Primeiro episódio psicótico: atendimento de emergência
DOI:
https://doi.org/10.25118/2763-9037.2014.v4.183Palavras-chave:
Psicoses, primeiro episódio psicótico, emergência psiquiátricaResumo
O termo psicose é usado para descrever um estado mental em que o indivíduo perde o contato com a realidade, e a etapa inicial de manifestação dos sintomas psicóticos define o primeiro episódio psicótico (PEP). Este artigo apresenta conceitos e dados gerais sobre PEP, apresenta fatores de risco e provê orientações sobre o diagnóstico (inclusive diagnósticos diferenciais), tratamento e acompanhamento de pacientes com PEP, com destaque para o papel das emergências psiquiátricas. As diferentes fases das psicoses também são descritas. Como conclusão, os autores salientam a importância da identificação e investigação dos casos, o início precoce do tratamento e o acompanhamento aproximado e individualizado dos pacientes.
Downloads
Métricas
Referências
Breitborde NJ, Srihari VH, Woods SW. Review of the operational defi nition for fi rst-episode psychosis. Early Interv Psychiatry. 2009;3:259-65. DOI: https://doi.org/10.1111/j.1751-7893.2009.00148.x
Reay R, Mitford E, McCabe K, Paxton R, Turkington D. Incidence and diagnostic diversity in fi rst-episode psychosis. Acta Psychiatr Scand. 2010;121:315-9. DOI: https://doi.org/10.1111/j.1600-0447.2009.01505.x
Ballageer T, Malla A, Manchanda R, Takhar J, Haricharan R. Is adolescent-onset fi rst-episode psychosis different from adult onset? J Am Acad Child Adolesc Psychiatry. 2005;44:782-9. DOI: https://doi.org/10.1097/01.chi.0000164591.55942.ea
Menezes PR, Scazufca M, Busatto G, Coutinho LM, McGuire PK, Murray RM. Incidence of fi rst-contact psychosis in Sao Paulo, Brazil. Br J Psychiatry Suppl. 2007;51:s102-6. DOI: https://doi.org/10.1192/bjp.191.51.s102
Nuechterlein KH, Dawson ME. A heuristic vulnerability/stress model of schizophrenic episodes. Schizophr Bull. 1984;10:300-12. DOI: https://doi.org/10.1093/schbul/10.2.300
van Os J, Kenis G, Rutten BP. The environment and schizophrenia. Nature. 2010;468:203-12. DOI: https://doi.org/10.1038/nature09563
Rutten BP, Mill J. Epigenetic mediation of environmental infl uences in major psychotic disorders. Schizophr Bull. 2009;35:1045-56. DOI: https://doi.org/10.1093/schbul/sbp104
Rapoport JL, Addington AM, Frangou S, Psych MR. The neurodevelopmental model of schizophrenia: update 2005. Mol Psychiatry. 2005;10:434-49. DOI: https://doi.org/10.1038/sj.mp.4001642
Cantor-Graae E, Selten JP. Schizophrenia and migration: a meta-analysis and review. Am J Psychiatry. 2005;162:12-24. DOI: https://doi.org/10.1176/appi.ajp.162.1.12
Sipos A, Rasmussen F, Harrison G, Tynelius P, Lewis G, Leon DA, et al. Paternal age and schizophrenia: a population based cohort study. BMJ. 2004;329:1070.11. Eaton WW, Mortensen PB, Frydenberg M. Obstetric factors, urbanization and psychosis. Schizophr Res. 2000;43:117-23. DOI: https://doi.org/10.1136/bmj.38243.672396.55
Marcelis M, Navarro-Mateu F, Murray R, Selten JP, Van Os J. Urbanization and psychosis: a study of 1942–1978 birth cohorts in The Netherlands. Psychol Med. 1998;28:871-9. DOI: https://doi.org/10.1017/S0033291798006898
Tandon R, Keshavan MS, Nasrallah HA. Schizophrenia, “just the facts” what we know in 2008. 2. Epidemiology and etiology. Schizophr Res. 2008;102:1-18. DOI: https://doi.org/10.1016/j.schres.2008.04.011
Barros RE, Tung TC, Mari Jde J. [Psychiatric emergency services and their relationships with mental health network in Brazil]. Rev Bras Psiquiatria. 2010;32:S71-7. DOI: https://doi.org/10.1590/S1516-44462010000600003
Barros RE, Marques JM, Carlotti IP, Zuardi AW, Del-Ben CM. Short admission in an emergency psychiatry unit can prevent prolonged lengths of stay in a psychiatric institution. Rev Bras Psiquiatr. 2010;32:145-51. DOI: https://doi.org/10.1590/S1516-44462009005000014
Del-Ben CM, Marques JM, Sponholz A Jr, Zuardi AW. [Mental health policies and changes in emergency service demand]. Rev Saude Publica. 1999;33:470-6. DOI: https://doi.org/10.1590/S0034-89101999000500006
McGorry PD. Psychoeducation in fi rst-episode psychosis: a therapeutic process. Psychiatry. 1995;58:313-28. DOI: https://doi.org/10.1080/00332747.1995.11024736
Garden G. Physical examination in psychiatric practice. Adv Psychiatr Treat. 2005;11:142-9. DOI: https://doi.org/10.1192/apt.11.2.142
Freudenreich O, Schulz SC, Goff DC. Initial medical work-up of fi rst-episode psychosis: a conceptual review. Early Interv Psychiatry. 2009;3:10-8. DOI: https://doi.org/10.1111/j.1751-7893.2008.00105.x
Sheitman BB, Lee H, Strous R, Lieberman JA. The evaluation and treatment of fi rst-episode psychosis. Schizophr Bull. 1997;23:653-61. DOI: https://doi.org/10.1093/schbul/23.4.653
Manjunatha N, Saddichha S. Brain imaging in psychiatry--a study of 435 psychiatric in-patients at a university clinic. Acta Psychiatr Scand. 2007;115:492; author reply 492. DOI: https://doi.org/10.1111/j.1600-0447.2007.01023.x
Lubman DI, Velakoulis D, McGorry PD, Smith DJ, Brewer W, Stuart G, et al. Incidental radiological fi ndings on brain magnetic resonance imaging in fi rstepisode psychosis and chronic schizophrenia. Acta Psychiatr Scand. 2002;106:331-6. DOI: https://doi.org/10.1034/j.1600-0447.2002.02217.x
Mochcovitch MD, Baczynski TP, Chagas MHC, Papelbaum M, Silva AG, Hallak JEC et al. Primeiro episódio psicótico (PEP): diagnóstico e diagnóstico diferencial [Internet]. 2012 [cited 2014 Nov 19]. http://www.projetodiretrizes.org.br/diretrizes11/primeiro_episodio_psicotico.pdf
Khandanpour N, Hoggard N, Connolly DJ. The role of MRI and CT of the brain in first episodes of psychosis. Clin Radiol. 2013;68:245-50. DOI: https://doi.org/10.1016/j.crad.2012.07.010
Conrad K. La esquizofrenia incipiente. Madri: Alhambra. 1963.
Fridgen GJ, Aston J, Gschwandtner U, Pflueger M, Zimmermann R, Studerus E, et al. Help-seeking and pathways to care in the early stages of psychosis. Soc Psychiatry Psychiatr Epidemiol. 2013;48:1033-43. DOI: https://doi.org/10.1007/s00127-012-0628-0
Platz C, Umbricht DS, Cattapan-Ludewig K, Dvorsky D, Arbach D, Brenner HD, et al. Help-seeking pathways in early psychosis. Soc Psychiatry Psychiatr Epidemiol. 2006;41:967-74. DOI: https://doi.org/10.1007/s00127-006-0117-4
Kirkpatrick B, Buchanan RW, Ross DE, Carpenter WT Jr. A separate disease within the syndrome of schizophrenia. Arch Gen Psychiatry. 2001;58:165-71. DOI: https://doi.org/10.1001/archpsyc.58.2.165
Hovington CL, Bodnar M, Joober R, Malla AK, Lepage M. Identifying persistent negative symptoms in first episode psychosis. BMC Psychiatry. 2012;12:224. DOI: https://doi.org/10.1186/1471-244X-12-224
Sands JR, Harrow H. Depression during the longitudinal course of schizophrenia. Schizophr Bull. 1999;25:157-71. DOI: https://doi.org/10.1093/oxfordjournals.schbul.a033362
Addington D, Addington J, Patten S. Depression in people with first-episode schizophrenia. Br J Psychiatry Suppl. 1998;172:90-2. DOI: https://doi.org/10.1192/S0007125000297729
Bottlender R, Strauss A, Moller HJ. Prevalence and background factors of depression in first admitted schizophrenic patients. Acta Psychiatr Scand. 2000;101:153-60. DOI: https://doi.org/10.1034/j.1600-0447.2000.90063.x
Romm KL, Rossberg JI, Berg AO, Barrett EA, Faerden A, Agartz I, et al. Depression and depressive symptoms in first episode psychosis. J Nerv Ment Dis. 2010;198:67-71. DOI: https://doi.org/10.1097/NMD.0b013e3181c81fc0
International Early Psychosis Association Writing Group. International clinical practice guidelines for early psychosis. Br J Psychiatry Suppl. 2005;48:s120-4. DOI: https://doi.org/10.1192/bjp.187.48.s120
Robinson D, Woerner MG, Alvir JM, Bilder R, Goldman R, Geisler S, et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry. 1999;56:241-7. DOI: https://doi.org/10.1001/archpsyc.56.3.241
Robinson DG, Woerner MG, McMeniman M, Mendelowitz A, Bilder RM. Symptomatic and functional recovery from a first episode of
schizophrenia or schizoaffective disorder. Am J Psychiatry. 2004;161:473-9. DOI: https://doi.org/10.1176/appi.ajp.161.3.473
Jaaskelainen E, Juola P, Hirvonen N, McGrath JJ, Saha S, Isohanni M, et al.A systematic review and metaanalysis of recovery in schizophrenia. Schizophr Bull. 013;39:1296-306. DOI: https://doi.org/10.1093/schbul/sbs130
Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T. Association between duration of untreated psychosis and outcome in cohorts of firstepisode patients: a systematic review. Arch Gen Psychiatry. 2005;62:975-83. DOI: https://doi.org/10.1001/archpsyc.62.9.975
Birchwood M, Todd P, Jackson C. Early intervention in psychosis. The critical period hypothesis. Br J Psychiatry Suppl. 1998;172:53-9. DOI: https://doi.org/10.1192/S0007125000297663
McGorry PD, Killackey E, Yung A. Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry. 2008;7:148-56. DOI: https://doi.org/10.1002/j.2051-5545.2008.tb00182.x
Wiersma D, Nienhuis FJ, Slooff CJ, Giel R. Natural course of schizophrenic disorders: a 15-year followup of a Dutch incidence cohort. Schizophr Bull. 1998;24:75-85. DOI: https://doi.org/10.1093/oxfordjournals.schbul.a033315
Craig TJ, Ye Q, Bromet EJ. Mortality among first-admission patients with psychosis. Compr Psychiatry.2006;47:246-51. DOI: https://doi.org/10.1016/j.comppsych.2005.11.004
Bjorkenstam C, Björkenstam E, Hjern A, Bodén R, Reutfors J. Suicide in first episode psychosis: a nationwide cohort study. Schizophr Res. 2014;157:1-7. DOI: https://doi.org/10.1016/j.schres.2014.05.010
Way BB, Banks S. Clinical factors related to admission and release decisions in psychiatric emergency services. Psychiatr Serv. 2001;52:214-8. DOI: https://doi.org/10.1176/appi.ps.52.2.214
Spencer E, Birchwood M, McGovern D. Management of first-episode psychosis. Adv Psychiatr Treat. 2001;7:133-40. DOI: https://doi.org/10.1192/apt.7.2.133
Crossley NA, Constante M, McGuire P, Power P. Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: meta-analysis. Br J Psychiatry. 2010;196:434-9. DOI: https://doi.org/10.1192/bjp.bp.109.066217
Zhang JP, Gallego JA, Robinson DG, Malhotra AK, Kane JM, Correll CU. Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis. Int J Neuropsychopharmacol. 2013;16:1205-18. DOI: https://doi.org/10.1017/S1461145712001277
Lehman AF, Lieberman JA, Dixon LB, McGlashan TH,Miller AL, Perkins DO, et al. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry. 2004;161:1-56.
Royal Australian and New Zealand College of Psychiatrists. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders [Internet]. 2005 [cited 2014 Nov 19]. https://www.ranzcp.org/Files/Resources/Publications/CPG/Clinician/CPG_Clinician_Full_Schizophrenia-pdf.aspx
Cremniter D, Payan C, Meidinger A, Batista G, Fermanian J. Predictors of short-term deterioration and compliance in psychiatric emergency patients: a prospective study of 457 patients referred to the emergency room of a general hospital. Psychiatry Res. 2001;104:49-59. DOI: https://doi.org/10.1016/S0165-1781(01)00293-1
Tohen M, Strakowski SM, Zarate C Jr, Hennen J, Stoll AL, Suppes T, et al. The McLean-Harvard fi rstepisode project: 6-month symptomatic and functional outcome in affective and nonaffective psychosis. Biol Psychiatry. 2000;48:467-76. DOI: https://doi.org/10.1016/S0006-3223(00)00915-X
Whitehorn D, Brown J, Richard J, Rui Q, Kopala L. Multiple dimensions of recovery in early psychosis. Int Rev Psychiatry. 2002;14:273-83. DOI: https://doi.org/10.1080/0954026021000016914
Penn DL, Waldheter EJ, Perkins DO, Mueser KT, Lieberman JA. Psychosocial treatment for fi rstepisode psychosis: a research update. Am J Psychiatry. 2005;162:2220-32. DOI: https://doi.org/10.1176/appi.ajp.162.12.2220
Brietzke E, Araripe Neto AG, Dias A, Mansur RB, Bressan RA. Early intervention in psychosis: a map of clinical and research initiatives in Latin America. Rev Bras Psiquiatr. 2011;33:s213-24. DOI: https://doi.org/10.1590/S1516-44462011000600007
Brasil, Centro Cultural Ministério da Saúde. Caps e outros serviços [Internet]. 2014 [cited 2014 Nov 19]. http://www.ccs.saude.gov.br/saudemental/capsacre.php
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial 4.0 International License.
Debates em Psiquiatria permite que o (s) autor (es) mantenha(m) seus direitos autorais sem restrições. Atribuição-NãoComercial 4.0 Internacional (CC BY-NC 4.0) - Debates em Psiquiatria é regida pela licença CC-BY-NC
