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Strategie zvládání stresu u lidí s psychotickým onemocněním / The stress coping strategies used by people with psychotic disorderHALO, Dagmar January 2015 (has links)
The aim of the thesis is to specify the stress coping strategies used by people with psychotic disorder and afterwards to find out the way of using these strategies is affected psychiatric rehabilitation. The thesis is structured in two parts. The theoretical part is particularly devoted to the theme of stress, coping strategies, psychotic disorder and psychiatric rehabilitation. In the practical part, there are mediated the answers to hypotheses and research questions with the assistance of the analysis of the data. The methods of research are the questionnaire SVF 78 and the semi-structured interview. The research group was formed by clients of Fokus civil association in South Bohemian region and the leader social worker.
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Proteômica da esquizofrenia: busca por biomarcadores em plaquetas / Proteomic of schizophrenia: research in biomarkers in plateletsHelena Passarelli Giroud Joaquim 02 February 2018 (has links)
Esquizofrenia é um transtorno psiquiátrico complexo que afeta cerca de 1% da população mundial. Apesar de progressos consideráveis nos últimos anos, a etiologia da doença ainda não foi elucidada principalmente pela heterogeneidade tanto do início quanto da progressão da doença. Frequentemente os sintomas dos pacientes são comuns a outras desordens neuropsiquiátricas, dificultando a diferenciação por meio de métodos essencialmente clínicos. Por isso, pesquisadores têm tentado identificar medidas baseadas em características moleculares que justifiquem e expliquem a etiologia da esquizofrenia. Já há alguns estudos com marcadores no cérebro, mas por esse ser um material com disponibilidade limitada, os esforços tem se concentrado em encontrar biomarcadores periféricos. Este estudo visou traçar um perfil proteico, em plaquetas, de pacientes drug-naïve com diagnóstico de esquizofrenia. Para tanto, comparamos este grupo com controles saudáveis e com controles psiquiátricos. Utilizamos duas abordagens proteômicas complementares para análise: a primeira, uma ferramenta clássica utilizando eletroforese bidimensional com posterior identificação dos spots por espectrometria de massas; e a segunda, uma abordagem de identificação em larga escala por shotgun label-free. Foram analisadas amostras de 16 controles saudáveis, de 11 pacientes com esquizofrenia e de 8 pacientes com transtornos do humor (controle psiquiátrico). Com a eletroforese bidimensional foram identificados 110 spots comuns nos géis de controles saudáveis, 83 spots comuns aos géis de pacientes com esquizofrenia e 80 spots comuns aos géis de pacientes com diagnóstico de transtornos do humor. Foram encontrados 27 spots exclusivos do grupo controle, não sendo detectados em nenhum dos dois grupos de pacientes. Esses spots foram recortados e analisados por espectrometria de massas revelando proteínas relacionadas com: neurotransmissão, sinapse, neurodesenvolvimento, homeostase celular, sinalização de cálcio, apoptose, resposta imune, e estresse oxidativo. Para verificação dos resultados, escolhemos proteínas de acordo com sua função já descrita na literatura e ineditismo na matriz e na casuística estudadas. Por meio da técnica de western blotting, encontramos diminuições significantes nos níveis de anexina A3 e peroxirredoxina 6 nos dois grupos de pacientes. Ambas proteínas diferentemente expressas nos pacientes já foram relacionadas à fosfolipase A2, que é a principal enzima responsável pelo metabolismo de fosfolípides de membrana e tem sido associada à desordens neuropsiquiátricas, inclusive à esquizofrenia. Ainda há algumas abordagens analíticas e bioinformáticas a serem realizadas na busca por candidatos a biomarcadores de esquizofrenia em plaquetas. Os resultados obtidos por shotgun necessitam de uma análise mais aprofundada além da verificação e validação em coortes maiores. A casuística utilizada para este trabalho é bastante valiosa já que permitirá a elucidação de alterações proteômicas já no primeiro episódio psicótico / Schizophrenia is a mulfatorial psychiatric disorder that affects about 1% of the world\'s population. Despite considerable progress in recent years, the etiology of the disease has not yet been elucidated mainly because the heterogeneity of disease onset and progression. Often the symptoms overlap to other neuropsychiatric disorders, which turns difficult to differentiate through essentially clinical methods. The researchers have focused in identify mesureable molecular characteristics that can help to elucidate schizophrenia etiology. There are already important findings regarding markers in the brain, but recent efforts have focused on finding peripheral biomarkers. This study aimed to find a protein profile in platelets of schizophrenia drug-naïve patients. For comparision we recruited two more groups: healthy controls and psychiatric control. We used two complementary proteomic approaches for analysis: a classic tool using two-dimensional electrophoresis with subsequent identification of the spots by mass spectrometry; and a large-scale label-free shotgun identification approach. The sample comprised 11 schizophrenic patients, 8 patients with mood disorders (psychiatric control and 16 healthy controls. 2-DE profiles of each sample were generated in triplicate. 110 proteins spots were identified in most gels of control group, 83 in most gels of schizophrenia group, and 80 proteins spots in most gels of bipolar disorder patients. Among these proteins spots, 76 were common to all three groups; 5 to controls and schizophrenia group; 2 common to controls and bipolar disorders groups; 2 exclusive of bipolar disorder patients and 27 proteins spots were identified exclusively in the control group. The 27 exclusive protein spots of control group were identified by LC-MS/MS. Proteins related to neurotransmission, synapse, neurodevelopment, cellular homeostasis, calcium signaling, apoptosis, immune response, and oxidative stress were identified. To verify the results, we chose proteins according to their function already described in the literature and novelty in platelets and first onset psychosis patients research. By western blotting we verified the difference in levels of annexin A3 and peroxiredoxin 6 between groups, but not of glutathione S-transferase pi 1 or 78-kDa glucose-regulated protein. Both proteins differentially expressed have already been related to phospholipase A2, which is the main enzyme responsible for the membrane phospholipids metabolism and has been associated with neuropsychiatric disorders, including schizophrenia. Despite the good and promising results presented and published, there are still some analytical and bioinformatic approaches to be performed in search for candidates for platelet schizophrenia biomarkers. The data from shotgun approach require further analysis, as well as verification and validation in larger cohorts. The sample enrroled in this study is greatly important and certainly informed us much about the proteomic alterations still in the first onset psychosis
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Duas sendas do discurso psicótico em O dia em que matei meu pai: esse silêncio... Você ainda está aí? / Two paths of psychotic discourse in The day I killed my father: that silence... Are you still there? 2017. 91p. Thesis (PhD in Arts) – Western Paraná State UniversityVersa, Cezar Roberto 10 March 2017 (has links)
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Previous issue date: 2017-03-10 / The present term paper produces the Discourse Analysis of a literary work, it was understood like the report of a man who claims to have killed the father. The novel The day I killed my father, by Mario Sabino, constitutes the textual corpus for discursive analysis. The methodology and theoretical basis of this analysis are based on the French School of Discourse Analysis, based on the conceptual assumptions by Michel Pêcheux. In this sense, the opacity of the language, the subjection of the subjects and the cleavage of the unconscious, they transverse the people through discourses. The discourse of madness will be seen from DF (Discourse Formation) of rationality and DF of madness, it was understood as an unreason, in which the effects of meaning are being constructed in this dual game of reason and unreason, of logic and illogical, antinomically way. It was understood this duality, the analytic process developed through two distinct analytical paths. In the first one, the paranoid discourse of a man who committed the murder of the father and he serves a sentence of security measures, this man tries to rationalize at all times the reasons that led to such an act, although it is considered incapable, therefore, in imputable. In the second path, the paranoid discourse is from a man who, within his logic of foreclusion, he constitutes his rationality for the materialization of this fact, of killing the father, at the level of his psychotic discourse, in a movement of decomposition, in which he lacks the paternal function, which eliminates with the murder of this same father. For the composition of these analytical frameworks, theories have been used as criminology and psychoanalysis, taking technical and scientific DF references to law and medicine. The complexity of the definition of rationality in the psychotic discourse was perceived, which happened due to the advent of psychoanalysis. Madness as lack of reason takes place in the most varied DF, yet understanding how logic exists in psychotic discourse enables a differentiated reading of this phenomenon, thanks to the basic concepts of the theories by Freud and Lacan. The great challenge of the two analytical paths of these paranoid discourses we took was to realize that both the condition of production of one who kills the father, in a materialized parricide, and that of a person who does so in the level of his paranoia, these discourses were in ideal of reality at DF levels of rationality, although they are intrinsic to psychotic discourses par excellence. / O presente trabalho produz a Análise do Discurso de uma obra literária, entendida como o relato de um homem que alega ter matado o pai. O romance O dia em que matei meu pai, de Mario Sabino, constitui o corpus textual para a análise discursiva. A metodologia e base teórica dessa análise se filiam à escola francesa da Análise de Discurso, baseada nos pressupostos conceituais de Michel Pêcheux. Nessa acepção, a opacidade da língua, o assujeitamento dos sujeitos e a clivagem do inconsciente interpelam os sujeitos por meio de discursos. O discurso da loucura será visto a partir de FD da racionalidade e da FD da loucura, entendida como uma desrazão, em que os efeitos de sentido vão sendo construídos nesse jogo dual de razão e desrazão, de lógica e ilógica, de forma antinômica. Entendida essa dualidade, o processo analítico se desenvolveu por meio de duas sendas analíticas distintas. Na primeira, analisou-se o discurso paranoico de um homem que cometeu o assassinato do pai e cumpre medida de segurança, o qual tenta racionalizar a todo momento os motivos que levaram a tal ato, embora seja considerado incapaz, por isso, inimputável. Na segunda senda, o discurso paranoico é de um homem que dentro de sua lógica de foraclusão constitui sua racionalidade para a materialização desse fato, de matar o pai, em nível de seu discurso psicótico, num movimento de descompesação, em que lhe falta a função paterna, a qual elimina com o assassinato desse mesmo pai. Para a composição desses quadros analíticos, utilizou-se de teorias como a criminologia e a psicanálise, tomando como referências FD técnico-científicas do direito e da medicina. Percebeu-se a complexidade de definição da racionalidade no discurso psicótico, a qual aconteceu devido ao advento da psicanálise. A loucura como falta de razão se efetua nas mais variadas FD, contudo entender como a lógica existe no discurso psicótico possibilita uma leitura diferenciada desse fenômeno, graças aos conceitos basilares das teorias de Freud e Lacan. O grande desafio dos dois caminhos analíticos desses discursos paranoicos que tomamos foi o de perceber que tanto a condição de produção de alguém que mata o pai, num parricídio materializado, quanto a de um sujeito que o faz no nível de sua paranoia, se constituíram no ideal de realidade em níveis da FD da racionalidade, embora estejam intrínsecos a discursos psicóticos por excelência.
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Koettu hallitsematon minuus psykoottisen potilaan hoitotyön lähtökohdaksiKoivisto, K. (Kaisa) 09 May 2003 (has links)
Abstract
The study describes adult patients' experiences of psychosis and being helped in an inpatient setting. The method is qualitative and the approach phenomenological. The study was carried out at the psychiatric clinic of a Finnish university hospital in 1998. The participants were men and women aged 23-57 coping with different types of psychosis. The data consists eight people's interviews (n=14), which were tape-recorded (except one). The data was analysed using the method developed by Amedeo Giorgi and Juha Perttula.
Patients experienced psychosis as an uncontrollable sense of self, which included emotional and physical feelings of a change and a loss of control over one's self. Uncontrollable sense of self increased sensitivity with self, others, the significant others were important and meaningful and coping with daily life was difficult and varied individually. The onset of psychosis was experienced situational, the progress of psychosis as holistic and exhaustive, and the admission into the treatment as difficult but inevitable. The care was experienced as helpful but unstructured. The care should be based on patients' experiences of psychosis with self, others and life. When patients have uncontrollable sense of self the care should be protection from vulnerability to more integrated inner world supporting individual empowerment and coping. / Tiivistelmä
Tutkimuksessa kuvaillaan aikuisten potilaiden kokemuksia psykoosin ja autetuksi tulemisen todellisuudesta psykiatrisen sairaalahoidon aikana. Tutkimuksen lähestymistapa on fenomenologinen. Keräsin tutkimusaineiston yliopistosairaalan psykiatrian klinikassa avoimilla haastatteluilla vuonna 1998. Tutkimukseen osallistuneet olivat erilaisia psykooseja kokeneita ja niistä selviytyneitä tai selviytymässä olevia, 25-57-vuotiaita naisia ja miehiä. Tutkimusaineistona on kahdeksan erimuotoista psykoosia kokeneen potilaan haastattelut (n=14), jotka nauhoitettiin (yhtä lukuun ottamatta). Analysoin aineiston Amedeo Giorgin kehittämällä ja Juha Perttulan Giorgin analyysimenetelmään liittämän muunnelman mukaan.
Potilaat kokivat psykoosin hallitsemattomana minuutena, mikä tarkoitti emotionaalista ja fyysistä minän muuttumisen ja itsehallinnan menetyksen tunnetta. Hallitsematon minuus merkitsi herkistyneisyyden lisääntymistä itsen ja muiden suhteen, omaisten ja ystävien tärkeyttä ja vaihtelevaa vaikeutta selviytyä jokapäiväisestä elämästä. Elämäntilanteeseen liittyvä hallitsematon minuus oli kokonaisvaltainen ja uuvuttava kokemus. Tällöin sairaalahoito koettiin vaikeana, mutta välttämättömänä. Autetuksi tuleminen oli helpottavaa ja välttämätöntä, mutta hoito jäi jäsentymättömäksi omaan sisäiseen tilanteeseen, hoitotoimintojen ja minuuden hallitsemattomuuden / hallinnan suhteen. Autetuksi tuleminen tarkoitti potilaiden kokemana haavoittuvuudelta suojaamisesta eheytyneemmäksi tuloa siten, että yksilöllistä voimaantumista ja selviytymistä tuetaan.
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Environmental Effect: Activator of the Psychotic ProcessMilam, Melody J. (Melody Joy) 12 1900 (has links)
The purpose of the present study was to determine specific psychotic factors associated with environmental sensitivities, the changes in those tendencies occurring with ecological treatment and the extent to which those behaviors could be attributed to the chronicity of the illness. An inpatient group of 42 environmental patients was compared to an inpatient population of 20 chronic spinal pain patients. Instruments utilized in the study included the Bender Gestalt Test of Motor Ability, the Minnesota Multiphasic Personality Inventory (MMPI) with the Harris and Lingoe subscales, and three subtests of the Wechsler Adult Intelligence Scale-Revised, Digit Symbol, Object Assembly, and Block Design. Data was analyzed via multivariate analysis of covariance, analysis of covariance, canonical analysis, and t tests for related and independent means.
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Metabolt syndrom vid psykos : en litteraturstudie om åtgärder mot metabolt syndrom vid psykossjukdom. / Metabolic syndrome and psychosis : a litterature review about actions against metabolic syndrome in psychotic illness.Svensk, Ludvig, Jakobson, Johanna January 2017 (has links)
Bakgrund: Patienter med psykossjukdom lider ofta av somatisk ohälsa som uttrycker sig i metabolt syndrom. Dåliga levnadsvanor som till exempel dålig kosthållning, inaktivitet, droger etcetera, samt den nödvändiga läkemedelsbehandling är faktorer som bidrar till utvecklandet av metabolt syndrom. Dessa faktorer leder till att denna patientgrupp riskerar att dö upp till 25 år tidigare än den övriga populationen. Syfte: Syftet med studien var att belysa preventiva och lindrande omvårdnadsinterventioner mot metabolt syndrom hos personer som behandlas för psykossjukdomar. Metod: Studien är utformad och genomförd som en allmän litteraturstudie med systematisk ansats. Databassökningen utfördes i Cinahl, Pubmed, Scopus, Psycinfo och Psycarticle. Artiklarna kvalitetsgranskades utifrån Linköpings universitets granskningsmallar och kvalitetsbedömdes utifrån författarnas kvalitetskrav. Resultat: Resultatet bildade tre kategorier; Levnadsvanor, Socialt stöd och Prevention, vilka står i beroende till varandra. Patienternas levnadsvanor är det huvudsakliga fyndet för att lindra och förhindra metabolt syndrom, men för att kunna genomföra livsstilsinterventioner hos patienter med psykos behövs socialt stöd och information. Dessa faktorer utgör även grunden för det preventiva arbetet för att förhindra metabolt syndrom innan det utvecklats. Konklusion: Sammanfattningsvis kan sägas att de preventiva och lindrande åtgärderna mot metabolt syndrom för personer som behandlas för psykossjukdom är att stödja och uppmuntra patienten till en hälsosammare livsstil, innefattande ökad fysisk aktivitet och förbättrad kosthållning. Det åligger även sjuksköterskans arbetsuppgift att individanpassa vården och skapa en personcentrerad vård, skräddarsydd för den enskilde patientens förmågor och behov. Nyckelord: Psykossjukdom, Metabolt syndrom, Omvårdnad, Sjuksköterska. / Background: Patient with psychosis often suffer from somatic illness that is expressed as metabolic syndrome. Bad living habits such as bad diet, inactivity, drugs etcetera is factors that contribute to the development of metabolic syndrome. Also, the necessary drug treatment is important for the development of metabolic syndrome. These factors sets the patient group in a risk to die up to 25 years earlier than the average population. Aim: The purpose of the study was to highlight preventive and mitigating nursing interventions against metabolic syndrome in people treated for psychiatric diseases. Method: This study was designed and implemented as a general literature study with a systematic approach. The database research was performed in Cinahl, Pubmed, Scopus, Psycinfo and Psycarticle. The articles was quality-reviewed by Linköpings University’s review-templates and was quality assessed by the authors quality requirement. Result: The result formed three categories; Lifestyles, Social support and Prevention, which depend on each other. Patients' living habits are the main finding for relieving and preventing metabolic syndrome, but in order to be able to implement lifestyle interventions in patients with psychosis, social support and information are needed. These factors also form the basis for preventive work to prevent metabolic syndrome before it develops. Conclusion: In summary, it can be said that the preventative and alleviate measures against metabolic syndrome for people treated for psychiatric disease are to support and encourage the patient to a healthier lifestyle, including increased physical activity and improved diet. It is also the duty of the nurse to personalize care and create a person-centered care tailored to the individual's abilities and needs. Keywords: Psychotic Disease, Metabolic Syndrome, Nursing, Nurse.
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Hyperlipidemia and metabolic syndrome in schizophrenia:a study of the Northern Finland 1966 Birth CohortSaari, K. (Kaisa) 31 May 2005 (has links)
Abstract
Schizophrenia is associated with a shortened life expectancy and increased somatic comorbidity with e.g. cardiovascular disorders. The purpose of this study was to evaluate hyperlipidemia and metabolic syndrome in schizophrenia and thus find specific risk factors for excess mortality and morbidity.
The study population was a subsample of the Northern Finland 1966 Birth Cohort, a general population-based birth cohort. In 1997, 8,463 members of the cohort were invited to a clinical examination, where e.g. blood samples were taken after an overnight fast. Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides (TG) were determined. The following psychiatric diagnostic categories were used: 1) DSM-III-R schizophrenia (n = 31), 2) other psychoses (n = 21), 3) non-psychotic disorders (n = 104), 4) comparison group (n = 5,498), having no psychiatric hospital treatment.
Mean TC (5.5 mmol/l) and TG (1.5 mmol/l) were significantly higher in the schizophrenia group than in the comparison group (5.1 mmol/l and 1.2 mmol/l, respectively).
To evaluate serum lipid levels in subjects with and without antipsychotic medication the sample was analyzed according to used medication. The prevalence of hypercholesterolemia, high LDL cholesterol and hypertriglyceridemia was high in persons using antipsychotic medication (31%, 20% and 22%, respectively) compared to persons without such medication (12%, 10% and 7%, respectively).
We found higher triglyceride levels in patients who were ≤ 20 years old at the onset of schizophrenia (mean 1.7 mmol/l; N = 17) as compared with patients with later onset (mean 1.4 mmol/l; N = 14) or non-hospitalized controls (mean 1.2 mmol/l; N = 5,453). The difference between the first and third group was significant (p < 0.01), and there was a negative correlation between the age at onset and the level of serum triglycerides (r = -0.35, p = 0.05).
To evaluate the prevalence of metabolic syndrome, the subjects were assessed for the presence of metabolic syndrome according to the criteria of the National Cholesterol Education Program. The prevalence of metabolic syndrome was high in subjects with schizophrenia compared with the comparison group (19% vs. 6%, p = 0.010).
The results indicate an elevated risk for hyperlipidemia and metabolic syndrome in persons with schizophrenia or on antipsychotic medication. Regular monitoring of weight, serum lipid and glucose levels and blood pressure is important. Comprehensive efforts directed at controlling weight and improving physical activity are needed.
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Ethnicity and psychosis : an investigation of the validity of psychosis screening instruments in the context of cross-cultural population-based survey researchHeuvelman, Hein Hendrik Pieter January 2014 (has links)
Population-based evidence suggests that the prevalence of psychotic symptoms varies with ethnicity. However, the validity of these self-reported experiences, both as measures of psychotic symptoms per se and as measures of ethnic variation in risk for reporting these symptoms, is questionable. Cultural background and social position may affect the experience and expression of symptoms, which may in turn affect their measurement in survey research. This thesis explores these issues by assessing the psychometric properties of psychosis screening instruments as measures of ethnic differences in psychosis risk in two contexts, Great Britain and the United States. Following this, differences in risk for reporting psychotic symptoms were examined in the context of the varying social and economic conditions to which different ethnic groups and migrant generations are exposed. This was accomplished in the following way: Firstly, the prevalence of self-reported psychotic symptoms was examined across ethnic and generational groups in two large samples of British and American populations; Secondly, the construct validity of the instruments was assessed by means of exploratory and confirmatory factor analyses of response to their symptom indicators. The concurrent validity of the symptoms with measures of self-perceived cognitive and social dysfunction was then examined in a structural equation modeling framework; Thirdly, the cross-ethnic and cross-generational validity of response to these screening instruments was assessed in a multiple-group confirmatory factor analysis framework in which in which the psychometric characteristics of the instruments were compared; And finally, ethnic and generational differences in risk for reporting psychotic symptoms were examined in the context of differential exposure to racial discrimination. Both instruments had construct validity in their measurement of psychotic symptoms, with the exception of one item in the British instrument, as well as concurrent validity with measures of self-perceived cognitive or social dysfunction. The British instrument performed adequately in the measurement of psychotic symptoms across ethnic groups, but did not across migrant generations. The American instrument performed adequately in the measurement of psychotic symptoms across generations, but not across ethnic groups. The effect of measurement noninvariance on the estimation of risk across groups was, however, modest in size. Finally, there was evidence for risk of reporting psychotic symptoms being raised among those who were exposed to racial discrimination. These findings suggest that these self-reported psychotic symptoms constitute clinically relevant phenomena which appear phenotypically similar to the clinical symptoms in diagnosed psychotic disorder. Risk is distributed unevenly over ethnic groups in Britain and the US, is higher among minorities who were exposed to social adversity, and higher among the second generation (in most cases). These patterns are, therefore, highly suggestive of social causation in the aetiology of these self-reported symptoms.
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Adaptação transcultural do "Schedule for the Assessment of Insight - Expanded version (SAI-E)" : estudo de confiabilidade e analise fatorial da versão brasileira do SAI-E / Cross-cultural of the Schedule for the Assessment of Insight - Expanded version (SAI-E) : inter-rater reliability and factor analysis of the brasillian version of SAI-EDantas, Clarissa de Rosalmeida, 1976- 11 October 2006 (has links)
Orientador: Claudio Eduardo Muller Banzato / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T12:31:36Z (GMT). No. of bitstreams: 1
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Previous issue date: 2006 / Resumo: O Schedule for the Assessment of Insight - Expanded Version (SAI-E) é constituído de 11 itens que abordam: reconhecimento de se ter um transtorno mental, capacidade de renomear fenômenos psicóticos como anormais, e adesão ao tratamento. Objetivos: traduzir e adaptar transculturalmente o SAI-E; e estudar a confiabilidade entre avaliadores e a estrutura fatorial da versão brasileira do instrumento. Métodos: A adaptação do SAI-E levou em conta as dimensões da equivalência transcultural: de conteúdo, semântica, técnica, de critério e conceitual. A versão brasileira do SAI-E foi utilizada na avaliação de 109 pacientes psicóticos internados, dos quais 60 tiveram a entrevista gravada para atribuição de escores por avaliador independente. Resultados: Uma boa equivalência transcultural foi alcançada. A confiabilidade entre avaliadores para os itens do SAI-E foi aceitável, com kappa variando de 0,48 a 0,76, e coeficiente de correlação intraclasse (ICC) de 0,66 a 0,78; para o escore total foi excelente, com ICC = 0,90. Uma estrutura fatorial semelhante à obtida para a versão original do SAI-E foi encontrada, com 3 fatores explicando 71,72% da variabilidade. O fator 1 (30,43% da variância) consistiu nos cinco itens sobre o reconhecimento da doença e no item sobre reconhecimento da necessidade de tratamento; o fator 2 (26,75% da variância) consistiu nos dois itens relativos à capacidade de reconhecer o caráter patológico dos sintomas, no item de contradição hipotética e no item 3 ¿atribuição da própria condição a um transtorno mental¿; e o fator 3 (14,54% da variância) consistiu nos dois itens que abordam adesão ao tratamento. Em um estudo preliminar de associação entre insight e variáveis sócio-demográficas, clínicas e relativas ao tratamento, constatou-se que melhor insight global esteve associado à ocorrência de episódio depressivo maior, internação voluntária, e experiência de atendimento em psicoterapia. Conclusão: no contexto brasileiro o SAI-E apresentou boa confiabilidade entre avaliadores e estrutura fatorial compatível com as dimensões do insight que pretende avaliar / Abstract: The Schedule for the Assessment of Insight - Expanded Version is constituted of 11 items that encompass: awareness of having a mental illness, ability to rename psychotic phenomena as abnormal and compliance to treatment. Objectives: Translate into Portuguese and adapt SAI-E cross-culturally and study the inter-rater reliability and the factorial structure of the Brazilian version of the instrument. Methods: The adaptation of SAI-E considered the dimensions of cross-cultural equivalence: content, semantic, technical, criterion and conceptual equivalences. The Brazilian version of SAI-E was used for the assessment of insight of 109 psychotic inpatients, 60 of whom had the interview taped in order to be scored by an independent evaluator. Results: Good cross-cultural equivalence was achieved. An acceptable inter-rater reliability was found to the individual items of SAI-E with kappa ranging from 0.48 to 0.76, and intraclass correlation coefficient (ICC) of 0.66 to 0.78. Regarding the total score, inter-rater reliability was excellent, with ICC=0.90. A factorial structure similar to the one obtained to the original version of SAI-E was found, with 3 factors accounting for 71.72% of variance. Factor 1 (30.43% of variance) consisted of the five items about awareness of illness and the item about the awareness of the need of treatment; factor 2 (26.75% of variance) consisted of the two items related to the renaming of symptoms as pathological, the item of hypothetical contradiction and item 3, ¿attribution of one¿s condition to a mental illness¿; and factor 3 (14.54% of variance) consisted of the two items regarding treatment compliance. In a preliminary study on the correlations between insight and socio-demographic and clinical variables, we found that better global insight was associated with occurrence of major depressive episodes, voluntary admissions, and previous psychotherapy treatment. Conclusion: In the Brazilian context, SAI-E presented good inter-rater reliability and factorial structure compatible to insight dimensions that are intended to be evaluated. / Mestrado / Saude Mental / Mestre em Ciências Médicas
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Avaliação da resposta terapêutica no tratamento de manutenção com lítio em pacientes com transtorno afetivo bipolar / Assessing treatment response to prophylactic lithium therapy in patients with bipolar disorderSilva, Luiz Fernando de Almeida Lima e, 1980- 27 August 2018 (has links)
Orientadores: Cláudio Eduardo Muller Banzato , Clarissa de Rosalmeida Dantas / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T15:11:19Z (GMT). No. of bitstreams: 1
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Previous issue date: 2015 / Resumo: O transtorno afetivo bipolar (TAB) é uma morbidade mental crônica e grave, que habitualmente se manifesta na adolescência ou início da vida adulta. Sua forma mais prevalente de apresentação é a de episódios maníacos ou hipomaníacos, intercalados por episódios depressivos ou períodos de eutimia. Modernamente, uma miríade de medicações possuem aprovação para o tratamento do TAB, porém o lítio ainda é considerado um dos fármacos de primeira linha no tratamento de manutenção do transtorno. Como a resposta ao lítio não é uniforme, a tentativa de identificar possíveis preditores de resposta terapêutica vem sendo alvo de diversos estudos. Neste contexto, um grande desafio é avaliação da melhora clínica de pacientes tratados fora de um protocolo estrito de pesquisa. Para contornar este problema, a escala ALDA vem se mostrando como um valioso instrumento nos trabalhos publicados na literatura. OBJETIVOS: estudar a confiabilidade da escala ALDA, avaliar de forma padronizada a resposta terapêutica ao lítio no tratamento de manutenção do TAB e identificar possíveis preditores clínicos e epidemiológicos de resposta. MÉTODOS: quarenta pacientes em tratamento ambulatorial com diagnostico confirmado de TAB e história de uso de lítio foram avaliados, com revisão minuciosa dos prontuários médicos. Um instrumento padronizado (a escala ALDA), que se baseia em informações clínicas obtidas de forma retrospectiva, foi usado para avaliar a melhora clínica global e possíveis fatores confundidores. Foram também coletados dados acerca de variáveis clínicas e sociodemográficas, para avaliar possíveis fatores preditores de resposta ao tratamento. Também aferimos a confiabilidade interavaliadores para o escore total e para cada um dos itens da escala ALDA, por meio do Coeficiente de Correlação Intraclasse (ICC), entre dois pesquisadores que realizaram suas avaliações de modo independente. RESULTADOS: nosso estudo encontrou uma relação inversa entre o número de episódios de humor com sintomas psicóticos e melhor desfecho no tratamento com lítio (PE -1,24241). Também constatamos a relação direta entre uso atual ou prévio de tabaco e melhora clínica com lítio (PE 7,66608). Com relação ao estudo de ICC nos diferentes itens da escala ALDA, encontramos valores que variaram de 0,610 a 0,833. CONCLUSÃO: nossos achados apontam que a escala ALDA pode ser uma ferramenta útil e confiável para a avaliação padronizada da resposta terapêutica em pacientes com TAB. Os resultados obtidos reforçam a hipótese que o lítio parece ser menos eficaz em pacientes que manifestam sintomas psicóticos, além de nos levarem a questionar o papel do tabaco no prognóstico de pacientes com transtorno bipolar / Abstract: Bipolar disorder (BD) is a chronic and severe mental illness, that usually manifest its first symptoms in early adulthood. The most prevalent clinical form of the disorder is the occurrence of episodes of mania or hypomania, interspersed with episodes of depression and periods of euthymia. Currently, a myriad of drugs have approval for treating BD, nevertheless lithium still stands as a gold standard in the prophylactic treatment of the disorder. Since lithium response is not uniform between patients, different studies have been trying to identify possible predictors of response to the treatment. In this scenario, accessing clinical improvement in patients not treated following a strict research protocol is a great challenge. To solve this issue, the ALDA scale appeared as a valuable tool in different published studies. OBJECTIVES: to study the reliability of the ALDA scale, to systematically access the response of prophylactic lithium treatment in BD and to identify possible clinical and epidemiological predictors of lithium response. METHODS: forty outpatients in treatment for confirmed clinical diagnose of BD, and with history of lithium use, were accessed with a thorough review of their medical charts. A standardized instrument (the ALDA scale), which is based on clinical information obtained retrospectively, was used to evaluate clinical improvement and possible confounding factors. In this process, we have obtained other clinical and sociodemographic data, to investigate possible predictive variables to treatment response. We have also used the Interclass Correlation Coefficient (ICC) to determine the inter-rater reliability between two independent researchers, for the ALDA scale total score and each of its sub items. RESULTS: our study found an inverse relation between the number of mood episodes with psychotic symptoms and improvement with lithium therapy (PE -1,24241). We have also found a direct relation between current or previous tobacco use and clinical improvement with lithium (PE 7,66608). Concerning the ICC for each of the ALDA scale sub items, we found values ranging between 0,610 and 0,833. CONCLUSION: our findings suggest that the ALDA scale can be a useful and trustworthy instrument in the standardized evaluation of clinical response in patients with BD. Our results also reinforce the hypothesis that lithium treatment seems to be less efficacious in patients with psychosis, and lead us to speculate the role of tobacco use in the outcome of patients with bipolar disorder / Mestrado / Saude Mental / Mestre em Ciências Médicas
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