Introdução: Os objetivos do tratamento do Transtorno Afetivo Bipolar (TB) foram além da recuperação sintomática, incluindo também a recuperação funcional, foco das abordagens psicossociais como a psicoeducação. Objetivo: Verificar o impacto da psicoeducação na recuperação sintomática e funcional dos pacientes bipolares. Métodos: Trata-se de um estudo randomizado controlado com 51 pacientes portadores de TB tipo I ou II, de acordo com os critérios do DSM-IV TR; em remissão, com pontuação 7 na escala HDRS 17 itens e 6 na escala YMRS; em acompanhamento ambulatorial no GRUDA do IPq HC FMUSP, ou em acompanhamento psiquiátrico particular ou ainda no CAPS Del Rei MG. A distribuição dos sujeitos nos grupos foi feita por meio de randomização estratificada, em que os sujeitos, primeiramente, foram divididos em blocos estratificados de acordo com gênero, faixa etária, número de episódios anteriores da doença, escolaridade e estado civil. Posteriormente, dentro de cada bloco, os sujeitos foram distribuídos nos grupos aleatoriamente, por meio do lançamento da moeda ao ar repetidas vezes, em que GE foi cara e GC coroa. Assim, foram formados dois grupos homogêneos, evitando-se tendências e favorecimentos. O grupo experimental foi composto de 29 pacientes que receberam, além do tratamento farmacológico, a intervenção psicoeducacional. O grupo controle foi composto de 22 pacientes que receberam, além do tratamento farmacológico, encontros placebo. Entende-se placebo por intervenção em relaxamento. Ambos os grupos tiveram 16 encontros, duas vezes por semana, com 90 minutos de duração. Os instrumentos de avaliação foram aplicados no início (TA), no meio (TB) e no fim do tratamento (TC), e no seguimento de seis (TD) e 12 meses (TE). As escalas utilizadas para avaliar a recuperação sintomática foram: HDRS para a depressão, e YMRS, para a mania. As escalas para avaliar a recuperação funcional foram: WHOQOL-Bref e Escala de Adequação Social- EAS. A melhora clínica global foi avaliada pela CGI. Resultados: HDRS aumentou de forma significativa ao longo do tempo (p=0,002), não houve diferença entre os grupos (p=0,890) e como a interação não foi significativa (p=0,373), o aumento foi equivalente entre os grupos; YMRS não alterou de forma significativa ao longo do tempo (p=0,359) e também não houve diferença significativa entre os grupos (p=0,294), as médias iniciaram baixas e mantiveram-se baixas; WHOQOL-Bref no domínio 4, houve uma tendência de diminuição das médias ao longo do tempo em ambos os grupos (p=0,059), apesar de não ter havido diferença significativa entre os grupos (p=0,175), parece haver uma tendência (p=0,084) do GE diminuir mais do que o GC; e EAS aumentou de forma significativa ao longo do tempo (p=0,044), não houve diferença entre os grupos (p=0,167) e, como a interação não foi significativa (p=0,410), o aumento foi equivalente nos dois grupos. CGI após o término do tratamento: 92,5% da PE e 78,2% do GC apresentaram melhora clínica global; após um ano, foram: 87,5% da PE e 75,1% do GC. Conclusão: Os resultados mostraram que a PE tendeu a impactar positivamente no bem estar do indivíduo em seu meio ambiente; promoveu uma melhora clínica global maior em todos os tempos avaliados com relação ao controle e essa melhora foi mantida em um ano; PE e controle mantiveram a recuperação sintomática maníaca. Apesar disso, a PE não protegeu de recaídas depressivas e de piora da adequação social. Portanto, a PE mostrou-se eficaz no bem-estar do paciente em seu meio ambiente, na melhora clínica global e na proteção de recaídas maníacas. / Introduction: The goals of treatment of bipolar affective disorder (BD) expanded beyond symptomatic recovery, also including functional recovery, the focus of psychosocial approaches as psychoeducation. Objective: To investigate the impact of psychoeducation (PE) in the symptomatic and functional recovery in bipolar patients. Methods: This is a randomized controlled trial with 51 patients with BD type I or II, according to the DSM-IV TR; in remission (score 7 on the HDRS - 17 items and 6 on the YMRS); in outpatient in the GRUDA IPq HC FMUSP, or in psychiatric care in private or CAPS Del Rei - MG. The distribution of subjects in the groups was made by stratified randomization, the subjects first were divided into blocks stratified by gender, age, number of previous episodes of illness, education and marital status. Subsequently, within each block, subjects were randomly divided into two groups, through the launch of the coin again and again, in which experimental group (EG) was expensive and control group (CG) crown. Thus were formed two homogeneous groups, avoiding trends and favors. The EG consisted of 29 patients who received, in addition to pharmacological treatment, the psychoeducational intervention. The CG consisted of 22 patients who received, in addition to pharmacological treatment, meetings \"placebo\". Both groups had 16 meetings, twice a week with 90 minutes. The assessment instruments were applied at the beginning (TA), in the middle (TB) and at the end of treatment (TC), and following six (TD) and 12 months (TE). The scales used to assess symptomatic recovery were: HDRS for depression, and YMRS for mania. Scales to assess functional recovery were WHOQOL-Bref and the Social Adjustment Scale- EAS. Clinical improvement was assessed by the CGI. Results: HDRS increased significantly over time (p = 0.002), no difference between groups (p = 0.890) and the interaction was not significant (p = 0.373), the increase was equivalent between groups; YMRS not change significantly over time (p = 0.359) and there was no significant difference between groups (p = 0.294), the averages started lower and remained low; WHOQOL-Bref in 4, there was a trend decrease in mean over time in both groups (p = 0.059), although there was no significant difference between groups (p = 0.175), there seems to be a trend (p = 0.084) lower in the EG than the CG , and EAS has increased significantly over time (p = 0.044), no difference between groups (p = 0.167), and the interaction was not significant (p = 0.410), the increase was equivalent in both groups. CGI after the end of treatment: 92.5% for PE and 78.2% of the control group showed clinical improvement overall, after one year were 87.5% for PE and 75.1% of GC. Conclusion: The results showed that the PE has tended to impact positively on the welfare of individuals in their environment, promoted a greater overall clinical improvement at all times evaluated than control and this improvement was maintained at one year. EG and CG maintained recovery symptomatic manic. Nevertheless, the PE did not protect depressive relapses and worsening of social adequacy. Therefore, the PE was effective in well-being of the patient in his environment, the global clinical improvement and protection of manic relapses.

As novas tecnologias têm sido aliadas a uma série de programas que visam melhorar a vida dos idosos. Embora o número de trabalhos que aliem novas tecnologias às intervenções psicoeducacionais seja crescente, a produção ainda é timida e não há registros de estudos que aliem dispositivos móveis com intervenções psicoeducativas visando promover a prevenção de quedas em idosos. Objetivos: Apresentar evidências científicas de uma revisão sistemática da literatura sobre o efeito de intervenções educativas associadas ou não ao treinamento físico no medo de quedas em pessoas idosas. Apresentar o desenvolvimento de uma intervenção educativa e tecnológica para prevenção de quedas em pessoas idosas. Apresentar os resultados do piloto de uma intervenção educativa e tecnológica para prevenção de quedas em pessoas idosas quanto a caracterização da amostra e teste piloto da intervenção psicoeducativa isolada e associada ao treinamento físico. Métodos: Foram convidados a participar do estudo 47 indivíduos participantes da Universidade Aberta a Terceira Idade (UnATI| EACH-USP) matriculados no programa Equilibre-se, com idade igual ou superior a 60 anos, randomizados e divididos em quatro grupos distintos: 1) grupo psicoeducativo; 2) grupo de psicoeducação e exercício físico; 3) grupo exercício e 4) grupo controle. Os participantes do grupo de intervenção psicoeducacional participaram de um encontro semanal de 60 minutos cada, durante 16 semanas e após o término desta intervenção, foram convidados a testar um jogo educativo. Esse procedimento foi realizado após os três últimos encontros com o grupo psicoeducativo. Os participantes do grupo psicoeducacional combinado com exercício realizaram adicionalmente ao grupo psicoeducativo mais 60 minutos de exercício físico, duas vezes na semana, durante 16 semanas. O desenho do presente estudo é multifatorial. A testagem ocorreu de maneira duplo-cega. O grupo controle foi convidado a participar da intervenção ao término da pesquisa. Todos os participantes preencheram o Termo de Consentimento Livre e Esclarecido. Instrumentos: Dados de caracterização e identificação (nome, sexo, idade, escolaridade, estado civil); Questionário sobre doenças autorrelatadas; Questões autorrelatadas sobre quedas; Addenbrooke Cognitive Examination Revised (ACE-R); v Escala de Depressão Geriátrica (EDG); Falls Efficacy Scale-International (FES-I); Falls Risk Awareness Questionnaire (FRAQ); subtestes de Dígitos Diretos e Indiretos da Escala de Inteligência Wechsler para Adultos (WAIS-III); subteste Códigos da WAS-III; Tteste Trilhas, versão A e versão B. Resultados: A revisão de literauta mostrou que embora não exista um consenso sobre o melhor tipo de intervenção para prevenir quedas em idosos, a literatura tem apresentado que intervenções multifatoriais podem gerar bons resultados. O Equilibre-se também apresentou bons resultados e aponta que a psicoeducação combinada a tecnologia pode ser utilizada em programas de prevenção de quedas em idosos. O piloto de usabilidade do jogo apresentou bons resultados, sugerindo que o jogo pode ser uma boa ferramenta tecnológica a ser empregada em programas de prevenção de quedas / The new technologies have been combined with a series of programs aimed at improving the lives of the elderly. Although the number of works that combine new technologies with psychoeducational interventions is increasing, production is still timid and there are no records of studies that include mobile devices with psychoeducational interventions aimed at promoting the prevention of falls in the elderly. Objectives: To present scientific evidence of a systematic review of the literature on the effect of educational interventions associated or not with physical training on fear of falls in the elderly. To present the development of an educational and technological intervention to prevent falls in the elderly. To present the results of the pilot of an educational and technological intervention to prevent falls in the elderly regarding the characterization of the sample and pilot test of the psychoeducational intervention isolated and associated to the physical training. Methods: Participants were enrolled in Equilibre-se program, aged 60 years or older, randomly divided into four groups: (1) psychoeducational group; 2) psychoeducation and physical exercise group; 3) group exercise and 4) control group. Participants in the psychoeducational intervention group participated in a weekly meeting of 60 minutes each, during 16 weeks and after the end of this intervention, were invited to test an educational game. This procedure was performed after the last three meetings with the psychoeducational group. Participants of the psychoeducational group combined with exercise performed the psychoeducational group plus 60 minutes of physical exercise, twice a week, for 16 weeks. The design of the present study is multifactorial. Testing occurred in a double-blind fashion. The control group was invited to participate in the intervention at the end of the research. All participants completed the Free and Informed Consent Form. Instruments: Characterization and identification data (name, sex, age, schooling, marital status); Questionnaire on self-reported diseases; Self-reported fall issues; Addenbrooke Cognitive Examination Revised (ACE-R); Geriatric Depression Scale (EDG); Falls Efficacy Scale-International (FES-I); Falls Risk Awareness Questionnaire (FRAQ); Direct and Indirect Digits subtests of the Wechsler Intelligence Scale for Adults (WAIS-III); subtest WAS-III codes; The literature review has shown that although there is no consensus on the best type of intervention to prevent falls in the vii elderly, the literature has shown that multifactorial interventions can generate good results. Equilibre-se has also presented good results and points out that psychoeducation combined technology can be used in programs to prevent falls in the elderly. The game\'s usability pilot has yielded good results, suggesting that the game may be a good technological tool to be employed in fall prevention programs

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-11T12:51:05Z No. of bitstreams: 1 Valeria Lopes Leite.pdf: 454676 bytes, checksum: bd1d42fe753ae763801016c4627dc537 (MD5) / Made available in DSpace on 2015-12-11T12:51:05Z (GMT). No. of bitstreams: 1 Valeria Lopes Leite.pdf: 454676 bytes, checksum: bd1d42fe753ae763801016c4627dc537 (MD5) Previous issue date: 2013 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Este trabalho tem como objetivos: Caracterizar o perfil sócio-demográfico, clínico, índice de sobrecarga e estratégias de enfrentamento dos familiares de idosos institucionalizados; Analisar fatores que determinam a aproximação ou afastamento da família do idoso no processo de institucionalização; e Propor um Programa de Intervenções psicoeducativas para familiares de idosos institucionalizados. Método: abordagem quantitativa e qualitativa, transversal e observacional, amostra intencional não probabilística. Foram selecionados 30 familiares de idosos institucionalizados para entrevista semi-estruturada e aplicação das escalas Inventário de Sobrecarga do Cuidador (Zarit) e Inventário de Estratégia de Coping (Folkman e Lazarus). Resultados: Houve prevalência do sexo feminino (83,3%), a maior parte da amostra composta por filhos (as) (56,7%) de grau de escolaridade nível superior (70%) e classe média, resultado diferenciado na pesquisa. A maioria aposentados (63,3%) com idade média de 60,5 anos com dp= 10,7, metade do grupo apresentou algum problema de saúde, e cinco participantes usavam neurolépticos. Quanto aos idosos, a maioria das institucionalizações se deu por complicações no manejo com os sintomas comportamentais e dependência causada pela Doença de Alzheimer. Somente um idoso apresentou diagnóstico de depressão; a faixa etária variou de 64 e 96 anos e prevaleceu o sexo feminino. Nas respostas relativas ao estresse, houve baixos índices de sobrecarga dos cuidadores familiares com 14 (46,65%) com ausência de estresse, sendo 3 homens e oito outros familiares, exceto filhos (57,1%), 9 (64,3%) possuíam nível superior e somente 1 (7,1%) fazia uso de neurolépticos. Com estresse leve e moderado 13, sexo feminino e sem vínculo marital 9 (69,2%), filhas com ensino superior 10 (76,9%), com problemas de saúde 8 (61,5%) e 3 (23,1%) fazendo uso de neurolépticos. Na categoria moderada e severa 2 filhas (66,7%) e 1 (33,3%) esposa, todas do sexo feminino e com nível superior. Sobre o Inventário de estratégias de coping, foram obtidos resultados significativos para os que faziam uso de neurolépticos, ou seja, faziam mais estratégia de enfrentamento (p<0,01), os que possuíam nível superior (p= 0,05), e os homens com resultados marginais (p=0,06), porém, ao observar-se em termos absolutos nos homens, o coping foi maior em média 61,8 contra 43,6 das mulheres. Foram obtidas 4 categorias sobre a percepção do processo de institucionalização: Relação com o idoso anterior a institucionalização, discute-se a proximidade familiar e a relação conflituosa como modeladores psicossociais decisivos na atitude de como se deu o processo de institucionalização; Família e a decisão pela institucionalização, tem-se a mudança de comportamento do idoso como decisiva na opção pela internação, associada pela falta de modelos alternativos e confronto com desqualificação profissional para o cuidado domestico; Relação com o idoso depois da internação, neste momento do processo emergiram relatos de sentimento de culpa, reparação, reconhecimento do cuidado na instituição e conflito com a morte. Família e participação no cuidado na instituição referem-se a importância das visitas e o papel da família na rotina de cuidados. Conclusão: Há relação entre as estratégias de enfrentamento e participação no cuidado institucional, portanto a proposta de programa psicoeducativo traria redução do estresse e integração da família com a Instituição e potencialização dos cuidados. / The study of the family and its relationship with the institutionalized elderly: the proposal of a psychoeducational program brings to discussion the relationship between the family and the institutionalized elderly regarding the social-demographic profile of the family, data related to the level of stress and the coping strategy used by relatives in a qualitative and quantitative approach, proposing a sychoeducational program that aims to assist the family in matters of inpatient, elderly disease and care. Thirty relatives of seniors who were in Long-Stay Institutions participated in this study. The following tools were used: a semi-structured questionnaire (to evaluate the social demographic profile), a Caregiver Burden Inventory (Zarit) and a Coping Strategy Inventory (Folkman and Lazarus). The results showed the prevalence of female gender, 83.3%; most of the sample comprising sons and daughters, 56.7%; higher education prevailed, 70%, a differentiated result in the research; most of them were retired, 63.3%. Half the group had some health problem; 5 of them were neuroleptics. The average age of the participants was 60.5 years with sd = 10.7. The minimum age was 38 years old and the maximum age was 86 years old. Most of the elderly inpatients were in the range of 64 to 96 years old, diagnosed with Alzheimer’s and only one was in depression. Female gender prevailed. There were low rates of family caregiver’s burden related to stress responses. Of the 14 participants, there were 3 men, 46.6% had no stress and there were eight others, representing 57.1%. 9, 64.3%, had higher education and only one, 7.1%, used neuroleptics. With light and moderate stress, there were 13 people, the most without marriage bond; 9 daughters (69.2%) with higher education; 10 (76.9%) out of work; 8 (61.5%) with health problems and 3 (23.1%) ingesting neuroleptics. In moderate and severe category, 2 daughters out of work and with no health problems (66.7%) and 1 wife out of work and using neuroleptics (33.3%), all female and 3 (100%) with higher education. In responses regarding Coping Strategies Inventory, significant results for those who were using neuroleptics were obtained: those who ingested neuroleptics were using more coping strategy (p-value<0.01). Those who had higher education also showed significant results (p-value<0.05). The result of coping was higher in men than in women in absolute terms, on average 61.8% versus 43.6 for women. The responses of proximity and conflict concerning the relationship with the elderly before inpatient were more significant in females with their mothers. Regarding responses by hospitalization decision, it was more significant in sons (23.3%), because of behavior changes, especially aggressiveness, followed by brother’s decision (13.35%), for the lack of adequate space, fragile heath and finally the wife’s decision, because of fragile health and lack of qualified caregivers. Among the feelings that lead to family stress there is fear, insecurity, guilt and remorse. The psychoeducational program proposal turns to reducing family stress, improving the integration between the family and the institution and also the potentiation of care taken.

Notre thèse explore et analyse la situation psychosociale et scolaire d’adolescents victimes de maltraitances dans le cadre d’une approche comparée entre la métropole et la Guyane française. Nous avons examiné comment les apprentissages psycho-éducatifs et l’usage des discours de résilience participent à être thérapeutiques auprès de cette population à la lumière également de la dimension transculturelle (notamment l’impact de l’esclavage pour la Guyane qui reste encore aujourd’hui présent). Cela nous a conduit à mettre en évidence les facteurs individuels, sociaux, et les discours de résilience qui favorisent l'adaptation et le succès de ces jeunes, confrontés à de nombreuses adversités traumatiques de la vie. Notre thèse présente des résultats spécifiques de deux adolescents. Ils nous ont permis ensuite d’élaborer les facteurs communs (capacité d’attachement sécure à la relation, capacité à obtenir le soutien des autres, à avoir des objectifs personnels et/ou collectifs, le sentiment de gestion de ses émotions et affects, la capacité à mettre des mots, à donner du sens, à poser des choix possibles, l’aptitude à utiliser l’humour, etc.) qui corroborent le consensus des chercheurs les plus imminents sur la question même du processus de résilience. Autrement dit, le discours de résilience apparaît comme un facteur prépondérant dans le cheminement thérapeutique. Ainsi les apprentissages psycho-éducatifs et les différents types de discours permettent une manière de conjuguer l’espoir donné au sujet à s’affranchir de son passé traumatique, en lui permettant d’agir par lui-même et pour les autres, dans son présent et en l’autorisant à disposer d’un avenir qui répond à ses attentes. / Our thesis explores and analyses the psychosocial and school situation of teenager victims of abuse in the context of a comparative approach between continental France and French Guyana. We studied how the psycho-educational learnings and the use of resilience speeches be involved as therapeutic treatment for these victims, while considering the cross-cultural dimension (including the impact of slavery in French Guyana, which is still on today ). With regard to our approach, our results enabled us to develop the common factors (ability of safe attachment to the relationship, ability to get the support from others, ability to have personal and/or collective goals, feeling of self-managing their emotions and affects, ability to put words, to make sense, to define possible choices, to use humour, etc.) that corroborate the consensus of the most imminent researchers on the very issue of the resilience process. In light of our results, the psycho-educational learnings and various types of speeches contribute to being critical protective factors, allowing the subject to resist the trauma and to run a therapeutic approach towards the process of resilience. The uniqueness of our research, that is part of a not investigated yet dimension, could open preventive tracks to improve practice and care, and, therefore, promote the resilience of both the individuals, who need to be accompanied, and the community, given the traumatic events experienced in Guyana, especially considering the printed marks left by slavery.

Background: Depression is a major health concern and self-management of depressive symptoms using patient-initiated strategies has the potential to reduce the burden of this condition. A better understanding of behaviour change related to these patient-initiated strategies is needed. Method: This randomized controlled trial study used an online survey and Knowledge Translation and Transfer theory-based educational intervention to examine the Theory of Planned Behavior model in the context of nine patient-initiated strategies for the self-management of depression and low mood. Results: Perceived Behavioural Control was identified as the single greatest predictor of Intentions to engage in strategies. Attitudes predicted Intentions to a lesser degree. Subjective Norms were not identified as unique predictors. Theory of Planned Behavior antecedent variables together explained over one third of the variance in Intentions. Intentions to engage in patient-initiated strategies were shown, in some cases, to significantly predict actual engagement in strategies. Level of depressive symptoms did not meaningfully impact any of the antecedent variables or Intentions. Results also suggest that an educational intervention based on Knowledge Translation and Knowledge Transfer principles significantly improved both Attitudes and Subjective Norms – Physician towards patient-initiated strategies. Perceived Behavioural Control and Intentions were not improved as a result of the educational intervention. Theoretical Conclusions: Findings suggest that the Theory of Planned Behavior functions well in the context of patient-initiated strategies for depression and low mood. Perceived Behavioural Control was identified as the greatest predictor of Intentions to engage in patient-initiated strategies. Results also suggest mood difficulties are not captured by the model’s antecedent variables but instead should be included as an additional variable in this model. The findings of the current study support an integrated model of Knowledge Translation and Transfer and Theory of Planned Behavior. Practical Conclusions: The current study’s findings provide a better understanding of behaviour change in the context of patient-initiated strategies and will help guide interventions aimed at improving engagement in these behaviours. Findings also provide support and recommendations for the use of Knowledge Translation and Transfer theory-based educational interventions to improve self-management of depression and low mood.

No description available.

[pt] A presente tese teve como objetivo estabelecer um quadro teórico e empírico para desenvolver programas de intervenção para a alexitimia, uma condição relacionada com prejuízos socioemocionais. A tese é composta por quatro artigos. O artigo 1 validou uma versão adaptada do Bermond–Vorst Alexithymia Questionnaire (BVAQ) para o português brasileiro, mostrando que o TAS-20 e o BVAQ-BR medem diferentes aspectos da alexitimia. O artigo 2 validou a escala de precisão interoceptiva (IAS) adaptada para o português brasileiro, destacando a correlação negativa entre a precisão interoceptiva e alexitimia, sintomas de TEA e síndromes disfóricas. Os artigos 1 e 2 forneceram ferramentas confiáveis para avaliar alexitimia e acurácia interoceptiva no Brasil, mostrando seus potenciais benefícios na identificação de fatores de risco para transtornos psiquiátricos. O artigo 3 realizou uma revisão sistemática do impacto das intervenções baseadas em DBT na alexitimia, indicando a eficácia de tais intervenções na melhoria das habilidades de processamento emocional, embora as intervenções que incorporam princípios de outros tratamentos tenham sido mais eficazes. Por fim, o Artigo 4 explorou a relação entre alexitimia e empatia, revelando os aspectos multifacetados dessa relação. A tese propõe uma estrutura robusta para facilitar o desenvolvimento de programas de intervenção para alexitimia. / [en] The current thesis aimed to establish a theoretical and empirical framework to develop intervention programs for alexithymia, a condition related to socio-emotional impairments. The thesis is comprised of four articles. Article 1 validated an adapted version of the Bermond–Vorst Alexithymia Questionnaire (BVAQ) for Brazilian Portuguese, showing that the TAS-20 and the BVAQ-BR measure different aspects of alexithymia. Article 2 validated the Interoceptive Accuracy Scale (IAS) adapted to Brazilian Portuguese, highlighting the negative correlation between interoceptive accuracy and alexithymia, and symptoms of ASD and dysphoric syndromes. Articles 1 and 2 provided reliable tools for assessing alexithymia and interoceptive accuracy in Brazil, showing their potential benefits in identifying risk factors for psychiatric disorders. Article 3 conducted a systematic review of the impact of DBT-based interventions on alexithymia, indicating the effectiveness of such interventions in improving emotional processing skills, although interventions incorporating principles from other treatments were more effective. Finally, Article 4 explored the relationship between alexithymia and empathy, revealing the multifaceted aspects of this relationship. The thesis proposes a robust framework to facilitate the development of intervention programs for alexithymia.

No description available.

Thesis (MA)--Stellenbosch University, 2015 / ENGLISH ABSTRACT : Worldwide there are various reports on the prevalence of depression in patients diagnosed with brain tumours. In South Africa, psychological research in relation to psychiatric symptoms among patients with brain tumours is lacking. The aims of this study were to determine the incidence of depression in patients diagnosed with brain tumours and to clarify our understanding of the relationship between depression and tumour localisation, histopathological type of tumour, and participant characteristics. The study sample consisted of 35 patients (11 males and 24 females) aged between 21 and 64 years with a solitary primary brain tumour. The patients were treated at the neurosurgery clinics located at Tygerberg Hospital in the Western Cape and Universitas Hospital in the Free State between mid-2010 and 2013. The major histological subgroup consisted of meningiomas (47%), glioblastomas (22%), astrocytomas (19%), gliomas (9%) and epidiomas (3%). The tumour distribution was as follows: 52% in the left hemisphere, 37% in the right hemisphere, and 11 % in the midline. The psychiatric symptoms of the patients were assessed before treatment by the Beck Depression Inventory and Mini International Neuropsychiatric Interview. In addition, the patients’ neuropsychological functions were evaluated by a short neuropsychological test battery (Mini Mental State Examination, Trail Making Test (Part A), Letter Number Sequencing subtest, Hopkins Verbal Learning Test – Revised, and Brief Visuospatial Memory Test – Revised). Results from the quantitative data, showed the prevalence of mild depression was 26% for men and 43% for women. Overall 37% of the total sample had depressive symptoms. No significant relationship was found between depression and tumour location or between the various neuropsychological characteristics and neurological symptoms and tumour location. The study showed that depression is a common symptom in patients diagnosed with brain tumours and therefore depression symptoms have to be recognised and treated by psycho-educating the patients and their families, pharmacotherapy, or psychotherapy as soon as possible. However, due to the relatively small sample size, the results are of limited generalisability. / AFRIKAANSE OPSOMMING : Wêreldwyd is daar verskeie verslae oor die voorkoms van depressie in pasiënte gediagnoseer met breingewasse. In Suid-Afrika is daar ’n tekort aan sielkundige navorsing met betrekking tot psigiatriese simptome by pasiënte. Die doel van hierdie studie was om die voorkoms van depressie te bepaal in pasiënte gediagnoseer met breingewasse en om duidelikheid te kry oor die verband tussen depressie en die ligging van breingewasse, histopatologiese tipe gewas en karakter eienskappe van die deelnemers. Die steekproef van die studie het bestaan uit 35 pasiënte (11 mans en 24 vroue) tussen die ouderdomme 21 en 64 jaar met ‘n soliede breingewas. Die pasiënte is behandel by die neurochirurgiese klinieke by Tygerberg Hospitaal in die Wes-Kaap en by Universitas Hospitaal in die Vrystaat vanaf middel 2010 tot 2013. Die mees algemene histologiese subgroep het bestaan uit meningiome (47%), glioblastomas (22%), astrocytomas (19%), gliomas (9%) en epidiomas (3%). Die verspreiding van die gewasse was soos volg: 52% in die linkerhemisfeer, 37% in die regterhemisfeer en 11% in die middel. Die psigiatriese simptome van die pasiënte is voor behandeling geëvalueer met behulp van die Beck Depression Inventory en die Mini International Neuropsychiatric Interview. Bykomend is die pasiënte se neurosielkundige funksies geëvalueer met behulp van ‘n neurosielkundige toetsbattery (Mini Mental State Examination, Trail Making Test (Part A), Letter Number Sequencing subtest, Hopkins Verbal Learning Test – Revised en Brief Visuospatial Memory Test – Revised). Die resultate van die kwantitatiewe data het getoon die voorkoms van matige depressie was 26% vir mans en 43% vir vroue. In geheel het 37% van die totale steekproef depressiewe simptome getoon. Daar was geen beduidende verhouding tussen depressie en die ligging van die gewas of tussen die verskeie neurosielkundige eienskappe en die ligging van die gewas nie. Die studie het getoon dat depressie ’n algemene simptoom is in pasiënte gediagnoseer met breingewasse en daarom moet depressiewe simptome herken en so gou as moontlik behandel word deur psigo-opvoeding van die pasiënte en hul familie, farmakoterapie of psigoterapie. As gevolg van die relatiewe klein steekproef grootte het die resultate ’n beperkte veralgemeenbaarheid.

Les écrits rapportent qu’entre 10% et 40% des personnes atteintes de troubles mentaux ont présenté des comportements agressifs depuis l’établissement du diagnostic, et qu’entre 50% et 65% de ces comportements sont perpétrés envers les membres de la famille (Estroff et al., 1998). Or, les aidants naturels se sentent fréquemment démunis devant le comportement impulsif et agressif de leur proche atteint d’un trouble de santé mentale (Bonin & Lavoie-Tremblay, 2010) et la majorité des proches aidants ne reçoivent pas de soutien professionnel (Doornbos, 2001). À cet effet, une équipe de chercheurs et d’organismes communautaires ont mis sur pied un projet de formation adaptée par et pour les familles relativement à la gestion des comportements agressifs de leur proche atteint d’un trouble de santé mentale s’appuyant sur l’approche OMEGA communautaire (Bonin et al., 2011). La présente recherche est inspirée du modèle de Fresan et ses collaborateurs (2007), qui inclut les familles et leur proche atteint dans la prévention de la rechute et le rétablissement de ce dernier. Cette étude avait donc pour but de décrire et analyser, par un devis mixte, les perceptions de l’agressivité, du fonctionnement familial ainsi que de l’observance au traitement médical de personnes atteintes de troubles mentaux, suite à une formation de gestion des comportements agressifs adaptée par et pour des membres de familles, et suivie par leur proche aidant. Des questionnaires auto-administrés ont été remis et complétés par 25 personnes atteintes et comprenaient trois instruments qui étaient : 1. un questionnaire sociodémographique; 2. le Basis-24 (Eisen, 2007) permettant d’évaluer la condition mentale de la personne atteinte; 3. l’Échelle de perception de l’agressivité permettant de mesurer la fréquence et le niveau des comportements agressifs (De Benedictis et al., 2011); et 4. l'Échelle du fonctionnement familial permettant de mesurer le fonctionnement familial (Epstein, Baldwin, & Bishop, 1983). Des questions supplémentaires au questionnaire portaient sur l’observance au traitement médical et sur les changements observés. Des analyses descriptives et corrélationnelles bivariées ont été réalisées pour analyser les données quantitatives. Par la suite, des entrevues individuelles ont été réalisées auprès de huit personnes atteintes de troubles mentaux dont le membre de famille avait suivi la formation de gestion des comportements agressifs. La méthode d’analyse classique de Miles et Huberman (2003) a été utilisée pour réaliser l’analyse des données. L’analyse des données a permis de dégager les perceptions des personnes atteintes de troubles mentaux au regard de la formation de gestion des comportements agressifs que leur membre de famille avait suivi. Ainsi, le programme de formation OMÉGA adaptée par et pour les familles permettrait d’une part de diminuer l’agressivité et, d’autre part, d’améliorer le climat familial. De plus, selon les personnes atteintes, leur membre de famille était plus à l’écoute et faisait moins preuve d’intrusion, ce qui diminuaient les conflits et favorisaient une meilleure dynamique familiale. Cette étude a mis en évidence qu’il est nécessaire d’impliquer les familles dans les programmes de prévention de la rechute de la maladie mentale dans les soins de première ligne. Cette étude contribue ainsi à l’amélioration des connaissances sur la dynamique famille-patient et sur le rétablissement des personnes atteintes de troubles mentaux. Aussi, cette recherche propose des recommandations pour la recherche, la pratique, la formation et la gestion en sciences infirmières. / Literature reports that between 10% and 40% of people with mental disorders showed aggressive behavior since establishing the diagnosis, and between 50% and 65% of these behaviors are perpetrated against members of the family (Estroff et al. 1998). However, caregivers often feel helpless in the face of impulsive and aggressive behavior of their loved one with a mental health disorder (Bonin & Lavoie-Tremblay, 2010) and the majority of caregivers do not receive professional support (Doornbos, 2001). For this purpose, a team of researchers and community organizations have established a training adapted by and for families in relation to the management of aggressive behavior of their loved one with a mental health disorder based on Community OMEGA approach (Bonin et al., 2011). This research was inspired by the Fresan and collaborators' model (2007), which includes families and their loved ones achieved in the prevention of relapse and recovery thereof. Using a mixed-design, the study aimed to describe and analyze, perceptions of aggression, family functioning and adherence to medical treatment of people with mental disorders, following a training about aggressive behavior management training adapted by and for family members and to which their caregiver attended. Self-administered questionnaires were distributed and completed by 25 people and included three instruments: 1. a sociodemographic questionnaire; 2) the Basis-24 (Eisen, 2007) to assess the mental condition of the person; 3. the perception of aggressiveness scale (POAS) to measure the frequency and the level of aggressive behavior (De Benedictis et al., 2011; and 4. the family assessment device (FAD) to measure family functioning (Epstein, Baldwin, & Bishop, 1983). Additional questions to the questionnaire focused on adherence to medical treatment and the observed changes. Descriptive correlative analyzes and T-test were performed to analyze quantitative data. Thereafter, individual interviews were held with eight persons with mental disorders whose family member was trained in management of aggressive behavior. The classical method of analysis of Miles and Huberman (2003) was used to perform data analysis. The data analysis allowed to identified the perceptions of people with mental disorders with regard to training in managing aggressive behavior that their family member had followed. Thus, the OMEGA training program adapted by and for family members would help on the one hand reducing aggression and on the other hand, improve family atmosphere. Moreover, according to the persons with mental disorders, their family member was more attentive and less intrusive, which decreased conflict and promoted better family dynamics. This study has highlighted the need to involve families in prevention programs about relapse of mental illness in primary care. This study contributes to the improvement of knowledge on the patient and family dynamics and on the recovery of people with mental disorders. Also, this research provides recommendations for research, practice, education and management in nursing.