental Disorders/psychology , Schizophrenic Psychology , Frontotemporal Dementia/complications , Cognitive Dysfunction/psychology , Mental Disorders/complicationsABSTRACT
La esquizofrenia como trastorno psiquiátrico es una enfermedad crónica que causa un impacto importante en la vida de las personas. Esta condición genera no sólo cambios en las capacidades organizativas y funcionales, sino que además emergen aspectos poco valorados en el plano subjetivo de las personas. Esta investigación tiene como propósito comprender el significado de vivir con esquizofrenia a partir de la experiencia de usuarios en control en un Centro de Salud Mental. Mediante la Metodología Cualitativa, se logra responder interrogantes sobre cuál es el significado de los usuarios en el desarrollo vivencial de la enfermedad. Se aplicó una entrevista en profundidad a seis usuarios en etapa de estabilización de la enfermedad, incluyendo los ejes de la Teoría de las Transiciones de la Dra. Afaf Meléis. De esta manera, se logra acceder al mundo de sus significados individuales; a través de los relatos emergen sentimientos de miedo, tristeza, soledad y rechazo, fuertemente relacionados con la falta de apoyo social y discriminación. Asimismo, el ser consciente de ser portador de una enfermedad mental es un elemento facilitador hacia el logro de un mejor nivel de satisfacción y conciencia personal, proceso fundamental para el mejoramiento de los procesos psicoterapéuticos.
Schizophrenia as a psychiatric disorder is a chronic disease that causes a major impact on people's lives. This condition generates not only changes in the organizational and functional capacities, but also emerge aspects that are not valued at the subjective level of the people. This research aims to understand the meaning of living with schizophrenia from the experience of users in control in a Mental Health Center. Through the Qualitative Methodology, it is possible to answer questions about the meaning of users in the experiential development of the disease. An in-depth interview was conducted with six users in the stage of disease stabilization, including the axes of Dr. Afaf Meléis's Theory of Transitions. In this way, one reaches the world of their individual meanings; through the stories emerge feelings of fear, sadness, loneliness and rejection, strongly related to the lack of social support and discrimination. Likewise, being aware of being a carrier of a mental illness is an element that facilitates the attainment of a better level of satisfaction and personal conscience, a fundamental process for the improvement of the psychotherapeutic processes.
Subject(s)
Humans , Schizophrenic Psychology , Social Support , Mental Health , Interviews as Topic , Qualitative Research , Social Stigma , Social DiscriminationABSTRACT
La esquizofrenia es una prioridad sanitaria de primer orden, debido a su alta frecuencia en relación con otras enfermedades mentales. Patologías que, por sus propias características y curso evolutivo, ponen más a prueba la solidez y consistencia de las pautas de intervención que sobre ellas se realizan. Además un porcentaje alto de familias sienten estrés y dificultades que afectan de manera significativa su funcionamiento. Desde la década de los noventa se ha postulado que aplicar intervenciones integrales, farmacológicas, psicológicas y psicosociales, en una etapa precoz de la enfermedad, sería una estrategia beneficiosa para los pacientes, logrando con ello mejores resultados en cuanto a la evolución de la enfermedad a largo plazo. Entre ellas está la Psicoeducación (PE), que también tiene la función de contribuir a la no estigmatización de los trastornos psicológicos y disminuir las barreras para el tratamiento. En este trabajo presentamos un estudio en Chile de Psicoeducación con familiares de pacientes en primer episodio de esquizofrenia, aplicada por el sector 1 del Instituto Psiquiátrico Dr. José Horwitz Barak. Los contenidos de éste se basan en las Guías Clínicas GES (2016), y se enmarcan en las políticas públicas de salud promovidas por el Ministerio de Salud.
Schizophrenia should be a health priority because of its high frequency in relation to other mental illnesses. Pathologies that, due to their own characteristics and evolutionary course, put more to the test the solidity and consistency of the intervention guidelines that are carried out on them. In addition, a high percentage of families feel stress and difficulties that significantly affect their functioning. Since the nineties it has been postulated that applying comprehensive, pharmacological, psychological and psychosocial interventions, at an early stage of the disease, would be a beneficial strategy for patients, thereby achieving better results in the evolution of the disease in the long term. Among them is Psychoeducation (PE), which also has the function of contributing to the non-stigmatization of psychological disorders and reducing barriers to treatment. In this paper we present a study in Chile of sychoeducation with family members of patients in the first episode of schizophrenia, applied by sector 1 of the Dr. José Horwitz Barak Psychiatric Institute. The contents are based on the GES Clinical Guidelines (2016), and are framed in public health policies promoted by the Ministry of Health.
Subject(s)
Humans , Psychotic Disorders/rehabilitation , Schizophrenia/rehabilitation , Family Health , Health Education/methods , Schizophrenic Psychology , Family/psychology , Chile , Caregivers/psychologyABSTRACT
Abstract Objective: This preliminary study aimed to identify and compare characteristics related to violent behavior in inpatients with schizophrenia at a general psychiatric hospital using the Historical, Clinical, and Risk Management 20 (HCR-20), the Modified Overt Aggression Scale (MOAS), and sociodemographic data. Method: Violent and nonviolent participants were selected based on psychiatric admission reports. Participants with reports of aggressive behavior and HCR-20 total score ≥ 21 upon admission were assigned to the violent patient group. Participants without aggressive behavior and with HCR-20 total score < 21 upon admission were assigned to the nonviolent patient group. The MOAS was applied to characterize the degree of severity of the violent behavior. Results: HCR-20 and its subscales were effective in differentiating between the violent and nonviolent participant groups. Twelve of the 20 HCR-20 items were useful for distinguishing between the groups, although total HCR-20 scores were more reliable when applied to the nonviolent patient group. The MOAS did not show high degrees of severity for the types of aggression observed in the participants. Conclusion: HCR-20 was useful and reliable for distinguishing between violent and nonviolent patients with schizophrenia in this clinical psychiatric setting. Item analysis identified the most relevant characteristics in each group. The use of the HCR-20 in clinical psychiatric settings should be encouraged.
Resumo Objetivo: Este estudo preliminar tem por objetivo identificar e comparar características relacionadas ao comportamento violento em pacientes com esquizofrenia internados em um hospital psiquiátrico utilizando o Historical, Clinical, and Risk Management 20 (HCR-20), a Modified Overt Aggression Scale (MOAS), e dados sociodemográficos. Método: Foram selecionados participantes com e sem histórico de comportamento violento, referidos nos relatórios de internação hospitalar. Participantes violentos e com escore total do HCR-20 ≥ 21 na internação foram selecionados para o grupo violento. Participantes não violentos com escore total do HCR-20 < 21 na internação foram selecionados para o grupo não violento. A MOAS foi aplicada para caracterizar o grau de severidade do comportamento violento. Resultados: O HCR-20 e suas subescalas foram eficazes na diferenciação entre os participantes dos grupos. Doze dos 20 itens do HCR-20 foram úteis na diferenciação entre os grupos, apesar do escore total do HCR-20 ter sido mais confiável quando aplicado ao grupo não violento. A MOAS não apresentou graus de severidade elevados para os tipos de agressividade observados nos participantes. Conclusão: O HCR-20 foi útil e confiável na distinção entre pacientes esquizofrênicos violentos e não violentos em ambiente psiquiátrico clínico, já que a análise dos itens identificou as características mais relevantes em cada grupo. O uso do HCR-20 em ambientes psiquiátricos clínicos deveria ser encorajado.
Subject(s)
Humans , Male , Adolescent , Adult , Young Adult , Violence , Psychiatric Status Rating Scales , Schizophrenia/diagnosis , Schizophrenia/therapy , Schizophrenic Psychology , Cross-Sectional Studies , Risk Assessment , Preliminary Data , Hospitalization , Hospitals, Psychiatric , Inpatients/psychology , Middle AgedABSTRACT
Abstract Objective To evaluate the relationship of sociodemographic and clinical characteristics and satisfaction with social support with the quality of life of schizophrenic patients. Methodology This study included a sample of 268 participants. An interview was conducted to obtain sociodemographic and clinical data, supplemented with two assessment tools used to evaluate quality of life (World Health Organization Quality of Life instrument-Abbreviated version - WHOQOL-Bref) and satisfaction with social support (Social Support Satisfaction Scale - SSSS). Descriptive and inferential analyses were performed. Results Most individuals were male (63.4%), with a mean age of 45.4 years, single (85.4%), living with their family (62.3%) and unemployed (90.3%). As for clinical characteristics, most had the disease for less than 20 years (50.7%), and 55.6% had at least one hospitalization within the last 5 years. Being employed and having had no hospitalization within the last 5 years were positively correlated with one or more WHOQOL-Bref domains. The results of the variables intimacy (p<0.001) and satisfaction with friends (p<0.001) were independently related to the total WHOQOL-Bref score. Conclusion Having a job, having had no hospitalization within the last 5 years and having greater satisfaction with social support are factors that positively influence quality of life among schizophrenics. It is therefore crucial that the psychosocial rehabilitation of patients with schizophrenia take these factors into account, increasing the support network, preventing relapses and promoting occupational activities.
Resumo Objetivo Avaliar a relação entre as características sociodemográficas e clínicas e a satisfação com o suporte social com a qualidade de vida dos doentes com esquizofrenia. Métodos A amostra do estudo é de 268 participantes. Foi realizada uma entrevista para obter os dados sociodemográficos e clínicos e aplicados dois questionários para avaliar a qualidade de vida (World Health Organization Quality of Life instrument-Abbreviated version - WHOQOL-Bref) e a satisfação com o suporte social (Escala de Satisfação com o Suporte Social - ESSS). Foram efetuadas análises descritivas e inferenciais. Resultados A maioria dos indivíduos era do gênero masculino (63,4%), com uma média de idade de 45,4 anos, solteiros (85,4%), vivendo com a família (62,3%) e desempregados (90,3%). Relativamente às características clínicas, 50,7% tinham a doença há menos de 20 anos, e 55,6% estiveram internados pelo menos uma vez nos últimos 5 anos. Os resultados demonstraram que estar empregado e não ter sido internado nos últimos 5 anos estão positivamente relacionados com um ou mais domínios da WHOQOL-Bref. A satisfação com a intimidade (p<0,001) e a satisfação com os amigos (p<0,001) foram independentemente associados ao escore total da WHOQOL-Bref. Conclusão Ter emprego, não ter hospitalizações nos últimos 5 anos e estar satisfeito com o suporte social são fatores que influenciam positivamente a qualidade de vida dos doentes com esquizofrenia. Por conseguinte, é crucial que esses fatores sejam levados em conta nos programas de reabilitação com o suporte social, aumentando a rede de suporte, evitando recaídas e promovendo atividades ocupacionais.
Subject(s)
Humans , Male , Female , Adult , Aged , Young Adult , Quality of Life , Schizophrenic Psychology , Social Support , Personal Satisfaction , Schizophrenia/physiopathology , Schizophrenia/therapy , Schizophrenia/epidemiology , Cross-Sectional Studies , Employment/psychology , Hospitalization , Middle AgedABSTRACT
Abstract Objective To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities. Methods Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships - Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively. Results Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale. Conclusion Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.
Resumo Objetivos Avaliar o padrão de apego em portadores de esquizofrenia e discutir a relação que tais padrões apresentam com a sintomatologia psicótica e as comorbidades dos pacientes investigados. Métodos Vinte pacientes diagnosticados com esquizofrenia de acordo com os critérios do Manual Diagnóstico e Estatístico de Transtornos Mentais, 5ª edição (DSM-5) foram submetidos a avaliação de sintomas retrospectivos e avaliação cuidadosa do número e modo de mudança de cuidador da infância. A Entrevista Diagnóstica para Psicoses e Transtornos Afetivos (DI-PAD) foi utilizada para avaliar sintomas relacionados à esquizofrenia (sintomas positivos e negativos), depressão e mania. As comorbidades de transtorno de ansiedade foram avaliadas pela Escala de Ansiedade Social de Liebowitz (LSAS), Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS) e Entrevista de Pânico e Esquizofrenia (PaSI). Os instrumentos Questionário das Experiências nas Relações Próximas-Estruturas Relacionais (ECR-RS) e Inventário de Autorrelato de Trauma Precoce - Forma Curta (ETISR-SF) foram utilizados para avaliar padrões de apego e histórico traumático, respectivamente. Resultados Foram identificadas correlações significativas entre a ocorrência de traumas precoces e o apego do tipo ansioso. Também foi verificada a relação entre traumas gerais e sintomas de pânico, constatando-se que as crises de pânico antecipam surtos quando predominam sintomas ansiosos, somáticos, alucinações e ideias delirantes. Foi observado que a ocorrência de traumas precoces contribui para o pânico, elevando o risco de episódios psicóticos. Conclusão . Os resultados indicam que as adversidades ambientais na infância estão associadas com o risco de desenvolvimento de esquizofrenia e de outras psicoses mais tarde na vida.
Subject(s)
Humans , Male , Female , Adult , Schizophrenia/complications , Schizophrenia/epidemiology , Schizophrenic Psychology , Adult Survivors of Child Adverse Events/psychology , Object Attachment , Psychiatric Status Rating Scales , Bipolar Disorder/complications , Bipolar Disorder/epidemiology , Comorbidity , Risk Factors , Panic Disorder/complications , Panic Disorder/epidemiology , Depression/complications , Depression/epidemiology , Hallucinations/complications , Hallucinations/epidemiologyABSTRACT
Abstract Objective Perplexity and hyperreflectivity are considered important aspects of self-disorders in patients with schizophrenia, yet knowledge of the appropriate psychotherapy for these patients is sparse. We aimed to explore how phenomenological psychologists or psychiatrists described their approach to these patients and their own emotional response when hyperreflectivity and perplexity emerged in therapy or consultations. Methods Four e-mail interviews with experienced clinical researchers within the field of phenomenology and schizophrenia were examined using a double hermeneutic qualitative analysis. Results The informants offered reassurance by authority and the encouragement of sharing of experiences interlaced in the beginning of therapy. Later they went on relating expressions of hyperreflectivity and perplexity to emotions, life events and goals. They described feelings of admiration and professional recognition along with worry, insecurity and sadness. Conclusion The list of primary themes covers what might seem very basic therapeutic interventions. However, the careful and open-minded manner in which these were carried out was noteworthy. The double task of staying closely attuned to the patient's airy reflections and, at the same time, when the patient was ready for it, carefully making links to domains of the patient's everyday life, was clearly molded to patients with fragile attachment.
Resumo Objetivo A perplexidade e a hiper-reflexão são consideradas aspectos importantes dos desordens do self em pacientes com esquizofrenia, porém o conhecimento sobre o tipo mais apropriado de psicoterapia para esses pacientes é escasso. Nosso objetivo foi explorar como psicologistas fenomenológicos ou psiquiatras descrevem suas abordagens a pacientes aos pacientes e sua própria resposta emocional, quando a hiper-reflexão e a perplexidade emergem durante a terapia ou as consultas. Métodos Quatro entrevistas feitas por e-mail com pesquisadores clínicos experientes na área de fenomenologia e esquizofrenia foram examinadas usando análise qualitativa dupla hermenêutica. Resultados Os informantes ofereceram confiança via autoridade e motivação para compartilhar experiências, interligadas, no início da terapia. Subsequentemente, eles seguiram relacionando expressões de hiper-reflexão e perplexidade a emoções, eventos de vida e objetivos. Eles descreveram sentimentos de admiração e reconhecimento profissional juntamente com preocupação, insegurança e tristeza. Conclusão A lista de tópicos primários engloba o que poderiam parecer intervenções terapêuticas muito básicas. No entanto, a forma cuidadosa e aberta como essas intervenções foram conduzidas é digna de nota. A tarefa dupla de estar atento às reflexões aéreas do paciente e, ao mesmo tempo, quando o paciente está pronto, cuidadosamente estabelecer relações com os domínios de sua vida diária, foi claramente moldada para pacientes com vínculo frágil.
Subject(s)
Humans , Psychotherapy/methods , Schizophrenia/therapy , Schizophrenic Psychology , Health Personnel/psychology , Electronic Mail , HermeneuticsABSTRACT
Abstract Introduction: Neurological soft signs (NSS) have been considered one of the target features and a potential endophenotype for schizophrenia. The present study aimed to characterize NSS in a sample of patients with chronic schizophrenia and to compare them with healthy control individuals. Methods: In this study, we evaluated the presence of NSS in a sample of stable patients (n = 24) diagnosed with schizophrenia according to DSM-IV criteria, recruited at the Schizophrenia Outpatient Clinic of Instituto Raul Soares, Belo Horizonte, state of Minas Gerais, southeastern Brazil. Assessment was made with the Brief Motor Scale (BMS), and extrapyramidal symptoms (EPS) were evaluated with the Simpson-Angus Scale (SAS) and the Abnormal Involuntary Movement Scale (AIMS). A control group (n = 21) was also submitted to the same battery of tests. Results: We observed a significant difference in relation to BMS and SAS scores (p < 0.0001), revealing that individuals with schizophrenia present more NSS and EPS than healthy ones. BMS total scores correlated positively with SAS scores (r = 0.495, p = 0.014), but not with AIMS scores, indicating that NSS could be influenced by the intensity of EPS. Nevertheless, we observed that this relationship remained only for motor coordination tasks (r = 0.550, p = 0.005), while motor sequencing tasks were not influenced by EPS (r = 0.313, p = 0.136). Conclusion: The results suggest that NSS are more frequent in patients with schizophrenia and that motor sequencing tasks could be more specific to the syndrome.
Resumo Introdução: Sinais neurológicos sutis (SNS) têm sido considerados características básicas e potenciais endofenótipos na esquizofrenia. O presente estudo procurou caracterizar os SNS em uma amostra de pacientes com esquizofrenia crônica e compará-los com indivíduos controles saudáveis. Métodos: Neste estudo, avaliamos a presença de SNS em uma amostra de pacientes estáveis (n = 24) com o diagnóstico de esquizofrenia de acordo com os critérios do DSM-IV, recrutados no Ambulatório de Esquizofrenia do Instituto Raul Soares, Belo Horizonte, MG, Brasil. A avaliação foi realizada com a Escala Motora Breve (BMS) e sinais extrapiramidais (SEP) foram observados com a Escala de Simpson-Angus (SAS) e a Escala de Movimentos Involuntários Anormais (AIMS). Um grupo controle (n = 21) também foi submetido à mesma bateria de testes. Resultados: Observamos uma diferença significativa em relação aos escores da BMS e da SAS (p < 0,0001), revelando que indivíduos com esquizofrenia apresentam mais SNS e SEP que indivíduos saudáveis. Os escores da BMS se correlacionaram positivamente com os da SAS (r = 0,495, p = 0,014), mas não com os da AIMS, indicando que os SNS podem ser influenciados pela intensidade de SEP. No entanto, observamos que essa relação permaneceu somente para as tarefas de coordenação motora (r = 0,550, p = 0,005), enquanto as tarefas de sequenciamento motor não foram influenciadas pelos SEP (r = 0,313, p = 0,136). Conclusão: Os resultados sugerem que os SNS são mais frequentes em pacientes com esquizofrenia e que tarefas de sequenciamento motor podem ser mais específicas na síndrome.
Subject(s)
Humans , Male , Female , Adult , Schizophrenia/diagnosis , Neurologic Examination , Psychiatric Status Rating Scales , Schizophrenia/physiopathology , Schizophrenic Psychology , Brazil , Endophenotypes , Motor SkillsABSTRACT
Abstract Introduction Assessing adherence in schizophrenia facilitates interventions that optimize outcomes. Adherence rating questionnaires are feasible and non-intrusive; however, no validated measure exists in sub-Saharan Africa. We aimed to assess the psychometric properties of the 10-item Medication Adherence Rating Scale (MARS). Methods This was a cross-sectional study of a cohort of patients with schizophrenia (n=230). A sociodemographic questionnaire, the Mini International Neuropsychiatric Interview (MINI), Positive and Negative Syndrome Scale (PANSS), Scale for the Unawareness of Mental Disorder (SUMD) and the MARS were all administered by an interviewer. Results The MARS demonstrated good reliability (Cronbach's alpha: 0.76). The scale was reducible to a 3-factor construct (1 - medication adherence behavior, 2 - attitude to taking medications, and 3 - negative side effects and attitude to psychotropics), with significant though weak external validity in relation to psychopathology (p<0.001) and insight (p<0.001). The first factor showed good internal consistency (α=0.80), comprising six items that could serve as a reliable proxy measure of adherence in place of the MARS Conclusion The MARS demonstrated fair psychometric characteristics in assessing adherence in patients with schizophrenia in this cohort. The scale may be useful in the dimensional assessment of medication adherence for schizophrenia in sub-Saharan African settings.
Resumo Introdução Avaliar adesão ao tratamento na esquizofrenia facilita intervenções que otimizam desfechos. Questionários de avaliação da adesão são factíveis e não intrusivos; no entanto, não há uma medida validada na África subsaariana. O objetivo deste estudo foi avaliar as propriedades psicométricas da escala de 10 itens intitulada Medication Adherence Rating Scale (MARS). Métodos Este foi um estudo transversal de uma coorte de pacientes com esquizofrenia (n=230). Um questionário sociodemográfico e os instrumentos Mini International Neuropsychiatric Interview (MINI), Positive and Negative Syndrome Scale (PANSS), Scale for the Unawareness of Mental Disorder (SUMD) e a MARS foram todos administrados por um entrevistador. Resultados A MARS demonstrou boa confiabilidade (alfa de Cronbach: 0,76). Foi possível reduzir a escala a um construto de 3 fatores (1 - comportamento de adesão à medicação, 2 - atitude em relação a tomar medicação, e 3 - efeitos colaterais negativos e atitude em relação aos psicotrópicos), com validade externa significativa, embora fraca, em relação à psicopatologia (p<0,001) e ao insight (p<0,001). O primeiro fator mostrou boa consistência interna (α=0,80), incluindo seis itens que poderiam servir como uma medida substituta confiável de adesão no lugar da MARS Conclusão A MARS demonstrou características psicométricas satisfatórias ao avaliar adesão em pacientes com esquizofrenia nesta coorte. A escala pode ser útil na avaliação dimensional da adesão ao tratamento para esquizofrenia em contextos africanos subsaarianos.