Background Studies on course and outcome of schizophrenia coming from low income countries are increasingly becoming important to challenge the existing dogma claiming good outcome in these countries. Besides clinical course and outcome, mortality is considered a very important outcome measure for schizophrenia. Culture and tradition play a significant role in the manifestations of severe mental illnesses (SMI). Khat is a culturally accepted plant endemic to Eastern Africa, which is chewed by people for its stimulating effect. It is believed that Khat influences the course and outcome of schizophrenia although systematic studies are scarce. Patients with SMI continue to chew khat despite advice from their doctors to desist. Reasons for this behavior were not fully investigated before. Objectives              -     To describe the 5-year clinical course and outcome and mortality of schizophrenia in Butajira. -       To explore traditional views on psychosis in the semi-nomadic Borana population. -       To describe the perceived causes and preferred treatment for SMI in the semi-nomadic Borana population -       To explore reasons for khat chewing behavior in people with SMI in Butajira. Methods The studies were done in two sites: Butajira and Borana. The Butajira study involved screening, using CIDI and Key Informants (KIs), of more than 68,000 adults aged 15-49. Of these, 321 people were diagnosed with schizophrenia and were followed-up for five years to look into their clinical course and outcome, including mortality. A qualitative study involving 37 men with SMI and 30 female caregivers was conducted in Butajira to study reasons why patients continue to chew khat despite their physicians’ advice against it. The Borana study of a remote semi-nomadic population in southern Ethiopia, used qualitative methods involving 56 KIs to identify descriptions of psychosis, perceived causes and preferred treatment in the community. Cases identified by the KIs also underwent SCAN interview for confirmatory diagnosis.   Results The five year follow-up of schizophrenia patients showed that 45% of participants were continuously symptomatic with 30.3% having had continuous psychotic episode. About 20% had experienced continuous remission. Being single (OR = 3.41, 95% CI = 1.08-10.82, P = 0.037), on antipsychotic treatment for at least 50% of follow up time (OR = 2.28, 95% CI = 1.12-4.62, P = 0.023), and having a diagnosis of paranoid subtype of schizophrenia (OR = 3.68, 95% CI = 1.30-10.44, P = 0.014) were associated with longer period of remission. A total of 38 (12.4%) patients, thirty four men (11.1%) and four women (1.3%) died during the 5-year follow-up period. The mean age (SD) of the deceased for both sexes was 35 (7.35): 35.3 (7.4) for men and 32.3 (6.8) for women. The most common cause of death was infection, 18/38 (47.4%) followed by severe malnutrition, 5/38 (13.2%) and suicide 4/38 (10.5%). The overall SMR was 5.98 (95% CI = 4.09 to 7.87): 6.27 (95% C I = 4.16 to 8.38) for men and 4.30 (95% CI = 1.02 to 8.52) for women. Patients residing in rural areas had lower mortality with adjusted HR of 0.30 (95% CI = 0.12-0.69) but those with insidious onset had higher mortality with adjusted HR 2.37 (95% CI = 1.04-5.41). Treatment with antipsychotics for less than 50% of the follow-up time was also associated with higher mortality, adjusted HR 2.66 (1.054-6.72). In the Borana study, the incongruity between local and psychiatric concepts in the CIDI lay mainly in the fact that KIs described characteristics of marata (madness) in terms of overt behavioral symptoms instead of thought disturbances. Following the focus group discussions, participants identified 8 individuals with schizophrenia and 13 with a psychotic mood disorder, confirmed by SCAN interview. Supernatural causes such as possession by evil spirits, curse, bewitchment, ‘exposure to wind’ and subsequent attack by evil spirits in postnatal women; bio-psycho-social causes such as infections (malaria), loss, ‘thinking too much’, and alcohol and khat abuse were mentioned as causes of SMI. The preferred treatments for severe mental illness included mainly traditional approaches, such as consulting Borana wise men or traditional healers, prayer, holy water treatment and, finally, seeking modern health care. Regarding khat and SMI in Butajira, reasons given by patients as well as caregivers were more or less congruent: social pressure, a means for survival by improving function, combating medication side effects, to experience pleasure and curbing appetite.  Conclusion Schizophrenia runs a chronic and non-remitting course and was associated with very high premature mortality in Butajira. Continued treatment with antipsychotics has been a consistent predictor of favorable outcome and reduced mortality. Case identification in studies of psychotic disorders in traditional communities are likely to benefit from combining structured interviews with the key informant method. Planning mental health care in traditional communities needs to involve influential people and traditional healers to increase acceptability of modern mental health care. Patients with SMI chewed khat for some important reasons that clinicians need to consider in their management.

Este trabalho investiga se no Brasil o lugar social destinado pela sociedade às pessoas que possuem diagnósticos relativos à psicose é semelhante àquele que o poder soberano destina ao homo sacer. Para isso, o referencial teórico estudado baseia-se na pesquisa de Agamben sobre o homo sacer e na teoria psicanalítica da psicose, mas não de forma exaustiva, e sim recortando possíveis contribuições. Essas noções subsidiam toda discussão que vai dos primeiros entendimentos sobre loucura, atravessando o ideal de eugenia, até desembocar na reforma psiquiátrica e no Serviço de Residência Terapêutica SRT como contraponto à política manicomial. Já para a pesquisa de campo, a metodologia escolhida baseou-se numa pesquisa qualitativa, com o uso de entrevista semiestruturada e de diários de campo. Os participantes foram divididos em três perfis: moradores do SRT que são egressos de períodos de longa internação em hospitais psiquiátricos, com nosologia relativa à psicose; cuidadores do SRT; e técnicos de nível superior que atuam na área da saúde mental. A análise das entrevistas foi baseada na análise de conteúdo. Os resultados evidenciam que a história da loucura no Brasil foi marcada pela exclusão, mas que os acontecimentos do século XX evidenciaram que o psicótico deixa de estar apenas no lugar do excluído e é jogado no lugar do homo sacer. Simultaneamente ao psicótico como homo sacer está a figura do neurótico como sobrevivente, mas ambos vivem a insegurança de se afogarem no rio da biopolítica. Já as falas dos moradores, cuidadores e técnicos reconheceram o hospital psiquiátrico como um lugar onde as pessoas são abandonadas por todos para morrer: abandonadas pelas famílias, abandonadas pela equipe do hospital, abandonadas pelo poder público, abandonadas pela sociedade como um todo. Mais que um lugar de abandono, o hospital psiquiátrico era um lugar de morte. A este lugar de morte surgiu como contraponto uma saúde mental voltada para a inserção social e territorial das pessoas acometidas de transtornos mentais, e o SRT mostrou-se um importante equipamento para efetivar tais ações. Para os participantes, o SRT é tudo o que o hospital psiquiátrico não é: Enquanto o hospital leva as pessoas para longe da cidade, a residência traz de volta para ela. Enquanto o hospital aprisiona irresponsavelmente, a residência liberta responsavelmente. Enquanto nos hospitais existem pacientes internados, na residência existem moradores que participam da sociedade. Enquanto nos hospitais corpos são usados desrespeitosamente, na residência vidas são vividas dignamente / This work problematizes and investigates if in Brazil the social place destined by the society to the people that have diagnoses related to the psychosis is similar to the one that the sovereign power destines to homo sacer. For this, the theoretical framework studied is based on Agamben\'s research on homo sacer and on the psychoanalytic theory of psychosis, but not in an exhaustive way, but rather by cutting possible contributions. These notions subsidize any discussion that goes from the first understandings about madness, crossing the ideal of eugenics, until it ends in the psychiatric reform and the Service of Therapeutic Residence - STR - as a counterpoint to the asylum policy. For the field research, the chosen methodology was based on a qualitative research, with the use of semi-structured interviews and field diaries. Participants were divided into three profiles: residents of the STR who are graduates of periods of long stay in psychiatric hospitals, with nosology related to psychosis; STR caregivers; and higher education technicians who work in the area of mental health. The analysis of the interviews was based on content analysis. The results show that the history of madness in Brazil was marked by exclusion, but that the events of the twentieth century showed that the psychotic is no longer only in the place of the excluded and is played in the place of homo sacer. Simultaneously with the psychotic as homo sacer is the figure of the neurotic as survivor, but both live the insecurity of drowning in the river of biopolitics. The speeches of the residents, caregivers and technicians have recognized the psychiatric hospital as a place where people are abandoned by all to die: abandoned by the families, abandoned by the hospital staff, abandoned by the public power, abandoned by society as a whole. More than a place of abandonment, the psychiatric hospital was a place of death. To this place of death a mental health aimed at the social and territorial insertion of the people affected by mental disorders appeared as a counterpoint, and the STR proved to be an important equipment to carry out such actions. For participants, the STR is all that the psychiatric hospital is not: While the hospital takes people away from the city, the residence brings it back to it. While the hospital imprisons irresponsibly, the residence frees responsibly. While in hospitals there are hospitalized patients, in the residence there are residents who participate in society. While in hospitals bodies are used disrespectfully, in residence lives are lived worthily

Os estudos de alto risco com descendentes de indivíduos portadores de psicoses fornecem uma oportunidade para estudar possíveis características fenotípicas e genéticas que podem estar envolvidas no desenvolvimento destes transtornos. Até o momento as pesquisas sobre a influência da vulnerabilidade genética e o ambiente sobre o comportamento das crianças de risco são escassos e inconclusivos. Objetivo: Revisão dos principais estudos genético-epidemiolólogicos e dos principais achados dos estudos de alto risco para psicose funcional. Revisão dos estudos genético-moleculares dos polimorfismos Ser9Gly (rs6280), VNTRDAT1 (NM_001044.3), Val66Met (rs6265) e 5HTTLPR (- X76753) e estudo de associação destes polimorfismos em mães portadoras de psicose funcional e em seus respectivos filhos. A distribuição destes polimorfismos em quatro características clínicas nos filhos (Síndrome Ansiedade/depressão e Retraimento/depressão do CBCL, atraso escolar e déficit intelectual) foi o objetivo secundário. Métodos: Sujeitos-Mães com esquizofrenia e transtorno afetivo bipolar atendidas no Instituto Psiquiatria do IPq-HCFMUSP e atendidas na Clínica de Ginecologia da mesma Universidade foram convidadas a participar.Para cada mãe, 1 filho foi escolhido, estratificando-se para gênero e idade (6-18 anos). Os entrevistadores eram cegos e aplicaram nas mães SCID (Entrevista Clínica Estruturada para DSM-IV) e GAF (Avaliação Global de Funcionamento) e nas crianças CBCL (Child Behavior Checklist) (Achenbach, 1983) e WASI (Wechsler Abbreviated Scale of Intelligence). Foi avaliado nível socioeconômico baseado em um instrumento utilizado em estudos de populacionais brasileiros (ANEP). As freqüências de polimorfismos da mães foi feita comparando-as segundo o diagnóstico psiquiátrico (Esquizofrenia, Transtorno Afetivo Bipolar e Controles). A análise das características das crianças foi realizado inicialmente segundo o diagnóstico da materno e posteriormente de acordo com possíveis síndromes clínicas que estas crianças apresentaram. A análise de dados foi executada pelo Programa Estatístico SPSS 15.0. Os grupos foram comparados de acordo com características através de Chi-quadrado de Pearson ou do Teste Exato de Fisher, adotando-se valor de significância de 0.05. RESULTADOS: 167 mães (58 com esquizofrenia, 47 com transtorno afetivo bipolar e 62 controles) e seus filhos participaram. Não se observaram diferenças significantes nos alelos e genótipos dos polimorfismos do Ser9Gly, VNTR-DAT1, Val66Met e 5HTTLPR. Houve diferença na freqüência das Síndromes Retraimento/depressão e Ansiedade/depressão no grupo de filhos de mães portadoras de TAB, porém sem associação com os polimorfismos estudados. Uma tendência de associação foi detectada entre homozigose ser9gly e prejuízo mental (p = 0,09) e uma associação entre homozigose 9 e 10 do VNTR-DAT1- (p=0,03) e Síndrome Ansiedade/Depressão nas crianças independente da diagnóstico da materno. CONCLUSÃO: Apesar da limitação do tamanho da amostra, nossos resultados apóiam a viabilidade metodológica dos estudos de risco alto para analise em genética molecular. Futuramente pretende-se explorar os dados encontrados com o aumento da amostra e com a introdução de novas variáveis advindas do segmento desta população. / The high-risk studies involving offspring of parents who developed psychoses provide the opportunity to clarify quantitative trait loci that may underlie liability traits. Until now, the research about the influence of genetic vulnerability and environmental factors on child behavior is scarce and inconclusive. Objective: In this research a review of the findings of previous HR studies in functional psychoses, the analyze polymorphisms distribution of the genes DRD3 (Ser9Gly - rs6280), DAT1 (VNTR-Variable Number of Tandem Repeats - NM_001044.3), BDNF (Val66Metrs6265) and serotonin transporter (5HTTLPR - X76753.2) among functional psychoses women and their offspring and polymorphisms distribution in four clinical characteristics among the offspring (Anxious/Depressed and Withdrawn/Depressed syndromes from CBCL, school delay and low intelligence coefficient) was done. Methods: Outpatient mothers with schizophrenia and bipolar referred from the Psychiatric Institute in Sao Paulo and outpatient mothers referred from the Gynecologic Clinic of the same university. For each mother, one offspring was chosen and stratified by gender and age (6-18 y.o.). Blinded interviewers applied the SCID (Structured Clinical Interview for DSM-IV) and Global Assessment of Functioning Scale (GAF) to the mothers, the Child Behavior Checklist (CBCL) (Achenbach, 1983) and WASI (Wechsler Abbreviated Scale of Intelligence) to the children. Socioeconomic status was evaluated based on a Brazilian standardized instrument used in population studies (ANEP). The polymorphisms distribution among mothers was done comparing the diagnoses (Controls, Bipolar Disorder and Schizophrenia). The analysis of the offspring characteristics was initially done according to mother s diagnosis and later according to likely clinical syndromes these children showed. Data analysis was performed with the Statistical Program for Social Sciences (SPSS - 15.0). The groups were compared according to characteristics using Pearson s Chi-square or Fisher s Exact Test adopting significance value of 0.05. RESULTS: 167 mothers (58 with schizophrenia, 47 with bipolar disorder and 62 controls) participated. No significant difference was observed in the allelic and genotype frequencies in the polymorphisms of the Ser9Gly, VNTR- DAT1, Val66Met- and 5HTTLPR. There was some difference in Anxious/Depressed and Withdrawn/Depressed syndromes frequency in the children from bipolar group, but without association with the polymorphism studied. A tendency of association was detected between homozygosis ser9gly DRD3 and mental impairment (p= 0,09), and an association between homozygosis 9* and 10* of DAT1-VNTR (p=0,03) and Anxious/Depressed in children, regardless of mother s diagnosis. CONCLUSION: Despite of the sample size limitation, our results supported the methodological feasibility of a high-risk study. Hereafter it intends to explore the data found by increasing the sample and introducing new variables from the follow up.

Objetivos: Definir o perfil sociodemográfico e a saúde mental em médiuns espíritas,bem como a fenomenologia e o histórico de suas experiências mediúnicas. Métodos: 115 médiuns em atividade foram selecionados aleatoriamente de centros espíritas de São Paulo. Numa primeira etapa foram aplicados os questionários: sociodemográfico e de atividade mediúnica, SRQ (Self-Report Psychiatric Screening Questionnaire) e EAS (Escala de Adequação Social). Todos os médiuns com provável psicopatologia pelo SRQ (n=12) e o mesmo número de controles foram entrevistados com base no DDIS (Dissociative Disorders Interview Schedule), SCAN (Schedules for Clinical Assessment in Neuropsychiatry) e através de uma entrevista qualitativa. Resultados: 76,5% da amostra eram mulheres, idade média 48,1 ± 10,7 anos, 2,7% de desemprego e 46,5% de escolaridade superior. Eram espíritas, em média, há 16,2 ± 12,7 anos e possuíam uma média de 3,5 tipos de mediunidade (incorporação 72%; psicofonia 66%; vidência 63%; audiência 32%; psicografia 23%). Cada modalidade mediúnica era exercitada entre 7 a 14 vezes por semana em média, não havendo diferença entre os sexos. 7,8% dos médiuns ficaram acima do ponto de corte para transtorno psiquiátrico menor pelo SRQ e a amostra alcançou uma pontuação de 1,85 ± 0,33 na EAS. Houve correlação significativa entre os escores de adequação social e de sintomas psiquiátricos pelo SRQ (r= 0,38 p<0,001). Não houve correlação entre a intensidade de atividade mediúnica e os escores SRQ e adequação social. Os médiuns diferiam das características de portadores de transtornos de identidade dissociativa e possuíam uma alta média (4) de sintomas Schneiderianos de primeira ordem para esquizofrenia, mas estes não se relacionaram aos escores do SRQ ou do EAS. Foram identificados quatro grupos de relatos de surgimento da mediunidade: sintomas isolados na infância ou na vida adulta, quadros de oscilação do humor e durante o curso de médiuns. A psicofonia/incorporação possui como pródromos uma sensação de presença, sintomas físicos diversos e sentimentos e sensações não reconhecidos como próprios do indivíduo. Posteriormente, é sentida uma pressão na garganta e mecanicamente começa-se a verbalizar um discurso não planejado. Aintuição foi caracterizada pelo surgimento de pensamentos ou imagens não reconhecidos como próprios. A audição e a vidência se caracterizaram pela percepção de imagens ou vozes no espaço psíquico interno ou objetivo externo. A psicofonia só ocorria no centro espírita, as demais modalidades mediúnicas ocorriam tanto dentro como fora dos centros espíritas Conclusões: Os médiuns estudados evidenciaram alto nível socioeducacional, baixa prevalência de transtornos psiquiátricos menores e razoável adequação social. A mediunidade provavelmente se constitui numa vivência diferente do transtorno de identidade dissociativa. A maioria teve o início de suas manifestações mediúnicas na infância, e estas, atualmente, se caracterizam por vivências de influência ou alucinatórias, que não necessariamente implicam num diagnóstico de esquizofrenia.¶ / Objectives: This study describes the social-demographic profile and psychopathology of Spiritist mediums, history and phenomenology of their mediumistic experiences. Methods: One hundred fifteen actively practicing medium subjects (27 male and 88 female) were randomly selected from different Kardecist Spiritist Centers in the City of Sao Paulo, Brazil. In the early phase of the study, all participants completed social-demographic and mediumistic activity questionnaires, SRQ (Self-Report Psychiatric Screening Questionnaire) and SAS (Social Adjustment Scale). All medium subjects (n = 12) identified by the SRQ with probable psychopathology, and a control group (12 healthy subjects) were submitted to interview using: the DDIS(Dissociative Disorders Interview Schedule), SCAN (Schedules for Clinical Assessment in Neuropsychiatry), and a qualitative interview. Results: Females were 76.5% of the sample, sample mean age was 48.1 ± 10.7 years; 2.7% of the subjects were currently unemployed; and 46% of the sample had a college degree. Participants indicated being Spiritist for an average of 16.2 ±12.7 years, having a mean of 3.5 different types of mediumistic abilities (receiving/embodiment of an spiritual entity 72%; seeing 63%; hearing 32%; and automatic writing 23%). Each mediumistic modality was carried out an average of 7 to 14 times a week with no gender difference; 7.8% of the medium subjects exhibited a minor psychiatric disorder according to the SRQ, and the entire sample scored 1.85 ± 0,33 points in the SAS. There was a significant correlation between social adjustment scores and SRQ psychiatric symptoms (r= 0,38 p<0,001). There was no significant correlation between the degree of mediumistic activity and either SRQ or SAS scores. Medium subjects differed from dissociative identity disorders subjects and displayed 4 Schneiderian first rank symptoms for schizophrenia that were unrelated to either the SRQ or SAS scores. Four distinct modes of emergence of mediumistic symptoms were recorded: isolated symptoms during childhood, isolated symptoms during adulthood, spontaneous mood fluctuations, and formal courses in mediumistic ability development. A full mediumistic trance process begins with: sensing another presence, experiencing a variety of physical symptoms and feelings, and experiencing vibratory frequencies which subjects attributed to an external source, or spiritual entity. Subsequently, subjects begin to feel pressure in the area of the throat and an unplanned speech is mechanically voiced. Intuition is characterized by the emergence of thoughts and/or images not recognized by the subjects as their own. Hearing and seeing are characterized as the awareness of images and voices within the internal psychic space or as an external object. Full mediumistic trance was recorded exclusively within the Spiritist Centers however all other mediumistic experiences were recorded both inside and outside these centers. Conclusions: The medium subjects included in this analysis displayed evidences of having a high social-educational level, a low prevalence rate of minor psychiatric symptoms and a sound level of social adjustment. Mediumistic trance is very possibly an experience other than a Dissociative Identity Disorder. The majority of the subjects experienced the onset of mediumistic experiences during childhood, and the mediumistic process was characterized by experiences of replacement of the ego mind, or visual and/or auditory hallucinations not necessarily related to a definite diagnosis of schizophrenia.

Com o advento da Reforma Psiquiátrica no Brasil, novos espaços de assistência e tratamento vêm sendo constituídos e a família passa a ser entendida como um fator fundamental na recuperação do portador de transtorno mental. Desta forma, compete aos profissionais apoiá- la, orientá-la e fortalecê-la, por meio de ações educativas e de apoio emocional. No entanto, estudos atuais na área apontam que a inclusão da família no tratamento de portadores de transtorno mental ainda não é procedimento de rotina em muitos serviços. O presente estudo teve como objetivo identificar e analisar as possibilidades e barreiras percebidas pelos profissionais de saúde para implantar e manter, na rotina de um serviço de saúde mental, o cuidado às famílias de portadores de transtorno mental. Método: Trata-se de um estudo qualitativo. Para a coleta de dados, foram realizadas duas sessões de grupo focal com os profissionais envolvidos com a criação e manutenção do atendimento familiar em um serviço especializado de nível ambulatorial. Resultados: Os profissionais participantes ressaltaram a importância da família no início do tratamento, e suas necessidades neste momento. Porém, reconheceram que os pacientes e seus familiares participam pouco das atividades de intervenção familiar oferecidas. As barreiras para uma participação mais ativa identificadas nas discussões estão relacionadas à própria família, ao serviço, e aos profissionais, e são semelhantes aos achados de outros estudos nacionais e internacionais. A supervalorização do modelo biomédico está presente em todas as barreiras. Conclusão: Concluímos que o estudo reforçou nossa compreensão sobre a importância da inclusão da família no atendimento de pessoas no primeiro episódio psicótico, e contribui apontando barreiras para efetivar esta proposta / With the advent of the Psychiatric Reform in Brazil, new care spaces and treatment have been made and the family passed being understood how a fundamental factor in the recovery of mental health patients. Thus, compete to professionals supports it, guides it and strengthen it through educational and emotional support. However, current studies points that inclusion of the family for treatment of mental disorders carriers still is not procedure of many services routine. The present study aimed to identify and analyze as perceived opportunities and barriers by health professionals to deploy and maintain, in a mental health service routine, the care of the families of mental disorders carriers. Method: This is a qualitative study. Data collection, were conducted two focus group sessions with professionals involved with the creation and maintenance of familiar care in a specialized outpatient service. Results: The professionals participants stressed the importance of family in the outset of the treatment, and their needs in this time. However, recognized that the patients and their families does not participate much in family intervention activities offered. The barriers for a more active participation identified in discussions are related to own family, the service, and professionals, and are similar to findings in other national and international studies. The overvaluation of biomedical model is present in all barriers. Conclusion: We conclude that the study reinforced our understanding of the importance of family inclusion in the care of people on first episode psychotic, and contributes pointing barriers to accomplish this proposal

A grande quantidade de informação e conhecimento, armazenada nos casos clínicos médicos documentados, gera a necessidade de recuperar, relacionar e categorizar essa informação para a geração de conhecimento através de pesquisas e para melhoria de treinamento e tratamento médico. Na área da saúde, especificamente Psiquiatria, os casos clínicos apresentam determinantes multifatoriais biológicas e sociais. Pela característica multifatorial, os casos são complexos e evidências importantes podem passar despercebidas para estudo, análise e auxílio a diagnóstico. Dentro da Psiquiatria, outro fator importante é a forma como os diagnósticos relacionados à Esquizofrenia e outros transtornos psicóticos (EOP) são feitos: trata-se de uma entrevista clinica estruturada que exige uma complexidade para aplicação e gera uma grande quantidade de informação. Nesse cenário, inundado de conhecimento espalhado, este trabalho tem o objetivo de apresentar um sistema informatizado com a função de realizar a entrevista clínica de forma informatizada, assim como a recuperação, relacionamento e categorização dos casos clínicos. Permite também a busca dos casos baseados em similaridade de conteúdo textual, através de técnica de similaridade baseada em raciocínio de caso. O sistema foi testado com uma base de dados previamente montada por especialistas e validado na sua perspectiva clinica e de pesquisa através da utilização em um cenário real, com casos reais. Para uma validação voltada a uma perspectiva de expansão e comercialização deste tipo de sistema foi feita uma avaliação através da perspectiva de inovação e novos negócios, o que se alinha com as metas nacionais de inovação em softwares e a transferência tecnológica das universidades para o atendimento da população. Por fim, foi demonstrado que esse sistema tem potencial para se tornar um gerador de conhecimento e apontamento de informação de fina relevância para auxiliar e acelerar treinamentos e tratamentos na área da saúde tendo impacto direto na formação dos profissionais dessa área e consequente melhoria no atendimento feito por eles. / A large amount of information and knowledge, stored in documented medical clinical cases creates the necessity to retrieve, categorize and relate that information to generate knowledge through research and to improve training and medical treatment. In the Health area, specifically Psychiatry, clinical cases have multifactorial biological and social determinants. Because of multifactorial feature, cases are complex and important evidence can be missed for study, analysis and aid the diagnosis. Another important factor is how the diagnoses related to schizophrenia and other psychotic disorders (EOP) are done: it is a structured clinical interview which requires a complexity to application and generates a lot of information. In this scenario, full with Spread Knowledge, this project aims to introduce a computerized system with the function to perform the clinical interview computerized form, As the Recovery, Relationship and categorization of Clinical Cases. Also it allows the pursuit of cases based on textual content similarity, through technique of reasoning based on similarity Case. The system was tested with database pre-assembled and validated by experts in their clinical and research perspective through the use of a real scenario with real cases. For a more focused assessment with a view to expansion and commercialization of this system, an evaluation through innovation perspective and new business, this is in line with national goals of innovation in software and technology transfer from universities to meet the population. Lastly it was demonstrated that this system has the potential to become a generator of knowledge and information for fine pointing relevance to assist and accelerate training and treatments in healthcare with a direct impact on training of professionals in this area and consequent improvement in treatment done for them.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-07-04T17:43:42Z No. of bitstreams: 1 adairdemenezesjunior.pdf: 1819956 bytes, checksum: adc4a19d06d1fea31d7a9b722aa63a73 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-13T16:21:41Z (GMT) No. of bitstreams: 1 adairdemenezesjunior.pdf: 1819956 bytes, checksum: adc4a19d06d1fea31d7a9b722aa63a73 (MD5) / Made available in DSpace on 2016-07-13T16:21:41Z (GMT). No. of bitstreams: 1 adairdemenezesjunior.pdf: 1819956 bytes, checksum: adc4a19d06d1fea31d7a9b722aa63a73 (MD5) Previous issue date: 2012-12-14 / Introdução: Experiências espirituais que se assemelham a sintomas psicóticos e dissociativos são comuns em diversas religiões, podendo trazer dúvidas se se tratam de experiências saudáveis ou patológicas. Objetivos: Investigar o perfil sociodemográfico, de experiências anômalas e de saúde mental dos indivíduos que apresentam vivências psicóticas e dissociativas e buscam auxílio em Centros Espíritas; identificar características fenomenológicas, clínicas e sociodemográficas que auxiliem na distinção entre experiência espiritual saudável e transtorno mental. Métodos: Pesquisa longitudinal com um ano de seguimento de 115 sujeitos que apresentavam experiências psicóticas e dissociativas e procuraram Centros Espíritas de Juiz de Fora/MG. Foram utilizadas entrevistas sociodemográficas, de avaliação das experiências anômalas, de critérios propostos para identificar uma experiência espiritual saudável, o SCID (Structured Clinical Interview for DSM-IV Axis I Disorders), o DDIS (Dissociative Disorders Interview Schedule) o DES (Dissociative Experience Scale) e o WHOQOL-bref (World Health Organization Quality of Life-bref). Modelos de regressão logística e linear, controlando para fatores sociodemográficos, foram usados para investigar as associações entre características das experiências anômalas e dissociativas com qualidade de vida e diagnósticos psiquiátricos. Resultados: A amostra foi composta por 70% de mulheres, com idade média de 39 anos e bom grau de instrução, perfil semelhante ao de outros estudos com médiuns espíritas no Brasil. Cinco Critérios Qualitativos da experiência espiritual saudável estiveram presentes na maioria da amostra no primeiro momento da avaliação: ausência de prejuízos sociais e ocupacionais, a experiência ser curta e ocorrer apenas episodicamente, compatibilidade com um contexto cultural, a experiência espiritual trazer benefícios para si mesmo e ser centrada nos outros. Quatro Critérios Qualitativos estavam presentes em uma minoria: ausência de sofrimento, ausência de co-morbidades, atitude crítica e controle sobre a experiência. 93% da amostra apresentavam algum transtorno mental pelo SCID, principalmente quadros ansiosos e depressivos, 23,5% algum transtorno dissociativo pelo DDIS, mas apenas um indivíduo (0,9%) apresentou transtorno de identidade dissociativa. Os escores médios de dissociação foram altos no DES (81,4 ± 54,8 desvio padrão) e no DES TAXON (18,8 ± 16,8). As dimensões de qualidade de vida pelo WHOQOL mais afetadas foram a psicológica (61,15 ± 19,39) e social (63,41 ± 24,07), sendo que a física (67,13 ± 18,25) e a ambiental (63,89 ± 15,05) estavam mais preservadas. Maiores escores de dissociação se relacionaram com mais diagnósticos de transtornos dissociativos e mentais em geral, bem como com menores níveis de qualidade de vida em todas as dimensões. A presença dos Critérios Qualitativos propostos para uma experiência espiritual saudável se relacionou com melhor qualidade de vida nas dimensões psicológica e social tanto no início como após um ano de seguimento. Conclusões: Indivíduos que apresentam experiências psicóticas e dissociativas e buscam auxílio em grupos religiosos são um grupo que necessitam atenção devido ao risco para problemas na saúde mental e qualidade de vida. O potencial efeito protetor do envolvimento religioso e dos critérios qualitativos precisa ser melhor investigado. / Introduction: Spiritual experiences that resemble psychotic and dissociative symptoms are common in several religions, and can bring doubts whether dealing with healthy or pathological experiences. Objectives: Investigating the sociodemographic profile of anomalous experiences and mental health ones of individuals with psychotic and dissociative experiences and seek help in Spiritist Centers; identifying phenomenological, clinical and sociodemographic characteristics which help in distinguishing between healthy spiritual experience and mental disorder. Methods: A Longitudinal Research with one-year follow-up of 115 individuals who have lived psychotic and dissociative experiences and sought Spiritist Centers of Juiz de Fora / MG. We used Sociodemographic interviews, of evaluation of anomalous experiences, and of the proposed criteria for identifying a healthy spiritual experience, the SCID (Structured Clinical Interview for DSM-IV Axis I Disorders), the DDIS (Dissociative Disorders Interview Schedule) DES (Dissociative Experience Scale) and the WHOQOL-BREF (World Health Organization Quality of Life-BREF). Logistic and linear regression model, controlling for sociodemographic factors, were used to investigate associations between characteristics of anomalous and dissociative experiences and quality of life and psychiatric diagnoses. Results: The sample was composed of 70% women, with average age 39 years old and good schooling, profile similar to other studies with Spiritist mediums in Brazil. Five Qualitative Criteria of healthy spiritual experience were present in most of the sample at the first time of evaluation: Absence of social and occupational impairment, the experience is short and occurs only episodically, compatibility with a cultural context, the spiritual experience brings benefits to oneself and it can be focused on others. Four Qualitative Criteria were present in a minority: The absence of suffering, lack of co-morbidities, critical attitude and control over the experience. 93% of the sample had some mental disorder by SCID, mainly anxiety and depression disorders, 23.5% had some dissociative disorder by DDIS, but only one individual (0.9%) had dissociative identity disorder. The average scores of dissociation were high in DES (81.4 ± 54.8 SD) and in DES TAXON (18.8 ± 16.8). The dimensions of quality of life by the WHOQOL which were most affected were the psychological (61.15 ± 19.39) and social (63.41 ± 24.07), and the physical (67.13 ± 18.25) and environmental (63.89 ± 15.05) were better preserved. Higher scores of dissociation were related to more diagnoses of dissociative and mental disorders in general, as well as to lower levels of quality of life in all dimensions. The presence of Qualitative Criteria proposed for a healthy spiritual experience was associated with better quality of life in psychological and social dimensions both at the beginning and and after one-year follow-up. Conclusions: Individuals who have psychotic and dissociative experiences and seek help religious groups are a group that needs attention because of the risk for mental health disorders and quality of life. The potential protective effect of the religious involvement and the qualitative criteria should be further investigated.

Background: It´s obvious that stigma reduces life opportunities and make people act throughout an outcast role. Stigma enters spheres where it is made up to protect a group, but only results in painful feelings for the vulnerable. Individuals suffering from psychosis are exposed to discrimination because of fear and prejudices. These are applied upon individuals whereas they stigmatize themselves.  Aim: To investigate the experience of self-stigma and stigmas effects on life for patients suffering from psychosis. Method: 24 scientific articles have been used and analyzed together with Whittemore and Knalfs integrative method (2005) for the result in this literature review.   After formulating a problem literature has been searched, evaluated, and analyzed in four steps which are presented. The literature was found through databases, free searching compounds and through references. As a theoretic framework the figure Existentiell ensamhet hos personer med psykiska funktionshinder from the doctoral Berättelser om ensamhetens vardag has been used.  Results: The psychiatric contact, to be a psychiatric patient and being labeled with a psychiatric diagnosis affected the way individuals labeled themselves. Individuals wanted to be seen as unique and listened to. The diagnosis contributed to feelings of shame and affected self-esteem and self-ability. Through acceptance of the disease participants could become something different than just a patient in the psychiatric services. Through other people the participant’s self-image could be built up. Social stigmas were described in all levels of society and also within the family. Relationships were important and a link to live a normal life and recover. Normality was desirable and said to occur through activities such as work and studies. Discussion: Was discussed through relevant research and Anette Erdners figure Existentiell ensamhet hos personer med psykiska funktionshinder from the doctoral Berättelser om ensamhetens vardag.

Background The base rate of transition from subthreshold psychotic experiences (the exposure) to clinical psychotic disorder (the outcome) in unselected, representative and non-help-seeking population-based samples is unknown. Method A systematic review and meta-analysis was conducted of representative, longitudinal population-based cohorts with baseline assessment of subthreshold psychotic experiences and follow-up assessment of psychotic and non-psychotic clinical outcomes. Results Six cohorts were identified with a 3–24-year follow-up of baseline subthreshold self-reported psychotic experiences. The yearly risk of conversion to a clinical psychotic outcome in exposed individuals (0.56%) was 3.5 times higher than for individuals without psychotic experiences (0.16%) and there was meta-analytic evidence of dose–response with severity/persistence of psychotic experiences. Individual studies also suggest a role for motivational impairment and social dysfunction. The evidence for conversion to non-psychotic outcome was weaker, although findings were similar in direction. Conclusions Subthreshold self-reported psychotic experiences in epidemiological non-help-seeking samples index psychometric risk for psychotic disorder, with strong modifier effects of severity/persistence. These data can serve as the population reference for selected and variable samples of help-seeking individuals at ultra-high risk, for whom much higher transition rates have been indicated.

Bakgrund: Patienter som lider av psykossjukdom är globalt förekommande. Konsekvenserna av sjukdomen kan vara både fysiska och psykiska och leda till förtidig död. Hos denna patientgrupp kan fysisk aktivitet generera i hälsofrämjande effekter och därför är det viktigt att sjuksköterskor arbetar motivationsinriktat.  Syfte: Syftet med litteraturstudien var att undersöka patienters och sjuksköterskors upplevelse av fysisk aktivitet vid psykossjukdom.  Metod: Designen är en kvalitativ litteraturstudie som genomfördes med en systematisk artikelsökning där 21 kvalitativa artiklar inkluderades. Dataanalysen genomfördes med Bettany-Saltikov och McSherry’s analysmetod för kvalitativ data. Resultat: I den analyserade litteraturen framkom följande teman: Patientperspektivet: Patienters upplevelser av motivation och socialt stöd, patienters upplevelser av försvårande omständigheter för fysisk aktivitet och patienters upplevelser av främjande omständigheter för fysisk aktivitet.   Sjuksköterskeperspektivet: Sjuksköterskans upplevelse av att motivera och individualisera, sjuksköterskans upplevelse av försvårande omständigheter för fysisk aktivitet och sjuksköterskans upplevelse av främjande omständigheter för fysisk aktivitet.  Slutsats: Baserat på den studerade litteraturen är motivation, individualisering, socialt stöd och positiva effekter av fysisk aktivitet är centrala delar för både sjuksköterskor och patienters upplevelser av fysisk aktivitet. Enligt den studerade litteraturen beror detta på att genom motivation, individualisering och socialt stöd kan fysisk aktivitet öka och bibehållas hos patienter med psykossjukdom. Det är även viktiga delar i den hälsofrämjande psykiatriska omvårdnaden och en förutsättning för att stödja patienten i återhämtningsprocessen. Positiva effekter av fysisk aktivitet har i sin tur en betydande roll för motivationsarbetet då de genererar i förbättrad hälsa både fysiskt och psykiskt. / Background: Psychotic disorders is a globally occurring mental illness. The impact of the disease can be both physical and mental and lead to premature death. Physical activity generates in health-promoting effects both physically and mentally in these patients. Thus, it is important that nurses encourage patients suffering from psychosis to increase their physical activity.  Purpose: The purpose of the literature study was to investigate patients' and nurses' experience of physical activity for people with psychotic disorders.  Method: The design is a qualitative literature study that was carried out with a systematic article search. 21 qualitative articles were included. The data analysis was carried out using Bettany-Saltikov and McSherry's analysis method for qualitative data. Results: In the studied literature, the following themes were included: The patient perspective: Patients' experiences of motivation and social support, patients' experiences of circumstances hindering physical activity and patients' experiences of circumstances promoting physical activity. The nurse's perspective: The nurse's experience of motivating and individualizing, the nurse's experience of conditions that hinder physical activity and the nurse's experience of conditions that promote physical activity. Slutsats: Utifrån den studerade litteraturen är motivation, individualisering, socialt stöd och positiva effekter av fysisk aktivitet centrala delar för både sjuksköterskors och patienters upplevelser av fysisk aktivitet. Enligt den studerade litteraturen, motivation, individualisering och socialt stöd kan fysisk aktivitet ökas och upprätthållas hos patienter med psykotiska störningar. De är också viktiga delar för både den hälsofrämjande psykiatriska vården och en förutsättning för att stödja patienten i tillfrisknandet. De positiva effekterna av fysisk aktivitet har också en betydande roll för motivationsarbetet eftersom de genererar förbättrad hälsa både fysiskt och psykiskt.