Ce travail dérive d’un parcours clinique et institutionel, à partir du quel s’est formulé la question sur les effets dans les liens sociaux du reencontre aves la specificité de la position psychique des sujets psychotiques. On raconte des passages d’un itinéraire de recherche, fait du pari à la réinscription des bordes de la clinique psychanalytique – lequel se montre par les experiences des ateliers thérapeutiques et de l’accompagnement thérapeutique, mais pas seulement –, pour dire des modes par lesquelles la question a pris la forme d’un discours en interrogation. On part de la formulation lacanienne sur la structure discursive des liens sociaux – en considerant, surtout, le discours universitaire et le discours capitaliste – et de la place extérière que la structure psychotique tient par rapport le discours. Puis on situe l’hospitalité, selon l’élabore Derrida, comme possibilité de accuellir les différences portées par les psychotiques. Dans ce chamin, les concepts de transfert, résistance et témoin, d’après Freud et Lacan, apparaissent comme manières de nommer l’espace-temp où l’hospitalité à l’hors-discours peut émerger – dont la specificité se present dans les impasses de l’inscription des contours subjetifs entre le Je/moi et l’autre-Autre, le prope et l’ailleurs. De cette façon, on suggère que offrir l’hospitalité à l’alterité de la position subjetive des psychoses implique accueillir la tension inhérente aux limits du propre et de l’ailleurs comme une demande de la strutucture. On problematise la façon par laquelle le discours universitaires de la science, dans um moment de l’histoire de la culture, a répondu à cette “demande” en edifiant les murs de l’hospice et de la catégorie “maladie mental”, qui n’ont pas inscrit la différence, mais, contrairement, ont produit une intensification de l’impasse du narcissisme. On se demande donc comment le discours universitaire de la science d'aujourd'hui, en complicité avec le discours du capitalisme, peut être affecté, si l’hors-discours retrouve l’hospitalité du chercheur. À l’horizont, la question: offrir l’hospitalité aux psychoses produirait des effets de méthode? Serait l’hospitalité aux psychoses une opportunité pour que nous nous replaçons sur le plan éthique et politique par rapport à la manière dont, aujourd'hui, nous faisons nos incursions dans le monde de la connaissance? / Este trabalho deriva de um percurso clínico e institucional, a partir do qual se formulou uma pergunta pelos efeitos para os laços sociais do encontro com a especificidade da posição psíquica dos sujeitos nas psicoses. Narram-se passagens de uma trajetória de pesquisa, feita da aposta na reinscrição das bordas da clínica psicanalítica – que pode ser observada nas experiências em oficinas terapêuticas e acompanhamentos terapêuticos, mas não somente –, para dizer dos modos pelos quais tal questão foi ganhando a forma de um discurso em interrogação. Parte-se da formulação lacaniana em torno da estrutura discursiva dos laços sociais – tomandose em consideração, especialmente, o discurso universitário e o discurso capitalista – e do lugar de exterioridade que a estrutura psicótica mantém em relação aos discursos. Em seguida, situa-se a hospitalidade, tal qual elaborada por Derrida, como possibilidade de acolhimento às diferenças que as psicoses portam. Nesse caminho, os conceitos de transferência, resistência e testemunho, desde Freud e Lacan, aparecem como formas de nomear o espaço-tempo em que pode emergir uma hospitalidade ao fora-do-discurso, cuja especificidade se apresenta na forma de impasses na inscrição dos contornos subjetivos entre o eu e o outro-Outro, o próprio e o alheio. Desde aí, sugere-se que dar hospitalidade à alteridade da posição subjetiva nas psicoses implica acolher a tensão inerente aos limites do próprio e do alheio, como um pedido estrutural. Problematiza-se o modo como o discurso universitário da ciência, em determinado momento da história da cultura, respondeu a este “pedido” edificando os muros do hospício e da categoria “doença mental”, que não fizeram inscrever a diferença, mas, ao contrário, operaram o recrudescimento do beco do narcisismo. Pergunta-se então como o discurso universitário da ciência de nossos dias, em cumplicidade com o discurso do capitalismo, pode ser afetado, caso o fora-do-discurso das psicoses encontre uma posição de hospitalidade desdobrada do lado do pesquisador. No horizonte, o interrogante: dar hospitalidade às psicoses produziria efeitos de método? Seria a hospitalidade às psicoses uma oportunidade para nos reposicionarmos ética e politicamente sobre o modo como, atualmente, concebemos nossas incursões pelo mundo do conhecimento? / This work derives from a clinical and institutional trajectory, from which raised the question about the effects of social ties on encountering with specification the psychic position of psychotic subjects. Then, segments of the path of research are reported, made with the bet of rewriting the edges of the psychoanalytic clinics - that can be observed in experiments with therapeutic workshops and follow-up therapy, but not only – to say the ways in which this issue has been gaining the form of a discourse in question. It starts with the Lacanian formulation around the discursive structure of social ties - especially taking into account the university and capitalistic discourses. In addition, the place of exteriority that maintains the structure in relation to psychotic speeches, for then situate the hospitality, as is elaborated by Derrida, as the possibility of welcoming the differences that the psychoses carries. In this way, the concepts of transference, resistance, and testimony, from Freud and Lacan, appear as ways of naming the space-time on that can emerge hospitality on out-ofspeech, whose specificity appears in the form of impasse on inscription of subjective contours between self and other-Other, self and strange. Since then, it is suggested that giving hospitality to otherness of the subjective position in the psychoses, implies on welcoming, as a structural request, the tension inherent of the limits between the self and the other-Other. Considering the way how the university discourse of science, in sometime of the history of culture, responded to this "request" building the walls of the asylum and the category of "mental illness", which did not include the difference, but rather, operated the fall for the narcissism’s alley. Then wonders how the university discourse in science, nowadays, in complicity with the discourse of capitalism, can be affected in case of the out-of-speech of psychosis find on the researcher a position of hospitality. The question that is on the horizon is: giving hospitality to psychosis would produce method effect's? The hospitality to psychosis would be an opportunity for a repositioning ethical and politically about how, nowadays, we've conceived our forays into the world of knowledge?

A reforma psiquiátrica teve como premissa o fim dos manicômios e atualmente observa-se que há indivíduos que continuam em situação de isolamento, mas no próprio domicílio. Nesse sentido, a Atenção Domiciliar (AD) é uma alternativa de intervenção àqueles que não chegam aos serviços de saúde. Esta dissertação tem como objetivo tecer reflexões sobre as especificidades da AD em saúde mental como modalidade interventiva em famílias cujo modo de vinculação é considerado psicótico, a partir da psicanálise vincular. Busca-se compreender de que forma se dá a transferência dessas famílias no domicílio, bem como refletir sobre as intervenções nesse setting terapêutico. Para tanto foram utilizadas cenas construídas a partir da experiência clínica da pesquisadora enquanto profissional da AD e das quais foram elaboradas as reflexões. É uma investigação que se insere no campo das pesquisas psicanalíticas, em que o inconsciente e suas manifestações clínicas são o objeto de estudo. O caminho percorrido neste texto foi pensar o domicílio como local de intervenção a partir dos conceitos de setting terapêutico, transferência e contratransferência. Sobre o setting discutiu-se a sua multiplicidade de possibilidades, de forma que a flexibilização do enquadre tradicional favoreceu as intervenções. Compreende-se que a casa, nessas famílias, é usada como barreira concreta para separar o dentro e o fora, entretanto, se as paredes podem ser utilizadas como defesa, elas dificultam o \"entre\". A AD em saúde mental tem por objetivo fazer uma ponte entre diferentes espaços - hospital/ casa e casa/serviços de saúde. Assim, foi utilizado o conceito de intermediário de Kaës para entender as intervenções do psicólogo que favoreçam essas funções de ligação, como entrar e sair da casa pelo terapeuta, além do uso de recursos gráficos e da construção de histórias; acrescido da compreensão freudiana acerca do jogo do carretel (Fort- dá), que tendo também uma função intermediária favorece a simbolização. Observou-se que se inicialmente foi difícil a escuta dos pacientes, pela mudez ou pela fala delirante, ao longo do acompanhamento houve a produção de sonhos e metáforas por parte dos mesmos, o que possibilitou uma ressignificação de seus sintomas iniciais - a restrição domiciliar. Além disso, no aspecto da função de ligação, evidenciou-se como crucial o estabelecimento do vínculo terapêutico junto aos pacientes, o que se estende a qualquer profissional da equipe. O trabalho vincular acontece quando há uma transformação mútua, não apenas do paciente mas do profissional, o que exige mudanças nas formas de atuação. Nesse sentido se fez necessário da terapeuta/pesquisadora \"sair da casinha\", abrindo-se ao modo possível desses atendimentos acontecerem. Se na clínica psicanalítica tradicional o recurso verbal é o principal instrumento terapêutico, nessa experiência outros recursos ganharam importância. Conclui-se, então, que as famílias que participaram desta investigação não poderiam ser abordadas no setting tradicional, tensionando conceitos que foram construídos a partir dele e, propiciando o surgimento de outras propostas terapêuticas / Psychiatric reform had as a premise the end of asylums, however individuals that remain in isolation are currently observed, but in their own domicile. In this sense, Home Care (HC) is an intervention alternative for those who dont reach health services. This dissertation has as objective to weave reflections about the specificities of HC in mental health as an interventive modality in families whose relational method is considered psychotic, from a psychoanalysis of bonds perspective. Its sought to comprehend the manner in which the transference of these families in the domicile is given, as well as reflecting about the interventions in this therapeutical setting. For such, scenes were built from the clinical experience of the researcher as a HC professional and upon these reflections were elaborated. Its an investigation that inserts itself in the field of psychoanalytic researches, in which the unconscious and its clinical manifestations are the object of study. The path trailed in this text was that of thinking of the domicile as a place of intervention from the concepts of therapeutical setting, transference and countertransference. About the setting, it was discussed its multiplicity of possibilities, in a way that the flexibilization of the traditional setting favored interventions. It is understood that the home, in these families, is used as a concrete barrier for separating the inside and the outside, however, if these walls can be used as defense, they hamper the in between. HC in mental health aims to build bridges between different spaces - hospital / home and home / health services. Thus, the concept of Kaës Intermediary was used in order to understand the psychologist\'s interventions that favor these bonding functions, such as the therapists entering and leaving of the domicile, in addition to the use of graphical resources and stories creation; added by the Freudian understanding of the cotton reel game (Fort-dá), that having an intermediary function also favors symbolization. It was observed that initially, listening to the patients was difficult, either by muteness or by delirious speech; throughout the follow-up there was the production of dreams and metaphors by the patients, which made a re-signification of their initial symptoms possible - household restriction. Additionally, on the connection function aspect, the establishment of the therapeutic bond with the patients showed to be crucial, something that extends to any professional of the team. The bonding effort happens when theres a transformation of both, not only of the patient but also from the professional, which requires the latter to change their way of acting. With this, it was necessary for the therapist / researcher to step out of the comfort zone, opening oneself to the format to which these treatments can take place. If in traditional psychoanalytic clinic the verbal resource is the main therapeutic instrument, in this experience other resources gained significance. It is then concluded that families that participated in this investigation couldnt be approached using the traditional setting, stressing concepts that were built from it and providing the emergence of other therapeutical proposals

D.Litt. et Phil. / The present work set out to evaluate whether the division on a neuropsychological basis between Korsakoff's amnesia and Kevin Walsh's Adaptive Behavioural Syndrome (ABS) was justified (Walsh, 1989). The research took the approach that the supposed agents responsible for the ABS (neurotoxicity of alcohol) and Korsakoff's syndrome (thiamine avitaminosis) had not been proven to produce site-specific lesions. Using Bowden (1990) as a point of departure, Luria's (1973) classic discussion of the hierarchical nature of brain functioning was used to generate the hypothesis that the two topographical areas of the brain are both subject to stimulation via the arousal mechanisms of the reticular activating system of the brainstem, and that this might well result in cortical arousal deficiencies giving rise to the frontal and axial deficits seen in alcohol related syndromes. Evidence was found, using techniques of analysis developed by the Boston group (Kaplan, 1980), that in fact the frontally-based ABS was less vulnerable to brainstem dysfunction, and that when arousal levels began to increase, as in the arousing neuropsychological evaluation environment, signs of frontal dysfunction waned, whilst signs of axial mnemonic difficulties did not. This discrepancy was explained using Luria's information that the frontal cortical areas are richly supplied with connections to the reticular activating system of the brainstem, whereas the axial structures are not so richly endowed. The conclusion was reached that the ASS and l(orsakoff's dysfunctions are two sides of the same coin, and that the division between the two is both an artifact of research designs in the past that have excluded those with signs of alcohol dementia ('pure' amnesias), and the heretofore invisible moderating influence of the acetaldehyde-damaged noradrenergic pathways of the brainstem. The post-traumatic amnesias seen following closed head injury and acute stress were discussed as contributing to the generalisability of the conclusions, and the role of neuropsychologists in the future within the field was discussed.

Bakgrund: Personer med schizofreni och liknande psykoser drabbas ofta av passivitet och inaktivitet och saknar tillgång till olika program som främjar aktivitet. Närstående tillbringar omfattande tid med att ta hand om sina anhöriga. Det finns ett begränsat utbud av förebyggande hälsofrämjande insatser för personer med psykisk ohälsa. Hästunderstödda aktiviteter och rehabilitering har visat potential att bidra till en ökad medvetenhet och genuin förändring. Det har även visat goda resultat vid allvarlig psykisk ohälsa och hos personer med schizofreni och liknande psykoser. Studierna är dock få och brist på kunskap om hästunderstödda aktiviteter kan utgöra ett allvarligt hinder för att insatsen ska bli accepterad. Närståendes erfarenheter bidrar till en ökad förståelse av hästunderstödda aktiviteter. Syfte: Syftet med studien var att beskriva närståendes erfarenheter av hästunderstödda aktiviteter för personer med schizofreni och liknande psykoser. Metod: Fem närstående till personer med schizofreni och liknande psykoser intervjuades och materialet analyserades med kvalitativ innehållsanalys. Resultat: I analysen framkom tre subtema:“ Samvaro med hästen främjar psykisk hälsa”, “Hästen främjar fysisk aktivitet”, “Hästen bidrar till ett sammanhang med gemensamt fokus”. Dessa bildade ett övergripande tema “Att vara med hästarna lockar fram dolda resurser” Slutsats: Resultatet visade att hästunderstöda aktiviteter kan främja psykisk hälsa och fysisk aktivitet samt bidra till ett sammanhang där hästarna utgör fokus och kan locka fram dolda resurser hos personer med schizofreni och liknande psykoser. Fler studier om hästunderstödda insatser och anhörigas erfarenheter kan bidra till att insatsen blir accepterad. / Background: People with schizophrenia and similar psychoses often suffer from passivity and inactivity and lack access to various programs that promote activity. Relatives spend extensive time caring for their affected relatives. There is a limited range of preventive health promotion initiatives for people with mental illness. Horsesupported activities have shown potential to contribute to increased awareness and genuine change with good results, even in severe and lasting mental illness and for people with schizophrenia and similar psychoses. However, the studies are few and lack of knowledge about horse-supported activities can be a serious obstacle to the efforts being accepted. Relatives' experiences contribute to an increased understanding of horse-supported activities. Objective: The aim of the study was to describe relatives' experiences of horse-supported activities for people with schizophrenia and similar psychoses. Method: Five relatives of people with schizophrenia and similar psychoses were interviewed and the material analysed based on qualitative content analysis. Results: In the analysis, three subthemes emerged: "Coexistence with the horse promotes mental health", "The horse promotes physical activity" and "The horse contributes to a context of common focus". These sub-themes formed an overall theme "Being with the horses attracts hidden resources" Conclusion: The result showed that horse-supported activities can promote mental health and physical activity and contribute to a context where the horses are the focus and can attract hidden resources in people with schizophrenia and psychoses. More studies on horse-supported efforts and relatives' experiences can help to accept the form of treatment.

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Objective: To investigate whether there is an association between use of cocaine, amphetamines, or psychedelics and psychotic symptoms. Method: Cumulated data from a prospective, longitudinal community study of 2588 adolescents and young adults in Munich, Germany were used. Substance use was assessed at baseline, 4-year and 10-year follow-up using the Munich Composite International Diagnostic Interview; psychotic symptoms were assessed at 4-year and 10-year follow-up. Multinomial logistic regression analyses, adjusted for sociodemographic factors, common mental disorders, other substance use, and childhood adversity (adjusted odds ratios, AOR), revealed associations between cocaine, amphetamine or psychedelic use and psychotic symptoms. Results: Lifetime experience of psychotic symptoms was associated with lifetime use of cocaine (AOR 1.94; 95%CI 1.10-3.45), amphetamines (AOR 1.69; 95%CI 0.98-2.93), psychedelics (AOR 2.37; 95%CI 1.20-4.66) and all three substances (AOR 1.95; 95%CI 1.19-3.18). Conclusion: Associations between psychotic symptoms and use of cocaine, amphetamines, and/or psychedelics in adolescents and young adults call for further studies to elucidate risk factors and developmental pathways.

Cette thèse porte sur l'évaluation du profil attentionnel d'adolescents en début d'évolution d'un trouble psychotique. Jusqu'à présent, aucune étude n'a documenté le profil de performances de l'ensemble des composantes attentionnelles chez les adolescents en premier épisode psychotique et effectué un suivi longitudinal du même échantillon à l'aide d'une approche neuropsychologique cognitive. La synthèse attentionnelle de Van Zomeren et Brouwer (1994) a été prévilégiée pour l'évaluation et l'interprétation des résultats. Dans la première étude (Chapitre II), le profil attentionnel d'adolescents hospitalisés pour un premier épisode psychotique actif a été évalué. Les résultats suggèrent principalement une atteinte de l'attention divisée et du contrôle attentionnel, plus précisément de la flexibilité et de l'inhibition de stimuli lexicaux. L'attention soutenue et sélective seraient cependant intactes. Sur l'ensemble des mesures évaluées, seulement une relation entre la vitesse de traitement de l'information et la symptomatologie positive tend à être significative. Dans la deuxième étude (Chapitre III), ces différentes composantes de l'attention sont réévaluées dans le même échantillon 18 mois après l'hospitalisation. L'interprétation des données suggère une stabilité du fonctionnement attentionnel, en présence d'une amélioration de la symptomatologie clinique. Cette thèse apporte une contribution importante à la compréhension du fonctionnement attentionnel des adolescents psychotiques en démontrant que : (a) des atteintes spécifiques de l'attention sont manifestes dès le premier épisode psychotique et que certaines fonctions attentionnelles sont préservées, (b) ces atteintes attentionnelles semblent stables dans le temps en ce sens que l'amélioration clinique de la psychose n'est pas associée à une amélioration cognitive et (c) qu'une indépendance partielle semble être présente 'en~re l'attention et la symptomatologie psychotique dans la population adolescente. Les connaissances dérivées de cette thèse ont des retombées cliniques importantes, en mettant en lumière des cibles d'intervention psychologique, pharmacologique et cognitive à privilégier auprès de cette clientèle.

No description available.

Diversos estudos têm demonstrado que indivíduos que apresentam sintomas psicóticos podem demorar meses ou anos para iniciar o tratamento. Este período em que o indivíduo apresenta sintomas psicóticos sem tratamento é descrito na literatura como \"período de psicose sem-tratamento\" (PPST). Estudos anteriores mostraram que o PPST em países ricos é geralmente inferior ao de países de renda baixa ou média. OBJETIVOS: estimar o PPST em indivíduos com psicoses funcionais (casos incidentes) na cidade de São Paulo, Brasil; investigar se o PPST está associado a características sociodemográficas e com as circunstâncias de moradia (morar com familiares ou não); verificar se existe associação entre o PPST com características clínicas (diagnóstico, funcionamento social, intensidade dos sintomas negativos, positivos e gerais e insight) e com o tipo de serviço de saúde onde foi realizado o primeiro contato para o tratamento do transtorno psicótico. MÉTODO: Os dados analisados fazem parte do estudo epidemiológico \"Estudo de casos incidentes (primeiro contato com serviços de saúde) de psicoses funcionais no Brasil\", que investigou a incidência das psicoses funcionais em diversas regiões da cidade de São Paulo. Os critérios de inclusão do estudo epidemiológico foram: ter entrado em contato, pela primeira vez, com serviços de saúde mental do setor público ou privado (internação, emergência, serviços intermediários ou atendimentos ambulatoriais), no período entre maio de 2003 e janeiro de 2005 por motivo de sintomas psicóticos; residir na área do estudo por pelo menos seis meses; idade entre 18 e 64 anos. O PPST foi definido como \"período entre o início dos sintomas psicóticos e o primeiro contato com serviço de saúde mental\". A mediana do PPST foi utilizada para dividir os participantes em dois grupos: curto PPST e longo PPST. Regressão logística foi utilizada nas análises de associação entre PPST e as variáveis sociodemográficas e clínicas e para investigar o possível efeito de variáveis confundidoras na associação entre PPST e circunstâncias de moradia. RESULTADOS: Duzentos indivíduos foram incluídos no presente estudo. Cento e cinco (52%) eram mulheres, a média de idade foi de 32,3 anos (desvio padrão=11,3), 165 (82,5%) moravam com familiares. Cento e quarenta e oito (74,0%) participantes haviam feito o primeiro contato em serviços de emergência, 122 (61,0%) apresentaram diagnóstico de psicose nãoafetiva e 78 (39%) de psicose afetiva, 106 (53,0%) apresentaram funcionamento social \"muito bom ou bom\", 133 (68,2%) apresentaram \"bom insight\". A média da pontuação dos sintomas psiquiátricos totais avaliados pela PANSS foi de 42,1 (desvio padrão=12,4). A mediana do PPST foi de 4,1 semanas para a amostra total, 3,1 semanas para os participantes com transtornos psicóticos afetivos e 5,5 semanas para os participantes com transtornos psicóticos não-afetivas. Indivíduos que não moravam com familiares tiveram uma chance aproximadamente três vezes maior de apresentarem longo PPST do que os que moravam com familiares, independentemente das características sociodemográficas e clínicas dos participantes (p=0,05 OR=2,53). CONCLUSÃO: Estudos anteriores sobre PPST, realizados principalmente em países ricos, apresentaram um PPST que variou entre 4 a 57 semanas, o que é bastante superior ao PPST encontrado em São Paulo. O curto PPST encontrado no presente estudo não confirmou a idéia de que o PPST em países ricos é menor do que o PPST em países de renda baixa ou média. Apesar da maioria dos participantes apresentarem características sociodemográficas e clínicas associadas a longo PPST, morar com familiares e a estrutura atual de atenção à pessoa em crise psicótica em São Paulo, particularmente os serviços de emergência psiquiátrica, parecem ter colaborado para o curto PPST nesta amostra e alterar o cenário esperado para o PPST em São Paulo. Características contextuais, juntamente com as características sociodemográficas e clínicas dos indivíduos, se apresentaram como importantes determinantes do PPST em São Paulo. / Several studies have shown that patients with psychotic disorders have experienced psychotic symptoms for long period before initiation of treatment. This period between onset of psychotic symptoms and first treatment has been described as \"duration of untreated psychosis\" (DUP). Previous studies have shown that DUP is lower between highincome countries when compared with low and middle-income countries. OBJECTIVES: to estimate the DUP in subjects with functional psychoses (incident cases) in the city of São Paulo, Brazil; to investigate the relationship between DUP and socio-demographic data and \"living circumstances\" (living with family or not); to investigate if DUP is associated with clinical characteristics (diagnosis, social functioning, severity of general, positive and negative symptoms, and level of insight) and the type of service use for the first psychotic disorder treatment. METHOD: the data is part of the epidemiological study \"The study of incident cases (first contact with health services) of functional psychoses in Brazil\". Inclusion criteria were: who had a first contact with any public or private mental health service (inpatient, emergence, day-hospitals or outpatient) due to psychotic symptoms, between May 2003 and January 2005, residence in a defined geographical area of São Paulo for at least six months, and age between 18 and 65 years. DUP was defined by \"the period from the onset of the first psychotic symptoms until the first contact with a mental health service\". The median DUP was calculated and used to divide the sample into two groups: short and long DUP. Logistic regression was used to analyze possible associations between socio-demographic and clinical variables with DUP, and to investigate possible effects caused by independent variables between living circumstances and DUP. RESULTS: A total of 200 individuals were included, 105 (52%) were women and the mean of age was 32.3 (SD 11.3) years old in the total sample, 165 (82.5%) were living with relatives. One hundred and eight (74.0%) participants had the first contact with emergence services, 122 (61.0%) diagnosis of non-affective psychosis, and 78 (39.0%) had a diagnosis of affective psychosis, 106 (53.0%) presented \"very good or good\" social functioning, 133 (68.2%) presented \"good insight\". The mean total \"Positive and Negative Syndrome Scale\" (PANSS) score was 42.1 (SD=12.4). The value found for the median DUP was 4.1 weeks for the total sample, 5.5 weeks for the psychotic non-affective disorders compared with those who received a diagnosis of psychotic affective disorder (3.1 weeks). Participants who were not living with relatives were three times more likely to present long DUP compared to participants who were living with relatives, independently of the clinical and socio-demographic characteristics (p=0.05, OR=2.53). CONCLUSION: Previous studies about DUP, especially from high-income countries, have presented a median value DUP between 4 and 57 weeks, which is much superior when compared the DUP found in São Paulo. The shorter median DUP found in the present study is not in accordance with the hypothesis that refers that DUP is higher in low-and-middle income countries. Despite a number of participants have presented socio-demographic and clinical characteristics associated to long DUP, living with relatives and the context related to mental health system for the people with acute psychotic symptoms in the city of São Paulo, especially emergence services, seem to have collaborated for the shorter DUP in this sample and changed the scenery expected about DUP in the present sample. Some contextual characteristics, with socio-demographic and clinical factors were very important determinants of DUP in São Paulo.

Psychosis most commonly first occurs during adolescence or early adulthood, disrupting the social and occupational transitions characterising this time. Studies on social and occupational outcomes in psychosis have tended to focus on observer-rated, dysfunction-based outcomes. However, mental health services are increasingly adopting a personal recovery model; focusing on facilitating hopeful and individually meaningful lives. Social inclusion is paramount to personal recovery but there is a need for greater awareness of the processes by which mental health services facilitate social inclusion for young people with psychosis. Cognitive models and research with longterm psychosis service users suggests that negative self-beliefs contribute to poorer social outcomes in psychosis, whereas personal recovery models emphasise the role of hopefulness and therapeutic relationships with optimistic mental health professionals. This thesis first investigates a structural model of social inclusion and its association with hope and negative self-beliefs for healthy young people (n= 387). Then the processes by which young service users' self-beliefs, therapeutic relationships and professionals' beliefs influence social inclusion are explored using directed path models (n= 51). Directed path models then test how professional characteristics, focusing on attachment styles and job attitudes, facilitate therapeutic relationships (n= 61). Finally, the contributions of self-beliefs, therapeutic relationships, professional beliefs and social inclusion in predicting vocational outcomes are explored (n= 51). Current findings support the relative importance of hopefulness over negative selfbeliefs in social inclusion for young people with and without psychosis. Hope appears particularly important for adolescents compared to young adults. Positive relationships with optimistic professionals predict service users' hopefulness, social inclusion and vocational activity. Findings suggest that professionals' own attachment style and job attitudes may aid in positive therapeutic relationship formation. These findings encourage a greater focus on therapeutic relationships and service users' hopefulness in youth psychosis service provision. Professional training should encourage greater awareness of professionals' own attachment style and job attitudes, and how these factors impact on positive therapeutic relationship development.