Gonçalves Laura Lamas Martins, Campos Rosana Teresa Onocko
Universidade Federal do Maranhão, São Luís, Brasil.
Universidade Estadual de Campinas, Campinas, Brasil.
Cad Saude Publica. 2017 Nov 21;33(11):e00166216. doi: 10.1590/0102-311X00166216.
Numerous studies have highlighted the tendency to chronicity of treatments centered on the use of medications. This study was conducted in a large Brazilian city with users of Centers for Psychosocial Care (CAPS), with the aim of evaluating the effects of experimenting with the personal Guide for Autonomous Management of Medication (GAM) and the users' relationship to their treatments and participation. The instrument, created in Canada and translated and adapted to Brazil, was tested in intervention groups with users of CAPS with severe mental disorders and a history of political participation in the field of health. Focus groups and in-depth interviews were performed. The transcriptions were transformed into narratives, and four analytical categories were defined: subjects with radical experiences of suffering; experiences with medication; users' rights; and participation and political activism. In testing GAM, users expressed a tension between reproduction of illness-centered identity and the legitimate uniqueness of their personal experiences. They showed greater knowledge of the medications they were taking, began to recognize their own expertise in their use of medications, and some sought adjustments to their treatment. They reported the need for support in claiming their rights and strengthening their participation as mental health activists. In conclusion, the Brazilian version of the GAM guide has the potential to contribute to users' empowerment, thus allowing dialogue between the results in mental health care in Brazil and the international scenario.
众多研究都强调了以药物使用为中心的治疗存在慢性化倾向。本研究在巴西一个大城市对心理社会关怀中心（CAPS）的使用者开展，旨在评估试用《药物自主管理个人指南》（GAM）的效果以及使用者与治疗的关系和参与情况。该指南在加拿大创建，后被翻译并改编用于巴西，在患有严重精神障碍且有卫生领域政治参与历史的CAPS使用者干预组中进行了测试。开展了焦点小组讨论和深度访谈。转录内容被转化为叙述内容，并定义了四个分析类别：有极端痛苦经历的主体；用药经历；使用者权利；以及参与和政治行动主义。在测试GAM时，使用者在以疾病为中心的身份认同的重现与其个人经历的合法独特性之间表现出一种紧张关系。他们对所服用药物有了更多了解，开始认识到自己在用药方面的专业知识，一些人还寻求调整治疗方案。他们报告称在主张权利和加强作为心理健康活动家的参与方面需要支持。总之，巴西版的GAM指南有潜力促进使用者赋权，从而使巴西心理健康护理的结果与国际情况之间能够展开对话。
