Orientador: Neury José Botega / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-17T15:41:56Z (GMT). No. of bitstreams: 1 Cais_CarlosFilintodaSilva_D.pdf: 5508164 bytes, checksum: c31e9a8839229803d4d10cae8544dd64 (MD5) Previous issue date: 2011 / Resumo: Este projeto implementou localizadamente duas estratégias selecionadas de prevenção de suicídio sintonizadas com as recomendações da Organização Mundial da Saúde: capacitação de equipes de saúde e estímulo aos indivíduos que tentaram o suicídio para que conseguissem e se mantivessem em tratamento. Para avaliar a eficácia da capacitação, o projeto mensurou o impacto da mesma em termos de mudança de conhecimento, habilidades clínicas e atitudes das equipes de saúde em relação ao comportamento suicida. Já em relação ao monitoramento avaliaram-se qualitativamente alguns casos monitorados visando à obtenção de informações que pudessem aperfeiçoar os serviços de saúde. A capacitação foi eficaz em promover mudanças desejadas nos profissionais de saúde, tanto do ponto de vista de mudanças de atitudes, quanto de aprimoramento nos conhecimentos/habilidades clínicas em prevenção do suicídio. Estas mudanças se deram do inicio do curso para o final do mesmo e mantiveramsediferentes de antes do curso em uma reavaliação após nove meses. Em relação ao conhecimento/habilidades clínicas, auferido através do respectivo questionário o mesmo subiu de 9,4 em 21 pontos possíveis para 13,7 em 21 (p < 0,001 com nível de significância de 95%) e após nove meses se manteve diferente do início do curso: 11,5 em 21 pontos possíveis (p < 0,001). Foram criados constructos agrupando itens correlacionados do Questionário de Atitudes Frente ao Comportamento Suicida: Sentimentos negativos diante do paciente; Percepção de capacidade profissional e Direito ao Suicídio, os três constructos mostraram mudanças favoráveis do início do curso para o final do mesmo (p= 0,04; p<0,01 e p=0,02 respectivamente) e os dois primeiros mantiveram-se diferentes do início do curso em uma reavaliação após nove meses do final do curso (p= 0,04; p<0,01 e p=0,07 respectivamente). Em relação ao monitoramento, nenhum dos 67 indivíduos monitorados faleceu por suicídio durante o seguimento de seis meses e quatro fizeram nova tentativa de suicídio neste período. Através da avaliação qualitativa de seis casos monitorados, notaram-se benefícios a adesão dos mesmos ao tratamento em saúde mental, e também pontos de possível aprimoramento no fluxo e acolhimento dos pacientes que tentaram o suicídio / Abstract: Two strategies in tune with the recommendations of the World Health Organization for suicide prevention were implemented: training of healthcare teams in suicide prevention and systematically monitoring individuals who attempted suicide by phone calls or home visits in order to help them to seek and keep treatment. A 18 hours-duration suicide prevention training designed to improve health professional?s knowledge and attitudes in suicide prevention was provided to 270 health professionals who were in contact with patients at high risk for suicide in their routine practice. Questionnaires were used to assess changes in professional?s attitudes and knowledge. The score in the questionnaire for the assessment of suicide prevention knowledge, which had 21 as maximum score, increased from 8.9 to 13 (p <0.001, significance level of 95%) and when professional?s knowledge was assessed nine months later it remained significantly higher than at first assessment: 11.5 (p <0.001). The Suicide Behavior Attitude Questionnaire had 25 items assessing professional?s attitudes, 18 of them showed significant changes after the training. The questionnaire was divided in sub-scales: "right to suicide"; "negative feelings towards the patient with suicidal behavior" and perceived professional ability to deal with patients with suicidal behavior". The three constructs showed favorable changes right after the training (p = 0.04, p <0.01 and p = 0.02) and the first two remained different nine months later (p = 0.04, p <0.01 and p = 0.07 respectively). The suicide prevention training adopted has enhanced knowledge and attitudes toward suicide prevention in healthcare workers Regarding the monitoring of patients, none of the 67 monitored individuals died by suicide during the following six months and only four attempted suicide again during the follow-up. Qualitative evaluation of six cases allowed for the identification of aspects of health care delivery to patients who attempted suicide that might need to be improved / Doutorado / Saude Mental / Doutor em Ciências Médicas

Bakgrund: Självskadebeteende ter sig olika från person till person. Vissa har en underliggande diagnos som gör att de skadar sig själva, andra har yttre påfrestningar som gör att de börjar skada sig själva. Det anses många gånger vara ett rop på hjälp, att de har svårt att hantera svåra känslor. Mötet mellan dessa personer och omvårdnadspersonalen är uppbyggt av kommunikation mellan dessa personers energier och känslor. Då en upplevelse är olika beroende på vem som upplever den. Syfte: Syftet var att belysa hur personer med självskadebeteende upplever bemötandet av omvårdnadspersonal på sjukhus. Metod: Litteraturstudien baseras på elva artiklar. En induktiv analys användes, vilket resulterade i fem kategorier. Dessa var upplevelse av omvårdnadspersonalens okunskap, upplevelse av skuld och skam, upplevelse av omvårdnadspersonalens oförståelse, upplevelse av att vara utan själ samt upplevelse av att få tillbaka sin själ. Resultat: Resultatet baseras på både positiva samt negativa upplevelser av omvårdnadspersonalens bemötande. Det framkom i resultatet att det handlade mest om en okunskap från omvårdnadspersonalen, som sedan bidrog till att personerna med självskadebeteende upplevde skuld och skam samt vara utan själ. Dock fanns det en viss del som visade att omvårdnadspersonal som behandlade dessa personer med respekt och medkänsla gav personerna med självskadebeteende upplevelse av att de hade en själ. Diskussion: Personer med självskadebeteende bör få ett bra bemötande oavsett var de befinner sig. Våra huvudfynd visar hur mycket bemötande påverkar dessa personerna samt hur och när de söker vård.

Burn injuries are associated with significant mortality and morbidity. Intentional burn injuries are not well understood, and warrant study to improve adjustment and outcomes. The present study examined group differences between intentional and unintentional burn injuries, comparing individuals with self-inflicted (SIB; n=109) and other-inflicted (OIB; n=109) burns to an unintentional burn (UB) group. Compared to UB, those with intentional (SIB, OIB) burn injuries were more likely to be young, female, unmarried, unemployed, abuse substances, and have positive alcohol/drug screens at hospital admission. Individuals with intentional burns report more psychological distress, lower quality of life in some areas, and lower life satisfaction. When SIB and OIB were examined individually, OIB were more likely to be African American compared to SIB and UB. OIB also had more anxiety and paranoia than UB. SIB was more likely than OIB and UB to have had medical problems or psychiatric disorders and treatment prior to the burn injury. Those with SIB were 3 times more likely than UB to die in the hospital even after controlling for age, severity of burn, and inhalation injuries. Moreover, the SIB group had high rates of suicidal ideation at discharge and follow-up. Treatment implications for burn treatment providers were discussed.

The primary interest of this investigation concerned the self-injurious thoughts and behaviors (SITBs) of inpatient adolescents. Previous researchers have provided descriptive information regarding either automatic (or intrinsic) and social components using the Self-Injurious Thoughts and Behaviors Interview (SITBI). However, the presence and trends of these components have not firmly been established, suggesting the need to explore this area further. Eighty-two adolescent inpatients were selected and interviewed using the SITBI to evaluate the predictive ability of self-reported self-injurious behavior with regard to social and automatic, negative and positive functions. Results showed that depending on the type of thought or behavior displayed one could discern the motivation behind their actions. Automatic-Negative was seen to have the strongest relationship across all SITB behaviors while Automatic-Negative was not found to be relatively low compared to other SITB behaviors. Both Social-Positive and Social-Negative were found to be present in moderate relationships compared to Automatic in general.

Self-injurious behavior (SIB) is a complex phenotype that occurs with an increasing prevalence of about 7-34% in humans and 10-12% in non-human primates (NHPs). This study evaluated the efficacy of probiotic Lactobacillus reuteri as a treatment for self-injurious behavior (SIB) and sleep disruption in rhesus macaques. The treatment was proposed to alleviate mild self-biting, sleep disruption, and reduce chronically elevated hypothalamic-pituitary-adrenocortical (HPA) axis activity, all hallmark features of monkeys with this condition. The probiotic preparation included two strains of L. reuteri (L. reuteri ATCC PTA 6475 & L. reuteri DSM 17938) containing on average 200 million colony forming units per chewable tablet. The study was conducted on 14 rhesus macaque monkeys (9 males) housed at the University of Massachusetts Amherst. To our knowledge this is the first time that a Lactobacillus strain has been used as a treatment for SIB in rhesus macaques. This study utilizes motion-activated infrared camera technology, modified enzyme-immunosorbent-assays (EIAs) techniques to measure hair cortisol concentrations, and daily behavioral observations to provide an overall assessment of the behavioral, physiological, and sleep associated implications of probiotic treatment on SIB and control non-human primates (NHPs). Administration of L reuteri modestly decreased biting behavior in monkeys with SIB (F(2,12) = 5.64, p= 0.02) and showed overall decrease in nighttime activity across all subjects but did not normalize SIB to nonSIB values. Hair cortisol values are pending. These findings and the findings of previous work further strengthen the argument for probiotics as an efficacious treatment for SIB behavior.

Bakgrund: Självskadebeteende är ett paraplybegrepp som benämner individer som skadar sig själva. I Sverige hamnar ungefär 4000 män och 7000 kvinnor på akuten på grund av självskador. Forskning visade att flertal av den här patientgruppen har negativa erfarenheter av hälso- och sjukvården på grund av negativa attityder hos vårdpersonal. Flera sjuksköterskor beskrev att de behöver mer kunskap och förståelse för självskadebeteende. Syfte: Syftet med det här arbetet var att sammanställa forskning om sjuksköterskors erfarenheter av att vårda patienter med självskadebeteende. Metod: En litteraturstudie genomfördes med hjälp av 11 kvalitativa artiklar som analyserades med integrerad analys. Resultat: Litteraturstudien resulterade i två huvudkategorier; Syn på omvårdnad och interna processer relaterade till omvårdnaden av patienter med självskadebeteende och förutsättningar för att uppnå god omvårdnad av patienter med självskadebeteende. Slutsats: I den här litteraturstudien framkom att flera sjuksköterskor upplever att de möter på flera utmaningar inom deras arbetsmiljö. Merparten av sjuksköterskorna har även uttryckt att har fått psykisk ohälsa på grund av bristande arbetsförhållanden och bristande stöd från ledningen. Sammanfattningsvis visar den här studien att det finns ett ökat behov av kompetens, handledning samt bättre förutsättningar och resurser inom arbetsplatsen för att sjuksköterskorna ska kunna erbjuda personcentrerad vård till patienter med självskadebeteende. / Background: Self-injurious behavior is an umbrella term that refers to individuals who harm themselves. In Sweden, approximately 4,000 men and 7,000 women end up in the emergency room due to self-harm. Research showed that the majority of this patient group have negative experiences with nurses due to prejudices and negative attitudes about self-harming behavior. Several nurses described that they need more knowledge and understanding of self-harming behavior. Purpose: The purpose of this work was to compile research on nurses' experiences of caring for patients with self-harming behaviour. Method: A literature study was conducted using 11 qualitative articles that were analyzed using integrated analysis. Results: The literature study is included in two main categories; Views on nursing and internal processes related to the nursing of patients with self-harming behavior and conditions for achieving good nursing of patients with self-harming behavior. Conclusion: In this literature study, it emerged that several nurses feel that they face several challenges within their work environment. Most of the nurses have also expressed that they have suffered from mental illness due to poor working conditions and lack of support from management. In summary, this study shows that there is an increased need for supervision as well as better conditions and resources within the workplace for nurses to be able to offer person-centered care to patients with self-harming behavior

This dissertation has multiple goals. First to analyze self-destructive behavior and its relations to ethics. Secondly to evaluate four different ethical perspectives regarding self-destructiveness from a certain position of human nature. The third goal is to construct a position that deals with self-destructive behavior in a way that is improved and well-managed compared to the four ethical perspectives analyzed earlier. The first goal is met by comparing and evaluating different theories concerning self-destructive behavior and discussing the ethical implications surrounding them. Self-destructive behavior is seen as a way of communicating, which puts a moral pressure on both the self-destructive person and the society around her. The four ethical perspectives represented by Robert Nozick and Thomas Szasz, two neoliberals, James B Nelson, a body theologian inspired by Paul Tillich, Gail Weiss, a body feminist and Mary Timothy Prokes, a catholic body theologian, are hence met by the problem of self-destruct, analyzed and critically evaluated. In the final chapter the author constructs an improved ethical perspective concerned with self-destructiveness, based on altruism, responsibility and broad-mindedness.

Made available in DSpace on 2016-07-27T14:20:35Z (GMT). No. of bitstreams: 1 Ellen Portilho de Souza.pdf: 1371955 bytes, checksum: 3ec9f0f9cb974638e8fca9566dbc2586 (MD5) Previous issue date: 2014-12-10 / This study aimed to functionally analyze and assess a series of treatments for the reduction of self-injurious behavior on a person with development disability. The assignment was carried out in a special education institute in central Goiás, and the subject was a 26-years-old female. Two experimental designs, multiple elements and alternate treatments, were applied. In order to assess the antecedents and consequents of self-injuring behavior, a functional assessment process was used, which included (1) indirect assessment through interview, (2) direct observation, and (3) functional analysis, through the design of multiple conditions using the following: attention, demand, control, and alone. The attention condition was subdivided into three sub conditions: shared attention, attention-reprimand, and noncontingent attention. The demand condition was subdivided into two kinds of academic demand: shape fitting and reading activities. The alone condition was subdivided into: alone with activity and alone without activities. The use of an intervention program through the design of ABCAD alternate treatments was chosen to intervene in self injurious behavior. The results suggest selfinjurious behavior has the role of self-stimulation, i.e., automatic reinforcement. The demand condition as an establishing operation for the emission of these behaviors and negative reinforcement was also discussed. Conditions of 30-seconds fixed-time (B) and differential reinforcement of alternative behaviors (D) resulted in reduction on the frequency of these behaviors. Density reduction of the noncontingent design as the responsible for the increase of self-injurious behavior frequency on condition (C) was also discussed. / O presente estudo teve como objetivo avaliar uma série de tratamentos para diminuição do comportamento autolesivo de uma pessoa com desenvolvimento atípico após avaliação funcional. O trabalho foi realizado em uma instituição de ensino especial do interior de Goiás e teve como participante uma pessoa adulta, sexo feminino e 26 anos. Foram empregados dois delineamentos experimentais: o de múltiplos elementos e o de tratamentos alternados. Para avaliar os antecedentes e consequentes do comportamento autolesivo, foi usado processo de avaliação funcional que incluiu (1) avaliação indireta por meio de entrevista, (2) observação direta e, (3) análise funcional, por meio do delineamento de múltiplas condições utilizando as condições: atenção, demanda, e controle e sozinha. A condição de atenção foi subdivida em três subcondições: atenção-dividida, atenção-reprimenda e atenção não contingente. A condição demanda foi subdivida em: demanda encaixe e demanda leitura. A condição sozinha foi subdivida em: sozinha c atividade e sozinha sem atividades. Para intervir no comportamento autolesivo, optou-se pelo uso de um programa de intervenção por meio do delineamento de tratamentos alternados do tipo ABCAD. Os resultados sugerem que o comportamento autolesivo tem função de autoestimulação, ou seja, reforçamento automático. Também foi discutida a condição de demanda como operação estabelecedora para emissão desses comportamentos e reforçamento negativo. As condições de tempo-fixo 30 segundos (B) e reforçamento diferencial de comportamentos alternativos (D) ocasionaram redução na frequência desses comportamentos. Discute-se ainda a diminuição da densidade do esquema não-contingente como sendo responsável pelo aumento da frequência do comportamento autolesivo na condição (C).

Contexto: Pouco se sabe a respeito da prevalência e correlatos de autolesão deliberada em jovens de países em desenvolvimento. Além disso, existe uma escassez de estudos avaliando associações clínicas e com psicopatologia familiar ajustando-se para outras comorbidades, especialmente numa faixa etária mais jovem da população (dos 6 aos 14 anos). Objetivos: Nós investigamos a prevalência e as associações de autolesão deliberada em jo- vens desta faixa etária com fatores de risco demográficos (idade, gênero, status socioeconô- mico e etnicidade), clínico (diagnóstico psiquiátrico das crianças) e familiar (diagnóstico psiquiátrico materno) em um grande estudo comunitário no Brasil. Métodos: Participantes (n=2.508) e suas mães (n=2,295) da Coorte de Alto-Risco para Transtornos Psiquiátricos foram avaliados através da Development and Well Being Assess- ment (DAWBA) e Mini International Neuropsychiatric Interview (MINI) respectivamente. Autolesão atual (no último mês) e ao longo da vida foram estimadas, incluindo análises estratificadas por faixa etária. Regressões logísticas foram realizadas investigando o papel do diagnóstico clínico de crianças e adolescentes e da psicopatologia materna sobre as estimativas de autolesão, ajustando-se para potenciais fatores confundidores. Resultados: A prevalência de autolesão deliberada atual foi de 0,8% (0,6% para crianças e 1% para adolescentes) e ao longo da vida foi de 1,6% (1,8% e 1,5% respectivamente). Estas estimativas não variaram de acordo com a idade, sexo e etnicidade. No entanto, pertencer à classe média esteve associado a uma diminuição de 70% na probabilidade de se relatar um episódio de autolesão ao longo da vida comparando-se com a classe mais favorecida. Autolesão atual e ao longo da vida foram mais frequentes em jovens com Depressão Maior, Transtorno de Déficit de Atenção e Hiperatividade (TDAH) e Transtorno Opositor Desafiante (TOD), mesmo em modelos múltiplos ajustado para variáveis demográficas e co- ocorrência de transtornos psiquiátricos. Além disso, a presença de transtorno de ansiedade nas mães esteve fortemente associada com autolesão deliberada recente e ao longo da vida em seus descendentes. Ao estratificar-se a análise por faixa etária, esta associação tornou- se não significativa para crianças com autolesão recente e adolescentes com autolesão ao longo da vida; ao passo que, especificamente em crianças, autolesão recente foi associada com transtorno de humor materno. Conclusão: A autolesão deliberada é um problema importante em crianças e adolescen- tes. Os diagnósticos de Depressão Maior, TDAH e TOD estão consistentemente associados com este comportamento, bem como ter uma mãe com um transtorno de ansiedade. Nos- sos resultados salientam a importância de se perguntar a respeito de comportamentos suicidas em jovens com comportamentos disruptivos, independentemente da comorbidade com depressão, e também realçam a necessidade de estratégias preventivas com um en- volvimento familiar. / Background: Little is known about the prevalence and correlates of deliberate self-harm (DSH) in youngsters from low and middle-income countries. In addition, there is a shortage of studies evaluating clinical associations and family psychopathology adjusting for other comorbidities, especially in a younger age-group (from 6 to 14 years). Objectives: We investigated prevalence and associations of DSH in youngsters of that age range with demographic (age, gender, socioeconomic status and ethnicity), clinical (children psychiatric diagnosis) and familial risk factors (maternal psychiatric diagnosis) from a community-based study from Brazil. Methods: Participants (n=2,508) and their mothers (n=2,295) from the High Risk Co- hort for Psychiatric Disorders (HRC) were assessed through the Development andWell Be- ing Assessment (DAWBA) and the Mini International Neuropsychiatric Interview (MINI) respectively. Current (last month) and lifetime DSH were estimated, including analysis stratified by age-groups. Logistic regressions were performed investigating the role of youths’ clinical diagnoses and maternal psychopathology on prevalence estimates of DSH adjusting for potential confounding factors. Results: Prevalence of current DSH was 0.8% (0.6% for children and 1% for adolescents) and life-time DSH was 1.6% (1.8% and 1.5% respectively). These estimatives did not vary with age, gender and ethnicity. However, being from middle class was associated with a 70% decrease in the odds of reporting a lifetime episode of DSH comparing to the wealthiest class. Current and life-time DSH was more frequent in youth with Major Depression, Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), even in multiple models accounting for demographic variables and co- occurring psychiatric disorders. Anxiety in mothers was strongly associated with current and life-time DSH in the offspring but when stratifying by age-group this association becomes non-significant for children with current DSH and for adolescents with lifetime DSH, whereas current DSH was associated with maternal mood disorder specifically in young children. Conclusion: Diagnoses of Major Depression, ADHD and ODD are consistently associated with DSH as well as having a mother with anxiety disorder. Our results emphasize the necessity to ask about suicidal behavior in young people with disruptive behaviors, regard- less of comorbidity with depression, and also highlight the need for preventive strategies with a family component.

Archived data was utilized for the present study which examined self-injurious behaviors in a college population. College students, who engage in non-suicidal self-injury, or NSSI, were expected to evidence a higher knowledge base for the behavior than those who do not. The demographic variables of gender and sexual orientation were predicted to be over represented in the NSSI group. Further, this study examines the perceived riskiness of the behavior in individuals who self-injure, as well as their perceptions of others who engage in NSSI. The survey consisted of four sections: demographics, knowledge ofNSSI, experience with NSSI, and perceptions ofNSSI. Individuals who engage in or have a history of NSSI evidence a higher mean score or better knowledge of the behavior than those who do not. The NSSI population evidences disproportionate numbers of females and individuals with gay, lesbian, and questioning sexual orientations. Further, when examining the perceived riskiness of self-injury, the NSSI group views the behavior as less risky than the non self-injury group. Results are discussed in relation to the need for accurate knowledge about NSSI and additional research directions.