A epidemiologia da esquizofrenia

UNIFESP-EPM Departamento de PsiquiatriaUNIFESP-EPM Departamento de Medicina PreventivaUNIFESP, EPM, Depto. de PsiquiatriaUNIFESP, EPM Depto. de Medicina PreventivaSciEL

The right time for a new leadership in Revista Brasileira de Psiquiatria

Universidade de São Paulo Faculdade de Medicina Departamento de PsiquiatriaUniversidade Federal de São Paulo (UNIFESP) Departamento de PsiquiatriaUNIFESP, Depto. de PsiquiatriaSciEL

Avaliação do programa assistencial de um serviço de interconsulta psiquiátrica e psicológica

OBJECTIVE: To investigate the relevance of subjective criteria adopted by a psychiatry and psychology consultation-liaison service, and their suitability in the evaluation of case registries and objective results. METHODS: Semi-structured interviews were conducted and all supervisors of the university hospital service were interviewed. Routinely collected case registries were also reviewed. Standardized assessment with content analysis for each category was carried out. RESULTS: The results showed distortions in the adopted service focus (doctor-patient relationship) and consultant requests. This focus is more on consulting physician-oriented interventions than on patients. DISCUSSION: Evaluation of the relevance of service criteria could help promoting quality assessment of the services provided, mainly when objective criteria have not yet been established to assure their suitability.OBJETIVO: Investigar a pertinência dos critérios subjetivos adotados por um serviço de interconsulta psiquiátrica e psicológica e sua adequação na avaliação dos registros e resultados objetivos obtidos. MÉTODOS: Foram realizadas entrevistas semi-estruturadas com todos os supervisores do serviço estudado de um hospital universitário, e revisados os registros de caso coletados rotineiramente no serviço. Foi realizada avaliação formal por meio de análise de conteúdo para cada categoria. RESULTADOS: Os resultados mostram distorção entre o foco adotado pelo serviço (relação médico-paciente) e a demanda dos consultantes. Esse foco direciona para maior predomínio de intervenções direcionadas aos médicos consultantes do que aos pacientes. CONCLUSÃO: A avaliação da pertinência dos critérios adotados pelo serviço pode servir ao propósito de promover análise da qualidade do serviço prestado, principalmente em casos em que não se possuem ainda critérios objetivos que possam atestar sua adequação.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

O papel da pesquisa na prevenção de transtornos mentais

National Institute of Mental HealthUniversidade Federal de São Paulo (UNIFESP) Department of PsychiatryUNIFESP, Department of PsychiatrySciEL

Sistemas inteligentes no diagnóstico da esquizofrenia

UNIFESP-EPM Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

The modest but growing Brazilian presence in psychiatric, psychobiological and mental health research: assessment of the 1998-2002 period

The objective of the present survey was to assess the Brazilian scientific production in psychiatry, psychobiology, and mental health during the 1998-2002 period. The universities' graduate programs concentrate the vast majority of the scientific production in Brazil. We assessed the annual reports from the graduate programs to the Brazilian Ministry of Education concerning master's and doctoral theses and the articles published in journals indexed by the Institute of Scientific Information (ISI). There are nine Master's and Doctoral graduate programs dedicated to research in psychiatry, neuropsychiatry, psychobiology, and mental health in the country, seven being located in southern states. During the 5-year period, from 1998 to 2002, 186 students received their doctorate degree (37/year). The programs published 637 articles in journals indexed by ISI, the majority of them in journals with an impact factor higher than 2. The research advisors' productivity varied among graduate programs, ranging from 0.6 to 2.0 articles per year in ISI-indexed journals. Despite the substantial barriers faced by the Brazilian scientific community (mainly financial and writing difficulties), Brazil's scientific mental health production is on the rise. The number of articles published in ISI-indexed journals has doubled without a significant increase in the number of graduate theses, suggesting that there was an improvement in both the quality of the scientific production and the productivity of the graduate programs. Based on these data, it is reasonable to predict a tendency to an increase in production over the next few years.Universidade Federal de São Paulo (UNIFESP) Departamento de PsiquiatriaUniversidade Federal de São Paulo (UNIFESP) Centro de Avaliação e Integração de Dados InstitucionaisUNIFESP, Depto. de PsiquiatriaUNIFESP, Centro de Avaliação e Integração de Dados InstitucionaisSciEL

Culture-bound syndromes in Spanish speaking Latin America: the case of Nervios, Susto and Ataques de Nervios

Background Cultural issues are important for diagnostic validity between different countries; little has been addressed from Latin America and Caribbean countries (LAC). Objective To identify LAC studies on culture-bound syndromes (CBS) and extract potential empirical evidence about Susto,Nervios and Ataques de Nervios. Methods Search strategies were carried out in Medline, Embase, Lilacs, ISI and PsycINFO, covering 1992 to 2015. Inclusion criteria studies on CBS conducted on populations residing in LAC, LAC articles on diagnostic classification and culture, where LAC has been included. Exclusion criteria studies on Latin American migrants outside LAC. Content analysis used the system proposed by Guarnaccia and Rogler (1999): epidemiological, ethnographic and socio-demographic data and identification of comorbidities with other psychiatric disorders. Results Thirty one articles were selected out of 1.090. These CBS were selected out of 1aphic data and identification of comorbidities with other ps proposed by Guarnaccia diagnostic classification and cun panic disorders and post-traumatic stress disorder and presented more psychosocial vulnerability. Discussion Analysis showed that Nervios, Susto andAtaques de Nervios are important idioms of distress, associated with socio-economically vulnerable populations and comorbidities with other psychiatric conditions, particularly post-traumatic stress disorder. More studies are needed on their relation with stress and in more LAC countries

Sudden cardiac death in schizophrenia: should the psychiatrist pay more attention?

UNIFESP-EPMUMCUNIFESP-EPM Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Custo direto médico-hospitalar de recaída em esquizofrenia em serviços de saúde na cidade de São Paulo

OBJECTIVE: To assess direct medical costs associated with schizophrenia relapses in mental health services. METHODS: The study was conducted in three health facilities in the city of São Paulo: a public state hospital; a Brazilian National Health System (SUS)-contracted hospital; and a community mental health center. Medical records of 90 patients with schizophrenia who received care in 2006 were reviewed. Information on inpatient expenditures was collected and used for cost estimates. RESULTS: Mean direct medical cost of schizophrenia relapses per patient was US$4,083.50 (R$ 8,167.58) in the public state hospital; US$2,302.76 (R$ 4,605.46) in the community mental health center; and US$1,198.50 (R$ 2,397.74) in the SUS-affiliated hospital. The main component was daily inpatient room rates (87% - 98%). Medication costs varied depending on the use of typical or atypical antipsychotic drugs. Atypical antipsychotic drugs were more often used in the community mental health center. CONCLUSIONS: Costs associated with schizophrenia relapses support investments in antipsychotic drugs and strategies to reduce disease relapse and the need for mental health inpatient services. Treating patients in a community mental health center was associated with medium costs and added the benefit of not depriving these patients from family life.OBJETIVO: Evaluar el costo directo médico-hospitalario de la recaída en esquizofrenia, en servicios en salud mental. MÉTODOS: Estudio conducido en tres servicios de salud de la ciudad de São Paulo (Sureste de Brasil): un hospital público estatal, un hospital contratado en convenio con el Sistema Único de Salud, y un centro de atención psicosocial. Se analizaron 90 prontuarios de pacientes portadores de esquizofrenia atendidos durante el año de 2006. Los recursos utilizados durante la permanencia de los pacientes en los servicios fueron obtenidos y valorados para cálculos de las estimaciones. RESULTADOS: El costo directo médico-hospitalario promedio de la recaída en esquizofrenia, por paciente, fue de US$4,083.50 (R$ 8.167,58) en el hospital público estatal; US$2,302.76 (R$ 4.605,46) en el centro de atención psicosocial y de US$1,198.50 (R$ 2.397,74) en el hospital con convenio. El principal componente fue el costo por día (87% a 98%). El costo con medicación difirió con relación a la utilización de antipsicóticos típicos o atípicos, siendo mayor en el centro de atención psicosocial, el mayor uso de atípicos. CONCLUSIONES: La inversión en medicamentos antipsióticos y en estrategias que disminuyan la recaída y la necesidad de pagos diarios en los servicios, especialmente hospitalarios, son justificables por la proporción de los costos que estas representan. Tratar la recaída en el centro de atención psicosocial presentó un costo intermedio, con el beneficio de no privar al paciente de la convivencia familiar.OBJETIVO: Avaliar o custo direto médico-hospitalar da recaída em esquizofrenia, em serviços em saúde mental. MÉTODOS: Estudo conduzido em três serviços de saúde da cidade de São Paulo: um hospital público estadual, um hospital contratado conveniado ao Sistema Único de Saúde e um centro de atenção psicossocial. Foram analisados 90 prontuários de pacientes portadores de esquizofrenia atendidos durante o ano de 2006. Os recursos utilizados durante a permanência dos pacientes nos serviços foram obtidos e valorados para cálculos das estimativas. RESULTADOS: O custo direto médico-hospitalar médio da recaída em esquizofrenia, por paciente, foi de R$8.167,58 (US$ 4,083.50) no hospital público estadual, R$4.605,46 (US$ 2,302.76) no centro de atenção psicossocial e de R$2.397,74 (US$ 1,198.50) no hospital conveniado. O principal componente foi o custo com diárias (87% a 98%). O custo com medicação diferiu quanto à utilização de antipsicóticos típicos ou atípicos. O uso de atípicos foi maior no centro de atenção psicossocial. CONCLUSÕES: O investimento em medicações antipsicóticas e em estratégias que diminuam a recaída e a necessidade de diárias nos serviços, especialmente hospitalares, são justificáveis pela proporção dos custos que estas representam. Tratar a recaída no centro de atenção psicossocial apresentou um custo intermediário, com o benefício de não privar o paciente do convívio familiar.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Programa de Pós-Graduação em PsiquiatriaUNIFESP-EPM Departamento de PsiquiatriaUNIFESP-EPM Centro Paulista de Economia da SaúdeUNIFESP, EPM, Programa de Pós-Graduação em PsiquiatriaUNIFESP, EPM Depto. de PsiquiatriaUNIFESP, EPM Centro Paulista de Economia da SaúdeSciEL