Alcohol and other substance use disorders are complex problems with multiple variables and determinants, requiring a multidimensional approach to prevention and treatment. A robust body of research shows that religiosity and spirituality (R/S) play a prominent role in these disorders; however, how to apply this knowledge remains unclear. We present practical guidelines on how to integrate R/S into substance use prevention and treatment in an ethical, evidence-based manner. These guidelines have been endorsed by prominent academic leaders in these topics and by health associations affiliated with the three major Brazilian religions. The integration of R/S is part of a respectful, person-centered, interdisciplinary approach, which imposes neither religious beliefs nor secular worldviews. The most critical interventions include collecting a history of spiritual and religious beliefs, practices, and experiences and evaluating how these may be used positively in treatment. It is also essential that health professionals are encouraged to value and respect the R/S of patients, and that religious groups recognize that professional and technical interventions can make a valuable contribution to preventing and treating these disorders. determinants RS R S (R/S however unclear ethical evidencebased evidence based manner religions respectful personcentered, personcentered person centered, centered person-centered worldviews practices patients

Objective: To propose a core curriculum for religiosity and spirituality (R/S) in clinical practice for psychiatry residency programs based on the available evidence. Methods: After performing a review of studies on the implementation of R/S curricula and identifying the most commonly taught topics and teaching methods, an R/S curriculum was developed based on the most prevalent strategies, as well as recommendations from psychiatric associations, resulting in a fairly comprehensive R/S curriculum that is simple enough to be easily implemented, even where there is a shortage of time and of faculty expertise. Results: The curriculum is a twelve-hour course (six 2-hour sessions). The topics include: concepts and evidence regarding R/S and mental health relationships, taking a spiritual history/case formulation, historical aspects and research, main local R/S traditions, differential diagnosis between spiritual experiences and mental disorders, and R/S integration in the approach to treatment. The teaching methods include: classes, group discussions, studying guidelines, taking spiritual histories, panels, field visits, case presentations, and clinical supervision. The evaluation of residents includes: taking a spiritual history and formulating an R/S case. The program evaluation includes: quantitative and qualitative written feedback. Conclusions: A brief and feasible core R/S curriculum for psychiatry residency programs is proposed; further investigation of the impact of this educational intervention is needed.

Resumo Objetivos: Religiosidade/espiritualidade (R/E) parecem ser fatores relevantes na adaptação a doenças crônicas, mas faltam estudos nessa área envolvendo pacientes com doença renal crônica (DRC). O presente estudo teve como objetivo investigar a associação entre R/E e felicidade em pacientes com DRC em hemodiálise e se o senso de coerência (SC) faz a mediação dessa possível associação. Métodos: Estudo transversal realizado em dois centros de terapia renal substitutiva no Brasil com 161 adultos em hemodiálise. Regressões lineares foram utilizadas para avaliar a associação entre R/E (variável preditora medida pelo Índice de Religiosidade de Duke - DUREL) e felicidade (variável de desfecho), ajustadas para variáveis sociodemográficas, clínicas e algumas variáveis laboratoriais. Posteriormente, o SC foi acrescentado ao modelo para testar seu possível efeito mediador. Resultados: A maioria dos pacientes (91,20%) relatou alguma afiliação religiosa. Religiosidade Privada (RP) (β = 0,53; IC 95% = 0,01 a 1,06) e Religiosidade Intrínseca (RI) (β = 0,48; IC 95% = 0,18 a 0,79) e SC (β = 0,11; IC 95% = -0,09 a 0,15) foram correlacionadas a níveis mais elevados de felicidade após controle para variáveis clínicas e sociodemográficas. Quando SC foi incluído no modelo, IR (β = 0.34; 95% IC = 0.07 a 0.60) and SC (β = 0.11; 95% IC = 0.08 a 0.14) continuaram se correlacionando significativamente com felicidade. Nenhuma variável clínica ou sociodemográfica apresentou correlação com felicidade. Conclusões: Os pacientes em hemodiálise apresentaram altos níveis de R/E, que por sua vez foi correlacionada com elevados níveis de felicidade. As variáveis clínicas e sociodemográficas não exibiram correlação com a felicidade dos pacientes. Variáveis psicossociais como R/E e SC são possíveis alvos para intervenções destinadas a promover a melhora da qualidade de sobrevida dos pacientes com DRC.

Abstract Objectives: Religiosity/spirituality (R/S) seems to be a relevant factor in chronic diseases adaptation, but there is a lack of studies involving chronic kidney disease (CKD). This study aimed to investigate the association between R/S and happiness among CKD patients on hemodialysis and whether Sense of Coherence (SC) mediates this possible association. Methods: This was a cross-sectional study in two renal replacement therapy centers in Brazil, involving 161 adults on hemodialysis. Linear regressions were performed to evaluate the association between R/S (predicting variable measured with Duke Religious Index - DUREL) and happiness (outcome variable), adjusted for sociodemographic, clinical, and some laboratory variables. Later, SC was added to the model to test the possible mediating effect. Results: Most patients (91.20%) reported some religious affiliation. Private Religiosity (PR) (β = 0.53; 95% CI = 0.01 a 1.06), Intrinsic Religiosity (IR) (β = 0.48; 95% CI = 0.18 a 0.79), and SC (β = 0.11; 95% CI = -0.09 a 0.15) correlated with higher levels of happiness, controlling for clinical and sociodemographic variables. When SC was included in the model, IR (β = 0.34; 95% CI = 0.07 to 0.60) and SC (β = 0.11; 95% CI = 0.08 to 0.14) remained significantly. No clinical or sociodemographic variable correlated with happiness. Conclusions: Patients on hemodialysis showed high levels of R/S, which correlated with higher happiness levels. Clinical and sociodemographic variables were not correlated with patients' happiness. Psychosocial variables such as R/S and SC are potential key targets for interventions to promote better survival quality among CKD patients.

ABSTRACT Objective: To investigate the forms of coping used to relieve tensions by elderly caregivers of elderly relatives and to know the type of support they receive from the Primary Health Care service at home. Method: A qualitative study with a theoretical-methodological contribution of Grounded Theory, carried out with 10 elderly caregivers interviewed between August 2014 and January 2015. Results: Participants use primarily religious coping to deal with adverse situations that arise in their lives; they attribute to the sacred the strength to continue to age and care for another elderly person at home. Religiousness was the main coping strategy used by the participants, but little recognized by the health service. Final considerations: It is recommended that the Primary Health Care service provide greater support to these caregivers and be attentive to the spiritual dimension as an auxiliary element in the process of comprehensive and inclusive health care of these elderly caregivers.

RESUMEN Objetivo: Investigar las formas de enfrentamiento utilizadas para alivio de tensiones por cuidadores ancianos de familiares ancianos y conocer el tipo de apoyo que reciben del servicio de Atención Primaria a la Salud en el domicilio. Método: Estudio cualitativo, con aporte teórico-metodológico de la Grounded Theory, realizado con 10 cuidadores ancianos entrevistados, entre agosto de 2014 y enero de 2015. Resultados: Los participantes se utilizan prioritariamente del coping religioso para enfrentar situaciones adversas que surgen en sus vidas; atribuyen al sagrado la fuerza para continuar envejeciendo y cuidar de otro anciano en el domicilio. La religiosidad fue la principal estrategia de enfrentamiento utilizada por los participantes, pero poco reconocida por el servicio de salud. Consideraciones finales: Se recomienda que el servicio de Atención Primaria a la Salud proporcione mayor apoyo a esos cuidadores y que esté atento a la dimensión espiritual como elemento auxiliar en el proceso de asistencia integral e inclusiva a la salud de esos cuidadores ancianos.

RESUMO Objetivo: Investigar as formas de enfrentamento utilizadas para alívio de tensões por cuidadores idosos de familiares idosos e conhecer o tipo de apoio que recebem do serviço de Atenção Primária à Saúde no domicílio. Método: Estudo qualitativo, com aporte teórico-metodológico da Grounded Theory, realizado com 10 cuidadores idosos entrevistados, entre agosto de 2014 e janeiro de 2015. Resultados: Os participantes utilizam-se prioritariamente do coping religioso para enfrentar situações adversas que surjam em suas vidas; atribuem ao sagrado a força para continuar a envelhecer e cuidar de outro idoso no domicílio. A religiosidade foi a principal estratégia de enfrentamento utilizada pelos participantes, porém, pouco reconhecida pelo serviço de saúde. Considerações finais: Recomenda-se que o serviço de Atenção Primária à Saúde proporcione maior apoio a esses cuidadores e que esteja atento à dimensão espiritual como elemento auxiliar no processo de assistência integral e inclusiva à saúde desses cuidadores idosos.

RESUMO Objetivo: Investigar as formas de enfrentamento utilizadas para alívio de tensões por cuidadores idosos de familiares idosos e conhecer o tipo de apoio que recebem do serviço de Atenção Primária à Saúde no domicílio. Método: Estudo qualitativo, com aporte teórico-metodológico da Grounded Theory, realizado com 10 cuidadores idosos entrevistados, entre agosto de 2014 e janeiro de 2015. Resultados: Os participantes utilizam-se prioritariamente do coping religioso para enfrentar situações adversas que surjam em suas vidas; atribuem ao sagrado a força para continuar a envelhecer e cuidar de outro idoso no domicílio. A religiosidade foi a principal estratégia de enfrentamento utilizada pelos participantes, porém, pouco reconhecida pelo serviço de saúde. Considerações finais: Recomenda-se que o serviço de Atenção Primária à Saúde proporcione maior apoio a esses cuidadores e que esteja atento à dimensão espiritual como elemento auxiliar no processo de assistência integral e inclusiva à saúde desses cuidadores idosos.

ABSTRACT Objective: To investigate the forms of coping used to relieve tensions by elderly caregivers of elderly relatives and to know the type of support they receive from the Primary Health Care service at home. Method: A qualitative study with a theoretical-methodological contribution of Grounded Theory, carried out with 10 elderly caregivers interviewed between August 2014 and January 2015. Results: Participants use primarily religious coping to deal with adverse situations that arise in their lives; they attribute to the sacred the strength to continue to age and care for another elderly person at home. Religiousness was the main coping strategy used by the participants, but little recognized by the health service. Final considerations: It is recommended that the Primary Health Care service provide greater support to these caregivers and be attentive to the spiritual dimension as an auxiliary element in the process of comprehensive and inclusive health care of these elderly caregivers.

RESUMEN Objetivo: Investigar las formas de enfrentamiento utilizadas para alivio de tensiones por cuidadores ancianos de familiares ancianos y conocer el tipo de apoyo que reciben del servicio de Atención Primaria a la Salud en el domicilio. Método: Estudio cualitativo, con aporte teórico-metodológico de la Grounded Theory, realizado con 10 cuidadores ancianos entrevistados, entre agosto de 2014 y enero de 2015. Resultados: Los participantes se utilizan prioritariamente del coping religioso para enfrentar situaciones adversas que surgen en sus vidas; atribuyen al sagrado la fuerza para continuar envejeciendo y cuidar de otro anciano en el domicilio. La religiosidad fue la principal estrategia de enfrentamiento utilizada por los participantes, pero poco reconocida por el servicio de salud. Consideraciones finales: Se recomienda que el servicio de Atención Primaria a la Salud proporcione mayor apoyo a esos cuidadores y que esté atento a la dimensión espiritual como elemento auxiliar en el proceso de asistencia integral e inclusiva a la salud de esos cuidadores ancianos.

Objective: Few quantitative studies have examined the effect of religious involvement on the course of bipolar disorder (BD). We investigated the effects of religious activity and coping behaviors on the course of depression, mania, and quality of life (QoL) in patients with BD. Methods: Two-year longitudinal study of 168 outpatients with BD. Linear regression was used to examine associations between religious predictors and outcome variables (manic symptoms, depression, QoL), controlling for sociodemographic variables. Results: Among the 158 patients reassessed after 2 years, positive religious coping at T1 predicted better QoL across all four domains: physical (β = 10.2, 95%CI 4.2 to 16.1), mental (β = 13.4, 95%CI 7.1 to 19.7), social (β = 10.5, 95%CI 3.6 to 17.33), and environmental (β = 11.1, 95%CI 6.2 to 16.1) at T2. Negative religious coping at T1 predicted worse mental (β = -28.1, 95%CI -52.06 to -4.2) and environmental (β = -20.4, 95%CI -39.3 to -1.6) QoL. Intrinsic religiosity at T1 predicted better environmental QoL (β = 9.56, 95%CI 2.76 to 16.36) at T2. Negative religious coping at T1 predicted manic symptoms (β = 4.1) at T2. Conclusion: Religiosity/spirituality (R/S) may influence the QoL of patients with BD over time, even among euthymic patients. Targeting R/S (especially positive and negative religious coping) in psychosocial interventions may enhance the quality of recovery in patients with BD.

Objective: The mind-brain problem (MBP) has marked implications for psychiatry, but has been poorly discussed in the psychiatric literature. This paper evaluates the presentation of the MBP in the three leading general psychiatry journals during the last 20 years. Methods: Systematic review of articles on the MBP published in the three general psychiatry journals with the highest impact factor from 1995 to 2015. The content of these articles was analyzed and discussed in the light of contemporary debates on the MBP. Results: Twenty-three papers, usually written by prestigious authors, explicitly discussed the MBP and received many citations (mean = 130). The two main categories were critiques of dualism and defenses of physicalism (mind as a brain product). These papers revealed several misrepresentations of theoretical positions and lacked relevant contemporary literature. Without further discussion or evidence, they presented the MBP as solved, dualism as an old-fashioned or superstitious idea, and physicalism as the only rational and empirically confirmed option. Conclusion: The MBP has not been properly presented and discussed in the three leading psychiatric journals in the last 20 years. The few articles on the topic have been highly cited, but reveal misrepresentations and lack of careful philosophical discussion, as well as a strong bias against dualism and toward a materialist/physicalist approach to psychiatry.

Abstract Introduction: Few data can be found about cardiac arrest in the intensive care unit outside reference centers in third world countries. Objective: To study epidemiology and prognostic factors associated with cardiac arrest in the intensive care unit (ICU) in an average Brazilian center. Methods: Between June 2011 and July 2014, 302 cases of cardiac arrest in the intensive care unit were prospectively evaluated in 273 patients (age: 68.9 ± 15 years) admitted in three mixed units. Data regarding cardiac arrest and cardiopulmonary resuscitation were collected in an "Utstein style" form and epidemiologic data was prospectively obtained. Factors associated with do not resuscitate orders, return of spontaneous circulation and survival were studied using binary logistic regression. Statistical package software used was SPSS 19.0 (IBM Inc., USA). Results: Among 302 cardiac arrests, 230 (76.3%) had their initial rhythm recorded and 141 (61.3%) was in asystole, 62 (27%) in pulseless electric activity (PEA) and 27 had a shockable rhythm (11.7%). In 109 (36.1%) cases, cardiac arrest had a suspected reversible cause. Most frequent suspected cardiac arrest causes were hypotension (n=98; 32.5%), multiple (19.2%) and hypoxemia (17.5%). Sixty (19.9%) cardiac arrests had do not resuscitate orders. Prior left ventricle dysfunction was the only predictor of do not resuscitate order (OR: 3.1 [CI=1.03-9.4]; P=0.04). Among patients that received cardiopulmonary resuscitation, 59 (24.4%) achieved return of spontaneous circulation and 12 survived to discharge (5.6%). Initial shockable rhythm was the only return of spontaneous circulation predictor (OR: 24.9 (2.4-257); P=0.007) and survival (OR: 4.6 (1.4-15); P=0.01). Conclusion: Cardiopulmonary resuscitation rate was high considering ICU patients, so was mortality. Prior left ventricular dysfunction was a predictor of do not resuscitate order. Initial shockable rhythm was a predictor of return of spontaneous circulation and survival.

Objective: It is unclear why some individuals reporting psychotic experiences have balanced lives while others go on to develop mental health problems. The objective of this study was to test if the personality traits of harm avoidance, self-directedness, and self-transcendence can be used as criteria to differentiate healthy from unhealthy schizotypal individuals. Methods: We interviewed 115 participants who reported a high frequency of psychotic experiences. The instruments used were the Temperament and Character Inventory (140), Structured Clinical Interview for DSM-IV, and the Oxford-Liverpool Inventory of Feelings and Experiences. Results: Harm avoidance predicted cognitive disorganization (β = 0.319; t = 2.94), while novelty seeking predicted bipolar disorder (β = 0.136, Exp [β] = 1.146) and impulsive non-conformity (β = 0.322; t = 3.55). Self-directedness predicted an overall decrease in schizotypy, most of all in cognitive disorganization (β = -0.356; t = -2.95) and in impulsive non-conformity (β = -0.313; t = -2.83). Finally, self-transcendence predicted unusual experiences (β = 0.256; t = 2.32). Conclusion: Personality features are important criteria to distinguish between pathology and mental health in individuals presenting high levels of anomalous experiences (AEs). While self-directedness is a protective factor, both harm avoidance and novelty seeking were predictors of negative mental health outcomes. We suggest that the impact of AEs on mental health is moderated by personality factors.

Resumo No início do século XIX, investigações sobre a natureza de fenômenos psíquicos/espirituais como transes e supostas aquisições de informações indisponíveis aos canais sensoriais normais geraram grande debate no meio científico. Este artigo discute as principais explicações oferecidas pelos pesquisadores dos fenômenos psíquicos entre 1811 e 1860, concentrando-se nos dois movimentos principais no período: sonambulismo magnético e espiritualismo moderno. As investigações desses fenômenos geraram diversas teorias, sem que se chegasse a consenso, mas trouxeram implicações para a compreensão da mente e de seus transtornos, notadamente na área do inconsciente e da dissociação, constituindo-se como parte importante da história da psicologia e da psiquiatria.

Abstract In the early nineteenth century, investigations into the nature of psychic/spiritual phenomena, like trances and the supposed acquisition of information unattainable using normal sensory channels, prompted much debate in the scientific arena. This article discusses the main explanations offered by the researchers of psychic phenomena reported between 1811 and 1860, concentrating on the two main movements in the period: magnetic somnambulism and modern spiritualism. While the investigations of these phenomena gave rise to multiple theories, they did not yield any consensus. However, they did have implications for the understanding of the mind and its disorders, especially in the areas of the unconscious and dissociation, constituting an important part of the history of psychology and psychiatry.

Abstract Background Studies on “Spirituality, religion and health” (R/S) have been increasing worldwide, including in Brazil. Mapping this production can help researchers to understand this field and also to identify gaps in the Brazilian R/S studies. Objective To analyze the Brazilian scientific articles on “Religion, Spirituality and Health” available on the main electronic databases using a bibliometric approach. Methods A comprehensive review of four major databases (PubMed, Scopus, BVS and Web of Science) was conducted. Three reviewers performed the data analysis. Off-topic articles, articles from Portugal, books and thesis were excluded. Articles were then classified by: Publication year, journal, Central focus in R/S, Academic Area, Main topic and Study Type. Results From 3,963 articles found, 686 studies were included in the final analysis (320 had central focus on R/S). There was an increase of articles in the last decade (most observational), with predominance of mental health issues, and from journals in the field of psychiatry, public health and nursing. Discussion This study enabled us to widen our understanding about how the field of “spirituality, religion and health” has been established and how this field is increasing in Brazil. These findings can help in the development of future Brazilian studies.

Contexto As visões dos psiquiatras sobre a relação mente-cérebro (RMC) têm marcantes implicações para a clínica e a pesquisa, mas há carência de estudos sobre esse tema. Objetivos Avaliar as opiniões dos psiquiatras sobre a RMC e se elas são suscetíveis ou não a mudanças. Métodos Realizamos um levantamento sobre as visões que os psiquiatras possuem sobre a RMC imediatamente antes e após um debate sobre a RMC no Congresso Brasileiro de Psiquiatria de 2014. Resultados Inicialmente, entre mais de 600 participantes, 53% endossaram a visão de que “a mente (o ‘Eu’) é um produto da atividade cerebral”, enquanto 47% discordaram. Além disso, 72% contestaram a visão de que “o universo é composto apenas de matéria”. Após o debate, 30% mudaram de uma visão materialista da mente para uma perspectiva não materialista, enquanto 17% mudaram na direção oposta. Conclusão Os psiquiatras se interessam por debates sobre a RMC, não possuem uma visão monolítica sobre o tema e suas opiniões estão abertas a reflexões e mudanças, sugerindo a necessidade de mais estudos em profundidade e de debates rigorosos, mas não dogmáticos sobre o tema.

Background Psychiatrists’ views on the mind-brain relationship (MBR) have marked clinical and research implications, but there is a lack of studies on this topic. Objectives To evaluate psychiatrists’ opinions on the MBR, and whether they are amenable to change or not. Methods We conducted a survey of psychiatrists’ views on the MBR just before and after a debate on the MBR at the Brazilian Congress of Psychiatry in 2014. Results Initially, from more than 600 participants, 53% endorsed the view that “the mind (your “I”) is a product of brain activity”, while 47% disagreed. Moreover, 72% contested the view that “the universe is composed only of matter”. After the debate, 30% changed from a materialist to a non-materialist view of mind, while 17% changed in the opposite way. Discussion Psychiatrists are interested in debates on the MBR, do not hold a monolithic view on the subject and their positions are open to reflection and change, suggesting the need for more in-depth studies and rigorous but open-minded debates on the subject.

Objective: Despite empirical evidence of a relationship between religiosity/spirituality (R/S) and mental health and recommendations by professional associations that these research findings be integrated into clinical practice, application of this knowledge in the clinic remains a challenge. This paper reviews the current state of the evidence and provides evidence-based guidelines for spiritual assessment and for integration of R/S into mental health treatment. Methods: PubMed searches of relevant terms yielded 1,109 papers. We selected empirical studies and reviews that addressed assessment of R/S in clinical practice. Results: The most widely acknowledged and agreed-upon application of R/S to clinical practice is the need to take a spiritual history (SH), which may improve patient compliance, satisfaction with care, and health outcomes. We found 25 instruments for SH collection, several of which were validated and of good clinical utility. Conclusions: This paper provides practical guidelines for spiritual assessment and integration thereof into mental health treatment, as well as suggestions for future research on the topic.

INTRODUÇÃO: Há alta prevalência de Experiências Anômalas (EAs), como as vivências chamadas de psicóticas, na população geral. Existe pouca informação a respeito das caraterísticas de pessoas que apresentam EAs de caráter não patológico e que buscam auxílio em instituições religiosas. OBJETIVOS: Investigar os perfis de personalidade, a qualidade de vida (QV) e a religiosidade em pessoas que apresentam EAs. MÉTODOS: Cento e quinze sujeitos que procuraram centros espíritas de Juiz de Fora/MG e que apresentavam EAs foram entrevistados: dados sociodemográficos; ITC-R (140) - (Inventário de Temperamento e Caráter, revisado e reduzido); DUREL-P (Duke University Religious Index, versão em português), e WHOQOL-BREF (Avaliação da Qualidade de Vida da Organização Mundial da Saúde - versão brasileira abreviada). RESULTADOS: Cooperatividade foi a dimensão de personalidade que obteve a maior média (77,0 ± 11,2); Religiosidade Não Organizacional obteve médias altas em 77% da amostra; 58,9% dos sujeitos eram Espíritas; QV psicológica obteve a média mais baixa (61,1 ± 19,4) e a mais alta foi QV física (67,1 ± 18,2). CONCLUSÕES: Os indivíduos com EAs que buscam auxílio parecem constituir uma população de risco para transtornos mentais ou problemas emocionais em geral, sendo preciso desenvolver abordagens adequadas e mais estudos sobre o tema.

INTRODUCTION: There is a high prevalence of Anomalous Experiences (AEs), as psychotic experiences, in the general population. There is little information about characteristics of people with non-pathological AEs seeking religious institutions. OBJECTIVES: To investigate personality profiles, quality of life (QoL) and religiosity in people with EAs. METHODS: One hundred and fifteen subjects who sought Spiritist Centers in Juiz de Fora/MG, Brazil, and who had AEs were interviewed: sociodemographic data; ITC-R (140) - (Temperament and Character Inventory, revised), Durel-P (Duke Religious Index, Portuguese version), and WHOQOL-BREF (Assessment of Quality of Life of the World Health Organization-Brazilian abbreviated version). RESULTS: Cooperativity was the personality dimension with the highest mean (77.0 ± 11.2). High non-organizational religiousness was reported by 77% of the sample; 58.9% were affiliated to Spiritism; psychological dimension of QoL had the lowest mean (61.1 ± 19.4) and physical domain the highest (67.1 ± 18.2). CONCLUSIONS: Individuals with AEs who seek help seem to be a population at risk for mental or emotional problems in general, being necessary to develop appropriate approaches and more studies about the topic.