Carlos Eduardo Leal Vidal

Tentativas de suicídio: fatores prognósticos e estimativa do excesso de mortalidade

No mundo, ainda sao relativamente poucos os estudos sobre a incidencia e mortalidade por câncer em adultos jovens. O objetivo foi explorar a distribuicao de câncer em adultos jovens no Brasil. Foi realizado um estudo descritivo da incidencia (capitais selecionadas), da morbidade hospitalar e da mortalidade (Brasil e capitais selecionadas) por câncer aos 20-24 anos, no periodo de 2000-2002, e da evolucao das taxas de mortalidade por câncer no Brasil no periodo de 1980-2008, na mesma populacao. O câncer de testiculo foi a principal localizacao anatomica em homens; e as neoplasias da glândula tireoide, do colo de utero e a doenca de Hodgkin nas mulheres. O câncer de encefalo foi a principal causa de obito por câncer em ambos os sexos, e a tendencia temporal da mortalidade mostra um aumento da mortalidade por câncer de encefalo em homens e pela leucemia linfoide em ambos os sexos. Em conjunto, os resultados apresentados retratam um padrao epidemiologico de câncer em adultos jovens no Brasil com caracteristicas regionais de distribuicao.Coorte retrospectiva com objetivos de analisar o perfil epidemiologico dos individuos que tentaram suicidio entre 2003 e 2009 na microrregiao de Barbacena, Minas Gerais, Brasil, verificar a taxa de mortalidade por suicidio e por outras causas, e estimar o risco de morrer nestes individuos. Foram utilizados dados dos Boletins de Ocorrencia Policial e das Declaracoes de Obitos. Foi realizada analise de sobrevida e empregada regressao multipla de Cox. Entre os 807 individuos que tentaram suicidio ocorreram 52 obitos, sendo 12 por suicidio, dez por causas externas e trinta por outras causas. Noventa por cento das mortes por suicidio ocorreram no periodo de 24 meses depois da tentativa. Verificou-se significativo aumento do risco de morrer entre os homens, nas pessoas casadas e naqueles com idade maior que 60 anos. A razao de mortalidade padronizada evidenciou excesso de mortalidade por suicidio. Os resultados do estudo mostraram que a taxa de mortalidade entre pacientes que tentaram o suicidio foi superior a esperada na populacao geral, indicando a necessidade de melhorar os cuidados a saude desses individuos.

Reforma psiquiátrica e serviços residenciais terapêuticos

OBJECTIVE: The aim of this article is to show the more relevant aspects of psychiatric reform and the community insert of psychiatric patients around the world and in Brazil. It will be detached the procedures of discharge occurred in the city of Barbacena, emphasizing the residential services and the psychosocial approaches. METHODS: Databases Medline and Lilacs were searched between 1990 and 2006 using the following keywords: deinstitutionalization, psychiatric reform, community-based treatment, psychosocial rehabilitation. For the implementation of the residential services, official documents were used. RESULTS: Review and follow-up studies were selected. The most of the studies indicate that the patients have better autonomy, social interaction, global behavior and life quality when they live in community settings. Nevertheless, the authors emphasize the importance of community support, professional staff and rehabilitation programs as a condition for good outcomes. In Barbacena, the procedures of deinstitutionalization began in 2000. Nowadays there are twenty four residential services in this city. DISCUSSION: In despite of difficulties in the psychiatric reform process, the community-based treatment and psychosocial rehabilitation approach are the principal models of psychiatric care presently, and the residential services play an important role in this process.

Attempted suicide: prognostic factors and estimated excess mortality

This retrospective cohort study aimed to analyze the epidemiological profile of individuals that attempted suicide from 2003 to 2009 in Barbacena, Minas Gerais State, Brazil, to calculate the mortality rate from suicide and other causes, and to estimate the risk of death in these individuals. Data were collected from police reports and death certificates. Survival analysis was performed and Cox multiple regression was used. Among the 807 individuals that attempted suicide, there were 52 deaths: 12 by suicide, 10 from external causes, and 30 from other causes. Ninety percent of suicide deaths occurred within 24 months after the attempt. Risk of death was significantly greater in males, married individuals, and individuals over 60 years of age. Standardized mortality ratio showed excess mortality by suicide. The findings showed that the mortality rate among patients that had attempted suicide was higher than expected in the general population, indicating the need to improve health care for these individuals.

Da tutela à autonomia: narrativas e construções do cotidiano em uma residência terapêutica

The process of psychiatric reform is a social movement that proposes a new relationship between society and insanity. Its a construction of a net of services, as the mental health residential service. This service attends people with chronic mental disease. Since the end of the 1990s, some experiences in mental health residential services are set up in many places of our country. However, the first residential service in the city of Barbacena, Minas Gerais, was developed only in 2000, with 06 patients. This article shows the individual process of identity reconstruction for each resident who lives in the first Barbacena´s residential service and identifies the subjective construction of the space of the residence and the building of a new social net. The methods used in this research were the participant observation and the collection of narratives and life histories of the first Barbacena´s residential service dwellers.

Sobrecarga de familiares cuidadores em relação ao diagnóstico de pacientes psiquiátricos

Objective This study aimed to compare the degree of objective and subjective burden felt by family caregivers of patients with schizophrenia and by family caregivers of patients with major depression, as well as the associated factors and life dimensions most affected in each group. Methods Participated in this study 50 family caregivers of patients with schizophrenia and 50 family caregivers of patients with major depression. These subjects participated in a structured interview for the application of the FBIS-BR burden scale and a sociodemographic and clinical questionnaire. Results The results indicated significant differences in the degree of burden of the two family caregivers groups, in the analysis of specific scale items. The family caregivers of patients with schizophrenia showed significantly higher objective burden in the subscale “Assistance in Everyday Life”, particularly in the tasks related to medication administration and financial management, and they also had more feeling of financial burden. Caregivers of patients with major depression had a higher frequency of self-injurious behaviors supervision, more concern with the social life of patients and a greater feeling of discomfort in the service tasks in everyday life. No difference was observed between groups regarding the scale global scores. Conclusion The differences found in this study pointed out the need for mental health services to plan specific interventions for each group of family caregivers.

Preditores de prováveis transtornos mentais comuns (TMC) em prostitutas utilizando o Self-Reporting Questionnaire

Objective To evaluate the prevalence of common mental disorders (CMD) and associated factors in a group of prostitutes in Minas Gerais. Methods Cross-sectional study using the Self-Reporting Questionnaire (SRQ-20) in women enrolled in the Association of Prostitutes of Minas Gerais (Aprosmig). We assessed sociodemographic characteristics and aspects of work in prostitution. Chi-square test was used to analyze the association between categorical sociodemographic variables and the presence of CMD. Analysis of factors associated with the presence of CMD was performed using logistic regression model. Results We interviewed 216 prostitutes. The overall prevalence of CMD was 57.9%, more seen in women with low education, history of physical violence and early entry into prostitution. Conclusion The results of this study showed that the prevalence of CMD among sex workers was higher than that observed in the general population, indicating the need to improve health care of these women.

Delírio de infestação parasitária e transtorno bipolar: relato de caso

O presente relato tem por objetivo descrever o caso de uma paciente portadora de delirio de infestacao parasitaria comorbido com transtorno bipolar. Trata-se de paciente portadora de transtorno bipolar ha mais de 30 anos e que se encontrava com quadro psiquico estabilizado e sem alteracoes do humor durante as consultas psiquiatricas. Em uma das suas avaliacoes periodicas, comecou a se queixar da presenca de vermes que estavam infestando seu corpo, o que ja vinha ocorrendo ha 8 anos. Estava em uso de carbonato de litio e nao aceitou tomar o antipsicotico prescrito porque ja experimentara efeito colateral com essa classe de medicamentos. A associacao entre delirio de infestacao parasitaria e transtorno bipolar e rara, e os autores encontraram apenas um caso semelhante descrito na literatura medica internacional.

Effects Of Music In The Postoperative Of Hospitalized Patients

Introdução: A musicoterapia pode ser definida como uma área interdisciplinar que une principalmente a música e a medicina. Pesquisas realizadas na área da saúde indicam inúmeros benefícios trazidos pela música no estado geral, bem estar e cognição de pacientes submetidos à musicoterapia. Apesar disso, ainda há uma escassez de trabalhos referentes ao impacto da música em pacientes hospitalizados. Objetivos: O objetivo dessa pesquisa foi então, analisar a influência da música na dor do pós-operatório e nos sinais vitais de pacientes hospitalizados. Métodos: Foi realizado um ensaio clínico aleatorizado no Hospital Regional de Barbacena com pacientes recém-operados. Os pacientes foram submetidos a quinze minutos de música, com dados vitais mensurados antes e depois da musicoterapia. Resultados: A amostra foi constituída por 50 pacientes, sendo 29 (58%) do sexo masculino. Foram observadas diferenças estatisticamente significantes na escala de dor e nas variáveis Pressão arterial diastólica e Frequência Respiratória (p<0.05) quando comparadas as medidas antes e depois da musicoterapia. Conclusões: A música se mostrou uma importante forma terapêutica a ser utilizada no ambiente hospitalar, por se tratar de uma ferramenta de baixo custo, sem contraindicações e sem efeitos colaterais, devendo, portanto, ser empregada no período de internação. Palavras-chave: Musicoterapia. Dor. Sinais vitais. Período pós-operatório. RESUMO Revi ta Médica d M nas Gerais

Misofonia: características clínicas e relato de caso

Misophonia refers to a condition in which there is a strong aversion to certain sounds, in response to it the person reports unpleasant emotional experiences and autonomic arousal. The objective of this paper is to present a case of misophonia carrier and discuss diagnostic features. Female, 32 years old, married. In anamnesis reported obsessive compulsive symptoms such as checking doors and windows, concerned with order and symmetry of objects; read all that lies ahead, pull the hand two or three times on furnitures. Also reported triggering situations of anger: intolerance to some noises and sounds, like chewing third, mobile keyboard, click the “mouse” computer, printer and rub hands. In the presence of these noises, she tries to move away, and already tried to attack physically relatives and coworkers. She was treated with escitalopram and reevaluation after forty five days, reported partial relief misophonia and reduction of obsessional symptoms. The condition was first described in the early 2000s by two audiologists, and has become the focus of interest in the field of psychiatry. Some reports suggest that misophonic symptoms may be part of other conditions such as Tourette’s syndrome, obsessive compulsive disorder (OCD) and Generalized Anxiety Disorder. In the case described, the patient presented comorbid condition of Misophonia, OCD and tic disorder.