Pacientes suicidas em uma unidade de emergência psiquiátrica : características clínicas e perfil de agressão

Objective: To explore and describe a profile of patients admitted to a psychiatric emergency facility, comparing patients with and without a recent suicide attempt in terms of their clinical characteristics and aggression. Methods: This was an exploratory comparative study where patients were assessed using the Brief Psychiatric Rating Scale (BPRS) and the Overt Aggression Scale (OAS). Participants with a suicide attempt in the last 24 hours (SA) were compared to participants with a prior history of suicide attempt but no recent attempt (PHSA). Results: 63 individuals (SA: 26; PHSA: 37) were selected. Both groups had similar demographic and clinical characteristics. The most prevalent diagnoses were mood (57.1%) and personality (50.8%) disorders. The majority of patients in both groups had a history of aggression episodes. Physical aggression in the week prior to admission was more prevalent in the PHSA group (51.4 vs. 19.2%, p = 0.017). The PHSA group also presented higher activation scores (p = 0.025), while the SA group presented higher affect scores on BPRS dimensions (p = 0.002). Conclusion: The majority of individuals with a history of suicide attempt also presented a history of aggression. Inpatients with recent suicide attempt were hospitalized mainly due to the risk of suicide, while those with no recent suicide attempt were hospitalized mainly due to the risk of hetero-aggression. These findings support the hypothesis of an aggressive profile in suicidal patients and may open up a path for future research.Objetivo: Explorar e descrever o perfil de pacientes internados em uma unidade de emergência psiquiátrica, comparando os pacientes com e sem tentativa recente de suicídio em termos de suas características clínicas e agressividade. Métodos: Trata-se de um estudo exploratório comparativo, onde os pacientes foram avaliados por meio da Escala Breve de Avaliação Psiquiátrica (BPRS) e da Escala de Agressividade Declarada (OAS). Os participantes com tentativa de suicídio (TS) nas últimas 24 horas foram comparados com participantes com história prévia de tentativa de suicídio, mas sem tentativa recente (HPTS). Resultados: Foram selecionados 63 indivíduos (TS: 26; HPTS: 37). Ambos os grupos tinham características demográficas e clínicas semelhantes. Os diagnósticos mais prevalentes foram transtornos de humor (57,1%) e de personalidade (50,8%). A maioria dos pacientes em ambos os grupos apresentava história de agressão. A agressão física na semana anterior à internação foi mais prevalente no grupo HPTS (51,4 vs. 19,2%, p = 0,017). O grupo HPTS também apresentou maior ativação (p = 0,025), enquanto o grupo TS apresentou maior afetividade nas dimensões da BPRS (p = 0,002). Conclusão: A maioria dos indivíduos com história de tentativa de suicídio também apresentou história de agressão. Os pacientes internados com tentativa recente de suicídio foram hospitalizados principalmente devido ao risco de suicídio, enquanto aqueles sem tentativa recente de suicídio foram hospitalizados principalmente devido ao risco de heteroagressão. Esses achados apoiam a hipótese de um perfil agressivo em pacientes suicidas e podem abrir caminho para pesquisas futuras

The association between traumatic experiences and suicide attempt in patients treated at the Hospital de Pronto Socorro in Porto Alegre, Brazil

Objective: To analyze associations between attempted suicide and childhood trauma. Methods: A seven month comparative case-control study (28 subjects – patients with suicide attempt; 56 controls – patients without suicide attempt). The following instruments were used: Childhood Trauma Questionnaire (CTQ), Mini International Neuropsychiatric Interview (MINI), and Medical Outcomes Study (MOS). Results: The group with suicide attempt had significantly higher scores for some variables: emotional abuse (p < 0.001), physical abuse (p < 0.001), emotional neglect (p < 0.001), and physical neglect (p < 0.001). Conclusions: The results suggest that variables related to previous trauma may influence future suicide attempts. The adoption of preventive and therapeutic actions related to mistreatments during child development is a crucial factor in reduction of suicide risk

Situaciones violentas durante la pandemia COVID-19

Introduction: The pandemic caused by the novel coronavirus (SARS-CoV-2) has changed the lifestyle of the general population, mainly due to the distancing and isolation measures adopted to contain the spread of the disease. These measures generated a series of stressors, including an increase in domestic violence. Objective: To identify the occurrence of domestic violence during isolation resulting from the COVID-19 pandemic in Brazil, its association with issues related to mental health and poorly adaptive personality traits. Method: Nonprobabilistic study, composed of a sample of 3625 participants who were assessed using the PCL-5, DASS-21, PID-5-BF and AUDIT-C. Instruments were administered on-line from April 22, 2020 to May 8, 2020. Results: 379 (13%) of respondents experienced some type of adverse situation during social distancing. Participants who experienced violence had higher alcohol consumption (p=0.004), greater severity of symptoms related to a diagnosis of PTSD (p <0.001), and greater prevalence of anxiety (p<0.001) and depression (p<0.001) symptoms in relation to those who had no such experiences. They also demonstrated higher PID-5 scores of maladaptive personality traits, such as negative affectivity (p<0.001), distance (p<0.001), antagonism (p<0.001), disinhibition (p<0.001) and psychoticism (p<0.001). Conclusion: Isolation due to the pandemic is having a great impact on people’s mental health, specifically on those who have experienced violence. Together with public agencies and the private sector, strategies should be created aimed at scaling up interventions to mitigate this impact of the pandemic, especially by providing expanded listening spaces in the health and social care sectors.Introdução: A pandemia causada pelo novo coronavírus (SARS-CoV-2) alterou o estilo de vida da população em geral, principalmente através das medidas de distanciamento e isolamento adotadas para contenção do avanço da doença. Estas medidas geraram uma série de estressores, dentre eles o aumento da violência doméstica. Objetivo: Identificar a ocorrência de violência doméstica durante o isolamento decorrente da pandemia de COVID-19 no Brasil, a sua associação com questões relacionadas à saúde mental e traços mal adaptativos de personalidade. Método: Estudo não probabilístico, composto por uma amostra de 3625 participantes que foram avaliados através do PCL-5, DASS-21, PID-5-BF e AUDIT-C. Instrumentos aplicados on-line no período entre 22 de abril de 2020 a 08 de maio de 2020. Resultados: 379 (13%) dos respondedores sofreu algum tipo de situação adversa durante o distanciamento social. Os participantes que vivenciaram violência possuem maior consumo de álcool (p=0,004), maior gravidade dos sintomas relacionada ao diagnóstico de TEPT (p<0,01), maior presença de sintomas de ansiedade (p<0,001), depressão (p<0,001), em relação àquelas que não sofreram. Demonstraram ainda possuir, de acordo com o PID-5, escores mais elevados de traços mal adaptativos de personalidade, como afetividade negativa (p<0.001), distanciamento (p<0.001), antagonismo (p<0.001), desinibição (p < 0.001) e psicoticismo (p<0.001). Conclusão: O isolamento devido a pandemia está causando grande impacto na saúde mental das pessoas, especificamente naquelas que sofreram violência. É necessário, junto ao órgão públicos e privados, criar estratégias visando uma escalada de intervenções relacionadas ao impacto da pandemia, sobretudo ampliando espaços de escuta no setor de saúde e na assistência social.Introducción: La pandemia provocada por el nuevo coronavirus (SARS-CoV-2) ha cambiado el estilo de vida de la población en general, principalmente a través de las medidas de distancia y aislamiento adoptadas para contener el avance de la enfermedad. Estas medidas generaron una serie de factores estresantes, entre ellos el aumento de la violencia intrafamiliar. Objetivo: Identificar la ocurrencia de violencia doméstica durante el aislamiento resultante de la pandemia COVID-19 en Brasil, su asociación con problemas relacionados con la salud mental y rasgos de personalidad poco adaptables. Método: Estudio no probabilístico, compuesto por una muestra de 3625 participantes que fueron evaluados mediante la PCL-5, DASS-21, PID-5-BF y AUDIT-C. Instrumentos aplicados on-line en el período comprendido entre el 22 de abril de 2020 y el 8 de mayo de 2020. Resultados: 379 (13%) de los encuestados sufrieron algún tipo de situación adversa durante la distancia social. Los participantes que experimentaron violencia tienen mayor consumo de alcohol (p=0,004), mayor gravedad de los síntomas relacionados con el diagnóstico de TEPT (p<0,01), mayor presencia de síntomas de ansiedad (p<0,001), depresión (p<0,001), en relación con los que no sufrieron. También demostraron tener, según PID-5, puntuaciones más altas de rasgos de personalidad poco adaptativos, como afectividad negativa (p<0.001), distancia (p<0.001), antagonismo (p<0.001), desinhibición (p<0.001) y psicoticismo (p<0.001). Conclusión: El aislamiento debido a la pandemia está teniendo un gran impacto en la salud mental de las personas, específicamente en quienes han sufrido violencia. Es necesario, junto con los organismos públicos y privados, crear estrategias orientadas a ampliar las intervenciones relacionadas con el impacto de la pandemia, especialmente ampliando los espacios de escucha en el sector salud y la asistencia social

COVID-19 pandemic and social distancing : economic, psychological, family, and technological effects

Introduction: The concept of social isolation is currently understood as a measure of epidemiological containment that aims to reduce the speed of spread of the disease, enabling health services to prepare their resources to cope with the likely increase in demand, while also seeking to provide additional protection to groups considered to be at higher risk. Objective: The present narrative review aims to compile and synthesize the literature related to social isolation produced during the COVID-19 pandemic in 2020. Method: This study is a narrative review of the literature on social isolation in the context of the COVID19 pandemic. Results: 73 publications were included for full-text reading and were classified into the following categories: levels of social isolation, economic effects, family relationships, health system, mental health of the population, and use of technology. Conclusions: It is necessary to plan an escalation of responses to the consequences of the pandemic, especially in view of the increased demand on the health sector and social services. The negative effects of social isolation can be prevented by public policies that offer a response to the economic recession, maintenance of social work, encouragement of quality care in mental health services, and community support for vulnerable families

The role of personality in posttraumatic stress disorder, trait resilience, and quality of life in people exposed to the Kiss nightclub fire

Objective To evaluate the relationship among personality (according to Cloninger’s psychobiological model), posttraumatic stress disorder (PTSD) symptoms, trait resilience and quality of life (QoL) in people who were exposed to the Kiss nightclub fire. Methods 188 participants were assessed with the Posttraumatic Checklist–civilian version (PCL-C), the Resilience Scale (RS), the Temperament and Character Inventory (TCI), the World Health Organization Quality of Life–Bref (WHOQOL-Bref), and the WHOQOL-100 Spirituality, religiousness, and personal beliefs (WHOQOL-100-SRPB). Data were analyzed in a dimensional approach, with correlation analysis, multiple linear regression and Structural Equation Modeling (SEM), with PCL-C, RS, and WHOQOL-Bref dimensions as dependent variables. Results Multiple linear regression showed that PTSD symptoms were predicted by harm avoidance (β = .34, p < .001), self-directedness (β = -.28, p < .01), and self-transcendence (β = .24, p < .01). Trait resilience was predicted by harm avoidance (β = -.38, p < .01), self-directedness (β = .20, p < .05), and self-transcendence (β = .18, p < .05). Also, PTSD symptoms had considerable negative effect on all dimensions of QoL. Self-transcendence was a positive predictor of subjective and spiritual QoL. SEM showed that QoL was predicted by PTSD symptoms (β = -.52, p < .001), trait resilience (β = .30, p < .001), cooperativeness (β = .135, p = 0.40), and self-directedness (β = .27, p < .01). The effect of self-directedness on QoL was mediated by PTSD symptoms and trait resilience. PTSD symptoms also mediated the relationship between trait resilience and QoL, and RS mediated the relationship of personality and PTSD symptoms. Conclusion The study gives insights on prediction of PTSD severity, trait resilience and QoL from temperament and character traits, in a sample of people exposed to the Kiss nightclub fire. Harm avoidance was the most influent trait on PTSD symptoms and trait resilience. Selfdirectedness was the most import trait related to QoL, still that it was more related to PTSD severity than personality traits. Self-transcendence had positive effects on both PTSD symptoms and trait resilience, indicating a coping style that may coexist with psychopathology

Translation and cultural adaptation of the DSM-5 Personality Inventory – Brief Form (PID-5-BF)

Introduction: The Personality Inventory for the DSM-5 – Brief Form (PID-5-BF) – is an instrument for assessment of the five pathological personality traits from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) alternative model of personality disorders. Objectives: To determine the psychometric properties of the version of the PID-5-BF translated and adapted to Brazilian Portuguese. Methods: The process of translating and cross-culturally adapting the text was carried out by independent translators and the resulting version was administered to 176 patients in two hospitals in Rio Grande do Sul. The internal structure was tested by means of confirmatory factor analysis. Evidence of reliability was tested by examining the internal consistency of the scales and their convergent and concurrent validity with other methods of psychopathology. Results: The five factors were replicated in the present sample with adequate indicators of fit of the data to the model. Appropriate reliability coefficients for the scales and evidence of validity were observed, indicating the clinical usefulness of the PID-5-BF in the Brazilian context. Conclusion: The psychometric properties of PID-5-BF proved satisfactory in an initial sample of Brazilians

The prevalence of mental disorders in suicide attempts, HPS - Porto Alegre, RS

O suicídio é um risco presente nos pacientes com transtornos psiquiátricos e, através da prática desempenhada no Serviço de Saúde Mental do Hospital de Pronto Socorro de Porto Alegre/RS, notase que a ocorrência de tentativas de suicídio tem-se evidenciado com índices elevados. O presente trabalho aborda aspectos sobre as tentativas de suicídio enquanto fenômeno social, tema pouco discutido e divulgado. Objetivos: estimar a prevalência de transtornos mentais e descrever o perfil sociodemográfico nas tentativas de suicídio. Método: estudo de caso não controlado, sendo incluídos pacientes que realizaram uma tentativa de suicídio e foram avaliados pelo Serviço de Psicologia deste Hospital. Resultados: evidenciou-se que os pacientes que tentaram suicídio por intoxicação exógena eram na maioria do sexo feminino, sem companheiro fixo, encontrando-se na fase jovem adulto. Os achados tiveram alto grau de risco de suicídio (83%), portanto, considera-se que a maior parte dos sujeitos tem maior predisposição para realizar nova tentativa de suicídio. Conclusões: a relevância desta discussão encontra-se associada à importância de uma melhor compreensão a respeito dos pacientes que realizaram uma tentativa de suicídio associada à prevalência de transtornos mentais, podendo-se desta forma compreender os motivos/efeitos da ocorrência e tomar as decisões mais adequadas sobre intervenções e encaminhamentos.Suicide is a risk present in patients with psychiatric disorders and, through the practice performed in the Mental Health Department of the Hospital de Pronto Socorro de Porto Alegre/RS, it is noted that the occurrence of suicide attempts has been quite high. This paper will address aspects of suicide attempts as a social phenomenon, little discussed and disclosed theme. Objectives: To estimate the prevalence of mental disorders and describe the sociodemographic in attempted suicides. Methods: Case study uncontrolled and included patients who had attempted suicide and were evaluated by the psychology of the Hospital Service. Results: It was observed that patients who attempted suicide by exogenous intoxication, most female without fixed companions, finding themselves in adult young stage. The findings had a high degree of suicide risk (83%), so it is considered that most subjects have a greater predisposition to perform a new suicide attempt. Conclusions: The relevance of this discussion is linked to the importance of a better understanding of the patients who underwent an attempt of suicide associated with the prevalence of mental disorders, therefore you can understand the reason/purpose of the event and make the most appropriate decisions about referrals interventions

O término de tratamento em psicoterapia psicanalítica

O presente artigo descreve algumas considerações a respeito do processo de término em psicoterapia psicanalítica, encontradas na literatura. O objetivo é discorrer sobre aspectos e recomendações que caracterizam a fase final do tratamento, considerando que a mesma é percebida de forma singular pela dupla: terapeutapaciente. Alguns autores destacam a capacidade do ego do paciente, o alcance de objetivos determinados na terapia, a superação de ansiedades e inibições, entre outros, como indicadores para a conclusão do tratamento. Tais critérios e demais questionamentos serão descritos ao longo deste estudo, contemplando principalmente o fechamento integral do processo, observando brevemente alguns aspectos relacionados às interrupções. O fim da terapêutica desperta, tanto em quem se trata quanto nos profissionais, angústias primitivas que devem ser elaboradas por ambos, portanto, reconhecidas e trabalhadas ao máximo durante o tratamento.This article compiles some considerations about the end of the process in psychoanalytic psychotherapy, found in the literature. The objective is to discuss aspects and recommendations that characterize the final phase of the treatment considering that it is perceived in a unique way by each of the dual therapist / patient. Some authors emphasize the capacity of the ego, the achievement of determined goals, the overcoming of anxieties and inhibitions, among others, as indicators for the conclusion of this modality of psychological care. These criteria and other questions will be better described throughout this study, contemplating the complete closure, that is, without stopping the interruptions. The end of the therapy awakens, both in those who are treated and in the professionals, primitive anxieties that must be elaborated by both, therefore, recognized and worked to the maximum during the treatment

Avaliação dos níveis de BDNF em pacientes hospitalizados por trauma físico em um hospital de emergência de Porto Alegre, sul do Brasil

Objective: To assess the association between brain-derived neurotrophic factor (BDNF) levels and acute stress disorder (ASD) in patients who have suffered physical trauma. Methods: Data were collected at an emergency hospital in Porto Alegre, state of Rio Grande do Sul, southern Brazil. Participants were over 18 years of age, victims of physical trauma, and had been hospitalized for a minimum of 48 hours. A total of 117 hospitalized patients who agreed to participate in the research were grouped according to the shift in which blood was collected (38 subjects from the morning shift and 79 from the afternoon shift), had their BDNF levels measured and responded to other questionnaires. Respondents were further grouped by age into three ranges: 18-30, 31-50 and 51-70 years. Results: We found a significant difference in the distribution of BDNF between the two shifts in which blood samples were collected, with the afternoon group having higher BDNF levels (U = 1906.5, p = 0.018). A difference was observed only between the 18-30 group and the 51-70 group in the afternoon shift (Umorning = 1107, pmorning = 0.575; Uafternoon = 7175, pafternoon = 0.028). Conclusions: The population whose blood samples were collected in the afternoon showed significantly higher values of BDNF compared to those of the morning shift. This same population presented lower BDNF levels when associated with ASD subtypes A1, A2, and A. We hypothesize that the lower values of BDNF measured in the morning shift were due to a response to the circadian cycle of cortisol, whose action inhibits the expression of serum neurotrophins.Objetivo: Verificar a associação entre os níveis de fator neurotrófico derivado do cérebro (brain-derived neurotrophic factor [BDNF]) e transtorno de estresse agudo (TEA) em pacientes que sofreram trauma físico. Métodos: Os dados foram coletados em um hospital de emergência de Porto Alegre, Rio Grande do Sul, Brasil. Os participantes eram maiores de 18 anos, vítimas de trauma físico e estavam hospitalizados por um período mínimo de 48 horas. Um total de 117 pacientes hospitalizados que concordaram em participar da pesquisa foram agrupados de acordo com o turno de realização da coleta de sangue (38 sujeitos no turno da manhã e 79 sujeitos no turno da tarde), tiveram seus níveis de BDNF medidos e responderam a outros questionários. Os entrevistados também foram agrupados por idade em três faixas etárias: 18-30, 31-50 e 51-70 anos. Resultados: Encontramos uma diferença significativa na distribuição de BDNF entre os turnos, sendo que o grupo da tarde apresentou níveis maiores de BDNF (U = 1906,5, p = 0,018). Houve diferença entre o grupo de 18-30 anos e o de 51-70 anos no turno da tarde (Umanhã = 1107, pmanhã = 0,575; Utarde = 7175, ptarde = 0,028). Conclusões: A população cuja coleta ocorreu à tarde apresentou valores significativamente maiores de BDNF em relação à coleta do turno da manhã. Esta mesma população apresentou menores níveis dessa neurotrofina quando associada com os subtipos A1, A2 e A de TEA. É possível hipotetizar que os menores valores de BDNF aferidos na coleta do turno da manhã se devam a uma resposta ao ciclo circadiano do cortisol, cuja ação inibe a expressão de neurotrofinas séricas

Closed doors: predictors of stress, anxiety, depression, and PTSD during the onset of COVID-19 pandemic in Brazil

BACKGROUND: The rise in mental health problems in the population directly or indirectly because of the coronavirus disease 2019 (COVID-19) pandemic is a major concern. The aim of this study was to investigate and compare independent predictors of symptoms of stress, anxiety, depression, and posttraumatic stress disorder (PTSD) in Brazilians one month after the implementation of measures of social distancing. METHODS: This cross-sectional study was performed using a web-based survey. The Depression, Anxiety, and Stress Scale (DASS-21) and PTSD Checklist for DSM-5 (PCL-5) were the outcomes. Data were gathered regarding demographics, social distancing, economic problems, exposure to the news of the pandemic, psychiatric history, sleep disturbances, traumatic situations, and substance use. The Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) was also administered. The predictors of the symptoms were investigated using hierarchical multiple linear regression. RESULTS: Of a sample of 3587 participants, approximately two-thirds considered that their mental health worsened after the beginning of the social restriction measures. The most important predictors of the symptoms investigated were the intensity of the distress related to the news of the pandemic, younger age, current psychiatric diagnosis, trouble sleeping, emotional abuse or violence, and economic problems. CONCLUSIONS: These results confirmed the hypothesis that the pandemic impacted the mental health of the population and indicated that the level of distress related to the news was the most important predictor of psychological suffering