<p> The present study examines the relation between depression and trait anxiety symptoms and women&rsquo;s utterances during a routine ultrasound procedure in the second trimester of pregnancy. Participants included a diverse group of 70 women seeking prenatal care at an academic medical center in the Midwestern United States. The Depression Anxiety Stress Scales (DASS-21) depression subscale and the State Trait Anxiety Inventory (STAI), trait form were used to assess symptoms of depression and trait anxiety, respectively. Audio and video of participants&rsquo; faces during the ultrasound examination were used to assess the content, sentiment, and number of utterances. Results of regression analyses indicated that higher levels of depression symptoms were significantly related to a lower proportion of fetus-related utterances to total utterances. Higher levels of depression symptoms and trait anxiety were significantly related to a lower proportion of positive fetus-related utterances to total fetus-related utterances, after controlling for gestational age. Higher levels of depression symptoms were significantly related to a higher proportion of negative-fetus-related utterances to total fetus-related utterances, after controlling for education. These findings suggest that pregnant women who are experiencing symptoms of depression and anxiety may exhibit certain types and patterns of utterances during routine prenatal sonogram procedures. Thus, observation of pregnant women&rsquo;s naturalistic speech may provide helpful supplemental information to the traditional self-report measure in screening for symptoms of depression and anxiety.</p><p>

Thesis (M.S.)--Boston University

The purpose of this study is to determine the possible effect of varying amounts of parental contact on the behavior of the institutionalized child. The effect that is being investigated is overt aggression. Also, the variable of peer support will be studied because of its important role when there is a lack of parental support.

BACKGROUND: There is an urgent need to provide training and tools to frontline health workers in order for them to properly diagnose and treat mental illnesses in Latin-American communities, since the vast majority of people with a mental illness suffer in silence. A computer-assisted interview, the Global Mental Health Assessment Tool (GMHAT/PC) has been developed to assist general practitioners and other health professionals to make a quick, convenient, yet reasonably comprehensive and standardised mental health assessment. GMHAT/PC has been translated into various languages including German, Dutch, Chinese, Hindi and Arabic. This is the first study, of a GMHAT/PC Spanish version carried out in Latin America, to establish its validity in that culture and feasibility to be used in the health care setting. If proven a valid tool through this study, the GMHAT/PC Spanish version will be an important aid towards improving the mental health of Spanish-speaking communities within the Latin-American region. AIM: The study aims at assessing both the validity of a GMHAT/PC Spanish version, and the feasibility of utilising a computer assisted diagnostic interview by GPs. DESIGN: 1) Validation study was planned to establish whether the GMHAT/PC based diagnosis compares well with the consultants ICD-10 based diagnosis (Gold Standard) 2) Feasibility study was carried out to examine whether GMHAT/PC can be used in routine clinical care in a general health setting. MATERIALS AND METHODS: In the first study (validation), participants varied from those who were in remission i.e. without much psychopathology to those had symptoms of a severe mental illness. They were recruited from in-patient (82%) and out-patient (18%) mental health settings in Colombia. The participants were expected to have a wide range of psychiatric diagnoses (anxiety disorders, depression, psychosis, bipolar affective disorder, organic mental disorders, and other diagnoses). All consecutive patients were interviewed by GPs using GMHAT/PC and psychiatrists made an independent diagnosis applying ICD-10 criteria. The second study (feasibility) was carried out on patients hospitalised at medical, surgical and women’s wards during a period of one month in each service. The diagnosis of a medical illness was made by specialists in each service. A trained GP carried out psychiatric assessment of all participants using GMHAT/PC. RESULTS: First study (validity): two hundred ninety-nine patients (n=299) participated, 54.18% males and 45.81% females in the age range of 14-78. All patients were interviewed independently by seven psychiatrists with over five years of clinical experience. The mean duration of GMHAT/PC interview was 12.5 minutes. Most patients were pleased that they were asked about every aspect of their mental health. Psychiatrists made a single diagnosis in 183 (61%) cases, multiple (two) diagnosis in 112 (37%) cases and multiple (three) diagnosis in another four cases. GMHAT/PC in almost all cases gave additional multiple diagnoses. The results show an acceptable-to-good level of agreement between the GPs’ (GMHAT/PC) diagnoses and the psychiatrists’ (clinical) diagnoses of any mental illness, Kappa 0.58- 95% C.I (0.46, 0.72). There is a good level of sensitivity (81%) and specificity (92%), with GPs correctly identifying 242 out of the 250 participants diagnosed with a mental illness, and 27 out of 35 of those who do not present any whatsoever. The agreement (kappa value) between GMHAT/PC diagnosis and psychiatrists ICD-10 based diagnosis of specific disorders were as follows: Organic disorders-0.87; Psychosis- 0.56; Depression-0.53; Mania-0.6, Alcohol and drug misuse- 0.62, Learning disorder- 0.4; Personality Disorder- 0.39 and Anxiety disorders- 0.14. The sensitivity of different disorders ranged from 63% (Mania) to 100% (Anxiety) and specificity from 71% (Anxiety) to 100% (organic). The second study (feasibility): out of 455 medically-ill patients, 4.8% had a mental illness identified by GMHAT/PC interview. Anxiety, depression and organic disorders were the most frequently identified mental disorders in internal medicine and surgery. Cancer had a significantly higher prevalence of comorbid mental illness. CONCLUSION: GMHAT/PC -Spanish version used by GPs in this study detected mental disorders accurately and it was feasible to use GMHAT/PC in Colombia and Latin-American health settings. The findings of this study will have a big impact upon mental health service provision in Spanish-speaking nations within the Latin-American region as the Spanish version for GMHAT/PC will assist primary care physicians and other health workers in detecting and managing mental health disorders in the communities. There is no other comparable easy-to-use comprehensive mental health diagnostic tool available in Spanish.

Made available in DSpace on 2019-03-29T23:14:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-12-19 / O presente estudo emprega a metodologia de pesquisa qualitativa bibliográfica e tem como objetivo problematizar e realizar uma análise do diagnóstico na área de saúde mental, derivada da constatação de um aumento importante na formulação de novas categorias nosográficas nos atuais manuais de classificação psiquiátricos - sobretudo no Diagnostic and Statistical Manual of Mental Disorders (DSM) - e de constatações clínicas que identificam um acréscimo na procura por diagnósticos. Aplicando ao diagnóstico um significado de relevância para a condução da própria vida, pacientes buscam, mediante emissões diagnósticas, definições e justificativas para as dificuldades e o sofrimento vivido, descrevendo a si mesmo como uma entidade nosográfica procedente de um mal funcionamento biológico corporal. O estudo, opondo-se ao caráter de verdade absoluta essencialista e universal atribuído ao diagnóstico na contemporaneidade, propõe compreendê-lo na interdependência do contexto social-históricopolítico. Para tanto, identifica a classificação dos fenômenos psicopatológicos na tradição da racionalidade médica ocidental, ancorada em sisifismo à procura por uma causalidade orgânica para a experiência da loucura bem como um diagnóstico nos dias de hoje como um veículo para a constituição de identidades biológicas reducionistas da subjetividade. Na atualidade, com a formulação do DSM-III como um instrumento diagnóstico decisivo na elaboração da idéia de transtorno mental como entidade universal essencialista, essa idéia corrobora o cenário das bioidentidades e de profundas mudanças ocorridas nas esferas política, econômica e antropológica do mundo. Concluindo, com contribuições na psicanálise, são analisadas condições de possibilidades para a emersão de novos discursos e de uma prática clínica que permitam produzir redescrição diagnósticas de um reducionismo fisicalista da subjetividade , ressaltando a singularidade e irredutibilidade da condição humana. Palavras-chave: diagnóstico, contemporaneidade, medicina, psicanálise.

Made available in DSpace on 2019-03-29T23:24:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-10 / The interest in a research on cognitive deficits began when a concern about the practices that should be implemented with people diagnosed with intellectual disabilities appeared. The proposal of the research was, therefore, to show how psychoanalysis understands the intellectual deficit, moving away from theories that propose only an adjustment of the subjects without considering the desire and the effects of such practices on subjectivity and education. Thus a general objective was established: To analyze the intellectual disability from the concept of the subject constituted by the desire, and the implication of this assertion in the field of education. And as specific objectives: To contextualize the historical construction of the concept of disability in conjunction with the concept of childhood; to define the concept of intellectual disability for psychoanalysis from Freud's concept of inhibition, to analyze the implications of intellectual inhibition in education from the concept of Maud Mannoni. In the accomplishment of this work, the bibliographic approach was used and the chosen methodology was qualitative, once investigates issues that are related to subjectivity. Psychoanalysis was elected as the theory that guided the conclusions of the work. Freud has shown inhibition as related to the Oedipus complex and to knowledge. Mannoni and Lacan have debated the disability as a symptom that protects the mother from the truth about castration, leaving the child to be identified as a maternal object. Such considerations point to the intellectual deficit as a psychological problem, and not just an organic one. In the educational field, a debate on the intellectual deficit was observed, although it was reduced to a simplistic educational practice and a misuse of psychoanalysis. By including psychoanalysis in the discussions on developmental disability, there could be an opening to critical thinking regarding the classical concepts and the duality between normality and illness could be left behind, as this theory emphasizes the uniqueness of the subject. Key-Words Disability, Inhibition, Psychoanalysis, Education. / O interesse por uma pesquisa sobre o déficit cognitivo teve inicio quando surgiu uma inquietação em relação às práticas que deveriam ser executadas com pessoas diagnosticadas com deficiência intelectual. A proposta da pesquisa, portanto, foi apresentar como a psicanálise entende o déficit intelectual, se afastando das teorias que propõem apenas um ajustamento dos sujeitos sem considerar o desejo e os efeitos de tais práticas na subjetividade e na educação. Assim, foi estabelecido como objetivo geral: Analisar a deficiência intelectual a partir da concepção de sujeito constituído pelo desejo e a implicação desta assertiva no campo da educação. E como específicos: Contextualizar a construção histórica do conceito de deficiência em articulação com a noção de infância; Definir o conceito de deficiência intelectual para a psicanálise a partir do conceito freudiano de inibição; Analisar as implicações da inibição intelectual na educação a partir da concepção de Maud Mannoni. Na realização do trabalho, o percurso metodológico investigativo foi de ordem bibliográfica e a metodologia escolhida foi qualitativa, pois esta se volta para investigar questões que são relativas à subjetividade. Elegeu-se a psicanálise como teoria que orientou as conclusões do trabalho. Freud apresentou a inibição como relacionada ao Complexo de Édipo e ao saber. Lacan e Mannoni debateram a debilidade como um sintoma que protege a mãe de sua verdade sobre a castração, deixando a criança identificada como um objeto materno. Tais considerações apontam o déficit intelectual como um problema psíquico, e não exclusivamente orgânico. No campo educativo observou-se um debate sobre o déficit intelectual, mas reduzido a uma prática educativa simplória e um uso errôneo da psicanálise. Ao incluir a psicanálise nas discussões sobre a deficiência mental poderia haver a abertura para pensar criticamente os conceitos clássicos e sair da dualidade entre o normal e o patológico, já que essa teoria enfatiza a singularidade do sujeito. Palavras-chave: Deficiência, Inibição, Psicanálise, Educação.

Made available in DSpace on 2019-03-29T23:29:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-12-28 / This dissertation examines the legal regulation of involuntary psychiatric hospitalization, the main legal instrument becomes the 10.216/2001 Act, known as the Brazilian Psychiatric Reform Law. In a democratic state of law, the fundamental mission of ordinary legislator, at all levels, is to make effective the values enshrined in the Constitution, notably the fundamental rights. This is the central premise of the inquiry conducted with this dissertation. It has been approached, then, the theory of fundamental rights, as well as the one about social rights, focusing on the right to health, all in order to prepare and support the critical analysis of the specific legislation for involuntary psychiatric hospitalizations. In addition, still as a preparatory stage and to better understand the context of the Brazilian Psychiatric Reform, it has been explained how the so called mental hospitals have appeared and how the need for the humanization of mental health care has become a worldwide concern over the undignified and inhumane treatment of asylum. Anyway, we decided to bring data that subscribes UN guidelines, as well as a study of Portuguese and Argentinian legislation on psychiatric hospitalization, especially involuntary, with the purpose of conducting a mapping of the needs, problems and solutions most relevant to theme, to be used as a historical frame of reference in understanding the national order. Aligns hypotheses of situations protectable by a mental health legislation and suggests that an interpretation according to the constitution allows a greater range for the mental health law in Brazil. It was found that in the Brazilian legal order there are instruments to protect the fundamental rights of all those affected by involuntary psychiatric admissions, especially those of people with mental disorder. Doctrine, legislation and case law the resources used through a search of a qualitative approach. Keywords: Fundamental rights. Mental health. Brazilian psychiatric reform. Involuntary psychiatric hospitalization. / Esta dissertação analisa a disciplina jurídica das internações psiquiátricas involuntárias, cujo principal diploma legal é a Lei 10.216/2001, conhecida como a Lei da Reforma Psiquiátrica Brasileira. Num Estado Democrático de Direito, missão fundamental do legislador infraconstitucional, em todos os níveis, é a realização os valores consagrados na Constituição, notadamente os direitos fundamentais. Esta e' a premissa central da investigação realizada na presente dissertação. Foi feita, portanto, uma abordagem da Teoria dos Direitos Fundamentais, bem como dos direitos sociais, focalizando no direito à saúde, tudo de modo a preparar e fundamentar a análise crítica da legislação específica relativa às internações psiquiátricas involuntárias. Ademais, ainda como etapa preparatória e para melhor compreender o contexto da Reforma Psiquiátrica Brasileira, explica-se como surgiram os chamados manicômios e de como a necessidade de humanização dos cuidados com a saúde mental foi tornando-se preocupação mundial face à forma indigna e desumana de tratamento manicomial. Enfim, optou-se por trazer dados que perfilham as diretrizes da ONU, bem como um estudo da legislação portuguesa e da argentina sobre as internações psiquiátricas, especialmente a involuntária, com a finalidade de realizar um mapeamento dos anseios, problemas e soluções mais relevantes sobre a temática abordada, a ser utilizado como quadro de referencia histórico na compreensão do ordenamento nacional. Alinha hipóteses de situações tuteláveis por uma legislação de saúde mental e sugere-se que uma interpretação conforme à constituição permite um maior alcance da Lei de saúde mental brasileira. Verificou-se que no ordenamento jurídico brasileiro existem instrumentos de proteção dos direitos fundamentais de todos aqueles afetados por internações psiquiátricas involuntárias, principalmente aqueles dos portadores de transtorno mentais. Doutrina, legislação e jurisprudência serão as fontes bibliográficas utilizadas, por meio de uma pesquisa de abordagem do tipo qualitativa. Palavras-chave: Direitos fundamentais. Saúde mental. Reforma psiquiátrica brasileira. Internação psiquiátrica involuntária.

Made available in DSpace on 2019-03-29T23:39:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-03-30 / This study aims to analyze comparatively the Psicossocial Clinic and the Alienist and Psychiatric Clinics. As references, we will analyze five elements mentioned by Robert Castel (1978): Theoric Code, Intervention Tecnology, Institutional Device, Professional Staff and User Statute. Pinel s Phylosofical Nosography was the first Theoric Code forged about madness. The Psychiatric Clinic created manuals of diagnosis such as CID-10 and DSM-IV, wich to this day establish the psychiatric practice. The Theoric Code of the psicossocial clinic possesses importante theoric productions, such as the ones showed by the psychoanalists and militants of the Brazilian Psychiatric Reform Antonio Lancetti, Ana Paula Lobosque and Fernando Tenório. The asylum, in the Alienist Clinic; the Psychiatric Hospital, in the Psychiatric Clinic, and the open equipments of the RASM, in the psychossocial clinic, are the Institutional Devices that have been sheltering the madness. But the fight for care for those who suffer from mental disorders being available at public services still meets some resistance. In the asylum and the psychiatric hospital, the alienist doctor and the psychiatric doctor are the central characters in the treatment of madness. In the psycossocial clinic, the Professional Staff consists of several professionals who entangle their knowledge and their skills in the assistence of those who suffer from mental disorders. However, medical power is still outstanding in the psycossocial clinic. The Alienist User Statute treated the mad as uncapable and dangerous. In the psychiatric clinic, the mad also shares the status on mentally ill. Whereas in the psychossocial clinic, the mad is seen, first of all, as a citizen, wich implies the need of a clinic that s commited with transforming society s relationship with madness. The Alienist Intervention Technology was the moral treatment idealized by Pinel, whereas the one elaborated by the Psychiatric Clinic was the Psychofarmacology Treatment. On the second half of the XXth century, the Psychiatric Reform proposed a new intervention technology, the psychossocial atention, nowadays transformed in a public policy in Brazil by the Ministry of Health. Well into the 21st century, deep marks of the alienist clinic and the psychiatric clinic still remain, in the relationship between society and madness, even considering the advances of the psychossocial clinic. Key words: Mental health; Alienism; Psicossocial Atention, Psychiatric Reform, Foucault; Psychoanalysis. / O objetivo deste estudo é fazer uma análise comparativa entre a Clínica Psicossocial e as Clínicas Alienista e Psiquiátrica. Como referência, analisaremos cinco elementos citados por Robert Castel (1978): código teórico, tecnologia de intervenção, dispositivo institucional, corpo de profissionais e estatuto de usuários. A Nosografia Filosófica de Pinel foi o primeiro Código Teórico elaborado sobre a loucura. A Clínica Psiquiátrica elaborou manuais diagnósticos, como o CID-10 ou DSM-IV, que embasam até hoje o fazer psiquiátrico. O Código Teórico da clínica psicossocial conta com produções teóricas importantes, como as apontadas pelos psicanalistas e militantes da reforma psiquiátrica brasileira Antonio Lancetti, Ana Marta Lobosque e Fernando Tenório. O asilo, na clínica alienista; o hospital psiquiátrico, na clínica psiquiátrica, e os equipamentos abertos da RASM, na clínica psicossocial, são os Dispositivos Institucionais que têm abrigado a loucura. Mas a luta para que os cuidados aos portadores de transtorno mental sejam ofertados em serviços abertos encontra ainda hoje grande resistência. No asilo e no hospital psiquiátrico, o médico alienista e o médico psiquiatra são os personagens centrais no tratamento da loucura. Na clínica psicossocial, o Corpo de Profissionais é marcado por vários profissionais que entrelaçam seus saberes e suas práticas na assistência aos portadores de transtorno mental. Entretanto, o poder médico ainda é marcante na clínica psicossocial. O Estatuto de Usuário alienista retratava o louco como incapaz e perigoso. Na clínica psiquiátrica, o louco assume também o status de doente mental. Já na clínica psicossocial, o louco é visto, antes de tudo, como um cidadão, o que implica na necessidade de uma clínica comprometida com a transformação da relação da sociedade com a loucura. A Tecnologia de Intervenção Alienista foi o tratamento moral idealizado por Pinel, enquanto o elaborado pela Clínica Psiquiátrica foi o tratamento psicofarmacológico. Na segunda metade do século XX, a Reforma Psiquiátrica propôs uma nova tecnologia de intervenção, a atenção psicossocial, hoje transformada no Brasil em uma política pública pelo Ministério da Saúde. Em pleno século XXI, marcas profundas da clínica alienista e psiquiátrica ainda permanecem na relação da sociedade com a loucura, mesmo considerando os avanços da clínica psicossocial. Palavras-chave: Saúde Mental. Alienismo. Atenção Psicossocial. Reforma Psiquiátrica. Foucault. Psicanálise.

<p>Abstract The increased prevalence of cognitive deterioration has increased the challenges of caring for older adults. This study?s project site offers a psychiatric program for older adults with customized care for complex geriatric mental health patients. Clinical assessment and care management are often overlooked in geriatric mental health patients diagnosed with behavioral and psychological symptoms of dementia (BPSD). The purpose of this project was to deliver an education program developed from the Staff Training in Assisted Living Residences-Veterans Administration, P.I.E.C.E.S ? model and the Castle framework to 42 nursing and allied health staff of the project site. The project question explored whether an education program on care of patients with BPSD increased staff members? perceived knowledge and competence in providing care to these patients. This education program focused on comprehensive assessment, individualized care planning, and individualized nonpharmacological interventions to manage older adults with dementia. Descriptive statistics were used to analyze performance outcomes data before and after staff education. In addition, care plans of patients were reviewed. Results included a 100% increase in recognition of core concepts of the education program; a 48% to 86% increase in staff willingness to use interdisciplinary care plans; and a 6.6% to 95% increase in documentation of key interventions in care plans for 6 behaviors of dementia. The results of this project might bring about social change by improving the skills and competence of nursing staff in managing the patients with dementia, thus positively impacting the quality of life of patients with BPSD by benefiting from nonpharmacological interventions.

<p> This study examined the communicative construction of mental health in correctional work. Using narrative interviews with 25 current and former correctional officers, I explore how macro, meso, and micro D/discourses both enable and constrain communication and action around mental health for correctional employees. The findings suggest that larger cultural Discourses related to masculinity, bounded rationality, and personal responsibility, meso discourses related to organizational expectations, and daily micro-talk about mental health and resources such as the Employee Assistance Program, primarily create and sustain communication barriers that limit correctional workers from communicating about or seeking help for mental health challenges. From a critical perspective, D/discourses related to power and control privileged the rational experiences of workers and marginalized the emotional/physical experiences, a practice I argue has significant implications for the health and well-being of workers. </p><p>