O trabalho reflete acerca dos critérios referentes à avaliação psiquiátrica nas internações e tratamento involuntários. A restrição da liberdade é infração aos direitos do homem e, se ela é justificada em nome da patologia mental, qualificá-la é um imperativo legal e ético. Historicamente, a internação crônica em hospitais psiquiátricos levou à exclusão social e rompimento dos laços significativos da vida pessoal. Nos serviços de emergência ela é muitas vezes determinada em nome de um risco. Assim, é proposta uma análise crítica (à semelhança da desconstrução de Derrida e da genealogia de Foucault) do saber médico-psiquiátrico, que é ferramenta essencial do trabalho clínico. Um panorama dos arranjos dos dispositivos públicos de regulação das internações psiquiátricas involuntárias no ocidente mostra a inter-relação de um modelo médico com um modelo legalista (focado nos direitos dos pacientes), cada qual com seus ganhos e dificuldades. A medicalização da vida humana é um fenômeno do mundo moderno, e é vista como um processo dinâmico, onde a apropriação das categorias médicas por parte dos usuários e familiares também gera empoderamento e mudanças. Vemos como, historicamente, o viés moral da práxis realizada no hospital psiquiátrico é indissociável da construção do saber, e a psicopatologia oficial é de uma nosologia descritiva; mas o trabalho clínico permite outras psicopatologias, mais participativas, centradas na relação do sujeito com o mundo, que possam servir a ele como instrumentos de compreensão e ajuda na experiência vivida. Assim, a categoria da vontade em psicopatologia clássica adota a perspectiva aristotélica de uma deliberação racional, mas a leitura filosófica de Arendt destaca a centralidade da liberdade e da espontaneidade inerentes ao conceito. Esta dicotomia entre vontade livre e determinação traz repercussões para a clínica e para a justiça, como nos casos da avaliação da responsabilidade dos pacientes sobre seus atos. Neste campo, assim como na avaliação do juízo crítico, a ciência não garante a objetividade totalizante, deixando sempre a decisão sobre a internação psiquiátrica involuntária na dependência do político, da moral e da ética que constituem a clínica. / This work is a reflection on the criteria used in psychiatric practice to justify involuntary detention and treatment. The restriction of freedom is an infringement of human rights, and if it is to be justified on the grounds of mental pathology, it must be legally and ethically qualified. Historically, long term internment of people in psychiatric institutions led to social exclusion and the rupture of importante social and personhood ties. Emergency hospitalization is often justified on the grounds of risk. Hence, a critical analysis is offered (along the lines of Derridas deconstruction and Foucaults genealogy), of our current medical-psychiatric understanding, which is the foundation of all clinical work. An overview of the many arrangements for psychiatric involuntary detention on a variety of Western countries demonstrates an interplay between medical and legal (rights based) models. These arrangements all come with benefits and challenges. The medicalization of human life is a modern, world-wide phenomenon, and is viewed as a dynamics process where the appropriation of medical categories by users and their families also produces empowerment and change. We see how, historically, moral bias of practice performed at psychiatric hospitals is inseparable to knowledge construction, and oficial psychopathology is a descriptive nosology, but clinical practice allows other psychopathologies, more participative ones, centered on the relations between the subject and the world, which may help him to understand and survive life experiences. Thus classical pathology adopts a rational aristotelian approach to understanding the concept of Will, while the philosophical view of Arendt emphasizes the centrality of freedom and spontaneity. The inherent dichotomy between free Will and determinism leads to clinical and legal repercussions, in the case of assessing a patients level of responsibility for his actions. In this field, as in the evaluation of a patients level of insight, science does not warrant total objectivity. Hence the decisions about psychiatric involuntary detention will always depend on the basis of the complex interplay between politics, morality and ethics, basis of all clinical work.

Introdução: Evidências recentes indicam que situações de abandono, negligência e abusos são fatores de risco para desencadeamento de psicopatologias na vida adulta. Esta associação ocorre na medida em que eventos traumáticos, nas fases iniciais do desenvolvimento podem desencadear transtornos psiquiátricos graves e incapacitantes no adulto. Objetivo: O presente estudo objetivou avaliar a associação entre a ocorrência e a gravidade do Estresse Precoce (EP) e o desencadeamento de transtornos psiquiátricos em pacientes adultos em seguimento no Hospital Dia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). Metodologia: A amostra foi composta por 81 pacientes psiquiátricos avaliados através de Entrevista Clínica, de acordo com os critérios do DSM-IV, para confirmação diagnóstica, divididos em 2 grupos: 58 pacientes com presença de EP e 23 com ausência de EP. A presença de EP foi confirmada através da aplicação do Questionário Sobre Traumas na Infância (QUESI). Os pacientes também foram avaliados quanto à gravidade da sintomatologia psiquiátrica através do Inventário de Depressão de Beck (BDI), Inventário de Ansiedade de Beck (BAI), Escala de Desesperança de Beck (BHS), Escala de Ideação Suicida de Beck (BSI), Escala Hospitalar de Ansiedade e Depressão (HAD) e da Escala de Impulsividade de Barratt (BIS-11). Resultados: Na amostra avaliada, 71.6% dos pacientes sofreram algum tipo grave de EP comparados a 28.4% dos pacientes que não sofreram. Considerando-se os subtipos de Estresse Precoce avaliados, os pacientes com história de trauma apresentaram escores maiores em todos os subtipos de Estresse Precoce em comparação aos pacientes sem história de abuso. A pontuação total do QUESI também foi significativamente diferente 66.05 vs. 34.78 (p<0.001) entre os grupos. A maioria dos pacientes avaliados (n=35; 60.4%) sofreu de 3 a 5 subtipos de Estresse Precoce. Os resultados indicam que o EP está associado principalmente com o desenvolvimento de transtornos de humor e também com o aumento da gravidade dos sintomas psiquiátricos, principalmente dos sintomas depressivos, sintomas de desesperança, de ideação suicida e de impulsividade. Com relação ao diagnóstico de eixo II, o EP está associado com o desenvolvimento de transtorno de personalidade (p=0.03). Pacientes com história de abuso emocional (OR: 5.2; 95% IC, 1.9-13.5), negligência emocional (OR: 4.02; 95% IC, 1.6-10.2) e negligência física (OR: 4.0; 95% IC, 1.6-10.1) apresentam um risco de 4 a 5 vezes maior de desenvolver transtorno de personalidade. Além disso, indivíduos que sofreram abuso físico (OR: 2.46; 95% IC; 0.89-6.78), abuso sexual (OR: 2.87; 95% IC; 0.86-9.57) e negligência física (OR: 2.50; 95% IC; 0.95-6.55) possuem de 2 a 3 vezes mais chances de cometer tentativas de suicídio. Nossos dados também demonstram que entre os subtipos de EP, o abuso emocional foi associado ao desencadeamento de psicopatologias na vida adulta, principalmente com os transtornos depressivos. Além disso, pacientes com presença de abuso emocional, tiveram maior gravidade em todos os sintomas psiquiátricos, tais como: sintomas de depressão, desesperança, ideação suicida, ansiedade e impulsividade. Também foram encontradas correlações positivas entre impulsividade, ideação suicida e desesperança com os escores totais do QUESI. Conclusões: Os dados apontam para a importância do Estresse Precoce como fator desencadeante de transtornos psiquiátricos, bem como indicam que a gravidade do Estresse Precoce está associada com a gravidade dos sintomas psiquiátricos.Dessa forma, há necessidade de mais estudos que avaliem a importância dos subtipos de Estresse Precoce como fator de risco para desencadeamento de psicopatologias graves no adulto. / Introduction: Recent evidences suggest that situations of abandonment, neglect and abuse are risk factors for onset of psychopathology on adulthood. This association occurs in that traumatic events in the early stages of development and may trigger severe and disabling psychiatric disorders in adults. Objective: The present study aimed to evaluate the association between the occurrence and severity of early life stress (ELS) and the development of psychiatric disorders in adult patients of the Day Hospital Unit of the Hospital das Clinicas, Faculty of Medicine of Ribeirão Preto University of São Paulo (HCFMRP- USP). Methodology: The sample was consisted of 81 psychiatric patients evaluated by Clinical Interview according to the DSM-IV criteria for the diagnosis, divided into two groups: 58 patients with presence of ELS and 23 with absence of ELS. The presence of ELS was confirmed by the Childhood Trauma Questionnaire (CTQ). Patients also were evaluated for severity of psychiatric symptoms by the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Beck Hopelessness Scale (BHS), the Beck Scale for Suicide Ideation (BSI), the Hospital Anxiety and Depression Scale (HAD) and the Barratt Impulsiveness Scale (BIS-11). Results: In the sample studied, 71.6% of patients with some type of severe ELS compared to 28.4% of patients without ELS. Considering the subtypes of ELS evaluated, patients with a history of trauma showed higher scores in all subtypes of ELS compared to patients without a history of abuse. The total score of QUESI was also significantly different 66.05 vs. 34.78 (p<0.001) between groups. Most patients (n = 35, 60.4%) suffered 3-5 subtypes of ELS. The results indicate that ELS is associated mainly with the development of mood disorders and also with increasing severity of psychiatric symptoms, especially the depressive symptoms, hopelessness, suicidal ideation and impulsivity. Regarding the diagnosis of axis II, ELS is associated with personality disorder (p=0.03). Patients with emotional abuse (OR: 5.2, 95% CI, 1.9-13.5), emotional neglect (OR: 2.4, 95% CI, 1.6-10.2) and physical neglect (OR: 4.0, 95% CI, 1.6-10.1) at 4-5 fold higher risk of personality disorder. In addition, individuals who suffered physical abuse (OR: 2.46, 95% CI, 0.89-6.78), sexual abuse (OR: 2.87, 95% CI, 0.86-9.57) and physical neglect (OR: 2.50; 95% CI, 0.95-6.55) at 2-3 fold higher to commit suicide attempts. Our data also showed that among the subtypes of ELS, emotional abuse was associated with the onset of psychopathology in adulthood, especially in depressive disorders. Furthermore, patients with presence of emotional abuse, had more severe psychiatric symptoms at all, such as depressive symptoms, hopelessness, suicidal ideation, anxiety and impulsivity. We also found positive correlations between impulsivity, suicide ideation and hopelessness with the total scores of the QUESI. Conclusions: These data demonstrate the importance of ELS as a trigger for psychiatric disorders, and indicate that the severity of ELS is associated with the severity of psychiatric symptoms. Therefore, further studies are needed to assess the importance of subtypes of ELS as a risk factor for onset of severe psychopathology in adults.

Com internações psiquiátricas criteriosas e marcadas por períodos mais curtos de institucionalização, pacientes e familiares se tornaram cada vez mais os principais provedores de cuidados em saúde mental. Nesse contexto a cronicidade dos transtornos mentais leva estas pessoas a conviverem com o processo de internação-reinternação, e suas as atividades cotidianas se organizam em torno das possibilidades de tratamento do transtorno mental. O objetivo deste trabalho foi conhecer quem são os egressos de internação e seus cuidadores em relação à: características sócio-demográficas; adesão do paciente ao tratamento psicofarmacológico, manifestação de sintomas psicopatológicos, ocorrência de reinternação e sobrecarga dos cuidadores. Foram entrevistados 48 pacientes e 21 cuidadores. Verificou-se que os egressos de internação psiquiátrica nessa amostra são em sua maioria mulheres (62,5%), residem com familiares (93,8%), com casa própria (70,8%), onde coabitam quatro pessoas (58,4). A renda individual não ultrapassou um salário mínimo para 66,7% dos pacientes, observando que 54,2% possuem até o primeiro grau completo de escolaridade e apenas 14,6% deles exercem algum tipo de trabalho regularmente. A manifestação de sintomas psiquiátricos esteve presente entre os pacientes e mostrou correlação com reinternação e grau de adesão ao tratamento psicofarmacológico. Entre os egressos 70,8% foram classificados com baixo grau de adesão ao tratamento medicamentoso. O baixo grau de adesão ao tratamento medicamentoso é fator relacionado à sobrecarga familiar, porém não é seu determinante. Sabe-se que pacientes com boa adesão ao tratamento têm menos riscos à ocorrência de recaídas e reinternações, mas não estão livres de suas doenças e de todo fardo que essa acarreta em suas vidas. Todos os cuidadores dessa amostra possuíam parentesco com os pacientes e para esses o cuidado sempre trouxe algum grau de sobrecarga. Intervenções de manutenção ao tratamento, educação, ventilação e alívio de crises podem buscar atender à demanda de cuidado dessas pessoas, não se restringindo a apenas garantir adesão ao tratamento psicofarmacológico, mas também visando identificar e minimizar riscos, trabalhar carências e os conflitos sociais, emocionais e financeiros gerados pela manifestação crônica da doença mental. Pesquisas e intervenções acerca das necessidades dos pacientes egressos de internação e de seus cuidadores são importantes para uma atuação sistematizada dos profissionais inseridos em serviços de saúde mental. / With severe psychiatric institutionalizations and shorter periods of institutionalization, familiar and patients had become each time more the main suppliers of cares in mental health. In this context the severity of the mental illness takes these people to coexist the process of restabilization and rehospitalization, and this daily activity if organized around the possibilities of treatment of illness. The objective of this work was to know who is the outpatients of psychiatric institucionalization and this family caregivers in relation to: demographic data characteristics; adherence to pharmacological treatment, psychiatric symptoms manifestation, rehospitalization and family burden. 48 patients and 21 family caregivers participated. The outpatients of psychiatric institucionalization in this sample are in majority women (62,5%), inhabit with family (93,8%), with proper house (70,8%), where four people cohabit (58,4). The individual income did not exceed a minimum wage for 66,7% of the patients, observing that 54.2% possess until the first complete degree of scholl and only 14.6% of them exert some type of work regularly. The manifestation of psychiatric symptoms was present between the patients and showed to correlation with rehospitalization and poor adherence to pharmacological treatment. Between outpatients 70.8% they had been classified with low degree of adherence to the pharmacological treatment. The low degree of adherence to the pharmacological treatment is factor related to the family burden, however it is not its determinative one. It is known that patient with good adherence to treatment they have little risks to the occurrence of fallen again and rehospitalization, but are not free of its illnesses and all pack that this causes its lives. All family caregivers of this sample have kinship with the patients and for these the care always brought some degree of overload. Interventions of maintenance to the treatment, education, ventilation and relief of crises can search to take care of to the social, emotional and financial demand of care of these people, if not restricting only to guarantee adhesion to the psychopharmacology family caregivers treatment, but also aiming at to identify and to minimize risks, to work lacks and conflicts generated by the chronic manifestation of the insanity. Research and interventions concerning the necessities of outpatients of psychiatric institucionalization and this family caregivers are important for a more efficient performance of the inserted professionals in services of mental health.

M.A. (Social Work) / South Africa is a society undergoing major and rapid social change. An understanding of psychiatric services in the psychiatric hospital should also be identified within this context. The needs of the mentally ill and other interested parties will determine the extent of the services that need to be rendered. The social worker as part of the interdisciplinary team in the hospital, must have a clear perception of her professional role in order to render a relevant service. Social work must become more responsive to the consumers' needs and allow itself to be shaped by the context in which it is practised. In this study the role of the social worker in Weskoppies Hospital was identified by means of a descriptive research design with qualitative and quantitative methods of data collection. The qualitative research was done by means of in depth interviews and focus groups with interested parties. The quantitative research was done by means of questionnaires completed by patients of the hospital. A model for the role description of the social worker was derived from a literature study; the view of Lister, as described by the authors Hepworth & Larsen; the view of other authors and the results of the qualitative and quantitative research. The results of the research confirmed a need for social work services in Weskoppies Hospital. The greatest need expressed, was a need for help with material problems, followed by a need for help to be linked with other resources. Although community involvement was emphasised, there still was a need for individual counseling and support. Other important roles were also identified. The model serves as an integrated description of the role of the social worker in the hospital. From the results of the research it was thus possible to convey a clear picture of the role of the social worker in Weskoppies Hospital. Hopefully this will enable the social workers in the hospital to render a better and more understanding service to the patients, hospital and community.

Bakgrund: Gungstolsterapi som omvårdnadsåtgärd är outforskat inom den psykiatriska heldygnsvården. Vetenskapliga studier av den typ av gungstol som här studerats har inte gått att hitta. Syfte: Syftet med studien var att utvärdera gungstolsterapi som omvårdnadsåtgärd vid en psykiatrisk heldygnsvårdsavdelning. Metod: En naturalistisk studie med både kvantitativa och kvalitativa inslag genomfördes. Under studieperioden fick patienter som vårdades på en psykiatrisk heldygnsvårdsavdelning lämna självskattningar på en VAS-skala avseende sitt mående före och efter genomförd gungstolsterapi. Patienterna kunde också lämna en skriftlig kommentar om gungningen. Resultat: Resultatet visar att deltagarna skattat en genomsnittlig förbättring motsvarande 16%-enheter i sitt generella mående efter genomförd gungning. Genomsnittliga gungtid var 33 min/gungtillfälle. Majoriteten av patienterna som deltog i studien har bipolär sjukdom. Många deltagare föredrog att gunga en viss del av dygnet. Innehållsanalysen av kommentarerna ledde till att fem kategorier bildades som sammanfattades i temat "En stol som berör". Den genomförda studien visar att patienterna generellt sett upplevde ett ökat välbefinnande efter gungstolsterapin. Studien visar också att inga allvarliga händelser inträffat vid användningen av gungstolen. Resultatet i de båda delarna av studien harmonierar väl med varandra. Slutsats: Studien ger underlag att rekommendera patienter gungstolsterapi för att förbättra sitt mående eller i symtomlindrande syfte. Genomgången visar att många patienter har individuella preferenser för sitt gungande. Gungstolsterapi bör ses som en hälsofrämjande egenvårdsåtgärd som patienten kan utföra dygnet runt och som kan läggas in i patientens vårdplan. / Background: Rocking chair therapy has been poorly researched. There are no scientific research studies where the current rocking chair was evaluated. Aim: The aim of the study was to evaluate rocking chair therapy as a nursing intervention in an inpatient psychiatric setting. Method: A mixed method design, combining quantitative and qualitative approaches, was used. The participants were asked to rate their well-being in a form by using a Visual Analogue Scale (VAS) before and after rocking chair therapy. Participants also had the possibility to leave free text comments in the form. Results: The participants rated a 16% increase in their well-being after using the rocking chair. The average rocking time was 33 minutes. The majority of the participants are diagnosed with bipolar disorder. Many participants preferred to use the rocking chair during a specific time frame every day. The content analysis resulted in five categories and the underlying meaning could be expressed by the theme "Moving emotions". No adverse effects were recorded during the study. Both the quantitative and qualitative analysis show positive results and there are no contradictions in the results. Conclusion: This study support the mental health nurse to recommend psychiatric patients to try rocking chair therapy as a way to increase well-being or reduce distress, it is also a method well suited for self-management. Each patient has his/her own preferences for using rocking chair therapy. The use of rocking chair therapy can easily be included in the patient’s personal care plan.

Background: Psychiatric inpatient staff members work with arguably the most challenging service users. However, reference to these challenges often does not go beyond ‘challenging behaviour’, offering no insight into the actual presentation, thus preventing formulation of the perceived challenges, or subsequent interventions. Moreover, studies have shown that staff responses to challenging presentations can impact on both the staff member and the service user. In particular, staff causal attributions have been shown to impact on their therapeutic response (Apel & Bar-Tal, 1996), as well as being associated with staff emotions (Colson et al., 1987). In turn, the emotional response has been found to be associated with coping, both of which have also been found to effect staff behavioural response, as well as staff members’ psychological well-being (Wykes & Whittington, 1998). However, there have been limited studies assessing these relationships with psychiatric inpatient staff. This may be due to the lack of assessment tools developed for this staff group to measure these particular domains. A specifically designed tool would enable consistent assessment to take place to build on our theoretical knowledge of psychiatric inpatient staff members’ perceived challenges, and their responses to them, as well as highlight specific areas within these domains where further staff training and support is required. Aims: The first aim of the study was to explore psychiatric staff’s views on the challenges they faced when working with service users in inpatient settings, their emotional responses, attributions, and coping strategies about those challenges and then to develop a measure which would accurately capture these (the SEACCS). The second aim was to assess the reliability of the new scale as well as explore relationships within the SEACCS. Finally, the third aim was to assess content and face validity, as well as conduct preliminary psychometric investigations of the construct validity of the newly developed measure. Method: The study was conducted using various methods across three phases. In order to generate items for the SEACCS, a systematic review of the relevant literature and semi-structured interviews took place during the first phase. Secondly, the results of Phase I were combined in order to develop and construct the SEACCS. The third phase involved a postal survey of the SEACCS (including re-test), followed by psychometric investigations to scrutinise the items, explore the reliability, and construct validity of the SEACCS.Results: Twenty three studies were included in the systematic review. The results highlighted inconsistent measurement and findings of the domains concerned. Seven multi-disciplinary staff interviews took place. Thematic analysis was used to conduct four separate analyses focusing on each of the research questions. Several themes and sub-themes were found. Themes such as: ‘Engagement’, ‘Attributions of controllability’, and ‘Behavioural responses’. Findings from the review, thematic analyses, and consultation groups (content and face validity) were combined in order to develop the 64 item SEACCS. A total of 76 multi-disciplinary psychiatric inpatient staff members completed the SEACCS, 15 of which completed re-tests. No items were removed following item scrutiny assessments. Preliminary psychometric investigations indicated good reliability, significant relationships across domains within the SEACCS, and partial construct validity with the GHQ-28.Conclusion: The results of the current study provide the first step in the development and construction of a clinically relevant tool that can be used to assess these domains. The methodological limitations and clinical implications are considered, and future directions for research in this area are suggested.

Abstract The aim was to describe the narratives unfolding in cooperative team meetings in acute psychiatric care. The cooperative team meeting is based on cooperative care, in which power and responsibility are shared between the participants. The participants in cooperative team meeting are the patient, her/his significant others and health care professionals. The aim of these meetings is defined based on the patient's need for care. The purpose of the study was to produce new knowledge about cooperative team meetings in psychiatric care. The results can be used to develop psychiatric care and the processes of learning and studying to nurse. The study approach was narrative, and it was focused on narratives in the cooperative team storytelling process. The data consisted of 11 videotaped cooperative team meeting in two acute psychiatric wards. The participants in each case consisted of a voluntary patient, his/her significant others, primary physicians, nurses and other experts. The research was a process. The spoken narratives in cooperative team meetings were approached using the methods of "Categorical-Content" reading and dialogue analysis based on a narrative approach. The unspoken narratives were unfolded using the QRS NVivo computer program and the "Holistic-Content" reading method. In the first phase, the silent narrative "shame" was found. In the second phase, the narratives "active" and "passive participation" based on cooperative care were found. In the third phase, the spoken and unspoken combined narrative "Shared-rhythm cooperation" was found. According to the results, the cooperative team meeting consisted of unspoken narratives. The cooperative team meeting was based on cooperative care if the participants defined and shared the topic of discussion and had eye contact and the authoritarian participant gave space for expression. The cooperative team meetings required open-ended and reasonable questions by the health care professionals. Furthermore, the interpretation was to be based on the patient's or the significant other's narratives and the meanings the events had had for them. The participants were able to introduce their narratives to the storytelling process if they had enough time. Shared understanding was possible if all participants' narratives were in interaction with each other. The cooperative team meeting was expert-initiative, if the storytelling was based on the professionals' narratives. The expert-initiative storytelling consisted of control, monologue, unreadable faces and immobility. The main goal was to elicit information of the patient, and the role of the patient and his/her significant others was to be a passive recipient. / Tiivistelmä Tutkimuksessa kuvataan psykiatrisen yhteistyöneuvottelun keskustelussa rakentuvia kertomuksia. Yhteistyöneuvottelu perustuu yhteistoiminnallisen hoidon lähtökohtiin, jossa valta ja vastuu ovat jaettu siihen osallistuvien kesken. Siten yhteistyöneuvottelu on psykiatrisen potilaan, hänen määrittelemiensä läheisten ja hänen hoitoonsa osallistuvien asiantuntijoiden potilaan tilanteeseen perustuva tapaaminen. Tutkimuksessa on tuotettu uutta tietoa yhteistoiminnallisesta yhteistyöneuvottelusta psykiatrisessa hoidossa. Tulosten perustella voidaan kehittää hoitotyön käytäntöä ja koulutusta. Tutkimuksen lähestymistapa oli narratiivinen ja tutkimuksen kohteena oli yhteistyöneuvottelun kertomistilanteessa rakentuvat kertomukset. Tutkimusaineisto muodostui 11 videoidusta yhteistyöneuvottelusta kahdelta psykiatriselta akuuttiosastolta. Näihin yhteistyöneuvotteluihin osallistuvat olivat vapaaehtoisia potilaita, hänen nimeämiään läheisiä, lääkäreitä, hoitajia ja muita asiantuntijoita. Tutkimus eteni prosessina. Yhteistyöneuvottelun sanallisia kertomuksia rakennettiin narratiivisella "Categorical-Content" - ja dialogianalyysi lukutavoilla. Sanattomia kertomuksia rakennettiin QRS NVivo-tietokoneohjelmalla ja " Holistic-Content"- lukutavalla. Prosessin ensimmäisessä vaiheessa löydettiin yhteistyöneuvottelun kertomaton kertomus "häpeä". Prosessin toisessa vaiheessa rakentui yhteistoiminnallisuutta kuvaavat "aktiivinen-" ja "passiivinen osallistuja"- kertomukset. Kolmannessa vaiheessa rakentui sanallisen ja sanattoman kertomisen yhdistävä "jaettu rytminen yhteistyö"-kertomus. Tulosten mukaan psykiatrinen yhteistyöneuvottelu sisälsi kertomatonta kertomusta. Psykiatrinen yhteistyöneuvottelu oli yhteistoiminnallista, jos siihen osallistujat määrittelivät ja jakoivat yhteisen kertomisen kohteen, osallistujilla oli katsekontakti ja auktoriteetti antoi tasapuolisesti tilaa kaikille osallistujille. Yhteistoiminnallisuus edellytti asiantuntijoilta avoimia ja perusteltuja kysymyksiä. Lisäksi se edellytti, että asiantuntija vahvisti kertomisen seurauksena syntyvän tulkinnan potilaalta. Yhteistoiminnallinen hoito edellytti myös aikaa, jotta kaikki voivat tuoda näkökulmansa yhteisen kertomuksen rakentamiseen. Jaettu ymmärrys potilaan tilanteesta mahdollistui, jos kaikkien osallistujien kertomukset olivat vuorovaikutuksessa keskenään. Psykiatrinen yhteistyöneuvottelu oli asiantuntijalähtöistä, jos yhteistyöneuvottelun sisältöä rakennettiin asiantuntijoiden kertomuksista ja asiantuntijat pitäytyivät omissa kertomuksissaan. Asiantuntijalähtöinen kertominen sisälsi kontrollointia, monologia, ilmeettömyyttä ja eleettömyyttä. Asiantuntijalähtöisen kertomuksen pääpaino oli tietojen keruussa, tällöin potilaan ja hänen läheisensä tehtävänä oli tiedon antaminen.

[pt] Neste trabalho abordam-se questões relativas a como a noção de Inserção Social tem sido interpretado pelos profissionais do Campo da Assistência em Saúde Mental. Inicialmente, é feita uma apresentação da formação do Campo Social e das mudanças que nele têm ocorrido a partir das últimas décadas. A nova questão social que é a exclusão social é apresentada, mas também o contrato social e a cidadania que lhes fazem contraponto. A partir desta realidade introduz-se o Campo da Saúde Mental, sua constituição, e suas questões de base, a tutela, periculosidade e cuidado. Em seguida, a discussão é trazida para o contexto brasileiro e discute-se a Reforma Psiquiátrica Brasileira, forma mais atual do Campo da Assistência em Saúde Mental,e como se pensa a Inserção Social em seu contexto. Finaliza-se com a apresentação do percurso feito para se constituir uma Rede Municipal de Assistência em Saúde Mental. / [en] In this work some of the questions related to how the Social Insertion notion has been used by the professionals on the Psychiatric Reform Field. First, a presentation of the Social Field constitution and the changes that have happened in it on the past decades is presented. The new social question which is the social exclusion is presented, and also the social contract and citizenship which oppose it.Based on that reality, the Mental Health Field is introduced, its constitution and its basic questions: dangerousness, tutelage and the care. Then, the discussion is presented about the Brazilian context and the Brazilian Psychiatric Reform, the Mental Health Field's new face, and how the Social Insertion on the former context has been thought. Finally, a presentation of the paths that have been followed so that a local Mental Health Help Net is presented.

DNA methylation is necessary for learning, memory consolidation and has been implicated in a number of neuropsychiatric disorders. Obtaining high quality and comprehensive data for the three common forms of methylation in brain is challenging for methylome-wide association studies (MWAS). To address this we optimized a panel of enrichment methods for screening the brain methylome. Results show that these enrichment techniques approach the coverage and fidelity of the current gold standard bisulfite based techniques. Our MBD-based method can also be used with low amounts of genomic material from limited human biomaterials. Psychiatric disorders have high prevalence and are often chronic making them a leading contributor to disability. Major depressive disorder (MDD) has a lifetime prevalence of ~15% and high recurrence leading to substantial morbidity and costs to society. The underlying biological processes that contribute to MDD are poorly understood. Noting the importance of DNA methylation in neurobiology, we conducted the largest MWAS in human post-mortem brain uncover novel candidate genes and biomarkers associated with MDD. The top result of this MDD MWAS was within the gene ANKS1B. This gene has been implicated in many past genetic studies of psychiatric disorders and has experimental support as a regulator of neurotransmission. Targeted epigenetic editing technologies allow for precise modification of DNA methylation in living cells. However, an appropriate model system is critical to properly interpreting such experiments. An accelerated protocol for differentiating Ntera2 cells into human neurons was developed for this purpose. Ntera2-derived neurons express key neuronal markers and are well suited to use in epigenetic editing experiments. Concurrently, the generation of the reagents necessary for recapitulating the aberrant methylation at ANKS1B linked to MDD was undertaken. Using a modified CRISPR/Cas9 approach demethylating enzyme was directed to target sites to attempt perform editing of DNA methylation. Results indicate that significant but biologically irrelevant changes to methylation at ANSK1B were achieved. The novelty of the technology employed presented challenges to the success of the current work. However, the field of epigenetic editing is advancing rapidly and will remain an attractive method for functional characterization of future MWAS findings and basic neuroscience research.

Hot och våld är vanligt förekommande inom psykiatrisk slutenvård och utgör ett betydande problem både för patienter som vårdas och för de sjuksköterskor som arbetar inom psykiatrisk verksamhet. Det finns ett ansvar hos sjuksköterskor inom psykiatrisk vård att hantera situationer med patienter där inslag av hot och direkt våld är en realitet utan att tillfoga patienten onödigt lidande. Det krävs kunskap och erfarenhet men också en förståelse inför patientens situation och egna upplevelser. Forskning som rör arbetsmiljön inom psykiatrisk slutenvård visar på att förekomst av hot och våld kan innebära relativa arbetsmiljöproblem för de sjuksköterskor som arbetar där. Detta kan resultera i psykosociala problem och med minskad arbetsglädje som följd. Känslor av skuld och självanklagelser drabbar ofta dem som möter hot och våld i sitt arbete. När sjuksköterskor känner bristande förmåga att klara av sitt arbete på grund av hot och våld kan känslan av misslyckande i sin yrkesroll påverka möjligheten till genuina möten med patienter. Denna studie syftar till att försöka beskriva sjuksköterskors upplevelser av ett hotfullt möte mellan dem och patienter. Data har insamlats genom kvalitativa intervjuer. Analysen har gjorts utifrån en innehållsanalys. Försökspersonerna har alla en specialistutbildning i psykiatri och alla arbetar på en allmänpsykiatrisk klinik. Resultatet visar på att sjuksköterskor som har förmågan att visa omtanke och respekt och att kunna vara närvarande under den hotfulla situationen har störst möjlighet att nå fram till patienten. När sjuksköterskorna känner som mest rädsla och osäkerhet har de en tendens att bli som mest påtvingande i sin attityd gentemot patienten. Det hotfulla mötet hotar den betydelsefulla relationen mellan patient och sjuksköterska där sjusköterskan har den svåra uppgiften att få till stånd en dialog som präglas av respekt och närvaro gentemot patienten trots att mötet kan utvecklas till en våldsam situation. En slutsats av studien är att en rädd och osäker sjuksköterska har minskad förmåga att erbjuda en genuin och rak kontakt gentemot patienten. Den andra slutsatsen är att möjligheten att förhindra en hotfull situation är som störst innan ett möte övergår i en hotfull situation mellan en patient och en sjuksköterska. / Threats and violence are common in psychiatric care and are a significant problem for both patients who are under treatment and for the nurses who work within the psychiatric healthcare. The nurses within the psychiatric healthcare has a responsibility to handle the situations with patients were elements of threat and violence are a reality without inflicting unnecessary suffering. It requires knowledge and experience but also an understanding for the patients situation and previous experiences. Research that concerns working environment within the psychiatric care shows that occurrence of threat and violence may result in working environmental problems for the nurses. The consequences that may occur among the nurses are psycho social problems with a result of demised work pleasure. Nurses who face threat and violence at their jobs has often feelings of guilt and self accusations. The feelings of failure affect the possibility of a genuine contact with the patient when nurses feel a lack of ability of coping with their jobs. This study is aimed to try to describe psychiatric nurses’ experiences of threatening meetings between them and patients. Data has been collected through qualitative interviews. The analysis has been done on the basis of a content analysis. All the subjects of the interviews have a specialist education within psychiatric care and works on a psychiatric clinic. The result shows that nurses who have the ability to show care and respect and also being able to be present in threatful situations have the best possibility to achieve a genuine dialog with the patient. When nurses are feeling fear and insecurity at its most they tend to be even more forced in their attitude against the patient. The threatful meeting threatens the important relation between the patient and the nurse who has the difficult task to achieve the dialog which is based on respect and presence towards the patient despite the fact that the meeting can evolve into a threat full meeting. One conclusion of the study is that a frightened and insecure nurse has a diminished capability to offer a genuine contact with the patient. The second conclusion is that the best possibility to prevent a threatful situation is before a meeting turns into a threatful situation between the patient and the nurse.