RESUMEN
Background and Objectives: The Psychosomatic and Liaison Psychiatry is an emerging psychiatric subspecialty. This article is intended to summarize the philosophy supporting training programmes in Spain, and the recommended training guidelines. Methods: Review of the literature and teaching experience. Results: The increasing complexity of diagnosis and treatment, and the demand by patients and providers of resources for higher and more efficient quality of care, make skills training a key tool for achieving these goals. The human being is biology, feelings, thoughts, experiences and thus individuality when sick. Understanding all this is the core on which to base our competencies in this exciting crossroads between psychiatry and other medical specialties. We propose a set of competencies to achieve, and point learning spaces and evaluation mechanisms. Conclusions: Based on accumulated experiences in Spain, and the review of European and international literature, it is possible to summarize a realistic set of norms and directions for training in Psychosomatic and Liaison Psychiatry in residency programmes (AU)
Asunto(s)
Humanos , Trastornos Psicofisiológicos/terapia , Trastornos Psicofisiológicos/diagnóstico , Psiquiatría/educación , Internado y Residencia , Capacitación ProfesionalRESUMEN
La catatonia, un clásico síndrome psiquiátrico, ha pasado por diversas vicisitudes desde su descripción en el siglo XIX. En la pasada década de los 70, un grupo de autores norteamericanos conceptualiza la catatonia como un síndrome plurietiológico (orgánico, el más frecuente, aproximadamente un 76% del total; afectivo, a continuación; esquizofrénico; y tóxicoinducido), siendo la causa más frecuente la lesión o disfunción del SNC. Su fisiopatología implica alteraciones D2 y en el balance GABA/ glutamato-NMDA. Su diagnóstico diferencial pasa por una adecuada exploración somática, psicopatológica y pruebas complementarias, incluyendo drogas de abuso y descartando Sdme. Neuroléptico Maligno y Sdme. Serotoninérgico Central. Las complicaciones derivadas de la inmovilidad (tromboembolismo pulmonar, aspiración, úlceras de decúbito) deben prevenirse o tratarse precozmente. El tratamiento incluye tto. etiológico, benzodiacepinas y/o TEC (AU)
Catatonia, a classic psychiatric syndrome, has turned in its conception since its description in XIXth Century. A group of north-american authors differentiates catatonia as a pluriethiological syndrome (organic, the most prevalent, around 76%; affective, the next; schizophrenic; and drug-induced). The most common cause is damage or disfunction in CNS. Physiopathology of catatonia includes D2 disfunction and disbalance in GABAergic/ glutamatergic-NMDA systems. Differential diagnosis is based on a complete somatic, psychopathological assessment, and complementary procedures, and it must consider both Neuroleptic-Malignant Syndrome and Serotoninergic-Central Syndrome. Abuse drugs may also be implicated. Complications due to inmovility must be early diagnosed (pulmonary thromboembolism, aspiration, pressure ulcers). Finally, ethiological treatment, benzodiazepines and/or ECT may be useful therapies in catatonia (AU)