Psychosocial Rehabilitation Process Research Articles

Qualified Listening to Relatives of Users at a Psychosocial Care Center

Introduction. The Psychiatric Reform introduced a new people-centered care model to replace psychiatric hospitals: the Psychosocial Care Center. Qualified listening can be used to achieve the integrality and humanization of the health care provided. It allows for the appreciation of content, the respect of its uniqueness, empathy, and the promotion of a space in which freedom of expression is provided. Objective. To identify the understanding of qualified listening from the perspective of the relative of a person with a mental disorder at a Psychosocial Care Center. Method. Qualitative, descriptive, exploratory study. Ten relatives over the age of 18 participated, contributing to the production of information. Data was obtained through the triangulation method, through semi-structured individual and collective interviews, observation, and field diary records. Results. For relatives, qualified listening translates into clarifying the illness, understanding the family’s painful situation and providing help and support during the psychosocial rehabilitation process. Discussion and conclusion. Listening constitutes a means of consolidating care networks, through the strengthening of bonds and co-responsibility, in a centered and expanded family-user logic model.

Aplicarea unui program de terapii cognitive a depresiei persoanelor cu accident vascular cerebral

This article describes the effectiveness of the application of a program of cognitive therapies for the depression of people with stroke, from the moment of initial contact with the psychologist during the acute period, as well as at the following stages of rehabilitation, for the formation of affective-behavioral regulation skills. The intervention through this program contributed to the optimization of the psychosocial rehabilitation process, by capitalizing on some principles, directions, methods, techniques of an integrated approach to post-stroke people from different well-organized psychological orientations and beneficial development for this group of people.

Efetividade de intervenções voltadas à participação social em pessoas com esquizofrenia: revisão sistemática

Abstract Introduction From Occupational Therapy, social participation is considered one of the areas of vital importance in the lives of people with schizophrenia. Therefore, when there is a limitation in participation in this occupational area, it is necessary to generate intervention strategies that favor and enable access to them. Objectives Know the effectiveness of different interventions in the occupational area "social participation" in users with schizophrenia. Method A bibliographic search was carried out in three databases in the health and social field: Pubmed, Scopus and Web of Science. The inclusion criteria for the selection of articles were: People between 18 and 65 years old with a diagnosis of schizophrenia, published in the last 10 years in English, Spanish and Portuguese, excluding opinion articles and articles with less than 10 participants in the intervention. A total of 13 studies were selected. All papers were evaluated according to a cheklist. Results The most effective intervention has been the ACT, with results of; improvement in symptomatic remission of 43.98 pints, comparing with control group; in terms of hospital readmissions, 19.05%; Regarding social functionality, it has had an improvement of 11.36 points; Finally, regarding the quality of life, there has been an improvement of 1.40 points. Conclusions Social participation is essential in the psychosocial rehabilitation process of a user with schizophrenia. Assertive Community Treatment (ACT) has shown significantly better results compared to Community-Based Rehabilitation (CBR). We must take the results obtained with caution due to the study’s limitations, where the little scientific evidence available on this subject stands out.

Habitation, Urban Context and Psychosocial Rehabilitation

This paper articulates architecture, urbanism and mental health through the study of specific habitation, called Therapeutic Residences, for people with severe mental illness who undergo psychosocial rehabilitation. The study analyzes the insertion of these habitations in the urban scheme, in relation to the possibilities of social coexistence, access to commerce, services and other public equipment through the presentation of two case studies located in the west zone of the city of Rio de Janeiro. Besides the considerations linked to the urban space in its physical sense, it also touches on the subjective questions inherent to the exchanges and experiences possible in this context. The methodological strategies correspond to the survey and data analysis along with a qualitative approach. Information made available by City Hall and Mental Health Office, satellite images, semi-structured interviews directed to professionals involved in assisting at the Therapeutic Residences and, in the case of the habitants, open interviews were used. The results indicate the offer of services, the location and the relation of the houses with the street as fundamental factors to the stimulus of social coexistence. It is concluded that the closed condominium model exclusive to TR, in addition to the fragility and difficulties in the urban area in which it is inserted, it hinders the process of psychosocial rehabilitation and it still refers to the idea of an asylum institution. The model of a one-story house integrated to the consolidated urban fabric suggests more possibilities of creating community ties and appropriating the urban space.

Satisfaction, independent living skills and perceived change of patients undergoing community psychiatric treatment

To estimate quality parameters in the treatments offered, these criteria be evaluated in a continuous and integrated manner, considering patients' and family members' perspectives as well as that of professionals. Literature has highlighted the need to evaluate the results of treatment in psychosocial care facilities from the user point of view. From a quantitative perspective, some studies seek to identify a “degree” of social reinsertion, presenting some variables. Thus, the present study evaluated parameters considered as possible indicators of good results in the psychosocial rehabilitation process, constituting a tool for the planning of managers and mental health professionals. This is a observational study performed between January 2015 and August 2016 in Brazil. The study included 84 patients invited to a verbal interview. The sample consisted of 84 patients treated by Psychosocial Care Facility. The results obtained reveal the achievement of a satisfactory mean regarding the service, about which 85% of the users declare themselves satisfied. However, we found that patients need significant support to perform simple tasks. Independent living skills and perceived change have a lower score when related to satisfaction with the services provided, suggesting, then, that rehabilitation needs to focus on the acquisition of independent living skills, so that the patient can seek a life as close to normal as possible.

PSYCHOSOCIAL REHABILITATION AS AN EFFORT TO ACHIEVE INDEPENDENCE FOR THE PATIENTS OF SCIZOFRENIAL (STUDY AT THE HOSPITAL OF MARZUKI MAHDI BOGOR)

Sebagian besar masyarakat Indonesia masih belum menyadari bahwa kesehatan jiwa merupakan hal yang sangat penting untuk diperhatikan. Pasien gangguan jiwa tersebut memerlukan pelayanan rehabilitasi psikososial agar dapat meningkatkan kemandirian pasien ketika nantinya kembali ke keluarga dan lingkungannya. Tujuan Penelitian ini untuk menjelaskan proses rehabilitasi psikososial sebagai upaya mencapai kemandirian bagi pasien gangguan jiwa skizofrenia di RSMM, Bogor. Metode Penelitian yang digunakan adalah metode deskriptif dengan pendekatan kualitatif. Hasil Penelitian menunjukkan bahwa proses pelaksanaan rehabilitasi psikososial yang dilakukan oleh RSMM terbagi menjadi dua yaitu latihan non vokasional dan vokasional. Rehabilitasi psikososial memberikan dampak bagi pasien gangguan jiwa skizofrenia yaitu mengalami peningkatan dalam hal fungsi personal dan sosial. Kemandirian dalam aspek sosial, emosi, intelektual dan ekonomi serta memiliki keterampilan. Untuk menunjang pemulihan pasien gangguan jiwa skizofrenia disarankan adanya dukungan keluarga dan lingkungan masyarakat. Most Indonesian people still do not realize that mental health is a very important thing to consider. Mental patients need psychosocial rehabilitation services in order to increase patient independence when they return to their families and environment. The purpose of this study is to explain the process of psychosocial rehabilitation as an effort to achieve independence for schizophrenic psychiatric patients at RSMM, Bogor. The research method used is descriptive method with a qualitative approach. The results showed that the process of implementing psychosocial rehabilitation carried out by RSMM was divided into two namely non-vocational and vocational training. Psychosocial rehabilitation has an impact on patients with schizophrenia, which is an increase in personal and social functioning. Independence in social, emotional, intellectual and economic aspects and have skills. To support the recovery of mental patients with schizophrenia, it is suggested that there is family and community environment support.

Trabalho, sentidos e saúde mental: percepção de participantes em um projeto geração de renda

Este estudo objetivou analisar os sentidos do trabalho para os participantes de uma pesquisa-ação denominada “Projeto Geração de Renda” na região metropolitana do Recife/PE com intuito de gerar reflexões em direção ao conceito de trabalho emancipado segundo os princípios da economia solidária. Tratou-se de uma pesquisa qualitativa, com entrevistas não-estruturadas de 8 sujeitos da pesquisa-ação realizada sob a perspectiva freireana de educação popular. Utilizou-se a análise do discurso de Gill, tomando-se como referencial o sentido do trabalho no contexto da Política de Saúde Mental. Observou-se que os sentidos encontrados no discurso dos participantes se baseiam em diferentes concepções, sobretudo no sentido do trabalho como sustento das necessidades da sobrevivência humana, e desta maneira, como potencialidade para a reprodução da vida. No entanto, estes sentidos estão no âmbito do trabalho protegido-terapêutico e distanciados do trabalho emancipado. O processo de reabilitação psicossocial para pessoas com experiência na loucura e na perspectiva do trabalho precisa ir além de geração de renda. Quando atrelada ao trabalho emancipado, pode-se pensar que promova a participação democrática e cidadã. Dessa forma, há um terreno fértil para a construção de novas relações consigo e com os outros, pautadas nos princípios do movimento da economia solidária.

The Multi-Dimensional Influence of a Sports Activity on the Process of Psycho-Social Rehabilitation and the Improvement in the Quality of Life of Persons with Physical Disabilities

Purpose: The purpose of the research is to analyze the role that sport plays in the lives of persons with physical disabilities within the process of rehabilitation and the improvement of their quality of life.Background: The article raises the notions of changes that take place in the life of a physically handicapped person which is due to their engagement in a sports activity. In the article, I refer to the subjective perspective of those researched, rendering their own point of view into the major subject of analysis.Methods: Qualitative data are exploited in the research, collected through a technique of unstructured interviews and undisguised observations conducted among the disabled practicing sports.Findings: The role of sport practiced by the disabled has been determined within several contexts, which were distinguished within the course of the research as analytical categories.Conclusion: On the basis of the research it was found that getting involved in a sports activity is significant within the process of experiencing life satisfaction, personal development and the reconstruction of the ego, self-identity, and transformations in the manner of perceiving both themselves and others. Therefore, a sports activity of a disabled person supports the rehabilitation process effectively.

Transferência de cuidados: processo de alta dos usuários de um centro de atenção psicossocial

A alta, em serviços de saúde mental, tem conotação de reabilitação psicossocial e articulação com os dispositivos da rede para promover a atenção continuada no território. Objetivou-se avaliar o processo de alta dos usuários de Centros de Atenção Psicossocial (CAPS). Pesquisa qualitativa e avaliativa, pautada na Avaliação de Quarta Geração. Realizada em um CAPS II de Santa Catarina, com 17 trabalhadores, 14 familiares e cinco usuários, em 2014. Utilizou-se o Método Comparativo Constante para análise dos dados. Compreende-se que o processo de alta é uma importante estratégia de reabilitação psicossocial, promovendo o cuidado no território de vida dos usuários. Este estudo põe em questão a cronificação nos CAPS, pois esses não devem ser serviços que mantenham os usuários em acompanhamento por longo período, mas ser transitórios, possibilitando o fortalecimento do cuidado em outros pontos da rede, estreitando vínculo com a atenção primária e com os demais equipamentos sociais do território.

Reabilitação psicossocial de moradores de um serviço residencial terapêutico

Objetivo: analisar o processo de reabilitação psicossocial no cotidiano dos moradores deste serviço. Métodos: trata-se de um estudo de caso, com abordagem qualitativa. O referencial teórico adotado foi a Teoria do Cotidiano e a Reabilitação Psicossocial. Utilizou-se como técnica de coleta de dados a observação participante. Foram sujeitos deste estudo, seis moradores de um serviço residencial terapêutico. Os dados foram analisados pela técnica de análise temática, considerando os aspectos históricos e sociais em que foram coletados. Resultados: evidenciaram a vida cotidiana, a alienação cotidiana e a superação desta alienação. Considerações finais: evidencia-se a reabilitação psicossocial quando os moradores apropriaram-se de seus cotidianos, todavia, em alguns momentos os cotidianos ficaram alienados e utilizou-se mecanismos para superá-los. São necessárias estratégias constantes, para profissionais, a fim de tornar o morar/cotidiano destes moradores possível.

War-affected children and psycho-social rehabilitation

The purpose of this paper is to examine how the concept of psycho-social and psycho-social programmes emerged and evolved. Further, this paper expects to identify the basic elements in a psycho-social rehabilitation programme, by using global level discourse regarding the effects of war on children and how they can be rehabilitated. According to literature, the impact of war on children was mainly given attention after Second World War and initially more attention was given on negative psychological effects. But later it was found that, due to war children faced another social risk as well and the different viewpoints which exemplified based on research findings on ‘war-affected children’ caused to re-strategize psycho-social interventions. As a result, two main components were identified as important dimensions when conducting a psycho-social rehabilitation process in war context. First is the diagnosis of the impact of war on affected children. Second is analysis on ‘social context’, which refers to the immediate physical and social setting, including culture, religion, traditions, beliefs, people, structures and institutions. Finally, this study concludes that in order to heal war-affected children in a successful way three main components should be taken into account. As the first component the psycho-social rehabilitation programmes should ensure that they attend to the most vulnerable children who are in need of psycho-social care. The second component is resource adequacy and the third component is selection of suitable rehabilitation approaches and methods.

Prévenir la violence associée à la schizophrénie avec la remédiation cognitive

ObjectivesThe association between schizophrenia and violence represents an important issue in psychiatry. Often highly publicized, violent acts raise the question of their detection, prevention, management and treatment. There is no single, direct and exclusive link between aggressiveness and the underlying psychiatric disorder. On the contrary, the processes underlying this violence are multiple and interlinked. In addition to static and dynamic risk factors, cognitive deficits play an important role in the genesis and maintenance of violent and aggressive behavior. MethodsUsing recent data from the international literature and the main databases, we first clarify the role played by cognitive deficits in the violence of patients with schizophrenia. We then evaluate the place of psychosocial interventions such as cognitive remediation and social cognitive training in managing the violent and aggressive behavior of these patients. ResultsExecutive functions and working memory are the most studied neurocognitive functions in the field of violence in schizophrenia. Impulsivity, lack of cognitive flexibility, lack of adaptation and inhibition of automatic motor responses, and altered anger regulation may explain this relationship. Three main components of social cognition are associated with violent behaviors in schizophrenia: (1) the recognition of facial emotions through the inoperability of systems of “emotional monitoring”, violent inhibition and recognition of informative facial zones; (2) the theory of the mind through the erroneous interpretation of the intentions of others; (3) the attributional style through the preferentially aggressive over interpretation of social situations and weak capacities of introspection. Overall, cognitive biases inhibit response in a socially acceptable manner and increase the risk of responding impulsively and aggressively to a stressful or provocative situation. In this context, we studied the place held by psychosocial interventions in the management of the violent and aggressive behaviors of these patients. Various cognitive remediation programs have shown their feasibility in people with schizophrenia and neurocognitive deficits with a history of violence as well as their effectiveness in reducing violence, mainly by reducing impulsivity. Similarly, specific programs dedicated to social cognitive training such as Social Cognition and Interaction Training (SCIT), Reasoning and Rehabilitation Mental Health Program (R&R2 MHP) and Metacognitive Training (MCT) have shown their positive impact on the control and reduction of global aggressive attitudes and on the numbers of physical and verbal aggressive incidents in schizophrenia. The improvement of social cognition would be achieved through the amendment of interpersonal relationships and social functioning. These interventions are effective at different stages of disease progression, in patients with varied profiles, on violent attitudes in general and on the number of verbal and physical attacks, whether for in-patients or out-patients. Beneficial effects can last up to 12months after termination of the study program. The interest of these interventions is preventive if the subject never entered in a violent register or curative in case of a personal history of violence. This type of care can be considered from a symptomatic point of view by limiting downstream the heavy consequences of such acts, but also etiologically by acting on one of the causes of violent behavior. Compliance with the eligibility criteria, carrying out a prior functional analysis and confirmation of the major impulsive part of the patient's violence are prerequisites for the use of these programs. Similarly, the early introduction of such therapies, their repetition over time and the integration of the patient into a comprehensive process of psychosocial rehabilitation will ensure the best chance of success. ConclusionsSome cognitive impairments appear to have their place in the genesis, progression and maintenance of violent acts of individuals with schizophrenia. Their management thus opens new therapeutic perspectives such as cognitive remediation, still rarely used in this aim, to complement the action of the traditional care tools. However, further therapeutic trials are needed before considering cognitive remediation and social cognitive training as central care modalities in the therapeutic control of violence in schizophrenia.

Психосоциальная реабилитация несовершеннолетних, попавших в юридически значимые ситуации, как задача культурно-исторической психологии

The article analyses psychosocial rehabilitation of adolescents caught in legally significant situations in relation to the professional standard. Most often, the term "rehabilitation" is defined as a system of certain measures and/or arrangements aimed at the restoration, correction, compensation of impaired mental functions or qualities. However, this approach does not allow to formulate the goal and tasks of the rehabilitation process that are relevant to legal psychology as a science and to providing practical psychological assistance to adolescents in legally significant situations. Basing on the key categories of cultural-historical psychology (such as social situation of development, new psychological formations, zone of proximal development, etc.) a model of psychosocial rehabilitation based on the replacement of the social situation of development is proposed. The article describes the process of psychosocial rehabilitation consisting of a cycle of activities of a legal psychologist and compares it to the job functions listed in the professional standard for specialists in social rehabilitation.

A reabilitação psicossocial como estratégia de cuidado: percepções e práticas desenvolvidas por trabalhadores de um serviço de saúde mental

As ações desenvolvidas nos Centros de Atenção Psicossocial (CAPS) defrontam-se com impasses clínicos e operacionais quando avaliadas sob a perspectiva da Reabilitação Psicossocial. O estudo, desenvolvido em um CAPS da cidade de São Paulo, visou conhecer como o conceito da Reabilitação Psicossocial é assimilado por seus trabalhadores, como estes a relacionam às suas práticas e como a percebem na instituição em que estão inseridos. A abordagem metodológica foi qualitativa. Participaram do estudo oito trabalhadores. Para a produção dos dados foi utilizada a entrevista semiestruturada e para a análise a técnica de Análise Temática. Verificou-se que a condução prática das ações do cuidado em saúde mental deve estar embasada pelo entendimento do que é o processo de Reabilitação Psicossocial. Também se observou que os trabalhadores percebem de forma crítica as condutas institucionais que priorizam intervenções dentro do serviço e pouco articuladas aos contextos externos. O estudo sugere que trabalhar com a estratégia da Reabilitação Psicossocial exige flexibilidade no enfrentamento de diferentes desafios, garantindo a presença da coletividade no processo. Também aponta para a necessidade de elaboração de instrumentos de monitoramento e avaliação dos serviços.

Psychiatric Nursing in Integrated Wards Accommodating Both Female and Male Patients: A Historic Pioneering Reform Initiative Implemented by the Institute of Psychiatry, a Unit of the Federal University of Rio De Janeiro, Brazil

The purpose of this research is to analyze aspects of the sexuality of people with mental disorders, an issue that influenced nursing care in the mixed nursing wards of the Institute of Psychiatry at the Federal University of Rio de Janeiro between 1996–2002. A qualitative Historical Social Study methodology used written and oral texts that were analyzed drawing on Michel Foucault's ideas about sexuality. Results of the study indicate that a rupture occurred in the distribution model according to gender at the Psychiatric Hospitalization Unit. This, in turn, influenced nursing care. From this study, we conclude that accommodating patients in mixed wards better facilitates the psychosocial rehabilitation process and changes nursing teams’ conceptions about the sexuality of people with mental disorders.

Parents′ expectations from rehabilitation services for their children with cerebral palsy: A retrospective study

Background: Early identification and intervention has brought change in the societies towards disability and its management. However, dependency on drug-cure (medical model) has influenced the community expectations on the outcomes of rehabilitation process. The psychosocial rehabilitation process has been sparsely studied in Indian context. Aim: The present study aims to study whether the expectations of the parents change across the age, as recorded in chief complaints, in a way that psychological disorders are late to be detected and are generally not recognized by parents and medical professionals. The study also found some interesting findings such as ratio of males and females registered and the mean age range of the children registered. Methodology: The present study has examined and analyzed the documentation of case history files of children brought by their parents and caregivers to the National Institute for the Mentally Handicapped, Bowenpally, General services (n = 3,960) for male and female ratio, mean age of registration, developmental and social age (DA and SA) for 3-36, 36-72, and 72-120 month age ranges, respectively. Results: As the age increases psychosocial difficulties also increases with psychomotor problems. Registered male cases were more than female cases. The visits to the Psychology department for the behavior problems have increased across the age range. Conclusions: Psycho-social rehabilitation and family counseling in managing the person with cerebral palsy is effective than behavior modification programs. A mobile Rehabilitation Services team must visit area wise for offering in-the-neighborhood services along with psycho-education for remote areas. Schools need to be sensitized that if motor and speech are the only disabilities in a child, he should not be refused admission. Parents counseling is necessary for vulnerability of psychological problems in this population due to restrictive environment and explain Medical Model VS Bio-Psycho-Social Model.

Sexuelle Gesundheit in der psychiatrischen Versorgung: Eine Pilotstudie zur professionellen Perspektive in psychosozialen Einrichtungen

The study explores the perspectives of Mental Health Care Professionals on the importance of Sexual Health promotion of severe mentally ill people in Mental Health Care. A qualitative approach was used. Eight semi-structured Problem Centred Interviews were conducted in August 2012 in two residential facilities in Berlin. Participants are aware of the importance of Sexual Health in the psychosocial rehabilitation process. However, they believe Sexual Health Promotion is yet to be acknowledged as a legitimate Mental Health care issue. Sexual Health Promotion is poorly integrated in Mental Health Care practice. However, sexuality contributes strongly to the health and quality of life of users. Adequate guidelines on Sexual Health Promotion are not available and are urgently needed.

Worrying about one's children after breast cancer diagnosis: desired timing of psychosocial intervention.

The purposes of this observational study were to analyze at what time point mothers desired psychosocial support regarding the worry about their children during the year after breast cancer diagnosis and to identify any psychosocial factors associated with this worry. In a population-based study, we analyzed data from 280 mothers diagnosed with breast cancer at Sahlgrenska University Hospital in Gothenburg, Sweden. Of those who did not receive chemotherapy treatment, 70 out of 112 women (63 %) reported a desire to receive support about the worry about their children, and of those who received chemotherapy treatment, 20 out of 49 (41 %) reported a need for support immediately following diagnosis and before surgery. We identified having children at home (P < 0.0001), worry about sex life (P = 0.0009), fear of dying from breast cancer (P = 0.0055), and worried about one's personal financial situation (P = 0.0413) as the variables most closely related to worry about the children. Our population-based study shows that mothers with breast cancer had an immediate desire to receive psychosocial support regarding the worry about their own children. If we wish to shorten the pain associated with this worry among women diagnosed with breast cancer, it may be helpful to offer support as early in the disease trajectory as possible as it may reduce the risk of a later, more complicated, unnecessarily prolonged psychosocial rehabilitation process.

The Integration of Cognitive Remediation Therapy into the Whole Psychosocial Rehabilitation Process: An Evidence-Based and Person-Centered Approach

Cognitive remediation therapies seem to ameliorate cognitive impairments in patients with schizophrenia. Interestingly, some improvement in daily functioning can also be expected as a result. However, to achieve these results it is necessary that cognitive remediation is carried out in the context of broader psychosocial rehabilitation involving the learning of other communication, social, and self-control skills. Unfortunately, little is known about how to integrate these different rehabilitation tools in broader rehabilitation programs. Based on both the neurocognitive behavioral approach and the action theory framework, a hierarchical flowchart is represented in this paper to integrate CRT with other evidence-based psychological therapies in outpatient settings. Finally, some evidence is provided in which cognitive abilities need to be targeted in remediation programs to improve functioning. In summary, to improve daily functioning, according to these studies, cognitive remediation needs to include the teaching of some cognitive strategies that target executive skills.

P-1314 - Characteristics of long-term hospitalized psychiatric patients

Introduction The period of two years of continuous stay in a mental hospital is the criterion for determining the long-term hospitalized psychiatric patients. Many of these patients were suffering from schizophrenia. Objective The aim of this study was to analyze the socio-demographic data of patients caught up in Special Hospital for Psychiatric Disease “G. TOPONICA” who were hospitalized in the continued hospitalization of more than two years and an analysis of the causes of such a long hospitalization. Method For this study used a specially designed questionnaire. Analysis comprises surprised at the long-term hospitalized patients SBPB “G. Toponica”. Results The data will be presented on the poster. Conclusion A long stay in hospital is not just the result only of disease but also to a range of social factors such as family neglect, lack of funds, lack of transitional institutions and so on. It is essential that the length of hospital stay should be reduced to a period that's required to reduce symptoms and psycho social rehabilitation process of a patient to provide a stable life in the community.