Aspectos psicossociais na epilepsia: contribuição para o seu estudo

Dissertação de Mestrado em Psiquiatria apresentada à Faculdade de Medicina da Universidade do Port

COVID-19 Suicide Survivors—A Hidden Grieving Population

Present time has been dominated by the COVID-19 pandemic. People are grieving several non-death related situations: the loss of a job, of a status, of a role, of their life. Restrictive measures and uncertainty about the future makes individuals vulnerable to feelings of hopelessness and helplessness. Mental health support has been hindered and teams are reinventing themselves to reach people in need. Nevertheless, decompensation of previous psychiatric disorders, increasing levels of depression and anxiety, economical handicaps and fear of the infection, are prompting several cases of COVID-19 related suicides worldwide. Every suicide affects between 5 and 80 individuals, which are known as suicide survivors. Suicide grief is particularly challenging, with rates of complicated grief as high as 40%. Suicide survivors are at increased risk of developing depression, anxiety disorders and of suicidal behaviors. Moreover, feelings of guilt and shame, as well as social stigma, are major obstacles for them to reach form help. This article aims to review the existing literature on COVID-19 related suicides, complicated grief in suicide survivors and highlight modifiable risk factors for both conditions, as well as propose some public health measures to reduce the impact of the pandemic context on self-inflicted harm and its consequences on families, friends and the community. Obstacles to access to mental health support need to be overcome through the use of technology. Technicians should actively approach populations more vulnerable to develop suicidal ideation. Social media have the obligation to provide accurate an non-sensationalistic information. Families and friends should maintain social proximity, despite the need for physical distancing. When a suicide death occurs, police forces and health staff should be prepared to share the news with the family using an empathic and humane approach and providing psychological support. Funerals, memorials and other services should be held as much as possible. Closer contacts should be signalized and closely followed in order to detect the need for specific interventions. Help seeking behaviors should be promoted. Additionally, people should be educated on suicide and its impacts, in order to reduce stigma

Validation of the Portuguese version of community attitudes toward people with mental illness (CAMI) [artigo]

Stigma remains a feature that influences the lifestyle of people with mental illness. Negative attitudes, stereotypes, and discrimination are still prevalent in these people’s life. Stigma is considered a public health problem that occurs unconsciously in society, categorizing people. Portugal is the seventh-worst country concerning stigma in Mental Health. There have been few improvements in reducing stigma over time, and there is a great need to create investigations and validate instruments that measure stigma in the population. This study aims to address the gaps in the level of studies and normative instruments that measure the stigma of the Portuguese population in the face of mental illness. It, therefore, aims to adapt and validate community attitudes toward people with mental illness (CAMI) culturally and examine its psychometric properties. Method: The 27-item version of CAMI was translated and back-translated into English, which was analyzed and evaluated by a panel of experts. A sociodemographic survey and CAMI were applied in an online format, in which participated 427 adults representing the Portuguese population in general. Finally, the reliability and validity of the instrument were analyzed. CAMI showed positive values of reliability and validity but not optimal. The confirmatory factor analysis values satisfactory values that indicate good quality of fit: x2 /df=3.296; comparative fit index = 0.601; goodness of fit index = 0.817; and root mean square error of approximation = 0.073, indicates good quality of fit. Cronbach alpha was different for each factor, but it was positive. Spearman coefficient (r=–0.343) obtained a negative but consistent value. This study contributed to the achievement and validation of new measures to assess the stigma of the general population related to people with mental illness. We must continue to analyze this theme, complete the validation of this instrument, and understand the existing levels of stigma, its predominance in society, and the possible creation and implementation of new measures that support literacy in mental illness and anti-stigma.info:eu-repo/semantics/publishedVersio

Stigmatizing attitudes in relatives of people with schizophrenia: a study using the Attribution Questionnaire AQ-27

BACKGROUND: Family members of people with mental disorders can contribute to stigmatization. Because of the lack of adequate information and resources, and the fatigue resulting from daily care, the family can reinforce social exclusion of the mentally ill and disbelieve recovery. Furthermore, family members may also suffer from self-stigma, experiencing a decrease in their own self-esteem and self-worth. OBJECTIVE: To evaluate the presence of stigmatizing attitudes towards patients diagnosed with schizophrenia in a group of relatives of patients with this disorder. METHODS: In this exploratory study, we surveyed 40 family members of patients with schizophrenia seen at the Community Psychiatry Unit of the Psychiatry Department at Centro Hospitalar de São João (CHSJ), in Porto, Portugal, using a preliminary version of the Attribution Questionnaire AQ-27 in Portuguese. RESULTS: The questionnaire dimensions with the highest mean scores were help, pity, and coercion, followed by segregation, anger, avoidance, dangerousness, responsibility, and fear. These results suggest that relatives do not see people with schizophrenia as responsible for their illness and that they show concern and willingness to help. They avoid but do not fear people with schizophrenia and neither consider them dangerous. CONCLUSION: The participants expressed positive, little stigmatizing attitudes towards people with schizophrenia, probably as a result of their familiarity with severe mental disorder, an adequate attribution process, and low levels of perceived dangerousness. However, the high scores of coercion, pity, and segregation may reflect concealed stigmas that may influence the self-determination of the mentally ill, suggesting the need for psychoeducational interventions aimed at family members

Prevalence of lipid and glycemic profile altered in patient with schizophrenia

CONTEXTO: Os pacientes com esquizofrenia (SCZ) apresentam anomalias importantes no metabolismo lipídico e da glicose, que podem ser induzidas pela terapia antipsicótica (AP) e pelo estilo de vida associado. O risco de doenças cardiovasculares, diabetes mellitus e síndrome metabólica está aumentado nestes pacientes, que apresentam taxa de mortalidade por doenças cardiovasculares duas vezes mais elevada do que a população geral. OBJETIVO: Analisar a prevalência de alterações nos perfis lipídicos e glicémicos e a terapêutica AP numa amostra de pacientes SCZ. METODOLOGIA: Realizou-se um estudo retrospetivo aos registos de perfis lipídico e glicémico e da terapia AP de pacientes SCZ de uma unidade de dia de cuidados de saúde mental, de 2009 a 2011. Selecionámos para estudo individualizado os casos que cumpriam os seguintes critérios: presença de fatores de risco cardiovascular, hiperglicemia ou fatores indicadores de síndrome metabólica. RESULTADOS: A amostra foi constituída por 51 pacientes SCZ, dos quais registámos 5 casos com fatores de risco cardiovascular, 6 com hiperglicemia indicadora de diabetes e 7 com fatores laboratoriais indicadores de síndrome metabólica. Para estes casos, analisámos o agente antipsicótico prescrito. CONCLUSÕES: Os dados mostram a necessidade de monitorização dos efeitos secundários metabólicos da terapia AP e do estabelecimento de medidas corretivas (alimentares, estilo de vida e terapêuticas).info:eu-repo/semantics/publishedVersio

Forty years of a psychiatric day hospital

INTRODUCTION: Day hospitals in psychiatry are a major alternative to inpatient care today, acting as key components of community and social psychiatry. Objective: To study trends in the use of psychiatric day hospitals over the last decades of the 20th century and the first decade of the 21st century, focusing on patient age, sex, and diagnostic group, using data from Centro Hospitalar S&#227;o Jo&#227;o, Porto, Portugal. METHODS: Data corresponding to years 1970 to 2009 were collected from patient files. Patients were classified into seven diagnostic groups considering their primary diagnoses only. RESULTS: Mean age upon admission rose from 32.7&#177;12.1 years in the second half of the 1970s to 43.5&#177;12.2 years in 2005-2009 (p for trend < 0.001). Most patients were female (63.2%), however their proportion decreased from nearly 70% in the 1970s to 60% in the first decade of the 21st century. In males, until the late 1980s, neurotic disorders (E) were the most common diagnosis, accounting for more than one third of admissions. In the subsequent years, this proportion decreased, and the number of admissions for schizophrenia (C) exceeded 50% in 2004- 2009. In females, until the late 1980s, affective disorders (D) and neurotic disorders (E), similarly distributed, accounted for most admissions. From the 1990s on, the proportion of neurotic disorders (E) substantially decreased, and affective disorders (D) came to represent more than 50% of all admissions. CONCLUSIONS: Mean age upon admission rose with time, as did the percentage of female admissions, even though the latter tendency weakened in the last 10 years assessed. There was also an increase in the proportion of patients with schizophrenia