Discapacidad mental y bioética: de la postergación a las oportunidades

Propósito/Contexto. La discapacidad mental altera el curso natural de la existencia humana porque impacta la construcción de la propia identidad y la interacción con el contexto en el que se habita. Pese a su relevancia, la discapacidad mental no ha estado en el centro del debate bioético. En el presente artículo se exponen algunas de las razones de esa postergación en este debate, revisando desde los modelos comprensivos anteriormente imperantes hasta los nuevos que incorporan principios éticos entre sus ejes. Metodología/Enfoque. Se revisaron los distintos modelos desde donde se comprende la discapacidad mental, comenzando por los de enfoque médico y social hasta los recientes modelos biopsicosociales y de la diversidad. Se identifica que los primeros modelos tenían el concepto de capacidad como eje teórico y que los actuales se proponen develar y erradicar la lógica de la exclusión aún no superada. Resultados/Hallazgos. La bioética tendría el doble rol de servir como modelo comprensivo y de instrumento que posibilite el debate ético en sociedades pluralistas, al propiciar abordajes ético-ontológicos útiles para el desarrollo de políticas sociosanitarias que permitan alcanzar la plena dignidad de las personas. Discusión/Conclusiones/Contribuciones. Se concluye que, si bien la bioética no ha sido indiferente al debate sobre discapacidad mental, esta tampoco ha estado en el centro de su interés ni ha logrado constituir un aporte para superar la postergación. A los profesionales expertos les cabe guiar a otros escenarios de impacto social, más allá de la investigación y de lo académico, de manera que los entornos educativos, culturales y comunitarios se conecten mejor alrededor de esa problemática.

Purpose/Context. Mental disability alters the natural course of human existence because it impacts the construction of one's identity and the interaction with the context in which one lives. Despite its relevance, mental disability has not been at the center of the bioethical debate. This article presents reasons for this postponement in the bioethical debate, ranging from the previously prevailing comprehensive models to new models that incorporate ethical principles into their pivotal elements. Methodology/Approach. We reviewed multiple models from which mental disability is understood, from the medical and social approach to the recent biopsycho-social and diversity models. We identified that the first models had the concept of ability as a theoretical line and current ones intend to unveil and eradicate the logic of exclusion not yet overcome. Results/Findings. Bioethics would have the dual role of serving as a comprehensive model and an instrument that enables ethical debate in pluralistic societies by promoting practical ethical-ontological approaches to develop socio-health policies and achieve the full dignity of individuals. Discussion/Conclusions/Contributions. While bioethics has not been indifferent to the debate on mental disability, it has not been its interest, nor has it been able to contribute to overcoming postponement. It is up to experts to guide other social impact settings beyond research and academia for educational, cultural, and community environments to better connect to this problem.

Objetivo/contexto. A deficiência mental altera o curso natural da existência humana porque impacta a construção da própria identidade e a interação com o contexto no qual habita-se. Apesar da sua relevância, a deficiência mental não tem estado no centro do debate bioético. No presente artigo expõem-se algumas das razões desse adiamento no debate bioético, revisando desde os modelos compreensivos anteriormente imperantes até os modelos novos que incorporam princípios éticos entre seus eixos. Metodologia/Abordagem. Foram revisados os diferentes modelos desde onde se compreende a incapacidade mental, começando pelos de enfoque médico e social até os recentes modelos biopsicossociais e da diversidade. Identifica-se que os primeiros modelos tinham o conceito de capacidade como eixo teórico e que os atuais propõem-se revelar e erradicar a lógica da exclusão ainda não superada. Resultados/Descobertas. A bioética teria o duplo papel de servir como modelo compreensivo e de instrumento que possibilite o debate ético em sociedades pluralistas, ao propiciar abordagens ético-ontológicos úteis para o desenvolvimento de políticas sociosanitárias que permitam alcançar a plena dignidade das pessoas. Discussão/Conclusões/Contribuições. Conclui-se que, embora a bioética não tenha sido indiferente ao debate sobre a deficiência mental, esta também não tem estado no centro de seu interesse nem tem conseguido constituir um contributo para superar o adiamento. Aos profissionais especializados devem ser orientados para outros cenários de impacto social, para além da investigação e do académico, de modo a que os ambientes educativos, culturais e comunitários se relacionem melhor em torno desta problemática.

Utilization and Demand of Health Care Service for Children with Mental Disabilities in China / 中国康复理论与实践

Objective:To investigate the utilization and demand of health care services for children with mental disabilities and provide implications for the development and update of related policies. Methods:Data of utilization and demand of health care services for children with mental disabilities aged 0 to 17 years were selected from The Second China National Sample Survey on Disability in 2006. The difference of utilization and demands of health care services for children was analyzed in socio-economic characteristics including gender, age, urban and rural areas, disabled level, parents' highest level of education and family income. Results:The utilization rate of health care service was relatively low (44.35%), and the demands was high (98.26%) among children with mental disabilities. Medical services and assistance, rehabilitation training and services, and aid and support for poor people with disabilities were the most-utilized and most-demanded services for children with mental disabilities. In terms of utilization, the utilization rates of medical services and assistance, and rehabilitation training and services were higher among children with mental disabilities in urban areas than in rural areas (χ2 > 11.028, P < 0.01). And the utilization rate of these two services also was higher among mentally disabled children from family with higher parental education and income than among the counterparts from families with low socioeconomic status (χ2 > 9.169, P < 0.05). In terms of demand, children with more severe mental disability had higher demand of aid and support for poor people with disabilities (χ2 = 17.822, P < 0.001). And higher demand of rehabilitation training and services was found among mentally disabled children with better family socio-economic status (χ2 = 7.797, P < 0.05). Conclusion:The demands for health care services among children with mental disabilities urgently need to be further met. Reinforcing the development of above three types of services, addressing the imbalance of health care services allocation between urban and rural areas, and improving the economic conditions of disabled families will effectively improve the utilization of the health care service for mentally disabled children.

Analysis of Post-Concussion Syndrome Disability Re-appraisal / 法医学杂志

OBJECTIVES@#To understand the current status of appraisal of post-concussion syndrome disability and the reasons for the changes in re-appraisal opinions.@*METHODS@#The cases that were judged as "post-concussion syndrome and ten-level disability" in the first appraisal and re-appraised for psychiatric impairment by the Academy of Forensic Science in 2019 were analyzed retrospectively.@*RESULTS@#There were 75 cases, including 58 cases with pre-hospital emergency medical records, among which 39 cases were clearly recorded to be without a history of coma; 74 cases had emergency medical records, among which 44 cases were recorded of having a history of coma; 43 cases had follow-up medical records, among which 24 cases had a history of psychiatric follow-up. The most complained symptoms of the appraisee in appraisal and examination include headache, dizziness, poor sleep at night, irritability, memory loss, fatigue and inattention. The main reasons for the re-appraisal application include doubts about the history of coma, doubts about the credibility of mental symptoms, post-concussion syndrome didn't meet the disability criteria, and objections to the original appraisal procedure or the original appraisal agency. The appraisal opinions of a total of 47 cases were changed. Seven of them did not meet the disability criteria, and the main reason was that there was no clear history of coma and no head injury was admitted; the coma history of the 40 other cases had to be confirmed by the court before they can be clearly identified as disabilities. The reason was that the records about the history of coma were inconsistent or there were alterations and additional information.@*CONCLUSIONS@#In the past, the conditions for appraisal of post-concussion syndrome disability were too lax and must be further standardized and strictly controlled.

Evaluación del uso de fármacos y conducta en pacientes con síndrome X frágil / Asessment of pharmacological freatment and behavioral changes in patients with fragile X syndrome

El Síndrome X Frágil (SXF) es la principal causa heredada de Discapacidad intelectual (DI) y Trastorno del espectro autista (TEA). Se caracteriza por presentar un fenotipo conductual asociado a hiperactividad, déficit atencional, impulsividad, ansiedad, trastornos conductuales, espectro autista y retraso global del desarrollo. No existe actualmente un tratamiento farmacológico para el trastorno genético de base. El tratamiento farmacológico se focaliza en los síntomas que interfieren con la calidad de vida y aprendizaje, entre ellos la irritabilidad e hiperactividad. OBJETIVO: Evaluar cambios conductuales a través de la escala conductual ABC, de pacientes masculinos con diagnóstico de SXF tratados con psicoestimulantes y/o antipsicóticos en comparación a controles. MÉTODO: Se evalúa a 40 pacientes hombres con diagnóstico de SXF entre los años 2014 y 2017. Se utiliza la evaluación de la conducta mediante el puntaje en la subescala de irritabilidad e hiperactividad de la encuesta ABC-C y el registro de fármacos indicados. Se compara la sintomatología conductual en pacientes que no utilizan fármacos, aquellos que utilizan antipsicóticos, los que usan psicoestimulantes y pacientes tratados con ambos fármacos. RESULTADOS: La mediana de edad fue de 15,1 (±9,3) años. Del total de pacientes, el 42,5% reportó uso de fármacos, de éstos el 35% utilizó psicoestimulantes, 35% antipsicóticos y 30% la combinación de ambos. Se observa que solo el grupo que recibe tratamiento con psicoestimulantes y antipsicóticos en forma simultánea presenta diferencias con el subgrupo sin tratamiento farmacológico. CONCLUSIONES: En más de la mitad de nuestros pacientes se decide no utilizar tratamiento farmacológico. Sin embargo, dichos pacientes igualmente presentan sintomatología de irritabilidad e hiperactividad. Los pacientes que recibieron terapia asociada de psicoestimulantes y antipsicóticos presentan puntajes significativamente más altos en la escala de irritabilidad que aquellos que no recibieron tratamiento farmacológico. Este grupo, que constituye el 12,5% del total de la muestra, presenta un fenotipo conductual que genera mayores dificultades en la calidad de vida del paciente y su entorno.

Fragile X Syndrome (FXS) is the main inherited cause of Intellectual Disability and Autism Spectrum Disorder. It characteristically presents as a behavioral phenotype asso- ciated with hyperactivity, attention deficit, impulsivity, anxiety, behavioral disorders, autistic spectrum and global developmental delay. There is currently no pharmacological treatment for the underlying genetic disorder. Pharmacological treatment targets symptoms that interfere with quality of life and learning, including irritability and hyperactivity.OBJECTIVE: To evaluate behavioral changes through the ABC behavioral scale of male patients diagnosed with FXS treated with psychostimulants and / or antipsychotics compared to controls. METHOD: 40 male patients with a diagnosis of FXS between 2014 and 2017 were evaluated. The behavioral assessment was done by scoring the irritability and hyperactivity subscale of the ABC-C survey and by registering the prescribed drug. Behavioral symptomatology was compared in patients who do not use drugs, those who use antipsychotics, those who use psychostimulants and patients treated with both drugs. RESULTS: The median age was 15.1 (± 9.3) years. Of the total of patients, 42.5% were prescribed drugs, of these 35% used psychostimulants, 35% antipsychotics and 30% the combination of both. It was observed that the group that received treatment with both psychostimulants and antipsychotics simultaneously presented differences with the subgroup without pharmacological treatment.CONCLUSIONS: In more than half of our patients no pharmacological treatment is prescribed. However, these patients also show symptoms of irritability and hyperactivity. Patients who received associated therapy of psychostimulants and antipsychotics have significantly higher scores on the irritability scale than those who did not receive pharmacological treatment. This group, which constitutes 12.5% of the total sample, has a behavioral phenotype that generates greater difficulties in the patient's quality of life and their environment.

Abordaje nutricional en pacientes con parálisis cerebral, espectro autista, síndrome de Down: un enfoque integral / Nutritional approach in patients with cerebral palsy, autism spectrum disorders, and Down syndrome: a comprehensive approach

RESUMEN Las enfermedades mentales abarcan un grupo de patologías relacionadas con factores fisiológicos, genéticos, psicológicos, sociales y medioambientales. Dentro de estas enfermedades se encuentran la parálisis cerebral, la discapacidad mental, la enfermedad del espectro autista y el síndrome de Down, las cuales son abordadas en la presente revisión. El abordaje integral del paciente por parte del equipo de salud es imprescindible. Se destaca el rol del nutricionista dietista, ya que su atención oportuna y regular permite evitar el deterioro del estado nutricional, el compromiso de la talla en caso de niños, o adquirir comorbilidades prevenibles en adultos, como sucede cuando está presente una de las complicaciones comunes como el reflujo gastroesofágico y la disfagia, permitiendo mejorar la calidad de vida de pacientes, cuidadores y familia. A pesar de esto, los sistemas de salud sólo autorizan la atención nutricional cada dos o tres meses; adicional a esto, se suman el tiempo prolongado que tardan los trámites para la consulta y las autorizaciones, pudiendo desencadenarse complicaciones que ponen en riesgo la vida del paciente. Se realizó una revisión bibliográfica en bases de datos Scielo, Dialnet, PubMed, para soportar la importancia del papel del nutricionista dietista en todos los estados de las patologías relacionadas con las enfermedades mentales.

ABSTRACT Mental illnesses encompass a group of pathologies concerning physical, genetic, psychological, social and environmental factors. These diseases include cerebral palsy, mental handicap, autism spectrum disorder and Down syndrome, which will be addressed in the present review. A comprehensive approach is essential, which includes the role of the nutritionist-dietitian, since prompt and regular attention allows avoiding the deterioration of nutritional status, compromised length, in the case of children, or acquiring preventable comorbidities in adults, such as gastroesophageal reflux and dysphagia. This approach improves the quality of life of patients, caregivers and families. In spite of this, health systems only authorize nutritional care every two or three months. In addition, there is often prolonged wait times to access treatment and obtain authorization, which may put the patient's life at risk. A systematic review was carried out using Scielo, Dialnet, and Pubmed to support the importance of the role of the nutritionist-dietitian in mental illness conditions.

Trauma-focused cognitive behavioral treatment helps hearing-impaired and mentally disabled children with post-traumatic stress disorder / 中华物理医学与康复杂志

Objective To study the efficacy of trauma-focused cognitive behavioral treatment ( TF-CBT) in treating post-traumatic stress disorder ( PTSD) among hearing-impaired or mentally-disabled children. Methods One hundred and four children with PTSD who were either hearing-impaired or mentally disabled were randomly divid-ed into a hearing-impaired Sunan group ( n=28) and a hearing-impaired Subei group ( n=24) . The mentally-disabled children were similarly divided into Sunan ( n=26) and Subei ( n=26) groups. All of the groups were given TF-CBT, and the effects were compared after one and three months of intervention. Results After one and three months the effectiveness rate was over 60％ for all four groups. After 3 months the efficacy in the hearing-impaired Su-bei group was significantly better than in the Sunan group. In the mentally-disabled Sunan group the treatment was more effective after 3 months than after one month. Conclusion Trauma-focused cognitive behavioral treatment is effective for hearing-impaired and mentally disabled children with post-traumatic stress disorder. For hearing-impaired children, the effect of Sunan is significantly better that of Subei. Mentally disabled children improve gradually for at least 3 months.

Interações familiares e deficiência intelectual: uma revisão de literatura / Family interactions and disability: a literature review

Este estudo objetivou analisar as publicações nacionais dos últimos dezesseis anos sobre interações familiares e as intervenções da equipe de saúde às crianças com deficiência intelectual e sua família. Utilizou-se a base de dados SciELO Brasil - Scientific Electronic Library Online, com combinações dos descritores (família and deficiência and mental and intelectual and criança): 66 artigos foram recuperados e lidos na íntegra, sendo 17 selecionados para o estudo. Para análise, dividiram-se os artigos em: a) fatores intrafamiliares; b) fatores extrafamiliares: múltiplas intervenções da equipe de saúde para lidar com a família e com a criança com deficiência. As pesquisas revelam que não só a mãe, mas outros membros, como o pai, contribuíram para o desenvolvimento da criança. Considerou-se a importância das intervenções junto a vários membros da família. Denotou-se importância na efetivação de políticas públicas de saúde e de capacitação profissional, para se construírem práticas adequadas com essa parcela da população.(AU)

This study is aimed at analyzing the national publications from the last sixteen years about family interaction and the interventions from the health team to the children with intellectual disabilities and their families. The database SciELO Brasil (Scientific Electronic Library Online) was used, combining the keywords "family", "disability", "mental", "intellectual", and "child": 66 papers were found and thoroughly read, 17 being selected for this particular study. For the purpose of analyzing them, the papers were categorized as: a) intrafamilial factors; b) extrafamilial factors: multiple interventions from the health team to deal with the family and with the disabled child. The research has revealed that not only the mother but also other family members such as the father contribute to the development of the disabled child. It was considered the importance of the interventions occurring with many family members. Finally, it was noted the importance of the creation and maintenance of public health and professional capacitation policies in order to develop more adequate practices to deal with the development of this part of the population.(AU)

Sobre educación inclusiva: enfoque de derechos humanos y contribuciones de la psicología / On inclusive education human rights approach and contributions of psychology

El movimiento de la educación inclusiva tuvo desde sus inicios el imperativo de ampliar el alcance del derecho a la educación a la totalidad de las personas. Basado en el enfoque de derechos humanos, su discurso impregnó en la bibliografía académica como en el diseño e implementación de políticas educativas. En este sentido, en el presente trabajo se argumenta cómo la materialización de esta tendencia educativa, si bien amplió las fronteras del derecho a la educación, amenazaría simultáneamente el respeto del derecho a la salud de las personas con discapacidad mental. A tal fin, se indaga las consecuencias de la injerencia de diagnósticos clínicos en contexto escolar y su configuración mediante políticas educativas. De esta manera, se busca exponer cómo el afianzamiento del derecho a la educación puede ubicarse en contradicción y detrimento del derecho a la salud, lo cual cuestionaría la indivisibilidad e interdependencia de los Derechos Humanos.

The inclusive education movement had from the outset the imperative to extend the scope of the right to education to all people. Based on the human rights approach, this speech permeated the academic literature as well as the design and implementation of educational policies. In this sense, in this article we argue how the materialization of this educational trend, while extending the borders of the right to education, simultaneously could threaten the respect of the right to health of people with mental disabilities. To this end, the consequences of clinical diagnoses interference on school context and their configuration through educational policies will be investigated. In this way, it will be demonstrated how the strengthening of the right to education could be located in contradiction and detriment of the right to health, questioning a fundamental characteristic of the Human Rights: their indivisibility and interdependence.

Discapacidad mental y ciudadanía activa: el desafío de una nueva legislación de salud mental para Chile / Mental disability and active citizenship: the challenge of a new legislation ofmental health for Chile

El enfoque de la discapacidad constituye actualmente una perspectiva que pretende hacerse cargo de la incorporación de la dimensión social en la comprensión de la salud mental, y su hegemonía en Chile es visible en el diseño de las legislaciones y políticas públicas sobre salud mental durante los últimos 20 años. Sin embargo, tanto este enfoque de la salud mental como las respectivas legislaciones y políticas desarrolladas, presentan importantes dificultades para hacerse cargo de la situación de justicia y ciudadanía de este grupo de personas. Estas dificultades del enfoque se hacen particularmente evidentes cuando se requiere garantizar el ejercicio de una ciudadanía activa, ya que los aspectos relativos a la ciudadanía han demostrado tener un efecto terapéutico sobre las deficiencias o trastornos mentales. La urgente necesidad de una ley de salud mental para Chile demanda el desafío de diseñar una legislación que se haga cargo de las particularidades de la discapacidad mental, pero además la posibilidad histórica de incluir efectivamente la perspectiva de las personas con discapacidad mental y sus familias en la discusión de una nueva ley.

Nowadays, the disability approach is a perspective that proposes a way to deal with the incorporation of social dimension in mental health understanding. Its hegemony in Chile turns visible considering the design of mental health laws and public policies over the past 20 years. However, this approach to mental health as well as the legislations and policies developed and related to it, hardly take over the situation of justice and citizenship of this group of people. These difficulties are particularly relevant when the exercise of active citizenship is required, since citizenship has been proved to show a therapeutic effect on the deficiencies or mental disorders. The urgent need of a mental health law for Chile demands the challenge of designing a law which recognizes the particularities of mental disability, but it also offers the historical possibility to effectively include the perspective of people with mental disabilities and their families in the discussion for a new law.

Effect of Occupational Therapy and Related Factors on Mental Retarded Persons in Community of Beijing / 中国康复理论与实践

@#Objective To observe the effect of the occupational therapy (OT) on people with mental disability in community of Beijing and analyze its related factors. Methods 180 mentally disabled persons from 15 disabled persons' centers (DPCs) in a district of Beijing were studied with a self-developed questionnaire. They were investigated twice with a 6-month interval, and the results were compared. Results 160 questionnaires were valid for analysis. The score of OT improved (P<0.05) in 103 (64.38%) respondents. The main factors related with the effectiveness of the OT included OT categories, age and vocational assessment. Conclusion OT is effective on people with mental disability in the DPCs, and could be improved in some aspects, such as regular vocational assessment.

Community-based Day-care Rehabilitation Model for Mental Disability Due to Schizophrenia / 中国康复理论与实践

Objective To create the effective community-based day-care model of mental disability with multiple approaches. Methods 30 subjects with schizophrenia in Taoranting community in Beijing were selected in control group (n=15) and intervention group (n=15). A day-care multiple rehabilitation model had been implemented in the intervention group. They were evaluated with Positive and Negative Syndrome Scale (PANSS) and WHO Disability Assessment Schedule 2.0 (WHO-DAS 2.0). Results The scores of PANSS negative symp-tom, general psychopathological symptom and WHO-DAS 2.0 significantly reduced continually in the intervention group 8 and 12 weeks af-ter intervention (P<0.01). Conclusion Community-based day-care model can improve the rehabilitation of mental disabled people and inte-grate the community resources for the schizophrenics.

Effect of Occupational Therapy and Related Factors on Mental Retarded Persons in Community of Beijing / 中国康复理论与实践

Objective To observe the effect of the occupational therapy (OT) on people with mental disability in community of Beijing and analyze its related factors. Methods 180 mentally disabled persons from 15 disabled persons' centers (DPCs) in a district of Beijing were studied with a self-developed questionnaire. They were investigated twice with a 6-month interval, and the results were compared. Re-sults 160 questionnaires were valid for analysis. The score of OT improved (P<0.05) in 103 (64.38%) respondents. The main factors related with the effectiveness of the OT included OT categories, age and vocational assessment. Conclusion OT is effective on people with mental disability in the DPCs, and could be improved in some aspects, such as regular vocational assessment.

Aprendizajes para las políticas e intervenciones sociales de discapacidad mental. El caso del Servicio de Capacitación Cecap, Toledo, España / Lessons for Policies and Social Interventions on Mental Disabilities. The Case of Training Service Cecap, Toledo, Spain / Aprendizagens para as políticas e intervenes sociais de discapacidade mental. O caso do Servido de Capacitado Cecap, Toledo, Espanha

Objetivos: recoger aprendizajes conceptuales para las iniciativas de discapacidad mental y determinar qué elementos metodológicos de intervención contribuyen mayormente a la inclusión del colectivo. Materiales y métodos: investigación centrada en el caso de Cecap, Toledo-España.¹ Integró herramientas cualitativas (revisión documental y entrevistas a, entre otros, sujetos de intervención) y cuantitativas (ahp datos estudiados con análisis de contenido y estadística. Resultados: la "especificidad" que orienta conceptual y metodológicamente la intervención de Cecap, dialogando con la CIF-OMS, el modelo social y el enfoque de derechos, entiende al colectivo como personas con características específicas y diferenciadas, al igual que personas sin discapacidad. Metodológicamente, trabajar desde planes individuales de intervención, tiene la mayor prioridad para la inclusión. Conclusiones: las políticas e intervenciones debiesen considerar instrumentos que reconozcan las características e intereses específicos de los sujetos como capitales pro inclusión.

Objectives: Collecting conceptual lessons for the initiatives on mental disabilities and determining what methodological interventions elements contribute the most to the inclusion of the group. Materials and Methods: Research focused on the Cacap case, Toledo, Spain². We integrated qualitative tools (review of documentation and interviews performed to intervention subjects, among others), and quantitative tools (ahp), data studied with content analysis. Results: the "specificity" that conceptually and methodologically guides the intervention of Cecap, in dialogue with the CIF-OMS, the social model and the rights approach, understands the group as people with specific and differentiated characteristics, exactly as people without disabilities. Methodologically, working from individual intervention plans has the top priority for inclusion. Conclusions: The policies and interventions should consider instruments that acknowledge the specific characteristics and interests of the subjects as of utmost importance for inclusion.

Objetivos: Coligir aprendizagens conceituais para as iniciativas de discapacidade mental e determinar quais elementos metodológicos de intervencao contribuem maiormente para a inclusao do coletivo. Materiais e métodos: pesquisa centrada no caso de Cecap, Toledo-Espanha.³ Integrou ferramentas qualitativas (revisao documental e entrevistas a, entre outros, sujeitos de intervencao) e quantitativas (ahp), dados estudados com análise de conteúdo. Resultados: a "especificidade" que orienta conceitual e metodologicamente a intervencao de Cecap, dialogando com a cifoms, o modelo social e o enfoque de direitos, entende o coletivo como pessoas com características específicas e diferenciadas, ao igual que pessoas sem discapacidade. Metodologicamente, trabalhar desde planos individuais de intervencao tem a maior prioridade para a inclusao. Conclusoes: as políticas e intervencoes deveriam considerar instrumentos que reconhecessem as características e interesses específicos dos sujeitos como capitais para a inclusao. *Em portugués nao existe o termo discapacidade mas deficiéncia, embora usa-se discapacidade para conservar o significado do termo em espanhol e evitar as implicacoes da deficiéncia ser inerente á pessoa e a discapacidade ser construída socialmente.

Estigma y comunidad: el desafío de la integración comunitaria de sujetos internados en instituciones psiquiátricas o de salud mental / Stigma and community: the challenge of the community integration of persons interned in psychiatric or mental health institutions

El presente trabajo intenta dar cuenta de los desafíos que implica el trabajo de integración comunitaria de sujetos con padecimiento o discapacidad mental que han estado internados en instituciones psiquiátricas, de salud y/o discapacidad mental. Los abordajes llamados “especiales”, la internación y el dignóstico psiquiátricos, y las figuras jurídicas de insanía e inhabilitación, tienen efectos estigmatizantes para el sujeto que obstaculizan el camino a desandar a la hora de reintegrarse a la comunidad. En este sentido, se proponen prácticas “antiestigma” y como orientación del trabajo un doble movimiento: desde la comunidad para tolerar y vérselas con lo diferente y desde el sujeto, para que ceda algo de lo que lo excluye de la “comunidad de los comunes”.

SUMMARYThe present articule focus on the challenge implied in community integration of persons that had been interned in mental or disability institutions. The “special” treatments, the psychiatric internment and diagnosis, and the juridic figures of insannity and disqualification, has stigmatizing effects that obstruct the way back to the community. “Anti-stigma” practices and a double movement are proposed: the community has to tolerate and deal with the difference and the individual has to give in the aspects that exclude him from “the community of the commons”.

Análisis y reflexiones desde una mirada bioética, en la práctica clínica psiquiátrica, a propósito de un caso / Analysis and reflections from a look bioethics, clinical psychiatric practice, a case report

Los autores proponen reflexionar desde una mirada bioética en la práctica clínica en psiquiatría a propósito de un caso, una paciente portadora de psicosis crónica cursando embarazo con feto incompatible con la vida extrauterina. El paciente con trastorno psiquiátrico grave y con declaración de incapacidad psíquica tiene autonomía y respetarla implica un desafío para el equipo de salud. La autonomía refiere a la capacidad que se les reconoce a las personas de participar en la toma de decisiones. El trastorno psiquiátrico grave y la declaración de incapacidad no suponen la pérdida de derechos como sujetos ni como usuarios de los servicios de salud, como lo establece la Ley 18.335. En el análisis de este caso el principio de autonomía es el más comprometido; la paciente no puede consentir pero puede asentir, tomándose en cuenta su opinión para la toma de decisiones. El asentimiento tiene valor desde el punto de vista bioético pero no desde el punto de vista legal. Los avances en el diagnóstico prenatal nos enfrentan a situaciones nuevas, de implicancia bioética que es necesario conocer para proteger a poblaciones vulnerables (pacientes psiquiátricos, entre otros). Queremos enfáticamente resaltar la figura institucional de los comités de Ética Asistencial y la importancia de su creación en las instituciones que asisten pacientes con patología mental. Urge incorporar la bioética en la formación de los psiquiatras. La interdisciplina se genera como resultado de la tarea clínica de un equipo,que se configura en función del planteo de un problema, el caso clínico planteado.

Two-way ANOVA on the influence of the medication adherence and family function on the schizophrenia mental disability patients / 中国实用护理杂志

Objective To explore the influence of the medication adherence and family function on mental disability status of the schizophrenia patients.Methods Morisky Medication Adherence Questionnaire(MAQ),Assessment Schedule Ⅱ (WHO-DAS Ⅱ),Family APGAR Index(APGAR) were used to analyze the influence of the medication adherence and family function on the schizophrenia mental disability patients.120 convalescence mental disability patients were included in Inner Mongolia Anding hospital.Results The mean score of medication adherence and family function of the schizophrenia mental disability patients was (2.40±1.10) points and (4.87±2.42) points,they both played a significant role on the effect of mental disability.The main effect of medication adherence and family function were significantly different.Through the simple effect analysis,the mental disability score was different in the various medication adherence level under the various family function situation,and the mental disability score was also different in the various family function situation under the medication adherence level.Conclusions Both medication adherence and family function have effect on mental disability status of the schizophrenia patients.The medical staff should take targeted measures to delay or improve patients' mental disability status.

Estrategias de inserción laboral en población con discapacidad mental: una revisión / Strategies of employability in population with mental disabilities: a review

The employability and access to the productive market are considered key elements for the full integration of the patient with mental disability. The aim of this review was to describe and analyze the scientific literature for the main employability strategies: traditional vocational rehabilitation (sheltered work and social firms) and supported employment (particularly in its mode of individualized supported employment). The results of the review suggest that individualized supported employment is the most effective approach in obtaining employment for people with mental disabilities.

La inserción laboral y el acceso al mercado productivo son considerados elementos claves para la plena integración del paciente con discapacidad mental. El objetivo de la presente revisión fue describir y analizar la literatura científica correspondiente a las principales estrategias de inserción laboral: rehabilitación vocacional tradicional (empleo protegido y empresas sociales) y empleo con apoyo (particularmente en su modalidad de empleo con apoyo individualizado). Los resultados de la revisión indican que el empleo con apoyo individualizado es el abordaje más efectivo en la obtención de empleo en personas con discapacidad mental.

Caracterización clínica y etiológica de las diferentes discapacidades en el Estado Plurinacional de Bolivia, 2009-2010 / Clinical and etiological characterization of different disabilities in Estado Plurinacional de Bolivia, 2009- 2010

La discapacidad es una realidad humana percibida de manera diferente en diferentes períodos históricos y civilizaciones. El término, de uso frecuente, se refiere al funcionamiento individual e incluye discapacidad físico-motora, sensorial, visceral,cognitiva o intelectual, y discapacidad psíquica o mental. Objetivos: Identificar las frecuencias de los distintos tipos de discapacidad, así como las principales causas que la originaron. Métodos: Se realizó un estudio descriptivo transversal de todas las personas con discapacidaden el Estado Plurinacional de Bolivia,identificadas en el marco de la Misión Solidaria del ALBA Moto Méndez.Resultados: La discapacidad físicomotor, seguido de la intelectual,auditiva y la visual, fueron las más frecuentes,y las causas postnatales predominaronen el 63.3 por ciento de los casos, seguido delas prenatales.Conclusiones: Los accidentes constituyeron un serio problemasocial como factor postnatal.

Disability is a human reality perceived differently in different historical periods and civilizations. The following types of disabilities are described: intellectual, physical-motor, sensory, visceral, and psychological or mental. Objective: To identify the frequencies of the different types of disabilities as well as the main causes that led to it. Methods: A descriptive study of all people with disabilities in the State of Bolivia was performed, identified in the framework of Mision Solidaria del ALBA Moto Mendez. Results: Motor physical disability, followed by intellectual, auditory and visual, were the most frequent types, and postnatal causes predominated in 63.3 percent of cases, followed by prenatal. Conclusion: Accidents were a serious social problem as postnatal factor.

Situation of Mental Disability and Rehabilitaion Needs in Hebei Province ZHAO Zhi-hang, FENG Chao / 中国康复理论与实践

@#Objective To investigate the situation of mental disability in Hebei province. Methods Based on the survey of the Second National Disabled Sample in Hebei province, the data of mental disability were analysed, including the morbidity, severity, causes, and the service and demand. Results The morbidity of mental disability was higher in the countryside than that in the city (χ2=364.24, P<0.01). The severity of the disabled was more in level 3 or 4 than in level 1 and 2 (χ2=221.16, P<0.01). The genetic disease and brain disease were the major causes to the mental disability. The service did not meet the demand. Conclusion The mental disability was more in the countryside than in the city, with severity of mild to moderate.

Characteristics of Gesell Developmental Schedules in Children with Movement Disorders / 中国康复理论与实践

@#Objective To investigate the incidence and structure of mental disability in children with movement disorders. Methods 157 children with movement disorders (103 with cerebral palsy and 54 with mental retardation) were assessed with Gesell developmental schedules,and mental disability was identified as development quotient (DQ)<75. Results The incidence of intelligence disability was 92.2% in children with cerebral palsy, including 91.2% in spastic type, and 100% in dyskinetic, mixed or dystonic type. The development of gross motor was retarded in children with spastic cerebral palsy, and gross and fine motor in children with dyskinetic cerebral palsy, compared with those with mental retardation. Conclusion It is important to focus the mental development in children with movement disorders, especially the dyskinetic cerebral palsy. Gesell developmental schedules should be used carefully to assess the mental development in children with movement disorder.