by Lam Ho Cheung, Andrew. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1993. / Includes bibliographical references (leaves 1-5 (3rd gp.)). / ABSTRACT --- p.I1-3 / ACKNOWLEDGEMENTS --- p.II / TABLE OF CONTENTS --- p.III1-2 / Chapter CHAPTER ONE - --- INTRODUCTION / Chapter 1.1 --- The Problem --- p.1 / Chapter 1.2 --- The purpose of the thesis --- p.5 / Chapter CHAPTER TWO - --- PSYCHIATRIC OUTPATIENT SERVICE PROVISION / Chapter 2.1 --- Provision of psychiatric outpatient provision --- p.6 / Chapter 2.2 --- The problem of pattern of consultation --- p.13 / Chapter CHAPTER THREE- --- OBJECTIVES AND HYPOTHESIS SETTING / Chapter 3.1 --- Objectives --- p.30 / Chapter 3.2 --- Definition of essential terms --- p.30 / Chapter 3.3 --- Hypothesis setting --- p.32 / Chapter CHAPTER FOUR - --- METHOD / Chapter 4.1 --- Research design and Data collection method --- p.36 / Chapter 4.2 --- Recording schedule design --- p.37 / Chapter 4.3 --- Setting --- p.39 / Chapter 4.4 --- Subjects --- p.40 / Chapter 4.5 --- Data Collection and Processing --- p.40 / Chapter 4.6 --- Data analysis --- p.43 / Chapter CHAPTER FIVE - --- DESCRIPTIVE FINDINGS / Chapter 5.1 --- The overall pattern of consultations --- p.45 / Chapter 5.2 --- Diagnostic group of sex and age group --- p.53 / Chapter CHAPTER SIX - --- FACTORS ASSOCIATED WITH DROP-OUTS OF PATIENTS / Chapter 6.1 --- Background of the drop-outs and the non-drop-outs group --- p.55 / Chapter 6.2 --- Univariate analysis of relationship between various variables and drop-outs --- p.55 / Chapter 6.3 --- Multiple logistic regression model of relationship between drop-outs and various variables --- p.58 / Chapter CHAPTER SEVEN - --- FACTORS ASSOCIATED WITH PROLONGED & CONTINUED ATTENDANCE / Chapter 7.1 --- Background of the treated & discharged group and prolonged & continued attendance group --- p.62 / Chapter 7.2 --- Univariate analysis of relationship between various variables and prolonged & continued attendance --- p.62 / Chapter 7.3 --- Multiple logistic regression model of relationship between prolonged & continued attendance and various variables --- p.65 / Chapter CHAPTER EIGHT - --- DISCUSSION / Chapter 8.1 --- The overall pattern of consultations --- p.69 / Chapter 8.2 --- Factors associated with the risk of drop-outs --- p.76 / Chapter 8.3 --- Factors associated with the prolonged & continued attendance --- p.80 / Chapter 8.4 --- Implications to service delivery --- p.85 / Chapter 8.5 --- Limitations of this thesis --- p.86 / Chapter CHAPTER NINE - --- CONCLUSION AND RECOMMENDATIONS / Chapter 9.1 --- Conclusion --- p.90 / Chapter 9.2 --- Recommendations --- p.92 / Chapter 9.3 --- Suggestion for future work --- p.93 / BIBLIOGRAPHY / APPENDIX I - TABLE / APPENDIX II- SAMPLE RECORDING SCHEDULE

Schizophrenia is a major psychiatric disorder that affects 1% of the world population and is among the 10 leading worldwide causes of disability. Disrupted-In- Schizophrenia (DISC1) is one of the most studied risk genes for mental illness and is disrupted by a balanced translocation between chromosomes 1 and 11 that co-segregates with major mental illness in a single large Scottish family. DISC1 is a scaffold protein with numerous interactors and has been shown to hold key roles in neuronal progenitor proliferation, migration, cells signalling and synapse formation and maintenance. The studies herein provide the platform in order to investigate the molecular and cellular consequences of the t(1;11) translocation using induced pluripotent stem cells (iPSCs)-derived neural precursor cells and neurons from within-family carriers and controls. Towards this end, several iPSC lines have been converted into neural progenitor cells (NPCs) and differentiated into physiologically active forebrain neurons following well-characterised protocols. These cells were characterised in terms of basic marker expression at each developmental stage. Inter-line variation was observed in all subsequent experiments but overall t(1;11) lines did not generate less neuronal or less proliferating cells compared to control lines. Furthermore, the expression pattern of genes disrupted by the t(1;11) translocation was investigated by RT-qPCR. DISC1 was reduced by ~50% in the translocation lines, both neural precursors and neurons. This observation corresponds to previous findings in lymphoblastoid cell lines (LBCs) derived from members of the same family. Moreover, DISC1 expression was found to increase as neural precursors differentiation to neurons. Two other genes are disrupted by the t(1;11) translocation;DISC2 and DISC1FP1. Their expression was detectable, but below the threshold of quantification. Similarly, DISC1/DISC1FP1 chimeric transcripts corresponding to such transcripts previously identifies in LBCs from the family were detectable, but not quantifiable. A fourth gene, TSNAX, was also investigated because it is located in close proximity to, and undergoes intergenic splicing with, DISC1. Interestingly, TSNAX was found to be altered in some but not all time points studied, in the translocation carriers compared to control lines. In addition to breakpoint gene expression profiling, iPSC-derived material was used to investigate neuronal differentiation. There seemed to be attenuation in BIII-TUBULIN expression at two weeks post-differentiation, while NESTIN, MAP2 and GFAP expression was similar between translocation carrier and control lines at all time points studied. I also had access to targeted mice designed to mimic the derived chromosome 1 of the t(1;11) balanced translocation. Using RT-qPCR Disc1 expression was found to be 50% lower in heterozygous mice compared to wild types, and I detected a similar profile of chimeric transcript expression as detected in translocation carrier-derived LBCs. These observations support my gene expression studies of the human cells and indicate that the iPSC-derived neural precursors and neurons can be studied in parallel with the genome edited mice to obtain meaningful insights into the mechanism by which the t(1;11) translocation confers substantially elevated risk of major mental illness. In conclusion, the studies described in this thesis provide an experimental platform for investigation of the effects of the t(1;11) translocation upon function and gene and protein expression in material derived from translocation carriers and in brain tissue from a corresponding mouse model.

Este trabalho pretendeu acompanhar o movimento do conceito de narcisismo em Freud e Lacan, no alcance do meu estudo atual de suas obras. Este tema tem sido estudado pelas diferentes linhas teóricas em psicanálise, evidenciando-se a dificuldade na diferenciação dos dois narcisismos. Assim, foi oportuno e importante que Lacan tenha retomado esta discussão, destacando os impasses do texto freudiano Introducción al narcisismo. A partir do estudo desenvolvido por Lacan, a questão deixada por Freud a respeito da constituição do narcisismo de que ao autoerotismo teria que se agregar um novo ato psíquico começa a se esclarecer. A segunda metáfora a respeito do narcisismo a dos espelhos conjugados foi um recurso retórico para dar conta do impasse deixado por Freud e já trabalhado por Lacan em sua primeira metáfora a do espelho plano. É neste momento de sua obra que Lacan situa o processo de simbolização ao nível do narcisismo primário e a relação especular ao do narcisismo secundário. O Outro aspecto destacado pelo seu trabalho foi mostrar que as miragens narcísicas estão estruturadas pelo discurso da degeneração / This work intended to follow the movement of narcissism in Freud and Lacan, considering my actual study of their work. This subject has been studied by different theoretical lines in psychoanalysis, becoming clear the difficulty in the differentiation between both narcissisms. So, it was convenient and important that Lacan could retake this debate, putting in relief the impasses of the freudiens text Introduction to the narcissism. From the study developed by Lacan, the question left by Freud about the constitution of narcissism to the autoerotism it should be added a new act psychic started to turn clear. The second metaphor about narcissism the one of de conjugated mirrors has been a rethoric mean to overcome the impasse left by Freud and already worked by Lacan in his first metaphor the one of the plane mirror. At this moment of his work Lacan establishes the symbolization process in the primary narcissism level and the specular relation in the second narcissism. Another aspect placed in relief by my work has been showing that the narcisic mirages were structured by denial discourse

Made available in DSpace on 2016-04-27T18:12:43Z (GMT). No. of bitstreams: 1 Beatriz Paiva Bueno de Almeida.pdf: 2073175 bytes, checksum: 32ea5f7bb9b915603a19f3f0278e4af7 (MD5) Previous issue date: 2010-02-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The objective of this work is to characterize and analyze the speech developed at the Integrated Healthcare of Santa Rita do Passa Quatro - SP (CAIS-SR), an institution whose history was marked by the process of institutionalization of mental patients and then by Psychiatric Reform. The research is designed as a case study, with emphasis on research for a project of care group (group / choir Sabiá na Laranjeira ) conducted by the Speech Therapy in CAIS-SR. The research method combines survey of speech-language record of the activities carried out, which occurred between 2001 and 2006, interviews with professional teams of CAIS-SR and group patients Sabiá na Laranjeira about the presence of speech therapist throughout this period, and especially analysis of the group work done with patients of Sabiá na Laranjeira . To put the analysis the work of Speech Therapy in CAIS-SR, is presented key issues to care of patients with mental disorders, namely: the marks that isolation makes the life history of these subjects, the composition and relevance of inter-and multidisciplinary teams in mental health; social exclusion and the search for activities that help in building a new and more satisfactory social conditions for such subjects. In this sense, the dissertation points to the fact that the speech therapist, participating in teams of CAIS-SR, beyond to identify and treat speech pathology, should value and encourage communication and discursive circulation among patients and those with family members and society by increasing the use of language (verbal and nonverbal) and shedding light on the importance of communication, among other things: biopsychosocial rehabilitation; training of interpersonal bonds; legitimacy and social belonging of the subjects with mental disorders, which aligns public policies with anti-psychiatric ward and social reintegration / O objetivo da dissertação é caracterizar e analisar o trabalho fonoaudiológico desenvolvido no Centro de Atenção Integral à Saúde de Santa Rita do Passa Quatro SP (CAIS-SR), instituição cuja história foi marcada pelo processo de institucionalização de portadores de transtornos mentais e, posteriormente, pela Reforma Psiquiátrica. A pesquisa se configura como um estudo de caso, com ênfase na investigação de um projeto de atendimento grupal (grupo/coral Sabiá na Laranjeira ) conduzido pela Fonoaudiologia no CAIS-SR. O método da pesquisa conjuga levantamento dos registros das atividades fonoaudiológicas realizadas, que ocorreram entre 2001 e 2006; entrevistas com profissionais das equipes do CAIS-SR e com pacientes do grupo Sabiá na Laranjeira sobre a presença do fonoaudiólogo ao longo desse período; e, especialmente, análise do trabalho grupal efetuado com os pacientes do Sabiá na Laranjeira . Para contextualizar a análise do trabalho fonoaudiológico no CAIS-SR, são apresentadas questões básicas ao atendimento do portador de transtornos mentais, a saber: as marcas que o isolamento deixa na história de vida destes sujeitos; a composição e a relevância das equipes inter e multidisciplinares na saúde mental; a exclusão social e a busca por atividades que auxiliem na construção de uma nova e mais satisfatória condição social para tais sujeitos. Nesse sentido, a dissertação aponta para o fato de que o fonoaudiólogo, participando de equipes do CAIS-SR, além de identificar e tratar alterações fonoaudiológicas, deve valorizar e estimular a comunicação e a circulação discursiva entre os pacientes e destes com familiares, profissionais e sociedade, intensificando o uso da linguagem (verbal e não-verbal) e lançando luz sobre a importância da comunicação para, entre outros aspectos: reabilitação biopsicossocial, formação de vínculos interpessoais, legitimação e pertencimento social dos sujeitos portadores de transtornos mentais, o que se alinha com as políticas públicas antimanicomiais e de reintegração social

Os Centros de Atenção Psicossocial estão sendo estruturados segundo práticas de atenção psicossocial, as quais têm provocado mudanças nas formas tradicionais de compreensão e tratamento dos transtornos mentais. A reinserção social, inclusão da família e da comunidade no tratamento são recursos utilizados para a promoção da saúde mental nestes serviços comunitários. Para que os portadores de transtornos mentais tenham uma melhor qualidade de vida é essencial que tenham participação social. Parece-nos importante caracterizar, segundo alguns aspectos, as pessoas portadoras de esquizofrenia, uma vez que este transtorno psicótico pode ocasionar dificuldades inerentes à sua vida social. Ao abordarmos a vida social de pacientes com diagnóstico de esquizofrenia, devemos enfocar a participação em atividades comunitárias e de lazer e a interação interpessoal com familiares e amigos. Acreditamos que esses aspectos são essenciais para a qualidade de vida e para a reinserção social dessas pessoas, o que vai ao encontro das premissas da reabilitação psicossocial. O atual estudo é de natureza qualitativa, descritiva e exploratória e tem, como objetivos, investigar a vida social de usuários com diagnóstico de esquizofrenia de um Centro de Atenção Psicossocial e identificar como o processo terapêutico, oferecido pelo CAPS, tem colaborado na vida social dessas pessoas. Os sujeitos envolvidos foram os pacientes portadores de esquizofrenia, na faixa etária de dezoito a quarenta anos, residentes em Uberaba- MG, matriculados no Centro de Atenção Psicossocial. Para a coleta de dados foi utilizada a entrevista semi estruturada, conduzida segundo um roteiro. Estas entrevistas foram gravadas e transcritas na íntegra para que os dados fossem analisados. Para análise e discussão dos dados foram utilizados os seguintes passos: ordenação dos dados, classificação dos mesmos e análise final, tendo por base a associação entre o material teórico e empírico. Foram identificadas três categorias: a vida dos pacientes antes e após o adoecimento; o cotidiano dos usuários no ambiente extra CAPS e a assistência do CAPS colaborando na vida social e na estabilização de sintomas dessas pessoas. Os resultados sinalizaram para uma redução na qualidade das relações interpessoais do paciente após o adoecimento, embora seu cotidiano, no ambiente extra CAPS, esteja satisfatório e produtivo. Por fim, verificamos que o CAPS está oferecendo recursos terapêuticos para enriquecer a vida social e estabilizar os sintomas da clientela assistida. Entretanto, acreditamos ser essencial uma reflexão acerca da necessidade da equipe atuante no CAPS estabelecer parceria intersetorial e junto à Estratégia Saúde da Família e à própria comunidade de forma que o paciente tenha oportunidade de ampliar suas possibilidades terapêuticas relacionadas à socialização e, assim, enriquecer sua vida social. Acreditamos que esta prática também resultará na desmistificação social acerca da esquizofrenia. / The Psychosocial Care Centers (CAPS) are being structured according to psychosocial care practices, which are leading to changes in the traditional ways of treating and comprehending mental disorders. Social reinsertion and inclusion of the family and community in the treatment are resources used for mental health promotion in these community services. Social participation is essential for the improvement of the quality of life of patients with mental disorders. It seems important to characterize, according to some aspects, people with schizophrenia, as this psychotic disorder can cause difficulties regarding social life. While approaching social life of patients with diagnosis of schizophrenia, we must focus their involvement in community and leisure activities, as well as their personal interaction with family and friends. We believe these aspects are essential for those peoples quality of life and social reinsertion, in accordance with the social rehabilitation principles. This qualitative, descriptive-exploratory study aimed to investigate the social life of patients with diagnosis of schizophrenia in a Psychosocial Care Center, and to indentify how the therapeutic process, offered by the CAPS, has contributed in their social lives. The subjects of the study were patients with schizophrenia, aged between eighteen and forty years, living in Uberaba-MG, registered at the Psychosocial Care Center. The data collection was done using semi-structured interview, directed by a guide. These interviews were recorded and fully transcribed for the data analysis. Based on the association between the theoretical and empiric material, the data analysis and discussion were done through the following steps: data ordering, classification and final data analysis. Three categories were identified: patients life before and after the sickness; patients daily life in environments outside CAPS and CAPS assistance contributing in patients social life and stabilization of symptoms. The results showed a decrease in the quality of the patients interpersonal relationships after the illness, although their daily life outside CAPS is satisfactory and productive. At last, we verified that CAPS offers therapeutic resources that enriches their clients social life and stabilizes their symptoms. Nevertheless, we believe that the possibility of the CAPS team establishing a partnership with the Family Health Strategy and the community itself should be considered, thus patients would have more options of therapies related to socialization, enriching their social life. We also believe this practice to result in the demystification of schizophrenia.

This dissertation develops several new statistical methods for disease classification that directly account for the unique logic structure of criteria sets found in the Diagnostic and Statistical Manual of Mental Disorders. For psychiatric disorders, a clinically significant anatomical or physiological deviation cannot be used to determine disease status. Instead, clinicians rely on criteria sets from the Diagnostic and Statistical Manual of Mental Disorders to make diagnoses. Each criteria set is comprised of several symptom domains, with the domains determined by expert opinion or psychometric analyses. In order to be diagnosed, an individual must meet the minimum number of symptoms, or threshold, required for each domain. If both the overall number of domains and the number of symptoms within each domain are small, an exhaustive search to determine these thresholds is feasible, with the thresholds chosen to minimize the overall misclassification rate. However, for more complicated scenarios, such as incorporating a continuous biomarker into the diagnostic criteria, a novel technique is necessary. In this dissertation, we propose several novel approaches to empirically determine these thresholds. Within each domain, we start by fitting a linear discriminant function based upon a sample of individuals in which disease status and the number of symptoms present in that domain are both known. Since one must meet the criteria for all domains, an overall positive diagnosis is only issued if the prediction in each domain is positive. Therefore, the overall decision rule is the intersection of all the domain specific rules. We fit this model using several approaches. In the first approach, we directly apply the framework of the support vector machine (SVM). This results in a non-convex minimization problem, which we can approximate by an iterative algorithm based on the Difference of Convex functions algorithm. In the second approach, we recognize that the expected population loss function can be re-expressed in an alternative form. Based on this alternative form, we propose two more iterative algorithms, SVM Iterative and Logistic Iterative. Although the number of symptoms per domain for the current clinical application is small, the proposed iterative methods are general and flexible enough to be adapted to complicated settings such as using continuous biomarker data, high-dimensional data (for example, imaging markers or genetic markers), other logic structures, or non-linear discriminant functions to assist in disease diagnosis. Under varying simulation scenarios, the Exhaustive Search and both proposed methods, SVM Iterative and Logistic Iterative, have good performance characteristics when compared with the oracle decision rule. We also examine one simulation in which the Exhaustive Search is not feasible and find that SVM Iterative and Logistic Iterative perform quite well. Each of these methods is then applied to a real data set in order to construct a criteria set for Complicated Grief, a new psychiatric disorder of interest. As the domain structure is currently unknown, both a two domain and three domain structure is considered. For both domain structures, all three methods choose the same thresholds. The resulting criteria sets are then evaluated on an independent data set of cases and shown to have high sensitivities. Using this same data, we also evaluate the sensitivity of three previously published criteria sets for Complicated Grief. Two of the three published criteria sets show poor sensitivity, while the sensitivity of the third is quite good. To fully evaluate our proposed criteria sets, as well as the previously published sets, a sample of controls is necessary so that specificity can also be assessed. The collection of this data is currently ongoing. We conclude the dissertation by considering the influence of study design on criteria set development and its evaluation. We also discuss future extensions of this work such as handling complex logic structures and simultaneously discovering both the domain structure and domain thresholds.

Since the government commissioned the Crossing Bridges programme in 1998 (Falcov, 1998) and through legislation and a number of government policies and initiatives since, there has been emphasis on addressing the needs of families where there are parental mental health problems. Furthermore, there is a fast-growing body of research pointing to the needs of these families. However, service structures, development and provision have lagged behind. Most often parents with mental health difficulties have access to services addressing their individual mental health needs while their needs as parents and the needs of their children remain largely invisible. One such need that has been highlighted repeatedly in the literature is the need for children to have information about and make sense of their parent’s mental health difficulties. Given the lack of services to respond to this need, it is most often left to the parent to make decisions about and respond to their child’s search for understanding. This study is a qualitative study that explores parents’ experiences of decision-making and responding to this need, and the social processes and dominant discourses that impact on these experiences. Fifteen parents with mental health difficulties were interviewed, using semi-structured individual interviews, which were transcribed, and interpretive Grounded Theory was employed to analyse and interpret the data. The grounded theory that was constructed suggest two main social processes that impact on parents’ talking with their children about parental mental health issues. Firstly, within a relational context, parents were Negotiating mutuality between themselves and their children. Secondly, within an identity context, parents had to navigate Holding on to self, holding on to life. These social processes indicate that both parents’ relationships with their children and also their own sense of themselves within the context of their mental distress powerfully shape telling, talking and keeping silent. Implications of these findings both in relation to clinical interventions and future research are considered. In particular, the importance of positioning the parent as active role-player in the healing of their child, and positioning the child as active role-payer in their own meaning-making, are highlighted. Furthermore, developing ‘double-stories’ beyond the mental health story and beyond ‘information’ is emphasised and the importance of a sense of continuity of self and identity over time for parent and child is accentuated. Finally, the importance of allowing for complex and ever-evolving understandings of mental distress is indicated, and the role of both talking and remaining silent in this process is stressed.

The study aimed to develop a theory of the possible links between voice-hearing and self-harm. Twelve semi-structured interviews were conducted with participants living in the community and in a secure forensic setting. All participants had experience of both voice-hearing and self-harm. A grounded theory of possible links was developed from participants’ accounts of their experiences. All participants described self-harm as way of coping with negative voices and of regulating painful emotions. Some described it as a response to a fear of judgement from others, as a form of control or as a means of seeking help. The results suggest that there are numerous links between voice-hearing and self-harm. Predominantly, self-harm seems to function as a way to cope with individual voice-hearing experience. Help should focus on triggers to distress and ways to cope. Training for healthcare staff could usefully be provided by service users, focusing on the importance of being non-judgemental. Future research could examine tactile and visual experiences in relation to self-harm too, clinician perspectives on the links between voice-hearing and self-harm, and service user perspectives on the emotional availability of clinicians.

Trata-se de um estudo ecológico do tipo séries temporais com delineamento exploratório e longitudinal; realizado na Clínica Psiquiátrica São Bento Menni, com os objetivos de descrever o perfil sócio-demográfico e clínico dos pacientes internados por alcoolismo nos anos de 1980 a 2008 e investigar a associação entre o tempo de permanência dos pacientes internados por alcoolismo e as variáveis sócio-demográficas e clínicas. O estudo foi realizado a partir dos dados do Sistema de Internações Hospitalares (SIH) da CSBM. As informações obtidas foram inseridas nos softwares Microsoft Exel (versão 2003) e Statistical Package for the Social Sciences (versão 13.0), os quais permitiram o tratamento das variáveis e a apresentação dos resultados. No período de 20 de outubro de 1980 a 31 de dezembro de 2008, foram internados 28.078 pacientes, sendo 2.203 destes pacientes em detrimento do alcoolismo. No que se refere ao perfil sócio-demográfico e clinico o maior número de pacientes (1796-81,5%) foi internado uma vez; houve uma predominância do sexo masculino (1815-82,4%); da faixa etária de 41 a 50 anos (715-32,5%); da cútis branca; dos casados (1048-47,6%); dos pacientes com nível fundamental (1073-48,7%); dos trabalhadores autônomos e vendedores do comércio (591-26,8%); dos pacientes procedentes da própria família para a internação (943 - 42,8%); de internações financiadas pelo SUS (1232 - 55,9%) e de pacientes acompanhados no momento da internação (2130-96,7%). Constatou-se no decorrer dos anos uma queda do número de internações involuntárias. Houve um elevado número de diagnósticos não especificados (288-47,4%) feitos através da CID-9 e um grande número de casos de uso de álcool - síndrome de dependência (695 - 43,5%) diagnosticados por meio da CID-10. .Ao avaliarmos a série histórica das internações verificamos um aumento progressivo do número de internações e uma queda considerável no tempo de permanência. Com relação ao tipo de alta foi prevalente o número de alta médica hospitalar (1950 - 88,5%). No que condiz ao diagnóstico de alta diferente do recebido para a internação, foi prevalente o diagnóstico de quadros psicóticos orgânicos e de esquizofrenia paranóide. A maioria (970 - 44%) dos pacientes foi referenciada para os Centros de Atenção Psicossocial após a alta. Ao investigarmos a associação entre o tempo de permanência dos pacientes e as variáveis constatou-se um tempo superior: do sexo feminino; da faixa etária entre 61 a 70 anos; dos pacientes de cútis do tipo amarelo; dos solteiros; dos semi-alfabetizados; dos trabalhadores de serviços administrativos; dos pacientes procedentes para a internação por ordem judicial; dos internados de forma voluntária; dos pacientes com diagnóstico de \"Outra Demência Alcoólica\"; dos internados pelo SUS; dos pacientes internados entre os anos de 1980 e 1990; dos que receberam alta médica; dos que receberam diagnóstico de alta diferente do recebido para a internação e dos que receberam o encaminhamento após a alta do tipo \"Ordem Judicial\". Os resultados assim nos permitem considerar que a relação entre o homem e o álcool foi e ainda continua sendo muito conflituosa, gerando ao final, mais prejuízos do que benefícios. Assim, o consumo de álcool configura-se como um grande vilão para a humanidade, tendo enorme peso como causa de adoecimento e morte no mundo, bem como, relacionando-se ao mesmo tempo a diversas características sócio-demográficas e clinicas. / This is an ecological study of the type temporal series with exploratory and longitudinal design, performed at the Psychiatric Clinic St. Benedict Menni, aiming to describe the sociodemographic and clinical features of patients hospitalized for alcoholism in the years 1980- 2008 and investigate the association between duration of stay of patients hospitalized for alcoholism and socio-demographic and clinical data. The study was conducted using the data from the Hospital Admission System (SIH) at the CSBM. The information obtained was entered into Microsoft Excel software (version 2003) and Statistical Package for Social Sciences (version 13.0), which allowed the treatment of variables and the presentation of results. From October 20 1980 to December 31, 2008, 28 078 patients were hospitalized, 2203 of them due to alcoholism. With regard to the socio-demographic and clinical profiles the largest number of patients (1796 - 81.5%) were hospitalized once, there was a predominance of males (1815 - 82.4%); aged from 41 to 50 years old (715 - 32.5%); with white complexion; married (1048 - 47.6%) ; patients with primary education (1073 - 48.7%); self-employed and salespeople (591 - 26.8%); patients brought by their own families to hospitalization (943 - 42.8%); admissions (1232 - 55.9%) financed by SUS and patients accompanied at the time of admission (2130 - 96.7%). It was found over the years a decline in the number of involuntary admissions. There was a large number of unspecified diagnoses (288 - 47.4%) made by ICD-9 and a large number of cases of alcohol use - dependence syndrome (695 - 43.5%) diagnosed by ICD- 10.In evaluating the historical series of admissions we found a progressive increase in the number of hospitalizations and a significant decrease in the length of stay. Regarding the type of discharge was prevalent the number of medical discharges from hospital (1950 - 88.5%). As for the discharge diagnosis different from the one received for admission, was prevalent the diagnosis of organic psychotic manifestations and paranoid schizophrenia. The majority (970-44%) of patients were referenced to the Centers of Psychosocial Care after discharge. Investigating the association between length of stay of patients and the variables we found that had a longer stay: females; age range between 61-70 years old; patients with yellow complexion; single; semi-literate; workers in administrative services; patients coming to hospital on court order; voluntarily hospitalized; patients diagnosed with \"Other Alcoholic Dementia\"; internees from the SUS; patients admitted between 1980 and 1990, those who received medical discharge, those who received a diagnosis other than the one received for admission and those who received the referral after discharge due to court order. The results thus allow us to consider that the relationship between man and alcohol was and still is very conflicting, resulting in more harm than good. Thus, alcohol consumption appears as a great villain for humanity, as a major cause of illnesses and death worldwide, being related as well to various socio-demographic and clinical characteristics.

Estudos epidemiológicos mostram que a incidência de transtornos mentais e comportamentais tem aumentando nos últimos anos e estas condições são acompanhadas de uma gama de doenças bucais que estão relacionadas à medicação utilizada e ao grau de instrução, condições financeiras, idade, estado de saúde geral e acesso ao atendimento odontológico dos pacientes. Entretanto, são escassos estudos que abordam a epidemiologia da saúde bucal e o impacto dela na qualidade de vida destes pacientes. Este estudo teve o objetivo de avaliar as condições bucais dos pacientes com transtornos mentais e comportamentais atendidos no Centro de Atendimento Psicossocial do Butantã (CAPS/Butantã) e o impacto da saúde bucal na qualidade de vida. Foram coletados dados demográficos, queixa principal, história médica [evolução da doença psiquiátrica, presença de comorbidades (hipertensão arterial sistêmica, doenças cardiovasculares, diabetes, distúrbios hepáticos, distúrbios hematológicos, distúrbios renais, distúrbios gastrointestinais e distúrbios respiratórios), medicações em uso], hábitos (álcool, fumo e drogas ilícitas), e história odontológica. No exame físico intraoral foram avaliados os índices de CPOD, índice gengival (IG) e índice comunitário periodontal (ICP) e a presença de lesões em mucosa. Como exame complementar, foi avaliado o fluxo salivar. Por fim o impacto da saúde oral na qualidade de vida foi medido através de questionário internacionalmente padronizado, o Oral Health Impact Profile (OHIP-14). Foram avaliados 50 pacientes, sendo 28 do sexo feminino e 22 do sexo masculino, com idades entre 22 e 74 anos e mediana de 45 anos. A maioria (66%) apresentava baixa escolaridade e os diagnósticos mais encontrados foram, respectivamente: esquizofrenia, transtornos esquizotípicos e transtornos delirantes, transtornos do humor afetivos e transtornos da personalidade do comportamento do adulto. Com relação às comorbidades, 34% apresentavam hipertensão arterial sistêmica (HAS), 26% Diabetes Mellitus (DM) e 18% doença cardiovascular. A maioria usava mais de dois medicamentos psicotrópicos associados. Com relação à queixa principal do paciente, 68% relataram boca seca, 66% relataram sangramento gengival durante a escovação, 56% relataram bruxismo e 50% relataram dor de origem dentária. O CPOD variou de 1 a 30, com média de 16,3 e mediana de 17, sendo que 64% dos pacientes apresentaram CPOD considerado alto pela Organização Mundial da Saúde (OMS). Com relação ao ICP, 70,5% apresentaram alguma necessidade de tratamento periodontal, sendo que 56,8% necessitavam de profilaxia e/ou raspagem supragengival e 43,2% necessitavam raspagem subgengival. O IG mostrou que 48% dos pacientes apresentavam gengivite moderada, 34% gengivite severa e 18% gengivite leve. Com relação ao fluxo salivar, observamos que estava diminuído em 46% dos pacientes e normal em 54% deles. O OHIP-14 mostrou que a saúde bucal possui médio impacto sobre a qualidade de vida de 40% dos pacientes, forte impacto para 28% dos pacientes, e fraco impacto para 32% dos pacientes. Conclui-se que estes pacientes apresentam uma condição bucal insatisfatória, que impacta negativamente na qualidade de vida, mostrando a importância de ações em saúde bucal, tanto preventivas quanto curativas, para esta população vulnerável. / Epidemiological studies show that the incidence of mental and behavioral disorders has been increasing in recent years and these conditions are followed by a range of oral diseases that are related to medications used and the level of education, financial condition, age, general health status and access dental care of patients. However, there are few studies on the epidemiology of oral health and the impact on the quality of life of these patients. This study aimed to evaluate the oral conditions of patients with mental and behavioral disorders treated at the Center of Psychosocial Care of Butantã (CAPS/Butantã) and the impact of oral health on quality of life. Demographics, main complaint, medical history [evolution of psychiatric illness, comorbidities (hypertension, cardiovascular disease, diabetes, liver disorders, blood disorders, kidney disorders, gastrointestinal disorders and respiratory disorders), current medications], habits (alcohol, tobacco and illicit drugs) and dental history were collected. In intraoral physical examination, were evaluated the DMFT Index, the Gingival Index (GI), the Community Periodontal Index (CPI) and the presence of mucosal lesions. As a complementary test, we evaluated the salivary flow. Finally the impact of oral health on quality of life was measured using an internationally standardized questionnaire, the Oral Health Impact Profile (OHIP-14). A total of 50 patients were evaluated (28 females and 22 males), with ages between 22 and 74 years old and a median of 45 years old. The majority (66%) had a low level of education and the most frequent diagnoses were, respectively: schizophrenia, schizotypal and delusional disorders, mood affective disorders and disorders of adult personality and behavior. Regarding comorbidities, 34% had systemic hypertension (SH), 26% had diabetes mellitus (DM) and 18% had cardiovascular disease. Most of the patients took more than two psychotropic medications in association. Regarding the patient\'s main complaint, 68% reported dry mouth, 66% reported bleeding gums during brushing, 56% reported bruxism and 50% reported pain of dental origin. The DMFT ranged from 1 to 30, with a mean of 16.3 and a median of 17, and 64% of the patients had a high DMFT according to the World Health Organization (WHO) standards. With respect to CPI, 70.5% showed some need for periodontal treatment, 56.8% need prophylaxis and/or supragingival scaling and 43.2% required subgingival scaling. The GI showed that 48% of patients had moderate gingivitis, 34% had severe and 18% had mild gingivitis. With respect to salivary flow, we found that it was decreased in 46% of patients and normal in 54% of them. The OHIP-14 questionnaire showed that oral health has an average impact on quality of life for 40% of patients, a strong impact for 28%, and low impact for 32% of the patients. We conclude that these patients have a poor oral condition, which impacts negatively on their quality of life, showing the importance of oral health practices, both preventive and curative, for this vulnerable population.