A crítica da doença na esquizofrenia
estudo comparativo entre pacientes e familiares
Palavras-chave:
Esquizofrenia, Conscientização, Auto-imagem, Relações familiares, Meio socialResumo
CONTEXTO: A despeito do reconhecimento da importância de fatores socioculturais na crítica da doença, a literatura recente sobre esse tema é escassa. OBJETIVOS: 1) traduzir e adaptar o Schedule for Assessment of Insight (SAI) para a língua portuguesa; 2) utilizar uma versão modificada deste instrumento para avaliar a crítica dos familiares em relação à esquizofrenia; 3) comparar a crítica dos pacientes com a de seus familiares. TIPO DE ESTUDO: Estudo transversal LOCAL DO ESTUDO: Ambulatório do Projeto Esquizofrenia do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Projesq). MÉTODOS: 40 pacientes com diagnóstico de esquizofrenia (Manual Diagnóstico e Estatístico de Transtornos Mentais – Quarta edição – DSM-IV) em tratamento ambulatorial e seus respectivos familiares foram entrevistados pela SAI e por uma versão modificada deste instrumento respectivamente. RESULTADOS: Os familiares apresentaram melhores notas que os pacientes nas avaliações parciais e total da SAI [total 13,0 e 8,75 (p < 0,001); aderência 3,9 e 3,4 (p < 0,005); reconhecimento da doença 5,5 e 3,5 (p < 0,001); reconhecimento dos fenômenos psicóticos 3,6 e 1,9 (p < 0,001)]. No entanto, quando as notas foram correlacionadas entre cada par paciente-familiar, a única nota parcial que teve uma correlação negativa foi o reconhecimento correto dos fenômenos psicóticos (r = -0,14), enquanto os outros tiveram correlações positivas (total r = 0,401; aderência r = 0,410; reconhecimento da doença r = 0,422). DISCUSSÃO: Não houve correlação entre as notas dos familiares e dos pacientes na habilidade de reconhecer os sintomas psicóticos como anormais. Isso pode ser entendido como uma menor influência dos fatores socioculturais nesta dimensão. A presença de características psicopatológicas e neuropsicológicas nos familiares pode ter influenciado estes resultados. O fato de os familiares não terem sido avaliados para estes déficits é uma limitação deste estudo. CONCLUSÃO: Diferentes dimensões da crítica da doença não são igualmente influenciadas pela doença e fatores socioculturais. O reconhecimento da doença parece sofrer maior influência dos fatores socioculturais que o componente reconhecimento correto dos fenômenos psicóticos.
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