Características clínicas e epidemiológicos associadas ao uso da contenção mecânica numa unidade psiquiátrica do interior do Rio Grande do Sul
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Manancial - Repositório Digital da UFSM |
Texto Completo: | http://repositorio.ufsm.br/handle/1/22357 |
Resumo: | Mechanical restraint (MR) is a procedure used in psychiatric units and emergencies with the aim of handling, mainly, episodes of aggression and agitation that are not responsive to other interventions. Even when correctly indicated and performed, it has been associated with the risk of clinical and psychological complications. Factors associated with the use of the MR vary widely among health services, and can support techniques that prevent its necessity. Hospital Universitário de Santa Maria (HUSM) does not yet have studies that aim to identify such factors. OBJECTIVES: To investigate the association of clinical and epidemiological factors of patients in psychiatric hospitalization at HUSM with the use of mechanical restraint to manage aggressive behavior. METHODOLOGY: A database generated from an observational, longitudinal, prospective and naturalistic study conducted between August 2012 and January 2013 was analyzed. Patients were interviewed at the Psychiatric Emergency Room (PS-PSIQ) and at the Paulo Guedes Unit (UPG) of HUSM. Demographic and clinical information were collected on admission. The Brief Psychiatric Rating Scale (BPRS) was applied at admission and at discharge. The Overt Aggression Scale (OAS) was scored daily. Data distribution occurred in a non-normal way. Bivariate analysis of categorical variables was performed using Fisher's exact test. Quantitative variables were assessed transversely by the Mann-Whitney test and longitudinally by the Wilcoxon test. RESULTS: Among the 1625 patients evaluated at the PS-PSIQ during the study period, 137 participants were selected. Adult inpatients were included, and patients with delirium were excluded. Among the participants, 27% required mechanical restraint throughout the study. The contained patients had a higher score on the BPRS scale at admission and on the OAS scale throughout hospitalization. Both contained and non-contained patients achieved general improvement in symptoms throughout hospitalization. The contained patients showed no change in the score of the Affect and Negative Symptoms domains of the BPRS scale during hospitalization. CONCLUSION: The determination of a profile of greater hetero-aggressiveness and psychopathological severity among the patients contained can collaborate with the use of early management techniques to prevent the need of MR at HUSM. The longitudinal analysis of the evolution of symptoms contradicts the hypothesis in the literature that MR could cause the onset or worsening of anxious and depressive symptoms. The present study corroborates the correct indication and use of MR as a way of protecting the patients and those close to them. |
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Características clínicas e epidemiológicos associadas ao uso da contenção mecânica numa unidade psiquiátrica do interior do Rio Grande do SulClinical and epidemiological caracteristics associated to the use of mechanical restraints in a psychiatric unit in the interior of Rio Grande do Sul state, BrazilRestrição físicaUnidade Hospitalar de PsiquiatriaAgressãoPhysical restraintHospital psychiatricDepartment. aggressionCNPQ::CIENCIAS DA SAUDEMechanical restraint (MR) is a procedure used in psychiatric units and emergencies with the aim of handling, mainly, episodes of aggression and agitation that are not responsive to other interventions. Even when correctly indicated and performed, it has been associated with the risk of clinical and psychological complications. Factors associated with the use of the MR vary widely among health services, and can support techniques that prevent its necessity. Hospital Universitário de Santa Maria (HUSM) does not yet have studies that aim to identify such factors. OBJECTIVES: To investigate the association of clinical and epidemiological factors of patients in psychiatric hospitalization at HUSM with the use of mechanical restraint to manage aggressive behavior. METHODOLOGY: A database generated from an observational, longitudinal, prospective and naturalistic study conducted between August 2012 and January 2013 was analyzed. Patients were interviewed at the Psychiatric Emergency Room (PS-PSIQ) and at the Paulo Guedes Unit (UPG) of HUSM. Demographic and clinical information were collected on admission. The Brief Psychiatric Rating Scale (BPRS) was applied at admission and at discharge. The Overt Aggression Scale (OAS) was scored daily. Data distribution occurred in a non-normal way. Bivariate analysis of categorical variables was performed using Fisher's exact test. Quantitative variables were assessed transversely by the Mann-Whitney test and longitudinally by the Wilcoxon test. RESULTS: Among the 1625 patients evaluated at the PS-PSIQ during the study period, 137 participants were selected. Adult inpatients were included, and patients with delirium were excluded. Among the participants, 27% required mechanical restraint throughout the study. The contained patients had a higher score on the BPRS scale at admission and on the OAS scale throughout hospitalization. Both contained and non-contained patients achieved general improvement in symptoms throughout hospitalization. The contained patients showed no change in the score of the Affect and Negative Symptoms domains of the BPRS scale during hospitalization. CONCLUSION: The determination of a profile of greater hetero-aggressiveness and psychopathological severity among the patients contained can collaborate with the use of early management techniques to prevent the need of MR at HUSM. The longitudinal analysis of the evolution of symptoms contradicts the hypothesis in the literature that MR could cause the onset or worsening of anxious and depressive symptoms. The present study corroborates the correct indication and use of MR as a way of protecting the patients and those close to them.A contenção mecânica (CM) é um procedimento utilizado nas internações e emergências psiquiátricas com o objetivo de manejar sobretudo quadros de agressividade e agitação não responsivos a outras intervenções. Mesmo quando corretamente indicada e executada, ela vem sendo associada ao risco de complicações clínicas e psicológicas. Fatores associados à CM variam muito entre os serviços de saúde, e podem embasar técnicas que previnam a necessidade do uso do procedimento. O Hospital Universitário de Santa Maria (HUSM) ainda não possui estudos que se proponham a identificar tais fatores. OBJETIVO: Investigar a associação de fatores clínicos e epidemiológicos dos pacientes em internação psiquiátrica no HUSM com o uso de contenção mecânica para manejo de comportamentos agressivos. METODOLOGIA: Foi analisado banco de dados gerado a partir de um estudo de desenho observacional, longitudinal, prospectivo e naturalístico realizado entre agosto de 2012 a janeiro de 2013. Os pacientes foram entrevistados no Pronto Socorro Psiquiátrico (PS-PSIQ) e na Unidade Paulo Guedes (UPG) do HUSM. Foram coletadas informações demográficas e clínicas à admissão. A Escala Breve de Sintomas Psiquiátricos (BPRS) foi aplicada na internação e na alta. A escala Escala de Agressividade Declarada (OAS) foi pontuada diariamente. A distribuição de dados ocorreu de maneira não-normal. Foi realizada análise bivariada das variáveis categóricas pelo Teste Exato de Fisher. As variáveis quantitativas foram avaliadas de forma transversal pelo teste Mann-Whitney e longitudinal pelo teste Wilcoxon. RESULTADOS: Dos 1625 pacientes atendidos no PS-PSIQ no período do estudo, foram selecionados 137 participantes. Foram incluídos pacientes adultos internados, e excluídos pacientes com delirium. Entre os participantes, 27% foram submetidos a CM ao longo do estudo. Os pacientes contidos apresentaram maior pontuação na escala BPRS à admissão e na escala OAS ao longo da internação. Tanto os pacientes contidos como os não contidos obtiveram melhora geral dos sintomas ao longo da internação. Os pacientes contidos não apresentaram mudança na pontuação das dimensões Afeto e Sintomas Negativos da escala BPRS ao longo da internação. CONCLUSÃO: A determinação de um perfil de maior heteroagressividade e gravidade psicopatológica entre os pacientes contidos pode colaborar com o uso de técnicas de manejo precoce e prevenção da necessidade de CM na UAP do HUSM. A análise longitudinal da evolução dos sintomas contraria a hipótese presente na literatura de que a CM poderia ocasionar o surgimento ou piora de sintomas ansiosos e depressivos. O presente estudo corrobora o uso da CM indicada e executada de maneira correta como forma de proteção ao paciente e àqueles próximos de si.Universidade Federal de Santa MariaBrasilCiências da SaúdeUFSMPrograma de Pós-Graduação em Ciências da SaúdeCentro de Ciências da SaúdeCunha, Angelo Batista Miralha dahttp://lattes.cnpq.br/1705812173977196Calegaro, Vitor CrestaniHoffmann, Maurício ScopelShansis, Flávio MilmanMosele, Pedro Henrique Canova2021-10-07T18:54:54Z2021-10-07T18:54:54Z2020-10-27info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfhttp://repositorio.ufsm.br/handle/1/22357porAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessreponame:Manancial - Repositório Digital da UFSMinstname:Universidade Federal de Santa Maria (UFSM)instacron:UFSM2021-10-08T06:00:47Zoai:repositorio.ufsm.br:1/22357Biblioteca Digital de Teses e Dissertaçõeshttps://repositorio.ufsm.br/ONGhttps://repositorio.ufsm.br/oai/requestatendimento.sib@ufsm.br||tedebc@gmail.comopendoar:2021-10-08T06:00:47Manancial - Repositório Digital da UFSM - Universidade Federal de Santa Maria (UFSM)false |
dc.title.none.fl_str_mv |
Características clínicas e epidemiológicos associadas ao uso da contenção mecânica numa unidade psiquiátrica do interior do Rio Grande do Sul Clinical and epidemiological caracteristics associated to the use of mechanical restraints in a psychiatric unit in the interior of Rio Grande do Sul state, Brazil |
title |
Características clínicas e epidemiológicos associadas ao uso da contenção mecânica numa unidade psiquiátrica do interior do Rio Grande do Sul |
spellingShingle |
Características clínicas e epidemiológicos associadas ao uso da contenção mecânica numa unidade psiquiátrica do interior do Rio Grande do Sul Mosele, Pedro Henrique Canova Restrição física Unidade Hospitalar de Psiquiatria Agressão Physical restraint Hospital psychiatric Department. aggression CNPQ::CIENCIAS DA SAUDE |
title_short |
Características clínicas e epidemiológicos associadas ao uso da contenção mecânica numa unidade psiquiátrica do interior do Rio Grande do Sul |
title_full |
Características clínicas e epidemiológicos associadas ao uso da contenção mecânica numa unidade psiquiátrica do interior do Rio Grande do Sul |
title_fullStr |
Características clínicas e epidemiológicos associadas ao uso da contenção mecânica numa unidade psiquiátrica do interior do Rio Grande do Sul |
title_full_unstemmed |
Características clínicas e epidemiológicos associadas ao uso da contenção mecânica numa unidade psiquiátrica do interior do Rio Grande do Sul |
title_sort |
Características clínicas e epidemiológicos associadas ao uso da contenção mecânica numa unidade psiquiátrica do interior do Rio Grande do Sul |
author |
Mosele, Pedro Henrique Canova |
author_facet |
Mosele, Pedro Henrique Canova |
author_role |
author |
dc.contributor.none.fl_str_mv |
Cunha, Angelo Batista Miralha da http://lattes.cnpq.br/1705812173977196 Calegaro, Vitor Crestani Hoffmann, Maurício Scopel Shansis, Flávio Milman |
dc.contributor.author.fl_str_mv |
Mosele, Pedro Henrique Canova |
dc.subject.por.fl_str_mv |
Restrição física Unidade Hospitalar de Psiquiatria Agressão Physical restraint Hospital psychiatric Department. aggression CNPQ::CIENCIAS DA SAUDE |
topic |
Restrição física Unidade Hospitalar de Psiquiatria Agressão Physical restraint Hospital psychiatric Department. aggression CNPQ::CIENCIAS DA SAUDE |
description |
Mechanical restraint (MR) is a procedure used in psychiatric units and emergencies with the aim of handling, mainly, episodes of aggression and agitation that are not responsive to other interventions. Even when correctly indicated and performed, it has been associated with the risk of clinical and psychological complications. Factors associated with the use of the MR vary widely among health services, and can support techniques that prevent its necessity. Hospital Universitário de Santa Maria (HUSM) does not yet have studies that aim to identify such factors. OBJECTIVES: To investigate the association of clinical and epidemiological factors of patients in psychiatric hospitalization at HUSM with the use of mechanical restraint to manage aggressive behavior. METHODOLOGY: A database generated from an observational, longitudinal, prospective and naturalistic study conducted between August 2012 and January 2013 was analyzed. Patients were interviewed at the Psychiatric Emergency Room (PS-PSIQ) and at the Paulo Guedes Unit (UPG) of HUSM. Demographic and clinical information were collected on admission. The Brief Psychiatric Rating Scale (BPRS) was applied at admission and at discharge. The Overt Aggression Scale (OAS) was scored daily. Data distribution occurred in a non-normal way. Bivariate analysis of categorical variables was performed using Fisher's exact test. Quantitative variables were assessed transversely by the Mann-Whitney test and longitudinally by the Wilcoxon test. RESULTS: Among the 1625 patients evaluated at the PS-PSIQ during the study period, 137 participants were selected. Adult inpatients were included, and patients with delirium were excluded. Among the participants, 27% required mechanical restraint throughout the study. The contained patients had a higher score on the BPRS scale at admission and on the OAS scale throughout hospitalization. Both contained and non-contained patients achieved general improvement in symptoms throughout hospitalization. The contained patients showed no change in the score of the Affect and Negative Symptoms domains of the BPRS scale during hospitalization. CONCLUSION: The determination of a profile of greater hetero-aggressiveness and psychopathological severity among the patients contained can collaborate with the use of early management techniques to prevent the need of MR at HUSM. The longitudinal analysis of the evolution of symptoms contradicts the hypothesis in the literature that MR could cause the onset or worsening of anxious and depressive symptoms. The present study corroborates the correct indication and use of MR as a way of protecting the patients and those close to them. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-10-27 2021-10-07T18:54:54Z 2021-10-07T18:54:54Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://repositorio.ufsm.br/handle/1/22357 |
url |
http://repositorio.ufsm.br/handle/1/22357 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Brasil Ciências da Saúde UFSM Programa de Pós-Graduação em Ciências da Saúde Centro de Ciências da Saúde |
publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Brasil Ciências da Saúde UFSM Programa de Pós-Graduação em Ciências da Saúde Centro de Ciências da Saúde |
dc.source.none.fl_str_mv |
reponame:Manancial - Repositório Digital da UFSM instname:Universidade Federal de Santa Maria (UFSM) instacron:UFSM |
instname_str |
Universidade Federal de Santa Maria (UFSM) |
instacron_str |
UFSM |
institution |
UFSM |
reponame_str |
Manancial - Repositório Digital da UFSM |
collection |
Manancial - Repositório Digital da UFSM |
repository.name.fl_str_mv |
Manancial - Repositório Digital da UFSM - Universidade Federal de Santa Maria (UFSM) |
repository.mail.fl_str_mv |
atendimento.sib@ufsm.br||tedebc@gmail.com |
_version_ |
1805922139774124032 |