Thesis (M.H.A.)--University of Michigan, 1965.

Thesis (M.H.A.)--University of Michigan, 1965.

Thesis (M.S.) -- University of Texas Southwestern Medical Center at Dallas, 2005. / Not embargoed. Vita. Bibliography: 57-63.

Psychiatric advance directives (PADs) are legal documents allowing competent individuals to declare their treatment preferences in advance of a mental health crisis. The objective of this thesis is to examine psychosocial perceptions of legal and mental health professionals in Ontario and Quebec regarding their knowledge and willingness to implement PADs. Two hundred professionals---psychiatrists, psychologists, lawyers and administrative tribunal members---participated in an Web-survey measuring psychosocial perceptions of clinical, ethical, legal and implementation factors of PADs. Results indicate Quebec professionals are more willing to begin using PADs than Ontario professionals. Mental health professionals reported more concern than legal professionals for medical malpractice lawsuits for overriding PADs. Advantages of PADs most commonly reported are patients' ability to declare their clear wishes ahead of time, respect for autonomous choice, and establishing a collaborative treatment plan with physicians. Disadvantages included patients' lack of awareness, treatment refusal, and being self-bound to an earlier decision.

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Objective: To determine whether continuity of care (COC) reduces emergency department (ED) visits and/or readmission in adolescents with psychiatric disorders. Methods: A retrospective cohort of adolescents discharged with psychiatric disorder between April 1, 2002 and March 1, 2004 was identified using hospital administrative databases. Good COC was defined as at least one aftercare contact in 30 days. Confounding by patient characteristics was adjusted for by propensity-score-matching of good and poor COC adolescents. Cox PH was used to analyze time to outcome. Results: 48.77% of adolescents had good COC. 38.39% of adolescents had ED visit or readmission in the year post-discharge. Good COC increased risk of readmission (HR = 1.38 (1.14 – 1.66)), but not of ED visits (HR = 1.14 (0.95 – 1.37)). Conclusions: COC increased risk of readmission by 38% but did not increase risk of ED visits. These findings are contextualized. Implications to adolescent mental health service delivery are discussed.

Objective: To determine whether continuity of care (COC) reduces emergency department (ED) visits and/or readmission in adolescents with psychiatric disorders. Methods: A retrospective cohort of adolescents discharged with psychiatric disorder between April 1, 2002 and March 1, 2004 was identified using hospital administrative databases. Good COC was defined as at least one aftercare contact in 30 days. Confounding by patient characteristics was adjusted for by propensity-score-matching of good and poor COC adolescents. Cox PH was used to analyze time to outcome. Results: 48.77% of adolescents had good COC. 38.39% of adolescents had ED visit or readmission in the year post-discharge. Good COC increased risk of readmission (HR = 1.38 (1.14 – 1.66)), but not of ED visits (HR = 1.14 (0.95 – 1.37)). Conclusions: COC increased risk of readmission by 38% but did not increase risk of ED visits. These findings are contextualized. Implications to adolescent mental health service delivery are discussed.

Orientador: Renata Cruz Soares de Azevedo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T18:34:02Z (GMT). No. of bitstreams: 1 Padilha_VitoriaMantoan_M.pdf: 5585179 bytes, checksum: 8135afde8664df21e30065b191cc727b (MD5) Previous issue date: 2012 / Resumo: O consumo e a dependência de substâncias psicoativas (SPA) representam um importante fator de risco de morbi-mortalidade no mundo todo. A literatura internacional mostra que 20% dos pacientes que procuram as Unidades de Emergência (UE) são usuários ou dependentes de SPA. Para a maioria destes pacientes, a UE é o único provedor de cuidados médicos, o que mostra a importância de se aproveitar esse tipo de serviço para uma abordagem inicial e encaminhamento para tratamento. Objetivos: Descrever o perfil de pacientes com transtornos relacionados ao uso de SPA atendidos pela Psiquiatria em serviço de emergência, compará-los com o demais pacientes atendidos pela Psiquiatria e avaliar intervenção a partir do atendimento de emergência, comparando os pacientes que receberam com os que não receberam a intervenção, quanto aos desfechos redução do uso de SPA e busca de tratamento em 30 e 90 dias. Método: Estudo descritivo e quantitativo, que levantou dados de pacientes atendidos pela Psiquiatria na Unidade de Emergência Referenciada (UER) do HC-UNICAMP, detectou os pacientes atendidos com transtornos por uso de SPA e realizou seguimento longitudinal. Durante o período de maio de 2010 a maio de 2011, todos os pacientes atendidos pela psiquiatria na UER do HC-UNICAMP com transtornos por uso de SPA foram convidados a participar do grupo de intervenção (GI). Após 30 e 90 dias, todos os pacientes, os que compareceram e os que não compareceram ao grupo (GNI), foram avaliados quanto à redução do consumo de SPA e busca por tratamento. Resultados: Durante o período, 1.465 pacientes foram atendidos pela Psiquiatria da UER. Encontrou-se predomínio de mulheres (53,7%), idade média de 37 anos e brancos (79,6%). Os diagnósticos mais frequentes foram transtornos relacionados a SPA (23%) e transtornos depressivos (18,5%). Entre os pacientes com transtornos por uso de SPA, o perfil se constituiu de homens (79,1%), idade média de 34,9 anos, cor branca (78,6%), sem ocupação regular (65,3%) e provenientes de demanda espontânea (65,2%). Quando comparados com os demais pacientes atendidos pela Psiquiatria, os usuários de SPA eram mais jovens, receberam mais medicações na UE, porém menos psicofármacos e foram mais encaminhados para serviços especializados. Compareceram ao GI 123 pacientes (35,1%). A maioria desses pacientes era dependente de álcool (73,1%). Entre os pacientes que não compareceram ao grupo, a taxa de comorbidades psiquiátricas foi maior, assim como o histórico de internações psiquiátricas e taxas maiores de dependência de crack. No seguimento de 30 e 90 dias, a redução do uso de SPA foi significativamente maior entre os pacientes do GI, assim como a busca por tratamento em 30 dias e em 90 dias. Ser dependente de crack esteve associado ao aumento do risco de não reduzir o uso de SPA em 90 dias. Conclusão: O grupo de intervenção se mostrou instrumento terapêutico eficaz na redução do uso de SPA e busca por tratamento após 30 e 90 dias, principalmente para os pacientes com dependência a álcool e sem comorbidade psiquiátrica / Abstract: The use and addiction to psychoactive substances (PAS) represent an important risk factor for morbidity and mortality worldwide. The international literature shows that 20% of patients seeking Emergency Unit (EU) are addicted or users of PAS. For most of these patients, the EU is the only provider of medical care, which shows the importance of taking this opportunity to use this type of service for an initial approach and referral for specific treatments. Objectives: Describe the profile of patients with disorders related to psychoactive substances use attended by the Psychiatry Service in the Emergency Unit, and evaluate the intervention given, starting from the care provided by EU and comparing the patients who received intervention with those who did not, regarding the outcomes reduction of psychoactive substances use and treatment-seeking in 30 and 90 days. Methodology: A descriptive and quantitative study that collected data of all patients attended by the Psychiatric Emergency Unit at UNICAMP Clinical Hospital, due to PAS use disorders and conducted longitudinal studies. During this period the patients with PAS use disorders were invited to join the support group of the patients attended by the UER, Intervention Group (IG). After 30 and 90 days, all patients, who attended and those who did not attend the group (NIG), were evaluated regarding the reduction in psychoactive substance use and search for treatment. Results: During the study period, 1465 patients were seen by the EU Psychiatric. We found a predominance of women (53,7%), mean age 37 years and white (79,6%). The most common diagnoses were substance use disorders (23%) and depressive disorders (18,5%). Among the patients with psychoactive substance use disorder, the profile consisted of men (79.1%), averaging 34.9 years old, caucasian (78.6%), with no regular occupation (65.3%) and from spontaneous demand (65.2 %). When compared with other patients seen by psychiatry, users of PAS were younger, received more medications in the EU, but less psychoactive and were more referred for specialized services. 123 patients (35.1%) attended the IG. Most of these patients were alcohol dependent (73.1%). Among patients who did not attend the group (NIG), the rate of psychiatric comorbidity was higher, as well as the history of psychiatric hospitalizations, and higher rates of crack addiction. In the following 30 and 90 days, the reduction of PAS use was higher among patients who attended the IG at 30 and 90 days as well as the search for treatment in 30 days and 90 days. Crack addiction was associated with the increased risk of not reducing the use of psychoactive substances in 90 days. Conclusion: The intervention group presented itself as an effective therapeutic tool to reduce the use of psychoactive substances abuse and promote treatment-seeking after 30 and 90 days, especially for patients with alcohol dependence and without psychiatric comorbidity / Mestrado / Saude Mental / Mestre em Ciências Médicas