Numa amostra de 997 óbitos de pacientes portadores de transtornos mentais procedeu-se a análise critica das estatísticas de mortalidade segundo causas básicas e associadas de morte por meio da comparação das causas mencionadas nos atestados de óbito originais com as causas de novo atestado refeito após consulta a todas informações disponíveis sobre os falecidos, informações estas existentes nos prontuários clínicos, resultados de exames de laboratório, relatórios de exames radiológicos, de biópsia, de autópsia e outros. O número médio de diagnósticos por atestado, após consulta às informações adicionais, aumentou de 2,08 para 4,11, número este que não variou sensivelmente com o sexo e a idade dos falecidos, observando-se entretanto variação da média de diagnósticos por atestado segundo a especialidade do médico atestante. As causas básicas dos atestados refeitos diferiram em 43,13 por cento dos casos das causas básicas selecionadas nos atestados originais. A tabulação de todas as causas, básicas e associadas, permitiu evidenciar a importância, no processo da morte, de muitas causas menos frequentes causa básica. como As principais causas de morte, básicas e associadas, de pacientes cujos transtornos mentais incluíram-se nos grupos Psicose, Transtornos da Personalidade e Outros Transtornos Mentais Não-Psicóticos e Deficiência Mental foram analisadas a partir dos diagnósticos do atestado refeito, comparando estas causas com aquelas dos atestados originais, constatando-se que, nestes atestados, os transtornos mentais são subestimados como causa de morte. Tal subestima se deve em parte a influência das disposições da Classificação Internacional de Doenças para a seleção da causa básica de morte. Foram também estudadas as principais associações de doenças naqueles casos em que as causas básicas pertenceram a grupos de causas relacionadas aos transtornos mentais. / In a sample of 997 deceased patients bearing mental disorders, a cri tical statistical analysis of the mortal i ty due to underlying and associated causes of death was undertaken by comparing the causes mentioned in the original death certificates and those registered in the renewed ones which were made up after full review of all available information on these patients by going through such sources as medica! and hospital records besides laboratory examinations, radiological, biopsy, autopsy and other results. The average number of diagnoees per certificate after the aditional information gained by the investigation went up from 2.08 to 4.11; the latter did not vary due do sex or age of the deceased but did according to the speciality of the certifying doctor. The underlying causes of death of the renewed death certificates differed from those of the original ones in 43.13 per cent of the patients. Crosstabulation of all causes of death, both the underlying and associated ones, uncovered the importance of many less frequent causes as underlying in the process of death. The main causes of death, both underlying and associated, of patients whose mental disorders were included in the groups i of Psychosis, Personality Disorders and Other Non-Psychotic Mental Disorders as well as Mental Deficiency were analysed through data obtanined from the renewed death certificates and later compared with those· registered in the original ones. An underestimation of mental disorders as causes of death in the latter was discovered. Such underestimation is partly due to the influence of arrangements in the Internacional Classification of Diseases for the selection of the underlying cause of death. The main associations of diseases were also studied in those cases where the underlying causes of death belonged to groups of causes related to mental disorders.

Orientador: Cláudio Eduardo Muller Banzato / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T17:15:01Z (GMT). No. of bitstreams: 1 Rodrigues_AdrianoCarvalhoTupinamba_D.pdf: 1424234 bytes, checksum: 7c9a6c292d86a65446a7a6874b0c40e0 (MD5) Previous issue date: 2012 / Resumo: Introdução: A despeito de sucessivas revisões dos sistemas classificatórios psiquiátricos enfatizarem a necessidade de que suas categorias diagnósticas e eles próprios sejam dotados de validade, não apenas o êxito obtido em relação a tal propósito é questionável, mas é incerto, também, o próprio significado dado ao atributo validade na nosologia psiquiátrica. Objetivo: No presente trabalho são examinadas as vicissitudes relativas ao entendimento e manejo da noção de validade no referido domínio, ao tempo em que também são oferecidas sugestões quanto a como melhor tratá-la. Método e resultados: A análise inicialmente realizada é dirigida à determinação da inteligibilidade e do quão dissonante são as descrições dadas à noção de validade na nosologia psiquiátrica, bem como à vasta terminologia a ela paralelamente relacionada. Uma vez reconhecida a vastidão e instabilidade semântica que afetam a terminologia relacionada ao termo validade, bem como o limitado tratamento teórico dado a este atributo na nosologia psiquiátrica, é empreendido um esforço em favor do reconhecimento de concepções específicas de validade nos programas investigativos existentes em tal campo. As quatro diferentes concepções da validade reconhecidas - aqui nomeadas concepção realista, concepção utilitarista, concepção psicométrica e concepção taxonômica - são então analisadas em suas potencialidade e limitações, bem como em relação à possibilidade de mútua redução. Concluindo-se que cada uma das concepções de validade reconhecidas não apenas têm méritos e restrições que lhes são inerentes, mas, também, que tais concepções de validade não são redutíveis entre si, é proposta uma visão pragmática para a noção de validade na nosologia psiquiátrica. Segundo tal visão, as concepções de validade que se opte por implementar, com os diferentes tipos de informações que carreiam, devem ser cuidadosamente acomodadas aos interesses científicos vigentes em determinado momento. Por fim e a título de melhor sistematização conceitual para as concepções de validade anteriormente reconhecidas e examinadas, é proposta sua inscrição sob duas noções de validade semanticamente mais básicas e abrangentes, reconhecidas por Claire Pouncey e por ela nomeadas validade diagnóstica e validade nosológica. Cada uma das concepções de validade anteriormente discutidas são, então, apresentadas como casos das noções de validade diagnóstica e validade nosológica, ou, pelo menos, como passíveis de serem lidos por seu intermédio / Abstract: Background: Successive reviews of psychiatric classificatory systems emphasize the need of validity for their diagnostic categories and for the classificatory systems themselves. However, it is not only arguable that success has been attained in this regard, but the very meaning of validity within psychiatric nosology seems to be uncertain. Aim: To examine the shortcomings concerning what is meant and on how to employ the notion of validity within psychiatric nosology, as well as suggesting how to better deal with that attribute in the aforementioned context. Method and results: The first analysis performed in this thesis aims at determining how intelligible and how dissonant are the descriptions given to the notion of validity within psychiatric nosology, as well as the broad related terminology. Once it is recognized that the terminology related to the notion of validity is both broad and semantically unstable, and that the theoretical treatment given to that attribute in psychiatric nosology is superficial, an effort is undertaken in order to expose particular conceptions of validity present in research programs in that field. Four conceptions of validity are recognized - here named realist conception, utilitarist conception, psychometric conception and taxonomic conception - and then analyzed as regards their virtues, limitations and liability to mutual reduction. After showing that each of these conceptions of validity has its strengths and limitations, and that they are not reducible to each other, a pragmatic view of the notion of validity in psychiatric nosology is proposed. Accordingly, any conception of validity adopted - conveying different sorts of information - must fit to the scientific interests at stake. Finally, aiming at an improved conceptual systematization to the conceptions of validity previously recognized and examined, it is proposed that they should be viewed as cases of two broader and more basic notions of validity from a semantic point of view - both of them recognized by Claire Pouncey and named nosologic validity and diagnostic validity. Each of the conceptions of validity previously discussed are then presented as particular cases of the notions of diagnostic validity and diagnostic validity, or, at least, as amenable to be read through their lens / Doutorado / Saude Mental / Doutor em Ciências Médicas

Recovery focus has shifted in recent years towards understanding the impact of mental health difficulties on the wider individual context. This includes focus on social inclusion, engendering hope and peer support. For adolescents, psychosis and mental health treatment may interrupt typical developmental tasks such as individuation and successful stage progression. The aim of this research was to expand understanding of how young people with psychosis experience hope. This included how hope was experienced in specific domains and to which factors young people attributed changes in their hopefulness. The study employed a qualitative non-experimental design, using a semi-structured interview schedule developed in accordance with narrative methodology. Ten young people between 16 - 26 years old were interviewed. The experience of hope as an overarching strand throughout the narratives had three common elements; a sense of belonging, the importance of information and the significance of planning and occupation in relation to hope. Work was often a goal within domain-specific hope, and friendships seemed to be less apparent. The study concludes that for some young people, psychosis can act as a turning point towards hopeful thinking. Information can both promote and hinder hope and the importance of meeting others with lived experience in engendering hopeful thinking and greater social inclusion should be considered when working with young people.

Psychiatric diagnosis is used to categorise and treat mental health problems in the UK yet is widely criticised for struggling to convincingly categorise the experience of distress and that it is socially constructed from the culmination of historical and cultural interactions. Service-user accounts are varied and there is a paucity of qualitative research that considers the positive and negative effects of labelling. To understand identity construction in the context of a psychiatric diagnosis, the present study recruited 16 participants from a service-user research group and five focus groups were conducted. Transcripts were studied using Foucauldian Discourse Analysis. Two major identities were detected ‘illness identity’ and ‘recovery identity’. Participants drew on multiple and competing discourses and which placed them in the position of patient and/or survivor. Medical discourses were dominant throughout the focus groups and were used in a way to convey the fluidity of the identity and how they related to their diagnosis. The study’s limitations are discussed, together with implications for clinical practice and future research.

Abstract Early family characteristics may influence the later development of severe mental disorders and criminality of a child. The association between an adverse family environment during childhood and its later consequences in adulthood, however, are still widely open. The aim of the present study was to analyse in a longitudinal perspective, family risks of severe hospital-treated mental disorders and criminal behaviour in the Northern Finland 1966 Birth Cohort and to develop a descriptive life span model of schizophrenia. A large, general population birth cohort (N =11 017), the Northern Finland 1966 Birth Cohort was used as a study population. This database provides the information of prospectively collected data on both biological and social aspects of pregnancy, the characteristics of family, the mother, the father, and the child. The information of psychiatric outcomes was gathered from the Finnish Hospital Discharge Register (FHDR) and the data on registered criminal behaviour of the cohort members come from computerized files maintained by the Ministry of Justice. Children born to multiparous mothers (GMP) i.e. those that had undergone at least six deliveries were more commonly treated in mental hospitals later in life (4.5% vs. 3.4%; p=0.028) than children born to mothers that have fewer children. Of the diagnostic groups, the risk of psychoses other than schizophrenia (OR 2.3; 95% CI 1.2-4.7), and depressive disorders (OR 2.2; 1.0-4.5) was elevated among adult children of those mothers. Birth order was associated with adult schizophrenia. The risk was elevated among male firstborns (ratio 1.5; 95% CI 1.0-2.2), but it was lower than expected among male lastborns (ratio 0.7; 95% CI 0.5-0.9). The elevated risk was not significantly associated with female schizophrenia patients. On the contrary, the risk was lower than expected among females who were not first, not last or not only children in the family (ratio 0.6; 95% CI 0.3-0.9). Among males the risk for violent crimes later in life was elevated among the only children (OR 1.8; 95% CI 1.1-3.0). If perinatal risk was additional exposure, the risk increased up to 4-fold (OR 4.4; 95% CI 1.9-10.8). Combining with maternal risks increased the risk up to 6-fold (OR 5.9; 95% CI 3.1-11.3) and with paternal risk up to 8-fold (OR 8.4; 95% CI 3.9-18.1), respectively. Among females the absence of the father during childhood until the age of 14 was the strongest risk factor in predicting later criminality (OR 2.5; 95% CI 1.4-4.3). Further, in the families, where the father was present, maternal smoking during pregnancy together with being born unwanted increased the prevalence for criminal offending significantly up to 7.2%. In conclusion, some characteristics of the early childhood family environment were associated with mental disorders and criminality in adulthood and form part of the developmental trajectory of these disorders. Early detection of such children at risk is important in preventing mental disorders and criminality in adulthood.

Magister Commercii - MCom / Mental disorders are estimated to be experienced by one out of three South Africans in their lifetime. (Stein, Seedat, Herman, Moomal, Heeringa, Kessler & Williams, 2009:3). Empirical studies indicate, that people, who are poor, live in impoverished neighbourhoods, have lower education levels and are subsequently more likely to have mental disorders. This study focuses on depression. Empirical studies point to depression being negatively correlated with socioeconomic determinants, but is this the case in South Africa? From a theoretical standpoint the study considers how socio-structural aspects such as poverty and educational outcomes (amongst other socioeconomic variables) can lead to the prevalence and persistence of depressive symptoms. The main question the study aimed to investigate was whether depression was negatively related to socioeconomic status, and through which pathways does socioeconomic status affect depression. This study used panel data from the National Income Dynamics Study (NIDS) to examine the socioeconomic determinants of depressive symptoms. Waves 1 (2008) and 4 (2014/2015) of the NIDS data were used to answer the research question. Depressive symptoms were assessed using the 10-item version of the Centre for Epidemiological Studies Depression Scale (CES-D). The scale measured depressive symptomatology. The cut off that was used was a score of 10 or higher, which indicated the occurrence of significant depressive symptoms. In order to assess which socioeconomic determinants increase the probability of experiencing significant depressive symptoms, a probit model was used to make this investigation. The results of the study indicate that, despite the recent increase in depression in 2012 and 2014/2015, the overall prevalence of depression in South Africa has declined significantly between 2008 and 2014/2015. Socioeconomic status was found to be negatively associated with depression. In particular, a low income and occupational status were associated with a significantly greater probability of being depressed. Disparities in depression outcomes followed the disparities in socioeconomic status. Hence the study found that women and Africans were particularly vulnerable to depression as they were socioeconomically disadvantaged.

My thesis is divided into 4 major sections. The first section is devoted in part to a description of the biochemical abnormalities in the metabolism of homocarnosine (y-aminobutyryl-L-histidine, HCarn) occurring in a patient with homocarnosinosis. The patient studied and two of her siblings have a progressive neurological disorder with grossly elevated concentrations of HCarn in their CSF. HCarn content was four times higher in a biopsy from the patient's frontal cortex than in biopsied cortex from a large group of control subjects. Using new techniques for the measurement of the HCarn synthesizing and catabolizing enzymes, it was found that the activity of HCarn-Carn synthetase was not increased in the patient's biopsy whereas homocarnosinase activity was undetectable. It is concluded that the elevated HCarn in brain and CSF in the homocarnosinosis patient is due to a deficiency of brain homocarnosinase activity. The first description of the regional distribution of the two HCarn metabolizing enzymes in human brain was also obtained. The remainder of the first section deals with a description of the neuropharmacological properties of HCarn. Intraventricular injection of HCarn in the rat produced hyperexcitability and in high doses, convulsions, whereas unilateral intra-striatal injection of HCarn resulted in contralateral myoclonus. The results of these experiments are consistent with the possibility that HCarn may be involved in the neuronal excitability of brain. The second section describes experiments which test the hypothesis that the content of the inhibitory neurotransmitter GABA is altered in the autopsied brains of some patients dying with schizophrenia. The mean content of GABA was reduced by 20-25% in nucleus accumbens, caudate nucleus, frontal cortex and thalamus of the schizophrenic patients as compared to a control group. However, the differences were found to be statistically significant for only the caudate and thalamus. Extraneous factors such as age of patient at death and prolonged drug treatment did not readily explain the observed reduction in GABA content. The results of the investigation suggest an association between a deficiency of GABAergic function in certain brain areas with some forms of schizophrenia. The third section describes experiments which test the hypothesis that a deficiency of aspartate found in the cerebellar cortex of some patients with dominantly inherited cerebellar disorders might be due to reduced activity of two enzymes involved in the synthesis of aspartate, namely, aspartate aminotransferase and pyruvate carboxylase. No deficiency of either enzyme was observed in the cerebellar specimens studied. The results of this investigation suggest that the aspartate deficiency in cerebellar cortex found in some dominantly inherited cerebellar disorders does not result from a deficiency of either of these two brain enzymes. In the final section, experiments are described which study the effects of chronic administration of Y-vinyl GABA and of hydrazine on the contents of GABA and other amino compounds in rat brain. Both of these compounds are presently under consideration for use in clinical trials on patients with disorders involving a brain GABA deficiency. Chronic administration of either y-vinyl GABA or of hydrazine markedly increased brain GABA content in the rat. Prolonged treatment with y-vinyl GABA, but not hydrazine, produced a decrease in the activity of glutamic acid decarboxylase (GAD) in rat brain. Since GAD is localized to a large extent in nerve endings, the possibility exists that y-vinyl GABA might reduce the amount of GABA available for release at synapses, a potentially undesirable effect. The contents of many brain amino compounds other than GABA were markedly altered by both drugs. Since the potential harmful effects of these unexpected biochemical alterations in brain are unknown, the nonspecific effects of Y-vinyl GABA and hydrazine are disturbing. / Medicine, Faculty of / Anesthesiology, Pharmacology and Therapeutics, Department of / Graduate

Orientador: Paulo Dalgalarrondo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T18:30:29Z (GMT). No. of bitstreams: 1 Ceara_AlexdeToledo_D.pdf: 2179422 bytes, checksum: fb6f8d912d6321c9be5707a94b9cfc21 (MD5) Previous issue date: 2015 / Resumo: Esta pesquisa investigou as dimensões dos transtornos mentais, do uso de substâncias psicoativas, da identidade e personalidade dos motoboys, na cidade de Campinas. Objetivou investigar a prevalência do uso de substâncias psicoativas, analisar a presença de sintomas psicopatológicos, compreender os modos de constituir a identidade, as relações grupais e a percepção desses jovens acerca do trabalho e da sociedade e a forma como percebem e se comportam em situações de risco e de acidentes. Também investigou dimensões da personalidade dos sujeitos acidentados em comparação com os não acidentados (grupos pareados). Trata-se de um estudo quantitativo e qualitativo. O método quantitativo consistiu na aplicação dos instrumentos padronizados: Self-Reporting Questionnaire (SRQ-20), MINI international neuropsychiatric interview (M.I.N.I. PLUS 5.0.0); The Alcohol Use Disorders Identification Test (AUDIT); um questionário sobre uso o de substâncias, baseado no método do CEBRID (Centro Brasileiro de Informação sobre Drogas Psicotrópicas) e o NEO PI-R (Inventário de Personalidade). O método qualitativo, cujos dados obtidos e analisados tiveram como base os teóricos Erik Erikson e Begg e Langley, consistiu na realização de entrevistas por meio de um inventário de identidade psicossocial para esta pesquisa. Foram entrevistados (n=194) sujeitos, todos da cidade de Campinas-SP. Em uma subamostra, foram investigadas as dimensões da personalidade de (n=25) com história de acidentes, comparando-os a (n=25) não acidentados (Pareados por idade, gênero e escolaridade) Os principais resultados, mediante a regressão logística múltipla, indicaram que os motoboys que mais se expõem ao risco têm menos tempo de profissão, com um ano de exercício (5,2 vezes mais risco que os com 3 anos ou mais de trabalho) e possuem algum transtorno mental, incluindo uso de substâncias (8,1 vezes mais exposição ao risco que os sem transtorno). O aumento em uma unidade do SRQ-20 (indicando sofrimento psíquico) eleva o risco de sofrer acidentes em 48%. Como resultado dessa amostragem e análise, chegou-se à conclusão de que sujeitos inexperientes e que apresentam sintomas psicopatológicos expõem-se mais ao risco; sujeitos com mais dificuldades psicoemocionais têm maiores chances de se acidentarem nessa profissão / Abstract: This research investigated the dimensions of mental health, use of alcohol and drugs, identity and personality in young "motoboys". The objective was to understand the ways to constitute identity, group relationships, the perception of these adolescents concerning work and society as well as the way they perceive and behave in dangerous situations and accidents. The research also investigated the personality of subjects who have suffered accidents in comparison with subjects who haven¿t. This is a quantitative and qualitative study. The quantitative method consisted in the application of standardized instruments, identified as follows: Self-Reporting Questionnaire (SRQ-20), in order to evaluate psychoemotional aspects; MINI international neuropsychiatric interview (M.I.N.I. PLUS 5.0.0), for mental health; The Alcohol Use Disorders Identification Test (AUDIT), for the use of alcohol; a questionnaire based on CEBRID method (Brazilian Center of Information on Psychotropic Drugs), for drugs use identification; and NEO PI-R(Personality Inventory). The qualitative method consisted in interviews made through an inventory of psychosocial identity, elaborated by a pilot study for this research. (n=95) subjects were interviewed, all of them from the city of Campinas in São Paulo state. Their personalities were investigated being (n=25) who have been through accidents, compared to other (n=25) who haven¿t been through accidents (paired by age, gender and education level). The qualitative data was analyzed based on social psychology. The main results, by multiple logistics regression, were that "motoboys" who mostly expose themselves to risky situations are the ones who have been in this job for one year (5.22 times more than the ones in this job for 3 or more years) and the ones with some mental disorder, including the use of substances (8.1 times more than the ones with no disorder). The increase in one unit of SRQ-20 increases the risk of accidents in 48%. Conclusion: inexperienced subjects and the ones who present disorders expose more themselves to risk; subjects who have more psychoemocional difficulties have significantly more chances to suffer accidents in this profession / Doutorado / Saude da Criança e do Adolescente / Doutor em Ciências

Philosophiae Doctor - PhD / Adolescence, a critical developmental period, requires a certain level of adjustment and may negatively impact youth psychosocial development. Unsurprisingly, adolescent substance use continues to be a major public global health concern. Additionally, some adolescents are immersed in various interpersonal relationships and exposed to various stressors daily, which may affect their psychological well-being and developmental trajectories. This research aimed to explore the experiences of interpersonal relationships, stress and coping, and determine substance use patterns, symptoms of two common mental disorders (depression and generalized anxiety) amongst adolescents who report using substances (legal and illegal) in low-income communities in South Africa by employing Bronfenbrenner’s bio-ecological theory and the person-process-context-time model as a theoretical lens.

Pregnant and postpartum women often face high levels of psychological stress that increase the risk of common mental disorders (CMDs), such as depression and anxiety. This stress is often not met with timely mental health care and, therefore, may create health inequities. Mobile technology-assisted interventions represent a new opportunity for pregnant and postpartum women that may address health equity, especially during and after the COVID-19 era. We conducted an equity-focused systematic review and included 18 randomized and non-randomized controlled trials for analysis. Our results suggest that mobile interventions can prevent and manage depression across ethnicities and carry the potential to reduce psychological distress. Evidence on anxiety and utilization of care was limited and more research is needed among pregnant adolescents. Our collaborative research approach highlights the potential of mobile technologies and the need for active involvement of patients and other stakeholders in the co-creation and evaluation of mobile interventions.