Eficácia do Treino Metacognitivo nos delírios, alucinações, insight cognitivo e funcionalidade na esquizofrenia

Schizophrenia is one of the most disabling mental disorders at the functional level. This thesis have the following objectives: to evaluate the relationship between affectivity and sociodemographic and clinical characteristics, quality of life, functionality and satisfaction with social support in schizophrenia (study 1); to evaluate the psychometric properties of the Beck Cognitive Insight Scale (BCIS) for a sample of Portuguese patients with psychotic disorders and to compare the cognitive insight of institutionalized patients with patients living in the community (study 2); to evaluate the efficacy of metacognitive group training in reducing psychotic symptoms, and improving cognitive insight and functions in people with schizophrenia (study 3) and to provide a rating scale for the ICF Core Set Brief specific for people with schizophrenia (study 4). Studies 1 and 2 are cross-sectional quantitative studies, study 3 is a randomized controlled study and in the study 4 the Delphi technique was used. In summary, in terms of diagnostic assessment, studies 1 and 2 contributed to the understanding of the importance of an assessment focused on the needs of the person, taking into account different aspects, such as: personal and clinical characteristics, affectivity, functionality, satisfaction with social support and cognitive insight. Studies 2 and 4 made a contribution by providing validation for the Portuguese population of BCIS (study 2) and by allowing a more rigorous assessment in functional terms, with the construction of the Schizophrenia Functioning Core Set (study 4). With regard to the implementation of psychotherapeutic interventions, when validating the effectiveness of MCT, the study 3 contributed so that it can be replicated in clinical practice, as an adjunct to the psychosocial rehabilitation process, and can be applied by mental health nurses

Quality of life in schizophrenia: contributions to the paradigm shift

Doutoramento em PsicologiaA esquizofrenia é, talvez, a perturbação mental mais devastadora e disfuncional, prejudicando, frequentemente, o desenvolvimento de competências socias e ocupacionais. Os objetivos desta investigação são adaptar e validar para a população portuguesa a Quality of Life Scale (QLS) e estudar a qualidade de vida dos indivíduos com esquizofrenia, analisando a relação entre esta e as características sociodemográficas e clínicas, bem como a satisfação com o suporte social. Inicialmente foram realizadas duas revisões sistemáticas da literatura (estudos 1 e 2) e uma revisão reflexiva (estudo 3), para melhor conhecer o estado da arte. Estas serviram de suporte para o contributo empírico que é constituído por cinco estudos cuja metodologia é de natureza quantitativa, do tipo transversal e correlacional. A amostra global é constituída por 282 indivíduos, de nacionalidade portuguesa, com o diagnóstico de esquizofrenia, sendo 112 (39,7%) do género feminino e 170 (60,3%) do género masculino, com uma média de idades de 46,15 anos (± 13,126). Foram utilizados os seguintes instrumentos de avaliação: questionário sociodemográfico e clínico, WHOQOL-BREF, QLS7PT e Escala de Satisfação com o Suporte Social (ESSS). A análise dos dados recorreu ao uso do SPSS, versão 22.0, tendo sido realizadas análises descritivas e inferenciais. Foram efetuados dois estudos piloto, o primeiro, com 198 participantes que analisou as características sociodemográficas da amostra e verificou a relação entre a coabitação e o grau de satisfação com o suporte social (estudo 4). Já o segundo, com 268 participantes, comparou as características sociodemográficas e clínicas e os resultados da ESSS com a qualidade de vida, utilizando a WHOQOL-BREF (estudo 5). Os estudos 6, 7 e 8 foram realizados com uma amostra de 282 indivíduos. O primeiro, efetuou a adaptação e validação da versão reduzida da Quality of Life Scale (QLS), para a população portuguesa (QLS7PT), que demonstrou boas propriedades psicométricas (estudo 6). O seguinte, analisou a relação entre a qualidade de vida (QLS7PT) e aspetos sociodemográficos e clínicos (estudo 7). O último, avaliou a influência da satisfação com o suporte social na qualidade de vida (QLS7PT) (estudo 8). Em relação aos resultados mais relevantes, verificou-se que o emprego/ocupação é extremamente significativo para a qualidade de vida das pessoas com esquizofrenia. Outros dados indicaram ainda, que esta pode ser influenciada pela coabitação, tempo de doença, idade, escolaridade, medicação com neurolépticos de primeira geração e existência de internamentos anteriores. A evidência dos nossos resultados mostrou ainda que a satisfação com o suporte social, tendo especial destaque a satisfação com os amigos e com a intimidade, está fortemente relacionada com a qualidade de vida. Estes dados estão ainda pouco estudados e são de elevada utilidade e pertinência tanto para a investigação como para a prática clínica. Sendo uma das perturbações mentais mais incapacitantes a nível mental, social e ocupacional, o nosso grande contributo para a mudança de paradigma é a disponibilização da escala QLS7PT para utilização e avaliação nas intervenções em saúde mental e em futuras investigações. Assim, consideramos que é necessária uma intervenção precoce, focalizada em programas de reabilitação psicossocial que englobem o treino de competências sociais e relacionais, tendo em consideração a melhoria dos fatores moldáveis que influenciam a qualidade de vida, como a ocupação e a promoção de redes sociais de apoio estáveis e consistentes, bem como estratégias para a redução do estigma.Schizophrenia is perhaps the most devastating and dysfunctional mental disorder, often jeopardizing the development of social and occupational skills. The aims of this research are to adapt and validate the Quality of Life Scale (QLS) for the Portuguese population and to study the quality of life of individuals with schizophrenia by analysing the relationship between this and sociodemographic and clinical characteristics, as well as satisfaction with social support. Initially, two systematic reviews of the literature (studies 1 and 2) and a reflective review (study 3) were conducted to understand the state of the art better. These would serve as support for the empirical contribution consisting of five studies whose methodology is quantitative, and cross-sectional and correlational. The overall sample consisted of 282 Portuguese individuals, diagnosed with schizophrenia with 112 females (39.7%) and 170 males (60.3%) with an average age of 46.15 (±13.126). The following assessment tools were used: a sociodemographic and clinical questionnaire, the WHOQOL-BREF, the QLS7PT and the Satisfaction with Social Support Scale (ESSS). Data analysis was performed using SPSS, version 22.0 with descriptive and inferential analysis being carried out. Two pilot studies were conducted: the first with 198 participants analysed the sociodemographic characteristics of the sample and found the relationship between cohabitation and the degree of satisfaction with social support (study 4). The second, with 268 participants, compared the sociodemographic and clinical characteristics and the results of the ESSS with quality of life, using the WHOQOL-BREF (study 5). Studies 6, 7 and 8 were conducted with a sample of 282 subjects. The first involved adapting and validating the reduced version of the Quality of Life Scale (QLS) for the Portuguese population (QLS7PT), which demonstrated good psychometric properties (Study 6). The following study, examined the relationship between quality of life (QLS7PT) and sociodemographic and clinical aspects (study 7). The last one evaluated the influence of satisfaction with social support on quality of life (QLS7PT) (Study 8). With regard to the most relevant results, it was found that employment/occupation is extremely significant for the quality of life of people with schizophrenia. Other data also indicated that this may be influenced by cohabitation, disease duration, age, education, medication with first generation neuroleptics and the existence of previous hospitalization. Our results also showed that satisfaction with social support, with special emphasis on satisfaction with friends and intimacy, is strongly related to quality of life. These data are still poorly studied and are highly useful and relevant both for research and for clinical practice. Being one of the most disabling mental disorders, at both the social and occupational level, our major contribution to the paradigm shift is making of QLSscale7PT available for use and assessment of mental health interventions and for future research. We therefore consider that early intervention is needed, focused on psychosocial rehabilitation programmes covering the training of social and relational skills, taking into account the improvement of mouldable factors that influence quality of life, such as employment and the promotion of stable and consistent social support networks, as well as strategies for reducing stigma

Portuguese Adaptation of the Quality of Life Scale for Schizophrenic Patients

A esquizofrenia é uma doença mental grave e crónica que acomete a qualidade de vida de quem dela padece. A Quality of Life Scale (QLS), de Heinrichs, Hanlon e Carpenter, 1984, é uma das escalas específicas mais utilizadas a nível internacional para a avaliar. Por não existir em Portugal nenhum instrumento ajustado para a esquizofrenia, este estudo tem como objetivo proceder à adaptação e validação para a população portuguesa desta escala, na sua versão reduzida, com 7 itens. A amostra foi constituída por 282 participantes com diagnóstico de esquizofrenia de diferentes instituições do país. A análise das qualidades psicométricas (análise fatorial exploratória e consistência interna) do instrumento avaliado mostrou índices adequados de fidedignidade e validade, consistentes com os dados internacionais existentes. Estes resultados justificam a utilização do mesmo no contexto português.Schizophrenia is a severe and chronic mental illness that affects the quality of life of those who suffer from it. The Quality of Life Scale (QLS), by Heinrichs, Hanlon and Carpenter, 1984, is one of the most specific scales used internationally to assess it. Because in Portugal there is no instrument designed for schizophrenia, the aim of this study is to adapt and validate this scale for the Portuguese population in its reduced 7-item version. The sample consisted of 282 participants with schizophrenia in different health institutions from north to south in the country. Analysis of the instrument’s psychometric properties (exploratory factor analysis and internal consistency) showed adequate levels of reliability and validity consistent with existing international data. These results justify the use of this scale in the Portuguese context.publishe

Influence of sociodemographic and clinical characteristics on the quality of life of patients with schizophrenia

RESUMO Objetivo: Avaliar a qualidade de vida dos indivíduos portugueses com esquizofrenia e relacioná-la com aspetos sociodemográficos e clínicos. Método: Estudo quantitativo de natureza transversal realizado com portadores de esquizofrenia, residentes em todo o território continental de Portugal, tendo sido aplicado um questionário sociodemográfico e clínico e a Quality of Life Scale versão reduzida (QLS7 PT). Foram realizados testes paramétricos e não paramétricos para avaliar a correlação entre as variáveis. Resultados: A amostra foi constituída por 282 participantes. Apontam para uma melhor qualidade de vida os indivíduos que vivem em residências autônomas ou com os pais, empregados/estudantes, com transtorno há menos tempo e menor idade, com o 12º ano de escolaridade e não medicados com neurolépticos de primeira geração. Conclusão: Os resultados indicam que algumas características sociodemográficas e clínicas influenciam a qualidade de vida dos indivíduos com esquizofrenia, pelo que devem ser consideradas na avaliação psiquiátrica e no planejamento das estratégias adaptadas e eficazes à sua reabilitação psicossocial.info:eu-repo/semantics/publishedVersio

Cognitive insight in psychotic patients institutionalized and living in the community: an examination using the Beck Cognitive Insight Scale

Improving cognitive insight can reduce delusions in patients with psychotic disorders. Although institutionalized patients usually have more severe delusions than outpatients, little is known about the differences in cognitive insight between these two groups. In this study, we evaluated the psychometric properties of the Beck Cognitive Insight Scale (BCIS) for a sample of Portuguese patients with psychotic disorders and compared the cognitive insight of institutionalized patients with patients living in the community. Participants in this study were 150 patients diagnosed with psychotic disorder (78 institutionalized patients and 72 outpatients). The tested model of the BCIS was a very good fit. Our study shows that patients living in the community showed higher levels of cognitive insight (total BCIS and self-reflectiveness) than institutionalized patients. Future studies assessing cognitive insight should take into account differences between the cognitive insights of institutionalized psychotic patients and psychotic patients living in the community.info:eu-repo/semantics/publishedVersio

Assessing the efficacy and feasibility of providing metacognitive training for patients with schizophrenia by mental health nurses: a randomized controlled trial

Aim: To evaluate the efficacy of metacognitive group training in reducing psychotic symptoms and improving cognitive insight and functions in people with schizophrenia.Design: Randomized controlled trial. It was carried out between July 2019-February 2020. Methods: Fifty-six patients with schizophrenia were enrolled and randomly as- signed to either a control group (N = 29) or a metacognitive training group (N = 27). Blinded assessments were made at baseline, 1-week post-treatment and at follow-up 3 months after treatment. The primary outcome measure was psychotic symptoms based on the Psychotic Symptom Rating Scales (PSYRATS). Secondary outcomes were assessed by the Beck Cognitive Insight Scale (BCIS), the Personal and Social Performance (PSP) scale and the World Health Organization Disability Assessment Schedule (WHODAS). Results: Completion at follow-up was high (92.86%). The intention-to-treat analy- ses demonstrated that patients in the metacognitive training group had significantly greater improvements of the Psychotic Symptom Rating Scales delusion score and total score and the Personal and Social Performance Scale, after 3 months, compared with the control group. The effect size was medium to large. The intention-to-treat analyses also demonstrated that patients in the metacognitive training group had significantly greater reductions of the Psychotic Symptom Rating Scales hallucination score and Beck Cognitive Insight Scale self-certainty score post-treatment, compared with the control group. The effect size was medium to large. Conclusion: The metacognitive training administered by psychiatric and mental health nurses was effective in ameliorating delusions and social functioning over time and it immediately reduced hallucinations post-treatment. Impact: Metacognitive training for treating psychosis in patients with schizophrenia is efficacious and administration is clinically feasible in the Portuguese context.info:eu-repo/semantics/publishedVersio

Editorial: Mental health literacy: how to obtain and maintain positive mental health

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Portuguese nurses’ stress, anxiety, and depression reduction strategies during the COVID-19 outbreak

The COVID-19 pandemic has contributed to mental health problems worldwide. Nurses are particularly prone to stress because they directly care for individuals with suspected or confirmed cases of COVID-19. The aims of this study were (a) to explore the association between the mental health promotion strategies used by nurses during the COVID-19 outbreak and their symptoms of depression, anxiety, and stress; (b) to compare the symptoms of depression, anxiety, and stress of mental health nurses to those of non-mental health nurses; and (c) to compare the frequency of use of mental health strategies of mental health nurses to those of non-mental health nurses. A cross-sectional study was conducted with a sample of 821 nurses. Univariate and multivariate regression models were developed to identify potential protective factors of depression, anxiety, and stress. The chi-square test was also used to compare the use of strategies among mental health and non-mental health nurses. Portuguese nurses demonstrated high symptoms of depressive symptoms, stress, and anxiety. Healthy eating, physical activity, rest between shifts, maintaining social contacts, verbalizing feelings/emotions, and spending less time searching for information about COVID-19 were associated with better mental health. Mental health nurses had less depression, anxiety, and stress, and used more strategies to promote mental health than other nurses. We consider it important to promote nurses’ mental health literacy by encouraging them to develop skills and strategies aimed at improving their resilience and ability to deal with difficult situations while caring for the population.info:eu-repo/semantics/publishedVersio

Satisfação com o suporte social e qualidade de vida dos doentes com esquizofrenia

CONTEXTO: A esquizofrenia, como doença mental grave, traz consequências nefastas para a qualidade de vida dos doentes, envolvendo, na maioria dos casos, um escasso apoio social, pelas características que estão inerentes à sua sintomatologia. Sendo o suporte social uma das variáveis de redução do impacto das perturbações mentais como a esquizofrenia, torna-se importante perceber a associação entre este e a qualidade de vida. OBJETIVO: Avaliar a in!uência da satisfação com o suporte social na qualidade de vida dos doentes com esquizofrenia. METODOLOGIA: Amostra constituída por 282 participantes com o diagnóstico de esquizofrenia pertencentes a várias instituições de norte a sul de Portugal Continental. Foram utilizados os seguintes instrumentos: Questionário de dados sociodemográ"cos, Escala de Qualidade de Vida QLS7PT e Escala de Satisfação com o Suporte Social (ESSS). Trata-se de um estudo transversal com análises de regressão linear simples para avaliar a correlação entre as variáveis. RESULTADOS: Obtiveram-se resultados estatisticamente signi"cativos entre os valores da QLS7PT e a satisfação com o suporte social total (p<0,001), a satisfação com os amigos (p<0,001), com a intimidade (p<0,001) e com as atividades sociais (p=0,008). Não se obtiveram resultados estatisticamente signi"cativos entre a QLS7PT e a satisfação com a família (p=0,294). CONCLUSÕES: Os resultados sugerem que quanto maior a satisfação com o suporte social maior a qualidade de vida. Torna-se assim crucial a implementação de intervenções de enfermagem em saúde mental que promovam as relações interpessoais não só dentro do grupo terapêutico mas também na comunidade.info:eu-repo/semantics/publishedVersio

Anxiety, stress and coping stress strategies in researchers: COVID-19 pandemic

Background: The COVID-19 pandemic has affected worldwide, with the need for changes at the level of personal and professional life. The researchers, as with other professions, have been one of the professional classes that have had to reinvent. Aim: This study had the aim, to assess the anxiety, stress, and coping strategies in Portuguese researchers during the COVID-19 pandemic. Methods: Data were collected from 243 researchers using an online questionnaire, that included a Depression, Anxiety and Stress (DASS-21), and Coping Inventory for Stressful Situations (CISS). The study was performed between 1st June to 11th August 2021. Results: The findings suggest singles and younger researchers showed higher values of stress and anxiety. Medical and health sciences research areas presented higher levels on the DASS21 stress scale (p<0.05). Also, the results showed a moderate or moderate strong significant positive linear relationship between the scales (p<0.001): DASS-21 stress and anxiety; CISS21 emotional-oriented with DASS-21 stress and anxiety. Conclusion: The findings of this study support the growing concern for the mental health of the population, and in this case in particular, for the mental health of researchers. This study draws attention to the need for the intervention with more extensive and diverse studies in this professional class.info:eu-repo/semantics/publishedVersio