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Opiniones sobre la práctica clínica psiquiátrica en centros comunitarios de salud mental y en centros de hospitalización psiquiátrica de corta estadía en Chile
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RESUMO: Avaliaram-se opiniões clínicas controversas entre psiquiatras que trabalham em
centros comunitários de saúde mental (COSAM) e hospitalizações psiquiátricas (UCE).
Enviou-se um inquérito por correio eletrônico a uma mostra extraída do total nacional
de psiquiatras do sistema público de saúde. Obteve-se uma taxa de resposta de 41,9%,
equivalente a 22% do universo, com 30 inquéritos recebidos por cada grupo.
Resultados: a orientação biológica nos UCE e a social comunitária nos COSAM são as
predominantes(p<0.001). Os UCE destinam 5,5 vezes mais horas à docência(p<0,0071).
Não houve diferença entre os grupos para a avaliação de: internações compulsórias,
propostas controversas, contenção física, farmacoterapia involuntária, informar
diagnóstico e tratamento. Para um paciente com esquizofrenia se comunica menos seu
diagnóstico, se hospitaliza mais involuntariamente e se informa mais ao cônjuge,
apesar de não quererem(p<0,001). Aqueles que realizam hospitalização involuntária:
indicam mais a hospitalização e 8,5 vezes menos encaminhamentos de hospitalização
diurna(p<0,015). Dos que não fazem internações compulsórias, em 14 de 16 situações
controversas as catalogam como menos éticas do que aqueles que internam
involuntariamente(p=0.016). Estes últimos consideram também mais aceitáveis todos
os tratamentos propostos, incluindo lobotomia frontal, estimulação cerebral profunda
e hipnose(p=0.016). Em uma análise de regressão se estimou que dão respostas menos
éticas os psiquiatras com mais de 10 anos e aqueles que hospitalizam
involuntariamente, e mais éticas os do UCE, mas com pouca reprodutibilidade.
Discussão: ambos os grupos são muito similares, demonstrando que ainda não existe
uma prática de respeito aos direitos que diferencie aqueles de orientações sociais ou
comunitárias dos mais biológicos. Podem ser determinantes os poucos anos dos
COSAM , além da formação de especialistas monopolizada por modelos hospitalares. É
necessário aumentar o número de entrevistados para conseguir maior consolidação
dos dados e esclarecer aqueles cuja significância foi limitada pelo tamanho amostral.É
necessário qualificar as equipes na CDPD e incorporar COSAMs ao ensino.
ABSTRACT: Clinical controversial opinions among psychiatrists working in community mental health centers(COSAM) and psychiatric hospitalization centers(UCE) were evaluated. A survey was e-mailed to a sample taken from the national roster of public health system psychiatrists. A response rate of 41.9%,22% of the universe, with 30 surveys received by each group. Results: biological orientation is the most common in UCE, and community social orientation in COSAM (p<0.001).In UCE allocated 5.5 times more hours to teaching(p<0.0071). There was no difference between groups for the evaluation of: involuntary hospitalization, controversial proposals, physical restraint, involuntary drug treatment, diagnosis and treatment report. The patient with schizophrenia receives fewer time his diagnosis, he is more involuntarily hospitalized , and psychiatrists report more often to the spouse despite he does not desire it (p<0.001). Psychiatrists that indicate involuntary hospitalizations: indicate more often hospitalization and 8.5 times less treatment indication of day hospitalization (p<0.015). Psychiatrists do not indicate forced hospitalizations, in 14 of the 16 controversial situations value them as less ethical situations compared to those who perform involuntary hospitalization(p = 0.016). These latter also considered more acceptable all proposed treatments, including frontal lobotomy, deep brain stimulation and hypnosis(p=0.045). In a regression analysis it was estimated that those deliver less ethical responses were psychiatrists with more than 10 years of professional practice and those who hospitalize involuntarily ,and ethical responses the UCE. Discussion: Yet there is no practical differentiates between the two working groups regards to patients human rights. It may be determinant few years of development of COSAM and the monopoly of the training of specialists in hospital models. Is necessary to increase the number of respondents order to achieve consolidate my findings and clarify those whose significance was limited by the sample size. It is needed qualify the teams in CRPD and incorporate COSAMs to teaching.
ABSTRACT: Clinical controversial opinions among psychiatrists working in community mental health centers(COSAM) and psychiatric hospitalization centers(UCE) were evaluated. A survey was e-mailed to a sample taken from the national roster of public health system psychiatrists. A response rate of 41.9%,22% of the universe, with 30 surveys received by each group. Results: biological orientation is the most common in UCE, and community social orientation in COSAM (p<0.001).In UCE allocated 5.5 times more hours to teaching(p<0.0071). There was no difference between groups for the evaluation of: involuntary hospitalization, controversial proposals, physical restraint, involuntary drug treatment, diagnosis and treatment report. The patient with schizophrenia receives fewer time his diagnosis, he is more involuntarily hospitalized , and psychiatrists report more often to the spouse despite he does not desire it (p<0.001). Psychiatrists that indicate involuntary hospitalizations: indicate more often hospitalization and 8.5 times less treatment indication of day hospitalization (p<0.015). Psychiatrists do not indicate forced hospitalizations, in 14 of the 16 controversial situations value them as less ethical situations compared to those who perform involuntary hospitalization(p = 0.016). These latter also considered more acceptable all proposed treatments, including frontal lobotomy, deep brain stimulation and hypnosis(p=0.045). In a regression analysis it was estimated that those deliver less ethical responses were psychiatrists with more than 10 years of professional practice and those who hospitalize involuntarily ,and ethical responses the UCE. Discussion: Yet there is no practical differentiates between the two working groups regards to patients human rights. It may be determinant few years of development of COSAM and the monopoly of the training of specialists in hospital models. Is necessary to increase the number of respondents order to achieve consolidate my findings and clarify those whose significance was limited by the sample size. It is needed qualify the teams in CRPD and incorporate COSAMs to teaching.
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Direitos humanos Ética Psiquiatria comunitária Estigma Human rights Ethics Psychiatrists communitary Stigma