Change in Defense Mechanisms During a Brief Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder.

ABSTRACT: Defense mechanisms (DMs) are strategies used by the individuals to protect the ego. Therefore, compulsive behaviors in obsessive-compulsive disorder (OCD) can be recognized as DMs. We analyzed how DMs changed in a brief cognitive behavioral therapy (CBT) for OCD. This was a quasi-experimental study with 92 OCD patients (aged 18-60 years). We used the Mini International Neuropsychiatric Interview to confirm OCD diagnosis, and we assessed the DMs with the Defense Style Questionnaire at three time points. Through a latent change score modeling, we found that the mature mechanism presented a constant change during the therapy. This mechanism increased in average 0.37 points at each measured moment of CBT, showing a linear trajectory. Neurotic and immature mechanisms showed no significant changes during therapy. The increased use of the mature mechanism can be an indicator of improvement in OCD treatment, showing that patients intensified their more adaptive responses to conflicts.

Evidence of validity of the revised Helping Alliance Questionnaire based on the internal structure in a Brazilian clinical sample.

The revised Helping Alliance Questionnaire (HAq-II) is among the most used instruments that measure therapeutic alliance. Despite its use in research, this instrument is not validated for the Brazilian population. The aim of this study was to explore the evidence of validity of the HAq-II based on the internal structure in a sample of Brazilian psychiatric patients. An ambulatory convenience sample of 204 patients with major depressive disorder (MDD) and 81 patients with obsessive-compulsive disorder (OCD) was randomized between two different types of treatment. The HAq-II was completed by patients (patient version) and by 33 therapists who performed the interventions (therapist version) between the second and third sessions. We used confirmatory factor analysis (CFA) to investigate two models: (1) a one-dimensional therapeutic alliance model and (2) a two-dimensional model considering the factors 'positive alliance' and 'negative alliance'. The internal consistency of the HAq-II was measured by Cronbach's alpha. To investigate discriminant validity, we used the t-test for independent samples, ANOVA and Pearson's correlation coefficient. The analysis showed that the best model of the instrument was one-dimensional. Cronbach's alpha for both versions displayed values above 0.89. The Brazilian version of the HAq-II presented properties similar to those found in the original version. However, studies related to the one-dimensional model with other samples are necessary.

Family perception of the symptoms of Obsessive-Compulsive Disorder patient and the family accommodation.

BACKGROUND: Family members tend to modify their routine by assisting or participating in the patient's rituals. These behaviors have been identified as family accommodation (FA). AIMS: The aim of this study was to describe the relationship between family accommodation of relatives of Obsessive-Compulsive Disorder (OCD) patients and their perceptions about the obsessions and compulsions of the patient. METHOD: This was a cross-sectional study with family members of Obsessive-Compulsive Disorder in a Southern Brazilian city. The family perception of the OCD symptoms and their accommodation were assessed through the Family Accommodation Scale for Obsessive-Compulsive Disorder - Interviewer-Rated (FAS-IR). RESULTS: The level of family accommodation was higher in those family members who lived with the patient when compared to those who did not live with them (p = .011). The obsessions associated with higher levels of family accommodation were: contamination (p < .001), hoarding/saving (p = .001), symmetry/exactness (p = .001), religious (p = .019), and diverse (p = .003). Regarding compulsions, the perception of all symptoms was associated with higher levels of family accommodation (p < .05). CONCLUSION: The family accommodation is present in family members of Obsessive-Compulsive Disorder patients, regardless of the type of obsessive/compulsive symptom perceived.

A Randomized, Controlled Trial of the Effectiveness of a Psychoeducational Intervention on Family Caregivers of Patients with Mental Disorders.

The present study aimed to investigate the effectiveness of a psychoeducational intervention on caregivers of patients assisted by the Center for Psychosocial Health Care (CPHC) focusing on the patient's psychopathology. This was a randomized clinical trial with 130 caregivers with higher mean burden scores assessed using the Zarit Burden Interview Scale (ZBI) (66 caregivers in the intervention group and 64 in the control group). The intervention included six home visits of psychoeducational interventions according to each mental disorder identified in the CPHC records. The intervention group had a reduction of 4.8 points in ZBI mean score (p = 0.008) and in the control group, the reduction was 1.9 points, which was not significant (p = 0.305). It is possible to think that psychoeducation may have served to inform about the disease and how to deal with it, to give emotional support to caregivers and to implement coping strategies and stress management.

[Quality of life with Obsessive-Compulsive Disorder: a study among Primary Care users]. / Qualidade de vida no Transtorno Obsessivo-Compulsivo: um estudo com usuários da Atenção Básica.

Quality of life (QOL) can be affected by the presence of mental disorders, like Obsessive-Compulsive Disorder (OCD). Thus, the evaluation and monitoring of QOL in patients with mental disorders enables the identification of priorities, making it possible to implement actions to improve QOL among health system users. The scope of this article is to measure QOL in OCD patients in primary health care. It involves a cross-sectional study with a convenience sample including all users of three Basic Health Units of Pelotas in the State of Rio Grande do Sul, Brazil. The quality of life was measured with the WHOQOL-Bref and the OCD was assessed using the Mini-International Neuropsychiatric Interview (M.I.N.I.) This study included 1081 individuals. The prevalence of OCD was 3.9%. OCD patients had a lower average in all domains of QOL when compared to individuals without OCD (p < 0.001). The findings of this study emphasize the importance of using QOL as a monitoring tool of the disorder in basic health care.

Qualidade de vida no Transtorno Obsessivo-Compulsivo: um estudo com usuários da Atenção Básica / Quality of life with Obsessive-Compulsive Disorder: a study among Primary Care users

Resumo A qualidade de vida (QV) pode ser afetada pela presença de transtornos mentais, como o Transtorno Obsessivo-Compulsivo (TOC). Assim, a avaliação e o acompanhamento dos índices de QV em pacientes com transtornos mentais permite a identificação de suas prioridades, sendo possível a implementação de ações para a melhora desses índices nos usuários do sistema de saúde. O objetivo deste artigo é avaliar a QV em portadores de TOC usuários da atenção primária à saúde. Estudo transversal com amostragem por conveniência, incluindo todos os usuários de três Unidades Básicas de Saúde de Pelotas, RS. Para avaliar a QV foi utilizada a WHOQOL-Bref, e o TOC foi avaliado através da M.I.N.I. Foram avaliados 1081 indivíduos. A prevalência de TOC foi de 3,9%. Portadores de TOC apresentaram médias inferiores em todos os domínios da QV quando comparados aos indivíduos sem TOC (p < 0,001). Os achados deste estudo enfatizam a importância de utilizar a QV como instrumento de monitoramento da melhora do transtorno no âmbito da atenção básica à saúde.

Abstract Quality of life (QOL) can be affected by the presence of mental disorders, like Obsessive-Compulsive Disorder (OCD). Thus, the evaluation and monitoring of QOL in patients with mental disorders enables the identification of priorities, making it possible to implement actions to improve QOL among health system users. The scope of this article is to measure QOL in OCD patients in primary health care. It involves a cross-sectional study with a convenience sample including all users of three Basic Health Units of Pelotas in the State of Rio Grande do Sul, Brazil. The quality of life was measured with the WHOQOL-Bref and the OCD was assessed using the Mini-International Neuropsychiatric Interview (M.I.N.I.) This study included 1081 individuals. The prevalence of OCD was 3.9%. OCD patients had a lower average in all domains of QOL when compared to individuals without OCD (p < 0.001). The findings of this study emphasize the importance of using QOL as a monitoring tool of the disorder in basic health care.

Burden on relatives of people with psychic disorder: levels and associated factors / Sobrecarga de familiares de pessoas com transtorno psíquico: níveis e fatoresassociados

Background Studies have shown that overburden with care of psychotic patients is associated with a significant reduction of quality of life and causes harm to the caregiver’s health. Objective In order to compare factors associated with levels of burden of caregivers with the psychopathology of the patient, we conducted a cross-sectional study with 435 primary caregivers of patients of Centers for Psychosocial Care (CAPS) from Pelotas, RS. Methods The patients were identified through medical records and their caregivers were interviewed in their homes. To evaluate the burden we used Zarit Burden Interview (ZBI). Results Caregivers of dependent users of alcohol and drugs had the highest average of burden, 52.2 points (sd = 20.4), followed by the caregivers of patients with suicide risk, 48.5 points (sd = 0.7). In adjusted analysis, women had 8.2 (95% CI: 4.6, 11.8) points higher on average than men in ZBI scale. Caregivers with less education had 1.6 (95% CI: -3.1, -1.0) points lower on average of burden compared to those with higher educational level. Caregivers with some health problem had 6.7 (95% CI: 3.3, 10.0) points higher in the middle of the ZBI when compared to those without disease. Discussion Several factors overload clearly indicate the need to develop interventions such as psychoeducation which may give some support to the family responsible for care.

Contexto Estudos têm mostrado que a sobrecarga gerada no cuidado de pacientes psicóticos está associada com uma redução importante na qualidade de vida, trazendo danos à saúde do cuidador. Objetivo Com objetivo de verificar fatores associados e comparar níveis de sobrecarga de cuidadores com a psicopatologia do paciente, foi realizado um estudo transversal com 435 cuidadores principais de usuários de Centros de Atenção Psicossocial (CAPS) da cidade de Pelotas, RS. Métodos Os usuários foram identificados por meio de prontuários e seus familiares foram entrevistados posteriormente em suas residências. Para avaliar a sobrecarga, foi utilizada a Zarit Burden Interview (ZBI). Resultados Cuidadores de usuários dependentes de álcool e drogas apresentaram as médias mais altas de sobrecarga, 52,2 pontos (dp = 20,4), seguidos dos cuidadores com risco de suicídio, 48,5 pontos (dp = 0,7). Na análise ajustada, mulheres tiveram 8,2 (IC 95%: 4,6, 11,8) pontos a mais na média do ZBI do que os homens. Cuidadores com menor escolaridade apresentaram 1,6 (IC 95%: -3,1, -1,0) pontos a menos na média de sobrecarga comparados aos com maior grau de instrução. Cuidadores com algum problema de saúde tiveram 6,7 (IC 95%: 3,3, 10,0) pontos a mais na média do ZBI comparado àqueles sem nenhuma doença. Conclusões Vários fatores de sobrecarga indicam claramente a necessidade de se desenvolverem intervenções, como a psicoeducação, que possam dar algum tipo de apoio ao familiar responsável pelo cuidado.

Qualidade de vida e esgotamento profissional entre docentes da rede pública de Ensino Médio e Fundamental no Sul do Brasil / Quality of life and burnout among public high school and primary school teachers in Southern Brazil

Para investigar os níveis de qualidade de vida entre docentes de escolas estaduais e municipais e relacioná-los com características sociodemográficas e do processo de trabalho, realizou-se um estudo transversal com 601 docentes da rede pública de Ensino Fundamental e Médio da zona urbana de Pelotas, Rio Grande do Sul, Brasil. Os domínios da escala de qualidade de vida WHOQOL-bref - físico, psicológico, relações sociais e ambiente - foram analisados. Os índices médios foram: 69,2 (desvio-padrão - DP = 16,8) para o domínio físico, 70,6 (DP = 14,0) para o psicológico, 72,5 (DP = 17,3) para o domínio relações sociais e 60,7 (DP = 14,0) para o ambiente. Idade, tempo de docência e total de alunos não se associaram significativamente à qualidade de vida. Docentes das escolas municipais pontuaram mais no domínio físico do que os da rede estadual (p = 0,026). Os homens estavam melhores do que as mulheres somente nos domínios físico e psicológico. Quanto maior a renda familiar, mais alta a pontuação na qualidade de vida. Quanto maior a carga horária na escola, melhor a pontuação nos domínios físico e ambiente.

In order to investigate quality of life among public schoolteachers in relation to socio-demographic characteristics and work conditions, a cross-sectional study was conducted in a sample of 601 primary and secondary teachers from the State and Municipal public school system in the urban area of Pelotas, Rio Grande do Sul State, Brazil. The study analyzed the following domains from the WHOQOL-BREF scale: physical health, psychological health, social relationships, and environment. The mean indices were: 69.2 (SD = 16.8) for physical health, 70.6 (SD = 14.0) for psychological health, 72.5 (SD = 17.3) for social relationships, and 60.7 (SD = 14.0) for environment. Age, time in the teaching career, and total number of students were not significantly associated with quality of life. Teachers in municipal schools scored higher than their counterparts in the State public schools in the physical health domain (p = 0.026). Men scored higher than women in the physical and psychological health domains. Higher family income was associated with better quality of life. Higher classroom workload was associated with better scores in the physical health and environment domains.

[Quality of life and burnout among public high school and primary school teachers in Southern Brazil]. / Qualidade de vida e esgotamento profissional entre docentes da rede pública de Ensino Médio e Fundamental no Sul do Brasil.

In order to investigate quality of life among public schoolteachers in relation to socio-demographic characteristics and work conditions, a cross-sectional study was conducted in a sample of 601 primary and secondary teachers from the State and Municipal public school system in the urban area of Pelotas, Rio Grande do Sul State, Brazil. The study analyzed the following domains from the WHOQOL-BREF scale: physical health, psychological health, social relationships, and environment. The mean indices were: 69.2 (SD = 16.8) for physical health, 70.6 (SD = 14.0) for psychological health, 72.5 (SD = 17.3) for social relationships, and 60.7 (SD = 14.0) for environment. Age, time in the teaching career, and total number of students were not significantly associated with quality of life. Teachers in municipal schools scored higher than their counterparts in the State public schools in the physical health domain (p = 0.026). Men scored higher than women in the physical and psychological health domains. Higher family income was associated with better quality of life. Higher classroom workload was associated with better scores in the physical health and environment domains.