Os desafios para o ensino de emergências de psiquiatria em desastres e conflitos armados / The challenges of Teaching Psychiatric Emergencies in situations of natural disasters and armed conflicts

Resumo: Introdução: A população moçambicana tem sido recorrentemente afectada por situações traumáticas devido a catástrofes naturais (ciclones, secas, inundações) ou provocadas pelo homem (conflitos armados), que podem levar ao desenvolvimento de perturbações mentais que, se não forem identificadas e tratadas, deixarão sequelas graves e causarão cronicidade. Objetivo: Este estudo teve como objetivo promover uma reflexão sobre a inclusão de temas psiquiátricos de emergência em desastres naturais e conflitos armados nas disciplinas ou módulos de psiquiatria, nos cursos de formação de graduação nas escolas médicas de Moçambique. Método: Trata-se de revisão narrativa da bibliografia, realizada entre abril e junho de 2021, com foco na pesquisa de artigos e documentos publicados nas plataformas virtuais Research4Life, PubMed, Hifa-pt e Google Scholar que abordam o tema desastres naturais e conflitos armados e seu ensino para estudantes de Medicina na disciplina de psiquiatria. Resultado: A inclusão das emergências psiquiátricas em desastres e conflitos armados no curso de Medicina pode proporcionar aos clínicos gerais que atuam na atenção primária à saúde conhecimentos e habilidades para que possam reconhecer emergências psiquiátricas causadas por desastres naturais e conflitos armados e trabalhar nelas, levando em consideração que o país atualmente tem poucos médicos especializados em psiquiatria. Conclusão: A adequada organização e assistência em emergências psiquiátricas à população exposta a desastres naturais e conflitos armados contribui para a resiliência e salvaguarda da saúde mental das comunidades. Neste ensaio, refletimos sobre o desafio de incorporar os temas das emergências psiquiátricas causadas pela exposição a desastres naturais e conflitos bélicos como contribuição para melhorar as habilidades dos médicos generalistas na resposta às demandas prementes de saúde mental dessa população vulnerável.

Abstract: Introduction: The Mozambican population has been recurrently affected by traumatic situations due to natural (cyclones, droughts, floods) or man-made (armed conflicts) catastrophes, which can lead to the development of mental disorders that, if not identified and treated, result in severe sequelae and cause chronicity. Objectives: To promote a reflection on the inclusion of emergency psychiatric topics in natural disasters and armed conflicts in the disciplines or modules of psychiatry in undergraduate medical school courses in Mozambique. Methods: Narrative literature review carried out between April and June 2021, focusing on the research of articles and documents published on the virtual platforms Research4life, PubMed, Hifa-PT, Google Scholar and that address the topics of natural disasters and armed conflicts and the teaching of these topics to medical students in the discipline of psychiatry. Results: The inclusion of psychiatric emergencies in situations of natural disasters and armed conflicts in the medical course can provide general practitioners who work in primary health care with knowledge and skills to recognize and act in psychiatric emergencies caused by natural disasters and armed conflicts, taking into account the fact that the country currently has few doctors specialized in psychiatry. Final considerations: The adequacy of the organization and assistance in psychiatric emergencies to the population exposed to natural disasters and armed conflicts contributes to the resilience and protection of the mental health of the communities. In this article, we reflect on the challenge of incorporating the topics of psychiatric emergencies caused by exposure to natural disasters and armed conflicts as a contribution to improving the skills of general practitioners in responding to the pressing mental health demands of this vulnerable population.

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.

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.

Difficulties in activities of daily living are associated with stigma in patients with Parkinson's disease who are candidates for deep brain stimulation

Objective: Parkinson's disease (PD) is often accompanied by stigma, which could contribute to a worse prognosis. The objective of this study is to identify the variables associated with stigma in PD patients who are candidates for deep brain stimulation (DBS). Methods: We investigated sociodemographic and clinical variables associated with stigma in a sample of 54 PD patients indicated for DBS. The independent variables were motor symptoms assessed by the Movement Disorder Society‐sponsored revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS III), depressive symptoms measured by the Hospital Anxiety and Depression Scale, age, disease duration and the presence of a general medical condition. The Mobility, Activities of daily living and Emotional well-being domains of the 39-item Parkinson's Disease Questionnaire (PDQ-39) were also investigated as independent variables, and the Stigma domain of the PDQ-39 scale was considered the outcome variable. Results: After multiple linear regression analysis, activities of daily living remained associated with the Stigma domain (B = 0.42 [95%CI 0.003-0.83], p = 0.048). The full model accounted for 15% of the variance in the Stigma domain (p = 0.03). Conclusions: Although causal assumptions are not appropriate for cross-sectional studies, the results suggest that ADL difficulties could contribute to greater stigma in PD patients with refractory motor symptoms who are candidates for DBS.

Difficulties in activities of daily living are associated with stigma in patients with Parkinson's disease who are candidates for deep brain stimulation.

OBJECTIVE: Parkinson's disease (PD) is often accompanied by stigma, which could contribute to a worse prognosis. The objective of this study is to identify the variables associated with stigma in PD patients who are candidates for deep brain stimulation (DBS). METHODS: We investigated sociodemographic and clinical variables associated with stigma in a sample of 54 PD patients indicated for DBS. The independent variables were motor symptoms assessed by the Movement Disorder Society-sponsored revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS III), depressive symptoms measured by the Hospital Anxiety and Depression Scale, age, disease duration and the presence of a general medical condition. The Mobility, Activities of daily living and Emotional well-being domains of the 39-item Parkinson's Disease Questionnaire (PDQ-39) were also investigated as independent variables, and the Stigma domain of the PDQ-39 scale was considered the outcome variable. RESULTS: After multiple linear regression analysis, activities of daily living remained associated with the Stigma domain (B = 0.42 [95%CI 0.003-0.83], p = 0.048). The full model accounted for 15% of the variance in the Stigma domain (p = 0.03). CONCLUSIONS: Although causal assumptions are not appropriate for cross-sectional studies, the results suggest that ADL difficulties could contribute to greater stigma in PD patients with refractory motor symptoms who are candidates for DBS.

Burnout syndrome and coping strategies in Portuguese oncology health care providers

Abstract Background Burnout is a multidimensional syndrome and includes symptoms of emotional exhaustion, depersonalization, and reduced personal accomplishment at work. Oncology health care providers are at high risk to develop symptoms of burnout because of work-related stressors. Adaptive coping strategies adopted to deal with stressors may prevent the development of burnout. Objective The present study aims to assess the association between burnout, functional coping strategies, and occupational factors in a sample of oncology providers, mostly nurses. Methods Sociodemographic Questionnaire, the Maslach Burnout Inventory, and the Problem Solving Inventory "Inventário de Resolução de Problemas" were administered. Descriptive, correlational, and linear regression analyses were performed. Results The study showed that emotional exhaustion correlated with lower levels of adaptive coping, less years of experience in Oncology, and a greater amount of hours worked per week. Personal accomplishment was associated with the adaptive coping strategies. No further statistically significant associations were identified. Discussion Our findings support the importance of adaptive coping strategies in order to prevent symptoms of burnout when health professionals face potentially stressful occupational factors. Training aimed at improving adaptive coping skills may prevent burnout syndrome for health care professionals working in Oncology.

Burnout syndrome and coping strategies in Portuguese oncology health care providers.

BACKGROUND: Burnout is a multidimensional syndrome and includes symptoms of emotional exhaustion, depersonalization, and reduced personal accomplishment at work. Oncology health care providers are at high risk to develop symptoms of burnout because of work-related stressors. Adaptive coping strategies adopted to deal with stressors may prevent the development of burnout. OBJECTIVE: The present study aims to assess the association between burnout, functional coping strategies, and occupational factors in a sample of oncology providers, mostly nurses. METHODS: Sociodemographic Questionnaire, the Maslach Burnout Inventory, and the Problem Solving Inventory "Inventário de Resolução de Problemas" were administered. Descriptive, correlational, and linear regression analyses were performed. RESULTS: The study showed that emotional exhaustion correlated with lower levels of adaptive coping, less years of experience in Oncology, and a greater amount of hours worked per week. Personal accomplishment was associated with the adaptive coping strategies. No further statistically significant associations were identified. DISCUSSION: Our findings support the importance of adaptive coping strategies in order to prevent symptoms of burnout when health professionals face potentially stressful occupational factors. Training aimed at improving adaptive coping skills may prevent burnout syndrome for health care professionals working in Oncology.

A confiabilidade de um questionário avaliando as práticas diárias de trabalhadores envolvidos com a saúde mental da comunidade / Reliability of a questionnaire assessing daily practices of community mental health workers

Resumo Objetivo Questões bioéticas foram levantadas entre agentes comunitários de saúde sobre as percepções e ameaças enfrentadas por eles durante suas atividades diárias de trabalho. Deste modo, questionários são necessários para avaliar os problemas enfrentados por esses profissionais e os efeitos psicológicos enfrentados por trabalhadores na área de cuidados primários. Para isso, este estudo demonstra a confiabilidade de uma dupla escala baseada em um estudo piloto envolvendo agentes comunitários de saúde. Métodos Uma investigação metodologicamente validada e baseada em escala foi desenvolvida incluindo 97 agentes comunitários de saúde nas cidades brasileiras de Riacho Fundo I e Riacho Fundo II, localizadas na região administrativa de Brasília. Resultados A consistência interna da escala de percepção mostrou bons valores de coeficiente alfa de Cronbach (0,76 no geral, e >0,75 para as diferentes dimensões). Além disso, o fator de análise apresentou uma solução de 3 fatores com significância proporcional. Conclusão A escala mostra boa confiabilidade e boas propriedades psicométricas, e tem potencial para uso em pesquisas futuras.

Abstract Objective Bioethical questions have been raised among community health workers in terms of the perceptions and threats that they face during their daily labor practices. Thus, questionnaires are required for assessing the issues experienced by these workers and the psychological effects experienced by primary care workers. Therefore, this study demonstrates the reliability of a double scale based on a pilot study involving community health workers. Methods A scale-based and validated methodological investigation was developed by including 97 community health workers in the Brazilian cities of Riacho Fundo I and Riacho Fundo II, located within the administrative region of Brasilia. Results The perception scale’s internal consistency exhibited good Cronbach’s alpha values (0.76 overall, and >0.75 for the different dimensions). Furthermore, the factor analysis presented a 3-factor solution with ratio significance. Conclusion The scale exhibits good reliability and psychometric properties and has potential for use in future research.

Um programa de economia de fichas aplicado a doentes psiquiátricos crónicos com deterioração cognitiva / Un programme d´économie de jetons appliqué aux patients chroniques atteints de détérioration cognitive / Un programa de economía de fichas aplicado a enfermos psiquiátricos crónicos con deterioro cognitivo / A token economy program applied to chronic psychiatric inpatients with cognitive deterioration

Este artigo descreve uma intervenção com economia de fichas numa unidade psiquiátrica de internamentos de longo curso. No documento, referimos detalhadamente sua elaboração e adaptação a 10 sujeitos com múltiplos diagnósticos. A avaliação geral dos participantes da amostra evidencia resultados positivos no aumento de comportamentos adequados e diminuição de comportamentos desadequados. Essa intervenção foi particularmente eficaz na melhoria do comportamento facial e verbal dos participantes. Obtivemos ganhos estatisticamente significativos na redução de comportamentos bizarros, apesar de os índices de deterioração cognitiva serem elevados na maioria dos doentes. Tendo sido a maioria desses estudos implementados já há mais de 40 anos, julgamos importante a comparação de novos estudos com os prévios, dadas as mudanças que se efectuaram entretanto nos recintos hospitalares, bem como nas terapias farmacológicas.

This article describes a Token Economy group intervention in a long-term psychiatric inpatients unit. The document offers a detailed account about the intervention conception and methodology adapted to 10 participants with several diagnoses. A general evaluation shows positive results concerning appropriate behaviour and a decrease of inadequate behaviour. This intervention was particularly efficient concerning the improvement in the facial and verbal behavior of the participants. We conclude that, in this study, the Token Economy was efficient towards the bizarre behaviours, even considering the high cognitive deterioration deficits in most participants. The majority of these studies were implemented more than forty years ago. The comparison of new studies with previous ones, however, is important, due to the changes in hospital settings as well as in pharmacological therapies.

Cet article décrit une intervention en groupe d'économie de jetons dans une unité psychiatrique d'internement de longue durée, réalisé au centre hospitalier Casa de Saúde do Bom Jesus. Nous présentons brièvement ce type d'interventions et les méthodes appliquées aux 10 patients atteints de maladie chronique. Une évaluation des comportements des sujets de l'échantillon met en évidence des résultats positifs, à savoir, une augmentation des comportements appropriés et une diminution des comportements inadéquats. On en conclut que, dans cette étude, l'économie des fiches a été efficace, en particulier concernant les comportements faciaux et verbaux bizarres des participants, quoique les indices de détérioration cognitive étaient élevés chez la plupart des malades. Ces études ont été implémentées au cours de plus de quarante ans. If faut maintenant comparer les nouvelles études avec les précedentes, une fois qu´il y a eu des modifications des pratiques dans les hôpitaux et aussi des thérapies pharmacologiques.

Este artículo se propone describir una intervención mediante economía de fichas en una unidad psiquiátrica de internamiento de larga estancia. Se relatan detalladamente la elaboración y la adaptación del tratamiento en 10 participantes con múltiplos diagnósticos. La evaluación general de los participantes revela resultados positivos en el aumento de comportamientos adecuados y en la reducción de comportamientos inadecuados. La eficacia de la intervención se verifica en la mejoría del comportamiento facial y verbal de los participantes. Se encontraron resultados estadísticamente significativos en la reducción de comportamientos bizarros, aunque la mayoría de los enfermos presenta elevados índices de deterioro cognitivo. A conclusión, teniéndose en cuenta que gran parte de estos estudios se implementaron hace más de cuarenta anos, se ha juzgado importante la comparación de nuevos estudios con los previos, en vista del progreso de los hospitales y de las terapias farmacológicas.

Um programa de economia de fichas aplicado a doentes psiquiátricos crónicos com deterioração cognitiva / Un programme d´économie de jetons appliqué aux patients chroniques atteints de détérioration cognitive / Un programa de economía de fichas aplicado a enfermos psiquiátricos crónicos con deterioro cognitivo / A token economy program applied to chronic psychiatric inpatients with cognitive deterioration

Este artigo descreve uma intervenção com economia de fichas numa unidade psiquiátrica de internamentos de longo curso. No documento, referimos detalhadamente sua elaboração e adaptação a 10 sujeitos com múltiplos diagnósticos. A avaliação geral dos participantes da amostra evidencia resultados positivos no aumento de comportamentos adequados e diminuição de comportamentos desadequados. Essa intervenção foi particularmente eficaz na melhoria do comportamento facial e verbal dos participantes. Obtivemos ganhos estatisticamente significativos na redução de comportamentos bizarros, apesar de os índices de deterioração cognitiva serem elevados na maioria dos doentes. Tendo sido a maioria desses estudos implementados já há mais de 40 anos, julgamos importante a comparação de novos estudos com os prévios, dadas as mudanças que se efectuaram entretanto nos recintos hospitalares, bem como nas terapias farmacológicas.(AU)

This article describes a Token Economy group intervention in a long-term psychiatric inpatients unit. The document offers a detailed account about the intervention conception and methodology adapted to 10 participants with several diagnoses. A general evaluation shows positive results concerning appropriate behaviour and a decrease of inadequate behaviour. This intervention was particularly efficient concerning the improvement in the facial and verbal behavior of the participants. We conclude that, in this study, the Token Economy was efficient towards the bizarre behaviours, even considering the high cognitive deterioration deficits in most participants. The majority of these studies were implemented more than forty years ago. The comparison of new studies with previous ones, however, is important, due to the changes in hospital settings as well as in pharmacological therapies.(AU)

Cet article décrit une intervention en groupe d'économie de jetons dans une unité psychiatrique d'internement de longue durée, réalisé au centre hospitalier Casa de Saúde do Bom Jesus. Nous présentons brièvement ce type d'interventions et les méthodes appliquées aux 10 patients atteints de maladie chronique. Une évaluation des comportements des sujets de l'échantillon met en évidence des résultats positifs, à savoir, une augmentation des comportements appropriés et une diminution des comportements inadéquats. On en conclut que, dans cette étude, l'économie des fiches a été efficace, en particulier concernant les comportements faciaux et verbaux bizarres des participants, quoique les indices de détérioration cognitive étaient élevés chez la plupart des malades. Ces études ont été implémentées au cours de plus de quarante ans. If faut maintenant comparer les nouvelles études avec les précedentes, une fois qu´il y a eu des modifications des pratiques dans les hôpitaux et aussi des thérapies pharmacologiques.(AU)

Este artículo se propone describir una intervención mediante economía de fichas en una unidad psiquiátrica de internamiento de larga estancia. Se relatan detalladamente la elaboración y la adaptación del tratamiento en 10 participantes con múltiplos diagnósticos. La evaluación general de los participantes revela resultados positivos en el aumento de comportamientos adecuados y en la reducción de comportamientos inadecuados. La eficacia de la intervención se verifica en la mejoría del comportamiento facial y verbal de los participantes. Se encontraron resultados estadísticamente significativos en la reducción de comportamientos bizarros, aunque la mayoría de los enfermos presenta elevados índices de deterioro cognitivo. A conclusión, teniéndose en cuenta que gran parte de estos estudios se implementaron hace más de cuarenta anos, se ha juzgado importante la comparación de nuevos estudios con los previos, en vista del progreso de los hospitales y de las terapias farmacológicas.(AU)