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En este trabajo analítico y cualitativo presentamos los resultados de una investigación aplicada a cinco chicas con diagnóstico de anorexia nerviosa o trastorno alimentario no especificado. Utilizamos metodología de la sociología clínica en seis sesiones grupales y dos entrevistas individuales, para conocer las instancias psíquicas que se ponen en juego cuando la joven con anorexia nerviosa es capaz de lastimar su cuerpo tan gravemente, y continuar con esa dinámica a veces hasta la muerte. Encontramos que no las mueve un ideal de delgadez estético y que la enfermedad es regulada por el superyó, sostenida por lo que llamamos mandatos sociales superyóicos, que son frases coaguladas -carentes de sentido-, que las instala en un fuera de control, como un regulador implacable, propiciando el dominio de la pulsión de muerte...
Assuntos
Humanos , Anorexia Nervosa , Corpo Humano , PsicanáliseRESUMO
BACKGROUND: There are no reliable and valid instruments in Mexico for breast cancer patients. Our objective was to measure reliability and validity of a Spanish version of the FACT-B (Functional Assessment of Cancer Therapy-Breast) questionnaire in Mexican population. METHODS: The translation of the questionnaire was reviewed and minor changes were made. The instrument was applied to 142 patients recently diagnosed with breast cancer. It was applied to 105 for the second time, and to 75 for the third time. An analysis of item discrimination was made. The questionnaire's reliability was determined by Cronbach's alpha. Concurrent validity was determined by an analysis of correlations between the instrument's scales and EORTC's QLQ C-30 y BR-23 scales. RESULTS: The five FACT-B subscales were reliable, their alpha coefficients varied between 0.65 and 0.82. The entire scale obtained a value of 0.87. The correlation analysis between FACT-B and EORTC QLQ C-30 subscales indicated that the same construct was being evaluated. CONCLUSIONS: FACT-B is a valid, reliable and sensitive instrument to measuring quality life in Mexican breast cancer patients.
Assuntos
Neoplasias da Mama , Qualidade de Vida , Inquéritos e Questionários , Neoplasias da Mama/diagnóstico , Feminino , Humanos , Estudos ProspectivosRESUMO
El intento de suicidio en los pacientes diagnosticados con Trastorno Límite de la Personalidad (TLP) es la causa más frecuente de hospitalización en esta categoría clínica, los riesgos suicidas constituyen con frecuencia la presentación del padecimiento. Los pacientes recaen continuamente generando altos costos personales-familiares, de hospitalización en tratamientos, medicación e incapacidades laborales en personas económicamente activas, siendo el costo más alto, la pérdida de la vida humana. La Asociación Psiquiátrica Americana, en el Manual del DSM-IV, define el trastorno límite de la personalidad como: <
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At the Department of Psychology of the Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes' (INPERIER), a hospital specialized in reproductive problems, we have detected a high proportion of couples with sexual problems. Therefore we decided to develope a line of research on human sexuality. Ever since, several exploratory studies have taken place with the aim of assessing the prevalence and the frequency of sexual dysfunction in both women and men attending the INPERIER. Our studies showed that 52% of women had one or more sexual dysfunctions and 38.8% of men had one or more sexual dysfunctions. Objective The main purpose of the study was to identify (in women and men) the relationship and the combination between hypoactive sexual desire disorder and some intervening variables catalogued as personality factors: gender role, self-esteem and locus of control. We also analysed sexual backgrounds by indentifying: child sexual traumatic experience, sexual information available, sex fears, masturbation and couple problems; in order to propose a profile of the relationship between psychological factors and hypoactive sexual desire in women and men. Material and methods A non-experimental, retrospective, transversal, field study with a correlation-multivariate design was used, which consisted of two independent samples divided into four groups selected through intentional sampling by quotas. This study is part of a larger research study aimed to assess risk factors for feminine and masculine sexual dysfunctions, whose original sample size was 400 participants. Out of this sample only participants with hypoactive sexual desire were selected, so in the end the groups included 58 women and 55 men. However, they were compared with the same number of participants with no sexual dysfunction. The groups were organized as follows: Group 1, women or men with no sexual dysfunction; Group 2, women or men who presented hypoactive sexual desire disorder. The participants included in the study were INPERIER regular patients. Samples were handled individually. In order to have an accurate sample all participants had to cover the selection criteria. Additionally, in order to place participants in the right group we used the Codified Clinical History Form on Female Sexuality (CCHFFS) for women -which also was used to examine their sexual background information- and in the case of men, we used the Male Sexuality Questionnaire. Furthermore the measurement of personality items was done by using the Inventory of Masculinity and Femininity IMAFE, the Coppersmith Self-Esteem Inventory and the Internal-External Locus of Control Scales. Sexuality questionnaires as well as other measurement instruments were applied at the External Clinic area during a single session followed by the transcription of data. In order to analyse the results we applied measures of central tendency to describe the socio-demographic factors (such as: age, civil status and education); for the analysis of personality factors (role of gender, self-esteem and locus of control) and its relationship with hypoactive sexual desire disorder we used the Student's T-test and estimated the Eta coefficient. The analysis of sexual background (child sexual traumatic experience, sexual information, sex fears, masturbation and couple problems) and its relationship with hypoactive sexual desire disorder was calculated by χ² and Cramer's V. Data analysis was performed with the statistical and data management package SPSS version 11. Results The thrown results showed that the descriptive analysis of data from women and men had a normal distribution. Also, results indicate that women with a hypoactive sexual desire disorder present a decrease in masculinity features and in their self-esteem level, and an increase in the submissive features when compared to women with no sexual dysfunction. When we analyzed the results of the sexual background in this group, we found a relationship between hypoactive sexual desire and child sexual traumatic experience, and between sex fears and couple problems, suggesting that these variables significantly intervene in the presence of hypoactive sexual desire disorder during women's adult life. In the discriminant analysis we obtained just one factor out of the six previously isolated variables with 75% of the cases correctly classified, indicating that this proportion of women with hypoactive sexual desire disorder are related to such indicators, the variables discriminated were an approximate explanation for the disorder. The results in the other group showed that in men with hypoactive sexual desire disorder there is a decrease in masculinity and femininity features and in the levels of self-esteem, plus an increase in the submissive features when compared to men with no sexual dysfunction. When we analyzed sexual background information, we found in the group with hypoactive sexual desire disorder that sex fears and couple problems significantly intervene in men's adult life. The discriminant analysis revealed a single factor with the six variables previously isolated, with 68.6% of cases correctly classified, which shows that men with hypoactive sexual desire disorder also have a relationship with the indicators, being the discriminated variables an approximate explanation. Conclusions When we discussed the results, we observed differences in two ways. First, for both women and men there was a decrease in masculinity features, defined as conducts directed to action, with well-defined, self-affirmed and self-reflective targets. Also there was a decrease in self-esteem, defined as the personal value judgment expressed as the individual's attitudes towards himself and the subjective experience transmitted to others; when masculinity features and self-esteem are diminished they may have an impact on sexuality, becoming a risk factor. In the group of men we also observed a decrease in the femininity features, defined as the traits aimed at feelings and abstraction, the expression of affection, the desire to provide protection as well as to experience nature feelings. When these three factors predominate they turn out to be a protective factor for an adequate practice of sexuality; both masculinity and femininity features could appear together or independently. In a second way, both in women and men we observed an increase in the submissive behavior, a risk indicator for the development of sexuality, because of the presence of self-denial, dependency, conformism, shyness and the capacity to endure suffering, features all shown as particular conducts. When it comes to sexual background in women, we found a close relationship with child sexual traumatic experience, sex fears and couple problems. In the case of men, the hypoactive sexual desire disorder was related to sex fears and couple problems. In this respect, in the review made by Basson, she mentions a new body of evidence that confirms what we have found in this study. She indicates that there are psychological factors that inhibit sexuality in women, for example, a history of child sexual traumatic experience may have a major impact in their sexual development, particularly in desire.
En el Departamento de Psicología del Instituto Nacional de Perinatología <
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Objetivo: Este trabajo tiene como finalidad la presentación de una propuesta de lineamientos para una psicoterapia dirigida a pacientes sujetas a tratamientos de reproducción asistida en instituciones de salud pública. Dichos lineamientos surgen a partir de los resultados obtenidos en una investigación realizada a esta población que tuvo como finalidad detectar los factores relevantes que influyen en su deseo de maternidad.Material y métodos: El estudio del que se parte fue realizado a 100 mujeres de 25 a 40 años de edad diagnosticadas de esterilidad primaria y que acudieron al Servicio de Reproducción Humana del Servicio de Ginecología del Centro Médico Nacional "20 de Noviembre" del ISSSTE para su tratamiento. A todas las pacientes se les realizaron de seis a ocho entrevistas a profundidad, semi-dirigidas, con el fin de facilitar las respuestas a indicadores clínicos previamente establecidos. Se escogieron diez casos representativos para su análisis a profundidad de acuerdo a una metodología interpretativa denominada teoría fundamentada en los datos.Resultados: En el estudio realizado se detectaron diversos factores que influyen en la decisión del grupo seleccionado de someterse reiterada e insistentemente a tratamientos de reproducción asistida. Entre ellos se encuentran de manera central el imaginario social genérico, las fallas en la estructura narcisista de la personalidad y el hijo imaginario A partir de este estudio, de las observaciones preliminares y el aporte de otros especialistas, se proponen lineamientos a seguir para llevar a cabo una psicoterapia focalizada en la paciente estéril que presenta una insistencia a someterse a tratamientos de R.A.Conclusiones: Dada la complejidad del fenómeno estudiado, es relevante llevar a cabo no sólo un trabajo individual con la paciente estéril, sino también considerar tanto sus redes de apoyo como el personal médico responsable. Se establecen elementos para trabajar con estas pacientes en la modalidad de psicoterapia breve focalizada, tomando en cuenta los niveles de acción-interacción, el imaginario social sobre el género, las fallas narcisistas de la personalidad y el hijo imaginario, en función de reestructurar estos factores en un proyecto identificatorio adecuado a su realidad psíquica, afectiva y socioeconómica.