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      Intervención de la esquizofrenia desde el modelo comunitario Translated title: Intervention of Schizophrenia From the Community Model

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          Abstract

          Introducción: La esquizofrenia es una enfermedad compleja cuyo manejo farmacológico es una medida terapéutica insuficiente para garantizar la adaptación a la comunidad y el restablecimiento de la calidad de vida del paciente, por lo que es necesario un manejo multidimensional, propuesto por las intervenciones comunitarias. Metodología: reporte de caso. Resultados: Se trata de un caso clínico que ilustra la respuesta a un tratamiento multidisciplinario basado en el modelo comunitario de atención a la salud mental en Envigado, Colombia. Discusión: El manejo de la esquizofrenia exige intervenciones multimodales que incluyan la detección en comunidad, la psicoeducación de los individuos, sus familias y la sociedad, y el abordaje de distintas áreas de funcionamiento que permitan la adaptación del sujeto a su ambiente social. Conclusiones: Es necesaria una intervención integradora que el modelo comunitario puede proporcionar implementando políticas que permitan su aplicación.

          Translated abstract

          Introduction: Schizophrenia is a complex disease for which pharmacological management is an insufficient therapeutic measure to ensure adaptation to the community and restoring the quality of life of the patient, with a multidimensional management and community interventions being necessary. Methodology: Case report. Results: This case report illustrates a multidisciplinary treatment response, based on a community care model for mental health from Envigado, Colombia. Discussion: The management of schizophrenia requires multimodal interventions that include community screening, psychoeducation of individuals, their families and society, addressing different areas of operation that allow adaptation of the subject to his social environment. Conclusions: A integrated intervention that can be provided on a Community scale, with the implementation of policies that allow it to be applied.

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          Most cited references24

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          Informe sobre la salud en el mundo 2001. Salud mental, nuevos conocimientos, nuevas esperanzas

          (2001)
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            Economic impacts of assertive community treatment: a review of the literature.

            Assertive community treatment (ACT) is an extensively studied and widely imitated community support treatment model for severely mentally ill individuals. Several previous reviews have documented its favourable effects on clients and their families. This is the first review to focus on economic outcomes. Nineteen randomized studies and 15 nonrandomized studies describing ACT programs were identified based on 2 criteria: 1) provision of services primarily in the community and 2) shared caseloads. Percentage reduction in hospital days was calculated for the 34 study sites where reported data allowed it. Multiple-regression methods were used to relate reduction in hospital days to program fidelity and other contextual factors. The impacts of ACT on emergency-room use, use of outpatient services, housing, costs, and other economic outcomes were also examined. Higher-fidelity programs appear to reduce hospital days by about 23 percentage points more than lower-fidelity programs (95% CI = -41.2, -5.2). The estimated regression coefficients imply that a high-fidelity program reduces hospitalizations by about 58% over 1 year if the alternative involves some type of case management and by 78% if it does not. ACT appears to increase the proportion of clients who live in independent housing situations, but the effect on use of supervised housing, and therefore on housing costs, is ambiguous. The effects on use of most other resources are inconsistent across studies. Overall, ACT appears to result in somewhat lower costs, whatever the perspective of analysis adopted. The most reliable cost offset to ACT treatment costs appears to be reduced hospital use. Using Quebec costs, an ACT program must enroll people with prior hospital use of about 50 days yearly, on average, to break even. As care systems evolve to reduce their reliance on hospitalization as a care modality with or without ACT, this threshold will become increasingly difficult to achieve. The primary justification for implementing ACT services will then become their clinical benefits.
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              Historia de la locura en la época clásica

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rcp
                Revista Colombiana de Psiquiatría
                rev.colomb.psiquiatr.
                Asociacion Colombiana de Psiquiatria.
                0034-7450
                January 2016
                : 45
                : 1
                : 46-50
                Affiliations
                [1 ] Universidad CES Colombia
                [2 ] Universidad de Antioquia Colombia
                Article
                S0034-74502016000100008
                10.1016/j.rcp.2015.09.001
                26896404
                4d278c97-2e22-4600-8bbe-e423180fdb7c

                http://creativecommons.org/licenses/by/4.0/

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                Product

                SciELO Colombia

                Self URI (journal page): http://www.scielo.org.co/scielo.php?script=sci_serial&pid=0034-7450&lng=en
                Categories
                PSYCHIATRY

                Clinical Psychology & Psychiatry
                Esquizofrenia,Soporte social,Estigma Salud mental,Psiquiatría comunitaria,Schizophrenia,Social support,Stigma,Mental health,Community psychiatry

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