RESUMEN
Egas Moniz is credited with the discovery in 1927 of radioarteriography, for which he was, on three occasions, nominated for the Nobel Prize, and in all three denied the award. In 1949 he was awarded the Nobel Prize for Medicine for having designed leucotomy, a brain surgery to treat some forms of severe metal disorders. He was also an successful politician and accomplished statesman.
Asunto(s)
Angiografía/historia , Premio Nobel , Psicocirugía/historia , Historia del Siglo XIX , Historia del Siglo XX , PortugalRESUMEN
Egas Moniz is credited with the discovery in 1927 of radioarteriography, for which he was, on three occasions, nominated for the Nobel Prize, and in all three denied the award. In 1949 he was awarded the Nobel Prize for Medicine for having designed leucotomy, a brain surgery to treat some forms of severe metal disorders. He was also an successful politician and accomplished statesman.
Egas Moniz foi o inventor da radioarteriografia, em 1927. Devido a essa descoberta, seu nome foi, por três vezes, indicado para receber o Prêmio Nobel de Medicina e, nas três, não foi considerado merecedor do prêmio. Em 1949 finalmente ele recebeu o Nobel por ter concebido a leucotomia, um procedimento cirúrgico para “tratar certos transtornos mentais graves”. Ele foi, ainda, um homem político e um estadista de sucesso.
Asunto(s)
Historia del Siglo XIX , Historia del Siglo XX , Psicocirugía/historia , Angiografía/historia , Premio Nobel , PortugalRESUMEN
OBJECTIVE: The present study aimed at estimating the prevalence of lifetime sexual abuse among women and at investigating its association with alcohol consumption. METHOD: Population-based survey conducted through a representative and stratified cluster sample of metropolitan São Paulo. GENACIS questionnaire was used. Sample unit was the home, and all residents aged 18 years and over were interviewed. The outcome was lifetime sexual abuse. The univariate statistical analysis used the Rao-Scott test. Logistic regression was used for the multivariate analysis. RESULTS: The final sample totalized 1,216 women aged 18 years and over; the response rate was 75.0%. Most women were married (56.6%) and had less than 12 years of formal education (59.0%); 46.2% were aged between 25 and 44 years, and 44.4% had a low income. Of the respondents, 7.5% reported having suffered lifetime sexual abuse. Multiple logistic regression model showed an association between lifetime sexual abuse and being a heavy drinker (OR = 4.97) and being a former drinker (OR = 2.04). CONCLUSIONS: There are few population studies in Brazil investigating sexual abuse and its relation to alcohol use. Although the prevalence of lifetime sexual abuse in the present study was smaller than that observed in other studies, it is a highly expressive percentage on account of its social and economic impact, as well as its potential effect on the health system. .
Asunto(s)
Adolescente , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Adulto Joven , Consumo de Bebidas Alcohólicas/epidemiología , Delitos Sexuales/estadística & datos numéricos , Brasil , Estudios Transversales , Encuestas y Cuestionarios , Población UrbanaRESUMEN
OBJECTIVE: The present study aimed at estimating the prevalence of lifetime sexual abuse among women and at investigating its association with alcohol consumption. METHOD: Population-based survey conducted through a representative and stratified cluster sample of metropolitan São Paulo. GENACIS questionnaire was used. Sample unit was the home, and all residents aged 18 years and over were interviewed. The outcome was lifetime sexual abuse. The univariate statistical analysis used the Rao-Scott test. Logistic regression was used for the multivariate analysis. RESULTS: The final sample totalized 1,216 women aged 18 years and over; the response rate was 75.0%. Most women were married (56.6%) and had less than 12 years of formal education (59.0%); 46.2% were aged between 25 and 44 years, and 44.4% had a low income. Of the respondents, 7.5% reported having suffered lifetime sexual abuse. Multiple logistic regression model showed an association between lifetime sexual abuse and being a heavy drinker (OR = 4.97) and being a former drinker (OR = 2.04). CONCLUSIONS: There are few population studies in Brazil investigating sexual abuse and its relation to alcohol use. Although the prevalence of lifetime sexual abuse in the present study was smaller than that observed in other studies, it is a highly expressive percentage on account of its social and economic impact, as well as its potential effect on the health system.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Delitos Sexuales/estadística & datos numéricos , Adolescente , Adulto , Anciano , Brasil , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Encuestas y Cuestionarios , Población Urbana , Adulto JovenRESUMEN
OBJECTIVE: Guide the health professional to identify risk factors and forms of protection, together with handling such patient throughout a clinical interview within the emergency service context. METHOD: Selected literature revision so as to identify relevant and illustrative key cases. RESULTS: The clinical interview is the best method to evaluate the suicidal risk and has two different aims: 1) emotional support and creation of a bond; 2) collecting information. There is a substantial amount of information to be collected during the clinical interview, such as: risk factors and protection, epidemiologic data, act characterization, psychical dynamics aspects, personal and familial historic patterns, identification models, data on physical wealth and social net support. Difficulties are to emerge throughout the clinical interview, but a trained and informed professional will be able to approach and adequately add the patient. Although several scales have been proposed, none of them have been efficient to deter the suicidal risk. CONCLUSION: There is no method to predict who is to commit suicide, nevertheless, it is possible to evaluate the individual risk of each patient with regards to a detailed and empathic clinical interview. Prevent the patient to commit suicide is the preliminary and fundamental rule.
Asunto(s)
Servicios de Urgencia Psiquiátrica , Suicidio/psicología , Medicina de Emergencia , Femenino , Personal de Salud/psicología , Humanos , Masculino , Psiquiatría/normas , Medición de Riesgo , Factores Sexuales , Intento de Suicidio/psicología , Prevención del SuicidioRESUMEN
OBJETIVO: Auxiliar o profissional de saúde na identificação dos fatores de risco e de proteção, e no manejo de pacientes com risco de suicídio, por meio de entrevista clinica, no contexto de emergência médica. MÉTODO: Revisão seletiva da literatura para identificar achados clínicos relevantes e ilustrativos. RESULTADO: A entrevista clinica é o melhor método para avaliar o risco suicida e tem dois objetivos: 1) apoio emocional e de estabelecimento de vínculo; 2) coleta de informações. Existe um número considerável de informações a serem coletadas durante a entrevista: fatores de risco e proteção (predisponentes e precipitantes), dados epidemiológicos, caracterização do ato, aspectos psicodinâmicos, antecedentes pessoais e familiares, modelos de identificação, dados sobre saúde física e rede de apoio social. Dificuldades ao longo da entrevista serão encontradas, mas com conhecimento e treinamento adequado, o profissional poderá abordar e ajudar adequadamente o paciente. Embora várias escalas tenham sido propostas, nenhuma delas demonstrou eficiência para a detecção de risco de suicídio. CONCLUSÃO: Não há como prever quem cometerá suicídio, mas é possível avaliar o risco individual que cada paciente apresenta, tendo em vista a investigação detalhada e empática da entrevista clinica. Impedir que o paciente venha a se matar é regra preliminar e fundamental.
OBJECTIVE: Guide the health professional to identify risk factors and forms of protection, together with handling such patient throughout a clinical interview within the emergency service context. METHOD: Selected literature revision so as to identify relevant and illustrative key cases. RESULTS: The clinical interview is the best method to evaluate the suicidal risk and has two different aims: 1) emotional support and creation of a bond; 2) collecting information. There is a substantial amount of information to be collected during the clinical interview, such as: risk factors and protection, epidemiologic data, act characterization, psychical dynamics aspects, personal and familial historic patterns, identification models, data on physical wealth and social net support. Difficulties are to emerge throughout the clinical interview, but a trained and informed professional will be able to approach and adequately add the patient. Although several scales have been proposed, none of them have been efficient to deter the suicidal risk. CONCLUSION: There is no method to predict who is to commit suicide, nevertheless, it is possible to evaluate the individual risk of each patient with regards to a detailed and empathic clinical interview. Prevent the patient to commit suicide is the preliminary and fundamental rule.
Asunto(s)
Femenino , Humanos , Masculino , Servicios de Urgencia Psiquiátrica , Suicidio/psicología , Medicina de Emergencia , Personal de Salud/psicología , Psiquiatría/normas , Medición de Riesgo , Factores Sexuales , Intento de Suicidio/psicología , Suicidio/prevención & controlRESUMEN
BACKGROUND: Attempted suicide is a strong risk factor for subsequent suicidal behaviors. Innovative strategies to deal with people who have attempted suicide are needed, particularly in resource-poor settings. AIMS: To evaluate a brief educational intervention and periodic follow-up contacts (BIC) for suicide attempters in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, People's Republic of China) as part of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS). METHODS: Among the 1,867 suicide attempters enrolled in the emergency departments of the participating sites, 922 (49.4%) were randomly assigned to a brief intervention and contact (BIC) group and 945 (50.6%) to a treatment as usual (TAU) group. Repeated suicide attempts over the 18 months following the index attempt - the secondary outcome measure presented in this paper - were identified by follow-up calls or visits. Subsequent completed suicide - the primary outcome measure - has been reported in a previous paper. RESULTS: Overall, the proportion of subjects with repeated suicide attempts was similar in the BIC and TAU groups (7.6% vs. 7.5%, chi(2) = 0.013; p = .909), but there were differences in rates across the five sites. CONCLUSIONS: This study from five low- and middle-income countries does not confirm the effectiveness of brief educational intervention and follow-up contacts for suicide attempters in reducing subsequent repetition of suicide attempts up to 18 months after discharge from emergency departments.
Asunto(s)
Intento de Suicidio/estadística & datos numéricos , Adulto , Brasil/epidemiología , China/epidemiología , Países Desarrollados/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , India/epidemiología , Irán/epidemiología , Masculino , Escalas de Valoración Psiquiátrica , Psicoterapia , Prevención Secundaria , Sri Lanka/epidemiología , Intento de Suicidio/economía , Intento de Suicidio/prevención & control , Intento de Suicidio/psicología , Adulto JovenRESUMEN
This cross-cultural study investigates whether religiosity assessed in three dimensions has a protective effect against attempted suicide. Community controls (n = 5484) were more likely than suicide attempters (n = 2819) to report religious denomination in Estonia (OR = 0.5) and subjective religiosity in four countries: Brazil (OR = 0.2), Estonia (OR = 0.5), Islamic Republic of Iran (OR = 0.6), and Sri Lanka (OR = 0.4). In South Africa, the effect was exceptional both for religious denomination (OR = 5.9) and subjective religiosity (OR = 2.7). No effects were found in India and Vietnam. Organizational religiosity gave controversial results. In particular, subjective religiosity (considering him/herself as religious person) may serve as a protective factor against non-fatal suicidal behavior in some cultures.
Asunto(s)
Actitud Frente a la Salud/etnología , Características Culturales , Religión y Psicología , Autoimagen , Espiritualidad , Intento de Suicidio/etnología , Brasil/epidemiología , Comparación Transcultural , Estudios Transversales , Estonia/epidemiología , Humanos , Relaciones Interpersonales , Irán/epidemiología , Factores Socioeconómicos , Sri Lanka/epidemiología , Intento de Suicidio/psicologíaRESUMEN
OBJECTIVE: To determine whether brief intervention and contact is effective in reducing subsequent suicide mortality among suicide attempters in low and middle-income countries. METHODS: Suicide attempters (n = 1867) identified by medical staff in the emergency units of eight collaborating hospitals in five culturally different sites (Campinas, Brazil; Chennai, India; Colombo, Sri Lanka; Karaj, Islamic Republic of Iran; and Yuncheng, China) participated, from January 2002 to October 2005, in a randomized controlled trial to receive either treatment as usual, or treatment as usual plus brief intervention and contact (BIC), which included patient education and follow-up. Overall, 91% completed the study. The primary study outcome measurement was death from suicide at 18-month follow-up. FINDINGS: Significantly fewer deaths from suicide occurred in the BIC than in the treatment-as-usual group (0.2% versus 2.2%, respectively; chi2 = 13.83, P < 0.001). CONCLUSION: This low-cost brief intervention may be an important part of suicide prevention programmes for underresourced low- and middle-income countries.
Asunto(s)
Trastornos Mentales/terapia , Relaciones Profesional-Paciente , Intento de Suicidio/prevención & control , Adulto , Brasil , China , Femenino , Humanos , India , Irán , Masculino , Apoyo Social , Sri Lanka , Intento de Suicidio/psicología , Adulto JovenRESUMEN
A Organização Mundial da Saúde (OMS) e a Seção de Psiquiatria da Pessoa Idosa da Associação Mundial de Psiquiatria (AMP), em colaboração com um grupo interdisciplinar de representantes das principais associações internacionais e organizações não-governamentais implicadas na saúde mental das pessoas idosas, publicaram três declarações técnicas de consenso sobre a psiquiatria da pessoa idosa (1), a organização dos cuidados em psiquiatria da pessoa idosa (2) e o ensino da psiquiatria da pessoa idosa (3). O Dia Mundial da Saúde 2001, cujo tema foi "Não à exclusão, sim aos cuidados", deu origem a uma nova reunião de consenso sobre o tema da estigmatização e discriminação das pessoas idosas com transtornos mentais. Essa nova reunião foi realizada em Lausanne nos dias 8 e 9 de outubro de 2001 e produziu uma declaração técnica de consenso. O texto inicial foi publicado pela OMS e AMP em inglês. Este artigo apresenta a versão em português desse documento.
This technical consensus statement is jointly produced by the Old Age Psychiatry section of the World Psychiatric Association and the World Health Organization, with the collaboration of several NGOs and the participation of experts from different regions. It is intended to be a tool for (i) promoting debate at all levels on the stigmatization of older people with mental disorders; (ii) outlining the nature, causes and consequences of this stigmatization; and (iii) promoting and suggesting policies, programs and actions to combat this stigmatization.
Asunto(s)
Humanos , Anciano , Conferencias de Consenso como Asunto , Psiquiatría Geriátrica , Trastornos Mentales/psicología , Estereotipo , Anciano/psicología , Prejuicio , Salud Mental , Salud del AncianoRESUMEN
OBJECTIVE: The study aims to approach forensic psychiatry within different contexts. It endeavors to show how this specific psychiatry science area is influenced by legal and cultural aspects. METHOD: The bibliography reviewed had in view understanding the different ways of how to deal with law within the psychiatric sphere, from a cultural point of view. RESULTS: there is a great heterogeneity, of different nature (legal, political, cultural, and religious) that enrich, but at the same time makes difficult, a debate about this issue. CONCLUSIONS: there are two great obstacles to achieve a good knowledge about the practice of forensic psychiatry all over the world. The first one is represented by a heterogeneity that makes difficult its description in a comprehensible way. The second is the lack of knowledge of the cultural diverse realities. These difficulties should be a stimulus for newer studies of this characteristic. Only in this way it becomes possible to gradually increase the comprehension of this issue.
Asunto(s)
Diversidad Cultural , Psiquiatría Forense/organización & administración , Salud Global , Servicios de Salud Mental/organización & administración , Salud Mental , África , Américas , Brasil , Europa (Continente) , Psiquiatría Forense/legislación & jurisprudencia , Reforma de la Atención de Salud , Humanos , Cooperación Internacional , Servicios de Salud Mental/legislación & jurisprudencia , OceaníaRESUMEN
OBJETIVO: Este estudo visa a uma abordagem da psiquiatria forense dentro de diferentes contextos, no sentido de mostrar como essa ciência é influenciada por aspectos legais e culturais. MÉTODO: Foi feita uma revisão bibliográfica com o objetivo de apreender formas culturalmente diferentes de se lidar com a lei dentro do campo médico-psiquiátrico. RESULTADOS: Existe uma enorme gama de fatores, de diversas naturezas (legal, política, cultural, religiosa), que enriquece e, simultaneamente, dificulta um debate sobre o tema. CONCLUSÕES: Existem dois grandes obstáculos para se adquirir um conhecimento sobre a prática, em todo o mundo, da psiquiatria forense. O primeiro diz respeito a uma heterogeneidade que dificulta sua descrição de forma clara, e o segundo se refere ao próprio desconhecimento de realidades culturalmente muito diferentes. Por outro lado, essas mesmas dificuldades devem representar um estímulo para novos estudos dessa natureza, objetivando a alcançar, pouco a pouco, uma maior compreensão da matéria
OBJECTIVE: The study aims to approach forensic psychiatry within different contexts. It endeavors to show how this specific psychiatry science area is influenced by legal and cultural aspects.METHOD: The bibliography reviewed had in view understanding the different ways of how to deal with law within the psychiatric sphere, from a cultural point of view. RESULTS: there is a great heterogeneity, of different nature (legal, political, cultural, and religious) that enrich, but at the same time makes difficult, a debate about this issue.CONCLUSIONS: there are two great obstacles to achieve a good knowledge about the practice of forensic psychiatry all over the world. The first one is represented by a heterogeneity that makes difficult its description in a comprehensible way. The second is the lack of knowledge of the cultural diverse realities. These difficulties should be a stimulus for newer studies of this characteristic. Only in this way it becomes possible to gradually increase the comprehension of this issue
Asunto(s)
Humanos , Diversidad Cultural , Psiquiatría Forense/organización & administración , Salud Mental , Servicios de Salud Mental/organización & administración , Salud Global , África , Américas , Brasil , Europa (Continente) , Psiquiatría Forense/legislación & jurisprudencia , Reforma de la Atención de Salud , Cooperación Internacional , Servicios de Salud Mental/legislación & jurisprudencia , OceaníaRESUMEN
Brazil is the largest and most populous country in South America (in 2002 the population was approximately 175 million). Although life expectancy in Brazil has increased, suicide and other forms of injury-related mortality, such as homicide and accident, have increased as a proportion of overall mortality (Oswaldo Cruz Foundation, 1984; Brazil Ministry of Health, 2001). The suicide rate in Brazil (3.0-4.0 per 100 000 inhabitants) is not considered high in global terms (World Health Organization, 1999). Nevertheless, it has followed the world tendency towards growth: during 1980-2000, the suicide rate in Brazil increased by 21%. Elderly people present the highest suicide rates in absolute numbers, but the alarming finding in the Brazilian data is that the youth population is increasingly dying by suicide (Mello-Santos et al, 2005). This statistic partially confirms a forecast by Diekstra & Guilbinat (1993) that the number of deaths by suicide would dramatically increase over the next decades, mainly in developing countries, including Latin America. In these regions, socio-economic factors (such as an increase in divorce and unemployment and a decrease in religiosity) increase the risk of self-harm. We discuss the reasons for the low suicide rate in Brazil and highlight the socio-economic factors affecting its increase among the youth population in particular.
RESUMEN
BACKGROUND: The objectives were to assess thoughts about suicide, plans to commit suicide and suicide attempts in the community, to investigate the use of health services following a suicide attempt, and to describe basic socio-cultural indices of the community. METHOD: The community survey was one component of the larger WHO multisite intervention study on suicidal behaviours (SUPRE-MISS). In each site, it aimed at randomly selecting and interviewing at least 500 subjects of the general population living in the catchment area of the emergency department where the intervention component of the study was conducted. Communities of eight SUPRE-MISS sites (in Brazil, China, Estonia, India, Iran, South Africa, Sri Lanka, and Viet Nam) participated plus two additional sites from Australia and Sweden conducting similar surveys. RESULTS: Suicide attempts (0.4-4.2%), plans (1.1-15.6%), and ideation (2.6-25.4%) varied by a factor of 10-14 across sites, but remained mostly within the ranges of previously published data. Depending on the site, the ratios between attempts, plans, and thoughts of suicide differed substantially. Medical attention following a suicide attempt varied between 22% and 88% of the attempts. CONCLUSIONS: The idea of the suicidal process as a continuous and smooth evolution from thoughts to plans and attempts of suicide needs to be further investigated as it seems to be dependent on the cultural setting. There are indications, that the burden of undetected attempted suicide is high in different cultures; an improved response from the health sector on how to identify and support these individuals is needed.
Asunto(s)
Intento de Suicidio/etnología , Encuestas y Cuestionarios , Pensamiento , Adulto , Australia/epidemiología , Brasil/epidemiología , China/epidemiología , Comparación Transcultural , Estonia/epidemiología , Femenino , Humanos , India/epidemiología , Irán/epidemiología , Masculino , Sudáfrica/epidemiología , Sri Lanka/epidemiología , Intento de Suicidio/estadística & datos numéricos , Suecia/epidemiología , Vietnam/epidemiologíaRESUMEN
BACKGROUND: The objective was to describe patients presenting themselves at emergency-care settings following a suicide attempt in eight culturally different sites [Campinas (Brazil), Chennai (India), Colombo (Sri Lanka), Durban (South Africa), Hanoi (Viet Nam), Karaj (Iran), Tallinn (Estonia), and Yuncheng, (China)]. METHOD: Subjects seen for suicide attempts, as identified by the medical staff in the emergency units of 18 collaborating hospitals were asked to participate in a 45-minute structured interview administered by trained health personnel after the patient was medically stable. RESULTS: Self-poisoning was the main method of attempting suicide in all eight sites. Self-poisoning by pesticides played a particularly important role in Yuncheng (71.6% females, 61.5% males), in Colombo (43.2% males, 19.6% females), and in Chennai (33.8% males, 23.8% females). The suicide attempt resulted in danger to life in the majority of patients in Yuncheng and in Chennai (over 65%). In four of the eight sites less than one-third of subjects received any type of referral for follow-up evaluation or care. CONCLUSIONS: Action for the prevention of suicide attempts can be started immediately in the sites investigated by addressing the one most important method of attempted suicide, namely self-poisoning. Regulations for the access to drugs, medicaments, pesticides, and other toxic substances need to be improved and revised regulations must be implemented by integrating the efforts of different sectors, such as health, agriculture, education, and justice. The care of patients who attempt suicide needs to include routine psychiatric and psychosocial assessment and systematic referral to professional services after discharge.
Asunto(s)
Servicios de Urgencia Psiquiátrica , Hospitales Generales , Renta , Intento de Suicidio , Adulto , Brasil/epidemiología , China/epidemiología , Cultura , Estonia/epidemiología , Femenino , Humanos , India/epidemiología , Irán/epidemiología , Masculino , Intoxicación/epidemiología , Factores Socioeconómicos , Sudáfrica/epidemiología , Sri Lanka/epidemiología , Intento de Suicidio/etnología , Intento de Suicidio/prevención & control , Intento de Suicidio/psicología , Encuestas y Cuestionarios , Vietnam/epidemiologíaRESUMEN
OBJECTIVE: To describe the suicide rates in Brazil in recent decades, drawing comparisons with the worldwide epidemiological situation. METHODS: Descriptive analyses of Brazilian suicide data, relating to the 1980-2000 period and extracted from the DATASUS database. Brazilian suicide trends were examined by age and gender. RESULTS: The overall rate of suicide in Brazil increased 21% in 20 years. Men were found to be 2.3 to 4.0 times more likely to commit suicide than were women, and the highest suicide rates were found in the over-65 age group. The greatest increase in suicide rates (1900%) was seen in the 15-24 age range. CONCLUSION: Brazilian suicide rates, although low, are consistent with the global trend toward growth. Although the highest rates are still seen among the elderly, members of the younger population have been killing themselves with ever-increasing frequency.
Asunto(s)
Suicidio/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Factores de TiempoRESUMEN
OBJETIVOS: Descrever as taxas de suicídio do Brasil nas últimas décadas, bem como compará-las com a situação epidemiológica mundial. MÉTODOS: Análise descritiva dos dados brasileiros sobre o suicídio, extraídos a partir do banco de dados de DATASUS, cobrindo o período de 1980-2000. Foram examinadas as tendências de suicídio no Brasil quanto à distribuição etária e gênero. RESULTADOS: A taxa global de suicídio no Brasil cresceu 21% em 20 anos. Os homens se suicidaram de 2,3 a 4 vezes mais que as mulheres e os idosos acima de 65 anos apresentaram as maiores taxas de suicídio. O estrato de jovens entre 15 a 24 anos foi o grupo de maior crescimento (1.900%). CONCLUSAO: A taxa de suicídio no Brasil, embora baixa, segue a tendência mundial de crescimento. Os idosos apresentam as taxas mais altas, mas, em números absolutos, a população jovem está se matando cada vez mais.