Submitted by Luciana Sebin (lusebin@ufscar.br) on 2016-09-23T12:52:25Z No. of bitstreams: 2 DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-27T19:21:16Z (GMT) No. of bitstreams: 2 DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-27T19:21:23Z (GMT) No. of bitstreams: 2 DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) / Made available in DSpace on 2016-09-27T19:21:31Z (GMT). No. of bitstreams: 2 DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) Previous issue date: 2016-02-24 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Under the approach of social studies of Science and technology (STS), tis research has analyzed issues in the current constitution of the mental health field that has taken care of children and adolescents in Brazil. Based on Pierre Bourdieu’s theoretical contribution, a case study was carried out in a Centro de Atenção Psicossocial (CAPSi), in a country in the state of São Paulo, in order to analyzed the institutionalized relations by the multiprofessionals that work in this Center, which is an apparatus implemented by the National Mental Health Policy (PNSM). The methodology was elaborated on corresponding literature to the theme of this research, and the case study was carried out through semi structured interviews with some professionals from CAPSi, through direct observation of the CAPSi’s team meetings, through meetings between the constituting service network to the municipal mental health, and by analyzed the Minutes Meeting of CAPSi’s team. The analysis of the data showed evidence of the dominance of psychiatric science in the epistemological basis that build concepts and institutions mental disorders care, as well as the existence of conflicting paradigms, the psychopharmalogical trivialization, considerations about children and adolescents social leadership and about the non recognition of CAPSi as healthcare institution by the municipal services and by the scholar and juridical fields. With the results of this research, it is expected to contribute to the STS studies and to researchers interested in the theme, intending to generate reflections and reviews about the efficiency and effectivenss of care for children and adolescents diagnosed with mental disorders, and the social position of children and adolescents. / Sob a abordagem dos estudos sociais da ciência e da tecnologia (CTS), buscou-se nesta pesquisa compreender a constituição atual do campo da saúde mental voltado aos cuidados de infantojuvenis no Brasil. A partir do uso do aporte teórico de Pierre Bourdieu, foi realizado um estudo de caso em um Centro de Atenção Psicossocial Infantojuvenil (CAPSi), em um município no interior do estado de São Paulo, para analisar as relações institucionalizadas pelos multiprofissionais atuantes nesse Centro, que se dá como um aparato implementado pela Política Nacional de Saúde Mental (PNSM). Os métodos investigativos utilizados deram-se por levantamento bibliográfico correspondente à temática da pesquisa, e o estudo de caso foi realizado através de entrevistas semi-estruturada a alguns profissionais do CAPSi, por observação direta em reuniões da equipe do CAPSi e em reuniões entre os serviços constitutivos da rede de atendimento à saúde mental municipal, e por análise de Atas de reuniões da equipe CAPSi. A análise dos dados resultou em apontamentos sobre a dominância científico psiquiátrica na base epistemológica que constrói conceitos e instituições de cuidado à doença mental, sobre a existência de paradigmas em conflito, sobre a banalização e vulgarização psicofarmacológica, sobre considerações relativas ao protagonismo social infantojuvenil e sobre o irreconhecimento do CAPSi como instituição de cuidados em saúde pelos serviços municipais e pelos campos escolar e jurídico. Com a conclusão dessa pesquisa, objetiva-se contribuições aos estudos CTS e aos pesquisadores que abordam a temática estudada, almejando-se reflexões e revisões sobre a eficiência e eficácia dos cuidados aos infantojuvenis diagnosticados com doença mental, e ao lugar social das crianças e adolescentes. / FAPESP: 2014/06638-0

Submitted by Cláudia Bueno (claudiamoura18@gmail.com) on 2015-10-16T20:26:47Z No. of bitstreams: 2 Dissertação - Ciro Mendes VArgas - 2014.pdf: 4522341 bytes, checksum: 6f69856baba60e9b908a309d91ea0294 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-19T13:36:27Z (GMT) No. of bitstreams: 2 Dissertação - Ciro Mendes VArgas - 2014.pdf: 4522341 bytes, checksum: 6f69856baba60e9b908a309d91ea0294 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-19T13:36:27Z (GMT). No. of bitstreams: 2 Dissertação - Ciro Mendes VArgas - 2014.pdf: 4522341 bytes, checksum: 6f69856baba60e9b908a309d91ea0294 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-09-30 / Information about pediatric and adolescent patients admitted to specialized psychiatric hospitals are rare and there are few data on the epidemiological profile of these patients. Two studies were conducted in order to investigate this population. Aiming to review the literature concerning this issue, the first study found 17 relevant articles that indicated conduct disorder and affective disorders as most prevalent diagnostics among the studies. There was gender balance. There was no ethnic differences. In the second study, were analyzed medical charts of 1318 patients under 18 years old admitted from January 2001 to December 2011 at a referral hospital in child psychiatric hospitalization. The most frequent diagnosis was Bipolar Disorder (35.4%). There was a significant male majority in bipolar disorder, organic mental disorder and substance-related disorder, female majority in depressive disorder and dissociative disorder. Prevalence of bipolar and related substance in the range 15-18 years and prevalence of organic mental disorder and attention-deficit hyperactivity disorder in the range of 10 to 14 years. Psychiatric family history occurred in greater frequency in the range 10-18 years. Comorbidities were present in 46.2% of the sample. The psychotic syndrome was the most frequent described. In an overview of the two studies, externalizing disorders were more common in younger children and males, and internalizing disorders in older children and females. / Informações sobre pacientes crianças e adolescentes internados em hospitais psiquiátricos especializados são raras e existem poucos dados sobre o perfil epidemiológico desses pacientes. Dois estudos foram realizados no intuito de investigar essa população. Com o objetivo de revisar a literatura concernente a este tema o primeiro estudo encontrou 17 artigos relevantes que indicaram os transtornos de conduta e transtornos afetivos como predominantes entre os diagnósticos dos estudos. Houve equilíbrio entre os gêneros. Não houve diferença étnica. No segundo estudo, foram analisados prontuários de um total de 1318 pacientes menores de 18 anos internados de janeiro de 2001 a dezembro de 2011 em um hospital referência em internação psiquiátrica infantil. O diagnóstico mais frequente foi o Transtorno Bipolar (35,4%). Houve significante maioria masculina no transtorno bipolar, transtorno relacionado à substância e transtorno mental orgânico, maioria feminina no transtorno depressivo e transtorno dissociativo. Predominância do transtorno bipolar e transtorno relacionado à substância na faixa de 15 a 18 anos e do transtorno mental orgânico e déficit atencional e hiperatividade na faixa de 10 a 14 anos. Antecedentes familiares psiquiátricos ocorreram em maior frequência na faixa de 10 a 18 anos. Comorbidades estiveram presentes em 46,2% da amostra. A síndrome psicótica foi a mais frequente descrita. Em uma visão geral dos dois estudos, os transtornos externalizantes foram mais comuns em crianças menores e do sexo masculino, e os transtornos internalizantes, em crianças maiores e do sexo feminino.

Denna kvalitativa intervjustudie syftar till att undersöka hur samverkan ser ut mellan skola, Barn och ungdomspsykiatrin (BUP) samt socialtjänsten i arbetet med att hjälpa barn och ungdomar i åldrarna 0 till 18 år som lider av psykisk ohälsa. Studien grundar sig i sex stycken semistrukturerade intervjuer med två skolkuratorer, två socialsekreterare från socialtjänsten samt två kuratorer från BUP. Resultaten visar att det finns flertal hindrande och möjliggörande faktorer vid samverkan. Resultaten visar att då professionella konsulterar med varandra kring svåra frågor rörande unga som lider av psykisk ohälsa främjas samsyn och samverkan möjliggörs. Vidare visar resultaten att förutsättningar för samverkan inom organisationer bygger på att ledningar uppnår domänkonsensus, för att på så sätt komma överens om hur aktörer skall samverka / This qualitative interview study aims to investigate the collaboration between school, children and adolescent psychiatry and the social service with the intent to help children and adolescents aged 0 to 18 who suffer from mental health problems. The study is based on six semistructured interviews with two school counselors, two employees from the social services and two counselors from children and adolescent psychiatry (BUP). The results show that there are several obstructive and enabling factors when collaborating. The results show that when professionals consult with each other about difficult issues regarding young people suffering from mental illness, it promotes consensus and enables cooperation. Furthermore, the results show the prerequisites for collaboration within organizations is based on the fact that the management reaches domain consensus, in order to agree on how professionals shall collaborate.

Att lyckas i skolan är den viktigaste faktorn för att också lyckas i livet och är än mer viktig för elever som har diagnosen adhd, eftersom de har större risk att hamna i en negativ livsspiral. Skolan har ett kompensatoriskt uppdrag och specialpedagogen kan vara en viktig del i att hjälpa till med att skapa en integrerad och bra lärmiljö för elever med diagnosen adhd. Elevhälsoarbetet i skolan förutsätter en hög grad av samverkan med olika interna och externa aktörer. Barn- och ungdomspsykiatrin är en av dessa. Syftet med denna studie är att belysa personalens beskrivningar av framgångsfaktorer och utmaningar i samarbetet mellan personal, på barn- och ungdomspsykiatrin och skolors elevhälsa, för att kunna stödja elever som har diagnosen adhd i deras utveckling och lärande. Den här kvalitativa studien bygger på intervjuer med personal från dessa verksamheter. Intervjuerna bestod av både fokusgruppsintervjuer och individuella semistrukturerade intervjuer. Intervjuerna transkriberades och sammanställdes utifrån studiens frågeställningar. Studiens urval var målinriktad och gjordes enligt bekvämlighetsprincipen. Informanterna från elevhälsan arbetade i en glesbygdskommun och deltagarna från barn- och ungdomspsykiatrin var verksamma i en stad men samverkar med informanterna i elevhälsan. Resultatet i studien visar att både skolan och barn- och ungdomspsykiatrin tycker att samverkan och samarbete mellan parterna är viktiga och nödvändiga. De största utmaningarna i samverkan tycks vara otydliga ramar för hur samarbetet ska fungera och oklarheter kring de olika professionernas uppdrag. De långa väntetiderna till barn- och ungdomspsykiatrin skapar också oro vid samverkan. I studien framkom också att samverkan i glesbygdskommuner innebär försvårande omständigheter. Resultatet tyder på att tydligare samverkansavtal bör arbetas fram och att all berörd personal bör göras delaktiga. / Success in school is the most important factor for success in life, and it is even more important for students with an ADHD-diagnosis, since they are in more danger of developing a negative spiral in life. Education has a compensatory duty and teachers in special education can be an important part in helping to create an integrated and meaningful learning environment for students with an ADHD-diagnosis. The work with the student health team within a school demands a high degree of cooperation between different internal and external players. BUP (child and adolescent psychiatry), which provides specialist care for children with mental health problems, is one of these players. The intention of this paper is to illustrate the personnel’s descriptions of not only the factors for success but the challenges as well, when it comes to the cooperation between the school´s student health team and BUP´s work to support students with the ADHD-diagnosis with their development and their learning. This qualitative study is based on interviews with personnel from these different arenas. The interviews where made with both focus groups, as well as semi structured interviews. The interviews where transcribed and compiled based on the intentions of this study. The selection was targeted and made according to the comfort principle. The informants from the student health team worked in a rural municipality, while the participants from BUP where based in a nearby city, but worked with the informants from the student health team. The result of the study shows that the school, as well as, BUP believes that cooperation and collaboration between these different arenas are important and necessary. The main challenges seem to be the lack of a defined framework that specifies how the cooperation should work as well as confusion about the responsibilities of the different professions. The long wait to BUP is also a cause for concern while striving for cooperation. The study also showed that cooperation within rural municipalities involves complicating circumstances. The result indicates that more clearly defined frameworks for cooperation should be developed and that all concerned personnel should be involved.

Psykisk ohälsa ses som ett folkhälsoproblem bland barn och ungdomar. Psykiska besvär tidigt i livet ökar risken för suicidförsök. I åldersgruppen 10–19 år begår ungefär 50–60 personer suicid per år i Sverige. Psykologer på barn- och ungdomspsykiatrin (BUP) arbetar bland annat med suicidnära barn och ungdomar. Syftet med studien var att undersöka psykologers upplevelse av att arbeta med suicidnära barn och ungdomar. Studien har även ämnat till att undersöka vilket stöd organisationen erbjuder psykologerna i arbetet med suicidnära barn och ungdomar samt hur stödet upplevs. Sju psykologer på BUP intervjuades med semistrukturerade intervjuer som analyserades med tematisk analys. Majoriteten av deltagarna upplevde arbetet med suicidnära barn och ungdomar som ensamt, utmanande och emotionellt belastande samt att känslorna följde med efter arbetstid. Stödet från organisationen beskrevs som svagt och bestod oftast av handledning, riktlinjer och utbildning. Det kollegiala stödet upplevdes som bra men otillräckligt. Det stöd som psykologerna upplevde som viktigast att få från organisationen var emotionellt stöd. Slutsatsen var att psykologerna upplever en obalans i arbetskrav och arbetsresurser som har resulterat i känslor som stress och oro. Förslag till framtida forskning är att studera patienternas och ledningens perspektiv på BUP samt jämföra arbetet på privatiserade BUP för att undersöka skillnader i upplevelse och stöd från organisationen. / Mental illness is seen as a public health problem among children and adolescents. Mental disorders early in life increase the risk of suicide attempts. In Sweden, approximately 50 to 60 people between the ages of 10 and 19 commit suicide each year. Among other things, psychologists in child and adolescent psychiatry (BUP) work with suicidal children and adolescents. The purpose of this study was to examine psychologists' experiences of working with suicidal children and adolescents. The study also aimed to investigate what organizational support is offered to psychologists working with suicidal children and adolescents and how the support is experienced. Semi-structured interviews of seven psychologists in BUP were conducted and analyzed using thematic analysis. The majority of the participants experienced their work with suicidal children and adolescents as lonely, challenging, and emotionally draining and that these emotions followed them home after working hours. The organizational support was described as weak and usually consisted of supervision, guidelines, and training. The support from colleagues was perceived as good but insufficient. The organizational support that psychologists felt was most important to receive was emotional support. The conclusion was that psychologists experience an imbalance in professional demands and resources that has resulted in emotions such as stress and anxiety. Suggestions for future research are to study patient and management perspectives on BUP and compare existing research with the work in privatized BUP to see if there are differences in experiences and organizational support.

I dagens Sverige drabbas allt fler barn och unga av psykisk ohälsa, i rapporter framkommer dystra framtidsutsikter om att antalet barn och unga kommer att öka. Då det kommer till barn och unga med komplexa behov, ställer det i sin tur högre krav på samverkan mellan kommun och region. För att säkra att barn och unga får den rätta hjälpen är samverkan lagstadgad och något socialtjänsten och barn- och ungdomspsykiatrin (BUP) behöver förhålla sig till. Därmed syftade denna studie till att undersöka hur kuratorer inom barn- och ungdomspsykiatrin och socialsekreterare som arbetar med barn och unga inom socialtjänsten upplever samverkan sinsemellan. För att undersöka studiens syfte användes kvalitativ metod varvid tre kuratorer från BUP samt fyra socialsekreterare från socialtjänstens barn och ungdomsenhet intervjuades. I arbetet med att tolka resultatet för studien användes tidigare forskning samt de teoretiska begreppen handlingsutrymme och samverkan. I analysen av empirin uppmärksammandes fyra teman som utgjorde grunden för resultatet, personbundet, kunskap och förståelse för varandras verksamheter, framgångsfaktorer för samverkan samt förhindrande faktorer för samverkan. Några viktiga slutsatser utifrån dessa var att en god relation till samverkanspartner var nödvändig samt att en mer omfattande kunskap och förståelse för varandras verksamheter önskades. Vidare nämndes brist på resurser samt avsaknad av insatser som förhindrande faktorer och högt engagemang samt uppvisande av respekt som främjande faktorer i samverkansarbetet. / In Sweden today more and more children and youths suffer from mental illness, and reports show that this decline in mental health will continue downwards. This puts more pressure on communal and regional instances to have better cooperative structures regarding the complex needs of these individuals. This cooperation between social services and child and adolescent psychiatry are obligated by law to ensure that the correct assistance is offered. This study therefore regard this cooperation and mainly focuses on the working relationship between the two. The method of gaining more knowledge in the matter was to use a qualitative form of research. This information was obtained by interviewing three curators from child and adolescent psychiatry and four social secretaries. To interpret this information former research results was studied and the meaning of the theoretical terms “room to maneuver” and “cooperation” was outlined. During the analysis four themes emerged. Person bound, knowledge and understanding of each other´s operation and inhibitory and promoting factors ofcooperation. The most important conclusions of the study were that in order for a good cooperation to take place, both parties needed to have a deeper understanding of each other’s operation. Moreover, the study showed that the lack of resources and effort from both parties complicated the partnership. Meanwhile displaying respect and commitment increased the likelihood of a good working relation.

For adolescents with asthma, adhering to asthma regimes implies not only taking medications to relieve asthma attacks, but also adjusting their life styles in order to prevent asthma attacks. These life style modifications, such as avoiding allergens or having to limit physical activity, sometimes force adolescents to compromise their social life. On the other hand, the impact of such life style modifications on their social life may in turn force adolescents to give up adhering to asthma regimes. Indeed, adolescents are learning to be more independent while they enjoy a more complicated social life at home and at school than previously, and this rapid social development may thus be a great life challenge to adolescents with asthma. This thesis reports four studies which investigated the relationship between multi-dimensional asthma management (in medication and life style regimes) and the social life of young people with asthma at the transitional age from childhood to adolescence (or early adolescence, age 9-14), which also marks the transition from primary school to secondary school. In line with the literature on other adolescent chronic illnesses, study 1 demonstrated a downward trend of multi-dimensional asthma management in early adolescence. This developmental change was further investigated in study 2, 3 and 4, in which theories in behavioural psychology were followed to emphasise human behaviour influenced by the social activities and social relationships in the living environment, or the social environment. This was supplemented by theories in developmental psychology to identify relevant aspects of the social environment in early adolescence, especially the social relationships with parents, school staff and peers. Using quantitative and qualitative approaches, the studies not only supported the direct influence of asthma-specific social support, but also explored some mechanisms with which social relationships influenced asthma management in a more subtle and context-dependent way. By approaching asthma management behaviour with theories from behavioural and developmental psychology, it is also hoped that this thesis could be an example that shows the importance of recognising and to understanding the social life of young adolescents when adolescent behaviour is concerned.

Autism spectrum disorders (ASD) are neurodevelopmental disorders with multiple neurobiological aetiologies, which could be genetic, structural, metabolic or immune-mediated. ASDs are diagnosed with deficits in social communication and restricted and repetitive behaviours, and are associated with sensorial atypicalities. 30% of cases have co-existing epilepsy. A series of in vitro, in vivo and post-mortem investigations were undertaken to examine sensory atypicalities in ASD. In vitro characterisation of hippocampal neuronal cultures using immunofluorescence demonstrated the presence of multiple cell types including neurons, astrocytes and microglia. The distribution of ion channels of the Shaker family and tumour necrosis factor α receptors in astrocytes and neurons were identified but not explored further. Neuroanatomical and neuropathological investigations of primary olfactory cortex, using post-mortem stereology, demonstrated a specific increase in glial cell densities in layer II, which was negatively associated with age in ASD. Increases in glia were also associated with symptom severity and often co-localised with the presence of corpora amylacea in layer I. Qualitative analysis of the olfactory tubercle demonstrated that corpora amylacea did not extend to this neighbouring region of the primary olfactory cortex in ASD. These changes were independent of co-existing epilepsy and not observed in epilepsy without ASD. Preliminary pilot studies of the hippocampus provided a stereological sampling strategy to quantify cell densities in future investigations of this area in ASD. Neurophysiological investigations using collected magnetoencephalography data demonstrated diminished occipital gamma oscillatory synchrony in ASD in a visual time perception task. This did not always predict behavioural outcome but was specific to ASD and could not be explained simply in terms of changes in task performance. Moreover, changes in oscillatory synchrony were associated with symptom severity. These observations in primary sensory domains in post-mortem tissue and in patients suggest possible novel mechanisms in ASD and extend knowledge of the neurobiological bases of these disorders.

<p>The aim with this study was to learn about the experiences of field workers and welfare officers in the field of possible self-harm behavior among young people.Our problem was: Do field workers and welfare officers treat young people with deliberate self-harm differently and - How do field workers and welfare officers describe deliberate self- harm?</p><p>Our study was conducted through qualitative semistructured interviews with twelve interviewee’s.The result of this study shows that there is a difference in how young people with self-harm behavior are being treated - based on their gender.One possible cause for this result could be the old tradition mindset of viewing boys and girls differently – and thus, treating them differently when they seek help.Our study shows there is a possibility of treating boys and girls differently – which shows that we made a thought-provoking point</p>

The aim with this study was to learn about the experiences of field workers and welfare officers in the field of possible self-harm behavior among young people.Our problem was: Do field workers and welfare officers treat young people with deliberate self-harm differently and - How do field workers and welfare officers describe deliberate self- harm? Our study was conducted through qualitative semistructured interviews with twelve interviewee’s.The result of this study shows that there is a difference in how young people with self-harm behavior are being treated - based on their gender.One possible cause for this result could be the old tradition mindset of viewing boys and girls differently – and thus, treating them differently when they seek help.Our study shows there is a possibility of treating boys and girls differently – which shows that we made a thought-provoking point