Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis

Objectives: To present evidence-based guidelines for clinical practice regarding religiosity and spirituality in mental health care in Brazil. Methods: A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS, and Cochrane databases. A summary of recommendations and their levels of evidence was produced in accordance with Oxford Centre for Evidence-Based Medicine guidelines. Results: The systematic review identified 6,609 articles, 41 of which satisfied all inclusion criteria. Taking a spiritual history was found to be an essential part of a compassionate and culturally sensitive approach to care. It represents a way of obtaining relevant information about the patient's religiosity/spirituality, potential conflicts that could impact treatment adherence, and improve patient satisfaction. Consistent evidence shows that reported perceptual experiences are unreliable for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful for distinguishing pathological and non-pathological anomalous experiences. Conclusion: Considering the importance of religiosity/spirituality for many patients, a spiritual history should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to differential diagnosis.

Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis.

OBJECTIVES: To present evidence-based guidelines for clinical practice regarding religiosity and spirituality in mental health care in Brazil. METHODS: A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS, and Cochrane databases. A summary of recommendations and their levels of evidence was produced in accordance with Oxford Centre for Evidence-Based Medicine guidelines. RESULTS: The systematic review identified 6,609 articles, 41 of which satisfied all inclusion criteria. Taking a spiritual history was found to be an essential part of a compassionate and culturally sensitive approach to care. It represents a way of obtaining relevant information about the patient's religiosity/spirituality, potential conflicts that could impact treatment adherence, and improve patient satisfaction. Consistent evidence shows that reported perceptual experiences are unreliable for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful for distinguishing pathological and non-pathological anomalous experiences. CONCLUSION: Considering the importance of religiosity/spirituality for many patients, a spiritual history should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to differential diagnosis.

Psychometric properties of the WHOQOL-SRPB BREF, Brazilian Portuguese version

Objective: To test the reliability and the discriminant and convergent validity of the abbreviated Brazilian Portuguese World Health Organization's Quality of Life Instrument - Spirituality, Religion, and Personal Beliefs module (WHOQOL-SRPB BREF). Methods: In a sample of 404 individuals, we applied a general questionnaire, the WHOQOL-BREF, the long-form SRPB, the Brief Religious-Spiritual Coping Scale (RCOPE), and the Beck Depression Inventory (BDI). Priority was given to the 9-item SRPB assessment: its unidimensionality was tested through confirmatory factor analysis and Rasch analysis. Results: Confirmatory factor analysis of the 9-item SRPB assessment indicated an adjusted model with acceptable fit to data. In the Rasch analysis, general fit measures showed adequate performance. The 9-item SRPB assessment showed good internal consistency (alpha = 0.85), and could differentiate (discriminant validity) between religious and atheist/agnostic respondents (mean = 74.7±14.1 and 56.8±15.5, respectively; t = 6.37; degrees of freedom [df] = 402; p < 0.01) and between non-depressed and depressed respondents (mean = 76.5±12.9 and 67.1±16.5; t = 5.57; df = 190.5; p < 0.01). Correlations (convergent validity) were significant with the positive-RCOPE subscale (r = 0.58, p < 0.01) and the WHOQOL-BREF domains (Pearson coefficient ranging between 0.24 and 0.49; p < 0.01), but were in the negative direction with the negative-RCOPE subscale (r = -0.10, p < 0.05). Correlation with the long-form SRPB domain (r = 0.934) was almost perfect. Conclusion: The Brazilian Portuguese 9-item SRPB has good psychometric properties and confirmed the findings of the long-form Brazilian Portuguese version and the abbreviated English version.

Psychometric properties of the WHOQOL-SRPB BREF, Brazilian Portuguese version.

OBJECTIVE: To test the reliability and the discriminant and convergent validity of the abbreviated Brazilian Portuguese World Health Organization's Quality of Life Instrument - Spirituality, Religion, and Personal Beliefs module (WHOQOL-SRPB BREF). METHODS: In a sample of 404 individuals, we applied a general questionnaire, the WHOQOL-BREF, the long-form SRPB, the Brief Religious-Spiritual Coping Scale (RCOPE), and the Beck Depression Inventory (BDI). Priority was given to the 9-item SRPB assessment: its unidimensionality was tested through confirmatory factor analysis and Rasch analysis. RESULTS: Confirmatory factor analysis of the 9-item SRPB assessment indicated an adjusted model with acceptable fit to data. In the Rasch analysis, general fit measures showed adequate performance. The 9-item SRPB assessment showed good internal consistency (alpha = 0.85), and could differentiate (discriminant validity) between religious and atheist/agnostic respondents (mean = 74.7±14.1 and 56.8±15.5, respectively; t = 6.37; degrees of freedom [df] = 402; p < 0.01) and between non-depressed and depressed respondents (mean = 76.5±12.9 and 67.1±16.5; t = 5.57; df = 190.5; p < 0.01). Correlations (convergent validity) were significant with the positive-RCOPE subscale (r = 0.58, p < 0.01) and the WHOQOL-BREF domains (Pearson coefficient ranging between 0.24 and 0.49; p < 0.01), but were in the negative direction with the negative-RCOPE subscale (r = -0.10, p < 0.05). Correlation with the long-form SRPB domain (r = 0.934) was almost perfect. CONCLUSION: The Brazilian Portuguese 9-item SRPB has good psychometric properties and confirmed the findings of the long-form Brazilian Portuguese version and the abbreviated English version.

Can Religious Coping and Depressive Symptoms Predict Clinical Outcome and Quality of Life in Panic Disorder? A Brazilian Longitudinal Study.

Few studies have investigated the relationship between spiritual/religious coping (S/R coping) and panic disorder (PD). This Brazilian longitudinal study evaluated if S/R coping and depressive symptoms can predict PD remission and improved quality of life (QoL). There were 101 outpatients with PD who were followed up for 12 to 16 weeks. The prevalence ratio (PR) between positive S/R coping and negative S/R coping and PD remission was assessed, as well as the association between positive S/R coping and negative S/R coping and QoL. After adjusting for confounding factors, positive S/R coping presented an inverse PR with PD remission, which was not statistically significant (0.88; p = 0.075). There was no association between S/R coping and QoL. Depressive symptoms were negatively associated with PD remission (PR = 0.97; p < 0.01) and were not predictive of a better QoL.

Relações entre espiritualidade/religiosidade e psiquiatria no Brasil / Relations between spirituality/religiosity and psychiatry in Brazil

As relações entre espiritualidade/religiosidade e Psiquiatria no Brasil passaram por momentos distintos. Os relatos estão fragmentados e distribuídos em diversas fontes. Em uma revisão narrativa esse artigo tem por objetivo oferecer uma visão geral dos protagonistas e principais fatos de cada etapa, desde o século XIX até os dias atuais. A nomeação de Juliano Moreira, em 1903, para a direção do Hospital Nacional dos Alienados (Rio de Janeiro/RJ) é o marco inicial da Psiquiatria cientifica brasileira. O pano de fundo é a visão Positivista do mundo e do ser humano, com a expectativa de que a ciência suplantaria todas as crenças religiosas e metafísicas. Foi preciso que o vigor da Modernidade esmaecesse para que outro entendimento aflorasse. Nas últimas décadas do século XX psiquiatras receptivos ao tema das crenças conseguiram abrir espaços em associações profissionais para debater sobre espiritualidade e somente a partir da década de 1990 as pesquisas nacionais em Psiquiatria começaram a incluir a espiritualidade. Desde então, o conjunto de evidências cresceu célere, mas consistentemente. Em nível mundial ­ e em menos de três décadas - o Brasil já está entre os cinco países com maior número de publicações sobre espiritualidade/religiosidade e saúde mental, com potencial para permanecer em posição de destaque, pois possui população com grande religiosidade, ao mesmo tempo em que surge uma nova geração de pesquisadores engajados no tema

The relations between spirituality / religiosity and psychiatry in Brazil went through different moments. Reports are fragmented and distributed across multiple sources. In a narrative review this article aims to provide an overview of the protagonists and key facts of each stage from the 19th century to the present day. The appointment of Juliano Moreira, in 1903, to the direction of the Alienados National Hospital (Rio de Janeiro/RJ) is the initial milestone of Brazilian scientific psychiatry. The background is the Positivist view of the world and human being, with the expectation that science would supersede all religious and metaphysical beliefs. The vigor of Modernity had to weaken for another understanding to emerge. In the last decades of the 20th century, psychiatrists receptive to the theme of beliefs were able to open spaces in professional associations to discuss spirituality and not until the 1990s did national research in psychiatry begin to include spirituality. Since then, the body of evidence has grown rapidly but consistently. Worldwide - and in less than three decades - Brazil is already among the five countries with the highest number of publications on spirituality/religiosity and mental health, with the potential to remain in a prominent position, as it has a highly religious population, while emerges a new generation of researchers engaged in the theme.

Quality-of-life and spirituality.

Spirituality has been identified as an important dimension of quality-of-life. The objective of this study was to review the literature on quality-of-life and spirituality, their association, and assessment tools. A search was conducted of the keyterms 'quality-of-life' and 'spirituality' in abstract or title in the databases PsycINFO and PubMed/Medline between 1979-2005, complemented by a new search at PUBMED from 2006-2016. Quality-of-life is a new concept, which encompasses and transcends the concept of health, being composed of multiple domains: physical, psychological, environmental, among others. The missing measure in health has been defined as the individual's perception of their position in life in the context of culture and value system in which they live and in relation to their goals, expectations, standards, and concerns. There is consistent evidence of an association between quality-of-life and religiosity/spirituality (R/S), through studies with reasonable methodological rigour, using several variables to assess R/S (e.g. religious affiliation, religious coping, and prayer/spirituality). There are also several valid and reliable instruments to evaluate quality-of-life and spirituality. Further studies are needed, however, especially in Brazil. Such studies will provide empirical data to be used in planning health interventions based on spirituality, seeking a better quality-of-life. In the last 10 years, research is consistently growing about quality-of-life and spirituality in many countries, and also in many areas of health research.

Depression as a major impact on the quality of life of HIV-positive Brazilians.

Given that mental symptoms might interfere with the quality of life (QOL) of people living with HIV/AIDS (PLHAs), the goal of this paper was to examine the correlation between depression, anxiety, and QOL in a sample of HIV-positive Brazilians. A cross-sectional study was designed to analyze the correlations between the presence of mental symptoms and the QOL scores of PLHAs. Depression and anxiety symptoms were measured using the Beck Depression Inventory and the State-Trait Anxiety Inventory, respectively. The QOL was assessed using the World Health Organization Quality of Life instrument - HIV module. A convenience sample of 308 men and women living with HIV (131 asymptomatic, 91 symptomatic, and 86 with AIDS) in Porto Alegre/RS-Brazil was selected. The depression scores were higher in patients with AIDS compared with asymptomatic and symptomatic patients, yet there were no differences in the anxiety scores between the stages of infection. Better QOL scores were observed in the earlier stages of infection (asymptomatic and symptomatic groups). In the correlation between mental symptoms and QOL scores, the Pearson's coefficient values were of a moderate (r = .47) to a large (r = .65) magnitude for depressive symptoms, and the scores for the anxiety symptoms were small to moderate (r ≤ .35). After adjusting for the disease stage and clinical and sociodemographic variables in a multiple regression model (using QOL as the dependent variable), the depressive symptoms showed significantly higher beta-coefficient values compared with the remaining variables. The data obtained from this study indicate that the QOL of PLHAs is primarily affected by depression. Thus, it has been strongly recommended that treatment programs dedicated to PLHAs assess depressive symptoms, providing subsequent referrals and treatments. Treating depression might be effective for PLHAs and might potentially improve both the overall QOL and the health outcomes.

Perfil e prática profissional de psiquiatras no Brasil / Professional profile and practice of psychiatrists in Brazil

Com o objetivo de identificar o perfil profissional de psiquiatras do Brasil, foram escolhidos para estudo cinco Estados representativos de cada regiäo do País (Bahia, Pará, Rio de Janeiro, Säo Paulo, Rio Grande do Sul, além do Distrito Federal). A amostra consistiu de 430 membros da ABP, que responderam a questionário enviado pelo correio. Os dados foram analisados pelo sistema EPI-INFO. Verificou-se que 76,5 por cento dos psiquiatras estudados fazem ou fizeram supervisäo de seu trabalho, 65, 1 por cento participam de grupos de estudo, 51,9 por cento submeteram-se a psicoterapia pessoal, 71,2 por cento foram ou säo pacientes de psicanálise. Quanto à atividade profissional, 30,2 por cento do tempo säo dedicados a instituiçöes públicas, 11,6 por cento a instituiçöes privadas e 48,3 por cento ao consultório particular. Neste, predominam as técnicas psicoterápicas

Perfil e pratica profissional de psiquiatras no Brasil

Com o objetivo de identificar o perfil profissional de psiquiatras do Brasil, foram escolhidos para estudo cinco Estados representativos de cada regiao do Pais (Bahia, Para, Rio de Janeiro, Sao Paulo, Rio Grande do Sul, alem do Distrito Federal). A amostra consistiu de 430 membros da ABP, que responderam a questionario enviado pelo correio. Os dados foram analisados pelo sistema EPI-INFO. Verificou-se que 76,5 por cento dos psiquiatras estudados fazem ou fizeram supervisao de seu trabalho, 65,1 por cento participam de grupos de estudo, 51,9 por cento submeteram-se a psicoterapia pessoal, 71,2 por cento foram ou sao pacientes de psicanalise. Quanto a atividade profissional, 30,2 por cento do tempo sao dedicados a instituicoes publicas, 11,6 por cento a instituicoes privadas e 48,3 por cento ao consultorio particular. Neste, predominam as tecnicas psicoterapicas.

SETA: um programa computacional de apoio ao tratamento farmacológico dos transtornos afetivos / SETA: a computer program aiding pharmacological treatment of affective disorders

Os autores situam o uso de Sistemas Especialistas em Psiquiatria e descrevem um desses sistemas desenvolvido para apoio ao tratamento farmacológico dos transtornos afetivos (SETA). O programa contém um módulo de consulta em que se encontram informaçöes sobre f rmacos utilizados nesses distúrbios: farmacocinética, farmacodinâmica, indicaçöes, contra-indicaçöes, efeitos colaterais e seu manejo, uso em crianças, gestantes, idosos e na presença de doenças físicas. Contém ainda um módulo especialista, que auxilia o usu rio a escolher a droga mais adequada às condiçöes do paciente (idade, perfil sintom tico, doenças físicas...). Submetido a uma avaliaçäo inicial, mostrou-se útil tanto na consulta ao banco de dados, como no auxílio à escolha dos psicof rmacos mais apropriados

SETA: um programa computacional de apoio ao tratamento farmacologico dos transtornos afetivos

Os autores situam o uso de Sistemas Especialistas em Psiquiatria e descrevem um desses sistemas desenvolvido para apoio ao tratamento farmacologico dos transtornos afetivos (SETA). O programa contem um modulo de consulta em que se encontram informacoes sobre os farmacos utilizados nesses disturbios: farmacocinetica, farmacodinamica, indicacoes, contra-indicacoes, efeitos colaterais e seu manejo, uso em criancas, gestantes, idosos e na presenca de doencas fisicas. Contem ainda um modulo especialista, que auxilia o usuario a escolher a droga mais adequada as condicoes do paciente (idade, perfil sintomatico, doencas fisicas...). Submetido a uma avaliacao inicial, mostrou-se util tanto na consulta ao banco de dados, como no auxilio a escolha dos psicofarmacos mais apropriados.

Uma amostra de psiquiatras do Rio Grande do Sul e Sao Paulo: perfil demografico e pratica de consultório / A sample of psychiatrists from Rio Grande do Sul and Sao Paulo: their demographic characteristics and office practices

Os autores realizaram um levantamento em forma de question rio em 1990, em que estudaram as características demogr ficas e a pr tica de consultório de uma amostra de psiquiatras do Rio Grande do Sul. Concluída essa etapa, estendeu-se a consulta para outros cinco estados do país. Säo Paulo foi o estado escolhido para uma an lise comparativa preliminar com os dados do Rio Grande do Sul, por ter sido o primeiro a atingir um mínimo de 10 por cento de respostas. Detectaram-se algumas semelhanças e diferenças entre as duas amostras: predominância de homens em ambas, psiquiatras paulistas em média mais velhos e com mais anos de pr tica do que os gaúchos, maior quantidade de psiquiatras paulistas com formaçäo analítica, sendo que existem semelhanças quanto aos tratamentos pessoais e grupos de estudo. Quanto à pr tica de consultório, a psicoterapia de orientaçäo analítica predomina no Rio Grande do Sul, enquanto a clínica psiqui trica predomina em Säo Paulo

Uma amostra de psiquiatras do Rio Grande do Sul e São Paulo:perfil demogratico e pratica de consultorio

Os autores realizaram um levantamento em forma de questionario em 1990, em que estudaram as caracteristicas demograficas e a pratica de consultorio de uma amostra de psiquiatras do Rio Grande do Sul. Concluida essa etapa, entendeu-se a consulta para outros cinco estados do pais. Sao Paulo foi o estado escolhido para uma analise comparativa preliminar com os dados do Rio Grande do Sul, por ter sido o primeiro a atingir um minimo de 10 por cento de respostas. Detectaram-se algumas semelhancas e diferencas entre as duas amostras: predominancia de homens em ambas, psiquiatras paulistas em media mais velhos e com mais anos de pratica do que os gauchos, maior quantidade de psiquiatras paulistas com formacao analitica, sendo que existem semelhancas quanto aos tratamentos pessoais e grupos de estudo. Quanto a pratica de consultorio, a psicoterapia de orientacao analitica predomina no Rio Grande do Sul, enquanto a clinica psiquiatrica predomina em Sao Paulo

Padrao de prescricao em hospital-escola pediatrico de Porto Alegre / Prescription pattern in children's university hospital of Porto Alegre

A partir de trabalhos sobre prescricoes hospitalares para adultos, realizou-se uma analise dos medicamentos prescritos para pacientes pediatricos hospitalizados. Foram avaliadas as prescricoes em um hospital-escola, em tres dias diferentes, com intervalos de um mes, durante o ano de 1988. As criancas recebiam em media 4,5 prescricoes por dia. As drogas de acao no trato respiratorio e as de uso topico apareceram entre as mais prescritas para criancas, juntamente com os analgesicos-antipireticos-antiinflamatorios, os antiinfecciosos e as drogas de acao no trato gastrointestinal. Estes tres ultimos tiveram perfil semelhante ao dos adultos. O uso de aminoglicosideos apresentou-se sem acompanhamanto adequado da funcao renal, bem como o uso geral de antiinfecciosos foi precedido poucas vezes de antibiograma, Por outro lado, o perfil do uso de psicofarmacos foi significativamente diferente ao dos adultos