Catarina Magalhães Dahl

Critérios de admissão e continuidade de cuidados em centros de atenção psicossocial, Rio de Janeiro, RJ

OBJETIVO: Analisar os criterios de admissao, encaminhamento e continuidade de cuidado a pacientes utilizados pelas equipes dos centros de atencao psicossocial. METODOS: Pesquisa qualitativa com avaliacao participativa realizada em tres centros de atencao psicossocial do municipio do Rio de Janeiro (RJ) em 2006. Foram sorteados 15 casos admitidos e 15 casos encaminhados dentre os pacientes admitidos para tratamento nos seis meses anteriores ao inicio da pesquisa. Os criterios apontados pela equipe para a admissao do paciente para tratamento ou encaminhamento foram analisados a partir de um roteiro estruturado. A analise da continuidade de cuidados baseou-se em pesquisa em prontuario, informacoes da equipe e dos proprios pacientes e/ou familiares seis meses apos a absorcao ou encaminhamento do paciente. RESULTADOS: Os pacientes admitidos apresentavam diagnostico de psicose (esquizofrenia), historia de internacoes previas, funcionamento social pobre e rede de apoio pequena e os pacientes encaminhados apresentavam transtornos ansiosos e depressivos, boa adesao a tratamento ambulatorial, bom funcionamento social e presenca de rede social. Quanto a continuidade de cuidados, oito pacientes em 27 tiveram destino desconhecido. Quanto aos encaminhamentos, dos 13 pacientes encaminhados a ambulatorios da rede, sete permaneceram em tratamento, dois retornaram aos CAPS e quatro tiveram destino desconhecido. CONCLUSOES: Os centros admitem pacientes que se encaixam na definicao de um transtorno mental severo e persistente. A continuidade de cuidado foi apontada como problema, provavelmente devido a dificuldade de acompanhar os pacientes na comunidade.OBJECTIVE To analyze the criteria used by teams for admission, referral and continuity of care among patients of the Centros de Atenção Psicossocial (CAPS - Psychosocial Care Centers). METHODS A qualitative study with participatory evaluation was conducted in three psychosocial healthcare services of the city of Rio de Janeiro, Southeastern Brazil, in 2006. A total of 15 admitted cases and 15 referred cases were selected among the patients admitted for treatment during the six months that preceded the beginning of research. Criteria pointed out by the team to admit patients for treatment or referral were analyzed from structured guidelines. Analysis of continuity of care was based on medical records and information from the team and patients and/or family members themselves, six months after patients were admitted or referred. RESULTS Patients admitted had psychosis (schizophrenia), history of previous admissions, poor social functioning and a small support network, patients referred had anxiety and depressive disorders, a good level of adherence to outpatient treatment, good social functioning and presence of a social network. In terms of continuity of care, eight out of 27 patients had an unknown destination. In terms of referrals, of the 13 patients referred to the networks outpatient clinics, seven continued in treatment, two returned to the centers and four had an unknown destination. CONCLUSIONS The centers admit patients who fit into the definition of severe and persistent mental disorder. Continuity of care was pointed out as a problem, probably due to the difficulty in following patients.

O processo de restabelecimento na perspectiva de pessoas com diagnóstico de transtornos do espectro esquizofrênico e de psiquiatras na rede pública de atenção psicossocial

O tema do restabelecimento (recovery) na perspectiva das pessoas portadoras de transtornos mentais graves, no contexto dos servicos comunitarios de saude mental e da transformacao da assistencia psiquiatrica, ainda carece de estudo, embora cada vez mais investigado. Objetivo: analisar como o processo de restabelecimento (recovery) e percebido por usuarios com diagnostico de transtornos do espectro esquizofrenico e psiquiatras inseridos na rede de atencao psicossocial. Metodo: pesquisa qualitativa multicentrica, informada pelo quadro de referencia da Analise Fenomenologica Interpretativa, na qual se utilizaram as tecnicas de observacao participante, entrevistas semiestruturadas e grupos focais para obtencao dos dados. Resultados: a partir do material analisado, identificaram-se as seguintes categorias tematicas: efeitos do adoecimento; contexto de tratamento no Centro de Atencao Psicossocial - CAPS; diagnostico; possibilidades e expectativas em relacao ao futuro/prognostico; e abertura para a experiencia do outro (posicao dialogica). Conclusao: existem pontos de convergencia e divergencia entre as perspectivas de usuarios e psiquiatras a respeito do processo de restabelecimento. Mesmo assim, e possivel criar contextos em que a experiencia dos usuarios ilumine o conhecimento tecnico/experiencia do psiquiatra e vice-versa.

McGill Entrevista Narrativa de Adoecimento - MINI: tradução e adaptação transcultural para o português

This paper presents the process of translation and cultural adaptation into Portuguese of the McGill Illness Narrative Interview - MINI, an interview protocol that is used to research meanings and modes of narrating illness experiences, tested, in the Brazilian context, for psychiatric and cancer-related problems. Two translations and their respective back-translations were developed. In addition, semantic equivalence was evaluated, a synthesis version and a final version were prepared, and two pre-tests were administered to the target populations (people with auditory verbal hallucinations or breast cancer). A high degree of semantic equivalence was found between the original instrument and the translation/back-translation pairs, and also in the perspective of referential and general meanings. The semantic and operational equivalence of the proposed modifications was confirmed in the pre-tests. Therefore, the first adaptation of an interview protocol that elicits the production of narratives about illness experiences has been provided for the Brazilian context.This paper presents the process of translation and cultural adaptation into Portuguese of the McGill Illness Narrative Interview – MINI, an interview protocol that is used to research meanings and modes of narrating illness experiences, tested, in the Brazilian context, for psychiatric and cancer-related problems. Two translations and their respective back-translations were developed. In addition, semantic equivalence was evaluated, a synthesis version and a final version were prepared, and two pre-tests were administered to the target populations (people with auditory verbal hallucinations or breast cancer). A high degree of semantic equivalence was found between the original instrument and the translation/back-translation pairs, and also in the perspective of referential and general meanings. The semantic and operational equivalence of the proposed modifications was confirmed in the pre-tests. Therefore, the first adaptation of an interview protocol that elicits the production of narratives about illness experiences has been provided for the Brazilian context.

Experiência, narrativa e conhecimento: a perspectiva do psiquiatra e a do usuário

O presente estudo, realizado em parceria entre UFRJ, UNICAMP e UFBA, pretendeu conhecer a experiencia das pessoas com o diagnostico de transtorno do espectro esquizofrenico, em tratamento nos CAPS, e a experiencia dos psiquiatras inseridos na rede publica de atencao a saude mental. Narrativas relacionadas ao processo saude-doenca, no caso de pessoas com diagnostico de esquizofrenia, e narrativas sobre o processo de formulacao do diagnostico de esquizofrenia, prognostico e tratamento, no caso dos psiquiatras, foram estudadas. Este e um estudo qualitativo, multicentrico, informado pelas abordagens teoricas da Analise Interpretativa Fenomenologica e da Antropologia medica, realizado nas cidades de Campinas, Rio de Janeiro e Salvador. A principal ferramenta metodologica empregada para producao das narrativas foram os grupos focais. Tecnicas da entrevista de explicitacao foram incorporadas. As categorias identificadas no estudo - Experiencia de Adoecimento, Diagnostico de Esquizofrenia, Estigma Social, Experiencia de Restabelecimento e Tratamento e o Contexto Dinâmico dos CAPS - e as narrativas que as compuseram foram apresentadas e discutidas com o proposito de dar visibilidade aos elementos que caracterizam as narrativas-experiencias dos parcipantes e indicar o modo como se configura sua complexidade.

Programa de tratamento assertivo na comunidade (PACT) e gerenciamento de casos (case management): revisão de 20 anos da literatura

OBJETIVE: To carry through a review of studies on PACT and case management to verify if the results demonstrate more favorable outcomes when such models are implemented in the the community care system for persons with serious and persistent mental illness. METHODS: the articles - published from 1985 to 2005 - were collected in two stages: the first one, from the PubMed database, with key-words mental health, community care, services evaluation and selection of the articles with PACT and Case Management as subjects and the second one, from the journal Psychiatric Services database, with key-words assertive community treatment, PACT and case management. Articles that analyzed exclusive services for children, aged and patients with substance abuse as single diagnosis; approached only the costs of the intervention and related exclusively hospital-based services were not considered. RESULTS: From the reading of the 73 selected articles, the authors had described 8 categories in which the articles had been gathered. One article could belong to more than one category. CONCLUSIONS: The PACT and case management are important and admittedly more efficient strategies, when compared with other models of care, in bringing favorable evolutions for individuals with serious and persistent mental illness.

Critical time intervention: Task shifting: a new psychosocial intervention for people with severe mental illness in Latin America

Since the mental health care in Latin America is undergoing a huge transformation with the change of hospital-based care for community assistance, has become clear that is essential the adequacy of these patients in society, being fundamental to the implementation of psy-chosocial interventions that benefit this population and their families, meeting their needs in a way adapted to the current economic and social reality in Latin America

Criteria for admission and continuity of health care in psychosocial healthcare services, City of Rio de Janeiro, Southeastern Brazil

OBJETIVO: Analisar os criterios de admissao, encaminhamento e continuidade de cuidado a pacientes utilizados pelas equipes dos centros de atencao psicossocial. METODOS: Pesquisa qualitativa com avaliacao participativa realizada em tres centros de atencao psicossocial do municipio do Rio de Janeiro (RJ) em 2006. Foram sorteados 15 casos admitidos e 15 casos encaminhados dentre os pacientes admitidos para tratamento nos seis meses anteriores ao inicio da pesquisa. Os criterios apontados pela equipe para a admissao do paciente para tratamento ou encaminhamento foram analisados a partir de um roteiro estruturado. A analise da continuidade de cuidados baseou-se em pesquisa em prontuario, informacoes da equipe e dos proprios pacientes e/ou familiares seis meses apos a absorcao ou encaminhamento do paciente. RESULTADOS: Os pacientes admitidos apresentavam diagnostico de psicose (esquizofrenia), historia de internacoes previas, funcionamento social pobre e rede de apoio pequena e os pacientes encaminhados apresentavam transtornos ansiosos e depressivos, boa adesao a tratamento ambulatorial, bom funcionamento social e presenca de rede social. Quanto a continuidade de cuidados, oito pacientes em 27 tiveram destino desconhecido. Quanto aos encaminhamentos, dos 13 pacientes encaminhados a ambulatorios da rede, sete permaneceram em tratamento, dois retornaram aos CAPS e quatro tiveram destino desconhecido. CONCLUSOES: Os centros admitem pacientes que se encaixam na definicao de um transtorno mental severo e persistente. A continuidade de cuidado foi apontada como problema, provavelmente devido a dificuldade de acompanhar os pacientes na comunidade.OBJECTIVE To analyze the criteria used by teams for admission, referral and continuity of care among patients of the Centros de Atenção Psicossocial (CAPS - Psychosocial Care Centers). METHODS A qualitative study with participatory evaluation was conducted in three psychosocial healthcare services of the city of Rio de Janeiro, Southeastern Brazil, in 2006. A total of 15 admitted cases and 15 referred cases were selected among the patients admitted for treatment during the six months that preceded the beginning of research. Criteria pointed out by the team to admit patients for treatment or referral were analyzed from structured guidelines. Analysis of continuity of care was based on medical records and information from the team and patients and/or family members themselves, six months after patients were admitted or referred. RESULTS Patients admitted had psychosis (schizophrenia), history of previous admissions, poor social functioning and a small support network, patients referred had anxiety and depressive disorders, a good level of adherence to outpatient treatment, good social functioning and presence of a social network. In terms of continuity of care, eight out of 27 patients had an unknown destination. In terms of referrals, of the 13 patients referred to the networks outpatient clinics, seven continued in treatment, two returned to the centers and four had an unknown destination. CONCLUSIONS The centers admit patients who fit into the definition of severe and persistent mental disorder. Continuity of care was pointed out as a problem, probably due to the difficulty in following patients.

Desinstitucionalização de pacientes de longa permanência de um hospital psiquiátrico no Rio de Janeiro

Resumo A Critical Time Intervention (CTI) e uma intervencao de saude mental limitada no tempo a periodos considerados criticos, geralmente ofertada a pessoas com transtornos mentais em situacao de transicao. O presente estudo avalia o impacto da utilizacao da Intervencao para Periodos de Transicao (CTI-BR) sobre o desempenho social e a qualidade de vida em uma populacao de pessoas em processo de desinstitucionalizacao, que deixaram um hospital psiquiatrico apos longa internacao. A populacao estudada foi dividida em dois grupos e um deles recebeu o programa CTI como intervencao adicional. Os resultados apontaram que nas areas avaliadas a presenca da intervencao CTI nao apresentou evidencia de vantagens em relacao ao programa habitual da instituicao realizado isoladamente. Quando o grupo de pacientes e analisado em seu conjunto e evidenciada uma evolucao positiva em relacao ao comportamento social e melhora da sua percepcao sobre a propria saude mental. Os resultados obtidos indicam a possibilidade de pessoas idosas oriundas de longa internacao em hospital psiquiatrico viverem em dispositivos residenciais comunitarios supervisionados por equipes de acompanhamento clinico.

Stigma and recovery in the narratives of peer support workers in Rio de Janeiro, Brazil

Stigma attaching to mental illness has been considered a major challenge to public policies, to the provision of care and to the well-being of people who live with the experience of mental illness worldwide. Here we discuss narratives from peer support workers which we obtained during the assessment of a new psychosocial intervention programme in Rio de Janeiro. We used a range of focus groups, in-depth interviews and clinical supervision notes to derive these narratives, which covered topics such as the peer support workers’ perceptions of family and social views, their sense of self and the experience of being stigmatised. We conclude that stigma appears to be a barrier to recovery. Peer support work for people with severe mental illness is a strategy that may help them to overcome stigma and discrimination. Fostering mutuality and hope in the context of peer support helps affected individuals to make sense of their being in the world and can facilitate their recovery.

Criterios de admisión y continuidad de cuidados en centros de atención psicosocial, Rio de Janeiro, Sureste de Brasil

OBJETIVO: Analisar os criterios de admissao, encaminhamento e continuidade de cuidado a pacientes utilizados pelas equipes dos centros de atencao psicossocial. METODOS: Pesquisa qualitativa com avaliacao participativa realizada em tres centros de atencao psicossocial do municipio do Rio de Janeiro (RJ) em 2006. Foram sorteados 15 casos admitidos e 15 casos encaminhados dentre os pacientes admitidos para tratamento nos seis meses anteriores ao inicio da pesquisa. Os criterios apontados pela equipe para a admissao do paciente para tratamento ou encaminhamento foram analisados a partir de um roteiro estruturado. A analise da continuidade de cuidados baseou-se em pesquisa em prontuario, informacoes da equipe e dos proprios pacientes e/ou familiares seis meses apos a absorcao ou encaminhamento do paciente. RESULTADOS: Os pacientes admitidos apresentavam diagnostico de psicose (esquizofrenia), historia de internacoes previas, funcionamento social pobre e rede de apoio pequena e os pacientes encaminhados apresentavam transtornos ansiosos e depressivos, boa adesao a tratamento ambulatorial, bom funcionamento social e presenca de rede social. Quanto a continuidade de cuidados, oito pacientes em 27 tiveram destino desconhecido. Quanto aos encaminhamentos, dos 13 pacientes encaminhados a ambulatorios da rede, sete permaneceram em tratamento, dois retornaram aos CAPS e quatro tiveram destino desconhecido. CONCLUSOES: Os centros admitem pacientes que se encaixam na definicao de um transtorno mental severo e persistente. A continuidade de cuidado foi apontada como problema, provavelmente devido a dificuldade de acompanhar os pacientes na comunidade.OBJECTIVE To analyze the criteria used by teams for admission, referral and continuity of care among patients of the Centros de Atenção Psicossocial (CAPS - Psychosocial Care Centers). METHODS A qualitative study with participatory evaluation was conducted in three psychosocial healthcare services of the city of Rio de Janeiro, Southeastern Brazil, in 2006. A total of 15 admitted cases and 15 referred cases were selected among the patients admitted for treatment during the six months that preceded the beginning of research. Criteria pointed out by the team to admit patients for treatment or referral were analyzed from structured guidelines. Analysis of continuity of care was based on medical records and information from the team and patients and/or family members themselves, six months after patients were admitted or referred. RESULTS Patients admitted had psychosis (schizophrenia), history of previous admissions, poor social functioning and a small support network, patients referred had anxiety and depressive disorders, a good level of adherence to outpatient treatment, good social functioning and presence of a social network. In terms of continuity of care, eight out of 27 patients had an unknown destination. In terms of referrals, of the 13 patients referred to the networks outpatient clinics, seven continued in treatment, two returned to the centers and four had an unknown destination. CONCLUSIONS The centers admit patients who fit into the definition of severe and persistent mental disorder. Continuity of care was pointed out as a problem, probably due to the difficulty in following patients.