More for the same?

Abstract

Tsuang MT, Woolson RF. Mortality in patients with schizophrenia, mania, depression and surgical conditions. A comparison with general population mortality. Br J Psychiatry. 1977;130:162-6. 3.Cooke BK, Magas LT, Virgo KS, Feinberg B, Adityanjee A, Johnson FE. Appendectomy for appendicitis in patients with schizophrenia. Am J Surg. 2007;193(1):41-8. 4.Rocha FF, Bezerra BPS. Síndrome metabólica e transtornos psiquiátricos: uma associação que não pode ser esquecida. Arq Bras Endocrinol Metab. 2006;50(6):1138-9. Our results show that psychiatric patients had a longer interval between the onset of their symptoms and the surgical procedure. This may suggest that the patients postponed the search for medical care. An alternative explanation would be that their clinical symptoms could be erroneously attributed to their psychiatric disorder. A delayed diagnosis could be associated with more postoperative complications. 2-3 In line with this, psychiatric patients had more complications than controls, although the length of hospital stay was the same for both groups. Other reasons for the increased morbidity in psychiatric patients in the postoperative period include: metabolic disorders related to the underlying disease or secondary to the use of psychiatric medications that have metabolic effects such as hyperglycemia, weight gain, and insulin resistance; inappropriate management of the psychiatric medication during the pre-, peri-and postoperative period, and the poor relationship among the members of the medical team (surgeons and psychiatrics). 2,4 An interesting point that should be mentioned is the noninclusion of psychiatric patients in most studies that evaluate surgical indexes and features related to the morbidity and mortality of surgical procedures. 5 Despite the evident limitations of our study (small sample, information obtained retrospectively and lack of laboratory or other clinical data possibly related to the outcome), the present results highlight the neglect of general medical problems in psychiatric patients.

Association between duration of untreated bipolar disorder and clinical outcome: data from a Brazilian sample

“…The longer DUB in our study may represent the poorer structure of general primary health services and, especially, mental health services in Brazil when compared to developed countries. 18,19 The lack of an efficient public health approach may delay first contact with medical professionals and, consequently, delay a correct diagnosis of BD. 20 We found that specific clinical features of BD were associated with a longer DUB.…”

Halfway Houses for Alcohol Dependents: From Theoretical Bases to Implications for the Organization of Facilities

“…In light of the issues described above, the lack of cost-benefit studies comparing the traditional model to new deinstitutionalization policies in Brazil has generated extensive criticism of the Psychiatric Reform proposal up to the present day. 10 , 16 , 17…”

Franco Basaglia (1924—1980): Three Decades (1979—2009) as a Bridge Between the Italian and Brazilian Mental Health Reform

“…Although the huge proportions of this network give the clear impression that a successful transition occurred from the restrictive psychiatric hospital environment to more socially inclusive, community-based equipments, some criticisms can be heard from Brazilian leading academic psychiatrists (Gentil, 2007), mostly related to its implementation without the real provision of alternative resources; inexistent primary and secondary prevention, and without proper training of mental health workers and community education In short, critics sustain that the new system was implanted without the adequate support from research evidence that it really serves the purpose it was created to serve (Gentil 2007). In little more than a decade, hundreds of services were established in the whole country and were remodelled according to general guidelines to maximize limited resources (Jacob et al, 2007).…”