Epidemiological trends in mental disorders are shown against a background governed by medical aid health policy. The study quantitatively analyzed a dataset of mental disorders for South Africa’s leading medical aid scheme. South Africa’s leading medical aid scheme has been in operation for almost three decades. This degree of longevity allows for a reliable longitudinal analysis of diagnostic trends. Through consent of the Scheme, a database was provided, which lists mental disorder diagnoses over seven years from 2008 to mid-way through 2015. Data from this source were analyzed and interpreted. Data fields provided and made use of from the raw medical scheme database are: Date of admission (Year, Month); Patient gender; Database population per year; Patient diagnosis (DEG Description); Total per DEG Description. Each diagnosis (mental disorder) is presented in the following ways: 1. Bar charts showing the volume of specific mental illnesses each year. 2. Bar charts showing fluctuations of occurrence of a specific mental illness over time. 3. Frequency of specific mental illnesses over time, relative to the entire database population. 4. Male:Female ratio per mental disorder. 5. Female Outpatient vs. Inpatient volumes across each mental disorder and across all years (2008 – 2015).v 6. Male Outpatient vs. Inpatient volumes across each mental disorder and across all years (2008 – 2015). 7. Total number of patients per mental disorder across time (2008 – 2015). 8. Frequency polygons showing the fluctuation of a selected mental disorder over time as compared to other selected mental disorders. It is found that there are changes in prevalence rates of mental disorders over time and that these fluctuations are attributed to an economic factor within medical aid scheme cost-driven policy. The effect of cost-driven policy is that members diagnosed with a mental disorder may not be granted provision of adequate treatment because diagnosis is in part, determined by economic structures. Costs for mental illness treatment programmes are curtailed by keeping patient numbers significantly low, by radically over-diagnosing certain mental illnesses treated with comparably cheaper pharmaceuticals or by drastically curbing time spent in a mental health facility. Some members of the medical aid scheme have been deliberately misdiagnosed. Alternatively, those, correctly diagnosed, do not receive the treatment required of such an illness. The scenario then is of thousands of mentally ill people, who are not treated effectively. Members continue to pay fees, paying under the illusion that medical cover ensures effective treatment / Psychology / M.A. Psychology

Les facteurs associés aux recommandations d’experts psychiatres-légistes et aux verdicts à la cour de non-responsabilité criminelle pour cause de troubles mentaux ont peu été étudiés au Canada. Une collecte de données sociodémographiques, criminologiques et psychologiques a été réalisée à l’Institut national de psychiatrie légale Philippe-Pinel et au Palais de justice de Montréal sur 100 dossiers médicaux et plumitifs. Des analyses de régressions logistiques ont été exécutées afin d’identifier les facteurs sociodémographiques, criminologiques et psychologiques associés aux recommandations et aux verdicts de non-responsabilité criminelle pour cause de troubles mentaux. Les psychiatres ont recommandé la non-responsabilité criminelle pour cause de troubles mentaux pour 49% des sujets alors que les tribunaux ont reconnu 45% de l’échantillon comme étant non criminellement responsable. Les résultats suggèrent qu’une désorganisation cognitive et une perte de contrôle causée par un état psychotique au moment du crime, ainsi qu’un historique de verdicts de non-responsabilité criminelle pour cause de troubles mentaux sont associés aux recommandations psychiatriques de non-responsabilité criminelle. De plus, les résultats indiquent que de ne pas avoir d’information concernant la présence ou l’absence d’idées délirantes au moment du crime est associé aux verdicts de non-responsabilité criminelle pour cause de troubles mentaux. Cette étude permet de mettre en lumière les biais possibles dans le processus d’évaluation de non-responsabilité criminelle pour cause de troubles mentaux ainsi que les définitions et éléments du processus décisionnel qui mériteraient d’être précisés. / To our knowledge, factors associated with experts’ recommendations and courts’ verdicts of not criminally responsible on account of mental disorder (NCRMD) have received little attention in Canada. Sociodemographic, criminological, and psychological variables were coded from 100 medical files at the Institut national de psychiatrie légale Philippe-Pinel and court dockets of Montréal's provincial court. Logistic regression analyses were carried out to identify factors associated with experts’ recommendations and courts’ verdicts of non-criminal responsibility on account of mental disorder. Psychiatrists recommended non-criminal responsibility on account of mental disorder for 49% of subjects while the court found 45% of the sample to be NCRMD. Results show that disorganized cognition and psychosis-associated loss of control at the time of the offence, as well as having prior NCRMD verdicts, are predictive of a psychiatric recommendation of non-criminal responsibility on account of mental disorder. Results also suggest that not having information regarding the presence or absence of delusional ideation is associated with receiving a verdict of non-criminal responsibility on account of mental disorder. This study paves the way for the forensic mental health and legal fields to better understand the current clinical operationalization - and its shortcomings - of section 16 of the Criminal Code - not criminally responsible on account of mental disorder.

Bakgrund: Fysisk aktivitet är något i princip alla människor behöver för att må bra fysiskt och mentalt. Några som är i extra stort behov av fysisk aktivitet är personer med psykisk ohälsa då de ofta också drabbas fysisk ohälsa. Bland annat beroende på att passivitet kan vara ett symtom och att en del psykofarmaka ger metabola störningar.   Syfte: Syftet var att belysa upplevelser av motion hos personer med psykisk ohälsa samt faktorer som kan vara motiverande.   Metod: En litteratursökning har genomförts för att skapa en översikt över vetenskapliga artiklar om   motiverande faktorer och upplevelser av fysisk aktivitet hos personer med psykisk ohälsa. Studien baseras på åtta kvalitativa artiklar som granskats och analyserats med influens av Willman & Stoltz (2012) samt Friberg (2012). Det vetenskapliga underlaget  är hämtat från Cinahl, psycinfo samt Pubmed och artiklarna är publicerade mellan 2000-2013.   Resultat: Dataanalysen gav tre huvudteman. Det första beskriver motion som inre tillfredsställelse med ett antal subteman som främst handlar om upplevelsen av fysisk aktivitet. Det andra huvudtemat är Gemenskap som stöd och trygghet som främst handlar om gruppen och hur brukaren kan bli delaktig . Det tredje temat är konsten att komma i form och beskriver självhjälpsstrategier, hinder och vikten av stöd för tillfrisknandet som process.   Diskusssion: Resultatet diskuterade möjligheterna att skapa ”empowerment” hos brukarna i form av delaktighet och självbestämmande. Dels genom brukarnas egna önskemål men också genom de Motiverande faktorer som upptäcktes. Här finns en möjlighet för vården att påskynda ett tillfrisknande.

Bakgrund: Psykisk ohälsa är ett växande samhällsproblem. Attityder av negativt slag presenteras som en grund för stigmatisering som preciserades redan av de gamla grekerna. Integrationen av stigma är ett problem för samhället då det påverkar och influerar våra tankar och handlingar. Vidare kan det bidra till hur vårdrelationen kommer att se ut vilket i sin tur kan bli positivt eller negativt. Hur sjuksköterskan uttrycker sina attityder mot patienter spelar således en viktig roll. Detta för att kunna ge alla patienter den personcentrerade och goda vård de har laglig rätt till få. Syfte: Att beskriva hur hälso- och sjukvårdspersonal uttrycker deras attityder gentemot patienter med psykisk störning. Metod: En litteraturöversikt med datainsamling från databaserna CINAHL Complete, Medline och PsycINFO. Resultat: Både positiva och negativa attityder återfanns i resultatet. Även stigmatisering av personer med psykisk ohälsa förekom. Patienter med psykiska störningar blev även misstrodda för sina fysiska symtom då de sökte somatisk vård. Attityder visade sig skilja sig beroende på erfarenhet, utbildning och var de arbetar. Det framkom en kunskapsbrist och ett kunskapsbehov. Vidare efterfrågas utbildning och mer träning i möten med personer med psykisk störning av hälso-och sjukvårdspersonal. Diskussion: Resultatet diskuteras utifrån bakgrunden samt Joyce Travelbees teori om den mellanmänskliga relationen. I resultatet framkom att både positiva och negativa attityder uttrycks gentemot patienter med psykisk störning. Även stigmatisering förekom i form av uttryckta attityder och som strukturellt problem. Hälso-och sjukvårdspersonal lyfter deras kunskap om psykisk ohälsa som bristfällig och en önskan om att öka kunskapen. / Background: Mental illness is a growing problem in the society. Attitudes of negative character are presented as the ground for stigmatizing and since the old Greeks we have been forming the meaning of the word stigma. Stigma has become wider and more integrated in the society. The integration of stigma is a growing problem due to its impact and influence in the way we humans think and act. In addition this can be a contribution to how the healthcare relationship turns out, it may be positive or negative. However the expressed attitudes against patients play an important role in the hope of providing good care. Aim: The aim of this study is to describe how healthcare professionals express their attitudes towards patients with mental disorder. Method: The method used by the authors is a structured review of the literature using databases such as CINAHL Complete, Medline and PsycINFO. Results: The result showed that healthcare workers express both positive and negative attitudes, even stigmatization occurs. Patients with mental disorder were also misbelieved for their physical symptoms. Healthcare professionals mixed attitudes varied depending on work experience, education and place of work. The need for more education was expressed by a big number   of participants. Discussion: The result has been discussed based on the background and Joyce Travelbee’s theory, Human-to-Human Relationship. The result revealed both positive and negative attitudes towards people with mental illness. Also stigmatization was highlighted in the form of expressed attitudes and structural problem. Healthcare professionals also underline their knowledge of mental illness as being inadequate and a wish for increased knowledge was expressed.

Psychologists and other mental health professionals working in correctional institutions bear the considerable responsibility for identifying, diagnosing, and treating mentally disordered inmates. The importance of these responsibilities has been recognized in recent years because of the burgeoning population of inmates in general and the higher numbers of inmates with mental illness in particular. Research has demonstrated that the screens currently used in correctional settings to identify mentally disordered and suicidal inmates are either unvalidated or generally ineffective. This study investigates the validity of different mental health screens in a jail population. Inmates from the Grayson County Jail were administered three screens: the Referral Decision Scale (RDS), Personality Assessment Screener (PAS), and the Mental Disability/Suicide Intake Screen (MDSIS). Criterion measures were the Schedule for Affective Disorders and Schizophrenia (SADS) for Axis I disorders and the Suicide Probability Scale (SPS) for suicidal ideation. Results indicate that each screen most effectively assessed one clinical domain: the RDS for psychosis, the MDSIS for suicidality, and the PAS for depression. Gender differences were observed in screen items most effective for classifying inmates by suicide risk level.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

[pt] A proposta deste estudo é verificar os avanços das políticas públicas no que diz respeito a promoção do direito à convivência familiar e comunitária às crianças e aos adolescentes portadores de transtorno mental. Elegeu-se as políticas de Assistência Social e de Saúde Mental, focando-se, mais especificamente, nas diretrizes para o CAPSi - Centro de Atenção Psicossocial Infantil e Juvenil - e para o CRAS - Centro de Referência de Assistência Social. A Política Nacional de Assistência Social e o Sistema Único de Assistência Social são recentes. A atual prioridade da Assistência Social recai sob a família e seus membros. Entende-se que as famílias das crianças e adolescentes portadores de transtorno mental são mais vulneráveis social e economicamente devido a toda sobrecarga causada pelos sintomas do transtorno mental, por isso considera-se que a atuação da Assistência Social seja de extrema relevância. No entanto, no que diz respeito à criança e ao adolescente portadores de transtorno mental, muito ainda pode ser feito. A Política de Saúde Mental Infantil e Juvenil também enfatiza muito a família. Acredita-se que a criança e o adolescente têm mais probabilidade de sucesso no tratamento quando mantidos em seu ambiente familiar. As famílias devem fazer parte integrante do tratamento. Este estudo verificou que os profissionais do CAPSi estão bastante atentos e envolvidos com a Política de Saúde Mental e suas diretrizes. Acima de tudo verifica-se a riqueza do trabalho com as famílias das crianças e adolescentes portadores de transtorno mental, demonstrando a preocupação com a promoção do direito à convivência familiar e comunitária. / [en] The purpose of this study is to check the progress of public policies regarding promotion of the right of children and adolescents with mental disorder to family and community living. We select the policies of Social Welfare and Mental Health, focusing, more specifically, the guidelines for the CAPSi - Psychosocial Care Centre for Children and Youth - and the CRAS - Reference Centre for Social Welfare. The National Policy on Social Welfare are recent. The current priority of the Social Welfare falls under the family and its members. It is understood that the families of children and adolescents with mental disorders are more vulnerable socially and economically because the entire burden caused by symptoms of mental disorder, so it is considered that the performance of Social Welfare is of extreme importance. However, regard to children and adolescents with mental disorder, much can still be done. The Mental Health Policy to Children and Youth also emphasizes the family too. It is believed that children and adolescents are most likely to have success in treatment when kept in their home environment. Families should be included in treatment. This study found that professionals in the CAPSi are very attentive and involved with the Mental Health Policy and its guidelines. Above all there is a wealth of work with families of children and adolescents with mental disorders, demonstrating the concern with the promotion of the right to family and community living.

O presente estudo tem como objetivo central analisar o conceito de deficiência intelectual e suas opções terminológicas, considerando como estas se instituem no contexto brasileiro. Buscou-se ainda refletir sobre os possíveis efeitos dessas alternativas conceituais e terminológicas quanto à avaliação inicial e ao encaminhamento aos serviços de apoio especializado em educação especial. A pesquisa, de cunho qualitativo, utiliza predominantemente o levantamento bibliográfico e a análise documental, além de discutir os indicadores educacionais vinculados às matrículas dos alunos público-alvo da educação especial. A base teórica de referência foi o pensamento sistêmico associado aos estudos do campo da educação especial. Essa perspectiva tende a favorecer uma análise baseada na busca de contextualização, valorizando os princípios da complexidade, instabilidade e intersubjetividade. A partir da análise, pode-se inferir que, historicamente, tem sido problematizadas as alternativas de nomeação da deficiência intelectual, sendo que tais alternativas produzem efeitos associados a sujeitos que podem ser identificados como integrantes do maior contingente dentre as pessoas com deficiência. Destaca-se a ação da Associação Americana de Deficiência Intelectual e Desenvolvimento (AAIDD) no que diz respeito à definição do conceito e dos processos de identificação e diagnóstico. A análise identifica que as alterações terminológicas coexistem com a manutenção de definição conceitual. Houve, ainda, uma busca de indicadores de matrículas associadas aos alunos inseridos na categoria de deficiência intelectual do Censo Escolar MEC/INEP no período de 2007 a 2014. Por meio desse levantamento, identificou-se um aumento expressivo das matrículas dos alunos inseridos na categoria de deficiência intelectual nos últimos anos. Em última análise, pode-se apontar que a responsabilidade pelo processo diagnóstico continua sendo dos profissionais da área clínica. Porém, recentemente as políticas de inclusão no Brasil introduziram, por meio da Nota técnica nº 4 de 2014, a valorização da ação dos profissionais da área da educação como responsável pelo processo de identificação e avaliação inicial. Este último ponto, considerado como um elemento novo, ainda não tem sido alvo das pesquisas acadêmicas e, dessa forma não temos como problematizar seus efeitos. / The present study was aimed at analyzing the concept of intellectual disability, its terminological options, and how they are instituted in the Brazilian context. In addition, the study also reflected on the possible effects of these conceptual and terminological alternatives regarding initial assessment and referral to special education support services. The research was qualitative and predominantly used literature survey and document analysis, besides discussing educational indicators linked to special education students’ enrollment. Systems thinking associated with studies in the field of special education were used as theoretical framework. The perspective used in this study tends to favor analysis based on the search for contextualization, which values principles of complexity, instability and intersubjectivity. Through analysis, it was inferred that intellectual disability nomenclature alternatives have been historically problematized. Such alternatives produce effects associated to individuals who can be identified as members of the largest contingent among people with disabilities. Action by the American Association on Intellectual and Developmental Disabilities (AAIDD) regarding the definition of concept and processes of identification and diagnosis was highlighted. Analysis found that terminological changes coexist with conceptual definition maintenance. Moreover, there was also search for enrollment indicators associated to students inserted in the Intellectual Disability category of MEC/INEP’s School Census from 2007 to 2014. Through the School Census survey, a significant increase in the enrollment of students classified in the Intellectual Disability category was identified in recent years. Ultimately, it was pointed out that diagnosis responsibility remains with professionals in the clinical area. However, inclusion policies in Brazil have recently introduced the valorization of education professionals as responsible for identification and initial assessment through Technical Note No. 4 2014. The latter point, which is considered a new element, has not been the subject of academic research yet. Therefore, it is not possible to problematize its effects.

Submitted by Natalie Mendes (nataliermendes@gmail.com) on 2015-07-25T00:52:58Z No. of bitstreams: 1 Disserta??o completa Word cor.pdf: 2734662 bytes, checksum: f03ea5559cb77d41d0061fd3950b12c6 (MD5) / Made available in DSpace on 2015-07-25T00:52:58Z (GMT). No. of bitstreams: 1 Disserta??o completa Word cor.pdf: 2734662 bytes, checksum: f03ea5559cb77d41d0061fd3950b12c6 (MD5) Previous issue date: 2014-03-20 / Objectives: General: estimating the prevalence of mental disorders related to work in Brazil according to sociodemographic, occupational and spatial variables in the period 2006-2012. Specifics: Describe cases of work-related mental disorders in Brazil according to: a) sociodemographic variables (gender, age, education) and b) branch of economic activity) and c) type specific diagnosis in the period 2006-2012 and estimate the prevalence of mental disorders related to work in Brazil, according to characteristics of spatial distribution in the period 2006-2012, considering the Brazilian federative units and regions.Methods: this is a exploratory study was conducted with drawing mixed and temporal series. The cases of work-related mental disorders were obtained in the SINAN and exposed workers was economically active and busy population during the reference period obtained from the IBGE. The occurrence measure was the prevalence rate of TMRT x 1.000.000.The Proportionate Percentage Change (PPV) was used to check the coefficients of variation. Results: there was a large undercount notifications of TMRT SINAN in the period, with each notification SINAN INSS gave 38,5 sickness benefits for workers with the disease. The largest coefficient in TMRT SINAN was in 2011 (7,5 to 1.000.000 workers). The highest proportion was white, young and average level of education women. The hive of activity with highest prevalence was public administration. The Northeast and Southeast regions were the most reported cases of the disease. Conclusion: The results indicate that there is a large underreporting of TMRT the SINAN, however, the prevalence estimates indicate directions to be prioritized by VISAT. / Objetivos: Geral:Estimar a preval?ncia de transtornos mentais relacionados ao trabalhono Brasil segundo vari?veis sociodemogr?ficas, ocupacionais e espaciais no per?odo de 2006 a 2012. Espec?ficos: Descrever os casos de transtornos mentais relacionados ao trabalho no Brasil segundo: a) vari?veis sociodemogr?ficas (sexo, faixa et?ria, escolaridade),b) ramo de atividades econ?mica, c)tipo de diagn?stico espec?fico no per?odo de 2006 a 2012 e estimar a preval?ncia de transtornos mentais relacionados ao trabalho no Brasil segundo caracter?sticas de distribui??o espacial no per?odo de 2006 a 2012, considerando as regi?es brasileiras e unidades federativas. M?todos: Foi realizado um estudo explorat?rio com desenho misto, incluindo an?lise de s?rie temporal e ?rea geogr?fica. Os dados de casos de transtornos mentais relacionados ao trabalho foram obtidos do SINAN e os trabalhadores potencialmente expostos foi obtida a partir da popula??o economicamente ativa e ocupada (PEAO) no per?odo de refer?ncia obtida no IBGE. A medida de ocorr?ncia foi o coeficiente de preval?ncia de TMRT x 1.000.000 trabalhadores. A Varia??o Percentual Proporcional (VPP) foi utilizada para verifica??o de varia??o dos coeficientes. Resultados: verificou-se um grande subregistro das notifica??es de TMRT no SINAN no per?odo, com uma raz?o de 38,5 benef?cios concedidos pelo INSS para cada caso notificado no SINAN. O maior coeficiente de TMRT no SINAN foi em 2011 (7,5 a cada 1.000.000 de trabalhadores). A maior propor??o foi em mulheres brancas, jovens e com n?vel m?dio de escolaridade. O ramo de atividade com maior preval?ncia foi administra??o p?blica. As regi?es Nordeste e Sudeste foram as que mais notificaram casos da doen?a. Conclus?o: os resultados apontam que h? uma grande subnotifica??o dos TMRT no SINAN em todas as regi?es do Brasil, o que dificulta a ado??o de medidas de controle da doen?a. Contudo, as estimativas de preval?ncia indicam dire??es a ser priorizadas pela VISAT.

Made available in DSpace on 2014-12-17T15:38:43Z (GMT). No. of bitstreams: 1 CristianneMDNM.pdf: 328027 bytes, checksum: 0ddd4dd281a69a8707df70fe04a93cba (MD5) Previous issue date: 2007-11-23 / This study aims to understand the experience of people suffering from mental disorder. The patients are enrolled in a mental health ambulatory clinic in the city of Natal (RN). Mental disorders are growing rapidly in the contemporary world and are a source of intense mental suffering. Besides patients being strongly marked by a history of isolation and prejudice, they have been the target of real atrocities committed in the name of preservation of a supposed normality. The understanding and treatment of this disorder is influenced by cultural and historical inferences, depending on the period in which it is experienced. Semi-directed Interviews were conducted with a group of users, with the emphasis on giving voice to their uniqueness and individuality, highlighting how each one perceives his or her own experience. These were recorded and later transcribed by identifying the core of meanings. The results were analyzed under the gaze of the Humanist Phenomenology Existential perspective, which aims to unravel the phenomenon, without truths from volatility, highlighting the existence of the mental disorder as a way of living, being permeated by suffering mental and influenced by social problems, assuming contours very particular to each individual. Some progress has been perceived, even by users, with respect to the change of paradigm in the way of care, but still there is a consistent emphasis on medical and drug use. The changes point to the need for offering services to replace the asylum hospital model, and in addition to accept the bearer of mental disorder as a citizen, a bearer of rights who should be accepted and respected by society. Despite the pain expressed and its close liaison with suicide, their reports are full of perspectives and attitudes of confrontation facing life, pointing to new possibilities to be, recreating itself / O presente trabalho tem como objetivo compreender a experi?ncia de pessoas portadoras de transtorno mental, atendidas em um ambulat?rio da rede substitutiva de aten??o e cuidados em sa?de mental da cidade de Natal (RN). O transtorno mental vem sofrendo um crescimento vertiginoso no mundo contempor?neo, sendo fonte de intenso sofrimento ps?quico. Al?m de fortemente marcado por um hist?rico de isolamento e preconceito, tem sido alvo de verdadeiras atrocidades cometidas em nome da preserva??o de uma suposta normalidade. A compreens?o e tratamento desse transtorno recebe interfer?ncias da cultura e do per?odo hist?rico em que est? inserido. Foram realizadas entrevistas semi-dirigidas com um grupo de usu?rios, com o prop?sito de dar voz ? sua singularidade e subjetividade, valorizando a forma como cada um percebe a sua pr?pria experi?ncia. As mesmas foram gravadas e posteriormente transcritas, identificando os n?cleos de significados. Os resultados foram analisados sob o olhar da perspectiva Humanista Fenomenol?gica Existencial, que aponta para o desvelar do fen?meno, sem partir de verdades aprior?sticas, destacando a exist?ncia do transtorno mental enquanto uma possibilidade de ser, permeado pelo sofrimento ps?quico e influenciado por quest?es sociais relevantes, assumindo contornos muito particulares para cada indiv?duo. Alguns avan?os foram percebidos, inclusive pelos usu?rios, com rela??o ? mudan?a de paradigma na maneira de cuidar, embora ainda se constate uma ?nfase no recurso m?dico e medicamentoso. As mudan?as apontam para a necessidade de ofertar servi?os substitutivos ao modelo asilar e hospitaloc?ntrico, al?m de aceitar o portador de transtorno mental enquanto um cidad?o, portador de direitos e devendo ser acolhido e respeitado pela sociedade. Apesar da dor expressada e da estreita liga??o desta com o suic?dio, seus relatos s?o permeados de perspectivas e atitudes de enfrentamento diante das vicissitudes da vida, apontando para novas possibilidades de ser, recriando-se a si mesmo