The Thesis is focused on music and physical education as a part of educational process. It has got an irreplaceable importance in children with mental disorders due to inspiration for their own activity and promotion of the whole motor development. This work is dealing with a content of this education, its importance and role in the Special basic school. It also defines mental handicaped childrens' character and the influence of music and physical education on their general development. It describes a variety of music and physical resources and their usage in the music and movement activities as well. These are applicated into a project called." Dancing and singing, with a fairy tale learning". This elaborated project represents specific examples of music and movement activities and their realization in the Special basic school. Key Words: Children, music, music and physical education, music and movement activities, music and movement games, mental disorders, motivation, songs, movement, physical exhibition, dancing games.

INTRODUÇÃO: O conceito de equidade enfatiza a diversidade como condição humana e propõe que a diferença seja tratada como princípio orientador das políticas públicas. O objetivo dessa investigação foi verificar a equidade na atenção à saúde de pessoas com indicativos de transtornos mentais comuns (TMC) na cidade de São Paulo. Foram analisadas a procura e utilização dos serviços de saúde, bem como o gasto com saúde no último mês de pessoas com indicativos de TMC, que referiram morbidade quinze dias precedentes à entrevista domiciliar, segundo características sociodemográficas e de condições de saúde. MÉTODOS: Foi realizado um estudo de corte transversal e utilizados os dados do Inquérito de Saúde no Município de São Paulo (ISA - Capital) de 2008. Foram selecionados sujeitos com 16 anos ou mais e com indicativos de transtornos mentais comuns; estes foram avaliados por meio do instrumento Self Reporting Questionnaire (SRQ-20). Foram analisados a procura e utilização de serviços de saúde, e o gasto com saúde no último mês, correlacionando com aspectos sociodemográficos e de condições de saúde. RESULTADOS: A procura pelo serviço de saúde foi menor entre as mulheres, maior na faixa etária dos 30 aos 44 anos e na faixa etária de 60 anos ou mais. A proporção de pessoas que procuraram pelo serviço e obtiveram atendimento foi elevada, o mesmo ocorreu para aquelas que procuraram por médico e foram atendidas por meio de consulta. A procura pelo SUS foi menor entre as pessoas de cor branca, de renda per capita elevada, com união estável e entre as pessoas com ensino superior. A cobertura pelo SUS foi menor para as pessoas das faixas etárias de 45 a 59 anos e de 60 anos ou mais, com renda per capita elevada, com Ensino Médio ou Técnico e Ensino Superior. As pessoas que gastaram mais com a saúde da família foram aquelas com idade igual ou superior a 60 anos, de cor branca, das faixas de renda per capita mais elevadas, com união estável e com Ensino Superior. Em relação à posse de plano de saúde, pessoas de cor branca, com renda per capita elevada e indivíduos com doença crônica apresentaram maiores chances de possuir este serviço. CONCLUSÕES: Foi observado, na população com indicativos de TMC, que não houve desigualdades no acesso e utilização dos serviços entre as pessoas que buscaram por ajuda diante de morbidade. Verificou-se que o SUS atende e cobre os gastos majoritariamente dos mais pobres, denotando uma cobertura desigual que favorece os mais necessitados, porém, considerando o fator idade, ficou explícita uma situação de iniquidade, pois foi constatado que o SUS oferece maior cobertura para a população mais jovem e não contempla as necessidades da população mais idosa. Além disso, verificou-se também uma demanda reprimida de pessoas que não acessaram o serviço, indicando barreiras que antecedem à busca / INTRODUCTION: The equity concept emphasizes diversity as a human condition and proposes this aspect as a guiding principle of the public policy. The objective of this investigation was to verify the equity in health care of people with signs of common mental disorders (CMD) in the city of São Paulo. We analyzed the demand and use of health services and the expenses on health in the last month of people with signs of CMD who reported morbidity 15 days before the home interview, according to socio-demographic characteristics and health conditions. METHODS: We developed a cross-sectional study and used the data from São Paulo\'s health survey (ISA - Capital) of 2008. We selected subjects with 16 years of age or older and with signs of common mental disorders; who were evaluated using the Self Reporting Questionnaire (SRQ-20). We analyzed the demand and the use of health services, and the health expenses in the last month, correlating them with sociodemographic and health condition aspects. RESULTS: The demand for health services was lower among women, higher in the age group from 30 to 44 years old and in the age group of 60 years old or more. The proportion of people who sought the service and were cared for was high, and the same thing happened to those who sought medical attention and had an appointment. The demand for SUS was lower among white people with high per capita income, married and among people with higher education degrees. The coverage of SUS was significantly lower for people aged between 45 and 59 years old and those aged 60 years old or more, with high per capita income, with high school, technical or college degree. The people who spent more on Family health were those with 60 years old or more, white, with high per capita income, married and with college degree. Regarding health care insurance ownership, white people with high per capita income and individuals with chronic diseases presented higher chances of owning a health care insurance. CONCLUSIONS: We observed, among people with signs of CMD, that there were no inequalities in the access and use of health services for those who sought for help faced with morbidity. We verified that SUS serves and covers the expenses mainly of the poorer, denoting an unequal coverage that favours the ones who need it the most, however, taking the age factor into account, a situation of inequity was explicit, since it was verified that SUS offers a wider coverage to the younger population and does not contemplate the needs of the elderly. In addition, there was also a repressed demand of people who could not access the health service, indicating barriers that precede the search

oucos estudos avaliaram a associação da ingestão de ácidos graxos ômega 3 e transtornos de ansiedade. O presente estudo utilizou dados transversais do exame de linha de base (2008-2010) do Estudo Longitudinal Brasileiro de Saúde do Adulto - ELSA-Brasil para avaliar essa associação. A exposição dietética foi medida por um questionário quantitativo de frequência alimentar validado para a população brasileira e adaptado para o estudo, e os diagnósticos mentais foram avaliados pelo Clinical Interview Schedule-Revised Version - CIS-R, diagnosticando transtornos mentais de acordo com a Classificação Internacional de Doenças - CID-10. Modelos de regressão logística foram construídos utilizando quintis do consumo de ácidos graxos ômega 3, ácidos graxos ômega 6, razão de consumo n-6/n-3, e ácidos graxos poli-insaturados, usando o primeiro quintil como referência. Dos 15.105 sujeitos participantes do ELSA-Brasil, foram excluídos aqueles que relataram ingestão de menos de 500 ou mais de 4000 kcal, aqueles que relataram ingestão de suplementos n-3 ou n-6 e aqueles que foram submetidos a cirurgia bariátrica. Após as exclusões, 12268 participantes permaneceram na análise, dos quais 1893 (15,4%) apresentaram transtornos de ansiedade. Os indivíduos com transtorno de ansiedade eram mais jovens, de sexo feminino, menor escolaridade e renda, referiram tabagismo atual e atividade física mais leve. Valores mais altos de IMC e de proteína C reativa de alta sensibilidade foram observados nos indivíduos com ansiedade. A ingestão diária média de ácido eicosapentaenoico (EPA), ácido docosapentanoico (DPA) e ácido docosaexaenoico (DHA) foi significativamente menor em participantes com ansiedade. Um maior consumo desses três ácidos graxos da família ômega-3 foi observado em indivíduos com mais idade, maior renda e escolaridade, com dislipidemia, consumo de álcool e tabagismo atuais, e prática de atividade física vigorosa. Após o ajuste para variáveis sociodemográficas (idade, sexo, etnia e educação) fatores de risco cardiovascular (hipertensão, diabetes, dislipidemia, tabagismo, ingestão de álcool e atividade física), calorias totais, qualidade da dieta e depressão, os participantes do quinto quintil de ingestão de EPA, DHA e DPA mostraram associação inversa com transtornos de ansiedade: OR 0,82 (IC 95%, 0,69-0,98), OR 0,83 (IC 95%, 0,69-0,98) e OR 0,82 (IC 95%, 0,69-0,98), respectivamente. Participantes no quinto quintil de razão ômega-6/ômega-3 tiveram associação positiva com transtornos de ansiedade. Nenhuma associação foi encontrada com a ingestão de PUFA, ou ômega-3 e ômega-6 isoladamente com ansiedade após os ajustes. Nesta análise, uma alta ingestão de ômega-3 EPA, DHA e DPA foi inversamente associada com a presença de transtornos de ansiedade, enquanto que a alta razão ômega-6/ômega-3 foi diretamente associada à presença desses transtornos, sugerindo um possível efeito protetor dos ácidos graxos omega-3 EPA, DPA e DHA contra a ansiedade / Few studies have evaluated the association of omega-3 fatty acids intake and anxiety disorders. The present study used cross-sectional data from the baseline (2008-2010) examination of the Brazilian Longitudinal Study of Adult Health - ELSA-Brazil to evaluate this association. The dietary exposure was measured by a quantitative food frequency questionnaire validated for the brazilian population and adapted for the study, and the mental diagnoses were assessed by the Clinical Interview Schedule-Revised Version (CIS-R), diagnosing mental disorders according to the International Classification of Diseases - ICD-10. Logistic regression models were built using quintiles of omega-3 fatty acids, omega-6 fatty acids, omega-6/omega-3 ratio, and polyunsaturated fatty acids consumption, using the first quintile as a reference. Of the 15,105 subjects participating in ELSA-Brazil, those who reported ingestion of less than 500 or more than 4000 kcal, those who reported ingestion of omega-3 or omega-6 supplements and those had undergone bariatric surgery were excluded. After exclusions, 12,268 participants remained in the analysis, of whom 1893 (15.4%) had anxiety disorders. Subjects with anxiety disorder were younger, female, had lower education and income, reported current smoking and mild physical activity. Higher values of BMI and high sensibility C reactive protein were observed in subjects with anxiety. The mean daily intakes of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) were significantly lower in subjects with anxiety. A higher intake of these three omega-3 fatty acids was observed in older individuals with higher income and education, with current dyslipidemias, alcohol consumption and smoking, and vigorous physical activity. After adjustment for socio-demographic variables (age, sex, ethnicity and education), cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, alcohol intake and physical activity), total calories, diet quality and depression, EPA, DHA and DPA intakes showed an inverse association with anxiety disorders: OR 0.82 (95% CI, 0.69-0.98), OR 0.83 (95% CI, 0.69-0.98) and OR 0.82 (95% CI, 0.69-0.98), respectively. Participants in the fifth quintile of omega-6/omega-3 ratio had a positive association with anxiety disorders. No association was found with ingestion of PUFA, or omega-3 and omega-6 alone with anxiety after adjustments. In this analysis, a high intake of omega-3 EPA, DHA and DPA was inversely associated with the presence of anxiety disorders, while the higher omega-6 omega-3 ratio was directly associated with the presence of these disorders, suggesting a possible protector effect of omega-3 fatty acids EPA, DPA and DHA against anxiety

Introdução: O Transtorno de Escoriação (TE) é caracterizado pelo comportamento repetitivo e excessivo de escoriar a pele saudável, resultando em dano tecidual e significativo sofrimento, associado a ânsia incontrolável e falha em controlar tal comportamento repetitivo. Atualmente o TE é classificado na seção de transtornos relacionados aos Transtornos Obsessivo-compulsivos (TOC) da 5ª edição do Manual de Diagnóstico e Estatística de Transtornos Mentais (DSM). No entanto, ainda existem debates a respeito da sua classificação, se o mesmo está relacionado a transtornos relacionados ao TOC, ou se é melhor conceituado como uma dependência comportamental. Objetivos: O presente estudo comparou um grupo de indivíduos com TE com dois paradigmas dos transtornos obsessivo-compulsivos, i.e., TOC, e dos transtornos impulsivo-aditivos, i.e., Transtorno do Jogo (TJ), analisando suas características sociodemográficas, clínicas, categorias diagnósticas, perfil de comorbidades, sintomas obsessivo-compulsivos, traços impulsivos e atributos de personalidade. O objetivo de tal comparação foi avaliar se o TE estaria mais relacionado aos transtornos relacionados ao TOC ou ao TJ. Métodos: Participaram do estudo 121 pacientes, que procuraram o tratamento no Instituto de Psiquiatria (IPq) do Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo (HCFMUSP), Brasil. Do total de 121 participantes, 40 foram diagnosticados com TE, 41 com TOC e 40 com TJ. Foram utilizadas entrevistas clínicas estruturadas para diagnosticar e comparar os três grupos na sobreposição diagnóstica e nas comorbidades psiquiátricas atuais, e escalas de autopreenchimento padronizadas para avaliar os sintomas dimensionais e comparar os três grupos em análise dimensional. Resultados: O grupo TE apresentou maior preponderância de mulheres, mais jovens e com maior instrução acadêmica. Na análise categorial TE se aproximou, significativamente, mais de TOC (n = 14) do que de TJ (n = 3), se sobrepondo ao primeiro. Os grupos TE e TOC também foram mais propensos a apresentar outros Comportamentos Repetitivos Focados no Corpo (CRFC) e transtornos ansiosos em geral. A presença de CRFC diferenciou TE de TJ, por outro lado, TE se diferenciou de TOC pela presença de comportamentos aditivos. A análise dimensional demonstrou que TE se apresenta como um modelo híbrido de obsessividade-compulsividade e impulsividade. Finalmente, a análise de correlação mostrou que os escores de obsessividade-compulsividade e impulsividade não foram correlacionados à gravidade dos sintomas de escoriação da pele. Discussão: Os dados da análise categorial apoiam a classificação de TE como um transtorno correlato ao TOC. Já os achados das análises dimensionais sugerem que uma apresentação psicopatológica híbrida de TE, contendo tanto elementos obsessivo-compulsivos, como com traços impulsivos. No entanto, nenhum desses aspectos foram correlacionados à gravidade dos sintomas de escoriação no grupo TE, sugerindo que o comportamento de escoriação da pele é independente desses fatores nestes indivíduos. O conjunto de tal apresentação sucinta a alocação de TE junto ao grupo dos chamados CRFC. Conclusão: TE apresenta um perfil demográfico e clínico próprios. TE e TOC compartilham mais similaridades no perfil de comorbidades psiquiátricas do que TJ, a maioria baseada nos transtornos ansiosos. Por outro lado, TE se diferencia de TOC, por uma associação mais frequente com os transtornos aditivos. TE apresentou níveis intermediários de compulsividade e impulsividade na abordagem dimensional. O comportamento de escoriação não mostrou correlação relevante com as medidas dimensionais de compulsividade nem impulsividade. TE, de uma forma geral, teve uma associação robusta com os outros CRFC, diferenciando-se de TOC e de TJ. TE poderia ser classificado em uma sessão à parte juntamente com outros CRFC / Introduction: Excoriation Disorder (ED) is characterized by repetitive and excessive picking on healthy skin, resulting in significant skin damage and psychological distress associated with uncontrollable urge and failure to control this repetitive behavior. ED is currently classified under the Obsessive-compulsive and Related Disorders (OCRD) section of the Diagnostic and Statistics Manual of Mental Disorders - 5th edition. Nevertheless, there is still no consensus whether ED is more closely related to OCRDs or it would be better conceptualized as a behavioral addiction. Objectives: Compare ED patients with two paradigms of obsessive-compulsive disorders (OCD) and impulsive-addictive disorders (gambling disorder), analyzing their sociodemographic and clinical characteristics, diagnostic categories, comorbidity profile, obsessive-compulsive symptoms, impulsive traits, and personality features. The purpose of this comparison was to assess whether ED was more related to OCD-related disorders (OCDRD) or to behavioral addictions, e.g., Gambling Disorder (GD). Methods: Study participants were 121 patients seeking treatment at Instituto de Psiquiatria (IPq), Hospital das Clinicas da Faculdade de Medicina da Universidade Sao Paulo (HCFMUSP), Sao Paulo, Brasil. Of the 121 participants, 40 were diagnosed with ED, 41 with OCD, and 40 with GD. Structured clinical interviews were used to diagnose and compare the three groups in diagnostic overlap and current psychiatric-comorbidities, and standardized self-reports were used to evaluate the dimensional variables. Results: Participants in the ED group were more likely to be women, young, and with higher levels of education compared with those of the other groups. In the categorical analysis, ED was more significantly approached to OCD (n=14) than to GD (n=3), overlapping the first. In general, ED and OCD were also more likely to exhibit other body-focused repetitive behaviors (BFRB) and anxiety disorders. The presence of BFRB differentiated ED from GD. In contrast, ED differed from OCD by the presence of addictive behaviors. The dimensional analysis found that ED is a hybrid model of obsessive-compulsivity and impulsivity. Discussion: Categorical analysis supports the classification of ED as OCDRD; however, ED presented differences that may share underlying characteristics with OCD (e.g., compulsivity) and behavioral addiction (e.g., impulsivity). Dimensional analysis suggests a heterogeneous psychopathological in ED with both obsessive-compulsive and impulsive features. Correlation analysis shows that obsessive-compulsivity and impulsivity scores were not correlated to skin excoriation severity symptoms. The overall viewpoints to the allocation of ED points to its own diagnostic category, that is, Body-focused Repetitive Behaviors (BFRB). Conclusion: ED shows a peculiar demographic and clinical profile. ED and OCD share more similarities in the profile of psychiatric comorbidities than GD, mostly based on anxiety disorders. In contrast, ED differs from OCD by a more frequent association with addictive disorders. ED presented intermediate levels of compulsivity and impulsivity between OCD and GD in the dimensional approach. The excoriation behavior showed no relevant correlation with dimensional measures of compulsivity or impulsivity

INTRODUÇÃO: O abuso sexual infantil pode influenciar na vulnerabilidade para os transtornos mentais na vida adulta, incluindo alterações do humor e exacerbação do comportamento sexual. Nos últimos anos têm surgido evidências de conexões entre os estados negativos do humor e a compulsividade sexual. Porém, faltava investigar se os estados de ansiedade e depressão poderiam ser mediadores da gravidade da compulsão sexual, em homens que referiram abuso sexual na infância/adolescência (ASI/ASA). OBJETIVOS: Investigar a prevalência de ASI/ASA em homens com comportamento sexual compulsivo (CSC); a associação entre o ASI/ASA e depressão/ansiedade; e o efeito mediador da ansiedade e depressão em relação a gravidade dos sintomas de compulsividade sexual e hipersexualidade daqueles que referiram ASI/ASA. MÉTODO: Estudo observacional, transversal e analítico, realizado com 222 homens que buscaram tratamento para o CSC no Ambulatório de Impulso Sexual Excessivo e de Prevenção aos Desfechos Negativos Associados ao Comportamento Sexual do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, de outubro de 2010 a dezembro de 2017. Os participantes, com idades acima de 18 anos, preencheram o critério para apetite sexual excessivo (CID-10: F52.7) e dependência de sexo, e não preencherem diagnóstico para transtorno de preferência (CID-10 F65), identidade sexual (CID-10 F64), esquizofrenia (CID-10 F20), quadros psicóticos devido a lesão ou doença física (CID-10 F0.6). Eles participaram de entrevistas diagnóstica e investigativa dos aspectos sociodemográficos e preencheram os instrumentos: \"Escala de Compulsividade Sexual\", \"Inventário de Triagem do Transtorno Hipersexual\", \"Inventário de Ansiedade de Beck\", \"Inventário de Depressão de Beck\", \"Questionário Sobre Traumas na Infância\", \"Instrumento para Caracterização de Experiências Sexuais Vivenciadas na Infância e Adolescência\". Foram considerados como tendo ASI/ASA aqueles que atingiram o ponto de corte (= 6) para abuso sexual no Questionário Sobre Traumas na Infância. Foi utilizada a análise estatística de mediação. RESULTADOS: A prevalência de ASI/ASA foi de 57% (n = 127), sendo que os participantes que referiram ASI/ASA apresentaram menor número médio de anos de educação (p = 0,008) e menor mediana de renda familiar mensal (p = 0,009), comparados aos que não referiram. Os participantes que referiram ASI/ASA apresentaram maior gravidade de compulsividade sexual (p = 0,004), hipersexualidade (p = 0,007), depressão (p = 0,005) e ansiedade (p = 0,004), comparados com os que não referiram. Os sintomas de ansiedade e depressão confirmaram todos os pressupostos como fatores mediadores para a variável dependente hipersexualidade e os sintomas de ansiedade para a variável dependente compulsividade sexual. Em relação as características do ASI/ASA, a maioria foi abusada por múltiplos abusadores, que geralmente eram pessoas conhecidas de seu convívio social e familiar. CONCLUSÕES: O estudo confirmou a alta prevalência de ASI/ASA em homens com CSC, os quais demonstraram maior gravidade dos sintomas depressivos, ansiosos, compulsivos sexuais e hipersexuais, comparados aos que não referiram ASI/ASA. Os sintomas de ansiedade e depressão apresentaram efeito mediador para a maior gravidade da hipersexualidade, bem como os sintomas de ansiedade apresentaram efeito mediador para a maior gravidade da compulsividade sexual nos que referiram ASI/ASA / INTRODUCTION: Childhood sexual abuse may influence the vulnerability to mental disorders in adult life, including mood alterations, and exacerbation of sexual behavior. In recent years has emerged evidence of connections between negative mood states and sexual compulsivity. But still lacking to investigate whether anxiety and depression could mediate the severity of sexual compulsion, in men who have suffered child/adolescence sexual abuse (CSA/ASA). OBJECTIVE: We investigate the prevalence of CSA/ASA in men with compulsive sexual behavior (CSB); the association between CSA/ASA and depression/anxiety; the mediating effect of anxiety and depression with respect to the severity of symptoms of sexual compulsivity and hypersexuality of those who reported CSA/ASA. METHOD: Observational, cross-sectional and analytical study conducted with 222 men who sought treatment for CSB, in the Ambulatório de Impulso Sexual Excessivo e de Prevenção aos Desfechos Negativos Associados ao Comportamento Sexual do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, from October 2010 to December 2017. Participants with ages over 18 years, who met criteria for excessive sexual drive (ICD-10: F52.7) and sex addiction, and did not meet diagnostic criteria for preference (ICD-10 F65), sexual identity disorder (CID-10 F64), schizophrenia (ICD-10 F20), psychotic disorders due to injury or physical disease (ICD-10 F0.6) were included. They underwent to diagnostic and sociodemographic investigative interviews and fulfilled: \"Sexual Compulsivity Scale\"; \"Hypersexual Disorder Screening Inventory\"; \"Beck Anxiety Inventory\"; \"Beck Depression Inventory\"; \"Childhood Trauma Questionnaire\"; \"Instrument for Characterization of Experiences Experienced in Childhood and Adolescence\". Those who reached the cutoff point (= 6) of the Childhood Trauma Questionnaire were considered as having CSA/ASA. The statistical analysis of mediation was used. RESULTS: The prevalence of CSA/ASA was 57% (n = 127), and the group of participants who reported CSA/ASA had a lower average number of years of education (p = 0.008), and lower Median of monthly family income (p = 0.009), compared to the group that did not report. Participants who reported CSA / ASA presented greater severity of sexual compulsivity (p = 0.004), hypersexuality (p = 0.007), depression (p = 0.005) and anxiety (p = 0.004), compared with those who did not. The symptoms of anxiety and depression confirmed all the assumptions as mediating factors for the dependent variable hypersexuality, and the symptoms of anxiety for the dependent variable sexual compulsivity. Regarding CSA/ASA characteristics, the majority were abused by multiple abusers, who were generally known people from their social and family life. CONCLUSIONS: The study confirmed the high prevalence of CSA/ASA in men with CSB, which showed a greater severity of depressive, anxious, sexually compulsive, hypersexual symptoms, compared to those who did not reported CSA/ASA. Symptoms of anxiety and depression showed mediating effect for the severity of the hypersexuality, as well as the symptoms of anxiety showed mediating effect for the severity of sexual compulsivity of those who reported CSA/ASA

Introdução: O Transtorno de Escoriação (TE) é caracterizado pelo comportamento repetitivo e excessivo de escoriar a pele saudável, resultando em dano tecidual e significativo sofrimento, associado a ânsia incontrolável e falha em controlar tal comportamento repetitivo. Atualmente o TE é classificado na seção de transtornos relacionados aos Transtornos Obsessivo-compulsivos (TOC) da 5ª edição do Manual de Diagnóstico e Estatística de Transtornos Mentais (DSM). No entanto, ainda existem debates a respeito da sua classificação, se o mesmo está relacionado a transtornos relacionados ao TOC, ou se é melhor conceituado como uma dependência comportamental. Objetivos: O presente estudo comparou um grupo de indivíduos com TE com dois paradigmas dos transtornos obsessivo-compulsivos, i.e., TOC, e dos transtornos impulsivo-aditivos, i.e., Transtorno do Jogo (TJ), analisando suas características sociodemográficas, clínicas, categorias diagnósticas, perfil de comorbidades, sintomas obsessivo-compulsivos, traços impulsivos e atributos de personalidade. O objetivo de tal comparação foi avaliar se o TE estaria mais relacionado aos transtornos relacionados ao TOC ou ao TJ. Métodos: Participaram do estudo 121 pacientes, que procuraram o tratamento no Instituto de Psiquiatria (IPq) do Hospital das Clínicas da Faculdade de Medicina da Universidade São Paulo (HCFMUSP), Brasil. Do total de 121 participantes, 40 foram diagnosticados com TE, 41 com TOC e 40 com TJ. Foram utilizadas entrevistas clínicas estruturadas para diagnosticar e comparar os três grupos na sobreposição diagnóstica e nas comorbidades psiquiátricas atuais, e escalas de autopreenchimento padronizadas para avaliar os sintomas dimensionais e comparar os três grupos em análise dimensional. Resultados: O grupo TE apresentou maior preponderância de mulheres, mais jovens e com maior instrução acadêmica. Na análise categorial TE se aproximou, significativamente, mais de TOC (n = 14) do que de TJ (n = 3), se sobrepondo ao primeiro. Os grupos TE e TOC também foram mais propensos a apresentar outros Comportamentos Repetitivos Focados no Corpo (CRFC) e transtornos ansiosos em geral. A presença de CRFC diferenciou TE de TJ, por outro lado, TE se diferenciou de TOC pela presença de comportamentos aditivos. A análise dimensional demonstrou que TE se apresenta como um modelo híbrido de obsessividade-compulsividade e impulsividade. Finalmente, a análise de correlação mostrou que os escores de obsessividade-compulsividade e impulsividade não foram correlacionados à gravidade dos sintomas de escoriação da pele. Discussão: Os dados da análise categorial apoiam a classificação de TE como um transtorno correlato ao TOC. Já os achados das análises dimensionais sugerem que uma apresentação psicopatológica híbrida de TE, contendo tanto elementos obsessivo-compulsivos, como com traços impulsivos. No entanto, nenhum desses aspectos foram correlacionados à gravidade dos sintomas de escoriação no grupo TE, sugerindo que o comportamento de escoriação da pele é independente desses fatores nestes indivíduos. O conjunto de tal apresentação sucinta a alocação de TE junto ao grupo dos chamados CRFC. Conclusão: TE apresenta um perfil demográfico e clínico próprios. TE e TOC compartilham mais similaridades no perfil de comorbidades psiquiátricas do que TJ, a maioria baseada nos transtornos ansiosos. Por outro lado, TE se diferencia de TOC, por uma associação mais frequente com os transtornos aditivos. TE apresentou níveis intermediários de compulsividade e impulsividade na abordagem dimensional. O comportamento de escoriação não mostrou correlação relevante com as medidas dimensionais de compulsividade nem impulsividade. TE, de uma forma geral, teve uma associação robusta com os outros CRFC, diferenciando-se de TOC e de TJ. TE poderia ser classificado em uma sessão à parte juntamente com outros CRFC / Introduction: Excoriation Disorder (ED) is characterized by repetitive and excessive picking on healthy skin, resulting in significant skin damage and psychological distress associated with uncontrollable urge and failure to control this repetitive behavior. ED is currently classified under the Obsessive-compulsive and Related Disorders (OCRD) section of the Diagnostic and Statistics Manual of Mental Disorders - 5th edition. Nevertheless, there is still no consensus whether ED is more closely related to OCRDs or it would be better conceptualized as a behavioral addiction. Objectives: Compare ED patients with two paradigms of obsessive-compulsive disorders (OCD) and impulsive-addictive disorders (gambling disorder), analyzing their sociodemographic and clinical characteristics, diagnostic categories, comorbidity profile, obsessive-compulsive symptoms, impulsive traits, and personality features. The purpose of this comparison was to assess whether ED was more related to OCD-related disorders (OCDRD) or to behavioral addictions, e.g., Gambling Disorder (GD). Methods: Study participants were 121 patients seeking treatment at Instituto de Psiquiatria (IPq), Hospital das Clinicas da Faculdade de Medicina da Universidade Sao Paulo (HCFMUSP), Sao Paulo, Brasil. Of the 121 participants, 40 were diagnosed with ED, 41 with OCD, and 40 with GD. Structured clinical interviews were used to diagnose and compare the three groups in diagnostic overlap and current psychiatric-comorbidities, and standardized self-reports were used to evaluate the dimensional variables. Results: Participants in the ED group were more likely to be women, young, and with higher levels of education compared with those of the other groups. In the categorical analysis, ED was more significantly approached to OCD (n=14) than to GD (n=3), overlapping the first. In general, ED and OCD were also more likely to exhibit other body-focused repetitive behaviors (BFRB) and anxiety disorders. The presence of BFRB differentiated ED from GD. In contrast, ED differed from OCD by the presence of addictive behaviors. The dimensional analysis found that ED is a hybrid model of obsessive-compulsivity and impulsivity. Discussion: Categorical analysis supports the classification of ED as OCDRD; however, ED presented differences that may share underlying characteristics with OCD (e.g., compulsivity) and behavioral addiction (e.g., impulsivity). Dimensional analysis suggests a heterogeneous psychopathological in ED with both obsessive-compulsive and impulsive features. Correlation analysis shows that obsessive-compulsivity and impulsivity scores were not correlated to skin excoriation severity symptoms. The overall viewpoints to the allocation of ED points to its own diagnostic category, that is, Body-focused Repetitive Behaviors (BFRB). Conclusion: ED shows a peculiar demographic and clinical profile. ED and OCD share more similarities in the profile of psychiatric comorbidities than GD, mostly based on anxiety disorders. In contrast, ED differs from OCD by a more frequent association with addictive disorders. ED presented intermediate levels of compulsivity and impulsivity between OCD and GD in the dimensional approach. The excoriation behavior showed no relevant correlation with dimensional measures of compulsivity or impulsivity

精神病康復者認同和內化公眾對他們的污名思維會經驗自我污名的想法。然而，自我污名思維本身並不一定會導致慢性心理困擾。只有當自我污名經常和自動地出現，成為心理習慣，才會產生恆定的精神困擾。自我污名的心理過程應該區別於心理內容，獨立評估，和不被假定相同於所有康復者。本論文基於心理習慣範式概念化自我污名的過程。 / 研究一開發一項名為自我污名的自動化和重複程度的測量工具，並於95位康復者建立這工具與其短版的效度。共有百分之四十二點一的參加者報告自我污名習慣。較負面的自我污名內容、較強的負面經驗避免和較低的靜觀跟自我污名習慣有關。這習慣和較差的自尊、主觀生活質量和復元亦有關。 / 研究二測量自我污名相關概念的自動聯想模式。具有較強（人數 = 46）和較弱（人數 = 45）自我污名習慣的康復者接受一系列簡短內隱聯想測驗，評估內隱自我污名的三個部分：康復者身份對自我的內隱中心性，對精神病的內隱態度和內隱自尊。較強的身份中心性與自我污名習慣有關。內隱身份中心性也會通過自我污名習慣降低自尊和主觀生活質量。 / 研究三測量對自我污名相關概念的自動注意力。具有較強（人數 = 46）和較弱（人數 = 45）自我污名習慣的康復者接受一項情緒斯特魯普任務，評估他們為自我污名、自信與非情感的刺激命名顏色的反應潛伏期。強組對自我污名刺激的反應較快，反映他們對那些信息的情感含義有較少的自動注意力，因此對顏色命名任務有較少的干擾。 / 自我污名習慣的概念為自我污名的理論、評估和干預提供了新的觀點。由於自我污名對心理健康的影響是雙重由於負面內容和其慣性的出現，如只基於傳統、以內容為本的工具測量自我污名，其對康復者的影響有可能被低估。現有的干預計劃亦應加強針對與自我污名習慣有關的不良應對機制（負面經驗避免和缺乏靜觀）和偏頗信息處理（自動聯想和注意力偏見）。以靜觀和接納為本的心理治療提升康復者對目前時刻的意識與對自我污名思維的不加批判驗收，可減輕自我污名習慣。 / People with mental illness (PMI) may endorse and internalize public stigma directed against them and at times experience self-stigmatizing thinking. However, having self-stigmatizing thoughts per se does not necessarily lead to chronic psychological distress. Only when such thinking occurs frequently and automatically as a mental habit, this creates constant mental negotiation within the individuals, which may have deleterious effects on their mental health and recovery. Of note, the mental process should be distinguished from the mental content of self-stigmatizing thinking, assessed independently, and not be assumed to be homogeneous across all PMI. In a series of three studies, I conceptualized process aspects of self-stigmatizing thinking based on the mental habit paradigm. / Study 1 applied the construct of self-stigmatizing thinking habit in developing a new assessment tool, the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR), and validated the STAR and its short form in a community sample of 95 PMI. Almost half (42.1%) of the participants reported habitual self-stigmatizing thinking. More negative cognitive content of self-stigmatizing thinking, greater experiential avoidance, and lower mindfulness contributed to stronger self-stigmatizing thinking habit. The adverse effects of the mental habit included lower self-esteem, decreased subjective quality of life, and poorer recovery. / Study 2 investigated the possibility of a pattern of more automatic self-stigma-relevant associations among habitual self-stigmatizing thinkers. A set of Brief Implicit Association Tests was administered to PMI with strong (n=44) and weak (n=50) self-stigmatizing thinking habit to assess the three components of implicit self-stigma: implicit centrality of the mental illness identity to the self, implicit attitudes toward mental illness, and implicit self-esteem. Greater implicit identity centrality, but not negative implicit attitudes toward mental illness and low implicit self-esteem, was predictive of stronger self-stigmatizing thinking habit. Implicit identity centrality also contributed to lower self-esteem and decreased subjective quality of life through self-stigmatizing thinking habit. / Study 3 examined the potential automatic attentional biases for self-stigmatizing information among habitual self-stigmatizing thinkers. An Emotional Stroop Task was administered to PMI with strong (n=46) and weak (n=45) self-stigmatizing thinking habit to assess response latencies in color-naming self-stigmatizing versus self-assurance versus non-affective words. The strong habit group was characterized by faster responses to the self-stigmatizing stimuli, reflecting their automatic attentional bias away from the emotional meaning of self-stigmatizing information and hence less interference effects on the color-naming task. / The construct of self-stigmatizing thinking habit offers new perspectives on self-stigma’s theory, assessment, and intervention. As the deleterious effects of self-stigma on mental health are due doubly to the negative content and habitual manifestation of self-stigmatizing thoughts, the impact of self-stigma on PMI may be underestimated if it is based solely on traditional content-oriented measures. Existing self-stigma intervention programmes, which are cognitive content-oriented, should be improved by additionally targeting the dysfunctional coping mechanisms (i.e., experiential avoidance and the lack of mindfulness) and information-processing biases (i.e., automatic evaluation and attentional biases) involved in the mental habit. In mitigating self-stigmatizing thinking habit, practitioners may apply psychotherapies based on mindfulness and acceptance in order to enhance present-moment awareness and nonjudgmental acceptance of self-stigmatizing thoughts. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chan, Ka Shing Kevin. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 119-149). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes in Chinese. / Abstract --- p.i / Acknowledgements --- p.iv / Table of Contents --- p.vii / List of Tables --- p.xi / List of Figures --- p.xii / Abbreviations --- p.xiii / Chapter Chapter 1. --- Self-Stigmatizing Thinking as Mental Habit --- p.1 / Chapter 1.1. --- Theoretical Conceptualizations of Habit --- p.1 / Chapter 1.2. --- Theoretical Conceptualizations of Mental Habit --- p.3 / Chapter Chapter 2. --- Self-Stigma in People with Mental Illness --- p.4 / Chapter 2.1. --- The Consequences of Self-Stigma for Mental Health of People with Mental Illness --- p.5 / Chapter 2.2. --- The Roots of Self-Stigma in People with Mental Illness --- p.5 / Chapter 2.3. --- Self-Stigma Interventions for People with Mental Illness --- p.7 / Chapter 2.3.1. --- Cognitive Content-Oriented Interventions for Self-Stigma --- p.7 / Chapter 2.3.2. --- Cognitive Process-Oriented Interventions for Self-Stigma --- p.10 / Chapter 2.4. --- Gaps in Research on Self-Stigma in People with Mental Illness --- p.12 / Chapter Chapter 3. --- Theoretical Conceptualizations of Self-Stigmatizing Thinking Habit --- p.15 / Chapter 3.1. --- The Mental Content of Self-Stigmatizing Thinking --- p.15 / Chapter 3.2. --- The Mental Process of Self-Stigmatizing Thinking --- p.16 / Chapter 3.2.1. --- The Frequency of Self-Stigmatizing Thinking --- p.16 / Chapter 3.2.2. --- The Automaticity of Self-Stigmatizing Thinking --- p.18 / Chapter 3.3. --- The Consequences of Self-Stigmatizing Thinking Habit for Mental Health of People with Mental Illness --- p.19 / Chapter 3.4. --- Interventions for Self-Stigmatizing Thinking Habit in People with Mental Illness --- p.20 / Chapter Chapter 4. --- Empirical Assessment of Self-Stigmatizing Thinking Habit --- p.24 / Chapter 4.1. --- The Self-stigmatizing Thinking‘s Automaticity and Repetition (STAR) Scale --- p.24 / Chapter 4.2. --- Implicit Association Test --- p.27 / Chapter 4.3. --- Emotional Stroop Task --- p.29 / Chapter Chapter 5. --- Overview of the Studies --- p.34 / Chapter 5.1. --- Objectives --- p.34 / Chapter 5.2. --- Long-Term Impact --- p.35 / Chapter Chapter 6. --- Study 1 Assessing Self-stigmatizing Thinking Habit Using a Self-Reported Questionnaire: A Validation Study of the Self-stigmatizing Thinking’s Automaticity and Repetition (STAR) Scale in People with Mental Illness --- p.38 / Chapter 6.1. --- Introduction --- p.38 / Chapter 6.2. --- Method --- p.39 / Chapter 6.2.1. --- Participants --- p.39 / Chapter 6.2.2. --- Procedure --- p.39 / Chapter 6.2.3. --- Measures --- p.40 / Chapter 6.2.3.1. --- Sociodemographic, clinical, and social contact characteristics --- p.40 / Chapter 6.2.3.2. --- Self-stigmatizing thinking habit --- p.40 / Chapter 6.2.3.3. --- Self-stigmatizing cognitive content --- p.40 / Chapter 6.2.3.4. --- Self-esteem --- p.41 / Chapter 6.2.3.5. --- Self-identity --- p.41 / Chapter 6.2.3.6. --- Experiential avoidance --- p.41 / Chapter 6.2.3.7. --- Mindfulness --- p.42 / Chapter 6.2.3.8. --- Subjective quality of life --- p.42 / Chapter 6.2.3.9. --- Recovery --- p.42 / Chapter 6.2.4. --- Data Analyses --- p.43 / Chapter 6.3. --- Power Calculation --- p.44 / Chapter 6.4. --- Results --- p.45 / Chapter 6.4.1. --- Participant characteristics --- p.45 / Chapter 6.4.2. --- Score distribution on the STAR --- p.46 / Chapter 6.4.3. --- Factor analyses on the STAR and STAR-S --- p.46 / Chapter 6.4.4. --- STAR-S reliability and validity --- p.48 / Chapter 6.4.5. --- Prevalence of self-stigmatizing thinking habit --- p.51 / Chapter 6.4.6. --- Predictors of self-stigmatizing thinking habit --- p.51 / Chapter 6.4.7. --- Impact of self-stigmatizing thinking habit on self-esteem when self-stigmatizing cognitive content was taken into consideration --- p.52 / Chapter 6.4.8. --- Impact of self-stigmatizing thinking habit on subjective quality of life when selfstigmatizing cognitive content was taken into consideration --- p.53 / Chapter 6.4.9. --- Impact of self-stigmatizing thinking habit on recovery when self-stigmatizing cognitive content was taken into consideration --- p.54 / Chapter 6.5. --- Discussion --- p.54 / Chapter 6.6. --- Implications for the Next Study --- p.58 / Chapter Chapter 7. --- Study 2 Automatic Self-Stigma-Relevant Associations in Self-Stigmatizing Thinking Habit: Evidence from the Brief Implicit Association Tests --- p.59 / Chapter 7.1. --- Introduction --- p.59 / Chapter 7.2. --- Method --- p.61 / Chapter 7.2.1. --- Participants --- p.61 / Chapter 7.2.2. --- Procedure --- p.61 / Chapter 7.2.3. --- Measures --- p.61 / Chapter 7.2.3.1. --- Self-stigmatizing thinking habit --- p.61 / Chapter 7.2.3.2. --- Explicit self-stigma --- p.62 / Chapter 7.2.3.3. --- Implicit attitudes toward mental illness --- p.62 / Chapter 7.2.3.4. --- Implicit identity centrality --- p.64 / Chapter 7.2.3.5. --- Implicit self-esteem --- p.64 / Chapter 7.2.3.6. --- Explicit self-esteem --- p.65 / Chapter 7.2.3.7. --- Subjective quality of life --- p.65 / Chapter 7.2.4. --- Data Analyses --- p.66 / Chapter 7.3. --- Power Calculation --- p.68 / Chapter 7.4. --- Results --- p.69 / Chapter 7.4.1. --- Participant characteristics --- p.69 / Chapter 7.4.2. --- Confirmation of the interrelated two-factor structure --- p.71 / Chapter 7.4.3. --- Confirmation of the second-order hierarchical structure --- p.71 / Chapter 7.4.4. --- Characteristics of participants in the strong and weak habit groups --- p.72 / Chapter 7.4.5. --- BIAT performance by participants in the strong and weak habit groups --- p.73 / Chapter 7.4.6. --- Predictors of self-stigmatizing thinking habit --- p.74 / Chapter 7.4.7. --- The mediating role of self-stigmatizing thinking habit on explicit self-esteem --- p.75 / Chapter 7.4.8. --- The mediating role of self-stigmatizing thinking habit on subjective quality of life . --- p.76 / Chapter 7.5. --- Discussion --- p.77 / Chapter 7.6. --- Implications for the Next Study --- p.81 / Chapter Chapter 8. --- Study 3 Attentional Bias for Self-Stigmatizing Stimuli in Self-Stigmatizing Thinking Habit: Evidence from the Emotional Stroop Task --- p.82 / Chapter 8.1. --- Introduction --- p.82 / Chapter 8.2. --- Method --- p.83 / Chapter 8.2.1. --- Participants --- p.83 / Chapter 8.2.2. --- Procedure --- p.83 / Chapter 8.2.3. --- Measures --- p.83 / Chapter 8.2.3.1. --- Self-stigmatizing thinking habit --- p.83 / Chapter 8.2.3.2. --- Self-stigmatizing cognitive content --- p.84 / Chapter 8.2.3.3. --- Experiential avoidance --- p.84 / Chapter 8.2.3.4. --- Self-esteem --- p.84 / Chapter 8.2.3.5. --- Subjective quality of life --- p.84 / Chapter 8.2.3.6. --- Depression --- p.84 / Chapter 8.2.3.7. --- Emotional Stroop effects --- p.85 / Chapter 8.2.3.8. --- Cognitive Stroop effects --- p.87 / Chapter 8.2.4. --- Data analyses --- p.87 / Chapter 8.3. --- Power Calculation --- p.89 / Chapter 8.4. --- Results --- p.90 / Chapter 8.4.1. --- Participant characteristics --- p.90 / Chapter 8.4.2. --- Characteristics of participants in the strong and weak habit groups --- p.91 / Chapter 8.4.3. --- Emotional Stroop effects --- p.93 / Chapter 8.4.3.1. --- Response errors on the Emotional Stroop trials --- p.93 / Chapter 8.4.3.2. --- Response latencies on the Emotional Stroop trials --- p.93 / Chapter 8.4.4. --- Cognitive Stroop effects --- p.95 / Chapter 8.4.4.1. --- Response errors on the Cognitive Stroop trials --- p.95 / Chapter 8.4.4.2. --- Response latencies on the Cognitive Stroop trials --- p.95 / Chapter 8.4.5. --- Predictors of self-stigmatizing thinking habit --- p.96 / Chapter 8.4.6. --- The Mediating role of self-stigmatizing thinking habit on self-esteem and subjective quality of life --- p.97 / Chapter 8.5. --- Discussion --- p.97 / Chapter Chapter 9. --- General Discussion --- p.102 / Chapter 9.1. --- Theoretical Implications --- p.102 / Chapter 9.2. --- Clinical Implications --- p.104 / Chapter 9.3. --- Limitations and Call for Future Research --- p.106 / Chapter Chapter 10. --- Concluding Remarks --- p.109 / Appendix 1 --- p.110 / Appendix 2 --- p.111 / Appendix 3 --- p.118 / References --- p.119

O presente trabalho tem por objetivo refletir sobre a atuação/inserção dos trabalhadores em saúde mental na implantação da rede substitutiva de saúde mental do município de São Paulo, entre os anos de 1989 e 1992. A discussão, orientada pelas contribuições da Psicologia Social como descrita por Pichon-Rivière, apoia-se em dados coletados a partir da observação grupos de supervisão clínica/institucional. Estes grupos são parte do Projeto de Formação Permanente em Recursos Humanos na Área de Saúde Mental, resultado do convênio entre a Prefeitura do Município de São Paulo e a Universidade de São Paulo (PMSP/USP), através do termo aditivo entre Secretaria Municipal de Saúde e Instituto de Psicologia (SMS/PST-IPUSP), cuja realização se deu paralelamente à implantação da rede referida. Ressignificar e construir/superar limites conceituais, teóricos, técnicos, práticos; e problematizar as contradições, conflitos e dúvidas decorrentes da prática são fundamentais na substituição de práticas antimanicomiais. Ao enfocar a contradição entre saberes e práticas do modelo psiquiátrico tradicional X modelo antimanicomial, analisou-se os conflitos de natureza objetiva e/ou subjetiva, emergentes no contexto de trabalho e relacionados principalmente à concepção de loucura, constituição da equipe multiprofissional e formação dos trabalhadores em saúde mental na construção de práticas inspiradas nos princípios antimanicomiais. Constatou-se que contradições ('loucura/doença mental x saúde mental’, ‘loucura/desrazão X razão’, ‘anormalidade/patologia x normalidade’, ‘saber x não saber’, ‘modelo médico x não médico’, ‘terapêutico x não terapêutico’) provenientes da quebra do modelo manicomial desencadeiam processos de indiscriminação, emergentes nas relações intersubjetivas, tendo como efeito a perda de limites (‘trabalhadores x usuários’, ‘técnicos x não técnicos’, ‘neurose x psicose’, ‘eficiência x ineficiência’ de técnicas, ‘público x privado). Assim, a construção destes novos modelos, ligada a desconstrução do manicômio, apresenta-se como uma tarefa complexa, cuja realização não se restringe ao âmbito das práticas, pois carrega consigo contradições inerentes ao sistema social do qual advém (burguesia X proletariado, movimentos sociais x Estado, sociedade global x instituição de saúde, instituição x trabalhadores, trabalhadores em saúde mental x usuário/familiares e usuários x familiares). / The aim of the present study is to analyse the performance of mental health workers in the implementation of a new model of mental health care is the municipality of São Paulo, in the years 1989 to 1992. This study is based on data collected from the observation of groups of clinical/institutional supervision and is guided by the contributions of the Social Psychology as proposed by Pichon-Rivière. These groups were part of a Project for Continued Education in Human Resources in the Mental Health Area, agreed between the Municipality of São Paulo and the University of São Paulo (PMSP/USP), through the Municipal Health Secretarial and the Institute of Psychology (SMS/PST-IPUSP). The Project was developed at the same time as a new model for mental health care was implemented. An analyses indicate that to substitute the asylum practice it’s essential to give a new meaning to conceptual, theoretical, technical and practical limits and to bring to discussion the contradictions, conflicts and doubts which emerge in action. Focusing the contradiction between knowledge and practice in the traditional psychiatric model and in the anti-asylum model, we analysed the objective/subjective conflict emerging in the context of work and related mainly to the conception of madnees, the building-up of a multiprofessional team and the education of mental health workers in the developement of a practice based on the anti-asylum principles. Our findings show that the contradictions (madness/mental illness X mental health, madness/unreason X reason, abnormality/pathology X normality, knowledge X non-knowledge, medical X non medical model, therapeutic X non therapeutic) that result from the break of the asylum model foster a process of indiscrimination emerging in the inter subjective relationship and have the effect of loss of limits (workers X users, technician X non-technician, neurosis X psychosis, efficiency X inefficiency of techiniques, public X private). Thus the construction of these new model, linked to the ‘disconstruction’ of an asylum model, is a complexe task that cannot be restricted to the bounds of practice, since it has contradiction which are inherente to the social system from which it derives (bourgeoisie X workers, social movements X state, global society X health institution, institution X workers, workers in mental health X users/family and users X family).

The special needs domain has long been recognised as problematic and adversarial. Much research has focused on areas of contention, such as the relationships between parents and practitioners, especially in educational settings, or on problems within the structure and operation of the domain. This study adopts a whole system approach in combining discussion of the structural basis of tension within the domain with an investigation of how both parents and practitioners describe, experience and respond to tensions within the special needs domain; such tensions being viewed as facets of the 'struggle' and 'fight' metaphor. Whole systems approaches are derived from the systems discipline, which developed initially out of the nineteenth century interest in organic and engineering systems, but more recently has focused on organisational and inter-organisational arrangements, including the part people play in enabling or disabling such arrangements. It is a strongly interdisciplinary approach more commonly found in organisational studies than in the social sciences more generally. Fifteen practitioners, from health and education settings, and twelve parents of children and young people with diagnoses of high functioning autism spectrum conditions participated in the study. The participants' stories of their experiences of the special needs domain were collected using a narrative inquiry approach. The data was analysed using concepts and theoretical frameworks derived from the work of Pierre Bourdieu, Uri Bronfenbrenner and Charles Wright Mills. An exploration of the influences shaping the special needs domain revealed a number of areas of unresolved tension, some of which result in tensions for those involved in the domain such as can be described as 'fight', and some of which might be addressed by structural changes to the systems comprising the special needs domain such as those envisaged in forthcoming legislation. However importantly the empirical study found that many tensions and struggles experienced by both parents and practitioners did not emanate from the structures of the domain and therefore were unlikely to be amenable to structural changes. Parents 'struggle' to maintain their identity as 'good' parents, to acquire information and to navigate the system in order to access services and resources. Practitioners experience conflict as they seek to access information and training, engage in the complex choreography of cooperating and collaborating in interagency and interprofessional working and endeavour to harmonise their professional practice with agency and public policy priorities. The thesis concludes with a brief discussion of the relationship between whole system approaches and other interdisciplinary approaches to investigating complex problems in the human sciences. It is suggested that systems diagramming techniques such as systems mapping and rich pictures are useful additions to the sociologist's toolkit.

Made available in DSpace on 2014-12-17T15:39:06Z (GMT). No. of bitstreams: 1 MariaGSGC_DISSERT.pdf: 2555739 bytes, checksum: 0efa18c9d47df1166ff7932c946b8297 (MD5) Previous issue date: 2014-03-14 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / The lack of studies aimed at the mental health of the rural population, the social, economic, familial and emotional impact that mental disorders produce and the vulnerability that women have in this context, lead us to believe in the need to investigate the mental health demands of female rural workers, in order to subsidize the development of more effective and culturally sensitive public health programs and policies that take into account the specificities of this population. The present study aims to investigate the prevalence of common mental disorders (CMD) and the possible factors associated with the emergence of such disorders among women living in a rural settlement in Rio Grande do Norte. This survey has a quantitative and qualitative character with an ethnographic approach. As methodological strategies, we made use of an adapted version of the socio-demographic and environmental questionnaire prepared by The Department of Geology/UFRN s Strategic Analysis Laboratory to evaluate the quality of life of the families from the rural settlement and the mental health screening test Self-Reporting Questionnaire (SRQ-20) to identify the prevalence of CMD in adult women from the community. Complementing the role of methodological tools, we use the participant observation and semi-structured interviews with women who presented positive hypothesis of CMD attempting to comprehend the crossings that build the subjective experience of being a woman in this context. The results point to the high prevalence of CMD (43.6%) and suggest the link between poverty, lack of social support, unequal gender relations and the occurrence of CMD. We also verified that the settled women do not access the health network to address issues relating to mental health and that the only recourse of care offered by primary health care is the prescription of anxiolytic medication. In this context, the religiosity and the work are the most important strategies for mental health support among women / A car?ncia de estudos voltados ? sa?de mental da popula??o rural, o impacto socioecon?mico, familiar e afetivo que os transtornos mentais produzem e o lugar de vulnerabilidade que as mulheres ocupam nas ?reas rurais, imp?em a necessidade de investigar a realidade de mulheres assentadas e trabalhadoras rurais, visando subsidiar a elabora??o de programas e pol?ticas p?blicas de sa?de mais eficazes e culturalmente sens?veis que levem em conta as especificidades dessa popula??o. Diante disso, o presente estudo tem como objetivo investigar a preval?ncia de transtornos mentais comuns (TMC) e os poss?veis fatores associados ? emerg?ncia de tais transtornos entre mulheres residentes de um assentamento rural do RN. Metodologicamente, trata-se de uma pesquisa que parte de uma abordagem quantitativa e qualitativa de inspira??o etnogr?fica. Inicialmente aplicamos uma vers?o adaptada do question?rio s?cio-demogr?fico-ambiental elaborado pelo Laborat?rio de An?lises Estrat?gicas da UFRN/Departamento de Geologia para avaliar a qualidade de vida das fam?lias do assentamento e o instrumento de rastreamento em sa?de mental Self-Reporting Questionnaire (SRQ-20) para identificar a preval?ncia de TMC nas mulheres adultas da comunidade. Complementando o rol de ferramentas, nos valemos da observa??o participante do cotidiano do assentamento e entrevistas semiestruturadas com as mulheres que apresentaram hip?tese positiva de TMC buscando apreender os atravessamentos que constroem a experi?ncia subjetiva de ser mulher nesse contexto. Os resultados apontam a alta preval?ncia de TMC (43,6%) e sugerem a articula??o entre pobreza, falta de redes de apoio social e comunit?ria, rela??es desiguais de g?nero e a ocorr?ncia de TMC. Constatamos ainda que as assentadas n?o acessam a rede de sa?de para tratar de quest?es relativas ? sa?de mental e que o ?nico recurso de cuidado ofertado pela aten??o prim?ria ? prescri??o de medica??o ansiol?tica, destacando-se a religiosidade e o trabalho como os mais importantes fatores de suporte ? sa?de mental entre as mulheres no contexto do assentamento rural