Context of outpatient psychological evaluation in a general hospital

O processo de psicodiagnóstico no ambiente hospitalar configura-se com especificidades, como a necessidade de interlocução entre as equipes, eventual dificuldade em acessá-las e grande demanda de solicitações. Este estudo busca mapear as solicitações de avaliação psicológica para crianças e adolescentes no contexto ambulatorial de um hospital geral de alta complexidade do SUS, considerando perfil de pacientes, equipes médicas solicitantes e demanda institucional para este exame. A partir destes resultados, propõe-se um novo sistema de gestão do psicodiagnóstico visando otimização em termos de custo efetividade. A análise do perfil dos pacientes e das solicitações do exame geraram a proposição de ações que visam otimizar os encaminhamentos, melhorar o fluxo de pacientes atendidos e estruturar o suporte às equipes de acordo com suas especificidades. A reformulação do fluxo assistencial propiciou uma perspectiva de gestão, possibilitando maior integração do psicodiagnóstico com demais processos assistenciais ofertados pela psicologia e de estreitamento com as equipes solicitantes.Psychological assessment in hospitals is marked by the need and the hardship of effective communication among professionals and a huge demand of this service. This study illustrates the demand of psychological evaluation for children and adolescents in an outpatient unit of a public general hospital, considering patients demographics, medical specialties that demand this exam and institutional demand. The ultimate goal is to propose a new management model for this exam to improve cost effectiveness of referrals. The remodeling of the care flow improved the integration among psychological assessment and other psychological interventions, and the communication between the requesting physician and the psychologist

Cognition and functioning in bipolar depression

Objectives: Depressive symptoms are associated with worse outcomes in patients with bipolar disorder (BD). However, scarce data are available regarding neurocognitive profiles across different areas of functioning among BD patients with moderate and severe depression. Our objective was to assess cognition and global functioning in a group of patients with bipolar depression. Methods: Data were available for 100 patients with bipolar depression (78% female) and 70 controls (64% female) paired by age and education level. Cognitive function was assessed with a neuropsychological test battery. Functioning was assessed with the Functioning Assessment Short Test. Results: In patients, severe depression was associated with poorer cognitive performance on measures of executive function. Patients with severe depression showed worse global functioning than those with moderate depression (z = 2.54, p = 0.011). In patients with severe depression, lower global functioning was associated with lower scores in working memory (r = -0.200, p = 0.010), and executive function (r = -0.210, p = 0.007; and r = 0.293, p o 0.001). Conclusion: Our findings suggest cognitive impairment and global functioning impairment are associated with the severity of depressive symptoms in bipolar depression. Intensive treatment of depressive symptoms in patients with BD is crucial to improve cognitive functioning and, consequently, functional outcomes

Childhood trauma and resilience : vulnerabilities to develop crack/cocaine dependence

Background: Crack cocaine dependence is a health problem of epidemic proportions and there is lack of evidence concerning vulnerability factors that could lead to crack cocaine use. The aim of this study is to investigate characteristics of resilience in a group of crack cocaine users and its association with childhood trauma and PTSD. Method: This is a case-control study in which we evaluated 218 crack cocaine inpatients users and 215 healthy controls, recruited from the capital city of the southern State of Brazil. Childhood Trauma was evaluated with the Childhood Trauma Questionnaire; resilience was evaluated with the Resilience Scale; and post-traumatic stress disorder (PTSD) was evaluated with the Mini-International Neuropsychiatric Interview. Results: Childhood trauma was significantly higher among crack cocaine users in all trauma domains (p<0.001), except for sexual abuse. Most resilience scores was lower among crack cocaine users (p<0.01). Having higher scores of childhood trauma and lower scores of resilience increase the odds to become a crack cocaine user (p<0.001), despite the diagnosis of PTSD. Discussion: Childhood trauma appears to be a risk factor to become a crack cocaine user while resilience features may be a protection factor. To understand factors of vulnerabilities in this population is important for the development of more efficacious treatment and preventive strategies