Work Environment Evaluation Instrument (WEEI) : development, validation, and association with burnout

Introduction: Physician burnout is considered an epidemic. In 2019, 44% of U.S. physicians reported feeling burned out. The work environment is a central risk factor for this. The aim of this study is to develop and test an instrument to evaluate work environment factors in medical training courses. Method: After focus groups, an initial pool of 14 items was generated and tested in a pilot study (n = 66). Face validity was verified, and small adjustments were made. The resulting version was administered to a sample of 115 psychiatry residents. Eleven items were selected based on the correlations between them, principal component analysis, and theoretical reasons, and then tested for internal and construct validity. Results: The final version had high reliability (Cronbach’s alpha = 0.898) and comprised three dimensions: relations with the institution; with colleagues; and with preceptors. Both total scores and dimensions correlated significantly with burnout scores (p 32 points); risky (23-31 points); or toxic (<22 points) were suggested and related to the risk of burnout. Conclusion: Several authors have emphasized the importance of approaching institutional factors as an effective strategy for coping with the increased prevalence of burnout. This instrument should contribute to these efforts

O ressentimento na psicoterapia de orientação analítica

Introdução: Apesar de ser um aspecto frequente e marcante, o tema do ressentimento foi pouco abordado pela teoria psicanalítica. Este trabalho tem o objetivo de (1) buscar na teoria psicanalítica uma compreensão do ressentimento, tendo como foco as situações onde há uma separação conjugal envolvida, e (2) buscar caminhos possíveis para sua resolução. Métodos: O ressentimento foi considerado a partir das questões que emergiram no atendimento de uma paciente com dificuldades de elaborar um divórcio. Para tanto, realizou-se uma revisão na literatura psicanalítica específica sobre o ressentimento, além de temas relacionados, como luto, inveja e masoquismo. Resultados: O paciente ressentido é caracterizado como aquele que não pode deixar de recordar. Nessas situações, a libido está tenazmente ligada a um objeto devedor, prevalecendo uma inércia psíquica através da qual o paciente pode ficar retido na temática torturante. Na psicoterapia, o ressentimento se apresenta como uma face intransigente da resistência. Considerações finais: A elaboração do ressentimento é um longo e complexo processo. Um foco possível no tratamento desses casos pode ser resumido em fazer do ressentimento interminável – baseado na memória do rancor – terminável, relacionado com a memória da dor. O ressentimento interminável pode passar a ser terminável quando o sujeito puder abrir mão do desejo de triunfar sobre o outro por meio da vingança. Essa renúncia se dá através de um trabalho de elaboração, no qual o cindido e projetado no ressentimento deve ser reintegrado e introjetado no próprio sujeito.Introduction: Despite resentment is a frequent issue in psychoanalytic psychoterapy, this topic was not broadly discussed by the psychoanalytic theory. This work aims to (1) review psychoanalytic theory an understanding of resentment, focusing on situations where there is a marital separation involved, and (2) to seek possible ways of its resolution. Methods: Resentment was considered from the issues that emerged in the care of a patient with difficulties to conduct a divorce. Therefore, there was a review of the specific psychoanalytic literature about resentment and related topics such as grief, envy and masochism. Results: The resentful patient is characterized as one that can not stop to remember. In these situations, the libido is tenaciously linked to a debtor object, prevailing psychic inertia through which the patient can be held in torturous theme. In psychotherapy, resentment appears as an uncompromising face of resistance. Final considerations: Treatment of resentment is a long and complex process. A focus in treatment of these cases can be summarized in making endless resentment - based on the rancor memory - in terminable resentment, related to the memory of pain. The resentment may become terminable when the subject can give up the desire to triumph by revenge. This waiver is through when that splited and designed in resentment should be reinstated and introjected in the subject itself

Social determinants of health and the analysis of the hospitalization characteristics of a psychiatric unit in southern Brazil

Internações psiquiátricas são dispositivos utilizados como último recurso para lidar com a sintomática de saúde mental. Objetivou-se analisar aspectos da internação psiquiátrica a partir do perfil dos internados, comparando as internações pelo tipo de convênio utilizado para o seu tratamento, considerando este como um indicativo de Determinantes Sociais de Saúde (DSS). Realizou-se análise descritiva e transversal dos prontuários da internação psiquiátrica do Hospital de Clínicas de Porto Alegre (HCPA), nos anos 2016, 2017 e 2018, totalizando 1119 internações. Em torno de metade (53,5%) eram mulheres, que se encontravam na faixa etária entre 30 e 59 anos (52,5%) e possuíam ensino fundamental incompleto (30,3 %). Os diagnósticos mais prevalentes foram transtornos de humor (55,7%) e esquizofrenia (20,2%). Pacientes internados pelo convênio Sistema Único de Saúde (SUS) se concentravam na faixa etária adulto jovem e intermediário, tiveram maior tempo médio de internação (p=0,001) e necessitaram de mais consultorias nas especialidades de Medicina Interna, Infectologia e Psicodiagnóstico (p≤0,05) do que pacientes internados por convênios privados. Tal estudo aponta para o impacto dos DSS na manifestação e tratamento das doenças e no acesso ao tratamento. O conhecimento do perfil dos pacientes que necessitam internação favorece a formulação de políticas públicas.Psychiatric hospitalizations are one of the last resources to deal with mental health symptoms. The objective of this study was to analyze the profile of the psychiatric inpatients, comparing the hospitalizations by the type of health insurance used at the intake, as an indicator of Social Determinant of Health. It is a descriptive and cross-sectional analysis of electronic records of patients in psychiatric hospitalization at the Hospital de Clínicas de Porto Alegre (HCPA), in 2016, 2017 and 2018, summing up 1119 hospitalizations. About half (53.5%) were women, aged between 30 and 59 years (52.5%) with incomplete elementary school (30.3%). The most prevalent diagnoses were mood disorders (55.7%) and schizophrenia (20,2%). Patients that used the public health insurance were mostly young and intermediate adult, had longer hospitalization (p=0,001) and needed more specialized consultancies on Internal Medicine, Infectious Diseases and Psychological Assessment (p≤0,05) than the ones who used private health insurance. This study shows the impact of Social Determinants of Health on the manifestation and treatment of the diseases and on access to treatment. Knowing the profile of the patients helps planning of public policies

Psychiatric symptoms, burnout and associated factors in psychiatry residents

Introduction: Mental health in training physicians is a growing issue. The aim of this study was to investigate emotional distress in psychiatry residents. Method: This web-based survey evaluated 115 (62%) psychiatry residents in training in the Brazilian State of Rio Grande do Sul. The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult, the Patient Health Questionnaire-2, the Alcohol Use Disorders Identification Test-concise, and the Maslach Burnout Inventory were all administered. Linear regression models were estimated with burnout dimensions as dependent variables. Result: Positive screening rates were 53% for anxiety, 35.7% for somatization, 16.5% for depression, and 7% for suicidal ideation. Half of the male residents were at risk of alcohol abuse and dependence. Regarding burnout, 60% met criteria for emotional exhaustion, 54.8% for depersonalization, and 33% for low personal accomplishment. The most consistent risk factors were the nature of the relationships with preceptors, relations to the institutions themselves, age, and the quality of relationships with family. Conclusion: Besides disconcerting rates of psychiatric symptoms, the study revealed that characteristics of the workplace (i.e., the nature of relationships with preceptors and relations to the institution) can be regarded as potential targets for development of interventions aimed at improving mental health during training periods

Protocolos de regulação ambulatorial : psiquiatria adulto

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