Em defesa da reforma psiquiátrica :por um amanhã que há de renascer sem pedir licença

Insanity was victim of several arbitrary acts perpetrated on behalf of the science. Psychiatric reform constitues an important movement which has attempted to rescue dignity and humanity in the treatment of mental disorder patients. Some countries have advanced in the implement of substutive models that work on the construction of a new social place for madness. The model of attention to mental health in Brazil has also suffered extensive modifications due to the wearing out of the psychiatric hospital model. In Santos, a town in the State of Sao Paulo, we have found a landmark in the development of an anti internment politics, through the creation of a dail care service, including psychosocial assistance. It is in this context that it has been founded in Natal, Rio Grande do Norte, the NAPS and CAPS ( Nucleus and Centres of Psychosocial Attention), municipal strategies that put into effect the law # 10.216/2001, which estabilishes the gradual extinction of psychiatric hospitals. This work has the purpose of carrying out a study about the historical process of psychiatric reform implantation in the State of Rio Grande do Norte, emphasizing the actors involved in process, their trajectory, achievements, improvements, and the movement s perspectives of achieving the ideal of reinstating mental disorder patients. In order to accomplish this purpose, it was necessary to understand the process occurred at the Municipal Secretary s Office for Health, since 1992, for it was the impelling experience towards the reflections about the psychiatric reform in the State of Rio Grande do Norte. The instruments used for this work were documentary analysis, through reports, legislation and handbooks, as well as the staments of people involved in this process. Through the statements analysis, we attempted to estabilish the social actors identity, their perception, emphasizing congruences and incongruences concerning the history of psychiatric reform in the State of Rio Grande do Norte. It is also analyzed the contribution of Psychology in this process, which has become a protagonist in the struggle for the rights of mental disorder patients

Saúde mental na estratégia saúde da família: notas cartográficas sobre processos de trabalho em saúde

This study aims to map the working process in the health area starting from the meeting between the family and health teams and mental trouble carriers./MTC. The area of research was the Family Health Unit of Ozeas Sampaio, which is located in the county of Teresina-PI. As regard to the methodology procedure, we used a semi-structured interview timetable, aimed to detail the care practices, admittance and diagnostics that those teams realize with their users. Three teams of eleven workers each were interviewed. There was a doctor, a nurse and two health community agents in each team. The other tools we used were a camp logbook, in which we wrote down some informal dialogs, daily observations and feelings of the unit, and also the accompaniment of the staffs in house calls as well as the weekly meetings in the unit. Those meetings allowed us the construction of two analytic axes: 1) description of the establishment (Family Health Unit) of the organization, (municipal foundation of health and the service network), and the institutions and practice of health. 2) Analysis of the meetings between the worker and the user of Mental Trouble Carriers. In the first axis, we verified the repetition of the working logic focused on jobs in the hospital with the maintenance of the hierarchical relations between worker and the work processes which dissociate management and watchfulness in health care. We identified the lack of physical structure, the lack of self-confidence of the worker in the attention of the mental health care. At the second axis, we assess that the meetings, at the Family Health Unit (FHU) or at the dwelling of the users cause nuisance, discomfort and anxiety to the workers because they deal with issues that go beyond what is named as being the health order such as life stories, family conflicts, unemployment, hunger, sexual and psychological violence. As a matter of fact, they involve difficulties for having new relationships, reception and responsibility for this request

Tradução e adaptação da escala de dependência de substâncias do Millon Clinical Multiaxial III para o Brasil

Millon describes the normal personality by means of adaptation styles that are effective in normal environments and personality disorders such as unadapted operating styles. To operacionalize his theoretical model, Millon has built several instruments, including the Millon Clinical Multiaxial Inventory III (MCMI-III), wich consists of a self report inventory composed by 175 true or false response items, containing four verification scales, and others scales wich evaluates 14 personality patterns and 10 clinical syndromes. The Substance Dependence scale (T) is placed along with Clinical Syndromes scales. This research is justified by the lack of a Brazilian instrument to assess personality psychopathological aspects, and aims to translate and semantically adapt the MCMI-III to the Brazilian context, checking validity elements of the Substance Dependence scale, and developing a computer application for assisting the evaluation of assessment results. To this intent, 2.588 individuals data was collected, male and female, aged between 18 and 85 years, characterized as belonging to a clinical or non-clinical group, who took part in the survey via the internet or in person. Respondents completed the MCMI-III, a socio-demographic questionnaire and a subgroup also answered to the Goldberg General Health Questionnaire (GHQ). Besides descriptive statistics, we performed the analysis using the Student t test, principal components analysis and internal consistency. Despite difficulties related to translating very specific English terms, the assessment by judges, experts on Millon´s theory, and the back translation, attested the adequacy of the Brazilian version. Factorial analysis indicated the grouping of translated T scale items into three factors (social activities prejudice, lack of impulse control, and oppositional behavior), by presenting a single item on a fourth factor (apparently related to seeking pleasurable stimuli). The Cronbach alpha for this set of items was 0,82, indicating an acceptable scale reliability. The data analysis resulted in distinction of scores between clinical and non-clinical groups and between men and women; the relationship between high scores on the scale T and the other scales; scores of drug users according to the declared used substance; and the relationship between high scores on T and the verification of disorder or risk on GHQ mental health factor, indicating the instrument´s adequate sensistivity in identifying psychopathologies and the relationship between the different disorders or psychopathological personality patterns. Although further studies are necessary to develop the scores transformation factors, the computerized correction tool was adequate.

Estudos de validade da escala de dependência alcoólica do millon clinical multiaxial inventory iii para o Brasil

This study has as main objectives to translate and to adapt the MCMI-III to brazilian Portuguese, as well as investigate and analyze the involved modifications in the Alcohol Dependence Scale concerning to the results obtained on the validity and on the process of adaptation to Brazil. The inventory was translated and, posteriorly, applied on people with different reading levels to certify that the items are understandable to public in general, from diverse places of the country, divided into clinical and non-clinical groups. Were evaluated 2855 subjects between the ages of 18 and 85 years old, male and female, resident and dwellers of Brazilian cities. The application methods were face-to-face and computerized. Results showed that the clinical group presented significant differences between the means in comparison to the non-clinical group. Through the application of the General Health Questionnaire were developed studies related to the achievement of convergent validity and its results pointed to the relation between the instrument scores and the MCMI-III. The Alcohol Dependence Scale analysis indicated that people who reported abusive use of alcohol had highest scores, indicating adequacy of the instrument on identifying manifestation of disorders and syndromes. Nevertheless, further studies are necessary to the establishment of normative patterns to the Brazilian sample

Caracterização de aspectos da cognição social, habilidades sociais e funções executivas de crianças diagnosticadas com transtorno autista e transtorno de asperger

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Gênero, trabalho e saúde mental entre trabalhadoras rurais assentadas na região do Mato Grande Potiguar

The lack of studies aimed at the mental health of the rural population, the social, economic, familial and emotional impact that mental disorders produce and the vulnerability that women have in this context, lead us to believe in the need to investigate the mental health demands of female rural workers, in order to subsidize the development of more effective and culturally sensitive public health programs and policies that take into account the specificities of this population. The present study aims to investigate the prevalence of common mental disorders (CMD) and the possible factors associated with the emergence of such disorders among women living in a rural settlement in Rio Grande do Norte. This survey has a quantitative and qualitative character with an ethnographic approach. As methodological strategies, we made use of an adapted version of the socio-demographic and environmental questionnaire prepared by The Department of Geology/UFRN s Strategic Analysis Laboratory to evaluate the quality of life of the families from the rural settlement and the mental health screening test Self-Reporting Questionnaire (SRQ-20) to identify the prevalence of CMD in adult women from the community. Complementing the role of methodological tools, we use the participant observation and semi-structured interviews with women who presented positive hypothesis of CMD attempting to comprehend the crossings that build the subjective experience of being a woman in this context. The results point to the high prevalence of CMD (43.6%) and suggest the link between poverty, lack of social support, unequal gender relations and the occurrence of CMD. We also verified that the settled women do not access the health network to address issues relating to mental health and that the only recourse of care offered by primary health care is the prescription of anxiolytic medication. In this context, the religiosity and the work are the most important strategies for mental health support among women

Adolescentes preocupadas em conquistar um corpo magro: Um estudo sobre discursos produzidos em diários eletrônicos

The concern about a good physical condition is heavily present nowadays, in documentary films about health and in the media, and it is also expressed through the outstanding growth of physical academies, beauty institutes and aesthetic medicine and all kind of aesthetic surgeries. In the western world the body wave is a significant trend, characterized by the great investments in body image. However, what is overlooked is the fact that in parallel trend grows the number of teenagers, especially females, with all kind of problems related to their body image. As adolescence is a moment of transformations, teenagers tend to be more aware of their body image and often neglect food ingestion and try to build their bodies following the images they have from top models and movie stars. The low self-esteem accompanying this sort of experience is an additional problem. Therefore the research aim to analyze discourses regarding the body image produced in world wide web diaries (blogs). The blogs selection was made through the site www.blogs.com.br, which is considered the widest guide of electronic diaries in Brazil. We looked after blogs including the keyword body and from adolescents aged 10 to 19, who showed concern about a slim body. Three blogs were chosen, considering the example criteria. Discourse analysis shows that these teenagers feel unsatisfied with their bodies, searching by all means the thinness presented as a aesthetic paradigm in western societies which often implies neglecting their own health, using appetite inhibitor drugs, restricting or totally abstaining food ingestion for long periods of time, or provoking themselves vomits after ingesting food. These behaviors, together with intense fear of gaining weight, can be characterized as alimentary disorders, related to the body image. As they usually hide this sort of behaviors from family and friends who do not share this concern, the blogs seem to be an easy tool for adolescents to find peers with whom to share common values and ideas and reaffirm their identities and virtual sense of community

Impacto do trabalho em profissionais de Saúde Mental de serviços de saúde do município de Mossoró-RN, 2012

The Psychiatric Reform has brought profound changes in assistance to people affected by mental disorders and behavior. In this context, mental health workers have played decisive roles of great impact, acting driving the process. Objective: To evaluate the impact felt by working professionals, because of the daily work with people who have psychiatric disorders. Methodology: This is a search field, a quantitative approach, sectional, descriptive and applied. Data collection occurred through the Assessment Scale Impact of Working in Mental Health Services (IMPACT-BR) applied to mental health researchers city Mossoró - RN. Results: Participants in this study 87 professionals, mostly female married, which took charge of higher education, working on a single service, working in the area for more than six years, aged between 25 and 64 years. There were a low effect of overloading the professionals surveyed. Discussion: Our results corroborate findings in other surveys conducted previously, not identifying large impact load at work among professionals of mental health teams studied. Subscales studied the highest score was observed in measuring the impact of work on team functioning. It was observed that the greater age and duration of action, reduced the emotional impact at work, suggesting that the experience enhances safety in decisions made and the possibility of greater control over the demands of work. Final Thoughts: The work presented showed that the interactive relationships between professionals and users are not the causes of greatest impact in the workplace, although it revealed overload in relation to specific aspects such as: fear of being assaulted by a patient and the feeling of physical exhaustion the end of the workday. Further investigations should be conducted on this topic in order to contribute to the implementation of psychiatric reform proposed by advances both in terms of assistance to individuals and the quality of life in the work of the professionals involved

Prevalência da disfunção temporomandibular em estudantes de odontologia por meio de diferentes índices

The epidemiology of temporomandibular disorders varies widely in the literature. The aim of this study was to determine the prevalence of TMD in dental students of the Federal University of Rio Grande do Norte assessed by different indexes. The sample consisted of 101 individuals selected by a randomized process, whose general outline was systematic sampling. For evaluation of the signs and symptoms of TMD, an anamnestic index, Fonseca s protocol, and two clinical indexes, the RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders), or standard index, and the Helkimo s Clinical Dysfunction Index were applied. Data were analyzed using the chi-square test and kappa, besides verifying the sensitivity and specificity (5% significance). The diagnosis of TMD by different indexes showed a variation in the prevalence between 72.3% (Helkimo s Clinical index), 64.4% (Fonseca s anamnestic index) and 35.6% (RDC/TMD). There was no statistical difference between the sexes for the RDC/TMD, although this difference was found for Fonseca s and Helkimo s indexes (p<0.05). The most frequent type of TMD were joint disorders (Groups II and III), and the subtypes disc displacement with reduction (17.8%) and arthralgia (15.8%). Most individuals showed a mild TMD (45.5%) for both indexes, Fonseca and Helkimo. When comparing the types of diagnoses, RDC/TMD with Fonseca and Helkimo, low agreement was found (k=0.17 and k= 0.35, respectively). A moderate correlation between the severity of TMD was obtained (kw= 0.53) for Fonseca s protocol and Helkimo s index. High sensitivity and low specificity were seen for both diagnoses compared to standard, resulting in excessive false positives. Within the limitations of the study, it was concluded that the prevalence of TMD can vary widely, depending on the index used for its diagnosis

Superando a aridez do semi-árido: encontros entre saúde mental e saúde da família na formação de médicos no alto sertão paraibano

A atenção primária à saúde é um importante cenário para o cuidado em saúde mental por suas características e pelo trabalho no território contribuir para a superação do modelo manicomial de atenção. Esta pesquisa partiu do questionamento sobre como acontece a atenção em saúde mental na atenção básica nas unidades em que se desenvolve a Residência de Medicina de Família e Comunidade em um município do sertão paraibano. Objetivou investigar as demandas de saúde mental e práticas de cuidado no contexto de ESF e da RMFC do município de Cajazeiras a partir do discurso dos profissionais ali inseridos e discutir estratégias de qualificação do cuidado em saúde mental nessa realidade. Utilizou-se abordagem qualitativa em que foram realizados grupos focais envolvendo profissionais de duas equipes da ESF e uma equipe de NASF. Os dados produzidos nos grupos foram analisados a partir do referencial da análise do discurso de inspiração foucaultiana. Como resultados evidenciou-se que os profissionais percebem a demanda em saúde mental na atenção básica principalmente na forma de sofrimento psíquico inespecífico e transtornos mentais graves. A atenção a essas pessoas não consegue superar a medicalização que é identificada por esses profissionais. A prática asilar persiste como alternativa para os casos de transtornos mentais graves, sendo limitada a incorporação do paradigma da desinstitucionalização como referencial para a prática profissional. Além disso, a relação com a rede de saúde encontra vários limites destacando-se a dificuldade de produção de continuidade e integralidade do cuidado. A partir disto, analisa-se a formação médica e sua capacidade de garantir o cuidado integral na atenção às demandas de saúde mental. No campo da pesquisa, dois modelos de formação se encontram. Os residentes participantes ou graduaram-se em Cuba ou em escola médica brasileira orientada pelas Diretrizes Curriculares Nacionais. Percebe-se então que a graduação, ao incorporar questões relativas à integralidade do cuidado, não é suficiente para gerar bons profissionais para o SUS. Considera-se necessário somar às mudanças na graduação a perspectiva da Educação Permanente em Saúde no mundo do trabalho, o envolvimento dos profissionais com a transformação das práticas de atenção à saúde e a construção da perspectiva da integralidade e da atenção psicossocial por dentro da Residência de Medicina de Família e Comunidade como importantes estratégias para a formação de médicos generalistas aptos para a atenção às demandas de saúde mental

Conhecimento sobre ergonomia no âmbito acadêmico: um estudo com alunos e professores de odontologia

OBJETIVO: As doenças osteomusculares são as afecções ocupacionais mais prevalentes em cirurgiões-dentistas. Nosso propósito: 1) investigar os conhecimentos, aplicabilidades clínicas dos princípios ergonômicos em discentes e docentes em atividades clínicas de uma universidade pública 2) pesquisar a incidência de sintomatologias dolorosas no pescoço, ombros, parte superior e inferior das costas, cotovelos, quadris, coxas, joelhos, tornozelos e pés no universo de alunos em estágios clínicos. 3) incitar discussões de normas e diretrizes ergonômicas na universidade. MÉTODOS: Esse estudo investigou o universo de alunos matriculados em disciplinas clínicas (148) e respectivos professores (30) do curso de odontologia da Universidade Federal do Rio Grande do Norte, Natal-RN a respeito dos princípios ergonômicos utilizados na rotina clínica. Paralelamente foi pesquisada a incidência de sintomatologia dolorosa nos alunos por intermédio do questionário nórdico e a partir dos resultados foi mensurado o índice de severidade dos sintomas em alunos. The Nordic Musculoskeletal Questionnaire (NMQ) é um instrumento de diagnóstico, proposto para padronizar a mensuração de relatos de sintomas osteomusculares. A análise dos dados foi através do programa SPSS-Statistical Package for the Social Sciences, versão 17.0 realizada analítica e descritivamente, com determinação das médias (x), desvio-padrão para variáveis quantitativas, freqüências simples e relativas para as variáveis categóricas, além da estatística de associação entre grupos (teste t) e a análise de associação do quiquadrado com nível de significância 5% entre as variáveis (Person). As respostas das questões abertas foram codificadas e transformadas em freqüências, descritas posteriormente. RESULTADOS: A aplicabilidade de medidas ergonômicas nas clínicas universitárias não foi evidenciada pelo universo de discentes e docentes. Quanto ao relato de sintomas osteomusculares o sexo feminino foi o mais acometido qualquer que seja o nível acadêmico cursado. As regiões anatômicas de maior grau de severidade de relatos dos sintomas foram: pescoço, parte inferior das costas, punhos, mãos e ombros, com significância etatística p<0,001. CONCLUSÃO: Em função dos achados os autores apresentam um protocolo de intervenção clínica baseado nos determinantes ergonômicos da Associação internacional de ergonomia (EAI) como medida de prevenção da saúde ocupacional dos futuros cirurgiões-dentistas ainda em processo de formação nas clínicas odontológicas das universidades.

Processos de construção do sentido por portadores da Síndrome de Asperger

Para la lingüística Cognitiva, la construcción del sentido darse a través del accionamiento de procesos mentales específicos que están directamente ligados a las experiencias socioculturales, sensorio motores y perceptuales. En portadores de la Síndrome de Asperger, el comprometimiento de estos procesos, debido a características específicas dela propia síndrome, puede estar directamente relacionado a problemas de construcción de sentido por estos individuos. En este sentido, el objetivo de esta investigación es investigar los procesos cognitivos que direccionan la construcción del sentido en estos portadores de trastornos neurales. La investigación es realizada con alumnos de la APPARN (Associação de país e amigos dos autistas do Rio Grande do Norte), teniendo como grupo de control alumnos neurotípicos de otras instituciones, siendo los portadores de la síndrome practicantes de la lengua materna o grupo experimental de la búsqueda. Para elucidar el proceso de construcción del sentido por estos alumno, fueron desarrollados testes contiendo rasgos linguisticos norteadores responsables por el accionamiento de algunos procesos cognitivos como los esquemas (JOHNSON, 1987), frames (MINSKY, 1974), affordances (GIBSON, 1979) y simulación mental (BARSALOU, 1999). Los testes fueron basados en los presupuestos teóricos de la Lingüística Cognitiva, más precisamente, de la Teoria Neural del Linguaje. Los resultados apuntan para una posible justificativa para el comprometimiento de la construcción del sentido en portadores de la Síndrome de Asperger, que comprende directamente la relevancia intersubjetiva de la infersencias recibidas y construidas socialmente por los participantes específicamente de este análisis.

Um estudo e análise do teste de emissões otoacústicas realizadas através de uma plataforma móvel

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES

Reservatório Tabatinga (Macaíba-RN): qualidade ambiental, conflitos e uso

The reservoirs are water sources built along the fluvial basins, between rivers and dams made by concrete or earth. In Brazil they are built for different purposes, standing out the generation of energy (hydroelectric power station), flowing regulation, water reserves and flooding control, therefore they have played and still play an important role in the modern society.In the Northeastern semiarid region, they are typically used to supply cities and as a source of food.In the state of Rio Grande do Norte, the large reservoirs are intended for the same purpose.The cities settled in the riverbanks, or which have river channels crossing them, face flooding related problems. In the city of Macaíba-RN, flooding occurred systematically during the rainy season, causing great inconvenience to the local population.As product of the collective claim Tabatinga Reservoir in Jundiaí river was built, upstream of the city. Facing this background, this thesis aimed to assess the sócio-environmental quality of this reservoir.To achieve this goal, methodologies pointed to assess water quality along with the aplication of a questionnaire were used aimed to verify the quality of water and to know the perception of the residents from urban and rural área settled near to the reservoir was performed. The results showed the existence of conflicts of residents of rural communities and the presence of the reservoir, while for the city's population, the reservoir is considered not only the right solution to solve flooding in urban areas, but also as economic source for the rural population. Considering the water source assessment, this study concluded that the Tabatinga Reservoir is unfit for human use, due to the presence of metals of toxicological significance with the potential to elicit damage to the genetic material of individuals that use water from this reservoir, leading to cause serious risks to health population.

Características psicológicas do paciente obeso grave e suas implicações pós-operatórias na cirurgia bariátrica

Obesity is a chronic disease that has multi-factorial aetiology, characterized by high degree of body fat; the degree of obesity will vary according to the Body Mass Index (BMI=m2 /kg). The severe degree of obesity is characterized by BMI>40 and it is regularly associated to endocrine-metabolic or mechanic clinical alterations, and to psychological disorders. Binge Eating (BE) results were overly high for this population. The Bariatric Surgery has been the treatment chosen by those diagnosed with severe obesity as this intervention provides prompt outcomes for loss of weight and clinical improvement conditions. However, recent research has acquiesced that after two years between 20% and 30% of people subject to this intervention gained weight. The main objective of this research is to assess the psychological and behavioral characteristics of those diagnosed with severe obesity that have been subject to Gastric Bypass Surgery in the past 24 months. Specific aspects were investigated: (1) characteristics of different personalities and diagnose of clinic and personality disorders; (2) BE and its relation with loss of weight; (2) the difference between the groups regarding post-surgery care, e.g. physical activity, psychological and dietician input. Method: 40 adults (women and men) aged 23 and 60 year-old who went through a bariatric surgery in the past 24 months, in the city of Natal-RN (Brazil); they were assembled in two groups n=20, Gain group displaying loss of < 50% of their initial surplus of weight, and the Loss group displaying loss of >50%. The research protocol is made of a socio-demographic questionnaire and 3 psychometric instruments: Rorschach – Comprehensive System; Millon Personality Inventory (MCMI-III); and the Binge Eating Scale (Escala de Compulsão Alimentar Periódica (ECAP). Through Rorschach significant differences between these groups were verified according to the kind of personality (EB) - more EB Extratensivo in Gain group and Intratensivo in Loss group – and the lack of control to express affect, increasing the answer for Color Pure at Group I. Concerning the people standardization, the sample as a whole tends to show psychic pain, denigrated selfperception, high levels of self-criticism, distorted perceptions, vulnerability to develop mood disorders and high scores regarding Suicide. MCMI-III results showed more clinic and personality disorders in Group I: Depressive Disorder and Schizotypal, Anxiety, Dysthymia, Major Depressive Disorder; Thought Disorder, Bipolar- Manic and Posttraumatic Stress Disorder. In relation to ECAP, the results indicated significant differences, showing increased BE results in Gain group. There were found significant differences between BE severity and the presence of clinic and personality disorders. Concerning the post-surgery care, the observed differences are statistically significant regarding physical activities with median-increased differences in Loss group. There is a difference between the initial weight and the time post-surgery, indicating that the higher the initial weight and the time after the surgery the higher the re-gain of weight post-surgery. Finally, the results show that the participants with more than 3 years of surgery will have Clinic and Major Depressive Disorders; Somatoform Disorder; Dysthymia. These results confirm prior studies related to BE post-surgery and re-gain of weight as well as the proneness of clinic disorders in severe obesity people. That means the results reinforce that the surgery process is a facet of the severe obesity treatment. The post-surgery process needs to be the main focus of attention and have a long-term input to sustain the care of the surgery results and the quality of life of the patients.