Este estudo teve como objetivo geral investigar a adesão ao tratamento medicamentoso em pessoas com transtorno de ansiedade atendidas em um serviço de saúde mental comunitário, localizado em município do interior paulista. Estudo retrospectivo, transversal e descritivo, com abordagem quantitativa. Dados qualitativos foram utilizados para complementar os resultados. A população foi constituída por 161 pessoas com transtorno de ansiedade que atenderam aos critérios de inclusão do estudo. Para a coleta dos dados quantitativos recorreu- se ao teste de Medida de Adesão ao Tratamento (MAT), ao Inventário de Ansiedade de Beck e à técnica de entrevista estruturada, com aplicação de questionário para obtenção de dados referentes ao perfil demográfico, socioeconômico, clínico e farmacoterapêutico. Para obtenção dos dados qualitativos, referentes às dificuldades de uma parcela dos sujeitos com relação ao seguimento da terapêutica medicamentosa, foi empregada entrevista semiestruturada gravada (N=32). Para análise dos dados quantitativos foi utilizado o programa SAS® 9 e, para os dados qualitativos, a análise de conteúdo, seguindo os passos propostos por Minayo. Os resultados revelaram que a maioria dos participantes era do sexo feminino (77,6%), na faixa etária entre 41-60 anos (50,3%), cor da pele branca (90,6%), com companheiro (62,1%) e renda familiar mensal de até três salários mínimos (50,7%). Os antidepressivos foram os medicamentos mais prescritos (91,3%). Ressalta-se o uso de ansiolítico por 69,5% dos participantes, apesar de terem iniciado o tratamento há mais de seis meses. A maioria dos participantes (85%) foi considerada aderente ao tratamento medicamentoso. Não houve associação estatisticamente significativa entre esta adesão e as variáveis investigadas neste estudo. Identificou-se alta porcentagem de pacientes com sintomas ansiosos moderados ou severos, apesar da adesão. Destaca-se o fato de 34,1% dos participantes desconhecerem a dose dos medicamentos prescritos. Os depoimentos dos sujeitos revelaram que, apesar da alta porcentagem de adesão, há dificuldades por eles vivenciadas na manutenção do tratamento medicamentoso, as quais foram sintetizadas nas seguintes categorias: \"Ter conhecimento insuficiente sobre o diagnóstico e tratamento medicamentoso\", \"Estar insatisfeito(a) com os efeitos do tratamento\", \"Desejar mais do que uma prescrição\", \"Apresentar temores e preocupações relacionadas ao tratamento\" e \"Identificar impedimentos para seguir a prescrição medicamentosa\". Este estudo sinaliza para aspectos, passíveis de intervenção, que interferem na segurança no tratamento farmacológico de pessoas com transtorno de ansiedade e contribuem para a implementação de estratégias nos serviços de saúde que otimizem a adesão ao tratamento medicamentoso / The general objective of this study was to investigate the drug treatment adherence among anxiety disorder patients following treatment at a community mental health center in an upstate São Paulo city. This retrospective, cross-sectional and descriptive study was performed with a quantitative approach. Qualitative data were used to complement the results. The population consisted of 161 people with anxiety disorders who met the inclusion criteria. The quantitative data was collected using the Treatment Adherence Measure (TAM) test, Beck\'s Anxiety Inventory and structured interviews, applying a questionnaire to obtain demographic, socioeconomic, clinical and pharmacotherapeutic data. A recorded semi- structured interview was conducted (N=32) to obtain qualitative data regarding the difficulty that some participants experienced in following the drug treatment. Quantitative data analysis was performed using SAS® 9, whereas content analysis was used for qualitative data, as proposed by Minayo. Results showed that most participants were women (77.6%), aged between 41 and 60 years (50.3%), white skin (90.6%), with a partner (62.1%) and with a monthly family income of three minimum salaries or less (50.7%). Antidepressants were the most commonly prescribed drugs (91.3%). It is noted that 69.5% of participants used anxiolytics, despite having been undergoing treatment for over six months. Most participants (85%) were considered compliant to the drug treatment. No statistically significant association was found between this adherence and the variables investigated in this study. A high percentage of patients with moderate or severe anxiety symptoms was found, despite their adherence. It is highlighted that 34.1% of participants were unaware of the prescribed medication dose. The participants\' reports showed that, despite the high adherence rate, they experience difficulties to maintain the drug treatment, which were summarized into the following categories: \"Having insufficient knowledge regarding the diagnosis and drug treatment\", \"Being dissatisfied with the treatment effects\", \"Wanting more than a prescription\", \"Showing fears and worries related to treatment\" and \"Identify obstacles to following the drug prescription\". This study points at aspects, subject to intervention, that affect the safety of the drug treatment of people with anxiety disorders and contribute with the implementation of strategies at health care services that improve the drug treatment adherence

Introdução: Infecção de corrente sanguínea é uma das principais complicações dos pacientes transplantados de medula óssea. Poucos estudos avaliam os pacientes transplantados que realizam acompanhamento ambulatorial. Objetivos: Descrever o perfil dos agentes isolados de infecção de corrente sanguínea de pacientes transplantados que realizam acompanhamento ambulatorial no HCFMUSP. Avaliar a proporção e fatores de risco associados com internação e óbitos desses pacientes. Método: Análise retrospectiva dos prontuários de pacientes acompanhados no ambulatório de TMO que apresentaram hemocultura positiva colhida durante janeiro de 2004 a dezembro de 2008. Os dados foram analisados utilizando o Epi Info 3.5.1, o nível de significância adotado foi de 5%. Hospitalização e óbito em 30 dias foram os desfechos avaliados e foram calculados fatores de risco associados nas análises bivariada e multivariada. Resultados: Os principais agentes isolados foram S. maltophilia (15%), SCN (12%), Acinectobacter spp (9%). Dos episódios ocorridos, 88% eram monomicrobianos e 12% polimicrobianos, em ambas a ocorrência de gram-negativos foi predominante. A internação hospitalar ocorreu em 26% dos episódios, sendo encontrado na analise bivariada e multivariada como fator protetor a realização de transplante autólogo. O óbito em 30 dias ocorreu em 10% dos isolados e foi encontrado, na análise bivariada, como fator de risco o isolamento de gram-positivos e a presença de neutropenia grave. A análise multivariada encontrou como fator protetor para óbito em 30 dias o uso do score MASCC, não sendo evidenciados fatores de risco. Conclusões: Os gram-negativos foram os principais agentes isolados neste estudo, destacando-se o isolamento de Stenotrophomonas maltophilia. A ocorrência de hospitalização e óbito não foi elevada, o transplante autólogo foi fator protetor para hospitalização e o uso do score MASCC fator protetor pra óbito em 30 dias. Mais estudos que avaliem o tratamento ambulatorial de pacientes transplantados de medula óssea a fim de possibilitar uma melhor qualidade de vida desses pacientes são necessários / Introduction: bloodstream infection is one of the most common medical complications in bone marrow transplanted patients. A few studies in fact evaluate the transplanted patients that are under outpatient attendance. Objectives: Describe the isolated bloodstream infection agents profile on bone marrow transplanted patients that are under outpatient attendance at HCFMUSP. Evaluate the proportion and risk factors associated with hospitalization and death of such patients. Method: Retrospective analysis on patients records of the TMOs ambulatory that presents positive blood culture gathered between January 2004 and December 2008. All the data was analyzed using the software Epi Info version 3.5.1, the significance level adopted was of 5%. Hospitalization and death in 30 days were the outcomes evaluated and which the risk factors associated were calculated and compared through the analysis bivariate and multivariate. Results: The most important agents isolated were S. maltophilia (15%), SCN (12%), Acinectobacter spp (9%). From all the episodes that occurred, 88% were monomicrobial and 12% polimicrobial, in both the occurrence of gram-negative was predominant. The hospitalization happened in 26% of the episodes, being found as the protection factor to the autologous transplant on both analyses, bivariate and multivariate. On 10% of the isolated cases occurred death in 30 days, and it was found in the bivariate analysis as factor of risk the isolation of the gramnegative and the presence of serious neutropenia. The multivariate analysis found as protection factor for death in 30 days score MASCC score use and a part of that no risk factors were highlighted. Conclusion: The gram-negative were the most important isolated agents in this research, highlighting the isolation of Stenotrophomonas maltophilia. The occurrence of hospitalization and death wasnt high, being the autologous transplant a protection factor for hospitalization and the use of MASCC score the protection factor for death in 30 days. More research is necessary evaluating the outpatient treatment for bone marrow transplanted patients to make it possible a better life standard for those patients

No description available.

No Brasil, poucos estudos investigaram a prevalência de medicamentos potencialmente inapropriados (MPIs) em idosos ambulatoriais. Este estudo visa determinar a prevalência de MPIs prescritos para estes pacientes, identificando os mais comumente envolvidos e verificando se a idade, o sexo e o número de medicamentos estão relacionados à prescrição de tais medicamentos. Foram coletadas prescrições de 3070 pacientes idosos (60 anos) em banco de dados, provenientes dos ambulatórios de Geriatria e Clínica Geral de um hospital universitário de atenção terciária em São Paulo-Brasil entre fevereiro e maio de 2008, que foram divididas de acordo com o sexo e faixa etária (60-69; 70-79 e 80). Os critérios de Beers versão 2003 foram utilizados para a avaliação de MPIs. A maior parte da casuística foi composta por mulheres em ambos os ambulatórios (66,6% na Clínica Geral e 77,7% na Geriatria). Os pacientes da Clínica Geral apresentaram média de idade de 71,3 anos e os da Geriatria, 80,1 anos. Na Clínica Geral a prevalência média de prescrição de MPIs foi de 37,6% e na Geriatria de 26,9%, sendo que em ambos as mulheres de 60-69 foram as que apresentaram a maior prevalência destes medicamentos. Os MPIs mais prescritos nos dois ambulatórios foram o carisoprodol, a fluoxetina e a amitriptilina, sendo que houve diferenças nos perfis de prescrições entre homens e mulheres. A chance de uso de MPI no sexo feminino é maior que no masculino (p<0,001); a chance de uso de MPI na faixa de 70-79 anos é menor que na faixa de 60-69 anos (p=0,030), assim como na faixa de 80 (p=0,024). Estas conclusões não dependem do ambulatório (p=0,164).O efeito de ambulatório depende do número de medicamentos (p=0,009). Se o número de medicamentos é < 9 a chance de uso de MPI na Clínica Geral é maior que na Geriatria (p=0,041). Quando o número de medicamentos é 7 ou 8, a chance de uso de MPI é maior do que quando são prescritos 1-4 medicamentos (p<0,001), nos dois ambulatórios (p=0,098). Quando são usados 9 medicamentos, a chance de uso de MPI depende do ambulatório (p=0,044). Na Geriatria, a chance de uso de um MPI é 8,2 vezes a RC na categoria 1-4 medicamentos; enquanto que na Clínica Geral a razão de chances é 4,6. As prevalências de MPIs encontradas foram semelhantes ao relatado na literatura e estão correlacionadas ao sexo feminino. A chance de prescrição de MPIs foi menor em pacientes com 70 anos; observou-se que se o número de medicamentos for <9, a chance de uso de MPI na Clínica Geral é maior que na Geriatria, porém, se o número de medicamentos for 9 não há diferença entre as chances de uso de MPI nos dois ambulatórios / In Brazil, few studies have investigated the prevalence of potentially inappropriate medications (PIMs) among elderly outpatients. This study aimed to determine the prevalence of PIMs prescribed to such patients, identify the medications most commonly involved and investigate whether age, sex and number of medications are related to the prescription of such medications. Prescriptions issued to 3,070 elderly patients (60 years) were gathered from a database. These patients were attended at the geriatric and general clinical outpatient services of a tertiary-level university hospital in São Paulo, Brazil, between February and May 2008. They were divided according to sex and age group (60- 69; 70-79; and 80 years). The Beers criteria (2003 version) were used to evaluate PIMs. The majority of the sample comprised women, at both outpatient services (66.6% in the general clinic and 77.7% in geriatrics). The mean age of the general clinical patients was 71.3 years and the mean for the geriatric patients was 80.1 years. At the general clinic, the mean prevalence of prescriptions of PIMs was 37.6%, and it was 26.9% at the geriatric clinic. At both outpatient services, women aged 60-69 years presented the highest prevalence of such medications. The PIMs most prescribed at the two outpatient services were carisoprodol, fluoxetine and amitriptyline, and there were differences in the prescription profiles between the men and women. The chances of using PIMs were greater for the women than for the men (p < 0.001). The chances of using PIMs in the 70-79 years group were lower than in the 60-69 years group (p = 0.030), and likewise for the group 80 years (p = 0.024). These conclusions were independent of the outpatient service (p = 0.164). The outpatient effect depended on the number of medications (p = 0.009). If the number of medications was < 9, the chances of using PIMs at the general clinic were greater than the chances at the geriatric clinic (p = 0.041). When the number of medications was 7 or 8, the chances of using PIMs were greater than when prescribed 1-4 medications (p < 0.001), at both outpatient services (p = 0.098). When 9 medications were used, the chances of using PIMs depended on the outpatient service (p = 0.044). At the geriatric clinic, the chances of using PIMs were 8.2 times greater than the chances in the category of 1-4 medications; while at the general clinic, the odds ratio was 4.6. The prevalence of PIMs encountered was similar to what has been reported in the literature, and it correlated with female sex. The chances of being prescribed PIMs were lower among patients 70 years. If the number of medications was < 9, the chances of using PIMs at the general clinic were greater than the chances at the geriatric clinic. However, if the number of medications was 9, there was no difference in the chances of using PIMs between the two outpatient services

Made available in DSpace on 2016-04-04T18:30:00Z (GMT). No. of bitstreams: 1 Maria Cristina Zago.pdf: 3147009 bytes, checksum: a0cd64f0e81d5b4791461884f1bce126 (MD5) Previous issue date: 2014-02-11 / Pontif?cia Universidade Cat?lica de Campinas / The aim of this research was to investigate a group tecnique named, Group of Physical Activities, as a psychotherapeutic device for outpatients with severe mental illness.The concepts of psychoanalysis and group analysis provided the theoretical basis for this study. The research developed an outpatient Unit from a Public Mental Health Service in Campinas city at the state of S?o Paulo in Brazil. The group was open, heterogeneous in terms of diagnosis, gender and age; 16 patients, aged between: 27-56 years old. The methodological path chosen was the qualitative research based on psychoanalysis method.The adopted technique, Group of Physical Activities, is comprised of three main stages: 1- walk (round trip on a community sports park), 2- physical activities collectively 3- symbolic moment. A method developed by Ren? K?es (group analyst) was used to analyze the results (13 group sessions registries). It was concluded that such technique is a useful psychotherapeutic device in the treatment of psychiatric patients with severe mental illness by sensitizing them to group phenomena leading them to psychic organization. During the analytic process, the dynamics of the group was giving notice of a movement of aggregation, of trying to be and to have a body against of no-existence anxieties. At the time of physical activity collectively the communication between the participants acquired a special feature by using nonverbal capabilities in a especial manner. One understands that the act of passing the ball as intrapsychic movement of libidinal investment towards object. At different times the group tecnique provided a space for the establishment of intersubjective contact. Moreover, the group technique developed led to the "exercise" of recognition of objects belonging to external reality. There was a favoring of projection and introjection mechanisms which led to a movement towards the integration of ego. The group tecnique that was developed represents an important adjunct in the treatment of psychiatric patients with severe mental illness consisting in a psychotherapeutic device. In particular by favoring the "relational-game," in other words, the exercise of unconscious communication between singular and plural. / A presente pesquisa teve como objetivo investigar a t?cnica grupal, Grupo de Atividades F?sicas enquanto dispositivo psicoterap?utico para pacientes psiqui?tricos com adoecimento mental severo. Os conceitos psicanal?ticos e as concep??es da grupan?lise embasaram este estudo. O campo de pesquisa foi um Centro de Aten??o Psicossocial (CAPS) de um Servi?o P?blico de Sa?de Mental (Campinas, estado de S?o Paulo, Brasil). O grupo era aberto, heterog?neo quanto ao diagn?stico, g?nero e idade; 16 pacientes, faixa et?ria: 27-56 anos. Trata-se de uma pesquisa qualitativa conduzida com base em psican?lise aplicada. A t?cnica grupal, Grupo de Atividades F?sicas, compreendia tr?s momentos principais: 1-) caminhada (de ida e volta do Servi?o ao Centro de Conviv?ncia); 2-atividade f?sica coletiva e 3-) momento simb?lico da sess?o. Para a an?lise dos resultados (registro de 13 sess?es do grupo) utilizou-se o m?todo desenvolvido pelo grupanalista Ren? K?es. Concluiu-se que a t?cnica grupal constitui-se num dispositivo psicoterap?utico no tratamento de pacientes com adoecimento mental severo, por sensibiliz?-los aos fen?menos de grupo direcionando-os a organiza??o ps?quica. Observou-se durante o processo anal?tico grupal um movimento de agrega??o, de tentativa de ser e ter corpo contra ang?stias de n?o-exist?ncia. No momento da atividade f?sica coletiva, a comunica??o entre os participantes adquiriu uma caracter?stica especial por utilizar de maneira mais marcante recursos n?o-verbais. Compreendeu-se o ato de passar a bola enquanto representante do movimento intraps?quico de investimento libidinal objetal. Em seus diferentes momentos, a t?cnica grupal propiciou um espa?o para o estabelecimento de contato intersubjetivo. Oportunizou o exerc?cio do re-conhecimento dos objetos pertencentes a realidade externa. Houve o favorecimento de mecanismos de proje??o e introje??o o que propiciou um movimento em dire??o a integra??o do ego. Finalmente, a t?cnica grupal desenvolvida figura como um importante coadjuvante no tratamento de pacientes psiqui?tricos com adoecimento mental severo, constituindo-se num dispositivo psicoterap?utico, principalmente por favorecer o jogo-relacional , isto ?, o exerc?cio da comunica??o inconsciente entre o singular e o plural.

Obesity is a disease of major proportion in the United States. The Surgeon General has identified obesity as a national health problem that affects approximately 34 million Americans. The aim of this study was to investigate the very-low-calorie diet, Optifast 70. Measurements for resting energy expenditure (REE} and body composition via circumference measurements (CBF} and infrared photospectromerty (NIR} with a Futrex 5000 were collected at weeks 1, 7, 13, 19, and 25. Biochemical data, including serum chemistry panel (SMA-12} and complete blood count (CBC}, were collected on weeks 1, 5, 9, 13, 17, 21, and 25. Lipid profiles were drawn on weeks 1 and 25. Participants ranged in age from 27 to 64. Subjects' mean body mass loss was -20.4 kg ± 6.6 kg with a maximum body mass loss of -33.23 kg and minimum body mass loss of -9.770 kg. Mean loss in body fat mass using infrared photospectrometry as a measurement was -13.4 kg; mean loss of lean body mass was -4.2 kg. A significant change was noted in resting energy expenditure over the course of the diet, and a positive correlation was identified between loss of body mass and resting energy expenditure. No significant correlation was identified between the loss of lean body mass or body fat mass and its relationship to resting energy expenditure. Both circumference and infrared body fat measurements showed a positive correlation as the loss in body mass increased, making their reliability better as subjects approached desirable weight. In examining biochemical data, only cholesterol showed a significant change over the course of the diet; all other parameters remained within normal limits. Variations in patients' lipid profiles were identified, but no significant changes were noted.

<p>Studiens syfte är att undersöka eventuella skillnader i användningen av tre centrala begrepp (missbruk, tungt missbruk samt öppenvård) inom missbruksvården. De frågeställningar som behandlas är; (I) Hur används de centrala begreppen; missbruk, tungt missbruk och öppenvård i texter kring missbruksvård? (II) Om det föreligger skillnader i användandet av de tre centrala begreppen, vilka likheter respektive olikheter kan urskiljas? (III) Hur kan begreppshanteringen utav de tre centrala begreppen förstås utifrån socialkonstruktivismen? Studien har genomförts som en litteraturstudie där resultatet har analyserats utifrån ett socialkon­struktivistiskt perspektiv. Resultatet tyder på att skillnader i begrepps­hanteringen utav de tre centrala begreppen förekommer samtidigt som också vissa likheter kan urskiljas. Definitionerna av missbruk skiljer sig åt genom att vissa definitioner behandlar konsumtionsmönster hos de som nyttjar drogen medan andra menar att missbruk ska ses som ett avvikande beteende. De flesta definitionerna kring missbruk berör dock i någon mån konsekvenser utav nyttjandet. Begrepps- användningen av tungt missbruk berör främst avgränsningar mellan narkotika­missbruk och tungt narkotikamissbruk. Gällande begreppet öppenvård tycks begreppsanvändningen vara samstämmig när det gäller dess yttre ramverk men skiljer sig åt när det kommer till diskussioner om hur snävt begreppet ska vara samt vilka insatser som bör inrymmas i det.</p> / <p>The study aims to examine possible differences in the use of three central concepts (substance abuse, heavy substance abuse and open care) within the substance abuse care. The issues addressed are (I) how is the three central concepts used in texts about substance abuse care? (II) if differences exists in the use of the three central concepts, which similarities and differences can be found? (III) how can the use of the three central concepts be understood from the basis of social constructionism? The study is a literature review and the results have been analyzed on the basis of social constructionism. The result indicates that differences in the concept handling occur. Differences in definitions of substance abuse is seen through that certain definitions treat consumption patterns while others definitions mean that it should be seen as<em> </em>deviance. Similarities can be seen as the majority of definitions around substance abuse concern consequences of the use. The use of the concept “heavy substance abuse” concerns mainly demarcations between drug abuse and heavy drug abuse. The concept handling of open care is coherent in the case of its extraneous framework however differences are found when it comes to how extensive the concept should be.</p>

<p>The general aim of the studies presented in this thesis is to investigate the possibility of using clinical data to measure outcomes in psychiatric outpatient services. The specific aims are to investigate whether routine clinical assessments and ratings are reliable and have adequate validity, and then to use these data to calculate treatment outcomes and explore factors that affect these outcomes.</p><p>The main result shows that ratings of global mental health made by clinicians in routine clinical work can be used to evaluate treatment outcomes in outpatient settings. The clinicians responsible for diagnosing and assessing patients used the GAF scale with satisfactory reliability (ICC1,1 = 0.81) and fair interrater reliability (overall kappa = 0.53) when categorizing main diagnostic groups of the DSM-IV axis I. The GAF scale can thus be used to assess global mental health and to monitor outcomes in clinical settings. However, a GAF culture bias was observed. This bias can probably be corrected with feedback and training.</p><p>Psychiatric treatment in outpatient settings had a generally positive effect on patients’ global mental heath (ES = 0.65). The overall result when clinical significance methodology was used showed that 28.1% of the patients had recovered and a further 6.6% showed reliable improvement. Patients being treated with psychotherapeutically influenced methods showed a considerably better effect (ES = 1.00). There is a dose of sessions effect that is particularly marked for short treatment episodes. Thirteen sessions are required for 50% of the patients to show reliable improvement. The strongest influence on treatment outcome was whether the termination of a patient’s treatment was planned or unplanned.</p><p>In conclusion: Clinical databases can be used to study the outcome of psychiatric services provided they a) include a large number of subjects representing an intention-to-treat perspective; b) the instruments used are clinically relevant and reliable; c) the raters contributing to the data base are motivated to decrease attrition; d) the database includes extensive data to allow for control of confounding factors; and e) data are collected at critical occasions in treatment, such as at the start of treatment and at discharge from treatment, making it possible to focus on effects. Psychiatric outpatient treatment has a positive effect, but considerable improvements may be possible with more stringent use of psychotherapeutic methods, sufficient doses of sessions, and planned terminations. However, the progress of treatment is also affected by such factors as pre-treatment severity and diagnoses.</p>

The general aim of the studies presented in this thesis is to investigate the possibility of using clinical data to measure outcomes in psychiatric outpatient services. The specific aims are to investigate whether routine clinical assessments and ratings are reliable and have adequate validity, and then to use these data to calculate treatment outcomes and explore factors that affect these outcomes. The main result shows that ratings of global mental health made by clinicians in routine clinical work can be used to evaluate treatment outcomes in outpatient settings. The clinicians responsible for diagnosing and assessing patients used the GAF scale with satisfactory reliability (ICC1,1 = 0.81) and fair interrater reliability (overall kappa = 0.53) when categorizing main diagnostic groups of the DSM-IV axis I. The GAF scale can thus be used to assess global mental health and to monitor outcomes in clinical settings. However, a GAF culture bias was observed. This bias can probably be corrected with feedback and training. Psychiatric treatment in outpatient settings had a generally positive effect on patients’ global mental heath (ES = 0.65). The overall result when clinical significance methodology was used showed that 28.1% of the patients had recovered and a further 6.6% showed reliable improvement. Patients being treated with psychotherapeutically influenced methods showed a considerably better effect (ES = 1.00). There is a dose of sessions effect that is particularly marked for short treatment episodes. Thirteen sessions are required for 50% of the patients to show reliable improvement. The strongest influence on treatment outcome was whether the termination of a patient’s treatment was planned or unplanned. In conclusion: Clinical databases can be used to study the outcome of psychiatric services provided they a) include a large number of subjects representing an intention-to-treat perspective; b) the instruments used are clinically relevant and reliable; c) the raters contributing to the data base are motivated to decrease attrition; d) the database includes extensive data to allow for control of confounding factors; and e) data are collected at critical occasions in treatment, such as at the start of treatment and at discharge from treatment, making it possible to focus on effects. Psychiatric outpatient treatment has a positive effect, but considerable improvements may be possible with more stringent use of psychotherapeutic methods, sufficient doses of sessions, and planned terminations. However, the progress of treatment is also affected by such factors as pre-treatment severity and diagnoses.

Studiens syfte är att undersöka eventuella skillnader i användningen av tre centrala begrepp (missbruk, tungt missbruk samt öppenvård) inom missbruksvården. De frågeställningar som behandlas är; (I) Hur används de centrala begreppen; missbruk, tungt missbruk och öppenvård i texter kring missbruksvård? (II) Om det föreligger skillnader i användandet av de tre centrala begreppen, vilka likheter respektive olikheter kan urskiljas? (III) Hur kan begreppshanteringen utav de tre centrala begreppen förstås utifrån socialkonstruktivismen? Studien har genomförts som en litteraturstudie där resultatet har analyserats utifrån ett socialkon­struktivistiskt perspektiv. Resultatet tyder på att skillnader i begrepps­hanteringen utav de tre centrala begreppen förekommer samtidigt som också vissa likheter kan urskiljas. Definitionerna av missbruk skiljer sig åt genom att vissa definitioner behandlar konsumtionsmönster hos de som nyttjar drogen medan andra menar att missbruk ska ses som ett avvikande beteende. De flesta definitionerna kring missbruk berör dock i någon mån konsekvenser utav nyttjandet. Begrepps- användningen av tungt missbruk berör främst avgränsningar mellan narkotika­missbruk och tungt narkotikamissbruk. Gällande begreppet öppenvård tycks begreppsanvändningen vara samstämmig när det gäller dess yttre ramverk men skiljer sig åt när det kommer till diskussioner om hur snävt begreppet ska vara samt vilka insatser som bör inrymmas i det. / The study aims to examine possible differences in the use of three central concepts (substance abuse, heavy substance abuse and open care) within the substance abuse care. The issues addressed are (I) how is the three central concepts used in texts about substance abuse care? (II) if differences exists in the use of the three central concepts, which similarities and differences can be found? (III) how can the use of the three central concepts be understood from the basis of social constructionism? The study is a literature review and the results have been analyzed on the basis of social constructionism. The result indicates that differences in the concept handling occur. Differences in definitions of substance abuse is seen through that certain definitions treat consumption patterns while others definitions mean that it should be seen as deviance. Similarities can be seen as the majority of definitions around substance abuse concern consequences of the use. The use of the concept “heavy substance abuse” concerns mainly demarcations between drug abuse and heavy drug abuse. The concept handling of open care is coherent in the case of its extraneous framework however differences are found when it comes to how extensive the concept should be.