Esquizofrenia : eficácia de um programa de psicoeducação com familiares

Mestrado em Psicologia - Psicologia Clínica e da SaúdeA esquizofrenia é uma doença mental grave e crónica que atinge cerca de 1% da população mundial. A psicoeducação e o acompanhamento dos familiares destes utentes é fundamental para que a sua inserção na comunidade seja eficaz e haja uma prevenção de recaídas com consequente redução do número de internamentos, aumentando os ganhos em saúde. A presente investigação tem como finalidade implementar um protocolo psicoeducativo em familiares de doentes com esquizofrenia e verificar a sua eficácia na redução da emoção expressa e da sobrecarga familiar objetiva e subjetiva, através da avaliação pré e pós intervenção destas variáveis. A amostra do estudo é constituída por 20 familiares destes doentes, de ambos os sexos e com idades compreendias entre os 18 e 69 anos (10 no grupo experimental e 10 no grupo de controlo), pertencentes à consulta externa no Departamento de Psiquiatria e Saúde Mental do Centro Hospitalar do Baixo Vouga E.P.E.. Foi utilizado o Questionário de Problemas Familiares (FPQ) para avaliar a eficácia deste tipo de intervenções na emoção expressa e na sobrecarga familiar a ambos os grupos, antes e após a intervenção. O grupo experimental foi sujeito a intervenções psicoeducativas multifamiliares enquanto que o grupo de controlo não teve qualquer intervenção. Dos resultados obtidos verificou-se a existência de uma sobrecarga objetiva e subjetiva elevada na amostra em estudo, em ambos os grupos, antes da aplicação do programa, o que nos indica uma elevada sobrecarga familiar. Após a aplicação do programa constataram-se diferenças estatisticamente significativas no grupo experimental relativamente a estes fatores, tendo ambas as sobrecargas diminuído. Relativamente à emoção expressa, antes da aplicação do programa, embora os resultados não tenham sido tão evidentes, houve uma redução do criticismo e aumento das atitudes positivas no grupo experimental. No grupo de controlo não se observaram diferenças estatisticamente significativas no pré e pós teste em nenhum dos fatores. Estes resultados parecem indicar que existiram diferenças possivelmente potenciadas pelo programa implementado, permitindo assim concluir a eficácia da aplicação do programa psicoeducacional, ao nível da diminuição da sobrecarga familiar e da emoção expressa. São referidas algumas implicações deste estudo para a prática clínica e para a intervenção junto dos familiares visando a promoção da saúde e o bem-estar destes indivíduos.Schizophrenia is a severe chronic mental illness that affects about 1% of the world population. Psycho-education and family monitoring of these patients is essential for an effective integration into the community and for relapse prevention with consequent reduction in the number of admissions, greater health promotion. This investigation focuses on the implementation of a psycho-educational protocol with the family of schizophrenic patients seeking to assess its effectiveness in reducting expressed emotion and objective and subjective family burden, through the evaluation of these variables pre and post-intervention. The study sample consists of 20 family members of these patients, from both genders and with ages between 18 and 69 years old (10 in the experimental group and 10 in the control group), attatched to the external medical consultations in the Department of Psychiatry and Mental Health of the Baixo Vouga Hospital Centre E.P.E.. The study used the Family Problems Questionnaire – FPQ to evaluate the effectiveness of this family interventions in the reduction of expressed emotion and the family burden, in both groups, before and after the intervention. The experimental group was subjected to psycho-educational interventions, while the control group wasn’t subject to any intervention. The results indicated the existence of an objective and subjective overload, in both groups, before and after the program, which indicated a high family burden. Regarding the expressed emotion, before the application of the program, although the results were not conclusive, there was a decrease in criticism and increase in the positive attitudes in the experimental group. The control group showed no significant changes in any of these variables. This results suggest that there are differences possibly attributable to the implemented program. Therefore, we can conclude that the implementation of a family psycho-educational program is very effective as it potentially decreases family burden and expressed emotion. This study also has implications for clinical practice and to the family intervention aiming at health promotion and the wellness in this area

Aging and functionality of the institutionalized elderly people of Alto Alentejo: Contributions to the diagnosis of the situation

The loss of functionality in aging process is a concern nowadays. We proposed to perform the diagnosis of the functionality of institutionalized elderly people in Portalegre city. We developed a quantitative, descriptive and transversal study with the application of three evaluation instruments (Elderly Nursing Core Set, Mini-Mental State Examination and Blessed Dementia Scale (BDS)). The sample consisted of 89 elderly people, with an average age of 86.6 years-old, most of them are female (71.9%), widowed (77,5%) and illiterate (51.7%). The average of years of institutionalization was 3.5. 45.3% showed cognitive deterioration, and 50% showed moderate to severe deficits on the BDS. It was also found that 7% of the older people had low weight and 79.4% were overweight. It was also found that 7% of them had low weight and 79.4% were overweight. 37% reported they have pain and more than 52% presented moderate to complete disability in daily life activities such as walking, washing, caring for body parts, excretion processes and dressing. However, less than 26% presented some deficiency in eating. Regarding environmental factors 88% of the elderly people reported having some kind of support from family and friends. We concluded that the sample presents functional deficits, including considered cognitive deficiencies, requiring intervention. Considering that the evaluation presented here was made before the pandemic period caused by Covid-19, it is important to re-evaluate this sample after the restrictions of social conviviality to assess the effect of the pandemic on functionality and rethink the model of care for the institutionalized elderly people

Components of Care Models that Influence Functionality in People Over 65 in the Context of Long-Term Care: Integrative Literature Review

Introduction: We verified the existence of a greater number of people over 65 years of age, with associated multimorbidity and in need of care. Cares that in previous times were provided by the extended family, at home. Nowadays, with the need for women to enter the labor market and the transition to nuclear families, this assistance becomes complicated, which is why institutionalization has been increasingly used. Institutionalization, in turn, often leads to the breakdown of social relationships among the elderly and, consecutively, to the loss of their own identity. Objective: To identify the components of care models that influence functionality in the context of long-term care. Methodology: Integrative Review of the Literature, for which research was done at EBSCO selecting the databases Cinahl, Medline. Results: We selected 10 articles from which resulted, two systematic reviews of the literature; two cross-sectional studies; Two Descriptive Studies; a cross-sectional cohort study; a randomized controlled trial and an Opinion Article. Conclusions: Identify essentially three models of care, being a model focused on self-care with a major focus on the person with impaired functionality, the chronic disease management model, more associated with the elderly with comorbidities, but with the ability to develop their daily living activities and the economic model in order to develop the improvement of the economic model of the health system itself. Among these various components, we can find both process and outcome indicators that first influence the quality of care itself and the functionality of people in the context of long-term care. Implication in Professional Practice: With the applicability of these components, comes the permission to apply and structure care models and as a thread of all care process, such as the structuring of individual care plans, involving the patient himself., and abolishing the current working method that currently focuses much on the task method

O SÍNDICO E O INSS: UMA OBRIGAÇÃO QUE POUCOS LEMBRAM

O presente trabalho trata da atividade exercida pelo síndico, prazo de duração, titularidade do cargo, assim como toca sucintamente nos seus deveres e direitos. Dá enfoque especial à, largamente praticada, isenção da taxa condominial conferida pelo condomínio para que o exercício do cargo torne-se um pouco atrativo, destacando a relevância prática deste tema para o quotidiano, em virtude de consequências previdenciárias, por vezes olvidada. Destaca, ainda, o posicionamento legislativo e jurisprudencial da existência da obrigação tributária do condomínio, bem como da exigibilidade da sua contribuição previdenciária. Além disso, discorre sobre o regime contributivo da Previdência Social, cuja proteção social é abrangida ao síndico segurado

O PLURALISMO FAMILIAR: A VALORIZAÇÃO DO DIREITO DE FAMÍLIA – ANTIGOS E NOVOS PARADIGMA

O presente trabalho trata da importante e recente evolução sofrida pelo direito de família, destacando a relevância deste ramo do direito para o sistema jurídico pátrio. Destaca a mudança legislativa e jurisprudencial a partir do surgimento de novas formas de família valorizando a escolha responsável dos indivíduos por seus parceiros. Toda trajetória da leitura visita a historicidade familiar, perpassando pelo Estatuto da Mulher Casada e pela Lei do Divórcio, culminada com a promulgação da Constituição Federal de 1988, baseando-se na dignidade da pessoa humana e no princípio da igualdade. Ainda, faz-se breve análise acerca dos efeitos ocorridos a partir da formação das novas famílias concluindo pela impossibilidade da determinação absoluta pelo Estado das consequências jurídicas decorrentes dos atos praticados nas vidas particulares/familiares de cada ser humano

Brief ICF Core Set for Schizophrenia: Development of Criteria for Assessing the Degree of Disability

Introduction: A paradigm shift in the assessment and rehabilitation of people with schizophrenia is needed, with an integrative perspective rather than a simple focus on the underlying symptomatology. To this end, it is essential to adopt integrated and continuous care focused on the person in his/her context. As a contribution, the Brief International Classification of Functioning, Disability and Health (ICF) Core Set for schizophrenia has been developed by international experts. The present study aims to develop a scale to classify the degree of disability for each of the categories of the Brief ICF Core Set for schizophrenia. Methods: The classification criteria were first developed by the researchers and then submitted for assessment by national experts in the area of schizophrenia, using the modified e-Delphi method. Results: Two rounds of questions were asked, and a consensus was reached on the development of the Schizophrenia Functioning Core Set, consisting of all categories of the Brief ICF Core Set for schizophrenia and the criteria for classifying the degree of disability. The degree of agreement of the experts was greater than 90% in all categories. Conclusion: The construction of the disability grading criteria was based on the characteristics of schizophrenia as defined in DSM-V, as well as on some functional assessment scales specifically for this disorder. The development of the Schizophrenia Functioning Core Set allows for reducing the subjectivity in the assessment of the functioning of people with schizophrenia, standardizing the application of criteria to assign the degree of disability in each of the categories

Hazard assessment of storm events in the central region of the Portuguese coast

The environmental and socio-economic importance of the coastal areas is widely recognized, but these areas face today severe weaknesses and high-risk situations. The increased demand and human occupation of the coast has greatly contributed to increase such weaknesses. Today, throughout the world, in all countries with coastlines, episodes of waves overtopping and coastal flooding are frequent. These episodes are usually responsible for property losses and often put human lives at risk. The floods are caused by coastal storms due to the action of very strong winds. The propagation of these storms towards the coast induces high water levels. Consequently, carrying out series of storm scenarios and analyzing their impacts through numerical modelling is of prime interest to the coastal decision-makers. A contribution to the preservation and sustainability of the coastal zone constitutes the main aim of this work. Firstly, historical storm tracks and intensities are characterized for the Portuguese coast, in terms of probability of occurrence. Secondly, several storm events with high potential of occurrence are generated using the specific tool DelftDashboard. The hydrodynamic model Delft3D is then used to simulate their effects on currents and on the coastal water levels. Two spatial domains are considered: a large domain encompassing the Iberian coastal zone and a smaller domain for the central region of the Portuguese coast (between cities of Aveiro and Figueira da Foz); this one with a more refined grid. Based on statistical data and by numerical modelling, a review of the impact of coastal storms to different locations within the study area is performed

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

A randomized controlled trial to evaluate the efficacy of metacognitive training for people with schizophrenia applied by mental health nurses: Study protocol

Aim To evaluate the efficacy of the Portuguese version of the metacognitive training (MCT) programme for schizophrenia and its effects on psychotic symptoms, insight into the disorder and functionality. Design This is a randomized controlled trial that will be undertaken in six psychiatric institutions in Portugal. Methods This study was approved in March 2019. The sample will consist of people with schizophrenia. The evaluation instruments will include sociodemographic and clinical questionnaires, the Psychotic Symptom Rating Scales, the Beck Cognitive Insight Scale, the World Health Disability Assessment Schedule, and the Personal and Social Performance Scale, applied to both groups at three different times. In the experimental group, the eight MCT modules will be applied over 4 weeks. Discussion It is expected that at the end of the programme, the experimental group will have reduced severity of psychotic symptoms and improved insight into the disease and functionality. Impact Schizophrenia is a severe mental disorder that, in most cases, leads to the deterioration of cognitive and social functioning as a result of psychotic symptoms. Metacognitive training for schizophrenia has been used in several countries, but its efficacy remains unclear. It is a type of programme that consists of changing the cognitive infrastructure of delusions

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