RESUMO
The coronavirus disease 2019 (COVID-19) pandemic is an unprecedent public health crisis, transforming many aspects of our daily life. Protection measures, such as social distancing, nationwide lockdowns, and restrictions on hospital visits and funerals have a serious impact on how people mourn their loved ones. The grieving process during childhood and adolescence evolves along the developmental stages and is a dynamic, non-linear process that needs time. Parental death increases the risk for psychopathology in the short and long term. We present a case of an 11-year-old girl referred to child psychiatry-liaison service by her neurologist due to peer relationship problems and sadness. Fifteen days before her first psychiatric consultation, her father suffered a myocardial infarction complicated with hypoxic ischemic encephalopathy, and he was hospitalized in the intensive care unit. Positive coping mechanisms and adaptive emotional expression strategies were explored during her consultations. Her father died 2 weeks after emergency state and nationwide lockdown was declared in Portugal, during the first COVID-19 outbreak. The family did not have the opportunity for a proper farewell, the funeral obeyed strict rules, and the patient and her family were at home, due to social distancing and school closure policies. Consultations were maintained by telephone calls and, less frequently, by face-to-face appointments. Adaptive and helpful strategies to grieve were shared with the patient and her mother. Intervention with the mother alone was also helpful. Death circumstances related to COVID-19, confinement policies, and social-economical stressors can intensify the grief experience, increasing the risk for complicated grief. Although psychiatric teleconsultation is essential during COVID-19 pandemic, it poses various limitations. Non-verbal communication clues may not be totally apprehended; it may represent a problem in the therapeutic relationship, and access to technology can be difficult for psychiatric patients and clinicians. COVID-19 pandemic policies should include mental health protection measures, which should facilitate adjusted grief responses for those who lose a loved one during this pandemic.
RESUMO
INTRODUCTION: Most mental disorders have a chronic evolution and therefore a certain amount of psychiatric readmissions are inevitable. Several studies indicate that over 25% of child and adolescent inpatients were readmitted within one year of discharge. Several risk factors for psychiatric readmissions have been reported in the literature, but the history of repeated readmissions is the most consistent risk factor. Our aim is to calculate the readmission rates at 30 days and 12 months after discharge and to identify associated risk factors. MATERIAL AND METHODS: The authors consulted the clinical files of patients admitted to the Inpatient Unit between 2010 and 2013, in order to calculate the readmission rates at 30 days and at 12 months. The demographic and clinical characteristics of the readmitted patients were analyzed and compared with a second group of patients with no hospital readmissions, in order to investigate possible predictors of readmission. RESULTS: A total of 445 patients were admitted to our inpatient unit between 2010 and 2013. Six adolescents were readmitted in a 30 days period (1.3%) and 52 were readmitted in a 12 month period after discharge (11.5%). Duration of the hospitalization and the previous number of mental health admissions were significant predictors of future hospital readmissions (p = 0.04 and p = 0.014). DISCUSSION: The low readmission rates may reflect the positive clinical and sociofamilial support being provided after discharge. CONCLUSION: Rehospitalisation is considered a fundamental target for intervention concerning prevention and intervention in mental healthcare. Thus, knowledge regarding their minimisation is crucial.
Introdução: A maioria das perturbações mentais tem uma evolução crónica pelo que certos reinternamentos são inevitáveis. Vários estudos indicam taxas de reinternamento pedopsiquiátrico superiores a 25%. O nosso objetivo é calcular as taxas de readmissão no internamento pedopsiquiátrico do Centro Hospitalar do Porto a 30 dias e um ano após a alta, e identificar os fatores de risco associados. Material e Métodos: A metodologia consistiu na consulta dos processos clínicos dos doentes internados na Unidade de Internamento do Centro Hospitalar do Porto entre 2010 e 2013, a fim de calcular as taxas de readmissão. Foram também recolhidas as características demográficas e clínicas dos doentes readmitidos. Finalmente, os resultados do grupo de doentes reinternados foram comparados com um segundo grupo de doentes selecionados aleatoriamente e sem readmissões hospitalares, a fim de investigar possíveis fatores de risco para reinternamentos. Resultados: Um total de 445 doentes foi admitido entre 2010 e 2013. Seis adolescentes foram readmitidos no período de 30 dias (1,3%) e 52 foram readmitidos nos 12 meses após a alta (11,5%). A análise comparativa revelou que a duração do internamento e o número de internamentos anteriores são preditores significativos (p = 0,04 e p = 0,014) para reinternamento.D iscussão: As baixas taxas de readmissão podem refletir não só a eficácia da intervenção terapêutica durante o internamento como também um bom suporte clínico e sociofamiliar após a alta. Conclusão: Os reinternamentos são considerados um alvo fundamental quanto à prevenção e intervenção nos cuidados de saúde mental. Assim, o conhecimento sobre a sua minimização é crucial.
