RESUMEN
Androgen deprivation is a therapeutic option for patients with prostate cancer, however with a range of side effects that negatively affects their physical and psychological condition. A multidisciplinary care program, ADAPP ("Androgenic deprivation in prostate cancer patients"), has been created with a special focus on managing these side effects. This article describes the intervention of the liaison psychiatry within this program, with care options ranging from psychological support to intensive psychotherapy to address patients' intrapsychic dynamics throughout this care program. Clinical cases are reported to illustrate the relevance and the necessity of this specialized counselling.
Asunto(s)
Antagonistas de Andrógenos/administración & dosificación , Consejo , Grupo de Atención al Paciente , Neoplasias de la Próstata/terapia , Anciano , Anciano de 80 o más Años , Antagonistas de Andrógenos/efectos adversos , Consejo/métodos , Depresión/inducido químicamente , Depresión/prevención & control , Disfunción Eréctil/inducido químicamente , Disfunción Eréctil/prevención & control , Fatiga/inducido químicamente , Fatiga/prevención & control , Humanos , Comunicación Interdisciplinaria , Libido/efectos de los fármacos , Masculino , Persona de Mediana Edad , Osteoporosis/inducido químicamente , Osteoporosis/prevención & control , Neoplasias de la Próstata/tratamiento farmacológico , Psicoterapia , Trastornos del Inicio y del Mantenimiento del Sueño/inducido químicamente , Trastornos del Inicio y del Mantenimiento del Sueño/prevención & control , Resultado del TratamientoRESUMEN
Recent research indicated that the outcome of borderline patients is better than previously reported. We assessed the impact of co-morbid personality disorders (PD) on response to treatment and 1-year outcome among 206 borderline patients assigned to crisis intervention program. An overwhelming majority (89%) of borderline patients without supplementary Axis 11 psychopathology exhibited good to very good treatment response at acute treatment discharge as well as good to very good global outcome at 1-year followup (85%). Borderline patients meeting criteria for paranoid, schizotypal, antisocial, narcissistic and dependant personality disorder showed, contrarily, significantly more treatment failures.
Asunto(s)
Trastorno de Personalidad Limítrofe/terapia , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno de Personalidad Limítrofe/tratamiento farmacológico , Trastorno de Personalidad Limítrofe/epidemiología , Comorbilidad , Estudios de Seguimiento , Humanos , Pronóstico , Escalas de Valoración Psiquiátrica , Psicoterapia , Psicotrópicos/uso terapéutico , Resultado del TratamientoRESUMEN
To determine whether ambulatory psychotherapy targeted to abandonment experiences and fears can reduce suicidality and improve outcome in borderline patients referred to the emergency room with major depressive disorder and self-destructive behavior severe enough to require medical/surgical treatment and a brief psychiatric hospitalization. A total of 170 subjects were randomized at hospital discharge into three treatment groups: treatment as usual (TAU), abandonment psychotherapy delivered by certified psychotherapists, and abandonment psychotherapy delivered by nurses. Assessments were performed before randomization and at 3-month follow-up. Continued suicidality and other outcome measures were significantly worse in the treatment-as-usual as compared to both abandonment psychotherapy groups, but there were no differences between the two psychotherapy groups. These results suggest the efficacy of manualized psychotherapy that specifically targets the abandonment fears and experiences that are so common as precipitants to suicidal and self-destructive acts in borderline patients. It does not appear that formal psychotherapy training is associated with better outcomes.