Declaração de consenso da seção de psiquiatria geriátrica da Associação Mundial de Psiquiatria sobre ética e capacidade em pessoas idosas com doença mental / World Psychiatric Association section of old age psychiatry consensus statement on ethics and capacity in older people with mental disorders

CONTEXTO: A Seção de Psiquiatria Geriátrica da Associação Mundial de Psiquiatria (AMP), desde 1997, vem desenvolvendo Declarações de Consenso relevantespara a prática da Psiquiatria Geriátrica. Desde 2006, a Seção vem trabalhando para desenvolver uma Declaração de Consenso sobre Ética e Capacidade em pessoas idosas com transtornos mentais. MÉTODO: Uma Conferência de Consenso foi realizada em Praga em setembro de 2008. Organizada pela Seção de Psiquiatria da Pessoa Idosa da AMP, ela contou com a participação do International Council of Nurses, Alzheimer Europe e Alzheimer Disease International. Os participantes foram reconhecidos pela sua perícia nesse domínio e vieram de 11 países. Incluíam psiquiatras, uma neurologista, um enfermeiro e representantes de cuidadores familiares. RESULTADOS: Após dois dias de reuniões e debate, redigiu-se um rascunho da declaração que foi submetida para análise nas diversas organizações/associações que participaram da reunião. Após as sugestões finais recolhidas, um texto definitivo foi preparado em inglês e publicado. A presente versão em português é da responsabilidade de dois participantes lusófonos da reunião, que são também coautores da declaração de consenso final. CONCLUSÕES: Essa Declaração de Consenso oferece aos clínicos em saúde mental que cuidam de pessoas idosas com transtornos mentais, cuidadores, outros profissionais da saúde e o público em geral as definições e o debate sobre os princípios éticos que podem frequentemente ser complexos e desafiadores, apoiados em orientações práticas para satisfazer tais necessidades e padrões éticos e encorajar a boa prática clínica.

BACKGROUND: The World Psychiatric Association (WPA) Section of Old Age Psychiatry, since 1997, has developed Consensus Statements relevant to the practice of Old Age Psychiatry. Since 2006 the Section has worked to develop a Consensus Statement on Ethics and Capacity in older people with mental disorders. METHOD: A Consensus Conference was realized in Prague, September 2008. The meeting was organized by the WPA Section of Old Age Psychiatry, with the participation of International Council of Nurses, Alzheimer Europe and Alzheimer Disease International. Participants who are recognised for their expertise in this area came from 11 countries and include psychiatrists, a neurologist, a nurse and family caregiving representatives. RESULTS: After two days of debate a draft was prepared and submitted to the organizations/associations represented at the meeting. When their respective comments were collected, a final text was prepared and published originally in English. This Portuguese version was prepared by two members of the meeting who came from Portuguese spoken countries. DISCUSSION: This Consensus Statement offers to mental health clinicians caring for older people with mental disorders, caregivers, other health professionals and the general public the setting out of and discourse in ethical principles which can often be complex and challenging, supported by practical guidance in meeting such ethical needs and standards, and to encouraged good clinical practice.

Public attitudes to schizophrenia in rural Turkey.

BACKGROUND: The aim of this study was to determine the public's attitudes and their correlates towards patients with schizophrenia in rural areas. METHODS: The study was carried out in a village near Manisa City, Turkey. Two hundred and eight subjects completed the public survey form which consists of ten items screening demographic and health status and 32 items rating attitudes towards schizophrenia. RESULTS: Half of the subjects stated that persons with schizophrenia are aggressive and that they should not be free in the community. More than half of the subjects stated that they would be irritated about having a neighbour with schizophrenia (61.5%), that they would not rent their home to a person with schizophrenia (58.2%), that they do not want to work with a person with schizophrenia (61.1%), and that they would not get married to a person with schizophrenia (85.6%). CONCLUSIONS: The public in rural areas sufficiently recognises schizophrenia but has a tendency to stigmatise schizophrenic patients. Their attitudes are generally negative and rejective. They do not want close contact with schizophrenic patients. Interpretation of schizophrenia as a mental illness leads to more negative attitudes and increases the social distance.

Postnatal depression in turkey: epidemiological and cultural aspects.

BACKGROUND: In some periods of a woman's life the risk of depression increases and the postnatal period is one of these. The prevalence and the risk factors of postnatal depression are not systematically studied in Turkey. The aim of this study is to investigate the epidemiological aspects and the cultural factors that may affect postnatal depression in our country. METHOD: According to the records of ten primary health care centres in Manisa, a city in western Turkey, there were 1,337 women who had given birth in the previous 6 months. A sample group of 317 mothers were randomised among these women and 257 (81.7%) of the sample group could be reached. Data were collected by use of the Edinburgh Postnatal Depression Scale and a questionnaire on sociodemographic variables designed for this study. RESULTS: The mean depression score was found to be 7.54 +/- 4.66. When the cut-off point was taken into consideration, 14% of mothers had a syndromal depression. The factors which affected the prevalence of depression were the number of living children, living in a shanty, being an immigrant, serious health problems in the baby, previous psychiatric history, psychiatric disorder in the spouse, and having bad relations with the spouse and his parents. CONCLUSION: These findings revealed that the prevalence of postnatal depression in the Manisa province and the factors affecting it were very similar to other studies; but the negative impact of bad relations of the mother with her family-in-law on postnatal depression seems to be a distinguishing aspect of Turkish culture.

[Depressive symptomatology among elderly residential home residents in Manisa: prevalence and related risk factors]. / Manisa huzurevlerinde kalan yaslilarda depresyon belirtilerinin yayginligi ve iliskili risk etkenleri.

OBJECTIVE: To determine the prevalence of depression and related factors among elderly residential home residents in Manisa. METHODS: The study was carried out in all residential homes in Manisa and the surrounding towns. One hundred and forty-five residents completed a form asking questions about demographic features, health conditions and the pattern of relationships with their relatives, the employees of the home, and the other residents. The Geriatric Depression Scale Turkish Form (GDS-TF) was used. The data was analysed by logistic regression to determine the factors which had an effect on the presence of depression. RESULTS: The mean age of the sample was 73.9 +/- 9.2 and the mean score of GDS-TF was 11.9 +/- 6.52. Some 35.9% of subjects were depressed according to the cutoff point of 13/14 for the GDS-Turkish Form. Associations between dissatisfaction with the perceived social level (p=0.004), decline in the ability to perform personal care (p=0.045), having worries about leaving the home (p<0.001), the lack of enthusiasm for participating in social activities (p=0.007), not being pleased with the physical conditions of the home (p=0.032) and the presence of depression were determined. CONCLUSION: The prevalence of depression, which is common in residential homes is not associated with the social support from outside the home, and the feelings of belonging towards the institution and other residents are more important than non-institutional social support.

[The public attitudes towards schizophrenia in a rural area in Turkey]. / Türkiye'de kirsal bir bölgede yasayan halkin sizofreniye iliskin tutumlari.

OBJECTIVE: To determine the public's attitude about schizophrenia and its related factors in a rural population. METHODS: This study was carried out in a village of Manisa. Of the 245 subjects which met the inclusion criteria, 230 subjects were reached and 208 of them constituted the sample of this study. The subjects filled out the sociodemographic information form and the 32-item subscale for schizophrenia of a public survey form which was developed by Psychiatric Research and Education Center. RESULTS: Of the 208 subjects, 76.3% appraised the schizophrenia as an illness, 62.0% considered it as a mental disease, 76.9% noted that social problems were the most frequent etiological factor, 66.8% denoted that the patient should consult with a psychiatrist for the treatment, 61.5% indicated that they would feel uncomfortable with a neighbor with schizophrenia, 61.1% declared that they didn't want to work with anyone with schizophrenia. CONCLUSION: The majority of subjects in rural population recognize the schizophrenia as a mental disease. Social problems are determined as the first-rank etiological factor by the subjects. The public has an adequate knowledge about the treatment of schizophrenia. However they hesitate to apply to psychiatric treatment because of the fear of stigmatisation. The public has a reluctant attitude in becoming close to the patients and has a rejective attitude in keeping a certain distance with the patients. The sociodemographic factors do not seem to have any influence on the attitudes towards the schizophrenia.