Pessoas com transtornos psicóticos enfrentam mudanças e limitações na vida cotidiana. Suas necessidades podem ser complexas e envolver vários tipos e níveis de cuidados. A avaliação sistemática das necessidades de usuários dos serviços de saúde é importante para a organização dos serviços e para estabelecer propostas individualizadas de tratamento. A avaliação de necessidades de usuários de serviços de saúde mental tem sido utilizada em vários países, mas ainda não é rotineira no Brasil. A CAN avalia necessidades em 22 domínios que envolvem diversas necessidades de ajuda, como problemas com moradia, alimentação, sintomas psicóticos, saúde física e outros. OBJETIVOS: Traduzir e adaptar a versão brasileira da CAN para pesquisa (CAN-R), e avaliar a sua confiabilidade entre avaliadores, em uma amostra de casos incidentes de psicoses funcionais na cidade de São Paulo. MÉTODO: Foram selecionados aleatoriamente participantes do \"Estudo de casos incidentes (primeiro contato com serviços de saúde) de psicoses funcionais no Brasil\", no qual este estudo está inserido. Os critérios de inclusão foram: contato pela primeira vez com serviços de saúde no período do estudo, diagnóstico de esquizofrenia, outras psicoses do espectro da esquizofrenia, mania ou depressão psicótica (DSM-IV); idade entre 18 e 64 anos; residir em determinadas regiões geográficas da cidade de São Paulo. A versão da CAN, traduzida e adaptada para o português pelo grupo de pesquisadores do estudo de casos incidentes, foi aplicada aos participantes do estudo por cinco auxiliares de pesquisa. Posteriormente um avaliador cego em relação às avaliações realizadas pelos auxiliares de pesquisa realizou a pontuação da escala de modo independente, utilizando fitas com a gravação das entrevistas. As pontuações das entrevistas realizadas pelos assistentes de pesquisa foram comparadas com as pontuações do avaliador independente utilizando-se o coeficiente kappa e o coeficiente de correlação intraclasse (CCI). RESULTADOS: Cinqüenta e dois sujeitos foram incluídos no estudo. Cinqüenta e dois por cento eram mulheres, a maioria dos participantes estava na faixa etária entre 18 e 39 anos, tinha no máximo oito anos de estudo e diagnósticos de esquizofrenia ou outros transtornos mentais do espectro da esquizofrenia. A confiabilidade entre avaliadores para os 22 domínios da escala foi substancial, quase perfeita ou total para 19 (87%) domínios. A confiabilidade para o total de necessidades, avaliada através do ICC, foi 0,95 (IC95% 0,90 - 1,00). CONCLUSÕES: A CAN mostrou boa aplicabilidade e reprodutibilidade segundo avaliação de profissionais de saúde mental com indivíduos em um primeiro episódio psicótico. O uso de instrumentos padronizados como a CAN em serviços de saúde mental no Brasil deve contribuir para a avaliação da efetividade das ações e para o cuidado individualizado das pessoas com transtornos mentais. / People with psychotic disorders usually face changes and limitation in their daily life activities. Their needs are complex and involve different types and levels of care. In several countries, the systematic assessment of needs is considered essential for service planning and to establish treatment goals. However, in Brazil, the assessment of needs is still limited. The Camberwell Assessment of Needs (CAN) assess needs in 22 domains that encompass a wide range of needs of care, as problems with accommodation, food, psychotic symptoms, physical health, and others. OBJECTIVES: The aims of this study were to translate and adapt the CAN for research (CAN-R) and to assess its inter-rater reliability, in a sample of first contact psychosis in São Paulo. METHOD: Subjects were randomly selected from the \'Brazilian First Contact Psychosis Study\' sample. The inclusion criteria were: first contact with health services due to a psychotic episode at the study period; diagnosis of schizophrenia, other psychotic disorders of schizophrenia spectrum, mania or psychotic depression (DSM-IV); age between 18 and 64 years; living in pre-defined areas of São Paulo. Five research assistants carried out the CAN version, adapted and translated into Portuguese by the investigators? group of the incidence study. Afterwards a blind investigator carried out the assessment independently, through tape-records of the interviews. Kappa coefficient and intraclass correlation coefficient were used to compare ratings of the independent investigator with ratings of the research assistants group. RESULTS: Fifty-two subjects were included, 27 (52%) of them were women. Most were in 18-39 age group, had studied eight years or less, and had diagnosis of schizophrenia or other schizophrenia spectrum disorders. Inter-rater reliability to 19 (87%) domains was substantial, almost perfect or total as measured by kappa coefficient. Reliability to total of needs measured by ICC was 0.95 (CI 95% 0,90 - 1,00). CONCLUSIONS: The Can showed good applicability and reliability with first contact psychotic individuals. The use of standardized instruments as the CAN in mental health services in Brazil, can contribute to the assessment of effectiveness of interventions, and individualized care to people with mental disorders.

No description available.

Major psychotic disorders are one of the leading causes of disability worldwide, having severe impacts on the people who suffer from the conditions, their families and society. There is evidence that if these conditions are identified and treated early, the prognosis is improved. The purpose of this dissertation study is to produce two manuscripts related to the use of family aided community treatment (FACT) with individuals who are experiencing early psychotic disorders. Using a proof of concept design with multiple repeated-measure t tests, this study focused on first-episode psychotic disorder participants (n = 8), with an average age of 19.6 (sd = 3.28) and males comprising 75% of the sample engaged in a family aided community treatment (FACT) protocol in order to examine if psychiatric symptoms scale scores decreased post-intervention. The hypothesis which stated that a year-long family aided community treatment (FACT) intervention would reduce psychiatric symptoms when assessed by the Structured Interview for Prodromal Syndromes (SIPS), the Positive and Negative Symptoms Scale (PANSS), and the Global Functioning Scales in a first episode psychotic disorder sample, is supported. The FACT intervention decreased psychiatric symptom scores in this population. Implications of this study include improved training on early recognition for mental health clinicians and students, implementation of a specific treatment model in community settings, and policy around treatment funding allocation. / Graduation date: 2012

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Bakgrund  Många studier visar att personer med psykiska besvär oftare drabbas av fysisk ohälsa och unga personer med psykossjukdom utgör en speciellt utsatt grupp. Syfte Syftet var att undersöka hur unga vuxna med psykossjukdomar upplever sin kroppsliga hälsa. Arbetet syftade även till att kartlägga patienternas uppfattning om hjälp- och stödbehov när det gäller upprätthållande/förbättring av hälsotillståndet. Metod En kvalitativ studie med intervjuer med tio patienter. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat Analysen ledde fram till ett tema: Synen på den kroppsliga hälsan är en strävan efter att med stöd och hjälp leva ett liv som alla andra. Temat uppstod utifrån fyra kategorier. 1. Hur man lever livet – livsstilsaspekter som studiedeltagarna förknippade med kroppslig hälsa, dvs. motion, kost, rökning, rutiner i vardagen. 2. Att känna sig frisk – kroppslig hälsa som motsats till sjukdom. Kategorin inkluderar även balans och energi. 3. Hälsa som en process – beskrivning av hälsa i följande dimensioner: gemenskap och självständighet, vändpunkt och förändring samt sorg och hopp. 4. Stöd och hjälp från hälso- och sjukvården – studiedeltagarnas erfarenhet av tillit samt önskemål om större tillgänglighet, mer individanpassade insatser och utökat finansiellt stöd. Slutsats Unga vuxna med psykossjukdom uppfattade kroppslig hälsa som ett mångdimensionellt fenomen som gick långt utanför den biomedicinska traditionen där hälsa ses som frånvaro av sjukdom. Det är patientens egen förståelse av hens hälsa som borde styra psykiatrisjuksköterskans omvårdnadsarbete i stort och hälsofrämjande insatser i synnerhet.

Background: There is currently very little research on recovery from the perspective ofindividuals with recent-onset of psychotic disorders. Forming a better understanding ofthesubjective meaning ofrecovery and recovery experiences during this early phase ofrecovery caninform effective and meaningful service design and practices.Method: Thirty individuals recovering from psychosis and receiving specialized earlyinterventiontreatment were interviewed regarding the meaning and experience of recovery frompsychosis during the early phase (2-5 years) ofthe illness course.Results: Recovery was described as a multidimensional experience that included aspects of"illness recovery," "psychological recovery," and "social recovery." Seven common earlyrecovery experiences were identified. Individual variations in the magnitude ofdescribeddisruption of self and social functioning, duration ofthe illness-acceptance process and theprocess treatment negotiation greatly influenced the experience ofrecovery.Conclusion: Differences in illness acceptance and social recovery trajectories have importantimplications for understanding individual responses to the experience ofpsychosis, its diagnosisand treatment. These differences emphasize the importance of assisting individuals with theconstruction of meaning and the reengagement in social roles following the initial illnessexperience. / Contexte: Il y a actuellement peu de recherche sur la rétablissement du point de vue d'individusaprès un premier épisode de psychose. La formation d'une meilleure compréhension de senssubjectif des expériences de rétablissement pendant cette première phase de rétablissement peutinformer le design efficace et expressif des services et des pratiques.Méthode: Trente individus se rétablissement de la psychose et recevant un traitement depremière intervention spécialisé ont été interviewés à propos du sens et de l'expérience derétablissement de la psychose pendant la première phase (2-5 ans) du cours de maladie.Résultats: La rétablissement a été décrite comme une expérience multidimensionnelle qui ainclus des aspects de "la rétablissement de maladie," "la rétablissement psychologique," et "larétablissement sociale." Identifiées ont été sept premières expériences de rétablissementcommunes. Les variations individuelles dans l'étendue de perturbation décrite de soi et defonctionnement social, la durée du processus d'acceptation de maladie et de la négociation duprocessus de traitement ont beaucoup influencé l'expérience de rétablissement.Conclusions : Les différences dans les trajectoires d'acceptation de maladie et de rétablissementsociale ont des implications importantes pour comprendre les réponses individuelles àl'expérience de psychose, sa diagnose et traitement. Ces différences accentuent l'importanced'assister les individus avec la construction de sens et avec le réengagement dans les rôlessociaux après l'expérience de maladie initiale.

Diss. Stockholm : Karolinska institutet, 2007.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 6 uppsatser.

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

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.