Bienestar y burnout en psiquiatras de Uruguay: estudio transversal descriptivo, año 2019 / Wellbeing and burnout in psychiatrists from Uruguay: transversal descriptive study, year 2019

El proceso de desarrollo profesional del psiquiatra lo hace especialmente vulnerable al agotamiento físico y emocional, puesto que el sujeto es la herramienta misma de atención en la relación médica. Se realizó un estudio descriptivo transversal mediante una encuesta electrónica anónima para psiquiatras y estudiantes de posgrado de Psiquiatría de Uruguay, pertenecientes a la Sociedad Uruguaya de Psiquiatría y a la Asociación de Psiquiatras del Interior, con el objetivo de identificar y describir las características sociodemográficas y de trabajo del médico con especialización en Psiquiatría, así como elementos de burnout y la percepción del bienestar en Uruguay en el año 2019. Se identificó la influencia del multiempleo y la presencia de burnout en el entorno del 10 % de los profesionales. La mitad de los encuestados trabaja en la capital y área metropolitana del país, contribuyendo a la inhomogeneidad de la asistencia. Aún estando inmersos en el modelo de recuperación en el contexto de la nueva ley de salud mental es escaso el porcentaje de profesionales que se desempeña en el área de rehabilitación de personas con trastornos mentales graves.

Psychiatrists' professional development process renders them specially vulnerable to physical and emotional exhaustion due to the fact that psychiatrists themselves become a treatment tool in the clinical relationship. With the aim of identifying and describing socio-demographic and work features as well as burnout elements and well-being perception, a descriptive crosssectional study was carried out by means of an anonymous electronic survey for psychiatrists and medical doctors specializing in psychiatry in postgraduate courses belonging to the Sociedad Uruguaya de Psiquiatría and the Asociación de Psiquiatras del Interior in 2019. Influence of multi-employment and burnout was identified in 10% of the cases. Half of the assessed psychiatrists work in the capital city and metropolitan area, contributing to non homogeneous care. Only a small percentage work in rehabilitation, even if the new mental health law emphasizes this model of care for severe mental disorders.

Evaluation of psychiatrist's communication with psychosis patients / Evaluación de la comunicación de psiquiatras con pacientes psicóticos / Avaliação da comunicação de psiquiatras com pacientes psicóticos

Abstract: Evaluation of the physician-patient relationship is very important in determining priorities in medical practice and medicine. For this purpose, in this study the psychiatrist's communication with psychotic patients as a sensitive group was evaluated. A questionnaire was administered to 210 patients in a psychiatric clinic of Inonu University Hospital in Turkey to determine how the examination is performed in the facility for outpatients in the psychosis unit. According to the study conducted, it was observed that the evaluation score of the psychiatrist's communication with psychotic patients increased positively with increasing consultation duration. Our work is particularly noteworthy because it deals with a sensitive area, such as a group of psychiatric patients. The scores were obtained based on data from the evaluation of the questionnaires, which showed that the communication between the psychiatrist and the psychotic patient was conducted in a sensitive and careful manner, and without ethical problems.

Resumen: La evaluación de la relación médico-paciente es muy importante para determinar las prioridades en la práctica médica y la medicina. Para este propósito, en este estudio se evaluó la comunicación del médico psiquiatra con los pacientes psicóticos como grupo sensible. Se administró un cuestionario a 210 pacientes de una clínica psiquiátrica del Hospital de la Universidad de Inonu en Turquía, para determinar cómo se realiza el examen en el establecimiento para los pacientes externos de la unidad de psicosis. De acuerdo con el estudio realizado, se observó que el puntaje de evaluación de la comunicación del psiquiatra con los pacientes psicóticos se incrementó positivamente al aumentar la duración de la consulta. Nuestro trabajo se destaca particularmente por tratarse de un área sensible, como es un grupo de pacientes psiquiátricos. Los puntajes se obtuvieron basándose en datos de la evaluación de los cuestionarios, que mostraron que la comunicación entre el psiquiatra y el paciente psicótico se realizó de una forma sensible y cuidadosa, y sin problemas éticos.

Resumo: A avaliação da relação médico-paciente é muito importante para determinar as prioridades na prática médica e na medicina. Para este fim, neste estudo foi avaliada a comunicação do psiquiatra com pacientes psicóticos como um grupo sensível. Um questionário foi aplicado a 210 pacientes em uma clínica psiquiátrica do Hospital Universitário Inonu na Turquia para determinar como o exame é conduzido nas instalações para pacientes ambulatoriais da unidade de psicose. De acordo com o estudo realizado, observou-se que a pontuação da avaliação da comunicação do psiquiatra com pacientes psicóticos aumentou positivamente à medida que a duração da consulta aumentava. Nosso trabalho é particularmente notável porque trata de uma área sensível, tal como um grupo de pacientes psiquiátricos. Os resultados foram obtidos com base nos dados da avaliação dos questionários, que mostraram que a comunicação entre psiquiatra e paciente psicótico foi realizada de forma sensível e cuidadosa, e sem problemas éticos.

Mediating effect of mental resilience between work stress and sleep quality of psychiatrists / 中国职业医学

@#Objective To analyze the mediating effect of mental resilience on the relationship between work stress and sleep quality in psychiatrists. Methods A total of 221 front-line psychiatrists from four mental health centers in Shannxi Province were selected as the study subjects using convenience sampling method. The questionnaires of Scale for Occupational Stressors on Clinician，Chinese Version of Connor-Davidson Resilience Scale and Pittsburgh Sleep Quality Index Scale were used to investigate the work stress，mental resilience and sleep quality of the psychiatrists. We conducted Bootstrap mediation test to analyze the mediating effect of mental resilience using SPSS PROCESS V3.5 macro program. Results The total score of work stress of psychiatrists was 97.0±17.5，and the medium（P25，P75）of mental resilience and sleep quality scores were 84.0（75.5， 94.0）and 6.0（5.0，9.0）respectively. The detection rate of sleep disorders among psychiatrists was 33.9%（75/221）. The total score of work stress of psychiatrists was negatively correlated with the total score of mental resilience ［rank correlation coefficient（rS ）=−0.34，P<0.01］，and was positively correlated with the total score of sleep quality（rS =0.48，P<0.01）. The total score of mental resilience was negatively correlated with that of sleep quality （rS = − 0.39，P<0.01）. The work stress of psychiatrists had a positive predictive effect on sleep quality［standardized regression coefficient（β）=0.41.P<0.01］，and a negative predictive effect on mental resilience（β）=−0.38，P<0.01）. Mental resilience had a negative predictive effect on sleep quality（β）=−0.24，P<0.01. Mental resilience played a partial mediating role between work stress and sleep quality，and the mediating effect accounted for 22.0% of the total effect. Conclusion Both work stress and mental resilience of psychiatrists can directly affect their sleep quality，and the mental resilience has a partial mediating role in the effect of work stress on sleep quality.

Síndrome de Burnout en psiquiatras de Pinar del Río / Burnout syndrome in Psychiatrists from Pinar del Río Province

Introducción: Las frecuentes quejas expresadas por profesionales de diferentes especialidades vinculadas a las tensiones generadas por el trabajo favorecen conductas que expresan agotamiento emocional, pérdida de interés en el trabajo y actitudes indiferentes ante las personas a las cuales atiende, lo que ha sido llamado síndrome de burnout. La apreciable frecuencia en que estas manifestaciones son expresadas por los colegas motivó la realización de la investigación. Objetivo: Identificar la presencia del síndrome de burnout en un grupo de psiquiatras de la provincia de Pinar del Río. Métodos: Se realizó una investigación transversal mediante la aplicación del Maslach Burnout Inventory a 35 psiquiatras de la provincia Pinar del Río, se utilizó el método porcentual de cálculo. Resultados: Se identificaron 12 profesionales (34,2 por ciento) que se les diagnosticó síndrome de burnout o en riesgo, así como una baja incidencia de casos en los 10 primeros años de graduado como médico, no así en los psiquiatras en que sí se diagnosticó mayoritariamente en los primeros años de ejercer la especialidad. La relación mental estable presupone un mayor riesgo de padecer el síndrome o estar en riesgo. Conclusiones: El síndrome de burnout o el riesgo de padecerlo se diagnosticó en poco más de un tercio de los psiquiatras, la relativa alta frecuencia del síndrome en los que tienen pareja estable pudiera atribuirse a otros factores que gravitan junto a los vinculados al trabajo y no a este solamente(AU)

Introduction: Complaints frequently expressed by professionals from different specialties and related to the tensions produced by work may provoke behaviors consistent with emotional exhaustion, loss of interest in work and indifferent attitudes towards the people they attend. This has been called burnout syndrome. The appreciable frequency in which these manifestations are expressed by colleagues motivated this research. Objective: To identify the presence of burnout syndrome in a group of psychiatrists in Pinar del Río Province. Methods: A cross-sectional research was carried out through the application of the Maslach Burnout Inventory to 35 psychiatrists from Pinar del Río Province. The percentage method of calculation was used. Results: Twelve professionals (34.2 percent) were identified as diagnosed with burnout syndrome or at risk of it, together with a low incidence of cases in the first ten years after graduating as a medical doctor; but not among psychiatrists, in which it was diagnosed mostly in the first years of practicing the specialty. The stable mental relationship presupposes a greater risk for suffering from the syndrome or for being at risk. Conclusions: Burnout syndrome or the risk of suffering from was diagnosed in just over one third of psychiatrists. The relative high frequency of the syndrome in those with a stable partner could be attributed to other factors together with those related to work and not to this alone(AU)

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

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

Stigma toward individuals with mental disorders among Brazilian psychiatrists: a latent class analysis

Objective: The stigma toward individuals with mental disorders is highly prevalent, not only in the general population but among health care providers as well. The aim of this study was to identify subgroups based on stigmatizing beliefs related to psychiatric disorders among Brazilian psychiatrists, as well as to investigate their association with clinical and personality characteristics. Methods: Latent cluster analysis was used to find subgroups of cases in multivariate data according to a psychotic (schizophrenia) and a nonpsychotic disorder (attention-deficit hyperactivity disorder). The clusters for each psychiatric disorder were compared according to sociodemographic, emotional traits, and personality characteristics. Results: A total of 779 psychiatrists answered the questionnaire. Three different subgroups of stigma levels were identified regarding schizophrenia: the highest (n=202 [51.7%]), intermediate (108 [27.6%]), and the lowest (81 [20.7%]). Participants from the highest stigma group had a significantly longer time since graduation, higher anxiety-state scores, and lower positive affect. Two subgroups were identified with respect to attention-deficit hyperactivity disorder, although there were no differences between them in sociodemographic or clinical variables. Conclusion: There were more subgroups of stigmatizing beliefs regarding psychotic disorders. Individual characteristics, such as those related to trait anxiety and affect, can be associated with high stigma toward schizophrenia.

Telepsychiatry exposure, interest, and intention to use among young Psychiatrists in the Philippines

OBJECTIVE@#This was a descriptive study to determine the telepsychiatry exposure, interest, and intention to use among young psychiatrists in the Philippines in December 2014.@*METHODOLOGY@#This was done through a 14 to 25 item online survey adapted from Glover et al. (2013)1. Through purposive sampling, the population of third and fourth year residents and graduates within the last two years of accredited psychiatry training institutions was included in the study.@*RESULTS@#Seventeen young psychiatrists participated. Exposure to telepsychiatry of the respondents varied with 10 (58.82%) having had independent study, three (17.65%) having had didactics, and 11 (64.71%) having had awareness about telepsychiatry initiatives in their training institution. Ten respondents (58.82%) expressed interest in telepsychiatry as well as the importance and usefulness of telepsychiatry exposure. Despite this, only six (35.29%) young psychiatrists thought that telepsychiatry should be part of the residency training curriculum. As for intention to use, only eight (47.06%) respondents expressed receptiveness to it, two did not (11.76%), and seven were undecided (41.18%).@*CONCLUSION@#Though more than half of the respondents had exposure to telepsychiatry and considered it interesting and relevant, less than half of them had any actual intention to use it in their clinical practice.

Initiation of pharmacist–psychiatrist collaborative patient education in ambulatory care settings of a tertiary care teaching hospital in south India

The aim of this study is to initiate the pharmacist–psychiatrist collaborative patient education in ambulatory caresettings. A prospective cohort study was conducted in psychiatry out-patient department of a tertiary care teachinghospital over a period of 6 months. All the eligible patients were enrolled, and the necessary information was collected.The collected data were analyzed for medication adherence by using medication adherence rating scale and healthrelated quality of life by using the World Health Organization Quality of Life questionnaire. Student t-test was usedto analyze the results at p-value <0.05. A total of 210 patients were analyzed and followed for a period of 6 months.When compared to the baseline values, a significant improvement in medication adherence and quality of life witheach follow-up at p-value <0.05 was observed. The study results have evidently proven that pharmacist–psychiatristcollaborative approach could significantly improve patient education and related clinical outcomes.

Mental Health Interventions Provided by Volunteer Psychiatrists after the Sewol Ferry Disaster: April 16–November 30, 2014

OBJECTIVE: The aim of this study was to examine the experience of volunteer psychiatrists who provided mental health interventions to adolescents and teachers of Danwon High School from April 16, 2014, to November 30, 2014. METHODS: Data for this study were collected from 72 volunteer psychiatrists about their intervention experiences for 212 adolescents and 32 teachers during the eight months following the disaster. Developmental survey themes were identified, and coding was used to analyze the data. In addition, qualitative data analysis was performed using ATLAS.ti (version 8.2, 2018, ATLAS.ti GmbH). RESULTS: A volunteer prepared with appropriate mental health interventions may facilitate the emergency response to a disaster. Intervention services included psychological first aid, psychoeducation, screening, anxiety reduction techniques, and group therapy. CONCLUSION: In the acute aftermath of the Sewol Ferry disaster of April 16, 2014, volunteer psychiatrists were able to provide mental health interventions in a disaster response setting. The outcomes from this study have important policy and mental health system implications for volunteer psychiatrists. The results of this study constitute the basis of a better understanding of the essential mechanisms of crisis interventions after a disaster.

The Epidemiology of Antidepressant Prescriptions in South Korea from the Viewpoint of Medical Providers: A Nationwide Register-Based Study

Antidepressants are widely used to treat depression in Korea, however, only a few studies have focused on the provider of the treatment. The aim of the study is to compare the differences between patients who were prescribed antidepressants by psychiatrists and those who were prescribed antidepressants by non-psychiatrists in South Korea. Patients with a diagnosis of depressive disorder who had been newly prescribed antidepressants in 2012 were selected from the Health Insurance Review and Assessment Service database. They were classified into two groups depending on whether they received the antidepressant prescription from a psychiatrist or non-psychiatrist. Sociodemographic, clinical, and depression related cost has been investigated. Treatment resistant depression, which is defined as a failure of two antidepressant regimens to alleviate symptoms, was also investigated. Prescription adequacy was assessed based on whether a regimen was maintained for at least 4 weeks. Among the 834694 patients with pharmaceutically treated depression (PTD) examined in this study, 326122 (39.1%) were treated by psychiatrists. Patients who were treated by psychiatrists were younger and had more psychiatric comorbidities than those treated by non-psychiatrists. They had longer PTD duration (229.3 days vs. 103.0 days, p < 0.05) and a larger proportion of treatment resistant depression (9.3% of PTD) when compared to those patients treated by non-psychiatrists. The patients treated by psychiatrists had a smaller proportion of inadequate antidepressant use compared to those patients in the non-psychiatrist group (44.5% vs. 65.1%, p < 0.05). The costs related to depression corrected with PTD duration were higher in the nonpsychiatrist group (32214 won vs. 56001 won, p < 0.05). Patients who receive antidepressants from psychiatrists are patients with more severe, treatment-resistant depression. Psychiatrists prescribe antidepressants more adequately and cost-effectively than non-psychiatrists.

When Experts Disagree

The objective of this case report is to highlight some learning points behind the reasoning of the Appellate Court in a case where there were two different expert opinions by two forensic psychiatrists from two distinctive Malaysian Approved Psychiatric Hospital in regard to the soundness of mind of Mr. A for an alleged offence punishable by a death penalty. Methods: This case report is based on the reasoning of the Appellate Court in rejecting the plea of the prosecutor. Results: The High Court order remained in which the defendant was found not guilty due to reason of insanity (NGRI) provided by the Malaysian Law under Section 84 of Penal Code for the charge of dangerous drug trafficking, and he was ordered by court to undergo treatment for his underlying mental illness in a Psychiatric Institution under Section 348(1) of the Malaysian Criminal Procedure Code. Conclusion: In writing expert report, it is preferable to use a singular first-person pronoun in stating the conclusion. If there are other experts involved in either current or previous assessment, it would be beneficial to address their different opinions in the expert report. However, expert opinion is still an ‘opinion',’ and the court would be perfectly entitled to reject or differ from any of the expert opinions when there are proper grounds to do so. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

Organ transplant & the psychiatrist: An overview.

Organ transplantation has emerged as the saving grace for those who are suffering from end organ disease. Advent of modern surgical procedures and immunosuppressants further decrease morbidity and mortality. Meta-analyses have shown that post-organ transplantation quality of life improves for social, physical and daily activity functioning, but not consistently for psychological health. Psychiatrists can play a useful role not only in selecting the best suitable candidate for the procedure by psychosocial screening but also to tackle post-operation psychological issues that trouble patients as well as caretakers and decrease their quality of life. Issues like selection of patients with psychiatric disorders and substance abuse for transplantation process and their treatment both pre- and post- operation, risky health behaviours, treatment adherence for immunosuppressants and psychological support for caretakers can be better addressed by a psychiatrist who is sensitive towards these issues. Prescribing various psychotropics and immunosuppressants in the background of impaired organ function and drug-drug interaction is further challenging. Thus, psychiatrists need to be knowledgeable about these issues and should be an integral part of organ transplantation team for overall better outcome.

La formación del psiquiatra militar en el contexto de la guerra contemporánea / Training of military psychiatrists for contemporary warfare

Se opina acerca de las características de las acciones del psiquiatra militar en casos de desastres y guerras. Teniendo en cuenta las características y preparación que demandan estas situaciones excepcionales, el psiquiatra militar debe estar dotado de una preparación, que le permita atender en breve tiempo, gran cantidad de pacientes. Esta base, no está en los currículos de preparación de tiempo de paz, lo cual establece una necesidad, de forma que se empleen los escenarios de desastres, naturales o no, a fin de obtener el entrenamiento necesario para alcanzar las habilidades.

An analysis is provided of the characteristics of military psychiatry actions in disaster and war situations. Considering the features of these exceptional situations and the preparation they require, the military psychiatrist should be trained to attend to a large number of patients in a short time. Since such training is not included in peace time curricula, it is necessary to take advantage of disaster scenarios, either natural or not, to develop those abilities.

A Practice Patterns of Child and Adolescent Psychiatrists in South Korea

OBJECTIVES: The aim of this study is to assess the career paths and practice patterns of child and adolescent psychiatrists in South Korea. METHODS: A survey on demographic data, work environment, opinion on fellowship training program, and current practice patterns was conducted in 76/223 (34.0%) of all child and adolescent psychiatrists (N=223) were from 1980 to 2008. The survey data from the responders were analyzed. RESULTS: More than half of those surveyed were women. The mean age of survey participants was 40.8 years; most were married, and lived in the Seoul National Capital Area. In general, the responders were very satisfied with their work. They worked in private practice, public sector, group practice, and as consultants. Up to 87% of the patients treated were children and adolescents. The most common treatment modalities were medication and parent psychoeducation. Social skills training and play therapy were applied mainly for children aged 4 to 12 years old. Cognitive behavioral therapy and counseling were preferred in adolescents. CONCLUSION: The current study used a database approach in order to define current practice patterns. These data may be helpful in consideration of future training programs, workforce issues in child and adolescent psychiatry in South Korea, and also in collaboration with other mental health providers.

Prevalencia y factores demográficos y laborales asociados al burnout de psiquiatras en Colombia / Prevalence and both Demographic and Work Factors Associated with Burnout of Psychiatrists in Colombia

La presencia de burnout puede afectar el bienestar de los médicos y la calidad del cuidado que brindan. El propósito de este estudio fue medir la prevalencia de burnout en los psiquiatras en Colombia, y determinar si su presencia está asociada con condiciones demográficas y otras variables laborales. Se realizó un estudio descriptivo transversal, encontrando que 9.9 % de los participantes presentaban altos niveles de burnout. La edad, el trabajo como empleado y la dedicación exclusiva al área clínica fueron los principales factores asociados a la presencia del síndrome en esta población. Debe destacarse el uso por primera vez en Colombia del instrumento del CESQT, el cual mostró propiedades psicométricas adecuadas, lo que indica que puede usarse para evaluar el síndrome de burnout.

Burnout can affect not only wellbeing of medical professionals but also the quality of care they can provide to their patients. Aims of the study were to assess prevalence of burnout in Colombian psychiatrist and determine the associations of experiencing burnout with other demographic and working conditions. Transversal descriptive study showed that 9.9% of the participants were experiencing high levels of burnout. Age, being employed and working exclusively with patients were the principal predictors of burnout in this population. This study showed the good psychometric properties of the CEQST that invite to use it to assess the syndrome in this country.

From New Zealand To Malaysia: Making Smoking Free Agenda for Psychiatrists In Malaysia

Objective: This article highlights the issues pertaining to psychiatry and smoking as reported in a symposium on smoking cessation in Malaysia. Methods: A report on a meeting outcome of a symposium on “Making smoking free agenda for psychiatrists in Malaysia.” Results: Smoking is still the number one public health problem and those with mental illness were at a high risk. Despite that, they are often under served in service provision by those caring for them. These shortcoming are seen more and more in Malaysia, where smoking and psychiatry is under researched. Conclusion: More research are needed on the why and how psychiatrist can play a major role in ensuring that those with mental illness in Malaysia are provided equal opportunities to quit smoking.

O cotidiano de usuários de CAPS: empoderamento ou captura / The daily life of users of CAPS: empowerment or capture

A reforma psiquiátrica tem investido na criação de serviços e qualificação técnica. Consideramos que a atenção técnica/especializada tem limitações para atender diversas demandas dos usuários e muitas formas de cuidado podem ser produzidas entre os mesmos. Este artigo discute a ajuda mútua e o empoderamento entre usuários de CAPS na perspectiva de ressaltar essa dimensão instituinte da reforma. Fazendo uso da entrevista e da observação participante percebemos que o modo de funcionamento e a gestão dos CAPS, bem como a concepção terapêutico-clínica da equipe, tendem a barrar as possibilidades de ajuda mútua entre os usuários, dificultando o empoderamento dos mesmos.

The psychiatrist reform has invested in service creation and the qualification of the technicians. We believe that attention specialist has limitations to meet various demands of users and many forms of care can be produced among the users. This article discusses the mutual aid and empowerment among users of CAPS investing in this dimension of instituting reform. Making use of mapping and participant observations, we see that the mode of operation and management of CAPS, and the design of therapeutic and clinical technical team, they tend to spread the opportunities for mutual support among users, making the empowerment of those.

Centro de Acolhimento da Crise: Hospital Galba Velloso e algumas de suas respostas aos desafios da Reforma Psiquiátrica / Centro de Acogida para las Crisis: Hospital Galba Velloso y algunas de sus respuestas a los desafíos de la Reforma Psiquiátrica / Refuge center of crisis: Galba Velloso Hospital and some of its answers about the challenge of the Psychiatrist reform

Este texto se constrói com base em pesquisa realizada no Hospital Galba Velloso, analisando as implicações da transformação do seu Posto de Urgência Psiquiátrica (PUP) em Centro de Acolhimento da Crise (CAC). O CAC foi o caso estudado por meio de 600 prontuários de pacientes residentes em Belo Horizonte, entre 2001 e 2006, e 25 entrevistas com profissionais relacionados a ele. Aqui se privilegiam os dados obtidos nas entrevistas semiestruturadas, trabalhadas por meio da análise de conteúdo. Eles foram refletidos com base nos princípios da Reforma Psiquiátrica e sua operacionalização na cidade de Belo Horizonte, onde o hospital se insere, do Plano Diretor do Hospital e da psicanálise como eixo articulador. As conclusões apresentam acordos e desacordos sobre o modo de funcionamento do CAC e mostram que o Programa de Atenção à Saúde Mental, de Belo Horizonte, reconhecido pelos avanços, não prescinde, ainda, da função social e terapêutica do Hospital.

This article builds itself according to researches realized at the Galba Velloso Hospital, analyzing the implications of the transformation of its Emergency Psychiatric Station (EPS) in Centre Crisis Refuge (CRC). The CRC was a case studied using 600 promptuary of patients who reside in Belo Horizonte, from 2001 to 2006, and 25 semi-structured interviews, developed through content analysis. They were reflected upon principles of the Psychiatric reform and its operationalization in Belo Horizonte city where the hospital inserts itself, of the Director's plane and of the psychoanalysis as an articulator axis. The conclusions show agreements and disagreements about the CRC operation mode and they show the Programa de Atenção à Saúde Mental, of Belo Horizonte, known by progress, and do not prescinds, until now, the social and therapeutics function of the Hospital.

Este artículo recoge la investigación llevada a cabo en el Hospital Galba Velloso, analizando las implicaciones de la trasformación de su Servicio de Urgencias Psiquiátricas (PUP) en el Centro de Acogida para las Crisis (CAC). Se consideró al CAC como el caso de estudio centrándose en los registros de 600 pacientes que residían en Belo Horizonte, entre 2001 y 2006 y, en 25 entrevistas con profesionales relacionados con este servicio. Se exponen, aquí, los datos obtenidos en las entrevistas semiestructuradas, analizadas por medio de análisis de contenido. Los datos obtenidos fueron analizados a partir de los principios de la Reforma Psiquiátrica y su operacionalización en la ciudad de Belo Horizonte donde se localiza el Hospital, del Plan Director del Hospital y teniendo el psicoanálisis como eje articulador. Los resultados presentan acuerdos y desacuerdos sobre el modo de funcionamiento del CAC y muestra que el Programa de Atención a la Salud Mental de Belo Horizonte, reconocido por sus avances, aún no descarta la función social y terapéutica del Hospital.

O retrato da psiquiatria pelos cinemas norte-americano e brasileiro / The portrayal of psychiatry in American and Brazilian cinema

INTRODUÇÃO: Em virtude de sua fácil acessibilidade, o cinema parece influenciar bastante a imagem que a sociedade faz da Psiquiatria. OBJETIVO: Realizar uma revisão sistemática da literatura sobre o retrato da Psiquiatria pelos cinemas norte-americano e brasileiro. MÉTODOS: Sem limite de data, fez-se uma busca bibliográfica manual e nos seguintes bancos de dados: LILACS, MedLine, PsychLit, PsycINFO e SciELO. Usaram-se as seguintes combinações de descritores em inglês e, nas bases LILACS e SciELO, os correspondentes em português: "psychiatry" E/OU "motion pictures as topic". Estipularam-se critérios precisos de inclusão e exclusão. RESULTADOS: Vinte artigos indexados e dois livros. No cinema norte-americano, tais fontes evidenciaram um constante retrato estereotipado de diferentes aspectos da Psiquiatria, cuja imagem se mostrou ambivalente e com cinco fases distintas de sua representação. No cinema brasileiro, os escassos estudos se limitaram praticamente à fase de "Retomada" e mostraram que a maioria dos filmes apresentava algum conteúdo psicopatológico. DISCUSSÃO: Apesar da dificuldade de comparação entre as fontes encontradas, uma vez que quase todas eram descritivas, foi possível traçar um paralelo do retrato da Psiquiatria entre as películas dos Estados Unidos e as nacionais. CONCLUSÃO: A representação da Psiquiatria difere bastante entre os cinemas norte-americano e brasileiro, sobretudo pela amostra de os filmes analisados abrangerem períodos bem distintos.

INTRODUCTION: As cinema has an easy accessibility, it seems to influence society's image of psychiatry. OBJECTIVES: To accomplish a systematic review of the literature about the portrayal of psychiatry in American and Brazilian films. METHODS: With no date limits, we searched the databases: LILACS, MedLine, PsychLit, PsycINFO and SciELO. We used the following terms in English and, in LILACS and SciELO, their equivalent in Portuguese: "psychiatry" AND/OR "motion pictures as topic". A manual search was also done. Accurate inclusion and exclusion criteria were stipulated. RESULTS: Twenty indexed articles and two books. In American cinema, the data have allowed to identify a constant stereotyped portrayal of different aspects of psychiatry, its ambivalent image and five distinct phases of its depiction. In Brazilian cinema, the few studies about the image of psychiatry have focused on "The retaken" phase. The majority of its films have showed some psychopathological content. DISCUSSION: As almost all articles have been descriptive, it was difficult to establish a comparison among them. However, it was possible to draw a parallel between US films and Brazilian ones. CONCLUSION: The portrayal of psychiatry differs between American and Brazilian cinema mainly because the sample of analyzed movies came from very distinct periods.

Rol del médico psiquiatra según equipos de salud mental comunitaria Servicio de Salud Metropolitano Oriente (SSMO) / Psychiatrist's Role as MentalHealth Teams S. S. M. O

Se presenta la evolución de la práctica médica del psiquiatra, según cambios del enfoque de la psiquiatría y del sistema de servicios de salud, en que esta labor se ha desarrollado. La psiquiatría, como una práctica biopsicosocial, se ve continuamente afectada por los cambios enunciados, que determinan el desempeño real del psiquiatra y las expectativas de este rol, tanto del equipo de salud mental como de los usuarios, en el sector público. En base a que existen escasos estudios empíricos sobre lo que ocurre en la realidad práctica del psiquiatra, a nivel de salud mental comunitaria, se presenta este estudio exploratorio, sobre la percepción de los distintos profesionales acerca del trabajo del psiquiatra: visión del rol real, rol deseado y las competencias valoradas por los equipos, para la buena práctica psiquiátrica.

It is presented the evolution of medical practice of the psychiatrist, according to changes in approach to psychiatry and health care system, that this work has been conducted. Psychiatry, as a biopsychosocial practice, is continually affected by the changes set forth, which determine the actual performance of the psychiatrist and the expectations of this role, both mental health team and users in the public sector. On the basis that there are few empirical studies about what happens in actual psychiatrist’s practiced at, community mental health level, this exploratory study presents the perception of the different professionals about the work of psychiatrist: real vision of the role, expectations of it, and skills valued by the teams for a good psychiatric practice.