RESUMO
El tratamiento combinado (TC) de la fobia social o trastorno de ansiedad social es frecuente en la práctica clínica. Sin embargo, la evidencia acerca de su superioridad sobre la psicoterapia o la farmacoterapia administradas en forma de monoterapia no está clara. En los últimos años se han publicado estudios clínicos que evalúan la eficacia del TC en la fobia social. En este artículo se realiza una revisión sistemática de estudios clínicos sobre el TC de la fobia social a través de las bases de datos: EBSCO, PubMed, Cochrane Collaboration y el Portal de Búsqueda de la Biblioteca Virtual en Salud. Se hallaron 8 estudios controlados y aleatorizados. En la mayoría de los estudios clínicos se observó una superioridad del TC sobre la monoterapia, sea psicoterapéutica o farmacológica. Se discuten estos hallazgos en función de las limitaciones metodológicas de los estudios clínicos encontrados y las sugerencias clínicas que de ellos pueden extraerse. Se concluye que existe evidencia acerca de la superioridad del TC sobre la monoterapia en el tratamiento de la fobia social aunque se sugiere cautela en la generalización de esta conclusión.
Combined treatment (CT) for patients with social anxiety disorder or social phobia is quite common in clinical practice. However, the superiority of TC over psychotherapy and/or pharmacotherapy as monotherapy is still not clear. Over the last few years, several clinical studies that evaluate the efficacy of CT in social phobia have been published. A systematic review of clinical studies about CT in social phobia was carried out in this article in the following database: EBSCO, PubMed, Cochrane Collaboration and the Portal de Búsqueda de la Biblioteca Virtual en Salud. We found 8 randomized controlled studies. There is a superiority of CT over monotherapy in most of them, either psychotherapeutic or pharmacologic. We discuss these findings in terms of the methodological limitations of all clinical studies found, and based on clinical suggestions derived therefrom. Given this, it is concluded that there is evidence about the superiority of CT over monotherapy in social phobia treatment, although caution in generalizing this conclusion is suggested.
Assuntos
Humanos , Masculino , Feminino , Psicoterapia , Tratamento Farmacológico/psicologia , Transtornos Fóbicos/psicologia , Terapia Combinada/psicologiaRESUMO
El tratamiento combinado (TC) de la fobia social o trastorno de ansiedad social es frecuente en la práctica clínica. Sin embargo, la evidencia acerca de su superioridad sobre la psicoterapia o la farmacoterapia administradas en forma de monoterapia no está clara. En los últimos años se han publicado estudios clínicos que evalúan la eficacia del TC en la fobia social. En este artículo se realiza una revisión sistemática de estudios clínicos sobre el TC de la fobia social a través de las bases de datos: EBSCO, PubMed, Cochrane Collaboration y el Portal de Búsqueda de la Biblioteca Virtual en Salud. Se hallaron 8 estudios controlados y aleatorizados. En la mayoría de los estudios clínicos se observó una superioridad del TC sobre la monoterapia, sea psicoterapéutica o farmacológica. Se discuten estos hallazgos en función de las limitaciones metodológicas de los estudios clínicos encontrados y las sugerencias clínicas que de ellos pueden extraerse. Se concluye que existe evidencia acerca de la superioridad del TC sobre la monoterapia en el tratamiento de la fobia social aunque se sugiere cautela en la generalización de esta conclusión. (AU)
Combined treatment (CT) for patients with social anxiety disorder or social phobia is quite common in clinical practice. However, the superiority of TC over psychotherapy and/or pharmacotherapy as monotherapy is still not clear. Over the last few years, several clinical studies that evaluate the efficacy of CT in social phobia have been published. A systematic review of clinical studies about CT in social phobia was carried out in this article in the following database: EBSCO, PubMed, Cochrane Collaboration and the ôPortal de Búsqueda de la Biblioteca Virtual en Saludö. We found 8 randomized controlled studies. There is a superiority of CT over monotherapy in most of them, either psychotherapeutic or pharmacologic. We discuss these findings in terms of the methodological limitations of all clinical studies found, and based on clinical suggestions derived therefrom. Given this, it is concluded that there is evidence about the superiority of CT over monotherapy in social phobia treatment, although caution in generalizing this conclusion is suggested. (AU)
Assuntos
Humanos , Masculino , Feminino , Transtornos Fóbicos/psicologia , Psicoterapia , Tratamento Farmacológico/psicologia , Terapia Combinada/psicologiaRESUMO
A young woman with Westphal variant (juvenile) Huntington disease (HD) also developed catatonia. Catatonia is an underdiagnosed psychomotor syndrome often associated with neurological and psychiatric disorders, but it has rarely been documented in patients with HD. Catatonia usually responds to standard treatment with benzodiazepines and electroconvulsive therapy; however, this patient's catatonic syndrome did not improve until we augmented the standard treatment with amantadine and levodopa. The underlying pathophysiology and a neurochemical hypothesis of HD and catatonia can explain their comorbidity and the refractoriness of catatonia to treatment. Both conditions are linked to dysregulation of neurotransmitters in the striatocortical and corticocortical pathways. This understanding may serve as a guide for the use of nonstandard treatments. Our evidence also suggests that electroconvulsive therapy can be useful and safe in the treatment of HD.
Assuntos
Catatonia/tratamento farmacológico , Catatonia/terapia , Terapia Combinada/psicologia , Dopaminérgicos/uso terapêutico , Eletroconvulsoterapia/psicologia , Doença de Huntington/psicologia , Adulto , Amantadina/uso terapêutico , Carbidopa/administração & dosagem , Carbidopa/uso terapêutico , Catatonia/complicações , Terapia Combinada/métodos , Dopaminérgicos/administração & dosagem , Combinação de Medicamentos , Resistência a Medicamentos , Eletroconvulsoterapia/métodos , Feminino , Humanos , Doença de Huntington/complicações , Doença de Huntington/tratamento farmacológico , Doença de Huntington/terapia , Levodopa/administração & dosagem , Levodopa/uso terapêuticoRESUMO
OBJECTIVE: Determine the effectiveness of surgical treatment and / or adjuvant to improve the quality of life in patients with colon cancer compared to rectal cancer. MATERIAL AND METHODS: Cohort study that evaluated 27 patients diagnosed with colon adenocarcinoma (Group A= 12) and rectum (Group B= 15) resectable treated at the Institute Regional of Neoplastic Diseases of Trujillo since the 1 January 2008 until 31 July 2009. RESULTS: The overall life quality, as assessed by the QLQ-C 30 at 3 months postoperatively was 67.86 +/- 17.90 points vs. 68.50 +/- 11.94 points respectively for the patients of groups A and B (p = 0.934).The social function was better in patients undergoing surgery for Group A than Group B , (37.50 + 13.36 points vs. 60.00 + 13.69 points, p = 0.018). Body image at 3 months assessed by the QLQ-CR-29 had an average score of 28.12 +/- 6.12 points and 50.00 +/- 25.00 points for Group A y B respectively (p = 0.034). The Group A patients had a mean score at 6 months for sexual function of 33.33 +/- 12.91 points, while Group B patients this average score was 65.00 +/- 22.36 points (p = 0.016). CONCLUSIONS: Both surgeries for colon and rectal cancer are as effective in improving the overall quality of life of these patients, however the social function, body image, and sexual function is better in colon surgery.
Assuntos
Adenocarcinoma/psicologia , Neoplasias do Colo/psicologia , Procedimentos Cirúrgicos do Sistema Digestório/psicologia , Pacientes/psicologia , Qualidade de Vida , Neoplasias Retais/psicologia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Adenocarcinoma/cirurgia , Idoso , Imagem Corporal , Quimioterapia Adjuvante/psicologia , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/radioterapia , Neoplasias do Colo/cirurgia , Terapia Combinada/psicologia , Humanos , Pessoa de Meia-Idade , Especificidade de Órgãos , Peru , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Radioterapia Adjuvante/psicologia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/psicologia , Comportamento Social , Inquéritos e QuestionáriosRESUMO
Since the fall of the Brazilian military dictatorship in 1984, a number of structural and ideological changes associated with demilitarization and democracy have changed the face of psychiatric theory and practice. Around the country, pockets of innovative, politically sensitive and Marxist-inspired community-based forms of "psi" practice are developing. This emergent psi movement is making a range of positive contributions to the lives of average citizens, including those of poor disenfranchized youth. This paper, however, explores one particular dimension of the work of psi practitioners that has proven antithetical to the psi community's current politicized community-based aims. Based on qualitative and quantitative longitudinal ethnographic fieldwork with therapists and young men in Pelotas, this paper analyzes how certain kinds of psi interventions being carried out in schools for a subset of lower-class young men during their early teen years are encouraging some youth to seek military training as a life option. Although these young men initially had quite captivating, engaged and politicized-if also conflicting-interactions with therapists, their eventual disillusionment with their therapeutic and scholastic experiences resulted in high levels of social alienation and de-politicization. In these young men's search for what can best be described as formulaic solutions to troubling psychological experiences associated with a tumultuous institutionalized transition to adulthood, military training came to represent a form of self-cultivation and self-therapy. Several youth also hoped military training would enable them to actively disengage with local political processes and find shelter from troubling social inequities and injustice. The paper ends by reviewing the implications of these results for the future of psi knowledge and practice in Brazil.
Assuntos
Transtornos de Deficit da Atenção e do Comportamento Disruptivo/terapia , Terapia Combinada/tendências , Militares/psicologia , Prática Profissional/organização & administração , Psiquiatria/métodos , Instituições Acadêmicas/organização & administração , Estudantes/psicologia , Adolescente , Adulto , Antropologia Cultural/métodos , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/epidemiologia , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Brasil/epidemiologia , Estudos de Coortes , Terapia Combinada/psicologia , Terapia Combinada/estatística & dados numéricos , Humanos , Masculino , Militares/legislação & jurisprudência , Política , Prática Profissional/tendências , Psiquiatria/organização & administração , Psiquiatria/tendências , Teoria Psicanalítica , Psicologia do Adolescente , Encaminhamento e Consulta/estatística & dados numéricos , Encaminhamento e Consulta/tendências , Instituições Acadêmicas/tendências , Mudança Social , Classe Social , Estudantes/estatística & dados numéricosRESUMO
A associação da psicofarmacoterapia à psicoterapia é prática freqüente e muitas vezes indispensável. É essencial a compreensão psicodinâmica da relação da dupla paciente/psicoterapeuta, caracterizando o tratamento combinado, e do trio paciente/psicoterapeuta/psicofarmacoterapeuta, no caso da co-terapia, já que, se negada ou pouco compreendida, pode levar ao fracasso do tratamento. Este estudo revisa os aspectos psicodinâmicos e técnicos relacionados à integração dos tratamentos psicoterápicos e psicofarmacológicos, na tentativa de buscar a maneira mais adequada de lidar com as questões transferenciais e contratransferenciais envolvidas nessas modalidades terapêuticas.
Association of psychotherapy and psychopharmacotherapy is a frequent and often indispensable practice. Understanding the psychodynamics of the patient-psychotherapist relationship, characterizing the combined treatment, and the triad patient-psychotherapist-psychopharmacotherapist, concerning split treatment, is essential, since it can lead to treatment failure if denied or poorly understood. The present study aims at reviewing the psychodynamic and technical aspects of psychopharmacologic and psychotherapeutic treatment integration, as an attempt to find the most adequate way to deal with the transference and countertransference aspects involved in these therapeutic modalities.