ICD-10 mental and behavioural disorders due to use of crack and powder cocaine as treated at a public psychiatric emergency service: An analysis of visit predictors

Abstract

The present study investigated the predictors of an increased number of visits from individuals with some of the diagnoses noted in chapter F14 of ICD-10, from calls to the emergency psychiatric unit of a general hospital in São Paulo state, Brazil, in the period 2011-2012. Poisson regression models were carried out for the outcome variable, accounting for number of subsequent visits to the psychiatric emergency unit. For the analysis of this outcome we took into account the exposure time of each individual in the study. Our findings point to a population at risk for frequent psychiatric emergency service visits: individuals over 25 years. This population should be targeted for interventions on entry into public healthcare due to increased psychiatric morbidity and greater clinical morbidity already confirmed by previous studies. We discussed the need of these individuals for special attention during the clinical or psychiatric emergency consultation which, unfortunately, may be the access point for the public health system. None of the other variables were related to the outcome of interest, such as those related to the level of individual entry into the care network before and after treatment, and other variables related to medical acts during the visit.

Sociodemographic Characteristics, Patterns of Crack Use, Concomitant Substance Use Disorders, and Psychiatric Symptomatology in Treatment-Seeking Crack-Dependent Individuals in Brazil

“…In agreement with previous findings (da Cruz et al, 2014; Moreira, Barbosa, Laranjeira, & Mitsuhiro, 2014; Narvaez et al 2014; Paim Kessler et al 2012; De Oliveira et al 2009; Falck et al 2004; Falck et al 2002), the high prevalence of concomitant substance use disorders, psychiatric symptomatology, and impulsivity observed in our sample indicates the highly comorbid nature of crack dependence. These findings further suggest that treatment facilities charged with treating crack-dependent individuals should consider combining pharmacological and psychosocial evidence-based treatments designed to address other substance use disorders, mood disorders, and anxiety disorders, as well as neurorehabilitation to improve impulse control.…”

“…Crack use is associated with a number of severe psychiatric comorbidities, such as alcohol dependence, mood disorders (e.g., major depressive disorder), anxiety disorders, antisocial personality disorder, and suicidal ideation (Narvaez et al 2014; Paim Kessler et al 2012; Zubaran et al 2010). Crack cocaine use has been found to be an important predicator for psychiatric emergency service visits in Brazil (da Cruz et al, 2014). In comparison with the general population, crack users are more likely to live or have lived on the streets, as well as to have been exposed to violence, hospitalization, prostitution, and risky sexual behaviors (Moreira, Barbosa, Laranjeira, & Mitsuhiro, 2014; Narvaez et al 2014; Carvalho & Seibel 2009; Dunn & Laranjeira 1999).…”

The impact of Basaglia on Brazilian psychiatry

“…A potentially ideal solution would be to have psychiatric beds in general hospitals, but this has been difficult for a number of reasons including financial imperatives and reasons of stigma (Candiago, da Silva Saraiva, Gonçalves, & Belmonte-de-Abreu, 2011). The whole situation overwhelms Brazilian psychiatric emergency units, which should observe the patients for a maximum of 72 hours (da Cruz et al, 2014). Sometimes, patients need longer hospitalization (voluntarily or involuntarily), but there are no places available to refer these patients (Barros, Tung, & Mari, 2010).…”

O cuidado aos dependentes químicos: com a palavra profissionais de saúde de centros de atenção psicossocial em álcool e drogas The care for chemically dependent: with words from health professional of centers of psychosocial on alcohol and drugs

“…7,14 In this context, a study found that care for health professionals should also involve the user's family, which must be understood as a fundamental part to the satisfactory progress in the mental health care paradigm. 26 The family can be a supporting. For this purpose, they must have information to enable their help in user needs and performance of health team.…”