Reinserción social en la unidad de Psiquiatría Forense en Sancti Spíritus

Fundamento:la Psiquiatría Forense es la aplicación de los conocimientos psiquiátricos al proceso de administración de justicia.Objetivo:describir el comportamiento de la reinserción social en la Unidad de Psiquiatría Forense de Sancti Spíritus.Métodos:se comunican los resultados del estudio del comportamiento de los asegurados en la Unidad de Psiquiatría Forense de Sancti Spíritus 2016 al 2018.Resultados:predomina el grupo etáreo entre 24 a 35 años, sexo masculino, la esquizofrenia paranoide con los neurolépticos atípicos como modalidad de tratamiento psico farmacológico más utilizado. Se lograron cambios positivos, que ayudó a la solicitud de cese de medida con su posterior reinserción social.Conclusiones:con la aplicación integral de terapias, se logran cambios que permiten la reinserción social, disminuye el riesgo de que puedan delinquir o violentarse en un futuro.[AU]

[Determinants of social participation and social inclusion of people with severe mental illness]. / Determinanten sozialer Partizipation und sozialer Inklusion chronisch psychisch erkrankter Menschen.

BACKGROUND: Individuals with mental disorders are known to be socially excluded so that improving social inclusion has become a major goal of healthcare provision. However, empirical research on specific determinants of social inclusion is rather scarce. METHODS: A cross-sectional survey of adults with a severe mental illness (n =70) was conducted using a measure of participation and social inclusion for individuals with a chronic mental disorder (F-INK). Univariate and multivariate regression analyses were conducted to identify determinants of social participation and social inclusion. RESULTS: Social participation increased with the number of friends and was, independently thereof, higher in adults living independently than in adults living in supported housing arrangements. The level of social inclusion was higher in those cohabitating and increased with duration of illness. CONCLUSION: Findings on social participation indicate the need for a re-organization of community-based supported housing arrangements, and, with respect to existing settings, an amendment of present conditions. To promote social inclusion, measures to prime a feeling of ongoing social affiliation should be taken during the first years of psychiatric illness.

"A world crazier than us": Vanishing social contexts and the consequences for psychiatric practice in contemporary Romania.

Since the end of Communism, mental health care in Romania has increasingly sought to align its practices with idealized models of Western psychiatric practice. Much of this realignment has been made possible by accessing and integrating new pharmaceuticals into psychiatric hospital settings. Less straightforward have been the painful attempts to create a system modeled on international standards for training and certifying psychotherapists. Unfortunately, the political, economic, infrastructural, and epistemological environment of the Romanian mental health care system has prevented many other reforms. This paper examines the ironic trajectory that Romanian psychiatry has taken since the end of state socialism. Specifically, this paper shows how psychiatric practice in most places (outside of university-training hospitals) is increasingly disconnected from a concern with the social conditions that surround mental illness during a period when social upheaval is profoundly impacting the lives of many people who receive mental health care. Thus, as the contribution of social problems to the suffering of those with mental illnesses has increased, some Romanian mental health practitioners have moved away from a concern with these social problems under the guise of aligning their psychiatric practices with (imagined) Western standards of biomedical care. The paper provides a brief history of Romanian psychiatry and explores contemporary challenges and contradictions in many Romanian psychiatric treatment settings through the case study of a 31-year-old Romanian female diagnosed with paranoid schizophrenia.

Intervenciones de enfermería para la atención de adultos con esquizofrenia paranoide / Nursing interventions for the care of adults with paranoid schizophrenia

Introducción. Los trastornos mentales tienen una alta prevalencia en todo el mundo y contribuyen de manera importante a la morbilidad, la discapacidad y la mortalidad prematura. Métodos. Con el descriptor “Paranoid Schizophrenia” y el planteamiento de preguntas clínicas, se realizó la búsqueda sistemática en: PUBMED, CUIDEN y algunos sitios web para la revisión de guías clínicas, revisiones sistemáticas, ensayos clínicos, estudios observacionales entre otros, cuyas evidencias y recomendaciones con mayor gradación y fuerza respectivamente, dieran respuesta a la detección y diagnóstico oportuno, intervenciones durante la fase aguda, adherencia terapéutica, identificación y tratamiento de efectos adversos e intervenciones dirigidas a la familia para facilitar la psicoeducación y el autocuidado. Se consideraron documentos en inglés y español publicados en 2010-2015.Resultados. De 20 estudios analizados, la evidencia científica denota que para el diagnóstico de esquizofrenia, es necesario considerar las características del cuadro clínico, antecedentes personales, familiares y factores de riesgo, además del abordaje durante la etapa aguda mediante la seguridad, contención verbal, farmacológica y física. Así mismo, el seguimiento para la detección y tratamiento de efectos adversos derivados del tratamiento farmacológico y el planteamiento de programas que consideren la identidad y cosmovisión de la persona, su familia y los efectos adversos sobre la salud, vida personal, social y económica.Conclusiones. Se deben estandarizar estrategias que faciliten la atención integral farmacológica, psicosocial y de autocuidado, con la finalidad de mejorar la calidad de la atención a personas con trastornos mentales así como de su familia.

Introduction. Mental disorders are highly prevalent worldwide and contribute significantly to morbidity, disability and premature mortality manner.Methods. With the descriptor "Paranoid Schizophrenia" and approach to clinical questions, the systematic search was conducted: PUBMED, CUIDEN and some websites for review of clinical guidelines, systematic reviews, clinical trials, observational studies among others, whose findings and recommendations more gradation and strength respectively, would respond to the detection and timely diagnosis, interventions during the acute phase, adherence, identification and treatment of adverse effects and interventions aimed at facilitating family psycho-education and self-care. documents were considered in English and Spanish published in 2010-2015.Results. 20 studies reviewed, scientific evidence indicates that for the diagnosis of schizophrenia, it is necessary to consider the clinical characteristics, personal history, and family risk factors, in addition to the approach during the acute stage by security, verbal, pharmacological containment and physical. Similarly, monitoring for the detection and treatment of adverse effects from the drug treatment programs and approach to consider the identity and worldview of the person, his family and adverse health effects, personal, social and economic life.Conclusions. Strategies should be standardized to facilitate the pharmacological, psychosocial self-care and comprehensive care in order to improve the quality of care for people with mental disorders and their family.

Introdução. Os transtornos mentais são altamente prevalentes em todo o mundo e contribuir significativamente para a morbidade, incapacidade e mortalidade prematura maneira.Métodos. Com o descritor "esquizofrenia paranóide" e abordagem de questões clínicas, a busca sistemática foi conduzida: PubMed, CUIDEN e alguns sites de revisão de diretrizes clínicas, revisões sistemáticas, ensaios clínicos, estudos observacionais, entre outros, cujas conclusões e recomendações mais gradação e força, respectivamente, iria responder ao diagnóstico de detecção e oportuna, as intervenções durante a fase aguda, a adesão, a identificação e tratamento de efeitos adversos e intervenções destinadas a facilitar família psico-educação e auto-cuidado. documentos foram considerados em Inglês e Espanhol publicado em 2010-2015.Resultados. 20 estudos revisados, evidências científicas indicam que, para o diagnóstico de esquizofrenia, é necessário considerar as características clínicas, história pessoal e fatores de risco familiar, além da abordagem durante a fase aguda de segurança, verbal, contenção farmacológica e física. Da mesma forma, o monitoramento para a detecção e tratamento dos efeitos adversos dos programas de tratamento de drogas e abordagem a considerar a identidade e visão de mundo da pessoa, sua família e efeitos adversos à saúde, vida pessoal, social e económico.Conclusões. As estratégias devem ser padronizados para facilitar a auto-atendimento psicossocial e farmacológico atendimento integral a fim de melhorar a qualidade dos cuidados para as pessoas com transtornos mentais e seus familiares.

[Senses and crumbs: psychosis and self-neglect at home]. / Les sens et les miettes: psychose et incurie à domicile.

What care can be given in cases of self-neglect? How can one be a good caregiver when one's senses and values are assaulted by the complete lack of hygiene? What is the bestway to help a patient who is used to living independently, when their health is under threat? What approach should be taken in order to rehabilitate their living place? A clinical illustration.

The stages of recovery in relation to the other subjective and objective aspects of psychosis.

The Stages of Recovery Instrument (STORI; Andresen et al., 2006) was used among 110 patients with psychosis. Recovery stages relationship with attribution, the way of experiencing illness and its phase and symptoms were analyzed. The samples were drawn from treatment facility including in-patient unit. The subgroups of recovering patients were identified: moratorium (27%), awareness (32%), preparation (30%) and rebuilding (11%). The achievement of higher stages of the recovery was correlated with: less severe symptoms of psychosis (with the exception of anxiety and depression, which have no impact on the stages of recovery), medical attribution (I am ill), integrative attitude toward the experience of psychosis, and the absence of involuntary hospitalizations. The logistic regression analysis model indicated the independent significance of the medical attribution, the integrating attitude toward psychotic experience and the remission of symptoms. Other clinical variables and social characteristics did not differentiate between the stages of recovery in any significant way. No juxtaposition as such was found between the processes of recovery and being ill, but rather a complementary relation. Recovery has been found to be enhanced by the remission of psychotic symptoms, medical attribution and integrative attitude toward the experience of psychotic crisis.

A pilot trial of cognitive behavioural therapy for interpersonal sensitivity in individuals with persecutory delusions.

BACKGROUND: Advances in understanding delusions may be used to improve clinical interventions. Interpersonal sensitivity - feeling vulnerable in the presence of others due to the expectation of criticism or rejection - has been identified as a potential causal factor in the occurrence of persecutory delusions. The purpose of this study was to examine the potential impact on persecutory delusions of a (newly devised) cognitive behavioural intervention targeting interpersonal sensitivity (CBT-IPS). METHODS: CBT-IPS was tested in an uncontrolled pilot study with eleven patients with persistent persecutory delusions in the context of a psychotic disorder. Patients had two baseline assessments over a fortnight period to establish the stability of the delusions, which was followed by six sessions of CBT-IPS, a post-therapy assessment, and a further follow-up assessment one month later. RESULTS: Interpersonal sensitivity and the persecutory delusions were stable during the baseline period. At the post-therapy assessment there were significant reductions of large effect size for both interpersonal sensitivity and the persecutory delusions. These gains were maintained at follow-up. LIMITATIONS: The main limitation is that in this initial test there was no control group. The intervention may not have caused the reduction in delusions. Further, bias may have been introduced by the outcome data being collected by the therapist. CONCLUSIONS: The findings from this evaluation are consistent with the hypothesised causal role for interpersonal sensitivity in the occurrence of persecutory delusions. CBT-IPS shows promise as a therapeutic intervention but requires a rigorous test of its efficacy.

Self psychology conceptualization of postpsychotic depression and recovery among paranoid schizophrenic patients.

Many psychoanalysts have offered innovative ideas on the treatment of schizophrenic patients, but none on postpsychotic depression. The author presents a psychoanalytic conceptualization of postpsychotic depression based on Kohut's ideas regarding the development of normal and pathological grandiosity. The main premise is that postpsychotic depression stems from the loss of psychotic grandiosity, and that it is the psychological reaction to the loss of omnipotent identity whose role it is to provide an alternative reality. Through near-experience connectedness, clinicians and practitioners in the psychiatric rehabilitation field can facilitate an empathic milieu in which new mental constructs can be established and new behavioral skills can be learned.

[The efficacy of cognitive neurorehabilitation with RehaCom program in schizophrenia patients]. / Skutecznosc rehabilitacji neuropsychologicznej z wykorzystaniem programów rehacom u pacjentów z rozpoznana schizofrenia.

UNLABELLED: Schizophrenic patients present cognitive dysfunctions which are currently regarded to be one of endophenotypical markers predisposing to schizophrenia. This indicates neurostructural changes underlying schizophrenia, which can be treated as a neurodegenerative and neurodeveloping disease. AIM: The purpose of this study was to assess the possibility of neuropsychological rehabilitation in schizophrenia. METHODS: 41 participants and 40 control subjects were randomly selected and did not show differences in gender, age and illness duration. Both groups had the diagnosis of paranoid schizophrenia according to ICD-10 criteria and were treated with antipsychotic drugs. Cognitive functions were checked with Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), and Stroop Color -Word Interference Test (SCWT) in the beginning and in the end of the experiment. In the research group each patient was trained with the rehabilitation programs that focused on attention and concentration and topological memory. This group was compared with the control group that was not trained with RehaCom. RESULTS: RehaCom procedures apparently can be useful in neuropsychological rehabilitation of cognitive dysfunctions in patients with diagnosed schizophrenia. Every participant from the research group showed a significant improvement in the training programs, especially in attention/concentration procedure. The analysis of parameters obtained in the neuropsychological tests showed some improvement in neuropsychological assessment in both groups. CONCLUSIONS: Cognitive rehabilitation produces moderate improvement in cognitive functioning. A comprehensive treatment using also new technologies supporting pharmacological treatments and other therapies should result in increased cognitive functioning and as a consequence improvement of quality of patient's life.

Integration of behavioral medicine in primary care.

The health care system in the United States is inefficient and there are many incentives for sustainable changes in the delivery of care. Incorporating behavioral medicine offers a wide range of opportunities. Within primary care settings, pain disorders, addiction, depression, and anxiety disorders are highly prevalent. Numerous chronic health conditions also require behavioral support for lifestyle change. These disorders are optimally managed through interdisciplinary collaborations that include a behavioral medicine component. This article discusses the effective integration of behavioral medicine within a primary care patient-centered medical home and describes the organizational planning and structure required for success.

Family therapy for schizophrenia: co-occurring psychotic and substance use disorders.

People with schizophrenia have a high prevalence of co-occurring substance use disorders, which is related to a worse course of psychiatric illness, more frequent relapses, and increased depression and suicide, compared with those with schizophrenia alone. The Family Intervention for Dual Diagnosis (FIDD) program, which includes psychoeducation and goal setting and focuses on building communication and problem-solving skills within the family, can aid in decreasing the stress related to having a close relationship with someone with a dual disorder. Here, the case of a young man with psychosis and marijuana dependence is examined. This article describes how the FIDD intervention helped him with his problematic substance use, as well as to build skills within his relationship for increased empathy and reduced interpersonal stress.

A gesture recognition system to transition autonomously through vocational tasks for individuals with cognitive impairments.

This study assessed the possibility of training two individuals with cognitive impairments using a Kinect-based task prompting system. This study was carried out according to an ABAB sequence in which A represented the baseline and B represented intervention phases. Data showed that the two participants significantly increased their target response, thus improving vocational job skills during the intervention phases. Practical and developmental implications of the findings are discussed.

An accelerometer-based handheld system to reduce breaks in performance of young adults with cognitive impairments.

This study assessed the possibility of training two individuals with cognitive impairments using a system that reduced breaks in performance. This study was carried out according to an ABAB sequence in which A represented the baseline and B represented intervention phases. Data showed that the two participants significantly increased their target response, thus reducing breaks and improving vocational job performance during the intervention phases. Practical and developmental implications of the findings are discussed.

Quantitative criteria of narrative coherence and complexity in persons with paranoid schizophrenia.

Narrative coherence and complexity have been considered as key concepts for understanding therapeutic improvement and recovery of persons with severe mental disorders. The main aim of this article is to study coherence and complexity of 18 life narratives of persons with paranoid schizophrenia by thirty quantitative analysis criteria. Two groups of patients were evaluated: a group of 9 patients recently admitted to specific Care Homes for people with severe mental disorders (G1) and another group of 9 patients who had been at the same Care Homes for a longer period of time (G2). Differences in patients' life narratives between 2 groups are explored. The analysis is divided into 3 phases. The first is called "analysis of lack of cohesion and delusional content"; the second "thematic analysis"; and the third "structural analysis". Results show that life narratives of long stay patients are more coherent and structured.

The REACT study: cost-effectiveness analysis of assertive community treatment in north London.

OBJECTIVE: Assertive community treatment (ACT) is a key component of mental health care, but recent information on its cost-effectiveness is limited. This article provides a cost-effectiveness analysis of assertive community treatment and usual care from community mental health teams (CMHTs) in the United Kingdom. METHODS: Participants who had difficulties engaging with community services were randomly assigned to ACT (N=127) or continued usual care from CMHTs (N= 124). Costs were measured at baseline and 18 months later and compared between the two groups. In the analysis, cost data were linked to information on satisfaction, which had been shown to be significantly higher with ACT. RESULTS: Total follow-up costs over 18 months were higher for the ACT group by pounds sterling 4,031 ($6,369), but this was not statistically significant (95% confidence interval of - pounds sterling 2,592 to pounds sterling 10,690 [-$4,095 to $16,890]). A one-unit improvement in satisfaction was associated with extra costs in the ACT group of pounds sterling 473 ($747). CONCLUSIONS: The costs of ACT were not significantly different from usual care. ACT did, however, result in greater levels of client satisfaction and engagement with services and as such may be the preferred community treatment option for patients with long-term serious mental health problems.