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INTRODUCTION: The COVID-19 pandemic had significant repercussions for the everyday life and public health of society. Healthcare professionals were particularly vulnerable. Here, we interviewed medical residents about their lived experiences during the pandemic to offer a phenomenological analysis. To this end, we discuss their pandemic experiences considering Jaspers' "limit situation" concept - that is, a radical shift from their everyday experiences, to one causing them to question the basis of their very existence. METHODS: We interviewed 33 medical residents from psychiatry and other specialties from the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) who either (a) worked directly with COVID-19 patients or (b) provided psychiatric care to other healthcare professionals. Semi-structured interviews were developed using the Inductive Process to Analyze the Structure of lived Experience (IPSE). RESULTS: The descriptions of the lived experiences of medical residents during the pandemic were organized into four content themes: (a) existential defense, (b) limit situations during the COVID-19 pandemic, (c) changes in lived experience, and (d) new world meanings through lived experience. CONCLUSION: During the COVID-19 pandemic, medical residents experienced what can be thought of as a "limit situation," as they encountered the healthcare delivery challenges coupled with the social isolation imposed by the COVID-19 pandemic. These challenges included fear of infection and potential death, uncertainty about the future, and the emotional overload caused by the sharp increase in patient deaths. That said, after facing such a limit situation, residents reported feeling strengthened by this experience. This is consistent with the notion that when confronted with limit situations, we draw on our resources to overcome adversity and, in turn, reap existential gains. Health care providers might use these experiences to energize their own professional approach.

Assuntos

COVID-19 , Internato e Residência , Médicos , Brasil , COVID-19/psicologia , Acontecimentos que Mudam a Vida , Médicos/psicologia , Psiquiatria , Entrevistas como Assunto , Existencialismo/psicologia , Mecanismos de Defesa , Ansiedade/psicologia , Humanos , Masculino , Feminino

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OBJECTIVE: It is not uncommon for medical residents to deal with critically ill patients who frequently show several ethical and human dilemmas, highlighting the need for a consultation with ethical specialists. The objective of this article is to present a description of a Brazilian Ethics Consultation group designed to attend psychiatry residents. METHODS: This article reports a case of a critically ill patient with Borderline Personality Disorder with multiple intervention failures and several ethical conflicts who was seen by a resident and supported by an ethics consultation group. RESULTS: When medical residents and medical staff face severe and unusual ethical dilemmas, they might feel unprepared and have ones' mental health impaired. Thus, this article reports a successful ethics consultation and discusses its development in other academic institutions. CONCLUSION: Medical educators and staff from academic hospitals should pay attention to the needs of the medical residents. The development and support of ethics consultation groups must be provided to fulfill the need of those residents who face serious ethical and human dilemmas.

Assuntos

Consultoria Ética , Psiquiatria , Brasil , Ética Médica , Humanos

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ABSTRACT Background: Psychiatric disorders cause significant impact to the individual, leading to lack of productivity and involvement with the legal system. Objectives: The present study aims to determine the association of mental disorders and an individuals' odds of involvement with the legal system Methods: Through a descriptive cross-sectional study, 126 patients selected according to convenience sampling were interviewed for the study on their appointment days at University of São Paulo School of Medicine hospital. They were divided into a case group (n = 63) with patients from the outpatient clinic of the Department of Psychiatry and a control group (n = 63), with patients from the outpatient clinic of Department of Internal Medicine. These patients were asked to answer a questionnaire on sociodemographic information, age, medical diagnosis, and legal proceedings as related to their diagnoses. Results: We found high difference between the groups, in longer absences 57.10% of psychiatric patients, with only 33.3% in clinical group. This difference also appears in the requirement for forensic medical exams - 65.1% of psychiatric patients versus 44.4% of clinical patients. Discussion: This data clearly shows that involvement of psychiatric patients in legal matters is quite common, and therefore it is increasingly important for psychiatrists to be aware of legal implications when evaluating their patients.

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OBJECTIVE: Many psychophysiological studies investigate whether psychopaths present low levels of electrodermal activity (EDA). However, despite evidence that varying degrees of psychopathy are normally distributed in the population, there is a paucity of EDA studies evaluating dimensionally. Moreover, although lack of empathy is a cornerstone of psychopathy, there has been a lack of studies using pictures of empathic emotional content to assess psychophysiological responses. METHOD: We studied a population of young male delinquents (n = 30) from a detention center, using the Psychopathy Checklist Revised (PCL-R) to determine if higher levels of psychopathy were related to lesser degrees of EDA in response to emotion-eliciting pictures of empathic content. RESULTS: There were significant correlations (p < 0.05) between latency and peak of EDA responses to unpleasant pictures and factor 1 scores, as well as between lability of EDA responses and factor 2 scores. CONCLUSION: These results extend previous findings indicating direct relationship between EDA and psychopathy, and suggest that separate investigations of the two PCL-R factors have the potential to unravel more complex relationships between EDA and psychopathy. Also, by demonstrating such associations using emotion-provoking stimuli with empathic content, our results provide a link between levels of psychopathy and biological indices of empathic detachment.

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O envenenamento por psicofármacos figura entre as intoxicações exógenas intencionais ou acidentais como causa freqüente de atendimentos médico-hospitalares, com considerável taxa de morbidade e mortalidade. Este artigo tem por objetivo apresentar dados epidemiológicos relevantes e revisar a conduta preconizada para estes casos, sumarizando cuidados em relação à obtenção de história clínica, exame físico e complementar, suporte básico e especializado. Procura também sistematizar as diretrizes para indicar encaminhamento à Unidade de Terapia Intensiva, internação e/ou avaliação psiquiátrica especializada.